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 127 records · Page 7Linked to original sources

PubMed2002

Making decisions about treatment for localized prostate cancer.

OBJECTIVE: To describe the decision-making processes used by men diagnosed with localized prostate cancer who were considering treatment. PATIENTS AND METHODS: Men newly diagnosed with localized prostate cancer from outpatient urology clinics and urologists' private practices were approached before treatment. Their decision-making processes and information-seeking behaviour was assessed; demographic information was also obtained. RESULTS: Of 119 men approached, 108 (90%) were interviewed; 91% reported non-systematic decision processes, with deferral to the doctor, positive and negative recollections of others' cancer experiences, and the pre-existing belief that surgery is a better cancer treatment being most common. For systematic information processing the mean (sd, range) number of items considered was 4.19 (2.28, 0-11), with 57% of men considering four or fewer treatment/medical aspects of prostate cancer. Men most commonly considered cancer stage (59%), urinary incontinence (55%) and impotence (51%) after surgery, and low overall mortality (45%). Uncertainty about probabilities for cure was reported by 43% of men and fear of cancer spread by 37%. Men also described uncertainty about the probabilities of side-effects (27%), decisional uncertainty (25%) and anticipated decisional regret (18%). Overall, 73% of men sought information about prostate cancer from external sources, most commonly the Internet, followed by family and friends. CONCLUSIONS: In general, men did not use information about medical treatments comprehensively or systematically when making treatment decisions, and their processing of medical information was biased by their previous beliefs about cancer and health. These findings have implications for the provision of informational and decisional support to men considering prostate cancer treatment.

Adult↗

PubMed2002

Applying evidence and theory to guide clinical decision making--implications for asthma management.

Evidence-based medicine has been described as the "conscientious, explicit and judicious use of current best evidence in making decisions about the healthcare of individual patients". Many sources of information may be used by doctors when making decisions about initiating asthma therapy. These include: personal experience, postgraduate education, continuous professional development and publications in peer-reviewed journals. However, despite these sources of information, available data suggest that it is often difficult to practice evidence-based medicine, particularly in general practice. In the future, physicians will be provided with better evidence of the relative efficacy of treatment to aid changes in clinical practice. This will be provided, in part, by large well-conducted clinical trials, systematic reviews and meta-analyses. Linked with these, will be other methods of presenting data, for example, the number of patients needed to treat (NNT) to prevent one clinically significant event (for example, an asthma exacerbation). Despite these advances, incorporation of evidence-based practice into routine asthma care will be a slow and complex process. However, this process can be facilitated by physician education and participation in intervention programmes. In addition, it is important that clinicians are trained in how to convey the best possible evidence to their asthma patients.

Asthma↗

PubMed1995

Do childbirth classes influence decision making about labor and postpartum issues?

This study investigated the role of childbirth education for women attending the Royal Women's Hospital Family Birth Center, Melbourne, Australia, in relation to making decisions about breastfeeding, pain medication, and length of hospital stay. Fifty-nine primiparous women completed a questionnaire after delivery about the influence of childbirth education classes on their decisions during pregnancy, birth, and the postnatal period. The results indicated that although the women enjoyed childbirth education classes, the information they received had minimal effect on their decision to breastfeed and the appropriateness of a 24-hour stay. Information gained about the use of pain medication in labor was clearly helpful when women made decisions about pain relief. Educational strategies have failed to address the tendency of nulliparous women to postpone making decisions about the postnatal period such as early discharge, and further investigation on this aspect of a childbirth education program is suggested.

Adolescent↗

PubMed2000

Overview of women's decision making regarding elective hysterectomy, oophorectomy, and hormone replacement therapy.

Over 600,000 hysterectomies are performed each year in the United States, the majority of which are to improve quality of life for perimenopausal women. Hysterectomy rates for common conditions differ between African American and white women, and African American women undergo surgery at a younger age for most diagnoses. Many hysterectomies are accompanied by elective oophorectomy, and hormone replacement therapy (HRT) is commonly used, especially among women experiencing surgical menopause, despite questions about its long-term benefits and risks. Despite the high rates of hysterectomy in the United States, little is known about how women make decisions regarding this surgery and, in particular, how ethnic and cultural factors may influence these decisions. This article provides a review of what is currently known about the epidemiology of hysterectomy, oophorectomy, and HRT use and identifies gaps in knowledge about women's decision making, with a special focus on ethnic variations and cultural influences, issues addressed by the Ethnicity, Needs, and Decisions of Women (ENDOW) project.

