Information order effects in clinical psychological diagnoses

Diagnostic error in mental health: a review

Diagnostic errors are associated with patient harm and suboptimal outcomes. Despite national scientific efforts to advance definition, measurement and interventions for diagnostic error, diagnosis in mental health is not well represented in this ongoing work. We aimed to summarise the current state of research on diagnostic errors in mental health and identify opportunities to align future research with the emerging science of diagnostic safety. We review conceptual considerations for defining and measuring diagnostic error, the application of these concepts to mental health settings, and the methods and subject matter focus of recent studies of diagnostic error in mental health. We found that diagnostic error is well understood to be a problem in mental healthcare. Although few studies used clear definitions or frameworks for understanding diagnostic error in mental health, several studies of missed, wrong, delayed and disparate diagnosis of common mental disorders have identified various avenues for future research and development. Nevertheless, a lack of clear consensus on how to conceptualise, define and measure errors in diagnosis will pose a barrier to advancement. Further research should focus on identifying preventable missed opportunities in the diagnosis of mental disorders, which may uncover generalisable opportunities for improvement.

The effects of base rate neglect on sequential belief updating and real-world beliefs

Base-rate neglect is a pervasive bias in judgment that is conceptualized as underweighting of prior information and can have serious consequences in real-world scenarios. This bias is thought to reflect variability in inferential processes but empirical support for a cohesive theory of base-rate neglect with sufficient explanatory power to account for longer-term and real-world beliefs is lacking. A Bayesian formalization of base-rate neglect in the context of sequential belief updating predicts that belief trajectories should exhibit dynamic patterns of dependence on the order in which evidence is presented and its consistency with prior beliefs. To test this, we developed a novel 'urn-and-beads' task that systematically manipulated the order of colored bead sequences and elicited beliefs via an incentive-compatible procedure. Our results in two independent online studies confirmed the predictions of the sequential base-rate neglect model: people exhibited beliefs that are more influenced by recent evidence and by evidence inconsistent with prior beliefs. We further found support for a noisy-sampling inference model whereby base-rate neglect results from rational discounting of noisy internal representations of prior beliefs. Finally, we found that model-derived indices of base-rate neglect-including noisier prior representation-correlated with propensity for unusual beliefs outside the laboratory. Our work supports the relevance of Bayesian accounts of sequential base-rate neglect to real-world beliefs and hints at strategies to minimize deleterious consequences of this pervasive bias.

Identifying effective cognitive biases in information retrieval

The purpose of this study is to identify the types of cognitive biases in the process of information retrieval. This research used a mixed-method approach for data collection. The research population consisted of 25 information retrieval specialists and 30 post-graduate students. We employed three tools for collecting data, including a checklist, log files and semi-structured interviews. The findings showed that from the perspective of information retrieval specialists, the cognitive biases such as ‘Familiarity’, ‘Anchoring’, ‘Rush to solve’ and ‘Curse of knowledge’ could be of the greatest importance in the field of information retrieval. Also, in terms of users’ searching, the ‘Rush to solve problems’ and ‘Mere exposure effects’ biases have the highest frequency, and the ‘Outcome’ and ‘Curse of knowledge’ biases have the lowest frequency in the process of user retrieval information. It can be concluded that, because cognitive biases occurring in information retrieval, designers of information retrieval systems and librarians should pay attention to this issue in designing and evaluating information systems.

Psychometric properties of the German version of the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) in clinical routine settings: study design and protocol of a multitrait-multimethod study

INTRODUCTION

The aim of this study is to investigate the diagnostic accuracy, psychometric properties and clinical utility of the German version of the Clinician-Administered Post-Traumatic Stress Disorder (PTSD) Scale for Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) (CAPS-5) in routine clinical settings.

METHODS AND ANALYSIS

This study is a non-interventional, multitrait-multimethod design, multicentre study that will be carried out at German civil and military inpatient and outpatient clinics. A total sample size of n=219 participants who have experienced at least one traumatic event according to criteria as defined in the DSM-5 will be recruited. For the investigation of the diagnostic accuracy and clinical utility of the CAPS-5, participants will be categorised into one of three groups, depending on their traumatic experiences and post-traumatic symptomatology: (1) monotraumatisation with PTSD; (2) multiple traumatisation with PTSD and (3) traumatisation without PTSD. Interviews will be conducted face to face by interviewers in routine clinical settings. All participants will also be asked to complete a comprehensive set of questionnaires in order to investigate different facets of construct validity and clinical utility. First, differences between all three groups in CAPS-5 sum and subscale scores will be investigated. Test-retest reliability and inter-rater reliability will be determined. Internal consistency will be calculated using structural equation modeling (SEM) based internal consistency coefficients. Construct validity will be measured with Spearman's rank correlation analyses and multivariate analyses of variance with Holm-Bonferroni corrected post hoc analysis of variances. In order to test diagnostic accuracy, receiver operating characteristics and sensitivity and specificity analyses will be conducted. The model structure of the German CAPS-5 will be analysed using confirmatory factor analyses.

ETHICS AND DISSEMINATION

The study received ethical approval by the Ethics Committees of the Faculty of Psychology at the Ruhr-Universität Bochum (reference numbers: 331 and 358). The results of the study will be presented nationally and internationally at scientific conferences and will be published in scientific journals.

TRIAL REGISTRATION NUMBER

DRKS00015325.

Evaluating Information Quality of Revised Patient Education Information on Colonoscopy: It Is New But Is It Improved?

BACKGROUND

Previous research indicates that patients and their families have many questions about colonoscopy that are not fully answered by existing resources. We developed revised forms on colonoscopy bowel preparation and on the procedure itself.

