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Cited by 160Decision-Making and Behavioral EconomicsHealth Sciences Research and EducationHealth Policy Implementation Science

Rationality versus reality: the challenges of evidence-based decision making for health policy makers

Open access
McCaughey, Deirdre, Bruning, Nealia S·2010·Implementation Science
DOI 10.1186/1748-5908-5-39PMC PMC2885987
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Abstract

BACKGROUND: Current healthcare systems have extended the evidence-based medicine (EBM) approach to health policy and delivery decisions, such as access-to-care, healthcare funding and health program continuance, through attempts to integrate valid and reliable evidence into the decision making process. These policy decisions have major impacts on society and have high personal and financial costs associated with those decisions. Decision models such as these function under a shared assumption of rational choice and utility maximization in the decision-making process. DISCUSSION: We contend that health policy decision makers are generally unable to attain the basic goals of evidence-based decision making (EBDM) and evidence-based policy making (EBPM) because humans make decisions with their naturally limited, faulty, and biased decision-making processes. A cognitive information processing framework is presented to support this argument, and subtle cognitive processing mechanisms are introduced to support the focal thesis: health policy makers' decisions are influenced by the subjective manner in which they individually process decision-relevant information rather than on the objective merits of the evidence alone. As such, subsequent health policy decisions do not necessarily achieve the goals of evidence-based policy making, such as maximizing health outcomes for society based on valid and reliable research evidence. SUMMARY: In this era of increasing adoption of evidence-based healthcare models, the rational choice, utility maximizing assumptions in EBDM and EBPM, must be critically evaluated to ensure effective and high-quality health policy decisions. The cognitive information processing framework presented here will aid health policy decision makers by identifying how their decisions might be subtly influenced by non-rational factors. In this paper, we identify some of the biases and potential intervention points and provide some initial suggestions about how the EBDM/EBPM process can be improved.

AI snapshot

Written from the paper’s full text.

TL;DR

This conceptual paper argues that evidence-based decision making (EBDM) and evidence-based policy making (EBPM) rest on rational-choice assumptions that are undermined by limited, biased cognitive information processing. It presents a cognitive framework in which decision maker utility, affect, and heuristics subtly shape how health policy makers interpret and use evidence.

Key findings

  • The paper argues that health policy makers generally cannot meet EBDM/EBPM’s rational goals because decision making is influenced by subjective cognitive processing rather than objective evidence alone; bounded rationality and “satisficing” lead decision makers to choose alternatives that meet minimum criteria rather than optimize.
  • It identifies three major cognitively generated influences on evidence processing: decision maker utility, affect, and heuristics (availability, representativeness, and anchoring and adjustment).
  • It offers propositions: policy decisions may reflect individual rather than societal utility and are more likely supported when linked to decision makers’ experience (1a, 1b); trait affect influences risk tolerance and uncertainty in supporting policies (2); and policy makers facing difficult information will use available relevant heuristics to support a policy (3).
  • As context, the paper reports 2008 US national health expenditures of $2.3 trillion, or $7,681 per person, accounting for 16.2% of GDP, projected to reach 19.3% of GDP by 2019, approximately $4.5 trillion.

Methods

  • Design: conceptual/theoretical paper, not an empirical study; it synthesizes decision-making and policy literature and presents a cognitive information processing framework based on Wyer and Srull.
  • Data or sample: no empirical data, sample, or formal analysis are reported.
  • Main analysis: narrative development of a framework and propositions linking utility, affect, and heuristics to health policy decision making, followed by suggested improvements for EBDM/EBPM.

Limitations

  • Stated: the paper notes that empirical studies could be designed to test the degree to which these issues impact health policy decisions, indicating its propositions are not empirically tested; it also states that group decision making is outside the focus of the paper.
  • Evident: there is no formal limitations section, no empirical sample, and no tested outcomes; the framework is conceptual and its proposed relationships remain untested in the paper itself.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/1748-5908-5-39

Cites

119 of 119 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

11 of 163 cited sources checked · 4 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Decision makers, even if they have access to required information and have relevant expertise, may not engage in complex cognitive information processing when making decisions.

    “However, decision-making research has shown that decision makers, even if they have access to required information and have relevant expertise, may not engage in complex cognitive information processing when making decisions [13,15,44,46-50].”
    Quote in the paperSubstantial claim1 of 8 sources checked
    • cites [13] Nutley SM, Walter I, Davies HTO: Using Evidence: How Research Can Inform Public Services. 2007, The Policy Press source
    • cites [15] Soumerai SB, Ross-Degnan D, Fortress EE, Walser BL: Determinants of Change in Medicaid Pharmaceutical Cost Sharing: Does Evidence Affect Policy?. The Milbank Quarterly. 1997, 75: 11-34. 10.1111/1468-0009.00043. source

      The Discussion (page unavailable) says Medicaid managers sometimes knew of relevant research and policy risks, yet political pressure for quick budget fixes often prevailed. This supports the point that access to information need not produce an evidence-based decision. The paper does not establish that decision makers with relevant expertise declined to engage in complex cognitive processing; it instead emphasizes political constraints and, in the ‘Lack of Infrastructure for Policy Formulation and Evaluation’ section, gaps in analytic skills. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [44] Simon HA: A Behavioral Model of Rational Choice. Quarterly Journal of Economics. 1955, 69: 99-118. 10.2307/1884852. source
    • cites [46] Simon HA: Bounded Rationality and Organizational Learning. Organization Science. 1991, 2: 125-135. 10.1287/orsc.2.1.125. source
    • cites [47] Kahneman D, Tversky A: Prospect Theory: An Analysis of Decision Under Risk. Econometrica. 1979, 47: 263-291. 10.2307/1914185. source
    • cites [48] Zey M: Criticisms of Rational Choice Models. Decision Making: Alternatives to Rational Choice Models. Edited by: Zey M. 1992, Newbury Park: Sage Publications, 10-31.

