Understanding clinical and non-clinical decisions under uncertainty: a scenario-based survey.

BACKGROUND: Prospect theory suggests that when faced with an uncertain outcome, people display loss aversion by preferring to risk a greater loss rather than incurring certain, lesser cost. Providing probability information improves decision making towards the economically optimal choice in these situations. Clinicians frequently make decisions when the outcome is uncertain, and loss aversion may influence choices. This study explores the extent to which prospect theory, loss aversion, and probability information in a non-clinical domain explains clinical decision making under uncertainty. METHODS: Four hundred sixty two participants (n = 117 non-medical undergraduates, n = 113 medical students, n = 117 resident trainees, and n = 115 medical/surgical faculty) completed a three-part online task. First, participants completed an iced-road salting task using temperature forecasts with or without explicit probability information. Second, participants chose between less or more risk-averse ("defensive medicine") decisions in standardized scenarios. Last, participants chose between recommending therapy with certain outcomes or risking additional years gained or lost. RESULTS: In the road salting task, the mean expected value for decisions made by clinicians was better than for non-clinicians(-$1,022 vs -$1,061; <0.001). Probability information improved decision making for all participants, but non-clinicians improved more (mean improvement of $64 versus $33; p = 0.027). Mean defensive decisions decreased across training level (medical students 2.1 ± 0.9, residents 1.6 ± 0.8, faculty1.6 ± 1.1; p-trend < 0.001) and prospect-theory-concordant decisions increased (25.4%, 33.9%, and 40.7%;p-trend = 0.016). There was no relationship identified between road salting choices with defensive medicine and prospect-theory-concordant decisions. CONCLUSIONS: All participants made more economically-rational decisions when provided explicit probability information in a non-clinical domain. However, choices in the non-clinical domain were not related to prospect-theory concordant decision making and risk aversion tendencies in the clinical domain. Recognizing this discordance may be important when applying prospect theory to interventions aimed at improving clinical care.

Climate Projections and Uncertainty Communication.

Lingering skepticism about climate change might be due in part to the way climate projections are perceived by members of the public. Variability between scientists' estimates might give the impression that scientists disagree about the fact of climate change rather than about details concerning the extent or timing. Providing uncertainty estimates might clarify that the variability is due in part to quantifiable uncertainty inherent in the prediction process, thereby increasing people's trust in climate projections. This hypothesis was tested in two experiments. Results suggest that including uncertainty estimates along with climate projections leads to an increase in participants' trust in the information. Analyses explored the roles of time, place, demographic differences (e.g., age, gender, education level, political party affiliation), and initial belief in climate change. Implications are discussed in terms of the potential benefit of adding uncertainty estimates to public climate projections.

The cry wolf effect and weather-related decision making.

Despite improvements in forecasting extreme weather events, noncompliance with weather warnings among the public remains a problem. Although there are likely many reasons for noncompliance with weather warnings, one important factor might be people's past experiences with false alarms. The research presented here explores the role of false alarms in weather-related decision making. Over a series of trials, participants used an overnight low temperature forecast and advice from a decision aid to decide whether to apply salt treatment to a town's roads to prevent icy conditions or take the risk of withholding treatment, which resulted in a large penalty when freezing temperatures occurred. The decision aid gave treatment recommendations, some of which were false alarms, i.e., treatment was recommended but observed temperatures were above freezing. The rate at which the advice resulted in false alarms was manipulated between groups. Results suggest that very high and very low false alarm rates led to inferior decision making, but that lowering the false alarm rate slightly did not significantly affect compliance or decision quality. However, adding a probabilistic uncertainty estimate in the forecasts improved both compliance and decision quality. These findings carry implications about how weather warnings should be communicated to the public.

Uncertainty forecasts improve weather-related decisions and attenuate the effects of forecast error.

Although uncertainty is inherent in weather forecasts, explicit numeric uncertainty estimates are rarely included in public forecasts for fear that they will be misunderstood. Of particular concern are situations in which precautionary action is required at low probabilities, often the case with severe events. At present, a categorical weather warning system is used. The work reported here tested the relative benefits of several forecast formats, comparing decisions made with and without uncertainty forecasts. In three experiments, participants assumed the role of a manager of a road maintenance company in charge of deciding whether to pay to salt the roads and avoid a potential penalty associated with icy conditions. Participants used overnight low temperature forecasts accompanied in some conditions by uncertainty estimates and in others by decision advice comparable to categorical warnings. Results suggested that uncertainty information improved decision quality overall and increased trust in the forecast. Participants with uncertainty forecasts took appropriate precautionary action and withheld unnecessary action more often than did participants using deterministic forecasts. When error in the forecast increased, participants with conventional forecasts were reluctant to act. However, this effect was attenuated by uncertainty forecasts. Providing categorical decision advice alone did not improve decisions. However, combining decision advice with uncertainty estimates resulted in the best performance overall. The results reported here have important implications for the development of forecast formats to increase compliance with severe weather warnings as well as other domains in which one must act in the face of uncertainty.