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PubMed2000

Mistakes on EUS staging of colorectal carcinoma: error in interpretation or deception from innate pathologic features?

BACKGROUND: Because endoscopic ultrasound (EUS) accuracy for staging gastrointestinal tract tumors is limited by many factors, this study was designed to analyze potential sources of error in the EUS staging of colorectal carcinoma. METHODS: All patients referred for EUS evaluation of colorectal carcinoma were staged prospectively by one ultrasonographer and retrospectively by two others with EUS videotape recordings. Pathologic staging was done independently in a blinded fashion. Deceptive pathologic features were defined for T staging by presence of inflammation extending beyond tumor or microscopic spread without inflammation extending to a level consistent with the next stage, and for N staging by large (> or = 10 mm) benign lymph nodes or small (< 10 mm) malignant lymph nodes. RESULTS: Of 22 patients entered into the study, an inflammatory reaction around microscopic tumor spread thought to actually enhance detection by EUS was present in 57.1% of cases. Nine deceptive pathologic lesions were present in 36.4% (8 of 22) of patients (5 T stage, 4 N stage lesions). Of 40 T and N stage mistakes made by the three physicians, 45% were made in the presence and 55% in the absence of deceptive pathologic lesions. Accuracy increased significantly from the presence to absence of deceptive pathologic lesions, from 53.3% to 83.7% (p = 0.029) for T stage, and 8.3% to 73. 1% for N stage (p = 0.0001). Confidence of T staging correlated significantly with accuracy, increasing from 63.3% when unsure to 88. 2% with staging certainty (p = 0.017), an effect not seen for N staging. CONCLUSIONS: Inflammation and desmoplasia around colorectal carcinoma are often present, but may actually enhance EUS detection of microscopic tumor spread. Deceptive pathologic lesions are present in only one third of patients, but account for almost half (45%) of the errors in T and N staging by EUS. Diagnostic accuracy for EUS was increased with confidence in T stage assessment (but not N stage) and in the absence of deceptive pathologic lesions. Errors in interpretation still accounted for the majority of mistakes (55%) made in EUS staging of colorectal carcinoma.

Adult↗
PubMed1997

Dimensions of deception in personality assessment: the example of the MMPI-2.

The topic of deception in personality assessment is discussed along a number of dimensions relevant to clinical practice. The dimensions described are consistency versus accuracy of item endorsement, simulation versus dissimulation, genetic versus specific deception, crude versus sophisticated deception, intentional versus nonintentional deception, self-deception versus impression management, and selectivity versus inclusiveness, as these may be encountered using the revised version of the Minnesota Multiphasic Personality Inventory. The emphasis is placed on deceptive strategies as operations as distinct from the traditional categories of response style such as social desirability. Directions for future research are indicated.

Journal Article↗
PubMed1994

Differentiation of truthful and deceptive criminal suspects in Behavior Analysis Interviews.

The Behavior Analysis Interview (BAI) is a commonly used procedure designed to assist investigators in distinguishing between suspects who are concealing their involvement in a criminal event (deceptive) from those who are not (truthful). During a BAI a protocol of questions is asked and suspects' verbal responses and accompanying nonverbal behaviors and attitudinal characteristics are assessed. Based on this assessment the likelihood of involvement in the criminal event is determined. The purpose of this study was to determine the effectiveness with which trained evaluators were able to distinguish between truthful and deceptive suspects undergoing BAIs. Sixty videotaped interviews, 30 of truthful and 30 of deceptive suspects, were observed by four evaluators, each of whom independently scored suspect's behaviors and attitudes and judged the suspect's truthfulness. The results showed that, excluding inconclusive decisions, evaluators' average accuracy on truthful suspects was 91% and on deceptive suspects, 80%. Suspects' status did not affect confidence of evaluators' decisions but confidence was greater when correct as opposed to incorrect calls were made. Deceptive suspects manifested "theoretically" predicted behaviors and attitudes of "deceptiveness" to a significantly greater degree than did truthful suspects. The BAI appears to be useful for investigative purposes in order to differentiate between suspects who are concealing involvement in a criminal offense from those who are not.

Adult↗
PubMed1989

Effects of deceptive self-reports of quitting on the results of treatment trials for smoking: a quantitative assessment.