      Not checked in the free run.

    • cites [49] Fernandes R, Simon HA: A Study of How Individuals Solve Complex and Ill-Structured Problems. Policy Sciences. 1999, 32: 225-245. 10.1023/A:1004668303848. source
    • cites [50] Agosto DE: Bounded Rationality and Satisficing in Young Peoples' Web-Based Decision Making. Journal of the American Society for Information Science and Technology. 2001, 53: 16-27. 10.1002/asi.10024. source
  • Premisecitation

    Research investigating individual decision making has identified cognitive information processing as a key factor in the decision-making process.

    “Research investigating individual decision making has identified cognitive information processing as a key factor in the decision-making process [6-8].”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [6] Isen AM: Positive Affect and Decision Making. Handbook of Emotions. Edited by: Lewis M, Haviland-Jones JM. 2000, New York: The Guilford Press, 417-435. 2

      Not checked in the free run.

    • cites [7] Kuvaas B, Selart M: Effects of Attribute Framing on Cognitive Processing and Evaluation. Organizational Behavior and Human Decision Processes. 2004, 95: 198-207. 10.1016/j.obhdp.2004.08.001. source
    • cites [8] Simon AF, Fagley NS, Halleran JG: Decision Framing: Moderating Effects of Differences and Cognitive Processing. Journal of Behavioral Decision Making. 2004, 17: 77-93. 10.1002/bdm.463. source
  • Premisecitation

    Cognitive processing research has identified both bounded rationality and 'satisficing' as limitations to complex cognitive processing.

    “For example, cognitive processing research has identified both bounded rationality and 'satisficing' as limitations to complex cognitive processing [2,15,44,46-50].”
    Quote in the paperSubstantial claim1 of 8 sources checked
    • cites [2] Redd SB: The Influence of Advisors on Foreign Policy Decision Making. Journal of Conflict Resolution. 2002, 46: 335-364. 10.1177/0022002702046003002. source
    • cites [15] Soumerai SB, Ross-Degnan D, Fortress EE, Walser BL: Determinants of Change in Medicaid Pharmaceutical Cost Sharing: Does Evidence Affect Policy?. The Milbank Quarterly. 1997, 75: 11-34. 10.1111/1468-0009.00043. source

      The 'Lack of Infrastructure for Policy Formulation and Evaluation' section (page unavailable) describes limited analytic skills and subjective Medicaid policy decisions, but does not identify bounded rationality or satisficing as cognitive-processing limitations. Searches for both terms found no passage in our copy addressing that claim. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [44] Simon HA: A Behavioral Model of Rational Choice. Quarterly Journal of Economics. 1955, 69: 99-118. 10.2307/1884852. source
    • cites [46] Simon HA: Bounded Rationality and Organizational Learning. Organization Science. 1991, 2: 125-135. 10.1287/orsc.2.1.125. source
    • cites [47] Kahneman D, Tversky A: Prospect Theory: An Analysis of Decision Under Risk. Econometrica. 1979, 47: 263-291. 10.2307/1914185. source
    • cites [48] Zey M: Criticisms of Rational Choice Models. Decision Making: Alternatives to Rational Choice Models. Edited by: Zey M. 1992, Newbury Park: Sage Publications, 10-31.

      Not checked in the free run.

    • cites [49] Fernandes R, Simon HA: A Study of How Individuals Solve Complex and Ill-Structured Problems. Policy Sciences. 1999, 32: 225-245. 10.1023/A:1004668303848. source
    • cites [50] Agosto DE: Bounded Rationality and Satisficing in Young Peoples' Web-Based Decision Making. Journal of the American Society for Information Science and Technology. 2001, 53: 16-27. 10.1002/asi.10024. source
  • Interpretationreasoning

    Health policy outcomes may actually be, to a varying extent, subjectively derived despite the positive intent of EBDM.

