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 973 records · Page 54Linked to original sources

PubMed1996

Individualizing care: family roles in nursing home decision-making.

l. Family members remain fully involved in nursing home decision-making after their relative has been admitted to a facility. 2. Family involvement in nursing home decision-making serves to individualize care and provide a continuing link to the resident's personal history and preferences. 3. Family members assume an array of decision-making roles in nursing homes, including: caregiving, pampering, comforting, engaging, educating, monitoring, mediating, colluding and controlling.

Aged↗

PubMed1988

African migration decision-making process.

Factors affecting the decision to migrate in Africa are reviewed. The author concludes that most migration studies have focused on the individual migrant, whereas migration decision-making in Africa is affected primarily by "the social institutions at local and household levels. Patterns of migration are influenced by the economic and social trends which developed especially since the colonial era." The importance of extended family relationships, agrarian change, forced migration, and restrictive migration policies indicate a need to take a macrolevel approach to the study of African migration.

Africa↗

PubMed1987

Ethics and administrative decision making.

Ethical issues in administrative decision making pose a critical problem for nurse executives in a changing health care environment. A study of all the acute care hospitals in one state reveals an identified ethical component to nursing administrative practice. A description of the study findings includes a discussion of the resources nurse executives use to resolve ethical dilemmas and the implications for practice.

Administrative Personnel↗

PubMed2006

Risky decision making assessed with the gambling task in adults with HIV.

Decision making was assessed using a laboratory gambling task in 67 adults with the Human Immunodeficiency Virus (HIV+) and in 19 HIV-seronegative (HIV-) control participants. Neurocognitive test performance across several domains was also analyzed to examine potential cognitive mechanisms of gambling task performance. As predicted, the HIV+ group performed worse on the gambling task, indicating greater risky decision making. Specifically, the HIV+ group selected more cards from the "risky" or disadvantageous deck that included relatively large payoffs but infrequent large penalties. The control group also selected such risky cards but quickly learned to avoid them. Exploratory analyses also indicated that in the HIV+ group, but not in the control group, gambling task performance was correlated with Stroop Interference performance and long delay free recall on the California Verbal Learning Test, suggesting the role of inhibitory processes and verbal memory in the poorer gambling task performance in HIV. These findings indicate the usefulness of the gambling task as a laboratory tool to examine risky decision making and cognition in the HIV population.

Adult↗

PubMed2004

Women's views of optimal risk communication and decision making in general practice consultations about the menopause and hormone replacement therapy.

Primary care consultations about the menopause and hormone replacement therapy (HRT) involve decision making in the face of clinical uncertainty. This qualitative study used focus groups and semi-structured interviews with primary care patients to explore patients' perspectives of optimal risk communication and decision making, and their views on how to improve its effectiveness. The study was set in two general practices in Cambridge, and the participants were 40 women aged between 50 and 55 years, known to be Current-Users (CU), Ex-Users (EU), or Never-Users (NU) of HRT. The majority of participants favoured communication of risks and benefits to facilitate an informed and personalised choice resulting in informed shared decision making, while some wanted a more directive approach. Women felt that risk communication would be optimised by the provision of unbiased, truthful and summarised information, and also by the personalisation of both this risk information and subsequent management of the menopause and treatment with HRT. Barriers to optimal risk communication and decision making included lack of time, GP attitudes and poor communication in the primary care consultation. In summary, consultations concerning the menopause and HRT involve complex decision making in the face of uncertainty, and most patients favour evidence-based, individualised risk information and shared decision making leading to informed choices. Some patients wish for a more directive approach, and practitioners need to develop skills to evaluate each patient's needs at each consultation.

Attitude of Health Personnel↗

PubMed2005

Patient decision making: strategies for diabetes diet adherence intervention.

