Trait Anxiety Has Effect on Decision Making under Ambiguity but Not Decision Making under Risk

PubMed Central

Zhang, Long; Wang, Kai; Zhu, Chunyan; Yu, Fengqiong; Chen, Xingui

2015-01-01

Previous studies have reported that trait anxiety (TA) affects decision making. However, results remain largely inconsistent across studies. The aim of the current study was to further address the interaction between TA and decision making. 304 subjects without depression from a sample consisting of 642 participants were grouped into high TA (HTA), medium TA (MTA) and low TA (LTA) groups based on their TA scores from State Trait Anxiety Inventory. All subjects were assessed with the Iowa Gambling Task (IGT) that measures decision making under ambiguity and the Game of Dice Task (GDT) that measures decision making under risk. While the HTA and LTA groups performed worse on the IGT compared to the MTA group, performances on the GDT between the three groups did not differ. Furthermore, the LTA and HTA groups showed different individual deck level preferences in the IGT: the former showed a preference for deck B indicating that these subjects focused more on the magnitude of rewards, and the latter showed a preference for deck A indicating significant decision making impairment. Our findings suggest that trait anxiety has effect on decision making under ambiguity but not decision making under risk and different levels of trait anxiety related differently to individual deck level preferences in the IGT. PMID:26000629

Consumer and relationship factors associated with shared decision making in mental health consultations.

PubMed

Matthias, Marianne S; Fukui, Sadaaki; Kukla, Marina; Eliacin, Johanne; Bonfils, Kelsey A; Firmin, Ruth L; Oles, Sylwia K; Adams, Erin L; Collins, Linda A; Salyers, Michelle P

2014-12-01

This study explored the association between shared decision making and consumers' illness management skills and consumer-provider relationships. Medication management appointments for 79 consumers were audio recorded. Independent coders rated overall shared decision making, minimum level of shared decision making, and consumer-provider agreement for 63 clients whose visit included a treatment decision. Mental health diagnoses, medication adherence, patient activation, illness management, working alliance, and length of consumer-provider relationships were also assessed. Correlation analyses were used to determine relationships among measures. Overall shared decision making was not associated with any variables. Minimum levels of shared decision making were associated with higher scores on the bond subscale of the Working Alliance Inventory, indicating a higher degree of liking and trust, and with better medication adherence. Agreement was associated with shorter consumer-provider relationships. Consumer-provider relationships and shared decision making might have a more nuanced association than originally thought.

The Hidden Dimension of Strategic Planning: Explorations in the Formation of Perspectives

DTIC Science & Technology

1991-09-01

13 2. Laws--Or Points Of Reference?.........18 B. THE HORIZONTAL LEVEL OF DECISION - MAKING . . . . 23 1. KNOWLEDGE, RATIONALITY , AND... decision - making is a horizontal level ranging from logic and rationalism to subjective emotionalism. This is the dimension of decision - making with which...the process of decision - making . The basis of game theory is the dual premises of rationality and maximization of utility.6 "It [game theory] is

Composite collective decision-making.

PubMed

Czaczkes, Tomer J; Czaczkes, Benjamin; Iglhaut, Carolin; Heinze, Jürgen

2015-06-22

Individual animals are adept at making decisions and have cognitive abilities, such as memory, which allow them to hone their decisions. Social animals can also share information. This allows social animals to make adaptive group-level decisions. Both individual and collective decision-making systems also have drawbacks and limitations, and while both are well studied, the interaction between them is still poorly understood. Here, we study how individual and collective decision-making interact during ant foraging. We first gathered empirical data on memory-based foraging persistence in the ant Lasius niger. We used these data to create an agent-based model where ants may use social information (trail pheromones), private information (memories) or both to make foraging decisions. The combined use of social and private information by individuals results in greater efficiency at the group level than when either information source was used alone. The modelled ants couple consensus decision-making, allowing them to quickly exploit high-quality food sources, and combined decision-making, allowing different individuals to specialize in exploiting different resource patches. Such a composite collective decision-making system reaps the benefits of both its constituent parts. Exploiting such insights into composite collective decision-making may lead to improved decision-making algorithms. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

Priming and Organizational Level Effects on Ethical Decision Making.

ERIC Educational Resources Information Center

Lautenschlager, Gary; Morris, Debbie

The study of ethical decision making has gained considerable interest among organizational scientists due to the widespread occurrence of wrongdoing in business, industry, government and various other institutions. This study examined the effects of priming and organizational level manipulation on an individual's ethical decision-making behavior.…

Modelling elderly cardiac patients decision making using Cognitive Work Analysis: identifying requirements for patient decision aids.

PubMed

Dhukaram, Anandhi Vivekanandan; Baber, Chris

2015-06-01

Patients make various healthcare decisions on a daily basis. Such day-to-day decision making can have significant consequences on their own health, treatment, care, and costs. While decision aids (DAs) provide effective support in enhancing patient's decision making, to date there have been few studies examining patient's decision making process or exploring how the understanding of such decision processes can aid in extracting requirements for the design of DAs. This paper applies Cognitive Work Analysis (CWA) to analyse patient's decision making in order to inform requirements for supporting self-care decision making. This study uses focus groups to elicit information from elderly cardiovascular disease (CVD) patients concerning a range of decision situations they face on a daily basis. Specifically, the focus groups addressed issues related to the decision making of CVD in terms of medication compliance, pain, diet and exercise. The results of these focus groups are used to develop high level views using CWA. CWA framework decomposes the complex decision making problem to inform three approaches to DA design: one design based on high level requirements; one based on a normative model of decision-making for patients; and the third based on a range of heuristics that patients seem to use. CWA helps in extracting and synthesising decision making from different perspectives: decision processes, work organisation, patient competencies and strategies used in decision making. As decision making can be influenced by human behaviour like skills, rules and knowledge, it is argued that patients require support to different types of decision making. This paper also provides insights for designers in using CWA framework for the design of effective DAs to support patients in self-management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Incentives for Optimal Multi-level Allocation of HIV Prevention Resources

PubMed Central

Malvankar, Monali M.; Zaric, Gregory S.

2013-01-01

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

A preliminary evaluation of trust and shared decision making among intensive care patients' family members.

PubMed

Epstein, Elizabeth G; Wolfe, Katherine

2016-11-01

The purpose of this study was to preliminarily evaluate ICU family members' trust and shared decision making using modified versions of the Wake Forest Trust Survey and the Shared Decision Making-9 Survey. Using a descriptive approach, the perceptions of family members of ICU patients (n=69) of trust and shared decision making were measured using the Wake Forest Trust Survey and the 9-item Shared Decision Making (SDM-9) Questionnaire. Both surveys were modified slightly to apply to family members of ICU patients and to include perceptions of nurses as well as physicians. Overall, family members reported high levels of trust and inclusion in decision making. Family members who lived with the patient had higher levels of trust than those who did not. Family members who reported strong agreement among other family about treatment decisions had higher levels of trust and higher SDM-9 scores than those who reported less family agreement. The modified surveys may be useful in evaluating family members' trust and shared decision making in ICU settings. Future studies should include development of a comprehensive patient-centered care framework that focuses on its central goal of maintaining provider-patient/family partnerships as an avenue toward effective shared decision making. Copyright © 2016 Elsevier Inc. All rights reserved.

Development of a Model of Interprofessional Shared Clinical Decision Making in the ICU: A Mixed-Methods Study.

PubMed

DeKeyser Ganz, Freda; Engelberg, Ruth; Torres, Nicole; Curtis, Jared Randall

2016-04-01

To develop a model to describe ICU interprofessional shared clinical decision making and the factors associated with its implementation. Ethnographic (observations and interviews) and survey designs. Three ICUs (two in Israel and one in the United States). A convenience sample of nurses and physicians. None. Observations and interviews were analyzed using ethnographic and grounded theory methodologies. Questionnaires included a demographic information sheet and the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration. From observations and interviews, we developed a conceptual model of the process of shared clinical decision making that involves four stepped levels, proceeding from the lowest to the highest levels of collaboration: individual decision, information exchange, deliberation, and shared decision. This process is influenced by individual, dyadic, and system factors. Most decisions were made at the lower two levels. Levels of perceived collaboration were moderate with no statistically significant differences between physicians and nurses or between units. Both qualitative and quantitative data corroborated that physicians and nurses from all units were similarly and moderately satisfied with their level of collaboration and shared decision making. However, most ICU clinical decision making continues to take place independently, where there is some sharing of information but rarely are decisions made collectively. System factors, such as interdisciplinary rounds and unit culture, seem to have a strong impact on this process. This study provides a model for further study and improvement of interprofessional shared decision making.

Cognitive level and health decision-making in children: A preliminary study.

PubMed

Okwumabua, J O; Okwumabua, T M; Hayes, A; Stovall, K

1994-06-01

The study examines children's stage of cognitive development in relation to their patterns of health decision-making, including their cognitive capabilities in integrating the sequential stages of the decision-making process. A sample of 81 male (N=33) and female (N=48) students were drawn from two urban public schools in West Tennessee. All participants in the study were of African-American descent. The Centers for Disease Control Decision-Making Instrument was used to assess students' decision-making as well as their understanding of the decision-making process. The children's cognitive level was determined by their performance on three Piagetian conservation tasks. Findings revealed that both the preoperational and concrete operational children performed significantly below the formal operational children in terms of total correct responses to the decision-making scenarios. Error type analyses indicated that the preoperational children made more errors involving "skipped step" than did either the concrete or formal operational children. There were no significant differences between children's level of cognitive development and any other error type. Implications for health promotion and disease prevention programs among prevention practitioners who work regularly with children are discussed.

Exploring Effective Decision Making through Human-Centered and Computational Intelligence Methods

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

Han, Kyungsik; Cook, Kristin A.; Shih, Patrick C.

Decision-making has long been studied to understand a psychological, cognitive, and social process of selecting an effective choice from alternative options. Its studies have been extended from a personal level to a group and collaborative level, and many computer-aided decision-making systems have been developed to help people make right decisions. There has been significant research growth in computational aspects of decision-making systems, yet comparatively little effort has existed in identifying and articulating user needs and requirements in assessing system outputs and the extent to which human judgments could be utilized for making accurate and reliable decisions. Our research focus ismore » decision-making through human-centered and computational intelligence methods in a collaborative environment, and the objectives of this position paper are to bring our research ideas to the workshop, and share and discuss ideas.« less

Acute psychosocial stress and everyday moral decision-making in young healthy men: The impact of cortisol.

PubMed

Singer, Nina; Sommer, Monika; Döhnel, Katrin; Zänkert, Sandra; Wüst, Stefan; Kudielka, Brigitte M

2017-07-01

In everyday life, moral decisions must frequently be made under acute stress. Although there is increasing evidence that both stress and cortisol affect moral judgment and behavior as well as decision-making in various domains unrelated to morality, surprisingly few attempts have been made to explore the effects of stress on everyday moral decision-making. Therefore, in the present study, we exposed 50 young healthy men to the Trier Social Stress Test (TSST) or its non-stressful placebo version (PTSST). We investigated the impact of acute stress exposure and stress-related cortisol levels on decision-making, decision certainty, and emotions in 28 everyday moral conflict situations with altruistic versus egoistic response alternatives. Results showed that the TSST-exposed group made more altruistic decisions than the non-stress control group, while groups did not differ in decision certainty and emotion ratings. Moreover, in correlational as well as regression analyses, additionally controlling for confounding variables, we observed significant positive associations between cortisol levels and altruistic decision-making. Further analyses revealed that altruistic decisions came along with significantly higher decision certainty and significantly more positive emotion ratings than egoistic decisions. Notably, our data also raise the idea that the personality trait agreeableness plays an important role in everyday moral decision-making. In sum, our findings provide initial evidence that both acute stress exposure and cortisol levels have prosocial effects on everyday moral decision-making in young healthy men. Copyright © 2017 Elsevier Inc. All rights reserved.

"If It Feels Right, Do It": Intuitive Decision Making in a Sample of High-Level Sport Coaches.

PubMed

Collins, Dave; Collins, Loel; Carson, Howie J

2016-01-01

Comprehensive understanding and application of decision making is important for the professional practice and status of sports coaches. Accordingly, building on a strong work base exploring the use of professional judgment and decision making (PJDM) in sport, we report a preliminary investigation into uses of intuition by high-level coaches. Two contrasting groups of high-level coaches from adventure sports (n = 10) and rugby union (n = 8), were interviewed on their experiences of using intuitive and deliberative decision making styles, the source of these skills, and the interaction between the two. Participants reported similarly high levels of usage to other professions. Interaction between the two styles was apparent to varying degrees, while the role of experience was seen as an important precursor to greater intuitive practice and employment. Initially intuitive then deliberate decision making was a particular feature, offering participants an immediate check on the accuracy and validity of the decision. Integration of these data with the extant literature and implications for practice are discussed.

When parsimony is not enough: Considering dual processes and dual levels of influence in sexual decision making

PubMed Central

Rendina, H. Jonathon

2015-01-01

The literature on sexual decision making that has been used to understand behaviors relevant to HIV and STI risk has relied primarily on cognitive antecedents of behavior. In contrast, several prominent models of decision making outside of the sexual behavior literature rely on dual process models, in which both affective and cognitive processing are considered important precursors to behavior. Moreover, much of the literature on sexual behavior utilizes individual-level traits and characteristics to predict aggregated sexual behavior, despite decision making itself being a situational or event-level process. This paper proposes a framework for understanding sexual decision making as the result of dual processes (affective and cognitive) operating at dual level of influence (individual and situational). Finally, the paper ends with a discussion of the conceptual and methodological benefits and challenges to its use and future directions for research. PMID:26168978

The Concept of Strategic Decisionmaking.

ERIC Educational Resources Information Center

Collier, Douglas J.

Strategic decision-making literature is reviewed, and applications to colleges and universities are made. The key requirement for strategic decision-making is that decisions affect the entire organization. While strategic decision-making can occur at different levels within the organization, the specific strategic decisions available to the…

Principals' Perceptions of Community and Staff Involvement in Shared Decision Making.

ERIC Educational Resources Information Center

Brown, David W.; And Others

1996-01-01

Survey of 217 Maine principals revealed that respondents perceived their staff as moderately to highly involved in decision making, viewed the community as informed but not actively involved in decision making, and desired greater involvement from staff and parents. Principal gender and school level did not affect desired levels of involvement.…

Registered nurses' decision-making regarding documentation in patients' progress notes.

PubMed

Tower, Marion; Chaboyer, Wendy; Green, Quentine; Dyer, Kirsten; Wallis, Marianne

2012-10-01

To examine registered nurses' decision-making when documenting care in patients' progress notes. What constitutes effective nursing documentation is supported by available guidelines. However, ineffective documentation continues to be cited as a major cause of adverse events for patients. Decision-making in clinical practice is a complex process. To make an effective decision, the decision-maker must be situationally aware. The concept of situation awareness and its implications for making safe decisions has been examined extensively in air safety and more recently is being applied to health. The study was situated in a naturalistic paradigm. Purposive sampling was used to recruit 17 registered nurses who used think-aloud research methods when making decisions about documenting information in patients' progress notes. Follow-up interviews were conducted to validate interpretations. Data were analysed systematically for evidence of cues that demonstrated situation awareness as nurses made decisions about documentation. Three distinct decision-making scenarios were illuminated from the analysis: the newly admitted patient, the patient whose condition was as expected and the discharging patient. Nurses used mental models for decision-making in documenting in progress notes, and the cues nurses used to direct their assessment of patients' needs demonstrated situation awareness at different levels. Nurses demonstrate situation awareness at different levels in their decision-making processes. While situation awareness is important, it is also important to use an appropriate decision-making framework. Cognitive continuum theory is suggested as a decision-making model that could support situation awareness when nurses made decisions about documenting patient care. Because nurses are key decision-makers, it is imperative that effective decisions are made that translate into safe clinical care. Including situation awareness training, combined with employing cognitive continuum theory as a decision-making framework, provides a powerful means of guiding nurses' decision-making. © 2012 Blackwell Publishing Ltd.

City-Level Energy Decision Making. Data Use in Energy Planning, Implementation, and Evaluation in U.S. Cities

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

Aznar, Alexandra; Day, Megan; Doris, Elizabeth

2015-07-08

The Cities-LEAP technical report, City-Level Energy Decision Making: Data Use in Energy Planning, Implementation, and Evaluation in U.S. Cities, explores how a sample of cities incorporates data into making energy-related decisions. This report provides the foundation for forthcoming components of the Cities-LEAP project that will help cities improve energy decision making by mapping specific city energy or climate policies and actions to measurable impacts and results.

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

PubMed

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

2018-05-31

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

Experts in offside decision making learn to compensate for their illusory perceptions.

PubMed

Put, Koen; Baldo M, V C; Cravo, André M; Wagemans, Johan; Helsen, Werner F

2013-12-01

In association football, the flash-lag effect appears to be a viable explanation for erroneous offside decision making. Due to this spatiotemporal illusion, assistant referees (ARs) perceive the player who receives the ball ahead of his real position. In this experiment, a laboratory decision-making task was used to demonstrate that international top-class ARs, compared with amateur soccer players, do not have superior perceptual sensitivity. They clearly modify their decision criterion according to the contextual needs and, therefore, show a higher response bias toward not responding to the stimulus, in particular in the most difficult situations. Thus, international ARs show evidence for response-level compensation, resulting in a specific cost (i.e., more misses), which clearly reflects the use of particular (cognitive) strategies. In summary, it appears that experts in offside decision making can be distinguished from novices more on the cognitive or decision-making level than on the perceptual level.

Decision-Making Competence, Social Orientation, Time Style, and Perceived Stress.

PubMed

Geisler, Martin; Allwood, Carl Martin

2018-01-01

Peoples' decision-making competence, defined as tendency to follow normative rational principles in their decision making, is important as it may influence the extent that requirements are met and levels of perceived stress. In addition, perceived stress could be influenced by social orientation and time style; for example, decisions need to comply with given deadlines and the expectations of others. In two studies, with students ( n = 118) and professionals (police investigators, n = 90), we examined how the three individual difference features: decision-making competence, social orientation, and time approach relate to perceived stress. Results showed that social orientation and time approach were related to levels of perceived stress, but decision-making competence was not. These results indicate that social orientation and time approach are important to consider in relation to perceived stress, but the role of decision-making competence may be less important for perceived stress. However, the role of decision-making competence for perceived stress needs to be further researched.

Decision-Making Competence, Social Orientation, Time Style, and Perceived Stress

PubMed Central

Geisler, Martin; Allwood, Carl Martin

2018-01-01

Peoples’ decision-making competence, defined as tendency to follow normative rational principles in their decision making, is important as it may influence the extent that requirements are met and levels of perceived stress. In addition, perceived stress could be influenced by social orientation and time style; for example, decisions need to comply with given deadlines and the expectations of others. In two studies, with students (n = 118) and professionals (police investigators, n = 90), we examined how the three individual difference features: decision-making competence, social orientation, and time approach relate to perceived stress. Results showed that social orientation and time approach were related to levels of perceived stress, but decision-making competence was not. These results indicate that social orientation and time approach are important to consider in relation to perceived stress, but the role of decision-making competence may be less important for perceived stress. However, the role of decision-making competence for perceived stress needs to be further researched. PMID:29686634

The Relationship between Ethical Decision Making and Ethical Reasoning in Information Technology Students

ERIC Educational Resources Information Center

Woodward, Belle; Davis, Diane C.; Hodis, Flaviu A.

2007-01-01

This study examined undergraduate information technology (IT) students' (N = 122) level of ethical reasoning and decision making at a Midwestern university. The purpose was to determine whether IT students' level of ethical reasoning provided information about the degree of their ethical decision making. The Defining Issues Test-2 (DIT-2) was used…

Supporting shared decision making beyond consumer-prescriber interactions: Initial development of the CommonGround fidelity scale

PubMed Central

Fukui, Sadaaki; Salyers, Michelle P.; Rapp, Charlie; Goscha, Rick; Young, Leslie; Mabry, Ally

2015-01-01

Shared decision-making has become a central tenet of recovery-oriented, person-centered mental health care, yet the practice is not always transferred to the routine psychiatric visit. Supporting the practice at the system level, beyond the interactions of consumers and medication prescribers, is needed for successful adoption of shared decision-making. CommonGround is a systemic approach, intended to be part of a larger integration of shared decision-making tools and practices at the system level. We discuss the organizational components that CommonGround uses to facilitate shared decision-making, and we present a fidelity scale to assess how well the system is being implemented. PMID:28090194

Energy-Water Nexus: Balancing the Tradeoffs between Two-Level Decision Makers

DOE PAGES

Zhang, Xiaodong; Vesselinov, Velimir Valentinov

2016-09-03

Energy-water nexus has substantially increased importance in the recent years. Synergistic approaches based on systems-analysis and mathematical models are critical for helping decision makers better understand the interrelationships and tradeoffs between energy and water. In energywater nexus management, various decision makers with different goals and preferences, which are often conflicting, are involved. These decision makers may have different controlling power over the management objectives and the decisions. They make decisions sequentially from the upper level to the lower level, challenging decision making in energy-water nexus. In order to address such planning issues, a bi-level decision model is developed, which improvesmore » upon the existing studies by integration of bi-level programming into energy-water nexus management. The developed model represents a methodological contribution to the challenge of sequential decisionmaking in energy-water nexus through provision of an integrated modeling framework/tool. An interactive fuzzy optimization methodology is introduced to seek a satisfactory solution to meet the overall satisfaction of the two-level decision makers. The tradeoffs between the two-level decision makers in energy-water nexus management are effectively addressed and quantified. Application of the proposed model to a synthetic example problem has demonstrated its applicability in practical energy-water nexus management. Optimal solutions for electricity generation, fuel supply, water supply including groundwater, surface water and recycled water, capacity expansion of the power plants, and GHG emission control are generated. In conclusion, these analyses are capable of helping decision makers or stakeholders adjust their tolerances to make informed decisions to achieve the overall satisfaction of energy-water nexus management where bi-level sequential decision making process is involved.« less

Energy-Water Nexus: Balancing the Tradeoffs between Two-Level Decision Makers

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

Zhang, Xiaodong; Vesselinov, Velimir Valentinov

Energy-water nexus has substantially increased importance in the recent years. Synergistic approaches based on systems-analysis and mathematical models are critical for helping decision makers better understand the interrelationships and tradeoffs between energy and water. In energywater nexus management, various decision makers with different goals and preferences, which are often conflicting, are involved. These decision makers may have different controlling power over the management objectives and the decisions. They make decisions sequentially from the upper level to the lower level, challenging decision making in energy-water nexus. In order to address such planning issues, a bi-level decision model is developed, which improvesmore » upon the existing studies by integration of bi-level programming into energy-water nexus management. The developed model represents a methodological contribution to the challenge of sequential decisionmaking in energy-water nexus through provision of an integrated modeling framework/tool. An interactive fuzzy optimization methodology is introduced to seek a satisfactory solution to meet the overall satisfaction of the two-level decision makers. The tradeoffs between the two-level decision makers in energy-water nexus management are effectively addressed and quantified. Application of the proposed model to a synthetic example problem has demonstrated its applicability in practical energy-water nexus management. Optimal solutions for electricity generation, fuel supply, water supply including groundwater, surface water and recycled water, capacity expansion of the power plants, and GHG emission control are generated. In conclusion, these analyses are capable of helping decision makers or stakeholders adjust their tolerances to make informed decisions to achieve the overall satisfaction of energy-water nexus management where bi-level sequential decision making process is involved.« less

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

PubMed

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

2017-04-01

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

Predicting explorative motor learning using decision-making and motor noise

PubMed Central

Galea, Joseph M.

2017-01-01

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

The Foci of In-Action Professional Judgement and Decision-Making in High-Level Adventure Sports Coaching Practice

ERIC Educational Resources Information Center

Collins, Loel; Collins, Dave

2017-01-01

This article continues a theme of previous investigations by the authors and examines the focus of in-action reflection as a component of professional judgement and decision-making (PJDM) processes in high-level adventure sports coaching. We utilised a thematic analysis approach to investigate the decision-making practices of a sample of…

Contrasting models of driver behaviour in emergencies using retrospective verbalisations and network analysis.

PubMed

Banks, Victoria A; Stanton, Neville A

2015-01-01

Automated assistance in driving emergencies aims to improve the safety of our roads by avoiding or mitigating the effects of accidents. However, the behavioural implications of such systems remain unknown. This paper introduces the driver decision-making in emergencies (DDMiEs) framework to investigate how the level and type of automation may affect driver decision-making and subsequent responses to critical braking events using network analysis to interrogate retrospective verbalisations. Four DDMiE models were constructed to represent different levels of automation within the driving task and its effects on driver decision-making. Findings suggest that whilst automation does not alter the decision-making pathway (e.g. the processes between hazard detection and response remain similar), it does appear to significantly weaken the links between information-processing nodes. This reflects an unintended yet emergent property within the task network that could mean that we may not be improving safety in the way we expect. This paper contrasts models of driver decision-making in emergencies at varying levels of automation using the Southampton University Driving Simulator. Network analysis of retrospective verbalisations indicates that increasing the level of automation in driving emergencies weakens the link between information-processing nodes essential for effective decision-making.

Anchor effects in decision making can be reduced by the interaction between goal monitoring and the level of the decision maker's executive functions.

PubMed

Schiebener, Johannes; Wegmann, Elisa; Pawlikowski, Mirko; Brand, Matthias

2012-11-01

Models of decision making postulate that interactions between contextual conditions and characteristics of the decision maker determine decision-making performance. We tested this assumption by using a possible positive contextual influence (goals) and a possible negative contextual influence (anchor) in a risky decision-making task (Game of Dice Task, GDT). In this task, making advantageous choices is well known to be closely related to a specific decision maker variable: the individual level of executive functions. One hundred subjects played the GDT in one of four conditions: with self-set goal for final balance (n = 25), with presentation of an anchor (a fictitious Top 10 list, showing high gains of other participants; n = 25), with anchor and goal definition (n = 25), and with neither anchor nor goal setting (n = 25). Subjects in the conditions with anchor made more risky decisions irrespective of the negative feedback, but this anchor effect was influenced by goal monitoring and moderated by the level of the subjects' executive functions. The findings imply that impacts of situational influences on decision making as they frequently occur in real life depend upon the individual's cognitive abilities. Anchor effects can be overcome by subjects with good cognitive abilities.

Situation awareness and documentation of changes that affect patient outcomes in progress notes.

PubMed

Tower, Marion; Chaboyer, Wendy

2014-05-01

To report on registered nurses' situation awareness as a precursor to decision-making when recording changes in patients' conditions. Progress notes are important to communicate patients' progress and detail changes in patients' conditions. However, documentation is often poorly completed. There is little work that examines nurses' decision-making during documentation. This study focused on describing situation awareness as a precursor to decision-making during documentation. This study used Endsley's (Situation Awareness Analysis and Measurement, 2000, Lawrence Erlbaum Associates, NJ) work on situation awareness to guide and conceptualise information. The study was situated in a naturalistic paradigm to provide an interpretation of nurses' decision-making. Think-aloud research methods and semi-structured interviews were employed to illuminate decision-making processes. Audio recordings and interview texts were individually examined for evidence of cues, informed by Endsley's (Situation Awareness Analysis and Measurement, 2000, Lawrence Erlbaum Associates, NJ) descriptions of situation awareness. As patients' conditions changed, nurses used complex mental models and pattern-matching of information, drawing on all 3 levels of situation awareness during documentation. Level 1 situation awareness provided context, level 2 situation awareness signified a change in condition and its significance for the patient, and level 3 situation awareness was evident when nurses thought aloud about what this information indicated. Three themes associated with changes in patients' conditions emerged: deterioration in condition, not responding to prescribed treatments as expected and issues related to professional practice that impacted on patients' conditions. Nurses used a complex mental model for decision-making, drawing on 3 levels of situation awareness. Hamm's cognitive continuum theory, when related to situation awareness, is a useful decision-making theory to provide a platform on which to draw together components of situation awareness and provide a framework on which to base decision-making regarding documentation. Understanding how RNs employ situation awareness and providing a framework for decision-making during documentation may assist effective documentation about changes in patients' conditions. © 2013 John Wiley & Sons Ltd.

Acute Exposure to Low-to-Moderate Carbon Dioxide Levels and Submariner Decision Making.

PubMed

Rodeheffer, Christopher D; Chabal, Sarah; Clarke, John M; Fothergill, David M

2018-06-01

Submarines routinely operate with higher levels of ambient carbon dioxide (CO2) (i.e., 2000 - 5000 ppm) than what is typically considered normal (i.e., 400 - 600 ppm). Although significant cognitive impairments are rarely reported at these elevated CO2 levels, recent studies using the Strategic Management Simulation (SMS) test have found impairments in decision-making performance during acute CO2 exposure at levels as low as 1000 ppm. This is a potential concern for submarine operations, as personnel regularly make mission-critical decisions that affect the safety and efficiency of the vessel and its crew while exposed to similar levels of CO2. The objective of this study was to determine if submariner decision-making performance is impacted by acute exposure to levels of CO2 routinely present in the submarine atmosphere during sea patrols. Using a subject-blinded balanced design, 36 submarine-qualified sailors were randomly assigned to receive 1 of 3 CO2 exposure conditions (600, 2500, or 15,000 ppm). After a 45-min atmospheric acclimation period, participants completed an 80-min computer-administered SMS test as a measure of decision making. There were no significant differences for any of the nine SMS measures of decision making between the CO2 exposure conditions. In contrast to recent research demonstrating cognitive deficits on the SMS test in students and professional-grade office workers, we were unable to replicate this effect in a submariner population-even with acute CO2 exposures more than an order of magnitude greater than those used in previous studies that demonstrated such effects.Rodeheffer CD, Chabal S, Clarke JM, Fothergill DM. Acute exposure to low-to-moderate carbon dioxide levels and submariner decision making. Aerosp Med Hum Perform. 2018; 89(6):520-525.

Measuring Shared Decision Making in Psychiatric Care

PubMed Central

Salyers, Michelle P.; Matthias, Marianne S.; Fukui, Sadaaki; Holter, Mark C.; Collins, Linda; Rose, Nichole; Thompson, John; Coffman, Melinda; Torrey, William C.

2014-01-01

Objective Shared decision making is widely recognized to facilitate effective health care; tools are needed to measure the level of shared decision making in psychiatric practice. Methods A coding scheme assessing shared decision making in medical settings (1) was adapted, including creation of a manual. Trained raters analyzed 170 audio recordings of psychiatric medication check-up visits. Results Inter-rater reliability among three raters for a subset of 20 recordings ranged from 67% to 100% agreement for the presence of each of nine elements of shared decision making and 100% for the overall agreement between provider and consumer. Just over half of the decisions met minimum criteria for shared decision making. Shared decision making was not related to length of visit after controlling for complexity of decision. Conclusions The shared decision making rating scale appears to reliably assess shared decision making in psychiatric practice and could be helpful for future research, training, and implementation efforts. PMID:22854725

An Integrated Decision-Making Model for Categorizing Weather Products and Decision Aids

NASA Technical Reports Server (NTRS)

Elgin, Peter D.; Thomas, Rickey P.

2004-01-01

The National Airspace System s capacity will experience considerable growth in the next few decades. Weather adversely affects safe air travel. The FAA and NASA are working to develop new technologies that display weather information to support situation awareness and optimize pilot decision-making in avoiding hazardous weather. Understanding situation awareness and naturalistic decision-making is an important step in achieving this goal. Information representation and situation time stress greatly influence attentional resource allocation and working memory capacity, potentially obstructing accurate situation awareness assessments. Three naturalistic decision-making theories were integrated to provide an understanding of the levels of decision making incorporated in three operational situations and two conditions. The task characteristics associated with each phase of flight govern the level of situation awareness attained and the decision making processes utilized. Weather product s attributes and situation task characteristics combine to classify weather products according to the decision-making processes best supported. In addition, a graphical interface is described that affords intuitive selection of the appropriate weather product relative to the pilot s current flight situation.

Integration of professional judgement and decision-making in high-level adventure sports coaching practice.

PubMed

Collins, Loel; Collins, Dave

2015-01-01

This study examined the integration of professional judgement and decision-making processes in adventure sports coaching. The study utilised a thematic analysis approach to investigate the decision-making practices of a sample of high-level adventure sports coaches over a series of sessions. Results revealed that, in order to make judgements and decisions in practice, expert coaches employ a range of practical and pedagogic management strategies to create and opportunistically use time for decision-making. These approaches include span of control and time management strategies to facilitate the decision-making process regarding risk management, venue selection, aims, objectives, session content, and differentiation of the coaching process. The implication for coaches, coach education, and accreditation is the recognition and training of the approaches that "create time" for the judgements in practice, namely "creating space to think". The paper concludes by offering a template for a more expertise-focused progression in adventure sports coaching.

Effects of Student Skill Level on Knowledge, Decision Making, Skill Execution and Game Performance in a Mini-Volleyball Sport Education Season

ERIC Educational Resources Information Center

Mahedero, Pilar; Calderón, Antonio; Arias-Estero, José Luis; Hastie, Peter A.; Guarino, Anthony J.

2015-01-01

The purpose of the paper was to examine the effects of student skill level on knowledge, decision making, skill execution and game performance in a mini-volleyball Sport Education season. Forty-eight secondary school students from two classes participated in a 12 lesson season. Knowledge, decision-making and skill execution (components of game…

Application of Construal Level and Value-Belief Norm Theories to Undergraduate Decision-Making on a Wildlife Socio-Scientific Issue

ERIC Educational Resources Information Center

Sutter, A. McKinzie; Dauer, Jenny M.; Forbes, Cory T.

2018-01-01

One aim of science education is to develop scientific literacy for decision-making in daily life. Socio-scientific issues (SSI) and structured decision-making frameworks can help students reach these objectives. This research uses value belief norm (VBN) theory and construal level theory (CLT) to explore students' use of personal values in their…

Gender differences in the association of depression with career indecisiveness, career-decision status, and career-preference crystallization.

PubMed

Gadassi, Reuma; Waser, Ayelet; Gati, Itamar

2015-10-01

Depression has detrimental effects on broad areas of functioning. However, its association with career decision-making factors has been largely unexplored. In the present study, we focused on the association between career decision-making difficulties, career-decision status, and career-preference crystallization, on the one hand, and depression, on the other. The hypothesis that high levels of career decision-making difficulties, less advanced decision status, and low levels of preference crystallization are associated with higher levels of depressive symptoms was tested with a sample of 222 college seniors. In addition, since it has been found that work-related stressors are more often associated with depression among men than women, it was hypothesized that the associations between vocational factors and depression would be stronger for men than for women. The participants filled out online self-report questionnaires assessing depressive symptoms, emotional and personality-related career decision-making difficulties, career-decision status, and career preferences. The results indicated that self-concept and identity-related career decision-making difficulties were associated with depressive symptoms for both men and women. In addition, for men, but not for women, less crystallization of career preferences also predicted higher levels of depressive symptoms. These results show how important it is for counseling psychologists to understand the role of the individual's vocational situation in depression. (c) 2015 APA, all rights reserved).

Selective exposure to information: how different modes of decision making affect subsequent confirmatory information processing.

PubMed

Fischer, Peter; Fischer, Julia; Weisweiler, Silke; Frey, Dieter

2010-12-01

We investigated whether different modes of decision making (deliberate, intuitive, distracted) affect subsequent confirmatory processing of decision-consistent and inconsistent information. Participants showed higher levels of confirmatory information processing when they made a deliberate or an intuitive decision versus a decision under distraction (Studies 1 and 2). As soon as participants have a cognitive (i.e., deliberate cognitive analysis) or affective (i.e., intuitive and gut feeling) reason for their decision, the subjective confidence in the validity of their decision increases, which results in increased levels of confirmatory information processing (Study 2). In contrast, when participants are distracted during decision making, they are less certain about the validity of their decision and thus are subsequently more balanced in the processing of decision-relevant information.

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

PubMed

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

2016-12-01

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

The PRC Decision-Making Process

DTIC Science & Technology

2002-03-01

REPORT DATE March 2002 3. REPORT TYPE AND DATES COVERED Master’s Thesis 4. TITLE AND SUBTITLE The PRC Decision - Making ...of crisis. It explores who has the authority to make decisions in China today and who will have this authority as new leaders...security and foreign policy decision - making during times of crisis. The April 2001 EP-3 incident is examined to assess high-level

Hot Topics: Cities, Energy Use, and Local Energy Decision Making | State,

Science.gov Websites

Making Hot Topics: Cities, Energy Use, and Local Energy Decision Making August 08, 2015 by Alexandra United States, read Alexandra's paper titled City-Level Energy Decision Making: Data Use in Energy Local, and Tribal Governments | NREL Hot Topics: Cities, Energy Use, and Local Energy Decision

Not just for consumers: context effects are fundamental to decision making.

PubMed

Trueblood, Jennifer S; Brown, Scott D; Heathcote, Andrew; Busemeyer, Jerome R

2013-06-01

Context effects--preference changes that depend on the availability of other options--have attracted a great deal of attention among consumer researchers studying high-level decision tasks. In the experiments reported here, we showed that these effects also arise in simple perceptual-decision-making tasks. This finding casts doubt on explanations limited to consumer choice and high-level decisions, and it indicates that context effects may be amenable to a general explanation at the level of the basic decision process. We demonstrated for the first time that three important context effects from the preferential-choice literature--similarity, attraction, and compromise effects--all occurred within a single perceptual-decision task. Not only do our results challenge previous explanations for context effects proposed by consumer researchers, but they also challenge the choice rules assumed in theories of perceptual decision making.

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

PubMed

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

2018-02-01

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

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

PubMed

Watanabe, Yoshiko; Takahashi, Miyako; Kai, Ichiro

2008-02-27

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

Use of economic evaluation in local health care decision-making in England: a qualitative investigation.

PubMed

Eddama, Oya; Coast, Joanna

2009-03-01

To explore decision-making and the use of economic evaluation at the local health care decision-making level in England (UK). Data collection was over a 16-month period (January 2003 to April 2004). Data collection comprised 29 in-depth interviews with a range of decision makers, 13 observations of decision-making meetings, and analysis of documents produced at meetings. A constant comparative approach was used to identify broad themes and sub-themes arising from the data. Data were analysed using Microsoft Word. National Institute for Health and Clinical Excellence (NICE) guidance provides the main way in which economic evaluation is used at a local level in the UK, although following NICE guidance is often regarded as detrimental to pursuing local priorities. Other than through NICE, economic evaluation is not considered at the local level; we found no evidence for use at the meeting group (by individuals). Although decision makers appear to understand notions of scarcity, with some also referring to value for money, the process of decision-making departs from these principles in practice. Disinvestment decisions are not made nor are decisions weighted against pre-defined criteria. Options appraisal is conducted, but it does not embody the principles of economic evaluation, since options are not considered in terms of their costs and benefits and opportunity cost is not accounted for. There appear to be two reasons why economic evaluation is not used at the local level: (1) the nature of management decisions concerned with the employment of extra staff and new equipment, rather than the choice of medicines or specific interventions usually assessed in published economic evaluation; (2) lack of awareness of the economic evaluation approach to decision-making. These two factors point to a lack of freedom in decision-making at the local level and a lack of understanding of how priority setting can be achieved in practice. A more detailed and rigorous approach to prioritisation at the local level is required. Whilst, PCTs have been given greater responsibility for priority setting, they lack the necessary power and understanding of the ways in which long term solutions to problems in health care can be achieved. Economics can be a valuable asset to priority setting and has already filtered into the jargon used by decision makers. Whilst most concepts are understood, the leap to adopting these concepts into the practice of decision-making needs to be made.

Strategic Decision-Making by Deans in Academic Health Centers: A Framework Analysis

ERIC Educational Resources Information Center

Keeney, Brianne

2012-01-01

This study examines strategic decision-making at the college level in relation to seven theoretical frames. Strategic decisions are those made by top executives, have wide-ranging influence throughout the organization, affect the long-term future of the organization, and are connected to the external environment. The seven decision-making frames…

Characteristics Associated With Preferences for Parent-Centered Decision Making in Neonatal Intensive Care.

PubMed

Weiss, Elliott Mark; Xie, Dawei; Cook, Noah; Coughlin, Katherine; Joffe, Steven

2018-05-01

Little is known about how characteristics of particular clinical decisions influence decision-making preferences by patients or their surrogates. A better understanding of the factors underlying preferences is essential to improve the quality of shared decision making. To identify the characteristics of particular decisions that are associated with parents' preferences for family- vs medical team-centered decision making across the spectrum of clinical decisions that arise in the neonatal intensive care unit (NICU). This cross-sectional survey assessed parents' preferences for parent- vs medical team-centered decision making across 16 clinical decisions, along with parents' assessments of 7 characteristics of those decisions. Respondents included 136 parents of infants in 1 of 3 academically affiliated hospital NICUs in Philadelphia, Pennsylvania, from January 7 to July 8, 2016. Respondents represented a wide range of educational levels, employment status, and household income but were predominantly female (109 [80.1%]), white (68 [50.0%]) or African American (53 [39.0%]), and married (81 of 132 responding [61.4%]). Preferences for parent-centered decision making. For each decision characteristic (eg, urgency), multivariable analyses tested whether middle and high levels of that characteristic (compared with low levels) were associated with a preference for parent-centered decision making, resulting in 2 odds ratios (ORs) per decision characteristic. Among the 136 respondents (109 women [80.1%] and 27 men [19.9%]; median age, 30 years [range, 18-43 years]), preferences for parent-centered decision making were positively associated with decisions that involved big-picture goals (middle OR, 2.01 [99% CI, 0.83-4.86]; high OR, 3.38 [99% CI, 1.48-7.75]) and that had the potential to harm the infant (middle OR, 1.32 [99% CI, 0.84-2.08]; high OR, 2.62 [99% CI, 1.67-4.11]). In contrast, preferences for parent-centered decision making were inversely associated with the following 4 decision characteristics: technical decisions (middle OR, 0.82 [99% CI, 0.45-1.52]; high OR, 0.48 [99% CI, 0.25-0.93]), the potential to benefit the infant (middle OR, 0.42 [99% CI, 0.16-1.05]; high OR, 0.21 [99% CI, 0.08-0.52]), requires medical expertise (middle OR, 0.48 [99% CI, 0.22-1.05]; high OR, 0.21 [99% CI, 0.10-0.48]), and a high level of urgency (middle OR, 0.47 [99% CI, 0.24-0.92]; high OR, 0.42 [99% CI, 0.22-0.83]). Preferences for parent-centered vs medical team-centered decision making among parents of infants in the NICU may vary systematically by the characteristics of particular clinical decisions. Incorporating this variation into shared decision making and endorsing models that allow parents to cede control to physicians in appropriate clinical circumstances might improve the quality and outcomes of medical decisions.

(De)centralization of social support in six Western European countries.

PubMed

Kroneman, Madelon; Cardol, Mieke; Friele, Roland

2012-06-01

Participation of disabled or chronically ill persons into the society may require support in the sense of human or technical aid. In this study we look into the decision making power of governments and the way citizens are involved in these processes. Decision making power can be political, financial and administrative and may be organized at national, regional or local level. This is a cross-sectional descriptive study of the decision making power in Belgium, France, Germany, the Netherlands, Sweden and the United Kingdom in 2010. We focused on acts and regulations for human and technical aids and for making the environment accessible. Several acts and regulations were identified in relation to social support. In the Netherlands and Sweden social support was mainly organized in one act, whereas in the other countries social support was part of several acts or regulations. Citizen's voice appeared to be represented in boards or advisory committees. Descriptions of entitlements varied from explicitly formulated to globally described. The level of decision making power varies between the countries en between the types of decision making power. Citizens' participation is mainly represented through patient associations. Countries with strongly decentralized decision making make use of framework legislation at national level to set general targets or aims. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Staff Involvement in Leadership Decision Making in the UK Further Education Sector: Perceptions of Quality and Social Justice

ERIC Educational Resources Information Center

Maringe, Felix

2012-01-01

Purpose: The purpose of the paper is to explore the quality of leadership decision making at various leadership levels in the further education (FE) sector. Using Hoffberg and Korver's model for integrated decision making, the paper aims to examine how staff in five UK FE colleges perceive the quality of their involvement in decision-making teams…

Effects of Expertise and Cognitive Style on Information Use in Tactical Decision Making

DTIC Science & Technology

1988-06-01

environmental situation. Demographic Characteristics Age Gender Rank/Command Level 5 Personality Characteristics Decision making style Cognitive style Learning...individuals with diverse decision making patterns to use a standard approach will adversely affect their decision making abilities. Further, the findings...Minneapolis MN: University of Minnesota, Cognitive, Science Research Group. Karp, S.A. (1963). Field dependence and overcoming embeddedness . J. Consult

Effects of emotion on prospection during decision-making.

PubMed

Worthy, Darrell A; Byrne, Kaileigh A; Fields, Sherecce

2014-01-01

In two experiments we examined the role of emotion, specifically worry, anxiety, and mood, on prospection during decision-making. Worry is a particularly relevant emotion to study in the context of prospection because high levels of worry may make individuals more aversive toward the uncertainty associated with the prospect of obtaining future improvements in rewards or states. Thus, high levels of worry might lead to reduced prospection during decision-making and enhance preference for immediate over delayed rewards. In Experiment 1 participants performed a two-choice dynamic decision-making task where they were required to choose between one option (the decreasing option) which provided larger immediate rewards but declines in future states, and another option (the increasing option) which provided smaller immediate rewards but improvements in future states, making it the optimal choice. High levels of worry were associated with poorer performance in the task. Additionally, fits of a sophisticated reinforcement-learning model that incorporated both reward-based and state-based information suggested that individuals reporting high levels of worry gave greater weight to the immediate rewards they would receive on each trial than to the degree to which each action would lead to improvements in their future state. In Experiment 2 we found that high levels of worry were associated with greater delay discounting using a standard delay discounting task. Combined, the results suggest that high levels of worry are associated with reduced prospection during decision-making. We attribute these results to high worriers' aversion toward the greater uncertainty associated with attempting to improve future rewards than to maximize immediate reward. These results have implications for researchers interested in the effects of emotion on cognition, and suggest that emotion strongly affects the focus on temporal outcomes during decision-making.

Exploring how different modes of governance act across health system levels to influence primary healthcare facility managers' use of information in decision-making: experience from Cape Town, South Africa.

PubMed

Scott, Vera; Gilson, Lucy

2017-09-15

Governance, which includes decision-making at all levels of the health system, and information have been identified as key, interacting levers of health system strengthening. However there is an extensive literature detailing the challenges of supporting health managers to use formal information from health information systems (HISs) in their decision-making. While health information needs differ across levels of the health system there has been surprisingly little empirical work considering what information is actually used by primary healthcare facility managers in managing, and making decisions about, service delivery. This paper, therefore, specifically examines experience from Cape Town, South Africa, asking the question: How is primary healthcare facility managers' use of information for decision-making influenced by governance across levels of the health system? The research is novel in that it both explores what information these facility managers actually use in decision-making, and considers how wider governance processes influence this information use. An academic researcher and four facility managers worked as co-researchers in a multi-case study in which three areas of management were served as the cases. There were iterative cycles of data collection and collaborative analysis with individual and peer reflective learning over a period of three years. Central governance shaped what information and knowledge was valued - and, therefore, generated and used at lower system levels. The central level valued formal health information generated in the district-based HIS which therefore attracted management attention across the levels of the health system in terms of design, funding and implementation. This information was useful in the top-down practices of planning and management of the public health system. However, in facilities at the frontline of service delivery, there was a strong requirement for local, disaggregated information and experiential knowledge to make locally-appropriate and responsive decisions, and to perform the people management tasks required. Despite central level influences, modes of governance operating at the subdistrict level had influence over what information was valued, generated and used locally. Strengthening local level managers' ability to create enabling environments is an important leverage point in supporting informed local decision-making, and, in turn, translating national policies and priorities, including equity goals, into appropriate service delivery practices.

The role of emotion in decision-making: evidence from neurological patients with orbitofrontal damage.

PubMed

Bechara, Antoine

2004-06-01

Most theories of choice assume that decisions derive from an assessment of the future outcomes of various options and alternatives through some type of cost-benefit analyses. The influence of emotions on decision-making is largely ignored. The studies of decision-making in neurological patients who can no longer process emotional information normally suggest that people make judgments not only by evaluating the consequences and their probability of occurring, but also and even sometimes primarily at a gut or emotional level. Lesions of the ventromedial (which includes the orbitofrontal) sector of the prefrontal cortex interfere with the normal processing of "somatic" or emotional signals, while sparing most basic cognitive functions. Such damage leads to impairments in the decision-making process, which seriously compromise the quality of decisions in daily life. The aim of this paper is to review evidence in support of "The Somatic Marker Hypothesis," which provides a systems-level neuroanatomical and cognitive framework for decision-making and suggests that the process of decision-making depends in many important ways on neural substrates that regulate homeostasis, emotion, and feeling. The implications of this theoretical framework for the normal and abnormal development of the orbitofrontal cortex are also discussed.

Decision-Making Processes in the Workplace: How Exhaustion, Lack of Resources and Job Demands Impair Them and Affect Performance

PubMed Central

Ceschi, Andrea; Demerouti, Evangelia; Sartori, Riccardo; Weller, Joshua

2017-01-01

The present study aims to connect more the I/O and the decision-making psychological domains, by showing how some common components across jobs interfere with decision-making and affecting performance. Two distinct constructs that can contribute to positive workplace performance have been considered: decision-making competency (DMCy) and decision environment management (DEM). Both factors are presumed to involve self-regulatory mechanisms connected to decision processes by influencing performance in relation to work environment conditions. In the framework of the job demands-resources (JD-R) model, the present study tested how such components as job demands, job resources and exhaustion can moderate decision-making processes and performance, where high resources are advantageous for decision-making processes and performance at work, while the same effect happens with low job demands and/or low exhaustion. In line with the formulated hypotheses, results confirm the relations between both the decision-making competences, performance (i.e., in-role and extra-role) and moderators considered. In particular, employees with low levels of DMCy show to be more sensitive to job demands toward in-role performance, whereas high DEM levels increase the sensitivity of employees toward job resources and exhaustion in relation to extra-role performance. These findings indicate that decision-making processes, as well as work environment conditions, are jointly related to employee functioning. PMID:28529491

Decision-Making Processes in the Workplace: How Exhaustion, Lack of Resources and Job Demands Impair Them and Affect Performance.

PubMed

Ceschi, Andrea; Demerouti, Evangelia; Sartori, Riccardo; Weller, Joshua

2017-01-01

The present study aims to connect more the I/O and the decision-making psychological domains, by showing how some common components across jobs interfere with decision-making and affecting performance. Two distinct constructs that can contribute to positive workplace performance have been considered: decision-making competency (DMCy) and decision environment management (DEM). Both factors are presumed to involve self-regulatory mechanisms connected to decision processes by influencing performance in relation to work environment conditions. In the framework of the job demands-resources (JD-R) model, the present study tested how such components as job demands, job resources and exhaustion can moderate decision-making processes and performance, where high resources are advantageous for decision-making processes and performance at work, while the same effect happens with low job demands and/or low exhaustion. In line with the formulated hypotheses, results confirm the relations between both the decision-making competences, performance (i.e., in-role and extra-role) and moderators considered. In particular, employees with low levels of DMCy show to be more sensitive to job demands toward in-role performance, whereas high DEM levels increase the sensitivity of employees toward job resources and exhaustion in relation to extra-role performance. These findings indicate that decision-making processes, as well as work environment conditions, are jointly related to employee functioning.

Campus-Level Decision-Making Practices: Principals and Teachers Differ in Their Views

ERIC Educational Resources Information Center

Noel, Cindi; Slate, John R.; Brown, Michelle; Tejeda-Delgado, Carmen

2009-01-01

With the implementation of site-based decision-making occurring in schools, the extent to which teachers perceive their involvement in decisions on planning, budgeting, curriculum, staffing patterns, staff development, and campus-level organization and the extent to which teachers' views of their involvement in these activities are congruent with…

Patterns of out-of-home placement decision-making in child welfare.

PubMed

Chor, Ka Ho Brian; McClelland, Gary M; Weiner, Dana A; Jordan, Neil; Lyons, John S

2013-10-01

Out-of-home placement decision-making in child welfare is founded on the best interest of the child in the least restrictive setting. After a child is removed from home, however, little is known about the mechanism of placement decision-making. This study aims to systematically examine the patterns of out-of-home placement decisions made in a state's child welfare system by comparing two models of placement decision-making: a multidisciplinary team decision-making model and a clinically based decision support algorithm. Based on records of 7816 placement decisions representing 6096 children over a 4-year period, hierarchical log-linear modeling characterized concordance or agreement, and discordance or disagreement when comparing the two models and accounting for age-appropriate placement options. Children aged below 16 had an overall concordance rate of 55.7%, most apparent in the least restrictive (20.4%) and the most restrictive placement (18.4%). Older youth showed greater discordant distributions (62.9%). Log-linear analysis confirmed the overall robustness of concordance (odd ratios [ORs] range: 2.9-442.0), though discordance was most evident from small deviations from the decision support algorithm, such as one-level under-placement in group home (OR=5.3) and one-level over-placement in residential treatment center (OR=4.8). Concordance should be further explored using child-level clinical and placement stability outcomes. Discordance might be explained by dynamic factors such as availability of placements, caregiver preferences, or policy changes and could be justified by positive child-level outcomes. Empirical placement decision-making is critical to a child's journey in child welfare and should be continuously improved to effect positive child welfare outcomes. Copyright © 2013 Elsevier Ltd. All rights reserved.

Analysis of Tactical, Decisional and Executional Behaviour according to the Level of Expertise in Squash

PubMed Central

Catalán-Eslava, María; González-Víllora, Sixto; Pastor-Vicedo, Juan C.; Contreras-Jordán, Onofre R.

2018-01-01

Abstract The objective of this study was to analyse the differences in tactical principles, decision-making and execution of the return shot and drop shot of squash players at different levels of proficiency. The sample was composed of 80 players, divided into four levels of expertise (first national category, second national category, autonomous regional level and provincial level). The Squash Performance Evaluation Tool was used for recording the level of decision-making and execution. The results revealed that reading of the context of the game improved as the level of the player’s expertise of both the return shot and the drop shot increased. The correlation between correct decision-making and better quality execution for both the return shot and the drop shot in squash also improved with the player’s level of expertise. According to these results, improvements in situational tactical principles and the application of tactical principles, correct decision-making and high-quality execution are essential to develop the athletic performance level among squash players. PMID:29599875

Expert Decision-Making in Naturalistic Environments: A Summary of Research

DTIC Science & Technology

2005-03-01

a number of descriptive decision theories arose (Plous, 1993). One of these is the rational choice model of decision - making (Janis & Mann, 1977...possible association between time pressure and increased levels of emotion . To date, the role played by emotion in decision - making has not been given... rational choice model seems to describe some decision events and Janis and Mann (1977) have highlighted emotion as a potential influence on decision

Locus of decision making in multinational corporations and its relationship to subsidiary performance

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

Goehle, D.G.

1978-01-01

A conceptual model was developed which drew from the existing research in organization theory, comparative management, and international business which assisted in the delineation of the relevant variables and suggested the nature of their relationship to the locus of decision making. The conceptual model incorporated certain corporate and subsidiary factors considered an influence on the determination of the locus of decision making. Corporate factors included product line or industry, size and complexity of international operations, organization structure, availability of managerial talent, and corporate philosophy. Subsidiary characteristics included subsidiary age and size, availability of local managerial talent, geographic distance from headquartersmore » and other affiliated units, and subsidiary environmental characteristics. The locus of desicion making was measured by the level of participation the headquarters and subsidiary management had in decision making for twenty-nine decisions, representing six functional areas. Levels of participation for headquarters and subsidiary managers were measured for each decision based on responses to a five-point scale of decision process categories which indicated varying levels of headquarters and subsidiary participation. The sample included ten US multinational corporations representing five industries: pharmaceuticals, tire and rubber, automobiles, capital equipment, and food processing.« less

Visualising Uncertainty for Decision Support

DTIC Science & Technology

2016-12-01

25 4.2.7 The perceived trust level of information in decision making ......... 26 4.3 User issues...crucial to understanding the “reliability” of information , and consequently affect decision making (Deitrick, 2007). Olston and Mackinlay (2002...have long been regarded as a difficult topic since the commander has to make decisions in a limited time frame with information that comes from

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…

Perceived involvement and preferences in shared decision-making among patients with hypertension.

PubMed

Mah, Hui Chin; Muthupalaniappen, Leelavathi; Chong, Wei Wen

2016-06-01

Shared decision-making (SDM) is an important component of patient-centred care. However, there is limited information on its implementation in Malaysia, particularly in chronic diseases such as hypertension. The objective of this study was to examine perceived involvement and role preferences of patients with hypertension in treatment decision-making. A cross-sectional survey was conducted among 210 patients with hypertension in a teaching hospital in Malaysia. The majority of respondents agreed that their doctor recognized that a decision needs to be made (89.5%) and informed them that different options are available (77.1%). However, respondents' perceived level of involvement in other aspects of treatment decision-making process was low, including in the selection of treatment and in reaching an agreement with their doctor on how to proceed with treatment. In terms of preferred decision-making roles, 51.4% of respondents preferred a collaborative role with their physicians, 44.8% preferred a passive role while only 1.9% preferred an active role. Age and educational level were found to be significantly related to patient preferences for involvement in SDM. Younger patients (<60 years) and those with higher educational level preferred SDM over passive decision-making (ρ < 0.01). Encouragement from health care providers was perceived as a major motivating factor for SDM among patients with hypertension, with 91% of respondents agreeing that this would motivate their participation in SDM. Preferences for involvement in decision-making among patients with hypertension are varied, and influenced by age and educational level. Physicians have a key role in encouraging patients to participate in SDM. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

How should treatment costs impact on physician's decisions?

PubMed

Neymark, N

1999-01-01

This article first discusses at what level of clinical decision making cost considerations may be most pertinent and important. It is argued that cost assessments will be of most relevance and value at an intermediate level of clinical decision making i.e. at a level where so-called policy decisions are made. These are decisions such as which drugs to include in a hospital formulary or which standard treatment 'protocols' to choose for particular types of patients. The personal encounter between individual patients and physicians will take place within the framework of available treatment options determined by these policy decisions, which must necessarily be based on a prior assessment of the expected costs and benefits of treatments. The article goes on to give a brief introduction to the various methods of economic evaluation that have been developed in order to provide the decision makers with the means to make policy decisions on the basis of the most reliable and pertinent information possible.

Impact of a decision-support tool on decision making at the district level in Kenya

PubMed Central

2013-01-01

Background In many countries, the responsibility for planning and delivery of health services is devolved to the subnational level. Health programs, however, often fall short of efficient use of data to inform decisions. As a result, programs are not as effective as they can be at meeting the health needs of the populations they serve. In Kenya, a decision-support tool, the District Health Profile (DHP) tool was developed to integrate data from health programs, primarily HIV, at the district level and to enable district health management teams to review and monitor program progress for specific health issues to make informed service delivery decisions. Methods Thirteen in-depth interviews were conducted with ten tool users and three non-users in six districts to qualitatively assess the process of implementing the tool and its effect on data-informed decision making at the district level. The factors that affected use or non-use of the tool were also investigated. Respondents were selected via convenience sample from among those that had been trained to use the DHP tool except for one user who was self-taught to use the tool. Selection criteria also included respondents from urban districts with significant resources as well as respondents from more remote, under-resourced districts. Results Findings from the in-depth interviews suggest that among those who used it, the DHP tool had a positive effect on data analysis, review, interpretation, and sharing at the district level. The automated function of the tool allowed for faster data sharing and immediate observation of trends that facilitated data-informed decision making. All respondents stated that the DHP tool assisted them to better target existing services in need of improvement and to plan future services, thus positively influencing program improvement. Conclusions This paper stresses the central role that a targeted decision-support tool can play in making data aggregation, analysis, and presentation easier and faster. The visual synthesis of data facilitates the use of information in health decision making at the district level of a health system and promotes program improvement. The experience in Kenya can be applied to other countries that face challenges making district-level, data-informed decisions with data from fragmented information systems. PMID:24011028

Extending decision making competence to special populations: a pilot study of persons on the autism spectrum

PubMed Central

Levin, Irwin P.; Gaeth, Gary J.; Foley-Nicpon, Megan; Yegorova, Vitaliya; Cederberg, Charles; Yan, Haoyang

2015-01-01

The area of decision making has much to offer in our effort to understand special populations. This pilot study is an example of just such a project, where we illustrate how traditional decision making tools and tasks can be used to uncover strengths and weaknesses within a growing population of young adults with autism. In this pilot project we extended accounts of autistic behavior such as those derived from “theory of mind” to predict key components of decision making in high-functioning young adults on the autism spectrum. A battery of tests was administered to 15 high-functioning college students with autism spectrum disorder (ASD), focusing on decision making competence (DMC) and other aspects of decision making related to known deficits associated with autism. Data from this group were compared to data from unselected college students receiving the same measures. First, as a test of a key social deficit associated with autism, the target group scored much lower on the Empathy Quotient scale. Traditional elements of decision making competency such as Numeracy and application of decision rules were comparable across groups. However, there were differences in thinking style, with the ASD group showing lesser ability and engagement in intuitive thinking, and they showed lower levels of risk taking. For comparisons within the ASD group, autobiographical reports concerning individual lifestyles and outcomes were used to derive a scale of Social Functioning. The lowest scoring individuals showed the lowest levels of intuitive thinking, the lowest perceived levels of others’ endorsement of socially undesirable behaviors, and the lowest ability to discriminate between “good” and “bad” risks. Results are discussed in terms of interventions that might aid high-functioning young adults with ASD in their everyday decision making. PMID:25972831

Extending decision making competence to special populations: a pilot study of persons on the autism spectrum.

