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 865 records · Page 48Linked to original sources

PubMed2006

To hospitalize or not to hospitalize? That is the question: an analysis of decision making in the nursing home.

The authors examined the processes and factors that influence physicians' decision-making processes as regarding hospitalization of nursing home residents. In a large nonprofit nursing home, 6 full-time male physicians and 1 female nurse practitioner completed questionnaires that described the medical decision-making process for 52 nursing home residents for whom hospitalization was considered. The questionnaire covered the following topics: medical event description, the decision-making process, considerations in making treatment decisions, and the role of advance directives. Hospitalized residents had fewer treatments considered and fewer treatments chosen than those who were not hospitalized. Residents with fractures were the most commonly hospitalized residents, whereas residents in frailer conditions, with breathing problems, and for whom the physician considered quality of life to be most important were less likely to be hospitalized. The results of this study clarify the complexity of factors affecting the decision-making process and suggest a methodology that may assist in discerning those factors in the future.

Aged↗

PubMed1996

The research basis of health care decision making.

Regarding health care services, the decision-making process occurs at three primary levels: macro (national), mid-range (hospital) and micro (individual practitioner). The research basis for this process at each of these levels is briefly discussed, with an emphasis concerning which type of data is and/or should be utilized. The paradigm assumptions behind data generation are also explored with reference to methodologies which seek to combine different types of data. The nursing profession, within the changing structure of the NHS, needs to take account of data generation if it is to play an active research role, and therefore be able to influence the health care decision-making process.

Data Collection↗

PubMed2002

Challenges in home care practice: a decision-making perspective.

A qualitative approach using an ethnographic design was used to investigate the nature of clinical decision making in home care practice from home care nurses' perspective. In-depth interviews were conducted with experienced home care nurses (N = 16) in addition to observations of nurses during meetings and client visits. The findings indicate that the decision-making challenges involved in home care practice consisted of the following 4 major categories: (a) challenges that arise in the development of client-centered care plans, (b) challenges that arise from the home care practice environment, (c) challenges related to developing confidence in clinical decision making, and (d) challenges in ethical decision making. Education and practice recommendations for enhancing clinical decision making are also discussed.

Communication↗

PubMed2004

Patients' preferences for involvement in treatment decision making in Japan.

BACKGROUND: A number of previous studies have suggested that the Japanese have few opportunities to participate in medical decision-making, as a result both of entrenched physician paternalism and national characteristics of dependency and passivity. The hypothesis that Japanese patients would wish to participate in treatment decision-making if adequate information were provided, and the decision to be made was clearly identified, was tested by interview survey. METHODS: The subjects were diabetic patients at a single outpatient clinic in Kyoto. One of three case study vignettes (pneumonia, gangrene or cancer) was randomly assigned to each subject and, employing face-to-face interviews, the subjects were asked what their wishes would be as patients, for treatment information, participation in decision-making and family involvement. RESULTS: 134 patients participated in the study, representing a response rate of 90%. The overall proportions of respondents who preferred active, collaborative, and passive roles were 12%, 71%, and 17%, respectively. Respondents to the cancer vignette were less likely to prefer an active role and were more likely to prefer family involvement in decision-making compared to non-cancer vignette respondents. If a physician's recommendation conflicted with their own wishes, 60% of the respondents for each vignette answered that they would choose to respect the physician's opinion, while few respondents would give the family's preference primary importance. CONCLUSIONS: Our study suggested that a majority of Japanese patients have positive attitudes towards participation in medical decision making if they are fully informed. Physicians will give greater patient satisfaction if they respond to the desire of patients for participation in decision-making.

Decision Making↗

PubMed1984

Quantitative theories for clinical decision making.

Clinical work involves a great many decisions in situations characterized by uncertainty and by the need for value judgments. Formal, mostly quantitative approaches to medical decision making have been developed over the last thirty years. The best known theories are discriminant analysis or supervised pattern recognition, decision analysis and, more recently, artificial intelligence. Discriminant analysis is used for estimating diagnostic probabilities on the basis of diagnostic data. Outcome, action, state, probability, utility, and choice are the main concepts of decision analysis. Problems of diagnosis and therapy choice can be structured within the framework of decision analysis. The quality of a decision analysis largely depends on a good structuring of the problem, and on the quality of the probability and utility assessments made during the analysis. Decision analysis is basically a prescriptive theory for decision making in individual patient management. Other areas of application include basic and advanced teaching, formulation, explication and analysis of clinical problems, detection of gaps in clinical knowledge, development of clinical protocols, etc.

