We hope you enjoy the Spring Newsletter from the Society for Medical Decision Making
SMDM Spring 2012 Newsletter


From the Editor
by A. Scott LaJoie, PhD, MSPH
From the President

by Anne Stiggelbout, PhD

Society Updates

Society Updates

Board of Trustees Planning Session
SMDM Awards

SMDM Journal
Call for AHRQ Abstracts


SMDM Meetings

SMDM Meetings

2012 Biennial SMDM European Meeting
Registration is Now Open
Pre-Conference Session: Modeling Approaches for HTA

2012 North American Meeting

Calls for Abstract and Short Proposals



The Gist of Health and Medical Decision Making:
New Developments in Fuzzy-Trace Theory

by Valerie F. Reyna, PhD

Patient Preferences and Biases of Thinking,
Fast and Slow

by Laura D. Scherer, PhD, and Marieka de Vries, PhD

Other News

Other News

Risk Calculator Constructor Platform
Decision Criteria in Healthcare: Survey Invitation
Revision of AMCP Format for Formulary Submission
Members in the News
FDA Hiring Decision Specialists
Recognition of Lifetime Contributors

Events and Opportunities

Be sure to take advantage of all of the events and opportunities SMDM has to offer.
2012 Biennial European Meeting
2012 North American Meeting
Call for Oral and Poster Abstracts
Call for Short Courses
Opportunities to Volunteer
Job Postings
Support SMDM
Join SMDM on Facebook
Contact Us


A. Scott LaJoie, PhD, MSPH, Editor-in-chief, University of Louisville
Donald A. Brand, PhD, Senior Editor, Winthrop University Hospital

Scott B. Cantor, PhD, Senior Editor, The University of Texas MD Anderson Cancer Center

Contributing Writers

Laura D. Scherer, PhD, University of Michigan
Marieke de Vries, PhD, Tilburg University
Valerie F. Reyna, PhD, Cornell University
Michael W. Kattan, PhD, Case Western Reserve University

From the Editor

by A. Scott LaJoie, PhD, MSPH, Editor-in-chief

A. Scott LaJoieGreetings! Welcome to the spring issue of the Society for Medical Decision Making newsletter. Despite the tempting warmth of an unusual winter, the members of our Society have remained busy and productive. This issue reflects the products of the tireless efforts of our members.

In this issue, you will find what I perceive to be the amalgamation of the many areas of medical decision making research. Our president, Anne Stiggelbout, PhD, reports on efforts to unite researchers from around the globe to insure that better health through better decision making can be enjoyed by all people. She focuses our attention on the potential for improving patient decision making by integrating health technology assessment with decision psychology, decision support system development, and increased training in medical decision making principles. A theme of Anne’s presidency is to strengthen our Society’s international presence and involvement. Judging on the number of abstracts submitted to the European SMDM meeting in Oslo, it appears that we are embracing her ideas!

The study of decision making has historically been divided into two camps: slow and deliberate decision making versus fast and intuition-based choices. Articles by Laura Scherer, PhD, Marieke de Vries, PhD, and Valerie Reyna, PhD, demonstrate how the division is being eroded. Drs. Scherer and de Vries encourage us to imagine how decision support systems can be developed to present necessary, but foreboding, analytical information in ways that enhances, rather than competes with, intuitive decision making. Dr. Reyna provides an update on fuzzy-trace theory. Fuzzy-trace theory posits that people extract summary or gist-level information from the complex data in the environment and base their choices on this reduction. She states that recent neurological evidence from her lab is confirming this process and offers insights for technology development to facilitate accurate gist-level information processing.

Additional evidence that SMDMers stayed inside this winter can be found in a new tool for developing and sharing statistical models from Michael Kattan, PhD, the success of Doctor, Your Patient Will See You Now, by Steven Kussin, MD, FACP, the appointment of Douglas Owens, MD, MS, to the United States Preventive Services Task Force, and the appointment of Ellen Peters, PhD, to the Food and Drug Administration’s Risk Communication Advisory Committee. These appointments will further the impact of SMDM at the federal level, and more importantly, lead to improved patient decision making and health outcomes.

Taken together as a whole, this newsletter issue reflects tremendous activity by our members and hints at the integration of our diverse activities for the betterment of health through better decision making. Please enjoy, and when you are done, share the newsletter with your colleagues, patients, legislators, and students!

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From the President

by Anne Stiggelbout, PhD
Anne Stiggelbout, President
Spring has arrived! Winter in the Netherlands only knew about two weeks of truly winter weather, but those two weeks did lead to all the excitement of a possible 11-Towns Skating Tour, the last of which was held in 1997. See for an interesting account on this wonderful Dutch event.

For me as President, this winter has been exciting because of all the new initiatives that sprung up like crocuses in our Society. The first one was the kick-off teleconference of the Society's International Engagement Committee charged with 1) promoting medical decision making principles and skills internationally; 2) promoting the Society internationally, and 3) building international membership in SMDM. The committee has members from all continents (which makes planning teleconferences challenging given the different time zones!). It was stressed that in Southeast Asia there is a strong need for training due to the many changing health care systems, particularly in the evolving countries with a strong economic growth, such as China. The committee, together with the Education Committee (Chair, Ahmed Bayoumi, MD, MSc), the Business Development Committee (Chair, Newell McElwee, PharmD, MSPH), and the leadership team, is working on ideas to offer short courses in the region, and later perhaps also a conference, e.g., in the odd years when there is no European meeting. After Asia, Latin America will likely be the next continent for the Society to focus on.