    “Therefore, despite the positive intent of EBDM, health policy outcomes may actually be, to a varying extent, subjectively derived [22,23,33,40,45,61].”
    Quote in the paperSubstantial claim3 of 6 sources checked
    • cites [22] Lavis JN, Ross SE, Hurley JE, Stoddart GL, Woodward C, Abelson J, Giacomini M: Examining the Role of Health Services Research in Public Policymaking. The Milbank Quarterly. 2002, 80: 125-154. 10.1111/1468-0009.00005. source
    • cites [23] Lavis JN, Robertson D, Woodside JM, McLeod CB, Abelson J, Knowledge Transfer Study Group: How Can Research Organizations More Effectively Transfer Research Knowledge to Decision Makers?. The Milbank Quarterly. 2003, 81: 221-245. 10.1111/1468-0009.t01-1-00052. source
    • cites [33] Mulrow CD, Lohr KN: Proof and Policy From Medical Research Evidence. Journal of Health Politics, Policy, and Law. 2001, 26: 249-266. 10.1215/03616878-26-2-249. source
    • cites [40] Walshe K, Rundall TG: Evidence-Based Management: From Theory to Practice in Health Care. The Milbank Quarterly. 2001, 79: 429-457. 10.1111/1468-0009.00214. source

      In “Research and Evidence,” the paper says managers may view research findings as subjective and context-dependent. “How Decisions Are Made” says managerial decisions can be shaped by stakeholders’ interests and political constraints, while the discussion on p. 429 extends the concern about evidence-based practice to health policy. These passages support the possibility of subjective influences on decisions, but do not establish that health policy outcomes themselves are subjectively derived. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [45] Maynard RA: Presidential Address - Evidence-Based Decision Making: What Will it Take for the Decision Makers to Care?. Journal of Policy Analysis and Management. 2006, 25: 249-265. 10.1002/pam.20169. source
    • cites [61] Spitz B, Abramson J: When Health Policy is the Problem: A Report From the Field. Journal of Health Politics, Policy, and Law. 2005, 30: 327-365. 10.1215/03616878-30-3-327. source
  • Premisecitation

    Decision-making research has demonstrated that a decision maker's utility is highly subjective and may include variables, such as personal gain, risk tolerance, relevance to related events, and value of a decision to the organization.

    “Decision-making research has demonstrated that a decision maker's utility is highly subjective and may include variables, such as personal gain, risk tolerance, relevance to related events, and value of a decision to the organization [22,28,44,46,47,54].”
    Quote in the paperSubstantial claim1 of 6 sources checked
    • cites [22] Lavis JN, Ross SE, Hurley JE, Stoddart GL, Woodward C, Abelson J, Giacomini M: Examining the Role of Health Services Research in Public Policymaking. The Milbank Quarterly. 2002, 80: 125-154. 10.1111/1468-0009.00005. source

      In “Finding Patterns in When Research is Used and Not Used” (page unavailable), the paper identifies policymakers’ values and interests, including perceptions of who benefits or is harmed, as influences on policy decisions. “What Conditions We Found That Appear to Favor Research Use” also describes policy legacies and the credibility of another initiative as influences. The copy does not characterize these influences as a decision maker’s subjective utility or identify risk tolerance among its variables. (LLM, conf=0.79)

      Experimental — accuracy not yet measured
    • cites [28] Tversky A, Kahneman D: The Framing of Decisions and the Psychology of Choice. Science. 1981, 211: 453-458. 10.1126/science.7455683. source
    • cites [44] Simon HA: A Behavioral Model of Rational Choice. Quarterly Journal of Economics. 1955, 69: 99-118. 10.2307/1884852. source
    • cites [46] Simon HA: Bounded Rationality and Organizational Learning. Organization Science. 1991, 2: 125-135. 10.1287/orsc.2.1.125. source
    • cites [47] Kahneman D, Tversky A: Prospect Theory: An Analysis of Decision Under Risk. Econometrica. 1979, 47: 263-291. 10.2307/1914185. source
    • cites [54] Jones BD: Reconceiving Decision-Making in Democratic Politics: Attention, Choice, and Public Policy. 1994, Chicago: University of Chicago Press

      Not checked in the free run.

  • May combine two claims. 18
  • Classified as probably not a substantial claim. 21

  • May combine two claims.

    Premisecitation

    Prospect theory demonstrates that a decision maker's perceived utility can be subjectively influenced by the manner in which the information is framed (as a loss/gain or risk/no risk), what reference is being used to evaluate the options, and the relationship/salience of the alternative to the decision maker.

    “Prospect theory, however, demonstrates that a decision maker's perceived utility can be subjectively influenced by the manner in which the information is framed (as a loss/gain or risk/no risk), what reference is being used to evaluate the options, and the relationship/salience of the alternative to the decision maker [47,70-74].”
    Quote in the paperSubstantial claim1 of 6 sources checked
    • cites [47] Kahneman D, Tversky A: Prospect Theory: An Analysis of Decision Under Risk. Econometrica. 1979, 47: 263-291. 10.2307/1914185. source
    • cites [70] Ubel PA, Baron J, Asch DA: Preference for Equity as a Framing Effect. Medical Decision Making. 2002, 21: 180-189. source
    • cites [71] Levin IP, Schneider SL, Gaeth GJ: All Frames are not Created Equal: A Typology and Critical Analysis of Framing Effects. Organizational Behavior and Human Decision Processes. 1998, 76: 149-188. 10.1006/obhd.1998.2804. source
    • cites [72] McElroy T, Seta JJ: Framing Effects: An Analytic-Holistic Perspective. Journal of Experimental Social Psychology. 2003, 39: 610-617. 10.1016/S0022-1031(03)00036-2. source
    • cites [73] Mittal V, Ross WT: The Impact of Positive and Negative Affect and Issue Framing on Issue Interpretation and Risk Taking. Organizational Behavior and Human Decision Processes. 1998, 76: 298-324. 10.1006/obhd.1998.2808. source
    • cites [74] Bless H, Betsch T, Franzen A: Framing the Framing Effect: The Impact of Context Cues on Solutions to the 'Asian Disease' Problem. European Journal of Social Psychology. 1999, 28: 287-291. 10.1002/(SICI)1099-0992(199803/04)28:2<287::AID-EJSP861>3.0.CO;2-U. source

  • May combine two claims.

