Cognitive biases, environmental, patient and personal factors associated with critical care decision making: A scoping review
Open accessAbstract
PURPOSE: Cognitive biases and factors affecting decision making in critical care can potentially lead to life-threatening errors. We aimed to examine the existing evidence on the influence of cognitive biases and factors on decision making in critical care. MATERIALS AND METHODS: We conducted a scoping review by searching MEDLINE for articles from 2004 to November 2020. We included studies conducted in physicians that described cognitive biases or factors associated with decision making. During the study process we decided on the method to summarize the evidence, and based on the obtained studies a descriptive summary of findings was the best fit. RESULTS: Thirty heterogenous studies were included. Four main biases or factors were observed, e.g. cognitive biases, personal factors, environmental factors, and patient factors. Six (20%) studies reported biases associated with decision making comprising omission-, status quo-, implicit-, explicit-, outcome-, and overconfidence bias. Nineteen (63%) studies described personal factors, twenty-two (73%) studies described environmental factors, and sixteen (53%) studies described patient factors. CONCLUSIONS: The current evidence on cognitive biases and factors is heterogenous, but shows they influence clinical decision. Future studies should investigate the prevalence of cognitive biases and factors in clinical practice and their impact on clinical outcomes.
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These biases stem from innate psychological tendencies and can potentially lead to misjudgments and suboptimal outcomes in patient care.
“These biases stem from innate psychological tendencies and can potentially lead to misjudgments and suboptimal outcomes in patient care [2-4].”
From Mitigating cognitive biases in clinical decision-making through multi-agent conversations using large language models: simulation study (2024) · cites this paper as [4]
The Introduction (page unavailable) says heuristics can give rise to cognitive biases that lead to errors in judgment, diagnostic inaccuracies and medical errors. It does not say those tendencies are innate, so that part of the claim is unsupported. (LLM, conf=0.85)
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“These biases stem from innate psychological tendencies and can potentially lead to misjudgments and suboptimal outcomes in patient care [2-4].”
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- Authors
- Beldhuis, I. E., Marapin, R. S., Jiang, Y. Y., Simões de Souza, N. F., Georgiou, A., Kaufmann, T., Castela Forte, J., & van der Horst, I. C. C.
- Affiliations
- University Medical Center Groningen (NL)
- Corresponding author
- Beldhuis, Iris E.
- Venue
- Journal of Critical Care
- Publisher
- Elsevier BV
- Published
- 2021-08
- Volume
- 64
- Pages
- 144-153
- ISSN
- 0883-9441 (ISSN-L)
- OpenAlex
- W3155782813
- Cited by
- 58
- References
- 57
- Citations by year
- 2026: 18 · 2025: 18 · 2024: 7 · 2023: 7 · 2022: 4 · 2021: 4
- FWCI
- 1.32
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Critical Care (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, cc-by)
- Research Publications (Maastricht University) (submittedVersion, cc-by)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Funders
- Rijksuniversiteit Groningen
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
- Keywords
- cognitive biases, clinical decision-making, intensive care, omission bias, status quo bias, implicit bias, overconfidence, outcome bias, environmental factors, patient factors, personal factors, medical errors, physician decision-making
- MeSH terms
- Cognition, Critical Care, Decision Making, Humans, Physicians, Bias
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