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At least 1,081 records · Page 60Linked to original sources

PubMed2004

The leap to trust: perspective of cholecystectomy patients on informed decision making and consent.

BACKGROUND: Although experts in ethics and law prescribe autonomous decision making as an essential component of informed consent to operative treatment, patients with esophageal cancer told us in a previous study that they preferred to entrust decision making to their caregivers in the context of life-threatening illness. The purpose of this study was to describe the patients' perspective on the process of informed decision making and consent to operative treatment in the context of a less frightening illness and intervention. STUDY DESIGN: Face-to-face interviews with 33 patients recovering from elective cholecystectomy for cholelithiasis were conducted at Toronto General Hospital in Ontario, Canada. The views of patients were analyzed using a qualitative approach. RESULTS: Patients described a spectrum of initial attitudes toward operative treatment ranging from profound distrust to unquestioning faith. Important factors influencing the decision to accept cholecystectomy included increasingly intolerable symptoms and fear of complications of the disease. Patients managed their doubts and fear by various means, without fully resolving them. CONCLUSIONS: In the context of symptomatic chronic cholelithiasis, pathways to consent for operative treatment originated at diverse, culturally determined starting points. Patients work their way through the decision process along many paths. Some rely on gathering information, but eventually all set aside unresolved residual doubts and fears, enabling a leap to trust and a decision to act.

Adult↗

PubMed1990

The ageing family in crisis: assessment and decision-making models.

The purpose of this paper is to present a multidisciplinary model for use with elderly families in crisis and decision making. The application of systems in family assessment theory is outlined in order to understand the complexities of family assessment and decision making. A schematic family assessment and decision-making model is discussed. These models identify what the problem is, the family structure and supports, and possible interventions and evaluation. Ineffective processing strategies such as regression and premature closure are reviewed, and strategies for effective decision making are outlined.

Adaptation, Psychological↗

PubMedDate not supplied

[Alterations in the decision making processes linked to the ventromedial prefrontal cortex in drug-abusing patients].

INTRODUCTION: The somatic marker hypothesis proposes that somatic signals guide the decision making processes in an adaptive sense for the organism. The processing of these somatic signals is linked to the ventromedial prefrontal cortex activity. The influence of somatic markers on decision making processes has been studied by means of the 'gambling task' (GT). Several studies using the GT in substance abusers have showed the existence of decision making impairments in these patients. AIMS: To examine the performance in the GT of a Spanish sample of substance abusers; and to study the influence of clinically relevant variables: type of substance, years of abuse and abstinence period on GT performance. PATIENTS AND METHODS: 106 substance abusers patients during the dishabituation phase participated in the study. We administered a computerized version of the GT in a single individual session. We used descriptive analyses to study the patients' performance in the GT. Next we carried out multiple regression analyses to study the influence of the clinical variables on the GT performance. RESULTS: A 76.4% of the sample patients showed impairments in the decision making processes measured by the GT. None of the clinical variables significantly predicted performance in the task. CONCLUSIONS: These results suggest the existence of decision making impairments in substance abusers that may be related to pre morbid alterations, or to a neurotoxic effect of drugs of abuse on the activity of the ventromedial prefrontal cortex.

Adaptation, Psychological↗

PubMed2002

[Health care resource allocation in Chile. Ethical considerations in decision making].

BACKGROUND: The inclusion of ethical aspects in the world health care reform is currently being discussed. AIM: To analyze the ethical component of health care decision making in Chile. MATERIAL AND METHODS: A qualitative analysis of interviews with 4 health service directors, 4 public hospital directors and 1 sub director. Inquiries to 16 public hospital ethics committees, about importance of ethical components in decision making, role of ethics committees in financial issues and the feasibility of incorporation explicit ethical considerations in decision making. RESULTS: There is an absence of explicit ethical criteria in decision making. There is little participation of directors in these issues and lack of information. Although ethical aspects are considered relevant, they are not taken into account. Ethics committees are mostly dedicated to evaluate research protocols. The community is not mentioned as a relevant actor in decision making about resource allocation. CONCLUSIONS: Health service directors and all health care personnel should be trained in bioethics. These aspects should be incorporated to their daily work.

