PubMed Health⌕ Search

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 91 records · Page 5Linked to original sources
PubMedDate not supplied

Cross-disciplinary communication needed to promote the effective use of indicators in making decisions.

This paper examines problems of assessment and decision-making that result from poor or inadequate communication of indicators among the disciplines of public health, the physical sciences, and economics. The specific examples used are drawn from climate impacts in the Americas although the issues are more general to environmental health. In terms of physical processes, problems arise in confusion about indicators at different steps along the DPSEEA framework of environmental health indicators and general scientific uncertainty about the underlying physical processes. Communication between public health and economics is hindered by a lack of understanding of economic costs used in making decisions and the presence of implicit value judgments in economic analysis. Organizational structures may further inhibit the effective use of indicators. Finally, the paper discusses the Pan American Health Organization proposal to enhance the communication of indicators by using information technology networking to support communication among program managers and decision-makers at the national and local levels. The aim of this initiative is to establish a better environment for making decisions. The problem of cholera in Peru is shown as an example of the need for better communication.

Climate↗
PubMed2007

Decision making process: problem-based decision making.

Clinical problems are often complex. Problems of great complexity are usually associated with a commensurately greater degree of difficulty with respect to the decision making process. This is most certainly true regarding the management of cervical spondylosis. Usually, clinicians make clinically appropriate decisions. However, more often than realized, suboptimal decisions may be made. Therefore, an assessment of the types of errors regarding clinical decision making are worthy of consideration. In this article, a scheme for decision making regarding the management of cervical spondylosis is presented.

Cervical Vertebrae↗
PubMedDate not supplied

When the patient lacks decision-making capacity.

Our society supports the right of its members to be self-determining and to make decisions based on their personal values and beliefs. However, what happens when a person lacks the capacity to make decisions? The author identifies criteria for determining decision-making capacity and discusses the surrogate decision maker, the best interests standard, and the substituted judgment standard. Nursing implications focusing on treating the patient with dignity and respect and protecting the patient's rights are discussed.

Aged↗
PubMed2003

What do patients want? Patient preferences and surrogate decision making in the treatment of colorectal cancer.

PURPOSE: Clinicians often make decisions for their patients, despite evidence that suggests that correspondence between patient and clinician decision making is poor. The management of colorectal cancer presents difficult decisions because the impact of treatment on quality of life might overshadow its survival efficacy. This study investigated whether patients are able to trade survival for quality of life as a means to express their preference for treatment options and to compare their preferences with those expressed by clinicians. METHODS: Patients undergoing curative surgery for colorectal cancer were interviewed postoperatively to elicit their preferences in four hypothetical treatment scenarios. A questionnaire was mailed to all Australian colorectal surgeons and medical oncologists that asked them to respond as if they themselves were patients. RESULTS: One hundred patients (91 percent), 43 colorectal surgeons (77 percent), and 103 medical oncologists (50 percent) participated. In all four scenarios, patients were able to trade survival for quality of life. Patients' responses varied between scenarios, both in willingness to trade and the average amount traded. There were significant differences between patients and clinicians. Clinicians were more willing than patients to trade survival to avoid a permanent colostomy in favor of chemoradiotherapy. Patients' strongest preference was to avoid chemotherapy, more than to avoid a permanent colostomy. CONCLUSIONS: Patients are able to trade survival as a measure of preference for quality of life and can do so differentially between treatment scenarios. Patients' preferences do not always accord with those of clinicians. Unless patients' preferences are explicitly sought and incorporated into clinical decision making, patients may not receive the treatment that is best for them.

Attitude of Health Personnel↗
PubMed1980

The patient's role in clinical decision-making.

Practicing physicians must frequently make decisions about how much they wish to encourage patient participation in clinical decision-making and how to respond to rational patient demands that do not coincide with their own decisions. These are difficult ethical dilemmas with no indisputable or universal solutions. The traditional concept of the doctor-patient relationship places the patient in a passive, compliant role. The patient's only obligation is to seek competent help and cooperate with the physician. A number of factors have contributed to the continued dominance of the traditional doctor-patient imbalance of power. Despite these factors, there seems to be a great deal of public dissatisfaction with health care delivery in the United States; demands for more patient autonomy are increasing. This paper discusses the concept of mutual participation, presents an approach to encouraging patient participation in clinical decision-making, and considers its theoretical advantages.

