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Results for “Decision Making”

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PubMed2003

Phineas gauged: decision-making and the human prefrontal cortex.

Poor social judgment and decision-making abilities have often been attributed to people who have suffered injury to the ventromedial prefrontal cortex (VMPFC). However, few laboratory tests of decision-making have been conducted on these patients. The exception to this is the Iowa Gambling Task which has often, but not always, demonstrated differential performance between patients and controls. Results from patients with prefrontal cortex lesions on a novel test of decision-making are presented. Participants explored and chose from pairs of gambles that differed in their underlying distributions, primarily in the variance of their respective outcomes. In accordance with many findings from the behavioral decision-making literature, both young normal participants and older patient controls demonstrated a marked avoidance of risk and selected largely from secure, low variance gambles. In contrast, patients with ventromedial lesions were divided into two clear sub-groups. One group behaved similarly to normals, showing a risk-averse strategy. The other group displayed a distinctive risk-seeking behavior pattern, choosing predominantly from the high-variance, high-risk decks. This research demonstrates some of the advantages of using methods and theories from traditional decision-making research to study the behavior of patients, as well as the benefits of examining individual participants, and provides new insights into the nature of the decision-making deficit in patients with ventromedial prefrontal cortex lesions.

Adult↗

PubMed2004

Ending in-vitro fertilization: women's perception's of decision making.

This study was undertaken to assess patient satisfaction with the decision making process as well as with the decision made at the end of in-vitro fertilization (IVF) treatment. Couples who had decided to end treatment after unsuccessful IVF at a single hospital within the last 24 months were invited to complete a questionnaire. Valid questionnaires were returned by 71 (51%) out of a total of 139 couples. Sixty-nine (97%) questionnaires were completed by the female partner. Most women (73%) felt that they were adequately informed about the issues important to the decision. Fifty-eight women (81%) were involved with the decision making process; 38 (58%) felt supported by the clinic doctor and 41 (62%) were satisfied with the decision made. In response to a number of questions about information provision, few women (18 - 24%, depending on the individual question) felt that they had received enough information from the IVF clinician about advantages and disadvantages of stopping treatment and options such as adoption and fostering. Women contemplating the end of IVF treatment appear to be satisfied with the clinician's attitude, the decision making process and the decision made. While information provided during the final consultation is felt to be adequate for decision making, discussion about certain important options such as adoption and fostering could be more detailed.

Adult↗

PubMedDate not supplied

Development of the student nurse coordinator role. A shared decision making process.

Using shared decision making, staff nurses designed a new system to support student nurses in their learning needs. This new system improved continuity of care and patient care follow through and assisted in strengthening relationships between the student, unit staff, and clinical instructors.

Decision Making, Organizational↗

PubMed1994

End-of-life family decision-making from disclosure of HIV through bereavement.

End-of-life decision-making is conceptualized as the foreground against the background of a family, transitional model of illness with the human immunodeficiency virus (HIV). Both foreground and background represent new knowledge and theory development emerging from six research studies over a 7-year period. The research was phenomenological, longitudinal, ethnographic, descriptive survey, narrative, and grounded using the constant comparative method. In all, 100 families were studied in their home settings in the District of Columbia and 29 states across the United States. Throughout the transitional process from disclosure of HIV through bereavement, families engaged in end-of-life decision-making. Their decision-making style was primarily cognitive or primarily emotional or somewhere in between. Families using a cognitive style of decision-making were less disrupted and more able to surmount hurdles and move toward goals. Exemplars from 23 families illustrated family decision-making and components of the transitional, family model.

Adaptation, Psychological↗

PubMed2006

Patient involvement in treatment decision-making: the case for a broader conceptual framework.

OBJECTIVE: To consider the conceptualisation of patient involvement in treatment decision-making. METHOD: Conceptual review. RESULTS: Current models and measures of patient involvement in treatment decision-making tend to focus on communication within consultations and/or on the patient's use of information to consider the selection of one treatment option from a well-defined set. These narrowly focused models and measures may obscure the relevance of patient involvement in decision-making for some health care contexts and limit investigations of the relationships between patient involvement in decision-making and health care outcomes. We outline a broader conceptual framework that reflects more of the complexity of the concept of involvement. It acknowledges that patients can be involved not only because of what they say and do to influence a decision, but also by virtue of what they think and feel about their roles, efforts and contributions to decision-making and their relationships with their clinicians. The framework encompasses the full range of activities associated with decision-making. CONCLUSION: The proposed conceptual framework may broaden the relevance of patient involvement in decision-making and encourage a more comprehensive characterisation that may facilitate more sophisticated investigations of the relationships between patient involvement in decision-making and health care outcomes. PRACTICE IMPLICATIONS: Clinicians who aspire to facilitate patient involvement in decision-making need to look beyond the way they discuss health care options with patients. They should also consider how they might enable patients to engage in the full range of decision-making activities and to develop a positive sense of involvement in these activities and with their clinicians.

