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Results for “Decision Making”

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At least 433 records · Page 24Linked to original sources

PubMed2002

Relationship power, sexual decision making and condom use among women at risk for HIV/STDS.

This study examines the associations among relationship power, sexual decision-making dominance, and condom use within a sample of women at risk of HIV/STDs. Data from face-to-face interviews with 112 women were analyzed to (a) describe who women perceive as more powerful and who makes sexual decisions within their heterosexual relationships, (b) explore the association between relationship power and sexual decision-making dominance, and (c) examine the relationship of power and decision making regarding condom use to condom use behavior. Women were recruited from clinics and community locations in Atlanta, Los Angeles, Oklahoma City and Portland, OR. Participants were 18-25 years of age and were primarily Hispanic and African American. Over half (58.2%) reported that they share power with their partner, 25.5% said they have more power, and 16.4% reported that their partner has more power in their relationship. For the five domains of sexual decision-making examined, over half (50.5%-75.7%) of the women reported that they and their partners make decisions together. A higher percentage of women who perceived that they have more power or share power, as compared to those who perceived that their partners have more power, reported that "I/We" make decisions about birth control use, condom use, whether to have sex, and type of sexual activity. Relationship power was not associated with condom use. Condom use was, however, significantly higher among women who reported that they make decisions about using condoms alone or with their partner as compared to those who reported that their partner makes those decisions.

Adolescent↗

PubMed2004

Communicating evidence for participatory decision making.

CONTEXT: Informed patients are more likely to actively participate in their care, make wiser decisions, come to a common understanding with their physicians, and adhere more fully to treatment; however, currently there are no evidence-based guidelines for discussing clinical evidence with patients in the process of making medical decisions. OBJECTIVE: To identify ways to communicate evidence that improve patient understanding, involvement in decisions, and outcomes. DATA SOURCES AND STUDY SELECTION: Systematic review of MEDLINE for the period 1966-2003 and review of reference lists of retrieved articles to identify original research dealing with communication between clinicians and patients and directly addressing methods of presenting clinical evidence to patients. DATA EXTRACTION: Two investigators and a research assistant screened 367 abstracts and 2 investigators reviewed 51 full-text articles, yielding 8 potentially relevant articles. DATA SYNTHESIS: Methods for communicating clinical evidence to patients include nonquantitative general terms, numerical translation of clinical evidence, graphical representations, and decision aids. Focus-group data suggest presenting options and/or equipoise before asking patients about preferred decision-making roles or formats for presenting details. Relative risk reductions may be misleading; absolute risk is preferred. Order of information presented and time-frame of outcomes can bias patient understanding. Limited evidence supports use of human stick figure graphics or faces for single probabilities and vertical bar graphs for comparative information. Less-educated and older patients preferred proportions to percentages and did not appreciate confidence intervals. Studies of decision aids rarely addressed patient-physician communication directly. No studies addressed clinical outcomes of discussions of clinical evidence. CONCLUSIONS: There is a paucity of evidence to guide how physicians can most effectively share clinical evidence with patients facing decisions; however, basing our recommendations largely on related studies and expert opinion, we describe means of accomplishing 5 communication tasks to address in framing and communicating clinical evidence: understanding the patient's (and family members') experience and expectations; building partnership; providing evidence, including a balanced discussion of uncertainties; presenting recommendations informed by clinical judgment and patient preferences; and checking for understanding and agreement.

Communication↗

PubMed1991

How top managers in health organizations set directions that guide decision making.

Cases describing strategic decisions made in health care organizations were analyzed to determine how top managers set directions that guide decision making. Four tactics were identified--issue, idea, objective, and reframing. Decision-adoption rates, decision merit, and duration of the decision-making process were used to determine the effectiveness of each tactic. The effects that stem from using each tactic were qualified by factors describing urgency, importance, and differences between the tactics used by CEOs and middle managers (leverage). Tactics were found to have more influence on decision effectiveness than the intervening variables of urgency, importance, and leverage. Reframing was found to be the most effective tactic under all conditions but was the least frequently used by decision makers. Issue and idea tactics were the least effective, but idea tactics were used more often than any other tactic. Issue tactics were even less effective when applied to urgent and important decisions. Objectives were surprisingly effective in a crisis and for the more important decision.

Analysis of Variance↗

PubMed2002

A philosophical discussion of end-of-life decision-making methods for incompetent patients.

