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PubMed2002

Do juries meet our expectations?

Surveys of public opinion indicate that people have high expectations for juries. When it comes to serious crimes, most people want errors of convicting the innocent (false positives) or acquitting the guilty (false negatives) to fall well below 10%. Using expected utility theory, Bayes' Theorem, signal detection theory, and empirical evidence from detection studies of medical decision making, eyewitness testimony, and weather forecasting, we argue that the frequency of mistakes probably far exceeds these "tolerable" levels. We are not arguing against the use of juries. Rather, we point out that a closer look at jury decisions reveals a serious gap between what we expect from juries and what probably occurs. When deciding issues of guilt and/or punishing convicted criminals, we as a society should recognize and acknowledge the abundance of error.

Bayes Theorem↗
PubMed1998

Treatment decision making and adjustment to breast cancer: a longitudinal study.

This study monitored women (N = 76) with breast cancer from diagnosis through 1 year, and tested constructs from subjective expected utility theory with regard to their ability to predict patients' choice of surgical treatment as well as psychological distress and well-being over time. Women's positive expectancies for the consequences of treatment generally were maintained in favorable perceptions of outcome in several realms (i.e., physician agreement, likelihood of cancer cure or recurrence, self-evaluation, likelihood of additional treatment, partner support for option, attractiveness to partner). Assessed before the surgical decision-making appointment, women's expectancies for consequences of the treatment options, along with age, correctly classified 94% of the sample with regard to election of mastectomy versus breast-conserving procedures. Calculated from the point of decision making to 3 months later, expectancy disconfirmations and value discrepancies concerning particular treatment consequences predicted psychological adjustment 3 months and 1 year after diagnosis.

Adaptation, Psychological↗
PubMed1984

A comparison of three social-psychological models of attitude and behavioral plan: prediction of contraceptive behavior.

We compared the predictive validities of three prominent models of attitudes and behavioral decisions: Rosenberg's instrumentality-value model, Fishbein's belief-evaluation model, and Beach's adaptation of subjective expected utility theory. Seventy female undergraduates rated each of the models' components and reported their attitudes and behavioral plans toward using three different methods of contraception. With the traditional across-subjects prediction procedure, the Rosenberg model generally accounted for 5-25% less variance in subjects' attitudes and behavioral plans than the Fishbein an Beach models, which were not different. With a within-subject prediction procedure, the Rosenberg model was again the least accurate, and the Fishbein and Beach models had similar predictive accuracy. As hypothesized, within-subject predictions were more accurate than across-subjects predictions. The relatively poor performance of the Rosenberg model was attributable to the instrumentality component. In addition, we found that the Beach model could be simplified with no appreciable loss in predictive accuracy. Finally, a subject's personal normative beliefs emerged as a strong independent predictor of behavioral plan.

Adult↗
PubMed1988

The precaution adoption process.

This article presents a critique of current models of preventive behavior. It discusses a variety of factors that are usually overlooked-including the appearance of costs and benefits over time, the role of cues to action, the problem of competing life demands, and the ways that actual decision behavior differs from the rational ideal implicit in expectancy-value and utility theories. Such considerations suggest that the adoption of new precautions should be viewed as a dynamic process with many determinants. The framework of a model that is able to accommodate these additional factors is described. This alternative model portrays the precaution adoption process as an orderly sequence of qualitatively different cognitive stages. Data illustrating a few of the suggestions made in the article are presented, and implications for prevention programs are discussed.

Accident Prevention↗
PubMed1983

Strategies for multiattribute binary choice.

Based on eye-fixation patterns, strategies for multiattribute binary choice were classified as holistic (within an alternative) or dimensional (within an attribute across alternatives). In a task environment hospitable to both strategies, dimensional processing predominated. Even for alternatives like simple gambles, which require holistic computations, dimensional strategies were used as often as holistic ones. The dimensional strategies were augmented by two procedures that simplify the computations. These simplification procedures reduce cognitive effort at the cost of a relatively small increase in errors. However, for about half the subjects the use of these simplification procedures led to systematic violations of expected utility theory on certain choices. Both the preference for dimensional over holistic strategies and the adoption of simplifying procedures are compatible with the desire to reduce cognitive effort. We propose that strategies are selected to minimize the joint cost of errors and effort.

Choice Behavior↗
PubMed2006

The priority heuristic: making choices without trade-offs.

