PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Decision Making”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 379 records · Page 21Linked to original sources
PubMed2003

[Antibiotic therapy: from pharmacology to decision making].

The decision of an antibiotic treatment depends first on clinical and bacteriological data. Then PK/PD (pharmacodynamics/pharmacokinetics) of antibiotics must be taken into account in order to optimise the dosing regimen, and to reach the targeted serum concentrations. The good oral bioavailability of some drugs allows the use of the oral route, at the beginning of the treatment, or shortly after an initial successful i.v. administration, even in severe infections.

Anti-Bacterial Agents↗
PubMed1991

Clinical decision making and pain.

Pain management is intimately linked to decision making. Nurses play a key role in making decisions regarding pain and its management. This paper presents data from a preliminary study (N = 53) extending the investigators' pain research into the areas of clinical decision making and ethical dilemmas related to pain management. Nurses completed surveys focused on actual experiences of caring for patients in pain. The results identify common clinical decisions related to pain, barriers to providing optimum pain relief, and ethical/professional conflicts in pain management. Decisions related to the amount of pain intensity, when to give medications, and choice of analgesics. Nurses identified verbal and nonverbal cues central to their decisions regarding pain assessment. Barriers to effective pain management included physician knowledge and cooperation, patient/family knowledge and cooperation, as well as nursing knowledge and time. Respondents identified ethical dilemmas about overmedication or undermedication, conflicts with physicians or patients, and concern over opioid side effects. A tentative model of decision making related to pain is presented.

Adult↗
PubMed2003

Are patients' decision-making preferences being met?

OBJECTIVE: To investigate the information and decision-making expectations of general practice patients during real life consultations. DESIGN: Post-consultation, quantitative patient preference and enablement questionnaire. SETTING AND PARTICIPANTS: Patients attending for routine appointments in general practice surgeries in Oxfordshire, UK. RESULTS: Thirteen Oxfordshire general practitioners (GPs) volunteered to take part and a total of 171 patients completed and returned the questionnaire. Between a quarter and one-third of patients reported receiving less information than they desired, particularly in relation to the risks and benefits of medical treatments. Patients who preferred the doctor to make decisions for them (35%), were more likely to have their preferences met (64%) compared with patients wishing to share decisions (47%) or make their own (18%) who were less likely to achieve this role (52 and 41%, respectively). However, it could not be demonstrated unequivocally that these differences were statistically significant. In total, 61% of patients perceived that they achieved their preferred decision-making role. No significant differences were found in post-consultation enablement scores between any of the decision preference groups. Patients' assessments indicated that some doctors were more successful at achieving congruence than others. CONCLUSION: The decision-making preferences of general practice patients tend to vary. However, there was a substantial mismatch between the stated preferences of patients for the role they wanted to have in decision-making and what they felt actually took place in their consultation. Therefore, it remains a challenge for doctors to match their consultation style to the decision-making preferences of individual patients.

Adolescent↗
PubMed1995

ComputerLink: the impact of a computer network on Alzheimer's caregivers' decision-making confidence and skill.

