Evidence-based decision making in health care settings: from theory to practice.

PubMed

Kohn, Melanie Kazman; Berta, Whitney; Langley, Ann; Davis, David

2011-01-01

The relatively recent attention that evidence-based decision making has received in health care management has been at least in part due to the profound influence of evidence-based medicine. The result has been several comparisons in the literature between the use of evidence in health care management decisions and the use of evidence in medical decision making. Direct comparison, however, may be problematic, given the differences between medicine and management as they relate to (1) the nature of evidence that is brought to bear on decision making; (2) the maturity of empirical research in each field (in particular, studies that have substantiated whether or not and how evidence-based decision making is enacted); and (3) the context within which evidence-based decisions are made. By simultaneously reviewing evidence-based medicine and management, this chapter aims to inform future theorizing and empirical research on evidence-based decision making in health care settings.

Goal Setting and Decision Making by At-Risk Youth

ERIC Educational Resources Information Center

Galotti, Kathleen M.; Kozberg, Steven F.; Gustafon, Mary

2009-01-01

Typically, adolescence is a time when individuals begin to make consequential, life-framing decisions. However, much of the decision-making literature focuses on high-risk decisions, such as the use of drugs and alcohol, while much less is known about how adolescents make positive decisions, for example, regarding their educational or career…

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.

Shared Decision-Making for Nursing Practice: An Integrative Review.

PubMed

Truglio-Londrigan, Marie; Slyer, Jason T

2018-01-01

Shared decision-making has received national and international interest by providers, educators, researchers, and policy makers. The literature on shared decision-making is extensive, dealing with the individual components of shared decision-making rather than a comprehensive process. This view of shared decision-making leaves healthcare providers to wonder how to integrate shared decision-making into practice. To understand shared decision-making as a comprehensive process from the perspective of the patient and provider in all healthcare settings. An integrative review was conducted applying a systematic approach involving a literature search, data evaluation, and data analysis. The search included articles from PubMed, CINAHL, the Cochrane Central Register of Controlled Trials, and PsycINFO from 1970 through 2016. Articles included quantitative experimental and non-experimental designs, qualitative, and theoretical articles about shared decision-making between all healthcare providers and patients in all healthcare settings. Fifty-two papers were included in this integrative review. Three categories emerged from the synthesis: (a) communication/ relationship building; (b) working towards a shared decision; and (c) action for shared decision-making. Each major theme contained sub-themes represented in the proposed visual representation for shared decision-making. A comprehensive understanding of shared decision-making between the nurse and the patient was identified. A visual representation offers a guide that depicts shared decision-making as a process taking place during a healthcare encounter with implications for the continuation of shared decisions over time offering patients an opportunity to return to the nurse for reconsiderations of past shared decisions.

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/

Decision-Making Phenomena Described by Expert Nurses Working in Urban Community Health Settings.

ERIC Educational Resources Information Center

Watkins, Mary P.

1998-01-01

Expert community health nurses (n=28) described crucial clinical situations. Content analysis revealed that decision making was both rational and intuitive. Eight themes were identified: decision-making focus, type, purpose, decision-maker characteristics, sequencing of events, data collection methods, facilitators/barriers, and decision-making…

How organizational context affects bioethical decision-making: pharmacists' management of gatekeeping processes in retail and hospital settings.

PubMed

Chiarello, Elizabeth

2013-12-01

Social science studies of bioethics demonstrate that ethics are highly contextual, functioning differently across local settings as actors make daily decisions "on the ground." Sociological studies that demonstrate the key role organizations play in shaping ethical decision-making have disproportionately focused on physicians and nurses working in hospital settings where they contend with life and death issues. This study broadens our understanding of the contexts of ethical decision-making by empirically examining understudied healthcare professionals - pharmacists - working in two organizational settings, retail and hospital, where they act as gatekeepers to regulated goods and services as they contend with ethical issues ranging from the serious to the mundane. This study asks: How do organizations shape pharmacists' identification, negotiation, and resolution of ethical challenges; in other words, how do organizations shape pharmacists' gatekeeping processes? Based on 95 semi-structured interviews with U.S. pharmacists practicing in retail and hospital pharmacies conducted between September 2009 and May 2011, this research finds that organizations influence ethical decision-making by shaping how pharmacists construct four gatekeeping processes: medical, legal, fiscal, and moral. Each gatekeeping process manifests differently across organizations due to how these settings structure inter-professional power dynamics, proximity to patients, and means of accessing information. Findings suggest new directions for theorizing about ethical decision-making in medical contexts by drawing attention to new ethical actors, new organizational settings, an expanded definition of ethical challenges, and a broader conceptualization of gatekeeping. Copyright © 2012 Elsevier Ltd. All rights reserved.

Intersubjective decision-making for computer-aided forging technology design

NASA Astrophysics Data System (ADS)

Kanyukov, S. I.; Konovalov, A. V.; Muizemnek, O. Yu.

2017-12-01

We propose a concept of intersubjective decision-making for problems of open-die forging technology design. The intersubjective decisions are chosen from a set of feasible decisions using the fundamentals of the decision-making theory in fuzzy environment according to the Bellman-Zadeh scheme. We consider the formalization of subjective goals and the choice of membership functions for the decisions depending on subjective goals. We study the arrangement of these functions into an intersubjective membership function. The function is constructed for a resulting decision, which is chosen from a set of feasible decisions. The choice of the final intersubjective decision is discussed. All the issues are exemplified by a specific technological problem. The considered concept of solving technological problems under conditions of fuzzy goals allows one to choose the most efficient decisions from a set of feasible ones. These decisions correspond to the stated goals. The concept allows one to reduce human participation in automated design. This concept can be used to develop algorithms and design programs for forging numerous types of forged parts.

Substitute decision-making for adults with intellectual disabilities living in residential care: learning through experience.

PubMed

Dunn, Michael C; Clare, Isabel C H; Holland, Anthony J

2008-03-01

In the UK, current policies and services for people with mental disorders, including those with intellectual disabilities (ID), presume that these men and women can, do, and should, make decisions for themselves. The new Mental Capacity Act (England and Wales) 2005 (MCA) sets this presumption into statute, and codifies how decisions relating to health and welfare should be made for those adults judged unable to make one or more such decisions autonomously. The MCA uses a procedural checklist to guide this process of substitute decision-making. The personal experiences of providing direct support to seven men and women with ID living in residential care, however, showed that substitute decision-making took two forms, depending on the type of decision to be made. The first process, 'strategic substitute decision-making', paralleled the MCA's legal and ethical framework, whilst the second process, 'relational substitute decision-making', was markedly different from these statutory procedures. In this setting, 'relational substitute decision-making' underpinned everyday personal and social interventions connected with residents' daily living, and was situated within a framework of interpersonal and interdependent care relationships. The implications of these findings for residential services and the implementation of the MCA are discussed.

Path Analysis on Educational Fiscal Decision-Making Mechanism in China

ERIC Educational Resources Information Center

Zhao, Hongbin; Sun, Baicai

2007-01-01

In China's current educational fiscal decision making, problems are as follows: no law to trust or not abiding by available laws, absence of equity and efficiency, as well as the standardization of decision-making procedures. It is necessary to set up effective fiscal decision-making mechanism in education and rationally devise reliable paths.

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.

The Decision-Making Structure and the Dean.

ERIC Educational Resources Information Center

Johnson, Betty M.; George, Shirley A.

1987-01-01

Characteristics in the college academic setting and the external environment that affect the decision-making structure and that the dean should consider before reorganization are examined. Concepts and theories about governance, decision-making, organizational structure, and characteristics of effective decision makers are also briefly reviewed. A…

Shared Decision-Making for Nursing Practice: An Integrative Review

PubMed Central

Truglio-Londrigan, Marie; Slyer, Jason T.

2018-01-01

Background: Shared decision-making has received national and international interest by providers, educators, researchers, and policy makers. The literature on shared decision-making is extensive, dealing with the individual components of shared decision-making rather than a comprehensive process. This view of shared decision-making leaves healthcare providers to wonder how to integrate shared decision-making into practice. Objective: To understand shared decision-making as a comprehensive process from the perspective of the patient and provider in all healthcare settings. Methods: An integrative review was conducted applying a systematic approach involving a literature search, data evaluation, and data analysis. The search included articles from PubMed, CINAHL, the Cochrane Central Register of Controlled Trials, and PsycINFO from 1970 through 2016. Articles included quantitative experimental and non-experimental designs, qualitative, and theoretical articles about shared decision-making between all healthcare providers and patients in all healthcare settings. Results: Fifty-two papers were included in this integrative review. Three categories emerged from the synthesis: (a) communication/ relationship building; (b) working towards a shared decision; and (c) action for shared decision-making. Each major theme contained sub-themes represented in the proposed visual representation for shared decision-making. Conclusion: A comprehensive understanding of shared decision-making between the nurse and the patient was identified. A visual representation offers a guide that depicts shared decision-making as a process taking place during a healthcare encounter with implications for the continuation of shared decisions over time offering patients an opportunity to return to the nurse for reconsiderations of past shared decisions. PMID:29456779

The Use of Research Evidence in Public Health Decision Making Processes: Systematic Review

PubMed Central

Orton, Lois; Lloyd-Williams, Ffion; Taylor-Robinson, David; O'Flaherty, Martin; Capewell, Simon

2011-01-01

Background The use of research evidence to underpin public health policy is strongly promoted. However, its implementation has not been straightforward. The objectives of this systematic review were to synthesise empirical evidence on the use of research evidence by public health decision makers in settings with universal health care systems. Methods To locate eligible studies, 13 bibliographic databases were screened, organisational websites were scanned, key informants were contacted and bibliographies of included studies were scrutinised. Two reviewers independently assessed studies for inclusion, extracted data and assessed methodological quality. Data were synthesised as a narrative review. Findings 18 studies were included: 15 qualitative studies, and three surveys. Their methodological quality was mixed. They were set in a range of country and decision making settings. Study participants included 1063 public health decision makers, 72 researchers, and 174 with overlapping roles. Decision making processes varied widely between settings, and were viewed differently by key players. A range of research evidence was accessed. However, there was no reliable evidence on the extent of its use. Its impact was often indirect, competing with other influences. Barriers to the use of research evidence included: decision makers' perceptions of research evidence; the gulf between researchers and decision makers; the culture of decision making; competing influences on decision making; and practical constraints. Suggested (but largely untested) ways of overcoming these barriers included: research targeted at the needs of decision makers; research clearly highlighting key messages; and capacity building. There was little evidence on the role of research evidence in decision making to reduce inequalities. Conclusions To more effectively implement research informed public health policy, action is required by decision makers and researchers to address the barriers identified in this systematic review. There is an urgent need for evidence to support the use of research evidence to inform public health decision making to reduce inequalities. PMID:21818262

Why we should talk about option generation in decision-making research

PubMed Central

Kalis, Annemarie; Kaiser, Stefan; Mojzisch, Andreas

2013-01-01

Most empirical studies on decision-making start from a set of given options for action. However, in everyday life there is usually no one asking you to choose between A, B, and C. Recently, the question how people come up with options has been receiving growing attention. However, so far there has been neither a systematic attempt to define the construct of “option” nor an attempt to show why decision-making research really needs this construct. This paper aims to fill that void by developing definitions of “option” and “option generation” that can be used as a basis for decision-making research in a wide variety of decision-making settings, while clarifying how these notions relate to familiar psychological constructs. We conclude our analysis by arguing that there are indeed reasons to believe that option generation is an important and distinct aspect of human decision-making. PMID:23986737

Why we should talk about option generation in decision-making research.

PubMed

Kalis, Annemarie; Kaiser, Stefan; Mojzisch, Andreas

2013-01-01

Most empirical studies on decision-making start from a set of given options for action. However, in everyday life there is usually no one asking you to choose between A, B, and C. Recently, the question how people come up with options has been receiving growing attention. However, so far there has been neither a systematic attempt to define the construct of "option" nor an attempt to show why decision-making research really needs this construct. This paper aims to fill that void by developing definitions of "option" and "option generation" that can be used as a basis for decision-making research in a wide variety of decision-making settings, while clarifying how these notions relate to familiar psychological constructs. We conclude our analysis by arguing that there are indeed reasons to believe that option generation is an important and distinct aspect of human decision-making.

Use of cost-effectiveness data in priority setting decisions: experiences from the national guidelines for heart diseases in Sweden

PubMed Central

Eckard, Nathalie; Janzon, Magnus; Levin, Lars-Åke

2014-01-01

Background: The inclusion of cost-effectiveness data, as a basis for priority setting rankings, is a distinguishing feature in the formulation of the Swedish national guidelines. Guidelines are generated with the direct intent to influence health policy and support decisions about the efficient allocation of scarce healthcare resources. Certain medical conditions may be given higher priority rankings i.e. given more resources than others, depending on how serious the medical condition is. This study investigated how a decision-making group, the Priority Setting Group (PSG), used cost-effectiveness data in ranking priority setting decisions in the national guidelines for heart diseases. Methods: A qualitative case study methodology was used to explore the use of such data in ranking priority setting healthcare decisions. The study addressed availability of cost-effectiveness data, evidence understanding, interpretation difficulties, and the reliance on evidence. We were also interested in the explicit use of data in ranking decisions, especially in situations where economic arguments impacted the reasoning behind the decisions. Results: This study showed that cost-effectiveness data was an important and integrated part of the decision-making process. Involvement of a health economist and reliance on the data facilitated the use of cost-effectiveness data. Economic arguments were used both as a fine-tuning instrument and a counterweight for dichotomization. Cost-effectiveness data were used when the overall evidence base was weak and the decision-makers had trouble making decisions due to lack of clinical evidence and in times of uncertainty. Cost-effectiveness data were also used for decisions on the introduction of new expensive medical technologies. Conclusion: Cost-effectiveness data matters in decision-making processes and the results of this study could be applicable to other jurisdictions where health economics is implemented in decision-making. This study contributes to knowledge on how cost-effectiveness data is used in actual decision-making, to ensure that the decisions are offered on equal terms and that patients receive medical care according their needs in order achieve maximum benefit. PMID:25396208

Nurse managers' decision-making in daily unit operation in peri-operative settings: a cross-sectional descriptive study.

PubMed

Siirala, Eriikka; Peltonen, Laura-Maria; Lundgrén-Laine, Heljä; Salanterä, Sanna; Junttila, Kristiina

2016-09-01

To describe the tactical and the operational decisions made by nurse managers when managing the daily unit operation in peri-operative settings. Management is challenging as situations change rapidly and decisions are constantly made. Understanding decision-making in this complex environment helps to develop decision support systems to support nurse managers' operative and tactical decision-making. Descriptive cross-sectional design. Data were collected from 20 nurse managers with the think-aloud method during the busiest working hours and analysed using thematic content analysis. Nurse managers made over 700 decisions; either ad hoc (n = 289), near future (n = 268) or long-term (n = 187) by nature. Decisions were often made simultaneously with many interruptions. Ad hoc decisions covered staff allocation, ensuring adequate staff, rescheduling surgical procedures, confirmation tangible resources and following-up the daily unit operation. Decisions in the near future were: planning of surgical procedures and tangible resources, and planning staff allocation. Long-term decisions were: human recourses, nursing development, supplies and equipment, and finances in the unit. Decision-making was vulnerable to interruptions, which sometimes complicated the managing tasks. The results can be used when planning decision support systems and when defining the nurse managers' tasks in peri-operative settings. © 2016 John Wiley & Sons Ltd.

An Intuitionistic Fuzzy Logic Models for Multicriteria Decision Making Under Uncertainty

NASA Astrophysics Data System (ADS)

Jana, Biswajit; Mohanty, Sachi Nandan

2017-04-01

The purpose of this paper is to enhance the applicability of the fuzzy sets for developing mathematical models for decision making under uncertainty, In general a decision making process consist of four stages, namely collection of information from various sources, compile the information, execute the information and finally take the decision/action. Only fuzzy sets theory is capable to quantifying the linguistic expression to mathematical form in complex situation. Intuitionistic fuzzy set (IFSs) which reflects the fact that the degree of non membership is not always equal to one minus degree of membership. There may be some degree of hesitation. Thus, there are some situations where IFS theory provides a more meaningful and applicable to cope with imprecise information present for solving multiple criteria decision making problem. This paper emphasis on IFSs, which is help for solving real world problem in uncertainty situation.

Insecticide treated bednet strategy in rural settings: can we exploit women's decision making power?

PubMed

Tilak, Rina; Tilak, V W; Bhalwar, R

2007-01-01

Use of insecticide treated bednets in prevention of malaria is a widely propagated global strategy, however, its use has been reported to be influenced and limited by many variables especially gender bias. A cross sectional field epidemiological study was conducted in a rural setting with two outcome variables, 'Bednet use'(primary outcome variable) and 'Women's Decision Making Power' which were studied in reference to various predictor variables. Analysis reveals a significant effect on the primary outcome variable 'Bednet use' of the predictor variables- age, occupation, bednet purchase decision, women's decision making power, husband's education and knowledge about malaria and its prevention. The study recommends IEC on treated bednets to be disseminated through TV targeting the elderly women who have better decision making power and mobilizing younger women who were found to prefer bednets for prevention of mosquito bites for optimizing the use of treated bednets in similar settings.

Probabilistic soft sets and dual probabilistic soft sets in decision making with positive and negative parameters

NASA Astrophysics Data System (ADS)

Fatimah, F.; Rosadi, D.; Hakim, R. B. F.

2018-03-01

In this paper, we motivate and introduce probabilistic soft sets and dual probabilistic soft sets for handling decision making problem in the presence of positive and negative parameters. We propose several types of algorithms related to this problem. Our procedures are flexible and adaptable. An example on real data is also given.

Comparativism and the Grounds for Person-Centered Care and Shared Decision Making.

PubMed

Herlitz, Anders

2017-01-01

This article provides a new argument and a new value-theoretical ground for person-centered care and shared decision making that ascribes to it the role of enabling rational choice in situations involving clinical choice. Rather than referring to good health outcomes and/or ethical grounds such as patient autonomy, it argues that a plausible justification and ground for person-centered care and shared decision making is preservation of rationality in the face of comparative non-determinacy in clinical settings. Often, no alternative treatment will be better than or equal to every other alternative. In the face of such comparative non-determinacy, Ruth Chang has argued that we can make rational decisions by invoking reasons that are created through acts of willing. This article transfers this view to clinical decision making and argues that shared decision making provides a solution to non-determinacy problems in clinical settings. This view of the role of shared decision making provides a new understanding of its nature, and it also allows us to better understand when caregivers should engage in shared decision making and when they should not. Copyright 2017 The Journal of Clinical Ethics. All rights reserved.

Teacher Decision-Making.

ERIC Educational Resources Information Center

Smith, Carl B.

Since teaching is fundamentally a decision-making process, analyzing teachers' decisions can lead to a better understanding of learning and of management in the classroom. Three major features of teacher decision making are (1) that teaching is an intensely active profession; (2) that most of the work of teaching occurs in a group setting; and (3)…

Enrollment in prescription drug insurance: the interaction of numeracy and choice set size.

PubMed

Szrek, Helena; Bundorf, M Kate

2014-04-01

To determine how choice set size affects decision quality among individuals of different levels of numeracy choosing prescription drug plans. Members of an Internet-enabled panel age 65 and over were randomly assigned to sets of prescription drug plans varying in size from 2 to 16 plans from which they made a hypothetical choice. They answered questions about enrollment likelihood and the costs and benefits of their choice. The measure of decision quality was enrollment likelihood among those for whom enrollment was beneficial. Enrollment likelihood by numeracy and choice set size was calculated. A model of moderated mediation was analyzed to understand the role of numeracy as a moderator of the relationship between the number of plans and the quality of the enrollment decision and the roles of the costs and benefits in mediating that relationship. More numerate adults made better decisions than less numerate adults when choosing among a small number of alternatives but not when choice sets were larger. Choice set size had little effect on decision making of less numerate adults. Differences in decision making costs between more and less numerate adults helped explain the effect of choice set size on decision quality. Interventions to improve decision making in the context of Medicare Part D may differentially affect lower and higher numeracy adults. The conflicting results on choice overload in the psychology literature may be explained in part by differences amongst individuals in how they respond to choice set size.

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

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

PubMed

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

2017-01-01

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

Is Air War College Teaching the Right Leadership Skill Sets?

DTIC Science & Technology

2008-02-15

Following are the skill sets for strategic leaders: • Critical Thinking (includes Conceptual Competence/ Decision Making / Strategic Thinking... Decision Making / Strategic Thinking) • Creative Thinking (includes Conceptual Flexibility) • Integrating internal and external environments • Long Range... Making / Strategic Thinking Yes Integrating Internal and External Environments Yes Long Range Vision Yes Team Performance Facilitation/Team Building

Integrating Decision Making and Mental Health Interventions Research: Research Directions

PubMed Central

Wills, Celia E.; Holmes-Rovner, Margaret

2006-01-01

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

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

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

PubMed Central

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

2010-01-01

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

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

PubMed Central

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

2011-01-01

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

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

PubMed

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

2011-05-01

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

Decision Making: Rational, Nonrational, and Irrational.

ERIC Educational Resources Information Center

Simon, Herbert A.

1993-01-01

Describes the current state of knowledge about human decision-making and problem-solving processes, explaining recent developments and their implications for management and management training. Rational goal-setting is the key to effective decision making and accomplishment. Bounded rationality is a realistic orientation, because the world is too…

Cue acquisition: A feature of Malawian midwives decision making process to support normality during the first stage of labour.

PubMed

Chodzaza, Elizabeth; Haycock-Stuart, Elaine; Holloway, Aisha; Mander, Rosemary

2018-03-01

to explore Malawian midwives decision making when caring for women during the first stage of labour in the hospital setting. this focused ethnographic study examined the decision making process of 9 nurse-midwives with varying years of clinical experience in the real world setting of an urban and semi urban hospital from October 2013 to May 2014.This was done using 27 participant observations and 27 post-observation in-depth interviews over a period of six months. Qualitative data analysis software, NVivo 10, was used to assist with data management for the analysis. All data was analysed using the principle of theme and category formation. analysis revealed a six-stage process of decision making that include a baseline for labour, deciding to admit a woman to labour ward, ascertaining the normal physiological progress of labour, supporting the normal physiological progress of labour, embracing uncertainty: the midwives' construction of unusual labour as normal, dealing with uncertainty and deciding to intervene in unusual labour. This six-stage process of decision making is conceptualised as the 'role of cue acquisition', illustrating the ways in which midwives utilise their assessment of labouring women to reason and make decisions on how to care for them in labour. Cue acquisition involved the midwives piecing together segments of information they obtained from the women to formulate an understanding of the woman's birthing progress and inform the midwives decision making process. This understanding of cue acquisition by midwives is significant for supporting safe care in the labour setting. When there was uncertainty in a woman's progress of labour, midwives used deductive reasoning, for example, by cross-checking and analysing the information obtained during the span of labour. Supporting normal labour physiological processes was identified as an underlying principle that shaped the midwives clinical judgement and decision making when they cared for women in labour. the significance of this study is in the new understanding and insight into the process of midwifery decision making. Whilst the approach to decision making by the midwives requires further testing and refinement in order to explore implications for practice, the findings here provide new conceptual and practical clarity of midwifery decision making. The work contributes to the identified lack of knowledge of how midwives working clinically, in the 'real world setting. These findings therefore, contribute to this body of knowledge with regards to our understanding of decision making of midwives. Copyright © 2017 Elsevier Ltd. All rights reserved.

Interval Neutrosophic Sets and Their Application in Multicriteria Decision Making Problems

PubMed Central

Zhang, Hong-yu; Wang, Jian-qiang; Chen, Xiao-hong

2014-01-01

As a generalization of fuzzy sets and intuitionistic fuzzy sets, neutrosophic sets have been developed to represent uncertain, imprecise, incomplete, and inconsistent information existing in the real world. And interval neutrosophic sets (INSs) have been proposed exactly to address issues with a set of numbers in the real unit interval, not just a specific number. However, there are fewer reliable operations for INSs, as well as the INS aggregation operators and decision making method. For this purpose, the operations for INSs are defined and a comparison approach is put forward based on the related research of interval valued intuitionistic fuzzy sets (IVIFSs) in this paper. On the basis of the operations and comparison approach, two interval neutrosophic number aggregation operators are developed. Then, a method for multicriteria decision making problems is explored applying the aggregation operators. In addition, an example is provided to illustrate the application of the proposed method. PMID:24695916

Interval neutrosophic sets and their application in multicriteria decision making problems.

PubMed

Zhang, Hong-yu; Wang, Jian-qiang; Chen, Xiao-hong

2014-01-01

As a generalization of fuzzy sets and intuitionistic fuzzy sets, neutrosophic sets have been developed to represent uncertain, imprecise, incomplete, and inconsistent information existing in the real world. And interval neutrosophic sets (INSs) have been proposed exactly to address issues with a set of numbers in the real unit interval, not just a specific number. However, there are fewer reliable operations for INSs, as well as the INS aggregation operators and decision making method. For this purpose, the operations for INSs are defined and a comparison approach is put forward based on the related research of interval valued intuitionistic fuzzy sets (IVIFSs) in this paper. On the basis of the operations and comparison approach, two interval neutrosophic number aggregation operators are developed. Then, a method for multicriteria decision making problems is explored applying the aggregation operators. In addition, an example is provided to illustrate the application of the proposed method.

Bedside nurse involvement in end-of-life decision making: a brief review of the literature.

PubMed

Erickson, Jodi

2013-01-01

Bedside nurses in the critical care setting deal with death on a regular basis. Historically, end-of-life decision making has been addressed by physicians with the family and patient, yet nurses may be a better resource for families during the decision-making process. The purpose of this article was to provide a brief review of literature surrounding end-of-life decision making. As patient advocates, nurses should be more actively involved with facilitating the end-of-life decision-making process for critically ill patients and their families.

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

NASA Technical Reports Server (NTRS)

Dezfuli, Homayoon

2010-01-01

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

Association between Self-Reported Participation in Decision Making and Inpatient Rehabilitation Outcomes.

PubMed

Wylegala, Juli A; Graham, James E; Karmarkar, Amol M; Illig, Caitlin; Illig, Sandra Bennett; Ottenbacher, Kenneth J

2015-09-01

Retrospective cross sectional. The purpose of this study was to assess the independent associations between perceived participation in clinical decision making on rehabilitation length of stay, discharge functional status, and discharge setting following inpatient rehabilitation. Active participation in the inpatient rehabilitation process, which is the most intense post-acute rehabilitation service, should lead to better patient experiences and outcomes. Self-reported information from participant interviews was linked with data in administrative medical records for Medicare beneficiaries discharged from inpatient rehabilitation facilities in 2007-2009. The decision making variable assessed participants' perceived participation in decision making during their inpatient rehabilitation stays. The three outcome variables were inpatient rehabilitation length of stay, discharge functional status, and discharge setting. Among the 41,110 participants interviewed, approximately 89% strongly agreed or agreed , and 12% disagreed that they participated in decision making during their rehabilitation stays. The multivariable regression models showed that greater participation in decision making was associated (p < .05) with slightly longer lengths of stay, higher discharge functional status, and increased likelihood of community discharge. Nearly nine in 10 Medicare beneficiaries report participating in decision making when receiving inpatient rehabilitation services. Increasing participation may lead to improvements in fundamental rehabilitation outcomes.

Decision making on fitness landscapes

NASA Astrophysics Data System (ADS)

Arthur, R.; Sibani, P.

2017-04-01

We discuss fitness landscapes and how they can be modified to account for co-evolution. We are interested in using the landscape as a way to model rational decision making in a toy economic system. We develop a model very similar to the Tangled Nature Model of Christensen et al. that we call the Tangled Decision Model. This is a natural setting for our discussion of co-evolutionary fitness landscapes. We use a Monte Carlo step to simulate decision making and investigate two different decision making procedures.

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.

Research on Bidding Decision-making of International Public-Private Partnership Projects

NASA Astrophysics Data System (ADS)

Hu, Zhen Yu; Zhang, Shui Bo; Liu, Xin Yan

2018-06-01

In order to select the optimal quasi-bidding project for an investment enterprise, a bidding decision-making model for international PPP projects was established in this paper. Firstly, the literature frequency statistics method was adopted to screen out the bidding decision-making indexes, and accordingly the bidding decision-making index system for international PPP projects was constructed. Then, the group decision-making characteristic root method, the entropy weight method, and the optimization model based on least square method were used to set the decision-making index weights. The optimal quasi-bidding project was thus determined by calculating the consistent effect measure of each decision-making index value and the comprehensive effect measure of each quasi-bidding project. Finally, the bidding decision-making model for international PPP projects was further illustrated by a hypothetical case. This model can effectively serve as a theoretical foundation and technical support for the bidding decision-making of international PPP projects.

Burden of Disease Study and Priority Setting in Korea: an Ethical Perspective

PubMed Central

2016-01-01

When thinking about priority setting in access to healthcare resources, decision-making requires that cost-effectiveness is balanced against medical ethics. The burden of disease has emerged as an important approach to the assessment of health needs for political decision-making. However, the disability adjusted life years approach hides conceptual and methodological issues regarding the claims and value of disabled people. In this article, we discuss ethical issues that are raised as a consequence of the introduction of evidence-based health policy, such as economic evidence, in establishing resource allocation priorities. In terms of ethical values in health priority setting in Korea, there is no reliable rationale for the judgment used in decision-making as well as for setting separate and distinct priorities for different government bodies. An important question, therefore, is which ethical values guiding the practice of decision-making should be reconciled with the economic evidence found in Korean healthcare. The health technology assessment core model from the European network for Health Technology Assessment (EUnetHTA) project is a good example of incorporating ethical values into decision-making. We suggest that a fair distribution of scarce healthcare resources in South Korea can be achieved by considering the ethical aspects of healthcare. PMID:27775247

Decision Making in Computer-Simulated Experiments.

ERIC Educational Resources Information Center

Suits, J. P.; Lagowski, J. J.

A set of interactive, computer-simulated experiments was designed to respond to the large range of individual differences in aptitude and reasoning ability generally exhibited by students enrolled in first-semester general chemistry. These experiments give students direct experience in the type of decision making needed in an experimental setting.…

Development and Enhancement of a Model of Performance and Decision Making Under Stress in a Real Life Setting

DTIC Science & Technology

1993-02-12

admission tnat occurred during airway manipulation, distracted the attending anesthesiologist managing patient one from detecting why the mechanical... articular interest in settings where skilled individuals function as a tear are the relationships between team performance and individual decision-making

Setting Proficiency Standards for School Leadership Assessment: An Examination of Cut Score Decision Making

ERIC Educational Resources Information Center

Cravens, Xiu Chen; Goldring, Ellen B.; Porter, Andrew C.; Polikoff, Morgan S.; Murphy, Joseph; Elliott, Stephen N.

2013-01-01

Purpose: Performance evaluation informs professional development and helps school personnel improve student learning. Although psychometric literature indicates that a rational, sound, and coherent standard-setting process adds to the credibility of an assessment, few studies have empirically examined the decision-making process. This article…

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

PubMed

Whitty, Jennifer A; Littlejohns, Peter

2015-02-01

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

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.

Data-Driven Decision-Making: Facilitating Teacher Use of Student Data to Inform Classroom Instruction

ERIC Educational Resources Information Center

Schifter, Catherine C.; Natarajan, Uma; Ketelhut, Diane Jass; Kirchgessner, Amanda

2014-01-01

Data-driven decision making is essential in K-12 education today, but teachers often do not know how to make use of extensive data sets. Research shows that teachers are not taught how to use extensive data (i.e., multiple data sets) to reflect on student progress or to differentiate instruction. This paper presents a process used in an National…

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.

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

PubMed

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

2017-06-01

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

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.

Clinical Decision Making of Rural Novice Nurses

ERIC Educational Resources Information Center

Seright, Teresa J.

2010-01-01

The purpose of this study was to develop substantive theory regarding decision making by the novice nurse in a rural hospital setting. Interviews were guided by the following research questions: What cues were used by novice rural registered nurses in order to make clinical decisions? What were the sources of feedback which influenced subsequent…

Teacher Participation in the Decision-Making Process: Reality and Repercussions in Indian Higher Education

ERIC Educational Resources Information Center

Mehta, Deepa; Gardia, Alok; Rathore, H. C. S.

2010-01-01

The study reported here focused on comparing teachers' actual and desired participation in different decision-making situations and examined how participation in decision making differs in Indian higher educational institutions. The paper provides a comparison of findings with similar studies conducted in Western settings regarding the…

Efficient group decision making in workshop settings

Treesearch

Daniel L. Schmoldt; David L. Peterson

2001-01-01

Public land managers must treat multiple values coincidentally in time and space, which requires the participation of multiple resource specialists and consideration of diverse clientele interests in the decision process. This implies decision making that includes multiple participants, both internally and externally. Decades of social science research on decision...

LECTURES ON DECISION THEORY,

DTIC Science & Technology

These lecture notes deal with the mathematical theory of decision - making , i.e., wihematical models of situations in which there is a set of...individual and group decision - making as a quantitative science, in contrast with a field such as physics, suggests that mathematical theorizing on...phenomena of decision - making is very much an exploratory enterprise and that ex isting models have limited generality and appli cability. The purpose is to

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

Health care priority setting: principles, practice and challenges

PubMed Central

Mitton, Craig; Donaldson, Cam

2004-01-01

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

Grey situation group decision-making method based on prospect theory.

PubMed

Zhang, Na; Fang, Zhigeng; Liu, Xiaqing

2014-01-01

This paper puts forward a grey situation group decision-making method on the basis of prospect theory, in view of the grey situation group decision-making problems that decisions are often made by multiple decision experts and those experts have risk preferences. The method takes the positive and negative ideal situation distance as reference points, defines positive and negative prospect value function, and introduces decision experts' risk preference into grey situation decision-making to make the final decision be more in line with decision experts' psychological behavior. Based on TOPSIS method, this paper determines the weight of each decision expert, sets up comprehensive prospect value matrix for decision experts' evaluation, and finally determines the optimal situation. At last, this paper verifies the effectiveness and feasibility of the method by means of a specific example.

Grey Situation Group Decision-Making Method Based on Prospect Theory

PubMed Central

Zhang, Na; Fang, Zhigeng; Liu, Xiaqing

2014-01-01

This paper puts forward a grey situation group decision-making method on the basis of prospect theory, in view of the grey situation group decision-making problems that decisions are often made by multiple decision experts and those experts have risk preferences. The method takes the positive and negative ideal situation distance as reference points, defines positive and negative prospect value function, and introduces decision experts' risk preference into grey situation decision-making to make the final decision be more in line with decision experts' psychological behavior. Based on TOPSIS method, this paper determines the weight of each decision expert, sets up comprehensive prospect value matrix for decision experts' evaluation, and finally determines the optimal situation. At last, this paper verifies the effectiveness and feasibility of the method by means of a specific example. PMID:25197706

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

ERIC Educational Resources Information Center

Hantula, Donald A.