    Premisecitation

    Many models guiding the policy making process assume policy makers are capable of accurately analyzing decision information, understanding the relevant evidence, are resistant to influences and biases, and seek to make decisions that maximize societal benefit.

    “many models guiding the policy making process assume policy makers are capable of accurately analyzing decision information, understanding the relevant evidence, are resistant to influences and biases, and seek to make decisions that maximize societal benefit [5,19,27,28].”
    Quote in the paperSubstantial claim1 of 4 sources checked
    • cites [5] Fox DM: Evidence of Evidence-Based Health Policy: The Politics of Systematic Reviews in Coverage Decisions. Health Affairs. 2005, 24: 114-122. 10.1377/hlthaff.24.1.114. source
    • cites [19] Howlett M, Ramesh M: Studying Public Policy: Policy Choices and Policy Subsystems. 2003, Don Mills: Oxford University Press

      Not checked in the free run.

    • cites [27] Sanderson I: Evaluation, Policy Learning and Evidence-Based Policy Making. Public Administration. 2002, 80: 1-22. 10.1111/1467-9299.00292. source

      The section “Rationalist Assumptions of Evidence-Based Policy Making and Management” describes a long-dominant rational model in which policy is based on careful assessment of alternatives. The discussion of instrumental rationality also describes an apolitical use of research and evaluation. But the paper does not say that these models assume policymakers are resistant to biases or seek to maximize societal benefit; it treats political influences as a challenge to the rational model. Page numbers were not available in our copy. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [28] Tversky A, Kahneman D: The Framing of Decisions and the Psychology of Choice. Science. 1981, 211: 453-458. 10.1126/science.7455683. source

  • May combine two claims.

    Interpretationreasoning

    Despite the expectation of rationality in policy decision making, policy makers' decisions can include individual and group utility factors and be a source of bias because decision information is rooted in individual cognitive processing.

    “Therefore, despite the expectation of rationality in policy decision making, policy makers' decisions can include individual and group utility factors and be a source of bias because decision information is rooted in individual cognitive processing [44-50,61].”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [44] Simon HA: A Behavioral Model of Rational Choice. Quarterly Journal of Economics. 1955, 69: 99-118. 10.2307/1884852. source
    • cites [45] Maynard RA: Presidential Address - Evidence-Based Decision Making: What Will it Take for the Decision Makers to Care?. Journal of Policy Analysis and Management. 2006, 25: 249-265. 10.1002/pam.20169. source
    • cites [46] Simon HA: Bounded Rationality and Organizational Learning. Organization Science. 1991, 2: 125-135. 10.1287/orsc.2.1.125. source
    • cites [47] Kahneman D, Tversky A: Prospect Theory: An Analysis of Decision Under Risk. Econometrica. 1979, 47: 263-291. 10.2307/1914185. source
    • cites [48] Zey M: Criticisms of Rational Choice Models. Decision Making: Alternatives to Rational Choice Models. Edited by: Zey M. 1992, Newbury Park: Sage Publications, 10-31.

      Not checked in the free run.

    • cites [49] Fernandes R, Simon HA: A Study of How Individuals Solve Complex and Ill-Structured Problems. Policy Sciences. 1999, 32: 225-245. 10.1023/A:1004668303848. source
    • cites [50] Agosto DE: Bounded Rationality and Satisficing in Young Peoples' Web-Based Decision Making. Journal of the American Society for Information Science and Technology. 2001, 53: 16-27. 10.1002/asi.10024. source
    • cites [61] Spitz B, Abramson J: When Health Policy is the Problem: A Report From the Field. Journal of Health Politics, Policy, and Law. 2005, 30: 327-365. 10.1215/03616878-30-3-327. source

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Decision models for health policy function under a shared assumption of rational choice and utility maximization.

    “Decision models such as these function under a shared assumption of rational choice and utility maximization in the decision-making process.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In Wyer and Srull's deliberate stage of information processing, the information subsequently recalled and the resulting decision is directly reflective of the information processing objectives.

    “The cognitive interaction between goal identification/clarification and deliberative processing is such that the information subsequently recalled and the resulting decision is directly reflective of the information processing objectives [9].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Wyer RS, Srull TK: The Processing of Social Stimulus Information: A Conceptual Integration. Person Memory: The Cognitive Basis of Social Perception. Edited by: Hastie R, Ostrom TM, Ebbesen EB, Wyer RS, Hamilton DL, Carlston DE. 1980, Hillsdale: Lawrence Erlbaum Associates, 227-300.

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    A cognitive information-processing approach accounts for internally generated mechanisms by which relevant decision-making information is processed by individuals and individuals participating in group decision making.

