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Results for “Decision Making”

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PubMed2002

Professionals' decision-making about out-of-home placements following instances of child abuse.

OBJECTIVE: The goal of this research was to study how different groups of child welfare professionals prioritize and use information to make placement decisions following instances of child abuse. METHOD: A total of 90 juvenile court judges and guardians ad litem, Court Appointed Special Advocates (CASA), social workers, and mental health professionals responded to a detailed questionnaire describing four case studies of child physical abuse in which a parent was the perpetrator, the child was either 2 years or 6 years of age, and the abuse was either first time or chronic. Participants rated the impact of specific pieces of information regarding child, family, and system-level characteristics on their decision-making process. RESULTS: Analyses of reactions to these vignettes demonstrate that professional groups use different kinds of information when making decisions about foster care placements. Social workers and mental health providers rely on information about the severity and pattern of abuse and on information about services offered in the past and parental responses to those services. Judges and guardians ad litem rely more heavily on information about the likelihood of a reoccurrence of abuse and the child's ability to recount the abuse, whereas CASA volunteers rely on information about the stability of the family. CONCLUSIONS: Professional group membership, rather than factors such as age or ethnicity of the child or chronicity of abuse, accounts for different patterns of prioritizing and using information when making decisions about whether a child should remain in the home or be placed in foster care. The implications for community-based training and intervention efforts are discussed.

Attitude of Health Personnel↗

PubMed2001

Value of fractional flow reserve in making decisions about bypass surgery for equivocal left main coronary artery disease.

OBJECTIVE: To investigate the value of coronary pressure derived fractional flow reserve (FFR) measurements in supporting decisions about medical or surgical treatment in patients with angiographically equivocal left main coronary artery stenosis. DESIGN: A two centre prospective single cohort follow up study. INTERVENTIONS: FFR of the left main coronary artery was determined in 54 consecutive patients with angiographically equivocal left main coronary artery disease. If FFR was >/= 0.75, medical treatment was chosen; if FFR was < 0.75, surgical treatment was chosen. MAIN OUTCOME MEASURES: Freedom from death, myocardial infarction, or any coronary revascularisation procedure. RESULTS: In 24 patients (44%), FFR was >/= 0.75 and medical treatment was chosen (medical group). In the remaining 30 patients (56%), FFR was < 0.75 and bypass surgery was performed (surgical group). Mean (SD) follow up was 29 (15) months (range 12-65 months). Survival among patients at three years of follow up was 100% in the medical group and 97% in the surgical group. Event-free survival was 76% in the medical group and 83% in the surgical group. CONCLUSIONS: FFR supports decision making in equivocal left main coronary artery disease. If FFR is below 0.75, the decision for bypass surgery is supported. If FFR is above 0.75, a conservative approach is justified.

Adult↗

PubMed2003

Patient centered decision making in palliative cancer treatment: a world of paradoxes.

Patient centered palliative cancer care would imply, first, the introduction of psychosocial endpoints when evaluating treatment and making decisions. Second, patient control would have to be enhanced by information giving and increased decision involvement. We have indicated that paradoxes exist when a patient centered approach is advocated in the context of palliative cancer care. So-called patient oriented outcomes, like quality of life, once introduced seem to be disregarded by many patients themselves and survival is given a more important weight. Likewise, physicians seem to be inclined to treat patients aggressively for little benefit rather than providing supportive care. Both parties seem to prefer to do something actively to maintain a semblance of control over the disease process. Giving treatment, even if aggressive, is a way to avoid the confrontation with the little efficacy that the physician has to offer to incurable cancer patients. This mechanism is reflected in the content of conversations in palliative care. Patient centered care would imply that patient control and autonomy are enhanced. However, again paradoxically, many patients seem to want to avoid information and leave the decisions to be made by their doctors. Physicians, then, follow such wishes while paying more attention to aggressive therapy than to the notion of watchful waiting. This may help to avoid the painful confrontation with bad news. Dilemmas then remain. Patients wishing to maintain hope and avoid emotional impact of a full understanding of their prognosis may rather not be informed brusquely about prognosis or the aims of supportive therapy and forced to make an informed decision. However, by giving more aggressive, maybe even futile, treatment, and withholding supportive care patients may receive less than 'quality end-of-life care'. Therefore, information about less intrusive strategies should still be given in a cautious manner, while regarding the patient's defenses respectfully.

Decision Making↗

PubMedDate not supplied

Managerial decision-making in the laboratory.

Although managers make decisions daily, they do not always make them well. Because of the complexity of some decisions, a decision aid such as the multiattribute utility model is often helpful. This model can help a decision-maker in problem structuring, including determining the criteria on which the alternatives should be judged, how important these criteria are in relation to each other, and how well the alternatives stack up against these criteria. Finally, the model brings all this information together so that the decision-maker can make appropriate recommendations. By using a multiattribute utility model, this case study shows the applicability of the model to the decision of choosing among alternative hematologic instruments in a medical laboratory. The model, in any of its forms, is also useful for many other types of decisions. The model can be used either to help make a choice or to reinforce a choice made by other means and to help communicate the factors on which a choice was made.