Decision Making↗

PubMed1988

The role of the left hemisphere in decision-making.

The role of the left hemisphere in decision-making processes in choice reactions to unstructured visual stimuli (Bisiach, Mini, Sterzi and Vallar, 1982) was further investigated in normal right-handed individuals. Subjects were required to provide a motor response to lateralized single dots, abstaining from giving a response when two dots were shown. In the first study, in which the disruptive effects of concurrent articulatory activity were assessed, the decision required integration of information provided to both hemispheres, as the no-go stimulus was constituted by two dots symmetrically positioned, one in each half-field. In the second study, all information relevant to the decision was available to each hemisphere, as the no-go stimulus was represented by two dots in either half-field. Since in both experiments the decision mechanism remained located in the left hemisphere, the following conclusions are drawn: (i) the right hemisphere is unable to fulfil the demands of the present decision-making task, even when either a secondary task interferes with left hemisphere processes or it has direct acces to all the relevant information; this suggests a pattern of absolute hemispheric specialization; (ii) the left hemisphere decision-making process does not rely upon any sort of articulatorily-based "inner speech" component.

Analysis of Variance↗

PubMed2005

Family decision making at end of life.

OBJECTIVE: To enhance understanding of the phenomenon of family surrogate decision-making at the end of life (EOL) by means of a systematic review and synthesis of published research reports that address this phenomenon. METHODS: Garrard's (1999) methods for conducting a systematic review of the literature were followed. Fifty-one studies focusing on family decision-making experiences, needs, and processes when assisting a dying family member were selected following electronic database searches and ancestry searches. RESULTS: In studies using hypothetical scenarios to compare patients' choices and surrogates' predictions of those choices, surrogates demonstrated low to moderate predictive accuracy. Increased accuracy occurred in more extreme scenarios, under conditions of forced choice, and when the surrogate was specifically directed to use substituted judgment. In qualitative explorations of their perspectives, family members voiced their desire to be involved and to accept the moral responsibility attendant to being a surrogate. Quality of communication available with providers significantly influenced family satisfaction with decision-making and EOL care. Group or consensual decision-making involving multiple family members was preferred over individual surrogate decision-making. Surrogates experienced long-term physical and psychological outcomes from being decision-makers. SIGNIFICANCE OF RESULTS: Functioning as a surrogate decision-maker typically places great moral, emotional, and cognitive demands on the family surrogate. Clinicians can provide improved care to both patients and families with better understanding of surrogates' needs and experiences.

Advance Directives↗

PubMed2005

Decision-making capacity of inpatients with schizophrenia in Hong Kong.

This is a prospective study examining decision-making abilities in Chinese schizophrenia patients in Hong Kong. We interviewed patients before their discharge from hospital after a psychotic relapse, examining their decision regarding whether or not they would take maintenance neuroleptic treatment. Decision-making abilities were assessed by the MacArthur Competence Assessment Tool-Treatment, a semistructured questionnaire. We examined their relationships with demographic, clinical, and cognitive variables, measured by standardized instruments. Eighty-one participants were seen. Weaknesses were noted in a range of relevant decision-making abilities. Positive and negative schizophrenic symptoms, specifically lack of judgment and insight, difficulty in abstract thinking, unusual thought content, and conceptual disorganization, were found to be correlated with performance in decision-making abilities, as were cognitive deficits. Verbal working memory was a moderate predictor of the ability to understand treatment information. Decision-making impairments and negative treatment attitude were related to the decision not to adhere to medication.

Adolescent↗

PubMed2005

A decision-making framework for sediment contamination.

