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At least 397 records · Page 22Linked to original sources
PubMed2006

Early interactions between orienting, visual sampling and decision making in facial preference.

Decision making has been regarded as the last stage before action in the human information processing, certainly subsequent to sensory sampling and perceptual integration. Our latest study showed that orienting contributes to preference decision making, by integrating preferential looking and mere exposure in a positive feedback loop leading to the conscious choice. Here, we introduce a gaze-contingent window method of stimulus presentation into our experimental paradigm, to completely block holistic stimulus processing while preserving piecemeal sampling through the gaze-contingent "peephole". This effectively zooms the visual processing in time domain, allowing us to show that orienting and decision making can interact long before the actual conscious choice. The finding also suggests that this interaction is independent of holistic properties of face stimuli and can be totally memory-driven.

Beauty↗
PubMed2005

Blood transfusion prescribing in the ACT: an insight into clinical decision making.

Medical practitioners with varying levels of experience may make medical decisions in hospitals. Little is known about who is responsible for these decisions. We determined transfusion appropriateness during an audit of blood transfusion, before developing practice improvement strategies, by concurrent medical record review. The prescriber could be determined in 78% of transfusion episodes: most were specialist staff. Registrars and after-hours staff prescribed significantly fewer inappropriate transfusions. The findings have significant implications in understanding clinical decision making in the hospital setting and for the targeting of quality improvement strategies in particular.

Australian Capital Territory↗
PubMedDate not supplied

Demystifying ethical decision making.

Ethical dilemmas frequently occur in the practice of orthopaedic nursing. Nurses, however, are often unsure about how to resolve these dilemmas. The language of ethics remains elusive. Yet, because nurses have a central role in patient care, they need to become more comfortable making ethical decisions related to their practice. This article briefly describes the dialectical process of ethical decision making and demonstrates this process by using a case presentation. Readers are encouraged to put themselves into the role of the bedside nurse in the case, determine what they believe to be the right action, and provide a well-grounded rationale for that decision.

Adult↗
PubMed2005

Choosing the greater of two goods: neural currencies for valuation and decision making.

To make adaptive decisions, animals must evaluate the costs and benefits of available options. The nascent field of neuroeconomics has set itself the ambitious goal of understanding the brain mechanisms that are responsible for these evaluative processes. A series of recent neurophysiological studies in monkeys has begun to address this challenge using novel methods to manipulate and measure an animal's internal valuation of competing alternatives. By emphasizing the behavioural mechanisms and neural signals that mediate decision making under conditions of uncertainty, these studies might lay the foundation for an emerging neurobiology of choice behaviour.

Animals↗
PubMed2024

Offering complex genomic screening in acute pediatric settings: Family decision-making and outcomes.

PURPOSE: Families of children in pediatric acute care who are offered ultrarapid genomic sequencing are making complex decisions during a high-stress period. To reduce complexity for families and clinicians, we offered genomic screening for the child and parents after the completion of diagnostic testing. We evaluated uptake, understanding, and service delivery preferences. METHODS: A cohort of 235 families who had completed ultrarapid diagnostic genomic sequencing at 17 Australian hospitals were offered up to 3 screens on their genomic data: pediatric-onset, adult-onset, and expanded couple carrier screening. We investigated decision making, understanding, and service delivery preferences using surveys at 3 time points (pre counseling, post counseling, and post result) and performed inductive content analysis of pretest genetic counseling transcripts. RESULTS: A total of 119 families (51%) attended genetic counseling with 115 (49%) accepting genomic screening. Survey respondents were more likely to find decisions about couple carrier screening easy (87%) compared with adult (68%; P = .002) or pediatric (71%; P = .01) screening decisions. All respondents with newly detected pathogenic variants accurately recalled this 1 month later. A delayed offer of screening was acceptable to most respondents (78%). CONCLUSION: Separating genomic screening from the stressful diagnostic period is supported by families who demonstrate good knowledge and recall. Our results suggest delaying genomic screening should be trialed more widely.

Humans↗
PubMed2001

Psychological model for judicial decision making in emergency or temporary child placement.

In emergencies, family court judges must often make rapid decisions, without benefit of thorough information, that have significant impact on people's lives. Action-oriented research was used to develop a model that would bring psychosocial factors to the legal system for the purpose of enhancing the judicial decision-making process in emergency and temporary child placement cases.