Another initiative with a strong international component is the cooperation with Health Technology Assessment international (HTAi). How can health technology assessment and medical decision making better interact and adapt as we move into an era emphasizing personalized decision making in environments with greater decision support tools? Just as SMDM produced a series of white papers together with the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), we aim to produce two papers that bring together HTA and decision psychology around personalized medicine. Most likely the first paper will look at methods up front, to ensure that the research will be performed in such a way that findings can be translated to patients. The second paper will then be aimed at getting findings from HTA into practice by looking at the challenges of communicating HTA results to doctors and patients. Workshops to elaborate on these ideas will be conducted at the June Oslo and Bilbao meetings of the respective Societies.

Another new development was launched by Scott Braithwaite, MD, our President-elect, who proposed building a Methods Concierge service. SMDM can leverage the expertise of its members to catalyze outcomes research that is methodologically rigorous, patient-centered, transparent, and accessible. A pilot program has started to test the viability of the service that matches policy-makers with SMDM experts. A Concierge Advisory Committee (CAC) has been installed, chaired by Scott Braithwaite.

Then, of course, there’s the excitement about the upcoming European meeting in Oslo. Deadline for submission has passed and a record number of 250 abstracts have been submitted!! A scholarship program similar to that of the North American meetings has been launched to facilitate travel to the meeting from low and middle income countries.

Our Agency for Healthcare Research and Quality (AHRQ) K-12 fellow Negin Hajizadeh, MD, MPH, has built a successful follow-up to the AHRQ-SMDM seminar series that was started by former AHRQ-fellow Tania Lourenco, PhD, MSc. The opportunity for SMDM members to present their research at the AHRQ research seminar series is valuable for promoting collaboration between SMDM and AHRQ. It allows for novel research areas to be presented to the leadership at AHRQ, for SMDM members to directly interact with project officers, and it highlights the relevance of research among SMDM members to the AHRQ agenda. In 2012, junior and mid-level faculty SMDM members are given the opportunity, through the “SMDM-AHRQ speaker award”, to get their travel and one night of lodging supported, to give an SMDM lecture.

And finally, as you will have seen in the mail, the membership selected the tagline SMDM: Better Health through Better Decisions. It will be used in all communications from SMDM to external parties, and will be prominent on our website. The tagline is meant as a clear message to the world about who we are. The votes were clear; the large majority agrees that our Society is all about better health through better decisions!

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Board of Trustees Mid-Year Planning Session

Philadelphia, The Liberty BellThe SMDM Board of Trustees and Officers met in Philadelphia, PA, on April 4, 2012, for a mid-year planning session. Some of the highlights from the meeting include:
  • The creation of new coordinator position to facilitate the formation and encouragement of Interest Groups. Beate Sander, PhD, will fulfill this role.
  • The search for a new MDM journal editor and the transition planning is on track for the person to be in place Fall 2012. Mark Helfand, MD, the current editor, will help to ensure a smooth transition.
  • The tagline, Better Health through Better Decisions, was accepted by the Board and SMDM members. Work is ongoing to integrate the slogan with other SMDM branding.
  • The International Engagement Committee reported that Mark Roberts, PhD, will lead a course for SMDM at a conference planned by the National University of Singapore. This represents the beginning of an outreach to south-east Asian countries to better meet the challenging healthcare needs of developing and developed countries globally.
  • Four short-courses have been labeled as the core SMDM educational classes. They are: Decision Psychology, Cost-Effectiveness Analysis, Decision Modeling, and Shared Decision Making.
  • The European SMDM conference planners report that 250 abstracts were submitted, with 46 accepted as oral presentations and 110 as posters. Acceptance notifications have been sent.
  • At the Annual SMDM Meeting this fall in Phoenix, AZ, SMDM will partner with INFORMS on three pre-meeting joint sessions. Arizona State University faculty will also host a symposium. The central theme of the meeting is health information technology. Areas of local interest in Arizona include the Grand Canyon, the Sedona Desert, and the Heard Museum of American Indian Art and History. Bowling will be the main activity for the social event.
  • The Methods Concierge program is being developed and tested. The Methods Concierge will function as a consultant or advisor to stakeholders who need assistance. Experts in a variety of SMDM fields will be recruited to the Methods Concierge program.
The newsletter further details many of the initiatives listed above.

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SMDM Awards

by John Wong, MD, Awards Committee Chair
John Wong, Awards Chair

Reassessing the Lusted Award Categories

This past year, SMDM had four categories including the meeting theme: Behavioral Economics; Quantitative Methods and Theoretical Developments; Decision Psychology and Shared Decision Making; and Applied Health Economics, Services, and Policy Research. The proportion of abstract submissions for each category, however, was disproportionate with five for Behavioral Economics; nine for Quantitative Methods and Theoretical Developments; 25 for Decision Psychology and Shared Decision Making; and 60 for Applied Health Economics, Services and Policies.

As part of the post-meeting evaluation, we asked for feedback. One Lusted judge who was also a scientific meeting chair commented that "there is a careful balancing between the breadth of our methodological/disciplinary base (reflected by acceptance and awards within tracks) and the very different numbers of abstracts submitted/judged in various categories. The most extreme example of this is the meeting-specific track (Behavioral Economics). My personal feeling was that for our standard tracks (Applied Health Economics, Decision Psychology, Quantitative Methods), the trade-off towards judging and acceptance within tracks was quite positive, but that for the meeting specific theme, I felt much less certain of that. Perhaps it is worth considering grouping the meeting-specific track within one of our other tracks for the purpose of acceptance and or judging?"
Based on that comment, the committee discussed and considered five options going forward: 1) Continue with separate meeting specific theme Lusted Award; 2) Continue with meeting specific theme Lusted Award but combine with Quantitative Methods and Theoretical Developments into a single heterogeneous category; 3) No meeting specific theme award and reduce to three awards; 4) No meeting specific theme award and split Applied Health Economics, Services, and Policy Research into Applied Health Economics Research and Applied Health Services and Policy Research (besides one in the other two categories); and 5) No meeting specific theme award and award two Lusted prizes in Applied Health Economics, Services, and Policy Research (besides one in the other two categories).