Cultural Characteristics↗

PubMed2005

[Decision making and executive function in severe traumatic brain injured patients: validation of a decision-making task and correlated features].

OBJECTIVE: At the chronic stage, severe traumatic brain injured (TBI) patients experience difficulty in making decisions. Several studies have demonstrated the involvement of the prefrontal cortex, in particular the orbitofrontal region, in decision-making. The aim of the present study was to validate a decision-making task in this population and to ascertain whether the components of their dysexecutive syndrome may affect their decision-making and lead to difficulties for social rehabilitation. PATIENTS AND METHODS: Fifteen TBI patients and 15 controlled subjects matched for age, sex and years of education were assessed by a battery of executive tests (GREFEX) and by the gambling task (GT). RESULTS: The TBI subjects performed significantly worse than the controlled group in five out of six GREFEX tests. The TBI choices are significantly more disadvantageous than the choices of the control group when considering the three last blocks of 20 cards of the GT. The GT total score correlated significantly with execution time of the Stroop interference condition and the Trail Making Task B, as well as with the two measures (correct sequence span and number of crossed boxes) of the double condition of Baddeley's task. CONCLUSION: We postulate that executive functioning (supervisory attentional system) influence performance in the gambling task through mechanisms of inhibitory control, divided attention and working memory. Thus, this task seems to be determined by multiple factors; the process of decision-making may depend on frontal integrity.

Adult↗

PubMed1982

Discharge planning and decision making.

Current advances in discharge planning have focused on comprehensive assessment, levels of care, and reducing the length of hospital stays. However, evidence also indicates the importance of involving patients and their families in making decisions about long-term care. This article identifies nine factors related to the patients' involvement in decision making.

Aged↗

PubMed2003

Making decisions about hazardous waste remediation when even considering a remediation technology is controversial.

This paper investigates the circumstances under which proposed hazardous waste remediation technologies are socially acceptable, that is, considered seriously as options in a public arena. First, it summarizes a conceptual framework that guides investigation and interpretation of site-specific remediation decision-making. Second, it describes an initial application of that framework to the public participation venue of U.S. DOE Site-Specific Advisory Boards. Investigating the attributes of involved parties and of site context highlights technology acceptability as social decision-making that involves technical and technological issues rather than as a process driven by the technology itself.

Decision Making↗

PubMed1990

Research in patient and family decision making regarding life sustaining and long term care.

Involving patients in making decisions about their medical treatment and health care is a widely accepted goal. Yet there is considerable debate about what constitutes effective involvement, how much involvement is desirable, what are the benefits of involvement and how practitioners can help patients recognize and communicate their own preferences. Recent research on patient and family decision making processes provide some answers to these questions. These studies also point to key areas for future research on these issues.

Comprehension↗

PubMedDate not supplied

Organizing your practice for success: vision setting, decision making, governance, and communications.

The ability to make decisions, commit to a plan, and move forward is often the Achilles heel of a medical group. With dramatic changes in the health-care environment, physicians and medical groups are no longer insulated from external forces or the need for good business practices. This article addresses a number of steps that medical practices can use to improve their long-term success: developing an agreed-upon "vision" for the practice, establishing a sound decision-making process, putting into place an effective practice governance structure, and taking steps to improve the efficiency and effectiveness of group meetings.

Communication↗

PubMed2006

Patterns of reasoning and decision making about condom use by urban college students.

HIV infection rates are rapidly increasing among young heterosexuals, making it increasingly important to understand how these individuals make decisions regarding risk in sexual encounters. Our objective in this study was to characterize young adults' safer sex behaviour and associate this behaviour with patterns of reasoning, using cognitive, information processing methods to understand the process of sexual risk taking. Sixty urban college students from NYC maintained diaries for two weeks and then were interviewed regarding lifetime condom use and sexual history. Using cognitive analysis, we characterized four patterns of condom use behaviour: consistent condom use (35.0%), inconsistent condom use (16.7%), shifting from consistent to inconsistent condom use (35.0%), and shifting from inconsistent to consistent condom use (13.3%). Directionality of reasoning (i.e. data-driven and hypothesis-driven reasoning) was analysed in the explanations provided for condom use decisions. The consistent and inconsistent patterns of condom use were associated with data-driven heuristic reasoning, where behaviour becomes automated and is associated with a high level of confidence in one's judgment. In the other two patterns, the shift in behaviour was due to a significant event that caused a change in type of reasoning to explanation-based reasoning, reflecting feelings of uncertainty and willingness to evaluate their decisions. We discuss these results within the framework of identifying potentially high-risk groups (e.g. heterosexual young adults) as well as intervention strategies for risk reduction. Further, our findings not only identify different patterns of condom use behaviour, but our investigation of the cognitive process of decision-making characterizes the conditions under which such behaviour and reasoning change.