1995-01-01

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

Toolbox or Adjustable Spanner? A Critical Comparison of Two Metaphors for Adaptive Decision Making

ERIC Educational Resources Information Center

Söllner, Anke; Bröder, Arndt

2016-01-01

For multiattribute decision tasks, different metaphors exist that describe the process of decision making and its adaptation to diverse problems and situations. Multiple strategy models (MSMs) assume that decision makers choose adaptively from a set of different strategies (toolbox metaphor), whereas evidence accumulation models (EAMs) hold that a…

A Common Mechanism Underlying Food Choice and Social Decisions.

PubMed

Krajbich, Ian; Hare, Todd; Bartling, Björn; Morishima, Yosuke; Fehr, Ernst

2015-10-01

People make numerous decisions every day including perceptual decisions such as walking through a crowd, decisions over primary rewards such as what to eat, and social decisions that require balancing own and others' benefits. The unifying principles behind choices in various domains are, however, still not well understood. Mathematical models that describe choice behavior in specific contexts have provided important insights into the computations that may underlie decision making in the brain. However, a critical and largely unanswered question is whether these models generalize from one choice context to another. Here we show that a model adapted from the perceptual decision-making domain and estimated on choices over food rewards accurately predicts choices and reaction times in four independent sets of subjects making social decisions. The robustness of the model across domains provides behavioral evidence for a common decision-making process in perceptual, primary reward, and social decision making.

A Common Mechanism Underlying Food Choice and Social Decisions

PubMed Central

Krajbich, Ian; Hare, Todd; Bartling, Björn; Morishima, Yosuke; Fehr, Ernst

2015-01-01

People make numerous decisions every day including perceptual decisions such as walking through a crowd, decisions over primary rewards such as what to eat, and social decisions that require balancing own and others’ benefits. The unifying principles behind choices in various domains are, however, still not well understood. Mathematical models that describe choice behavior in specific contexts have provided important insights into the computations that may underlie decision making in the brain. However, a critical and largely unanswered question is whether these models generalize from one choice context to another. Here we show that a model adapted from the perceptual decision-making domain and estimated on choices over food rewards accurately predicts choices and reaction times in four independent sets of subjects making social decisions. The robustness of the model across domains provides behavioral evidence for a common decision-making process in perceptual, primary reward, and social decision making. PMID:26460812

Network-centric decision architecture for financial or 1/f data models

NASA Astrophysics Data System (ADS)

Jaenisch, Holger M.; Handley, James W.; Massey, Stoney; Case, Carl T.; Songy, Claude G.

2002-12-01

This paper presents a decision architecture algorithm for training neural equation based networks to make autonomous multi-goal oriented, multi-class decisions. These architectures make decisions based on their individual goals and draw from the same network centric feature set. Traditionally, these architectures are comprised of neural networks that offer marginal performance due to lack of convergence of the training set. We present an approach for autonomously extracting sample points as I/O exemplars for generation of multi-branch, multi-node decision architectures populated by adaptively derived neural equations. To test the robustness of this architecture, open source data sets in the form of financial time series were used, requiring a three-class decision space analogous to the lethal, non-lethal, and clutter discrimination problem. This algorithm and the results of its application are presented here.

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.

A Validation and Reliability Study of the Physical Activity and Healthy Food Efficacy Scale for Children (PAHFE)

ERIC Educational Resources Information Center

Perry, Christina M.; De Ayala, R. J.; Lebow, Ryan; Hayden, Emily

2008-01-01

The purpose of this study was to obtain validity evidence for the Physical Activity and Healthy Food Efficacy Scale for Children (PAHFE). Construct validity evidence identifies four subscales: Goal-Setting for Physical Activity, Goal-Setting for Healthy Food Choices, Decision-Making for Physical Activity, and Decision-Making for Healthy Food…

How to use multi-criteria decision analysis methods for reimbursement decision-making in healthcare: a step-by-step guide.

PubMed

Diaby, Vakaramoko; Goeree, Ron

2014-02-01

In recent years, the quest for more comprehensiveness, structure and transparency in reimbursement decision-making in healthcare has prompted the research into alternative decision-making frameworks. In this environment, multi-criteria decision analysis (MCDA) is arising as a valuable tool to support healthcare decision-making. In this paper, we present the main MCDA decision support methods (elementary methods, value-based measurement models, goal programming models and outranking models) using a case study approach. For each family of methods, an example of how an MCDA model would operate in a real decision-making context is presented from a critical perspective, highlighting the parameters setting, the selection of the appropriate evaluation model as well as the role of sensitivity and robustness analyses. This study aims to provide a step-by-step guide on how to use MCDA methods for reimbursement decision-making in healthcare.

Decision Making and Cancer

PubMed Central

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

2014-01-01

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

Just in Time: How Evidence-on-Demand Services Support Decision Making in Ontario's Child and Youth Mental Health Sector

ERIC Educational Resources Information Center

Notarianni, Maryann; Sundar, Purnima; Carter, Charles

2016-01-01

Using the best available evidence to inform decision making is important for the design or delivery of effective health-related services and broader public policy. Several studies identify barriers and facilitators to evidence-informed decision making in Canadian health settings. This paper describes how the Ontario Centre of Excellence for Child…

Goal-directed decision making as probabilistic inference: A computational framework and potential neural correlates

PubMed Central

Solway, A.; Botvinick, M.

2013-01-01

Recent work has given rise to the view that reward-based decision making is governed by two key controllers: a habit system, which stores stimulus-response associations shaped by past reward, and a goal-oriented system that selects actions based on their anticipated outcomes. The current literature provides a rich body of computational theory addressing habit formation, centering on temporal-difference learning mechanisms. Less progress has been made toward formalizing the processes involved in goal-directed decision making. We draw on recent work in cognitive neuroscience, animal conditioning, cognitive and developmental psychology and machine learning, to outline a new theory of goal-directed decision making. Our basic proposal is that the brain, within an identifiable network of cortical and subcortical structures, implements a probabilistic generative model of reward, and that goal-directed decision making is effected through Bayesian inversion of this model. We present a set of simulations implementing the account, which address benchmark behavioral and neuroscientific findings, and which give rise to a set of testable predictions. We also discuss the relationship between the proposed framework and other models of decision making, including recent models of perceptual choice, to which our theory bears a direct connection. PMID:22229491

44 CFR 10.12 - Pre-implementation actions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... integrated into the decision-making process. Because of the diversity of FEMA, it is not feasible to describe..., for integration of environmental considerations into the decision-making process. The Regional... document for the purpose of justifying the decision. Rather it is a concise document that sets forth the...

44 CFR 10.12 - Pre-implementation actions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... integrated into the decision-making process. Because of the diversity of FEMA, it is not feasible to describe..., for integration of environmental considerations into the decision-making process. The Regional... document for the purpose of justifying the decision. Rather it is a concise document that sets forth the...

44 CFR 10.12 - Pre-implementation actions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... integrated into the decision-making process. Because of the diversity of FEMA, it is not feasible to describe..., for integration of environmental considerations into the decision-making process. The Regional... document for the purpose of justifying the decision. Rather it is a concise document that sets forth the...

Managing healthcare budgets in times of austerity: the role of program budgeting and marginal analysis.

PubMed

Mitton, Craig; Dionne, Francois; Donaldson, Cam

2014-04-01

Given limited resources, priority setting or choice making will remain a reality at all levels of publicly funded healthcare across countries for many years to come. The pressures may well be even more acute as the impact of the economic crisis of 2008 continues to play out but, even as economies begin to turn around, resources within healthcare will be limited, thus some form of rationing will be required. Over the last few decades, research on healthcare priority setting has focused on methods of implementation as well as on the development of approaches related to fairness and legitimacy and on more technical aspects of decision making including the use of multi-criteria decision analysis. Recently, research has led to better understanding of evaluating priority setting activity including defining 'success' and articulating key elements for high performance. This body of research, however, often goes untapped by those charged with making challenging decisions and as such, in line with prevailing public sector incentives, decisions are often reliant on historical allocation patterns and/or political negotiation. These archaic and ineffective approaches not only lead to poor decisions in terms of value for money but further do not reflect basic ethical conditions that can lead to fairness in the decision-making process. The purpose of this paper is to outline a comprehensive approach to priority setting and resource allocation that has been used in different contexts across countries. This will provide decision makers with a single point of access for a basic understanding of relevant tools when faced with having to make difficult decisions about what healthcare services to fund and what not to fund. The paper also addresses several key issues related to priority setting including how health technology assessments can be used, how performance can be improved at a practical level, and what ongoing resource management practice should look like. In terms of future research, one of the most important areas of priority setting that needs further attention is how best to engage public members.

Equipment Selection by using Fuzzy TOPSIS Method

NASA Astrophysics Data System (ADS)

Yavuz, Mahmut

2016-10-01

In this study, Fuzzy TOPSIS method was performed for the selection of open pit truck and the optimal solution of the problem was investigated. Data from Turkish Coal Enterprises was used in the application of the method. This paper explains the Fuzzy TOPSIS approaches with group decision-making application in an open pit coal mine in Turkey. An algorithm of the multi-person multi-criteria decision making with fuzzy set approach was applied an equipment selection problem. It was found that Fuzzy TOPSIS with a group decision making is a method that may help decision-makers in solving different decision-making problems in mining.

Speech pathologists' experience of involving people with stroke-induced aphasia in clinical decision making during rehabilitation.

PubMed

Berg, Karianne; Rise, Marit By; Balandin, Susan; Armstrong, Elizabeth; Askim, Torunn

2016-01-01

Although client participation has been part of legislation and clinical guidelines for several years, the evidence of these recommendations being implemented into clinical practice is scarce, especially for people with communication disorders. The aim of this study was to investigate how speech pathologists experienced client participation during the process of goal-setting and clinical decision making for people with aphasia. Twenty speech pathologists participated in four focus group interviews. A qualitative analysis using Systematic Text Condensation was undertaken. Analysis revealed three different approaches to client participation: (1) client-oriented, (2) next of kin-oriented and (3) professional-oriented participation. Participants perceived client-oriented participation as the gold standard. The three approaches were described as overlapping, with each having individual characteristics incorporating different facilitators and barriers. There is a need for greater emphasis on how to involve people with severe aphasia in goal setting and treatment planning, and frameworks made to enhance collaboration could preferably be used. Participants reported use of next of kin as proxies in goal-setting and clinical decision making for people with moderate-to-severe aphasia, indicating the need for awareness towards maintaining the clients' autonomy and addressing the goals of next of kin. Speech pathologists, and most likely other professionals, should place greater emphasis on client participation to ensure active involvement of people with severe aphasia. To achieve this, existing tools and techniques made to enhance collaborative goal setting and clinical decision making have to be better incorporated into clinical rehabilitation practice. To ensure the autonomy of the person with aphasia, as well as to respect next of kin's own goals, professionals need to make ethical considerations when next of kin are used as proxies in collaborative goal setting and clinical decision making.

Adapting Scott and Bruce's General Decision-Making Style Inventory to Patient Decision Making in Provider Choice.

PubMed

Fischer, Sophia; Soyez, Katja; Gurtner, Sebastian

2015-05-01

Research testing the concept of decision-making styles in specific contexts such as health care-related choices is missing. Therefore, we examine the contextuality of Scott and Bruce's (1995) General Decision-Making Style Inventory with respect to patient choice situations. Scott and Bruce's scale was adapted for use as a patient decision-making style inventory. In total, 388 German patients who underwent elective joint surgery responded to a questionnaire about their provider choice. Confirmatory factor analyses within 2 independent samples assessed factorial structure, reliability, and validity of the scale. The final 4-dimensional, 13-item patient decision-making style inventory showed satisfactory psychometric properties. Data analyses supported reliability and construct validity. Besides the intuitive, dependent, and avoidant style, a new subdimension, called "comparative" decision-making style, emerged that originated from the rational dimension of the general model. This research provides evidence for the contextuality of decision-making style to specific choice situations. Using a limited set of indicators, this report proposes the patient decision-making style inventory as valid and feasible tool to assess patients' decision propensities. © The Author(s) 2015.

New approaches for real time decision support systems

NASA Technical Reports Server (NTRS)

Hair, D. Charles; Pickslay, Kent

1994-01-01

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

Genital surgery for disorders of sex development: implementing a shared decision-making approach.

PubMed

Karkazis, Katrina; Tamar-Mattis, Anne; Kon, Alexander A

2010-08-01

Ongoing controversy surrounds early genital surgery for children with disorders of sex development, making decisions about these procedures extraordinarily complex. Professional organizations have encouraged healthcare providers to adopt shared decision-making due to its broad potential to improve the decision-making process, perhaps most so when data are lacking, when there is no clear "best-choice" treatment, when decisions involve more than one choice, where each choice has both advantages and disadvantages, and where the ranking of options depends heavily on the decision-maker's values. We present a 6-step model for shared decision-making in decisions about genital surgery for disorders of sex development: (1) Set the stage and develop an appropriate team; (2) Establish preferences for information and roles in decision-making; (3) Perceive and address emotions; (4) Define concerns and values; (5) Identify options and present evidence; and (6) Share responsibility for making a decision. As long as controversy persists regarding surgery for DSD, an SDM process can facilitate the increased sharing of relevant information essential for making important health care decisions.

Participatory environmental governance in China: public hearings on urban water tariff setting.

PubMed

Zhong, Li-Jin; Mol, Arthur P J

2008-09-01

In the late 1990s China started to expand its market economic reform to the public sector, such as water services. This reform led to major changes in urban water management, including water tariff management. The reforms in water tariff management relate not only to tariffs, but also to the decision-making on tariffs. Water tariff decision-making seems to move away from China's conventional mode of highly centralized and bureaucratic policy- and decision-making. The legalization, institutionalization and performance of public hearings in water tariff management forms a crucial innovation in this respect. This article analyzes the emergence, development and current functioning of public hearings in water tariff setting, and assesses to what extent public hearings are part of a turning point in China's tradition of centralized bureaucratic decision-making, towards more transparent, decentralized and participative governance.

Advancing beyond the system: telemedicine nurses' clinical reasoning using a computerised decision support system for patients with COPD - an ethnographic study.

PubMed

Barken, Tina Lien; Thygesen, Elin; Söderhamn, Ulrika

2017-12-28

Telemedicine is changing traditional nursing care, and entails nurses performing advanced and complex care within a new clinical environment, and monitoring patients at a distance. Telemedicine practice requires complex disease management, advocating that the nurses' reasoning and decision-making processes are supported. Computerised decision support systems are being used increasingly to assist reasoning and decision-making in different situations. However, little research has focused on the clinical reasoning of nurses using a computerised decision support system in a telemedicine setting. Therefore, the objective of the study is to explore the process of telemedicine nurses' clinical reasoning when using a computerised decision support system for the management of patients with chronic obstructive pulmonary disease. The factors influencing the reasoning and decision-making processes were investigated. In this ethnographic study, a combination of data collection methods, including participatory observations, the think-aloud technique, and a focus group interview was employed. Collected data were analysed using qualitative content analysis. When telemedicine nurses used a computerised decision support system for the management of patients with complex, unstable chronic obstructive pulmonary disease, two categories emerged: "the process of telemedicine nurses' reasoning to assess health change" and "the influence of the telemedicine setting on nurses' reasoning and decision-making processes". An overall theme, termed "advancing beyond the system", represented the connection between the reasoning processes and the telemedicine work and setting, where being familiar with the patient functioned as a foundation for the nurses' clinical reasoning process. In the telemedicine setting, when supported by a computerised decision support system, nurses' reasoning was enabled by the continuous flow of digital clinical data, regular video-mediated contact and shared decision-making with the patient. These factors fostered an in-depth knowledge of the patients and acted as a foundation for the nurses' reasoning process. Nurses' reasoning frequently advanced beyond the computerised decision support system recommendations. Future studies are warranted to develop more accurate algorithms, increase system maturity, and improve the integration of the digital clinical information with clinical experiences, to support telemedicine nurses' reasoning process.

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

PubMed

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

2018-05-01

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

Understanding Decision-Making, Communication Rules, and Communication Satisfaction as Culture: Implications for Organizational Effectiveness.

ERIC Educational Resources Information Center

Shockley-Zalabak, Pamela

A study of decision making processes and communication rules, in a corporate setting undergoing change as a result of organizational ineffectiveness, examined whether (1) decisions about formal communication reporting systems were linked to management assumptions about technical creativity/effectiveness, (2) assumptions about…

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…

Goal Setting, Decision-Making Skills and Academic Performance of Undergraduate Distance Learners: Implications for Retention and Support Services

ERIC Educational Resources Information Center

Tanglang, Nebath; Ibrahim, Aminu Kazeem

2015-01-01

The study adopted an ex-post facto research design. Randomization sampling technique was used to select 346 undergraduate distance learners and the learners were grouped into four, High and Low Goal setter learners and High and Low Decision-making skills learners. The instruments for data collection were Undergraduate Academic Goal Setting Scale…

Anxiety and Decision-Making

PubMed Central

Hartley, Catherine A.; Phelps, Elizabeth A.

2013-01-01

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

Capturing a Commander's decision making style

NASA Astrophysics Data System (ADS)

Santos, Eugene; Nguyen, Hien; Russell, Jacob; Kim, Keumjoo; Veenhuis, Luke; Boparai, Ramnjit; Stautland, Thomas Kristoffer

2017-05-01

A Commander's decision making style represents how he weighs his choices and evaluates possible solutions with regards to his goals. Specifically, in the naval warfare domain, it relates the way he processes a large amount of information in dynamic, uncertain environments, allocates resources, and chooses appropriate actions to pursue. In this paper, we describe an approach to capture a Commander's decision style by creating a cognitive model that captures his decisionmaking process and evaluate this model using a set of scenarios using an online naval warfare simulation game. In this model, we use the Commander's past behaviors and generalize Commander's actions across multiple problems and multiple decision making sequences in order to recommend actions to a Commander in a manner that he may have taken. Our approach builds upon the Double Transition Model to represent the Commander's focus and beliefs to estimate his cognitive state. Each cognitive state reflects a stage in a Commander's decision making process, each action reflects the tasks that he has taken to move himself closer to a final decision, and the reward reflects how close he is to achieving his goal. We then use inverse reinforcement learning to compute a reward for each of the Commander's actions. These rewards and cognitive states are used to compare between different styles of decision making. We construct a set of scenarios in the game where rational, intuitive and spontaneous decision making styles will be evaluated.

Using the Networked Fire Chief for ego-depletion research: measuring dynamic decision-making effort and performance.

PubMed

Barber, Larissa K; Smit, Brandon W

2014-01-01

This study replicated ego-depletion predictions from the self-control literature in a computer simulation task that requires ongoing decision-making in relation to constantly changing environmental information: the Network Fire Chief (NFC). Ego-depletion led to decreased self-regulatory effort, but not performance, on the NFC task. These effects were also buffered by task enjoyment so that individuals who enjoyed the dynamic decision-making task did not experience ego-depletion effects. These findings confirm that past ego-depletion effects on decision-making are not limited to static or isolated decision-making tasks and can be extended to dynamic, naturalistic decision-making processes more common to naturalistic settings. Furthermore, the NFC simulation provides a methodological mechanism for independently measuring effort and performance when studying ego-depletion.

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

PubMed

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

2017-05-09

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

A Multicriteria Decision Making Approach for Estimating the Number of Clusters in a Data Set

PubMed Central

Peng, Yi; Zhang, Yong; Kou, Gang; Shi, Yong

2012-01-01

Determining the number of clusters in a data set is an essential yet difficult step in cluster analysis. Since this task involves more than one criterion, it can be modeled as a multiple criteria decision making (MCDM) problem. This paper proposes a multiple criteria decision making (MCDM)-based approach to estimate the number of clusters for a given data set. In this approach, MCDM methods consider different numbers of clusters as alternatives and the outputs of any clustering algorithm on validity measures as criteria. The proposed method is examined by an experimental study using three MCDM methods, the well-known clustering algorithm–k-means, ten relative measures, and fifteen public-domain UCI machine learning data sets. The results show that MCDM methods work fairly well in estimating the number of clusters in the data and outperform the ten relative measures considered in the study. PMID:22870181

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.

How do community pharmacists make decisions? Results of an exploratory qualitative study in Ontario.

PubMed

Gregory, Paul A M; Whyte, Brenna; Austin, Zubin

2016-03-01

As the complexity of pharmacy practice increases, pharmacists are required to make more decisions under ambiguous or information-deficient conditions. There is scant literature examining how pharmacists make decisions and what factors or values influence their choices. The objective of this exploratory research was to characterize decision-making patterns in the clinical setting of community pharmacists in Ontario. The think-aloud decision-making method was used for this study. Community pharmacists with 3 or more years' experience were presented with 2 clinical case studies dealing with challenging situations and were asked to verbally reason through their decision-making process while being probed by an interviewer for clarification, justification and further explication. Verbatim transcripts were analyzed using a protocol analysis method. A total of 12 pharmacists participated in this study. Participants experienced cognitive dissonance in attempting to reconcile their desire for a clear and confrontation-free conclusion to the case discussion and the reality of the challenge presented within each case. Strategies for resolving this cognitive dissonance included strong emphasis on the educational (rather than decision-making) role of the pharmacist, the value of strong interpersonal relationships as a way to avoid conflict and achieve desired outcomes, the desire to seek external advice or defer to others' authority to avoid making a decision and the use of strict interpretations of rules to avoid ambiguity and contextual interpretation. This research was neither representative nor generalizable but was indicative of patterns of decisional avoidance and fear of assuming responsibility for outcomes that warrant further investigation. The think-aloud method functioned effectively in this context and provided insights into pharmacists' decision-making patterns in the clinical setting. Can Pharm J (Ott) 2016;149:90-98.

Decision making and coping in healthcare: the Coping in Deliberation (CODE) framework.

PubMed

Witt, Jana; Elwyn, Glyn; Wood, Fiona; Brain, Kate

2012-08-01

To develop a framework of decision making and coping in healthcare that describes the twin processes of appraisal and coping faced by patients making preference-sensitive healthcare decisions. We briefly review the literature for decision making theories and coping theories applicable to preference-sensitive decisions in healthcare settings. We describe first decision making, then coping and finally attempt to integrate these processes by building on current theory. Deliberation in healthcare may be described as a six step process, comprised of the presentation of a health threat, choice, options, preference construction, the decision itself and consolidation post-decision. Coping can be depicted in three stages, beginning with a threat, followed by primary and secondary appraisal and ultimately resulting in a coping effort. Drawing together concepts from prominent decision making theories and coping theories, we propose a multidimensional, interactive framework which integrates both processes and describes coping in deliberation. The proposed framework offers an insight into the complexity of decision making in preference-sensitive healthcare contexts from a patient perspective and may act as theoretical basis for decision support. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

A rough set approach for determining weights of decision makers in group decision making.

PubMed

Yang, Qiang; Du, Ping-An; Wang, Yong; Liang, Bin

2017-01-01

This study aims to present a novel approach for determining the weights of decision makers (DMs) based on rough group decision in multiple attribute group decision-making (MAGDM) problems. First, we construct a rough group decision matrix from all DMs' decision matrixes on the basis of rough set theory. After that, we derive a positive ideal solution (PIS) founded on the average matrix of rough group decision, and negative ideal solutions (NISs) founded on the lower and upper limit matrixes of rough group decision. Then, we obtain the weight of each group member and priority order of alternatives by using relative closeness method, which depends on the distances from each individual group member' decision to the PIS and NISs. Through comparisons with existing methods and an on-line business manager selection example, the proposed method show that it can provide more insights into the subjectivity and vagueness of DMs' evaluations and selections.

Out-of-Home Placement Decision-Making and Outcomes in Child Welfare: A Longitudinal Study

PubMed Central

McClelland, Gary M.; Weiner, Dana A.; Jordan, Neil; Lyons, John S.

2015-01-01

After children enter the child welfare system, subsequent out-of-home placement decisions and their impact on children’s well-being are complex and under-researched. This study examined two placement decision-making models: a multidisciplinary team approach, and a decision support algorithm using a standardized assessment. Based on 3,911 placement records in the Illinois child welfare system over 4 years, concordant (agreement) and discordant (disagreement) decisions between the two models were compared. Concordant decisions consistently predicted improvement in children’s well-being regardless of placement type. Discordant decisions showed greater variability. In general, placing children in settings less restrictive than the algorithm suggested (“under-placing”) was associated with less severe baseline functioning but also less improvement over time than placing children according to the algorithm. “Over-placing” children in settings more restrictive than the algorithm recommended was associated with more severe baseline functioning but fewer significant results in rate of improvement than predicted by concordant decisions. The importance of placement decision-making on policy, restrictiveness of placement, and delivery of treatments and services in child welfare are discussed. PMID:24677172

Prospective Analysis of Decision Making During Joint Cardiology Cardiothoracic Conference in Treatment of 107 Consecutive Children with Congenital Heart Disease.

PubMed

Duignan, Sophie; Ryan, Aedin; O'Keeffe, Dara; Kenny, Damien; McMahon, Colin J

2018-05-12

The complexity and potential biases involved in decision making have long been recognised and examined in both the aviation and business industries. More recently, the medical community have started to explore this concept and its particular importance in our field. Paediatric cardiology is a rapidly expanding field and for many of the conditions we treat, there is limited evidence available to support our decision-making. Variability exists within decision-making in paediatric cardiology and this may influence outcomes. There are no validated tools available to support and examine consistent decision-making for various treatment strategies in children with congenital heart disease in a multidisciplinary cardiology and cardiothoracic institution. Our primary objective was to analyse the complexity of decision-making for children with cardiac conditions in the context of our joint cardiology and cardiothoracic conference (JCC). Two paediatric cardiologists acted as investigators by observing the weekly joint cardiology-cardiothoracic surgery conference and prospectively evaluating the degree of complexity of decision-making in the management of 107 sequential children with congenital heart disease discussed. Additionally, the group consensus on the same patients was prospectively assessed to compare this to the independent observers. Of 107 consecutive children discussed at our JCC conference 32 (27%) went on to receive surgical intervention, 20 (17%) underwent catheterisation and 65 (56%) received medical treatment. There were 53 (50%) cases rated as simple by one senior observer, while 54 (50%) were rated as complex to some degree. There was high inter-observer agreement with a Krippendorff's alpha of ≥ 0.8 between 2 observers and between 2 observers and the group consensus as a whole for grading of the complexity of decision-making. Different decisions were occasionally made on patients with the same data set. Discussions revisiting the same patient, in complex cases, resulted in different management decisions being reached in this series. Anchoring of decision-making was witnessed in certain cases. Potential application of decision making algorithms is discussed in making decisions in paediatric cardiology patients. Decision-making in our institution's joint cardiology-cardiothoracic conference proved to be complex in approximately half of our patients. Inconsistency in decision-making for patients with the same diagnosis, and different decisions made for the same complex patient at different time points confounds the reliability of the decision-making process. These novel data highlight the absence of evidence-based medicine for many decisions, occasional lack of consistency and the impact of anchoring, heuristics and other biases in complex cases. Validated decision-making algorithms may assist in providing consistency to decision-making in this setting.

Precautionary principles: a jurisdiction-free framework for decision-making under risk.

PubMed

Ricci, Paolo F; Cox, Louis A; MacDonald, Thomas R

2004-12-01

Fundamental principles of precaution are legal maxims that ask for preventive actions, perhaps as contingent interim measures while relevant information about causality and harm remains unavailable, to minimize the societal impact of potentially severe or irreversible outcomes. Such principles do not explain how to make choices or how to identify what is protective when incomplete and inconsistent scientific evidence of causation characterizes the potential hazards. Rather, they entrust lower jurisdictions, such as agencies or authorities, to make current decisions while recognizing that future information can contradict the scientific basis that supported the initial decision. After reviewing and synthesizing national and international legal aspects of precautionary principles, this paper addresses the key question: How can society manage potentially severe, irreversible or serious environmental outcomes when variability, uncertainty, and limited causal knowledge characterize their decision-making? A decision-analytic solution is outlined that focuses on risky decisions and accounts for prior states of information and scientific beliefs that can be updated as subsequent information becomes available. As a practical and established approach to causal reasoning and decision-making under risk, inherent to precautionary decision-making, these (Bayesian) methods help decision-makers and stakeholders because they formally account for probabilistic outcomes, new information, and are consistent and replicable. Rational choice of an action from among various alternatives--defined as a choice that makes preferred consequences more likely--requires accounting for costs, benefits and the change in risks associated with each candidate action. Decisions under any form of the precautionary principle reviewed must account for the contingent nature of scientific information, creating a link to the decision-analytic principle of expected value of information (VOI), to show the relevance of new information, relative to the initial (and smaller) set of data on which the decision was based. We exemplify this seemingly simple situation using risk management of BSE. As an integral aspect of causal analysis under risk, the methods developed in this paper permit the addition of non-linear, hormetic dose-response models to the current set of regulatory defaults such as the linear, non-threshold models. This increase in the number of defaults is an important improvement because most of the variants of the precautionary principle require cost-benefit balancing. Specifically, increasing the set of causal defaults accounts for beneficial effects at very low doses. We also show and conclude that quantitative risk assessment dominates qualitative risk assessment, supporting the extension of the set of default causal models.

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

PubMed

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

2010-02-01

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

Decision-making in Swiss home-like childbirth: A grounded theory study.

PubMed

Meyer, Yvonne; Frank, Franziska; Schläppy Muntwyler, Franziska; Fleming, Valerie; Pehlke-Milde, Jessica

2017-12-01

Decision-making in midwifery, including a claim for shared decision-making between midwives and women, is of major significance for the health of mother and child. Midwives have little information about how to share decision-making responsibilities with women, especially when complications arise during birth. To increase understanding of decision-making in complex home-like birth settings by exploring midwives' and women's perspectives and to develop a dynamic model integrating participatory processes for making shared decisions. The study, based on grounded theory methodology, analysed 20 interviews of midwives and 20 women who had experienced complications in home-like births. The central phenomenon that arose from the data was "defining/redefining decision as a joint commitment to healthy childbirth". The sub-indicators that make up this phenomenon were safety, responsibility, mutual and personal commitments. These sub-indicators were also identified to influence temporal conditions of decision-making and to apply different strategies for shared decision-making. Women adopted strategies such as delegating a decision, making the midwife's decision her own, challenging a decision or taking a decision driven by the dynamics of childbirth. Midwives employed strategies such as remaining indecisive, approving a woman's decision, making an informed decision or taking the necessary decision. To respond to recommendations for shared responsibility for care, midwives need to strengthen their shared decision-making skills. The visual model of decision-making in childbirth derived from the data provides a framework for transferring clinical reasoning into practice. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

E Pluribus Analysis: Applying a Superforecasting Methodology to the Detection of Homegrown Violence

DTIC Science & Technology

2018-03-01

actor violence and a set of predefined decision-making protocols. This research included running four simulations using the Monte Carlo technique, which...actor violence and a set of predefined decision-making protocols. This research included running four simulations using the Monte Carlo technique...PREDICTING RANDOMNESS.............................................................24 1. Using a “ Runs Test” to Determine a Temporal Pattern in Lone

The Effectiveness of an Undecided Decision-Making, Goal-Setting Workshop on the Academic Success of College Students Who Have Not Declared a Major

ERIC Educational Resources Information Center

Mushegyan, Anaid

2010-01-01

The problem: The purpose of this study was to determine the efficacy of an Undecided Decision-Making, Goal-Setting Workshop through an examination of changes in grade point averages (GPAs) among participating community college students. The method: To investigate this problem, 98 EOPS undecided students were asked to attend an Undecided…

The Development and Validation of a Novice Nurse Decision-Making Skills Education Curriculum

ERIC Educational Resources Information Center

Simmons, Joanne

2017-01-01

Novice nurses (NNs) are entering critical care environments with limited knowledge, skills, and decision-making expertise. They are expected to care for complex patients in a dynamic healthcare setting. The research question for this project examined whether NNs improve their knowledge and skills by participating in a nursing decision-making…

Hindsight Bias and Outcome-Consistent Thoughts when Observing and Making Service Provider Decisions

ERIC Educational Resources Information Center

Louie, Therese A.

2005-01-01

Two studies examined the relationship between hindsight bias and corresponding open-ended thoughts for decisions in a service provider setting. Perspectives of those observing and making decisions were examined. In study 1, business students who learned the results of a financial advisor's stock purchase showed the traditional hindsight effect…

Decision making and cancer.

PubMed

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

2015-01-01

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

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

PubMed

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

2013-01-01

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

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

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.

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

PubMed

Treichler, Emily B H; Spaulding, William D

2017-01-01

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

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.

Measuring (shared) decision-making--a review of psychometric instruments.

PubMed

Simon, Daniela; Loh, Andreas; Härter, Martin

2007-01-01

In recent years shared decision-making (SDM) has gained importance as an appropriate approach to patient-physician communication and decision-making. However, there is a conceptual variety that implies problems of inconsistent measurement, of defining relationships of SDM and outcome measures, and of comparisons across different studies. This article presents the results of a literature search of psychometric instruments measuring aspects of decision-making. Altogether 18 scales were found. The majority covers the patients' perspective and relates to preferences for information and participation, decisional conflict, self-efficacy as well as to the evaluation of decision-making process and outcomes. The scales differ widely in their extent of validation. Although this review is not exhaustive, it presents a variety of available decision-making instruments. Yet, many of them still need to show their psychometric quality for other settings in further studies.

Evaluating a Web-Based MMR Decision Aid to Support Informed Decision-Making by UK Parents: A Before-and-After Feasibility Study

ERIC Educational Resources Information Center

Jackson, Cath; Cheater, Francine M.; Peacock, Rose; Leask, Julie; Trevena, Lyndal

2010-01-01

Objective: The objective of this feasibility study was to evaluate the acceptability and potential effectiveness of a web-based MMR decision aid in supporting informed decision-making for the MMR vaccine. Design: This was a prospective before-and-after evaluation. Setting: Thirty parents of children eligible for MMR vaccination were recruited from…

Research on Group Decision-Making Mechanism of Internet Emergency Management

NASA Astrophysics Data System (ADS)

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

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

Information and decision-making needs among people with affective disorders - results of an online survey.

