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Results for “Decision Making”

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PubMed1986

Introducing conceptual tempo: an attempt to refocus health decision making in youth.

This paper reassesses the current trend toward health decision-making skills for youth. A new field of research for health behavior called conceptual tempo is introduced in an attempt to make health decision-making interventions more effective. The argument is made that decision-making programs may not realize their full potential because of the lack of emphasis placed on the child's rate of response or "conceptual tempo" in making health decisions. Suggestions are made on how best to utilize the conceptual tempo literature to enhance health decision-making program objectives in school health education.

Adolescent↗

PubMed2006

Distinct neural mechanisms of risk and ambiguity: a meta-analysis of decision-making.

Converging evidence from human and animal studies suggests that decision-making relies upon a distributed neural network based in the frontal lobes. In particular, models of decision-making emphasize the involvement of orbitofrontal cortices (OFC) and the medial wall. While decision-making has been studied broadly as a class of executive function, recent models have suggested the differentiation between risky and ambiguous decision-making. Given recent emphasis on the role of OFC in affectively laden "hot" executive function and dorsolateral prefrontal cortex (DLPFC) in more purely cognitive "cool" executive function, we hypothesize that the neural substrates of decision-making may differ depending on the nature of the decision required. To test this hypothesis, we used recently developed meta-analytic techniques to examine the existent functional neuroimaging literature. An initial meta-analysis of decision-making, both risky and ambiguous, found significantly elevated probabilities of activation in frontal and parietal regions, thalamus, and caudate. Ambiguous decision-making was associated with activity in DLPFC, regions of dorsal and subcallosal anterior cingulate cortex (ACC), and parietal cortex. Risky decision-making was associated with activity in OFC, rostral portions of the ACC, and parietal cortex. Direct statistical comparisons revealed significant differences between risky and ambiguous decision-making in frontal regions, including OFC, DLPFC, and ACC, that were consistent with study hypotheses. These findings provide evidence for the dissociation of neural circuits underlying risky and ambiguous decision-making, reflecting differential involvement of affective "hot" and cognitive "cool" processes.

Brain↗

PubMed2006

Involvement of human left dorsolateral prefrontal cortex in perceptual decision making is independent of response modality.

Perceptual decision making typically entails the processing of sensory signals, the formation of a decision, and the planning and execution of a motor response. Although recent studies in monkeys and humans have revealed possible neural mechanisms for perceptual decision making, much less is known about how the decision is subsequently transformed into a motor action and whether or not the decision is represented at an abstract level, i.e., independently of the specific motor response. To address this issue, we used functional MRI to monitor changes in brain activity while human subjects discriminated the direction of motion in random-dot visual stimuli that varied in coherence and responded with either button presses or saccadic eye movements. We hypothesized that areas representing decision variables should respond more to high- than to low-coherence stimuli independent of the motor system used to express a decision. Four areas were found that fulfilled this condition: left posterior dorsolateral prefrontal cortex (DLPFC), left posterior cingulate cortex, left inferior parietal lobule, and left fusifom/parahippocampal gyrus. We previously found that, when subjects made categorical decisions about degraded face and house stimuli, left posterior DLPFC showed a greater response to high- relative to low-coherence stimuli. Furthermore, the left posterior DLPFC appears to perform a comparison of signals from sensory processing areas during perceptual decision making. These data suggest that the involvement of left posterior DLPFC in perceptual decision making transcends both task and response specificity, thereby enabling a flexible link among sensory evidence, decision, and action.

Adult↗

PubMedDate not supplied

The decision systems group: creating a framework for decision making.

The Decision Systems Group is pursuing a vision in which every available medical resource can be brought together at the point of need. The DSG focuses on the components and tools in specific areas as well as on the models, approaches, and infrastructure that make this type of integration possible. Its academic mission is to train individuals with dual expertise: those who understand and appreciate the issues involved in developing and validating a method or technique, plus the issues of deployment, operation, and interaction in practical environments. Ultimately, the application of this vision can only serve to enhance the current level of healthcare.

Boston↗

PubMed1999

Decision-making preference and opportunity in VA ambulatory care patients: association with patient satisfaction.

Using data from the Veterans Health Study, associations were examined for decision-making preference, decision-making opportunity, and satisfaction with medical care among a sample of 266 men who use Department of Veterans Affairs (VA) ambulatory health care services. Results indicated that veterans with a high preference for involvement in decision-making and low provider-offered decision-making opportunities had significantly lower satisfaction with medical care compared to veterans with either low preference for decision-making involvement with high or low opportunity, or those with a high decision-making preference and high decision-making opportunity. The findings suggest that health care providers may increase patient satisfaction with medical care by providing opportunities for decision-making to patients who prefer involvement in their health care decision-making. Provider strategies for increasing patient decision-making involvement are discussed.