1. INTRODUCTION. Decision-making demands faced by homebound caregivers of persons with Alzheimer's Disease (AD) are numerous and complex. Although caregivers frequently know what to do in caring for the person with AD, they lack confidence in their decisions [1]. The challenge of caregiving decisions may be compounded by the lack of resources to aid in decision-making or affirm decisions made. Because many caregivers are homebound, they are unable to avail themselves of traditional health and social services. ComputerLink, computer network, was designed to address the needs of these homebound caregivers. 2. DESCRIPTION. The ComputerLink consisted of a set of specialized programs and utilities residing within a public computer network. The three main features of the ComputerLink, which may provide aid to caregivers in decision making, include: the electronic encyclopedia (EE); a communications utility composed of a question and answer bulletin board (Q&A) and public (Forum) and private mail services; and a decision support module (DSM). The EE contained illness-specific information to support decision-making. The Forum and private mail provided caregivers with a means to interact with peers and professionals about their caregiving decisions. Q&A provided the opportunity to ask questions about caregiving and receive feedback from professionals and peers. The DSM could be accessed to gain information about decision-making or to actually work through a decision problem. The DSM was built on a multi-attribute utility model which employed English-language questions to guide users through a decision analysis. The analysis strategy was designed to help the user focus on the values and trade-offs that occur during difficult choices. The impact of ComputerLink on decision confidence and skill was evaluated as part of a larger randomized experiment. 102 AD caregivers were recruited: 51 caregivers in the control group and 47 in the experimental group completed the 12-month study. The mean age of the caregivers was 60 years. Thirty-three percent were male and 28 percent were Black. The groups did not differ in demographic characteristics. The ComputerLink interface was menu-driven and the system was available 24 hours. ComputerLink use was captured through a passive monitoring system. AD caregivers accessed ComputerLink a total of 3,875 times, with a mean access per individual of 83 (range: 3 - 590). The mean length of an encounter was 13 minutes; subjects typically accessed two or more functions during this time. The decision support model was accessed 91 times. The communication functions were most frequently used (3,724 Forum accesses and 1,888 private mail); the information utility was accessed 518 times. 3. RESULTS. Decision confidence was objectively measured using a modification of the Saunders and Courtney confidence-in-decision making instrument. Caregivers who had access to ComputerLink experienced greater confidence in decision-making than caregivers in the control group (t = 2.73, p < .01). Access to ComputerLink did not alter decision skill as measured by the number of alternative solutions generated for two self-identified decisions problems (t = .18, p < .05). Decision-making confidence correlated positively with ComputerLink accesses (r = .32, p = < .02) and with length of time spent on ComputerLink (r = .30, p = < .02). 56% of the AD caregivers reported that use of ComputerLink increased both their confidence and skill in decision making, though only 38 percent reported using the DSM to make a decision. 4. DISCUSSION. Access to ComputerLink increased decision-making confidence, but not decision-making skill in AD caregivers. The impact of ComputerLink on decision confidence, and not skill, may be related to the differential use of the utilities. (abstract truncated)

Alzheimer Disease↗
PubMed2007

Expected value of information and decision making in HTA.

Decision makers within a jurisdiction facing evidence of positive but uncertain incremental net benefit of a new health care intervention have viable options where no further evidence is anticipated to:(1)adopt the new intervention without further evidence;(2)adopt the new intervention and undertake a trial; or(3)delay the decision and undertake a trial.Value of information methods have been shown previously to allow optimal design of clinical trials in comparing option (2) against option (1), by trading off the expected value and cost of sample information. However, this previous research has not considered the effect of cost of reversal on expected value of information in comparing these options. This paper demonstrates that, where a new intervention is adopted, the expected value of information is reduced under optimal decision making with costs of reversing decisions. Further, the paper shows that comparing expected net gain of optimally designed trials for option (2) vs (1) conditional on cost of reversal, and (3) vs (1) conditional on opportunity cost of delay allow systematic identification of an optimal decision strategy and trial design.

Clinical Trials as Topic↗
PubMed2000

Decision analysis in evidence-based decision making.

Many real world decisions have to be made on a limited evidence base, and clinical decisions are at best problematic. We explored some of the reasons why decision making in health care is so complex, and examined how decision analytic techniques might contribute to problem structuring and to implementation of evidence-based practice. We argued that decision analysis could, to some extent, overcome complexity of decision making by a clear structuring of the problem and a formal analysis of the implications of different decisions. Decision-analytic techniques can guide the management of individual patients or can be used to address policy questions about the use of treatment for groups of patients. However, decision analysis is not without its criticisms, e.g. problems are narrowly defined, replacing judgement and dehumanizing care, neglect of process utility and lack of primary data to develop decision analytic models. The development of evidence-based guidelines is a key component of the UK Government's quality strategy led by the National Institute for Clinical Excellence (NICE). However, the guidelines approach may lead to conflict when assessments of the effectiveness of interventions for individuals (whether or not supported by a formal decision analysis) conflict with the recommendations made by NICE for cost and clinical effectiveness for aggregate groups of patients. Decision analysis may or may not help with this but if guidelines are derived from a decision analysis, then the implications of patient preferences should be made clearer. However, decision analysis-derived guidelines will make general recommendations that may not be appropriate for all individuals. Nonetheless, decision analysis does make such implications explicit and propose that the guidelines should be supported by some mechanism for determining individual patient preferences. It will now need to consider whether some of NICE resources should be directed beyond evidence-based guidelines into decision analysis-derived guidelines and into decision analytical techniques to provide support for clinical and cost effective decision making within the patient-clinician encounter.

Decision Making↗
PubMed2005

Basic and applied decision making in cancer control.