    “A cognitive information-processing approach accounts for internally generated mechanisms by which relevant decision-making information is processed by individuals and individuals participating in group decision making [9,10].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [9] Wyer RS, Srull TK: The Processing of Social Stimulus Information: A Conceptual Integration. Person Memory: The Cognitive Basis of Social Perception. Edited by: Hastie R, Ostrom TM, Ebbesen EB, Wyer RS, Hamilton DL, Carlston DE. 1980, Hillsdale: Lawrence Erlbaum Associates, 227-300.

      Not checked in the free run.

    • cites [10] Wyer RS, Srull TK: Human Cognition in its Social Context. Psychological Review. 1986, 93: 322-359. 10.1037/0033-295X.93.3.322. source

  • May combine two claims.

    Interpretationcitation

    Numerous individuals do not have the broad ranging expertise to adequately assess scientific information across health policy domains, thus they will satisfice their decision information needs and rely on secondary sources that summarize research results and translate the findings into 'lay' language.

    “As such, it is posited that numerous individuals do not have the broad ranging expertise to adequately assess scientific information across health policy domains, thus they will satisfice their decision information needs and rely on secondary sources that summarize research results and translate the findings into 'lay' language.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13] Nutley SM, Walter I, Davies HTO: Using Evidence: How Research Can Inform Public Services. 2007, The Policy Press source

  • May combine two claims.

    Interpretationreasoning

    Goals filter information processing and determine what information is attained, retained, and utilized.

    “The nature of goals as drivers of information processing suggests that goals filter information processing and determine what information is attained, retained, and utilized.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    These assumptions are problematic, incomplete, and, in some cases, false according to decision-making literature.

    “However, these objectives and models collectively fail to consider the decision-making literature, which shows these assumptions are problematic, incomplete, and, in some cases, false [19,29-33].”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [19] Howlett M, Ramesh M: Studying Public Policy: Policy Choices and Policy Subsystems. 2003, Don Mills: Oxford University Press

      Not checked in the free run.

    • cites [29] Weiss C, Bucuvalas MJ: Social Science Research and Decision Making. 1980, New York: Columbia University Press

      Not checked in the free run.

    • cites [30] Jones BD: Politics and the Architecture of Choice: Bounded Rationality and Governance. 2001, Chicago: University of Chicago Press

      Not checked in the free run.

    • cites [31] Sabatier PA: Fostering the Development of Policy Theory. Theories of the Policy Process. Edited by: Sabatier PA. 1999, Boulder: Westview Press, 3-17.

      Not checked in the free run.

    • cites [32] Simon HA: Decision Making and Problem Solving. Decision Making: Alternatives to Rational Choice. Edited by: Zey M. 1992, Newbury Park: Sage Publications, 32-53.

      Not checked in the free run.

    • cites [33] Mulrow CD, Lohr KN: Proof and Policy From Medical Research Evidence. Journal of Health Politics, Policy, and Law. 2001, 26: 249-266. 10.1215/03616878-26-2-249. source

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Expressing data, findings, and reports in commonly used language will aid decision makers to use the available evidence.

    “The ability to ensure data, findings, and reports are expressed in commonly used language will aid decision makers to use the available evidence.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationreasoning

    Availability of translatable data would expand the individual experience factor and become part of the information basis that influence decision making.

    “Availability of translatable data would expand the individual experience factor and become part of the information basis that influence decision making.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    The EBM foundation privileges positivist science and diminishes research conducted outside the empirical, quantitative perspective to being of lesser value.

    “This EBM foundation privileges positivist science and diminishes research conducted outside the empirical, quantitative perspective to being of lesser value, an unfair and unfounded position.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Research is theorized, conducted, analyzed, and evaluated using many different methods.

    “Deriving from these various epistemologies, research is theorized, conducted, analyzed, and evaluated using many different methods [97,98].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [97] Kuhn TS: The Structure of Scientific Revolutions. 1996, Chicago: The University of Chicago Press, 3 source
    • cites [98] Kuhn TS: The Nature and Necessity of Scientific Revolutions. Scientific Knowledge: Basic Issues in the Philosophy of Science. Edited by: Kourany JA. 1998, Belmont: Wadsworth Publishing Company, 316-326. 2

      Not checked in the free run.

    • Rests on an assumption: Healthcare is a multi-sector industry that draws health services researchers from a wide variety of health and social science disciplines.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Health services research, aggregated across studies and translated into reliable and valid findings, is a key to evidence-based decisions.

    “As noted, health services research, aggregated across studies and translated into reliable and valid findings, is a key to evidence-based decisions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Personal utility assessments often cloud relevant societal level assessments of policy alternatives and/or drive the overall assessment of decision options.

    “Personal utility assessments often cloud relevant societal level assessments of policy alternatives and/or drive the overall assessment of decision options.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    This behavior has major implications for the rationality assumptions of EBDM.

    “This behavior has major implications for the rationality assumptions of EBDM.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Positive affect has been shown to trigger quicker, more flexible, and more efficient processing strategies, while negative affect tends to trigger slower, more systematic, and more analytical processing strategies.

    “In general, positive affect has been shown to trigger quicker, more flexible, and more efficient processing strategies. Conversely, negative affect tends to trigger slower, more systematic, and more analytical processing strategies [6,77,79,88-92].”
    Quote in the paperNot a substantial claim0 of 8 sources checked
    • cites [6] Isen AM: Positive Affect and Decision Making. Handbook of Emotions. Edited by: Lewis M, Haviland-Jones JM. 2000, New York: The Guilford Press, 417-435. 2

      Not checked in the free run.

