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 1,063 records · Page 59Linked to original sources

PubMed1997

Femoral neck fracture fixation. Clinical decision making.

Femoral neck fractures continue to pose significant decision making problems for the busy practitioner. Indirect factors over which the orthopaedic surgeon has little control include the patient's preinjury medical status, metabolic bone quality, and fracture classification. Direct factors that fall on the decision making ability of the surgeon include surgical timing, capsular hematoma, quality of reduction, and mechanics of fixation. Early, rigid anatomic reduction with 6.5-mm compression screws in patients with few comorbidities will achieve the optimum outcomes using fixation techniques. Anterolateral open approaches afford capsular hematoma decompression and anatomic access for fixation in the young or irreducible fracture pattern.

Bone Density↗

PubMed2004

Making decisions about sexual rights in psychiatric facilities.

Making decisions about sexual activity between residents living in psychiatric facilities is a complex issue. The objectives of this study were to determine staff perception of sexual activity within psychiatric facilities and the prevalence of facilities with sexual policies and sexual education programs in place for residents and staff. Questionnaires were mailed to psychiatric facilities nation-wide. Fifty-seven (60%) facilities had a sexual policy in place. Seventy (69%) of the facilities had sex education programs for staff, and 84 (83%) had sex education programs for residents.

Adult↗

PubMed2004

[Development and validation of assessment instruments for shared decision making].

The German Ministry for Health and Social Security is funding ten projects to introduce shared decision making into clinical practice. The medical problems the projects are focussing on were chosen from among various diseases (e. g. depression, multiple sclerosis, cancer). The ten projects achieved consensus on a core set of instruments for the measurement of process and outcome of the shared decision making. Instruments developed in German-speaking countries are currently not available. Thus, linguistic and cultural validation had to be performed for the core set instruments. The results of the data analysis as well as patient interviews demonstrate the need for improving these instruments. Therefore, the members of the methodological working group concentrated on the integration of these results in a new instrument. In a first step the construct of "shared decision making" was defined, followed by a definition of the process elements characterising shared decision making. Thereafter, items were developed on the basis of the process elements. The new instrument will now be validated for different diseases.

Decision Making↗

PubMed2006

Laparoscopic decision making: impact of preoperative reading and laparoscopic experience.

PURPOSE: A competent laparoscopic surgeon requires good technical skills and good surgical judgment. The assessment of technical skills using bench models and simulators has been well studied. However, there has been a paucity of studies examining the cognitive aspects of surgery. We developed a novel tool to assess the procedural knowledge and higher level decision making required for successful laparoscopic nephrectomy. We assessed the effect of laparoscopic experience and the effect of self-preparation or preoperative reading on surgical decision making abilities using a novel assessment tool and methodology. MATERIALS AND METHODS: A total of 17 novice and advanced urology residents were randomized to preoperative reading or no preoperative reading. Subjects viewed laparoscopic nephrectomy clips and verbalized their thought processes. Their performance was transcribed and blindly rated using a new surgical decision making rating scale. RESULTS: The correlation with overall surgical decision making rating scale score was good for years of training and moderate for the number of laparoscopic cases performed (r = 0.7 and 0.54, respectively, p < 0.05). Preoperative reading did not have a significant impact on the overall surgical decision making rating scale score (p > 0.05). However, when stratified by laparoscopic experience level (fewer than 10 cases), preoperative reading had a significant impact on the performance of novices with respect to the knowledge components of the procedure but not the judgment domain (each p > 0.05). CONCLUSIONS: Overall preoperative reading did not improve the surgical decision making rating scale. Novice procedural knowledge benefited from preoperative reading but not surgical judgment. The surgical decision making rating scale appears promising and it may have future implications for assessing surgical competency.

Clinical Competence↗

PubMedDate not supplied

'Do not attempt resuscitation' decision-making: a study exploring the attitudes and experiences of nurses.

At the time of the research being undertaken, a policy regarding resuscitation decisions did not exist at a local hospital. However, it was proposed that a new 'do not attempt resuscitation' policy should be implemented. Nurses' attitudes to, and experiences of, the communication involved in 'do not attempt resuscitation' decision-making were explored and compared with five variables (nurses' age, nurses' grade, years of nursing, area of nursing practice and length of nursing experience on current ward). Seventy-eight qualified nurses, who made up a convenience sample, participated in the study. An adapted questionnaire was used to explore nurses' attitudes to, and experiences of, 'do not attempt resuscitation' decision-making. The findings suggested that nurses' attitudes did generally concur with the guidelines outlined in the new policy. However, in practice, there were many disparities between nurses' experiences of current 'do not attempt resuscitation' decision-making and the policy's guidelines. There were no significant differences between nurses' attitudes to current 'do not attempt resuscitation' decision-making and the five variables. However, there was one significant difference identified between nurses' experiences and the area of nursing practice (p=0.008). To adhere to the principles of the forthcoming 'do not attempt resuscitation' policy at the local hospital, the research findings have suggested that changes need to occur to both nurses' attitudes to and nurses' experiences of current 'do not attempt resuscitation' decision-making.