PubMed

Levin, Irwin P; Gaeth, Gary J; Foley-Nicpon, Megan; Yegorova, Vitaliya; Cederberg, Charles; Yan, Haoyang

2015-01-01

The area of decision making has much to offer in our effort to understand special populations. This pilot study is an example of just such a project, where we illustrate how traditional decision making tools and tasks can be used to uncover strengths and weaknesses within a growing population of young adults with autism. In this pilot project we extended accounts of autistic behavior such as those derived from "theory of mind" to predict key components of decision making in high-functioning young adults on the autism spectrum. A battery of tests was administered to 15 high-functioning college students with autism spectrum disorder (ASD), focusing on decision making competence (DMC) and other aspects of decision making related to known deficits associated with autism. Data from this group were compared to data from unselected college students receiving the same measures. First, as a test of a key social deficit associated with autism, the target group scored much lower on the Empathy Quotient scale. Traditional elements of decision making competency such as Numeracy and application of decision rules were comparable across groups. However, there were differences in thinking style, with the ASD group showing lesser ability and engagement in intuitive thinking, and they showed lower levels of risk taking. For comparisons within the ASD group, autobiographical reports concerning individual lifestyles and outcomes were used to derive a scale of Social Functioning. The lowest scoring individuals showed the lowest levels of intuitive thinking, the lowest perceived levels of others' endorsement of socially undesirable behaviors, and the lowest ability to discriminate between "good" and "bad" risks. Results are discussed in terms of interventions that might aid high-functioning young adults with ASD in their everyday decision making.

Social support plays a role in the attitude that people have towards taking an active role in medical decision-making.

PubMed

Brabers, Anne E M; de Jong, Judith D; Groenewegen, Peter P; van Dijk, Liset

2016-09-21

There is a growing emphasis towards including patients in medical decision-making. However, not all patients are actively involved in such decisions. Research has so far focused mainly on the influence of patient characteristics on preferences for active involvement. However, it can be argued that a patient's social context has to be taken into account as well, because social norms and resources affect behaviour. This study aims to examine the role of social resources, in the form of the availability of informational and emotional support, on the attitude towards taking an active role in medical decision-making. A questionnaire was sent to members of the Dutch Health Care Consumer Panel (response 70 %; n = 1300) in June 2013. A regression model was then used to estimate the relation between medical and lay informational support and emotional support and the attitude towards taking an active role in medical decision-making. Availability of emotional support is positively related to the attitude towards taking an active role in medical decision-making only in people with a low level of education, not in persons with a middle and high level of education. The latter have a more positive attitude towards taking an active role in medical decision-making, irrespective of the level of emotional support available. People with better access to medical informational support have a more positive attitude towards taking an active role in medical decision-making; but no significant association was found for lay informational support. This study shows that social resources are associated with the attitude towards taking an active role in medical decision-making. Strategies aimed at increasing patient involvement have to address this.

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.

Novel Statistical Approach to Determine Inflammatory Bowel Disease: Patients' Perspectives on Shared Decision Making.

PubMed

Siegel, Corey A; Lofland, Jennifer H; Naim, Ahmad; Gollins, Jan; Walls, Danielle M; Rudder, Laura E; Reynolds, Chuck

2016-02-01

Limited information is available on patients' perspectives of shared decision-making practices used in inflammatory bowel disease (IBD). The aim of this study was to examine patient insights regarding shared decision making among patients with IBD using novel statistical technology to analyze qualitative data. Two 10-patient focus groups (10 ulcerative colitis patients and 10 Crohn's disease patients) were conducted in Chicago in January 2012 to explore patients' experiences, concerns, and preferences related to shared decision making. Key audio excerpts of focus group insights were embedded within a 25-min online patient survey and used for moment-to-moment affect trace analysis. A total of 355 IBD patients completed the survey (ulcerative colitis 51 %; Crohn's disease 49 %; female 54 %; 18-50 years of age 50 %). The majority of patients (66 %) reported increased satisfaction when they participated in shared decision making. Three unique patient clusters were identified based on their involvement in shared decision making: satisfied, content, and dissatisfied. Satisfied patients (18 %) had a positive physician relationship and a high level of trust with their physician. Content patients (48 %) had a moderate level of trust with their physician. Dissatisfied patients (34 %) had a life greatly affected by IBD, a low level of trust of their physician, a negative relationship with their physician, were skeptical of decisions, and did not rely on their physician for assistance. This study provides valuable insights regarding patients' perceptions of the shared decision-making process in IBD treatment using a novel moment-to-moment hybrid technology approach. Patient perspectives in this study indicate an increased desire for shared decision making in determining an optimal IBD treatment plan.

Poor Decision Making Is a Consequence of Cognitive Decline among Older Persons without Alzheimer’s Disease or Mild Cognitive Impairment

PubMed Central

Boyle, Patricia A.; Yu, Lei; Wilson, Robert S.; Gamble, Keith; Buchman, Aron S.; Bennett, David A.

2012-01-01

Objective Decision making is an important determinant of health and well-being across the lifespan but is critical in aging, when many influential decisions are made just as cognitive function declines. Increasing evidence suggests that older adults, even those without dementia, often make poor decisions and are selectively vulnerable to scams. To date, however, the factors associated with poor decision making in old age are unknown. The objective of this study was to test the hypothesis that poor decision making is a consequence of cognitive decline among older persons without Alzheimer’s disease or mild cognitive impairment. Methods Participants were 420 non-demented persons from the Memory and Aging Project, a longitudinal, clinical-pathologic cohort study of aging in the Chicago metropolitan area. All underwent repeated cognitive evaluations and subsequently completed assessments of decision making and susceptibility to scams. Decision making was measured using 12 items from a previously established performance-based measure and a self-report measure of susceptibility to scams. Results Cognitive function data were collected over an average of 5.5 years prior to the decision making assessment. Regression analyses were used to examine whether the prior rate of cognitive decline predicted the level of decision making and susceptibility to scams; analyses controlled for age, sex, education, and starting level of cognition. Among 420 persons without dementia, more rapid cognitive decline predicted poorer decision making and increased susceptibility to scams (p’s<0.001). Further, the relations between cognitive decline, decision making and scams persisted in analyses restricted to persons without any cognitive impairment (i.e., no dementia or even mild cognitive impairment). Conclusions Poor decision making is a consequence of cognitive decline among older persons without Alzheimer’s disease or mild cognitive impairment, those widely considered “cognitively healthy.” These findings suggest that even very subtle age-related changes in cognition have detrimental effects on judgment. PMID:22916287

A system of system lenses for leadership decision-making.

PubMed

Cady, Phil

2016-01-01

The sheer volume and dynamics among system agents in healthcare makes decision-making a daunting task at all levels. Being clear about what leaders mean by "healthcare system" is critical in aligning system strategy and leadership decision-making. This article presents an emerging set of lenses (ideology and beliefs, rational and irrational information processing, interpersonal social dynamics, process and value creation, and context) to help frame leadership decision-making in healthcare systems. © 2015 The Canadian College of Health Leaders.

The Selection of Test Items for Decision Making with a Computer Adaptive Test.

ERIC Educational Resources Information Center

Spray, Judith A.; Reckase, Mark D.

The issue of test-item selection in support of decision making in adaptive testing is considered. The number of items needed to make a decision is compared for two approaches: selecting items from an item pool that are most informative at the decision point or selecting items that are most informative at the examinee's ability level. The first…

Decision Making about Computer Acquisition and Use in American Schools.

ERIC Educational Resources Information Center

Becker, Henry Jay

1993-01-01

Discusses the centralization and decentralization of decision making about computer use in elementary and secondary schools based on results of a 1989 national survey. Results unexpectedly indicate that more successful programs are the result of districtwide planning than individual teacher or school-level decision making. (LRW)

Transformational Leadership & Decision Making in Schools

ERIC Educational Resources Information Center

Brower, Robert E.; Balch, Bradley V.

2005-01-01

It is essential for every school leader to possess the savvy to effect positive change, raise achievement levels, and foster a positive school climate. Now it seems that the struggle for school leaders to make productive decisions has become clouded with ever-growing uncertainty and skepticism. "Transformational Leadership & Decision Making in…

Principles of shared decision-making within teams.

PubMed

Jacobs, Jeffrey P; Wernovsky, Gil; Cooper, David S; Karl, Tom R

2015-12-01

In the domain of paediatric and congenital cardiac care, the stakes are huge. Likewise, the care of these children assembles a group of "A+ personality" individuals from the domains of cardiac surgery, cardiology, anaesthesiology, critical care, and nursing. This results in an environment that has opportunity for both powerful collaboration and powerful conflict. Providers of healthcare should avoid conflict when it has no bearing on outcome, as it is clearly a squandering of individual and collective political capital. Outcomes after cardiac surgery are now being reported transparently and publicly. In the present era of transparency, one may wonder how to balance the following potentially competing demands: quality healthcare, transparency and accountability, and teamwork and shared decision-making. An understanding of transparency and public reporting in the domain of paediatric cardiac surgery facilitates the implementation of a strategy for teamwork and shared decision-making. In January, 2015, the Society of Thoracic Surgeons (STS) began to publicly report outcomes of paediatric and congenital cardiac surgery using the 2014 Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) Mortality Risk Model. The 2014 STS-CHSD Mortality Risk Model facilitates description of Operative Mortality adjusted for procedural and patient-level factors. The need for transparency in reporting of outcomes can create pressure on healthcare providers to implement strategies of teamwork and shared decision-making to assure outstanding results. A simple strategy of shared decision-making was described by Tom Karl and was implemented in multiple domains by Jeff Jacobs and David Cooper. In a critical-care environment, it is not unusual for healthcare providers to disagree about strategies of management of patients. When two healthcare providers disagree, each provider can classify the disagreement into three levels: • SDM Level 1 Decision: "We disagree but it really does not matter, so do whatever you desire!" • SDM Level 2 Decision: "We disagree and I believe it matters, but I am OK if you do whatever you desire!!" • SDM Level 3 Decision: "We disagree and I must insist (diplomatically and politely) that we follow the strategy that I am proposing!!!!!!" SDM Level 1 Decisions and SDM Level 2 Decisions typically do not create stress on the team, especially when there is mutual purpose and respect among the members of the team. SDM Level 3 Decisions are the real challenge. Periodically, the healthcare team is faced with such Level 3 Decisions, and teamwork and shared decision-making may be challenged. Teamwork is a learned behaviour, and mentorship is critical to achieve a properly balanced approach. If we agree to leave our egos at the door, then, in the final analysis, the team will benefit and we will set the stage for optimal patient care. In the environment of strong disagreement, true teamwork and shared decision-making are critical to preserve the unity and strength of the multi-disciplinary team and simultaneously provide excellent healthcare.

[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.

HPV vaccine introduction at the local level in a developing country: attitudes and criteria among key actors.

PubMed

Piñeros, Marion; Wiesner, Carolina; Cortés, Claudia; Trujillo, Lina María

2010-05-01

In most developing countries, HPV vaccines have been licensed but there are no national policy recommendations, nor is it clear how decisions on the introduction of this new vaccine are made. Decentralization processes in many Latin American countries favor decision-making at the local level. Through a qualitative study we explored knowledge regarding the HPV vaccine and the criteria that influence decision-making among local health actors in four regions of Colombia. We conducted a total of 14 in-depths interviews with different actors; for the analysis we performed content analysis. Results indicate that decision-making on the HPV vaccine at the local level has mainly been driven by pressure from local political actors, in a setting where there is low technical knowledge of the vaccine. This increases the risk of initiatives that may foster inequity. Local decisions and initiatives need to be strengthened technically and supported by national-level decisions, guidelines and follow-up.

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

PubMed

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

2011-12-01

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

Evidence-informed decision-making by professionals working in addiction agencies serving women: a descriptive qualitative study.

PubMed

Jack, Susan M; Dobbins, Maureen; Sword, Wendy; Novotna, Gabriela; Brooks, Sandy; Lipman, Ellen L; Niccols, Alison

2011-11-07

Effective approaches to the prevention and treatment of substance abuse among mothers have been developed but not widely implemented. Implementation studies suggest that the adoption of evidence-based practices in the field of addictions remains low. There is a need, therefore, to better understand decision making processes in addiction agencies in order to develop more effective approaches to promote the translation of knowledge gained from addictions research into clinical practice. A descriptive qualitative study was conducted to explore: 1) the types and sources of evidence used to inform practice-related decisions within Canadian addiction agencies serving women; 2) how decision makers at different levels report using research evidence; and 3) factors that influence evidence-informed decision making. A purposeful sample of 26 decision-makers providing addiction treatment services to women completed in-depth qualitative interviews. Interview data were coded and analyzed using directed and summative content analysis strategies as well as constant comparison techniques. Across all groups, individuals reported locating and using multiple types of evidence to inform decisions. Some decision-makers rely on their experiential knowledge of addiction and recovery in decision-making. Research evidence is often used directly in decision-making at program management and senior administrative levels. Information for decision-making is accessed from a range of sources, including web-based resources and experts in the field. Individual and organizational facilitators and barriers to using research evidence in decision making were identified. There is support at administrative levels for integrating EIDM in addiction agencies. Knowledge transfer and exchange strategies should be focussed towards program managers and administrators and include capacity building for locating, appraising and using research evidence, knowledge brokering, and for partnering with universities. Resources are required to maintain web-based databases of searchable evidence to facilitate access to research evidence. A need exists to address the perception that there is a paucity of research evidence available to inform program decisions. Finally, there is a need to consider how experiential knowledge influences decision-making and what guidance research evidence has to offer regarding the implementation of different treatment approaches within the field of addictions.

Evidence-informed decision-making by professionals working in addiction agencies serving women: a descriptive qualitative study

PubMed Central

2011-01-01

Background Effective approaches to the prevention and treatment of substance abuse among mothers have been developed but not widely implemented. Implementation studies suggest that the adoption of evidence-based practices in the field of addictions remains low. There is a need, therefore, to better understand decision making processes in addiction agencies in order to develop more effective approaches to promote the translation of knowledge gained from addictions research into clinical practice. Methods A descriptive qualitative study was conducted to explore: 1) the types and sources of evidence used to inform practice-related decisions within Canadian addiction agencies serving women; 2) how decision makers at different levels report using research evidence; and 3) factors that influence evidence-informed decision making. A purposeful sample of 26 decision-makers providing addiction treatment services to women completed in-depth qualitative interviews. Interview data were coded and analyzed using directed and summative content analysis strategies as well as constant comparison techniques. Results Across all groups, individuals reported locating and using multiple types of evidence to inform decisions. Some decision-makers rely on their experiential knowledge of addiction and recovery in decision-making. Research evidence is often used directly in decision-making at program management and senior administrative levels. Information for decision-making is accessed from a range of sources, including web-based resources and experts in the field. Individual and organizational facilitators and barriers to using research evidence in decision making were identified. Conclusions There is support at administrative levels for integrating EIDM in addiction agencies. Knowledge transfer and exchange strategies should be focussed towards program managers and administrators and include capacity building for locating, appraising and using research evidence, knowledge brokering, and for partnering with universities. Resources are required to maintain web-based databases of searchable evidence to facilitate access to research evidence. A need exists to address the perception that there is a paucity of research evidence available to inform program decisions. Finally, there is a need to consider how experiential knowledge influences decision-making and what guidance research evidence has to offer regarding the implementation of different treatment approaches within the field of addictions. PMID:22059528

Long range healthcare capacity planning in the Netherlands. The case of radiotherapy.

PubMed

Postma, T J B M; Terpstra, S

2002-01-01

This contribution discusses centralization vs. decentralization in healthcare strategic decision making, focusing on long-range planning of facilities for radiotherapy. The radiotherapy case illustrates that more centralized, comprehensive, and systematic planning and strategic decisions making may be necessary to account for inputs of various parties and decision-making levels in this area. The expertise required cannot generally be found at a local or even regional level. It requires initiatives from coordinating healthcare institutions such as the Health Council and other professional organizations.

What To Do, What To Do? Determining a Course of Action at the Operational Level of War

DTIC Science & Technology

1992-05-18

and making choices can expand the limits of human rationality . 5 Where decisions involve the lives of soldiers and the future of nations, any edge or...ANALYSIS 15. N5Iu,,3E•a -r PAGES115 OPERATIONAL DECISION - MAKING MISSION ANALYSIS 115 COURSE OF ACTION SELECTION STAFF ESTIMATES I1. SECUlPIT... decision - making procedures for the operational level of war. These doctrinal procedures are found in emerging joint doctrine. For these procedures to be

Patients With Limited Health Literacy Have Similar Preferences but Different Perceptions in Surgical Decision-making for Carpal Tunnel Release.

PubMed

Roh, Young Hak; Koh, Young Do; Kim, Jong Oh; Noh, Jung Ho; Gong, Hyun Sik; Baek, Goo Hyun

2018-04-01

Health literacy is the ability to obtain, process, and understand health information needed to make appropriate health decisions. The proper comprehension by patients regarding a given disease, its treatment, and the physician's instructions plays an important role in shared decision-making. Studies have disagreed over the degree to which differences in health literacy affect patients' preferences for shared decision-making; we therefore sought to evaluate this in the context of shared decision-making about carpal tunnel release. (1) Do patients with limited health literacy have different preferences of shared decision-making for carpal tunnel release than those with greater levels of health literacy? (2) How do patients with limited health literacy retrospectively perceive their role in shared decision-making after carpal tunnel release? Over a 32-month period, one surgeon surgically treated 149 patients for carpal tunnel syndrome. Patients were eligible if they had cognitive and language function to provide informed consent and complete a self-reported questionnaire and were not eligible if they had nerve entrapment other than carpal tunnel release or had workers compensation issues; based on those, 140 (94%) were approached for study. Of those, seven (5%) were lost to followup before 6 months, leaving 133 for analysis here. Their mean age was 55 years (range, 31-76 years), and 83% (111 of 133) were women. Thirty-three percent (44 of 133) of patients had less than a high school education. Health literacy was measured according to the Newest Vital Sign during the initial visit, and a score of ≤ 3 was considered limited health literacy. Forty-four percent of patients had limited health literacy. The Control Preferences Scale was used for patients to indicate their preferred role in surgical decision-making preoperatively and to assess their perceived level of involvement postoperatively. Bivariate and multivariable analyses were performed to determine whether patients' clinical, demographic, and health literacy factors accounted for the preoperative preferences and postoperative assessments of their role in shared decision-making. A total of 133 patients would provide 94% power for a medium effect size for linear regression with five main predictors. We found no differences between patients with lower levels of health literacy and those with greater health literacy in terms of preferences of shared decision-making for carpal tunnel release (3.0 ± 1.6 versus 2.7 ± 1.4; mean difference, 0.3; 95% confidence interval, -0.2 to 0.8; p = 0.25). A history of surgical procedures (coefficient = -0.32, p < 0.01) and a lower Disabilities of the Arm, Shoulder and Hand score (coefficient = 0.17, p = 0.02) were independently associated with a preference for an active role in shared decision-making. However, patients with limited health literacy (coefficient = -0.31, p = 0.01) and an absence of a caregiver (coefficient = -0.28, p = 0.03) perceived a more passive role in actual decision-making. Physicians should be aware of the discrepancy between preferences and perceptions of shared decision-making among patients with limited health literacy, and physicians should consider providing a decision aid tailored to basic levels of health literacy to help patients achieve their preferred role in decision-making. Level II, prognostic study.

Predictors of Shared Decision Making and Level of Agreement between Consumers and Providers in Psychiatric Care

PubMed Central

Fukui, Sadaaki; Salyers, Michelle P.; Matthias, Marianne S.; Collins, Linda; Thompson, John; Coffman, Melinda; Torrey, William C.

2014-01-01

The purpose of this study was to quantitatively examine elements of shared decision making (SDM), and to establish empirical evidence for factors correlated with SDM and the level of agreement between consumer and provider in psychiatric care. Transcripts containing 128 audio-recorded medication check-up visits with eight providers at three community mental health centers were rated using the Shared Decision Making scale, adapted from Braddock’s Informed Decision Making Scale (Braddock et al., 1997; 1999; 2008). Multilevel regression analyses revealed that greater consumer activity in the session and greater decision complexity significantly predicted the SDM score. The best predictor of agreement between consumer and provider was “exploration of consumer preference,” with a four-fold increase in full agreement when consumer preferences were discussed more completely. Enhancing active consumer participation, particularly by incorporating consumer preferences in the decision making process appears to be an important factor in SDM. PMID:23299226

An economic theory of patient decision-making.

PubMed

Stewart, Douglas O; DeMarco, Joseph P

2005-01-01

Patient autonomy, as exercised in the informed consent process, is a central concern in bioethics. The typical bioethicist's analysis of autonomy centers on decisional capacity--finding the line between autonomy and its absence. This approach leaves unexplored the structure of reasoning behind patient treatment decisions. To counter that approach, we present a microeconomic theory of patient decision-making regarding the acceptable level of medical treatment from the patient's perspective. We show that a rational patient's desired treatment level typically departs from the level yielding an absence of symptoms, the level we call ideal. This microeconomic theory demonstrates why patients have good reason not to pursue treatment to the point of absence of physical symptoms. We defend our view against possible objections that it is unrealistic and that it fails to adequately consider harm a patient may suffer by curtailing treatment. Our analysis is fruitful in various ways. It shows why decisions often considered unreasonable might be fully reasonable. It offers a theoretical account of how physician misinformation may adversely affect a patient's decision. It shows how billing costs influence patient decision-making. It indicates that health care professionals' beliefs about the 'unreasonable' attitudes of patients might often be wrong. It provides a better understanding of patient rationality that should help to ensure fuller information as well as increased respect for patient decision-making.

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

PubMed Central

Nakao, Takashi; Ohira, Hideki; Northoff, Georg

2012-01-01

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

The effect of small-sided games with different levels of opposition on the tactical behaviour of young footballers with different levels of sport expertise.

PubMed

Práxedes, Alba; Moreno, Alberto; Gil-Arias, Alexander; Claver, Fernando; Del Villar, Fernando

2018-01-01

To optimize players' tactical abilities, coaches need to design training sessions with representative learning tasks, such as, small-sided games. Moreover, it is necessary to adapt the complexity of the tasks to the skill level of the athletes to maximally improve their perceptual, visual and attentive abilities. The objective of this study was to analyze the effect of two teaching programs, each utilizing modified games with varied levels of opposition, on decision-making and action execution in young players with different levels of sports expertise. 19 football players (U12), separated into two ability groups (Average versus Low skill-level), participated in a series of training sessions that were spread over 4 phases: Pre-intervention 1, Intervention 1 (teaching program based on modified games with numerical superiority in attack), Pre-intervention 2 and Intervention 2 (teaching program based on modified games with numerical equality). Each intervention phase lasted 14 sessions. Decision-making and the execution of pass action during league matches over the same period were evaluated using the Game Performance Evaluation Tool (GPET). The Average skill-level group showed significant differences after the first intervention in decision-making and execution of the pass action (decision-making, p = .015; execution, p = .031), but not after the second intervention (decision-making, p = 1.000; execution, p = 1.000). For the Low skill-level group, significant differences were only observed in the execution of passing between the first and last phases (p = .014). These findings seem to indicate that for groups with an average level of expertise, training with numerical superiority in attack provides players with more time to make better decisions and to better execute actions. However, for lower-level groups programs may take longer to facilitate improvement. Nevertheless, numerical equality did not result in improvement for either group.

The relationship between role preferences in decision-making and level of psychological distress in patients with head and neck cancer.

PubMed

Jabbour, Joe; Dhillon, Haryana M; Shepherd, Heather L; Sundaresan, Puma; Milross, Chris; Clark, Jonathan R

2018-05-28

Is there a relationship between decision-making preferences and psychological distress? Patients who had received treatment for head and neck cancer (HNC) at four institutions within NSW, Australia were invited to complete a single questionnaire. Five hundred and ninety-seven patients completed the questionnaire. The majority of patients (308, 54%) preferred shared decision making. Significant predictors of a preference towards active decision making were education level (OR 2.1 for tertiary, p < 0.001), primary cancer site (OR 1.9 for thyroid compared to salivary gland, p = 0.024) and gender (OR 1.4 for female, p = 0.028). Mean psychological distress score on Kessler 6 (K6) was 9 (Range: 0-28). Significant predictors of psychological distress were age (p < 0.001), gender (p < 0.001), primary site (p < 0.01), and decision preference (p < 0.01). HNC patients who are either tertiary educated or female are more likely to prefer active involvement in decision-making. Psychological distress is more likely in patients actively involved in decision making, younger patients, and in females. Patients experienced paternalistic decision-making, but most preferred active or a shared approached. Clinicians need to be aware of potential for psychological distress in active decision-makers and refer patients for psychosocial support. Copyright © 2018. Published by Elsevier B.V.

Study protocol for 'we DECide': implementation of advance care planning for nursing home residents with dementia.

PubMed

Ampe, Sophie; Sevenants, Aline; Coppens, Evelien; Spruytte, Nele; Smets, Tinne; Declercq, Anja; van Audenhove, Chantal

2015-05-01

To evaluate the effects of 'we DECide', an educational intervention for nursing home staff on shared decision-making in the context of advance care planning for residents with dementia. Advance care planning (preparing care choices for when persons no longer have decision-making capacity) is of utmost importance for nursing home residents with dementia, but is mostly not realized for this group. Advance care planning consists of discussing care choices and making decisions and corresponds to shared decision-making (the involvement of persons and their families in care and treatment decisions). This quasi-experimental pre-test-post-test study is conducted in 19 nursing homes (Belgium). Participants are nursing home staff. 'We DECide' focuses on three crucial moments for discussing advance care planning: the time of admission, crisis situations and everyday conversations. The 'ACP-audit' assesses participants' views on the organization of advance care planning (organizational level), the 'OPTION scale' evaluates the degree of shared decision-making in individual conversations (clinical level) and the 'IFC-SDM Questionnaire' assesses participants' views on Importance, Frequency and Competence of realizing shared decision-making (clinical level). (Project funded: July 2010). The study hypothesis is that 'we DECide' results in a higher realization of shared decision-making in individual conversations on advance care planning. A better implementation of advance care planning will lead to a higher quality of end-of-life care and more person-centred care. We believe our study will be of interest to researchers and to professional nursing home caregivers and policy-makers. © 2014 John Wiley & Sons Ltd.

Differences in Simulated Doctor and Patient Medical Decision Making: A Construal Level Perspective

PubMed Central

Zhang, Yan; Liu, Quanhui; Miao, Danmin; Xiao, Wei

2013-01-01

Background Patients are often confronted with diverse medical decisions. Often lacking relevant medical knowledge, patients fail to independently make medical decisions and instead generally rely on the advice of doctors. Objective This study investigated the characteristics of and differences in doctor–patient medical decision making on the basis of construal level theory. Methods A total of 420 undergraduates majoring in clinical medicine were randomly assigned to six groups. Their decisions to opt for radiotherapy and surgery were investigated, with the choices described in a positive/neutral/negative frame × decision making for self/others. Results Compared with participants giving medical advice to patients, participants deciding for themselves were more likely to select radiotherapy (F1, 404 = 13.92, p = 011). Participants from positive or neutral frames exhibited a higher tendency to choose surgery than did those from negative frames (F2, 404 = 22.53, p<.001). The effect of framing on independent decision making was nonsignificant (F2, 404 = 1.07, p = 35); however the effect of framing on the provision of advice to patients was significant (F2, 404 = 12.95, p<.001). The effect of construal level was significant in the positive frame (F1, 404 = 8.06, p = 005) and marginally significant in the neutral frame (F2, 404 = 3.31, p = 07) but nonsignificant in the negative frame (F2, 404 = .29, p = 59). Conclusion Both social distance and framing depiction significantly affected medical decision making and exhibited a significant interaction. Differences in medical decision making between doctors and patients need further investigation. PMID:24244445

Differences in simulated doctor and patient medical decision making: a construal level perspective.

PubMed

Peng, Jiaxi; He, Fei; Zhang, Yan; Liu, Quanhui; Miao, Danmin; Xiao, Wei

2013-01-01

Patients are often confronted with diverse medical decisions. Often lacking relevant medical knowledge, patients fail to independently make medical decisions and instead generally rely on the advice of doctors. This study investigated the characteristics of and differences in doctor-patient medical decision making on the basis of construal level theory. A total of 420 undergraduates majoring in clinical medicine were randomly assigned to six groups. Their decisions to opt for radiotherapy and surgery were investigated, with the choices described in a positive/neutral/negative frame × decision making for self/others. Compared with participants giving medical advice to patients, participants deciding for themselves were more likely to select radiotherapy (F1, 404 = 13.92, p = 011). Participants from positive or neutral frames exhibited a higher tendency to choose surgery than did those from negative frames (F2, 404 = 22.53, p<.001). The effect of framing on independent decision making was nonsignificant (F2, 404 = 1.07, p = 35); however the effect of framing on the provision of advice to patients was significant (F2, 404 = 12.95, p<.001). The effect of construal level was significant in the positive frame (F1, 404 = 8.06, p = 005) and marginally significant in the neutral frame (F2, 404 = 3.31, p = 07) but nonsignificant in the negative frame (F2, 404 = .29, p = 59). Both social distance and framing depiction significantly affected medical decision making and exhibited a significant interaction. Differences in medical decision making between doctors and patients need further investigation.

Scientific Literacy for Democratic Decision-Making

ERIC Educational Resources Information Center

Yacoubian, Hagop A.

2018-01-01

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

High Expectations: Untenured Teacher Involvement in School Decision-Making

ERIC Educational Resources Information Center

Turnbull, Barbara

2004-01-01

Findings from the current study show that new teacher expectations for involvement in school decision-making are not being actualized. Based on feedback from elementary and secondary teachers (n=504) in 87 schools, the results show significant differences between actual and preferred levels of participation in 16 areas of school decision-making.…

Effects of reflection on clinical decision-making of intensive care unit nurses.

PubMed

Razieh, Shahrokhi; Somayeh, Ghafari; Fariba, Haghani

2018-07-01

Nurses are one of the most influential factors in overcoming the main challenges faced by health systems throughout the world. Every health system should, hence, empower nurses in clinical judgment and decision-making skills. This study evaluated the effects of implementing Tanner's reflection method on clinical decision-making of nurses working in an intensive care unit (ICU). This study used an experimental, pretest, posttest design. The setting was the intensive care unit of Amin Hospital Isfahan, Iran. The convenience sample included 60 nurses working in the ICU of Amin Hospital (Isfahan, Iran). This clinical trial was performed on 60 nurses working in the ICU of Amin Hospital (Isfahan, Iran). The nurses were selected by census sampling and randomly allocated to either the case or the control group. Data were collected using a questionnaire containing demographic characteristics and the clinical decision-making scale developed by Laurie and Salantera (NDMI-14). The questionnaire was completed before and one week after the intervention. The data were analyzed using SPSS 21.0. The two groups were not significantly different in terms of the level and mean scores of clinical decision-making before the intervention (P = 0.786). Based on the results of independent t-test, the mean score of clinical decision-making one week after the intervention was significantly higher in the case group than in the control group (P = 0.009; t = -2.69). The results of Mann Whitney test showed that one week after the intervention, the nurses' level of clinical decision-making in the case group rose to the next level (P = 0.001). Reflection could improve the clinical decision-making of ICU nurses. It is, thus, recommended to incorporate this method into the nursing curriculum and care practices. Copyright © 2018. Published by Elsevier Ltd.

Comparing perceptual and preferential decision making.

PubMed

Dutilh, Gilles; Rieskamp, Jörg

2016-06-01

Perceptual and preferential decision making have been studied largely in isolation. Perceptual decisions are considered to be at a non-deliberative cognitive level and have an outside criterion that defines the quality of decisions. Preferential decisions are considered to be at a higher cognitive level and the quality of decisions depend on the decision maker's subjective goals. Besides these crucial differences, both types of decisions also have in common that uncertain information about the choice situation has to be processed before a decision can be made. The present work aims to acknowledge the commonalities of both types of decision making to lay bare the crucial differences. For this aim we examine perceptual and preferential decisions with a novel choice paradigm that uses the identical stimulus material for both types of decisions. This paradigm allows us to model the decisions and response times of both types of decisions with the same sequential sampling model, the drift diffusion model. The results illustrate that the different incentive structure in both types of tasks changes people's behavior so that they process information more efficiently and respond more cautiously in the perceptual as compared to the preferential task. These findings set out a perspective for further integration of perceptual and preferential decision making in a single ramework.

Finding the numerical compensation in multiple criteria decision-making problems under fuzzy environment

NASA Astrophysics Data System (ADS)

Gupta, Mahima; Mohanty, B. K.

2017-04-01

In this paper, we have developed a methodology to derive the level of compensation numerically in multiple criteria decision-making (MCDM) problems under fuzzy environment. The degree of compensation is dependent on the tranquility and anxiety level experienced by the decision-maker while taking the decision. Higher tranquility leads to the higher realisation of the compensation whereas the increased level of anxiety reduces the amount of compensation in the decision process. This work determines the level of tranquility (or anxiety) using the concept of fuzzy sets and its various level sets. The concepts of indexing of fuzzy numbers, the risk barriers and the tranquility level of the decision-maker are used to derive his/her risk prone or risk averse attitude of decision-maker in each criterion. The aggregation of the risk levels in each criterion gives us the amount of compensation in the entire MCDM problem. Inclusion of the compensation leads us to model the MCDM problem as binary integer programming problem (BIP). The solution to BIP gives us the compensatory decision to MCDM. The proposed methodology is illustrated through a numerical example.

Deep Rationality: The Evolutionary Economics of Decision Making.

PubMed

Kenrick, Douglas T; Griskevicius, Vladas; Sundie, Jill M; Li, Norman P; Li, Yexin Jessica; Neuberg, Steven L

2009-10-01

What is a "rational" decision? Economists traditionally viewed rationality as maximizing expected satisfaction. This view has been useful in modeling basic microeconomic concepts, but falls short in accounting for many everyday human decisions. It leaves unanswered why some things reliably make people more satisfied than others, and why people frequently act to make others happy at a cost to themselves. Drawing on an evolutionary perspective, we propose that people make decisions according to a set of principles that may not appear to make sense at the superficial level, but that demonstrate rationality at a deeper evolutionary level. By this, we mean that people use adaptive domain-specific decision-rules that, on average, would have resulted in fitness benefits. Using this framework, we re-examine several economic principles. We suggest that traditional psychological functions governing risk aversion, discounting of future benefits, and budget allocations to multiple goods, for example, vary in predictable ways as a function of the underlying motive of the decision-maker and individual differences linked to evolved life-history strategies. A deep rationality framework not only helps explain why people make the decisions they do, but also inspires multiple directions for future research.

Deep Rationality: The Evolutionary Economics of Decision Making

PubMed Central

Kenrick, Douglas T.; Griskevicius, Vladas; Sundie, Jill M.; Li, Norman P.; Li, Yexin Jessica; Neuberg, Steven L.

2009-01-01

What is a “rational” decision? Economists traditionally viewed rationality as maximizing expected satisfaction. This view has been useful in modeling basic microeconomic concepts, but falls short in accounting for many everyday human decisions. It leaves unanswered why some things reliably make people more satisfied than others, and why people frequently act to make others happy at a cost to themselves. Drawing on an evolutionary perspective, we propose that people make decisions according to a set of principles that may not appear to make sense at the superficial level, but that demonstrate rationality at a deeper evolutionary level. By this, we mean that people use adaptive domain-specific decision-rules that, on average, would have resulted in fitness benefits. Using this framework, we re-examine several economic principles. We suggest that traditional psychological functions governing risk aversion, discounting of future benefits, and budget allocations to multiple goods, for example, vary in predictable ways as a function of the underlying motive of the decision-maker and individual differences linked to evolved life-history strategies. A deep rationality framework not only helps explain why people make the decisions they do, but also inspires multiple directions for future research. PMID:20686634

Attitudes toward concordance and self-efficacy in decision making: a cross-sectional study on pharmacist-patient consultations.

PubMed

Ng, Yew Keong; Shah, Noraida Mohamed; Loong, Ly Sia; Pee, Lay Ting; Hidzir, Sarina Anim M; Chong, Wei Wen

2018-01-01

This study investigated patients' and pharmacists' attitudes toward concordance in a pharmacist-patient consultation and how patients' attitudes toward concordance relate to their involvement and self-efficacy in decision making associated with medication use. A cross-sectional study was conducted among patients with chronic diseases and pharmacists from three public hospitals in Malaysia. The Revised United States Leeds Attitudes toward Concordance (RUS-LATCon) was used to measure attitudes toward concordance in both patients and pharmacists. Patients also rated their perceived level of involvement in decision making and completed the Decision Self-Efficacy scale. One-way analysis of variance (ANOVA) and independent t -test were used to determine significant differences between different subgroups on attitudes toward concordance, and multiple linear regression was performed to find the predictors of patients' self-efficacy in decision making. A total of 389 patients and 93 pharmacists participated in the study. Pharmacists and patients scored M=3.92 (SD=0.37) and M=3.84 (SD=0.46) on the RUS-LATCon scale, respectively. Seven items were found to be significantly different between pharmacists and patients on the subscale level. Patients who felt fully involved in decision making (M=3.94, SD=0.462) scored significantly higher on attitudes toward concordance than those who felt partially involved (M=3.82, SD=0.478) and not involved at all (M=3.68, SD=0.471; p <0.001). Patients had an average score of 76.7% (SD=14.73%) on the Decision Self-Efficacy scale. In multiple linear regression analysis, ethnicity, number of medications taken by patients, patients' perceived level of involvement, and attitudes toward concordance are significant predictors of patients' self-efficacy in decision making ( p <0.05). Patients who felt involved in their consultations had more positive attitudes toward concordance and higher confidence in making an informed decision. Further study is recommended on interventions involving pharmacists in supporting patients' involvement in medication-related decision making.

District decision-making for health in low-income settings: a systematic literature review

PubMed Central

Avan, Bilal Iqbal

2016-01-01

Health management information systems (HMIS) produce large amounts of data about health service provision and population health, and provide opportunities for data-based decision-making in decentralized health systems. Yet the data are little-used locally. A well-defined approach to district-level decision-making using health data would help better meet the needs of the local population. In this second of four papers on district decision-making for health in low-income settings, our aim was to explore ways in which district administrators and health managers in low- and lower-middle-income countries use health data to make decisions, to describe the decision-making tools they used and identify challenges encountered when using these tools. A systematic literature review, following PRISMA guidelines, was undertaken. Experts were consulted about key sources of information. A search strategy was developed for 14 online databases of peer reviewed and grey literature. The resources were screened independently by two reviewers using pre-defined inclusion criteria. The 14 papers included were assessed for the quality of reported evidence and a descriptive evidence synthesis of the review findings was undertaken. We found 12 examples of tools to assist district-level decision-making, all of which included two key stages—identification of priorities, and development of an action plan to address them. Of those tools with more steps, four included steps to review or monitor the action plan agreed, suggesting the use of HMIS data. In eight papers HMIS data were used for prioritization. Challenges to decision-making processes fell into three main categories: the availability and quality of health and health facility data; human dynamics and financial constraints. Our findings suggest that evidence is available about a limited range of processes that include the use of data for decision-making at district level. Standardization and pre-testing in diverse settings would increase the potential that these tools could be used more widely. PMID:27591202

Incorporating affective bias in models of human decision making

NASA Technical Reports Server (NTRS)

Nygren, Thomas E.

1991-01-01

Research on human decision making has traditionally focused on how people actually make decisions, how good their decisions are, and how their decisions can be improved. Recent research suggests that this model is inadequate. Affective as well as cognitive components drive the way information about relevant outcomes and events is perceived, integrated, and used in the decision making process. The affective components include how the individual frames outcomes as good or bad, whether the individual anticipates regret in a decision situation, the affective mood state of the individual, and the psychological stress level anticipated or experienced in the decision situation. A focus of the current work has been to propose empirical studies that will attempt to examine in more detail the relationships between the latter two critical affective influences (mood state and stress) on decision making behavior.

The potential for shared decision-making and decision aids in rehabilitation medicine.

PubMed

van Til, Janine A; Drossaert, Constance H C; Punter, R Annemiek; Ijzerman, Maarten J

2010-06-01

Shared decision-making and the use of decision aids are increasingly promoted in various healthcare settings. The extent of their current use and potential in rehabilitation medicine is unknown. The aim of the present study was to explore the barriers to and facilitators of shared decision-making and use of decision aids in daily practice, and to explore the perceptions of physical and rehabilitation medicine (PRM) physicians toward them. A cross-sectional survey of 408 PRM physicians was performed (response rate 31%). PRM physicians expressed the highest levels of comfort with shared decision-making as opposed to paternalistic and informed decision-making. The majority reported that shared decision-making constituted their usual approach. The most important barriers to shared decision-making were cases in which the patient received conflicting recommendations and when the patient had difficulty accepting the disease. Key facilitators were the patient's trust in the PRM physician and the patient being knowledgeable about the disease and about treatment options. PRM physicians' attitudes towards the use of decision aids to inform patients were moderately positive. Shared decision-making appears to have great potential in the rehabilitation setting. Increasing the use of decision aids may contribute to the further implementation of shared decision-making.

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

PubMed

Mühlbacher, Axel C; Juhnke, Christin

2016-01-01

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

Effects of outcome on the covariance between risk level and brain activity in adolescents with internet gaming disorder.

PubMed

Qi, Xin; Yang, Yongxin; Dai, Shouping; Gao, Peihong; Du, Xin; Zhang, Yang; Du, Guijin; Li, Xiaodong; Zhang, Quan

2016-01-01

Individuals with internet gaming disorder (IGD) often have impaired risky decision-making abilities, and IGD-related functional changes have been observed during neuroimaging studies of decision-making tasks. However, it is still unclear how feedback (outcomes of decision-making) affects the subsequent risky decision-making in individuals with IGD. In this study, twenty-four adolescents with IGD and 24 healthy controls (HCs) were recruited and underwent functional magnetic resonance imaging while performing the balloon analog risk task (BART) to evaluate the effects of prior outcomes on brain activity during subsequent risky decision-making in adolescents with IGD. The covariance between risk level and activation of the bilateral ventral medial prefrontal cortex, left inferior frontal cortex, right ventral striatum (VS), left hippocampus/parahippocampus, right inferior occipital gyrus/fusiform gyrus and right inferior temporal gyrus demonstrated interaction effects of group by outcome ( P  < 0.05, AlphaSim correction). The regions with interactive effects were defined as ROI, and ROI-based intergroup comparisons showed that the covariance between risk level and brain activation was significantly greater in adolescents with IGD compared with HCs after a negative outcome occurred ( P  < 0.05). Our results indicated that negative outcomes affected the covariance between risk level and activation of the brain regions related to value estimation (prefrontal cortex), anticipation of rewards (VS), and emotional-related learning (hippocampus/parahippocampus), which may be one of the underlying neural mechanisms of disadvantageous risky decision-making in adolescents with IGD.

Using the decision ladder to understand road user decision making at actively controlled rail level crossings.

PubMed

Mulvihill, Christine M; Salmon, Paul M; Beanland, Vanessa; Lenné, Michael G; Read, Gemma J M; Walker, Guy H; Stanton, Neville A

2016-09-01

Rail level crossings (RLXs) represent a key strategic risk for railways worldwide. Despite enforcement and engineering countermeasures, user behaviour at RLXs can often confound expectations and erode safety. Research in this area is limited by a relative absence of insights into actual decision making processes and a focus on only a subset of road user types. One-hundred and sixty-six road users (drivers, motorcyclists, cyclists and pedestrians) completed a diary entry for each of 457 naturalistic encounters with RLXs when a train was approaching. The final eligible sample comprised 94 participants and 248 encounters at actively controlled crossings where a violation of the active warnings was possible. The diary incorporated Critical Decision Method probe questions, which enabled user responses to be mapped onto Rasmussen's decision ladder. Twelve percent of crossing events were non-compliant. The underlying decision making was compared to compliant events and a reference decision model to reveal important differences in the structure and type of decision making within and between road user groups. The findings show that engineering countermeasures intended to improve decision making (e.g. flashing lights), may have the opposite effect for some users because the system permits a high level of flexibility for circumvention. Non-motorised users were more likely to access information outside of the warning signals because of their ability to achieve greater proximity to the train tracks and the train itself. The major conundrum in resolving these issues is whether to restrict the amount of time and information available to users so that it cannot be used for circumventing the system or provide more information to help users make safe decisions. Copyright © 2016 Elsevier Ltd. All rights reserved.

What Informs Primary School Principals' Decision-Making in Relation to Teacher Placement in Class Levels?

ERIC Educational Resources Information Center

Carlyon, Tracey; Fisher, Anthony

2012-01-01

One of the most challenging decisions for primary school principals is to decide what class level each of their teachers will teach. It seems there is very little research on the way principals go about making these decisions. Government reforms have had significant impact on the role of the primary school principal in New Zealand, and a trend has…

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

USGS Publications Warehouse

Caughlan, L.

2002-01-01

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

Good decision-making is associated with an adaptive cardiovascular response to social competitive stress.

PubMed

Alacreu-Crespo, Adrián; Costa, Raquel; Abad-Tortosa, Diana; Salvador, Alicia; Serrano, Miguel Ángel

2018-06-22

Competition elicits different psychological and cardiovascular responses depending on a person's skills. Decision-making has been considered a distal factor that influences competition, but there are no studies analyzing this relationship. Our objective was to analyze whether decision-making affects the response to competition. Specifically, we aimed to test whether good performers on a decision-making test, the Iowa Gambling Task (IGT), showed an adaptive cardiovascular response to competition. In all, 116 participants (44 women) performed the IGT and were classified into Good or Poor decision-makers. Subsequently, they were exposed to a stress task in two different conditions: a face-to-face competition (winners/losers) or a control condition, while an electrocardiogram was recorded. In the competition group, good decision-makers increased their high-frequency respect to the total heart rate variability (HF/HRV) levels during the task, compared to Poor decision-makers. Again, competition group good decision-makers, showed lower LF and higher HF/HRV reactivity than the control group, which represents lower HRV stress pattern. Moreover, in the group of losers, good decision-makers had a decline in low frequency (LF) during the task and faster recovery than poor decision-makers. In conclusion, good decision-makers have a more adaptive stress response and higher levels of mental effort, based on total HRV interpretation. Decision-making skills could be a factor in a more adaptive cardiovascular response to competition.

Oxygen desaturation during night sleep affects decision-making in patients with obstructive sleep apnea.

PubMed

Delazer, Margarete; Zamarian, Laura; Frauscher, Birgit; Mitterling, Thomas; Stefani, Ambra; Heidbreder, Anna; Högl, Birgit

2016-08-01

This study assessed decision-making and its associations with executive functions and sleep-related factors in patients with obstructive sleep apnea. Thirty patients with untreated obstructive sleep apnea and 20 healthy age- and education-matched controls performed the Iowa Gambling Task, a decision-making task under initial ambiguity, as well as an extensive neuropsychological test battery. Patients, but not controls, also underwent a detailed polysomnographic assessment. Results of group analyses showed that patients performed at the same level of controls on the Iowa Gambling Task. However, the proportion of risky performers was significantly higher in the patient group than in the control group. Decision-making did not correlate with executive functions and subjective ratings of sleepiness, whereas there was a significant positive correlation between advantageous performance on the Iowa Gambling Task and percentage of N2 sleep, minimal oxygen saturation, average oxygen saturation and time spent below 90% oxygen saturation level. Also, the minimal oxygen saturation accounted for 27% of variance in decision-making. In conclusion, this study shows that a subgroup of patients with obstructive sleep apnea may be at risk of disadvantageous decision-making under ambiguity. Among the sleep-related factors, oxygen saturation is a significant predictor of advantageous decision-making. © 2016 European Sleep Research Society.

Decision-making impairment in anorexia nervosa: New insights into the role of age and decision-making style.

PubMed

Giannunzio, Valeria; Degortes, Daniela; Tenconi, Elena; Collantoni, Enrico; Solmi, Marco; Santonastaso, Paolo; Favaro, Angela

2018-07-01

Patients with anorexia nervosa (AN) often report difficulties in decision making, which may interfere with treatment. The aim of this study was to investigate decision making in a large sample of adolescent and adult patients with AN, by using the Iowa gambling task. Participants were 611 female individuals (310 patients and 301 controls) who underwent neuropsychological and clinical assessment. Significantly poorer decision-making performance was observed in adult patients, whereas no difference emerged between affected and nonaffected adolescents. Both adolescent and adult patients were characterized by trends for higher levels of attention to losses in comparison with healthy controls. Although healthy adult women exhibited better decision-making performance than healthy adolescents, in AN, there was no improvement of decision making with age. A cluster analysis identified 2 different styles of decision making in both patients and controls: a conservative style and an impulsive style. Our study provides evidence of dysfunctional decision making in adult patients with AN and reveals an association between poor decision making and excessive punishment sensitivity in AN. The clinical and scientific implications of these findings merit further exploration. Copyright © 2018 John Wiley & Sons, Ltd and Eating Disorders Association.

Placement decisions and disparities among aboriginal groups: an application of the decision making ecology through multi-level analysis.

PubMed

Fluke, John D; Chabot, Martin; Fallon, Barbara; MacLaurin, Bruce; Blackstock, Cindy

2010-01-01

This paper examined the relative influence of clinical and organizational characteristics on the decision to place a child in out-of-home care at the conclusion of a child maltreatment investigation. It tested the hypothesis that extraneous factors, specifically, organizational characteristics, impact the decision to place a child in out-of-home care. A secondary aim was to identify possible decision making influences related to disparities in placement decisions tied to Aboriginal children. Research suggests that the Aboriginal status of the child and structural risk factors affecting the family, such as poverty and poor housing, substantially account for this overrepresentation. The decision to place a child in out-of-home care was examined using data from the Canadian Incidence Study of Reported Child Abuse and Neglect. This child welfare dataset collected information about the results of nearly 5,000 child maltreatment investigations as well as a description of the characteristics of the workers and organization responsible for conducting those investigations. Multi-level statistical models were developed using MPlus software, which can accommodate dichotomous outcome variables, which are more reflective of decision making in child welfare. MPlus allows the specific case of the logistic link function for binary outcome variables under maximum likelihood estimation. Final models revealed the importance of the number of Aboriginal reports to an organization as a key second level predictor of the placement decision. It is the only second level factor that remains in the final model. This finding was very stable when tested over several different levels of proportionate caseload representation ranging from greater than 50% to 20% of the caseload. Disparities among Aboriginal children in child welfare decision making were identified at the agency level. The study provides additional evidence supporting the possibility that one source of overrepresentation of Aboriginal children in the Canadian foster care system is a lack of appropriate resources at the agency or community level. Copyright (c) 2009 Elsevier Ltd. All rights reserved.

Complexity science and participation in decision making among Taiwanese nurses.

PubMed

Liu, Yi

2008-04-01

The perspective of interconnection in complexity science is used to examine the concept of participation in decision making among Taiwanese nurses in the context of Chinese communication culture. Participation in decision making among nurses has been widely discussed and tested in the Western healthcare systems. Many studies have shown that participation in decision making relates to nurses' autonomy, job satisfaction and quality of care. However, participation in decision making has not been fully discussed in Taiwan's nursing community. In a different cultural environment, participation in decision making may have different effects. The concept of participation in decision making is analysed in three facets of Chinese communication culture: (1) hierarchical social relationship; (2) harmony maintenance; and (3) insider effects. Key issues Taiwanese nurses might establish different levels of participation and need to use different strategies to enhance participation in decision making for desired outcomes. While applying participation in decision making in a different context, it is very important to consider the social and cultural differences. Two implications are made. First, nursing leaders/managers who are working with a multicultural team should be aware of the cultural difference in the pattern of interaction in the process of participation in decision making. Second, leaders/managers should be creative and try to apply different strategies to encourage staff's participation in decision making.

Consideration of Shared Decision Making in Nursing: A Review of Clinicians’ Perceptions and Interventions

PubMed Central

Clark, Noreen M; Nelson, Belinda W; Valerio, Melissa A; Gong, Z. Molly; Taylor-Fishwick, Judith C; Fletcher, Monica

2009-01-01

As the number of individuals with chronic illness increases so has the need for strategies to enable nurses to engage them effectively in daily management of their conditions. Shared decision making between patients and nurses is one approach frequently discussed in the literature. This paper reviews recent studies of shared decision making and the meaning of findings for the nurse-patient relationship. Patients likely to prefer to engage in shared decision making are younger and have higher levels of education. However, there is a lack of evidence for the effect of shared decision making on patient outcomes. Further, studies are needed to examine shared decision making when the patient is a child. Nurses are professionally suited to engage their patients fully in treatment plans. More evidence for how shared decision making affects outcomes and how nurses can successfully achieve such engagement is needed. PMID:19855848

Health technology funding decision-making processes around the world: the same, yet different.

PubMed

Stafinski, Tania; Menon, Devidas; Philippon, Donald J; McCabe, Christopher

2011-06-01

All healthcare systems routinely make resource allocation decisions that trade off potential health gains to different patient populations. However, when such trade-offs relate to the introduction of new, promising health technologies, perceived 'winners' and 'losers' are more apparent. In recent years, public scrutiny over such decisions has intensified, raising the need to better understand how they are currently made and how they might be improved. The objective of this paper is to critically review and compare current processes for making health technology funding decisions at the regional, state/provincial and national level in 20 countries. A comprehensive search for published, peer-reviewed and grey literature describing actual national, state/provincial and regional/institutional technology decision-making processes was conducted. Information was extracted by two independent reviewers and tabulated to facilitate qualitative comparative analyses. To identify strengths and weaknesses of processes identified, websites of corresponding organizations were searched for commissioned reviews/evaluations, which were subsequently analysed using standard qualitative methods. A total of 21 national, four provincial/state and six regional/institutional-level processes were found. Although information on each one varied, they could be grouped into four sequential categories: (i) identification of the decision problem; (ii) information inputs; (iii) elements of the decision-making process; and (iv) public accountability and decision implementation. While information requirements of all processes appeared substantial and decision-making factors comprehensive, the way in which they were utilized was often unclear, as were approaches used to incorporate social values or equity arguments into decisions. A comprehensive inventory of approaches to implementing the four main components of all technology funding decision-making processes was compiled, from which areas for future work or research aimed at improving the acceptability of decisions were identified. They include the explication of decision criteria and social values underpinning processes.

Decision-making for risky gains and losses among college students with Internet gaming disorder.

PubMed

Yao, Yuan-Wei; Chen, Pin-Ru; Li, Song; Wang, Ling-Jiao; Zhang, Jin-Tao; Yip, Sarah W; Chen, Gang; Deng, Lin-Yuan; Liu, Qin-Xue; Fang, Xiao-Yi

2015-01-01

Individuals with Internet gaming disorder (IGD) tend to exhibit disadvantageous risky decision-making not only in their real life but also in laboratory tasks. Decision-making is a complex multifaceted function and different cognitive processes are involved in decision-making for gains and losses. However, the relationship between impaired decision-making and gain versus loss processing in the context of IGD is poorly understood. The main aim of the present study was to separately evaluate decision-making for risky gains and losses among college students with IGD using the Cups task. Additionally, we further examined the effects of outcome magnitude and probability level on decision-making related to risky gains and losses respectively. Sixty college students with IGD and 42 matched healthy controls (HCs) participated. Results indicated that IGD subjects exhibited generally greater risk taking tendencies than HCs. In comparison to HCs, IGD subjects made more disadvantageous risky choices in the loss domain (but not in the gain domain). Follow-up analyses indicated that the impairment was associated to insensitivity to changes in outcome magnitude and probability level for risky losses among IGD subjects. In addition, higher Internet addiction severity scores were associated with percentage of disadvantageous risky options in the loss domain. These findings emphasize the effect of insensitivity to losses on disadvantageous decisions under risk in the context of IGD, which has implications for future intervention studies.

Neonatologists can impede or support parents' participation in decision-making during medical rounds in neonatal intensive care units.

PubMed

Axelin, Anna; Outinen, Jyri; Lainema, Kirsi; Lehtonen, Liisa; Franck, Linda S

2018-05-03

We explored the dynamics of neonatologist-parent communication and decision-making during medical rounds in a level three neonatal intensive care unit. This was a qualitative study, with an ethnographic approach, that was conducted at Turku University Hospital, Finland, from 2013-2014. We recruited eight mothers and seven couples, their 11 singletons and four sets of twins and two neonatologists and observed and video recorded 15 medical rounds. The infants were born at 23+5 to 40+1 weeks and the parents were aged 24-47. The neonatologists and parents were interviewed separately after the rounds. Four patterns of interaction emerged. The collaborative pattern was most consistent, with the ideal of shared decision-making, as the parents' preferences were genuinely and visibly integrated into the treatment decisions. In the neonatologist-led interactional pattern, the decision-making process was only somewhat inclusive of the parents' observations and preferences. The remaining two patterns, emergency and disconnected, were characterised by a paternalistic decision-making model where the parents' observations and preferences had minimal to no influence on the communication or decision-making. The neonatologists played a central role in facilitating parental participation and their interaction during medical rounds were characterised by the level of parent participation in decision-making. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Decision-Making in Elementary School-Age Children: Effects Upon Motor Learning and Self-Concept Development.

ERIC Educational Resources Information Center

Lydon, Mary C.; Cheffers, John T. F.

1984-01-01

This article reports on a study that sought to determine the effects of variable decision-making teaching models upon the development of body coordination and self-concept of elementary school children. Results indicated that level of motor skill achievement was maintained when students were given decision-making responsibility. (Author/DF)

75 FR 7212 - Definition of “Reasonable Factors Other Than Age” Under the Age Discrimination in Employment Act

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-18

...' were ubiquitous components of `systems for making personnel decisions' ''), vacated and remanded, 128 S... discrimination by lower-level managers given unchecked discretion to engage in subjective decision making needs... system of subjective decision-making' '') (quoting Stout v. Potter, 276 F.3d 118, 1124 (9th Cir. 2002...

Career Decision Making in the Shadow of Economic Downturn: A Study of Cape Breton High School Students.

ERIC Educational Resources Information Center

Chisholm, Joe; Edmunds, Alan

2001-01-01

Examines differences in levels of career decision-making self-efficacy in Cape Breton high school students who lived in communities with recent closures of mining and steel industries compared to students from communities with no such closures. Students demonstrated considerable confidence in their career decision-making abilities implying that…

Goal-Directed Decision Making with Spiking Neurons.

PubMed

Friedrich, Johannes; Lengyel, Máté

2016-02-03

Behavioral and neuroscientific data on reward-based decision making point to a fundamental distinction between habitual and goal-directed action selection. The formation of habits, which requires simple updating of cached values, has been studied in great detail, and the reward prediction error theory of dopamine function has enjoyed prominent success in accounting for its neural bases. In contrast, the neural circuit mechanisms of goal-directed decision making, requiring extended iterative computations to estimate values online, are still unknown. Here we present a spiking neural network that provably solves the difficult online value estimation problem underlying goal-directed decision making in a near-optimal way and reproduces behavioral as well as neurophysiological experimental data on tasks ranging from simple binary choice to sequential decision making. Our model uses local plasticity rules to learn the synaptic weights of a simple neural network to achieve optimal performance and solves one-step decision-making tasks, commonly considered in neuroeconomics, as well as more challenging sequential decision-making tasks within 1 s. These decision times, and their parametric dependence on task parameters, as well as the final choice probabilities match behavioral data, whereas the evolution of neural activities in the network closely mimics neural responses recorded in frontal cortices during the execution of such tasks. Our theory provides a principled framework to understand the neural underpinning of goal-directed decision making and makes novel predictions for sequential decision-making tasks with multiple rewards. Goal-directed actions requiring prospective planning pervade decision making, but their circuit-level mechanisms remain elusive. We show how a model circuit of biologically realistic spiking neurons can solve this computationally challenging problem in a novel way. The synaptic weights of our network can be learned using local plasticity rules such that its dynamics devise a near-optimal plan of action. By systematically comparing our model results to experimental data, we show that it reproduces behavioral decision times and choice probabilities as well as neural responses in a rich set of tasks. Our results thus offer the first biologically realistic account for complex goal-directed decision making at a computational, algorithmic, and implementational level. Copyright © 2016 the authors 0270-6474/16/361529-18$15.00/0.

