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 649 records · Page 36Linked to original sources

PubMed2005

'Unilateral' and 'bilateral' practitioner approaches in decision-making about treatment.

Practitioners can present and discuss decisions about the management of health problems in a variety of ways during consultations. This paper examines in detail how doctors talk with patients in relation to decision-making about treatment. Conversation analyses of decision-making sequences in consultations about diabetes in primary care and about treatment of ear nose and throat (ENT) cancer in a specialist oncology setting, both in the UK, revealed a spectrum of practitioner approaches ranging from more 'bilateral' to more 'unilateral'. This paper identifies the key communicative and organisational features of these approaches and provides some preliminary observations about the implications of these for patient participation in decision-making.

Communication↗

PubMedDate not supplied

Clinical decision-making regarding intravenous hydration in normal labor in a birth center setting.

Intravenous hydration (IVH) in normal labor is used routinely in most hospital settings despite the lack of support from recent research. However, it is not used routinely at one in-hospital, Alternative Birthing Center (ABC), in the Midwest. The purpose of this study was to explore and describe the criteria and perspectives of the certified nurse-midwives (CNMs) and nurses (RNs) in their decision-making process toward nonroutine use of IVH. In-depth interviews with five CNMs and four RNs that work in the ABC provided insight into how they balanced patient preference, research-based knowledge, and clinical judgments, in making decisions about IVH. The RNs were slightly more in favor of IVH than the CNMs, but not because of philosophic differences. Rather, the different roles and responsibilities of CNMs and RNs seemed to be most important. CNMs had a stronger commitment to client preferences, whereas RNs were more concerned about their responsibility for efficiently starting IVs prior to an emergency situation. Understanding professional differences in the decision-making process for IVH can enhance clinical functioning of the caregiving team by helping CNMs anticipate and address potential conflicts.

Attitude of Health Personnel↗

PubMed1991

A metacognitive analysis of decision making in adolescence.

Samples of 43 early (CA = 13 years) and 41 middle (CA = 15 years) adolescents were compared on three categories of metacognitive knowledge as they relate to decision making--person knowledge, task knowledge and strategy knowledge. Metacognitive knowledge was assessed using a 19-item questionnaire. Consistent with our hypothesis, middle adolescents showed significantly greater metacognitive knowledge than early adolescents on all three scales. Self-reported decision making style (using the Flinders Adolescent Decision Making Questionnaire) and decision making performance on a hypothetical scenario were also measured. Middle adolescents reported a more competent decision making style than early adolescents, while group differences on the scenario were not found. Adolescents completing the scenario scored significantly higher on all measures of decision making metacognition. Significant correlations were found between metacognitive knowledge of decision making, self-reported decision making style and performance on the decision scenario task. By middle adolescence understanding of what is involved in the activity of decision making is well developed. This growth in understanding, accompanied by changes in social domains, plays a part in decision execution and style.

Adolescent↗

PubMed1995

Expert role assignment and information sampling during collective recall and decision making.

Previous research has found that decision-making groups do not effectively pool unshared information. This study examined how personal expertise facilitates the mentioning and validation of unshared information in collective recall and decision-making groups by increasing members' awareness of who holds what types of information. Assigned expertise increased substantially the proportion of unshared information mentioned during both collective recall and decision-making tasks. Two results supported the hypothesis that assigned expertise provides validation for the recall of unshared information. When expertise was assigned, (a) more of the unshared information mentioned during the recall task was retained on the collectively endorsed written protocol, and (b) unshared information that was mentioned in discussion was more likely to be correctly recognized by members after group interaction.

Adult↗

PubMed1997

Line of reasoning as a representation of nurses' clinical decision making.

Line of reasoning (LOR) is offered as an alternative representation of clinical decision making for studies using protocol analysis. A LOR is defined as an argument or set of arguments leading to a conclusion. Because LOR combines both knowledge and cognitive processes, it provides a more complete representation of how a person uses knowledge to make a decision in a particular situation than do other representations. Operationalization of LOR in the form of templates and narratives enhances systematic data interpretation and coding. The use of LOR as a representation is illustrated in a study of critical care nurses' clinical decision making, specifically the determination of a patient's readiness to wean from mechanical ventilation.

Clinical Competence↗

PubMedDate not supplied

Medical decision-making and information needs in end-stage renal disease patients.