Adult↗

PubMedDate not supplied

Institutional decision-making to select patient care devices: identifying venues to promote patient safety.

Many medical errors that involve drug infusion devices are related to classic interface problems. Although manufacturers are becoming increasingly aware of human factors design considerations, many devices that are currently on the market are still sub-optimal for human use. This places significant responsibility for device selection on institutional purchasing groups. Theories of naturalistic decision-making point to many potential strengths and pitfalls of group decision-making processes that may affect the final outcome. This paper describes a retrospective analysis of decision-making process for infusion pump selection in a large hospital and focuses on factors related to patient safety. Through a series of detailed interviews and a study of relevant documentation we characterized the nature of the decision-making, patterns of communication, and the roles of different participants. Findings show that although the process involves a number of different professional groups and committees, the information flow among them is restricted. This results in inadequate representation of critical device usability considerations in the decision-making process. While all participants view device safety as an important consideration in the selection process, administrators (who are the final decision-makers) tend to equate safety with technical accuracy and reliability, paying less attention to the role of human factors in safe device use. Findings suggest that collaborative communication technology and automated evidence-based guidelines could provide support to institutional decision-making, ensuring that the process is efficient, effective, and ultimately safe for the patients.

Decision Making, Organizational↗

PubMed1993

Flight leads and crisis decision-making.

Flight leads of fighter aircraft are typically considered to be superior airmen. However, little research has explicitly studied the decision-making ability of flight leads. In this study, the crisis decision-making of pilots in the role of flight lead is examined. Data from 156 fighter aircraft mechanical breakdown mishaps are used to compare the decision-making of flight leads to that of wingmen. The results suggest decision-making performance of flight leads is significantly inferior to wingmen. Further, we demonstrate this effect of flight leadership only affects experienced pilots, not inexperienced pilots. Explanations for this counter-intuitive finding include stress, training practices, and communication limitations.

Accidents, Aviation↗

PubMed1993

Unsafe sex: decision-making biases and heuristics.

This paper suggests that continued high-risk behavior is the result of the heuristics used to make judgments under uncertainty, and that the same heuristics may be mobilized to increase the use of safer-sex practices. In order to explain why it is that individuals fail to make effective use of the information they may have concerning rates of infection, consequences of infection and their own at-risk status, theory and research in several areas will be considered. Developments in the breadth of areas to which basic research on decision-making has been applied continue to provide new approaches toward understanding and overcoming the processes by which we reason (Kahnemann, 1991). It is worth reminding ourselves that public health campaigns in other areas have led to changes in behavior. Reasoning, even with its biases, is still the route by which we make decisions, most of them effective and self-protective.

Acquired Immunodeficiency Syndrome↗

PubMed1990

The teaching of decision-making process to nurses working in hospital.

The study examines how systematic teaching of nursing decision-making process can develop nurses' decision-making in practice. The study was carried out as action research. Teaching lasted five months. The subjects were measured by many methods at the beginning and at the end of the study. The results showed that by systematic teaching nurses can learn the identifying and understanding of decision-making process as separate from the organisational factors in the work environment. The utilisation of this knowledge in nursing practice presupposes the support of the work environment.

Clinical Nursing Research↗

PubMed2000

Decision making and depressive symptoms in black and white multigenerational teen-parent families.

This study investigated correlates of depressive symptoms among 56 (30 Black and 26 White) low-income, coresiding teenage mothers and their mothers (referred to as grandmothers). Racial differences in teenage mothers' and grandmothers' reports of decision making and depressive symptoms and in the association of decision making with depressive symptoms were explored. Racial differences in levels of depressive symptoms emerged for grandmothers but not for teens. There were no significant differences in levels of decision making; however, the relation of decision making to depressive symptoms differed by racial group. Among White families, greater teen participation in decision making was negatively associated with teenage mothers' depressive symptoms. Among Black families, the opposite was found. A similar pattern of effects was observed for grandmothers.

Adolescent↗

PubMed2005

Countering the negative effects of job insecurity through participative decision making: lessons from the demand-control model.

