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PubMed2005

Negotiating responsibility: case studies of reproductive decision-making and prenatal genetic testing in families facing Huntington disease.

Three case studies are presented to further our understanding of how responsibility is negotiated in families when making decisions about genetic risk. These draw on a model of responsibility generated in a study of reproductive decision-making in families facing Huntington disease (HD) to illustrate the impact of prenatal testing on this process. This involves analyzing: how people present themselves as acting responsibly whether or not they utilize genetic testing; who they feel responsible to in their family and elsewhere; the impact that testing has on these relationships; and, how negotiating responsibility changes over time with repeated use of prenatal testing, changing risk status and maturational changes. Two key findings are: how decision-making is perceived can become as important as what is decided; and, how responsibility is negotiated depends on which of these relationships are prioritized. Implications of the findings for clinical practice are noted and suggestions made for further applications of the model.

Adult↗
PubMed2005

Deficits in decision-making in head injury survivors.

Many survivors of head injury suffer chronic personality changes, such as increased impulsivity and a lack of insight and poor judgment. These changes are well recognized and likely to affect the ability to make decisions. However, systematic investigations into their nature have been limited. This study aims to explore the nature of decision making in head injury survivors using a computerized task. Forty-three head injury survivors and a group of 29 matched controls completed the computerized task. The task required participants to make a probability-based choice and to further qualify this choice with an associated "bet." This betting component allows an assessment of the participant's level of confidence in the decision, via the affective evaluation of its possible consequences in terms of points won or lost. The survivors were found to be slow at making the probability- based choice. Whilst at highly favorable odds, the survivors chose the most likely option in a similar manner to the controls, they chose the most likely option less often than the controls at less favorable odds. Examination of the survivors' betting behavior revealed that they responded impulsively compared to controls. This pattern of prolonged decision making and poor quality of decisions is similar to that found in patients with orbitofrontal cortex lesions, whilst impulsive betting has been associated with abnormalities of the dopamine system. These complex deficits in decision making may contribute to difficulties with poor judgment and inhibition in head injury survivors.

Adolescent↗
PubMedDate not supplied

Health information seeking in context: how women make decisions regarding hormone replacement therapy.

This multimethod study explored women's information seeking behaviour and decision making regarding menopause, hormone replacement therapy (HRT), and use of complementary and alternative medicines (CAM) during menopause. This research was underway during the mass media release of the Women's Health Initiative (WHI) estrogen-progestin trial results, allowing an examination of the impact of this news on women's decisions. There were two studies: first, 20 women who currently were or previously had used HRT were interviewed about their experiences with menopause and HRT-related information seeking and decision making. Following this, 285 demographically representative Canadian women aged 45-65 who were current or former HRT users completed a questionnaire. Results indicate that women's information behaviour differed according to which decision they were making (starting versus stopping HRT, considering CAM), as did the sources they consulted. In general, there has been a paucity of good information to help women who are deciding to stop HRT. The types and sources of CAM information often are found to be less than credible and helpful. When information is lacking, women rely on informal sources, and on their own judgement, to make decisions. The results are discussed in the context of information behaviour and help-seeking theory.

Aged↗
PubMedDate not supplied

Fostering decision making in nursing.

Health care organizations have focused on external nursing recruitment incentives such as improved pay scales, greater bonuses, and flexible scheduling. Frequently, they have failed to take into account a fundamental source of professional satisfaction: the opportunity to make decisions. It is important for nurse managers, nurse educators, and clinical nurse specialists to understand the anatomy of the decision-making process, which includes gathering patient data, recalling possible nursing diagnoses and interventions, analyzing, synthesizing, making judgments, and implementing, following through, and evaluating the intervention. More decision making will put more fulfillment into the role of the professional nurse.

Decision Support Techniques↗
PubMed2006

Women's decision making at menopause - a focus group study.