PubMed

Liebherz, Sarah; Tlach, Lisa; Härter, Martin; Dirmaier, Jörg

2015-01-01

Patient decision aids are one possibility for enabling and encouraging patients to participate in medical decisions. This paper aims to describe patients' information and decision-making needs as a prerequisite for the development of high-quality, web-based patient decision aids for affective disorders. We conducted an online cross-sectional survey by using a self-administered questionnaire including items on Internet use, online health information needs, role in decision making, and important treatment decisions, performing descriptive and comparative statistical analyses. A total of 210 people with bipolar disorder/mania as well as 112 people with unipolar depression participated in the survey. Both groups specified general information search as their most relevant information need and decisions on treatment setting (inpatient or outpatient) as well as decisions on pharmacological treatment as the most difficult treatment decisions. For participants with unipolar depression, decisions concerning psychotherapeutic treatment were also especially difficult. Most participants of both groups preferred shared decisions but experienced less shared decisions than desired. Our results show the importance of information for patients with affective disorders, with a focus on pharmacological treatment and on the different treatment settings, and highlight patients' requirements to be involved in the decision-making process. Since our sample reported a chronic course of disease, we do not know if our results are applicable for newly diagnosed patients. Further studies should consider how the reported needs could be addressed in health care practice.

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

A qualitative exploration of patient and family views and experiences of treatment decision-making in bipolar II disorder.

PubMed

Fisher, Alana; Manicavasagar, Vijaya; Sharpe, Louise; Laidsaar-Powell, Rebekah; Juraskova, Ilona

2018-02-01

Treatment decision-making in bipolar II disorder (BPII) is challenging, yet the decision support needs of patients and family remain unknown. To explore patient and family perspectives of treatment decision-making in BPII. Semistructured, qualitative interviews were conducted with 28 patients with BPII-diagnosis and 13 family members with experience in treatment decision-making in the outpatient setting. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Participant demographics, clinical characteristics and preferences for patient decision-making involvement were assessed. Four inter-related themes emerged: (1) Attitudes and response to diagnosis and treatment; (2) Influences on decision-making; (3) The nature and flow of decision-making; (4) Decision support and challenges. Views differed according to patient involvement preferences, time since diagnosis and patients' current mood symptoms. This is the first known study to provide in-depth patient and family insights into the key factors influencing BPII treatment decision-making, and potential improvements and challenges to this process. Findings will inform the development of BPII treatment decision-making resources that better meet the informational and decision-support priorities of end users. This research was partly funded by a Postgraduate Research Grant awarded to the first author by the University of Sydney. No conflicts of interest declared.

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

PubMed

1995-08-01

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

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.

Enhancing decision making about participation in cancer clinical trials: development of a question prompt list

PubMed Central

Brown, Richard F.; Shuk, Elyse; Leighl, Natasha; Butow, Phyllis; Ostroff, Jamie; Edgerson, Shawna; Tattersall, Martin

2016-01-01

Purpose Slow accrual to cancer clinical trials impedes the progress of effective new cancer treatments. Poor physician–patient communication has been identified as a key contributor to low trial accrual. Question prompt lists (QPLs) have demonstrated a significant promise in facilitating communication in general, surgical, and palliative oncology settings. These simple patient interventions have not been tested in the oncology clinical trial setting. We aimed to develop a targeted QPL for clinical trials (QPL-CT). Method Lung, breast, and prostate cancer patients who either had (trial experienced) or had not (trial naive) participated in a clinical trial were invited to join focus groups to help develop and explore the acceptability of a QPL-CT. Focus groups were audio-recorded and transcribed. A research team, including a qualitative data expert, analyzed these data to explore patients’ decision-making processes and views about the utility of the QPL-CT prompt to aid in trial decision making. Results Decision making was influenced by the outcome of patients’ comparative assessment of perceived risks versus benefits of a trial, and the level of trust patients had in their doctors’ recommendation about the trial. Severity of a patient’s disease influenced trial decision making only for trial-naive patients. Conclusion Although patients were likely to prefer a paternalistic decision-making style, they expressed valuation of the QPL as an aid to decision making. QPL-CT utility extended beyond the actual consultation to include roles both before and after the clinical trial discussion. PMID:20593202

Feedback Blunting: Total Sleep Deprivation Impairs Decision Making that Requires Updating Based on Feedback

PubMed Central

Whitney, Paul; Hinson, John M.; Jackson, Melinda L.; Van Dongen, Hans P.A.

2015-01-01

Study Objectives: To better understand the sometimes catastrophic effects of sleep loss on naturalistic decision making, we investigated effects of sleep deprivation on decision making in a reversal learning paradigm requiring acquisition and updating of information based on outcome feedback. Design: Subjects were randomized to a sleep deprivation or control condition, with performance testing at baseline, after 2 nights of total sleep deprivation (or rested control), and following 2 nights of recovery sleep. Subjects performed a decision task involving initial learning of go and no go response sets followed by unannounced reversal of contingencies, requiring use of outcome feedback for decisions. A working memory scanning task and psychomotor vigilance test were also administered. Setting: Six consecutive days and nights in a controlled laboratory environment with continuous behavioral monitoring. Subjects: Twenty-six subjects (22–40 y of age; 10 women). Interventions: Thirteen subjects were randomized to a 62-h total sleep deprivation condition; the others were controls. Results: Unlike controls, sleep deprived subjects had difficulty with initial learning of go and no go stimuli sets and had profound impairment adapting to reversal. Skin conductance responses to outcome feedback were diminished, indicating blunted affective reactions to feedback accompanying sleep deprivation. Working memory scanning performance was not significantly affected by sleep deprivation. And although sleep deprived subjects showed expected attentional lapses, these could not account for impairments in reversal learning decision making. Conclusions: Sleep deprivation is particularly problematic for decision making involving uncertainty and unexpected change. Blunted reactions to feedback while sleep deprived underlie failures to adapt to uncertainty and changing contingencies. Thus, an error may register, but with diminished effect because of reduced affective valence of the feedback or because the feedback is not cognitively bound with the choice. This has important implications for understanding and managing sleep loss-induced cognitive impairment in emergency response, disaster management, military operations, and other dynamic real-world settings with uncertain outcomes and imperfect information. Citation: Whitney P, Hinson JM, Jackson ML, Van Dongen HPA. Feedback blunting: total sleep deprivation impairs decision making that requires updating based on feedback. SLEEP 2015;38(5):745–754. PMID:25515105

Adolescent psychological development, parenting styles, and pediatric decision making.

PubMed

Partridge, Brian C

2010-10-01

The United Nations Convention on the Rights of the Child risks harm to adolescents insofar as it encourages not only poor decision making by adolescents but also parenting styles that will have an adverse impact on the development of mature decision-making capacities in them. The empirical psychological and neurophysiological data weigh against augmenting and expression of the rights of children. Indeed, the data suggest grounds for expanding parental authority, not limiting its scope. At the very least, any adequate appreciation of the moral claims regarding the authority of parents with respect to the decision-making capacity of adolescents needs to be set within an understanding of the psychological and neurophysiological facts regarding the development of adolescent decision-making capacity.

Using sense-making theory to aid understanding of the recognition, assessment and management of pain in patients with dementia in acute hospital settings.

PubMed

Dowding, Dawn; Lichtner, Valentina; Allcock, Nick; Briggs, Michelle; James, Kirstin; Keady, John; Lasrado, Reena; Sampson, Elizabeth L; Swarbrick, Caroline; José Closs, S

2016-01-01

The recognition, assessment and management of pain in hospital settings is suboptimal, and is a particular challenge in patients with dementia. The existing process guiding pain assessment and management in clinical settings is based on the assumption that nurses follow a sequential linear approach to decision making. In this paper we re-evaluate this theoretical assumption drawing on findings from a study of pain recognition, assessment and management in patients with dementia. To provide a revised conceptual model of pain recognition, assessment and management based on sense-making theories of decision making. The research we refer to is an exploratory ethnographic study using nested case sites. Patients with dementia (n=31) were the unit of data collection, nested in 11 wards (vascular, continuing care, stroke rehabilitation, orthopaedic, acute medicine, care of the elderly, elective and emergency surgery), located in four NHS hospital organizations in the UK. Data consisted of observations of patients at bedside (170h in total); observations of the context of care; audits of patient hospital records; documentary analysis of artefacts; semi-structured interviews (n=56) and informal open conversations with staff and carers (family members). Existing conceptualizations of pain recognition, assessment and management do not fully explain how the decision process occurs in clinical practice. Our research indicates that pain recognition, assessment and management is not an individual cognitive activity; rather it is carried out by groups of individuals over time and within a specific organizational culture or climate, which influences both health care professional and patient behaviour. We propose a revised theoretical model of decision making related to pain assessment and management for patients with dementia based on theories of sense-making, which is reflective of the reality of clinical decision making in acute hospital wards. The revised model recognizes the salience of individual cognition as well as acknowledging that decisions are constructed through social interaction and organizational context. The model will be used in further research to develop decision support interventions to assist with the assessment and management of patients with dementia in acute hospital settings. Copyright © 2015. Published by Elsevier Ltd.

An integrated, ethically driven environmental model of clinical decision making in emergency settings.

PubMed

Wolf, Lisa

2013-02-01

To explore the relationship between multiple variables within a model of critical thinking and moral reasoning. A quantitative descriptive correlational design using a purposive sample of 200 emergency nurses. Measured variables were accuracy in clinical decision-making, moral reasoning, perceived care environment, and demographics. Analysis was by bivariate correlation using Pearson's product-moment correlation coefficients, chi square and multiple linear regression analysis. The elements as identified in the integrated ethically-driven environmental model of clinical decision-making (IEDEM-CD) corrected depict moral reasoning and environment of care as factors significantly affecting accuracy in decision-making. The integrated, ethically driven environmental model of clinical decision making is a framework useful for predicting clinical decision making accuracy for emergency nurses in practice, with further implications in education, research and policy. A diagnostic and therapeutic framework for identifying and remediating individual and environmental challenges to accurate clinical decision making. © 2012, The Author. International Journal of Nursing Knowledge © 2012, NANDA International.

The effect of professional identity on comprehensiveness in strategic decision making: physician executives in the Canadian health care context.

PubMed

Karmali, Shazia

2012-01-01

This paper explores differences in decision-making approaches between physician executives and nonphysician executives in a managerial setting. Fredrickson and Mitchell's (1984) conceptualization of the construct of comprehensiveness in strategic decision making is the central construct of this paper. Theories of professional identity, socialization, and institutional/dominant logics are applied to illustrate their impact on strategic decision-making approaches of physician and nonphysician executives. This paper proposes that high-status professionals, specifically physicians, occupying senior management roles are likely to approach decision making in a way that is consistent with their professional identity, and by extension, that departments led by physician executives are less likely to exhibit comprehensiveness in strategic decision-making processes than departments led by nonphysician executives. This paper provides conceptual evidence that physicians and nonphysicians approach management differently, and introduces the utility of comprehensiveness as a construct for strategic decision making in the context of health care management.

Dynamics of individual perceptual decisions

PubMed Central

Clark, Torin K.; Lu, Yue M.; Karmali, Faisal

2015-01-01

Perceptual decision making is fundamental to a broad range of fields including neurophysiology, economics, medicine, advertising, law, etc. Although recent findings have yielded major advances in our understanding of perceptual decision making, decision making as a function of time and frequency (i.e., decision-making dynamics) is not well understood. To limit the review length, we focus most of this review on human findings. Animal findings, which are extensively reviewed elsewhere, are included when beneficial or necessary. We attempt to put these various findings and data sets, which can appear to be unrelated in the absence of a formal dynamic analysis, into context using published models. Specifically, by adding appropriate dynamic mechanisms (e.g., high-pass filters) to existing models, it appears that a number of otherwise seemingly disparate findings from the literature might be explained. One hypothesis that arises through this dynamic analysis is that decision making includes phasic (high pass) neural mechanisms, an evidence accumulator and/or some sort of midtrial decision-making mechanism (e.g., peak detector and/or decision boundary). PMID:26467513

Robust Decision Making for Improved Mission Assurance

DTIC Science & Technology

2014-06-01

Technology Team (STT) proposed and was approved to receive funding for a set of four research projects advancing foundational decision science and... technology over a three year period of performance. At the time it was approved, the initiative involved 27 collaborating scientists and engineers from five...Appendix E. Sensors Directorate Technologies for Robust Decision Making for Improved Mission Assurance

Trouble in Paradise: Teacher Conflicts in Shared Decision Making. NCEL Occasional Paper No. 8.

ERIC Educational Resources Information Center

Weiss, Carol H.; And Others

Drawing on interviews with 180 staff members from 45 public high schools in 15 states, this document examines the advantages and disadvantages of teacher participation in shared decision making. The settings of six high schools that had structured mechanisms for teacher participation in school decisions are described, and problems that emerged…

Determining rules for closing customer service centers: A public utility company's fuzzy decision

NASA Technical Reports Server (NTRS)

Dekorvin, Andre; Shipley, Margaret F.

1992-01-01

In the present work, we consider the general problem of knowledge acquisition under uncertainty. A commonly used method is to learn by examples. We observe how the expert solves specific cases and from this infer some rules by which the decision was made. Unique to this work is the fuzzy set representation of the conditions or attributes upon which the decision make may base his fuzzy set decision. From our examples, we infer certain and possible rules containing fuzzy terms. It should be stressed that the procedure determines how closely the expert follows the conditions under consideration in making his decision. We offer two examples pertaining to the possible decision to close a customer service center of a public utility company. In the first example, the decision maker does not follow too closely the conditions. In the second example, the conditions are much more relevant to the decision of the expert.

The Design and Development of an Intelligent Planning Aid

DTIC Science & Technology

1986-07-01

reasons why widening the scope of TACPLAK’s applicability make sense. First# plan execution and monitoring (and the re-planning that then occurs) are...Orsssnu, contracting officer’s representative I», KKY voees o Decision Making Tactical Planning Taxonomy Problem Solving ii M ifrntitr *r MM* I...planning aid. It documents the development of a decision- making , planning, and decision-aiding analytical framework comprising a set of models, s generic

Analysis of a decision model in the context of equilibrium pricing and order book pricing

NASA Astrophysics Data System (ADS)

Wagner, D. C.; Schmitt, T. A.; Schäfer, R.; Guhr, T.; Wolf, D. E.

2014-12-01

An agent-based model for financial markets has to incorporate two aspects: decision making and price formation. We introduce a simple decision model and consider its implications in two different pricing schemes. First, we study its parameter dependence within a supply-demand balance setting. We find realistic behavior in a wide parameter range. Second, we embed our decision model in an order book setting. Here, we observe interesting features which are not present in the equilibrium pricing scheme. In particular, we find a nontrivial behavior of the order book volumes which reminds of a trend switching phenomenon. Thus, the decision making model alone does not realistically represent the trading and the stylized facts. The order book mechanism is crucial.

Designing and evaluating an interprofessional shared decision-making and goal-setting decision aid for patients with diabetes in clinical care--systematic decision aid development and study protocol.

PubMed

Yu, Catherine H; Stacey, Dawn; Sale, Joanna; Hall, Susan; Kaplan, David M; Ivers, Noah; Rezmovitz, Jeremy; Leung, Fok-Han; Shah, Baiju R; Straus, Sharon E

2014-01-22

Care of patients with diabetes often occurs in the context of other chronic illness. Competing disease priorities and competing patient-physician priorities present challenges in the provision of care for the complex patient. Guideline implementation interventions to date do not acknowledge these intricacies of clinical practice. As a result, patients and providers are left overwhelmed and paralyzed by the sheer volume of recommendations and tasks. An individualized approach to the patient with diabetes and multiple comorbid conditions using shared decision-making (SDM) and goal setting has been advocated as a patient-centred approach that may facilitate prioritization of treatment options. Furthermore, incorporating interprofessional integration into practice may overcome barriers to implementation. However, these strategies have not been taken up extensively in clinical practice. To systematically develop and test an interprofessional SDM and goal-setting toolkit for patients with diabetes and other chronic diseases, following the Knowledge to Action framework. 1. Feasibility study: Individual interviews with primary care physicians, nurses, dietitians, pharmacists, and patients with diabetes will be conducted, exploring their experiences with shared decision-making and priority-setting, including facilitators and barriers, the relevance of a decision aid and toolkit for priority-setting, and how best to integrate it into practice.2. Toolkit development: Based on this data, an evidence-based multi-component SDM toolkit will be developed. The toolkit will be reviewed by content experts (primary care, endocrinology, geriatricians, nurses, dietitians, pharmacists, patients) for accuracy and comprehensiveness.3. Heuristic evaluation: A human factors engineer will review the toolkit and identify, list and categorize usability issues by severity.4. Usability testing: This will be done using cognitive task analysis.5. Iterative refinement: Throughout the development process, the toolkit will be refined through several iterative cycles of feedback and redesign. Interprofessional shared decision-making regarding priority-setting with the use of a decision aid toolkit may help prioritize care of individuals with multiple comorbid conditions. Adhering to principles of user-centered design, we will develop and refine a toolkit to assess the feasibility of this approach.

Designing and evaluating an interprofessional shared decision-making and goal-setting decision aid for patients with diabetes in clinical care - systematic decision aid development and study protocol

PubMed Central

2014-01-01

Background Care of patients with diabetes often occurs in the context of other chronic illness. Competing disease priorities and competing patient-physician priorities present challenges in the provision of care for the complex patient. Guideline implementation interventions to date do not acknowledge these intricacies of clinical practice. As a result, patients and providers are left overwhelmed and paralyzed by the sheer volume of recommendations and tasks. An individualized approach to the patient with diabetes and multiple comorbid conditions using shared decision-making (SDM) and goal setting has been advocated as a patient-centred approach that may facilitate prioritization of treatment options. Furthermore, incorporating interprofessional integration into practice may overcome barriers to implementation. However, these strategies have not been taken up extensively in clinical practice. Objectives To systematically develop and test an interprofessional SDM and goal-setting toolkit for patients with diabetes and other chronic diseases, following the Knowledge to Action framework. Methods 1. Feasibility study: Individual interviews with primary care physicians, nurses, dietitians, pharmacists, and patients with diabetes will be conducted, exploring their experiences with shared decision-making and priority-setting, including facilitators and barriers, the relevance of a decision aid and toolkit for priority-setting, and how best to integrate it into practice. 2. Toolkit development: Based on this data, an evidence-based multi-component SDM toolkit will be developed. The toolkit will be reviewed by content experts (primary care, endocrinology, geriatricians, nurses, dietitians, pharmacists, patients) for accuracy and comprehensiveness. 3. Heuristic evaluation: A human factors engineer will review the toolkit and identify, list and categorize usability issues by severity. 4. Usability testing: This will be done using cognitive task analysis. 5. Iterative refinement: Throughout the development process, the toolkit will be refined through several iterative cycles of feedback and redesign. Discussion Interprofessional shared decision-making regarding priority-setting with the use of a decision aid toolkit may help prioritize care of individuals with multiple comorbid conditions. Adhering to principles of user-centered design, we will develop and refine a toolkit to assess the feasibility of this approach. PMID:24450385

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

PubMed

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

2018-04-20

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

TESTING MULTI-CRITERIA DECISION ANALYSIS FOR MORE TRANSPARENT RESOURCE-ALLOCATION DECISION MAKING IN COLOMBIA.

PubMed

Castro Jaramillo, Hector Eduardo; Goetghebeur, Mireille; Moreno-Mattar, Ornella

2016-01-01

In 2012, Colombia experienced an important institutional transformation after the establishment of the Health Technology Assessment Institute (IETS), the disbandment of the Regulatory Commission for Health and the reassignment of reimbursement decision-making powers to the Ministry of Health and Social Protection (MoHSP). These dynamic changes provided the opportunity to test Multi-Criteria Decision Analysis (MCDA) for systematic and more transparent resource-allocation decision-making. During 2012 and 2013, the MCDA framework Evidence and Value: Impact on Decision Making (EVIDEM) was tested in Colombia. This consisted of a preparatory stage in which the investigators conducted literature searches and produced HTA reports for four interventions of interest, followed by a panel session with decision makers. This method was contrasted with a current approach used in Colombia for updating the publicly financed benefits package (POS), where narrative health technology assessment (HTA) reports are presented alongside comprehensive budget impact analyses (BIAs). Disease severity, size of population, and efficacy ranked at the top among fifteen preselected relevant criteria. MCDA estimates of technologies of interest ranged between 71 to 90 percent of maximum value. The ranking of technologies was sensitive to the methods used. Participants considered that a two-step approach including an MCDA template, complemented by a detailed BIA would be the best approach to assist decision-making in this context. Participants agreed that systematic priority setting should take place in Colombia. This work may serve as the basis to the MoHSP on its interest of setting up a systematic and more transparent process for resource-allocation decision-making.

Recursive Rational Choice.

DTIC Science & Technology

1981-11-01

that a decision entity acted as though it were making rational choices among a set of alternatives, as a not unreason- able paradigm of human behavior...Gottinger l / , which, like Kramer’s approach, consider the item of rationality in decision making for social decision rules as representable by finite...1974] in the consideration of whether or not a decisive choice function that is regular rational in the sense of Richter [19711 when defined on subsets

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.

Choosing an out-of-hospital birth centre: Exploring women's decision-making experiences.

PubMed

Wood, Rebecca J; Mignone, Javier; Heaman, Maureen I; Robinson, Kristine J; Roger, Kerstin Stieber

2016-08-01

the primary objective for this study was to explore women's experiences of choosing to plan a birth at an out-of-hospital birth centre. We sought to understand how women make the choice to plan for an out-of-hospital birth and the meaning that women ascribe to this decision-making process. a qualitative phenomenological study was conducted in Winnipeg, Canada with a sample of seventeen post partum women who represent the socio-demographic characteristics of the actual users of the Birth Centre in Winnipeg. The women participated in semistructured interviews. Through a feminist perspective and using interpretative phenomenological analysis (IPA), each participant's experience of birthplace decision-making was explored. six themes emerged through the analysis: (1) Making the decision in the context of relationships; (2) Exercising personal agency; (3) An expression of one's ideology; (4) Really thinking it through; (5) Fitting into the eligibility criteria; and (6) The psychology of the space. The findings suggested that a woman's sense of safety was related to each of these themes. the birth centre decision-making experience has many similarities to the homebirth decision-making process. The visceral impact of the physical design of the facility plays an important role and differentiates the birth centre decision from other birth setting options. The concept of relational autonomy was emphasised in this study, in that women make the decision in the context of their relationships with their midwives and partners. The study has implications for midwifery practice and health-care policy related to: client education on birth settings, design of birth environments, validation of the birth centre concept, and upholding the women-centred midwifery model of care. The study highlighted the importance of increasing access to out-of-hospital birth centres. Copyright © 2016 Elsevier Ltd. All rights reserved.

Temporal characteristics of decisions in hospital encounters: a threshold for shared decision making? A qualitative study.

PubMed

Ofstad, Eirik H; Frich, Jan C; Schei, Edvin; Frankel, Richard M; Gulbrandsen, Pål

2014-11-01

To identify and characterize physicians' statements that contained evidence of clinically relevant decisions in encounters with patients in different hospital settings. Qualitative analysis of 50 videotaped encounters from wards, the emergency room (ER) and outpatient clinics in a department of internal medicine at a Norwegian university hospital. Clinical decisions could be grouped in a temporal order: decisions which had already been made, and were brought into the encounter by the physician (preformed decisions), decisions made in the present (here-and-now decisions), and decisions prescribing future actions given a certain course of events (conditional decisions). Preformed decisions were a hallmark in the ward and conditional decisions a main feature of ER encounters. Clinical decisions related to a patient-physician encounter spanned a time frame exceeding the duration of the encounter. While a distribution of decisions over time and space fosters sharing and dilution of responsibility between providers, it makes the decision making process hard to access for patients. In order to plan when and how to involve patients in decisions, physicians need increased awareness of when clinical decisions are made, who usually makes them, and who should make them. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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.

Probability or Reasoning: Current Thinking and Realistic Strategies for Improved Medical Decisions

PubMed Central

2017-01-01

A prescriptive model approach in decision making could help achieve better diagnostic accuracy in clinical practice through methods that are less reliant on probabilistic assessments. Various prescriptive measures aimed at regulating factors that influence heuristics and clinical reasoning could support clinical decision-making process. Clinicians could avoid time-consuming decision-making methods that require probabilistic calculations. Intuitively, they could rely on heuristics to obtain an accurate diagnosis in a given clinical setting. An extensive literature review of cognitive psychology and medical decision-making theory was performed to illustrate how heuristics could be effectively utilized in daily practice. Since physicians often rely on heuristics in realistic situations, probabilistic estimation might not be a useful tool in everyday clinical practice. Improvements in the descriptive model of decision making (heuristics) may allow for greater diagnostic accuracy. PMID:29209469

Probability or Reasoning: Current Thinking and Realistic Strategies for Improved Medical Decisions.

PubMed

Nantha, Yogarabindranath Swarna

2017-11-01

A prescriptive model approach in decision making could help achieve better diagnostic accuracy in clinical practice through methods that are less reliant on probabilistic assessments. Various prescriptive measures aimed at regulating factors that influence heuristics and clinical reasoning could support clinical decision-making process. Clinicians could avoid time-consuming decision-making methods that require probabilistic calculations. Intuitively, they could rely on heuristics to obtain an accurate diagnosis in a given clinical setting. An extensive literature review of cognitive psychology and medical decision-making theory was performed to illustrate how heuristics could be effectively utilized in daily practice. Since physicians often rely on heuristics in realistic situations, probabilistic estimation might not be a useful tool in everyday clinical practice. Improvements in the descriptive model of decision making (heuristics) may allow for greater diagnostic accuracy.

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

PubMed Central

Dolan, James G.

2008-01-01

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

Social setting, intuition and experience in laboratory experiments interact to shape cooperative decision-making

PubMed Central

Capraro, Valerio; Cococcioni, Giorgia

2015-01-01

Recent studies suggest that cooperative decision-making in one-shot interactions is a history-dependent dynamic process: promoting intuition versus deliberation typically has a positive effect on cooperation (dynamism) among people living in a cooperative setting and with no previous experience in economic games on cooperation (history dependence). Here, we report on a laboratory experiment exploring how these findings transfer to a non-cooperative setting. We find two major results: (i) promoting intuition versus deliberation has no effect on cooperative behaviour among inexperienced subjects living in a non-cooperative setting; (ii) experienced subjects cooperate more than inexperienced subjects, but only under time pressure. These results suggest that cooperation is a learning process, rather than an instinctive impulse or a self-controlled choice, and that experience operates primarily via the channel of intuition. Our findings shed further light on the cognitive basis of human cooperative decision-making and provide further support for the recently proposed social heuristics hypothesis. PMID:26156762

Data Management & Decision Making. Technical Report No. 14.

ERIC Educational Resources Information Center

Speedie, Stuart M.; Sanders, Susan

"Data Management and Decision Making" is a set of instructional materials designed to teach practicing and potential educational administrators about the uses of operations research in educational administration. It consists of five units--"Operations Research in Education,""PERT/CPM: A Planning and Analysis…

A framework for multi-stakeholder decision-making and conflict resolution

EPA Science Inventory

We propose a decision-making framework to compute compromise solutions that balance conflicting priorities of multiple stakeholders on multiple objectives. In our setting, we shape the stakeholder dis-satisfaction distribution by solving a conditional-value-at-risk (CVaR) minimiz...

Setting Priorities: Personal Values, Organizational Results. Ideas into Action Guidebooks

ERIC Educational Resources Information Center

Cartwright, Talula

2007-01-01

Successful leaders get results. To get results, you need to set priorities. This book can help you do a better job of setting priorities, recognizing the personal values that motivate your decision making, the probable trade-offs and consequences of your decisions, and the importance of aligning your priorities with your organization's…

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

Risk Stratification and Shared Decision Making for Colorectal Cancer Screening: A Randomized Controlled Trial.

PubMed

Schroy, Paul C; Duhovic, Emir; Chen, Clara A; Heeren, Timothy C; Lopez, William; Apodaca, Danielle L; Wong, John B

2016-05-01

Eliciting patient preferences within the context of shared decision making has been advocated for colorectal cancer (CRC) screening, yet providers often fail to comply with patient preferences that differ from their own. To determine whether risk stratification for advanced colorectal neoplasia (ACN) influences provider willingness to comply with patient preferences when selecting a desired CRC screening option. Randomized controlled trial. Asymptomatic, average-risk patients due for CRC screening in an urban safety net health care setting. Patients were randomized 1:1 to a decision aid alone (n= 168) or decision aid plus risk assessment (n= 173) arm between September 2012 and September 2014. The primary outcome was concordance between patient preference and test ordered; secondary outcomes included patient satisfaction with the decision-making process, screening intentions, test completion rates, and provider satisfaction. Although providers perceived risk stratification to be useful in selecting an appropriate screening test for their average-risk patients, no significant differences in concordance were observed between the decision aid alone and decision aid plus risk assessment groups (88.1% v. 85.0%,P= 0.40) or high- and low-risk groups (84.5% v. 87.1%,P= 0.51). Concordance was highest for colonoscopy and relatively low for tests other than colonoscopy, regardless of study arm or risk group. Failure to comply with patient preferences was negatively associated with satisfaction with the decision-making process, screening intentions, and test completion rates. Single-institution setting; lack of provider education about the utility of risk stratification into their decision making. Providers perceived risk stratification to be useful in their decision making but often failed to comply with patient preferences for tests other than colonoscopy, even among those deemed to be at low risk of ACN. © The Author(s) 2016.

A rough set approach for determining weights of decision makers in group decision making

PubMed Central

Yang, Qiang; Du, Ping-an; Wang, Yong; Liang, Bin

2017-01-01

This study aims to present a novel approach for determining the weights of decision makers (DMs) based on rough group decision in multiple attribute group decision-making (MAGDM) problems. First, we construct a rough group decision matrix from all DMs’ decision matrixes on the basis of rough set theory. After that, we derive a positive ideal solution (PIS) founded on the average matrix of rough group decision, and negative ideal solutions (NISs) founded on the lower and upper limit matrixes of rough group decision. Then, we obtain the weight of each group member and priority order of alternatives by using relative closeness method, which depends on the distances from each individual group member’ decision to the PIS and NISs. Through comparisons with existing methods and an on-line business manager selection example, the proposed method show that it can provide more insights into the subjectivity and vagueness of DMs’ evaluations and selections. PMID:28234974

Developmental changes in autonomic responses are associated with future reward/punishment expectations: A study of sympathetic skin responses in the Markov decision task.

PubMed

Hosaka, Hiromi; Aoyagi, Kakuro; Kaga, Yoshimi; Kanemura, Hideaki; Sugita, Kanji; Aihara, Masao

2017-08-01

Autonomic nervous system activity is recognized as a major component of emotional responses. Future reward/punishment expectations depend upon the process of decision making in the frontal lobe, which is considered to play an important role in executive function. The aim of this study was to investigate the relationship between autonomic responses and decision making during reinforcement tasks using sympathetic skin responses (SSR). Nine adult and 9 juvenile (mean age, 10.2years) volunteers were enrolled in this study. SSRs were measured during the Markov decision task (MDT), which is a reinforcement task. In this task, subjects must endure a small immediate loss to ultimately get a large reward. The subjects had to undergo three sets of tests and their scores in these tests were assessed and evaluated. All adults showed gradually increasing scores for the MDT from the first to third set. As the trial progressed from the first to second set in adults, SSR appearance ratios remarkably increased for both punishment and reward expectations. In comparison with adults, children showed decreasing scores from the first to second set. There were no significant inter-target differences in the SSR appearance ratio in the first and second set in children. In the third set, the SSR appearance ratio for reward expectations was higher than that in the neutral condition. In reinforcement tasks, such as MDT, autonomic responses play an important role in decision making. We assume that SSRs are elicited during efficient decision making tasks associated with future reward/punishment expectations, which demonstrates the importance of autonomic function. In contrast, in children around the age of 10years, the autonomic system does not react as an organized response specific to reward/punishment expectations. This suggests the immaturity of the future reward/punishment expectations process in children. Copyright © 2017 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Impact of Interprofessional Relationships from Nurses' Perspective on the Decision-Making Capacity of Patients in a Clinical Setting.

PubMed

Molina-Mula, Jesús; Gallo-Estrada, Julia; Perelló-Campaner, Catalina

2017-12-29

Interprofessional relationships may impact the decision making of patients in a clinical setting. The objective of this study was to analyse the decision-making capabilities of patients from nurses' perspectives of interprofessional relationships using Foucauldian ethics. This qualitative study was based on poststructuralist Foucault references with in-depth interviews of nurses working in internal medicine and specialties in a general hospital. The patients constantly appeared in the definition of teamwork, but also as a passive element used by every professional to communicate with others. Nurses continue modelling a type of patient passivity, or what Foucault called passive subjectivity in relation to oneself, because the patient is guided and directed to take charge of a truth provided by professionals. Nurses must break the rigid design of sections or professional skills, and adopt a model of teamwork that meets the needs of the patient and increases their decision-making power. The quality of care will increase to the extent that professionals establish a relationship of equality with the patient, allowing the patient to make real decisions about their care. An egalitarian model of teamwork is beneficial to the patient, abandoning the idea of a team where the patient and family are constantly excluded from decisions about their care.

Impact of Interprofessional Relationships from Nurses’ Perspective on the Decision-Making Capacity of Patients in a Clinical Setting

PubMed Central

Gallo-Estrada, Julia; Perelló-Campaner, Catalina

2017-01-01

Interprofessional relationships may impact the decision making of patients in a clinical setting. The objective of this study was to analyse the decision-making capabilities of patients from nurses’ perspectives of interprofessional relationships using Foucauldian ethics. This qualitative study was based on poststructuralist Foucault references with in-depth interviews of nurses working in internal medicine and specialties in a general hospital. The patients constantly appeared in the definition of teamwork, but also as a passive element used by every professional to communicate with others. Nurses continue modelling a type of patient passivity, or what Foucault called passive subjectivity in relation to oneself, because the patient is guided and directed to take charge of a truth provided by professionals. Nurses must break the rigid design of sections or professional skills, and adopt a model of teamwork that meets the needs of the patient and increases their decision-making power. The quality of care will increase to the extent that professionals establish a relationship of equality with the patient, allowing the patient to make real decisions about their care. An egalitarian model of teamwork is beneficial to the patient, abandoning the idea of a team where the patient and family are constantly excluded from decisions about their care. PMID:29286342

Making Debris Avoidance Decisions for ESMO's EOS Mission Set

NASA Technical Reports Server (NTRS)

Mantziaras, Dimitrios

2016-01-01

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

Analysis of the decision-making process leading to appendectomy: a grounded theory study.

