Evidence map›Paper›PMID 36421915›Full record

ArticleBrain sciences2022

'We Have Guidelines, but We Can Also Be Artists': Neurologists Discuss Prognostic Uncertainty, Cognitive Biases, and Scoring Tools.

Luca Tolsa, Laura Jones, Patrik Michel, Gian Domenico Borasio, Ralf J Jox, Rachel Rutz Voumard

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Brain sciences, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
1.7field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it, 7 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Review
  5. Review
  6. Review
  7. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 1 institution in 1 country.

Luca TolsaChair of Geriatric Palliative Care, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland.
Laura JonesChair of Geriatric Palliative Care, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland.
Patrik MichelStroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland.
Gian Domenico BorasioPalliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland.
Ralf J JoxChair of Geriatric Palliative Care, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland.ORCID 0000-0002-3040-4714
Rachel Rutz VoumardPalliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland.
University of Lausanne · CH

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionIschemic stroke is a leading cause of disability and mortality worldwide. As acute stroke patients often lose decision-making capacity, acute management is fraught with complicated decisions regarding life-sustaining treatment (LST). We aimed to explore (1) the perspectives and experiences of clinicians regarding the use of predictive scores for LST decision making in severe acute stroke, and (2) clinicians' awareness of their own cognitive biases in this context.

methodsFour focus groups (FGs) were conducted with 21 physicians (13 residents and 8 attending physicians); two FGs in a university hospital and two in a regional hospital in French-speaking Switzerland. Discussions were audio-recorded and transcribed verbatim. Transcripts were analyzed thematically. Two of the four transcripts were double coded to establish coding framework consistency.

resultsParticipants reported that predictive tools were not routinely used after severe stroke, although most knew about such scores. Scores were reported as being useful in quantifying prognosis, advancing scientific evidence, and minimizing potential biases in decisions. Their use is, however, limited by the following barriers: perception of inaccuracy, general disbelief in scoring, fear of self-fulfilling prophecy, and preference for clinical judgement. Emotional and cognitive biases were common. Emotional biases distort clinicians' knowledge and are notably: bias of personal values, negative experience, and cultural bias. Cognitive biases, such as availability, confirmation, and anchoring biases, that produce systematic deviations from rational thinking, were also identified.

conclusionsThe results highlight opportunities to improve decision making in severe stroke through the promotion of predictive tools, strategies for communicating prognostic uncertainty, and minimizing cognitive biases among clinicians, in order to promote goal-concordant care.

Indexed as

cognitive biasesdecision makingprognostic uncertaintysevere stroke

Identifiers

PMID36421915
PMCPMC9688358
OpenAlexW4309738945

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.