This study examined the effectiveness of increased organizational participative decision making in attenuating the negative consequences of job insecurity. Data were collected from 807 employees in 6 different companies. Analyses suggest that job insecurity is related to lower coworker, work, and supervisor satisfaction and higher turnover intentions and work withdrawal behaviors. However, employees with greater participative decision-making opportunities reported fewer negative consequences of job insecurity compared with employees with fewer participative decision-making opportunities. Results are interpreted using the demand-control model and suggest that organizations that allow greater employee participative decision making may experience fewer negative side effects from today's rising levels of employee job insecurity.

Adolescent↗

PubMed2002

Use of risk assessment and life cycle assessment in decision making: a common policy research agenda.

Quantitative risk assessment (RA) and life cycle assessment (LCA) are both analytical tools used to support decision making in environmental management. They have been developed and used by largely separate groups of specialists, and it is worth considering whether there is a common research agenda that may increase the relevance of these tools in decision-making processes. The validity of drawing comparisons between use of the tools is established through examining key aspects of the two approaches for their similarities and differences, including the nature of each approach and contextual and methodological aspects. Six case studies involving use of each approach in public decision making are described and used to draw out concerns about using RA and LCA in this context. The following categories of concern can be distinguished: philosophical approach of the tools; quantitative versus qualitative assessment; stakeholder participation; the nature of the results; and the usefulness of the results in relation to time and financial resource requirements. These can be distilled into a common policy research agenda focusing on: the legitimacy of using tools built on a particular perspective in decision making; recognition and role of value judgments in RA and LCA; treatment of uncertainty and variability; the influence of analytical tools in focusing attention on particular aspects of a decision-making situation; and understandability of the results for nonspecialists. It is concluded that it is time to bring together the experiences of RA and LCA specialists and benefit from cross-fertilization of ideas.

Decision Making↗

PubMed1999

Decision-making for percutaneous endoscopic gastrostomy among older adults in a community setting.

OBJECTIVE: To describe clinical decision-making for percutaneous endoscopic gastrostomy from the perspective of patients, caregivers, and physicians. DESIGN: A prospective cohort study. SETTING AND PATIENTS: All patients aged 60 and older receiving percutaneous endoscopic gastrostomies in a defined community over a 16-month period. MAIN OUTCOMES MEASURES: Either patients or their surrogate decision-makers completed a semistructured face-to-face interview to map out the information gathering process, expectations, and discussants involved in the decision to proceed with gastrostomy feeding. Physicians completed a written questionnaire to determine their likelihood of recommending percutaneous endoscopic gastrostomy, their involvement in the decision-making and recommendation process, and sources of perceived pressure in the decision-making. RESULTS: We identified 100 patients who received percutaneous endoscopic gastrostomy during the study window and 82 primary care physicians who provided care in the defined community. The most common reasons for the procedure were stroke, neurologic disease, and cancer. Patients or their surrogate decision-makers reported multiple discussants, incomplete information, and considerable distress in arriving at the decision to proceed with artificial feeding. This distress was usually in the context of an acute and debilitating illness that often overshadowed the decision about artificial feeding. The decision for gastrostomy often appeared to be a "non-decision" in the sense that decision-makers perceived few alternatives. Physicians also reported considerable distress in arriving at recommendations to proceed with percutaneous endoscopic gastrostomy, including perceived pressures from families or other healthcare professionals. Physicians have clear patterns of triage for percutaneous endoscopic gastrostomy, but the assumptions underlying these patterns are not well supported by the medical literature. CONCLUSIONS: Patients, caregivers, and physicians are often compelled to make decisions about long-term enteral feeding under tragic circumstances and with incomplete information. Decision-makers typically do not perceive any acceptable alternatives. Because data on these patients' long-term functional outcomes are lacking, decision-makers appear to focus primarily on the short-term safety of the procedure and the potential for improved nutrition.

Aged↗

PubMed2006

Evaluation and ethical review of a tool to explore patient preferences for information and involvement in decision making.