BACKGROUND: Women are faced with a confusion of information and uncertainty when making decisions at menopause. METHODS: We conducted four focus groups of 31 women aged 40-64 years, exploring their experience and views about menopause, its management, and decision support needs. RESULTS: Focus group participants saw menopause as a natural progression rather than a medical condition, and decision making about therapies as a personal responsibility. They wanted reliable, agenda free information, and opportunities to discuss personal needs with (preferably female) health professionals. They preferred minimal intervention and found life style strategies helpful. DISCUSSION: Women's preference to make their own decisions at menopause is frustrated by conflicting information and the perceived marketing agenda of information sources. Women need unbiased, timely, menopause information backed by expert commentary in a range of media to suit their access needs.

Adult↗
PubMed2003

Psychological models of professional decision making.

People are often expected to make decisions based on all of the relevant information, weighted and combined appropriately. Under many conditions, however, people use heuristic strategies that depart from this ideal. I tested the ability of two models to predict bail decisions made by judges in two courts. In both courts, a simple heuristic proved to be a better predictor of judicial decisions than a more complex model that instantiated the principles of due process. Specifically, judges were "passing the buck" because they relied on decisions made by the police, prosecution, and previous bench. Problematically, these earlier decisions were not significantly related to case characteristics. These findings have implications for the types of models researchers use to capture professional decision-making policies.

Criminal Law↗
PubMed2005

Neural systems responding to degrees of uncertainty in human decision-making.

Much is known about how people make decisions under varying levels of probability (risk). Less is known about the neural basis of decision-making when probabilities are uncertain because of missing information (ambiguity). In decision theory, ambiguity about probabilities should not affect choices. Using functional brain imaging, we show that the level of ambiguity in choices correlates positively with activation in the amygdala and orbitofrontal cortex, and negatively with a striatal system. Moreover, striatal activity correlates positively with expected reward. Neurological subjects with orbitofrontal lesions were insensitive to the level of ambiguity and risk in behavioral choices. These data suggest a general neural circuit responding to degrees of uncertainty, contrary to decision theory.

Adult↗
PubMed1999

Effects of prognosis, perceived benefit, and decision style on decision making and critical care on decision making in critical care.

OBJECTIVE: To assess the effects of prognostic estimates, perceived benefit of treatment, and practice style on decision-making in critical care. DESIGN: Randomized assignment of subjects to either of two versions of a questionnaire designed to elicit treatment decisions for six intensive care unit cases based on actual patients. One version offered optimistic survival forecasts; the other, pessimistic forecasts. SUBJECTS: A random sample of 120 clinicians obtained from the Canadian Critical Care Society was contacted by mail. One version of the questionnaire was randomly assigned and mailed to each. Thirty-four replies, 17 for each version (response rate, 28%), were received and analyzed. MEASUREMENTS AND MAIN RESULTS: A list of treatment/management options was developed for each case, in three categories: recommended, questionable, and unacceptable. Subjects were also able to list new options that they would order that were not on the list. The dependent variables were the number of actions ordered in each category and the total for each case. Perceived benefit was measured by comparing subjective estimates of the probability of survival with the optimistic/pessimistic forecast given in the case. Practice style was assessed by correlating the total number of actions ordered across all possible pairs of cases. There were no significant differences between the two questionnaires on actions ordered either by category or by amount per category. Perceived benefit did not appear to be an important factor in decision-making. However, statistically significant correlations provide evidence for practice style in intensive care unit decision-making on an interventionist/noninterventionist dimension. CONCLUSIONS: There is no evidence that erroneous or biased prognostic estimates affect intensive care unit treatment choices. Neither the principle of maximizing expected utility nor the Rule of Rescue appear to affect these decisions systematically, but practice style does.

Canada↗
PubMed1995

Health promotion in primary care: physician-patient communication and decision making about prescription medications.

