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PubMedDate not supplied

Decision making regarding multifetal reduction.

OBJECTIVE: To identify salient variables that influence decision making regarding multifetal reduction (MFR) and describe their effect on individuals over time. DESIGN: Prospective, exploratory, descriptive design, using qualitative and quantitative methods. SETTING: Midwestern tertiary care center. PARTICIPANTS: A convenience sample of 11 consecutive consenting couples with triplet or higher-order pregnancies who elected to undergo MFR. METHODS: Semistructured audiotaped telephone interviews at three points: (a) 2 weeks postreduction, (b) 6 weeks postpartum, and (c) 6 months postpartum; a demographic and marital adjustment questionnaire. MAIN OUTCOME MEASURES: Themes identified by content analysis and compared via matrix analysis between males and females and at three points in time; trends in marital adjustment. RESULTS: Dominant variables influencing MFR decision making were risks associated with higher-order pregnancies and preservation of infants' and mothers' health. Most participants identified emotional issues, including moral and ethical dilemmas, as the most difficult aspect of reduction. Over time, participants reported feeling more positive about their decision; nonetheless, negative feelings emerged progressively. CONCLUSIONS: Risk aversion favored MFR decision making. Yet, both making and living with the decision were emotionally difficult for this sample. Interventions are needed to assist couples with this decision and its consequences.

Adult↗

PubMed1990

The parents' perspective: ethical decision-making in neonatal intensive care.

Ethical debate abounds in the literature relative to treatment decisions for the high risk neonate in the intensive care nursery. A systematic examination of the parents' perspective is missing. To fill this existing gap, the ethical dimension of care was explored with 32 families of high risk newborns from a Level III nursery, using a moral conflict interview guide in order to describe their perspective. A concept of the medicalization of parenting appears to best reflect the parents' view of ethical decision-making responsibility. This concept evolved through the parents' reflection on conflict naming, content of decision-making, context of decision-making, information sharing and perception of infant status. These concerns differ profoundly from those of health professionals, philosophers, theologians and others active in this debate who cite lower limits of viability, iatrogenic effects of treatment, use of multiple invasive procedures, and the role of paternalism as ethical issues.

Comprehension↗

PubMed2001

Relations between decision-making deficits and discriminating contingencies following brain injury.

Deficits in decision-making characterized by failures to respond adaptively to consequences that follow responding are common following brain injury. To examine decision-making about consequences, individuals with and without acquired brain injury responded under different response-reinforcer contingencies. In two control conditions, reinforcement was contingent on responding and response repetition. Results showed responding (pressing four computer keys) by both groups produced similar amounts of reinforcement (money) and highlight equal sensitivity to money as a reinforcer. In subsequent experimental conditions, reinforcement was contingent upon varying responses. Results showed both groups produced variable response patterns, but injured subjects earned less reinforcement than controls. With instructions to vary responding across trials, injured subjects earned similar amounts of reinforcement as controls. Collectively, the results suggest reductions in sensitivity to contingencies may be present following injury and function as one behavioural mechanism of maladaptive decision-making.

Adult↗

PubMed1999

Involvement in decision-making and breast cancer survivor quality of life.

Advances in treatment for breast cancer have improved women's chances of surviving this disease, while giving patients more treatment options than in the past. This study examined the influence of patient involvement in decision-making on survivor quality of life. A prevalence sample of breast cancer survivors were interviewed about their involvement in decision-making about their cancer treatment and follow-up care. A series of multivariate regression analyses were then conducted to examine how involvement in decision-making about cancer treatment and follow-up care contributed to survivor quality of life. Analyses revealed involvement in decision-making about the use of testing for recurrent disease (TFR) as part of follow-up care is associated with improved quality of life in several domains (p < 0.05). This association of improved quality of life with involvement in decision-making about follow-up TFR was independent of associations of quality of life with surgical treatment received, involvement in decision-making about surgical treatment, frequency of TFR, use of mammography, age, income, education, and years since diagnosis. This suggests that efforts to increase patient involvement in decision-making about follow-up care may improve quality of life for breast cancer survivors.

Aged↗

PubMed1990

[Decision-making in the psychiatric emergency room].

The decision-making process in the emergency room is evaluated in accordance with the literature and our growing experience. Research until now emphasized correlations among different variables, demographic, clinical, and the individuality of clinicians and systems, on the decision to admit. Many subtle and difficult-to-describe variables were not considered in most of the studies; we have tried to describe some of them. There is a place for clinical research in the decision-making process.

Decision Making↗

PubMed2002

The ethical decision making process: a demonstration.

