Baruch Fischhoff

PurposePerceived poor prognosis can lead to withdrawal of life-sustaining therapies (WLST) in patients who might otherwise recover. We characterized clinicians’ approach to post-arrest prognostication in a multicenter clinical trial.MethodsSemi-structured interviews were conducted with clinicians who treated a comatose post-cardiac arrest patient enrolled in the Influence of Cooling Duration on Efficacy in Cardiac Arrest Patients (ICECAP) trial (NCT04217551). Two authors independently analyzed each interview using inductive and deductive coding. The clinician reported how they arrived at a prognosis for the specific patient. We summarized the frequency with which clinicians reported using objective diagnostics to formulate their prognosis, and compared the reported approaches to established guidelines. Each respondent provided demographic information and described local neuroprognostication practices …

Background Transfer of severely injured patients to trauma centers, either directly from the field or after evaluation at non-trauma centers, reduces preventable morbidity and mortality. Failure to transfer these patients appropriately (i.e., under-triage) remains common, and occurs in part because physicians at non-trauma centers make diagnostic errors when evaluating the severity of patients’ injuries. We developed Night Shift, a theory-based adventure video game, to recalibrate physician heuristics (intuitive judgments) in trauma triage and established its efficacy in the laboratory. We plan a type 1 hybrid effectiveness-implementation trial to determine whether the game changes physician triage decisions in real-life and hypothesize that it will reduce the proportion of patients under-triaged.MethodsWe will recruit 800 physicians who work in the emergency departments (EDs) of non-trauma centers in the US and will …

BACKGROUNDClinicians, patients, and families alike perceive a need to improve how goals of care (GOC) decisions occur in chronic critical illness (CCI) but little is currently known about this decision making process.RESEARCH QUESTIONHow do intensivists from various health systems facilitate decision-making about GOC for patients with CCI? What are barriers to, and facilitators of, this decision-making process?STUDY DESIGNAND METHODS: We conducted semi-structured interviews with a purposeful sample of intensivists from the United States and Canada using a ‘mental models’ approach adapted from decision science. We analyzed transcripts inductively using qualitative description.RESULTSWe interviewed 29 intensivists from six institutions. Participants across all sites described GOC decision-making in CCI as a complex, longitudinal, and iterative process that involved substantial preparatory …

ObjectiveWe examine individuals’ ability to detect social bots among Twitter personas, along with participant and persona features associated with that ability.BackgroundSocial media users need to distinguish bots from human users. We develop and demonstrate a methodology for assessing those abilities, with a simulated social media task.MethodWe analyze performance from a signal detection theory perspective, using a task that asked lay participants whether each of 50 Twitter personas was a human or social bot. We used the agreement of two machine learning models to estimate the probability of each persona being a bot. We estimated the probability of participants indicating that a persona was a bot with a generalized linear mixed-effects model using participant characteristics (social media experience, analytical reasoning, and political views) and stimulus characteristics (bot indicator score and political …

Well-designed visual displays have the power to convey health messages in clear, effective ways to non-experts, including journalists, patients and policymakers. Poorly designed visual displays, however, can confuse and alienate recipients, undermining health messages. In this Perspective, we propose a structured framework for effective visual communication of health information, using case examples of three common communication tasks: comparing treatment options, interpreting test results, and evaluating risk scenarios. We also show simple, practical ways to evaluate a design’s success and guide improvements. The proposed framework is grounded in research on health risk communication, visualization and decision science, as well as our experience in communicating health data.

Scientific reasoning ability, the ability to reason critically about the quality of scientific evidence, can help laypeople use scientific evidence when making judgments and decisions. We ask whether individuals with greater scientific reasoning ability are also better calibrated with respect to their ability, comparing calibration for skill with the more widely studied calibration for knowledge. In three studies, participants (Study 1: N = 1022; Study 2: N = 101; and Study 3: N = 332) took the Scientific Reasoning Scale (SRS; Drummond & Fischhoff, 2017), comprised of 11 true–false problems, and provided confidence ratings for each problem. Overall, participants were overconfident, reporting mean confidence levels that were 22.4–25% higher than their percentages of correct answers; calibration improved with score. Study 2 found similar calibration patterns for the SRS and another skill, the Cognitive Reflection Test …

Many patients hospitalized after severe acute brain injury are comatose and require life-sustaining therapies. Some of these patients make favorable recoveries with continued intensive care, while others do not. In addition to providing medical care, clinicians must guide surrogate decision makers through high-stakes, emotionally charged decisions about whether to continue life-sustaining therapies. These consultations require clinicians first to assess a patient's likelihood of recovery given continued life-sustaining therapies (i.e., prognosticate), then to communicate that prediction to surrogates, and, finally, to elicit and interpret the patient's preferences. At each step, both clinicians and surrogates are vulnerable to flawed decision making. Clinicians can be imprecise, biased, and overconfident when prognosticating after brain injury. Surrogates can misperceive the choice and misunderstand or misrepresent a …

WINTER 2023 59 risk communication different goals than training in communication and media skills. The right content, not just the right delivery, is essential for building and maintaining public trust in science. Although many scientific organizations provide skills training about message delivery, few support evidence-based content development and testing. We believe that just as legal, financial, and data management capacity are essential for science-based organizations, so is risk communication.