Adult↗

PubMed1994

[A model for ethical decision-making in nursing].

Although various models of ethical decision-making in nursing have been developed, these models only identify the steps for ethical decision-making but describe no framework within which the decisions must be made. This model for ethical decision-making in nursing describes the practice of the nurse/midwife, steps for ethical decision-making as well as the framework for ethical decision-making. This model can be used as a guideline facilitating ethical decision-making which can be justified and explained.

Decision Making↗

PubMed1999

An embedded decisional model of stress and coping: implications for exploring treatment decision making by women with breast cancer.

Treatment decision making by women with breast cancer has been recognized to be an inherently stressful process. However, past decisional theory and research has failed to fully elucidate the personal, transactional and relational nature of choice behaviour. The purpose of this paper is to explore an embedded decisional model of stress and coping that locates key assumptions of Janis and Mann's conflict-theory model (CTM) of decision making within Lazarus and Folkman's transactional framework. Through combining decisional and stress and coping theories, a model is developed that addresses the theoretical limitations of the CTM and provides greater specificity within decision-making research. The paper examines the complexity of treatment decision making within the context of the constructs of causal antecedents, primary appraisal, secondary appraisal, coping and adaptational outcomes. Examples specific to women with breast cancer are provided to illustrate the potential application of the embedded model. The implications of this inclusive and comprehensive decisional theory for future knowledge development and research in the area of treatment decision making are also discussed.

Adaptation, Psychological↗

PubMedDate not supplied

Ten myths about decision-making capacity.

As a matter of practical reality, what role patients will play in decisions about their health care is determined by whether their clinicians judge them to have decision-making capacity. Because so much hinges on assessments of capacity, clinicians who work with patients have an ethical obligation to understand this concept. This article, based on a report prepared by the National Ethics Committee (NEC) of the Veterans Health Administration (VHA), seeks to provide clinicians with practical information about decision-making capacity and how it is assessed. A study of clinicians and ethics committee chairs carried out under the auspices of the NEC identified the following 10 common myths clinicians hold about decision-making capacity: (1) decision-making capacity and competency are the same; (2) lack of decision-making capacity can be presumed when patients go against medical advice; (3) there is no need to assess decision-making capacity unless patients go against medical advice; (4) decision-making capacity is an "all or nothing" phenomenon; (5) cognitive impairment equals lack of decision-making capacity; (6) lack of decision-making capacity is a permanent condition; (7) patients who have not been given relevant and consistent information about their treatment lack decision-making capacity; (8) all patients with certain psychiatric disorders lack decision-making capacity; (9) patients who are involuntarily committed lack decision-making capacity; and (10) only mental health experts can assess decision-making capacity. By describing and debunking these common misconceptions, this article attempts to prevent potential errors in the clinical assessment of decision-making capacity, thereby supporting patients' right to make choices about their own health care.

Cognition Disorders↗

PubMedDate not supplied

Ten myths about decision-making capacity.

Attitude of Health Personnel↗

PubMed2006

Practice standards for quality clinical decision-making in nursing.

The purpose of this study is to formulate practice standards for quality clinical decision-making in nursing. Clinical decision-making is a critical component of nursing practice, as the life of the patient is at stake. The quality of clinical decision-making is, therefore, essential in delivering quality nursing care. The facilitation of quality clinical decision-making in nursing requires the development of standards to monitor, evaluate and implement remedial actions that improve on the quality of clinical decision-making (Muller, 2002:203; Beyea & Nicoll, 1999: 495). However, there are no such practice standards against which the quality of clinical decision-making by nurses can be evaluated and assessed. A qualitative, explorative, descriptive and standard formulation research design (Mouton & Marais, 1990:45-46; Muller, 1990:49-55) has been followed to develop standards for quality clinical decision-making in nursing. Standard development was based on the principles described by Muller (in Booyens, 1998: 607-608; 636-637), and consists of development and quantification phases that are modified to meet the requirements for instrument development, as described by Lynn (1986: 382-385). The formulation of these practice-standards was derived deductively from a conceptual framework. The conceptual framework was constructed based on an exploration and description of the expectations of the stakeholders about quality clinical decision-making in nursing and a literature study on clinical decision-making. To ensure the credibility of the standards for clinical decision-making in nursing, principles of logic, prolonged engagement, triangulation, peer-group discussion, dense description, step-wise repetition and an investigative audit (Lincoln & Guba, 1985:289-331) were adhered to. Two experts were consulted to validate the standards for quality clinical decision-making in nursing.

Attitude of Health Personnel↗

PubMed1982

Nursing decision making in critical care areas.

