Dataset Information

Intuitive decision making as a gradual process: investigating semantic intuition-based and priming-based decisions with fMRI.

ABSTRACT:

Introduction

Intuition has been defined as the instantaneous, experience-based impression of coherence elicited by cues in the environment. In a context of discovery, intuitive decision-making processes can be conceptualized as occurring within two stages, the first of which comprises an implicit perception of coherence that is not (yet) verbalizable. Through a process of spreading activation, this initially non-conscious perception gradually crosses over a threshold of awareness and thereby becomes explicable. Because of its experiential basis, intuition shares conceptual similarities with implicit memory processes. Based on these, the study addresses two research questions: (1) Is the gradual nature of intuitive processes reflected on a neural level? (2) Do intuition-based decisions differ neurally from priming-based decisions?

Methods

To answer these questions, we conducted an fMRI study using the triads task and presented participants with coherent word triads that converge on a common fourth concept, and incoherent word triads that do not converge on a common fourth concept. Participants had to perform semantic coherence judgments as well as to indicate whether they immediately knew the fourth concept. To enable investigating intuition-based and priming-based decisions within the same task and with the same participants, we implemented a conceptual priming procedure into the coherence judgment task. We realized this by priming participants with concepts associated with incoherent triads in separate priming blocks prior to the coherence judgments.

Results

For intuition-based decisions, imaging results mainly revealed activity within the orbitofrontal cortex, within the inferior frontal gyrus and the middle temporal gyrus. Activity suppression in the right temporo-occipital complex was observed for priming-based decisions.

Conclusions

With respect to research question 1, our data support a continuity model of intuition because the two intuitive stages show quantitatively distinct brain activation patterns. Regarding research question 2, we can draw the preliminary conclusion of a qualitative difference between intuition-based and priming-based decisions.

SUBMITTER: Zander T

PROVIDER: S-EPMC4834943 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Importance:Patients with serious illnesses are often encouraged to actively deliberate about the desirability of life support. Yet it is unknown whether deliberation changes the substance or quality of such decisions. Objective:To identify differences in decisions about life support interventions and goals of care made intuitively vs deliberatively by patients with serious illnesses. Design, Setting, and Participants:Randomized clinical trial in which patients were asked to express treatment preferences in a series of clinical scenarios. Participants were 199 hospitalized patients aged 60 years and older with serious oncologic, cardiac, and pulmonary illnesses treated in a large, urban academic hospital from July 1, 2015, through March 15, 2016. Interventions:Patients in the intuitive group were subjected to a cognitive load and instructed to answer each question immediately based on gut instinct. Patients in the deliberative group were not cognitively loaded, were instructed to think carefully about their answers, and were required to explain their answers. Main Outcomes and Measures:Choices regarding life support (4 scenarios) and goals of care (1 scenario), concordance of these choices with patients' valuations of health states that could follow from them, and decisional uncertainty. Results:Of 199 patients, 132 (66%) were male and the mean (SD) age was 67.2 (5.0) years. Similar proportions of patients in the intuitive group (n = 97) and the deliberative group (n = 102) said they would accept a feeding tube for chronic aspiration (42% vs 44%, respectively; difference, -2%; 95% CI, -16% to 12%; P = .79), antibiotics for life-threatening infection in the event of terminal illness (39% vs 43%, respectively; difference, -4%; 95% CI, -18% to 10%; P = .57), a trial of mechanical ventilation (59% vs 60%, respectively; difference,-1%; 95% CI, -15% to 13%; P = .88), and a tracheostomy tube (37% vs 41%, respectively; difference, -4%; 95% CI, -22% to 13%; P = .64). Patients in the deliberative group were slightly more likely than patients in the intuitive group to choose a palliative approach to treatment in the event of serious illness (45% vs 30%, respectively; difference, 15%; 95% CI, 1%-29%; P = .04). Across scenarios, decisional uncertainty was similar between the 2 groups (all P > .05), and intuitive decisions were either equally or more closely aligned with patients' health state valuations than deliberative decisions. Conclusions and Relevance:In this study, encouraging hospitalized patients with serious illnesses to deliberate on end-of-life decisions did not change the content or improve the quality of these decisions. It is important to evaluate whether decision aids and structured communication interventions improve seriously ill patients' choices. Trial Registration:ClinicalTrials.gov Identifier: NCT02487810.