A decision-making framework for determining whether or not contaminated sediments are polluted is described. This framework is intended to be sufficiently prescriptive to standardize the decision-making process but without using "cook book" assessments. It emphasizes 4 guidance "rules": (1) sediment chemistry data are only to be used alone for remediation decisions when the costs of further investigation outweigh the costs of remediation and there is agreement among all stakeholders to act; (2) remediation decisions are based primarily on biology; (3) lines of evidence (LOE), such as laboratory toxicity tests and models that contradict the results of properly conducted field surveys, are assumed incorrect; and (4) if the impacts of a remedial alternative will cause more environmental harm than good, then it should not be implemented. Sediments with contaminant concentrations below sediment quality guidelines (SQGs) that predict toxicity toless than 5% of sediment-dwelling infauna and that contain no quantifiable concentrations of substances capable of biomagnifying are excluded from further consideration, as are sediments that do not meet these criteria but have contaminant concentrations equal to or below reference concentrations. Biomagnification potential is initially addressed by conservative (worst case) modeling based on benthos and sediments and, subsequently, by additional food chain data and more realistic assumptions. Toxicity (acute and chronic) and alterations to resident communities are addressed by, respectively, laboratory studies and field observations. The integrative decision point for sediments is a weight of evidence (WOE) matrix combining up to 4 main LOE: chemistry, toxicity, community alteration, and biomagnification potential. Of 16 possible WOE scenarios, 6 result in definite decisions, and 10 require additional assessment. Typically, this framework will be applied to surficial sediments. The possibility that deeper sediments may be uncovered as a result of natural or other processes must also be investigated and may require similar assessment.

Animals↗

PubMed2006

Holiday waistline. Time to consensus: the effect of the stomach on consensus decision-making at large conferences.

INTRODUCTION: The factors affecting decision-making at consensus conferences are not well understood. This paper studies the complex association between time to consensus (TTC) and the timing and quality of food, as well as the self-reported level of frustration (PITA factor) with the question at hand. METHODS: We came, we saw, we ate. RESULTS: There was an association between the TTC and the time to eating, especially lunch. There was a trend to faster TTC the better the researchers rated the food. The speed of decision-making was also increased when the PITA score was high, especially late in the day. INTERPRETATION: Organizers of large consensus conferences need to be aware of these factors in decision-making and should try to use them to get more controversial items voted to their satisfaction.

Consensus Statements as Topic↗

PubMedDate not supplied

The timing of medical technology acquisition: strategic decision making in turbulent environments.

Healthcare decision makers and researchers have long been interested in the factors behind medical technology acquisition. The rate of environmental change in recent years has dramatically affected technology acquisition decision making in acute care hospitals. This study examines the relative role of decision-maker influence and environmental factors on the timing of MRI acquisition in hospitals operating in three western states with different levels of environmental uncertainty. The results suggest that the relative influence of decision makers and environmental factors on innovation acquisition timing varies depending on environmental turbulence, and that hospitals acquire new technology as one way of controlling the turbulence in their environments.

California↗

PubMed2002

Disease-specific influences on meaning and significance in self-care decision-making in chronic illness.

The purpose of this study was to investigate the everyday self-care decision-making of individuals with chronic illness for the purpose of developing a comparison of decision-making processes between chronic diseases and to identify criteria by which persons with various chronic conditions evaluate the quality of self-care decisions. A sample of 21 individuals with either Type II diabetes, HIV/AIDS, or multiple sclerosis, who were nominated as expert self-care managers by their clinicians, recorded the decisions they made in their daily self-care over a 1-week period and were interviewed in depth to elaborate on the decisions, the processes by which they made them, and the factors that influenced them. This process was repeated to obtain depth and detail in relation to decisions and decision-making processes. The findings revealed that although participants shared similar elements in their self-care decision-making, they differed in the perceived meaning and significance of their decisions, depending on disease-specific attributes relating to timeliness, biomarkers, interaction within a social context, the construction of healthy practices, and available relevant information. Findings were analyzed and compared to suggest future directions for research and educational interventions to enhance the quality of self-care decision-making in chronic illness by considering the influence of disease-specific attributes in self-care management.

Adult↗

PubMed2006

Neural basis of quasi-rational decision making.

Standard economic theories conceive homo economicus as a rational decision maker capable of maximizing utility. In reality, however, people tend to approximate optimal decision-making strategies through a collection of heuristic routines. Some of these routines are driven by emotional processes, and others are adjusted iteratively through experience. In addition, routines specialized for social decision making, such as inference about the mental states of other decision makers, might share their origins and neural mechanisms with the ability to simulate or imagine outcomes expected from alternative actions that an individual can take. A recent surge of collaborations across economics, psychology and neuroscience has provided new insights into how such multiple elements of decision making interact in the brain.

