Remembrance of Things Future: Prospective Memory in Laboratory, Workplace, and Everyday Settings

A break from pain! Interruption management in the context of pain

Activity interruptions, namely temporary suspensions of an ongoing task with the intention to resume it later, are common in pain. First, pain is a threat signal that urges us to interrupt ongoing activities in order to manage the pain and its cause. Second, activity interruptions are used in chronic pain management. However, activity interruptions by pain may carry costs for activity performance. These costs have recently started to be systematically investigated. We review the evidence on the consequences of activity interruptions by pain for the performance of the interrupted activity. Further, inspired by literature on interruptions from other research fields, we suggest ways to improve interruption management in the field of pain, and provide a future research agenda.

Test results management and distributed cognition in electronic health record-enabled primary care

Managing abnormal test results in primary care involves coordination across various settings. This study identifies how primary care teams manage test results in a large, computerized healthcare system in order to inform health information technology requirements for test results management and other distributed healthcare services. At five US Veterans Health Administration facilities, we interviewed 37 primary care team members, including 16 primary care providers, 12 registered nurses, and 9 licensed practical nurses. We performed content analysis using a distributed cognition approach, identifying patterns of information transmission across people and artifacts (e.g. electronic health records). Results illustrate challenges (e.g. information overload) as well as strategies used to overcome challenges. Various communication paths were used. Some team members served as intermediaries, processing information before relaying it. Artifacts were used as memory aids. Health information technology should address the risks of distributed work by supporting awareness of team and task status for reliable management of results.

Forgetting to remember? Prospective memory within the context of pain

BACKGROUND

Pain interferes with cognitive functioning in several ways. Among other symptoms, pain patients often report difficulties with remembering future intentions. It remains unclear, however, whether it is the pain per se that impairs prospective remembering or other factors that often characterize people with pain (e.g. poor sleep quality). In this experiment, we investigated whether prospective memory is impaired within the context of pain, and whether this impairment is enhanced when the threat value of pain is increased.

METHODS

Healthy participants engaged in an ongoing word categorization task, during which they received either experimental pain stimuli (with or without threatening instructions designed to increase the threat value of pain), or no pain stimuli (no somatic stimuli and no threatening instructions). Crucially, participants were also instructed to perform a prospective memory intention on future moments that would be signalled by specific retrieval cues.

RESULTS

Threatening instructions did not differentiate the pain groups in terms of pain threat value; therefore, we only focus on the difference between pain and no pain. Pain and no-pain groups performed the prospective memory intention with similar frequency, indicating that prospective memory is not necessarily impaired when the intended action has to be performed in a painful context.

CONCLUSIONS

Findings are discussed in the framework of the multiprocess theory of prospective memory, which differentiates between the spontaneous and the strategic retrieval of intentions. Methodological considerations and suggestions for future research are discussed.

SIGNIFICANCE

This laboratory study combines established methods from two research fields to investigate the effects of a painful context on memory for future intentions. Painful context did not impair performance of a prospective memory intention that is assumed to be retrieved by means of spontaneous processing.

The Status of the Strategic Task Overload Model (STOM) for Predicting Multi-Task Management

A model for task switching which focuses on the decision making of operators in overloaded multitask conditions is reviewed and new research presented. The STOM model is an ongoing effort and as such, work is now accumulating, which serves to validate the model as a useful predictive method, but also is uncovering uncertainties that require further investigation. Here we summarize the origins of the model, which was informed by past modeling efforts, a literature review and a meta-analysis. We then describe in detail the basic parameters of STOM and the current status of each, before discussing future directions and six uncertainties uncovered when building our understanding of task switching choice.

The effect of interruption on the decision-making process

Previous research has shown that interruptions can lead to delays and errors on the interrupted task. Such research, however, seldom considers whether interruptions cause a change in how information is processed. The central question of this research is to determine whether an interruption causes a processing change. We investigate this question in a decision-making paradigm well-suited for examining the decision-making process. Participants are asked to select from a set of risky gambles, each with multiple possible stochastic outcomes. The information gathering process is measured using a mouse-click paradigm. Consistent with past work, interruptions did incur a cost: An interruption increased the time and the amount of information needed to make a decision. Furthermore, after an interruption, participants did seem to partially “restart” the task. Importantly, however, there was no evidence that the information gathering pattern was changed by an interruption. There was also no overall cost to the interruption in terms of choice outcome. These results are consistent with the idea that participants recall a subset of pre-interruption information, which was then incorporated into post-interruption processing.