Decision making is fundamental to all aspects of cancer care--prevention, detection, treatment, survivorship, and end of life--yet researchers and clinicians have limited knowledge of the ways in which patients and their health care providers make critical health decisions. Recognizing how important it is to understand how patients and their providers make potentially life-altering decisions, the National Cancer Institute developed a decision making in cancer control initiative. The goal of this initiative is to enhance understanding of human decision-making processes so that individuals can make more informed and satisfying choices regarding their health. This article describes the multidisciplinary meeting that provided the scientific foundation for this initiative.

Decision Support Techniques↗
PubMed2005

Neurobiology of decision-making: quo vadis?

Decision-making is an important aspect of daily life. Moreover, dysfunctions of decision-making play a critical role in a number of neuropsychiatric disorders. Several important research groups have contributed a diverse set of approaches to study decision-making and its underlying neurobiology. Insights from these studies may provide important directions for future research in this area.

Animals↗
PubMed2006

A neural network reflecting individual differences in cognitive processing of emotions during perceptual decision making.

Even simple perceptual decisions are influenced by the emotional content of a stimulus. Recent neuroimaging studies provide evidence about the neural mechanisms of perceptual decision making on emotional stimuli. However, the effect of individual differences in cognitive processing of emotions on perceptual decision making remains poorly understood. Here, we investigated how changes in the fMRI signal during perceptual decision making on facial stimuli covaried with individual differences in the ability to identify and communicate one's emotional state. Although this personality trait covaried with changes in activity in the dorsal anterior cingulate cortex (dACC) during gender decisions on facial expressions, there was no correlation during emotion decisions. Further, we investigated whether individual differences in the ability to cognitively process emotions depend on differences in the functional integration of emotional and cognitive brain regions. We therefore compared task-dependent changes in effective connectivity of dACC in individuals with good and with poor ability to cognitively process emotions using a psychophysiological interaction analysis. We found greater coupling of dACC with prefrontal regions in individuals with good ability to identify and communicate their emotional state. Conversely, individuals with poor ability in this domain showed greater coupling of dACC with the amygdala. Our data indicate that individual differences in the ability to identify and communicate one's emotional state are reflected by altered effective connectivity of the dACC with prefrontal and limbic regions. Thus, we provide neurophysiological evidence for a theoretical model that posits that a discommunication between limbic areas and the neocortex impairs cognitive processing of emotions.

Adult↗
PubMed2006

The influence of patient complexity and nurses' experience on haemodynamic decision-making following cardiac surgery.

Critical care nurses' haemodynamic decision-making in the immediate postoperative cardiac surgical context is complex. To optimise patient outcomes, nurses of varying levels of experience are required to make complex decisions rapidly and accurately. In a dynamic clinical context such as critical care, the quality of such decision-making is likely to vary considerably. The aim of this study was to describe variability of nurses' haemodynamic decision-making in the 2-hour period after cardiac surgery as a function of interplay between decision complexity, nurses' levels of experience, and the support provided. A descriptive study based on naturalistic decision-making was used. Data were collected using continuous non-participant observation of clinical practice for a 2-hour period and follow-up interview. Purposive sampling was used to recruit 38 nurses for inclusion in the study. The quality of nurses' decision-making was influenced by interplay between the complexity of patients' haemodynamic presentations, nurses' levels of cardiac surgical intensive care experience, and the form of decision support provided by nursing colleagues. Two factors specifically influenced decision-making quality: nurses' utilisation of evidence for practice and the experience levels of both nurses and their colleagues. The findings have implications for staff resourcing decisions and postoperative patient management, and may be used to inform nurses' professional development and education.

Adult↗
PubMed2005

HMIS and decision-making in Zambia: re-thinking information solutions for district health management in decentralized health systems.

At the onset of health system decentralization as a primary health care strategy, which constituted a key feature of health sector reforms across the developing world, efficient and effective health management information systems (HMIS) were widely acknowledged and adopted as a critical element of district health management strengthening programmes. The focal concern was about the performance and long-term sustainability of decentralized district health systems. The underlying logic was that effective and efficient HMIS would provide district health managers with the information required to make effective strategic decisions that are the vehicle for district performance and sustainability in these decentralized health systems. However, this argument is rooted in normative management and decision theory without significant unequivocal empirical corroboration. Indeed, extensive empirical evidence continues to indicate that managers' decision-making behaviour and the existence of other forms of information outside the HMIS, within the organizational environment, suggest a far more tenuous relationship between the presence of organizational management information systems (such as HMIS) and effective strategic decision-making. This qualitative comparative case-study conducted in two districts of Zambia focused on investigating the presence and behaviour of five formally identified, different information forms, including that from HMIS, in the strategic decision-making process. The aim was to determine the validity of current arguments for HMIS, and establish implications for current HMIS policies. Evidence from the eight strategic decision-making processes traced in the study confirmed the existence of different forms of information in the organizational environment, including that provided by the conventional HMIS. These information forms attach themselves to various organizational management processes and key aspects of organizational routine. The study results point to the need for a radical re-think of district health management information solutions in ways that account for the existence of other information forms outside the formal HMIS in the district health system.

