Multi-criteria clinical decision support: A primer on the use of multiple criteria decision making methods to promote evidence-based, patient-centered healthcare.

PubMed

Dolan, James G

2010-01-01

Current models of healthcare quality recommend that patient management decisions be evidence-based and patient-centered. Evidence-based decisions require a thorough understanding of current information regarding the natural history of disease and the anticipated outcomes of different management options. Patient-centered decisions incorporate patient preferences, values, and unique personal circumstances into the decision making process and actively involve both patients along with health care providers as much as possible. Fundamentally, therefore, evidence-based, patient-centered decisions are multi-dimensional and typically involve multiple decision makers.Advances in the decision sciences have led to the development of a number of multiple criteria decision making methods. These multi-criteria methods are designed to help people make better choices when faced with complex decisions involving several dimensions. They are especially helpful when there is a need to combine "hard data" with subjective preferences, to make trade-offs between desired outcomes, and to involve multiple decision makers. Evidence-based, patient-centered clinical decision making has all of these characteristics. This close match suggests that clinical decision support systems based on multi-criteria decision making techniques have the potential to enable patients and providers to carry out the tasks required to implement evidence-based, patient-centered care effectively and efficiently in clinical settings.The goal of this paper is to give readers a general introduction to the range of multi-criteria methods available and show how they could be used to support clinical decision-making. Methods discussed include the balance sheet, the even swap method, ordinal ranking methods, direct weighting methods, multi-attribute decision analysis, and the analytic hierarchy process (AHP).

Multi-criteria clinical decision support: A primer on the use of multiple criteria decision making methods to promote evidence-based, patient-centered healthcare

PubMed Central

Dolan, James G.

2010-01-01

Current models of healthcare quality recommend that patient management decisions be evidence-based and patient-centered. Evidence-based decisions require a thorough understanding of current information regarding the natural history of disease and the anticipated outcomes of different management options. Patient-centered decisions incorporate patient preferences, values, and unique personal circumstances into the decision making process and actively involve both patients along with health care providers as much as possible. Fundamentally, therefore, evidence-based, patient-centered decisions are multi-dimensional and typically involve multiple decision makers. Advances in the decision sciences have led to the development of a number of multiple criteria decision making methods. These multi-criteria methods are designed to help people make better choices when faced with complex decisions involving several dimensions. They are especially helpful when there is a need to combine “hard data” with subjective preferences, to make trade-offs between desired outcomes, and to involve multiple decision makers. Evidence-based, patient-centered clinical decision making has all of these characteristics. This close match suggests that clinical decision support systems based on multi-criteria decision making techniques have the potential to enable patients and providers to carry out the tasks required to implement evidence-based, patient-centered care effectively and efficiently in clinical settings. The goal of this paper is to give readers a general introduction to the range of multi-criteria methods available and show how they could be used to support clinical decision-making. Methods discussed include the balance sheet, the even swap method, ordinal ranking methods, direct weighting methods, multi-attribute decision analysis, and the analytic hierarchy process (AHP) PMID:21394218

The Defense Industrial Base: Prescription for a Psychosomatic Ailment

DTIC Science & Technology

1983-08-01

The Decision- Making Process ------------------------- 65 Notes ---------------------------------------- FIGURE 4-1. The Decision [laking Process...the strategy and tactics process to make certain that we can attain out national security objectives. (IFP is also known as mobilization planning or...decision- making model that could improve the capacity and capability-of the military-industrial complex, thereby increasing the probability of success

Integrated Risk-Informed Decision-Making for an ALMR PRISM

DOE Office of Scientific and Technical Information (OSTI.GOV)

Muhlheim, Michael David; Belles, Randy; Denning, Richard S.

Decision-making is the process of identifying decision alternatives, assessing those alternatives based on predefined metrics, selecting an alternative (i.e., making a decision), and then implementing that alternative. The generation of decisions requires a structured, coherent process, or a decision-making process. The overall objective for this work is that the generalized framework is adopted into an autonomous decision-making framework and tailored to specific requirements for various applications. In this context, automation is the use of computing resources to make decisions and implement a structured decision-making process with limited or no human intervention. The overriding goal of automation is to replace ormore » supplement human decision makers with reconfigurable decision-making modules that can perform a given set of tasks rationally, consistently, and reliably. Risk-informed decision-making requires a probabilistic assessment of the likelihood of success given the status of the plant/systems and component health, and a deterministic assessment between plant operating parameters and reactor protection parameters to prevent unnecessary trips and challenges to plant safety systems. The probabilistic portion of the decision-making engine of the supervisory control system is based on the control actions associated with an ALMR PRISM. Newly incorporated into the probabilistic models are the prognostic/diagnostic models developed by Pacific Northwest National Laboratory. These allow decisions to incorporate the health of components into the decision–making process. Once the control options are identified and ranked based on the likelihood of success, the supervisory control system transmits the options to the deterministic portion of the platform. The deterministic portion of the decision-making engine uses thermal-hydraulic modeling and components for an advanced liquid-metal reactor Power Reactor Inherently Safe Module. The deterministic multi-attribute decision-making framework uses various sensor data (e.g., reactor outlet temperature, steam generator drum level) and calculates its position within the challenge state, its trajectory, and its margin within the controllable domain using utility functions to evaluate current and projected plant state space for different control decisions. The metrics that are evaluated are based on reactor trip set points. The integration of the deterministic calculations using multi-physics analyses and probabilistic safety calculations allows for the examination and quantification of margin recovery strategies. This also provides validation of the control options identified from the probabilistic assessment. Thus, the thermalhydraulics analyses are used to validate the control options identified from the probabilistic assessment. Future work includes evaluating other possible metrics and computational efficiencies, and developing a user interface to mimic display panels at a modern nuclear power plant.« less

Mental Health Providers' Decision-Making Around the Implementation of Evidence-Based Treatment for PTSD.

PubMed

Osei-Bonsu, Princess E; Bolton, Rendelle E; Wiltsey Stirman, Shannon; Eisen, Susan V; Herz, Lawrence; Pellowe, Maura E

2017-04-01

It is estimated that <15% of veterans with posttraumatic stress disorder (PTSD) have engaged in two evidence-based psychotherapies highly recommended by VA-cognitive processing therapy (CPT) and prolonged exposure (PE). CPT and PE guidelines specify which patients are appropriate, but research suggests that providers may be more selective than the guidelines. In addition, PTSD clinical guidelines encourage "shared decision-making," but there is little research on what processes providers use to make decisions about CPT/PE. Sixteen licensed psychologists and social workers from two VA medical centers working with ≥1 patient with PTSD were interviewed about patient factors considered and decision-making processes for CPT/PE use. Qualitative analyses revealed that patient readiness and comorbid conditions influenced decisions to use or refer patients with PTSD for CPT/PE. Providers reported mentally derived and instances of patient-involved decision-making around CPT/PE use. Continued efforts to assist providers in making informed and collaborative decisions about CPT/PE use are discussed.

A conceptual framework for automating the operational and strategic decision-making process in the health care delivery system.

PubMed

Ruohonen, Toni; Ennejmy, Mohammed

2013-01-01

Making reliable and justified operational and strategic decisions is a really challenging task in the health care domain. So far, the decisions have been made based on the experience of managers and staff, or they are evaluated with traditional methods, using inadequate data. As a result of this kind of decision-making process, attempts to improve operations usually have failed or led to only local improvements. Health care organizations have a lot of operational data, in addition to clinical data, which is the key element for making reliable and justified decisions. However, it is progressively problematic to access it and make usage of it. In this paper we discuss about the possibilities how to exploit operational data in the most efficient way in the decision-making process. We'll share our future visions and propose a conceptual framework for automating the decision-making process.

A communication model of shared decision making: accounting for cancer treatment decisions.

PubMed

Siminoff, Laura A; Step, Mary M

2005-07-01

The authors present a communication model of shared decision making (CMSDM) that explicitly identifies the communication process as the vehicle for decision making in cancer treatment. In this view, decision making is necessarily a sociocommunicative process whereby people enter into a relationship, exchange information, establish preferences, and choose a course of action. The model derives from contemporary notions of behavioral decision making and ethical conceptions of the doctor-patient relationship. This article briefly reviews the theoretical approaches to decision making, notes deficiencies, and embeds a more socially based process into the dynamics of the physician-patient relationship, focusing on cancer treatment decisions. In the CMSDM, decisions depend on (a) antecedent factors that have potential to influence communication, (b) jointly constructed communication climate, and (c) treatment preferences established by the physician and the patient.

Finding shared decisions in stakeholder networks: An agent-based approach

NASA Astrophysics Data System (ADS)

Le Pira, Michela; Inturri, Giuseppe; Ignaccolo, Matteo; Pluchino, Alessandro; Rapisarda, Andrea

2017-01-01

We address the problem of a participatory decision-making process where a shared priority list of alternatives has to be obtained while avoiding inconsistent decisions. An agent-based model (ABM) is proposed to mimic this process in different social networks of stakeholders who interact according to an opinion dynamics model. Simulations' results show the efficacy of interaction in finding a transitive and, above all, shared decision. These findings are in agreement with real participation experiences regarding transport planning decisions and can give useful suggestions on how to plan an effective participation process for sustainable policy-making based on opinion consensus.

The Career Decision-Making Competence: A New Construct for the Career Realm

ERIC Educational Resources Information Center

Ceschi, Andrea; Costantini, Arianna; Phillips, Susan D.; Sartori, Riccardo

2017-01-01

Purpose: This paper aims to link findings from laboratory-based decision-making research and decision-making competence (DMC) aspects that may be central for career-related decision-making processes. Past research has identified individual differences in rational responses in decision situations, which the authors refer to as DMC. Although there…

Multiple attribute decision making model and application to food safety risk evaluation.

PubMed

Ma, Lihua; Chen, Hong; Yan, Huizhe; Yang, Lifeng; Wu, Lifeng

2017-01-01

Decision making for supermarket food purchase decisions are characterized by network relationships. This paper analyzed factors that influence supermarket food selection and proposes a supplier evaluation index system based on the whole process of food production. The author established the intuitive interval value fuzzy set evaluation model based on characteristics of the network relationship among decision makers, and validated for a multiple attribute decision making case study. Thus, the proposed model provides a reliable, accurate method for multiple attribute decision making.

A new web-based framework development for fuzzy multi-criteria group decision-making.

PubMed

Hanine, Mohamed; Boutkhoum, Omar; Tikniouine, Abdessadek; Agouti, Tarik

2016-01-01

Fuzzy multi-criteria group decision making (FMCGDM) process is usually used when a group of decision-makers faces imprecise data or linguistic variables to solve the problems. However, this process contains many methods that require many time-consuming calculations depending on the number of criteria, alternatives and decision-makers in order to reach the optimal solution. In this study, a web-based FMCGDM framework that offers decision-makers a fast and reliable response service is proposed. The proposed framework includes commonly used tools for multi-criteria decision-making problems such as fuzzy Delphi, fuzzy AHP and fuzzy TOPSIS methods. The integration of these methods enables taking advantages of the strengths and complements each method's weakness. Finally, a case study of location selection for landfill waste in Morocco is performed to demonstrate how this framework can facilitate decision-making process. The results demonstrate that the proposed framework can successfully accomplish the goal of this study.

Chronic Motivational State Interacts with Task Reward Structure in Dynamic Decision-Making

PubMed Central

Cooper, Jessica A.; Worthy, Darrell A.; Maddox, W. Todd

2015-01-01

Research distinguishes between a habitual, model-free system motivated toward immediately rewarding actions, and a goal-directed, model-based system motivated toward actions that improve future state. We examined the balance of processing in these two systems during state-based decision-making. We tested a regulatory fit hypothesis (Maddox & Markman, 2010) that predicts that global trait motivation affects the balance of habitual- vs. goal-directed processing but only through its interaction with the task framing as gain-maximization or loss-minimization. We found support for the hypothesis that a match between an individual’s chronic motivational state and the task framing enhances goal-directed processing, and thus state-based decision-making. Specifically, chronic promotion-focused individuals under gain-maximization and chronic prevention-focused individuals under loss-minimization both showed enhanced state-based decision-making. Computational modeling indicates that individuals in a match between global chronic motivational state and local task reward structure engaged more goal-directed processing, whereas those in a mismatch engaged more habitual processing. PMID:26520256

Who decides? The decision-making process of juvenile judges concerning minors with mental disorders.

PubMed

Cappon, Leen

2016-01-01

Previous research on juvenile judges' decision-making process has neglected the role of the different actors involved in judicial procedures. The decision can be considered as a result of information exchange between the different actors involved. The process of making a decision is equally important as the decision itself, especially when the decision considers minors with mental disorders. The presence and the type of interaction determine the information available to the juvenile judges to make their final decision. The overall aim of this study is to gain insight into the role of all actors, including the juvenile judge, in the juvenile judge's decision-making process in cases relating to minors with mental disorders. Semi-structured interviews were carried out with professional actors (n=32), minors (n=31) and parents (n=17). The findings indicated that the judge's decision is overall the result of an interaction between the juvenile judge, the social services investigator and the youth psychiatrist. The other professional actors, the minors and the parents had only a limited role in the decision-making process. The research concludes that the judge's decision-making process should be based on dialogue, and requires enhanced collaboration between the juvenile court and youth psychiatrists from mental health services. Future decision-making research should pay more attention to the interactions of the actors that guide a juvenile judge's decision. Copyright © 2016 Elsevier Ltd. All rights reserved.

Making the case for evidence-based design in healthcare: a descriptive case study of organizational decision making.

PubMed

Shoemaker, Lorie K; Kazley, Abby Swanson; White, Andrea

2010-01-01

The aim of this study was to describe the organizational decision-making process used in the selection of evidence-based design (EBD) concepts, the criteria used to make these decisions, and the extent to which leadership style may have influenced the decision-making process. Five research questions were formulated to frame the direction of this study, including: (1) How did healthcare leaders learn of innovations in design? (2) How did healthcare leaders make decisions in the selection of healthcare design concepts? (3) What criteria did healthcare leaders use in the decision-making process? (4) How did healthcare leaders consider input from the staff in design decisions? and (5) To what extent did the leadership style of administrators affect the outcomes of the decision-making process? Current issues affecting healthcare in the community led the principal investigator's organization to undertake an ambitious facilities expansion project. As part of its planning process, the organization learned of EBD principles that seemingly had a positive impact on patient care and safety and staff working conditions. Although promising, a paucity of empirical research addressed the cost/benefit of incorporating many EBD concepts into one hospital setting, and there was no research that articulated the organizational decision-making process used by healthcare administrators when considering the use of EBD in expansion projects. A mixed-method, descriptive, qualitative, single-case study and quantitative design were used to address the five research questions. The Systems Research Organizing Model provided the theoretical framework. A variety of data collection methods was used, including interviews of key respondents, the review of documentary evidence, and the Multifactor Leadership Questionnaire. A participatory process was used throughout the design decision phases, involving staff at all levels of the organization. The Internet and architects facilitated learning about EBD. Financial considerations were a factor in decision making. The prevalence of the transformational leadership style among the organization's administrators exceeded the U.S. mean.

Patient Preferences and Surrogate Decision Making in Neuroscience Intensive Care Units

PubMed Central

Cai, Xuemei; Robinson, Jennifer; Muehlschlegel, Susanne; White, Douglas B.; Holloway, Robert G.; Sheth, Kevin N.; Fraenkel, Liana; Hwang, David Y.

2016-01-01

In the neuroscience intensive care unit (NICU), most patients lack the capacity to make their own preferences known. This fact leads to situations where surrogate decision makers must fill the role of the patient in terms of making preference-based treatment decisions, oftentimes in challenging situations where prognosis is uncertain. The neurointensivist has a large responsibility and role to play in this shared decision making process. This review covers how NICU patient preferences are determined through existing advance care documentation or surrogate decision makers and how the optimum roles of the physician and surrogate decision maker are addressed. We outline the process of reaching a shared decision between family and care team and describe a practice for conducting optimum family meetings based on studies of ICU families in crisis. We review challenges in the decision making process between surrogate decision makers and medical teams in neurocritical care settings, as well as methods to ameliorate conflicts. Ultimately, the goal of shared decision making is to increase knowledge amongst surrogates and care providers, decrease decisional conflict, promote realistic expectations and preference-centered treatment strategies, and lift the emotional burden on families of neurocritical care patients. PMID:25990137

Using Data-Based Inquiry and Decision Making To Improve Instruction.

ERIC Educational Resources Information Center

Feldman, Jay; Tung, Rosann

2001-01-01

Discusses a study of six schools using data-based inquiry and decision-making process to improve instruction. Findings identified two conditions to support successful implementation of the process: administrative support, especially in providing teachers learning time, and teacher leadership to encourage and support colleagues to own the process.…

Decision Making: New Paradigm for Education.

ERIC Educational Resources Information Center

Wales, Charles E.; And Others

1986-01-01

Defines education's new paradigm as schooling based on decision making, the critical thinking skills serving it, and the knowledge base supporting it. Outlines a model decision-making process using a hypothetical breakfast problem; a late riser chooses goals, generates ideas, develops an action plan, and implements and evaluates it. (4 references)…

Nurse manager cognitive decision-making amidst stress and work complexity.

PubMed

Shirey, Maria R; Ebright, Patricia R; McDaniel, Anna M

2013-01-01

  The present study provides insight into nurse manager cognitive decision-making amidst stress and work complexity.   Little is known about nurse manager decision-making amidst stress and work complexity. Because nurse manager decisions have the potential to impact patient care quality and safety, understanding their decision-making processes is useful for designing supportive interventions.   This qualitative descriptive study interviewed 21 nurse managers from three hospitals to answer the research question: What decision-making processes do nurse managers utilize to address stressful situations in their nurse manager role? Face-to-face interviews incorporating components of the Critical Decision Method illuminated expert-novice practice differences. Content analysis identified one major theme and three sub-themes.   The present study produced a cognitive model that guides nurse manager decision-making related to stressful situations. Experience in the role, organizational context and situation factors influenced nurse manager cognitive decision-making processes.   Study findings suggest that chronic exposure to stress and work complexity negatively affects nurse manager health and their decision-making processes potentially threatening individual, patient and organizational outcomes.   Cognitive decision-making varies based on nurse manager experience and these differences have coaching and mentoring implications. This present study contributes a current understanding of nurse manager decision-making amidst stress and work complexity. © 2012 Blackwell Publishing Ltd.

Decision making under uncertainty in a spiking neural network model of the basal ganglia.

PubMed

Héricé, Charlotte; Khalil, Radwa; Moftah, Marie; Boraud, Thomas; Guthrie, Martin; Garenne, André

2016-12-01

The mechanisms of decision-making and action selection are generally thought to be under the control of parallel cortico-subcortical loops connecting back to distinct areas of cortex through the basal ganglia and processing motor, cognitive and limbic modalities of decision-making. We have used these properties to develop and extend a connectionist model at a spiking neuron level based on a previous rate model approach. This model is demonstrated on decision-making tasks that have been studied in primates and the electrophysiology interpreted to show that the decision is made in two steps. To model this, we have used two parallel loops, each of which performs decision-making based on interactions between positive and negative feedback pathways. This model is able to perform two-level decision-making as in primates. We show here that, before learning, synaptic noise is sufficient to drive the decision-making process and that, after learning, the decision is based on the choice that has proven most likely to be rewarded. The model is then submitted to lesion tests, reversal learning and extinction protocols. We show that, under these conditions, it behaves in a consistent manner and provides predictions in accordance with observed experimental data.

Recognition Decisions From Visual Working Memory Are Mediated by Continuous Latent Strengths.

PubMed

Ricker, Timothy J; Thiele, Jonathan E; Swagman, April R; Rouder, Jeffrey N

2017-08-01

Making recognition decisions often requires us to reference the contents of working memory, the information available for ongoing cognitive processing. As such, understanding how recognition decisions are made when based on the contents of working memory is of critical importance. In this work we examine whether recognition decisions based on the contents of visual working memory follow a continuous decision process of graded information about the correct choice or a discrete decision process reflecting only knowing and guessing. We find a clear pattern in favor of a continuous latent strength model of visual working memory-based decision making, supporting the notion that visual recognition decision processes are impacted by the degree of matching between the contents of working memory and the choices given. Relation to relevant findings and the implications for human information processing more generally are discussed. Copyright © 2016 Cognitive Science Society, Inc.

Instructional decision making of high school science teachers

NASA Astrophysics Data System (ADS)

Carver, Jeffrey S.

The instructional decision-making processes of high school science teachers have not been well established in the literature. Several models for decision-making do exist in other teaching disciplines, business, computer game programming, nursing, and some fields of science. A model that incorporates differences in science teaching that is consistent with constructivist theory as opposed to conventional science teaching is useful in the current climate of standards-based instruction that includes an inquiry-based approach to teaching science. This study focuses on three aspects of the decision-making process. First, it defines what factors, both internal and external, influence high school science teacher decision-making. Second, those factors are analyzed further to determine what instructional decision-making processes are articulated or demonstrated by the participants. Third, by analyzing the types of decisions that are made in the classroom, the classroom learning environments established as a result of those instructional decisions are studied for similarities and differences between conventional and constructivist models. While the decision-making process for each of these teachers was not clearly articulated by the teachers themselves, the patterns that establish the process were clearly exhibited by the teachers. It was also clear that the classroom learning environments that were established were, at least in part, established as a result of the instructional decisions that were made in planning and implementation of instruction. Patterns of instructional decision-making were different for each teacher as a result of primary instructional goals that were different for each teacher. There were similarities between teachers who exhibited more constructivist epistemological tendencies as well as similarities between teachers who exhibited a more conventional epistemology. While the decisions that will result from these two camps may be different, the six step process for instructional decision-making that was established during this study shows promise for use in both situations.

Social value and individual choice: The value of a choice-based decision-making process in a collectively funded health system.

PubMed

Espinoza, Manuel Antonio; Manca, Andrea; Claxton, Karl; Sculpher, Mark

2018-02-01

Evidence about cost-effectiveness is increasingly being used to inform decisions about the funding of new technologies that are usually implemented as guidelines from centralized decision-making bodies. However, there is also an increasing recognition for the role of patients in determining their preferred treatment option. This paper presents a method to estimate the value of implementing a choice-based decision process using the cost-effectiveness analysis toolbox. This value is estimated for 3 alternative scenarios. First, it compares centralized decisions, based on population average cost-effectiveness, against a decision process based on patient choice. Second, it compares centralized decision based on patients' subgroups versus an individual choice-based decision process. Third, it compares a centralized process based on average cost-effectiveness against a choice-based process where patients choose according to a different measure of outcome to that used by the centralized decision maker. The methods are applied to a case study for the management of acute coronary syndrome. It is concluded that implementing a choice-based process of treatment allocation may be an option in collectively funded health systems. However, its value will depend on the specific health problem and the social values considered relevant to the health system. Copyright © 2017 John Wiley & Sons, Ltd.

Factors affecting long-term-care residents' decision-making processes as they formulate advance directives.

PubMed

Lambert, Heather C; McColl, Mary Ann; Gilbert, Julie; Wong, Jiahui; Murray, Gale; Shortt, Samuel E D

2005-10-01

The purpose of this study was to describe factors contributing to the decision-making processes of elderly persons as they formulate advance directives in long-term care. This study was qualitative, based on grounded theory. Recruitment was purposive and continued until saturation was reached. Nine residents of a long-term-care facility were interviewed by use of a semistructured format. Open and axial coding of interview transcripts were carried out and the factors contributing to the decision process were defined. Elders based their decisions primarily on information gathered from personal experiences with death and illness. They obtained very little information from professionals or the media. Major factors considered by elders as they weighed information included spiritual, emotional, and social considerations. The factors considered during the decision-making process were oriented more toward the individual's experiences and less on contributions from objective sources than anticipated. Decision making for advance directives is a highly personalized process. The approach of health professionals when assisting with end-of-life decision making should be planned with these contributing factors in mind, so that the services offered to the individuals in this population best meet their needs.

Error-associated behaviors and error rates for robotic geology

NASA Technical Reports Server (NTRS)

Anderson, Robert C.; Thomas, Geb; Wagner, Jacob; Glasgow, Justin

2004-01-01

This study explores human error as a function of the decision-making process. One of many models for human decision-making is Rasmussen's decision ladder [9]. The decision ladder identifies the multiple tasks and states of knowledge involved in decision-making. The tasks and states of knowledge can be classified by the level of cognitive effort required to make the decision, leading to the skill, rule, and knowledge taxonomy (Rasmussen, 1987). Skill based decisions require the least cognitive effort and knowledge based decisions require the greatest cognitive effort. Errors can occur at any of the cognitive levels.

How Reasoning, Judgment, and Decision Making are Colored by Gist-based Intuition: A Fuzzy-Trace Theory Approach

PubMed Central

Corbin, Jonathan C.; Reyna, Valerie F.; Weldon, Rebecca B.; Brainerd, Charles J.

2015-01-01

Fuzzy-trace theory distinguishes verbatim (literal, exact) from gist (meaningful) representations, predicting that reliance on gist increases with experience and expertise. Thus, many judgment-and-decision-making biases increase with development, such that cognition is colored by context in ways that violate logical coherence and probability theories. Nevertheless, this increase in gist-based intuition is adaptive: Gist is stable, less sensitive to interference, and easier to manipulate. Moreover, gist captures the functionally significant essence of information, supporting healthier and more robust decision processes. We describe how fuzzy-trace theory accounts for judgment-and-decision making phenomena, predicting the paradoxical arc of these processes with the development of experience and expertise. We present data linking gist memory processes to gist processing in decision making and provide illustrations of gist reliance in medicine, public health, and intelligence analysis. PMID:26664820

How Reasoning, Judgment, and Decision Making are Colored by Gist-based Intuition: A Fuzzy-Trace Theory Approach.

PubMed

Corbin, Jonathan C; Reyna, Valerie F; Weldon, Rebecca B; Brainerd, Charles J

2015-12-01

Fuzzy-trace theory distinguishes verbatim (literal, exact) from gist (meaningful) representations, predicting that reliance on gist increases with experience and expertise. Thus, many judgment-and-decision-making biases increase with development, such that cognition is colored by context in ways that violate logical coherence and probability theories. Nevertheless, this increase in gist-based intuition is adaptive: Gist is stable, less sensitive to interference, and easier to manipulate. Moreover, gist captures the functionally significant essence of information, supporting healthier and more robust decision processes. We describe how fuzzy-trace theory accounts for judgment-and-decision making phenomena, predicting the paradoxical arc of these processes with the development of experience and expertise. We present data linking gist memory processes to gist processing in decision making and provide illustrations of gist reliance in medicine, public health, and intelligence analysis.

Supporting decision-making processes for evidence-based mental health promotion.

PubMed

Jané-Llopis, Eva; Katschnig, Heinz; McDaid, David; Wahlbeck, Kristian

2011-12-01

The use of evidence is critical in guiding decision-making, but evidence from effect studies will be only one of a number of factors that will need to be taken into account in the decision-making processes. Equally important for policymakers will be the use of different types of evidence including implementation essentials and other decision-making principles such as social justice, political, ethical, equity issues, reflecting public attitudes and the level of resources available, rather than be based on health outcomes alone. This paper, aimed to support decision-makers, highlights the importance of commissioning high-quality evaluations, the key aspects to assess levels of evidence, the importance of supporting evidence-based implementation and what to look out for before, during and after implementation of mental health promotion and mental disorder prevention programmes.

An Interactive Model of Career Decision Making.

ERIC Educational Resources Information Center

Amundson, Norman E.

1995-01-01

The decision-making model described highlights the interaction between contextual factors, decision triggers, establishing a frame of the problem, reframing, and action planning. The interactive perspective is based on process and change. Career counseling with an interactive decision-making approach requires an acknowledgment of external…

Risk Communication in Special Education.

ERIC Educational Resources Information Center

Bull, Kay S.; Kimball, Sarah

This paper describes the application of a risk-based decision-making process in education and the use of risk communication with special education students and their parents. Risk-based decision making clarifies uncertainties inherent in a decision by examining the probability of a resulting harmful effect and the consequences of decisions made.…

Disciplined Decision Making in an Interdisciplinary Environment: Some Implications for Clinical Applications of Statistical Process Control.

ERIC Educational Resources Information Center

Hantula, Donald A.

1995-01-01

Clinical applications of statistical process control (SPC) in human service organizations are considered. SPC is seen as providing a standard set of criteria that serves as a common interface for data-based decision making, which may bring decision making under the control of established contingencies rather than the immediate contingencies of…

Examination of Children Decision Making Using Clues during the Logical Reasoning Process

ERIC Educational Resources Information Center

Çelik, Meryem

2017-01-01

Logical reasoning is the process of thinking about a problem and finding the most effective solution. Children's decision-making skills are part of their cognitive development and are also indicative. The purpose of this study was to examine children's decision-making skills using clues in logical reasoning based on various variables. The study…

Risk-taking and decision-making in youth: relationships to addiction vulnerability.

PubMed

Balogh, Kornelia N; Mayes, Linda C; Potenza, Marc N

2013-03-01

Decision-making and risk-taking behavior undergo developmental changes during adolescence. Disadvantageous decision-making and increased risk-taking may lead to problematic behaviors such as substance use and abuse, pathological gambling and excessive internet use. Based on MEDLINE searches, this article reviews the literature on decision-making and risk-taking and their relationship to addiction vulnerability in youth. Decision-making and risk-taking behaviors involve brain areas that undergoing developmental changes during puberty and young adulthood. Individual differences and peer pressure also relate importantly to decision-making and risk-taking. Brain-based changes in emotional, motivational and cognitive processing may underlie risk-taking and decision-making propensities in adolescence, making this period a time of heightened vulnerability for engagement in additive behaviors.

Indicators of Informal and Formal Decision-Making about a Socioscientific Issue

ERIC Educational Resources Information Center

Dauer, Jenny M.; Lute, Michelle L.; Straka, Olivia

2017-01-01

We propose two contrasting types of student decision-making based on social and cognitive psychology models of separate mental processes for problem solving. Informal decision-making uses intuitive reasoning and is subject to cognitive biases, whereas formal decision-making uses effortful, logical reasoning. We explored indicators of students'…

[Cognitive errors in diagnostic decision making].

PubMed

Gäbler, Martin

2017-10-01

Approximately 10-15% of our diagnostic decisions are faulty and may lead to unfavorable and dangerous outcomes, which could be avoided. These diagnostic errors are mainly caused by cognitive biases in the diagnostic reasoning process.Our medical diagnostic decision-making is based on intuitive "System 1" and analytical "System 2" diagnostic decision-making and can be deviated by unconscious cognitive biases.These deviations can be positively influenced on a systemic and an individual level. For the individual, metacognition (internal withdrawal from the decision-making process) and debiasing strategies, such as verification, falsification and rule out worst-case scenarios, can lead to improved diagnostic decisions making.

Using health outcomes data to inform decision-making: formulary committee perspective.

PubMed

Janknegt, R

2001-01-01

When healthcare resources are limited, decisions about the treatments to fund can be complex and difficult to make, involving the careful balancing of multiple factors. The decisions taken may have far-reaching consequences affecting many people. Clearly, decisions such as the choice of products on a formulary must be taken using a selection process that is fully transparent and that can be justified to all parties concerned. Although everyone would agree that drug selection should be a rational process that follows the guidelines of evidence-based medicine, many other factors may play a role in decision-making. Although some of these are explicit and rational, others are less clearly defined, and decision-makers may be unaware of the influence exerted by some of these factors. In order to facilitate transparent decision-making that makes rational use of health outcomes information, the System of Objectified Judgement Analysis (SOJA) has been developed by the author. SOJA includes interactive software that combines the quality advantages of the 'top-down' approach to drug selection, based on a thorough literature review, with the compliance advantages of a 'bottom-up' approach, where the final decision is made by the individual formulary committee and not by the authors of the review. The SOJA method, based on decision-making processes in economics, ensures that health outcomes information is given appropriate weight. Such approaches are valuable tools in discussions about product selection for formularies.

Gaze data reveal distinct choice processes underlying model-based and model-free reinforcement learning

PubMed Central

Konovalov, Arkady; Krajbich, Ian

2016-01-01

Organisms appear to learn and make decisions using different strategies known as model-free and model-based learning; the former is mere reinforcement of previously rewarded actions and the latter is a forward-looking strategy that involves evaluation of action-state transition probabilities. Prior work has used neural data to argue that both model-based and model-free learners implement a value comparison process at trial onset, but model-based learners assign more weight to forward-looking computations. Here using eye-tracking, we report evidence for a different interpretation of prior results: model-based subjects make their choices prior to trial onset. In contrast, model-free subjects tend to ignore model-based aspects of the task and instead seem to treat the decision problem as a simple comparison process between two differentially valued items, consistent with previous work on sequential-sampling models of decision making. These findings illustrate a problem with assuming that experimental subjects make their decisions at the same prescribed time. PMID:27511383

A decision-making model based on a spiking neural circuit and synaptic plasticity.

PubMed

Wei, Hui; Bu, Yijie; Dai, Dawei

2017-10-01

To adapt to the environment and survive, most animals can control their behaviors by making decisions. The process of decision-making and responding according to cues in the environment is stable, sustainable, and learnable. Understanding how behaviors are regulated by neural circuits and the encoding and decoding mechanisms from stimuli to responses are important goals in neuroscience. From results observed in Drosophila experiments, the underlying decision-making process is discussed, and a neural circuit that implements a two-choice decision-making model is proposed to explain and reproduce the observations. Compared with previous two-choice decision making models, our model uses synaptic plasticity to explain changes in decision output given the same environment. Moreover, biological meanings of parameters of our decision-making model are discussed. In this paper, we explain at the micro-level (i.e., neurons and synapses) how observable decision-making behavior at the macro-level is acquired and achieved.

Surgical Consultation as Social Process: Implications for Shared Decision Making.

PubMed

Clapp, Justin T; Arriaga, Alexander F; Murthy, Sushila; Raper, Steven E; Schwartz, J Sanford; Barg, Frances K; Fleisher, Lee A

2017-12-12

This qualitative study examines surgical consultation as a social process and assesses its alignment with assumptions of the shared decision-making (SDM) model. SDM stresses the importance of patient preferences and rigorous discussion of therapeutic risks/benefits based on these preferences. However, empirical studies have highlighted discrepancies between SDM and realities of surgical decision making. Qualitative research can inform understanding of the decision-making process and allow for granular assessment of the nature and causes of these discrepancies. We observed consultations between 3 general surgeons and 45 patients considering undergoing 1 of 2 preference-sensitive elective operations: (1) hernia repair, or (2) cholecystectomy. These patients and surgeons also participated in semi-structured interviews. By the time of the consultation, patients and surgeons were predisposed toward certain decisions by preceding events occurring elsewhere. During the visit, surgeons had differential ability to arbitrate surgical intervention and construct the severity of patients' conditions. These upstream dynamics frequently displaced the centrality of the risk/benefit-based consent discussion. The influence of events preceding consultation suggests that decision-making models should account for broader spatiotemporal spans. Given surgeons' authority to define patients' conditions and control service provision, SDM may be premised on an overestimation of patients' power to alter the course of decision making once in a specialist's office. Considering the subordinate role of the risk/benefit discussion in many surgical decisions, it will be important to study if and how the social process of decision making is altered by SDM-oriented decision aids that foreground this discussion.

Neural and neurochemical basis of reinforcement-guided decision making.

PubMed

Khani, Abbas; Rainer, Gregor

2016-08-01

Decision making is an adaptive behavior that takes into account several internal and external input variables and leads to the choice of a course of action over other available and often competing alternatives. While it has been studied in diverse fields ranging from mathematics, economics, ecology, and ethology to psychology and neuroscience, recent cross talk among perspectives from different fields has yielded novel descriptions of decision processes. Reinforcement-guided decision making models are based on economic and reinforcement learning theories, and their focus is on the maximization of acquired benefit over a defined period of time. Studies based on reinforcement-guided decision making have implicated a large network of neural circuits across the brain. This network includes a wide range of cortical (e.g., orbitofrontal cortex and anterior cingulate cortex) and subcortical (e.g., nucleus accumbens and subthalamic nucleus) brain areas and uses several neurotransmitter systems (e.g., dopaminergic and serotonergic systems) to communicate and process decision-related information. This review discusses distinct as well as overlapping contributions of these networks and neurotransmitter systems to the processing of decision making. We end the review by touching on neural circuitry and neuromodulatory regulation of exploratory decision making. Copyright © 2016 the American Physiological Society.

Structuring Disaster Recovery Infrastructure Decisions: Lessons from Boulder County's 2013 Flood Recovery

NASA Astrophysics Data System (ADS)

Clavin, C.; Petropoulos, Z.

2017-12-01

Recovery phase decision making processes, as compared to mitigation and response phase decision making processes, require communities make significant financial and capital decisions in the months after a disaster. Collectively, these investments may significantly contribute to the resilience of a community to future hazards. Pre-disaster administrative decisions are well-established within existing planning processes. Post-event recovery requires community decision makers to quickly evaluate technical proposals and manage significant recovery financial resources to ensure their community rebuilds in a manner that will be more resilient to future events. These technical and administrative hurdles in the aftermath of a disaster create a challenging atmosphere to make sound, scientifically-informed decisions leading to resilient recovery. In September 2013, a 1,000-year rain event that resulted in flooding throughout the Front Range of Colorado, significantly impacting Boulder County. While the event is long past, disaster recovery efforts still continue in parts of Boulder County. Boulder County officials formed a county collaborative that adapted the NIST Community Resilience Planning Guide for Buildings and Infrastructure Systems to facilitate a goals-based multi-criteria decision making process. Rather than use hazard-based information to guide infrastructure design, the county's decision process established time-to-recovery goals for infrastructure systems that were used as criteria for project design. This presentation explores the decision-making process employed by Boulder County to specify design standards for resilient rebuilding of infrastructure systems and examine how this infrastructure planning model could be extrapolated to other situations where there is uncertainty regarding future infrastructure design standards.

[Value-based cancer care. From traditional evidence-based decision making to balanced decision making within frameworks of shared values].

PubMed

Palazzo, Salvatore; Filice, Aldo; Mastroianni, Candida; Biamonte, Rosalbino; Conforti, Serafino; Liguori, Virginia; Turano, Salvatore; De Simone, Rosanna; Rovito, Antonio; Manfredi, Caterina; Minardi, Stefano; Vilardo, Emmanuelle; Loizzo, Monica; Oriolo, Carmela

2016-04-01

Clinical decision making in oncology is based so far on the evidence of efficacy from high-quality clinical research. Data collection and analysis from experimental studies provide valuable insight into response rates and progression-free or overall survival. Data processing generates valuable information for medical professionals involved in cancer patient care, enabling them to make objective and unbiased choices. The increased attention of many scientific associations toward a more rational resource consumption in clinical decision making is mirrored in the Choosing Wisely campaign against the overuse or misuse of exams and procedures of little or no benefit for the patient. This cultural movement has been actively promoting care solutions based on the concept of "value". As a result, the value-based decision-making process for cancer care should not be dissociated from economic sustainability and from ethics of the affordability, also given the growing average cost of the most recent cancer drugs. In support of this orientation, the National Comprehensive Cancer Network (NCCN) has developed innovative and "complex" guidelines based on values, defined as "evidence blocks", with the aim of assisting the medical community in making overall sustainable choices.

Emotion and decision-making: affect-driven belief systems in anxiety and depression.

PubMed

Paulus, Martin P; Yu, Angela J

2012-09-01

Emotion processing and decision-making are integral aspects of daily life. However, our understanding of the interaction between these constructs is limited. In this review, we summarize theoretical approaches that link emotion and decision-making, and focus on research with anxious or depressed individuals to show how emotions can interfere with decision-making. We integrate the emotional framework based on valence and arousal with a Bayesian approach to decision-making in terms of probability and value processing. We discuss how studies of individuals with emotional dysfunctions provide evidence that alterations of decision-making can be viewed in terms of altered probability and value computation. We argue that the probabilistic representation of belief states in the context of partially observable Markov decision processes provides a useful approach to examine alterations in probability and value representation in individuals with anxiety and depression, and outline the broader implications of this approach. Copyright © 2012. Published by Elsevier Ltd.

Emotion and decision-making: affect-driven belief systems in anxiety and depression

PubMed Central

Paulus, Martin P.; Yu, Angela J.

2012-01-01

Emotion processing and decision-making are integral aspects of daily life. However, our understanding of the interaction between these constructs is limited. In this review, we summarize theoretical approaches to the link between emotion and decision-making, and focus on research with anxious or depressed individuals that reveals how emotions can interfere with decision-making. We integrate the emotional framework based on valence and arousal with a Bayesian approach to decision-making in terms of probability and value processing. We then discuss how studies of individuals with emotional dysfunctions provide evidence that alterations of decision-making can be viewed in terms of altered probability and value computation. We argue that the probabilistic representation of belief states in the context of partially observable Markov decision processes provides a useful approach to examine alterations in probability and value representation in individuals with anxiety and depression and outline the broader implications of this approach. PMID:22898207

Protocol-based care: the standardisation of decision-making?

PubMed

Rycroft-Malone, Jo; Fontenla, Marina; Seers, Kate; Bick, Debra

2009-05-01

To explore how protocol-based care affects clinical decision-making. In the context of evidence-based practice, protocol-based care is a mechanism for facilitating the standardisation of care and streamlining decision-making through rationalising the information with which to make judgements and ultimately decisions. However, whether protocol-based care does, in the reality of practice, standardise decision-making is unknown. This paper reports on a study that explored the impact of protocol-based care on nurses' decision-making. Theoretically informed by realistic evaluation and the promoting action on research implementation in health services framework, a case study design using ethnographic methods was used. Two sites were purposively sampled; a diabetic and endocrine unit and a cardiac medical unit. Within each site, data collection included observation, postobservation semi-structured interviews with staff and patients, field notes, feedback sessions and document review. Data were inductively and thematically analysed. Decisions made by nurses in both sites were varied according to many different and interacting factors. While several standardised care approaches were available for use, in reality, a variety of information sources informed decision-making. The primary approach to knowledge exchange and acquisition was person-to-person; decision-making was a social activity. Rarely were standardised care approaches obviously referred to; nurses described following a mental flowchart, not necessarily linked to a particular guideline or protocol. When standardised care approaches were used, it was reported that they were used flexibly and particularised. While the logic of protocol-based care is algorithmic, in the reality of clinical practice, other sources of information supported nurses' decision-making process. This has significant implications for the political goal of standardisation. The successful implementation and judicious use of tools such as protocols and guidelines will likely be dependant on approaches that facilitate the development of nurses' decision-making processes in parallel to paying attention to the influence of context.

Enhancing Decision-Making in STSE Education by Inducing Reflection and Self-Regulated Learning

NASA Astrophysics Data System (ADS)

Gresch, Helge; Hasselhorn, Marcus; Bögeholz, Susanne

2017-02-01

Thoughtful decision-making to resolve socioscientific issues is central to science, technology, society, and environment (STSE) education. One approach for attaining this goal involves fostering students' decision-making processes. Thus, the present study explores whether the application of decision-making strategies, combined with reflections on the decision-making processes of others, enhances decision-making competence. In addition, this study examines whether this process is supported by elements of self-regulated learning, i.e., self-reflection regarding one's own performance and the setting of goals for subsequent tasks. A computer-based training program which involves the resolution of socioscientific issues related to sustainable development was developed in two versions: with and without elements of self-regulated learning. Its effects on decision-making competence were analyzed using a pre test-post test follow-up control-group design ( N = 242 high school students). Decision-making competence was assessed using an open-ended questionnaire that focused on three facets: consideration of advantages and disadvantages, metadecision aspects, and reflection on the decision-making processes of others. The findings suggest that students in both training groups incorporated aspects of metadecision into their statements more often than students in the control group. Furthermore, both training groups were more successful in reflecting on the decision-making processes of others. The students who received additional training in self-regulated learning showed greater benefits in terms of metadecision aspects and reflection, and these effects remained significant two months later. Overall, our findings demonstrate that the application of decision-making strategies, combined with reflections on the decision-making process and elements of self-regulated learning, is a fruitful approach in STSE education.

Decision Making under Ambiguity and Objective Risk in Higher Age - A Review on Cognitive and Emotional Contributions.

PubMed

Liebherr, Magnus; Schiebener, Johannes; Averbeck, Heike; Brand, Matthias

2017-01-01

The ability of decision making plays a highly relevant role in our survival, but is adversely affected during the process of aging. The present review aims to provide a better understanding of age-related differences in decision making and the role of cognitive and emotional factors in this context. We reviewed the literature about age-effects on decision-making performance, focusing on decision making under ambiguous and objective risk. In decisions under ambiguous risks, as measured by the Iowa Gambling Task, decisions are based on the experiences with consequences. In this case, many articles have attributed age-related impairments in decision making to changes in emotional and somatic reward- and punishment processing. In decisions under objective risks, as measured for example by the Game of Dice Task, decisions can be based on explicit information about risks and consequences. In this case, age-related changes have been attributed mainly to a cognitive decline, particularly impaired executive functions. However, recent findings challenge these conclusions. The present review summarizes neuropsychological and neurophysiological findings of age-related differences in decision making under ambiguous and objective risk. In this context, the relevance of learning, but also of cognitive and emotional contributors - responsible for age-related differences in decision making - are additionally pointed out.

Decision Making under Ambiguity and Objective Risk in Higher Age – A Review on Cognitive and Emotional Contributions

PubMed Central

Liebherr, Magnus; Schiebener, Johannes; Averbeck, Heike; Brand, Matthias

2017-01-01

The ability of decision making plays a highly relevant role in our survival, but is adversely affected during the process of aging. The present review aims to provide a better understanding of age-related differences in decision making and the role of cognitive and emotional factors in this context. We reviewed the literature about age-effects on decision-making performance, focusing on decision making under ambiguous and objective risk. In decisions under ambiguous risks, as measured by the Iowa Gambling Task, decisions are based on the experiences with consequences. In this case, many articles have attributed age-related impairments in decision making to changes in emotional and somatic reward- and punishment processing. In decisions under objective risks, as measured for example by the Game of Dice Task, decisions can be based on explicit information about risks and consequences. In this case, age-related changes have been attributed mainly to a cognitive decline, particularly impaired executive functions. However, recent findings challenge these conclusions. The present review summarizes neuropsychological and neurophysiological findings of age-related differences in decision making under ambiguous and objective risk. In this context, the relevance of learning, but also of cognitive and emotional contributors – responsible for age-related differences in decision making – are additionally pointed out. PMID:29270145

The impact of simulation sequencing on perceived clinical decision making.

PubMed

Woda, Aimee; Hansen, Jamie; Paquette, Mary; Topp, Robert

2017-09-01

An emerging nursing education trend is to utilize simulated learning experiences as a means to optimize competency and decision making skills. The purpose of this study was to examine differences in students' perception of clinical decision making and clinical decision making-related self-confidence and anxiety based on the sequence (order) in which they participated in a block of simulated versus hospital-based learning experiences. A quasi-experimental crossover design was used. Between and within group differences were found relative to self-confidence with the decision making process. When comparing groups, at baseline the simulation followed by hospital group had significantly higher self-confidence scores, however, at 14-weeks both groups were not significantly different. Significant within group differences were found in the simulation followed by hospital group only, demonstrating a significant decrease in clinical decision making related anxiety across the semester. Finally, there were no significant difference in; perceived clinical decision making within or between the groups at the two measurement points. Preliminary findings suggest that simulated learning experiences can be offered with alternating sequences without impacting the process, anxiety or confidence with clinical decision making. This study provides beginning evidence to guide curriculum development and allow flexibility based on student needs and available resources. Copyright © 2017. Published by Elsevier Ltd.

URBAN DECISION MAKING - THE FINDINGS FROM A CONFERENCE (CHICAGO, NOVEMBER 5-12, 1965). APPLICATIONS OF HUMAN RELATIONS LABORATORY TRAINING, NUMBER 1, 1967.

ERIC Educational Resources Information Center

FRANKLIN, PAULA; FRANKLIN, RICHARD

THIS NATIONAL TRAINING LABORATORIES (NTL) CONFERENCE, DEPARTING SOMEWHAT FROM ITS USUAL EXPERIENCE-BASED LEARNING PROGRAMS, FOCUSED LABORATORY TRAINING METHODS ON THE DECISION-MAKING PROCESS IN URBAN COMMUNITY PROBLEM SOLVING. THE CONFERENCE PRESENTED THEORY, INFORMATION, AND OPINION ON THE NATURE OF CITIES AND THEIR DECISION-MAKING PROCESSES.…

On the Road to Empowerment: A Comprehensive Analysis of Teacher Involvement in Decision Making Processes.

ERIC Educational Resources Information Center

Murray, David R.; And Others

Within the arena of public school reform, teacher empowerment and participation in the decision making process at the building level are of paramount importance. A collaborative team of teacher educators and public school staff was assembled to assess various perceptions of site-based decision making throughout Georgia. A random sample of 400…

An intelligent, knowledge-based multiple criteria decision making advisor for systems design

NASA Astrophysics Data System (ADS)

Li, Yongchang

In systems engineering, design and operation of systems are two main problems which always attract researcher's attentions. The accomplishment of activities in these problems often requires proper decisions to be made so that the desired goal can be achieved, thus, decision making needs to be carefully fulfilled in the design and operation of systems. Design is a decision making process which permeates through out the design process, and is at the core of all design activities. In modern aircraft design, more and more attention is paid to the conceptual and preliminary design phases so as to increase the odds of choosing a design that will ultimately be successful at the completion of the design process, therefore, decisions made during these early design stages play a critical role in determining the success of a design. Since aerospace systems are complex systems with interacting disciplines and technologies, the Decision Makers (DMs) dealing with such design problems are involved in balancing the multiple, potentially conflicting attributes/criteria, transforming a large amount of customer supplied guidelines into a solidly defined set of requirement definitions. Thus, one could state with confidence that modern aerospace system design is a Multiple Criteria Decision Making (MCDM) process. A variety of existing decision making methods are available to deal with this type of decision problems. The selection of the most appropriate decision making method is of particular importance since inappropriate decision methods are likely causes of misleading engineering design decisions. With no sufficient knowledge about each of the methods, it is usually difficult for the DMs to find an appropriate analytical model capable of solving their problems. In addition, with the complexity of the decision problem and the demand for more capable methods increasing, new decision making methods are emerging with time. These various methods exacerbate the difficulty of the selection of an appropriate decision making method. Furthermore, some DMs may be exclusively using one or two specific methods which they are familiar with or trust and not realizing that they may be inappropriate to handle certain classes of the problems, thus yielding erroneous results. These issues reveal that in order to ensure a good decision a suitable decision method should be chosen before the decision making process proceeds. The first part of this dissertation proposes an MCDM process supported by an intelligent, knowledge-based advisor system referred to as Multi-Criteria Interactive Decision-Making Advisor and Synthesis process (MIDAS), which is able to facilitate the selection of the most appropriate decision making method and which provides insight to the user for fulfilling different preferences. The second part of this dissertation presents an autonomous decision making advisor which is capable of dealing with ever-evolving real time information and making autonomous decisions under uncertain conditions. The advisor encompasses a Markov Decision Process (MDP) formulation which takes uncertainty into account when determines the best action for each system state. (Abstract shortened by UMI.)

Chronic motivational state interacts with task reward structure in dynamic decision-making.

PubMed

Cooper, Jessica A; Worthy, Darrell A; Maddox, W Todd

2015-12-01

Research distinguishes between a habitual, model-free system motivated toward immediately rewarding actions, and a goal-directed, model-based system motivated toward actions that improve future state. We examined the balance of processing in these two systems during state-based decision-making. We tested a regulatory fit hypothesis (Maddox & Markman, 2010) that predicts that global trait motivation affects the balance of habitual- vs. goal-directed processing but only through its interaction with the task framing as gain-maximization or loss-minimization. We found support for the hypothesis that a match between an individual's chronic motivational state and the task framing enhances goal-directed processing, and thus state-based decision-making. Specifically, chronic promotion-focused individuals under gain-maximization and chronic prevention-focused individuals under loss-minimization both showed enhanced state-based decision-making. Computational modeling indicates that individuals in a match between global chronic motivational state and local task reward structure engaged more goal-directed processing, whereas those in a mismatch engaged more habitual processing. Copyright © 2015 Elsevier Inc. All rights reserved.

Towards a Transparent, Credible, Evidence-Based Decision-Making Process of New Drug Listing on the Hong Kong Hospital Authority Drug Formulary: Challenges and Suggestions.

PubMed

Wong, Carlos King Ho; Wu, Olivia; Cheung, Bernard M Y

2018-02-01

The aim of this article is to describe the process, evaluation criteria, and possible outcomes of decision-making for new drugs listed in the Hong Kong Hospital Authority Drug Formulary in comparison to the health technology assessment (HTA) policy overseas. Details of decision-making processes including the new drug listing submission, Drug Advisory Committee (DAC) meeting, and procedures prior to and following the meeting, were extracted from the official Hong Kong Hospital Authority drug formulary management website and manual. Publicly-available information related to the new drug decision-making process for five HTA agencies [the National Institute of Health and Care Excellence (NICE), the Scottish Medicines Consortium (SMC), the Australia Pharmaceutical Benefits Advisory Committee (PBAC), the Canadian Agency for Drugs and Technologies in Health (CADTH), and the New Zealand Pharmaceutical Management Agency (PHARMAC)] were reviewed and retrieved from official documents from public domains. The DAC is in charge of systemically and critically appraising new drugs before they are listed on the formulary, reviewing submitted applications, and making the decision to list the drug based on scientific evidence to which safety, efficacy, and cost-effectiveness are the primary considerations. When compared with other HTA agencies, transparency of the decision-making process of the DAC, the relevance of clinical and health economic evidence, and the lack of health economic and methodological input of submissions are the major challenges to the new-drug listing policy in Hong Kong. Despite these challenges, this review provides suggestions for the establishment of a more transparent, credible, and evidence-based decision-making process in the Hong Kong Hospital Authority Drug Formulary. Proposals for improvement in the listing of new drugs in the formulary should be a priority of healthcare reforms.

Science and intuition: do both have a place in clinical decision making?

PubMed

Pearson, Helen

Intuition is widely used in clinical decision making yet its use is underestimated compared to scientific decision-making methods. Information processing is used within scientific decision making and is methodical and analytical, whereas intuition relies more on a practitioner's perception. Intuition is an unconscious process and may be referred to as a 'sixth sense', 'hunch' or 'gut feeling'. It is not underpinned by valid and reliable measures. Expert health professionals use a rapid, automatic process to recognise familiar problems instantly. Intuition could therefore involve pattern recognition, where experts draw on experiences, so could be perceived as a cognitive skill rather than a perception or knowing without knowing how. The NHS places great importance on evidence-based practice but intuition is seemingly becoming an acceptable way of thinking and knowing in clinical decision making. Recognising nursing as an art allows intuition to be used and the environment or situation to be interpreted to help inform decision making. Intuition can be used in conjunction with evidence-based practice and to achieve good outcomes and deserves to be acknowledged within clinical practice.

The influence of expert opinions on the selection of wastewater treatment alternatives: a group decision-making approach.

PubMed

Kalbar, Pradip P; Karmakar, Subhankar; Asolekar, Shyam R

2013-10-15

The application of multiple-attribute decision-making (MADM) to real life decision problems suggests that avoiding the loss of information through scenario-based approaches and including expert opinions in the decision-making process are two major challenges that require more research efforts. Recently, a wastewater treatment technology selection effort has been made with a 'scenario-based' method of MADM. This paper focuses on a novel approach to incorporate expert opinions into the scenario-based decision-making process, as expert opinions play a major role in the selection of treatment technologies. The sets of criteria and the indicators that are used consist of both qualitative and quantitative criteria. The group decision-making (GDM) approach that is implemented for aggregating expert opinions is based on an analytical hierarchy process (AHP), which is the most widely used MADM method. The pairwise comparison matrices (PCMs) for qualitative criteria are formed based on expert opinions, whereas, a novel approach is proposed for generating PCMs for quantitative criteria. It has been determined that the experts largely prefer natural treatment systems because they are more sustainable in any scenario. However, PCMs based on expert opinions suggest that advanced technologies such as the sequencing batch reactor (SBR) can also be appropriate for a given decision scenario. The proposed GDM approach is a rationalized process that will be more appropriate in realistic scenarios where multiple stakeholders with local and regional societal priorities are involved in the selection of treatment technology. Copyright © 2013 Elsevier Ltd. All rights reserved.

Risk-taking and decision-making in youth: relationships to addiction vulnerability

PubMed Central

Balogh, Kornelia N.; Mayes, Linda C.; Potenza, Marc N.

2013-01-01

Background Decision-making and risk-taking behavior undergo developmental changes during adolescence. Disadvantageous decision-making and increased risk-taking may lead to problematic behaviors such as substance use and abuse, pathological gambling and excessive internet use. Methods Based on MEDLINE searches, this article reviews the literature on decision-making and risk-taking and their relationship to addiction vulnerability in youth. Results Decision-making and risk-taking behaviors involve brain areas that undergoing developmental changes during puberty and young adulthood. Individual differences and peer pressure also relate importantly to decision-making and risk-taking. Conclusions Brain-based changes in emotional, motivational and cognitive processing may underlie risk-taking and decision-making propensities in adolescence, making this period a time of heightened vulnerability for engagement in additive behaviors. PMID:24294500

General Formalism of Decision Making Based on Theory of Open Quantum Systems

NASA Astrophysics Data System (ADS)

Asano, M.; Ohya, M.; Basieva, I.; Khrennikov, A.

2013-01-01

We present the general formalism of decision making which is based on the theory of open quantum systems. A person (decision maker), say Alice, is considered as a quantum-like system, i.e., a system which information processing follows the laws of quantum information theory. To make decision, Alice interacts with a huge mental bath. Depending on context of decision making this bath can include her social environment, mass media (TV, newspapers, INTERNET), and memory. Dynamics of an ensemble of such Alices is described by Gorini-Kossakowski-Sudarshan-Lindblad (GKSL) equation. We speculate that in the processes of evolution biosystems (especially human beings) designed such "mental Hamiltonians" and GKSL-operators that any solution of the corresponding GKSL-equation stabilizes to a diagonal density operator (In the basis of decision making.) This limiting density operator describes population in which all superpositions of possible decisions has already been resolved. In principle, this approach can be used for the prediction of the distribution of possible decisions in human populations.

Parallel constraint satisfaction in memory-based decisions.

PubMed

Glöckner, Andreas; Hodges, Sara D

2011-01-01

Three studies sought to investigate decision strategies in memory-based decisions and to test the predictions of the parallel constraint satisfaction (PCS) model for decision making (Glöckner & Betsch, 2008). Time pressure was manipulated and the model was compared against simple heuristics (take the best and equal weight) and a weighted additive strategy. From PCS we predicted that fast intuitive decision making is based on compensatory information integration and that decision time increases and confidence decreases with increasing inconsistency in the decision task. In line with these predictions we observed a predominant usage of compensatory strategies under all time-pressure conditions and even with decision times as short as 1.7 s. For a substantial number of participants, choices and decision times were best explained by PCS, but there was also evidence for use of simple heuristics. The time-pressure manipulation did not significantly affect decision strategies. Overall, the results highlight intuitive, automatic processes in decision making and support the idea that human information-processing capabilities are less severely bounded than often assumed.

Shared Decision Making in ICUs: An American College of Critical Care Medicine and American Thoracic Society Policy Statement.

PubMed

Kon, Alexander A; Davidson, Judy E; Morrison, Wynne; Danis, Marion; White, Douglas B

2016-01-01

Shared decision making is endorsed by critical care organizations; however, there remains confusion about what shared decision making is, when it should be used, and approaches to promote partnerships in treatment decisions. The purpose of this statement is to define shared decision making, recommend when shared decision making should be used, identify the range of ethically acceptable decision-making models, and present important communication skills. The American College of Critical Care Medicine and American Thoracic Society Ethics Committees reviewed empirical research and normative analyses published in peer-reviewed journals to generate recommendations. Recommendations approved by consensus of the full Ethics Committees of American College of Critical Care Medicine and American Thoracic Society were included in the statement. Six recommendations were endorsed: 1) DEFINITION: Shared decision making is a collaborative process that allows patients, or their surrogates, and clinicians to make healthcare decisions together, taking into account the best scientific evidence available, as well as the patient's values, goals, and preferences. 2) Clinicians should engage in a shared decision making process to define overall goals of care (including decisions regarding limiting or withdrawing life-prolonging interventions) and when making major treatment decisions that may be affected by personal values, goals, and preferences. 3) Clinicians should use as their "default" approach a shared decision making process that includes three main elements: information exchange, deliberation, and making a treatment decision. 4) A wide range of decision-making approaches are ethically supportable, including patient- or surrogate-directed and clinician-directed models. Clinicians should tailor the decision-making process based on the preferences of the patient or surrogate. 5) Clinicians should be trained in communication skills. 6) Research is needed to evaluate decision-making strategies. Patient and surrogate preferences for decision-making roles regarding value-laden choices range from preferring to exercise significant authority to ceding such authority to providers. Clinicians should adapt the decision-making model to the needs and preferences of the patient or surrogate.

Balancing emotion and cognition: a case for decision aiding in conservation efforts.

PubMed

Wilson, Robyn S

2008-12-01

Despite advances in the quality of participatory decision making for conservation, many current efforts still suffer from an inability to bridge the gap between science and policy. Judgment and decision-making research suggests this gap may result from a person's reliance on affect-based shortcuts in complex decision contexts. I examined the results from 3 experiments that demonstrate how affect (i.e., the instantaneous reaction one has to a stimulus) influences individual judgments in these contexts and identified techniques from the decision-aiding literature that help encourage a balance between affect-based emotion and cognition in complex decision processes. In the first study, subjects displayed a lack of focus on their stated conservation objectives and made decisions that reflected their initial affective impressions. Value-focused approaches may help individuals incorporate all the decision-relevant objectives by making the technical and value-based objectives more salient. In the second study, subjects displayed a lack of focus on statistical risk and again made affect-based decisions. Trade-off techniques may help individuals incorporate relevant technical data, even when it conflicts with their initial affective impressions or other value-based objectives. In the third study, subjects displayed a lack of trust in decision-making authorities when the decision involved a negatively affect-rich outcome (i.e., a loss). Identifying shared salient values and increasing procedural fairness may help build social trust in both decision-making authorities and the decision process.

Distinction between Externally vs. Internally Guided Decision-Making: Operational Differences, Meta-Analytical Comparisons and Their Theoretical Implications

PubMed Central

Nakao, Takashi; Ohira, Hideki; Northoff, Georg

2012-01-01

Most experimental studies of decision-making have specifically examined situations in which a single less-predictable correct answer exists (externally guided decision-making under uncertainty). Along with such externally guided decision-making, there are instances of decision-making in which no correct answer based on external circumstances is available for the subject (internally guided decision-making). Such decisions are usually made in the context of moral decision-making as well as in preference judgment, where the answer depends on the subject’s own, i.e., internal, preferences rather than on external, i.e., circumstantial, criteria. The neuronal and psychological mechanisms that allow guidance of decisions based on more internally oriented criteria in the absence of external ones remain unclear. This study was undertaken to compare decision-making of these two kinds empirically and theoretically. First, we reviewed studies of decision-making to clarify experimental–operational differences between externally guided and internally guided decision-making. Second, using multi-level kernel density analysis, a whole-brain-based quantitative meta-analysis of neuroimaging studies was performed. Our meta-analysis revealed that the neural network used predominantly for internally guided decision-making differs from that for externally guided decision-making under uncertainty. This result suggests that studying only externally guided decision-making under uncertainty is insufficient to account for decision-making processes in the brain. Finally, based on the review and results of the meta-analysis, we discuss the differences and relations between decision-making of these two types in terms of their operational, neuronal, and theoretical characteristics. PMID:22403525

Decision-making in nursing practice: An integrative literature review.

PubMed

Nibbelink, Christine W; Brewer, Barbara B

2018-03-01

To identify and summarise factors and processes related to registered nurses' patient care decision-making in medical-surgical environments. A secondary goal of this literature review was to determine whether medical-surgical decision-making literature included factors that appeared to be similar to concepts and factors in naturalistic decision making (NDM). Decision-making in acute care nursing requires an evaluation of many complex factors. While decision-making research in acute care nursing is prevalent, errors in decision-making continue to lead to poor patient outcomes. Naturalistic decision making may provide a framework for further exploring decision-making in acute care nursing practice. A better understanding of the literature is needed to guide future research to more effectively support acute care nurse decision-making. PubMed and CINAHL databases were searched, and research meeting criteria was included. Data were identified from all included articles, and themes were developed based on these data. Key findings in this review include nursing experience and associated factors; organisation and unit culture influences on decision-making; education; understanding patient status; situation awareness; and autonomy. Acute care nurses employ a variety of decision-making factors and processes and informally identify experienced nurses to be important resources for decision-making. Incorporation of evidence into acute care nursing practice continues to be a struggle for acute care nurses. This review indicates that naturalistic decision making may be applicable to decision-making nursing research. Experienced nurses bring a broad range of previous patient encounters to their practice influencing their intuitive, unconscious processes which facilitates decision-making. Using naturalistic decision making as a conceptual framework to guide research may help with understanding how to better support less experienced nurses' decision-making for enhanced patient outcomes. © 2017 John Wiley & Sons Ltd.

Clinical errors that can occur in the treatment decision-making process in psychotherapy.

PubMed

Park, Jake; Goode, Jonathan; Tompkins, Kelley A; Swift, Joshua K

2016-09-01

Clinical errors occur in the psychotherapy decision-making process whenever a less-than-optimal treatment or approach is chosen when working with clients. A less-than-optimal approach may be one that a client is unwilling to try or fully invest in based on his/her expectations and preferences, or one that may have little chance of success based on contraindications and/or limited research support. The doctor knows best and the independent choice models are two decision-making models that are frequently used within psychology, but both are associated with an increased likelihood of errors in the treatment decision-making process. In particular, these models fail to integrate all three components of the definition of evidence-based practice in psychology (American Psychological Association, 2006). In this article we describe both models and provide examples of clinical errors that can occur in each. We then introduce the shared decision-making model as an alternative that is less prone to clinical errors. PsycINFO Database Record (c) 2016 APA, all rights reserved

Beyond Bioethics: A Child Rights-Based Approach to Complex Medical Decision-Making.

PubMed

Wade, Katherine; Melamed, Irene; Goldhagen, Jeffrey

2016-01-01

This analysis adopts a child rights approach-based on the principles, standards, and norms of child rights and the U.N. Convention on the Rights of the Child (CRC)-to explore how decisions could be made with regard to treatment of a severely impaired infant (Baby G). While a child rights approach does not provide neat answers to ethically complex issues, it does provide a framework for decision-making in which the infant is viewed as an independent rights-holder. The state has obligations to develop the capacity of those who make decisions for infants in such situations to meet their obligations to respect, protect, and fulfill their rights as delineated in the CRC. Furthermore, a child rights approach requires procedural clarity and transparency in decision-making processes. As all rights in the CRC are interdependent and indivisible, all must be considered in the process of ethical decision-making, and the reasons for decisions must be delineated by reference to how these rights were considered. It is also important that decisions that are made in this context be monitored and reviewed to ensure consistency. A rights-based framework ensures decision-making is child-centered and that there are transparent criteria and legitimate procedures for making decisions regarding the child's most basic human right: the right to life, survival, and development.

Decision-making in schizophrenia: A predictive-coding perspective.

PubMed

Sterzer, Philipp; Voss, Martin; Schlagenhauf, Florian; Heinz, Andreas

2018-05-31

Dysfunctional decision-making has been implicated in the positive and negative symptoms of schizophrenia. Decision-making can be conceptualized within the framework of hierarchical predictive coding as the result of a Bayesian inference process that uses prior beliefs to infer states of the world. According to this idea, prior beliefs encoded at higher levels in the brain are fed back as predictive signals to lower levels. Whenever these predictions are violated by the incoming sensory data, a prediction error is generated and fed forward to update beliefs encoded at higher levels. Well-documented impairments in cognitive decision-making support the view that these neural inference mechanisms are altered in schizophrenia. There is also extensive evidence relating the symptoms of schizophrenia to aberrant signaling of prediction errors, especially in the domain of reward and value-based decision-making. Moreover, the idea of altered predictive coding is supported by evidence for impaired low-level sensory mechanisms and motor processes. We review behavioral and neural findings from these research areas and provide an integrated view suggesting that schizophrenia may be related to a pervasive alteration in predictive coding at multiple hierarchical levels, including cognitive and value-based decision-making processes as well as sensory and motor systems. We relate these findings to decision-making processes and propose that varying degrees of impairment in the implicated brain areas contribute to the variety of psychotic experiences. Copyright © 2018 Elsevier Inc. All rights reserved.

Parental decision-making after ultrasound diagnosis of a serious foetal abnormality.