Decision Making↗
PubMed1997

[Decision making in cardiology: methodology].

This article reviews the methods employed in usual clinical thinking for making decisions, the problems and limitations inherent in them and claims that a more frequent utilization of the so called "Evidence Based Medicine" methods is a more valid and efficient alternative for medical decision making. We also describe the theoretical basis and strategies used in the medical decision process; the specific concepts and basic components for building decision trees are also shown. Finally, a real case is presented and approached step by step: the statement of the decision problem, its possible alternatives, the allocation of probabilities to each outcome based on the best available evidence, and the calculations of the expected values (projected usefulness, cost-effectiveness) and sensitivity analysis by means of specific software for making decisions.

Aged↗
PubMed2004

The concept of futility in health care decision making.

Life saving or life sustaining treatment may not be instigated in the clinical setting when such treatment is deemed to be futile and therefore not in the patient's best interests. The concept of futility, however, is related to many assumptions about quality and quantity of life, and may be relied upon in a manner that is ethically unjustifiable. It is argued that the concept of futility will remain of limited practical use in making decisions based on the best interests principle because it places such high demands on the individual responsible for decision making. This article provides a critical analysis of futility (in the context of the best interests decision-making principle), and proposes an ethically defensible notion of futility.

Australia↗
PubMed2007

Therapy preference and decision-making among patients with severe sickle cell anemia and their families.

BACKGROUND: Patients with severe sickle cell anemia (SCA) may benefit from therapeutic intervention with hydroxyurea (HU), chronic red cell transfusion (CT), or stem cell transplantation (SCT). Determination of best treatment is complicated by the tradeoff between each treatment's risks and benefits and the lack of data comparing them to determine efficacy. We explored factors that influenced making decisions regarding interventions and examined the relations between treatment preference and health-related quality of life (HRQOL). METHODS: Children with severe SCA and their parents received brochures describing each treatment, discussed risk/benefits with a nurse-educator, and answered questions regarding HRQOL and the factors influencing treatment preference. Severe SCA was defined as >or=3 pain events requiring ER visits or hospitalizations within 12 months, >or=2 acute chest syndrome (ACS) events within 24 months, or a combination of the two. RESULTS: Thirty parents and 7 patients participated. HU was preferred by 21 parents and 4 children, CT by 5 parents and 1 child, and SCT by 3 parents and 1 child. One parent was undecided and one child preferred no treatment. Interviewees were most influenced by perceived efficacy and safety, but no factors differed significantly among treatment preference groups. HRQOL median scores (0-100 scale) for parents (56; range, 28-91) and children (61; range, 31-96) did not differ significantly among treatment preference groups. CONCLUSIONS: Patients with severe SCA and their parents can identify their treatment preferences. Improved understanding of their preferences and decision-making process will aid in the design of future clinical trials and in medical decision-making.

Adolescent↗
PubMed2003

How do examiners decide?: a qualitative study of the process of decision making in the oral examination component of the MRCGP examination.

OBJECTIVE: To determine how examiners make decisions about candidates in the oral examination for membership in the Royal College of General Practitioners. DESIGN: Qualitative research using interpersonal process recall interviews with oral examiners immediately following examination of an Medical Research Council General Practitioner (MRCGP) candidate. SETTING: Summer 1999 sessions of the MRCGP examination in Edinburgh and London. PARTICIPANTS: Twenty-six examiners in a convenience sample from the panel of Royal College of General Practitioners (RCGP) oral examiners. RESULTS: Analysis of the transcripts revealed a three-stage process of decision-making consisting of a first impression, followed by a provisional grade and a final grade decision. The examiners used stem questions, exploratory questions and confirming questions during this process. Examiners produced lists of the attributes of successful and unsuccessful candidates, which resembled the grading guidelines provided by the examination committee. Some of the candidates' attributes which influenced the examiners' grading decisions related to personal qualities rather than knowledge or behaviours acquired in vocational training. When examiners were presented with the explanatory model arising from the analysis of the transcripts, they confirmed the validity of the observations. CONCLUSIONS: Decision-making by examiners during oral examinations is a complex process involving initial impressions, hypothesis generation and hypothesis testing. Candidates' knowledge, attitudes and performance influence the final outcome of the examination. Interpersonal process recall is a useful tool for exploring professional communication.

