Saad, Mohd Shukri Mat
(2017)
Determining the content validity and reliability of twed matrix as a cognitive debiasing strategy in clinical decision making in Emergency Department.
Masters thesis, Pusat Pengajian Sains Perubatan.
Abstract
Background: Cognitive biases always complicate clinical decision making in
emergency department. TWED Matrix was invented as a tool for debiasing strategy to
reduce diagnostic error caused by cognitive biases. It is in the form of mnemonic to
encourage metacognition by doctors to reduce errors in clinical decision making in
emergency department. As it is relatively new tool, a study was conducted to determine
the content validity and reliability of TWED Matrix as cognitive debiasing strategy in
clinical decision making in emergency medicine.
Methodology: This study was divided into two stages; the developmental stage and the
judgment stage. In the developmental stage, we narrowed down 50 cognitive biases into
six classes, and total of four vital questions covering eight items were asked. Then, in
the judgment stage, emergency physicians as expert judges were chosen to evaluate
eight items in the form of Likert scale for their relevance and representativeness. For
relevance, CVI and modified Kappa were assessed and for representativeness, CVI was
calculated. Reliability was tested using Cronbach Alpha.
Results: For relevancy, all of the items were scored of CVI more than 0.78. CVI
average for relevancy was 0.89. Modified Kappa statistic was calculated to make
adjustment for possibilities of chance agreement. For representativeness, all eight items
produced CVI of more than 0.78 which is the minimum value for CVI acceptance. CVIaverage was 0.94. Alpha value for item relevancy was 0.767 which is within acceptable
value. Reliability on item representativeness produced Cronbach’s Alpha of 0.737
which is still above acceptance value of 0.7.
Conclusion: TWED Matrix showed significant validity and reliability in this study
although further evaluation and assessment needed to strengthen the power of the study
before it could safely and widely use as a cognitive debiasing strategy in clinical
decision making in emergency department.
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