title: Evidence of Cognitive Bias in Decision Making Around Implantable-Cardioverter Defibrillators: A Qualitative Framework Analysis.
abstract: BACKGROUND
  Studies have demonstrated that patients with primary prevention implantable cardioverter-defibrillators (ICDs) often misunderstand the ICD. Advances in behavioral economics demonstrate that some misunderstandings may be due to cognitive biases. We aimed to explore the influence of cognitive bias on ICD decision making.
  
  
  RESULTS
  We used a qualitative framework analysis including 9 cognitive biases: affect heuristic, affective forecasting, anchoring, availability, default effects, halo effects, optimism bias, framing effects, and state dependence. We interviewed 48 patients from 4 settings in Denver. The majority were male (n = 32). Overall median age was 61 years. We found frequent evidence for framing, default, and halo effects; some evidence of optimism bias, affect heuristic, state dependence, anchoring and availability bias; and little or no evidence of affective forecasting. Framing effects were apparent in overestimation of benefits and downplaying or omitting potential harms.
  
  
  CONCLUSIONS
  We found evidence of cognitive bias in decision making for ICD implantation. The majority of these biases appeared to encourage ICD treatment.
authors.affiliation: Colorado Cardiovascular Outcomes Research Consortium, University of Colorado School of Medicine, Aurora, Colorado. Electronic address: daniel.matlock@ucdenver.edu.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Matlock
authors.affiliation: University of Colorado School of Nursing, Aurora, Colorado.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Jones
authors.affiliation: Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Carolyn T
authors.initials: CT
authors.lastname: Nowels
authors.affiliation: Colorado Cardiovascular Outcomes Research Consortium, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Amy
authors.initials: A
authors.lastname: Jenkins
authors.affiliation: Colorado Cardiovascular Outcomes Research Consortium, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.affiliation: Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Jean S
authors.initials: JS
authors.lastname: Kutner
mesh_terms: D000328:Adult; D000368:Aged; D003071:Cognition; D003657:Decision Making; D017147:Defibrillators, Implantable / Q000523:psychology* / Q000639:trends; D005260:Female; D006333:Heart Failure / Q000523:psychology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012189:Retrospective Studies
keywords: Catheter ablation and implantable cardioverter-defibrillator; health services; heart failure; quality and outcomes; sudden cardiac death