This article provides an analysis of decision-making methods that can be used with incompetent patients (patients who are unable to make decisions for themselves). It is intended as a general discussion of the relevant issues rather than an examination of legal or policy concerns. The advance directive principle (whereby a person leaves instructions for what to do if they become unable to make their own decisions) is discussed with reference to practical and philosophical issues. Substituted judgement (where surrogate decision makers make decisions that the patient who is incompetent would make if competent) is then discussed followed by the principle of best interests, which requires consideration beyond purely medical interests. The need to make patient-centred quality-of-life judgements as a component of best interests decisions is argued. Conclusions reached include the notion that the advance directive principle and the substituted judgement principle facilitate the concept of self-determination. The best interests principle helps to ensure that patients ending up in this vulnerable position are protected.

Advance Directives↗

PubMed1993

The pattern of personal knowing in nurse clinical decision making.

The struggle to teach clinical decision making effectively continues despite recent efforts aimed at improvement. In recognizing that a complex activity like clinical decision making entails multiple patterns of knowing, qualitative research methodology was used to gain a practice-based understanding of clinical decision making. The result is a description of the pattern of personal knowledge in nurse clinical decision making. Nurse informants label the pattern of personal knowledge as knowing, and describe their success in making clinical decisions as highly dependent upon the quality of interpersonal relationships with patients, peer nursing staff, and physicians. The dynamic of interpersonal relationships and the difficulties in establishing them are identified as important influencing factors in nurses' clinical decision making.

Clinical Competence↗

PubMed2005

Effective leadership and decision-making in animal groups on the move.

For animals that forage or travel in groups, making movement decisions often depends on social interactions among group members. However, in many cases, few individuals have pertinent information, such as knowledge about the location of a food source, or of a migration route. Using a simple model we show how information can be transferred within groups both without signalling and when group members do not know which individuals, if any, have information. We reveal that the larger the group the smaller the proportion of informed individuals needed to guide the group, and that only a very small proportion of informed individuals is required to achieve great accuracy. We also demonstrate how groups can make consensus decisions, even though informed individuals do not know whether they are in a majority or minority, how the quality of their information compares with that of others, or even whether there are any other informed individuals. Our model provides new insights into the mechanisms of effective leadership and decision-making in biological systems.

Animal Communication↗

PubMed2005

Gender relations and reproductive decision making in Honduras.

CONTEXT: Gender differences influence decision making about reproductive health. Most information on reproductive health decision making in Latin America has come from women's reports of men's involvement. METHODS: Data were collected in Honduras in 2001 through two national surveys that used independent samples of men aged 15-59 years and women aged 15-49. Bivariate and multivariate analyses were used to identify factors associated with male-centered decision-making attitudes and behaviors regarding family size and family planning use. RESULTS: Overall, 25% of women and 28% of men said that men alone should be responsible for at least one of these reproductive decisions, and 27% of women and 21% of men said that the man in their household made one or both decisions. For women, having no children and being in a consensual union were each associated with holding male-centered decision-making attitudes; having less than a secondary education, being of medium or low socioeconomic status and living in a rural area were each associated with male-centered decision making. Among men, having less than secondary education and being in a consensual union were each associated with male-centered decision-making attitudes and behavior. Women who had ever used or were currently using modern methods were significantly less likely to hold attitudes supporting male-centered decision-making than were those who relied on traditional methods and those who had never used a modern method. CONCLUSIONS: Programs should recognize power imbalances between genders that affect women's ability to meet their stated fertility desires. In rural areas, programs should target men, encouraging them to communicate with their wives on reproductive decisions.

Adolescent↗

PubMed1992

An operational decision-making model for the cognitively sensing-thinking manager.

Whereas all managers face decision-making situations, not all managers discharge the decision-making process in the same manner. Individuals possess different personalities that influence how they gather and process information and subsequently make decisions. Research has reported a link between personality type and a preferred cognitive decision-making style. ST personalities prefer structured methods to resolve problems. For ST managers, a three-dimensional decision-making models is proposed. The model is based on the decision-making process initiated by Dewey and evolved by theorists and practitioners over time. Unique to the model is the institution of a second dimension of operational categories. Thus, the decision process is not conducted within a vacuum but within a context defined by the problem to be resolved. A further degree of thoroughness is achieved by unfolding the categorical dimension into sub-categories and conducting the decision-making process at that level. Several additional managerial tools exist that are compatible with the ST cognitive style and that facilitate an effective and efficiency decision process. What does this mean for the practicing health information manager? The manager's first step is to identify his or her personality type. The popularity of the MBTI as an organizational and career counseling tool has received wide acceptance across industries, including health care. The MBTI can be obtained, administered, scored, and interpreted only by trained personnel. Such individuals may be found in human resource and staff development departments; career centers and seminars; and vocational-technical schools, community colleges, and universities.

