Understanding scientific decision-making and uncertainty through grounded theory

Abstract

The purpose of this study is to understand how decisions are made by members of a public agency that addresses scientific and technical issues under conditions of uncertainty. The primary research method used is grounded theory, a major qualitative research tool used in the social sciences for decades. Decision-making under conditions of uncertainty is an important topic because, despite the textbook approach to administrative decision-making where the steps involved in reaching a conclusion are relatively straightforward and linear, the reality is more complex. This research project uses the Advisory Committee on Immunization Practices (ACIP) as an example of how decisions are made under conditions of scientific uncertainty. The ACIP is a fifteen-member group of physicians that meets periodically to review data on vaccines licensed for use in the United States by the U.S. Food & Drug Administration (FDA). Group members make recommendations to the U.S. Centers for Disease Control & Prevention (CDC) on vaccine uses and doses for specific populations. Using semi-structured interviews with current and former ACIP members, the dissertation seeks to understand how ACIP members make recommendations to the CDC where a high degree of evidence exists (e.g., the primary age groups for which a new vaccine is needed and has been shown to be safe and effective) and where lesser (or no) evidence exists (e.g., interchangeability of vaccine brands) and poses questions about the bases of recommendations in these two circumstances. The conclusion is that where a high degree of technical consensus exists about the evidence and data, a decision generally is made according to a clear, relatively linear decision-making process. If a high degree of technical consensus does not exist, the decision is made based on a variety of criteria, including readily available resources, decision-process constraints, and the available knowledge base, among other things. In short, where a reasonably clear, consensus-based decision-making process is in place, decision-makers generally follow a long-established decision rule. In the absence of such a rule, decision-makers rely on a variety of contextual factors as well as familiar processes and analogies that are accepted practice within their professional community.