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Results for “Decision Making”

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PubMed1985

Decision making and job satisfaction among youth workers in community-based agencies.

Sixty-four counselors and 32 alternative school teachers in 13 grass-roots agencies reported on levels of participation, influence, and competence in making clinical and administrative decisions. The data supported predictions that (a) professionals would report greater decision-making opportunities and abilities than nonprofessionals, and (b) that workers in general would report higher levels of participation, influence, and competence in clinical than in administrative domains, and higher levels of competence than influence in both domains. However, regression analyses testing the effects of the decision-making variables on different aspects of job satisfaction did not support predicted interactions among participation, influence, and competence. Rather, decision-making involvements had positive effects and decision-making abilities had negative effects on worker morale. The discussion high-lights the need for further research to identify the underlying processes involved in the observed relationships.

Adult↗

PubMed2004

Insurance knowledge and decision-making practices among Medicare beneficiaries and their caregivers.

BACKGROUND: The complexity of health plans and the Medicare program may require some beneficiaries to seek help when making health insurance decisions. However, there has been little research examining the Medicare-related knowledge and information gathering of beneficiaries who receive decision-making help and those who assist them. OBJECTIVES: We sought to compare the Medicare knowledge and information-gathering of beneficiaries who receive help with insurance decisions or their proxy respondents with beneficiaries who make their own decisions. RESEARCH DESIGN: Data were drawn from the 2000 Medicare Current Beneficiary Survey (MCBS), which includes a nationally representative sample of noninstitutionalized Medicare beneficiaries. SUBJECTS: We included a total of 11,978 beneficiaries and 1401 proxies who completed the MCBS. MEASURES: Measures were items and indices from the MCBS measuring the Medicare education campaign goals of access, awareness, and use of information sources, understanding of Medicare, and confidence in decision-making. RESULTS: Beneficiaries who receive help with health insurance decisions have lower knowledge of the Medicare program and are less likely to be aware of and use information sources than beneficiaries who make their own decisions. With few exceptions, proxy respondents had similar levels of access and knowledge as beneficiaries who make their own insurance decisions. CONCLUSIONS: Beneficiaries who receive help with their insurance decisions may be a particularly vulnerable population. They may have limited Medicare knowledge and not be aware of the resources that could help them.

Adult↗

PubMed1997

Partnerships with patients: the pros and cons of shared clinical decision-making.

The traditional style of medical decision-making in which doctors take sole responsibility for treatment decisions is being challenged. Attempts are being made to promote shared decision-making in which patients are given the opportunity to express their values and preferences and to participate in decisions about their care. Critics of shared decision-making argue that most patients do not want to participate in decisions; that revealing the uncertainties inherent in medical care could be harmful; that it is not feasible to provide information about the potential risks and benefits of all treatment options; and that increasing patient involvement in decision-making will lead to greater demand for unnecessary, costly or harmful procedures which could undermine the equitable allocation of health care resources. This article examines the evidence for and against these claims. There is considerable evidence that patients want more information and greater involvement, although knowledge about the circumstances in which shared decision-making should be encouraged, and the effects of doing so, is sparse. There is an urgent need for more research into patients' information needs and preferences and for the development and evaluation of decision-support mechanisms to enable patients to become informed participants in treatment decisions.

Decision Making↗

PubMedDate not supplied

Physician-patient interaction and hysterectomy decision making: the ENDOW study. Ethnicity, Needs, and Decisions of Women.

OBJECTIVE: To investigate physician-patient communication in the context of hysterectomy decision making. METHODS: A series of 17 focus groups with African American and white women (n=82) between the ages of 30 and 65 were run. Personal interviews with physicians (n=7) also were conducted. Transcripts were analyzed using NUD*IST software and note-based techniques. RESULTS: For both patients and physicians, the optimal physician-patient interaction would be for the physician to provide plain, usable information to the patient allowing the patient to make the hysterectomy decision. CONCLUSIONS: The current state of physician-patient interaction represents collaboration but not a shared approach approximating the deliberative model.

Adult↗

PubMed1994

Evaluation of a rule base for decision making in general practice.