Administrative Personnel↗

PubMedDate not supplied

The hidden traps in decision making.

Bad decisions can often be traced back to the way the decisions were made--the alternatives were not clearly defined, the right information was not collected, the costs and benefits were not accurately weighed. But sometimes the fault lies not in the decision-making process but rather in the mind of the decision maker. The way the human brain works can sabotage the choices we make. Eight psychological traps that are particularly likely to affect the way we make business decisions are examined. The anchoring trap leads us to give disproportionate weight to the first information we receive. The status-quo trap biases us toward maintaining the current situation--even when better alternatives exist. The sunk-cost trap inclines us to perpetuate the mistakes of the past. The confirming-evidence trap leads us to seek out information supporting an existing predilection and to discount opposing information. The framing trap occurs when we misstate a problem, undermining the entire decision-making process. The overconfidence trap makes us over-estimate the accuracy of our forecasts. The prudence trap leads us to be overcautious when we make estimates about uncertain events. And the recallability trap leads us to give undue weight to recent, dramatic events. The best way to avoid all the traps is awareness--forewarned is forearmed. The authors show how to take action to ensure that important business decisions are sound and reliable.

Administrative Personnel↗

PubMedDate not supplied

The hidden traps in decision making.

Bad decisions can often be traced back to the way the decisions were made--the alternatives were not clearly defined, the right information was not collected, the costs and benefits were not accurately weighted. But sometimes the fault lies not in the decision-making process but rather in the mind of the decision maker. The way the human brain works can sabotage the choices we make. John Hammond, Ralph Keeney, and Howard Raiffa examine eight psychological traps that are particularly likely to affect the way we make business decisions: The anchoring trap leads us to give disproportionate weight to the first information we receive. The statusquo trap biases us toward maintaining the current situation--even when better alternatives exist. The sunk-cost trap inclines us to perpetuate the mistakes of the past. The confirming-evidence trap leads us to seek out information supporting an existing predilection and to discount opposing information. The framing trap occurs when we misstate a problem, undermining the entire decision-making process. The overconfidence trap makes us overestimate the accuracy of our forecasts. The prudence trap leads us to be overcautious when we make estimates about uncertain events. And the recallability trap leads us to give undue weight to recent, dramatic events. The best way to avoid all the traps is awareness--forewarned is forearmed. But executives can also take other simple steps to protect themselves and their organizations from the various kinds of mental lapses. The authors show how to take action to ensure that important business decisions are sound and reliable.

Administrative Personnel↗

PubMed1995

Decision making in the treatment of school-age children who stutter.

The purpose of this article is to provide clinicians information on some of the key issues in making decisions about the treatment process for children who stutter. Ten decisions that should be considered prior to, during, and at the time of dismissal are discussed. These decisions relate to a number of issues regarding treatment such as: increasing clinicians' confidence in treating stuttering in children, setting long- and short-term goals, selecting an approach to treatment, documenting progress, involving parents and teachers in the treatment process, and determining when the child is ready to be dismissed from treatment. Additionally, questions clinicians should ask themselves are presented with each of the ten decisions. The intent of this article is to show how an analysis of clinical information systematically collected over a period of time will help a clinician make accurate decisions about the treatment of children who stutter.

Adolescent↗

PubMedDate not supplied

Triage in the emergency department--a qualitative study of the factors which nurses consider when making decisions.

Triage, as a concept, is relatively new in Sweden and means 'sorting'. The triage process was developed to grade patients who needed immediate care. Triage is currently important for the emergency treatment system, and nurses are expected to work with it professionally. The aim of this study is to describe how nurses implement triage when patients arrive at the emergency department of a county hospital, situated in a rural area of Sweden, as well as to highlight the factors considered when prioritizing, in connection with nurses' decision-making. The method used was observations of 19 nurses, with minimal disturbance in their triage work, followed by a short tape-recorded interview, during which the nurses were asked to reflect upon their decision of priorities. Qualitative content analysis of data has been used. The results were divided into two areas, internal factors and external factors. The internal factors reflect the nurse skills and personal capacity. The external factors reflect work environment, including high workload and practical arrangements, and should always be perceived and taken into consideration. Using these factors as a basis, the patients' clinical condition, clinical history, various examinations and tests form an assessment, which subsequently results in a prioritization.

Attitude of Health Personnel↗

PubMed2000

Does help in decision-making in biology help in decision-making in human sciences and conversely?