Time Sharing Between Robotics and Process Control: Validating a Model of Attention Switching

OBJECTIVE

The aim of this study was to validate the strategic task overload management (STOM) model that predicts task switching when concurrence is impossible.

BACKGROUND

The STOM model predicts that in overload, tasks will be switched to, to the extent that they are attractive on task attributes of high priority, interest, and salience and low difficulty. But more-difficult tasks are less likely to be switched away from once they are being performed.

METHOD

In Experiment 1, participants performed four tasks of the Multi-Attribute Task Battery and provided task-switching data to inform the role of difficulty and priority. In Experiment 2, participants concurrently performed an environmental control task and a robotic arm simulation. Workload was varied by automation of arm movement and both the phases of environmental control and existence of decision support for fault management. Attention to the two tasks was measured using a head tracker.

RESULTS

Experiment 1 revealed the lack of influence of task priority and confirmed the differing roles of task difficulty. In Experiment 2, the percentage attention allocation across the eight conditions was predicted by the STOM model when participants rated the four attributes. Model predictions were compared against empirical data and accounted for over 95% of variance in task allocation. More-difficult tasks were performed longer than easier tasks. Task priority does not influence allocation.

CONCLUSIONS

The multiattribute decision model provided a good fit to the data.

APPLICATIONS

The STOM model is useful for predicting cognitive tunneling given that human-in-the-loop simulation is time-consuming and expensive.

Effects of sleep restriction, sleep inertia, and overload on complex cognitive performance before and after workload transition

We describe performance models and meta-analytic data in a period before and after an unexpected workload transition typical, for example, of a catastrophic automation failure, experienced by a fatigued operator. We first present meta-analytic findings on the effects of sleep restriction and sleep inertia on the complex cognitive performance that might typify such a “failure response”. We then present a workload overload task management model whose parameters are based on meta-analyses, relevant to predicting multi-task performance in the post-transition phase performance (independent of sleep disruption effects). We cite the lack of research intersecting these two areas.

Applying Psychological Science to Examine Prospective Memory in Simulated Air Traffic Control

Failures to remember to perform deferred task actions in work settings such as air traffic control can have serious consequences. Most research examining the cognitive mechanisms underlying prospective memory has used simple, static tasks, which may make it difficult to generalize results to work settings. I describe a body of research that has applied theory and methods from the basic prospective-memory and attention-capture literatures to simulations of air traffic control. These theories and methods can be used to anticipate many findings, such as the finding that prospective-memory demands incur performance costs in ongoing air traffic control tasks, and that prospective-memory error and costs to ongoing air traffic control tasks can be reduced by the use of spatial context or prospective-memory aids. Research in laboratory settings that simulates work contexts such as air traffic control can both establish the utility of psychological theory and produce application-relevant information.

Emergency medical equipment storage: benefits of visual cues tested in field and simulated settings

OBJECTIVE

We tested the effectiveness of an illustrated divider ("the divider") for bedside emergency equipment drawers in an intensive care unit (ICU). In Study I, we assessed whether the divider increases completeness and standardizes the locations of emergency equipment within the drawer. In Study 2, we investigated whether the divider decreases nurses' restocking and retrieval times and decreases their workload.

BACKGROUND

Easy access to fully stocked emergency equipment is important during emergencies. However, inefficient equipment storage and cognitively demanding work settings might mean that drawers are incompletely stocked and access to items is slow.

METHOD

A pre-post-post study investigated drawer completeness and item locations before and after the introduction of the divider to 30 ICU drawers. A subsequent experiment measured item restocking time, item retrieval time, and subjective workload for nurses.

RESULTS

At 2 weeks and 10 weeks after the divider was introduced, the completeness of the drawer increased significantly compared with before the divider was introduced. The divider decreased the variability of the locations of the 17 items in the drawer to 16% of its original value. Study 2 showed that restocking times but not retrieval times were significantly faster with the divider present For both tasks, nurses rated their workload lower with the divider.

