Bridging the gap between science and decision making.
ABSTRACT: All decisions, whether they are personal, public, or business-related, are based on the decision maker's beliefs and values. Science can and should help decision makers by shaping their beliefs. Unfortunately, science is not easily accessible to decision makers, and scientists often do not understand decision makers' information needs. This article presents a framework for bridging the gap between science and decision making and illustrates it with two examples. The first example is a personal health decision. It shows how a formal representation of the beliefs and values can reflect scientific inputs by a physician to combine with the values held by the decision maker to inform a medical choice. The second example is a public policy decision about managing a potential environmental hazard. It illustrates how controversial beliefs can be reflected as uncertainties and informed by science to make better decisions. Both examples use decision analysis to bridge science and decisions. The conclusions suggest that this can be a helpful process that requires skills in both science and decision making.
Project description:An important category of seemingly maladaptive decisions involves failure to postpone gratification. A person pursuing a desirable long-run outcome may abandon it in favor of a short-run alternative that has been available all along. Here we present a theoretical framework in which this seemingly irrational behavior emerges from stable preferences and veridical judgments. Our account recognizes that decision makers generally face uncertainty regarding the time at which future outcomes will materialize. When timing is uncertain, the value of persistence depends crucially on the nature of a decision maker's prior temporal beliefs. Certain forms of temporal beliefs imply that a delay's predicted remaining length increases as a function of time already waited. In this type of situation, the rational, utility-maximizing strategy is to persist for a limited amount of time and then give up. We show empirically that people's explicit predictions of remaining delay lengths indeed increase as a function of elapsed time in several relevant domains, implying that temporal judgments offer a rational basis for limiting persistence. We then develop our framework into a simple working model and show how it accounts for individual differences in a laboratory task (the well-known "marshmallow test"). We conclude that delay-of-gratification failure, generally viewed as a manifestation of limited self-control capacity, can instead arise as an adaptive response to the perceived statistics of one's environment.
Project description:BACKGROUND:Chile and Colombia are examples of Latin American countries with health systems shaped by similar values. Recently, both countries have crafted policies to regulate the participation of private for-profit insurance companies in their health systems, but through very different mechanisms. This study asks: what values are important in the decision-making processes that crafted these policies? And how and why are they used? METHODS:An embedded multiple-case study design was carried out for 2 specific decisions in each country: (1) in Chile, the development of the Universal Plan of Explicit Entitlements -AUGE/GES - and mandating universal coverage of treatments for high-cost diseases; and (2) in Colombia, the declaration of health as a fundamental right and a mechanism to explicitly exclude technologies that cannot be publicly funded. We interviewed key informants involved in one or more of the decisions and/or in the policy analysis and development process that contributed to the eventual decision. The data analysis involved a constant comparative approach and thematic analysis for each case study. RESULTS:From the 40 individuals who were invited, 28 key informants participated. A tension between 2 important values was identified for each decision (eg, solidarity vs. individualism for the AUGE/GES plan in Chile; human dignity vs. sustainability for the declaration of the right to health in Colombia). Policy-makers used values in the decisionmaking process to frame problems in meaningful ways, to guide policy development, as a pragmatic instrument to make decisions, and as a way to legitimize decisions. In Chile, values such as individualism and free choice were incorporated in decision-making because attaining private health insurance was seen as an indicator of improved personal economic status. In Colombia, human dignity was incorporated as the core value because the Constitutional Court asserted its importance in its use of judicial activism as a check on the power of the executive and legislative branches. CONCLUSION:There is an opportunity to open further exploration of the role of values in different health decisions, political sectors besides health, and even other jurisdictions.