Goal-Directed Decision Making with Spiking Neurons

PubMed Central

Lengyel, Máté

2016-01-01

Behavioral and neuroscientific data on reward-based decision making point to a fundamental distinction between habitual and goal-directed action selection. The formation of habits, which requires simple updating of cached values, has been studied in great detail, and the reward prediction error theory of dopamine function has enjoyed prominent success in accounting for its neural bases. In contrast, the neural circuit mechanisms of goal-directed decision making, requiring extended iterative computations to estimate values online, are still unknown. Here we present a spiking neural network that provably solves the difficult online value estimation problem underlying goal-directed decision making in a near-optimal way and reproduces behavioral as well as neurophysiological experimental data on tasks ranging from simple binary choice to sequential decision making. Our model uses local plasticity rules to learn the synaptic weights of a simple neural network to achieve optimal performance and solves one-step decision-making tasks, commonly considered in neuroeconomics, as well as more challenging sequential decision-making tasks within 1 s. These decision times, and their parametric dependence on task parameters, as well as the final choice probabilities match behavioral data, whereas the evolution of neural activities in the network closely mimics neural responses recorded in frontal cortices during the execution of such tasks. Our theory provides a principled framework to understand the neural underpinning of goal-directed decision making and makes novel predictions for sequential decision-making tasks with multiple rewards. SIGNIFICANCE STATEMENT Goal-directed actions requiring prospective planning pervade decision making, but their circuit-level mechanisms remain elusive. We show how a model circuit of biologically realistic spiking neurons can solve this computationally challenging problem in a novel way. The synaptic weights of our network can be learned using local plasticity rules such that its dynamics devise a near-optimal plan of action. By systematically comparing our model results to experimental data, we show that it reproduces behavioral decision times and choice probabilities as well as neural responses in a rich set of tasks. Our results thus offer the first biologically realistic account for complex goal-directed decision making at a computational, algorithmic, and implementational level. PMID:26843636

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

PubMed

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

2010-06-01

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

Medical Decision-Making by Psychiatry Residents

ERIC Educational Resources Information Center

El-Mallakh, Rif; Zinner, Jill; Mackey, Amanda; Tamas, Rebecca L.; Martin, Chanley M.; Dalton, Jerad; Dhaliwal, Nitu; Luddington, Nicole; Numan, Farhad U.; Nunes, Ross; Taylor, Stephen; Ye, Lu

2007-01-01

Objective: Several conspiring factors have resulted in an increase in the level of medical burden in psychiatric patients. Psychiatry residents require increasing levels of medical sophistication. To assess the medical decision-making of psychiatry residents, the authors examined the outcome in subjects initially seen in the emergency psychiatric…

Cannabis, alcohol use, psychological distress, and decision-making style.

PubMed

Phillips, James G; Ogeil, Rowan P

2017-09-01

There have been suggestions of hypofrontality in cannabis users. To understand cannabis-related differences in decisional processes, Janis and Mann's conflict model of decision making was applied to recreational cannabis smokers who varied in their alcohol use and level of psychological distress. An online sample of recreational substance users (114 male, 119 female) completed the Melbourne Decision Making Questionnaire, the Alcohol Use Disorders Identification Test (AUDIT), Kessler's Psychological Distress Scale (K10), and the Severity of Dependence Scale (SDS) for cannabis. Multivariate analysis of variance examined self-reported decision-making styles as a function of gender, recent cannabis use, risky alcohol consumption, and levels of psychological distress. Psychological distress was associated with lower decisional self-esteem and higher levels of procrastination and buck-passing. There were gender differences associated with cannabis use. Female cannabis users reported higher levels of hypervigilance, while male cannabis users reported lower levels of buck-passing. Although there was little indication of an avoidant decisional style in cannabis users, the results suggest that cannabis affects decisional processes, contributing to panic in females and impulsivity in males.

The influence of spatiotemporal structure of noisy stimuli in decision making.

PubMed

Insabato, Andrea; Dempere-Marco, Laura; Pannunzi, Mario; Deco, Gustavo; Romo, Ranulfo

2014-04-01

Decision making is a process of utmost importance in our daily lives, the study of which has been receiving notable attention for decades. Nevertheless, the neural mechanisms underlying decision making are still not fully understood. Computational modeling has revealed itself as a valuable asset to address some of the fundamental questions. Biophysically plausible models, in particular, are useful in bridging the different levels of description that experimental studies provide, from the neural spiking activity recorded at the cellular level to the performance reported at the behavioral level. In this article, we have reviewed some of the recent progress made in the understanding of the neural mechanisms that underlie decision making. We have performed a critical evaluation of the available results and address, from a computational perspective, aspects of both experimentation and modeling that so far have eluded comprehension. To guide the discussion, we have selected a central theme which revolves around the following question: how does the spatiotemporal structure of sensory stimuli affect the perceptual decision-making process? This question is a timely one as several issues that still remain unresolved stem from this central theme. These include: (i) the role of spatiotemporal input fluctuations in perceptual decision making, (ii) how to extend the current results and models derived from two-alternative choice studies to scenarios with multiple competing evidences, and (iii) to establish whether different types of spatiotemporal input fluctuations affect decision-making outcomes in distinctive ways. And although we have restricted our discussion mostly to visual decisions, our main conclusions are arguably generalizable; hence, their possible extension to other sensory modalities is one of the points in our discussion.

The Influence of Spatiotemporal Structure of Noisy Stimuli in Decision Making

PubMed Central

Deco, Gustavo; Romo, Ranulfo

2014-01-01

Decision making is a process of utmost importance in our daily lives, the study of which has been receiving notable attention for decades. Nevertheless, the neural mechanisms underlying decision making are still not fully understood. Computational modeling has revealed itself as a valuable asset to address some of the fundamental questions. Biophysically plausible models, in particular, are useful in bridging the different levels of description that experimental studies provide, from the neural spiking activity recorded at the cellular level to the performance reported at the behavioral level. In this article, we have reviewed some of the recent progress made in the understanding of the neural mechanisms that underlie decision making. We have performed a critical evaluation of the available results and address, from a computational perspective, aspects of both experimentation and modeling that so far have eluded comprehension. To guide the discussion, we have selected a central theme which revolves around the following question: how does the spatiotemporal structure of sensory stimuli affect the perceptual decision-making process? This question is a timely one as several issues that still remain unresolved stem from this central theme. These include: (i) the role of spatiotemporal input fluctuations in perceptual decision making, (ii) how to extend the current results and models derived from two-alternative choice studies to scenarios with multiple competing evidences, and (iii) to establish whether different types of spatiotemporal input fluctuations affect decision-making outcomes in distinctive ways. And although we have restricted our discussion mostly to visual decisions, our main conclusions are arguably generalizable; hence, their possible extension to other sensory modalities is one of the points in our discussion. PMID:24743140

Assessing Affective and Deliberative Decision-Making: Adaptation of the Columbia Card Task to Brazilian Portuguese.

PubMed

Kluwe-Schiavon, Bruno; Sanvicente-Vieira, Breno; Viola, Thiago W; Veiga, Eduardo; Bortolotto, Vanessa; Grassi-Oliveira, Rodrigo

2015-11-20

The ability to predict reward and punishment is essential for decision-making and the ability to learn about an ever-changing environment. Therefore, efforts have been made in understanding the mechanisms underlying decision-making, especially regarding how affective and deliberative processes interact with risk behavior. To adapt to Brazilian Portuguese the Columbia Card Task (CCT) and investigate affective and deliberative processes involved in decision-making. This study had two main phases: (1) a transcultural adaptation and (2) a pilot study. The feedback manipulation among the three conditions of CCT had an effect on the risk-taking level (p < .005, ES = .201). In addition, the feedback manipulation among the three conditions of CCT had an effect on the information use at both the individual and group levels. Further, a linear regression suggested that the use of information, indicated by the advantageous level of the scenarios, predict the number of cards chosen R 2 = .029, p < .001, accounting for 17% of the variance. The Brazilian CCT performs well and is a versatile method for the assessment of affective and deliberative decision-making under risk according to different feedback manipulation scenarios. This study goes further, comparing electrodermal activity during hot and warm conditions and addressing an advantageous level index analysis to asses deliberative processing.

Dysfunctional representation of expected value is associated with reinforcement-based decision-making deficits in adolescents with conduct problems.

PubMed

White, Stuart F; Tyler, Patrick M; Erway, Anna K; Botkin, Mary L; Kolli, Venkata; Meffert, Harma; Pope, Kayla; Blair, James R

2016-08-01

Previous work has shown that patients with conduct problems (CP) show impairments in reinforcement-based decision-making. However, studies with patients have not previously demonstrated any relationships between impairment in any of the neurocomputations underpinning reinforcement-based decision-making and specific symptom sets [e.g. level of CP and/or callous-unemotional (CU) traits]. Seventy-two youths [20 female, mean age = 13.81 (SD = 2.14), mean IQ = 102.34 (SD = 10.99)] from a residential treatment program and the community completed a passive avoidance task while undergoing functional MRI. Greater levels of CP were associated with poorer task performance. Reduced representation of expected values (EV) when making avoidance responses within bilateral anterior insula cortex/inferior frontal gyrus (AIC/iFG) and striatum was associated with greater levels of CP but not CU traits. The current data indicate that difficulties in the use of value information to motivate decisions to avoid suboptimal choices are associated with increased levels of CP (though not severity of CU traits). Moreover, they account for the behavioral deficits observed during reinforcement-based decision-making in youth with CP. In short, an individual's relative failure to utilize value information within AIC/iFG to avoid bad choices is associated with elevated levels of CP. © 2016 Association for Child and Adolescent Mental Health.

Effects of Clinical Decision Topic on Patients' Involvement in and Satisfaction With Decisions and Their Subsequent Implementation.

PubMed

Freidl, Marion; Pesola, Francesca; Konrad, Jana; Puschner, Bernd; Kovacs, Attila Istvan; De Rosa, Corrado; Fiorillo, Andrea; Krogsgaard Bording, Malene; Kawohl, Wolfram; Rössler, Wulf; Nagy, Marietta; Munk-Jørgensen, Povl; Slade, Mike

2016-06-01

Clinical decision making is an important aspect of mental health care. Predictors of how patients experience decision making and whether decisions are implemented are underresearched. This study investigated the relationship between decision topic and involvement in the decision, satisfaction with it, and its subsequent implementation from both staff and patient perspectives. As part of the Clinical Decision Making and Outcome in Routine Care for People With Severe Mental Illness study, patients (N=588) and their providers (N=213) were recruited from community-based mental health services in six European countries. Both completed bimonthly assessments for one year using the Clinical Decision Making in Routine Care Scale to assess the decision topic and implementation; both also completed the Clinical Decision Making Involvement and Satisfaction Scale. Three categories of decision topics were determined: treatment (most frequently cited), social, and financial. The topic identified as most important remained stable over the follow-up. Patients were more likely to rate their involvement as active rather than passive for social decisions (odds ratio [OR]=5.7, p<.001) and financial decisions (OR=9.5, p<.001). They were more likely to report higher levels of satisfaction rather than lower levels for social decisions (OR=1.5, p=.01) and financial decisions (OR=1.7, p=.01). Social decisions were more likely to be partly implemented (OR=3.0, p<.001) or fully implemented (OR=1.7, p=.03) than not implemented. Patients reported poorer involvement, satisfaction, and implementation in regard to treatment-related decisions, compared with social and financial decisions. Clinicians may need to employ different interactional styles for different types of decisions to maximize satisfaction and decision implementation.

Individual differences in decision making competence revealed by multivariate fMRI.

PubMed

Talukdar, Tanveer; Román, Francisco J; Operskalski, Joachim T; Zwilling, Christopher E; Barbey, Aron K

2018-06-01

While an extensive literature in decision neuroscience has elucidated the neurobiological foundations of decision making, prior research has focused primarily on group-level effects in a sample population. Due to the presence of inherent differences between individuals' cognitive abilities, it is also important to examine the neural correlates of decision making that explain interindividual variability in cognitive performance. This study therefore investigated how individual differences in decision making competence, as measured by the Adult Decision Making Competence (A-DMC) battery, are related to functional brain connectivity patterns derived from resting-state fMRI data in a sample of 304 healthy participants. We examined connectome-wide associations, identifying regions within frontal, parietal, temporal, and occipital cortex that demonstrated significant associations with decision making competence. We then assessed whether the functional interactions between brain regions sensitive to decision making competence and seven intrinsic connectivity networks (ICNs) were predictive of specific facets of decision making assessed by subtests of the A-DMC battery. Our findings suggest that individual differences in specific facets of decision making competence are mediated by ICNs that support executive, social, and perceptual processes, and motivate an integrative framework for understanding the neural basis of individual differences in decision making competence. © 2018 Wiley Periodicals, Inc.

Multiple perspectives on shared decision-making and interprofessional collaboration in mental healthcare.

PubMed

Chong, Wei Wen; Aslani, Parisa; Chen, Timothy F

2013-05-01

Shared decision-making is an essential element of patient-centered care in mental health. Since mental health services involve healthcare providers from different professions, a multiple perspective to shared decision-making may be valuable. The objective of this study was to explore the perceptions of different healthcare professionals on shared decision-making and current interprofessional collaboration in mental healthcare. Semi-structured interviews were conducted with 31 healthcare providers from a range of professions, which included medical practitioners (psychiatrists, general practitioners), pharmacists, nurses, occupational therapists, psychologists and social workers. Findings indicated that healthcare providers supported the notion of shared decision-making in mental health, but felt that it should be condition dependent. Medical practitioners advocated a more active participation from consumers in treatment decision-making; whereas other providers (e.g. pharmacists, occupational therapists) focused more toward acknowledging consumers' needs in decisions, perceiving themselves to be in an advisory role in supporting consumers' decision-making. Although healthcare providers acknowledged the importance of interprofessional collaboration, only a minority discussed it within the context of shared decision-making. In conclusion, healthcare providers appeared to have differing perceptions on the level of consumer involvement in shared decision-making. Interprofessional roles to facilitate shared decision-making in mental health need to be acknowledged, understood and strengthened, before an interprofessional approach to shared decision-making in mental health can be effectively implemented.

Different profiles of decision making and physiology under varying levels of stress in trained military personnel.

PubMed

Gamble, Katherine R; Vettel, Jean M; Patton, Debra J; Eddy, Marianna D; Caroline Davis, F; Garcia, Javier O; Spangler, Derek P; Thayer, Julian F; Brooks, Justin R

2018-03-23

Decision making is one of the most vital processes we use every day, ranging from mundane decisions about what to eat to life-threatening choices such as how to avoid a car collision. Thus, the context in which our decisions are made is critical, and our physiology enables adaptive responses that account for how environmental stress influences our performance. The relationship between stress and decision making can additionally be affected by one's expertise in making decisions in high-threat environments, where experts can develop an adaptive response that mitigates the negative impacts of stress. In the present study, 26 male military personnel made friend/foe discriminations in an environment where we manipulated the level of stress. In the high-stress condition, participants received a shock when they incorrectly shot a friend or missed shooting a foe; in the low-stress condition, participants received a vibration for an incorrect decision. We characterized performance using signal detection theory to investigate whether a participant changed their decision criterion to avoid making an error. Results showed that under high-stress, participants made more false alarms, mistaking friends as foes, and this co-occurred with increased high frequency heart rate variability. Finally, we examined the relationship between decision making and physiology, and found that participants exhibited adaptive behavioral and physiological profiles under different stress levels. We interpret this adaptive profile as a marker of an expert's ingrained training that does not require top down control, suggesting a way that expert training in high-stress environments helps to buffer negative impacts of stress on performance. Published by Elsevier B.V.

Moving data off the shelf and into action: an intervention to improve data-informed decision making in Côte d'Ivoire.

PubMed

Nutley, Tara; Gnassou, Léontine; Traore, Moussa; Bosso, Abitche Edwige; Mullen, Stephanie

2014-01-01

Improving a health system requires data, but too often they are unused or under-used by decision makers. Without interventions to improve the use of data in decision making, health systems cannot meet the needs of the populations they serve. In 2008, in Côte d'Ivoire, data were largely unused in health decision-making processes. To implement and evaluate an intervention to improve the use of data in decision making in Cote d'Ivoire. From 2008 to 2012, Cote d'Ivoire sought to improve the use of national health data through an intervention that broadens participation in and builds links between data collection and decision-making processes; identifies information needs; improves data quality; builds capacity to analyze, synthesize, and interpret data; and develops policies to support data use. To assess the results, a Performance of Routine Information System Management Assessment was conducted before and after the intervention using a combination of purposeful and random sampling. In 2008, the sample consisted of the central level, 12 districts, and 119 facilities, and in 2012, the sample consisted of the central level, 20 districts, and 190 health facilities. To assess data use, we developed dichotomous indicators: discussions of analysis findings, decisions taken based on the analysis, and decisions referred to upper management for action. We aggregated the indicators to generate a composite, continuous index of data use. From 2008 to 2012, the district data-use score increased from 40 to 70%; the facility score remained the same - 38%. The central score is not reported, because of a methodological difference in the two assessments. The intervention improved the use of data in decision making at the district level in Côte d'Ivoire. This study provides an example of, and guidance for, implementing a large-scale intervention to improve data-informed decision making.

Using social network analysis to examine the decision-making process on new vaccine introduction in Nigeria.

PubMed

Wonodi, C B; Privor-Dumm, L; Aina, M; Pate, A M; Reis, R; Gadhoke, P; Levine, O S

2012-05-01

The decision-making process to introduce new vaccines into national immunization programmes is often complex, involving many stakeholders who provide technical information, mobilize finance, implement programmes and garner political support. Stakeholders may have different levels of interest, knowledge and motivations to introduce new vaccines. Lack of consensus on the priority, public health value or feasibility of adding a new vaccine can delay policy decisions. Efforts to support country-level decision-making have largely focused on establishing global policies and equipping policy makers with the information to support decision-making on new vaccine introduction (NVI). Less attention has been given to understanding the interactions of policy actors and how the distribution of influence affects the policy process and decision-making. Social network analysis (SNA) is a social science technique concerned with explaining social phenomena using the structural and relational features of the network of actors involved. This approach can be used to identify how information is exchanged and who is included or excluded from the process. For this SNA of vaccine decision-making in Nigeria, we interviewed federal and state-level government officials, officers of bilateral and multilateral partner organizations, and other stakeholders such as health providers and the media. Using data culled from those interviews, we performed an SNA in order to map formal and informal relationships and the distribution of influence among vaccine decision-makers, as well as to explore linkages and pathways to stakeholders who can influence critical decisions in the policy process. Our findings indicate a relatively robust engagement of key stakeholders in Nigeria. We hypothesized that economic stakeholders and implementers would be important to ensure sustainable financing and strengthen programme implementation, but some economic and implementation stakeholders did not appear centrally on the map; this may suggest a need to strengthen the decision-making processes by engaging these stakeholders more centrally and earlier.

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.

Decision-making under surprise and uncertainty: Arsenic contamination of water supplies

NASA Astrophysics Data System (ADS)

Randhir, Timothy O.; Mozumder, Pallab; Halim, Nafisa

2018-05-01

With ignorance and potential surprise dominating decision making in water resources, a framework for dealing with such uncertainty is a critical need in hydrology. We operationalize the 'potential surprise' criterion proposed by Shackle, Vickers, and Katzner (SVK) to derive decision rules to manage water resources under uncertainty and ignorance. We apply this framework to managing water supply systems in Bangladesh that face severe, naturally occurring arsenic contamination. The uncertainty involved with arsenic in water supplies makes the application of conventional analysis of decision-making ineffective. Given the uncertainty and surprise involved in such cases, we find that optimal decisions tend to favor actions that avoid irreversible outcomes instead of conventional cost-effective actions. We observe that a diversification of the water supply system also emerges as a robust strategy to avert unintended outcomes of water contamination. Shallow wells had a slight higher optimal level (36%) compare to deep wells and surface treatment which had allocation levels of roughly 32% under each. The approach can be applied in a variety of other cases that involve decision making under uncertainty and surprise, a frequent situation in natural resources management.

Antibiotic and shared decision-making preferences among adolescents in Malaysia

PubMed Central

Ngadimon, Irma Wati; Islahudin, Farida; Hatah, Ernieda; Mohamed Shah, Noraida; Makmor-Bakry, Mohd

2015-01-01

Background The purpose of this study was to establish baseline information on the current level of knowledge about, attitude toward, and experience with antibiotic usage, and preferences for shared decision making among adolescents in Malaysia. Methods A cross-sectional survey, involving 1,105 respondents who were aged between 13 and 17 years and who lived in Malaysia, was conducted using a validated questionnaire. The survey assessed knowledge, attitude, and experience with regard to antibiotic usage, and adolescents’ preferences for the style of shared decision-making process. Results The majority (n=786 [71.13%]) of the respondents had a low level of knowledge, 296 (26.79%) had a moderate level of knowledge, and 23 (2.08%) had a high level of knowledge. Further, they demonstrated a slightly negative attitude mean score of 3.30±0.05 (range: 0–8 points) but a positive experience mean score of 2.90±0.029 (range: 0–4 points). There was a positive correlation between knowledge and attitude scores, with a higher knowledge level associated with a more positive attitude toward antibiotic usage (r=0.257, P<0.001). Higher knowledge scores were associated with a more negative experience with antibiotic usage (r=−0.83, P=0.006). When assessing preference in shared decision making, more adolescents preferred an active role (n=408 [37%]) compared with collaborative (n=360 [32.6%]) or passive (n=337 [30.5%]) (P=0.028) roles. Conclusion Current health care settings should involve adolescents in the decision-making process. Education packages can be introduced to improve adolescents’ knowledge of and practice of taking antibiotics, as well as to encourage their participation in decision making, in an attempt to reduce misuse of antibiotics. PMID:25999702

Incorporating Ecosystem Services into Community-level Decision-Making: A San Juan, Puerto Rico Case Study

EPA Science Inventory

EPA’s Office of Research and Development’s Sustainable and Healthy Communities Research Program is developing tools and approaches to incorporate ecosystem goods and services concepts into community-level decision-making. The San Juan Community Study is one of a serie...

Does good critical thinking equal effective decision-making among critical care nurses? A cross-sectional survey.

PubMed

Ludin, Salizar Mohamed

2018-02-01

A critical thinker may not necessarily be a good decision-maker, but critical care nurses are expected to utilise outstanding critical thinking skills in making complex clinical judgements. Studies have shown that critical care nurses' decisions focus mainly on doing rather than reflecting. To date, the link between critical care nurses' critical thinking and decision-making has not been examined closely in Malaysia. To understand whether critical care nurses' critical thinking disposition affects their clinical decision-making skills. This was a cross-sectional study in which Malay and English translations of the Short Form-Critical Thinking Disposition Inventory-Chinese Version (SF-CTDI-CV) and the Clinical Decision-making Nursing Scale (CDMNS) were used to collect data from 113 nurses working in seven critical care units of a tertiary hospital on the east coast of Malaysia. Participants were recruited through purposive sampling in October 2015. Critical care nurses perceived both their critical thinking disposition and decision-making skills to be high, with a total score of 71.5 and a mean of 48.55 for the SF-CTDI-CV, and a total score of 161 and a mean of 119.77 for the CDMNS. One-way ANOVA test results showed that while age, gender, ethnicity, education level and working experience factors significantly impacted critical thinking (p<0.05), only age and working experience significantly impacted clinical decision-making (p<0.05). Pearson's correlation analysis showed a strong and positive relationship between critical care nurses' critical thinking and clinical decision-making (r=0.637, p=0.001). While this small-scale study has shown a relationship exists between critical care nurses' critical thinking disposition and clinical decision-making in one hospital, further investigation using the same measurement tools is needed into this relationship in diverse clinical contexts and with greater numbers of participants. Critical care nurses' perceived high level of critical thinking and decision-making also needs further investigation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Complementary Cognitive Capabilities, Economic Decision-Making, and Aging

PubMed Central

Li, Ye; Baldassi, Martine; Johnson, Eric J.; Weber, Elke U.

2014-01-01

Fluid intelligence decreases with age, yet evidence about age declines in decision-making quality is mixed: Depending on the study, older adults make worse, equally good, or even better decisions than younger adults. We propose a potential explanation for this puzzle, namely that age differences in decision performance result from the interplay between two sets of cognitive capabilities that impact decision making, one in which older adults fare worse (i.e., fluid intelligence) and one in which they fare better (i.e., crystallized intelligence). Specifically, we hypothesized that older adults’ higher levels of crystallized intelligence can provide an alternate pathway to good decisions when the fluid intelligence pathway declines. The performance of older adults relative to younger adults therefore depends on the relative importance of each type of intelligence for the decision at hand. We tested this complementary capabilities hypothesis in a broad sample of younger and older adults, collecting a battery of standard cognitive measures and measures of economically important decision-making “traits”—including temporal discounting, loss aversion, financial literacy, and debt literacy. We found that older participants performed as well as or better than younger participants on these four decision-making measures. Structural equation modeling verified our hypothesis: Older participants’ greater crystallized intelligence offset their lower levels of fluid intelligence for temporal discounting, financial literacy, and debt literacy, but not for loss aversion. These results have important implications for public policy and for the design of effective decision environments for older adults. PMID:24040999

Complementary cognitive capabilities, economic decision making, and aging.

PubMed

Li, Ye; Baldassi, Martine; Johnson, Eric J; Weber, Elke U

2013-09-01

Fluid intelligence decreases with age, yet evidence about age declines in decision-making quality is mixed: Depending on the study, older adults make worse, equally good, or even better decisions than younger adults. We propose a potential explanation for this puzzle, namely that age differences in decision performance result from the interplay between two sets of cognitive capabilities that impact decision making, one in which older adults fare worse (i.e., fluid intelligence) and one in which they fare better (i.e., crystallized intelligence). Specifically, we hypothesized that older adults' higher levels of crystallized intelligence can provide an alternate pathway to good decisions when the fluid intelligence pathway declines. The performance of older adults relative to younger adults therefore depends on the relative importance of each type of intelligence for the decision at hand. We tested this complementary capabilities hypothesis in a broad sample of younger and older adults, collecting a battery of standard cognitive measures and measures of economically important decision-making "traits"--including temporal discounting, loss aversion, financial literacy, and debt literacy. We found that older participants performed as well as or better than younger participants on these four decision-making measures. Structural equation modeling verified our hypothesis: Older participants' greater crystallized intelligence offset their lower levels of fluid intelligence for temporal discounting, financial literacy, and debt literacy, but not for loss aversion. These results have important implications for public policy and for the design of effective decision environments for older adults.

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 clinical decision-making and placing both within the broader healthcare context. The conceptual models provide a way of thinking about decisions informing rural physiotherapy service provision. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Cycles of shame: menstrual shame, body shame, and sexual decision-making.

PubMed

Schooler, Deborah; Ward, L Monique; Merriwether, Ann; Caruthers, Allison S

2005-11-01

Although numerous factors have been implicated in women's sexual decision-making, less attention has been focused on how their feelings about their bodies and reproductive functions affect these processes. Recent findings link menstrual shame to lower levels of sexual activity and higher levels of sexual risk; however the mechanisms behind these relations remain unexplored. Accordingly, this study investigates the contributions of menstrual shame and global body shame to sexual decision-making among 199 undergraduate women. Using structural equation modeling, we evaluated a mediated model, whereby menstrual shame is indirectly associated with sexual decision-making via body shame. As expected, women who reported feeling more comfort about menstruation also reported more body comfort and, in turn, more sexual assertiveness, more sexual experience, and less sexual risk.

The Effects of Conflict, Quality and Time on Small Group Information Use and Behavior in Evaluative Decision-Making Situations.

ERIC Educational Resources Information Center

Pflum, Glenn D.; Brown, Robert D.

This study investigated information needs and use by groups in decision-making processes. Problem contexts were varied by conflict, quality, and time conditions and presented to 89 graduate level education students who simulated school board members making decisions about educational programs. The research hypotheses were: (1) there are no…

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

ERIC Educational Resources Information Center

Murray, David R.; And Others

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

Decision making for wildfires: A guide for applying a risk management process at the incident level

Treesearch

Mary A. Taber; Lisa M. Elenz; Paul G. Langowski

2013-01-01

This publication focuses on the thought processes and considerations surrounding a risk management process for decision making on wildfires. The publication introduces a six element risk management cycle designed to encourage sound risk-informed decision making in accordance with Federal wildland fire policy, although the process is equally applicable to non-Federal...

The impact of threat of shock on the framing effect and temporal discounting: executive functions unperturbed by acute stress?

PubMed

Robinson, Oliver J; Bond, Rebecca L; Roiser, Jonathan P

2015-01-01

Anxiety and stress-related disorders constitute a large global health burden, but are still poorly understood. Prior work has demonstrated clear impacts of stress upon basic cognitive function: biasing attention toward unexpected and potentially threatening information and instantiating a negative affective bias. However, the impact that these changes have on higher-order, executive, decision-making processes is unclear. In this study, we examined the impact of a translational within-subjects stress induction (threat of unpredictable shock) on two well-established executive decision-making biases: the framing effect (N = 83), and temporal discounting (N = 36). In both studies, we demonstrate (a) clear subjective effects of stress, and (b) clear executive decision-making biases but (c) no impact of stress on these decision-making biases. Indeed, Bayes factor analyses confirmed substantial preference for decision-making models that did not include stress. We posit that while stress may induce subjective mood change and alter low-level perceptual and action processes (Robinson et al., 2013c), some higher-level executive processes remain unperturbed by these impacts. As such, although stress can induce a transient affective biases and altered mood, these need not result in poor financial decision-making.

Pain relief in labour: a qualitative study to determine how to support women to make decisions about pain relief in labour

PubMed Central

2014-01-01

Background Engagement in decision making is a key priority of modern healthcare. Women are encouraged to make decisions about pain relief in labour in the ante-natal period based upon their expectations of what labour pain will be like. Many women find this planning difficult. The aim of this qualitative study was to explore how women can be better supported in preparing for, and making, decisions during pregnancy and labour regarding pain management. Methods Semi-structured interviews were conducted with 13 primiparous and 10 multiparous women at 36 weeks of pregnancy and again within six weeks postnatally. Data collection and analysis occurred concurrently to identify key themes. Results Three main themes emerged from the data. Firstly, during pregnancy women expressed a degree of uncertainty about the level of pain they would experience in labour and the effect of different methods of pain relief. Secondly, women reflected on how decisions had been made regarding pain management in labour and the degree to which they had felt comfortable making these decisions. Finally, women discussed their perceived levels of control, both desired and experienced, over both their bodies and the decisions they were making. Conclusion This study suggests that the current approach of antenatal preparation in the NHS, of asking women to make decisions antenatally for pain relief in labour, needs reviewing. It would be more beneficial to concentrate efforts on better informing women and on engaging them in discussions around their values, expectations and preferences and how these affect each specific choice rather than expecting them to make to make firm decisions in advance of such an unpredictable event as labour. PMID:24397421

Congruence between Preferred and Actual Participation Roles Increases Satisfaction with Treatment Decision Making among Japanese Women with Breast Cancer

PubMed

Yamauchi, Keiko; Nakao, Motoyuki; Nakashima, Mitsuyo; Ishihara, Yoko

2017-04-01

Objective: This study investigated the correlation between participation in the treatment decision-making process and satisfaction with the process among Japanese women with breast cancer. The influence of sociodemographic and clinical characteristics on satisfaction with the treatment decision-making process was also examined. Methods: We conducted a cross-sectional, self-administered internet survey of 650 Japanese women with breast cancer in March 2016. Decisional role (active, collaborative, passive) in the treatment decision-making was elicited using the Japanese version of the Control Preference Scale. Satisfaction with the decision-making process was assessed. Result: About half of the participants preferred to play a collaborative role, while half of the participants perceived that they played an active role. Satisfaction among the participants who made their treatment choice collaboratively with their physicians was significantly higher than that of participants who made the choice by themselves or entrusted their physicians to make the decision. However, two-way ANOVA demonstrated that satisfaction level was associated with the congruence between the participants’ preferred and actual decisional roles, but not with the actual decisional roles that they played. This association had no interaction with sociodemographic and clinical status, except for education level. A majority of the participants who participated in the roles they preferred in choosing their treatment option indicated that they would participate in the same role if they were to face a similar decision-making situation in the future. Conclusion: Regardless of their role played in the cancer treatment decision-making process, and irrespective of their sociodemographic and clinical status, Japanese women with breast cancer are more satisfied with the treatment decision-making process when their participation in the process matches their preferred role in the process. Creative Commons Attribution License

Congruence between Preferred and Actual Participation Roles Increases Satisfaction with Treatment Decision Making among Japanese Women with Breast Cancer

PubMed Central

Yamauchi, Keiko; Nakao, Motoyuki; Nakashima, Mitsuyo; Ishihara, Yoko

2017-01-01

Objective: This study investigated the correlation between participation in the treatment decision-making process and satisfaction with the process among Japanese women with breast cancer. The influence of sociodemographic and clinical characteristics on satisfaction with the treatment decision-making process was also examined. Methods: We conducted a cross-sectional, self-administered internet survey of 650 Japanese women with breast cancer in March 2016. Decisional role (active, collaborative, passive) in the treatment decision-making was elicited using the Japanese version of the Control Preference Scale. Satisfaction with the decision-making process was assessed. Result: About half of the participants preferred to play a collaborative role, while half of the participants perceived that they played an active role. Satisfaction among the participants who made their treatment choice collaboratively with their physicians was significantly higher than that of participants who made the choice by themselves or entrusted their physicians to make the decision. However, two-way ANOVA demonstrated that satisfaction level was associated with the congruence between the participants’ preferred and actual decisional roles, but not with the actual decisional roles that they played. This association had no interaction with sociodemographic and clinical status, except for education level. A majority of the participants who participated in the roles they preferred in choosing their treatment option indicated that they would participate in the same role if they were to face a similar decision-making situation in the future. Conclusion: Regardless of their role played in the cancer treatment decision-making process, and irrespective of their sociodemographic and clinical status, Japanese women with breast cancer are more satisfied with the treatment decision-making process when their participation in the process matches their preferred role in the process. PMID:28545197

Reaching a Consensus: Terminology and Concepts Used in Coordination and Decision-Making Research.

PubMed

Pyritz, Lennart W; King, Andrew J; Sueur, Cédric; Fichtel, Claudia

2011-12-01

Research on coordination and decision-making in humans and nonhuman primates has increased considerably throughout the last decade. However, terminology has been used inconsistently, hampering the broader integration of results from different studies. In this short article, we provide a glossary containing the central terms of coordination and decision-making research. The glossary is based on previous definitions that have been critically revised and annotated by the participants of the symposium "Where next? Coordination and decision-making in primate groups" at the XXIIIth Congress of the International Primatological Society (IPS) in Kyoto, Japan. We discuss a number of conceptual and methodological issues and highlight consequences for their implementation. In summary, we recommend that future studies on coordination and decision-making in animal groups do not use the terms "combined decision" and "democratic/despotic decision-making." This will avoid ambiguity as well as anthropocentric connotations. Further, we demonstrate the importance of 1) taxon-specific definitions of coordination parameters (initiation, leadership, followership, termination), 2) differentiation between coordination research on individual-level process and group-level outcome, 3) analyses of collective action processes including initiation and termination, and 4) operationalization of successful group movements in the field to collect meaningful and comparable data across different species.

Controlling Chronic Diseases Through Evidence-Based Decision Making: A Group-Randomized Trial.

PubMed

Brownson, Ross C; Allen, Peg; Jacob, Rebekah R; deRuyter, Anna; Lakshman, Meenakshi; Reis, Rodrigo S; Yan, Yan

2017-11-30

Although practitioners in state health departments are ideally positioned to implement evidence-based interventions, few studies have examined how to build their capacity to do so. The objective of this study was to explore how to increase the use of evidence-based decision-making processes at both the individual and organization levels. We conducted a 2-arm, group-randomized trial with baseline data collection and follow-up at 18 to 24 months. Twelve state health departments were paired and randomly assigned to intervention or control condition. In the 6 intervention states, a multiday training on evidence-based decision making was conducted from March 2014 through March 2015 along with a set of supplemental capacity-building activities. Individual-level outcomes were evidence-based decision making skills of public health practitioners; organization-level outcomes were access to research evidence and participatory decision making. Mixed analysis of covariance models was used to evaluate the intervention effect by accounting for the cluster randomized trial design. Analysis was performed from March through May 2017. Participation 18 to 24 months after initial training was 73.5%. In mixed models adjusted for participant and state characteristics, the intervention group improved significantly in the overall skill gap (P = .01) and in 6 skill areas. Among the 4 organizational variables, only access to evidence and skilled staff showed an intervention effect (P = .04). Tailored and active strategies are needed to build capacity at the individual and organization levels for evidence-based decision making. Our study suggests several dissemination interventions for consideration by leaders seeking to improve public health practice.

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

PubMed

Ren, Peijia; Xu, Zeshui; Hao, Zhinan

2017-09-01

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

Mild cognitive impairment is associated with poorer decision-making in community-based older persons.

PubMed

Han, S Duke; Boyle, Patricia A; James, Bryan D; Yu, Lei; Bennett, David A

2015-04-01

To test the hypothesis that mild cognitive impairment (MCI) is associated with poorer financial and healthcare decision-making. Community-based epidemiological cohort study. Communities throughout northeastern Illinois. Older persons without dementia from the Rush Memory and Aging Project (N = 730). All participants underwent a detailed clinical evaluation and decision-making assessment using a measure that closely approximates materials used in real-world financial and healthcare settings. This allowed for measurement of total decision-making and financial and healthcare decision-making. Regression models were used to examine whether MCI was associated with a lower level of decision-making. In subsequent analyses, the relationship between specific cognitive systems (episodic memory, semantic memory, working memory, perceptual speed, visuospatial ability) and decision-making was explored in participants with MCI. MCI was associated with lower total, financial, and healthcare decision-making scores after accounting for the effects of age, education, and sex. The effect of MCI on total decision-making was equivalent to the effect of more than 10 additional years of age. Additional models showed that, when considering multiple cognitive systems, perceptual speed accounted for the most variance in decision-making in participants with MCI. Persons with MCI may have poorer financial and healthcare decision-making in real-world situations, and perceptual speed may be an important contributor to poorer decision-making in persons with MCI. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Understanding shared decision making in pediatric otolaryngology.

PubMed

Chorney, Jill; Haworth, Rebecca; Graham, M Elise; Ritchie, Krista; Curran, Janet A; Hong, Paul

2015-05-01

The aim of this study was to describe the level of decisional conflict experienced by parents considering surgery for their children and to determine if decisional conflict and perceptions of shared decision making are related. Prospective cohort study. Academic pediatric otolaryngology clinic. Sixty-five consecutive parents of children who underwent surgical consultation for elective otolaryngological procedures were prospectively enrolled. Participants completed the Shared Decision Making Questionnaire and the Decisional Conflict Scale. Surgeons completed the Shared Decision Making Questionnaire-Physician version. Eleven participants (16.9%) scored over 25 on the Decisional Conflict Scale, a previously defined clinical cutoff indicating significant decisional conflict. Parent years of education and parent ratings of shared decision making were significantly correlated with decisional conflict (positively and negatively correlated, respectively). A logistic regression indicated that shared decision making but not education predicted the presence of significant decisional conflict. Parent and physician ratings of shared decision making were not related, and there was no correlation between physician ratings of shared decision making and parental decisional conflict. Many parents experienced considerable decisional conflict when making decisions about their child's surgical treatment. Parents who perceived themselves as being more involved in the decision-making process reported less decisional conflict. Parents and physicians had different perceptions of shared decision making. Future research should develop and assess interventions to increase parents' involvement in decision making and explore the impact of significant decisional conflict on health outcomes. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2015.

Two Validated Ways of Improving the Ability of Decision-Making in Emergencies; Results from a Literature Review

PubMed Central

Khorram-Manesh, Amir; Berlin, Johan; Carlström, Eric

2016-01-01

The aim of the current review wasto study the existing knowledge about decision-making and to identify and describe validated training tools.A comprehensive literature review was conducted by using the following keywords: decision-making, emergencies, disasters, crisis management, training, exercises, simulation, validated, real-time, command and control, communication, collaboration, and multi-disciplinary in combination or as an isolated word. Two validated training systems developed in Sweden, 3 level collaboration (3LC) and MacSim, were identified and studied in light of the literature review in order to identify how decision-making can be trained. The training models fulfilled six of the eight identified characteristics of training for decision-making.Based on the results, these training models contained methods suitable to train for decision-making. PMID:27878123

Virtual Beach: Decision Support Tools for Beach Pathogen Prediction

EPA Science Inventory

The Virtual Beach Managers Tool (VB) is decision-making software developed to help local beach managers make decisions as to when beaches should be closed due to predicted high levels of water borne pathogens. The tool is being developed under the umbrella of EPA's Advanced Monit...

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

PubMed

Brogan, Paula; Hasson, Felicity; McIlfatrick, Sonja

2018-01-01

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

A conceptual framework for negotiating public involvement in municipal waste management decision-making in the UK.

PubMed

Garnett, Kenisha; Cooper, Tim; Longhurst, Philip; Jude, Simon; Tyrrel, Sean

2017-08-01

The technical expertise that politicians relied on in the past to produce cost-effective and environmentally sound solutions no longer provides sufficient justification to approve waste facilities. Local authorities need to find more effective ways to involve stakeholders and communities in decision-making since public acceptance of municipal waste facilities is integral to delivering effective waste strategies. This paper presents findings from a research project that explored attitudes towards greater levels of public involvement in UK waste management decision-making. The study addressed questions of perception, interests, the decision context, the means of engagement and the necessary resources and capacity for adopting a participatory decision process. Adopting a mixed methods approach, the research produced an empirical framework for negotiating the mode and level of public involvement in waste management decision-making. The framework captures and builds on theories of public involvement and the experiences of practitioners, and offers guidance for integrating analysis and deliberation with public groups in different waste management decision contexts. Principles in the framework operate on the premise that the decision about 'more' and 'better' forms of public involvement can be negotiated, based on the nature of the waste problem and wider social context of decision-making. The collection of opinions from the wide range of stakeholders involved in the study has produced new insights for the design of public engagement processes that are context-dependent and 'fit-for-purpose'; these suggest a need for greater inclusivity in the case of contentious technologies and high levels of uncertainty regarding decision outcomes. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

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

PubMed

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

2015-11-01

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

The Use of Information by Policymakers at the Local Community Level.

ERIC Educational Resources Information Center

Florio, Evelyn; DeMartini, Joseph R.

1993-01-01

Discussion of decision making focuses on a study that was conducted to examine how policymakers at the local community level use social science information in making decisions. The use of social science information and other information sources in two communities examining health care issues is described. (Contains 18 references.) (LRW)

Examining Decision Making Level of Wrestlers in Terms of Some Variable

ERIC Educational Resources Information Center

Yigit, Sihmehmet; Dalbudak, Ibrahim; Musa, Mihriay; Gürkan, Alper C.; Dalkiliç, Mehmet

2016-01-01

The aim of this research is to examine decision making level of wrestlers who joined Turkey inter university wrestling championship, according to variables as wrestlers' sex, age, grade, department, and education type. Study group consists of 34 females and 196 males, totally 230 athletes, who joined Turkey Inter University Wrestling Championship…

Parental role in decision making about pediatric cardiac transplantation: familial and ethical considerations.

PubMed

Higgins, S S

2001-10-01

Parents of children with complex or terminal heart conditions often face agonizing decisions about cardiac transplantation. There are differences in the level of involvement that parents prefer when making such decisions. The purpose of this study was to identify and describe parents' preferences for their roles in decisions related to cardiac transplantation. A prospective ethnographic method was used to study 24 parents of 15 children prior to their decision of accepting or rejecting the transplant option for their children. Findings revealed that the style of parent decision making ranged from a desire to make an independent, autonomous choice to a wish for an authoritarian, paternalistic choice. Nurses and physicians can best support families in this situation, showing sensitivity to the steps that parents use to make their decisions. An ethical model of decision making is proposed that includes respect for differences in beliefs and values of all persons involved in the transplantation discussion. Copyright 2001 by W.B. Saunders Company

The cognitive processes underpinning clinical decision in triage assessment: a theoretical conundrum?

PubMed

Noon, Amy J

2014-01-01

High quality clinical decision-making (CDM) has been highlighted as a priority across the nursing profession. Triage nurses, in the Accident and Emergency (A&E) department, work in considerable levels of uncertainty and require essential skills including: critical thinking, evaluation and decision-making. The content of this paper aims to promote awareness of how triage nurses make judgements and decisions in emergency situations. By exploring relevant literature on clinical judgement and decision-making theory, this paper demonstrates the importance of high quality decision-making skills underpinning the triage nurse's role. Having an awareness of how judgements and decisions are made is argued as essential, in a time where traditional nurse boundaries and responsibilities are never more challenged. It is hoped that the paper not only raises this awareness in general but also, in particular, engages the triage nurse to look more critically at how they make their own decisions in their everyday practice. Copyright © 2013 Elsevier Ltd. All rights reserved.

Attitudes toward concordance and self-efficacy in decision making: a cross-sectional study on pharmacist–patient consultations

PubMed Central

Ng, Yew Keong; Shah, Noraida Mohamed; Loong, Ly Sia; Pee, Lay Ting; Hidzir, Sarina Anim M; Chong, Wei Wen

2018-01-01

Purpose This study investigated patients’ and pharmacists’ attitudes toward concordance in a pharmacist–patient consultation and how patients’ attitudes toward concordance relate to their involvement and self-efficacy in decision making associated with medication use. Subjects and methods A cross-sectional study was conducted among patients with chronic diseases and pharmacists from three public hospitals in Malaysia. The Revised United States Leeds Attitudes toward Concordance (RUS-LATCon) was used to measure attitudes toward concordance in both patients and pharmacists. Patients also rated their perceived level of involvement in decision making and completed the Decision Self-Efficacy scale. One-way analysis of variance (ANOVA) and independent t-test were used to determine significant differences between different subgroups on attitudes toward concordance, and multiple linear regression was performed to find the predictors of patients’ self-efficacy in decision making. Results A total of 389 patients and 93 pharmacists participated in the study. Pharmacists and patients scored M=3.92 (SD=0.37) and M=3.84 (SD=0.46) on the RUS-LATCon scale, respectively. Seven items were found to be significantly different between pharmacists and patients on the subscale level. Patients who felt fully involved in decision making (M=3.94, SD=0.462) scored significantly higher on attitudes toward concordance than those who felt partially involved (M=3.82, SD=0.478) and not involved at all (M=3.68, SD=0.471; p<0.001). Patients had an average score of 76.7% (SD=14.73%) on the Decision Self-Efficacy scale. In multiple linear regression analysis, ethnicity, number of medications taken by patients, patients’ perceived level of involvement, and attitudes toward concordance are significant predictors of patients’ self-efficacy in decision making (p<0.05). Conclusion Patients who felt involved in their consultations had more positive attitudes toward concordance and higher confidence in making an informed decision. Further study is recommended on interventions involving pharmacists in supporting patients’ involvement in medication-related decision making. PMID:29731609

Designing Dynamic Adaptive Policy Pathways using Many-Objective Robust Decision Making

NASA Astrophysics Data System (ADS)

Kwakkel, Jan; Haasnoot, Marjolijn

2017-04-01

Dealing with climate risks in water management requires confronting a wide variety of deeply uncertain factors, while navigating a many dimensional space of trade-offs amongst objectives. There is an emerging body of literature on supporting this type of decision problem, under the label of decision making under deep uncertainty. Two approaches within this literature are Many-Objective Robust Decision Making, and Dynamic Adaptive Policy Pathways. In recent work, these approaches have been compared. One of the main conclusions of this comparison was that they are highly complementary. Many-Objective Robust Decision Making is a model based decision support approach, while Dynamic Adaptive Policy Pathways is primarily a conceptual framework for the design of flexible strategies that can be adapted over time in response to how the future is actually unfolding. In this research we explore this complementarity in more detail. Specifically, we demonstrate how Many-Objective Robust Decision Making can be used to design adaptation pathways. We demonstrate this combined approach using a water management problem, in the Netherlands. The water level of Lake IJselmeer, the main fresh water resource of the Netherlands, is currently managed through discharge by gravity. Due to climate change, this won't be possible in the future, unless water levels are changed. Changing the water level has undesirable flood risk and spatial planning consequences. The challenge is to find promising adaptation pathways that balance objectives related to fresh water supply, flood risk, and spatial issues, while accounting for uncertain climatic and land use change. We conclude that the combination of Many-Objective Robust Decision Making and Dynamic Adaptive Policy Pathways is particularly suited for dealing with deeply uncertain climate risks.

How Awareness Changes the Relative Weights of Evidence During Human Decision-Making

PubMed Central

Lamme, Victor A. F.; Dehaene, Stanislas

2011-01-01

Human decisions are based on accumulating evidence over time for different options. Here we ask a simple question: How is the accumulation of evidence affected by the level of awareness of the information? We examined the influence of awareness on decision-making using combined behavioral methods and magneto-encephalography (MEG). Participants were required to make decisions by accumulating evidence over a series of visually presented arrow stimuli whose visibility was modulated by masking. Behavioral results showed that participants could accumulate evidence under both high and low visibility. However, a top-down strategic modulation of the flow of incoming evidence was only present for stimuli with high visibility: once enough evidence had been accrued, participants strategically reduced the impact of new incoming stimuli. Also, decision-making speed and confidence were strongly modulated by the strength of the evidence for high-visible but not low-visible evidence, even though direct priming effects were identical for both types of stimuli. Neural recordings revealed that, while initial perceptual processing was independent of visibility, there was stronger top-down amplification for stimuli with high visibility than low visibility. Furthermore, neural markers of evidence accumulation over occipito-parietal cortex showed a strategic bias only for highly visible sensory information, speeding up processing and reducing neural computations related to the decision process. Our results indicate that the level of awareness of information changes decision-making: while accumulation of evidence already exists under low visibility conditions, high visibility allows evidence to be accumulated up to a higher level, leading to important strategical top-down changes in decision-making. Our results therefore suggest a potential role of awareness in deploying flexible strategies for biasing information acquisition in line with one's expectations and goals. PMID:22131904

How awareness changes the relative weights of evidence during human decision-making.

PubMed

de Lange, Floris P; van Gaal, Simon; Lamme, Victor A F; Dehaene, Stanislas

2011-11-01

Human decisions are based on accumulating evidence over time for different options. Here we ask a simple question: How is the accumulation of evidence affected by the level of awareness of the information? We examined the influence of awareness on decision-making using combined behavioral methods and magneto-encephalography (MEG). Participants were required to make decisions by accumulating evidence over a series of visually presented arrow stimuli whose visibility was modulated by masking. Behavioral results showed that participants could accumulate evidence under both high and low visibility. However, a top-down strategic modulation of the flow of incoming evidence was only present for stimuli with high visibility: once enough evidence had been accrued, participants strategically reduced the impact of new incoming stimuli. Also, decision-making speed and confidence were strongly modulated by the strength of the evidence for high-visible but not low-visible evidence, even though direct priming effects were identical for both types of stimuli. Neural recordings revealed that, while initial perceptual processing was independent of visibility, there was stronger top-down amplification for stimuli with high visibility than low visibility. Furthermore, neural markers of evidence accumulation over occipito-parietal cortex showed a strategic bias only for highly visible sensory information, speeding up processing and reducing neural computations related to the decision process. Our results indicate that the level of awareness of information changes decision-making: while accumulation of evidence already exists under low visibility conditions, high visibility allows evidence to be accumulated up to a higher level, leading to important strategical top-down changes in decision-making. Our results therefore suggest a potential role of awareness in deploying flexible strategies for biasing information acquisition in line with one's expectations and goals.

Household Decision-Making Process: It's Effect on School Dropout Behavior for Girls in the Secondary School Level in Bangladesh

ERIC Educational Resources Information Center

Shahidul, S. M.

2013-01-01

This study aims to understand the parents' household decision-making process with respect to allowing girls to drop out of school, an area that has, thus far, been overlooked in the research regarding school dropouts. This paper has examined the household decision-making process between fathers and mothers and explores how their respective levels…

District decision-making for health in low-income settings: a systematic literature review.

PubMed

Wickremasinghe, Deepthi; Hashmi, Iram Ejaz; Schellenberg, Joanna; Avan, Bilal Iqbal

2016-09-01

Health management information systems (HMIS) produce large amounts of data about health service provision and population health, and provide opportunities for data-based decision-making in decentralized health systems. Yet the data are little-used locally. A well-defined approach to district-level decision-making using health data would help better meet the needs of the local population. In this second of four papers on district decision-making for health in low-income settings, our aim was to explore ways in which district administrators and health managers in low- and lower-middle-income countries use health data to make decisions, to describe the decision-making tools they used and identify challenges encountered when using these tools. A systematic literature review, following PRISMA guidelines, was undertaken. Experts were consulted about key sources of information. A search strategy was developed for 14 online databases of peer reviewed and grey literature. The resources were screened independently by two reviewers using pre-defined inclusion criteria. The 14 papers included were assessed for the quality of reported evidence and a descriptive evidence synthesis of the review findings was undertaken. We found 12 examples of tools to assist district-level decision-making, all of which included two key stages-identification of priorities, and development of an action plan to address them. Of those tools with more steps, four included steps to review or monitor the action plan agreed, suggesting the use of HMIS data. In eight papers HMIS data were used for prioritization. Challenges to decision-making processes fell into three main categories: the availability and quality of health and health facility data; human dynamics and financial constraints. Our findings suggest that evidence is available about a limited range of processes that include the use of data for decision-making at district level. Standardization and pre-testing in diverse settings would increase the potential that these tools could be used more widely. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

A canonical theory of dynamic decision-making.

PubMed

Fox, John; Cooper, Richard P; Glasspool, David W

2013-01-01

Decision-making behavior is studied in many very different fields, from medicine and economics to psychology and neuroscience, with major contributions from mathematics and statistics, computer science, AI, and other technical disciplines. However the conceptualization of what decision-making is and methods for studying it vary greatly and this has resulted in fragmentation of the field. A theory that can accommodate various perspectives may facilitate interdisciplinary working. We present such a theory in which decision-making is articulated as a set of canonical functions that are sufficiently general to accommodate diverse viewpoints, yet sufficiently precise that they can be instantiated in different ways for specific theoretical or practical purposes. The canons cover the whole decision cycle, from the framing of a decision based on the goals, beliefs, and background knowledge of the decision-maker to the formulation of decision options, establishing preferences over them, and making commitments. Commitments can lead to the initiation of new decisions and any step in the cycle can incorporate reasoning about previous decisions and the rationales for them, and lead to revising or abandoning existing commitments. The theory situates decision-making with respect to other high-level cognitive capabilities like problem solving, planning, and collaborative decision-making. The canonical approach is assessed in three domains: cognitive and neuropsychology, artificial intelligence, and decision engineering.

A Canonical Theory of Dynamic Decision-Making

PubMed Central

Fox, John; Cooper, Richard P.; Glasspool, David W.

2012-01-01

Decision-making behavior is studied in many very different fields, from medicine and economics to psychology and neuroscience, with major contributions from mathematics and statistics, computer science, AI, and other technical disciplines. However the conceptualization of what decision-making is and methods for studying it vary greatly and this has resulted in fragmentation of the field. A theory that can accommodate various perspectives may facilitate interdisciplinary working. We present such a theory in which decision-making is articulated as a set of canonical functions that are sufficiently general to accommodate diverse viewpoints, yet sufficiently precise that they can be instantiated in different ways for specific theoretical or practical purposes. The canons cover the whole decision cycle, from the framing of a decision based on the goals, beliefs, and background knowledge of the decision-maker to the formulation of decision options, establishing preferences over them, and making commitments. Commitments can lead to the initiation of new decisions and any step in the cycle can incorporate reasoning about previous decisions and the rationales for them, and lead to revising or abandoning existing commitments. The theory situates decision-making with respect to other high-level cognitive capabilities like problem solving, planning, and collaborative decision-making. The canonical approach is assessed in three domains: cognitive and neuropsychology, artificial intelligence, and decision engineering. PMID:23565100

Ethical Decisions in Palliative Care: Interprofessional Relations as a Burnout Protective Factor? Results From a Mixed-Methods Multicenter Study in Portugal.

PubMed

Hernández-Marrero, Pablo; Pereira, Sandra Martins; Carvalho, Ana Sofia

2016-09-01

Ethical decisions are part of contemporary practices in palliative care. The need of making such decisions is associated to higher burnout levels and other work related problems among healthcare professionals. As part of the project entitled "Decisions in End-of-Life Care in Spain and Portugal" (DELiCaSP), this study aims to (i) identify the most common ethical decisions made by Portuguese palliative care teams and (ii) understand how the making of such decisions relates to burnout. A mixed methods study was conducted with 9 palliative care teams, using (i) questionnaires of socio-demographic and professional variables, work-related experiences, (ii) the Maslach Burnout Inventory, (iii) interviews and (iv) observations. These teams were geographically dispersed across the country, covering the North, Centrum and South regions, and heterogeneous: Five palliative care units for inpatients; three home care teams; and one hospital support team. A total of 20 interviews and 240 hours of observations were completed until reaching saturation. The most common ethical decisions were related to communication issues (information disclosure of the diagnosis and prognosis), forgoing treatment and sedation. Although perceived as stressful, emotionally demanding and challenging, ethical decisions were not significantly associated with burnout. Making ethical decisions is not associated with higher burnout levels among professionals working in Portuguese palliative care teams. This can be explained by the interprofessional decision-making process followed by these teams, which promotes a sense of shared-decision and team-based empowerment; and by the advanced level of interdisciplinary education in palliative care that these professionals have. © The Author(s) 2015.

Women's role in sanitation decision making in rural coastal Odisha, India.

PubMed

Routray, Parimita; Torondel, Belen; Clasen, Thomas; Schmidt, Wolf-Peter

2017-01-01

While women and girls face special risks from lack of access to sanitation facilities, their ability to participate and influence household-level sanitation is not well understood. This paper examines the association between women's decision-making autonomy and latrine construction in rural areas of Odisha, India. We conducted a mixed-method study among rural households in Puri district. This included a cross sectional survey among 475 randomly selected households. These were classified as either having a functional latrine, a non-functional latrine or no latrine at all. We also conducted 17 in-depth interviews and 9 focus group discussions among household members of these three categories of households. Decisions on the construction of household level sanitation facilities were made exclusively by the male head in 80% of households; in 11% the decision was made by men who consulted or otherwise involved women. In only 9% of households the decision was made by women. Households where women were more involved in general decision making processes were no more likely to build a latrine, compared to households where they were excluded from decisions. Qualitative research revealed that women's non-involvement in sanitation decision making is attributed to their low socio-economic status and inability to influence the household's financial decisions. Female heads lacked confidence to take decisions independently, and were dependent on their spouse or other male family members for most decisions. The study revealed the existence of power hierarchies and dynamics within households, which constrained female's participation in decision-making processes regarding sanitation. Though governments and implementers emphasize women's involvement in sanitation programmes, socio-cultural factors and community and household level dynamics often prevent women from participating in sanitation-related decisions. Measures are needed for strengthening sanitation policies and effective implementation of programmes to address gender power relations and familial relationships that influence latrine adoption and use.

Women's role in sanitation decision making in rural coastal Odisha, India

PubMed Central

Torondel, Belen; Clasen, Thomas; Schmidt, Wolf-Peter

2017-01-01

Background While women and girls face special risks from lack of access to sanitation facilities, their ability to participate and influence household-level sanitation is not well understood. This paper examines the association between women's decision-making autonomy and latrine construction in rural areas of Odisha, India. Methods We conducted a mixed-method study among rural households in Puri district. This included a cross sectional survey among 475 randomly selected households. These were classified as either having a functional latrine, a non-functional latrine or no latrine at all. We also conducted 17 in-depth interviews and 9 focus group discussions among household members of these three categories of households. Results Decisions on the construction of household level sanitation facilities were made exclusively by the male head in 80% of households; in 11% the decision was made by men who consulted or otherwise involved women. In only 9% of households the decision was made by women. Households where women were more involved in general decision making processes were no more likely to build a latrine, compared to households where they were excluded from decisions. Qualitative research revealed that women’s non-involvement in sanitation decision making is attributed to their low socio-economic status and inability to influence the household’s financial decisions. Female heads lacked confidence to take decisions independently, and were dependent on their spouse or other male family members for most decisions. The study revealed the existence of power hierarchies and dynamics within households, which constrained female’s participation in decision-making processes regarding sanitation. Conclusions Though governments and implementers emphasize women’s involvement in sanitation programmes, socio-cultural factors and community and household level dynamics often prevent women from participating in sanitation-related decisions. Measures are needed for strengthening sanitation policies and effective implementation of programmes to address gender power relations and familial relationships that influence latrine adoption and use. PMID:28542525

The Role of Censorship in School

ERIC Educational Resources Information Center

Petress, Ken

2005-01-01

School authorities face great complexities and inevitable challenges when deciding to make or not to make censorship decisions in schools. Matters of educational content, age level, acceptability by parents and communities, and appropriateness in the school setting are among the decisions having to be made. When school official decisions result in…

Relationship Power, Sexual Decision Making, and HIV Risk Among Midlife and Older Women.

PubMed

Altschuler, Joanne; Rhee, Siyon

2015-01-01

The number of midlife and older women with HIV/AIDS is high and increasing, especially among women of color. This article addresses these demographic realities by reporting on findings about self-esteem, relationship power, and HIV risk from a pilot study of midlife and older women. A purposive sample (N = 110) of ethnically, economically, and educationally diverse women 40 years and older from the Greater Los Angeles Area was surveyed to determine their levels of self-esteem, general relationship power, sexual decision-making power, safer sex behaviors, and HIV knowledge. Women with higher levels of self-esteem exercised greater power in their relationships with their partner. Women with higher levels of general relationship power and self-esteem tend to exercise greater power in sexual decision making, such as having sex and choosing sexual acts. Income and sexual decision-making power were statistically significant in predicting the use of condoms. Implications and recommendations for future HIV/AIDS research and intervention targeting midlife and older women are presented.

Salivary cortisol and alpha-amylase levels during an assessment procedure correlate differently with risk-taking measures in male and female police recruits

PubMed Central

van den Bos, Ruud; Taris, Ruben; Scheppink, Bianca; de Haan, Lydia; Verster, Joris C.