Child↗
PubMedDate not supplied

Evidence-based decision making: global evidence, local decisions.

Variations in health care services have been well documented worldwide. The result is that increased health care spending is not uniformly associated with improved health. Interest in increasing the value obtained from health care investments has stimulated efforts to develop the best science and apply it to health care delivery. Advances in communications and information technology have made such developments of the scientific basis for health care a truly global enterprise, but its application must remain local. Consumers' use of evidence-based information to choose providers, make treatment decisions, and play a more active role represents the ultimate local application of scientific information.

Decision Making, Organizational↗
PubMed2000

[Psychological aspects of decision-making by women about using hormone replacement therapy].

The number of women living to advanced age increases and also escalates an interest in efforts to prevent or reduce morbidity and premature mortality during the postmenopausal period. The use of postmenopausal hormone replacement therapy (HRT) is recommended by many investigators. While the prevalence of hormone therapy use has been studied, there is limited understanding of how women make a decision about whether or not to adopt hormonal therapy and continue its use. The number of women using HRT varies from 9 to 69%, and also the time of using it is different. Many investigators in Western Europe and in USA found that less educated women were less likely to opt for HRT. Professionally active women, women having children formed the group of estrogen users. The doctors advice has an important significance in making decision about using HRT. In our country there is a need for investigation about using HRT.

Aged↗
PubMed1997

Diverse decisions. How culture affects ethical decision making.

Even under optimal conditions, assisting patients and families in making ethical decisions is difficult at best. Often these decisions revolve around the end-of-life issues that require acknowledgement that the patient is unlikely to survive, which may be perceived as a failure to both the family and the staff. At the very least, it can be a sad time, fraught with uncertainty and indecision. When these difficulties are coupled with ineffective communication related to cultural insensitivity or unawareness, the effects can be devastating to the decision-making process. All CCNs are expected to master the skills necessary for assisting patients and families through the harrowing experience of life-threatening illness. Whereas much of critical care focuses on managing pathophysiologic disturbances, emotional needs are equally important. It follows then that the CCN must assume responsibility for assisting patients and families in coping with the crisis of critical illness and working through ethical issues, which often include end-of-life decisions and organ donation. Culturally competent care is required when addressing patient needs holistically, but it is so much more. It is an opportunity to enrich and deepen the CCN/patient/family relationship, advocate for the patient, and broaden the opportunities for communication among staff. This article has provided some beginning steps for increasing nursing cultural awareness and has offered some initial strategies to consider when designing a plan of care. Through continuing efforts, CCNs and organizations can do much to decrease the alienation that many patients and families have traditionally encountered in the CCU, an estrangement that is exacerbated when their culture is different from the predominant culture of the unit. The effort to become more culturally aware may appear to require extraordinary effort; however, the rewards of optimizing patient care are unsurpassed.

Attitude to Health↗
PubMed2005

Omission bias and decision making in pulmonary and critical care medicine.

BACKGROUND: Pulmonary and critical care physicians routinely make complex decisions, but little is known about cognitive aspects of this process. Omission bias and status quo bias are well-described cognitive biases that can cause lay decision makers to prefer inaction that preserves the status quo even when changing the status quo through action is more likely to lead to the best outcomes. It is unknown if these biases influence trained decision makers such as pulmonologists. STUDY OBJECTIVES: To determine whether omission bias and status quo bias influence the medical decisions of pulmonologists. DESIGN AND INTERVENTIONS: The study was a randomized controlled trial conducted within a cross-sectional survey of pulmonologists' opinions about the relevance of various factors in pulmonary and critical care decision making. We designed case vignettes that presented patient information with an associated patient management choice. The status quo state and the action/omission distinction were varied in two forms of otherwise identical vignettes. One form of each case vignette pair (A and B) was administered randomly to each prospective respondent during the first mailing of the opinion survey. PARTICIPANTS: Five hundred pulmonologists selected randomly from the membership of the American College of Chest Physicians. MEASUREMENTS AND RESULTS: There were 125 respondents, including 59 for form A and 66 form B (enrollment rate, 25%). In vignettes involving evaluation of pulmonary embolism and treatment of septic shock, respondents were more likely to choose a suboptimal management strategy when an omission option was present that allowed preservation of the status quo (71% vs 53%, p = 0.048; 50% vs 29%, p = 0.016, respectively). In a vignette involving a hypothetical clinical trial and the decision to prescribe tube feeding, the omission option was not significantly associated with the decision to prescribe tube feeding (54% vs 50%, p = 0.67). CONCLUSION: Pulmonary and critical care decisions are susceptible to the influence of omission and status quo bias. Because of the great number of decisions that are made each day involving choices between maintaining or changing the status quo, this finding could have far-reaching implications for patient outcomes, cost-effectiveness, resource utilization, clinical practice variability, and medical errors.

