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PubMed1976

Order of information presentation and children's moral judgments.

It was hypothesized that age differences in use of intent information in children's moral judgments might be due to a recency effect in the judgments of younger children. A study was conducted to examine the effect of order of stimulus presentation on children's moral judgments. The information was presented to children, ages 4-5 and 8-9 years old, through stories with either normal information order, intent-consequence, or reversed order, consequence-intent. It was found that order has a significant impact on children's moral judgments. In addition, memory data were gathered which indicated that the pattern of forgetting was parallel to the pattern of information preference for the younger subjects. The findings suggested that younger subjects' relative neglect of intent in the normal order of information was based, in part, on their failure to remember the material correctly rather than on differential weighting of the 2 cues.

Age Factors↗
PubMed1992

Utilization of base-rate information during feeling-of-knowing judgments.

We examined whether subjects use base-rate information about item difficulty when making feeling-of-knowing judgments for items they failed to recall. First, the subjects attempted to recall the answers to general-information questions. Then, for those items they recalled incorrectly, half of the subjects received information about the normative probability of recall of each item while judging their feeling of knowing. The other subjects made their feeling-of-knowing judgments without receiving any base-rate information. Finally, all subjects had a forced-choice recognition test on those items to validate the accuracy of their feeling-of-knowing judgments. Relative to the no-base-rate information group, the base-rate group had lower feelings of knowing for normatively difficult items and higher feelings of knowing for normatively easier items. Subjects who had received base-rate information during the judgment state had greater feeling-of-knowing accuracy than subjects who did not receive base-rate information. However, even the predictions from subjects who received base-rate information were not significantly more accurate for predicting subsequent recognition than were the predictions derived from normative information alone.

Adult↗
PubMed2003

Facial appearance and judgments of credibility: the effects of facial babyishness and age on statement credibility.

Researchers have found that facial appearance influences social judgments. For example, evidence has shown that facial babyishness and age affect perceivers' impressions of the stimulus person's veracity. In this experiment, the researchers examined whether these variables also influenced the credibility attributed to written statements purportedly made by these people in addition to several topics of interest in deception-detection research. Undergraduates (N = 270) were presented babyfaced or mature-faced photographs that depicted a child, an adult, or an older individual, in addition to a written truthful or deceptive statement purportedly made by the person in the photograph. Results showed that, as predicted, when the statements were accompanied by babyfaced pictures, participants tended to judge them as truthful, but only if the pictures did not depict children. Also, when the statements were accompanied by childen's pictures, participants tended to judge them as deceptive, but only if the pictures depicted a babyish face. Overall detection accuracy was close to chance and did not correlate with either judgmental confidence or with the respondents' estimated lie-detection accuracy. However, confidence and estimated ability were significantly correlated. Also, more confidence was placed in judgments of truthfulness than in judgments of deceptiveness. Respondents' truth bias and the existence of a veracity effect in the diverse experimental conditions were examined as well.

Adolescent↗
PubMed2004

Nurse judgments of hallucinated voice descriptions: relevance for intervention.

The aim of the research was to explore the importance of 58 items of descriptive content represented on two parallel forms of an Inventory of Voice Experiences (IVE). A convenience sample of 317 well-educated psychiatric nurses rated descriptions of IVE item content three times over a period of six months according to how the content might relate to the selection of interventions for the management of verbal auditory hallucinations. Cronbach's alpha, Cohen's kappa, Pearson's r, and Bartko's intra-class correlation coefficients were used to measure the internal consistency of the nurses' judgments as well as the concordance of the judgments with a pre-selected standard. Findings from the study revealed modest-to-moderate support for internal consistency and overall equivalence of parallel item content represented on both forms of the IVE within and across three waves of data collection. Also revealed was a relative lack of concordance of the nurses' judgments with the pre-selected standard, and modest-but-consistent concordance of the nurses' original and subsequent judgments. Eight parallel items represented on the IVE demonstrated potential to serve as important cues for making decisions about intervention. This information shall be used to standardize the language and response categories of items tied to the IVE to permit more-definitive decisions about the management of verbal auditory hallucinations.