Bernoulli's framework of expected utility serves as a model for various psychological processes, including motivation, moral sense, attitudes, and decision making. To account for evidence at variance with expected utility, the authors generalize the framework of fast and frugal heuristics from inferences to preferences. The priority heuristic predicts (a) the Allais paradox, (b) risk aversion for gains if probabilities are high, (c) risk seeking for gains if probabilities are low (e.g., lottery tickets), (d) risk aversion for losses if probabilities are low (e.g., buying insurance), (e) risk seeking for losses if probabilities are high, (f) the certainty effect, (g) the possibility effect, and (h) intransitivities. The authors test how accurately the heuristic predicts people's choices, compared with previously proposed heuristics and 3 modifications of expected utility theory: security-potential/aspiration theory, transfer-of-attention-exchange model, and cumulative prospect theory.

Attention↗
PubMed1998

The family impact of childhood atopic dermatitis: the Dermatitis Family Impact Questionnaire.

Little information is available about the effect of childhood atopic dermatitis (AD) on family function. The aim of this study was to identify the areas of family life most affected and their perceived importance. Intensive qualitative interviews with 34 families were conducted and 11 basic problem areas were identified. A detailed questionnaire was prepared, part of which addressed the perceived importance of particular issues using the framework of multi-attribute utility theory. The results from using this questionnaire in 41 families were analysed and a shorter 10-question one-page Dermatitis Family Impact (DFI) questionnaire designed (maximum score = 30). In affected families the mean DFI score was 9.6 +/- 7.0 (range 0-27, n = 56) and in unaffected families the mean score was 0.4 +/- 0.9 (range 0-3, n = 26, P < 0.0001). The DFI could potentially be used as an extra measure in clinical studies, or to help guide appropriate management of AD.

Adolescent↗
PubMed2003

Measuring the quality of judgement and decision-making in nursing.

AIM: This paper discusses measurement of the quality of judgement and decision-making in nursing research. It examines theoretical and research issues surrounding how to measure judgement accuracy as a component of evaluating decision-making in nursing practice. DISCUSSION: Judgement accuracy is discussed with reference to different methods of measurement, including comparing judgements with independent criteria and inter-judge approaches. Existing research on how judgement accuracy has been measured in nursing practice is examined. Evaluation of decisions is then discussed, including consideration of the process of decision-making and evaluating decision outcomes. Finally, existing research on decision-making in nursing is assessed and the strengths and limitations of different types of measurement discussed. CONCLUSION: We suggests that researchers examining the quality of judgement and decision-making in nursing need to be aware of both the strengths and limitations of existing methods of measurement. We also suggest that researchers need to use a number of different methods, including normative approaches such as Bayes' Theorem and Subjective Expected Utility Theory.

Decision Making↗
PubMed1981

Speech and survival: tradeoffs between quality and quantity of life in laryngeal cancer.

In State T3 carcinoma of the larynx (carcinoma restricted to the vocal cords, causing complete immobility of the cords but not extending to adjacent structures), laryngectomy leads to a three-year survival rate of approximately 60 per cent and the loss of normal speech. Radiation therapy, on the other hand, leads to a lower survival (30 to 40 per cent at three years) but preserves normal or nearly normal speech. We investigated attitudes toward the quantity and quality of life in 37 healthy volunteers, interviewing 12 firefighters and 25 middle and upper management executives to determine their preferences for longevity and voice preservation. We used the principles of expected utility theory to develop a method for sharpening decisions involving tradeoffs between quantity and quality of life. Our analysis indicates that to maintain their voices, approximately 20 per cent of volunteers would choose radiation instead of surgery. These results suggest that treatment choices should be made on the basis of patients' attitudes toward the quality as well as the quantity of survival.

Attitude↗
PubMed1983

Incremental evaluation of risky choices.

This paper compares the incremental method of valuation and its possible effects on choices analysed through utility theory with similar zero-base valuations. Analysis shows how biases can arise using incremental valuations in situations with decreasing risk aversion. This could be important in certain circumstances, e.g. delegated decision-making in cases where the total value of an organisation is unknown to the decision-maker or difficult to quantify.

Choice Behavior↗
PubMed1984

Balancing the failure modes in the electronic circuit of a cardiac pacemaker: a decision analysis.

