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Results for “Decision Making”

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PubMed1996

Neonatal and pediatric critical care: ethical decision making.

The current standards for surrogate decision making for children are analyzed in this article. A number of potential pitfalls are involved with this issue, including questions about the child's maturity and competence. The present approach for medical decision making for noncompetent children is the "best interest" standard. In many medical decisions, the "best interest" standard is not applicable and a "rational parent" standard is presented.

Child↗

PubMed2000

Increasing independent decision-making skills of women with mental retardation in simulated interpersonal situations of abuse.

The effectiveness of two decision-making training approaches in increasing independent decision-making skills of 36 women with mild mental retardation in response to hypothetical social interpersonal situations involving abuse was evaluated. Participants were randomly assigned to a control or one of two training conditions (a decision-making training approach that either addressed both cognitive and motivational aspects of decision-making or included only instruction on the cognitive aspect of decision-making). Although both approaches were effective relative to a control condition, the combined cognitive and motivational training approach was superior to the cognitive only training approach. The superiority of this approach was also reflected on a verbally presented generalization task requiring participants to respond to a decision-making situation involving abuse from their own perspective and on a locus of control scale that measured perceptions of control.

Adult↗

PubMed1995

Analysis of medical decision making: a cognitive perspective on medical informatics.

The improved support of complex medical decision making will require a greater understanding of the cognitive processes of physicians. Decision making in medicine often involves the careful weighing of uncertain and ill-structured information from various sources. In this paper a cognitive approach to analyzing complex intensive care decision making is outlined. The study described involved the presentation of case descriptions of systematically varied complexity, to two levels of physicians: intensive care residents (intermediates) and intensive care specialists (experts). Subjects were asked to "think aloud" in providing treatment and management decisions for the cases. The audiotaped protocols were then analyzed for the use of decision strategies and for key aspects of decision making. It was found that expert subjects tended to focus on developing a more refined situational analysis of the decision problem. The study results are being used in the design of a system for aiding physicians in making complex decisions in intensive care medicine.

Aged↗

PubMed1987

Rationing medical technology. Hospital decision making in the United States and England.

This paper analyzes medical technology decision making in the United States and England in terms of the appropriateness of different decision-making models to the organization and delivery of medical care, and to the rationing of technology among and within hospitals. It examines the effect on the American hospital of prospective payment programs from the perspective of organizational structure and decision making. The strategies of central control and specification which characterize these programs are contrasted with decision-making procedures in the English National Health Service, which have emphasized decentralization, delegation, and consensus. The analysis suggests that decentralized models of decision making are more supportive of essential elements of medical care including doctor-patient trust and professional responsibility and are more able to achieve rationing decisions which are compatible with professional and consumer preferences.

Data Collection↗

PubMed2003

Factors affecting tuberculosis control : decision-making at the household level.

OBJECTIVE: To explore the factors influencing decision-making process at household level vis-a-vis decision to seek health care, decision regarding the type of care and the decision to continue treatment. DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Government TB Center, Rawalpindi, from 16th January 2002 to 28th February 2002. SUBJECTS AND METHODS: In total, 100 smear positive patients were included in the study. First questionnaire was administered to first 50 randomly selected patients. The ethnographic decision models (EDM) were developed from the responses. The second questionnaire, derived from these models, was administered to the second group of randomly selected 50 patients to test the predictive ability of the EDM. RESULTS: Decision-making regarding treatment of tuberculosis was influenced by patients' knowledge about the disease itself as well as its severity, infectivity and curability. Close relatives were found to play a critical role at all the decision-making levels. The EDM developed on these results had 80-90% ability to predict the decision-making in tuberculosis patients. CONCLUSION: Effective health education, easy accessibility to treatment centres and trained and motivated health care providers can go a long way in making national Tb control program a success.

Adult↗

PubMed2003

MDFT account of decision making under time pressure.

