Factors influencing the surgical decision for the treatment of degenerative lumbar stenosis in a preference-based shared decision-making process.

PubMed

Kim, Ho-Joong; Park, Jae-Young; Kang, Kyoung-Tak; Chang, Bong-Soon; Lee, Choon-Ki; Yeom, Jin S

2015-02-01

In a preference-based shared decision-making system, several subjective and/or objective factors such as pain severity, degree of disability, and the radiological severity of canal stenosis may influence the final surgical decision for the treatment of lumbar spinal stenosis (LSS). However, our understanding of the shared decision-making process and the significance of each factor remain primitive. In the present study, we aimed to investigate which factors influence the surgical decision for the treatment of LSS when using a preference-based, shared decision-making process. We included 555 patients, aged 45-80 years, who used a preference-based shared decision-making process and were treated conservatively or surgically for chronic leg and/or back pain caused by LSS from April 2012 to December 2012. Univariate and multivariable-adjusted logistic regression analyses were used to assess the association of surgical decision making with age, sex, body mass index, symptom duration, radiologic stenotic grade, Oswestry Disability Index (ODI), visual analog scale (VAS) scores for back and leg pain, Short Form-36 (SF-36) subscales, and motor weakness. In univariate analysis, the following variables were associated with a higher odds of a surgical decision for LSS: male sex; the VAS score for leg pain; ODI; morphological stenotic grades B, C, and D; motor weakness; and the physical function, physical role, bodily pain, social function, and emotional role of the SF-36 subscales. Multivariate analysis revealed that male sex, ODI, morphological stenotic grades C and D, and motor weakness were significantly associated with a higher possibility of a surgical decision. Motor weakness, male sex, morphological stenotic grade, and the amount of disability are critical factors leading to a surgical decision for LSS when using a preference-based shared decision-making process.

Non-medical influences on medical decision-making.

PubMed

McKinlay, J B; Potter, D A; Feldman, H A

1996-03-01

The influence of non-medical factors on physicians' decision-making has been documented in many observational studies, but rarely in an experimental setting capable of demonstrating cause and effect. We conducted a controlled factorial experiment to assess the influence of non-medical factors on the diagnostic and treatment decisions made by practitioners of internal medicine in two common medical situations. One hundred and ninety-two white male internists individually viewed professionally produced video scenarios in which the actor-patient, presenting with either chest pain or dyspnea, possessed various balanced combinations of sex, race, age, socioeconomic status, and health insurance coverage. Physician subjects were randomly drawn from lists of internists in private practice, hospital-based practice, and HMO's, at two levels of experience. The most frequent diagnoses for both chest pain and dyspnea were psychogenic origin and cardiac problems. Smoking cessation was the most frequent treatment recommendation for both conditions. Younger patients (all other factors being the same) were significantly more likely to receive the psychogenic diagnosis. Older patients were more likely to receive the cardiac diagnosis for chest pain, particularly if they were insured. HMO-based physicians were more likely to recommend a follow-up visit for chest pain. Several interactions of patient and physician factors were significant in addition to the main effects. The variability in decision-making evidenced by physicians in this experiment was not entirely accounted for by strictly rational Bayesian inference (the common prescriptive model for medical decision-making), in-as-much as non-medical factors significantly affected the decisions that they made. There is a need to supplement idealized medical schemata with considerations of social behavior in any comprehensive theory of medical decision-making.

Social Influences in Sequential Decision Making

PubMed Central

Schöbel, Markus; Rieskamp, Jörg; Huber, Rafael

2016-01-01

People often make decisions in a social environment. The present work examines social influence on people’s decisions in a sequential decision-making situation. In the first experimental study, we implemented an information cascade paradigm, illustrating that people infer information from decisions of others and use this information to make their own decisions. We followed a cognitive modeling approach to elicit the weight people give to social as compared to private individual information. The proposed social influence model shows that participants overweight their own private information relative to social information, contrary to the normative Bayesian account. In our second study, we embedded the abstract decision problem of Study 1 in a medical decision-making problem. We examined whether in a medical situation people also take others’ authority into account in addition to the information that their decisions convey. The social influence model illustrates that people weight social information differentially according to the authority of other decision makers. The influence of authority was strongest when an authority's decision contrasted with private information. Both studies illustrate how the social environment provides sources of information that people integrate differently for their decisions. PMID:26784448

Social Influences in Sequential Decision Making.

PubMed

Schöbel, Markus; Rieskamp, Jörg; Huber, Rafael

2016-01-01

People often make decisions in a social environment. The present work examines social influence on people's decisions in a sequential decision-making situation. In the first experimental study, we implemented an information cascade paradigm, illustrating that people infer information from decisions of others and use this information to make their own decisions. We followed a cognitive modeling approach to elicit the weight people give to social as compared to private individual information. The proposed social influence model shows that participants overweight their own private information relative to social information, contrary to the normative Bayesian account. In our second study, we embedded the abstract decision problem of Study 1 in a medical decision-making problem. We examined whether in a medical situation people also take others' authority into account in addition to the information that their decisions convey. The social influence model illustrates that people weight social information differentially according to the authority of other decision makers. The influence of authority was strongest when an authority's decision contrasted with private information. Both studies illustrate how the social environment provides sources of information that people integrate differently for their decisions.

Understanding Risky Behavior: The Influence of Cognitive, Emotional and Hormonal Factors on Decision-Making under Risk

PubMed Central

Kusev, Petko; Purser, Harry; Heilman, Renata; Cooke, Alex J.; Van Schaik, Paul; Baranova, Victoria; Martin, Rose; Ayton, Peter

2017-01-01

Financial risky decisions and evaluations pervade many human everyday activities. Scientific research in such decision-making typically explores the influence of socio-economic and cognitive factors on financial behavior. However, very little research has explored the holistic influence of contextual, emotional, and hormonal factors on preferences for risk in insurance and investment behaviors. Accordingly, the goal of this review article is to address the complexity of individual risky behavior and its underlying psychological factors, as well as to critically examine current regulations on financial behavior. PMID:28203215

Understanding Risky Behavior: The Influence of Cognitive, Emotional and Hormonal Factors on Decision-Making under Risk.

PubMed

Kusev, Petko; Purser, Harry; Heilman, Renata; Cooke, Alex J; Van Schaik, Paul; Baranova, Victoria; Martin, Rose; Ayton, Peter

2017-01-01

Financial risky decisions and evaluations pervade many human everyday activities. Scientific research in such decision-making typically explores the influence of socio-economic and cognitive factors on financial behavior. However, very little research has explored the holistic influence of contextual, emotional, and hormonal factors on preferences for risk in insurance and investment behaviors. Accordingly, the goal of this review article is to address the complexity of individual risky behavior and its underlying psychological factors, as well as to critically examine current regulations on financial behavior.

An Investigation of Factors Influencing Nurses' Clinical Decision-Making Skills.

PubMed

Wu, Min; Yang, Jinqiu; Liu, Lingying; Ye, Benlan

2016-08-01

This study aims to investigate the influencing factors on nurses' clinical decision-making (CDM) skills. A cross-sectional nonexperimental research design was conducted in the medical, surgical, and emergency departments of two university hospitals, between May and June 2014. We used a quantile regression method to identify the influencing factors across different quantiles of the CDM skills distribution and compared the results with the corresponding ordinary least squares (OLS) estimates. Our findings revealed that nurses were best at the skills of managing oneself. Educational level, experience, and the total structural empowerment had significant positive impacts on nurses' CDM skills, while the nurse-patient relationship, patient care and interaction, formal empowerment, and information empowerment were negatively correlated with nurses' CDM skills. These variables explained no more than 30% of the variance in nurses' CDM skills and mainly explained the lower quantiles of nurses' CDM skills distribution. © The Author(s) 2016.

Community ambulation: influences on therapists and clients reasoning and decision making.

PubMed

Corrigan, Rosemary; McBurney, Helen

2008-01-01

Community ambulation is an important element of a rehabilitation training programme and its achievement is a goal shared by rehabilitation professionals and clients. The factors that influence a physiotherapist's or health professionals decision making around the preparation of a client for community ambulation and the factors that influence a client's decision to return to walking in their community are unclear. To review the available literature about the factors that have influenced the reasoning and decision making of rehabilitation therapists and clients around the topic of ambulation in the community. Three separate searches of the available literature were undertaken using Ovid, Cinahl, ProQuest, Medline and Ebscohost databases. Databases were searched from 1966 to October 2006.The first search explored the literature for factors that influence the clinical reasoning of rehabilitation therapists. The second search explored the literature for factors that influence client's decision to ambulate in the community. A third search was undertaken to explore the literature for the demands of community ambulation in rural communities. Very few studies were found that explored community ambulation in the context of clinical reasoning and decision making, the facilitators and barriers to a clients return to ambulation in their community or the demands of ambulation in a rural community. Consideration of the environment is key to the successful return to walking in the community of clients with mobility problems yet little literature has been found to guide physiotherapist's decision making about preparing a clients to return to walking in the community. An individual's participation in their society is also a result of the interaction between their personal characteristics and his or her environment. The influence of these characteristics may vary from one individual to another yet the factors that influence a person's decision to return to walking in their community

Intrinsic Factors Influencing Decision making of Arbitrators in Dispute Resolution of variation Claims

NASA Astrophysics Data System (ADS)

Iyer, K. C.; Chaphalkar, N. B.; Patil, Smita K.

2018-06-01

Occurrence of disputes is a common feature in construction contracts. Adjudication of disputes through the arbitration process involves detailed and through analysis of facts and evidences related to the case before arriving at the final decision. These facts and evidences have been explored by researchers to develop dispute resolution mechanisms. As a part of the research, the present work identifies the factors which influence the decision making of arbitrators in resolving disputes through a case study of 72 arbitration awards and settled court cases related to Indian construction contracts. This work further seeks consensus for the identified factors from experts and also ranks the factors based on their importance with the help of the responses obtained through a questionnaire survey and statistical tests.

Selecting a provider: what factors influence patients' decision making?

PubMed

Abraham, Jean; Sick, Brian; Anderson, Joseph; Berg, Andrea; Dehmer, Chad; Tufano, Amanda

2011-01-01

Each year consumers make a variety of decisions relating to their healthcare. Some experts argue that stronger consumer engagement in decisions about where to obtain medical care is an important mechanism for improving efficiency in healthcare delivery and financing. Consumers' ability and motivation to become more active decision makers are affected by several factors, including financial incentives and access to information. This study investigates the set of factors that consumers consider when selecting a provider, including attributes of the provider and the care experience and the reputation of the provider. Additionally, the study evaluates consumers awareness and use of formal sources of provider selection information. Our results from analyzing data from a survey of 467 patients at four clinics in Minnesota suggest that the factors considered of greatest importance include reputation of the physician and reputation of the healthcare organization. Contractual and logistical factors also play a role, with respondents highlighting the importance of seeing a provider affiliated with their health plan and appointment availability. Few respondents indicated that advertisements or formal sources of quality information affected their decision making. The key implication for provider organizations is to carefully manage referral sources to ensure that they consistently meet the needs of referrers. Excellent service to existing patients and to the network of referring physicians yields patient and referrer satisfaction that is critical to attracting new patients. Finally, organizations more generally may want to explore the capabilities of new media and social networking sites for building reputation.

The decision-making threshold and the factors that affect it: A qualitative study of patients' decision-making in knee replacement surgery.

PubMed

Barlow, T; Scott, P; Thomson, L; Griffin, D; Realpe, A

2018-03-01

Osteoarthritis is a significant cause of burden to the ageing population and knee replacement is a common operation for treatment of end-stage disease. We aimed to explore these factors to help understand patients' decision-making, which is critical in informing patient-centred care. These can be used to enhance decision-making and dialogue between clinicians and patients, allowing a more informed choice. The study consisted of two focus groups, in a patient cohort after total knee replacement followed by more in-depth interviews to further test and explore themes from the focus groups, in patients in either the deliberation stage or the decision-making stage. Using qualitative research methods (iterative thematic analysis) reviewing decision-making and deliberation phases of making informed choices we found nine key themes that emerged from the study groups. An awareness of the deliberation phase, the factors that influence it, the stress associated with it, preferred models of care, and the influence of the decision-making threshold will aid useful communication between doctors and patients. Copyright © 2017 John Wiley & Sons, Ltd.

Teachers' Grading Decision Making: Multiple Influencing Factors and Methods

ERIC Educational Resources Information Center

Cheng, Liying; Sun, Youyi

2015-01-01

This study investigated Chinese secondary school English language teachers' grading decision making, focusing on the factors they considered and types of assessment they used for grading. A questionnaire was issued to 350 secondary school English language teachers in China. Descriptive analyses of the questionnaire data showed that these teachers…

Factors influencing elderly women's mammography screening decisions: implications for counseling.

PubMed

Schonberg, Mara A; McCarthy, Ellen P; York, Meghan; Davis, Roger B; Marcantonio, Edward R

2007-11-16

Although guidelines recommend that clinicians consider life expectancy before screening older women for breast cancer, many older women with limited life expectancies are screened. We aimed to identify factors important to mammography screening decisions among women aged 80 and older compared to women aged 65-79. Telephone surveys of 107 women aged 80+ and 93 women aged 65-79 randomly selected from one academic primary care practice who were able to communicate in English (60% response rate). The survey addressed the following factors in regards to older women's mammography screening decisions: perceived importance of a history of breast disease, family history of breast cancer, doctor's recommendations, habit, reassurance, previous experience, mailed reminder cards, family/friend's recommendations or experience with breast cancer, age, health, and media. The survey also assessed older women's preferred role in decision making around mammography screening. Of the 200 women, 65.5% were non-Hispanic white and 82.8% were in good to excellent health. Most (81.3%) had undergone mammography in the past 2 years. Regardless of age, older women ranked doctor's recommendations as the most important factor influencing their decision to get screened. Habit and reassurance were the next two highly ranked factors influencing older women to get screened. Among women who did not get screened, women aged 80 and older ranked age and doctor's counseling as the most influential factors and women aged 65-79 ranked a previous negative experience with mammography as the most important factor. There were no significant differences in preferred role in decision-making around mammography screening by age, however, most women in both age groups preferred to make the final decision on their own (46.6% of women aged 80+ and 50.5% of women aged 65-79). While a doctor's recommendation is the most important factor influencing elderly women's mammography screening decisions, habit and reassurance

Parental influences on adolescent decision making and contraceptive use.

PubMed

Commendador, Kathleen A

2010-01-01

This article reviews the literature in the area of parental and maternal influences on contraceptive decision making, thus determining future directions of research and potential interventions. A review of published literature using PubMed, CINAHL, Infotrak, Science and Technology, and Medline spanning 1980-2007 was used to gather information. Results from 35 research studies and 15 scholarly articles were included. The search terms adolescent decision making, maternal influences on adolescent contraceptive decision making, adolescent contraceptive decision making, paternal influences on adolescent decision making, and contraception were used to gather data. The literature reveals there is an association between parental communication, parenting style, and adolescent sexual activity and contraception use. Maternal communication has been shown to delay sexual intercourse and increase contraceptive use. Maternal communication has rich potential as an intervention to impact positive adolescent sexual decision making and contraception use. Gaps in the research identified were the lack of studies on the influences on parenting style and the father/adolescent influences on sexual initiation and contraceptive decision making.

Understanding the factors that influence breast reconstruction decision making in Australian women.

PubMed

Somogyi, Ron Barry; Webb, Angela; Baghdikian, Nairy; Stephenson, John; Edward, Karen-Leigh; Morrison, Wayne

2015-04-01

Breast reconstruction is safe and improves quality of life. Despite this, many women do not undergo breast reconstruction and the reasons for this are poorly understood. This study aims to identify the factors that influence a woman's decision whether or not to have breast reconstruction and to better understand their attitudes toward reconstruction. An online survey was distributed to breast cancer patients from Breast Cancer Network Australia. Results were tabulated, described qualitatively and analyzed for significance using a multiple logistic regression model. 501 mastectomy patients completed surveys, of which 62% had undergone breast reconstruction. Factors that positively influenced likelihood of reconstruction included lower age, bilateral mastectomy, access to private hospitals, decreased home/work responsibilities, increased level of home support and early discussion of reconstructive options. Most common reasons for avoiding reconstruction included "I don't feel the need" and "I don't want more surgery". The most commonly sited sources of reconstruction information came from the breast surgeon followed by the plastic surgeon then the breast cancer nurse and the most influential of these was the plastic surgeon. A model using factors easily obtained on clinical history can be used to understand likelihood of reconstruction. This knowledge may help identify barriers to reconstruction, ultimately improving the clinicians' ability to appropriately educate mastectomy patients and ensure effective decision making around breast reconstruction. Copyright © 2014 Elsevier Ltd. All rights reserved.

Qualitatively Assessing Family Influence in Career Decision Making

ERIC Educational Resources Information Center

Chope, Robert C.

2005-01-01

Assessing influential factors in the family relative to career decision making is consistent with evolving postmodern approaches to career counseling. However, the challenge of measuring family influence is technically demanding considering the ongoing revolutionary changes in the structure of the family. Moreover, while measuring the impact of…

[Factors behind action, emotion, and decision making].

PubMed

Watanabe, Katsumi

2009-12-01

Human actions, emotions, and decision making are products of complex interactions between explicit and implicit processes at various levels of spatial and temporal scales. Although it may not be possible to obtain to experimental data for all the complexity of human behavioral and emotional processes in our everyday life, recent studies have investigated the effects of social contexts on actions, emotions, and decision making; these studies include those in the fields of experimental psychology, cognitive science, and neuroscience. In this paper, we review several empirical studies that exemplify how our actions, social emotions, and decision making are influenced by the presence of implicit external, rather than internal factors, particularly by presence of other individuals. The following are the main principles identified. (1) Unconscious behavioral contagion: Individuals tend to mimic others' actions. This tendency occurs unconsciously even when the observed and the to-be-executed movements are unrelated at various levels and aspects of behaviors (e. g., behavioral tempo and speed). (2) Neural substrates of social emotions: Various social emotions, including admiration, compassion, envy, and schadenfreude, are represented in neuronal networks that are similar to those of basic emotional processes. (3) Evasive nature of human decision making: Individuals tend to overrate their own subjective impression of and emotional reaction in forecasting affective reaction to events in the future, even though the predictive power of information from peer group is much larger in this regard. Individuals are seldom aware of the dissociation between their intended choice and excuted actions and are willing to give elaborate explanations for the choices they, in fact, did not make. Using these empirical examples, I will illustrate the considerable influences of implicit, unconscious processes on human actions, emotions, and decision making.

Embodied Choice: How Action Influences Perceptual Decision Making

PubMed Central

Lepora, Nathan F.; Pezzulo, Giovanni

2015-01-01

Embodied Choice considers action performance as a proper part of the decision making process rather than merely as a means to report the decision. The central statement of embodied choice is the existence of bidirectional influences between action and decisions. This implies that for a decision expressed by an action, the action dynamics and its constraints (e.g. current trajectory and kinematics) influence the decision making process. Here we use a perceptual decision making task to compare three types of model: a serial decision-then-action model, a parallel decision-and-action model, and an embodied choice model where the action feeds back into the decision making. The embodied model incorporates two key mechanisms that together are lacking in the other models: action preparation and commitment. First, action preparation strategies alleviate delays in enacting a choice but also modify decision termination. Second, action dynamics change the prospects and create a commitment effect to the initially preferred choice. Our results show that these two mechanisms make embodied choice models better suited to combine decision and action appropriately to achieve suitably fast and accurate responses, as usually required in ecologically valid situations. Moreover, embodied choice models with these mechanisms give a better account of trajectory tracking experiments during decision making. In conclusion, the embodied choice framework offers a combined theory of decision and action that gives a clear case that embodied phenomena such as the dynamics of actions can have a causal influence on central cognition. PMID:25849349

Embodied choice: how action influences perceptual decision making.

PubMed

Lepora, Nathan F; Pezzulo, Giovanni

2015-04-01

Embodied Choice considers action performance as a proper part of the decision making process rather than merely as a means to report the decision. The central statement of embodied choice is the existence of bidirectional influences between action and decisions. This implies that for a decision expressed by an action, the action dynamics and its constraints (e.g. current trajectory and kinematics) influence the decision making process. Here we use a perceptual decision making task to compare three types of model: a serial decision-then-action model, a parallel decision-and-action model, and an embodied choice model where the action feeds back into the decision making. The embodied model incorporates two key mechanisms that together are lacking in the other models: action preparation and commitment. First, action preparation strategies alleviate delays in enacting a choice but also modify decision termination. Second, action dynamics change the prospects and create a commitment effect to the initially preferred choice. Our results show that these two mechanisms make embodied choice models better suited to combine decision and action appropriately to achieve suitably fast and accurate responses, as usually required in ecologically valid situations. Moreover, embodied choice models with these mechanisms give a better account of trajectory tracking experiments during decision making. In conclusion, the embodied choice framework offers a combined theory of decision and action that gives a clear case that embodied phenomena such as the dynamics of actions can have a causal influence on central cognition.

Cells, circuits, and choices: social influences on perceptual decision making.

PubMed

Mojzisch, Andreas; Krug, Kristine

2008-12-01

Making decisions is an integral part of everyday life. Social psychologists have demonstrated in many studies that humans' decisions are frequently and strongly influenced by the opinions of others--even in simple perceptual decisions, where, for example, participants have to judge what an image looks like. However, because the effect of other people's opinions on decision making has remained largely unaddressed by the neuroimaging and neurophysiology literature, we are only beginning to understand how social influence is integrated into the decision-making process. We put forward the thesis that by probing the neurophysiology of social influence with perceptual decision-making tasks similar to those used in the seminal work of Asch (1952, 1956), this gap could be remedied. Perceptual paradigms are already widely used to probe neuronal mechanisms of decision making in nonhuman primates. There is also increasing evidence about how nonhuman primates' behavior is influenced by observing conspecifics. The high spatial and temporal resolution of neurophysiological recordings in awake monkeys could provide insight into where and how social influence modulates decision making, and thus should enable us to develop detailed functional models of the neural mechanisms that support the integration of social influence into the decision-making process.

Decentralised water systems: emotional influences on resource decision making.

PubMed

Mankad, Aditi

2012-09-01

The study of emotion has gathered momentum in the field of environmental science, specifically in the context of community resource decision-making. Of particular interest in this review is the potential influence of emotion, risk and threat perception on individuals' decisions to acceptance and adopt decentralised water systems, such as rainwater tanks and greywater systems. The role of message framing is also considered in detail, as well as the influences that different types of framing can have on decision making. These factors are considered as possible predictors for analysing community acceptance of decentralised water in urban environments. Concepts believed to be influenced by emotion, such as trust and framing, are also discussed as potentially meaningful contributors to an overall model of community acceptance of decentralised water. Recommendations are made for how emotion-based concepts, such as risk and threat, can be targeted to facilitate widespread adoption of decentralised systems and how researchers can explore different types of emotions that influence decision making in distinct ways. This review is an important theoretical step in advancing the psycho-social understanding of acceptance and adoption of on-site water sources. Avenues for future research are recommended, including the need for greater theoretical development to encourage future social science research on decentralised systems. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

29 CFR 98.860 - What factors may influence the debarring official's decision?

Code of Federal Regulations, 2010 CFR

2010-07-01

... your present responsibility. In making a debarment decision, the debarring official may consider the... 29 Labor 1 2010-07-01 2010-07-01 true What factors may influence the debarring official's decision... (NONPROCUREMENT) Debarment § 98.860 What factors may influence the debarring official's decision? This section...

Factors Influencing College Decision-Making for First-Generation Appalachian Students

ERIC Educational Resources Information Center

Wood, Kristy Lynn

2012-01-01

This investigation determined the degree of importance for selected personal-psychological, academic, peer, financial, and family factors influencing the decision to attend college by first-generation, Appalachian (FGA) sophomore students. Outcomes were further related to the degree of academic and social integration in college and the likelihood…

Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice.

PubMed

Hajjaj, F M; Salek, M S; Basra, M K A; Finlay, A Y

2010-05-01

This article reviews an aspect of daily clinical practice which is of critical importance in virtually every clinical consultation, but which is seldom formally considered. Non-clinical influences on clinical decision-making profoundly affect medical decisions. These influences include patient-related factors such as socioeconomic status, quality of life and patient's expectations and wishes, physician-related factors such as personal characteristics and interaction with their professional community, and features of clinical practice such as private versus public practice as well as local management policies. This review brings together the different strands of knowledge concerning non-clinical influences on clinical decision-making. This aspect of decision-making may be the biggest obstacle to the reality of practising evidence-based medicine. It needs to be understood in order to develop clinical strategies that will facilitate the practice of evidence-based medicine.

Information Dominance: Informations Role in Influencing Decision Making

DTIC Science & Technology

2014-03-01

AND DATES COVERED Master’s Thesis 4. TITLE AND SUBTITLE INFORMATION DOMINANCE : INFORMATION’S ROLE IN INFLUENCING DECISION MAKING 5. FUNDING...unlimited INFORMATION DOMINANCE : INFORMATION’S ROLE IN INFLUENCING DECISION MAKING Geoffrey C. Gaines Lieutenant, United States Navy B.S...NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA THESIS Approved for public release; distribution is unlimited INFORMATION

Factors influencing career decisions in internal medicine.

PubMed

Macdonald, C; Cawood, T

2012-08-01

Numerous factors influence career decisions for internal medicine trainees and Fellows. There is a perception that a greater emphasis is placed on work-family balance by younger physicians. To determine the characteristics of the modern internal medicine workforce and ascertain whether job flexibility is important to career decision-making. We hypothesised that factors which reflect flexibility would be highly influential in decision-making, especially for women and those with young children. A questionnaire was mailed to 250 New Zealand internal medicine trainees and Fellows. It focused on factors, including job flexibility, interest and collegial support, and included demographic details which were primarily aimed at ascertaining family responsibilities. Response rate was 54%. The majority of female physicians are the main person responsible for their children (62%), and the majority of their partners work full-time (80%). This contrasts with male physicians, of whom only 4% are the main person responsible for their children. Flexibility was found to be more influential in women, those with young children, trainees and those working in outpatient-based subspecialties. However, contrary to our original hypothesis, flexibility was not reported to be highly influential in any group, with career choice being most influenced by interest and enjoyment, intellectual challenge and variety within the job. It is hoped that results will inform employers and those involved with training to enable them to better cater for the needs of the workforce and also encourage trainees to consider future family commitments when making career decisions. © 2012 The Authors. Internal Medicine Journal © 2012 Royal Australasian College of Physicians.

Factors influencing decision-making role preferences: A qualitative study of Malaysian patients with type 2 diabetes during insulin initiation.

PubMed

Lee, Yew Kong; Low, Wah Yun; Lee, Ping Yein; Ng, Chirk Jenn

2015-05-01

Patient decision-making role preference (DMRP) is a patient's preferred degree of control when making medical decisions. This descriptive qualitative study aimed to explore Malaysian patients' views on their DMRP. Between January 2011 and March 2012, 22 individual face-to-face in-depth interviews were conducted with patients with type 2 diabetes who were deciding about insulin initiation. The interviews were audio-recorded and analysed using a thematic approach. The age range of participants was 28-67 years old with 11 men. Ten patients preferred to make the decision themselves, six patients indicated that the clinician should make the decision and only one patient expressed a preference for a collaborative role. The following factors influenced DMRP: trust in clinicians, responsibility for diabetes care, level of knowledge and awareness, involvement of family and personal characteristics. In conclusion, the concept of shared decision-making is still alien, and a more participative communication style might help to facilitate patients' expression of DMRP. © 2014 Wiley Publishing Asia Pty Ltd.

Relationship of external influence to parental distress in decision making regarding children with a life-threatening illness.

PubMed

Miller, Victoria A; Luce, Mary Frances; Nelson, Robert M

2011-01-01

To examine the relationship of external influence to parental distress when making a decision about research or treatment for a child with a life-threatening illness and to test potential moderators of this relationship. Parents (n = 219) who made a decision about research or treatment for a child completed measures of external influence, distress, decision-making preference, and coping. More external influence was associated with more hostility, uncertainty, and confusion. Decision-making preference and coping style moderated the relationship between external influence and distress: More external influence was associated with more distress when decision-making preference was low and task-focused coping was high. External influence appears to be related to distress in parents making research and treatment decisions for children with life-threatening illnesses. However, it is important to consider parent characteristics, such as decision-making preference and coping style, when examining the effects of contextual factors on distress during decision making.

Why do we do as we do? Factors influencing clinical reasoning and decision-making among physiotherapists in an acute setting.

PubMed

Holdar, Ulrika; Wallin, Lars; Heiwe, Susanne

2013-12-01

Despite the current movement for health-care to become more informed by evidence, knowledge on effective implementation of evidence-based practice is scarce. To improve research application among physiotherapists, the process of implementation and clinical reasoning needs to be scrutinized. The aim of this study was to identify various experiences of factors that influence the physiotherapist's clinical reasoning in specialist care. A phenomenographic approach was chosen. Eleven physiotherapists at two acute care hospitals in nn. Data was obtained by observations and interviews. Phenomenographic data analysis identified various experiences of clinical decision-making. The Ethical Review Board of the nn approved the study. The observations and the interviews enabled identification of various experiences that influenced clinical decision-making. The physiotherapists' clinical reasoning was perceived to be constrained by contextual factors. The physiotherapists collected current information on the patient by using written and verbal information exchange and used this to generate an inner picture of the patient. By creating hypotheses that were accepted or rejected, they made decisions in advance of their interventions. The decisions were influenced by the individual characteristics of the physiotherapist, his/her knowledge and patient perceptions. Clinical reasoning is a complex and constantly evolving process. Contextual factors such as economy and politics are not easily changed, but factors such as the patient and the physiotherapist as a person are more tangible. Copyright © 2013 John Wiley & Sons, Ltd.

Factors influencing parents' decision-making when sending children with respiratory tract infections to nursery.

PubMed

Carroll, Fran E; Rooshenas, Leila; Owen-Smith, Amanda; Al-Janabi, Hareth; Hollinghurst, Sandra; Hay, Alastair D

2016-06-01

Many families rely on formal day care provision, which can be problematic when children are unwell. Attendance in these circumstances may impact on the transmission of infections in both day care and the wider community. Thirty-one semi-structured interviews were conducted to investigate how parents make decisions about nursery care when children are unwell. Topics for discussion included: illness attitudes, current practice during childhood illness and potential nursery policy changes that could affect decision-making. A combination of illness perceptions and external factors affected decision-making. Parents: (i) considered the severity of respiratory and non-respiratory symptoms differently, and stated that while most other contagious illnesses required nursery exclusion, coughs/colds did not; (ii) said decisions were not solely based on nursery policy, but on practical challenges such as work absences, financial penalties and alternative care availability; (iii) identified modifiable nursery policy factors that could potentially help parents keep unwell children at home, potentially reducing transmission of infectious illness. Decision-making is a complex interaction between the child's illness, personal circumstance and nursery policy. Improving our understanding of the modifiable aspects of nursery policies and the extent to which these factors affect decision-making could inform the design and implementation of interventions to reduce the transmission of infectious illness and the associated burden on NHS services. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

41 CFR 105-68.860 - What factors may influence the debarring official's decision?

Code of Federal Regulations, 2010 CFR

2010-07-01

... responsibility. In making a debarment decision, the debarring official may consider the following factors: (a... influence the debarring official's decision? 105-68.860 Section 105-68.860 Public Contracts and Property...) Debarment § 105-68.860 What factors may influence the debarring official's decision? This section lists the...

Factors that Influence Career Decision-Making among Elite Athletes

ERIC Educational Resources Information Center

Fogarty, Gerard J.; McGregor-Bayne, Heather

2008-01-01

A common belief about elite athletes is that they invest so much effort into the pursuit of their athletic careers that they fail to develop good career decision-making skills. Recent findings challenge that belief. The present study investigated career decision-making difficulties among 117 elite Australian athletes. Participants completed…

Analyzing the effectiveness of teaching and factors in clinical decision-making.

PubMed

Hsieh, Ming-Chen; Lee, Ming-Shinn; Chen, Tsung-Ying; Tsai, Tsuen-Chiuan; Pai, Yi-Fong; Sheu, Min-Muh

2017-01-01

The aim of this study is to prepare junior physicians, clinical education should focus on the teaching of clinical decision-making. This research is designed to explore teaching of clinical decision-making and to analyze the benefits of an "Analogy guide clinical decision-making" as a learning intervention for junior doctors. This study had a "quasi-experimental design" and was conducted in a medical center in eastern Taiwan. Participants and Program Description: Thirty junior doctors and three clinical teachers were involved in the study. The experimental group (15) received 1 h of instruction from the "Analogy guide for teaching clinical decision-making" every day for 3 months. Program Evaluation: A "Clinical decision-making self-evaluation form" was used as the assessment tool to evaluate participant learning efficiency before and after the teaching program. Semi-structured qualitative research interviews were also conducted. We found using the analogy guide for teaching clinical decision-making could help enhance junior doctors' self-confidence. Important factors influencing clinical decision-making included workload, decision-making, and past experience. Clinical teaching using the analogy guide for clinical decision-making may be a helpful tool for training and can contribute to a more comprehensive understanding of decision-making.

Case-based ethics instruction: the influence of contextual and individual factors in case content on ethical decision-making.

PubMed

Bagdasarov, Zhanna; Thiel, Chase E; Johnson, James F; Connelly, Shane; Harkrider, Lauren N; Devenport, Lynn D; Mumford, Michael D

2013-09-01

Cases have been employed across multiple disciplines, including ethics education, as effective pedagogical tools. However, the benefit of case-based learning in the ethics domain varies across cases, suggesting that not all cases are equal in terms of pedagogical value. Indeed, case content appears to influence the extent to which cases promote learning and transfer. Consistent with this argument, the current study explored the influences of contextual and personal factors embedded in case content on ethical decision-making. Cases were manipulated to include a clear description of the social context and the goals of the characters involved. Results indicated that social context, specifically the description of an autonomy-supportive environment, facilitated execution of sense making processes and resulted in greater decision ethicality. Implications for designing optimal cases and case-based training programs are discussed.

5 CFR 919.860 - What factors may influence the debarring official's decision?

Code of Federal Regulations, 2010 CFR

2010-01-01

... responsibility. In making a debarment decision, the debarring official may consider the following factors: (a... official's decision? 919.860 Section 919.860 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT...) Debarment § 919.860 What factors may influence the debarring official's decision? This section lists the...

Adolescent Sexual Decision-Making: An Integrative Review.

PubMed

Hulton, Linda J.

2001-10-03

PURPOSE: The purpose of this integrative review was to summarize the present literature to identify factors associated with adolescent sexual decision-making. Thirty-eight salient research studies were selected as a basis of this review from the databases of Medline, CINAHL, and Psychinfo using the Cooper methodology. CONCLUSIONS: Two categories of decision-making were identified: 1) The research on factors related to the decisions that adolescents make to become sexually active or to abstain from sexual activity; 2) The research on factors related to contraceptive decision-making. The most consistent findings were that the factors of gender differences, cognitive development, perception of benefits, parental influences, social influences, and sexual knowledge were important variables in the decision-making processes of adolescents. IMPLICATIONS: Practice implications for nursing suggest that clinicians should assess adolescent sexual decision-making in greater detail and address the social and psychological context in which sexual experiences occur. Nurses must be aware of the differences between adolescent and adult decision-making processes and incorporate knowledge of growth and development into intervention strategies. Moreover, to the degree that adolescent sexual decision-making proves to be less than rational, interventions designed to improve competent sexual decision-making are needed.

Unconscious influences on decision making: a critical review.

PubMed

Newell, Ben R; Shanks, David R

2014-02-01

To what extent do we know our own minds when making decisions? Variants of this question have preoccupied researchers in a wide range of domains, from mainstream experimental psychology (cognition, perception, social behavior) to cognitive neuroscience and behavioral economics. A pervasive view places a heavy explanatory burden on an intelligent cognitive unconscious, with many theories assigning causally effective roles to unconscious influences. This article presents a novel framework for evaluating these claims and reviews evidence from three major bodies of research in which unconscious factors have been studied: multiple-cue judgment, deliberation without attention, and decisions under uncertainty. Studies of priming (subliminal and primes-to-behavior) and the role of awareness in movement and perception (e.g., timing of willed actions, blindsight) are also given brief consideration. The review highlights that inadequate procedures for assessing awareness, failures to consider artifactual explanations of "landmark" results, and a tendency to uncritically accept conclusions that fit with our intuitions have all contributed to unconscious influences being ascribed inflated and erroneous explanatory power in theories of decision making. The review concludes by recommending that future research should focus on tasks in which participants' attention is diverted away from the experimenter's hypothesis, rather than the highly reflective tasks that are currently often employed.

Factors influencing treatment decision-making for maintaining or extracting compromised teeth.

PubMed

Lang-Hua, Bich Hue; McGrath, Colman P J; Lo, Edward C M; Lang, Niklaus P

2014-01-01

To evaluate treatment decision-making with respect to maintaining periodontally compromised teeth among dentists with or without postgraduate qualifications in implant dentistry. A series of patient scenarios with varying degrees of periodontal disease levels was presented to dental practitioners. Practitioners' decision-making outcome was determined, and intention to retain the compromised teeth was analyzed in bivariate and regression analyses (accounting for postgraduate implant training, gender, years in dental practice, and implant placement experience). This study involved 30 dental practitioners with postgraduate implant qualifications (GDPP), 33 dental practitioners without postgraduate implant qualifications (GDP), and 27 practitioners undergoing training for postgraduate implant qualifications (GDPT). Variations in treatment decision-making were evident between the three groups. Differences in treatment approaches to retaining compromised teeth were apparent. Furthermore, variations in rehabilitation of extracted scenarios existed in terms of use of implant and number of implants need for rehabilitation. Accounting for dentist and practice factors in regression analyses, GDPP/GDPT were three times as likely to retain periodontally compromised upper molar, with or without pain, compared to GDP (without pain OR 3.10, 95%CI 1.04, 10.62 P = 0.04; with pain OR 3.08, 95%CI 1.09, 8.14 P = 0.03). Variations in treatment decision-making with respect to retaining periodontally compromised teeth exist between dental practitioners with and those without postgraduate training in implant dentistry. Furthermore differences in management approaches in how they would retain the teeth or rehabilitate the dental arch were apparent. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

Factors Influencing the Adoption of Cloud Computing by Decision Making Managers

ERIC Educational Resources Information Center

Ross, Virginia Watson

2010-01-01

Cloud computing is a growing field, addressing the market need for access to computing resources to meet organizational computing requirements. The purpose of this research is to evaluate the factors that influence an organization in their decision whether to adopt cloud computing as a part of their strategic information technology planning.…

External factors affecting decision-making and use of evidence in an Australian public health policy environment.