PubMed

Bijma, Hilmar H; Wildschut, Hajo I J; van der Heide, Agnes; Passchier, Jan; Wladimiroff, Juriy W; van der Maas, Paul J

2005-01-01

The purpose of this article is to provide clinicians who are involved in the field of foetal medicine with a comprehensive overview of theories that are relevant for the parental decision-making process after ultrasound diagnosis of a serious foetal abnormality. Since little data are available of parental decision-making after ultrasound diagnosis of foetal abnormality, we reviewed the literature on parental decision-making in genetic counselling of couples at increased genetic risk together with the literature on general decision-making theories. The findings were linked to the specific situation of parental decision-making after an ultrasound diagnosis of foetal abnormality. Based on genetic counselling studies, several cognitive mechanisms play a role in parental decision-making regarding future pregnancies. Parents often have a binary perception of risk. Probabilistic information is translated into two options: the child will or will not be affected. The graduality of chance seems to be of little importance in this process. Instead, the focus shifts to the possible consequences for future family life. General decision-making theories often focus on rationality and coherence of the decision-making process. However, studies of both the influence of framing and the influence of stress indicate that emotional mechanisms can have an important and beneficial function in the decision-making process. Cognitive mechanisms that are elicited by emotions and that are not necessarily rational can have an important and beneficial function in parental decision-making after ultrasound diagnosis of a foetal abnormality. Consequently, the process of parental decision-making should not solely be assessed on the basis of its rationality, but also on the basis of the parental emotional outcome. Copyright (c) 2005 S. Karger AG, Basel.

[Patients' preferences and experience regarding participation in nursing care decisions in acute hospitals--an analysis of conformity of preferences and experience, and factors influencing different types of decision making].

PubMed

Smoliner, Andrea; Hantikainen, Virpi; Mayer, Hanna; Ponocny-Seliger, Elisabeth; Them, Christa

2009-12-01

Patients' preferences regarding their participation in nursing care decisions represent a key aspect of the concept of evidence-based nursing; nonetheless, very little quantitative research has been carried out in this area. The aim of the present study was to describe the patients' preferences and experience concerning their participation in nursing care decision-making processes in acute hospitals. A total of 967 patients in five hospitals in Vienna participated in this study by completing questionnaires. The results revealed that 38.5 % of patients preferred the paternalistic style of decision-making, 42.1 % wanted to make decisions together with the nursing staff and 5.7 % expressed a wish to make their own decisions. During their hospital stay, however, patients experienced paternalistic decision-making to a higher degree than they wished for. Age, sex, form of treatment and subjectively experienced health condition represented person-related characteristics that influenced preferences regarding the form of decision-making. The results of this study underline the importance of collecting data on patients' preferences in decision-making processes in order to meet the social, legal, and professional demands of patient-oriented nursing care based on the most recent scientific knowledge.

Cognitive processes in anesthesiology decision making.

PubMed

Stiegler, Marjorie Podraza; Tung, Avery

2014-01-01

The quality and safety of health care are under increasing scrutiny. Recent studies suggest that medical errors, practice variability, and guideline noncompliance are common, and that cognitive error contributes significantly to delayed or incorrect diagnoses. These observations have increased interest in understanding decision-making psychology.Many nonrational (i.e., not purely based in statistics) cognitive factors influence medical decisions and may lead to error. The most well-studied include heuristics, preferences for certainty, overconfidence, affective (emotional) influences, memory distortions, bias, and social forces such as fairness or blame.Although the extent to which such cognitive processes play a role in anesthesia practice is unknown, anesthesia care frequently requires rapid, complex decisions that are most susceptible to decision errors. This review will examine current theories of human decision behavior, identify effects of nonrational cognitive processes on decision making, describe characteristic anesthesia decisions in this context, and suggest strategies to improve decision making.

Adult Age Differences in Dual Information Processes: Implications for the Role of Affective and Deliberative Processes in Older Adults' Decision Making.

PubMed

Peters, Ellen; Hess, Thomas M; Västfjäll, Daniel; Auman, Corinne

2007-03-01

Age differences in affective/experiential and deliberative processes have important theoretical implications for judgment and decision theory and important pragmatic implications for older-adult decision making. Age-related declines in the efficiency of deliberative processes predict poorer-quality decisions as we age. However, age-related adaptive processes, including motivated selectivity in the use of deliberative capacity, an increased focus on emotional goals, and greater experience, predict better or worse decisions for older adults depending on the situation. The aim of the current review is to examine adult age differences in affective and deliberative information processes in order to understand their potential impact on judgments and decisions. We review evidence for the role of these dual processes in judgment and decision making and then review two representative life-span perspectives (based on aging-related changes to cognitive or motivational processes) on the interplay between these processes. We present relevant predictions for older-adult decisions and make note of contradictions and gaps that currently exist in the literature. Finally, we review the sparse evidence about age differences in decision making and how theories and findings regarding dual processes could be applied to decision theory and decision aiding. In particular, we focus on prospect theory (Kahneman & Tversky, 1979) and how prospect theory and theories regarding age differences in information processing can inform one another. © 2007 Association for Psychological Science.

Building the Foundation for Data-Based Decision Making: Creating Consensus on Language and Concepts

ERIC Educational Resources Information Center

Crum, Karen

2009-01-01

Data Based Decision Making (DBDM), the process of gathering, analyzing, applying, and sharing data in order to promote school improvement, has recently become a prominent process in the quest to assist students in attaining educational success and helping schools meet accountability benchmarks (Wayman, 2005; Poynton & Carey, 2006). This…

Management Data for Selection Decisions in Building Library Collections.

ERIC Educational Resources Information Center

Hamaker, Charles A.

1992-01-01

Discusses the use of library management data, particularly circulation data, in making selection decisions for library collection development based on experiences at Louisiana State University. Development of a collection based on actual use rather than perceived research needs is considered, and the decision-making process for serials…

Training in Decision-making Strategies: An approach to enhance students' competence to deal with socio-scientific issues

NASA Astrophysics Data System (ADS)

Gresch, Helge; Hasselhorn, Marcus; Bögeholz, Susanne

2013-10-01

Dealing with socio-scientific issues in science classes enables students to participate productively in controversial discussions concerning ethical topics, such as sustainable development. In this respect, well-structured decision-making processes are essential for elaborate reasoning. To foster decision-making competence, a computer-based programme was developed that trains secondary school students (grades 11-13) in decision-making strategies. The main research question is: does training students to use these strategies foster decision-making competence? In addition, the influence of meta-decision aids was examined. Students conducted a task analysis to select an appropriate strategy prior to the decision-making process. Hence, the second research question is: does combining decision-making training with a task analysis enhance decision-making competence at a higher rate? To answer these questions, 386 students were tested in a pre-post-follow-up control-group design that included two training groups (decision-making strategies/decision-making strategies combined with a task analysis) and a control group (decision-making with additional ecological information instead of strategic training). An open-ended questionnaire was used to assess decision-making competence in situations related to sustainable development. The decision-making training led to a significant improvement in the post-test and the follow-up, which was administered three months after the training. Long-term effects on the quality of the students' decisions were evident for both training groups. Gains in competence when reflecting upon the decision-making processes of others were found, to a lesser extent, in the training group that received the additional meta-decision training. In conclusion, training in decision-making strategies is a promising approach to deal with socio-scientific issues related to sustainable development.

Models based on value and probability in health improve shared decision making.

PubMed

Ortendahl, Monica

2008-10-01

Diagnostic reasoning and treatment decisions are a key competence of doctors. A model based on values and probability provides a conceptual framework for clinical judgments and decisions, and also facilitates the integration of clinical and biomedical knowledge into a diagnostic decision. Both value and probability are usually estimated values in clinical decision making. Therefore, model assumptions and parameter estimates should be continually assessed against data, and models should be revised accordingly. Introducing parameter estimates for both value and probability, which usually pertain in clinical work, gives the model labelled subjective expected utility. Estimated values and probabilities are involved sequentially for every step in the decision-making process. Introducing decision-analytic modelling gives a more complete picture of variables that influence the decisions carried out by the doctor and the patient. A model revised for perceived values and probabilities by both the doctor and the patient could be used as a tool for engaging in a mutual and shared decision-making process in clinical work.

Vocational Choice: A Decision Making Perspective

ERIC Educational Resources Information Center

Sauermann, Henry

2005-01-01

We propose a model of vocational choice that can be used for analyzing and guiding the decision processes underlying career and job choices. Our model is based on research in behavioral decision making (BDM), in particular the choice goals framework developed by Bettman, Luce, and Payne (1998). The basic model involves two major processes. First,…

Clinical Decision-Making in Community Children's Mental Health: Using Innovative Methods to Compare Clinicians With and Without Training in Evidence-Based Treatment.

PubMed

Baker-Ericzén, Mary J; Jenkins, Melissa M; Park, Soojin; Garland, Ann F

2015-02-01

Mental health professionals' decision-making practice is an area of increasing interest and importance, especially in the pediatric research and clinical communities. The present study explored the role of prior training in evidence-based treatments on clinicians' assessment and treatment formulations using case vignettes. Specifically, study aims included using the Naturalistic Decision Making (NDM) cognitive theory to 1) examine potential associations between EBT training and decision-making processes (novice versus expert type), and 2) explore how client and family contextual information affects clinical decision-making. Forty-eight clinicians across two groups (EBT trained=14, Not EBT trained=34) participated. Clinicians were comparable on professional experience, demographics, and discipline. The quasi-experimental design used an analog "think aloud" method where clinicians read case vignettes about a child with disruptive behavior problems and verbalized case conceptualization and treatment planning out-loud. Responses were coded according to NDM theory. MANOVA results were significant for EBT training status such that EBT trained clinicians' displayed cognitive processes more closely aligned with "expert" decision-makers and non-EBT trained clinicians' decision processes were more similar to "novice" decision-makers, following NDM theory. Non-EBT trained clinicians assigned significantly more diagnoses, provided less detailed treatment plans and discussed fewer EBTs. Parent/family contextual information also appeared to influence decision-making. This study offers a preliminary investigation of the possible broader impacts of EBT training and potential associations with development of expert decision-making skills. Targeting clinicians' decision-making may be an important avenue to pursue within dissemination-implementation efforts in mental health practice.

Development of a safety decision-making scenario to measure worker safety in agriculture.

PubMed

Mosher, G A; Keren, N; Freeman, S A; Hurburgh, C R

2014-04-01

Human factors play an important role in the management of occupational safety, especially in high-hazard workplaces such as commercial grain-handling facilities. Employee decision-making patterns represent an essential component of the safety system within a work environment. This research describes the process used to create a safety decision-making scenario to measure the process that grain-handling employees used to make choices in a safety-related work task. A sample of 160 employees completed safety decision-making simulations based on a hypothetical but realistic scenario in a grain-handling environment. Their choices and the information they used to make their choices were recorded. Although the employees emphasized safety information in their decision-making process, not all of their choices were safe choices. Factors influencing their choices are discussed, and implications for industry, management, and workers are shared.

Medical Decision-Making Among Adolescents with Neonatal Brachial Plexus Palsy and their Families: A Qualitative Study

PubMed Central

Squitieri, Lee; Larson, Bradley P.; Chang, Kate W-C; Yang, Lynda J-S.; Chung, Kevin C.

2016-01-01

Background Elective surgical management of neonatal brachial plexus palsy is complex, variable, and often individualized. Little is known about the medical decision-making process among adolescents with NBPP and their families faced with making complex treatment decisions. The experiences of these patients and their parents were analyzed to identify key factors in the decision-making process. Patients and Methods Eighteen adolescents with residual NBPP deficits between the ages of 10 to 17 years along with their parents were included in the present study. A qualitative research design was employed involving the use of separate one hour, in person, semi-structured interviews, which were audio recorded and transcribed. Grounded theory was applied by two independent members of the research team to identify recurrent themes and ultimately create a codebook that was then applied to the data. Results Medical decision-making among adolescents with NBPP and their families is multifaceted and individualized, comprised of both patient and system dependent factors. Four codes pertaining to the medical decision-making process were identified: 1) knowledge acquisition, 2) multidisciplinary care, 3) adolescent autonomy, and 4) patient expectations and treatment desires. Overall, parental decision-making was heavily influenced by system dependent factors, while adolescents largely based their medical decision-making on individual treatment desires to improve function and/or aesthetics. Conclusions There are many areas for improving the delivery of information and health care organization among adolescents with NBPP and their families. We recommend the development of educational interdisciplinary programs and decision aids containing evidence-based management guidelines targeted toward primary care providers and patients. We believe that a computer-based learning module may provide the best avenue to achieve maximum penetrance and convenience of information sharing. PMID:23714810

Fuzzy methods in decision making process - A particular approach in manufacturing systems

NASA Astrophysics Data System (ADS)

Coroiu, A. M.

2015-11-01

We are living in a competitive environment, so we can see and understand that the most of manufacturing firms do the best in order to accomplish meeting demand, increasing quality, decreasing costs, and delivery rate. In present a stake point of interest is represented by the development of fuzzy technology. A particular approach for this is represented through the development of methodologies to enhance the ability to managed complicated optimization and decision making aspects involving non-probabilistic uncertainty with the reason to understand, development, and practice the fuzzy technologies to be used in fields such as economic, engineering, management, and societal problems. Fuzzy analysis represents a method for solving problems which are related to uncertainty and vagueness; it is used in multiple areas, such as engineering and has applications in decision making problems, planning and production. As a definition for decision making process we can use the next one: result of mental processes based upon cognitive process with a main role in the selection of a course of action among several alternatives. Every process of decision making can be represented as a result of a final choice and the output can be represented as an action or as an opinion of choice. Different types of uncertainty can be discovered in a wide variety of optimization and decision making problems related to planning and operation of power systems and subsystems. The mixture of the uncertainty factor in the construction of different models serves for increasing their adequacy and, as a result, the reliability and factual efficiency of decisions based on their analysis. Another definition of decision making process which came to illustrate and sustain the necessity of using fuzzy method: the decision making is an approach of choosing a strategy among many different projects in order to achieve some purposes and is formulated as three different models: high risk decision, usual risk decision and low risk decision - some specific formulas of fuzzy logic. The fuzzy set concepts has some certain parameterization features which are certain extensions of crisp and fuzzy relations respectively and have a rich potential for application to the decision making problems. The proposed approach from this paper presents advantages of fuzzy approach, in comparison with other paradigm and presents a particular way in which fuzzy logic can emerge in decision making process and planning process with implication, as a simulation, in manufacturing - involved in measuring performance of advanced manufacturing systems. Finally, an example is presented to illustrate our simulation.

Enhancing clinical decision making: development of a contiguous definition and conceptual framework.

PubMed

Tiffen, Jennifer; Corbridge, Susan J; Slimmer, Lynda

2014-01-01

Clinical decision making is a term frequently used to describe the fundamental role of the nurse practitioner; however, other terms have been used interchangeably. The purpose of this article is to begin the process of developing a definition and framework of clinical decision making. The developed definition was "Clinical decision making is a contextual, continuous, and evolving process, where data are gathered, interpreted, and evaluated in order to select an evidence-based choice of action." A contiguous framework for clinical decision making specific for nurse practitioners is also proposed. Having a clear and unique understanding of clinical decision making will allow for consistent use of the term, which is relevant given the changing educational requirements for nurse practitioners and broadening scope of practice. Copyright © 2014 Elsevier Inc. All rights reserved.

What is on your mind? Using the perceptual cycle model and critical decision method to understand the decision-making process in the cockpit.

PubMed

Plant, Katherine L; Stanton, Neville A

2013-01-01

Aeronautical decision-making is complex as there is not always a clear coupling between the decision made and decision outcome. As such, there is a call for process-orientated decision research in order to understand why a decision made sense at the time it was made. Schema theory explains how we interact with the world using stored mental representations and forms an integral part of the perceptual cycle model (PCM); proposed here as a way to understand the decision-making process. This paper qualitatively analyses data from the critical decision method (CDM) based on the principles of the PCM. It is demonstrated that the approach can be used to understand a decision-making process and highlights how influential schemata can be at informing decision-making. The reliability of this approach is established, the general applicability is discussed and directions for future work are considered. This paper introduces the PCM, and the associated schema theory, as a framework to structure and explain data collected from the CDM. The reliability of both the method and coding scheme is addressed.

Testing the Intelligence of Unmanned Autonomous Systems

DTIC Science & Technology

2008-01-01

decisions without the operator. The term autonomous is also used interchangeably with intelligent, giving rise to the name unmanned autonomous system ( UAS ...For the purposes of this article, UAS describes an unmanned system that makes decisions based on gathered information. Because testers should not...make assumptions about the decision process within a UAS , there is a need for a methodology that completely tests this decision process without biasing

Potential mechanisms contributing to decision-making difficulties in late adulthood.

PubMed

McCarrey, Anna C; Henry, Julie D; Luszcz, Mary

2010-01-01

This paper critiques Brand and Markowitsch's viewpoint that the decision-making difficulties experienced by older adults during laboratory-based gambling tasks can be attributed to deficits in executive control and feedback operations. While Brand and Markowitsch provide an important platform with which to understand the role of these specific component processes, there are other additional mechanisms that also seem likely to be important when understanding gambling decisions in late adulthood. We focus on several of these mechanisms, and in particular, the manner in which decision-relevant information is received, the role of changes in emotion and motivation (with particular reference to Socioemotional Selectivity Theory), and changes in autobiographical memory that may affect understanding how decision-making during gambling occurs in late adulthood. By building on the cognitive-based and emotion-based processes that Brand and Markowitsch mention as important in decision-making by the aged, our critique highlights avenues for future research in this important area. Copyright 2010 S. Karger AG, Basel.

An Analysis of the Associations among Cognitive Impulsiveness, Reasoning Process, and Rational Decision Making

PubMed Central

Jelihovschi, Ana P. G.; Cardoso, Ricardo L.; Linhares, Alexandre

2018-01-01

Impulsivity may lead to several unfortunate consequences and maladaptive behaviors for both clinical and nonclinical people. It has a key role in many forms of psychopathology. Although literature has discussed the negative impact of impulsivity, few have emphasized the relationship between cognitive impulsiveness and decision making. The aim of this study is to investigate the effects of cognitive impulsiveness on decision making and explore the strategies used by participants to solve problems. For this purpose, we apply two measures of impulsivity: the self-report Barratt Impulsiveness Scale (BIS-11) and the performance based Cognitive Reflection Test (CRT). Moreover, we evaluate participants' reasoning processes employed to answer CRT questions based on the calculation expressions, data organization, and erasures they made while answering the CRT (note that we utilized the instruments using pen and paper). These reasoning processes are related to the role of executive functions in decision making, and its relationship with impulsiveness. The sample consists of 191 adults, who were either professionals or undergraduate students from the fields of business, management, or accounting. The results show that cognitive impulsiveness may negatively affect decision making, and that those who presented the calculation to answer the CRT questions made better decisions. Moreover, there was no difference in the strategies used by impulsive vs. nonimpulsive participants during decision making. Finally, people who inhibited their immediate answers to CRT questions performed better during decision making. PMID:29375440

An Analysis of the Associations among Cognitive Impulsiveness, Reasoning Process, and Rational Decision Making.

PubMed

Jelihovschi, Ana P G; Cardoso, Ricardo L; Linhares, Alexandre

2017-01-01

Impulsivity may lead to several unfortunate consequences and maladaptive behaviors for both clinical and nonclinical people. It has a key role in many forms of psychopathology. Although literature has discussed the negative impact of impulsivity, few have emphasized the relationship between cognitive impulsiveness and decision making. The aim of this study is to investigate the effects of cognitive impulsiveness on decision making and explore the strategies used by participants to solve problems. For this purpose, we apply two measures of impulsivity: the self-report Barratt Impulsiveness Scale (BIS-11) and the performance based Cognitive Reflection Test (CRT). Moreover, we evaluate participants' reasoning processes employed to answer CRT questions based on the calculation expressions, data organization, and erasures they made while answering the CRT (note that we utilized the instruments using pen and paper). These reasoning processes are related to the role of executive functions in decision making, and its relationship with impulsiveness. The sample consists of 191 adults, who were either professionals or undergraduate students from the fields of business, management, or accounting. The results show that cognitive impulsiveness may negatively affect decision making, and that those who presented the calculation to answer the CRT questions made better decisions. Moreover, there was no difference in the strategies used by impulsive vs. nonimpulsive participants during decision making. Finally, people who inhibited their immediate answers to CRT questions performed better during decision making.

Zero-Based Budgeting.

ERIC Educational Resources Information Center

Wichowski, Chester

1979-01-01

The zero-based budgeting approach is designed to achieve the greatest benefit with the fewest undesirable consequences. Seven basic steps make up the zero-based decision-making process: (1) identifying program goals, (2) classifying goals, (3) identifying resources, (4) reviewing consequences, (5) developing decision packages, (6) implementing a…

Navigating the Decision Space: Shared Medical Decision Making as Distributed Cognition.

PubMed

Lippa, Katherine D; Feufel, Markus A; Robinson, F Eric; Shalin, Valerie L

2017-06-01

Despite increasing prominence, little is known about the cognitive processes underlying shared decision making. To investigate these processes, we conceptualize shared decision making as a form of distributed cognition. We introduce a Decision Space Model to identify physical and social influences on decision making. Using field observations and interviews, we demonstrate that patients and physicians in both acute and chronic care consider these influences when identifying the need for a decision, searching for decision parameters, making actionable decisions Based on the distribution of access to information and actions, we then identify four related patterns: physician dominated; physician-defined, patient-made; patient-defined, physician-made; and patient-dominated decisions. Results suggests that (a) decision making is necessarily distributed between physicians and patients, (b) differential access to information and action over time requires participants to transform a distributed task into a shared decision, and (c) adverse outcomes may result from failures to integrate physician and patient reasoning. Our analysis unifies disparate findings in the medical decision-making literature and has implications for improving care and medical training.

The Multifold Relationship Between Memory and Decision Making: An Individual-differences Study

PubMed Central

Del Missier, Fabio; Mäntylä, Timo; Hansson, Patrik; Bruine de Bruin, Wändi; Parker, Andrew M.; Nilsson, Lars-Göran

2014-01-01

Several judgment and decision-making tasks are assumed to involve memory functions, but significant knowledge gaps on the memory processes underlying these tasks remain. In a study on 568 adults between 25 to 80 years, hypotheses were tested on the specific relationships between individual differences in working memory, episodic memory, and semantic memory, respectively, and six main components of decision-making competence. In line with the hypotheses, working memory was positively related with the more cognitively-demanding tasks (Resistance to Framing, Applying Decision Rules, and Under/Overconfidence), whereas episodic memory was positively associated with a more experience-based judgment task (Recognizing Social Norms). Furthermore, semantic memory was positively related with two more knowledge-based decision-making tasks (Consistency in Risk Perception and Resistance to Sunk Costs). Finally, the age-related decline observed in some of the decision-making tasks was (partially or totally) mediated by the age-related decline in working memory or episodic memory. These findings are discussed in relation to the functional roles fulfilled by different memory processes in judgment and decision-making tasks. PMID:23565790

Deliberation before determination: the definition and evaluation of good decision making.

PubMed

Elwyn, Glyn; Miron-Shatz, Talya

2010-06-01

In this article, we examine definitions of suggested approaches to measure the concept of good decisions, highlight the ways in which they converge, and explain why we have concerns about their emphasis on post-hoc estimations and post-decisional outcomes, their prescriptive concept of knowledge, and their lack of distinction between the process of deliberation, and the act of decision determination. There has been a steady trend to involve patients in decision making tasks in clinical practice, part of a shift away from paternalism towards the concept of informed choice. An increased understanding of the uncertainties that exist in medicine, arising from a weak evidence base and, in addition, the stochastic nature of outcomes at the individual level, have contributed to shifting the responsibility for decision making from physicians to patients. This led to increasing use of decision support and communication methods, with the ultimate aim of improving decision making by patients. Interest has therefore developed in attempting to define good decision making and in the development of measurement approaches. We pose and reflect whether decisions can be judged good or not, and, if so, how this goodness might be evaluated. We hypothesize that decisions cannot be measured by reference to their outcomes and offer an alternative means of assessment, which emphasizes the deliberation process rather than the decision's end results. We propose decision making comprises a pre-decisional process and an act of decision determination and consider how this model of decision making serves to develop a new approach to evaluating what constitutes a good decision making process. We proceed to offer an alternative, which parses decisions into the pre-decisional deliberation process, the act of determination and post-decisional outcomes. Evaluating the deliberation process, we propose, should comprise of a subjective sufficiency of knowledge, as well as emotional processing and affective forecasting of the alternatives. This should form the basis for a good act of determination.

Housing decision making methods for initiation development phase process

NASA Astrophysics Data System (ADS)

Zainal, Rozlin; Kasim, Narimah; Sarpin, Norliana; Wee, Seow Ta; Shamsudin, Zarina

2017-10-01

Late delivery and sick housing project problems were attributed to poor decision making. These problems are the string of housing developer that prefers to create their own approach based on their experiences and expertise with the simplest approach by just applying the obtainable standards and rules in decision making. This paper seeks to identify the decision making methods for housing development at the initiation phase in Malaysia. The research involved Delphi method by using questionnaire survey which involved 50 numbers of developers as samples for the primary stage of collect data. However, only 34 developers contributed to the second stage of the information gathering process. At the last stage, only 12 developers were left for the final data collection process. Finding affirms that Malaysian developers prefer to make their investment decisions based on simple interpolation of historical data and using simple statistical or mathematical techniques in producing the required reports. It was suggested that they seemed to skip several important decision-making functions at the primary development stage. These shortcomings were mainly due to time and financial constraints and the lack of statistical or mathematical expertise among the professional and management groups in the developer organisations.

Eating and drinking interventions for people at risk of lacking decision-making capacity: who decides and how?

PubMed

Clarke, Gemma; Galbraith, Sarah; Woodward, Jeremy; Holland, Anthony; Barclay, Stephen

2015-06-11

Some people with progressive neurological diseases find they need additional support with eating and drinking at mealtimes, and may require artificial nutrition and hydration. Decisions concerning artificial nutrition and hydration at the end of life are ethically complex, particularly if the individual lacks decision-making capacity. Decisions may concern issues of life and death: weighing the potential for increasing morbidity and prolonging suffering, with potentially shortening life. When individuals lack decision-making capacity, the standard processes of obtaining informed consent for medical interventions are disrupted. Increasingly multi-professional groups are being utilised to make difficult ethical decisions within healthcare. This paper reports upon a service evaluation which examined decision-making within a UK hospital Feeding Issues Multi-Professional Team. A three month observation of a hospital-based multi-professional team concerning feeding issues, and a one year examination of their records. The key research questions are: a) How are decisions made concerning artificial nutrition for individuals at risk of lacking decision-making capacity? b) What are the key decision-making factors that are balanced? c) Who is involved in the decision-making process? Decision-making was not a singular decision, but rather involved many different steps. Discussions involving relatives and other clinicians, often took place outside of meetings. Topics of discussion varied but the outcome relied upon balancing the information along four interdependent axes: (1) Risks, burdens and benefits; (2) Treatment goals; (3) Normative ethical values; (4) Interested parties. Decision-making was a dynamic ongoing process with many people involved. The multiple points of decision-making, and the number of people involved with the decision-making process, mean the question of 'who decides' cannot be fully answered. There is a potential for anonymity of multiple decision-makers to arise. Decisions in real world clinical practice may not fit precisely into a model of decision-making. The findings from this service evaluation illustrate that within multi-professional team decision-making; decisions may contain elements of both substituted and supported decision-making, and may be better represented as existing upon a continuum.

Health-care decision-making processes in Latin America: problems and prospects for the use of economic evaluation.

PubMed

Iglesias, Cynthia P; Drummond, Michael F; Rovira, Joan

2005-01-01

The use of economic evaluation studies (EE) in the decision-making process within the health-care system of nine Latin American (LA) and three European countries was investigated. The aim was to identify the opportunities, obstacles, and changes needed to facilitate the introduction of EE as a formal tool in health-care decision-making processes in LA. A comparative study was conducted based on existing literature and information provided through a questionnaire applied to decision makers in Argentina, Brazil, Colombia, Cuba, Mexico, Nicaragua, Peru, Portugal Spain, United Kingdom, Uruguay, and Venezuela. Systematic electronic searches of HEED, NHS EED, and LILACS were conducted to identify published economic evaluation studies in LA from 1982 onward. There is relatively little evidence of the conduct and use of EE within the health care systems in LA. Electronic searches retrieved 554 records; however, only 93 were EE. In the nine LA participating countries, broad allocation of health-care resources is primarily based on political criteria, historical records, geographical areas, and specific groups of patients and diseases. Public-health provision and inclusion of services in health-insurance package are responsibilities of the Ministry of Health. Decisions regarding the purchase of medicines are primarily made through public tenders, and mainly based on differences in clinical efficacy and the price of health technologies of interest. To expedite the process of incorporating EE as a formal tool to inform decision-making processes within the health-care systems in LA countries, two main conditions need to be fulfilled. First, adequate resources and skills need to be available to conduct EE of good quality. Second, decision-making procedures need to be modified to accommodate "evidence-based" approaches such as EE.

Due Process and Higher Education: A Systemic Approach to Fair Decision Making. ERIC Digest.

ERIC Educational Resources Information Center

Stevens, Ed

University officials and faculty are frequently required to make decisions based on interpretations of disputed facts. By applying the concept of due process within the context of higher education, they can meet legal challenges of contract and constitutional law and the pedagogical demand for justice. To guide their efforts, decision makers can…

The Role of Evidence-Based Research in the Decision-Making Process as Perceived by Local Board of Education Policymakers in West Virginia

ERIC Educational Resources Information Center

Hoylman, Elizabeth Anne

2017-01-01

This non-experimental, descriptive study explored the perceptions of PK-12 policymakers in West Virginia regarding the sources of information they use in the decision-making process; whether and how evidence-based research is relied upon; whether evidence-based research is considered credible and usable; and what barriers, facilitators, and…

Towards a conceptual multi-agent-based framework to simulate the spatial group decision-making process

NASA Astrophysics Data System (ADS)

Ghavami, Seyed Morsal; Taleai, Mohammad

2017-04-01

Most spatial problems are multi-actor, multi-issue and multi-phase in nature. In addition to their intrinsic complexity, spatial problems usually involve groups of actors from different organizational and cognitive backgrounds, all of whom participate in a social structure to resolve or reduce the complexity of a given problem. Hence, it is important to study and evaluate what different aspects influence the spatial problem resolution process. Recently, multi-agent systems consisting of groups of separate agent entities all interacting with each other have been put forward as appropriate tools to use to study and resolve such problems. In this study, then in order to generate a better level of understanding regarding the spatial problem group decision-making process, a conceptual multi-agent-based framework is used that represents and specifies all the necessary concepts and entities needed to aid group decision making, based on a simulation of the group decision-making process as well as the relationships that exist among the different concepts involved. The study uses five main influencing entities as concepts in the simulation process: spatial influence, individual-level influence, group-level influence, negotiation influence and group performance measures. Further, it explains the relationship among different concepts in a descriptive rather than explanatory manner. To illustrate the proposed framework, the approval process for an urban land use master plan in Zanjan—a provincial capital in Iran—is simulated using MAS, the results highlighting the effectiveness of applying an MAS-based framework when wishing to study the group decision-making process used to resolve spatial problems.

Nurses' decision-making process in cases of physical restraint in acute elderly care: a qualitative study.

PubMed

Goethals, S; Dierckx de Casterlé, B; Gastmans, C

2013-05-01

The increasing vulnerability of patients in acute elderly care requires constant critical reflection in ethically charged situations such as when employing physical restraint. Qualitative evidence concerning nurses' decision making in cases of physical restraint is limited and fragmented. A thorough understanding of nurses' decision-making process could be useful to understand how nurses reason and make decisions in ethically laden situations. The aims of this study were to explore and describe nurses' decision-making process in cases of physical restraint. We used a qualitative interview design inspired by the Grounded Theory approach. Data analysis was guided by the Qualitative Analysis Guide of Leuven. Twelve hospitals geographically spread throughout the five provinces of Flanders, Belgium. Twenty-one acute geriatric nurses interviewed between October 2009 and April 2011 were purposively and theoretically selected, with the aim of including nurses having a variety of characteristics and experiences concerning decisions on using physical restraint. In cases of physical restraint in acute elderly care, nurses' decision making was never experienced as a fixed decision but rather as a series of decisions. Decision making was mostly reasoned upon and based on rational arguments; however, decisions were also made routinely and intuitively. Some nurses felt very certain about their decisions, while others experienced feelings of uncertainty regarding their decisions. Nurses' decision making is an independent process that requires nurses to obtain a good picture of the patient, to be constantly observant, and to assess and reassess the patient's situation. Coming to thoughtful and individualized decisions requires major commitment and constant critical reflection. Copyright © 2012 Elsevier Ltd. All rights reserved.

Annual Research Review: Transdiagnostic neuroscience of child and adolescent mental disorders--differentiating decision making in attention-deficit/hyperactivity disorder, conduct disorder, depression, and anxiety.

PubMed

Sonuga-Barke, Edmund J S; Cortese, Samuele; Fairchild, Graeme; Stringaris, Argyris

2016-03-01

Ineffective decision making is a major source of everyday functional impairment and reduced quality of life for young people with mental disorders. However, very little is known about what distinguishes decision making by individuals with different disorders or the neuropsychological processes or brain systems underlying these. This is the focus of the current review. We first propose a neuroeconomic model of the decision-making process with separate stages for the prechoice evaluation of expected utility of future options; choice execution and postchoice management; the appraisal of outcome against expectation; and the updating of value estimates to guide future decisions. According to the proposed model, decision making is mediated by neuropsychological processes operating within three domains: (a) self-referential processes involved in autobiographical reflection on past, and prospection about future, experiences; (b) executive functions, such as working memory, inhibition, and planning, that regulate the implementation of decisions; and (c) processes involved in value estimation and outcome appraisal and learning. These processes are underpinned by the interplay of multiple brain networks, especially medial and lateralized cortical components of the default mode network, dorsal corticostriatal circuits underpinning higher order cognitive and behavioral control, and ventral frontostriatal circuits, connecting to brain regions implicated in emotion processing, that control valuation and learning processes. Based on clinical insights and considering each of the decision-making stages in turn, we outline disorder-specific hypotheses about impaired decision making in four childhood disorders: attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), depression, and anxiety. We hypothesize that decision making in ADHD is deficient (i.e. inefficient, insufficiently reflective, and inconsistent) and impulsive (biased toward immediate over delayed alternatives). In CD, it is reckless and insensitive to negative consequences. In depression, it is disengaged, perseverative, and pessimistic, while in anxiety, it is hesitant, risk-averse, and self-deprecating. A survey of current empirical indications related to these disorder-specific hypotheses highlights the limited and fragmentary nature of the evidence base and illustrates the need for a major research initiative in decision making in childhood disorders. The final section highlights a number of important additional general themes that need to be considered in future research. © 2015 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.

Choosing an Advanced Therapy in Parkinson's Disease; is it an Evidence-Based Decision in Current Practice?

PubMed

Nijhuis, Frouke A P; van Heek, Jolien; Bloem, Bastiaan R; Post, Bart; Faber, Marjan J

2016-07-25

In advanced Parkinson's disease (PD), neurologists and patients face a complex decision for an advanced therapy. When choosing a treatment, the best available evidence should be combined with the professional's expertise and the patient's preferences. The objective of this study was to explore current decision-making in advanced PD. We conducted focus group discussions and individual interviews with patients (N = 20) who had received deep brain stimulation, Levodopa-Carbidopa intestinal gel, or subcutaneous apomorphine infusion, and with their caregivers (N = 16). Furthermore, we conducted semi-structured interviews with neurologists (N = 7) and PD nurse specialists (N = 3) to include the perspectives of all key players in this decision-making process. Data were analyzed by two researchers using a qualitative thematic analysis approach. Four themes representing current experiences with the decision-making process were identified: 1) information and information needs, 2) factors influencing treatment choice and individual decision strategies, 3) decision-making roles, and 4) barriers and facilitators to shared decision-making (SDM). Patient preferences were taken into account, however patients were not always provided with adequate information. The professional's expertise influenced the decision-making process in both positive and negative ways. Although professionals and patients considered SDM essential for the decision of an advanced treatment, they mentioned several barriers for the implementation in current practice. In this study we found several factors explaining why in current practice, evidence-based decision-making in advanced PD is not optimal. An important first step would be to develop objective information on all treatment options.

Informed decision-making with and for people with dementia: Developing and pilot testing an education program for legal representatives (PRODECIDE).

PubMed

Lühnen, Julia; Mühlhauser, Ingrid; Richter, Tanja

2017-01-01

Background People living with dementia are often appointed a legal representative, to support and protect their ethical and legal rights to informed healthcare decisions. However, legal representatives usually have no qualifications in healthcare. Objective The aim of this study was to explore decision-making processes with participation of legal representatives and, resulting from this, to develop and pilot test an education program for legal representatives in Germany. Methods We conducted interviews with legal representatives and senior citizens about decision-making processes in healthcare, with special focus on percutaneous endoscopic gastrostomy, physical restraints, and prescription of antipsychotics for people with dementia. We generated a curriculum based on systematic literature searches and the results of these interviews. We tested the education program for comprehensibility, feasibility, usability, and acceptance. Results Personal interviews with voluntary ( n = 12) and professional ( n = 12) representatives, and senior citizens ( n = 14) were conducted. Preferences, attitudes, and wishes regarding percutaneous endoscopic gastrostomy, physical restraints, and antipsychotics, and the process of decision-making, were heterogeneous. A structural approach is lacking. The education program proxy-decison-making (PRODECIDE) comprises four modules: (A) decision-making processes and methods; (B-D) evidence-based knowledge about percutaneous endoscopic gastrostomy, physical restraints, and antipsychotics. We conducted eight trainings with 47 legal representatives. PRODECIDE was well accepted. Comprehensibility of contents and materials was rated high. The program seems feasible for implementation. Conclusion PRODECIDE seems suitable to improve the decision-making processes of legal representatives in Germany. Implementation will be appropriate if efficacy is proven; a randomized controlled trial is currently underway.

A web-based tool to support shared decision making for people with a psychotic disorder: randomized controlled trial and process evaluation.

PubMed

van der Krieke, Lian; Emerencia, Ando C; Boonstra, Nynke; Wunderink, Lex; de Jonge, Peter; Sytema, Sjoerd

2013-10-07

Mental health policy makers encourage the development of electronic decision aids to increase patient participation in medical decision making. Evidence is needed to determine whether these decision aids are helpful in clinical practice and whether they lead to increased patient involvement and better outcomes. This study reports the outcome of a randomized controlled trial and process evaluation of a Web-based intervention to facilitate shared decision making for people with psychotic disorders. The study was carried out in a Dutch mental health institution. Patients were recruited from 2 outpatient teams for patients with psychosis (N=250). Patients in the intervention condition (n=124) were provided an account to access a Web-based information and decision tool aimed to support patients in acquiring an overview of their needs and appropriate treatment options provided by their mental health care organization. Patients were given the opportunity to use the Web-based tool either on their own (at their home computer or at a computer of the service) or with the support of an assistant. Patients in the control group received care as usual (n=126). Half of the patients in the sample were patients experiencing a first episode of psychosis; the other half were patients with a chronic psychosis. Primary outcome was patient-perceived involvement in medical decision making, measured with the Combined Outcome Measure for Risk Communication and Treatment Decision-making Effectiveness (COMRADE). Process evaluation consisted of questionnaire-based surveys, open interviews, and researcher observation. In all, 73 patients completed the follow-up measurement and were included in the final analysis (response rate 29.2%). More than one-third (48/124, 38.7%) of the patients who were provided access to the Web-based decision aid used it, and most used its full functionality. No differences were found between the intervention and control conditions on perceived involvement in medical decision making (COMRADE satisfaction with communication: F1,68=0.422, P=.52; COMRADE confidence in decision: F1,67=0.086, P=.77). In addition, results of the process evaluation suggest that the intervention did not optimally fit in with routine practice of the participating teams. The development of electronic decision aids to facilitate shared medical decision making is encouraged and many people with a psychotic disorder can work with them. This holds for both first-episode patients and long-term care patients, although the latter group might need more assistance. However, results of this paper could not support the assumption that the use of electronic decision aids increases patient involvement in medical decision making. This may be because of weak implementation of the study protocol and a low response rate.

Age differences in experiential and deliberative processes in unambiguous and ambiguous decision making.

PubMed

Huang, Yumi H; Wood, Stacey; Berger, Dale E; Hanoch, Yaniv

2015-09-01

Older adults experience declines in deliberative decisional capacities, while their affective or experiential abilities tend to remain intact (Peters & Bruine de Bruin, 2012). The current study used this framework to investigate age differences in description-based and experience-based decision-making tasks. Description-based tasks emphasize deliberative processing by allowing decision makers to analyze explicit descriptions of choice-reward information. Experience-based tasks emphasize affective or experiential processing because they lack the explicit choice-reward information, forcing decision makers to rely on feelings and information derived from past experiences. This study used the Columbia Card Task (CCT) as a description-based task where probability information is provided and the Iowa Gambling Task (IGT) as an experience-based task, where it is not. As predicted, compared to younger adults (N = 65), older adults (N = 65) performed more poorly on the CCT but performed similarly on the IGT. Deliberative capacities (i.e., executive control and numeracy abilities) explained the relationship between age and performance on the CCT, suggesting that age-related differences in description-based decision-making tasks are related to declines in deliberative capacities. However, deliberative capacities were not associated with performance on the IGT for either older or younger adults. Nevertheless, on the IGT, older adults reported more use of affect-based strategies versus deliberative strategies, whereas younger adults reported similar use of these strategies. This finding offers partial support for the idea that decision-making tasks that rely on deliberate processing are more likely to demonstrate age effects than those that are more experiential. (c) 2015 APA, all rights reserved).

A new computational account of cognitive control over reinforcement-based decision-making: Modeling of a probabilistic learning task.

PubMed

Zendehrouh, Sareh

2015-11-01

Recent work on decision-making field offers an account of dual-system theory for decision-making process. This theory holds that this process is conducted by two main controllers: a goal-directed system and a habitual system. In the reinforcement learning (RL) domain, the habitual behaviors are connected with model-free methods, in which appropriate actions are learned through trial-and-error experiences. However, goal-directed behaviors are associated with model-based methods of RL, in which actions are selected using a model of the environment. Studies on cognitive control also suggest that during processes like decision-making, some cortical and subcortical structures work in concert to monitor the consequences of decisions and to adjust control according to current task demands. Here a computational model is presented based on dual system theory and cognitive control perspective of decision-making. The proposed model is used to simulate human performance on a variant of probabilistic learning task. The basic proposal is that the brain implements a dual controller, while an accompanying monitoring system detects some kinds of conflict including a hypothetical cost-conflict one. The simulation results address existing theories about two event-related potentials, namely error related negativity (ERN) and feedback related negativity (FRN), and explore the best account of them. Based on the results, some testable predictions are also presented. Copyright © 2015 Elsevier Ltd. All rights reserved.

Serotonin and decision making processes.

PubMed

Homberg, Judith R

2012-01-01

Serotonin (5-HT) is an important player in decision making. Serotonergic antidepressant, anxiolytic and antipsychotic drugs are extensively used in the treatment of neuropsychiatric disorders characterized by impaired decision making, and exert both beneficial and harmful effects in patients. Detailed insight into the serotonergic mechanisms underlying decision making is needed to strengthen the first and weaken the latter. Although much remains to be done to achieve this, accumulating studies begin to deliver a coherent view. Thus, high central 5-HT levels are generally associated with improved reversal learning, improved attentional set shifting, decreased delay discounting, and increased response inhibition, but a failure to use outcome representations. Based on 5-HT's evolutionary role, I hypothesize that 5-HT integrates expected, or changes in, relevant sensory and emotional internal/external information, leading to vigilance behaviour affecting various decision making processes. 5-HT receptor subtypes play distinctive roles in decision making. 5-HT(2A) agonists and 5-HT2c antagonists decrease compulsivity, whereas 5-HT(2A) antagonists and 5-HT(2C) agonists decrease impulsivity. 5-HT(6) antagonists univocally affect decision making processes. Copyright © 2011 Elsevier Ltd. All rights reserved.

Modelling decision-making by pilots

NASA Technical Reports Server (NTRS)

Patrick, Nicholas J. M.

1993-01-01

Our scientific goal is to understand the process of human decision-making. Specifically, a model of human decision-making in piloting modern commercial aircraft which prescribes optimal behavior, and against which we can measure human sub-optimality is sought. This model should help us understand such diverse aspects of piloting as strategic decision-making, and the implicit decisions involved in attention allocation. Our engineering goal is to provide design specifications for (1) better computer-based decision-aids, and (2) better training programs for the human pilot (or human decision-maker, DM).

A methodology for eliciting, representing, and analysing stakeholder knowledge for decision making on complex socio-ecological systems: from cognitive maps to agent-based models.

PubMed

Elsawah, Sondoss; Guillaume, Joseph H A; Filatova, Tatiana; Rook, Josefine; Jakeman, Anthony J

2015-03-15

This paper aims to contribute to developing better ways for incorporating essential human elements in decision making processes for modelling of complex socio-ecological systems. It presents a step-wise methodology for integrating perceptions of stakeholders (qualitative) into formal simulation models (quantitative) with the ultimate goal of improving understanding and communication about decision making in complex socio-ecological systems. The methodology integrates cognitive mapping and agent based modelling. It cascades through a sequence of qualitative/soft and numerical methods comprising: (1) Interviews to elicit mental models; (2) Cognitive maps to represent and analyse individual and group mental models; (3) Time-sequence diagrams to chronologically structure the decision making process; (4) All-encompassing conceptual model of decision making, and (5) computational (in this case agent-based) Model. We apply the proposed methodology (labelled ICTAM) in a case study of viticulture irrigation in South Australia. Finally, we use strengths-weakness-opportunities-threats (SWOT) analysis to reflect on the methodology. Results show that the methodology leverages the use of cognitive mapping to capture the richness of decision making and mental models, and provides a combination of divergent and convergent analysis methods leading to the construction of an Agent Based Model. Copyright © 2014 Elsevier Ltd. All rights reserved.

End-of-Life Decision Making in Palliative Care and Recommendations of the Council of Europe: Qualitative Secondary Analysis of Interviews and Observation Field Notes.

PubMed

Martins Pereira, Sandra; Fradique, Emília; Hernández-Marrero, Pablo

2018-05-01

End-of-life decisions (ELDs) are embedded in clinical, sociocultural, political, economic, and ethical concerns. In 2014, the Council of Europe (CoE) through its Committee on Bioethics launched the "Guide on the decision-making process regarding medical treatment in end-of-life situations," aiming at improving decision-making processes and empowering professionals in making ELDs. To analyze if end-of-life decision making in palliative care (PC) is consistent with this Guide and to identify if disputed/controversial issues are part of current ELDs. Qualitative secondary analysis. Four qualitative datasets, including 44 interviews and 9 team observation field notes from previous studies with PC teams/professionals in Portugal. An analysis grid based on the abovementioned guide was created considering three dimensions: ethical and legal frameworks, decision-making process, and disputed/controversial issues. The majority of the professionals considered the ethical principle of autonomy paramount in end-of-life decision making. Justice and beneficence/nonmaleficence were also valued. Although not mentioned in the Guide, the professionals also considered other ethical principles when making ELDs, namely, responsibility, integrity, and dignity. Most of the interviewees and field notes referred to the collective interprofessional dimension of the decision-making process. Palliative sedation and the wish to hasten death were the most mentioned disputed/controversial issues. The nature, limitations, and benefits of qualitative secondary analysis are discussed. End-of-life decision-making processes made by Portuguese PC teams seem to be consistent with the guidelines of the CoE. Further research is needed about disputed/controversial issues and the actual use, effectiveness, and impact of ethical guidelines for end-of-life decision making on professionals' empowerment and for all parties involved.

Development of an instrument to understand the child protective services decision-making process, with a focus on placement decisions.

PubMed

Dettlaff, Alan J; Christopher Graham, J; Holzman, Jesse; Baumann, Donald J; Fluke, John D

2015-11-01

When children come to the attention of the child welfare system, they become involved in a decision-making process in which decisions are made that have a significant effect on their future and well-being. The decision to remove children from their families is particularly complex; yet surprisingly little is understood about this decision-making process. This paper presents the results of a study to develop an instrument to explore, at the caseworker level, the context of the removal decision, with the objective of understanding the influence of the individual and organizational factors on this decision, drawing from the Decision Making Ecology as the underlying rationale for obtaining the measures. The instrument was based on the development of decision-making scales used in prior decision-making studies and administered to child protection caseworkers in several states. Analyses included reliability analyses, principal components analyses, and inter-correlations among the resulting scales. For one scale regarding removal decisions, a principal components analysis resulted in the extraction of two components, jointly identified as caseworkers' decision-making orientation, described as (1) an internal reference to decision-making and (2) an external reference to decision-making. Reliability analyses demonstrated acceptable to high internal consistency for 9 of the 11 scales. Full details of the reliability analyses, principal components analyses, and inter-correlations among the seven scales are discussed, along with implications for practice and the utility of this instrument to support the understanding of decision-making in child welfare. Copyright © 2015 Elsevier Ltd. All rights reserved.

Clinical Decision-Making in Community Children’s Mental Health: Using Innovative Methods to Compare Clinicians With and Without Training in Evidence-Based Treatment

PubMed Central

Baker-Ericzén, Mary J.; Jenkins, Melissa M.; Park, Soojin; Garland, Ann F.

2014-01-01

Background Mental health professionals’ decision-making practice is an area of increasing interest and importance, especially in the pediatric research and clinical communities. Objective The present study explored the role of prior training in evidence-based treatments on clinicians’ assessment and treatment formulations using case vignettes. Specifically, study aims included using the Naturalistic Decision Making (NDM) cognitive theory to 1) examine potential associations between EBT training and decision-making processes (novice versus expert type), and 2) explore how client and family contextual information affects clinical decision-making. Methods Forty-eight clinicians across two groups (EBT trained=14, Not EBT trained=34) participated. Clinicians were comparable on professional experience, demographics, and discipline. The quasi-experimental design used an analog “think aloud” method where clinicians read case vignettes about a child with disruptive behavior problems and verbalized case conceptualization and treatment planning out-loud. Responses were coded according to NDM theory. Results MANOVA results were significant for EBT training status such that EBT trained clinicians’ displayed cognitive processes more closely aligned with “expert” decision-makers and non-EBT trained clinicians’ decision processes were more similar to “novice” decision-makers, following NDM theory. Non-EBT trained clinicians assigned significantly more diagnoses, provided less detailed treatment plans and discussed fewer EBTs. Parent/family contextual information also appeared to influence decision-making. Conclusion This study offers a preliminary investigation of the possible broader impacts of EBT training and potential associations with development of expert decision-making skills. Targeting clinicians’ decision-making may be an important avenue to pursue within dissemination-implementation efforts in mental health practice. PMID:25892901

A Review of Shared Decision-Making and Patient Decision Aids in Radiation Oncology.

PubMed

Woodhouse, Kristina Demas; Tremont, Katie; Vachani, Anil; Schapira, Marilyn M; Vapiwala, Neha; Simone, Charles B; Berman, Abigail T

2017-06-01

Cancer treatment decisions are complex and may be challenging for patients, as multiple treatment options can often be reasonably considered. As a result, decisional support tools have been developed to assist patients in the decision-making process. A commonly used intervention to facilitate shared decision-making is a decision aid, which provides evidence-based outcomes information and guides patients towards choosing the treatment option that best aligns with their preferences and values. To ensure high quality, systematic frameworks and standards have been proposed for the development of an optimal aid for decision making. Studies have examined the impact of these tools on facilitating treatment decisions and improving decision-related outcomes. In radiation oncology, randomized controlled trials have demonstrated that decision aids have the potential to improve patient outcomes, including increased knowledge about treatment options and decreased decisional conflict with decision-making. This article provides an overview of the shared-decision making process and summarizes the development, validation, and implementation of decision aids as patient educational tools in radiation oncology. Finally, this article reviews the findings from decision aid studies in radiation oncology and offers various strategies to effectively implement shared decision-making into clinical practice.

Racial and ethnic variation in partner perspectives about the breast cancer treatment decision-making experience.

PubMed

Lillie, Sarah E; Janz, Nancy K; Friese, Christopher R; Graff, John J; Schwartz, Kendra; Hamilton, Ann S; Gay, Brittany Bartol; Katz, Steven J; Hawley, Sarah T

2014-01-01

To characterize the perspectives of partners (husbands or significant others) of patients with breast cancer in the treatment decision-making process and to evaluate racial and ethnic differences in decision outcomes. A cross-sectional survey. Los Angeles, CA, and Detroit, MI. 517 partners of a population-based sample of patients with breast cancer four years post-treatment. A self-administered mailed questionnaire. Chi-square tests and logistic regression were used to assess associations between race and ethnicity and decision outcomes. Decision regret and three elements of the decision process: information received, actual involvement, and desired involvement. Most partners reported receiving sufficient information (77%), being involved in treatment decisions (74%), and having sufficient involvement (73%). Less-acculturated Hispanic partners were more likely than their Caucasian counterparts to report high decision regret (45% versus 14%, p<0.001). Factors significantly associated (p<0.05) with high decision regret were insufficient receipt of treatment information, low involvement in decision making, and a desire for more involvement. Partners were generally positive regarding their perspectives about participating in the breast cancer treatment decision-making process. However, less acculturated Hispanic partners were most vulnerable to decision regret. In addition, high decision regret was associated with modifiable elements of the decision-making process. Attention should be paid to ensuring racial and ethnic minority partners are sufficiently involved in breast cancer treatment decisions and receive decision support.

Decision-making about complementary and alternative medicine by cancer patients: integrative literature review.

PubMed

Weeks, Laura; Balneaves, Lynda G; Paterson, Charlotte; Verhoef, Marja

2014-01-01

Patients with cancer consistently report conflict and anxiety when making decisions about complementary and alternative medicine (CAM) treatment. To design evidence-informed decision-support strategies, a better understanding is needed of how the decision-making process unfolds for these patients during their experience with cancer. We undertook this study to review the research literature regarding CAM-related decision-making by patients with cancer within the context of treatment, survivorship, and palliation. We also aimed to summarize emergent concepts within a preliminary conceptual framework. We conducted an integrative literature review, searching 12 electronic databases for articles published in English that described studies of the process, context, or outcomes of CAM-related decision-making. We summarized descriptive data using frequencies and used a descriptive constant comparative method to analyze statements about original qualitative results, with the goal of identifying distinct concepts pertaining to CAM-related decision-making by patients with cancer and the relationships among these concepts. Of 425 articles initially identified, 35 met our inclusion criteria. Seven unique concepts related to CAM and cancer decision-making emerged: decision-making phases, information-seeking and evaluation, decision-making roles, beliefs, contextual factors, decision-making outcomes, and the relationship between CAM and conventional medical decision-making. CAM decision-making begins with the diagnosis of cancer and encompasses 3 distinct phases (early, mid, and late), each marked by unique aims for CAM treatment and distinct patterns of information-seeking and evaluation. Phase transitions correspond to changes in health status or other milestones within the cancer trajectory. An emergent conceptual framework illustrating relationships among the 7 central concepts is presented. CAM-related decision-making by patients with cancer occurs as a nonlinear, complex, dynamic process. The conceptual framework presented here identifies influential factors within that process, as well as patients' unique needs during different phases. The framework can guide the development and evaluation of theory-based decision-support programs that are responsive to patients' beliefs and preferences.

Evidence based policy making in the European Union: the role of the scientific community.

PubMed

Majcen, Špela

2017-03-01

In the times when the acquis of the European Union (EU) has developed so far as to reach a high level of technical complexity, in particular in certain policy fields such as environmental legislation, it is important to look at what kind of information and data policy decisions are based on. This position paper looks at the extent to which evidence-based decision-making process is being considered in the EU institutions when it comes to adopting legislation in the field of environment at the EU level. The paper calls for closer collaboration between scientists and decision-makers in view of ensuring that correct data is understood and taken into consideration when drafting, amending, negotiating and adopting new legal texts at all levels of the EU decision-making process. It concludes that better awareness of the need for such collaboration among the decision-makers as well as the scientific community would benefit the process and quality of the final outcomes (legislation).

Cognitive Continuum Theory in nursing decision-making.

PubMed

Cader, Raffik; Campbell, Steve; Watson, Don

2005-02-01

The purpose of this paper is to analyse and evaluate Cognitive Continuum Theory and to provide evidence for its relevance to nurses' decision-making. It is critical that theories used in nursing are evaluated to provide an understanding of their aims, concepts and usefulness. With the advent of evidence-based care, theories on decision-making have acquired increased significance. The criteria identified by Fawcett's framework has been used to analyse and evaluate Hammond's Cognitive Continuum Theory. Findings. There is empirical evidence to support many of the concepts and propositions of Cognitive Continuum Theory. The theory has been applied to the decision-making process of many professionals, including medical practitioners and nurses. Existing evidence suggests that Cognitive Continuum Theory can provide the framework to explain decision-making in nursing. Cognitive Continuum Theory has the potential to make major contributions towards understanding the decision-making process of nurses in the clinical environment. Knowledge of the theory in nursing practice has become crucial.

Application of the principles of evidence-based practice in decision making among senior management in Nova Scotia's addiction services agencies.

PubMed

Murphy, Matthew; MacCarthy, M Jayne; McAllister, Lynda; Gilbert, Robert

2014-12-05

Competency profiles for occupational clusters within Canada's substance abuse workforce (SAW) define the need for skill and knowledge in evidence-based practice (EBP) across all its members. Members of the Senior Management occupational cluster hold ultimate responsibility for decisions made within addiction services agencies and therefore must possess the highest level of proficiency in EBP. The objective of this study was to assess the knowledge of the principles of EBP, and use of the components of the evidence-based decision making (EBDM) process in members of this occupational cluster from selected addiction services agencies in Nova Scotia. A convenience sampling method was used to recruit participants from addiction services agencies. Semi-structured qualitative interviews were conducted with eighteen Senior Management. The interviews were audio-recorded, transcribed verbatim and checked by the participants. Interview transcripts were coded and analyzed for themes using content analysis and assisted by qualitative data analysis software (NVivo 9.0). Data analysis revealed four main themes: 1) Senior Management believe that addictions services agencies are evidence-based; 2) Consensus-based decision making is the norm; 3) Senior Management understand the principles of EBP and; 4) Senior Management do not themselves use all components of the EBDM process when making decisions, oftentimes delegating components of this process to decision support staff. Senior Management possess an understanding of the principles of EBP, however, when making decisions they often delegate components of the EBDM process to decision support staff. Decision support staff are not defined as an occupational cluster in Canada's SAW and have not been ascribed a competency profile. As such, there is no guarantee that this group possesses competency in EBDM. There is a need to advocate for the development of a defined occupational cluster and associated competency profile for this critical group.

Linking Effective Project Management to Business Strategy in Oil and Gas Industry through Decision-making Processes

NASA Astrophysics Data System (ADS)

Adeleke, Adeyinka

The construction project in the oil and gas industry covers the entire spectrum of hydrocarbon production from the wellhead (upstream) to downstream facilities. In each of these establishments, the activities in a construction project include: consulting, studies, front-end engineering, detail engineering, procurement, program management, construction, installation, commissioning and start-up. Efficient management of each of the activities involved in construction projects is one of the driving forces for the successful completion of the project. Optimizing the crucial factors in project management during each phase of a project in an oil and gas industry can assist managers to maximize the use of available resources and drive the project to successful conclusions. One of these factors is the decision-making process in the construction project. Current research effort investigated the relationship between decision-making processes and business strategy in oil and gas industry using employee surveys. I recruited employees of different races, age group, genders, and years of experience in order understand their influence on the implementation of the decision-making process in oil and gas industry through a quantitative survey. Decision-making was assessed using five decision measures: (a) rational, (b) intuitive, (c) dependent, (d) avoidant, and (e) spontaneous. The findings indicated gender, age, years of work experience and job titles as primary variables with a negative relationship with decision-making approach for employees working in a major oil and gas industry. The study results revealed that the two most likely decision-making methods in oil and gas industry include: making a decision in a logical and systematic way and seek assistance from others when making a decision. Additionally, the two leading management approaches to decision-making in the oil and gas industry include: decision analysis is part of organization culture and management is committed to the decision-making process. Some recommendations for future studies were presented based on the need to intensify the importance of the current study and enlarge the body of knowledge regarding decision-making process in oil and gas industry.

Collective Decision Making in Organizations.

ERIC Educational Resources Information Center

Svenning, Lynne L.

Based on the assumption that educators can adopt new patterns of organization and management to improve the quality of decision and change in education, this paper attempts to make decision theory and small group process theory relevant to practical decision situations confronting educational managers. Included are (1) a discussion of the…

The Role of Intuition and Deliberative Thinking in Experts' Superior Tactical Decision-Making

ERIC Educational Resources Information Center

Moxley, Jerad H.; Ericsson, K. Anders; Charness, Neil; Krampe, Ralf T.

2012-01-01

Current theories argue that human decision making is largely based on quick, automatic, and intuitive processes that are occasionally supplemented by slow controlled deliberation. Researchers, therefore, predominantly studied the heuristics of the automatic system in everyday decision making. Our study examines the role of slow deliberation for…

Scientific Literacy for Democratic Decision-Making

ERIC Educational Resources Information Center

Yacoubian, Hagop A.

2018-01-01

Scientifically literate citizens must be able to engage in making decisions on science-based social issues. In this paper, I start by showing examples of science curricula and policy documents that capitalise the importance of engaging future citizens in decision-making processes whether at the personal or at the societal levels. I elucidate the…

A two-phased fuzzy decision making procedure for IT supplier selection

NASA Astrophysics Data System (ADS)

Shohaimay, Fairuz; Ramli, Nazirah; Mohamed, Siti Rosiah; Mohd, Ainun Hafizah

2013-09-01

In many studies on fuzzy decision making, linguistic terms are usually represented by corresponding fixed triangular or trapezoidal fuzzy numbers. However, the fixed fuzzy numbers used in decision making process may not explain the actual respondents' opinions. Hence, a two-phased fuzzy decision making procedure is proposed. First, triangular fuzzy numbers were built based on respondents' opinions on the appropriate range (0-100) for each seven-scale linguistic terms. Then, the fuzzy numbers were integrated into fuzzy decision making model. The applicability of the proposed method is demonstrated in a case study of supplier selection in Information Technology (IT) department. The results produced via the developed fuzzy numbers were consistent with the results obtained using fixed fuzzy numbers. However, with different set of fuzzy numbers based on respondents, there is a difference in the ranking of suppliers based on criterion X1 (background of supplier). Hopefully the proposed model which incorporates fuzzy numbers based on respondents will provide a more significant meaning towards future decision making.

Quantum decision-maker theory and simulation

NASA Astrophysics Data System (ADS)

Zak, Michail; Meyers, Ronald E.; Deacon, Keith S.

2000-07-01

A quantum device simulating the human decision making process is introduced. It consists of quantum recurrent nets generating stochastic processes which represent the motor dynamics, and of classical neural nets describing the evolution of probabilities of these processes which represent the mental dynamics. The autonomy of the decision making process is achieved by a feedback from the mental to motor dynamics which changes the stochastic matrix based upon the probability distribution. This feedback replaces unavailable external information by an internal knowledge- base stored in the mental model in the form of probability distributions. As a result, the coupled motor-mental dynamics is described by a nonlinear version of Markov chains which can decrease entropy without an external source of information. Applications to common sense based decisions as well as to evolutionary games are discussed. An example exhibiting self-organization is computed using quantum computer simulation. Force on force and mutual aircraft engagements using the quantum decision maker dynamics are considered.

Choosing to Decline: Finding Common Ground through the Perspective of Shared Decision Making.

PubMed

Megregian, Michele; Nieuwenhuijze, Marianne

2018-05-18

Respectful communication is a key component of any clinical relationship. Shared decision making is the process of collaboration that occurs between a health care provider and patient in order to make health care decisions based upon the best available evidence and the individual's preferences. A midwife and woman (and her support persons) engage together to make health care decisions, using respectful communication that is based upon the best available evidence and the woman's preferences, values, and goals. Supporting a woman's autonomy, however, can be particularly challenging in maternity care when recommended treatments or interventions are declined. In the past, the real or perceived increased risk to a woman's health or that of her fetus as a result of that choice has occasionally resulted in coercion. Through the process of shared decision making, the woman's autonomy may be supported, including the choice to decline interventions. The case presented here demonstrates how a shared decision-making framework can support the health care provider-patient relationship in the context of informed refusal. © 2018 by the American College of Nurse-Midwives.

Evidence-based coverage decisions? Primum non nocere.

PubMed

McElwee, Newell E; Ho, S Yin; McGuigan, Kimberly A; Horn, Mark L

2006-01-01

Drug class reviews are blunt tools for medical decision making. The practice of evidence-based medicine is far more than simply systematic reviews: The patient and doctor are integral. Here we highlight areas of evidence-based coverage decision making where greater balance and transparency could serve to improve the current process, and we recommend elements of a more positive approach that could optimize patient outcomes under resource constraints.

A framework for designing and analyzing binary decision-making strategies in cellular systems†

PubMed Central

Porter, Joshua R.; Andrews, Burton W.; Iglesias, Pablo A.

2015-01-01

Cells make many binary (all-or-nothing) decisions based on noisy signals gathered from their environment and processed through noisy decision-making pathways. Reducing the effect of noise to improve the fidelity of decision-making comes at the expense of increased complexity, creating a tradeoff between performance and metabolic cost. We present a framework based on rate distortion theory, a branch of information theory, to quantify this tradeoff and design binary decision-making strategies that balance low cost and accuracy in optimal ways. With this framework, we show that several observed behaviors of binary decision-making systems, including random strategies, hysteresis, and irreversibility, are optimal in an information-theoretic sense for various situations. This framework can also be used to quantify the goals around which a decision-making system is optimized and to evaluate the optimality of cellular decision-making systems by a fundamental information-theoretic criterion. As proof of concept, we use the framework to quantify the goals of the externally triggered apoptosis pathway. PMID:22370552

Enhancing the role of science in the decision-making of the European Union.

PubMed

Allio, Lorenzo; Ballantine, Bruce; Meads, Richard

2006-02-01

Used well, science provides effective ways of identifying potential risks, protecting citizens, and using resources wisely. It enables government decisions to be based on evidence and provides a foundation for a rule-based framework that supports global trade. To ensure that the best available science becomes a key input in the decisions made by EU institutions, this abridged version of a working paper produced for the European Policy Centre, a leading, independent think tank, considers how science is currently used in the policy and decision-making processes of the EU, what the limitations of scientific evidence are, and how a risk assessment process based on scientific 'good practices' can be advantageous. Finally, the paper makes recommendations on how to improve the use of science by EU institutions.

The neural basis of rationalization: cognitive dissonance reduction during decision-making.

PubMed

Jarcho, Johanna M; Berkman, Elliot T; Lieberman, Matthew D

2011-09-01

People rationalize the choices they make when confronted with difficult decisions by claiming they never wanted the option they did not choose. Behavioral studies on cognitive dissonance provide evidence for decision-induced attitude change, but these studies cannot fully uncover the mechanisms driving the attitude change because only pre- and post-decision attitudes are measured, rather than the process of change itself. In the first fMRI study to examine the decision phase in a decision-based cognitive dissonance paradigm, we observed that increased activity in right-inferior frontal gyrus, medial fronto-parietal regions and ventral striatum, and decreased activity in anterior insula were associated with subsequent decision-related attitude change. These findings suggest the characteristic rationalization processes that are associated with decision-making may be engaged very quickly at the moment of the decision, without extended deliberation and may involve reappraisal-like emotion regulation processes.

The neural basis of rationalization: cognitive dissonance reduction during decision-making

PubMed Central

Jarcho, Johanna M.; Berkman, Elliot T.

2011-01-01

People rationalize the choices they make when confronted with difficult decisions by claiming they never wanted the option they did not choose. Behavioral studies on cognitive dissonance provide evidence for decision-induced attitude change, but these studies cannot fully uncover the mechanisms driving the attitude change because only pre- and post-decision attitudes are measured, rather than the process of change itself. In the first fMRI study to examine the decision phase in a decision-based cognitive dissonance paradigm, we observed that increased activity in right-inferior frontal gyrus, medial fronto-parietal regions and ventral striatum, and decreased activity in anterior insula were associated with subsequent decision-related attitude change. These findings suggest the characteristic rationalization processes that are associated with decision-making may be engaged very quickly at the moment of the decision, without extended deliberation and may involve reappraisal-like emotion regulation processes. PMID:20621961

Interpersonal reactivity and the attribution of emotional reactions.

PubMed

Haas, Brian W; Anderson, Ian W; Filkowski, Megan M

2015-06-01

The ability to identify the cause of another person's emotional reaction is an important component associated with improved success of social relationships and survival. Although many studies have investigated the mechanisms involved in emotion recognition, very little is currently known regarding the processes involved during emotion attribution decisions. Research on complementary "emotion understanding" mechanisms, including empathy and theory of mind, has demonstrated that emotion understanding decisions are often made through relatively emotion- or cognitive-based processing streams. The current study was designed to investigate the behavioral and brain mechanisms involved in emotion attribution decisions. We predicted that dual processes, emotional and cognitive, are engaged during emotion attribution decisions. Sixteen healthy adults completed the Interpersonal Reactivity Index to characterize individual differences in tendency to make emotion- versus cognitive-based interpersonal decisions. Participants then underwent functional MRI while making emotion attribution decisions. We found neuroimaging evidence that emotion attribution decisions engage a similar brain network as other forms of emotion understanding. Further, we found evidence in support of a dual processes model involved during emotion attribution decisions. Higher scores of personal distress were associated with quicker emotion attribution decisions and increased anterior insula activity. Conversely, higher scores in perspective taking were associated with delayed emotion attribution decisions and increased prefrontal cortex and premotor activity. These findings indicate that the making of emotion attribution decisions relies on dissociable emotional and cognitive processing streams within the brain. (c) 2015 APA, all rights reserved).

Accelerated bridge construction (ABC) decision making and economic modeling tool.