Attitude of Health Personnel↗
PubMed1991

Prevalence of illicit drug use among prenatal patients and predictive validity of nurses' judgments.

The purposes of this investigation were to: (1) estimate the prevalence of illicit drug use within the prenatal population of a midwestern suburban ambulatory care center; (2) explore the relationship between nurses' judgments of patient illicit drug use and urine toxicology results; and (3) determine if a difference exists between nurses' judgments of illicit drug use by private physicians' patients (PPP) and nurses' judgments of illicit drug use by resident physicians' patients (RPP). For a 16-week period, all new prenatal patients (N = 189) were included in this study; 78 (41%) were in the RPP group and 111 (59%) were in the PPP group. Urine remaining from routine urinalysis was assayed for seven drugs or drug classes. Fourteen (7.5%) subjects tested positive for illicit drugs, 8 (10.3%) in the RPP group, and 6 (5.4%) in the PPP group (chi 2, P greater than .33). Using a Likert-type scale, nurses rated the likelihood of a positive result of each patient's urine test. Nurses' judgments of patient illicit drug use and positive results were related, r = .28. Nurses were more likely (P less than .0001) to suspect residents' patients of illicit drug use than private physicians' patients.

Adult↗
PubMed1991

Can clinical judgment detect children with speech-language problems?

Pediatricians often rely on clinical judgment derived from observation or parental concern to identify children with developmental problems. The less popular but recommended alternative is to repeatedly administer standardized screening tests. Such tests are time consuming but, unlike clinical judgment, have known detection rates. Preliminary research concerning clinical judgment showed that clusters of parental concerns related to their childrens' performances on screening tests. In the present study, previous research was refined by assessment of the meaning of parents' concerns about their childrens' speech-language development. In this study of 157 families seeking pediatric care, 72% of children whose speech-language screening yielded positive results had parents who were concerned about their speech-language development. Of children with negative screening results, 83% had parents with no concerns about their speech-language development. Although standardized screening tests should be used occasionally in the developmental surveillance process, the findings show that the problems of most children with developmental problems were detected through clinical judgment based on parental concern.

Child↗
PubMed1978

When does a response error become a judgmental bias? Commentary on "Judged Frequency of Lethal Events".

The study of Lichtenstein, Slovic, Fischhoff, Layman, and Combs reports several types of errors in subjects' frequency judgments of lethal events. These errors are interpreted as reflecting the operation of two types of judgment biases. In this research, the objective or actual frequency of lethal events served as a standard of comparison; any deviation from this standard was defined as a bias. Thus, the research strategy used is apparently modeled after that of a psychophysicist using illusions to study basic perceptual processes. There is one key difference, however. In the case of illusions, the subject is directly exposed to the physical stimulus object. In the present study, however, subjects were never exposed to actual stimuli. Since subjects were asked to make judgments about things they had not directly experienced, it is not surprising that they would be inaccurate. But unlike the study of illusions, such inaccuracies have not been shown to have any necessary connection to psychological mechanisms. Therefore, it seems somewhat tenuous to offer psychological interpretations of judgmental biases when the origins of those biases have not yet been identified.

Female↗
PubMed1995

Critical thinking: the use of intuition in making clinical nursing judgments.

Making clinical nursing judgements is central to the practice of nursing, and critical thinking skills are essential to making clinical judgments. Qualitative studies have shown that the use of intuition in making clinical nursing judgments is an important part of the critical thinking process. This descriptive correlational study examines the relationships between the use of intuition in clinical judgment-making and characteristics of the nurse, such as level of nursing proficiency and years of clinical experience. Findings support Benner's (1984) model of skill acquisition as well as prior findings of studies on the use of intuition in clinical nursing practice. Thus, as the level of nursing proficiency increases from beginner to expert and as the amount of clinical experience increases, the use of intuition to make clinical nursing judgments increases significantly.