BACKGROUND: Decision making in general practice relies heavily on judgmental expertise. It should be possible to codify this expertise into rules and principles. AIM: A study was undertaken to evaluate the effectiveness, of rules from a rule base designed to improve students' and trainees' management decisions relating to patients seen in general practice. METHOD: The rule base was developed after studying decisions about and management of thousands of patients seen in one general practice over an eight year period. Vignettes were presented to 93 fourth year medical students and 179 general practitioner trainees. They recorded their perception and management of each case before and after being presented with a selection of relevant rules. Participants also commented on their level of agreement with each of the rules provided with the vignettes. A panel of five independent assessors then rated as good, acceptable or poor, the participants' perception and management of each case before and after seeing the rules. RESULTS: Exposure to a few selected rules of thumb improved the problem perception and management decisions of both undergraduates and trainees. The degree of improvement was not related to previous experience or to the stated level of agreement with the proposed rules. The assessors identified difficulties students and trainees experienced in changing their perceptions and management decisions when the rules suggested options they had not considered. CONCLUSION: The rules developed to improve decision making skills in general practice are effective when used with vignettes. The next phase is to transform the rule base into an expert system to train students and doctors to acquire decision making skills. It could also be used to provide decision support when confronted with difficult management decisions in general practice.

Clinical Competence↗

PubMed1990

Computers and diabetes therapy: key variables and quality of data for clinical decision-making.

Approaches to clinical decision-making in diabetes have undergone a revolution over the past decade. Since the introduction of reflectance meters and subsequently the addition of a micro chip to store glucose data, clinical decision-making by both the professional and person with diabetes has significantly changed. The memory-based reflectance meter made it possible to collect, aggregate and interpret self-monitored blood glucose values at a level of reliability and accuracy heretofore impossible to obtain. With the ability to collect self-monitored blood glucose values and transmit these data to micro computers has come the development of different approaches to the interpretation of these data. Innovations, such as the Ambulatory Glucose Profile and the Modal Day permit the expression of blood glucose values as dynamic entities. Using this means of representation, blood glucose over time can be thought of as a measure of change having such properties as variability and oscillation. By viewing blood glucose from this innovative perspective it may be possible to reexamine the relationship between insulin dose and glucose level and thereby improve clinical decision-making.

Blood Glucose↗

PubMed2006

Family patterns of decision-making in pediatric clinical trials.

The decision-making process related to a child's participation in clinical trials often involves multiple family members. The aim of this study was to compare family patterns of decision-making within and across family units in pediatric clinical trials. Participants for this secondary analysis included 14 families from a larger study of informed consent. Four distinct patterns of decision-making were identified: Exclusionary, informative, collaborative, and delegated. These patterns varied with regard to three dimensions of parents' decision-making goals, child level of involvement, and the parental role. These patterns of decision-making affect how parents and children communicate with health professionals and influence the effectiveness of health care providers interactions with the family related to the decision-making process.

Adaptation, Psychological↗

PubMed1994

Psychometric properties of two instruments to measure quality decision making.

The results of testing two instruments for consequential decision making are reported: a screening instrument, the Decision Making Quality Scale (DMQS), which assesses the degree to which a person adheres to seven quality criteria of decision making; and a diagnostic measure, the Decision Making Quality Inventory (DMQI), which assesses an individual's dominant decision-making style through six sequential stages of the process. The instruments are conceptually linked through the same theoretical framework, the Janis and Mann (1977) conflict model of decision making, as well as operationally linked as counterpart instruments. Feasibility of the instruments was demonstrated with low readability indexes, reasonable administration times, and respondent acceptability by six samples (N = 766). Content validity was supported by panels of experts in decision theory. Reliability coefficients were consistently high ( > .70) for all samples. Support for construct validity was obtained using the contrasted groups approach and relationship testing. The instruments are ready for research and clinical use with healthy adolescents and their parents, as well as with adolescents and young adults who have experienced a chronic illness such as cancer and with their parents.

Adolescent↗

PubMed1989

Ethical decision-making.

Even though nurses engage in ethical decision-making on a daily basis, few practical resources are available and little is known about how nurses resolve ethical dilemmas in the clinical setting. A descriptive clinical ethical decision-making model has been presented and factors influencing current ethical decision-making skills have been identified. What is known suggests that some nurses do not consider multiple options during ethical deliberations. This may be due to the fact that there is limited time available for ethical deliberations in the clinical setting. In addition, the nurse may be prevented from implementing the chosen option by a variety of yet unidentified and uncontrolled variables. Recommendations In order to increase the amount of time available for ethical deliberation, a pro-active approach must be developed toward ethical issues. Ethics rounds need to be integrated into traditional medical and nursing rounds as a means for identifying ethical issues. Research is needed to describe (1) the process nurses use to resolve ethical situations, (2) the variables influencing decision-making in the clinical setting, and (3) the problems nurses experience during ethical decision-making. The nurse's ability to identify several options may increase as more time is available for ethical decision-making. Traditionally, nurses have identified ethical dilemmas that imply two options. Nurses need to consider ethical issues, concerns, and situations in order to identify multiple options. Ethics discussions, inservice education, and consultations with ethicists would provide the opportunity to critique previously experienced ethical situations and enhance the nurses's decision-making skills for future situations.