Two issues identified from the scenario have been explored using the Ethical Decision Making Tree. Now look at some of the other issues identified earlier in this article work through the decision-making process using the Ethical Decision Making Tree. In looking at the use of experimental or futile care, what information would you need to gather and analyze? What personal values and moral positions need to be considered? Based on the previous two steps, what are the options? What is your decision and course of action? How are you going to evaluate the action taken to see if it worked or if other actions need to be taken? Remember, the solution is not what is best for you but what is best for the patient at this point of time.

Acquired Immunodeficiency Syndrome↗

PubMed1996

Family and physicians' views of surrogate decision-making: the roles and how to choose.

Physicians and family members were compared on the roles played in surrogate decision-making and their views as to how choices should be made by surrogate decision-makers. Thirty-six family members of patients with Alzheimer's disease, 35 family members of patients with schizophrenia, and 34 physicians from a diversity of specialties were the respondents. There was general agreement that shared decision-making was preferred. Physicians seem to make surrogate decisions in accordance with contemporary views about their roles. Families believed they had a strong subjective appreciation of the patient's overall good. The burden of decision-making was greater for families, but that depended to some degree on the diagnosis of the patient.

Activities of Daily Living↗

PubMedDate not supplied

Validation of numerical ground water models used to guide decision making.

Many sites of ground water contamination rely heavily on complex numerical models of flow and transport to develop closure plans. This complexity has created a need for tools and approaches that can build confidence in model predictions and provide evidence that these predictions are sufficient for decision making. Confidence building is a long-term, iterative process and the author believes that this process should be termed model validation. Model validation is a process, not an end result. That is, the process of model validation cannot ensure acceptable prediction or quality of the model. Rather, it provides an important safeguard against faulty models or inadequately developed and tested models. If model results become the basis for decision making, then the validation process provides evidence that the model is valid for making decisions (not necessarily a true representation of reality). Validation, verification, and confirmation are concepts associated with ground water numerical models that not only do not represent established and generally accepted practices, but there is not even widespread agreement on the meaning of the terms as applied to models. This paper presents a review of model validation studies that pertain to ground water flow and transport modeling. Definitions, literature debates, previously proposed validation strategies, and conferences and symposia that focused on subsurface model validation are reviewed and discussed. The review is general and focuses on site-specific, predictive ground water models used for making decisions regarding remediation activities and site closure. The aim is to provide a reasonable starting point for hydrogeologists facing model validation for ground water systems, thus saving a significant amount of time, effort, and cost. This review is also aimed at reviving the issue of model validation in the hydrogeologic community and stimulating the thinking of researchers and practitioners to develop practical and efficient tools for evaluating and refining ground water predictive models.

Decision Making↗

PubMed2006

The neural implementation of multi-attribute decision making: a parametric fMRI study with human subjects.

Decision making is not a unitary entity but involves rather a series of interdependent processes. Decisions entail a choice between two or more alternatives. Within the complex series of decisional processes, at least two levels can be differentiated: a first level of information integration (process level) and a second level of information interpretation (control level), leading to a subsequent motor response or cognitive process. The aim of this study was to investigate the neural network of these decisional processes. In a single trial fMRI study, we implemented a simple decision-making task, where subjects had to decide between two alternatives represented on five attributes. The similarity between the two alternatives was varied systematically in order to achieve a parametric variation of decisional effort. For easy trials, the two alternatives differed significantly in several attributes, whereas for difficult trials, the two alternatives differed only in small details. The results show a distributed neural network related to decisional effort. By means of time course analysis different subprocesses within this network could be differentiated: regions subserving the integration of the presented information (premotor areas and superior parietal lobe) and regions subserving the interpretation of this information (frontolateral and frontomedial cortex, anterior insula, and caudate) as well as a region in the inferior frontal junction updating task rules.

Adult↗

PubMed1989

Health-care decision making, Part II. Choices for incapacitated patients.

The traditional, informal approach to making medical decisions for incapacitated patients is often inappropriate today. Guidelines are needed in two major areas: assessing incapacity and seeking surrogate decision makers. Judicially declared incompetency does not necessarily imply incapacity to make medical choices. Proposed standards for determining incapacity require a multistep evaluation of the patient's abilities to understand, reason, and communicate. When decisions must be made for an incapacitated patient, priority is given to the patient's previously stated preferences. An advance directive--living will or durable power of attorney--simplifies the process. If no advance directive was prepared, a surrogate decision maker may be designated according to applicable state statutes. Standards are still evolving for protecting the autonomy and best interests of vulnerable, incapacitated patients.

Decision Making↗

PubMed2004

Neuropsychological investigation of decision-making in anorexia nervosa.

