To honor the wishes of an incapacitated patient, surrogate decision makers must predict the treatment decisions patients would make for themselves if able. Social psychological research, however, ...suggests that surrogates' own treatment preferences may influence their predictions of others' preferences. In 2 studies (1 involving 60 college student surrogates and a parent, the other involving 361 elderly outpatients and their chosen surrogate decision maker), surrogates predicted whether a close other would want life-sustaining treatment in hypothetical end-of-life scenarios and stated their own treatment preferences in the same scenarios. Surrogate predictions more closely resembled surrogates' own treatment wishes than they did the wishes of the individual they were trying to predict. Although the majority of prediction errors reflected inaccurate use of surrogates' own treatment preferences, projection was also found to result in accurate prediction more often than counterprojective predictions. The rationality and accuracy of projection in surrogate decision making is discussed.
Motivated Skepticism Ditto, Peter H; Lopez, David F
Journal of personality and social psychology,
10/1992, Letnik:
63, Številka:
4
Journal Article
Recenzirano
Three experiments show that information consistent with a preferred conclusion is examined less critically than information inconsistent with a preferred conclusion, and consequently, less ...information is required to reach the former than the latter. In Study 1, Ss judged which of 2 students was most intelligent, believing they would work closely with the 1 they chose. Ss required less information to decide that a dislikable student was less intelligent than that he was more intelligent. In Studies 2 and 3, Ss given an unfavorable medical test result took longer to decide their test result was complete, were more likely to retest the validity of their result, cited more life irregularities that might have affected test accuracy, and rated test accuracy as lower than did Ss receiving more favorable diagnoses. Results suggest that a core component of self-serving bias is the differential quantity of cognitive processing given to preference-consistent and preference-inconsistent information.
If preference-inconsistent information initiates more effortful cognitive analysis than does preference-consistent information, then people should be more sensitive processors of information they do ...not want to believe than of information they do want to believe. Three studies supported this prediction. Study 1 found that inferences drawn from favorable interpersonal feedback revealed a correspondence bias, whereas inferences drawn from unfavorable feedback were sensitive to situational constraint. Study 2 showed this sensitivity to the quality of unfavorable feedback to disappear under cognitive load. Study 3 showed that evaluations of the accuracy of favorable medical diagnoses were insensitive to the probability of alternative explanation, whereas evaluations of unfavorable diagnoses were sensitive to probability information. The importance of adaptive considerations in theories of motivated reasoning is discussed.
Two studies examined (a) whether biased assimilation and attitude polarization occur in the processing of stereotype-relevant scientific information and (B) the role of affect in these processes. ...Participants perceived research consistent with their attitudes as more convincing that research inconsistent with their attitudes.
The tendency for people to rate attitude-confirming information more positively than attitude-disconfirming information (biased assimilation) was studied in a naturalistic context. Participants ...watched and evaluated the first 1996 Presidential Debate between Bill Clinton and Bob Dole. Regression analyses revealed that predebate attitudes but not expectations predicted postdebate argument evaluations and perceived attitude change. Participants evaluated the arguments that confirmed their predebate attitudes as being stronger than the arguments that disconfirmed their predebate attitudes, and they perceived their postdebate attitudes to have become more extreme than their predebate attitudes. Self-reported affective responses mediated the association between predebate attitudes and postdebate argument evaluations. The role of affect in information-processing theories and the significance of the findings for sociopolitical debates are discussed.
Purpose: This study examined patients' and surrogates' attitudes about using advance directives to manage end-of-life medical care. It also explored process preferences, or how patients want ...decisions to be made. Design and Methods: Data come from the third wave of the Advance Directives, Values Assessment, and Communication Enhancement project, a longitudinal study designed to investigate psychological assumptions underlying the use of advance directives. Three-hundred thirty-seven outpatients aged 65 and older and their designated surrogate decision makers completed interviews and questionnaires. Results: Very few individuals wished to document specific medical treatment preferences and mandate that they be followed, without exception, near death. Most desired to express more general preferences, such as values and goals for care, in addition to (or, instead of) specific treatment preferences and to allow surrogate decision makers leeway in decision making. Patient-to-patient variability with regard to process preferences was substantial, as was surrogates' misunderstanding of the patients' process preferences. Implications: Very few individuals may desire the standard approach to advance care planning whereby preferences for specific life-sustaining treatments are documented and these requests are strictly followed near death. Instead, patient autonomy may be better served by emphasizing discussion of process preferences and leeway in decision making.
Seriously ill
individuals, including those seriously ill with cancer, are frequently encouraged to
complete instructional advance directives (i.e., living wills) to ensure that their wishes
about the ...use of life-sustaining treatment are honored if they should lose the ability to
make decisions for themselves. The authors present a social psychological analysis making
explicit a series of steps that must necessarily take place if living wills are to honor
the wishes of incapacitated patients. They then focus on 3 key steps in the analysis and
review relevant research from the medical and psychological literatures. In each case,
this research raises serious questions about the psychological assumptions underlying the
effective use of living wills in end-of-life decision making. Discussion focuses on the
need for policy and law guiding the use of advance directives to be informed by both basic
and applied research on judgment and decision making.
The use of instructional advance directives assumes that preferences for life-sustaining medical treatment remain stable over time and across changes in life condition. A sample of 332 older adults ...recorded their preferences for 4 life-sustaining treatments in 9 illness scenarios. These preferences were elicited again 1 and 2 years after the original interview. Overall, preferences for life-sustaining treatment were moderately stable over time, but stability varied significantly across judgments. Preferences were most stable for illness scenarios that were most and least serious and for decisions to refuse treatment. Age, gender, education, and prior completion of an advance directive were all related to preference stability, and evidence indicated that declines in physical or psychological functioning resulted in decreased interest in life-sustaining treatment.
Rid and Wendler propose the development of a Patient Preference Predictor (PPP), an actuarial model for predicting incapacitated patient's life-sustaining treatment preferences across a wide range of ...end-of-life scenarios. An actuarial approach to end-of-life decision making has enormous potential, but transferring the logic of actuarial prediction to end-of-life decision making raises several conceptual complexities and logistical problems that need further consideration. Actuarial models have proven effective in targeted prediction tasks, but no evidence supports their effectiveness in the kind of broad spectrum prediction task that is the proposed goal of the PPP. We argue that a more focused approach, targeting specific medical conditions and generating treatment predictions based on the preferences of individuals with actual disease experience, is both more firmly grounded in past research and is a more prudent initial strategy for exploring the efficacy of actuarial prediction in end-of-life decision making.
Visceral influences on risk-taking behavior Ditto, Peter H.; Pizarro, David A.; Epstein, Eden B. ...
Journal of behavioral decision making,
April 2006, Letnik:
19, Številka:
2
Journal Article
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