Animals↗

PubMed2003

Ethical perspectives on decision-making capacity and consent for treatment and research.

Decision-making capacity for treatment and research raises complex conceptual issues. Given the fact that both considerations of respect for patient autonomy and beneficence/harm prevention have moral relevance in many cases, in the practice of health care the need exists to balance both in a moral responsible way. The moral concept of (mental) capacity or decisional capacity has a role to play in this balancing process. The current dominant approach towards the conceptualization and assessment of decision-making capacity, which focuses on cognition and rationality, has some serious shortcomings. In order to compensate for these shortcomings of the dominant approach, a number of alternative approaches may be promising. A first alternative focuses on issues of emotion and narrative; a second on identity and identification, and a third on dialogue and deliberation. By paying attention to the way in which people interprete their world (not only by cognition, but also by emotion), and how they shape their lives by processes of identification and communication, a broader perspective on capacity assessment in health care can be developed. Above that, these alternative approaches are less focused on the assessment of (in)capacity and more on enabling a person to become more competent through a process of empowerment, participation, and shared decision-making.

Clinical Trials as Topic↗

PubMed2001

Declining the offer of flexible sigmoidoscopy screening for bowel cancer: a qualitative investigation of the decision-making process.

Qualitative methods were used to investigate decision-making among a group of older adults who declined the offer of flexible sigmoidoscopy screening for bowel cancer. Interviews were conducted with 60 people (30 men and 30 women) who either had not responded to the screening letter or who responded saying that they were not interested in participating. The findings suggest that low perceived susceptibility to bowel cancer, in terms of current health status, family history or absence of bowel symptoms. was an important factor in the decision to decline screening. Procedural barriers such as embarrassment, pain/discomfort and perceived unpleasantness of the test were reported as relatively minor, although the test was considered more physically intrusive than other screening tests. Avoidant attitudes emerged as an important theme and were reported by a third of respondents. Distinct patterns of decision-making were also observed and three groups emerged from accounts: (i) forgetting or avoiding making a decision about the test (ii) a confident rejection of the test based on a few salient factors, and (iii) a more careful consideration of the test focusing on issues of susceptibility. The findings are discussed in the context of models of health behaviour and bowel cancer screening participation research.

Colorectal Neoplasms↗

PubMed1995

Revisiting New York State's proposed surrogate decision-making legislation.

More than 2 years have passed since legislation was first proposed in New York to remedy the absence of legal authority for family members who must make important health care decisions for incapacitated loved ones who have left no advance directives. This legislation, the "Family Health Care Decisions Act," included standards for surrogate decision-making and safeguards for surrogate decisions about the use of life-sustaining treatments. This article argues in favor of the legislation and discusses the concerns presented in opposition.

Advance Directives↗

PubMed1997

The Stanford Health Information Network for Education: integrated information for decision making and learning.

Although multiple decision support systems have been built for physicians, efficient delivery of valid and complete medical knowledge remains an elusive goal. In this paper we describe a new project, the Stanford Health Information Network for Education (SHINE). SHINE unifies core medical resources in an intuitive interface to support clinical decision making. Included in the description is a novel paradigm for continuing medical education (CME).

California↗

PubMedDate not supplied

Focussing in reasoning and decision making.

Our principal hypothesis is that reasoning and decision making are alike in that they both depend on the construction of mental models, and so they should both give rise to similar phenomena. In this paper, we consider one such phenomenon, which we refer to as "focussing": individuals are likely to restrict their thoughts to what is explicitly represented in their models. We show that focussing occurs in four domains. First, individuals fail to draw inferences in the modus tollens form: if p then q, not-q, therefore not-p, because they focus on their initial models of the conditional, which make explicit only the case where the antecedent (p) and consequent (q) occur. Second, in Wason's selection task, they similarly tend to select only those cards that are explicitly represented in their initial models of the conditional rule. Third, their requests for information in order to enable them to make a decision about whether or not to carry out a certain action are focussed on the action to the exclusion of alternatives to it. In each of these cases, we show how the focussing bias can be reduced by certain experimental manipulations. Finally, in counterfactual reasoning, focussing underlies individuals' attempts to imagine an alternative scenario that avoids an unfortunate ending to a story.

Adolescent↗