To examine health promotion in a primary-care context, we studied perceived and actual communication in 271 consultations between general practitioners and patients in Oxford (England). Although health promotion is a term usually reserved for public-health or wellness programs, a health promotion perspective enriches the examination of communication in physician-patient interactions by emphasizing issues of empowerment, competence and control. Accordingly, we are interested in how communication during medical encounters can improve patients' abilities to exercise appropriate control over their health. A major factor in enabling patients to increase control over their health involves developing their competencies for making decisions and enacting behaviors that can lead to desired, and attainable, health outcomes. This report focuses on communication and decision making about prescription medications, since whether and how to use medications are among the most common and important decisions in which patients can participate. Five instruments were employed to collect data about physicians, patients and their consultations: a Video Analysis, which allowed assessment of actual communication behavior; a Patient Questionnaire designed to gauge perceptions of the encounter and collect demographic information; a Medical-Record Review, which provided information on utilization, diagnosis and treatment; a Telephone Interview, conducted 14 days after the consultation to obtain follow-up information (e.g. experience with the prescribed medication); and a Doctor Questionnaire that focused on attitudes toward consultations and patients. With respect to communication about prescription medications, physicians most frequently mentioned product name (78.2% of consultations) and instructions for use (86.7% of consultations). Patients were extremely passive, rarely offering their opinion or initiating discussion about any aspect of the treatment. We suggest that improving patients' decision-making competencies may require more discussion of benefits and risks, as well as discussion of patients' opinions about the prescribed medications and their abilities to follow through with the treatment plans. The research design proved useful in highlighting discrepancies between perceived and actual communication. Physicians tended to overestimate the extent to which they discussed patients' ability to follow the treatment plan, elicited patients' opinion about the prescribed medication and discussed risks of the medication. And, 24.3% of the patients left the consultation with an 'illusion of competence', a belief that important topics had been discussed when, in fact, they had not been mentioned at all. The pattern of results illustrates the complexity of health promotion in primary care, and underscores the importance of attending to both perceived and actual communication in medical encounters.

Adolescent↗
PubMed2002

Punitive damage decision making: the decisions of citizens and trial court judges.

Some states have allocated the authority to determine the amount of punitive damages to judges rather than to juries. This study explored the determination of damages by jury-eligible citizens and trial court judges. The punitive damage awards of both groups were of similar magnitude and variability. The compensatory damages ofjurors were marginally lower but, in some conditions, were more variable than the compensatory damage awards of judges. Both groups appropriately utilized information about both the actual and potential severity of the harm to the plaintiff in determining punitive damages and used only the actual severity of the injury in determining compensatory damages. The punitive damage awards of both groups were influenced by the wealth of the defendant, but the compensatory damage awards of judges were marginally more influenced by defendant wealth than those of citizens. The results are discussed in the context of proposals for punitive damages reform.

Adult↗
PubMed2006

Stop making plans; start making decisions.

Many executives have grown skeptical of strategic planning. Is it any wonder? Despite all the time and energy that go into it, strategic planning most often acts as a barrier to good decision making and does little to influence strategy. Strategic planning fails because of two factors: It typically occurs annually, and it focuses on individual business units. As such, the process is completely at odds with the way executives actually make important strategy decisions, which are neither constrained by the calendar nor defined by unit boundaries. Thus, according to a survey of 156 large companies, senior executives often make strategic decisions outside the planning process, in an ad hoc fashion and without rigorous analysis or productive debate. But companies can fix the process if they attack its root problems. A few forward-looking firms have thrown out their calendar-driven, business-unit-focused planning procedures and replaced them with continuous, issues-focused decision making. In doing so, they rely on several basic principles: They separate, but integrate, decision making and plan making. They focus on a few key themes. And they structure strategy reviews to produce real decisions. When companies change the timing and focus of strategic planning, they also change the nature of senior management's discussions about strategy--from "review and approve" to "debate and decide," in which top executives actively think through every major decision and its implications for the company's performance and value. The authors have found that these companies make more than twice as many important strategic decisions per year as companies that follow the traditional planning model.

Commerce↗
PubMedDate not supplied

Parents' perspectives on decision making after antenatal diagnosis of congenital heart disease.