Adult↗
PubMedDate not supplied

Teaching clinical decision making in a family practice clerkship.

Limited health care resources and other social factors are making clinical decision making (CDM) a necessary subject of study for medical students. However, CDM material is technical and could be perceived by students as arcane. This study evaluated student attitudes toward a CDM module imbedded in a third-year medical student (MSIII) family medicine clerkship. A survey instrument was used for the evaluation and included a within-subject check for response consistency. The results show that MSIIIs feel that technical CDM material is within their grasp and that it is relevant to their day-to-day care of patients.

Attitude↗
PubMed2005

Left inferior prefrontal cortex activation during a semantic decision-making task predicts the degree of semantic organization.

Semantic organization, an aspect of semantic processing, requires a pre-existing network of semantic knowledge that relies on a widely distributed neural network. The inferior prefrontal cortex (IPFC) has been identified as a vital structure for processing competing semantic information when making a decision about the meaning of a stimulus. However, the precise role of the IPFC in maintaining or creating a consistent semantic organizational structure is unclear. In this study, a semantic triadic decision-making task (Tallent, K.A., Weinberger, D.R., and Goldberg, T.E. 2001. Associating semantic space abnormalities with formal thought disorder in schizophrenia: use of triadic comparisons. J. Clin. Exp. Neuropsychol. 285-296) was used during functional magnetic resonance imaging to test the hypothesis that the degree of activation in the IPFC correlates with the consistency of semantic organization in healthy subjects. In this sample, subjects who had greater activation in the IPFC also demonstrated smaller stress coefficients in a two-dimensional "semantic space", indicating a greater organization of words along semantic dimensions. This finding is consistent with the role of the IPFC in establishing self-generated semantic relationships between stimuli.

Adult↗
PubMed2001

Empowerment and decision-making for people with dementia: the use of legal interventions in Scotland.

Dementia is associated with a decline in the ability to reason and make judgements thereby affecting a person's ability to make sound decisions. Others are not legally entitled to make these decisions until they have been assigned legal jurisdiction to do so. It is not clear, however, the extent to which people with dementia rely on available legal interventions. The growing emphasis on early diagnosis for people with dementia provides an opportunity for people to plan and control decisions about financial management and welfare and may well lead to an increase in the uptake of these interventions. This paper coincides with a move to reform outdated Scottish Law with the Adults with Incapacity (Scotland) Act 2000. This legislation proposes a more integrated and flexible approach to the legal management of the affairs of people with reduced decision-making capability. The paper reviews of the recent literature on the use of legal interventions for people with dementia and their families, and discusses the empowering or disempowering nature of the interventions.

Decision Making↗
PubMed2002

Contributions of the prefrontal cortex to the neural basis of human decision making.

The neural basis of decision making has been an elusive concept largely due to the many subprocesses associated with it. Recent efforts involving neuroimaging, neuropsychological studies, and animal work indicate that the prefrontal cortex plays a central role in several of these subprocesses. The frontal lobes are involved in tasks ranging from making binary choices to making multi-attribute decisions that require explicit deliberation and integration of diverse sources of information. In categorizing different aspects of decision making, a division of the prefrontal cortex into three primary regions is proposed. (1) The orbitofrontal and ventromedial areas are most relevant to deciding based on reward values and contribute affective information regarding decision attributes and options. (2) Dorsolateral prefrontal cortex is critical in making decisions that call for the consideration of multiple sources of information, and may recruit separable areas when making well defined versus poorly defined decisions. (3) The anterior and ventral cingulate cortex appear especially relevant in sorting among conflicting options, as well as signaling outcome-relevant information. This topic is broadly relevant to cognitive neuroscience as a discipline, as it generally comprises several aspects of cognition and may involve numerous brain regions depending on the situation. The review concludes with a summary of how these regions may interact in deciding and possible future research directions for the field.