Adult↗

PubMed1996

Cognitive fatigue and complex decision making under prolonged isolation and confinement.

Cognitive fatigue and subjective state were assessed in four healthy subject (three males and one female), confined for a period of 60 days in a hyperbaric chamber stimulating a space station environment. They were required to carry out daily a working memory/decision-making test, simulating the management of the levels of contaminants present in a spacecraft atmosphere. Information about a set of contaminants is presented on a 'reference screen.' This has to be memorized, then used to make decisions about the need for corrective action across a sequence of four 'status screens.' Subjects may check back to the reference information at any time. A low error rate was emphasized in the instructions and training. In addition to error rate, performance was also measured in terms of the time taken to make decisions and checks of reference screens (decision time and check time). Subjective measures were also made of workload and environmental resources (personal control and support), levels of anxiety and fatigue before the task, and cognitive effort expended during the task. The search for decrements during the second half of the isolation period was complicated by evidence of a continued learning process during the first half, probably because of insufficient practice before isolation. Learning curves (negative exponential functions) were fitted to the data points for the first half of the isolation period, and residuals between predicted and observed data for the second four weeks were analyzed. All subjects showed increases in decision time and check time during the last weeks of isolation, with one subject also showing an increase in errors. Workload levels were reported as moderate, but varied across the four subjects, The same was true for resources. Anxiety was low and relatively stable over the entire 60-day period, but fatigue levels were elevated during the second half. This was particularly true for the two subjects who maintained the required low error rate. Effort was also quite stable, through it tended to follow changes in work demands and fatigue. Individual subjects are seen to adapt to the stress of prolonged isolation in different ways. Two subjects maintained low error rates under increasing subjective demands by additional cognitive effort and slowing of performance. The other two subjects exhibit more widespread decrement, including high error rates, without increase in subjective demands. The analysis of individual patterns of adaptation is recommended as a way of understanding and predicting the impact of isolation and confinement during spaceflights.

Adaptation, Psychological↗

PubMedDate not supplied

Medical decision making in the choice of a thrombolytic agent for acute myocardial infarction. Quebec Acute Coronary Care Working Group.

Little is known about how physicians make decisions when the evidence is incomplete or controversial. While thrombolysis improves survival following acute myocardial infarction (AMI), conflicting evidence exists as to any specific agent's superiority, particularly if cost-effectiveness is considered. Using a Bayesian hierarchical model, the authors examined the patient, physician, and hospital characteristics that are related to the decision-making process concerning the choice of thrombolytic agent in a prospective registry of 1,165 AMI patients receiving thrombolysis. Tissue plasminogen activator (t-PA) was administered to 432 patients (31.8%) and streptokinase (SK) to the remainder. The presence of an anterior infarction, a previous myocardial infarction, low blood pressure, a cardiologist decision maker, younger age, and receiving treatment within six hours after the start of symptoms were independent predictors of receiving t-PA. The levels of importance that physicians accorded to these patient characteristics differed according to their practicing institutions. Generally, they followed evidence-based medicine and reasonably targeted high-risk patients to receive the more expensive t-PA. However, they also preferentially treated younger patients, where only a small absolute advantage appears to exist.

Aged↗

PubMed1998

The surrogate's experience during treatment decision-making.

PURPOSE: To explore the experiences, thoughts, and feelings of surrogates making decisions for older adults. To identify nursing practices perceived as helpful to surrogates. SAMPLE: Eleven surrogate decision-makers. METHOD: Qualitative. Semi-structured interviews/descriptive data used to enrich a larger study. FINDINGS: Four main themes were identified that described the surrogates' experiences: Contextualizing the decision Actualizing agency Reviewing and resolving Transcending CLINICAL IMPLICATIONS: Three paradigm cases describe caregiving, protecting, and trusting response patterns of surrogates. Surrogates found decision-making an evolving and difficult process. Nurses can be more helpful to surrogates by giving them more opportunities to ask questions, solicit information, express emotions and obtain comfort and support.

Aged↗

PubMed1999

The management of chronic wounds: factors that affect nurses' decision-making.