DOT National Transportation Integrated Search

2011-12-01

In this FHWA-sponsored pool funded study, a set of decision making tools, based on the Analytic Hierarchy Process (AHP) was developed. This tool set is prepared for transportation specialists and decision-makers to determine if ABC is more effective ...

Informing clinical policy decision-making practices in ambulance services.

PubMed

Muecke, Sandy; Curac, Nada; Binks, Darryn

2013-12-01

This study aims to identify the processes and frameworks that support an evidence-based approach to clinical policy decision-making practices in ambulance services. This literature review focused on: (i) the setting (pre-hospital); and (ii) the process of evidence translation, for studies published after the year 2000. Searches of Medline, CINAHL and Google were undertaken. Reference lists of eligible publications were searched for relevant articles. A total of 954 articles were identified. Of these, 20 full text articles were assessed for eligibility and seven full text articles met the inclusion criteria. Three provided detailed descriptions of the evidence-based practice processes used to inform ambulance service protocol or guideline development or review. There is little published literature that describes the processes involved, and frameworks required, to inform clinical policy decision making within ambulance services. This review found that processes were iterative and involved collaborations across many internal and external stakeholders. In several jurisdictions, these were coordinated by a dedicated team. Success appears dependent on committed leadership and purposive human and structural resources. Although time consuming, structured processes have been developed in some jurisdictions to assist decision-making processes. Further insight is likely to be obtained from literature published by those from other disciplines. © 2013 The Authors. International Journal of Evidence-Based Healthcare © 2013 The Joanna Briggs Institute.

Family involvement in medical decision-making: Perceptions of nursing and psychology students.

PubMed

Itzhaki, Michal; Hildesheimer, Galya; Barnoy, Sivia; Katz, Michael

2016-05-01

Family members often rely on health care professionals to guide and support them through the decision-making process. Although family involvement in medical decisions should be included in the preservice curriculum for the health care professions, perceptions of students in caring professions on family involvement in medical decision-making have not yet been examined. To examine the perceptions of nursing and psychology students on family involvement in medical decision-making for seriously ill patients. A descriptive cross-sectional design was used. First year undergraduate nursing and psychology students studying for their Bachelor of Arts degree were recruited. Perceptions were assessed with a questionnaire constructed based on the Multi-Attribute Utility Theory (MAUT), which examines decision-maker preferences. The questionnaire consisted of two parts referring to the respondent once as the patient and then as the family caregiver. Questionnaires were completed by 116 nursing students and 156 psychology students. Most were of the opinion that family involvement in decision-making is appropriate, especially when the patient is incapable of making decisions. Nursing students were more inclined than psychology students to think that financial, emotional, and value-based considerations should be part of the family's involvement in decision-making. Both groups of students perceived the emotional consideration as most acceptable, whereas the financial consideration was considered the least acceptable. Nursing and psychology students perceive family involvement in medical decision-making as appropriate. In order to train students to support families in the process of decision-making, further research should examine Shared Decision-Making (SDM) programs, which involve patient and clinician collaboration in health care decisions. Copyright © 2016 Elsevier Ltd. All rights reserved.

Shared Decision Making in Intensive Care Units: An American College of Critical Care Medicine and American Thoracic Society Policy Statement

PubMed Central

Kon, Alexander A.; Davidson, Judy E.; Morrison, Wynne; Danis, Marion; White, Douglas B.

2015-01-01

Objectives Shared decision-making (SDM) is endorsed by critical care organizations, however there remains confusion about what SDM is, when it should be used, and approaches to promote partnerships in treatment decisions. The purpose of this statement is to define SDM, recommend when SDM should be used, identify the range of ethically acceptable decision-making models, and present important communication skills. Methods The American College of Critical Care Medicine (ACCM) and American Thoracic Society (ATS) Ethics Committees reviewed empirical research and normative analyses published in peer-reviewed journals to generate recommendations. Recommendations approved by consensus of the full Ethics Committees of ACCM and ATS were included in the statement. Main Results Six recommendations were endorsed: 1) Definition: Shared decision-making is a collaborative process that allows patients, or their surrogates, and clinicians to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values, goals, and preferences. 2) Clinicians should engage in a SDM process to define overall goals of care (including decisions regarding limiting or withdrawing life-prolonging interventions) and when making major treatment decisions that may be affected by personal values, goals, and preferences. 3) Clinicians should use as their “default” approach a SDM process that includes three main elements: information exchange, deliberation, and making a treatment decision. 4) A wide range of decision-making approaches are ethically supportable including patient- or surrogate-directed and clinician-directed models. Clinicians should tailor the decision-making process based on the preferences of the patient or surrogate. 5) Clinicians should be trained in communication skills. 6) Research is needed to evaluate decision-making strategies. Conclusions Patient and surrogate preferences for decision-making roles regarding value-laden choices range from preferring to exercise significant authority to ceding such authority to providers. Clinicians should adapt the decision-making model to the needs and preferences of the patient or surrogate. PMID:26509317

Emotion-based decision-making in healthy subjects: short-term effects of reducing dopamine levels.

PubMed

Sevy, Serge; Hassoun, Youssef; Bechara, Antoine; Yechiam, Eldad; Napolitano, Barbara; Burdick, Katherine; Delman, Howard; Malhotra, Anil

2006-10-01

Converging evidences from animal and human studies suggest that addiction is associated with dopaminergic dysfunction in brain reward circuits. So far, it is unclear what aspects of addictive behaviors are related to a dopaminergic dysfunction. We hypothesize that a decrease in dopaminergic activity impairs emotion-based decision-making. To demonstrate this hypothesis, we investigated the effects of a decrease in dopaminergic activity on the performance of an emotion-based decision-making task, the Iowa gambling task (IGT), in 11 healthy human subjects. We used a double-blind, placebo-controlled, within-subject design to examine the effect of a mixture containing the branched-chain amino acids (BCAA) valine, isoleucine and leucine on prolactin, IGT performance, perceptual competency and visual aspects of visuospatial working memory, visual attention and working memory, and verbal memory. The expectancy-valence model was used to determine the relative contributions of distinct IGT components (attention to past outcomes, relative weight of wins and losses, and choice strategies) in the decision-making process. Compared to placebo, the BCAA mixture increased prolactin levels and impaired IGT performance. BCAA administration interfered with a particular component process of decision-making related to attention to more recent events as compared to more distant events. There were no differences between placebo and BCAA conditions for other aspects of cognition. Our results suggest a direct link between a reduced dopaminergic activity and poor emotion-based decision-making characterized by shortsightedness, and thus difficulties resisting short-term reward, despite long-term negative consequences. These findings have implications for behavioral and pharmacological interventions targeting impaired emotion-based decision-making in addictive disorders.

Best-worst scaling to assess the most important barriers and facilitators for the use of health technology assessment in Austria.

PubMed

Feig, Chiara; Cheung, Kei Long; Hiligsmann, Mickaël; Evers, Silvia M A A; Simon, Judit; Mayer, Susanne

2018-04-01

Although Health Technology Assessment (HTA) is increasingly used to support evidence-based decision-making in health care, several barriers and facilitators for the use of HTA have been identified. This best-worst scaling (BWS) study aims to assess the relative importance of selected barriers and facilitators of the uptake of HTA studies in Austria. A BWS object case survey was conducted among 37 experts in Austria to assess the relative importance of HTA barriers and facilitators. Hierarchical Bayes estimation was applied, with the best-worst count analysis as sensitivity analysis. Subgroup analyses were also performed on professional role and HTA experience. The most important barriers were 'lack of transparency in the decision-making process', 'fragmentation', 'absence of appropriate incentives', 'no explicit framework for decision-making process', and 'insufficient legal support'. The most important facilitators were 'transparency in the decision-making process', 'availability of relevant HTA research for policy makers', 'availability of explicit framework for decision-making process', 'sufficient legal support', and 'appropriate incentives'. This study suggests that HTA barriers and facilitators related to the context of decision makers, especially 'policy characteristics' and 'organization and resources' are the most important in Austria. A transparent and participatory decision-making process could improve the adoption of HTA evidence.

Evidence-based management - healthcare manager viewpoints.

PubMed

Janati, Ali; Hasanpoor, Edris; Hajebrahimi, Sakineh; Sadeghi-Bazargani, Homayoun

2018-06-11

Purpose Hospital manager decisions can have a significant impact on service effectiveness and hospital success, so using an evidence-based approach can improve hospital management. The purpose of this paper is to identify evidence-based management (EBMgt) components and challenges. Consequently, the authors provide an improving evidence-based decision-making framework. Design/methodology/approach A total of 45 semi-structured interviews were conducted in 2016. The authors also established three focus group discussions with health service managers. Data analysis followed deductive qualitative analysis guidelines. Findings Four basic themes emerged from the interviews, including EBMgt evidence sources (including sub-themes: scientific and research evidence, facts and information, political-social development plans, managers' professional expertise and ethical-moral evidence); predictors (sub-themes: stakeholder values and expectations, functional behavior, knowledge, key competencies and skill, evidence sources, evidence levels, uses and benefits and government programs); EBMgt barriers (sub-themes: managers' personal characteristics, decision-making environment, training and research system and organizational issues); and evidence-based hospital management processes (sub-themes: asking, acquiring, appraising, aggregating, applying and assessing). Originality/value Findings suggest that most participants have positive EBMgt attitudes. A full evidence-based hospital manager is a person who uses all evidence sources in a six-step decision-making process. EBMgt frameworks are a good tool to manage healthcare organizations. The authors found factors affecting hospital EBMgt and identified six evidence sources that healthcare managers can use in evidence-based decision-making processes.

A three-talk model for shared decision making: multistage consultation process

PubMed Central

Durand, Marie Anne; Song, Julia; Aarts, Johanna; Barr, Paul J; Berger, Zackary; Cochran, Nan; Frosch, Dominick; Galasiński, Dariusz; Gulbrandsen, Pål; Han, Paul K J; Härter, Martin; Kinnersley, Paul; Lloyd, Amy; Mishra, Manish; Perestelo-Perez, Lilisbeth; Scholl, Isabelle; Tomori, Kounosuke; Trevena, Lyndal; Witteman, Holly O; Van der Weijden, Trudy

2017-01-01

Objectives To revise an existing three-talk model for learning how to achieve shared decision making, and to consult with relevant stakeholders to update and obtain wider engagement. Design Multistage consultation process. Setting Key informant group, communities of interest, and survey of clinical specialties. Participants 19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialties. Results After extended consultation over three iterations, we revised the three-talk model by making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of shared decision making is proposed, based on “team talk,” “option talk,” and “decision talk,” to depict a process of collaboration and deliberation. Team talk places emphasis on the need to provide support to patients when they are made aware of choices, and to elicit their goals as a means of guiding decision making processes. Option talk refers to the task of comparing alternatives, using risk communication principles. Decision talk refers to the task of arriving at decisions that reflect the informed preferences of patients, guided by the experience and expertise of health professionals. Conclusions The revised three-talk model of shared decision making depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences. PMID:29109079

Shared decision-making at the end of life: A focus group study exploring the perceptions and experiences of multi-disciplinary healthcare professionals working in the home setting.

PubMed

Brogan, Paula; Hasson, Felicity; McIlfatrick, Sonja

2018-01-01

Globally recommended in healthcare policy, Shared Decision-Making is also central to international policy promoting community palliative care. Yet realities of implementation by multi-disciplinary healthcare professionals who provide end-of-life care in the home are unclear. To explore multi-disciplinary healthcare professionals' perceptions and experiences of Shared Decision-Making at end of life in the home. Qualitative design using focus groups, transcribed verbatim and analysed thematically. A total of 43 participants, from multi-disciplinary community-based services in one region of the United Kingdom, were recruited. While the rhetoric of Shared Decision-Making was recognised, its implementation was impacted by several interconnecting factors, including (1) conceptual confusion regarding Shared Decision-Making, (2) uncertainty in the process and (3) organisational factors which impeded Shared Decision-Making. Multiple interacting factors influence implementation of Shared Decision-Making by professionals working in complex community settings at the end of life. Moving from rhetoric to reality requires future work exploring the realities of Shared Decision-Making practice at individual, process and systems levels.

Theory-informed design of values clarification methods: a cognitive psychological perspective on patient health-related decision making.

PubMed

Pieterse, Arwen H; de Vries, Marieke; Kunneman, Marleen; Stiggelbout, Anne M; Feldman-Stewart, Deb

2013-01-01

Healthcare decisions, particularly those involving weighing benefits and harms that may significantly affect quality and/or length of life, should reflect patients' preferences. To support patients in making choices, patient decision aids and values clarification methods (VCM) in particular have been developed. VCM intend to help patients to determine the aspects of the choices that are important to their selection of a preferred option. Several types of VCM exist. However, they are often designed without clear reference to theory, which makes it difficult for their development to be systematic and internally coherent. Our goal was to provide theory-informed recommendations for the design of VCM. Process theories of decision making specify components of decision processes, thus, identify particular processes that VCM could aim to facilitate. We conducted a review of the MEDLINE and PsycINFO databases and of references to theories included in retrieved papers, to identify process theories of decision making. We selected a theory if (a) it fulfilled criteria for a process theory; (b) provided a coherent description of the whole process of decision making; and (c) empirical evidence supports at least some of its postulates. Four theories met our criteria: Image Theory, Differentiation and Consolidation theory, Parallel Constraint Satisfaction theory, and Fuzzy-trace Theory. Based on these, we propose that VCM should: help optimize mental representations; encourage considering all potentially appropriate options; delay selection of an initially favoured option; facilitate the retrieval of relevant values from memory; facilitate the comparison of options and their attributes; and offer time to decide. In conclusion, our theory-based design recommendations are explicit and transparent, providing an opportunity to test each in a systematic manner. Copyright © 2012 Elsevier Ltd. All rights reserved.

Vicarious Effort-Based Decision-Making in Autism Spectrum Disorders.

PubMed

Mosner, Maya G; Kinard, Jessica L; McWeeny, Sean; Shah, Jasmine S; Markiewitz, Nathan D; Damiano-Goodwin, Cara R; Burchinal, Margaret R; Rutherford, Helena J V; Greene, Rachel K; Treadway, Michael T; Dichter, Gabriel S

2017-10-01

This study investigated vicarious effort-based decision-making in 50 adolescents with autism spectrum disorders (ASD) compared to 32 controls using the Effort Expenditure for Rewards Task. Participants made choices to win money for themselves or for another person. When choosing for themselves, the ASD group exhibited relatively similar patterns of effort-based decision-making across reward parameters. However, when choosing for another person, the ASD group demonstrated relatively decreased sensitivity to reward magnitude, particularly in the high magnitude condition. Finally, patterns of responding in the ASD group were related to individual differences in consummatory pleasure capacity. These findings indicate atypical vicarious effort-based decision-making in ASD and more broadly add to the growing body of literature addressing social reward processing deficits in ASD.

Pregnancy as Foreground in Cystic Fibrosis Carrier Testing Decisions in Primary Care

PubMed Central

Williams, Janet K.

2009-01-01

Cystic fibrosis carrier testing (CFCT) is among the first of the DNA tests offered prenatally in primary care settings. This paper from a descriptive qualitative study describes the influence of pregnancy in CFCT decisions by women receiving community-based prenatal care. Twenty-seven women receiving prenatal care in Midwestern U.S. primary care clinics completed semistructured interviews. Audiotaped interviews were analyzed using content analysis. Participants described decision-making influences and strategies from the perspective of “being pregnant.” Patterns of attitudes and beliefs include (1) dealing with emotions, (2) pregnancy is natural, and (3) thinking about the baby. Strategies in the decision-making process included (1) reducing stress, (2) choosing what is relevant, (3) doing everything right, (4) wanting to be prepared, (5) delaying information, and (6) trusting God. While other factors were mentioned by some women, major themes reflect the influence of currently being pregnant on the decision-making process. These findings suggest that pregnancy is a powerful influence on the decision-making process and may not be the optimal time to make fully informed decisions regarding genetic carrier testing. Further understanding of factors influencing the genetic testing decision-making process is needed. Offering CFCT prior to conception is advocated. PMID:19309287

An Autonomous Flight Safety System

DTIC Science & Technology

2008-11-01

are taken. AFSS can take vehicle navigation data from redundant onboard sensors and make flight termination decisions using software-based rules...implemented on redundant flight processors. By basing these decisions on actual Instantaneous Impact Predictions and by providing for an arbitrary...number of mission rules, it is the contention of the AFSS development team that the decision making process used by Missile Flight Control Officers

Distributed decision making in action: diagnostic imaging investigations within the bigger picture.

PubMed

Makanjee, Chandra R; Bergh, Anne-Marie; Hoffmann, Willem A

2018-03-01

Decision making in the health care system - specifically with regard to diagnostic imaging investigations - occurs at multiple levels. Professional role players from various backgrounds are involved in making these decisions, from the point of referral to the outcomes of the imaging investigation. The aim of this study was to map the decision-making processes and pathways involved when patients are referred for diagnostic imaging investigations and to explore distributed decision-making events at the points of contact with patients within a health care system. A two-phased qualitative study was conducted in an academic public health complex with the district hospital as entry point. The first phase included case studies of 24 conveniently selected patients, and the second phase involved 12 focus group interviews with health care providers. Data analysis was based on Rapley's interpretation of decision making as being distributed across time, situations and actions, and including different role players and technologies. Clinical decisions incorporating imaging investigations are distributed across the three vital points of contact or decision-making events, namely the initial patient consultation, the diagnostic imaging investigation and the post-investigation consultation. Each of these decision-making events is made up of a sequence of discrete decision-making moments based on the transfer of retrospective, current and prospective information and its transformation into knowledge. This paper contributes to the understanding of the microstructural processes (the 'when' and 'where') involved in the distribution of decisions related to imaging investigations. It also highlights the interdependency in decision-making events of medical and non-medical providers within a single medical encounter. © 2017 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.

Modeling Hospital Discharge and Placement Decision Making: Whither the Elderly.

ERIC Educational Resources Information Center

Clark, William F.; Pelham, Anabel O.

This paper examines the hospital discharge decision making process for elderly patients, based on observations of the operations of a long term care agency, the California Multipurpose Senior Services Project. The analysis is divided into four components: actors, factors, processes, and strategy critique. The first section discusses the major…

Decision-making theories and their usefulness to the midwifery profession both in terms of midwifery practice and the education of midwives.

PubMed

Jefford, Elaine; Fahy, Kathleen; Sundin, Deborah

2011-06-01

What are the strengths and limitations of existing Decision-Making Theories as a basis for guiding best practice clinical decision-making within a framework of midwifery philosophy? Each theory is compared in relation with how well they provide a teachable framework for midwifery clinical reasoning that is consistent with midwifery philosophy. Hypothetico-Deductive Theory, from which medical clinical reasoning is based; intuitive decision-making; Dual Processing Theory; The International Confederation of Midwives Clinical Decision-Making Framework; Australian Nursing and Midwifery Council Midwifery Practice Decisions Flowchart and Midwifery Practice. Best practice midwifery clinical Decision-Making Theory needs to give guidance about: (i) effective use of cognitive reasoning processes; (ii) how to include contextual and emotional factors; (iii) how to include the interests of the baby as an integral part of the woman; (iv) decision-making in partnership with woman; and (v) how to recognize/respond to clinical situations outside the midwife's legal/personal scope of practice. No existing Decision-Making Theory meets the needs of midwifery. Medical clinical reasoning has a good contribution to make in terms of cognitive reasoning processes. Two limitations of medical clinical reasoning are its reductionistic focus and privileging of reason to the exclusion of emotional and contextual factors. Hypothetico-deductive clinical reasoning is a necessary but insufficient condition for best practice clinical decision-making in midwifery. © 2011 Blackwell Publishing Asia Pty Ltd.

Clinical intuition in the nursing process and decision-making-A mixed-studies review.

PubMed

Melin-Johansson, Christina; Palmqvist, Rebecca; Rönnberg, Linda

2017-12-01

To review what is characteristic of registered nurses' intuition in clinical settings, in relationships and in the nursing process. Intuition is a controversial concept and nurses believe that there are difficulties in how they should explain their nursing actions or decisions based on intuition. Much of the evidence from the body of research indicates that nurses value their intuition in a variety of clinical settings. More information on how nurses integrate intuition as a core element in daily clinical work would contribute to an improved understanding on how they go about this. Intuition deserves a place in evidence-based activities, where intuition is an important component associated with the nursing process. An integrative review strengthened with a mixed-studies review. Literature searches were conducted in the databases CINAHL, PubMed and PsycINFO, and literature published 1985-2016 were included. The findings in the studies were analysed with content analysis, and the synthesis process entailed a reasoning between the authors. After a quality assessment, 16 studies were included. The analysis and synthesis resulted in three categories. The characteristics of intuition in the nurse's daily clinical activities include application, assertiveness and experiences; in the relationships with patients' intuition include unique connections, mental and bodily responses, and personal qualities; and in the nursing process include support and guidance, component and clues in decision-making, and validating decisions. Intuition is more than simply a "gut feeling," and it is a process based on knowledge and care experience and has a place beside research-based evidence. Nurses integrate both analysis and synthesis of intuition alongside objective data when making decisions. They should rely on their intuition and use this knowledge in clinical practice as a support in decision-making, which increases the quality and safety of patient care. We find that intuition plays a key role in more or less all of the steps in the nursing process as a base for decision-making that supports safe patient care, and is a validated component of nursing clinical care expertise. © 2017 John Wiley & Sons Ltd.

A potential role of reward and punishment in the facilitation of the emotion-cognition dichotomy in the Iowa Gambling Task.

PubMed

Singh, Varsha

2013-01-01

The Iowa Gambling Task (IGT) is based on the assumption that a decision maker is equally motivated to seek reward and avoid punishment, and that decision making is governed solely by the intertemporal attribute (i.e., preference for an option that produces an immediate outcome instead of one that yields a delayed outcome is believed to reflect risky decision making and is considered a deficit). It was assumed in the present study that the emotion- and cognition-based processing dichotomy manifests in the IGT as reward and punishment frequency and the intertemporal attribute. It was further proposed that the delineation of emotion- and cognition-based processing is contingent upon reward and punishment as manifested in the frame of the task (variant type) and task motivation (instruction type). The effects of IGT variant type (reward vs. punishment) and instruction type (task motivation induced by instruction types: reward, punishment, reward and punishment, or no hint) on the intertemporal and frequency attributes of IGT decision-making were analyzed. Decision making in the reward variant was equally governed by both attributes, and significantly affected by instruction type, while decision making in the punishment variant was differentially affected by the two attributes and not significantly impacted by instruction type. These results suggest that reward and punishment manifested via task frame as well as the task motivation may facilitate the differentiation of emotion- and cognition-based processing in the IGT.

A potential role of reward and punishment in the facilitation of the emotion-cognition dichotomy in the Iowa Gambling Task

PubMed Central

Singh, Varsha

2013-01-01

The Iowa Gambling Task (IGT) is based on the assumption that a decision maker is equally motivated to seek reward and avoid punishment, and that decision making is governed solely by the intertemporal attribute (i.e., preference for an option that produces an immediate outcome instead of one that yields a delayed outcome is believed to reflect risky decision making and is considered a deficit). It was assumed in the present study that the emotion- and cognition-based processing dichotomy manifests in the IGT as reward and punishment frequency and the intertemporal attribute. It was further proposed that the delineation of emotion- and cognition-based processing is contingent upon reward and punishment as manifested in the frame of the task (variant type) and task motivation (instruction type). The effects of IGT variant type (reward vs. punishment) and instruction type (task motivation induced by instruction types: reward, punishment, reward and punishment, or no hint) on the intertemporal and frequency attributes of IGT decision-making were analyzed. Decision making in the reward variant was equally governed by both attributes, and significantly affected by instruction type, while decision making in the punishment variant was differentially affected by the two attributes and not significantly impacted by instruction type. These results suggest that reward and punishment manifested via task frame as well as the task motivation may facilitate the differentiation of emotion- and cognition-based processing in the IGT. PMID:24381567

Shared decision-making – transferring research into practice: the Analytic Hierarchy Process (AHP)

PubMed Central

Dolan, James G.

2008-01-01

Objective To illustrate how the Analytic Hierarchy Process (AHP) can be used to promote shared decision-making and enhance clinician-patient communication. Methods Tutorial review. Results The AHP promotes shared decision making by creating a framework that is used to define the decision, summarize the information available, prioritize information needs, elicit preferences and values, and foster meaningful communication among decision stakeholders. Conclusions The AHP and related multi-criteria methods have the potential for improving the quality of clinical decisions and overcoming current barriers to implementing shared decision making in busy clinical settings. Further research is needed to determine the best way to implement these tools and to determine their effectiveness. Practice Implications Many clinical decisions involve preference-based trade-offs between competing risks and benefits. The AHP is a well-developed method that provides a practical approach for improving patient-provider communication, clinical decision-making, and the quality of patient care in these situations. PMID:18760559

Factors influencing the clinical decision-making of midwives: a qualitative study.

PubMed

Daemers, Darie O A; van Limbeek, Evelien B M; Wijnen, Hennie A A; Nieuwenhuijze, Marianne J; de Vries, Raymond G

2017-10-06

Although midwives make clinical decisions that have an impact on the health and well-being of mothers and babies, little is known about how they make those decisions. Wide variation in intrapartum decisions to refer women to obstetrician-led care suggests that midwives' decisions are based on more than the evidence based medicine (EBM) model - i.e. clinical evidence, midwife's expertise, and woman's values - alone. With this study we aimed to explore the factors that influence clinical decision-making of midwives who work independently. We used a qualitative approach, conducting in-depth interviews with a purposive sample of 11 Dutch primary care midwives. Data collection took place between May and September 2015. The interviews were semi-structured, using written vignettes to solicit midwives' clinical decision-making processes (Think Aloud method). We performed thematic analysis on the transcripts. We identified five themes that influenced clinical decision-making: the pregnant woman as a whole person, sources of knowledge, the midwife as a whole person, the collaboration between maternity care professionals, and the organisation of care. Regarding the midwife, her decisions were shaped not only by her experience, intuition, and personal circumstances, but also by her attitudes about physiology, woman-centredness, shared decision-making, and collaboration with other professionals. The nature of the local collaboration between maternity care professionals and locally-developed protocols dominated midwives' clinical decision-making. When midwives and obstetricians had different philosophies of care and different practice styles, their collaborative efforts were challenged. Midwives' clinical decision-making is a more varied and complex process than the EBM framework suggests. If midwives are to succeed in their role as promoters and protectors of physiological pregnancy and birth, they need to understand how clinical decisions in a multidisciplinary context are actually made.

A Web-Based Tool to Support Shared Decision Making for People With a Psychotic Disorder: Randomized Controlled Trial and Process Evaluation

PubMed Central

Emerencia, Ando C; Boonstra, Nynke; Wunderink, Lex; de Jonge, Peter; Sytema, Sjoerd

2013-01-01

Background Mental health policy makers encourage the development of electronic decision aids to increase patient participation in medical decision making. Evidence is needed to determine whether these decision aids are helpful in clinical practice and whether they lead to increased patient involvement and better outcomes. Objective This study reports the outcome of a randomized controlled trial and process evaluation of a Web-based intervention to facilitate shared decision making for people with psychotic disorders. Methods The study was carried out in a Dutch mental health institution. Patients were recruited from 2 outpatient teams for patients with psychosis (N=250). Patients in the intervention condition (n=124) were provided an account to access a Web-based information and decision tool aimed to support patients in acquiring an overview of their needs and appropriate treatment options provided by their mental health care organization. Patients were given the opportunity to use the Web-based tool either on their own (at their home computer or at a computer of the service) or with the support of an assistant. Patients in the control group received care as usual (n=126). Half of the patients in the sample were patients experiencing a first episode of psychosis; the other half were patients with a chronic psychosis. Primary outcome was patient-perceived involvement in medical decision making, measured with the Combined Outcome Measure for Risk Communication and Treatment Decision-making Effectiveness (COMRADE). Process evaluation consisted of questionnaire-based surveys, open interviews, and researcher observation. Results In all, 73 patients completed the follow-up measurement and were included in the final analysis (response rate 29.2%). More than one-third (48/124, 38.7%) of the patients who were provided access to the Web-based decision aid used it, and most used its full functionality. No differences were found between the intervention and control conditions on perceived involvement in medical decision making (COMRADE satisfaction with communication: F1,68=0.422, P=.52; COMRADE confidence in decision: F1,67=0.086, P=.77). In addition, results of the process evaluation suggest that the intervention did not optimally fit in with routine practice of the participating teams. Conclusions The development of electronic decision aids to facilitate shared medical decision making is encouraged and many people with a psychotic disorder can work with them. This holds for both first-episode patients and long-term care patients, although the latter group might need more assistance. However, results of this paper could not support the assumption that the use of electronic decision aids increases patient involvement in medical decision making. This may be because of weak implementation of the study protocol and a low response rate. Trial Registration Dutch Trial Register (NTR) trial number: 10340; http://www.trialregister.nl/trialreg/admin/rctsearch.asp?Term=10340 (Archived by WebCite at http://www.webcitation.org/6Jj5umAeS). PMID:24100091

Ag2S atomic switch-based `tug of war' for decision making

NASA Astrophysics Data System (ADS)

Lutz, C.; Hasegawa, T.; Chikyow, T.

2016-07-01

For a computing process such as making a decision, a software controlled chip of several transistors is necessary. Inspired by how a single cell amoeba decides its movements, the theoretical `tug of war' computing model was proposed but not yet implemented in an analogue device suitable for integrated circuits. Based on this model, we now developed a new electronic element for decision making processes, which will have no need for prior programming. The devices are based on the growth and shrinkage of Ag filaments in α-Ag2+δS gap-type atomic switches. Here we present the adapted device design and the new materials. We demonstrate the basic `tug of war' operation by IV-measurements and Scanning Electron Microscopy (SEM) observation. These devices could be the base for a CMOS-free new computer architecture.For a computing process such as making a decision, a software controlled chip of several transistors is necessary. Inspired by how a single cell amoeba decides its movements, the theoretical `tug of war' computing model was proposed but not yet implemented in an analogue device suitable for integrated circuits. Based on this model, we now developed a new electronic element for decision making processes, which will have no need for prior programming. The devices are based on the growth and shrinkage of Ag filaments in α-Ag2+δS gap-type atomic switches. Here we present the adapted device design and the new materials. We demonstrate the basic `tug of war' operation by IV-measurements and Scanning Electron Microscopy (SEM) observation. These devices could be the base for a CMOS-free new computer architecture. Electronic supplementary information (ESI) available. See DOI: 10.1039/c6nr00690f

Scrutinizing screening: a critical interpretive review of primary care provider perspectives on mammography decision-making with average-risk women.

PubMed

Siedlikowski, Sophia; Ells, Carolyn; Bartlett, Gillian

2018-01-01

A decision to undertake screening for breast cancer often takes place within the primary care setting, but current controversies such as overdiagnosis and inconsistent screening recommendations based on evolving evidence render this a challenging process, particularly for average-risk women. Given the responsibility of primary care providers in counseling women in this decision-making process, it is important to understand their thoughts on these controversies and how they manage uncertainty in their practice. To review the perspectives and approaches of primary care providers regarding mammography decision-making with average-risk women. This study is a critical interpretive review of peer-review literature that reports primary care provider perspectives on mammography screening decision-making. Ovid MEDLINE®, Ovid PsycInfo, and Scopus databases were searched with dates from 2002 to 2017 using search terms related to mammography screening, uncertainty, counseling, decision-making, and primary health care providers. Nine articles were included following a review process involving the three authors. Using an inductive and iterative approach, data were grouped into four thematic categories: (1) perceptions on the effectiveness of screening, screening initiation age, and screening frequency; (2) factors guiding primary care providers in the screening decision-making process, including both provider and patient-related factors, (3) uncertainty faced by primary care providers regarding guidelines and screening discussions with their patients; and (4) informed decision-making with average-risk women, including factors that facilitate and hinder this process. The discussion of results addresses several factors about the diversity of perspectives and practices of physicians counseling average-risk women regarding breast cancer screening. This has implications for the challenge of understanding and explaining evidence, what should be shared with average-risk women considering screening, the forms of knowledge that physicians value to guide screening decision-making, and the consent process for population-based screening initiatives. Within the data, there was little attention placed on how physicians coped with uncertainty in practice. Given the dual responsibility of physicians in caring for both individuals and the larger population, further research should probe more deeply into how they balance their duties to individual patients with those to the larger population they serve.

Dual Processes in Decision Making and Developmental Neuroscience: A Fuzzy-Trace Model.

PubMed

Reyna, Valerie F; Brainerd, Charles J

2011-09-01

From Piaget to the present, traditional and dual-process theories have predicted improvement in reasoning from childhood to adulthood, and improvement has been observed. However, developmental reversals-that reasoning biases emerge with development -have also been observed in a growing list of paradigms. We explain how fuzzy-trace theory predicts both improvement and developmental reversals in reasoning and decision making. Drawing on research on logical and quantitative reasoning, as well as on risky decision making in the laboratory and in life, we illustrate how the same small set of theoretical principles apply to typical neurodevelopment, encompassing childhood, adolescence, and adulthood, and to neurological conditions such as autism and Alzheimer's disease. For example, framing effects-that risk preferences shift when the same decisions are phrases in terms of gains versus losses-emerge in early adolescence as gist-based intuition develops. In autistic individuals, who rely less on gist-based intuition and more on verbatim-based analysis, framing biases are attenuated (i.e., they outperform typically developing control subjects). In adults, simple manipulations based on fuzzy-trace theory can make framing effects appear and disappear depending on whether gist-based intuition or verbatim-based analysis is induced. These theoretical principles are summarized and integrated in a new mathematical model that specifies how dual modes of reasoning combine to produce predictable variability in performance. In particular, we show how the most popular and extensively studied model of decision making-prospect theory-can be derived from fuzzy-trace theory by combining analytical (verbatim-based) and intuitive (gist-based) processes.

One Step at a Time: SBM as an Incremental Process.

ERIC Educational Resources Information Center

Conrad, Mark

1995-01-01

Discusses incremental SBM budgeting and answers questions regarding resource equity, bookkeeping requirements, accountability, decision-making processes, and purchasing. Approaching site-based management as an incremental process recognizes that every school system engages in some level of site-based decisions. Implementation can be gradual and…

Prioritization of Stockpile Maintenance with Layered Pareto Fronts

DOE Office of Scientific and Technical Information (OSTI.GOV)

Burke, Sarah E.; Anderson-Cook, Christine M.; Lu, Lu

Difficult choices are required for a decision-making process where resources and budgets are increasingly constrained. This study demonstrates a structured decision-making approach using layered Pareto fronts to identify priorities about how to allocate funds between munitions stockpiles based on their estimated reliability, the urgency of needing available units, and the consequences if adequate numbers of units are not available. This case study, while specific to the characteristics of a group of munitions stockpiles, illustrates the general process of structured decision-making based on first identifying appropriate metrics that summarize the important dimensions of the decision, and then objectively eliminating non-contenders frommore » further consideration. Finally, the final subjective stage incorporates user priorities to select the four stockpiles to receive additional maintenance and surveillance funds based on understanding the trade-offs and robustness to various user priorities.« less

Prioritization of Stockpile Maintenance with Layered Pareto Fronts

DOE PAGES

Burke, Sarah E.; Anderson-Cook, Christine M.; Lu, Lu; ...

2017-10-11

Difficult choices are required for a decision-making process where resources and budgets are increasingly constrained. This study demonstrates a structured decision-making approach using layered Pareto fronts to identify priorities about how to allocate funds between munitions stockpiles based on their estimated reliability, the urgency of needing available units, and the consequences if adequate numbers of units are not available. This case study, while specific to the characteristics of a group of munitions stockpiles, illustrates the general process of structured decision-making based on first identifying appropriate metrics that summarize the important dimensions of the decision, and then objectively eliminating non-contenders frommore » further consideration. Finally, the final subjective stage incorporates user priorities to select the four stockpiles to receive additional maintenance and surveillance funds based on understanding the trade-offs and robustness to various user priorities.« less

The Role of Dysfunctional Myths in a Decision-Making Process under Bounded Rationality: A Complex Dynamical Systems Perspective.

PubMed

Stamovlasis, Dimitrios; Vaiopoulou, Julie

2017-07-01

The present study examines the factors influencing a decision-making process, with specific focus on the role of dysfunctional myths (DM). DM are thoughts or beliefs that are rather irrational, however influential to people's decisions. In this paper a decision-making process regarding the career choice of university students majoring in natural sciences and education (N=496) is examined by analyzing survey data taken via Career Decision Making Difficulties Questionnaire (CDDQ). The difficulty of making the choice and the certainty about one's decision were the state variables, while the independent variables were factors related to the lack of information or knowledge needed, which actually reflect a bounded rationality. Cusp catastrophe analysis, based on both least squares and maximum likelihood procedures, showed that the nonlinear models predicting the two state variables were superior to linear alternatives. Factors related to lack of knowledge about the steps involved in the process of career decision-making, lack of information about the various occupations, lack of information about self and lack of motivation acted as asymmetry, while dysfunctional myths acted as bifurcation factor for both state variables. The catastrophe model, grounded in empirical data, revealed a unique role for DM and a better interpretation within the context of complexity and the notion of bounded rationality. The analysis opens the nonlinear dynamical systems (NDS) perspective in studying decision-making processes. Theoretical and practical implications are discussed.

Beyond shared decision-making: Collaboration in the age of recovery from serious mental illness.

PubMed

Treichler, Emily B H; Spaulding, William D

2017-01-01

The role that people with serious mental illness (SMI) play in making decisions about their own treatment and rehabilitation is attracting increasing attention and scrutiny. This attention is embedded in a broader social/consumer movement, the recovery movement , whose agenda includes extensive reform of the mental health system and advancing respect for the dignity and autonomy of people with SMI. Shared decision-making (SDM) is an approach for enhancing consumer participation in health-care decision-making. SDM translates straightforwardly to specific clinical procedures that systematically identify domains of decision-making and guide the practitioner and consumer through making the decisions. In addition, Collaborative decision-making (CDM) is a set of guiding principles that avoids the connotations and limitations of SDM. CDM looks broadly at the range of decisions to be made in mental health care, and assigns consumers and providers equal responsibility and power in the decision-making process. It recognizes the diverse history, knowledge base, and values of each consumer by assuming patients can lead and contribute to decision-making, contributing both value-based information and technical information. This article further discusses the importance of CDM for people with SMI. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Accounting for reasonableness: Exploring the personal internal framework affecting decisions about cancer drug funding.

PubMed

Sinclair, Shane; Hagen, Neil A; Chambers, Carole; Manns, Braden; Simon, Anita; Browman, George P

2008-05-01

Drug decision-makers are involved in developing and implementing policy, procedure and processes to support health resource allocation regarding drug treatment formularies. A variety of approaches to decision-making, including formal decision-making frameworks, have been developed to support transparent and fair priority setting. Recently, a decision tool, 'The 6-STEPPPs Tool', was developed to assist in making decisions about new cancer drugs within the public health care system. We conducted a qualitative study, utilizing focus groups and participant observation, in order to investigate the internal frameworks that supported and challenged individual participants as they applied this decision tool within a multi-stakeholder decision process. We discovered that health care resource allocation engaged not only the minds of decision-makers but profoundly called on the often conflicting values of the heart. Objective decision-making frameworks for new drug therapies need to consider the subjective internal frameworks of decision-makers that affect decisions. Understanding the very human, internal turmoil experienced by individuals involved in health care resource allocation, sheds additional insight into how to account for reasonableness and how to better support difficult decisions through transparent, values-based resource allocation policy, procedures and processes.

Development of a support tool for complex decision-making in the provision of rural maternity care.

PubMed

Hearns, Glen; Klein, Michael C; Trousdale, William; Ulrich, Catherine; Butcher, David; Miewald, Christiana; Lindstrom, Ronald; Eftekhary, Sahba; Rosinski, Jessica; Gómez-Ramírez, Oralia; Procyk, Andrea

2010-02-01

Decisions in the organization of safe and effective rural maternity care are complex, difficult, value laden and fraught with uncertainty, and must often be based on imperfect information. Decision analysis offers tools for addressing these complexities in order to help decision-makers determine the best use of resources and to appreciate the downstream effects of their decisions. To develop a maternity care decision-making tool for the British Columbia Northern Health Authority (NH) for use in low birth volume settings. Based on interviews with community members, providers, recipients and decision-makers, and employing a formal decision analysis approach, we sought to clarify the influences affecting rural maternity care and develop a process to generate a set of value-focused objectives for use in designing and evaluating rural maternity care alternatives. Four low-volume communities with variable resources (with and without on-site births, with or without caesarean section capability) were chosen. Physicians (20), nurses (18), midwives and maternity support service providers (4), local business leaders, economic development officials and elected officials (12), First Nations (women [pregnant and non-pregnant], chiefs and band members) (40), social workers (3), pregnant women (2) and NH decision-makers/administrators (17). We developed a Decision Support Manual to assist with assessing community needs and values, context for decision-making, capacity of the health authority or healthcare providers, identification of key objectives for decision-making, developing alternatives for care, and a process for making trade-offs and balancing multiple objectives. The manual was deemed an effective tool for the purpose by the client, NH. Beyond assisting the decision-making process itself, the methodology provides a transparent communication tool to assist in making difficult decisions. While the manual was specifically intended to deal with rural maternity issues, the NH decision-makers feel the method can be easily adapted to assist decision-making in other contexts in medicine where there are conflicting objectives, values and opinions. Decisions on the location of new facilities or infrastructure, or enhancing or altering services such as surgical or palliative care, would be examples of complex decisions that might benefit from this methodology.

Development of a Support Tool for Complex Decision-Making in the Provision of Rural Maternity Care

PubMed Central

Hearns, Glen; Klein, Michael C.; Trousdale, William; Ulrich, Catherine; Butcher, David; Miewald, Christiana; Lindstrom, Ronald; Eftekhary, Sahba; Rosinski, Jessica; Gómez-Ramírez, Oralia; Procyk, Andrea

2010-01-01

Context: Decisions in the organization of safe and effective rural maternity care are complex, difficult, value laden and fraught with uncertainty, and must often be based on imperfect information. Decision analysis offers tools for addressing these complexities in order to help decision-makers determine the best use of resources and to appreciate the downstream effects of their decisions. Objective: To develop a maternity care decision-making tool for the British Columbia Northern Health Authority (NH) for use in low birth volume settings. Design: Based on interviews with community members, providers, recipients and decision-makers, and employing a formal decision analysis approach, we sought to clarify the influences affecting rural maternity care and develop a process to generate a set of value-focused objectives for use in designing and evaluating rural maternity care alternatives. Setting: Four low-volume communities with variable resources (with and without on-site births, with or without caesarean section capability) were chosen. Participants: Physicians (20), nurses (18), midwives and maternity support service providers (4), local business leaders, economic development officials and elected officials (12), First Nations (women [pregnant and non-pregnant], chiefs and band members) (40), social workers (3), pregnant women (2) and NH decision-makers/administrators (17). Results: We developed a Decision Support Manual to assist with assessing community needs and values, context for decision-making, capacity of the health authority or healthcare providers, identification of key objectives for decision-making, developing alternatives for care, and a process for making trade-offs and balancing multiple objectives. The manual was deemed an effective tool for the purpose by the client, NH. Conclusions: Beyond assisting the decision-making process itself, the methodology provides a transparent communication tool to assist in making difficult decisions. While the manual was specifically intended to deal with rural maternity issues, the NH decision-makers feel the method can be easily adapted to assist decision-making in other contexts in medicine where there are conflicting objectives, values and opinions. Decisions on the location of new facilities or infrastructure, or enhancing or altering services such as surgical or palliative care, would be examples of complex decisions that might benefit from this methodology. PMID:21286270

Heuristic-based information acquisition and decision making among pilots.

PubMed

Wiggins, Mark W; Bollwerk, Sandra

2006-01-01

This research was designed to examine the impact of heuristic-based approaches to the acquisition of task-related information on the selection of an optimal alternative during simulated in-flight decision making. The work integrated features of naturalistic and normative decision making and strategies of information acquisition within a computer-based, decision support framework. The study comprised two phases, the first of which involved familiarizing pilots with three different heuristic-based strategies of information acquisition: frequency, elimination by aspects, and majority of confirming decisions. The second stage enabled participants to choose one of the three strategies of information acquisition to resolve a fourth (choice) scenario. The results indicated that task-oriented experience, rather than the information acquisition strategies, predicted the selection of the optimal alternative. It was also evident that of the three strategies available, the elimination by aspects information acquisition strategy was preferred by most participants. It was concluded that task-oriented experience, rather than the process of information acquisition, predicted task accuracy during the decision-making task. It was also concluded that pilots have a preference for one particular approach to information acquisition. Applications of outcomes of this research include the development of decision support systems that adapt to the information-processing capabilities and preferences of users.

Error affect inoculation for a complex decision-making task.

PubMed

Tabernero, Carmen; Wood, Robert E

2009-05-01

Individuals bring knowledge, implicit theories, and goal orientations to group meetings. Group decisions arise out of the exchange of these orientations. This research explores how a trainee's exploratory and deliberate process (an incremental theory and learning goal orientation) impacts the effectiveness of individual and group decision-making processes. The effectiveness of this training program is compared with another program that included error affect inoculation (EAI). Subjects were 40 Spanish Policemen in a training course. They were distributed in two training conditions for an individual and group decision-making task. In one condition, individuals received the Self-Guided Exploration plus Deliberation Process instructions, which emphasised exploring the options and testing hypotheses. In the other condition, individuals also received instructions based on Error Affect Inoculation (EAI), which emphasised positive affective reactions to errors and mistakes when making decisions. Results show that the quality of decisions increases when the groups share their reasoning. The AIE intervention promotes sharing information, flexible initial viewpoints, and improving the quality of group decisions. Implications and future directions are discussed.

24 CFR 55.20 - Decision making process.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Decision making process. 55.20... Decision making process. The decision making process for compliance with this part contains eight steps... decision making process are: (a) Step 1. Determine whether the proposed action is located in a 100-year...

Nurse educators and decision making: a female perspective.

PubMed

Valentine, P E

1992-01-01

Quality of work life issues are major concerns of nurses today. Decision making is one such issue. This article is part of a larger case study of a Canadian hospital school of nursing that asked whether women nurse educators bring unique orientations to the workplace that have relevance for the administration of nursing organizations. The process of decision making, a small part of the larger study, is discussed in this article. The results suggested that women nurse educators used a cooperative, collaborative, highly participatory style of decision making that resulted in decisions based on consensus. The implications this female style of decision making has for nurses and nurse administrators is discussed.

Electrophysiological correlates reflect the integration of model-based and model-free decision information.

PubMed

Eppinger, Ben; Walter, Maik; Li, Shu-Chen

2017-04-01

In this study, we investigated the interplay of habitual (model-free) and goal-directed (model-based) decision processes by using a two-stage Markov decision task in combination with event-related potentials (ERPs) and computational modeling. To manipulate the demands on model-based decision making, we applied two experimental conditions with different probabilities of transitioning from the first to the second stage of the task. As we expected, when the stage transitions were more predictable, participants showed greater model-based (planning) behavior. Consistent with this result, we found that stimulus-evoked parietal (P300) activity at the second stage of the task increased with the predictability of the state transitions. However, the parietal activity also reflected model-free information about the expected values of the stimuli, indicating that at this stage of the task both types of information are integrated to guide decision making. Outcome-related ERP components only reflected reward-related processes: Specifically, a medial prefrontal ERP component (the feedback-related negativity) was sensitive to negative outcomes, whereas a component that is elicited by reward (the feedback-related positivity) increased as a function of positive prediction errors. Taken together, our data indicate that stimulus-locked parietal activity reflects the integration of model-based and model-free information during decision making, whereas feedback-related medial prefrontal signals primarily reflect reward-related decision processes.

Ignorance- versus Evidence-Based Decision Making: A Decision Time Analysis of the Recognition Heuristic

ERIC Educational Resources Information Center

Hilbig, Benjamin E.; Pohl, Rudiger F.

2009-01-01

According to part of the adaptive toolbox notion of decision making known as the recognition heuristic (RH), the decision process in comparative judgments--and its duration--is determined by whether recognition discriminates between objects. By contrast, some recently proposed alternative models predict that choices largely depend on the amount of…

Predicting explorative motor learning using decision-making and motor noise.

PubMed

Chen, Xiuli; Mohr, Kieran; Galea, Joseph M

2017-04-01

A fundamental problem faced by humans is learning to select motor actions based on noisy sensory information and incomplete knowledge of the world. Recently, a number of authors have asked whether this type of motor learning problem might be very similar to a range of higher-level decision-making problems. If so, participant behaviour on a high-level decision-making task could be predictive of their performance during a motor learning task. To investigate this question, we studied performance during an explorative motor learning task and a decision-making task which had a similar underlying structure with the exception that it was not subject to motor (execution) noise. We also collected an independent measurement of each participant's level of motor noise. Our analysis showed that explorative motor learning and decision-making could be modelled as the (approximately) optimal solution to a Partially Observable Markov Decision Process bounded by noisy neural information processing. The model was able to predict participant performance in motor learning by using parameters estimated from the decision-making task and the separate motor noise measurement. This suggests that explorative motor learning can be formalised as a sequential decision-making process that is adjusted for motor noise, and raises interesting questions regarding the neural origin of explorative motor learning.

Predicting explorative motor learning using decision-making and motor noise

PubMed Central

Galea, Joseph M.

2017-01-01

A fundamental problem faced by humans is learning to select motor actions based on noisy sensory information and incomplete knowledge of the world. Recently, a number of authors have asked whether this type of motor learning problem might be very similar to a range of higher-level decision-making problems. If so, participant behaviour on a high-level decision-making task could be predictive of their performance during a motor learning task. To investigate this question, we studied performance during an explorative motor learning task and a decision-making task which had a similar underlying structure with the exception that it was not subject to motor (execution) noise. We also collected an independent measurement of each participant’s level of motor noise. Our analysis showed that explorative motor learning and decision-making could be modelled as the (approximately) optimal solution to a Partially Observable Markov Decision Process bounded by noisy neural information processing. The model was able to predict participant performance in motor learning by using parameters estimated from the decision-making task and the separate motor noise measurement. This suggests that explorative motor learning can be formalised as a sequential decision-making process that is adjusted for motor noise, and raises interesting questions regarding the neural origin of explorative motor learning. PMID:28437451

A Descriptive Study of Decision-Making Conversations during Pediatric Intensive Care Unit Family Conferences.

PubMed

Smith, Michael A; Clayman, Marla L; Frader, Joel; Arenson, Melanie; Haber-Barker, Natalie; Ryan, Claire; Emanuel, Linda; Michelson, Kelly

2018-06-19

Little is known about how decision-making conversations occur during pediatric intensive care unit (PICU) family conferences (FCs). Describe the decision-making process and implementation of shared decision making (SDM) during PICU FCs. Observational study. University-based tertiary care PICU, including 31 parents and 94 PICU healthcare professionals involved in FCs. We recorded, transcribed, and analyzed 14 PICU FCs involving decision-making discussions. We used a modified grounded theory and content analysis approach to explore the use of traditionally described stages of decision making (DM) (information exchange, deliberation, and determining a plan). We also identified the presence or absence of predefined SDM elements. DM involved the following modified stages: information exchange; information-oriented deliberation; plan-oriented deliberation; and determining a plan. Conversations progressed through stages in a nonlinear manner. For the main decision discussed, all conferences included a presentation of the clinical issues, treatment alternatives, and uncertainty. A minority of FCs included assessing the family's understanding (21%), assessing the family's need for input from others (28%), exploring the family's desired decision-making role (35%), and eliciting the family's opinion (42%). In the FCs studied, we found that DM is a nonlinear process. We also found that several SDM elements that could provide information about parents' perspectives and needs did not always occur, identifying areas for process improvement.

Facilitators and constraints at each stage of the migration decision process.

PubMed

Kley, Stefanie

2017-10-01

Behavioural models of migration emphasize the importance of migration decision-making for the explanation of subsequent behaviour. But empirical migration research regularly finds considerable gaps between those who intend to migrate and those who actually realize their intention. This paper applies the Theory of Planned Behaviour, enriched by the Rubicon model, to test specific hypotheses about distinct effects of facilitators and constraints on specific stages of migration decision-making and behaviour. The data come from a tailor-made panel survey based on random samples of people drawn from two German cities in 2006-07. The results show that in conventional models the effects of facilitators and constraints on migration decision-making are likely to be underestimated. Splitting the process of migration decision-making into a pre-decisional and a pre-actional phase helps to avoid bias in the estimated effects of facilitators and constraints on both migration decision-making and migration behaviour.

Values based practice: a framework for thinking with.

PubMed

Mohanna, Kay

2017-07-01

Values are those principles that govern behaviours, and values-based practice has been described as a theory and skills base for effective healthcare decision-making where different (and hence potentially conflicting) values are in play. The emphasis is on good process rather than pre-set right outcomes, aiming to achieve balanced decision-making. In this article we will consider the utility of this model by looking at leadership development, a current area of much interest and investment in healthcare. Copeland points out that 'values based leadership behaviors are styles with a moral, authentic and ethical dimension', important qualities in healthcare decision-making.

Practical Guide for the Selection of Audio Visual Media. General Criteria System and Evaluation Procedure for Educational Media Decisions.

ERIC Educational Resources Information Center

Klepzig, H. J.; Weiss, M.

Designed to aid in making concrete decisions on the acquisition and use of media, the criteria system and evaluation procedure described is a multiphase, objective-based decision making process. This report includes guidelines for setting up goal systems and developing criteria for the evaluation of media based on a goal system; an outline of…

The System Dynamics Model User Sustainability Explorer (SD-MUSE) user interface: a user-friendly tool for interpreting system dynamic models

EPA Science Inventory

Sustainability-based decision making is a challenging process that requires balancing trade-offs among social, economic, and environmental components. System Dynamic (SD) models can be useful tools to inform sustainability-based decision making because they provide a holistic co...

Emotion-based decision-making in healthy subjects: short-term effects of reducing dopamine levels

PubMed Central

Sevy, Serge; Hassoun, Youssef; Bechara, Antoine; Yechiam, Eldad; Napolitano, Barbara; Burdick, Katherine; Delman, Howard; Malhotra, Anil

2007-01-01

Introduction Converging evidences from animal and human studies suggest that addiction is associated with dopaminergic dysfunction in brain reward circuits. So far, it is unclear what aspects of addictive behaviors are related to a dopaminergic dysfunction. Discussion We hypothesize that a decrease in dopaminergic activity impairs emotion-based decision-making. To demonstrate this hypothesis, we investigated the effects of a decrease in dopaminergic activity on the performance of an emotion-based decision-making task, the Iowa gambling task (IGT), in 11 healthy human subjects. Materials and methods We used a double-blind, placebo-controlled, within-subject design to examine the effect of a mixture containing the branched-chain amino acids (BCAA) valine, isoleucine and leucine on prolactin, IGT performance, perceptual competency and visual aspects of visuospatial working memory, visual attention and working memory, and verbal memory. The expectancy-valence model was used to determine the relative contributions of distinct IGT components (attention to past outcomes, relative weight of wins and losses, and choice strategies) in the decision-making process. Observations and results Compared to placebo, the BCAA mixture increased prolactin levels and impaired IGT performance. BCAA administration interfered with a particular component process of decision-making related to attention to more recent events as compared to more distant events. There were no differences between placebo and BCAA conditions for other aspects of cognition. Our results suggest a direct link between a reduced dopaminergic activity and poor emotion-based decision-making characterized by shortsightedness, and thus difficulties resisting short-term reward, despite long-term negative consequences. These findings have implications for behavioral and pharmacological interventions targeting impaired emotion-based decision-making in addictive disorders. PMID:16915385

Hesitant Fuzzy Thermodynamic Method for Emergency Decision Making Based on Prospect Theory.

PubMed

Ren, Peijia; Xu, Zeshui; Hao, Zhinan

2017-09-01

Due to the timeliness of emergency response and much unknown information in emergency situations, this paper proposes a method to deal with the emergency decision making, which can comprehensively reflect the emergency decision making process. By utilizing the hesitant fuzzy elements to represent the fuzziness of the objects and the hesitant thought of the experts, this paper introduces the negative exponential function into the prospect theory so as to portray the psychological behaviors of the experts, which transforms the hesitant fuzzy decision matrix into the hesitant fuzzy prospect decision matrix (HFPDM) according to the expectation-levels. Then, this paper applies the energy and the entropy in thermodynamics to take the quantity and the quality of the decision values into account, and defines the thermodynamic decision making parameters based on the HFPDM. Accordingly, a whole procedure for emergency decision making is conducted. What is more, some experiments are designed to demonstrate and improve the validation of the emergency decision making procedure. Last but not the least, this paper makes a case study about the emergency decision making in the firing and exploding at Port Group in Tianjin Binhai New Area, which manifests the effectiveness and practicability of the proposed method.

The Role of Evidence in the Decision-Making Process of Selecting Essential Medicines in Developing Countries: The Case of Tanzania

PubMed Central

Mori, Amani Thomas; Kaale, Eliangiringa Amos; Ngalesoni, Frida; Norheim, Ole Frithjof; Robberstad, Bjarne

2014-01-01

Background Insufficient access to essential medicines is a major health challenge in developing countries. Despite the importance of Standard Treatment Guidelines and National Essential Medicine Lists in facilitating access to medicines, little is known about how they are updated. This study aims to describe the process of updating the Standard Treatment Guidelines and National Essential Medicine List in Tanzania and further examines the criteria and the underlying evidence used in decision-making. Methods This is a qualitative study in which data were collected by in-depth interviews and document reviews. Interviews were conducted with 18 key informants who were involved in updating the Standard Treatment Guidelines and National Essential Medicine List. We used a thematic content approach to analyse the data. Findings The Standard Treatment Guidelines and National Essential Medicine List was updated by committees of experts who were recruited mostly from referral hospitals and the Ministry of Health and Social Welfare. Efficacy, safety, availability and affordability were the most frequently utilised criteria in decision-making, although these were largely based on experience rather than evidence. In addition, recommendations from international guidelines and medicine promotions also influenced decision-making. Cost-effectiveness, despite being an important criterion for formulary decisions, was not utilised. Conclusions Recent decisions about the selection of essential medicines in Tanzania were made by committees of experts who largely used experience and discretionary judgement, leaving evidence with only a limited role in decision-making process. There may be several reasons for the current limited use of evidence in decision-making, but one hypothesis that remains to be explored is whether training experts in evidence-based decision-making would lead to a better and more explicit use of evidence. PMID:24416293

The role of evidence in the decision-making process of selecting essential medicines in developing countries: the case of Tanzania.

PubMed

Mori, Amani Thomas; Kaale, Eliangiringa Amos; Ngalesoni, Frida; Norheim, Ole Frithjof; Robberstad, Bjarne

2014-01-01

Insufficient access to essential medicines is a major health challenge in developing countries. Despite the importance of Standard Treatment Guidelines and National Essential Medicine Lists in facilitating access to medicines, little is known about how they are updated. This study aims to describe the process of updating the Standard Treatment Guidelines and National Essential Medicine List in Tanzania and further examines the criteria and the underlying evidence used in decision-making. This is a qualitative study in which data were collected by in-depth interviews and document reviews. Interviews were conducted with 18 key informants who were involved in updating the Standard Treatment Guidelines and National Essential Medicine List. We used a thematic content approach to analyse the data. The Standard Treatment Guidelines and National Essential Medicine List was updated by committees of experts who were recruited mostly from referral hospitals and the Ministry of Health and Social Welfare. Efficacy, safety, availability and affordability were the most frequently utilised criteria in decision-making, although these were largely based on experience rather than evidence. In addition, recommendations from international guidelines and medicine promotions also influenced decision-making. Cost-effectiveness, despite being an important criterion for formulary decisions, was not utilised. Recent decisions about the selection of essential medicines in Tanzania were made by committees of experts who largely used experience and discretionary judgement, leaving evidence with only a limited role in decision-making process. There may be several reasons for the current limited use of evidence in decision-making, but one hypothesis that remains to be explored is whether training experts in evidence-based decision-making would lead to a better and more explicit use of evidence.

Wishful Thinking? Inside the Black Box of Exposure Assessment.

PubMed

Money, Annemarie; Robinson, Christine; Agius, Raymond; de Vocht, Frank

2016-05-01

Decision-making processes used by experts when undertaking occupational exposure assessment are relatively unknown, but it is often assumed that there is a common underlying method that experts employ. However, differences in training and experience of assessors make it unlikely that one general method for expert assessment would exist. Therefore, there are concerns about formalizing, validating, and comparing expert estimates within and between studies that are difficult, if not impossible, to characterize. Heuristics on the other hand (the processes involved in decision making) have been extensively studied. Heuristics are deployed by everyone as short-cuts to make the often complex process of decision-making simpler, quicker, and less burdensome. Experts' assessments are often subject to various simplifying heuristics as a way to reach a decision in the absence of sufficient data. Therefore, investigating the underlying heuristics or decision-making processes involved may help to shed light on the 'black box' of exposure assessment. A mixed method study was conducted utilizing both a web-based exposure assessment exercise incorporating quantitative and semiqualitative elements of data collection, and qualitative semi-structured interviews with exposure assessors. Qualitative data were analyzed using thematic analysis. Twenty-five experts completed the web-based exposure assessment exercise and 8 of these 25 were randomly selected to participate in the follow-up interview. Familiar key themes relating to the exposure assessment exercise emerged; 'intensity'; 'probability'; 'agent'; 'process'; and 'duration' of exposure. However, an important aspect of the detailed follow-up interviews revealed a lack of structure and order with which participants described their decision making. Participants mostly described some form of an iterative process, heavily relying on the anchoring and adjustment heuristic, which differed between experts. In spite of having undertaken comparable training (in occupational hygiene or exposure assessment), experts use different methods to assess exposure. Decision making appears to be an iterative process with heavy reliance on the key heuristic of anchoring and adjustment. Using multiple experts to assess exposure while providing some form of anchoring scenario to build from, and additional training in understanding the impact of simple heuristics on the process of decision making, is likely to produce a more methodical approach to assessment; thereby improving consistency and transparency in expert exposure assessment. © The Author 2016. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.

System and method for integrating hazard-based decision making tools and processes

DOEpatents

Hodgin, C Reed [Westminster, CO

2012-03-20

A system and method for inputting, analyzing, and disseminating information necessary for identified decision-makers to respond to emergency situations. This system and method provides consistency and integration among multiple groups, and may be used for both initial consequence-based decisions and follow-on consequence-based decisions. The system and method in a preferred embodiment also provides tools for accessing and manipulating information that are appropriate for each decision-maker, in order to achieve more reasoned and timely consequence-based decisions. The invention includes processes for designing and implementing a system or method for responding to emergency situations.

A three-talk model for shared decision making: multistage consultation process.

PubMed

Elwyn, Glyn; Durand, Marie Anne; Song, Julia; Aarts, Johanna; Barr, Paul J; Berger, Zackary; Cochran, Nan; Frosch, Dominick; Galasiński, Dariusz; Gulbrandsen, Pål; Han, Paul K J; Härter, Martin; Kinnersley, Paul; Lloyd, Amy; Mishra, Manish; Perestelo-Perez, Lilisbeth; Scholl, Isabelle; Tomori, Kounosuke; Trevena, Lyndal; Witteman, Holly O; Van der Weijden, Trudy

2017-11-06

Objectives  To revise an existing three-talk model for learning how to achieve shared decision making, and to consult with relevant stakeholders to update and obtain wider engagement. Design  Multistage consultation process. Setting  Key informant group, communities of interest, and survey of clinical specialties. Participants  19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialties. Results  After extended consultation over three iterations, we revised the three-talk model by making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of shared decision making is proposed, based on "team talk," "option talk," and "decision talk," to depict a process of collaboration and deliberation. Team talk places emphasis on the need to provide support to patients when they are made aware of choices, and to elicit their goals as a means of guiding decision making processes. Option talk refers to the task of comparing alternatives, using risk communication principles. Decision talk refers to the task of arriving at decisions that reflect the informed preferences of patients, guided by the experience and expertise of health professionals. Conclusions  The revised three-talk model of shared decision making depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

An innovative approach to addressing childhood obesity: a knowledge-based infrastructure for supporting multi-stakeholder partnership decision-making in Quebec, Canada.

PubMed

Addy, Nii Antiaye; Shaban-Nejad, Arash; Buckeridge, David L; Dubé, Laurette

2015-01-23

Multi-stakeholder partnerships (MSPs) have become a widespread means for deploying policies in a whole of society strategy to address the complex problem of childhood obesity. However, decision-making in MSPs is fraught with challenges, as decision-makers are faced with complexity, and have to reconcile disparate conceptualizations of knowledge across multiple sectors with diverse sets of indicators and data. These challenges can be addressed by supporting MSPs with innovative tools for obtaining, organizing and using data to inform decision-making. The purpose of this paper is to describe and analyze the development of a knowledge-based infrastructure to support MSP decision-making processes. The paper emerged from a study to define specifications for a knowledge-based infrastructure to provide decision support for community-level MSPs in the Canadian province of Quebec. As part of the study, a process assessment was conducted to understand the needs of communities as they collect, organize, and analyze data to make decisions about their priorities. The result of this process is a "portrait", which is an epidemiological profile of health and nutrition in their community. Portraits inform strategic planning and development of interventions, and are used to assess the impact of interventions. Our key findings indicate ambiguities and disagreement among MSP decision-makers regarding causal relationships between actions and outcomes, and the relevant data needed for making decisions. MSP decision-makers expressed a desire for easy-to-use tools that facilitate the collection, organization, synthesis, and analysis of data, to enable decision-making in a timely manner. Findings inform conceptual modeling and ontological analysis to capture the domain knowledge and specify relationships between actions and outcomes. This modeling and analysis provide the foundation for an ontology, encoded using OWL 2 Web Ontology Language. The ontology is developed to provide semantic support for the MSP process, defining objectives, strategies, actions, indicators, and data sources. In the future, software interacting with the ontology can facilitate interactive browsing by decision-makers in the MSP in the form of concepts, instances, relationships, and axioms. Our ontology also facilitates the integration and interpretation of community data, and can help in managing semantic interoperability between different knowledge sources. Future work will focus on defining specifications for the development of a database of indicators and an information system to help decision-makers to view, analyze and organize indicators for their community. This work should improve MSP decision-making in the development of interventions to address childhood obesity.

An Innovative Approach to Addressing Childhood Obesity: A Knowledge-Based Infrastructure for Supporting Multi-Stakeholder Partnership Decision-Making in Quebec, Canada

PubMed Central

Addy, Nii Antiaye; Shaban-Nejad, Arash; Buckeridge, David L.; Dubé, Laurette

2015-01-01

Multi-stakeholder partnerships (MSPs) have become a widespread means for deploying policies in a whole of society strategy to address the complex problem of childhood obesity. However, decision-making in MSPs is fraught with challenges, as decision-makers are faced with complexity, and have to reconcile disparate conceptualizations of knowledge across multiple sectors with diverse sets of indicators and data. These challenges can be addressed by supporting MSPs with innovative tools for obtaining, organizing and using data to inform decision-making. The purpose of this paper is to describe and analyze the development of a knowledge-based infrastructure to support MSP decision-making processes. The paper emerged from a study to define specifications for a knowledge-based infrastructure to provide decision support for community-level MSPs in the Canadian province of Quebec. As part of the study, a process assessment was conducted to understand the needs of communities as they collect, organize, and analyze data to make decisions about their priorities. The result of this process is a “portrait”, which is an epidemiological profile of health and nutrition in their community. Portraits inform strategic planning and development of interventions, and are used to assess the impact of interventions. Our key findings indicate ambiguities and disagreement among MSP decision-makers regarding causal relationships between actions and outcomes, and the relevant data needed for making decisions. MSP decision-makers expressed a desire for easy-to-use tools that facilitate the collection, organization, synthesis, and analysis of data, to enable decision-making in a timely manner. Findings inform conceptual modeling and ontological analysis to capture the domain knowledge and specify relationships between actions and outcomes. This modeling and analysis provide the foundation for an ontology, encoded using OWL 2 Web Ontology Language. The ontology is developed to provide semantic support for the MSP process, defining objectives, strategies, actions, indicators, and data sources. In the future, software interacting with the ontology can facilitate interactive browsing by decision-makers in the MSP in the form of concepts, instances, relationships, and axioms. Our ontology also facilitates the integration and interpretation of community data, and can help in managing semantic interoperability between different knowledge sources. Future work will focus on defining specifications for the development of a database of indicators and an information system to help decision-makers to view, analyze and organize indicators for their community. This work should improve MSP decision-making in the development of interventions to address childhood obesity. PMID:25625409

Hierarchical semi-numeric method for pairwise fuzzy group decision making.

PubMed

Marimin, M; Umano, M; Hatono, I; Tamura, H

2002-01-01

Gradual improvements to a single-level semi-numeric method, i.e., linguistic labels preference representation by fuzzy sets computation for pairwise fuzzy group decision making are summarized. The method is extended to solve multiple criteria hierarchical structure pairwise fuzzy group decision-making problems. The problems are hierarchically structured into focus, criteria, and alternatives. Decision makers express their evaluations of criteria and alternatives based on each criterion by using linguistic labels. The labels are converted into and processed in triangular fuzzy numbers (TFNs). Evaluations of criteria yield relative criteria weights. Evaluations of the alternatives, based on each criterion, yield a degree of preference for each alternative or a degree of satisfaction for each preference value. By using a neat ordered weighted average (OWA) or a fuzzy weighted average operator, solutions obtained based on each criterion are aggregated into final solutions. The hierarchical semi-numeric method is suitable for solving a larger and more complex pairwise fuzzy group decision-making problem. The proposed method has been verified and applied to solve some real cases and is compared to Saaty's (1996) analytic hierarchy process (AHP) method.