Anorexia nervosa (AN) could be considered a form of obsessive-compulsive disorder in which an impairment of the cognitive domain related to decision-making was found. We explored this function in AN patients, as well as possible differences between restricting type and binge/purge type, with the aim of examining the hypothesis that AN is part of the obsessive-compulsive spectrum. Decision-making was assessed in 59 inpatients with AN and 82 control subjects using the Gambling task, which simulates real-life decision-making by assessing the ability to balance immediate rewards against long-term negative consequences. We confirmed the supposed deficit of decision-making in AN. However, restricting and binge eating/purge subtypes showed different patterns of decision-making impairment. Poor performance on the Gambling task is not a mere consequence of starvation and does not appear to be related to illness severity. The decision-making deficiency that some AN patients show is linked to those individual features that contribute to the phenomenological expression of the disorder.

Adult↗

PubMed2005

Obsessive-compulsive behaviour: a disorder of decision-making.

OBJECTIVE: Compulsive individuals are habitually indecisive, and indecision reaches its pathological apex in obsessive-compulsive disorder (OCD). With the increasing interest in the neurobiology of decision-making, it may be useful to conceptualize OCD as a disorder of decision-making. METHOD: A selective review of the neurobiological studies of the decision-making process was performed, and the convergence with the understanding of the neurobiology of OCD examined. RESULTS: The dorsolateral, orbitofrontal and anterior cingulate cortices are engaged in multiregion neural subsystems that interact with each other to retain information online, manipulate options, make choices and maintain goals. These interact with the limbic regions, especially the amygdala, in relation to history of reward and emotional valence relating to a choice, and the basal ganglia for behavioural execution. Abnormalities in these regions also characterize OCD and related disorders, therefore leading to problems in making some decisions that are affect-laden by nature or association. CONCLUSION: Conceptualizing OCD as a disorder of decision-making leads to new approaches for its investigation, and novel strategies for both physical and behavioural-cognitive treatments.

Affect↗

PubMed1990

[Medical decision making: its impact to clinical pathology].

Medical diagnosis is a complex decision making by clinicians, based on three kinds of medical informations; patient's complaints, physical findings and laboratory findings. Among those, laboratory findings are most objective, and more than 1,000 laboratory tests are routinely available at present. It is impossible for a physician to utilize all these medical informations effectively for adequate diagnosis. "Medical decision making" is mandatory for the most effective application of various laboratory tests. Thus, medical decision making is becoming a very important tool for adequate clinical laboratory practice.

Decision Making↗

PubMed2003

Decisional regret and quality of life after participating in medical decision-making for early-stage prostate cancer.

OBJECTIVE: To determine the effect of men's reported levels of involvement in medical decision-making and quality of life (QoL) on their levels of decisional regret after definitive treatment. PATIENTS AND METHODS: Men referred to a hospital-based resource centre completed QoL and decisional-regret measures after definitive treatment for localized prostate cancer. Data from these questionnaires were linked with a previous study conducted to determine if providing individualized information to men newly diagnosed with prostate cancer would lower their levels of psychological distress and enable them to become more active participants in treatment decision-making. The preferred role in medical decision-making and QoL had previously been measured at the time of diagnosis and the assumed role at 4 months after the definitive treatment decision. This postal survey was conducted approximately 18 months after diagnosis. RESULTS: Of 74 men, 67 (91%) responded; the mean (sd) time since definitive treatment was 10.3 (4.7) months and the mean age of the men 62.5 (6.9) years. Radical prostatectomy was the most frequent treatment (72%). Most (94%) patients participated in medical decision-making either actively or collaboratively and did not regret their treatment choice. The type of definitive treatment received had no effect on decisional regret; patients' QoL scores were similar to the levels before treatment. Levels of sexual function were significantly lower after definitive treatment, but urinary incontinence was not significantly affected. Men who had neoadjuvant hormone therapy reported having significantly more treatment-related symptoms. CONCLUSIONS: There is no evidence that providing information to facilitate participation in medical decision-making causes decisional regret or psychological distress within the first year after definitive treatment. A longitudinal follow-up of these patients is required to adequately assess the long-term effects of treatment on QoL and decisional regret.

Adult↗

PubMed2004

Instruments to assess decision-making capacity: an overview.