Adult↗
PubMedDate not supplied

Critical thinking and clinical judgment of professional nurses in a career mobility program.

This study's purpose was to establish the impact of a Career Advancement Program on critical thinking and clinical judgment of Registered Nurses. Findings of the study suggest that critical thinking and clinical judgment are not influenced by patterns of upward mobility. Additionally, an analysis did not indicate significant predictors in education, specialty area, or years of nursing experience related to scores. Whereas this study questions the efficacy of career mobility programs on critical thinking and clinical judgment, it does not measure the impact of career advancement programs on other key outcome variables. The study suggests nurse educators emphasize critical thinking and clinical judgment rather than transmission of information in educational offerings.

Career Mobility↗
PubMed1995

A simplified judgment system for medical informatics.

This report describes a new simplified judgment system which enables users to register appropriate judgment rules with ease and to apply them to a wide variety of medical problems. The rule utilized in this system is 3-AND-3-OR, quite a simple one. By applying this judgment rule to the data of as many as 60 items, judgment results of the individual on each item is given by four different grades or categories, namely: 1) normal, 2) borderline, 3) abnormal, and 4) severe. As many as 20 types can be obtained simultaneously. The simplicity of the algorithm allows medical users who are not the experts in computer technology to use this system on a DOS-based personal computer.

Algorithms↗
PubMed1996

Practice setting and physician influences on judgments of colon cancer treatment by community physicians.

OBJECTIVE: This article compares judgments about the treatment of Dukes' B2 and C colon cancer made by general surgeons to those of internists and family practitioners. Physician and practice variables were specialty, affiliation with a Community Clinical Oncology Program (CCOP) hospital, time in practice, professional centrality (level of participation in cancer information networks), solo practice, and number of colon cancer patients. DATA COLLECTION METHODS: Data are combined from national probability samples of CCOP- and non-CCOP-affiliated physicians. This study focused on 1,138 internists, family physicians, and general surgeons who participated in decision making for patients diagnosed with Dukes' B2 or C stage colon cancer. Judgments were elicited using brief vignettes. METHODS OF ANALYSIS: Judgments of adjuvant therapy are classified as (a) consistent with the National Institutes of Health Consensus Conference recommendations (experimental for Dukes' B2, accepted for Dukes' C); (b) accepted treatment for both stages; or (c) experimental for both stages. Multinomial logit analyses were used to examine the association of practice setting and physician characteristics to judgments of treatment. RESULTS: Surgeons and CCOP-affiliated physicians were more likely to endorse the NIH consensus conference position. Surgeons, younger physicians, and those in group practice were more likely to approve of chemotherapy for both cancer stages. The most common position (chemotherapy experimental) was more likely from nonsurgeons, solo practitioners, and non-CCOP physicians. CONCLUSION: Physician and practice setting characteristics, including organized structures such as the CCOP, are possible mediating structures that can facilitate dissemination of standards of treatment.

Clinical Protocols↗
PubMedDate not supplied

Futility and the varieties of medical judgment.

Pellegrino has argued that end-of-life decisions should be based upon the physician's assessment of the effectiveness of the treatment and the patient's assessment of its benefits and burdens. This would seem to imply that conditions for medical futility could be met either if there were a judgment of ineffectiveness, or if the patient were in a state in which he or she were incapable of a subjective judgment of the benefits and burdens of the treatment. I argue that a theory of futility according to Pellegrino would deny that latter but would permit some cases of the former. I call this the "circumspect" view. I show that Pellegrino would adopt the circumspect view because he would see the medical futility debate in the context of a system of medical ethics based firmly upon a philosophy of medicine. The circumspect view is challenged by those who would deny that one can distinguish objective from subjective medical judgments. I defend the circumspect view on the basis of a previously neglected aspect of the philosophy of medicine-an examination of varieties of medical judgment. I then offer some practical applications of this theory in clinical practice.