Decision Making↗

PubMed1981

Risk taking behavior: decision making in the face of genetic uncertainty.

Clients of genetic counseling frequently are called on to choose courses of action which may place themselves, their families, or their future offspring at some physical and/or emotional risk. This paper focuses on the nature of decision making in the face of such uncertainties. Evidence is presented from both research with clients making decision as well as from basic social psychological investigations of decision making which indicates the emotional and cognitive strains involved in making judgments under uncertainty. A framework for social work intervention is suggested that emphasizes prevention of deficiencies in information processing and decision making.

Decision Making↗

PubMed2005

HIV prevention community planning: challenges and opportunities for data-informed decision-making.

The use of data in decision-making by the Massachusetts Prevention Planning Group (MPPG) was assessed using multiple methods: in-depth interviews, member surveys, directed observations, and archival review. Three factors known to influence group decision-making were of interest: (1) member characteristics, (2) group structure, and (3) data inputs. Membership characteristics were not related to reliance on data. However, group structure factors and data inputs were directly related to reliance on data. Most members accepted an advisory role and felt participation was worthwhile. About half were dissatisfied with decision-making processes, citing member conflicts and distrust. Incompleteness of data, inadequate presentation quality, and lengthy intervals between presentations and actual decision-making were identified as deficits. Although most members reported skills with HIV- and intervention-related data, most also reported deficiencies in interpreting evaluation and cost-effectiveness studies. Member trust and use of data in decision-making could be improved by clarifying decision-making structures and processes, assuring high-quality data presentations, and supporting or training members to better interpret and use data.

Committee Membership↗

PubMed2003

Orbitofrontal cortex dysfunction in abstinent cocaine abusers performing a decision-making task.

Cocaine abusers demonstrate faulty decision-making as manifested by their inability to discontinue self-destructive drug-seeking behaviors. The orbitofrontal cortex (OFC) plays an important role in decision-making. In this preliminary study we tested whether 25-day-abstinent cocaine abusers show alterations in normalized cerebral blood flow (rCBF) in the OFC using PET with (15)O during the Iowa Gambling Task (a decision-making task). This task measures the ability to weigh short-term rewards against long-term losses. A control task matched the sensorimotor aspects of the task but did not require decision-making. Cocaine abusers (N = 13) showed greater activation during performance of the Iowa Gambling Task in the right OFC and less activation in the right dorsolateral prefrontal cortex (DLPFC) and left medial prefrontal cortex (MPFC) compared to a control group (N = 13). Better Iowa Gambling Task performance was associated with greater activation in the right OFC in both groups. Also, the amount of cocaine used (grams/week) prior to the 25 days of enforced abstinence was negatively correlated with activation in the left OFC. Greater activation in the OFC in cocaine abusers compared to a control group may reflect differences in the anticipation of reward while less activation in the DLPFC and MPFC may reflect differences in planning and working memory. These findings suggest that cocaine abusers show persistent functional abnormalities in prefrontal neural networks involved in decision-making and these effects are related to cocaine abuse. Compromised decision-making could contribute to the development of addiction and undermine attempts at abstinence.

Adult↗

PubMed2004

The cognitive neuroscience of human decision making: a review and conceptual framework.

Decision making, the process of choosing between options, is a fundamental human behavior that has been studied intensively by disciplines ranging from cognitive psychology to economics. Despite the importance of this behavior, the neural substrates of decision making are only beginning to be understood. Impaired decision making is recognized in neuropsychiatric conditions such as dementia and drug addiction, and the inconsistencies and biases of healthy decision makers have been intensively studied. However, the tools of cognitive neuroscience have only recently been applied to understanding the brain basis of this complex behavior. This article reviews the literature on the cognitive neuroscience of human decision making, focusing on the roles of the frontal lobes, and provides a conceptual framework for organizing this disparate body of work.

Amygdala↗

PubMed1999

Options, outcomes, values, likelihoods decision-making guide for patients and their families.

When family caregivers are faced with making daily decisions, they may feel burdened, frustrated, and even in conflict with other family members. The OOVL Guide is a tool to help people think about the various aspects of a decision situation and combine them to make a decision. The OOVL Guide supports nurses in their advocacy role because it affirms the importance of the clients' values and preferences. The OOVL Guide provides decision-makers, both professionals and lay people, with a structure and procedure for making choices for themselves or others.