BACKGROUND: Patient self-care is critical in controlling diabetes and its complications. Lack of diet adherence is a particular challenge to effective diabetes intervention. The Transtheoretical Model (TTM) of Change, decision-making theory, and self-efficacy have contributed to successful tailoring of interventions in many target behaviors. OBJECTIVE: The purpose of this study was to develop a diagnostic tool, including TTM measures for the stages of change, decisional balance, and self-efficacy, that pharmacists involved in diabetes intervention can use for patients resistant to a diet regimen. METHODS: A questionnaire was developed through a literature review, interviews with diabetic patients, an expert panel input, and pretesting. Cross-sectional implementation of the questionnaire among a convenience sample of 193 type 1 and type 2 diabetic patients took place at 4 patient care sites throughout the southeastern United States. Validated measures were used to collect respondent self-report for the TTM variables and for demographic and diabetes history variables. Social desirability was also assessed. RESULTS: Relationships among TTM measures for diet adherence generally replicated those established for other target behaviors. Salient items were identified as potential facilitators (decisional balance pros) or barriers (decisional balance cons and self-efficacy tempting situations) to change. Social desirability exhibited a statistically significant relationship with patient report of diet adherence, with statistically significant differences in mean social desirability across race categories. CONCLUSIONS: The TTM measures for the stages of change, decisional balance, and self-efficacy are useful for making decisions on individually tailored interventions for diet adherence, with caution asserted about the potential of diabetes patients to self-report the target behavior in a socially desirable manner. Future research directions, implications, and limitations of the findings are also presented.

Decision Making↗

PubMed1996

Reproductive decision-making and determinants of contraceptive use in HIV-infected women.

Perinatal transmission and reproductive decisions of HIV-infected women can be categorized in statistical and epidemiological terms. These reports and figures, however, do little to fully explain the complexities of human relationships, life experiences, personal and cultural influences, and situational and environmental variables that impact on the HIV-infected woman regarding reproductive decision-making. It is only with genuine attempts to understand the woman's perspective and the dynamic and unique variables that influence reproductive decision-making, as well as maintaining a non-judgmental and culturally sensitive perspective, can we hope to assist women, and society as a whole, in coming to terms with the complexities of HIV and reproductive decision-making. Further study is needed to identify factors that influence reproductive decision-making in HIV-infected women. The determinants of contraceptive use regarding demographic factors, barriers to contraceptive use, and factors that contribute to successful contraceptive use in this population must be understood if efforts to reduce the number of unplanned pregnancies are to be successful. More conclusive data are needed on the safety and efficacy of oral contraceptives in HIV-infected women as well as data that describe the effects of longer acting hormonal contraceptives such as levonorgestrel implants (Norplant; Wyeth-Ayerst, Philadelphia, PA) and injectable medroxyprogesterone acetate (Depo Provera; Upjohn Company, Kalamazoo, MI). More research is needed to determine the effects of patient education and counseling and closer follow-up on effective long-term contraception in HIV-infected women.

Contraception↗

PubMed1997

Processes used by nurses to make decisions in the clinical practice setting.

A qualitative study was conducted to examine the processes nurses used to make decisions in actual practice settings. Nurse participants (n = 17) practicing in acute care settings were observed and interviewed to determine the covert cognitive processes that occurred while they were making decisions. Data were analyzed using a constant comparative method. Two decision-making categories emerged: goal-directed process and rule-out process. The goal-directed process was used to reach a goal. The rule-out process involved the development and elimination of hypotheses until only one remained. This process was used to determine what problems existed, the cause of a problem, or the action needed.

Acute Disease↗

PubMed2007

The influence of four serotonin-related genes on decision-making in suicide attempters.

Genetic factors have been associated with the vulnerability to suicidal behavior. We previously reported decision-making impairment in suicide attempters and hypothesized that these cognitive alterations may represent an endophenotype of suicidal behavior. In this study, we aimed to investigate the influence of four serotonin-related genes relevant to suicidal behavior on decision-making, in a large population of suicide attempters. The Iowa Gambling Task was used to assess decision-making in 168 patients with a personal history of attempted suicide. Patients were genotyped for four serotonergic polymorphisms: 5HTTLPR, TPH1 A218C, MAOA u-VNTR, and TPH2 rs1118997. Patients carrying the 5HTTLPR-ll and -sl, TPH1-CC and -AC, MAOA-HH (in women) and TPH2-AA genotypes significantly improved their performance during the task, suggesting a genetic modulation of the learning process required for advantageous decision-making. In contrast, genotypes previously associated with a higher risk of suicidal behavior, a greater sensitivity to the environment and a higher propensity to negative feelings are those conferring poorer learning abilities. We hypothesize that the influence of genetic factors on the vulnerability to suicidal behavior may partly be achieved through their modulation of decision-making and particularly its learning component.

