SEARCH · PubMed Health

Results for “Decision Making”

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

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

At least 577 records · Page 32Linked to original sources

PubMed2005

Missed expectations? Physicians' views of patients' participation in medical decision-making.

OBJECTIVE: Physicians are encouraged to actively involve patients in clinical decision-making, but this expectation has not been adequately examined from the physicians' perspective. Our objective was to identify and characterize physicians' attitudes toward patient participation in decision-making and to gain insight into how they consequently think about and structure the decision-making process. DESIGN: This was a qualitative cross-sectional study of physicians' reported attitudes and practices. SETTING: The study took place in private practice and academic physicians' practices. PARTICIPANTS: A total of 53 academic and private practice physicians from primary care and surgical specialties, ranging from first year residents to recently retired, participated in the study. MEASUREMENTS: We performed a qualitative analysis of semistructured individual interviews. RESULTS: The physicians in this study expressed consistently positive attitudes toward patient participation in medical decision-making. They identified patient autonomy as an essential justification for patient participation but often went beyond an autonomy-based rationale. Several were motivated by the fundamental principle of beneficence as well as their own self-interest in avoiding legal liability. Many physicians saw their role as an expert who educates the patient but retains control over the decision-making process; others took a more collaborative approach, encouraging patients to assume decisional priority. The decision-making process often was modified by patient, physician, and environmental factors. CONCLUSIONS: The physicians in this study demonstrated a positive, flexible approach toward including patients in decision-making. A one-dimensional model of shared decision-making based solely on the principle of autonomy fails to account for variability in how physicians allocate decisional priority and is therefore ethically inadequate.

Academic Medical Centers↗

PubMed2005

End-of-life decision making is more than rational.

Most medical models of end-of-life decision making by patients assume a rational autonomous adult obtaining and deliberating over information to arrive at some conclusion. If the patient is deemed incapable of this, family members are often nominated as substitutes, with assumptions that the family are united and rational. These are problematic assumptions. We interviewed 23 outpatients with cancer about the decision not to resuscitate a patient following cardiopulmonary arrest and examined their accounts of decision making using discourse analytical techniques. Our analysis suggests that participants access two different interpretative repertoires regarding the construct of persons, invoking a 'modernist' repertoire to assert the appropriateness of someone, a patient or family, making a decision, and a 'romanticist' repertoire when identifying either a patient or family as ineligible to make the decision. In determining the appropriateness of an individual to make decisions, participants informally apply 'Sanity' and 'Stability' tests, assessing both an inherent ability to reason (modernist repertoire) and the presence of emotion (romanticist repertoire) which might impact on the decision making process. Failure to pass the tests respectively excludes or excuses individuals from decision making. The absence of the romanticist repertoire in dominant models of patient decision making has ethical implications for policy makers and medical practitioners dealing with dying patients and their families.

Australia↗

PubMed2006

Treatment decision-making among older women with breast cancer.

This study examined breast cancer treatment decision-making among older adults, including professional and lay involvement. Thirty respondents were interviewed for this study; cancer survivors (70%) and newly diagnosed (30%) women with breast cancer. Respondents reported making treatment decisions in consultation with their oncologists. However, women differed on the extent to which they perceived their participation in the treatment process. Respondents' oncologists appear to be the primary factor associated with older women's breast cancer surveillance decision-making and adherence. The influence of women's support systems on their treatment decisions and surveillance activities appears to be minimal. Informal support systems, however, likely enhance women's ability to be active participants in their care. The growing need for interventions which target older women has been indicated. Interventions, however, cannot be adequately developed without first identifying the physical and psychosocial phenomena which affect decision-making.

Aged↗

PubMed1998

Two Pairs of Conflicting Motives in Decision Making.

A concept is proposed that decision making consists of resolving two conflicts. One of them is between the desire to make an accurate decision and the desire to minimize the effort of making a choice. The second conflict is between the desire to make an accurate decision and the desire that this decision is distinct. To operationalize basic motives involved in decision making, as assumed in the model, a new process tracing technique has been developed. Using this technique, three experiments were performed to test the predictions of the model. The experiments supported the predictions concerning the conflict between accuracy and distinctness. Similarity of choice alternative and decision importance appeared to affect the way the conflict between accuracy and distinctiveness is solved. An alternative explanation of the results obtained and perspectives of further research are discussed. Copyright 1998 Academic Press.

Journal Article↗

PubMed2001

A timely account of the role of duration in decision making.