2013-01-01

Recent laboratory studies have shown that men display more risk-taking behavior in decision-making tasks following stress, whilst women are more risk-aversive or become more task-focused. In addition, these studies have shown that sex differences are related to levels of the stress hormone cortisol (indicative of activation of the hypothalamus-pituitary-adrenocortical-axis): the higher the levels of cortisol the more risk-taking behavior is shown by men, whereas women generally display more risk-aversive or task-focused behavior following higher levels of cortisol. Here, we assessed whether such relationships hold outside the laboratory, correlating levels of cortisol obtained during a job-related assessment procedure with decision-making parameters in the Cambridge Gambling Task (CGT) in male and female police recruits. The CGT allows for discriminating different aspects of reward-based decision-making. In addition, we correlated levels of alpha-amylase [indicative of activation of the sympatho-adrenomedullary-axis (SAM)] and decision-making parameters. In line with earlier studies men and women only differed in risk-adjustment in the CGT. Salivary cortisol levels correlated positively and strongly with risk-taking measures in men, which was significantly different from the weak negative correlation in women. In contrast, and less strongly so, salivary alpha-amylase levels correlated positively with risk-taking in women, which was significantly different from the weak negative correlation with risk-taking in men. Collectively, these data support and extend data of earlier studies indicating that risky decision-making in men and women is differently affected by stress hormones. The data are briefly discussed in relation to the effects of stress on gambling. PMID:24474909

Decision-making of older patients in context of the doctor-patient relationship: a typology ranging from "self-determined" to "doctor-trusting" patients.

PubMed

Wrede-Sach, Jennifer; Voigt, Isabel; Diederichs-Egidi, Heike; Hummers-Pradier, Eva; Dierks, Marie-Luise; Junius-Walker, Ulrike

2013-01-01

Background. This qualitative study aims to gain insight into the perceptions and experiences of older patients with regard to sharing health care decisions with their general practitioners. Patients and Methods. Thirty-four general practice patients (≥70 years) were asked about their preferences and experiences concerning shared decision making with their doctors using qualitative semistructured interviews. All interviews were analysed according to principles of content analysis. The resulting categories were then arranged into a classification grid to develop a typology of preferences for participating in decision-making processes. Results. Older patients generally preferred to make decisions concerning everyday life rather than medical decisions, which they preferred to leave to their doctors. We characterised eight different patient types based on four interdependent positions (self-determination, adherence, information seeking, and trust). Experiences of a good doctor-patient relationship were associated with trust, reliance on the doctor for information and decision making, and adherence. Conclusion. Owing to the varied patient decision-making types, it is not easy for doctors to anticipate the desired level of patient involvement. However, the decision matter and the self-determination of patients provide good starting points in preparing the ground for shared decision making. A good relationship with the doctor facilitates satisfying decision-making experiences.

Information support for decision making on dispatching control of water distribution in irrigation

NASA Astrophysics Data System (ADS)

Yurchenko, I. F.

2018-05-01

The research has been carried out on developing the technique of supporting decision making for on-line control, operational management of water allocation for the interfarm irrigation projects basing on the analytical patterns of dispatcher control. This technique provides an increase of labour productivity as well as higher management quality due to the improved level of automation, as well as decision making optimization taking into account diagnostics of the issues, solutions classification, information being required to the decision makers.

A spiral model of musical decision-making.

PubMed

Bangert, Daniel; Schubert, Emery; Fabian, Dorottya

2014-01-01

This paper describes a model of how musicians make decisions about performing notated music. The model builds on psychological theories of decision-making and was developed from empirical studies of Western art music performance that aimed to identify intuitive and deliberate processes of decision-making, a distinction consistent with dual-process theories of cognition. The model proposes that the proportion of intuitive (Type 1) and deliberate (Type 2) decision-making processes changes with increasing expertise and conceptualizes this change as movement along a continually narrowing upward spiral where the primary axis signifies principal decision-making type and the vertical axis marks level of expertise. The model is intended to have implications for the development of expertise as described in two main phases. The first is movement from a primarily intuitive approach in the early stages of learning toward greater deliberation as analytical techniques are applied during practice. The second phase occurs as deliberate decisions gradually become automatic (procedural), increasing the role of intuitive processes. As a performer examines more issues or reconsiders decisions, the spiral motion toward the deliberate side and back to the intuitive is repeated indefinitely. With increasing expertise, the spiral tightens to signify greater control over decision type selection. The model draws on existing theories, particularly Evans' (2011) Intervention Model of dual-process theories, Cognitive Continuum Theory Hammond et al. (1987), Hammond (2007), Baylor's (2001) U-shaped model for the development of intuition by level of expertise. By theorizing how musical decision-making operates over time and with increasing expertise, this model could be used as a framework for future research in music performance studies and performance science more generally.

A spiral model of musical decision-making

PubMed Central

Bangert, Daniel; Schubert, Emery; Fabian, Dorottya

2014-01-01

This paper describes a model of how musicians make decisions about performing notated music. The model builds on psychological theories of decision-making and was developed from empirical studies of Western art music performance that aimed to identify intuitive and deliberate processes of decision-making, a distinction consistent with dual-process theories of cognition. The model proposes that the proportion of intuitive (Type 1) and deliberate (Type 2) decision-making processes changes with increasing expertise and conceptualizes this change as movement along a continually narrowing upward spiral where the primary axis signifies principal decision-making type and the vertical axis marks level of expertise. The model is intended to have implications for the development of expertise as described in two main phases. The first is movement from a primarily intuitive approach in the early stages of learning toward greater deliberation as analytical techniques are applied during practice. The second phase occurs as deliberate decisions gradually become automatic (procedural), increasing the role of intuitive processes. As a performer examines more issues or reconsiders decisions, the spiral motion toward the deliberate side and back to the intuitive is repeated indefinitely. With increasing expertise, the spiral tightens to signify greater control over decision type selection. The model draws on existing theories, particularly Evans’ (2011) Intervention Model of dual-process theories, Cognitive Continuum Theory Hammond et al. (1987), Hammond (2007), Baylor’s (2001) U-shaped model for the development of intuition by level of expertise. By theorizing how musical decision-making operates over time and with increasing expertise, this model could be used as a framework for future research in music performance studies and performance science more generally. PMID:24795673

Ovarian tissue cryopreservation (OTC) in prepubertal girls and young women: an analysis of parents' and patients' decision-making.

PubMed

Sullivan-Pyke, Chantae S; Carlson, Claire A; Prewitt, Maureen; Gracia, Clarisa R; Ginsberg, Jill P

2018-04-01

The purpose of this study was to explore the decision-making influences, perceived level of control over decision-making, and mood states of parents and patients who were offered OTC prior to gonadotoxic therapy. Parents and patients, at least 12 years old, who required gonadotoxic therapy and were offered OTC prior to therapy, were asked to complete questionnaires. Two validated instruments were also used: the Decision-Making Control Instrument (DMCI) and the Profile of Mood States (POMS). The factors that influenced decision-making were compared using Student's t test, and the scores of DMCI and POMS were compared using the Mann-Whitney test. Thirty-six parents and 16 patients who elected ovarian tissue cryopreservation (OTC) completed questionnaires. Five parents who declined OTC also completed questionnaires. Accepters thought OTC was a good idea and that, in the future, science would enable cryopreserved ovarian tissue to be used to restore fertility (100% parents, 93.8% patients). Among accepters, the desire for genetically related children and prevention of the stress of infertility drove parents' and patients' decisions (90.9 and 100%, respectively). The desire to prevent the stress of infertility was important to parents, but patients were less likely to report that a desire to prevent the stress of infertility factored into their decision-making (66.7 vs. 50.0%; p < 0.001). All respondents felt in control of their decision and displayed low levels of mood disturbance. Though the decision to undergo experimental OTC is difficult and often urgent, this study suggests that families feel in control of their decision-making and report little emotional disturbance.

The role of economic evaluation in the decision-making process of family physicians: design and methods of a qualitative embedded multiple-case study

PubMed Central

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

2009-01-01

Background A considerable amount of resource allocation decisions take place daily at the point of the clinical encounter; especially in primary care, where 80 percent of health problems are managed. Ignoring economic evaluation evidence in individual clinical decision-making may have a broad impact on the efficiency of health services. To date, almost all studies on the use of economic evaluation in decision-making used a quantitative approach, and few investigated decision-making at the clinical level. An important question is whether economic evaluations affect clinical practice. The project is an intervention research study designed to understand the role of economic evaluation in the decision-making process of family physicians (FPs). The contributions of the project will be from the perspective of Pierre Bourdieu's sociological theory. Methods/design A qualitative research strategy is proposed. We will conduct an embedded multiple-case study design. Ten case studies will be performed. The FPs will be the unit of analysis. The sampling strategies will be directed towards theoretical generalization. The 10 selected cases will be intended to reflect a diversity of FPs. There will be two embedded units of analysis: FPs (micro-level of analysis) and field of family medicine (macro-level of analysis). The division of the determinants of practice/behaviour into two groups, corresponding to the macro-structural level and the micro-individual level, is the basis for Bourdieu's mode of analysis. The sources of data collection for the micro-level analysis will be 10 life history interviews with FPs, documents and observational evidence. The sources of data collection for the macro-level analysis will be documents and 9 open-ended, focused interviews with key informants from medical associations and academic institutions. The analytic induction approach to data analysis will be used. A list of codes will be generated based on both the original framework and new themes introduced by the participants. We will conduct within-case and cross-case analyses of the data. Discussion The question of the role of economic evaluation in FPs' decision-making is of great interest to scientists, health care practitioners, managers and policy-makers, as well as to consultants, industry, and society. It is believed that the proposed research approach will make an original contribution to the development of knowledge, both empirical and theoretical. PMID:19210787

Countering the negative effects of job insecurity through participative decision making: lessons from the demand-control model.

PubMed

Probst, Tahira M

2005-10-01

This study examined the effectiveness of increased organizational participative decision making in attenuating the negative consequences of job insecurity. Data were collected from 807 employees in 6 different companies. Analyses suggest that job insecurity is related to lower coworker, work, and supervisor satisfaction and higher turnover intentions and work withdrawal behaviors. However, employees with greater participative decision-making opportunities reported fewer negative consequences of job insecurity compared with employees with fewer participative decision-making opportunities. Results are interpreted using the demand-control model and suggest that organizations that allow greater employee participative decision making may experience fewer negative side effects from today's rising levels of employee job insecurity. Copyright (c) 2005 APA, all rights reserved.

Is fear perception special? Evidence at the level of decision-making and subjective confidence.

PubMed

Koizumi, Ai; Mobbs, Dean; Lau, Hakwan

2016-11-01

Fearful faces are believed to be prioritized in visual perception. However, it is unclear whether the processing of low-level facial features alone can facilitate such prioritization or whether higher-level mechanisms also contribute. We examined potential biases for fearful face perception at the levels of perceptual decision-making and perceptual confidence. We controlled for lower-level visual processing capacity by titrating luminance contrasts of backward masks, and the emotional intensity of fearful, angry and happy faces. Under these conditions, participants showed liberal biases in perceiving a fearful face, in both detection and discrimination tasks. This effect was stronger among individuals with reduced density in dorsolateral prefrontal cortex, a region linked to perceptual decision-making. Moreover, participants reported higher confidence when they accurately perceived a fearful face, suggesting that fearful faces may have privileged access to consciousness. Together, the results suggest that mechanisms in the prefrontal cortex contribute to making fearful face perception special. © The Author (2016). Published by Oxford University Press.

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

PubMed

Majcen, Špela

2017-03-01

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

Effect of noise in intelligent cellular decision making.

PubMed

Bates, Russell; Blyuss, Oleg; Alsaedi, Ahmed; Zaikin, Alexey

2015-01-01

Similar to intelligent multicellular neural networks controlling human brains, even single cells, surprisingly, are able to make intelligent decisions to classify several external stimuli or to associate them. This happens because of the fact that gene regulatory networks can perform as perceptrons, simple intelligent schemes known from studies on Artificial Intelligence. We study the role of genetic noise in intelligent decision making at the genetic level and show that noise can play a constructive role helping cells to make a proper decision. We show this using the example of a simple genetic classifier able to classify two external stimuli.

Sharing intelligence: Decision-making interactions between users and software in MAESTRO

NASA Technical Reports Server (NTRS)

Geoffroy, Amy L.; Gohring, John R.; Britt, Daniel L.

1991-01-01

By combining the best of automated and human decision-making in scheduling many advantages can accrue. The joint performance of the user and system is potentially much better than either alone. Features of the MAESTRO scheduling system serve to illustrate concepts of user/software cooperation. MAESTRO may be operated at a user-determinable and dynamic level of autonomy. Because the system allows so much flexibility in the allocation of decision-making responsibilities, and provides users with a wealth of information and other support for their own decision-making, better overall schedules may result.

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

NASA Technical Reports Server (NTRS)

Kirlik, Alex

1992-01-01

Currently, two main approaches exist for improving the human-machine interface component of a system in order to improve overall system performance - display enhancement and intelligent decision making. Discussed here are the characteristic issues of these two decision-making strategies. Differences in expert and novice decision making are described in order to help determine whether a particular strategy may be better for a particular type of user. Research is outlined to compare and contrast the two technologies, as well as to examine the interaction effects introduced by the different skill levels and the different methods for training operators.

Mild Cognitive Impairment is Associated with PoorerDecision Making in Community-Based Older Persons

PubMed Central

Duke Han, S.; Boyle, Patricia A.; James, Bryan D.; Yu, Lei; Bennett, David A.

2015-01-01

Background/Objectives Financial and healthcare decision making are important for maintaining wellbeing and independence in old age. We tested the hypothesis that Mild Cognitive Impairment (MCI) is associated with poorer decision making in financial and healthcare matters. Design Community-based epidemiologic cohort study. Setting Communities throughout Northeastern Illinois. Participants Participants were 730 older nondemented persons from the Rush Memory and Aging Project. Measurements All participants underwent a detailed clinical evaluation and decision making assessment using a measure that closely approximates materials utilized in real world financial and healthcare settings. This allowed for measurement of total decision making, as well as financial and healthcare decision making. Regression models were used to examine whether the presence of MCI was associated with a lower level of decision making. In subsequent analyses, we explored the relation of specific cognitive systems (i.e., episodic memory, semantic memory, working memory, perceptual speed, and visuospatial ability) with decision making in those with MCI. Results Results showed that MCI was associated with lower decision making total scores as well as financial and healthcare scores, respectively, after accounting for the effects of age, education, and sex. The effect of MCI on total decision making was equivalent to the effect of more than 10 additional years of age. Additional models showed that when considering multiple cognitive systems, perceptual speed accounted for the most variance in decision making among participants with MCI. Conclusion Results suggest that persons with MCI may exhibit poorer financial and healthcare decision making in real world situations, and that perceptual speed may be an important contributor to poorer decision making among persons with MCI. PMID:25850350

Decision Making and Communications Process Assessment of NASA Using Three Change Requests from the Space Launch System Program

NASA Technical Reports Server (NTRS)

Hicks, Karen Campbell

2015-01-01

This thesis investigated the communication and decision making process as part of the Systems Engineering practices at the NASA/Marshall Center to determine its level of effectiveness. Data was collected across three change requests to assess how decisions were made, how the decisions were communicated, and whether a process mattered in the formulation and dissemination of those decisions. Data results revealed the comprehensive decision making process for the technical change requests to be effective. Evidence revealed that the process was sufficiently tailored to accommodate the need of each individual technical change which promoted effective communication amongst the stakeholders in the formulation of the strategic decision recommendations elevated to upper management. However, data results also revealed the dissemination of the final decision and approval of the change requests from the higher organizational level down to all stakeholders was less effective. An establishment of a culmination meeting at the end of the change request decision process in which to close the communication loop with all entities would be beneficial.

Genders of patients and clinicians and their effect on shared decision making: a participant-level meta-analysis.

PubMed

Wyatt, Kirk D; Branda, Megan E; Inselman, Jonathan W; Ting, Henry H; Hess, Erik P; Montori, Victor M; LeBlanc, Annie

2014-09-02

Gender differences in communication styles between clinicians and patients have been postulated to impact patient care, but the extent to which the gender dyad structure impacts outcomes in shared decision making remains unclear. Participant-level meta-analysis of 775 clinical encounters within 7 randomized trials where decision aids, shared decision making tools, were used at the point of care. Outcomes analysed include decisional conflict scale scores, satisfaction with the clinical encounter, concordance between stated decision and action taken, and degree of patient engagement by the clinician using the OPTION scale. An estimated minimal important difference was used to determine if nonsignificant results could be explained by low power. We did not find a statistically significant interaction between clinician/patient gender mix and arm for decisional conflict, satisfaction with the clinical encounter or patient engagement. A borderline significant interaction (p = 0.05) was observed for one outcome: concordance between stated decision and action taken, where encounters with female clinician/male patient showed increased concordance in the decision aid arm compared to control (8% more concordant encounters). All other gender dyads showed decreased concordance with decision aid use (6% fewer concordant encounters for same-gender, 16% fewer concordant encounters for male clinician/female patient). In this participant-level meta-analysis of 7 randomized trials, decision aids used at the point of care demonstrated comparable efficacy across gender dyads. Purported barriers to shared decision making based on gender were not detected when tested for a minimum detected difference. ClinicalTrials.gov NCT00888537, NCT01077037, NCT01029288, NCT00388050, NCT00578981, NCT00949611, NCT00217061.

Universal prescriptivism: traditional moral decision-making theory revisited.

PubMed

Crigger, N J

1994-09-01

Universal prescriptivism is a recently developed moral decision-making theory that combines utilitarian and Kantian theories with two levels of moral thinking. A combined approach offers a creative solution to the weaknesses inherent in traditional moral theories. The paper describes the theory and discusses important implications for nursing education, practical ethical decision-making, and research. The relationship of an ethical theory of caring to traditional moral theory is discussed.

The assessment of depressive patients' involvement in decision making in audio-taped primary care consultations.

PubMed

Loh, Andreas; Simon, Daniela; Hennig, Katrin; Hennig, Benjamin; Härter, Martin; Elwyn, Glyn

2006-11-01

In primary care of depression treatment options such as antidepressants, counseling and psychotherapy are reasonable. Patient involvement could foster adherence and clinical outcome. However, there is a lack of empirical information about the extent to which general practitioners involve patients in decision making processes in this condition, and about the consultation time spent for distinct decision making tasks. Twenty general practice consultations with depressive patients prior to a treatment decision were audio-taped and transcribed. Patient involvement in decision making was assessed with the OPTION-scale and durations of decision making stages were measured. Mean duration of consultations was 16 min, 6s. The mean of the OPTION-items were between 0.0 and 26.9, in a scale range from 0 to 100. Overall, 78.6% of the consultation time was spent for the step "problem definition" (12 min, 42 s). Very low levels of patient involvement in medical decisions were observed in consultations about depression. Physicians used the majority of their time for the definition of the patient's medical problem. To improve treatment decision making in this condition, general practitioners should enhance their decision making competences and be more aware of the time spent in each decision making stage.

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

PubMed

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

2018-07-01

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

Women's decision-making autonomy and children's schooling in rural Mozambique.

PubMed

Luz, Luciana; Agadjanian, Victor

2015-03-24

Women's decision-making autonomy in developing settings has been shown to improve child survival and health outcomes. However, little research has addressed possible connections between women's autonomy and children's schooling. To examine the relationship between rural women's decision-making autonomy and enrollment status of primary school-age children living in their households and how this relationship differs by child's gender. The analysis uses data from a 2009 survey of rural households in four districts of Gaza province in southern Mozambique. Multilevel logistic models predict the probability of being in school for children between 6 and 14 years old. The results show a positive association of women's decision-making autonomy with the probability of being enrolled in primary school for daughters, but not for sons. The effect of women's autonomy is net of other women's characteristics typically associated with enrollment and does not mediate the effects of those characteristics. Based on the results, we argue that women with higher levels of decision-making autonomy may have a stronger preference for daughters' schooling and may have a greater say in making and implementing decisions regarding daughters' education, compared to women with lower autonomy levels. Results also illustrate a need for considering a broader set of autonomy-related characteristics when examining the effects of women's status on children's educational outcomes.

Risk of predation makes foragers less choosy about their food.

PubMed

Charalabidis, Alice; Dechaume-Moncharmont, François-Xavier; Petit, Sandrine; Bohan, David A

2017-01-01

Animals foraging in the wild have to balance speed of decision making and accuracy of assessment of a food item's quality. If resource quality is important for maximizing fitness, then the duration of decision making may be in conflict with other crucial and time consuming tasks, such as anti-predator behaviours or competition monitoring. Individuals facing the risk of predation and/or competition should adjust the duration of decision making and, as a consequence, their level of choosiness for resources. When exposed to predation, the forager could either maintain its level of choosiness for food items but accept a reduction in the amount of food items consumed or it could reduce its level of choosiness and accept all prey items encountered. Under competition risk, individuals are expected to reduce their level of choosiness as slow decision making exposes individuals to a higher risk of opportunity costs. To test these predictions, the level of choosiness of a seed-eating carabid beetle, Harpalus affinis, was examined under 4 different experimental conditions of risk: i) predation risk; ii) intraspecific competition; iii) interspecific competition; and, iv) control. All the risks were simulated using chemical cues from individual conspecifics or beetles of different species that are predatory or granivorous. Our results show that when foraging under the risk of predation, H. affinis individuals significantly reduce their level of choosiness for seeds. Reductions in level of choosiness for food items might serve as a sensible strategy to reduce both the total duration of a foraging task and the cognitive load of the food quality assessment. No significant differences were observed when individuals were exposed to competition cues. Competition, (i.e opportunity cost) may not be perceived as risk high enough to induce changes in the level of choosiness. Our results suggest that considering the amount of items consumed, alone, would be a misleading metric when assessing individual response to a risk of predation. Foraging studies should therefore also take in account the decision making process.

Utilising Benchmarking to Inform Decision-Making at the Institutional Level: A Research-Informed Process

ERIC Educational Resources Information Center

Booth, Sara

2013-01-01

Benchmarking has traditionally been viewed as a way to compare data only; however, its utilisation as a more investigative, research-informed process to add rigor to decision-making processes at the institutional level is gaining momentum in the higher education sector. Indeed, with recent changes in the Australian quality environment from the…

Involvement of Youth with Disabilities in State-Level Decision Making. inForum

ERIC Educational Resources Information Center

Muller, Eve

2007-01-01

During the National Association of State Directors of Special Education's (NASDSE) 2005 annual meeting, a panel of youth representatives challenged states to do a better job of including youth with disabilities in state-level decision making (e.g., as members of state advisory panels [SAPs] and/or transition councils). State directors of special…

A safety-based decision making architecture for autonomous systems

NASA Technical Reports Server (NTRS)

Musto, Joseph C.; Lauderbaugh, L. K.

1991-01-01

Engineering systems designed specifically for space applications often exhibit a high level of autonomy in the control and decision-making architecture. As the level of autonomy increases, more emphasis must be placed on assimilating the safety functions normally executed at the hardware level or by human supervisors into the control architecture of the system. The development of a decision-making structure which utilizes information on system safety is detailed. A quantitative measure of system safety, called the safety self-information, is defined. This measure is analogous to the reliability self-information defined by McInroy and Saridis, but includes weighting of task constraints to provide a measure of both reliability and cost. An example is presented in which the safety self-information is used as a decision criterion in a mobile robot controller. The safety self-information is shown to be consistent with the entropy-based Theory of Intelligent Machines defined by Saridis.

36 CFR 251.99 - Appeal decision.

Code of Federal Regulations, 2010 CFR

2010-07-01

... decision. (a) The Reviewing Officer shall base the appeal decision on the appeal record and applicable laws... level of appeal, the Reviewing Officer shall make and issue an appeal decision within 30 days of the date the record is closed. (d) At the second level of appeal provided in § 251.87(c), the Reviewing...

Culture and medical decision making: Healthcare consumer perspectives in Japan and the United States.

PubMed

Alden, Dana L; Friend, John M; Lee, Angela Y; de Vries, Marieke; Osawa, Ryosuke; Chen, Qimei

2015-12-01

Two studies identified core value influences on medical decision-making processes across and within cultures. In Study 1, Japanese and American adults reported desired levels of medical decision-making influence across conditions that varied in seriousness. Cultural antecedents (interdependence, independence, and power distance) were also measured. In Study 2, American adults reviewed a colorectal cancer screening decision aid. Decision preparedness was measured along with interdependence, independence, and desire for medical information. In Study 1, higher interdependence predicted stronger desire for decision-making information in both countries, but was significantly stronger in Japan. The path from information desire to decision-making influence desire was significant only in Japan. The independence path to desire for decision-making influence was significant only in the United States. Power distance effects negatively predicted desire for decision-making influence only in the United States. For Study 2, high (low) interdependents and women (men) in the United States felt that a colorectal cancer screening decision aid helped prepare them more (less) for a medical consultation. Low interdependent men were at significantly higher risk for low decision preparedness. Study 1 suggests that Japanese participants may tend to view medical decision-making influence as an interdependent, information sharing exchange, whereas American respondents may be more interested in power sharing that emphasizes greater independence. Study 2 demonstrates the need to assess value influences on medical decision-making processes within and across cultures and suggests that individually tailored versions of decision aids may optimize decision preparedness. (c) 2015 APA, all rights reserved).

An Assessment of Direct Restorative Material Use in Posterior Teeth by American and Canadian Pediatric Dentists: III. Preferred Level of Participation in Decision-making.

PubMed

Varughese, Rae E; Andrews, Paul; Sigal, Michael J; Azarpazhooh, Amir

2016-11-15

The purpose of this study was to assess Canadian and American pediatric dentists' preferred level of participation in clinical decision-making. A web-based survey was used to collect the opinions of all active Royal College of Dentists of Canada members and American Academy of Pediatric Dentistry members on the use of direct restorative materials in posterior teeth (n equals 4,648; 19.3 percent response rate). The main survey also included a domain to elicit participants' preferred role in clinical decision-making, ranging from an active role (the dentist takes the primary role in decision-making while considering patients/caregivers opinions) to a passive role (the dentist prefers to have the patient guide the decision-making). Bivariate and multivariate analyses for the preferred role and its predictor were performed (two-tailed P<0.05). Fifty-eight percent of participants preferred an active role. The passive role was chosen three times more by those who worked in a hospital-based setting (odds ratio [OR] equals 3.15, 95 percent confidence interval [CI] equals 1.13 to 8.79) or a university-based setting versus a combined setting (OR equals 3.61, 95 percent CI equals 1.11 to 11.77). The majority of participants preferred an active role in decision-making, a role that may not be consistent with a patient-centered practice that emphasizes patient autonomy in decision-making.

Medical and pharmacy coverage decision making at the population level.

PubMed

Mohr, Penny E; Tunis, Sean R

2014-06-01

Medicare is one of the largest health care payers in the United States. As a result, its decisions about coverage have profound implications for patient access to care. In this commentary, the authors describe how Medicare used evidence on heterogeneity of treatment effects to make population-based decisions on health care coverage for implantable cardiac defibrillators. This case is discussed in the context of the rapidly expanding availability of comparative effectiveness research. While there is a potential tension between population-based and patient-centered decision making, the expanded diversity of populations and settings included in comparative effectiveness research can provide useful information for making more discerning and informed policy and clinical decisions.

Insights into the concept and measurement of health literacy from a study of shared decision-making in a low literacy population.

PubMed

Smith, Sian K; Nutbeam, Don; McCaffery, Kirsten J

2013-08-01

This article explores the concept and measurement of health literacy in the context of shared health decision-making. It draws upon a series of qualitative and quantitative studies undertaken in the development and evaluation of a bowel cancer screening decision aid for low literacy populations. The findings indicate that different types of health literacy (functional, interactive and critical) are required in decision-making and present a set of instruments to assess and discriminate between higher level health literacy skills required for engagement in decision-making. It concludes that greater sophistication in both the definition and measurement of health literacy in research is needed.

3D technology of Sony Bloggie has no advantage in decision-making of tennis serve direction: A randomized placebo-controlled study.

PubMed

Liu, Sicong; Ritchie, Jason; Sáenz-Moncaleano, Camilo; Ward, Savanna K; Paulsen, Cody; Klein, Tyler; Gutierrez, Oscar; Tenenbaum, Gershon

2017-06-01

This study aimed at exploring whether 3D technology enhances tennis decision-making under the conceptual framework of human performance model. A 3 (skill-level: varsity, club, recreational) × 3 (experimental condition: placebo, weak 3D [W3D], strong 3D [S3D]) between-participant design was used. Allocated to experimental conditions by a skill-level stratified randomization, 105 tennis players judged tennis serve direction from video scenarios and rated their perceptions of enjoyment, flow, and presence during task performance. Results showed that varsity players made more accurate decisions than less skilled ones. Additionally, applying 3D technology to typical video displays reduced tennis players' decision-making accuracy, although wearing the 3D glasses led to a placebo effect that shortened the decision-making reaction time. The unexpected negative effect of 3D technology on decision-making was possibly due to participants being more familiar to W3D than to S3D, and relatedly, a suboptimal task-technology match. Future directions for advancing this area of research are offered. Highlights 3D technology augments binocular depth cues to tradition video displays, and thus results in the attainment of more authentic visual representation. This process enhances task fidelity in researching perceptual-cognitive skills in sports. The paper clarified both conceptual and methodological difficulties in testing 3D technology in sports settings. Namely, the nomenclature of video footage (with/without 3D technology) and the possible placebo effect (arising from wearing glasses of 3D technology) merit researchers' attention. Participants varying in level of domain-specific expertise were randomized into viewing conditions using a placebo-controlled design. Measurement consisted of both participants' subjective experience (i.e., presence, flow, and enjoyment) and objective performance (i.e., accuracy and reaction time) in a decision-making task. Findings revealed that wearing glasses of 3D technology resulted in a placebo effect that shortened participants' reaction times in decision-making. Moreover, participants' decision-making accuracy decreased when viewing video scenarios using 3D technology. The findings generated meaningful implications regarding applying 3D technology to sports research.

Unraveling the Role of Curriculum in Teacher Decision Making

ERIC Educational Resources Information Center

Siuty, Molly Baustien; Leko, Melinda M.; Knackstedt, Kimberly M.

2018-01-01

Teachers make numerous decisions each day, yet processes undergirding these decisions are elusive and have not been the subject of many in-depth investigations within special education. The purpose of this qualitative investigation, therefore, was to complete a micro-level analysis of the influence of curriculum on 11 middle school teachers'…

Nudging Students' Creative Problem-Solving Skills

ERIC Educational Resources Information Center

Griffin, Dana

2011-01-01

People often make choices that go against their own best interests. In the controversial bestseller "Nudge," Richard Thaler and Cass Sunstein argue that people can benefit from simple "nudges" to improve their decision-making. In an upper-level undergraduate course on political decision-making, I created a series of assignments around "Nudge." In…

Gendered Behavior Patterns in School Board Governance

ERIC Educational Resources Information Center

Mountford, Meredith; Brunner, C. Cryss

2010-01-01

Background/Context: Educational leadership literature lacks research focused on how gender influences decision making, in particular at the highest level of school governance, the school board table. Consequently, whether gender makes a difference during decision making at the school board table has yet to be determined. Purpose/Objective/Research…

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

PubMed

Fellows, Lesley K

2006-04-01

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

Behavioral preference in sequential decision-making and its association with anxiety.

PubMed

Zhang, Dandan; Gu, Ruolei

2018-06-01

In daily life, people often make consecutive decisions before the ultimate goal is reached (i.e., sequential decision-making). However, this kind of decision-making has been largely overlooked in the literature. The current study investigated whether behavioral preference would change during sequential decisions, and the neural processes underlying the potential changes. For this purpose, we revised the classic balloon analogue risk task and recorded the electroencephalograph (EEG) signals associated with each step of decision-making. Independent component analysis performed on EEG data revealed that four EEG components elicited by periodic feedback in the current step predicted participants' decisions (gamble vs. no gamble) in the next step. In order of time sequence, these components were: bilateral occipital alpha rhythm, bilateral frontal theta rhythm, middle frontal theta rhythm, and bilateral sensorimotor mu rhythm. According to the information flows between these EEG oscillations, we proposed a brain model that describes the temporal dynamics of sequential decision-making. Finally, we found that the tendency to gamble (as well as the power intensity of bilateral frontal theta rhythms) was sensitive to the individual level of trait anxiety in certain steps, which may help understand the role of emotion in decision-making. © 2018 Wiley Periodicals, Inc.

Shared decision making in chronic care in the context of evidence based practice in nursing.

PubMed

Friesen-Storms, Jolanda H H M; Bours, Gerrie J J W; van der Weijden, Trudy; Beurskens, Anna J H M

2015-01-01

In the decision-making environment of evidence-based practice, the following three sources of information must be integrated: research evidence of the intervention, clinical expertise, and the patient's values. In reality, evidence-based practice usually focuses on research evidence (which may be translated into clinical practice guidelines) and clinical expertise without considering the individual patient's values. The shared decision-making model seems to be helpful in the integration of the individual patient's values in evidence-based practice. We aim to discuss the relevance of shared decision making in chronic care and to suggest how it can be integrated with evidence-based practice in nursing. We start by describing the following three possible approaches to guide the decision-making process: the paternalistic approach, the informed approach, and the shared decision-making approach. Implementation of shared decision making has gained considerable interest in cases lacking a strong best-treatment recommendation, and when the available treatment options are equivalent to some extent. We discuss that in chronic care it is important to always invite the patient to participate in the decision-making process. We delineate the following six attributes of health care interventions in chronic care that influence the degree of shared decision making: the level of research evidence, the number of available intervention options, the burden of side effects, the impact on lifestyle, the patient group values, and the impact on resources. Furthermore, the patient's willingness to participate in shared decision making, the clinical expertise of the nurse, and the context in which the decision making takes place affect the shared decision-making process. A knowledgeable and skilled nurse with a positive attitude towards shared decision making—integrated with evidence-based practice—can facilitate the shared decision-making process. We conclude that nurses as well as other health care professionals in chronic care should integrate shared decision making with evidence-based practice to deliver patient-centred care. Copyright © 2014 Elsevier Ltd. All rights reserved.

High Levels of Decisional Conflict and Decision Regret When Making Decisions About Biologics.

PubMed

Lipstein, Ellen A; Lovell, Daniel J; Denson, Lee A; Kim, Sandra C; Spencer, Charles; Ittenbach, Richard F; Britto, Maria T

2016-12-01

The aim of the study was to understand the association between parents' perceptions of the decision process and the decision outcomes in decisions about the use of biologics in pediatric chronic conditions. We mailed surveys to parents of children with inflammatory bowel disease or juvenile idiopathic arthritis who had started treatment with biologics in the prior 2 years and were treated at either of 2 children's hospitals. The survey included measures of the decision process, including decision control and physician engagement, and decision outcomes, including conflict and regret. We used means and frequencies to assess the response distributions. General linear models were used to test the associations between decision process and decision outcomes. We had 201 respondents (response rate 54.9%). Approximately 47.0% reported using shared decision making. Each physician engagement behavior was experienced by the majority of parents, with the highest percentage reporting that their child's physician used language they understood and listened to them. Approximately 48.5% of parents had decisional conflict scores of 25 or greater, indicating high levels of conflict. Approximately 28.2% had no regret, 31.8% had mild regret, and the remaining 40.0% had moderate to severe regret. Shared decision making was not associated with improved decisional conflict, but physician engagement behaviors were associated with both decisional conflict and regret. Improving decision outcomes will require more than just focusing on who parents perceive as controlling the final decision. Developing interventions that facilitate specific physician engagement behaviors may decrease parents' distress around decision making and improve decision outcomes.

Perspectives on Multiunit Colleges

ERIC Educational Resources Information Center

Rossmeier, Joseph G.

1976-01-01

Research shows that neither centralization nor decentralization of decision-making authority in multiunit community colleges is a primary determinant of organizational effectiveness; rather it is the degree of participation in decision-making by staff members at all hierarchical levels. (BB)

Effects of Gain/Loss Framing in Cyber Defense Decision-Making

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

Bos, Nathan; Paul, Celeste; Gersh, John

Cyber defense requires decision making under uncertainty. Yet this critical area has not been a strong focus of research in judgment and decision-making. Future defense systems, which will rely on software-defined networks and may employ ‘moving target’ defenses, will increasingly automate lower level detection and analysis, but will still require humans in the loop for higher level judgment. We studied the decision making process and outcomes of 17 experienced network defense professionals who worked through a set of realistic network defense scenarios. We manipulated gain versus loss framing in a cyber defense scenario, and found significant effects in one ofmore » two focal problems. Defenders that began with a network already in quarantine (gain framing) used a quarantine system more than those that did not (loss framing). We also found some difference in perceived workload and efficacy. Alternate explanations of these findings and implications for network defense are discussed.« less

Decision-Making of Older Patients in Context of the Doctor-Patient Relationship: A Typology Ranging from “Self-Determined” to “Doctor-Trusting” Patients

PubMed Central

Voigt, Isabel; Diederichs-Egidi, Heike; Hummers-Pradier, Eva; Dierks, Marie-Luise; Junius-Walker, Ulrike

2013-01-01

Background. This qualitative study aims to gain insight into the perceptions and experiences of older patients with regard to sharing health care decisions with their general practitioners. Patients and Methods. Thirty-four general practice patients (≥70 years) were asked about their preferences and experiences concerning shared decision making with their doctors using qualitative semistructured interviews. All interviews were analysed according to principles of content analysis. The resulting categories were then arranged into a classification grid to develop a typology of preferences for participating in decision-making processes. Results. Older patients generally preferred to make decisions concerning everyday life rather than medical decisions, which they preferred to leave to their doctors. We characterised eight different patient types based on four interdependent positions (self-determination, adherence, information seeking, and trust). Experiences of a good doctor-patient relationship were associated with trust, reliance on the doctor for information and decision making, and adherence. Conclusion. Owing to the varied patient decision-making types, it is not easy for doctors to anticipate the desired level of patient involvement. However, the decision matter and the self-determination of patients provide good starting points in preparing the ground for shared decision making. A good relationship with the doctor facilitates satisfying decision-making experiences. PMID:23691317

Introduction of New Vaccines: Decision-making Process in Bangladesh

PubMed Central

Sarma, Haribondhu; Bari, Tajul I.; Koehlmoos, Tracey P.

2013-01-01

The understanding of the decision-making process in the introduction of new vaccines helps establish why vaccines are adopted or not. It also contributes to building a sustainable demand for vaccines in a country. The purpose of the study was to map and analyze the formal decision-making process in relation to the introduction of new vaccines within the context of health policy and health systems and identify the ways of making decisions to introduce new vaccines in Bangladesh. During February-April 2011, a qualitative assessment was made at the national level to evaluate the decision-making process around the adoption of new vaccines in Bangladesh. The study population included: policy-level people, programme heads or associates, and key decision-makers of the Government, private sector, non-governmental organizations, and international agencies at the national level. In total, 13 key informants were purposively selected. Data were collected by interviewing key informants and reviewing documents. Data were analyzed thematically. The findings revealed that the actors from different sectors at the policy level were involved in the decision-making process in the introduction of new vaccines. They included policy-makers from the ministries of health and family welfare, finance, and local government and rural development; academicians; researchers; representatives from professional associations; development partners; and members of different committees on EPI. They contributed to the introduction of new vaccines in their own capacity. The burden of disease, research findings on vaccine-preventable diseases, political issues relating to outbreaks of certain diseases, initiatives of international and local stakeholders, pressure of development partners, the Global Alliance for Vaccines and Immunization (GAVI) support, and financial matters were the key factors in the introduction of new vaccines in Bangladesh. The slow introduction and uptake of new vaccines is a concern in the country. Rapid action on the application of GAVI support and less time taken by the Government in processing the implementation and administrative work may expedite the introduction of new vaccines in future in this country. PMID:23930339

Introduction of new vaccines: decision-making process in Bangladesh.

PubMed

Uddin, Jasim; Sarma, Haribondhu; Bari, Tajul I; Koehlmoos, Tracey P

2013-06-01

The understanding of the decision-making process in the introduction of new vaccines helps establish why vaccines are adopted or not. It also contributes to building a sustainable demand for vaccines in a country. The purpose of the study was to map and analyze the formal decision-making process in relation to the introduction of new vaccines within the context of health policy and health systems and identify the ways of making decisions to introduce new vaccines in Bangladesh. During February-April 2011, a qualitative assessment was made at the national level to evaluate the decision-making process around the adoption of new vaccines in Bangladesh. The study population included: policy-level people, programme heads or associates, and key decision-makers of the Government, private sector, non-governmental organizations, and international agencies at the national level. In total, 13 key informants were purposively selected. Data were collected by interviewing key informants and reviewing documents. Data were analyzed thematically. The findings revealed that the actors from different sectors at the policy level were involved in the decision-making process in the introduction of new vaccines. They included policy-makers from the ministries of health and family welfare, finance, and local government and rural development; academicians; researchers; representatives from professional associations; development partners; and members of different committees on EPI. They contributed to the introduction of new vaccines in their own capacity. The burden of disease, research findings on vaccine-preventable diseases, political issues relating to outbreaks of certain diseases, initiatives of international and local stakeholders, pressure of development partners, the Global Alliance for Vaccines and Immunization (GAVI) support, and financial matters were the key factors in the introduction of new vaccines in Bangladesh. The slow introduction and uptake of new vaccines is a concern in the country. Rapid action on the application of GAVI support and less time taken by the Government in processing the implementation and administrative work may expedite the introduction of new vaccines in future in this country.

Patient Preferences regarding Shared Decision-making in the Emergency Department: Findings from a multi-site survey.

PubMed

Schoenfeld, Elizabeth M; Kanzaria, Hemal K; Quigley, Denise D; Marie, Peter St; Nayyar, Nikita; Sabbagh, Sarah H; Gress, Kyle L; Probst, Marc A

2018-06-13

As Shared Decision-Making (SDM) has received increased attention as a method to improve the patient-centeredness of emergency department (ED) care, we sought to determine patients' desired level of involvement in medical decisions and their perceptions of potential barriers and facilitators to SDM in the ED. We surveyed a cross-sectional sample of adult ED patients at three academic medical centers across the United States. The survey included 32 items regarding patient involvement in medical decisions including a modified Control Preference Scale (CPS) and questions about barriers and facilitators to SDM in the ED. Items were developed and refined based on prior literature and qualitative interviews with ED patients. Research assistants administered the survey in person. Of 797 patients approached, 661 (83%) agreed to participate. Participants were 52% female, 45% white, and 30% Hispanic. The majority of respondents (85-92%, depending on decision type) expressed a desire for some degree of involvement in decision-making in the ED, while 8-15% preferred to leave decision-making to their physician alone. Ninety-eight percent wanted to be involved with decisions when "something serious is going on." The majority of patients (94%) indicated that self-efficacy was not a barrier to SDM in the ED. However, most patients (55%) reported a tendency to defer to the physician's decision-making during an ED visit, with about half reporting they would wait for a physician to ask them to be involved. We found the majority of ED patients in our large, diverse sample wanted to be involved in medical decisions, especially in the case of a "serious" medical problem, and felt that they had the ability to do so. Nevertheless, many patients were unlikely to actively seek involvement and defaulted to allowing the physician to make decisions during the ED visit. After fully explaining the consequences of a decision, clinicians should make an effort to explicitly ascertain patients' desired level of involvement in decision-making. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Serotonin and decision making processes.

PubMed

Homberg, Judith R

2012-01-01

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

Decision-Making Deficits Among Maltreated Children

PubMed Central

Weller, Joshua A.; Fisher, Philip A.

2013-01-01

Although maltreated children involved with child welfare services are known to exhibit elevated levels of health-risking behaviors, little is known about their decision-making processes leading to these behaviors. Research findings suggest that maltreated children exhibit developmental delays in neurocognitive and emotional regulation systems that could adversely impact their abilities to make decisions under conditions of risk. Whereas prior researchers have examined risky decision making as a global construct, maltreated children’s decision making was examined in two contexts in the present study: potential gains and potential losses. Comparing maltreated children (n = 25) and a nonmaltreated community group (n = 112), it was found that the maltreated children showed decision-making impairments for both domains: This impairment was especially prominent in the loss domain. The maltreated children took excessive risks and were insensitive to changes in expected value. Follow-up analyses revealed that these differences were primarily associated with insensitivity to changes in outcome magnitude for the risky option. Finally, response latency analyses indicated that the maltreated children were slower to make choices, reinforcing underlying differences in decision processes between groups. These results have implications for basic and translational science. PMID:23220788

Chimpanzees and Bonobos Exhibit Emotional Responses to Decision Outcomes

PubMed Central

Rosati, Alexandra G.; Hare, Brian

2013-01-01

The interface between cognition, emotion, and motivation is thought to be of central importance in understanding complex cognitive functions such as decision-making and executive control in humans. Although nonhuman apes have complex repertoires of emotional expression, little is known about the role of affective processes in ape decision-making. To illuminate the evolutionary origins of human-like patterns of choice, we investigated decision-making in humans' closest phylogenetic relatives, chimpanzees (Pan troglodytes) and bonobos (Pan paniscus). In two studies, we examined these species' temporal and risk preferences, and assessed whether apes show emotional and motivational responses in decision-making contexts. We find that (1) chimpanzees are more patient and more risk-prone than are bonobos, (2) both species exhibit affective and motivational responses following the outcomes of their decisions, and (3) some emotional and motivational responses map onto species-level and individual-differences in decision-making. These results indicate that apes do exhibit emotional responses to decision-making, like humans. We explore the hypothesis that affective and motivational biases may underlie the psychological mechanisms supporting value-based preferences in these species. PMID:23734175

Moral Hypocrisy on the Basis of Construal Level: To Be a Utilitarian Personal Decision Maker or to Be a Moral Advisor?

PubMed Central

Xiao, Wei; Wu, Qing; Yang, Qun; Zhou, Liang; Jiang, Yuan; Zhang, Jiaxi; Miao, Danmin; Peng, Jiaxi

2015-01-01

Background People encounter various moral issues that involve making decisions for others by giving advice. Objective This study investigated the characteristics of providing suggestions for oneself versus providing suggestions for others in ethical decision-making and the differences between them based on Construal Level Theory (CLT). Methods A total of 768 undergraduate students from three universities in China were randomly assigned to eight groups on the basis of a grid of two Construal Levels (self or others) by two different numbers of people saved (5 people or 15 people) by two problem situations (trolley problem vs. footbridge problem). The investigation examined participants’ decisions to opt to take action or refrain from action that would have the consequence of saving more people. Results The main effects of Construal Level (F1, 752 = 6.46, p = .011), saving number (F1, 752 = 35.81, p < .001), and problem situation type (F1, 752 = 330.55, p < .001) were all significant. The interaction of the problem situation and saving number (F1, 752 = 1.01, p = .31), and social distance and saving number (F1, 752 = 0.85, p = .36), and interaction of the three independent factors (F1, 752 = 0.47, p = .49) were not significant. However, the interaction of social distance and problem situation (F1, 752 = 9.46, p = .002) was significant. Results indicated the participants utilized a component of utilitarian reasoning in the decision-making, and their behaviors appeared more utilitarian at low Construal Levels (CLs) compared to high. Conclusion CLs, saving numbers, and problem situation significantly affected moral decision-making and exhibited significant interaction. Making decisions for oneself (low-construal) rather than giving advice to others (high-construal) was one important factor that determined whether the people were utilitarian or not. Utilitarian considerations are more relevant in impersonal dilemmas. PMID:25689521

Patients' preferences for involvement in the decision-making process for treating diabetic retinopathy.

PubMed

Marahrens, Lydia; Kern, Raimar; Ziemssen, Tjalf; Fritsche, Andreas; Martus, Peter; Ziemssen, Focke; Roeck, Daniel

2017-08-09

To assess factors associated with the preferred role of the attending ophthalmologist in the decision-making processes before treating diabetic retinopathy (DR). Cross-sectional study of 810 adults attending secondary diabetes care centers (NCT02311504). Diabetes patients were classified using a validated questionnaire in an ophthalmologist-dominant decision-making (ODM), shared decision-making (SDM) and patient-dominant decision-making (PDM) style. Multivariate logistic regression was performed to determine factors associated with the decision-making process. A majority of 74.3% patients preferred SDM between ophthalmologist and patient, 17.4% patients wanted ODM, delegating the decision-making process to the ophthalmologist, 8.3% preferred the autonomous style of PDM. Patients wanting ODM were older (OR = 1.2 per decade, p = 0.013), had a lower level of education (OR = 1.4, p = 0.001) and had a higher frequency of consultations per year (OR = 1.3, p = 0.022). Patients with better basic knowledge in DR and memorizing their HbA 1 c level showed a higher propensity for SDM (OR = 1.1, p = 0.037). Patients wanting PDM had a significantly higher education (OR = 1.3, p = 0.036) and a greater desire for receiving information from self-help groups (OR = 1.3, p = 0.015). The first evaluation of the general patient wishes for the treatment of DR confirmed the concept of SDM, which was favored by three quarters. In particular, older patients with low educational attainment wanted to delegate the decision-making process to the ophthalmologist. Amelioration of ophthalmologic education in diabetic programs might take up patients' propensity for SDM. Regardless of the decision-making group, nearly all patients wanted the medical and scientific information to be transferred by and shared with the ophthalmologist. The study was registered on www.clinicaltrials.gov (identifier: NCT02311504) on December 4th 2014.

Ethical decision making in intensive care units: a burnout risk factor? Results from a multicentre study conducted with physicians and nurses.

PubMed

Teixeira, Carla; Ribeiro, Orquídea; Fonseca, António M; Carvalho, Ana Sofia

2014-02-01

Ethical decision making in intensive care is a demanding task. The need to proceed to ethical decision is considered to be a stress factor that may lead to burnout. The aim of this study is to explore the ethical problems that may increase burnout levels among physicians and nurses working in Portuguese intensive care units (ICUs). A quantitative, multicentre, correlational study was conducted among 300 professionals. The most crucial ethical decisions made by professionals working in ICU were related to communication, withholding or withdrawing treatments and terminal sedation. A positive relation was found between ethical decision making and burnout in nurses, namely, between burnout and the need to withdraw treatments (p=0.032), to withhold treatments (p=0.002) and to proceed to terminal sedation (p=0.005). This did not apply to physicians. Emotional exhaustion was the burnout subdimension most affected by the ethical decision. The nurses' lack of involvement in ethical decision making was identified as a risk factor. Nevertheless, in comparison with nurses (6%), it was the physicians (34%) who more keenly felt the need to proceed to ethical decisions in ICU. Ethical problems were reported at different levels by physicians and nurses. The type of ethical decisions made by nurses working in Portuguese ICUs had an impact on burnout levels. This did not apply to physicians. This study highlights the need for education in the field of ethics in ICUs and the need to foster inter-disciplinary discussion so as to encourage ethical team deliberation in order to prevent burnout.

Higher Trait Psychopathy Is Associated with Increased Risky Decision-Making and Less Coincident Insula and Striatal Activity

PubMed Central

Sutherland, Matthew T.; Fishbein, Diana H.

2017-01-01

Higher trait levels of psychopathy have been associated with both a tendency to maintain disadvantageous decision-making strategies and aberrant cortico-limbic neural activity. To explore the neural mechanisms associated with the psychopathy-related propensity to continue selecting risky choices, a non-forensic sample of participants completed a self-report psychopathy questionnaire and two runs of a risky decision-making task during H215O positron emission tomography (PET) scanning. In this secondary data analysis study, we leveraged data previously collected to examine the impact of previous drug use on risky decision-making to explore the relations between self-reported psychopathy and behavioral and brain metrics during performance of the Cambridge Decision-Making Task (CDMT), in which volunteers chose between small/likely or large/unlikely potential reward outcomes. Behaviorally, we observed that psychopathy scores were differentially correlated with the percent of risky decisions made in run 1 vs. run 2 of the task. Specifically, higher levels of psychopathy, above and beyond that attributable to drug use or sex, were associated with greater tendencies to make risky selections only in the second half (run 2) of the task. In parallel, psychopathy scores negatively correlated with regional cerebral blood flow (rCBF) in the right insula and right ventral striatum during run 2 of the CDMT. These exploratory outcomes suggest that greater levels of psychopathy may be associated with an inability to translate experience with negative outcomes into behavioral adaptations possibly due to decreased neural efficiency in regions related to somatic and/or reward feedback processes. PMID:29311863

Ethical dilemmas concerning decision-making within health care leadership: a systematic literature review.

PubMed

Zydziūnaite, Vilma; Suominen, Tarja; Astedt-Kurki, Päivi; Lepaite, Daiva

2010-01-01

The objective was to describe the research methods and research focuses on ethical dilemmas concerning decision-making within health care leadership. The search was conducted on Medline and PubMed databases (1998-2008). The systematic review included 21 selected articles. The ethical dilemmas concerning decision-making within health care leadership are related to three levels: institutional (particular organization), political and local interface (local governmental structure), and national (professional expertise and system). The terms that are used as adequate to the term of "ethical dilemma" are the following: "continuous balancing," "result of resource allocation," "gap between professional obligations and possibilities," "ethically controversial situation," "concern about interactions," "ethical difficulty," "outcome of medical choices," "concern about society access to health care resources," "ethically difficult/challenging situation," "(the consequence of) ethical concern/ethical issue." In qualitative studies, a semi-structured interview and qualitative content analysis are the most commonly applied methods; in quantitative studies, questionnaire surveys are employed. In the research literature, there is a lack of specification according to professional qualification of health care professionals concerning ethical dilemmas by decision-making within health care management/administration. The research on ethical dilemmas in health care leadership, management, and administration should integrate data about levels at which ethical dilemmas occur and investigate ethical dilemmas as complex phenomena because those are attached to decision-making and specific nuances of health care management/administration. In this article, the presented scientific problem requires extensive scientific discussions and research on ethical dilemmas concerning decision-making within health care leadership at various levels.

Planning ahead in public health? A qualitative study of the time horizons used in public health decision-making

PubMed Central

Taylor-Robinson, David C; Milton, Beth; Lloyd-Williams, Ffion; O'Flaherty, Martin; Capewell, Simon

2008-01-01

Background In order to better understand factors that influence decisions for public health, we undertook a qualitative study to explore issues relating to the time horizons used in decision-making. Methods Qualitative study using semi-structured interviews. 33 individuals involved in the decision making process around coronary heart disease were purposively sampled from the UK National Health Service (national, regional and local levels), academia and voluntary organizations. Analysis was based on the framework method using N-VIVO software. Interviews were transcribed, coded and emergent themes identified. Results Many participants suggested that the timescales for public health decision-making are too short. Commissioners and some practitioners working at the national level particularly felt constrained in terms of planning for the long-term. Furthermore respondents felt that longer term planning was needed to address the wider determinants of health and to achieve societal level changes. Three prominent 'systems' issues were identified as important drivers of short term thinking: the need to demonstrate impact within the 4 year political cycle; the requirement to 'balance the books' within the annual commissioning cycle and the disruption caused by frequent re-organisations within the health service. In addition respondents suggested that the tools and evidence base for longer term planning were not well established. Conclusion Many public health decision and policy makers feel that the timescales for decision-making are too short. Substantial systemic barriers to longer-term planning exist. Policy makers need to look beyond short-term targets and budget cycles to secure investment for long-term improvement in public health. PMID:19094194

Planning ahead in public health? A qualitative study of the time horizons used in public health decision-making.

PubMed

Taylor-Robinson, David C; Milton, Beth; Lloyd-Williams, Ffion; O'Flaherty, Martin; Capewell, Simon

2008-12-18

In order to better understand factors that influence decisions for public health, we undertook a qualitative study to explore issues relating to the time horizons used in decision-making. Qualitative study using semi-structured interviews. 33 individuals involved in the decision making process around coronary heart disease were purposively sampled from the UK National Health Service (national, regional and local levels), academia and voluntary organizations. Analysis was based on the framework method using N-VIVO software. Interviews were transcribed, coded and emergent themes identified. Many participants suggested that the timescales for public health decision-making are too short. Commissioners and some practitioners working at the national level particularly felt constrained in terms of planning for the long-term. Furthermore respondents felt that longer term planning was needed to address the wider determinants of health and to achieve societal level changes. Three prominent 'systems' issues were identified as important drivers of short term thinking: the need to demonstrate impact within the 4 year political cycle; the requirement to 'balance the books' within the annual commissioning cycle and the disruption caused by frequent re-organisations within the health service. In addition respondents suggested that the tools and evidence base for longer term planning were not well established. Many public health decision and policy makers feel that the timescales for decision-making are too short. Substantial systemic barriers to longer-term planning exist. Policy makers need to look beyond short-term targets and budget cycles to secure investment for long-term improvement in public health.

Female participation in household decision-making: an analysis of consumer durables' acquisition in Pakistan.

PubMed

Mujahid-mukhtar, E; Mukhtar, H

1991-01-01

Investigating the nature and degree of female household decision-making in Pakistan, this paper analyzes the influence of women in the purchase consumer durables. The paper also identifies those factors which enable women to play a more active role in the decision-making process. Because women in Pakistan are generally excluded from the public sphere, their level of emancipation is better assessed according to the degree of participation in household decision-making. A good measure of women's power within a household is their influence in the purchase of consumer durables (cars, appliances, etc.), whose expense and life-long nature makes their purchase an important decision. For this study, the authors relied on data from a 1989 nationwide household survey conducted by AERC, which included a information concerning the acquisition of 12 consumer durables as expected. As expected, men make more decisions on the purchase of all consumer goods than women, even for items in which women feel more need than men (e.g. sewing machines, washing machines). The study found that for the needs felt by women for all durable goods, men make 2/3 of all decisions, while women make only 1/3 of decisions. And in cases where the need is felt by men, the men make 93% of the decisions, while women decide only 3 % of the times. The study identified various cultural and economic factors that affect women's decision making power: urban women, women in nuclear families, educated women, and working women generally have more decision making power than rural women, women in extended families, illiterate women, and unemployed women.

Police response to domestic violence: making decisions about risk and risk management.

PubMed

Perez Trujillo, Monica; Ross, Stuart

2008-04-01

Assessing and responding to risk are key elements in how police respond to domestic violence. However, relatively little is known about the way police make judgments about the risks associated with domestic violence and how these judgments influence their actions. This study examines police decisions about risk in domestic violence incidents when using a risk assessment instrument. Based on a sample of 501 risk assessments completed by police in Australia, this study shows that a limited number of items on the risk assessment instrument are important in police officers' decisions about risk. Statistical analyses show that the victim's level of fear contributes to police officers' judgment on the level of risk and their decisions on which risk management strategy should be used. These findings suggest that research on police responses to domestic violence needs to pay greater attention to situational dynamics and the task requirements of risk-based decision making.

[Adoption of new technologies by health services: the challenge of analyzing relevant factors].

PubMed

Trindade, Evelinda

2008-05-01

The exponential increase in the incorporation of health technologies has been considered a key factor in increased expenditures by the health sector. Such decisions involve multiple levels and stakeholders. Decentralization has multiplied the decision-making levels, with numerous difficult choices and limited resources. The interrelationship between stakeholders is complex, in creative systems with multiple determinants and confounders. The current review discusses the interaction between the factors influencing the decisions to incorporate technologies by health services, and proposes a structure for their analysis. The application and intensity of these factors in decision-making and the incorporation of products and programs by health services shapes the installed capacity of local and regional networks and modifies the health system. Empirical observation of decision-making and technology incorporation in Brazilian health services poses an important challenge. The structured recognition and measurement of these variables can assist proactive planning of health services.

Context, Participation and Discourse: The Role of the Communities of Practice Concept in Understanding Farmer Decision-Making

ERIC Educational Resources Information Center

O'Kane, M. P.; Paine, M. S.; King, B. J.

2008-01-01

This article contributes to the study of decision-making processes both at a farm systems level and at the level of agricultural research in partnership with commercial farms. It also highlights the way in which adoption and adaptation of innovation occurs in a socially rich context with information, group formation and connectivity converging to…

Relationship of Teachers' Readiness for Change with Their Participation in Decision Making and School Culture

ERIC Educational Resources Information Center

Inandi, Yusuf; Giliç, Fahrettin

2016-01-01

The aim of this research is to study the relationship between primary school teachers' level of participation in decision making, school culture and their level of readiness for change. The data in the study were collected from 597 primary school teachers (304 men and 293 women) in central districts of Mersin in 2014 spring semester. Participation…

Assessing the Desired and Actual Levels of Teachers' Participation in Decision-Making in Secondary Schools of Ethiopia

ERIC Educational Resources Information Center

Bademo, Yismaw; Tefera, Bekalu Ferede

2016-01-01

This study was conducted to assess the desired and actual levels of teachers' participation in decision-making process in Ethiopian secondary schools. For this, the study employed a cross-sectional survey design collecting data from sampled secondary school teachers (n = 258) found in Assosa Zone, Benishangual Gumuz Regional state, Ethiopia.…

Creating a System for Data-Driven Decision-Making: Applying the Principal-Agent Framework

ERIC Educational Resources Information Center

Wohlstetter, Priscilla; Datnow, Amanda; Park, Vicki

2008-01-01

The purpose of this article is to improve our understanding of data-driven decision-making strategies that are initiated at the district or system level. We apply principal-agent theory to the analysis of qualitative data gathered in a case study of 4 urban school systems. Our findings suggest educators at the school level need not only systemic…

Consumer's Online Shopping Influence Factors and Decision-Making Model

NASA Astrophysics Data System (ADS)

Yan, Xiangbin; Dai, Shiliang

Previous research on online consumer behavior has mostly been confined to the perceived risk which is used to explain those barriers for purchasing online. However, perceived benefit is another important factor which influences consumers’ decision when shopping online. As a result, an integrated consumer online shopping decision-making model is developed which contains three elements—Consumer, Product, and Web Site. This model proposed relative factors which influence the consumers’ intention during the online shopping progress, and divided them into two different dimensions—mentally level and material level. We tested those factors with surveys, from both online volunteers and offline paper surveys with more than 200 samples. With the help of SEM, the experimental results show that the proposed model and method can be used to analyze consumer’s online shopping decision-making process effectively.

