Evidence-informed person-centered healthcare part I: do 'cognitive biases plus' at organizational levels influence quality of evidence?

J Eval Clin Pract. 2014 Dec;20(6):734-47. doi: 10.1111/jep.12280. Epub 2014 Nov 28.


Introduction: There is increasing concern about the unreliability of much of health care evidence, especially in its application to individuals.

Hypothesis: Cognitive biases, financial and non-financial conflicts of interest, and ethical violations (which, together with fallacies, we collectively refer to as 'cognitive biases plus') at the levels of individuals and organizations involved in health care undermine the evidence that informs person-centred care.

Methods: This study used qualitative review of the pertinent literature from basic, medical and social sciences, ethics, philosophy, law etc.

Results: Financial conflicts of interest (primarily industry related) have become systemic in several organizations that influence health care evidence. There is also plausible evidence for non-financial conflicts of interest, especially in academic organizations. Financial and non-financial conflicts of interest frequently result in self-serving bias. Self-serving bias can lead to self-deception and rationalization of actions that entrench self-serving behaviour, both potentially resulting in unethical acts. Individuals and organizations are also susceptible to other cognitive biases. Qualitative evidence suggests that 'cognitive biases plus' can erode the quality of evidence.

Conclusions: 'Cognitive biases plus' are hard wired, primarily at the unconscious level, and the resulting behaviours are not easily corrected. Social behavioural researchers advocate multi-pronged measures in similar situations: (i) abolish incentives that spawn self-serving bias; (ii) enforce severe deterrents for breaches of conduct; (iii) value integrity; (iv) strengthen self-awareness; and (v) design curricula especially at the trainee level to promote awareness of consequences to society. Virtuous professionals and organizations are essential to fulfil the vision for high-quality individualized health care globally.

Keywords: EBM; cognitive biases; conflicts of interest; ethics; evidence; health care.

Publication types

  • Review

MeSH terms

  • Bias
  • Conflict of Interest
  • Delivery of Health Care / organization & administration
  • Evidence-Based Practice / organization & administration*
  • Evidence-Based Practice / standards*
  • Health Services Needs and Demand*
  • Humans
  • Organizational Innovation
  • Patient Advocacy
  • Patient-Centered Care / ethics
  • Patient-Centered Care / methods*
  • Patient-Centered Care / organization & administration*
  • Quality Assurance, Health Care / standards*
  • United States