Regulatory focus as a predictor of omission bias in moral judgment: Mediating role of anticipated regrets

Omission bias occurs when people are more reluctant to accept negative consequences caused by their actions than by their inaction. Recent research on omission bias in decision‐making has found evidence for individual differences, thus indicating that some people are more likely to show omission inclination than others. The present research aims to explore the role of regulatory focus as individual difference variables in omission bias. Moreover, we examine whether anticipated regret mediates the relationship between regulatory focus and moral judgement. Moral judgement tasks utilized include: (i) moral dilemma scenarios (Study 1); and (ii) ethical scenarios embracing apparent legal rule violations (Study 2). The results of both studies show that only prevention focus is significantly related to omission bias in moral judgement. Specifically, this relationship holds regardless of the nature of the ‘omission’ (whether they are deontological or utilitarian). In addition, anticipated regret/guilt for action was found to mediate the relationship between prevention focus and omission bias. Implications and limitations are discussed based on the results of the current study.     

Untapped Potential: Psychologists Leading Research in Clinical Practice

Enhancing the capacity of allied health professionals to engage in research is central to improving healthcare delivery. Psychologists have research skills given their training focus that emphasises the scientist‐practitioner model. We aimed to investigate among psychologists the link between individual research capacity and their current level of research activity, how this compares with other allied health professions, and the role of team and organisation research capacity. Psychologists (n = 60) working in clinical roles in a large metropolitan public health setting completed an online survey consisting of the validated Research Capacity and Culture tool, and questions related to current research activities, barriers, and motivators. The results indicated that psychologists reported relatively high individual research capacity, higher than both team and organisation levels, and greater individual research capacity compared with studies of dietitians and a mixed group of allied health. Preliminary findings suggested that team research capacity mediated the link between individual research capacity and the level of current research activity. Finally, barriers and motivators to research activity were similar compared with studies of other allied health professions. Overall, a multi‐strategy approach that focuses on and facilitates practice‐based and interdisciplinary research, and enhances the leadership skills of psychologists in research, as well as broader efforts from an organisational perspective to build a strong and sustainable research culture, may contribute to the rapid use of research skills in clinical practice and improve health and healthcare delivery.     

Patient Perspectives on the Learning Health System: The Importance of Trust and Shared Decision Making

We conducted focus groups to assess patient attitudes toward research on medical practices in the context of usual care. We found that patients focus on the implications of this research for their relationship with and trust in their physicians. Patients view research on medical practices as separate from usual care, demanding dissemination of information and in most cases, individual consent. Patients expect information about this research to come through their physician, whom they rely on to identify and filter associated risks. In general, patients support this research, but worry that participation in research involving randomization may undermine individualized care that acknowledges their unique medical histories. These findings suggest the need for public education on variation in practice among physicians and the need for a collaborative approach to the governance of research on medical practices that addresses core values of trust, transparency, and partnership.     

Social Judgement Theory and Medical Judgement

Social judgement theory is particularly well suited to the study of medical judgements. Medical judgements characteristically involve decision making under uncertainty with inevitable error and an abundance of fallible cues. In medicine, as in other areas, SJT research has found wide variation among decision makers in their judgements and in the weighting of clinical information. Strategies inferred from case vignettes differ from physicians' self-described strategies and from the weights suggested by experts. These observations parallel recent findings of unexplained variation in diagnosis and management in clinical practice that have been the source of concern in the medical community. The lens model provides one of the few methods for quantitatively analysing physicians' judgements. Contrary to what one might expect from the variation in strategies on paper cases, several studies suggest that, in practice, physicians' diagnostic judgements are highly accurate. Cognitive feedback has been less successful as a practical teaching tool than originally hoped, but some aspects of this methodology show promise, particularly in conjunction with the increasing emphasis on statistical decision support. All things considered, SJT has provided insight into physicians' decisions and gives the medical research community important tools for studying judgements in actual practice.     