CONCLUSIONS

The divider improved the standardization and completeness of emergency equipment. In addition, restocking times and workload were decreased with the divider.

APPLICATION

Redesigning storage for certain equipment using human factors design principles can help to speed and standardize restocking and ease access to equipment.

Modelos Explicativos da Memória Prospectiva: Uma Revisão Teórica

Neste artigo é apresentada uma revisão da literatura sobre os mecanismos cognitivos associados à memória prospectiva, organizados de acordo com a divisão das diferentes fases da recordação prospectiva (i.e., codificação, retenção e recuperação). Inicialmente, é apresentada a diversidade de dados da investigação que sustentam diferentes abordagens explicativas do fenômeno de recuperação de intenções, considerando a natureza automática ou estratégica da memória prospectiva. Em seguida, são salientadas as potenciais explicações sobre os mecanismos presentes durante o intervalo de retenção e na fase de codificação.

Prospective Memory in Complex Sociotechnical Systems

An important cognitive function is the ability to remember to execute future tasks, a capability known as prospective memory (PM). Workers in complex sociotechnical systems such as healthcare and aviation face many PM challenges and forgetting tasks can have severe consequences. Although researchers have made progress in understanding how individuals remember future tasks, system-level support for PM has seldom been addressed. In the present paper, we briefly review PM research in healthcare and aviation, focusing on naturalistic studies using expert workers, and we present the concept of distributed prospective memory, which incorporates the interaction between the environment and the individual when future tasks must be remembered. PM in sociotechnical settings is a complex process involving human and nonhuman agents. Therefore, a systems approach is needed to fully understand PM processes, thus supporting workers and eventually minimizing errors and increasing safety.

A Computational Model of Task Overload Management and Task Switching

We describe a computational model that predicts the decision aspect of sequential multitasking. We investigate how people choose to switch tasks or continue performing an ongoing task when they are in overload conditions where concurrent performance of tasks is impossible. The model is based on a metaanalytic integration of 46 experiments from two literatures: interruption management and applied task switching. Consistent trends from the meta-analysis are used to set parameters in the mathematical model, which is then implemented in a task network model.

Developing software to "track and catch" missed follow-up of abnormal test results in a complex sociotechnical environment

BACKGROUND

Abnormal test results do not always receive timely follow-up, even when providers are notified through electronic health record (EHR)-based alerts. High workload, alert fatigue, and other demands on attention disrupt a provider's prospective memory for tasks required to initiate follow-up. Thus, EHR-based tracking and reminding functionalities are needed to improve follow-up.

OBJECTIVES

The purpose of this study was to develop a decision-support software prototype enabling individual and system-wide tracking of abnormal test result alerts lacking follow-up, and to conduct formative evaluations, including usability testing.

METHODS

We developed a working prototype software system, the Alert Watch And Response Engine (AWARE), to detect abnormal test result alerts lacking documented follow-up, and to present context-specific reminders to providers. Development and testing took place within the VA's EHR and focused on four cancer-related abnormal test results. Design concepts emphasized mitigating the effects of high workload and alert fatigue while being minimally intrusive. We conducted a multifaceted formative evaluation of the software, addressing fit within the larger socio-technical system. Evaluations included usability testing with the prototype and interview questions about organizational and workflow factors. Participants included 23 physicians, 9 clinical information technology specialists, and 8 quality/safety managers.

RESULTS

Evaluation results indicated that our software prototype fit within the technical environment and clinical workflow, and physicians were able to use it successfully. Quality/safety managers reported that the tool would be useful in future quality assurance activities to detect patients who lack documented follow-up. Additionally, we successfully installed the software on the local facility's "test" EHR system, thus demonstrating technical compatibility.

CONCLUSION

To address the factors involved in missed test results, we developed a software prototype to account for technical, usability, organizational, and workflow needs. Our evaluation has shown the feasibility of the prototype as a means of facilitating better follow-up for cancer-related abnormal test results.