OBJECTIVE: To discover and describe how prospective parents make decisions when they learn of their baby's congenital heart disease (CHD) during pregnancy, and to provide professionals with direction for their interactions with these families. DESIGN AND METHOD: Qualitative analysis informed by symbolic interactionism. SETTING: A tertiary care women's health center that provided referral services for a province with a population of 4 million. PARTICIPANTS: Mothers and fathers of 19 babies with antenatally diagnosed CHD participated in interviews during pregnancy and after the birth of their baby. Thirty-four interviews were analyzed for common themes and distinguishing characteristics of antenatal decision making. RESULTS: Parents approached their antenatal decisions regarding further testing and continuation of the pregnancy as their first parenting decisions. They made their decisions with differing degrees of apparent ease or deliberation, and some parents more readily sought the opinion of professionals. The offered opinions offended some parents, even though the professionals may have intended the information as descriptive of options, not suggestive of a particular decision. CONCLUSION: Although advances in technology have enabled diagnosis of CHD antenatally, health care professionals, including nurses, must elicit each parent's particular perspective, be cognizant of their professional influence, and actively support parents from the time of the antenatal diagnosis.

Abortion, Therapeutic↗
PubMed2000

Influence of consultation on ethical decision making: an analogue study.

Participants (62 students from 6 doctoral programs in professional psychology) were given 3 ethical dilemmas, asked to generate their own solutions, and asked to make judgments about a number of provided alternatives. Students were asked either to make decisions after seeking consultation or to make decisions independently of consultation. There were few significant between-group differences along a number of dimensions including participants' ratings of acceptability of provided alternatives and levels of certainty, justification, and satisfaction with personally generated solutions. For one of the vignettes, individuals using consultation, when compared with the control group, were significantly more likely to prefer their own solution to that of provided alternatives. The study was viewed as a needed first step in investigating a cherished assumption in clinical practice.

Attitude↗
PubMed1986

Communication and decision-making in a study of a multidisciplinary team conference with the registered nurse as conference chairman.

It was decided that the medical and nursing staff had to communicate verbally concerning the patient's need for information and to make decisions concerning steps to be taken when satisfying the patient's need for information. The aim of this study was, accordingly, to investigate if a training programme for registered nurses as chairperson of the multidisciplinary team conference (MTC) changed the communication and decision pattern during the neurological ward conference. The training material provided instructions and a scheme for the chairperson of the MTC. The training was carried through with the help of patient case reports and role play. Data were collected through tape recordings of the communication at ten MTCs before the training and ten MTCs after the training. The strictly medical communication was less illuminated, while the patient's psychological needs, especially concerning the patient's need for information, were better illuminated than before the training. After the training 42 information problems were reported and two before. For half of them, decisions were made on the steps to be taken in order to fulfil the patient's need. For the other half, the discussion concerning the patient's need for information was communicated between the staff. Only the decision-making was missed.

Communication↗
PubMed2006

The decision to donate: a model of decision making among individuals and families.

Fifty years ago, the first successful kidney transplantation was performed. Since then significant advances in transplantation have been made. Unfortunately, the number of people needing transplants far surpasses the number willing to donate. The literature addresses a plethora of variables influencing whether individuals will become donors themselves or whether family members will donate a loved one's organs. However, to date, no model has examined similarities and differences in the processes by which individuals and families go about making decisions to donate their own or another's organs. In this article, individual and family donation decisions are discussed using Janis' 5-stage model of decision making. We suggest that the weighty nature of donation decisions levels the playing field for decisions made for self and for others. Although the specifics (eg, micro-level) may vary slightly, the processes by which people go about deciding to donate their own organs or those of another individual are similar (eg, macro-level).

Altruism↗
PubMed1990

Decision making of satisfied and dissatisfied married couples.

Ten satisfied and ten dissatisfied married couples described how they make decisions of low, moderate, and high levels of difficulty. Responses were coded as reflecting the use of equity, need-based, situational, or other norms. Results were consistent with previous findings that a state of equity is associated with marital satisfaction but also indicated that multiple norms are used in decision making of both satisfied and dissatisfied couples. Decision difficulty influenced use of both situational and need-based norms. A trend was found for satisfied husbands but not wives, to make greater use of need-based norms than dissatisfied husbands when decisions were high in difficulty. The results are interpreted as supporting a distinction between equity as a state and equity as a process and as supporting an instrumental value theory of norm use.

Adaptation, Psychological↗