Conceptual Problems.

ERIC Educational Resources Information Center

Foley, Walter J.

A systems theory approach to information requirements in education and in evaluation strategies is applied to decision making. Educational decision making itself involves long range planning, system structuring to implement goals, system allocation (cost), and system monitoring which provides the feedback. Each level requires differential…

Two studies on participation in decision-making and equity among FAA personnel.

DOT National Transportation Integrated Search

1991-07-01

Study 1 Moderated multiple regression analyses on data collected from 2,177 FAA air traffic controller specialists indicated that equity perceptions moderated the relationship between participation in decision-making and level of job satisfaction. Sp...

Stress and Aeronautical Team Decision Making: Strengthening the Weak Links

NASA Technical Reports Server (NTRS)

Orasanu, Judith; Rosekind, Mark R. (Technical Monitor)

1996-01-01

A model that characterizes pilots'decision making in flight will be presented. Elements of the model that appear most vulnerable to stress will be examined in light of accidents and incidents. The model includes two major components: Situation assessment and choice of a course of action. While based on Klein's Recognition-Primed Decision Making, it is tailored to the aviation environment which includes certain features that may be common to other domains: Primarily, aviation is highly proceduralized and options are generally well known. What appears to make decisions difficult are ambiguity, time pressure, and risk. In addition, decisions must often be made while carrying out the standard procedures of flight, including checklists, review of approach plates, standard briefings, and communication with air traffic controllers or cabin crew. The effects of stressors on decision making by pilots with varying levels of expertise will be explored, along with strategies for strengthening the weak links.

To close the childhood immunization gap, we need a richer understanding of parents' decision-making.

PubMed

Corben, Paul; Leask, Julie

2016-12-01

Vaccination is widely acknowledged as one of the most successful public health interventions globally and in most high-income countries childhood vaccination coverage rates are moderately high. Yet in many instances, immunisation rates remain below aspirational targets and have shown only modest progress toward those targets in recent years, despite concerted efforts to improve uptake. In part, coverage rates reflect individual parents' vaccination attitudes and decisions and, because vaccination decision-making is complex and context-specific, it remains challenging at individual and community levels to assist parents to make positive decisions. Consequently, in the search for opportunities to improve immunisation coverage, there has been a renewed research focus on parents' decision-making. This review provides an overview of the literature surrounding parents' vaccination decision-making, offering suggestions for where efforts to increase vaccination coverage should be targeted and identifying areas for further research.

Use of antipsychotic blood levels in clinician decision making: A cross-over study using clinical vignettes of patients with schizophrenia.

PubMed

Savitz, Adam; Melkote, Rama; Riley, Ralph; Pobre, Maria A; McQuarrie, Kelly; Williamson, David; Banderas, Benjamin

2018-05-19

The cause of treatment failure of antipsychotic medications is often difficult to determine in patients with schizophrenia. Evaluation of antipsychotic blood levels (ABLs) may aid clinicians in determining the cause of antipsychotic failure. The Clinical Assessment of the Schizophrenia Patient (CASP) was developed to evaluate clinical decision making during outpatient visits. The CASP assesses changes in medications, psychosocial treatments, and acute interventions along with factors influencing clinical decision making. Nine vignettes representative of clinical situations in patients with schizophrenia were created in two versions (one with ABLs, one without ABLs). The CASP was used to evaluate clinical decisions using the vignettes. Thirty-four clinicians participated in the study. In 8 out of 9 vignettes, most clinicians (at least 89.7%) made a different clinical decision with ABLs compared to without ABLs. In assessing the usefulness of ABLs, a majority (60.7%-85.7%, depending on the vignette) of clinicians responded that ABLs changed their clinical decision for 8 vignettes. Most clinicians (79%-93%) responded that they were more confident in their decisions with ABL information. This study demonstrated that ABLs have the potential to influence clinical decision making in the treatment of patients with schizophrenia. Copyright © 2018. Published by Elsevier B.V.

Decision making in a human population living sustainably.

PubMed

Hicks, John S; Burgman, Mark A; Marewski, Julian N; Fidler, Fiona; Gigerenzer, Gerd

2012-10-01

The Tiwi people of northern Australia have managed natural resources continuously for 6000-8000 years. Tiwi management objectives and outcomes may reflect how they gather information about the environment. We qualitatively analyzed Tiwi documents and management techniques to examine the relation between the social and physical environment of decision makers and their decision-making strategies. We hypothesized that principles of bounded rationality, namely, the use of efficient rules to navigate complex decision problems, explain how Tiwi managers use simple decision strategies (i.e., heuristics) to make robust decisions. Tiwi natural resource managers reduced complexity in decision making through a process that gathers incomplete and uncertain information to quickly guide decisions toward effective outcomes. They used management feedback to validate decisions through an information loop that resulted in long-term sustainability of environmental use. We examined the Tiwi decision-making processes relative to management of barramundi (Lates calcarifer) fisheries and contrasted their management with the state government's management of barramundi. Decisions that enhanced the status of individual people and their attainment of aspiration levels resulted in reliable resource availability for Tiwi consumers. Different decision processes adopted by the state for management of barramundi may not secure similarly sustainable outcomes. ©2012 Society for Conservation Biology.

Effort-Based Decision-Making in Schizophrenia.

PubMed

Culbreth, Adam J; Moran, Erin K; Barch, Deanna M

2018-08-01

Motivational impairment has long been associated with schizophrenia but the underlying mechanisms are not clearly understood. Recently, a small but growing literature has suggested that aberrant effort-based decision-making may be a potential contributory mechanism for motivational impairments in psychosis. Specifically, multiple reports have consistently demonstrated that individuals with schizophrenia are less willing than healthy controls to expend effort to obtain rewards. Further, this effort-based decision-making deficit has been shown to correlate with severity of negative symptoms and level of functioning, in many but not all studies. In the current review, we summarize this literature and discuss several factors that may underlie aberrant effort-based decision-making in schizophrenia.

The Neuropeptide Oxytocin Enhances Information Sharing and Group Decision Making Quality.

PubMed

De Wilde, Tim R W; Ten Velden, Femke S; De Dreu, Carsten K W

2017-01-11

Groups can make better decisions than individuals when members cooperatively exchange and integrate their uniquely held information and insights. However, under conformity pressures group members are biased towards exchanging commonly known information, and away from exchanging unique information, thus undermining group decision-making quality. At the neurobiological level, conformity associates with the neuropeptide oxytocin. A double-blind placebo controlled study found no evidence for oxytocin induced conformity. Compared to placebo groups, three-person groups whose members received intranasal oxytocin, focused more on unique information (i) and repeated this information more often (ii). These findings reveal oxytocin as a neurobiological driver of group decision-making processes.

The Neuropeptide Oxytocin Enhances Information Sharing and Group Decision Making Quality

PubMed Central

De Wilde, Tim R. W.; Ten Velden, Femke S.; De Dreu, Carsten K. W.

2017-01-01

Groups can make better decisions than individuals when members cooperatively exchange and integrate their uniquely held information and insights. However, under conformity pressures group members are biased towards exchanging commonly known information, and away from exchanging unique information, thus undermining group decision-making quality. At the neurobiological level, conformity associates with the neuropeptide oxytocin. A double-blind placebo controlled study found no evidence for oxytocin induced conformity. Compared to placebo groups, three-person groups whose members received intranasal oxytocin, focused more on unique information (i) and repeated this information more often (ii). These findings reveal oxytocin as a neurobiological driver of group decision-making processes. PMID:28074896

Poor Decision Making is Associated with an Increased Risk of Mortality Among Community-Dwelling Older Persons without Dementia

PubMed Central

Boyle, Patricia A.; Wilson, Robert S.; Yu, Lei; Buchman, Aron S.; Bennett, David A.

2013-01-01

Background Decision making is thought to be an important determinant of health and well-being across the lifespan, but little is known about the association of decision making with mortality. Methods Participants were 675 older persons without dementia from the Rush Memory and Aging Project, a longitudinal cohort study of aging. Baseline assessments of decision making were used to predict the risk of mortality during up to 4 years of follow-up. Results The mean score on the decision making measure at baseline was 7.1 (SD=2.9, range: 0-12), with lower scores indicating poorer decision making. During up to 4 years of follow-up (mean=1.7 years), 40 (6% of 675) persons died. In a proportional hazards model adjusted for age, sex, and education, the risk of mortality increased by about 20% for each additional decision making error (HR=1.19, 95% CI 1.07, 1.32, p=0.002). Thus, a person who performed poorly on the measure of decision making (score=3, 10th percentile) was about four times more likely to die compared to a person who performed well (score=11, 90th percentile). Further, the association of decision making with mortality persisted after adjustment for the level of cognitive function. Conclusion Poor decision making is associated with an increased risk of mortality in old age even after accounting for cognitive function. PMID:23364306

Poor decision making is associated with an increased risk of mortality among community-dwelling older persons without dementia.

PubMed

Boyle, Patricia A; Wilson, Robert S; Yu, Lei; Buchman, Aron S; Bennett, David A

2013-01-01

Decision making is thought to be an important determinant of health and well-being across the lifespan, but little is known about the association of decision making with mortality. Participants were 675 older persons without dementia from the Rush Memory and Aging Project, a longitudinal cohort study of aging. Baseline assessments of decision making were used to predict the risk of mortality during up to 4 years of follow-up. The mean score on the decision making measure at baseline was 7.1 (SD = 2.9, range: 0-12), with lower scores indicating poorer decision making. During up to 4 years of follow-up (mean = 1.7 years), 40 (6% of 675) persons died. In a proportional hazards model adjusted for age, sex and education, the risk of mortality increased by about 20% for each additional decision making error (HR = 1.19, 95% CI = 1.07-1.32, p = 0.002). Thus, a person who performed poorly on the measure of decision making (score = 3, 10th percentile) was about 4 times more likely to die compared to a person who performed well (score = 11, 90th percentile). Further, the association of decision making with mortality persisted after adjustment for the level of cognitive function. Poor decision making is associated with an increased risk of mortality in old age even after accounting for cognitive function. Copyright © 2013 S. Karger AG, Basel.

Students' Reasoning Processes in Making Decisions about an Authentic, Local Socio-Scientific Issue: Bat Conservation

ERIC Educational Resources Information Center

Lee, Yeung Chung; Grace, Marcus

2010-01-01

Education for scientific literacy entails the development of scientific knowledge and the ability to apply this knowledge and value judgments to decisions about real-life issues. This paper reports an attempt to involve secondary level biology students in making decisions about an authentic socio-scientific issue--that of bat conservation--through…

Teacher and Lay Participation in Local Curriculum Change Considerations.

ERIC Educational Resources Information Center

Schaffarzick, Jon

This study examines the roles of teachers and citizens in decision-making related to curriculum planning and change. Interviews were conducted with persons involved in curriculum decision-making in 34 school districts in order to ascertain how they determined whether or not to make elementary-level curriculum changes. The rational and political…

Different roads to the same destination - The impact of impulsivity on decision-making processes under risk within a rewarding context in a healthy male sample.

PubMed

Dinu-Biringer, Ramona; Nees, Frauke; Falquez, Rosalux; Berger, Moritz; Barnow, Sven

2016-02-28

The results of research about the influences of impulsivity on decision-making in situations of risk have been inconsistent. In this study, we used functional magnetic resonance imaging to examine the neural correlates of decision-making under risk in 12 impulsive, as defined by the Barratt Impulsiveness Scale-11, and 13 normal men. Although both groups showed similar decision-making behavior, neural activation regarding decision-making processes differed significantly. Impulsive persons revealed stronger activation in the (ventro-) medial prefrontal cortex and less deactivation of the orbitofrontal cortex while playing for potential gains. These brain regions might be associated with the emotional components of decision-making processes. Significant differences in brain areas linked to cognitive decision-making components were not found. This activation pattern might be seen as an indication for a hypersensitivity to rewarding cues in impulsive persons and might be linked to the propensity for inappropriate risk-taking behavior in persons with more extreme impulsivity levels, especially in situations in which they have a strong emotional involvement in the decision process. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Why older adults make more immediate treatment decisions about cancer than younger adults.

PubMed

Meyer, Bonnie J F; Talbot, Andrew P; Ranalli, Carlee

2007-09-01

Literature relevant to medical decision making was reviewed, and a model was outlined for testing. Two studies examined whether older adults make more immediate decisions than younger adults about treatments for prostate or breast cancer in authentic scenarios. Findings clearly showed that older adults were more likely to make immediate decisions than younger adults. The research is important because it not only demonstrates the consistency of this age-related effect across disease domains, gender, ethnic groups, and prevalent education levels but begins to investigate a model to explain the effect. Major reasons for the effect focus on treatment knowledge, interest and engagement, and cognitive resources. Treatment knowledge, general cancer knowledge, interest, and cognitive resources relate to different ways of processing treatment information and preferences for immediate versus delayed decision making. Adults with high knowledge of treatments on a reliable test tended to make immediate treatment decisions, which supports the knowledge explanation. Adults with more cognitive resources and more interest tended to delay their treatment decisions. Little support was found for a cohort explanation for the relationship between age and preference for immediate medical decision making. (PsycINFO Database Record (c) 2007 APA, all rights reserved).

Implementing shared decision-making: consider all the consequences.

PubMed

Elwyn, Glyn; Frosch, Dominick L; Kobrin, Sarah

2016-08-08

The ethical argument that shared decision-making is "the right" thing to do, however laudable, is unlikely to change how healthcare is organized, just as evidence alone will be an insufficient factor: practice change is governed by factors such as cost, profit margin, quality, and efficiency. It is helpful, therefore, when evaluating new approaches such as shared decision-making to conceptualize potential consequences in a way that is broad, long-term, and as relevant as possible to multiple stakeholders. Yet, so far, evaluation metrics for shared decision-making have been mostly focused on short-term outcomes, such as cognitive or affective consequences in patients. The goal of this article is to hypothesize a wider set of consequences, that apply over an extended time horizon, and include outcomes at interactional, team, organizational and system levels, and to call for future research to study these possible consequences. To date, many more studies have evaluated patient decision aids rather than other approaches to shared decision-making, and the outcomes measured have typically been focused on short-term cognitive and affective outcomes, for example knowledge and decisional conflict. From a clinicians perspective, the shared decision-making process could be viewed as either intrinsically rewarding and protective, or burdensome and impractical, yet studies have not focused on the impact on professionals, either positive or negative. At interactional levels, group, team, and microsystem, the potential long-term consequences could include the development of a culture where deliberation and collaboration are regarded as guiding principles, where patients are coached to assess the value of interventions, to trade-off benefits versus harms, and assess their burdens-in short, to new social norms in the clinical workplace. At organizational levels, consistent shared decision-making might boost patient experience evaluations and lead to fewer complaints and legal challenges. In the long-term, shared decision-making might lead to changes in resource utilization, perhaps to reductions in cost, and to modification of workforce composition. Despite the gradual shift to value-based payment, some organizations, motivated by continued income derived from achieving high volumes of procedures and contacts, will see this as a negative consequence. We suggest that a broader conceptualization and measurement of shared decision-making would provide a more substantive evidence base to guide implementation. We outline a framework which illustrates a hypothesized set of proximal, distal, and distant consequences that might occur if collaboration and deliberation could be achieved routinely, proposing that well-informed preference-based patient decisions might lead to safer, more cost-effective healthcare, which in turn might result in reduced utilization rates and improved health outcomes.

Decision Making and Ratio Processing in Patients with Mild Cognitive Impairment.

PubMed

Pertl, Marie-Theres; Benke, Thomas; Zamarian, Laura; Delazer, Margarete

2015-01-01

Making advantageous decisions is important in everyday life. This study aimed at assessing how patients with mild cognitive impairment (MCI) make decisions under risk. Additionally, it investigated the relationship between decision making, ratio processing, basic numerical abilities, and executive functions. Patients with MCI (n = 22) were compared with healthy controls (n = 29) on a complex task of decision making under risk (Game of Dice Task-Double, GDT-D), on two tasks evaluating basic decision making under risk, on a task of ratio processing, and on several neuropsychological background tests. Patients performed significantly lower than controls on the GDT-D and on ratio processing, whereas groups performed comparably on basic decision tasks. Specifically, in the GDT-D, patients obtained lower net scores and lower mean expected values, which indicate a less advantageous performance relative to that of controls. Performance on the GDT-D correlated significantly with performance in basic decision tasks, ratio processing, and executive-function measures when the analysis was performed on the whole sample. Patients with MCI make sub-optimal decisions in complex risk situations, whereas they perform at the same level as healthy adults in simple decision situations. Ratio processing and executive functions have an impact on the decision-making performance of both patients and healthy older adults. In order to facilitate advantageous decisions in complex everyday situations, information should be presented in an easily comprehensible form and cognitive training programs for patients with MCI should focus--among other abilities--on executive functions and ratio processing.

Sexual picture processing interferes with decision-making under ambiguity.

PubMed

Laier, Christian; Pawlikowski, Mirko; Brand, Matthias

2014-04-01

Many people watch sexually arousing material on the Internet in order to receive sexual arousal and gratification. When browsing for sexual stimuli, individuals have to make several decisions, all possibly leading to positive or negative consequences. Decision-making research has shown that decisions under ambiguity are influenced by consequences received following earlier decisions. Sexual arousal might interfere with the decision-making process and should therefore lead to disadvantageous decision-making in the long run. In the current study, 82 heterosexual, male participants watched sexual pictures, rated them with respect to sexual arousal, and were asked to indicate their current level of sexual arousal before and following the sexual picture presentation. Afterwards, subjects performed one of two modified versions of the Iowa Gambling Task in which sexual pictures were displayed on the advantageous and neutral pictures on the disadvantageous card decks or vice versa (n = 41/n = 41). Results demonstrated an increase of sexual arousal following the sexual picture presentation. Decision-making performance was worse when sexual pictures were associated with disadvantageous card decks compared to performance when the sexual pictures were linked to the advantageous decks. Subjective sexual arousal moderated the relationship between task condition and decision-making performance. This study emphasized that sexual arousal interfered with decision-making, which may explain why some individuals experience negative consequences in the context of cybersex use.

Medical decision-making in children and adolescents: developmental and neuroscientific aspects.

PubMed

Grootens-Wiegers, Petronella; Hein, Irma M; van den Broek, Jos M; de Vries, Martine C

2017-05-08

Various international laws and guidelines stress the importance of respecting the developing autonomy of children and involving minors in decision-making regarding treatment and research participation. However, no universal agreement exists as to at what age minors should be deemed decision-making competent. Minors of the same age may show different levels of maturity. In addition, patients deemed rational conversation-partners as a child can suddenly become noncompliant as an adolescent. Age, context and development all play a role in decision-making competence. In this article we adopt a perspective on competence that specifically focuses on the impact of brain development on the child's decision-making process. We believe that the discussion on decision-making competence of minors can greatly benefit from a multidisciplinary approach. We adopted such an approach in order to contribute to the understanding on how to deal with children in decision-making situations. Evidence emerging from neuroscience research concerning the developing brain structures in minors is combined with insights from various other fields, such as psychology, decision-making science and ethics. Four capacities have been described that are required for (medical) decision-making: (1) communicating a choice; (2) understanding; (3) reasoning; and (4) appreciation. Each capacity is related to a number of specific skills and abilities that need to be sufficiently developed to support the capacity. Based on this approach it can be concluded that at the age of 12 children can have the capacity to be decision-making competent. However, this age coincides with the onset of adolescence. Early development of the brain's reward system combined with late development of the control system diminishes decision-making competence in adolescents in specific contexts. We conclude that even adolescents possessing capacities required for decision-making, may need support of facilitating environmental factors. This paper intends to offer insight in neuroscientific mechanisms underlying the medical decision-making capacities in minors and to stimulate practices for optimal involvement of minors. Developing minors become increasingly capable of decision-making, but the neurobiological development in adolescence affects competence in specific contexts. Adequate support should be offered in order to create a context in which minors can make competently make decisions.

Medical Decision-Making Incapacity among Newly Diagnosed Older Patients with Hematological Malignancy Receiving First Line Chemotherapy: A Cross-Sectional Study of Patients and Physicians

PubMed Central

Sugano, Koji; Okuyama, Toru; Iida, Shinsuke; Komatsu, Hirokazu; Ishida, Takashi; Kusumoto, Shigeru; Uchida, Megumi; Nakaguchi, Tomohiro; Kubota, Yosuke; Ito, Yoshinori; Takahashi, Kazuhisa; Akechi, Tatsuo

2015-01-01

Background Decision-making capacity to provide informed consent regarding treatment is essential among cancer patients. The purpose of this study was to identify the frequency of decision-making incapacity among newly diagnosed older patients with hematological malignancy receiving first-line chemotherapy, to examine factors associated with incapacity and assess physicians’ perceptions of patients’ decision-making incapacity. Methods Consecutive patients aged 65 years or over with a primary diagnosis of malignant lymphoma or multiple myeloma were recruited. Decision-making capacity was assessed using the Structured Interview for Competency and Incompetency Assessment Testing and Ranking Inventory-Revised (SICIATRI-R). Cognitive impairment, depressive condition and other possible associated factors were also evaluated. Results Among 139 eligible patients registered for this study, 114 completed the survey. Of these, 28 (25%, 95% confidence interval [CI]: 17%-32%) were judged as having some extent of decision-making incompetency according to SICIATRI-R. Higher levels of cognitive impairment and increasing age were significantly associated with decision-making incapacity. Physicians experienced difficulty performing competency assessment (Cohen’s kappa -0.54). Conclusions Decision-making incapacity was found to be a common and under-recognized problem in older patients with cancer. Age and assessment of cognitive impairment may provide the opportunity to find patients that are at a high risk of showing decision-making incapacity. PMID:26296202

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.

Spillover Effects of Loss of Control on Risky Decision-Making

PubMed Central

Beisswingert, Birgit M.; Zhang, Keshun; Goetz, Thomas; Fischbacher, Urs

2016-01-01

Decision making in risky situations is frequently required in our everyday lives and has been shown to be influenced by various factors, some of which are independent of the risk context. Based on previous findings and theories about the central role of perceptions of control and their impact on subsequent settings, spillover effects of subjective loss of control on risky decision-making are assumed. After developing an innovative experimental paradigm for inducing loss of control, its hypothesized effects on risky decision-making are investigated. Partially supporting the hypotheses, results demonstrated no increased levels of risk perceptions but decreased risk-taking behavior following experiences of loss of control. Thus, this study makes a methodological contribution by proposing a newly developed experimental paradigm facilitating further research on the effects of subjective loss of control, and additionally provides partial evidence for the spillover effects of loss of control experiences on risky decision-making. PMID:26930066

Three-level global resource allocation model for hiv control: A hierarchical decision system approach.

PubMed

Kassa, Semu Mitiku

2018-02-01

Funds from various global organizations, such as, The Global Fund, The World Bank, etc. are not directly distributed to the targeted risk groups. Especially in the so-called third-world-countries, the major part of the fund in HIV prevention programs comes from these global funding organizations. The allocations of these funds usually pass through several levels of decision making bodies that have their own specific parameters to control and specific objectives to achieve. However, these decisions are made mostly in a heuristic manner and this may lead to a non-optimal allocation of the scarce resources. In this paper, a hierarchical mathematical optimization model is proposed to solve such a problem. Combining existing epidemiological models with the kind of interventions being on practice, a 3-level hierarchical decision making model in optimally allocating such resources has been developed and analyzed. When the impact of antiretroviral therapy (ART) is included in the model, it has been shown that the objective function of the lower level decision making structure is a non-convex minimization problem in the allocation variables even if all the production functions for the intervention programs are assumed to be linear.

Downward delegation of implantable cardioverter defibrillator decision-making in a restricted-resource environment: the pitfalls of bedside rationing.

PubMed

Simpson, Christopher S; Hoffmaster, Barry; Dorian, Paul

2005-05-15

Implantable cardioverter defibrillators have been shown to reduce all-cause mortality in some patient populations at risk of sudden death. New Canadian guidelines recommend implantable cardioverter defibrillator therapy for these patients. However, the need for these devices exceeds the funded volumes in many Canadian jurisdictions. As a result, rationing of this resource has been necessary. While rationing at the macro (Ministry of Health) and meso (hospital) levels has achieved some level of acceptance by society, the responsibility for the decisions taken at the micro (individual) patient level actually rests with the physician at the bedside. This 'bedside rationing' creates a moral dilemma for physicians, who are torn between their traditional fiduciary role as 'patient advocate' and the competing role of 'gatekeeper'. This 'downward delegation' of rationing decision-making obscures the reality that rationing occurs, and encourages covert, opaque and inconsistent approaches. The remedy is the development of fair, legitimate procedures for making rationing decisions that include guidelines that structure and constrain those decisions. Macro- and meso-level stakeholders must also recognize and take responsibility for their part in restricting resources in a broadly inclusive and transparent process.

Information giving and decision-making in patients with advanced cancer: a systematic review.

PubMed

Gaston, Christine M; Mitchell, Geoffrey

2005-11-01

Patients with advanced, non-curable cancer face difficult decisions on further treatment, where a small increase in survival time must be balanced against the toxicity of the treatment. If patients want to be involved in these decisions, in keeping with current notions of autonomy and empowerment, they also require to be adequately informed both on the treatments proposed and on their own disease status and prognosis. A systematic review was performed on decision-making and information provision in patients with advanced cancer. Studies of interventions to improve information giving and encourage participation in decision-making were reviewed, including both randomised controlled trials and uncontrolled studies. Almost all patients expressed a desire for full information, but only about two-thirds wished to participate actively in decision-making. Higher educational level, younger age and female sex were predictive of a desire to participate in decision-making. Active decision-making was more common in patients with certain cancers (e.g. breast) than others (e.g. prostate). A number of simple interventions including question prompt sheets, audio-taping of consultations and patient decision aids have been shown to facilitate such involvement.

Neural substrates of approach-avoidance conflict decision-making

PubMed Central

Aupperle, Robin L.; Melrose, Andrew J.; Francisco, Alex; Paulus, Martin P.; Stein, Murray B.

2014-01-01

Animal approach-avoidance conflict paradigms have been used extensively to operationalize anxiety, quantify the effects of anxiolytic agents, and probe the neural basis of fear and anxiety. Results from human neuroimaging studies support that a frontal-striatal-amygdala neural circuitry is important for approach-avoidance learning. However, the neural basis of decision-making is much less clear in this context. Thus, we combined a recently developed human approach-avoidance paradigm with functional magnetic resonance imaging (fMRI) to identify neural substrates underlying approach-avoidance conflict decision-making. Fifteen healthy adults completed the approach-avoidance conflict (AAC) paradigm during fMRI. Analyses of variance were used to compare conflict to non-conflict (avoid-threat and approach-reward) conditions and to compare level of reward points offered during the decision phase. Trial-by-trial amplitude modulation analyses were used to delineate brain areas underlying decision-making in the context of approach/avoidance behavior. Conflict trials as compared to the non-conflict trials elicited greater activation within bilateral anterior cingulate cortex (ACC), anterior insula, and caudate, as well as right dorsolateral prefrontal cortex. Right caudate and lateral PFC activation was modulated by level of reward offered. Individuals who showed greater caudate activation exhibited less approach behavior. On a trial-by-trial basis, greater right lateral PFC activation related to less approach behavior. Taken together, results suggest that the degree of activation within prefrontal-striatal-insula circuitry determines the degree of approach versus avoidance decision-making. Moreover, the degree of caudate and lateral PFC activation is related to individual differences in approach-avoidance decision-making. Therefore, the AAC paradigm is ideally suited to probe anxiety-related processing differences during approach-avoidance decision-making. PMID:25224633

Neural substrates of approach-avoidance conflict decision-making.

PubMed

Aupperle, Robin L; Melrose, Andrew J; Francisco, Alex; Paulus, Martin P; Stein, Murray B

2015-02-01

Animal approach-avoidance conflict paradigms have been used extensively to operationalize anxiety, quantify the effects of anxiolytic agents, and probe the neural basis of fear and anxiety. Results from human neuroimaging studies support that a frontal-striatal-amygdala neural circuitry is important for approach-avoidance learning. However, the neural basis of decision-making is much less clear in this context. Thus, we combined a recently developed human approach-avoidance paradigm with functional magnetic resonance imaging (fMRI) to identify neural substrates underlying approach-avoidance conflict decision-making. Fifteen healthy adults completed the approach-avoidance conflict (AAC) paradigm during fMRI. Analyses of variance were used to compare conflict to nonconflict (avoid-threat and approach-reward) conditions and to compare level of reward points offered during the decision phase. Trial-by-trial amplitude modulation analyses were used to delineate brain areas underlying decision-making in the context of approach/avoidance behavior. Conflict trials as compared to the nonconflict trials elicited greater activation within bilateral anterior cingulate cortex, anterior insula, and caudate, as well as right dorsolateral prefrontal cortex (PFC). Right caudate and lateral PFC activation was modulated by level of reward offered. Individuals who showed greater caudate activation exhibited less approach behavior. On a trial-by-trial basis, greater right lateral PFC activation related to less approach behavior. Taken together, results suggest that the degree of activation within prefrontal-striatal-insula circuitry determines the degree of approach versus avoidance decision-making. Moreover, the degree of caudate and lateral PFC activation related to individual differences in approach-avoidance decision-making. Therefore, the approach-avoidance conflict paradigm is ideally suited to probe anxiety-related processing differences during approach-avoidance decision-making. © 2014 Wiley Periodicals, Inc.

Optimal allocation model of construction land based on two-level system optimization theory

NASA Astrophysics Data System (ADS)

Liu, Min; Liu, Yanfang; Xia, Yuping; Lei, Qihong

2007-06-01

The allocation of construction land is an important task in land-use planning. Whether implementation of planning decisions is a success or not, usually depends on a reasonable and scientific distribution method. Considering the constitution of land-use planning system and planning process in China, multiple levels and multiple objective decision problems is its essence. Also, planning quantity decomposition is a two-level system optimization problem and an optimal resource allocation decision problem between a decision-maker in the topper and a number of parallel decision-makers in the lower. According the characteristics of the decision-making process of two-level decision-making system, this paper develops an optimal allocation model of construction land based on two-level linear planning. In order to verify the rationality and the validity of our model, Baoan district of Shenzhen City has been taken as a test case. Under the assistance of the allocation model, construction land is allocated to ten townships of Baoan district. The result obtained from our model is compared to that of traditional method, and results show that our model is reasonable and usable. In the end, the paper points out the shortcomings of the model and further research directions.

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

PubMed

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

2006-10-01

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

Domestic decision-making power, social support, and postpartum depression symptoms among immigrant and native women in Taiwan.

PubMed

Chien, Li-Yin; Tai, Chen-Jei; Yeh, Mei-Chiang

2012-01-01

Domestic decision-making power is an integral part of women's empowerment. No study has linked domestic decision-making power and social support concurrently to postpartum depression and compared these between immigrant and native populations. The aim of this study was to examine domestic decision-making power and social support and their relationship to postpartum depressive symptoms among immigrant and native women in Taiwan. This cross-sectional survey included 190 immigrant and 190 native women who had delivered healthy babies during the past year in Taipei City. Depression was measured using the Edinburgh Postnatal Depression Scale, with a cutoff score of 10. Logistic regression was used to determine the factors associated with postpartum depression symptoms. Immigrant mothers had significantly higher prevalence of postpartum depression symptoms (41.1% vs. 8.4%) and had significantly lower levels of domestic decision-making power and social support than native mothers did. Logistic regression showed that insufficient family income was associated with an increased risk of postpartum depression symptoms, whereas social support and domestic decision-making power levels were associated negatively with postpartum depression symptoms. After accounting for these factors, immigrant women remained at higher risk of postpartum depression symptoms than native women did, odds ratio = 2.59, 95% CI [1.27, 5.28]. Domestic decision-making power and social support are independent protective factors for postpartum depression symptoms among immigrant and native women in Taiwan. Social support and empowerment interventions should be tested to discover whether they are able to prevent or alleviate postpartum depression symptoms, with special emphasis on immigrant mothers.

Women’s decision-making autonomy and children’s schooling in rural Mozambique

PubMed Central

Luz, Luciana; Agadjanian, Victor

2015-01-01

BACKGROUND Women’s decision-making autonomy in developing settings has been shown to improve child survival and health outcomes. However, little research has addressed possible connections between women’s autonomy and children’s schooling. OBJECTIVE To examine the relationship between rural women’s decision-making autonomy and enrollment status of primary school-age children living in their households and how this relationship differs by child’s gender. METHODS The analysis uses data from a 2009 survey of rural households in four districts of Gaza province in southern Mozambique. Multilevel logistic models predict the probability of being in school for children between 6 and 14 years old. RESULTS The results show a positive association of women’s decision-making autonomy with the probability of being enrolled in primary school for daughters, but not for sons. The effect of women’s autonomy is net of other women’s characteristics typically associated with enrollment and does not mediate the effects of those characteristics. CONCLUSIONS Based on the results, we argue that women with higher levels of decision-making autonomy may have a stronger preference for daughters’ schooling and may have a greater say in making and implementing decisions regarding daughters’ education, compared to women with lower autonomy levels. Results also illustrate a need for considering a broader set of autonomy-related characteristics when examining the effects of women’s status on children’s educational outcomes. PMID:26491400

Health literacy, numeracy, and other characteristics associated with hospitalized patients' preferences for involvement in decision making.

PubMed

Goggins, Kathryn M; Wallston, Kenneth A; Nwosu, Samuel; Schildcrout, Jonathan S; Castel, Liana; Kripalani, Sunil

2014-01-01

Little research has examined the association of health literacy and numeracy with patients' preferred involvement in the problem-solving and decision-making process in the hospital. Using a sample of 1,249 patients hospitalized with cardiovascular disease from the Vanderbilt Inpatient Cohort Study (VICS), we assessed patients' preferred level of involvement using responses to two scenarios of differing symptom severity from the Problem-Solving Decision-Making Scale. Using multivariable modeling, we determined the relationship of health literacy, subjective numeracy, and other patient characteristics with preferences for involvement in decisions, and how this differed by scenario. The authors found that patients with higher levels of health literacy desired more participation in the problem-solving and decision-making process, as did patients with higher subjective numeracy skills, greater educational attainment, female gender, less perceived social support, or greater health care system distrust (p<.05 for each predictor in multivariable models). Patients also preferred to participate more in the decision-making process when the hypothetical symptom they were experiencing was less severe (i.e., they deferred more to their physician when the hypothetical symptom was more severe). These findings underscore the role that patient characteristics, especially health literacy and numeracy, play in decisional preferences among hospitalized patients.

Improving Shipboard Decision Making in the CBR-D (Chemical/Biological Radiological Defense) Environment: Concepts of Use for and Functional Description of a Decision Aid/Training System (DECAID)

DTIC Science & Technology

1988-08-19

take place over the period of several days. Decisions regarding MOPP level or resource allocation made on day I may have no immediate impact, but a...present -- conditions, and manage a resource library to assist the DCA in making decisions under conditions of uncertainty. Several areas of utilization are...students work through a scenario, the device couid then display the consequences of those decisions or provide optimal decision recommendations

Decision-making deficits in pathological gambling: the role of executive functions, explicit knowledge and impulsivity in relation to decisions made under ambiguity and risk.

PubMed

Ochoa, Cristian; Alvarez-Moya, Eva M; Penelo, Eva; Aymami, M Neus; Gómez-Peña, Mónica; Fernández-Aranda, Fernando; Granero, Roser; Vallejo-Ruiloba, Julio; Menchón, José Manuel; Lawrence, Natalia S; Jiménez-Murcia, Susana

2013-01-01

A variety of cognitive and emotional processes influence the decision-making deficits observed in pathological gambling (PG). This study investigated the role of immediate/delayed sensitivity to reward and punishment, executive functions, impulsivity and explicit knowledge in relation to decision-making performance on the original Iowa Gambling Task (IGT-ABCD) and a variant (IGT-EFGH). We assessed 131 consecutive patients with a diagnosis of PG by using executive functioning and decision-making tasks, self-report measures of impulsivity and explicit knowledge. The majority of pathological gamblers (PGs) showed deficits in decision-making, characterized mainly by myopia for the future. Decisions made under risk showed different predictors. Performance on the IGT-ABCD for decisions made under risk was predicted by medium and high levels of explicit knowledge of the task, as well as by scores on the Disorderliness subscale and the degree of Stroop interference. By contrast, IGT-EFGH results were only associated with self-report impulsivity measures. Decision making in PG involves distinct patterns of deficits, and the predictors differ depending on the reinforcement schedule. Decisions made under risk on the IGT-ABCD are associated with explicit knowledge, executive functions and impulsivity traits related to conscious awareness and control processes. On the IGT-EFGH, however, only impulsivity traits predict decision making. Copyright © American Academy of Addiction Psychiatry.

Is economic valuation of ecosystem services useful to decision-makers? Lessons learned from Australian coastal and marine management.

PubMed

Marre, Jean-Baptiste; Thébaud, Olivier; Pascoe, Sean; Jennings, Sarah; Boncoeur, Jean; Coglan, Louisa

2016-08-01

Economic valuation of ecosystem services is widely advocated as being useful to support ecosystem management decision-making. However, the extent to which it is actually used or considered useful in decision-making is poorly documented. This literature blindspot is explored with an application to coastal and marine ecosystems management in Australia. Based on a nation-wide survey of eighty-eight decision-makers representing a diversity of management organizations, the perceived usefulness and level of use of economic valuation of ecosystem services, in support of coastal and marine management, are examined. A large majority of decision-makers are found to be familiar with economic valuation and consider it useful - even necessary - in decision-making, although this varies across groups of decision-makers. However, most decision-makers never or rarely use economic valuation. The perceived level of importance and trust in estimated dollar values differ across ecosystem services, and are especially high for values that relate to commercial activities. A number of factors are also found to influence respondent's use of economic valuation. Such findings concur with conclusions from other studies on the usefulness and use of ESV in environmental management decision-making. They also demonstrate the strength of the survey-based approach developed in this application to examine this issue in a variety of contexts. Copyright © 2016 Elsevier Ltd. All rights reserved.

Challenging Operations: An Ethical Framework to Assist Humanitarian Aid Workers in their Decision-making Processes.

PubMed

Clarinval, Caroline; Biller-Andorno, Nikola

2014-06-23

This paper aims to raise awareness regarding ethical issues in the context of humanitarian action, and to offer a framework for systematically and effectively addressing such issues. Several cases highlight ethical issues that humanitarian aid workers are confronted with at different levels over the course of their deployments. The first case discusses a situation at a macro-level concerning decisions being made at the headquarters of a humanitarian organization. The second case looks at meso-level issues that need to be solved at a country or regional level. The third case proposes an ethical dilemma at the micro-level of the individual patient-provider relationship. These real-life cases have been selected to illustrate the ethical dimension of conflicts within the context of humanitarian action that might remain unrecognized in everyday practice. In addition, we propose an ethical framework to assist humanitarian aid workers in their decision-making process. The framework draws on the principles and values that guide humanitarian action and public health ethics more generally. Beyond identifying substantive core values, the framework also includes a ten-step process modelled on tools used in the clinical setting that promotes a transparent and clear decision-making process and improves the monitoring and evaluation of aid interventions. Finally, we recommend organizational measures to implement the framework effectively. This paper uses a combination of public health/clinical ethics concepts and practices and applies them to the decision-making challenges encountered in relief operations in the humanitarian aid context.

Dopaminergic modulation of reward-guided decision making in alcohol-preferring AA rats.

PubMed

Oinio, Ville; Bäckström, Pia; Uhari-Väänänen, Johanna; Raasmaja, Atso; Piepponen, Petteri; Kiianmaa, Kalervo

2017-05-30

R**esults from animal gambling models have highlighted the importance of dopaminergic neurotransmission in modulating decision making when large sucrose rewards are combined with uncertainty. The majority of these models use food restriction as a tool to motivate animals to accomplish operant behavioral tasks, in which sucrose is used as a reward. As enhanced motivation to obtain sucrose due to hunger may impact its reward-seeking effect, we wanted to examine the decision-making behavior of rats in a situation where rats were fed ad libitum. For this purpose, we chose alcohol-preferring AA (alko alcohol) rats, as these rats have been shown to have high preference for sweet agents. In the present study, AA rats were trained to self-administer sucrose pellet rewards in a two-lever choice task (one pellet vs. three pellets). Once rational choice behavior had been established, the probability of gaining three pellets was decreased over time (50%, 33%, 25% then 20%). The effect of d-amphetamine on decision making was studied at every probability level, as well as the effect of the dopamine D 1 receptor agonist SKF-81297 and D 2 agonist quinpirole at probability levels of 100% and 25%. d-Amphetamine increased unprofitable choices in a dose-dependent manner at the two lowest probability levels. Quinpirole increased the frequency of unprofitable decisions at the 25% probability level, and SKF-82197 did not affect choice behavior. These results mirror the findings of probabilistic discounting studies using food-restricted rats. Based on this, the use of AA rats provides a new approach for studies on reward-guided decision making. Copyright © 2017 Elsevier B.V. All rights reserved.

Comparison of fusion methods from the abstract level and the rank level in a dispersed decision-making system

NASA Astrophysics Data System (ADS)

Przybyła-Kasperek, M.; Wakulicz-Deja, A.

2017-05-01

Issues related to decision making based on dispersed knowledge are discussed in the paper. A dispersed decision-making system, which was proposed by the authors in previous articles, is used in this paper. In the system, a process of combining classifiers into coalitions with a negotiation stage is realized. The novelty that is proposed in this article involves the use of six different methods of conflict analysis that are known from the literature.The main purpose of the tests, which were performed, was to compare the methods from the two groups - the abstract level and the rank level. An additional aim was to investigate the efficiency of the fusion methods used in a dispersed system with a dynamic structure with the efficiency that is obtained when no structure is used. Conclusions were drawn that, in most cases, the use of a dispersed system improves the efficiency of inference.

Whose Values? Whose Risk? Exploring Decision Making About Trial of Labor After Cesarean.

PubMed

Charles, Sonya; Wolf, Allison B

2018-06-01

In this article, we discuss decision making during labor and delivery, specifically focusing on decision making around offering women a trial of labor after cesarean section (TOLAC). Many have discussed how humans are notoriously bad at assessing risks and how we often distort the nature of various risks surrounding childbirth. We will build on this discussion by showing that physicians make decisions around TOLAC not only based on distortions of risk, but also based on personal values (i.e. what level of risk are you comfortable with or what types of risks are you willing to take) rather than medical data (or at least medical data alone). As a result of this, we will further suggest that the party who is best epistemically situated to make decisions about TOLAC is the woman herself.

Mission at Mubasi - A Simulation for Leadership Development

NASA Technical Reports Server (NTRS)

Cummings, Pau; Aude, Steven; Fallesen, Jon

2012-01-01

The United States Army is investing in simulations as a way of providing practice for leader decision making. Such simulations, grounded in lessons learned from deployment experienced leaders, place less experienced and more junior leaders in challenging situations they might soon be confronted with. And given increased demands on the Army to become more efficient, while maintaining acceptable levels of mission readiness, simulations offer a cost effective complement to live field training. So too, the design parameters of such a simulation can be made to reinforce specific behavior responses which teach leaders known theory and application of effective (and ineffective) decision making. With this in mind, the Center for Army Leadership (CAL) determined that decision-making was of critical importance. Specifically, the following aspects of decision-making were viewed as particularly important for today's Army leaders: 1) Decision dilemmas, in the form of equally appealing or equally unappealing choices, such that there is no clear "right" or "wrong" choice 2) Making decisions with incomplete or ambiguous information, and 3) Predicting and experiencing second- and third-order consequences of decisions. It is decision making in such a setting or environment that Army leaders are increasingly confronted with given the full spectrum of military operations they must be prepared for. This paper details the approach and development of this decision making simulation.

Theoretical aspects of cellular decision-making and information-processing.

PubMed

Kobayashi, Tetsuya J; Kamimura, Atsushi

2012-01-01

Microscopic biological processes have extraordinary complexity and variety at the sub-cellular, intra-cellular, and multi-cellular levels. In dealing with such complex phenomena, conceptual and theoretical frameworks are crucial, which enable us to understand seemingly different intra- and inter-cellular phenomena from unified viewpoints. Decision-making is one such concept that has attracted much attention recently. Since a number of cellular behavior can be regarded as processes to make specific actions in response to external stimuli, decision-making can cover and has been used to explain a broad range of different cellular phenomena [Balázsi et al. (Cell 144(6):910, 2011), Zeng et al. (Cell 141(4):682, 2010)]. Decision-making is also closely related to cellular information-processing because appropriate decisions cannot be made without exploiting the information that the external stimuli contain. Efficiency of information transduction and processing by intra-cellular networks determines the amount of information obtained, which in turn limits the efficiency of subsequent decision-making. Furthermore, information-processing itself can serve as another concept that is crucial for understanding of other biological processes than decision-making. In this work, we review recent theoretical developments on cellular decision-making and information-processing by focusing on the relation between these two concepts.

Community trust reduces myopic decisions of low-income individuals

PubMed Central

Jachimowicz, Jon M.; Chafik, Salah; Munrat, Sabeth; Prabhu, Jaideep C.; Weber, Elke U.

2017-01-01

Why do the poor make shortsighted choices in decisions that involve delayed payoffs? Foregoing immediate rewards for larger, later rewards requires that decision makers (i) believe future payoffs will occur and (ii) are not forced to take the immediate reward out of financial need. Low-income individuals may be both less likely to believe future payoffs will occur and less able to forego immediate rewards due to higher financial need; they may thus appear to discount the future more heavily. We propose that trust in one’s community—which, unlike generalized trust, we find does not covary with levels of income—can partially offset the effects of low income on myopic decisions. Specifically, we hypothesize that low-income individuals with higher community trust make less myopic intertemporal decisions because they believe their community will buffer, or cushion, against their financial need. In archival data and laboratory studies, we find that higher levels of community trust among low-income individuals lead to less myopic decisions. We also test our predictions with a 2-y community trust intervention in rural Bangladesh involving 121 union councils (the smallest rural administrative and local government unit) and find that residents in treated union councils show higher levels of community trust and make less myopic intertemporal choices than residents in control union councils. We discuss the implications of these results for the design of domestic and global policy interventions to help the poor make decisions that could alleviate poverty. PMID:28400516

Prehospital Trauma Triage Decision-making: A Model of What Happens between the 9-1-1 Call and the Hospital.

PubMed

Jones, Courtney Marie Cora; Cushman, Jeremy T; Lerner, E Brooke; Fisher, Susan G; Seplaki, Christopher L; Veazie, Peter J; Wasserman, Erin B; Dozier, Ann; Shah, Manish N

2016-01-01

We describe the decision-making process used by emergency medical services (EMS) providers in order to understand how 1) injured patients are evaluated in the prehospital setting; 2) field triage criteria are applied in-practice; and 3) selection of a destination hospital is determined. We conducted separate focus groups with advanced and basic life support providers from rural and urban/suburban regions. Four exploratory focus groups were conducted to identify overarching themes and five additional confirmatory focus groups were conducted to verify initial focus group findings and provide additional detail regarding trauma triage decision-making and application of field triage criteria. All focus groups were conducted by a public health researcher with formal training in qualitative research. A standardized question guide was used to facilitate discussion at all focus groups. All focus groups were audio-recorded and transcribed. Responses were coded and categorized into larger domains to describe how EMS providers approach trauma triage and apply the Field Triage Decision Scheme. We conducted 9 focus groups with 50 EMS providers. Participants highlighted that trauma triage is complex and there is often limited time to make destination decisions. Four overarching domains were identified within the context of trauma triage decision-making: 1) initial assessment; 2) importance of speed versus accuracy; 3) usability of current field triage criteria; and 4) consideration of patient and emergency care system-level factors. Field triage is a complex decision-making process which involves consideration of many patient and system-level factors. The decision model presented in this study suggests that EMS providers place significant emphasis on speed of decisions, relying on initial impressions and immediately observable information, rather than precise measurement of vital signs or systematic application of field triage criteria.

Using Curriculum-Embedded Assessment for Making Educational Decisions: An Empirical Study with Implications for Including Students with Disabilities in Accountability.

ERIC Educational Resources Information Center

Swisher, Judith D.; Green, Samuel B.; Tollefson, Nona

The focus of this research was to examine the perceived effectiveness of the Practical Assessment Exploration System (PAES) (J. Swisher, 1987) for making educational decisions at the instructional program level for students with disabilities across groups of teachers who have various levels of familiarity with the PAES. The PAES is a functional…

The precuneus may encode irrationality in human gambling.

PubMed

Sacre, P; Kerr, M S D; Subramanian, S; Kahn, K; Gonzalez-Martinez, J; Johnson, M A; Sarma, S V; Gale, J T

2016-08-01

Humans often make irrational decisions, especially psychiatric patients who have dysfunctional cognitive and emotional circuitry. Understanding the neural basis of decision-making is therefore essential towards patient management, yet current studies suffer from several limitations. Functional magnetic resonance imaging (fMRI) studies in humans have dominated decision-making neuroscience, but have poor temporal resolution and the blood oxygenation level-dependent signal is only a proxy for neural activity. On the other hand, lesion studies in humans used to infer functionality in decision-making lack characterization of neural activity altogether. Using a combination of local field potential recordings in human subjects performing a financial decision-making task, spectral analyses, and non-parametric cluster statistics, we analyzed the activity in the precuneus. In nine subjects, the neural activity modulated significantly between rational and irrational trials in the precuneus (p <; 0.001). In particular, high-frequency activity (70-100 Hz) increased when irrational decisions were made. Although preliminary, these results suggest suppression of gamma rhythms via electrical stimulation in the precuneus as a therapeutic intervention for pathological decision-making.

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

PubMed

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

2018-03-01

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

The Impact of Corporate Culture, the Reward System, and Perceived Moral Intensity on Marketing Students' Ethical Decision Making

ERIC Educational Resources Information Center

Nill, Alexander; Schibrowsky, John A.

2005-01-01

An experiment was conducted to study how marketing students' ethical decision making was influenced by their perceived moral intensity (PMI), corporate culture, and the reward system. The findings indicate that levels of awareness of the ethical consequences of a decision, the corporate culture, and the reward system all significantly affect…

The application of system dynamics modelling to environmental health decision-making and policy - a scoping review.

PubMed

Currie, Danielle J; Smith, Carl; Jagals, Paul

2018-03-27

Policy and decision-making processes are routinely challenged by the complex and dynamic nature of environmental health problems. System dynamics modelling has demonstrated considerable value across a number of different fields to help decision-makers understand and predict the dynamic behaviour of complex systems in support the development of effective policy actions. In this scoping review we investigate if, and in what contexts, system dynamics modelling is being used to inform policy or decision-making processes related to environmental health. Four electronic databases and the grey literature were systematically searched to identify studies that intersect the areas environmental health, system dynamics modelling, and decision-making. Studies identified in the initial screening were further screened for their contextual, methodological and application-related relevancy. Studies deemed 'relevant' or 'highly relevant' according to all three criteria were included in this review. Key themes related to the rationale, impact and limitation of using system dynamics in the context of environmental health decision-making and policy were analysed. We identified a limited number of relevant studies (n = 15), two-thirds of which were conducted between 2011 and 2016. The majority of applications occurred in non-health related sectors (n = 9) including transportation, public utilities, water, housing, food, agriculture, and urban and regional planning. Applications were primarily targeted at micro-level (local, community or grassroots) decision-making processes (n = 9), with macro-level (national or international) decision-making to a lesser degree. There was significant heterogeneity in the stated rationales for using system dynamics and the intended impact of the system dynamics model on decision-making processes. A series of user-related, technical and application-related limitations and challenges were identified. None of the reported limitations or challenges appeared unique to the application of system dynamics within the context of environmental health problems, but rather to the use of system dynamics in general. This review reveals that while system dynamics modelling is increasingly being used to inform decision-making related to environmental health, applications are currently limited. Greater application of system dynamics within this context is needed before its benefits and limitations can be fully understood.

Faculty Perceptions of Organizational Politics

ERIC Educational Resources Information Center

Lawrence, Janet; Ott, Molly

2013-01-01

This study focuses on a contested area of shared governance, intercollegiate athletics. The researchers consider how faculty perceptions of organizational politics shape their orientations toward collaborative decision-making in this domain. The results provide insights into ways social cognitions about campus-level decision-making affect faculty…

Participation in Decision Making as a Property of Complex Adaptive Systems: Developing and Testing a Measure

PubMed Central

Anderson, Ruth A.; Hsieh, Pi-Ching; Su, Hui Fang; Landerman, Lawrence R.; McDaniel, Reuben R.

2013-01-01

Objectives. To (1) describe participation in decision-making as a systems-level property of complex adaptive systems and (2) present empirical evidence of reliability and validity of a corresponding measure. Method. Study 1 was a mail survey of a single respondent (administrators or directors of nursing) in each of 197 nursing homes. Study 2 was a field study using random, proportionally stratified sampling procedure that included 195 organizations with 3,968 respondents. Analysis. In Study 1, we analyzed the data to reduce the number of scale items and establish initial reliability and validity. In Study 2, we strengthened the psychometric test using a large sample. Results. Results demonstrated validity and reliability of the participation in decision-making instrument (PDMI) while measuring participation of workers in two distinct job categories (RNs and CNAs). We established reliability at the organizational level aggregated items scores. We established validity of the multidimensional properties using convergent and discriminant validity and confirmatory factor analysis. Conclusions. Participation in decision making, when modeled as a systems-level property of organization, has multiple dimensions and is more complex than is being traditionally measured. Managers can use this model to form decision teams that maximize the depth and breadth of expertise needed and to foster connection among them. PMID:24349771

Participation in decision making as a property of complex adaptive systems: developing and testing a measure.

PubMed

Anderson, Ruth A; Plowman, Donde; Corazzini, Kirsten; Hsieh, Pi-Ching; Su, Hui Fang; Landerman, Lawrence R; McDaniel, Reuben R

2013-01-01

Objectives. To (1) describe participation in decision-making as a systems-level property of complex adaptive systems and (2) present empirical evidence of reliability and validity of a corresponding measure. Method. Study 1 was a mail survey of a single respondent (administrators or directors of nursing) in each of 197 nursing homes. Study 2 was a field study using random, proportionally stratified sampling procedure that included 195 organizations with 3,968 respondents. Analysis. In Study 1, we analyzed the data to reduce the number of scale items and establish initial reliability and validity. In Study 2, we strengthened the psychometric test using a large sample. Results. Results demonstrated validity and reliability of the participation in decision-making instrument (PDMI) while measuring participation of workers in two distinct job categories (RNs and CNAs). We established reliability at the organizational level aggregated items scores. We established validity of the multidimensional properties using convergent and discriminant validity and confirmatory factor analysis. Conclusions. Participation in decision making, when modeled as a systems-level property of organization, has multiple dimensions and is more complex than is being traditionally measured. Managers can use this model to form decision teams that maximize the depth and breadth of expertise needed and to foster connection among them.

Avoiding bias in medical ethical decision-making. Lessons to be learnt from psychology research.

PubMed

Albisser Schleger, Heidi; Oehninger, Nicole R; Reiter-Theil, Stella

2011-05-01

When ethical decisions have to be taken in critical, complex medical situations, they often involve decisions that set the course for or against life-sustaining treatments. Therefore the decisions have far-reaching consequences for the patients, their relatives, and often for the clinical staff. Although the rich psychology literature provides evidence that reasoning may be affected by undesired influences that may undermine the quality of the decision outcome, not much attention has been given to this phenomenon in health care or ethics consultation. In this paper, we aim to contribute to the sensitization of the problem of systematic reasoning biases by showing how exemplary individual and group biases can affect the quality of decision-making on an individual and group level. We are addressing clinical ethicists as well as clinicians who guide complex decision-making processes of ethical significance. Knowledge regarding exemplary group psychological biases (e.g. conformity bias), and individual biases (e.g. stereotypes), will be taken from the disciplines of social psychology and cognitive decision science and considered in the field of ethical decision-making. Finally we discuss the influence of intuitive versus analytical (systematical) reasoning on the validity of ethical decision-making.

Individual responsibility as ground for priority setting in shared decision-making.

PubMed

Sandman, Lars; Gustavsson, Erik; Munthe, Christian

2016-10-01

Given healthcare resource constraints, voices are being raised to hold patients responsible for their health choices. In parallel, there is a growing trend towards shared decision-making, aiming to empower patients and give them more control over healthcare decisions. More power and control over decisions is usually taken to mean more responsibility for them. The trend of shared decision-making would therefore seem to strengthen the case for invoking individual responsibility in the healthcare priority setting. To analyse whether the implementation of shared decision-making would strengthen the argument for invoking individual responsibility in the healthcare priority setting using normative analysis. Shared decision-making does not constitute an independent argument in favour of employing individual responsibility since these notions rest on different underlying values. However, if a health system employs shared decision-making, individual responsibility may be used to limit resource implications of accommodating patient preferences outside professional standards and goals. If a healthcare system employs individual responsibility, high level dynamic shared decision-making implying a joint deliberation resulting in a decision where both parties are willing to revise initial standpoints may disarm common objections to the applicability of individual responsibility by virtue of making patients more likely to exercise adequate control of their own actions. However, if communication strategies applied in the shared decision-making are misaligned to the patient's initial capacities, arguments against individual responsibility might, on the other hand, gain strength. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Can decision-making skills affect responses to psychological stress in healthy women?

PubMed

Santos-Ruiz, Ana; Garcia-Rios, M Carmen; Fernandez-Sanchez, José Carlos; Perez-Garcia, Miguel; Muñoz-García, Miguel Angel; Peralta-Ramirez, Maria Isabel

2012-12-01

In recent studies showing how stress can affect an individual's decision-making process, the cognitive component of decision-making could also be considered a coping resource available to individuals when faced with a stressful situation. The Iowa Gambling Task (IGT) constitutes the standard test for the assessment of decision-making skills under conditions of uncertainty. Responses of the hypothalamic-pituitary-adrenal (HPA) axis to psychosocial stress, in turn, have been estimated by means of cortisol measurements. Our main objective in this study was to test if good and bad IGT performers show distinct HPA axis responses, when challenged in a classic psychosocial stress test. Because women have been shown to outperform men on the IGT under the influence of psychosocial stress, we chose a sample of 40 women to take the IGT before they were exposed to a public speaking task in a virtual environment. The activation of the HPA axis, involved in the stress response, was assessed by examining the levels of cortisol in the subjects' saliva at the following four stages: before the challenge, after the challenge, and 10 and 20 min after the task. Participants were divided into two groups according to their level of performance, good or poor, on the IGT. Results showed statistically significant differences between the groups for pre-exposure cortisol levels and for cortisol levels 20 min after exposure. Overall cortisol levels were significantly higher in the group with poor performance on the IGT. It appears that good decision-making, which may be an important resource for coping with stress, is associated with a lower HPA axis response to a psychosocial stressor. Copyright © 2012 Elsevier Ltd. All rights reserved.

Jordanian Physicians' Attitudes toward Disclosure of Cancer Information and Patient Participation in Treatment Decision-making.

PubMed

Obeidat, Rana; Khrais, Huthaifah I

2016-01-01

This study aims to determine the attitude of Jordanian physicians toward disclosure of cancer information, comfort and use of different decision-making approaches, and treatment decision making. A descriptive, comparative research design was used. A convenience sample of 86 Jordanian medical and radiation oncologists and surgeons practicing mainly in oncology was recruited. A modified version of a structured questionnaire was used for data collection. The questionnaire is a valid measure of physicians' views of shared decision making. Almost 91% of all physicians indicated that the doctor should tell the patient and let him/her decide if the family should know of an early-stage cancer diagnosis. Physicians provide abundant information about the extent of the disease, the side effects and benefits of the treatment, and details of the treatment procedures. They also provided less information on the effects of treatment on the sexuality, mood, and family of the patient. Almost 48% of the participating physicians reported using shared decision making as their usual approach for treatment decision making, and 67% reported that they were comfortable with this approach. The main setting of clinical activity was the only factor associated with physicians' usual approach to medical decision making. Moreover, age, years of experience, and main setting of clinical activity were associated with physicians' comfort level with the shared approach. Although Jordanian physicians appreciate patient autonomy, self-determination, and right to information, paternalistic decision making and underuse of the shared decision-making approach persist. Strategies that target both healthcare providers and patients must be employed to promote shared decision making in the Jordanian healthcare system.

Implications of the Naturalistic Decision Making Framework for Information Dominance.

DTIC Science & Technology

1997-07-01

Information Dominance , defined as an operational advantage obtained through superior effectiveness of informational activity. NDM is the study of how people use their experience to make decisions in field settings. Expertise was considered at both the individual and the team level of decision making. The report defines the components of expertise and identifies obstacles to the acquisition of Information Dominance . These obstacles include: (1) excessive data, (2) pre-processed data, (3) excessive procedures, (4) performing formal analyses, (5) passive

Framing effects and risk-sensitive decision making.

PubMed

Mishra, Sandeep; Gregson, Margaux; Lalumière, Martin L

2012-02-01

Prospect theory suggests that people are risk-averse when facing gains, but risk-prone when facing losses, a pattern known as the framing effect. Although framing effects have been widely demonstrated, few studies have investigated framing effects under conditions of need. Risk-sensitivity theory predicts that decision makers should prefer high-risk options in situations of high need, when lower risk options are unlikely to meet those needs. In two experiments, we examined (1) whether framing effects occurred in behavioural tasks involving risky decision making from description and decision making from experience, (2) whether participants' risky decision making conformed to the predictions of risk-sensitivity theory, and (3) whether decision framing interacted with conditions of need to influence decision making under risk. The results suggest that under all circumstances, risky decision making conformed to the predictions of risk-sensitivity theory. Framing effects were at least partially demonstrable under all experimental conditions. Finally, negative frames interacted with situations of high need to produce particularly elevated levels of risky choice. Together, the results suggest that risk-sensitivity theory can augment prospect theory to explain choice under conditions of need. ©2011 The British Psychological Society.