PubMed

Larsson, Gerry; Weibull, Henrik; Larsson, Bodil Wilde

2004-11-01

The aim was to develop a theoretical understanding of the decision-making process leading to appendectomy. A qualitative interview study was performed in the grounded theory tradition using the constant comparative method to analyze data. The study setting was one county hospital and two local hospitals in Sweden, where 11 surgeons and 15 surgical nurses were interviewed. A model was developed which suggests that surgeons' decision making regarding appendectomy is formed by the interplay between their medical assessment of the patient's condition and a set of contextual characteristics. The latter consist of three interacting factors: (1) organizational conditions, (2) the professional actors' individual characteristics and interaction, and (3) the personal characteristics of the patient and his or her family or relatives. In case the outcome of medical assessment is ambiguous, the risk evaluation and final decision will be influenced by an interaction of the contextual characteristics. It was concluded that, compared to existing, rational models of decision making, the model presented identified potentially important contextual characteristics and an outline on when they come into play.

Children's participation in consultations and decision-making at health service level: a review of the literature.

PubMed

Coyne, Imelda

2008-11-01

The past decade has seen a growing recognition in Ireland and internationally that children and young people have a right to participate in matters that affect their lives. To critique the research literature on children's, parents and healthcare professionals' experiences of children's participation in consultations and decision-making within the healthcare setting. The literature was obtained from electronic databases, books, and journals focusing on work published in between 1993 and 2007. Despite the importance of consulting with sick children, their views are rarely sought nor acknowledged within the healthcare setting. Children are rarely involved in decision-making process and appear to occupy a marginalized position in healthcare encounters. Healthcare professionals and parents play a significant influence on whether children's efforts to participate are facilitated and supported in the hospital setting. There is a need for further research to explore health professionals' and parents' perspectives on children's participation in consultations and decision-making, as clearly they have reservations/concerns about children's active involvement in such matters. This information could be used to develop guidelines that will assist professionals and parents in facilitating and supporting children's participation.

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

Reaching Common Ground

ERIC Educational Resources Information Center

Hoerr, Thomas R.

2006-01-01

It is not easy being a principal. The principal's job is not just set the vision for a school, but also to make sure that everyone embraces that vision and works to make it a reality. In the process, principals will be occasionally be seen as "enforcers." Principals must make hard decisions, and virtually no decision is appreciated by everyone.…

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

PubMed

Helsloot, Ira; Groenendaal, Jelle

2011-07-01

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

Multiple Criteria Decision Analysis for Health Care Decision Making--An Introduction: Report 1 of the ISPOR MCDA Emerging Good Practices Task Force.

PubMed

Thokala, Praveen; Devlin, Nancy; Marsh, Kevin; Baltussen, Rob; Boysen, Meindert; Kalo, Zoltan; Longrenn, Thomas; Mussen, Filip; Peacock, Stuart; Watkins, John; Ijzerman, Maarten

2016-01-01

Health care decisions are complex and involve confronting trade-offs between multiple, often conflicting, objectives. Using structured, explicit approaches to decisions involving multiple criteria can improve the quality of decision making and a set of techniques, known under the collective heading multiple criteria decision analysis (MCDA), are useful for this purpose. MCDA methods are widely used in other sectors, and recently there has been an increase in health care applications. In 2014, ISPOR established an MCDA Emerging Good Practices Task Force. It was charged with establishing a common definition for MCDA in health care decision making and developing good practice guidelines for conducting MCDA to aid health care decision making. This initial ISPOR MCDA task force report provides an introduction to MCDA - it defines MCDA; provides examples of its use in different kinds of decision making in health care (including benefit risk analysis, health technology assessment, resource allocation, portfolio decision analysis, shared patient clinician decision making and prioritizing patients' access to services); provides an overview of the principal methods of MCDA; and describes the key steps involved. Upon reviewing this report, readers should have a solid overview of MCDA methods and their potential for supporting health care decision making. Copyright © 2016. Published by Elsevier Inc.

Formative Justice: The Regulative Principle of Education

ERIC Educational Resources Information Center

McClintock, Robert

2016-01-01

Background/Context: Concepts of justice relevant to making personal and public decisions about education. Purpose: To clarify a concept of formative justice that persons and the public often ignore in making decisions about educational effort. Setting: "The windmills of your mind" Research Design: Reflective essay.…

The Impact of Prepersuasion Social Influence Tactics on Military Decision Making

DTIC Science & Technology

2011-03-01

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

Directional Slack-Based Measure for the Inverse Data Envelopment Analysis

PubMed Central

Abu Bakar, Mohd Rizam; Lee, Lai Soon; Jaafar, Azmi B.; Heydar, Maryam

2014-01-01

A novel technique has been introduced in this research which lends its basis to the Directional Slack-Based Measure for the inverse Data Envelopment Analysis. In practice, the current research endeavors to elucidate the inverse directional slack-based measure model within a new production possibility set. On one occasion, there is a modification imposed on the output (input) quantities of an efficient decision making unit. In detail, the efficient decision making unit in this method was omitted from the present production possibility set but substituted by the considered efficient decision making unit while its input and output quantities were subsequently modified. The efficiency score of the entire DMUs will be retained in this approach. Also, there would be an improvement in the efficiency score. The proposed approach was investigated in this study with reference to a resource allocation problem. It is possible to simultaneously consider any upsurges (declines) of certain outputs associated with the efficient decision making unit. The significance of the represented model is accentuated by presenting numerical examples. PMID:24883350

On-Line Allocation Of Robot Resources To Task Plans

NASA Astrophysics Data System (ADS)

Lyons, Damian M.

1989-02-01

In this paper, I present an approach to representing plans that make on-line decisions about resource allocation. An on-line decision is the evaluation of a conditional expression involving sensory information as the plan is being executed. I use a plan representation called 7ZS10'1 1,12that has been especially designed for the domain of robot programming, and in particular, for the problem of on-line decisions. The resource allocation example is based on the robot assembly cell architecture outlined by Venkataraman and Lyons16. I begin by setting forth a definition of on-line decision making and some arguments as to why this form of decision making is important and useful. To set the context for the resource allocation example, I take some care in categorizing the types of on-line decision making and the approaches adopted by other workers so far. In particular, I justify a plan-based approach to the study of on-line decision making. From that, the focus shifts to one type of decision making: on-line allocation of robot resources to task plans. Robot resources are the physical manipulators (grippers, wrists, arms, feeders, etc) that are available to carry out the task. I formulate the assembly cell architecture of Venkataraman and Lyons16 as an R.S plan schema, and show how the on-line allocation specified in that architecture can be implemented. Finally, I show how considering the on-line allocation of logical resources, that is a physical resource plus some model information, can be used as a non-traditional approach to some problems in robot task planning.

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

PubMed Central

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

2017-01-01

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

Informed decision making before initiating screening mammography: does it occur and does it make a difference?

PubMed

Nekhlyudov, Larissa; Li, Rong; Fletcher, Suzanne W

2008-12-01

Informed decision making regarding screening mammography is recommended for women under age 50. To what extent it occurs in clinical settings is unclear. Using a mailed instrument, we surveyed women aged 40-44 prior to their first screening mammogram. All women were members of a large health maintenance organization and received care at a large medical practice in the Greater Boston area. The survey measured informed decision making, decisional conflict, satisfaction, and screening mammography knowledge and intentions to undergo screening. Ninety-six women responded to the survey (response rate 47%). Overall, women reported limited informed decision making regarding screening mammography, both with respect to information exchange and involvement in the decision process. Less than half (47%) reported discussing the benefits of screening; 23% the uncertainties; and only 7% the harms. About 30% reported discussing the nature of the decision or clinical issue; and 29% reported their provider elicited their preferred role in the decision; 38% their preferences; and 24% their understanding of the information. Women who were uninformed had higher decisional conflict (2.37 vs. 1.83, P=0.005) about screening mammography and were more likely to be dissatisfied with the information and involvement. Women's screening mammography knowledge was limited in most areas; however being presented with information did not diminish their intentions to undergo screening. Informed decision making before initiating screening mammography is limited in this setting. There appears to be little indication that information about the benefits and harms decreases women's intentions to undergo screening. Methods to communicate information to women before initiating screening mammography are needed.

In search of tools to aid logical thinking and communicating about medical decision making.

PubMed

Hunink, M G

2001-01-01

To have real-time impact on medical decision making, decision analysts need a wide variety of tools to aid logical thinking and communication. Decision models provide a formal framework to integrate evidence and values, but they are commonly perceived as complex and difficult to understand by those unfamiliar with the methods, especially in the context of clinical decision making. The theory of constraints, introduced by Eliyahu Goldratt in the business world, provides a set of tools for logical thinking and communication that could potentially be useful in medical decision making. The author used the concept of a conflict resolution diagram to analyze the decision to perform carotid endarterectomy prior to coronary artery bypass grafting in a patient with both symptomatic coronary and asymptomatic carotid artery disease. The method enabled clinicians to visualize and analyze the issues, identify and discuss the underlying assumptions, search for the best available evidence, and use the evidence to make a well-founded decision. The method also facilitated communication among those involved in the care of the patient. Techniques from fields other than decision analysis can potentially expand the repertoire of tools available to support medical decision making and to facilitate communication in decision consults.

A Structured approach to incidental take decision making

USGS Publications Warehouse

McGowan, Conor P.

2013-01-01

Decision making related to incidental take of endangered species under U.S. law lends itself well to a structured decision making approach. Incidental take is the permitted killing, harming, or harassing of a protected species under the law as long as that harm is incidental to an otherwise lawful activity and does not “reduce appreciably the probability of survival and recovery in the wild.” There has been inconsistency in the process used for determining incidental take allowances across species and across time for the same species, and structured decision making has been proposed to improve decision making. I use an example decision analysis to demonstrate the process and its applicability to incidental take decisions, even under significant demographic uncertainty and multiple, competing objectives. I define the example problem, present an objectives statement and a value function, use a simulation model to assess the consequences of a set of management actions, and evaluate the tradeoffs among the different actions. The approach results in transparent and repeatable decisions.

Decision-Making in Multiple Sclerosis Patients: A Systematic Review.

PubMed

Neuhaus, Mireille; Calabrese, Pasquale; Annoni, Jean-Marie

2018-01-01

Multiple sclerosis (MS) is frequently associated with cognitive and behavioural deficits. A growing number of studies suggest an impact of MS on decision-making abilities. The aim of this systematic review was to assess if (1) performance of MS patients in decision-making tasks was consistently different from controls and (2) whether this modification was associated with cognitive dysfunction and emotional alterations. The search was conducted on Pubmed/Medline database. 12 studies evaluating the difference between MS patients and healthy controls using validated decision-making tasks were included. Outcomes considered were quantitative (net scores) and qualitative measurements (deliberation time and learning from feedback). Quantitative and qualitative decision-making impairment in MS was present in 64.7% of measurements. Patients were equally impaired in tasks for decision-making under risk and ambiguity. A correlation to other cognitive functions was present in 50% of cases, with the highest associations in the domains of processing speed and attentional capacity. In MS patients, qualitative and quantitative modifications may be present in any kind of decision-making task and can appear independently of other cognitive measures. Since decision-making abilities have a significant impact on everyday life, this cognitive aspect has an influential importance in various MS-related treatment settings.

Working memory capacity as controlled attention in tactical decision making.

PubMed

Furley, Philip A; Memmert, Daniel

2012-06-01

The controlled attention theory of working memory capacity (WMC, Engle 2002) suggests that WMC represents a domain free limitation in the ability to control attention and is predictive of an individual's capability of staying focused, avoiding distraction and impulsive errors. In the present paper we test the predictive power of WMC in computer-based sport decision-making tasks. Experiment 1 demonstrated that high-WMC athletes were better able at focusing their attention on tactical decision making while blocking out irrelevant auditory distraction. Experiment 2 showed that high-WMC athletes were more successful at adapting their tactical decision making according to the situation instead of relying on prepotent inappropriate decisions. The present results provide additional but also unique support for the controlled attention theory of WMC by demonstrating that WMC is predictive of controlling attention in complex settings among different modalities and highlight the importance of working memory in tactical decision making.

Methods for Conducting Cognitive Task Analysis for a Decision Making Task.

DTIC Science & Technology

1996-01-01

Cognitive task analysis (CTA) improves traditional task analysis procedures by analyzing the thought processes of performers while they complete a...for using these methods to conduct a CTA for domains which involve critical decision making tasks in naturalistic settings. The cognitive task analysis methods

APPLYING ECOLOGICAL PRINCIPLES TO LAND-USE DECISION MAKING IN AGRICULTURAL WATERSHEDS

EPA Science Inventory

The Ecological Society of America on sustainable Land Use has put together a set of ecological principles and guidelines to help in land-use decision making. The practical application of these principles and the associated guidelines to planning efforts in real landscapes will r...

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

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 Central

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. PMID:28552943

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.

Parents, adolescents, and consent for research participation.

PubMed

Iltis, Ana S

2013-06-01

Decisions concerning children in the health care setting have engendered significant controversy and sparked ethics policies and statements, legal action, and guidelines regarding who ought to make decisions involving children and how such decisions ought to be made. Traditionally, parents have been the default decision-makers for children not only with regard to health care but with regard to other matters, such as religious practice and education. In recent decades, there has been a steady trend away from the view that parents are in authority over their children and toward the view that children are rights-bearers who should be granted greater authority over themselves. The mature minor doctrine refers to the decision to grant mature minors the authority to make decisions traditionally reserved for their parents. This essay (1) documents the trend towards expanding the understanding of some minors as "mature" and hence as having the right and authority to give informed consent, (2) examines the reasons for which some commentators have a special interest in expanding the mature minor doctrine to the research setting and allowing minors to enroll in research without parental permission, and (3) defends the view that the mature minor doctrine, regardless of its application to clinical health care decisions, ought to be set aside in the research setting in favor of greater parental involvement.

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

ERIC Educational Resources Information Center

Klepzig, H. J.; Weiss, M.

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

Investigating the Decision-Making of Response to Intervention (RtI) Teams within the School Setting

ERIC Educational Resources Information Center

Thur, Scott M.

2015-01-01

The purpose of this study was to measure decision-making influences within RtI teams. The study examined the factors that influence school personnel involved in three areas of RtI: determining which RtI measures and tools teams select and implement (i.e. Measures and Tools), evaluating the data-driven decisions that are made based on the…

"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…

Patient Preferences and Surrogate Decision Making in Neuroscience Intensive Care Units

PubMed Central

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

2016-01-01

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

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

Assessment of Healthcare Decision-making Capacity

PubMed Central

Palmer, Barton W.; Harmell, Alexandrea L.

2016-01-01

It is often necessary for neuropsychologists, clinical psychologists, and other healthcare professionals to assess an individual's capacity to consent to treatment related to healthcare. This task can be challenging and requires a delicate balance of both respect for individuals' autonomy, as well as the protection of individuals with diminished capacity to make an autonomous decision. The purpose of the present review is to provide an overview of the conceptual model of decisional capacity as well as a brief summary of some of the currently available instruments designed to help evaluate medical decision making. In addition, current empirical literature on the relationship between neuropsychological abilities and decision-making capacity is discussed and a brief set of recommendations is provided to further aid clinicians or consultants when they are required to complete the ethically important but difficult task of making determinations about healthcare decision-making capacity. PMID:27551024

Robustness Regions for Dichotomous Decisions.

ERIC Educational Resources Information Center

Vijn, Pieter; Molenaar, Ivo W.

1981-01-01

In the case of dichotomous decisions, the total set of all assumptions/specifications for which the decision would have been the same is the robustness region. Inspection of this (data-dependent) region is a form of sensitivity analysis which may lead to improved decision making. (Author/BW)

Fuzzy sets, rough sets, and modeling evidence: Theory and Application. A Dempster-Shafer based approach to compromise decision making with multiattributes applied to product selection

NASA Technical Reports Server (NTRS)

Dekorvin, Andre

1992-01-01

The Dempster-Shafer theory of evidence is applied to a multiattribute decision making problem whereby the decision maker (DM) must compromise with available alternatives, none of which exactly satisfies his ideal. The decision mechanism is constrained by the uncertainty inherent in the determination of the relative importance of each attribute element and the classification of existing alternatives. The classification of alternatives is addressed through expert evaluation of the degree to which each element is contained in each available alternative. The relative importance of each attribute element is determined through pairwise comparisons of the elements by the decision maker and implementation of a ratio scale quantification method. Then the 'belief' and 'plausibility' that an alternative will satisfy the decision maker's ideal are calculated and combined to rank order the available alternatives. Application to the problem of selecting computer software is given.

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.

Relational autonomy: moving beyond the limits of isolated individualism.

PubMed

Walter, Jennifer K; Ross, Lainie Friedman

2014-02-01

Although clinicians may value respecting a patient's or surrogate's autonomy in decision-making, it is not always clear how to proceed in clinical practice. The confusion results, in part, from which conception of autonomy is used to guide ethical practice. Reliance on an individualistic conception such as the "in-control agent" model prioritizes self-sufficiency in decision-making and highlights a decision-maker's capacity to have reason transcend one's emotional experience. An alternative model of autonomy, relational autonomy, highlights the social context within which all individuals exist and acknowledges the emotional and embodied aspects of decision-makers. These 2 conceptions of autonomy lead to different interpretations of several aspects of ethical decision-making. The in-control agent model believes patients or surrogates should avoid both the influence of others and emotional persuasion in decision-making. As a result, providers have a limited role to play and are expected to provide medical expertise but not interfere with the individual's decision-making process. In contrast, a relational autonomy approach acknowledges the central role of others in decision-making, including clinicians, who have a responsibility to engage patients' and surrogates' emotional experiences and offer clear guidance when patients are confronting serious illness. In the pediatric setting, in which decision-making is complicated by having a surrogate decision-maker in addition to a patient, these conceptions of autonomy also may influence expectations about the role that adolescents can play in decision-making.

42 CFR 423.44 - Involuntary disenrollment by the PDP.

Code of Federal Regulations, 2010 CFR

2010-10-01

... expertise reviews the case before making a final decision. The PDP sponsor is required to provide a... deems necessary. CMS notifies the PDP sponsor within 5 working days after making its decision. (vi... disenroll affected enrollees in accordance with the procedures for disenrollment set forth at § 423.507...

Personal Decision Making. Focus on Economics.

ERIC Educational Resources Information Center

Leet, Don R.; Charkins, R. J.; Lang, Nancy A.; Lopus, Jane S.; Tamaribuchi, Gail

This book highlights and examines basic economic concepts as they relate to consumer, business, social, and personal choices. Students are shown connections between their classroom learning and their real-world experiences in budgeting, career planning, credit management, and housing. The set of 15 lessons include: (1) "Decision Making: Scarcity,…

Societal Boundaries on Cybernetic Action or Decision-Making.

ERIC Educational Resources Information Center

Schulman, Rosalind; Steg, Doreen E.

This paper discusses the development, application, and implications of a statistical technique--a concordance index--for measuring the restrictions and constrictions (legal and societal) which inhibit individual decision making and adapting behavior. It was found that as sophistication sets in there will be less and less tolerance of these…

Training Volunteers in Community Education: A Manual for Staff Members in Community Decision-Making Settings.

ERIC Educational Resources Information Center

Slotnik, William J.; And Others

Methods for encouraging community involvement and training community volunteers for decision making positions in community schools are described. The functions of community schools are to provide a broad diversity of learning opportunities and to involve citizens in assessing community needs, evaluating services, and advocating…

Ethical Decision-Making in Academic Administration: A Qualitative Study of College Deans' Ethical Frameworks

ERIC Educational Resources Information Center

Catacutan, Maria Rosario G.; de Guzman, Allan B.

2015-01-01

Ethical decision-making in school administration has received considerable attention in educational leadership literature. However, most research has focused on principals working in secondary school settings while studies that explore ethical reasoning processes of academic deans have been significantly few. This qualitative study aims to…

44 CFR 9.6 - Decision-making process.

Code of Federal Regulations, 2012 CFR

2012-10-01

... HOMELAND SECURITY GENERAL FLOODPLAIN MANAGEMENT AND PROTECTION OF WETLANDS § 9.6 Decision-making process. (a) Purpose. The purpose of this section is to set out the floodplain management and wetlands... light of the information gained in Steps 4 and 5. FEMA shall not act in a floodplain or wetland unless...

44 CFR 9.6 - Decision-making process.

Code of Federal Regulations, 2011 CFR

2011-10-01

... HOMELAND SECURITY GENERAL FLOODPLAIN MANAGEMENT AND PROTECTION OF WETLANDS § 9.6 Decision-making process. (a) Purpose. The purpose of this section is to set out the floodplain management and wetlands... light of the information gained in Steps 4 and 5. FEMA shall not act in a floodplain or wetland unless...

44 CFR 9.6 - Decision-making process.

Code of Federal Regulations, 2013 CFR

2013-10-01

... HOMELAND SECURITY GENERAL FLOODPLAIN MANAGEMENT AND PROTECTION OF WETLANDS § 9.6 Decision-making process. (a) Purpose. The purpose of this section is to set out the floodplain management and wetlands... light of the information gained in Steps 4 and 5. FEMA shall not act in a floodplain or wetland unless...

44 CFR 9.6 - Decision-making process.

Code of Federal Regulations, 2014 CFR

2014-10-01

... HOMELAND SECURITY GENERAL FLOODPLAIN MANAGEMENT AND PROTECTION OF WETLANDS § 9.6 Decision-making process. (a) Purpose. The purpose of this section is to set out the floodplain management and wetlands... light of the information gained in Steps 4 and 5. FEMA shall not act in a floodplain or wetland unless...

DEVELOPING A CONSISTENT DECISION-MAKING FRAMEWORK BY USING THE U.S. EPA'S TRACI

EPA Science Inventory

The most effective way to achieve long-term environmental results is through the use of a consistent set of metrics and decision-making framework. The U.S. EPA has developed TRACI, the Tool for the Reduction and Assessment of Chemical and other environmental Impacts, which allows...

Psychological Peculiarities of Judge Professional Activity and Decision-Making

ERIC Educational Resources Information Center

Uspanov, Zholdybai T.; Turabayeva, Dana S.

2016-01-01

The article considers the psychological peculiarities of judge professional activity and decision-making, judge's mental set and requirements to ethical and moral requirements and quality. Moreover, this work offers original job analysis and competency model of judge professional activity. The authors have studied the problems concerning the…

Decision-Making Accuracy of CBM Progress-Monitoring Data

ERIC Educational Resources Information Center

Hintze, John M.; Wells, Craig S.; Marcotte, Amanda M.; Solomon, Benjamin G.

2018-01-01

This study examined the diagnostic accuracy associated with decision making as is typically conducted with curriculum-based measurement (CBM) approaches to progress monitoring. Using previously published estimates of the standard errors of estimate associated with CBM, 20,000 progress-monitoring data sets were simulated to model student reading…

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

NASA Astrophysics Data System (ADS)

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

2013-09-01

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

The Re-contextualization of the Patient: What Home Health Care Can Teach Us About Medical Decision-Making.

PubMed

Salter, Erica K

2015-06-01

This article examines the role of context in the development and deployment of standards of medical decision-making. First, it demonstrates that bioethics, and our dominant standards of medical decision-making, developed out of a specific historical and philosophical environment that prioritized technology over the person, standardization over particularity, individuality over relationship and rationality over other forms of knowing. These forces de-contextualize the patient and encourage decision-making that conforms to the unnatural and contrived environment of the hospital. The article then explores several important differences between the home health care and acute care settings. Finally, it argues that the personalized, embedded, relational and idiosyncratic nature of the home is actually a much more accurate reflection of the context in which real people make real decisions. Thus, we should work to "re-contextualize" patients, in order that they might be better equipped to make decisions that harmonize with their real lives.

Development and pilot testing of a decision aid for surrogates of patients with prolonged mechanical ventilation

PubMed Central

Cox, Christopher E.; Lewis, Carmen L.; Hanson, Laura C.; Hough, Catherine L.; Kahn, Jeremy M.; White, Douglas B.; Song, Mi-Kyung; Tulsky, James A.; Carson, Shannon S.

2013-01-01

Objective Shared decision making is inadequate in intensive care units (ICUs). Decision aids can improve decision making quality, though their role in an ICU setting is unclear. We aimed to develop and pilot test a decision aid for shared decision makers of patients undergoing prolonged mechanical ventilation. Setting ICUs at three medical centers. Subjects 53 surrogate decision makers and 58 physicians. Design and interventions We developed the decision aid using defined methodological guidelines. After an iterative revision process, formative cognitive testing was performed among surrogate-physician dyads. Next, we compared the decision aid to usual care control in a prospective, before/after design study. Measurements and main results Primary outcomes were physician-surrogate discordance for expected patient survival, comprehension of relevant medical information, and the quality of communication. Compared to control, the intervention group had lower surrogate-physician discordance (7 [10] vs 43 [21]), greater comprehension (11.4 [0.7] vs 6.1 [3.7]), and improved quality of communication (8.7 [1.3] vs 8.4 [1.3]) (all p<0.05) post-intervention. Hospital costs were lower in the intervention group ($110,609 vs $178,618; p=0.044); mortality did not differ by group (38% vs 50%, p=0.95). 94% of surrogates and 100% of physicians reported that the decision aid was useful in decision making. Conclusion We developed a prolonged mechanical ventilation decision aid that is feasible, acceptable, and associated with both improved decision making quality and less resource utilization. Further evaluation using a randomized controlled trial design is needed to evaluate the decision aid's effect on long-term patient and surrogate outcomes. PMID:22635048

An evidence-based shared decision making programme on the prevention of myocardial infarction in type 2 diabetes: protocol of a randomised-controlled trial.

PubMed

Buhse, Susanne; Heller, Tabitha; Kasper, Jürgen; Mühlhauser, Ingrid; Müller, Ulrich Alfons; Lehmann, Thomas; Lenz, Matthias

2013-10-19

Lack of patient involvement in decision making has been suggested as one reason for limited treatment success. Concepts such as shared decision making may contribute to high quality healthcare by supporting patients to make informed decisions together with their physicians.A multi-component shared decision making programme on the prevention of heart attack in type 2 diabetes has been developed. It aims at improving the quality of decision-making by providing evidence-based patient information, enhancing patients' knowledge, and supporting them to actively participate in decision-making. In this study the efficacy of the programme is evaluated in the setting of a diabetes clinic. A single blinded randomised-controlled trial is conducted to compare the shared decision making programme with a control-intervention. The intervention consists of an evidence-based patient decision aid on the prevention of myocardial infarction and a corresponding counselling module provided by diabetes educators. Similar in duration and structure, the control-intervention targets nutrition, sports, and stress coping. A total of 154 patients between 40 and 69 years of age with type 2 diabetes and no previous diagnosis of ischaemic heart disease or stroke are enrolled and allocated either to the intervention or the control-intervention. Primary outcome measure is the patients' knowledge on benefits and harms of heart attack prevention captured by a standardised knowledge test. Key secondary outcome measure is the achievement of treatment goals prioritised by the individual patient. Treatment goals refer to statin taking, HbA1c-, blood pressure levels and smoking status. Outcomes are assessed directly after the counselling and at 6 months follow-up. Analyses will be carried out on intention-to-treat basis. Concurrent qualitative methods are used to explore intervention fidelity and to gain insight into implementation processes. Interventions to facilitate evidence-based shared decision making represent an innovative approach in diabetes care. The results of this study will provide information on the efficacy of such a concept in the setting of a diabetes clinic in Germany. ISRCTN84636255.

Critical thinking in clinical nurse education: application of Paul's model of critical thinking.

PubMed

Andrea Sullivan, E

2012-11-01

Nurse educators recognize that many nursing students have difficulty in making decisions in clinical practice. The ability to make effective, informed decisions in clinical practice requires that nursing students know and apply the processes of critical thinking. Critical thinking is a skill that develops over time and requires the conscious application of this process. There are a number of models in the nursing literature to assist students in the critical thinking process; however, these models tend to focus solely on decision making in hospital settings and are often complex to actualize. In this paper, Paul's Model of Critical Thinking is examined for its application to nursing education. I will demonstrate how the model can be used by clinical nurse educators to assist students to develop critical thinking skills in all health care settings in a way that makes critical thinking skills accessible to students. Copyright © 2012 Elsevier Ltd. All rights reserved.

Linking Theoretical Decision-making Mechanisms in the Simon Task with Electrophysiological Data: A Model-based Neuroscience Study in Humans.

PubMed

Servant, Mathieu; White, Corey; Montagnini, Anna; Burle, Borís

2016-10-01

A current challenge for decision-making research is in extending models of simple decisions to more complex and ecological choice situations. Conflict tasks (e.g., Simon, Stroop, Eriksen flanker) have been the focus of much interest, because they provide a decision-making context representative of everyday life experiences. Modeling efforts have led to an elaborated drift diffusion model for conflict tasks (DMC), which implements a superimposition of automatic and controlled decision activations. The DMC has proven to capture the diversity of behavioral conflict effects across various task contexts. This study combined DMC predictions with EEG and EMG measurements to test a set of linking propositions that specify the relationship between theoretical decision-making mechanisms involved in the Simon task and brain activity. Our results are consistent with a representation of the superimposed decision variable in the primary motor cortices. The decision variable was also observed in the EMG activity of response agonist muscles. These findings provide new insight into the neurophysiology of human decision-making. In return, they provide support for the DMC model framework.

Deciding together? Best interests and shared decision-making in paediatric intensive care.

PubMed

Birchley, Giles

2014-09-01

In the western healthcare, shared decision making has become the orthodox approach to making healthcare choices as a way of promoting patient autonomy. Despite the fact that the autonomy paradigm is poorly suited to paediatric decision making, such an approach is enshrined in English common law. When reaching moral decisions, for instance when it is unclear whether treatment or non-treatment will serve a child's best interests, shared decision making is particularly questionable because agreement does not ensure moral validity. With reference to current common law and focusing on intensive care practice, this paper investigates what claims shared decision making may have to legitimacy in a paediatric intensive care setting. Drawing on key texts, I suggest these identify advantages to parents and clinicians but not to the child who is the subject of the decision. Without evidence that shared decision making increases the quality of the decision that is being made, it appears that a focus on the shared nature of a decision does not cohere with the principle that the best interests of the child should remain paramount. In the face of significant pressures toward the displacement of the child's interests in a shared decision, advantages of a shared decision to decisional quality require elucidation. Although a number of arguments of this nature may have potential, should no such advantages be demonstrable we have cause to revise our commitment to either shared decision making or the paramountcy of the child in these circumstances.

Expectation Violation in Political Decision Making: A Psychological Case Study.

PubMed

Öllinger, Michael; Meissner, Karin; von Müller, Albrecht; Collado Seidel, Carlos

2017-01-01

Since the early Gestaltists there has been a strong interest in the question of how problem solvers get stuck in a mental impasse. A key idea is that the repeated activation of a successful strategy from the past results in a mental set ('Einstellung') which determines and constrains the option space to solve a problem. We propose that this phenomenon, which mostly was tested by fairly restricted experiments in the lab, could also be applied to more complex problem constellations and naturalistic decision making. We aim at scrutinizing and reconstructing how a mental set determines the misinterpretation of facts in the field of political decision making and leads in consequence to wrong expectations and an ill-defined problem representation. We will exemplify this psychological mechanism considering a historical example, namely the unexpected stabilization of the Franco regime at the end of World War II and its survival thereafter. A specific focus will be drawn to the significant observation that erroneous expectations were taken as the basis for decisions. This is congruent with the notion that in case of discrepancy between preconceived notions and new information, the former prevails over the new findings. Based on these findings, we suggest a theoretical model for expectation violation in political decision making and develop novel approaches for cognitive empirical research on the mechanisms of expectation violation and its maintenance in political decision making processes.

Expectation Violation in Political Decision Making: A Psychological Case Study

PubMed Central

Öllinger, Michael; Meissner, Karin; von Müller, Albrecht; Collado Seidel, Carlos

2017-01-01

Since the early Gestaltists there has been a strong interest in the question of how problem solvers get stuck in a mental impasse. A key idea is that the repeated activation of a successful strategy from the past results in a mental set (‘Einstellung’) which determines and constrains the option space to solve a problem. We propose that this phenomenon, which mostly was tested by fairly restricted experiments in the lab, could also be applied to more complex problem constellations and naturalistic decision making. We aim at scrutinizing and reconstructing how a mental set determines the misinterpretation of facts in the field of political decision making and leads in consequence to wrong expectations and an ill-defined problem representation. We will exemplify this psychological mechanism considering a historical example, namely the unexpected stabilization of the Franco regime at the end of World War II and its survival thereafter. A specific focus will be drawn to the significant observation that erroneous expectations were taken as the basis for decisions. This is congruent with the notion that in case of discrepancy between preconceived notions and new information, the former prevails over the new findings. Based on these findings, we suggest a theoretical model for expectation violation in political decision making and develop novel approaches for cognitive empirical research on the mechanisms of expectation violation and its maintenance in political decision making processes. PMID:29085316

Decision-Making Style and Response to Parental Involvement in Brief Interventions for Adolescent Substance Use

PubMed Central

Piehler, Timothy F.; Winters, Ken C.

2016-01-01

Adolescent decision making has been previously identified as risk factor for substance abuse as well as a proximal intervention target. The study sought to extend this research by evaluating the role of decision-making style in response to parent involvement in brief substance abuse interventions. Adolescents (aged 12–18 years; n= 259) identified in a school setting as abusing alcohol and marijuana were randomly assigned to complete one of two brief interventions (BIs): either a 2-session adolescent-only program (BI-A) or the 2-session adolescent program with an additional parent session (BI-AP). Interventions were manualized and delivered in a school setting by trained counselors. Adolescent decision-making style was evaluated at intake, and alcohol and marijuana use were evaluated at intake and at a 6-month follow-up assessment. Supporting past research with these interventions, BI-AP demonstrated overall stronger outcomes for marijuana when compared to BI-A. Across both intervention models, an adaptive decision-making style (i.e., constructive, rational) assessed at intake predicted greater reductions in marijuana use. A significant moderation effect emerged for alcohol outcomes. Adolescents with maladaptive decision making tendencies (i.e., impulsive/careless, avoidant) demonstrated the largest benefit from the parental involvement in BI-AP, whereas those with a less impulsive style derived little additional benefit from parental involvement in regard to alcohol use outcomes. Implications for the tailoring of brief interventions for adolescent substance abuse are discussed. PMID:27929312

Decision-making style and response to parental involvement in brief interventions for adolescent substance use.

