Manigault Andrew Wilhelm, Handley Ian Michael, Whillock Summer Rain
Montana State University, Department of Psychology, Bozeman, MT, United States.
J Med Internet Res. 2015 Feb 5;17(2):e37. doi: 10.2196/jmir.3739.
To improve patient health, recent research urges for medical decision aids that are designed to enhance the effectiveness of specific medically related decisions. Many such decisions involve complex information, and decision aids that independently use deliberative (analytical and slower) or intuitive (more affective and automatic) cognitive processes for such decisions result in suboptimal decisions. Unconscious thought can arguably use both intuitive and deliberative (slow and analytic) processes, and this combination may further benefit complex patient (or practitioner) decisions as medical decision aids. Indeed, mounting research demonstrates that individuals render better decisions generally if they are distracted from thinking consciously about complex information after it is presented (but can think unconsciously), relative to thinking about that information consciously or not at all.
The current research tested whether the benefits of unconscious thought processes can be replicated using an Internet platform for a patient medical decision involving complex information. This research also explored the possibility that judgments reported after a period of unconscious thought are actually the result of a short period of conscious deliberation occurring during the decision report phase.
A total of 173 participants in a Web-based experiment received information about four medical treatments, the best (worst) associated with mostly positive (negative) side-effects/attributes and the others with equal positive-negative ratios. Next, participants were either distracted for 3 minutes (unconscious thought), instructed to think about the information for 3 minutes (conscious thought), or moved directly to the decision task (immediate decision). Finally, participants reported their choice of, and attitudes toward, the treatments while experiencing high, low, or no cognitive load, which varied their ability to think consciously while reporting judgments. Cognitive load was manipulated by having participants memorize semi-random (high), line structured (low), or no dot patterns and recall these intermittently with their decision reports. Overall then, participants were randomly assigned to the conditions of a 3 (thought condition) by 3 (cognitive-load level) between-subjects design.
A logistic regression analysis indicated that the odds of participants choosing the best treatment were 2.25 times higher in the unconscious-thought condition compared to the immediate-decision condition (b=.81, Wald=4.32, P=.04, 95% CI 1.048-4.836), and 2.39 times greater compared to the conscious-thought condition (b=.87, Wald=4.87, P=.027, 95% CI 1.103-5.186). No difference was observed between the conscious-thought condition compared to the immediate-decision condition, and cognitive load manipulations did not affect choices or alter the above finding.
This research demonstrates a plausible benefit of unconscious thinking as a decision aid for complex medical decisions, and represents the first use of unconscious thought processes as a patient-centered medical decision aid. Further, the quality of decisions reached unconsciously does not appear to be affected by the amount of cognitive load participants experienced.
为改善患者健康状况，近期研究呼吁开发旨在提高特定医疗相关决策有效性的医疗决策辅助工具。许多此类决策涉及复杂信息，而独立使用审慎（分析性且较慢）或直觉（更具情感性且自动）认知过程进行此类决策的决策辅助工具会导致决策效果欠佳。可以说，无意识思维能够同时运用直觉和审慎（缓慢且分析性）过程，这种结合可能会进一步有益于复杂的患者（或从业者）决策，作为医疗决策辅助工具。事实上，越来越多的研究表明，相较于有意识地思考复杂信息或根本不思考，个体在呈现复杂信息后被分散注意力而进行无意识思考时，通常能做出更好的决策。
当前研究测试了是否可以通过互联网平台，针对涉及复杂信息的患者医疗决策，复制无意识思维过程的益处。本研究还探讨了在经过一段时间的无意识思考后报告的判断实际上是在决策报告阶段发生的短时间有意识思考的结果这一可能性。
在一项基于网络的实验中，共有173名参与者收到了关于四种医疗治疗方法的信息，其中最佳（最差）治疗方法大多与积极（消极）副作用/属性相关，其他治疗方法的正负比例相等。接下来，参与者要么被分散注意力3分钟（无意识思考），被指示思考信息3分钟（有意识思考），要么直接进入决策任务（立即决策）。最后，参与者在经历高、低或无认知负荷的情况下报告他们对治疗方法的选择和态度，这会改变他们在报告判断时进行有意识思考的能力。通过让参与者记忆半随机（高）、线性结构（低）或无点阵模式，并在决策报告时间歇性地回忆这些模式来操纵认知负荷。总体而言，参与者被随机分配到一个3（思维条件）×3（认知负荷水平）的组间设计条件中。
逻辑回归分析表明，与立即决策条件相比，在无意识思考条件下参与者选择最佳治疗方法的几率高出2.25倍（b = 0.81，Wald = 4.32，P = 0.04，95% CI 1.048 - 4.836），与有意识思考条件相比高出2.39倍（b = 0.87，Wald = 4.87，P = 0.027，95% CI 1.103 - 5.186）。有意识思考条件与立即决策条件之间未观察到差异，并且认知负荷操纵并未影响选择或改变上述结果。
本研究证明了无意识思维作为复杂医疗决策辅助工具的一种合理益处，并且代表了首次将无意识思维过程用作以患者为中心的医疗决策辅助工具。此外，无意识做出的决策质量似乎不受参与者所经历的认知负荷量的影响。