‘Radical Interpretation’ and the Assessment of Decision‐Making Capacity

The assessment of patients' decision‐making capacity (DMC) has become an important area of clinical practice, and since it provides the gateway for a consideration of non‐consensual treatment, has major ethical implications. Tests of DMC such as under the Mental Capacity Act (2005) for England and Wales aim at supporting autonomy and reducing unwarranted paternalism by being ‘procedural’, focusing on how the person arrived at a treatment decision. In practice, it is difficult, especially in problematic or borderline cases, to avoid a consideration of beliefs and values; that is, of the substantive content of ideas rather than simple ‘cognitive’ or procedural abilities. However, little attention has been paid to how beliefs and values might be assessed in the clinical context and what kind of ‘objectivity’ is possible. We argue that key aspects of Donald Davidson's ideas of ‘Radical Interpretation’ and the ‘Principle of Charity’ provide useful guidance as to how clinicians might approach the question of whether an apparent disturbance in a person's thinking about beliefs or values undermines their DMC. A case example is provided, and a number of implications for clinical practice are discussed.     

Modeling the Covariance Structure of Complex Datasets Using Cognitive Models: An Application to Individual Differences and the Heritability of Cognitive Ability

Understanding individual differences in cognitive performance is an important part of understanding how variations in underlying cognitive processes can result in variations in task performance. However, the exploration of individual differences in the components of the decision process—such as cognitive processing speed, response caution, and motor execution speed—in previous research has been limited. Here, we assess the heritability of the components of the decision process, with heritability having been a common aspect of individual differences research within other areas of cognition. Importantly, a limitation of previous work on cognitive heritability is the underlying assumption that variability in response times solely reflects variability in the speed of cognitive processing. This assumption has been problematic in other domains, due to the confounding effects of caution and motor execution speed on observed response times. We extend a cognitive model of decision‐making to account for relatedness structure in a twin study paradigm. This approach can separately quantify different contributions to the heritability of response time. Using data from the Human Connectome Project, we find strong evidence for the heritability of response caution, and more ambiguous evidence for the heritability of cognitive processing speed and motor execution speed. Our study suggests that the assumption made in previous studies—that the heritability of cognitive ability is based on cognitive processing speed—may be incorrect. More generally, our methodology provides a useful avenue for future research in complex data that aims to analyze cognitive traits across different sources of related data, whether the relation is between people, tasks, experimental phases, or methods of measurement.     

TOWARD NARROWING THE RESEARCH-PRACTICE GAP IN PERFORMANCE APPRAISAL

Recently, performance appraisal researchers have adopted a cognitive approach to analyzing judgment processes in performance appraisal. While this approach allows researchers to tap a wealth of knowledge applicable to the appraisal context, this line of research is likely to widen the already existing gap between research and practice. We argue that coordination of the talents of researchers and practitioners is essential for narrowing the gap. Specifically, we suggest researchers focus their research on the best methods of ensuring use of relevant and valid data in appraisal, given organizational constraints. We also suggest practitioners focus on determining observable and measurable aspects of performance, and thus, specify appropriate appraisal content. We also note that cognitive process research has promise for increasing raters' ability to judge accurately, but that this approach does not necessarily address the rater's willingness to provide accurate ratings.     

The dependency of the validity of information integration on cognitive variables and the judgement task

Simple models of information integration focus essentially on the combination of the components of information. This research investigated whether cognitive variables in the constructs of intelligence and cognitive complexity, as well as concentration, could predict the conditions of simple models of judgement. As additional predictors, the two qualitative variables [type of information] and [experience of the judgement task] were introduced. Subjects judged three types of stimuli using the pair comparison method. The conditions of the judgement models were analysed in the framework of the conjoint-measurement approach. Five different regression functions provided mediocre approximations to the 10 conditions of the models, when the 9 cognitive variables were considered. The small differences did not favour one of the five functions. The introduction of the qualitative predictor [type of information] improved the estimations more clearly than the experience of the judgement task, the effect of which was small.     

Neurocognitive Impairment: Addressing Couple and Family Challenges

Conditions involving neurocognitive impairment pose enormous challenges to couples and families. However, research and practice tend to focus narrowly on immediate issues for individual caregivers and their dyadic relationship with the affected member. A broad family systems approach with attention to family processes over time is needed in training, practice, and research. In this paper, Rolland's Family Systems Illness model provides a guiding framework to consider the interaction of different psychosocial types of neurocognitive conditions and their evolution over time with individual, couple, and family life‐course development. Discussion addresses key family and couple issues with mild‐to‐severe cognitive impairment and progressive dementias, including: communication, multigenerational legacies, threatened future neurocognitive disability, ambiguous loss, decisional capacity, reaching limits, placement decisions, issues for adult children and spousal caregivers, and the transformation of intimate bonds. Principles and guidelines are offered to help couples and families master complex challenges, deepen bonds, and forge positive pathways ahead.     