OBJECTIVE

As the goal of the revised materials is to have improved information relative to currently available information, we were interested in how revised information compared with what is currently available in terms of information quality and patient preference.

METHODS

Participants were asked to review one at a time the Revised and Current versions of Colonoscopy bowel preparation instructions (study 1) and About Colonoscopy (study 2). The order of administration of the Revised and Current versions was randomly counterbalanced to assess order effects. Respondents rated each form along the following dimensions: amount, clarity, trustworthiness, readability and understandability, how new or familiar the information was, and reassurance. Participants were asked which form they preferred and 4 questions about why they preferred it. Open-ended questions asked participants to describe likes and dislikes of the forms and suggestions for improvement.

RESULTS

The study 1 and study 2 samples were similar. Overall, in study 1, 62.4% preferred the Revised form, 28.1% preferred the Current form, and 6.7% were not sure. Overall, in study 2, 50.5% preferred the Revised form, 31.1% preferred the Current form, and 18.4% were not sure. Almost 75% of those in study 1 who received the Revised form first, preferred it, compared with less than half of those who received it first in study 2. In study 1, 75% of those without previous colonoscopy experience preferred the Revised form, compared with more than half of those who had previously undergone a colonoscopy. The study 1 logistic regression analysis demonstrated that participants were more likely to prefer the Revised form if they had viewed it first and had no previous experience with colonoscopy. In study 2, none of the variables assessed were associated with a preference for the Revised form. In comparing the 2 forms head-to-head, participants who preferred the Revised form in study 1 rated it as clearer compared with those who preferred the Current form. Finally, many participants who preferred the Revised form indicated in the open-ended questions that they liked it because it had more information than the Current form and that it had good visual information.

CONCLUSIONS

This study is one of the first to evaluate 2 different patient education resources in a head-to-head comparison using the same participants in a within-subjects design. This approach was useful in comparing revised educational information with current resources. Moving forward, this knowledge translation approach of a head-to-head comparison of 2 different information sources could be taken to develop and refine information sources on other health issues.

Survey of patients of the Tver region of Russia regarding maggots and maggot therapy

The 21st century is seeing a resurgence in the use of maggot therapy-using the physical and biochemical benefits of fly larvae to debride and heal chronic, problematic wounds. Maggots are repulsive to many people, and this could interfere with the acceptance of this modality. Before instituting a maggot therapy programme at our institution, we sought to better understand the psychological barriers that may exist among patients in the Tver region of Russia. Between 2014 and 2016, all patients with arterial insufficiency and trophic ulcers at City Clinical Hospital No. 7 in Tver were administered a survey consisting of six images. Subjects were asked to rank the images in the order of least to most repulsive or disgusting. A total of 576 subjects were recruited for this study: 414 (72%) women and 162 (28%) men. Nearly 60% of subjects considered the images of maggots to be more repulsive than images of gangrenous wounds. This finding is significant because it indicates that much education and support will need to be conducted to address patient fears and anxiety if patients are to be comfortable with a maggot therapy programme.

Blinding or information control in diagnosis: could it reduce errors in clinical decision-making?

Background Clinical medicine has long recognized the potential for cognitive bias in the development of new treatments, and in response developed a tradition of blinding both clinicians and patients to address this specific concern. Although cognitive biases have been shown to exist which impact the accuracy of clinical diagnosis, blinding the diagnostician to potentially misleading information has received little attention as a possible solution. Recently, within the forensic sciences, the control of contextual information (i.e. information apart from the objective test results) has been studied as a technique to reduce errors. We consider the applicability of this technique to clinical medicine. Content This article briefly describes the empirical research examining cognitive biases arising from context which impact clinical diagnosis. We then review the recent awakening of forensic sciences to the serious effects of misleading information. Comparing the approaches, we discuss whether blinding to contextual information might (and in what circumstances) reduce clinical errors. Summary and outlook Substantial research indicates contextual information plays a significant role in diagnostic error and conclusions across several medical specialties. The forensic sciences may provide a useful model for the control of potentially misleading information in diagnosis. A conceptual analog of the forensic blinding process (the "agnostic" first reading) may be applicable to diagnostic investigations such as imaging, microscopic tissue examinations and waveform recognition. An "agnostic" approach, where the first reading occurs with minimal clinical referral information, but is followed by incorporation of the clinical history and reinterpretation, has the potential to reduce errors.

Strukturierte klinische Interviews zur Erfassung psychischer Störungen über die Lebensspanne

Zusammenfassung. Psychische Störungen können über die ganze Lebensspanne auftreten. Strukturierte klinische Interviews sind zentrale Hilfsmittel für ihre rasche, zuverlässige und umfassende Diagnostik. Im deutschsprachigen Raum stehen mit den Verfahren der DIPS-Familie Interviews zur Diagnostik psychischer Störungen über die gesamte Lebensspanne zur Verfügung, die seit den 90er Jahren regelmäßig aktualisiert wurden. Ihre Reliabilität, Validität und Akzeptanz wurde wiederholt in großen Stichproben aus ambulanten, stationären und Forschungssettings überprüft. Die Einführung des DSM-5 erforderte eine umfassende Überarbeitung der DIPS-Interviews, deren wesentliche Merkmale dargestellt werden. Um die breitere Verwendung von strukturierten klinischen Interviews zu fördern, werden die Verfahren der DIPS-Familie neu als „Open Access-Dokumente“ zur Verfügung gestellt. Abschließend werden weitere Entwicklungen zu Training, Dissemination und Computerisierung im Ausblick angesprochen.