Decision Making, Organizational↗

PubMed2005

An approach to develop effective health care decision making for women in prison.

BACKGROUND: Decision making about medical treatment, advance care planning and end-of-life care often is limited or influenced by a patient's capacity to read or comprehend crucial information. Ineffective communication between patient and physician, and the complex nature of serious illness and dying also affect these decisions. America's incarcerated have virtually no autonomy in decision making, especially with regard to medical care and treatment. For the nearly 100,000 incarcerated women in the United States, medical issues differ significantly from those of male prisoners. Many women enter prison with chronic illnesses or are diagnosed with such illnesses while in prison. In addition, America's prison population reflects our country's unsolved literacy problems with almost two thirds of aging inmates lacking basic literacy skills. Maintaining a balance between the Eighth Amendment rights of prisoners and their status as wards of the state is a concern for inmates and for those responsible for their care. OBJECTIVE: The purpose of this study was to identify informational barriers to people making medical care and treatment decisions, particularly those with low literacy. Findings were used to in the development of a tool to assist patients to initiate discussion and become active participants in their own care. DESIGN: Female inmates of diverse ethnicity and literacy levels were recruited through self-selection from the Central California Women's Facility near Sacramento to participate in focus group discussions. The focus groups were guided by a set of research questions and were facilitated by the first author to identify informational barriers to medical care needs. SETTING: The female prison setting was identified as an appropriate setting for the development of a new approach to stimulate effective decision making by introducing basic information on medical care and treatment, advance care planning, and end-of-life care. A total of 113 inmates participated in 16 focus group, each 2 hours in length. RESULTS: Findings were used to develop a handbook to assist low literacy populations in general, and female inmates in particular, to obtain appropriate medical care and treatment and to make advance care decisions regarding the end of life. CONCLUSION: Those who face chronic, potentially life-limiting illness cannot make meaningful decisions regarding medical care and treatment without having a basic foundation of health information. Acquiring knowledge and improving communication skills reduce stress and vulnerability, assuring individuals of some control over decision making.

Communication Barriers↗

PubMed2003

[Decision making in cariology].

By conducting an oral examination, during radiographic examination and in treatment planning procedures dentists make numerous decisions. A dentist will be required to make his decisions explicit. Decision trees and decision analyses may play an important role. In a decision analysis, the probability of correct and incorrect decisions are multiplied by the utility of the decision outcomes. The treatment outcome with the highest expected utility should be selected. Complex decision tasks such as the estimation of an individual's caries risk or the diagnosis of bone disorders are currently available as computer applications. Also, a preliminary version of a computer programme which detects caries lesions from bitewing radiographs independent from the dentist has become available. It is expected that the applicability of decision analyses will increase when implemented in the dental practice software packages.

Decision Making↗

PubMedDate not supplied

Concept analysis of adolescent decision making and contraception.

TOPIC: Adolescent decision making. PURPOSE: To clarify the concept of adolescent decision making and the use of contraceptives. SOURCE: Published literature. CONCLUSION: The process of adolescent decision making and contraception is influenced by the integration of the intimacy and closeness of the relationship; family, partner and peer influences; locus of control; and self-image.

Adolescent↗

PubMed1999

Hormone replacement therapy: women's decision-making process.

Making an informed decision about whether to take hormone replacement therapy to offset short- and/or long-range effects of decreased estrogen due to menopause is particularly important because of the health-related risks and benefits associated with hormone replacements. A qualitative study was conducted in which a cohort of menopausal women were interviewed for the purpose of investigating their decision-making process regarding HRT. Findings illuminate the major factors contributing to the decision, the kinds and sources of information used in arriving at a decision, the decision-making process followed, and whether the decision was informed. Clinical and research implications of the findings are examined.

Decision Making↗

PubMed1997

Vigilant and hypervigilant decision making.