PubMed

Piehler, Timothy F; Winters, Ken C

2017-04-01

Adolescent decision making has been previously identified as risk factor for substance abuse as well as a proximal intervention target. The study sought to extend this research by evaluating the role of decision-making style in response to parent involvement in brief substance abuse interventions. Adolescents (aged 12 to 18 years; n = 259) identified in a school setting as abusing alcohol and marijuana were randomly assigned to complete 1 of 2 brief interventions (BIs), either a 2-session adolescent-only program (BI-A) or the 2-session adolescent program with an additional parent session (BI-AP). Interventions were manualized and delivered in a school setting by trained counselors. Adolescent decision-making style was evaluated at intake, and alcohol and marijuana use were evaluated at intake and at a 6-month follow-up assessment. Supporting past research with these interventions, BI-AP demonstrated overall stronger outcomes for marijuana when compared with BI-A. Across both intervention models, an adaptive decision-making style (i.e., constructive, rational) assessed at intake predicted greater reductions in marijuana use. A significant moderation effect emerged for alcohol outcomes. Adolescents with maladaptive decision-making tendencies (i.e., impulsive/careless, avoidant) demonstrated the largest benefit from the parental involvement in BI-AP, whereas those with a less impulsive style derived little additional benefit from parental involvement in regard to alcohol use outcomes. Implications for the tailoring of brief interventions for adolescent substance abuse are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Factors Perceived to Influence the Decision for African Americans to Become Registered Organ Donors at the Department of Motorized Vehicles.

PubMed

DuBay, Derek A; Ivankova, Nataliya; Herby, Ivan; Schoenberger, Yu-Mei; Redden, David T; Holt, Cheryl; Siminoff, Laura; Fouad, Mona; Martin, Michelle Y

2017-01-01

African Americans (AA) are a third as likely as Caucasians to become registered organ donors at the Department of Motorized Vehicles (DMV). The Department of Health and Human Services has set the goal that at least 50% of adults in each state are registered donors. The purpose of this study was to explore the personal, behavioral and environmental factors associated with AA donor registration decision-making at the DMV. Guided by the Social Cognitive Theory, 13 focus groups (n = 100 participants) were conducted with AAs within 3 months of visiting a DMV and making a decision regarding whether to become or to not become a registered donor. The data were analyzed using inductive thematic and qualitative content analyses. Study participants expressed a desire to learn more information while waiting in line at the DMV. Knowing a family member or friend in need of an organ transplant, and the desire to make one's own decision were two salient factors associated with the decision to become a registered organ donor. Several aspects of the DMV environment (e.g., noisy, overcrowded, lacking privacy) were cited as deterrents to becoming a registered donor. This study highlights the personal, behavioral and environmental factors associated with AA organ donor registration decision-making at the DMV. The DMV is a setting where many adults make a decision about organ donation. Policies that create an environment in the DMV to support informed decision-making (e.g., privacy, informed clerks, available educational materials, etc.) are indicated. Copyright © 2017 National Medical Association. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2017-11-06

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

Shared decision-making in an intercultural context. Barriers in the interaction between physicians and immigrant patients.

PubMed

Suurmond, Jeanine; Seeleman, Conny

2006-02-01

The objective of this exploratory paper is to describe several barriers in shared decision-making in an intercultural context. Based on the prevailing literature on intercultural communication in medical settings, four conceptual barriers were described. When the conceptual barriers were described, they were compared with the results from semi-structured interviews with purposively selected physicians (n = 18) and immigrant patients (n = 13). Physicians differed in medical discipline (GPs, company doctors, an internist, a cardiologist, a gynaecologist, and an intern) and patients had different ethnic and immigration backgrounds. The following barriers were found: (1) physician and patient may not share the same linguistic background; (2) physician and patient may not share similar values about health and illness; (3) physician and patient may not have similar role expectations; and (4) physician and patient may have prejudices and do not speak to each other in an unbiased manner. We conclude that due to these barriers, the transfer of information, the formulation of the diagnosis, and the discussion of treatment options are at stake and the shared decision-making process is impeded. Improving physician's skills to recognize the communication limitations during shared decision-making as well as improving the skills to deal with the barriers may help to ameliorate shared decision-making in an intercultural setting.

Linguistic multi-criteria decision-making with representing semantics by programming

NASA Astrophysics Data System (ADS)

Yang, Wu-E.; Ma, Chao-Qun; Han, Zhi-Qiu

2017-01-01

A linguistic multi-criteria decision-making method is introduced. In this method, a maximising discrimination programming assigns the semanteme values to linguistic variables to represent their semantics. Incomplete preferences from using linguistic information are expressed by the constraints of the model. Such assignment can amplify the difference between alternatives. Thus, the discrimination of the decision model is increased, which facilitates the decision-maker to rank or order the alternatives for making a decision. We also discuss the parameter setting and its influence, and use an application example to illustrate the proposed method. Further, the results with three types of semantic structure highlight the ability of the method in handling different semantic structures.

Social setting, intuition and experience in laboratory experiments interact to shape cooperative decision-making.

PubMed

Capraro, Valerio; Cococcioni, Giorgia

2015-07-22

Recent studies suggest that cooperative decision-making in one-shot interactions is a history-dependent dynamic process: promoting intuition versus deliberation typically has a positive effect on cooperation (dynamism) among people living in a cooperative setting and with no previous experience in economic games on cooperation (history dependence). Here, we report on a laboratory experiment exploring how these findings transfer to a non-cooperative setting. We find two major results: (i) promoting intuition versus deliberation has no effect on cooperative behaviour among inexperienced subjects living in a non-cooperative setting; (ii) experienced subjects cooperate more than inexperienced subjects, but only under time pressure. These results suggest that cooperation is a learning process, rather than an instinctive impulse or a self-controlled choice, and that experience operates primarily via the channel of intuition. Our findings shed further light on the cognitive basis of human cooperative decision-making and provide further support for the recently proposed social heuristics hypothesis. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

A double-slit experiment for non-classical interference effects in decision making.

PubMed

La Mura, Pierfrancesco

2014-01-01

We discuss the possible nature and role of non-physical entanglement, and the classical vs. non-classical interface, in models of human decision-making. We also introduce an experimental setting designed after the double-slit experiment in physics, and discuss how it could be used to discriminate between classical and non-classical interference effects in human decisions. Copyright © 2013 Cognitive Science Society, Inc.

Applications of urban tree canopy assessment and prioritization tools: supporting collaborative decision making to achieve urban sustainability goals

Treesearch

Dexter H. Locke; J. Morgan Grove; Michael Galvin; Jarlath P.M. ONeil-Dunne; Charles Murphy

2013-01-01

Urban Tree Canopy (UTC) Prioritizations can be both a set of geographic analysis tools and a planning process for collaborative decision-making. In this paper, we describe how UTC Prioritizations can be used as a planning process to provide decision support to multiple government agencies, civic groups and private businesses to aid in reaching a canopy target. Linkages...

Implementing shared decision-making in routine practice: barriers and opportunities.

PubMed

Holmes-Rovner, Margaret; Valade, Diane; Orlowski, Catherine; Draus, Catherine; Nabozny-Valerio, Barbara; Keiser, Susan

2000-09-01

OBJECTIVE: Determine feasibility of shared decision-making programmes in fee-for-service hospital systems including physicians' offices and in-patient facilities. DESIGN: Survey and participant observation. Data obtained during Phase 1 of a patient outcome study. SETTINGS AND PARTICIPANTS: Three hospitals in Michigan: one 299-bed rural regional hospital, one 650-bed urban community hospital, one 459-bed urban and suburban teaching hospital. All nurses and physicians who agreed to use the programmes participated in the evaluation (n = 34). INTERVENTION: Two shared decision-making(R) (SDP) multimedia programmes: surgical treatment choice for breast cancer and ischaemic heart disease treatment choice. MAIN OUTCOME MEASURES: (1) clinicians' evaluations of programme quality; (2) challenges in hospital settings; and (3) patient referral rates. RESULTS: SDP programmes were judged to be clear, accurate and about the right length and amount of information. Programmes were judged to be informative and appropriate for patients to see before making a decision. Clinicians were neutral about patients' desire to participate in treatment decision-making. Referral volume to SDPs was lower than expected: 24 patients in 7 months across three hospitals. Implementation challenges centred on time pressures in patient care. CONCLUSIONS: Productivity and time pressure in US health care severely constrain shared decision-making programme implementation. Physician referral may not be a reliable mechanism for patient access. Possible innovations include: (1) incorporation into the informed consent process; (2) provider or payer negotiated requirement in the routine hospital procedure to use the SDP as a quality indicator; and (3) payer reimbursement to professional providers who make SDP programmes available to patients.

A Novel Approach to Study Medical Decision Making in the Clinical Setting: The "Own-point-of-view" Perspective.

PubMed

Pelaccia, Thierry; Tardif, Jacques; Triby, Emmanuel; Charlin, Bernard

2017-07-01

Making diagnostic and therapeutic decisions is a critical activity among physicians. It relies on the ability of physicians to use cognitive processes and specific knowledge in the context of a clinical reasoning. This ability is a core competency in physicians, especially in the field of emergency medicine where the rate of diagnostic errors is high. Studies that explore medical decision making in an authentic setting are increasing significantly. They are based on the use of qualitative methods that are applied at two separate times: 1) a video recording of the subject's actual activity in an authentic setting and 2) an interview with the subject, supported by the video recording. Traditionally, activity is recorded from an "external perspective"; i.e., a camera is positioned in the room in which the consultation takes place. This approach has many limits, both technical and with respect to the validity of the data collected. The article aims at 1) describing how decision making is currently being studied, especially from a qualitative standpoint, and the reasons why new methods are needed, and 2) reporting how we used an original, innovative approach to study decision making in the field of emergency medicine and findings from these studies to guide further the use of this method. The method consists in recording the subject's activity from his own point of view, by fixing a microcamera on his temple or the branch of his glasses. An interview is then held on the basis of this recording, so that the subject being interviewed can relive the situation, to facilitate the explanation of his reasoning with respect to his decisions and actions. We describe how this method has been used successfully in investigating medical decision making in emergency medicine. We provide details on how to use it optimally, taking into account the constraints associated with the practice of emergency medicine and the benefits in the study of clinical reasoning. The "own-point-of-view" video technique is a promising method to study clinical decision making in emergency medicine. It is a powerful tool to stimulate recall and help physicians make their reasoning explicit, thanks to a greater psychological immersion. © 2017 by the Society for Academic Emergency Medicine.

Participation in communication and decision-making: children and young people's experiences in a hospital setting.

PubMed

Coyne, Imelda; Gallagher, Pamela

2011-08-01

To explore hospitalised children and young people's experiences of participation in communication and decision-making. There is a growing recognition internationally that children and young people have a right to participate in matters that affect their lives. Although this has led to more support for children's participation in communication exchanges and decision-making in health care, there remains a lack of studies in this area. Qualitative. Data were obtained through a combination of focus groups and single interviews with participants aged 7-18 (n = 55), from three hospitals in Ireland. Children wanted to be included in communication exchanges but appeared to occupy a marginal role with discussions largely carried out between parents and health professionals. They wanted to participate in 'small' everyday decisions about their care and treatment but were constrained mainly by adults' actions. Although children want to be included in the decision-making process, some prefer to leave the more 'serious' decisions to parents and health professionals, whilst others prefer to share the decision. Children's preferences can vary; therefore, decision-making should be seen as being on a continuum rather than an 'all or nothing' basis. Health care professionals and parents appear to play a significant role on whether children's efforts to participate are facilitated and supported in the hospital setting. Clearly, some may have reservations/concerns about children's participation, which suggests the need for clear guidelines/policies that reflect all stakeholder views. Children should be supported in having their voices heard in matters that directly affect their lives. © 2011 Blackwell Publishing Ltd.

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

NASA Astrophysics Data System (ADS)

Gresch, Helge; Hasselhorn, Marcus; Bögeholz, Susanne

2017-02-01

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

Altered moral decision-making in patients with idiopathic Parkinson's disease.

PubMed

Rosen, Jan B; Rott, Elisa; Ebersbach, Georg; Kalbe, Elke

2015-10-01

Moral decision-making essentially contributes to social conduct. Although patients with Parkinson's disease (PD) show deficits in (non-moral) decision making and related neuropsychological functions, i.e. executive functions, theory of mind (ToM), and empathy, moral decision-making has rarely been examined in PD patients. We examined possible alterations of moral decision-making and associated functions in PD. Twenty non-demented PD patients and 23 age- and education-matched healthy control participants were examined with tests that assess reasoning, executive functions (set-shifting and planning), ToM and empathy, decision-making under risk, and moral intuitions. Moral decision-making was assessed with a close-to-everyday moral dilemma paradigm that opposes socially oriented "altruistic" choices to self-beneficial "egoistic" choices in 20 moral dilemma short stories (10 high and 10 low emotional). Concurrently, electrodermal activity was recorded. PD patients made more egoistic moral decisions than healthy controls. Remarkably, while reasoning, planning and empathy correlated with moral decision-making in the control group, in the PD group neuropsychological functions and dopaminergic medication did not correlate with moral decisions. No evidence for reduced skin conductance responses in PD patients and no relationships between skin conductance responses and moral decisions were observed. This study provides evidence for moral decision-making dysfunctions in PD patients who made more egoistic moral decisions. As a possible underlying mechanism, reduced exercise of attentional control due to a dysfunctional interplay between the prefrontal cortex and the basal ganglia is discussed. Future research will have to determine the impact of PD patients' moral decision-making dysfunctions on everyday life and further determine correlates of the deficits. Copyright © 2015 Elsevier Ltd. All rights reserved.

Following Human Footsteps: Proposal of a Decision Theory Based on Human Behavior

NASA Technical Reports Server (NTRS)

Mahmud, Faisal

2011-01-01

Human behavior is a complex nature which depends on circumstances and decisions varying from time to time as well as place to place. The way a decision is made either directly or indirectly related to the availability of the options. These options though appear at random nature, have a solid directional way for decision making. In this paper, a decision theory is proposed which is based on human behavior. The theory is structured with model sets that will show the all possible combinations for making a decision, A virtual and simulated environment is considered to show the results of the proposed decision theory

Demographics of reintroduced populations: estimation, modeling, and decision analysis

USGS Publications Warehouse

Converse, Sarah J.; Moore, Clinton T.; Armstrong, Doug P.

2013-01-01

Reintroduction can be necessary for recovering populations of threatened species. However, the success of reintroduction efforts has been poorer than many biologists and managers would hope. To increase the benefits gained from reintroduction, management decision making should be couched within formal decision-analytic frameworks. Decision analysis is a structured process for informing decision making that recognizes that all decisions have a set of components—objectives, alternative management actions, predictive models, and optimization methods—that can be decomposed, analyzed, and recomposed to facilitate optimal, transparent decisions. Because the outcome of interest in reintroduction efforts is typically population viability or related metrics, models used in decision analysis efforts for reintroductions will need to include population models. In this special section of the Journal of Wildlife Management, we highlight examples of the construction and use of models for informing management decisions in reintroduced populations. In this introductory contribution, we review concepts in decision analysis, population modeling for analysis of decisions in reintroduction settings, and future directions. Increased use of formal decision analysis, including adaptive management, has great potential to inform reintroduction efforts. Adopting these practices will require close collaboration among managers, decision analysts, population modelers, and field biologists.

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.

Medical Decision-Making for Adults Who Lack Decision-Making Capacity and a Surrogate: State of the Science.

PubMed

Kim, Hyejin; Song, Mi-Kyung

2018-01-01

Adults who lack decision-making capacity and a surrogate ("unbefriended" adults) are a vulnerable, voiceless population in health care. But little is known about this population, including how medical decisions are made for these individuals. This integrative review was to examine what is known about unbefriended adults and identify gaps in the literature. Six electronic databases were searched using 4 keywords: "unbefriended," "unrepresented patients," "adult orphans," and "incapacitated patients without surrogates." After screening, the final sample included 10 data-based articles for synthesis. Main findings include the following: (1) various terms were used to refer to adults who lack decision-making capacity and a surrogate; (2) the number of unbefriended adults was sizable and likely to grow; (3) approaches to medical decision-making for this population in health-care settings varied; and (4) professional guidelines and laws to address the issues related to this population were inconsistent. There have been no studies regarding the quality of medical decision-making and its outcomes for this population or societal impact. Extremely limited empirical data exist on unbefriended adults to develop strategies to improve how medical decisions are made for this population. There is an urgent need for research to examine the quality of medical decision-making and its outcomes for this vulnerable population.

The effects of fatigue on decision making and shooting skill performance in water polo players.

PubMed

Royal, Kylie A; Farrow, Damian; Mujika, Iñigo; Halson, Shona L; Pyne, David; Abernethy, Bruce

2006-08-01

The aim of this study was to assess the effects of fatigue on decision making and goal shooting skill in water polo. Fourteen junior elite male players (age 17.2 +/- 0.5 years; mass 84.2 +/- 7.6 kg; height 1.85 +/- 0.05 m) completed four sets of eight repetitions of an approximately 18 s maximal water polo specific drill. Progressively declining rest ratios for each successive set of the drill were employed to induce increasing fatigue and reflect the demands of match-play. A video-based temporally occluded decision-making task (verbalized response to various tactical situations) or goal shooting skill test (qualitative and quantitative analysis of goal shooting) was performed after each set. Heart rate, rating of perceived exertion (RPE) and blood lactate concentration were recorded. Heart rate (159 +/- 12, 168 +/- 13, 176 +/- 12, 181 +/- 12 Deats min-1; P < 0.001) and RPE (13.1 +/- 2.2, 15.5 +/- 1.7, 17.3 +/- 1.6, 19.1 +/- 1.1; P < 0.001) increased with declining rest ratios. At very high fatigue, decision-making accuracy was 18.0 +/- 21.8% better than at low fatigue (P = 0.008). Shooting accuracy and velocity were unaffected by incremental fatigue; however, skill proficiency (technique) decreased by 43 +/- 24% between the pre-test and high-fatigue conditions (P < 0.001). In conclusion, incremental increases in fatigue differentially influenced decision making (improved) relative to the technical performance (declined), accuracy and speed of the ball (unchanged) of a water polo goal shot.

Measuring and Modeling Behavioral Decision Dynamics in Collective Evacuation

PubMed Central

Carlson, Jean M.; Alderson, David L.; Stromberg, Sean P.; Bassett, Danielle S.; Craparo, Emily M.; Guiterrez-Villarreal, Francisco; Otani, Thomas

2014-01-01

Identifying and quantifying factors influencing human decision making remains an outstanding challenge, impacting the performance and predictability of social and technological systems. In many cases, system failures are traced to human factors including congestion, overload, miscommunication, and delays. Here we report results of a behavioral network science experiment, targeting decision making in a natural disaster. In a controlled laboratory setting, our results quantify several key factors influencing individual evacuation decision making in a controlled laboratory setting. The experiment includes tensions between broadcast and peer-to-peer information, and contrasts the effects of temporal urgency associated with the imminence of the disaster and the effects of limited shelter capacity for evacuees. Based on empirical measurements of the cumulative rate of evacuations as a function of the instantaneous disaster likelihood, we develop a quantitative model for decision making that captures remarkably well the main features of observed collective behavior across many different scenarios. Moreover, this model captures the sensitivity of individual- and population-level decision behaviors to external pressures, and systematic deviations from the model provide meaningful estimates of variability in the collective response. Identification of robust methods for quantifying human decisions in the face of risk has implications for policy in disasters and other threat scenarios, specifically the development and testing of robust strategies for training and control of evacuations that account for human behavior and network topologies. PMID:24520331

Decision-Making in Multiple Sclerosis Patients: A Systematic Review

PubMed Central

2018-01-01

Background Multiple sclerosis (MS) is frequently associated with cognitive and behavioural deficits. A growing number of studies suggest an impact of MS on decision-making abilities. The aim of this systematic review was to assess if (1) performance of MS patients in decision-making tasks was consistently different from controls and (2) whether this modification was associated with cognitive dysfunction and emotional alterations. Methods The search was conducted on Pubmed/Medline database. 12 studies evaluating the difference between MS patients and healthy controls using validated decision-making tasks were included. Outcomes considered were quantitative (net scores) and qualitative measurements (deliberation time and learning from feedback). Results Quantitative and qualitative decision-making impairment in MS was present in 64.7% of measurements. Patients were equally impaired in tasks for decision-making under risk and ambiguity. A correlation to other cognitive functions was present in 50% of cases, with the highest associations in the domains of processing speed and attentional capacity. Conclusions In MS patients, qualitative and quantitative modifications may be present in any kind of decision-making task and can appear independently of other cognitive measures. Since decision-making abilities have a significant impact on everyday life, this cognitive aspect has an influential importance in various MS-related treatment settings. PMID:29721338

Rodent models of adaptive decision making.

PubMed

Izquierdo, Alicia; Belcher, Annabelle M

2012-01-01

Adaptive decision making affords the animal the ability to respond quickly to changes in a dynamic environment: one in which attentional demands, cost or effort to procure the reward, and reward contingencies change frequently. The more flexible the organism is in adapting choice behavior, the more command and success the organism has in navigating its environment. Maladaptive decision making is at the heart of much neuropsychiatric disease, including addiction. Thus, a better understanding of the mechanisms that underlie normal, adaptive decision making helps achieve a better understanding of certain diseases that incorporate maladaptive decision making as a core feature. This chapter presents three general domains of methods that the experimenter can manipulate in animal decision-making tasks: attention, effort, and reward contingency. Here, we present detailed methods of rodent tasks frequently employed within these domains: the Attentional Set-Shift Task, Effortful T-maze Task, and Visual Discrimination Reversal Learning. These tasks all recruit regions within the frontal cortex and the striatum, and performance is heavily modulated by the neurotransmitter dopamine, making these assays highly valid measures in the study of psychostimulant addiction.

"Choice Set" for health behavior in choice-constrained settings to frame research and inform policy: examples of food consumption, obesity and food security.

PubMed

Dover, Robert V H; Lambert, Estelle V

2016-03-16

Using the nexus between food consumption, food security and obesity, this paper addresses the complexity of health behavior decision-making moments that reflect relational social dynamics in context-specific dialogues, often in choice-constrained conditions. A pragmatic review of literature regarding social determinants of health in relation to food consumption, food security and obesity was used to advance this theoretical model. We suggest that health choice, such as food consumption, is based on more than the capacity and volition of individuals to make "healthy" choices, but is dialogic and adaptive. In terms of food consumption, there will always be choice-constrained conditions, along a continuum representing factors over which the individual has little or no control, to those for which they have greater agency. These range from food store geographies and inventories and food availability, logistical considerations such as transportation, food distribution, the structure of equity in food systems, state and non-government food and nutrition programs, to factors where the individual exercises a greater degree of autonomy, such as sociocultural foodways, family and neighborhood shopping strategies, and personal and family food preferences. At any given food decision-making moment, many factors of the continuum are present consciously or unconsciously when the individual makes a decision. These health behavior decision-making moments are mutable, whether from an individual perspective, or within a broader social or policy context. We review the construct of "choice set", the confluence of factors that are temporally weighted by the differentiated and relationally-contextualized importance of certain factors over others in that moment. The choice transition represents an essential shift of the choice set based on the conscious and unconscious weighting of accumulated evidence, such that people can project certain outcomes. Policies and interventions should avoid dichotomies of "good and bad" food choices or health behaviors, but focus on those issues that contribute to the weightedness of factors influencing food choice behavior at a given decision-making moment and within a given choice set.

Selection of Film Clips and Development of a Video for the Investigation of Sexual Decision Making among Men Who Have Sex with Men

PubMed Central

Woolf-King, Sarah E.; Maisto, Stephen; Carey, Michael; Vanable, Peter

2013-01-01

Experimental research on sexual decision making is limited, despite the public health importance of such work. We describe formative work conducted in advance of an experimental study designed to evaluate the effects of alcohol intoxication and sexual arousal on risky sexual decision making among men who have sex with men. In Study 1, we describe the procedures for selecting and validating erotic film clips (to be used for the experimental manipulation of arousal). In Study 2, we describe the tailoring of two interactive role-play videos to be used to measure risk perception and communication skills in an analog risky sex situation. Together, these studies illustrate a method for creating experimental stimuli to investigate sexual decision making in a laboratory setting. Research using this approach will support experimental research that affords a stronger basis for drawing causal inferences regarding sexual decision making. PMID:19760530

KNOW ESSENTIALS: a tool for informed decisions in the absence of formal HTA systems.

PubMed

Mathew, Joseph L

2011-04-01

Most developing countries and resource-limited settings lack robust health technology assessment (HTA) systems. Because the development of locally relevant HTA is not immediately viable, and the extrapolation of external HTA is inappropriate, a new model for evaluating health technologies is required. The aim of this study was to describe the development and application of KNOW ESSENTIALS, a tool facilitating evidence-based decisions on health technologies by stakeholders in settings lacking formal HTA systems. Current HTA methodology was examined through literature search. Additional issues relevant to resource-limited settings, but not adequately addressed in current methodology, were identified through further literature search, appraisal of contextually relevant issues, discussion with healthcare professionals familiar with the local context, and personal experience. A set of thirteen elements important for evidence-based decisions was identified, selected and combined into a tool with the mnemonic KNOW ESSENTIALS. Detailed definitions for each element, coding for the elements, and a system to evaluate a given health technology using the tool were developed. Developing countries and resource-limited settings face several challenges to informed decision making. Models that are relevant and applicable in high-income countries are unlikely in such settings. KNOW ESSENTIALS is an alternative that facilitates evidence-based decision making by stakeholders without formal expertise in HTA. The tool could be particularly useful, as an interim measure, in healthcare systems that are developing HTA capacity. It could also be useful anywhere when rapid evidence-based decisions on health technologies are required.

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…

Developing High Quality Decision-Making Discussions about Biological Conservation in a Normal Classroom Setting

ERIC Educational Resources Information Center

Grace, Marcus

2009-01-01

The conservation of biodiversity is an important socio-scientific issue that is often regarded as a precondition to sustainable development. The foundation for citizens' understanding of conservation issues can be laid down in formal school education. This research focuses on decision-making discussions about biological conservation issues among…

Ecosystem Services in Environmental Science Literacy

ERIC Educational Resources Information Center

Ruppert, John Robert

2015-01-01

Human beings depend on a set of benefits that emerge from functioning ecosystems, termed Ecosystem Services (ES), and make decisions in everyday life that affect these ES. Recent advancements in science have led to an increasingly sophisticated understanding of ES and how they can be used to inform environmental decision-making. Following suit, US…

75 FR 20358 - Intra-Agency Appeal Process: Guidelines for Appeals of Material Supervisory Determinations and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-19

... decisional deadline for written decisions by the SARC. Also, both the SARC Guidelines and the AAC Guidelines have been amended to make additional, limited technical clarifying and conforming amendments. Both sets... action or decision, and to make limited technical amendments. (73 FR 54822 (Sept. 23, 2008)). Although...

School Board Decision Making Practices

ERIC Educational Resources Information Center

Beard, Nicole R.

2017-01-01

The purpose of this study was to examine the way in which school boards use data when making decisions, specifically their orientations, perceptions, concerns and priorities around data. This study sought to understand how school boards use data when setting or tracking progress toward goals and aimed following the process of board use of data to…

Education and Training in Ethical Decision Making: Comparing Context and Orientation

ERIC Educational Resources Information Center

Perri, David F.; Callanan, Gerard A.; Rotenberry, Paul F.; Oehlers, Peter F.

2009-01-01

Purpose: The purpose of this paper is to present a teaching methodology for improving the understanding of ethical decision making. This pedagogical approach is applicable in college courses and in corporate training programs. Design/methodology/approach: Participants are asked to analyze a set of eight ethical dilemmas with differing situational…

Teaching Perspectives of Pre-Service Physical Education Teachers: The Shanghai Experience

ERIC Educational Resources Information Center

Wang, Lijuan

2014-01-01

Background: In the physical education (PE) domain, teachers are given the freedom to make important educational decisions. Because of the common assumption that the decisions teachers make are based on a set of educational perspectives, a considerable number of studies have addressed the importance of studying the thinking and beliefs of PE…

The pitfalls of premature closure: clinical decision-making in a case of aortic dissection

PubMed Central

Kumar, Bharat; Kanna, Balavenkatesh; Kumar, Suresh

2011-01-01

Premature closure is a type of cognitive error in which the physician fails to consider reasonable alternatives after an initial diagnosis is made. It is a common cause of delayed diagnosis and misdiagnosis borne out of a faulty clinical decision-making process. The authors present a case of aortic dissection in which premature closure was avoided by the aggressive pursuit of the appropriate differential diagnosis, and discuss the importance of disciplined clinical decision-making in the setting of chest pain. PMID:22679162

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

PubMed

Dolan, James G

2010-01-01

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

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

PubMed Central

Dolan, James G.

2010-01-01

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

Does the community want devolved authority? Results of deliberative polling in Ontario.

PubMed Central

Abelson, J; Lomas, J; Eyles, J; Birch, S; Veenstra, G

1995-01-01

OBJECTIVE: To obtain and contrast the informed opinions of people in five decision-making groups that could have a role in devolved governance of health care and social services. DESIGN: Deliberative polling. SETTING: Three rural and three urban communities selected from the 32 areas covered by a district health council in Ontario. PARTICIPANTS: A total of 280 citizens from five potential decision-making groups: randomly selected citizens, attendees at town-hall meetings, appointees to district health councils, elected officials and experts in health care and social services. INTERVENTION: Participants' opinions were polled during 29 structured 2-hour meetings. MAIN OUTCOME MEASURES: Participants' opinions on their personal willingness and their group's suitability to be involved in devolved decision making, desired type of decision-making involvement, information preferences, preferred areas of decision-making involvement and preferred composition of decision-making bodies. RESULTS: Mean attendance at each meeting was 9.6 citizens. Although there were some significant differences in opinion among the five potential decision-making groups, there were few differences among citizens from different geographic areas. A total of 189 (72%) of people polled were personally willing to take on a role involving responsibility for overall decision-making, but far fewer thought that their group was suited to taking on responsibility (30%) or a consulting role (55%). Elected officials were the most willing (85% personally willing, 50% thought their group was suitable) and randomly selected citizens the least willing (60% personally willing, 17% thought their group was suitable) to take responsibility for overall decision making. Most citizens polled indicated less interest in involvement in specific types of decisions, except for planning and setting priorities, than in overall decision making. Only 24 participants (9%) rated their own group as suitable to take responsibility for raising revenue, 91 (33%) deemed their group suited to distribution of funds and 108 (39%) felt their group was suitable for management of services. People in all five groups ranked health care needs (mean rank 1.5 out of four options) as the most important and preferences (mean rank 3.6) as the least important information. They rated a combination body involving several community groups as the most suitable overall decision-making body (8.8 on 10-point scale). Participants favoured the representation of elected officials, the provincial government and experts on combination bodies responsible for the specific types of decisions. Overall, as the complexity of devolved decision making became clear, participants tended to assign authority to traditional decision makers such as elected officials, experts and the provincial government, but also favoured a consulting role for attendees at town-hall meetings (i.e., interested citizens). CONCLUSION: There are significant differences among groups in the community in their willingness to be involved, desired roles and representation in devolved decision making on health care and social services in Ontario. PMID:7634217

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.

Shared decision making or paternalism in nursing consultations? A qualitative study of primary care asthma nurses’ views on sharing decisions with patients regarding inhaler device selection

PubMed Central

Upton, Jane; Fletcher, Monica; Madoc‐Sutton, Hazel; Sheikh, Aziz; Caress, Ann‐Louise; Walker, Samantha

2011-01-01

Abstract Background  Although patients with asthma would like more involvement in the decision‐making process, and UK government policy concerning chronic conditions supports shared decision making, it is not widely used in practice. Objective  To investigate how nurses approach decision making in relation to inhaler choice and long‐term inhaler use within a routine asthma consultation and to better understand the barriers and facilitators to shared decision making in practice. Setting and participants  Semi‐structured interviews were conducted with post‐registration, qualified nurses who routinely undertook asthma consultations and were registered on a respiratory course. Interviews were recorded, transcribed and analysed using the Framework approach. Results  Twenty participants were interviewed. Despite holding positive views about shared decision making, limited shared decision making was reported. Opportunities for patients to share decisions were only offered in relation to inhaler device, which were based on the nurse’s pre‐selected recommendations. Giving patients this ‘choice’ was seen as key to improving adherence. Discussion  There is a discrepancy between nurses’ understanding of shared decision making and the depictions of shared decision making presented in the academic literature and NHS policy. In this study, shared decision making was used as a tool to support the nurses’ agenda, rather than as a natural expression of equality between the nurse and patient. Conclusion  There is a misalignment between the goals of practice nurses and the rhetoric regarding patient empowerment. Shared decision making may therefore only be embraced if it improves patient outcomes. This study indicates attitudinal shifts and improvements in knowledge of ‘shared decision‐making’ are needed if policy dictates are to be realised. PMID:21323822

The emergence of coherence over the course of decision making.

PubMed

Simon, D; Pham, L B; Le, Q A; Holyoak, K J

2001-09-01

Previous research has indicated that decision making is accompanied by an increase in the coherence of assessments of the factors related to the decision alternatives. In the present study, the authors investigated whether this coherence shift is obtained before people commit to a decision, and whether it is obtained in the course of a number of other processing tasks. College students were presented with a complex legal case involving multiple conflicting arguments. Participants rated agreement with the individual arguments in isolation before seeing the case and after processing it under various initial sets, including playing the role of a judge assigned to decide the case. Coherence shifts were observed when participants were instructed to delay making the decision (Experiment 1), to memorize the case (Experiment 2), and to comprehend the case (Experiment 3). The findings support the hypothesis that a coherence-generating mechanism operates in a variety of processing tasks, including decision making.

Ancillary care in public health intervention research in low-resource settings: researchers' practices and decision-making.

PubMed

Taylor, Holly A; Merritt, Maria W; Mullany, Luke C

2011-09-01

Little is known about researchers' practices regarding the provision of ancillary care (AC) in public health intervention studies they have conducted and the factors that influence their decisions about whether to provide ancillary care in low-resource settings. We conducted 52 in-person in-depth interviews with public health researchers. Data analysis was iterative and led to the identification of themes and patterns among themes. We found that researchers who conduct their research in the community setting are more likely to identify and plan for the AC needs of potential research subjects before a study begins, whereas those affiliated with a permanent facility are more likely to deliver AC to research subjects on an ad hoc basis. Our findings suggest that on the whole, at least for public health intervention research in low-resource settings, researchers conducting research in the community setting confront more complex ethical and operational challenges in their decision-making about AC than do researchers conducting facility-based studies.

A review of clinical decision making: models and current research.