In this paper, decision making under time pressure for multiattribute choice alternatives in a risky environment is investigated. A model, multiattribute decision field theory (MDFT), is introduced that describes both the dynamic and the stochastic nature of decision making and accounts for the observed changes in choice probabilities, including preference reversals as a function of time limit. An experiment in which five different time limits were imposed on the decision maker is presented to test the predictions of the model. It is shown that MDFT is able to account for the complex decision behavior observed in the data. Furthermore, MDFT is compared with the predictions of decision field theory (Busemeyer & Townsend, 1993; Roe, Busemeyer, & Townsend, 2001).

Adult↗

PubMed2005

Residents' end-of-life decision making with adult hospitalized patients: a review of the literature.

PURPOSE: The authors performed a structured literature review to understand residents' experiences with end-of-life (EOL) decision making with adult hospitalized patients, specifically regarding decisions to withhold or withdraw advanced life-support measures. METHOD: An Ovid-based strategy was used to search Medline, ERIC, PsychINFO, and CINHAL databases for articles published between 1966 and February 2005, combining the domains of "resuscitation orders," "decision making," and "internship and residency." All quantitative and qualitative studies examining residents' EOL decision making with adult hospitalized patients were included. The authors developed and applied a scoring system for relevance and quality, performed data abstraction and quality assessment independently and in duplicate, then met to collate findings and identify factors in residents' EOL decision making. RESULTS: The searches yielded 884 articles, of which 26 were included. Variable methodologies precluded meta-analysis. In these studies, residents felt unprepared to handle patient EOL decision making, although exposure to EOL discussions helped them gain confidence. Residents' attitudes, skills, and knowledge were key determinants of whether EOL decisions were addressed. Many misinterpreted the terms "DNR" and "futility." Residents' understanding of the patient EOL decision-making process could be extremely variable, and their do-not-resuscitate discussions suboptimal. Residents' lived practice experience of the patient EOL decision-making process was often at odds with what they were taught in formal curricula. CONCLUSIONS: Educational strategies aimed at changing residents' knowledge, skills and attitude should address the hidden curriculum for the patient EOL decision-making process that is part of the experienced culture of every day practice. Future studies of this experienced culture would inform specific educational interventions.

Adult↗

PubMed1984

Faculty and administrator perceptions of decision making.

This research study was conducted in associate and baccalaureate schools of nursing. This research focused on the extent of faculty participation in decision making; a description and analysis of the characteristics of nurse faculty, nurse administrators, and the organizations of associate and baccalaureate schools of nursing; the interrelationships between opportunities for participation in decision making and the level and type of decision making; the relationships between various personal and situational variables that affect decision making, the relationship between the type of involvement in decision making to the variables of job satisfaction, professional commitment, and job tension; and the relationships among the variables of job satisfaction, professional commitment and job tension. Ninety-three faculty and 10 administrators participated in the research study. Research data were collected by three instruments: the School Information Profile, the Administrative Questionnaire, and the Faculty Questionnaire. The data were subjected to frequency distribution statistics, the RELIABILITY program of SPSS, Pearson correlation coefficients, Canonical correlations, and Multiple Regression analysis. The primary study results were: Faculty reported that their participation in decision making is primarily in the area of making recommendations, not final determinations. Faculty stated that decision making is usually a group process. Administrator perceptions were that faculty possess more decision-making power than faculty believed. Faculty reaffirmed that job satisfaction and professional commitment are positively correlated, and that job tension was found to be negatively correlated to job satisfaction and professional commitment.(ABSTRACT TRUNCATED AT 250 WORDS)

Administrative Personnel↗

PubMed1997

Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango).

Shared decision-making is increasingly advocated as an ideal model of treatment decision-making in the medical encounter. To date, the concept has been rather poorly and loosely defined. This paper attempts to provide greater conceptual clarity about shared treatment decision-making, identify some key characteristics of this model, and discuss measurement issues. The particular decision-making context that we focus on is potentially life threatening illnesses, where there are important decisions to be made at key points in the disease process, and several treatment options exist with different possible outcomes and substantial uncertainty. We suggest as key characteristics of shared decision-making (1) that at least two participants-physician and patient be involved; (2) that both parties share information; (3) that both parties take steps to build a consensus about the preferred treatment; and (4) that an agreement is reached on the treatment to implement. Some challenges to measuring shared decision-making are discussed as well as potential benefits of a shared decision-making model for both physicians and patients.