PubMed

Zardo, Pauline; Collie, Alex; Livingstone, Charles

2014-05-01

This study examined external factors affecting policy and program decision-making in a specific public health policy context: injury prevention and rehabilitation compensation in the Australian state of Victoria. The aim was twofold: identify external factors that affect policy and program decision-making in this specific context; use this evidence to inform targeting of interventions aimed at increasing research use in this context. Qualitative interviews were undertaken from June 2011 to January 2012 with 33 employees from two state government agencies. Key factors identified were stakeholder feedback and action, government and ministerial input, legal feedback and action, injured persons and the media. The identified external factors were able to significantly influence policy and program decision-making processes: acting as both barriers and facilitators, depending on the particular issue at hand. The factors with the most influence were the Minister and government, lawyers, and agency stakeholders, particularly health providers, trade unions and employer groups. This research revealed that interventions aimed at increasing use of research in this context must target and harness the influence of these groups. This research provides critical insights for researchers seeking to design interventions to increase use of research in policy environments and influence decision-making in Victorian injury prevention and rehabilitation compensation. Copyright © 2014 Elsevier Ltd. All rights reserved.

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.

Social, institutional, and psychological factors affecting wildfire incident decision making

Treesearch

Matthew P. Thompson

2014-01-01

Managing wildland fire incidents can be fraught with complexity and uncertainty. Myriad human factors can exert significant influence on incident decision making, and can contribute additional uncertainty regarding programmatic evaluations of wildfire management and attainment of policy goals. This article develops a framework within which human sources of uncertainty...

Influences on Decision Making Identified by Parents of Children Receiving Pediatric Palliative Care.

PubMed

Carroll, Karen W; Mollen, Cynthia J; Aldridge, Sarah; Hexem, Kari R; Feudtner, Chris

2012-01-01

Parental decision making is a critical component in the provision of palliative and end-of-life care, yet factors that parents perceive as influencing this process, when they are making decisions for their children, have not been well characterized. As part of a mixed-methods cohort study, we interviewed 73 parents of 50 pediatric patients who were referred to the hospital's pediatric palliative care service. The semistructured interviews focused on "decision making for your child"; the interviews were recorded and transcribed. A random sample (n = 13) was first coded and analyzed for core themes, and these themes were then cross-validated with a second random sample (n = 3) of interviews. Four dominant interrelated themes permeated parents' discussions about the decisions they were making for their children and the process of decision making. First, Orientation and Direction (including the subthemes of Goals and Hopes, Spirituality and Meaning, and Purposeful Effort) connotes the parents' effort to establish and clarify the broad context of decision making. Second, Defining What Is Good for the Child (including the subthemes of Quality of Life and Suffering, and Normalcy and Normalization) conveys how the parents posed questions and pondered what decisions would be in the child's best interests. Third, the entwined theme of Relationships, Communication, and Support reflects how parents reported the social and interactive nature of decision making. Fourth, the theme of Feelings and Personal Accountability focuses inward as parents report efforts to deal with their emotional responses and self-judgments. Parents report grappling with several influences upon their decision-making processes that extend well beyond the standard discussions of medical information exchanges and the evaluation of risks and benefits. Decision support for these parents should account for these diverse influences.

What influences patient decision-making in amyotrophic lateral sclerosis multidisciplinary care? A study of patient perspectives.

PubMed

Hogden, Anne; Greenfield, David; Nugus, Peter; Kiernan, Matthew C

2012-01-01

Patients with amyotrophic lateral sclerosis (ALS) are required to make decisions concerning quality of life and symptom management over the course of their disease. Clinicians perceive that patients' ability to engage in timely decision-making is extremely challenging. However, we lack patient perspectives on this issue. This study aimed to explore patient experiences of ALS, and to identify factors influencing their decision-making in the specialized multidisciplinary care of ALS. An exploratory study was conducted. Fourteen patients from two specialized ALS multidisciplinary clinics participated in semistructured interviews that were audio recorded and transcribed. Data were analyzed for emergent themes. Decision-making was influenced by three levels of factors, ie, structural, interactional, and personal. The structural factor was the decision-making environment of specialized multidisciplinary ALS clinics, which supported decision-making by providing patients with disease-specific information and specialized care planning. Interactional factors were the patient experiences of ALS, including patients' reaction to the diagnosis, response to deterioration, and engagement with the multidisciplinary ALS team. Personal factors were patients' personal philosophies, including their outlook on life, perceptions of control, and planning for the future. Patient approaches to decision-making reflected a focus on the present, rather than anticipating future progression of the disease and potential care needs. Decision-making for symptom management and quality of life in ALS care is enhanced when the patient's personal philosophy is supported by collaborative relationships between the patient and the multidisciplinary ALS team. Patients valued the support provided by the multidisciplinary team; however, their focus on living in the present diverged from the efforts of health professionals to prepare patients and their carers for the future. The challenge facing health

A study exploring factors which influence the decision to commence nurse-led weaning.

PubMed

Gelsthorpe, Tony; Crocker, Cheryl

2004-01-01

Nurse-led weaning can improve patient outcome. Exploration of the factors that influence the commencement of weaning. Themes of decision-making, pathophysiological and multidisciplinary team factors emerged. Experience was a key factor in the decision to wean. The use of protocol-led weaning may not be useful in the decision to wean.

Results of our national survey. Current formulary decision-making strategies and new factors influencing the process.

PubMed

1995-08-01

Formulary recently conducted a survey of 2,000 of its readers to uncover what forces are at play in their formulary decision-making processes. Topics included general philosophies toward formulary decision making, philosophies toward adding and deleting products, influences on the process, trends related to product reviews, formulary management strategies, drug information educational strategies, and new approaches to the formulary decision-making process. Some 295 surveys (14.75%) were returned. Highlights and analyses of the survey findings are presented for your review and comparison with your practice setting's approaches.

7 CFR 3017.860 - What factors may influence the debarring official's decision?

Code of Federal Regulations, 2010 CFR

2010-01-01

... your present responsibility. In making a debarment decision, the debarring official may consider the... decision? 3017.860 Section 3017.860 Agriculture Regulations of the Department of Agriculture (Continued... (NONPROCUREMENT) Debarment § 3017.860 What factors may influence the debarring official's decision? This section...

The influence of number line estimation precision and numeracy on risky financial decision making.

PubMed

Park, Inkyung; Cho, Soohyun

2018-01-10

This study examined whether different aspects of mathematical proficiency influence one's ability to make adaptive financial decisions. "Numeracy" refers to the ability to process numerical and probabilistic information and is commonly reported as an important factor which contributes to financial decision-making ability. The precision of mental number representation (MNR), measured with the number line estimation (NLE) task has been reported to be another critical factor. This study aimed to examine the contribution of these mathematical proficiencies while controlling for the influence of fluid intelligence, math anxiety and personality factors. In our decision-making task, participants chose between two options offering probabilistic monetary gain or loss. Sensitivity to expected value was measured as an index for the ability to discriminate between optimal versus suboptimal options. Partial correlation and hierarchical regression analyses revealed that NLE precision better explained EV sensitivity compared to numeracy, after controlling for all covariates. These results suggest that individuals with more precise MNR are capable of making more rational financial decisions. We also propose that the measurement of "numeracy," which is commonly used interchangeably with general mathematical proficiency, should include more diverse aspects of mathematical cognition including basic understanding of number magnitude. © 2018 International Union of Psychological Science.

Whose decision is it anyway? How clinicians support decision-making participation after acquired brain injury.

PubMed

Knox, Lucy; Douglas, Jacinta M; Bigby, Christine

2013-01-01

To raise professional awareness of factors that may influence the support offered by clinicians to people with acquired brain injury (ABI), and to consider the potential implications of these factors in terms of post-injury rehabilitation and living. A review of the literature was conducted to identify factors that determine how clinicians provide support and influence opportunities for individuals with ABI to participate in decision making across the rehabilitation continuum. Clinical case studies are used to highlight two specific issues: (1) hidden assumptions on the part of the practitioner, and (2) perceptions of risk operating in clinical practice. There are a range of factors which may influence the decision-making support provided by clinicians and, ultimately, shape lifetime outcomes for individuals with ABI. A multidimensional framework may assist clinicians to identify relevant factors and consider their potential implications including those that influence how clinicians involved in supporting decision making approach this task. Participation in decision making is an undisputed human right and central to the provision of person-centred care. Further research is required to understand how clinical practice can maximise both opportunities and support for increased decision-making participation by individuals with ABI. There is an increasing focus on the rights of all individuals to be supported to participate in decision making about their life. A number of changes associated with ABI mean that individuals with ABI will require support with decision making. Clinicians have a critical role in providing this support over the course of the rehabilitation continuum. Clinicians need to be aware of the range of factors that may influence the decision-making support they provide. A multidimensional framework may be used by clinicians to identify influences on the decision-making support they provide.

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.

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

Selection for inpatient rehabilitation after severe stroke: what factors influence rehabilitation assessor decision-making?

PubMed

Hakkennes, Sharon; Hill, Keith D; Brock, Kim; Bernhardt, Julie; Churilov, Leonid

2013-01-01

This study aimed to identify factors that assessors considered important in decision-making regarding suitability for inpatient rehabilitation after acute severe stroke. Multi-site prospective observational cohort study. Consecutive acute, severe stroke patients and their assessors for inpatient rehabilitation. Rehabilitation assessors completed a questionnaire, rating the importance (10 point visual analogue scale) and direction (positive, negative or neutral) of 15 patient related and 2 organisational items potentially affecting their decision regarding patients' acceptance to rehabilitation. Of the 75 patients referred to rehabilitation and included in this study 61 (81.3%) were accepted for inpatient rehabilitation. The items considered to be most important in the decision to accept the patient for rehabilitation were pre-morbid cognition, pre-morbid mobility and pre-morbid communication. For those not accepted the most important items were current mobility, social support and current cognition. Factor analysis revealed 3 underlying factors, interpreted as post-stroke status, pre-morbid status, and social attributes, accounting for 61.8% of the total variance. All were independently associated with acceptance for rehabilitation (p < 0.05). This study highlights the importance of pre-morbid function and social factors in addition to post-stroke function in the decision making process for acceptance to rehabilitation following severe stroke. Future models for selection for rehabilitation should consider inclusion of these factors.

Patient factors that influence clinicians' decision making in self-management support: A clinical vignette study.

PubMed

Bos-Touwen, Irene D; Trappenburg, Jaap C A; van der Wulp, Ineke; Schuurmans, Marieke J; de Wit, Niek J

2017-01-01

Self-management support is an integral part of current chronic care guidelines. The success of self-management interventions varies between individual patients, suggesting a need for tailored self-management support. Understanding the role of patient factors in the current decision making of health professionals can support future tailoring of self-management interventions. The aim of this study is to identify the relative importance of patient factors in health professionals' decision making regarding self-management support. A factorial survey was presented to primary care physicians and nurses. The survey consisted of clinical vignettes (case descriptions), in which 11 patient factors were systematically varied. Each care provider received a set of 12 vignettes. For each vignette, they decided whether they would give this patient self-management support and whether they expected this support to be successful. The associations between respondent decisions and patient factors were explored using ordered logit regression. The survey was completed by 60 general practitioners and 80 nurses. Self-management support was unlikely to be provided in a third of the vignettes. The most important patient factor in the decision to provide self-management support as well as in the expectation that self-management support would be successful was motivation, followed by patient-provider relationship and illness perception. Other factors, such as depression or anxiety, education level, self-efficacy and social support, had a small impact on decisions. Disease, disease severity, knowledge of disease, and age were relatively unimportant factors. This is the first study to explore the relative importance of patient factors in decision making and the expectations regarding the provision of self-management support to chronic disease patients. By far, the most important factor considered was patient's motivation; unmotivated patients were less likely to receive self-management support

Critical factors in career decision making for women medical graduates.

PubMed

Lawrence, Joanna; Poole, Phillippa; Diener, Scott

2003-04-01

Within the next 30 years there will be equal numbers of women and men in the medical workforce. Indications are that women are increasing their participation in specialties other than general practice, although at a slower rate than their participation in the workforce as a whole. To inform those involved in training and employment of medical women, this study investigated the influencing factors in career decision making for female medical graduates. A total of 305 women medical graduates from the University of Auckland responded to a mail survey (73% response rate) which examined influences on decision making, in both qualitative and quantitative ways, as part of a larger survey. Most women were satisfied with their careers. The principal component analysis of the influencing factors identified four distinct factors important in career choice - interest, flexibility, women friendliness and job security, although the first two of these were rated more highly than the others. Barriers to full participation by medical women in training and employment need to be systematically examined and removed. This is not only to allow women themselves to reach their full potential, but for workforce and socio-economic reasons. Initiatives that allow and value more flexible training and work practices, particularly through the years of child raising, are necessary for women and the health care workforce at large.

Factors influencing US medical students' decision to pursue surgery.

PubMed

Schmidt, Lauren E; Cooper, Clairice A; Guo, Weidun Alan

2016-06-01

Interest and applications to surgery have steadily decreased over recent years in the United States. The goal of this review is to collect the current literature regarding US medical students' experience in surgery and factors influencing their intention to pursue surgery as a career. We hypothesize that multiple factors influence US medical students' career choice in surgery. Six electronic databases (PubMed, SCOPUS, Web of Science, Education Resources Information Center, Embase, and PsycINFO) were searched. The inclusion criteria were studies published after the new century related to factors influencing surgical career choice among US medical students. Factors influencing US medical student surgical career decision-making were recorded. A quality index score was given to each article selected to minimize risk of bias. We identified 38 relevant articles of more than 1000 nonduplicated titles. The factors influencing medical student decision for a surgical career were categorized into five domains: mentorship and role model (n = 12), experience (clerkship n = 9, stereotype n = 4), timing of exposure (n = 9), personal (lifestyle n = 8, gender n = 6, finance n = 3), and others (n = 2). This comprehensive systemic review identifies mentorship, experience in surgery, stereotypes, timing of exposure, and personal factors to be major determinants in medical students' decisions to pursue surgery. These represent areas that can be improved to attract applicants to general surgery residencies. Surgical faculty and residents can have a positive influence on medical students' decisions to pursue surgery as a career. Early introduction to the field of surgery, as well as recruitment strategies during the preclinical and clinical years of medical school can increase students' interest in a surgical career. Copyright © 2016 Elsevier Inc. All rights reserved.

Hospice Decision Making: Diagnosis Makes a Difference

ERIC Educational Resources Information Center

Waldrop, Deborah P.; Meeker, Mary Ann

2012-01-01

Purpose: This study explored the process of decision making about hospice enrollment and identified factors that influence the timing of that decision. Methods: This study employed an exploratory, descriptive, cross-sectional design and was conducted using qualitative methods. In-depth in-person semistructured interviews were conducted with 36…

Factors Affecting the Corporate Decision-Making Process of Air Transport Manufacturers

NASA Technical Reports Server (NTRS)

Ollila, R. G.; Hill, J. D.; Noton, B. R.; Duffy, M. A.; Epstein, M. M.

1976-01-01

Fuel economy is a pivotal question influencing the future sale and utilization of commercial aircraft. The NASA Aircraft Energy Efficiency (ACEE) Program Office has a program intended to accelerate the readiness of advanced technologies for energy efficient aircraft. Because the decision to develop a new airframe or engine is a major financial hazard for manufacturers, it is important to know what factors influence the decision making process. A method is described for identifying and ranking individuals and organizations involved at each stage of commercial air transport development, and the barriers that must be overcome in adopting new technologies.

The factors facilitating and inhibiting effective clinical decision-making in nursing: a qualitative study

PubMed Central

Hagbaghery, Mohsen Adib; Salsali, Mahvash; Ahmadi, Fazlolah

2004-01-01

Background Nurses' practice takes place in a context of ongoing advances in research and technology. The dynamic and uncertain nature of health care environment requires nurses to be competent decision-makers in order to respond to clients' needs. Recently, the public and the government have criticized Iranian nurses because of poor quality of patient care. However nurses' views and experiences on factors that affect their clinical function and clinical decision-making have rarely been studied. Methods Grounded theory methodology was used to analyze the participants' lived experiences and their viewpoints regarding the factors affecting their clinical function and clinical decision-making. Semi-structured interviews and participant observation methods were used to gather the data. Thirty-eight participants were interviewed and twelve sessions of observation were carried out. Constant comparative analysis method was used to analyze the data. Results Five main themes emerged from the data. From the participants' points of view, "feeling competent", "being self-confident", "organizational structure", "nursing education", and "being supported" were considered as important factors in effective clinical decision-making. Conclusion As participants in this research implied, being competent and self-confident are the most important personal factors influencing nurses clinical decision-making. Also external factors such as organizational structure, access to supportive resources and nursing education have strengthening or inhibiting effects on the nurses' decisions. Individual nurses, professional associations, schools of nursing, nurse educators, organizations that employ nurses and government all have responsibility for developing and finding strategies that facilitate nurses' effective clinical decision-making. They are responsible for identifying barriers and enhancing factors within the organizational structure that facilitate nurses' clinical decision-making. PMID

Frustration influences impact of history and disciplinary attitudes on physical discipline decision making.

PubMed

Russa, Mary B; Rodriguez, Christina M; Silvia, Paul J

2014-01-01

Although intergenerational patterns of punitive physical punishment garner considerable research attention, the mechanisms by which historical, cognitive, and contextual factors interplay to influence disciplinary responding remains poorly understood. Disciplinary attitudes have been shown to mediate the association between disciplinary history and disciplinary responding. The present study investigated whether frustration influences these mediation effects. Half of a sample of 330 undergraduates was randomly assigned to frustration induction. Structural equation modeling confirmed that, for participants in the frustration condition, the relation between disciplinary history and physical discipline decision-making was fully mediated by attitudes approving physical discipline. In contrast, for respondents in the no-frustration condition, the pathway from disciplinary history to discipline decision-making was only partially mediated by attitudes. Under conditions of frustration, attitudes may become a more central means by which personal disciplinary history is associated with disciplinary decision-making. © 2013 Wiley Periodicals, Inc.

A qualitative study of factors in nurses' and physicians' decision-making related to family presence during resuscitation.

PubMed

Twibell, Renee; Siela, Debra; Riwitis, Cheryl; Neal, Alexis; Waters, Nicole

2018-01-01

To explore the similarities and differences in factors that influence nurses' and physicians' decision-making related to family presence during resuscitation. Despite the growing acceptance of family presence during resuscitation worldwide, healthcare professionals continue to debate the risks and benefits of family presence. As many hospitals lack a policy to guide family presence during resuscitation, decisions are negotiated by resuscitation teams, families and patients in crisis situations. Research has not clarified the factors that influence the decision-making processes of nurses and physicians related to inviting family presence. This is the first study to elicit written data from healthcare professionals to explicate factors in decision-making about family presence. Qualitative exploratory-descriptive. Convenience samples of registered nurses (n = 325) and acute care physicians (n = 193) from a Midwestern hospital in the United States of America handwrote responses to open-ended questions about family presence. Through thematic analysis, decision-making factors for physicians and nurses were identified and compared. Physicians and nurses evaluated three similar factors and four differing factors when deciding to invite family presence during resuscitation. Furthermore, nurses and physicians weighted the factors differently. Physicians weighted most heavily the family's potential to disrupt life-saving efforts and compromise patient care and then the family's knowledge about resuscitations. Nurses heavily weighted the potential for the family to be traumatised, the potential for the family to disrupt the resuscitation, and possible family benefit. Nurses and physicians considered both similar and different factors when deciding to invite family presence. Physicians focused on the patient primarily, while nurses focused on the patient, family and resuscitation team. Knowledge of factors that influence the decision-making of interprofessional colleagues

Influence of branding on preference-based decision making.

PubMed

Philiastides, Marios G; Ratcliff, Roger

2013-07-01

Branding has become one of the most important determinants of consumer choices. Intriguingly, the psychological mechanisms of how branding influences decision making remain elusive. In the research reported here, we used a preference-based decision-making task and computational modeling to identify which internal components of processing are affected by branding. We found that a process of noisy temporal integration of subjective value information can model preference-based choices reliably and that branding biases are explained by changes in the rate of the integration process itself. This result suggests that branding information and subjective preference are integrated into a single source of evidence in the decision-making process, thereby altering choice behavior.

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

Decision Making and Cancer

PubMed Central

Reyna, Valerie F.; Nelson, Wendy L.; Han, Paul K.; Pignone, Michael P.

2014-01-01

We review decision-making along the cancer continuum in the contemporary context of informed and shared decision making, in which patients are encouraged to take a more active role in their health care. We discuss challenges to achieving informed and shared decision making, including cognitive limitations and emotional factors, but argue that understanding the mechanisms of decision making offers hope for improving decision support. Theoretical approaches to decision making that explain cognition, emotion, and their interaction are described, including classical psychophysical approaches, dual-process approaches that focus on conflicts between emotion versus cognition (or reason), and modern integrative approaches such as fuzzy-trace theory. In contrast to the earlier emphasis on rote use of numerical detail, modern approaches emphasize understanding the bottom-line gist of options (which encompasses emotion and other influences on meaning) and retrieving relevant social and moral values to apply to those gist representations. Finally, research on interventions to support better decision making in clinical settings is reviewed, drawing out implications for future research on decision making and cancer. PMID:25730718

Decision making and cancer.

PubMed

Reyna, Valerie F; Nelson, Wendy L; Han, Paul K; Pignone, Michael P

2015-01-01

We review decision making along the cancer continuum in the contemporary context of informed and shared decision making in which patients are encouraged to take a more active role in their health care. We discuss challenges to achieving informed and shared decision making, including cognitive limitations and emotional factors, but argue that understanding the mechanisms of decision making offers hope for improving decision support. Theoretical approaches to decision making that explain cognition, emotion, and their interaction are described, including classical psychophysical approaches, dual-process approaches that focus on conflicts between emotion versus cognition (or reason), and modern integrative approaches such as fuzzy-trace theory. In contrast to the earlier emphasis on rote use of numerical detail, modern approaches emphasize understanding the bottom-line gist of options (which encompasses emotion and other influences on meaning) and retrieving relevant social and moral values to apply to those gist representations. Finally, research on interventions to support better decision making in clinical settings is reviewed, drawing out implications for future research on decision making and cancer. PsycINFO Database Record (c) 2015 APA, all rights reserved.

Multi-disciplinary decision making in general practice.

PubMed

Kirby, Ann; Murphy, Aileen; Bradley, Colin

2018-04-09

Purpose Internationally, healthcare systems are moving towards delivering care in an integrated manner which advocates a multi-disciplinary approach to decision making. Such an approach is formally encouraged in the management of Atrial Fibrillation patients through the European Society of Cardiology guidelines. Since the emergence of new oral anticoagulants switching between oral anticoagulants (OACs) has become prevalent. This case study considers the role of multi-disciplinary decision making, given the complex nature of the agents. The purpose of this paper is to explore Irish General Practitioners' (GPs) experience of switching between all OACs for Arial Fibrillation (AF) patients; prevalence of multi-disciplinary decision making in OAC switching decisions and seeks to determine the GP characteristics that appear to influence the likelihood of multi-disciplinary decision making. Design/methodology/approach A probit model is used to determine the factors influencing multi-disciplinary decision making and a multinomial logit is used to examine the factors influencing who is involved in the multi-disciplinary decisions. Findings Results reveal that while some multi-disciplinary decision-making is occurring (64 per cent), it is not standard practice despite international guidelines on integrated care. Moreover, there is a lack of patient participation in the decision-making process. Female GPs and GPs who have initiated prescriptions for OACs are more likely to engage in multi-disciplinary decision-making surrounding switching OACs amongst AF patients. GPs with training practices were less likely to engage with cardiac consultants and those in urban areas were more likely to engage with other (non-cardiac) consultants. Originality/value For optimal decision making under uncertainty multi-disciplinary decision-making is needed to make a more informed judgement and to improve treatment decisions and reduce the opportunity cost of making the wrong decision.

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.

Factors and outcomes of decision making for cancer clinical trial participation.

PubMed

Biedrzycki, Barbara A

2011-09-01

To describe factors and outcomes related to the decision-making process regarding participation in a cancer clinical trial. Cross-sectional, descriptive. Urban, academic, National Cancer Institute-designated comprehensive cancer center in the mid-Atlantic United States. 197 patients with advanced gastrointestinal cancer. Mailed survey using one investigator-developed instrument, eight instruments used in published research, and a medical record review. disease context, sociodemographics, hope, quality of life, trust in healthcare system, trust in health professional, preference for research decision control, understanding risks, and information. decision to accept or decline research participation and satisfaction with this decision. All of the factors within the Research Decision Making Model together predicted cancer clinical trial participation and satisfaction with this decision. The most frequently preferred decision-making style for research participation was shared (collaborative) (83%). Multiple factors affect decision making for cancer clinical trial participation and satisfaction with this decision. Shared decision making previously was an unrecognized factor and requires further investigation. Enhancing the process of research decision making may facilitate an increase in cancer clinical trial enrollment rates. Oncology nurses have unique opportunities as educators and researchers to support shared decision making by those who prefer this method for deciding whether to accept or decline cancer clinical trial participation.

Game Relativity: How Context Influences Strategic Decision Making

ERIC Educational Resources Information Center

Vlaev, Ivo; Chater, Nick

2006-01-01

Existing models of strategic decision making typically assume that only the attributes of the currently played game need be considered when reaching a decision. The results presented in this article demonstrate that the so-called "cooperativeness" of the previously played prisoner's dilemma games influence choices and predictions in the current…

Influence of uncertainty on framed decision-making with moral dilemma.

PubMed

Merlhiot, Gaëtan; Mermillod, Martial; Le Pennec, Jean-Luc; Dutheil, Frédéric; Mondillon, Laurie

2018-01-01

In cases of impending natural disasters, most events are uncertain and emotionally relevant, both critical factors for decision-making. Moreover, for exposed individuals, the sensitivity to the framing of the consequences (gain or loss) and the moral judgments they have to perform (e.g., evacuate or help an injured person) constitute two central effects that have never been examined in the same context of decision-making. In a framed decision-making task with moral dilemma, we investigated whether uncertainty (i.e., unpredictably of events) and a threatening context would influence the framing effect (actions framed in loss are avoided in comparison to the ones framed in gain) and the personal intention effect (unintentional actions are more morally acceptable in comparison to intentional actions) on the perceived moral acceptability of taking action. Considering the impact of uncertainty and fear on the processes underlying these effects, we assumed that these emotions would lead to the negation of the two effects. Our results indicate that the exposure to uncertain events leads to the negation of the framing effect, but does not influence the moral acceptability and the effect of personal intention. We discuss our results in the light of dual-process models (i.e. systematic vs. heuristic), appraisal theories, and neurocognitive aspects. These elements highlight the importance of providing solutions to cope with uncertainty, both for scientists and local populations exposed to natural hazards.

The neural substrates of social influence on decision making.

PubMed

Tomlin, Damon; Nedic, Andrea; Prentice, Deborah A; Holmes, Philip; Cohen, Jonathan D

2013-01-01

The mechanisms that govern human learning and decision making under uncertainty have been the focus of intense behavioral and, more recently, neuroscientific investigation. Substantial progress has been made in building models of the processes involved, and identifying underlying neural mechanisms using simple, two-alternative forced choice decision tasks. However, less attention has been given to how social information influences these processes, and the neural systems that mediate this influence. Here we sought to address these questions by using tasks similar to ones that have been used to study individual decision making behavior, and adding conditions in which participants were given trial-by-trial information about the performance of other individuals (their choices and/or their rewards) simultaneously playing the same tasks. We asked two questions: How does such information about the behavior of others influence performance in otherwise simple decision tasks, and what neural systems mediate this influence? We found that bilateral insula exhibited a parametric relationship to the degree of misalignment of the individual's performance with those of others in the group. Furthermore, activity in the bilateral insula significantly predicted participants' subsequent choices to align their behavior with others in the group when they were misaligned either in their choices (independent of success) or their degree of success (independent of specific choices). These findings add to the growing body of empirical data suggesting that the insula participates in an important way in social information processing and decision making.

Virtual Human Role Players for Studying Social Factors in Organizational Decision Making

PubMed Central

Khooshabeh, Peter; Lucas, Gale

2018-01-01

The cyber domain of military operations presents many challenges. A unique element is the social dynamic between cyber operators and their leadership because of the novel subject matter expertise involved in conducting technical cyber tasks, so there will be situations where senior leaders might have much less domain knowledge or no experience at all relative to the warfighters who report to them. Nonetheless, it will be important for junior cyber operators to convey convincing information relevant to a mission in order to persuade or influence a leader to make informed decisions. The power dynamic will make it difficult for the junior cyber operator to successfully influence a higher ranking leader. Here we present a perspective with a sketch for research paradigm(s) to study how different factors (normative vs. informational social influence, degree of transparency, and perceived appropriateness of making suggestions) might interact with differential social power dynamics of individuals in cyber decision-making contexts. Finally, we contextualize this theoretical perspective for the research paradigms in viable training technologies. PMID:29545759

The Influence of Family Factors on the Retention Decision Making Process of Military Members.

ERIC Educational Resources Information Center

Bowen, Gary L.

Retention of military personnel has become a top priority to military leadership. Given the investment made in recruiting and training personnel, it is vital that military decision makers understand the factors that influence the career commitments of service members. Research has demonstrated an increased interest in the influence of family…

Four Factors of Clinical Decision Making: A Teaching Model.

ERIC Educational Resources Information Center

Leist, James C.; Konen, Joseph C.

1996-01-01

Four factors of clinical decision making identified by medical students include quality of care, cost, ethics, and legal concerns. This paper argues that physicians have two responsibilities in the clinical decision-making model: to be the primary advocate for quality health care and to ensure balance among the four factors, working in partnership…

The factors influencing the decision making of operative treatment for proximal humeral fractures.

PubMed

Hageman, Michiel G J S; Jayakumar, Prakash; King, John D; Guitton, Thierry G; Doornberg, Job N; Ring, David

2015-01-01

The factors influencing the decision making of operative treatment for fractures of the proximal humerus are debated. We hypothesized that there is no difference in treatment recommendations between surgeons shown radiographs alone and those shown radiographs and patient information. Secondarily, we addressed (1) factors associated with a recommendation for operative treatment, (2) factors associated with recommendation for arthroplasty, (3) concordance with the recommendations of the treating surgeons, and (4) factors affecting the inter-rater reliability of treatment recommendations. A total of 238 surgeons of the Science of Variation Group rated 40 radiographs of patients with proximal humerus fractures. Participants were randomized to receive information about the patient and mechanism of injury. The response variables included the choice of treatment (operative vs nonoperative) and the percentage of matches with the actual treatment. Participants who received patient information recommended operative treatment less than those who received no information. The patient information that had the greatest influence on treatment recommendations included age (55%) and fracture mechanism (32%). The only other factor associated with a recommendation for operative treatment was region of practice. There was no significant difference between participants who were and were not provided with information regarding agreement with the actual treatment (operative vs nonoperative) provided by the treating surgeon. Patient information-older age in particular-is associated with a higher likelihood of recommending nonoperative treatment than radiographs alone. Clinical information did not improve agreement of the Science of Variation Group with the actual treatment or the generally poor interobserver agreement on treatment recommendations. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Key factors that influence government policies and decision making about healthcare priorities: Lessons for the field of eating disorders.

PubMed

Whiteford, Harvey; Weissman, Ruth Striegel

2017-03-01

Worldwide, the demand for healthcare exceeds what individuals and governments are able to afford. Priority setting is therefore inevitable, and mental health services have often been given low priority in the decision-making process. Drawing on established economic criteria, and specifically the work of Philip Musgrove, key factors which influence government decision-making about health priorities are reviewed. These factors include the size of the health burden, the availability of cost-effective interventions to reduce the burden, whether private markets can provide the necessary treatment efficiently, whether there are "catastrophic costs" incurred in accessing treatment, whether negative externalities arise from not providing care, and if the "rule of rescue" applies. Beyond setting priorities for resource allocation, governments also become involved where there is a need for regulation to maintain quality in the delivery of healthcare. By providing field-specific examples for each factor, we illustrate how advocates in the eating disorder field may use evidence to inform government policy about resource allocation and regulation in support of individuals with an eating disorder. © 2017 Wiley Periodicals, Inc.

Attitudes and Factors that Influence Decision-Making in Adoption from Care in Northern Ireland

ERIC Educational Resources Information Center

Barr, Lily

2004-01-01

This is a small-scale local study aimed at exploring the thinking and attitudes that inform or influence decision-making around proceeding to adoption. It also sought to explore or establish practitioners' views of potential tensions in this area and potential supports. It included open questions, attitudinal questions and required respondents to…

Psychological Factors Associated with Genetic Test Decision-Making among Parents of Children with Autism Spectrum Disorders in Taiwan

ERIC Educational Resources Information Center

Xu, Lei; Richman, Alice R.

2015-01-01

Making decisions to undergo Autism Spectrum Disorders (ASD) genetic testing can be challenging. It is important to understand how the perceptions of affected individuals might influence testing decision-making. Although evidence has shown that psychological factors are important in predicting testing decisions, affect-type variables have been…

Nonrational processes in ethical decision making.

PubMed

Rogerson, Mark D; Gottlieb, Michael C; Handelsman, Mitchell M; Knapp, Samuel; Younggren, Jeffrey

2011-10-01

Most current ethical decision-making models provide a logical and reasoned process for making ethical judgments, but these models are empirically unproven and rely upon assumptions of rational, conscious, and quasilegal reasoning. Such models predominate despite the fact that many nonrational factors influence ethical thought and behavior, including context, perceptions, relationships, emotions, and heuristics. For example, a large body of behavioral research has demonstrated the importance of automatic intuitive and affective processes in decision making and judgment. These processes profoundly affect human behavior and lead to systematic biases and departures from normative theories of rationality. Their influence represents an important but largely unrecognized component of ethical decision making. We selectively review this work; provide various illustrations; and make recommendations for scientists, trainers, and practitioners to aid them in integrating the understanding of nonrational processes with ethical decision making.

Naturalistic decision making in forensic science: toward a better understanding of decision making by forensic team leaders.

PubMed

Helsloot, Ira; Groenendaal, Jelle

2011-07-01

This study uses the naturalistic decision-making (NDM) perspective to examine how Dutch forensic team leaders (i.e., the officers in charge of criminal forensic research from the crime scene until the use of laboratory assistance) make decisions in real-life settings and identifies the contextual factors that might influence those decisions. First, a focus group interview was conducted to identify four NDM mechanisms in day-to-day forensic decision making. Second, a serious game was conducted to examine the influence of three of these contextual mechanisms. The results uncovered that forensic team leaders (i) were attracted to obtain further information when more information was initially made available, (ii) were likely to devote more attention to emotionally charged cases, and (iii) used not only forensic evidence in the decision making but also tactical, unverified information of the police inquiry. Interestingly, the measured contextual influences did not deviate significantly from a control group of laypeople. © 2011 American Academy of Forensic Sciences.

Women with bipolar disorder and pregnancy: factors influencing their decision-making.

PubMed

Dolman, Clare; Jones, Ian R; Howard, Louise M

2016-09-01

Women with bipolar disorder are at increased risk of having a severe episode of illness associated with childbirth. To explore the factors that influence the decision-making of women with bipolar disorder regarding pregnancy and childbirth. Qualitative study with a purposive sample of women with bipolar disorder considering pregnancy, or currently or previously pregnant, supplemented by data from an online forum. Data were analysed using thematic analysis. Twenty-one women with bipolar disorder from an NHS organisation were interviewed, and data were used from 50 women's comments via the online forum of the UK's national bipolar charity. The centrality of motherhood, social and economic contextual factors, stigma and fear were major themes. Within these themes, new findings included women considering an elective Caesarian section in an attempt to avoid the deleterious effects of a long labour and loss of sleep, or trying to avoid the risks of pregnancy altogether by means of adoption or surrogacy. This study highlights the information needs of women with bipolar disorder, both pre-conception and when childbearing, and the need for improved training for all health professionals working with women with bipolar disorder of childbearing age to reduce stigmatising attitudes and increase knowledge of the evidence base on treatment in the perinatal period. None. © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Factors influencing parental decision making in prenatal diagnosis of sex chromosome aneuploidy.

PubMed

Mezei, Gábor; Papp, Csaba; Tóth-Pál, Ernö; Beke, Artúr; Papp, Zoltán

2004-07-01

To evaluate factors influencing parental decisions toward continuing or terminating a pregnancy with prenatal diagnosis of sex chromosome aneuploidy. We reviewed the records of patients with fetuses with sex chromosome aneuploidy between 1990 and 2001. A questionnaire survey of women who chose to terminate such pregnancies was designed to examine aspects of their decision-making process. Forty-nine of 89 pregnancies with sex chromosome aneuploidy were terminated (termination rate 0.55; 95% confidence interval 0.45-0.65). Pregnancies with abnormal ultrasound findings (14/16, 87%), with 45,X or 47,XXY karyotypes (26/36, 72%), and with nonmosaic karyotypes (30/48, 63%) were terminated significantly more often than pregnancies with normal ultrasound findings (35/73, 48%; P <.01), with 47,XXX or 47,XYY karyotypes (4/12, 33%; P <.05), and with mosaic karyotypes (5/25, 20%; P =.01). There was a trend (P =.136) toward a lower rate of termination from 67% to 36% across time, with a significant decrease from 67% to 7% in pregnancies with 47,XXX; 47,XYY; and mosaic karyotypes (P <.01), and no change in cases with 45,X and 47,XXY karyotypes (67% compared with 69%; P = 1.0). Abnormal sexual development and infertility were the greatest parental concerns related to termination. Fear of having a child with abnormal sexual development or infertility remains the major determinant of parental decision toward terminating pregnancy, resulting in consistently high termination rates across time in pregnancies with 45,X and 47,XXY karyotypes. In cases with 47,XXX; 47,XYY; and mosaic karyotypes, the declining termination rate across time is a consequence of recent studies reporting normal sexual development and fertility.

Appropriate and inappropriate influences on outpatient discharge decision making in dermatology: a prospective qualitative study.