    • cites [77] Forgas JP, Vargas PT: The Effects of Mood on Social Judgment and Reasoning. Handbook of Emotions. Edited by: Lewis M, Haviland-Jones JM. 2000, New York: The Guilford Press, 350-367. 2

      Not checked in the free run.

    • cites [79] Bower GH, Forgas JP: Mood and Social Memory. Handbook of Affect and Social Cognition. Edited by: Forgas JP. 2001, Mahwah: Lawrence Erlbaum Associates, Inc, 95-120.

      Not checked in the free run.

    • cites [88] Forgas JP: Affect and Information Processing Strategies: An Interactive Relationship. Feeling and Thinking: The Role of Affect in Social Cognition. Edited by: Forgas JP. 2000, New York: Cambridge University Press, 253-282.

      Not checked in the free run.

    • cites [89] Forgas JP: Mood and Judgment: The Affect Infusion Model (AIM). Psychological Bulletin. 1995, 117: 39-66. 10.1037/0033-2909.117.1.39. source
    • cites [90] Forgas JP: Affect, Cognition, and Interpersonal Behavior: The Mediating Role of Processing Strategies. Handbook of Affect and Social Cognition. Edited by: Forgas JP. 2001, Mahwah: Lawrence Erlbaum Associates, Inc, 293-318.

      Not checked in the free run.

    • cites [91] Jundt DK, Hinsz VB: Influences of Positive and Negative Affect on Decisions Involving Judgmental Biases. Social Behavior and Personality. 2002, 30: 45-52. 10.2224/sbp.2002.30.1.45. source
    • cites [92] Fiedler K: Affective Influences on Social Information Processing. Handbook of Affect and Social Cognition. Edited by: Forgas JP. 2001, Mahwah: Lawrence Erlbaum Associates, Inc, 163-185.

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The manner in which policy questions are framed and policy maker experience will influence decision utility assessments and subsequent choices regarding health policies.

    “Thus, the above propositions suggest that the manner in which policy questions are framed and policy maker experience will influence decision utility assessments and subsequent choices regarding health policies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The influence of affect on individuals has been shown to influence the manner in which individuals perceive situations, the motivation of decision behaviors, the degree of decision risk tolerance, and the level and type of information recall people exhibit.

    “With respect to decision making, the influence of affect on individuals has been shown to influence the manner in which individuals perceive situations, the motivation of decision behaviors, the degree of decision risk tolerance, and the level and type of information recall people exhibit [6,76-80].”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [6] Isen AM: Positive Affect and Decision Making. Handbook of Emotions. Edited by: Lewis M, Haviland-Jones JM. 2000, New York: The Guilford Press, 417-435. 2

      Not checked in the free run.

    • cites [76] Eich E, Schooler JW: Cognition/Emotion Interactions. Cognition and Emotion. Edited by: Eich E, Kihlstrom JF, Bower GH, Forgas JP, Niedenthal PM. 2000, New York: Oxford University Press, 87-168. source
    • cites [77] Forgas JP, Vargas PT: The Effects of Mood on Social Judgment and Reasoning. Handbook of Emotions. Edited by: Lewis M, Haviland-Jones JM. 2000, New York: The Guilford Press, 350-367. 2

      Not checked in the free run.

    • cites [78] Johnson-Laird PN, Oatley K: Cognitive and Social Construction in Emotions. Handbook of Emotions. Edited by: Lewis M, Haviland-Jones JM. 2000, New York: The Guilford Press, 458-475. 2

      Not checked in the free run.

    • cites [79] Bower GH, Forgas JP: Mood and Social Memory. Handbook of Affect and Social Cognition. Edited by: Forgas JP. 2001, Mahwah: Lawrence Erlbaum Associates, Inc, 95-120.

      Not checked in the free run.

    • cites [80] Clore GL, Gasper K, Garvin E: Affect as Information. Handbook of Affect and Social Cognition. Edited by: Forgas JP. 2001, Mahwah: Lawrence Erlbaum Associates, Inc, 121-144. source

  • May combine two claims.

    Interpretationcitation

    In complex decision situations, automatic processing becomes a dominant force in information processing and results in cognitive shortcutting tactics.

    “In complex decision situations, this automatic processing becomes a dominant force in information processing and results in cognitive shortcutting tactics.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [64] Lord RG, Maher KJ: Cognitive Processes in Industrial and Organizational Psychology. International Review of Industrial and Organizational Psychology. Edited by: Cooper CL, Robertson IT. 1989, New York: John Wiley and Sons, 49-91.
    • cites [65] Lord RG, Maher KJ: Leadership and Information Processing. 1991, Cambridge: Unwin Hyman Inc

      Not checked in the free run.

    • cites [66] Bazerman MH: Judgment in Managerial Decision Making. 1998, New York: John Wiley and Sons, 4

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    Decision processes involving numerous people are more likely to strike a balance among affect states, thereby minimizing a dominant affect influence and balance risk taking.

    “Decision processes involving numerous people are more likely to strike a balance among affect states, thereby minimizing a dominant affect influence and balance risk taking.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Heuristics are cognitive processes where full information processing requirements are bypassed and mental shortcutting occurs.

