Cognitive biases, environmental, patient and personal factors associated with critical care decision making: A scoping review

Iris E. Beldhuis*, Ramesh S. Marapin, You Yuan Jiang, Nadia F. Simoes de Souza, Artemis Georgiou, Thomas Kaufmann, Jose Castela Forte, Iwan C. C. van der Horst

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

11 Citations (Scopus)
262 Downloads (Pure)


Purpose: Cognitive biases and factors affecting decision making in critical care can potentially lead to life threatening errors. We aimed to examine the existing evidence on the influence of cognitive biases and factors on decision making in critical care. Materials and methods: We conducted a scoping review by searching MEDLINE for articles from 2004 to November 2020. We included studies conducted in physicians that described cognitive biases or factors associated with decision making. During the study process we decided on the method to summarize the evidence, and based on the obtained studies a descriptive summary of findings was the best fit. Results: Thirty heterogenous studies were included. Four main biases or factors were observed, e.g. cognitive biases, personal factors, environmental factors, and patient factors. Six (20%) studies reported biases associated with decision making comprising omission-, status quo-, implicit-, explicit-, outcome-, and overconfidence bias. Nineteen (63%) studies described personal factors, twenty-two (73%) studies described environmental factors, and sixteen (53%) studies described patient factors. Conclusions: The current evidence on cognitive biases and factors is heterogenous, but shows they influence clinical decision. Future studies should investigate the prevalence of cognitive biases and factors in clinical practice and their impact on clinical outcomes. (c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://

Original languageEnglish
Pages (from-to)144-153
Number of pages10
JournalJournal of Critical Care
Publication statusPublished - Aug-2021


  • Critical care
  • Decision making
  • Cognitive bias
  • Factors
  • Scoping review
  • UNIT


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