Adaptive neural coding: from biological to behavioral decision-making

PubMed Central

Louie, Kenway; Glimcher, Paul W.; Webb, Ryan

2015-01-01

Empirical decision-making in diverse species deviates from the predictions of normative choice theory, but why such suboptimal behavior occurs is unknown. Here, we propose that deviations from optimality arise from biological decision mechanisms that have evolved to maximize choice performance within intrinsic biophysical constraints. Sensory processing utilizes specific computations such as divisive normalization to maximize information coding in constrained neural circuits, and recent evidence suggests that analogous computations operate in decision-related brain areas. These adaptive computations implement a relative value code that may explain the characteristic context-dependent nature of behavioral violations of classical normative theory. Examining decision-making at the computational level thus provides a crucial link between the architecture of biological decision circuits and the form of empirical choice behavior. PMID:26722666

Age differences in attention toward decision-relevant information: education matters.

PubMed

Xing, Cai; Isaacowitz, Derek

2011-01-01

Previous studies suggested that older adults are more likely to engage in heuristic decision-making than young adults. This study used eye tracking technique to examine young adults' and highly educated older adults' attention toward two types of decision-relevant information: heuristic cue vs. factual cues. Surprisingly, highly educated older adults showed the reversed age pattern-they looked more toward factual cues than did young adults. This age difference disappeared after controlling for educational level. Additionally, education correlated with attentional pattern to decision-relevant information. We interpret this finding as an indication of the power of education: education may modify what are thought to be "typical" age differences in decision-making, and education may influence young and older people's decision-making via different paths.

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2014-09-01

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

Navigating the boundary of science for decision making at the state and local level

NASA Astrophysics Data System (ADS)

Gonzales, L. M.; Wood, C.; Boland, M. A.; Rose, C. A.

2015-12-01

Scientific information should play a vital role in many decision making processes, yet issues incorporating geoscience information often arise due to inherent differences between how scientists and decision makers operate. Decision makers and scientists have different priorities, produce work at different rates, and often lack an understanding of each others' institutional constraints. Boundary organizations, entities that facilitate collaboration and information flow across traditional boundaries such as that between scientists and decision makers, are in a unique position to improve the dialogue between disparate groups. The American Geosciences Institute (AGI), a nonprofit federation of 50 geoscience societies and organizations, is linking the geoscience and decision-making communities through its Critical Issues Program. AGI's Critical Issues program has first-hand experience in improving the transfer of information across the science-decision making boundary, particularly in areas pertaining to water resources and hazards. This presentation will focus on how, by collaborating with organizations representing the decision making and geoscience communities to inform our program development, we have created our three main content types - website, webinar series, and research database - to better meet the needs of the decision-making process. The program presents existing geoscience information in a way that makes the interconnected nature of geoscience topics more easily understood, encourages discussion between the scientific and decision-making communities, and has established a trusted source of impartial geoscience information. These efforts have focused on state and local decision makers—groups that increasingly influence climate and risk-related decisions, yet often lack the resources to access and understand geoscience information.

The impact of sleep deprivation on decision making: a review.

PubMed

Harrison, Y; Horne, J A

2000-09-01

Few sleep deprivation (SD) studies involve realism or high-level decision making, factors relevant to managers, military commanders, and so forth, who are undergoing prolonged work during crises. Instead, research has favored simple tasks sensitive to SD mostly because of their dull monotony. In contrast, complex rule-based, convergent, and logical tasks are unaffected by short-term SD, seemingly because of heightened participant interest and compensatory effort. However, recent findings show that despite this effort, SD still impairs decision making involving the unexpected, innovation, revising plans, competing distraction, and effective communication. Decision-making models developed outside SD provide useful perspectives on these latter effects, as does a neuropsychological explanation of sleep function. SD presents particular difficulties for sleep-deprived decision makers who require these latter skills during emergency situations.

Exploring patient involvement in healthcare decision making across different education and functional health literacy groups.

PubMed

Smith, Sian K; Dixon, Ann; Trevena, Lyndal; Nutbeam, Don; McCaffery, Kirsten J

2009-12-01

Education and health literacy potentially limit a person's ability to be involved in decisions about their health. Few studies, however, have explored understandings and experiences of involvement in decision making among patients varying in education and health literacy. This paper reports on a qualitative interview study of 73 men and women living in Sydney, Australia, with varying education and functional health literacy levels. Participants were recruited from a community sample with lower educational attainment, plus an educated sample of University of Sydney alumni. The transcripts were analysed using the 'Framework' approach, a matrix-based method of thematic analysis. We found that participants with different education conceptualised their involvement in decision making in diverse ways. Participants with higher education appeared to conceive their involvement as sharing the responsibility with the doctor throughout the decision-making process. This entailed verifying the credibility of the information and exploring options beyond those presented in the consultation. They also viewed themselves as helping others in their health decisions and acting as information resources. In contrast, participants with lower education appeared to conceive their involvement in terms of consenting to an option recommended by the doctor, and having responsibility for the ultimate decision, to agree or disagree with the recommendation. They also described how relatives and friends sought information on their behalf and played a key role in their decisions. Both education groups described how aspects of the patient-practitioner relationship (e.g. continuity, negotiation, trust) and the practitioner's interpersonal communication skills influenced their involvement. Health information served a variety of needs for all groups (e.g. supporting psychosocial, practical and decision support needs). These findings have practical implications for how to involve patients with different education and literacy levels in decision making, and highlight the important role of the patient-practitioner relationship in the process of decision making.

Parental decision making in pediatric otoplasty: The role of shared decision making in parental decisional conflict and decisional regret.

PubMed

Hong, Paul; Gorodzinsky, Ayala Y; Taylor, Benjamin A; Chorney, Jill MacLaren

2016-07-01

To date, there has been little research on shared decision making and decisional outcomes in pediatric surgery. The objectives of this study were to describe the level of decisional conflict and decisional regret experienced by parents considering otoplasty for their children, and to determine if they are related to perceptions of shared decision making. Prospective cohort clinical study. Sixty-five consecutive parents of children who underwent surgical consultation for otoplasty were prospectively enrolled. Participants completed the Demographic Form, the Decisional Conflict Scale, and the Shared Decision-Making Questionnaire after the consultation visit. The consulting surgeons completed the physician version of the Shared Decision-Making Questionnaire. Six months after surgery, parents completed the Decisional Regret Scale. The median decisional conflict was 15.63; 21 (32.8%) parents scored 25 or above, a previously defined cutoff indicating clinically significant decisional conflict. Parent ratings of shared decision making and decisional conflict were significantly negatively correlated (P < 0.001); however, there was no significant correlation between physician ratings of shared decision making and parental decisional conflict. Significant decisional regret was reported in two (3.2%) participants. Decisional regret and parent and physician ratings of shared decision making were both significantly negatively correlated (P = 0.044 and P = 0.001, respectively). Decisional regret and decisional conflict scores were significantly positively correlated (P = 0.001). Parent and physician ratings of shared decision making were correlated (intraclass correlation = 0.625, P < 0.001). Many parents experienced significant decisional conflict when making decisions about their child's elective surgical treatment. Fewer parents experienced significant decisional regret after the procedure. Parents who perceived themselves as being more involved in the decision making process reported less decisional conflict and decisional regret. Parents and physicians had varied perceptions of the degree of shared decision making. Future research should develop interventions to increase parents' involvement in decision making and explore the influence of significant decisional conflict and decisional regret on health outcomes. 2b. Laryngoscope, 126:S5-S13, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Neurocognitive Development of Risk Aversion from Early Childhood to Adulthood

PubMed Central

Paulsen, David J.; Carter, R. McKell; Platt, Michael L.; Huettel, Scott A.; Brannon, Elizabeth M.

2012-01-01

Human adults tend to avoid risk. In behavioral economic studies, risk aversion is manifest as a preference for sure gains over uncertain gains. However, children tend to be less averse to risk than adults. Given that many of the brain regions supporting decision-making under risk do not reach maturity until late adolescence or beyond it is possible that mature risk-averse behavior may emerge from the development of decision-making circuitry. To explore this hypothesis, we tested 5- to 8-year-old children, 14- to 16-year-old adolescents, and young adults in a risky-decision task during functional magnetic resonance imaging (fMRI) data acquisition. To our knowledge, this is the youngest sample of children in an fMRI decision-making task. We found a number of decision-related brain regions to increase in activation with age during decision-making, including areas associated with contextual memory retrieval and the incorporation of prior outcomes into the current decision-making strategy, e.g., insula, hippocampus, and amygdala. Further, children who were more risk-averse showed increased activation during decision-making in ventromedial prefrontal cortex and ventral striatum. Our findings indicate that the emergence of adult levels of risk aversion co-occurs with the recruitment of regions supporting decision-making under risk, including the integration of prior outcomes into current decision-making behavior. This pattern of results suggests that individual differences in the development of risk aversion may reflect differences in the maturation of these neural processes. PMID:22291627

Neurocognitive development of risk aversion from early childhood to adulthood.

PubMed

Paulsen, David J; Carter, R McKell; Platt, Michael L; Huettel, Scott A; Brannon, Elizabeth M

2011-01-01

Human adults tend to avoid risk. In behavioral economic studies, risk aversion is manifest as a preference for sure gains over uncertain gains. However, children tend to be less averse to risk than adults. Given that many of the brain regions supporting decision-making under risk do not reach maturity until late adolescence or beyond it is possible that mature risk-averse behavior may emerge from the development of decision-making circuitry. To explore this hypothesis, we tested 5- to 8-year-old children, 14- to 16-year-old adolescents, and young adults in a risky-decision task during functional magnetic resonance imaging (fMRI) data acquisition. To our knowledge, this is the youngest sample of children in an fMRI decision-making task. We found a number of decision-related brain regions to increase in activation with age during decision-making, including areas associated with contextual memory retrieval and the incorporation of prior outcomes into the current decision-making strategy, e.g., insula, hippocampus, and amygdala. Further, children who were more risk-averse showed increased activation during decision-making in ventromedial prefrontal cortex and ventral striatum. Our findings indicate that the emergence of adult levels of risk aversion co-occurs with the recruitment of regions supporting decision-making under risk, including the integration of prior outcomes into current decision-making behavior. This pattern of results suggests that individual differences in the development of risk aversion may reflect differences in the maturation of these neural processes.

Predicting Sentencing for Low-Level Crimes: Comparing Models of Human Judgment

ERIC Educational Resources Information Center

von Helversen, Bettina; Rieskamp, Jorg

2009-01-01

Laws and guidelines regulating legal decision making are often imposed without taking the cognitive processes of the legal decision maker into account. In the case of sentencing, this raises the question of whether the sentencing decisions of prosecutors and judges are consistent with legal policy. Especially in handling low-level crimes, legal…

Naturalistic Decision Making for Power System Operators

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

Greitzer, Frank L.; Podmore, Robin; Robinson, Marck

2010-02-01

Motivation – Investigations of large-scale outages in the North American interconnected electric system often attribute the causes to three T’s: Trees, Training and Tools. To document and understand the mental processes used by expert operators when making critical decisions, a naturalistic decision making (NDM) model was developed. Transcripts of conversations were analyzed to reveal and assess NDM-based performance criteria. Findings/Design – An item analysis indicated that the operators’ Situation Awareness Levels, mental models, and mental simulations can be mapped at different points in the training scenario. This may identify improved training methods or analytical/ visualization tools. Originality/Value – This studymore » applies for the first time, the concepts of Recognition Primed Decision Making, Situation Awareness Levels and Cognitive Task Analysis to training of electric power system operators. Take away message – The NDM approach provides a viable framework for systematic training management to accelerate learning in simulator-based training scenarios for power system operators and teams.« less

Clinical decision-making among new graduate nurses attending residency programs in Saudi Arabia.

PubMed

Al-Dossary, Reem Nassar; Kitsantas, Panagiota; Maddox, P J

2016-02-01

This study examined the impact of residency programs on clinical decision-making of new Saudi graduate nurses who completed a residency program compared to new Saudi graduate nurses who did not participate in residency programs. This descriptive study employed a convenience sample (N=98) of new graduate nurses from three hospitals in Saudi Arabia. A self-administered questionnaire was used to collect data. Clinical decision-making skills were measured using the Clinical Decision Making in Nursing Scale. Descriptive statistics, independent t-tests, and multiple linear regression analysis were utilized to examine the effect of residency programs on new graduate nurses' clinical decision-making skills. On average, resident nurses had significantly higher levels of clinical decision-making skills than non-residents (t=23.25, p=0.000). Enrollment in a residency program explained 86.9% of the variance in total clinical decision making controlling for age and overall grade point average. The findings of this study support evidence in the nursing literature conducted primarily in the US and Europe that residency programs have a positive influence on new graduate nurses' clinical decision-making skills. This is the first study to examine the impact of residency programs on clinical decision-making among new Saudi graduate nurses who completed a residency program. The findings of this study underscore the need for the development and implementation of residency programs for all new nurses. Copyright © 2015 Elsevier Inc. All rights reserved.

Justifying scale type for a latent variable: Formative or reflective?

NASA Astrophysics Data System (ADS)

Liu, Hao; Bahron, Arsiah; Bagul, Awangku Hassanal Bahar Pengiran

2015-12-01

The study attempted to explore the possibilities to create a procedure at the experimental level to double confirm whether manifest variables scale type is formative or reflective. Now, the criteria of making such a decision are heavily depended on researchers' judgment at the conceptual and operational level. The study created an experimental procedure that seems could double confirm the decisions from the conceptual and operational level judgments. The experimental procedure includes the following tests, Variance Inflation Factor (VIF), Tolerance (TOL), Ridge Regression, Cronbach's alpha, Dillon-Goldstein's rho, and first and second eigenvalue. The procedure considers manifest variables' both multicollinearity and consistency. As the result, the procedure received the same judgment with the carefully established decision making at the concept and operational level.

[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.

Affective decision-making and externalizing behaviors: the role of autonomic activity.

PubMed

Bubier, Jennifer L; Drabick, Deborah A G

2008-08-01

We tested a conceptual model involving the inter-relations among affective decision-making (indexed by a gambling task), autonomic nervous system (ANS) activity, and attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms in a largely impoverished, inner city sample of first through third grade children (N=63, 54% male). The present study hypothesized that impaired affective decision-making and decreased sympathetic and parasympathetic activation would be associated with higher levels of ADHD and ODD symptoms, and that low sympathetic and parasympathetic activation during an emotion-inducing task would mediate the relation between affective decision-making and child externalizing symptoms. In support of our model, disadvantageous decision-making on a gambling task was associated with ADHD hyperactivity/impulsivity symptoms among boys, and attenuated sympathetic activation during an emotion-inducing task mediated this relation. Support for the model was not found among girls.

Anticipatory stress influences decision making under explicit risk conditions.

PubMed

Starcke, Katrin; Wolf, Oliver T; Markowitsch, Hans J; Brand, Matthias

2008-12-01

Recent research has suggested that stress may affect memory, executive functioning, and decision making on the basis of emotional feedback processing. The current study examined whether anticipatory stress affects decision making measured with the Game of Dice Task (GDT), a decision-making task with explicit and stable rules that taps both executive functioning and feedback learning. The authors induced stress in 20 participants by having them anticipate giving a public speech and also examined 20 comparison subjects. The authors assessed the level of stress with questionnaires and endocrine markers (salivary cortisol and alpha-amylase), both revealing that speech anticipation led to increased stress. Results of the GDT showed that participants under stress scored significantly lower than the comparison group and that GDT performance was negatively correlated with the increase of cortisol. Our results indicate that stress can lead to disadvantageous decision making even when explicit and stable information about outcome contingencies is provided.

Do neurocognitive deficits in decision making differentiate conduct disorder subtypes?

PubMed

Fanti, Kostas A; Kimonis, Eva R; Hadjicharalambous, Maria-Zoe; Steinberg, Laurence

2016-09-01

The present study aimed to test whether neurocognitive deficits involved in decision making underlie subtypes of conduct-disorder (CD) differentiated on the basis of callous-unemotional (CU) traits. Eighty-five participants (M age = 10.94 years) were selected from a sample of 1200 children based on repeated assessment of CD and CU traits. Participants completed a multi-method battery of well-validated measures of risky decision making and associated constructs of selective attention and future orientation (Stroop, Stoplight, and Delay-Discounting Tasks). Findings indicated that impaired decision making, selective attention, and future orientation contribute to the antisocial presentations displayed by children with CD, irrespective of level of CU traits. Youth high on CU traits without CD showed less risky decision making, as indicated by their performance on the Stoplight laboratory task, than those high on both CD and CU traits, suggesting a potential protective factor against the development of antisocial behavior.

Decision-making process of Kala Azar care: results from a qualitative study carried out in disease endemic areas of Nepal

PubMed Central

2013-01-01

Background Analysis of consumer decision making in the health sector is a complex process of comparing feasible alternatives and evaluating the levels of satisfaction associated with the relevant options. This paper makes an attempt to understand how and why consumers make specific decisions, what motivates them to adopt a specific health intervention, and what features they find attractive in each of the options. Method The study used a descriptive-explanatory design to analyze the factors determining the choices of healthcare providers. Information was collected through focus group discussions and in-depth interviews. Results The results suggest that the decision making related to seeking healthcare for Kala Azar (KA) treatment is a complex, interactive process. Patients and family members follow a well-defined road map for decision making. The process of decision making starts from the recognition of healthcare needs and is then modified by a number of other factors, such as indigenous knowledge, healthcare alternatives, and available resources. Household and individual characteristics also play important roles in facilitating the process of decision making. The results from the group discussions and in-depth interviews are consistent with the idea that KA patients and family members follow the rational approach of weighing the costs against the benefits of using specific types of medical care. Conclusion The process of decision making related to seeking healthcare follows a complex set of steps and many of the potential factors affect the decision making in a non-linear fashion. Our analysis suggests that it is possible to derive a generalized road map of the decision-making process starting from the recognition of healthcare needs, and then modifying it to show the influences of indigenous knowledge, healthcare alternatives, and available resources. PMID:23849617

Older adults newly diagnosed with symptomatic myeloma and treatment decision making.

PubMed

Tariman, Joseph D; Doorenbos, Ardith; Schepp, Karen G; Singhal, Seema; Berry, Donna L

2014-07-01

To describe the preferences for participation in decision making of older adult patients newly diagnosed with symptomatic myeloma and to explore the association between sociodemographic variables and decisional role preferences. Descriptive, cross-sectional design. Participants' homes and two large academic cancer centers in Seattle, WA, and Chicago, IL. A convenience sample of 20 older adults (60 years of age and older) with symptomatic myeloma diagnosed within the past six months. The Control Preferences Scale was administered followed by an in-person, one-time, semistructured interview. Role preferences for participation in treatment decision making, age, gender, race, work status, personal relationship status, education, and income. Fifty-five percent of the participants preferred a shared role with the physician and 40% preferred to make the decisions after seriously considering the opinion of their physicians. Only one participant preferred to leave the decision to the doctor, as long as the doctor considered the patient's treatment preferences. The study findings indicate that older adults newly diagnosed with myeloma want to participate in treatment decision making. Oncology nurses must respect the patient's desired role preference and oncology clinicians must listen to the patient and allow him or her to be autonomous in making treatment decisions. Nurses and other oncology clinicians can elicit a patient's preferred level of participation in treatment decision making. Oncology nurses can make sure patients receive disease- and treatment-related information, encourage them to express their decisional role preference to the physician, develop a culture of mutual respect and value their desire for autonomy for treatment decision making, acknowledge that the right to make a treatment choice belongs to the patient, and provide support during treatment decision making throughout the care continuum.

Decision-making process of Kala Azar care: results from a qualitative study carried out in disease endemic areas of Nepal.

PubMed

Adhikari, Shiva Raj; Supakankunti, Siripen; Khan, M Mahmud

2013-07-12

Analysis of consumer decision making in the health sector is a complex process of comparing feasible alternatives and evaluating the levels of satisfaction associated with the relevant options. This paper makes an attempt to understand how and why consumers make specific decisions, what motivates them to adopt a specific health intervention, and what features they find attractive in each of the options. The study used a descriptive-explanatory design to analyze the factors determining the choices of healthcare providers. Information was collected through focus group discussions and in-depth interviews. The results suggest that the decision making related to seeking healthcare for Kala Azar (KA) treatment is a complex, interactive process. Patients and family members follow a well-defined road map for decision making. The process of decision making starts from the recognition of healthcare needs and is then modified by a number of other factors, such as indigenous knowledge, healthcare alternatives, and available resources. Household and individual characteristics also play important roles in facilitating the process of decision making. The results from the group discussions and in-depth interviews are consistent with the idea that KA patients and family members follow the rational approach of weighing the costs against the benefits of using specific types of medical care. The process of decision making related to seeking healthcare follows a complex set of steps and many of the potential factors affect the decision making in a non-linear fashion. Our analysis suggests that it is possible to derive a generalized road map of the decision-making process starting from the recognition of healthcare needs, and then modifying it to show the influences of indigenous knowledge, healthcare alternatives, and available resources.

Treatment decision-making among breast cancer patients in Malaysia.

PubMed

Nies, Yong Hui; Islahudin, Farida; Chong, Wei Wen; Abdullah, Norlia; Ismail, Fuad; Ahmad Bustamam, Ros Suzanna; Wong, Yoke Fui; Saladina, J J; Mohamed Shah, Noraida

2017-01-01

This study investigated breast cancer patients' involvement level in the treatment decision-making process and the concordance between patients' and physician's perspectives in decision-making. A cross-sectional study was conducted involving physicians and newly diagnosed breast cancer patients from three public/teaching hospitals in Malaysia. The Control Preference Scale (CPS) was administered to patients and physicians, and the Krantz Health Opinion Survey (KHOS) was completed by the patients alone. Binary logistic regression was used to determine the association between sociodemographic characteristics, the patients' involvement in treatment decision-making, and patients' preference for behavioral involvement and information related to their disease. The majority of patients preferred to share decision-making with their physicians (47.5%), while the second largest group preferred being passive (42.6%) and a small number preferred being active (9.8%). However, the physicians perceived that the majority of patients preferred active decision-making (56.9%), followed by those who desired shared decision-making (32.8%), and those who preferred passive decision-making (10.3%). The overall concordance was 26.5% (54 of 204 patient-physician dyads). The median of preference for information score and behavioral involvement score was 4 (interquartile range [IQR] =3-5) and 2 (IQR =2-3), respectively. In univariate analysis, the ethnicity and educational qualification of patients were significantly associated with the patients' preferred role in the process of treatment decision-making and the patients' preference for information seeking ( p >0.05). However, only educational qualification ( p =0.004) was significantly associated with patients' preference for information seeking in multivariate analysis. Physicians failed to understand patients' perspectives and preferences in treatment decision-making. The concordance between physicians' perception and patients' perception was quite low as the physicians perceived that more than half of the patients were active in treatment decision-making. In actuality, more than half of patients perceived that they shared decision-making with their physicians.

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

ERIC Educational Resources Information Center

Maringe, Felix; Carter, Steve

2007-01-01

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

The Arab-Israeli Conflict: A Decision-Making Game. Revised Edition. Supplementary Empirical Teaching Units in Political Science.

ERIC Educational Resources Information Center

Feste, Karen Ann

The Middle East decision making game has been developed to provide college level political science students with some indication of the complexities of international political situations. The central issue examined in the game is the way in which perceptions of a conflict relate to foreign policy decision. The game is divided into two sections. In…

Trends in Governance and Decision-Making: A Democratic Analysis with Attention to Application in Education

ERIC Educational Resources Information Center

Edwards, D. Brent, Jr.

2010-01-01

Recent decades have witnessed the rise in popularity of a handful of related yet distinct approaches to governance and decision-making in many different contexts that either relocate the level and location at which decisions are made or how they are made, or both. True for developing as well as developed countries, and for both the public and…

"I Think We Should Take This Offline...": Conversational Patterns that Undermine Effective Decision Making in Action Learning Sets

ERIC Educational Resources Information Center

Donovan, Paul

2011-01-01

Collective decision making is an increasing requirement in organizations where the emphasis is on team work at every level. It is, however, very complex and difficult to achieve in practice. Too frequently, important discussions are bypassed or, while the majority of the meeting participants remain mute, decisions are being made by a vocal few. In…

Assessing Patient Participation in Health Policy Decision-Making in Cyprus

PubMed Central

Souliotis, Kyriakos; Agapidaki, Eirini; Peppou, Lily Evangelia; Tzavara, Chara; Samoutis, George; Theodorou, Mamas

2016-01-01

Although the importance of patient participation in the design and evaluation of health programs and services is well-documented, there is scarcity of research with regard to patient association (PA) participation in health policy decision-making processes. To this end, the present study aimed to validate further a previously developed instrument as well as to investigate the degree of PA participation in health policy decision-making in Cyprus. A convenient sample of 114 patients-members of patients associations took part in the study. Participants were recruited from an umbrella organization, the Pancyprian Federation of Patient Associations and Friends (PFPA). PA participation in health policy decision-making was assessed with the Health Democracy Index (HDI), an original 8-item tool. To explore its psychometric properties, Cronbach α was computed as regards to its internal consistency, while its convergent validity was tested against a self-rated question enquiring about the degree of PA participation in health policy decision-making. The findings revealed that the HDI has good internal consistency and convergent validity. Furthermore, PAs were found to participate more in consultations in health-related organizations and the Ministry of Health (MoH) as well as in reforms or crucial decisions in health policy. Lower levels were documented with regard to participation in hospital boards, ethics committees in clinical trials and health technology assessment (HTA) procedures. Overall, PA participation levels were found to be lower than the mid-point of the scale. Targeted interventions aiming to facilitate patients’ involvement in health policy decision-making processes and to increase its impact are greatly needed in Cyprus. PMID:27694659

Differential effects of social stress on laboratory-based decision-making are related to both impulsive personality traits and gender.

PubMed

Wise, Richard J; Phung, Alissa L; Labuschagne, Izelle; Stout, Julie C

2015-01-01

Urgency is the tendency to make impulsive decisions under extreme positive or negative emotional states. Stress, gender and impulsive personality traits are all known to influence decision-making, but no studies have examined the interplay of all of these factors. We exposed 78 men and women to a stress or a non-stress condition, and then administered the Balloon Analogue Risk Task. We found that stress effects varied as a function of gender and urgency traits. Under stress, women low in negative urgency and men high in negative urgency made fewer risky decisions. Positive urgency yielded a similar pattern. Thus, decisions under stress depend on a complex interplay between gender and impulsive personality traits. These findings have implications for clinical disorders, such as substance use disorders, in which there are known deficits in decision-making and high levels of impulsive traits.

Trait anxiety affects decision-making differently in healthy men and women: towards gender-specific endophenotypes of anxiety.

PubMed

de Visser, L; van der Knaap, L J; van de Loo, A J A E; van der Weerd, C M M; Ohl, F; van den Bos, R

2010-05-01

Excessive levels of trait anxiety are a risk factor for psychiatric conditions, including anxiety disorders and substance abuse. High trait anxiety has been associated with altered cognitive functioning, in particular with an attentional bias towards aversive stimuli. Decision-making is a crucial aspect of cognitive functioning that relies on the correct processing and control of emotional stimuli. Interestingly, anxiety and decision-making share underlying neural substrates, involving cortico-limbic pathways, including the amygdala, striatum and medial and dorsolateral prefrontal cortices. In the present study, we investigated the relationship between trait anxiety, measured by the State-Trait Anxiety Inventory, and complex decision-making, measured by the Iowa Gambling Task, in healthy male and female volunteers. The main focus of this study was the inclusion of gender as a discriminative factor. Indeed, we found distinct gender-specific effects of trait anxiety: in men, both low and high anxiety groups showed impaired decision-making compared to medium anxiety individuals, whereas in women only high anxiety individuals performed poorly. Furthermore, anxiety affected decision-making in men early in the task, i.e. the exploration phase, as opposed to an effect on performance in women during the second part of the test, i.e. the exploitation phase. These findings were related to different profiles of trait anxiety in men and women, and were independent of performance in the Wisconsin Card Sorting Test and cortisol levels. Our data show gender-specific effects of trait anxiety on emotional decision-making. We suggest gender-specific endophenotypes of anxiety to exist, that differentially affect cognitive functioning. 2010 Elsevier Ltd. All rights reserved.

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

PubMed Central

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

2007-01-01

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

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

PubMed

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

2012-06-07

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

Neural systems analysis of decision making during goal-directed navigation.

PubMed

Penner, Marsha R; Mizumori, Sheri J Y

2012-01-01

The ability to make adaptive decisions during goal-directed navigation is a fundamental and highly evolved behavior that requires continual coordination of perceptions, learning and memory processes, and the planning of behaviors. Here, a neurobiological account for such coordination is provided by integrating current literatures on spatial context analysis and decision-making. This integration includes discussions of our current understanding of the role of the hippocampal system in experience-dependent navigation, how hippocampal information comes to impact midbrain and striatal decision making systems, and finally the role of the striatum in the implementation of behaviors based on recent decisions. These discussions extend across cellular to neural systems levels of analysis. Not only are key findings described, but also fundamental organizing principles within and across neural systems, as well as between neural systems functions and behavior, are emphasized. It is suggested that studying decision making during goal-directed navigation is a powerful model for studying interactive brain systems and their mediation of complex behaviors. Copyright © 2011. Published by Elsevier Ltd.

Collective decision-making in microbes

PubMed Central

Ross-Gillespie, Adin; Kümmerli, Rolf

2014-01-01

Microbes are intensely social organisms that routinely cooperate and coordinate their activities to express elaborate population level phenotypes. Such coordination requires a process of collective decision-making, in which individuals detect and collate information not only from their physical environment, but also from their social environment, in order to arrive at an appropriately calibrated response. Here, we present a conceptual overview of collective decision-making as it applies to all group-living organisms; we introduce key concepts and principles developed in the context of animal and human group decisions; and we discuss, with appropriate examples, the applicability of each of these concepts in microbial contexts. In particular, we discuss the roles of information pooling, control skew, speed vs. accuracy trade-offs, local feedbacks, quorum thresholds, conflicts of interest, and the reliability of social information. We conclude that collective decision-making in microbes shares many features with collective decision-making in higher taxa, and we call for greater integration between this fledgling field and other allied areas of research, including in the humanities and the physical sciences. PMID:24624121

Decision making under ambiguity and under risk in mesial temporal lobe epilepsy.

PubMed

Delazer, Margarete; Zamarian, Laura; Bonatti, Elisabeth; Kuchukhidze, Giorgi; Koppelstätter, Florian; Bodner, Thomas; Benke, Thomas; Trinka, Eugen

2010-01-01

Decision making is essential in everyday life. Though the importance of the mesial temporal lobe in emotional processing and feedback learning is generally recognized, decision making in mesial temporal lobe epilepsy (mTLE) is almost unexplored so far. Twenty-eight consecutive epilepsy patients with drug resistant mTLE and fifty healthy controls performed decision tasks under initial ambiguity (participants have to learn by feedback to make advantageous decisions) and under risk (advantageous choices may be made by estimating risks and by rational strategies). A subgroup analysis compared the performance of patients affected by MRI-verified abnormalities of the hippocampus or amygdala. The effect of lesion side was also assessed. In decision under ambiguity, mTLE patients showed marked deficits and did not improve over the task. Patients with hippocampus abnormality and patients with amygdala abnormality showed comparable deficits. No difference was found between right and left TLE groups. In decision under risk, mTLE patients performed at the same level as controls. Results suggest that mTLE patients have difficulties in learning from feedback and in making decisions in uncertain, ambiguous situations. By contrast, they are able to make advantageous decisions when full information is given and risks, possible gains and losses are exactly defined.

Decision-making in product portfolios of pharmaceutical research and development – managing streams of innovation in highly regulated markets

PubMed Central

Jekunen, Antti

2014-01-01

Decision-making is a core function of any drug development firm. Developing drugs demands a firm to be highly innovative, while at the same time the activity is strictly regulated. Successful drug development offers the right to apply for a long-term patent that confers exclusive marketing rights. This article addresses the issue of what constitutes an adequate portfolio of drugs for a drug development firm and how it might be managed successfully. The paper investigates decision-making in the industry and specifically in the development of oncology drugs from various perspectives: the need for decisions, their timing, decision-making at the project level, the optimal portfolio, tools for portfolio analysis, the evaluation of patents, and finally the importance of the drug portfolio. Drug development decisions as important organizational elements should get more emphasis, and decisions in drug portfolio using modern decision-making methods should be used more widely than what currently happens. Structured, informed decisions would help avoiding late terminations of drugs in Phase III development. An improved research and development pipeline and drug portfolio management are the major elements in the general strategy targeting success. PMID:25364229

Decision-making in product portfolios of pharmaceutical research and development--managing streams of innovation in highly regulated markets.

PubMed

Jekunen, Antti

2014-01-01

Decision-making is a core function of any drug development firm. Developing drugs demands a firm to be highly innovative, while at the same time the activity is strictly regulated. Successful drug development offers the right to apply for a long-term patent that confers exclusive marketing rights. This article addresses the issue of what constitutes an adequate portfolio of drugs for a drug development firm and how it might be managed successfully. The paper investigates decision-making in the industry and specifically in the development of oncology drugs from various perspectives: the need for decisions, their timing, decision-making at the project level, the optimal portfolio, tools for portfolio analysis, the evaluation of patents, and finally the importance of the drug portfolio. Drug development decisions as important organizational elements should get more emphasis, and decisions in drug portfolio using modern decision-making methods should be used more widely than what currently happens. Structured, informed decisions would help avoiding late terminations of drugs in Phase III development. An improved research and development pipeline and drug portfolio management are the major elements in the general strategy targeting success.

Decision-Making Quality in Parents Considering Adenotonsillectomy or Tympanostomy Tube Insertion for Their Children.

PubMed

Hong, Paul; Maguire, Erin; Purcell, Mary; Ritchie, Krista C; Chorney, Jill

2017-03-01

Shared decision making is a process in which clinicians and patients make health care decisions in a collaborative manner using the most up-to-date evidence, while considering patient values and preferences. Shared decision making is thought to have a positive influence on the decision-making process in medicine. To describe the level of decisional conflict and decisional regret experienced by parents considering surgery for their children and to determine relations among decisional conflict, decisional regret, and shared decision making. A prospective cohort study was conducted at an academic pediatric otolaryngology clinic. Participants included 126 parents of children younger than 6 years who underwent consultation for adenotonsillectomy or tympanostomy tube insertion. Parent participants completed the Shared Decision Making Questionnaire-Parent version, Decisional Conflict Scale (DCS), and Decisional Regret Scale (DRS). Surgeons completed the Shared Decision Making Questionnaire-Physician version. This study included 126 parents; 102 women (mean [SD] age, 33.2 [5.1] years) and 24 men (mean [SD] age, 35.6 [6.3] years). Overall, 34 parents (26%) reported clinically significant decisional conflict. Only 1 parent experienced moderate to strong decisional regret; 28 parents (43.7%) had mild decisional regret. Both parent and physician ratings of shared decision making were significantly negatively correlated with total DCS scores. Parent SDM-Q-9 and total DCS scores were significantly negatively correlated (rs[118] = -0.582; P < .001). Similarly, physician SDM-Q-Doc and total DCS scores were also significantly negatively correlated (rs[118] = -0.221; P = .04). Only parent ratings of shared decision making were significantly negatively correlated with total DRS scores (rs[63] = -0.254; P = .045). Those parents with clinically significant decisional conflict had significantly higher DRS scores (P = .02). Many parents experienced significant decisional conflict when making decisions about their child's elective surgical treatment. Parents who perceived themselves as being more involved in the decision-making process reported less decisional conflict and decisional regret. Future research should explore the influence of decision quality on health outcomes and develop methods to improve shared decision making.

Decision Making and Behavioral Choice during Predator Avoidance

PubMed Central

Herberholz, Jens; Marquart, Gregory D.

2012-01-01

One of the most important decisions animals have to make is how to respond to an attack from a potential predator. The response must be prompt and appropriate to ensure survival. Invertebrates have been important models in studying the underlying neurobiology of the escape response due to their accessible nervous systems and easily quantifiable behavioral output. Moreover, invertebrates provide opportunities for investigating these processes at a level of analysis not available in most other organisms. Recently, there has been a renewed focus in understanding how value-based calculations are made on the level of the nervous system, i.e., when decisions are made under conflicting circumstances, and the most desirable choice must be selected by weighing the costs and benefits for each behavioral choice. This article reviews samples from the current literature on anti-predator decision making in invertebrates, from single neurons to complex behaviors. Recent progress in understanding the mechanisms underlying value-based behavioral decisions is also discussed. PMID:22973187

Supporting Students with Disabilities Entering the Science, Technology, Engineering, and Mathematics Field Disciplines

NASA Astrophysics Data System (ADS)

Dishauzi, Karen M.

Extensive research exists on female, African American, and Hispanic students pursuing Science, Technology, Engineering and Mathematics (STEM) field disciplines. However, little research evaluates students with disabilities and career decision-making relating to STEM field disciplines. This study explored the career decision-making experiences and self-efficacy for students with disabilities. The purpose of this research study was to document experiences and perceptions of students with disabilities who pursue, and may consider pursuing, careers in the STEM field disciplines by exploring the career decision-making self-efficacy of students with disabilities. This study documented the level of influence that the students with disabilities had or may not have had encountered from parents, friends, advisors, counselors, and instructors as they managed their decision-making choice relating to their academic major/career in the STEM or non-STEM field disciplines. A total of 85 respondents of approximately 340 students with disabilities at one Midwestern public university completed a quantitatively designed survey instrument. The Career Decision-Making Self-Efficacy Scale-Short Form by Betz and Hackett was the instrument used, and additional questions were included in the survey. Data analysis included descriptive statistics and analysis of variance. Based upon the results, college students with disabilities are not currently being influenced by individuals and groups of individuals to pursue the STEM field disciplines. This is a cohort of individuals who can be marketed to increase enrollment in STEM programs at academic institutions. This research further found that gender differences at the institution under study did not affect the career decision-making self-efficacy scores. The men did not score any higher in confidence in career decision-making than the women. Disability type did not significantly affect the relationship between the Career Decision-Making Self-Efficacy Total Scores or college major choice. Of the three disability types represented more frequently, the Mental Health disability was found to be a growing disability at the institution under study. This research was found to be beneficial in the documentation of specific levels of influence perceived by students with disabilities from parents, friends, advisors, counselors, and instructors that related to their career decision-making and academic major choices.

The impact of patient autonomy on older adults with asthma.

PubMed

Karamched, Keerthi R; Hao, Wei; Song, Peter X; Carpenter, Laurie; Steinberg, Joel; Baptist, Alan P

2018-05-03

Understanding patient preferences and desire for involvement in making medical decisions is important when managing chronic conditions. Previous studies have utilized the Autonomy Preference Index (API) in younger asthmatic patients to evaluate these preferences. To identify factors associated with autonomy, and to determine if autonomy is related to asthma outcomes among older adults. 189 older adults (>55 yr) with persistent asthma were included. Preferences for autonomy were assessed using the API, with a higher score indicating higher desire for autonomy. Scores were separated into two domains of 'information seeking' and 'decision making' preferences. The separated scores were correlated with asthma outcomes and demographic variables. To control for confounding factors, a linear regression analysis was performed. Higher 'decision making' preference scores correlated with female gender (p=0.007), higher education level (p=0.01), and lower depression scores (p=0.04). Regarding outcomes, 'decision making' scores positively correlated with asthma quality of life questionnaire (AQLQ) scores (p=0.01). On linear regression analysis, the AQLQ score remained significantly associated with 'decision making' preference scores (p=0.03). There was no association with asthma control test scores, spirometry values, and healthcare utilization. 'Information seeking' preference scores correlated with education level (p=0.03), but there was no correlation with asthma outcomes. Older asthmatic adults with a greater desire for involvement in decision making have a higher asthma related quality of life. Future studies with the intention to increase patient autonomy may help establish a causal relationship. Copyright © 2018. Published by Elsevier Inc.

eHealth Literacy and Partner Involvement in Treatment Decision Making for Men With Newly Diagnosed Localized Prostate Cancer.

PubMed

Song, Lixin; Tatum, Kimberly; Greene, Giselle; Chen, Ronald C

2017-03-01

To examine how the eHealth literacy of partners of patients with newly diagnosed prostate cancer affects their involvement in decision making, and to identify the factors that influence their eHealth literacy.
. Cross-sectional exploratory study.
. North Carolina.
. 142 partners of men with newly diagnosed localized prostate cancer. 
. A telephone survey and descriptive and multiple linear regression analyses were used.
. The partners' eHealth literacy, involvement in treatment decision making, and demographics, and the health statuses of the patients and their partners. 
. Higher levels of eHealth literacy among partners were significantly associated with their involvement in getting a second opinion, their awareness of treatment options, and the size of the social network they relied on for additional information and support for treatment decision making for prostate cancer. The factor influencing eHealth literacy was the partners' access to the Internet for personal use, which explained some of the variance in eHealth literacy.
. This study described how partners' eHealth literacy influenced their involvement in treatment decision making for prostate cancer and highlighted the influencing factors (i.e., partners' access to the Internet for personal use).
. When helping men with prostate cancer and their partners with treatment decision making, nurses need to assess eHealth literacy levels to determine whether nonelectronically based education materials are needed and to provide clear instructions on how to use eHealth resources.

The Role of Psychological Adjustment in the Decision-making Process for Voluntary Termination of Pregnancy.

PubMed

Sereno, Sara; Leal, Isabel; Maroco, João

2013-07-01

This study's objective was to evaluate the role of psychological adjustment in the decision-making process to have an abortion and explore individual variables that might influence this decision. In this cross-sectional study, we sequentially enrolled 150 women who made the decision to voluntarily terminate a pregnancy in Maternity Dr. Alfredo da Costa, in Lisbon, Portugal, between September 2008 and June 2009. The instruments were the Depression, Anxiety and Stress Scale (DASS), Satisfaction with Social Support Scale (SSSS), Emotional Assessment Scale (EAS), Decision Conflict Scale (DCS), and Beliefs and Values Questionnaire (BVQ). We analyzed the data using Student's T-tests, MANOVA, ANOVA, Tukey's post-hoc tests and CATPCA. Statistically significant effects were accepted for p<0.05. The participants found the decision difficult and emotionally demanding, although they also identified it as a low conflict decision. The prevailing emotions were sadness, fear and stress; but despite these feelings, the participants remained psychologically adjusted in the moment they decided to have an abortion. The resolution to terminate the pregnancy was essentially shared with supportive people and it was mostly motivated by socio-economic issues. The different beliefs and values found in this sample, and their possible associations are discussed. Despite high levels of stress, the women were psychologically adjusted at the time of making the decision to terminate the pregnancy. However, opposing what has been previously reported, the women presented high levels of sadness and fear, showing that this decision was hard to make, triggering disruptive emotions.

ASSESSING THE EFFECTS OF DICHLOROACETIC ACID (DCA) USING A MULTI-ENDPOINT MEDAKA ASSAY

EPA Science Inventory

In regulating the safety of water, EPA makes decisions on what chemical contaminants to regulate and at what levels. To make these decisions, the EPA needs hazard identification and dose-response information. Current rodent methods for generating required information have limita...

Challenging Operations: An Ethical Framework to Assist Humanitarian Aid Workers in their Decision-making Processes

PubMed Central

Clarinval, Caroline; Biller-Andorno, Nikola

2014-01-01

Introduction: This paper aims to raise awareness regarding ethical issues in the context of humanitarian action, and to offer a framework for systematically and effectively addressing such issues. Methods: Several cases highlight ethical issues that humanitarian aid workers are confronted with at different levels over the course of their deployments. The first case discusses a situation at a macro-level concerning decisions being made at the headquarters of a humanitarian organization. The second case looks at meso-level issues that need to be solved at a country or regional level. The third case proposes an ethical dilemma at the micro-level of the individual patient-provider relationship. Discussion: These real-life cases have been selected to illustrate the ethical dimension of conflicts within the context of humanitarian action that might remain unrecognized in everyday practice. In addition, we propose an ethical framework to assist humanitarian aid workers in their decision-making process. The framework draws on the principles and values that guide humanitarian action and public health ethics more generally. Beyond identifying substantive core values, the framework also includes a ten-step process modelled on tools used in the clinical setting that promotes a transparent and clear decision-making process and improves the monitoring and evaluation of aid interventions. Finally, we recommend organizational measures to implement the framework effectively. Conclusion: This paper uses a combination of public health/clinical ethics concepts and practices and applies them to the decision-making challenges encountered in relief operations in the humanitarian aid context. PMID:24987575

Quantum Decision Theory in Simple Risky Choices.

PubMed

Favre, Maroussia; Wittwer, Amrei; Heinimann, Hans Rudolf; Yukalov, Vyacheslav I; Sornette, Didier

2016-01-01

Quantum decision theory (QDT) is a recently developed theory of decision making based on the mathematics of Hilbert spaces, a framework known in physics for its application to quantum mechanics. This framework formalizes the concept of uncertainty and other effects that are particularly manifest in cognitive processes, which makes it well suited for the study of decision making. QDT describes a decision maker's choice as a stochastic event occurring with a probability that is the sum of an objective utility factor and a subjective attraction factor. QDT offers a prediction for the average effect of subjectivity on decision makers, the quarter law. We examine individual and aggregated (group) data, and find that the results are in good agreement with the quarter law at the level of groups. At the individual level, it appears that the quarter law could be refined in order to reflect individual characteristics. This article revisits the formalism of QDT along a concrete example and offers a practical guide to researchers who are interested in applying QDT to a dataset of binary lotteries in the domain of gains.

Quantum Decision Theory in Simple Risky Choices

PubMed Central

Favre, Maroussia; Wittwer, Amrei; Heinimann, Hans Rudolf; Yukalov, Vyacheslav I.; Sornette, Didier

2016-01-01

Quantum decision theory (QDT) is a recently developed theory of decision making based on the mathematics of Hilbert spaces, a framework known in physics for its application to quantum mechanics. This framework formalizes the concept of uncertainty and other effects that are particularly manifest in cognitive processes, which makes it well suited for the study of decision making. QDT describes a decision maker’s choice as a stochastic event occurring with a probability that is the sum of an objective utility factor and a subjective attraction factor. QDT offers a prediction for the average effect of subjectivity on decision makers, the quarter law. We examine individual and aggregated (group) data, and find that the results are in good agreement with the quarter law at the level of groups. At the individual level, it appears that the quarter law could be refined in order to reflect individual characteristics. This article revisits the formalism of QDT along a concrete example and offers a practical guide to researchers who are interested in applying QDT to a dataset of binary lotteries in the domain of gains. PMID:27936217

Referees' Decision Making about Transgressions: The Influence of Player Gender at the Highest National Level

ERIC Educational Resources Information Center

Souchon, Nicolas; Cabagno, Genevieve; Rascle, Olivier; Traclet, Alan; Dosseville, Fabrice; Maio, Gregory R.

2009-01-01

Prior research has found that referees are harsher toward sporting offenses in regional-level matches between women than in regional-level matches between men. We tested whether this bias also occurs at a higher, national level of competition, despite the greater pressures for objectivity and fairness at this level. Referees' decisions were…

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.

Affective decision-making moderates the effects of automatic associations on alcohol use among drug offenders.

PubMed

Cappelli, Christopher; Ames, Susan; Shono, Yusuke; Dust, Mark; Stacy, Alan

2017-09-01

This study used a dual-process model of cognition in order to investigate the possible influence of automatic and deliberative processes on lifetime alcohol use in a sample of drug offenders. The objective was to determine if automatic/implicit associations in memory can exert an influence over an individual's alcohol use and if decision-making ability could potentially modify the influence of these associations. 168 participants completed a battery of cognitive tests measuring implicit alcohol associations in memory (verb generation) as well as their affective decision-making ability (Iowa Gambling Task). Structural equation modeling procedures were used to test the relationship between implicit associations, decision-making, and lifetime alcohol use. Results revealed that among participants with lower levels of decision-making, implicit alcohol associations more strongly predicted higher lifetime alcohol use. These findings provide further support for the interaction between a specific decision function and its influence over automatic processes in regulating alcohol use behavior in a risky population. Understanding the interaction between automatic associations and decision processes may aid in developing more effective intervention components.

Identifying Non-Sustainable Courses of Action: A Prerequisite for Decision-Making in Education for Sustainable Development

NASA Astrophysics Data System (ADS)

Gresch, Helge; Bögeholz, Susanne

2013-04-01

Students are faced with a multitude of decisions as consumers and in societal debates. Because of the scarcity of resources, the destruction of ecosystems and social injustice in a globalized world, it is vital that students are able to identify non-sustainable courses of action when involved in decision-making. The application of decision-making strategies is one approach to enhancing the quality of decisions. Options that do not meet ecological, social or economic standards should be excluded using non-compensatory strategies whereas other tasks may require a complete trade-off of all the evidence, following a compensatory approach. To enhance decision-making competence, a computer-based intervention study was conducted that focused on the use of decision-making strategies. While the results of the summative evaluation are reported by Gresch et al. (International Journal of Science Education, 2011), in-depth analyses of process-related data collected during the information processing are presented in this paper to reveal insights into the mechanisms of the intervention. The quality of high school students' ( n = 120) metadecision skills when selecting a decision-making strategy was investigated using qualitative content analyses combined with inferential statistics. The results reveal that the students offered elaborate reflections on the sustainability of options. However, the characteristics that were declared non-sustainable differed among the students because societal norms and personal values were intertwined. One implication for education for sustainable development is that students are capable of reflecting on decision-making tasks and on corresponding favorable decision-making strategies at a metadecision level. From these results, we offer suggestions for improving learning environments and constructing test instruments for decision-making competence.

The Psychology and Neuroscience of Financial Decision Making.

PubMed

Frydman, Cary; Camerer, Colin F

2016-09-01

Financial decisions are among the most important life-shaping decisions that people make. We review facts about financial decisions and what cognitive and neural processes influence them. Because of cognitive constraints and a low average level of financial literacy, many household decisions violate sound financial principles. Households typically have underdiversified stock holdings and low retirement savings rates. Investors overextrapolate from past returns and trade too often. Even top corporate managers, who are typically highly educated, make decisions that are affected by overconfidence and personal history. Many of these behaviors can be explained by well-known principles from cognitive science. A boom in high-quality accumulated evidence-especially how practical, low-cost 'nudges' can improve financial decisions-is already giving clear guidance for balanced government regulation. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Decision making under explicit risk is impaired in individuals with human immunodeficiency virus (HIV).

PubMed

Fujiwara, Esther; Tomlinson, Sara E; Purdon, Scot E; Gill, M John; Power, Christopher

2015-01-01

Human immunodeficiency virus (HIV) can affect the frontal-striatal brain regions, which are known to subserve decision-making functions. Previous studies have reported impaired decision making among HIV+ individuals using the Iowa Gambling Task, a task that assesses decision making under ambiguity. Previous study populations often had significant comorbidities such as past or present substance use disorders and/or hepatitis C virus coinfection, complicating conclusions about the unique contributions of HIV-infection to decision making. Decision making under explicit risk has very rarely been examined in HIV+ individuals and was tested here using the Game of Dice Task (GDT). We examined decision making under explicit risk in the GDT in 20 HIV+ individuals without substance use disorder or HCV coinfection, including a demographically matched healthy control group (n = 20). Groups were characterized on a standard neuropsychological test battery. For the HIV+ group, several disease-related parameters (viral load, current and nadir CD4 T-cell count) were included. Analyses focused on the GDT and spanned between-group (t-tests; analysis of covariance, ANCOVA) as well as within-group comparisons (Pearson/Spearman correlations). HIV+ individuals were impaired in the GDT, compared to healthy controls (p = .02). Their decision-making impairments were characterized by less advantageous choices and more random choice strategies, especially towards the end of the task. Deficits in the GDT in the HIV+ group were related to executive dysfunctions, slowed processing/motor speed, and current immune system status (CD4+ T-cell levels, ps < .05). Decision making under explicit risk in the GDT can occur in HIV-infected individuals without comorbidities. The correlational patterns may point to underlying fronto-subcortical dysfunctions in HIV+ individuals. The GDT provides a useful measure to assess risky decision making in this population and should be tested in larger studies.

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 professionals is how best to engage each patient in decision-making for their future needs, to bridge this gap.

[Mechanisms for allocating financial resources after decentralization in the state of Jalisco].

PubMed

Pérez-Núñez, Ricardo; Arredondo-López, Armando; Pelcastre, Blanca

2006-01-01

To analyze, from the decision maker's perspective, the financial resource allocation process of the health services of the state of Jalisco (SSJ, per its abbreviation in spanish), within the context of decentralization. Through a qualitative approximation using semi-structured individual interviews of key personnel in managerial positions as the method for compiling information, the experience of the SSJ in financial resource allocation was documented. From September to November 2003, the perception of managers and administrators regarding their level of autonomy in decision-making was explored as well as the process they follow for the allocation of financial resources, in order to identify the criteria they use and their justifications. From the point of view of decision-makers, autonomy of the SSJ has increased considerably since decentralization was implemented, although the degree of decision-making freedom remains limited due mainly to high adminstrative costs associated with salaries. In this sense, the implications attributable to labor situations that are still centralized are evident. Some innovative systems for financial resource allocation have been established in the SSJ for the sanitary regions and hospitals based upon administrative-managerial and productivity incentives. Adjustments were also made for degree of marginalization and population lag, under the equity criterion. General work conditions and decision-making autonomy of the sanitary regions constitute outstanding aspects pending decentralization. Although decentralization has granted more autonomy to the SSJ, the level of decision-making freedom for allocating financial resources has been held within the highest hierarchical levels.

Spatiotemporal dynamics of random stimuli account for trial-to-trial variability in perceptual decision making

PubMed Central

Park, Hame; Lueckmann, Jan-Matthis; von Kriegstein, Katharina; Bitzer, Sebastian; Kiebel, Stefan J.

2016-01-01

Decisions in everyday life are prone to error. Standard models typically assume that errors during perceptual decisions are due to noise. However, it is unclear how noise in the sensory input affects the decision. Here we show that there are experimental tasks for which one can analyse the exact spatio-temporal details of a dynamic sensory noise and better understand variability in human perceptual decisions. Using a new experimental visual tracking task and a novel Bayesian decision making model, we found that the spatio-temporal noise fluctuations in the input of single trials explain a significant part of the observed responses. Our results show that modelling the precise internal representations of human participants helps predict when perceptual decisions go wrong. Furthermore, by modelling precisely the stimuli at the single-trial level, we were able to identify the underlying mechanism of perceptual decision making in more detail than standard models. PMID:26752272

The Assisted Decision-Making (Capacity) Act 2015: what it is and why it matters.

PubMed

Kelly, B D

2017-05-01

Ireland's Assisted Decision-Making (Capacity) Act 2015 was signed by President Higgins in December 2015 and scheduled for commencement in 2016. To explore the content and implications of the 2015 Act. Review of the 2015 Act and related literature. The 2015 Act places the "will and preferences" of persons with impaired mental capacity at the heart of decision-making relating to "personal welfare" (including healthcare) and "property and affairs". Capacity is to be "construed functionally" and interventions must be "for the benefit of the relevant person". The Act outlines three levels of decision-making assistance: "decision-making assistant", "co-decision-maker" (joint decision-maker) and "decision-making representative" (substitute decision-maker). There are procedures relating to "enduring power of attorney" and "advance healthcare directives"; in the case of the latter, a "refusal of treatment" can be legally binding, while a "request for a specific treatment" must "be taken into consideration". The 2015 Act is considerably more workable than the 2013 Bill that preceded it. Key challenges include the subtle decision-making required by patients, healthcare staff, Circuit Court judges and the director of the Decision Support Service; implementation of "advance healthcare directives", especially if they do not form part of a broader model of advance care planning (incorporating the flexibility required for unpredictable future circumstances); and the over-arching issue of logistics, as very many healthcare decisions are currently made in situations where the patient's capacity is impaired. A key challenge will lie in balancing the emphasis on autonomy with principles of beneficence, mutuality and care.

A Decision-Making Method with Grey Multi-Source Heterogeneous Data and Its Application in Green Supplier Selection

PubMed Central

Dang, Yaoguo; Mao, Wenxin

2018-01-01

In view of the multi-attribute decision-making problem that the attribute values are grey multi-source heterogeneous data, a decision-making method based on kernel and greyness degree is proposed. The definitions of kernel and greyness degree of an extended grey number in a grey multi-source heterogeneous data sequence are given. On this basis, we construct the kernel vector and greyness degree vector of the sequence to whiten the multi-source heterogeneous information, then a grey relational bi-directional projection ranking method is presented. Considering the multi-attribute multi-level decision structure and the causalities between attributes in decision-making problem, the HG-DEMATEL method is proposed to determine the hierarchical attribute weights. A green supplier selection example is provided to demonstrate the rationality and validity of the proposed method. PMID:29510521

A Decision-Making Method with Grey Multi-Source Heterogeneous Data and Its Application in Green Supplier Selection.

PubMed

Sun, Huifang; Dang, Yaoguo; Mao, Wenxin

2018-03-03

In view of the multi-attribute decision-making problem that the attribute values are grey multi-source heterogeneous data, a decision-making method based on kernel and greyness degree is proposed. The definitions of kernel and greyness degree of an extended grey number in a grey multi-source heterogeneous data sequence are given. On this basis, we construct the kernel vector and greyness degree vector of the sequence to whiten the multi-source heterogeneous information, then a grey relational bi-directional projection ranking method is presented. Considering the multi-attribute multi-level decision structure and the causalities between attributes in decision-making problem, the HG-DEMATEL method is proposed to determine the hierarchical attribute weights. A green supplier selection example is provided to demonstrate the rationality and validity of the proposed method.

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.

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

PubMed

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

2008-03-01

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

Decision making in acquiring medical technologies in Israeli medical centers: a preliminary study.

PubMed

Greenberg, Dan; Pliskin, Joseph S; Peterburg, Yitzhak

2003-01-01

This preliminary study had two objectives: a) charting the considerations relevant to decisions about acquisition of new medical technology at the hospital level; and b) creating a basis for the development of a research tool that will examine the function of the Israeli health system in assessment of new medical technologies. A comprehensive literature review and in-depth interviews with decision makers at different levels allowed formulation of criteria considered by decision makers when they decide to purchase and use (or disallow the use) of new medical technology. The resulting questionnaire was sent to medical center directors, along with a letter explaining the goals of the study. The questionnaire included 31 possible considerations for decision making concerning the acquisition of new medical technology by medical centers. The interviewees were asked to indicate the relevance of each consideration in the decision-making process. The most relevant criteria for the adoption of new technologies related to the need for a large capital investment, clinical efficacy of the technology as well as its influence on side effects and complication rates, and a formal approval by the Ministry of Health. Most interviewees stated that pressures exerted by the industry, by patients, or by senior physicians in the hospital are less relevant to decision making. Very small and usually not statistically significant differences in the ranking of hospital directors were found according to the hospitals' ownership, size, or location. The present study is a basis for a future study that will map and describe the function of hospital decision makers within the area of new technology assessment and the decision-making process in the adoption of new healthcare technologies.

A Neuropsychological Approach to Understanding Risk-Taking for Potential Gains and Losses

PubMed Central

Levin, Irwin P.; Xue, Gui; Weller, Joshua A.; Reimann, Martin; Lauriola, Marco; Bechara, Antoine

2012-01-01

Affective neuroscience has helped guide research and theory development in judgment and decision-making by revealing the role of emotional processes in choice behavior, especially when risk is involved. Evidence is emerging that qualitatively and quantitatively different processes may be involved in risky decision-making for gains and losses. We start by reviewing behavioral work by Kahneman and Tversky (1979) and others, which shows that risk-taking differs for potential gains and potential losses. We then turn to the literature in decision neuroscience to support the gain versus loss distinction. Relying in part on data from a new task that separates risky decision-making for gains and losses, we test a neural model that assigns unique mechanisms for risky decision-making involving potential losses. Included are studies using patients with lesions to brain areas specified as important in the model and studies with healthy individuals whose brains are scanned to reveal activation in these and other areas during risky decision-making. In some cases, there is evidence that gains and losses are processed in different regions of the brain, while in other cases the same region appears to process risk in a different manner for gains and losses. At a more general level, we provide strong support for the notion that decisions involving risk-taking for gains and decisions involving risk-taking for losses represent different psychological processes. At a deeper level, we present mounting evidence that different neural structures play different roles in guiding risky choices in these different domains. Some structures are differentially activated by risky gains and risky losses while others respond uniquely in one domain or the other. Taken together, these studies support a clear functional dissociation between risk-taking for gains and risk-taking for losses, and further dissociation at the neural level. PMID:22347161

Supporting shared decision making using an Option Grid for osteoarthritis of the knee in an interface musculoskeletal clinic: A stepped wedge trial.

