To admit or not to admit? The effect of framing on risk assessment decision making in psychiatrists

Abstract

Background: The way that information is presented is well known to induce a range of biases in human decision tasks. Little research exists on framing effects in psychiatric decision making, but it is reasonable to assume that psychiatrists are not immune and, if so, there may be implications for the welfare of patients, staff and the general public.

Aims: To investigate whether presentation of risk information in different formats (frequency, percentage and semantic) influences inpatient admission decisions by psychiatrists.

Methods: Six-hundred seventy-eight general adult psychiatrists read a short clinical vignette presenting a case scenario of a patient presenting for inpatient admission. One of four condition questions followed the vignette, incorporating either numerical or percentage probabilities and the semantic labels “high” and “low” risk. In each condition, the actual risk was identical, but the way it was presented varied. The decision to admit the patient or not was recorded and compared across conditions.

Results: More individuals chose to admit the patient when risk information was presented in numerical form (X² = 7.43, p = 0.006) and with the semantic label “high” (X² = 7.27, p = 0.007).

Conclusions: Presentation of risk information may influence decision making in psychiatrists. This has important implications for mental health clinical practice where clinicians are required to interpret probabilistic information within their daily work.

• Admissions
• decision making
• framing
• psychiatry

Declaration of interest

This study was completed as part of a research assistant/PhD post funded by Hertfordshire Partnership University NHS Foundation Trust.