Adolescent↗

PubMed2002

The development of decision-making.

PURPOSE: To describe what is currently known and not known about the development of decision-making skills during adolescence. METHODS: The author provides a definition of competent decision-making, gives a brief overview of the literature on the development of this competence, and describes the kinds of studies that should be conducted in the near future. RESULTS AND CONCLUSIONS: Although the literature is still too sparse to be conclusive at present, the literature as a whole suggests that adolescents may have less decision-making competence than adults in certain areas (i.e., advice-seeking, evaluation processes, adaptive goal-setting, and learning) but may have similar levels of competence in other areas (i.e., knowledge of options in familiar areas, response to certain moderating factors, and making choices in a number of areas). Moreover, age differences in deliberative aspects of competence have not yet been linked to age differences in the tendency to pursue good options, although one recent study did find a possible link between a post-decisional process (i.e., learning from decisions) and age differences in the selection of good options. Additional studies are needed to firm up the tentative conclusions that can be drawn from the extant research and determine which kinds of interventions improve decision-making in adolescents and which do not.

Adolescent↗

PubMed2005

Abnormal frontal activations related to decision-making in current and former amphetamine and opiate dependent individuals.

RATIONALE: There is converging evidence for impairments in decision-making in chronic substance users. In the light of findings that substance abuse is associated with disruptions of the functioning of the striato-thalamo-orbitofrontal circuits, it has been suggested that decision-making impairments are linked to frontal lobe dysfunction. We sought to investigate this possibility using functional neuroimaging. METHODS: Decision-making was investigated using the Cambridge Risk Task during H2(15)O PET scans. A specific feature of the Risk Task is the decisional conflict between an unlikely high reward option and a likely low reward option. Four groups, each consisting of 15 participants, were compared: chronic amphetamine users, chronic opiate users, ex-drug users who had been long-term amphetamine/opiate users but are abstinent from all drugs of abuse for at least 1 year and healthy matched controls without a drug-taking history. RESULTS: During decision-making, control participants showed relatively greater activation in the right dorsolateral prefrontal cortex, whereas participants engaged in current or previous drug use showed relatively greater activation in the left orbitofrontal cortex. CONCLUSION: Our results indicate a disturbance in the mediation by the prefrontal cortex of a risky decision-making task associated with amphetamine and opiate abuse. Moreover, this disturbance was observed in a group of former drug users who had been abstinent for at least 1 year.

Adult↗

PubMed2004

Predictive value of fear avoidance in developing chronic neck pain disability: consequences for clinical decision making.

OBJECTIVE: To improve clinical decision making in posttraumatic neck pain by investigating the additional value of fear-avoidance variables in predicting chronic neck pain disability. DESIGN: An inception cohort with baseline assessment 1 week posttrauma and outcome assessment 24 weeks posttrauma. Predictive factors include pain intensity, Neck Disability Index (NDI), catastrophizing, fear of movement (Tampa Scale for Kinesiophobia [TSK]), and avoidance muscle behavior. SETTING: Hospital emergency department of a general hospital. PARTICIPANTS: A consecutive sample of 90 people reporting of pain in neck or head region after a motor vehicle collision. Eighty-two subjects (91.1%) of the sample provided 24-week follow-up on the outcome. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The NDI assessing physical disability of subjects with neck pain. RESULTS: By using a combination of the baseline NDI and TSK, it appears to be possible to predict chronic disability with a probability of 54.3% (95% confidence interval [CI], 35.2%-72.3%) after entering the NDI (cutoff, 15) as a first test, and with a probability of 83.3% (95% CI, 70.3%-91.3%) after entering the TSK (cutoff, 40) in a second test. CONCLUSIONS: A simple rating of baseline neck pain disability within a week of the trauma, separately or in combination with a test for fear of movement, can be used to predict future outcome. Patients showing fear of movement can be offered an intervention that focuses on reduction of this fear.