Problems with self-report measures for smoking motivate the use of biochemical tests in treatment trials for smoking. These biochemical tests, unfortunately, are not perfect. In this paper, we present an algebraic model of bias in treatment trials for smoking. Bias is expressed in terms of the deception rate among continued smokers in a control group, the relative deception rate among continued smokers in an experimental group, and the sensitivity and specificity of a biochemical test which may be used either to confirm self-reports of quitting or to replace self-report entirely. For given test specificity and sensitivity, the model defines deception rates for which different biochemical testing strategies are preferred. The model is presented in the context of current knowledge on the phenomenon of deception among adult smokers. The paper concludes that better judgements regarding the role of biochemical tests in treatment trials for smoking require more precise information regarding the magnitude and determinants of deception.

Clinical Trials as Topic↗
PubMed2006

Anticipation skill and susceptibility to deceptive movement.

The ability to detect deceptive movement was examined in skilled and novice rugby players. Participants (14 per group) attempted to predict direction change from video of expert and recreational rugby players changing direction with and without deceptive movement. Confidence associated with judgments was recorded on each trial to seek evidence regarding use of inferential (heuristic-based) and direct-perceptual (invariant-based) judgments. Novices were found to be susceptible to deceptive movement whereas skilled participants were not; however, both skilled and novice participants were more confident on trials containing deceptive movement. The data suggest that the skill-level difference in sensitivity to advance visual information extends to deceptive information. The implications of this finding, and the importance of considering the underlying process of anticipation skill, are discussed.

Adult↗
PubMed2005

Deception and subtypes of aggression during early childhood.

A multi-informant study investigated the association between deception capacities and subtypes of aggression in a young early childhood sample (M = 44.65 months of age, SD = 13.39, N = 64). A newly developed teacher report of deception had appropriate psychometric properties (reliability, concurrent validity, and construct validity). Recently introduced observational methods of physical and relational aggression were reliable and valid with this sample. Findings indicated that both physical and relational aggression were associated with concurrent deception. For boys only, physical aggression uniquely predicted deception, controlling for the variance associated with relational aggression. In addition, relational aggression predicted deception above and beyond the role of physical aggression for the entire sample.

Aggression↗
PubMed2005

The influence of self-deception and impression management upon self-assessment in oral surgery.

OBJECTIVE: To see if poor self-assessment of surgical performance during removal of mandibular third molars is influenced by self-deception (lack of insight) and impression management (trying to convey a favourable impression). DESIGN: A prospective study of 50 surgeons, surgically removing a lower third molar tooth. SETTING: One UK dental school over a two year period. METHODS: The surgeons' surgical skills were assessed (by two assessors) and self-assessed using check-list and global rating scales. Post-operatively, surgeons completed validated deception questionnaires which measured both self-deception enhancement (lack of insight), and impression management (the tendency to deliberately convey a favourable impression). MAIN OUTCOME MEASURES: Reliability between assessors, and between assessors' and surgeons' self-assessments were calculated. Discrepancies between assessors' and surgeons' scores were correlated with surgeons' deception scores. RESULTS: Reliability between assessors was excellent for checklist (0.96) and global rating scales (0.89) and better than the reliability between assessors and surgeons (0.51 and 0.49). There was a statistically significant correlation (r=0.45 p=0.001 checklist, r= 0.48 p<0.001 global) between over/ under-rating of their surgical performance by surgeons and their impression management scores. No statistically significant correlation was found between this inaccuracy in self-assessment and surgeons' individual self-deception scores. CONCLUSION: The majority of surgeons scored themselves higher than their assessors did for surgical skill in removing a single mandibular third molar tooth. Impression management (the tendency to deliberately convey a favourable impression) may contribute to a surgeon's inaccurate self-reporting of performance. Lack of insight appears to be much less important as a contributing factor. The authors speculate that pressure to provide evidence of good performance may be encouraging surgeons to manage their image and over-score themselves.

Attitude of Health Personnel↗
PubMed2006

Online deception: prevalence, motivation, and emotion.

This research has three goals: first, to find out how prevalent online deception is within a sample of Israeli users, second, to explore the underlying motivations to deceive online, and third, to discover the emotions that accompany online deception. A web-based survey was distributed in 14 discussion groups, and the answers of 257 respondents were analyzed. It was found that, while most of the respondents believe that online deception is very widespread, only about one-third of them reported engaging in online deception. Frequent users deceive online more than infrequent users, young users more than old, and competent users more than non-competent. The most common motivations to deceive online were "play" on the one hand and privacy concerns on the other. Most people felt a sense of enjoyment while engaging in online deception. The results are discussed in light of a possible mechanism for changing personal moral standards.

Adolescent↗
PubMed1999

Hope and deception.