PubMed

Harun, N A; Finlay, A Y; Salek, M S; Piguet, V

2015-09-01

Outpatient discharge decision making in dermatology is poorly understood. To identify the influences on clinicians' thought processes when making discharge decisions in dermatology outpatient clinics. Forty clinicians from 11 National Health Service Trusts in England were interviewed. The interviews were audiorecorded, transcribed, coded and thematically analysed. The mean age of the clinicians was 48.8 years (range 33.0-67.0), 17 (43%) were men and 19 (48%) had > 20 years of clinical experience. One hundred and forty-eight influences were reported, with five main themes: (i) disease-based influences included type of diagnosis (100% of clinicians), guidelines (100%) and treatment needed (100%); (ii) clinician-based influences included the clinician's level of experience (100%), seniority (37%), emotional attitude (95%), 'gut feeling' (25%), personal attitude towards discharge (45%) and level of perception (100%); (iii) patient-based influences included patients' ability to cope with their disease (100%), wishes (70%), quality of life (32%), command of English (40%) and cultural background (25%); (iv) practice-based influences included good primary care (100%), secondary support structure (100%) and clinic capacity pressure (67%); (v) policy-based influences included pressure from hospital managers (57%) and an active discharge policy (7%). Fourteen (9%) influences were potentially inappropriate. This study has identified multiple factors influencing outpatient discharge decision making. This provides the basis for developing evidence-based training to improve discharge decision appropriateness. © 2015 British Association of Dermatologists.

Factors that influence case managers' resource allocation decisions in pediatric home care: an ethnographic study.

PubMed

Fraser, Kimberly D; Estabrooks, Carole; Allen, Marion; Strang, Vicki

2009-03-01

Case managers make decisions that directly affect the amount and type of services home care clients receive and subsequently affect the overall available health care resources of home care programs. A recent systematic review of the literature identified significant knowledge gaps with respect to resource allocation decision-making in home care. Using Spradley's methodology, we designed an ethnographic study of a children's home care program in Western Canada. The sample included 11 case managers and program leaders. Data sources included interviews, card sorts, and participant observation over a 5-month period. Data analyses included open coding, domain, taxonomic, and componential analysis. One of the key findings was a taxonomy of factors that influence case manager resource allocation decisions. The factors were grouped into one of four main categories: system-related, home care program-related, family related, or client-related. Family related factors have not been previously reported as influencing case manager resource allocation decision-making and nor has the team's role been reported as an influencing factor. The findings of this study are examined in light of Daniels and Sabin's Accountability for Reasonableness framework, which may be useful for future knowledge development about micro-level resource allocation theory.

Transfer of Patients in a Telestroke Network: What Are the Relevant Factors for Making This Decision?

PubMed

Klingner, Carsten M; Brodoehl, Stefan; Funck, Laura; Klingner, Caroline C; Berrouschot, Jörg; Witte, Otto W; Günther, Albrecht

2018-02-01

Background/Introduction: Current telestroke network consultations are focused on decision-making in the hyperacute stage of stroke management. The two main questions in telestroke consultations are whether thrombolysis should be initiated and whether the patient should be transferred to a hub hospital. Although guidelines exist for initiating intravenous thrombolytic therapy, the question of whether patients should be transferred is far more elusive. In this study, we investigated the factors involved in the decision to transfer stroke patients to a hub hospital. We were particularly interested in identifying factors that promote or impede the transfer of patients. We enrolled 1,615 cases of telestroke consultation of the University Hospital Jena. The two main factors that independently influenced the probability of transferring a patient were the patient's age and the identification of a proximal vessel occlusion. Interestingly, factors such as the severity of symptoms and the time elapsed from symptom onset were not found to have an independent influence on the decision to transfer a patient. The transfer of most patients was justified by the possibility of performing interventional reperfusion therapy. We discuss the effectiveness of the current decision-making process and possible ways to improve decision-making for a more effective selection of patients who would benefit from transfer. The decision-making process to a transfer patient is not standardized and constitutes a trade-off between the intention to treat all possible patients while avoiding the transfer of patients without treatment options.

Influence of uncertainty on framed decision-making with moral dilemma

PubMed Central

Mermillod, Martial; Le Pennec, Jean-Luc; Dutheil, Frédéric; Mondillon, Laurie

2018-01-01

In cases of impending natural disasters, most events are uncertain and emotionally relevant, both critical factors for decision-making. Moreover, for exposed individuals, the sensitivity to the framing of the consequences (gain or loss) and the moral judgments they have to perform (e.g., evacuate or help an injured person) constitute two central effects that have never been examined in the same context of decision-making. In a framed decision-making task with moral dilemma, we investigated whether uncertainty (i.e., unpredictably of events) and a threatening context would influence the framing effect (actions framed in loss are avoided in comparison to the ones framed in gain) and the personal intention effect (unintentional actions are more morally acceptable in comparison to intentional actions) on the perceived moral acceptability of taking action. Considering the impact of uncertainty and fear on the processes underlying these effects, we assumed that these emotions would lead to the negation of the two effects. Our results indicate that the exposure to uncertain events leads to the negation of the framing effect, but does not influence the moral acceptability and the effect of personal intention. We discuss our results in the light of dual-process models (i.e. systematic vs. heuristic), appraisal theories, and neurocognitive aspects. These elements highlight the importance of providing solutions to cope with uncertainty, both for scientists and local populations exposed to natural hazards. PMID:29847589

Factors influencing and modifying the decision to pursue genetic testing for skin cancer risk.

PubMed

Fogel, Alexander L; Jaju, Prajakta D; Li, Shufeng; Halpern-Felsher, Bonnie; Tang, Jean Y; Sarin, Kavita Y

2017-05-01

Across cancers, the decision to pursue genetic testing is influenced more by subjective than objective factors. However, skin cancer, which is more prevalent, visual, and multifactorial than many other malignancies, may offer different motivations for pursuing such testing. The primary objective was to determine factors influencing the decision to receive genetic testing for skin cancer risk. A secondary objective was to assess the impact of priming with health questions on the decision to receive testing. We distributed anonymous online surveys through ResearchMatch.org to assess participant health, demographics, motivations, and interest in pursuing genetic testing for skin cancer risk. Two surveys with identical questions but different question ordering were used to assess the secondary objective. We received 3783 responses (64% response rate), and 85.8% desired testing. Subjective factors, including curiosity, perceptions of skin cancer, and anxiety, were the most statistically significant determinants of the decision to pursue testing (P < .001), followed by history of sun exposure (odds ratio 1.85, P < .01) and history of skin cancer (odds ratio 0.5, P = .01). Age and family history of skin cancer did not influence this decision. Participants increasingly chose testing if first queried about health behaviors (P < .0001). The decision to pursue hypothetical testing may differ from in-clinic decision-making. Self-selected, online participants may differ from the general population. Surveys may be subject to response bias. The decision to pursue genetic testing for skin cancer is primarily determined by subjective factors, such as anxiety and curiosity. Health factors, including skin cancer history, also influenced decision-making. Priming with consideration of objective health factors can increase the desire to pursue testing. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

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.

Factors influencing malaria control policy-making in Kenya, Uganda and Tanzania.

PubMed

Mutero, Clifford M; Kramer, Randall A; Paul, Christopher; Lesser, Adriane; Miranda, Marie Lynn; Mboera, Leonard E G; Kiptui, Rebecca; Kabatereine, Narcis; Ameneshewa, Birkinesh

2014-08-08

Policy decisions for malaria control are often difficult to make as decision-makers have to carefully consider an array of options and respond to the needs of a large number of stakeholders. This study assessed the factors and specific objectives that influence malaria control policy decisions, as a crucial first step towards developing an inclusive malaria decision analysis support tool (MDAST). Country-specific stakeholder engagement activities using structured questionnaires were carried out in Kenya, Uganda and Tanzania. The survey respondents were drawn from a non-random purposeful sample of stakeholders, targeting individuals in ministries and non-governmental organizations whose policy decisions and actions are likely to have an impact on the status of malaria. Summary statistics across the three countries are presented in aggregate. Important findings aggregated across countries included a belief that donor preferences and agendas were exerting too much influence on malaria policies in the countries. Respondents on average also thought that some relevant objectives such as engaging members of parliament by the agency responsible for malaria control in a particular country were not being given enough consideration in malaria decision-making. Factors found to influence decisions regarding specific malaria control strategies included donor agendas, costs, effectiveness of interventions, health and environmental impacts, compliance and/acceptance, financial sustainability, and vector resistance to insecticides. Malaria control decision-makers in Kenya, Uganda and Tanzania take into account health and environmental impacts as well as cost implications of different intervention strategies. Further engagement of government legislators and other policy makers is needed in order to increase funding from domestic sources, reduce donor dependence, sustain interventions and consolidate current gains in malaria.

A Pilot Study of the Perceptions of Actively Practicing Obstetricians in Puerto Rico: Factors that Influence Decision Making in Cesarean Delivery.

PubMed

Carrera, Alberto M; Sternke, Elizabeth A; Rivera-Viñas, Juana I

2017-03-01

The reported cesarean delivery (CD) rate for 2012 in Puerto Rico was higher than that of the United States (48.5% and 32.8%, respectively). Multiple reasons for and consequences of the high rates of CD exist. The decision to perform a CD is based on multiple factors, some of which are not obstetrical. In order to better understand those factors, the pilot study described in this manuscript analyzed data collected from obstetricians themselves. During 2011, convenience sampling was used to collect data from active obstetric practitioners attending the Caribe Gyn 2011 conference in Ponce, Puerto Rico. A self-administered survey was piloted and analyzed using formative content analysis. Obstetricians were asked to name factors that contribute to their decision to perform a CD and factors they felt influence other obstetricians to make that decision. In general, common maternal and fetal causes for choosing CD were noted. Hypertensive disorders (60%) and abnormal intrapartum fetal tracing (83%) were highly rated, as were non-obstetrical factors, including physician convenience (52%) and concern for medical liability for vaginal delivery (50%). According to the participating obstetricians, many factors associated with the standard practice of obstetrics influence the decision to perform a CD. However, non-obstetrical reasons were also found. Future studies using a larger sample of Puerto Rican obstetricians are required to fully understand these factors in order to both address them through educational interventions for patients, physicians, administrators, and insurers, and inform public policy.

Parental Influence on Exploratory Students' College Choice, Major, and Career Decision Making

ERIC Educational Resources Information Center

Workman, Jamie L.

2015-01-01

This article explores parental influence on exploratory students' college choice, major, and career decision making. The research began with examination of a first year academic advising model and Living Learning Community. Parental influence emerged as a key theme in student decision making processes. The project was conducted using grounded…

The Influence of Emotion Regulation on Decision-making under Risk

PubMed Central

Martin, Laura N.; Delgado, Mauricio R.

2011-01-01

Cognitive strategies typically involved in regulating negative emotions have recently been shown to also be effective with positive emotions associated with monetary rewards. However, it is less clear how these strategies influence behavior, such as preferences expressed during decision-making under risk, and the underlying neural circuitry. That is, can the effective use of emotion regulation strategies during presentation of a reward-conditioned stimulus influence decision-making under risk and neural structures involved in reward processing such as the striatum? To investigate this question, we asked participants to engage in imagery-focused regulation strategies during the presentation of a cue that preceded a financial decision-making phase. During the decision phase, participants then made a choice between a risky and a safe monetary lottery. Participants who successfully used cognitive regulation, as assessed by subjective ratings about perceived success and facility in implementation of strategies, made fewer risky choices in comparison to trials where decisions were made in the absence of cognitive regulation. Additionally, blood-oxygen-level-dependent (BOLD) responses in the striatum were attenuated during decision-making as a function of successful emotion regulation. These findings suggest that exerting cognitive control over emotional responses can modulate neural responses associated with reward processing (e.g., striatum), and promote more goal-directed decision-making (e.g., less risky choices), illustrating the potential importance of cognitive strategies in curbing risk-seeking behaviors before they become maladaptive (e.g., substance abuse). PMID:21254801

The influence of emotion regulation on decision-making under risk.

PubMed

Martin, Laura N; Delgado, Mauricio R

2011-09-01

Cognitive strategies typically involved in regulating negative emotions have recently been shown to also be effective with positive emotions associated with monetary rewards. However, it is less clear how these strategies influence behavior, such as preferences expressed during decision-making under risk, and the underlying neural circuitry. That is, can the effective use of emotion regulation strategies during presentation of a reward-conditioned stimulus influence decision-making under risk and neural structures involved in reward processing such as the striatum? To investigate this question, we asked participants to engage in imagery-focused regulation strategies during the presentation of a cue that preceded a financial decision-making phase. During the decision phase, participants then made a choice between a risky and a safe monetary lottery. Participants who successfully used cognitive regulation, as assessed by subjective ratings about perceived success and facility in implementation of strategies, made fewer risky choices in comparison with trials where decisions were made in the absence of cognitive regulation. Additionally, BOLD responses in the striatum were attenuated during decision-making as a function of successful emotion regulation. These findings suggest that exerting cognitive control over emotional responses can modulate neural responses associated with reward processing (e.g., striatum) and promote more goal-directed decision-making (e.g., less risky choices), illustrating the potential importance of cognitive strategies in curbing risk-seeking behaviors before they become maladaptive (e.g., substance abuse).

Factors influencing antibiotic-prescribing decisions among inpatient physicians: a qualitative investigation

PubMed Central

Livorsi, D; Comer, AR; Matthias, MS; Perencevich, EN; Bair, MJ

2016-01-01

Objective To understand the professional and psychosocial factors that influence physicians' antibiotic-prescribing habits in the inpatient setting. Design We conducted semi-structured interviews with 30 inpatient physicians. Interviews consisted of open-ended questions and flexible probes based on participants' responses. Interviews were audio recorded, transcribed, de-identified, and reviewed for accuracy and completeness. Data were analyzed using emergent thematic analysis. Setting Two teaching hospitals in Indianapolis, IN Participants Thirty inpatient physicians (10 physicians-in-training, 20 supervising staff) Results Participants recognized that antibiotics are over-used, and many admitted to prescribing antibiotics even when the clinical evidence of infection was uncertain. Over-prescription was largely driven by anxiety about missing an infection while potential adverse effects of antibiotics did not strongly influence decision-making. Participants did not routinely disclose potential adverse effects of antibiotics to inpatients. Physicians-in-training were strongly influenced by the antibiotic prescribing behavior of their supervising staff physicians. Participants sometimes questioned their colleagues' antibiotic-prescribing decisions but frequently avoided providing direct feedback or critique, citing obstacles of hierarchy, infrequent face-to-face encounters, and the awkwardness of these conversations. Conclusion There is a physician-based culture of prescribing antibiotics, which involves over-using antibiotics and not challenging colleagues' decisions. The potential adverse effects of antibiotics do not strongly influence decision-making in this sample. A better understanding of these factors could be leveraged in future efforts to improve antibiotic-prescribing in the inpatient setting. PMID:26078017

Service Level Decision-making in Rural Physiotherapy: Development of Conceptual Models.

PubMed

Adams, Robyn; Jones, Anne; Lefmann, Sophie; Sheppard, Lorraine

2016-06-01

Understanding decision-making about health service provision is increasingly important in an environment of increasing demand and constrained resources. Multiple factors are likely to influence decisions about which services will be provided, yet workforce is the most noted factor in the rural physiotherapy literature. This paper draws together results obtained from exploration of service level decision-making (SLDM) to propose 'conceptual' models of rural physiotherapy SLDM. A prioritized qualitative approach enabled exploration of participant perspectives about rural physiotherapy decision-making. Stakeholder perspectives were obtained through surveys and in-depth interviews. Interviews were transcribed verbatim and reviewed by participants. Participant confidentiality was maintained by coding both participants and sites. A system theory-case study heuristic provided a framework for exploration across sites within the investigation area: a large area of one Australian state with a mix of regional, rural and remote communities. Thirty-nine surveys were received from participants in 11 communities. Nineteen in-depth interviews were conducted with physiotherapists and key decision-makers. Results reveal the complexity of factors influencing rural physiotherapy service provision and the value of a systems approach when exploring decision-making about rural physiotherapy service provision. Six key features were identified that formed the rural physiotherapy SLDM system: capacity and capability; contextual influences; layered decision-making; access issues; value and beliefs; and tensions and conflict. Rural physiotherapy SLDM is not a one-dimensional process but results from the complex interaction of clusters of systems issues. Decision-making about physiotherapy service provision is influenced by both internal and external factors. Similarities in influencing factors and the iterative nature of decision-making emerged, which enabled linking physiotherapy SLDM with

Decision making in childbirth: the influence of traditional structures in a Ghanaian village.

PubMed

Jansen, I

2006-03-01

The regional health administration of the Brong-Ahafo Region in Ghana identified that although informed about the advantages of both aspects of care, pregnant women made use of antenatal services but not of the supervised delivery. Quantitative studies have identified economic factors that influence the decisions of pregnant women. To describe and understand the traditional structures of childbirth in Kwame Danso/Ghana and to explore why the pregnant women do not make use of supervised deliveries in the modern institutions. A mini-ethnographic study, using participant observation and ethnographic interviews. Cultural and social factors have a significant influence on the decisions related to childbirth. One of the most important factors identified was that the responsible persons for decisions related to a delivery were the older female relatives, rather than the mothers themselves. Older females used rational judgements to weigh up the possibilities of risks, interests and advantages related to their cultural, spiritual and social system. Other factors were staff behaviour that was characterized as unfriendly and lacking for respect as to the living conditions and thinking of the pregnant women in the village. Ethnographic research provided an understanding of traditional structures that have an influence on the decisions and behaviour of the community related to childbirth. Appreciation of these structures enabled health promotion and structured health services to be delivered in a more culturally appropriate way.

Sensemaking Strategies for Ethical Decision-making.

PubMed

Caughron, Jay J; Antes, Alison L; Stenmark, Cheryl K; Thiel, Chaise E; Wang, Xiaoqian; Mumford, Michael D

2011-01-01

The current study uses a sensemaking model and thinking strategies identified in earlier research to examine ethical decision-making. Using a sample of 163 undergraduates, a low fidelity simulation approach is used to study the effects personal involvement (in causing the problem and personal involvement in experiencing the outcomes of the problem) could have on the use of cognitive reasoning strategies that have been shown to promote ethical decision-making. A mediated model is presented which suggests that environmental factors influence reasoning strategies, reasoning strategies influence sensemaking, and sensemaking in turn influences ethical decision-making. Findings were mixed but generally supported the hypothesized model. Interestingly, framing the outcomes of ethically charged situations in terms of more global organizational outcomes rather than personal outcomes was found to promote the use of pro-ethical cognitive reasoning strategies.

Women with bipolar disorder and pregnancy: factors influencing their decision-making

PubMed Central

Jones, Ian R.; Howard, Louise M.

2016-01-01

Background Women with bipolar disorder are at increased risk of having a severe episode of illness associated with childbirth. Aims To explore the factors that influence the decision-making of women with bipolar disorder regarding pregnancy and childbirth. Method Qualitative study with a purposive sample of women with bipolar disorder considering pregnancy, or currently or previously pregnant, supplemented by data from an online forum. Data were analysed using thematic analysis. Results Twenty-one women with bipolar disorder from an NHS organisation were interviewed, and data were used from 50 women’s comments via the online forum of the UK’s national bipolar charity. The centrality of motherhood, social and economic contextual factors, stigma and fear were major themes. Within these themes, new findings included women considering an elective Caesarian section in an attempt to avoid the deleterious effects of a long labour and loss of sleep, or trying to avoid the risks of pregnancy altogether by means of adoption or surrogacy. Conclusions This study highlights the information needs of women with bipolar disorder, both pre-conception and when childbearing, and the need for improved training for all health professionals working with women with bipolar disorder of childbearing age to reduce stigmatising attitudes and increase knowledge of the evidence base on treatment in the perinatal period. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license. PMID:27703792

Characteristics, perceptions, and factors influencing the decision making of physical therapy chairpersons in 2000.

PubMed

Page, C G

2001-01-01

The physical therapy (PT) profession is changing. A mailed survey elicited characteristics of current PT chairpersons, such as time spent on responsibilities, influences on decision making, perceptions of working relationships, and satisfaction with decision making, as well as information about their supervisors and the faculty they managed. Chairpersons of 115 (54.28%) accredited PT programs responded. They had been in their positions for a mean of 6.04 years; 63 (57.8%) held doctoral degrees. They had a mean of 25.6 years of experience in PT practice and 17.5 years in academic positions. Their levels of satisfaction and the power and influence they had in their positions were high. However, the time spent on faculty recruitment and mentoring, given the lack of seniority of their faculty, and the small percentage of time they devoted to their own professional development may be concerns. Long-range planning and accreditation duties take up most of the time of PT chairpersons. This information may be helpful to people who seek, or who are recruited for, chairperson positions. It provides a foundational database for longitudinal studies of PT chairpersons.

When elders choose: Which factors could influence the decision-making among elderly in the selection of health tourism services?

PubMed

Tomasović Mrčela, N; Borovac, J A; Vrdoljak, D; Grazio, S; Tikvica Luetić, A; Tomek-Roksandić, S

2015-12-01

Elderly beneficiaries (age 65+) exhibit specific characteristics that influence the distribution of health tourism market. High incidence of multiple morbidities and functional disability are hallmarks in this age group. For these reasons, elderly population requires different elements and diverse spectrum of services within health tourism, in comparison to younger beneficiaries. Thus, differences would occur within heterogeneous elderly population itself. A preliminary study that we conducted showed that the level of functional independence was one of the significant factors that guided decision-making among elderly beneficiaries when it came to their health tourism-related choices. Results suggested that beneficiaries recognized and appreciated the effect of the natural remedies and attractions available at the given destination. Maritime and continental health tourism are two different entities commonly selected by elderly beneficiaries for therapeutic purposes. We propose that the climate conditions, geographical location and availability of regional natural remedies are the key factors to why different services were elected by different groups of elderly. The model of Croatia, an established country in the field of health tourism was utilized for this purpose. Differences in the diagnostic categories of beneficiaries are expected due to effects of marine (sea, Mediterranean climate) and continental (thermal water, healing mud) health tourism. In addition, multitudes of mutually intertwined factors affect decision-making process among elderly regarding their health tourism choices. Such factors include the scale of preferences (with special emphasis on well-being and health), leisure opportunities, marketing influences, cost (price) and the availability/diversity of health tourism services within the particular region. Moreover, individual psychosocial and physical characteristics, disabilities and other debilitating conditions, examined in our preliminary

Hospice decision making: diagnosis makes a difference.

PubMed

Waldrop, Deborah P; Meeker, Mary Ann

2012-10-01

This study explored the process of decision making about hospice enrollment and identified factors that influence the timing of that decision. This study employed an exploratory, descriptive, cross-sectional design and was conducted using qualitative methods. In-depth in-person semistructured interviews were conducted with 36 hospice patients and 55 caregivers after 2 weeks of hospice care. The study was guided by Janis and Mann's conflict theory model (CTM) of decision making. Qualitative data analysis involved a directed content analysis using concepts from the CTM. A model of hospice enrollment decision making is presented. Concepts from the CTM (appraisal, surveying and weighing the alternatives, deliberations, adherence) were used as an organizing framework to illustrate the dynamics. Distinct differences were found by diagnosis (cancer vs. other chronic illness, e.g., heart and lung diseases) during the pre-encounter phase or before the hospice referral but no differences emerged during the post-encounter phase. Differences in decision making by diagnosis suggest the need for research about effective means for tailored communication in end-of-life decision making by type of illness. Recognition that decision making about hospice admission varies is important for clinicians who aim to provide person-centered and family-focused care.

Nurse aide decision making in nursing homes: factors affecting empowerment.

PubMed

Chaudhuri, Tanni; Yeatts, Dale E; Cready, Cynthia M

2013-09-01

To evaluate factors affecting structural empowerment among nurse aides in nursing homes. Structural empowerment can be defined as the actual rather than perceived ability to make autonomous decisions within an organisation. Given the paucity of research on the subject, this study helps to close the gap by identifying factors that affect nurse aide empowerment, that is, decision-making among nurse aides. The data for the study come from self-administered questionnaires distributed to direct-care workers (nurse aides) in 11 nursing homes in a southern state in the USA. Ordinary least square regression models were estimated to analyse the effects of demographic predictors, personal factors (competency, emotional exhaustion and positive attitude) and structural characteristics (coworker and supervisor support, information availability and shared governance) on nurse aide decision-making. Findings suggest race among demographic predictors, emotional exhaustion among personal characteristics, and supervisor support, and shared governance among structural factors, significantly affect nurse aide decision-making. It is important to explore race as one of the central determinants of structural empowerment among nurse aides. In addition, the nature and type of emotional exhaustion that propels decision-making needs to be further examined. The study shows the importance of shared governance and supervisor support for fostering nurse aide empowerment. © 2013 Blackwell Publishing Ltd.

Choosing between staying at home or moving: A systematic review of factors influencing housing decisions among frail older adults.

PubMed

Roy, Noémie; Dubé, Roxanne; Després, Carole; Freitas, Adriana; Légaré, France

2018-01-01

Most older adults wish to stay at home during their late life years, but physical disabilities and cognitive impairment may force them to face a housing decision. However, they lack relevant information to make informed value-based housing decisions. Consequently, we sought to identify the sets of factors influencing the housing decision-making of older adults. We performed a systematic literature search for studies evaluating any factors influencing the housing decisions among older adults over 65 years old without cognitive disabilities. Primary research from any study design reported after 1990 in a peer-reviewed journal, a book chapter or an evaluated doctoral thesis and written in English, French or Spanish were eligible. We extracted the main study characteristics, the participant characteristics and any factors reported as associated with the housing decision. We conducted a qualitative thematic analysis from the perspective of the meaning and experience of home. The search resulted in 660 titles (after duplicate removal) from which 86 studies were kept for analysis. One study out of five reported exclusively on frail older adults (n = 17) and two on adults over 75 years old. Overall, a total of 88 factors were identified, of which 71 seem to have an influence on the housing decision-making of older adults, although the influence of 19 of them remains uncertain due to discrepancies between research methodologies. No conclusion was made regarding 12 additional factors due to lack of evidence. A wealth of factors were found to influence housing decisions among older adults. However, very few of them have been studied extensively. Our results highlight the importance of interdisciplinary teamwork to study the influence of a broader range of factors as a whole. These results will help older adults make the best possible housing decision based on their unique situation and values.

Choosing between staying at home or moving: A systematic review of factors influencing housing decisions among frail older adults

PubMed Central

Roy, Noémie; Dubé, Roxanne; Després, Carole; Freitas, Adriana

2018-01-01

Background Most older adults wish to stay at home during their late life years, but physical disabilities and cognitive impairment may force them to face a housing decision. However, they lack relevant information to make informed value-based housing decisions. Consequently, we sought to identify the sets of factors influencing the housing decision-making of older adults. Methods We performed a systematic literature search for studies evaluating any factors influencing the housing decisions among older adults over 65 years old without cognitive disabilities. Primary research from any study design reported after 1990 in a peer-reviewed journal, a book chapter or an evaluated doctoral thesis and written in English, French or Spanish were eligible. We extracted the main study characteristics, the participant characteristics and any factors reported as associated with the housing decision. We conducted a qualitative thematic analysis from the perspective of the meaning and experience of home. Results The search resulted in 660 titles (after duplicate removal) from which 86 studies were kept for analysis. One study out of five reported exclusively on frail older adults (n = 17) and two on adults over 75 years old. Overall, a total of 88 factors were identified, of which 71 seem to have an influence on the housing decision-making of older adults, although the influence of 19 of them remains uncertain due to discrepancies between research methodologies. No conclusion was made regarding 12 additional factors due to lack of evidence. Conclusion A wealth of factors were found to influence housing decisions among older adults. However, very few of them have been studied extensively. Our results highlight the importance of interdisciplinary teamwork to study the influence of a broader range of factors as a whole. These results will help older adults make the best possible housing decision based on their unique situation and values. PMID:29293511

Stop making plans; start making decisions.

PubMed

Mankins, Michael C; Steele, Richard

2006-01-01

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

Influential factors on treatment decision making among patients with colorectal cancer: A scoping review.

PubMed

Cranley, Nicole M; Curbow, Barbara; George, Thomas J; Christie, Juliette

2017-09-01

In recent years, a greater emphasis has been placed on shared decision-making (SDM) techniques between providers and patients with the goal of helping patients make informed decisions about their care and subsequently to improve patient health outcomes. Previous research has shown variability in treatment decision-making among patients with colorectal cancer (CRC), and there is little comprehensive information available to help explain this variability. Thus, the purpose of this study was to evaluate the current state of the literature on factors that are influential in treatment decision-making among patients with CRC. A priori search terms using Boolean connectors were used to examine PubMed, PsycINFO, Web of Science, CINAHL, and MEDLINE for relevant studies. Eligibility criteria for inclusion in the study included patients with CRC and examination of influences on CRC treatment decision-making. All relevant data were extracted including, author, title and year, study methodology, and study results. Findings (n = 13) yielded influences in four areas: informational, patient treatment goals, patient role preferences, and relationship with provider. Quality of life and trust in physician were rated a high priority among patients when making decisions between different therapeutic options. Several studies found that patients wanted to be informed and involved but did not necessarily want to make autonomous treatment choices, with many preferring a more passive role. Providers who initiate a dialog to better understand their patients' treatment goals can establish rapport, increase patient understanding of treatment options, and help patients assume their desired role in their decision-making. Overall, there were a small number of studies that met all inclusion criteria with most used a cross-sectional design.

The Influence of Social Comparison and Peer Group Size on Risky Decision-Making.

PubMed

Wang, Dawei; Zhu, Liping; Maguire, Phil; Liu, Yixin; Pang, Kaiyuan; Li, Zhenying; Hu, Yixin

2016-01-01

This study explores the influence of different social reference points and different comparison group sizes on risky decision-making. Participants were presented with a scenario describing an exam, and presented with the opportunity of making a risky decision in the context of different information provided about the performance of their peers. We found that behavior was influenced, not only by comparison with peers, but also by the size of the comparison group. Specifically, the larger the reference group, the more polarized the behavior it prompted. In situations describing social loss, participants were led to make riskier decisions after comparing themselves against larger groups, while in situations describing social gain, they become more risk averse. These results indicate that decision making is influenced both by social comparison and the number of people making up the social reference group.

The Influence of Social Comparison and Peer Group Size on Risky Decision-Making

PubMed Central

Wang, Dawei; Zhu, Liping; Maguire, Phil; Liu, Yixin; Pang, Kaiyuan; Li, Zhenying; Hu, Yixin

2016-01-01

This study explores the influence of different social reference points and different comparison group sizes on risky decision-making. Participants were presented with a scenario describing an exam, and presented with the opportunity of making a risky decision in the context of different information provided about the performance of their peers. We found that behavior was influenced, not only by comparison with peers, but also by the size of the comparison group. Specifically, the larger the reference group, the more polarized the behavior it prompted. In situations describing social loss, participants were led to make riskier decisions after comparing themselves against larger groups, while in situations describing social gain, they become more risk averse. These results indicate that decision making is influenced both by social comparison and the number of people making up the social reference group. PMID:27582723

Sensemaking Strategies for Ethical Decision-making

PubMed Central

Caughron, Jay J.; Antes, Alison L.; Stenmark, Cheryl K.; Thiel, Chaise E.; Wang, Xiaoqian; Mumford, Michael D.

2015-01-01

The current study uses a sensemaking model and thinking strategies identified in earlier research to examine ethical decision-making. Using a sample of 163 undergraduates, a low fidelity simulation approach is used to study the effects personal involvement (in causing the problem and personal involvement in experiencing the outcomes of the problem) could have on the use of cognitive reasoning strategies that have been shown to promote ethical decision-making. A mediated model is presented which suggests that environmental factors influence reasoning strategies, reasoning strategies influence sensemaking, and sensemaking in turn influences ethical decision-making. Findings were mixed but generally supported the hypothesized model. Interestingly, framing the outcomes of ethically charged situations in terms of more global organizational outcomes rather than personal outcomes was found to promote the use of pro-ethical cognitive reasoning strategies. PMID:26257505

Anxiety and Decision-Making

PubMed Central

Hartley, Catherine A.; Phelps, Elizabeth A.

2013-01-01

While the everyday decision-making of clinically anxious individuals is clearly influenced by their excessive fear and worry, the relationship between anxiety and decision-making remains relatively unexplored in neuroeconomic studies. In this review, we attempt to explore the role of anxiety in decision-making using a neuroeconomic approach. We first review the neural systems mediating fear and anxiety, which overlap with a network of brain regions implicated in studies of economic decision-making. We then discuss the potential influence of cognitive biases associated with anxiety upon economic choice, focusing on a set of decision-making biases involving choice in the face of potential aversive outcomes. We propose that the neural circuitry supporting fear learning and regulation may mediate the influence of anxiety upon choice, and suggest that techniques for altering fear and anxiety may also change decisions. PMID:22325982

Influence of negative affect on decision making in women with restrictive and binge-purge type anorexia nervosa.

PubMed

Danner, Unna N; Sternheim, Lot; Bijsterbosch, Jojanneke M; Dingemans, Alexandra E; Evers, Catharine; van Elburg, Annemarie A

2016-05-30

The present study aims to examine the influence of negative affect on decision making in women with anorexia nervosa (AN) compared to healthy control women and, secondly, to assess differences between the restrictive (ANR) and binge-purge (ANBP) subtypes. One hundred four women (32 with ANR, 32 with ANBP, and 40 healthy controls) participated. All women were asked to watch either a negative or a control film fragment, both followed by the Bechara Gambling Task (BGT). Before and after the fragments negative affect was measured. Additionally, relevant characteristics (e.g., overall depressive symptoms) were assessed. Differences in negative affect did not influence decision making performance. Independent of affective state, decision making was found to be impaired in women with ANBP (no learning effect on the BGT), but not in women with ANR. These findings highlight the importance of considering different AN subtypes when examining decision making processes. However, the role of negative affect on decision making remains uncertain. Since other affect related factors such as affect dysregulation may also play a role, future studies on decision making in AN should take the role of affect into account. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Mature Age Professionals: Factors Influencing Their Decision to Make a Career Change into Teaching

ERIC Educational Resources Information Center

Bauer, Carmel; Thomas, Sue; Sim, Cheryl

2017-01-01

This paper presents the early findings from a study that addresses the topic of mature age professionals making a career change into the secondary teaching profession by undertaking a postgraduate coursework initial teacher education program. The paper specifically addresses the factors that affect the decision for mature age professionals to make…

How to introduce medical ethics at the bedside - Factors influencing the implementation of an ethical decision-making model.

PubMed

Meyer-Zehnder, Barbara; Albisser Schleger, Heidi; Tanner, Sabine; Schnurrer, Valentin; Vogt, Deborah R; Reiter-Theil, Stella; Pargger, Hans

2017-02-23

As the implementation of new approaches and procedures of medical ethics is as complex and resource-consuming as in other fields, strategies and activities must be carefully planned to use the available means and funds responsibly. Which facilitators and barriers influence the implementation of a medical ethics decision-making model in daily routine? Up to now, there has been little examination of these factors in this field. A medical ethics decision-making model called METAP was introduced on three intensive care units and two geriatric wards. An evaluation study was performed from 7 months after deployment of the project until two and a half years. Quantitative and qualitative methods including a questionnaire, semi-structured face-to-face and group-interviews were used. Sixty-three participants from different professional groups took part in 33 face-to-face and 9 group interviews, and 122 questionnaires could be analysed. The facilitating factors most frequently mentioned were: acceptance and presence of the model, support given by the medical and nursing management, an existing or developing (explicit) ethics culture, perception of a need for a medical ethics decision-making model, and engaged staff members. Lack of presence and acceptance, insufficient time resources and staff, poor inter-professional collaboration, absence of ethical competence, and not recognizing ethical problems were identified as inhibiting the implementation of the METAP model. However, the results of the questionnaire as well as of explicit inquiry showed that the respondents stated to have had enough time and staff available to use METAP if necessary. Facilitators and barriers of the implementation of a medical ethics decision-making model are quite similar to that of medical guidelines. The planning for implementing an ethics model or guideline can, therefore, benefit from the extensive literature and experience concerning the implementation of medical guidelines. Lack of time and

Stereotype threat affects financial decision making.

PubMed

Carr, Priyanka B; Steele, Claude M

2010-10-01

The research presented in this article provides the first evidence that one's decision making can be influenced by concerns about stereotypes and the devaluation of one's identity. Many studies document gender differences in decision making, and often attribute these differences to innate and stable factors, such as biological and hormonal differences. In three studies, we found that stereotype threat affected decision making and led to gender differences in loss-aversion and risk-aversion behaviors. In Study 1, women subjected to stereotype threat in academic and business settings were more loss averse than both men and women who were not facing the threat of being viewed in light of negative stereotypes. We found no gender differences in loss-aversion behavior in the absence of stereotype threat. In Studies 2a and 2b, we found the same pattern of effects for risk-aversion behavior that we had observed for loss-aversion behavior. In addition, in Study 2b, ego depletion mediated the effects of stereotype threat on women's decision making. These results suggest that individuals' decision making can be influenced by stereotype concerns.

Influences on Immunization Decision-Making among US Parents of Young Children.

PubMed

Chung, Yunmi; Schamel, Jay; Fisher, Allison; Frew, Paula M

2017-12-01

Objectives This study assessed influences on vaccination decisions among parents of young children and examined common vaccination information and advice sources. Methods Using panel samples of parents of children under 7 years, web-based surveys were conducted in 2012 (n = 2603) and 2014 (n = 2518). A vaccine decision-making typology (non-hesitant acceptors, hesitant acceptors, delayers, and refusers) was established and weighted population estimates of potential factors influencing parental vaccination decision (e.g., provider influence, source of information and advice) were computed by year and decision type. Results Delayers and refusers were more likely than acceptors to know someone whose child experienced a severe reaction to a vaccine or delayed/refused vaccine(s). High proportions of delayers (2012: 33.4%, 2014: 33.9%) and refusers (2012: 49.6%, 2014: 58.6%) reported selecting their healthcare provider based on whether the provider would allow them to delay/refuse vaccines. Providers were the most frequently reported trusted vaccine information source among all parents, though more often by acceptors than refusers (2012, 2014: p < 0.01). We found differing patterns of provider advice-seeking and internet as a reliable vaccine information source by group. Among those who had considered delay/refusal, trust in their healthcare provider's advice was the most common reason cited for their decision reversal. Conclusions for Practice Provider trust and communication along with varying degrees of personal-network influences likely contribute to immunization decisions of parents. Vaccine hesitant parents often seek providers amenable to accommodating their vaccine beliefs. Providers may benefit from vaccine communication training as their recommendations may influence hesitant parents to immunize their children.

