Evidence‐informed person‐centered healthcare part I: Do 'cognitive biases plus' at organizational levels influence quality of evidence?. Issue 6 (28th November 2014)

• Record Type: Journal Article
• Authors: Seshia, Shashi S.; Makhinson, Michael; Phillips, Dawn F.; Young, G. Bryan
• Is Part Of: Journal of evaluation in clinical practice. Volume 20:Issue 6(2014)
• Page Start: 734
• Page End: 747
• Publication Date: 2014-11-28
• Subjects: Clinical medicine -- Periodicals; 616.005
• DOI: 10.1111/jep.12280
• Languages: English
• ISSNs: 1356-1294

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="jep12280-sec-0001" sec-type="section"> <title>Introduction</title> <p>There is increasing concern about the unreliability of much of health care evidence, especially in its application to individuals.</p> </sec> <sec id="jep12280-sec-0002" sec-type="section"> <title>Hypothesis</title> <p>Cognitive biases, financial and non‐financial conflicts of interest, and ethical violations (which, together with fallacies, we collectively refer to as 'cognitive biases plus') at the levels of individuals and organizations involved in health care undermine the evidence that informs person‐centred care.</p> </sec> <sec id="jep12280-sec-0003" sec-type="section"> <title>Methods</title> <p>This study used qualitative review of the pertinent literature from basic, medical and social sciences, ethics, philosophy, law etc.</p> </sec> <sec id="jep12280-sec-0004" sec-type="section"> <title>Results</title> <p>Financial conflicts of interest (primarily industry related) have become systemic in several organizations that influence health care evidence. There is also plausible evidence for non‐financial conflicts of interest, especially in academic organizations. Financial and non‐financial conflicts of interest frequently result in self‐serving bias. Self‐serving bias can lead to self‐deception and rationalization of actions that entrench self‐serving behaviour, both potentially resulting in unethical acts. Individuals and organizations are also susceptible to other cognitive biases. Qualitative evidence suggests that 'cognitive biases plus' can erode the quality of evidence.</p> </sec> <sec id="jep12280-sec-0005" sec-type="section"> <title>Conclusions</title> <p>'Cognitive biases plus' are hard wired, primarily at the unconscious level, and the resulting behaviours are not easily corrected. Social behavioural researchers advocate multi‐pronged measures in similar situations: (i) abolish incentives that spawn self‐serving bias; (ii) enforce severe deterrents for breaches of conduct; (iii) value integrity; (iv) strengthen self‐awareness; and (v) design curricula especially at the trainee level to promote awareness of consequences to society. Virtuous professionals and organizations are essential to fulfil the vision for high‐quality individualized health care globally.</p> </sec> </abstract>