A link between biological and human sciences may be established, under the condition that we should admit the existence of reciprocal influences between them. The model for the regulation of agonistic antagonistic couples (MRAAC) is built from the study of biological systems and gives rise to specific types of control. This model can be helpful in decision processes in some human sciences such as management, economical and political strategies. The reason for such an opportunity lies in the fact that MRAAC is a general and phenomenological model able to incorporate the whole of the agonistic antagonistic systems. This type of regulation might be related to the concept of the viability of a system (yet also valid for human science systems) and to a functional and structural pattern which is the basis for agonistic antagonistic networks.

Biology↗

PubMed1986

Making decisions for the severely handicapped newborn.

Standard ethical approaches to decision-making which are based on rights, duties, obligations, beneficence, or best interests often seem inadequate or insufficient when applied to the individual infant, as in the case of Baby Jane Doe. A process approach which takes account of moral theory, but which allows tolerance, within limits, for a possible range of decisions, would appear to offer more reasonable decisions. However, any decision must be based on good facts and accurate prognosis. Pending the availability of medical records on Baby Jane Doe, judgment of the decisions made at Stony Brook must be suspended.

Abnormalities, Multiple↗

PubMed1995

Patient desire for information and decision making in health care decisions: the Autonomy Preference Index and the Health Opinion Survey.

OBJECTIVES: To compare results on the Autonomy Preference Index (API) and the Health Opinion Survey (HOS), two instruments that measure patient desire for information and involvement in decision making. DESIGN: Cross-sectional survey. SETTING: University-based primary care outpatient longitudinal and acute care clinic. PATIENTS: 167 patients with benign prostatic hyperplasia, back pain, or mild hypertension seen from October 1991 to December 1992. MEASUREMENTS AND MAIN RESULTS: On the API and the HOS (both scaled from 0 to 1), the patients had intermediate desire for involvement in decision making (median API: 0.42; HOS: 0.36) and higher desire for information (median API: 0.97; HOS: 0.57). With either instrument, the desire for information exceeded that for involvement in decision making (p < 0.0001). The API information scores were higher than the HOS information scores (p < 0.0001), probably because the HOS focuses on patient behavior rather than desire. Variation in desire for information and involvement in decision making was substantial and largely unexplained. CONCLUSIONS: Most patients have a high desire for information, the desire for information and involvement in decision making varies substantially among patients, and the API is preferable to the HOS for researchers interested in focusing solely on patient desire for information.

Adult↗

PubMed2000

Nurses' experiences of making decisions to call emergency assistance to their patients.

Patient survival often depends on decisions by nurses to call emergency assistance. The experiences of nurses calling emergency assistance have not been described. This descriptive study explored the experiences of registered nurses (n=32) using unstructured interviews. The main findings were that nurses questioned whether they were doing the 'right thing' calling the emergency team, sometimes collaborated with others prior to calling and most felt nervous and anxious. They recognized patient deterioration from feelings they had that something was wrong. However, they were not able 'to put their finger on it'. Knowing the patient and past experiences were involved in the recognition of deterioration. This association indicates the importance of experience in the development of clinical decision-making skills. Further, nurses calling emergency assistance need to be provided with the opportunity to debrief after calling. Their heavy reliance on subjective data before searching for objective data as outlined in the emergency calling criteria suggests that it is essential that nurses do not devalue or ignore concerns they may have about patients.

Decision Making↗

PubMed2004

Learning to make decisions in dynamic environments: effects of time constraints and cognitive abilities.

This study investigated the effects of time constraints and cognitive abilities on dynamic decision making (DDM). The learning and performance of individuals trained in a DDM task with time constraints were compared with those who were trained without time constraints. Although all participants received the same total amount of time to perform the task, individuals under more stringent time constraints were given 3 times more practice trials on the first 2 days of the study than were people under less stringent time constraints. Despite the additional practice runs, participants under high time constraints performed worse than did participants under low time constraints on the 3rd day of the study. A subsequent analysis of cognitive abilities and decision heuristics revealed that individuals' actions corresponded with simple heuristic predictions more closely with minimal practice than with extended practice, under high rather than low time constraints, and in individuals with low rather than high cognitive abilities. These findings suggest that mere repetition of a task with less time within a trial is counterproductive to learning and that learning depends on cognitive abilities. Potential applications of this research include the design of training procedures for dynamic tasks.

Adaptation, Psychological↗

PubMed1999

Validity of the MMPI-2 and Beck Depression Inventory for making decisions of organ allocation in renal transplantation.

Psychosocial factors are presented which affect clinical decision-making regarding the allocation of renal organs. Patients were rated as being either High Risk or Low Risk transplant candidates. High Risk candidates were scored as being significantly different from the Low Risk candidates on many psychosocial variables. Interestingly, significant differences were not found between these two groups on either the MMPI-2 or the Beck Depression Inventory. The validity of using information from these inventories to allocate organs is discussed.