Multiple factors, including non-motor impairments, influence decision making with regard to exercise participation in Parkinson's disease: a qualitative enquiry.

PubMed

O'Brien, Christine; Clemson, Lindy; Canning, Colleen G

2016-01-01

To explore how the meaning of exercise and other factors interact and influence the exercise behaviour of individuals with Parkinson's disease (PD) enrolled in a 6-month minimally supervised exercise program to prevent falls, regardless of whether they completed the prescribed exercise or not. This qualitative study utilised in-depth semi-structured interviews analysed using grounded theory methodology. Four main themes were constructed from the data: adapting to change and loss, the influence of others, making sense of the exercise experience and hope for a more active future. Participation in the PD-specific physiotherapy program involving group exercise provided an opportunity for participants to reframe their identity of their "active" self. Three new influences on exercise participation were identified and explored: non-motor impairments of apathy and fatigue, the belief in a finite energy quota, and the importance of feedback. A model was developed incorporating the themes and influences to explain decision-making for exercise participation in this group. Complex and interacting issues, including non-motor impairments, need to be considered in order to enhance the development and ongoing implementation of effective exercise programmes for people with PD. Exercise participation can assist individuals to reframe their identity as they are faced with losses associated with Parkinson's disease and ageing. Non-motor impairments of apathy and fatigue may influence exercise participation in people with Parkinson's disease. Particular attention needs to be paid to the provision of feedback in exercise programs for people with Parkinson's disease as it important for their decision-making about continuing exercise.

Role of affect in decision making.

PubMed

Bandyopadhyay, Debarati; Pammi, V S Chandrasekhar; Srinivasan, Narayanan

2013-01-01

Emotion plays a major role in influencing our everyday cognitive and behavioral functions, including decision making. We introduce different ways in which emotions are characterized in terms of the way they influence or elicited by decision making. This chapter discusses different theories that have been proposed to explain the role of emotions in judgment and decision making. We also discuss incidental emotional influences, both long-duration influences like mood and short-duration influences by emotional context present prior to or during decision making. We present and discuss results from a study with emotional pictures presented prior to decision making and how that influences both decision processes and postdecision experience as a function of uncertainty. We conclude with a summary of the work on emotions and decision making in the context of decision-making theories and our work on incidental emotions. Copyright © 2013 Elsevier B.V. All rights reserved.

Shared clinical decision making

PubMed Central

AlHaqwi, Ali I.; AlDrees, Turki M.; AlRumayyan, Ahmad; AlFarhan, Ali I.; Alotaibi, Sultan S.; AlKhashan, Hesham I.; Badri, Motasim

2015-01-01

Objectives: To determine preferences of patients regarding their involvement in the clinical decision making process and the related factors in Saudi Arabia. Methods: This cross-sectional study was conducted in a major family practice center in King Abdulaziz Medical City, Riyadh, Saudi Arabia, between March and May 2012. Multivariate multinomial regression models were fitted to identify factors associated with patients preferences. Results: The study included 236 participants. The most preferred decision-making style was shared decision-making (57%), followed by paternalistic (28%), and informed consumerism (14%). The preference for shared clinical decision making was significantly higher among male patients and those with higher level of education, whereas paternalism was significantly higher among older patients and those with chronic health conditions, and consumerism was significantly higher in younger age groups. In multivariate multinomial regression analysis, compared with the shared group, the consumerism group were more likely to be female [adjusted odds ratio (AOR) =2.87, 95% confidence interval [CI] 1.31-6.27, p=0.008] and non-dyslipidemic (AOR=2.90, 95% CI: 1.03-8.09, p=0.04), and the paternalism group were more likely to be older (AOR=1.03, 95% CI: 1.01-1.05, p=0.04), and female (AOR=2.47, 95% CI: 1.32-4.06, p=0.008). Conclusion: Preferences of patients for involvement in the clinical decision-making varied considerably. In our setting, underlying factors that influence these preferences identified in this study should be considered and tailored individually to achieve optimal treatment outcomes. PMID:26620990

International Students Decision-Making Process

ERIC Educational Resources Information Center

Cubillo, Jose Maria; Sanchez, Joaquin; Cervino, Julio

2006-01-01

Purpose--The purpose of this paper is to propose a theoretical model that integrates the different groups of factors which influence the decision-making process of international students, analysing different dimensions of this process and explaining those factors which determine students' choice. Design/methodology/approach--A hypothetical model…

Influence of biases in numerical magnitude allocation on human prosocial decision making.

PubMed

Arshad, Qadeer; Nigmatullina, Yuliya; Siddiqui, Shuaib; Franka, Mustafa; Mediratta, Saniya; Ramachandaran, Sanjeev; Lobo, Rhannon; Malhotra, Paresh A; Roberts, R E; Bronstein, Adolfo M

2017-12-01

Over the past decade neuroscientific research has attempted to probe the neurobiological underpinnings of human prosocial decision making. Such research has almost ubiquitously employed tasks such as the dictator game or similar variations (i.e., ultimatum game). Considering the explicit numerical nature of such tasks, it is surprising that the influence of numerical cognition on decision making during task performance remains unknown. While performing these tasks, participants typically tend to anchor on a 50:50 split that necessitates an explicit numerical judgement (i.e., number-pair bisection). Accordingly, we hypothesize that the decision-making process during the dictator game recruits overlapping cognitive processes to those known to be engaged during number-pair bisection. We observed that biases in numerical magnitude allocation correlated with the formulation of decisions during the dictator game. That is, intrinsic biases toward smaller numerical magnitudes were associated with the formulation of less favorable decisions, whereas biases toward larger magnitudes were associated with more favorable choices. We proceeded to corroborate this relationship by subliminally and systematically inducing biases in numerical magnitude toward either higher or lower numbers using a visuo-vestibular stimulation paradigm. Such subliminal alterations in numerical magnitude allocation led to proportional and corresponding changes to an individual's decision making during the dictator game. Critically, no relationship was observed between neither intrinsic nor induced biases in numerical magnitude on decision making when assessed using a nonnumerical-based prosocial questionnaire. Our findings demonstrate numerical influences on decisions formulated during the dictator game and highlight the necessity to control for confounds associated with numerical cognition in human decision-making paradigms. NEW & NOTEWORTHY We demonstrate that intrinsic biases in numerical magnitude

What is known about parents' treatment decisions? A narrative review of pediatric decision making.

PubMed

Lipstein, Ellen A; Brinkman, William B; Britto, Maria T

2012-01-01

With the increasing complexity of decisions in pediatric medicine, there is a growing need to understand the pediatric decision-making process. To conduct a narrative review of the current research on parent decision making about pediatric treatments and identify areas in need of further investigation. Articles presenting original research on parent decision making were identified from MEDLINE (1966-6/2011), using the terms "decision making," "parent," and "child." We included papers focused on treatment decisions but excluded those focused on information disclosure to children, vaccination, and research participation decisions. We found 55 papers describing 52 distinct studies, the majority being descriptive, qualitative studies of the decision-making process, with very limited assessment of decision outcomes. Although parents' preferences for degree of participation in pediatric decision making vary, most are interested in sharing the decision with the provider. In addition to the provider, parents are influenced in their decision making by changes in their child's health status, other community members, prior knowledge, and personal factors, such as emotions and faith. Parents struggle to balance these influences as well as to know when to include their child in decision making. Current research demonstrates a diversity of influences on parent decision making and parent decision preferences; however, little is known about decision outcomes or interventions to improve outcomes. Further investigation, using prospective methods, is needed in order to understand how to support parents through the difficult treatment decisions.

Factors influencing access to education, decision making, and receipt of preferred dialysis modality in unplanned dialysis start patients.

PubMed

Machowska, Anna; Alscher, Mark Dominik; Reddy Vanga, Satyanarayana; Koch, Michael; Aarup, Michael; Qureshi, Abdul Rashid; Lindholm, Bengt; Rutherford, Peter A

2016-01-01

Unplanned dialysis start (UPS) leads to worse clinical outcomes than planned start, and only a minority of patients ever receive education on this topic and are able to make a modality choice, particularly for home dialysis. This study aimed to determine the predictive factors for patients receiving education, making a decision, and receiving their preferred modality choice in UPS patients following a UPS educational program (UPS-EP). The Offering Patients Therapy Options in Unplanned Start (OPTiONS) study examined the impact of the implementation of a specific UPS-EP, including decision support tools and pathway improvement on dialysis modality choice. Linear regression models were used to examine the factors predicting three key steps: referral and receipt of UPS-EP, modality decision making, and actual delivery of preferred modality choice. A simple economic assessment was performed to examine the potential benefit of implementing UPS-EP in terms of dialysis costs. The majority of UPS patients could receive UPS-EP (214/270 patients) and were able to make a decision (177/214), although not all patients received their preferred choice (159/177). Regression analysis demonstrated that the initial dialysis modality was a predictive factor for referral and receipt of UPS-EP and modality decision making. In contrast, age was a predictor for referral and receipt of UPS-EP only, and comorbidity was not a predictor for any step, except for myocardial infarction, which was a weak predictor for lower likelihood of receiving preferred modality. Country practices predicted UPS-EP receipt and decision making. Economic analysis demonstrated the potential benefit of UPS-EP implementation because dialysis modality costs were associated with modality distribution driven by patient preference. Education and decision support can allow UPS patients to understand their options and choose dialysis modality, and attention needs to be focused on ensuring equity of access to educational

Factors considered in end-of-life care decision making by health care professionals.

PubMed

Foo, Wei Ting; Zheng, Yiliang; Kwee, Ann K; Yang, Grace M; Krishna, Lalit

2013-06-01

To explore the importance of factors influencing the end-of-life care decision making of health care professionals (HCPs) in Singapore. This cross-sectional survey encompassed facets of patient, family, and HCP-related care considerations. In total, 187 questionnaires were distributed to physicians and nurses and had a response rate of 78.6%. The respondents rated patients' wishes (96.6%), their clinical symptoms (93.9%), and patients' beliefs (91.1%) very high. In all, 94.6% of the HCPs would respect a competent patient's wishes over the family's wishes when goals conflict. However, 59.9% of HCPs would abide by the family's wishes when the patient loses capacity even if the patient's previously expressed wishes are known. End-of-life care decision making by HCPs appears largely patient centered, although familial determination still wields significant influence with implications for advance care planning.

The influence of fatigue on decision-making in athletes: a systematic review.

PubMed

Almonroeder, Thomas Gus; Tighe, Sarah Marie; Miller, Taylor Matthew; Lanning, Christopher Ray

2018-06-14

A potential challenge associated with sports is that athletes must often perform the cognitive processing associated with decision-making (i.e., movement selection) when fatigued. The purpose of this systematic review was to summarise studies that have analysed the extent to which fatigue influences the effects of decision-making on lower extremity mechanics during execution of common sports manoeuvres. We specifically focused on mechanics associated with ACL injury risk. Reviewers searched the PubMed, SPORTDiscus, CINAHL and Web of Science databases. The search identified 183 unique articles. Five of these articles met our eligibility criteria. Two of the studies incorporated fatigue protocols where athletes progressed to exhaustion and found that the effects of decision-making on mechanics were more pronounced with fatigue. The nature of the results appears to indicate that fatigue may compromise an athlete's cognitive processing in a manner that diminishes their ability to control movement when rapid decision-making is required. However, three subsequent studies utilised fatigue protocols designed to mimic sports participation and found that fatigue did not influence the effects of decision-making on mechanics. In general, these findings appear to indicate that fatigue may only affect the cognitive processing associated with decision-making when athletes approach a state of exhaustion.

Mutual influence in shared decision making: a collaborative study of patients and physicians.

PubMed

Lown, Beth A; Clark, William D; Hanson, Janice L

2009-06-01

To explore how patients and physicians describe attitudes and behaviours that facilitate shared decision making. Background Studies have described physician behaviours in shared decision making, explored decision aids for informing patients and queried whether patients and physicians want to share decisions. Little attention has been paid to patients' behaviors that facilitate shared decision making or to the influence of patients and physicians on each other during this process. Qualitative analysis of data from four research work groups, each composed of patients with chronic conditions and primary care physicians. Eighty-five patients and physicians identified six categories of paired physician/patient themes, including act in a relational way; explore/express patient's feelings and preferences; discuss information and options; seek information, support and advice; share control and negotiate a decision; and patients act on their own behalf and physicians act on behalf of the patient. Similar attitudes and behaviours were described for both patients and physicians. Participants described a dynamic process in which patients and physicians influence each other throughout shared decision making. This study is unique in that clinicians and patients collaboratively defined and described attitudes and behaviours that facilitate shared decision making and expand previous descriptions, particularly of patient attitudes and behaviours that facilitate shared decision making. Study participants described relational, contextual and affective behaviours and attitudes for both patients and physicians, and explicitly discussed sharing control and negotiation. The complementary, interactive behaviours described in the themes for both patients and physicians illustrate mutual influence of patients and physicians on each other.

How do beliefs and other factors such as prior experience influence the decision-making of new teachers during their first year teaching experience?

NASA Astrophysics Data System (ADS)

Short, Barbara J.

2003-06-01

The qualitative research project explored the perceptions of three new secondary education physics teachers. The content question stated: How do beliefs and other factors such as prior experience influence the decision-making of new teachers during their first year teaching experience? Specific questions includes: (1) What do first year teachers identify as their beliefs about teaching and learning? (2) How do first year teachers arrive at decisions about their instruction, materials, lessons, assessment, and student achievement? (3) How does decision-making occur in the learning environment from their perspective? (4) How do first year teachers solve problems? (5) To what extent do first year teachers actively think about what they do? The participants and their university professor were interviewed. Data was collected, transcribed, and coded using grounded theory techniques to conclude: (1) Belief systems take time to develop using filters. (2) Beliefs and perceptions help to fill gaps between knowledge. Gestalts change beliefs. (3) Modeling is a powerful technique influencing decision-making and beliefs over time. (4) Nurturing and preparation build confidence fostered at the university and public school. (5) New teachers' personalities, dispositions, and self-understandings effect filtering of perceptions, influencing behaviors in the learning environment. (6) Knowledge gained through experience, instruction, and reflection by the teacher enhances student learning. (7) Problem solving is learned and personality-based, helping to determine success. (8) Too many constraints to a novice cause limitations in his/her ability to be an effective teacher. (9) Early acceptance into a new environment helps to increase a sense of belonging leading to performance. (10) Positive attitudes towards students affect relationships with students in the classroom. (11) Backgrounds, personalities, and environments affect beliefs and decision-making. (12) New teachers focus more on

Factors related to voluntary parental decision-making in pediatric oncology.

PubMed

Miller, Victoria A; Nelson, Robert M

2012-05-01

The aim of the current study was to examine demographic and contextual correlates of voluntariness in parents making research or treatment decisions for their children with cancer. Participants included 184 parents of children with cancer who made a decision about enrolling the child in a research or treatment protocol within the previous 10 days. Parents completed questionnaires that assessed voluntariness, external influence by others, concern that the child's care would be negatively affected if the parent did not agree, time pressure, information adequacy, and demographics. Lower perceived voluntariness was associated with lower education, male gender, minority status, and not having previous experience with a similar decision. Parents who reported lower voluntariness also perceived more external influence and time pressure, had more concern about the child's care being negatively affected if they declined, and perceived that they had either too much or not enough information about the decision. In a multivariate regression, education, minority status, gender, external influence, and too little information remained significantly associated with voluntariness. Several groups of parents appear to be at risk for decreased voluntariness when making research or treatment decisions for their seriously ill children, including fathers, nonwhite parents, and those with less education. Parental voluntariness may be enhanced by helping parents to mitigate the effects of unhelpful or unwanted influences by others and ensuring that their information needs are met.

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.

What Is Known about Parents’ Treatment Decisions? A Narrative Review of Pediatric Decision Making

PubMed Central

Lipstein, Ellen A.; Brinkman, William B.; Britto, Maria T.

2013-01-01

Background With the increasing complexity of decisions in pediatric medicine, there is a growing need to understand the pediatric decision-making process. Objective To conduct a narrative review of the current research on parent decision making about pediatric treatments and identify areas in need of further investigation. Methods Articles presenting original research on parent decision making were identified from MEDLINE (1966–6/2011), using the terms “decision making,” “parent,” and “child.” We included papers focused on treatment decisions but excluded those focused on information disclosure to children, vaccination, and research participation decisions. Results We found 55 papers describing 52 distinct studies, the majority being descriptive, qualitative studies of the decision-making process, with very limited assessment of decision outcomes. Although parents’ preferences for degree of participation in pediatric decision making vary, most are interested in sharing the decision with the provider. In addition to the provider, parents are influenced in their decision making by changes in their child’s health status, other community members, prior knowledge, and personal factors, such as emotions and faith. Parents struggle to balance these influences as well as to know when to include their child in decision making. Conclusions Current research demonstrates a diversity of influences on parent decision making and parent decision preferences; however, little is known about decision outcomes or interventions to improve outcomes. Further investigation, using prospective methods, is needed in order to understand how to support parents through the difficult treatment decisions. PMID:21969136

Genetic Factors of Individual Differences in Decision Making in Economic Behavior: A Japanese Twin Study using the Allais Problem.

PubMed

Shikishima, Chizuru; Hiraishi, Kai; Yamagata, Shinji; Ando, Juko; Okada, Mitsuhiro

2015-01-01

Why does decision making differ among individuals? People sometimes make seemingly inconsistent decisions with lower expected (monetary) utility even when objective information of probabilities and reward are provided. It is noteworthy, however, that a certain proportion of people do not provide anomalous responses, choosing the alternatives with higher expected utility, thus appearing to be more "rational." We investigated the genetic and environmental influences on these types of individual differences in decision making using a classical Allais problem task. Participants were 1,199 Japanese adult twins aged 20-47. Univariate genetic analysis revealed that approximately a third of the Allais problem response variance was explained by genetic factors and the rest by environmental factors unique to individuals and measurement error. The environmental factor shared between families did not contribute to the variance. Subsequent multivariate genetic analysis clarified that decision making using the expected utility theory was associated with general intelligence and that the association was largely mediated by the same genetic factor. We approach the mechanism underlying two types of "rational" decision making from the perspective of genetic correlations with cognitive abilities.

The Measurement and Correlates of Career Decision Making.

ERIC Educational Resources Information Center

Harren, Vincent A.; Kass, Richard A.

This paper presents a theoretical framework for understanding career decision making (CDM); introduces an instrument, Assessment of Career Decision Making (ACDM) to measure CDM with college students; and presents correlational data on sex role and cognitive style factors hypothesized to influence CDM. The ACDM, designed to measure the Tiedeman and…

Value-based attentional capture influences context-dependent decision-making

PubMed Central

Cha, Kexin; Rangsipat, Napat; Serences, John T.

2015-01-01

Normative theories posit that value-based decision-making is context independent. However, decisions between two high-value options can be suboptimally biased by the introduction of a third low-value option. This context-dependent modulation is consistent with the divisive normalization of the value of each stimulus by the total value of all stimuli. In addition, an independent line of research demonstrates that pairing a stimulus with a high-value outcome can lead to attentional capture that can mediate the efficiency of visual information processing. Here we tested the hypothesis that value-based attentional capture interacts with value-based normalization to influence the optimality of decision-making. We used a binary-choice paradigm in which observers selected between two targets and the color of each target indicated the magnitude of their reward potential. Observers also had to simultaneously ignore a task-irrelevant distractor rendered in a color that was previously associated with a specific reward magnitude. When the color of the task-irrelevant distractor was previously associated with a high reward, observers responded more slowly and less optimally. Moreover, as the learned value of the distractor increased, electrophysiological data revealed an attenuation of the lateralized N1 and N2Pc responses evoked by the relevant choice stimuli and an attenuation of the late positive deflection (LPD). Collectively, these behavioral and electrophysiological data suggest that value-based attentional capture and value-based normalization jointly mediate the influence of context on free-choice decision-making. PMID:25995350

Factors That Influence Students to Participate in Team Decision Making

ERIC Educational Resources Information Center

Forrester, William R.; Tashchian, Armen

2011-01-01

This study investigated the effects of personality on participation in decision making in a sample of 225 business students. The Neo-FFI scale was used to measure the five personality dimensions of openness, agreeableness, extroversion, conscientiousness and neuroticism. Analysis indicated that personality dimensions, extroversion and…

Nonrational Processes in Ethical Decision Making

ERIC Educational Resources Information Center

Rogerson, Mark D.; Gottlieb, Michael C.; Handelsman, Mitchell M.; Knapp, Samuel; Younggren, Jeffrey

2011-01-01

Most current ethical decision-making models provide a logical and reasoned process for making ethical judgments, but these models are empirically unproven and rely upon assumptions of rational, conscious, and quasi-legal reasoning. Such models predominate despite the fact that many nonrational factors influence ethical thought and behavior,…

What factors influence health professionals to use decision aids for Down syndrome prenatal screening?

PubMed

Lépine, Johanie; Leiva Portocarrero, Maria Esther; Delanoë, Agathe; Robitaille, Hubert; Lévesque, Isabelle; Rousseau, François; Wilson, Brenda J; Giguère, Anik M C; Légaré, France

2016-09-05

Health professionals are expected to engage pregnant women in shared decision making to help them make informed values-based decisions about prenatal screening. Patient decision aids (PtDAs) foster shared decision-making, but are rarely used in this context. Our objective was to identify factors that could influence health professionals to use a PtDA for decisions about prenatal screening for Down syndrome during a clinical pregnancy follow-up. We planned to recruit a purposive sample of 45 health professionals (obstetrician-gynecologists, family physicians and midwives) involved in the care of pregnant women in three clinical sites (15 per site). Participating health professionals first watched a video showing two simulated consecutive prenatal follow-up consultations during which a pregnant woman, her partner and a health professional used a PtDA about Down syndrome prenatal screening. Participants were then interviewed about factors that would influence their use of the PtDA. Questions were based on the Theoretical Domains Framework. We performed content analyses of transcribed verbatim interviews. Out of 42 eligible health professionals approached, 36 agreed to be interviewed (86 % response rate). Of these, 27 were female (75 %), nine were obstetrician-gynecologists (25 %), 15 were family physicians (42 %), and 12 were midwives (33 %), with a mean age of 42.1 ± 11.6 years old. We identified 35 distinct factors reported by 20 % or more participants that were mapped onto 10 of the 12 of the Theoretical Domains Framework domains. The six most frequently mentioned factors influencing use of the PtDA were: 1) a positive appraisal (n = 29, 81 %, beliefs about consequences domain); 2) its availability in the office (n = 27, 75 %, environmental context and resources domain); 3) colleagues' approval (n = 27, 75 %, social influences domain); 4) time constraints (n = 26, 72 %, environmental context and resources domain); 5) finding it a

Lenses for Framing Decisions: Undergraduates' Decision Making about Stem Cell Research

ERIC Educational Resources Information Center

Halverson, Kristy Lynn; Siegel, Marcelle A.; Freyermuth, Sharyn K.

2009-01-01

Decision making is influenced by multiple factors, especially when approaching controversial socio-scientific issues, such as stem cell research. In the present study, we used qualitative data from 132 college student papers in a biotechnology course to investigate how students made decisions about stem cell research issues. Students indicated…

Patient involvement in health care decision making: a review.

PubMed

Vahdat, Shaghayegh; Hamzehgardeshi, Leila; Hessam, Somayeh; Hamzehgardeshi, Zeinab

2014-01-01

Patient participation means involvement of the patient in decision making or expressing opinions about different treatment methods, which includes sharing information, feelings and signs and accepting health team instructions. Given the importance of patient participation in healthcare decision making which empowers patients and improves services and health outcomes, this study was performed to review previous studies on patient participation in healthcare decision making. To prepare this narrative review article, researchers used general and specific search engines, as well as textbooks addressing this subject for an in-depth study of patient involvement in healthcare decision-making. As a result, 35 (out of 100 relevant) articles and also two books were selected for writing this review article. BASED ON THE REVIEW OF ARTICLES AND BOOKS, TOPICS WERE DIVIDED INTO SIX GENERAL CATEGORIES: definition of participation, importance of patient participation, factors influencing participation of patients in healthcare decisions, method of patient participation, tools for evaluating participation, and benefits and consequences of patient participation in health care decision-making. IN MOST STUDIES, FACTORS INFLUENCING PATIENT PARTICIPATION CONSISTED OF: factors associated with health care professionals such as doctor-patient relationship, recognition of patient's knowledge, allocation of sufficient time for participation, and also factors related to patients such as having knowledge, physical and cognitive ability, and emotional connections, beliefs, values and their experiences in relation to health services.

Overlooked Factors in Voc Ed Decision-Making

ERIC Educational Resources Information Center

Pucel, David J.; Schneck, Gerald R.

1978-01-01

Literature from the broad field of administration was examined by the authors for clues to pressure groups and other factors operating in policy- and decision-making situations in vocational education administration in schools. Eight major sources of pressure and ways that administrators respond to them are given. (MF)

Informed Decision-Making in the Context of Prenatal Chromosomal Microarray.

PubMed

Baker, Jessica; Shuman, Cheryl; Chitayat, David; Wasim, Syed; Okun, Nan; Keunen, Johannes; Hofstedter, Renee; Silver, Rachel

2018-03-07

The introduction of chromosomal microarray (CMA) into the prenatal setting has involved considerable deliberation due to the wide range of possible outcomes (e.g., copy number variants of uncertain clinical significance). Such issues are typically discussed in pre-test counseling for pregnant women to support informed decision-making regarding prenatal testing options. This research study aimed to assess the level of informed decision-making with respect to prenatal CMA and the factor(s) influencing decision-making to accept CMA for the selected prenatal testing procedure (i.e., chorionic villus sampling or amniocentesis). We employed a questionnaire that was adapted from a three-dimensional measure previously used to assess informed decision-making with respect to prenatal screening for Down syndrome and neural tube defects. This measure classifies an informed decision as one that is knowledgeable, value-consistent, and deliberated. Our questionnaire also included an optional open-ended question, soliciting factors that may have influenced the participants' decision to accept prenatal CMA; these responses were analyzed qualitatively. Data analysis on 106 participants indicated that 49% made an informed decision (i.e., meeting all three criteria of knowledgeable, deliberated, and value-consistent). Analysis of 59 responses to the open-ended question showed that "the more information the better" emerged as the dominant factor influencing both informed and uninformed participants' decisions to accept prenatal CMA. Despite learning about the key issues in pre-test genetic counseling, our study classified a significant portion of women as making uninformed decisions due to insufficient knowledge, lack of deliberation, value-inconsistency, or a combination of these three measures. Future efforts should focus on developing educational approaches and counseling strategies to effectively increase the rate of informed decision-making among women offered prenatal CMA.

Patient, physician and presentational influences on clinical decision making for breast cancer: results from a factorial experiment.

PubMed

McKinlay, J B; Burns, R B; Durante, R; Feldman, H A; Freund, K M; Harrow, B S; Irish, J T; Kasten, L E; Moskowitz, M A

1997-02-01

This study examines the influence of six patient characteristics (age, race, socioeconomic status, comorbidities, mobility and presentational style) and two physician characteristics (medical specialty and years of clinical experience) on physicians' clinical decision making behaviour in the evaluation treatment of an unknown and known breast cancer. Physicians' variability and certainty associated with diagnostic and treatment behaviour were also examined. Separate analyses explored the influence of these non-medical factors on physicians' cognitive processes. Using a fractional factorial design, 128 practising physicians were shown two videotaped scenarios and asked about possible diagnoses and medical recommendations. Results showed that physicians displayed considerable variability in response to several patient-based factors. Physician characteristics also emerged as important predictors of clinical behaviour, thus confirming the complexity of the medical decision-making process.

Reimbursement decisions in health policy--extending our understanding of the elements of decision-making.

PubMed

Wirtz, Veronika; Cribb, Alan; Barber, Nick

2005-09-08

Previous theoretical and empirical work on health policy decisions about reimbursement focuses on specific rationales such as effectiveness, economic considerations and equal access for equal needs. As reimbursement decisions take place in a social and political context we propose that the analysis of decision-making should incorporate factors, which go beyond those commonly discussed. As an example we chose three health technologies (sildenafil, rivastigmine and statins) to investigate how decisions about reimbursement of medicines are made in the United Kingdom National Health Service and what factors influence these decisions. From face-to-face, in-depth interviews with a purposive sample of 20 regional and national policy makers and stakeholders we identified two dimensions of decision-making, which extend beyond the rationales conventionally cited. The first dimension relates to the role of 'subjectivity' or 'the personal' in the decisions, including personal experiences of the condition and excitement about the novelty or potential benefit of the technology-these factors affect what counts as evidence, or how evidence is interpreted, in practice. The second dimension relates to the social and political function of decision-making and broadens what counts as the relevant ends of decision-making to include such things as maintaining relationships, avoiding organisational burden, generating politically and legally defensible decisions and demonstrating the willingness to care. More importantly, we will argue that these factors should not be treated as contaminants of an otherwise rational decision-making. On the contrary we suggest that they seem relevant, reasonable and also of substantial importance in considering in decision-making. Complementing the analysis of decision-making about reimbursement by incorporating these factors could increase our understanding and potentially improve decision-making.

Influence of the Family in Career Decision-Making.

ERIC Educational Resources Information Center

Chope, Robert C.

2001-01-01

Two recently emerging factors are changing the role of family in career decision making: the revolutionary changes in family structure and increased emphasis on interpersonal relationships in work. Career counselors need new protocols in order to work with clients and family members. (SK)

Cultural influences on the physician-patient encounter: The case of shared treatment decision-making.

PubMed

Charles, Cathy; Gafni, Amiram; Whelan, Tim; O'Brien, Mary Ann

2006-11-01

In this paper we discuss the influence of culture on the process of treatment decision-making, and in particular, shared treatment decision-making in the physician-patient encounter. We explore two key issues: (1) the meaning of culture and the ways that it can affect treatment decision-making; (2) cultural issues and assumptions underlying the development and use of treatment decision aids. This is a conceptual paper. Based on our knowledge and reading of the key literature in the treatment decision-making field, we looked for written examples where cultural influences were taken into account when discussing the physician-patient encounter and when designing instruments (decision aids) to help patients participate in making decisions. Our assessment of the situation is that to date, and with some recent exceptions, research in the above areas has not been culturally sensitive. We suggest that more research attention should be focused on exploring potential cultural variations in the meaning of and preferences for shared decision-making as well as on the applicability across cultural groups of decision aids developed to facilitate patient participation in treatment decision-making with physicians. Both patients and physicians need to be aware of the cultural assumptions underlying the development and use of decision aids and assess their cultural sensitivity to the needs and preferences of patients in diverse cultural groups.

Chinese immigrant parents' vaccination decision making for children: a qualitative analysis.

PubMed

Wang, Linda D L; Lam, Wendy W T; Wu, Joseph T; Liao, Qiuyan; Fielding, Richard

2014-02-07

While immunization coverage rates for childhood routine vaccines in Hong Kong are almost 100%, the uptake rates of optional vaccines remain suboptimal. Understanding parental decision-making for children's vaccination is important, particularly among minority groups who are most vulnerable and underserved. This study explored how a subsample of new immigrant mothers from mainland China, a rapidly-growing subpopulation in Hong Kong, made decisions on various childhood and adolescent vaccines for their offspring, and identified key influences affecting their decision making. Semi-structured in-depth interviews were conducted with 23 Chinese new immigrant mothers recruited by purposive sampling. All interviews were audio-taped, transcribed and analyzed using a Grounded Theory approach. Participants' conversation revealed five underlying themes which influenced parents' vaccination decision-making: (1) Institutional factors, (2) Insufficient vaccination knowledge and advice, (3) Affective impacts on motivation, (4) Vaccination barriers, and (5) Social influences. The role of social norms appeared overwhelmingly salient influencing parents' vaccination decision making. Institutional factors shaped parent's perceptions of vaccination necessity. Fear of vaccine-targeted diseases was a key motivating factor for parents adopting vaccination. Insufficient knowledge about vaccines and targeted diseases, lack of advice from health professionals and, if provided, suspicions regarding the motivations for such advice were common issues. Vaccination cost was a major barrier for many new immigrant parents. Social norms play a key role influencing parental vaccination decision-making. Insight gained from this study will help inform healthcare providers in vaccination communication and policymakers in future vaccination programme.

Value-based attentional capture influences context-dependent decision-making.

PubMed

Itthipuripat, Sirawaj; Cha, Kexin; Rangsipat, Napat; Serences, John T

2015-07-01

Normative theories posit that value-based decision-making is context independent. However, decisions between two high-value options can be suboptimally biased by the introduction of a third low-value option. This context-dependent modulation is consistent with the divisive normalization of the value of each stimulus by the total value of all stimuli. In addition, an independent line of research demonstrates that pairing a stimulus with a high-value outcome can lead to attentional capture that can mediate the efficiency of visual information processing. Here we tested the hypothesis that value-based attentional capture interacts with value-based normalization to influence the optimality of decision-making. We used a binary-choice paradigm in which observers selected between two targets and the color of each target indicated the magnitude of their reward potential. Observers also had to simultaneously ignore a task-irrelevant distractor rendered in a color that was previously associated with a specific reward magnitude. When the color of the task-irrelevant distractor was previously associated with a high reward, observers responded more slowly and less optimally. Moreover, as the learned value of the distractor increased, electrophysiological data revealed an attenuation of the lateralized N1 and N2Pc responses evoked by the relevant choice stimuli and an attenuation of the late positive deflection (LPD). Collectively, these behavioral and electrophysiological data suggest that value-based attentional capture and value-based normalization jointly mediate the influence of context on free-choice decision-making. Copyright © 2015 the American Physiological Society.

Choosing a College Major: Factors that Might Influence the Way Students Make Decisions

ERIC Educational Resources Information Center

Lee, Wei-Chun Vanessa

2009-01-01

This current study investigated Janis and Mann's (1977) Conflict Model of Decision Making. Specifically, Janis and Mann's model was tested to examine decision-making styles (coping patterns) and students who either have already decided or who have yet to decide on their college major. Furthermore, the current study is aimed to expand Janis and…

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.

Does ambiguity aversion influence the framing effect during decision making?

PubMed

Osmont, Anaïs; Cassotti, Mathieu; Agogué, Marine; Houdé, Olivier; Moutier, Sylvain

2015-04-01

Decision-makers present a systematic tendency to avoid ambiguous options for which the level of risk is unknown. This ambiguity aversion is one of the most striking decision-making biases. Given that human choices strongly depend on the options' presentation, the purpose of the present study was to examine whether ambiguity aversion influences the framing effect during decision making. We designed a new financial decision-making task involving the manipulation of both frame and uncertainty levels. Thirty-seven participants had to choose between a sure option and a gamble depicting either clear or ambiguous probabilities. The results revealed a clear preference for the sure option in the ambiguity condition regardless of frame. However, participants presented a framing effect in both the risk and ambiguity conditions. Indeed, the framing effect was bidirectional in the risk condition and unidirectional in the ambiguity condition given that it did not involve preference reversal but only a more extreme choice tendency.

Factors influencing women's decisions about timing of motherhood.

PubMed

Benzies, Karen; Tough, Suzanne; Tofflemire, Karen; Frick, Corine; Faber, Alexandra; Newburn-Cook, Christine

2006-01-01

To examine the factors that influence women's decisions about the timing of motherhood from a life span perspective. Qualitative. Large Western Canadian city with a high rate of infants born to women aged 35 years and older. 45 Canadian women aged 20 to 48 years. Independence, a stable relationship, and declining fertility influenced women's decisions about the timing of motherhood. Women integrated child developmental transitions into a projected life plan as they considered the timing of motherhood. Partner readiness and family of origin influences played a lesser role. Delayed childbearing has become more socially acceptable, with subsequent negative connotations associated with younger motherhood. Parental benefits have limited influence on the timing of motherhood. Recognition by nurses of the various and complex factors that influence women's decisions about the timing of motherhood may flag the importance of pregnancy-related counseling for woman across the fertility life span. Policy decision makers must be cognizant of the need for additional high-risk obstetric and neonatal health services when societal norms encourage women to delay childbearing in favor of completing education and establishing a career. (c) 2006, AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses

Strategic planning decision making using fuzzy SWOT-TOPSIS with reliability factor

NASA Astrophysics Data System (ADS)

Mohamad, Daud; Afandi, Nur Syamimi; Kamis, Nor Hanimah

2015-10-01

Strategic planning is a process of decision making and action for long-term activities in an organization. The Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis has been commonly used to help organizations in strategizing their future direction by analyzing internal and external environment. However, SWOT analysis has some limitations as it is unable to prioritize appropriately the multiple alternative strategic decisions. Some efforts have been made to solve this problem by incorporating Multi Criteria Decision Making (MCDM) methods. Nevertheless, another important aspect has raised concerns on obtaining the decision that is the reliability of the information. Decision makers evaluate differently depending on their level of confidence or sureness in the evaluation. This study proposes a decision making procedure for strategic planning using SWOT-TOPSIS method by incorporating the reliability factor of the evaluation based on Z-number. An example using a local authority in the east coast of Malaysia is illustrated to determine the strategic options ranking and to prioritize factors in each SWOT category.

The Relationship of Sex Role and Career Factors in Career Decision Making.

ERIC Educational Resources Information Center

Piggott, Tonya; And Others

Although the effects of sex-role socialization factors on career decision-making have received increased attention, little research has assessed the relationship between sex role variables and the factors affecting career decision-making. Differential effects and interactions of sex, sex role orientation, and sex role attitudes on six factors…

Criminal decision making: the development of adolescent judgment, criminal responsibility, and culpability.

PubMed

Fried, C S; Reppucci, N D

2001-02-01

Theories of judgment in decision making hypothesize that throughout adolescence, judgment is impaired because the development of several psychosocial factors that are presumed to influence decision making lags behind the development of the cognitive capacities that are required to make mature decisions. This study uses an innovative video technique to examine the role of several psychosocial factors--temporal perspective, peer influence, and risk perception--in adolescent criminal decision making. Results based on data collected from 56 adolescents between the ages of 13 and 18 years revealed that detained youth were more likely to think of future-oriented consequences of engaging in the depicted delinquent act and less likely to anticipate pressure from their friends than nondetained youth. Examination of the developmental functions of the psychosocial factors indicates age-based differences on standardized measures of temporal perspective and resistance to peer influence and on measures of the role of risk perception in criminal decision making. Assessments of criminal responsibility and culpability were predicted by age and ethnicity. Implications for punishment in the juvenile justice system are discussed.