    “Heuristics are cognitive processes where full information processing requirements are bypassed and mental shortcutting occurs [66,71,73,94].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [66] Bazerman MH: Judgment in Managerial Decision Making. 1998, New York: John Wiley and Sons, 4

      Not checked in the free run.

    • cites [71] Levin IP, Schneider SL, Gaeth GJ: All Frames are not Created Equal: A Typology and Critical Analysis of Framing Effects. Organizational Behavior and Human Decision Processes. 1998, 76: 149-188. 10.1006/obhd.1998.2804. source
    • cites [73] Mittal V, Ross WT: The Impact of Positive and Negative Affect and Issue Framing on Issue Interpretation and Risk Taking. Organizational Behavior and Human Decision Processes. 1998, 76: 298-324. 10.1006/obhd.1998.2808. source
    • cites [94] Slattery JP, Ganster DC: Determinants of Risk Taking in a Dynamic Uncertain Context. Journal of Management. 2002, 28: 89-106. 10.1177/014920630202800106. source

  • May combine two claims.

    Interpretationreasoning

    Utility perceptions of decision makers are governed by goals retrieved during the goal-directed information processing stage and influence which information is retrieved and how it is evaluated.

    “We argue that utility perceptions of decision makers are governed by goals retrieved during the goal-directed information processing stage and influence which information is retrieved and how it is evaluated.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Expecting end-users to have a full comprehension of 'research speak' sets up the dissemination mode for ineffective translation.

    “Expecting end-users to have a full comprehension of 'research speak' sets up the dissemination mode for ineffective translation as certainly as would it be if health services researchers were expected to have full comprehension of the language, jargon, and acronyms commonly used in 'med speak'.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Expressing data in commonly used language may help alleviate situations in which decision makers are attempting to utilize evidence with conflicting information and conclusions.

    “Additionally, this may help alleviate situations in which decision makers are attempting to utilize evidence with conflicting information and conclusions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Diverse groups are more creative in their decision processes as a result of their diversity and tend to attain more creative solutions to issues being addressed.

    “Diverse groups are known to be more creative in their decision processes as a result of their diversity and tend to attain more creative solutions to issues being addressed [59,66].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [59] Allison G, Zelikow P: Essence of Decision: Explaining the Cuban Missile Crisis. 1999, New York: Addison-WesleyEducational Publishers Inc

      Not checked in the free run.

    • cites [66] Bazerman MH: Judgment in Managerial Decision Making. 1998, New York: John Wiley and Sons, 4

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    Increased recognition of the inherent biases and individual decision-making flaws is a first step of aligning policy goals with decision utilities.

    “Increased recognition of the inherent biases and individual decision-making flaws is a first step of aligning policy goals with decision utilities.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The hierarchical evidence spectrum argued by Sackett and others highlights RCTs and meta-analyses as the gold standard of evidence.

    “Evidence, as we know, is a major element of EBM (the precursor to EBDM), and the hierarchical evidence spectrum argued by Sackett and others highlight Randomized controlled trials (RCTs) and meta-analyses as the gold standard of evidence [100].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [100] Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS: Evidence-Based Medicine: What it is and What it isn't. British Medical Journal. 1996, 312: 71-72. source

  • May combine two claims.

    Interpretationreasoning

    The Asian disease example demonstrates the influence of framing on decision alternative utility assessment and exemplifies how evidence is subjectively interpreted and used to make healthcare decisions.

    “The Asian disease example clearly demonstrates the influence of framing on decision alternative utility assessment and exemplifies how evidence is subjectively interpreted and used to make healthcare decisions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    Policy makers' trait affect will influence the degree of risk tolerance and uncertainty they will allow in supporting/devising new policies. Those high in positive affect are more likely to support policies with high risk and high uncertainty, while those high in negative affect are more likely to support policies with minimal risk and minimal uncertainty.

    “Proposition 2: Policy makers' trait affect will influence the degree of risk tolerance and uncertainty they will allow in supporting/devising new policies. Those high in positive affect are more likely to support policies with high risk and high uncertainty, while those high in negative affect are more likely to support policies with minimal risk and minimal uncertainty.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    Involving stakeholders to become part of the policy creation process naturally leads to their participation in the evaluation process.

    “Involving stakeholders to become part of the policy creation process naturally leads to their participation in the evaluation process.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    These considerations are globally relevant.

    “Furthermore, we argue that these considerations are globally relevant and that a comprehensive understanding of the mechanisms of cognitive processing aids decision makers in developing awareness of how they process relevant decision information and how they may be subtly influenced while discounting actual evidence.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Policy makers might experience differing utility perceptions when considering policy options, and thus be subject to varying, subtle influences.

    “The nature of decision maker utility is such that policy makers might experience differing utility perceptions when considering policy options, and thus be subject to varying, subtle influences.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Identifying and better understanding these influences will empower both health policy makers and managers to enhance their decision-making.

    “Identifying and better understanding these influences will empower both health policy makers and managers to enhance their decision-making.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    A comprehensive understanding of the mechanisms of cognitive processing aids decision makers in developing awareness of how they process relevant decision information and how they may be subtly influenced while discounting actual evidence.