Health information and decision-making are increasingly important to patients with diverse illnesses. The aim of this study was to examine health information needs and decision-making in individuals with end-stage renal disease (ESRD) and to examine the influence of age and gender. A self-report survey was administered to 197 consecutive ESRD patients receiving renal replacement therapy. Their mean age was 52.8 years; 58.2% were male, 64.3% were on hemodialysis, and 35.7% on peritoneal dialysis. Actual participation levels in decision-making were not necessarily in agreement with the preferred degree of participation. Eighty percent of patients wanted the health care team (HCT) to make their treatment decisions for them, but only 40% of those who preferred autonomous and 30% of those who preferred shared decision making with their HCT reported that this was their actual experience. Consequently, many more patients perceived that their decision-making was made by their HCT than preferred this. No significant gender differences were observed; however, older participants preferred and experienced their HCT make their treatment decisions (P<.05). All patients wanted high levels of information with some differences by gender and age. HCT should strive to ascertain and meet the information needs and treatment decision-making roles preferred by individual patients.

Attitude to Health↗

PubMedDate not supplied

As a matter of fact: evidence-based decision-making unplugged.

The rationale of evidence-based decision-making is to inform the decision-making process with information relevant to the decisions being taken. In this paper the models of research and analytical approaches used to generate the evidence are shown to be generally not 'decision-informing'. The researcher's interest in health care interventions has led to the development and use of designs which strip the research of contextual issues and hence represent a major departure from both the underlying notions of the complex pathways to health and the empirical findings concerning the importance of population context. In this way, the evidence-based approach, dominated by a focus on health outcomes from health care interventions, overlooks the notion that society is not a 'level playing field'. Decisions based on research 'evidence' of this type risk redeploying resources inefficiently and in ways which systematically favour those groups with favourable 'prospects for health' (or non-health care determinants of health), and the conditions that those groups in society tend to suffer from, and away from those groups with less favourable prospects for health. Existing approaches to informing the decision-making process could be enhanced by broadening the scope of the research to incorporate relevant determinants of health in both the specification of the problem and the selection of methods of analysis that enable us to explore the complex pathways to health.

Decision Making↗

PubMed2002

Somatic markers, working memory, and decision making.

The somatic marker hypothesis formulated by Damasio (e.g., 1994; Damasio, Tranel, & Damasio, 1991) argues that affective reactions ordinarily guide and simplify decision making. Although originally intended to explain decision-making deficits in people with specific frontal lobe damage, the hypothesis also applies to decision-making problems in populations without brain injury. Subsequently, the gambling task was developed by Bechara (Bechara, Damasio, Damasio, & Anderson, 1994) as a diagnostic test of decision-making deficit in neurological populations. More recently, the gambling task has been used to explore implications of the somatic marker hypothesis, as well as to study suboptimal decision making in a variety of domains. We examined relations among gambling task decision making, working memory (WM) load, and somatic markers in a modified version of the gambling task. Increased WM load produced by secondary tasks led to poorer gambling performance. Declines in gambling performance were associated with the absence of the affective reactions that anticipate choice outcomes and guide future decision making. Our experiments provide evidence that WM processes contribute to the development of somatic markers. If WM functioning is taxed, somatic markers may not develop, and decision making may thereby suffer.

Adolescent↗

PubMed2005

Portrayals of treatment decision-making on popular breast and prostate cancer web sites.

The objective of this study was to describe the messages about treatment decision-making on popular cancer web sites, with particular reference to gender differences. The two most popular UK based web sites for breast and prostate cancer were chosen. Qualitative and quantitative comparative content analysis of the two case study web sites were performed. Web site portrayals of treatment decision-making by men with prostate cancer emphasize the obligation to be decisive, using information derived from medical sources, with minimal consultation with families and friends. Portrayals of treatment decision-making by women with breast cancer emphasize their family obligations, their need to make decisions about matters other than treatment, their right to opt out of decision-making, to take time, sometimes change their minds, consult with families and friends, and thereby take non-medical factors into account. This study will help health care practitioners understand the different factors that men and women feel obliged to consider when making decisions about their cancer treatments, and the role of the Internet in reinforcing gender differences.

Attitude to Health↗

PubMed2001

Making choices: the neurophysiology of visual-saccadic decision making.

