Some teams may judge ‘success’ by only focusing on limited outcomes. Being able to overlook poor outcomes (impacts on quality of life, length of stay, rehabilitation) and focus on simple survival metrics is an Availability bias . This survivorship bias is made possible by not collecting data on the outcomes that also matter to make the invisible visible (e.g. PROMS – Patient-reported outcome measures).
Clinicians may suffer versions of egocentric bias; overestimation of their ability to control events (Illusion of control) and an overestimation of their judgement (Illusion of validity). These egocentric biases lead to Overconfidence effect (I am personally absolutely sure of this).
“Introducing the CGA is too difficult”
Some colleagues viewed change with suspicion and dread of a more difficult future; Declinism in action. When there are multiple options for improvement, sticking with the status quo is ‘default effect’ version of Framing effect. Being averse to loss and avoiding the disruption of change feed into Status quo bias and System justification bias.
Teams may not want to change because they are justly proud in the thing that they built (IKEA effect).
Colleagues may be unsure that the effort of CGA will bring a positive outcome, they are showing the Ambiguity effect, part of the Prospect theory discussed by Daniel Kahnemann.
The prominence of CGA at the 2020 ASCO meeting may lead some to think that CGA is ‘new’ (ignorant of previous decades of work). This misunderstanding is an example of Recency illusion.
The CGA presentations at ASCO fought for prominence with the newest and brightest oncology treatments. When Availability bias leads us to focus on the excitement of immunotherapy over the prosaic simplicity of CGA we become victims of Salience bias.
Some have the ‘double trouble’ bias of simultaneously overestimating their ability to treat an older person safely whilst underestimating how simple introducing CGA into practice may be. This bias was described by Festinger as the Hard–easy effect.
Semmelweiss provided a foundation and when he was stopped Lister and Pasteur continued to build until bias could no longer stand in its’ way. Evidence and continued implementation are the tools to chip away at the bias of those who don’t believe. I hope you recognise your own biases and are able to bust the biases of others!