In a poll of SMDM leadership and discussions with meeting chairs, we've decided to go with "option four" and split Applied Health Economics, Services, and Policy Research into Applied Health Economics Research and Applied Health Services and Policy Research. Abstracts pertaining to the meeting specific theme would be welcomed in any category. Any comments about this decision and about the Lusted Awards in general would be welcome, particularly from Lusted Award candidates. Please email them to

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SMDM Journal: Medical Decision Making

Medical Decision Making JournalThe January/February 2012 Issue of Medical Decision Making is available online.

Please be sure to check it out here.

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Call for Abstracts to Present at AHRQ Research Seminar Series

AHRQ headquartersAre you an SMDM member?

Is your research relevant to health care policy?
If so, here is an exciting opportunity to present your work to research staff at the Agency for Healthcare Research and Quality (AHRQ) located in Rockville, MD. Your presentation should specifically identify the research usefulness to AHRQ’s mission to improve the quality, safety, efficiency, and effectiveness of health care and to help people make more informed decisions and improve the quality of health care services.
If you are interested in presenting your research at AHRQ, please email Negin Hajizadeh, MD, at with your topic of research.
Junior and mid-level faculty SMDM members interested in giving a lecture have the opportunity to get their travel and one night of lodging supported through the “SMDM-AHRQ speaker award." Email for more information.

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2012 Biennial European Meeting

Good News from Norway!

Dear Colleagues,

We are very happy to report an almost overwhelming response to our call for abstracts for the 14th Biennial European SMDM meeting in Oslo, June 10 – 12. At closure of submission we had 250 abstracts for oral presentations, posters, workshops and panel discussions. Also we have an exciting slate of short courses, 9 half day and 2 full day courses in total. In line with the main theme of the conference there are courses on infectious disease modelling and ethical and legal aspects of infectious disease management. Other courses cover a broad range of MDM issues, such as decision analysis and CEA, shared decision making and decision aids, propensity score analysis, discrete event simulation, cost-value analysis, parametric survival models for health economic evaluation, and barriers to rational, evidence based decisions (see ). Registration is open (, and there may still be some seats left in the Pre Meeting 3-day Hands-On Modelling Course ( ) or the Post Meeting Workshop on Utility Assessment with the EQ-5D ( ). While the folk dancers and military brass band start rehearsals for the social event at Akershus fortress, we wish you all a warm welcome to Oslo!


Ivar Sønbø Kristiansen, MD, PhD, MPH
Peder A. Halvorsen, MD, PhD
Elisabeth Fenwick, PhD, MSc
Uwe Siebert, MD, MPH, MSc, ScD

I love Oslo

The Norwegian contingency was seen at the Annual Meeting last fall, advertising their love of country and encouraging all to attend the European Meeting of SMDM.

Registration is Now Open!

Reserve your spot in at the 14th Biennial SMDM European Meeting, June 10-12, 2012. Registration is now open! For full details, registration forms, travel tips and supporting information

See additional information on the pre-conference workshop Modeling Approaches for HTA: A Practical Hands-On Workshop below.

We will see you in Oslo!

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Pre-Conference Workshop:
Modeling Approaches for HTA

We are pleased to announce our third 3-Day Certificate Course to be held in Oslo, Norway.

Modeling Approaches for HTA: A Practical Hands-On Workshop
June 7 - 9, 2012

This practical hands-on workshop on different modeling techniques for health technology assessment (HTA) will be held right before the European Meeting of the Society of Medical Decision Making (

Course Directors:
Uwe Siebert, MD, MPH, MSc, ScD
Professor of Public Health, UMIT

Ron Goeree, MA
Associate Professor, Department of Clinical Epidemiology and Biostatistics, McMaster University

This 3-day Practical Hands-On Modeling Workshop was developed and will be held in collaboration between the PATH Research Institute at McMaster University, Canada and the Department of Public Health, Medical Decision Making and Health Technology Assessment at the University for Health Sciences, Medical Informatics and Technology (UMIT), Hall i.T., Austria

The workshop combines theoretical concepts with practical hands-on exercises comprising five different modeling techniques applied in Public Health and HTA. Real-world case examples from different acute and chronic diseases will be discussed. The course covers the following subjects:
  • Modeling overview and taxonomy
  • Decision trees, state-transition and Markov models
  • Microsimulation models
  • Discrete event simulation models
  • Infectious disease models
  • Other modeling approaches (e.g., agent-based models, system dynamics models, causal inference models, biologic systems models)
  • Handling uncertainty and variability
  • Handling individual behavior and waiting lines
  • Handling dynamic transmissions and herd immunity
Online booking for this course is available via

This course is part of the International Health Technology Assessment & Decision Sciences (HTADS) Continuing Education Program developed by the Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health and Health Technology Assessment (Chair: Prof. Dr. Uwe Siebert) at UMIT. The HTADS Program was designed to provide excellent quality education and comprehensive training in the key issues of Health Technology Assessment and Decision Sciences for anyone involved in the health sector. To find out more about the HTADS Program and the Certified Courses, please  visit our website (

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2012 North American Meeting

2012 North American MeetingThe 34th Annual Meeting of the Society for Medical Decision Making will be held Wednesday, October 17, 2012, through Saturday, October 20, 2012, at the Hyatt Regency, Phoenix, AZ. This year’s theme: "Designing Health Information Technology for Better Health Decisions."