Imagine the decisions you might make while playing a simple game like 'matching pennies'. At each play, you and your opponent, say the mathematician John vonNeumann, each lay down a penny heads or tails up. If both pennies show the same side, vonNeumann wins, if not, you win. Before each play, you have the subjective experience of deciding what to do: of choosing whether to play heads or tails. Although decisions like these are not yet understood at a physiological level, progress has been made towards understanding simple decision making in at least one model system: the primate neural architecture that uses visual data and prior knowledge about patterns in the environment to select and execute saccades. Both the visual system and the brainstem circuits that control saccadic eye movements are particularly well understood, making it possible for physiologists to begin to study the connections between these sensory and motor processes at a level of complexity that would be impossible in other less well understood systems.

Choice Behavior↗

PubMed2001

Diagnostic decision-making in anatomic pathology.

In diagnostic pathology, decision-making skills are used to match the facts of a particular case to a diagnostic category. Ideally the diagnosis is established with "beyond a reasonable doubt" certainty, but substantial uncertainty orfrank diagnostic error can afflict the diagnostic process for a variety of reasons. Many of these diagnostic problems are explained by failures of decision-making. Unfortunately, it appears that substantial components of decision-making are too poorly understood to study or improve. For example, "instant pattern recognition," use of implicit knowledge, and use of creativity represent areas where discussion may not be helpful. In contrast, rule-based problem-solving is sufficiently well understood that the members of an almost purely cognitive specialty might be prompted to ask, what do we know about what we do when we problem-solve? This article reviews some of the more intriguing aspects of decision-making in the hope of stimulating interest in the topic among pathologists.

Data Collection↗

PubMed2005

Decision making in pathological gambling: a comparison between pathological gamblers, alcohol dependents, persons with Tourette syndrome, and normal controls.

Decision making deficits play an important role in the definition of pathological gambling (PG). However, only few empirical studies are available regarding decision making processes in PG. This study therefore compares decision making processes in PG and normal controls in detail using three decision making tasks examining general performance levels on these tasks as well as feedback processing using reaction time analyses. To investigate the specificity of decision making deficits in PG, a substance dependence group (alcohol dependence; AD) and an impulse control disordered group (Tourette syndrome; TS) were included. The PG group (n = 48), AD group (n = 46), TS group (n = 47), and a normal control (NC) group (n = 49) were administered (1) the Iowa Gambling Task (IGT), an ecologically valid gambling task; (2) the Card Playing Task, a task measuring perseveration for reward; and (3) a Go/No-Go discrimination task, a task measuring reward and response cost sensitivity. The PG group showed a diminished performance on all tasks and deficient feedback processing as compared to the NC group on the IGT and the Card Playing Task. In general, performance measures were not associated with levels of comorbidity or with self-reported motivational measures. For the larger part, deficiencies in decision making processes in the PG group were also present in the AD group, but not in the TS group. Subgroup analyses revealed larger decision making deficits in pathological slot machine gamblers than in pathological casino gamblers. Deficits in decision making and feedback processing in PG should be addressed in treatment and incorporated more explicitly in theoretical models of PG.

Adult↗

PubMedDate not supplied

Implications of patient and physician decision making: an illustration in treatment options for coronary artery disease.

The objective of this study was to explore the extent to which patients and physicians desire patient participation in medical decision making. The cross-sectional pilot study involved 92 patients with coronary artery disease (CAD) and 50 physicians involved in treating patients with CAD. Desire to participate in making the decision between treatment options for CAD and factors that influence the decision were assessed. Physicians prefer to participate in shared decision making more often than do the patients (P = .016). When faced with clinical scenarios requiring a decision to be made between percutaneous transluminal coronary angioplasty and coronary artery bypass graft, patients and physicians tended to defer to one another to make the decision. Multinomial logistic regression models showed that the overriding factor influencing patient decision making was the physician's opinion (P < .0001) and the patient's preference was the overriding factor influencing physician decision making (P < .0001). Because patients tend to defer to physicians when making medical decisions, it is incumbent upon the physician to assure that the physician-patient dialogue reflects important information about the procedures (coronary artery bypass graft and percutaneous transluminal coronary angioplasty) and that preferences are acknowledged. This may impact greatly on achieving satisfactory health outcomes and patient satisfaction.

Aged↗

PubMed1987

Corporate ethical decision making in health care institutions.

The health care environment in which ethical decisions are made is changing rapidly. Ultimately, these changes may produce a more effective health care system. However, they also create new ethical dilemmas and greater complexity in ethical decision making. To clarify the problems of ethical decision making in health care institutions, and to define some guidelines for making these decisions, Ross Laboratories convened a roundtable of ethicists, attorneys, and health care practitioners, including physicians, nurses, and dietitians. The roundtable was chaired by Monsignor Charles Fahey of Fordham University's Third Age Center, who reflected on the discussions and, in this issue of Hospital Administration Currents, shares his thoughts on the issues of ethical decision making by corporate health care entities.