Decision Making↗

PubMedDate not supplied

Women's decision making regarding hysterectomy.

OBJECTIVE: To describe the decision-making process of women who choose hysterectomy for treatment of benign disease or distressing symptoms. DESIGN: Qualitative design based on grounded theory, using semistructured interviews. SETTING: Participants were interviewed in their homes or at their place of employment. PARTICIPANTS: Ten women who were premenopausal prior to hysterectomy. RESULTS: Decision making began when the women recognized abnormal body changes or bothersome symptoms. Four major processes were identified. "Seeking Solutions" was characterized by information seeking, information processing, and utilization of pharmacologic and nonpharmacologic treatments in an attempt to cure the disease and/or alleviate symptoms. "Holding On" included managing symptoms, rearranging activities of daily living to accommodate symptoms, and waiting. "Changing Course" was characterized by an abrupt change from Holding On to focusing on hysterectomy as the solution to the distressing symptoms. During "Taking Charge," the women displayed purposeful actions directed at arranging and preparing for surgery. CONCLUSIONS: Understanding the process of decision making will enable nurses to provide support for women who choose hysterectomy for treatment of benign gynecologic diseases and/or distressing gynecologic symptoms. Nurses' support of women's decision making should include referrals, education, and emotional support. In addition, nurses can help these women improve their quality of life by assisting them with symptom management.

Activities of Daily Living↗

PubMed1996

Family involvement in medical decision making.

BACKGROUND AND OBJECTIVES: The standard medical ethics model of decision making is based on the four principles of beneficence, nonmaleficence, autonomy, and justice. The recognized relationship is the physician and patient. This study considered the role(s) family plays in medical decision making. METHODS: Thirteen semi-structured interviews were conducted with a total of 39 patients and family members. Codebook and template analysis of the transcripts identified common themes. RESULTS: Patients and families identified three roles for family involvement in medical decision making--supporting the patient, being affected by the decision, and advocating for autonomy. CONCLUSIONS: Through these roles, patients acknowledge the context of family life in medical decision making, while families actively promote patient autonomy. Consideration of nonmedical burdens related to family roles and relationships takes an equal or higher priority than consideration of medical burdens. Family is, and should be treated as, a significant moral participant in medical decision making.

Adult↗

PubMedDate not supplied

[Brain mechanisms involved in decision-making].

AIM: To review the studies on brain mechanisms in decision making within the framework of the somatic marker hypothesis, and based on experiments employing the Iowa Gambling Task. DEVELOPMENT: An overview of the somatic marker hypothesis is presented together with the review of the main results obtained from research in brain damaged patients, and normal subjects with functional neuroimaging studies, that have led to the identification of the neural structures involved in decision making in humans. CONCLUSIONS: The main region involved in decision making is the ventromedial prefrontal cortex, that integrates sensory, mnesic and emotional information relevant to the task. Other structures intervening in the various relevant processes in decision making are the amygdala (processing and encoding of the emotional signal and its association with contextual stimuli) and the cingulate cortex (process monitoring and response inhibition, especially in situations of uncertainty). The prefrontal dorsolateral cortex would also be involved through the necessary activation of the working memory in the decision making process, especially in the case of complex tasks.

Brain↗

PubMed1992

Therapeutic decision making of physicians.

In this review the therapeutic decision-making process of physicians is described. This process is divided into two steps: the generation of a limited set of possible options (the 'evoked set') and the selection from this evoked set of a treatment for a specific patient. Factors that are important in both steps are reviewed. Behavioural and decision-making theories in general and decision-making analysis of physicians in particular are discussed to identify possible shortcomings in their decision-making process. Based on this information a model of the drug choice process is presented. With reference to this model possible ways of influencing drug choices of physicians are discussed.

Decision Making↗

PubMedDate not supplied

Application of a model to guide ethical decision making in burn treatment.