Patient Involvement in Health Care Decision Making: A Review

PubMed Central

Vahdat, Shaghayegh; Hamzehgardeshi, Leila; Hessam, Somayeh; Hamzehgardeshi, Zeinab

2014-01-01

Background: Patient participation means involvement of the patient in decision making or expressing opinions about different treatment methods, which includes sharing information, feelings and signs and accepting health team instructions. Objectives: Given the importance of patient participation in healthcare decision making which empowers patients and improves services and health outcomes, this study was performed to review previous studies on patient participation in healthcare decision making. Materials and Methods: To prepare this narrative review article, researchers used general and specific search engines, as well as textbooks addressing this subject for an in-depth study of patient involvement in healthcare decision-making. As a result, 35 (out of 100 relevant) articles and also two books were selected for writing this review article. Results: Based on the review of articles and books, topics were divided into six general categories: definition of participation, importance of patient participation, factors influencing participation of patients in healthcare decisions, method of patient participation, tools for evaluating participation, and benefits and consequences of patient participation in health care decision-making. Conclusions: In most studies, factors influencing patient participation consisted of: factors associated with health care professionals such as doctor-patient relationship, recognition of patient’s knowledge, allocation of sufficient time for participation, and also factors related to patients such as having knowledge, physical and cognitive ability, and emotional connections, beliefs, values and their experiences in relation to health services. PMID:24719703

The Impact of Prepersuasion Social Influence Tactics on Military Decision Making

DTIC Science & Technology

2011-03-01

prepersuasion influence. 15. NUMBER OF PAGES 89 14. SUBJECT TERMS Military Decision Making, OODA Loop, Social Influence, Prepersuasion, Storytelling ...Operations ............13 2. Storytelling ..........................................................................................14 3. Limiting and...2. Postinvasion Effects of Fortitude South...........................................40 3. Storytelling and Expectation Setting Shape the Cognitive

Patient's decision making in selecting a hospital for elective orthopaedic surgery.

PubMed

Moser, Albine; Korstjens, Irene; van der Weijden, Trudy; Tange, Huibert

2010-12-01

The admission to a hospital for elective surgery, like arthroplasty, can be planned ahead. The elective nature of arthroplasty and the increasing stimulus of the public to critically select a hospital raise the issue of how patients actually take such decisions. The aim of this paper is to describe the decision-making process of selecting a hospital as experienced by people who underwent elective joint arthroplasty and to understand what factors influenced the decision-making process. Qualitative descriptive study with 18 participants who had a hip or knee replacement within the last 5 years. Data were gathered from eight individual interviews and four focus group interviews and analysed by content analysis. Three categories that influenced the selection of a hospital were revealed: information sources, criteria in decision making and decision-making styles within the GP- patient relationship. Various contextual aspects influenced the decision-making process. Most participants gave higher priority to the selection of a medical specialist than to the selection of a hospital. Selecting a hospital for arthroplasty is extremely complex. The decision-making process is a highly individualized process because patients have to consider and assimilate a diversity of aspects, which are relevant to their specific situation. Our findings support the model of shared decision making, which indicates that general practitioners should be attuned to the distinct needs of each patient at various moments during the decision making, taking into account personal, medical and contextual factors. © 2010 Blackwell Publishing Ltd.

Social modulation of decision-making: a cross-species review

PubMed Central

van den Bos, Ruud; Jolles, Jolle W.; Homberg, Judith R.

2013-01-01

Taking decisions plays a pivotal role in daily life and comprises a complex process of assessing and weighing short-term and long-term costs and benefits of competing actions. Decision-making has been shown to be affected by factors such as sex, age, genotype, and personality. Importantly, also the social environment affects decisions, both via social interactions (e.g., social learning, cooperation and competition) and social stress effects. Although everyone is aware of this social modulating role on daily life decisions, this has thus far only scarcely been investigated in human and animal studies. Furthermore, neuroscientific studies rarely discuss social influence on decision-making from a functional perspective such as done in behavioral ecology studies. Therefore, the first aim of this article is to review the available data of the influence of the social context on decision-making both from a causal and functional perspective, drawing on animal and human studies. Also, there is currently still a gap between decision-making in real life where influences of the social environment are extensive, and decision-making as measured in the laboratory, which is often done without any (deliberate) social influences. However, methods are being developed to bridge this gap. Therefore, the second aim of this review is to discuss these methods and ways in which this gap can be increasingly narrowed. We end this review by formulating future research questions. PMID:23805092

Chinese immigrant parents’ vaccination decision making for children: a qualitative analysis

PubMed Central

2014-01-01

Background While immunization coverage rates for childhood routine vaccines in Hong Kong are almost 100%, the uptake rates of optional vaccines remain suboptimal. Understanding parental decision-making for children’s vaccination is important, particularly among minority groups who are most vulnerable and underserved. This study explored how a subsample of new immigrant mothers from mainland China, a rapidly-growing subpopulation in Hong Kong, made decisions on various childhood and adolescent vaccines for their offspring, and identified key influences affecting their decision making. Methods Semi-structured in-depth interviews were conducted with 23 Chinese new immigrant mothers recruited by purposive sampling. All interviews were audio-taped, transcribed and analyzed using a Grounded Theory approach. Results Participants’ conversation revealed five underlying themes which influenced parents’ vaccination decision-making: (1) Institutional factors, (2) Insufficient vaccination knowledge and advice, (3) Affective impacts on motivation, (4) Vaccination barriers, and (5) Social influences. The role of social norms appeared overwhelmingly salient influencing parents’ vaccination decision making. Institutional factors shaped parent’s perceptions of vaccination necessity. Fear of vaccine-targeted diseases was a key motivating factor for parents adopting vaccination. Insufficient knowledge about vaccines and targeted diseases, lack of advice from health professionals and, if provided, suspicions regarding the motivations for such advice were common issues. Vaccination cost was a major barrier for many new immigrant parents. Conclusions Social norms play a key role influencing parental vaccination decision-making. Insight gained from this study will help inform healthcare providers in vaccination communication and policymakers in future vaccination programme. PMID:24507384

Influence Diagrams as Decision-Making Tools for Pesticide Risk Management

EPA Science Inventory

The pesticide policy arena is filled with discussion of probabilistic approaches to assess ecological risk, however, similar discussions about implementing formal probabilistic methods in pesticide risk decision making are less common. An influence diagram approach is proposed f...

Survey of Literature Pertaining to Decision Making Styles and Individual Factors

DTIC Science & Technology

2005-10-01

facilitation Rules of engagement (ROE) Deductive reasoning Heuristic(s) Emotion/ Affect Consensus Time pressure Rational decision making Recognition...managers are more likely to use an intuitive decision making style, while Sensing/ Feeling types use more of a rational style. These results were also...performance of the individual, team and organization. Research has indicated that a variety of individual factors affect the way in which people make

Reduction of influence of task difficulty on perceptual decision making by STN deep brain stimulation.

PubMed

Green, Nikos; Bogacz, Rafal; Huebl, Julius; Beyer, Ann-Kristin; Kühn, Andrea A; Heekeren, Hauke R

2013-09-09

Neurocomputational models of optimal decision making ascribe a crucial role-the computation of conflict between choice alternatives-to the subthalamic nucleus (STN). Specifically, these models predict that deep brain stimulation (DBS) of the STN will diminish the influence of decision conflict on decision making. In this work, patients with Parkinson's disease judged the direction of motion in random dot stimuli while ON and OFF DBS. To induce decision conflict, we varied the task difficulty (motion coherence), leading to increased reaction time (RT) in trials with greater task difficulty in healthy subjects. Results indicate that DBS significantly influences performance for perceptual decisions under high decision conflict. RT increased substantially OFF DBS as the task became more difficult, and a diffusion model best accounted for behavioral data. In contrast, ON DBS, the influence of task difficulty on RT was significantly reduced and a race model best accounted for the observed data. Individual data fits of evidence accumulation models demonstrate different information processing under distinct DBS states. Furthermore, ON DBS, speed-accuracy tradeoffs affected the magnitude of decision criterion adjustment significantly less compared to OFF DBS. Together, these findings suggest a crucial role for the STN in adjusting decision making during high-conflict trials in perceptual decision making. Copyright © 2013 Elsevier Ltd. All rights reserved.

Self-related factors and decision making styles among early adults.

PubMed

Batool, Naila; Riaz, Muhammad Naveed; Riaz, Muhammad Akram; Akhtar, Masud

2017-05-01

To examine the effect of self-related factors, including self-regulation, self-esteem and self-efficacy, on decision-making styles of early adults. The cross-sectional study was conducted from February to August, 2014 at four universities of Islamabad, Pakistan, and comprised adult students of both Social and Natural sciences. Data was collected through Self-Regulation Questionnaire, Self-Esteem Scale, Self-Efficacy Scale and the General Decision Making Styles Questionnaire. Data was subjected to multivariate regression analysis. Of the 300 participants, 160(53%) were men and 140(47%) were women. The overall mean age was 22.68±5.96 years. Besides, 170(56%) were studying Social sciences and 130(44%) Natural sciences. Self-regulation, self-esteem and self-efficacy positively predicted rational and intuitive style and negatively predicted avoidant and spontaneous style. Self-efficacy and self-regulation negatively predicted dependent style. Ensuring positive self-related factors affected adults' effective decision-making choices.

Factors influencing decision regret regarding placement of a PEG among substitute decision-makers of older persons in Japan: a prospective study.

PubMed

Kuraoka, Yumiko; Nakayama, Kazuhiro

2017-06-28

A tube feeding decision aid designed at the Ottawa Health Research Institute was specifically created for substitute decision-makers who must decide whether to allow placement of a percutaneous endoscopic gastrostomy (PEG) tube in a cognitively impaired older person. We developed a Japanese version and found that the decision aid promoted the decision-making process of substitute decision-makers to decrease decisional conflict and increase knowledge. However, the factors that influence decision regret among substitute decision-makers were not measured after the decision was made. The objective of this study was to explore the factors that influence decision regret among substitute decision-makers 6 months after using a decision aid for PEG placement. In this prospective study, participants comprised substitute decision-makers for 45 inpatients aged 65 years and older who were being considered for placement of a PEG tube in hospitals, nursing homes and patients' homes in Japan. The Decisional Conflict Scale (DCS) was used to evaluate decisional conflict among substitute decision-makers immediately after deciding whether to introduce tube feeding and the Decision Regret Scale (DRS) was used to evaluate decisional regret among substitute decision-makers 6 months after they made their decision. Normalized scores were evaluated and analysis of variance was used to compare groups. The results of the multiple regression analysis suggest that PEG placement (P < .01) and decision conflict (P < .001) are explanatory factors of decision regret regarding placement of a PEG among substitute decision-makers. PEG placement and decision conflict immediately after deciding whether to allow PEG placement have an influence on decision regret among substitute decision-makers after 6 months.

Serotonin transporter gene-linked polymorphic region (5-HTTLPR) influences decision making under ambiguity and risk in a large Chinese sample.

PubMed

He, Qinghua; Xue, Gui; Chen, Chuansheng; Lu, Zhonglin; Dong, Qi; Lei, Xuemei; Ding, Ni; Li, Jin; Li, He; Chen, Chunhui; Li, Jun; Moyzis, Robert K; Bechara, Antoine

2010-11-01

Risky decision making is a complex process that involves weighing the probabilities of alternative options that can be desirable, undesirable, or neutral. Individuals vary greatly in how they make decisions either under ambiguity and/or under risk. Such individual differences may have genetic bases. Based on previous studies on the genetic basis of decision making, two decision making tasks [i.e., the Iowa Gambling Task (IGT) and Loss Aversion Task (LAT)] were used to test the effect of 5-HTTLPR polymorphism on decision making under ambiguity and under risk in a large Han Chinese sample (572 college students, 312 females). Basic intelligence and memory tests were also included to control for the influence of basic cognitive abilities on decision making. We found that 5-HTTLPR polymorphism significantly influenced performance in both IGT and LAT. After controlling for intelligence and memory abilities, subjects homozygous for s allele had lower IGT scores than l carriers in the first 40 trials of the IGT task. They also exhibited higher loss aversion than l carriers in the LAT task. Moreover, the effects of 5-HTTLPR were stronger for males than for females. These results extend the literature on the important role of emotion in decision making under ambiguity and risk, and shed additional lights on how decision making is influenced by culture as well as sex differences. Combining our results with existing literature, we propose that these effects might be mediated by a neural circuitry that comprises the amygdala, ventromedial prefrontal cortex, and insular cortex. Understanding the genetic factors affecting decision making in healthy subjects may allow us to better identify at-risk individuals, and better target the development of new potential treatments for specific disorders such as schizophrenia, addiction, and depression. Copyright © 2010 Elsevier Ltd. All rights reserved.

Understanding decision-making in cardiac imaging: determinants of appropriate use.

PubMed

Fonseca, Ricardo; Jose, Kim; Marwick, Thomas H

2018-03-01

Appropriate Use Criteria (AUC) for echocardiography were developed in 2007 to facilitate decision-making, reduce variability in test utilization, and encourage rational use of imaging. However, there is little evidence that the AUC have favourably influenced ordering behaviour. This study explores the factors that contribute to clinicians requesting echocardiograms with a focus on appropriate use. Semi-structured face-to-face interviews with cardiologists and non-cardiologists who had requested echocardiograms were conducted at an Australian tertiary hospital. The interview guide included hypothetical clinical scenarios to better understand decision-making in ordering echocardiograms and the actions they could take when receiving test reports. Interviews underwent thematic analysis. Seventeen clinicians were interviewed, ten of whom were cardiologists. All participants ordered echocardiograms to support their clinical decision-making. Awareness of the AUC was low. The categorization of tests as 'appropriate' or 'inappropriate' was considered ineffective as it failed to reflect the decision-making process. The decision to request echocardiograms was influenced by a number of personal and systemic factors as well as guidelines and protocols. Training and experience, patients' expectations, and management of uncertainty were key personal factors. Systemic factors involved the accessibility of services and health insurance status of the patient. Factors that influenced the ordering of echocardiograms by clinicians at a tertiary care hospital did not appear to be amenable to control with AUC. Alternative approaches may be more effective than the AUC in addressing the overuse of echocardiography. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

Food ordering for children in restaurants: multiple sources of influence on decision making.

PubMed

Castro, Iana A; Williams, Christine B; Madanat, Hala; Pickrel, Julie L; Jun, Hee-Jin; Zive, Michelle; Gahagan, Sheila; Ayala, Guadalupe X

2016-09-01

Restaurants are playing an increasingly important role in children's dietary intake. Interventions to promote healthy ordering in restaurants have primarily targeted adults. Much remains unknown about how to influence ordering for and by children. Using an ecological lens, the present study sought to identify sources of influence on ordering behaviour for and by children in restaurants. A mixed-methods study was conducted using unobtrusive observations of dining parties with children and post-order interviews. Observational data included: child's gender, person ordering for the child and server interactions with the dining party. Interview data included: child's age, restaurant visit frequency, timing of child's decision making, and factors influencing decision making. Ten independent, table-service restaurants in San Diego, CA, USA participated. Complete observational and interview data were obtained from 102 dining parties with 150 children (aged 3-14 years). Taste preferences, family influences and menus impacted ordering. However, most children knew what they intended to order before arriving at the restaurant, especially if they dined there at least monthly. Furthermore, about one-third of children shared their meals with others and all shared meals were ordered from adult (v. children's) menus. Parents placed most orders, although parental involvement in ordering was less frequent with older children. Servers interacted frequently with children but generally did not recommend menu items or prompt use of the children's menu. Interventions to promote healthy ordering should consider the multiple sources of influence that are operating when ordering for and by children in restaurants.

Influences on decision-making for young women undergoing bilateral prophylactic mastectomy.

PubMed

Glassey, Rachael; O'Connor, Moira; Ives, Angela; Saunders, Christobel; Hardcastle, Sarah J

2018-02-01

The objective of this study was to explore the influences on decision-making of younger women (<35) undergoing or considering bilateral prophylactic mastectomy (BPM). Qualitative interviews guided by interpretative phenomenological analysis (IPA) were conducted with forty-six women who had a strong family history of breast cancer (BC) who had either undergone (n=26) or were considering (n=20) BPM. Participants were recruited from Australia and New Zealand (NZ) via hospitals, a genetics clinic, a research cohort, a registry and online. Four themes underpinning the influences on decision-making were identified: fear and anxiety, children, personal experiences with BC, health professional's influence. The decision to undergo BPM for younger women (<35) was multifaceted, however, it appeared that fear and anxiety were the main influence. Younger women appear more anxious than previous research with older women. There appears to be few differences between those with confirmed BRCA1/2 mutations and those with no known mutation and this is clinically significant. These findings have important practice implications, particularly improving communication of risk statistics, especially to those with no known mutation. Health professionals need to take into account the way younger women perceive information given to them when discussing risk. Copyright © 2017 Elsevier B.V. All rights reserved.

Longitudinal associations between mothers' perceptions of nonresidential fathers' investment of resources and influence in decision-making.

PubMed

Fagan, Jay; Palkovitz, Rob

2018-02-01

Nonresidential fathers are challenged to remain involved with their children across time in both direct and indirect ways, including influencing decision-making around important issues such as school attendance and medical care. An analytic sample of 1,350 families with residential mothers and nonresidential fathers was selected from the Early Childhood Longitudinal Survey-Birth Cohort (ECLS-B) to examine the longitudinal relationships between mothers' reports of nonresidential fathers' influence in decision-making and their provision of resources to their children. Findings indicate that fathers' voluntary contribution of tangible resources (informal child support, caregiving time) when children are 2 years old positively predict fathers' influence in decision-making regarding the care of their 4-year-old children. Fathers' early formal child support is not related to later decision-making. Fathers' communication with mother about the child at 24 months is related to later decision-making among daughters but not sons. Fathers' early decision-making is longitudinally related to later informal child support, caregiving time, and coparenting communication. The findings support the utility of a resource theory of fathering for understanding and predicting observed patterns of father involvement. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Conflict when making decisions about dialysis modality.

PubMed

Chen, Nien-Hsin; Lin, Yu-Ping; Liang, Shu-Yuan; Tung, Heng-Hsin; Tsay, Shiow-Luan; Wang, Tsae-Jyy

2018-01-01

To explore decisional conflict and its influencing factors on choosing dialysis modality in patients with end-stage renal diseases. The influencing factors investigated include demographics, predialysis education, dialysis knowledge, decision self-efficacy and social support. Making dialysis modality decisions can be challenging for patients with end-stage renal diseases; there are pros and cons to both haemodialysis and peritoneal dialysis. Patients are often uncertain as to which one will be the best alternative for them. This decisional conflict increases the likelihood of making a decision that is not based on the patient's values or preferences and may result in undesirable postdecisional consequences. Addressing factors predisposing patients to decisional conflict helps to facilitate informed decision-making and then to improve healthcare quality. A predictive correlational cross-sectional study design was used. Seventy patients were recruited from the outpatient dialysis clinics of two general hospitals in Taiwan. Data were collected with study questionnaires, including questions on demographics, dialysis modality and predialysis education, the Dialysis Knowledge Scale, the Decision Self-Efficacy scale, the Social Support Scale, and the Decisional Conflict Scale. The mean score on the Decisional Conflict Scale was 29.26 (SD = 22.18). Decision self-efficacy, dialysis modality, predialysis education, professional support and dialysis knowledge together explained 76.4% of the variance in decisional conflict. Individuals who had lower decision self-efficacy, did not receive predialysis education on both haemodialysis and peritoneal dialysis, had lower dialysis knowledge and perceived lower professional support reported higher decisional conflict on choosing dialysis modality. When providing decisional support to predialysis stage patients, practitioners need to increase patients' decision self-efficacy, provide both haemodialysis and peritoneal dialysis

Reported Influences on Restaurant-Type Food Selection Decision Making in a Grocery Store Chain.

PubMed

Bachman, Jessica Lynne; Arigo, Danielle

2018-06-01

To examine food decision-making priorities for restaurant-type foods at grocery stores and determine whether adding calorie information, as required by federal menu labeling laws, affected decision-making priorities. Natural experiment: intervention and control groups with baseline and follow-up. Regional grocery store chain with 9 locations. Participants (n = 393; mean age, 54.8 ± 15.1 years) were primarily women (71%) and Caucasian (95%). Data were collected before and after calorie information was added to restaurant-type foods at 4 intervention locations. Primary influencers of food selection decision making for restaurant-type foods and frequency of use of nutrition information. Quantitative analysis examined the top 3 influencers of food selections and chi-square goodness of fit test determined whether the calorie labeling intervention changed food decision-making priorities. Qualitative data were used to describe responses. Taste, cost, and convenience were the most frequently reported influencers of restaurant-type food selections; 20% of participants rated calories as influential. Calorie labeling did not affect food selection decision making; 16% of participants in intervention stores noticed calorie labels. Qualitative explanations confirmed these findings. Menu labeling laws increase access to calorie information; however, use of this information is limited. Additional interventions are needed to encourage healthier restaurant-type food selections in grocery stores. Copyright © 2018 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Decision Making Analysis: Critical Factors-Based Methodology

DTIC Science & Technology

2010-04-01

the pitfalls associated with current wargaming methods such as assuming a western view of rational values in decision - making regardless of the cultures...Utilization theory slightly expands the rational decision making model as it states that “actors try to maximize their expected utility by weighing the...items to categorize the decision - making behavior of political leaders which tend to demonstrate either a rational or cognitive leaning. Leaders

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

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.

Teachers' Grading Decision Making

ERIC Educational Resources Information Center

Isnawati, Ida; Saukah, Ali

2017-01-01

This study investigated teachers' grading decision making, focusing on their beliefs underlying their grading decision making, their grading practices and assessment types, and factors they considered in grading decision making. Two teachers from two junior high schools applying different curriculum policies in grade reporting in Indonesian…

A Computational Approach to Characterizing the Impact of Social Influence on Individuals’ Vaccination Decision Making

PubMed Central

Xia, Shang; Liu, Jiming

2013-01-01

In modeling individuals vaccination decision making, existing studies have typically used the payoff-based (e.g., game-theoretical) approaches that evaluate the risks and benefits of vaccination. In reality, whether an individual takes vaccine or not is also influenced by the decisions of others, i.e., due to the impact of social influence. In this regard, we present a dual-perspective view on individuals decision making that incorporates both the cost analysis of vaccination and the impact of social influence. In doing so, we consider a group of individuals making their vaccination decisions by both minimizing the associated costs and evaluating the decisions of others. We apply social impact theory (SIT) to characterize the impact of social influence with respect to individuals interaction relationships. By doing so, we propose a novel modeling framework that integrates an extended SIT-based characterization of social influence with a game-theoretical analysis of cost minimization. We consider the scenario of voluntary vaccination against an influenza-like disease through a series of simulations. We investigate the steady state of individuals’ decision making, and thus, assess the impact of social influence by evaluating the coverage of vaccination for infectious diseases control. Our simulation results suggest that individuals high conformity to social influence will increase the vaccination coverage if the cost of vaccination is low, and conversely, will decrease it if the cost is high. Interestingly, if individuals are social followers, the resulting vaccination coverage would converge to a certain level, depending on individuals’ initial level of vaccination willingness rather than the associated costs. We conclude that social influence will have an impact on the control of an infectious disease as they can affect the vaccination coverage. In this respect, our work can provide a means for modeling the impact of social influence as well as for estimating

A computational approach to characterizing the impact of social influence on individuals' vaccination decision making.

PubMed

Xia, Shang; Liu, Jiming

2013-01-01

In modeling individuals vaccination decision making, existing studies have typically used the payoff-based (e.g., game-theoretical) approaches that evaluate the risks and benefits of vaccination. In reality, whether an individual takes vaccine or not is also influenced by the decisions of others, i.e., due to the impact of social influence. In this regard, we present a dual-perspective view on individuals decision making that incorporates both the cost analysis of vaccination and the impact of social influence. In doing so, we consider a group of individuals making their vaccination decisions by both minimizing the associated costs and evaluating the decisions of others. We apply social impact theory (SIT) to characterize the impact of social influence with respect to individuals interaction relationships. By doing so, we propose a novel modeling framework that integrates an extended SIT-based characterization of social influence with a game-theoretical analysis of cost minimization. We consider the scenario of voluntary vaccination against an influenza-like disease through a series of simulations. We investigate the steady state of individuals' decision making, and thus, assess the impact of social influence by evaluating the coverage of vaccination for infectious diseases control. Our simulation results suggest that individuals high conformity to social influence will increase the vaccination coverage if the cost of vaccination is low, and conversely, will decrease it if the cost is high. Interestingly, if individuals are social followers, the resulting vaccination coverage would converge to a certain level, depending on individuals' initial level of vaccination willingness rather than the associated costs. We conclude that social influence will have an impact on the control of an infectious disease as they can affect the vaccination coverage. In this respect, our work can provide a means for modeling the impact of social influence as well as for estimating the

The Influence of Emotion on Fairness-Related Decision Making: A Critical Review of Theories and Evidence.

PubMed

Zheng, Ya; Yang, Zhong; Jin, Chunlan; Qi, Yue; Liu, Xun

2017-01-01

Fairness-related decision making is an important issue in the field of decision making. Traditional theories emphasize the roles of inequity aversion and reciprocity, whereas recent research increasingly shows that emotion plays a critical role in this type of decision making. In this review, we summarize the influences of three types of emotions (i.e., the integral emotion experienced at the time of decision making, the incidental emotion aroused by a task-unrelated dispositional or situational source, and the interaction of emotion and cognition) on fairness-related decision making. Specifically, we first introduce three dominant theories that describe how emotion may influence fairness-related decision making (i.e., the wounded pride/spite model, affect infusion model, and dual-process model). Next, we collect behavioral and neural evidence for and against these theories. Finally, we propose that future research on fairness-related decision making should focus on inducing incidental social emotion, avoiding irrelevant emotion when regulating, exploring the individual differences in emotional dispositions, and strengthening the ecological validity of the paradigm.

The Influence of Emotion on Fairness-Related Decision Making: A Critical Review of Theories and Evidence

PubMed Central

Zheng, Ya; Yang, Zhong; Jin, Chunlan; Qi, Yue; Liu, Xun

2017-01-01

Fairness-related decision making is an important issue in the field of decision making. Traditional theories emphasize the roles of inequity aversion and reciprocity, whereas recent research increasingly shows that emotion plays a critical role in this type of decision making. In this review, we summarize the influences of three types of emotions (i.e., the integral emotion experienced at the time of decision making, the incidental emotion aroused by a task-unrelated dispositional or situational source, and the interaction of emotion and cognition) on fairness-related decision making. Specifically, we first introduce three dominant theories that describe how emotion may influence fairness-related decision making (i.e., the wounded pride/spite model, affect infusion model, and dual-process model). Next, we collect behavioral and neural evidence for and against these theories. Finally, we propose that future research on fairness-related decision making should focus on inducing incidental social emotion, avoiding irrelevant emotion when regulating, exploring the individual differences in emotional dispositions, and strengthening the ecological validity of the paradigm. PMID:28974937

Expectant parents' views of factors influencing infant feeding decisions in the antenatal period: A systematic review.

PubMed

Roll, Coralie L; Cheater, Francine

2016-08-01

To explore the factors that influence expectant parents' infant feeding decisions in the antenatal period. Mixed method systematic review focussing on participant views data. CINAHL, Medline, Embase and PsychInfo databases were interrogated using initial keywords and then refined terms to elicit relevant studies. Reference lists were checked and hand-searching was undertaken for 2 journals ('Midwifery' and 'Social Science and Medicine') covering a 3 year time period (January 2011-March 2014). Key inclusion criteria: studies reflecting expectant parents' views of the factors influencing their infant feeding decisions in the antenatal period; Studies in the English language published after 1990, from developed countries and of qualitative, quantitative or mixed method design. A narrative interpretive synthesis of the views data from studies of qualitative, quantitative and mixed method design. Data were extracted on study characteristics and parents' views, using the Social Ecological Model to support data extraction and thematic synthesis. Synthesis was influenced by the Evidence for Policy and Practice Information and Co-Ordinating Centre approach to mixed method reviews. Of the 409 studies identified through search methods, 17 studies met the inclusion criteria for the review. Thematic synthesis identified 9 themes: Bonding/Attachment; Body Image; Self Esteem/Confidence; Female Role Models; Family and Support Network; Lifestyle; Formal Information Sources; Knowledge; and Feeding in front of others/Public. The review identified a significant bias in the data towards negative factors relating to the breastfeeding decision, suggesting that infant feeding was not a choice between two feeding options, but rather a process of weighing reasons for and against breastfeeding. Findings reflected the perception of the maternal role as intrinsic to the expectant mothers' infant feeding decisions. Cultural perceptions permeated personal, familial and social influences on the

Making Informed Decisions: Management Issues Influencing Computers in the Classroom.

ERIC Educational Resources Information Center

Strickland, James

A number of noninstructional factors appear to determine the extent to which computers make a difference in writing instruction. Once computers have been purchased and installed, it is generally school administrators who make management decisions, often from an uninformed pedagogical orientation. Issues such as what hardware and software to buy,…

The influence of emotion regulation on social interactive decision-making

PubMed Central

van ’t Wout, Mascha; Chang, Luke J.; Sanfey, Alan G.

2010-01-01

Although adequate emotion regulation is considered to be essential in every day life, it is especially important in social interactions. However, the question as to what extent two different regulation strategies are effective in changing decision-making in a consequential socially interactive context remains unanswered. We investigated the effect of expressive suppression and emotional reappraisal on strategic decision-making in a social interactive task, i.e. the Ultimatum Game. As hypothesized, participants in the emotional reappraisal condition accepted unfair offers more often than participants in the suppression and no-regulation condition. Additionally, the effect of emotional reappraisal influenced the amount of money participants proposed during a second interaction with partners that had treated them unfairly in a previous interaction. These results support and extend previous findings that emotional reappraisal as compared to expressive suppression, is a powerful regulation strategy that influences and changes how we interact with others even in the face of inequity. PMID:21171756

The influence of emotion regulation on social interactive decision-making.

PubMed

van't Wout, Mascha; Chang, Luke J; Sanfey, Alan G

2010-12-01

Although adequate emotion regulation is considered to be essential in every day life, it is especially important in social interactions. However, the question as to what extent two different regulation strategies are effective in changing decision-making in a consequential socially interactive context remains unanswered. We investigated the effect of expressive suppression and emotional reappraisal on strategic decision-making in a social interactive task, that is, the Ultimatum Game. As hypothesized, participants in the emotional reappraisal condition accepted unfair offers more often than participants in the suppression and no-regulation condition. Additionally, the effect of emotional reappraisal influenced the amount of money participants proposed during a second interaction with partners that had treated them unfairly in a previous interaction. These results support and extend previous findings that emotional reappraisal as compared to expressive suppression, is a powerful regulation strategy that influences and changes how we interact with others even in the face of inequity.

[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.

How Numeracy Influences Risk Comprehension and Medical Decision Making

PubMed Central

Reyna, Valerie F.; Nelson, Wendy L.; Han, Paul K.; Dieckmann, Nathan F.

2009-01-01

We review the growing literature on health numeracy, the ability to understand and use numerical information, and its relation to cognition, health behaviors, and medical outcomes. Despite the surfeit of health information from commercial and noncommercial sources, national and international surveys show that many people lack basic numerical skills that are essential to maintain their health and make informed medical decisions. Low numeracy distorts perceptions of risks and benefits of screening, reduces medication compliance, impedes access to treatments, impairs risk communication (limiting prevention efforts among the most vulnerable), and, based on the scant research conducted on outcomes, appears to adversely affect medical outcomes. Low numeracy is also associated with greater susceptibility to extraneous factors (i.e., factors that do not change the objective numerical information). That is, low numeracy increases susceptibility to effects of mood or how information is presented (e.g., as frequencies vs. percentages) and to biases in judgment and decision making (e.g., framing and ratio bias effects). Much of this research is not grounded in empirically supported theories of numeracy or mathematical cognition, which are crucial for designing evidence-based policies and interventions that are effective in reducing risk and improving medical decision making. To address this gap, we outline four theoretical approaches (psychophysical, computational, standard dual-process, and fuzzy trace theory), review their implications for numeracy, and point to avenues for future research. PMID:19883143

Temporal characteristics of the influence of punishment on perceptual decision making in the human brain.

PubMed

Blank, Helen; Biele, Guido; Heekeren, Hauke R; Philiastides, Marios G

2013-02-27

Perceptual decision making is the process by which information from sensory systems is combined and used to influence our behavior. In addition to the sensory input, this process can be affected by other factors, such as reward and punishment for correct and incorrect responses. To investigate the temporal dynamics of how monetary punishment influences perceptual decision making in humans, we collected electroencephalography (EEG) data during a perceptual categorization task whereby the punishment level for incorrect responses was parametrically manipulated across blocks of trials. Behaviorally, we observed improved accuracy for high relative to low punishment levels. Using multivariate linear discriminant analysis of the EEG, we identified multiple punishment-induced discriminating components with spatially distinct scalp topographies. Compared with components related to sensory evidence, components discriminating punishment levels appeared later in the trial, suggesting that punishment affects primarily late postsensory, decision-related processing. Crucially, the amplitude of these punishment components across participants was predictive of the size of the behavioral improvements induced by punishment. Finally, trial-by-trial changes in prestimulus oscillatory activity in the alpha and gamma bands were good predictors of the amplitude of these components. We discuss these findings in the context of increased motivation/attention, resulting from increases in punishment, which in turn yields improved decision-related processing.

Serotonin Transporter Gene-Linked Polymorphic Region (5-HTTLPR) Influences Decision Making under Ambiguity and Risk in a Large Chinese Sample

PubMed Central

He, Qinghua; Xue, Gui; Chen, Chuansheng; Lu, Zhonglin; Dong, Qi; Lei, Xuemei; Ding, Ni; Li, Jin; Li, He; Chen, Chunhui; Li, Jun; Moyzis, Robert K.; Bechara, Antoine

2010-01-01

Risky decision-making is a complex process that involves weighing the probabilities of alternative options that can be desirable, undesirable, or neutral. Individuals vary greatly in how they make decisions either under ambiguity and/or under risk. Such individual differences may have genetic bases. Based on previous studies on the genetic basis of decision making, two decision making tasks [i.e., Iowa Gambling Task (IGT) and Loss Aversion Task (LAT)] were used to test the effect of 5-HTTLPR polymorphism on decision making under ambiguity and under risk in a large Han Chinese sample (572 college students, 312 females). Basic intelligence and memory tests were also included to control for the influence of basic cognitive abilities on decision making. We found that 5-HTTLPR polymorphism significantly influenced performance in both IGT and LAT. After controlling for intellectual and memory abilities, subjects homozygous for s allele had lower IGT scores than l carriers in the first 40 trials of the IGT task. They also exhibited higher loss aversion than l carriers in the LAT task. Moreover, the effects of 5-HTTLPR were stronger for males than for females. These results extend the literature on the important role of emotion in decision under ambiguity and risk, and provide additional lights on how decision-making is influenced by culture as well as sex differences. Combining our results with existing literature, we propose that these effects might be mediated by a neural circuitry that comprises the amygdala, ventromedial prefrontal cortex, and insular cortex. Understanding the genetic factors affecting decision in healthy subjects may allow us better identify at-risk individuals, and target better the development of new potential treatments for specific disorders such as schizophrenia, addiction, and depression. PMID:20659488

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.

Implementation of shared decision making in anaesthesia and its influence on patient satisfaction.

PubMed

Flierler, W J; Nübling, M; Kasper, J; Heidegger, T

2013-07-01

There is a lack of data about the implementation of shared decision making in anaesthesia. To assess patients' preference to be involved in medical decision making and its influence on patient satisfaction, we studied 197 matched pairs (patients and anaesthetists) using two previously validated questionnaires. Before surgery, patients had to decide between general vs regional anaesthesia and, where appropriate, between conventional postoperative pain therapy vs catheter techniques. One hundred and eighty-six patients (94%) wished to be involved in shared decision making. One hundred and twenty-two patients (62%) experienced the exact amount of shared decision making that they wanted; 44 (22%) were slightly more involved and 20 (10%) slightly less involved in shared decision making than they desired. Preferences regarding involvement in shared decision making were similar between patients and anaesthetists with mean (SD) points of 54.1 (16.2) vs 56.4 (27.6) (p=0.244), respectively on a 0-100 scale; however, patients were found to have a stronger preference for a totally balanced shared decision-making process (65% vs 32%). Overall patient satisfaction was high: 88% were very satisfied and 12% satisfied with a mean (SD) value of 96.1 (10.6) on a 0-100 scale. Shared decision making is important for providing high levels of patient satisfaction. Anaesthesia © 2013 The Association of Anaesthetists of Great Britain and Ireland.

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…

Food ordering for children in restaurants: multiple sources of influence on decision making

PubMed Central

Castro, Iana A; Williams, Christine B; Madanat, Hala; Pickrel, Julie L; Jun, Hee-Jin; Zive, Michelle; Gahagan, Sheila; Ayala, Guadalupe X

2017-01-01

Objective Restaurants are playing an increasingly important role in children’s dietary intake. Interventions to promote healthy ordering in restaurants have primarily targeted adults. Much remains unknown about how to influence ordering for and by children. Using an ecological lens, the present study sought to identify sources of influence on ordering behaviour for and by children in restaurants. Design A mixed-methods study was conducted using unobtrusive observations of dining parties with children and post-order interviews. Observational data included: child’s gender, person ordering for the child and server interactions with the dining party. Interview data included: child’s age, restaurant visit frequency, timing of child’s decision making, and factors influencing decision making. Setting Ten independent, table-service restaurants in San Diego, CA, USA participated. Subjects Complete observational and interview data were obtained from 102 dining parties with 150 children (aged 3–14 years). Results Taste preferences, family influences and menus impacted ordering. However, most children knew what they intended to order before arriving at the restaurant, especially if they dined there at least monthly. Furthermore, about one-third of children shared their meals with others and all shared meals were ordered from adult (v. children’s) menus. Parents placed most orders, although parental involvement in ordering was less frequent with older children. Servers interacted frequently with children but generally did not recommend menu items or prompt use of the children’s menu. Conclusions Interventions to promote healthy ordering should consider the multiple sources of influence that are operating when ordering for and by children in restaurants. PMID:27334904

Exogenous cortisol acutely influences motivated decision making in healthy young men.