Decision Making↗

PubMed2001

The emergence of coherence over the course of decision making.

Previous research has indicated that decision making is accompanied by an increase in the coherence of assessments of the factors related to the decision alternatives. In the present study, the authors investigated whether this coherence shift is obtained before people commit to a decision, and whether it is obtained in the course of a number of other processing tasks. College students were presented with a complex legal case involving multiple conflicting arguments. Participants rated agreement with the individual arguments in isolation before seeing the case and after processing it under various initial sets, including playing the role of a judge assigned to decide the case. Coherence shifts were observed when participants were instructed to delay making the decision (Experiment 1), to memorize the case (Experiment 2), and to comprehend the case (Experiment 3). The findings support the hypothesis that a coherence-generating mechanism operates in a variety of processing tasks, including decision making.

Adult↗

PubMed1990

Assessing treatment decision-making capacity in elderly nursing home residents.

Clinicians usually employ indirect measures of cognitive and physical function in order to assess medical decision-making capacity. We tested a reference group of well elderly (Mini-Mental State Exam [MMSE] score = 29.1 +/- 0.8, mean +/- SD), for their understanding of three increasingly complex, hypothetical treatment situations or "vignettes"--use of a hypnotic, need for thoracocentesis, and desire for CPR. From this, we have developed a more direct, Guttman-like assessment of decision-making capacity. Of 51 Veterans Affairs nursing home residents (MMSE score = 22.4 +/- 6.9), only 33.3% demonstrated intact decision-making capacity by this method, whereas 77% were felt by their primary physicians to be capable of giving consent for oral surgery; 37.3% had very impaired decision-making capacity; and 29.4% were intermediate in this ability. Judged against our more direct assessment of decision-making capacity, primary physicians' judgment of capacity for consent was 31% to 39% sensitive in identifying impaired decision-making and the MMSE was 53% to 63% sensitive. These measures were 100% and 82% to 83% specific in identifying intact decision-making capacity, respectively. We conclude that (1) more directly assessed decision-making capacity varies noticeably among elderly nursing home residents and correlates in only limited fashion with frequently used cognitive screening methods; and (2) cognitive screening tests underestimate the prevalence of impaired decision-making capacity in this population. For informed consent and advance directives, our study suggests that decision-making capacity should be directly, rather than indirectly, assessed.

Activities of Daily Living↗

PubMed2005

Understanding medical decision making in hand surgery.

The practice of medicine takes place in an environment of uncertainty. Expected value decision making, prospect theory, and regret theory are three theories of decision making under uncertainty that may be used to help us learn how patients and physicians make decisions. These theories form the underpinnings of decision analysis and provide the opportunity to introduce the broad discipline of decision science. Because decision analysis and economic analysis are underrepresented in upper extremity surgery, the authors believe these are important areas for future research.

Decision Making↗

PubMed1996

Clinical decision making of experienced and novice nurses.

Decision making is an important daily nursing activity. Given contradictory past findings concerning the ease of use cognitive schema for reaching decisions among experts and novices, we chose to examine consistency of information as a parameter that may clarify the process of decision making. Ninety-two experienced nurses and 65 nursing students rated their decisional difficulty and levels of certainty in reaching a diagnosis for two scenarios: one including consistent information and one providing information that was partly inconsistent with the given diagnosis. For the consistent information, students showed more difficulty and less certainty in the given diagnosis than the experienced nurses. The inconsistent scenario was perceived as more difficult by nurses in comparison to students. The cognitive processes responsible for these results are discussed.

Adult↗

PubMed1998

Clinicians' decision making about involuntary commitment.