Ethical considerations in the decision to resuscitate and continue treatment of a massive burn injury are complex. As survival improves, the parameters we use in deciding to resuscitate are less clear. The point at which further treatment is futile is often difficult to recognize, and the decision-making process of whether to withhold or withdraw care can cause great anxiety for the family, as well as for the burn team. The identification of the operative ethical principles in this decision-making process helps clarify issues and values. Although there is no simple algorithm for decision making with ethical dilemmas, the systematic application of the decision-making model presented here that consists of 4 prioritized questions that address medical indications, patient preferences, quality-of-life issues, and contextual factors can focus the problem and define options. In addition, early use of a hospital bioethics committee is advocated to resolve conflict and to provide an acceptable forum for discussion.

Burns↗

PubMed1996

Decision making in ruminant orthopedics.

Decision making in ruminant orthopedics is determined by many factors, the most of important of which is age, size, and value of the patient, the nature of the injury, the prognosis for effective treatment and satisfactory healing, the intentions of the client, and the experiences of the veterinarian. Ruminant orthopedics currently is expanding to include the treatment of llamas and small ruminants as companion animals in addition to the treatment of valuable livestock. The future promises increasing sophistication in treatments and an ever higher quality of patient care.

Animals↗

PubMed2006

Decision-making competence and adherence to treatment in adolescents with diabetes.

OBJECTIVE: To examine decision-making competence (the ability to form effective plans for managing different situations) in a sample of adolescents with type I diabetes and their parents. We hypothesized that adolescent decision-making competence would mediate the relationship between parent-adolescent communication and adherence to treatment. METHODS: The sample consisted of 63 adolescents and their parents. Parent-adolescent communication during a problem-solving task was assessed, as well as adolescent maladaptive decision-making (adolescent report), adherence to treatment (parent and provider report; number of glucose tests), and metabolic control (HbA1C). RESULTS: Parent-adolescent communication was associated with adherence to treatment but not with adolescent decision-making. Poorer decision-making was associated with lower adherence per parent report but not provider report or the number of glucose tests. Decision-making competence did not mediate the relationships between parent-adolescent communication and adherence. CONCLUSIONS: These results are consistent with prior research demonstrating associations between parent-adolescent communication and adherence and identify adolescent decision-making competence as another potentially important correlate of adherence. These findings highlight several areas for future research.

Adolescent↗

PubMed2005

Beyond autonomy: diversifying end-of-life decision-making approaches to serve patients and families.

Efforts to improve end-of-life decision-making quality have emphasized the principle of individual autonomy to better ensure that patients receive care consistent with their preferences. This principle has primarily been defined through court decisions during the past 3 decades as a patient's right to refuse medical technologies and avoid life-prolonging treatments. However, autonomy as traditionally defined only serves a small segment of dying patients. Patients might not value autonomy or consider autonomy important but define it differently than decision-making self-determination. Some patients also think in terms of their care goals rather than individual treatment preferences. Patients' functional and cognitive abilities, age, racial and ethnic backgrounds, and desire to avoid burdening loved ones may influence attitudes and definitions regarding autonomy. To improve end-of-life decision-making for an increasingly multicultural and aging population, the following priorities should be set: (1) Increase the flexibility of advance care planning and decision-making strategies used with capable patients to encompass diverse perceptions of autonomy; and (2) Improve communication between physicians and patients' families when patients lack decision-making capacity to facilitate decision-making and address families' emotional burdens. The goal of these priorities is to promote understanding of patients' and families' decision-making preferences and goals and to minimize decision-making burdens on families.

Adult↗

PubMed2004

How research-conscious GPs make decisions about anticoagulation in patients with atrial fibrillation: a qualitative study.

BACKGROUND: Delays in the implementation of research findings have been of particular concern during the last decade. New findings, such as the use of warfarin to prevent stroke in patients with atrial fibrillation, have been found to be implemented patchily in clinical practice, in both primary and secondary care. OBJECTIVE: The purpose [corrected] of the study was to explore how GPs with an active interest in research or evidence-based medicine (EBM) make decisions about anticoagulation in patients with atrial fibrillation. METHODS: Semi-structured interviews with GPs about their experiences in managing patients with atrial fibrillation were recorded on audio-tape, transcribed and analysed using the 'Framework' method. A constructivist approach was taken to analysis and interpretation. RESULTS: Eleven interviews were included in the analysis. Two key themes, 'evidence' and 'professional role', were identified. No two respondents had the same perception of the evidence, which was influenced by experience, attitudes and a variable knowledge of the literature. Recent publications about the effectiveness of aspirin compared with warfarin, and the publication Clinical Evidence were the most frequently mentioned sources of evidence. GPs with confidence in EBM skills described giving highly detailed explanations to patients and having a great commitment to shared decision making, even if this resulted in patients declining treatment. For this reason, they also expressed antagonism towards prescriptive clinical guidelines. Hospital doctors were seen as exerting a powerful influence on decisions, as being 'disease-centred', difficult to challenge and poor at communicating. CONCLUSIONS: Decision making about anticoagulation is complex and is determined by a socially constructed view of the evidence strongly influenced by the GP's professional role.