Clinical use of patient decision-making aids for stone patients.

PubMed

Lim, Amy H; Streeper, Necole M; Best, Sara L; Penniston, Kristina L; Nakada, Stephen Y

2017-08-01

Patient decision-making aids (PDMAs) help patients make informed healthcare decisions and improve patient satisfaction. The utility of PDMAs for patients considering treatments for urolithiasis has not yet been published. We report our experience using PDMAs developed at our institution in the outpatient clinical setting in patients considering a variety of treatment options for stones. Patients with radiographically confirmed urolithiasis were given PDMAs regarding treatment options for their stone(s) based on their clinical profile. We assessed patients' satisfaction, involvedness, and feeling of making a more informed decision with utilization of the PDMAs using a Likert Scale Questionnaire. Information was also collected regarding previous stone passage, history and type of surgical intervention for urolithiasis, and level of education. Patients (n = 43; 18 males, 23 females and two unknown) 53 +/- 14years old were included. Patients reported that they understood the advantages and disadvantages outlined in the PDMAs (97%), that the PDMAs helped them make a more informed decision (83%) and felt more involved in the decision making process (88%). Patients reported that the aids were presented in a balanced manner and used up-to-date scientific information (100%, 84% respectively). Finally, a majority of the patients prefer an expert's opinion when making a treatment decision (98%) with 73% of patients preferring to form their own opinion based on available information. Previous stone surgery was associated with patients feeling more involved with the decision making process (p = 0.0465). PDMAs have a promising role in shared decision-making in the setting of treatment options for nephrolithiasis.

[Evidence-based Risk and Benefit Communication for Shared Decision Making].

PubMed

Nakayama, Takeo

2018-01-01

　Evidence-based medicine (EBM) can be defined as "the integration of the best research evidence with clinical expertise and a patient's unique values and circumstances". However, even with the best research evidence, many uncertainties can make clinical decisions difficult. As the social requirement of respecting patient values and preferences has been increasingly recognized, shared decision making (SDM) and consensus development between patients and clinicians have attracted attention. SDM is a process by which patients and clinicians make decisions and arrive at a consensus through interactive conversations and communications. During the process of SDM, patients and clinicians share information with each other on the goals they hope to achieve and responsibilities in meeting those goals. From the clinician's standpoint, information regarding the benefits and risks of potential treatment options based on current evidence and professional experience is provided to patients. From the patient's standpoint, information on personal values, preferences, and social roles is provided to clinicians. SDM is a sort of "wisdom" in the context of making autonomous decisions in uncertain, difficult situations through interactions and cooperation between patients and clinicians. Joint development of EBM and SDM will help facilitate patient-clinician relationships and improve the quality of healthcare.

Intergroup Conflict and Rational Decision Making

PubMed Central

Martínez-Tur, Vicente; Peñarroja, Vicente; Serrano, Miguel A.; Hidalgo, Vanesa; Moliner, Carolina; Salvador, Alicia; Alacreu-Crespo, Adrián; Gracia, Esther; Molina, Agustín

2014-01-01

The literature has been relatively silent about post-conflict processes. However, understanding the way humans deal with post-conflict situations is a challenge in our societies. With this in mind, we focus the present study on the rationality of cooperative decision making after an intergroup conflict, i.e., the extent to which groups take advantage of post-conflict situations to obtain benefits from collaborating with the other group involved in the conflict. Based on dual-process theories of thinking and affect heuristic, we propose that intergroup conflict hinders the rationality of cooperative decision making. We also hypothesize that this rationality improves when groups are involved in an in-group deliberative discussion. Results of a laboratory experiment support the idea that intergroup conflict –associated with indicators of the activation of negative feelings (negative affect state and heart rate)– has a negative effect on the aforementioned rationality over time and on both group and individual decision making. Although intergroup conflict leads to sub-optimal decision making, rationality improves when groups and individuals subjected to intergroup conflict make decisions after an in-group deliberative discussion. Additionally, the increased rationality of the group decision making after the deliberative discussion is transferred to subsequent individual decision making. PMID:25461384

Intergroup conflict and rational decision making.

PubMed

Martínez-Tur, Vicente; Peñarroja, Vicente; Serrano, Miguel A; Hidalgo, Vanesa; Moliner, Carolina; Salvador, Alicia; Alacreu-Crespo, Adrián; Gracia, Esther; Molina, Agustín

2014-01-01

The literature has been relatively silent about post-conflict processes. However, understanding the way humans deal with post-conflict situations is a challenge in our societies. With this in mind, we focus the present study on the rationality of cooperative decision making after an intergroup conflict, i.e., the extent to which groups take advantage of post-conflict situations to obtain benefits from collaborating with the other group involved in the conflict. Based on dual-process theories of thinking and affect heuristic, we propose that intergroup conflict hinders the rationality of cooperative decision making. We also hypothesize that this rationality improves when groups are involved in an in-group deliberative discussion. Results of a laboratory experiment support the idea that intergroup conflict -associated with indicators of the activation of negative feelings (negative affect state and heart rate)- has a negative effect on the aforementioned rationality over time and on both group and individual decision making. Although intergroup conflict leads to sub-optimal decision making, rationality improves when groups and individuals subjected to intergroup conflict make decisions after an in-group deliberative discussion. Additionally, the increased rationality of the group decision making after the deliberative discussion is transferred to subsequent individual decision making.

Decision problems in management of construction projects

NASA Astrophysics Data System (ADS)

Szafranko, E.

2017-10-01

In a construction business, one must oftentimes make decisions during all stages of a building process, from planning a new construction project through its execution to the stage of using a ready structure. As a rule, the decision making process is made more complicated due to certain conditions specific for civil engineering. With such diverse decision situations, it is recommended to apply various decision making support methods. Both, literature and hands-on experience suggest several methods based on analytical and computational procedures, some less and some more complex. This article presents the methods which can be helpful in supporting decision making processes in the management of civil engineering projects. These are multi-criteria methods, such as MCE, AHP or indicator methods. Because the methods have different advantages and disadvantages, whereas decision situations have their own specific nature, a brief summary of the methods alongside some recommendations regarding their practical applications has been given at the end of the paper. The main aim of this article is to review the methods of decision support and their analysis for possible use in the construction industry.

Cancer care decision making in multidisciplinary meetings.

PubMed

Dew, Kevin; Stubbe, Maria; Signal, Louise; Stairmand, Jeannine; Dennett, Elizabeth; Koea, Jonathan; Simpson, Andrew; Sarfati, Diana; Cunningham, Chris; Batten, Lesley; Ellison-Loschmann, Lis; Barton, Josh; Holdaway, Maureen

2015-03-01

Little research has been undertaken on the actual decision-making processes in cancer care multidisciplinary meetings (MDMs). This article was based on a qualitative observational study of two regional cancer treatment centers in New Zealand. We audiorecorded 10 meetings in which 106 patient cases were discussed. Members of the meetings categorized cases in varying ways, drew on a range of sources of authority, expressed different value positions, and utilized a variety of strategies to justify their actions. An important dimension of authority was encountered authority-the authority a clinician has because of meeting the patient. The MDM chairperson can play an important role in making explicit the sources of authority being drawn on and the value positions of members to provide more clarity to the decision-making process. Attending to issues of process, authority, and values in MDMs has the potential to improve cancer care decision making and ultimately, health outcomes. © The Author(s) 2014.

Multimorbidity and Decision-Making Preferences Among Older Adults.

PubMed

Chi, Winnie C; Wolff, Jennifer; Greer, Raquel; Dy, Sydney

2017-11-01

Understanding individuals' preferences for participating in health care decisions is foundational to delivering person-centered care. We aimed to (1) explore preferences for health care decision making among older adults, and (2) identify multimorbidity profiles associated with preferring less active, ie, passive, participation among older US adults. Ours was a cross-sectional, nationally representative study of 2,017 National Health and Aging Trends Study respondents. Passive decision-making preference was defined as preferring to leave decisions to physicians. Multimorbidity profiles, based on 13 prevalent chronic conditions, were examined as (1) presence of 2 or more conditions, (2) a simple conditions count, and (3) a condition clusters count. Multiple logistic regression was used with adjustment for age, sex, education, English proficiency, and mobility limitation. Most older adults preferred to participate actively in making health care decisions. Older adults with 4 or more conditions, however, and those with multiple condition clusters are relatively less likely to prefer active decision making. Primary care physicians should initiate a shared decision-making process with older adults with 4 or more conditions or multiple condition clusters. Physicians should anticipate variation in decision-making preferences among older adults and adapt a decision-making process that suits individuals' preferences for participation to ensure person-centered care delivery. © 2017 Annals of Family Medicine, Inc.

Strategies to facilitate shared decision-making about pediatric oncology clinical trial enrollment: A systematic review.

PubMed

Robertson, Eden G; Wakefield, Claire E; Signorelli, Christina; Cohn, Richard J; Patenaude, Andrea; Foster, Claire; Pettit, Tristan; Fardell, Joanna E

2018-07-01

We conducted a systematic review to identify the strategies that have been recommended in the literature to facilitate shared decision-making regarding enrolment in pediatric oncology clinical trials. We searched seven databases for peer-reviewed literature, published 1990-2017. Of 924 articles identified, 17 studies were eligible for the review. We assessed study quality using the 'Mixed-Methods Appraisal Tool'. We coded the results and discussions of papers line-by-line using nVivo software. We categorized strategies thematically. Five main themes emerged: 1) decision-making as a process, 2) individuality of the process; 3) information provision, 4) the role of communication, or 5) decision and psychosocial support. Families should have adequate time to make a decision. HCPs should elicit parents' and patients' preferences for level of information and decision involvement. Information should be clear and provided in multiple modalities. Articles also recommended providing training for healthcare professionals and access to psychosocial support for families. High quality, individually-tailored information, open communication and psychosocial support appear vital in supporting decision-making regarding enrollment in clinical trials. These data will usefully inform future decision-making interventions/tools to support families making clinical trial decisions. A solid evidence-base for effective strategies which facilitate shared decision-making is needed. Copyright © 2018 Elsevier B.V. All rights reserved.

Launching a virtual decision lab: development and field-testing of a web-based patient decision support research platform.

PubMed

Hoffman, Aubri S; Llewellyn-Thomas, Hilary A; Tosteson, Anna N A; O'Connor, Annette M; Volk, Robert J; Tomek, Ivan M; Andrews, Steven B; Bartels, Stephen J

2014-12-12

Over 100 trials show that patient decision aids effectively improve patients' information comprehension and values-based decision making. However, gaps remain in our understanding of several fundamental and applied questions, particularly related to the design of interactive, personalized decision aids. This paper describes an interdisciplinary development process for, and early field testing of, a web-based patient decision support research platform, or virtual decision lab, to address these questions. An interdisciplinary stakeholder panel designed the web-based research platform with three components: a) an introduction to shared decision making, b) a web-based patient decision aid, and c) interactive data collection items. Iterative focus groups provided feedback on paper drafts and online prototypes. A field test assessed a) feasibility for using the research platform, in terms of recruitment, usage, and acceptability; and b) feasibility of using the web-based decision aid component, compared to performance of a videobooklet decision aid in clinical care. This interdisciplinary, theory-based, patient-centered design approach produced a prototype for field-testing in six months. Participants (n = 126) reported that: the decision aid component was easy to use (98%), information was clear (90%), the length was appropriate (100%), it was appropriately detailed (90%), and it held their interest (97%). They spent a mean of 36 minutes using the decision aid and 100% preferred using their home/library computer. Participants scored a mean of 75% correct on the Decision Quality, Knowledge Subscale, and 74 out of 100 on the Preparation for Decision Making Scale. Completing the web-based decision aid reduced mean Decisional Conflict scores from 31.1 to 19.5 (p < 0.01). Combining decision science and health informatics approaches facilitated rapid development of a web-based patient decision support research platform that was feasible for use in research studies in terms of recruitment, acceptability, and usage. Within this platform, the web-based decision aid component performed comparably with the videobooklet decision aid used in clinical practice. Future studies may use this interactive research platform to study patients' decision making processes in real-time, explore interdisciplinary approaches to designing web-based decision aids, and test strategies for tailoring decision support to meet patients' needs and preferences.

Certainty, leaps of faith, and tradition: rethinking clinical interventions.

PubMed

Dzurec, L C

1998-12-01

Clinical decision making requires that clinicians think quickly and in ways that will foster optimal, safe client care. Tradition influences clinical decision making, enhancing efficiency of resulting nursing action; however, since many decisions must be based on data that are either uncertain, incomplete, or indirect, clinicians are readily ensnared in processes involving potentially faulty logic associated with tradition. The author addresses the tenacity of tradition and then focuses on three processes--consensus formation, the grounding of certainty in inductive reasoning, and affirming the consequent--that have affected clinical decision making. For some recipients of care, tradition has had a substantial and invalid influence on their ability to access care.

Wishful Thinking? Inside the Black Box of Exposure Assessment

PubMed Central

Money, Annemarie; Robinson, Christine; Agius, Raymond; de Vocht, Frank

2016-01-01

Background: Decision-making processes used by experts when undertaking occupational exposure assessment are relatively unknown, but it is often assumed that there is a common underlying method that experts employ. However, differences in training and experience of assessors make it unlikely that one general method for expert assessment would exist. Therefore, there are concerns about formalizing, validating, and comparing expert estimates within and between studies that are difficult, if not impossible, to characterize. Heuristics on the other hand (the processes involved in decision making) have been extensively studied. Heuristics are deployed by everyone as short-cuts to make the often complex process of decision-making simpler, quicker, and less burdensome. Experts’ assessments are often subject to various simplifying heuristics as a way to reach a decision in the absence of sufficient data. Therefore, investigating the underlying heuristics or decision-making processes involved may help to shed light on the ‘black box’ of exposure assessment. Methods: A mixed method study was conducted utilizing both a web-based exposure assessment exercise incorporating quantitative and semiqualitative elements of data collection, and qualitative semi-structured interviews with exposure assessors. Qualitative data were analyzed using thematic analysis. Results: Twenty-five experts completed the web-based exposure assessment exercise and 8 of these 25 were randomly selected to participate in the follow-up interview. Familiar key themes relating to the exposure assessment exercise emerged; ‘intensity’; ‘probability’; ‘agent’; ‘process’; and ‘duration’ of exposure. However, an important aspect of the detailed follow-up interviews revealed a lack of structure and order with which participants described their decision making. Participants mostly described some form of an iterative process, heavily relying on the anchoring and adjustment heuristic, which differed between experts. Conclusion: In spite of having undertaken comparable training (in occupational hygiene or exposure assessment), experts use different methods to assess exposure. Decision making appears to be an iterative process with heavy reliance on the key heuristic of anchoring and adjustment. Using multiple experts to assess exposure while providing some form of anchoring scenario to build from, and additional training in understanding the impact of simple heuristics on the process of decision making, is likely to produce a more methodical approach to assessment; thereby improving consistency and transparency in expert exposure assessment. PMID:26764244

Decisions, Decisions, Decisions: Recreation Site Choice with Expected Congestion and Social Interaction

ERIC Educational Resources Information Center

Snipes, Katherine H.

2009-01-01

A set of computer-based recreation choice experiments were run to examine the effect of expected congestion and social interactions on the decision making process. MouseTrace is a process-tracing program that recorded individual subject's information acquisitions and provided the necessary information to determine if subjects used attribute-based…

Investigation and design of a Project Management Decision Support System for the 4950th Test Wing.

DTIC Science & Technology

1986-03-01

all decision makers is the need for memory aids (reports, hand written notes, mental memory joggers, etc.). 4. Even in similar decision making ... memories to synthesize a decision- making process based on their individual styles, skills, and knowledge (Sprague, 1982: 106). Control mechanisms...representations shown in Figures 4.9 and 4.10 provide a means to this objective. By enabling a manager to make and record reasonable changes to

IONIO Project: Computer-mediated Decision Support System and Communication in Ocean Science

NASA Astrophysics Data System (ADS)

Oddo, Paolo; Acierno, Arianna; Cuna, Daniela; Federico, Ivan; Galati, Maria Barbara; Awad, Esam; Korres, Gerasimos; Lecci, Rita; Manzella, Giuseppe M. R.; Merico, Walter; Perivoliotis, Leonidas; Pinardi, Nadia; Shchekinova, Elena; Mannarini, Gianandrea; Vamvakaki, Chrysa; Pecci, Leda; Reseghetti, Franco

2013-04-01

A decision Support System is composed by four main steps. The first one is the definition of the problem, the issue to be covered, decisions to be taken. Different causes can provoke different problems, for each of the causes or its effects it is necessary to define a list of information and/or data that are required in order to take the better decision. The second step is the determination of sources from where information/data needed for decision-making can be obtained and who has that information. Furthermore it must be possible to evaluate the quality of the sources to see which of them can provide the best information, and identify the mode and format in which the information is presented. The third step is relying on the processing of knowledge, i.e. if the information/data are fitting for purposes. It has to be decided which parts of the information/data need to be used, what additional data or information is necessary to access, how can information be best presented to be able to understand the situation and take decisions. Finally, the decision making process is an interactive and inclusive process involving all concerned parties, whose different views must be taken into consideration. A knowledge based discussion forum is necessary to reach a consensus. A decision making process need to be examined closely and refined, and modified to meet differing needs over time. The report is presenting legal framework and knowledge base for a scientific based decision support system and a brief exploration of some of the skills that enhances the quality of decisions taken.

Including values in evidence-based policy making for breast screening: An empirically grounded tool to assist expert decision makers.

PubMed

Parker, Lisa

2017-07-01

Values are an important part of evidence-based decision making for health policy: they guide the type of evidence that is collected, how it is interpreted, and how important the conclusions are considered to be. Experts in breast screening (including clinicians, researchers, consumer advocates and senior administrators) hold differing values in relation to what is important in breast screening policy and practice, and committees may find it difficult to incorporate the complexity and variety of values into policy decisions. The decision making tool provided here is intended to assist with this process. The tool is modified from more general frameworks that are intended to assist with ethical decision making in public health, and informed by data drawn from previous empirical studies on values amongst Australian breast screening experts. It provides a structured format for breast screening committees to consider and discuss the values of themselves and others, suggests relevant topics for further inquiry and highlights areas of need for future research into the values of the public. It enables committees to publicly explain and justify their decisions with reference to values, improving transparency and accountability. It is intended to act alongside practices that seek to accommodate the values of individual women in the informed decision making process for personal decision making about participation in breast screening. Copyright © 2017 Elsevier B.V. All rights reserved.

Increased Reliance on Value-based Decision Processes Following Motor Cortex Disruption.

PubMed

Zénon, Alexandre; Klein, Pierre-Alexandre; Alamia, Andrea; Boursoit, François; Wilhelm, Emmanuelle; Duque, Julie

2015-01-01

During motor decision making, the neural activity in primary motor cortex (M1) encodes dynamically the competition occurring between potential action plans. A common view is that M1 represents the unfolding of the outcome of a decision process taking place upstream. Yet, M1 could also be directly involved in the decision process. Here we tested this hypothesis by assessing the effect of M1 disruption on a motor decision-making task. We applied continuous theta burst stimulation (cTBS) to inhibit either left or right M1 in different groups of subjects and included a third control group with no stimulation. Following cTBS, participants performed a task that required them to choose between two finger key-presses with the right hand according to both perceptual and value-based information. Effects were assessed by means of generalized linear mixed models and computational simulations. In all three groups, subjects relied both on perceptual (P < 0.0001) and value-based information (P = 0.003) to reach a decision. Yet, left M1 disruption led to an increased reliance on value-based information (P = 0.03). This result was confirmed by a computational model showing an increased weight of the valued-based process on the right hand finger choices following left M1 cTBS (P < 0.01). These results indicate that M1 is involved in motor decision making, possibly by weighting the final integration of multiple sources of evidence driving motor behaviors. Copyright © 2015 Elsevier Inc. All rights reserved.

Decision making in pediatric oncology: Views of parents and physicians in two European countries.

PubMed

Badarau, Domnita O; Ruhe, Katharina; Kühne, Thomas; De Clercq, Eva; Colita, Anca; Elger, Bernice S; Wangmo, Tenzin

2017-01-01

Decision making is a highly complex task when providing care for seriously ill children. Physicians, parents, and children face many challenges when identifying and selecting from available treatment options. This qualitative interview study explored decision-making processes for children with cancer at different stages in their treatment in Switzerland and Romania. Thematic analysis of interviews conducted with parents and oncologists identified decision making as a heterogeneous process in both countries. Various decisions were made based on availability and reasonableness of care options. In most cases, at the time of diagnosis, parents were confronted with a "choiceless choice"-that is, there was only one viable option (a standard protocol), and physicians took the lead in making decisions significant for health outcomes. Parents' and sometimes children's role increased during treatment when they had to make decisions regarding research participation and aggressive therapy or palliative care. Framing these results within the previously described Decisional Priority in Pediatric Oncology Model (DPM) highlights family's more prominent position when making elective decisions regarding quality-of-life or medical procedures, which had little effect on health outcomes. The interdependency between oncologists, parents, and children is always present. Communication, sharing of information, and engaging in discussions about preferences, values, and ultimately care goals should be decision making's foundation. Patient participation in these processes was reported as sometimes limited, but parents and oncologists should continue to probe patients' abilities and desire to be involved in decision making. Future research should expand the DPM and explore how decisional priority and authority can be shared by oncologists with parents and even patients.

Optimal decision making modeling for copper-matte Peirce-Smith converting process by means of data mining

NASA Astrophysics Data System (ADS)

Song, Yanpo; Peng, Xiaoqi; Tang, Ying; Hu, Zhikun

2013-07-01

To improve the operation level of copper converter, the approach to optimal decision making modeling for coppermatte converting process based on data mining is studied: in view of the characteristics of the process data, such as containing noise, small sample size and so on, a new robust improved ANN (artificial neural network) modeling method is proposed; taking into account the application purpose of decision making model, three new evaluation indexes named support, confidence and relative confidence are proposed; using real production data and the methods mentioned above, optimal decision making model for blowing time of S1 period (the 1st slag producing period) are developed. Simulation results show that this model can significantly improve the converting quality of S1 period, increase the optimal probability from about 70% to about 85%.

Studying the Impact of Three Different Instructional Methods on Preservice Teachers' Decision-Making

ERIC Educational Resources Information Center

Cevik, Yasemin Demiraslan; Andre, Thomas

2014-01-01

This study compared the impact of three types of instructional methods (case-based learning, worked example and faded worked example) on preservice teachers' (n?=?72) decision-making about classroom management. A quasi-experimental study was conducted to investigate both the outcomes and the processes of preservice teachers' decision-making…

7 CFR 247.33 - Fair hearings.

Code of Federal Regulations, 2010 CFR

2010-01-01

... benefits until a decision on the appeal is made by the hearing official, or until the end of the... conducted in an orderly manner, in accordance with due process; and (5) Making a hearing decision. (j) How... and regulations, and is based on the facts in the hearing record. In making the decision, the hearing...

Youth-Led Decision Making in Community Development Grants

ERIC Educational Resources Information Center

Blanchet-Cohen, Natasha; Manolson, Sarah; Shaw, Katie

2014-01-01

This study examines youth-led decision making (YLDM) among groups of youth who are providers or recipients of community development grants. Focus groups, interviews, and participant observation with 14- to 20-year-olds and supporting adults showed youth have a preference for consensus-based decisions. Youth used due process to reach decisions…

Dual processing model of medical decision-making.

PubMed

Djulbegovic, Benjamin; Hozo, Iztok; Beckstead, Jason; Tsalatsanis, Athanasios; Pauker, Stephen G

2012-09-03

Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I) and/or an analytical, deliberative (system II) processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administered to the patient who may or may not have a disease. We developed a mathematical model in which we linked a recently proposed descriptive psychological model of cognition with the threshold model of medical decision-making and show how this approach can be used to better understand decision-making at the bedside and explain the widespread variation in treatments observed in clinical practice. We show that physician's beliefs about whether to treat at higher (lower) probability levels compared to the prescriptive therapeutic thresholds obtained via system II processing is moderated by system I and the ratio of benefit and harms as evaluated by both system I and II. Under some conditions, the system I decision maker's threshold may dramatically drop below the expected utility threshold derived by system II. This can explain the overtreatment often seen in the contemporary practice. The opposite can also occur as in the situations where empirical evidence is considered unreliable, or when cognitive processes of decision-makers are biased through recent experience: the threshold will increase relative to the normative threshold value derived via system II using expected utility threshold. This inclination for the higher diagnostic certainty may, in turn, explain undertreatment that is also documented in the current medical practice. We have developed the first dual processing model of medical decision-making that has potential to enrich the current medical decision-making field, which is still to the large extent dominated by expected utility theory. The model also provides a platform for reconciling two groups of competing dual processing theories (parallel competitive with default-interventionalist theories).

Facilitating Leadership: A Broader Look at Data Based Interventions.

ERIC Educational Resources Information Center

Mink, Oscar G.

Rational decision making by leaders in higher education and similar institutions suffers from both a lack of relevant data and the failure to use data when it is available. The purpose of this paper is to describe a process which when applied seems to facilitate the rational decision making processes of an institution's leadership. The process…

Factors Affecting Long-Term-Care Residents' Decision-Making Processes as They Formulate Advance Directives

ERIC Educational Resources Information Center

Lambert, Heather C.; McColl, Mary Ann; Gilbert, Julie; Wong, Jiahui; Murray, Gale; Shortt, Samuel E. D.

2005-01-01

Purpose: The purpose of this study was to describe factors contributing to the decision-making processes of elderly persons as they formulate advance directives in long-term care. Design and Methods: This study was qualitative, based on grounded theory. Recruitment was purposive and continued until saturation was reached. Nine residents of a…

Informed shared decision-making supported by decision coaches for women with ductal carcinoma in situ: study protocol for a cluster randomized controlled trial.

PubMed

Berger-Höger, Birte; Liethmann, Katrin; Mühlhauser, Ingrid; Haastert, Burkhard; Steckelberg, Anke

2015-10-12

Women with breast cancer want to participate in treatment decision-making. Guidelines have confirmed the right of informed shared decision-making. However, previous research has shown that the implementation of informed shared decision-making is suboptimal for reasons of limited resources of physicians, power imbalances between patients and physicians and missing evidence-based patient information. We developed an informed shared decision-making program for women with primary ductal carcinoma in situ (DCIS). The program provides decision coaching for women by specialized nurses and aims at supporting involvement in decision-making and informed choices. In this trial, the informed shared decision-making program will be evaluated in breast care centers. A cluster randomized controlled trial will be conducted to compare the informed shared decision-making program with standard care. The program comprises an evidence-based patient decision aid and training of physicians (2 hours) and specialized breast care and oncology nurses (4 days) in informed shared decision-making. Sixteen certified breast care centers will be included, with 192 women with primary DCIS being recruited. Primary outcome is the extent of patients' involvement in shared decision-making as assessed by the MAPPIN-Odyad (Multifocal approach to the 'sharing' in shared decision-making: observer instrument dyad). Secondary endpoints include the sub-measures of the MAPPIN-inventory (MAPPIN-Onurse, MAPPIN-Ophysician, MAPPIN-Opatient, MAPPIN-Qnurse, MAPPIN-Qpatient and MAPPIN-Qphysician), informed choice, decisional conflict and the duration of encounters. It is expected that decision coaching and the provision of evidence-based patient decision aids will increase patients' involvement in decision-making with informed choices and reduce decisional conflicts and duration of physician encounters. Furthermore, an accompanying process evaluation will be conducted. To our knowledge, this is the first study investigating the implementation of decision coaches in German breast care centers. Current Controlled Trials ISRCTN46305518 , date of registration: 5 June 2015.

Natural Resource Information System. Volume 1: Overall description

NASA Technical Reports Server (NTRS)

1972-01-01

A prototype computer-based Natural Resource Information System was designed which could store, process, and display data of maximum usefulness to land management decision making. The system includes graphic input and display, the use of remote sensing as a data source, and it is useful at multiple management levels. A survey established current decision making processes and functions, information requirements, and data collection and processing procedures. The applications of remote sensing data and processing requirements were established. Processing software was constructed and a data base established using high-altitude imagery and map coverage of selected areas of SE Arizona. Finally a demonstration of system processing functions was conducted utilizing material from the data base.

CorRECTreatment: A Web-based Decision Support Tool for Rectal Cancer Treatment that Uses the Analytic Hierarchy Process and Decision Tree

PubMed Central

Karakülah, G.; Dicle, O.; Sökmen, S.; Çelikoğlu, C.C.

2015-01-01

Summary Background The selection of appropriate rectal cancer treatment is a complex multi-criteria decision making process, in which clinical decision support systems might be used to assist and enrich physicians’ decision making. Objective The objective of the study was to develop a web-based clinical decision support tool for physicians in the selection of potentially beneficial treatment options for patients with rectal cancer. Methods The updated decision model contained 8 and 10 criteria in the first and second steps respectively. The decision support model, developed in our previous study by combining the Analytic Hierarchy Process (AHP) method which determines the priority of criteria and decision tree that formed using these priorities, was updated and applied to 388 patients data collected retrospectively. Later, a web-based decision support tool named corRECTreatment was developed. The compatibility of the treatment recommendations by the expert opinion and the decision support tool was examined for its consistency. Two surgeons were requested to recommend a treatment and an overall survival value for the treatment among 20 different cases that we selected and turned into a scenario among the most common and rare treatment options in the patient data set. Results In the AHP analyses of the criteria, it was found that the matrices, generated for both decision steps, were consistent (consistency ratio<0.1). Depending on the decisions of experts, the consistency value for the most frequent cases was found to be 80% for the first decision step and 100% for the second decision step. Similarly, for rare cases consistency was 50% for the first decision step and 80% for the second decision step. Conclusions The decision model and corRECTreatment, developed by applying these on real patient data, are expected to provide potential users with decision support in rectal cancer treatment processes and facilitate them in making projections about treatment options. PMID:25848413

CorRECTreatment: a web-based decision support tool for rectal cancer treatment that uses the analytic hierarchy process and decision tree.

PubMed

Suner, A; Karakülah, G; Dicle, O; Sökmen, S; Çelikoğlu, C C

2015-01-01

The selection of appropriate rectal cancer treatment is a complex multi-criteria decision making process, in which clinical decision support systems might be used to assist and enrich physicians' decision making. The objective of the study was to develop a web-based clinical decision support tool for physicians in the selection of potentially beneficial treatment options for patients with rectal cancer. The updated decision model contained 8 and 10 criteria in the first and second steps respectively. The decision support model, developed in our previous study by combining the Analytic Hierarchy Process (AHP) method which determines the priority of criteria and decision tree that formed using these priorities, was updated and applied to 388 patients data collected retrospectively. Later, a web-based decision support tool named corRECTreatment was developed. The compatibility of the treatment recommendations by the expert opinion and the decision support tool was examined for its consistency. Two surgeons were requested to recommend a treatment and an overall survival value for the treatment among 20 different cases that we selected and turned into a scenario among the most common and rare treatment options in the patient data set. In the AHP analyses of the criteria, it was found that the matrices, generated for both decision steps, were consistent (consistency ratio<0.1). Depending on the decisions of experts, the consistency value for the most frequent cases was found to be 80% for the first decision step and 100% for the second decision step. Similarly, for rare cases consistency was 50% for the first decision step and 80% for the second decision step. The decision model and corRECTreatment, developed by applying these on real patient data, are expected to provide potential users with decision support in rectal cancer treatment processes and facilitate them in making projections about treatment options.

Evaluating the Quality of Patient Decision-Making Regarding Post-Acute Care.

PubMed

Burke, Robert E; Jones, Jacqueline; Lawrence, Emily; Ladebue, Amy; Ayele, Roman; Leonard, Chelsea; Lippmann, Brandi; Matlock, Daniel D; Allyn, Rebecca; Cumbler, Ethan

2018-05-01

Despite a national focus on post-acute care brought about by recent payment reforms, relatively little is known about how hospitalized older adults and their caregivers decide whether to go to a skilled nursing facility (SNF) after hospitalization. We sought to understand to what extent hospitalized older adults and their caregivers are empowered to make a high-quality decision about utilizing an SNF for post-acute care and what contextual or process elements led to satisfaction with the outcome of their decision once in SNF. Qualitative inquiry using the Ottawa Decision Support Framework (ODSF), a conceptual framework that describes key components of high-quality decision-making. Thirty-two previously community-dwelling older adults (≥ 65 years old) and 22 caregivers interviewed at three different hospitals and three skilled nursing facilities. We used key components of the ODSF to identify elements of context and process that affected decision-making and to what extent the outcome was characteristic of a high-quality decision: informed, values based, and not associated with regret or blame. The most important contextual themes were the presence of active medical conditions in the hospital that made decision-making difficult, prior experiences with hospital readmission or SNF, relative level of caregiver support, and pressure to make a decision quickly for which participants felt unprepared. Patients described playing a passive role in the decision-making process and largely relying on recommendations from the medical team. Patients commonly expressed resignation and a perceived lack of choice or autonomy, leading to dissatisfaction with the outcome. Understanding and intervening to improve the quality of decision-making regarding post-acute care supports is essential for improving outcomes of hospitalized older adults. Our results suggest that simply providing information is not sufficient; rather, incorporating key contextual factors and improving the decision-making process for both patients and clinicians are also essential.

Integrating conflict analysis and consensus reaching in a decision support system for water resource management.

PubMed

Giordano, R; Passarella, G; Uricchio, V F; Vurro, M

2007-07-01

The importance of shared decision processes in water management derives from the awareness of the inadequacy of traditional--i.e. engineering--approaches in dealing with complex and ill-structured problems. It is becoming increasingly obvious that traditional problem solving and decision support techniques, based on optimisation and factual knowledge, have to be combined with stakeholder based policy design and implementation. The aim of our research is the definition of an integrated decision support system for consensus achievement (IDSS-C) able to support a participative decision-making process in all its phases: problem definition and structuring, identification of the possible alternatives, formulation of participants' judgments, and consensus achievement. Furthermore, the IDSS-C aims at structuring, i.e. systematising the knowledge which has emerged during the participative process in order to make it comprehensible for the decision-makers and functional for the decision process. Problem structuring methods (PSM) and multi-group evaluation methods (MEM) have been integrated in the IDSS-C. PSM are used to support the stakeholders in providing their perspective of the problem and to elicit their interests and preferences, while MEM are used to define not only the degree of consensus for each alternative, highlighting those where the agreement is high, but also the consensus label for each alternative and the behaviour of individuals during the participative decision-making. The IDSS-C is applied experimentally to a decision process regarding the use of treated wastewater for agricultural irrigation in the Apulia Region (southern Italy).

New approaches for real time decision support systems

NASA Technical Reports Server (NTRS)

Hair, D. Charles; Pickslay, Kent

1994-01-01

NCCOSC RDT&E Division (NRaD) is conducting research into ways of improving decision support systems (DSS) that are used in tactical Navy decision making situations. The research has focused on the incorporation of findings about naturalistic decision-making processes into the design of the DSS. As part of that research, two computer tools were developed that model the two primary naturalistic decision-making strategies used by Navy experts in tactical settings. Current work is exploring how best to incorporate the information produced by those tools into an existing simulation of current Navy decision support systems. This work has implications for any applications involving the need to make decisions under time constraints, based on incomplete or ambiguous data.

Development of a video-based education and process change intervention to improve advance cardiopulmonary resuscitation decision-making.

PubMed

Waldron, Nicholas; Johnson, Claire E; Saul, Peter; Waldron, Heidi; Chong, Jeffrey C; Hill, Anne-Marie; Hayes, Barbara

2016-10-06

Advance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice. We aimed to explore physician barriers to advance CPR decision-making in an inpatient hospital setting and develop a pragmatic intervention to support clinicians to undertake and document routine advance care planning discussions. Two focus groups, which involved eight consultants and ten junior doctors, were conducted following a review of the current literature. A subsequent iterative consensus process developed two intervention elements: (i) an updated 'Goals of Patient Care' (GOPC) form and process; (ii) an education video and resources for teaching advance CPR decision-making and communication. A multidisciplinary group of health professionals and policy-makers with experience in systems development, education and research provided critical feedback. Three key themes emerged from the focus groups and the literature, which identified a structure for the intervention: (i) knowing what to say; (ii) knowing how to say it; (iii) wanting to say it. The themes informed the development of a video to provide education about advance CPR decision-making framework, improving communication and contextualising relevant clinical issues. Critical feedback assisted in refining the video and further guided development and evolution of a medical GOPC approach to discussing and recording medical treatment and advance care plans. Through an iterative process of consultation and review, video-based education and an expanded GOPC form and approach were developed to address physician and systemic barriers to advance CPR decision-making and documentation. Implementation and evaluation across hospital settings is required to examine utility and determine effect on quality of care.

Health technology assessment and primary data collection for reducing uncertainty in decision making.

PubMed

Goeree, Ron; Levin, Les; Chandra, Kiran; Bowen, James M; Blackhouse, Gord; Tarride, Jean-Eric; Burke, Natasha; Bischof, Matthias; Xie, Feng; O'Reilly, Daria

2009-05-01

Health care expenditures continue to escalate, and pressures for increased spending will continue. Health care decision makers from publicly financed systems, private insurance companies, or even from individual health care institutions, will continue to be faced with making difficult purchasing, access, and reimbursement decisions. As a result, decision makers are increasingly turning to evidence-based platforms to help control costs and make the most efficient use of existing resources. Most tools used to assist with evidence-based decision making focus on clinical outcomes. Health technology assessment (HTA) is increasing in popularity because it also considers other factors important for decision making, such as cost, social and ethical values, legal issues, and factors such as the feasibility of implementation. In some jurisdictions, HTAs have also been supplemented with primary data collection to help address uncertainty that may still exist after conducting a traditional HTA. The HTA process adopted in Ontario, Canada, is unique in that assessments are also made to determine what primary data research should be conducted and what should be collected in these studies. In this article, concerns with the traditional HTA process are discussed, followed by a description of the HTA process that has been established in Ontario, with a particular focus on the data collection program followed by the Programs for Assessment of Technology in Health Research Institute. An illustrative example is used to show how the Ontario HTA process works and the role value of information analyses plays in addressing decision uncertainty, determining research feasibility, and determining study data collection needs.

Dual Processes in Decision Making and Developmental Neuroscience: A Fuzzy-Trace Model

PubMed Central

Reyna, Valerie F.; Brainerd, Charles J.

2011-01-01

From Piaget to the present, traditional and dual-process theories have predicted improvement in reasoning from childhood to adulthood, and improvement has been observed. However, developmental reversals—that reasoning biases emerge with development —have also been observed in a growing list of paradigms. We explain how fuzzy-trace theory predicts both improvement and developmental reversals in reasoning and decision making. Drawing on research on logical and quantitative reasoning, as well as on risky decision making in the laboratory and in life, we illustrate how the same small set of theoretical principles apply to typical neurodevelopment, encompassing childhood, adolescence, and adulthood, and to neurological conditions such as autism and Alzheimer's disease. For example, framing effects—that risk preferences shift when the same decisions are phrases in terms of gains versus losses—emerge in early adolescence as gist-based intuition develops. In autistic individuals, who rely less on gist-based intuition and more on verbatim-based analysis, framing biases are attenuated (i.e., they outperform typically developing control subjects). In adults, simple manipulations based on fuzzy-trace theory can make framing effects appear and disappear depending on whether gist-based intuition or verbatim-based analysis is induced. These theoretical principles are summarized and integrated in a new mathematical model that specifies how dual modes of reasoning combine to produce predictable variability in performance. In particular, we show how the most popular and extensively studied model of decision making—prospect theory—can be derived from fuzzy-trace theory by combining analytical (verbatim-based) and intuitive (gist-based) processes. PMID:22096268

Heuristics in Managing Complex Clinical Decision Tasks in Experts’ Decision Making

PubMed Central

Islam, Roosan; Weir, Charlene; Del Fiol, Guilherme

2016-01-01

Background Clinical decision support is a tool to help experts make optimal and efficient decisions. However, little is known about the high level of abstractions in the thinking process for the experts. Objective The objective of the study is to understand how clinicians manage complexity while dealing with complex clinical decision tasks. Method After approval from the Institutional Review Board (IRB), three clinical experts were interviewed the transcripts from these interviews were analyzed. Results We found five broad categories of strategies by experts for managing complex clinical decision tasks: decision conflict, mental projection, decision trade-offs, managing uncertainty and generating rule of thumb. Conclusion Complexity is created by decision conflicts, mental projection, limited options and treatment uncertainty. Experts cope with complexity in a variety of ways, including using efficient and fast decision strategies to simplify complex decision tasks, mentally simulating outcomes and focusing on only the most relevant information. Application Understanding complex decision making processes can help design allocation based on the complexity of task for clinical decision support design. PMID:27275019

Heuristics in Managing Complex Clinical Decision Tasks in Experts' Decision Making.

PubMed

Islam, Roosan; Weir, Charlene; Del Fiol, Guilherme

2014-09-01

Clinical decision support is a tool to help experts make optimal and efficient decisions. However, little is known about the high level of abstractions in the thinking process for the experts. The objective of the study is to understand how clinicians manage complexity while dealing with complex clinical decision tasks. After approval from the Institutional Review Board (IRB), three clinical experts were interviewed the transcripts from these interviews were analyzed. We found five broad categories of strategies by experts for managing complex clinical decision tasks: decision conflict, mental projection, decision trade-offs, managing uncertainty and generating rule of thumb. Complexity is created by decision conflicts, mental projection, limited options and treatment uncertainty. Experts cope with complexity in a variety of ways, including using efficient and fast decision strategies to simplify complex decision tasks, mentally simulating outcomes and focusing on only the most relevant information. Understanding complex decision making processes can help design allocation based on the complexity of task for clinical decision support design.

Exploring decision-making for environmental health services: perspectives from four cities.

PubMed

Hunt, C; Lewin, S

2000-01-01

Increasing resources are being allocated to environmental health monitoring, especially for developing methods and collecting data to construct environmental health indicators (EHIs). Yet, little research has focused on understanding how communities and service providers make decisions with regard to environmental health priorities and the role of indicators in this process. This paper presents insights regarding local decision-making that arose from a project to test the feasibility of using community-based EHIs to facilitate communication between the providers and the recipients of environmental services in four developing-country cities. The results of the study indicate that decision-making for environmental health services is complex and iterative rather than rational and linear. Contextual and process factors play an important role. These factors include the morale of service providers, the extent of collaboration between service agencies, the priorities of different community groups and relations between service providers and communities. Scientific information, in the form of EHIs, did not appear to be a key element of decision-making in the settings studied. As tools, EHIs are unlikely to become part of the decision-making process unless they are integrated with local agendas and backed by strong local representation.

Interactive Management and Updating of Spatial Data Bases

NASA Technical Reports Server (NTRS)

French, P.; Taylor, M.

1982-01-01

The decision making process, whether for power plant siting, load forecasting or energy resource planning, invariably involves a blend of analytical methods and judgement. Management decisions can be improved by the implementation of techniques which permit an increased comprehension of results from analytical models. Even where analytical procedures are not required, decisions can be aided by improving the methods used to examine spatially and temporally variant data. How the use of computer aided planning (CAP) programs and the selection of a predominant data structure, can improve the decision making process is discussed.

Stochastic model for fatigue crack size and cost effective design decisions. [for aerospace structures

NASA Technical Reports Server (NTRS)

Hanagud, S.; Uppaluri, B.

1975-01-01

This paper describes a methodology for making cost effective fatigue design decisions. The methodology is based on a probabilistic model for the stochastic process of fatigue crack growth with time. The development of a particular model for the stochastic process is also discussed in the paper. The model is based on the assumption of continuous time and discrete space of crack lengths. Statistical decision theory and the developed probabilistic model are used to develop the procedure for making fatigue design decisions on the basis of minimum expected cost or risk function and reliability bounds. Selections of initial flaw size distribution, NDT, repair threshold crack lengths, and inspection intervals are discussed.

Developing an Advanced Environment for Collaborative Computing

NASA Technical Reports Server (NTRS)

Becerra-Fernandez, Irma; Stewart, Helen; DelAlto, Martha; DelAlto, Martha; Knight, Chris

1999-01-01

Knowledge management in general tries to organize and make available important know-how, whenever and where ever is needed. Today, organizations rely on decision-makers to produce "mission critical" decisions that am based on inputs from multiple domains. The ideal decision-maker has a profound understanding of specific domains that influence the decision-making process coupled with the experience that allows them to act quickly and decisively on the information. In addition, learning companies benefit by not repeating costly mistakes, and by reducing time-to-market in Research & Development projects. Group-decision making tools can help companies make better decisions by capturing the knowledge from groups of experts. Furthermore, companies that capture their customers preferences can improve their customer service, which translates to larger profits. Therefore collaborative computing provides a common communication space, improves sharing of knowledge, provides a mechanism for real-time feedback on the tasks being performed, helps to optimize processes, and results in a centralized knowledge warehouse. This paper presents the research directions. of a project which seeks to augment an advanced collaborative web-based environment called Postdoc, with workflow capabilities. Postdoc is a "government-off-the-shelf" document management software developed at NASA-Ames Research Center (ARC).

Structured decision making for managing pneumonia epizootics in bighorn sheep

USGS Publications Warehouse

Sells, Sarah N.; Mitchell, Michael S.; Edwards, Victoria L.; Gude, Justin A.; Anderson, Neil J.

2016-01-01

Good decision-making is essential to conserving wildlife populations. Although there may be multiple ways to address a problem, perfect solutions rarely exist. Managers are therefore tasked with identifying decisions that will best achieve desired outcomes. Structured decision making (SDM) is a method of decision analysis used to identify the most effective, efficient, and realistic decisions while accounting for values and priorities of the decision maker. The stepwise process includes identifying the management problem, defining objectives for solving the problem, developing alternative approaches to achieve the objectives, and formally evaluating which alternative is most likely to accomplish the objectives. The SDM process can be more effective than informal decision-making because it provides a transparent way to quantitatively evaluate decisions for addressing multiple management objectives while incorporating science, uncertainty, and risk tolerance. To illustrate the application of this process to a management need, we present an SDM-based decision tool developed to identify optimal decisions for proactively managing risk of pneumonia epizootics in bighorn sheep (Ovis canadensis) in Montana. Pneumonia epizootics are a major challenge for managers due to long-term impacts to herds, epistemic uncertainty in timing and location of future epizootics, and consequent difficulty knowing how or when to manage risk. The decision tool facilitates analysis of alternative decisions for how to manage herds based on predictions from a risk model, herd-specific objectives, and predicted costs and benefits of each alternative. Decision analyses for 2 example herds revealed that meeting management objectives necessitates specific approaches unique to each herd. The analyses showed how and under what circumstances the alternatives are optimal compared to other approaches and current management. Managers can be confident that these decisions are effective, efficient, and realistic because they explicitly account for important considerations managers implicitly weigh when making decisions, including competing management objectives, uncertainty in potential outcomes, and risk tolerance.

Structured decision making as a framework for large-scale wildlife harvest management decisions

USGS Publications Warehouse

Robinson, Kelly F.; Fuller, Angela K.; Hurst, Jeremy E.; Swift, Bryan L.; Kirsch, Arthur; Farquhar, James F.; Decker, Daniel J.; Siemer, William F.

2016-01-01

Fish and wildlife harvest management at large spatial scales often involves making complex decisions with multiple objectives and difficult tradeoffs, population demographics that vary spatially, competing stakeholder values, and uncertainties that might affect management decisions. Structured decision making (SDM) provides a formal decision analytic framework for evaluating difficult decisions by breaking decisions into component parts and separating the values of stakeholders from the scientific evaluation of management actions and uncertainty. The result is a rigorous, transparent, and values-driven process. This decision-aiding process provides the decision maker with a more complete understanding of the problem and the effects of potential management actions on stakeholder values, as well as how key uncertainties can affect the decision. We use a case study to illustrate how SDM can be used as a decision-aiding tool for management decision making at large scales. We evaluated alternative white-tailed deer (Odocoileus virginianus) buck-harvest regulations in New York designed to reduce harvest of yearling bucks, taking into consideration the values of the state wildlife agency responsible for managing deer, as well as deer hunters. We incorporated tradeoffs about social, ecological, and economic management concerns throughout the state. Based on the outcomes of predictive models, expert elicitation, and hunter surveys, the SDM process identified management alternatives that optimized competing objectives. The SDM process provided biologists and managers insight about aspects of the buck-harvest decision that helped them adopt a management strategy most compatible with diverse hunter values and management concerns.

Recognition Decisions from Visual Working Memory Are Mediated by Continuous Latent Strengths

ERIC Educational Resources Information Center

Ricker, Timothy J.; Thiele, Jonathan E.; Swagman, April R.; Rouder, Jeffrey N.

2017-01-01

Making recognition decisions often requires us to reference the contents of working memory, the information available for ongoing cognitive processing. As such, understanding how recognition decisions are made when based on the contents of working memory is of critical importance. In this work we examine whether recognition decisions based on the…

Age Differences in Information Use While Making Decisions: Resource Limitations or Processing Differences?

PubMed

Jacobs-Lawson, Joy M; Schumacher, Mitzi M; Wackerbarth, Sarah B

2016-09-20

Recent research on the decision-making abilities of older adults has shown that they use less information than young adults. One explanation ascribes this age difference to reductions in cognitive abilities with age. The article includes three experimental studies that focused on determining the conditions in which older and young adults would display dissimilar information processing characteristics. Findings from Studies 1 and 2 demonstrated that older adults are not necessarily at greater disadvantage than young adults in decision contexts that demand more information processing resources. Findings from Study 3 indicated that older adults when faced with decisions that require greater processing are likely to use a strategy that reduces the amount of information needed, whereas younger adults rely on strategies that utilize more resources. Combined the findings indicate that older adults change their decision-making strategies based on the context and information provided. Furthermore, support is provided for processing difference. © The Author(s) 2016.

A game theory perspective on environmental assessment: What games are played and what does this tell us about decision making rationality and legitimacy?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bond, Alan; Research Unit for Environmental Sciences and Management, North-West University; Pope, Jenny

Game theory provides a useful theoretical framework to examine the decision process operating in the context of environmental assessment, and to examine the rationality and legitimacy of decision-making subject to Environmental Assessment (EA). The research uses a case study of the Environmental Impact Assessment and Sustainability Appraisal processes undertaken in England. To these are applied an analytical framework, based on the concept of decision windows to identify the decisions to be assessed. The conditions for legitimacy are defined, based on game theory, in relation to the timing of decision information, the behaviour type (competitive, reciprocal, equity) exhibited by the decisionmore » maker, and the level of public engagement; as, together, these control the type of rationality which can be brought to bear on the decision. Instrumental rationality is based on self-interest of individuals, whereas deliberative rationality seeks broader consensus and is more likely to underpin legitimate decisions. The results indicate that the Sustainability Appraisal process, conducted at plan level, is better than EIA, conducted at project level, but still fails to provide conditions that facilitate legitimacy. Game theory also suggests that Sustainability Appraisal is likely to deliver ‘least worst’ outcomes rather than best outcomes when the goals of the assessment process are considered; this may explain the propensity of such ‘least worst’ decisions in practise. On the basis of what can be learned from applying this game theory perspective, it is suggested that environmental assessment processes need to be redesigned and better integrated into decision making in order to guarantee the legitimacy of the decisions made. - Highlights: • Decision legitimacy is defined in terms of game theory. • Game theory is applied to EIA and SA decision windows. • Game theory suggests least worst outcomes prevail. • SA is more likely to be perceived legitimate than EIA.« less

Shared decision-making, gender and new technologies.

PubMed

Zeiler, Kristin

2007-09-01

Much discussion of decision-making processes in medicine has been patient-centred. It has been assumed that there is, most often, one patient. Less attention has been given to shared decision-making processes where two or more patients are involved. This article aims to contribute to this special area. What conditions need to be met if decision-making can be said to be shared? What is a shared decision-making process and what is a shared autonomous decision-making process? Why make the distinction? Examples are drawn from the area of new reproductive medicine and clinical genetics. Possible gender-differences in shared decision-making are discussed.

Empowering occupational therapists to become evidence-based work rehabilitation practitioners.

PubMed

Vachon, Brigitte; Durand, Marie-José; LeBlanc, Jeannette

2010-01-01

Occupational therapists (OTs) engage in continuing education to integrate best available knowledge and skills into their practice. However, many barriers influence the degree to which they are currently able to integrate research evidence into their clinical decision making process. The specific objectives were to explore the clinical decision-making processes they used, and to describe the empowerment process they developed to become evidence-based practitioners. Eight OTs, who had attended a four-day workshop on evidence-based work rehabilitation, were recruited to participate to a reflective practice group. A collaborative research methodology was used. The group was convened for 12 meetings and held during a 15-month period. The data collected was analyzed using the grounded theory method. The results revealed the different decision-making modes used by OTs: defensive, repressed, cautious, autonomous intuitive and autonomous thoughtful. These modes influenced utilization of evidence and determined the stances taken toward practice change. Reflective learning facilitated their utilization of an evidence-based practice model through a three-level empowerment process: deliberateness, client-centeredness and system mindedness. During the course of this study, participants learned to become evidence-based practitioners. This process had an impact on how they viewed their clients, their practice and the work rehabilitation system.

Mothers' process of decision making for gastrostomy placement.

PubMed

Brotherton, Ailsa; Abbott, Janice

2012-05-01

In this article we present the findings of an exploration of mothers' discourses on decision making for gastrostomy placement for their child. Exploring in-depth interviews of a purposive sample, we analyzed the mothers' discourses of the decision-making process to understand how their experiences of the process influenced their subsequent constructions of decision making. Mothers negotiated decision making by reflecting on their personal experiences of feeding their child, either orally or via a tube, and interwove their background experiences with the communications from members of the health care team until a decision was reached. Decision making was often fraught with difficulty, resulting in anxiety and guilt. Experiences of decision making ranged from perceived coercion to true choice, which encompasses a truly child-centered decision. The resulting impact of the decision-making process on the mothers was profound. We conclude with an exploration of the implications for clinical practice and describe how health care professionals can support mothers to ensure that decision-making processes for gastrostomy placement in children are significantly improved.

Discovering Decision Knowledge from Web Log Portfolio for Managing Classroom Processes by Applying Decision Tree and Data Cube Technology.

ERIC Educational Resources Information Center

Chen, Gwo-Dong; Liu, Chen-Chung; Ou, Kuo-Liang; Liu, Baw-Jhiune

2000-01-01

Discusses the use of Web logs to record student behavior that can assist teachers in assessing performance and making curriculum decisions for distance learning students who are using Web-based learning systems. Adopts decision tree and data cube information processing methodologies for developing more effective pedagogical strategies. (LRW)

Leadership of risk decision making in a complex, technology organization: The deliberative decision making model

NASA Astrophysics Data System (ADS)

Flaming, Susan C.

2007-12-01

The continuing saga of satellite technology development is as much a story of successful risk management as of innovative engineering. How do program leaders on complex, technology projects manage high stakes risks that threaten business success and satellite performance? This grounded theory study of risk decision making portrays decision leadership practices at one communication satellite company. Integrated product team (IPT) leaders of multi-million dollar programs were interviewed and observed to develop an extensive description of the leadership skills required to navigate organizational influences and drive challenging risk decisions to closure. Based on the study's findings the researcher proposes a new decision making model, Deliberative Decision Making, to describe the program leaders' cognitive and organizational leadership practices. This Deliberative Model extends the insights of prominent decision making models including the rational (or classical) and the naturalistic and qualifies claims made by bounded rationality theory. The Deliberative Model describes how leaders proactively engage resources to play a variety of decision leadership roles. The Model incorporates six distinct types of leadership decision activities, undertaken in varying sequence based on the challenges posed by specific risks. Novel features of the Deliberative Decision Model include: an inventory of leadership methods for managing task challenges, potential stakeholder bias and debates; four types of leadership meta-decisions that guide decision processes, and aligned organizational culture. Both supporting and constraining organizational influences were observed as leaders managed major risks, requiring active leadership on the most difficult decisions. Although the company's engineering culture emphasized the importance of data-based decisions, the uncertainties intrinsic to satellite risks required expert engineering judgment to be exercised throughout. An investigation into the co-variation of decision methods with uncertainty suggests that perceived risk severity may serve as a robust indicator for choices about decision practices. The Deliberative Decision processes incorporate multiple organizational and cultural controls as cross-checks to mitigate potential parochial bias of individuals, stakeholder groups, or leaders. Overall the Deliberative Decision framework describes how expert leadership practices, supportive organizational systems along with aligned cultural values and behavioral norms help leaders drive high stakes risk decisions to closure in this complex, advanced-technology setting.

Exploratory Decision-Making as a Function of Lifelong Experience, Not Cognitive Decline

PubMed Central

2016-01-01

Older adults perform worse than younger adults in some complex decision-making scenarios, which is commonly attributed to age-related declines in striatal and frontostriatal processing. Recently, this popular account has been challenged by work that considered how older adults’ performance may differ as a function of greater knowledge and experience, and by work showing that, in some cases, older adults outperform younger adults in complex decision-making tasks. In light of this controversy, we examined the performance of older and younger adults in an exploratory choice task that is amenable to model-based analyses and ostensibly not reliant on prior knowledge. Exploration is a critical aspect of decision-making poorly understood across the life span. Across 2 experiments, we addressed (a) how older and younger adults differ in exploratory choice and (b) to what extent observed differences reflect processing capacity declines. Model-based analyses suggested that the strategies used by the 2 groups were qualitatively different, resulting in relatively worse performance for older adults in 1 decision-making environment but equal performance in another. Little evidence was found that differences in processing capacity drove performance differences. Rather the results suggested that older adults’ performance might result from applying a strategy that may have been shaped by their wealth of real-word decision-making experience. While this strategy is likely to be effective in the real world, it is ill suited to some decision environments. These results underscore the importance of taking into account effects of experience in aging studies, even for tasks that do not obviously tap past experiences. PMID:26726916

Faculty in Faith-Based Institutions: Participation in Decision-Making and Its Impact on Job Satisfaction

ERIC Educational Resources Information Center

Metheny, Glen A.; West, G. Bud; Winston, Bruce E.; Wood, J. Andy

2015-01-01

This study examined full-time faculty in Christian, faith-based colleges and universities and investigated the type of impact their participation in the decision-making process had on job satisfaction. Previous studies have examined relationships among faculty at state universities and community colleges, yet little research has been examined in…

Teachers' Thoughts on Student Decision Making during Engineering Design Lessons

ERIC Educational Resources Information Center

Meyer, Helen

2018-01-01

In this paper, I share the results of a study of teachers' ideas about student decision-making at entry into a professional development program to integrate engineering into their instruction. The framework for the Engineering Design Process (EDP) was based on a Challenge-Based Learning (CBL) model. The EDP embedded within the CBL model suggests…

Introduction of human papillomavirus (HPV) vaccination into national immunisation schedules in Europe: Results of the VENICE 2007 survey.

PubMed

King, L A; Lévy-Bruhl, D; O'Flanagan, D; Bacci, S; Lopalco, P L; Kudjawu, Y; Salmaso, S

2008-08-14

The European Union Member States are simultaneously considering introducing HPV vaccination into their national immunisation schedules. The Vaccine European New Integrated Collaboration Effort (VENICE) project aims to develop a collaborative European vaccination network. A survey was undertaken to describe the decision status and the decision-making process regarding the potential introduction of human papillomavirus (HPV) vaccination in to their national immunisation schedules. A web-based questionnaire was developed and completed online in 2007 by 28 countries participating in VENICE. As of 31 October 2007,five countries had decided to introduce HPV vaccination into the national immunisation schedule, while another seven had started the decision-making process with a recommendation favouring introduction. Varying target populations were selected by the five countries which had introduced the vaccination. Half of the surveyed countries had undertaken at least one ad hoc study to support the decision-making process. According to an update of the decision-status from January 2008, the number of countries which had made a decision or recommendation changed to 10 and 5 respectively. This survey demonstrates the rapidly evolving nature of HPV vaccine introduction in Europe and the existence of expertise and experience among EU Member States. The VENICE network is capable of following this process and supporting countries in making vaccine introduction decisions. A VENICE collaborative web-space is being developed as a European resource for the decision-making process for vaccine introduction.

Evaluating Quality of Decision-Making Processes in Medicines' Development, Regulatory Review, and Health Technology Assessment: A Systematic Review of the Literature.

PubMed

Bujar, Magdalena; McAuslane, Neil; Walker, Stuart R; Salek, Sam

2017-01-01

Introduction: Although pharmaceutical companies, regulatory authorities, and health technology assessment (HTA) agencies have been increasingly using decision-making frameworks, it is not certain whether these enable better quality decision making. This could be addressed by formally evaluating the quality of decision-making process within those organizations. The aim of this literature review was to identify current techniques (tools, questionnaires, surveys, and studies) for measuring the quality of the decision-making process across the three stakeholders. Methods: Using MEDLINE, Web of Knowledge, and other Internet-based search engines, a literature review was performed to systematically identify techniques for assessing quality of decision making in medicines development, regulatory review, and HTA. A structured search was applied using key words and a secondary review was carried out. In addition, the measurement properties of each technique were assessed and compared. Ten Quality Decision-Making Practices (QDMPs) developed previously were then used as a framework for the evaluation of techniques identified in the review. Due to the variation in studies identified, meta-analysis was inappropriate. Results: This review identified 13 techniques, where 7 were developed specifically to assess decision making in medicines' development, regulatory review, or HTA; 2 examined corporate decision making, and 4 general decision making. Regarding how closely each technique conformed to the 10 QDMPs, the 13 techniques assessed a median of 6 QDMPs, with a mode of 3 QDMPs. Only 2 techniques evaluated all 10 QDMPs, namely the Organizational IQ and the Quality of Decision Making Orientation Scheme (QoDoS), of which only one technique, QoDoS could be applied to assess decision making of both individuals and organizations, and it possessed generalizability to capture issues relevant to companies as well as regulatory authorities. Conclusion: This review confirmed a general paucity of research in this area, particularly regarding the development and systematic application of techniques for evaluating quality decision making, with no consensus around a gold standard. This review has identified QoDoS as the most promising available technique for assessing decision making in the lifecycle of medicines and the next steps would be to further test its validity, sensitivity, and reliability.

Teacher Roles in the Process of Critical Thinking/Decision Making Skills Development among Elementary/Secondary Students in the Social Studies Curriculum.

ERIC Educational Resources Information Center

Peters, Richard

Today's students must be aware of local, regional, national, and international issues, problems, situations, and cultural diversities. This paper presents curriculum ideas for involving elementary and secondary students in classroom inquiry processes and in field-based settings in order to teach them to think critically, make decisions, act, and…

Brain mechanisms for perceptual and reward-related decision-making.

PubMed

Deco, Gustavo; Rolls, Edmund T; Albantakis, Larissa; Romo, Ranulfo

2013-04-01

Phenomenological models of decision-making, including the drift-diffusion and race models, are compared with mechanistic, biologically plausible models, such as integrate-and-fire attractor neuronal network models. The attractor network models show how decision confidence is an emergent property; and make testable predictions about the neural processes (including neuronal activity and fMRI signals) involved in decision-making which indicate that the medial prefrontal cortex is involved in reward value-based decision-making. Synaptic facilitation in these models can help to account for sequential vibrotactile decision-making, and for how postponed decision-related responses are made. The randomness in the neuronal spiking-related noise that makes the decision-making probabilistic is shown to be increased by the graded firing rate representations found in the brain, to be decreased by the diluted connectivity, and still to be significant in biologically large networks with thousands of synapses onto each neuron. The stability of these systems is shown to be influenced in different ways by glutamatergic and GABAergic efficacy, leading to a new field of dynamical neuropsychiatry with applications to understanding schizophrenia and obsessive-compulsive disorder. The noise in these systems is shown to be advantageous, and to apply to similar attractor networks involved in short-term memory, long-term memory, attention, and associative thought processes. Copyright © 2012 Elsevier Ltd. All rights reserved.

Assessing the Preconditions for Communication Influence on Decision Making: The North American Quitline Consortium

PubMed Central

Bonito, Joseph A.; Ruppel, Erin K.; Leischow, Scott J.; Saul, Jessie

2013-01-01

The network of North American quitlines is a loose confederation of telephone-based smoking cessation counseling providers. Each quitline has some leeway in the types of services it provides, and the purpose of this paper is to identify factors that explain such choices. Representatives from quitline organizations responded to a survey regarding the importance of several items that were hypothesized to influence general intentions to adopt and implement new cessation methods. Results indicate that internal (to the quitline) constraints are positively associated with consensus processes and that implementation of practices in general was more likely if consensus processes were used. Unilateral decision making (one person within an organization makes decisions for the quitline on his/her own) was unrelated to either internal or external constraints, and was negatively associated with adoption of quitline practices. Discussion focuses on factors that influence consensus decision making processes beyond those investigated in the paper. PMID:22582759

How shrinks think: decision making in psychiatry.

PubMed

Bhugra, Dinesh; Malliaris, Yanni; Gupta, Susham

2010-10-01

Psychiatrists use biopsychosocial models in identifying aetiological factors in assessing their patients and similar approaches in planning management. Models in decision making will be influenced by previous experience, training, age and gender, among other factors. Critical thinking and evidence base are both important components in the process of reaching clinical decisions. Expected outcome of treatment may be another factor. The way we think influences our decision making, clinical or otherwise. With patients expecting and taking larger roles in their own management, there needs to be a shift towards patient-centred care in decision making. Further exploration in how clinical decisions are made by psychiatrists is necessary. An understanding of the manner in which therapeutic alliances are formed between the clinician and the patient is necessary to understand decision making.

How stakeholder roles, power, and negotiation impact natural resource policy: A political economy view

USGS Publications Warehouse

Caughlan, L.

2002-01-01

Natural resource management decisions are complicated by multiple property rights, management objectives, and stakeholders with varying degrees of influence over the decision making process. In order to make efficient decisions, managers must incorporate the opinions and values of the involved stakeholders as well as understand the complex institutional constraints and opportunities that influence the decision-making process. Often this type of information is not understood until after a decision has been made, which can result in wasted time and effort.The purpose of my dissertation was to show how institutional frameworks and stakeholder involvement influence the various phases of the resource management decision-making process in a public choice framework. The intent was to assist decision makers and stakeholders by developing a methodology for formally incorporating stakeholders'' objectives and influence into the resource management planning process and to predict the potential success of rent-seeking activity based on stakeholder preferences and level of influence. Concepts from decision analysis, institutional analysis, and public choice economics were used in designing this interdisciplinary framework. The framework was then applied to an actual case study concerning elk and bison management on the National Elk Refuge and Grand Teton National Park near Jackson, Wyoming. The framework allowed for the prediction of the level of support and conflict for all relevant policy decisions, and the identification of each stakeholder''s level of support or opposition for each management decision.

Family and physician influence on asthma research participation decisions for adolescents: the effects of adolescent gender and research risk.

PubMed

Brody, Janet L; Scherer, David G; Annett, Robert D; Turner, Charles; Dalen, Jeanne

2006-08-01

There is considerable ethical and legal ambiguity surrounding the role of adolescents in the decision-making process for research participation. Depending on the nature of the study and the regulations involved, adolescents may have independent responsibility for providing informed consent, they may be asked to provide their assent, or they may be completely excluded from the decision-making process. This study examined parent and adolescent perceptions of decision-making authority and sources of influence on adolescent research participation decisions, and examined whether perceptions of influence differed based on adolescent gender and level of research risk. Adolescents (n = 36) with asthma and their parents reviewed 9 pediatric research protocols, decided whether they would choose to participate, rated the extent they would be responsible for the actual decision, and indicated the ability of family and physician to influence their decisions. Multivariate analyses of variance were used to evaluate differences in perceptions of decision-making authority and sources of influence on the decisions. Adolescents were less willing to cede decision making authority to parents than parents anticipated. Parents and adolescents acknowledged a greater openness to influence from physicians than from family for above minimal risk studies. Parents were more willing to consider opinions from male adolescents. Adolescents desire responsibility for research participation decisions, though parents may not share these views. Physicians' views on research participation are important to families, especially for above minimal risk studies. Parents may grant more decision-making autonomy to adolescent males than to females. Researchers, physicians, and institutions play a key role in facilitating the ethical enrollment of adolescents into biomedical research. Educational, policy, and oversight processes that support both adolescent autonomy and parental responsibility for research participation decision-making in biomedical research are discussed.

Informing the Gestalt: An Ethical Framework for Allocating Scarce Federal Public Health and Medical Resources to States During Disasters

PubMed Central

Knebel, Ann R.; Sharpe, Virginia A.; Danis, Marion; Toomey, Lauren M.; Knickerbocker, Deborah K.

2017-01-01

During catastrophic disasters, government leaders must decide how to efficiently and effectively allocate scarce public health and medical resources. The literature about triage decision making at the individual patient level is substantial, and the National Response Framework provides guidance about the distribution of responsibilities between federal and state governments. However, little has been written about the decision-making process of federal leaders in disaster situations when resources are not sufficient to meet the needs of several states simultaneously. We offer an ethical framework and logic model for decision making in such circumstances. We adapted medical triage and the federalism principle to the decision-making process for allocating scarce federal public health and medical resources. We believe that the logic model provides a values-based framework that can inform the gestalt during the iterative decision process used by federal leaders as they allocate scarce resources to states during catastrophic disasters. PMID:24612854

Practice guidelines in the context of primary care, learning and usability in the physicians' decision-making process--a qualitative study.