The current work takes a general perspective on the role of time in decision making. There are many different relationships and interactions between time and decision making, and no single summary can do justice to this topic. In this paper we will describe a few of the aspects in which time and decision making are interleaved: (a) temporal perspectives of decisions--the various temporal orientations that decision-makers may adopt while making decisions, and the impact of such temporal orientations on the decision process and its outcomes; (b) time as a medium within which decisions take place--the nature of decision processes that occur along time; (c) time as a resource and as a contextual factor--the implications of shortage in time resources and the impact of time limits on decision making processes and performance; (d) time as a commodity--time as the subject matter of decision making. The paper ends with a few general questions on the role of duration in decision making.

Choice Behavior↗

PubMed1999

Strategic decision making on shifting sands.

Strategic decision making in today's health care marketplace is very challenging. In the past, strategic plans were written for five to ten years. With the rapidly changing environment, planning for more than two years is difficult. It is critical for organizations to set a pathway for success. However, the organization needs to be able to respond quickly to environmental changes and take advantage of opportunities. The article presents a case study on a relatively new organization that has ambitious strategic goals. It discusses the decision-making process on the ways to enter a new marketplace, including the key factors assessed by the organization and their implications.

Decision Making, Organizational↗

PubMed2004

Complex decision-making in early childhood.

Decision-making over time is an important aspect of adaptive social functioning. The main goal of this study was to investigate the development of this ability in young children. A simplified version of the Iowa Gambling Task was given to 69 children at 3 ages (3, 4, and 6 years). Children were also given an awareness test to assess their knowledge of the task. Significant age differences were found for awareness of the task while significant sex effects were found for performance on the task. Females chose significantly more from the advantageous decks than would be expected by chance in the second block. Males demonstrated no significant difference in choice of decks. Further analysis indicated female superiority in the task was not due to greater knowledge of the game. One interpretation of these results is that there are two systems affecting decision-making over time.

Adaptation, Psychological↗

PubMed2001

Assessing ADHD across settings: contributions of behavioral assessment to categorical decision making.

Adapted methods of behavioral assessment to assess home and school functioning in a way that maps directly to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., [DSM-IV]; American Psychiatric Association, 1994). The study was conducted in a school-based sample with 5- to 12-year-old children referred to a school intervention team. A multigate set of procedures was used to assign children to one of 3 groups: attention deficit hyperactivity disorder (ADHD), inattentive group; ADHD, combined group; and a non-ADHD control group. The ADHD Rating Scale-IV was used to assess parent and teacher ratings of ADHD symptoms as delineated in DSM-IV. The findings suggest that the use of a fixed cutoff point (i.e., 6 or more symptoms), which is employed in the DSM-IV, is often not the best strategy for making diagnostic decisions. The optimal approach depends on whether diagnostic information is being provided by the parent or teacher and whether the purpose of assessment is to conduct a screening or a diagnostic evaluation. Also, the results indicate that a strategy that aggregates symptoms in the order in which they are accurate in predicting a diagnosis of ADHD is a more effective strategy than the approach used in DSM-IV, which aggregates any combination of a specific number of items. Implications for using methods of behavioral assessment to make diagnostic decisions using DSM-IV criteria are discussed.

Attention Deficit Disorder with Hyperactivity↗

PubMed1993

The clinical decision-making processes of student nurses.

This descriptive study examined the clinical decision-making processes used by 19 female senior diploma nursing students in a simulated client situation. The subjects were divided into two groups, with either an internal or external locus of control, as measured by the Rotter Internal-External Locus of Control Scale. From a content analysis of the data, six decision-making elements and eight decision-making processes were identified. The frequency and pattern of use of the decision-making processes differed between internally and externally oriented subjects. Internal subjects used a significantly higher proportion of complex decision-making processes than the external subjects (z = 3.48; p < .01). All subjects were found to use decision-making elements and processes in a manner that reflected novice characteristics and supported the theoretical framework of information-processing theory. These findings have implications for nurse educators in relation to teaching strategies that facilitate clinical decision-making ability and internalization strategies for students with an external locus of control.

Clinical Competence↗

PubMed1999

The hierarchical organization of decision making in the primate prefrontal cortex.