Adult↗

PubMed1997

Between knowledge and desire: perceptions of decision-making in the addictive behaviors.

Behavioral change in the addictions is often conceptualized in terms of decision-making. It is argued that there are various problems and ambiguities inherent in the experimental research approach. An exploratory study across a range of dependencies (smoking, excessive gambling, drinking, and eating) is reported. The main aim is to examine personal accounts and views of the decision-making process instead of looking at this indirectly. Qualitative and quantitative evidence from a clinical and general population sample supports the perceived importance of decision-making across the dependencies studied. Such a process is thought to facilitate action and commitment. Firmness of decision in the clinical sample is significantly related to confidence in maintaining change. However, choices or decisions often involve relatively unsystematic processing. Blocks to implementation include unpleasant affect. The importance of understanding the link between affect and decision is emphasized as this is thought to be one of the critical determinants of successful change, yet is rarely explicitly studied. The discussion elaborates on possible ways of integrating decision-making with current clinical practice.

Adolescent↗

PubMed1981

Medical foundations of various approaches to medical-ethic decision-making.

Philosophers have long recognized that the unique values of the individual physician effect medical-ethical decision-making. While not taking issue with this basic assumption, this article critically examines one discussion of how different philosophies (existential, utilitarian, and value realist) can influence a neurosurgeon's decision to operate upon a person having a malignant brain tumor. It also delineates and discusses a fund of "medical wisdom" commonly available to any neurosurgeon and easily obtainable by both researcher and patient. The article suggests that those in the humanities interested in studying the ethical decision-making process in a medical subspecialty become familiar with this fund of knowledge. It can provide a base for evaluating when and how individual medical decisions vary. In this specific instance, the medical knowledge base was used to direct attention to when and how ethical issues are identified and resolved within the staff clinical neurosurgical setting. An informal survey among resident and staff neurosurgeons supported the conclusions that philosophical analyses of medical-ethical decision-making are appreciated when case examples are carefully and accurately documented, when medical terminology is used correctly and when recognition of the practical limits placed on medical decision-making is given.

Decision Making↗

PubMed1998

Breast restoration decision making: enhancing the process.

The purpose of this study was to explore the breast restoration decision-making patterns used by women who opted to have their breast cancer treated by mastectomy. Sixty-four women wearing external breast prostheses and 31 women with breast reconstructions were interviewed. Modified versions of Simon's notion of "bounded rationality" and Janis and Mann's conflict model provided the conceptual scaffolding for the study. Five breast restoration decision-making patterns emerged from the analysis of the interview data: (a) Enlightened (actively seeks information, considers positive and negative aspects, and demonstrates deliberation on the alternatives), (b) Contented (passively accepts minimum information on alternatives because of a preference toward a particular type), (c) Sideliner (uncritically adopts any alternative that is easy and simple to implement), (d) Shifter (gives over the decision to others), and (e) Panic-stricken (can make no rational decision on alternatives). In the prosthesis group, the major pattern used was the Sideliner, and in the reconstruction group it was the Contented. None of the participants used the Enlightened pattern. The data indicated that there was no evidence of active information-seeking behavior or deliberation on the alternatives as part of the women's decision-making process. The findings suggest a need for a registered nurse oncology specialist to be accessible to women during the period when decisions regarding breast restoration are made. This professional has the knowledge to interact effectively with these women and serve as their advocate during the decision-making process. Implications for professional practice and a model for competent breast restoration decision making are presented.

Adult↗

PubMed2003

The structure of everyday self-care decision making in chronic illness.

As health care reform strategists increasingly recognize the critically important potential of effective everyday self-care decision making for reducing the burden of illness and the strain on health service systems, we must find ways to understand and support it. In this study, the authors investigate persons with expertise in self-care management of type 2 diabetes, HIV/AIDS, and multiple sclerosis to understand how everyday self-care decision making is learned and experienced. They used interview, think-aloud, and focus groups to construct an account of how persons affected by these chronic diseases make decisions in relation to the choices in their everyday lives and learn to manage the untoward effects of these conditions according to their unique contexts and values. The findings form a conceptual foundation for ongoing inquiry into this complex phenomenon and provide insights that might assist clinicians to understand more fully the responses and attitudes of those they serve.