PubMed

Ingemansson, Maria; Bastholm-Rahmner, Pia; Kiessling, Anna

2014-08-20

Decision-making is central for general practitioners (GP). Practice guidelines are important tools in this process but implementation of them in the complex context of primary care is a challenge. The purpose of this study was to explore how GPs approach, learn from and use practice guidelines in their day-to-day decision-making process in primary care. A qualitative approach using focus-group interviews was chosen in order to provide in-depth information. The participants were 22 GPs with a median of seven years of experience in primary care, representing seven primary healthcare centres in Stockholm, Sweden in 2011. The interviews focused on how the GPs use guidelines in their decision-making, factors that influence their decision how to approach these guidelines, and how they could encourage the learning process in routine practice.Data were analysed by qualitative content analysis. Meaning units were condensed and grouped in categories. After interpreting the content in the categories, themes were created. Three themes were conceptualized. The first theme emphasized to use guidelines by interactive contextualized dialogues. The categories underpinning this theme: 1. Feedback by peer-learning 2. Feedback by collaboration, mutual learning, and equality between specialties, identified important ways to achieve this learning dialogue. Confidence was central in the second theme, learning that establishes confidence to provide high quality care. Three aspects of confidence were identified in the categories of this theme: 1. Confidence by confirmation, 2. Confidence by reliability and 3. Confidence by evaluation of own results. In the third theme, learning by use of relevant evidence in the decision-making process, we identified two categories: 1. Design and lay-out visualizing the evidence 2. Accessibility adapted to the clinical decision-making process as prerequisites for using the practice guidelines. Decision-making in primary care is a dual process that involves use of intuitive and analytic thinking in a balanced way in order to provide high quality care. Key aspects of effective learning in this clinical decision-making process were: contextualized dialogue, which was based on the GPs' own experiences, feedback on own results and easy access to short guidelines perceived as trustworthy.

Shared decision making: relevant concepts and facilitating strategies.

PubMed

Bae, Jong-Myon

2017-01-01

As the paradigm in healthcare nowadays is the evidence-based, patient-centered decision making, the issue of shared decision making (SDM) is highlighted. The aims of this manuscript were to look at the relevant concepts and suggest the facilitating strategies for overcoming barriers of conducting SDM. While the definitions of SDM were discordant, several concepts such as good communication, individual autonomy, patient participants, and patient-centered decision-making were involved. Further, the facilitating strategies of SDM were to educate and train physician, to apply clinical practice guidelines and patient decision aids, to develop valid measurement tools for evaluation of SDM processes, and to investigate the impact of SDM.

Mental workload as a key factor in clinical decision making.

PubMed

Byrne, Aidan

2013-08-01

The decision making process is central to the practice of a clinician and has traditionally been described in terms of the hypothetico-deductive model. More recently, models adapted from cognitive psychology, such as the dual process and script theories have proved useful in explaining patterns of practice not consistent with purely cognitive based practice. The purpose of this paper is to introduce the concept of mental workload as a key determinant of the type of cognitive processing used by clinicians. Published research appears to be consistent with 'schemata' based cognition as the principle mode of working for those engaged in complex tasks under time pressure. Although conscious processing of factual data is also used, it may be the primary mode of cognition only in situations where time pressure is not a factor. Further research on the decision making process should be based on outcomes which are not dependant on conscious recall of past actions or events and include a measure of mental workload. This further appears to support the concept of the patient, within the clinical environment, as the most effective learning resource.

The role (or not) of economic evaluation at the micro level: can Bourdieu's theory provide a way forward for clinical decision-making?

PubMed

Lessard, Chantale; Contandriopoulos, André-Pierre; Beaulieu, Marie-Dominique

2010-06-01

Despite increasing interest in health economic evaluation, investigations have shown limited use by micro (clinical) level decision-makers. A considerable amount of health decisions take place daily at the point of the clinical encounter; especially in primary care. Since every decision has an opportunity cost, ignoring economic information in family physicians' (FPs) decision-making may have a broad impact on health care efficiency. Knowledge translation of economic evaluation is often based on taken-for-granted assumptions about actors' interests and interactions, neglecting much of the complexity of social reality. Health economics literature frequently assumes a rational and linear decision-making process. Clinical decision-making is in fact a complex social, dynamic, multifaceted process, involving relationships and contextual embeddedness. FPs are embedded in complex social networks that have a significant impact on skills, attitudes, knowledge, practices, and on the information being used. Because of their socially constructed nature, understanding preferences, professional culture, practices, and knowledge translation requires serious attention to social reality. There has been little exploration by health economists of whether the problem may be more fundamental and reside in a misunderstanding of the process of decision-making. There is a need to enhance our understanding of the role of economic evaluation in decision-making from a disciplinary perspective different than health economics. This paper argues for a different conceptualization of the role of economic evaluation in FPs' decision-making, and proposes Bourdieu's sociological theory as a research framework. Bourdieu's theory of practice illustrates how the context-sensitive nature of practice must be understood as a socially constituted practical knowledge. The proposed approach could substantially contribute to a more complex understanding of the role of economic evaluation in FPs' decision-making. Copyright 2010 Elsevier Ltd. All rights reserved.

Specializations for reward-guided decision-making in the primate ventral prefrontal cortex.

PubMed

Murray, Elisabeth A; Rudebeck, Peter H

2018-05-23

The estimated values of choices, and therefore decision-making based on those values, are influenced by both the chance that the chosen items or goods can be obtained (availability) and their current worth (desirability) as well as by the ability to link the estimated values to choices (a process sometimes called credit assignment). In primates, the prefrontal cortex (PFC) has been thought to contribute to each of these processes; however, causal relationships between particular subdivisions of the PFC and specific functions have been difficult to establish. Recent lesion-based research studies have defined the roles of two different parts of the primate PFC - the orbitofrontal cortex (OFC) and the ventral lateral frontal cortex (VLFC) - and their subdivisions in evaluating each of these factors and in mediating credit assignment during reward-based decision-making.

A conversation-based process tracing method for use with naturalistic decisions: an evaluation study.

PubMed

Williamson, J; Ranyard, R; Cuthbert, L

2000-05-01

This study is an evaluation of a process tracing method developed for naturalistic decisions, in this case a consumer choice task. The method is based on Huber et al.'s (1997) Active Information Search (AIS) technique, but develops it by providing spoken rather than written answers to respondents' questions, and by including think aloud instructions. The technique is used within a conversation-based situation, rather than the respondent thinking aloud 'into an empty space', as is conventionally the case in think aloud techniques. The method results in a concurrent verbal protocol as respondents make their decisions, and a retrospective report in the form of a post-decision summary. The method was found to be virtually non-reactive in relation to think aloud, although the variable of Preliminary Attribute Elicitation showed some evidence of reactivity. This was a methodological evaluation, and as such the data reported are essentially descriptive. Nevertheless, the data obtained indicate that the method is capable of producing information about decision processes which could have theoretical importance in terms of evaluating models of decision-making.

Comparing decision making between cancer patients and the general population: thoughts, emotions, or social influence?

PubMed

Yang, Z Janet; McComas, Katherine A; Gay, Geri K; Leonard, John P; Dannenberg, Andrew J; Dillon, Hildy

2012-01-01

This study extends a risk information seeking and processing model to explore the relative effect of cognitive processing strategies, positive and negative emotions, and normative beliefs on individuals' decision making about potential health risks. Most previous research based on this theoretical framework has examined environmental risks. Applying this risk communication model to study health decision making presents an opportunity to explore theoretical boundaries of the model, while also bringing this research to bear on a pressing medical issue: low enrollment in clinical trials. Comparative analysis of data gathered from 2 telephone surveys of a representative national sample (n = 500) and a random sample of cancer patients (n = 411) indicated that emotions played a more substantive role in cancer patients' decisions to enroll in a potential trial, whereas cognitive processing strategies and normative beliefs had greater influences on the decisions of respondents from the national sample.

Decision-making in crisis: Applying a healthcare triage methodology to business continuity management.

PubMed

Moore, Bethany; Bone, Eric A

2017-01-01

The concept of triage in healthcare has been around for centuries and continues to be applied today so that scarce resources are allocated according to need. A business impact analysis (BIA) is a form of triage in that it identifies which processes are most critical, which to address first and how to allocate limited resources. On its own, however, the BIA provides only a roadmap of the impacts and interdependencies of an event. When disaster strikes, organisational decision-makers often face difficult decisions with regard to allocating limited resources between multiple 'mission-critical' functions. Applying the concept of triage to business continuity provides those decision-makers navigating a rapidly evolving and unpredictable event with a path that protects the fundamental priorities of the organisation. A business triage methodology aids decision-makers in times of crisis by providing a simplified framework for decision-making based on objective, evidence-based criteria, which is universally accepted and understood. When disaster strikes, the survival of the organisation depends on critical decision-making and quick actions to stabilise the incident. This paper argues that organisations need to supplement BIA processes with a decision-making triage methodology that can be quickly applied during the chaos of an actual event.

Apathy and emotion-based decision-making in amnesic mild cognitive impairment and Alzheimer's disease.

PubMed

Bayard, Sophie; Jacus, Jean-Pierre; Raffard, Stéphane; Gely-Nargeot, Marie-Christine

2014-01-01

Apathy and reduced emotion-based decision-making are two behavioral modifications independently described in Alzheimer's disease (AD) and amnestic mild cognitive impairment (aMCI). The aims of this study were to investigate decision-making based on emotional feedback processing in AD and aMCI and to study the impact of reduced decision-making performances on apathy. We recruited 20 patients with AD, 20 participants with aMCI, and 20 healthy controls. All participants completed the Lille apathy rating scale (LARS) and the Iowa gambling task (IGT). Both aMCI and AD participants had reduced performances on the IGT and were more apathetic compared to controls without any difference between aMCI and AD groups. For the entire sample, LARS initiation dimension was related to IGT disadvantageous decision-making profile. We provide the first study showing that both aMCI and AD individuals make less profitable decisions than controls, whereas aMCI and AD did not differ. Disadvantageous decision-making profile on the IGT was associated with higher level of apathy on the action initiation dimension. The role of an abnormal IGT performance as a risk factor for the development of apathy needs to be investigated in other clinical populations and in normal aging.

Doing what's right: A grounded theory of ethical decision-making in occupational therapy.

PubMed

VanderKaay, Sandra; Letts, Lori; Jung, Bonny; Moll, Sandra E

2018-04-20

Ethical decision-making is an important aspect of reasoning in occupational therapy practice. However, the process of ethical decision-making within the broader context of reasoning is yet to be clearly explicated. The purpose of this study was to advance a theoretical understanding of the process by which occupational therapists make ethical decisions in day-to-day practice. A constructivist grounded theory approach was adopted, incorporating in-depth semi-structured interviews with 18 occupational therapists from a range of practice settings and years of experience. Initially, participants nominated as key informants who were able to reflect on their decision-making processes were recruited. Theoretical sampling informed subsequent stages of data collection. Participants were asked to describe their process of ethical decision-making using scenarios from clinical practice. Interview transcripts were analyzed using a systematic process of initial then focused coding, and theoretical categorization to construct a theory regarding the process of ethical decision-making. An ethical decision-making prism was developed to capture three main processes: Considering the Fundamental Checklist, Consulting Others, and Doing What's Right. Ethical decision-making appeared to be an inductive and dialectical process with the occupational therapist at its core. Study findings advance our understanding of ethical decision-making in day-to-day clinical practice.

Making Debris Avoidance Decisions for ESMO's EOS Mission Set

NASA Technical Reports Server (NTRS)

Mantziaras, Dimitrios

2016-01-01

The presentation will cover the aspects of making debris risk decisions from the NASA Mission Director's perspective, specifically for NASA Earth Science Mission Operations (ESMO) Earth Observing System (EOS) mission set. ESMO has been involved in analyzing potential debris risk conjunctions with secondary objects since the inception of this discipline. Through the cumulated years of experience and continued exposure to various debris scenarios, ESMO's understanding of the problem and process to deal with this issue has evolved. The presentation will describe the evolution of the ESMO process, specifically as it relates to the maneuver execution and spacecraft risk management decision process. It will briefly cover the original Drag Make-Up Maneuver, several day, methodical manually intensive, ramp up waive off approach, to the present day more automated, pre-canned onboard command, tools based approach. The presentation will also cover the key information needed to make debris decisions and challenges in doing so while still trying to meet science goals, constellation constraints and manage resources. A slide or two at the end of the presentation, will be devoted to discussing what further improvements could be helpful to improve decision making and future process improvement plans challenges.

Challenges to fair decision-making processes in the context of health care services: a qualitative assessment from Tanzania.

PubMed

Shayo, Elizabeth H; Norheim, Ole F; Mboera, Leonard E G; Byskov, Jens; Maluka, Stephen; Kamuzora, Peter; Blystad, Astrid

2012-06-07

Fair processes in decision making need the involvement of stakeholders who can discuss issues and reach an agreement based on reasons that are justifiable and appropriate in meeting people's needs. In Tanzania, the policy of decentralization and the health sector reform place an emphasis on community participation in making decisions in health care. However, aspects that can influence an individual's opportunity to be listened to and to contribute to discussion have been researched to a very limited extent in low-income settings. The objective of this study was to explore challenges to fair decision-making processes in health care services with a special focus on the potential influence of gender, wealth, ethnicity and education. We draw on the principle of fairness as outlined in the deliberative democratic theory. The study was carried out in the Mbarali District of Tanzania. A qualitative study design was used. In-depth interviews and focus group discussion were conducted among members of the district health team, local government officials, health care providers and community members. Informal discussion on the topics was also of substantial value. The study findings indicate a substantial influence of gender, wealth, ethnicity and education on health care decision-making processes. Men, wealthy individuals, members of strong ethnic groups and highly educated individuals had greater influence. Opinions varied among the study informants as to whether such differences should be considered fair. The differences in levels of influence emerged most clearly at the community level, and were largely perceived as legitimate. Existing challenges related to individuals' influence of decision making processes in health care need to be addressed if greater participation is desired. There is a need for increased advocacy and a strengthening of responsive practices with an emphasis on the right of all individuals to participate in decision-making processes. This simultaneously implies an emphasis on assuring the distribution of information, training and education so that individuals can participate fully in informed decision making.

Uncertainty quantification in downscaling procedures for effective decisions in energy systems

NASA Astrophysics Data System (ADS)

Constantinescu, E. M.

2010-12-01

Weather is a major driver both of energy supply and demand, and with the massive adoption of renewable energy sources and changing economic and producer-consumer paradigms, the management of the next-generation energy systems is becoming ever more challenging. The operational and planning decisions in energy systems are guided by efficiency and reliability, and therefore a central role in these decisions will be played by the ability to obtain weather condition forecasts with accurate uncertainty estimates. The appropriate temporal and spatial resolutions needed for effective decision-making, be it operational or planning, is not clear. It is arguably certain however, that such temporal scales as hourly variations of temperature or wind conditions and ramp events are essential in this process. Planning activities involve decade or decades-long projections of weather. One sensible way to achieve this is to embed regional weather models in a global climate system. This strategy acts as a downscaling procedure. Uncertainty modeling techniques must be developed in order to quantify and minimize forecast errors as well as target variables that impact the decision-making process the most. We discuss the challenges of obtaining a realistic uncertainty quantification estimate using mathematical algorithms based on scalable matrix-free computations and physics-based statistical models. The process of making decisions for energy management systems based on future weather scenarios is a very complex problem. We shall focus on the challenges in generating wind power predictions based on regional weather predictions, and discuss the implications of making the common assumptions about the uncertainty models.

Evaluating team decision-making as an emergent phenomenon.

PubMed

Kinnear, John; Wilson, Nick; O'Dwyer, Anthony

2018-04-01

The complexity of modern clinical practice has highlighted the fallibility of individual clinicians' decision-making, with effective teamwork emerging as a key to patient safety. Dual process theory is widely accepted as a framework for individual decision-making, with type 1 processes responsible for fast, intuitive and automatic decisions and type 2 processes for slow, analytical decisions. However, dual process theory does not explain cognition at the group level, when individuals act in teams. Team cognition resulting from dynamic interaction of individuals is said to be more resilient to decision-making error and greater than simply aggregated cognition. Clinicians were paired as teams and asked to solve a cognitive puzzle constructed as a drug calculation. The frequency at which the teams made incorrect decisions was compared with that of individual clinicians answering the same question. When clinicians acted in pairs, 63% answered the cognitive puzzle correctly, compared with 33% of clinicians as individuals, showing a statistically significant difference in performance (χ 2 (1, n=116)=24.329, P<0.001). Based on the predicted performance of teams made up of the random pairing of individuals who had the same propensity to answer as previously, there was no statistical difference in the actual and predicted teams' performance. Teams are less prone to making errors of decision-making than individuals. However, the improved performance is likely to be owing to the effect of aggregated cognition rather than any improved decision-making as a result of the interaction. There is no evidence of team cognition as an emergent and distinct entity. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Emotion-affected decision making in human simulation.

PubMed

Zhao, Y; Kang, J; Wright, D K

2006-01-01

Human modelling is an interdisciplinary research field. The topic, emotion-affected decision making, was originally a cognitive psychology issue, but is now recognized as an important research direction for both computer science and biomedical modelling. The main aim of this paper is to attempt to bridge the gap between psychology and bioengineering in emotion-affected decision making. The work is based on Ortony's theory of emotions and bounded rationality theory, and attempts to connect the emotion process with decision making. A computational emotion model is proposed, and the initial framework of this model in virtual human simulation within the platform of Virtools is presented.

Music and Video Gaming during Breaks: Influence on Habitual versus Goal-Directed Decision Making.

PubMed

Liu, Shuyan; Schad, Daniel J; Kuschpel, Maxim S; Rapp, Michael A; Heinz, Andreas

2016-01-01

Different systems for habitual versus goal-directed control are thought to underlie human decision-making. Working memory is known to shape these decision-making systems and their interplay, and is known to support goal-directed decision making even under stress. Here, we investigated if and how decision systems are differentially influenced by breaks filled with diverse everyday life activities known to modulate working memory performance. We used a within-subject design where young adults listened to music and played a video game during breaks interleaved with trials of a sequential two-step Markov decision task, designed to assess habitual as well as goal-directed decision making. Based on a neurocomputational model of task performance, we observed that for individuals with a rather limited working memory capacity video gaming as compared to music reduced reliance on the goal-directed decision-making system, while a rather large working memory capacity prevented such a decline. Our findings suggest differential effects of everyday activities on key decision-making processes.

Music and Video Gaming during Breaks: Influence on Habitual versus Goal-Directed Decision Making

PubMed Central

Kuschpel, Maxim S.; Rapp, Michael A.; Heinz, Andreas

2016-01-01

Different systems for habitual versus goal-directed control are thought to underlie human decision-making. Working memory is known to shape these decision-making systems and their interplay, and is known to support goal-directed decision making even under stress. Here, we investigated if and how decision systems are differentially influenced by breaks filled with diverse everyday life activities known to modulate working memory performance. We used a within-subject design where young adults listened to music and played a video game during breaks interleaved with trials of a sequential two-step Markov decision task, designed to assess habitual as well as goal-directed decision making. Based on a neurocomputational model of task performance, we observed that for individuals with a rather limited working memory capacity video gaming as compared to music reduced reliance on the goal-directed decision-making system, while a rather large working memory capacity prevented such a decline. Our findings suggest differential effects of everyday activities on key decision-making processes. PMID:26982326

"If it's worth my time, i will make the time": school-based providers' decision-making about participating in an evidence-based psychotherapy consultation program.

PubMed

Lyon, Aaron R; Ludwig, Kristy; Romano, Evalynn; Leonard, Skyler; Stoep, Ann Vander; McCauley, Elizabeth

2013-11-01

This study evaluated influences on school-based clinicians' decision-making surrounding participation in a modular psychotherapy training and consultation program lasting one academic year. Clinicians were recruited from three participation groups: those who never engaged, those who engaged and then discontinued, and those who participated fully. Qualitative interviews explored influences on initial and continued participation, as well as differences in decision-making by participation group, knowledge about evidence-based practices, and attitudes toward evidence-based practices. Eight major themes were identified: time, practice utility, intervention/training content, training process, attitudes toward training, social influences, commitment to training, and expectations. Some themes were discussed universally across all comparison groups, while others varied in frequency or content. Recommendations for increasing participation are presented, based on the findings.

44 CFR 9.6 - Decision-making process.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Decision-making process. 9.6... HOMELAND SECURITY GENERAL FLOODPLAIN MANAGEMENT AND PROTECTION OF WETLANDS § 9.6 Decision-making process... protection decision-making process to be followed by the Agency in applying the Orders to its actions. While...

Shared decision making: empowering the bedside nurse.

PubMed

Slack, Stephanie M; Boguslawski, Jean M; Eickhoff, Rachel M; Klein, Kristi A; Pepin, Teresa M; Schrandt, Kevin; Wise, Carrie A; Zylstra, Jody A

2005-12-01

Shared decision making is a process that has empowered specialty nurses at the Mayo Clinic in Rochester, MN, to solve a practice concern. Staff nurses recognized a lack of concise, collated information available that described what nurses need to know when caring for patients receiving chemotherapy. Many aspects of the administration process were knowledge and experience based and not easily retrievable. The Hematology/Oncology/Blood and Marrow Transplant Clinical Practice Committee identified this as a significant practice issue. Ideas were brainstormed regarding how to make the information available to nursing colleagues. The Chemotherapy Yellow Pages is a resource that was developed to facilitate the rapid retrieval of pertinent information for bedside nurses. The content of this article outlines a'model of shared decision making and the processes used to address and resolve the practice concern.

Views of Administrators and Teachers on Participation in Decision Making at School (The City of Ankara Sample)

ERIC Educational Resources Information Center

Gulcan, Murat Gurkan

2011-01-01

Any kind of practices at schools are made based on a planned and programmed process. There is a decision taken prior to every action and it is important at what level these decisions are taken. Development of participative management approach at schools positively affects the teaching process. Education staff participation in decisions causes…

Sustainability in health care by allocating resources effectively (SHARE) 3: examining how resource allocation decisions are made, implemented and evaluated in a local healthcare setting.

PubMed

Harris, Claire; Allen, Kelly; Waller, Cara; Brooke, Vanessa

2017-05-09

This is the third in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. Leaders in a large Australian health service planned to establish an organisation-wide, systematic, integrated, evidence-based approach to disinvestment. In order to introduce new systems and processes for disinvestment into existing decision-making infrastructure, we aimed to understand where, how and by whom resource allocation decisions were made, implemented and evaluated. We also sought the knowledge and experience of staff regarding previous disinvestment activities. Structured interviews, workshops and document analysis were used to collect information from multiple sources in an environmental scan of decision-making systems and processes. Findings were synthesised using a theoretical framework. Sixty-eight respondents participated in interviews and workshops. Eight components in the process of resource allocation were identified: Governance, Administration, Stakeholder engagement, Resources, Decision-making, Implementation, Evaluation and, where appropriate, Reinvestment of savings. Elements of structure and practice for each component are described and a new framework was developed to capture the relationships between them. A range of decision-makers, decision-making settings, type and scope of decisions, criteria used, and strengths, weaknesses, barriers and enablers are outlined. The term 'disinvestment' was not used in health service decision-making. Previous projects that involved removal, reduction or restriction of current practices were driven by quality and safety issues, evidence-based practice or a need to find resource savings and not by initiatives where the primary aim was to disinvest. Measuring resource savings is difficult, in some situations impossible. Savings are often only theoretical as resources released may be utilised immediately by patients waiting for beds, clinic appointments or surgery. Decision-making systems and processes for resource allocation are more complex than assumed in previous studies. There is a wide range of decision-makers, settings, scope and type of decisions, and criteria used for allocating resources within a single institution. To our knowledge, this is the first paper to report this level of detail and to introduce eight components of the resource allocation process identified within a local health service.

Deciding how to decide: ventromedial frontal lobe damage affects information acquisition in multi-attribute decision making.

PubMed

Fellows, Lesley K

2006-04-01

Ventromedial frontal lobe (VMF) damage is associated with impaired decision making. Recent efforts to understand the functions of this brain region have focused on its role in tracking reward, punishment and risk. However, decision making is complex, and frontal lobe damage might be expected to affect it at other levels. This study used process-tracing techniques to explore the effect of VMF damage on multi-attribute decision making under certainty. Thirteen subjects with focal VMF damage were compared with 11 subjects with frontal damage that spared the VMF and 21 demographically matched healthy control subjects. Participants chose rental apartments in a standard information board task drawn from the literature on normal decision making. VMF subjects performed the decision making task in a way that differed markedly from all other groups, favouring an 'alternative-based' information acquisition strategy (i.e. they organized their information search around individual apartments). In contrast, both healthy control subjects and subjects with damage predominantly involving dorsal and/or lateral prefrontal cortex pursued primarily 'attribute-based' search strategies (in which information was acquired about categories such as rent and noise level across several apartments). This difference in the pattern of information acquisition argues for systematic differences in the underlying decision heuristics and strategies employed by subjects with VMF damage, which in turn may affect the quality of their choices. These findings suggest that the processes supported by ventral and medial prefrontal cortex need to be conceptualized more broadly, to account for changes in decision making under conditions of certainty, as well as uncertainty, following damage to these areas.

Modeling Common-Sense Decisions

NASA Astrophysics Data System (ADS)

Zak, Michail

This paper presents a methodology for efficient synthesis of dynamical model simulating a common-sense decision making process. The approach is based upon the extension of the physics' First Principles that includes behavior of living systems. The new architecture consists of motor dynamics simulating actual behavior of the object, and mental dynamics representing evolution of the corresponding knowledge-base and incorporating it in the form of information flows into the motor dynamics. The autonomy of the decision making process is achieved by a feedback from mental to motor dynamics. This feedback replaces unavailable external information by an internal knowledgebase stored in the mental model in the form of probability distributions.

The feminist approach in the decision-making process for treatment of women with breast cancer.

PubMed

Szumacher, Ewa

2006-09-01

The principal aim of this review was to investigate a feminist approach to the decision-making process for women with breast cancer. Empirical research into patient preferences for being informed about and participating in healthcare decisions has some limitations because it is mostly quantitative and designed within the dominant medical culture. Indigenous medical knowledge and alternative medical treatments are not widely accepted because of the lack of confirmed efficacy of such treatments in evidence-based literature. While discussing their treatment options with oncologists, women with breast cancer frequently express many concerns regarding treatment side effects, and sometimes decline conventional treatment when the risks are too high. A search of all relevant literary sources, including Pub-Med, ERIC, Medline, and the Ontario Institute for Studies in Education at the University of Toronto was conducted. The key words for selection of the articles were "feminism," "decision-making," "patients preferences for treatment," and "breast cancer." Fifty-one literary sources were selected. The review was divided into the following themes: (1) limitations of the patient decision-making process in conventional medicine; (2) participation of native North American patients in healthcare decisions; (3) towards a feminist approach to breast cancer; and (4) towards a feminist theory of breast cancer. This article discusses the importance of a feminist approach to the decision-making process for treatment of patients with breast cancer. As the literature suggests, the needs of minority patients are not completely fulfilled in Western medical culture. Introducing feminist theory into evidence-based medicine will help patients to be better informed about treatment choices and will assist them to select treatment according to their own beliefs and values.

Making reasonable decisions: a qualitative study of medical decision making in the care of patients with a clinically significant haemoglobin disorder.

PubMed

Crowther, Helen J; Kerridge, Ian

2015-10-01

Therapies utilized in patients with clinically significant haemoglobin disorders appear to vary between clinicians and units. This study aimed to investigate the processes of evidence implementation and medical decision making in the care of such patients in NSW, Australia. Using semi-structured interviews, 11 haematologists discussed their medical decision-making processes with particular attention paid to the use of published evidence. Transcripts were thematically analysed by a single investigator on a line-by-line basis. Decision making surrounding the care of patients with significant haemoglobin disorders varied and was deeply contextual. Three main determinants of clinical decision making were identified - factors relating to the patient and to their illness, factors specific to the clinician and the institution in which they were practising and factors related to the notion of evidence and to utility and role of evidence-based medicine in clinical practice. Clinicians pay considerable attention to medical decision making and evidence incorporation and attempt to tailor these to particular patient contexts. However, the patient context is often inferred and when discordant with the clinician's own contexture can lead to discomfort with decision recommendations. Clinicians strive to improve comfort through the use of experience and trustworthy evidence. © 2015 John Wiley & Sons, Ltd.

[Cognitive mechanisms in risky decision-making in cannabis users].

PubMed

J R, Alameda-Bailén; M P, Salguero-Alcañiz; A, Merchán-Clavellino; S, Paíno-Quesada

2014-01-01

The relationship between the use of cannabis and the decision-making processes was explored. A computerized version of the Iowa Gambling Task (Cards Software) in its normal and reverse version was used, and the Prospect Valence Learning (PVL) model, which characterize the process of decision-making based on the parameters: Recency, Consistency, Loss aversion and Utility shape, was applied. Seventy-three cannabis consumers and a control group with 73 nonconsumers participated in the study. In the normal mode, subjects in the control group scored higher than cannabis consumers. Both groups showed consistent responses and aversion to loss. Nonconsumers showed greater influence of the gain-loss frequency, while consumers were more influenced by the magnitude of the gain-loss. The influence of immediate choices was higher among consumers who showed a quick oblivion while in the control group this process was more gradual. In the reverse mode, task performance was better among control group participants. Both groups showed consistency, loss aversion, more influenced by the magnitude of the gain-loss, and low influence of immediate elections. The results show the relationship between drug use and the decision-making processes, being consistent with the results obtained in other studies where consumers had worse results than control group. Moreover, the PVL parameters allow to adequately characterize decision-making. This confirms the relationship between drug use and decision-making by either the vulnerability prior to consumption or the neurotoxicity of drugs.

What Goes Into a Decision? How Nursing Faculty Decide Which Best Practices to Use for Classroom Testing.

PubMed

Killingsworth, Erin; Kimble, Laura P; Sudia, Tanya

2015-01-01

To explore the decision-making process of BSN faculty when determining which best practices to use for classroom testing. A descriptive, correlational study was conducted with a national sample (N = 127) of full-time BSN faculty. Participants completed a web-based survey incorporating instruments that measured beliefs about evaluation, decision-making, and best practices for item analysis and constructing and revising classroom tests. Study participants represented 31 states and were primarily middle-aged white women. In multiple linear regression analyses, faculty beliefs, contextual factors for decision-making, and decision-making processes accounted for statistically significant amounts of the variance in item analysis and test construction and revision. Strong faculty beliefs that rules were important when evaluating students was a significant predictor of increased use of best practices. Results support that understanding faculty beliefs around classroom testing is important in promoting the use of best practices.

The Effect of Decision-Making Skill Training Programs on Self-Esteem and Decision-Making Styles

ERIC Educational Resources Information Center

Colakkadioglu, Oguzhan; Celik, D. Billur

2016-01-01

Problem Statement: Decision making is a critical cognitive process in every area of human life. In this process, the individuals play an active role and obtain outputs with their functional use of decision-making skills. Therefore, the decision-making process can affect the course of life, life satisfaction, and the social relations of an…

Diagnostic decision-making and strategies to improve diagnosis.

PubMed

Thammasitboon, Satid; Cutrer, William B

2013-10-01

A significant portion of diagnostic errors arises through cognitive errors resulting from inadequate knowledge, faulty data gathering, and/or faulty verification. Experts estimate that 75% of diagnostic failures can be attributed to clinician diagnostic thinking failure. The cognitive processes that underlie diagnostic thinking of clinicians are complex and intriguing, and it is imperative that clinicians acquire explicit appreciation and application of different cognitive approaches to make decisions better. A dual-process model that unifies many theories of decision-making has emerged as a promising template for understanding how clinicians think and judge efficiently in a diagnostic reasoning process. The identification and implementation of strategies for decreasing or preventing such diagnostic errors has become a growing area of interest and research. Suggested strategies to decrease diagnostic error incidence include increasing clinician's clinical expertise and avoiding inherent cognitive errors to make decisions better. Implementing Interventions focused solely on avoiding errors may work effectively for patient safety issues such as medication errors. Addressing cognitive errors, however, requires equal effort on expanding the individual clinician's expertise. Providing cognitive support to clinicians for robust diagnostic decision-making serves as the final strategic target for decreasing diagnostic errors. Clinical guidelines and algorithms offer another method for streamlining decision-making and decreasing likelihood of cognitive diagnostic errors. Addressing cognitive processing errors is undeniably the most challenging task in reducing diagnostic errors. While many suggested approaches exist, they are mostly based on theories and sciences in cognitive psychology, decision-making, and education. The proposed interventions are primarily suggestions and very few of them have been tested in the actual practice settings. Collaborative research effort is required to effectively address cognitive processing errors. Researchers in various areas, including patient safety/quality improvement, decision-making, and problem solving, must work together to make medical diagnosis more reliable. © 2013 Mosby, Inc. All rights reserved.

Low-income women with early-stage breast cancer: physician and patient decision-making styles.

PubMed

McVea, K L; Minier, W C; Johnson Palensky, J E

2001-01-01

Poor women have low rates of breast conservation therapy not explained by differences in insurance status or treatment preferences. The purpose of this study was to explore how low-income women make decisions about breast cancer treatment. Twenty-five women diagnosed with early-stage breast cancer through the Nebraska Every Woman Matters program were interviewed about their experiences selecting treatment options. These interviews were transcribed and then analysed using established qualitative techniques. More than half of the women (n=16) described playing a passive role in decision making. Choice was determined by medical factors or not offered by their physicians. Intense emotional distress affected some women's ability to compare options. The women who did engage in a rational decision-making process (n=9) based their choices on concerns about body image and fear of recurrence. When presented with a choice, and when able to objectively weigh treatment options, low-income women base their treatment decisions on the same issues as those of higher income. Whether differences in income strata alter the doctor-patient power dynamic in favor of physician control over decision making, or whether low-income women are less prepared to engage in a rational deliberative process warrants further study. Copyright 2001 John Wiley & Sons, Ltd.

Facilitating access to pre-processed research evidence in public health

PubMed Central

2010-01-01

Background Evidence-informed decision making is accepted in Canada and worldwide as necessary for the provision of effective health services. This process involves: 1) clearly articulating a practice-based issue; 2) searching for and accessing relevant evidence; 3) appraising methodological rigor and choosing the most synthesized evidence of the highest quality and relevance to the practice issue and setting that is available; and 4) extracting, interpreting, and translating knowledge, in light of the local context and resources, into practice, program and policy decisions. While the public health sector in Canada is working toward evidence-informed decision making, considerable barriers, including efficient access to synthesized resources, exist. Methods In this paper we map to a previously developed 6 level pyramid of pre-processed research evidence, relevant resources that include public health-related effectiveness evidence. The resources were identified through extensive searches of both the published and unpublished domains. Results Many resources with public health-related evidence were identified. While there were very few resources dedicated solely to public health evidence, many clinically focused resources include public health-related evidence, making tools such as the pyramid, that identify these resources, particularly helpful for public health decisions makers. A practical example illustrates the application of this model and highlights its potential to reduce the time and effort that would be required by public health decision makers to address their practice-based issues. Conclusions This paper describes an existing hierarchy of pre-processed evidence and its adaptation to the public health setting. A number of resources with public health-relevant content that are either freely accessible or requiring a subscription are identified. This will facilitate easier and faster access to pre-processed, public health-relevant evidence, with the intent of promoting evidence-informed decision making. Access to such resources addresses several barriers identified by public health decision makers to evidence-informed decision making, most importantly time, as well as lack of knowledge of resources that house public health-relevant evidence. PMID:20181270

The Effects of Cognitive Process and Decision Making Training in Reading Experience on Meaningful Learning with Underachieving College Students

ERIC Educational Resources Information Center

Dean, Rebecca J.

2010-01-01

The ability of underprepared college students to read and learn from their reading is essential to their academic success and to their ability to persist towards completing their degree. The purposes of this study were to (a) assess the relationship between the cognitive processes of reading-based decision making and meaningful learning and (b)…

A decision-making process model of young online shoppers.

PubMed

Lin, Chin-Feng; Wang, Hui-Fang

2008-12-01

Based on the concepts of brand equity, means-end chain, and Web site trust, this study proposes a novel model called the consumption decision-making process of adolescents (CDMPA) to understand adolescents' Internet consumption habits and behavioral intention toward particular sporting goods. The findings of the CDMPA model can help marketers understand adolescents' consumption preferences and habits for developing effective Internet marketing strategies.

Development of shared decision-making resources to help inform difficult healthcare decisions: An example focused on dysvascular partial foot and transtibial amputations.

PubMed

Quigley, Matthew; Dillon, Michael P; Fatone, Stefania

2018-02-01

Shared decision making is a consultative process designed to encourage patient participation in decision making by providing accurate information about the treatment options and supporting deliberation with the clinicians about treatment options. The process can be supported by resources such as decision aids and discussion guides designed to inform and facilitate often difficult conversations. As this process increases in use, there is opportunity to raise awareness of shared decision making and the international standards used to guide the development of quality resources for use in areas of prosthetic/orthotic care. To describe the process used to develop shared decision-making resources, using an illustrative example focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Development process: The International Patient Decision Aid Standards were used to guide the development of the decision aid and discussion guide focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Examples from these shared decision-making resources help illuminate the stages of development including scoping and design, research synthesis, iterative development of a prototype, and preliminary testing with patients and clinicians not involved in the development process. Lessons learnt through the process, such as using the International Patient Decision Aid Standards checklist and development guidelines, may help inform others wanting to develop similar shared decision-making resources given the applicability of shared decision making to many areas of prosthetic-/orthotic-related practice. Clinical relevance Shared decision making is a process designed to guide conversations that help patients make an informed decision about their healthcare. Raising awareness of shared decision making and the international standards for development of high-quality decision aids and discussion guides is important as the approach is introduced in prosthetic-/orthotic-related practice.

Voice, Collaboration and School Culture: Creating a Community for School Improvement. Evaluation of the Pioneer SCBM Schools, Hawaii's School/Community-Based Management Initiative. Executive Summary.

ERIC Educational Resources Information Center

Izu, Jo Ann; And Others

Site-based management is designed to bring decision making to the school level and involve all stakeholders in a process that will result ultimately in improved student outcomes. Enacted into law in June 1989, Hawaii's School/Community-Based Management Initiative (SCBM) is part of a national trend toward decentralizing decision making and…

Negotiation and Decision Making with Collaborative Software: How MarineMap 'Changed the Game' in California's Marine Life Protected Act Initiative.

PubMed

Cravens, Amanda E

2016-02-01

Environmental managers and planners have become increasingly enthusiastic about the potential of decision support tools (DSTs) to improve environmental decision-making processes as information technology transforms many aspects of daily life. Discussions about DSTs, however, rarely recognize the range of ways software can influence users' negotiation, problem-solving, or decision-making strategies and incentives, in part because there are few empirical studies of completed processes that used technology. This mixed-methods study-which draws on data from approximately 60 semi-structured interviews and an online survey--examines how one geospatial DST influenced participants' experiences during a multi-year marine planning process in California. Results suggest that DSTs can facilitate communication by creating a common language, help users understand the geography and scientific criteria in play during the process, aid stakeholders in identifying shared or diverging interests, and facilitate joint problem solving. The same design features that enabled the tool to aid in decision making, however, also presented surprising challenges in certain circumstances by, for example, making it difficult for participants to discuss information that was not spatially represented on the map-based interface. The study also highlights the importance of the social context in which software is developed and implemented, suggesting that the relationship between the software development team and other participants may be as important as technical software design in shaping how DSTs add value. The paper concludes with considerations to inform the future use of DSTs in environmental decision-making processes.

Negotiation and Decision Making with Collaborative Software: How MarineMap `Changed the Game' in California's Marine Life Protected Act Initiative

NASA Astrophysics Data System (ADS)

Cravens, Amanda E.

2016-02-01

Environmental managers and planners have become increasingly enthusiastic about the potential of decision support tools (DSTs) to improve environmental decision-making processes as information technology transforms many aspects of daily life. Discussions about DSTs, however, rarely recognize the range of ways software can influence users' negotiation, problem-solving, or decision-making strategies and incentives, in part because there are few empirical studies of completed processes that used technology. This mixed-methods study—which draws on data from approximately 60 semi-structured interviews and an online survey—examines how one geospatial DST influenced participants' experiences during a multi-year marine planning process in California. Results suggest that DSTs can facilitate communication by creating a common language, help users understand the geography and scientific criteria in play during the process, aid stakeholders in identifying shared or diverging interests, and facilitate joint problem solving. The same design features that enabled the tool to aid in decision making, however, also presented surprising challenges in certain circumstances by, for example, making it difficult for participants to discuss information that was not spatially represented on the map-based interface. The study also highlights the importance of the social context in which software is developed and implemented, suggesting that the relationship between the software development team and other participants may be as important as technical software design in shaping how DSTs add value. The paper concludes with considerations to inform the future use of DSTs in environmental decision-making processes.

How social cognition can inform social decision making.

PubMed

Lee, Victoria K; Harris, Lasana T

2013-12-25

Social decision-making is often complex, requiring the decision-maker to make inferences of others' mental states in addition to engaging traditional decision-making processes like valuation and reward processing. A growing body of research in neuroeconomics has examined decision-making involving social and non-social stimuli to explore activity in brain regions such as the striatum and prefrontal cortex, largely ignoring the power of the social context. Perhaps more complex processes may influence decision-making in social vs. non-social contexts. Years of social psychology and social neuroscience research have documented a multitude of processes (e.g., mental state inferences, impression formation, spontaneous trait inferences) that occur upon viewing another person. These processes rely on a network of brain regions including medial prefrontal cortex (MPFC), superior temporal sulcus (STS), temporal parietal junction, and precuneus among others. Undoubtedly, these social cognition processes affect social decision-making since mental state inferences occur spontaneously and automatically. Few studies have looked at how these social inference processes affect decision-making in a social context despite the capability of these inferences to serve as predictions that can guide future decision-making. Here we review and integrate the person perception and decision-making literatures to understand how social cognition can inform the study of social decision-making in a way that is consistent with both literatures. We identify gaps in both literatures-while behavioral economics largely ignores social processes that spontaneously occur upon viewing another person, social psychology has largely failed to talk about the implications of social cognition processes in an economic decision-making context-and examine the benefits of integrating social psychological theory with behavioral economic theory.

How social cognition can inform social decision making

PubMed Central

Lee, Victoria K.; Harris, Lasana T.

2013-01-01

Social decision-making is often complex, requiring the decision-maker to make inferences of others' mental states in addition to engaging traditional decision-making processes like valuation and reward processing. A growing body of research in neuroeconomics has examined decision-making involving social and non-social stimuli to explore activity in brain regions such as the striatum and prefrontal cortex, largely ignoring the power of the social context. Perhaps more complex processes may influence decision-making in social vs. non-social contexts. Years of social psychology and social neuroscience research have documented a multitude of processes (e.g., mental state inferences, impression formation, spontaneous trait inferences) that occur upon viewing another person. These processes rely on a network of brain regions including medial prefrontal cortex (MPFC), superior temporal sulcus (STS), temporal parietal junction, and precuneus among others. Undoubtedly, these social cognition processes affect social decision-making since mental state inferences occur spontaneously and automatically. Few studies have looked at how these social inference processes affect decision-making in a social context despite the capability of these inferences to serve as predictions that can guide future decision-making. Here we review and integrate the person perception and decision-making literatures to understand how social cognition can inform the study of social decision-making in a way that is consistent with both literatures. We identify gaps in both literatures—while behavioral economics largely ignores social processes that spontaneously occur upon viewing another person, social psychology has largely failed to talk about the implications of social cognition processes in an economic decision-making context—and examine the benefits of integrating social psychological theory with behavioral economic theory. PMID:24399928

Chronic Exposure to Methamphetamine Disrupts Reinforcement-Based Decision Making in Rats.

PubMed

Groman, Stephanie M; Rich, Katherine M; Smith, Nathaniel J; Lee, Daeyeol; Taylor, Jane R

2018-03-01

The persistent use of psychostimulant drugs, despite the detrimental outcomes associated with continued drug use, may be because of disruptions in reinforcement-learning processes that enable behavior to remain flexible and goal directed in dynamic environments. To identify the reinforcement-learning processes that are affected by chronic exposure to the psychostimulant methamphetamine (MA), the current study sought to use computational and biochemical analyses to characterize decision-making processes, assessed by probabilistic reversal learning, in rats before and after they were exposed to an escalating dose regimen of MA (or saline control). The ability of rats to use flexible and adaptive decision-making strategies following changes in stimulus-reward contingencies was significantly impaired following exposure to MA. Computational analyses of parameters that track choice and outcome behavior indicated that exposure to MA significantly impaired the ability of rats to use negative outcomes effectively. These MA-induced changes in decision making were similar to those observed in rats following administration of a dopamine D2/3 receptor antagonist. These data use computational models to provide insight into drug-induced maladaptive decision making that may ultimately identify novel targets for the treatment of psychostimulant addiction. We suggest that the disruption in utilization of negative outcomes to adaptively guide dynamic decision making is a new behavioral mechanism by which MA rigidly biases choice behavior.

Neural signatures of experience-based improvements in deterministic decision-making.

PubMed

Tremel, Joshua J; Laurent, Patryk A; Wolk, David A; Wheeler, Mark E; Fiez, Julie A

2016-12-15

Feedback about our choices is a crucial part of how we gather information and learn from our environment. It provides key information about decision experiences that can be used to optimize future choices. However, our understanding of the processes through which feedback translates into improved decision-making is lacking. Using neuroimaging (fMRI) and cognitive models of decision-making and learning, we examined the influence of feedback on multiple aspects of decision processes across learning. Subjects learned correct choices to a set of 50 word pairs across eight repetitions of a concurrent discrimination task. Behavioral measures were then analyzed with both a drift-diffusion model and a reinforcement learning model. Parameter values from each were then used as fMRI regressors to identify regions whose activity fluctuates with specific cognitive processes described by the models. The patterns of intersecting neural effects across models support two main inferences about the influence of feedback on decision-making. First, frontal, anterior insular, fusiform, and caudate nucleus regions behave like performance monitors, reflecting errors in performance predictions that signal the need for changes in control over decision-making. Second, temporoparietal, supplementary motor, and putamen regions behave like mnemonic storage sites, reflecting differences in learned item values that inform optimal decision choices. As information about optimal choices is accrued, these neural systems dynamically adjust, likely shifting the burden of decision processing from controlled performance monitoring to bottom-up, stimulus-driven choice selection. Collectively, the results provide a detailed perspective on the fundamental ability to use past experiences to improve future decisions. Copyright © 2016 Elsevier B.V. All rights reserved.

Neural signatures of experience-based improvements in deterministic decision-making

PubMed Central

Tremel, Joshua J.; Laurent, Patryk A.; Wolk, David A.; Wheeler, Mark E.; Fiez, Julie A.

2016-01-01

Feedback about our choices is a crucial part of how we gather information and learn from our environment. It provides key information about decision experiences that can be used to optimize future choices. However, our understanding of the processes through which feedback translates into improved decision-making is lacking. Using neuroimaging (fMRI) and cognitive models of decision-making and learning, we examined the influence of feedback on multiple aspects of decision processes across learning. Subjects learned correct choices to a set of 50 word pairs across eight repetitions of a concurrent discrimination task. Behavioral measures were then analyzed with both a drift-diffusion model and a reinforcement learning model. Parameter values from each were then used as fMRI regressors to identify regions whose activity fluctuates with specific cognitive processes described by the models. The patterns of intersecting neural effects across models support two main inferences about the influence of feedback on decision-making. First, frontal, anterior insular, fusiform, and caudate nucleus regions behave like performance monitors, reflecting errors in performance predictions that signal the need for changes in control over decision-making. Second, temporoparietal, supplementary motor, and putamen regions behave like mnemonic storage sites, reflecting differences in learned item values that inform optimal decision choices. As information about optimal choices is accrued, these neural systems dynamically adjust, likely shifting the burden of decision processing from controlled performance monitoring to bottom-up, stimulus-driven choice selection. Collectively, the results provide a detailed perspective on the fundamental ability to use past experiences to improve future decisions. PMID:27523644

Need-Supportive Advising for Undecided Students

ERIC Educational Resources Information Center

Leach, Jennifer Kay; Patall, Erika A.

2016-01-01

To explore the relationship between need-supportive advising and students' decision making on academic majors, we conducted a longitudinal study of 145 students based on their reports of basic psychological need satisfaction and their decision-making processes. We hypothesized that need-supportive advising would positively contribute to autonomous…

Extending The P4P Agenda, Part 1: How Medicare Can Improve Patient Decision Making And Reduce Unnecessary Care

PubMed Central

Wennberg, John E.; O'Connor, Annette M.; Collins, E. Dale; Weinstein, James N.

2008-01-01

The decision to undergo many discretionary medical treatments should be based on informed patient choice. Shared decision making is an effective strategy for achieving this goal. The Centers for Medicare and Medicaid Services (CMS) should extend its pay-for-performance (P4P) agenda to assure that all Americans have access to a certified shared decision-making process. This paper outlines a strategy to achieve informed patient choice as the standard of practice for preference-sensitive care. PMID:17978377

Social values and health priority setting in Australia: an analysis applied to the context of health technology assessment.

PubMed

Whitty, Jennifer A; Littlejohns, Peter

2015-02-01

To describe the role of social values in priority setting related to health technology assessment processes and decision-making in Australia. The processes and decision criteria of the Pharmaceutical and Medical Benefits Advisory Committees are described based on literature and policy sources, and analysed using a framework for identifying social values in priority-setting. Transparency and accountability of processes are apparent. Participation balances inclusiveness and effectiveness of decision-making, but presents an opportunity to enhance priority setting processes. Clinical and cost-effectiveness are important content considerations. Social values related to justice/equity are considered, without quantification of criteria weights for equity relative to other factors. HTA processes support solidarity through subsidising approved technologies for all Australians, whilst retaining autonomy by permitting non-subsidised technologies to be accessed privately, leading to possible tension between the values of solidarity, autonomy and equity. Priority setting related to health technology subsidy incorporates a range of inter-related social values in the processes and content of decision-making. Participation in decision-making could arguably be improved if a patient and public engagement policy were to be formulated alongside more widespread changes across processes to assess social values using approaches such as the Citizens' Jury. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Risk perception and decision processes underlying informed consent to research participation.

PubMed

Reynolds, William W; Nelson, Robert M

2007-11-01

According to the rational choice model, informed consent should consist of a systematic, step-by-step evaluation of all information pertinent to the treatment or research participation decision. Research shows that people frequently deviate from this normative model, however, employing decision-making shortcuts, or heuristics. In this paper we report findings from a qualitative study of 32 adolescents and (their) 31 parents who were recruited from two Northeastern US hospitals and asked to consider the risks of and make hypothetical decisions about research participation. The purpose of this study was to increase our understanding of how diabetic and at-risk adolescents (i.e., those who are obese and/or have a family history of diabetes) and their parents perceive risks and make decisions about research participation. Using data collected from adolescents and parents, we identify heuristic decision processes in which participant perceptions of risk magnitude, which are formed quickly and intuitively and appear to be based on affective responses to information, are far more prominent and central to the participation decision than are perceptions of probability. We discuss participants' use of decision-making heuristics in the context of recent research on affect and decision processes, and we consider the implications of these findings for researchers.

Roles, processes, and outcomes of interprofessional shared decision-making in a neonatal intensive care unit: A qualitative study.

PubMed

Dunn, Sandra I; Cragg, Betty; Graham, Ian D; Medves, Jennifer; Gaboury, Isabelle

2018-05-01

Shared decision-making provides an opportunity for the knowledge and skills of care providers to synergistically influence patient care. Little is known about interprofessional shared decision-making processes in critical care settings. The aim of this study was to explore interprofessional team members' perspectives about the nature of interprofessional shared decision-making in a neonatal intensive care unit (NICU) and to determine if there are any differences in perspectives across professional groups. An exploratory qualitative approach was used consisting of semi-structured interviews with 22 members of an interprofessional team working in a tertiary care NICU in Canada. Participants identified four key roles involved in interprofessional shared decision-making: leader, clinical experts, parents, and synthesizer. Participants perceived that interprofessional shared decision-making happens through collaboration, sharing, and weighing the options, the evidence and the credibility of opinions put forward. The process of interprofessional shared decision-making leads to a well-informed decision and participants feeling valued. Findings from this study identified key concepts of interprofessional shared decision-making, increased awareness of differing professional perspectives about this process of shared decision-making, and clarified understanding of the different roles involved in the decision-making process in an NICU.

Dual processing model of medical decision-making

PubMed Central

2012-01-01

Background Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I) and/or an analytical, deliberative (system II) processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administered to the patient who may or may not have a disease. Methods We developed a mathematical model in which we linked a recently proposed descriptive psychological model of cognition with the threshold model of medical decision-making and show how this approach can be used to better understand decision-making at the bedside and explain the widespread variation in treatments observed in clinical practice. Results We show that physician’s beliefs about whether to treat at higher (lower) probability levels compared to the prescriptive therapeutic thresholds obtained via system II processing is moderated by system I and the ratio of benefit and harms as evaluated by both system I and II. Under some conditions, the system I decision maker’s threshold may dramatically drop below the expected utility threshold derived by system II. This can explain the overtreatment often seen in the contemporary practice. The opposite can also occur as in the situations where empirical evidence is considered unreliable, or when cognitive processes of decision-makers are biased through recent experience: the threshold will increase relative to the normative threshold value derived via system II using expected utility threshold. This inclination for the higher diagnostic certainty may, in turn, explain undertreatment that is also documented in the current medical practice. Conclusions We have developed the first dual processing model of medical decision-making that has potential to enrich the current medical decision-making field, which is still to the large extent dominated by expected utility theory. The model also provides a platform for reconciling two groups of competing dual processing theories (parallel competitive with default-interventionalist theories). PMID:22943520

Health care priority setting: principles, practice and challenges

PubMed Central

Mitton, Craig; Donaldson, Cam

2004-01-01

Background Health organizations the world over are required to set priorities and allocate resources within the constraint of limited funding. However, decision makers may not be well equipped to make explicit rationing decisions and as such often rely on historical or political resource allocation processes. One economic approach to priority setting which has gained momentum in practice over the last three decades is program budgeting and marginal analysis (PBMA). Methods This paper presents a detailed step by step guide for carrying out a priority setting process based on the PBMA framework. This guide is based on the authors' experience in using this approach primarily in the UK and Canada, but as well draws on a growing literature of PBMA studies in various countries. Results At the core of the PBMA approach is an advisory panel charged with making recommendations for resource re-allocation. The process can be supported by a range of 'hard' and 'soft' evidence, and requires that decision making criteria are defined and weighted in an explicit manner. Evaluating the process of PBMA using an ethical framework, and noting important challenges to such activity including that of organizational behavior, are shown to be important aspects of developing a comprehensive approach to priority setting in health care. Conclusion Although not without challenges, international experience with PBMA over the last three decades would indicate that this approach has the potential to make substantial improvement on commonly relied upon historical and political decision making processes. In setting out a step by step guide for PBMA, as is done in this paper, implementation by decision makers should be facilitated. PMID:15104792

Documenting the decision structure in software development

NASA Technical Reports Server (NTRS)

Wild, J. Christian; Maly, Kurt; Shen, Stewart N.

1990-01-01

Current software development paradigms focus on the products of the development process. Much of the decision making process which produces these products is outside the scope of these paradigms. The Decision-Based Software Development (DBSD) paradigm views the design process as a series of interrelated decisions which involve the identification and articulation of problems, alternates, solutions and justifications. Decisions made by programmers and analysts are recorded in a project data base. Unresolved problems are also recorded and resources for their resolution are allocated by management according to the overall development strategy. This decision structure is linked to the products affected by the relevant decision and provides a process oriented view of the resulted system. Software maintenance uses this decision view of the system to understand the rationale behind the decisions affecting the part of the system to be modified. D-HyperCase, a prototype Decision-Based Hypermedia System is described and results of applying the DBSD approach during its development are presented.

Functional neuroimaging of the Iowa Gambling Task in older adults.

PubMed

Halfmann, Kameko; Hedgcock, William; Bechara, Antoine; Denburg, Natalie L

2014-11-01

The neural systems most susceptible to age-related decline mirror the systems linked to decision making. Yet, the neural processes underlying decision-making disparities among older adults are not well understood. We sought to identify neural response patterns that distinguish 2 groups of older adults who exhibit divergent decision-making patterns. Participants were 31 healthy older adults (ages 59-88, 53% female), defined as advantageous or disadvantageous decision-makers based on Iowa Gambling Task (IGT) performance, who completed an alternate version of the IGT while undergoing functional MRI. The groups were indistinguishable on neuropsychological testing. We contrasted the BOLD signal between groups during 3 phases of the decision-making process: Prechoice (preselection), Prefeedback (postselection), and Feedback (receipt of gains/losses). We further examined whether BOLD signal varied as a function of age in each group. We observed greater activation among the IGT-Disadvantageous relative to -Advantageous older adults in the prefrontal cortex during the early phases of the decision-making process (Prechoice), and in posterior brain regions (e.g., the precuneus) during the later phases (Prefeedback and Feedback). We also found that with increasing age, IGT-Advantageous older adults showed increasing activation in the prefrontal cortex during all phases and increasing activation in the posterior cingulate during earlier phases of the decision process. By contrast, the IGT-Disadvantageous older adults exhibited a reduced or reversed trend. These functional differences may be a consequence of altered reward processing or differing compensatory strategies between IGT-Disadvantageous and -Advantageous older adults. This supports the notion that divergent neurobiological aging trajectories underlie disparate decision-making patterns. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Nordic couples' decision-making processes during assisted reproduction treatments.

PubMed

Sol Olafsdottir, Helga; Wikland, Matts; Möller, Anders

2013-06-01

To study couples' perceptions of their decision-making process during the first three years of infertility treatments. This study is a part of a larger project studying the decision-making processes of 22 infertile heterosexual couples, recruited from fertility clinics in all five Nordic countries, over a three year period. A descriptive qualitative method was used. Process of decision-making during assisted reproduction treatments. Seventeen couples had succeeded in becoming parents after approximately three years. Our study suggests that the decision-making process during fertility treatments has three phases: (i) recognizing the decisions to be made, with subcategories; the driving force, mutual project, (ii) gathering knowledge and experience about the options, with subcategories; trust, patient competence, personalized support, and (iii) adapting decisions to possible options, with subcategories; strategic planning, adaption. The core category was "maintaining control in a situation of uncertainty." Two parallel processes affect couples' decision-making process, one within themselves and their relationship, and the other in their contact with the fertility clinic. Couples struggle to make decisions, trusting clinic personnel for guidance, knowledge, and understanding. Nevertheless, couples expressed disappointment with the clinics' reactions to their requests for shared decision-making. Copyright © 2013 Elsevier B.V. All rights reserved.

Neural Signatures of Controlled and Automatic Retrieval Processes in Memory-based Decision-making.

PubMed

Khader, Patrick H; Pachur, Thorsten; Weber, Lilian A E; Jost, Kerstin

2016-01-01

Decision-making often requires retrieval from memory. Drawing on the neural ACT-R theory [Anderson, J. R., Fincham, J. M., Qin, Y., & Stocco, A. A central circuit of the mind. Trends in Cognitive Sciences, 12, 136-143, 2008] and other neural models of memory, we delineated the neural signatures of two fundamental retrieval aspects during decision-making: automatic and controlled activation of memory representations. To disentangle these processes, we combined a paradigm developed to examine neural correlates of selective and sequential memory retrieval in decision-making with a manipulation of associative fan (i.e., the decision options were associated with one, two, or three attributes). The results show that both the automatic activation of all attributes associated with a decision option and the controlled sequential retrieval of specific attributes can be traced in material-specific brain areas. Moreover, the two facets of memory retrieval were associated with distinct activation patterns within the frontoparietal network: The dorsolateral prefrontal cortex was found to reflect increasing retrieval effort during both automatic and controlled activation of attributes. In contrast, the superior parietal cortex only responded to controlled retrieval, arguably reflecting the sequential updating of attribute information in working memory. This dissociation in activation pattern is consistent with ACT-R and constitutes an important step toward a neural model of the retrieval dynamics involved in memory-based decision-making.

DECISION-MAKING ALIGNED WITH RAPID-CYCLE EVALUATION IN HEALTH CARE.

PubMed

Schneeweiss, Sebastian; Shrank, William H; Ruhl, Michael; Maclure, Malcolm

2015-01-01

Availability of real-time electronic healthcare data provides new opportunities for rapid-cycle evaluation (RCE) of health technologies, including healthcare delivery and payment programs. We aim to align decision-making processes with stages of RCE to optimize the usefulness and impact of rapid results. Rational decisions about program adoption depend on program effect size in relation to externalities, including implementation cost, sustainability, and likelihood of broad adoption. Drawing on case studies and experience from drug safety monitoring, we examine how decision makers have used scientific evidence on complex interventions in the past. We clarify how RCE alters the nature of policy decisions; develop the RAPID framework for synchronizing decision-maker activities with stages of RCE; and provide guidelines on evidence thresholds for incremental decision-making. In contrast to traditional evaluations, RCE provides early evidence on effectiveness and facilitates a stepped approach to decision making in expectation of future regularly updated evidence. RCE allows for identification of trends in adjusted effect size. It supports adapting a program in midstream in response to interim findings, or adapting the evaluation strategy to identify true improvements earlier. The 5-step RAPID approach that utilizes the cumulating evidence of program effectiveness over time could increase policy-makers' confidence in expediting decisions. RCE enables a step-wise approach to HTA decision-making, based on gradually emerging evidence, reducing delays in decision-making processes after traditional one-time evaluations.

Cancer patient decision making related to clinical trial participation: an integrative review with implications for patients' relational autonomy.

PubMed

Bell, Jennifer A H; Balneaves, Lynda G

2015-04-01

Oncology clinical trials are necessary for the improvement of patient care as they have the ability to confirm the efficacy and safety of novel cancer treatments and in so doing, contribute to a solid evidence base on which practitioners and patients can make informed treatment decisions. However, only 3-5 % of adult cancer patients enroll in clinical trials. Lack of participation compromises the success of clinical trials and squanders an opportunity for improving patient outcomes. This literature review summarizes the factors and contexts that influence cancer patient decision making related to clinical trial participation. An integrative review was undertaken within PubMed, CINAHL, and EMBASE databases for articles written between 1995 and 2012 and archived under relevant keywords. Articles selected were data-based, written in English, and limited to adult cancer patients. In the 51 articles reviewed, three main types of factors were identified that influence cancer patients' decision making about participation in clinical trials: personal, social, and system factors. Subthemes included patients' trust in their physician and the research process, undue influence within the patient-physician relationship, and systemic social inequalities. How these factors interact and influence patients' decision-making process and relational autonomy, however, is insufficiently understood. Future research is needed to further elucidate the sociopolitical barriers and facilitators of clinical trial participation and to enhance ethical practice within clinical trial enrolment. This research will inform targeted education and support interventions to foster patients' relational autonomy in the decision-making process and potentially improve clinical trial participation rates.

Development and pilot testing of an online case-based approach to shared decision making skills training for clinicians.

PubMed

Volk, Robert J; Shokar, Navkiran K; Leal, Viola B; Bulik, Robert J; Linder, Suzanne K; Mullen, Patricia Dolan; Wexler, Richard M; Shokar, Gurjeet S

2014-11-01

Although research suggests that patients prefer a shared decision making (SDM) experience when making healthcare decisions, clinicians do not routinely implement SDM into their practice and training programs are needed. Using a novel case-based strategy, we developed and pilot tested an online educational program to promote shared decision making (SDM) by primary care clinicians. A three-phased approach was used: 1) development of a conceptual model of the SDM process; 2) development of an online teaching case utilizing the Design A Case (DAC) authoring template, a well-tested process used to create peer-reviewed web-based clinical cases across all levels of healthcare training; and 3) pilot testing of the case. Participants were clinician members affiliated with several primary care research networks across the United States who answered an invitation email. The case used prostate cancer screening as the clinical context and was delivered online. Post-intervention ratings of clinicians' general knowledge of SDM, knowledge of specific SDM steps, confidence in and intention to perform SDM steps were also collected online. Seventy-nine clinicians initially volunteered to participate in the study, of which 49 completed the case and provided evaluations. Forty-three clinicians (87.8%) reported the case met all the learning objectives, and 47 (95.9%) indicated the case was relevant for other equipoise decisions. Thirty-one clinicians (63.3%) accessed supplementary information via links provided in the case. After viewing the case, knowledge of SDM was high (over 90% correctly identified the steps in a SDM process). Determining a patient's preferred role in making the decision (62.5% very confident) and exploring a patient's values (65.3% very confident) about the decisions were areas where clinician confidence was lowest. More than 70% of the clinicians intended to perform SDM in the future. A comprehensive model of the SDM process was used to design a case-based approach to teaching SDM skills to primary care clinicians. The case was favorably rated in this pilot study. Clinician skills training for helping patients clarify their values and for assessing patients' desire for involvement in decision making remain significant challenges and should be a focus of future comparative studies.

Gendered negotiations for research participation in community-based studies: implications for health research policy and practice

PubMed Central

Kamuya, Dorcas M; Molyneux, Catherine, S; Theobald, Sally

2017-01-01

There is a growing literature documenting the complex realities of consent processes in the field, and the negotiations and ethical dilemmas involved. Much has also been written about how gender and power shape household decision-making processes. However, these bodies of literature have rarely been brought together to inform research theory and practice in low-income settings. In this paper, qualitative research (observation, focus group discussions and interviews) were used alongside large clinical community-based studies conducted on the Kenyan Coast to explore how gender and power relations within households and communities and between fieldworkers and communities shape consent processes and interactions. This exploration is embedded in relevant literature and the implications for community-based health research policy and practice are considered. Across diverse forms of households, we observed significant consultation on whether or not to participate in research. Although men are typically described as household decision-makers, in practice, decision-making processes are often far more nuanced, with many women using their agency to control, sometimes subtly, the decisions made. Where decisions are made without adequately consulting women, many find strategies to exercise their choice, in ways that safeguard important relationships within households in the longer term. We also found that the gender of field staff who typically conduct research activities in the field, including consent processes, can influence household dynamics and decision-making processes with important implications for the science and ethics of research. It is essential that frontline field staff and their supervisors are aware of the complex and gendered realities of consent processes at household level, and their implications, and that they develop appropriate context-informed approaches that support ethical practice. PMID:29225935

HTA and decision-making processes in Central, Eastern and South Eastern Europe: Results from a survey.

PubMed

García-Mochón, Leticia; Espín Balbino, Jaime; Olry de Labry Lima, Antonio; Caro Martinez, Araceli; Martin Ruiz, Eva; Pérez Velasco, Román

2017-03-31

To gain knowledge and insights on health technology assessment (HTA) and decision-making processes in Central, Eastern and South Eastern Europe (CESEE) countries. A cross-sectional study was performed. Based on the literature, a questionnaire was developed in a multi-stage process. The questionnaire was arranged according to 5 broad domains: (i) introduction/country settings; (ii) use of HTA in the country; (iii) decision-making process; (iv) implementation of decisions; and (v) HTA and decision-making: future challenges. Potential survey respondents were identified through literature review-with a total of 118 contacts from the 24 CESEE countries. From March to July 2014, the survey was administered via e-mail. A total of 22 questionnaires were received generating an 18.6% response rate, including 4 responses indicating that their institutions had no involvement in HTA. Most of the CESEE countries have entities under government mandates with advisory functions and different responsibilities for decision-making, but mainly in charge of the reimbursement and pricing of medicines. Other areas where discrepancies across countries were found include criteria for selecting technologies to be assessed, stakeholder involvement, evidence requirements, use of economic evaluation, and timeliness of HTA. A number of CESEE countries have created formal decision-making processes for which HTA is used. However, there is a high level of heterogeneity related to the degree of development of HTA structures, and the methods and processes followed. Further studies focusing on the countries from which information is scarcer and on the HTA of health technologies other than medicines are warranted. Reviews/comparative analyses. Copyright © 2017 Elsevier B.V. All rights reserved.

End-of-life decisions for people with intellectual disabilities, an interview study with patient representatives.

PubMed

Wagemans, Annemieke M A; Van Schrojenstein Lantman-de Valk, Henny M J; Proot, Ireen M; Metsemakers, Job; Tuffrey-Wijne, Irene; Curfs, Leopold M G

2013-09-01

Not much is known about the process of end-of-life decision-making for people with intellectual disabilities. To clarify the process of end-of-life decision-making for people with intellectual disabilities from the perspective of patient representatives. A qualitative study based on semi-structured interviews, recorded digitally and transcribed verbatim. Data were analysed using Grounded Theory procedures. We interviewed 16 patient representatives after the deaths of 10 people with intellectual disabilities in the Netherlands. The core category 'Deciding for someone else' describes the context in which patient representatives took end-of-life decisions. The patient representatives felt highly responsible for the outcomes. They had not involved the patients in the end-of-life decision-making process, nor any professionals other than the doctor. The categories of 'Motives' and 'Support' were connected to the core category of 'Deciding for someone else'. 'Motives' refers to the patient representatives' ideas about quality of life, prevention from suffering, patients who cannot understand the burden of interventions and emotional reasons reported by patient representatives. 'Support' refers to the support that patient representatives wanted the doctors to give to them in the decision-making process. From the perspective of the patient representatives, the process of end-of-life decision-making can be improved by ensuring clear roles and an explicit description of the tasks and responsibilities of all participants. Regular discussion between everyone involved including people with intellectual disabilities themselves can improve knowledge about each other's motives for end-of-decisions and can clarify expectations towards each other.