PubMed

Banning, Maggi

2008-01-01

The aim of this paper was to review the current literature clinical decision-making models and the educational application of models to clinical practice. This was achieved by exploring the function and related research of the three available models of clinical decision making: information-processing model, the intuitive-humanist model and the clinical decision-making model. Clinical decision making is a unique process that involves the interplay between knowledge of pre-existing pathological conditions, explicit patient information, nursing care and experiential learning. Historically, two models of clinical decision making are recognized from the literature; the information-processing model and the intuitive-humanist model. The usefulness and application of both models has been examined in relation the provision of nursing care and care related outcomes. More recently a third model of clinical decision making has been proposed. This new multidimensional model contains elements of the information-processing model but also examines patient specific elements that are necessary for cue and pattern recognition. Literature review. Evaluation of the literature generated from MEDLINE, CINAHL, OVID, PUBMED and EBESCO systems and the Internet from 1980 to November 2005. The characteristics of the three models of decision making were identified and the related research discussed. Three approaches to clinical decision making were identified, each having its own attributes and uses. The most recent addition to the clinical decision making is a theoretical, multidimensional model which was developed through an evaluation of current literature and the assessment of a limited number of research studies that focused on the clinical decision-making skills of inexperienced nurses in pseudoclinical settings. The components of this model and the relative merits to clinical practice are discussed. It is proposed that clinical decision making improves as the nurse gains experience of nursing patients within a specific speciality and with experience, nurses gain a sense of saliency in relation to decision making. Experienced nurses may use all three forms of clinical decision making both independently and concurrently to solve nursing-related problems. It is suggested that O'Neill's clinical decision-making model could be tested by educators and experienced nurses to assess the efficacy of this hybrid approach to decision making.

Effect of experience on clinical decision making by cardiorespiratory physiotherapists in acute care settings.

PubMed

Smith, Megan; Higgs, Joy; Ellis, Elizabeth

2010-02-01

This article investigates clinical decision making in acute care hospitals by cardiorespiratory physiotherapists with differing degrees of clinical experience. Participants were observed as they engaged in their everyday practice and were interviewed about their decision making. Texts of the data were interpreted by using a hermeneutic approach that involved repeated reading and analysis of fieldnotes and interview transcripts to develop an understanding of the effect of experience on clinical decision making. Participants were classified into categories of cardiorespiratory physiotherapy experience: less experienced (<2 years), intermediate experience (2.5-4 years), and more experienced (>7 years). Four dimensions characteristic of increasing experience in cardiorespiratory physiotherapy clinical decision making were identified: 1) an individual practice model, 2) refined approaches to clinical decision making, 3) working in context, and 4) social and emotional capability. Underpinning these dimensions was evidence of reflection on practice, motivation to achieve best practice, critique of new knowledge, increasing confidence, and relationships with knowledgeable colleagues. These findings reflect characteristics of physiotherapy expertise that have been described in the literature. This study adds knowledge about the field of cardiorespiratory physiotherapy to the existing body of research on clinical decision making and broadens the existing understanding of characteristics of physiotherapy expertise.

Decision-making capacity should not be decisive in emergencies.

PubMed

Hubbeling, Dieneke

2014-05-01

Examples of patients with anorexia nervosa, depression or borderline personality disorder who have decision-making capacity as currently operationalized, but refuse treatment, are discussed. It appears counterintuitive to respect their treatment refusal because their wish seems to be fuelled by their illness and the consequences of their refusal of treatment are severe. Some proposed solutions have focused on broadening the criteria for decision-making capacity, either in general or for specific patient groups, but these adjustments might discriminate against particular groups of patients and render the process less transparent. Other solutions focus on preferences expressed when patients are not ill, but this information is often not available. The reason for such difficulties with assessing decision-making capacity is that the underlying psychological processes of normal decision-making are not well known and one cannot differentiate between unwise decisions caused by an illness or other factors. The proposed alternative, set out in this paper, is to allow compulsory treatment of patients with decision-making capacity in cases of an emergency, if the refusal is potentially life threatening, but only for a time-limited period. The argument is also made for investigating hindsight agreement, in particular after compulsory measures.

A Plea for Process in Personality Prevarication

PubMed Central

Kuncel, Nathan R.; Goldberg, Lewis R.; Kiger, Tom

2011-01-01

We make a series recommendations for focusing research on personality test faking. Overall we suggest that a focus on the response process test takers go through will accelerate our understanding of faking behavior. We argue that the decision making process for faking must be simple and dependent on a modest set of decision rules or heuristics. The set of heuristics used by any given test taker will, in turn, be the result of test taker goals and situational press. By focusing in on what the test taker is doing we will avoid adopting the wrong frame of reference and, hopefully, make ever more rapid progress. PMID:21966260

Dispositional optimism, self-framing and medical decision-making.

PubMed

Zhao, Xu; Huang, Chunlei; Li, Xuesong; Zhao, Xin; Peng, Jiaxi

2015-03-01

Self-framing is an important but underinvestigated area in risk communication and behavioural decision-making, especially in medical settings. The present study aimed to investigate the relationship among dispositional optimism, self-frame and decision-making. Participants (N = 500) responded to the Life Orientation Test-Revised and self-framing test of medical decision-making problem. The participants whose scores were higher than the middle value were regarded as highly optimistic individuals. The rest were regarded as low optimistic individuals. The results showed that compared to the high dispositional optimism group, participants from the low dispositional optimism group showed a greater tendency to use negative vocabulary to construct their self-frame, and tended to choose the radiation therapy with high treatment survival rate, but low 5-year survival rate. Based on the current findings, it can be concluded that self-framing effect still exists in medical situation and individual differences in dispositional optimism can influence the processing of information in a framed decision task, as well as risky decision-making. © 2014 International Union of Psychological Science.

Feedback Blunting: Total Sleep Deprivation Impairs Decision Making that Requires Updating Based on Feedback.

PubMed

Whitney, Paul; Hinson, John M; Jackson, Melinda L; Van Dongen, Hans P A

2015-05-01

To better understand the sometimes catastrophic effects of sleep loss on naturalistic decision making, we investigated effects of sleep deprivation on decision making in a reversal learning paradigm requiring acquisition and updating of information based on outcome feedback. Subjects were randomized to a sleep deprivation or control condition, with performance testing at baseline, after 2 nights of total sleep deprivation (or rested control), and following 2 nights of recovery sleep. Subjects performed a decision task involving initial learning of go and no go response sets followed by unannounced reversal of contingencies, requiring use of outcome feedback for decisions. A working memory scanning task and psychomotor vigilance test were also administered. Six consecutive days and nights in a controlled laboratory environment with continuous behavioral monitoring. Twenty-six subjects (22-40 y of age; 10 women). Thirteen subjects were randomized to a 62-h total sleep deprivation condition; the others were controls. Unlike controls, sleep deprived subjects had difficulty with initial learning of go and no go stimuli sets and had profound impairment adapting to reversal. Skin conductance responses to outcome feedback were diminished, indicating blunted affective reactions to feedback accompanying sleep deprivation. Working memory scanning performance was not significantly affected by sleep deprivation. And although sleep deprived subjects showed expected attentional lapses, these could not account for impairments in reversal learning decision making. Sleep deprivation is particularly problematic for decision making involving uncertainty and unexpected change. Blunted reactions to feedback while sleep deprived underlie failures to adapt to uncertainty and changing contingencies. Thus, an error may register, but with diminished effect because of reduced affective valence of the feedback or because the feedback is not cognitively bound with the choice. This has important implications for understanding and managing sleep loss-induced cognitive impairment in emergency response, disaster management, military operations, and other dynamic real-world settings with uncertain outcomes and imperfect information. © 2015 Associated Professional Sleep Societies, LLC.

Maximizing gait and balance: behaviors and decision-making processes of persons with multiple sclerosis and physical therapists.

PubMed

Held Bradford, Elissa; Finlayson, Marcia; White Gorman, Andrea; Wagner, Joanne

2018-05-01

To describe the behavioral decisions used by persons with multiple sclerosis (MS) and physical therapists to maximize gait and balance following outpatient physical therapy. A multi-method case series with seven matched pairs (persons with MS-physical therapists). Quota sampling maximized variability among persons with MS (disease steps score range 3-6). Three of the four physical therapists were MS or neurology certified. Persons with MS completed a phone survey, follow-up interview, and standardized questionnaires. Physical therapists completed an interview. Data were collected 2-8 weeks following discharge. Content and constant comparison analyses were used for thematic development and triangulation. Core themes arose exemplifying the decision-making processes and actions of persons with MS (challenging self by pushing but respecting limits) and physical therapists (finding the right fit). One overarching theme, keeping their lived world large, or participation in valued life roles, emerged integrating both perspectives driving decision-making. Participants have a shared goal of maximizing gait and balance so persons with MS can participate in valued life roles. Understanding the differences in the behavioral decisions and optimizing skill sets in shared decision-making and self-management may enhance the therapeutic partnership and engagement in gait- and balance-enhancing behaviors. Implications for Rehabilitation Persons with MS and physical therapists have a shared goal of maximizing gait and balance so persons with MS can participate in valued activities and life roles, or more poetically, keep their lived world large. Knowledge that persons with MS aim to challenge themselves by pushing but respecting limits can provide physical therapists with greater insight in helping persons with MS resolve uncertainty, set meaningful goals, and build the routines and resilience needed for engagement in gait- and balance-enhancing behaviors. Enriching skill sets in shared decision-making, behavior change and self-management may optimize the physical therapist toolbox.

Evolution of quantum-like modeling in decision making processes

NASA Astrophysics Data System (ADS)

Khrennikova, Polina

2012-12-01

The application of the mathematical formalism of quantum mechanics to model behavioral patterns in social science and economics is a novel and constantly emerging field. The aim of the so called 'quantum like' models is to model the decision making processes in a macroscopic setting, capturing the particular 'context' in which the decisions are taken. Several subsequent empirical findings proved that when making a decision people tend to violate the axioms of expected utility theory and Savage's Sure Thing principle, thus violating the law of total probability. A quantum probability formula was devised to describe more accurately the decision making processes. A next step in the development of QL-modeling in decision making was the application of Schrödinger equation to describe the evolution of people's mental states. A shortcoming of Schrödinger equation is its inability to capture dynamics of an open system; the brain of the decision maker can be regarded as such, actively interacting with the external environment. Recently the master equation, by which quantum physics describes the process of decoherence as the result of interaction of the mental state with the environmental 'bath', was introduced for modeling the human decision making. The external environment and memory can be referred to as a complex 'context' influencing the final decision outcomes. The master equation can be considered as a pioneering and promising apparatus for modeling the dynamics of decision making in different contexts.

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

PubMed

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

2008-05-01

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

Policy decision-making under scientific uncertainty: radiological risk assessment and the role of expert advisory groups.

PubMed

Mossman, Kenneth L

2009-08-01

Standard-setting agencies such as the U.S. Nuclear Regulatory Commission and the U.S. Environmental Protection Agency depend on advice from external expert advisory groups on matters of public policy and standard-setting. Authoritative bodies including the National Research Council and the National Council on Radiation Protection and Measurements provide analyses and recommendations that enable the technical and scientific soundness in decision-making. In radiological protection the nature of the scientific evidence is such that risk assessment at radiation doses typically encountered in environmental and occupational settings is highly uncertain, and several policy alternatives are scientifically defensible. The link between science and policy is problematic. The fundamental issue is the failure to properly consider risk assessment, risk communication, and risk management and then consolidate them in a process that leads to sound policy. Authoritative bodies should serve as unbiased brokers of policy choices by providing balanced and objective scientific analyses. As long as the policy-decision environment is characterized by high scientific uncertainty and a lack of values consensus, advisory groups should present unbiased evaluations of all scientifically plausible alternatives and recommend selection criteria that decision makers can use in the policy-setting process. To do otherwise (e.g., by serving as single position advocates) weakens decision-making by eliminating options and narrowing discussions of scientific perspectives. Understanding uncertainties and the limitations on available scientific information and conveying such information to policy makers remain key challenges for the technical and policy communities.

Neither Pollyanna nor Chicken Little: Thoughts on the Ethics of Automation

NASA Technical Reports Server (NTRS)

Holloway, C. Michael; Knight, John C.; McDermid, John A.

2014-01-01

This paper has raised issues concerning the ethics of automation in aviation systems, and outlined ways of thinking about the issues that may help in ethical decision making. It is very easy to be carried along by technology and the Pollyanna view, but just because we can do something, doesn't mean we should - which is perhaps a little milder than the Chicken Little view. Both views have merits, and we would view ethical decisions as ones that more appropriately balance or reconcile these conflicting viewpoints. We have set out some of the background to the problems of automation in aviation systems, but are aware that there is much more that could be said (considering military UAS, for example). We hope, however, that the brief introduction provides a foundation for the ethical questions that we have set out. The underlying aim in proposing ESCs is to make understanding ethical issues easier so that ethically-informed decisions can be made. Whilst we have not linked the discussion directly back to specific ethical decisions, we believe that making explicit those issues on which such judgments are based is a contribution to ethically informed decision making. We also believe that the four principles set out by the RAEng are reflected in this approach. We acknowledge that what we have set out, especially the ideas of ESC, goes some way beyond current practice and principles and there are significant technical issues to resolve before such an approach could be implemented. It is hoped, however, that the ideas will help improve the production and presentation of safety cases in a range of industries not just aviation - a Pollyanna view, of course!

Health technology assessment process of a cardiovascular medical device in four different settings.

PubMed

Olry de Labry Lima, Antonio; Espín Balbino, Jaime; Lemgruber, Alexandre; Caro Martínez, Araceli; García-Mochón, Leticia; Martín Ruiz, Eva; Lessa, Fernanda

2017-10-01

Health technology assessment (HTA) is a tool to help the decision-making process. The aim is to describe methods and processes used in the reimbursement decision making for drug-eluting stents (DES) in four different settings. DES as a technology under study was selected according to different criteria, all of them agreed by a working group. A survey of key informants was designed. DES was evaluated following well-structured HTA processes. Nonetheless, scope for improvement was observed in relation to the data considered for the final decision, the transparency and inclusiveness of the process as well as in the methods employed. An attempt to describe the HTA processes of a well-known medical device.

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.

Key components of effective collaborative goal setting in the chronic care encounter.

PubMed

Bigi, Sarah

2014-01-01

Collaborative goal setting in patient-provider communication with chronic patients is the phase in which--after collecting the data regarding the patient's health--it is necessary to make a decision regarding the best therapy and behaviors the patient should adopt until the next encounter. Although it is considered a pivotal phase of shared decision making, there remain a few open questions regarding its components and its efficacy: What are the factors that improve or impede agreement on treatment goals and strategies?; What are the 'success conditions' of collaborative goal setting?; How can physicians effectively help patients make their preferences explicit and then co-construct with them informed preferences to help them reach their therapeutic goals? Using the theoretical framework of dialogue types, an approach developed in the field of Argumentation Theory, it will be possible to formulate hypotheses on the success conditions' and effects on patient commitment of collaborative goal setting.

The EVOTION Decision Support System: Utilizing It for Public Health Policy-Making in Hearing Loss.

PubMed

Katrakazas, Panagiotis; Trenkova, Lyubov; Milas, Josip; Brdaric, Dario; Koutsouris, Dimitris

2017-01-01

As Decision Support Systems start to play a significant role in decision making, especially in the field of public-health policy making, we present an initial attempt to formulate such a system in the concept of public health policy making for hearing loss related problems. Justification for the system's conceptual architecture and its key functionalities are presented. The introduction of the EVOTION DSS sets a key innovation and a basis for paradigm shift in policymaking, by incorporating relevant models, big data analytics and generic demographic data. Expected outcomes for this joint effort are discussed from a public-health point of view.

Involvement of people with dementia in making decisions about their lives: a qualitative study that appraises shared decision-making concerning daycare

PubMed Central

Groen-van de Ven, Leontine; Smits, Carolien; de Graaff, Fuusje; Span, Marijke; Eefsting, Jan; Jukema, Jan; Vernooij-Dassen, Myrra

2017-01-01

Objective To explore how people with dementia, their informal caregivers and their professionals participate in decision making about daycare and to develop a typology of participation trajectories. Design A qualitative study with a prospective, multiperspective design, based on 244 semistructured interviews, conducted during three interview rounds over the course of a year. Analysis was by means of content analysis and typology construction. Setting Community settings and nursing homes in the Netherlands. Participants 19 people with dementia, 36 of their informal caregivers and 38 of their professionals (including nurses, daycare employees and case managers). Results The participants’ responses related to three critical points in the decision-making trajectory about daycare: (1) the initial positive or negative expectations of daycare; (2) negotiation about trying out daycare by promoting, resisting or attuning to others; and (3) trying daycare, which resulted in positive or negative reactions from people with dementia and led to a decision. The ways in which care networks proceeded through these three critical points resulted in a typology of participation trajectories, including (1) working together positively toward daycare, (2) bringing conflicting perspectives together toward trying daycare and (3) not reaching commitment to try daycare. Conclusion Shared decision making with people with dementia is possible and requires and adapted process of decision making. Our results show that initial preferences based on information alone may change when people with dementia experience daycare. It is important to have a try-out period so that people with dementia can experience daycare without having to decide whether to continue it. Whereas shared decision making in general aims at moving from initial preferences to informed preferences, professionals should focus more on moving from initial preferences to experienced preferences for people with dementia. Professionals can play a crucial role in facilitating the possibilities for a try-out period. PMID:29133329

Linguistic Multi-Attribute Group Decision Making with Risk Preferences and Its Use in Low-Carbon Tourism Destination Selection.

PubMed

Lin, Hui; Wang, Zhou-Jing

2017-09-17

Low-carbon tourism plays an important role in carbon emission reduction and environmental protection. Low-carbon tourism destination selection often involves multiple conflicting and incommensurate attributes or criteria and can be modelled as a multi-attribute decision-making problem. This paper develops a framework to solve multi-attribute group decision-making problems, where attribute evaluation values are provided as linguistic terms and the attribute weight information is incomplete. In order to obtain a group risk preference captured by a linguistic term set with triangular fuzzy semantic information, a nonlinear programming model is established on the basis of individual risk preferences. We first convert individual linguistic-term-based decision matrices to their respective triangular fuzzy decision matrices, which are then aggregated into a group triangular fuzzy decision matrix. Based on this group decision matrix and the incomplete attribute weight information, a linear program is developed to find an optimal attribute weight vector. A detailed procedure is devised for tackling linguistic multi-attribute group decision making problems. A low-carbon tourism destination selection case study is offered to illustrate how to use the developed group decision-making model in practice.

Linguistic Multi-Attribute Group Decision Making with Risk Preferences and Its Use in Low-Carbon Tourism Destination Selection

PubMed Central

Lin, Hui; Wang, Zhou-Jing

2017-01-01

Low-carbon tourism plays an important role in carbon emission reduction and environmental protection. Low-carbon tourism destination selection often involves multiple conflicting and incommensurate attributes or criteria and can be modelled as a multi-attribute decision-making problem. This paper develops a framework to solve multi-attribute group decision-making problems, where attribute evaluation values are provided as linguistic terms and the attribute weight information is incomplete. In order to obtain a group risk preference captured by a linguistic term set with triangular fuzzy semantic information, a nonlinear programming model is established on the basis of individual risk preferences. We first convert individual linguistic-term-based decision matrices to their respective triangular fuzzy decision matrices, which are then aggregated into a group triangular fuzzy decision matrix. Based on this group decision matrix and the incomplete attribute weight information, a linear program is developed to find an optimal attribute weight vector. A detailed procedure is devised for tackling linguistic multi-attribute group decision making problems. A low-carbon tourism destination selection case study is offered to illustrate how to use the developed group decision-making model in practice. PMID:28926985

Experiences of treatment decision making for young people diagnosed with depressive disorders: a qualitative study in primary care and specialist mental health settings

PubMed Central

2011-01-01

Background Clinical guidelines advocate for the inclusion of young people experiencing depression as well as their caregivers in making decisions about their treatment. Little is known, however, about the degree to which these groups are involved, and whether they want to be. This study sought to explore the experiences and desires of young people and their caregivers in relation to being involved in treatment decision making for depressive disorders. Methods Semi-structured interviews were carried out with ten young people and five caregivers from one primary care and one specialist mental health service about their experiences and beliefs about treatment decision making. Interviews were audio taped, transcribed verbatim and analysed using thematic analysis. Results Experiences of involvement for clients varied and were influenced by clients themselves, clinicians and service settings. For caregivers, experiences of involvement were more homogenous. Desire for involvement varied across clients, and within clients over time; however, most clients wanted to be involved at least some of the time. Both clients and caregivers identified barriers to involvement. Conclusions This study supports clinical guidelines that advocate for young people diagnosed with depressive disorders to be involved in treatment decision making. In order to maximise engagement, involvement in treatment decision making should be offered to all clients. Involvement should be negotiated explicitly and repeatedly, as desire for involvement may change over time. Caregiver involvement should be negotiated on an individual basis; however, all caregivers should be supported with information about mental disorders and treatment options. PMID:22151735

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

PubMed

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

2016-10-06

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

'Kids need to talk too': inclusive practices for children's healthcare education and participation.

PubMed

Koller, Donna

2017-09-01

To examine how children with chronic medical conditions view healthcare education and decision-making and to propose the application of the universal design for learning in paediatric settings. Children and adolescents with chronic medical conditions tend to be excluded from healthcare decision-making. In schools, the universal design for learning promotes access to education and participation in school communities for all children, regardless of their disabilities or medical needs, rendering it an appropriate model for children's participation in healthcare decision-making. This article presents findings from a qualitative study with 26 children and adolescents with chronic medical conditions about their views and experiences with healthcare education and decision-making. Twenty-six children and adolescents with chronic medical conditions were interviewed using semi-structured interviews. Findings provide evidence that clinical practices often fail to provide equal opportunities for paediatric patients to understand their condition, share their views and/or participate in decisions regarding their care. In response to ongoing concerns about paediatric decision-making, we propose that the universal design for learning be adapted in paediatrics. The model presents exemplary programmes as inclusive, accounting for the needs of all children through multiple means of engagement and expression. A discussion of how the principles of universal design for learning could be applied in paediatric settings is offered for the purpose of advancing ethical and psychosocial care for all children regardless of their age, developmental capacity or condition. © 2016 John Wiley & Sons Ltd.

Risk, rationality, and community: Psychology, ethnography, and transactions in the risk management process

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

Cantor, R.; Schoepfle, M.

Communities at risk are confronted by an increasingly complex array of opportunities and need for involvement in decisions affecting them. Policy analysis often demands from researchers insights into the complicated process of how best to account for community involvement in decision making. Often, this requires additional understanding of how decisions are made by community members. Researchers trying to capture the important features of decision making will necessarily make assumptions regarding the rationality underlying the decision process. Two implicit and often incompatible sets of research assumptions about decision processes have emerged: outcome rationality and process rationality. Using outcome rationality, the principalmore » goal of risk research often is to predict how people will react to risk regardless of what they say they would do. Using process rationality, the research goal is to determine how people perceive the risks to which they are exposed and how perceptions actually influence responses. The former approach is associated with research in risk communication, conducted by economists and cognitive psychologists; the latter approach is associated with the field of risk negotiation and acceptance, conducted by anthropologists, some sociologists, and planners. This article describes (1) the difference between the assumptions behind outcome and process rationality regarding decision making and the problems resulting from these differences; (2) the promise and limitations of both sets of assumptions; (3) the potential contributions from cognitive psychology, cognitive ethnography, and the theory of transaction costs in reconciling the differences in assumptions and making them more complementary; and (4) the implications of such complementarity.« less

Stereotype threat affects financial decision making.

PubMed

Carr, Priyanka B; Steele, Claude M

2010-10-01

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

Losing a dime with a satisfied mind: positive affect predicts less search in sequential decision making.

PubMed

von Helversen, Bettina; Mata, Rui

2012-12-01

We investigated the contribution of cognitive ability and affect to age differences in sequential decision making by asking younger and older adults to shop for items in a computerized sequential decision-making task. Older adults performed poorly compared to younger adults partly due to searching too few options. An analysis of the decision process with a formal model suggested that older adults set lower thresholds for accepting an option than younger participants. Further analyses suggested that positive affect, but not fluid abilities, was related to search in the sequential decision task. A second study that manipulated affect in younger adults supported the causal role of affect: Increased positive affect lowered the initial threshold for accepting an attractive option. In sum, our results suggest that positive affect is a key factor determining search in sequential decision making. Consequently, increased positive affect in older age may contribute to poorer sequential decisions by leading to insufficient search. 2013 APA, all rights reserved

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.

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

ERIC Educational Resources Information Center

Snipes, Katherine H.

2009-01-01

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

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.

Demystifying Data: Designing and Implementing Data-Driven Systems and Practices for Continuous Quality Improvement

ERIC Educational Resources Information Center

Krugly, Andrew; Stein, Amanda; Centeno, Maribel G.

2014-01-01

Data-based decision making should be the driving force in any early care and education setting. Data usage compels early childhood practitioners and leaders to make decisions on the basis of more than just professional instinct. This article explores why early childhood schools should be using data for continuous quality improvement at various…

Principles, values, and ethics set the stage for managed care nursing.

PubMed

Moss, M T

1995-01-01

Principles, values, and ethics constitute an ethical system that provides nurses a context in which to make ethical decisions. As the managed care environment generates new ethical issues and intensifies already existing ones, ethical education and decision-making skills become even more critical to nursing professionals, as well as physicians and hospital administrators.

Quality in Higher Education: The Need for Feedback from Students

ERIC Educational Resources Information Center

Okogbaa, Veronica

2016-01-01

Students in higher institutions are part and parcel of the system, thus their opinions should count in decision making concerning the quality of the education they are receiving. This study set out to examine from literature the place of feedback from students and its possible relevance in decision making on quality issues in higher education.…

Advertising Practitioner's Ethical Decision-Making: The Utilitarian Viewpoint.

ERIC Educational Resources Information Center

Overstreet, Charles William

A study compared the decision making process of large and small advertising agencies to determine if the size of the agency, in terms of gross annual billing, had any effect on adherence to the rules set forth in the American Association of Advertising's Standards of Practice. Forty agency employees, 20 from agencies with billings less than $2.5…

Teacher Knowledge about Technology Integration: An Examination of Inservice and Preservice Teachers' Instructional Decision-Making

ERIC Educational Resources Information Center

Greenhow, Christine; Dexter, Sara; Hughes, Joan E.

2008-01-01

This study compared the abilities of inservice and preservice teachers to demonstrate an understanding of technology integration and to apply such knowledge to instructional decision-making. Using a set of online content-specific multimedia scenarios to resolve complex problems of teaching with technology in a simulated school environment,…

Curriculum-Based Measurement of Reading Progress Monitoring: The Importance of Growth Magnitude and Goal Setting in Decision Making

ERIC Educational Resources Information Center

Van Norman, Ethan R.; Christ, Theodore J.; Newell, Kirsten W.

2017-01-01

Research regarding the technical adequacy of growth estimates from curriculum-based measurement of reading progress monitoring data suggests that current decision-making frameworks are likely to yield inaccurate recommendations unless data are collected for extensive periods of time. Instances where data may not need to be collected for long…

Static Analysis Alert Audits: Lexicon and Rules

DTIC Science & Technology

2016-11-04

collaborators • Includes a standard set of well-defined determinations for static analysis alerts • Includes a set of auditing rules to help auditors make...consistent decisions in commonly-encountered situations Different auditors should make the same determination for a given alert! Improve the quality and...scenarios • Establish assumptions auditors can make • Overall: help make audit determinations more consistent We developed 12 rules • Drew on our own

Communication and Decision Making in Cancer Care: Setting Research Priorities for Decision Support/Patients’ Decision Aids

PubMed Central

Barnato, Amber E.; Llewellyn-Thomas, Hilary A.; Peters, Ellen M.; Siminoff, Laura; Collins, E. Dale; Barry, Michael J.

2013-01-01

The following is a summary report from a special symposium, entitled “Translating Research into Practice: Setting a Research Agenda for Clinical Decision Tools in Cancer Prevention, Early Detection, and Treatment”, that was held on October 23, 2005 in San Francisco at the Annual Meeting of the Society for Medical Decision Making (SMDM). The symposium was designed to answer the question: “What are the top two research priorities in the field of patients’ cancer-related decision aids?” After introductory remarks by Dr. Barry, each of four panelists–Drs. Hilary Llewellyn-Thomas, Ellen Peters, Laura Siminoff, and Dale Collins–addressed the question and provided their rationale during prepared remarks. The moderator, Dr. Michael Barry, then facilitated a discussion between the panelists, with input from the audience, to further explore and add to the various proposed research questions. Finally, Dr. Amber Barnato conducted a simple vote count (see Table 1) to prioritize the panelists’ and the audience’s recommendations. PMID:17873249

A conceptual evolutionary aseismic decision support framework for hospitals

NASA Astrophysics Data System (ADS)

Hu, Yufeng; Dargush, Gary F.; Shao, Xiaoyun

2012-12-01

In this paper, aconceptual evolutionary framework for aseismic decision support for hospitalsthat attempts to integrate a range of engineering and sociotechnical models is presented. Genetic algorithms are applied to find the optimal decision sets. A case study is completed to demonstrate how the frameworkmay applytoa specific hospital.The simulations show that the proposed evolutionary decision support framework is able to discover robust policy sets in either uncertain or fixed environments. The framework also qualitatively identifies some of the characteristicbehavior of the critical care organization. Thus, by utilizing the proposedframework, the decision makers are able to make more informed decisions, especially toenhance the seismic safety of the hospitals.

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.

Decision making in urological surgery.

PubMed

Abboudi, Hamid; Ahmed, Kamran; Normahani, Pasha; Abboudi, May; Kirby, Roger; Challacombe, Ben; Khan, Mohammed Shamim; Dasgupta, Prokar

2012-06-01

Non-technical skills are important behavioural aspects that a urologist must be fully competent at to minimise harm to patients. The majority of surgical errors are now known to be due to errors in judgment and decision making as opposed to the technical aspects of the craft. The authors reviewed the published literature regarding decision-making theory and in practice related to urology as well as the current tools available to assess decision-making skills. Limitations include limited number of studies, and the available studies are of low quality. Decision making is the psychological process of choosing between alternative courses of action. In the surgical environment, this can often be a complex balance of benefit and risk within a variable time frame and dynamic setting. In recent years, the emphasis of new surgical curriculums has shifted towards non-technical surgical skills; however, the assessment tools in place are far from objective, reliable and valid. Surgical simulators and video-assisted questionnaires are useful methods for appraisal of trainees. Well-designed, robust and validated tools need to be implemented in training and assessment of decision-making skills in urology. Patient safety can only be ensured when safe and effective decisions are made.

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

What is lacking in current decision aids on cancer screening?

PubMed Central

Jimbo, Masahito; Rana, Gurpreet K.; Hawley, Sarah; Holmes-Rovner, Margaret; Kelly-Blake, Karen; Nease, Donald E.; Ruffin, Mack T.

2013-01-01

Recent guidelines on cancer screening have given not only more screening options but also conflicting recommendations. Thus, patients, with their clinicians’ support, must decide whether to get screened or not, which modality to use, and how often to get screened. Decision aids could potentially lead to better shared decision making regarding screening between the patient and the clinician. We reviewed 73 decision aids on screening for breast, cervical, colorectal, and prostate cancers. The goal of this review was to assess the effectiveness of such decision aids, examine areas in need for more research, and determine how the decision aids can be currently applied in the real world setting. Most studies used sound study design. Significant variation existed in setting, theoretical framework, and measured outcomes. Just over a third of the decision aids included an explicit values clarification. Other than knowledge, little consistency was noted in which patient attributes were measured as outcomes. Few studies actually measured shared decision making. Little information was available on the feasibility and outcomes of integrating decision aids into practice. We discuss the implications for future research, as well as what the clinicians can do now to incorporate decision aids into their practice. PMID:23504675

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.

A framework for multi-stakeholder decision-making and ...

EPA Pesticide Factsheets

We propose a decision-making framework to compute compromise solutions that balance conflicting priorities of multiple stakeholders on multiple objectives. In our setting, we shape the stakeholder dis-satisfaction distribution by solving a conditional-value-at-risk (CVaR) minimization problem. The CVaR problem is parameterized by a probability level that shapes the tail of the dissatisfaction distribution. The proposed approach allows us to compute a family of compromise solutions and generalizes multi-stakeholder settings previously proposed in the literature that minimize average and worst-case dissatisfactions. We use the concept of the CVaR norm to give a geometric interpretation to this problem +and use the properties of this norm to prove that the CVaR minimization problem yields Pareto optimal solutions for any choice of the probability level. We discuss a broad range of potential applications of the framework that involve complex decision-making processes. We demonstrate the developments using a biowaste facility location case study in which we seek to balance stakeholder priorities on transportation, safety, water quality, and capital costs. This manuscript describes the methodology of a new decision-making framework that computes compromise solutions that balance conflicting priorities of multiple stakeholders on multiple objectives as needed for SHC Decision Science and Support Tools project. A biowaste facility location is employed as the case study

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

PubMed Central

2013-01-01

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

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

PubMed

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

2013-07-12

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

A qualitative study of nulliparous women's decision making on mode of delivery under China's two-child policy.

PubMed

Gu, Chunyi; Zhu, Xinli; Ding, Yan; Setterberg Simone; Wang, Xiaojiao; Tao, Hua; Zhang, Yu

2018-07-01

To explore nulliparous women's perceptions of decision making regarding mode of delivery under China's two-child policy. Qualitative descriptive design with in-depth semi-structured interviews. Postnatal wards at a tertiary specialized women's hospital in Shanghai, China. 21 nulliparous women 2-3 days postpartum were purposively sampled until data saturation. In-depth semi-structured interviews were conducted between October 8th, 2015 and January 31st, 2016. Two overarching descriptive categories were identified: (1) women's decision-making process: stability versus variability, and (2) factors affecting decision making: variety versus interactivity. Four key themes emerged from each category: (1) initial decision making with certainty: anticipated trial of labour, failed trial of labour, 'shy away' and compromise, anticipated caesarean delivery; (2) initial decision making with uncertainty: anticipated trial of labour, failed trial of labour, 'shy away' and compromise; (3) internal factors affecting decision making: knowledge and attitude, and childbirth self-efficacy; and (4) external factors affecting decision making: social support, and the situational environment. At the initial period of China's two-child policy, nulliparous women have perceived their decision-making process regarding mode of delivery as one with complexity and uncertainty, influenced by both internal and external factors. This may have implications for the obstetric setting to develop a well-designed decision support system for pregnant women during the entire pregnancy periods. And it is recommended that care providers should assess women's preferences for mode of delivery from early pregnancy and provide adequate perinatal support and continuity of care for them. Copyright © 2018 Elsevier Ltd. All rights reserved.

The Effects of Framing Vocational Choices on Young Adults' Sets of Career Options

ERIC Educational Resources Information Center

Feldman, Daniel C.; Whitcomb, Kathleen M.