Adult↗

PubMed2006

Advanced breast cancer patients' perceptions of decision making for palliative chemotherapy.

PURPOSE: To examine advanced breast cancer patients' perceptions of the key decision-making consultation for palliative chemotherapy. PATIENTS AND METHODS: One hundred two women with advanced breast cancer, who were offered palliative chemotherapy, participated in a study-specific semistructured interview examining perceptions of the information they had received and their involvement in the decision-making process. One hundred seventeen interviews included 70 in relation to first-line chemotherapy and 47 in relation to second-line chemotherapy (15 patients were interviewed in relation to both first- and second-line chemotherapy). RESULTS: Eighty-six percent of patient interviews (n = 101) reported patient satisfaction with the information they received, and 91% (n = 106) reported satisfaction with the decision-making process. Factors most influential in decisions to accept chemotherapy were the possibility of controlling the tumor (45%, n = 53 of patient interviews) and providing hope (33%, n = 28 of patient interviews; 19%, n = 13 being offered first-line chemotherapy v 43%, n = 20 being offered second-line chemotherapy; P = .006). Thirty-eight percent of patient interviews (n = 44) reported the patient as taking an active role in the decision-making process (33%, n = 23 at first-line chemotherapy v 43%, n = 20 at second-line chemotherapy; P = .06). CONCLUSION: Women offered second-line chemotherapy were more likely to undergo chemotherapy because of the hope it offers and were more likely to take an active role in that decision compared with women who were offered first-line chemotherapy. Compassionate and honest communication about prognosis and likelihood of benefit from treatment may help to close the gap between hope and expectation and enable patients to make fully informed decisions about palliative chemotherapy.

Adult↗

PubMed1996

Decision making and risk behaviors of cancer-surviving adolescents and their peers.

The specific aims of this descriptive, comparative study were (1) to compare the decision-making quality and prevalence of risk behaviors (smoking, alcohol consumption, and illicit drug use) between 52 cancer-surviving adolescents and their peers; (2) to compare the relationship of decision-making quality and risk behavior prevalence in a subset of survivors who had a history of therapy with cognitive threat due to late effects of treatment to those without cognitive threat; and (3) to test the hypothesis that the higher the number of quality decision criteria adhered to, the fewer the risk behaviors exhibited by cancer-surviving adolescents. Findings indicated that the majority of teen survivors reported practicing poor-quality decision making for five of the seven criteria (peers, four of seven). There were no significant differences in decision making between teen survivors and their peers nor between survivors with cognitive threat and those without. Peers were significantly more likely to engage in one or more risk behaviors than teen survivors, but comparisons with two normative samples (state and national) revealed that cigarette smoking and alcohol use of the teen survivors were comparable with the general population. There was no significant difference in risk behaviors between survivors with a history of therapy with cognitive threat and those without. Survivors who reported higher adherence to quality decision criteria were less likely to report exhibiting risk behaviors than those with poorer decision making. Using the context of late effects due to cancer treatment, oncology nurses need to provide guidance in quality decision making as well as in risk behavior education.

Adolescent↗

PubMed2001

Adolescent Sexual Decision-Making: An Integrative Review.