[Decision process in a multidisciplinary cancer team with limited evidence].

PubMed

Lassalle, R; Marold, J; Schöbel, M; Manzey, D; Bohn, S; Dietz, A; Boehm, A

2014-04-01

The Head and Neck Cancer Tumor Board is a multispeciality comprehensive conference that brings together experts with different backgrounds to make group decisions about the appropriate treatment. Due to the complexity of the patient cases and the collaboration of different medical disciplines most of these decisions have to be made under uncertainty, i. e., with-out knowing all relevant factors and without being quite sure about the outcome. To develop effective team decision making under uncertainty, it is necessary to understand how medical experts perceive and handle uncertainties. The aim of this field study was to develop a knowledge base by exploring additionally the factors that influence group decision making processes. A structured nonparticipant observational study was employed to address the research goal. Video data were analyzed by 2 independent observers using an observation checklist. A total of 20 videotaped case discussions were studied. Observations were complemented by a questionnaire gathering subjective evaluations of board members about the process and quality of their decisions (N=15). The results show that uncertainty is recognized by board members. Reasons for uncertainty may stem from the complexity of the cases (e. g. therapy options) or the assessment from different disciplines coming together at the board. With respect to handling uncertainty and guaranteeing an optimal decision making process potential for improvement could be defined. This pertains to the handling of different levels of competence, the promotion of a positive discussion culture as well as structuring of the decision making process. © Georg Thieme Verlag KG Stuttgart · New York.

Driving with roadmaps and dashboards: using information resources to structure the decision models in service organizations.

PubMed

Chorpita, Bruce F; Bernstein, Adam; Daleiden, Eric L

2008-03-01

This paper illustrates the application of design principles for tools that structure clinical decision-making. If the effort to implement evidence-based practices in community services organizations is to be effective, attention must be paid to the decision-making context in which such treatments are delivered. Clinical research trials commonly occur in an environment characterized by structured decision making and expert supports. Technology has great potential to serve mental health organizations by supporting these potentially important contextual features of the research environment, through organization and reporting of clinical data into interpretable information to support decisions and anchor decision-making procedures. This article describes one example of a behavioral health reporting system designed to facilitate clinical and administrative use of evidence-based practices. The design processes underlying this system-mapping of decision points and distillation of performance information at the individual, caseload, and organizational levels-can be implemented to support clinical practice in a wide variety of settings.

Application of risk-based multiple criteria decision analysis for selection of the best agricultural scenario for effective watershed management.

PubMed

Javidi Sabbaghian, Reza; Zarghami, Mahdi; Nejadhashemi, A Pouyan; Sharifi, Mohammad Bagher; Herman, Matthew R; Daneshvar, Fariborz

2016-03-01

Effective watershed management requires the evaluation of agricultural best management practice (BMP) scenarios which carefully consider the relevant environmental, economic, and social criteria involved. In the Multiple Criteria Decision-Making (MCDM) process, scenarios are first evaluated and then ranked to determine the most desirable outcome for the particular watershed. The main challenge of this process is the accurate identification of the best solution for the watershed in question, despite the various risk attitudes presented by the associated decision-makers (DMs). This paper introduces a novel approach for implementation of the MCDM process based on a comparative neutral risk/risk-based decision analysis, which results in the selection of the most desirable scenario for use in the entire watershed. At the sub-basin level, each scenario includes multiple BMPs with scores that have been calculated using the criteria derived from two cases of neutral risk and risk-based decision-making. The simple additive weighting (SAW) operator is applied for use in neutral risk decision-making, while the ordered weighted averaging (OWA) and induced OWA (IOWA) operators are effective for risk-based decision-making. At the watershed level, the BMP scores of the sub-basins are aggregated to calculate each scenarios' combined goodness measurements; the most desirable scenario for the entire watershed is then selected based on the combined goodness measurements. Our final results illustrate the type of operator and risk attitudes needed to satisfy the relevant criteria within the number of sub-basins, and how they ultimately affect the final ranking of the given scenarios. The methodology proposed here has been successfully applied to the Honeyoey Creek-Pine Creek watershed in Michigan, USA to evaluate various BMP scenarios and determine the best solution for both the stakeholders and the overall stream health. Copyright © 2015 Elsevier Ltd. All rights reserved.

Drug pricing and reimbursement decision making systems in Mongolia.

PubMed

Dorj, Gereltuya; Sunderland, Bruce; Sanjjav, Tsetsegmaa; Dorj, Gantuya; Gendenragchaa, Byambatsogt

2017-01-01

It is essential to allocate available resources equitably in order to ensure accessibility and affordability of essential medicines, especially in less fortunate nations with limited health funding. Currently, transparent and evidence based research is required to evaluate decision making regarding drug registration, drug pricing and reimbursement processes in Mongolia. To assess the drug reimbursement system and discuss challenges faced by policy-makers and stakeholders. The study has examined Mongolian administrative documents and directives for stakeholders and analysed published statistics. Experts and decision-makers were interviewed about the drug pricing and reimbursement processes in Mongolia. Decisions regarding Mongolian drug registration were based on commonly used criteria of quality, safety, efficacy plus some economic considerations. A total of 11.32 billion Mongolian National Tugrugs (MNT) [5.6 million United States Dollars (USD)] or 12.1% of total health expenditure was spent on patient reimbursement of essential drugs. The highest reimbursed drugs with respect to cost in 2014 were the cardiovascular drug group. Health insurance is compulsory for all citizens; in addition all insured patients have access to reimbursed drugs. However, the decision making process, in particular the level of reimbursement was limited by various barriers, including lack of evidence based data regarding efficacy and comparative cost-effectiveness analysis of drugs and decisions regarding reimbursement. Drug registration, pricing and reimbursement process in Mongolia show an increasing trend of drug registration and reimbursement rates, along with lack of transparency. Limited available data indicate that more evidence-based research studies are required in Mongolia to evaluate and improve the effectiveness of drug pricing and reimbursement policies.

Toward a synthesis of cognitive biases: how noisy information processing can bias human decision making.

PubMed

Hilbert, Martin

2012-03-01

A single coherent framework is proposed to synthesize long-standing research on 8 seemingly unrelated cognitive decision-making biases. During the past 6 decades, hundreds of empirical studies have resulted in a variety of rules of thumb that specify how humans systematically deviate from what is normatively expected from their decisions. Several complementary generative mechanisms have been proposed to explain those cognitive biases. Here it is suggested that (at least) 8 of these empirically detected decision-making biases can be produced by simply assuming noisy deviations in the memory-based information processes that convert objective evidence (observations) into subjective estimates (decisions). An integrative framework is presented to show how similar noise-based mechanisms can lead to conservatism, the Bayesian likelihood bias, illusory correlations, biased self-other placement, subadditivity, exaggerated expectation, the confidence bias, and the hard-easy effect. Analytical tools from information theory are used to explore the nature and limitations that characterize such information processes for binary and multiary decision-making exercises. The ensuing synthesis offers formal mathematical definitions of the biases and their underlying generative mechanism, which permits a consolidated analysis of how they are related. This synthesis contributes to the larger goal of creating a coherent picture that explains the relations among the myriad of seemingly unrelated biases and their potential psychological generative mechanisms. Limitations and research questions are discussed.

Decision-making process of prenatal screening described by pregnant women and their partners.

PubMed

Wätterbjörk, Inger; Blomberg, Karin; Nilsson, Kerstin; Sahlberg-Blom, Eva

2015-10-01

Pregnant women are often faced with having to decide about prenatal screening for Down's syndrome. However, the decision to participate in or refrain from prenatal screening can be seen as an important decision not only for the pregnant woman but also for both the partners. The aim of this study was to explore the couples' processes of decision making about prenatal screening. A total of 37 semi-structured interviews conducted at two time points were analysed using the interpretive description. The study was carried out in Maternal health-care centres, Örebro County Council, Sweden. Fifteen couples of different ages and with different experiences of pregnancy and childbirth were interviewed. Three different patterns of decision making were identified. For the couples in 'The open and communicative decision-making process', the process was straightforward and rational, and the couples discussed the decision with each other. 'The closed and personal decision-making process' showed an immediate and non-communicative decision making where the couples decided each for themselves. The couples showing 'The searching and communicative decision-making process' followed an arduous road in deciding whether to participate or not in prenatal screening and how to cope with the result. The decision-making process was for some couples a fairly straightforward decision, while for others it was a more complex process that required a great deal of consideration. © 2013 John Wiley & Sons Ltd.

Digital technology and clinical decision making in depression treatment: Current findings and future opportunities.

PubMed

Hallgren, Kevin A; Bauer, Amy M; Atkins, David C

2017-06-01

Clinical decision making encompasses a broad set of processes that contribute to the effectiveness of depression treatments. There is emerging interest in using digital technologies to support effective and efficient clinical decision making. In this paper, we provide "snapshots" of research and current directions on ways that digital technologies can support clinical decision making in depression treatment. Practical facets of clinical decision making are reviewed, then research, design, and implementation opportunities where technology can potentially enhance clinical decision making are outlined. Discussions of these opportunities are organized around three established movements designed to enhance clinical decision making for depression treatment, including measurement-based care, integrated care, and personalized medicine. Research, design, and implementation efforts may support clinical decision making for depression by (1) improving tools to incorporate depression symptom data into existing electronic health record systems, (2) enhancing measurement of treatment fidelity and treatment processes, (3) harnessing smartphone and biosensor data to inform clinical decision making, (4) enhancing tools that support communication and care coordination between patients and providers and within provider teams, and (5) leveraging treatment and outcome data from electronic health record systems to support personalized depression treatment. The current climate of rapid changes in both healthcare and digital technologies facilitates an urgent need for research, design, and implementation of digital technologies that explicitly support clinical decision making. Ensuring that such tools are efficient, effective, and usable in frontline treatment settings will be essential for their success and will require engagement of stakeholders from multiple domains. © 2017 Wiley Periodicals, Inc.

Altered Risk-Based Decision Making following Adolescent Alcohol Use Results from an Imbalance in Reinforcement Learning in Rats

PubMed Central

Hart, Andrew S.; Collins, Anne L.; Bernstein, Ilene L.; Phillips, Paul E. M.

2012-01-01

Alcohol use during adolescence has profound and enduring consequences on decision-making under risk. However, the fundamental psychological processes underlying these changes are unknown. Here, we show that alcohol use produces over-fast learning for better-than-expected, but not worse-than-expected, outcomes without altering subjective reward valuation. We constructed a simple reinforcement learning model to simulate altered decision making using behavioral parameters extracted from rats with a history of adolescent alcohol use. Remarkably, the learning imbalance alone was sufficient to simulate the divergence in choice behavior observed between these groups of animals. These findings identify a selective alteration in reinforcement learning following adolescent alcohol use that can account for a robust change in risk-based decision making persisting into later life. PMID:22615989

A new intuitionistic fuzzy rule-based decision-making system for an operating system process scheduler.

PubMed

Butt, Muhammad Arif; Akram, Muhammad

2016-01-01

We present a new intuitionistic fuzzy rule-based decision-making system based on intuitionistic fuzzy sets for a process scheduler of a batch operating system. Our proposed intuitionistic fuzzy scheduling algorithm, inputs the nice value and burst time of all available processes in the ready queue, intuitionistically fuzzify the input values, triggers appropriate rules of our intuitionistic fuzzy inference engine and finally calculates the dynamic priority (dp) of all the processes in the ready queue. Once the dp of every process is calculated the ready queue is sorted in decreasing order of dp of every process. The process with maximum dp value is sent to the central processing unit for execution. Finally, we show complete working of our algorithm on two different data sets and give comparisons with some standard non-preemptive process schedulers.

[Cancer screening in clinical practice: the value of shared decision-making].

PubMed

Cornuz, Jacques; Junod, Noëlle; Pasche, Olivier; Guessous, Idris

2010-07-14

Shared decision-making approach to uncertain clinical situations such as cancer screening seems more appropriate than ever. Shared decision making can be defined as an interactive process where physician and patient share all the stages of the decision making process. For patients who wish to be implicated in the management of their health conditions, physicians might express difficulty to do so. Use of patient decision aids appears to improve such process of shared decision making.

Japanese cancer patient participation in and satisfaction with treatment-related decision-making: A qualitative study.

PubMed

Watanabe, Yoshiko; Takahashi, Miyako; Kai, Ichiro

2008-02-27

Over the last decade, patient involvement in treatment-related decision-making has been widely advocated in Japan, where patient-physician encounters are still under the influence of the long-standing tradition of paternalism. Despite this profound change in clinical practice, studies investigating the actual preferences of Japanese people regarding involvement in treatment-related decision-making are limited. The main objectives of this study were to (1) reveal the actual level of involvement of Japanese cancer patients in the treatment-related decision-making and their overall satisfaction with the decision-making process, and (2) consider the practical implications of increased satisfaction in cancer patients with regard to the decision-making process. We conducted semi-structured interviews with 24 Japanese cancer patients who were recruited from a cancer self-help group in Tokyo. The interviews were qualitatively analysed using the approach described by Lofland and Lofland. The analyses of the patients' interviews focused on 2 aspects: (1) who made treatment-related decisions (the physician or the patient), and (2) the informants' overall satisfaction with the decision-making process. The analyses revealed the following 5 categories of decision-making: 'patient as the active decision maker', 'doctor selection', 'wilfully entrusting the physician', 'compelled decision-making', and 'surrendering decision-making'. While the informants under the first 3 categories were fairly satisfied with the decision-making process, those under the latter 2 were extremely dissatisfied. Informants' views regarding their preferred role in the decision-making process varied substantially from complete physician control to complete patient control; the key factor for their satisfaction was the relation between their preferred involvement in decision-making and their actual level of involvement, irrespective of who the decision maker was. In order to increase patient satisfaction with regard to the treatment-related decision-making process, healthcare professionals in Japan must assess individual patient preferences and provide healthcare accordingly. Moreover, a better environment should be created in hospitals and in society to facilitate patients in expressing their preferences and appropriate resources need to be made available to facilitate their decision-making process.

Evaluator-blinded trial evaluating nurse-led immunotherapy DEcision Coaching In persons with relapsing-remitting Multiple Sclerosis (DECIMS) and accompanying process evaluation: study protocol for a cluster randomised controlled trial.

PubMed

Rahn, Anne Christin; Köpke, Sascha; Kasper, Jürgen; Vettorazzi, Eik; Mühlhauser, Ingrid; Heesen, Christoph

2015-03-21

Multiple sclerosis is a chronic neurological condition usually starting in early adulthood and regularly leading to severe disability. Immunotherapy options are growing in number and complexity, while costs of treatments are high and adherence rates remain low. Therefore, treatment decision-making has become more complex for patients. Structured decision coaching, based on the principles of evidence-based patient information and shared decision-making, has the potential to facilitate participation of individuals in the decision-making process. This cluster randomised controlled trial follows the assumption that decision coaching by trained nurses, using evidence-based patient information and preference elicitation, will facilitate informed choices and induce higher decision quality, as well as better decisional adherence. The decision coaching programme will be evaluated through an evaluator-blinded superiority cluster randomised controlled trial, including 300 patients with suspected or definite relapsing-remitting multiple sclerosis, facing an immunotherapy decision. The clusters are 12 multiple sclerosis outpatient clinics in Germany. Further, the trial will be accompanied by a mixed-methods process evaluation and a cost-effectiveness study. Nurses in the intervention group will be trained in shared decision-making, coaching, and evidence-based patient information principles. Patients who meet the inclusion criteria will receive decision coaching (intervention group) with up to three face-to-face coaching sessions with a trained nurse (decision coach) or counselling as usual (control group). Patients in both groups will be given access to an evidence-based online information tool. The primary outcome is 'informed choice' after six months, assessed with the multi-dimensional measure of informed choice including the sub-dimensions risk knowledge (questionnaire), attitude concerning immunotherapy (questionnaire), and immunotherapy uptake (telephone survey). Secondary outcomes include decisional conflict, adherence to immunotherapy decisions, autonomy preference, planned behaviour, coping self-efficacy, and perceived involvement in coaching and decisional encounters. Safety outcomes are comprised of anxiety and depression and disease-specific quality of life. This trial will assess the effectiveness of a new model of patient decision support concerning MS-immunotherapy options. The delegation of treatment information provision from physicians to trained nurses bears the potential to change current doctor-focused practice in Germany. Current Controlled Trials (identifier: ISRCTN37929939 ), May 27, 2014.

Involving Students in Natural Resource Decision-Making Groups.

ERIC Educational Resources Information Center

Ellsworth, Peter; Ellsworth, Judith

2001-01-01

Describes the Coordinated Resource Management (CRM) in the Classroom project, in which Wyoming high school students work on an authentic natural resource problem, using a decision-making process based on consensus to reach agreement on solutions to the problem. Notes implementation issues of professional development and support, and considers…

Decision making in prioritization of required operational capabilities

NASA Astrophysics Data System (ADS)

Andreeva, P.; Karev, M.; Kovacheva, Ts.

2015-10-01

The paper describes an expert heuristic approach to prioritization of required operational capabilities in the field of defense. Based on expert assessment and by application of the method of Analytical Hierarchical Process, a methodology for their prioritization has been developed. It has been applied to practical simulation decision making games.

Are Leaders Influenced by Advocates in Decisions on Special Education Eligibility?

ERIC Educational Resources Information Center

Kirkland, Erin K. B.; Bauer, Scott C.

2016-01-01

The purpose of this study was to investigate the influence of the opinions of private practitioners and educational advocates on instructional leaders' decision-making processes when making a recommendation for special education eligibility. School-based administrators (n = 56) with varying years of experience as special education administrators…

Medical Decision Making: A Selective Review for Child Psychiatrists and Psychologists

ERIC Educational Resources Information Center

Galanter, Cathryn A.; Patel, Vimla L.

2005-01-01

Physicians, including child and adolescent psychiatrists, show variability and inaccuracies in diagnosis and treatment of their patients and do not routinely implement evidenced-based medical and psychiatric treatments in the community. We believe that it is necessary to characterize the decision-making processes of child and adolescent…

[Involving patients, the insured and the general public in healthcare decision making].

PubMed

Mühlbacher, Axel C; Juhnke, Christin

2016-01-01

No doubt, the public should be involved in healthcare decision making, especially when decision makers from politics and self-government agencies are faced with the difficult task of setting priorities. There is a general consensus on the need for a stronger patient centeredness, even in HTA processes, and internationally different ways of public participation are discussed and tested in decision making processes. This paper describes how the public can be involved in different decision situations, and it shows how preference measurement methods are currently being used in an international context to support decision making. It distinguishes between different levels of decision making on health technologies: approval, assessment, pricing, and finally utilization. The range of participation efforts extends from qualitative surveys of patients' needs (Citizen Councils of NICE in the UK) to science-based documentation of quantitative patient preferences, such as in the current pilot projects of the FDA in the US and the EMA at the European level. Possible approaches for the elicitation and documentation of preference structures and trade-offs in relation to alternate health technologies are decision aids, such as multi-criteria decision analysis (MCDA), that provide the necessary information for weighting and prioritizing decision criteria. Copyright © 2015. Published by Elsevier GmbH.

Shared decision-making in neonatology: an utopia or an attainable goal?

PubMed

D'Aloja, Ernesto; Floris, Laura; Muller, Mima; Birocchi, Francesca; Fanos, Vassilios; Paribello, Francesco; Demontis, Roberto

2010-10-01

Medical decision making is sometimes considered as a relatively simple process in which a decision may be made by the physician, by the patient, or by both patient and physician working together. There are three main models of decision making--paternalism, patient informed choice, and shared decision-making (SDM), having each one of these drawbacks and limitations. Historically, the most adopted one was the paternalism (strongly 'Doctor knows best'), where the professional made the decision based on what he/she considered to be as the patient's best interest, not necessarily contemplating patient's will and wishes. Currently, at the antipodes, the patient informed choice, where the patient makes his/her decision based on information received from the physician with no possible interference of professional's own preferences, seems to be the preferred relationship standard. SDM represents an intermediate approach between the two above-mentioned opposite models, being a medical process that involves actively the doctor and the patient who both bring their own facts and preferences to reach an agreement on the decision on if, when and how to treat a disease. This model, being characterized by elements pertaining to both the others, is gaining popularity in several medical and surgical scenarios whenever a competent patient is able to actively participate into the decisional process. On this basis can this model be implemented also in a Neonatology Intensive Care Unit where little patients are--by nature--incompetent, being the diagnostic/therapeutic choices taken by parents? We focused on this complex item considering four possible different scenarios and it seems to us that it could be possible to introduce such an approach, providing that parents' empowerment, a good physician's communication skill and consideration of all cultural, religious, economic, and ethic values of every single actor have been fairly taken into account.

A decision support system using analytical hierarchy process (AHP) for the optimal environmental reclamation of an open-pit mine

NASA Astrophysics Data System (ADS)

Bascetin, A.

2007-04-01

The selection of an optimal reclamation method is one of the most important factors in open-pit design and production planning. It also affects economic considerations in open-pit design as a function of plan location and depth. Furthermore, the selection is a complex multi-person, multi-criteria decision problem. The group decision-making process can be improved by applying a systematic and logical approach to assess the priorities based on the inputs of several specialists from different functional areas within the mine company. The analytical hierarchy process (AHP) can be very useful in involving several decision makers with different conflicting objectives to arrive at a consensus decision. In this paper, the selection of an optimal reclamation method using an AHP-based model was evaluated for coal production in an open-pit coal mine located at Seyitomer region in Turkey. The use of the proposed model indicates that it can be applied to improve the group decision making in selecting a reclamation method that satisfies optimal specifications. Also, it is found that the decision process is systematic and using the proposed model can reduce the time taken to select a optimal method.

[Decision Making and Electrodermal Activity].

PubMed

Kobayakawa, Mutsutaka

2016-08-01

Decision making is aided by emotions. Bodily responses, such as sweating, heartbeat, and visceral sensation, are used to monitor the emotional state during decision making. Because decision making in dairy life is complicated and cognitively demanding, these bodily signals are thought to facilitate the decision making process by assigning positive or negative values for each of the behavioral options. The sweat response in a decision making task is measured by skin conductance response (SCR). SCR in decision making is divided into two categories: anticipatory SCR is observed before making decisions, and reward/punishment SCR is observed after the outcome of the decision is perceived. Brain lesion studies in human revealed that the amygdala and ventromedial prefrontal cortex are important in decision making. Patients with lesinon in the amygdala exhibit neither the anticipatory nor reward/punishment SCRs, while patients with the ventromedial prefrontal lesions have deficits only in the anticipatory SCRs. Decision making tasks and SCR analysis have contributed to reveal the implicit aspects of decision making. Further research is necessary for clarifying the role of explicit process of decision making and its relationship with the implicit process.

Fuzzy, crisp, and human logic in e-commerce marketing data mining

NASA Astrophysics Data System (ADS)

Hearn, Kelda L.; Zhang, Yanqing

2001-03-01

In today's business world there is an abundance of available data and a great need to make good use of it. Many businesses would benefit from examining customer habits and trends and making marketing and product decisions based on that analysis. However, the process of manually examining data and making sound decisions based on that data is time consuming and often impractical. Intelligent systems that can make judgments similar to human judgments are sorely needed. Thus, systems based on fuzzy logic present themselves as an option to be seriously considered. The work described in this paper attempts to make an initial comparison between fuzzy logic and more traditional hard or crisp logic to see which would make a better substitute for human intervention. In this particular case study, customers are classified into categories that indicate how desirable the customer would be as a prospect for marketing. This classification is based on a small set of customer data. The results from these investigations make it clear that fuzzy logic is more able to think for itself and make decisions that more closely match human decision and is therefore significantly closer to human logic than crisp logic.

Factors affecting evidence-based decision making in local health departments.

PubMed

Sosnowy, Collette D; Weiss, Linda J; Maylahn, Christopher M; Pirani, Sylvia J; Katagiri, Nancy J

2013-12-01

Data indicating the extent to which evidence-based decision making (EBDM) is used in local health departments (LHDs) are limited. This study aims to determine use of decision-making processes by New York State LHD leaders and upper-level staff and identify facilitators and barriers to the use of EBDM in LHDs. The New York Public Health Practice-Based Research Network implemented a mixed-methods study in 31 LHDs. There were 20 individual interviews; five small-group interviews (two or three participants each); and two focus groups (eight participants each) conducted with people who had decision-making authority. Information was obtained about each person's background and position, decision-making responsibilities, how decisions are made within their LHD, knowledge and experience with EBDM, use of each step of the EBDM process, and barriers and facilitators to EBDM implementation. Data were collected from June to November 2010 and analyzed in 2011. Overall, participants supported EBDM and expressed a desire to increase their department's use of it. Although most people understood the concept, a relatively small number had substantial expertise and experience with its practice. Many indicated that they applied EBDM unevenly. Factors associated with use of EBDM included strong leadership; workforce capacity (number and skills); resources; funding and program mandates; political support; and access to data and program models suitable to community conditions. EBDM is used inconsistently in LHDs in New York. Despite knowledge and interest among LHD leadership, the LHD capacity, resources, appropriate programming, and other issues serve as impediments to EBDM and optimal implementation of evidence-based strategies. Published by Elsevier Inc.

Incentives for Optimal Multi-level Allocation of HIV Prevention Resources

PubMed Central

Malvankar, Monali M.; Zaric, Gregory S.

2013-01-01

HIV/AIDS prevention funds are often allocated at multiple levels of decision-making. Optimal allocation of HIV prevention funds maximizes the number of HIV infections averted. However, decision makers often allocate using simple heuristics such as proportional allocation. We evaluate the impact of using incentives to encourage optimal allocation in a two-level decision-making process. We model an incentive based decision-making process consisting of an upper-level decision maker allocating funds to a single lower-level decision maker who then distributes funds to local programs. We assume that the lower-level utility function is linear in the amount of the budget received from the upper-level, the fraction of funds reserved for proportional allocation, and the number of infections averted. We assume that the upper level objective is to maximize the number of infections averted. We illustrate with an example using data from California, U.S. PMID:23766551

Acceptance of shared decision making with reference to an electronic library of decision aids (arriba-lib) and its association to decision making in patients: an evaluation study.

PubMed

Hirsch, Oliver; Keller, Heidemarie; Krones, Tanja; Donner-Banzhoff, Norbert

2011-07-07

Decision aids based on the philosophy of shared decision making are designed to help patients make informed choices among diagnostic or treatment options by delivering evidence-based information on options and outcomes. A patient decision aid can be regarded as a complex intervention because it consists of several presumably relevant components. Decision aids have rarely been field tested to assess patients' and physicians' attitudes towards them. It is also unclear what effect decision aids have on the adherence to chosen options. The electronic library of decision aids (arriba-lib) to be used within the clinical encounter has a modular structure and contains evidence-based decision aids for the following topics: cardiovascular prevention, atrial fibrillation, coronary heart disease, oral antidiabetics, conventional and intensified insulin therapy, and unipolar depression. We conducted an evaluation study in which 29 primary care physicians included 192 patients. After the consultation, patients filled in questionnaires and were interviewed via telephone two months later. We used generalised estimation equations to measure associations within patient variables and traditional crosstab analyses. Patients were highly satisfied with arriba-lib and the process of shared decision making. Two-thirds of patients reached in the telephone interview wanted to be counselled again with arriba-lib. There was a high congruence between preferred and perceived decision making. Of those patients reached in the telephone interview, 80.7% said that they implemented the decision, independent of gender and education. Elderly patients were more likely to say that they implemented the decision. Shared decision making with our multi-modular electronic library of decision aids (arriba-lib) was accepted by a high number of patients. It has positive associations to general aspects of decision making in patients. It can be used for patient groups with a wide range of individual characteristics.

'Gun! Gun! Gun!': An exploration of law enforcement officers' decision-making and coping under stress during actual events.

PubMed

Harris, Kevin R; Eccles, David W; Freeman, Carlos; Ward, Paul

2017-08-01

Research on decision-making under stress has mainly involved laboratory-based studies with few contextual descriptions of decision-making under stress in the natural ecology. We examined how police officers prepared for, coped with and made decisions under threat-of-death stress during real events. A delayed retrospective report method was used to elicit skilled police officers' thoughts and feelings during attempts to resolve such events. Reports were analysed to identify experiences of stress and coping, and thought processes underpinning decision-making during the event. Officers experienced a wide range of events, coped with stress predominantly via problem-focused strategies, and adapted their decision-making under stress based on the available context. Future officer training should involve a greater variety of training scenarios than is involved in current training, and expose trainees to the possible variants of each situation to foster better situational representation and, thus, a more reliable and adaptive mental model for use in decision-making. Practitioner Summary: This study concerns decision-making and coping strategies used by skilled police officers during real threat-of-death situations. Officers' decision-making strategies differed according to the complexity of the situation and they coped with the stress of these situations via attempts to resolve the situations (e.g. by planning responses) and, to a lesser extent, via attempts to deal with their emotions.

Bridging the gap between the economic evaluation literature and daily practice in occupational health: a qualitative study among decision-makers in the healthcare sector.

PubMed

van Dongen, Johanna M; Tompa, Emile; Clune, Laurie; Sarnocinska-Hart, Anna; Bongers, Paulien M; van Tulder, Maurits W; van der Beek, Allard J; van Wier, Marieke F

2013-06-03

Continued improvements in occupational health can only be ensured if decisions regarding the implementation and continuation of occupational health and safety interventions (OHS interventions) are based on the best available evidence. To ensure that this is the case, scientific evidence should meet the needs of decision-makers. As a first step in bridging the gap between the economic evaluation literature and daily practice in occupational health, this study aimed to provide insight into the occupational health decision-making process and information needs of decision-makers. An exploratory qualitative study was conducted with a purposeful sample of occupational health decision-makers in the Ontario healthcare sector. Eighteen in-depth interviews were conducted to explore the process by which occupational health decisions are made and the importance given to the financial implications of OHS interventions. Twenty-five structured telephone interviews were conducted to explore the sources of information used during the decision-making process, and decision-makers' knowledge on economic evaluation methods. In-depth interview data were analyzed according to the constant comparative method. For the structured telephone interviews, summary statistics were prepared. The occupational health decision-making process generally consists of three stages: initiation stage, establishing the need for an intervention; pre-implementation stage, developing an intervention and its business case in order to receive senior management approval; and implementation and evaluation stage, implementing and evaluating an intervention. During this process, information on the financial implications of OHS interventions was found to be of great importance, especially the employer's costs and benefits. However, scientific evidence was rarely consulted, sound ex-post program evaluations were hardly ever performed, and there seemed to be a need to advance the economic evaluation skill set of decision-makers. Financial information is particularly important at the front end of implementation decisions, and can be a key deciding factor of whether to go forward with a new OHS intervention. In addition, it appears that current practice in occupational health in the healthcare sector is not solidly grounded in evidence-based decision-making and strategies should be developed to improve this.

Bridging the gap between the economic evaluation literature and daily practice in occupational health: a qualitative study among decision-makers in the healthcare sector

PubMed Central

2013-01-01

Background Continued improvements in occupational health can only be ensured if decisions regarding the implementation and continuation of occupational health and safety interventions (OHS interventions) are based on the best available evidence. To ensure that this is the case, scientific evidence should meet the needs of decision-makers. As a first step in bridging the gap between the economic evaluation literature and daily practice in occupational health, this study aimed to provide insight into the occupational health decision-making process and information needs of decision-makers. Methods An exploratory qualitative study was conducted with a purposeful sample of occupational health decision-makers in the Ontario healthcare sector. Eighteen in-depth interviews were conducted to explore the process by which occupational health decisions are made and the importance given to the financial implications of OHS interventions. Twenty-five structured telephone interviews were conducted to explore the sources of information used during the decision-making process, and decision-makers’ knowledge on economic evaluation methods. In-depth interview data were analyzed according to the constant comparative method. For the structured telephone interviews, summary statistics were prepared. Results The occupational health decision-making process generally consists of three stages: initiation stage, establishing the need for an intervention; pre-implementation stage, developing an intervention and its business case in order to receive senior management approval; and implementation and evaluation stage, implementing and evaluating an intervention. During this process, information on the financial implications of OHS interventions was found to be of great importance, especially the employer’s costs and benefits. However, scientific evidence was rarely consulted, sound ex-post program evaluations were hardly ever performed, and there seemed to be a need to advance the economic evaluation skill set of decision-makers. Conclusions Financial information is particularly important at the front end of implementation decisions, and can be a key deciding factor of whether to go forward with a new OHS intervention. In addition, it appears that current practice in occupational health in the healthcare sector is not solidly grounded in evidence-based decision-making and strategies should be developed to improve this. PMID:23731570

International Students' Motivations for Studying in UK HE: Insights into the Choice and Decision Making of African Students

ERIC Educational Resources Information Center

Maringe, Felix; Carter, Steve

2007-01-01

Purpose: International students' HE decision making is a high stakes process. There is an insufficient evidence base that would aid university level strategic planning in areas of recruitment from the African continent and in supporting its students to maximise the benefits from a UK HE experience. This paper aims to explore the decision making…

Making Invasion models useful for decision makers; incorporating uncertainty, knowledge gaps, and decision-making preferences

Treesearch

Denys Yemshanov; Frank H Koch; Mark Ducey

2015-01-01

Uncertainty is inherent in model-based forecasts of ecological invasions. In this chapter, we explore how the perceptions of that uncertainty can be incorporated into the pest risk assessment process. Uncertainty changes a decision maker’s perceptions of risk; therefore, the direct incorporation of uncertainty may provide a more appropriate depiction of risk. Our...

Cost-benefit decision circuitry: proposed modulatory role for acetylcholine.

PubMed

Fobbs, Wambura C; Mizumori, Sheri J Y

2014-01-01

In order to select which action should be taken, an animal must weigh the costs and benefits of possible outcomes associate with each action. Such decisions, called cost-benefit decisions, likely involve several cognitive processes (including memory) and a vast neural circuitry. Rodent models have allowed research to begin to probe the neural basis of three forms of cost-benefit decision making: effort-, delay-, and risk-based decision making. In this review, we detail the current understanding of the functional circuits that subserve each form of decision making. We highlight the extensive literature by detailing the ability of dopamine to influence decisions by modulating structures within these circuits. Since acetylcholine projects to all of the same important structures, we propose several ways in which the cholinergic system may play a local modulatory role that will allow it to shape these behaviors. A greater understanding of the contribution of the cholinergic system to cost-benefit decisions will permit us to better link the decision and memory processes, and this will help us to better understand and/or treat individuals with deficits in a number of higher cognitive functions including decision making, learning, memory, and language. © 2014 Elsevier Inc. All rights reserved.

Teachers' Experiences with the Data-Driven Decision Making Process in Increasing Students' Reading Achievement in a Title I Elementary Public School

ERIC Educational Resources Information Center

Atkinson, Linton

2015-01-01

This paper is a research dissertation based on a qualitative case study conducted on Teachers' Experiences within a Data-Driven Decision Making (DDDM) process. The study site was a Title I elementary school in a large school district in Central Florida. Background information is given in relation to the need for research that was conducted on the…

Introducing high-cost health care to patients: dentists' accounts of offering dental implant treatment.

PubMed

Vernazza, Christopher R; Rousseau, Nikki; Steele, Jimmy G; Ellis, Janice S; Thomason, John Mark; Eastham, Jane; Exley, Catherine

2015-02-01

The decision-making process within health care has been widely researched, with shared decision-making, where both patients and clinicians share technical and personal information, often being cited as the ideal model. To date, much of this research has focused on systems where patients receive their care and treatment free at the point of contact (either in government-funded schemes or in insurance-based schemes). Oral health care often involves patients making direct payments for their care and treatment, and less is known about how this payment affects the decision-making process. It is clear that patient characteristics influence decision-making, but previous evidence suggests that clinicians may assume characteristics rather than eliciting them directly. The aim was to explore the influences on how dentists' engaged in the decision-making process surrounding a high-cost item of health care, dental implant treatments (DITs). A qualitative study using semi-structured interviews was undertaken using a purposive sample of primary care dentists (n = 25). Thematic analysis was undertaken to reveal emerging key themes. There were differences in how dentists discussed and offered implants. Dentists made decisions about whether to offer implants based on business factors, professional and legal obligations and whether they perceived the patient to be motivated to have treatment and their ability to pay. There was evidence that assessment of these characteristics was often based on assumptions derived from elements such as the appearance of the patient, the state of the patient's mouth and demographic details. The data suggest that there is a conflict between three elements of acting as a healthcare professional: minimizing provision of unneeded treatment, trying to fully involve patients in shared decisions and acting as a business person with the potential for financial gain. It might be expected that in the context of a high-cost healthcare intervention for which patients pay the bill themselves, that decision-making would be closer to an informed than a paternalistic model. Our research suggests that paternalistic decision-making is still practised and is influenced by assumptions about patient characteristics. Better tools and training may be required to support clinicians in this area of practice. © 2014 The Authors. Community Dentistry and Oral Epidemiology Published by John Wiley & Sons Ltd.

Decision-Making in Agent-Based Models of Migration: State of the Art and Challenges.

PubMed

Klabunde, Anna; Willekens, Frans

We review agent-based models (ABM) of human migration with respect to their decision-making rules. The most prominent behavioural theories used as decision rules are the random utility theory, as implemented in the discrete choice model, and the theory of planned behaviour. We identify the critical choices that must be made in developing an ABM, namely the modelling of decision processes and social networks. We also discuss two challenges that hamper the widespread use of ABM in the study of migration and, more broadly, demography and the social sciences: (a) the choice and the operationalisation of a behavioural theory (decision-making and social interaction) and (b) the selection of empirical evidence to validate the model. We offer advice on how these challenges might be overcome.

Integrating Decision Making and Mental Health Interventions Research: Research Directions

PubMed Central

Wills, Celia E.; Holmes-Rovner, Margaret

2006-01-01

The importance of incorporating patient and provider decision-making processes is in the forefront of the National Institute of Mental Health (NIMH) agenda for improving mental health interventions and services. Key concepts in patient decision making are highlighted within a simplified model of patient decision making that links patient-level/“micro” variables to services-level/“macro” variables via the decision-making process that is a target for interventions. The prospective agenda for incorporating decision-making concepts in mental health research includes (a) improved measures for characterizing decision-making processes that are matched to study populations, complexity, and types of decision making; (b) testing decision aids in effectiveness research for diverse populations and clinical settings; and (c) improving the understanding and incorporation of preference concepts in enhanced intervention designs. PMID:16724158

Clinical decision-making by midwives: managing case complexity.

PubMed

Cioffi, J; Markham, R

1997-02-01

In making clinical judgements, it is argued that midwives use 'shortcuts' or heuristics based on estimated probabilities to simplify the decision-making task. Midwives (n = 30) were given simulated patient assessment situations of high and low complexity and were required to think aloud. Analysis of verbal protocols showed that subjective probability judgements (heuristics) were used more frequently in the high than low complexity case and predominated in the last quarter of the assessment period for the high complexity case. 'Representativeness' was identified more frequently in the high than in the low case, but was the dominant heuristic in both. Reports completed after each simulation suggest that heuristics based on memory for particular conditions affect decisions. It is concluded that midwives use heuristics, derived mainly from their clinical experiences, in an attempt to save cognitive effort and to facilitate reasonably accurate decisions in the decision-making process.

Formal Process Modeling to Improve Human Decision-Making in Test and Evaluation Acoustic Range Control

DTIC Science & Technology

2017-09-01

AVAILABILITY STATEMENT Approved for public release. Distribution is unlimited. 12b. DISTRIBUTION CODE 13. ABSTRACT (maximum 200 words) Test and...ambiguities and identify high -value decision points? This thesis explores how formalization of these experience-based decisions as a process model...representing a T&E event may reveal high -value decision nodes where certain decisions carry more weight or potential for impacts to a successful test. The

Evaluating Quality of Decision-Making Processes in Medicines' Development, Regulatory Review, and Health Technology Assessment: A Systematic Review of the Literature

PubMed Central

Bujar, Magdalena; McAuslane, Neil; Walker, Stuart R.; Salek, Sam

2017-01-01

Introduction: Although pharmaceutical companies, regulatory authorities, and health technology assessment (HTA) agencies have been increasingly using decision-making frameworks, it is not certain whether these enable better quality decision making. This could be addressed by formally evaluating the quality of decision-making process within those organizations. The aim of this literature review was to identify current techniques (tools, questionnaires, surveys, and studies) for measuring the quality of the decision-making process across the three stakeholders. Methods: Using MEDLINE, Web of Knowledge, and other Internet-based search engines, a literature review was performed to systematically identify techniques for assessing quality of decision making in medicines development, regulatory review, and HTA. A structured search was applied using key words and a secondary review was carried out. In addition, the measurement properties of each technique were assessed and compared. Ten Quality Decision-Making Practices (QDMPs) developed previously were then used as a framework for the evaluation of techniques identified in the review. Due to the variation in studies identified, meta-analysis was inappropriate. Results: This review identified 13 techniques, where 7 were developed specifically to assess decision making in medicines' development, regulatory review, or HTA; 2 examined corporate decision making, and 4 general decision making. Regarding how closely each technique conformed to the 10 QDMPs, the 13 techniques assessed a median of 6 QDMPs, with a mode of 3 QDMPs. Only 2 techniques evaluated all 10 QDMPs, namely the Organizational IQ and the Quality of Decision Making Orientation Scheme (QoDoS), of which only one technique, QoDoS could be applied to assess decision making of both individuals and organizations, and it possessed generalizability to capture issues relevant to companies as well as regulatory authorities. Conclusion: This review confirmed a general paucity of research in this area, particularly regarding the development and systematic application of techniques for evaluating quality decision making, with no consensus around a gold standard. This review has identified QoDoS as the most promising available technique for assessing decision making in the lifecycle of medicines and the next steps would be to further test its validity, sensitivity, and reliability. PMID:28443022

Insights into water managers' perception and handling of uncertainties - a study of the role of uncertainty in practitioners' planning and decision-making

NASA Astrophysics Data System (ADS)

Höllermann, Britta; Evers, Mariele

2017-04-01

Planning and decision-making under uncertainty is common in water management due to climate variability, simplified models, societal developments, planning restrictions just to name a few. Dealing with uncertainty can be approached from two sites, hereby affecting the process and form of communication: Either improve the knowledge base by reducing uncertainties or apply risk-based approaches to acknowledge uncertainties throughout the management process. Current understanding is that science more strongly focusses on the former approach, while policy and practice are more actively applying a risk-based approach to handle incomplete and/or ambiguous information. The focus of this study is on how water managers perceive and handle uncertainties at the knowledge/decision interface in their daily planning and decision-making routines. How they evaluate the role of uncertainties for their decisions and how they integrate this information into the decision-making process. Expert interviews and questionnaires among practitioners and scientists provided an insight into their perspectives on uncertainty handling allowing a comparison of diverse strategies between science and practice as well as between different types of practitioners. Our results confirmed the practitioners' bottom up approach from potential measures upwards instead of impact assessment downwards common in science-based approaches. This science-practice gap may hinder effective uncertainty integration and acknowledgement in final decisions. Additionally, the implementation of an adaptive and flexible management approach acknowledging uncertainties is often stalled by rigid regulations favouring a predict-and-control attitude. However, the study showed that practitioners' level of uncertainty recognition varies with respect to his or her affiliation to type of employer and business unit, hence, affecting the degree of the science-practice-gap with respect to uncertainty recognition. The level of working experience was examined as a cross-cutting property of science and practice with increasing levels of uncertainty awareness and integration among more experienced researchers and practitioners. In conclusion, our study of water managers' perception and handling of uncertainties provides valuable insights for finding routines for uncertainty communication and integration into planning and decision-making processes by acknowledging the divers perceptions among producers, users and receivers of uncertainty information. These results can contribute to more effective integration of hydrological forecast and improved decisions.

Heuristic decision-making about research participation in children with cystic fibrosis.

PubMed

Christofides, Emily; Dobson, Jennifer A; Solomon, Melinda; Waters, Valerie; O'Doherty, Kieran C

2016-08-01

Traditional perspectives on informed consent assume that when faced with decisions about whether to participate in research, individuals behave according to principles of classical rationality, taking into account all available information to weigh risks and benefits to come to a decision that is optimal for them. However, theoretical and empirical research in psychology suggests that people may not make decisions in this way. Less is known about decision-making processes as they pertain to participating in biomedical research, particularly when the participants are children. We sought to better understand research decision processes especially in children who tend to participate extensively in research due to chronic illness. To learn more about children's decision-making in this context, we interviewed 19 young patients with cystic fibrosis (male n = 7; female n = 12) aged 8-18 years (M = 13 years) at a children's hospital in Canada between April and August 2013. We found that participants generally had a default approach to participation decisions, which they attributed to their parents' attitudes to research, experiences of having grown up participating in research, trusting the researchers, and wanting to help. Most of our participants made the decision to participate in research based on a heuristic with a baseline to say "yes", subject to change based on aspects of the research or particular preferences. In particular, concerns with the procedure, unwillingness to talk about cystic fibrosis, logistical challenges, and perceptions of risk all influenced the decision, as did the perceived importance or personal relevance of the research. Our study illustrates that rather than conducting risk/benefit analyses, participants tended to adopt a heuristic-like approach, consistent with decision theories that view heuristic decision-making as ecologically rational. Copyright © 2016 Elsevier Ltd. All rights reserved.

The decision to extract or retain compromised teeth is not helped by the application of a scoring system.

PubMed

Palmer, Richard M

2010-06-01

A Novel Decision-Making Process for Tooth Retention or Extraction J Periodontol 2009;80:476-491. Avila G, Galindo-Moreno P, Soehren S, Misch CE, Morelli T, Wang H-L. Richard M. Palmer, PhD, BDS, FDS RCS PURPOSE/QUESTION: Is it possible to devise a system to help in the decision-making process of tooth extraction/retention based on a critical evaluation of the literature? University of Michigan Periodontal Graduate Student Research Fund Comprehensive literature review Level 3: Other evidence Not applicable.

Know the risk, take the win: how executive functions and probability processing influence advantageous decision making under risk conditions.

PubMed

Brand, Matthias; Schiebener, Johannes; Pertl, Marie-Theres; Delazer, Margarete

2014-01-01

Recent models on decision making under risk conditions have suggested that numerical abilities are important ingredients of advantageous decision-making performance, but empirical evidence is still limited. The results of our first study show that logical reasoning and basic mental calculation capacities predict ratio processing and that ratio processing predicts decision making under risk. In the second study, logical reasoning together with executive functions predicted probability processing (numeracy and probability knowledge), and probability processing predicted decision making under risk. These findings suggest that increasing an individual's understanding of ratios and probabilities should lead to more advantageous decisions under risk conditions.

Achieving a Risk-Informed Decision-Making Environment at NASA: The Emphasis of NASA's Risk Management Policy

NASA Technical Reports Server (NTRS)

Dezfuli, Homayoon

2010-01-01

This slide presentation reviews the evolution of risk management (RM) at NASA. The aim of the RM approach at NASA is to promote an approach that is heuristic, proactive, and coherent across all of NASA. Risk Informed Decision Making (RIDM) is a decision making process that uses a diverse set of performance measures along with other considerations within a deliberative process to inform decision making. RIDM is invoked for key decisions such as architecture and design decisions, make-buy decisions, and budget reallocation. The RIDM process and how it relates to the continuous Risk Management (CRM) process is reviewed.

Decision aids for randomised controlled trials: a qualitative exploration of stakeholders’ views

PubMed Central

Gillies, Katie; Skea, Zoë C; Campbell, Marion K

2014-01-01

Objectives To explore stakeholders’ perceptions of decision aids designed to support the informed consent decision-making process for randomised controlled trials. Design Qualitative semistructured interviews. Participants were provided with prototype trial decision aids in advance to stimulate discussion. Interviews were analysed using an established interpretive approach. Participants 23 stakeholders: Trial Managers (n=5); Research Nurses (n=5); Ethics Committee Chairs (n=5); patients (n=4) and Clinical Principal Investigators (n=4). Setting Embedded within two ongoing randomised controlled trials. All interviews conducted with UK-based participants. Results Certain key aspects (eg, values clarification exercises, presentation of probabilities, experiences of others and balance of options) in the prototype decision aids were perceived by all stakeholders as having a significant advantage (over existing patient information leaflets) in terms of supporting well informed appropriate decisions. However, there were some important differences between the stakeholder groups on specific content (eg, language used in the section on positive and negative features of taking part in a trial and the overall length of the trial decision aids). Generally the stakeholders believed trial decision aids have the potential to better engage potential participants in the decision-making process and allow them to make more personally relevant decisions about their participation. Conclusions Compared to existing patient information leaflets, stakeholders perceived decision aids for trial participation to have the potential to promote a more ‘informed’ decision-making process. Further efforts to develop, refine and formally evaluate trial decision aids should be explored. PMID:25138811

Spatial education: improving conservation delivery through space-structured decision making

USGS Publications Warehouse

Moore, Clinton T.; Shaffer, Terry L.; Gannon, Jill J.

2013-01-01

Adaptive management is a form of structured decision making designed to guide management of natural resource systems when their behaviors are uncertain. Where decision making can be replicated across units of a landscape, learning can be accelerated, and biological processes can be understood in a larger spatial context. Broad-based partnerships among land management agencies, exemplified by Landscape Conservation Cooperatives (conservation partnerships created through the U.S. Department of the Interior), are potentially ideal environments for implementing spatially structured adaptive management programs.

Developing guidelines in low-income and middle-income countries: lessons from Kenya

PubMed Central

English, Mike; Irimu, Grace; Nyamai, Rachel; Were, Fred; Garner, Paul; Opiyo, Newton

2017-01-01

There are few examples of sustained nationally organised, evidence-informed clinical guidelines development processes in Sub-Saharan Africa. We describe the evolution of efforts from 2005 to 2015 to support evidence-informed decision making to guide admission hospital care practices in Kenya. The approach to conduct reviews, present evidence, and structure and promote transparency of consensus-based procedures for making recommendations improved over four distinct rounds of policy making. Efforts to engage important voices extended from government and academia initially to include multiple professional associations, regulators and practitioners. More than 100 people have been engaged in the decision-making process; an increasing number outside the research team has contributed to the conduct of systematic reviews, and 31 clinical policy recommendations has been developed. Recommendations were incorporated into clinical guideline booklets that have been widely disseminated with a popular knowledge and skills training course. Both helped translate evidence into practice. We contend that these efforts have helped improve the use of evidence to inform policy. The systematic reviews, Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approaches and evidence to decision-making process are well understood by clinicians, and the process has helped create a broad community engaged in evidence translation together with a social or professional norm to use evidence in paediatric care in Kenya. Specific sustained efforts should be made to support capacity and evidence-based decision making in other African settings and clinical disciplines. PMID:28584069

Multi-criteria Integrated Resource Assessment (MIRA)

EPA Pesticide Factsheets

MIRA is an approach that facilitates stakeholder engagement for collaborative multi-objective decision making. MIRA is designed to facilitate and support an inclusive, explicit, transparent, iterative learning-based decision process.

Decision Making Under Objective Risk Conditions-a Review of Cognitive and Emotional Correlates, Strategies, Feedback Processing, and External Influences.

PubMed

Schiebener, Johannes; Brand, Matthias

2015-06-01

While making decisions under objective risk conditions, the probabilities of the consequences of the available options are either provided or calculable. Brand et al. (Neural Networks 19:1266-1276, 2006) introduced a model describing the neuro-cognitive processes involved in such decisions. In this model, executive functions associated with activity in the fronto-striatal loop are important for developing and applying decision-making strategies, and for verifying, adapting, or revising strategies according to feedback. Emotional rewards and punishments learned from such feedback accompany these processes. In this literature review, we found support for the role of executive functions, but also found evidence for the importance of further cognitive abilities in decision making. Moreover, in addition to reflective processing (driven by cognition), decisions can be guided by impulsive processing (driven by anticipation of emotional reward and punishment). Reflective and impulsive processing may interact during decision making, affecting the evaluation of available options, as both processes are affected by feedback. Decision-making processes are furthermore modulated by individual attributes (e.g., age), and external influences (e.g., stressors). Accordingly, we suggest a revised model of decision making under objective risk conditions.

Value judgements in the decision-making process for the elderly patient.

PubMed

Ubachs-Moust, J; Houtepen, R; Vos, R; ter Meulen, R

2008-12-01

The question of whether old age should or should not play a role in medical decision-making for the elderly patient is regularly debated in ethics and medicine. In this paper we investigate exactly how age influences the decision-making process. To explore the normative argumentation in the decisions regarding an elderly patient we make use of the argumentation model advanced by Toulmin. By expanding the model in order to identify normative components in the argumentation process it is possible to analyse the way that age-related value judgements influence the medical decision-making process. We apply the model to practice descriptions made by medical students after they had attended consultations and meetings in medical practice during their clinical training. Our results show the pervasive character of age-related value judgements. They influence the physician's decision in several ways and at several points in the decision-making process. Such explicit value judgements were not exclusively used for arguments against further diagnosis or treatment of older patients. We found no systematic "ageist" pattern in the clinical decisions by physicians. Since age plays such an important, yet hidden role in the medical decision-making process, we make a plea for revealing such normative argumentation in order to gain transparency and accountability in this process. An explicit deliberative approach will make the medical decision-making process more transparent and improve the physician-patient relationship, creating confidence and trust, which are at the heart of medical practice.

Enhanced cardiac perception is associated with increased susceptibility to framing effects.

PubMed

Sütterlin, Stefan; Schulz, Stefan M; Stumpf, Theresa; Pauli, Paul; Vögele, Claus

2013-07-01

Previous studies suggest in line with dual process models that interoceptive skills affect controlled decisions via automatic or implicit processing. The "framing effect" is considered to capture implicit effects of task-irrelevant emotional stimuli on decision-making. We hypothesized that cardiac awareness, as a measure of interoceptive skills, is positively associated with susceptibility to the framing effect. Forty volunteers performed a risky-choice framing task in which the effect of loss versus gain frames on decisions based on identical information was assessed. The results show a positive association between cardiac awareness and the framing effect, accounting for 24% of the variance in the framing effect. These findings demonstrate that good interoceptive skills are linked to poorer performance in risky choices based on ambivalent information when implicit bias is induced by task-irrelevant emotional information. These findings support a dual process perspective on decision-making and suggest that interoceptive skills mediate effects of implicit bias on decisions. Copyright © 2013 Cognitive Science Society, Inc.

From science to action: Principles for undertaking environmental research that enables knowledge exchange and evidence-based decision-making.

PubMed

Cvitanovic, C; McDonald, J; Hobday, A J

2016-12-01

Effective conservation requires knowledge exchange among scientists and decision-makers to enable learning and support evidence-based decision-making. Efforts to improve knowledge exchange have been hindered by a paucity of empirically-grounded guidance to help scientists and practitioners design and implement research programs that actively facilitate knowledge exchange. To address this, we evaluated the Ningaloo Research Program (NRP), which was designed to generate new scientific knowledge to support evidence-based decisions about the management of the Ningaloo Marine Park in north-western Australia. Specifically, we evaluated (1) outcomes of the NRP, including the extent to which new knowledge informed management decisions; (2) the barriers that prevented knowledge exchange among scientists and managers; (3) the key requirements for improving knowledge exchange processes in the future; and (4) the core capacities that are required to support knowledge exchange processes. While the NRP generated expansive and multidisciplinary science outputs directly relevant to the management of the Ningaloo Marine Park, decision-makers are largely unaware of this knowledge and little has been integrated into decision-making processes. A range of barriers prevented efficient and effective knowledge exchange among scientists and decision-makers including cultural differences among the groups, institutional barriers within decision-making agencies, scientific outputs that were not translated for decision-makers and poor alignment between research design and actual knowledge needs. We identify a set of principles to be implemented routinely as part of any applied research program, including; (i) stakeholder mapping prior to the commencement of research programs to identify all stakeholders, (ii) research questions to be co-developed with stakeholders, (iii) implementation of participatory research approaches, (iv) use of a knowledge broker, and (v) tailored knowledge management systems. Finally, we articulate the individual, institutional and financial capacities that must be developed to underpin successful knowledge exchange strategies. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Shared Decision-Making and Patient Empowerment in Preventive Cardiology.

PubMed

Kambhampati, Swetha; Ashvetiya, Tamara; Stone, Neil J; Blumenthal, Roger S; Martin, Seth S

2016-05-01

Shared decision-making, central to evidence-based medicine and good patient care, begins and ends with the patient. It is the process by which a clinician and a patient jointly make a health decision after discussing options, potential benefits and harms, and considering the patient's values and preferences. Patient empowerment is crucial to shared decision-making and occurs when a patient accepts responsibility for his or her health. They can then learn to solve their own problems with information and support from professionals. Patient empowerment begins with the provider acknowledging that patients are ultimately in control of their care and aims to increase a patient's capacity to think critically and make autonomous, informed decisions about their health. This article explores the various components of shared decision-making in scenarios such as hypertension and hyperlipidemia, heart failure, and diabetes. It explores barriers and the potential for improving medication adherence, disease awareness, and self-management of chronic disease.

Decision making in cancer primary prevention and chemoprevention.

PubMed

Gorin, Sherri Sheinfeld; Wang, Catharine; Raich, Peter; Bowen, Deborah J; Hay, Jennifer

2006-12-01

We know very little about how individuals decide to undertake, maintain, or discontinue cancer primary prevention or chemoprevention. The aims of this article are to (a) examine whether and, if so, how traditional health behavior change models are relevant for decision making in this area; (b) review the application of decision aids to forming specific, personal choices between options; and (c) identify the challenges of evaluating these decision processes to suggest areas for future research. Theoretical models and frameworks derived from the health behavior change and decision-making fields were applied to cancer primary prevention choices. Decision aids for the human papillomavirus (HPV) vaccine, Hormone Replacement Therapy (HRT), and tamoxifen were systematically examined. Traditional concepts such as decisional balance and cues to action are relevant to understanding cancer primary prevention choices; Motivational Interviewing, Self-Determination Theory, and the Preventive Health Model may also explain the facilitators of decision making. There are no well-tested HPV vaccine decision aids, although there have been some studies on aids for HPV testing. There are several effective decision aids for HRT and tamoxifen; evidence-based decision aid components have also been identified. Additional theory-based empirical research on decision making in cancer primary prevention and chemoprevention, particularly at the interface of psychology and behavioral economics, is suggested.

Bridging the gap between science and decision making.

PubMed

von Winterfeldt, Detlof

2013-08-20

All decisions, whether they are personal, public, or business-related, are based on the decision maker's beliefs and values. Science can and should help decision makers by shaping their beliefs. Unfortunately, science is not easily accessible to decision makers, and scientists often do not understand decision makers' information needs. This article presents a framework for bridging the gap between science and decision making and illustrates it with two examples. The first example is a personal health decision. It shows how a formal representation of the beliefs and values can reflect scientific inputs by a physician to combine with the values held by the decision maker to inform a medical choice. The second example is a public policy decision about managing a potential environmental hazard. It illustrates how controversial beliefs can be reflected as uncertainties and informed by science to make better decisions. Both examples use decision analysis to bridge science and decisions. The conclusions suggest that this can be a helpful process that requires skills in both science and decision making.

Bridging the gap between science and decision making

PubMed Central

von Winterfeldt, Detlof

2013-01-01

All decisions, whether they are personal, public, or business-related, are based on the decision maker’s beliefs and values. Science can and should help decision makers by shaping their beliefs. Unfortunately, science is not easily accessible to decision makers, and scientists often do not understand decision makers’ information needs. This article presents a framework for bridging the gap between science and decision making and illustrates it with two examples. The first example is a personal health decision. It shows how a formal representation of the beliefs and values can reflect scientific inputs by a physician to combine with the values held by the decision maker to inform a medical choice. The second example is a public policy decision about managing a potential environmental hazard. It illustrates how controversial beliefs can be reflected as uncertainties and informed by science to make better decisions. Both examples use decision analysis to bridge science and decisions. The conclusions suggest that this can be a helpful process that requires skills in both science and decision making. PMID:23940310

A novel computer based expert decision making model for prostate cancer disease management.

PubMed

Richman, Martin B; Forman, Ernest H; Bayazit, Yildirim; Einstein, Douglas B; Resnick, Martin I; Stovsky, Mark D

2005-12-01

We propose a strategic, computer based, prostate cancer decision making model based on the analytic hierarchy process. We developed a model that improves physician-patient joint decision making and enhances the treatment selection process by making this critical decision rational and evidence based. Two groups (patient and physician-expert) completed a clinical study comparing an initial disease management choice with the highest ranked option generated by the computer model. Participants made pairwise comparisons to derive priorities for the objectives and subobjectives related to the disease management decision. The weighted comparisons were then applied to treatment options to yield prioritized rank lists that reflect the likelihood that a given alternative will achieve the participant treatment goal. Aggregate data were evaluated by inconsistency ratio analysis and sensitivity analysis, which assessed the influence of individual objectives and subobjectives on the final rank list of treatment options. Inconsistency ratios less than 0.05 were reliably generated, indicating that judgments made within the model were mathematically rational. The aggregate prioritized list of treatment options was tabulated for the patient and physician groups with similar outcomes for the 2 groups. Analysis of the major defining objectives in the treatment selection decision demonstrated the same rank order for the patient and physician groups with cure, survival and quality of life being more important than controlling cancer, preventing major complications of treatment, preventing blood transfusion complications and limiting treatment cost. Analysis of subobjectives, including quality of life and sexual dysfunction, produced similar priority rankings for the patient and physician groups. Concordance between initial treatment choice and the highest weighted model option differed between the groups with the patient group having 59% concordance and the physician group having only 42% concordance. This study successfully validated the usefulness of a computer based prostate cancer management decision making model to produce individualized, rational, clinically appropriate disease management decisions without physician bias.

Making objective decisions in mechanical engineering problems

NASA Astrophysics Data System (ADS)

Raicu, A.; Oanta, E.; Sabau, A.

2017-08-01

Decision making process has a great influence in the development of a given project, the goal being to select an optimal choice in a given context. Because of its great importance, the decision making was studied using various science methods, finally being conceived the game theory that is considered the background for the science of logical decision making in various fields. The paper presents some basic ideas regarding the game theory in order to offer the necessary information to understand the multiple-criteria decision making (MCDM) problems in engineering. The solution is to transform the multiple-criteria problem in a one-criterion decision problem, using the notion of utility, together with the weighting sum model or the weighting product model. The weighted importance of the criteria is computed using the so-called Step method applied to a relation of preferences between the criteria. Two relevant examples from engineering are also presented. The future directions of research consist of the use of other types of criteria, the development of computer based instruments for decision making general problems and to conceive a software module based on expert system principles to be included in the Wiki software applications for polymeric materials that are already operational.

Age differences in dual information-processing modes: implications for cancer decision making.

PubMed

Peters, Ellen; Diefenbach, Michael A; Hess, Thomas M; Västfjäll, Daniel

2008-12-15

Age differences in affective/experiential and deliberative processes have important theoretical implications for cancer decision making, as cancer is often a disease of older adulthood. The authors examined evidence for adult age differences in affective and deliberative information processes, reviewed the sparse evidence about age differences in decision making, and introduced how dual process theories and their findings might be applied to cancer decision making. Age-related declines in the efficiency of deliberative processes predict poorer-quality decisions as we age, particularly when decisions are unfamiliar and the information is numeric. However, age-related adaptive processes, including an increased focus on emotional goals and greater experience, can influence decision making and potentially offset age-related declines. A better understanding of the mechanisms that underlie cancer decision processes in our aging population should ultimately allow us to help older adults to better help themselves.

Age Differences in Dual Information-Processing Modes: Implications for Cancer Decision Making

PubMed Central

Peters, Ellen; Diefenbach, Michael A.; Hess, Thomas M.; Västfjäll, Daniel

2008-01-01

Age differences in affective/experiential and deliberative processes have important theoretical implications for cancer decision making as cancer is often a disease of older adulthood. We examine evidence for adult age differences in affective and deliberative information processes, review the sparse evidence about age differences in decision making and introduce how dual process theories and their findings might be applied to cancer decision making. Age-related declines in the efficiency of deliberative processes predict poorer-quality decisions as we age, particularly when decisions are unfamiliar and the information is numeric. However, age-related adaptive processes, including an increased focus on emotional goals and greater experience, can influence decision making and potentially offset age-related declines. A better understanding of the mechanisms that underlie cancer decision processes in our aging population should ultimately allow us to help older adults to better help themselves. PMID:19058148

Influence of prior information on pain involves biased perceptual decision-making.

PubMed

Wiech, Katja; Vandekerckhove, Joachim; Zaman, Jonas; Tuerlinckx, Francis; Vlaeyen, Johan W S; Tracey, Irene

2014-08-04

Prior information about features of a stimulus is a strong modulator of perception. For instance, the prospect of more intense pain leads to an increased perception of pain, whereas the expectation of analgesia reduces pain, as shown in placebo analgesia and expectancy modulations during drug administration. This influence is commonly assumed to be rooted in altered sensory processing and expectancy-related modulations in the spinal cord, are often taken as evidence for this notion. Contemporary models of perception, however, suggest that prior information can also modulate perception by biasing perceptual decision-making - the inferential process underlying perception in which prior information is used to interpret sensory information. In this type of bias, the information is already present in the system before the stimulus is observed. Computational models can distinguish between changes in sensory processing and altered decision-making as they result in different response times for incorrect choices in a perceptual decision-making task (Figure S1A,B). Using a drift-diffusion model, we investigated the influence of both processes in two independent experiments. The results of both experiments strongly suggest that these changes in pain perception are predominantly based on altered perceptual decision-making. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Assessing the preconditions for communication influence on decision making: the North American Quitline Consortium.

PubMed

Bonito, Joseph A; Ruppel, Erin K; Saul, Jessie E; Leischow, Scott J

2013-01-01

The network of North American quitlines is a loose confederation of telephone-based smoking cessation professionals, including smoking cessation counseling providers, funders, researcher and policy advocates. Each quitline has some leeway in the types of services it provides, and the purpose of this article is to identify factors that explain such choices. Representatives from quitline organizations responded to a survey regarding the importance of several items that were hypothesized to influence general intentions to adopt and implement new cessation methods. Results indicate that internal (to the quitline) constraints are positively associated with consensus processes and that implementation of practices in general was more likely if consensus processes were used. Unilateral decision making (one person within an organization makes decisions for the quitline on his/her own) was unrelated to either internal or external constraints and was negatively associated with adoption of quitline practices. Discussion focuses on factors that influence consensus decision-making processes beyond those investigated in the article.

A qualitative systematic review of internal and external influences on shared decision-making in all health care settings.