Convinced of hope's therapeutic benefits, physicians routinely support patients' false hopes, often with family collusion and vague, euphemistic diagnoses and prognoses, if not overt lies. Bioethicists charge them with paternalistic violations of Patient Autonomy. There are, I think, too many morally significant exceptions to accept the physician's rationales, or the bioethicist's criticisms, stated sweepingly. Physicians need to take account of the harms caused by loss of hopes, especially false hopes due to deception, as well as of the harms of successfully maintained deceptive hopes. As for autonomy, hopes -- even if based on deception -- can protect and enhance autonomy, understood broadly as the capacity to lead a chosen or embraced life. Deception aside, patients' hopes often rest on beliefs about possible rather than probable outcomes -- beliefs themselves supported by optimism, 'denial', or self-deception. Such 'possibility-hopes' may conflict with physicians' often more fact-sensitive 'probability hopes.' To resolve such conflicts physicians may try to 'down-shift' patients' or parents' hopes to lesser, more realistic hopes. Alternatively, physicians may alter or enlarge their own professional hopes to include the 'vital hopes' that define the lives of patients or parents, as well as 'survival hopes' needed to face and bear the loss of loved ones, especially children. A principle of Hope-giving might help guide such sympathetic hope-accommodations. More generally, it would give Hope a distinct place among Beneficence, Autonomy, and the other moral factors already highlighted by canonical principles of Medical Ethics. To formulate such a principle, however, we will need a collective Project Hope to pursue deeper philosophical and psychological studies.

Altruism↗
PubMed1999

[The effects of pleasantness of verbal messages on perceived deceptiveness in romantic relationships].

The present study examined the effects of pleasantness expressed in verbal messages on their perceived deceptiveness. The hypothesis was that pleasant messages are perceived as less deceptive than neutral or unpleasant ones. To test the hypothesis, three types of messages were constructed: pleasant, neutral, and unpleasant. Sixty-seven university students answered the questionnaire in which they rated, on seven-point semantic differential scales, perceived deceptiveness in one of the three types of messages. The result indicated that the unpleasant messages were perceived as the most deceptive, while the pleasant ones the least deceptive. The computer program "GPOWER" was used in order to obtain appropriate sample size.

Adult↗
PubMed2001

Differentiation of deception using pupillary responses as an index of cognitive processing.

The deception literature has predominantly focused on detection of guilty individuals using electrodermal measures. Little research has examined other psychophysiological measures or the mechanisms underlying deception. Therefore, the present study examined pupillary responses in a differentiation-of-deception paradigm. Twenty-four undergraduate participants answered the same questions twice, once truthfully and once deceptively, while pupillary responses were recorded. Questions were based on recently learned (episodic) information from scenarios or on general (semantic) knowledge from long-term memory. Task-evoked pupil dilation was significantly greater when participants confabulated responses than when they told the truth for both episodic and semantic memory questions. Previous research has demonstrated that pupil size increases with increased cognitive processing load. The present study suggested that generating deceptive recall was associated with increased pupil size and required greater cognitive processing than truthful recall.

Adult↗
PubMed1992

Deception. ACOG Committee opinion: Committee on Ethics number 87--November 1990.

Deception is the deliberate misrepresentation of facts through words or actions in order to make a person believe that which is not true. The forms deception can take include explicit lying, deception by implication, and deception by omission of information that patients need to make decisions in their own regard. Deception intended to advantage the physician economically or otherwise at the expense of the patient is unethical.

Conflict of Interest↗
PubMed1991

Volition, deception, and the evolution of justice.

Criminal justice is inextricably associated with the attributive concept of volition. Although the voluntary-involuntary distinction is subjectively vivid, causal research shows its poles to be inseparable, i.e., the dichotomy is deceptive. Why a bulwark of civilization should be founded on paradox, may be clarified by examining the role of self-deception in man's evolutionary heritage. Natural selection for an optimal degree of self-deception probably occurred, both to facilitate deception of others and to foster human cooperation. This contributed to the evolution of psychiatric disorders, the voluntary-involuntary continuum, and large scale social systems. Society and its members reach an equilibrium within the truth-deception continuum, manifest in individuals by conscious versus unconscious and voluntary versus involuntary, and in society by tension between what actually occurs (realism) and its organizing ideals (idealism). Three legal models of criminal justice are understood in this context: The (1) utilitarian, most realistic, is essential to social survival but vulnerable to abuse; (2) rehabilitative, at an opposite idealistic pole, better supports the image of social beneficence that helps to bind society's members; (3) retributive, most heavily grounded in volition, puts greater emphasis on individual autonomy, and reciprocally modulates the other models. All are legitimized by evolutionary traditions that antedate homo sapiens, and none is sufficient in itself. Elements of all three models necessarily coexist within any existing society, their relative strength varying with its collective values, prosperity, and perceived safety.