Dissent and Disputes↗
PubMed1998

Variations in physicians' judgments about corticosteroid induced osteoporosis by physician specialty.

OBJECTIVE: Longterm corticosteroid use is associated with an increased risk of osteoporosis and fractures. Calcium and vitamin D supplementation and estrogen replacement therapy can decrease this risk, but the majority of patients receiving longterm corticosteroid treatment do not receive treatments to prevent bone loss. We assess whether this is due to variations in physicians' judgments about risks and efficacy of treatments to prevent corticosteroid-induced osteoporosis. METHODS: Questionnaires were mailed to 425 physicians, who were sampled so that half were generalists and half were specialists. Physicians were given hypothetical clinical scenarios involving patients taking corticosteroids and asked to judge the importance of osteoporosis as a risk of corticosteroid treatment, the importance of discussing this side effect with patients, and to indicate how often they would use calcium with vitamin D and estrogen for a hypothetical postmenopausal patient receiving longterm corticosteroid treatment. RESULTS: In total 198 physicians (50%) responded to this survey. Most physicians rated osteoporosis as one of the 3 most significant side effects of corticosteroid treatment for postmenopausal women, but there was significant variation in physician judgments about the importance of corticosteroid induced osteoporosis for premenopausal women (p=0.03) and men (p=0.001). There was also significant variation in physician judgments about the importance of discussing osteoporosis as a side effect with patients (p=0.001), and their use of both calcium and vitamin D (p=0.002) and estrogen replacement therapy (p=0.001) for a hypothetical postmenopausal patient. The physician characteristics most associated with these differences were physician specialty and experience with corticosteroid use. Primary care physicians and physicians who more commonly prescribe corticosteroids were more likely to report that they would use estrogen and calcium to prevent corticosteroid induced bone loss. Physician age, sex, and university affiliation had no association with physician assessments. CONCLUSION: Physicians' judgments varied significantly by physician specialty and experience with corticosteroid use. These data suggest that patients cared for by physicians in different specialties will get varying advice about osteoporosis risk and preventive treatments when receiving longterm corticosteroid treatment.

Adrenal Cortex Hormones↗
PubMed2000

Impact of evidence-based "clinical judgment" on the number of American adults requiring lipid-lowering therapy based on updated NHANES III data. National Health and Nutrition Examination Survey.

BACKGROUND: When the National Cholesterol Education Program Adult Treatment Panel II (ATP II) guidelines were published, National Health and Nutrition Examination Survey III data for 1988 to 1991 were used to estimate the number of Americans requiring lipid-lowering therapy based on ATP II cut points. However, the guidelines recommend using clinical judgment to determine whether to initiate drug therapy in individuals whose low-density lipoprotein cholesterol levels remain above treatment goals with diet therapy but below the initiation level for drug therapy. METHODS: We analyzed updated (1988-1994) National Health and Nutrition Examination Survey III data, based on a sample of 6796 adults aged 20 years and older, to estimate the numbers of American adults with an elevated low-density lipoprotein cholesterol level and requiring drug therapy using cut points vs clinical judgment as specified in ATP II guidelines. RESULTS: Assuming a 10% low-density lipoprotein cholesterol reduction with diet, an estimated 10.4 million American adults require drug therapy based on ATP II cut points. If we include individuals for whom the guidelines recommend clinical judgment, the estimate increases to 28.4 million. The largest increase occurs in individuals without known coronary heart disease but with 2 or more risk factors: from 5.5 to 17.5 million. These high-risk individuals have low-density lipoprotein cholesterol concentrations similar to those in patients with coronary heart disease. CONCLUSIONS: Since the ATP II guidelines were published, clinical judgment has been informed by abundant clinical trial evidence establishing the safety and benefit of lipid-lowering therapy. The large number of individuals at high risk for coronary heart disease emphasizes the need for cost-effective therapy to extend treatment to the greatest number of individuals who may benefit.

Adult↗
PubMed1982

Public judgments of information in a diazepam patient package insert.