OBJECTIVE: The main objective of this article is to evaluate and describe instruments for assessing decision-making capacity in psychiatry and psychogeriatrics, and to evaluate them for use in daily practice. METHODS: The instruments were selected in Medline articles. We focus on the relationship between these instruments and the concept of competence, represented in the following elements: context in which an instrument is developed, disclosure of information, standards to assess decision-making capacity, the scale or threshold model, and validity and reliability. RESULTS: The developmental context influences how information is provided and standards defined. Although it is not clear how decision-making capacity relates to competency judgments, most instruments provide good reliability. CONCLUSIONS: Comparison of the different instruments opens directions for future research. Although instruments can never replace a physician's judgment, they may provide a clear starting point for a discussion on competence. In daily practice assessments, attention should be given to information disclosure, the influence of our own normative values in evaluating standards of decision-making capacity, and the relation between decision-making capacity and competence.

Aged↗

PubMedDate not supplied

The application of the heuristic-systematic processing model to treatment decision making about prostate cancer.

The study investigated the utility of the Heuristic-Systematic Processing Model as a framework for the investigation of patient decision making. A total of 111 men recently diagnosed with localized prostate cancer were assessed using Verbal Protocol Analysis and self-report measures. Study variables included men's use of nonsystematic and systematic information processing, desire for involvement in decision making, and the individual differences of health locus of control, tolerance of ambiguity, and decision-related uncertainty. Most men (68%) preferred that decision making be shared equally between them and their doctor. Men's use of the expert opinion heuristic was related to men's verbal reports of decisional uncertainty and having a positive orientation to their doctor and medical care; a desire for greater involvement in decision making was predicted by a high internal locus of health control. Trends were observed for systematic information processing to increase when the heuristic strategy used was negatively affect laden and when men were uncertain about the probabilities for cure and side effects. There was a trend for decreased systematic processing when the expert opinion heuristic was used. Findings were consistent with the Heuristic-Systematic Processing Model and suggest that this model has utility for future research in applied decision making about health.

Adult↗

PubMed2005

Husbands' and wives' reports of women's decision-making power in Western Guatemala and their effects on preventive health behaviors.

Surveys have attempted to measure married women's decision-making power by asking women who has a say and/or final say in a number of household decisions. In several studies where the same questions were posed to husbands, considerable discrepancies in reports were found. This paper assesses husband and wife reports of decision-making on four matters (whether or not to buy household items; what to do if a child becomes ill; whether or not to buy medicine for a family member who is ill; what to do if a pregnant women becomes very ill) and the relationship of these reports to three recent health behaviors (having an emergency plan during pregnancy; delivering in a health facility; having a postpartum checkup within 4 weeks). A sample of 1000 women in 53 communities in three departments of western Guatemala was selected using a stratified random sampling approach. A standard household questionnaire was used to identify the respondents as well as to obtain data on household characteristics. Husbands of interviewed women were interviewed in every other household giving information on 546 couples for this analysis. Women and men's questionnaires were similar and were designed to obtain information on the respondent's knowledge, attitudes and behaviors regarding maternal health. Consistent with other research, results show that relative to their husbands' report, wives tend to under-report their household decision-making power. In couples with both partners educated and in couples in which women work for pay, both partners were significantly more likely to report that both of them participate in the final decisions than was the case in couples without education or in which the wife did not work for pay. Women's reports of their decision-making power was significantly related to the household having a plan for what to do in case of a maternal emergency, but was not associated with place of childbirth or with having a postpartum checkup, while husband's reports of the wife's decision-making power was negatively associated with the likelihood of having the last birth in a health facility.

Adult↗

PubMed2004

[Factors on decision-making participation related to clinical experience difference].

PURPOSE: The purpose of this study was to investigate the relationship between decision-making factors(theoretical knowledge, expertise, empowerment, intuition) and participation in proportion to nurses's clinical experience. METHOD: Data was collected by quota sampling from July 10, 2001 to August 22, 2001 from 132 clinical nurses who work for 3 General hospitals. Data was analyzed using SPSSWIN 10.0 with crosstab, ANOVA, and stepwise multiple regression. RESULT: Expertise(F=34.347, p=.000), empowerment(F=29.316, p=.000), and participation(F=3.276, p=.041) were significantly different among 3 clinical experience groups. Clinical experience correlated with expertise(r=.551, p=.000) and empowerment(r=.492, p=.000), and Decision-making participation also correlated with expertise(r=.351, p=.000) and empowerment(r=.265, p=.002). Decision-making participation is effected by theoretical knowledge(under 3.00 yr clinical experience), expertise(3.01-5.00 yr), and empowerment(above 5.01 yr). CONCLUSION: These findings indicate that factors(theoretical knowledge, expertise, or empowerment) on decision-making participation varies as nurses's clinical experience differs. Therefore, decision-making needs bilateral agreement between staff nurses and nurse managers rather than the responsibility of one.

Adult↗