PubMed

Putman, Peter; Antypa, Niki; Crysovergi, Panagiota; van der Does, Willem A J

2010-02-01

The glucocorticoid (GC) hormone cortisol is the end product of the hypothalamic-pituitary-adrenal axis (HPA axis). Acute psychological stress increases HPA activity and GC release. In humans, chronic disturbances in HPA activity have been observed in affective disorders and in addictive behaviour. Recent research indicates that acute effects of GCs may be anxiolytic and increase reward sensitivity. Furthermore, cortisol acutely influences early cognitive processing of emotional stimuli. In order to extend such findings to more complex emotional-cognitive behaviour, the present study tested acute effects of 40 mg cortisol on motivated decision making in 30 healthy young men. Results showed that cortisol indeed increased risky decision making, as predicted. This effect occurred for decisions where making a risky choice could potentially yield a big reward. These results are discussed with respect to currently proposed mechanisms for cortisol's potential anxiolytic effect and GCs' involvement in reward systems.

Decision making about pre-medication to children.

PubMed

Proczkowska-Björklund, M; Runeson, I; Gustafsson, P A; Svedin, C G

2008-11-01

Inviting the child to participate in medical decisions regarding common medical procedures might influence the child's behaviour during the procedures. We wanted to study nurse decision-making communication regarding pre-medication before ear, nose and throat (ENT) surgery. In total, 102 children (3-6 years) signed for ENT surgery were video-filmed during the pre-medication process. The nurse decision-making communication was identified, transcribed and grouped in six main categories dependent on the level of participation (self-determination, compromise, negotiation, questioning, information, lack of communication). Associations between child factors (age, gender, verbal communication and non-verbal communication) and different nurse decision-making communication were studied. Associations between the decision-making communication and verbal hesitation and/or the child's compliance in taking pre-medication were also studied. Totally, information was the most frequently used category of decision making communication followed by negotiation and questioning. To the children showing signs of shyness, the nurse used more negotiation, questions and self-determination communication and less information. The nurse used more compromise, negotiation and gave less information to children with less compliance. No specific type of nurse decision-making communication was associated with verbal hesitation. The most important predictors for verbal hesitation were none or hesitant eye contact with nurse (OR = 4.5) and placement nearby or in parent's lap (OR = 4.7). Predictors for less compliance in taking pre-medication were verbal hesitation from the child (OR = 22.7) and children who did not give any verbal answer to nurse initial questions (OR = 5.5). Decision-making communication could not predict the child's compliance during pre-medication. Although negotiation, questioning and self-determination communication were associated with more unwillingness to take pre

Factors influencing bereaved families' decisions about organ donation: an integrative literature review.

PubMed

Walker, Wendy; Broderick, Andrew; Sque, Magi

2013-11-01

This article reports on the process and outcomes of a systematic integrative literature review, designed to enhance understanding of the factors influencing bereaved families' decisions to agree or decline the donation of their deceased relative's organs for transplantation. Research originating from eight Western countries (N = 20 studies) provided an international perspective to the review. Thematic analysis and synthesis of textual data culminated in the development of three global themes (past, present, and future) that captured the temporal dimensions of family decision making. The review findings provide valuable insight into ways of increasing the rate of consent to organ donation through the development family-centered care interventions that reflect the needs of the bereaved. Further research to explore the pathway of donation after circulatory death and the experiences of bereaved families who decline organ donation is essential to providing a more complete understanding of the factors affecting donation decisions.

An electrophysiological index of changes in risk decision-making strategies

PubMed Central

Zhang, Dandan; Gu, Ruolei; Wu, Tingting; Broster, Lucas S.; Luo, Yi; Jiang, Yang; Luo, Yue-jia

2014-01-01

Human decision-making is significantly modulated by previously experienced outcomes. Using event-related potentials (ERPs), we examined whether ERP components evoked by outcome feedbacks could serve as biomarkers to signal the influence of current outcome evaluation on subsequent decision-making. In this study, eighteen adult volunteers participated in a simple monetary gambling task, in which they were asked to choose between two options that differed in risk. Their decisions were immediately followed by outcome presentation. Temporospatial principle component analysis (PCA) was applied to the outcome-onset locked ERPs in the -200 – 1000 ms time window. The PCA factors that approximated classical ERP components (P2, feedback-related negativity, P3a, & P3b) in terms of time course and scalp distribution were tested for their association with subsequent decision-making strategies. Our results revealed that a fronto-central PCA factor approximating the classical P3a was related to changes of decision-making strategies on subsequent trials. The decision to switch between high- and low-risk options resulted in a larger P3a relative to the decision to retain the same choice. According to the results, we suggest the amplitude of the fronto-central P3a is an electrophysiological index of the influence of current outcome on subsequent risk decision-making. Furthermore, the ERP source analysis indicated that the activations of the frontopolar cortex and sensorimotor cortex were involved in subsequent changes of strategies, which enriches our understanding of the neural mechanisms of adjusting decision-making strategies based on previous experience. PMID:23643796

Gender bias and judicial decisions of undue influence in testamentary challenges.

PubMed

Recupero, Patricia R; Christopher, Paul P; Strong, David R; Price, Marilyn; Harms, Samara E

2015-03-01

Allegations of undue influence constitute a common basis for contests of wills. Legal research from the 1990s suggests that gender bias factors significantly into judicial decision-making regarding alleged undue influence and testamentary intent. In this study, we sought to assess whether this bias is present today and to identify any factors that may be associated with it. Probate judges from several jurisdictions in the United States were asked to consider two hypothetical case vignettes drawn from actual published decisions. In our study, the gender of the testator played only a minor role in how judges weighed factors in the decision-making process and, overall, did not significantly influence opinions regarding the presence of undue influence. The specifics of the case and the gender of the judge emerged as the most consistent and robust potential influences on decision-making. Our results suggest that probate rulings involving undue influence are likely to represent a complex interaction of factors involving the testator's and judge's genders and the specifics of individual cases. The implications of these findings are discussed. © 2015 American Academy of Psychiatry and the Law.

Game relativity: how context influences strategic decision making.

PubMed

Vlaev, Ivo; Chater, Nick

2006-01-01

Existing models of strategic decision making typically assume that only the attributes of the currently played game need be considered when reaching a decision. The results presented in this article demonstrate that the so-called "co-operativeness" of the previously played prisoner's dilemma games influence choices and predictions in the current prisoner's dilemma game, which suggests that games are not considered independently. These effects involved reinforcement-based assimilation to the previous choices and also a perceptual contrast of the present game with preceding games, depending on the range and the rank of their co-operativeness. A. Parducci's (1965) range frequency theory and H. Helson's (1964) adaptation level theory are plausible theories of relative judgment of magnitude information, which could provide an account of these context effects. ((c) 2006 APA, all rights reserved).

Factors Promoting and Hindering Data-Based Decision Making in Schools

ERIC Educational Resources Information Center

Schildkamp, Kim; Poortman, Cindy; Luyten, Hans; Ebbeler, Johanna

2017-01-01

Although data-based decision making can lead to improved student achievement, data are often not used effectively in schools. This paper therefore focuses on conditions for effective data use. We studied the extent to which school organizational characteristics, data characteristics, user characteristics, and collaboration influenced data use for…

Categorization = Decision Making + Generalization

PubMed Central

Seger, Carol A; Peterson, Erik J.

2013-01-01

We rarely, if ever, repeatedly encounter exactly the same situation. This makes generalization crucial for real world decision making. We argue that categorization, the study of generalizable representations, is a type of decision making, and that categorization learning research would benefit from approaches developed to study the neuroscience of decision making. Similarly, methods developed to examine generalization and learning within the field of categorization may enhance decision making research. We first discuss perceptual information processing and integration, with an emphasis on accumulator models. We then examine learning the value of different decision making choices via experience, emphasizing reinforcement learning modeling approaches. Next we discuss how value is combined with other factors in decision making, emphasizing the effects of uncertainty. Finally, we describe how a final decision is selected via thresholding processes implemented by the basal ganglia and related regions. We also consider how memory related functions in the hippocampus may be integrated with decision making mechanisms and contribute to categorization. PMID:23548891

A delicate subject: The impact of cultural factors on neonatal and perinatal decision making.

PubMed

Van McCrary, S; Green, H C; Combs, A; Mintzer, J P; Quirk, J G

2014-01-01

The neonatal intensive care unit (NICU) is a high-stress environment for both families and health care providers that can sometimes make appropriate medical decisions challenging. We present a review article of non-medical barriers to effective decision making in the NICU, including: miscommunication, mixed messages, denial, comparative social and cultural influences, and the possible influence of perceived legal issues and family reliance on information from the Internet. As examples of these barriers, we describe and discuss two cases that occurred simultaneously in the same NICU where decisions were influenced by social and cultural differences that were misunderstood by both medical staff and patients' families. The resulting stress and emotional discomfort created an environment with sub-optimal relationships between patients' families and health care providers. We provide background on the sources of conflict in these particular cases. We also offer suggestions for possible amelioration of similar conflicts with the twin goals of facilitating compassionate decision making in NICU settings and promoting enhanced well-being of both families and providers.

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

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.

Influence of framing on medical decision making.

PubMed

Gong, Jingjing; Zhang, Yan; Feng, Jun; Huang, Yonghua; Wei, Yazhou; Zhang, Weiwei

2013-01-01

Numerous studies have demonstrated the robustness of the framing effect in a variety of contexts, especially in medical decision making. Unfortunately, research is still inconsistent as to how so many variables impact framing effects in medical decision making. Additionally, much attention should be paid to the framing effect not only in hypothetical scenarios but also in clinical experience.

Heterosexual female adolescents' decision-making about sexual intercourse and pregnancy in rural Ontario, Canada.

PubMed

Ezer, Paulina; Leipert, Bev; Evans, Marilyn; Regan, Sandra

2016-01-01

Rural female adolescents experience unique circumstances to sexual health care and information as compared to urban adolescents. These circumstances are largely due to their more isolated geographical location and rural sociocultural factors. These circumstances may be contributing factors to an incidence of adolescent pregnancy that is higher in rural areas than in urban cities. Thus, this higher incidence of pregnancy may be due to the ways in which rural adolescents make decisions regarding engagement in sexual intercourse. However, the rural female adolescent sexual decision-making process has rarely, if ever, been studied, and further investigation of this process is necessary. Focusing on rural female adolescents aged 16-19 years is especially significant as this age range is used for reporting most pregnancy and birth statistics in Ontario. Charmaz's guidelines for a constructivist grounded theory methodology were used to gain an in-depth understanding of eight Ontario rural female adolescents' decision-making process regarding sexual intercourse and pregnancy, and how they viewed rural factors and circumstances influencing this process. Research participants were obtained through initial sampling (from criteria developed prior to the study) and theoretical sampling (by collecting data that better inform the categories emerging from the data). Eight participants, aged 16-19 years, were invited to each take part in 1-2-hour individual interviews, and four of these participants were interviewed a second time to verify and elaborate on emerging constructed concepts, conceptual relationships, and the developing process. Data collection and analysis included both field notes and individual interviews in person and over the telephone. Data were analyzed for emerging themes to construct a theory to understand the participants' experiences making sexual decisions in a rural environment. The adolescent sexual decision-making process, Prioritizing Influences, that

Acquisition and production of skilled behavior in dynamic decision-making tasks

NASA Technical Reports Server (NTRS)

Kirlik, Alex

1990-01-01

Ongoing research investigating perceptual and contextual influences on skilled human performance in dynamic decision making environments is discussed. The research is motivated by two general classes of findings in recent decision making research. First, many studies suggest that the concrete context in which a task is presented has strong influences on the psychological processes used to perform the task and on subsequent performance. Second, studies of skilled behavior in a wide variety of task environments typically implicate the perceptual system as an important contributor to decision-making performance, either in its role as a mediator between the current decision context and stored knowledge, or as a mechanism capable of directly initiating activity through the development of a 'trained eye.' Both contextual and perceptual influences place limits on the ability of traditional utility-theoretic accounts of decision-making to guide display design, as variance in behavior due to contextual factors or the development of a perceptual skill is left unexplained. The author outlines a framework in which to view questions of perceptual and contextual influences on behavior and describe an experimental task and analysis technique which will be used to diagnose the possible role of perception in skilled decision making performance.

Understanding the Harms and Benefits of Cancer Screening: A Model of Factors That Shape Informed Decision Making.

PubMed

Petrova, Dafina; Garcia-Retamero, Rocio; Cokely, Edward T

2015-10-01

Decisions about cancer screenings often involve the consideration of complex and counterintuitive evidence. We investigated psychological factors that promote the comprehension of benefits and harms associated with common cancer screenings and their influence on shared decision making. In experiment 1, 256 men received information about PSA-based prostate cancer screening. In experiment 2, 355 women received information about mammography-based breast cancer screening. In both studies, information about potential screening outcomes was provided in 1 of 3 formats: text, a fact box, or a visual aid (e.g., mortality with and without screening and rate of overdiagnosis). We modeled the interplay of comprehension, perceived risks and benefits, intention to participate in screening, and desire for shared decision making. Generally, visual aids were the most effective format, increasing comprehension by up to 18%. Improved comprehension was associated with 1) superior decision making (e.g., fewer intentions to participate in screening when it offered no benefit) and 2) more desire to share in decision making. However, comprehension of the evidence had a limited effect on experienced emotions, risk perceptions, and decision making among those participants who felt that the consequences of cancer were extremely severe. Even when information is counterintuitive and requires the integration of complex harms and benefits, user-friendly risk communications can facilitate comprehension, improve high-stakes decisions, and promote shared decision making. However, previous beliefs about the effectiveness of screening or strong fears about specific cancers may interfere with comprehension and informed decision making. © The Author(s) 2015.

An Analysis of Factors that Influence Enlistment Decisions in the U.S. Army

DTIC Science & Technology

1998-03-01

NAVAL POSTGRADUATE SCHOOL Monterey, California CM THESIS AN ANALYSIS OF FACTORS THAT INFLUENCE ENLISTMENT DECISIONS IN THE U.S. ARMY by Young...TITLE AND SUBTITLE : AN ANALYSIS OF FACTORS THAT INFLUENCE ENLISTMENT DECISIONS IN THE U.S. ARMY 6. AUTHOR(S) Oh, Young Yeol 7...200 words) The purpose of this thesis is to analyze factors that influence decisions to enlist in the U.S. Army. This thesis uses 1997 New Recruit

Sport Management Career Decision-Making Self-Efficacy

ERIC Educational Resources Information Center

Lumpkin, Angela; Franco, Dan; Multon, Karen; Achen, Rebecca M.

2017-01-01

Grounded in a social cognitive theoretical perspective, this study explores the career decision-making self-efficacy (CDSE) and vocational identity development process for college students interested or majoring in sport management. While a popular undergraduate major, little research has investigated the specific factors that influence different…

Women's decision-making processes and the influences on their mode of birth following a previous caesarean section in Taiwan: a qualitative study.

PubMed

Chen, Shu-Wen; Hutchinson, Alison M; Nagle, Cate; Bucknall, Tracey K

2018-01-17

Vaginal birth after caesarean (VBAC) is an alternative option for women who have had a previous caesarean section (CS); however, uptake is limited because of concern about the risks of uterine rupture. The aim of this study was to explore women's decision-making processes and the influences on their mode of birth following a previous CS. A qualitative approach was used. The research comprised three stages. Stage I consisted of naturalistic observation at 33-34 weeks' gestation. Stage II involved interviews with pregnant women at 35-37 weeks' gestation. Stage III consisted of interviews with the same women who were interviewed postnatally, 1 month after birth. The research was conducted in a private medical centre in northern Taiwan. Using a purposive sampling, 21 women and 9 obstetricians were recruited. Data collection involved in-depth interviews, observation and field notes. Constant comparative analysis was employed for data analysis. Ensuring the safety of mother and baby was the focus of women's decisions. Women's decisions-making influences included previous birth experience, concern about the risks of vaginal birth, evaluation of mode of birth, current pregnancy situation, information resources and health insurance. In communicating with obstetricians, some women complied with obstetricians' recommendations for repeat caesarean section (RCS) without being informed of alternatives. Others used four step decision-making processes that included searching for information, listening to obstetricians' professional judgement, evaluating alternatives, and making a decision regarding mode of birth. After birth, women reflected on their decisions in three aspects: reflection on birth choices; reflection on factors influencing decisions; and reflection on outcomes of decisions. The health and wellbeing of mother and baby were the major concerns for women. In response to the decision-making influences, women's interactions with obstetricians regarding birth choices

Influence of framing on medical decision making

PubMed Central

Gong, Jingjing; Zhang, Yan; Feng, Jun; Huang, Yonghua; Wei, Yazhou; Zhang, Weiwei

2013-01-01

Numerous studies have demonstrated the robustness of the framing effect in a variety of contexts, especially in medical decision making. Unfortunately, research is still inconsistent as to how so many variables impact framing effects in medical decision making. Additionally, much attention should be paid to the framing effect not only in hypothetical scenarios but also in clinical experience. PMID:27034630

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 study on participation in clinical decision making by home healthcare nurses].

PubMed

Kim, Se Young

2010-12-01

This study was done to identify participation by home healthcare nurses in clinical decision making and factors influencing clinical decision making. A descriptive survey was used to collect data from 68 home healthcare nurses in 22 hospital-based home healthcare services in Korea. To investigate participation, the researcher developed 3 scenarios through interviews with 5 home healthcare nurses. A self-report questionnaire composed of tools for characteristics, factors of clinical decision making, and participation was used. Participation was relatively high, but significantly lower in the design phase (F=3.51, p=.032). Competency in clinical decision making (r=.45, p<.001), perception of the decision maker role (r=.47, p<.001), and perception of the utility of clinical practice guidelines (r=.25, p=.043) were significantly correlated with participation. Competency in clinical decision making (Odds ratio [OR]=41.79, p=.007) and perception of the decision maker role (OR=15.09, p=.007) were significant factors predicting participation in clinical decision making by home healthcare nurses. In order to encourage participation in clinical decision making, education programs should be provided to home healthcare nurses. Official clinical practice guidelines should be used to support home healthcare nurses' participation in clinical decision making in cases where they can identify and solve the patient health problems.

Influences on women's decision making about intrauterine device use in Madagascar.

PubMed

Gottert, Ann; Jacquin, Karin; Rahaivondrafahitra, Bakoly; Moracco, Kathryn; Maman, Suzanne

2015-04-01

We explored influences on decision making about intrauterine device (IUD) use among women in the Women's Health Project (WHP), managed by Population Services International in Madagascar. We conducted six small group photonarrative discussions (n=18 individuals) and 12 individual in-depth interviews with women who were IUD users and nonusers. All participants had had contact with WHP counselors in three sites in Madagascar. Data analysis involved creating summaries of each transcript, coding in Atlas.ti and then synthesizing findings in a conceptual model. We identified three stages of women's decision making about IUD use, and specific forms of social support that seemed helpful at each stage. During the first stage, receiving correct information from a trusted source such as a counselor conveys IUD benefits and corrects misinformation, but lingering fears about the method often appeared to delay method adoption among interested women. During the second stage, hearing testimony from satisfied users and receiving ongoing emotional support appeared to help alleviate these fears. During the third stage, accompaniment by a counselor or peer seemed to help some women gain confidence to go to the clinic to receive the IUD. Identifying and supplying the types of social support women find helpful at different stages of the decision-making process could help program managers better respond to women's staged decision-making process about IUD use. This qualitative study suggests that women in Madagascar perceive multiple IUD benefits but also fear the method even after misinformation is corrected, leading to a staged decision-making process about IUD use. Programs should identify and supply the types of social support that women find helpful at each stage of decision making. Copyright © 2015 Elsevier Inc. All rights reserved.

Influences on Healthy-Eating Decision Making in Latino Adolescent Children of Migrant and Seasonal Agricultural Workers.

PubMed

Kilanowski, Jill F

2016-01-01

Latino children demonstrate high rates of unhealthy weight, and children of Latino migrant and seasonal agricultural workers are heavier than their Latino peers. This one-group, cross-sectional, mixed-methods pilot study explored healthy-eating decision making with 12- to 14-year-olds recruited from a Midwest summer migrant education program. Demographics, decision-making, self-efficacy, and social support survey instruments were used, along with gender-specific focus groups. In the convenience sample, which included 24 participants, students felt varying degrees of uncertainty when choosing healthy foods in social situations, and 67% made poor-quality decisions. Parents offered greater support for healthy eating compared with friends. Qualitative analyses identified three themes: healthy decision making includes fruits, vegetables, and physical activity; mothers have influence over health and healthy decisions; and friends encourage unhealthy food choices. Influences on healthy-eating decision making in Latino adolescent children of migrant and seasonal agricultural workers, which were previously missing from the literature, were identified. Future research includes development of interventions to assist these adolescents with healthy-eating decision making. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

An electrophysiological index of changes in risk decision-making strategies.

PubMed

Zhang, Dandan; Gu, Ruolei; Wu, Tingting; Broster, Lucas S; Luo, Yi; Jiang, Yang; Luo, Yue-jia

2013-07-01

Human decision-making is significantly modulated by previously experienced outcomes. Using event-related potentials (ERPs), we examined whether ERP components evoked by outcome feedbacks could serve as biomarkers to signal the influence of current outcome evaluation on subsequent decision-making. In this study, 18 adult volunteers participated in a simple monetary gambling task, in which they were asked to choose between two options that differed in risk. Their decisions were immediately followed by outcome presentation. Temporospatial principle component analysis (PCA) was applied to the outcome-onset locked ERPs in the 200-1000 ms time window. The PCA factors that approximated classical ERP components (P2, feedback-related negativity, P3a, and P3b) in terms of time course and scalp distribution were tested for their association with subsequent decision-making strategies. Our results revealed that a fronto-central PCA factor approximating the classical P3a was related to changes of decision-making strategies on subsequent trials. The decision to switch between high- and low-risk options resulted in a larger P3a relative to the decision to retain the same choice. According to the results, we suggest that the amplitude of the fronto-central P3a is an electrophysiological index of the influence of current outcome on subsequent risk decision-making. Furthermore, the ERP source analysis indicated that the activations of the frontopolar cortex and sensorimotor cortex were involved in subsequent changes of strategies, which enriches our understanding of the neural mechanisms of adjusting decision-making strategies based on previous experience. Copyright © 2013 Elsevier Ltd. All rights reserved.

Research on Group Decision-Making Mechanism of Internet Emergency Management

NASA Astrophysics Data System (ADS)

Xie, Kefan; Chen, Gang; Qian, Wu; Shi, Zhao

With the development of information technology, internet has become a popular term and internet emergency has an intensive influence on people's life. This article offers a short history of internet emergency management. It discusses the definition, characteristics, and factor of internet emergency management. A group decision-making mechanism of internet emergency is presented based on the discussion. The authors establish a so-called Rough Set Scenario Flow Graphs (RSSFG) of group decision-making mechanism of internet emergency management and make an empirical analysis based on the RSSFG approach. The experimental results confirm that this approach is effective in internet emergency decision-making.

News media reporting on civil litigation and its influence on civil justice decision making.

PubMed

Robbennolt, Jennifer K; Studebaker, Christina A

2003-02-01

The news media have the potential to act as a powerful influence on the civil litigation system, influencing decision making in particular cases and on the system more generally as media reports influence the decision making of various participants in the system. This paper reviews the research that has examined the relationship between news media reporting and civil litigation and proposes a framework that integrates this work and provides guidance for future research efforts. Specifically, we discuss the nature of media reporting on civil litigation, perceptions of the civil litigation system held by the public and legal actors, and the potential influence of news reporting about civil litigation on the decision making of jurors, judges, civil litigants, and policymakers. Overall, the research suggests that news reporting of civil litigation presents a systematically distorted picture of civil litigation and that this reporting can influence perceptions and outcomes of civil litigation in various ways. However, there are many gaps in the existing research that need to be filled. The proposed organizational scheme helps to identify ways that future research can provide links between the findings of existing research and to identify ways in which this research can be extended to new areas.

[The role of research-based evidence in health system policy decision-making].

PubMed

Patiño, Daniel; Lavis, John N; Moat, Kaelan

2013-01-01

Different models may be used for explaining how research-based evidence is used in healthcare system policy-making. It is argued that models arising from a clinical setting (i.e. evidence-based policy-making model) could be useful regarding some types of healthcare system decision-making. However, such models are "silent" concerning the influence of political contextual factors on healthcare policy-making and are thus inconsistent with decision-making regarding the modification of healthcare system arrangements. Other political science-based models would seem to be more useful for understanding that research is just one factor affecting decision-making and that different types of research-based evidence can be used instrumentally, conceptual or strategically during different policy-making stages.

Factors associated with oncology patients' involvement in shared decision making during chemotherapy.

PubMed

Colley, Alexis; Halpern, Jodi; Paul, Steven; Micco, Guy; Lahiff, Maureen; Wright, Fay; Levine, Jon D; Mastick, Judy; Hammer, Marilyn J; Miaskowski, Christine; Dunn, Laura B

2017-11-01

Oncology patients are increasingly encouraged to play an active role in treatment decision making. While previous studies have evaluated relationships between demographic characteristics and decision-making roles, less is known about the association of symptoms and psychological adjustment characteristics (eg, coping styles and personality traits) and decision-making roles. As part of a larger study of symptom clusters, patients (n = 765) receiving chemotherapy for breast, gastrointestinal, gynecological, or lung cancer provided information on demographic, clinical, symptom, and psychological adjustment characteristics. Patient-reported treatment decision-making roles (ie, preferred role and role actually played) were assessed using the Control Preferences Scale. Differences among patients, who were classified as passive, collaborative, or active, were evaluated using χ 2 analyses and analyses of variance. Over half (56.3%) of the patients reported that they both preferred and actually played a collaborative role. Among those patients with concordant roles, those who were older, those with less education and lower income, and those who were less resilient were more likely to prefer a passive role. Several psychological adjustment characteristics were associated with decision-making role, including coping style, personality, and fatalism. Oncology patients' preferences for involvement in treatment decision making are associated with demographic characteristics as well as with symptoms and psychological adjustment characteristics, such as coping style and personality. These results reaffirm the complexities of predicting patients' preferences for involvement in decision making. Further study is needed to determine if role or coping style may be influenced by interventions designed to teach adaptive coping skills. Copyright © 2016 John Wiley & Sons, Ltd.

Clinical decision making in dermatology: observation of consultations and the patients' perspectives.

PubMed

Hajjaj, F M; Salek, M S; Basra, M K A; Finlay, A Y

2010-01-01

Clinical decision making is a complex process and might be influenced by a wide range of clinical and non-clinical factors. Little is known about this process in dermatology. The aim of this study was to explore the different types of management decisions made in dermatology and to identify factors influencing those decisions from observation of consultations and interviews with the patients. 61 patient consultations were observed by a physician with experience in dermatology. The patients were interviewed immediately after each consultation. Consultations and interviews were audio recorded, transcribed and their content analysed using thematic content analysis. The most common management decisions made during the consultations included: follow-up, carrying out laboratory investigation, starting new topical treatment, renewal of systemic treatment, renewal of topical treatment, discharging patients and starting new systemic treatment. Common influences on those decisions included: clinical factors such as ineffectiveness of previous therapy, adherence to prescribing guidelines, side-effects of medications, previous experience with the treatment, deterioration or improvement in the skin condition, and chronicity of skin condition. Non-clinical factors included: patient's quality of life, patient's friends or relatives, patient's time commitment, travel or transportation difficulties, treatment-related costs, availability of consultant, and availability of treatment. The study has shown that patients are aware that management decisions in dermatology are influenced by a wide range of clinical and non-clinical factors. Education programmes should be developed to improve the quality of decision making. Copyright © 2010 S. Karger AG, Basel.

Decision Making About Gastrostomy and Noninvasive Ventilation in Amyotrophic Lateral Sclerosis.

PubMed

Martin, Naomi H; Lawrence, Vanessa; Murray, Joanna; Janssen, Anna; Higginson, Irene; Lyall, Rebecca; Burman, Rachel; Leigh, P Nigel; Al-Chalabi, Ammar; Goldstein, Laura H

2016-08-01

We used thematic analysis to investigate factors affecting decision making about gastrostomy and noninvasive ventilation (NIV) by people with Amyotrophic Lateral Sclerosis (ALS) from the viewpoint of the health care professionals (HCPs) supporting them. We conducted 20 in-depth interviews with 19 HCPs nominated by people with ALS who had made a decision to accept or decline NIV or gastrostomy. We found the main themes influencing decision making were patient-centric, caregiver-related or related to HCPs' own beliefs, perspectives, and actions. HCPs felt patients should be, and were, in control of decision making, although caregivers and HCPs played a role. The patient's evaluation of quality of life, the desirability of prolonging life, and acceptance of the disease and its progression by both patient and caregiver were the most important factors identified by HCPs. HCPs should be aware of the importance of multiprofessional discussions, and the potential influences (identified above) that might require discussion with patients and caregivers. © The Author(s) 2015.

The tale of hearts and reason: the influence of mood on decision making.

PubMed

Laborde, Sylvain; Raab, Markus

2013-08-01

In decision-making research, one important aspect of real-life decisions has so far been neglected: the mood of the decision maker when generating options. The authors tested the use of the take-the-first (TTF) heuristic and extended the TTF model to understand how mood influences the option-generation process of individuals in two studies, the first using a between-subjects design (30 nonexperts, 30 near-experts, and 30 experts) and the second conceptually replicating the first using a within-subject design (30 nonexperts). Participants took part in an experimental option-generation task, with 31 three-dimensional videos of choices in team handball. Three moods were elicited: positive, neutral, and negative. The findings (a) replicate previous results concerning TTF and (b) show that the option-generation process was associated with the physiological component of mood, supporting the neurovisceral integration model. The extension of TTF to processing emotional factors is an important step forward in explaining fast choices in real-life situations.

Physician Perspectives on Decision Making for Treatment of Pediatric Sleep-Disordered Breathing.

PubMed

Boss, Emily F; Links, Anne R; Saxton, Ron; Cheng, Tina L; Beach, Mary Catherine

2017-10-01

Sleep-disordered breathing (SDB) is prevalent in children and most commonly treated by surgery with adenotonsillectomy. We aimed to learn physician perspectives of social and communication factors that influence decision making for treatment of pediatric SDB. Purposive sampling identified 10 physician key informants across disciplines and practice settings, who participated in semistructured interviews regarding SDB care experiences and communication with parents. Interviews were analyzed using directed qualitative content analysis. Physicians provided a variety of perspectives on decision making for treatment that fell into 3 overarching themes: approach to surgery and alternatives, communication and decision making with families, and sociocultural factors/barriers to care. Perspectives were moderately heterogeneous, suggesting that individual social and relational elements may significantly influence how physicians refer patients and recommend treatment, and how parents choose surgery for this prevalent condition. These findings will inform development of culturally competent communication strategies and support tools to enhance shared decision making for physicians treating children with SDB.

Overdue choices: how information and role in decision-making influence women's preferences for induction for prolonged pregnancy.

PubMed

Stevens, Gabrielle; Miller, Yvette D

2012-09-01

Enabling women to make informed decisions is a crucial component of consumer-focused maternity care. Current evidence suggests that health care practitioners' communication of care options may not facilitate patient involvement in decision-making. The aim of this study was to investigate the effect of specific variations in health caregiver communication on women's preferences for induction of labor for prolonged pregnancy. A convenience sample of 595 female participants read a hypothetical scenario in which an obstetrician discusses induction of labor with a pregnant woman. Information provided on induction and the degree of encouragement for the woman's involvement in decision-making was manipulated to create four experimental conditions. Participants indicated preference with respect to induction, their perceptions of the quality of information received, and other potential moderating factors. Participants who received information that was directive in favor of medical intervention were significantly more likely to prefer induction than those given nondirective information. No effect of level of involvement in decision-making was found. Participants' general trust in doctors moderated the relationship between health caregiver communication and preferences for induction, such that the influence of information provided on preferences for induction differed across levels of involvement in decision-making for women with a low trust in doctors, but not for those with high trust. Many women were not aware of the level of information required to make an informed decision. Our findings highlight the potential value of strategies such as patient decision aids and health care professional education to improve the quality of information available to women and their capacity for informed decision-making during pregnancy and birth. © 2012, Copyright the Authors Journal compilation © 2012, Wiley Periodicals, Inc.

Using the Situated Clinical Decision-Making framework to guide analysis of nurses' clinical decision-making.

PubMed

Gillespie, Mary

2010-11-01

Nurses' clinical decision-making is a complex process that holds potential to influence the quality of care provided and patient outcomes. The evolution of nurses' decision-making that occurs with experience has been well documented. In addition, literature includes numerous strategies and approaches purported to support development of nurses' clinical decision-making. There has been, however, significantly less attention given to the process of assessing nurses' clinical decision-making and novice clinical educators are often challenged with knowing how to best support nurses and nursing students in developing their clinical decision-making capacity. The Situated Clinical Decision-Making framework is presented for use by clinical educators: it provides a structured approach to analyzing nursing students' and novice nurses' decision-making in clinical nursing practice, assists educators in identifying specific issues within nurses' clinical decision-making, and guides selection of relevant strategies to support development of clinical decision-making. A series of questions is offered as a guide for clinical educators when assessing nurses' clinical decision-making. The discussion presents key considerations related to analysis of various decision-making components, including common sources of challenge and errors that may occur within nurses' clinical decision-making. An exemplar illustrates use of the framework and guiding questions. Implications of this approach for selection of strategies that support development of clinical decision-making are highlighted. Copyright © 2010 Elsevier Ltd. All rights reserved.

Defining decision making: a qualitative study of international experts' views on surgical trainee decision making.

PubMed

Rennie, Sarah C; van Rij, Andre M; Jaye, Chrystal; Hall, Katherine H

2011-06-01

Decision making is a key competency of surgeons; however, how best to assess decisions and decision makers is not clearly established. The aim of the present study was to identify criteria that inform judgments about surgical trainees' decision-making skills. A qualitative free text web-based survey was distributed to recognized international experts in Surgery, Medical Education, and Cognitive Research. Half the participants were asked to identify features of good decisions, characteristics of good decision makers, and essential factors for developing good decision-making skills. The other half were asked to consider these areas in relation to poor decision making. Template analysis of free text responses was performed. Twenty-nine (52%) experts responded to the survey, identifying 13 categories for judging a decision and 14 for judging a decision maker. Twelve features/characteristics overlapped (considered, informed, well timed, aware of limitations, communicated, knowledgeable, collaborative, patient-focused, flexible, able to act on the decision, evidence-based, and coherent). Fifteen categories were generated for essential factors leading to development of decision-making skills that fall into three major themes (personal qualities, training, and culture). The categories compiled from the perspectives of good/poor were predominantly the inverse of each other; however, the weighting given to some categories varied. This study provides criteria described by experts when considering surgical decisions, decision makers, and development of decision-making skills. It proposes a working definition of a good decision maker. Understanding these criteria will enable clinical teachers to better recognize and encourage good decision-making skills and identify poor decision-making skills for remediation.

End-of-life decision-making for children with severe developmental disabilities: The parental perspective.

PubMed

Zaal-Schuller, I H; de Vos, M A; Ewals, F V P M; van Goudoever, J B; Willems, D L

2016-01-01

The objectives of this integrative review were to understand how parents of children with severe developmental disorders experience their involvement in end-of-life decision-making, how they prefer to be involved and what factors influence their decisions. We searched MEDLINE, EMBASE, CINAHL and PsycINFO. The search was limited to articles in English or Dutch published between January 2004 and August 2014. We included qualitative and quantitative original studies that directly investigated the experiences of parents of children aged 0-18 years with severe developmental disorders for whom an end-of-life decision had been considered or made. We identified nine studies that met all inclusion criteria. Reportedly, parental involvement in end-of-life decision-making varied widely, ranging from having no involvement to being the sole decision-maker. Most parents preferred to actively share in the decision-making process regardless of their child's specific diagnosis or comorbidity. The main factors that influenced parents in their decision-making were: their strong urge to advocate for their child's best interests and to make the best (possible) decision. In addition, parents felt influenced by their child's visible suffering, remaining quality of life and the will they perceived in their child to survive. Most parents of children with severe developmental disorders wish to actively share in the end-of-life decision-making process. An important emerging factor in this process is the parents' feeling that they have to stand up for their child's interests in conversations with the medical team. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Influence of Counterfactual Thinking and Regret on Ethical Decision Making

ERIC Educational Resources Information Center

Celuch, Kevin; Saxby, Carl; Oeding, Jill

2015-01-01

The authors explore the influence of counterfactual thoughts in triggering the emotions of regret and disappointment in ethical decision making. Counterfactual thinking involves examining possible outcomes to events and is often explored in what-if scenarios. Findings support that subjects were able to transfer regret (but not disappointment)…

Organizational Factors and Instructional Decision-Making: A Cognitive Perspective

ERIC Educational Resources Information Center

Hora, Matthew Tadashi

2012-01-01

Given the limited adoption of research-based teaching methods at the postsecondary level, research is necessary that examines why faculty choose to teach the way they do. In this article, I draw on insights from research on teacher cognition and naturalistic decision-making research to identify how perceptions of organizational factors influence…

Ethical Behavior & Decision-Making among Graduate Students

ERIC Educational Resources Information Center

French, Jennifer A.

2012-01-01

One-hundred and eleven graduate students enrolled in a clinical psychology training program (PsyD) participated in a research study that examined the ethical decision-making processes and factors that have been proposed to influence behavior (Smith, McGuire, Abbott, & Blau, 1991). Using a two-part questionnaire, data regarding the ethical…

Factors that influence parental decisions to participate in clinical research: consenters vs nonconsenters.