PubMed

Truglio-Londrigan, Marie; Slyer, Jason T; Singleton, Joanne K; Worral, Priscilla

The objective of this review is to identify and synthesize the best available evidence related to the meaningfulness of internal and external influences on shared-decision making for adult patients and health care providers in all health care settings.The specific questions to be answered are: BACKGROUND: Patient-centered care is emphasized in today's healthcare arena. This emphasis is seen in the works of the International Alliance of Patients' Organizations (IAOP) who describe patient-centered healthcare as care that is aimed at addressing the needs and preferences of patients. The IAOP presents five principles which are foundational to the achievement of patient-centered healthcare: respect, choice, policy, access and support, as well as information. These five principles are further described as:Within the description of these five principles the idea of shared decision-making is clearly evident.The concept of shared decision-making began to appear in the literature in the 1990s. It is defined as a "process jointly shared by patients and their health care provider. It aims at helping patients play an active role in decisions concerning their health, which is the ultimate goal of patient-centered care." The details of the shared decision-making process are complex and consist of a series of steps including:Three overall representative decision-making models are noted in contemporary literature. These three models include: paternalistic, informed decision-making, and shared decision-making. The paternalistic model is an autocratic style of decision-making where the healthcare provider carries out the care from the perspective of knowing what is best for the patient and therefore makes all decisions. The informed decision-making model takes place as the information needed to make decisions is conveyed to the patient and the patient makes the decisions without the healthcare provider involvement. Finally, the shared decision-making model is representative of a sharing and a negotiation towards treatment decisions. Thus, these models represent a range with patient non-participation at one end of the continuum to informed decision making or a high level of patient power at the other end. Several shared decision-making models focus on the process of shared decision-making previously noted. A discussion of several process models follows below.Charles et al. depicts a process model of shared decision-making that identifies key characteristics that must be in evidence. The patient shares in the responsibility with the healthcare provider in this model. The key characteristics included:This model illustrates that there must be at least two individuals participating, however, family and friends may be involved in a variety of roles such as the collector of information, the interpreter of this information, coach, advisor, negotiator, and caretaker. This model also depicts the need to take steps to participate in the shared decision-making process. To take steps means that there is an agreement between and among all involved that shared decision-making is necessary and preferred. Research about patient preferences, however, offers divergent views. The link between patient preferences for shared decision-making and the actuality of shared decision-making in practice is not strong. Research concerning patients and patient preferences on shared decision-making points to variations depending on age, education, socio-economic status, culture, and diagnosis. Healthcare providers may also hold preferences for shared decision-making; however, research in this area is not as comprehensive as is patient focused research. Elwyn et al. explored the views of general practice providers on involving patients in decisions. Both positive and negative views were identified ranging from receptive, noting potential benefits, to concern for the unrealistic nature of participation and sharing in the decision-making process. An example of this potential difficulty, from a healthcare provider perspective, is identifying the potential conflict that may develop when a patient's preference is different from clinical practice guidelines. This is further exemplified in healthcare encounters when a situation may not yield itself to a clear answer but rather lies in a grey area. These situations are challenging for healthcare providers.The notion of information sharing as a prerequisite to shared decision-making offers insight into another process. The healthcare provider must provide the patient the information that they need to know and understand in order to even consider and participate in the shared decision-making process. This information may include the disease, potential treatments, consequences of those treatments, and any alternatives, which may include the decision to do nothing. Without knowing this information the patient will not be able to participate in the shared decision-making process. The complexity of this step is realized if one considers what the healthcare provider needs to know in order to first assess what the patient knows and does not know, the readiness of the patient to participate in this educational process and learn the information, as well as, the individual learning styles of the patient taking into consideration the patient's ideas, values, beliefs, education, culture, literacy, and age. Depending on the results of this assessment the health care provider then must communicate the information to the patient. This is also a complex process that must take into consideration the relationship, comfort level, and trust between the healthcare provider and the patient.Finally, the treatment decision is reached between both the healthcare provider and the patient. Charles et al. portrays shared decision-making as a process with the end product, the shared decision, as the outcome. This outcome may be a decision as to the agreement of a treatment decision, no agreement reached as to a treatment decision, and disagreement as to a treatment decision. Negotiation is a part of the process as the "test of a shared decision (as distinct from the decision-making process) is if both parties agree on the treatment option."Towle and Godolphin developed a process model that further exemplifies the role of the healthcare provider and the patient in the shared decision-making process as mutual partners with mutual responsibilities. The capacity to engage in this shared decision-making rests, therefore, on competencies including knowledge, skills, and abilities for both the healthcare provider and the patient. This mutual partnership and the corresponding competencies are presented for both the healthcare provider and the patient in this model. The competencies noted for the healthcare provider for shared decision making include:Patient competencies include:This model illustrates the shared decision-making process with emphasis on the role of the healthcare provider and the patient very similar to the prior model. This model, however, gives greater emphasis to the process of the co-participation of the healthcare provider and the patient. The co-participation depicts a mutual partnership with mutual responsibilities that can be seen as "reciprocal relationships of dialogue." For this to take place the relationship between and among the participants of the shared decision-making process is important along with other internal and external influences such as communication, trust, mutual respect, honesty, time, continuity, and commitment. Cultural, social, and age group differences; evidence; and team and family are considered within this model.Elwyn et al. presents yet another model that depicts the shared decision-making process; however, this model offers a view where the healthcare provider holds greater responsibility in this process. In this particular model the process focuses on the healthcare provider and the essential skills needed to engage the patient in shard decisions. The competencies outlined in this model include:The healthcare provider must demonstrate knowledge, competencies, and skills as a communicator. The skills for communication competency require the healthcare provider to be able to elicit the patient's thoughts and input regarding treatment management throughout the consultation. The healthcare provider must also demonstrate competencies in assessment skills beyond physical assessment that includes the ability to assess the patient's perceptions and readiness to participate. In addition, the healthcare provider must be able to assess the patient's readiness to learn the information that the patient needs to know in order to fully engage in the shared decision-making process, assess what the patient already knows, what the patient does not know, and whether or not the information that the patient knows is accurate. Once this assessment is completed the healthcare provider then must draw on his/her knowledge, competencies, and skills necessary to teach the patient what the patient needs to know to be informed. This facilitates the notion of the tailor-made information noted previously. The healthcare provider also requires competencies in how to check and evaluate the entire process to ensure that the patient does understand and accept with comfort not only the plan being negotiated but the entire process of sharing in decision-making. In addition to the above, there are further competencies such as competence in working with groups and teams, competencies in terms of cultural knowledge, competencies with regard to negotiation skills, as well as, competencies when faced with ethical challenges.Shared decision-making has been associated with autonomy, empowerment, and effectiveness and efficiency. Both patients and health care providers have noted improvement in relationships and improved interactions when shared decision-making is in evidence. Along with this improved relationship and interaction enhanced compliance is noted. Additional research points to patient satisfaction and enhanced quality of life. There is some evidence to suggest that shared decision-making does facilitate positive health outcomes.In today's healthcare environment there is greater emphasis on patient-centered care that exemplifies patient engagement, participation, partnership, and shared decision-making. Given the shift from the more autocratic delivery of care to the shared approach there is a need to more fully understand the what of shared decision-making as well as how shared decision-making takes place along with what internal and external influences may encourage, support, and facilitate the shared decision-making process. These influences are intervening variables that may be of significance for the successful development of practice-based strategies that may foster shared decision-making in practice. The purpose of this qualitative systematic review is to identify internal and external influences on shared decision-making in all health care settings.A preliminary search of the Joanna Briggs Library of Systematic Reviews, MEDLINE, CINAHL, and PROSPERO did not identify any previously conducted qualitative systematic reviews on the meaningfulness of internal and external influences on shared decision-making.

Changes of mind in an attractor network of decision-making.

PubMed

Albantakis, Larissa; Deco, Gustavo

2011-06-01

Attractor networks successfully account for psychophysical and neurophysiological data in various decision-making tasks. Especially their ability to model persistent activity, a property of many neurons involved in decision-making, distinguishes them from other approaches. Stable decision attractors are, however, counterintuitive to changes of mind. Here we demonstrate that a biophysically-realistic attractor network with spiking neurons, in its itinerant transients towards the choice attractors, can replicate changes of mind observed recently during a two-alternative random-dot motion (RDM) task. Based on the assumption that the brain continues to evaluate available evidence after the initiation of a decision, the network predicts neural activity during changes of mind and accurately simulates reaction times, performance and percentage of changes dependent on difficulty. Moreover, the model suggests a low decision threshold and high incoming activity that drives the brain region involved in the decision-making process into a dynamical regime close to a bifurcation, which up to now lacked evidence for physiological relevance. Thereby, we further affirmed the general conformance of attractor networks with higher level neural processes and offer experimental predictions to distinguish nonlinear attractor from linear diffusion models.

The Role of Human Factors/Ergonomics in the Science of Security: Decision Making and Action Selection in Cyberspace.

PubMed

Proctor, Robert W; Chen, Jing

2015-08-01

The overarching goal is to convey the concept of science of security and the contributions that a scientifically based, human factors approach can make to this interdisciplinary field. Rather than a piecemeal approach to solving cybersecurity problems as they arise, the U.S. government is mounting a systematic effort to develop an approach grounded in science. Because humans play a central role in security measures, research on security-related decisions and actions grounded in principles of human information-processing and decision-making is crucial to this interdisciplinary effort. We describe the science of security and the role that human factors can play in it, and use two examples of research in cybersecurity--detection of phishing attacks and selection of mobile applications--to illustrate the contribution of a scientific, human factors approach. In these research areas, we show that systematic information-processing analyses of the decisions that users make and the actions they take provide a basis for integrating the human component of security science. Human factors specialists should utilize their foundation in the science of applied information processing and decision making to contribute to the science of cybersecurity. © 2015, Human Factors and Ergonomics Society.

Medical students, clinical preventive services, and shared decision-making.

PubMed

Keefe, Carole W; Thompson, Margaret E; Noel, Mary Margaret

2002-11-01

Improving access to preventive care requires addressing patient, provider, and systems barriers. Patients often lack knowledge or are skeptical about the importance of prevention. Physicians feel that they have too little time, are not trained to deliver preventive services, and are concerned about the effectiveness of prevention. We have implemented an educational module in the required family practice clerkship (1) to enhance medical student learning about common clinical preventive services and (2) to teach students how to inform and involve patients in shared decision making about those services. Students are asked to examine available evidence-based information for preventive screening services. They are encouraged to look at the recommendations of various organizations and use such resources as reports from the U.S. Preventive Services Task Force to determine recommendations they want to be knowledgeable about in talking with their patients. For learning shared decision making, students are trained to use a model adapted from Braddock and colleagues(1) to discuss specific screening services and to engage patients in the process of making informed decisions about what is best for their own health. The shared decision making is presented and modeled by faculty, discussed in small groups, and students practice using Web-based cases and simulations. The students are evaluated using formative and summative performance-based assessments as they interact with simulated patients about (1) screening for high blood cholesterol and other lipid abnormalities, (2) screening for colorectal cancer, (3) screening for prostate cancer, and (4) screening for breast cancer. The final student evaluation is a ten-minute, videotaped discussion with a simulated patient about screening for colorectal cancer that is graded against a checklist that focuses primarily on the elements of shared decision making. Our medical students appear quite willing to accept shared decision making as a skill that they should have in working with patients, and this was the primary focus of the newly implemented module. However, we have learned that students need to deepen their understanding of screening services in order to help patients understand the associated benefits and risks. The final videotaped interaction with a simulated patient about colorectal cancer screening has been very helpful in making it more obvious to faculty what students believe and know about screening for colorectal cancer. As the students are asked to discuss clinical issues with patients and discuss the pros and cons of screening tests as part of the shared decision-making process, their thinking becomes transparent and it is evident where curricular changes and enhancements are required. We have found that an explicit model that allows students to demonstrate a process for shared decision making is a good introductory tool. We think it would be helpful to provide students with more formative feedback. We would like to develop faculty development programs around shared decision making so that more of our clinical faculty would model such a process with patients. Performance-based assessments are resource-intensive, but they appear to be worth the added effort in terms of enhanced skills development and a more comprehensive appraisal of student learning.

How organizational context affects bioethical decision-making: pharmacists' management of gatekeeping processes in retail and hospital settings.

PubMed

Chiarello, Elizabeth

2013-12-01

Social science studies of bioethics demonstrate that ethics are highly contextual, functioning differently across local settings as actors make daily decisions "on the ground." Sociological studies that demonstrate the key role organizations play in shaping ethical decision-making have disproportionately focused on physicians and nurses working in hospital settings where they contend with life and death issues. This study broadens our understanding of the contexts of ethical decision-making by empirically examining understudied healthcare professionals - pharmacists - working in two organizational settings, retail and hospital, where they act as gatekeepers to regulated goods and services as they contend with ethical issues ranging from the serious to the mundane. This study asks: How do organizations shape pharmacists' identification, negotiation, and resolution of ethical challenges; in other words, how do organizations shape pharmacists' gatekeeping processes? Based on 95 semi-structured interviews with U.S. pharmacists practicing in retail and hospital pharmacies conducted between September 2009 and May 2011, this research finds that organizations influence ethical decision-making by shaping how pharmacists construct four gatekeeping processes: medical, legal, fiscal, and moral. Each gatekeeping process manifests differently across organizations due to how these settings structure inter-professional power dynamics, proximity to patients, and means of accessing information. Findings suggest new directions for theorizing about ethical decision-making in medical contexts by drawing attention to new ethical actors, new organizational settings, an expanded definition of ethical challenges, and a broader conceptualization of gatekeeping. Copyright © 2012 Elsevier Ltd. All rights reserved.

Cancer Counseling of Low-Income Limited English Proficient Latina Women Using Medical Interpreters: Implications for Shared Decision-Making.

PubMed

Kamara, Daniella; Weil, Jon; Youngblom, Janey; Guerra, Claudia; Joseph, Galen

2018-02-01

In cancer genetic counseling (CGC), communication across language and culture challenges the model of practice based on shared decision-making. To date, little research has examined the decision-making process of low-income, limited English proficiency (LEP) patients in CGC. This study identified communication patterns in CGC sessions with this population and assessed how these patterns facilitate or inhibit the decision-making process during the sessions. We analyzed 24 audio recordings of CGC sessions conducted in Spanish via telephone interpreters at two public hospitals. Patients were referred for risk of hereditary breast and ovarian cancer; all were offered genetic testing. Audio files were coded by two bilingual English-Spanish researchers and analyzed using conventional content analysis through an iterative process. The 24 sessions included 13 patients, 6 counselors, and 18 interpreters. Qualitative data analyses identified three key domains - Challenges Posed by Hypothetical Explanations, Misinterpretation by the Medical Interpreter, and Communication Facilitators - that reflect communication patterns and their impact on the counselor's ability to facilitate shared decision-making. Overall, we found an absence of patient participation in the decision-making process. Our data suggest that when counseling LEP Latina patients via medical interpreter, prioritizing information with direct utility for the patient and organizing information into short- and long-term goals may reduce information overload and improve comprehension for patient and interpreter. Further research is needed to test the proposed counseling strategies with this population and to assess how applicable our findings are to other populations.

Neural correlates of conventional and harm/welfare-based moral decision-making.

PubMed

White, Stuart F; Zhao, Hui; Leong, Kelly Kimiko; Smetana, Judith G; Nucci, Larry P; Blair, R James R

2017-12-01

The degree to which social norms are processed by a unitary system or dissociable systems remains debated. Much research on children's social-cognitive judgments has supported the distinction between "moral" (harm/welfare-based) and "conventional" norms. However, the extent to which these norms are processed by dissociable neural systems remains unclear. To address this issue, 23 healthy participants were scanned with functional magnetic resonance imaging (fMRI) while they rated the wrongness of harm/welfare-based and conventional transgressions and neutral vignettes. Activation significantly greater than the neutral vignette baseline was observed in regions implicated in decision-making regions including rostral/ventral medial frontal, anterior insula and dorsomedial frontal cortices when evaluating both harm/welfare-based and social-conventional transgressions. Greater activation when rating harm/welfare-based relative to social-conventional transgressions was seen through much of ACC and bilateral inferior frontal gyrus. Greater activation was observed in superior temporal gyrus, bilateral middle temporal gyrus, left PCC, and temporal-parietal junction when rating social-conventional transgressions relative to harm/welfare-based transgressions. These data suggest that decisions regarding the wrongness of actions, irrespective of whether they involve care/harm-based or conventional transgressions, recruit regions generally implicated in affect-based decision-making. However, there is neural differentiation between harm/welfare-based and conventional transgressions. This may reflect the particular importance of processing the intent of transgressors of conventional norms and perhaps the greater emotional content or salience of harm/welfare-based transgressions.

Contribution of different regions of the prefrontal cortex and lesion laterality to deficit of decision-making on the Iowa Gambling Task.

PubMed

Ouerchefani, Riadh; Ouerchefani, Naoufel; Allain, Philippe; Ben Rejeb, Mohamed Riadh; Le Gall, Didier

2017-02-01

Few studies have examined the contribution of different sub-regions of the prefrontal cortex and lesion laterality to decision-making abilities. In addition, there are inconsistent findings about the role of ventromedial and dorsolateral lesions in decision-making deficit. In this study, decision-making processes are investigated following different damaged areas of the prefrontal cortex. We paid particular attention to the contribution of laterality, lesion location and lesion volume in decision-making deficit. Twenty-seven patients with discrete ventromedial lesions, dorsolateral lesions or extended-frontal lesions were compared with normal subjects on the Iowa Gambling Task (IGT). Our results showed that all frontal subgroups were impaired on the IGT in comparison with normal subjects. We noted also that IGT performance did not vary systematically based on lesion laterality or location. More precisely, our lesion analysis revealed that decision-making processes depend on a large cerebral network, including both ventromedial and dorsolateral areas of the prefrontal cortex. Consistent with past findings, our results support the claim that IGT deficit is not solitarily associated with ventromedial prefrontal cortex lesions. Copyright © 2016 Elsevier Inc. All rights reserved.

Locus of decision making in multinational corporations and its relationship to subsidiary performance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Goehle, D.G.

1978-01-01

A conceptual model was developed which drew from the existing research in organization theory, comparative management, and international business which assisted in the delineation of the relevant variables and suggested the nature of their relationship to the locus of decision making. The conceptual model incorporated certain corporate and subsidiary factors considered an influence on the determination of the locus of decision making. Corporate factors included product line or industry, size and complexity of international operations, organization structure, availability of managerial talent, and corporate philosophy. Subsidiary characteristics included subsidiary age and size, availability of local managerial talent, geographic distance from headquartersmore » and other affiliated units, and subsidiary environmental characteristics. The locus of desicion making was measured by the level of participation the headquarters and subsidiary management had in decision making for twenty-nine decisions, representing six functional areas. Levels of participation for headquarters and subsidiary managers were measured for each decision based on responses to a five-point scale of decision process categories which indicated varying levels of headquarters and subsidiary participation. The sample included ten US multinational corporations representing five industries: pharmaceuticals, tire and rubber, automobiles, capital equipment, and food processing.« less

Rethinking autonomy: decision making between patient and surgeon in advanced illnesses

PubMed Central

Hinshaw, Daniel B.

2016-01-01

Patients with advanced illness such as advanced stage cancer presenting with the need for possible surgical intervention can be some of the most challenging cases for a surgeon. Often there are multiple factors influencing the decisions made. For patients they are facing not just the effects of the disease on their body, but the stark realization that the disease will also limit their life. Not only are these factors a consideration when patients are making decisions, but also the desire to make the decision that is best for themselves, the autonomous decision. Also included in this process for the patient facing the possible need for an intervention is the surgeon. While patient autonomy remains one of the main principles within medicine, guiding treatment decisions, there is also the surgeon’s autonomy to be considered. Surgeons determine if there is even a possible intervention to be offered to patients, a decision making process that respects surgeons’ autonomous choices and includes elements of paternalism as surgeons utilize their expertise to make decisions. Included in the treatment decisions that are made and the care of the patient is the impact patients’ outcomes have on the surgeon, the inherent drive to be the best for the patient and desire for good outcomes for the patient. While both the patient’s and surgeon’s autonomy are a dynamic interface influencing decision making, the main goal for the patient facing a palliative procedure is that of making treatment decisions based on the concept of shared decision making, always giving primary consideration to the patient’s goals and values. Lastly, regardless of the decision made, it is the responsibility of surgeons to their patients to be a source of support through this challenging time. PMID:27004224

A timely account of the role of duration in decision making.

PubMed

Ariely, D; Zakay, D

2001-09-01

The current work takes a general perspective on the role of time in decision making. There are many different relationships and interactions between time and decision making, and no single summary can do justice to this topic. In this paper we will describe a few of the aspects in which time and decision making are interleaved: (a) temporal perspectives of decisions--the various temporal orientations that decision-makers may adopt while making decisions, and the impact of such temporal orientations on the decision process and its outcomes; (b) time as a medium within which decisions take place--the nature of decision processes that occur along time; (c) time as a resource and as a contextual factor--the implications of shortage in time resources and the impact of time limits on decision making processes and performance; (d) time as a commodity--time as the subject matter of decision making. The paper ends with a few general questions on the role of duration in decision making.

History matching through dynamic decision-making

PubMed Central

Maschio, Célio; Santos, Antonio Alberto; Schiozer, Denis; Rocha, Anderson

2017-01-01

History matching is the process of modifying the uncertain attributes of a reservoir model to reproduce the real reservoir performance. It is a classical reservoir engineering problem and plays an important role in reservoir management since the resulting models are used to support decisions in other tasks such as economic analysis and production strategy. This work introduces a dynamic decision-making optimization framework for history matching problems in which new models are generated based on, and guided by, the dynamic analysis of the data of available solutions. The optimization framework follows a ‘learning-from-data’ approach, and includes two optimizer components that use machine learning techniques, such as unsupervised learning and statistical analysis, to uncover patterns of input attributes that lead to good output responses. These patterns are used to support the decision-making process while generating new, and better, history matched solutions. The proposed framework is applied to a benchmark model (UNISIM-I-H) based on the Namorado field in Brazil. Results show the potential the dynamic decision-making optimization framework has for improving the quality of history matching solutions using a substantial smaller number of simulations when compared with a previous work on the same benchmark. PMID:28582413

Clinical, information and business process modeling to promote development of safe and flexible software.

PubMed

Liaw, Siaw-Teng; Deveny, Elizabeth; Morrison, Iain; Lewis, Bryn

2006-09-01

Using a factorial vignette survey and modeling methodology, we developed clinical and information models - incorporating evidence base, key concepts, relevant terms, decision-making and workflow needed to practice safely and effectively - to guide the development of an integrated rule-based knowledge module to support prescribing decisions in asthma. We identified workflows, decision-making factors, factor use, and clinician information requirements. The Unified Modeling Language (UML) and public domain software and knowledge engineering tools (e.g. Protégé) were used, with the Australian GP Data Model as the starting point for expressing information needs. A Web Services service-oriented architecture approach was adopted within which to express functional needs, and clinical processes and workflows were expressed in the Business Process Execution Language (BPEL). This formal analysis and modeling methodology to define and capture the process and logic of prescribing best practice in a reference implementation is fundamental to tackling deficiencies in prescribing decision support software.

Decision-making in Swiss home-like childbirth: A grounded theory study.

PubMed

Meyer, Yvonne; Frank, Franziska; Schläppy Muntwyler, Franziska; Fleming, Valerie; Pehlke-Milde, Jessica

2017-12-01

Decision-making in midwifery, including a claim for shared decision-making between midwives and women, is of major significance for the health of mother and child. Midwives have little information about how to share decision-making responsibilities with women, especially when complications arise during birth. To increase understanding of decision-making in complex home-like birth settings by exploring midwives' and women's perspectives and to develop a dynamic model integrating participatory processes for making shared decisions. The study, based on grounded theory methodology, analysed 20 interviews of midwives and 20 women who had experienced complications in home-like births. The central phenomenon that arose from the data was "defining/redefining decision as a joint commitment to healthy childbirth". The sub-indicators that make up this phenomenon were safety, responsibility, mutual and personal commitments. These sub-indicators were also identified to influence temporal conditions of decision-making and to apply different strategies for shared decision-making. Women adopted strategies such as delegating a decision, making the midwife's decision her own, challenging a decision or taking a decision driven by the dynamics of childbirth. Midwives employed strategies such as remaining indecisive, approving a woman's decision, making an informed decision or taking the necessary decision. To respond to recommendations for shared responsibility for care, midwives need to strengthen their shared decision-making skills. The visual model of decision-making in childbirth derived from the data provides a framework for transferring clinical reasoning into practice. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Neural correlates of decision making with explicit information about probabilities and incentives in elderly healthy subjects.

PubMed

Labudda, Kirsten; Woermann, Friedrich G; Mertens, Markus; Pohlmann-Eden, Bernd; Markowitsch, Hans J; Brand, Matthias

2008-06-01

Recent functional neuroimaging and lesion studies demonstrate the involvement of the orbitofrontal/ventromedial prefrontal cortex as a key structure in decision making processes. This region seems to be particularly crucial when contingencies between options and consequences are unknown but have to be learned by the use of feedback following previous decisions (decision making under ambiguity). However, little is known about the neural correlates of decision making under risk conditions in which information about probabilities and potential outcomes is given. In the present study, we used functional magnetic resonance imaging to measure blood-oxygenation-level-dependent (BOLD) responses in 12 subjects during a decision making task. This task provided explicit information about probabilities and associated potential incentives. The responses were compared to BOLD signals in a control condition without information about incentives. In contrast to previous decision making studies, we completely removed the outcome phase following a decision to exclude the potential influence of feedback previously received on current decisions. The results indicate that the integration of information about probabilities and incentives leads to activations within the dorsolateral prefrontal cortex, the posterior parietal lobe, the anterior cingulate and the right lingual gyrus. We assume that this pattern of activation is due to the involvement of executive functions, conflict detection mechanisms and arithmetic operations during the deliberation phase of decisional processes that are based on explicit information.

An Integrated Web-based Decision Support System in Disaster Risk Management

NASA Astrophysics Data System (ADS)

Aye, Z. C.; Jaboyedoff, M.; Derron, M. H.

2012-04-01

Nowadays, web based decision support systems (DSS) play an essential role in disaster risk management because of their supporting abilities which help the decision makers to improve their performances and make better decisions without needing to solve complex problems while reducing human resources and time. Since the decision making process is one of the main factors which highly influence the damages and losses of society, it is extremely important to make right decisions at right time by combining available risk information with advanced web technology of Geographic Information System (GIS) and Decision Support System (DSS). This paper presents an integrated web-based decision support system (DSS) of how to use risk information in risk management efficiently and effectively while highlighting the importance of a decision support system in the field of risk reduction. Beyond the conventional systems, it provides the users to define their own strategies starting from risk identification to the risk reduction, which leads to an integrated approach in risk management. In addition, it also considers the complexity of changing environment from different perspectives and sectors with diverse stakeholders' involvement in the development process. The aim of this platform is to contribute a part towards the natural hazards and geosciences society by developing an open-source web platform where the users can analyze risk profiles and make decisions by performing cost benefit analysis, Environmental Impact Assessment (EIA) and Strategic Environmental Assessment (SEA) with the support of others tools and resources provided. There are different access rights to the system depending on the user profiles and their responsibilities. The system is still under development and the current version provides maps viewing, basic GIS functionality, assessment of important infrastructures (e.g. bridge, hospital, etc.) affected by landslides and visualization of the impact-probability matrix in terms of socio-economic dimension.

The conscious mind and its emergent properties; an analysis based on decision theory.

PubMed

Morris, James A

2011-08-01

The process of conscious and unconscious decision making is analyzed using decision theory. An essential part of an optimum decision strategy is the assessment of values and costs associated with correct and incorrect decisions. In the case of unconscious decisions this involves an automatic process akin to computation using numerical values. But for conscious decisions the conscious mind must experience the outcome of the decision as pleasure or pain. It is suggested that the rules of behavior are programmed in our genes but modified by experience of the society in which we are reared. Our unconscious then uses the rules to reward or punish our conscious mind for the decisions it makes. This is relevant to concepts of altruism and religion in society. It is consistent with the observation that we prefer beauty to utility. The decision theory equations also explain the paradox that a single index of happiness can be applied in society. The symptoms of mental illness can be due to appropriate or inappropriate action by the unconscious. The former indicates a psychological conflict between conscious and unconscious decision making. Inappropriate action indicates that a pathological process has switched on genetic networks that should be switched off. Copyright © 2011 Elsevier Ltd. All rights reserved.

How do small groups make decisions? : A theoretical framework to inform the implementation and study of clinical competency committees.

PubMed

Chahine, Saad; Cristancho, Sayra; Padgett, Jessica; Lingard, Lorelei

2017-06-01

In the competency-based medical education (CBME) approach, clinical competency committees are responsible for making decisions about trainees' competence. However, we currently lack a theoretical model for group decision-making to inform this emerging assessment phenomenon. This paper proposes an organizing framework to study and guide the decision-making processes of clinical competency committees.This is an explanatory, non-exhaustive review, tailored to identify relevant theoretical and evidence-based papers related to small group decision-making. The search was conducted using Google Scholar, Web of Science, MEDLINE, ERIC, and PsycINFO for relevant literature. Using a thematic analysis, two researchers (SC & JP) met four times between April-June 2016 to consolidate the literature included in this review.Three theoretical orientations towards group decision-making emerged from the review: schema, constructivist, and social influence. Schema orientations focus on how groups use algorithms for decision-making. Constructivist orientations focus on how groups construct their shared understanding. Social influence orientations focus on how individual members influence the group's perspective on a decision. Moderators of decision-making relevant to all orientations include: guidelines, stressors, authority, and leadership.Clinical competency committees are the mechanisms by which groups of clinicians will be in charge of interpreting multiple assessment data points and coming to a shared decision about trainee competence. The way in which these committees make decisions can have huge implications for trainee progression and, ultimately, patient care. Therefore, there is a pressing need to build the science of how such group decision-making works in practice. This synthesis suggests a preliminary organizing framework that can be used in the implementation and study of clinical competency committees.

Canadian Innovations in Siting Hazardous Waste Management Facilities

PubMed

Kuhn; Ballard

1998-07-01

/ Siting hazardous waste facilities is an extremely complex and difficult endeavor. Public aversion to the construction of these facilities in or near their community often results in concerted opposition, referred to as the NIMBY syndrome. For the most part, siting processes do not fail because of inadequate environmental or technical considerations, but because of the adversarial decision-making strategies employed by the proponents. Innovative siting processes used in the provinces of Alberta and Manitoba offer tangible evidence of the successful application of an innovative siting approach based on the principles of decentralization of decision-making authority and full and meaningful public involvement. The purpose of this paper is to evaluate four Canadian siting processes from the perspective of public participation and access to decision-making authority. Examples of siting processes related to hazardous waste management facilities are provided from the provinces of Alberta, Manitoba, British Columbia, and Ontario. Siting has evolved from approaches dominated by top-down decision making to increasing decentralized and pluralistic approaches. Focusing on social and political concerns of potentially affected communities and on the process of decision making itself are fundamental to achieving siting success. In Alberta initially, and later in Manitoba, this new "open approach" to siting has resulted in the construction of the first two comprehensive hazardous waste treatment facilities in Canada.KEY WORDS: Hazardous waste facilities; Siting methodologies; Public participation

24 CFR 55.11 - Applicability of subpart C decision making process.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Management § 55.11 Applicability of subpart C decision making process. (a) Before reaching the decision... table indicates the applicability, by location and type of action, of the decision making process for... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Applicability of subpart C decision...

ACTIVITIES TO DEVELOP AN INTERIM GUIDANCE FOR MICROARRAY-BASED ASSAYS FOR REGULATORY AND RISK ASSESSMENT APPLICATIONS AT EPA

EPA Science Inventory

Abstract for presentation. Advances in genomics will have significant implications for risk assessment policies and regulatory decision making. In 2002, EPA issued its lnterim Policy on Genomics which stated that such data may be considered in the decision making process, but tha...

Consumer Education: A Guide for Teachers of Home Economics.

ERIC Educational Resources Information Center

Gray, Ava A.; Whorley, Beulah

The guide offers suggested curriculum materials in consumer education for secondary schools or as background information for teaching adults. It focuses on an understanding of decision making, the economic system, and management. The units of instruction are based on 13 concepts: (1) the process of decision making in relation to consumer behavior;…

Instructional Design for Advanced Learners: Training Recognition Skills to Hasten Expertise

ERIC Educational Resources Information Center

Fadde, Peter Jae

2009-01-01

Expertise in domains ranging from sports to surgery involves a process of recognition-primed decision-making (RPD) in which experts make rapid, intuitive decisions based on recognizing critical features of dynamic performance situations. While the development of expert RPD is assumed to require years of domain experience, the transition from…

Identifying Non-Sustainable Courses of Action: A Prerequisite for Decision-Making in Education for Sustainable Development

NASA Astrophysics Data System (ADS)

Gresch, Helge; Bögeholz, Susanne

2013-04-01

Students are faced with a multitude of decisions as consumers and in societal debates. Because of the scarcity of resources, the destruction of ecosystems and social injustice in a globalized world, it is vital that students are able to identify non-sustainable courses of action when involved in decision-making. The application of decision-making strategies is one approach to enhancing the quality of decisions. Options that do not meet ecological, social or economic standards should be excluded using non-compensatory strategies whereas other tasks may require a complete trade-off of all the evidence, following a compensatory approach. To enhance decision-making competence, a computer-based intervention study was conducted that focused on the use of decision-making strategies. While the results of the summative evaluation are reported by Gresch et al. (International Journal of Science Education, 2011), in-depth analyses of process-related data collected during the information processing are presented in this paper to reveal insights into the mechanisms of the intervention. The quality of high school students' ( n = 120) metadecision skills when selecting a decision-making strategy was investigated using qualitative content analyses combined with inferential statistics. The results reveal that the students offered elaborate reflections on the sustainability of options. However, the characteristics that were declared non-sustainable differed among the students because societal norms and personal values were intertwined. One implication for education for sustainable development is that students are capable of reflecting on decision-making tasks and on corresponding favorable decision-making strategies at a metadecision level. From these results, we offer suggestions for improving learning environments and constructing test instruments for decision-making competence.

Medical ethics: a rational approach to patient management.

PubMed

Livadas, Gerry

2002-01-01

Physicians make their decisions based upon scientific evidence with their first consideration being the Hippocratic axiom 'not to do harm'. In practice, a number of non-medical issues influence this process and generate conflicting judgments. We analyze these issues that form the context of medical ethics which is perceived as a subject wider than morality. It is also a religious, social, political, economic, legal and cultural issue. Therefore, the patient, physician and other professionals play important roles in the decision-making. The final decision is not a decision based on medical textbooks, but is rational in that it is based on reason for the benefit of the individual. Copyright 2002 S. Karger AG, Basel

Does the Medicare Part D Decision-Making Experience Differ by Rural/Urban Location?

PubMed

Henning-Smith, Carrie; Casey, Michelle; Moscovice, Ira

2017-01-01

Although much has been written about Medicare Part D enrollment, much less is known about beneficiaries' personal experiences with choosing a Part D plan, especially among rural residents. This study sought to address this gap by examining geographic differences in Part D enrollees' perceptions of the plan decision-making process, including their confidence in their choice, their knowledge about the program, and their satisfaction with available information. We used data from the 2012 Medicare Current Beneficiary Survey and included adults ages 65 and older who were enrolled in Part D at the time of the survey (n = 3,706). We used ordered logistic regression to model 4 outcomes based on beneficiaries' perceptions of the Part D decision-making and enrollment process, first accounting only for differences by rurality, then adjusting for sociodemographic, health, and coverage characteristics. Overall, half of all beneficiaries were not very confident in their Part D knowledge. Rural beneficiaries had lower odds of being confident in the plan they chose and in being satisfied with the amount of information available to them during the decision-making process. After adjusting for all covariates, micropolitan residents continued to have lower odds of being confident in the plan that they chose. Policy-makers should pay particular attention to making information about Part D easily accessible for all beneficiaries and to addressing unique barriers that rural residents have in accessing information while making decisions, such as reduced Internet availability. Furthermore, confidence in the decision-making process may be improved by simplifying the Part D program. © 2016 National Rural Health Association.

Human Factors of CC-130 Operations. Volume 5: Human Factors in Decision Making

DTIC Science & Technology

1998-02-01

known about human information processing and decision making. Topics for HFDM training come directly from this theoretical framework . The proposed...The proposed training can be distinguished from other approaches with similar goals (either explicit or implicit) by its base within a theoretical ... framework of human information processing. The differences lie less in the content than in the way the material is organized and shaped by theory. The

A Cognitive Modeling Approach to Strategy Formation in Dynamic Decision Making.

PubMed

Prezenski, Sabine; Brechmann, André; Wolff, Susann; Russwinkel, Nele

2017-01-01

Decision-making is a high-level cognitive process based on cognitive processes like perception, attention, and memory. Real-life situations require series of decisions to be made, with each decision depending on previous feedback from a potentially changing environment. To gain a better understanding of the underlying processes of dynamic decision-making, we applied the method of cognitive modeling on a complex rule-based category learning task. Here, participants first needed to identify the conjunction of two rules that defined a target category and later adapt to a reversal of feedback contingencies. We developed an ACT-R model for the core aspects of this dynamic decision-making task. An important aim of our model was that it provides a general account of how such tasks are solved and, with minor changes, is applicable to other stimulus materials. The model was implemented as a mixture of an exemplar-based and a rule-based approach which incorporates perceptual-motor and metacognitive aspects as well. The model solves the categorization task by first trying out one-feature strategies and then, as a result of repeated negative feedback, switching to two-feature strategies. Overall, this model solves the task in a similar way as participants do, including generally successful initial learning as well as reversal learning after the change of feedback contingencies. Moreover, the fact that not all participants were successful in the two learning phases is also reflected in the modeling data. However, we found a larger variance and a lower overall performance of the modeling data as compared to the human data which may relate to perceptual preferences or additional knowledge and rules applied by the participants. In a next step, these aspects could be implemented in the model for a better overall fit. In view of the large interindividual differences in decision performance between participants, additional information about the underlying cognitive processes from behavioral, psychobiological and neurophysiological data may help to optimize future applications of this model such that it can be transferred to other domains of comparable dynamic decision tasks.

A Cognitive Modeling Approach to Strategy Formation in Dynamic Decision Making

PubMed Central

Prezenski, Sabine; Brechmann, André; Wolff, Susann; Russwinkel, Nele

2017-01-01

Decision-making is a high-level cognitive process based on cognitive processes like perception, attention, and memory. Real-life situations require series of decisions to be made, with each decision depending on previous feedback from a potentially changing environment. To gain a better understanding of the underlying processes of dynamic decision-making, we applied the method of cognitive modeling on a complex rule-based category learning task. Here, participants first needed to identify the conjunction of two rules that defined a target category and later adapt to a reversal of feedback contingencies. We developed an ACT-R model for the core aspects of this dynamic decision-making task. An important aim of our model was that it provides a general account of how such tasks are solved and, with minor changes, is applicable to other stimulus materials. The model was implemented as a mixture of an exemplar-based and a rule-based approach which incorporates perceptual-motor and metacognitive aspects as well. The model solves the categorization task by first trying out one-feature strategies and then, as a result of repeated negative feedback, switching to two-feature strategies. Overall, this model solves the task in a similar way as participants do, including generally successful initial learning as well as reversal learning after the change of feedback contingencies. Moreover, the fact that not all participants were successful in the two learning phases is also reflected in the modeling data. However, we found a larger variance and a lower overall performance of the modeling data as compared to the human data which may relate to perceptual preferences or additional knowledge and rules applied by the participants. In a next step, these aspects could be implemented in the model for a better overall fit. In view of the large interindividual differences in decision performance between participants, additional information about the underlying cognitive processes from behavioral, psychobiological and neurophysiological data may help to optimize future applications of this model such that it can be transferred to other domains of comparable dynamic decision tasks. PMID:28824512

Chemotherapy treatment decision-making experiences of older adults with cancer, their family members, oncologists and family physicians: a mixed methods study.

PubMed

Puts, Martine T E; Sattar, Schroder; McWatters, Kara; Lee, Katherine; Kulik, Michael; MacDonald, Mary-Ellen; Jang, Raymond; Amir, Eitan; Krzyzanowska, Monika K; Leighl, Natasha; Fitch, Margaret; Joshua, Anthony M; Warde, Padraig; Tourangeau, Ann E; Alibhai, Shabbir M H

2017-03-01

Although comorbidities, frailty, and functional impairment are common in older adults (OA) with cancer, little is known about how these factors are considered during the treatment decision-making process by OAs, their families, and health care providers. Our aim was to better understand the treatment decision process from all these perspectives. A mixed methods multi-perspective longitudinal study using semi-structured interviews and surveys with 29 OAs aged ≥70 years with advanced prostate, breast, colorectal, or lung cancer, 24 of their family members,13 oncologists, and 15 family physicians was conducted. The sample was stratified on age (70-79 and 80+). All interviews were analyzed using thematic analysis. There was no difference in the treatment decision-making experience based on age. Most OAs felt that they should have the final say in the treatment decision, but strongly valued their oncologists' opinion. "Trust in my oncologist" and "chemotherapy as the last resort to prolong life" were the most important reasons to accept treatment. Families indicated a need to improve communication between them, the patient and the specialist, particularly around goals of treatment. Comorbidity and potential side-effects did not play a major role in the treatment decision-making for patients, families, or oncologists. Family physicians reported no involvement in decisions but desired to be more involved. This first study using multiple perspectives showed neither frailty nor comorbidity played a role in the treatment decision-making process. Efforts to improve communication were identified as an opportunity that may enhance quality of care. In a mixed methods study multiple perspective study with older adults with cancer, their family members, their oncologist and their family physician we explored the treatment decision making process and found that most older adults were satisfied with their decision. Comorbidity, functional status and frailty did not impact the older adult's or their family members' decision.

The environmental management problem of Pohorje, Slovenia: A new group approach within ANP - SWOT framework.

PubMed

Grošelj, Petra; Zadnik Stirn, Lidija

2015-09-15

Environmental management problems can be dealt with by combining participatory methods, which make it possible to include various stakeholders in a decision-making process, and multi-criteria methods, which offer a formal model for structuring and solving a problem. This paper proposes a three-phase decision making approach based on the analytic network process and SWOT (strengths, weaknesses, opportunities and threats) analysis. The approach enables inclusion of various stakeholders or groups of stakeholders in particular stages of decision making. The structure of the proposed approach is composed of a network consisting of an objective cluster, a cluster of strategic goals, a cluster of SWOT factors and a cluster of alternatives. The application of the suggested approach is applied to a management problem of Pohorje, a mountainous area in Slovenia. Stakeholders from sectors that are important for Pohorje (forestry, agriculture, tourism and nature protection agencies) who can offer a wide range of expert knowledge were included in the decision-making process. The results identify the alternative of "sustainable development" as the most appropriate for development of Pohorje. The application in the paper offers an example of employing the new approach to an environmental management problem. This can also be applied to decision-making problems in various other fields. Copyright © 2015 Elsevier Ltd. All rights reserved.

Developmental changes of neuronal networks associated with strategic social decision-making.

PubMed

Steinmann, Elisabeth; Schmalor, Antonia; Prehn-Kristensen, Alexander; Wolff, Stephan; Galka, Andreas; Möhring, Jan; Gerber, Wolf-Dieter; Petermann, Franz; Stephani, Ulrich; Siniatchkin, Michael

2014-04-01

One of the important prerequisites for successful social interaction is the willingness of each individual to cooperate socially. Using the ultimatum game, several studies have demonstrated that the process of decision-making to cooperate or to defeat in interaction with a partner is associated with activation of the dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC), anterior insula (AI), and inferior frontal cortex (IFC). This study investigates developmental changes in this neuronal network. 15 healthy children (8-12 years), 15 adolescents (13-18 years) and 15 young adults (19-28 years) were investigated using the ultimatum game. Neuronal networks representing decision-making based on strategic thinking were characterized using functional MRI. In all age groups, the process of decision-making in reaction to unfair offers was associated with hemodynamic changes in similar regions. Compared with children, however, healthy adults and adolescents revealed greater activation in the IFC and the fusiform gyrus, as well as the nucleus accumbens. In contrast, healthy children displayed more activation in the AI, the dorsal part of the ACC, and the DLPFC. There were no differences in brain activations between adults and adolescents. The neuronal mechanisms underlying strategic social decision making are already developed by the age of eight. Decision-making based on strategic thinking is associated with age-dependent involvement of different brain regions. Neuronal networks underlying theory of mind and reward anticipation are more activated in adults and adolescents with regard to the increasing perspective taking with age. In relation to emotional reactivity and respective compensatory coping in younger ages, children have higher activations in a neuronal network associated with emotional processing and executive control. Copyright © 2014 Elsevier Ltd. All rights reserved.

Difficult Decisions: A Qualitative Exploration of the Statistical Decision Making Process from the Perspectives of Psychology Students and Academics

PubMed Central

Allen, Peter J.; Dorozenko, Kate P.; Roberts, Lynne D.

2016-01-01

Quantitative research methods are essential to the development of professional competence in psychology. They are also an area of weakness for many students. In particular, students are known to struggle with the skill of selecting quantitative analytical strategies appropriate for common research questions, hypotheses and data types. To begin understanding this apparent deficit, we presented nine psychology undergraduates (who had all completed at least one quantitative methods course) with brief research vignettes, and asked them to explicate the process they would follow to identify an appropriate statistical technique for each. Thematic analysis revealed that all participants found this task challenging, and even those who had completed several research methods courses struggled to articulate how they would approach the vignettes on more than a very superficial and intuitive level. While some students recognized that there is a systematic decision making process that can be followed, none could describe it clearly or completely. We then presented the same vignettes to 10 psychology academics with particular expertise in conducting research and/or research methods instruction. Predictably, these “experts” were able to describe a far more systematic, comprehensive, flexible, and nuanced approach to statistical decision making, which begins early in the research process, and pays consideration to multiple contextual factors. They were sensitive to the challenges that students experience when making statistical decisions, which they attributed partially to how research methods and statistics are commonly taught. This sensitivity was reflected in their pedagogic practices. When asked to consider the format and features of an aid that could facilitate the statistical decision making process, both groups expressed a preference for an accessible, comprehensive and reputable resource that follows a basic decision tree logic. For the academics in particular, this aid should function as a teaching tool, which engages the user with each choice-point in the decision making process, rather than simply providing an “answer.” Based on these findings, we offer suggestions for tools and strategies that could be deployed in the research methods classroom to facilitate and strengthen students' statistical decision making abilities. PMID:26909064

Difficult Decisions: A Qualitative Exploration of the Statistical Decision Making Process from the Perspectives of Psychology Students and Academics.

PubMed

Allen, Peter J; Dorozenko, Kate P; Roberts, Lynne D

2016-01-01

Quantitative research methods are essential to the development of professional competence in psychology. They are also an area of weakness for many students. In particular, students are known to struggle with the skill of selecting quantitative analytical strategies appropriate for common research questions, hypotheses and data types. To begin understanding this apparent deficit, we presented nine psychology undergraduates (who had all completed at least one quantitative methods course) with brief research vignettes, and asked them to explicate the process they would follow to identify an appropriate statistical technique for each. Thematic analysis revealed that all participants found this task challenging, and even those who had completed several research methods courses struggled to articulate how they would approach the vignettes on more than a very superficial and intuitive level. While some students recognized that there is a systematic decision making process that can be followed, none could describe it clearly or completely. We then presented the same vignettes to 10 psychology academics with particular expertise in conducting research and/or research methods instruction. Predictably, these "experts" were able to describe a far more systematic, comprehensive, flexible, and nuanced approach to statistical decision making, which begins early in the research process, and pays consideration to multiple contextual factors. They were sensitive to the challenges that students experience when making statistical decisions, which they attributed partially to how research methods and statistics are commonly taught. This sensitivity was reflected in their pedagogic practices. When asked to consider the format and features of an aid that could facilitate the statistical decision making process, both groups expressed a preference for an accessible, comprehensive and reputable resource that follows a basic decision tree logic. For the academics in particular, this aid should function as a teaching tool, which engages the user with each choice-point in the decision making process, rather than simply providing an "answer." Based on these findings, we offer suggestions for tools and strategies that could be deployed in the research methods classroom to facilitate and strengthen students' statistical decision making abilities.

Hemorrhage Detection and Segmentation in Traumatic Pelvic Injuries

PubMed Central

Davuluri, Pavani; Wu, Jie; Tang, Yang; Cockrell, Charles H.; Ward, Kevin R.; Najarian, Kayvan; Hargraves, Rosalyn H.

2012-01-01

Automated hemorrhage detection and segmentation in traumatic pelvic injuries is vital for fast and accurate treatment decision making. Hemorrhage is the main cause of deaths in patients within first 24 hours after the injury. It is very time consuming for physicians to analyze all Computed Tomography (CT) images manually. As time is crucial in emergence medicine, analyzing medical images manually delays the decision-making process. Automated hemorrhage detection and segmentation can significantly help physicians to analyze these images and make fast and accurate decisions. Hemorrhage segmentation is a crucial step in the accurate diagnosis and treatment decision-making process. This paper presents a novel rule-based hemorrhage segmentation technique that utilizes pelvic anatomical information to segment hemorrhage accurately. An evaluation measure is used to quantify the accuracy of hemorrhage segmentation. The results show that the proposed method is able to segment hemorrhage very well, and the results are promising. PMID:22919433

Reaching a Consensus: Terminology and Concepts Used in Coordination and Decision-Making Research.

PubMed

Pyritz, Lennart W; King, Andrew J; Sueur, Cédric; Fichtel, Claudia

2011-12-01

Research on coordination and decision-making in humans and nonhuman primates has increased considerably throughout the last decade. However, terminology has been used inconsistently, hampering the broader integration of results from different studies. In this short article, we provide a glossary containing the central terms of coordination and decision-making research. The glossary is based on previous definitions that have been critically revised and annotated by the participants of the symposium "Where next? Coordination and decision-making in primate groups" at the XXIIIth Congress of the International Primatological Society (IPS) in Kyoto, Japan. We discuss a number of conceptual and methodological issues and highlight consequences for their implementation. In summary, we recommend that future studies on coordination and decision-making in animal groups do not use the terms "combined decision" and "democratic/despotic decision-making." This will avoid ambiguity as well as anthropocentric connotations. Further, we demonstrate the importance of 1) taxon-specific definitions of coordination parameters (initiation, leadership, followership, termination), 2) differentiation between coordination research on individual-level process and group-level outcome, 3) analyses of collective action processes including initiation and termination, and 4) operationalization of successful group movements in the field to collect meaningful and comparable data across different species.

mobilityRERC state of the science conference: Considerations for developing an evidence base for wheeled mobility and seating service delivery.

PubMed

Cohen, Laura; Greer, Nancy; Berliner, Elise; Sprigle, Stephen

2013-11-01

This article, developed as background content for discussion during the Mobility Rehabilitation Engineering Research Center State of the Science Conference, reviews research surrounding wheeled mobility and seating (WMS) service delivery, discusses the challenges of improving clinical decision-making, and discusses research approaches used to study and improve health services in other practice areas that might be leveraged to develop the evidence base for WMS. Narrative literature review. An overview of existing research found general agreement across models of WMS service delivery but little high quality evidence to support the recommended approaches and few studies of the relationship between service delivery steps and individual patient outcomes. The definition of successful clinical decision-making is different for different stakeholders. Clinical decision-making should incorporate the best available evidence along with patient values, preferences, circumstances, and clinical expertise. To advance the evidence base for WMS service delivery, alternatives to randomized controlled trials should be considered and reliable and valid outcome measures developed. Technological advances offer tremendous opportunities for individuals with complex rehabilitation technology needs. However, with ongoing scrutiny of WMS service delivery there is an increased need for evidence to support the clinical decision-making process and to support evidence-based coverage policies for WMS services and technologies. An evidence base for wheeled mobility and seating services is an important component of the clinical decision-making process. At present, there is little evidence regarding essential components of the wheeled mobility and seating evaluation or the relationship between the evaluation process and patient outcomes. Many factors can confound this relationship and present challenges to research in this area. All stakeholders (i.e. clinicians, rehabilitation technology suppliers, manufacturers, researchers, payers, policy makers, and wheelchair users) need to work together to develop and support an evidence base for wheeled mobility and seating service delivery.

Challenges to fair decision-making processes in the context of health care services: a qualitative assessment from Tanzania

PubMed Central

2012-01-01

Background Fair processes in decision making need the involvement of stakeholders who can discuss issues and reach an agreement based on reasons that are justifiable and appropriate in meeting people’s needs. In Tanzania, the policy of decentralization and the health sector reform place an emphasis on community participation in making decisions in health care. However, aspects that can influence an individual’s opportunity to be listened to and to contribute to discussion have been researched to a very limited extent in low-income settings. The objective of this study was to explore challenges to fair decision-making processes in health care services with a special focus on the potential influence of gender, wealth, ethnicity and education. We draw on the principle of fairness as outlined in the deliberative democratic theory. Methods The study was carried out in the Mbarali District of Tanzania. A qualitative study design was used. In-depth interviews and focus group discussion were conducted among members of the district health team, local government officials, health care providers and community members. Informal discussion on the topics was also of substantial value. Results The study findings indicate a substantial influence of gender, wealth, ethnicity and education on health care decision-making processes. Men, wealthy individuals, members of strong ethnic groups and highly educated individuals had greater influence. Opinions varied among the study informants as to whether such differences should be considered fair. The differences in levels of influence emerged most clearly at the community level, and were largely perceived as legitimate. Conclusions Existing challenges related to individuals’ influence of decision making processes in health care need to be addressed if greater participation is desired. There is a need for increased advocacy and a strengthening of responsive practices with an emphasis on the right of all individuals to participate in decision-making processes. This simultaneously implies an emphasis on assuring the distribution of information, training and education so that individuals can participate fully in informed decision making. PMID:22676204

Evaluation and selection of decision-making methods to assess landfill mining projects.

PubMed

Hermann, Robert; Baumgartner, Rupert J; Vorbach, Stefan; Ragossnig, Arne; Pomberger, Roland

2015-09-01

For the first time in Austria, fundamental technological and economic studies on recovering secondary raw materials from large landfills have been carried out, based on the 'LAMIS - Landfill Mining Austria' pilot project. A main focus of the research - and the subject of this article - was to develop an assessment or decision-making procedure that allows landfill owners to thoroughly examine the feasibility of a landfill mining project in advance. Currently there are no standard procedures that would sufficiently cover all the multiple-criteria requirements. The basic structure of the multiple attribute decision making process was used to narrow down on selection, conceptual design and assessment of suitable procedures. Along with a breakdown into preliminary and main assessment, the entire foundation required was created, such as definitions of requirements to an assessment method, selection and accurate description of the various assessment criteria and classification of the target system for the present 'landfill mining' vs. 'retaining the landfill in after-care' decision-making problem. Based on these studies, cost-utility analysis and the analytical-hierarchy process were selected from the range of multiple attribute decision-making procedures and examined in detail. Overall, both methods have their pros and cons with regard to their use for assessing landfill mining projects. Merging these methods or connecting them with single-criteria decision-making methods (like the net present value method) may turn out to be reasonable and constitute an appropriate assessment method. © The Author(s) 2015.

Decision Making and Ratio Processing in Patients with Mild Cognitive Impairment.

PubMed

Pertl, Marie-Theres; Benke, Thomas; Zamarian, Laura; Delazer, Margarete

2015-01-01

Making advantageous decisions is important in everyday life. This study aimed at assessing how patients with mild cognitive impairment (MCI) make decisions under risk. Additionally, it investigated the relationship between decision making, ratio processing, basic numerical abilities, and executive functions. Patients with MCI (n = 22) were compared with healthy controls (n = 29) on a complex task of decision making under risk (Game of Dice Task-Double, GDT-D), on two tasks evaluating basic decision making under risk, on a task of ratio processing, and on several neuropsychological background tests. Patients performed significantly lower than controls on the GDT-D and on ratio processing, whereas groups performed comparably on basic decision tasks. Specifically, in the GDT-D, patients obtained lower net scores and lower mean expected values, which indicate a less advantageous performance relative to that of controls. Performance on the GDT-D correlated significantly with performance in basic decision tasks, ratio processing, and executive-function measures when the analysis was performed on the whole sample. Patients with MCI make sub-optimal decisions in complex risk situations, whereas they perform at the same level as healthy adults in simple decision situations. Ratio processing and executive functions have an impact on the decision-making performance of both patients and healthy older adults. In order to facilitate advantageous decisions in complex everyday situations, information should be presented in an easily comprehensible form and cognitive training programs for patients with MCI should focus--among other abilities--on executive functions and ratio processing.

Optimal policy for value-based decision-making.

PubMed

Tajima, Satohiro; Drugowitsch, Jan; Pouget, Alexandre

2016-08-18

For decades now, normative theories of perceptual decisions, and their implementation as drift diffusion models, have driven and significantly improved our understanding of human and animal behaviour and the underlying neural processes. While similar processes seem to govern value-based decisions, we still lack the theoretical understanding of why this ought to be the case. Here, we show that, similar to perceptual decisions, drift diffusion models implement the optimal strategy for value-based decisions. Such optimal decisions require the models' decision boundaries to collapse over time, and to depend on the a priori knowledge about reward contingencies. Diffusion models only implement the optimal strategy under specific task assumptions, and cease to be optimal once we start relaxing these assumptions, by, for example, using non-linear utility functions. Our findings thus provide the much-needed theory for value-based decisions, explain the apparent similarity to perceptual decisions, and predict conditions under which this similarity should break down.

Optimal policy for value-based decision-making

PubMed Central

Tajima, Satohiro; Drugowitsch, Jan; Pouget, Alexandre

2016-01-01

For decades now, normative theories of perceptual decisions, and their implementation as drift diffusion models, have driven and significantly improved our understanding of human and animal behaviour and the underlying neural processes. While similar processes seem to govern value-based decisions, we still lack the theoretical understanding of why this ought to be the case. Here, we show that, similar to perceptual decisions, drift diffusion models implement the optimal strategy for value-based decisions. Such optimal decisions require the models' decision boundaries to collapse over time, and to depend on the a priori knowledge about reward contingencies. Diffusion models only implement the optimal strategy under specific task assumptions, and cease to be optimal once we start relaxing these assumptions, by, for example, using non-linear utility functions. Our findings thus provide the much-needed theory for value-based decisions, explain the apparent similarity to perceptual decisions, and predict conditions under which this similarity should break down. PMID:27535638

Artificial intelligence in cardiology.

PubMed

Bonderman, Diana

2017-12-01

Decision-making is complex in modern medicine and should ideally be based on available data, structured knowledge and proper interpretation in the context of an individual patient. Automated algorithms, also termed artificial intelligence that are able to extract meaningful patterns from data collections and build decisions upon identified patterns may be useful assistants in clinical decision-making processes. In this article, artificial intelligence-based studies in clinical cardiology are reviewed. The text also touches on the ethical issues and speculates on the future roles of automated algorithms versus clinicians in cardiology and medicine in general.

Inside the black box of shared decision making: distinguishing between the process of involvement and who makes the decision

PubMed Central

Edwards, Adrian; Elwyn, Glyn

2006-01-01

Abstract Background  Shared decision making has practical implications for everyday health care. However, it stems from largely theoretical frameworks and is not widely implemented in routine practice. Aims  We undertook an empirical study to inform understanding of shared decision making and how it can be operationalized more widely. Method  The study involved patients visiting UK general practitioners already well experienced in shared decision making. After these consultations, semi‐structured telephone interviews were conducted and analysed using the constant comparative method of content analysis. Results  All patients described at least some components of shared decision making but half appeared to perceive the decision as shared and half as ‘patient‐led’. However, patients exhibited some uncertainty about who had made the decision, reflecting different meanings of decision making from those described in the literature. A distinction is indicated between the process of involvement (option portrayal, exchange of information and exploring preferences for who makes the decision) and the actual decisional responsibility (who makes the decision). The process of involvement appeared to deliver benefits for patients, not the action of making the decision. Preferences for decisional responsibility varied during some consultations, generating unsatisfactory interactions when actual decisional responsibility did not align with patient preferences at that stage of a consultation. However, when conducted well, shared decision making enhanced reported satisfaction, understanding and confidence in the decisions. Conclusions  Practitioners can focus more on the process of involving patients in decision making rather than attaching importance to who actually makes the decision. They also need to be aware of the potential for changing patient preferences for decisional responsibility during a consultation and address non‐alignment of patient preferences with the actual model of decision making if this occurs. PMID:17083558

The Impact of Multifaceted Osteoporosis Group Education on Patients' Decision-Making regarding Treatment Options and Lifestyle Changes.

PubMed

Jensen, Annesofie L; Wind, Gitte; Langdahl, Bente Lomholt; Lomborg, Kirsten

2018-01-01

Patients with chronic diseases like osteoporosis constantly have to make decisions related to their disease. Multifaceted osteoporosis group education (GE) may support patients' decision-making. This study investigated multifaceted osteoporosis GE focusing on the impact of GE on patients' decision-making related to treatment options and lifestyle. An interpretive description design using ethnographic methods was utilized with 14 women and three men diagnosed with osteoporosis who attended multifaceted GE. Data consisted of participant observation during GE and individual interviews. Attending GE had an impact on the patients' decision-making in all educational themes. Patients decided on new ways to manage osteoporosis and made decisions regarding bone health and how to implement a lifestyle ensuring bone health. During GE, teachers and patients shared evidence-based knowledge and personal experiences and preferences, respectively, leading to a two-way exchange of information and deliberation about recommendations. Though teachers and patients explored the implications of the decisions and shared their preferences, teachers stressed that the patients ultimately had to make the decision. Teachers therefore refrained from participating in the final step of the decision-making process. Attending GE has an impact on the patients' decision-making as it can initiate patient reflection and support decision-making.

Using Visualization in Cockpit Decision Support Systems

NASA Technical Reports Server (NTRS)

Aragon, Cecilia R.

2005-01-01

In order to safely operate their aircraft, pilots must make rapid decisions based on integrating and processing large amounts of heterogeneous information. Visual displays are often the most efficient method of presenting safety-critical data to pilots in real time. However, care must be taken to ensure the pilot is provided with the appropriate amount of information to make effective decisions and not become cognitively overloaded. The results of two usability studies of a prototype airflow hazard visualization cockpit decision support system are summarized. The studies demonstrate that such a system significantly improves the performance of helicopter pilots landing under turbulent conditions. Based on these results, design principles and implications for cockpit decision support systems using visualization are presented.

An fMRI-Based Neural Signature of Decisions to Smoke Cannabis.

PubMed

Bedi, Gillinder; Lindquist, Martin A; Haney, Margaret

2015-11-01

Drug dependence may be at its core a pathology of choice, defined by continued decisions to use drugs irrespective of negative consequences. Despite evidence of dysregulated decision making in addiction, little is known about the neural processes underlying the most clinically relevant decisions drug users make: decisions to use drugs. Here, we combined functional magnetic resonance imaging (fMRI), machine learning, and human laboratory drug administration to investigate neural activation underlying decisions to smoke cannabis. Nontreatment-seeking daily cannabis smokers completed an fMRI choice task, making repeated decisions to purchase or decline 1-12 placebo or active cannabis 'puffs' ($0.25-$5/puff). One randomly selected decision was implemented. If the selected choice had been bought, the cost was deducted from study earnings and the purchased cannabis smoked in the laboratory; alternatively, the participant remained in the laboratory without cannabis. Machine learning with leave-one-subject-out cross-validation identified distributed neural activation patterns discriminating decisions to buy cannabis from declined offers. A total of 21 participants were included in behavioral analyses; 17 purchased cannabis and were thus included in fMRI analyses. Purchasing varied lawfully with dose and cost. The classifier discriminated with 100% accuracy between fMRI activation patterns for purchased vs declined cannabis at the level of the individual. Dorsal striatum, insula, posterior parietal regions, anterior and posterior cingulate, and dorsolateral prefrontal cortex all contributed reliably to this neural signature of decisions to smoke cannabis. These findings provide the basis for a brain-based characterization of drug-related decision making in drug abuse, including effects of psychological and pharmacological interventions on these processes.

Intuition: A Concept Analysis.

PubMed

Chilcote, Deborah R

2017-01-01

The purpose of this article is to conceptually examine intuition; identify the importance of intuition in nursing education, clinical practice, and patient care; encourage acceptance of the use of intuition; and add to the body of nursing knowledge. Nurses often report using intuition when making clinical decisions. Intuition is a rapid, unconscious process based in global knowledge that views the patient holistically while synthesizing information to improve patient outcomes. However, with the advent of evidence-based practice (EBP), the use of intuition has become undervalued in nursing. Walker and Avant's framework was used to analyze intuition. A literature search from 1987 to 2014 was conducted using the following keywords: intuition, intuition and nursing, clinical decision making, clinical decision making and intuition, patient outcomes, EBP, and analytical thinking. The use of intuition is reported by nurses, but is not legitimized within the nursing profession. Defining attributes of intuition are an unconscious, holistic knowledge gathered without using an analytical process and knowledge derived through synthesis, not analysis. Consequences include verification of intuition through an analytical process and translating that knowledge into a course of action. This article supports the use of intuition in nursing by offering clarity to the concept, adds to the nursing knowledge base, encourages a holistic view of the patient during clinical decision making, and encourages nurse educators to promote the use of intuition. © 2016 Wiley Periodicals, Inc.

Theoretical aspects of cellular decision-making and information-processing.

PubMed

Kobayashi, Tetsuya J; Kamimura, Atsushi

2012-01-01

Microscopic biological processes have extraordinary complexity and variety at the sub-cellular, intra-cellular, and multi-cellular levels. In dealing with such complex phenomena, conceptual and theoretical frameworks are crucial, which enable us to understand seemingly different intra- and inter-cellular phenomena from unified viewpoints. Decision-making is one such concept that has attracted much attention recently. Since a number of cellular behavior can be regarded as processes to make specific actions in response to external stimuli, decision-making can cover and has been used to explain a broad range of different cellular phenomena [Balázsi et al. (Cell 144(6):910, 2011), Zeng et al. (Cell 141(4):682, 2010)]. Decision-making is also closely related to cellular information-processing because appropriate decisions cannot be made without exploiting the information that the external stimuli contain. Efficiency of information transduction and processing by intra-cellular networks determines the amount of information obtained, which in turn limits the efficiency of subsequent decision-making. Furthermore, information-processing itself can serve as another concept that is crucial for understanding of other biological processes than decision-making. In this work, we review recent theoretical developments on cellular decision-making and information-processing by focusing on the relation between these two concepts.

Multicriteria Selection of Optimal Location of TCSC in a Competitive Energy Market

NASA Astrophysics Data System (ADS)

Alomoush, Muwaffaq I.

2010-05-01

The paper investigates selection of the best location of thyristor-controlled series compensator (TCSC) in a transmission system from many candidate locations in a competitive energy market such that the TCSC causes a net valuable impact on congestion management outcome, transmission utilization, transmission losses, voltage stability, degree of fulfillment of spot market contracts, and system security. The problem is treated as a multicriteria decision-making process such that the candidate locations of TCSC are the alternatives and the conflicting objectives are the outcomes of the dispatch process, which may have different importance weights. The paper proposes some performance indices that the dispatch decision-making entity can use to measure market dispatch outcomes of each alternative. Based on agreed-upon preferences, the measures presented may help the decision maker compare and rank dispatch scenarios to ultimately decide which location is the optimal one. To solve the multicriteria decision, we use the preference ranking organization method for enrichment evaluations (PROMETHEE), which is a multicriteria decision support method that can handle complex conflicting-objective decision-making processes.

What factors hinder the decision-making process for women with cancer and contemplating fertility preservation treatment?

PubMed

Jones, Georgina; Hughes, Jane; Mahmoodi, Neda; Smith, Emily; Skull, Jonathan; Ledger, William

2017-07-01

Although fertility preservation (FP) treatment options have increased, the existing evidence suggests that many women with cancer do not feel well supported in making these decisions, but find them stressful and complex and fail to take up fertility care at this crucial time. Whilst existing reviews have all made important contributions to our understanding of the FP decision-making process, none of them examine solely and specifically these processes for women of reproductive age with a diagnosis of any cancer, leaving a gap in the knowledge base. Given the expectation that care is patient-centred, our review aims to address this gap which may be of help to those managing patients struggling to make difficult decisions in the often brief period before potentially sterilizing cancer treatment is started. Underpinning this narrative review was the question 'What factors hinder the decision-making process for women with any cancer and contemplating FP treatment?' Our objectives were to (i) assess and summarize this existing literature, (ii) identify the factors that hinder this decision-making process, (iii) explore to what extent these factors may differ for women choosing different methods of FP and (iv) make recommendations for service delivery and future research. A systematic search of the medical and social science literature from the 1 January 2005 up to the end of January 2016 was carried out using three electronic databases (Web of Science (PubMed), Ovid SP Medline and CINAHL via Ebsco). Included in the review were quantitative, qualitative and mixed-method studies. Reference lists of relevant papers were also hand searched. From the 983 papers identified, 46 papers were included. Quality assessment was undertaken using the Mixed Methods Appraisal Tool and thematic analysis was used to analyse the data. From the analysis, 6 key themes with 15 sub-themes emerged: (i) fertility information provision (lack of information, timing of the information, patient-provider communication); (ii) fear concerning the perceived risks associated with pursuing FP (delaying cancer treatment, aggravating a hormone positive cancer and consequences of a future pregnancy); (iii) non-referral from oncology (personal situation, having a hormone positive cancer, FP not a priority and transition between service issues); (iv) the dilemma (in survival mode, whether to prioritize one treatment over another); (v) personal situation (parity, relationship status) and (iv) costs (financial concerns). This review has found that a wide range of internal and external factors impact the FP decision-making process. Key external issues related to current service delivery such as the provision and timing of FP information, and lack of referral from oncology to the fertility clinic. However, internal issues such as women's fears concerning the perceived risks associated with pursuing FP also hindered decision-making but these 'risks' were typically overestimated and non-evidence based. These findings suggest that the implementation of a range of decision support interventions may be of benefit within the clinical care pathway of FP and cancer. Women would benefit from the provision of more evidence-based FP information, ideally received at cancer diagnosis, in advance of seeing a fertility specialist, for example through the implementation of patient decision aids. Healthcare professionals in both oncology and fertility services may also benefit from the implementation of training programmes and educational tools targeted at improving the communication skills needed to improve collaborative decision-making and deliver care that is patient-centred. Exploration of the current barriers, both intellectual and practical, that prevent some patients from accepting FP will help care providers to do better for their patients in the future. Finally, the extent to which a poorer prognosis and moral, ethical and religious beliefs influence the FP decision-making process also warrant further research. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Healthy participants in phase I clinical trials: the quality of their decision to take part.

PubMed

Rabin, Cheryl; Tabak, Nili

2006-08-01

This study was set out to test the quality of the decision-making process of healthy volunteers in clinical trials. Researchers fear that the decision to volunteer for clinical trials is taken inadequately and that the signature on the consent forms, meant to affirm that consent was 'informed', is actually insubstantial. The study design was quasi-experimental, using a convenience quota sample. Over a period of a year, candidates were approached during their screening process for a proposed clinical trial, after concluding the required 'Informed Consent' procedure. In all, 100 participants in phase I trials filled out questionnaires based ultimately on the Janis and Mann model of vigilant information processing, during their stay in the research centre. Only 35% of the participants reached a 'quality decision'. There is a definite correlation between information processing and quality decision-making. However, many of the healthy research volunteers (58%) do not seek out information nor check alternatives before making a decision. Full disclosure is essential to a valid informed consent procedure but not sufficient; emphasis must be put on having the information understood and assimilated. Research nurses play a central role in achieving this objective.

Decision making and coping in healthcare: the Coping in Deliberation (CODE) framework.