Save the date and join us in 2012 as we focus on presenting current state-of-art health information technology (HIT) aimed at improving the delivery of health care services. In addition, the meeting will host several symposia which will enable attendees to gain an in-depth understanding of the methods needed to develop and implement innovative HIT interventions. Meeting attendees will have the opportunity to interact with international leaders in HIT and be exposed to the latest research methods in medical decision making.

SMDM and INFORMS Combined Program

A special combined program including participants from both SMDM and the Institute for Operations Research and Management Sciences (INFORMS) will take place at the INFORMS Annual Meeting on Wednesday, October 17, 2012. The combined program will include two concurrent oral abstract sessions and a keynote event to be headed by Mark Roberts, MD, MPP. The combined program will enable SMDM attendees to learn from and network with experts in decision making science and HIT from allied fields.

Calls for Abstracts and Short Course Proposals

SMDM is soliciting proposals for Oral and Poster Abstracts as well as Short Courses to be presented at the Annual Meeting. All accepted oral and poster abstracts will be published online in Medical Decision Making, SMDM’s peer-reviewed scientific journal. To submit abstracts and short course proposals, please visit the SMDM Annual Meeting web page, Submissions will be accepted through Friday, May 18, 2012. All submissions will be reviewed and notifications will be sent out by Friday, July 27, 2012.
If you have any questions regarding the annual meeting or an abstract submission please contact the SMDM office at
Situated in the heart of the Southwest (easy driving distance from the Grand Canyon), Phoenix is the perfect gateway for travelers wishing to spend some time outdoors in a spectacular desert setting or explore Sedona Valley, a must see for art lovers! We hope to see you all in Phoenix.

2012 Annual Meeting Planning Committee

Meeting Co-Chairs: Scott Braithwaite, MD, MS, FACP, and Liana Fraenkel, MD, MPH
Scientific Review Committee Co-Chairs: Mary Politi, PhD, Eran Bendavid, MD, MS, and Paul K. Han, MD, MA, MPH
Short Course Co-Chairs: Katia Noyes, PhD, MPH, Claire Wang, MD, ScD and Stacey Sheridan, MD, MPH

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The Gist of Health and Medical Decision Making: New Developments in Fuzzy-Trace Theory

by Valerie F. Reyna, PhD, Cornell University

Valerie F. Reyna, PhD“That’s not how people think!” exclaimed a recent visitor to my lab. The visitor was referring to the inadequacy of traditional decision theories -- theories that are the mainstay of SMDM. Furthermore, the visitor added, the medical school faculty at his university agreed: “They don’t even let me finish before telling me that decision theory just does not apply to their patients — or to physicians" (Lloyd & Reyna, 2009; Reyna & Lloyd, 2006). Clearly, this conclusion is too sweeping. But it does suggest that traditional theories have important gaps. The visitor was spending a week in my lab to learn about an alternative to traditional decision theories that I developed, fuzzy-trace theory.

In his invitation to write this article, the Newsletter's senior editor included this note: “When I first read your piece on fuzzy trace theory in the Nov-Dec 2008 issue of Medical Decision Making, it gave me quite a jolt. Your ‘gist’ model of how humans process information and make decisions about health and health care seemed uncomfortably on target. I say ‘uncomfortably’ because the model seemed to be at odds with nearly everything SMDM is about: rational decision making, methods to help people think systematically about harms and benefits, and so forth. At the same time, your article seemed to be on target as a description of how normal people actually make decisions.”

Since I was steeped in traditional decision theory as a student and deeply impressed by research conducted by SMDM members, it may seem odd for me to be at odds with such research. In truth, I don’t see a conflict. Instead, I believe my work with my colleagues builds on that foundation (Kahneman, 2011). Indeed, in fuzzy-trace theory, heuristics and biases occupy an important role because they often reflect advanced cognition, as opposed to being primitive and vestigial. Fuzzy-trace theory differs from other dual-process models in distinguishing impulsivity from intuition and in emphasizing that advanced cognition is intuitive. The difference between intuition and analysis, in this view, is in the mental representations used to process information. Verbatim representations — precise and detailed — support analysis. In contrast, gist-based intuition operates on simple, bottom-line representations of the meaning of information or experience. Together, verbatim and gist representations confer cognitive options (Mills et al., 2008). However, despite processing verbatim and gist representations in parallel, most adults rely on the least precise gist representations that they can use to make a decision.

These principles explain why, in the gain frame, framing effects boil down to saving some for sure (some lives, money or other “gain” outcomes) versus gambling on either saving some or saving none; the categorical possibility of saving none drives risk aversion. In the loss frame, the categorical possibility of losing none (or nothing) drives risk seeking. The principles also explain how people process risk information, not as precise numbers even when numerate, but, rather, as categorical or ordinal gists — safe or risky and low or high risk (Reyna & Brainerd, 2008; Reyna, Nelson et al., 2009). Moreover, it is not until a patient understands the gist — whether a procedure is safe or risky or whether a risk is low or high — that decision-making is informed (Reyna, 2008; Reyna & Hamilton, 2001).

In recent developments, these same small set of theoretical principles have been shown to apply to typical neurodevelopment, encompassing childhood, adolescence, and adulthood, and to neurological conditions such as autism and Alzheimer’s disease. They explain unhealthy risk taking in adolescence, decreased gist-based biases in autism, and the growth of gist-based biases from childhood to adulthood (Reyna & Brainerd, 2011; Reyna, Estrada et al., 2011; see also Reyna & Farley, 2006). A new model of decision making under risk and uncertainty has been introduced, showing how prospect theory can be derived from fuzzy-trace theory by combining analytical (verbatim-based) and intuitive (gist-based) processes (Reyna & Brainerd, 2011). A new model of vaccination decisions has also been introduced, which explains how anti-vaccination messages proliferate due to meaning threats, plausibility of anti-vaccination beliefs, and because anti-vaccination sources provide more coherent narratives of the gist of vaccination (Reyna, 2011).