Attitude to Health↗

PubMed2003

A qualitative study of clinical decision making in recommending discharge placement from the acute care setting.

BACKGROUND AND PURPOSE: One of the roles of rehabilitation professionals in the acute care setting is making recommendations for patients' discharge placement. The purpose of this investigation was to explore the decision-making process of physical therapists and occupational therapists when recommending discharge destination for patients following acute care hospitalization. SUBJECTS: Participants were 7 physical therapists and 2 occupational therapists in an acute care rotation at a large academic medical center. METHODS: A grounded-theory strategy was used. Three interviews were conducted and guided by questions about participants' approaches to discharge decision making. Information from the interview transcripts was used to define constructs. A model was generated to explain the relationships among the constructs. RESULTS: Decision making regarding discharge recommendations was guided by 4 constructs: patients' functioning and disability, patients' wants and needs, patients' ability to participate in care, and patients' life context. Information was filtered through therapists' experiences and modified by the health care team's opinions and by health care regulations. DISCUSSION AND CONCLUSION: The decision making of the rehabilitation professionals studied in recommending discharge placements for their patients reflects consideration of patients as individuals and the environments in which they live. Information about patients is filtered through the experience of therapists and influenced by health care regulations and opinions of other health care professionals, the patients, and their associates. The findings might be used in teaching clinical decision making to clinicians and students as they learn to make discharge recommendations.

Academic Medical Centers↗

PubMed2006

Decision making under uncertainty in case of soil remediation.

Decisions on soil remediation are one of the most difficult management issues of municipal and state agencies. The assessment of contamination is uncertain, the costs of remediation are high, and the impacts on the environment are multiple. This paper presents a general, transparent, and consistent method for decision making among the remediation alternatives. Soil washing, phytoremediation, and no remediation are exemplarily considered. Multi-criteria utility functions including (a) the cost of remediation (b) the impact on human health and agricultural productivity, and (c) the economic gain after remediation are constructed using probability density functions representing contamination for all site coordinates. Herewith, the probability of different types of (i) correct decisions such as a hit or a true rejection and (ii) erroneous decisions such as a false alarm or miss are examined. The decision theoretic model is applied to a case study on heavy metal contaminated soil. This case study reveals the non-linear structure of multi-criteria-decision making. The case study shows that the geostatistical uncertainties of the log-normal distributed soil contamination must be taken into account: When uncertainties are not considered and the utilities are assessed according to the estimated value for a spatial unit, only few (N=26) spatial units result where the utility score of the alternative soil washing are higher than the utility score to the no remediation alternative. However, when taking into account geostatistical uncertainties of the log-normal soil distribution this number is about ten times greater (N=237). Furthermore, the use of 'maximizing expected utility' as decision rule is critical in that it may lead to a high probability of misses.

Cadmium↗

PubMed2001

Critical analysis of everyday self-care decision making in chronic illness.

AIMS OF THE PAPER: The purpose of the paper is to (1) identify prevalent assumptions that underlie the traditional conceptualization of everyday self-care decision making and (2) contrast these with the findings of relevant research. BACKGROUND/RATIONALE: Current understandings of self-care decision making in chronic illness tend to be extrapolated from knowledge gained in relation to one-time decisions, or decision making in contexts that are only superficially related to the complexity and pervasiveness of living with a chronic disease. FINDINGS: The authors challenge the assumptions with which current understandings represent self-care decision making in chronic illness, using evidence from their research on what it is like to live with and manage the implications of having a chronic disease on an everyday basis. CONCLUSIONS: The paper concludes with a call for a new conceptualization of self-care decision making in chronic illness which sufficiently addresses the unique and complex nature of such decisions.

Adaptation, Psychological↗

PubMedDate not supplied

A topographical model of clinical decision making and interviewing.

A model linking clinical decision making, interviewing skills, and countertransference is presented. It derives from the psychoanalytical topographic model which is hierarchically organized into unconscious, preconscious, and conscious aspects of thought, feeling, and action. This model provides a format for understanding and teaching about physicians' unconscious, unrecognized responses to patients (countertransference), an important determinant of physician learning about clinical decision making and the clinical interview.

Countertransference↗

PubMed1989

The decision-making process in critical care of the aged.