OBJECTIVE: Clinicians' decision making about involuntary commitment was examined, with a focus on the effects of patient and clinician characteristics and bed availability on decisions to detain patients, the first step in involuntary commitment. METHODS: Eighteen psychologists and social workers in the emergency service of a community mental health center completed the Risk Assessment Questionnaire for 169 consecutive patients they deemed to present some degree of risk. Forty-two patients were detained. RESULTS: Three underlying constructs were significantly associated with a patient's overall risk rating, which in turn predicted the decision to detain. Two were clinician characteristics: the clinician detention ratio, which reflects the proportion of patients detained by the clinician in the past three months, and the setting in which the evaluation occurred, either an in-house emergency service or a mobile crisis unit. The availability of detention beds in the community was also a significant predictor of whether a patient would be detained. No patient characteristic, including diagnosis, sex, age, or insurance status, was significantly related to the detention decision. CONCLUSIONS: The findings suggest that the decision-making process is influenced by multiple factors, such as setting, the clinician's tendency to detain patients, and the availability of detention beds.

Adult↗

PubMed2003

Measuring the quality of judgement and decision-making in nursing.

AIM: This paper discusses measurement of the quality of judgement and decision-making in nursing research. It examines theoretical and research issues surrounding how to measure judgement accuracy as a component of evaluating decision-making in nursing practice. DISCUSSION: Judgement accuracy is discussed with reference to different methods of measurement, including comparing judgements with independent criteria and inter-judge approaches. Existing research on how judgement accuracy has been measured in nursing practice is examined. Evaluation of decisions is then discussed, including consideration of the process of decision-making and evaluating decision outcomes. Finally, existing research on decision-making in nursing is assessed and the strengths and limitations of different types of measurement discussed. CONCLUSION: We suggests that researchers examining the quality of judgement and decision-making in nursing need to be aware of both the strengths and limitations of existing methods of measurement. We also suggest that researchers need to use a number of different methods, including normative approaches such as Bayes' Theorem and Subjective Expected Utility Theory.

Decision Making↗

PubMed2004

Who wants to be involved? Decision-making preferences among residents of long-term care facilities.

While the benefits of participating in care or medical decision making are widely reported, research on decision-making participation preferences usually reveals some portion of individuals who do not want to be involved. Data collected through structured, in-person interviews with 100 residents of six long-term care (LTC) facilities in Victoria, British Columbia, were used to examine participation preferences with respect to four types of care decisions (bedtimes, medication choice, room transfer, and advance directives), as well as predictors of these preferences. Residents with higher levels of formal education, a greater number of chronic conditions, and greater confidence about the worth of their input tend to prefer more active involvement in decision making. This research also suggests that predictors of preference for independent control over decision making (active involvement) differ from predictors of preference for joint or shared decision making. Implications for the empowerment of LTC facility residents and the meaning of decision-making involvement in these environments are discussed.

Aged↗

PubMed2006

When staff and parents disagree: decision making for a baby with trisomy 13.

Parents often make medical decisions for their children. As pediatricians, we must be sure that the decisions are medically informed. At times, we may disagree with the decisions that parents make and must decide if they are acting in the best interest of their child. This article presents a case in which these issues arose regarding a child with trisomy 13.

Chromosome Disorders↗

PubMed1989

Towards ethical decision-making in nursing practice.

This article explores some nursing research done by the author illustrating nurses' experiences with decision-making in ethical issues. The article then looks at how we can foster ethical decision-making in nursing practice. Nurses in the author's study described their experience of decision-making in relation to the ethical issue of prolongation of life. The results of the study portrayed nurses' descriptions in terms of an overall theme of senselessness. Senseless decision-making was a major finding in the study and included inadequate involvement of the patient, inadequate involvement of the family, inadequate involvement of the nurse, and fragmentary team decision-making. Nurses' descriptions of a senseless decision-making process are examined by the author in terms of conflict and powerlessness. The author concludes by reviewing recent nursing literature suggesting how we can move from senseless to ethical decision-making in nursing practice.

Decision Making↗