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Interventions to Mitigate Cognitive Biases in the Decision Making of Eye Care Professionals

A Systematic Review

Shlonsky, Aron PhD1,2; Featherston, Rebecca PhD1,2; Galvin, Karyn L. PhD3; Vogel, Adam P. PhD3,4,5,6; Granger, Catherine L. PhD7; Lewis, Courtney MSc3; Luong, My-Linh MSPH7; Downie, Laura E. BOptom, PhD, FAAO8*

doi: 10.1097/OPX.0000000000001445

SIGNIFICANCE Cognitive biases, systematic errors in thinking that impact a person's choices and judgments, can influence decision making at various points during patient care provision. These biases can potentially result in misdiagnoses, delayed clinical care, and/or patient mismanagement. A range of interventions exists to mitigate cognitive biases. There is a need to understand the relative efficacy of these interventions within the context of eye care practice.

PURPOSE The aim of this systematic review was to synthesize the evidence relating to interventions for mitigating cognitive biases associated with clinical decision making by eye care professionals.

DATA SOURCES Electronic databases (including Ovid MEDLINE, Embase, Scopus, PsycINFO) were searched from inception to October 2017 for studies investigating interventions intended to mitigate cognitive biases in the clinical decision making of eye care professionals. This review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines.

STUDY ELIGIBILITY CRITERIA To ensure inclusion of all relevant literature, a wide range of study designs was eligible for inclusion, such as randomized controlled trials, nonrandomized trials, interrupted time series and repeated measures, controlled before-after studies, and qualitative studies that were a component of any of these quantitative study designs.

STUDY APPRAISAL AND SYNTHESIS METHODS Two review authors independently screened titles, abstracts, and full-text articles in duplicate, applying a priori eligibility criteria.

RESULTS After screening 2759 nonduplicate records, including full-text screening of 201 articles, no relevant studies were identified.

CONCLUSIONS AND IMPLICATIONS OF FINDINGS Given that cognitive biases can significantly impact the accuracy of clinical decision making and thus can have major effects on clinical care and patient health outcomes, the lack of studies identified in this systematic review indicates a critical need for research within the area of cognitive bias mitigation for decision making within eye care practice.

1Department of Social Work, University of Melbourne, Parkville, Victoria, Australia

2Department of Social Work, Monash University, Caufield, Victoria, Australia

3Department of Audiology and Speech Pathology, University of Melbourne, Parkville, Victoria, Australia

4Centre for Neuroscience of Speech, University of Melbourne, Parkville, Victoria, Australia

5Redenlab, Melbourne, Victoria, Australia

6Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany

7Department of Physiotherapy, University of Melbourne, Parkville, Victoria, Australia

8Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia


Supplemental Digital Content: Appendix A. The protocol used in this review is available at

Appendix Table A1. Example search strategy (Ovid MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily, and Ovid MEDLINE 1946 to present) is available at

Appendix Table A2. The list of studies excluded at the full-text screening stage is available at

Submitted: January 9, 2019

Accepted: July 29, 2019

Funding/Support: University of Melbourne (Melbourne School of Health Sciences interdisciplinary research grant; to AS, LED, APV, KLG, CLG).

Conflict of Interest Disclosure: This study was supported by a University of Melbourne School of Health Sciences interdisciplinary research grant (AS, LED, APV, KLG, CLG). The sponsor had no role in the experimental design or conduct of this research. APV is Chief Science Officer of Redenlab, which assists in decision making in clinical trials. All other authors declare no conflicts of interest.

Study Registration Information: Campbell Collaboration (published July 27, 2017).

Author Contributions and Acknowledgments: Conceptualization: AS, RF, KLG, APV, CLG, LED; Data Curation: AS, RF, KLG, CL, M-LL, LED; Formal Analysis: AS, RF, CL, M-LL, LED; Funding Acquisition: AS, KLG, APV, CLG, LED; Investigation: AS, RF; Methodology: AS, RF, KLG, APV, CLG, LED; Project Administration: AS, RF, CL, M-LL; Resources: AS; Supervision: AS; Writing – Original Draft: LED; Writing – Review & Editing: AS, RF, KLG, APV, CLG, CL, M-LL, LED.

The authors thank Jason Wasiak for assisting with the literature searches.

Supplemental Digital Content: Direct URL links are provided within the text.

Online date: October 29, 2019

© 2019 American Academy of Optometry