Is consent for research genuinely informed? Using decision aid tools to obtain informed consent in the global south

Gaining informed consent among marginalized groups that include decisionally incapacitated individuals and those outside of the researcher's own geo-social and ethnic background still challenges many researchers. We suggest that there is a need for consideration of a different approach to research ethics in international settings. Based on extensive field work in West Africa on medical knowledge transfers and patient–healer relationships, this paper will discuss the challenges posed in obtaining informed individual consent in international settings. It is argued that while being on the whole convincing, the top-down approach of the proposed solutions, which clearly dominates the participative approach, fails in building sustainable capacity, decision-making competency, and empowerment in the communities in which the research is conducted. Using appropriate decision aids can help resolve these issues.     

ASSESSING THE CANDIDATE AS A WHOLE: A HISTORICAL AND CRITICAL ANALYSIS OF INDIVIDUAL PSYCHOLOGICAL ASSESSMENT FOR PERSONNEL DECISION MAKING

Although individual assessment is a thriving area of professional practice in industry, it receives little, if any, attention from textbooks on industrial psychology or personnel management. This article is an attempt to establish individual assessment's place in the history of personnel selection, and to examine why the practice has survived despite receiving little attention in research and graduate training. It is argued that the clinical, holistic approach that has characterized individual-assessment practice has survived primarily because the "elementalistic" testing approach, focusing on traits and abilities, has often been dismissed as inadequate for addressing the complexities of the executive profile. Moreover, public displeasure with standard paper-and-pencil testing in the 1960s and 1970s made the holistic approach to assessment an attractive, alternative. The article contrasts individual assessment practice with the current state of knowledge on psychological assessment and personnel decision making. Like psychotherapy in the 1950s, individual psychological assessment appears to have achieved the status of functional autonomy within psychology.     

Investigating medical decision‐making capacity in patients with cognitive impairment using a protocol based on linguistic features

A critical question is whether cognitively impaired patients have the competence for autonomous decisions regarding participation in clinical trials. The present study aimed to investigate medical decision‐making capacity by use of a Swedish linguistic instrument for medical decision‐making (LIMD) in hypothetical clinical trials in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). Three comparable groups (age, education) participated in the study: AD (n = 20; MMSE: 24.1 ± 3.3) and MCI (n = 22; MMSE: 26.7 ± 2.4) patients and healthy controls (n = 37; MMSE: 29.1 ± 1.0). Medical decision‐making capacity was operationalized as answers to questions regarding participation in three hypothetical clinical trials. Answers were scored regarding comprehension, evaluation and intelligibility of decisions, and a total LIMD score was used as the measure of medical decision‐making ability. Groups differed significantly in LIMD with AD patients performing worst and MCI poorer than the control group. A strong association was found between all LIMD scores and diagnosis which supported the assertion that LIMD as it is designed is a one‐dimensional instrument of medical decision‐making capacity (MDMC). The results indicate that a fundamental communicative ability has an impact on the competence for autonomous decisions in cognitive impairment.     

Modeling Intraindividual Cognitive Change in Aging Adults: Results from the Einstein Aging Studies

This paper reviews research from the longitudinal Einstein Aging Studies (EAS) that has focused on modeling intraindividual cognitive change in aging adults. We describe how to separate models of intraindividual change at the within-person level from models of individual differences in change at the between-person level. We illustrate this distinction by analyzing new data from the EAS to test the speed hypothesis at the intraindividual level of analyses. The present findings replicate those of Sliwinski and Buschke (1999) by showing that within-person changes in speed predict within-person changes in cognition, but that speed does not substantially attenuate estimates of within-person cognitive decline. We conclude that correct measurement and explanatory modeling of intraindividual change should be the primary focus of longitudinal aging research, and that the more common practice of modeling individual differences in change should be a secondary focus.     