Most recently, fuzzy-trace theory has been used to design effective public health programs and patient education tools. For example, an interactive, Web-based educational module was designed to effectively communicate the risks and benefits associated with biologic therapy for arthritis; the tool increased knowledge, patient willingness to escalate care, and the likelihood of making an informed choice (Fraenkel et al., in press; see also Wolfe & Reyna, 2010, for interventions to reduce biases). Using this simple tool to promote accurate gist representations, the proportion of subjects making an informed, value-concordant choice increased substantially from 35% to 64%.

Finally, as I write these words, our lab has completed the first neuroimaging study showing that fuzzy-trace theory predicts patterns of activation in the brain during risky decision making (see also Chick & Reyna, 2012; Reyna et al., 2012). Using the new GE Signa MR 750 3T scanner situated at Cornell University in Ithaca, our lab plans to investigate how preferences and values are represented in the brain and how these representations develop across the life span.

For more information and to see the references cited in this article, see

I would like to thank Christina Chick and Priscila Brust for their help and to gratefully acknowledge grant support from the National Institutes of Health’s National Institute on Aging (RC1AG036915-01) and the National Cancer Institute (R21CA149796-01).

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Patient Preferences and Biases of Thinking, Fast and Slow

by Laura D. Scherer, PhD, VA Ann Arbor Center for Clinical Management Research and Center for Bioethics and Social Sciences in Medicine, University of Michigan
Marieke de Vries, PhD, Department of Social Psychology, Tilburg University

Laura D. Scherer and Mariele de VriesShared decision-making is becoming an increasingly important part of the medical landscape, and there has been a corresponding surge in research on how to improve it. One question is what kinds of mental processes we should encourage patients to use in their decisions. We know that fast, effortless intuitions can be subject to heuristics and biases, yet preference sensitive decisions also require patients to incorporate their feelings, and slow, effortful deliberations do not necessarily reveal or construct unbiased feelings. As a result, it is currently unclear whether decision aids, or any other mechanism of patient decision support, should encourage either deliberative or intuitive processes, or both.

On their own, people tend to choose a deliberative approach when a decision is important, when they place a premium on accuracy, when they feel pressure to justify their decision, and when they have little confidence in their own expertise. In other words, medical decisions tend to be situations in which most people think they should deliberate.

But does deliberation actually improve patients’ decisions, or reduce bias? This question is difficult to answer, in part because deliberative processes can have unintended consequences for judgment. Take, for example, the literature on “cognitive fluency”. Cognitive fluency refers to a person’s subjective experience of mental ease or difficulty. When we read small fonts or make long lists of pros and cons, these activities produce feelings of mental effort. Usually, people don’t like mental effort, and it causes negative feelings and attributions. If, however, we believe that mental effort is required to get the best outcome, we may mistakenly interpret the exertion of effort as a signal that we have achieved an optimal result. Hence, the experience of mental ease or difficulty can influence the individual's perception of the validity of their decision making process and, consequently, the validity of their decision.

Furthermore, sometimes it feels right to carefully analyze a decision problem, but other times, it feels right to rely on intuition. As it turns out, the strategy that feels right may depend on one's mood (deliberation feels more “right” when you’re sad versus happy). Hence, one thing that can determine whether a decision is perceived favorably is if it is made in a way that is consistent with one’s mood.

Other psychological research indicates that deliberative thought does not have the powers of rationality that are often ascribed to it. For example, we do not always have conscious access to the reasons for our feelings, and so we often make up reasons that seem plausible but that are not correct. Deliberation can also cause a person to focus on choice attributes that are salient and easy to articulate, even though these attributes are not always related to long-term satisfaction. In fact, a person’s gut feelings may actually incorporate more information than analytical thought, because conscious thought has very limited processing capacity.

To illustrate how this psychological perspective bears on the optimal approach to decision support, consider a man with early stage prostate cancer who believes that impotence, incontinence and anxiety about living with cancer are all very bad-sounding outcomes. One approach is to encourage this man to analyze his values in order to determine whether the ability to have sex is more or less important than death anxiety or having to wear a diaper. Yet the research outlined above suggests that deliberative analysis may cause him to (a) generate reasons for his feelings that may or may not be correct, (b) over-weight salient information, and (c) experience a feeling of mental effort that results in a (perhaps erroneous) belief that his decision is good. None of these outcomes are necessarily bad, per se. The point is simply that this man’s deliberation will not necessarily cause him to construct coherent and stable preferences that accurately reflect underlying personal values.

It would be very useful to know when deliberation provides an advantage over intuition, and vice versa. In a 2005 chapter, Robin Hogarth proposed that deliberation will provide an advantage over intuition in situations where (a) intuitions are likely to be biased, and (b) the decision is not analytically complex. By “analytic complexity,” Hogarth was referring to situations in which there are many factors to consider, and it is difficult to accurately weigh those factors. His framework clarifies why it is so difficult to determine how to best support patient decisions: Patient intuitions are very likely to be biased (e.g. by question framing, order effects, emotions, etc.). But these decisions can also be very complex, requiring that patients know the relevant medical information and then weigh it using their subjective feelings. Interestingly, Hogarth was not able to determine what kind of processing style would be most effective in cases where intuitions are biased and the decision is analytically complex.