Recent studies have argued that deficient decision making under stress is due to adoption of a hypervigilant style of decision making, which has been characterized as disorganized and inefficient. However, under the conditions that characterize many real-world or naturalistic tasks, a hypervigilant pattern of decision making may be adaptive, because the decision maker does not have the luxury of implementing a more elaborate analytic procedure. This study examined the effectiveness of vigilant and hypervigilant decision-making strategies on a naturalistic task. Results indicated that participants who used a hypervigilant decision-making strategy performed better than those who used a vigilant strategy. Implications for decision making in naturalistic environments are discussed.

Arousal↗

PubMed1990

[Comment on the application of medical decision making].

There are three features in decision making in medicine. Decisions must be made on uncertain diagnostic and therapeutic information, a selected course of action may have an unwanted outcome, and finally, actions can not be retried from the beginning. We often assume that, by ordering a test, we can obtain more information to assist better decision making. It should be pointed out, however, that the test itself may be harmful and/or costly, may cause delay of treatment, and may misguide the decision by giving a false result. The benefit/risk ratio of choosing a test depends on the prior probability of disease, sensitivity and specificity of the test, and the outcome (utilities) of the correct and incorrect diagnosis. By drawing decision trees and making a sensitivity analysis, decision analysis helps to make the balance explicit.

Clinical Laboratory Techniques↗

PubMedDate not supplied

Parental perspectives related to decision-making and neonatal death.

With the advent of many new technologies, decision-making about the care of critically ill neonates represents one of the primary ethical arenas in health care today. Professionals and parents are forced to make decisions about when, how, and if critically ill neonates die. This qualitative study, based on interviews with a very small, convenience sample of parents, begins to explore the parental perspective about ethical decision-making regarding critically ill neonates by describing their personal experiences as they faced the reality or possibility of their babies' deaths.

Attitude to Death↗

PubMed2006

Treatment decision making in prostate cancer: patients' participation in complex decisions.

OBJECTIVE: (1) To explore to what degree prostate cancer (PC) patients felt they had participated in treatment decision making (TDM). (2) To determine whether perceived roles during TDM were associated with medical and sociodemographic variables. (3) To examine to what extent satisfaction with TDM was related to perceived role or medical and sociodemographic variables. METHODS: Patients (n=126) were recruited in hospitals and from the Dutch PC patient organization. The relationship between patients' role and stage of disease, treatment modality, age, social status and education was determined, as well as patients' satisfaction with TDM. RESULTS: Most patients felt they had participated in TDM (autonomous 18%, collaborative 60%). Older patients and those with advanced disease more frequently reported not having been involved in decision making. Satisfaction with TDM was related to age and role in TDM but not to stage of disease or treatment modality. Younger men were least content when they had not been involved in decision making. CONCLUSION: Patients' level of participation and satisfaction with TDM appears to be related to medical and sociodemographic variables. PRACTICE IMPLICATIONS: Satisfaction with TDM may be related to patients' age and assumed role. It is recommended to take this into account when planning treatment for prostate cancer patients.

Aged↗

PubMed2005

Aggregation of fuzzy views of a large number of stakeholders for multi-objective flood management decision-making.

Flood management decision-making problems are often associated with multiple objectives and multiple stakeholders. The challenge remains on how to obtain the diversified opinions of a large number of stakeholders where uncertainty plays a major role. In response to this challenge, a methodology has been proposed to capture the views of multiple stakeholders using fuzzy set theory and fuzzy logic. Three possible forms of individual stakeholders' input, scale (crisp), linguistic (fuzzy), and conditional (fuzzy), are analyzed to obtain the aggregated input by using Fuzzy Expected Value. The methodology is applied to flood management in the Red River Basin, Manitoba, Canada. The outputs derived from the three different input types show good correlation. Thus, the proposed methodology shows alternative ways of soliciting the opinion of a large number of stakeholders and aggregating those opinions for use in multi-objective decision making.

Community Participation↗

PubMedDate not supplied

Improving work group decision-making effectiveness.

Many of the decisions in complex health care organizations are made by small work groups. Nurse administrators often lead or are highly involved in these groups, where reaching quality decisions is a critical goal. This paper examines research and information from the communications field, presenting a model for making decisions in small groups. The author identifies common pitfalls of decision-making groups and presents strategies for problem solving and improved decision making.

Communication↗