PubMed

Elwyn, Glyn; Pickles, Tim; Edwards, Adrian; Kinsey, Katharine; Brain, Kate; Newcombe, Robert G; Firth, Jill; Marrin, Katy; Nye, Alan; Wood, Fiona

2016-04-01

To evaluate whether introducing tools, specifically designed for use in clinical encounters, namely Option Grids, into a clinical practice setting leads to higher levels of shared decision making. A stepped wedge trial design where 6 physiotherapists at an interface clinic in Oldham, UK, were sequentially instructed in how to use an Option Grid for osteoarthritis of the knee. Patients with suspected or confirmed osteoarthritis of the knee were recruited, six per clinician prior to instruction, and six per clinician afterwards. We measured shared decision making, patient knowledge, and readiness to decide. A total of 72 patients were recruited; 36 were allocated to the intervention group. There was an 8.4 point (95% CI 4.4 to 12.2) increase in the Observer OPTION score (range 0-100) in the intervention group. The mean gain in knowledge was 0.9 points (score range 0-5, 95% CI, 0.3 to 1.5). There was no increase in encounter duration. Shared decision making increased when clinicians used the knee osteoarthritis Option Grid. Tools designed to support collaboration and deliberation about treatment options lead to increased levels of shared decision making. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Patchy 'coherence': using normalization process theory to evaluate a multi-faceted shared decision making implementation program (MAGIC).

PubMed

Lloyd, Amy; Joseph-Williams, Natalie; Edwards, Adrian; Rix, Andrew; Elwyn, Glyn

2013-09-05

Implementing shared decision making into routine practice is proving difficult, despite considerable interest from policy-makers, and is far more complex than merely making decision support interventions available to patients. Few have reported successful implementation beyond research studies. MAking Good Decisions In Collaboration (MAGIC) is a multi-faceted implementation program, commissioned by The Health Foundation (UK), to examine how best to put shared decision making into routine practice. In this paper, we investigate healthcare professionals' perspectives on implementing shared decision making during the MAGIC program, to examine the work required to implement shared decision making and to inform future efforts. The MAGIC program approached implementation of shared decision making by initiating a range of interventions including: providing workshops; facilitating development of brief decision support tools (Option Grids); initiating a patient activation campaign ('Ask 3 Questions'); gathering feedback using Decision Quality Measures; providing clinical leads meetings, learning events, and feedback sessions; and obtaining executive board level support. At 9 and 15 months (May and November 2011), two rounds of semi-structured interviews were conducted with healthcare professionals in three secondary care teams to explore views on the impact of these interventions. Interview data were coded by two reviewers using a framework derived from the Normalization Process Theory. A total of 54 interviews were completed with 31 healthcare professionals. Partial implementation of shared decision making could be explained using the four components of the Normalization Process Theory: 'coherence,' 'cognitive participation,' 'collective action,' and 'reflexive monitoring.' Shared decision making was integrated into routine practice when clinical teams shared coherent views of role and purpose ('coherence'). Shared decision making was facilitated when teams engaged in developing and delivering interventions ('cognitive participation'), and when those interventions fit with existing skill sets and organizational priorities ('collective action') resulting in demonstrable improvements to practice ('reflexive monitoring'). The implementation process uncovered diverse and conflicting attitudes toward shared decision making; 'coherence' was often missing. The study showed that implementation of shared decision making is more complex than the delivery of patient decision support interventions to patients, a portrayal that often goes unquestioned. Normalizing shared decision making requires intensive work to ensure teams have a shared understanding of the purpose of involving patients in decisions, and undergo the attitudinal shifts that many health professionals feel are required when comprehension goes beyond initial interpretations. Divergent views on the value of engaging patients in decisions remain a significant barrier to implementation.

Patchy ‘coherence’: using normalization process theory to evaluate a multi-faceted shared decision making implementation program (MAGIC)

PubMed Central

2013-01-01

Background Implementing shared decision making into routine practice is proving difficult, despite considerable interest from policy-makers, and is far more complex than merely making decision support interventions available to patients. Few have reported successful implementation beyond research studies. MAking Good Decisions In Collaboration (MAGIC) is a multi-faceted implementation program, commissioned by The Health Foundation (UK), to examine how best to put shared decision making into routine practice. In this paper, we investigate healthcare professionals’ perspectives on implementing shared decision making during the MAGIC program, to examine the work required to implement shared decision making and to inform future efforts. Methods The MAGIC program approached implementation of shared decision making by initiating a range of interventions including: providing workshops; facilitating development of brief decision support tools (Option Grids); initiating a patient activation campaign (‘Ask 3 Questions’); gathering feedback using Decision Quality Measures; providing clinical leads meetings, learning events, and feedback sessions; and obtaining executive board level support. At 9 and 15 months (May and November 2011), two rounds of semi-structured interviews were conducted with healthcare professionals in three secondary care teams to explore views on the impact of these interventions. Interview data were coded by two reviewers using a framework derived from the Normalization Process Theory. Results A total of 54 interviews were completed with 31 healthcare professionals. Partial implementation of shared decision making could be explained using the four components of the Normalization Process Theory: ‘coherence,’ ‘cognitive participation,’ ‘collective action,’ and ‘reflexive monitoring.’ Shared decision making was integrated into routine practice when clinical teams shared coherent views of role and purpose (‘coherence’). Shared decision making was facilitated when teams engaged in developing and delivering interventions (‘cognitive participation’), and when those interventions fit with existing skill sets and organizational priorities (‘collective action’) resulting in demonstrable improvements to practice (‘reflexive monitoring’). The implementation process uncovered diverse and conflicting attitudes toward shared decision making; ‘coherence’ was often missing. Conclusions The study showed that implementation of shared decision making is more complex than the delivery of patient decision support interventions to patients, a portrayal that often goes unquestioned. Normalizing shared decision making requires intensive work to ensure teams have a shared understanding of the purpose of involving patients in decisions, and undergo the attitudinal shifts that many health professionals feel are required when comprehension goes beyond initial interpretations. Divergent views on the value of engaging patients in decisions remain a significant barrier to implementation. PMID:24006959

Risk estimation and decision-making: implications of the 1980 BEIR-III report

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

Fabrikant, J.I.

1981-04-01

The report gives a general background of the implications the current Report of the Committee on the Biological Effects of Ionizing Radiation (The BEIR-III Report) may have on societal decision-making in the regulation of activities concerned with the health effects of low-level radiation. (ACR)

Evidence, Interpretation, and Persuasion: Instructional Decision Making at the District Central Office

ERIC Educational Resources Information Center

Coburn, Cynthia E.; Toure, Judith; Yamashita, Mika

2009-01-01

Background/Context: Calls for evidence-based decision making have become increasingly prominent on the educational landscape. School district central offices increasingly experience these demands. Yet there are few empirical studies of evidence use at the district level. Furthermore, research on evidence use among policy makers in noneducation…

Couple Consensus during Marital Joint Decision-Making: A Context, Process, Outcome Model.

ERIC Educational Resources Information Center

Godwin, Deborah D.; Scanzoni, John

1989-01-01

Tested conceptual model of context, processes, and outcomes of joint marital decision making of married couples (N=188) which specified spouses' process variables as individual-level measures and partners' consensus as a couple construct. Found context factor of spouses' emotional interdependence influenced both partners' coerciveness and degree…

Safety in the Science Classroom

ERIC Educational Resources Information Center

Online Submission, 2006

2006-01-01

The goal of this K-12 science safety resource is to bring together information needed by administrators, planners, teachers and support staff to help them make sound decisions regarding science safety. The document identifies areas for decision making and action at a variety of levels. It supports planning and action by providing information on…

Applying LD Documentation Guidelines at the Postsecondary Level: Decision Making with Sparse or Missing Data

ERIC Educational Resources Information Center

Banerjee, Manju; Madaus, Joseph W.; Gelbar, Nicholas

2015-01-01

A key issue in fostering transition to postsecondary education for students with disabilities is documentation verifying the nature of the disability and supporting the need for services and reasonable accommodations. Documentation guidelines assist postsecondary disability service providers in making decisions about eligibility and reasonable…

Individual moral philosophies and ethical decision making of undergraduate athletic training students and educators.

PubMed

Caswell, Shane V; Gould, Trenton E

2008-01-01

Ethics research in athletic training is lacking. Teaching students technical skills is important, but teaching them how to reason and to behave in a manner that befits responsible health care professionals is equally important. To expand ethics research in athletic training by (1) describing undergraduate athletic training students' and educators' individual moral philosophies and ethical decision-making abilities and (2) investigating the effects of sex and level of education on mean composite individual moral philosophies and ethical decision-making scores. Stratified, multistage, cluster-sample correlational study. Mailed survey instruments were distributed in classroom settings at 30 institutions having Commission on Accreditation of Allied Health Education Programs (CAAHEP)-accredited athletic training programs. Undergraduate students and educators (n = 598: 373 women, 225 men; mean age = 23.5 +/- 6.3 years) from 25 CAAHEP-accredited athletic training programs. We used the Ethics Position Questionnaire and the Dilemmas in Athletic Training Questionnaire to compute participants' mean composite individual moral philosophies (idealism and relativism) and ethical decision-making scores, respectively. Three separate 2 (sex: male, female) x 3 (education level: underclass, upper class, educator) between-subjects factorial analyses of variance using idealism, relativism, and ethical decision-making scores as dependent measures were performed. Respondents reported higher idealism scores (37.57 +/- 4.91) than relativism scores (31.70 +/- 4.80) (response rate = 83%). The mean ethical decision-making score for all respondents was 80.76 +/- 7.88. No significant interactions were revealed. The main effect for sex illustrated that men reported significantly higher relativism scores ( P = .0014, eta (2) = .015) than did women. The main effect for education level revealed significant differences between students' and educators' idealism ( P = .0190, eta (2) = .013), relativism ( P < .001, eta (2) = .050), and ethical decision-making scores ( P < .001, eta (2) = .027). Tukey honestly significant difference post hoc analysis indicated that educators possessed lower idealism scores (36.90 +/- 5.70) and relativism scores (29.92 +/- 4.86) and higher ethical decision-making scores (82.98 +/- 7.62) than did students. Our findings do not support changes in athletic training ethics education practices to address sex-specific needs. However, when opportunities occur for students to reason using different ethical perspectives, educators should be aware of their students' and their own moral philosophies in order to optimally facilitate professional growth.

Economic evaluations of health technologies in Dutch healthcare decision-making: a qualitative study of the current and potential use, barriers, and facilitators.

PubMed

Roseboom, Kitty J; van Dongen, Johanna M; Tompa, Emile; van Tulder, Maurits W; Bosmans, Judith E

2017-01-26

The use of economic evaluations in healthcare decision-making can potentially help decision-makers in allocating scarce resources as efficiently as possible. Over a decade ago, the use of such studies was found to be limited in Dutch healthcare decision-making, but their current use is unknown. Therefore, this study aimed to provide insight into the current and potential use of economic evaluations in Dutch healthcare decision-making and to identify barriers and facilitators to the use of such studies. Interviews containing semi-structured and structured questions were conducted among Dutch healthcare decision-makers. Participants were purposefully selected and special efforts were made to include decision-makers working at the macro- (national), meso- (local/regional), and micro-level (patient setting). During the interviews, a topic list was used that was based on the research questions and a literature search, and was developed in consultation with the Dutch National Healthcare Institute. Responses to the semi-structured questions were analyzed using a constant comparative approach. As for the structured questions, participants' definitions of various economic evaluation concepts were scored as either being "correct" or "incorrect" by two researchers, and summary statistics were prepared. Sixteen healthcare decision-makers were interviewed and two health economists. Decision-makers' knowledge of economic evaluations was only modest, and their current use appeared to be limited. Nonetheless, decision-makers recognized the importance of economic evaluations and saw several opportunities for extending their use at the macro- and meso-level, but not at the micro-level. The disparity between the limited use and recognition of the importance of economic evaluations is likely due to the many barriers decision-makers experience preventing their use (e.g. lack of resources, lack of formal willingness-to-pay threshold). Possible facilitators for extending the use of economic evaluations include, amongst others, educating decision-makers and the general population about economic evaluations and presenting economic evaluation results in a clearer and more understandable way. This study demonstrated that the current use and impact of economic evaluations in Dutch healthcare decision-making is limited at best. Therefore, strategies are needed to overcome the barriers that currently prevent economic evaluations from being used extensively.

Applying voting theory in natural resource management: a case of multiple-criteria group decision support.

PubMed

Laukkanen, Sanna; Kangas, Annika; Kangas, Jyrki

2002-02-01

Voting theory has a lot in common with utility theory, and especially with group decision-making. An expected-utility-maximising strategy exists in voting situations, as well as in decision-making situations. Therefore, it is natural to utilise the achievements of voting theory also in group decision-making. Most voting systems are based on a single criterion or holistic preference information on decision alternatives. However, a voting scheme called multicriteria approval is specially developed for decision-making situations with multiple criteria. This study considers the voting theory from the group decision support point of view and compares it with some other methods applied to similar purposes in natural resource management. A case study is presented, where the approval voting approach is introduced to natural resources planning and tested in a forestry group decision-making process. Applying multicriteria approval method was found to be a potential approach for handling some challenges typical for forestry group decision support. These challenges include (i) utilising ordinal information in the evaluation of decision alternatives, (ii) being readily understandable for and treating equally all the stakeholders in possession of different levels of knowledge on the subject considered, (iii) fast and cheap acquisition of preference information from several stakeholders, and (iv) dealing with multiple criteria.

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

PubMed

Elwyn, Glyn; Miron-Shatz, Talya

2010-06-01

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

Lithium might be associated with better decision-making performance in euthymic bipolar patients.

PubMed

Adida, Marc; Jollant, Fabrice; Clark, Luke; Guillaume, Sebastien; Goodwin, Guy M; Azorin, Jean-Michel; Courtet, Philippe

2015-06-01

Bipolar disorder is associated with impaired decision-making. Little is known about how treatment, especially lithium, influences decision-making abilities in bipolar patients when euthymic. We aimed at testing for an association between lithium medication and decision-making performance in remitted bipolar patients. Decision-making was measured using the Iowa Gambling Task in 3 groups of subjects: 34 and 56 euthymic outpatients with bipolar disorder, treated with lithium (monotherapy and lithium combined with anticonvulsant or antipsychotic) and without lithium (anticonvulsant, antipsychotic and combination treatment), respectively, and 152 matched healthy controls. Performance was compared between the 3 groups. In the 90 euthymic patients, the relationship between different sociodemographic and clinical variables and decision-making was assessed by stepwise multivariate regression analysis. Euthymic patients with lithium (p=0.007) and healthy controls (p=0.001) selected significantly more cards from the safe decks than euthymic patients without lithium, with no significant difference between euthymic patients with lithium and healthy controls (p=0.9). In the 90 euthymic patients, the stepwise linear multivariate regression revealed that decision-making was significantly predicted (p<0.001) by lithium dose, level of education and no family history of bipolar disorder (all p≤0.01). Because medication was not randomized, it was not possible to discriminate the effect of different medications. Lithium medication might be associated with better decision-making in remitted bipolar patients. A randomized trial is required to test for the hypothesis that lithium, but not other mood stabilizers, may specifically improve decision-making abilities in bipolar disorder. Copyright © 2015 Elsevier B.V. and ECNP. All rights reserved.

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

PubMed

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

2017-08-01

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

Shared decision making in Brazil: Concrete efforts to empower the patients' voice.

PubMed

Mendes de Abreu, Mirhelen; Simao de Mello, Joao Pedro; Ferreira F Ribeiro, Lilah; Andrade Mussi, Luiza; L Borges, Mariana Luiza; Petroli, Maurício; da Costa Tavares, Nycholas; da Cunha Cancela, Rafael; Fausto de Lima, Sabrina

2017-06-01

Patient involvement in healthcare decisions has grown in Brazil at three different levels: 1) the macro level, which includes the patient actively influencing legislation and regulation of medical care as well as political changes in the process of care itself; 2) the meso level, which includes institutions that aim to improve information, empowerment and counseling to patients, and 3) the micro level, which focuses on the actual decision-making process that takes place within patient-physician encounter. In Brazil, the macro and meso levels are stronger than the micro one. In this paper, the practical efforts to engage patients in the center of their own care are presented. In order to do that, an overview on the National Humanization Policy and the Brazilian patient's movement is provided. Copyright © 2017. Published by Elsevier GmbH.

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

PubMed

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

2014-01-01

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

Understanding the Association Between Negative Symptoms and Performance on Effort-Based Decision-Making Tasks: The Importance of Defeatist Performance Beliefs.

PubMed

Reddy, L Felice; Horan, William P; Barch, Deanna M; Buchanan, Robert W; Gold, James M; Marder, Stephen R; Wynn, Jonathan K; Young, Jared; Green, Michael F

2017-11-13

Effort-based decision-making paradigms are increasingly utilized to gain insight into the nature of motivation deficits. Research has shown associations between effort-based decision making and experiential negative symptoms; however, the associations are not consistent. The current study had two primary goals. First, we aimed to replicate previous findings of a deficit in effort-based decision making among individuals with schizophrenia on a test of cognitive effort. Second, in a large sample combined from the current and a previous study, we sought to examine the association between negative symptoms and effort by including the related construct of defeatist beliefs. The results replicated previous findings of impaired cognitive effort-based decision making in schizophrenia. Defeatist beliefs significantly moderated the association between negative symptoms and effort-based decision making such that there was a strong association between high negative symptoms and deficits in effort-based decision making, but only among participants with high levels of defeatist beliefs. Thus, our findings suggest the relationship between negative symptoms and effort performance may be understood by taking into account the role of defeatist beliefs, and finding that might explain discrepancies in previous studies. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center 2017.

Shared decision-making in medical encounters regarding breast cancer treatment: the contribution of methodological triangulation.

PubMed

Durif-Bruckert, C; Roux, P; Morelle, M; Mignotte, H; Faure, C; Moumjid-Ferdjaoui, N

2015-07-01

The aim of this study on shared decision-making in the doctor-patient encounter about surgical treatment for early-stage breast cancer, conducted in a regional cancer centre in France, was to further the understanding of patient perceptions on shared decision-making. The study used methodological triangulation to collect data (both quantitative and qualitative) about patient preferences in the context of a clinical consultation in which surgeons followed a shared decision-making protocol. Data were analysed from a multi-disciplinary research perspective (social psychology and health economics). The triangulated data collection methods were questionnaires (n = 132), longitudinal interviews (n = 47) and observations of consultations (n = 26). Methodological triangulation revealed levels of divergence and complementarity between qualitative and quantitative results that suggest new perspectives on the three inter-related notions of decision-making, participation and information. Patients' responses revealed important differences between shared decision-making and participation per se. The authors note that subjecting patients to a normative behavioural model of shared decision-making in an era when paradigms of medical authority are shifting may undermine the patient's quest for what he or she believes is a more important right: a guarantee of the best care available. © 2014 John Wiley & Sons Ltd.

Neural reactivation links unconscious thought to decision-making performance.

PubMed

Creswell, John David; Bursley, James K; Satpute, Ajay B

2013-12-01

Brief periods of unconscious thought (UT) have been shown to improve decision making compared with making an immediate decision (ID). We reveal a neural mechanism for UT in decision making using blood oxygen level-dependent (BOLD) functional magnetic resonance imaging. Participants (N = 33) encoded information on a set of consumer products (e.g. 48 attributes describing four different cars), and we manipulated whether participants (i) consciously thought about this information (conscious thought), (ii) completed a difficult 2-back working memory task (UT) or (iii) made an immediate decision about the consumer products (ID) in a within-subjects blocked design. To differentiate UT neural activity from 2-back working memory neural activity, participants completed an independent 2-back task and this neural activity was subtracted from neural activity occurring during the UT 2-back task. Consistent with a neural reactivation account, we found that the same regions activated during the encoding of complex decision information (right dorsolateral prefrontal cortex and left intermediate visual cortex) continued to be activated during a subsequent 2-min UT period. Moreover, neural reactivation in these regions was predictive of subsequent behavioral decision-making performance after the UT period. These results provide initial evidence for post-encoding unconscious neural reactivation in facilitating decision making.

Neural reactivation links unconscious thought to decision-making performance

PubMed Central

Bursley, James K.; Satpute, Ajay B.

2013-01-01

Brief periods of unconscious thought (UT) have been shown to improve decision making compared with making an immediate decision (ID). We reveal a neural mechanism for UT in decision making using blood oxygen level-dependent (BOLD) functional magnetic resonance imaging. Participants (N = 33) encoded information on a set of consumer products (e.g. 48 attributes describing four different cars), and we manipulated whether participants (i) consciously thought about this information (conscious thought), (ii) completed a difficult 2-back working memory task (UT) or (iii) made an immediate decision about the consumer products (ID) in a within-subjects blocked design. To differentiate UT neural activity from 2-back working memory neural activity, participants completed an independent 2-back task and this neural activity was subtracted from neural activity occurring during the UT 2-back task. Consistent with a neural reactivation account, we found that the same regions activated during the encoding of complex decision information (right dorsolateral prefrontal cortex and left intermediate visual cortex) continued to be activated during a subsequent 2-min UT period. Moreover, neural reactivation in these regions was predictive of subsequent behavioral decision-making performance after the UT period. These results provide initial evidence for post-encoding unconscious neural reactivation in facilitating decision making. PMID:23314012

Analysis of decision fusion algorithms in handling uncertainties for integrated health monitoring systems

NASA Astrophysics Data System (ADS)

Zein-Sabatto, Saleh; Mikhail, Maged; Bodruzzaman, Mohammad; DeSimio, Martin; Derriso, Mark; Behbahani, Alireza

2012-06-01

It has been widely accepted that data fusion and information fusion methods can improve the accuracy and robustness of decision-making in structural health monitoring systems. It is arguably true nonetheless, that decision-level is equally beneficial when applied to integrated health monitoring systems. Several decisions at low-levels of abstraction may be produced by different decision-makers; however, decision-level fusion is required at the final stage of the process to provide accurate assessment about the health of the monitored system as a whole. An example of such integrated systems with complex decision-making scenarios is the integrated health monitoring of aircraft. Thorough understanding of the characteristics of the decision-fusion methodologies is a crucial step for successful implementation of such decision-fusion systems. In this paper, we have presented the major information fusion methodologies reported in the literature, i.e., probabilistic, evidential, and artificial intelligent based methods. The theoretical basis and characteristics of these methodologies are explained and their performances are analyzed. Second, candidate methods from the above fusion methodologies, i.e., Bayesian, Dempster-Shafer, and fuzzy logic algorithms are selected and their applications are extended to decisions fusion. Finally, fusion algorithms are developed based on the selected fusion methods and their performance are tested on decisions generated from synthetic data and from experimental data. Also in this paper, a modeling methodology, i.e. cloud model, for generating synthetic decisions is presented and used. Using the cloud model, both types of uncertainties; randomness and fuzziness, involved in real decision-making are modeled. Synthetic decisions are generated with an unbiased process and varying interaction complexities among decisions to provide for fair performance comparison of the selected decision-fusion algorithms. For verification purposes, implementation results of the developed fusion algorithms on structural health monitoring data collected from experimental tests are reported in this paper.

Health sector decentralization and local decision-making: Decision space, institutional capacities and accountability in Pakistan.

PubMed

Bossert, Thomas John; Mitchell, Andrew David

2011-01-01

Health sector decentralization has been widely adopted to improve delivery of health services. While many argue that institutional capacities and mechanisms of accountability required to transform decentralized decision-making into improvements in local health systems are lacking, few empirical studies exist which measure or relate together these concepts. Based on research instruments administered to a sample of 91 health sector decision-makers in 17 districts of Pakistan, this study analyzes relationships between three dimensions of decentralization: decentralized authority (referred to as "decision space"), institutional capacities, and accountability to local officials. Composite quantitative indicators of these three dimensions were constructed within four broad health functions (strategic and operational planning, budgeting, human resources management, and service organization/delivery) and on an overall/cross-function basis. Three main findings emerged. First, district-level respondents report varying degrees of each dimension despite being under a single decentralization regime and facing similar rules across provinces. Second, within dimensions of decentralization-particularly decision space and capacities-synergies exist between levels reported by respondents in one function and those reported in other functions (statistically significant coefficients of correlation ranging from ρ=0.22 to ρ=0.43). Third, synergies exist across dimensions of decentralization, particularly in terms of an overall indicator of institutional capacities (significantly correlated with both overall decision space (ρ=0.39) and accountability (ρ=0.23)). This study demonstrates that decentralization is a varied experience-with some district-level officials making greater use of decision space than others and that those who do so also tend to have more capacity to make decisions and are held more accountable to elected local officials for such choices. These findings suggest that Pakistan's decentralization policy should focus on synergies among dimensions of decentralization to encouraging more use of de jure decision space, work toward more uniform institutional capacity, and encourage greater accountability to local elected officials. Copyright © 2010 Elsevier Ltd. All rights reserved.

Need for power and the choice of technologies: State decisions on electric power facilities

NASA Astrophysics Data System (ADS)

1981-06-01

The decision-making processes at the state level regarding the licensing of electric generating facilities were assessed. The basic issues addressed are the need for power and choice of technology: state decisions which directly influence and affect the nation's energy supply, and the tradeoffs involved in meeting energy demand. The areas of special emphasis included the legal mechanisms and regulatory procedures used to determine and resolve these issues. The effectiveness of state decision-making was assessed, focusing on legal and administrative histories and accommodation of interests of concerned parties. Recent innovations to enhance the decision-making process were also assessed where applicable. No particular substantive results are advocated in the findings. The recommendations presented are broad in scope.

Introduction to health economics and decision-making: Is economics relevant for the frontline clinician?

PubMed

Goeree, Ron; Diaby, Vakaramoko

2013-12-01

In a climate of escalating demands for new health care services and significant constraints on new resources, the disciplines of health economics and health technology assessment (HTA) have increasingly been turned to as explicit evidence-based frameworks to help make tough health care access and reimbursement decisions. Health economics is the discipline of economics concerned with the efficient allocation of health care resources, essentially trying to maximize health benefits to society contingent upon available resources. HTA is a broader field drawing upon several disciplines, but which relies heavily upon the tools of health economics and economic evaluation. Traditionally, health economics and economic evaluation have been widely used at the political (macro) and local (meso) decision-making levels, and have progressively had an important role even at informing individual clinical decisions (micro level). The aim of this paper is to introduce readers to health economics and discuss its relevance to frontline clinicians. Particularly, the content of the paper will facilitate clinicians' understanding of the link between economics and their medical practice, and how clinical decision-making reflects on health care resource allocation. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

PubMed

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

2006-08-01

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

Who has the D? How clear decision roles enhance organizational performance.

PubMed

Rogers, Paul; Blenko, Marcia

2006-01-01

Decisions are the coin of the realm in business. But even in highly respected companies, decisions can get stuck inside the organization like loose change. As a result, the entire decision-making process can stall, usually at one of four bottlenecks: global versus local, center versus business unit, function versus function, and inside versus outside partners. Decision-making bottlenecks can occur whenever there is ambiguity or tension over who gets to decide what. For example, do marketers or product developers get to decide the features of a new product? Should a major capital investment depend on the approval of the business unit that will own it, or should headquarters make the final call? Which decisions can be delegated to an outsourcing partner, and which must be made internally? Bain consultants Paul Rogers and Marcia Blenko use an approach called RAPID (recommend, agree, perform, input, and decide) to help companies unclog their decision-making bottlenecks by explicitly defining roles and responsibilities. For example, British American Tobacco struck a new balance between global and local decision making to take advantage of the company's scale while maintaining its agility in local markets. At Wyeth Pharmaceuticals, a growth opportunity revealed the need to push more decisions down to the business units. And at the UK department-store chain John Lewis, buyers and sales staff clarified their decision roles in order to implement a new strategy for selling its salt and pepper mills. When revamping its decision-making process, a company must take some practical steps: Align decision roles with the most important sources of value, make sure that decisions are made by the right people at the right levels of the organization, and let the people who will live with the new process help design it.

[Shared decision-making in mental health care: a role model from youth mental health care].

PubMed

Westermann, G M A; Maurer, J M G

2015-01-01

In the communication and interaction between doctor and patient in Western health care there has been a paradigm shift from the paternalistic approach to shared decision-making. To summarise the background situation, recent developments and the current level of shared decision-making in (youth) mental health care. We conducted a critical review of the literature relating to the methodology development, research and the use of counselling and decision-making in mental health care. The majority of patients, professionals and other stakeholders consider shared decision-making to be desirable and important for improving the quality and efficiency of care. Up till recently most research and studies have concentrated on helping patients to develop decision-making skills and on showing patients how and where to access information. At the moment more attention is being given to the development of skills and circumstances that will increase patients' interaction with care professionals and patients' emotional involvement in shared decision-making. In mental health for children and adolescents, more often than in adult mental health care, it has been customary to give more attention to these aspects of shared decision-making, particularly during counselling sessions that mark the transition from diagnosis to treatment. This emphasis has been apparent for a long time in textbooks, daily practice, methodology development and research in youth mental health care. Currently, a number of similar developments are taking place in adult mental health care. Although most health professionals support the policy of shared decision-making, the implementation of the policy in mental health care is still at an early stage. In practice, a number of obstacles still have to be surmounted. However, the experience gained with counselling and decision-making in (youth) mental health care may serve as an example to other sections of mental health care and play an important role in the further development of shared decision-making.

Negative decision outcomes are more common among people with lower decision-making competence: an item-level analysis of the Decision Outcome Inventory (DOI).

PubMed

Parker, Andrew M; Bruine de Bruin, Wändi; Fischhoff, Baruch

2015-01-01

Most behavioral decision research takes place in carefully controlled laboratory settings, and examination of relationships between performance and specific real-world decision outcomes is rare. One prior study shows that people who perform better on hypothetical decision tasks, assessed using the Adult Decision-Making Competence (A-DMC) measure, also tend to experience better real-world decision outcomes, as reported on the Decision Outcomes Inventory (DOI). The DOI score reflects avoidance of outcomes that could result from poor decisions, ranging from serious (e.g., bankruptcy) to minor (e.g., blisters from sunburn). The present analyses go beyond the initial work, which focused on the overall DOI score, by analyzing the relationships between specific decision outcomes and A-DMC performance. Most outcomes are significantly more likely among people with lower A-DMC scores, even after taking into account two variables expected to produce worse real-world decision outcomes: younger age and lower socio-economic status. We discuss the usefulness of DOI as a measure of successful real-world decision-making.

Influence of Men's Personality and Social Support on Treatment Decision-Making for Localized Prostate Cancer.

PubMed

Reamer, Elyse; Yang, Felix; Holmes-Rovner, Margaret; Liu, Joe; Xu, Jinping

2017-01-01

Optimal treatment for localized prostate cancer (LPC) is controversial. We assessed the effects of personality, specialists seen, and involvement of spouse, family, or friends on treatment decision/decision-making qualities. We surveyed a population-based sample of men ≤ 75 years with newly diagnosed LPC about treatment choice, reasons for the choice, decision-making difficulty, satisfaction, and regret. Of 160 men (71 black, 89 white), with a mean age of 61 (±7.3) years, 59% chose surgery, 31% chose radiation, and 10% chose active surveillance (AS)/watchful waiting (WW). Adjusting for age, race, comorbidity, tumor risk level, and treatment status, men who consulted friends during decision-making were more likely to choose curative treatment (radiation or surgery) than WW/AS (OR = 11.1, p < 0.01; 8.7, p < 0.01). Men who saw a radiation oncologist in addition to a urologist were more likely to choose radiation than surgery (OR = 6.0, p = 0.04). Men who consulted family or friends (OR = 2.6, p < 0.01; 3.7, p < 0.01) experienced greater decision-making difficulty. No personality traits (pessimism, optimism, or faith) were associated with treatment choice/decision-making quality measures. In addition to specialist seen, consulting friends increased men's likelihood of choosing curative treatment. Consulting family or friends increased decision-making difficulty.

Value Assessment at the Point of Care: Incorporating Patient Values throughout Care Delivery and a Draft Taxonomy of Patient Values.

PubMed

Armstrong, Melissa J; Mullins, C Daniel

2017-02-01

Incorporation of patient values is a key element of patient-centered care, but consistent incorporation of patient values at the point of care is lacking. Shared decision making encourages incorporation of patient values in decision making, but associated tools often lack guidance on value assessment. In addition, focusing on patient values relating only to specific decisions misses an opportunity for a more holistic approach to value assessment that could impact other aspects of clinical encounters, including health care planning, communication, and stakeholder involvement. In this commentary, we propose a taxonomy of values underlying patient decision making and provide examples of how these impact provision of health care. The taxonomy describes four categories of patient values: global, decisional, situational, and external. Global values are personal values impacting decision making at a universal level and can include value traits and life priorities. Decisional values are the values traditionally conceptualized in decision making, including considerations such as efficacy, toxicity, quality of life, convenience, and cost. Situational values are values tied to a specific moment in time that modify patients' existing global and decisional values. Finally, discussion of external values acknowledges that many patients consider values other than their own when making decisions. Recognizing the breadth of values impacting patient decision making has implications for both overall health care delivery and shared decision making because value assessments focusing only on decisional values may miss important patient considerations. This draft taxonomy highlights different values impacting decision making and facilitates a more complete value assessment at the point of care. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Structured decision making as a framework for linking quantitative decision support to community values

EPA Science Inventory

Community-level decisions can have large impacts on production and delivery of ecosystem services, which ultimately affects community well-being. But engaging stakeholders in a process to explore these impacts is a significant challenge. The principles of Structured Decision Ma...

Military Medical Decision Support for Homeland Defense During Emergency

DTIC Science & Technology

2004-12-01

abstraction hierarchy, three levels of information requirement for designing emergency training interface are recognized. These are epistemological ...support human decision making process is considered to be decision-centric. A typical decision-centric interface is supported by at least four design ... Designing Emergency Training Interface ......................................................................................... 5 Epistemological

Neural Correlates of Decision-Making Under Ambiguity and Conflict.

PubMed

Pushkarskaya, Helen; Smithson, Michael; Joseph, Jane E; Corbly, Christine; Levy, Ifat

2015-01-01

HIGHLIGHTS We use a simple gambles design in an fMRI study to compare two conditions: ambiguity and conflict.Participants were more conflict averse than ambiguity averse.Ambiguity aversion did not correlate with conflict aversion.Activation in the medial prefrontal cortex correlated with ambiguity level and ambiguity aversion.Activation in the ventral striatum correlated with conflict level and conflict aversion. Studies of decision making under uncertainty generally focus on imprecise information about outcome probabilities ("ambiguity"). It is not clear, however, whether conflicting information about outcome probabilities affects decision making in the same manner as ambiguity does. Here we combine functional magnetic resonance imaging (fMRI) and a simple gamble design to study this question. In this design the levels of ambiguity and conflict are parametrically varied, and ambiguity and conflict gambles are matched on expected value. Behaviorally, participants avoided conflict more than ambiguity, and attitudes toward ambiguity and conflict did not correlate across participants. Neurally, regional brain activation was differentially modulated by ambiguity level and aversion to ambiguity and by conflict level and aversion to conflict. Activation in the medial prefrontal cortex was correlated with the level of ambiguity and with ambiguity aversion, whereas activation in the ventral striatum was correlated with the level of conflict and with conflict aversion. These novel results indicate that decision makers process imprecise and conflicting information differently, a finding that has important implications for basic and clinical research.

Neural Correlates of Decision-Making Under Ambiguity and Conflict

PubMed Central

Pushkarskaya, Helen; Smithson, Michael; Joseph, Jane E.; Corbly, Christine; Levy, Ifat

2015-01-01

HIGHLIGHTS We use a simple gambles design in an fMRI study to compare two conditions: ambiguity and conflict.Participants were more conflict averse than ambiguity averse.Ambiguity aversion did not correlate with conflict aversion.Activation in the medial prefrontal cortex correlated with ambiguity level and ambiguity aversion.Activation in the ventral striatum correlated with conflict level and conflict aversion. Studies of decision making under uncertainty generally focus on imprecise information about outcome probabilities (“ambiguity”). It is not clear, however, whether conflicting information about outcome probabilities affects decision making in the same manner as ambiguity does. Here we combine functional magnetic resonance imaging (fMRI) and a simple gamble design to study this question. In this design the levels of ambiguity and conflict are parametrically varied, and ambiguity and conflict gambles are matched on expected value. Behaviorally, participants avoided conflict more than ambiguity, and attitudes toward ambiguity and conflict did not correlate across participants. Neurally, regional brain activation was differentially modulated by ambiguity level and aversion to ambiguity and by conflict level and aversion to conflict. Activation in the medial prefrontal cortex was correlated with the level of ambiguity and with ambiguity aversion, whereas activation in the ventral striatum was correlated with the level of conflict and with conflict aversion. These novel results indicate that decision makers process imprecise and conflicting information differently, a finding that has important implications for basic and clinical research. PMID:26640434

Making the Connection between Environmental Science and Decision Making

NASA Astrophysics Data System (ADS)

Woodhouse, C. A.; Crimmins, M.; Ferguson, D. B.; Garfin, G. M.; Scott, C. A.

2011-12-01

As society is confronted with population growth, limited resources, and the impacts of climate variability and change, it is vital that institutions of higher education promote the development of professionals who can work with decision-makers to incorporate scientific information into environmental planning and management. Skills for the communication of science are essential, but equally important is the ability to understand decision-making contexts and engage with resource managers and policy makers. It is increasingly being recognized that people who understand the linkages between science and decision making are crucial if science is to better support planning and policy. A new graduate-level seminar, "Making the Connection between Environmental Science and Decision Making," is a core course for a new post-baccalaureate certificate program, Connecting Environmental Science and Decision Making at the University of Arizona. The goal of the course is to provide students with a basic understanding of the dynamics between scientists and decision makers that result in scientific information being incorporated into environmental planning, policy, and management decisions. Through readings from the environmental and social sciences, policy, and planning literature, the course explores concepts including scientific information supply and demand, boundary organizations, co-production of knowledge, platforms for engagement, and knowledge networks. Visiting speakers help students understand some of the challenges of incorporating scientific information into planning and decision making within institutional and political contexts. The course also includes practical aspects of two-way communication via written, oral, and graphical presentations as well as through the interview process to facilitate the transfer of scientific information to decision makers as well as to broader audiences. We aspire to help students develop techniques that improve communication and understanding between scientists and decision-makers, leading to enhanced outcomes in the fields of climate science, water resources, and ecosystem services.

Assessing Patient Participation in Health Policy Decision-Making in Cyprus.

PubMed

Souliotis, Kyriakos; Agapidaki, Eirini; Peppou, Lily Evangelia; Tzavara, Chara; Samoutis, George; Theodorou, Mamas

2016-06-20

Although the importance of patient participation in the design and evaluation of health programs and services is well-documented, there is scarcity of research with regard to patient association (PA) participation in health policy decision-making processes. To this end, the present study aimed to validate further a previously developed instrument as well as to investigate the degree of PA participation in health policy decision-making in Cyprus. A convenient sample of 114 patients-members of patients associations took part in the study. Participants were recruited from an umbrella organization, the Pancyprian Federation of Patient Associations and Friends (PFPA). PA participation in health policy decision-making was assessed with the Health Democracy Index (HDI), an original 8-item tool. To explore its psychometric properties, Cronbach α was computed as regards to its internal consistency, while its convergent validity was tested against a self-rated question enquiring about the degree of PA participation in health policy decision-making. The findings revealed that the HDI has good internal consistency and convergent validity. Furthermore, PAs were found to participate more in consultations in health-related organizations and the Ministry of Health (MoH) as well as in reforms or crucial decisions in health policy. Lower levels were documented with regard to participation in hospital boards, ethics committees in clinical trials and health technology assessment (HTA) procedures. Overall, PA participation levels were found to be lower than the mid-point of the scale. Targeted interventions aiming to facilitate patients' involvement in health policy decision-making processes and to increase its impact are greatly needed in Cyprus. © 2016 by Kerman University of Medical Sciences.

Cognitive Fatigue Destabilizes Economic Decision Making Preferences and Strategies.

PubMed

Mullette-Gillman, O'Dhaniel A; Leong, Ruth L F; Kurnianingsih, Yoanna A

2015-01-01

It is common for individuals to engage in taxing cognitive activity for prolonged periods of time, resulting in cognitive fatigue that has the potential to produce significant effects in behaviour and decision making. We sought to examine whether cognitive fatigue modulates economic decision making. We employed a between-subject manipulation design, inducing fatigue through 60 to 90 minutes of taxing cognitive engagement against a control group that watched relaxing videos for a matched period of time. Both before and after the manipulation, participants engaged in two economic decision making tasks (one for gains and one for losses). The analyses focused on two areas of economic decision making--preferences and choice strategies. Uncertainty preferences (risk and ambiguity) were quantified as premium values, defined as the degree and direction in which participants alter the valuation of the gamble in comparison to the certain option. The strategies that each participant engaged in were quantified through a choice strategy metric, which contrasts the degree to which choice behaviour relies upon available satisficing or maximizing information. We separately examined these metrics for alterations within both the gains and losses domains, through the two choice tasks. The fatigue manipulation resulted in significantly greater levels of reported subjective fatigue, with correspondingly higher levels of reported effort during the cognitively taxing activity. Cognitive fatigue did not alter uncertainty preferences (risk or ambiguity) or informational strategies, in either the gains or losses domains. Rather, cognitive fatigue resulted in greater test-retest variability across most of our economic measures. These results indicate that cognitive fatigue destabilizes economic decision making, resulting in inconsistent preferences and informational strategies that may significantly reduce decision quality.

Clean birth kits to improve birth practices: development and testing of a country level decision support tool.

PubMed

Hundley, Vanora A; Avan, Bilal I; Ahmed, Haris; Graham, Wendy J

2012-12-19

Clean birth practices can prevent sepsis, one of the leading causes of both maternal and newborn mortality. Evidence suggests that clean birth kits (CBKs), as part of package that includes education, are associated with a reduction in newborn mortality, omphalitis, and puerperal sepsis. However, questions remain about how best to approach the introduction of CBKs in country. We set out to develop a practical decision support tool for programme managers of public health systems who are considering the potential role of CBKs in their strategy for care at birth. Development and testing of the decision support tool was a three-stage process involving an international expert group and country level testing. Stage 1, the development of the tool was undertaken by the Birth Kit Working Group and involved a review of the evidence, a consensus meeting, drafting of the proposed tool and expert review. In Stage 2 the tool was tested with users through interviews (9) and a focus group, with federal and provincial level decision makers in Pakistan. In Stage 3 the findings from the country level testing were reviewed by the expert group. The decision support tool comprised three separate algorithms to guide the policy maker or programme manager through the specific steps required in making the country level decision about whether to use CBKs. The algorithms were supported by a series of questions (that could be administered by interview, focus group or questionnaire) to help the decision maker identify the information needed. The country level testing revealed that the decision support tool was easy to follow and helpful in making decisions about the potential role of CBKs. Minor modifications were made and the final algorithms are presented. Testing of the tool with users in Pakistan suggests that the tool facilitates discussion and aids decision making. However, testing in other countries is needed to determine whether these results can be replicated and to identify how the tool can be adapted to meet country specific needs.

Neural correlates of decision making with explicit information about probabilities and incentives in elderly healthy subjects.

PubMed

Labudda, Kirsten; Woermann, Friedrich G; Mertens, Markus; Pohlmann-Eden, Bernd; Markowitsch, Hans J; Brand, Matthias

2008-06-01

Recent functional neuroimaging and lesion studies demonstrate the involvement of the orbitofrontal/ventromedial prefrontal cortex as a key structure in decision making processes. This region seems to be particularly crucial when contingencies between options and consequences are unknown but have to be learned by the use of feedback following previous decisions (decision making under ambiguity). However, little is known about the neural correlates of decision making under risk conditions in which information about probabilities and potential outcomes is given. In the present study, we used functional magnetic resonance imaging to measure blood-oxygenation-level-dependent (BOLD) responses in 12 subjects during a decision making task. This task provided explicit information about probabilities and associated potential incentives. The responses were compared to BOLD signals in a control condition without information about incentives. In contrast to previous decision making studies, we completely removed the outcome phase following a decision to exclude the potential influence of feedback previously received on current decisions. The results indicate that the integration of information about probabilities and incentives leads to activations within the dorsolateral prefrontal cortex, the posterior parietal lobe, the anterior cingulate and the right lingual gyrus. We assume that this pattern of activation is due to the involvement of executive functions, conflict detection mechanisms and arithmetic operations during the deliberation phase of decisional processes that are based on explicit information.

How can the use of data within the immunisation programme be increased in order to improve data quality and ensure greater accountability in the health system? A protocol for implementation science study.

PubMed

Tilahun, Binyam; Teklu, Alemayehu; Mancuso, Arielle; Abebaw, Zeleke; Dessie, Kassahun; Zegeye, Desalegn

2018-05-03

Immunisation remains one of the most important and cost-effective interventions to reduce vaccine-preventable child morbidity, disability and mortality. Health programmes like the Expanded Program of Immunization rely on complex decision-making and strong local level evidence is important to effectively and efficiently utilise limited resources. Lack of data use for decision-making at each level of the health system remains the main challenge in most developing countries. While there is much evidence on data quality and how to improve it, there is a lack of sufficient evidence on why the use of data for decision-making at each level of the health system is low. Herein, we describe a comprehensive implementation science study that will be conducted to identify organisational, technical and individual level factors affecting local data use at each level of the Ethiopian health system. We will apply a mixed methods approach using key informant interviews and document reviews. The qualitative data will be gathered through key informant interviews using a semi-structured guide with open- and closed-ended questions with four categories of respondents, namely decision-makers, data producers, data users and community representatives at the federal, regional, zonal, woreda and community levels of the health system. The document review will be conducted on selected reports and feedback documented at different levels of the health system. Data will be collected from July 2017 to March 2018. Descriptive statistics will be analysed for the quantitative study using SPSS version 20 software and thematic content analysis will be performed for the qualitative part using NVivo software. Appropriate and timely use of health and health-related information for decision-making is an essential element in the process of transforming the health sector. The findings of the study will inform stakeholders at different levels on the institutionalisation of evidence-based practice in immunisation programmes.

Real-life decision making in college students. I: Consistency across specific decisions.

PubMed

Galotti, Kathleen M; Wiener, Hillary J D; Tandler, Jane M

2014-01-01

First-year undergraduates participated in a short-term longitudinal study of real-life decision making over their first 14 months of college. They were surveyed about 7 different decisions: choosing courses for an upcoming term (3 different terms), choosing an academic major (twice), planning for the upcoming summer, and planning for sophomore-year housing. Participants showed moderate levels of consistency in the options they considered and in the criteria they used to decide between options, with about half of the options or criteria being used at 2 different points on the decision repeatedly studied. Participants varied somewhat in structural consistency, the tendency to consider the same number of options or criteria across decisions. They also varied in the way they integrated information across decision-making tasks. We suggest that people attempt to keep the information demands of the task within workable limits, sometimes sacrificing consistency as a result.

Decision framework for corridor planning within the roadside right-of-way.

DOT National Transportation Integrated Search

2013-08-01

A decision framework was developed for context-sensitive planning within the roadside ROW in : Michigan. This framework provides a roadside suitability assessment model that may be used to : support integrated decision-making and policy level conside...

Hospital drug and therapeutics committees in Australia: is there a role for economic evaluation at the institutional level?

PubMed

Gallego, Gisselle

2011-12-01

Decisions about spending on medicines occur at different levels in the Australian health care system. This commentary describes the role of economic evaluation at the institutional (public hospital) level. In contrast to the decisions taken at the level of Federal subsidy (listing on the Pharmaceutical Benefits Scheme) formal pharmacoeonomic data analyses are usually not available, and arguably often not relevant to decision making within the public hospital setting. Future research is needed to develop and explore models of best practice and how to incorporate pharmacoeconomic evidence into local decisions.

Greenhouse gas emissions control in integrated municipal solid waste management through mixed integer bilevel decision-making.

PubMed

He, Li; Huang, G H; Lu, Hongwei

2011-10-15

Recent studies indicated that municipal solid waste (MSW) is a major contributor to global warming due to extensive emissions of greenhouse gases (GHGs). However, most of them focused on investigating impacts of MSW on GHG emission amounts. This study presents two mixed integer bilevel decision-making models for integrated municipal solid waste management and GHG emissions control: MGU-MCL and MCU-MGL. The MGU-MCL model represents a top-down decision process, with the environmental sectors at the national level dominating the upper-level objective and the waste management sectors at the municipal level providing the lower-level objective. The MCU-MGL model implies a bottom-up decision process where municipality plays a leading role. Results from the models indicate that: the top-down decisions would reduce metric tonne carbon emissions (MTCEs) by about 59% yet increase about 8% of the total management cost; the bottom-up decisions would reduce MTCE emissions by about 13% but increase the total management cost very slightly; on-site monitoring and downscaled laboratory experiments are still required for reducing uncertainty in GHG emission rate from the landfill facility. Copyright © 2011 Elsevier B.V. All rights reserved.

The Role of Psychological Adjustment in the Decision-making Process for Voluntary Termination of Pregnancy

PubMed Central

Sereno, Sara; Leal, Isabel; Maroco, João

2013-01-01

Background This study's objective was to evaluate the role of psychological adjustment in the decision-making process to have an abortion and explore individual variables that might influence this decision. Methods In this cross-sectional study, we sequentially enrolled 150 women who made the decision to voluntarily terminate a pregnancy in Maternity Dr. Alfredo da Costa, in Lisbon, Portugal, between September 2008 and June 2009. The instruments were the Depression, Anxiety and Stress Scale (DASS), Satisfaction with Social Support Scale (SSSS), Emotional Assessment Scale (EAS), Decision Conflict Scale (DCS), and Beliefs and Values Questionnaire (BVQ). We analyzed the data using Student's T-tests, MANOVA, ANOVA, Tukey's post-hoc tests and CATPCA. Statistically significant effects were accepted for p<0.05. Results The participants found the decision difficult and emotionally demanding, although they also identified it as a low conflict decision. The prevailing emotions were sadness, fear and stress; but despite these feelings, the participants remained psychologically adjusted in the moment they decided to have an abortion. The resolution to terminate the pregnancy was essentially shared with supportive people and it was mostly motivated by socio-economic issues. The different beliefs and values found in this sample, and their possible associations are discussed. Conclusion Despite high levels of stress, the women were psychologically adjusted at the time of making the decision to terminate the pregnancy. However, opposing what has been previously reported, the women presented high levels of sadness and fear, showing that this decision was hard to make, triggering disruptive emotions. PMID:24163799

Affective and cognitive decision-making in adolescents.

PubMed

van Duijvenvoorde, Anna C K; Jansen, Brenda R J; Visser, Ingmar; Huizenga, Hilde M

2010-01-01

Adolescents demonstrate impaired decision-making in emotionally arousing situations, yet they appear to exhibit relatively mature decision-making skills in predominantly cognitive, low-arousal situations. In this study we compared adolescents' (13-15 years) performance on matched affective and cognitive decision-making tasks, in order to determine (1) their performance level on each task and (2) whether performance on the cognitive task was associated with performance on the affective task. Both tasks required a comparison of choice dimensions characterized by frequency of loss, amount of loss, and constant gain. Results indicated that in the affective task, adolescents performed sub-optimally by considering only the frequency of loss, whereas in the cognitive task adolescents used relatively mature decision rules by considering two or all three choice dimensions. Performance on the affective task was not related to performance on the cognitive task. These results are discussed in light of neural developmental trajectories observed in adolescence.

Economic Evaluation in Ethiopian Healthcare Sector Decision Making: Perception, Practice and Barriers.

PubMed

Zegeye, Elias Asfaw; Mbonigaba, Josue; Kaye, Sylvia Blanche; Wilkinson, Thomas

2017-02-01

Globally, economic evaluation (EE) is increasingly being considered as a critical tool for allocating scarce healthcare resources. However, such considerations are less documented in low-income countries, such as in Ethiopia. In particular, to date there has been no assessment conducted to evaluate the perception and practice of and barriers to health EE. This paper assesses the use and perceptions of EE in healthcare decision-making processes in Ethiopia. In-depth interview sessions with decision makers/healthcare managers and program coordinators across six regional health bureaus were conducted. A qualitative analysis approach was conducted on three thematic areas. A total of 57 decision makers/healthcare managers were interviewed from all tiers of the health sector in Ethiopia, ranging from the Federal Ministry of Health down to the lower levels of the health facility pyramid. At the high-level healthcare decision-making tier, only 56 % of those interviewed showed a good understanding of EE when explaining in terms of cost and consequences of alternative courses of action and value for money. From the specific program perspective, 50 % of the prevention of mother-to-child transmission of HIV/AIDS program coordinators indicated the relevance of EE to program planning and decision making. These respondents reported a limited application of costing studies on the HIV/AIDS prevention and control program, which were most commonly used during annual planning and budgeting. The study uncovered three important barriers to growth of EE in Ethiopia: a lack of awareness, a lack of expertise and skill, and the traditional decision-making culture.

CRIS Case Study Materials in Ethical Decision Making.

ERIC Educational Resources Information Center

Blanning, James R.

Designed for secondary-level classroom discussion, these materials contain nine, short case studies of ethical dilemmas. The cast studies focus mainly on incidents and issues relevant to high school students. Discussion questions for each case study require students to examine the case, discuss the issue, and make an ethical decision about how…

Engaging Undergraduates in Soil Sustainability Decision-Making through an InTeGrate Module

ERIC Educational Resources Information Center

Fortner, Sarah K.; Scherer, Hannah H.; Murphy, Martha A.

2016-01-01

Continued agricultural productivity hinges on understanding how to manage soil resources. A 2-week undergraduate introductory-level module: "A Growing Concern: Sustaining Soil Resources Through Local Decision Making" was collaboratively developed through the InTeGrate Project. InTeGrate modules and courses engage students in grand…

The Politics of Information: Building a Relational Database To Support Decision-Making at a Public University.

ERIC Educational Resources Information Center

Friedman, Debra; Hoffman, Phillip

2001-01-01

Describes creation of a relational database at the University of Washington supporting ongoing academic planning at several levels and affecting the culture of decision making. Addresses getting started; sharing the database; questions, worries, and issues; improving access to high-demand courses; the advising function; management of instructional…

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…

The Role of Emotion Expectancies in Adolescents' Moral Decision Making

ERIC Educational Resources Information Center

Krettenauer, Tobias; Jia, Fanli; Mosleh, Maureen

2011-01-01

This study investigated the impact of emotion expectancies on adolescents' moral decision making in hypothetical situations. The sample consisted of 160 participants from three different grade levels (mean age=15.79 years, SD=2.96). Participants were confronted with a set of scenarios that described various emotional outcomes of (im)moral actions…

Responding to the Gulf War: A Case Study of Instructional Decision Making.

ERIC Educational Resources Information Center

Merryfield, Merry M.

1993-01-01

Reports on study of teacher decision making regarding instruction about Gulf War. Finds teachers were influenced by student grade level, number of students in class from another culture, and their own knowledge of Middle Eastern history and geography. Concludes that local and state curriculum officials should provide more flexibility so teachers…

Decision Making. Level Two/Three. Career Guidance.

ERIC Educational Resources Information Center

Cooper, Irene; And Others

Materials contained in this career guidance unit are designed to provide the seven-, eight-, or nine-year-old student with a framework of logical steps for decision making and problem solving. The seventeen activities included in the unit vary in length from thirty to sixty minutes; the entire unit requires approximately ten hours of instructional…

Psychiatric and Psychological Factors in Patient Decision Making Concerning Antidepressant Use

ERIC Educational Resources Information Center

Dijkstra, Arie; Jaspers, Merlijne; van Zwieten, Marianne

2008-01-01

The observation that the use of antidepressants has strongly increased during the past decade implies that on a micro level doctors and patients more often decide that antidepressants are the appropriate treatment. Therefore, it is important to increase insight into patients' decision making regarding the use of antidepressants. The decision…

Decision-Making and Thought Processes among Poker Players

ERIC Educational Resources Information Center

St. Germain, Joseph; Tenenbaum, Gershon

2011-01-01

This study was aimed at delineating decision-making and thought processing among poker players who vary in skill-level. Forty-five participants, 15 in each group, comprised expert, intermediate, and novice poker players. They completed the Computer Poker Simulation Task (CPST) comprised of 60 hands of No-Limit Texas Hold 'Em. During the CPST, they…

Regulatory Fit and Systematic Exploration in a Dynamic Decision-Making Environment

ERIC Educational Resources Information Center

Otto, A. Ross; Markman, Arthur B.; Gureckis, Todd M.; Love, Bradley C.

2010-01-01

This work explores the influence of motivation on choice behavior in a dynamic decision-making environment, where the payoffs from each choice depend on one's recent choice history. Previous research reveals that participants in a regulatory fit exhibit increased levels of exploratory choice and flexible use of multiple strategies over the course…

Philosophy for Teachers (P4T)--Developing New Teachers' Applied Ethical Decision-Making

ERIC Educational Resources Information Center

Orchard, Janet; Heilbronn, Ruth; Winstanley, Carrie

2016-01-01

Teaching, irrespective of its geographical location, is fundamentally a relational practice in which unique ethically complex situations arise to which teachers need to respond at different levels of ethical decision-making. These range from "big" abstract questions about whether or not what they teach is inherently good, through to…

Moral Development and Social Worker Ethical Decision-Making

ERIC Educational Resources Information Center

Groessl, Joan

2013-01-01

This study examined both the moral development levels using the Defining Issues Test-2 (DIT--2) and ethical decision-making using the Professional Opinion Scale (POS) of social workers who provide field supervision to students within accredited social work programs in Wisconsin. Using the moral development theory of Kohlberg (1981) which defined…

Software Enabling School Improvement through Analysis of Student Data. Report Number 67

ERIC Educational Resources Information Center

Wayman, Jeffrey C.; Stringfield, Sam; Yakimowski, Mary

2004-01-01

The No Child Left Behind legislation has drawn increased attention to student data. Data are most useful in educational decision-making when the purpose extends beyond vertical accountability and toward school- and classroom-level decision-making that enhances the experience and achievement of students. This necessarily involves getting practical…

[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.

Prolonged Effects of Acute Stress on Decision-Making under Risk: A Human Psychophysiological Study

PubMed Central

Yamakawa, Kaori; Ohira, Hideki; Matsunaga, Masahiro; Isowa, Tokiko

2016-01-01

This study investigates the prolonged effects of physiological responses induced by acute stress on risk-taking in decision-making. Participants were divided into a Stress group (N = 14) and a Control group (N = 12). The Trier Social Stress Test was administered as an acute stressor, and reading was administered as a control task; thereafter, participants performed a decision-making task in which they needed to choose a sure option or a gamble option in Gain and Loss frame trials 2 h after (non-) exposure to the stressor. Increased cortisol, adrenaline, heart rate (HR), and subjective stress levels validated acute stress manipulation. Stressed participants made fewer risky choices only in the Gain domain, whereas no effect of stress was shown in the Loss domain. Deceleration of HR reflecting attention was greater for Gains compared with Losses only in the Stress group. Risk avoidance was determined by increased levels of cortisol caused by acute stress. These results suggest that processes regarding glucocorticoid might be involved in the prolonged effects of acute stress on the evaluation of risks and the monitoring of outcomes in decision-making. PMID:27679566

Do personal stories make patient decision aids more effective? A critical review of theory and evidence

PubMed Central

2013-01-01

Background Patient decision aids support people to make informed decisions between healthcare options. Personal stories provide illustrative examples of others’ experiences and are seen as a useful way to communicate information about health and illness. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in non-narrative prose. It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions. Methods A survey of primary empirical research employing a systematic review method investigated the effect of patient decision aids with or without a personal story on people’s healthcare judgements and decisions. Searches were carried out between 2005-2012 of electronic databases (Medline, PsycINFO), and reference lists of identified articles, review articles, and key authors. A narrative analysis described and synthesised findings. Results Of 734 citations identified, 11 were included describing 13 studies. All studies found participants’ judgments and/or decisions differed depending on whether or not their decision aid included a patient story. Knowledge was equally facilitated when the decision aids with and without stories had similar information content. Story-enhanced aids may help people recall information over time and/or their motivation to engage with health information. Personal stories affected both “system 1” (e.g., less counterfactual reasoning, more emotional reactions and perceptions) and “system 2” (e.g., more perceived deliberative decision making, more stable evaluations over time) decision-making strategies. Findings exploring associations with narrative communications, decision quality measures, and different levels of literacy and numeracy were mixed. The pattern of findings was similar for both experimental and real-world studies. Conclusions There is insufficient evidence that adding personal stories to decision aids increases their effectiveness to support people’s informed decision making. More rigorous research is required to elicit evidence about the type of personal story that a) encourages people to make more reasoned decisions, b) discourages people from making choices based on another’s values, and c) motivates people equally to engage with healthcare resources. PMID:24625283

Association of patient preferences for participation in decision making with length of stay and costs among hospitalized patients.

PubMed

Tak, Hyo Jung; Ruhnke, Gregory W; Meltzer, David O

2013-07-08

Patient participation in medical decision making has been associated with improved patient satisfaction and health outcomes. However, there is little evidence concerning its effects on resource utilization. Patient participation in medical decision making has been hypothesized to decrease excess utilization but might be expected to increase utilization when other decision makers have incentives to reduce utilization, as under prospective payment systems for hospital care. To examine the relationship between patient preferences for participation in medical decision making and health care utilization among hospitalized patients. Survey study in an academic research setting. A survey that included questions about preferences to receive medical information and to participate in medical decision making was administered to all patients admitted to the University of Chicago Medical Center general internal medicine service between July 1, 2003, and August 31, 2011, and completed by 21,754 (69.6%) of admitted patients. The survey data were linked with administrative data, including length of stay and total hospitalization costs. We used generalized linear models to measure the association of patient preference for participation in decision making with length of stay and costs. The mean length of stay was 5.34 days, and the mean hospitalization costs were $14,576. While 96.3% of patients expressed a desire to receive information about their illnesses and treatment options, 71.1% of patients preferred to leave medical decision making to their physician. Preference to participate in decision making increased with educational level and with private health insurance. Compared with patients who had a strong desire to delegate decisions to their physician, patients who preferred to participate in decision making concerning their care had a 0.26-day (95% CI, 0.06-0.47 day) longer length of stay (P = .01) and $865 (95% CI, $155-$1575) higher total hospitalization costs (P = .02). Patient preference to participate in decision making concerning their care may be associated with increased resource utilization among hospitalized patients. Variation in patient preference to participate in medical decision making and its effects on costs and outcomes in the presence of varying physician incentives deserve further examination.