Nurses in a critical care setting are challenged daily to provide safe, effective quality care for elderly patients. The decision process underlying this care is complex because of the amount, diversity, and uncertainty of information that must be processed. Some variables associated with the client, the nurse, and the critical care environment are irrelevant to the decision process, yet continue to influence nurses' decision making. Suboptimal and erroneous diagnoses and interventions may result. Awareness of factors that adversely affect decision making should assist nurses in enhancing their information processing. Use of objective and systematic decision-making techniques also can improve the efficiency and quality of decision making in the critical care of aging people.

Aged↗

PubMed2004

Decision making for physical therapy service delivery in schools: a nationwide survey of pediatric physical therapists.

BACKGROUND AND PURPOSE: A nationwide survey was conducted to explore decision making among school-based physical therapists and to examine recommendations regarding the models, contexts, frequency, and intensity of physical therapy service delivery. Factors that the therapists considered important in making clinical decisions also were examined. SUBJECTS AND METHODS: A survey instrument using a clinical case format was sent to all members of the American Physical Therapy Association's Section on Pediatrics who identified themselves as school-based therapists (N=1,154); 626 respondents, from all 50 states, completed the survey. Four case descriptions were presented in the survey: 2 preschool girls with developmental delay (1 with and 1 without cognitive impairment) and a boy with cerebral palsy (at 6 and 12 years of age). RESULTS: Individual direct services were recommended by 52% to 55% of the respondents for both 4-year-old girls and for the boy at 12 years of age; 92% of the respondents recommended them for the boy at 6 years of age. The most prevalent choice (48%-73%) for the context of service delivery (location or environment) was a combination of integrated and isolated contexts. For those respondents who selected direct services (individual or group, or both), the mean recommended monthly frequency for the boy at 6 years of age (5.8) was more than twice that for the boy at 12 years of age (2.4). The mean suggested direct frequency for the girl with cognitive impairment (4.5) was greater than that for the girl without cognitive impairment (4). The students' functional levels were considered very to extremely important in decision making by 87% to 90% of the respondents. DISCUSSION AND CONCLUSION: Survey responses were relatively consistent with current literature regarding school practice and principles of motor learning. Recommendations varied for each case, regarding the models, contexts, frequency, and intensity of physical therapy service delivery.

Adult↗

PubMed2001

Evidence-based decision making in dental hygiene education, practice, and research.

PURPOSE: The purpose of this article is to highlight key aspects of the white paper prepared in 1999 for the American Dental Hygienists' Association (ADHA) Institute for Oral Health on Evidence-Based Decision Making and its Application to Dental Hygiene Education, Practice, and Research. These aspects include the need for evidence-based decision making, how it supports contemporary practice and education, basic evidence-based concepts, and strategies for integrating evidence-based decision making into dental hygiene. METHODS: A review of the biomedical literature, evidence-based Internet sites and textbooks, and clinical guideline development was systematically conducted to identify models of evidence-based practice, skills needed to practice and teach evidence-based decision making (EBDM), and challenges faced by those implementing an EBDM approach. These resources were then analyzed and synthesized to develop a model for initiating the development of evidence-based dental hygiene practice. RESULTS: The need for using an evidence-based decision making approach was well supported throughout the literature. Consistency was found in how EBDM methodology and levels of evidence were defined and in the skills required for evidence-based practice. Implied in the use of an evidence-based approach were corresponding requirements in three areas: 1) redesigning educational programs to better prepare students and current practitioners to integrate the most current knowledge into their clinical decision-making; 2) conducting research for areas in which evidence applicable to clinical practice is lacking or limited; and 3) designing more effective dissemination tools making relevant research findings more easily accessible and part of every day practice. CONCLUSIONS: Variations in practice patterns, difficulties in keeping current with the scientific literature, and providing students with knowledge, skills, and competencies necessary for contemporary practice are challenges facing the health care professions today, including dental hygiene. To address these problems, an evidence-based approach has been recommended by national organizations. This paper reviews the issues and proposes a model and strategies for engaging dental hygiene clinicians, educators, and researchers in EBDM. Those involved in each area will need training in EBDM concepts and skills before this approach can be fully integrated into education and practice or used to guide research activities. National leadership will be needed to coordinate and prioritize research strategies, promote curricular changes, and improve access to clinically relevant information so that an EBDM approach can become the norm in practice.