This exploratory study sought to identify factors that critical care nurses consider relevant in making rapid patient care decisions; to explore the decision making of these nurses in crisis situations; and to identify critical patient care situations where rapid nursing decisions are made. The convenience sample consisted of 50 nurses in critical care settings. A semi-structured interview with a critical care case study was utilized to examine the nurses' decision making. Open ended responses were transformed into fixed categories for tabulation. The findings suggested that: 1 knowledge and experience were the most important factors influencing rapid decision making; 2 although the nurses identified the appropriate decisions in a given crisis situation they had difficulty providing a theoretical rationale for their decisions; 3 the given case study and the 50 crisis situations identified by the subjects indicated that many nursing decisions for critically ill patients were carried out prior to physician assistance. A demographic data questionnaire that examined age, nursing experience, formal education and continuing education of the subjects determined that the majority of the nurses were under 30 years old, had either less than 1 year experience or 7-9 years in critical care, were graduates of a 2-year diploma programme, and took continuing education courses at the community college level.

Adult↗

PubMed2006

Decision making in pediatric oncology: who should take the lead? The decisional priority in pediatric oncology model.

Decision making in pediatric oncology can look different to the ethicist and the clinician. Popular ethical theories argue that clinicians should not make decisions for patients, but rather provide information so that patients can make their own decisions. However, this theory does not always reflect clinical reality. We present a new model of decision making that reconciles this apparent discrepancy. We first distinguish decisional priority from decisional authority. The person (parent, child, or clinician) who first identifies a preferred choice exercises decisional priority. In contrast, decisional authority is a nondelegable parental right and duty, in which a mature child may join. This distinction enables us to analyze decisional priority without diminishing parental authority. This model analyzes decisions according to two continuous underlying characteristics. One dominant characteristic is the likelihood of cure. Because cure, when possible, is the ultimate goal, the clinician is in a better position to assume decisional priority when a child probably can be cured. The second characteristic is whether there is more than one reasonable treatment option. The interaction of these two complex continual results in distinctive types of decisional situations. This model explains why clinicians sometimes justifiably assume decisional priority when there is one best medical choice. It also suggests that clinicians should particularly encourage parents (and children, when appropriate) to assume decisional priority when there are two or more clinically reasonable choices. In this circumstance, the family, with its deeper understanding of the child's nature and preferences, is better positioned to take the lead.

Child↗

PubMedDate not supplied

Moral decision making in neonatal intensive care.

OBJECTIVE: To gain information about the perspective that neonatal intensive-care unit nurses use to make moral decisions. DESIGN: Descriptive. SETTING: Neonatal intensive-care unit of a large teaching hospital in the midwestern United States. PARTICIPANTS: Convenience sample of 26 female nurses working in a neonatal intensive-care unit. METHOD: Audiotaped, semistructured interviews and demographic questionnaires. RESULTS: The results indicated that most (65%) of the nurses used the care perspective to make moral decisions. A small number (12%) used the justice perspective, and the remaining nurses (23%) used a combined care and justice perspective. CONCLUSIONS: Both the care and justice perspectives were found to be important for understanding how nurses make moral decisions.

Adult↗

PubMedDate not supplied

Governance in multihospital systems: an assessment of decision-making responsibility.

This study examines decision-making responsibility in multihospital system governance. The investigation focuses on the division of decision-making authority between local (hospital) and corporate boards. Fifteen decision areas were considered, including strategic planning, allocation of financial resources, appointment and evaluation of hospital CEOs, and controlling medical staff privileges. Results suggest moderately high levels of corporate (centralized) decision making in multihospital systems. Findings also indicate that type of decision determines whether control is centralized or decentralized. Most centralized decisions were related to resource allocation, formation of new companies, and changes in by-laws of a system hospital. Most decentralized decisions were related to medical staff privileges, service changes, and hospital strategic planning.

Analysis of Variance↗

PubMed2006

Queuing theory under competitive social foraging may explain a mathematical equivalence of delay and probability in impulsive decision-making.

Intertemporal and probabilistic decision-making has been studied in psychiatry, ecology, and neuroeconomics. Because drug addicts and psycopaths often make risky decisions (e.g., drug misuse and aggression), investigation into types of impulsivity in intertemporal and probabilistic choices (delay and probability discounting) are important for psychiatric treatments. Studies in behavioral ecology proposed that delay and probability discounting are mediated by the same psychological process, because a decrease in probability of winning corresponds to an increase in delay until winning. According to this view, odds-against winning (=1/p-1) in probabilistic choice corresponds to delay in intertemporal choice. This hypothesis predicts that preference of gambling (low degree of probability discounting) may be associated with patience, rather than impulsivity or impatience, in intertemporal choice (low degree of delay discounting). However, recent empirical evidence in psychiatric research employing pathological gamblers indicates that pathological gamblers are impulsive in intertemporal choice (high degrees of delay discounting). However, a hyperbolic discounting function (usually adopted to explain intertemporal choice) with odds-against (instead of delay) explain experimental data in probabilistic choice dramatically well. Therefore, an alternative explanation is required for the hypothetical equivalence of odds-against to delay. We propose that queuing theory (often adopted for analyzing computer network traffic) under a competitive social foraging condition may explain the equivalence. Our hypothesis may help understand impulsivity of psychiatrics in social behavior (e.g., aggression and antisocial behavior) in addition to non-social impulsivity in reward-seeking (e.g., substance misuse).

