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Emotional Influences on Diagnostic Error in Emergency Medicine: An Experimental Approach to Understand Diagnostic Failure and Facilitate Improvement for Patients with and without Mental Illness

Award Number: R01HS025752
ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY
OPDIV: AHRQ
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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PROJECT SUMMARY Diagnostic errors are pervasive in medicine and often result from failures in clinical reasoning. Yet, little is known about how to improve clinical reasoning, and even less is known about how emotional experiences may contribute to diagnostic failure. This significant gap in knowledge is important for all populations, but is especially important for highly vulnerable and stigmatized populations who tend to evoke negative emotions. Individuals with mental illnesses comprise nearly 20% of the U.S. population and represent one such group. The primary objective of this research is to identify specific ways in which emotional factors may contribute to errors in diagnosis in the practice of emergency medicine (EM), and to develop and test cognitive interventions that may reduce these errors. Specific aims are to: 1) identify factors that serve as barriers to and facilitators of diagnostic reasoning in EM from key stakeholders (physicians, nurses, and patients) in the diagnostic process; 2) determine the impact of emotional factors (e.g., anger) on clinical reasoning processes among providers assessing patients with physical health complaints either with or without comorbid mental illnesses in emergency contexts; and 3) assess the influence of cognitive interventions that may mitigate affect-induced errors and improve the reliability of the diagnostic process. To achieve these objectives, qualitative interviews will first be conducted with EM physicians, nurses, and patients to inform the experimental studies that follow. Using rigorous, highly-reliable, and well-established methods from social psychology, EM physicians and nurses will participate in highly- controlled experiments designed to examine the causal influences of experimentally-manipulated (a) emotional experiences and (b) cognitive interventions. In these experiments, participants will assess and diagnose patient cases (presented in multimedia formats) to determine the causal effects of these manipulations on providers’ clinical reasoning. This approach is theoretically and methodologically innovative in that it employs cutting-edge theory, research, and methods from social cognitive and affective science to investigate a critical knowledge gap that has not yet been systematically investigated. The proposed research is significant because it will expand our understanding of how emotions influence diagnostic reasoning and investigate possible ways to reduce adverse influences and promote diagnostic accuracy. Such knowledge has the potential to enhance patient safety not only for vulnerable, stigmatized populations such as those with mental illness, but for all patient populations.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $0 )
2025	2021	UNIVERSITY OF MASSACHUSETTS	101 COMMONWEALTH AVE	AMHERST	MA	01003	HAMPSHIRE	USA	Research on Healthcare Costs, Quality and Outcomes	000	5	11/4/2024	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2023 ( Subtotal = $0 )
2023	2021	UNIVERSITY OF MASSACHUSETTS	COMMONWEALTH AVE	AMHERST	MA	01003	HAMPSHIRE	USA	Research on Healthcare Costs, Quality and Outcomes	001	5	7/24/2023	NON-COMPETING CONTINUATION	$0
2023	2021	UNIVERSITY OF MASSACHUSETTS	COMMONWEALTH AVE	AMHERST	MA	01003	HAMPSHIRE	USA	Research on Healthcare Costs, Quality and Outcomes	000	5	11/2/2022	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2021 ( Subtotal = $343,681 )
2021	2021	UNIVERSITY OF MASSACHUSETTS	COMMONWEALTH AVE	AMHERST	MA	01003	HAMPSHIRE	USA	Research on Healthcare Costs, Quality and Outcomes	000	5	6/24/2021	NON-COMPETING CONTINUATION	$343,681
														Subtotal = $343,681

Issue Date FY: 2020 ( Subtotal = $342,586 )
2020	2020	UNIVERSITY OF MASSACHUSETTS	COMMONWEALTH AVE	AMHERST	MA	01003	HAMPSHIRE	USA	Research on Healthcare Costs, Quality and Outcomes	000	4	6/19/2020	NON-COMPETING CONTINUATION	$342,586
														Subtotal = $342,586

Issue Date FY: 2019 ( Subtotal = $343,274 )
2019	2019	UNIVERSITY OF MASSACHUSETTS	COMMONWEALTH AVE	AMHERST	MA	01003	HAMPSHIRE	USA	Research on Healthcare Costs, Quality and Outcomes	000	3	6/7/2019	NON-COMPETING CONTINUATION	$343,274
														Subtotal = $343,274

Issue Date FY: 2018 ( Subtotal = $345,920 )
2018	2018	UNIVERSITY OF MASSACHUSETTS	COMMONWEALTH AVE	AMHERST	MA	01003	HAMPSHIRE	USA	Research on Healthcare Costs, Quality and Outcomes	000	2	5/8/2018	NON-COMPETING CONTINUATION	$345,920
														Subtotal = $345,920

Issue Date FY: 2017 ( Subtotal = $337,382 )
2017	2017	UNIVERSITY OF MASSACHUSETTS	COMMONWEALTH AVE	AMHERST	MA	01003	HAMPSHIRE	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	9/1/2017	NEW	$337,382
2017	2017	UNIVERSITY OF MASSACHUSETTS	COMMONWEALTH AVE	AMHERST	MA	01003	HAMPSHIRE	USA	Research on Healthcare Costs, Quality and Outcomes	001	1	9/6/2017	NEW	$0
														Subtotal = $337,382

Grand Total All Awards = $1,712,843

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Emotional Influences on Diagnostic Error in Emergency Medicine: An Experimental Approach to Understand Diagnostic Failure and Facilitate Improvement for Patients with and without Mental Illness

Award Number: R01HS025752

ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY

OPDIV: AHRQ

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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