2005-01-01

Purpose: The present paper examines the effects of two decision-framing inductions on young adults' set of career options: first, whether young adults use abilities or interests as the grounds for their vocational choices and, second, whether young adults approach the decision-making task by including all career options to which they feel…

Exponential operations and aggregation operators of interval neutrosophic sets and their decision making methods.

PubMed

Ye, Jun

2016-01-01

An interval neutrosophic set (INS) is a subclass of a neutrosophic set and a generalization of an interval-valued intuitionistic fuzzy set, and then the characteristics of INS are independently described by the interval numbers of its truth-membership, indeterminacy-membership, and falsity-membership degrees. However, the exponential parameters (weights) of all the existing exponential operational laws of INSs and the corresponding exponential aggregation operators are crisp values in interval neutrosophic decision making problems. As a supplement, this paper firstly introduces new exponential operational laws of INSs, where the bases are crisp values or interval numbers and the exponents are interval neutrosophic numbers (INNs), which are basic elements in INSs. Then, we propose an interval neutrosophic weighted exponential aggregation (INWEA) operator and a dual interval neutrosophic weighted exponential aggregation (DINWEA) operator based on these exponential operational laws and introduce comparative methods based on cosine measure functions for INNs and dual INNs. Further, we develop decision-making methods based on the INWEA and DINWEA operators. Finally, a practical example on the selecting problem of global suppliers is provided to illustrate the applicability and rationality of the proposed methods.

Values based practice: a framework for thinking with.

PubMed

Mohanna, Kay

2017-07-01

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

The conduct and process of mental capacity assessments in home health care settings.

PubMed

Cliff, Charlotte; McGraw, Caroline

2016-11-02

The assessment of capacity to consent to treatment is key to shared practitioner-patient decision-making. It is the responsibility of the person closest to the decision being made to carry out the assessment. The aim was to examine the factors that influence mental capacity assessments in home health care settings and identify the facilitators and inhibitors to the conduct and process of assessments as perceived and experienced by non-medical health practitioners providing generalist community services. Semi-structured interviews with a purposive sample of community nurses, community physiotherapists and community occupational therapists in one NHS Trust in London. Data were analysed thematically. The main themes were issues relating to: intrinsic patient factors and behaviours; recognising, managing and utilising the influence of the family; practitioner motivation and competence; working together as a team to optimise shared decision making, and; the importance of place. While some issues appear germane to both hospital and home health care settings, others are unique to - or manifest very differently in - home health care settings. The findings suggest that the influence of family members, long-term practitioner-patient relationships and physical distance from co-workers make the conduct and process of mental capacity assessments in home health care settings an inherently complex endeavour.

A conceptual framework for effectively anticipating water-quality changes resulting from changes in agricultural activities

USGS Publications Warehouse

Capel, Paul D.; Wolock, David M.; Coupe, Richard H.; Roth, Jason L.

2018-01-10

Agricultural activities can affect water quality and the health of aquatic ecosystems; many water-quality issues originate with the movement of water, agricultural chemicals, and eroded soil from agricultural areas to streams and groundwater. Most agricultural activities are designed to sustain or increase crop production, while some are designed to protect soil and water resources. Numerous soil- and water-protection practices are designed to reduce the volume and velocity of runoff and increase infiltration. This report presents a conceptual framework that combines generalized concepts on the movement of water, the environmental behavior of chemicals and eroded soil, and the designed functions of various agricultural activities, as they relate to hydrology, to create attainable expectations for the protection of—with the goal of improving—water quality through changes in an agricultural activity.The framework presented uses two types of decision trees to guide decision making toward attainable expectations regarding the effectiveness of changing agricultural activities to protect and improve water quality in streams. One decision tree organizes decision making by considering the hydrologic setting and chemical behaviors, largely at the field scale. This decision tree can help determine which agricultural activities could effectively protect and improve water quality in a stream from the movement of chemicals, or sediment, from a field. The second decision tree is a chemical fate accounting tree. This decision tree helps set attainable expectations for the permanent removal of sediment, elements, and organic chemicals—such as herbicides and insecticides—through trapping or conservation tillage practices. Collectively, this conceptual framework consolidates diverse hydrologic settings, chemicals, and agricultural activities into a single, broad context that can be used to set attainable expectations for agricultural activities. This framework also enables better decision making for future agricultural activities as a means to reduce current, and prevent new, water-quality issues.

Clinical decision-making of rural novice nurses.

PubMed

Seright, T J

2011-01-01

Nurses in rural settings are often the first to assess and interpret the patient's clinical presentations. Therefore, an understanding of how nurses experience decision-making is important in terms of educational preparation, resource allocation to rural areas, institutional cultures, and patient outcomes. Theory development was based on the in-depth investigation of 12 novice nurses practicing in rural critical access hospitals in a north central state. This grounded theory study consisted of face-to-face interviews with 12 registered nurses, nine of whom were observed during their work day. The participants were interviewed a second time, as a method of member checking, and during this interview they reviewed their transcripts, the emerging themes and categories. Directors of nursing from both the research sites and rural hospitals not involved in the study, experienced researchers, and nurse educators facilitated triangulation of the findings. 'Sociocentric rationalizing' emerged as the central phenomenon and referred to the sense of belonging and agency which impacted the decision-making in this small group of novice nurses in rural critical access hospitals. The observed consequences, which were conceptualized during the axial coding process and were derived from observations and interviews of the 12 novice nurses in this study include: (1) gathering information before making a decision included assessment of: the credibility of co-workers, patients' subjective and objective data, and one's own past and current experiences; (2) conferring with co-workers as a direct method of confirming/denying decisions being made was considered more realistic and expedient than policy books and decision trees; (3) rural practicum clinical experiences, along with support after orientation, provide for transition to the rural nurse role; (4) involved directors of nursing served as both models and protectors of novice nurses placed in high accountability positions early in their careers. These novice nurses were often working with a limited staff, while managing an ever-changing census and acuity of patients. The significance of interdependence and welcoming relationships with their co-workers and directors of nursing was pivotal in the clinical decision-making process. Despite access to a number of resources at their disposal (including policy books, decision trees, standing orders, textbooks, and in some cases internet resources), the 12 nurses in this study indicated collaboration with co-workers was a major means of facilitating their decision-making. Rural novice nurses require facilitation of social skills as much as critical thinking skills both within their programs of nursing and during their new employee orientation; however, decision-making must be guided by more experienced nurses who are willing to mentor novice nurses and advise them to to reflect upon their decisions as they care for patients using evidenced based practice. In a rural setting, this is especially important because novice nurses are tasked early in their career with decision-making, which often involves ill-structured problems set in dynamic and changing environments, in high-stakes situations where patient safety is a concern.

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

PubMed

Mühlbacher, Axel C; Juhnke, Christin

2016-01-01

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

Shared Decision-Making as the Future of Emergency Cardiology.

PubMed

Probst, Marc A; Noseworthy, Peter A; Brito, Juan P; Hess, Erik P

2018-02-01

Shared decision-making is playing an increasingly large role in emergency cardiovascular care. Although there are many challenges to successfully performing shared decision-making in the emergency department, there are numerous clinical scenarios in which it should be used. In this article, we explore new research and emerging decision aids in the following emergency care scenarios: (1) low-risk chest pain; (2) new-onset atrial fibrillation; and (3) moderate-risk syncope. These decision aids are designed to engage patients and facilitate shared decision-making for specific treatment and disposition (admit vs discharge) decisions. We then offer a 3-step, practical approach to performing shared decision-making in the acute care setting, on the basis of broad stakeholder input and previous conceptual work. Step 1 involves simply acknowledging that a clinical decision needs to be made. Step 2 involves a shared discussion about the working diagnosis and the options for care in the context of the patient's values, preferences, and circumstances. The third and final step requires the patient and provider to agree on a plan of action regarding further medical care. The implementation of shared decision-making in emergency cardiology has the potential to shift the paradigm of clinical practice from paternalism toward mutualism and improve the quality and experience of care for our patients. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

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.

44 CFR 10.12 - Pre-implementation actions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... decision-making process. Because of the diversity of FEMA, it is not feasible to describe in this part the... shall provide further guidance, commensurate with their programs and organization, for integration of... the decision. Rather it is a concise document that sets forth the decision and describes the...

Heuristic decision making in medicine

PubMed Central

Marewski, Julian N.; Gigerenzer, Gerd

2012-01-01

Can less information be more helpful when it comes to making medical decisions? Contrary to the common intuition that more information is always better, the use of heuristics can help both physicians and patients to make sound decisions. Heuristics are simple decision strategies that ignore part of the available information, basing decisions on only a few relevant predictors. We discuss: (i) how doctors and patients use heuristics; and (ii) when heuristics outperform information-greedy methods, such as regressions in medical diagnosis. Furthermore, we outline those features of heuristics that make them useful in health care settings. These features include their surprising accuracy, transparency, and wide accessibility, as well as the low costs and little time required to employ them. We close by explaining one of the statistical reasons why heuristics are accurate, and by pointing to psychiatry as one area for future research on heuristics in health care. PMID:22577307

Heuristic decision making in medicine.

PubMed

Marewski, Julian N; Gigerenzer, Gerd

2012-03-01

Can less information be more helpful when it comes to making medical decisions? Contrary to the common intuition that more information is always better, the use of heuristics can help both physicians and patients to make sound decisions. Heuristics are simple decision strategies that ignore part of the available information, basing decisions on only a few relevant predictors. We discuss: (i) how doctors and patients use heuristics; and (ii) when heuristics outperform information-greedy methods, such as regressions in medical diagnosis. Furthermore, we outline those features of heuristics that make them useful in health care settings. These features include their surprising accuracy, transparency, and wide accessibility, as well as the low costs and little time required to employ them. We close by explaining one of the statistical reasons why heuristics are accurate, and by pointing to psychiatry as one area for future research on heuristics in health care.

Using measurement uncertainty in decision-making and conformity assessment

NASA Astrophysics Data System (ADS)

Pendrill, L. R.

2014-08-01

Measurements often provide an objective basis for making decisions, perhaps when assessing whether a product conforms to requirements or whether one set of measurements differs significantly from another. There is increasing appreciation of the need to account for the role of measurement uncertainty when making decisions, so that a ‘fit-for-purpose’ level of measurement effort can be set prior to performing a given task. Better mutual understanding between the metrologist and those ordering such tasks about the significance and limitations of the measurements when making decisions of conformance will be especially useful. Decisions of conformity are, however, currently made in many important application areas, such as when addressing the grand challenges (energy, health, etc), without a clear and harmonized basis for sharing the risks that arise from measurement uncertainty between the consumer, supplier and third parties. In reviewing, in this paper, the state of the art of the use of uncertainty evaluation in conformity assessment and decision-making, two aspects in particular—the handling of qualitative observations and of impact—are considered key to bringing more order to the present diverse rules of thumb of more or less arbitrary limits on measurement uncertainty and percentage risk in the field. (i) Decisions of conformity can be made on a more or less quantitative basis—referred in statistical acceptance sampling as by ‘variable’ or by ‘attribute’ (i.e. go/no-go decisions)—depending on the resources available or indeed whether a full quantitative judgment is needed or not. There is, therefore, an intimate relation between decision-making, relating objects to each other in terms of comparative or merely qualitative concepts, and nominal and ordinal properties. (ii) Adding measures of impact, such as the costs of incorrect decisions, can give more objective and more readily appreciated bases for decisions for all parties concerned. Such costs are associated with a variety of consequences, such as unnecessary re-manufacturing by the supplier as well as various consequences for the customer, arising from incorrect measures of quantity, poor product performance and so on.

Evolution of Pediatric Chronic Disease Treatment Decisions: A Qualitative, Longitudinal View of Parents' Decision-Making Process.

PubMed

Lipstein, Ellen A; Britto, Maria T

2015-08-01

In the context of pediatric chronic conditions, patients and families are called upon repeatedly to make treatment decisions. However, little is known about how their decision making evolves over time. The objective was to understand parents' processes for treatment decision making in pediatric chronic conditions. We conducted a qualitative, prospective longitudinal study using recorded clinic visits and individual interviews. After consent was obtained from health care providers, parents, and patients, clinic visits during which treatment decisions were expected to be discussed were video-recorded. Parents then participated in sequential telephone interviews about their decision-making experience. Data were coded by 2 people and analyzed using framework analysis with sequential, time-ordered matrices. 21 families, including 29 parents, participated in video-recording and interviews. We found 3 dominant patterns of decision evolution. Each consisted of a series of decision events, including conversations, disease flares, and researching of treatment options. Within all 3 patterns there were both constant and evolving elements of decision making, such as role perceptions and treatment expectations, respectively. After parents made a treatment decision, they immediately turned to the next decision related to the chronic condition, creating an iterative cycle. In this study, decision making was an iterative process occurring in 3 distinct patterns. Understanding these patterns and the varying elements of parents' decision processes is an essential step toward developing interventions that are appropriate to the setting and that capitalize on the skills families may develop as they gain experience with a chronic condition. Future research should also consider the role of children and adolescents in this decision process. © The Author(s) 2015.

Patient and Clinician Perspectives on Shared Decision-making in Early Adopting Lung Cancer Screening Programs: a Qualitative Study.

PubMed

Wiener, Renda Soylemez; Koppelman, Elisa; Bolton, Rendelle; Lasser, Karen E; Borrelli, Belinda; Au, David H; Slatore, Christopher G; Clark, Jack A; Kathuria, Hasmeena

2018-02-21

Guidelines recommend, and Medicare requires, shared decision-making between patients and clinicians before referring individuals at high risk of lung cancer for chest CT screening. However, little is known about the extent to which shared decision-making about lung cancer screening is achieved in real-world settings. To characterize patient and clinician impressions of early experiences with communication and decision-making about lung cancer screening and perceived barriers to achieving shared decision-making. Qualitative study entailing semi-structured interviews and focus groups. We enrolled 36 clinicians who refer patients for lung cancer screening and 49 patients who had undergone lung cancer screening in the prior year. Participants were recruited from lung cancer screening programs at four hospitals (three Veterans Health Administration, one urban safety net). Using content analysis, we analyzed transcripts to characterize communication and decision-making about lung cancer screening. Our analysis focused on the recommended components of shared decision-making (information sharing, deliberation, and decision aid use) and barriers to achieving shared decision-making. Clinicians varied in the information shared with patients, and did not consistently incorporate decision aids. Clinicians believed they explained the rationale and gave some (often purposely limited) information about the trade-offs of lung cancer screening. By contrast, some patients reported receiving little information about screening or its trade-offs and did not realize the CT was intended as a screening test for lung cancer. Clinicians and patients alike did not perceive that significant deliberation typically occurred. Clinicians perceived insufficient time, competing priorities, difficulty accessing decision aids, limited patient comprehension, and anticipated patient emotions as barriers to realizing shared decision-making. Due to multiple perceived barriers, patient-clinician conversations about lung cancer screening may fall short of guideline-recommended shared decision-making supported by a decision aid. Consequently, patients may be left uncertain about lung cancer screening's rationale, trade-offs, and process.

Effect of Women's Decision-Making Autonomy on Infant's Birth Weight in Rural Bangladesh

PubMed Central

Sharma, Arpana

2013-01-01

Background. Low birth weight (LBW), an outcome of maternal undernutrition, is a major public health concern in Bangladesh where the problem is most prominent. Women's decision-making autonomy is likely an important factor influencing maternal and child health outcomes. The aim of the study was to assess the effect of women's decision-making autonomy on infant's birth weight (BW). Methods. The study included data of 2175 enrolled women (14–45 years of age) from the Maternal and Infant Nutritional Intervention in Matlab (MINIMat-study) in Bangladesh. Pearson's chi-square test, analysis of covariance (ANCOVA), and logistic regression analysis were applied at the collected data. Results. Women with lowest decision-making autonomy were significantly more likely to have a low birth weight (LBW) child, after controlling for maternal age, education (woman's and her husband's), socioeconomic status (SES) (odds ratio (OR) = 1.4; 95% confidence interval (CI) 1.0, 1.8). BW was decreased significantly among women with lowest decision making autonomy after adjusting for all confounders. Conclusion. Women's decision-making autonomy has an independent effect on BW and LBW outcome. In addition, there is a need for further exploration to identify sociocultural attributes and gender related determinants of women decision-making autonomy in this study setting. PMID:24575305

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

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

PubMed Central

Williams, Janet K.

2009-01-01

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

Multicriteria Decision-Making Approach with Hesitant Interval-Valued Intuitionistic Fuzzy Sets

PubMed Central

Peng, Juan-juan; Wang, Jian-qiang; Wang, Jing; Chen, Xiao-hong

2014-01-01

The definition of hesitant interval-valued intuitionistic fuzzy sets (HIVIFSs) is developed based on interval-valued intuitionistic fuzzy sets (IVIFSs) and hesitant fuzzy sets (HFSs). Then, some operations on HIVIFSs are introduced in detail, and their properties are further discussed. In addition, some hesitant interval-valued intuitionistic fuzzy number aggregation operators based on t-conorms and t-norms are proposed, which can be used to aggregate decision-makers' information in multicriteria decision-making (MCDM) problems. Some valuable proposals of these operators are studied. In particular, based on algebraic and Einstein t-conorms and t-norms, some hesitant interval-valued intuitionistic fuzzy algebraic aggregation operators and Einstein aggregation operators can be obtained, respectively. Furthermore, an approach of MCDM problems based on the proposed aggregation operators is given using hesitant interval-valued intuitionistic fuzzy information. Finally, an illustrative example is provided to demonstrate the applicability and effectiveness of the developed approach, and the study is supported by a sensitivity analysis and a comparison analysis. PMID:24983009

Resurfacing the care in nursing by telephone: lessons from ambulatory oncology.

PubMed

Wilson, Rosemary; Hubert, John

2002-01-01

The practice of providing telephone mediated advice and assistance is often described as "telephone triage" in relevant literature. The decision-making processes required for priority-setting and the provision of advice have been found to be complex and multifaceted. Conceptualization of this valuable patient care activity as a linear "triage" function serves to make invisible the nursing care provided. This article explores the current practice of providing telephone mediated advice and assistance in the following 2 distinct nursing care settings: emergency departments and ambulatory oncology centers. Examination of this activity in these 2 settings provides a forum to discuss and critique legally and fiscally driven prescriptive protocol use to inform decision-making. The effectiveness of experiential knowledge coupled with the strengths of nurse-patient relationships suggests that a need exists to highlight the caring aspects of telephone mediated assistance.

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

PubMed

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

2018-06-01

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

Depressive symptoms and decision-making preferences in patients with comorbid illnesses.

PubMed

Moise, Nathalie; Ye, Siqin; Alcántara, Carmela; Davidson, Karina W; Kronish, Ian

2017-01-01

Shared decision-making (SDM) is increasingly promoted in the primary care setting, but depressive symptoms, which are associated with cognitive changes, may influence decision-making preferences. We sought to assess whether elevated depressive symptoms are associated with decision-making preference in patients with comorbid chronic illness. We enrolled 195 patients ≥18years old with uncontrolled hypertension from two urban, academic primary care clinics. Depressive symptoms were assessed using the 8-item Patient Health Questionnaire. Clinician-directed decision-making preference was assessed according to the Control Preference Scale. The impact of depressive symptoms on decision-making preference was assessed using generalized linear mixed models adjusted for age, gender, race, ethnicity, education, Medicaid status, Charlson Comorbidity Index, partner status, and clustering within clinicians. The mean age was 64.2years; 72% were women, 77% Hispanic, 38% Black, and 33% had elevated depressive symptoms. Overall, 35% of patients preferred clinician-directed decision-making, 19% mostly clinician-directed, 39% shared, and 7% some or little clinician-input. Patients with (vs. without) elevated depressive symptoms were more likely to prefer clinician-directed decision-making (46% versus 29%; p=0.02; AOR 2.51, 95% CI 1.30-4.85, p=0.005). Remitted depressive symptoms (vs. never depressed) were not associated with preference. Elevated depressive symptoms are associated with preference for clinician-directed decision-making. We suggest that clinicians should be aware of this effect when incorporating preference into their communication styles and take an active role in eliciting patient values and exchanging information about treatment choice, all important components of shared decision-making, particularly when patients are depressed. Copyright © 2015 Elsevier Inc. All rights reserved.

Patient involvement in decision-making: a cross-sectional study in a Malaysian primary care clinic

PubMed Central

Ambigapathy, Ranjini; Ng, Chirk Jenn

2016-01-01

Objective Shared decision-making has been advocated as a useful model for patient management. In developing Asian countries such as Malaysia, there is a common belief that patients prefer a passive role in clinical consultation. As such, the objective of this study was to determine Malaysian patients’ role preference in decision-making and the associated factors. Design A cross-sectional study. Setting Study was conducted at an urban primary care clinic in Malaysia in 2012. Participants Patients aged >21 years were chosen using systematic random sampling. Methods Consenting patients answered a self-administered questionnaire, which included demographic data and their preferred and actual role before and after consultation. Doctors were asked to determine patients’ role preference. The Control Preference Scale was used to assess patients’ role preference. Primary outcome Prevalence of patients’ preferred role in decision-making. Secondary outcomes (1) Actual role played by the patient in decision-making. (2) Sociodemographic factors associated with patients’ preferred role in decision-making. (3) Doctors’ perception of patients’ involvement in decision-making. Results The response rate was 95.1% (470/494). Shared decision-making was preferred by 51.9% of patients, followed by passive (26.3%) and active (21.8%) roles in decision-making. Higher household income was significantly associated with autonomous role preference (p=0.018). Doctors’ perception did not concur with patients’ preferred role. Among patients whom doctors perceived to prefer a passive role, 73.5% preferred an autonomous role (p=0.900, κ=0.006). Conclusions The majority of patients attending the primary care clinic preferred and played an autonomous role in decision-making. Doctors underestimated patients’ preference to play an autonomous role. PMID:26729393

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

PubMed

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

2017-10-01

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

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.

Priority setting in the Austrian healthcare system: results from a discrete choice experiment and implications for mental health.

PubMed

Mentzakis, Emmanouil; Paolucci, Francesco; Rubicko, Georg

2014-06-01

The impact of mental conditions is expected to be among the highest ranked causes of illness in high income countries by 2020. With changing health needs, policy makers have to make choices in an environment with increasingly constrained resources and competing demands. Discrete choice experiments have been identified as a useful approach to inform and support decision-making in health care systems and, in particular, its rationing. Policymakers, researchers and health practitioners from Austria participated in an experiment designed to elicit preferences for efficiency and equity in a generic priority setting framework. Using aggregate criteria an empirical measure of the efficiency/equity trade-off is calculated and a selection of health care interventions, including mental health, are ranked in composite league tables (CLTs). With the exception of severity of the condition, all equity parameters decrease attractiveness of an intervention, whereas the opposite holds for all three efficiency criteria. The efficiency/equity ratio (i.e. decision-makers' preference for efficiency over equity) is 3.5 and 5 for interventions targeted at younger and middle age populations, respectively, while for older populations this ratio is negative implying a rejection of all equity criteria. Irrespective of such differences interventions targeting mental health rank highly on all CLTs. Based on system-wide generic decision making criteria, mental health is shown to be a top priority for Austria. Preference-based approaches might offer complementary information to policymakers in priority setting decisions and a useful tool to support rationale rather than ad hoc decision-making.

Do Not Fear Your Opponent: Suboptimal Changes of a Prevention Strategy when Facing Stronger Opponents

ERIC Educational Resources Information Center

Slezak, Diego Fernandez; Sigman, Mariano

2012-01-01

The time spent making a decision and its quality define a widely studied trade-off. Some models suggest that the time spent is set to optimize reward, as verified empirically in simple-decision making experiments. However, in a more complex perspective compromising components of regulation focus, ambitions, fear, risk and social variables,…

Satisficing Decision-Making in Supervisory Control. Part 2.

DTIC Science & Technology

1986-07-31

purpose of the United States Government. C-P Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge, Massachusetts 02139...of Mechanical Engineering Massachusetts Institute of Technology Cambridge MA 02139 Satisficing Decision-Making in Supervisory Control Leonid Charny...example, that there are two attributes, speed and accuracy, and one is selecting a robot manipulator based -4n these two parameters. A set of alternatives

Using Social Simulations to Assess and Train Potential Leaders to Make Effective Decisions in Turbulent Environments

ERIC Educational Resources Information Center

Hunsaker, L. Phillip

2007-01-01

Purpose: The purpose of this paper is to describe two social simulations created to assess leadership potential and train leaders to make effective decisions in turbulent environments. One is set in the novel environment of a lunar moon colony and the other is a military combat command. The research generated from these simulations for assessing…

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

ERIC Educational Resources Information Center

Peters, Richard

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

Teacher and Leader Perceptions Concerning the Implementation of a Web-Based Data Warehouse for Instructional Decision-Making

ERIC Educational Resources Information Center

Curtis, Jennifer Lee

2010-01-01

The purpose of this study was to identify, describe, and examine the perceptions of teachers and leaders when implementing a Web-based data warehouse (DW) for instructional decision-making in a K-12 public school setting. It identified the challenges and benefits of DW implementation by measuring teacher and leader concerns, studied teacher and…

Prospect Theory and Interval-Valued Hesitant Set for Safety Evacuation Model

NASA Astrophysics Data System (ADS)

Kou, Meng; Lu, Na

2018-01-01

The study applies the research results of prospect theory and multi attribute decision making theory, combined with the complexity, uncertainty and multifactor influence of the underground mine fire system and takes the decision makers’ psychological behavior of emotion and intuition into full account to establish the intuitionistic fuzzy multiple attribute decision making method that is based on the prospect theory. The model established by this method can explain the decision maker’s safety evacuation decision behavior in the complex system of underground mine fire due to the uncertainty of the environment, imperfection of the information and human psychological behavior and other factors.

An ERP analysis of recognition and categorization decisions in a prototype-distortion task.

PubMed

Tunney, Richard J; Fernie, Gordon; Astle, Duncan E

2010-04-12

Theories of categorization make different predictions about the underlying processes used to represent categories. Episodic theories suggest that categories are represented in memory by storing previously encountered exemplars in memory. Prototype theories suggest that categories are represented in the form of a prototype independently of memory. A number of studies that show dissociations between categorization and recognition are often cited as evidence for the prototype account. These dissociations have compared recognition judgements made to one set of items to categorization judgements to a different set of items making a clear interpretation difficult. Instead of using different stimuli for different tests this experiment compares the processes by which participants make decisions about category membership in a prototype-distortion task and with recognition decisions about the same set of stimuli by examining the Event Related Potentials (ERPs) associated with them. Sixty-three participants were asked to make categorization or recognition decisions about stimuli that either formed an artificial category or that were category non-members. We examined the ERP components associated with both kinds of decision for pre-exposed and control participants. In contrast to studies using different items we observed no behavioural differences between the two kinds of decision; participants were equally able to distinguish category members from non-members, regardless of whether they were performing a recognition or categorisation judgement. Interestingly, this did not interact with prior-exposure. However, the ERP data demonstrated that the early visual evoked response that discriminated category members from non-members was modulated by which judgement participants performed and whether they had been pre-exposed to category members. We conclude from this that any differences between categorization and recognition reflect differences in the information that participants focus on in the stimuli to make the judgements at test, rather than any differences in encoding or process.

An ERP Analysis of Recognition and Categorization Decisions in a Prototype-Distortion Task

PubMed Central

Tunney, Richard J.; Fernie, Gordon; Astle, Duncan E.

2010-01-01

Background Theories of categorization make different predictions about the underlying processes used to represent categories. Episodic theories suggest that categories are represented in memory by storing previously encountered exemplars in memory. Prototype theories suggest that categories are represented in the form of a prototype independently of memory. A number of studies that show dissociations between categorization and recognition are often cited as evidence for the prototype account. These dissociations have compared recognition judgements made to one set of items to categorization judgements to a different set of items making a clear interpretation difficult. Instead of using different stimuli for different tests this experiment compares the processes by which participants make decisions about category membership in a prototype-distortion task and with recognition decisions about the same set of stimuli by examining the Event Related Potentials (ERPs) associated with them. Method Sixty-three participants were asked to make categorization or recognition decisions about stimuli that either formed an artificial category or that were category non-members. We examined the ERP components associated with both kinds of decision for pre-exposed and control participants. Conclusion In contrast to studies using different items we observed no behavioural differences between the two kinds of decision; participants were equally able to distinguish category members from non-members, regardless of whether they were performing a recognition or categorisation judgement. Interestingly, this did not interact with prior-exposure. However, the ERP data demonstrated that the early visual evoked response that discriminated category members from non-members was modulated by which judgement participants performed and whether they had been pre-exposed to category members. We conclude from this that any differences between categorization and recognition reflect differences in the information that participants focus on in the stimuli to make the judgements at test, rather than any differences in encoding or process. PMID:20404932

Setting priorities in the health care sector - the case of oral anticoagulants in nonvalvular atrial fibrillation in Denmark.

PubMed

Poulsen, Peter Bo; Johnsen, Søren Paaske; Hansen, Morten Lock; Brandes, Axel; Husted, Steen; Harboe, Louise; Dybro, Lars

2017-01-01

Resources devoted to health care are limited, therefore setting priorities is required. It differs between countries whether decision-making concerning health care technologies focus on broad economic perspectives or whether focus is narrow on single budgets ("silo mentality"). The cost perspective as one part of the full health economic analysis is important for decision-making. With the case of oral anticoagulants in patients with nonvalvular atrial fibrillation (NVAF), the aim is to discuss the implication of the use of different cost perspectives for decision-making and priority setting. In a cost analysis, the annual average total costs of five oral anticoagulants (warfarin and non-vitamin K oral anticoagulants [NOACs; dabigatran, rivaroxaban, apixaban, and edoxaban]) used in daily clinical practice in Denmark for the prevention of stroke in NVAF patients are analyzed. This is done in pairwise comparisons between warfarin and each NOAC based on five potential cost perspectives, from a "drug cost only" perspective up to a "societal" perspective. All comparisons of warfarin and NOACs show that the cost perspective based on all relevant costs, ie, total costs perspective, is essential for the choice of therapy. Focusing on the reimbursement costs of the drugs only, warfarin is the least costly option. However, with the aim of therapy to prevent strokes and limit bleedings, including the economic impact of this, all NOACs, except rivaroxaban, result in slightly lower health care costs compared with warfarin. The same picture was found applying the societal perspective. Many broad cost-effectiveness analyses of NOACs exist. However, in countries with budget focus in decision-making this information does not apply. The present study's case of oral anticoagulants has shown that decision-making should be based on health care or societal cost perspectives for optimal use of limited resources. Otherwise, the risk is that suboptimal decisions will be likely.

Public Health Applications of Remotely-sensed Environmental Datasets for the Conterminous United States

NASA Technical Reports Server (NTRS)

Al-Hamdan, Mohammad; Crosson, William; Economou, Sigrid; Estes, Marice Jr; Estes, Sue; Hemmings, Sarah; Kent, Shia; Puckett, Mark; Quattrochi, Dale; Wade, Gina

2013-01-01

NASA Marshall Space Flight Center is collaborating with the University of Alabama at Birmingham (UAB) School of Public Health and the Centers for Disease Control and Prevention (CDC) National Center for Public Health Informatics to address issues of environmental health and enhance public health decision-making using NASA remotely-sensed data and products. The objectives of this study are to develop high-quality spatial data sets of environmental variables, link these with public health data from a national cohort study, and deliver the linked data sets and associated analyses to local, state and federal end-user groups. Three daily environmental data sets were developed for the conterminous U.S. on different spatial resolutions for the period 2003-2008: (1) spatial surfaces of estimated fine particulate matter (PM2.5) exposures on a 10-km grid using the US Environmental Protection Agency (EPA) ground observations and NASA's MODerate-resolution Imaging Spectroradiometer (MODIS) data; (2) a 1-km grid of Land Surface Temperature (LST) using MODIS data; and (3) a 12-km grid of daily Incoming Solar Radiation (Insolation) and heat-related products using the North American Land Data Assimilation System (NLDAS) forcing data. These environmental data sets were linked with public health data from the UAB REasons for Geographic And Racial Differences in Stroke (REGARDS) national cohort study to determine whether exposures to these environmental risk factors are related to cognitive decline, stroke and other health outcomes. These environmental datasets and the results of the public health linkage analyses will be disseminated to end-users for decision-making through the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) system and through peer-reviewed publications respectively. The linkage of these data with the CDC WONDER system substantially expands public access to NASA data, making their use by a wide range of decision makers feasible. By successful completion of this research, decision-making activities, including policy-making and clinical decision-making, can be positively affected through utilization of the data products and analyses provided on the CDC WONDER system.

Non-monetary valuation using Multi-Criteria Decision Analysis: Sensitivity of additive aggregation methods to scaling and compensation assumptions

EPA Science Inventory

Analytical methods for Multi-Criteria Decision Analysis (MCDA) support the non-monetary valuation of ecosystem services for environmental decision making. Many published case studies transform ecosystem service outcomes into a common metric and aggregate the outcomes to set land ...

49 CFR 211.77 - Appeal to the Administrator.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) days from issuance of the presiding officer's decision and must set forth the specific exceptions of the party to the decision, making reference to the portions of the administrative record which are... Appeal to the Administrator. (a) Any party aggrieved by the final decision of a presiding officer (other...

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.

Simplified neutrosophic sets and their applications in multi-criteria group decision-making problems

NASA Astrophysics Data System (ADS)

Peng, Juan-juan; Wang, Jian-qiang; Wang, Jing; Zhang, Hong-yu; Chen, Xiao-hong

2016-07-01

As a variation of fuzzy sets and intuitionistic fuzzy sets, neutrosophic sets have been developed to represent uncertain, imprecise, incomplete and inconsistent information that exists in the real world. Simplified neutrosophic sets (SNSs) have been proposed for the main purpose of addressing issues with a set of specific numbers. However, there are certain problems regarding the existing operations of SNSs, as well as their aggregation operators and the comparison methods. Therefore, this paper defines the novel operations of simplified neutrosophic numbers (SNNs) and develops a comparison method based on the related research of intuitionistic fuzzy numbers. On the basis of these operations and the comparison method, some SNN aggregation operators are proposed. Additionally, an approach for multi-criteria group decision-making (MCGDM) problems is explored by applying these aggregation operators. Finally, an example to illustrate the applicability of the proposed method is provided and a comparison with some other methods is made.

[Shared decision-making and individualized goal setting - a pilot trial using PRISM (Pictorial Representation of Illness and Self Measure) in psychiatric inpatients].