Attitude to Health↗

PubMedDate not supplied

Safer sexual decision making in adolescent women: perspectives from the conflict theory of decision-making.

Adolescent women are at risk for unintended pregnancies and sexually transmitted diseases, including human immune deficiency virus (HIV)/acquired immunodeficiency deficiency syndrome (AIDS), if they do not engage in safer sexual practices. Adolescent women are biologically, behaviorally, and socially more at risk for sexually transmitted diseases (STDs) and HIV than adolescent men. Although abstinence is the safest sexual health practice for adolescent women, once sexual activity begins, safer sexual practices involve condom and contraceptive use, and communicating with sexual partners to negotiate condom use. A number of implicit and explicit decisions are involved in these activities. A number of researchers have examined safer sexual decisions of adolescent women, some of whom have used theory models such as the Transtheoretical Model of Change. Although these findings have contributed to the knowledge base about safer sexual decision making, many questions remain unanswered about how adolescent women make safer sexual decisions. The Conflict Model of Decision Making is presented and discussed as a framework for enhanced understanding of safer sexual decision making by adolescent women.

Adolescent↗

PubMed1996

Triage: techniques and applications in decision making.

Correct decision making may have far-reaching consequences. Triage is an area in which decision-makers must know what they are doing, why they are doing it, and which actions to take to achieve a satisfactory outcome. Triage has its origins in military history and today is used in a variety of medical settings. In this article we focus on the role of triage in disaster situations, its application in military settings, and its use in disaster medicine. Useful concepts enabling correct decision making by the triage officer include the application of computer technology and a review of methods of patient categorization. The dynamic nature of triage and the role of the triage officer as part of a team approach to disaster patient management are highlighted. We explore techniques for the successful training and education of triage officers and investigate a model of the emergency physician as the triage officer.

Decision Making↗

PubMed2003

Tourism climatology: evaluating environmental information for decision making and business planning in the recreation and tourism sector.

This work grew from initiatives of the International Society of Biometeorology's Commission on Climate, Tourism and Recreation (ISBCCTR). The ISBCCTR was formed during the 15th Congress of the ISB held in November 1999 in Sydney, Australia. The aim of ISBCCTR is to promote research in tourism climatology. The first formal meeting of the Commission took place at the Meliton Resort, Halkidiki, Greece, 5-10 October 2001. The aims were to (1) bring together a selection of scientists and tourism experts to review the current state of knowledge of tourism climatology and (2) explore areas and priorities for future work and the role of the Commission in this. The Workshop highlighted the fact that, although climate is widely recognised as vitally important to tourism, relatively little is known about its effects. Even less is known about the economic impact or significance of climate on commercial prospects for tourism. Important research themes that warrant attention were identified. Among these was the need for a tourism climate index (or indices) that integrates all facets of climate, uses standard data and is objectively tested and verified. Work is also required on developing a better understanding of what climate-related information is required by both tourists and the tourism industry, exploring the distinction between the impact of climate on tourists and the impact on the tourism industry, setting a standard approach to tourism climate assessment, assessing the role of weather forecasts and long-term expectations of climate on choices made by tourists, the risks to tourism caused by extreme atmospheric events, what climate-related criteria people use to make decisions about tourism and recreational choices, how products giving information about weather and climate are currently used by the recreation and tourism industry and what are the existing and future requirements for this climate information.

Climate↗

PubMed2004

Neural representation of interval encoding and decision making.

Our perception of time depends on multiple psychological processes that allow us to anticipate events. In this study, we used event-related functional magnetic resonance imaging (fMRI) to differentiate neural systems involved in formulating representations of time from processes associated with making decisions about their duration. A time perception task consisting of two randomly presented standard intervals was used to ensure that intervals were encoded on each trial and to enhance memory requirements. During the encoding phase of a trial, activation was observed in the right caudate nucleus, right inferior parietal cortex and left cerebellum. Activation in these regions correlated with timing sensitivity (coefficient of variation). In contrast, encoding-related activity in the right parahippocampus and hippocampus correlated with the bisection point and right precuneus activation was associated with a measure of memory distortion. Decision processes were studied by examining brain activation during the decision phase of a trial that was associated with the difficulty of interval discriminations. Activation in the right parahippocampus was greater for easier than harder discriminations. In contrast, activation was greater for harder than easier discriminations in systems involved in working memory (left middle-frontal and parietal cortex) and auditory rehearsal (left inferior-frontal and superior-temporal cortex). Activity in the auditory rehearsal network correlated with memory distortion. Our results support the independence of systems that mediate interval encoding and decision processes. The results also suggest that distortions in memory for time may be due to strategic processing in cortical systems involved in either encoding or rehearsal.

Acoustic Stimulation↗