Center for Evidence-based Medicine and Health Outcomes Research, Tampa, FL, USA.
BMC Med Inform Decis Mak. 2012 Sep 3;12:94. doi: 10.1186/1472-6947-12-94.
Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I) and/or an analytical, deliberative (system II) processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administered to the patient who may or may not have a disease.
We developed a mathematical model in which we linked a recently proposed descriptive psychological model of cognition with the threshold model of medical decision-making and show how this approach can be used to better understand decision-making at the bedside and explain the widespread variation in treatments observed in clinical practice.
We show that physician's beliefs about whether to treat at higher (lower) probability levels compared to the prescriptive therapeutic thresholds obtained via system II processing is moderated by system I and the ratio of benefit and harms as evaluated by both system I and II. Under some conditions, the system I decision maker's threshold may dramatically drop below the expected utility threshold derived by system II. This can explain the overtreatment often seen in the contemporary practice. The opposite can also occur as in the situations where empirical evidence is considered unreliable, or when cognitive processes of decision-makers are biased through recent experience: the threshold will increase relative to the normative threshold value derived via system II using expected utility threshold. This inclination for the higher diagnostic certainty may, in turn, explain undertreatment that is also documented in the current medical practice.
We have developed the first dual processing model of medical decision-making that has potential to enrich the current medical decision-making field, which is still to the large extent dominated by expected utility theory. The model also provides a platform for reconciling two groups of competing dual processing theories (parallel competitive with default-interventionalist theories).
人类认知的双重加工理论假定，推理和决策可以描述为直觉、经验、情感系统（系统 I）和/或分析、审慎（系统 II）加工系统的函数。迄今为止，尚未基于双重加工理论开发出正式的医学决策描述模型。在这里，我们假设了这样一个模型，并将其应用于一个常见的临床情况：是否应该对可能患有或可能没有疾病的患者进行治疗。
我们开发了一个数学模型，将最近提出的认知描述性心理模型与医学决策的阈值模型联系起来，并展示了如何使用这种方法更好地理解床边决策，并解释在临床实践中观察到的广泛的治疗差异。
我们表明，与通过系统 II 处理获得的规定治疗阈值相比，医生对是否在较高（较低）概率水平进行治疗的信念受到系统 I 和系统 I 和 II 评估的收益和危害比值的调节。在某些条件下，系统 I 决策者的阈值可能会大幅低于系统 II 推导出的预期效用阈值。这可以解释当代实践中经常出现的过度治疗现象。相反的情况也可能发生，例如当经验证据被认为不可靠时，或者当决策者的认知过程因近期经验而出现偏差时：相对于通过系统 II 使用预期效用阈值推导出的规范阈值，阈值会增加。这种对更高诊断确定性的倾向可能反过来解释了当前医学实践中也有记录的治疗不足。
我们开发了第一个医学决策的双重加工模型，该模型有可能丰富当前在很大程度上仍由预期效用理论主导的医学决策领域。该模型还为调和两种相互竞争的双重加工理论（平行竞争与默认干预理论）提供了一个平台。
