1 — The process of decision-making & decision framing in the real-world
Traditional theories of the most rational choice to make in particular well-specified circumstances give good mathematical analysis where the probabilities and utilities of all outcomes and options are known, but this is rarely the case in any complex real-world situation. Such theories say nothing about how to frame a decision – the process of working out what decision needs to be made, what the various options are and the implications of each.
The Deontics approach is based on a richer theory of the way people – especially clinicians – actually make decisions in the real world, where probabilities and utilities are often unknown and may have outcomes of radically different types that cannot easily be compared. Our cognitive framework, based on studies of clinical decision-making, encompasses the full range of processes surrounding framing, analysing, making and following up decisions. The PROforma logic model developed by the Deontics team for representing clinical pathways is directly based on this cognitive framework, in order to provide knowledge representation for processes surrounding clinical decisions and workflows which fits the way clinicians naturally think.
Fox, J (2016). Cognitive systems at the point of care: the CREDO program
Retrospective review of the work of the team behind Deontics over more than 20 years in modelling and understanding clinical thinking and developing computer systems to assist clinicians.
Fox, J., Glasspool, D. W., Patkar, V., Austin, M., Black, L., South, M., et al. (2010). Delivering clinical decision support services: there is nothing as practical as a good theory. J. Biomed. Inform. 43, 831–843.
Shows how the Domino model and associated cognitive theory successfully underpins a wide range of real-world clinical applications.
Fox, J. and Glasspool, D. W. (2006). Knowledge, arguments, and intentions in clinical decision-making. In R. Paton & L. McNamara (Eds.) Multidisciplinary Approaches to Theory in Medicine. Amsterdam: Elsevier. pp. 103-129.
Discusses the full range of processes that must be taken into account in order to understand clinical decision making, and shows how the Domino model and Argumentation Logic capture them.
Fox, J., Beveridge, M., and Glasspool, D. W. (2003). Understanding intelligent agents: analysis and synthesis. AI Commun. 16, 139–152.
Shows how the PROforma language is based on the Domino model, and how this underlies its clinical usefulness.
Fox, J., and Das, S. (2000). Safe and Sound: Artificial Intelligence in Hazardous Applications. Cambridge: American Association for Artificial Intelligence and The MIT Press.
Original introduction of the Domino model and PROforma.