In sum, the problem with determining how to support preference sensitive decisions is that these decisions are complex and must ultimately be based on both objective information as well as subjective feelings. Unlike facts, feelings are often not articulable, stable, or strictly reflective of the information that we would like them to reflect (e.g., objective risk). Moreover, deliberation does not necessarily construct or reveal feelings, but instead can inhibit the use of feelings, justify preexisting feelings with tenuous reasoning, and create feelings of effort that influence judgments. Ultimately, this means that in order to become maximally adept supporters of patient decisions, we must be aware of the fact that our assumptions (and yes, intuitions) about how and why analytical thinking supports decision making may well be incorrect.

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Other News

Business Tip: Free Risk Calculator Constructor Platform

by Michael W. Kattan, PhD, Cleveland Clinic

Michael W. KattanThe Department of Quantitative Health Sciences at Cleveland Clinic now provides a free risk calculator platform to deploy your statistical prediction models. Say you are a biostatistician who has come up with an accurate statistical prediction model that you would like others to be able to use. You could write your own software application, but that can be difficult. You could pay someone to do this, but this can be expensive. You now have a third option: copy and paste your model into our platform at You can customize the presentation of your model with respect to friendly variable names, limits, etc. The platform can accommodate various types of regression models. Once you are happy with the presentation of the model, share the URL of your model with others who will then be able to run your model on their desktop computer, BlackBerry, iPhone, etc. You just email them the link to your prediction model, which is generated by our system. All of this is free, and there are YouTube videos on the website to walk you through the steps. Moreover, if you have suggestions for enhancement, please send them to me (; we received a large grant to provide additional work on the functionality of this website. You can see ideas for many live models at Once you have your model running as you like it, you can list the URL for the model (generated by the system) on your own website (so you can make your own web page for your own models).

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International Study on Decision Criteria in Healthcare: Invitation to Participate

Dear Healthcare Decisionmaker,

We are currently carrying out an international study to gather quantitative and qualitative data on decision criteria in healthcare decisionmaking.

This survey-based study was designed to explore criteria considered by healthcare decisionmakers from around the world at the policy level (macro & meso levels, e.g., government, hospital or MCO) or the clinical level (micro level, e.g., physicians). Criteria included in the survey are based on a systematic  literature review and field testing of criteria-based decisionmaking approaches in several regions of the world. We are seeking your participation in this short online survey-based study because your role and experience as a decisionmaker will help map key decision criteria used around the world.

This research project is a collaboration between several universities involving a task force of 30 colleagues from 17 countries. The study is partly funded by the Canadian Institute for Health Research (CIHR) and was approved by the Board of Ethics of the University of Montreal. No personal information is required and all data will be collected anonymously and remains so. The time to complete the survey is estimated to be 10 to 15 minutes. It is possible to leave the survey at any point.

Please allot a small amount of your time to complete the survey at: and contribute to this significant study that will stimulate reflection on decision criteria. And feel free to circulate this survey to your colleagues. The survey will be closed April 30, 2012.

If you have any questions, please contact Nataly Tanios (, study coordinator.

Your participation will be most valuable. Thanking you in advance,

The study leadership team
Nataly Tanios, & Michele Tony, University of Montreal, Canada
Rob Baltussen, Radboud University, Netherlands
Janine Van Til, Twente University, Netherlands
Paul Kind, York University, UK
Monika Wagner, Donna Rindress and Mireille Goetghebeur, EVIDEM Collaboration and BioMedCom Consultants, Canada

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Revision of AMCP Format for Formulary Submissions: Comments Welcome

The Academy of Managed Care Pharmacy (AMCP) Format for Formulary Submissions is a template used by managed care organizations and health systems to formally request that pharmaceutical manufacturers present a "dossier" containing detailed information, not only on the drug's safety and efficacy, but also on its overall clinical and economic value relative to alternative therapies. In short, the AMCP Format aids in the development of a more rigorous and systematic evidence-based process for sifting through information, balancing individual patient characteristics and preferences with population norms, and making difficult judgments in the face of uncertainty. The Format for Formulary Submissions offers a clear, shared vision of the requirements to facilitate the collaboration necessary between healthcare systems and manufacturers to support appropriate and evidence-based drug product evaluation.
AMCP is beginning an update to Version 3.0 of the Format. Society for Medical Decision Making members familiar with the Format have an opportunity to comment until April 30, 2012.

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Member News

Doug Owens appointed to AHRQ Task Force

Owens among those named by AHRQ to the USPS Task Force

The Agency for Healthcare Research and Quality (AHRQ) announced the addition of four new experts in prevention and evidence-based medicine to serve as members of the United States Preventive Services Task Force (USPSTF): Linda Ciofu Baumann, PhD, RN; Mark H. Ebell, MD, MS; Jessica Herzstein, MD, MPH; and SMDM Member Douglas K. Owens, MD, MS. The new members were appointed with guidance from USPSTF Chair Dr. Virginia Moyer and Co-Vice Chairs Drs. Michael LeFevre and Albert Siu. The new members will each serve 4-year terms.
The USPSTF is an independent, volunteer panel of 16 private-sector experts in prevention and evidence-based medicine that makes recommendations about preventive services such as screenings, counseling, or preventive medications. Its recommendations empower patients, their families, and their primary care providers in making informed decisions about prevention. More information on the Task Force is available at
AHRQ, whose mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans, provides administrative, research, technical, and dissemination support to the USPSTF through the Agency’s Prevention and Care Management Portfolio. More information on AHRQ and the nomination of Task Force members is available at

The results of the first multicenter, randomized clinical trial to establish efficacy of a patient decision support system for localized prostate cancer was recently published by Urologic Oncology. Donna L. Berry, PhD, FAAN, nurse scientist at Harvard Medical School, Dana-Farber Cancer Institute, led the trial that tested the Personal Patient Profile-Prostate (P3P). The P3P, a web-based, patient-centered technology, significantly reduced decisional conflict in men over 6 months from study enrollment (Berry et al., Urologic Oncology, Dec 7, 2011; e-pub ahead of print]

Jason Beckstead, PhD, University of South Florida recently published a methodological paper, "Isolating and examining sources of suppression and multicollinearity in multiple linear regression" in Multivariate Behavioral Research. Judgment researchers who use multiple regression techniques ought to find it interesting.