Adult↗

PubMed2005

Optical imaging of neuronal populations during decision-making.

We investigated decision-making in the leech nervous system by stimulating identical sensory inputs that sometimes elicit crawling and other times swimming. Neuronal populations were monitored with voltage-sensitive dyes after each stimulus. By quantifying the discrimination time of each neuron, we found single neurons that discriminate before the two behaviors are evident. We used principal component analysis and linear discriminant analysis to find populations of neurons that discriminated earlier than any single neuron. The analysis highlighted the neuron cell 208. Hyperpolarizing cell 208 during a stimulus biases the leech to swim; depolarizing it biases the leech to crawl or to delay swimming.

Analysis of Variance↗

PubMed2005

Cache decision making: the effects of competition on cache decisions in Merriam's kangaroo rat (Dipodomys merriami).

Caching food is an economic, decision-making process that requires animals to take many factors into account, including the risk of pilferage. However, little is known about how food-storing animals determine the risk of pilferage. In this study, the authors examined the effect of a dominant competitor species on the caching and behavior of Merriam's kangaroo rat (Dipodomys merriami). The authors found that, as with conspecific competitors, kangaroo rats did not alter caching in response to the mere presence of a heterospecific competitor, but moved caches to an unpreferred area when the competitor's presence was paired with pilferage. These data suggest that Merriam's kangaroo rat assesses pilfer risk from actual pilferage by a competitor and adaptively alters cache strategy to minimize future risk.

Animals↗

PubMed2004

Decision-making in clinical nursing: investigating contributing factors.

BACKGROUND: This article describes the results of a study which investigated the contextual factors influencing clinical decision-making. Education and experience have been suggested by some as having a positive effect on clinical decision-making, and have been listed as being of high importance. Values, knowledge, clinical setting and stress have also been identified as being important to decision-making, with various rankings given by different researchers. AIM: The study was undertaken to determine relationships between occupational orientation (value to role), educational level, experience, area of practice, level of appointment, age and clinical decision-making in Australian nurses. The predictive ability of each factor on clinical decision-making was determined. METHOD: This correlational study examined Australian nurses' decision-making about some common nursing interventions and 'occupational orientation', educational level, experience, level of appointment, area of clinical speciality and age. A model was constructed using stepwise selection regression to predict the 'weight' of each variable in clinical decision-making. RESULTS: Education and experience were not significantly related to decision-making. The factor that accounted for the greatest variability to clinical decision-making was holding a professional occupational orientation, followed by level of appointment, area of clinical speciality, and age in that order. CONCLUSION: In contrast to other studies, experience and educational level were not found to influence decision-making strongly, the value of role was the most significant predictor. The model developed, however, only accounted for a low amount of variability in decision-making. The findings indicate that there are other factors affecting clinical decision-making that still require identification.

Adult↗

PubMed1985

Sex-role stereotype, self-concept, education and experience: do they influence decision-making?

The purpose of this study was to investigate the effects of self-concept, sex-role stereotype, educational preparation and years of experience upon the nurse's attitudes regarding decision-making. The Joseph Decision-making Tool (JDMT) was designed by the investigator to measure nurses' attitudes regarding decision-making. The tool consists of 20 scenarios in which the subject is asked to make a decision regarding a patient problem. Having an alpha reliability of 0.79, the JDMT was found to be exceedingly useful and easy to administer. Self-concept was measured by the BEM Scale. A heterogeneous population of female staff nurses working in medical-surgical units of two large metropolitan hospitals was used. A stepwise multiple regression technique was used to measure the potency of the particular variables in question. In a selected sample of 85 nurses, it was found that nurses with masculine sex-type scores and diploma education (P less than 0.05) felt that nurses should assume responsibility for decision-making. Experience was found to have an inverse relationship (P less than 0.01) with the JDMT. The more experience the nurse has, the less willing she is to make decisions. The majority of nurses (62%) who participated in the study were found to have androgynous rather than feminine sex-role stereotype scores. These two findings indicate changing trends in the traditional view of staff nurses. These new findings will assist nurses in changing the current image of a typically feminine nurse with a low self-concept. This study found strengths in nurses that are often overlooked by the feminists when they study nurses.

Adult↗