The prefrontal cortex plays an important role in making the association between sensory information and specific behavior. For example, in a complex stimulus response situation, such as the Wisconsin card sorting test, prefrontal patients show difficulty in making appropriate decisions. To understand the neural mechanisms, we recorded prefrontal cell activity while monkeys performed a go/no-go selective attention task where the subjects made a go or no-go response depending on the color or the motion direction of compound visual stimuli (moving colored dots). Groups of cells showed differential activity for go and no-go stimuli (go/no-go activity): some showed the activity either in the color or motion attending condition, and others showed the activity both in the color and motion conditions. Cells of shorter latencies, found mainly in the prefrontal subareas receiving visual input, showed go/no-go activity only when task demands necessitated that the monkeys attended to that cell's preferred visual dimension. We also found cells with longer latencies in the motor-related periarcuate area that showed go/no-go activity regardless of the dimension attended. These results suggest that subareas in the prefrontal cortex play different roles in associating the sensory information with its behavioral meaning and are hierarchically organized to make appropriate decisions in complex tasks.

Animals↗

PubMed1994

[Meta-analysis: its role in clinical decision making in cardiology].

Clinical decision-making in cardiology requires accurate estimates of the efficacy of diagnostic and therapeutic procedures. Defined as the quantitative integration of results from different studies on the same scientific question, meta-analyses are well-suited to summarize the evidence on the efficacy of clinical interventions. Meta-analyses aim at obtaining combined estimates of effect using all relevant information in a systematic fashion, complementing narrative reviews and expert committee reports. In this paper, the advantages and limitations of meta-analyses and their usefulness in clinical decision making in cardiology are illustrated using three recent examples in the literature--i.e., use of beta-blockers in secondary prevention of ischemic heart disease, intravenous streptokinase in acute myocardial infarction and fish intake in primary prevention of cardiovascular mortality. The steps to follow when conducting a meta-analysis are also discussed. Finally, a list of the most important meta-analyses in cardiology published to date is included for easy reference.

Adrenergic beta-Antagonists↗

PubMed1996

Should we do another test? Decision making in blood banking.

A decision model was developed to evaluate the costs and benefits of further reducing the risk of transfusion-transmitted disease. The model addresses recipient risk factors as well as operational considerations. Application of the model to prior risk reduction decisions documents its validity as a decision-making tool. Adoption of such a standardized decision-making approach would ensure recipient safety while controlling the costs of providing blood for transfusion.

Acquired Immunodeficiency Syndrome↗

PubMed2006

A novel sustainable decision making model for municipal solid waste management.

This paper reviews several models developed to support decision making in municipal solid waste management (MSWM). The concepts underlying sustainable MSWM models can be divided into two categories: one incorporates social factors into decision making methods, and the other includes public participation in the decision-making process. The public is only apprised or takes part in discussion, and has little effect on decision making in most research efforts. Few studies have considered public participation in the decision-making process, and the methods have sought to strike a compromise between concerned criteria, not between stakeholders. However, the source of the conflict arises from the stakeholders' complex web of value. Such conflict affects the feasibility of implementing any decision. The purpose of this study is to develop a sustainable decision making model for MSWM to overcome these shortcomings. The proposed model combines multicriteria decision making (MCDM) and a consensus analysis model (CAM). The CAM is built up to aid in decision-making when MCDM methods are utilized and, subsequently, a novel sustainable decision making model for MSWM is developed. The main feature of CAM is the assessment of the degree of consensus between stakeholders for particular alternatives. A case study for food waste management in Taiwan is presented to demonstrate the practicality of this model.

Cities↗

PubMed2003

Decision making in Greek and English registered nurses in coronary care units.

Clinical decision-making is an integral component of the role of the professional nurse. The aim of the study was to identify the quality of decision making of Greek and English coronary care nurses during the acute and recovery phases post-myocardial infarction (MI), and determine factors that best predict clinical decision-making in these two discrete groups of nurses. By identifying best practice from standard textbooks and expert practitioners, Clinical Decision-Making cards were developed and employed to explore nurse decision-making. A questionnaire (influencing factor questionnaire-IFQ) was also administered to determine which factors predicted quality nurse decision-making in the acute and recovery phase of post-MI patient care. The results showed that nurses in England made better quality clinical decisions in the recovery phase of MI than the Greek counterparts (p<0.001). Variables were identified which best-predicted decision-making. Interestingly, the main finding of this study was that English nurses had greater autonomy in the recovery phase and therefore made more clinical decisions concerning the patient psychosocial recovery than Greek nurses. Nurses perceived clinical experience as the strongest factor influencing decision-making.

Adult↗

PubMed2002

Achieving quality in clinical decision making: cognitive strategies and detection of bias.