Activities of Daily Living↗

PubMed1990

[Medical decision making: its history and technical terms].

Medical decision making, an application of decision sciences to medicine, has been increasingly recognized as an important clinical armamentarium in the past several decades. Clinical medicine abounds in uncertainties arising from the very nature of clinical data and physicians' judgments. These uncertainties provide room for decision sciences to be widely used in clinical medicine. There are two major research areas in medical decision making, i.e., prescriptive and descriptive approaches. The prescriptive approach, an endeavor to explore how decisions should be made, is quantitative and probabilistic, and employs decision analytical procedures which are designed to maximize expected value or utility. An example of a decision tree is shown as well as such essential technical terms as decision node, chance node, averaging out, folding back, sensitivity, specificity, predictive values, Bayes' theorem, and expected value of clinical information. The descriptive approach, on the other hand, is related to how people behave. In this context, strict meaning of judgment and decision making, some heuristics and psychological pitfalls, and the necessity of elucidating patients' preferences, though difficult, are recapitulated.

Clinical Laboratory Techniques↗

PubMedDate not supplied

Documentation of decision-making during air transport.

INTRODUCTION: Decision-making is an integral part of quality patient care. The aim of this study was to evaluate decision-making documentation. METHODS: A retrospective descriptive design was used to examine the documentation for a convenience sample of 48 trauma patients transported by rotor-wing aircraft. RESULTS: A total of 1012 decisions were documented in the 48 records. The decisions were grouped into major conceptual problems. An average of 10.2 +/- 4.56 conceptual problems were identified in each record. The top 10 conceptual problems were evaluated. Adequate documentation was found to support all decision-making related to the top 10 problems. CONCLUSION: Although air medical personnel may not directly document statements of rationale for their decision-making, sufficient data were present in the records to support each documented decision.

Air Ambulances↗

PubMedDate not supplied

Two instruments to measure interdisciplinary bioethical decision making.

OBJECTIVE: To develop and test two instruments measuring decision making about level of aggressiveness of intensive care unit (ICU) patient care. Decisions about Aggressiveness of Patient Care (DAC) measures care providers' general perceptions about decision making. Decisions about Aggressiveness of Patient Care for Specific Patients (DAC[SP]) measures perceptions in specific situations. DESIGN: Two-phase psychometric instrument evaluation. SETTING: Phase I, nationally mailed questionnaire. Phase II, northeastern medical center medical ICU. SUBJECTS: Phase I, 22 ICU nurse and physician experts. Phase II, 35 medical ICU staff nurses and eight medical resident physicians. OUTCOME MEASURE: Psychometric properties of instruments. RESULTS: Content validity of both tools was supported by their development from the literature and by the experts. Face validity was supported by the experts, staff nurses, and medical resident physicians. Both instruments had variance in responses, internal consistency reliability (r = 0.53, r = 0.73) and, test-retest reliability (r = 0.73). CONCLUSION: These instruments may enrich our understanding of how care providers make bioethical decisions for ICU patients. Such understanding could assist with development of interventions to increase collaborative interdisciplinary decision making, leading to increased care provider satisfaction and better patient outcomes.

Attitude of Health Personnel↗

PubMed2006

Investigating the decision-making needs of HIV-positive women in Africa using the Ottawa Decision-Support Framework: Knowledge gaps and opportunities for intervention.

OBJECTIVE: To examine HIV-positive women's decision making in the context of pregnancy and HIV/AIDS and to explore interventions that may enhance and develop women's decision-making capacity in the sub-Saharan African context. METHODS: The Ottawa Decision-Support Framework was used to assemble evidence of women's decision-making needs. Several electronic databases were searched and an Internet search of the World Wide Web was conducted to search grey literature sources. An evidence-based approach to assessing benefits, harms and current practices was employed. RESULTS: Several gaps in our knowledge about women's decision making in the context of pregnancy and HIV were identified. The availability of evidence varied for each decision; however, significant gaps included: evidence around testing for ones status, advanced directives for self and child, disclosure (specifically, the impact of), others perceptions of antiretroviral use and data on termination of pregnancies. CONCLUSION: Decision making as a concept was generally not addressed in the MTCT literature. Evidence regarding the perceptions of women and others regarding the various decisions was often not available and subsequently an important aspect of MTCT interventions neglected. PRACTICE IMPLICATIONS: Incorporating a multi-disciplinary decision-support framework may prove useful to promote women's autonomy and involvement in MTCT-related decision making.

Africa South of the Sahara↗