Conflict, Psychological↗

PubMed2006

Primer: using decision analysis to improve clinical decision making in urology.

Many clinical decisions in urology involve uncertainty about the course of disease or the effectiveness of treatment. Many decisions also involve trade-offs; for example, an improvement in patient survival at the cost of an increased risk of treatment-related adverse effects. Decision analysis is a formal, quantitative method for systematically comparing the benefits and harms of alternative clinical strategies under circumstances of uncertainty. The basic steps in performing a decision analysis are to define the clinical scenario or problem, identify the clinical strategies to be considered in the decision, enumerate all of the important sequelae of each strategy and their associated probabilities, define the outcome of interest, and assign a value to each possible outcome. Health outcomes can be defined in a number of ways, including quality-adjusted survival. A key aspect of decision analysis is allowing the values of particular health outcomes to vary from patient to patient, depending on individual preferences. Decision analysis has already been used to assess a variety of prevention, screening and treatment decisions in urology, and there is much potential for its future application. Greater incorporation of decision-analytic techniques into urology research and clinical practice might improve decision making, and thereby improve patient outcomes.

Decision Making↗

PubMed2001

Backing and forthing: the process of decision making by women considering participation in a breast cancer prevention trial.

PURPOSE/OBJECTIVES: To describe the process of decision making by women considering participation in a breast cancer prevention trial (BCPT). DESIGN: Qualitative. SETTING/SAMPLE: Twenty-six women considering participation in a BCPT in the Northeastern United States. METHODS: Women were interviewed one or two times over a period of one year, with each interview averaging 40 minutes in length. The grounded theory method was used to collect and analyze the data. In-depth interviews were conducted with each participant. Data were analyzed using the constant comparative method. MAIN RESEARCH CONCEPTS: Context, decision making, meaning. FINDINGS: The core variable of backing and forthing is a nonlinear complex process of decision making that includes reviewing life, wanting to be sure, chancing and deciding within the contexts of fear, view of self in the world, transgenerational issues, and social support. CONCLUSIONS: The process of decision making for women considering participation in a BCPT is complex. Women tend to make decisions based on what is in their heads and hearts. They often are concerned more about others than they are about themselves. IMPLICATIONS FOR NURSING PRACTICE: Trust in the provider and active involvement in the process is critical to women making a decision to participate in a BCPT. Decision making is unique for each woman; however, understanding the context, the core variables, and the process will help healthcare providers to support decision making.

Adult↗

PubMedDate not supplied

Home parenteral nutrition: an ethical decision making dilemma.

Ethics is a hot topic these days. Home health care providers need not be ethicists, however they do need to be able to identify problems quickly, and know how to address them. This paper explores the ethical issues arising from a narrative analysis involving an advanced cancer patient receiving Total Parenteral Nutrition (TPN) at home. It shows how complicated it is today to make nutrition support decisions that would have been customary less than 30 years ago. For and against arguments of TPN for advanced cancer patients are reviewed. Ethical positions adopted by the medical and nursing professions are explored and contrasted. The importance of patient autonomy, within a holistic notion of care, including decisions incorporating quality of life, are affirmed, providing a challenge to monitoring the status quo in approaches to decision making.

Aged↗

PubMed2006

Group decision making in fission-fusion societies: evidence from two-field experiments in Bechstein's bats.

Group decisions are required when group coordination is beneficial, but individuals can choose between alternatives. Despite the increased interest in animal group decision making, there is a lack of experimental field studies that investigate how animals with conflicting information make group decisions. In particular, no field studies have considered the influence of fission-fusion behaviour (temporary splitting into subgroups) on group decisions. We studied group decision making in two wild Bechstein's bat colonies, which are fission-fusion societies of stable individual composition. Since they frequently switch communal roosts, colony members must regularly make group decisions over where to roost. In the two-field experiments, we provided marked individuals with conflicting information about the suitability of potential roosts. We investigated whether conflicting information led to group decisions that followed a 'unanimous' or a 'majority' rule, or increased colony fission. Individual behaviour suggests that bats considered both their own information and the behaviour of others when deciding where to roost. Group decisions about communal roosts reflected the information available to a majority of the bats roosting together, but conflicting information led to an increased fission in one colony. Our results suggest that fission-fusion societies allow individuals to avoid majority decisions that are not in their favour.

Animals↗