Judgement bias in pigs is independent of performance in a spatial holeboard task and conditional discrimination learning

Biases in judgement of ambiguous stimuli, as measured in a judgement bias task, have been proposed as a measure of the valence of affective states in animals. We recently suggested a list of criteria for behavioural tests of emotion, one of them stating that responses on the task used to assess emotionality should not be confounded by, among others, differences in learning capacity, i.e. must not simply reflect the cognitive capacity of an animal. We performed three independent studies in which pigs acquired a spatial holeboard task, a free choice maze which simultaneously assesses working memory and reference memory. Next, pigs learned a conditional discrimination between auditory stimuli predicting a large or small reward, a prerequisite for assessment of judgement bias. Once pigs had acquired the conditional discrimination task, optimistic responses to previously unheard ambiguous stimuli were measured in the judgement bias task as choices indicating expectation of the large reward. We found that optimism in the judgement bias task was independent of all three measures of learning and memory indicating that the performance is not dependent on the pig’s cognitive abilities. These results support the use of biases in judgement as proxy indicators of emotional valence in animals.     

Feelings or words? Understanding the content in self-report ratings of experienced emotion

People differ in the extent to which their verbal reports of experienced emotion are valence focused or arousal focused. Three multimethod studies are reported to explore whether differential focus reflects individual differences in the cognitive structure of emotion language versus differences in phenomenological experience. Although there was some evidence that valence focus and arousal focus were linked to variations differences in cognitive structure, the findings are also consistent with the view that self-report ratings are being driven by the properties of the feelings that are being reported. Implications for the study of experienced emotion are discussed.     

Le jugement clinique en contexte d’évaluation du potentiel et des compétences au travail : Quelle est sa valeur prédictive et peut-il être formalisé ?

This study intends (1) to investigate the predictive validity of clinical (integrative) judgement based on personality data collected in psychological assessment and (2) to verify the capacity of assessors to formalize their judgment in a standardised algorithm. Three psychologists had the task to predict results of 78 managers on multisource assessment measuring two performance criteria (results orientation and relationship building). Results show that the psychologists’ integrative judgement predicts one of performance criteria up to .39. However, it appears that the standardisation of their judgment in mechanic decision rules was less predictive of performance criteria than their global clinical judgement. Overall, this research suggests there is still much to understand in the interpretative process.     

Why older adults make more immediate treatment decisions about cancer than younger adults

Literature relevant to medical decision making was reviewed, and a model was outlined for testing. Two studies examined whether older adults make more immediate decisions than younger adults about treatments for prostate or breast cancer in authentic scenarios. Findings clearly showed that older adults were more likely to make immediate decisions than younger adults. The research is important because it not only demonstrates the consistency of this age-related effect across disease domains, gender, ethnic groups, and prevalent education levels but begins to investigate a model to explain the effect. Major reasons for the effect focus on treatment knowledge, interest and engagement, and cognitive resources. Treatment knowledge, general cancer knowledge, interest, and cognitive resources relate to different ways of processing treatment information and preferences for immediate versus delayed decision making. Adults with high knowledge of treatments on a reliable test tended to make immediate treatment decisions, which supports the knowledge explanation. Adults with more cognitive resources and more interest tended to delay their treatment decisions. Little support was found for a cohort explanation for the relationship between age and preference for immediate medical decision making.     

Naturalistic Recovery From Nonsuicidal Self‐Injury: A Phenomenological Inquiry

The authors conducted a phenomenological inquiry of 12 individuals who recovered from nonsuicidal self‐injury without psychotherapeutic or medical intervention. Results indicated that participants’ naturalistic recovery emanated from their recognition of serious physical damage, corrective interpersonal influences, and movement from unhealthy to healthy surroundings. Implications of these findings for clinical practice and future research are discussed.     

The Default Position: Optimizing Pediatric Participation in Medical Decision Making

Inclusion of children in medical decision making, to the extent of their ability and interest in doing so, should be the default position, ensuring that children are routinely given a voice. However, optimizing the involvement of children in their health care decisions remains challenging for clinicians. Missing from the literature is a stepwise approach to assessing when and how a child should be included in medical decision making. We propose a systematic approach for doing so, and we apply this approach in a discussion of two challenging clinical cases. The approach is informed by a literature review, and is anchored by case studies of teenagers' refusal of clinical care, regulatory requirements for research assent, and the accepted approach to involving cognitively impaired adults in medical decisions.