This study sought to determine how registered nurses make decisions regarding the management of chronic wounds. A self-administered questionnaire consisting of both Likert-type and open-ended questions was used to survey registered nurses working in hospitals and community services in a large Australian city. A total of 140 questionnaires were returned from a variety of clinical settings. The study revealed that registered nurses had a significant role in chronic wound management. However, they relied primarily on their own experience and that of colleagues for decision making in which they had varying degrees of autonomy. The authors conclude that nurses and medical staff require more objective, research-based education on wound assessment and management.

Bandages↗

PubMed1996

Decision making in HIV testing among a group with low HIV risk.

Relatively little is known about how individuals (apart from gay and bisexual men) decide to have an HIV test and how, once they have presented for testing, they make decisions about proceeding through the testing trajectory. This paper reports on a qualitative study in which 55 mainly heterosexual respondents with low HIV risk were interviewed about their experiences of decision making around HIV testing. Reasons for deciding to be tested centred on a desire for reassurance and the circumstances of the respondents' current relationship. The most common relationship reason focused on a desire to confirm HIV status before beginning sexual relations or engaging in unprotected sex with a partner. Although some respondents recognized that other individuals had influenced their decision to be tested, few said that pre-test counselling had been influential in this respect. Instead, it was said to have promoted feelings of 'ownership' of a decision which had already been taken prior to counselling. The potential effects of HIV testing on HIV risk behaviour were also examined and a non-significant increase in unprotected sex was reported between the month before the test and the month after. The implications of these findings for the provision of HIV testing services are explored.

AIDS Serodiagnosis↗

PubMed2002

The relationship between critical thinking and decision-making in respiratory care students.

INTRODUCTION: Respiratory therapists evaluate the condition of their patients, make decisions about the appropriateness of the treatment plan, provide care, and evaluate the outcomes of their decisions. To practice effectively they must think critically and make appropriate decisions. As educators make curriculum changes to improve students' decision-making (DM) skills, strategies to develop critical thinking (CT) have been proposed as one method of achieving that goal. This approach is based on the hypothesis that a positive relationship exists between DM and CT. The present study examines the relationship between CT and DM in respiratory care students. If there is a positive relationship between CT and DM, respiratory care training programs might improve the DM skills of future practitioners by providing instruction that improves CT. METHODS: Using a correlational research design, DM scores from the Clinical Simulation Self-Assessment Examination (CSSAE) were compared with scores from the Watson-Glaser Critical Thinking Appraisal for 143 graduating respiratory care students from 10 programs. Program directors completed a questionnaire and were then interviewed about the methods they employ to develop CT and DM in their students. RESULTS: A significant correlation between CT and DM was found for 110 students completing the Secure Form of the CSSAE (r = 0.32, p < 0.01). All programs used case studies and clinical simulations, and most used role modeling, computer-assisted instruction, patient rounds, small group discussion, and study skills courses. No differences were identified in the use of the CT and DM development strategies by different programs. CONCLUSIONS: The findings support the belief that students with strong CT proficiency make better clinical decisions. Assessment of CT proficiency could be used as one part of a process for evaluating prospective students and faculty for respiratory care programs. Program directors and faculty felt that case studies and clinical simulations are important strategies.

Adult↗

PubMed1989

Durable power of attorney for health care: planning for substitute decision making.

Too frequently a relative who is not emotionally close to the patient and who does not know the patient's desires related to health care is authorized to make decisions for the unconscious or incompetent patient, while a non-relative who is intimately involved with the patient and knows the patient's health care desires has no authority to make these decisions. Health care providers must too often stand by helplessly as disinterested or malevolent relatives make these decisions, while caring, competent non-relatives are shut out of the decision-making process. Planning for substitute decision-making can reduce stress and uncertainty for the patient, for the family and for health care providers.

Humans↗

PubMed2006

Uncertainty, decision-making and trust: lessons from the MMR controversy.

Uncertainty about the likelihood of a particular child coming to harm is a chief concern for parents making decisions about the MMR vaccine, but little attention has been given to the ways that parents cope with this uncertainty. Social science frameworks may help practitioners to understand parental decision making and its implications for community practice. In focus groups and interviews involving 87 parents, three distinct strategies for dealing with uncertainty emerged: reducing complexity through trust, compromise strategies that embrace ambivalence and identifying vulnerable groups. Community practitioners should seek to understand how parents may be using these strategies in order to appropriately tailor their information provision and foster trusting relationships in the communities they serve.

Attitude to Health↗