How the dual process model of human cognition can inform efforts to de-implement ineffective and harmful clinical practices: A preliminary model of unlearning and substitution

Journal of Evaluation in Clinical Practice
Christian D HelfrichDavid C Aron

Abstract

One way to understand medical overuse at the clinician level is in terms of clinical decision-making processes that are normally adaptive but become maladaptive. In psychology, dual process models of cognition propose 2 decision-making processes. Reflective cognition is a conscious process of evaluating options based on some combination of utility, risk, capabilities, and/or social influences. Automatic cognition is a largely unconscious process occurring in response to environmental or emotive cues based on previously learned, ingrained heuristics. De-implementation strategies directed at clinicians may be conceptualized as corresponding to cognition: (1) a process of unlearning based on reflective cognition and (2) a process of substitution based on automatic cognition. We define unlearning as a process in which clinicians consciously change their knowledge, beliefs, and intentions about an ineffective practice and alter their behaviour accordingly. Unlearning has been described as "the questioning of established knowledge, habits, beliefs and assumptions as a prerequisite to identifying inappropriate or obsolete knowledge underpinning and/or embedded in existing practices and routines." We hypothesize that as an unintended c...Continue Reading

References

Nov 5, 2002·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Pat Croskerry
Apr 26, 2003·The American Journal of Medicine·Paul B CorniaBenjamin A Lipsky
Oct 23, 2003·Journal of Experimental Psychology. Applied·Gilles O EinsteinR Key Dismukes
Jan 1, 1996·Annual Review of Psychology·K A Ericsson, A C Lehmann
Sep 24, 2004·Academic Medicine : Journal of the Association of American Medical Colleges·K Anders Ericsson
Dec 4, 2004·Quality & Safety in Health Care·R Rushmer, H T O Davies
Mar 29, 2005·Joint Commission Journal on Quality and Patient Safety·Mark Graber
Feb 23, 2007·The New England Journal of Medicine·Peter M A CalverleyUNKNOWN TORCH investigators
Mar 3, 2007·Journal of Clinical Nursing·Maggi Banning
Oct 6, 2007·American Journal of Respiratory and Critical Care Medicine·Jadwiga A WedzichaUNKNOWN INSPIRE Investigators
Dec 25, 2007·Annual Review of Psychology·Jonathan St B T Evans
Mar 24, 2009·Current Neuropharmacology·Rosa LiperotiAndrea Corsonello
Jul 30, 2009·Academic Medicine : Journal of the Association of American Medical Colleges·Pat Croskerry
Aug 12, 2009·Advances in Health Sciences Education : Theory and Practice·Pat Croskerry
Jun 23, 2010·Psychological Bulletin·Martin S HaggerNikos L D Chatzisarantis
Dec 2, 2011·BMJ Quality & Safety·Ayse P GursesPeter J Pronovost
Jan 25, 2012·Archives of Internal Medicine·Deborah KorensteinSalomeh Keyhani
May 25, 2012·Journal of the National Cancer Institute. Monographs·Bryan J WeinerKaryn B Stitzenberg
Jan 30, 2014·JAMA Internal Medicine·Daniella MeekerJason N Doctor
Mar 19, 2014·Journal of the American Geriatrics Society·Helen C KalesUNKNOWN Detroit Expert Panel on Assessment and Management of Neuropsychiatric Symptoms of Dementia
Mar 22, 2014·Annals of Behavioral Medicine : a Publication of the Society of Behavioral Medicine·Justin PresseauFalko F Sniehotta
Sep 23, 2014·The Lancet. Respiratory Medicine·Lydia FinneyPatrick Mallia
Nov 15, 2014·Journal of General Internal Medicine·David TannenbaumCraig R Fox
Jan 30, 2015·Worldviews on Evidence-based Nursing·Kirsten HanrahanAnn Williamson
Mar 4, 2015·BMJ : British Medical Journal·Helen C KalesConstantine G Lyketsos
May 1, 2013·Perspectives on Psychological Science : a Journal of the Association for Psychological Science·Jonathan St B T Evans, Keith E Stanovich
Oct 9, 2015·BMC Medicine·Daniel J NivenHenry Thomas Stelfox
Feb 13, 2016·JAMA : the Journal of the American Medical Association·Daniella MeekerJason N Doctor
Sep 23, 2016·JAMA : the Journal of the American Medical Association·Joshua M LiaoAmol S Navathe
Nov 15, 2016·Healthcare : the Journal of Delivery Science and Innovation·Michael L ParchmanEmily H Ganos
Mar 11, 2017·Worldviews on Evidence-based Nursing·Per NilsenBenjamin Gardner
May 12, 2017·The Medical Journal of Australia·Ian A ScottRobyn Lindner

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Citations

Jan 19, 2019·International Journal of Nursing Practice·Annette M Bourgault, Michele J Upvall
Jan 19, 2019·American Journal of Medical Quality : the Official Journal of the American College of Medical Quality·Melanie D WhittingtonChristian D Helfrich
Dec 7, 2018·Critical Care Nurse·Annette M Bourgault
Jun 7, 2019·Implementation Science : IS·Shannon Wiltsey StirmanChristopher J Miller
Jan 22, 2020·Critical Care Nurse·Michele J UpvallChristine A Swartzman
Aug 29, 2018·Proceedings of the National Academy of Sciences of the United States of America·Deepika MohanAmber E Barnato
Jan 10, 2020·Implementation Science : IS·Wynne E Norton, David A Chambers
Oct 4, 2020·Dimensions of Critical Care Nursing : DCCN·Annette M BourgaultMichele J Upvall
Aug 10, 2019·Intensive Care Medicine·Henry T StelfoxDaniel J Niven
Aug 23, 2018·Annals of the American Thoracic Society·Rosechelle Ruggiero, Lynn F Reinke
Aug 10, 2019·Journal of General Internal Medicine·Krysttel StryczekChristian D Helfrich
Nov 10, 2020·Medical Care·Sarah A NowakCraig E Pollack
Jan 16, 2021·American Journal of Psychotherapy·Joel YagerKimberly Kelsay
Feb 6, 2021·Implementation Science Communications·Hanna AugustssonHenna Hasson
Feb 11, 2019·Gaceta sanitaria·Clara Bermúdez-TamayoLeticia García-Mochón
Feb 8, 2020·The American Journal of Medicine·Michael L ParchmanEmmy Ganos
Dec 1, 2020·Australian Health Review : a Publication of the Australian Hospital Association·Ian A Scott, Steven M McPhail
Jul 22, 2021·BMJ Quality & Safety·Carolyn Tarrant, Eva M Krockow

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