Behavior, Addictive↗

PubMed1997

A role for the sick role. Patient preferences regarding information and participation in clinical decision-making.

OBJECTIVE: To assess whether patient preferences regarding information and participation in decision-making about treatment options are related to patient characteristics and the context of the decision. Other studies have compared decision-making preferences in patients with cancer and healthy subjects, or in different contexts among patients in the same group. This study combined these designs. DESIGN: Questionnaire completed by the subjects. SETTING: Outpatient clinic of a university hospital. PARTICIPANTS: A consecutive sample of 55 patients with cancer treated at a radiotherapy clinic, 53 persons accompanying them, a consecutive sample of 53 patients visiting a surgical outpatient clinic for a nonmalignant condition and 36 persons accompanying them. MAIN MEASURES: Preferences regarding information and participation in decision-making in general and with respect to 4 vignettes that described different diseases of varying seriousness, varying treatment options and side effects. RESULTS: Older patients and men were more likely to let the physician make decisions regarding their treatment. Patients, as compared with nonpatients (their companions), were more likely to prefer a passive role regarding treatment decisions. No differences were seen between patients with cancer and patients with nonmalignant conditions. Also, no effect was observed in relation to the decision-making situations described in the vignettes. Of the patients who preferred more information, a substantial proportion still preferred a passive decision-making role. CONCLUSION: The lack of strong predictors of a preferred decision-making role implies that clinicians need to assess every patient individually to determine what role he or she prefers. The finding that the patients preferred a more passive role than their companions suggests that the "sick role" influences the preference regarding participation more strongly than the type of decision to be made or the presence of a life-threatening disease. This hypothesized shift in preference among subjects who are sick implies that these patients need encouragement to participate.

Adult↗

PubMed1999

Different contributions of the human amygdala and ventromedial prefrontal cortex to decision-making.

The somatic marker hypothesis proposes that decision-making is a process that depends on emotion. Studies have shown that damage of the ventromedial prefrontal (VMF) cortex precludes the ability to use somatic (emotional) signals that are necessary for guiding decisions in the advantageous direction. However, given the role of the amygdala in emotional processing, we asked whether amygdala damage also would interfere with decision-making. Furthermore, we asked whether there might be a difference between the roles that the amygdala and VMF cortex play in decision-making. To address these two questions, we studied a group of patients with bilateral amygdala, but not VMF, damage and a group of patients with bilateral VMF, but not amygdala, damage. We used the "gambling task" to measure decision-making performance and electrodermal activity (skin conductance responses, SCR) as an index of somatic state activation. All patients, those with amygdala damage as well as those with VMF damage, were (1) impaired on the gambling task and (2) unable to develop anticipatory SCRs while they pondered risky choices. However, VMF patients were able to generate SCRs when they received a reward or a punishment (play money), whereas amygdala patients failed to do so. In a Pavlovian conditioning experiment the VMF patients acquired a conditioned SCR to visual stimuli paired with an aversive loud sound, whereas amygdala patients failed to do so. The results suggest that amygdala damage is associated with impairment in decision-making and that the roles played by the amygdala and VMF in decision-making are different.

Acoustic Stimulation↗

PubMed1995

Critical appraisal of medical literature: an aid to rational decision making.

Clinical decisions should be based on evidence. This paper explores the skills necessary to read critically and evaluate medical literature, and in particular discusses how to appraise a study from a general practice perspective. It outlines the different types of study used in medical literature and the weight that should be attributed to each. The anatomy of a research paper is described indicating the important features to be found in each section of a study; the Introduction, Methods, Results, Discussion and Conclusion (IMRAD) and the essential components, possible problems, and sources of bias that may be found in each section. The need for close examination of the methodology is emphasised, as this determines the quality of the study, with sufficient detail provided in the methods section that the study could be replicated. Sampling and bias are explored in detail and the important features of a measuring instrument are described. Response rates, confounding factors and the use of statistics are also highlighted. The study upon which the research paper is based is usually the best that was possible within resource limitations and, while the evidence should be appraised objectively, the quality of the study should be seen within the context of these limitations.

Bias↗