PubMed

Witt, Jana; Elwyn, Glyn; Wood, Fiona; Brain, Kate

2012-08-01

To develop a framework of decision making and coping in healthcare that describes the twin processes of appraisal and coping faced by patients making preference-sensitive healthcare decisions. We briefly review the literature for decision making theories and coping theories applicable to preference-sensitive decisions in healthcare settings. We describe first decision making, then coping and finally attempt to integrate these processes by building on current theory. Deliberation in healthcare may be described as a six step process, comprised of the presentation of a health threat, choice, options, preference construction, the decision itself and consolidation post-decision. Coping can be depicted in three stages, beginning with a threat, followed by primary and secondary appraisal and ultimately resulting in a coping effort. Drawing together concepts from prominent decision making theories and coping theories, we propose a multidimensional, interactive framework which integrates both processes and describes coping in deliberation. The proposed framework offers an insight into the complexity of decision making in preference-sensitive healthcare contexts from a patient perspective and may act as theoretical basis for decision support. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

End of Life in a Haitian American, Faith-Based Community: Caring for Family and Communal Unity.

PubMed

Ladd, Susan Charlotte; Gordon, Shirley C

This article presents two models resulting from a grounded theory study of the end-of-life decision-making process for Haitian Americans. Successful access to this vulnerable population was achieved through the faith-based community. The first model describes this faith-based community of Haitian Americans. The second model describes the process used by families in this community who must make end-of-life healthcare decisions. Implications for nursing practice and caring science include a need to improve the congruence between the nursing care provided at this vulnerable time and the cultural values of a population.

ED Triage Decision-Making With Mental Health Presentations: A "Think Aloud" Study.

PubMed

Clarke, Diana E; Boyce-Gaudreau, Krystal; Sanderson, Ana; Baker, John A

2015-11-01

Triage is the process whereby persons presenting to the emergency department are quickly assessed by a nurse and their need for care and service is prioritized. Research examining the care of persons presenting to emergency departments with psychiatric and mental health problems has shown that triage has often been cited as the most problematic aspect of the encounter. Three questions guided this investigation: Where do the decisions that triage nurses make fall on the intuitive versus analytic dimensions of decision making for mental health presentations in the emergency department, and does this differ according to comfort or familiarity with the type of mental health/illness presentation? How do "decision aids" (i.e., structured triage scales) help in the decision-making process? To what extent do other factors, such as attitudes, influence triage nurses' decision making? Eleven triage nurses participating in this study were asked to talk out loud about the reasoning process they would engage in while triaging patients in 5 scenarios based on mental health presentations to the emergency department. Themes emerging from the data were tweaking the results (including the use of intuition and early judgments) to arrive at the desired triage score; consideration of the current ED environment; managing uncertainty and risk (including the consideration of physical reasons for presentation); and confidence in communicating with patients in distress and managing their own emotive reactions to the scenario. Findings support the preference for using the intuitive mode of decision making with only tacit reliance on the decision aid. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Frontal, Striatal, and Medial Temporal Sensitivity to Value Distinguishes Risk-Taking from Risk-Aversive Older Adults during Decision Making.

PubMed

Goh, Joshua O S; Su, Yu-Shiang; Tang, Yong-Jheng; McCarrey, Anna C; Tereshchenko, Alexander; Elkins, Wendy; Resnick, Susan M

2016-12-07

Aging compromises the frontal, striatal, and medial temporal areas of the reward system, impeding accurate value representation and feedback processing critical for decision making. However, substantial variability characterizes age-related effects on the brain so that some older individuals evince clear neurocognitive declines whereas others are spared. Moreover, the functional correlates of normative individual differences in older-adult value-based decision making remain unclear. We performed a functional magnetic resonance imaging study in 173 human older adults during a lottery choice task in which costly to more desirable stakes were depicted using low to high expected values (EVs) of points. Across trials that varied in EVs, participants decided to accept or decline the offered stakes to maximize total accumulated points. We found that greater age was associated with less optimal decisions, accepting stakes when losses were likely and declining stakes when gains were likely, and was associated with increased frontal activity for costlier stakes. Critically, risk preferences varied substantially across older adults and neural sensitivity to EVs in the frontal, striatal, and medial temporal areas dissociated risk-aversive from risk-taking individuals. Specifically, risk-averters increased neural responses to increasing EVs as stakes became more desirable, whereas risk-takers increased neural responses with decreasing EV as stakes became more costly. Risk preference also modulated striatal responses during feedback with risk-takers showing more positive responses to gains compared with risk-averters. Our findings highlight the frontal, striatal, and medial temporal areas as key neural loci in which individual differences differentially affect value-based decision-making ability in older adults. Frontal, striatal, and medial temporal functions implicated in value-based decision processing of rewards and costs undergo substantial age-related changes. However, age effects on brain function and cognition differ across individuals. How this normative variation relates to older-adult value-based decision making is unclear. We found that although the ability make optimal decisions declines with age, there is still much individual variability in how this deterioration occurs. Critically, whereas risk-averters showed increased neural activity to increasingly valuable stakes in frontal, striatal, and medial temporal areas, risk-takers instead increased activity as stakes became more costly. Such distinct functional decision-making processing in these brain regions across normative older adults may reflect individual differences in susceptibility to age-related brain changes associated with incipient cognitive impairment. Copyright © 2016 the authors 0270-6474/16/3612498-12$15.00/0.

Development of spatial density maps based on geoprocessing web services: application to tuberculosis incidence in Barcelona, Spain.

PubMed

Dominkovics, Pau; Granell, Carlos; Pérez-Navarro, Antoni; Casals, Martí; Orcau, Angels; Caylà, Joan A

2011-11-29

Health professionals and authorities strive to cope with heterogeneous data, services, and statistical models to support decision making on public health. Sophisticated analysis and distributed processing capabilities over geocoded epidemiological data are seen as driving factors to speed up control and decision making in these health risk situations. In this context, recent Web technologies and standards-based web services deployed on geospatial information infrastructures have rapidly become an efficient way to access, share, process, and visualize geocoded health-related information. Data used on this study is based on Tuberculosis (TB) cases registered in Barcelona city during 2009. Residential addresses are geocoded and loaded into a spatial database that acts as a backend database. The web-based application architecture and geoprocessing web services are designed according to the Representational State Transfer (REST) principles. These web processing services produce spatial density maps against the backend database. The results are focused on the use of the proposed web-based application to the analysis of TB cases in Barcelona. The application produces spatial density maps to ease the monitoring and decision making process by health professionals. We also include a discussion of how spatial density maps may be useful for health practitioners in such contexts. In this paper, we developed web-based client application and a set of geoprocessing web services to support specific health-spatial requirements. Spatial density maps of TB incidence were generated to help health professionals in analysis and decision-making tasks. The combined use of geographic information tools, map viewers, and geoprocessing services leads to interesting possibilities in handling health data in a spatial manner. In particular, the use of spatial density maps has been effective to identify the most affected areas and its spatial impact. This study is an attempt to demonstrate how web processing services together with web-based mapping capabilities suit the needs of health practitioners in epidemiological analysis scenarios.

Development of spatial density maps based on geoprocessing web services: application to tuberculosis incidence in Barcelona, Spain

PubMed Central

2011-01-01

Background Health professionals and authorities strive to cope with heterogeneous data, services, and statistical models to support decision making on public health. Sophisticated analysis and distributed processing capabilities over geocoded epidemiological data are seen as driving factors to speed up control and decision making in these health risk situations. In this context, recent Web technologies and standards-based web services deployed on geospatial information infrastructures have rapidly become an efficient way to access, share, process, and visualize geocoded health-related information. Methods Data used on this study is based on Tuberculosis (TB) cases registered in Barcelona city during 2009. Residential addresses are geocoded and loaded into a spatial database that acts as a backend database. The web-based application architecture and geoprocessing web services are designed according to the Representational State Transfer (REST) principles. These web processing services produce spatial density maps against the backend database. Results The results are focused on the use of the proposed web-based application to the analysis of TB cases in Barcelona. The application produces spatial density maps to ease the monitoring and decision making process by health professionals. We also include a discussion of how spatial density maps may be useful for health practitioners in such contexts. Conclusions In this paper, we developed web-based client application and a set of geoprocessing web services to support specific health-spatial requirements. Spatial density maps of TB incidence were generated to help health professionals in analysis and decision-making tasks. The combined use of geographic information tools, map viewers, and geoprocessing services leads to interesting possibilities in handling health data in a spatial manner. In particular, the use of spatial density maps has been effective to identify the most affected areas and its spatial impact. This study is an attempt to demonstrate how web processing services together with web-based mapping capabilities suit the needs of health practitioners in epidemiological analysis scenarios. PMID:22126392

A qualitative study on community pharmacists' decision-making process when making a diagnosis.

PubMed

Sinopoulou, Vassiliki; Summerfield, Paul; Rutter, Paul

2017-12-01

Self-care policies are increasingly directing patients to seek advice from community pharmacists. This means pharmacists need to have sound diagnostic decision-making skills to enable them to recognise a variety of conditions. The aim of this study was to investigate the process by which pharmacists manage patient signs and symptoms and to explore their use of decision-making for diagnostic purposes. Data were collected through semi-structured, face-to-face interviews with community pharmacists working in England, between August 2013 and November 2014. Pharmacists were asked to share their experiences on how they performed patient consultations, and more specifically how they would approach a hypothetical headache scenario. As part of the interview, their sources of knowledge and experience were also explored. Framework analysis was used to identify themes and subthemes. Eight interviews were conducted with pharmacists who had a wide range of working practice, from 1 year through to 40 years of experience. The pharmacists' main motivations during consultations were product selection and risk minimisation. Their questioning approach and decision-making relied heavily on mnemonic methods. This led to poor quality information gathering-although pharmacists acknowledged they needed to "delve deeper" but were often unable to articulate how or why. Some pharmacists exhibited elements of clinical reasoning in their consultations, but this seemed, mostly, to be unconscious and subsequently applied inappropriately. Overall, pharmacists exhibited poor decision-making ability, and often decisions were based on personal belief and experiences rather than evidence. Community pharmacists relied heavily on mnemonic methods to manage patients' signs and symptoms with diagnosis-based decision-making being seldom employed. These findings suggest practicing pharmacists should receive more diagnostic training. © 2017 John Wiley & Sons, Ltd.

Overlapping Risky Decision-Making and Olfactory Processing Ability in HIV-Infected Individuals.

PubMed

Jackson, Christopher; Rai, Narayan; McLean, Charlee K; Hipolito, Maria Mananita S; Hamilton, Flora Terrell; Kapetanovic, Suad; Nwulia, Evaristus A

2017-09-01

Given neuroimaging evidences of overlap in the circuitries for decision-making and olfactory processing, we examined the hypothesis that impairment in psychophysical tasks of olfaction would independently predict poor performances on Iowa Gambling Task (IGT), a laboratory task that closely mimics real-life decision-making, in a US cohort of HIV-infected (HIV+) individuals. IGT and psychophysical tasks of olfaction were administered to a Washington DC-based cohort of largely African American HIV+ subjects (N=100), and to a small number of demographically-matched non-HIV healthy controls (N=43) from a different study. Constructs of olfactory ability and decision-making were examined through confirmatory factor analysis (CFA). Structural equation models (SEMs) were used to evaluate the validity of the path relationship between these two constructs. The 100 HIV+ participants (56% female; 96% African Americans; median age = 48 years) had median CD4 count of 576 cells/μl and median HIV RNA viral load <48 copies per milliliter. Majority of HIV+ participants performed randomly throughout the course of IGT tasks, and failed to demonstrate a learning curve. Confirmatory factor analysis provided support for a unidimensional factor underlying poor performances on IGT. Nomological validity for correlations between olfactory ability and IGT performance was confirmed through SEM. Finally, factor scores of olfactory ability and IGT performance strongly predicted 6 months history of drug use, while olfaction additionally predicted hallucinogen use. This study suggests that combination of simple, office-based tasks of olfaction and decision-making may identify those HIV+ individuals who are more prone to risky decision-making. This finding may have significant clinical, public health value if joint impairments in olfaction and IGT task correlates with more decreased activity in brain regions relevant to decision-making.

Attention and choice: a review on eye movements in decision making.

PubMed

Orquin, Jacob L; Mueller Loose, Simone

2013-09-01

This paper reviews studies on eye movements in decision making, and compares their observations to theoretical predictions concerning the role of attention in decision making. Four decision theories are examined: rational models, bounded rationality, evidence accumulation, and parallel constraint satisfaction models. Although most theories were confirmed with regard to certain predictions, none of the theories adequately accounted for the role of attention during decision making. Several observations emerged concerning the drivers and down-stream effects of attention on choice, suggesting that attention processes plays an active role in constructing decisions. So far, decision theories have largely ignored the constructive role of attention by assuming that it is entirely determined by heuristics, or that it consists of stochastic information sampling. The empirical observations reveal that these assumptions are implausible, and that more accurate assumptions could have been made based on prior attention and eye movement research. Future decision making research would benefit from greater integration with attention research. Copyright © 2013 Elsevier B.V. All rights reserved.

Family involvement in cancer treatment decision-making: A qualitative study of patient, family, and clinician attitudes and experiences.

PubMed

Laidsaar-Powell, Rebekah; Butow, Phyllis; Bu, Stella; Charles, Cathy; Gafni, Amiram; Fisher, Alana; Juraskova, Ilona

2016-07-01

Little is known about how family are involved in cancer treatment decision-making. This study aimed to qualitatively explore Australian oncology clinicians', patients', and family members' attitudes towards, and experiences of, family involvement in decision-making. Semi-structured interviews were conducted with 30 cancer patients, 33 family members, 10 oncology nurses and 11 oncologists. Framework analysis methods were used. Three main themes were uncovered: (i) how family are involved in the decision-making process: specific behaviours of family across 5 (extended) decision-making stages; (ii) attitudes towards family involvement in the decision-making process: balancing patient authority with the rights of the family; and (iii) factors influencing family involvement: patient, family, cultural, relationship, and decision. This study highlighted many specific behaviours of family throughout the decision-making process, the complex participant attitudes toward retaining patient authority whilst including the family, and insight into influencing factors. These findings will inform a conceptual framework describing family involvement in decision-making. Clinicians could ascertain participant preferences and remain open to the varying forms of family involvement in decision-making. Given the important role of family in the decision-making process, family inclusive consultation strategies are needed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Caregiving decision making by older mothers and adult children: process and expected outcome.

PubMed

Cicirelli, Victor G

2006-06-01

Dyadic caregiving decision making was studied in 30 mother-son and 29 mother-daughter pairs (mother's age=65-94 years) who responded to a vignette depicting a caregiving decision situation. The observed decision-making process of mother-child pairs was largely naturalistic, with few alternatives proposed and quick convergence to a decision followed by a postdecision justification; a degree of more rational decision making was seen in some pairs. Among significant findings, adult children, especially sons, dominated the decision process, doing more talking and introducing more alternatives than did their mothers, who played a more subordinate role. Mother-son pairs expected more negative outcomes and greater regrets regarding their decisions than mother-daughter pairs. Closeness of the parent-child relationship influenced the decision-making process, expected outcomes, and regrets. Copyright (c) 2006 APA, all rights reserved.

36 CFR 1010.5 - Major decision points.

Code of Federal Regulations, 2010 CFR

2010-07-01

...-making process. Most Trust projects have three distinct stages in the decision-making process: (1... stage. (b) Environmental review will be integrated into the decision-making process of the Trust as... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Major decision points. 1010.5...

Goal-directed decision making as probabilistic inference: A computational framework and potential neural correlates

PubMed Central

Solway, A.; Botvinick, M.

2013-01-01

Recent work has given rise to the view that reward-based decision making is governed by two key controllers: a habit system, which stores stimulus-response associations shaped by past reward, and a goal-oriented system that selects actions based on their anticipated outcomes. The current literature provides a rich body of computational theory addressing habit formation, centering on temporal-difference learning mechanisms. Less progress has been made toward formalizing the processes involved in goal-directed decision making. We draw on recent work in cognitive neuroscience, animal conditioning, cognitive and developmental psychology and machine learning, to outline a new theory of goal-directed decision making. Our basic proposal is that the brain, within an identifiable network of cortical and subcortical structures, implements a probabilistic generative model of reward, and that goal-directed decision making is effected through Bayesian inversion of this model. We present a set of simulations implementing the account, which address benchmark behavioral and neuroscientific findings, and which give rise to a set of testable predictions. We also discuss the relationship between the proposed framework and other models of decision making, including recent models of perceptual choice, to which our theory bears a direct connection. PMID:22229491

Cost-effectiveness thresholds: pros and cons.

PubMed

Bertram, Melanie Y; Lauer, Jeremy A; De Joncheere, Kees; Edejer, Tessa; Hutubessy, Raymond; Kieny, Marie-Paule; Hill, Suzanne R

2016-12-01

Cost-effectiveness analysis is used to compare the costs and outcomes of alternative policy options. Each resulting cost-effectiveness ratio represents the magnitude of additional health gained per additional unit of resources spent. Cost-effectiveness thresholds allow cost-effectiveness ratios that represent good or very good value for money to be identified. In 2001, the World Health Organization's Commission on Macroeconomics in Health suggested cost-effectiveness thresholds based on multiples of a country's per-capita gross domestic product (GDP). In some contexts, in choosing which health interventions to fund and which not to fund, these thresholds have been used as decision rules. However, experience with the use of such GDP-based thresholds in decision-making processes at country level shows them to lack country specificity and this - in addition to uncertainty in the modelled cost-effectiveness ratios - can lead to the wrong decision on how to spend health-care resources. Cost-effectiveness information should be used alongside other considerations - e.g. budget impact and feasibility considerations - in a transparent decision-making process, rather than in isolation based on a single threshold value. Although cost-effectiveness ratios are undoubtedly informative in assessing value for money, countries should be encouraged to develop a context-specific process for decision-making that is supported by legislation, has stakeholder buy-in, for example the involvement of civil society organizations and patient groups, and is transparent, consistent and fair.

Health Care Coverage Decision Making in Low- and Middle-Income Countries: Experiences from 25 Coverage Schemes.

PubMed

Gutierrez, Hialy; Shewade, Ashwini; Dai, Minghan; Mendoza-Arana, Pedro; Gómez-Dantés, Octavio; Jain, Nishant; Khonelidze, Irma; Nabyonga-Orem, Juliet; Saleh, Karima; Teerawattananon, Yot; Nishtar, Sania; Hornberger, John

2015-08-01

Lessons learned by countries that have successfully implemented coverage schemes for health services may be valuable for other countries, especially low- and middle-income countries (LMICs), which likewise are seeking to provide/expand coverage. The research team surveyed experts in population health management from LMICs for information on characteristics of health care coverage schemes and factors that influenced decision-making processes. The level of coverage provided by the different schemes varied. Nearly all the health care coverage schemes involved various representatives and stakeholders in their decision-making processes. Maternal and child health, cardiovascular diseases, cancer, and HIV were among the highest priorities guiding coverage development decisions. Evidence used to inform coverage decisions included medical literature, regional and global epidemiology, and coverage policies of other coverage schemes. Funding was the most commonly reported reason for restricting coverage. This exploratory study provides an overview of health care coverage schemes from participating LMICs and contributes to the scarce evidence base on coverage decision making. Sharing knowledge and experiences among LMICs can support efforts to establish systems for accessible, affordable, and equitable health care.

Memory-based decision-making with heuristics: evidence for a controlled activation of memory representations.

PubMed

Khader, Patrick H; Pachur, Thorsten; Meier, Stefanie; Bien, Siegfried; Jost, Kerstin; Rösler, Frank

2011-11-01

Many of our daily decisions are memory based, that is, the attribute information about the decision alternatives has to be recalled. Behavioral studies suggest that for such decisions we often use simple strategies (heuristics) that rely on controlled and limited information search. It is assumed that these heuristics simplify decision-making by activating long-term memory representations of only those attributes that are necessary for the decision. However, from behavioral studies alone, it is unclear whether using heuristics is indeed associated with limited memory search. The present study tested this assumption by monitoring the activation of specific long-term-memory representations with fMRI while participants made memory-based decisions using the "take-the-best" heuristic. For different decision trials, different numbers and types of information had to be retrieved and processed. The attributes consisted of visual information known to be represented in different parts of the posterior cortex. We found that the amount of information required for a decision was mirrored by a parametric activation of the dorsolateral PFC. Such a parametric pattern was also observed in all posterior areas, suggesting that activation was not limited to those attributes required for a decision. However, the posterior increases were systematically modulated by the relative importance of the information for making a decision. These findings suggest that memory-based decision-making is mediated by the dorsolateral PFC, which selectively controls posterior storage areas. In addition, the systematic modulations of the posterior activations indicate a selective boosting of activation of decision-relevant attributes.

The vexing problem of defining the meaning, role and measurement of values in treatment decision-making.

PubMed

Charles, Cathy; Gafni, Amiram

2014-03-01

Two international movements, evidence-based medicine (EBM) and shared decision-making (SDM) have grappled for some time with issues related to defining the meaning, role and measurement of values/preferences in their respective models of treatment decision-making. In this article, we identify and describe unresolved problems in the way that each movement addresses these issues. The starting point for this discussion is that at least two essential ingredients are needed for treatment decision-making: research information about treatment options and their potential benefits and risks; and the values/preferences of participants in the decision-making process. Both the EBM and SDM movements have encountered difficulties in defining the meaning, role and measurement of values/preferences in treatment decision-making. In the EBM model of practice, there is no clear and consistent definition of patient values/preferences and no guidance is provided on how to integrate these into an EBM model of practice. Methods advocated to measure patient values are also problematic. Within the SDM movement, patient values/preferences tend to be defined and measured in a restrictive and reductionist way as patient preferences for treatment options or attributes of options, while broader underlying value structures are ignored. In both models of practice, the meaning and expected role of physician values in decision-making are unclear. Values clarification exercises embedded in patient decision aids are suggested by SDM advocates to identify and communicate patient values/preferences for different treatment outcomes. Such exercises have the potential to impose a particular decision-making theory and/or process onto patients, which can change the way they think about and process information, potentially impeding them from making decisions that are consistent with their true values. The tasks of clarifying the meaning, role and measurement of values/preferences in treatment decision-making models such as EBM and SDM, and determining whose values ought to count are complex and difficult tasks that will not be resolved quickly. Additional conceptual thinking and research are needed to explore and clarify these issues. To date, the values component of these models remains elusive and underdeveloped.

Making ResourceFULL™ Decisions: A Process Model for Civic Engagement

ERIC Educational Resources Information Center

Radke, Barbara; Chazdon, Scott

2015-01-01

Many public issues are becoming more complex, interconnected, and cannot be resolved by one individual or entity. Research shows an informed decision is not enough. Addressing these issues requires authentic civic engagement (deliberative dialogue) with the public to reach resourceFULL™ decisions--a decision based on diverse sources of information…

The value of decision models: Using ecologically based invasive plant management as an example

USDA-ARS?s Scientific Manuscript database

Humans have both fast and slow thought processes which influence our judgment and decision-making. The fast system is intuitive and valuable for decisions which do not require multiple steps or the application of logic or statistics. However, many decisions in natural resources are complex and req...

A work-centered cognitively based architecture for decision support: the work-centered infomediary layer (WIL) model

NASA Astrophysics Data System (ADS)

Zachary, Wayne; Eggleston, Robert; Donmoyer, Jason; Schremmer, Serge

2003-09-01

Decision-making is strongly shaped and influenced by the work context in which decisions are embedded. This suggests that decision support needs to be anchored by a model (implicit or explicit) of the work process, in contrast to traditional approaches that anchor decision support to either context free decision models (e.g., utility theory) or to detailed models of the external (e.g., battlespace) environment. An architecture for cognitively-based, work centered decision support called the Work-centered Informediary Layer (WIL) is presented. WIL separates decision support into three overall processes that build and dynamically maintain an explicit context model, use the context model to identify opportunities for decision support and tailor generic decision-support strategies to the current context and offer them to the system-user/decision-maker. The generic decision support strategies include such things as activity/attention aiding, decision process structuring, work performance support (selective, contextual automation), explanation/ elaboration, infosphere data retrieval, and what if/action-projection and visualization. A WIL-based application is a work-centered decision support layer that provides active support without intent inferencing, and that is cognitively based without requiring classical cognitive task analyses. Example WIL applications are detailed and discussed.

A decision method based on uncertainty reasoning of linguistic truth-valued concept lattice

NASA Astrophysics Data System (ADS)

Yang, Li; Xu, Yang

2010-04-01

Decision making with linguistic information is a research hotspot now. This paper begins by establishing the theory basis for linguistic information processing and constructs the linguistic truth-valued concept lattice for a decision information system, and further utilises uncertainty reasoning to make the decision. That is, we first utilise the linguistic truth-valued lattice implication algebra to unify the different kinds of linguistic expressions; second, we construct the linguistic truth-valued concept lattice and decision concept lattice according to the concrete decision information system and third, we establish the internal and external uncertainty reasoning methods and talk about the rationality of them. We apply these uncertainty reasoning methods into decision making and present some generation methods of decision rules. In the end, we give an application of this decision method by an example.

Local Orientation and the Evolution of Foraging: Changes in Decision Making Can Eliminate Evolutionary Trade-offs

PubMed Central

van der Post, Daniel J.; Semmann, Dirk

2011-01-01

Information processing is a major aspect of the evolution of animal behavior. In foraging, responsiveness to local feeding opportunities can generate patterns of behavior which reflect or “recognize patterns” in the environment beyond the perception of individuals. Theory on the evolution of behavior generally neglects such opportunity-based adaptation. Using a spatial individual-based model we study the role of opportunity-based adaptation in the evolution of foraging, and how it depends on local decision making. We compare two model variants which differ in the individual decision making that can evolve (restricted and extended model), and study the evolution of simple foraging behavior in environments where food is distributed either uniformly or in patches. We find that opportunity-based adaptation and the pattern recognition it generates, plays an important role in foraging success, particularly in patchy environments where one of the main challenges is “staying in patches”. In the restricted model this is achieved by genetic adaptation of move and search behavior, in light of a trade-off on within- and between-patch behavior. In the extended model this trade-off does not arise because decision making capabilities allow for differentiated behavioral patterns. As a consequence, it becomes possible for properties of movement to be specialized for detection of patches with more food, a larger scale information processing not present in the restricted model. Our results show that changes in decision making abilities can alter what kinds of pattern recognition are possible, eliminate an evolutionary trade-off and change the adaptive landscape. PMID:21998571

Local orientation and the evolution of foraging: changes in decision making can eliminate evolutionary trade-offs.

PubMed

van der Post, Daniel J; Semmann, Dirk

2011-10-01

Information processing is a major aspect of the evolution of animal behavior. In foraging, responsiveness to local feeding opportunities can generate patterns of behavior which reflect or "recognize patterns" in the environment beyond the perception of individuals. Theory on the evolution of behavior generally neglects such opportunity-based adaptation. Using a spatial individual-based model we study the role of opportunity-based adaptation in the evolution of foraging, and how it depends on local decision making. We compare two model variants which differ in the individual decision making that can evolve (restricted and extended model), and study the evolution of simple foraging behavior in environments where food is distributed either uniformly or in patches. We find that opportunity-based adaptation and the pattern recognition it generates, plays an important role in foraging success, particularly in patchy environments where one of the main challenges is "staying in patches". In the restricted model this is achieved by genetic adaptation of move and search behavior, in light of a trade-off on within- and between-patch behavior. In the extended model this trade-off does not arise because decision making capabilities allow for differentiated behavioral patterns. As a consequence, it becomes possible for properties of movement to be specialized for detection of patches with more food, a larger scale information processing not present in the restricted model. Our results show that changes in decision making abilities can alter what kinds of pattern recognition are possible, eliminate an evolutionary trade-off and change the adaptive landscape.

Decision-making of older patients in context of the doctor-patient relationship: a typology ranging from "self-determined" to "doctor-trusting" patients.

PubMed

Wrede-Sach, Jennifer; Voigt, Isabel; Diederichs-Egidi, Heike; Hummers-Pradier, Eva; Dierks, Marie-Luise; Junius-Walker, Ulrike

2013-01-01

Background. This qualitative study aims to gain insight into the perceptions and experiences of older patients with regard to sharing health care decisions with their general practitioners. Patients and Methods. Thirty-four general practice patients (≥70 years) were asked about their preferences and experiences concerning shared decision making with their doctors using qualitative semistructured interviews. All interviews were analysed according to principles of content analysis. The resulting categories were then arranged into a classification grid to develop a typology of preferences for participating in decision-making processes. Results. Older patients generally preferred to make decisions concerning everyday life rather than medical decisions, which they preferred to leave to their doctors. We characterised eight different patient types based on four interdependent positions (self-determination, adherence, information seeking, and trust). Experiences of a good doctor-patient relationship were associated with trust, reliance on the doctor for information and decision making, and adherence. Conclusion. Owing to the varied patient decision-making types, it is not easy for doctors to anticipate the desired level of patient involvement. However, the decision matter and the self-determination of patients provide good starting points in preparing the ground for shared decision making. A good relationship with the doctor facilitates satisfying decision-making experiences.

Multi-Criteria Decision Making for a Spatial Decision Support System on the Analysis of Changing Risk

NASA Astrophysics Data System (ADS)

Olyazadeh, Roya; van Westen, Cees; Bakker, Wim H.; Aye, Zar Chi; Jaboyedoff, Michel; Derron, Marc-Henri

2014-05-01

Natural hazard risk management requires decision making in several stages. Decision making on alternatives for risk reduction planning starts with an intelligence phase for recognition of the decision problems and identifying the objectives. Development of the alternatives and assigning the variable by decision makers to each alternative are employed to the design phase. Final phase evaluates the optimal choice by comparing the alternatives, defining indicators, assigning a weight to each and ranking them. This process is referred to as Multi-Criteria Decision Making analysis (MCDM), Multi-Criteria Evaluation (MCE) or Multi-Criteria Analysis (MCA). In the framework of the ongoing 7th Framework Program "CHANGES" (2011-2014, Grant Agreement No. 263953) of the European Commission, a Spatial Decision Support System is under development, that has the aim to analyse changes in hydro-meteorological risk and provide support to selecting the best risk reduction alternative. This paper describes the module for Multi-Criteria Decision Making analysis (MCDM) that incorporates monetary and non-monetary criteria in the analysis of the optimal alternative. The MCDM module consists of several components. The first step is to define criteria (or Indicators) which are subdivided into disadvantages (criteria that indicate the difficulty for implementing the risk reduction strategy, also referred to as Costs) and advantages (criteria that indicate the favorability, also referred to as benefits). In the next step the stakeholders can use the developed web-based tool for prioritizing criteria and decision matrix. Public participation plays a role in decision making and this is also planned through the use of a mobile web-version where the general local public can indicate their agreement on the proposed alternatives. The application is being tested through a case study related to risk reduction of a mountainous valley in the Alps affected by flooding. Four alternatives are evaluated in this case study namely: construction of defense structures, relocation, implementation of an early warning system and spatial planning regulations. Some of the criteria are determined partly in other modules of the CHANGES SDSS, such as the costs for implementation, the risk reduction in monetary values, and societal risk. Other criteria, which could be environmental, economic, cultural, perception in nature, are defined by different stakeholders such as local authorities, expert organizations, private sector, and local public. In the next step, the stakeholders weight the importance of the criteria by pairwise comparison and visualize the decision matrix, which is a matrix based on criteria versus alternatives values. Finally alternatives are ranked by Analytic Hierarchy Process (AHP) method. We expect that this approach will help the decision makers to ease their works and reduce their costs, because the process is more transparent, more accurate and involves a group decision. In that way there will be more confidence in the overall decision making process. Keywords: MCDM, Analytic Hierarchy Process (AHP), SDSS, Natural Hazard Risk Management

How do patients between the age of 65 and 75 use a web-based decision aid for treatment choice in localized prostate cancer?

PubMed

Schrijvers, Jessie; Vanderhaegen, Joke; Van Poppel, Hendrik; Haustermans, Karin; Van Audenhove, Chantal

2013-08-01

This study was designed to evaluate the use of a web-based decision aid by a 65plus patient group in their decision-making process for treatment of localized prostate cancer. Of particular interest was the use of technology features such as patients' statements, comparative tables, and a values clarification tool. One hundred men from the University Hospital of Leuven campus, Gasthuisberg, were invited to use the web-based decision aid in their decision-making process. Twenty-six men were excluded based on non- or limited use of the decision aid. Of the remaining 74 men, user specifications, decision aid surfing characteristics by means of web-log data, and especially the use of technology features were analyzed. Men spent on average 30 minutes on the web-based decision aid. Most time was spent on the pages with information on treatment options. These pages were also most frequently accessed. The use of the feature 'comparative tables' was the highest, followed by the 'values clarification tool'. According to age (<70 or >70 years) differences were observed for the time spent on the decision aid, the pages accessed, and the use of the technology features. Despite concerns about the usability of a web-based decision aid for elderly patients, these results indicated that the majority of 65plus persons with good internet skills use a web-based decision aid as well as its incorporated technology features. © 2013 Wiley Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

Classifying clinical decision making: a unifying approach.

PubMed

Buckingham, C D; Adams, A

2000-10-01

This is the first of two linked papers exploring decision making in nursing which integrate research evidence from different clinical and academic disciplines. Currently there are many decision-making theories, each with their own distinctive concepts and terminology, and there is a tendency for separate disciplines to view their own decision-making processes as unique. Identifying good nursing decisions and where improvements can be made is therefore problematic, and this can undermine clinical and organizational effectiveness, as well as nurses' professional status. Within the unifying framework of psychological classification, the overall aim of the two papers is to clarify and compare terms, concepts and processes identified in a diversity of decision-making theories, and to demonstrate their underlying similarities. It is argued that the range of explanations used across disciplines can usefully be re-conceptualized as classification behaviour. This paper explores problems arising from multiple theories of decision making being applied to separate clinical disciplines. Attention is given to detrimental effects on nursing practice within the context of multidisciplinary health-care organizations and the changing role of nurses. The different theories are outlined and difficulties in applying them to nursing decisions highlighted. An alternative approach based on a general model of classification is then presented in detail to introduce its terminology and the unifying framework for interpreting all types of decisions. The classification model is used to provide the context for relating alternative philosophical approaches and to define decision-making activities common to all clinical domains. This may benefit nurses by improving multidisciplinary collaboration and weakening clinical elitism.

Parents' information needs and influential factors when making decisions about TNF-α inhibitors.

PubMed

Lipstein, Ellen A; Lovell, Daniel J; Denson, Lee A; Kim, Sandra C; Spencer, Charles; Britto, Maria T

2016-09-15

Parents struggle when making treatment decisions for children with arthritis or other chronic conditions. Understanding their decision-making process is an essential step towards improving the decision-making experience. The objective of this study was to describe parents' information needs and the influences on their decision making about treatment with TNF-α inhibitors. Survey domains were developed based on qualitative data and cognitive interviewing. We mailed the survey to parents of children with juvenile idiopathic arthritis or inflammatory bowel disease who had initiated treatment with TNF-α inhibitors in the prior 2 years. Data were analyzed using descriptive and non-parametric statistics. Survey response rate was 54.9 %. Each item had <2 % missing responses. Parents used an array of information sources when deciding about treatment with TNF-α inhibitors. Resources other than their child's specialist were most often used to increase confidence in parents' decisions or because they wanted to know more about other people's experiences being treated with TNF-α inhibitors, rather than due to a lack of understanding. All but two (cost and route of administration) of the influential decision factors were very or extremely important to the majority of participants with factors related to long-term side effects, treatment efficacy, and disease impact being most important. This study describes parents' information needs and influential factors in treatment decision making. Results suggest that future work should be aimed at helping families weigh risks and benefits, such as through decision support interventions, as well as developing opportunities to include people beyond the family and physician in the decision-making process.

Narrative Interest Standard: A Novel Approach to Surrogate Decision-Making for People With Dementia.

PubMed

Wilkins, James M

2017-06-17

Dementia is a common neurodegenerative process that can significantly impair decision-making capacity as the disease progresses. When a person is found to lack capacity to make a decision, a surrogate decision-maker is generally sought to aid in decision-making. Typical bases for surrogate decision-making include the substituted judgment standard and the best interest standard. Given the heterogeneous and progressive course of dementia, however, these standards for surrogate decision-making are often insufficient in providing guidance for the decision-making for a person with dementia, escalating the likelihood of conflict in these decisions. In this article, the narrative interest standard is presented as a novel and more appropriate approach to surrogate decision-making for people with dementia. Through case presentation and ethical analysis, the standard mechanisms for surrogate decision-making for people with dementia are reviewed and critiqued. The narrative interest standard is then introduced and discussed as a dementia-specific model for surrogate decision-making. Through incorporation of elements of a best interest standard in focusing on the current benefit-burden ratio and elements of narrative to provide context, history, and flexibility for values and preferences that may change over time, the narrative interest standard allows for elaboration of an enriched context for surrogate decision-making for people with dementia. More importantly, however, a narrative approach encourages the direct contribution from people with dementia in authoring the story of what matters to them in their lives.

Risk-based analysis and decision making in multi-disciplinary environments

NASA Technical Reports Server (NTRS)

Feather, Martin S.; Cornford, Steven L.; Moran, Kelly

2003-01-01

A risk-based decision-making process conceived of and developed at JPL and NASA, has been used to help plan and guide novel technology applications for use on spacecraft. These applications exemplify key challenges inherent in multi-disciplinary design of novel technologies deployed in mission-critical settings. 1) Cross-disciplinary concerns are numerous (e.g., spacecraft involve navigation, propulsion, telecommunications). These concems are cross-coupled and interact in multiple ways (e.g., electromagnetic interference, heat transfer). 2) Time and budget pressures constrain development, operational resources constrain the resulting system (e.g., mass, volume, power). 3) Spacecraft are critical systems that must operate correctly the first time in only partially understood environments, with no chance for repair. 4) Past experience provides only a partial guide: New mission concepts are enhanced and enabled by new technologies, for which past experience is lacking. The decision-making process rests on quantitative assessments of the relationships between three classes of information - objectives (the things the system is to accomplish and constraints on its operation and development), risks (whose occurrence detracts from objectives), and mitigations (options for reducing the likelihood and or severity of risks). The process successfully guides experts to pool their knowledge, using custom-built software to support information gathering and decision-making.

Assessment Practices of Educational Psychologists in Aotearoa/New Zealand: From Diagnostic to Dialogic Ways of Working

ERIC Educational Resources Information Center

Bourke, Roseanna; Dharan, Vijaya

2015-01-01

Psychologists working in education in Aotearoa/New Zealand work in diverse educational environments making day-to-day decisions informed by evidence-based practice. As a relatively small professional group with a complex work programme, they contribute to the assessments and decision-making processes of children and young people across multiple…

The Micropolitics of School Principals' Decision Making in Nigeria: Principals' Perspective

ERIC Educational Resources Information Center

Olayiwola, Shina; Alabi, Kingsley

2015-01-01

This study depicted a micropolitical analysis of school principals' decision making as regards the influence of formal and informal groups on school administrative processes from the point of view of principals. It was based on descriptive survey study of all 24 public secondary schools within Ile-Ife community, Osun State, Nigeria, out of which a…

An Information Theoretic Approach for Measuring Data Discovery and Utilization During Analytical and Decision Making Processes

DTIC Science & Technology

2015-07-31

and make the expected decision outcomes. The scenario is based around a scripted storyboard where an organized crime network is operating in a city to...interdicted by law enforcement to disrupt the network. The scenario storyboard was used to develop a probabilistic vehicle traffic model in order to

Decision Making, Self-Efficacy, and the Place of Career Education in Elementary School Social Studies

ERIC Educational Resources Information Center

Gallavan, Nancy P.

2003-01-01

In 1960, Shirley Engle identified the primary purposes or "heart of social studies instruction" as educating citizens living in a democracy and teaching them the process of decision making based on values formulation through genuine problem solving. Engle's recommendations for helping students to confront and comprehend today's complex issues…

Parent Decision-Making When Selecting Schools: The Case of Nepal

ERIC Educational Resources Information Center

Joshi, Priyadarshani

2014-01-01

This paper analyzes the parent decision-making processes underlying school selection in Nepal. The analysis is based on primary survey and focus group data collected from parent meetings in diverse local education markets in two districts of Nepal in 2011. It highlights three main arguments that are less frequently discussed in the context of…

Influencing Factors on Planning Decision-Making among Spanish In-Service Physical Education Teachers. A Population-Based Study

ERIC Educational Resources Information Center

Viciana, Jesús; Mayorga-Vega, Daniel

2017-01-01

Introduction: Traditionally, literature has contributed qualitative approaches for studying how to plan Physical Education (PE). To our knowledge there are not quantitative populationbased studies regarding the decision-making process among in-service Spanish PE teachers. The aim of this study was to analyze possible differences in the factors of…

Factors Influencing New Entrant Dairy Farmer's Decision-Making Process around Technology Adoption

ERIC Educational Resources Information Center

McDonald, Roberta; Heanue, Kevin; Pierce, Karina; Horan, Brendan

2016-01-01

Purpose: The aims of this paper are to (1) evaluate the main factors influencing grazing system technology adoption among new entrant (NE) dairy farmers within Europe and the Irish pasture-based dairy industry, and (2) to determine the extent to which economic factors influence decision-making around technology adoption and use among NEs to the…

Potential for Improved Crop Yield Prediction Through Assimilation of Satellite-Derived Soil Moisture Data

USDA-ARS?s Scientific Manuscript database

Crop yield estimates have a strong impact on dealing with food shortages and on market demand and supply; these estimates are critical for decision-making processes by the U.S. Government, policy makers, stakeholders, etc. Most of the decision making is based on forecasts provided by the U.S. Depart...

The Clinical Intuition Exploration Guide: A Decision-Making Tool for Counselors and Supervisors

ERIC Educational Resources Information Center

Jeffrey, Aaron

2012-01-01

Clinical intuition is a common experience among counselors, yet many do not know what to do with intuition when it occurs. This article reviews the role intuition plays in clinical work and presents the research-based Clinical Intuition Exploration Guide to help counselors navigate the decision-making process. The guide consists of self-reflection…

Multialternative drift-diffusion model predicts the relationship between visual fixations and choice in value-based decisions.

PubMed

Krajbich, Ian; Rangel, Antonio

2011-08-16

How do we make decisions when confronted with several alternatives (e.g., on a supermarket shelf)? Previous work has shown that accumulator models, such as the drift-diffusion model, can provide accurate descriptions of the psychometric data for binary value-based choices, and that the choice process is guided by visual attention. However, the computational processes used to make choices in more complicated situations involving three or more options are unknown. We propose a model of trinary value-based choice that generalizes what is known about binary choice, and test it using an eye-tracking experiment. We find that the model provides a quantitatively accurate description of the relationship between choice, reaction time, and visual fixation data using the same parameters that were estimated in previous work on binary choice. Our findings suggest that the brain uses similar computational processes to make binary and trinary choices.

Application of a web-based Decision Support System in risk management

NASA Astrophysics Data System (ADS)

Aye, Zar Chi; Jaboyedoff, Michel; Derron, Marc-Henri

2013-04-01

Increasingly, risk information is widely available with the help of advanced technologies such as earth observation satellites, global positioning technologies, coupled with hazard modeling and analysis, and geographical information systems (GIS). Even though it exists, no effort will be put into action if it is not properly presented to the decision makers. These information need to be communicated clearly and show its usefulness so that people can make better informed decision. Therefore, communicating available risk information has become an important challenge and decision support systems have been one of the significant approaches which can help not only in presenting risk information to the decision makers but also in making efficient decisions while reducing human resources and time needed. In this study, the conceptual framework of an internet-based decision support system is presented to highlight its importance role in risk management framework and how it can be applied in case study areas chosen. The main purpose of the proposed system is to facilitate the available risk information in risk reduction by taking into account of the changes in climate, land use and socio-economic along with the risk scenarios. It allows the users to formulate, compare and select risk reduction scenarios (mainly for floods and landslides) through an enhanced participatory platform with diverse stakeholders' involvement in the decision making process. It is based on the three-tier (client-server) architecture which integrates web-GIS plus DSS functionalities together with cost benefit analysis and other supporting tools. Embedding web-GIS provides its end users to make better planning and informed decisions referenced to a geographical location, which is the one of the essential factors in disaster risk reduction programs. Different risk reduction measures of a specific area (local scale) will be evaluated using this web-GIS tool, available risk scenarios obtained from Probabilistic Risk Assessment (PRA) model and the knowledge collected from experts. The visualization of the risk reduction scenarios can also be shared among the users on the web to support the on-line participatory process. In addition, cost-benefit ratios of the different risk reduction scenarios can be prepared in order to serve as inputs for high-level decision makers. The most appropriate risk reduction scenarios will be chosen using Multi-Criteria Evaluation (MCE) method by weighting different parameters according to the preferences and criteria defined by the users. The role of public participation has been changing from one-way communication between authorities, experts, stakeholders and citizens towards more intensive two-way interaction. Involving the affected public and interest groups can enhance the level of legitimacy, transparency, and confidence in the decision making process. Due to its important part in decision making, online participatory tool is included in the DSS in order to allow the involved stakeholders interactively in risk reduction and be aware of the existing vulnerability conditions of the community. Moreover, it aims to achieve a more transparent and better informed decision-making process. The system is under in progress and the first tools implemented will be presented showing the wide possibilities of new web technologies which can have a great impact on the decision making process. It will be applied in four pilot areas in Europe: French Alps, North Eastern Italy, Romania and Poland. Nevertheless, the framework will be designed and implemented in a way to be applicable in any other regions.

Toward an operational model of decision making, emotional regulation, and mental health impact.

PubMed

Collura, Thomas Francis; Zalaquett, Ronald P; Bonnstetter, Carlos Joyce; Chatters, Seria J

2014-01-01

Current brain research increasingly reveals the underlying mechanisms and processes of human behavior, cognition, and emotion. In addition to being of interest to a wide range of scientists, educators, and professionals, as well as laypeople, brain-based models are of particular value in a clinical setting. Psychiatrists, psychologists, counselors, and other mental health professionals are in need of operational models that integrate recent findings in the physical, cognitive, and emotional domains, and offer a common language for interdisciplinary understanding and communication. Based on individual traits, predispositions, and responses to stimuli, we can begin to identify emotional and behavioral pathways and mental processing patterns. The purpose of this article is to present a brain-path activation model to understand individual differences in decision making and psychopathology. The first section discusses the role of frontal lobe electroencephalography (EEG) asymmetry, summarizes state- and trait-based models of decision making, and provides a more complex analysis that supplements the traditional simple left-right brain model. Key components of the new model are the introduction of right hemisphere parallel and left hemisphere serial scanning in rendering decisions, and the proposition of pathways that incorporate both past experiences as well as future implications into the decision process. Main attributes of each decision-making mechanism are provided. The second section applies the model within the realm of clinical mental health as a tool to understand specific human behavior and pathology. Applications include general and chronic anxiety, depression, paranoia, risk taking, and the pathways employed when well-functioning operational integration is observed. Finally, specific applications such as meditation and mindfulness are offered to facilitate positive functioning.

Quantum-like dynamics of decision-making

NASA Astrophysics Data System (ADS)

Asano, Masanari; Basieva, Irina; Khrennikov, Andrei; Ohya, Masanori; Tanaka, Yoshiharu

2012-03-01

In cognitive psychology, some experiments for games were reported, and they demonstrated that real players did not use the “rational strategy” provided by classical game theory and based on the notion of the Nasch equilibrium. This psychological phenomenon was called the disjunction effect. Recently, we proposed a model of decision making which can explain this effect (“irrationality” of players) Asano et al. (2010, 2011) [23,24]. Our model is based on the mathematical formalism of quantum mechanics, because psychological fluctuations inducing the irrationality are formally represented as quantum fluctuations Asano et al. (2011) [55]. In this paper, we reconsider the process of quantum-like decision-making more closely and redefine it as a well-defined quantum dynamics by using the concept of lifting channel, which is an important concept in quantum information theory. We also present numerical simulation for this quantum-like mental dynamics. It is non-Markovian by its nature. Stabilization to the steady state solution (determining subjective probabilities for decision making) is based on the collective effect of mental fluctuations collected in the working memory of a decision maker.

The drift diffusion model as the choice rule in reinforcement learning.

PubMed

Pedersen, Mads Lund; Frank, Michael J; Biele, Guido

2017-08-01

Current reinforcement-learning models often assume simplified decision processes that do not fully reflect the dynamic complexities of choice processes. Conversely, sequential-sampling models of decision making account for both choice accuracy and response time, but assume that decisions are based on static decision values. To combine these two computational models of decision making and learning, we implemented reinforcement-learning models in which the drift diffusion model describes the choice process, thereby capturing both within- and across-trial dynamics. To exemplify the utility of this approach, we quantitatively fit data from a common reinforcement-learning paradigm using hierarchical Bayesian parameter estimation, and compared model variants to determine whether they could capture the effects of stimulant medication in adult patients with attention-deficit hyperactivity disorder (ADHD). The model with the best relative fit provided a good description of the learning process, choices, and response times. A parameter recovery experiment showed that the hierarchical Bayesian modeling approach enabled accurate estimation of the model parameters. The model approach described here, using simultaneous estimation of reinforcement-learning and drift diffusion model parameters, shows promise for revealing new insights into the cognitive and neural mechanisms of learning and decision making, as well as the alteration of such processes in clinical groups.

The drift diffusion model as the choice rule in reinforcement learning

PubMed Central

Frank, Michael J.

2017-01-01

Current reinforcement-learning models often assume simplified decision processes that do not fully reflect the dynamic complexities of choice processes. Conversely, sequential-sampling models of decision making account for both choice accuracy and response time, but assume that decisions are based on static decision values. To combine these two computational models of decision making and learning, we implemented reinforcement-learning models in which the drift diffusion model describes the choice process, thereby capturing both within- and across-trial dynamics. To exemplify the utility of this approach, we quantitatively fit data from a common reinforcement-learning paradigm using hierarchical Bayesian parameter estimation, and compared model variants to determine whether they could capture the effects of stimulant medication in adult patients with attention-deficit hyper-activity disorder (ADHD). The model with the best relative fit provided a good description of the learning process, choices, and response times. A parameter recovery experiment showed that the hierarchical Bayesian modeling approach enabled accurate estimation of the model parameters. The model approach described here, using simultaneous estimation of reinforcement-learning and drift diffusion model parameters, shows promise for revealing new insights into the cognitive and neural mechanisms of learning and decision making, as well as the alteration of such processes in clinical groups. PMID:27966103

Using real options analysis to support strategic management decisions

NASA Astrophysics Data System (ADS)

Kabaivanov, Stanimir; Markovska, Veneta; Milev, Mariyan

2013-12-01

Decision making is a complex process that requires taking into consideration multiple heterogeneous sources of uncertainty. Standard valuation and financial analysis techniques often fail to properly account for all these sources of risk as well as for all sources of additional flexibility. In this paper we explore applications of a modified binomial tree method for real options analysis (ROA) in an effort to improve decision making process. Usual cases of use of real options are analyzed with elaborate study on the applications and advantages that company management can derive from their application. A numeric results based on extending simple binomial tree approach for multiple sources of uncertainty are provided to demonstrate the improvement effects on management decisions.

Health technology funding decision-making processes around the world: the same, yet different.

PubMed

Stafinski, Tania; Menon, Devidas; Philippon, Donald J; McCabe, Christopher

2011-06-01

All healthcare systems routinely make resource allocation decisions that trade off potential health gains to different patient populations. However, when such trade-offs relate to the introduction of new, promising health technologies, perceived 'winners' and 'losers' are more apparent. In recent years, public scrutiny over such decisions has intensified, raising the need to better understand how they are currently made and how they might be improved. The objective of this paper is to critically review and compare current processes for making health technology funding decisions at the regional, state/provincial and national level in 20 countries. A comprehensive search for published, peer-reviewed and grey literature describing actual national, state/provincial and regional/institutional technology decision-making processes was conducted. Information was extracted by two independent reviewers and tabulated to facilitate qualitative comparative analyses. To identify strengths and weaknesses of processes identified, websites of corresponding organizations were searched for commissioned reviews/evaluations, which were subsequently analysed using standard qualitative methods. A total of 21 national, four provincial/state and six regional/institutional-level processes were found. Although information on each one varied, they could be grouped into four sequential categories: (i) identification of the decision problem; (ii) information inputs; (iii) elements of the decision-making process; and (iv) public accountability and decision implementation. While information requirements of all processes appeared substantial and decision-making factors comprehensive, the way in which they were utilized was often unclear, as were approaches used to incorporate social values or equity arguments into decisions. A comprehensive inventory of approaches to implementing the four main components of all technology funding decision-making processes was compiled, from which areas for future work or research aimed at improving the acceptability of decisions were identified. They include the explication of decision criteria and social values underpinning processes.

Logics of pre-merger decision-making processes: the case of Karolinska University Hospital.

PubMed

Choi, Soki; Brommels, Mats

2009-01-01

The purpose of this paper is to examine how and why a decision to merge two university hospitals in a public context might occur by using an in-depth case study of the pre-merger process of Karolinska University Hospital. Based on extensive document analysis and 35 key informant interviews the paper reconstructed the pre-merger process, searched for empirical patterns, and interpreted those by applying neo-institutional theory. Spanning nearly a decade, the pre-merger process goes from idea generation through transition to decision, and took place on two arenas, political, and scientific. Both research excellence and economic efficiency are stated merger motives. By applying a neo-institutional perspective, the paper finds that the two initial phases are driven by decision rationality, which is typical for political organizations and that the final phase demonstrated action rationality, which is typical for private firms. Critical factors behind this radical change of decision logic are means convergence, uniting key stakeholder groups, and an economic and political crisis, triggering critical incidents, which ultimately legitimized the formal decision. It is evident from the paper that merger decisions in the public sector might not necessarily result from stated and/or economic drivers only. This paper suggests that a change of decision logic from decision to action rationality might promote effective decision making on large and complex issues in a public context. This is the first systematic in-depth study of a university hospital merger employing a decision-making perspective.

Group assessment of key indicators of sustainable waste management in developing countries.

PubMed

Tot, Bojana; Vujić, Goran; Srđević, Zorica; Ubavin, Dejan; Russo, Mário Augusto Tavares

2017-09-01

Decision makers in developing countries are struggling to solve the present problems of solid waste management. Prioritisation and ranking of the most important indicators that influence the waste management system is very useful for any decision maker for the future planning and implementation of a sustainable waste management system. The aim of this study is to evaluate key indicators and their related sub-indicators in a group decision-making environment. In order to gain insight into the subject it was necessary to obtain the qualified opinions of decision makers from different countries who understand the situation in the sector of waste management in developing countries. An assessment is performed by 43 decision makers from both developed and developing countries, and the applied methodology is based on a combined use of the analytic hierarchy process, from the multi-criteria decision-making set of tools, and the preferential voting method known as Borda Count, which belongs to social choice theory. Pairwise comparison of indicators is performed with the analytic hierarchy process, and the ranking of indicators once obtained is assessed with Borda Count. Detailed analysis of the final results showed that the Institutional-Administrative indicator was the most important one, with the maximum weight as derived by both groups of decision makers. The results also showed that the combined use of the analytic hierarchy process and Borda Count contributes to the credibility and objectivity of the decision-making process, allowing its use in more complex waste management group decision-making problems to be recommended.

Communication-based behaviour support for adults with intellectual disabilities receiving dental care: A focus group study exploring dentists' decision-making and communication.

PubMed

Phadraig, Caoimhin Mac Giolla; Griffiths, Colin; McCallion, Philip; McCarron, Mary; Nunn, June

2017-01-01

A better understanding of how communication-based behaviour supports are applied with adults with intellectual disabilities may reduce reliance on restrictive practices such as holding, sedation and anaesthesia in dentistry. In this study, we explore how communication is used by dentists who provide treatment for adults with intellectual disabilities. A descriptive qualitative study, adopting synchronous online focus groups, was undertaken with six expert dentists in Ireland. Members were contacted again in pairs or individually for further data collection, analysed using thematic content analysis. Two relevant categories emerged from the data, relating to the selection and application of communication-based behaviour support for adults with intellectual disabilities. Decision-making processes were explored. Building on these categories, a co-regulating process of communication emerged as the means by which dentists iteratively apply and adapt communicative strategies. This exploration revealed rationalist and intuitive decision-making. Implications for education, practice and research are identified.

Call for shared decision making in China: Challenges and opportunities.

PubMed

Yao, Mi; Finnikin, Samuel; Cheng, K K

2017-06-01

China's healthcare system has undergone extensive changes over recent years and the most recent reforms are designed to shift the emphasis away from hospital based services towards a more primary care based system. There is an increasing recognition that shared decision making needs to play a central role in the delivery of healthcare in China, but there are several significant barriers to overcome before this aspiration becomes a reality. Doctor-patient relationships in China are poor, consultations are often brief transactions and levels of trust are low. Implementing a shared decision making process developed in the Western World may be hampered by cultural differences, although this remains an under-researched area. There is, however, a suggestion that the academic community is starting to take an interest in encouraging shared decision making in practice and indications that the Chinese public may be willing to consider this new approach to healthcare. Copyright © 2017. Published by Elsevier GmbH.

Using the Reliability Theory for Assessing the Decision Confidence Probability for Comparative Life Cycle Assessments.

PubMed

Wei, Wei; Larrey-Lassalle, Pyrène; Faure, Thierry; Dumoulin, Nicolas; Roux, Philippe; Mathias, Jean-Denis

2016-03-01

Comparative decision making process is widely used to identify which option (system, product, service, etc.) has smaller environmental footprints and for providing recommendations that help stakeholders take future decisions. However, the uncertainty problem complicates the comparison and the decision making. Probability-based decision support in LCA is a way to help stakeholders in their decision-making process. It calculates the decision confidence probability which expresses the probability of a option to have a smaller environmental impact than the one of another option. Here we apply the reliability theory to approximate the decision confidence probability. We compare the traditional Monte Carlo method with a reliability method called FORM method. The Monte Carlo method needs high computational time to calculate the decision confidence probability. The FORM method enables us to approximate the decision confidence probability with fewer simulations than the Monte Carlo method by approximating the response surface. Moreover, the FORM method calculates the associated importance factors that correspond to a sensitivity analysis in relation to the probability. The importance factors allow stakeholders to determine which factors influence their decision. Our results clearly show that the reliability method provides additional useful information to stakeholders as well as it reduces the computational time.

A software development and evolution model based on decision-making

NASA Technical Reports Server (NTRS)

Wild, J. Christian; Dong, Jinghuan; Maly, Kurt

1991-01-01

Design is a complex activity whose purpose is to construct an artifact which satisfies a set of constraints and requirements. However the design process is not well understood. The software design and evolution process is the focus of interest, and a three dimensional software development space organized around a decision-making paradigm is presented. An initial instantiation of this model called 3DPM(sub p) which was partly implemented, is presented. Discussion of the use of this model in software reuse and process management is given.

Decision-making process of Kala Azar care: results from a qualitative study carried out in disease endemic areas of Nepal

PubMed Central

2013-01-01

Background Analysis of consumer decision making in the health sector is a complex process of comparing feasible alternatives and evaluating the levels of satisfaction associated with the relevant options. This paper makes an attempt to understand how and why consumers make specific decisions, what motivates them to adopt a specific health intervention, and what features they find attractive in each of the options. Method The study used a descriptive-explanatory design to analyze the factors determining the choices of healthcare providers. Information was collected through focus group discussions and in-depth interviews. Results The results suggest that the decision making related to seeking healthcare for Kala Azar (KA) treatment is a complex, interactive process. Patients and family members follow a well-defined road map for decision making. The process of decision making starts from the recognition of healthcare needs and is then modified by a number of other factors, such as indigenous knowledge, healthcare alternatives, and available resources. Household and individual characteristics also play important roles in facilitating the process of decision making. The results from the group discussions and in-depth interviews are consistent with the idea that KA patients and family members follow the rational approach of weighing the costs against the benefits of using specific types of medical care. Conclusion The process of decision making related to seeking healthcare follows a complex set of steps and many of the potential factors affect the decision making in a non-linear fashion. Our analysis suggests that it is possible to derive a generalized road map of the decision-making process starting from the recognition of healthcare needs, and then modifying it to show the influences of indigenous knowledge, healthcare alternatives, and available resources. PMID:23849617

Decision-making process of Kala Azar care: results from a qualitative study carried out in disease endemic areas of Nepal.

PubMed

Adhikari, Shiva Raj; Supakankunti, Siripen; Khan, M Mahmud

2013-07-12

Analysis of consumer decision making in the health sector is a complex process of comparing feasible alternatives and evaluating the levels of satisfaction associated with the relevant options. This paper makes an attempt to understand how and why consumers make specific decisions, what motivates them to adopt a specific health intervention, and what features they find attractive in each of the options. The study used a descriptive-explanatory design to analyze the factors determining the choices of healthcare providers. Information was collected through focus group discussions and in-depth interviews. The results suggest that the decision making related to seeking healthcare for Kala Azar (KA) treatment is a complex, interactive process. Patients and family members follow a well-defined road map for decision making. The process of decision making starts from the recognition of healthcare needs and is then modified by a number of other factors, such as indigenous knowledge, healthcare alternatives, and available resources. Household and individual characteristics also play important roles in facilitating the process of decision making. The results from the group discussions and in-depth interviews are consistent with the idea that KA patients and family members follow the rational approach of weighing the costs against the benefits of using specific types of medical care. The process of decision making related to seeking healthcare follows a complex set of steps and many of the potential factors affect the decision making in a non-linear fashion. Our analysis suggests that it is possible to derive a generalized road map of the decision-making process starting from the recognition of healthcare needs, and then modifying it to show the influences of indigenous knowledge, healthcare alternatives, and available resources.

Controlling Chronic Diseases Through Evidence-Based Decision Making: A Group-Randomized Trial.

PubMed

Brownson, Ross C; Allen, Peg; Jacob, Rebekah R; deRuyter, Anna; Lakshman, Meenakshi; Reis, Rodrigo S; Yan, Yan

2017-11-30

Although practitioners in state health departments are ideally positioned to implement evidence-based interventions, few studies have examined how to build their capacity to do so. The objective of this study was to explore how to increase the use of evidence-based decision-making processes at both the individual and organization levels. We conducted a 2-arm, group-randomized trial with baseline data collection and follow-up at 18 to 24 months. Twelve state health departments were paired and randomly assigned to intervention or control condition. In the 6 intervention states, a multiday training on evidence-based decision making was conducted from March 2014 through March 2015 along with a set of supplemental capacity-building activities. Individual-level outcomes were evidence-based decision making skills of public health practitioners; organization-level outcomes were access to research evidence and participatory decision making. Mixed analysis of covariance models was used to evaluate the intervention effect by accounting for the cluster randomized trial design. Analysis was performed from March through May 2017. Participation 18 to 24 months after initial training was 73.5%. In mixed models adjusted for participant and state characteristics, the intervention group improved significantly in the overall skill gap (P = .01) and in 6 skill areas. Among the 4 organizational variables, only access to evidence and skilled staff showed an intervention effect (P = .04). Tailored and active strategies are needed to build capacity at the individual and organization levels for evidence-based decision making. Our study suggests several dissemination interventions for consideration by leaders seeking to improve public health practice.

Data-Based Decision Making in Education: Challenges and Opportunities

ERIC Educational Resources Information Center

Schildkamp, Kim, Ed.; Lai, Mei Kuin, Ed.; Earl, Lorna, Ed.

2013-01-01

In a context where schools are held more and more accountable for the education they provide, data-based decision making has become increasingly important. This book brings together scholars from several countries to examine data-based decision making. Data-based decision making in this book refers to making decisions based on a broad range of…

Family Communication about End-of-Life Decisions and the Enactment of the Decision-Maker Role.

PubMed

Trees, April R; Ohs, Jennifer E; Murray, Meghan C

2017-06-07

End-of-life (EOL) decisions in families are complex and emotional sites of family interaction necessitating family members coordinate roles in the EOL decision-making process. How family members in the United States enact the decision-maker role in EOL decision situations was examined through in-depth interviews with 22 individuals who participated in EOL decision-making for a family member. A number of themes emerged from the data with regard to the enactment of the decision-maker role. Families varied in how decision makers enacted the role in relation to collective family input, with consulting, informing and collaborating as different patterns of behavior. Formal family roles along with gender- and age-based roles shaped who took on the decision-maker role. Additionally, both family members and medical professionals facilitated or undermined the decision-maker's role enactment. Understanding the structure and enactment of the decision-maker role in family interaction provides insight into how individuals and/or family members perform the decision-making role within a cultural context that values autonomy and self-determination in combination with collective family action in EOL decision-making.

Configural displays can improve nutrition-related. decisions: an application of the proximity compatibility principle.

PubMed

Marino, Christopher J; Mahan, Robert R

2005-01-01

The nutrition label format currently used by consumers to make dietary-related decisions presents significant information-processing demands for integration-based decisions; however, those demands were not considered as primary factors when the format was adopted. Labels designed in accordance with known principles of cognitive psychology might enhance the kind of decision making that food labeling was intended to facilitate. Three experiments were designed on the basis of the proximity compatibility principle (PCP) to investigate the relationship between nutrition label format and decision making; the experiments involved two types of integration decisions and one type of filtering decision. Based on the PCP, decision performance was measured to test the overall hypothesis that matched task-display tandems would result in better decision performance than would mismatched tandems. In each experiment, a statistically significant increase in mean decision performance was found when the display design was cognitively matched to the demands of the task. Combined, the results from all three experiments support the general hypothesis that task-display matching is a design principle that may enhance the utility of nutrition labeling in nutrition-related decision making. Actual or potential applications of this research include developing robust display solutions that aid in less effortful assimilation of nutrition-related information for consumers.

Impact of Participation in Decision Making on Job Satisfaction: An Organizational Communication Perspective.

PubMed

Xia, Ying; Zhang, Li; Zhao, Ning

2016-09-20

Participation in organizational decision-making has received considerable attention from scholars. Beyond the perspectives proposed in past studies, we offer a new account, based upon a communication perspective, to explain why and when participation in decision-making can influence job satisfaction. Drawing from social capital theory, we examine whether communication openness mediates the relationship between participation in decision-making and job satisfaction. We also investigate how information adequacy moderates this mediated process. Results from a sample of 184 employees in China showed that the four-factor model was the best fitting solution (CFI = .91, GFI = .90, RMSEA = .09). The analyses indicated that employees' participation in decision-making positively affected their job satisfaction (β = .32, p < .001), and the effect was mediated by communication openness (direct effect became non-significant when communication openness was included: β = .06, n.s.). Results also found that decision-making information adequacy positively moderated the relationship between participation in decision-making and communication openness (β = .13, p < .05). Thus, open communication and the free flow of information within organizations should be encouraged.

10 CFR 820.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the person, or his designee, in charge of making a decision under this part. Enforcement adjudication means the portion of the enforcement process that commences when a respondent requests an on-the-record... Decision means the decision filed by the Presiding Officer based upon the record of the enforcement...

Chimpanzees and Bonobos Exhibit Emotional Responses to Decision Outcomes

PubMed Central

Rosati, Alexandra G.; Hare, Brian

2013-01-01

The interface between cognition, emotion, and motivation is thought to be of central importance in understanding complex cognitive functions such as decision-making and executive control in humans. Although nonhuman apes have complex repertoires of emotional expression, little is known about the role of affective processes in ape decision-making. To illuminate the evolutionary origins of human-like patterns of choice, we investigated decision-making in humans' closest phylogenetic relatives, chimpanzees (Pan troglodytes) and bonobos (Pan paniscus). In two studies, we examined these species' temporal and risk preferences, and assessed whether apes show emotional and motivational responses in decision-making contexts. We find that (1) chimpanzees are more patient and more risk-prone than are bonobos, (2) both species exhibit affective and motivational responses following the outcomes of their decisions, and (3) some emotional and motivational responses map onto species-level and individual-differences in decision-making. These results indicate that apes do exhibit emotional responses to decision-making, like humans. We explore the hypothesis that affective and motivational biases may underlie the psychological mechanisms supporting value-based preferences in these species. PMID:23734175

Colorectal cancer patients' attitudes towards involvement in decision making.

PubMed

Beaver, Kinta; Campbell, Malcolm; Craven, Olive; Jones, David; Luker, Karen A; Susnerwala, Shabbir S

2009-03-01

To design and administer an attitude rating scale, exploring colorectal cancer patients' views of involvement in decision making. To examine the impact of socio-demographic and/or treatment-related factors on decision making. To conduct principal components analysis to determine if the scale could be simplified into a number of factors for future clinical utility. An attitude rating scale was constructed based on previous qualitative work and administered to colorectal cancer patients using a cross-sectional survey approach. 375 questionnaires were returned (81.7% response). For patients it was important to be informed and involved in the decision-making process. Information was not always used to make decisions as patients placed their trust in medical expertise. Women had more positive opinions on decision making and were more likely to want to make decisions. Written information was understood to a greater degree than verbal information. The scale could be simplified to a number of factors, indicating clinical utility. Few studies have explored the attitudes of colorectal cancer patients towards involvement in decision making. This study presents new insights into how patients view the concept of participation; important when considering current policy imperatives in the UK of involving service users in all aspects of care and treatment.

How Critical Thinking Shapes the Military Decision Making Process

DTIC Science & Technology

2004-05-17

emotional rebuttal. Conversely, people cannot make good rational decisions without at least a twinge of emotion attached to the decision . 2) Our minds... decision they make . If emotions overwhelm reason, then decisions should be postponed.27 Service biases are one of the strongest emotional bias. Any...FINAL 3. DATES COVERED (From - To) 4. TITLE AND SUBTITLE How Critical Thinking Shapes the Military Decision Making Process 5a. CONTRACT