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Cognitive psychology is the study of the thinking mind. It emerged as a field of psychology in the 1980s and includes perception, attention, memory, decision making, problem solving, reasoning, and language among its areas of study. Using theory and empirical study, cognitive psychology aims to understand the cognitive processes used and what influences their use. In medical decision making, for decisions relevant to individuals, systems, and society, understanding the cognitive processes that people typically use, and why, would help (a) developers of decision support interventions target the interventions most effectively and (b) identify outcomes appropriate for judging the effectiveness of particular decision-making strategies.

Decision making in cognitive psychology focuses on how people make choices. The field is distinct from problem solving, which is characterized by situations where a goal is clearly established and where reaching the goal is decomposed into sub-goals that, in turn, help clarify which actions need to be taken and when. In the medical world, making a diagnosis, for example, typically requires problem-solving processes. Decision making is also distinct from reasoning, which is characterized as the processes by which people move from what they already know to further knowledge. Although historically, decision making, problem solving, and reasoning were studied independently within cognitive psychology, it is recognized that in complex decisions both reasoning and problem-solving processes can be required to make a choice.

Decision making requires the integration of information with values. The information in a medical decision is often about a health state and the options for addressing it. Values are the qualities that underlie worth or desirability. A decision maker's values determine the particular subset of information that is most germane to his or her decision. Although both information and values are part of most medical decisions, the particular cognitive processing required can vary significantly from one decision to another.

Levels of Decisions

Four levels of decisions have been described—the higher the level, the greater the energy required and the more complex the decision processes.

Level 1—simple, familiar decisions: They are made quickly and largely automatically (unconsciously). An example occurs when people prone to headaches automatically reach for a particular painkiller in response to early headache signs.

Level 2—decisions that use static mappings when evaluating options: An example occurs when people choose particularly invasive treatments only because they believe that the more a treatment makes one suffer, the more likely it is to be successful.

Level 3—decisions that belong to a class of decision that is familiar to the decision maker, although the particular instance is not and can include options that have both pros and cons: An example occurs when people choose a family doctor after losing their doctor for the third time and therefore know what is important to them in the decision, but they need to learn about the new choices.

Level 4—decisions in unfamiliar situations when the choices are also not familiar: These decisions often require problem-solving (and possibly reasoning) processes to learn about the situation and the options. An example is a person, newly diagnosed with a relatively unfamiliar medical condition, needing to choose a treatment.

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