Cardiac pacemaker malfunctions are of continuous concern to the medical profession as well as to the electronics industry. Certain failures in cardiac pacemaker performance are critical and can result in patient deaths. Cardiac pacemakers are vulnerable to certain malfunctions in the electrode, batteries and the electronic circuit. This paper focuses on failures and reliability of the electronic circuit and how they affect its choice and design. The paper discusses the issues of balancing the various failure modes by considering both failure rates and failure outcomes. As the choice of an appropriate pacemaker is a decision problem under conditions of uncertainty, we employ decision analysis as the analytical and conceptual framework. Use of utility theory enables a systematic quantitative evaluation of such seeming intangibles as the various failure outcomes. Probabilities are assessed using specific engineering and reliability literature. The method is demonstrated on a choice problem between two specific electronic circuit designs. The methodology can be useful in designing the electronic circuit to meet certain reliability specifications, deciding whether or not to introduce redundancy, decisions affecting components and technology, and establishing minimal reliability standards, with regard not only to cardiac pacemakers but to other electronics as well.

Electronics, Medical↗
PubMed2002

Two functional equations preserving functional forms.

Two functional equations are considered that are motivated by three considerations: work in utility theory and psychophysics, questions concerning when pairs of degree 1 homogeneous functions can be homomorphic and calculating their homomorphisms, and the link of the latter questions to quasilinear mean values. The first equation is h(σ(y)x + [1 - σ(y)]y) = τ(y)h(x) + [1 - τ(y)]h(y) (x ≥ y ≥ 0), where h maps [0, ∞[into a subset of [0, ∞[and is strictly increasing and continuously differentiable; the functions σ and τ map [0, ∞[continuously into [0,1], σ(y) > 0 for y > 0 but σ is not 1 on]0, ∞[. The solutions are fully determined. (Recently Zsolt Páles has eliminated the differentiability assumption.) The second equation is h[y + f(x - y)] = h(y) + g[h(x) - h(y)] (x ≥ y ≥ 0), where h maps [0, ∞[onto a subinterval of positive length of [0, ∞[and is strictly increasing and twice continuously differentiable, f and g map [0, ∞[onto[0, ∞[and are twice differentiable, and either f"(0) ≠ 0 or g"(0) ≠ 0. The solutions are fully determined under these conditions. When f"(0) = g"(0) = 0 and h" is not identically zero, we determine the solutions under the added assumption of analyticity. It remains an open problem to find the solutions in the latter case under the assumption of only second order differentiability. A more general open problem is to eliminate all differentiability conditions for the second equation.

Journal Article↗
PubMed1999

Are decisions under risk malleable?

Human decision making under risk and uncertainty may depend on individual involvement in the outcome-generating process. Expected utility theory is silent on this issue. Prospect theory in its current form offers little, if any, prediction of how or why involvement in a process should matter, although it may offer ex post interpretations of empirical findings. Well-known findings in psychology demonstrate that when subjects exercise more involvement or choice in lottery procedures, they value their lottery tickets more highly. This often is interpreted as an "illusion of control," meaning that when subjects are more involved in a lottery, they may believe they are more likely to win, perhaps because they perceive that they have more control over the outcome. Our experimental design eliminates several possible alternative explanations for the results of previous studies in an experiment that varies the degree and type of involvement in lottery procedures. We find that in treatments with more involvement subjects on average place less rather than more value on their lottery tickets. One possible explanation for this is that involvement interacts with loss aversion by causing subjects to weigh losses more heavily than they would otherwise. One implication of our study is that involvement, either independently or in interaction with myopic loss aversion, may help explain the extreme risk aversion of bond investors.

Behavior↗
PubMed1976

Clincal observations of sex as a reverberation of the total relationship.

In the psychiatric treatment of sexual dysfunctioning the generally accepted method has been to concentrate heavily on the intrapsychic conflicts of one or both spouses. There now is increasing evidence that treatment is sometimes more effective if the therapeutic intervention takes place directly in the interpersonal system. Such evidence has been provided by those therapists with clinical experience in marital systems who are prepared to utilize theories evolved from a multidisciplinary approach to marital problems. This paper is meant to discuss and illustrate this shift in treatment strategy as it applies to sexual dysfunctioning and deals with the function of the interplay of sex, love, and commitment through the illustrative cases.

Female↗
PubMed2005

Creating a reliable and valid blueprint for the internal medicine clerkship evaluation.