Decision Making↗
PubMedDate not supplied

The radiochemist's role in the quality evaluation and assessment of radiological data in environmental decision making.

The quality evaluation and assessment of radiological data is the final step in the overall environmental data decisionprocess. This quality evaluation and assessment process is performed outside of the laboratory, and generally the radiochemist is not involved. However, with the laboratory quality management systems in place today, the data packages of radiochemical analyses are frequently much more complex than the project/program manager can effectively handle and additionally, with little involvement from radiochemists in this process, the potential for misinterpretation of radiological data is increasing. The quality evaluation and assessment of radiochemistry data consists of making three decisions for each sample and result, remembering that the laboratory reports all the data for each analyses as well as the uncertainty in each of these analyses. Therefore, at the data evaluation and assessment stage, the decisions are: (1) is the radionuclide of concern detected (each data point always has a number associated with it?); (2) is the uncertainty associated with the result greater than would normally be expected; and (3) if the laboratory rejected the analyses is there serious consequences to other samples in the same group? The need for the radiochemist's expertise for this process is clear. Quality evaluation and assessment requires the input of the radiochemist particularly in radiochemistry because of the lack of redundancy in the analytical data. This paper describes the role of the radiochemist in the quality assessment of radiochemical data for environmental decision making.

Data Collection↗
PubMed1997

Enhanced decision-making: the use of a videotape decision-aid for patients with prostate cancer.

We describe the development and evaluation of a videotape decision-aid to assist patients in considering treatment options for clinically localized prostate cancer. The content and form of the videotape were developed utilizing literature review, an expert opinion panel and patient focus groups. Thirty-two men, aged 50-85 years, who did not have prostate cancer underwent pre- and post-videotape testing. A quantitative analysis found the videotape to be moderately effective in improving short-term recall of treatment options and outcomes. Qualitative analysis demonstrate that after viewing the videotape, subjects were more likely to consider an active role in the treatment decision-making process. We conclude that a videotape decision-aid will benefit clinical practice by conveying knowledge to patients regarding treatment options and outcomes and encouraging them to participate with their physicians in medical decision-making.

Aged↗
PubMed1997

Rational or uncommitted? Depression and indecisiveness in interpersonal decision making.

Two studies were run which tested the prediction that clinically depressed persons, known for difficulties in making a decision, would process predecisional information relevant to an interpersonal choice in a more impartial, less biased way than non-depressed persons. Both studies provided confirmation for this hypothesis. In each case, the depressed group focused less on specific alternatives, asked more criterion-based questions, and made decisions on the basis of information which was more evenly distributed over alternatives, thus conforming less to biasing, dominance structuring processes, than non-depressed participants. The depressed and non-depressed participants did not differ, however, in evaluative aspects of their decisions, suggesting a relative independence of affective and informational aspects of predecisional processes. The question arises; are depressed patients less biased and hence more rational when making decisions or are they just indifferent and uncommitted? The data have been discussed with reference to research on effortful versus automatic information processing in depression.

Cognition↗
PubMed2005

Medical decision-making in membranous nephropathy: how to use limited clinical research evidence in patient management.

Evidence-based medicine (EBM) originally referred to the use of a combination of clinical expertise and research evidence to make medical decisions, while carefully considering the patient's preference. In Japan, however, EBM has been misunderstood as the more abstract pursuit of acquiring research evidence and building medical guidelines. This review aims to summarize the available data regarding therapy for membranous nephropathy (MN), a field in which no consensus has been reached, and to discuss medical decision-making by using a decision tree in several model cases. In clinical practice, we have to consider both the risks and benefits of treatment. These are evaluated by their therapeutic effect (the rate of improvement, no change, or worsening) and by the patients' quality of life (QOL). This process is compatible with the essential concept of EBM.

Adult↗