Erkan Ceyhan, PhD, recently joined Lean Advancement Initiative (LAI) at Massachusetts Institute of Technology (MIT) in order to support simulation modeling efforts of Post Traumatic Disorder Innovations (PTSI) project (USAMRMC # 11126005) under the supervision of Prof. Deborah Nightingale (PI), Director, MIT Sociotechnical Systems Research Center (SSRC), Co-director, LAI,

Emmi Solutions (which creates interactive shared decision making programs for conditions like Crohn's disease, chronic low back pain, bariatric surgery, and hip and knee OA) won the 2011 Silver New Product & Technology Award for Interactive Patient Engagement from the Mature Market Resource Center. This organization recognizes innovative products and services for older adults and their families.

University of California at San Francisco faculty members Tom Newman, MD, MPH, and Michael Kohn, MD, MPP, will be giving an Advanced Workshop on Evaluating and Using Medical Tests in San Francisco, June 28-29, 2012. For more information, see

Jeni Fan, MS, reports that since completing her Master of Sciences in Cognitive Psychology at the University of Oklahoma, she joined the Health Advanced Analytics team at Booz Allen Hamilton working with major Civil and DoD healthcare agencies. The work she does at Booz Allen allows her to marry her quantitative research background in behavioral sciences with her desire for direct application and impact. Her career and experiences as a Behavioral Decision Theorist in the government healthcare consulting industry will be featured on the Meet Our People section of Outside of work, she went with the FaithCare organization on a medical humanitarian relief effort to Northern Nigeria in July-August 2011. “We staffed and ran a free clinic in an impoverished area of Kaduna state, offering a wide variety of services such as physical check-ups, pharmaceutical consultations, vision care, dental care, OB/GYN, and general surgery. I had the incredible opportunity to help with triage, conduct clinical intake assessments, and assist in 20+ surgeries. This was a very impactful and humbling experience for me and I highly recommend it for all of us in research and industry,” said Fan.

Doctor, Your Patient Will See You Now, by Steven Kussin, MD, FACP, Medical Advocate, was named a top ten health and wellness title of the year by Booklist. He will be appearing weekly as a medical advocate on his local Fox TV affiliate to educate consumers on health care consumer skills. His practice, The Shared Decision Center, located in Utica, NY, has been featured on local TV and our regional newspapers.

Takeshi Morimoto, MD, PhD, MPH, was promoted to Professor of Medicine at Kinki University School of Medicine, Osaka, Japan. He also serves as Chief of Center for General Internal Medicine and Emergency Care of Kinki University Hospital. He is one of the youngest professors of medicine in clinical department in Japan.

Ellen Peters, PhD,  was recently selected to chair the Food and Drug Administration (FDA)’s Risk Communication Advisory Committee (RCAC) for the next 4 years. Peters had already served a two year term on the RCAC beginning in 2007. Two other SMDM members (Valerie Reyna, PhD, and Angela Fagerlin, PhD) currently serve on the 15-member Committee. Peters’ first meeting as chair focused on a portion of the Patient Protection and Affordable Care Act (i.e., the healthcare reform law) that asked the FDA to examine aspects of numeracy in the promotion of direct-to-consumer advertising for pharmaceuticals, in order to assess how science should inform the type of quantitative information supplied in promotional materials. A second series of discussions were initiated to address recent theoretical developments on information use in decision-making and the implications for strategic communication. As such, the Committee invited two psychologists, Alan Castel, PhD, and SMDM member Brian Zikmund-Fisher, PhD, as guest speakers and focused on two questions: Given what you've heard and know about the state of the science regarding how people process and use risk information in different types of decisions and at different stages of life, what does that suggest about how to communicate most effectively? How can we work with different abilities in gist memory and verbatim number memory to be most effective in communicating our key message?

Fabio Tine, MD, Gastroenterology Unit at Villa Sofia Cervello Hospital Palermo (Italy), published a paper in Statistics in Medicine (2011, vol 22, pp 2671-82) entitled "Assessing covariate imbalance in meta-analysis studies". The relevant topic is the "ex-ante" verification of combinability of studies before statistical pooling.

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FDA’s Center for Devices is Considering Hiring Decision Analysis Specialists

The US Food and Drug Administration’s Center for Devices and Radiological Health is considering hiring scientists who specialize in qualitative and quantitative decision analysis to help develop new methods for regulatory decision-making. We are interested in understanding the breadth and depth of expertise in this field in order to potentially create a broader program to develop regulatory decision tools. Interested applicants will be contacted to discuss FDA’s plan for program development.

US Food and Drug Administration
Center for Devices and Radiological Health
10903 New Hampshire Avenue
Silver Spring, MD 20993

  • The analyst will interact with high-level management within the Center and influence early-stage development of decision analytic tools that will be used for pre- and/or post-market regulatory decisions for medical devices.
  • The tools are expected to have a broad impact on the way the Center does business. In designing the tools, the analyst will work closely with multiple Offices and Divisions within the Center in order to understand different user needs, design appropriate tools, and take steps to encourage wide adoption.
  • Work will involve collaboration with senior policy makers, clinicians, statisticians, and information technology specialists.