Project description:BACKGROUND: Patient decision aids support people to make informed decisions between healthcare options. Personal stories provide illustrative examples of others' experiences and are seen as a useful way to communicate information about health and illness. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in non-narrative prose. It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions. METHODS: A survey of primary empirical research employing a systematic review method investigated the effect of patient decision aids with or without a personal story on people's healthcare judgements and decisions. Searches were carried out between 2005-2012 of electronic databases (Medline, PsycINFO), and reference lists of identified articles, review articles, and key authors. A narrative analysis described and synthesised findings. RESULTS: Of 734 citations identified, 11 were included describing 13 studies. All studies found participants' judgments and/or decisions differed depending on whether or not their decision aid included a patient story. Knowledge was equally facilitated when the decision aids with and without stories had similar information content. Story-enhanced aids may help people recall information over time and/or their motivation to engage with health information. Personal stories affected both "system 1" (e.g., less counterfactual reasoning, more emotional reactions and perceptions) and "system 2" (e.g., more perceived deliberative decision making, more stable evaluations over time) decision-making strategies. Findings exploring associations with narrative communications, decision quality measures, and different levels of literacy and numeracy were mixed. The pattern of findings was similar for both experimental and real-world studies. CONCLUSIONS: There is insufficient evidence that adding personal stories to decision aids increases their effectiveness to support people's informed decision making. More rigorous research is required to elicit evidence about the type of personal story that a) encourages people to make more reasoned decisions, b) discourages people from making choices based on another's values, and c) motivates people equally to engage with healthcare resources.
Project description:The aim of this article is to explore how personal values and the role of the representative influence representation principles when making decisions in natural resource management. This was tested in an empirical case of wildlife management in Sweden, the regional Wildlife Conservation Committees (WCCs). These WCCs consist of a mix of actors in collaborative settings, where both politicians and interest organization representatives make decisions on wildlife related issues. The results show that the value dimension of self-enhancement, associated with giving importance to values such as achievement and power, significantly affects a representational style associated with following the representative's personal preferences when making decisions, the trustee principle. The role of the representative also significantly affects representational style when making decisions in these cases, where the interest organizational representatives more often follow the party principle, i.e., the view of the parties or organization they represent, than the political actors. Age also had a significant impact where older representatives relied more on the trustee principle than their younger peers. The implications of these results are that personal values in this case matters for decision-making, which is in line with earlier research on decision-making on environmental issues. Further, politicians behave atypically for the Swedish context relying more on the trustee principle rather than the party principle, which policy makers should take into consideration when designing collaborative arenas similar to the WCCs.
Project description:Collective intelligence refers to the ability of groups to outperform individuals in solving cognitive tasks. Although numerous studies have demonstrated this effect, the mechanisms underlying collective intelligence remain poorly understood. Here, we investigate diversity in cue beliefs as a mechanism potentially promoting collective intelligence. In our experimental study, human groups observed a sequence of cartoon characters, and classified each character as a cooperator or defector based on informative and uninformative cues. Participants first made an individual decision. They then received social information consisting of their group members' decisions before making a second decision. Additionally, individuals reported their beliefs about the cues. Our results showed that individuals made better decisions after observing the decisions of others. Interestingly, individuals developed different cue beliefs, including many wrong ones, despite receiving identical information. Diversity in cue beliefs, however, did not predict collective improvement. Using simulations, we found that diverse collectives did provide better social information, but that individuals failed to reap those benefits because they relied too much on personal information. Our results highlight the potential of belief diversity for promoting collective intelligence, but suggest that this potential often remains unexploited because of over-reliance on personal information.
Project description:Daniels, Porteny and Urrutia et al make a good case for the idea that that public decisions ought to be made not only "in the light of" evidence but also "on the basis of" budget impact, financial protection and equity. Health technology assessment (HTA) should, they say, be accordingly expanded to consider matters additional to safety and cost-effectiveness. They also complain that most HTA reports fail to develop ethical arguments and generally do not even mention ethical issues. This comment argues that some of these defects are more apparent than real and are not inherent in HTA - as distinct from being common characteristics found in poorly conducted HTAs. More generally, HTA does not need "extension" since (1) ethical issues are already embedded in HTA processes, not least in their scoping phases, and (2) HTA processes are already sufficiently flexible to accommodate evidence about a wide range of factors, and will not need fundamental change in order to accommodate the new forms of decision-relevant evidence about distributional impact and financial protection that are now starting to emerge. HTA and related techniques are there to support decision-makers who have authority to make decisions. Analysts like us are there to support and advise them (and not to assume the responsibilities for which they, and not we, are accountable). The required quality in HTA then becomes its effectiveness as a means of addressing the issues of concern to decision-makers. What is also required is adherence by competent analysts to a standard template of good analytical practice. The competencies include not merely those of the usual disciplines (particularly biostatistics, cognitive psychology, health economics, epidemiology, and ethics) but also the imaginative and interpersonal skills for exploring the "real" question behind the decision-maker's brief (actual or postulated) and eliciting the social values that necessarily pervade the entire analysis. The product of such exploration defines the authoritative scope of an HTA.
