Cognitive Biases in Physician Decision-Making: A Systematic Review

Cognitive biases may affect physician decision-making. We sought to: 1) delineate which cognitive biases in physicians have been investigated, 2) report the prevalence of cognitive biases, 3) determine their impact on physician decisions, 4) characterize interventions that aim to reduce the impact of cognitive biases in physicians, and 5) highlight the role of individual differences. A PRISMA-compliant systematic review was performed using PubMed, Embase, Cochrane, CINAHL, PsycINFO, Scopus, and Web of Science. Of 4177 resultant articles, 61 were included (46 on group level outcomes and 15 on individual differences). The most common specialties were internal medicine (15, 24.6%), emergency medicine (11, 18.0%), and psychiatry (5, 8.2%). Studies provided evidence for the existence of hindsight bias, anchoring, framing effect, outcome bias, and availability bias. Prevalence varied by bias. Of five studies examining how cognitive biases affected physician diagnosis, 4 (80.0%) found a negative effect. Interventions to reduce the impact of cognitive biases were limited. Individual differences in susceptibility to cognitive biases may relate to length of experience, similarity to previous cases, and case complexity. This systematic review of studies of moderate quality and with moderate risk of bias indicated cognitive biases are prevalent in physicians and often negatively impact decision-making.