  • Familiarity with decision analytic concepts and quantitative and qualitative methods to aid decision making
  • Ability to translate concepts and needs from users within the agency to decision analytic concepts and tools, including designing disease and decision-making models
  • Strong communication skills in order to roll out tools across the agency
  • Strong appreciation for the unique considerations involved in the approval of medical devices: diagnostics, implantable devices, short- and long-term use devices, devices intended to improve quality of life, and the fact that devices are engineered products that are expected to iterate over time.

Interested Candidates:
Please send your CV to: Megan Moynahan, (Acting) Associate Director for Technology and Innovation, FDA, Center for Devices and Radiological Health:
Please note that this is not a vacancy announcement. Sending your CV indicates your willingness to be considered for a possible future program within FDA’s Center for Devices.

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Lifetime Contributors

The Society for Medical Decision Making extends its heartfelt appreciation to the following members for their charitable contributions over the years. *

Pareto Level
(Contributions total $1,000 or more)
Michael Barry (’06, ’07, ’08, ’09, ’10)
Dennis Fryback (’05, ’06, ’07, ’08, ’09, ’10, ’11)
Mark Helfand (’05, ’07, ’10, ’11)
Joseph King (’06, ’07, ’08, ’09, ’10)
William Lawrence (’06, ’10, ’11)
Uwe Siebert ('11)
Frank Sonnenberg (’06, ’09)
Sankey Williams (’06, ’07, ’08)
John Wong (’06, ’07, ’08, ’09, ’10, ’11)

Edwards Level
(Contributions total $750 - $999)
David Meltzer (’07, ’09)
Stephen Pauker (’06, ’09)
David Rovner & Margaret Holmes-Rovner (’05, ’06, ’07, ’08, ’09, ’11)
Marilyn Schapira (’07, ’08, ’09, ’10, ’11)
Joel Tsevat (’06, ’09, ’10)

Tversky Level
(Contributions total $500 - $749)
Robert Beck (’07)
Scott Cantor & Lisa Stone (’07, ’08, ’09, ’10, ’11)
Kate Christensen (’09)
Nananda Col (’05, ’06, ’07, ’08, ’09)
Kathryn McDonald (’07, ’09, ’10)
Jill Metcalf (’07, ’08, ’09, ’10, ’11)
David Paltiel (’07, ’09)
Mark Roberts (’08, ’09)
Bruce Schackman (’06, ’07, ’08, ’09, ’10, ’11)
Hal Sox (’10, ’11)

von Neumann-Morgenstern Level
(Contributions total $250 - $499)
Ahmed Bayoumi (’06, ’09, ’10, ’11)
Dena Bravata (’06, ’09, ’10, ’11)
Randall Cebul (’06, ’08, ’10)
Neal Dawson (’05, ’06, ’07, ’08, ’09, ’10, ’11)
Mark Eckman (’06, ’09)
Arthur Elstein (’06, ’07, ’09, ’10)
Sara Knight (’05, ’06, ’07, ’08, ’09, ’10, ’11)
Karen Kuntz (’09, ’11)
Steven Kymes (’05, ’06, ’07, ’08, ’09)
Seema Sonnad (’06, ’07, ’09)
David Sugano (’07, ’09, ’10, ’11)

Markov Level
(Contributions total $100 - $249)
Amber Barnato (’05, ’07, ’08, ’11)
Cathy Bradley (’07)
Scott Braithwaite (’09)
Phaedra Corso (’06, ’07, ’08)
Elena Elkin (’07)
Alan Garber (’10)
Heather Taffet Gold (’08, ’11)
Peder Halvorsen ('11)
Robert Hamm (’06, ’08)
Myriam Hunink (’05, ’06, ’07, ’08, ’09, ’10, ’11)
Esther Kaufmann ('11)
Miriam Kuppermann (’06, ’07, ’08, ’09, ’10)
Lisa Maillart (’10)
Richard Orr (’05, ’06)
Brian Rittenhouse (’07)
Allison Rosen (’07)
Alan Schwartz (’07, ’10)
James Stahl (’06, ’09, ’10)
Joanne Sutherland (’08, ’09)
Thomas Tape (’10, ’11)
John Thornbury (’05)
George Torrance (’05)
Jef Van den Ende (’10)
Robert Wigton (’10, ’11)

Bayes Level
(Contributions total up to $100)
Eran Bendavid (’11)
Denise Bijlenga (’08)
Kimberly Blake (’09)
Rowland Chang (’06, ’07)
Carmel Crock (’09)
James Dolan (’09)
Arna Dresser (’10)
Ted Ganiats (’05)
Lee Green (’07, ’09)
Amit Gupta (’06)
Michael Hagen (’10)
David Howard (’09)
David Katz (’08)
Job Kievit (’09)
Kerry Kilbridge (’05, ’07, ’08)
Sun-Young Kim (’07, ’08, ’09)
Ivar Sonbo Kristiansen (’10)
Andrew Scott LaJoie (’10)
Andreas Maetzel (’09)
Daniel Masica (’08)
Thomas B. Newman (’10)
Jesse D. Ortendahl ('11)
Jane Pai ('10)
George Papadopoulos (’08)
Lisa Prosser (’08)
Michael Rothberg (’09, ’10, ’11)
Gillian Sanders (’07)
Jha Saurabh (’09)
Ewout Steyerberg (’06, ’09, ’11)
Anne Stiggelbout (’06)
Carol Stockman (’05)
Danielle Timmermans (’07)
Hugues Vaillancourt (’11)
Milton Weinstein (’09, ’11)
Robert Werner (’08)
Brian Zikmund-Fisher (’08, ’09, ’10, ’11)

*Donations received Oct. 2005 – December 31, 2011

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