Project description:Human decision-making is driven by subjective values assigned to alternative choice options. These valuations are based on reward cues. It is unknown, however, whether complex reward cues, such as brand logos, may bias the neural encoding of subjective value in unrelated decisions. In this functional magnetic resonance imaging (fMRI) study, we subliminally presented brand logos preceding intertemporal choices. We demonstrated that priming biased participants' preferences towards more immediate rewards in the subsequent temporal discounting task. This was associated with modulations of the neural encoding of subjective values of choice options in a network of brain regions, including but not restricted to medial prefrontal cortex. Our findings demonstrate the general susceptibility of the human decision making system to apparently incidental contextual information. We conclude that the brain incorporates seemingly unrelated value information that modifies decision making outside the decision-maker's awareness.
Project description:Collective intelligence refers to the ability of groups to outperform individual decision-makers. At present, relatively little is known about the mechanisms promoting collective intelligence in natural systems. We here test a novel mechanism generating collective intelligence: self-organization according to information quality. We tested this mechanism by performing simulated predator detection experiments using human groups. By continuously tracking the personal information of all members prior to collective decisions, we found that individuals adjusted their response time during collective decisions to the accuracy of their personal information. When individuals possessed accurate personal information, they decided quickly during collective decisions providing accurate information to the other group members. By contrast, when individuals had inaccurate personal information, they waited longer, allowing them to use social information before making a decision. Individuals deciding late during collective decisions had an increased probability of changing their decision leading to increased collective accuracy. Our results thus show that groups can self-organize according to the information accuracy of their members, thereby promoting collective intelligence. Interestingly, we find that individuals flexibly acted both as leader and as follower depending on the quality of their personal information at any particular point in time.
Project description:People often make decisions in a social environment. The present work examines social influence on people's decisions in a sequential decision-making situation. In the first experimental study, we implemented an information cascade paradigm, illustrating that people infer information from decisions of others and use this information to make their own decisions. We followed a cognitive modeling approach to elicit the weight people give to social as compared to private individual information. The proposed social influence model shows that participants overweight their own private information relative to social information, contrary to the normative Bayesian account. In our second study, we embedded the abstract decision problem of Study 1 in a medical decision-making problem. We examined whether in a medical situation people also take others' authority into account in addition to the information that their decisions convey. The social influence model illustrates that people weight social information differentially according to the authority of other decision makers. The influence of authority was strongest when an authority's decision contrasted with private information. Both studies illustrate how the social environment provides sources of information that people integrate differently for their decisions.
Project description:Cost-effectiveness analysis (CEA) is increasingly important in public health decision making, including in low- and middle-income countries. The decision makers' valuation of a unit of health gain, or ceiling ratio (lambda), is important in CEA as the relative value against which acceptability is defined, although values are usually chosen arbitrarily in practice. Reference case estimates for lambda are useful to promote consistency, facilitate new developments in decision analysis, compare estimates against benefit-cost ratios from other economic sectors, and explicitly inform decisions about equity in global health budgets. The aim of this article is to discuss values for lambda used in practice, including derivation based on affordability expectations (such as $US150 per disability-adjusted life-year [DALY]), some multiple of gross national income or gross domestic product, and preference-elicitation methods, and explore the implications associated with each approach. The background to the debate is introduced, the theoretical bases of current values are reviewed, and examples are given of their application in practice. Advantages and disadvantages of each method for defining lambda are outlined, followed by an exploration of methodological and policy implications.