As part of a larger study of the effects of giving patients written take-home information with prescription medications, a "patient package insert" (PPI) for diazepam was prepared based on content determined by "experts." This report compares the experts' judgments of what information should be included with judgments obtained from the public. Information judged to be most important for inclusion in a PPI was identified by having subjects sort cards containing facts about diazepam. Subjects who had previously used diazepam were no different in their judgments than inexperienced subjects. In general, there was a high degree of concordance between public and expert judgments and also a remarkably strong consensus across very different demographic samples. In those few instances of disagreement, the public attached even greater importance to warnings and "bad news" about diazepam than to information providing reassurances, benign general education, and "good news." To what extent patients would effectively use this information--whether conveyed by PPIs or alternative educational routes--must await empirical evaluation.

Adult↗
PubMed1985

Hand movement quality: a neglected aspect of nonverbal behavior in clinical judgment and person perception.

Hand movement quality, the way in which human hand movements are executed in terms of circumference, velocity, and acceleration, seems to be very important both in terms of clinical diagnosis and in everyday person perception. This research studied movement quality by using objective physical measurements of movement parameters and subjective movement quality judgments and by comparing both approaches in terms of reliability and validity. This is done on the basis of clinical behavior samples that compared movements of psychiatric patients before and after therapy (N = 20). Results indicate that subjective judgments of movement quality are used reliably by lay judges and that these judgments are related closely to objective movement parameters. Some characteristics of movement quality seem to be important cues in clinical judgments of patients' improvement, although, objectively, movements do not differ before and after successful therapy.

Cues↗
PubMed1998

Effects of a Relative-Frequency Elicitation Question on Likelihood Judgment Accuracy: The Case of External Correspondence.

In three experiments, college students judged the likelihood that they chose the correct alternative for each of 40 two-alternative, general-knowledge items. They responded either to a relative-frequency elicitation question ("Out of 100 questions for which you felt this certain of the answer, how many would you answer correctly?") or to a probability elicitation question ("What is the probability that you chose the correct answer?"). Judgments in response to the relative-frequency elicitation question tended to be lower, exhibit less scatter, and express complete certainty less often than judgments in response to the probability elicitation question. Two types of explanation for these effects are considered. First, the effect of the relative-frequency elicitation question may be to reduce random response error in participants' likelihood judgments. Second, the relative-frequency elicitation question may encourage the use of frequency information and simpler algorithms for making likelihood judgments. Copyright 1998 Academic Press.

Journal Article↗
PubMed1999

Comparison Opportunity and Judgment Revision.

Prior evaluations are frequently challenged and need to be revised. We propose that an important determinant of such revisions is the degree to which the challenge provides an opportunity to compare the target against a competitor. Whenever a challenge offers an opportunity, the information contained in the challene will carry a disproportionate weight in the revised judgments. We call this proposition the comparison-revision hypothesis. In Experiments 1-3, we manipulated comparison opportunity by varying the format of the challenge and examined the weights assigned to different inputs in the revised judgments. The results indicate that prior information about the target receives a greater weight under a noncomparative challenge (which provides information only about the target) than under a comparative challenge (which compares the target with a competitor). In contrast, information presented in the challenge receives a greater weight under a comparative challenge than under a noncomparative challenge. Interestingly, when presented in a comparative format, the information contained in the challenge received a relatively disproportionate weight even when the attributes presented in the challenge were less important than those on which the prior target evaluations were based. Results from Experiment 4 suggest that, under certain conditions, even a noncomparative challenge from a superior competitor can provide strong comparison opportunity and thus cause greater revisions in the prior evaluations of the target. Specifically, a greater elaboration of the initial target information and a high degree of commensurability between the target and competitor information jointly promote comparison opportunity and thus cause greater revisions of the prior target judgments. Our findings offer important extensions to previous research on the effects of amount and elaboration of prior target information on subsequent judgment revision. Copyright 1999 Academic Press.

Journal Article↗