    “Furthermore, we argue that these considerations are globally relevant and that a comprehensive understanding of the mechanisms of cognitive processing aids decision makers in developing awareness of how they process relevant decision information and how they may be subtly influenced while discounting actual evidence.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    A greater awareness of the reasons behind policy makers' actions will promote better and more informed decisions.

    “We posit that a greater awareness of the reasons behind policy makers' actions will promote better and more informed decisions.”
    Quote in the paperNot a substantial claim
36 of 36

  • The paper relies on this without support.

    The Wyer and Srull social information processing model is applicable to health policy decision makers.

    “Wyer and Srull [10] have proposed one of most recognized information processing models, which will be used here to provide the structure for the basic cognitive information processing discussion (Figure 2).”

  • The paper relies on this without support.

    Health policy decision makers process decision-relevant information in the same cognitive manner as individuals in the general decision-making literature.

    “Utilizing health policy decision making as a basis, this article presents a theoretical decision-processing framework that supports the focal thesis: during the health policy process, decision makers are subjectively influenced by the manner in which they cognitively process information.”

  • The paper relies on this without support.

    Most nations' health system challenges are complex.

    “Given the complexity of most nations' health system challenges, cognitive shortcutting by policy makers is to be expected.”

  • The paper relies on this without support.

    Individual goals play a role in how information is processed.

    “Given consideration of the complexity of cognitive information processing and the role of individual goals in how information is being processed, it is not surprising that health policy makers would readily adopt cognitive processes that simplify decisions.”

  • The paper relies on this without support.

    Policy making does not occur in isolation.

    “Given that policy making does not occur in isolation, it is important to identify the components of the network that are relevant and require consideration”

  • The paper relies on this without support.

    Healthcare is a multi-sector industry that draws health services researchers from a wide variety of health and social science disciplines.

    “As healthcare is a multi-sector industry, it draws health services researchers from a wide variety of health and social science disciplines (e.g., management, economics, political science, sociology, nursing).”

  • The paper relies on this without support.

    Decision-making processes within groups often involve either a process of inquiry or a process of advocacy.

    “Decision-making processes within groups often involve either a process of inquiry (collaborative problem solving) or a process of advocacy (a function of persuasion and opinion influencing).”
7 of 7

Cites

Flagged first, then by citations

3 of the 122 references couldn’t be matched to a known paper.

Research works printed but not linked: 7

  1. Flemming K, Fenton M: Making Sense of Research Evidence to Inform Decision-Making. Clinical Decision-Making and Judgment in Nursing. Edited by: Thompson C, Dowding D. 2002, Toronto: Harcourt Publishers, 110-129.
  2. Murnighan JK, Mowen JC: The Art of High-Stakes Decision Making. 2002, New York: John Wiley and Sons
  3. Howlett M, Ramesh M: Studying Public Policy: Policy Choices and Policy Subsystems. 2003, Don Mills: Oxford University Press
  4. Haddow R: Interest Representation and the Canadian State. Canadian Politics. Edited by: Bickerton J, Gagnon A. 1999, Peterborough: Broadview Press, 501-522.
  5. Forgas JP, Vargas PT: The Effects of Mood on Social Judgment and Reasoning. Handbook of Emotions. Edited by: Lewis M, Haviland-Jones JM. 2000, New York: The Guilford Press, 350-367. 2
  6. Johnson-Laird PN, Oatley K: Cognitive and Social Construction in Emotions. Handbook of Emotions. Edited by: Lewis M, Haviland-Jones JM. 2000, New York: The Guilford Press, 458-475. 2
  7. Kourany JA: The Validation of Scientific Knowledge. Scientific Knowledge: Basic Issues in the Philosophy of Science. Edited by: Kourany JA. 1998, Belmont: Wadsworth Publishing Company, 153-163. 2

Cited by

Sorted by citations

Related

Authors
McCaughey, D., & Bruning, N. S.
Affiliations
  • Pennsylvania State University (US)
  • University of Manitoba (CA)
Corresponding author
McCaughey, Deirdre
ORCID
McCaughey, Deirdre
Venue
Implementation Science
Publisher
Springer Science and Business Media LLC
Published
2010-05-26
Volume
5
Issue
1
Pages
39-39
ISSN
1748-5908 (ISSN-L)
DOI
10.1186/1748-5908-5-39
PMC
PMC2885987
OpenAlex
W2022170372
Semantic Scholar
50abb1ebc6c386e36bbc1a80a5ecd0931ed379bb
Cited by
160
References
122
Citations by year
2026: 7 · 2025: 6 · 2024: 4 · 2023: 2 · 2022: 9 · 2021: 4 · 2020: 5 · 2019: 9 · 2018: 9 · 2017: 6 · 2016: 4 · 2015: 5 · 2014: 5 · 2013: 73 · 2012: 8
FWCI
18.71
Type
journal article
Language
en
Open access
Licence
Locations
  • Implementation Science (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Mspace (University of Manitoba) (submittedVersion)
Topics
  • Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
  • Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords
evidence-based decision making, evidence-based policy making, health policy decision-making, cognitive biases, bounded rationality, cognitive information processing, decision-making, health policy makers, health care financing, health care access

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-27.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-27.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

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