PubMed

Hoberman, Alejandro; Shaikh, Nader; Bhatnagar, Sonika; Haralam, Mary Ann; Kearney, Diana H; Colborn, D Kathleen; Kienholz, Michelle L; Wang, Li; Bunker, Clareann H; Keren, Ron; Carpenter, Myra A; Greenfield, Saul P; Pohl, Hans G; Mathews, Ranjiv; Moxey-Mims, Marva; Chesney, Russell W

2013-06-01

A child's health, positive perceptions of the research team and consent process, and altruistic motives play significant roles in the decision-making process for parents who consent for their child to enroll in clinical research. This study identified that nonconsenting parents were better educated, had private insurance, showed lower levels of altruism, and less understanding of study design. To determine the factors associated with parental consent for their child's participation in a randomized, placebo-controlled trial. Cross-sectional survey conducted from July 2008 to May 2011. The survey was an ancillary study to the Randomized Intervention for Children with VesicoUreteral Reflux Study. Seven children's hospitals participating in a randomized trial evaluating management of children with vesicoureteral reflux. Parents asked to provide consent for their child's participation in the randomized trial were invited to complete an anonymous online survey about factors influencing their decision. A total of 120 of the 271 (44%) invited completed the survey; 58 of 125 (46%) who had provided consent and 62 of 144 (43%) who had declined consent completed the survey. A 60-question survey examining child, parent, and study characteristics; parental perception of the study; understanding of the design; external influences; and decision-making process. RESULTS Having graduated from college and private health insurance were associated with a lower likelihood of providing consent. Parents who perceived the trial as having a low degree of risk, resulting in greater benefit to their child and other children, causing little interference with standard care, or exhibiting potential for enhanced care, or who perceived the researcher as professional were significantly more likely to consent to participate. Higher levels of understanding of the randomization process, blinding, and right to withdraw were significantly positively associated with consent to participate. CONCLUSIONS AND

Decision-making on shared sanitation in the informal settlements of Kisumu, Kenya.

PubMed

Simiyu, Sheillah; Swilling, Mark; Cairncross, Sandy

2017-10-01

Unlike most quantitative studies that investigate decision-making on investing in sanitation, this study adopted a qualitative approach to investigate decision-making on shared sanitation in the informal settlements of Kisumu city, in Kenya. Using a grounded theory approach, landlords and tenants were interviewed to identify sanitation decisions, individuals involved in decision-making and factors influencing decision-making. The results indicate that the main sanitation decisions are on investment, emptying, repair and cleaning. Landlords make investment, emptying and repair decisions, while tenants make cleaning decisions. Absentee landlords are less involved in most decision-making compared to live-in landlords, who rarely consult tenants in decision-making. Tenants make decisions after consultations with a third party and often collectively with other tenants. Sanitation interventions in informal settlements should thus, target landlords and tenants, with investment efforts being directed at landlords and maintenance efforts at tenants.

Enrolling adolescents in asthma research: adolescent, parent, and physician influence in the decision-making process.

PubMed

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

2009-06-01

The factors influencing family decisions to participate in adolescent asthma research are not well understood. Legal and ethical imperatives require adolescent research participation to be voluntary. While parents and adolescents often agree about research decisions, disagreements may also occur with relative frequency. Physician recommendations are also known to influence research participation decisions. Little attention has been given to how these dynamics may affect adolescents' involvement in decisions to participate in research. To examine the influence of family and physician-investigator relationships and recommendations on adolescent asthma clinical research participation decisions. A statewide community sample of 111 adolescents 11 to 17 years of age, with a diagnosis of asthma, and their parents participated in this study. Adolescents received a medical evaluation from an asthma specialist and then the family was offered participation in a hypothetical asthma clinical trial. By random assignment, the research study was presented by either the same or an unknown asthma specialist, and half the families in each group also received affirmative recommendations from the asthma specialist to participate in the hypothetical asthma clinical trial. Parents and adolescents made initial private decisions about participating in the trial. Then, following a family discussion of the clinical trial, a final research participation decision was made. Thirty-three percent of parents and adolescents initially disagreed about the research participation decision. When disagreements occurred, final decisions followed the parents' initial views except when the physician-investigator was known and a recommendation was made. Families with initial disagreement about participating were less likely to enroll when the investigator was unknown or when no recommendation was made. Adolescents who initially disagreed with parents' views were less likely to concur with the final research

Enrolling adolescents in asthma research: Adolescent, parent, and physician influence in the decision-making process

PubMed Central

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

2009-01-01

Background The factors influencing family decisions to participate in adolescent asthma research are not well understood. Legal and ethical imperatives require adolescent research participation to be voluntary. While parents and adolescents often agree about research decisions, disagreements may also occur with relatively frequency. Physician recommendations are also known to influence research participation decisions. Little attention has been given to how these dynamics may affect adolescents’ involvement in decisions to participate in research. Objective To examine the influence of family and physician-investigator relationships and recommendations on adolescent asthma clinical research participation decisions. Methods A statewide community sample of 111 adolescents aged 11–17, with a diagnosis of asthma, and their parents participated in this study. Adolescents received a medical evaluation from an asthma specialist and then the family was offered participation in a hypothetical asthma clinical trial. By random assignment, the research study was presented by either the same or an unknown asthma specialist and half the families in each group also received affirmative recommendations from the asthma specialist to participate in the hypothetical asthma clinical trial. Parents and adolescent made initial private decisions about participating in the trial. Then, following a family discussion of the clinical trial, a final research participation decision was made. Results Thirty three percent of parents and adolescents initially disagreed about the research participation decision. When disagreements occurred, final decisions followed the parents’ initial views except when the physician-investigator was known and a recommendation was made. Families with initial disagreement about participating were less likely to enroll when the investigator was unknown or when no recommendation was made. Adolescents who initially disagreed with parents’ views were less likely

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

Decision Making in Nursing Practice: A Concept Analysis.

PubMed

Johansen, Mary L; O'Brien, Janice L

2016-01-01

The study aims to gain an understanding of the concept of decision making as it relates to the nurse practice environment. Rodgers' evolutionary method on concept analysis was used as a framework for the study of the concept. Articles from 1952 to 2014 were reviewed from PsycINFO, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), JSTOR, PubMed, and Science Direct. Findings suggest that decision making in the nurse practice environment is a complex process, integral to the nursing profession. The definition of decision making, and the attributes, antecedents, and consequences, are discussed. Contextual factors that influence the process are also discussed. An exemplar is presented to illustrate the concept. Decision making in the nurse practice environment is a dynamic conceptual process that may affect patient outcomes. Nurses need to call upon ways of knowing to make sound decisions and should be self-reflective in order to develop the process further in the professional arena. The need for further research is discussed. © 2015 Wiley Periodicals, Inc.

Questioning context: a set of interdisciplinary questions for investigating contextual factors affecting health decision making

PubMed Central

Charise, Andrea; Witteman, Holly; Whyte, Sarah; Sutton, Erica J.; Bender, Jacqueline L.; Massimi, Michael; Stephens, Lindsay; Evans, Joshua; Logie, Carmen; Mirza, Raza M.; Elf, Marie

2011-01-01

Abstract Objective  To combine insights from multiple disciplines into a set of questions that can be used to investigate contextual factors affecting health decision making. Background  Decision‐making processes and outcomes may be shaped by a range of non‐medical or ‘contextual’ factors particular to an individual including social, economic, political, geographical and institutional conditions. Research concerning contextual factors occurs across many disciplines and theoretical domains, but few conceptual tools have attempted to integrate and translate this wide‐ranging research for health decision‐making purposes. Methods  To formulate this tool we employed an iterative, collaborative process of scenario development and question generation. Five hypothetical health decision‐making scenarios (preventative, screening, curative, supportive and palliative) were developed and used to generate a set of exploratory questions that aim to highlight potential contextual factors across a range of health decisions. Findings  We present an exploratory tool consisting of questions organized into four thematic domains – Bodies, Technologies, Place and Work (BTPW) – articulating wide‐ranging contextual factors relevant to health decision making. The BTPW tool encompasses health‐related scholarship and research from a range of disciplines pertinent to health decision making, and identifies concrete points of intersection between its four thematic domains. Examples of the practical application of the questions are also provided. Conclusions  These exploratory questions provide an interdisciplinary toolkit for identifying the complex contextual factors affecting decision making. The set of questions comprised by the BTPW tool may be applied wholly or partially in the context of clinical practice, policy development and health‐related research. PMID:21029277

From Hospital to Nursing Facility: Factors Influencing Decisions

ERIC Educational Resources Information Center

Mason, Susan E.; Auerbach, Charles; LaPorte, Heidi Heft

2009-01-01

This study addresses the factors influencing decisions to send medicine-surgical (med-surg) patients home or to nursing facilities (NFs). The sample (n = 7,852) was taken from a large, urban, teaching, med-surg unit where discharges were documented and data collected over a two-and-a-half-year period. Using logistical regression, the factors found…

Family factors in end-of-life decision-making: family conflict and proxy relationship.

PubMed

Parks, Susan Mockus; Winter, Laraine; Santana, Abbie J; Parker, Barbara; Diamond, James J; Rose, Molly; Myers, Ronald E

2011-02-01

Few studies have examined proxy decision-making regarding end-of-life treatment decisions. Proxy accuracy is defined as whether proxy treatment choices are consistent with the expressed wishes of their index elder. The purpose of this study was to examine proxy accuracy in relation to two family factors that may influence proxy accuracy: perceived family conflict and type of elder-proxy relationship. Telephone interviews with 202 community-dwelling elders and their proxy decision makers were conducted including the Life-Support Preferences Questionnaire (LSPQ), and a measure of family conflict, and sociodemographic characteristics, including type of relationship. Elder-proxy accuracy was associated with the type of elder-proxy relationship. Adult children demonstrated the lowest elder-proxy accuracy and spousal proxies the highest elder-proxy accuracy. Elder-proxy accuracy was associated with family conflict. Proxies reporting higher family conflict had lower elder-proxy accuracy. No interaction between family conflict and relationship type was revealed. Spousal proxies were more accurate in their substituted judgment than adult children, and proxies who perceive higher degree of family conflict tended to be less accurate than those with lower family conflict. Health care providers should be aware of these family factors when discussing advance care planning.

Role-players in abortion decision-making in the Accra Metropolis, Ghana.

PubMed

Kumi-Kyereme, Akwasi; Gbagbo, Fred Yao; Amo-Adjei, Joshua

2014-09-16

Making the final decision to terminate a pregnancy can be influenced by different circumstances involving various individuals. This paper describes the key players involved in the decision-making process regarding abortions among women who elected to undergo an induced abortion in a cosmopolitan urban setting in Ghana. A retrospective cross-sectional mixed method study was conducted between January and December 2011. A total of 401 women with records in abortion logbooks were selected for an interviewer-administered questionnaire and an in-depth interview. Descriptive and multinomial logistic regression analyses were used to assess the quantitative data, and a thematic analysis was applied to the qualitative data. The findings of the study reveal that pregnant individuals, mothers of abortion-seekers, male partners, and "Others" (for example, friends, employers) were instrumental in making a decision to terminate unplanned/unwanted pregnancies. Several key factors influenced the decision-making processes, including aversion from the men responsible for the pregnancy, concerns about abnormalities/deformities in future births due to unprofessionally conducted abortions, and economic considerations. A number of individuals, such as friends, mothers, and male partners, influence the decision-making process regarding abortion among the participants of the study. Various targeted messages are needed for the various participants in the decision.

Contextual influences on animal decision-making: Significance for behavior-based wildlife conservation and management.

PubMed

Owen, Megan A; Swaisgood, Ronald R; Blumstein, Daniel T

2017-01-01

Survival and successful reproduction require animals to make critical decisions amidst a naturally dynamic environmental and social background (i.e. "context"). However, human activities have pervasively, and rapidly, extended contextual variation into evolutionarily novel territory, potentially rendering evolved animal decision-making mechanisms and strategies maladaptive. We suggest that explicitly focusing on animal decision-making (ADM), by integrating and applying findings from studies of sensory ecology, cognitive psychology, behavioral economics and eco-evolutionary strategies, may enhance our understanding of, and our ability to predict how, human-driven changes in the environment and population demography will influence animal populations. Fundamentally, the decisions animals make involve evolved mechanisms, and behaviors emerge from the combined action of sensory integration, cognitive mechanisms and strategic rules of thumb, and any of these processes may have a disproportionate influence on behavior. Although there is extensive literature exploring ADM, it generally reflects a canalized, discipline-specific approach that lacks a unified conceptual framework. As a result, there has been limited application of ADM theory and research findings into predictive models that can enhance management outcomes, even though it is likely that the relative resilience of species to rapid environmental change is fundamentally a result of how ADM is linked to contextual variation. Here, we focus on how context influences ADM, and highlight ideas and results that may be most applicable to conservation biology. © 2016 International Society of Zoological Sciences, Institute of Zoology/Chinese Academy of Sciences and John Wiley & Sons Australia, Ltd.

Decision-Making Capacity for Chemotherapy and Associated Factors in Newly Diagnosed Patients with Lung Cancer.

PubMed

Ogawa, Asao; Kondo, Kyoko; Takei, Hiroyuki; Fujisawa, Daisuke; Ohe, Yuichiro; Akechi, Tatsuo

2018-04-01

The objective of this study was to assess decision-making capacity in patients newly diagnosed with lung cancer, clinical factors associated with impaired capacity, and physicians' perceptions of patients' decision-making capacity. We recruited 122 patients newly diagnosed with lung cancer. One hundred fourteen completed the assessment. All patients were receiving a combination of treatments (e.g., chemotherapy, chemo-radiotherapy, or targeted therapy). Decision-making capacity was assessed using the MacArthur Competence Tool for Treatment. Cognitive impairment, depressive symptoms, and frailty were also evaluated. Physicians' perceptions were compared with the ascertainments. Twenty-seven (24%, 95% confidence interval [CI], 16-31) patients were judged to have incapacity. Clinical teams had difficulty in judging six (22.2%) patients for incapacity. Logistic regression identified frailty (odds ratio, 3.51; 95% CI, 1.13-10.8) and cognitive impairment (odds ratio, 5.45; 95% CI, 1.26-23.6) as the factors associated with decision-making incapacity. Brain metastasis, emphysema, and depression were not associated with decision-making incapacity. A substantial proportion of patients diagnosed with lung cancer show impairments in their capacity to make a medical decision. Assessment of cognitive impairment and frailty may provide appropriate decision-making frameworks to act in the best interest of patients. Decision-making capacity is the cornerstone of clinical practice. A substantial proportion of patients with cancer show impairments in their capacity to make a medical decision. Assessment of cognitive impairment and frailty may provide appropriate decision-making frameworks to act in the best interest of patients. © AlphaMed Press 2017.

Analysis of the decision-making process of nurse managers: a collective reflection.

PubMed

Eduardo, Elizabete Araujo; Peres, Aida Maris; de Almeida, Maria de Lourdes; Roglio, Karina de Dea; Bernardino, Elizabeth

2015-01-01

to analyze the decision-making model adopted by nurses from the perspective of some decision-making process theories. qualitative approach, based on action research. Semi-structured questionnaires and seminars were conducted from April to June 2012 in order to understand the nature of decisions and the decision-making process of nine nurses in position of managers at a public hospital in Southern Brazil. Data were subjected to content analysis. data were classified in two categories: the current situation of decision-making, which showed a lack of systematization; the construction and collective decision-making, which emphasizes the need to develop a decision-making model. the decision-making model used by nurses is limited because it does not consider two important factors: the limits of human rationality, and the external and internal organizational environments that influence and determine right decisions.

Strengthening forensic DNA decision making through a better understanding of the influence of cognitive bias.

PubMed

Jeanguenat, Amy M; Budowle, Bruce; Dror, Itiel E

2017-11-01

Cognitive bias may influence process flows and decision making steps in forensic DNA analyses and interpretation. Currently, seven sources of bias have been identified that may affect forensic decision making with roots in human nature; environment, culture, and experience; and case specific information. Most of the literature and research on cognitive bias in forensic science has focused on patterned evidence; however, forensic DNA testing is not immune to bias, especially when subjective interpretation is involved. DNA testing can be strengthened by recognizing the existence of bias, evaluating where it influences decision making, and, when applicable, implementing practices to reduce or control its effects. Elements that may improve forensic decision making regarding bias include cognitively informed education and training, quality assurance procedures, review processes, analysis and interpretation, and context management of irrelevant information. Although bias exists, reliable results often can be (and have been) produced. However, at times bias can (and has) impacted the interpretation of DNA results negatively. Therefore, being aware of the dangers of bias and implementing measures to control its potential impact should be considered. Measures and procedures that handicap the workings of the crime laboratory or add little value to improving the operation are not advocated, but simple yet effective measures are suggested. This article is meant to raise awareness of cognitive bias contamination in forensic DNA testing and to give laboratories possible pathways to make sound decisions to address its influences. Copyright © 2017 The Chartered Society of Forensic Sciences. Published by Elsevier B.V. All rights reserved.

'She's usually quicker than the calculator': financial management and decision-making in couples living with dementia.

PubMed

Boyle, Geraldine

2013-09-01

This article explores how married couples managed their finances and made financial decisions when one spouse had dementia, drawing comparisons with the approaches used prior to the illness. More specifically, the article examines the role of social factors in influencing the involvement of people with dementia in financial management and decision-making, particularly whether a gender dynamic adopted earlier in a marriage similarly influenced a gendered approach following dementia. The research formed part of a larger study of everyday decision-making by couples living with dementia which explored the role of non-cognitive factors in influencing whether people with dementia were involved in decision-making processes. Twenty-one married couples living at home took part; the recently-diagnosed were excluded. Qualitative methods -including participant observation and interviews - were used to examine the couples' fiscal management and decision-making-processes, the perceptions of people with dementia and their spouses about their current financial abilities and whether any support provided by spouse-carers influenced their partners' financial capacity. The fieldwork was undertaken in the North of England between June 2010 and May 2011. Thematic analysis of the data showed that social factors influenced the perceived capacity of people with dementia and the financial practices adopted by the couples. In particular, gender influenced whether people with dementia were involved in financial decisions. The research demonstrated that non-cognitive factors need to be taken into account when assessing and facilitating the capacity of people with dementia. In addition, as people with dementia were somewhat marginalised in decisions about designating financial authority (Lasting Power of Attorney), spouse-carers may need guidance on how to undertake advance care planning and how to support their relatives with dementia in major decision-making, particularly when there are

The Extent to Which Principals' Leadership and Decision-Making Processes Exerts Influence on the Operations of Inclusion Classrooms Including Students with Autism Spectrum Disorder at the Elementary School Level

ERIC Educational Resources Information Center

Bermani, Michelle Ines

2017-01-01

In this quantitative and qualitative mixed study, the researcher focused on a range of factors that drive principals' decision making and examined the variables that affect principals' decision-making. The study assessed the extent to which principals' leadership and decision-making processes exert influence on the operations of inclusion…

Clinical holistic medicine: factors influencing the therapeutic decision-making. From academic knowledge to emotional intelligence and spiritual "crazy" wisdom.

PubMed

Ventegodt, Søren; Kandel, Isack; Merrick, Joav

2007-12-10

Scientific holistic medicine is built on holistic medical theory, on therapeutic and ethical principles. The rationale is that the therapist can take the patient into a state of salutogenesis, or existential healing, using his skills and knowledge. But how ever much we want to make therapy a science it remains partly an art, and the more developed the therapist becomes, the more of his/her decisions will be based on intuition, feeling and even inspiration that is more based on love and human concern and other spiritual motivations than on mental reason and rationality in a simple sense of the word. The provocative and paradoxal medieval western concept of the "truth telling clown", or the eastern concepts of "crazy wisdom" and "holy madness" seems highly relevant here. The problem is how we can ethically justify this kind of highly "irrational" therapeutic behavior in the rational setting of a medical institution. We argue here that holistic therapy has a very high success rate and is doing no harm to the patient, and encourage therapists, psychiatrists, psychologist and other academically trained "helpers" to constantly measure their own success-rate. This paper discusses many of the important factors that influence clinical holistic decision-making. Sexuality could, as many psychoanalysts from Freud to Reich and Searles have believed, be the most healing power that exists and also the most difficult for the mind to comprehend, and thus the most "crazy-wise" tool of therapy.

A Multilevel Model of Minority Opinion Expression and Team Decision-Making Effectiveness

ERIC Educational Resources Information Center

Park, Guihyun; DeShon, Richard P.

2010-01-01

The consideration of minority opinions when making team decisions is an important factor that contributes to team effectiveness. A multilevel model of minority opinion influence in decision-making teams is developed to address the conditions that relate to adequate consideration of minority opinions. Using a sample of 57 teams working on a…

What factors do patients consider most important in making lung cancer screening decisions? Findings from a demonstration project conducted in the Veterans Health Administration.

PubMed

Lillie, Sarah E; Fu, Steven S; Fabbrini, Angela E; Rice, Kathryn L; Clothier, Barbara; Nelson, David B; Doro, Elizabeth A; Moughrabieh, M Anas; Partin, Melissa R

2017-02-01

The National Lung Screening Trial recently reported that annual low-dose computed tomography screening is associated with decreased lung cancer mortality in high-risk smokers. This study sought to identify the factors patients consider important in making lung cancer screening (LCS) decisions, and explore variations by patient characteristics and LCS participation. This observational survey study evaluated the Minneapolis VA LCS Clinical Demonstration Project in which LCS-eligible Veterans (N=1388) were randomized to either Direct LCS Invitation (mailed with decision aid, N=926) or Usual Care (provider referral, N=462). We surveyed participants three months post-randomization (response rate 44%) and report the proportion of respondents rating eight decision-making factors (benefits, harms, and neutral factors) as important by condition, patient characteristics, and LCS completion. Overall, the most important factor was personal risk of lung cancer and the least important factor was health risks from LCS. The reported importance varied by patient characteristics, including smoking status, health status, and education level. Overall, the potential harms of LCS were reported less important than the benefits or the neutral decision-making factors. Exposure to Direct LCS Invitation (with decision aid) increased Veterans' attention to specific decision-making factors; compared to Usual Care respondents, a larger proportion of Direct LCS Invitation respondents rated the chance of false-positive results, LCS knowledge, LCS convenience, and anxiety as important. Those completing LCS considered screening harms less important, with the exception of incidental findings. Decision tools influence Veterans' perceptions about LCS decision-making factors. As the factors important to LCS decision making vary by patient characteristics, targeted materials for specific subgroups may be warranted. Attention should be paid to how LCS incidental findings are communicated. Published by

The relationship between risk factors and aeronautical decision making in the flight training environment

NASA Astrophysics Data System (ADS)

Wetmore, Michael J.

The purpose of this applied dissertation was to investigate the relationship between risk factors and aeronautical decision making in the flight training environment using a quantitative, non-experimental, ex post facto research design. All 75 of the flight training accidents that involved a fatality from the years 2001-2003 were selected for study from the National Transportation Safety Board (NTSB) aviation accident database. Objective evidence from the Factual Reports was used to construct accident chains and to code and quantify total risk factors and total poor aeronautical decisions. The data were processed using correlational statistical tests at the 1% significance level. There was a statistically significant relationship between total risk factors per flight and poor decisions per flight. Liveware risks were the most prevalent risk factor category. More poor decisions were made during preflight than any other phase of flight. Pilots who made multiple poor decisions per flight had significantly higher risk factors per flight. A risk factor threat to decision making chart is presented for use by flight instructors and/or flight training organizations. The main threat to validity of this study was the NTSB accident investigation team investigative equality assumption.

Reproductive decision-making and determinants of contraceptive use in HIV-infected women.

PubMed

Williams, H A; Watkins, C E; Risby, J A

1996-06-01

Perinatal transmission and reproductive decisions of HIV-infected women can be categorized in statistical and epidemiological terms. These reports and figures, however, do little to fully explain the complexities of human relationships, life experiences, personal and cultural influences, and situational and environmental variables that impact on the HIV-infected woman regarding reproductive decision-making. It is only with genuine attempts to understand the woman's perspective and the dynamic and unique variables that influence reproductive decision-making, as well as maintaining a non-judgmental and culturally sensitive perspective, can we hope to assist women, and society as a whole, in coming to terms with the complexities of HIV and reproductive decision-making. Further study is needed to identify factors that influence reproductive decision-making in HIV-infected women. The determinants of contraceptive use regarding demographic factors, barriers to contraceptive use, and factors that contribute to successful contraceptive use in this population must be understood if efforts to reduce the number of unplanned pregnancies are to be successful. More conclusive data are needed on the safety and efficacy of oral contraceptives in HIV-infected women as well as data that describe the effects of longer acting hormonal contraceptives such as levonorgestrel implants (Norplant; Wyeth-Ayerst, Philadelphia, PA) and injectable medroxyprogesterone acetate (Depo Provera; Upjohn Company, Kalamazoo, MI). More research is needed to determine the effects of patient education and counseling and closer follow-up on effective long-term contraception in HIV-infected women.

School Counselors and Ethical Decision Making

ERIC Educational Resources Information Center

West, Dana R.

2016-01-01

Students and their parents/guardians rely on school counselors to provide counseling services based on ethically sound principles. However, there is a lack of empirical evidence about what influences a school counselor's ethical decision making. Ethical decision making for this study was defined as the degree to which decisions pertaining to…

Cognitive-emotional decision making (CEDM): a framework of patient medical decision making.

PubMed

Power, Tara E; Swartzman, Leora C; Robinson, John W

2011-05-01

Assistance for patients faced with medical decisions has largely focussed on the clarification of information and personal values. Our aim is to draw on the decision research describing the role of emotion in combination with health behaviour models to provide a framework for conceptualizing patient decisions. A review of the psychological and medical decision making literature concerned with the role of emotion/affect in decision making and health behaviours. Emotion plays an influential role in decision making. Both current and anticipated emotions play a motivational role in choice. Amalgamating these findings with that of Leventhal's (1970) SRM provide a framework for thinking about the influence of emotion on a patient medical decision. Our framework suggests that a patient must cope with four sets of elements. The first two relate to the need to manage the cognitive and emotional aspects of the health threat. The second set relate to the management of the cognitive and emotional elements of the decision, itself. The framework provides a way for practitioners and researchers to frame thinking about a patient medical decision in order to assist the patient in clarifying decisional priorities. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

What factors influence the decisions of mental health professionals to release service users from seclusion?

PubMed

Jackson, Haley; Baker, John; Berzins, Kathyrn

2018-06-22

Mental health policy stipulates seclusion should only be used as an intervention of last resort and for the minimum possible duration. Current evidence details which service users are more likely to be secluded, why they are secluded, and what influences the decision to seclude them. However, very little is known about the decision to release service users from seclusion. An integrative review was undertaken to explore the decision-making processes of mental health professionals which guide the ending of seclusion. The review used a systematic approach to gather and thematically analyse evidence within a framework approach. The twelve articles identified generated one overriding theme, maintaining safety. In addition, several subthemes emerged including the process of risk assessing which was dependent upon interaction and control, mediated by factors external to the service user such as the attitude and experience of staff and the acuity of the environment. Service users were expected to demonstrate compliance with the process ultimately ending in release and reflection. Little evidence exists regarding factors influencing mental health professionals in decisions to release service users from seclusion. There is no evidence-based risk assessment tool, and service users are not routinely involved in the decision to release them. Support from experienced professionals is vital to ensure timely release from seclusion. Greater insight into influences upon decisions to discontinue episodes may support initiatives aimed at reducing durations and use of seclusion. © 2018 Australian College of Mental Health Nurses Inc.

Emergency medical service provider decision-making in out of hospital cardiac arrest: an exploratory study.

PubMed

Brandling, J; Kirby, K; Black, S; Voss, S; Benger, J

2017-07-25

There are approximately 60,000 out-of-hospital cardiac arrests (OHCA) in the United Kingdom (UK) each year. Within the UK there are well-established clinical practice guidelines that define when resuscitation should be commenced in OHCA, and when resuscitation should cease. Background literature indicates that decision-making in the commencement and cessation of resuscitation efforts in OHCA is complex, and not comprehensively understood. No relevant research from the UK has been published to date and this research study seeks to explore the influences on UK Emergency Medical Service (EMS) provider decision-making when commencing and ceasing resuscitation attempts in OHCA. The aim of this research to explore the influences on UK Emergency Medical Services provider decision-making when commencing and ceasing resuscitation attempts in OHCA. Four focus groups were convened with 16 clinically active EMS providers. Four case vignettes were discussed to explore decision-making within the focus groups. Thematic analysis was used to analyse transcripts. This research found that there are three stages in the decision-making process when EMS providers consider whether to commence or cease resuscitation attempts in OHCA. These stages are: the call; arrival on scene; the protocol. Influential factors present at each of the three stages can lead to different decisions and variability in practice. These influences are: factual information available to the EMS provider; structural factors such as protocol, guidance and research; cultural beliefs and values; interpersonal factors; risk factors; personal values and beliefs. An improved understanding of the circumstantial, individual and interpersonal factors that mediate the decision-making process in clinical practice could inform the development of more effective clinical guidelines, education and clinical decision support in OHCA. These changes have the potential to lead to greater consistency. and EMS provider confidence, with

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.

Career Decision Making of Lesbian, Gay, and Bisexual Individuals.

ERIC Educational Resources Information Center

Chung, Y. Barry

1995-01-01

Discusses career decision making of lesbian, gay, and bisexual individuals within the framework of personal (interests, values, and skills) and environmental (workplace barriers) factors and their interactive influences. Reviews empirical literature and proposes suggestions for research and practice. (Author/JBJ)

A Qualitative Study of Factors Underlying Decision Making for Joint Replacement among African Americans and Latinos with Osteoarthritis

PubMed Central

Parks, Michael L.; Hebert-Beirne, Jennifer; Rojas, Mary; Tuzzio, Leah; Nelson, Charles L.; Boutin-Foster, Carla

2015-01-01

To support patients in making decisions that align with their unique cultural beliefs, an understanding of factors underlying patient preferences is needed. We sought to identify psychosocial factors that influenced decision making among African-American and Hispanic patients referred for knee or hip arthroplasty. Thirty-six participants deciding on surgery were interviewed. Responses were audio-taped, transcribed, and read. Codes were assigned to the raw data and then clustered into categories that were analyzed to yield overarching themes. This process was repeated independently by two corroborators. Six categories described the mental calculations made in patients' decision-making processes: 1) self-assessment of ft for surgery based on age and comorbidity, 2) research and development of mental report cards of their surgeons, 3) reliving of social network experiences, 4) reliance on faith and spirituality for guidance, 5) acknowledgment of fear and anxiety, and 6) setting expectations for recovery. This study advanced the understanding of how decisions about joint replacement are constructed and identified cultural levers that can be targeted for intervention. Developing culturally tailored health information that addresses some of our findings and disseminating messages through social networks may reduce the underutilization of joint replacement among racial and ethnic minority populations. PMID:25272219

A qualitative study of factors underlying decision making for joint replacement among African Americans and Latinos with osteoarthritis.

PubMed

Parks, Michael L; Hebert-Beirne, Jennifer; Rojas, Mary; Tuzzio, Leah; Nelson, Charles L; Boutin-Foster, Carla

2014-01-01

To support patients in making decisions that align with their unique cultural beliefs, an understanding of factors underlying patient preferences is needed. We sought to identify psychosocial factors that influenced decision making among African-American and Hispanic patients referred for knee or hip arthroplasty. Thirty-six participants deciding on surgery were interviewed. Responses were audio-taped, transcribed, and read. Codes were assigned to the raw data and then clustered into categories that were analyzed to yield overarching themes. This process was repeated independently by two corroborators. Six categories described the mental calculations made in patients' decision-making processes: 1) self-assessment of fit for surgery based on age and comorbidity, 2) research and development of mental report cards of their surgeons, 3) reliving of social network experiences, 4) reliance on faith and spirituality for guidance, 5) acknowledgment of fear and anxiety, and 6) setting expectations for recovery. This study advanced the understanding of how decisions about joint replacement are constructed and identified cultural levers that can be targeted for intervention. Developing culturally tailored health information that addresses some of our findings and disseminating messages through social networks may reduce the underutilization of joint replacement among racial and ethnic minority populations.

Factors Affecting Career Decision Making of Mexican and Mexican-American Students.

ERIC Educational Resources Information Center

Newlon, Betty J.; Borboa, Roman

The purpose of this research was to identify the self-reported factors affecting the career decision making of Mexican and Mexican-American students. It was hypothesized that the factor clusters would differ between the two sample populations, Mexican and Mexican-American. It was also hypothesized that these clusters would differ from six clusters…

Factors Which Influence The Fish Purchasing Decision: A study on Traditional Market in Riau Mainland

NASA Astrophysics Data System (ADS)

Siswati, Latifa; Putri, Asgami

2018-05-01

The purposes of the research are to analyze and assess the factors which influence fish purchasing by the community at Tenayan Raya district Pekanbaru.Research methodology which used is survey method, especially interview and observation technique or direct supervision on the market which located at Tenayan Raya district. Determination technique of sampling location/region is done by purposive sampling. The sampling method is done by accidental sampling. Technique analysis of factors which used using the data that derived from the respondent opinion to various fish variable. The result of this research are the factors which influence fish purchasing decision done in a traditional market which located at Tenayan Raya district are product factor, price factors, social factor and individual factor. Product factor which influences fish purchasing decision as follows: the eyelets condition, the nutrition of fresh fish, the diversity of sold fish. Price factors influence the fish purchasing decision, such as: the price of fresh fish, the convincing price and the suitability price and benefits of the fresh fish. Individual factors which influence a fish purchasing decision, such as education and income levels. Social factors which influence a fish purchasing decision, such as family, colleagues and feeding habits of fish.

29 CFR 1471.860 - What factors may influence the debarring official's decision?

Code of Federal Regulations, 2010 CFR

2010-07-01

... decision? 1471.860 Section 1471.860 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND... may influence the debarring official's decision? This section lists the mitigating and aggravating... in this section, is not necessarily determinative of your present responsibility. In making a...

What Factors Do Allied Health Take Into Account When Making Resource Allocation Decisions?

PubMed Central

Lane, Haylee; Sturgess, Tamica; Philip, Kathleen; Markham, Donna; Martin, Jennifer; Walsh, Jill; Hubbard, Wendy; Haines, Terry

2018-01-01

Background: Allied health comprises multiple professional groups including dietetics, medical radiation practitioners, occupational therapists, optometrists and psychologists. Different to medical and nursing, Allied health are often organized in discipline specific departments and allocate budgets within these to provide services to a range of clinical areas. Little is known of how managers of allied health go about allocating these resources, the factors they consider when making these decisions, and the sources of information they rely upon. The purpose of this study was to identify the key factors that allied health consider when making resource allocation decisions and the sources of information they are based upon. Methods: Four forums were conducted each consisting of case studies, a large group discussion and two hypothetical scenarios to elicit data. A thematic content analysis commenced during post-forum discussions of key factors by forum facilitators. These factors were then presented to an expert working party for further discussion and refinement. Transcripts were generated of all data recordings and a detailed thematic analysis was undertaken by one author to ensure coded data matched the initial thematic analysis. Results: Twelve factors affecting the decision-making of allied health managers and clinicians were identified. One of these factors was disendorsed by the expert working party. The 11 remaining factors can be considered to be key decision-making principles that should be consistently applied to resource allocation. These principles were clustered into three overarching themes of readiness, impact and appropriateness. Conclusion: Understanding these principles now means further research can be completed to more effectively integrate research evidence into health policy and service delivery, create partnerships among policy-makers, managers, service providers and researchers, and to provide support to answer difficult questions that policy

[Decision-making process and health management councils: theoretical approaches].

PubMed

Wendhausen, Agueda; Cardoso, Sandra de Mello

2007-01-01

With the institutionalization of participation in health, through conferences and management councils at national, state, municipal and local levels, a process of democratization is initiated in the health area. However, in relation to the health councils in particular, there is still much to be done, including improving the quality of the decision-making process. This work aims to place the decision-making process in its theoretical context in terms of participatory democracy, elements which make up, factors which influence its development, and finally, to explore some possibilities of this theoretical basis to analyze the practices of the health councils in the area of health. It is hoped that it will make a theoretical contribution to the analyses carried out in this area, in order to provide a decision-making process that is more inclusive in terms of participation.

An investigation of the factors effecting high-risk individuals’ decision-making about prophylactic total gastrectomy and surveillance for hereditary diffuse gastric cancer (HDGC)

PubMed Central

Hallowell, Nina; Badger, Shirlene; Richardson, Sue; Caldas, Carlos; Hardwick, Richard H.; Fitzgerald, Rebecca C.; Lawton, Julia

2018-01-01

Because Hereditary Diffuse Gastric Cancer (HDGC) has an early onset and poor prognosis, individuals who carry a pathogenic (CDH1) mutation in the E-cadherin gene (CDH1) are offered endoscopic surveillance and advised to undergo prophylactic total gastrectomy (PTG) in their early to mid-twenties. Patients not ready or fit to undergo gastrectomy, or in whom the genetic testing result is unknown or ambiguous, are offered surveillance. Little is known about the factors that influence decisions to undergo or decline PTG, making it difficult to provide optimal support for those facing these decisions. Qualitative interviews were carried out with 35 high-risk individuals from the Familial Gastric Cancer Study in the UK. Twenty-seven had previously undergone PTG and eight had been identified as carrying a pathogenic CDH1 mutation but had declined surgery at the time of interview. The interviews explored the experience of decision-making and factors influencing risk-management decisions. The data suggest that decisions to proceed with PTG are influenced by a number of potentially competing factors: objective risk confirmation by genetic testing and/or receiving a positive biopsy; perceived familial cancer burden and associated risk perceptions; perceptions of post-surgical life; an increasing inability to tolerate endoscopic procedures; a concern that surveillance could miss a cancer developing and individual’s life stage. These findings have implications for advising this patient group. PMID:27256430

The influence of discrete emotions on judgement and decision-making: a meta-analytic review.

PubMed

Angie, Amanda D; Connelly, Shane; Waples, Ethan P; Kligyte, Vykinta

2011-12-01

During the past three decades, researchers interested in emotions and cognition have attempted to understand the relationship that affect and emotions have with cognitive outcomes such as judgement and decision-making. Recent research has revealed the importance of examining more discrete emotions, showing that same-valence emotions (e.g., anger and fear) differentially impact judgement and decision-making outcomes. Narrative reviews of the literature (Lerner & Tiedens, 2006 ; Pham, 2007 ) have identified some under-researched topics, but provide a limited synthesis of findings. The purpose of this study was to review the research examining the influence of discrete emotions on judgement and decision-making outcomes and provide an assessment of the observed effects using a meta-analytic approach. Results, overall, show that discrete emotions have moderate to large effects on judgement and decision-making outcomes. However, moderator analyses revealed differential effects for study-design characteristics and emotion-manipulation characteristics by emotion type. Implications are discussed.

[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.

Married women's decision making power on family planning use and associated factors in Mizan-Aman, South Ethiopia: a cross sectional study.