The objective of this study was to design an examination blueprint for the Internal Medicine clerkship rotation that is congruent with both the learning objectives and delivered learning experiences and reflects the perceived importance of clinical presentations from both the students' and clinicians' perspectives. In this cross-sectional study 11 specialists in General Internal Medicine (GIM) and 11 clinical clerks at the University of Calgary were asked to score each of the 47 clinical presentations in the Internal Medicine clerkship rotation for 'impact' and 'frequency'. These attributes were used to provide an estimate of the relative importance of each clinical presentation. Statistical tests used were the Pearson's correlation coefficient and the Kappa statistic. Multi-attribute utility theory was applied to assess the best way of combining the variables of 'impact' and 'frequency'. The correlation between clerks and GIM specialists was 0.85 for the impact score and 0.86 for the frequency score (p < 0.001 for both). Corresponding Kappa values were 0.71 and 0.82, respectively (p < 0.001 for both). Combining impact and frequency as a multiplicative function produced a distribution that was positively skewed towards common, high impact presentations such as chest pain. We have created an examination blueprint that provides a realistic and objective measure of the relative importance of clinical presentations. Such a blueprint provides both face validity and content validity to the evaluation process.

Alberta↗
PubMed2003

Arousal, anxiety, and performance: a reexamination of the Inverted-U hypothesis.

Until recently, the traditional Inverted-U hypothesis had been the primary model used by sport psychologists to describe the arousal-performance relationship. However, many sport psychology researchers have challenged this relationship, and the current trend is a shift toward a more "multidimensional" view of arousal-anxiety and its effects on performance. In the current study, 104 college-age participants performed a simple response time task while riding a bicycle ergometer. Participants were randomly assigned to one of eight arousal groups (between 20 and 90% of heart rate reserve) and were told they were competing for a cash prize. Prior to the task, the Competitive State Anxiety Inventory-2 and Sport Anxiety Scale (SAS) were administered to assess the influence of cognitive and somatic anxiety. As hypothesized, regression analysis revealed a significant quadratic trend for arousal and reaction time. This accounted for 13.2% of the variance, F change (1, 101) = 15.10, p < .001, in performance beyond that accounted for by the nonsignificant linear trend. As predicted by the Inverted-U hypothesis, optimal performance on the simple task was seen at 60 and 70% of maximum arousal. Furthermore, for the simple task used in this study, only somatic anxiety as measured by the SAS accounted for significant variance in performance beyond that accounted for by arousal alone. These findings support predictions of the Inverted-U hypothesis and raise doubts about the utility theories that rely on differentiation of cognitive and somatic anxiety to predict performance on simple tasks that are not cognitively loaded.

Adult↗
PubMed2004

The precautionary principle and medical decision making.

The precautionary principle is a useful strategy for decision-making when physicians and patients lack evidence relating to the potential outcomes associated with various choices. According to a version of the principle defended here, one should take reasonable measures to avoid threats that are serious and plausible. The reasonableness of a response to a threat depends on several factors, including benefit vs. harm, realism, proportionality, and consistency. Since a concept of reasonableness plays an essential role in applying the precautionary principle, this principle gives physicians and patients a decision-making strategy that encourages the careful weighing and balancing of different values that one finds in humanistic approaches to clinical reasoning. Properly understood, the principle presents a worthwhile alternative to approaches to clinical reasoning that apply expected utility theory to decision problems.

Decision Making↗
PubMed2005

AIDS and risk: the handling of uncertainty in northern Tanzania.

Studies of sexual risk behaviour in the context of HIV/AIDS often utilize theories of risk which are predicated on the idea of the rational actor making choices, and thus operate with a strong notion of the autonomous individual. The underlying assumption is that a well-informed individual would strive to reduce risk and therefore choose not to engage in risky behaviour in sexual encounters. Drawing on longitudinal fieldwork in Arusha town and the surrounding districts in northern Tanzania, this paper explores how people draw on a complexity of knowledge and experience when they try to reduce the likelihood of contracting HIV. It shows how the embeddedness of social relationships, and the constraints of culture restrict the possible range of options, particularly for women. The paper examines the paired concepts of risk and trust, arguing that trust in a sexual relationship is gendered in particular ways. Gender hierarchies often place women in a subordinate position to men as a result of which women have to make compromises which put their health at risk.

Adult↗