Criminal Law↗
PubMedDate not supplied

Should the nurse participate in planned deception?

Nurses encounter situations in their practice involving planned deception. A decision has been made that the deception will enhance the patient's welfare. For the deception to work, all who care for the patient must participate. To determine if planned deception is ethical, there is a need to consider ethical concerns related to promoting patient well-being, deception, respect for persons, and truthtelling. Before deciding what they ought to do nurses need to examine the various alternatives that are available.

Beneficence↗
PubMed1993

Is deception for reimbursement in obstetrics and gynecology justified?

Deceptive reporting to insurers of procedure indications to obtain reimbursement for non-covered services creates ethical and legal problems for practitioners. The motive for deceptive reporting is rooted in the expectation that any medical intervention recommended by the physician--even if of marginal benefit--should be covered. This traditional expectation collides with changing medical economics. Patient expectations of medical technology and insurance also promote deception. The deceptive physician fails to acknowledge a changed paradigm of medical economics, threatens his or her future practice, and does not model technical and ethical virtues to residents and students. Such deception preempts any possible dialogue with insurers that might result in coverage for a larger group of patients. The harmful outcomes of false reporting, present and future, far outweigh any temporary monetary gain for the patient or physician.

Deception↗
PubMed1998

The role of inhibitory processes in young children's difficulties with deception and false belief.

This research examines whether children's difficulties with deception and false belief arise from a lack of inhibitory control rather than from a conceptual deficit. In 3 studies, 3-year-olds deceived frequently under conditions requiring relatively low inhibitory control (e.g., misleading pictorial cues or arrows) but failed to do so under conditions of high inhibitory control (deceptive pointing). Study 2 ruled out that the findings were due to social intimidation: Children were equally successful using an arrow to deceive under anonymous and public conditions. Study 3 indicated that, under well-controlled conditions, children did not reveal greater understanding of false belief in deceptive than nondeceptive conditions. The results of these studies suggest that children may have greater deceptive abilities than some earlier studies indicated, and that the source of their difficulty on deceptive pointing tasks lies in a failure of inhibitory control. More generally, it is argued that children's performance on false belief tasks is also likely to be affected by inhibition deficits.

Child Development↗
PubMed1998

How children with head injury represent real and deceptive emotion in short narratives.

Narratives are not only about events, but also about the emotions those events elicit. Understanding a narrative involves not just the affective valence of implied emotional states, but the formation of an explicit mental representation of those states. In turn, this representation provides a mechanism that particularizes emotion and modulates its display, which then allows emotional expression to be modified according to particular contexts. This includes understanding that a character may feel an emotion but inhibit its display or even express a deceptive emotion. We studied how 59 school-aged children with head injury and 87 normally-developing age-matched controls understand real and deceptive emotions in brief narratives. Children with head injury showed less sensitivity than controls to how emotions are expressed in narratives. While they understood the real emotions in the text, and could recall what provoked the emotion and the reason for concealing it, they were less able than controls to identify deceptive emotions. Within the head injury group, factors such as an earlier age at head injury and frontal lobe contusions were associated with poor understanding of deceptive emotions. The results are discussed in terms of the distinction between emotions as felt and emotions as a cognitive framework for understanding other people's actions and mental states. We conclude that children with head injury understand emotional communication, the spontaneous externalization of real affect, but not emotive communication, the conscious, strategic modification of affective signals to influence others through deceptive facial expressions.

Adolescent↗
PubMed1988

Double-blind versus deceptive administration of a placebo.

Subjects were given varying doses of a placebo, consisting of decaffeinated coffee, with double-blind or deceptive instructions. Deceptive administration simulated clinical situations in that subjects were led to believe that they were receiving an active drug. In contrast, subjects in double-blind conditions were aware that they might receive a placebo. Double-blind and deceptive administration of the placebo produced different, and in some instances, opposite effects on pulse rate, systolic blood pressure, and subjective mood. Deceptive administration produced an increase in pulse rate, whereas double-blind administration did not. A theoretically predicted curvilinear effect on systolic blood pressure, alertness, tension, and certainty of having consumed caffeine was confirmed with deceptive administration, but not with double-blind administration. Double-blind administration produced curves in the opposite direction on each of these variables. The effects of the placebo on motor performance varied as a function of subject's beliefs about the effects of caffeine. These data challenge the validity of double-blind experimental designs and suggest that this common method of drug assessment may lead to spurious conclusions.

Adolescent↗