PubMed

Belay, Abeba Daniel; Mengesha, Zelalem Birhanu; Woldegebriel, Manay Kifle; Gelaw, Yalemzewod Assefa

2016-03-08

Women's use of family planning service is influenced by many factors, especially by their decision making power. A woman's decision-making power, be it individual or decision made in collaboration with a partner, is the most important factor in the use of family planning in a household. The purpose of this study was to assess the impact of women's decision making power on family planning use and its associated factors. A community-based cross-sectional study was conducted on married women in the child bearing age. The women who were living in Mizan city were selected using the simple random sampling method. Trained nurses collected the data by interview, using a structured and pre-tested questioner. Bivariable and multivariable binary logistic regression analysis was used to identify the associated factors, and the odds ratio with a 95% CI was computed to assess the strength of the association. Collinearity was also assessed by looking at standard errors in the final fitted model. Overall, more than two-thirds [67.2%: 95% CI (63-71%)] of the married women were found to be more autonomous to decide family planning use. Secondary education [AOR: 9.04, 95% CI: (4.50, 18.16)], government employment [AOR: 4.84, 95% CI: (2.03, 11.52)], being wives of government employed spouses [AOR 2.71, 95% CI: (1.24, 7.97)], having husbands with college or university education [AOR: 11.29, 95% CI: (4.66, 27.35)], and being in the younger age [AOR: 0.27, 95% CI :(0.09, 0.75)] were significantly associated with women's decision-making power on family planning. In this study, women had a high decision making power in family planning use. Age category (34-44-years), formal education, and occupational status had effects on women's decision making power. Promoting parental adult education and engaging women in out of house employment is essential to improve their decision making power in using family planning.

Effect of Health Literacy on Decision-Making Preferences among Medically Underserved Patients.

PubMed

Seo, Joann; Goodman, Melody S; Politi, Mary; Blanchard, Melvin; Kaphingst, Kimberly A

2016-05-01

Participation in the decision-making process and health literacy may both affect health outcomes; data on how these factors are related among diverse groups are limited. This study examined the relationship between health literacy and decision-making preferences in a medically underserved population. We analyzed a sample of 576 primary care patients. Multivariable logistic regression was used to examine the independent association of health literacy (measured by the Rapid Estimate of Adult Literacy in Medicine-Revised) and patients' decision-making preferences (physician directed or patient involved), controlling for age, race/ethnicity, and gender. We tested whether having a regular doctor modified this association. Adequate health literacy (odds ratio [OR] = 1.7;P= 0.009) was significantly associated with preferring patient-involved decision making, controlling for age, race/ethnicity, and gender. Having a regular doctor did not modify this relationship. Males were significantly less likely to prefer patient-involved decision making (OR = 0.65;P= 0.024). Findings suggest health literacy affects decision-making preferences in medically underserved patients. More research is needed on how factors, such as patient knowledge or confidence, may influence decision-making preferences, particularly for those with limited health literacy. © The Author(s) 2016.

Factors influencing maternal decision-making for the infant sleep environment in families at higher risk of SIDS: a qualitative study.

PubMed

Pease, Anna; Ingram, Jenny; Blair, Peter S; Fleming, Peter J

2017-01-01

Qualitative interviews with mothers of babies at higher risk of sudden infant death syndrome (SIDS) were carried out to understand their views and decision-making process on the infant sleep environment and safe sleep messages. Twenty semi-structured interviews were conducted between February and November 2014 in deprived areas of Bristol, UK. Mothers were asked about their decision-making for the infant sleep environment and safe sleep messages including infant sleep position, co-sleeping, smoking, dummy use, feeding and disrupted routines. The interviews were transcribed, coded and thematic analysis carried out. Participants were invited based on an algorithm developed in a previous SIDS case control study that identified an increased risk of SIDS from four demographic characteristics: young maternal age, smoking during pregnancy, three or more children, and a measure of deprivation. The presence of three, or more characteristics led to being invited to take part in the qualitative study. Factors influencing mothers' adherence to the safe sleep messages included previous experience and the credibility of the advice given. They described disrupted routines that led to risky scenarios with a belief that occasional risks were acceptable. Where circumstances made following the advice more difficult they found alternative strategies to reduce the risk, including the use of movement monitors, regular checking and a belief that lighter maternal sleep in the presence of a baby was protective. Safer sleep messages should be tailored to fit with the lived realities of mothers, especially those at higher risk. The traditional list of 'do's' and 'don'ts' was not well accepted by this group. Interventions that seek to influence this higher-risk group should acknowledge mothers' own protective instincts and consider their beliefs and understanding behind the safer sleep messages if they are to be effective and encourage this group to change.

Factors influencing maternal decision-making for the infant sleep environment in families at higher risk of SIDS: a qualitative study

PubMed Central

Ingram, Jenny; Blair, Peter S; Fleming, Peter J

2017-01-01

Objective Qualitative interviews with mothers of babies at higher risk of sudden infant death syndrome (SIDS) were carried out to understand their views and decision-making process on the infant sleep environment and safe sleep messages. Design and setting Twenty semi-structured interviews were conducted between February and November 2014 in deprived areas of Bristol, UK. Mothers were asked about their decision-making for the infant sleep environment and safe sleep messages including infant sleep position, co-sleeping, smoking, dummy use, feeding and disrupted routines. The interviews were transcribed, coded and thematic analysis carried out. Participants Participants were invited based on an algorithm developed in a previous SIDS case control study that identified an increased risk of SIDS from four demographic characteristics: young maternal age, smoking during pregnancy, three or more children, and a measure of deprivation. The presence of three, or more characteristics led to being invited to take part in the qualitative study. Results Factors influencing mothers’ adherence to the safe sleep messages included previous experience and the credibility of the advice given. They described disrupted routines that led to risky scenarios with a belief that occasional risks were acceptable. Where circumstances made following the advice more difficult they found alternative strategies to reduce the risk, including the use of movement monitors, regular checking and a belief that lighter maternal sleep in the presence of a baby was protective. Conclusions Safer sleep messages should be tailored to fit with the lived realities of mothers, especially those at higher risk. The traditional list of ‘do’s’ and ‘don’ts’ was not well accepted by this group. Interventions that seek to influence this higher-risk group should acknowledge mothers’ own protective instincts and consider their beliefs and understanding behind the safer sleep messages if they are to be

31 CFR 19.860 - What factors may influence the debarring official's decision?

Code of Federal Regulations, 2010 CFR

2010-07-01

... debarring official's decision? 19.860 Section 19.860 Money and Finance: Treasury Office of the Secretary of... may influence the debarring official's decision? This section lists the mitigating and aggravating... in this section, is not necessarily determinative of your present responsibility. In making a...

Reproductive Health Decision-Making in Perinatally HIV-Infected Adolescents and Young Adults

PubMed Central

Wiener, Lori; Zadeh, Sima; Albright, Jamie; Mellins, Claude Ann; Mancilla, Michael; Tepper, Vicki; Trexler, Connie; Purdy, Julia; Osherow, Janet; Lovelace, Susan; Kapetanovic, Suad

2013-01-01

With widespread access to antiretroviral therapy in the United States, many perinatally HIV-infected (PHIV+) children are surviving into adolescence and adulthood, becoming sexually active and making decisions about their reproductive health. The literature focusing on the reproductive decisions of individuals behaviorally infected with HIV can serve as a springboard for understanding the decision-making process of PHIV+ youth. Yet, there are many differences that critically distinguish reproductive health and related decision-making of PHIV+ youth. Given the potential public health implications of their reproductive decisions, better understanding of factors influencing the decision-making process is needed to help inform the development of salient treatment and prevention interventions. To begin addressing this understudied area, a “think tank” session, comprised of clinicians, medical providers, and researchers with expertise in the area of adolescent HIV, was held in Bethesda, MD, on September 21, 2011. The focus was to explore what is known about factors that influence the reproductive decision-making of PHIV+ adolescents and young adults, determine what important data are needed in order to develop appropriate intervention for PHIV+ youth having children, and to recommend future directions for the field in terms of designing and carrying out collaborative studies. In this report, we summarize the findings from this meeting. The paper is organized around the key themes that emerged, including utilizing a developmental perspective to create an operational definition of reproductive decision-making, integration of psychosocial services with medical management, and how to design future research studies. Case examples are presented and model program components proposed. PMID:22736033

Reproductive health decision-making in perinatally HIV-infected adolescents and young adults.

PubMed

Fair, Cynthia; Wiener, Lori; Zadeh, Sima; Albright, Jamie; Mellins, Claude Ann; Mancilla, Michael; Tepper, Vicki; Trexler, Connie; Purdy, Julia; Osherow, Janet; Lovelace, Susan; Kapetanovic, Suad

2013-07-01

With widespread access to antiretroviral therapy in the United States, many perinatally HIV-infected (PHIV+) children are surviving into adolescence and adulthood, becoming sexually active and making decisions about their reproductive health. The literature focusing on the reproductive decisions of individuals behaviorally infected with HIV can serve as a springboard for understanding the decision-making process of PHIV+ youth. Yet, there are many differences that critically distinguish reproductive health and related decision-making of PHIV+ youth. Given the potential public health implications of their reproductive decisions, better understanding of factors influencing the decision-making process is needed to help inform the development of salient treatment and prevention interventions. To begin addressing this understudied area, a "think tank" session, comprised of clinicians, medical providers, and researchers with expertise in the area of adolescent HIV, was held in Bethesda, MD, on September 21, 2011. The focus was to explore what is known about factors that influence the reproductive decision-making of PHIV+ adolescents and young adults, determine what important data are needed in order to develop appropriate intervention for PHIV+ youth having children, and to recommend future directions for the field in terms of designing and carrying out collaborative studies. In this report, we summarize the findings from this meeting. The paper is organized around the key themes that emerged, including utilizing a developmental perspective to create an operational definition of reproductive decision-making, integration of psychosocial services with medical management, and how to design future research studies. Case examples are presented and model program components proposed.

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.

Health care professionals' views of the factors influencing the decision to refer patients to a stroke rehabilitation trial.

PubMed

Thomas, Nessa; Plant, Sarah; Woodward-Nutt, Kate; Prior, Yeliz; Tyson, Sarah

2015-12-18

Effective recruitment is an essential element of successful research but notoriously difficult to achieve. This article examines health care professionals' views on the factors influencing decision-making regarding referral to a stroke rehabilitation trial. Semi-structured interviews and a card-sorting task were undertaken with stroke service staff in acute and community hospital trusts. Data analysis used a thematic framework approach. Twenty-seven qualified health care professionals from 12 (6 acute and 6 community) hospital trusts and one charity participated. Four main factors emerged: patient-related, professional views, the organisation and research logistics, which all contributed to staff's decision about whether to refer patients to a trial. Clinicians identified patient-related factors as the most frequent influence and considered themselves the patients' advocate. They used their knowledge of the patient to anticipate the patients' reaction to possible participation and tended to only refer those whom they perceived would respond positively. Participants also identified experience of research, a sense of ownership of the project and a positive view of the intervention being evaluated as factors influencing referral. The need to prioritise clinical matters, meet managerial demands and cope with constant change were organisational factors impacting negatively on referral. Staff often simply forgot about recruitment in the face of other higher priorities. Quick, simple, flexible research processes that were closely aligned with existing ways of working were felt to facilitate recruitment. Patient- and professional-related factors were the most frequent influence on clinicians' recruitment decisions, which often had a 'gate-keeping' effect. Managerial and clinical responsibility to juggle multiple (often higher) priorities was also an important factor. To facilitate recruitment, researchers need to develop strategies to approach potential participants as

Accumulation of evidence during sequential decision making: the importance of top-down factors.

PubMed

de Lange, Floris P; Jensen, Ole; Dehaene, Stanislas

2010-01-13

In the last decade, great progress has been made in characterizing the accumulation of neural information during simple unitary perceptual decisions. However, much less is known about how sequentially presented evidence is integrated over time for successful decision making. The aim of this study was to study the mechanisms of sequential decision making in humans. In a magnetoencephalography (MEG) study, we presented healthy volunteers with sequences of centrally presented arrows. Sequence length varied between one and five arrows, and the accumulated directions of the arrows informed the subject about which hand to use for a button press at the end of the sequence (e.g., LRLRR should result in a right-hand press). Mathematical modeling suggested that nonlinear accumulation was the rational strategy for performing this task in the presence of no or little noise, whereas quasilinear accumulation was optimal in the presence of substantial noise. MEG recordings showed a correlate of evidence integration over parietal and central cortex that was inversely related to the amount of accumulated evidence (i.e., when more evidence was accumulated, neural activity for new stimuli was attenuated). This modulation of activity likely reflects a top-down influence on sensory processing, effectively constraining the influence of sensory information on the decision variable over time. The results indicate that, when making decisions on the basis of sequential information, the human nervous system integrates evidence in a nonlinear manner, using the amount of previously accumulated information to constrain the accumulation of additional evidence.

Decision Making in NCAA Athletics: Factors Associated with Adding Sports to Division I Institutions

ERIC Educational Resources Information Center

Milstein, Sloane

2014-01-01

The purpose of this research was to gain insight into the decision-making factors, priorities and process used when adding sports to NCAA Division I institutions. The media often focuses on gender equity and financial parameters when discussing athletic decision-making, but this study seeks to go beyond speculation and add to intercollegiate…

Environmental influences: factors influencing a woman's decision to use dietary supplements.

PubMed

Conner, Mark; Kirk, Sara F L; Cade, Janet E; Barrett, Jennifer H

2003-06-01

Use of dietary supplements by women, particularly those over 40 years of age may be widespread in the United Kingdom. However, from surveillance data, there appears to be a disparity between nutrition and health needs and the rationale for and actual use of dietary supplements by women. This apparent paradox forms the basis for an inverse supplement hypothesis (i.e., supplement use in women appears to be most prevalent among those with least need). Little research has been done to examine the factors underlying the decision to use dietary supplements. Reasons for consuming dietary supplements are often complex, combining social, psychological, knowledge and economic factors. The theory of planned behavior is a widely used model for assessing factors influencing behavioral motivation and action that may be useful for assessing specific diet- and nutrition-related practices. It provided the basis for the development of a questionnaire to explore overall dietary supplement use in a cohort of women in the United Kingdom. The analysis of factors related to beliefs underlying dietary supplement use revealed differences between supplement users and nonusers. Differences included a stronger belief by users than nonusers that taking dietary supplements ensures against possible ill health. Both users and nonusers of supplements also perceived the media (books and magazines) to be a powerful influence on a person's decision to use supplements. These findings highlight the potential of the theory of planned behavior in exploring supplement-taking behavior while throwing light on the factors influencing an individual's motivations to use dietary supplements.

Strategic Decision Making Paradigms: A Primer for Senior Leaders

DTIC Science & Technology

2009-07-01

decision making . STRATEGIC DECISION MAKING Strategic Change: There are several strategic...influenced by stakeholders outside of the organization. The Ontology of Strategic Decision Making . Strategic decisions are non-routine and involve...Coates USAWC, July 2009 5 The Complexity of Strategic Decision Making Strategic decisions entail “ill-structured,”6 “messy” or

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.

Surviving Surrogate Decision-Making: What Helps and Hampers the Experience of Making Medical Decisions for Others

PubMed Central

Starks, Helene; Taylor, Janelle S.; Hopley, Elizabeth K.; Fryer-Edwards, Kelly

2007-01-01

BACKGROUND A majority of end-of-life medical decisions are made by surrogate decision-makers who have varying degrees of preparation and comfort with their role. Having a seriously ill family member is stressful for surrogates. Moreover, most clinicians have had little training in working effectively with surrogates. OBJECTIVES To better understand the challenges of decision-making from the surrogate’s perspective. DESIGN Semistructured telephone interview study of the experience of surrogate decision-making. PARTICIPANTS Fifty designated surrogates with previous decision-making experience. APPROACH We asked surrogates to describe and reflect on their experience of making medical decisions for others. After coding transcripts, we conducted a content analysis to identify and categorize factors that made decision-making more or less difficult for surrogates. RESULTS Surrogates identified four types of factors: (1) surrogate characteristics and life circumstances (such as coping strategies and competing responsibilities), (2) surrogates’ social networks (such as intrafamily discord about the “right” decision), (3) surrogate–patient relationships and communication (such as difficulties with honoring known preferences), and (4) surrogate–clinician communication and relationship (such as interacting with a single physician whom the surrogate recognizes as the clinical spokesperson vs. many clinicians). CONCLUSIONS These data provide insights into the challenges that surrogates encounter when making decisions for loved ones and indicate areas where clinicians could intervene to facilitate the process of surrogate decision-making. Clinicians may want to include surrogates in advance care planning prior to decision-making, identify and address surrogate stressors during decision-making, and designate one person to communicate information about the patient’s condition, prognosis, and treatment options. PMID:17619223

Exploring the link between environmental identity, behaviors and decision making

NASA Astrophysics Data System (ADS)

Freed, Allison

This study was conducted with undergraduate students at a large university to investigate the association between environmental identity, pro-environmental behaviors and environmental decision-making. This study explored how environmental identity as defined by Clayton (2003) influenced the type of pro-environmental behaviors individuals choose to participate in. Environmental decision-making based on Kahneman's (2003, 2011) System 1 and System 2 framework was also assessed in association with environmental identity. A survey including the Environmental Identity Survey (Clayton, 2003), the Environmentally Responsible Behaviors Index (Smith-Sebasto & D'Acosta, 1995), and a Decision Making Questionnaire were administered. After administering the surveys, eight participants were chosen for a 60-minute interview. The quantitative results of the study showed there was a significant relationship between environmental identity and participating in environmental behaviors more often. There was also a significant relation between environmental identity and making the decision to recycle in a fast and automatic way. The interview results showed that participants with both a strong and a weak environmental identity recycled often and thought it was a fast decision. The results of this study show that certain components of environmental identity are important, but other factors like the physical environment and social norms influence the thinking that goes into recycling more than environmental identity alone. This study provides evidence of the importance of social norms and environmental structures in fostering pro-environmental behaviors and influencing the type of thinking that goes into making environmental decisions. Keywords: environmental identity, environmental behaviors, System 1, System 2, recycling.

Human Factors Influencing Decision Making

DTIC Science & Technology

1998-07-01

than General Grant. Van Fleet and Yukl 28 (1986): "A study of World War I veterans suggested that the presence of hunger , thirst, fatigue, ignorance of...Greenwood Press, New York, 1987, pp. 167-184. 27 Fishburne, F.J. " Neuropsychological applications in military settings." In Reuven Gal and A. David...suggested that the presence of hunger , thirst, fatigue, ignorance of plans and idleness increases the danger from fear. The most important factors in

The influence of a bystander agent's beliefs on children's and adults' decision-making process.

PubMed

Buttelmann, Frances; Buttelmann, David

2017-01-01

The ability to attribute and represent others' mental states (e.g., beliefs; so-called "theory of mind") is essential for participation in human social interaction. Despite a considerable body of research using tasks in which protagonists in the participants' attentional focus held false or true beliefs, the question of automatic belief attribution to bystander agents has received little attention. In the current study, we presented adults and 6-year-olds (N=92) with an implicit computer-based avoidance false-belief task in which participants were asked to place an object into one of three boxes. While doing so, we manipulated the beliefs of an irrelevant human-like or non-human-like bystander agent who was visible on the screen. Importantly, the bystander agent's beliefs were irrelevant for solving the task. Still, children's decision making was significantly influenced by the bystander agent's beliefs even if this was a non-human-like self-propelled object. Such an influence did not become obvious in adults' deliberate decisions but occurred only in their reaction times, which suggests that they also processed the bystander agent's beliefs but were able to suppress the influence of such beliefs on their behavior regulation. The results of a control study (N=53) ruled out low-level explanations and confirmed that self-propelledness of agents is a necessary factor for belief attribution to occur. Thus, not only do humans spontaneously ascribe beliefs to self-propelled bystander agents, but those beliefs even influence meaningful decisions in children. Copyright © 2016 Elsevier Inc. All rights reserved.

Factors that impact on emergency nurses' ethical decision-making ability.

PubMed

Alba, Barbara

2016-11-10

Reliance on moral principles and professional codes has given nurses direction for ethical decision-making. However, rational models do not capture the emotion and reality of human choice. Intuitive response must be considered. Supporting intuition as an important ethical decision-making tool for nurses, the aim of this study was to determine relationships between intuition, years of worked nursing experience, and perceived ethical decision-making ability. A secondary aim explored the relationships between rational thought to years of worked nursing experience and perceived ethical decision-making ability. A non-experimental, correlational research design was used. The Rational Experiential Inventory measured intuition and rational thought. The Clinical Decision Making in Nursing Scale measured perceived ethical decision-making ability. Pearson's r was the statistical method used to analyze three primary and two secondary research questions. A sample of 182 emergency nurses was recruited electronically through the Emergency Nurses Association. Participants were self-selected. Approval to conduct this study was obtained by the Adelphi University Institutional Review Board. A relationship between intuition and perceived ethical decision-making ability (r = .252, p = .001) was a significant finding in this study. This study is one of the first of this nature to make a connection between intuition and nurses' ethical decision-making ability. This investigation contributes to a broader understanding of the different thought processes used by emergency nurses to make ethical decisions. © The Author(s) 2016.

Field and Experience Influences on Ethical Decision-Making in the Sciences

PubMed Central

Mumford, Michael D.; Connelly, Shane; Murphy, Stephen T.; Devenport, Lynn D.; Antes, Alison L.; Brown, Ryan P.; Hill, Jason H.; Waples, Ethan P.

2009-01-01

Differences across fields and experience levels are frequently considered in discussions of ethical decision-making and ethical behavior. In the present study, doctoral students in the health, biological, and social sciences completed measures of ethical decision-making. The effects of field and level of experience with respect to ethical decision-making, metacognitive reasoning strategies, social-behavioral responses, and exposure to unethical events were examined. Social and biological scientists performed better than health scientists with respect to ethical decision-making. Furthermore, the ethical decision-making of health science students decreased as experience increased. Moreover, these effects appeared to be linked to the specific strategies underlying participants' ethical decision-making. The implications of these findings for ethical decision-making are discussed. PMID:19750129

The Role of Psychological and Physiological Factors in Decision Making under Risk and in a Dilemma

PubMed Central

Fooken, Jonas; Schaffner, Markus

2016-01-01

Different methods to elicit risk attitudes of individuals often provide differing results despite a common theory. Reasons for such inconsistencies may be the different influence of underlying factors in risk-taking decisions. In order to evaluate this conjecture, a better understanding of underlying factors across methods and decision contexts is desirable. In this paper we study the difference in result of two different risk elicitation methods by linking estimates of risk attitudes to gender, age, and personality traits, which have been shown to be related. We also investigate the role of these factors during decision-making in a dilemma situation. For these two decision contexts we also investigate the decision-maker's physiological state during the decision, measured by heart rate variability (HRV), which we use as an indicator of emotional involvement. We found that the two elicitation methods provide different individual risk attitude measures which is partly reflected in a different gender effect between the methods. Personality traits explain only relatively little in terms of driving risk attitudes and the difference between methods. We also found that risk taking and the physiological state are related for one of the methods, suggesting that more emotionally involved individuals are more risk averse in the experiment. Finally, we found evidence that personality traits are connected to whether individuals made a decision in the dilemma situation, but risk attitudes and the physiological state were not indicative for the ability to decide in this decision context. PMID:26834591

Variation in clinical decision-making for induction of labour: a qualitative study.

PubMed

Nippita, Tanya A; Porter, Maree; Seeho, Sean K; Morris, Jonathan M; Roberts, Christine L

2017-09-22

Unexplained variation in induction of labour (IOL) rates exist between hospitals, even after accounting for casemix and hospital differences. We aimed to explore factors that influence clinical decision-making for IOL that may be contributing to the variation in IOL rates between hospitals. We undertook a qualitative study involving semi-structured, audio-recorded interviews with obstetricians and midwives. Using purposive sampling, participants known to have diverse opinions on IOL were selected from ten Australian maternity hospitals (based on differences in hospital IOL rate, size, location and case-mix complexities). Transcripts were indexed, coded, and analysed using the Framework Approach to identify main themes and subthemes. Forty-five participants were interviewed (21 midwives, 24 obstetric medical staff). Variations in decision-making for IOL were based on the obstetrician's perception of medical risk in the pregnancy (influenced by the obstetrician's personality and knowledge), their care relationship with the woman, how they involved the woman in decision-making, and resource availability. The role of a 'gatekeeper' in the procedural aspects of arranging an IOL also influenced decision-making. There was wide variation in the clinical decision-making practices of obstetricians and less accountability for decision-making in hospitals with a high IOL rate, with the converse occurring in hospitals with low IOL rates. Improved communication, standardised risk assessment and accountability for IOL offer potential for reducing variation in hospital IOL rates.

22 CFR 1508.860 - What factors may influence the debarring official's decision?

Code of Federal Regulations, 2010 CFR

2010-04-01

... not necessarily determinative of your present responsibility. In making a debarment decision, the... official's decision? 1508.860 Section 1508.860 Foreign Relations AFRICAN DEVELOPMENT FOUNDATION... debarring official's decision? This section lists the mitigating and aggravating factors that the debarring...

Decision making: the neuroethological turn

PubMed Central

Pearson, John M.; Watson, Karli K.; Platt, Michael L.

2014-01-01

Neuroeconomics applies models from economics and psychology to inform neurobiological studies of choice. This approach has revealed neural signatures of concepts like value, risk, and ambiguity, which are known to influence decision-making. Such observations have led theorists to hypothesize a single, unified decision process that mediates choice behavior via a common neural currency for outcomes like food, money, or social praise. In parallel, recent neuroethological studies of decision-making have focused on natural behaviors like foraging, mate choice, and social interactions. These decisions strongly impact evolutionary fitness and thus are likely to have played a key role in shaping the neural circuits that mediate decision-making. This approach has revealed a suite of computational motifs that appear to be shared across a wide variety of organisms. We argue that the existence of deep homologies in the neural circuits mediating choice may have profound implications for understanding human decision-making in health and disease. PMID:24908481

Manipulating memory efficacy affects the behavioral and neural profiles of deterministic learning and decision-making.

PubMed

Tremel, Joshua J; Ortiz, Daniella M; Fiez, Julie A

2018-06-01

When making a decision, we have to identify, collect, and evaluate relevant bits of information to ensure an optimal outcome. How we approach a given choice can be influenced by prior experience. Contextual factors and structural elements of these past decisions can cause a shift in how information is encoded and can in turn influence later decision-making. In this two-experiment study, we sought to manipulate declarative memory efficacy and decision-making in a concurrent discrimination learning task by altering the amount of information to be learned. Subjects learned correct responses to pairs of items across several repetitions of a 50- or 100-pair set and were tested for memory retention. In one experiment, this memory test interrupted learning after an initial encoding experience in order to test for early encoding differences and associate those differences with changes in decision-making. In a second experiment, we used fMRI to probe neural differences between the two list-length groups related to decision-making across learning and assessed subsequent memory retention. We found that a striatum-based system was associated with decision-making patterns when learning a longer list of items, while a medial cortical network was associated with patterns when learning a shorter list. Additionally, the hippocampus was exclusively active for the shorter list group. Altogether, these behavioral, computational, and imaging results provide evidence that multiple types of mnemonic representations contribute to experienced-based decision-making. Moreover, contextual and structural factors of the task and of prior decisions can influence what types of evidence are drawn upon during decision-making. Copyright © 2018 Elsevier Ltd. All rights reserved.

A systematic review of factors influencing older adults' decision to accept or decline cancer treatment.

PubMed

Puts, Martine T E; Tapscott, Brianne; Fitch, Margaret; Howell, Doris; Monette, Johanne; Wan-Chow-Wah, Doreen; Krzyzanowska, Monika; Leighl, Nathasha B; Springall, Elena; Alibhai, Shabbir M

2015-02-01

Cancer is a disease that affects mostly older adults. Older adults often have other chronic health conditions in addition to cancer and may have different health priorities, both of which can impact cancer treatment decision-making. However, no systematic review of factors that influence an older cancer patient's decision to accept or decline cancer treatment has been conducted. Systematic review of the literature published between inception of the databases and February 2013. Dutch, English, French or German articles reporting on qualitative studies, cross-sectional, longitudinal observational or intervention studies describing factors why older adults accepted or declined cancer treatment examining actual treatment decisions were included. Ten databases were used. Two independent reviewers reviewed manuscripts and performed data abstraction using a standardized form and the quality of studies was assessed with the Mixed Methods Appraisal Tool. Of 17,343 abstracts reviewed, a total of 38 studies were included. The majority focused on breast and prostate cancer treatment decisions and most studies used a qualitative design. Important factors for accepting treatment were convenience and success rate of treatment, seeing necessity of treatment, trust in the physician and following the physician's recommendation. Factors important for declining cancer treatment included concerns about the discomfort of the treatments, fear of side effects and transportation difficulties. Although the reasons why older adults with cancer accepted or declined treatment varied considerably, the most consistent determinant was physician recommendation. Further studies using large, representative samples and exploring decision-making incorporating health literacy and comorbidity are needed. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Factors influencing teacher decisions on school, classroom, and curriculum

NASA Astrophysics Data System (ADS)

Crocker, Robert K.; Banfield, Helen

This article describes a study designed to explore sources of influence on the judgments made by science teachers on school characteristics, classroom features, and properties of a science curriculum. The study had its theoretical basis in the concept that members of a social organization operate under certain functional paradigms, which govern their approach to events within the organization, and particularly to the implementation of innovations. Empirically, the study formed part of the Canadian contribution to the Second International Science Study, and was based on a survey of some 2000 Canadian teachers. The survey used an adaptation of policy capturing methodology, in which teachers were presented with variations in a hypothetical scenario designed to simulate a decision-making situation. Results suggest that teachers' judgments center around a number of factors, the primary ones being concern for student ability and interest, teaching methods, and school spirit and morale. On the other hand, variations in the scientific basis of a curriculum appear to exert little influence. The results are interpreted as indicators of the major elements of teacher functional paradigms.

22 CFR 208.860 - What factors may influence the debarring official's decision?

Code of Federal Regulations, 2010 CFR

2010-04-01

... not necessarily determinative of your present responsibility. In making a debarment decision, the... official's decision? 208.860 Section 208.860 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT... debarring official's decision? This section lists the mitigating and aggravating factors that the debarring...

22 CFR 1006.860 - What factors may influence the debarring official's decision?

Code of Federal Regulations, 2010 CFR

2010-04-01

... not necessarily determinative of your present responsibility. In making a debarment decision, the... official's decision? 1006.860 Section 1006.860 Foreign Relations INTER-AMERICAN FOUNDATION GOVERNMENTWIDE... official's decision? This section lists the mitigating and aggravating factors that the debarring official...

Shared decision-making and patient autonomy.

PubMed

Sandman, Lars; Munthe, Christian

2009-01-01

In patient-centred care, shared decision-making is advocated as the preferred form of medical decision-making. Shared decision-making is supported with reference to patient autonomy without abandoning the patient or giving up the possibility of influencing how the patient is benefited. It is, however, not transparent how shared decision-making is related to autonomy and, in effect, what support autonomy can give shared decision-making. In the article, different forms of shared decision-making are analysed in relation to five different aspects of autonomy: (1) self-realisation; (2) preference satisfaction; (3) self-direction; (4) binary autonomy of the person; (5) gradual autonomy of the person. It is argued that both individually and jointly these aspects will support the models called shared rational deliberative patient choice and joint decision as the preferred versions from an autonomy perspective. Acknowledging that both of these models may fail, the professionally driven best interest compromise model is held out as a satisfactory second-best choice.

Pharmacists’ Perceptions of the Influence of Interactions with the Pharmaceutical Industry on Clinical Decision-Making

PubMed Central

Tejani, Aaron M; Loewen, Peter; Bachand, Richard; Harder, Curtis K

2015-01-01

Background: There is a paucity of literature examining the perceptions of Canadian pharmacists toward drug promotion by the pharmaceutical industry and pharmacist–industry interactions. Objectives: To determine whether hospital pharmacists perceive their interactions with the pharmaceutical industry as influencing their clinical decision-making or that of their colleagues and whether hospital pharmacists perceive that interactions with the pharmaceutical industry create a conflict of interest. Methods: A cross-sectional survey of the complete sample of hospital pharmacists practising in 3 large health authorities in a single Canadian province was conducted from February to April 2010. Results: A total of 224 responses were received from the approximately 480 pharmacists in the target health authorities (response rate approximately 47%). Fifty-eight percent of respondents (127/218) did not believe that information received at industry-sponsored events influenced their clinical decision-making. Most (142/163 [87%]) disagreed that small gifts influenced their clinical decision-making, whereas responses were divided for large gifts. Respondents were also divided on the issue of whether their interactions created conflicts of interest, with most of those who had received gifts agreeing that large gifts would create a conflict of interest (134/163 [82%]) whereas small gifts would not (100/163 [61%]). There were positive correlations between respondents’ beliefs about their own susceptibility to influence from sponsored events or receipt of small or large gifts and the susceptibility of others, but 22% of respondents (28/127) expressed a different perception about sponsored events, all believing themselves to be less influenced than their colleagues. Only 6% (4/64) of those who received large gifts and 4% (5/142) of those who received small gifts and felt they were not influenced by these gifts reported that it was likely others would be influenced by the receipt of

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

Emotion and decision making.

PubMed

Lerner, Jennifer S; Li, Ye; Valdesolo, Piercarlo; Kassam, Karim S

2015-01-03

A revolution in the science of emotion has emerged in recent decades, with the potential to create a paradigm shift in decision theories. The research reveals that emotions constitute potent, pervasive, predictable, sometimes harmful and sometimes beneficial drivers of decision making. Across different domains, important regularities appear in the mechanisms through which emotions influence judgments and choices. We organize and analyze what has been learned from the past 35 years of work on emotion and decision making. In so doing, we propose the emotion-imbued choice model, which accounts for inputs from traditional rational choice theory and from newer emotion research, synthesizing scientific models.

The influence of providing a clinical practice guideline on dental students' decision making.

PubMed

van der Sanden, Wil J M; Mettes, Dirk G; Plasschaert, Alphons J M; Mulder, Jan; Verdonschot, Emiel H

2004-02-01

The aim of this study was to assess the effect of the provision of a clinical practice guideline (CPG) on dental students' decisions to remove asymptomatic, impacted lower third molars. All dental students, who in 2001 were in the 3rd, 4th or 5th (final) year of their study at the Nijmegen College of Dental Sciences, were invited to participate. A pre-test-post-test control group design was used. Given 36 patient cases, all dental students were asked to assess the need for removal of asymptomatic, impacted lower third molars. All pre-test respondents were randomly allocated to the control or intervention group. After the provision of a CPG to the intervention group, both groups were asked to assess the same cases again. Frequencies of decisions to remove the third molars were calculated. Chi-square tests and anova were used to test the influence of study year and gender on the drop-out rate and on the effect of the provision of a CPG on students' treatment decisions. The decrease in indications to remove third molars by the intervention group was statistically significant (P < 0.05). In the control group, no significant decrease was observed. It was concluded that the provision of a CPG significantly influences dental students' decision making about treatment in a third-molar decision task. Students who used the CPG showed more guideline-conformed decision 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.

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

PubMed

Wiederkehr, S; Barat, M; Dehail, P; de Sèze, M; Lozes-Boudillon, S; Giroire, J-M

2005-02-01

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

The Adoption Alternative for Pregnant Adolescents: Decision Making, Consequences, and Policy Implications.

ERIC Educational Resources Information Center

Sobol, Michael P.; Daly, Kerry J.

1992-01-01

Reviews issues surrounding adoption as an option for resolving teen crisis pregnancies. Examines the decision-making processes and social psychological consequences of adoption as a distinct phenomenon, including adoption rates and characteristics, factors influencing the adoption decision, birth mother response to adoption placement, and social…

Autonomy, evidence and intuition: nurses and decision-making.

PubMed

Traynor, Michael; Boland, Maggie; Buus, Niels

2010-07-01

This paper is a report of a study conducted to examine how nurses represent professional clinical decision-making processes, and to determine what light Jamous and Peloille's 'Indeterminacy/Technicality ratio' concept can shed on these representations. Classic definitions of professional work feature autonomy of decision-making and control over the field of work. Sociologists Jamous and Peloille have described professional work as being high in 'indeterminacy' (the use of tacit judgements) relative to technicality (activity able to be codified). The rise of the evidence-based practice movement has been seen as increasing the realm of technical decision-making in healthcare, and it is relevant to analyse nurses' professional discourse and study how they respond to this increase. Three focus groups with qualified nurses attending post-qualifying courses at a London university were held in 2008. Participants were asked to talk about influences on their decision-making. The discussions were tape-recorded, transcribed and subjected to discourse analysis. Participants described their decision-making as influenced by both indeterminate and technical features. They acknowledged useful influences from both domains, but pointed to their personal 'experience' as the final arbiter of decision-making. Their accounts of decision-making created a sense of professional autonomy while at the same time protecting it against external critique. Pre- and post-registration nurse education could encourage robust discussion of the definition and roles of 'irrational' aspects of decision-making and how these might be understood as components of credible professional practice.

An examination of the principles of influence on condom use decision making during casual sex encounters.

PubMed

Rinaldi-Miles, Anna; Quick, Brian L; LaVoie, Nicole R

2014-01-01

Cialdini's (1984) principles of influence were employed to inform the decision-making process with respect to using condoms during casual sex. In the current study, focus groups (n = 9) were conducted to understand the relationship between the six principles of influence (authority, consistency, liking, reciprocity, scarcity, and social proof) and condom use in casual sex relationships. Results revealed that authority, consistency, and social proof were endorsed often as influencing condom use. Gender differences in the endorsement of the principles were also observed. The results speak to how these principles of influence aide the condom decision-making process during these often spontaneous sexual encounters and are discussed with an emphasis on the theoretical and practical implications for using these principles in future health campaigns.

When Family Considerations Influence Work Decisions: Decision-Making Processes

ERIC Educational Resources Information Center

Powell, Gary N.; Greenhaus, Jeffrey H.

2012-01-01

The work-family literature has provided an abundance of evidence that various family factors are linked to various work decisions, suggesting that the "family-relatedness" of work decisions is a prevalent phenomenon (Greenhaus & Powell, 2012). However, the cognitive processes by which such linkages occur have received little attention. We offer a…

2 CFR 180.860 - What factors may influence the debarring official's decision?