AIM: To improve clinical and ethical understanding of patient preferences for information and involvement in decision making. OBJECTIVES: To develop and evaluate a clinical tool to elicit these preferences and to consider the ethical issues raised. DESIGN: A before and after study. SETTING: Three UK hospices. PARTICIPANTS: Patients with advanced life-threatening illnesses and their doctors. INTERVENTION: Questionnaire on information and decision-making preferences. MAIN OUTCOME MEASURES: Patient-based outcome measures were satisfaction with the amount of information given, with the way information was given, with family or carer information, and confidence about future decision making. Doctor-based outcome measures were confidence in matching information to patient preference, matching family or carer communication to patient preference, knowing patient preferences and matching future decision making with patient preference. RESULTS: Of 336 admissions, 101 patients (mean age 67.3 years, 47.5% men) completed the study (control, n = 40; intervention, n = 61). Patient satisfaction with the way information was given (chi2 = 6.38, df = 2, p = 0.041) and family communication (chi2 = 14.65, df = 2, p < 0.001) improved after introduction of the tool. Doctor confidence improved across all outcome measures (all p values < 0.001). CONCLUSIONS: Patient satisfaction and doctor confidence were improved by administering the questionnaire, but complex ethical issues were raised by implementing and applying this research. The balance of ethical considerations were changed by advanced life-threatening illness, because there is increased risk of harm through delivery of information discordant with the patient's own preferences. The importance of truly understanding patient preferences towards the end of life is highlighted by this study.

Attitude of Health Personnel↗

PubMedDate not supplied

Patient decision-making behavior: an emerging paradigm for nursing science.

BACKGROUND: As healthcare technology and medical therapies proliferate, healthcare providers have more options to offer and patients have more options from which to choose. Active patient participation in healthcare decision making is a relatively new phenomenon that has been born of sociocultural, ethical, and legal influences. Patients, however, often find healthcare decisions bewildering, stressful, and anxiety-provoking. OBJECTIVES: The purpose of this review is to provide a framework for those interested in pursuing patient decision-making investigations and suggest ways in which current knowledge can be extended to develop a scientific platform upon which to build decision support interventions. METHOD: Literature review. DISCUSSION: This review (a) provides a context for understanding patient decision making; (b) explicates the state of the science of patient decision making; (c) identifies significant theoretical, methodological, and measurement issues; and, (d) identifies gaps in patient decision-making knowledge and propose areas for further investigation.

Decision Making↗

PubMed1989

A patient with new Q waves: methods for decision making in the individual patient.

Decision analysis, an analytic approach to making decisions when uncertainty is present, has its foundation in probability and utility theory. It provides insights into the trade-offs that are involved when a selection must be made among patient management strategies. In general, several broad steps are involved. The process begins by formulating the clinical problem as a well focused choice among a limited set of clinical etiologies. These strategies are then structured explicitly in a model that depicts the clinical events that may ensue from each option. By assigning probability values to each outcome, the weighted average outcome or expected utility can be calculated for each alternative strategy. The strategy with the highest expected utility is the optimal one. The methods of decision analysis offer a number of distinct advantages. These include: 1) providing a structure with which to simplify and focus clinical dilemmas; 2) providing a forum for discussing clinical reasoning; and 3) developing a consensus among groups of decision makers.

Aged↗

PubMed2005

Informed decision making in the context of prenatal screening.

OBJECTIVE: This study aimed to construct a measure of informed decision making that includes knowledge, deliberation, and value-consistency, and to assess the level of informed decision making about prenatal screening, and differences between test acceptors and test decliners. METHODS: Women attending one of 44 midwifery and gynaecology practices were asked to fill out postal questionnaires before and after the prenatal screening offer. The principal outcome was the level of informed decision making. For this purpose, knowledge about prenatal screening, deliberation about the pros and cons of the alternatives, test uptake, and attitude towards having a prenatal screening test were measured. RESULTS: Eighty-four percent of the participants were sufficiently knowledgeable about prenatal screening, 75% of the decisions were deliberate, and 82% were value-consistent. Fifty-one percent of the participants made an informed decision. Test acceptors made less informed decisions as compared to test decliners. This difference was mainly caused by the lower rate of deliberation in this group. CONCLUSION: It appears from this study that prenatal screening decisions are often not informed decisions. This is inconsistent with the main objective of offering screening, which is to enable people to make informed decisions. PRACTICE IMPLICATIONS: Decision makers should be encouraged during the counselling to deliberate about the various alternatives.

Algorithms↗

PubMed2000

Evaluation of a distance education course in students' decision-making and beliefs about careers.

To assess the influence of a distance course on careers in students' career decision-making and beliefs, 178 distance education college students in the Open University in Taiwan completed the Career Decision Scale, the Career Beliefs Checklist, and a demographic sheet. Unlike most prior research, the course was not associated with career decision-making and beliefs of the students, but students mentioned that career beliefs influenced their decision-making. Three-way multivariate analysis of covariance showed a main effect for age groups on career indecision. On a follow-up questionnaire to which 143 of the same subjects responded, the students indicated their concern about specific factors in career decision-making. The research findings have important implications for the redesign of the career education course for adults and for research.

Adult↗