Data Collection↗
PubMed1987

Medical decision making for the incompetent patient.

In America competent adult patients have a right to refuse unwanted medical treatments. For incompetent patients who have made no advance directive, the family ordinarily makes decisions about medical treatments. But in many healthcare facilities, problems arise in choosing a surrogate to make decisions for an incompetent patient and in working with that surrogate. Concrete, step-by-step procedures for resolving conflict are needed. Every effort should be made to have competent patients fill out advance directives or indicate their treatment preferences in the event of loss of competence. Family members may not override decisions made by competent patients, but anyone closely involved with the patients' care may question their competence. The physician generally assesses the patients' competence, but sometimes the courts are involved. The physician may be the appropriate person to choose a surrogate for a patient with limited competence or to make decisions for a totally incompetent patient. The surrogate may be a relative, close friend, physician who knows the patient well, or someone provided by the hospital or government. Treatment decisions are made within the surrogate-patient-physician triad. When different value judgments about the proper treatment conflict, the surrogate may have to mediate to restore physician-patient communication, or institutional proceedings through the ethics committee may be needed to resolve disputes quickly, amicably, and at low cost. As a last resort, the case may be referred to the courts.

Conflict, Psychological↗
PubMed2000

[Decision making: biological bases and limitations].

In the human brain, simple molecules and complex circuits are constantly making decisions which are indispensable for our survival and also to accomplish a variety of daily activities such as walking, memorizing, conversing, composing music, painting or poetry.... All are the result of the integration of many neural systems that perceive many and simultaneous visual, tactile, auditory and/or mental stimuli. Once synthetized, they are immediately transmitted to the corresponding executive systems, thus completing the fascinating functional loop of decision-making: a) perception of stimuli or information which originate in the environment, b) selection and elaboration of the decision which is considered more appropriate or attractive according to personal experience or intuition and c) execution. If these neural nets have been damaged or haven failed to develop the mechanisms of facilitation or inhibition that govern them become unbalanced. If inhibition is reduced, excessive and violent behaviour is expressed as in patients suffering from manic phases. Conversely, if inhibition is excessive, decision making mechanisms are not operative. In either case, behaviour is not "reasonable" and does not follow prototypical patterns. All these processes must be the consequence of a constant molecular activity full of micro-decisions whose effectiveness depends on the histological and biochemical integrity of the neurons. This microenvironment is responsible for all types of decisions of all forms of life and represents one of the fundamental successes of evolution.

Decision Making↗
PubMed2006

Neuroeconomics: cross-currents in research on decision-making.

Despite substantial advances, the question of how we make decisions and judgments continues to pose important challenges for scientific research. Historically, different disciplines have approached this problem using different techniques and assumptions, with few unifying efforts made. However, the field of neuroeconomics has recently emerged as an inter-disciplinary effort to bridge this gap. Research in neuroscience and psychology has begun to investigate neural bases of decision predictability and value, central parameters in the economic theory of expected utility. Economics, in turn, is being increasingly influenced by a multiple-systems approach to decision-making, a perspective strongly rooted in psychology and neuroscience. The integration of these disparate theoretical approaches and methodologies offers exciting potential for the construction of more accurate models of decision-making.

Brain↗
PubMed2005

Trying to do my best as a mother: decision-making in families of children undergoing elective surgical treatment for short stature.