Clinical decision making is a cornerstone of high-quality care in emergency medicine. The density of decision making is unusually high in this unique milieu, and a combination of strategies has necessarily evolved to manage the load. In addition to the traditional hypothetico-deductive method, emergency physicians use several other approaches, principal among which are heuristics. These cognitive short-cutting strategies are especially adaptive under the time and resource limitations that prevail in many emergency departments (EDs), but occasionally they fail. When they do, we refer to them as cognitive errors. They are costly but highly preventable. It is important that emergency physicians be aware of the nature and extent of these heuristics and biases, or cognitive dispositions to respond (CDRs). Thirty are catalogued in this article, together with descriptions of their properties as well as the impact they have on clinical decision making in the ED. Strategies are delineated in each case, to minimize their occurrence. Detection and recognition of these cognitive phenomena are a first step in achieving cognitive de-biasing to improve clinical decision making in the ED.

Decision Making↗

PubMed1997

Patients' preferences for risk disclosure and role in decision making for invasive medical procedures.

OBJECTIVE: To assess the level of involvement patients want in decision making related to the acceptance or rejection of an invasive medical intervention and whether their preference for decision making is related to their preference for qualitative (verbal) or quantitative (numeric) information about the risks of the procedure. SETTING: A university-based Department of Veterans Affairs Medical Center. DESIGN: Cross-sectional study using structured interviews of consecutive patients seen for continuity care visits in a general medicine clinic. PATIENTS: Four hundred and sixty-seven consecutive patients with a mean age of 65.2 years (SD 10.70 years, range 31-88 years) and with a mean of 12.6 years (SD 2.96 years, range 0-24 years) of formal education. MEASUREMENTS AND MAIN RESULTS: In the context of an invasive diagnostic or therapeutic intervention, patients were asked whether they preferred patient-based, physician-based, or shared patient-physician decision making. Patients were asked to give the ratio of patient-to-physician decision making they preferred, and whether they preferred discussions using words, numbers, or both. Of 467 subjects, 318 (68%) preferred shared decision making; 100 (21.4%) preferred physician-based decision making; and 49 (10.5%) preferred patient-based decision making. In terms of risk disclosure, 436 (93.4%) preferred that their physician disclose risk information to them. Of these 436 patients, 42.7% preferred disclosure of information about the probability of adverse outcomes using qualitative (verbal) expressions of probability; 35.7% preferred disclosure in terms of quantitative (numeric) expressions of probability; and 9.8% preferred disclosure in both qualitative and quantitative terms. Younger patients (odds ratio [OR] 0.96; confidence interval [CI] 0.93, 0.99), patients who had at least one stroke (OR 3.03; CI 1.03, 8.90), and patients who preferred to discuss risk information with their physicians in terms of numbers (OR 2.39; CI 1.40, 4.06) tended to prefer patient-based or shared decision making. CONCLUSIONS: Male veterans consistently preferred shared patient-physician decision making in the context of invasive medical interventions.

Adult↗

PubMed2003

Mathematical modeling of decision making: a soft and fuzzy approach to capturing hard decisions.

This research focuses on a modeling approach and set of mathematical tools that were derived from research on intelligence systems, namely fuzzy system modeling. This study systematically evaluates these tools as an approach for modeling human decision making, contrasting the approach with more traditional methods based on regression. The research was conducted using experts and a simulated task environment related to allocating rewards in the form of merit pay. The results indicate that fuzzy system models generally perform as well as or better than both linear and nonlinear regression methods in terms of model fit. These results are discussed in terms of issues regarding modeling precision versus parsimony, the value of adaptive modeling techniques, empirical versus subjective approaches to model building, and individual differences in judgment strategies. Potential applications of this research include using the modeling approach studied to build higher-fidelity models that yield new insights and a better understanding of decision-making strategies and environments.

Decision Making↗

PubMed2000

Emotion, decision making and the orbitofrontal cortex.

The somatic marker hypothesis provides a systems-level neuroanatomical and cognitive framework for decision making and the influence on it by emotion. The key idea of this hypothesis is that decision making is a process that is influenced by marker signals that arise in bioregulatory processes, including those that express themselves in emotions and feelings. This influence can occur at multiple levels of operation, some of which occur consciously and some of which occur non-consciously. Here we review studies that confirm various predictions from the hypothesis. The orbitofrontal cortex represents one critical structure in a neural system subserving decision making. Decision making is not mediated by the orbitofrontal cortex alone, but arises from large-scale systems that include other cortical and subcortical components. Such structures include the amygdala, the somatosensory/insular cortices and the peripheral nervous system. Here we focus only on the role of the orbitofrontal cortex in decision making and emotional processing, and the relationship between emotion, decision making and other cognitive functions of the frontal lobe, namely working memory.

Animals↗