PURPOSE: The purpose of this integrative review was to summarize the present literature to identify factors associated with adolescent sexual decision-making. Thirty-eight salient research studies were selected as a basis of this review from the databases of Medline, CINAHL, and Psychinfo using the Cooper methodology. CONCLUSIONS: Two categories of decision-making were identified: 1) The research on factors related to the decisions that adolescents make to become sexually active or to abstain from sexual activity; 2) The research on factors related to contraceptive decision-making. The most consistent findings were that the factors of gender differences, cognitive development, perception of benefits, parental influences, social influences, and sexual knowledge were important variables in the decision-making processes of adolescents. IMPLICATIONS: Practice implications for nursing suggest that clinicians should assess adolescent sexual decision-making in greater detail and address the social and psychological context in which sexual experiences occur. Nurses must be aware of the differences between adolescent and adult decision-making processes and incorporate knowledge of growth and development into intervention strategies. Moreover, to the degree that adolescent sexual decision-making proves to be less than rational, interventions designed to improve competent sexual decision-making are needed.

Journal Article↗

PubMed1985

Occupational ideology and clinical decision-making in British nursing.

As the first phase of a study to assess the usefulness of the nursing process model of nursing practice, a survey was carried out in one health district to ascertain the predominant occupational ideology of clinical nurses, their perception of decision-making about individual patient care in everyday work, and their view of whether they ought to exercise a decision-making role with respect to 23 aspects of patient care. Two hundred ideology scale questionnaires were processed, together with perceived and normative decisions inventories. Subjects were representative of six nursing fields, i.e. general nursing, geriatric nursing, psychiatric nursing, mental handicap nursing, health visiting and district nursing. The main findings were that nurses predominantly espouse a professional ideology, they perceive decision-making to be part of their everyday work and contend that they ought to be able to make decisions in 22 out of the 23 areas of patient care included in the inventories. Differences in ideology between the groups and between men and women are identified and discussed, and some areas of role conflict highlighted. The professional ideology was found to correlate significantly with decision-making and a significant correlation was established between paramedicine and bureaucracy.

Community Health Nursing↗

PubMed1999

Applying a contingency model of strategic decision making to the implementation of smoking bans: a case study.

A model of strategic decision making was applied to study the implementation of worksite smoking policy. This model assumes there is no best way of implementing smoking policies, but that 'the best way' depends on how decision making fits specific content and context factors. A case study at Wehkamp, a mail-order company, is presented to illustrate the usefulness of this model to understand how organizations implement smoking policies. Interview data were collected from representatives of Wehkamp, and pre- and post-ban survey data were collected from employees. After having failed to solve the smoking problem in a more democratic way, Wehkamp's top management choose a highly confrontational and decentralized decision-making approach to implement a complete smoking ban. This resulted in an effective smoking ban, but was to some extent at the cost of employees' satisfaction with the policy and with how the policy was implemented. The choice of implementation approach was contingent upon specific content and context factors, such as managers' perception of the problem, leadership style and legislation. More case studies from different types of companies are needed to better understand how organizational factors affect decision making about smoking bans and other health promotion innovations.

Adult↗

PubMed2003

Decision-making preferences towards surgical intervention in a Hong Kong Chinese population.

BACKGROUND: Economic, social, ethical and legal concerns are motivating changes in western-type health practice to encourage individuals to participate in health-care decisions. Patient participation in health care is perceived to be beneficial because health care is negotiated with the patient so the selected regimen of care is more likely to be acceptable. Hong Kong, in accordance with contemporary trends in other industrialized countries, has adopted a Patient's Charter that outlines patient's rights regarding health treatment and choices. Studies indicate that not all patients wish to take part in decision making about treatment. AIM: To explore the degree to which a Hong Kong Chinese population desired to participate in decision making about surgical intervention. METHOD: 96 participants, 49 surgical and medical patients and 47 students of nursing, participated. Participants were given three hypothetical scenarios: cardiac failure, where major surgery is suggested; cholecystitis, where routine surgery is suggested; and the presence of a benign skin lesion, where minor surgery is suggested. Participants were asked about the degree to which they desired to participate in the decision-making process. There were five choices, ranging from the doctor having full control, to various types of collaborative decision making, to the individual having full control. RESULTS: When the medical condition is not severe, participants desired greater participation in the decision-making process. Younger participants desired greater collaboration with the doctor in decision making while older participants preferred the doctor to have the greater input with respect to decision making.

Adult↗