Clinical Competence↗

PubMed1985

Rural-urban mobility in Thailand: a decision-making approach.

This paper has analyzed a theoretical model of mobility decision-making. The model relies entirely on individual-level factors rather than macro-level factors as determinants of migration decision-making. The individual-level variables included in the model are: recent mobility history, urban social contacts, information about urban areas, evaluations of different locations, migration plans, and actual movements in the period subsequent to an initial interview. The empirical results indicate that with some exceptions there are relatively strong links of the type suggested in the model among these variables. The model was evaluated separately for two groups of villages for movement to Bangkok and for movement to Northeast Thai towns. Thus, four submodels were estimated, providing an opportunity to observe how robust the model is with respect to varying destinations and origins. Although certain differences are found among the four submodels, the overwhelming feature is their similarity. Where differences do exist, they generally reflect differences in the effectiveness of prior mobility as a predictor of other variables in the process. Clearly, a villager's previous history of movement is a key factor affecting subsequent movement and the entire decision-making process. The primary effect of having friends and relatives in a particular urban center is to increase the amount of information a villager has about that urban center. Information has a significant effect on evaluations and plans. Except in one submodel, evaluations have a significant effect on plans; and the existence of plans--which to some extent represent a culmination of social contacts, information, and evaluations--is the only factor other than previous mobility which has a significant direct effect on subsequent movement. Thai policy makers are searching for ways to stimulate the growth of regional urban growth centers and reduce the growth of Bangkok. From the standpoint of intervention, a key variable in this process would appear to be information. Not only is information level related to evaluations of an urban area and mobility plans, but, compared to other variables in the model, it appears to be relatively amenable to modification by inputs deriving from a source external to the village itself. It appears difficult to modify evaluations or migration plans directly, though both could be indirectly influenced by informational inputs. Movement history would be difficult, if not impossible, to manipulate; while villagers could be sponsored for short trips to town, this is not likely to produce much long-range effect.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed2007

The basal ganglia and cortex implement optimal decision making between alternative actions.

Neurophysiological studies have identified a number of brain regions critically involved in solving the problem of action selection or decision making. In the case of highly practiced tasks, these regions include cortical areas hypothesized to integrate evidence supporting alternative actions and the basal ganglia, hypothesized to act as a central switch in gating behavioral requests. However, despite our relatively detailed knowledge of basal ganglia biology and its connectivity with the cortex and numerical simulation studies demonstrating selective function, no formal theoretical framework exists that supplies an algorithmic description of these circuits. This article shows how many aspects of the anatomy and physiology of the circuit involving the cortex and basal ganglia are exactly those required to implement the computation defined by an asymptotically optimal statistical test for decision making: the multihypothesis sequential probability ratio test (MSPRT). The resulting model of basal ganglia provides a new framework for understanding the computation in the basal ganglia during decision making in highly practiced tasks. The predictions of the theory concerning the properties of particular neuronal populations are validated in existing experimental data. Further, we show that this neurobiologically grounded implementation of MSPRT outperforms other candidates for neural decision making, that it is structurally and parametrically robust, and that it can accommodate cortical mechanisms for decision making in a way that complements those in basal ganglia.

Algorithms↗

PubMed2001

Touch and go: decision-making mechanisms in somatosensation.

A complex sequence of neural events unfolds between sensory receptor activation and motor activity. To understand the underlying decision-making mechanisms linking somatic sensation and action, we ask what components of the neural activity evoked by a stimulus are directly related to psychophysical performance, and how are they related. We find that single-neuron responses in primary and secondary somatosensory cortices account for the observed performance of monkeys in vibrotactile discrimination tasks, and that neuronal and behavioral responses covary in single trials. This sensory activity, which provides input to memory and decision-making mechanisms, is modulated by attention and behavioral context, and microstimulation experiments indicate that it may trigger normal perceptual experiences. Responses recorded in motor areas seem to reflect the output of decision-making operations, which suggests that the ability to make decisions occurs at the sensory-motor interface.

Animals↗