# 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

> **NIH AHRQ R01** · UNIVERSITY OF MASSACHUSETTS AMHERST · 2021 · $343,681

## Abstract

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.

## Key facts

- **NIH application ID:** 10199043
- **Project number:** 5R01HS025752-05
- **Recipient organization:** UNIVERSITY OF MASSACHUSETTS AMHERST
- **Principal Investigator:** LINDA M ISBELL
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $343,681
- **Award type:** 5
- **Project period:** 2017-09-01 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10199043

## Citation

> US National Institutes of Health, RePORTER application 10199043, 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 (5R01HS025752-05). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10199043. Licensed CC0.

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