The role of emotion expectancies in adolescents' moral decision making.

PubMed

Krettenauer, Tobias; Jia, Fanli; Mosleh, Maureen

2011-02-01

This study investigated the impact of emotion expectancies on adolescents' moral decision making in hypothetical situations. The sample consisted of 160 participants from three different grade levels (mean age=15.79 years, SD=2.96). Participants were confronted with a set of scenarios that described various emotional outcomes of (im)moral actions and needed to decide what they would do if they were in the protagonist's shoes. Findings demonstrate that emotion expectancies differentially influenced adolescents' hypothetical decision making in antisocial versus prosocial behavioral contexts. Whereas negatively charged self-evaluative emotions over failing to act morally (e.g., guilt) were the strongest predictor for moral choice in antisocial behavioral contexts, positively charged self-evaluative emotions over acting morally (e.g., pride) most strongly predicted moral choice in prosocial contexts. Older adolescents paid greater attention to outcome-oriented emotions that make the decision to act morally less attractive (e.g., regret). Overall, the study suggests that emotion expectancies influence moral decision making in unique and meaningful ways. Copyright © 2010 Elsevier Inc. All rights reserved.

Exploring information provision in reconstructive breast surgery: A qualitative study.

PubMed

Potter, Shelley; Mills, Nicola; Cawthorn, Simon; Wilson, Sherif; Blazeby, Jane

2015-12-01

Women considering reconstructive breast surgery (RBS) require adequate information to make informed treatment decisions. This study explored patients' and health professionals' (HPs) perceptions of the adequacy of information provided for decision-making in RBS. Semi-structured interviews with a purposive sample of patients who had undergone RBS and HPs providing specialist care explored participants' experiences of information provision prior to RBS. Professionals reported providing standardised verbal, written and photographic information about the process and outcomes of surgery. Women, by contrast, reported varying levels of information provision. Some felt fully-informed but others perceived they had received insufficient information about available treatment options or possible outcomes of surgery to make an informed decision. Women need adequate information to make informed decisions about RBS and current practice may not meet women's needs. Minimum agreed standards of information provision, especially about alternative types of reconstruction, are recommended to improve decision-making in RBS. Copyright © 2015 Elsevier Ltd. All rights reserved.

Decision-making and planning in full recovery of anorexia nervosa.

PubMed

Lindner, Susanne E; Fichter, Manfred M; Quadflieg, Norbert

2012-11-01

Based on findings of persisting neuropsychological impairments in women recovered from anorexia nervosa (rec AN), this study examined decision-making and planning, for achieving a desired goal, as central executive functions in a large sample of rec AN. The definition of recovery included physiological, behavioral, and psychological variables. A total of 100 rec AN women were compared to 100 healthy women, 1:1 matched for age and educational level. Decision-making was assessed with the Iowa Gambling Task and planning with the Tower of London. Expert interviews and self-ratings were used for assessing the inclusion/exclusion criteria and control variables. Compared to healthy controls, rec AN women were better in decision-making and worse in planning even after considering control variables. This study does not support results from other studies showing that rec AN participants perform better in decision-making. Results from this study show that planning is impaired even after full recovery from AN. Copyright © 2012 Wiley Periodicals, Inc.

Association of a traditional vs shared meal decision-making and preparation style with eating behavior of Hispanic women in San Diego County.

PubMed

Arredondo, Elva M; Elder, John P; Ayala, Guadalupe X; Slymen, Donald; Campbell, Nadia R

2006-01-01

To examine the influence of meal decision-making and preparation on Hispanic women's dietary practices. One-on-one structured interviews were conducted, assessing meal decision-making and preparation practices, barriers, and behavioral strategies to eating low-fat and high-fiber diets, fat and fiber intake, demographic, and other psychosocial factors. The study population included 357 Hispanic women living in the southern or central regions of San Diego County. Participants were recruited via random-digit dialing to a tailored nutrition communication intervention. Household decision-making style (alone vs with family) by household activity (decides meals, prepares meals, and decides snacks). Multiple logistic regressions were used to evaluate associations between the predictors and dependent variable. All models included adjustments for potential confounders, such as marital status, education, employment, age, and acculturation. A positive statistical association between Hispanic women's acculturation level and shared decision-making style was found. Also, Hispanic women in shared decision-making households faced greater psychosocial barriers to healthful eating and reported less healthful eating compared with Hispanic women in traditional households. Women in shared decision-making households were more likely to eat at fast-food restaurants, less likely to engage in behavioral strategies promoting fiber consumption, eat more saturated fat, and encounter more barriers to reduce dietary fat as compared with Hispanic women in traditional households. Acculturation did not attenuate differences in psychosocial and dietary practices between shared decision-making and traditional households. Study findings suggest intervention efforts should focus on different aspects of healthful eating among Hispanic women in shared-decision, compared with traditional, households.

Modelling human decision-making in coupled human and natural systems

NASA Astrophysics Data System (ADS)

Feola, G.

2012-12-01

A solid understanding of human decision-making is essential to analyze the complexity of coupled human and natural systems (CHANS) and inform policies to promote resilience in the face of environmental change. Human decisions drive and/or mediate the interactions and feedbacks, and contribute to the heterogeneity and non-linearity that characterize CHANS. However, human decision-making is usually over-simplistically modeled, whereby human agents are represented deterministically either as dumb or clairvoyant decision-makers. Decision-making models fall short in the integration of both environmental and human behavioral drivers, and concerning the latter, tend to focus on only one category, e.g. economic, cultural, or psychological. Furthermore, these models render a linear decision-making process and therefore fail to account for the recursive co-evolutionary dynamics in CHANS. As a result, these models constitute only a weak basis for policy-making. There is therefore scope and an urgent need for better approaches to human decision-making, to produce the knowledge that can inform vulnerability reduction policies in the face of environmental change. This presentation synthesizes the current state-of-the-art of modelling human decision-making in CHANS, with particular reference to agricultural systems, and delineates how the above mentioned shortcomings can be overcome. Through examples from research on pesticide use and adaptation to climate change, both based on the integrative agent-centered framework (Feola and Binder, 2010), the approach for an improved understanding of human agents in CHANS are illustrated. This entails: integrative approach, focus on behavioral dynamics more than states, feedbacks between individual and system levels, and openness to heterogeneity.

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

PubMed

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

2010-01-01

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

The impact of stakeholder involvement in hospital policy decision-making: a study of the hospital's business processes.

PubMed

Malfait, Simon; Van Hecke, Ann; Hellings, Johan; De Bodt, Griet; Eeckloo, Kristof

2017-02-01

In many health care systems, strategies are currently deployed to engage patients and other stakeholders in decisions affecting hospital services. In this paper, a model for stakeholder involvement is presented and evaluated in three Flemish hospitals. In the model, a stakeholder committee advises the hospital's board of directors on themes of strategic importance. To study the internal hospital's decision processes in order to identify the impact of a stakeholder involvement committee on strategic themes in the hospital decision processes. A retrospective analysis of the decision processes was conducted in three hospitals that implemented a stakeholder committee. The analysis consisted of process and outcome evaluation. Fifteen themes were discussed in the stakeholder committees, whereof 11 resulted in a considerable change. None of these were on a strategic level. The theoretical model was not applied as initially developed, but was altered by each hospital. Consequentially, the decision processes differed between the hospitals. Despite alternation of the model, the stakeholder committee showed a meaningful impact in all hospitals on the operational level. As a result of the differences in decision processes, three factors could be identified as facilitators for success: (1) a close interaction with the board of executives, (2) the inclusion of themes with a more practical and patient-oriented nature, and (3) the elaboration of decisions on lower echelons of the organization. To effectively influence the organization's public accountability, hospitals should involve stakeholders in the decision-making process of the organization. The model of a stakeholder committee was not applied as initially developed and did not affect the strategic decision-making processes in the involved hospitals. Results show only impact at the operational level in the participating hospitals. More research is needed connecting stakeholder involvement with hospital governance.

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

NASA Astrophysics Data System (ADS)

Ghavami, Seyed Morsal; Taleai, Mohammad

2017-04-01

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

Men's attitudes on gender equality and their contraceptive use in Uttar Pradesh India.

PubMed

Mishra, Anurag; Nanda, Priya; Speizer, Ilene S; Calhoun, Lisa M; Zimmerman, Allison; Bhardwaj, Rochak

2014-06-04

Men play crucial role in contraceptive decision-making, particularly in highly gender-stratified populations. Past research examined men's attitudes toward fertility and contraception and the association with actual contraceptive practices. More research is needed on whether men's attitudes on gender equality are associated with contraceptive behaviors; this is the objective of this study. This study uses baseline data of the Measurement, Learning, and Evaluation (MLE) Project for the Urban Health Initiative in Uttar Pradesh, India. Data were collected from a representative sample of 6,431 currently married men in four cities of the state. Outcomes are current use of contraception and contraceptive method choice. Key independent variables are three gender measures: men's attitudes toward gender equality, gender sensitive decision making, and restrictions on wife's mobility. Multivariate analyses are used to identify the association between the gender measures and contraceptive use. Most men have high or moderate levels of gender sensitive decision-making, have low to moderate levels of restrictions on wife's mobility, and have moderate to high levels of gender equitable attitudes in all four cities. Gender sensitive decision making and equitable attitudes show significant positive association and restrictions on wife's mobility showed significant negative relationship with current contraceptive use. The study demonstrates that contraceptive programs need to engage men and address gender equitable attitudes; this can be done through peer outreach (interpersonal communication) or via mass media. Engaging men to be more gender equal may have an influence beyond contraceptive use in contexts where men play a crucial role in household decision-making.

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

PubMed

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

2018-05-01

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

Integrated Risk-Informed Decision-Making for an ALMR PRISM

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

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

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

Risk assessment and decision making about in-labour transfer from rural maternity care: a social judgment and signal detection analysis

PubMed Central

2012-01-01

Background The importance of respecting women’s wishes to give birth close to their local community is supported by policy in many developed countries. However, persistent concerns about the quality and safety of maternity care in rural communities have been expressed. Safe childbirth in rural communities depends on good risk assessment and decision making as to whether and when the transfer of a woman in labour to an obstetric led unit is required. This is a difficult decision. Wide variation in transfer rates between rural maternity units have been reported suggesting different decision making criteria may be involved; furthermore, rural midwives and family doctors report feeling isolated in making these decisions and that staff in urban centres do not understand the difficulties they face. In order to develop more evidence based decision making strategies greater understanding of the way in which maternity care providers currently make decisions is required. This study aimed to examine how midwives working in urban and rural settings and obstetricians make intrapartum transfer decisions, and describe sources of variation in decision making. Methods The study was conducted in three stages. 1. 20 midwives and four obstetricians described factors influencing transfer decisions. 2. Vignettes depicting an intrapartum scenario were developed based on stage one data. 3. Vignettes were presented to 122 midwives and 12 obstetricians who were asked to assess the level of risk in each case and decide whether to transfer or not. Social judgment analysis was used to identify the factors and factor weights used in assessment. Signal detection analysis was used to identify participants’ ability to distinguish high and low risk cases and personal decision thresholds. Results When reviewing the same case information in vignettes midwives in different settings and obstetricians made very similar risk assessments. Despite this, a wide range of transfer decisions were still made, suggesting that the main source of variation in decision making and transfer rates is not in the assessment but the personal decision thresholds of clinicians. Conclusions Currently health care practice focuses on supporting or improving decision making through skills training and clinical guidelines. However, these methods alone are unlikely to be effective in improving consistency of decision making. PMID:23114289

Moderate social sensitivity in a risky context supports adaptive decision making in adolescence: evidence from brain and behavior.

PubMed

van Hoorn, Jorien; McCormick, Ethan M; Telzer, Eva H

2018-05-01

Adolescence is a time of increased social-affective sensitivity, which is often related to heightened health-risk behaviors. However, moderate levels of social sensitivity, relative to either low (social vacuum) or high levels (exceptionally attuned), may confer benefits as it facilitates effective navigation of the social world. The present fMRI study tested a curvilinear relationship between social sensitivity and adaptive decision-making. Participants (ages 12-16; N = 35) played the Social Analogue Risk Task, which measures participants' willingness to knock on doors in order to earn points. With each knock, the facial expression of the house's resident shifted from happy to somewhat angrier. If the resident became too angry, the door slammed and participants lost points. Social sensitivity was defined as the extent to which adolescents adjusted their risky choices based on shifting facial expressions. Results confirmed a curvilinear relationship between social sensitivity and self-reported adaptive decision-making at the behavioral and neural level. Moderate adolescent social sensitivity was modulated via heightened tracking of social cues in the temporoparietal junction, insula and dorsolateral prefrontal cortex and related to adaptive decision-making. These findings suggest that social-affective sensitivity may positively impact outcomes in adolescence and have implications for interventions to help adolescents reach mature social goals into adulthood.

Differences in Biases and Compensatory Strategies Across Discipline, Rank, and Gender among University Academics

PubMed Central

Giorgini, Vincent; Gibson, Carter; Mecca, Jensen T.; Medeiros, Kelsey E.; Mumford, Michael D.; Connelly, Shane; Devenport, Lynn D.

2014-01-01

The study of ethical behavior and ethical decision making is of increasing importance in many fields, and there is a growing literature addressing the issue. However, research examining differences in ethical decision making across fields and levels of experience is limited. In the present study, biases that undermine ethical decision making and compensatory strategies that may aid ethical decision making were identified in a series of interviews with 63 faculty members across six academic fields (e.g. biological sciences, health sciences, social sciences) and three levels of rank (assistant professor, associate professor, and full professor) as well as across gender. The degree to which certain biases and compensatory strategies were used in justifications for responses to ethical situations was compared across fields, level of experience, and gender. Major differences were found across fields for several biases and compensatory strategies, including biases and compensatory strategies related to use of professional field principles and field-specific guidelines. Furthermore, full professors tend to differ greatly from assistant and associate professors on a number of constructs, and there were differences in the consistency with which biases and compensatory strategies were displayed within these various groups. Implications of these findings for ethics training and future research are discussed. PMID:25479960

Evidence-based librarianship: an overview.

PubMed

Eldredge, J D

2000-10-01

To demonstrate how the core characteristics of both evidence-based medicine (EBM) and evidence-based health care (EBHC) can be adapted to health sciences librarianship. Narrative review essay involving development of a conceptual framework. The author describes the central features of EBM and EBHC. Following each description of a central feature, the author then suggests ways that this feature applies to health sciences librarianship. First, the decision-making processes of EBM and EBHC are compatible with health sciences librarianship. Second, the EBM and EBHC values of favoring rigorously produced scientific evidence in decision making are congruent with the core values of librarianship. Third, the hierarchical levels of evidence can be applied to librarianship with some modifications. Library researchers currently favor descriptive-survey and case-study methods over systematic reviews, randomized controlled trials, or other higher levels of evidence. The library literature nevertheless contains diverse examples of randomized controlled trials, controlled-comparison studies, and cohort studies conducted by health sciences librarians. Health sciences librarians are confronted with making many practical decisions. Evidence-based librarianship offers a decision-making framework, which integrates the best available research evidence. By employing this framework and the higher levels of research evidence it promotes, health sciences librarians can lay the foundation for more collaborative and scientific endeavors.

Evidence-based librarianship: an overview

PubMed Central

Eldredge, Jonathan D.

2000-01-01

Objective: To demonstrate how the core characteristics of both evidence-based medicine (EBM) and evidence-based health care (EBHC) can be adapted to health sciences librarianship. Method: Narrative review essay involving development of a conceptual framework. The author describes the central features of EBM and EBHC. Following each description of a central feature, the author then suggests ways that this feature applies to health sciences librarianship. Results: First, the decision-making processes of EBM and EBHC are compatible with health sciences librarianship. Second, the EBM and EBHC values of favoring rigorously produced scientific evidence in decision making are congruent with the core values of librarianship. Third, the hierarchical levels of evidence can be applied to librarianship with some modifications. Library researchers currently favor descriptive-survey and case-study methods over systematic reviews, randomized controlled trials, or other higher levels of evidence. The library literature nevertheless contains diverse examples of randomized controlled trials, controlled-comparison studies, and cohort studies conducted by health sciences librarians. Conclusions: Health sciences librarians are confronted with making many practical decisions. Evidence-based librarianship offers a decision-making framework, which integrates the best available research evidence. By employing this framework and the higher levels of research evidence it promotes, health sciences librarians can lay the foundation for more collaborative and scientific endeavors. PMID:11055296

The decision-making matrix of propensity to outsourcing hospital services in Bandar Abbas, Iran.

PubMed

Hayati, Ramin; Setoodehzadeh, Fateme; Heydarvand, Sanaz; Khammarnia, Mohammad; Ravangard, Ramin; Sadeghi, Ahmad; Sobhani, Ghasem

2015-12-01

To determine the level of managers' propensity for outsourcing the services in hospitals using decision-making matrix. The applied, cross-sectional study was conducted at three hospitals affiliated to Bandar Abbas University of Medical Sciences, Iran, in 2013, and comprised managers and employees of four service units: radiology, laboratory, nursing, and nutrition services. Data was collected using two questionnaires and face-to-face interviews. Data was analysed using SPSS 16 and by using decision-making matrix. Of the 122 subjects in the study, 12(9.8%) were managers and 110(90.2%) were other employees. The highest and lowest propensities for outsourcing were related to nutrition (66.6%) and nursing services one (8.33%). The decision-making matrix showed low outsourcing of the nursing, radiology, and laboratory services based on the services' features. However, there were difference between the results obtained from laboratory service decision-making matrix and the propensity for laboratory service outsourcing. The difference between the results obtained from the matrix and managers' viewpoint can be due to the lack of managers' sufficient attention to the features of hospital services when making decisions on outsourcing them.

To what extent is treatment adherence of psychiatric patients influenced by their participation in shared decision making?

PubMed

De Las Cuevas, Carlos; Peñate, Wenceslao; de Rivera, Luis

2014-01-01

Nonadherence to prescribed medications is a significant barrier to the successful treatment of psychiatric disorders in clinical practice. It has been argued that patient participation in shared decision making improves adherence to treatment plans. To assess to what extent treatment adherence of psychiatric patients is influenced by the concordance between their preferred participation and their actual participation in decision making. A total of 967 consecutive psychiatric outpatients completed the Control Preference Scale twice consecutively before consultation, one for their preferences of participation, and the other for the style they had usually experienced until then, and the eight-item self-report Morisky Medication Adherence Scale 8. Most psychiatric outpatients preferred a collaborative role in decision making. Congruence was achieved in only 50% of the patients, with most mismatch cases preferring more involvement than had been experienced. Self-reported adherence was significantly higher in those patients in whom there was concordance between their preferences and their experiences of participation in decision making, regardless of the type of participation preferred. Congruence between patients' preferences and actual experiences for level of participation in shared decision making is relevant for their adherence to treatment.

Safety Assessment of Dangerous Goods Transport Enterprise Based on the Relative Entropy Aggregation in Group Decision Making Model

PubMed Central

Wu, Jun; Li, Chengbing; Huo, Yueying

2014-01-01

Safety of dangerous goods transport is directly related to the operation safety of dangerous goods transport enterprise. Aiming at the problem of the high accident rate and large harm in dangerous goods logistics transportation, this paper took the group decision making problem based on integration and coordination thought into a multiagent multiobjective group decision making problem; a secondary decision model was established and applied to the safety assessment of dangerous goods transport enterprise. First of all, we used dynamic multivalue background and entropy theory building the first level multiobjective decision model. Secondly, experts were to empower according to the principle of clustering analysis, and combining with the relative entropy theory to establish a secondary rally optimization model based on relative entropy in group decision making, and discuss the solution of the model. Then, after investigation and analysis, we establish the dangerous goods transport enterprise safety evaluation index system. Finally, case analysis to five dangerous goods transport enterprises in the Inner Mongolia Autonomous Region validates the feasibility and effectiveness of this model for dangerous goods transport enterprise recognition, which provides vital decision making basis for recognizing the dangerous goods transport enterprises. PMID:25477954

Age differences in the effects of conscious and unconscious thought in decision making.

PubMed

Queen, Tara L; Hess, Thomas M

2010-06-01

The roles of unconscious and conscious thought in decision making were investigated to examine both (a) boundary conditions associated with the efficacy of each type of thought and (b) age differences in intuitive versus deliberative thought. Participants were presented with 2 decision tasks, one requiring active deliberation and the other intuitive processing. Young and older adults then engaged in conscious or unconscious thought processing before making a decision. A manipulation check revealed that young adults were more accurate in their representations of the decision material than older adults, which accounted for much of the age-related variation in performance when the full sample was considered. When only accurate participants were considered, decision making was best when there was congruence between the nature of the information and the thought condition. Thus, unconscious thought was more appropriate when participants relied on intuitive rather than deliberative processing to make their decision, whereas the converse was true with conscious thought. Although older adults displayed somewhat less efficient deliberative processing, their ability to process information at the intuitive level was relatively preserved. Additionally, both young and older adults displayed choice-supportive memory. (c) 2010 APA, all rights reserved

Safety assessment of dangerous goods transport enterprise based on the relative entropy aggregation in group decision making model.

PubMed

Wu, Jun; Li, Chengbing; Huo, Yueying

2014-01-01

Safety of dangerous goods transport is directly related to the operation safety of dangerous goods transport enterprise. Aiming at the problem of the high accident rate and large harm in dangerous goods logistics transportation, this paper took the group decision making problem based on integration and coordination thought into a multiagent multiobjective group decision making problem; a secondary decision model was established and applied to the safety assessment of dangerous goods transport enterprise. First of all, we used dynamic multivalue background and entropy theory building the first level multiobjective decision model. Secondly, experts were to empower according to the principle of clustering analysis, and combining with the relative entropy theory to establish a secondary rally optimization model based on relative entropy in group decision making, and discuss the solution of the model. Then, after investigation and analysis, we establish the dangerous goods transport enterprise safety evaluation index system. Finally, case analysis to five dangerous goods transport enterprises in the Inner Mongolia Autonomous Region validates the feasibility and effectiveness of this model for dangerous goods transport enterprise recognition, which provides vital decision making basis for recognizing the dangerous goods transport enterprises.

Evaluation of a rule base for decision making in general practice.

PubMed Central

Essex, B; Healy, M

1994-01-01

BACKGROUND. Decision making in general practice relies heavily on judgmental expertise. It should be possible to codify this expertise into rules and principles. AIM. A study was undertaken to evaluate the effectiveness, of rules from a rule base designed to improve students' and trainees' management decisions relating to patients seen in general practice. METHOD. The rule base was developed after studying decisions about and management of thousands of patients seen in one general practice over an eight year period. Vignettes were presented to 93 fourth year medical students and 179 general practitioner trainees. They recorded their perception and management of each case before and after being presented with a selection of relevant rules. Participants also commented on their level of agreement with each of the rules provided with the vignettes. A panel of five independent assessors then rated as good, acceptable or poor, the participants' perception and management of each case before and after seeing the rules. RESULTS. Exposure to a few selected rules of thumb improved the problem perception and management decisions of both undergraduates and trainees. The degree of improvement was not related to previous experience or to the stated level of agreement with the proposed rules. The assessors identified difficulties students and trainees experienced in changing their perceptions and management decisions when the rules suggested options they had not considered. CONCLUSION. The rules developed to improve decision making skills in general practice are effective when used with vignettes. The next phase is to transform the rule base into an expert system to train students and doctors to acquire decision making skills. It could also be used to provide decision support when confronted with difficult management decisions in general practice. PMID:8204334

Internet use and decision making in community-based older adults

PubMed Central

James, Bryan D.; Boyle, Patricia A.; Yu, Lei; Bennett, David A.

2013-01-01

Use of the internet may provide tools and resources for better decision making, yet little is known about the association of internet use with decision making in older persons. We examined this relationship in 661 community-dwelling older persons without dementia from the Rush Memory and Aging Project, an ongoing longitudinal study of aging. Participants were asked to report if they had access to the internet and how frequently they used the internet and email. A 12-item instrument was used to assess financial and healthcare decision making using materials designed to approximate those used in real world settings. Items were summed to yield a total decision making score. Associations were tested via linear regression models adjusted for age, sex, race, education, and a measure of global cognitive function. Secondary models further adjusted for income, depression, loneliness, social networks, social support, chronic medical conditions, instrumental activities of daily living (IADLs), life space size, and health and financial literacy. Interaction terms were used to test for effect modification. Almost 70% of participants had access to the internet, and of those with access, 55% used the internet at least several times a week. Higher frequency of internet use was associated with better financial and healthcare decision making (β = 0.11, p = 0.002). The association persisted in a fully adjusted model (β = 0.08, p = 0.024). Interaction models indicated that higher frequency of internet use attenuated the relationships of older age, poorer cognitive function, and lower levels of health and financial literacy with poorer healthcare and financial decision making. These findings indicate that internet use is associated with better health and financial decision making in older persons. Future research is required to understand whether promoting the use of the internet can produce improvements in healthcare and financial decision making. PMID:24578696

Trait-related decision-making impairment in the three phases of bipolar disorder.

PubMed

Adida, Marc; Jollant, Fabrice; Clark, Luke; Besnier, Nathalie; Guillaume, Sébastien; Kaladjian, Arthur; Mazzola-Pomietto, Pascale; Jeanningros, Régine; Goodwin, Guy M; Azorin, Jean-Michel; Courtet, Philippe

2011-08-15

In bipolar disorder (BD), little is known about how deficits in neurocognitive functions such as decision-making are related to phase of illness. We predicted that manic, depressed, and euthymic bipolar patients (BPs) would display impaired decision-making, and we tested whether clinical characteristics could predict patients' decision-making performance. Subjects (N = 317; age range: 18-65 years) including 167 BPs (45 manic and 32 depressed inpatients, and 90 euthymic outpatients) and 150 age-, IQ-, and gender-matched healthy control (HC) participants, were included within three university psychiatric hospitals using a cross-sectional design. The relationship between predictor variables and decision-making was assessed by one-step multivariate analysis. The main outcome measures were overall decision-making ability on the Iowa Gambling Task (IGT) and an index of sensitivity to punishment frequency. Manic, depressed, and euthymic BPs selected significantly more cards from the risky decks than HCs (p < .001, p < .01, and p < .05, respectively), with no significant differences between the three BD groups. However, like HCs, BPs preferred decks that yielded infrequent penalties over those yielding frequent penalties. In multivariate analysis, decision-making impairment was significantly (p < .001) predicted by low level of education, high depressive scores, family history of BD, use of benzodiazepines, and nonuse of serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressants. BPs have a trait-related impairment in decision-making that does not vary across illness phase. However, some subtle differences between the BD groups in the individual deck analyses may point to subtle state influences on reinforcement mechanisms, in addition to a more fundamental trait impairment in risk-sensitive decision making. Copyright © 2011 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Human-Computer Interaction with Medical Decisions Support Systems

NASA Technical Reports Server (NTRS)

Adolf, Jurine A.; Holden, Kritina L.

1994-01-01

Decision Support Systems (DSSs) have been available to medical diagnosticians for some time, yet their acceptance and use have not increased with advances in technology and availability of DSS tools. Medical DSSs will be necessary on future long duration space missions, because access to medical resources and personnel will be limited. Human-Computer Interaction (HCI) experts at NASA's Human Factors and Ergonomics Laboratory (HFEL) have been working toward understanding how humans use DSSs, with the goal of being able to identify and solve the problems associated with these systems. Work to date consists of identification of HCI research areas, development of a decision making model, and completion of two experiments dealing with 'anchoring'. Anchoring is a phenomenon in which the decision maker latches on to a starting point and does not make sufficient adjustments when new data are presented. HFEL personnel have replicated a well-known anchoring experiment and have investigated the effects of user level of knowledge. Future work includes further experimentation on level of knowledge, confidence in the source of information and sequential decision making.

The ethics of end-of-life decisions in the elderly: deliberations from the ECOPE study.

PubMed

Reiter-Theil, Stella

2003-06-01

Is age a factor underlying clinical decision-making? Should age be a criterion in the allocation of health care resources? Is it correct to criticize this approach as 'ageism'? What role does 'paternalism' play? These questions are the focus of this chapter which takes an interdisciplinary perspective of clinical ethics in order to provide an ethical evaluation of the situation of the elderly in health care. First, the text of the chapter is based on the descriptive level referring to (a) clinical ethics consultation, (b) the ECOPE study on 'Ethical Conditions of Passive Euthanasia' focusing on decision-making, and studies about age as a factor in clinical decisions, such as the American SUPPORT study. Second, at the normative level, ethical deliberations are discussed for and against age as a criterion for allocating health care resources. Finally, it is suggested that the differences in evidence to be found about the role of age as a factor in clinical decision-making may be due to the different national health policies as well as to the insufficient awareness of ethical principles violated by covert 'ageist' attitudes.

Three Levels of Push-Pull Dynamics among Chinese International Students' Decision to Study Abroad in the Canadian Context

ERIC Educational Resources Information Center

Chen, Jun Mian

2017-01-01

The extant literature on student migration flows generally focus on the traditional push-pull factors of migration at the individual level. Such a tendency excludes the broader levels affecting international student mobility. This paper proposes a hybrid of three levels of push-pull dynamics (micro-individual decision-making, meso-academic…

If you want to save, focus on the forest rather than on trees. The effects of shifts in levels of construal on saving decisions.

PubMed

Rudzinska-Wojciechowska, Joanna

2017-01-01

Although financial decisions are expected to be rational, there is a growing body of experimental research indicating that small psychological changes in one's mind-set in the actual decision-making moment might affect saving ratios. In this article, another type of change in one's mind-set, which can influence saving decisions, is explored, namely the level of construal. Construal level is a key descriptor of people's cognitive representations of targets, and is a way of characterising the mental mind-sets people use. Building on recent advances in the link between construal levels and intertemporal choices, the present research evaluates the effect of shifts in levels of construal in the very moment of decision making on people's propensity to save money. It is suggested that triggering a high-level construal mind-set would influence individuals' financial decisions and result in greater willingness to save than triggering a low-level construal mind-set. This assumption is supported by the findings: across three experiments, those with an abstract mind-set showed an increased willingness to save when compared to those with a concrete mind-set. The first experiment demonstrated that people in an abstract mind-set are more willing to delay financial gratification than those in a concrete mind-set. In the second and third experiments, those with an abstract mind-set showed an increased willingness to save when compared to those with a concrete mind-set. The research provides further evidence that mental states, which can be evoked by previous, unrelated tasks, such as level of cognitive abstraction, can influence everyday financial decisions. It, thus, highlights the role of situational factors that consumers may be not aware of, which still affect their savings decisions.

The application of reduced-processing decision support systems to facilitate the acquisition of decision-making skills.

PubMed

Perry, Nathan C; Wiggins, Mark W; Childs, Merilyn; Fogarty, Gerard

2013-06-01

The study was designed to examine whether the availability of reduced-processing decision support system interfaces could improve the decision making of inexperienced personnel in the context of Although research into reduced-processing decision support systems has demonstrated benefits in minimizing cognitive load, these benefits have not typically translated into direct improvements in decision accuracy because of the tendency for inexperienced personnel to focus on less-critical information. The authors investigated whether reduced-processing interfaces that direct users' attention toward the most critical cues for decision making can produce improvements in decision-making performance. Novice participants made incident command-related decisions in experimental conditions that differed according to the amount of information that was available within the interface, the level of control that they could exert over the presentation of information, and whether they had received decision training. The results revealed that despite receiving training, participants improved in decision accuracy only when they were provided with an interface that restricted information access to the most critical cues. It was concluded that an interface that restricts information access to only the most critical cues in the scenario can facilitate improvements in decision performance. Decision support system interfaces that encourage the processing of the most critical cues have the potential to improve the accuracy and timeliness of decisions made by inexperienced personnel.

Anticipated Job Benefits, Career Aspiration, and Generalized Self-efficacy as Predictors for Migration Decision-Making

PubMed Central

Hoppe, Annekatrin; Fujishiro, Kaori

2015-01-01

This study aims to identify person-level factors, rather than economic situations, that influence migration decision-making and actual migration. Building on the theory of planned behavior, this study investigated potential migrants’ expectations and attitudes toward migration and career (i.e., anticipated job benefits of migration, career aspiration) as well as beliefs (i.e., generalized self-efficacy) as predictors of migration decision-making conceptualized in three phases: the pre-decisional, pre-actional, and actional phases. This was examined with cross-sectional pre-migration questionnaire data from 1163 potential migrants from Spain to Germany. We also examined whether the migration decision-making phases predicted actual migration with a subsample (n=249) which provided follow-up data within twelve months. For the cross-sectional sample, multinomial logistic regressions revealed that anticipated job benefits and career aspiration are predictive for all migration phases. Self-efficacy predicts the preactional (e.g., gathering information) and actional phases (e.g., making practical arrangements). Finally, for those with low self-efficacy, anticipated job benefits play a stronger role for taking action. For the longitudinal subsample, a logistic regression revealed that being in the preactional and actional phases at baseline is predictive of actual migration within twelve months. This study expands previous research on migration intentions and behaviors by focusing on expectations, values, and beliefs as person-level predictors for migration decision-making. With a longitudinal sample, it shows that international migration is a process that involves multiple phases. PMID:26379343

Do Proxies for the Neurotransmitter Cortisol Predict Adaptation to Life with Chronic Pain?

NASA Astrophysics Data System (ADS)

Deamond, Wade

Among the numerous difficulties encountered by chronic pain patients, impulsive and dysfunctional decision-making complicate their already difficult life situations yet remains relatively understudied. This study examined a recently published neurobiological decision making model that identifies eight specific neurotransmitters and hormones (Dopamine, Testosterone, Endogenous Opioids Glutamate, Serotonin, Norepinephrine, Cortisol, and GABA) linked to unsound decision making related to cognitive, motivational and emotional dysregulation (Nussbaum et al., 2011) (see Appendix 2). The Perceived Stress Scale (PSS), a proxy for the cortisol element in the pharmacological decision making model was analyzed for the neurotransmitter's relationship to functionality and quality of life in a group of 37 chronic pain patients. Participants were comprised of males and females ranging from 23 to 52 years of age and were classified with respect to levels of adjustment to living with chronic pain based on the Quality of Life Scale (QLS), the Dartmouth WONCA COOP Charts and the Global Assessment of Functioning (GAF). The Iowa Gambling Task (IGT) and Frontal System Behavioral Scale (FSBS) measured decision making related to immediate gratification and daily living respectively. Results suggest that emotional dysregulation, as measured by the PSS is a significant predictor for adaptation to life with chronic pain and the PSS is superior to predicting adaptation to life with chronic pain than reported levels of pain as measured by the McGill Pain Questionnaire.

Misfortune may be a blessing in disguise: Fairness perception and emotion modulate decision making.

PubMed

Liu, Hong-Hsiang; Hwang, Yin-Dir; Hsieh, Ming H; Hsu, Yung-Fong; Lai, Wen-Sung

2017-08-01

Fairness perception and equality during social interactions frequently elicit affective arousal and affect decision making. By integrating the dictator game and a probabilistic gambling task, this study aimed to investigate the effects of a negative experience induced by perceived unfairness on decision making using behavioral, model fitting, and electrophysiological approaches. Participants were randomly assigned to the neutral, harsh, or kind groups, which consisted of various asset allocation scenarios to induce different levels of perceived unfairness. The monetary gain was subsequently considered the initial asset in a negatively rewarded, probabilistic gambling task in which the participants were instructed to maintain as much asset as possible. Our behavioral results indicated that the participants in the harsh group exhibited increased levels of negative emotions but retained greater total game scores than the participants in the other two groups. Parameter estimation of a reinforcement learning model using a Bayesian approach indicated that these participants were more loss aversive and consistent in decision making. Data from simultaneous ERP recordings further demonstrated that these participants exhibited larger feedback-related negativity to unexpected outcomes in the gambling task, which suggests enhanced reward sensitivity and signaling of reward prediction error. Collectively, our study suggests that a negative experience may be an advantage in the modulation of reward-based decision making. © 2017 Society for Psychophysiological Research.

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

PubMed Central

2012-01-01

Background Fair processes in decision making need the involvement of stakeholders who can discuss issues and reach an agreement based on reasons that are justifiable and appropriate in meeting people’s needs. In Tanzania, the policy of decentralization and the health sector reform place an emphasis on community participation in making decisions in health care. However, aspects that can influence an individual’s opportunity to be listened to and to contribute to discussion have been researched to a very limited extent in low-income settings. The objective of this study was to explore challenges to fair decision-making processes in health care services with a special focus on the potential influence of gender, wealth, ethnicity and education. We draw on the principle of fairness as outlined in the deliberative democratic theory. Methods The study was carried out in the Mbarali District of Tanzania. A qualitative study design was used. In-depth interviews and focus group discussion were conducted among members of the district health team, local government officials, health care providers and community members. Informal discussion on the topics was also of substantial value. Results The study findings indicate a substantial influence of gender, wealth, ethnicity and education on health care decision-making processes. Men, wealthy individuals, members of strong ethnic groups and highly educated individuals had greater influence. Opinions varied among the study informants as to whether such differences should be considered fair. The differences in levels of influence emerged most clearly at the community level, and were largely perceived as legitimate. Conclusions Existing challenges related to individuals’ influence of decision making processes in health care need to be addressed if greater participation is desired. There is a need for increased advocacy and a strengthening of responsive practices with an emphasis on the right of all individuals to participate in decision-making processes. This simultaneously implies an emphasis on assuring the distribution of information, training and education so that individuals can participate fully in informed decision making. PMID:22676204

What Explains the Gender Gap in Financial Literacy? The Role of Household Decision Making.

PubMed

Fonseca, Raquel; Mullen, Kathleen J; Zamarro, Gema; Zissimopoulos, Julie

2012-01-01

Using newly collected data from the RAND American Life Panel, we examine potential explanations for the gender gap in financial literacy, including the role of marriage and who within a couple makes the financial decisions. Blinder-Oaxaca decomposition reveals the majority of the gender gap in financial literacy is not explained by differences in the characteristics of men and women-but rather differences in coefficients, or how literacy is produced. We find that financial decision making of couples is not centralized in one spouse although it is sensitive to the relative education level of spouses.

Competency in health care management: a training model in epidemiologic methods for assessing and improving the quality of clinical practice through evidence-based decision making.

PubMed

Hudak, R P; Jacoby, I; Meyer, G S; Potter, A L; Hooper, T I; Krakauer, H

1997-01-01

This article describes a training model that focuses on health care management by applying epidemiologic methods to assess and improve the quality of clinical practice. The model's uniqueness is its focus on integrating clinical evidence-based decision making with fundamental principles of resource management to achieve attainable, cost-effective, high-quality health outcomes. The target students are current and prospective clinical and administrative executives who must optimize decision making at the clinical and managerial levels of health care organizations.

What Explains the Gender Gap in Financial Literacy? The Role of Household Decision Making

PubMed Central

FONSECA, RAQUEL; MULLEN, KATHLEEN J.; ZAMARRO, GEMA; ZISSIMOPOULOS, JULIE

2012-01-01

Using newly collected data from the RAND American Life Panel, we examine potential explanations for the gender gap in financial literacy, including the role of marriage and who within a couple makes the financial decisions. Blinder–Oaxaca decomposition reveals the majority of the gender gap in financial literacy is not explained by differences in the characteristics of men and women—but rather differences in coefficients, or how literacy is produced. We find that financial decision making of couples is not centralized in one spouse although it is sensitive to the relative education level of spouses. PMID:23049140

Technological disasters, crisis management and leadership stress.

PubMed

Weisaeth, Lars; Knudsen, Øistein; Tønnessen, Arnfinn

2002-07-01

This paper discusses how psychological stress disturbs decision making during technological crisis and disaster, and how to prevent this from happening. This is exemplified by scientific studies of a Norwegian large scale accident involving hazardous material, and of handling the far-off effects of the nuclear disaster at Chernobyl. The former constitutes an operative level of crisis management, whereas the latter involves crisis management at the strategic and political level. We conclude that stress had a negative effect on decision making in both cases.

Site Management. An Analysis of the Concepts and Fundamental Operational Components Associated with the Delegation of Decision-Making Authority and Control of Resources to the School-Site Level in the California Public School System.

ERIC Educational Resources Information Center

Decker, Erwin A.; And Others

The pros and cons of decentralization of decision-making authority to the school-site level as a public school management technique are intended to serve as an informational summary for the members of the California State Board of Education, and as a resource for school district governing boards and district administrators to use to determine the…

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.

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

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

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

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

Serum BDNF levels in patients with gambling disorder are associated with the severity of gambling disorder and Iowa Gambling Task indices

PubMed Central

Choi, Sam-Wook; Shin, Young-Chul; Mok, Jung Yeon; Kim, Dai-Jin; Choi, Jung-Seok; Suk-Hyun Hwang, Samuel

2016-01-01

Background and aims Gambling disorder (GD) shares many similarities with substance use disorders (SUDs) in clinical, neurobiological, and neurocognitive features, including decision-making. We evaluated the relationships among, GD, decision-making, and brain-derived neurotrophic factor (BDNF), as measured by serum BDNF levels. Methods Twenty-one male patients with GD and 21 healthy sex- and age-matched control subjects were evaluated for associations between serum BDNF levels and the Problem Gambling Severity Index (PGSI), as well as between serum BDNF levels and Iowa Gambling Task (IGT) indices. Results The mean serum BDNF levels were significantly increased in patients with GD compared to healthy controls. A significant correlation between serum BDNF levels and PGSI scores was found when controlling for age, depression, and duration of GD. A significant negative correlation was obtained between serum BDNF levels and IGT improvement scores. Discussion These findings support the hypothesis that serum BDNF levels constitute a dual biomarker for the neuroendocrine changes and the severity of GD in patients. Serum BDNF level may serve as an indicator of poor decision-making performance and learning processes in GD and help to identify the common physiological underpinnings between GD and SUDs. PMID:28092195

The effect of methylphenidate on decision making in patients with borderline personality disorder and attention-deficit/hyperactivity disorder.

PubMed

Gvirts, Hila Z; Lewis, Yael D; Dvora, Shira; Feffer, Kfir; Nitzan, Uriel; Carmel, Ziv; Levkovitz, Yechiel; Maoz, Hagai

2018-07-01

Impaired decision making in patients with borderline personality disorder (BPD) has been reported in several studies. Although methylphenidate (MPH) is known to ameliorate impaired decision making in patients with attention-deficit/hyperactivity disorder (ADHD), it has not yet been examined in patients with BPD. We therefore assessed the efficacy of a single dose of MPH on cognitive functions and decision making in patients with BPD. Twenty-two patients diagnosed with BPD participated in the study. The study was a randomized, double-blind placebo-controlled, random block order cross-over trial. Patients participated in two sessions and performed the Test of Variables of Attention, a digit-span test, and the computerized Iowa Gambling Task, after they had been administered either the MPH or a placebo. ADHD symptoms were assessed using the Adult ADHD Self-Report Scale-18. Lower scores on the inattention symptoms scale were associated with a greater improvement in decision making following the administration of MPH when compared with improvements in patients with higher ADHD scores [F(1,17)=5.63, P=0.030]. We conclude that MPH may improve decision making in patients with BPD, although this effect is mediated by the level of ADHD symptoms. Further studies are needed to assess whether a prolonged beneficial effect of MPH on decision making in patients with BPD might also be present in 'real life'.

Translational Cognition for Decision Support in Critical Care Environments: A Review

PubMed Central

Patel, Vimla L.; Zhang, Jiajie; Yoskowitz, Nicole A.; Green, Robert; Sayan, Osman R.

2008-01-01

The dynamic and distributed work environment in critical care requires a high level of collaboration among clinical team members and a sophisticated task coordination system to deliver safe, timely and effective care. A complex cognitive system underlies the decision-making process in such cooperative workplaces. This methodological review paper addresses the issues of translating cognitive research to clinical practice with a specific focus on decision-making in critical care, and the role of information and communication technology to aid in such decisions. Examples are drawn from studies of critical care in our own research laboratories. Critical care, in this paper, includes both intensive (inpatient) and emergency (outpatient) care. We define translational cognition as the research on basic and applied cognitive issues that contribute to our understanding of how information is stored, retrieved and used for problem-solving and decision-making. The methods and findings are discussed in the context of constraints on decision-making in real world complex environments and implications for supporting the design and evaluation of decision support tools for critical care health providers. PMID:18343731

Age Differences in the Effects of Conscious and Unconscious Thought in Decision Making

PubMed Central

Queen, Tara L.; Hess, Thomas M.

2010-01-01

The roles of unconscious and conscious thought in decision making were investigated to examine both (a) boundary conditions associated with the efficacy of each type of thought and (b) age differences in intuitive versus deliberative thought. Participants were presented with two decision tasks, one requiring active deliberation and the other intuitive processing. Younger and older adults then engaged in conscious or unconscious thought processing before making a decision. A manipulation check revealed that younger adults were more accurate in their representations of the decision material than older adults, which accounted for much of the age-related variation in performance when the full sample was considered. When only considering accurate participants, decision making was best when there was congruence between the nature of the information and the thought condition. Thus, unconscious thought was more appropriate when the decision relied on intuitive rather than deliberative processing, whereas the converse was true with conscious thought. Although older adults displayed somewhat less efficient deliberative processing, their ability to process information at the intuitive level was relatively preserved. Additionally, both young and older adults displayed choice-supportive memory. PMID:20545411

Translational cognition for decision support in critical care environments: a review.

PubMed

Patel, Vimla L; Zhang, Jiajie; Yoskowitz, Nicole A; Green, Robert; Sayan, Osman R

2008-06-01

The dynamic and distributed work environment in critical care requires a high level of collaboration among clinical team members and a sophisticated task coordination system to deliver safe, timely and effective care. A complex cognitive system underlies the decision-making process in such cooperative workplaces. This methodological review paper addresses the issues of translating cognitive research to clinical practice with a specific focus on decision-making in critical care, and the role of information and communication technology to aid in such decisions. Examples are drawn from studies of critical care in our own research laboratories. Critical care, in this paper, includes both intensive (inpatient) and emergency (outpatient) care. We define translational cognition as the research on basic and applied cognitive issues that contribute to our understanding of how information is stored, retrieved and used for problem-solving and decision-making. The methods and findings are discussed in the context of constraints on decision-making in real-world complex environments and implications for supporting the design and evaluation of decision support tools for critical care health providers.

Changes of mind in an attractor network of decision-making.

PubMed

Albantakis, Larissa; Deco, Gustavo

2011-06-01

Attractor networks successfully account for psychophysical and neurophysiological data in various decision-making tasks. Especially their ability to model persistent activity, a property of many neurons involved in decision-making, distinguishes them from other approaches. Stable decision attractors are, however, counterintuitive to changes of mind. Here we demonstrate that a biophysically-realistic attractor network with spiking neurons, in its itinerant transients towards the choice attractors, can replicate changes of mind observed recently during a two-alternative random-dot motion (RDM) task. Based on the assumption that the brain continues to evaluate available evidence after the initiation of a decision, the network predicts neural activity during changes of mind and accurately simulates reaction times, performance and percentage of changes dependent on difficulty. Moreover, the model suggests a low decision threshold and high incoming activity that drives the brain region involved in the decision-making process into a dynamical regime close to a bifurcation, which up to now lacked evidence for physiological relevance. Thereby, we further affirmed the general conformance of attractor networks with higher level neural processes and offer experimental predictions to distinguish nonlinear attractor from linear diffusion models.

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.

How to Choose? Using the Delphi Method to Develop Consensus Triggers and Indicators for Disaster Response.

PubMed

Lis, Rebecca; Sakata, Vicki; Lien, Onora

2017-08-01

To identify key decisions along the continuum of care (conventional, contingency, and crisis) and the critical triggers and data elements used to inform those decisions concerning public health and health care response during an emergency. A classic Delphi method, a consensus-building survey technique, was used with clinicians around Washington State to identify regional triggers and indicators. Additionally, using a modified Delphi method, we combined a workshop and single-round survey with panelists from public health (state and local) and health care coalitions to identify consensus state-level triggers and indicators. In the clinical survey, 122 of 223 proposed triggers or indicators (43.7%) reached consensus and were deemed important in regional decision-making during a disaster. In the state-level survey, 110 of 140 proposed triggers or indicators (78.6%) reached consensus and were deemed important in state-level decision-making during a disaster. The identification of consensus triggers and indicators for health care emergency response is crucial in supporting a comprehensive health care situational awareness process. This can inform the creation of standardized questions to ask health care, public health, and other partners to support decision-making during a response. (Disaster Med Public Health Preparedness. 2017;11:467-472).

The provision of information and informed decision-making on prenatal screening for Down syndrome: a questionnaire- and register-based survey in a non-selected population.

PubMed

Schoonen, Marleen; Wildschut, Hajo; Essink-Bot, Marie-Louise; Peters, Ingrid; Steegers, Eric; de Koning, Harry

2012-06-01

Evaluating the information provision procedure about prenatal screening for Down syndrome, using informed decision-making as a quality-indicator. Questionnaire- and register-based surveys. Midwives associated with 59 midwifery practices completed process data for 6435 pregnancies. Pregnant women (n=510) completed questionnaires on informed decision-making. Midwives offered information to 98.5% of women; 62.6% of them wished to receive information, of these, 81.9% actually received information. Decision-relevant knowledge was adequate in 89.0% of responding women. Knowledge about Down syndrome was less adequate than knowledge about the screening program. Participants in the screening program had higher knowledge scores on Down syndrome and on the screening program than non-participants. Of the women who intended to participate (35.8%), 3.1% had inadequate knowledge. A total of 75.5% of women made an informed decision; 94.3% of women participating in the screening program, and 64.9% of women not participating. This quality assurance study showed high levels of informed decision-making and a relatively low participation rate in the national screening program for Down syndrome in the Netherlands. Knowledge of the Down syndrome condition needs to be improved. This evaluation may serve as a pilot study for quality monitoring studies at a national level. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Ethnic differences in informed decision-making about prenatal screening for Down's syndrome.

PubMed

Fransen, Mirjam P; Essink-Bot, Marie-Louise; Vogel, Ineke; Mackenbach, Johan P; Steegers, Eric A P; Wildschut, Hajo I J

2010-03-01

The aim of this study was to assess ethnic variations in informed decision-making about prenatal screening for Down's syndrome and to examine the contribution of background and decision-making variables. Pregnant women of Dutch, Turkish and Surinamese origin were recruited between 2006 and 2008 from community midwifery or obstetrical practices in The Netherlands. Each woman was personally interviewed 3 weeks (mean) after booking for prenatal care. Knowledge, attitude and participation in prenatal screening were assessed following the 'Multidimensional Measure of Informed Choice' that has been developed and applied in the UK. In total, 71% of the Dutch women were classified as informed decision-makers, compared with 5% of the Turkish and 26% of the Surinamese women. Differences between Surinamese and Dutch women could largely be attributed to differences in educational level and age. Differences between Dutch and Turkish women could mainly be attributed to differences in language skills and gender emancipation. Women from ethnic minority groups less often made an informed decision whether or not to participate in prenatal screening. Interventions to decrease these ethnic differences should first of all be aimed at overcoming language barriers and increasing comprehension among women with a low education level. To further develop diversity-sensitive strategies for counselling, it should be investigated how women from different ethnic backgrounds value informed decision-making in prenatal screening, what decision-relevant knowledge they need and what they take into account when considering participation in prenatal screening.

[Shared decision making in breast cancer. Womens' attitudes].

PubMed

Martín-Fernández, Roberto; Abt-Sacks, Analía; Perestelo-Perez, Lilisbeth; Serrano-Aguilar, Pedro

2013-01-01

The patient autonomy and the greater role for women with breast cancer in the decisions about their health are recent issues in healthcare. The objective of this work is to identify and characterize the elements that influence them in treatment decisions. A phenomenological type qualitative study. Theoretical Sampling included 70 women diagnosed with breast cancer. 45 semi structured interviews and 3 focus groups were performed between October 2009 and July 2010 in 15 regions of Spain. The analysis was based on the principles of grounded theory with the support of Atlas.ti v6.1. Patients are likely to take an active or passive role regarding decision-making depending on different variables such as their age, the information available, their self-assessment as capable agents to make decisions and the relative importance given to physical appearance. As the disease progresses, it can cause a change in women attitude, from an initially passive attitude to a more active role. The attitude of health professionals concerning shared decision-making and the information they offer determines patient participation while the family plays an essential role as a support or reinforcement of decisions made by patients. The patients' attitude regarding the decision-making of patients is very variable, becoming increasingly important the emotional status, the level of information available and the influence of the context.

Metabolic State Alters Economic Decision Making under Risk in Humans

PubMed Central

Drew, Megan E.; Batterham, Rachel L.; Dolan, Raymond J.

2010-01-01

Background Animals' attitudes to risk are profoundly influenced by metabolic state (hunger and baseline energy stores). Specifically, animals often express a preference for risky (more variable) food sources when below a metabolic reference point (hungry), and safe (less variable) food sources when sated. Circulating hormones report the status of energy reserves and acute nutrient intake to widespread targets in the central nervous system that regulate feeding behaviour, including brain regions strongly implicated in risk and reward based decision-making in humans. Despite this, physiological influences per se have not been considered previously to influence economic decisions in humans. We hypothesised that baseline metabolic reserves and alterations in metabolic state would systematically modulate decision-making and financial risk-taking in humans. Methodology/Principal Findings We used a controlled feeding manipulation and assayed decision-making preferences across different metabolic states following a meal. To elicit risk-preference, we presented a sequence of 200 paired lotteries, subjects' task being to select their preferred option from each pair. We also measured prandial suppression of circulating acyl-ghrelin (a centrally-acting orexigenic hormone signalling acute nutrient intake), and circulating leptin levels (providing an assay of energy reserves). We show both immediate and delayed effects on risky decision-making following a meal, and that these changes correlate with an individual's baseline leptin and changes in acyl-ghrelin levels respectively. Conclusions/Significance We show that human risk preferences are exquisitely sensitive to current metabolic state, in a direction consistent with ecological models of feeding behaviour but not predicted by normative economic theory. These substantive effects of state changes on economic decisions perhaps reflect shared evolutionarily conserved neurobiological mechanisms. We suggest that this sensitivity in human risk-preference to current metabolic state has significant implications for both real-world economic transactions and for aberrant decision-making in eating disorders and obesity. PMID:20585383

Decision-Making in Pediatric Transport Team Dispatch Using Script Concordance Testing.

PubMed

Rajapreyar, Prakadeshwari; Marcdante, Karen; Zhang, Liyun; Simpson, Pippa; Meyer, Michael T

2017-11-01

Our objective was to compare decision-making in dispatching pediatric transport teams by Medical Directors of pediatric transport teams (serving as experts) to that of Pediatric Intensivists and Critical Care fellows who often serve as Medical Control physicians. Understanding decision-making around team composition and dispatch could impact clinical management, cost effectiveness, and educational needs. Survey was developed using Script Concordance Testing guidelines. The survey contained 15 transport case vignettes covering 20 scenarios (45 questions). Eleven scenarios assessed impact of intrinsic patient factors (e.g., procedural needs), whereas nine assessed extrinsic factors (e.g., weather). Pediatric Critical Care programs accredited by the Accreditation Council for Graduate Medical Education (the United States). Pediatric Intensivists and senior Critical Care fellows at Pediatric Critical Care programs were the target population with Transport Medical Directors serving as the expert panel. None. Survey results were scored per Script Concordance Testing guidelines. Concordance within groups was assessed using simple percentage agreement. There was little concordance in decision-making by Transport Medical Directors (median Script Concordance Testing percentage score [interquartile range] of 33.9 [30.4-37.3]). In addition, there was no statistically significant difference between the median Script Concordance Testing scores among the senior fellows and Pediatric Intensivists (31.1 [29.6-33.2] vs 29.7 [28.3-32.3], respectively; p = 0.12). Transport Medical Directors were more concordant on reasoning involving intrinsic patient factors rather than extrinsic factors (10/21 vs 4/24). Our study demonstrates pediatric transport team dispatch decision-making discordance by pediatric critical care physicians of varying levels of expertise and experience. Script Concordance Testing at a local level may better elucidate standards in medical decision-making within pediatric critical care physicians. The development of a curriculum, which provides education and trains our workforce on the logistics of pediatric transport team dispatch, would help standardize practice and evaluate outcomes based on decision-making.

Towards decision support for waiting lists: an operations management view.

PubMed

Vissers, J M; Van Der Bij, J D; Kusters, R J

2001-06-01

This paper considers the phenomenon of waiting lists in a healthcare setting, which is characterised by limitations on the national expenditure, to explore the potentials of an operations management perspective. A reference framework for waiting list management is described, distinguishing different levels of planning in healthcare--national, regional, hospital and process--that each contributes to the existence of waiting lists through managerial decision making. In addition, different underlying mechanisms in demand and supply are distinguished, which together explain the development of waiting lists. It is our contention that within this framework a series of situation specific models should be designed to support communication and decision making. This is illustrated by the modelling of the demand for cataract treatment in a regional setting in the south-eastern part of the Netherlands. An input-output model was developed to support decisions regarding waiting lists. The model projects the demand for treatment at a regional level and makes it possible to evaluate waiting list impacts for different scenarios to meet this demand.

Women's career choices in chemistry: Motivations, perceptions, and a conceptual model

NASA Astrophysics Data System (ADS)

Grunert, Megan L.

Statistics showing the under-representation of women at all levels within the physical sciences abound, particularly at the graduate and faculty levels. Women chemists choosing an academic career tend to select teaching institutions over research institutions. This study examined women at the graduate and faculty levels through interviews and the construction of participant narratives to better understand why many women opt out of a career in academic research. Specific attention was paid to women's decision-making processes and what motivates women to choose careers, the rewards and challenges associated with different careers, and the perception of different careers contribute to their decisions. The participant narratives were analyzed on a cross-case basis and constructivist grounded theory was used to develop a model about women's decision-making regarding their careers. Additionally, preliminary work has suggested that graduate students have inaccurate perceptions of careers in academia. Interviews with faculty at teaching and research institutions provided a clearer picture of what each type of career entails. Career-choice motivators, rewards, and challenges were identified for each of the faculty groups. It was found that graduate student women have inaccurate perceptions of academic research careers, which affects how they make career decisions. A model of career choice shows interactions between motivation and perception that guide the career decision-making process. By better understanding these women and their motivations, changes can be made to foster inclusion and accommodation for women and other underrepresented groups in academic chemistry.

Different effects of dopaminergic medication on perceptual decision-making in Parkinson's disease as a function of task difficulty and speed-accuracy instructions.

PubMed

Huang, Yu-Ting; Georgiev, Dejan; Foltynie, Tom; Limousin, Patricia; Speekenbrink, Maarten; Jahanshahi, Marjan

2015-08-01

When choosing between two options, sufficient accumulation of information is required to favor one of the options over the other, before a decision is finally reached. To establish the effect of dopaminergic medication on the rate of accumulation of information, decision thresholds and speed-accuracy trade-offs, we tested 14 patients with Parkinson's disease (PD) on and off dopaminergic medication and 14 age-matched healthy controls on two versions of the moving-dots task. One version manipulated the level of task difficulty and hence effort required for decision-making and the other the urgency, requiring decision-making under speed vs. accuracy instructions. The drift diffusion model was fitted to the behavioral data. As expected, the reaction time data revealed an effect of task difficulty, such that the easier the perceptual decision-making task was, the faster the participants responded. PD patients not only made significantly more errors compared to healthy controls, but interestingly they also made significantly more errors ON than OFF medication. The drift diffusion model indicated that PD patients had lower drift rates when tested ON compared to OFF medication, indicating that dopamine levels influenced the quality of information derived from sensory information. On the speed-accuracy task, dopaminergic medication did not directly influence reaction times or error rates. PD patients OFF medication had slower RTs and made more errors with speed than accuracy instructions compared to the controls, whereas such differences were not observed ON medication. PD patients had lower drift rates and higher response thresholds than the healthy controls both with speed and accuracy instructions and ON and OFF medication. For the patients, only non-decision time was higher OFF than ON medication and higher with accuracy than speed instructions. The present results demonstrate that when task difficulty is manipulated, dopaminergic medication impairs perceptual decision-making and renders it more errorful in PD relative to when patients are tested OFF medication. In contrast, for the speed/accuracy task, being ON medication improved performance by eliminating the significantly higher errors and slower RTs observed for patients OFF medication compared to the HC group. There was no evidence of dopaminergic medication inducing impulsive decisions when patients were acting under speed pressure. For the speed-accuracy instructions, the sole effect of dopaminergic medication was on non-decision time, which suggests that medication primarily affected processes tightly coupled with the motor symptoms of PD. Interestingly, the current results suggest opposite effects of dopaminergic medication on the levels of difficulty and speed-accuracy versions of the moving dots task, possibly reflecting the differential effect of dopamine on modulating drift rate (levels of difficulty task) and non-decision time (speed-accuracy task) in the process of perceptual decision making. Copyright © 2015 Elsevier Ltd. All rights reserved.