Adaptation, Psychological↗
PubMed2006

Insufficient knowledge among psoriasis patients can represent a barrier to participation in decision-making.

Patient participation in treatment decisions can have positive effects on patient satisfaction, compliance and health outcomes. The objectives of this study were to examine attitudes of psoriasis patients regarding participation in treatment decisions and to evaluate the effect of a decision-aid for discussing treatment options. A "quasi experiment" was conducted in a large dermatological hospital in Italy: a questionnaire evaluating the decision-making process and treatment knowledge was self-completed by 231 consecutive psoriasis patients after routine clinical practice and by a second sample of 171 patients exposed to a decision-board. In routine clinical practice 67.9% of patients wanted to be involved in decision-making, 28.4% wanted to leave decisions entirely to the doctor and 3.7% preferred making decisions alone. 17.9% and 25.3% of the control and decision-board group had good knowledge. At multivariate analysis good knowledge increased the likelihood of preferring an active role (risk ratio (RR) = 2.21; 95% confidence interval (CI) 1.3-3.9; p = 0.006). The decision-board only marginally improved patient knowledge and doctor-patient communication. In conclusion, large proportions of psoriasis patients want to participate in decision-making, but insufficient patient knowledge can represent a barrier.

Adult↗
PubMed1997

Strategies for teaching clinical decision-making.

Nursing today requires clinicians who are autonomous decision-makers. It is therefore essential that nurses develop effective problem-solving and decision-making skills. The authors have found, both in practice and in searches of the literature, that registered nurses (RNs) appear to lack the skills necessary to make effective decisions. RNs demonstrate a propensity to stereotype, to be influenced by cultural bias and a desire to make rapid decisions. The literature abounds with research into and discussion on clinical decision-making. It fails however, to specify the skills required and to delineate the educational strategies that may be employed to improve the process of making decisions. An educational program developed by the authors indicates that it is possible to facilitate the development of cognitive skills in clinical decision-making. This paper explores views expressed in the literature, as well as examining the skills developed within the program that have been found to enhance decision-making. Finally, educational strategies designed to improve these skills are discussed.

Clinical Competence↗
PubMed2004

By-person factor analysis in clinical ethical decision making: Q methodology in end-of-life care decisions.

OBJECTIVE: To determine the usefulness of Q methodology to locate and describe shared subjective influences on clinical decision making among participant physicians using hypothetical cases containing common ethical issues. DESIGN: Qualitative study using by-person factor analysis of subjective Q sort data matrix. SETTING: University medical center. PARTICIPANTS: Convenience sample of internal medicine attending physicians and house staff (n = 35) at one midwestern academic health sciences center. INTERVENTIONS: Presented with four hypothetical cases involving urgent decision making near the end of life, participants selected one of three specific clinical actions offered for each case. Immediately afterward and while considering their decision, each respondent sorted twenty-five subjective self-referent items in terms of the influence of each statement on their decision-making process. By-person factor analysis, where participants are defined as variates, yielded information about the attitudinal background the physicians brought to their consideration of each hypothetical case. We performed a second-order factor analysis on all of the subjective viewpoints to determine if a smaller core of shared attitudes existed across some or all of the four case vignettes. Factor scores for each item and post-sort comments from interviews conducted individually with each respondent guided the interpretation of ethical perspective used by these respondents in making clinical decisions about the cases. MEASUREMENTS AND MAIN RESULTS: Second-order factor analysis on seventeen viewpoints used by physicians in the four hypothetical urgent decision cases revealed three moderately correlated (r2 < 40%) subjective core attitudinal guides used broadly among all the cases and among sixteen of the seventeen original factors. Across all the cases, our participants were guided in general by: (1) patient-focused beneficence, (2) a patient- and surrogate-focused perspective that includes risk avoidance, and (3) best interest of the patient guided by ethical values. Economic impact on the physician, expediency in resolution of the situation, and the expense of medical treatment were not found to be influential determinants in this study. CONCLUSIONS: Q sorting and by-person factor analysis are useful qualitative methodological tools to study the complex structure of subjective attitudes that influence physicians in making medical decisions. This study revealed the subjective viewpoints used by our physician participants as they made ethically challenging treatment decisions. The three second-order factors identified here are grounded in current bioethical values as well as the personal traits of physicians. The participants' decision methods appear to resemble casuistry more than principle-based decision making. Generalizability of results will require further studies.

Adult↗