OBJECTIVES: To explore how families make decisions about elective leg-lengthening surgical treatment. DESIGN: Interviews were conducted and analysed using Interpretative Phenomeno logical Analysis (Smith, 1995). METHODS: Data were gathered using semi-structured interviews with nine mothers of children who had recently decided to undergo treatment. RESULTS: Overall, the decision process was guided by the mothers' central concern to act responsibly as a parent. Thematic analysis indicated that the decision was taken in a social context where short stature could lead to discrimination and disability. The decision-making process evolved gradually over several years as mothers and children gathered information about treatment. While mothers emphasized that ultimately it was their child's decision, they monitored the decision process and filtered the information available in an attempt to ensure that the child made a well-informed and wise choice. CONCLUSIONS: The decision was presented as an ongoing process by the mothers, their concerns representing their desire to do their best as parents for their children. Theoretically, the mothers' description of the process can be understood in terms of their attempts to resolve an ethical dilemma. Clinical implications include recognition of the role of the psychologist in supporting mothers in their decision making and thus indirectly helping children.

Adolescent↗
PubMed1997

Care-related decision-making satisfaction and caregiver well-being in families caring for older members.

Families provide care and make decisions regarding care within the context of specific structural characteristics and the broader family environment. This research analyzes data from 244 adult child and spouse caregiver interviews. It examines the impact of structural variables (e.g., caregiver type, elder impairment) and family environment (adaptability, conflict, cohesion) on satisfaction with care-related decision making and caregiver well-being. Regression analysis results indicate that aspects of family environment such as adaptability and conflict are the best predictors of decision-making satisfaction are the best predictors of caregiver depression.

Adaptation, Psychological↗
PubMed2000

Biased information search in group decision making.

Research has shown that people prefer supporting to conflicting information when making decisions. Whether this biased information search also occurs in group decision making was examined in three experiments. Experiment 1 indicated that groups as well as individuals prefer supporting information and that the strength of this bias depends on the distribution of the group members' initial decision preferences. The more group members had chosen the same alternative prior to the group discussion (group homogeneity), the more strongly the group preferred information supporting that alternative. Experiment 2 replicated these results with managers. Experiment 3 showed that the differences between homogeneous and heterogeneous groups reflect group-level processes. Higher commitment and confidence in homogeneous groups mediated this effect. Functional and dysfunctional aspects of biased information seeking in group decision making are discussed.

Adolescent↗
PubMedDate not supplied

[An ethical decision-making tool. Training for decision-making in crisis or end-of-life situations].

We developed a patient-centered decision making tool to help healthcare teams make ethical decisions in crisis or end-of-life situations. This tool is the fruit of 15 years of healthcare experience and discussions on ethical issues with patients suffering from cancer, severe handicaps or terminal disease. It has been enriched by experience acquired since the publication of earlier work in the nineties. A three-step decision-making process is proposed providing a methodic aid for management decisions which remain unique for each individual patient.

Decision Making↗
PubMed2000

The role of male partners in women's decision making regarding hysterectomy.

Although hysterectomy is a frequently performed surgical procedure, little is known about how women make decisions regarding hysterectomy. This report details the women's perceptions of male partners' knowledge and attitudes about hysterectomy and the role women expect or allow men to play in their decision-making process. Seventeen focus groups were conducted with a total of 82 African American and Caucasian women aged 30-65 years in two coastal counties of South Carolina. Transcripts were coded and analyzed using the nonnumerical unstructured data indexing searching and theory building (QSR NUD*IST) software program. Results indicate that women perceive men to be not well informed or knowledgeable about hysterectomy, to be concerned about the quality of sexual relations after hysterectomy, and, in some cases, to be neutral about hysterectomy. African American women reported that men hold more negative perceptions about hysterectomized women. Caucasian women stressed men's inability to understand what a woman is going through and men's concern with the hysterectomy's effect on their own egos. Nonhysterectomized women felt that men would be more bothered by a surgical procedure that left more visible effects (such as mastectomy). These women defined a limited role for men in their decision making regarding hysterectomy, consisting of discussion and offering of support/sympathy, but they reserved the actual decision for themselves. In a few instances, women accorded men a role in the hysterectomy decision based on a religious interpretation of marriage. Intervention programs are recommended that target women and their partners together, using hysterectomized women and their partners as peer educators.

Adult↗