Wait a second: Brief delays in responding reduce focality effects in event-based prospective memory

Remembering to perform deferred actions when an event is encountered in the future is referred to as event-based prospective memory (PM). We examined whether the failure of individuals to allocate sufficient attentional resources to nonfocal PM tasks can be linked to the response demands inherent in PM paradigms that require the PM task to race for response selection with the speeded ongoing task. In three experiments, participants performed a lexical decision task while being required to make a separate PM response to a specific word (focal), an exemplar of a category (nonfocal), or a syllable (nonfocal). We manipulated the earliest time participants could make task responses by presenting a tone at varying onsets (0–1,600 ms) following stimulus presentation. Improvements in focal PM and nonfocal PM were observed at response delays as brief as 200 ms and 400 ms, respectively. Nonfocal PM accuracy was comparable to focal PM accuracy at delays of 600 ms and 1,600 ms for categorical targets and syllable targets, respectively. Delaying task responses freed the resource-demanding processing operations used on the ongoing task for use on the nonfocal PM task, increasing the probability that the nonfocal PM features of ongoing task stimuli were adequately assessed prior to the ongoing task response.

Prospective memory in the ICU: the effect of visual cues on task execution in a representative simulation

Despite the potential dangers of clinical tasks being forgotten, few researchers have investigated prospective memory (PM) - the ability to remember to execute future tasks - in health-care contexts. Visual cues help people remember to execute intentions at the appropriate moment. Using an intensive care unit simulator, we investigated whether nurses' memory for future tasks improves when visual cues are present, and how nurses manage PM demands. Twenty-four nurses participated in a 40-minute scenario simulating the start of a morning shift. The scenario included eight PM tasks. The presence or absence of a visually conspicuous cue for each task was manipulated. The presence of a visual cue improved recall compared to no cue (64% vs. 50%, p = 0.03 one-tailed, η(p)(2) = 0.15). Nurses used deliberate reminders to manage their PM demands. PM in critical care might be supported by increasing the visibility of cues related to tasks.

PRACTITIONER SUMMARY

Nurses must remember to execute multiple future tasks to ensure patient safety. We investigated the effect of visual cues on nurses' ability to remember future tasks. Experimental manipulation of cues in a representative intensive care unit simulation indicated that visual cues increase the likelihood that future tasks are executed.

Primary care practitioners' views on test result management in EHR-enabled health systems: a national survey

Context

Failure to notify patients of test results is common even when electronic health records (EHRs) are used to report results to practitioners. We sought to understand the broad range of social and technical factors that affect test result management in an integrated EHR-based health system.

Methods

Between June and November 2010, we conducted a cross-sectional, web-based survey of all primary care practitioners (PCPs) within the Department of Veterans Affairs nationwide. Survey development was guided by a socio-technical model describing multiple inter-related dimensions of EHR use.

Findings

Of 5001 PCPs invited, 2590 (51.8%) responded. 55.5% believed that the EHRs did not have convenient features for notifying patients of test results. Over a third (37.9%) reported having staff support needed for notifying patients of test results. Many relied on the patient's next visit to notify them for normal (46.1%) and abnormal results (20.1%). Only 45.7% reported receiving adequate training on using the EHR notification system and 35.1% reported having an assigned contact for technical assistance with the EHR; most received help from colleagues (60.4%). A majority (85.6%) stayed after hours or came in on weekends to address notifications; less than a third reported receiving protected time (30.1%). PCPs strongly endorsed several new features to improve test result management, including better tracking and visualization of result notifications.

Conclusions

Despite an advanced EHR, both social and technical challenges exist in ensuring notification of test results to practitioners and patients. Current EHR technology requires significant improvement in order to avoid similar challenges elsewhere.

Prospective Memory in Workplace and Everyday Situations

Forgetting to perform intended actions can have major consequences, including loss of life in some situations. Laboratory research on prospective memory—remembering (and sometimes forgetting) to perform deferred intentions—is growing rapidly, thanks to new laboratory paradigms that are being used to uncover underlying cognitive mechanisms. Everyday situations and workplace situations in fields such as aviation and medicine, which have been studied less extensively, reveal aspects of prospective remembering that have both practical and theoretical implications, which are discussed here. Several types of situations in which individuals are vulnerable to forgetting intentions, but which have not been studied extensively in laboratory research, are described, and ways to reduce vulnerability to forgetting are suggested.