PubMed

Büchi, S; Straub, S; Schwager, U

2010-12-01

Although there is much talk about shared decision making and individualized goal setting, there is a lack of knowledge and knowhow in their realization in daily clinical practice. There is a lack in tools for easy applicable tools to ameliorate person-centred individualized goal setting processes. In three selected psychiatric inpatients the semistructured, theory driven use of PRISM (Pictorial Representation of Illness and Self Measure) in patients with complex psychiatric problems is presented and discussed. PRISM sustains a person-centred individualized process of goal setting and treatment and reinforces the active participation of patients. The process of visualisation and synchronous documentation is validated positively by patients and clinicians. The visual goal setting requires 30 to 45 minutes. In patients with complex psychiatric illness PRISM was used successfully to ameliorate individual goal setting. Specific effects of PRISM-visualisation are actually evaluated in a randomized controlled trial.

Can streamlined multi-criteria decision analysis be used to implement shared decision making for colorectal cancer screening?

PubMed Central

Dolan, James G.; Boohaker, Emily; Allison, Jeroan; Imperiale, Thomas F.

2013-01-01

Background Current US colorectal cancer screening guidelines that call for shared decision making regarding the choice among several recommended screening options are difficult to implement. Multi-criteria decision analysis (MCDA) is an established methodology well suited for supporting shared decision making. Our study goal was to determine if a streamlined form of MCDA using rank order based judgments can accurately assess patients’ colorectal cancer screening priorities. Methods We converted priorities for four decision criteria and three sub-criteria regarding colorectal cancer screening obtained from 484 average risk patients using the Analytic Hierarchy Process (AHP) in a prior study into rank order-based priorities using rank order centroids. We compared the two sets of priorities using Spearman rank correlation and non-parametric Bland-Altman limits of agreement analysis. We assessed the differential impact of using the rank order-based versus the AHP-based priorities on the results of a full MCDA comparing three currently recommended colorectal cancer screening strategies. Generalizability of the results was assessed using Monte Carlo simulation. Results Correlations between the two sets of priorities for the seven criteria ranged from 0.55 to 0.92. The proportions of absolute differences between rank order-based and AHP-based priorities that were more than ± 0.15 ranged from 1% to 16%. Differences in the full MCDA results were minimal and the relative rankings of the three screening options were identical more than 88% of the time. The Monte Carlo simulation results were similar. Conclusion Rank order-based MCDA could be a simple, practical way to guide individual decisions and assess population decision priorities regarding colorectal cancer screening strategies. Additional research is warranted to further explore the use of these methods for promoting shared decision making. PMID:24300851

An overview of patient involvement in healthcare decision-making: a situational analysis of the Malaysian context.

PubMed

Ng, Chirk-Jenn; Lee, Ping-Yein; Lee, Yew-Kong; Chew, Boon-How; Engkasan, Julia P; Irmi, Zarina-Ismail; Hanafi, Nik-Sherina; Tong, Seng-Fah

2013-10-11

Involving patients in decision-making is an important part of patient-centred care. Research has found a discrepancy between patients' desire to be involved and their actual involvement in healthcare decision-making. In Asia, there is a dearth of research in decision-making. Using Malaysia as an exemplar, this study aims to review the current research evidence, practices, policies, and laws with respect to patient engagement in shared decision-making (SDM) in Asia. In this study, we conducted a comprehensive literature review to collect information on healthcare decision-making in Malaysia. We also consulted medical education researchers, key opinion leaders, governmental organisations, and patient support groups to assess the extent to which patient involvement was incorporated into the medical curriculum, healthcare policies, and legislation. There are very few studies on patient involvement in decision-making in Malaysia. Existing studies showed that doctors were aware of informed consent, but few practised SDM. There was limited teaching of SDM in undergraduate and postgraduate curricula and a lack of accurate and accessible health information for patients. In addition, peer support groups and 'expert patient' programmes were also lacking. Professional medical bodies endorsed patient involvement in decision-making, but there was no definitive implementation plan. In summary, there appears to be little training or research on SDM in Malaysia. More research needs to be done in this area, including baseline information on the preferred and actual decision-making roles. The authors have provided a set of recommendations on how SDM can be effectively implemented in Malaysia.

An overview of patient involvement in healthcare decision-making: a situational analysis of the Malaysian context

PubMed Central

2013-01-01

Background Involving patients in decision-making is an important part of patient-centred care. Research has found a discrepancy between patients’ desire to be involved and their actual involvement in healthcare decision-making. In Asia, there is a dearth of research in decision-making. Using Malaysia as an exemplar, this study aims to review the current research evidence, practices, policies, and laws with respect to patient engagement in shared decision-making (SDM) in Asia. Methods In this study, we conducted a comprehensive literature review to collect information on healthcare decision-making in Malaysia. We also consulted medical education researchers, key opinion leaders, governmental organisations, and patient support groups to assess the extent to which patient involvement was incorporated into the medical curriculum, healthcare policies, and legislation. Results There are very few studies on patient involvement in decision-making in Malaysia. Existing studies showed that doctors were aware of informed consent, but few practised SDM. There was limited teaching of SDM in undergraduate and postgraduate curricula and a lack of accurate and accessible health information for patients. In addition, peer support groups and 'expert patient’ programmes were also lacking. Professional medical bodies endorsed patient involvement in decision-making, but there was no definitive implementation plan. Conclusion In summary, there appears to be little training or research on SDM in Malaysia. More research needs to be done in this area, including baseline information on the preferred and actual decision-making roles. The authors have provided a set of recommendations on how SDM can be effectively implemented in Malaysia. PMID:24119237

Decision-making process of patients with gynecological cancer regarding their cancer treatment choices using the analytic hierarchy process.

PubMed

Kitamura, Yuko

2010-12-01

In order to support patients' decision-making regarding cancer treatments, it is important to clarify which criteria that cancer patients use to set priorities in their treatment choices. Using the analytic hierarchy process (AHP), a mathematical decision-making method, this article investigates the criteria and the priorities of patients with gynecological cancer. In the AHP, multiple and hierarchical criteria in the decision-making process were organized by a repeated pairwise judgment of the participants so as to serialize the alternatives along with the rational order of the priorities. For the alternatives "to receive treatment" and "to not receive treatment," the following five criteria were set: "anxiety about relapse and metastasis", "distress about side-effects", "advice of family", "advice of medical staff", and "economic burden". The participants determined a pairwise priority scale, as well as a priority scale between the alternatives for every criterion. The logical consistency of their answers was checked by a consistency index (CI). The participants were 31 patients with ovarian or endometrial cancer who were being followed up after undergoing surgery and adjuvant chemotherapy. Of the participants who answered the questionnaire, 17 satisfied the logical consistency. Of the five criteria for the treatment choices, "anxiety about relapse and metastasis" and "advice of medical staff" were found to be the important factors for treatment choice; however, the weight attached to the priority criteria differed much among the patients. The AHP made it possible to support patients' decision-making in order to clarify their priority criteria and to quantitatively present their decision-making process. © 2010 The Author. Journal compilation © 2010 Japan Academy of Nursing Science.

Gatekeepers for Pragmatic Clinical Trials

PubMed Central

Whicher, Danielle M.; Miller, Jennifer E.; Dunham, Kelly M.; Joffe, Steven

2015-01-01

To successfully implement a pragmatic clinical trial, investigators need access to numerous resources, including financial support, institutional infrastructure (e.g., clinics, facilities, staff), eligible patients, and patient data. Gatekeepers are people or entities who have the ability to allow or deny access to the resources required to support the conduct of clinical research. Based on this definition, gatekeepers relevant to the United States clinical research enterprise include research sponsors, regulatory agencies, payers, health system and other organizational leadership, research team leadership, human research protections programs, advocacy and community groups, and clinicians. This manuscript provides a framework to help guide gatekeepers’ decision-making related to the use of resources for pragmatic clinical trials. These include (1) concern for the interests of individuals, groups, and communities affected by the gatekeepers’ decisions, including protection from harm and maximization of benefits, (2) advancement of organizational mission and values, and (3) stewardship of financial, human, and other organizational resources. Separate from these ethical considerations, gatekeepers’ actions will be guided by relevant federal, state, and local regulations. This framework also suggests that to further enhance the legitimacy of their decision-making, gatekeepers should adopt transparent processes that engage relevant stakeholders when feasible and appropriate. We apply this framework to the set of gatekeepers responsible for making decisions about resources necessary for pragmatic clinical trials in the United States, describing the relevance of the criteria in different situations and pointing out where conflicts among the criteria and relevant regulations may affect decision-making. Recognition of the complex set of considerations that should inform decision-making will guide gatekeepers in making justifiable choices regarding the use of limited and valuable resources. PMID:26374683

Quantum-mechanical machinery for rational decision-making in classical guessing game

NASA Astrophysics Data System (ADS)

Bang, Jeongho; Ryu, Junghee; Pawłowski, Marcin; Ham, Byoung S.; Lee, Jinhyoung

2016-02-01

In quantum game theory, one of the most intriguing and important questions is, “Is it possible to get quantum advantages without any modification of the classical game?” The answer to this question so far has largely been negative. So far, it has usually been thought that a change of the classical game setting appears to be unavoidable for getting the quantum advantages. However, we give an affirmative answer here, focusing on the decision-making process (we call ‘reasoning’) to generate the best strategy, which may occur internally, e.g., in the player’s brain. To show this, we consider a classical guessing game. We then define a one-player reasoning problem in the context of the decision-making theory, where the machinery processes are designed to simulate classical and quantum reasoning. In such settings, we present a scenario where a rational player is able to make better use of his/her weak preferences due to quantum reasoning, without any altering or resetting of the classically defined game. We also argue in further analysis that the quantum reasoning may make the player fail, and even make the situation worse, due to any inappropriate preferences.

Quantum-mechanical machinery for rational decision-making in classical guessing game

PubMed Central

Bang, Jeongho; Ryu, Junghee; Pawłowski, Marcin; Ham, Byoung S.; Lee, Jinhyoung

2016-01-01

In quantum game theory, one of the most intriguing and important questions is, “Is it possible to get quantum advantages without any modification of the classical game?” The answer to this question so far has largely been negative. So far, it has usually been thought that a change of the classical game setting appears to be unavoidable for getting the quantum advantages. However, we give an affirmative answer here, focusing on the decision-making process (we call ‘reasoning’) to generate the best strategy, which may occur internally, e.g., in the player’s brain. To show this, we consider a classical guessing game. We then define a one-player reasoning problem in the context of the decision-making theory, where the machinery processes are designed to simulate classical and quantum reasoning. In such settings, we present a scenario where a rational player is able to make better use of his/her weak preferences due to quantum reasoning, without any altering or resetting of the classically defined game. We also argue in further analysis that the quantum reasoning may make the player fail, and even make the situation worse, due to any inappropriate preferences. PMID:26875685

Quantum-mechanical machinery for rational decision-making in classical guessing game.

PubMed

Bang, Jeongho; Ryu, Junghee; Pawłowski, Marcin; Ham, Byoung S; Lee, Jinhyoung

2016-02-15

In quantum game theory, one of the most intriguing and important questions is, "Is it possible to get quantum advantages without any modification of the classical game?" The answer to this question so far has largely been negative. So far, it has usually been thought that a change of the classical game setting appears to be unavoidable for getting the quantum advantages. However, we give an affirmative answer here, focusing on the decision-making process (we call 'reasoning') to generate the best strategy, which may occur internally, e.g., in the player's brain. To show this, we consider a classical guessing game. We then define a one-player reasoning problem in the context of the decision-making theory, where the machinery processes are designed to simulate classical and quantum reasoning. In such settings, we present a scenario where a rational player is able to make better use of his/her weak preferences due to quantum reasoning, without any altering or resetting of the classically defined game. We also argue in further analysis that the quantum reasoning may make the player fail, and even make the situation worse, due to any inappropriate preferences.

(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.

Treatment decision-making in ductal carcinoma in situ: A mixed methods systematic review of women's experiences and information needs.

PubMed

Rutherford, Claudia; Mercieca-Bebber, Rebecca; Butow, Phyllis; Wu, Jenny Liang; King, Madeleine T

2017-09-01

Decision-making in ductal carcinoma in situ (DCIS) is complex due to the heterogeneity of the disease. This study aimed to understand women's experience of making treatment decisions for DCIS, their information and support needs, and factors that influenced decisions. We searched six electronic databases, conference proceedings, and key authors. Two reviewers independently applied inclusion and quality criteria, and extracted findings. Thematic analysis was used to combine and summarise findings. We identified six themes and 28 subthemes from 18 studies. Women with DCIS have knowledge deficits about DCIS, experience anxiety related to information given at diagnosis and the complexity of decision-making, and have misconceptions regarding risks and outcomes of treatment. Women's decisions are influenced by their understanding of risk, the clinical features of their DCIS, and the benefits and harms of treatment options. Women are dissatisfied with the decisional support available. Informed and shared decision-making in this complex decision setting requires clear communication of information specific to DCIS and individual's, as well as decision support for patients and clinicians. This approach would educate patients and clinicians, and assist clinicians in supporting patients to an evidence-based treatment plan that aligns with individual values and pReferences. Copyright © 2017 Elsevier B.V. All rights reserved.

Patient decision aids in routine maternity care: Benefits, barriers, and new opportunities.

PubMed

Stevens, Gabrielle; Thompson, Rachel; Watson, Bernadette; Miller, Yvette D

2016-02-01

Participation in decision-making, supported by comprehensive and quality information provision, is increasingly emphasised as a priority for women in maternity care. Patient decision aids are tools that can offer women greater access to information and guidance to participate in maternity care decision-making. Relative to their evaluation in controlled settings, the implementation of patient decision aids in routine maternity care has received little attention and our understanding of which approaches may be effective is limited. This paper critically discusses the application of patient decision aids in routine maternity care and explores viable solutions for promoting their successful uptake. A range of patient decision aids have been developed for use within maternity care, and controlled trials have highlighted their positive impact on the decision-making process for women. Nevertheless, evidence of successful patient decision aid implementation in real world health care settings is lacking due to practical and ideological barriers that exist. Patient-directed social marketing campaigns are a relatively novel approach to patient decision aid delivery that may facilitate their adoption in maternity care, at least in the short-term, by overcoming common implementation barriers. Social marketing may also be particularly well suited to maternity care, given the unique characteristics of this health context. The potential of social marketing campaigns to facilitate patient decision aid adoption in maternity care highlights the need for pragmatic trials to evaluate their effectiveness. Identifying which sub-groups of women are more or less likely to respond to these strategies will further direct implementation. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. 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.

Priority setting at the micro-, meso- and macro-levels in Canada, Norway and Uganda.

PubMed

Kapiriri, Lydia; Norheim, Ole Frithjof; Martin, Douglas K

2007-06-01

The objectives of this study were (1) to describe the process of healthcare priority setting in Ontario-Canada, Norway and Uganda at the three levels of decision-making; (2) to evaluate the description using the framework for fair priority setting, accountability for reasonableness; so as to identify lessons of good practices. We carried out case studies involving key informant interviews, with 184 health practitioners and health planners from the macro-level, meso-level and micro-level from Canada-Ontario, Norway and Uganda (selected by virtue of their varying experiences in priority setting). Interviews were audio-recorded, transcribed and analyzed using a modified thematic approach. The descriptions were evaluated against the four conditions of "accountability for reasonableness", relevance, publicity, revisions and enforcement. Areas of adherence to these conditions were identified as lessons of good practices; areas of non-adherence were identified as opportunities for improvement. (i) at the macro-level, in all three countries, cabinet makes most of the macro-level resource allocation decisions and they are influenced by politics, public pressure, and advocacy. Decisions within the ministries of health are based on objective formulae and evidence. International priorities influenced decisions in Uganda. Some priority-setting reasons are publicized through circulars, printed documents and the Internet in Canada and Norway. At the meso-level, hospital priority-setting decisions were made by the hospital managers and were based on national priorities, guidelines, and evidence. Hospital departments that handle emergencies, such as surgery, were prioritized. Some of the reasons are available on the hospital intranet or presented at meetings. Micro-level practitioners considered medical and social worth criteria. These reasons are not publicized. Many practitioners lacked knowledge of the macro- and meso-level priority-setting processes. (ii) Evaluation-relevance: medical evidence and economic criteria were thought to be relevant, but lobbying was thought to be irrelevant. Publicity: all cases lacked clear and effective mechanisms for publicity. REVISIONS: formal mechanisms, following the planning hierarchy, were considered less effective, informal political mechanisms were considered more effective. Canada and Norway had patients' relations officers to deal with patients' dissensions; however, revisions were more difficult in Uganda. Enforcement: leadership for ensuring decision-making fairness was not apparent. The different levels of priority setting in the three countries fulfilled varying conditions of accountability for reasonableness, none satisfied all the four conditions. To improve, decision makers at the three levels in all three cases should engage frontline practitioners, develop more effectively publicized reasons, and develop formal mechanisms for challenging and revising decisions.

Improving accountability in vaccine decision-making.

PubMed

Timmis, James Kenneth; Black, Steven; Rappuoli, Rino

2017-11-01

Healthcare decisions, in particular those affecting entire populations, should be evidence-based and taken by decision-makers sharing broad alignment with affected stakeholders. However, criteria, priorities and procedures for decision-making are sometimes non-transparent, frequently vary considerably across equivalent decision-bodies, do not always consider the broader benefits of new health-measures, and therefore do not necessarily adequately represent the relevant stakeholder-spectrum. Areas covered: To address these issues in the context of the evaluation of new vaccines, we have proposed a first baseline set of core evaluation criteria, primarily selected by members of the vaccine research community, and suggested their implementation in vaccine evaluation procedures. In this communication, we review the consequences and utility of stakeholder-centered core considerations to increase transparency in and accountability of decision-making procedures, in general, and of the benefits gained by their inclusion in Multi-Criteria-Decision-Analysis tools, exemplified by SMART Vaccines, specifically. Expert commentary: To increase effectiveness and comparability of health decision outcomes, decision procedures should be properly standardized across equivalent (national) decision bodies. To this end, including stakeholder-centered criteria in decision procedures would significantly increase their transparency and accountability, support international capacity building to improve health, and reduce societal costs and inequity resulting from suboptimal health decision-making.

The accountability for reasonableness approach to guide priority setting in health systems within limited resources--findings from action research at district level in Kenya, Tanzania, and Zambia.

PubMed

Byskov, Jens; Marchal, Bruno; Maluka, Stephen; Zulu, Joseph M; Bukachi, Salome A; Hurtig, Anna-Karin; Blystad, Astrid; Kamuzora, Peter; Michelo, Charles; Nyandieka, Lillian N; Ndawi, Benedict; Bloch, Paul; Olsen, Oystein E

2014-08-20

Priority-setting decisions are based on an important, but not sufficient set of values and thus lead to disagreement on priorities. Accountability for Reasonableness (AFR) is an ethics-based approach to a legitimate and fair priority-setting process that builds upon four conditions: relevance, publicity, appeals, and enforcement, which facilitate agreement on priority-setting decisions and gain support for their implementation. This paper focuses on the assessment of AFR within the project REsponse to ACcountable priority setting for Trust in health systems (REACT). This intervention study applied an action research methodology to assess implementation of AFR in one district in Kenya, Tanzania, and Zambia, respectively. The assessments focused on selected disease, program, and managerial areas. An implementing action research team of core health team members and supporting researchers was formed to implement, and continually assess and improve the application of the four conditions. Researchers evaluated the intervention using qualitative and quantitative data collection and analysis methods. The values underlying the AFR approach were in all three districts well-aligned with general values expressed by both service providers and community representatives. There was some variation in the interpretations and actual use of the AFR in the decision-making processes in the three districts, and its effect ranged from an increase in awareness of the importance of fairness to a broadened engagement of health team members and other stakeholders in priority setting and other decision-making processes. District stakeholders were able to take greater charge of closing the gap between nationally set planning and the local realities and demands of the served communities within the limited resources at hand. This study thus indicates that the operationalization of the four broadly defined and linked conditions is both possible and seems to be responding to an actual demand. This provides arguments for the continued application and further assessment of the potential of AFR in supporting priority-setting and other decision-making processes in health systems to achieve better agreed and more sustainable health improvements linked to a mutual democratic learning with potential wider implications.

The accountability for reasonableness approach to guide priority setting in health systems within limited resources – findings from action research at district level in Kenya, Tanzania, and Zambia

PubMed Central

2014-01-01

Background Priority-setting decisions are based on an important, but not sufficient set of values and thus lead to disagreement on priorities. Accountability for Reasonableness (AFR) is an ethics-based approach to a legitimate and fair priority-setting process that builds upon four conditions: relevance, publicity, appeals, and enforcement, which facilitate agreement on priority-setting decisions and gain support for their implementation. This paper focuses on the assessment of AFR within the project REsponse to ACcountable priority setting for Trust in health systems (REACT). Methods This intervention study applied an action research methodology to assess implementation of AFR in one district in Kenya, Tanzania, and Zambia, respectively. The assessments focused on selected disease, program, and managerial areas. An implementing action research team of core health team members and supporting researchers was formed to implement, and continually assess and improve the application of the four conditions. Researchers evaluated the intervention using qualitative and quantitative data collection and analysis methods. Results The values underlying the AFR approach were in all three districts well-aligned with general values expressed by both service providers and community representatives. There was some variation in the interpretations and actual use of the AFR in the decision-making processes in the three districts, and its effect ranged from an increase in awareness of the importance of fairness to a broadened engagement of health team members and other stakeholders in priority setting and other decision-making processes. Conclusions District stakeholders were able to take greater charge of closing the gap between nationally set planning and the local realities and demands of the served communities within the limited resources at hand. This study thus indicates that the operationalization of the four broadly defined and linked conditions is both possible and seems to be responding to an actual demand. This provides arguments for the continued application and further assessment of the potential of AFR in supporting priority-setting and other decision-making processes in health systems to achieve better agreed and more sustainable health improvements linked to a mutual democratic learning with potential wider implications. PMID:25142148

Training Decisions Technology Analysis

DTIC Science & Technology

1992-06-01

4.5.1 Relational Data Base Management 69 4.5.2 TASCS Data Content 69 4.5.3 Relationships with TDS 69 4.6 Other Air Force Modeling R&D 70 4.6.1 Time ...executive decision making were first developed by M. S. Scott Morton in the early 1970’s who, at that time , termed them " management decision systems" (Scott...Allocations to Training Settings o Managers ’ Preferences for Task Allocations to Training Settings o Times Required to Training Tasks in Various

Extending emotion and decision-making beyond the laboratory: The promise of palliative care contexts.

PubMed

Ferrer, Rebecca A; Padgett, Lynne; Ellis, Erin M

2016-08-01

Although laboratory-based research on emotion and decision-making holds the distinct advantage of rigorous experimental control conditions that allow causal inferences, the question of how findings in a laboratory generalize to real-world settings remains. Identifying ecologically valid, real-world opportunities to extend laboratory findings is a valuable means of advancing this field. Palliative care-or care intended to provide relief from serious illness and aging-related complications during treatment or at the end of life-provides a particularly rich opportunity for such work. Here, we present an overview of palliative care, summarize existing research on emotion and palliative care decision-making, highlight challenges associated with conducting such research, outline examples of collaborative projects leveraging palliative care as a context for generating fundamental knowledge about emotion and decision-making, and describe the resources and collaborations necessary to conduct this type of research. In sum, palliative care holds unique promise as an emotionally laden context in which to answer fundamental questions about emotion and decision-making that extends our theoretical understanding of the role of emotion in high-stakes decision-making while simultaneously generating knowledge that can improve palliative care implementation. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

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

PubMed

Hunt, C; Lewin, S

2000-01-01

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

Evidence use in decision-making on introducing innovations: a systematic scoping review with stakeholder feedback.

PubMed

Turner, Simon; D'Lima, Danielle; Hudson, Emma; Morris, Stephen; Sheringham, Jessica; Swart, Nick; Fulop, Naomi J

2017-12-04

A range of evidence informs decision-making on innovation in health care, including formal research findings, local data and professional opinion. However, cultural and organisational factors often prevent the translation of evidence for innovations into practice. In addition to the characteristics of evidence, it is known that processes at the individual level influence its impact on decision-making. Less is known about the ways in which processes at the professional, organisational and local system level shape evidence use and its role in decisions to adopt innovations. A systematic scoping review was used to review the health literature on innovations within acute and primary care and map processes at the professional, organisational and local system levels which influence how evidence informs decision-making on innovation. Stakeholder feedback on the themes identified was collected via focus groups to test and develop the findings. Following database and manual searches, 31 studies reporting primary qualitative data met the inclusion criteria: 24 were of sufficient methodological quality to be included in the thematic analysis. Evidence use in decision-making on innovation is influenced by multi-level processes (professional, organisational, local system) and interactions across these levels. Preferences for evidence vary by professional group and health service setting. Organisations can shape professional behaviour by requiring particular forms of evidence to inform decision-making. Pan-regional organisations shape innovation decision-making at lower levels. Political processes at all levels shape the selection and use of evidence in decision-making. The synthesis of results from primary qualitative studies found that evidence use in decision-making on innovation is influenced by processes at multiple levels. Interactions between different levels shape evidence use in decision-making (e.g. professional groups and organisations can use local systems to validate evidence and legitimise innovations, while local systems can tailor or frame evidence to influence activity at lower levels). Organisational leaders need to consider whether the environment in which decisions are made values diverse evidence and stakeholder perspectives. Further qualitative research on decision-making practices that highlights how and why different types of evidence come to count during decisions, and tracks the political aspects of decisions about innovation, is needed.

Judgment and decision making.

PubMed

Mellers, B A; Schwartz, A; Cooke, A D

1998-01-01

For many decades, research in judgment and decision making has examined behavioral violations of rational choice theory. In that framework, rationality is expressed as a single correct decision shared by experimenters and subjects that satisfies internal coherence within a set of preferences and beliefs. Outside of psychology, social scientists are now debating the need to modify rational choice theory with behavioral assumptions. Within psychology, researchers are debating assumptions about errors for many different definitions of rationality. Alternative frameworks are being proposed. These frameworks view decisions as more reasonable and adaptive that previously thought. For example, "rule following." Rule following, which occurs when a rule or norm is applied to a situation, often minimizes effort and provides satisfying solutions that are "good enough," though not necessarily the best. When rules are ambiguous, people look for reasons to guide their decisions. They may also let their emotions take charge. This chapter presents recent research on judgment and decision making from traditional and alternative frameworks.

Situationally-Sensitive Knowledge Translation and Relational Decision Making in Hyperacute Stroke: A Qualitative Study

PubMed Central

Murtagh, Madeleine J.; Burges Watson, Duika L.; Jenkings, K. Neil; Lie, Mabel L. S.; Mackintosh, Joan E.; Ford, Gary A.; Thomson, Richard G.

2012-01-01

Stroke is a leading cause of disability. Early treatment of acute ischaemic stroke with rtPA reduces the risk of longer term dependency but carries an increased risk of causing immediate bleeding complications. To understand the challenges of knowledge translation and decision making about treatment with rtPA in hyperacute stroke and hence to inform development of appropriate decision support we interviewed patients, their family and health professionals. The emergency setting and the symptomatic effects of hyper-acute stroke shaped the form, content and manner of knowledge translation to support decision making. Decision making about rtPA in hyperacute stroke presented three conundrums for patients, family and clinicians. 1) How to allow time for reflection in a severely time-limited setting. 2) How to facilitate knowledge translation regarding important treatment risks and benefits when patient and family capacity is blunted by the effects and shock of stroke. 3) How to ensure patient and family views are taken into account when the situation produces reliance on the expertise of clinicians. Strategies adopted to meet these conundrums were fourfold: face to face communication; shaping decisions; incremental provision of information; and communication tailored to the individual patient. Relational forms of interaction were understood to engender trust and allay anxiety. Shaping decisions with patients was understood as an expression of confidence by clinicians that helped alleviate anxiety and offered hope and reassurance to patients and their family experiencing the shock of the stroke event. Neutral presentations of information and treatment options promoted uncertainty and contributed to anxiety. ‘Drip feeding’ information created moments for reflection: clinicians literally made time. Tailoring information to the particular patient and family situation allowed clinicians to account for social and emotional contexts. The principal responses to the challenges of decision making about rtPA in hyperacute stroke were relational decision support and situationally-sensitive knowledge translation. PMID:22675477

Situationally-sensitive knowledge translation and relational decision making in hyperacute stroke: a qualitative study.

PubMed

Murtagh, Madeleine J; Burges Watson, Duika L; Jenkings, K Neil; Lie, Mabel L S; Mackintosh, Joan E; Ford, Gary A; Thomson, Richard G

2012-01-01

Stroke is a leading cause of disability. Early treatment of acute ischaemic stroke with rtPA reduces the risk of longer term dependency but carries an increased risk of causing immediate bleeding complications. To understand the challenges of knowledge translation and decision making about treatment with rtPA in hyperacute stroke and hence to inform development of appropriate decision support we interviewed patients, their family and health professionals. The emergency setting and the symptomatic effects of hyper-acute stroke shaped the form, content and manner of knowledge translation to support decision making. Decision making about rtPA in hyperacute stroke presented three conundrums for patients, family and clinicians. 1) How to allow time for reflection in a severely time-limited setting. 2) How to facilitate knowledge translation regarding important treatment risks and benefits when patient and family capacity is blunted by the effects and shock of stroke. 3) How to ensure patient and family views are taken into account when the situation produces reliance on the expertise of clinicians. Strategies adopted to meet these conundrums were fourfold: face to face communication; shaping decisions; incremental provision of information; and communication tailored to the individual patient. Relational forms of interaction were understood to engender trust and allay anxiety. Shaping decisions with patients was understood as an expression of confidence by clinicians that helped alleviate anxiety and offered hope and reassurance to patients and their family experiencing the shock of the stroke event. Neutral presentations of information and treatment options promoted uncertainty and contributed to anxiety. 'Drip feeding' information created moments for reflection: clinicians literally made time. Tailoring information to the particular patient and family situation allowed clinicians to account for social and emotional contexts. The principal responses to the challenges of decision making about rtPA in hyperacute stroke were relational decision support and situationally-sensitive knowledge translation.

Interpreting results of cluster surveys in emergency settings: is the LQAS test the best option?

PubMed

Bilukha, Oleg O; Blanton, Curtis

2008-12-09

Cluster surveys are commonly used in humanitarian emergencies to measure health and nutrition indicators. Deitchler et al. have proposed to use Lot Quality Assurance Sampling (LQAS) hypothesis testing in cluster surveys to classify the prevalence of global acute malnutrition as exceeding or not exceeding the pre-established thresholds. Field practitioners and decision-makers must clearly understand the meaning and implications of using this test in interpreting survey results to make programmatic decisions. We demonstrate that the LQAS test--as proposed by Deitchler et al.--is prone to producing false-positive results and thus is likely to suggest interventions in situations where interventions may not be needed. As an alternative, to provide more useful information for decision-making, we suggest reporting the probability of an indicator's exceeding the threshold as a direct measure of "risk". Such probability can be easily determined in field settings by using a simple spreadsheet calculator. The "risk" of exceeding the threshold can then be considered in the context of other aggravating and protective factors to make informed programmatic decisions.

Interpreting results of cluster surveys in emergency settings: is the LQAS test the best option?

PubMed Central

Bilukha, Oleg O; Blanton, Curtis

2008-01-01

Cluster surveys are commonly used in humanitarian emergencies to measure health and nutrition indicators. Deitchler et al. have proposed to use Lot Quality Assurance Sampling (LQAS) hypothesis testing in cluster surveys to classify the prevalence of global acute malnutrition as exceeding or not exceeding the pre-established thresholds. Field practitioners and decision-makers must clearly understand the meaning and implications of using this test in interpreting survey results to make programmatic decisions. We demonstrate that the LQAS test–as proposed by Deitchler et al. – is prone to producing false-positive results and thus is likely to suggest interventions in situations where interventions may not be needed. As an alternative, to provide more useful information for decision-making, we suggest reporting the probability of an indicator's exceeding the threshold as a direct measure of "risk". Such probability can be easily determined in field settings by using a simple spreadsheet calculator. The "risk" of exceeding the threshold can then be considered in the context of other aggravating and protective factors to make informed programmatic decisions. PMID:19068120

Risking Your Life without a Second Thought: Intuitive Decision-Making and Extreme Altruism

PubMed Central

Rand, David G.; Epstein, Ziv G.

2014-01-01

When faced with the chance to help someone in mortal danger, what is our first response? Do we leap into action, only later considering the risks to ourselves? Or must instinctive self-preservation be overcome by will-power in order to act? We investigate this question by examining the testimony of Carnegie Hero Medal Recipients (CHMRs), extreme altruists who risked their lives to save others. We collected published interviews with CHMRs where they described their decisions to help. We then had participants rate the intuitiveness versus deliberativeness of the decision-making process described in each CHMR statement. The statements were judged to be overwhelmingly dominated by intuition; to be significantly more intuitive than a set of control statements describing deliberative decision-making; and to not differ significantly from a set of intuitive control statements. This remained true when restricting to scenarios in which the CHMRs had sufficient time to reflect before acting if they had so chosen. Text-analysis software found similar results. These findings suggest that high-stakes extreme altruism may be largely motivated by automatic, intuitive processes. PMID:25333876

Risking your life without a second thought: intuitive decision-making and extreme altruism.

PubMed

Rand, David G; Epstein, Ziv G

2014-01-01

When faced with the chance to help someone in mortal danger, what is our first response? Do we leap into action, only later considering the risks to ourselves? Or must instinctive self-preservation be overcome by will-power in order to act? We investigate this question by examining the testimony of Carnegie Hero Medal Recipients (CHMRs), extreme altruists who risked their lives to save others. We collected published interviews with CHMRs where they described their decisions to help. We then had participants rate the intuitiveness versus deliberativeness of the decision-making process described in each CHMR statement. The statements were judged to be overwhelmingly dominated by intuition; to be significantly more intuitive than a set of control statements describing deliberative decision-making; and to not differ significantly from a set of intuitive control statements. This remained true when restricting to scenarios in which the CHMRs had sufficient time to reflect before acting if they had so chosen. Text-analysis software found similar results. These findings suggest that high-stakes extreme altruism may be largely motivated by automatic, intuitive processes.

Fostering Informed Decisions: Impact of a Decision Aid Among Men Registered to Undergo Mass Screening for Prostate Cancer in a Randomized Controlled Trial

PubMed Central

Williams, Randi M.; Davis, Kimberly M.; Luta, George; Edmond, Sara N.; Dorfman, Caroline S.; Schwartz, Marc D.; Lynch, John; Ahaghotu, Chiledum; Taylor, Kathryn L.

2013-01-01

Objective Screening asymptomatic men for prostate cancer is controversial and informed decision making is recommended. Within two prostate cancer screening programs, we evaluated the impact of a print-based decision aid (DA) on decision-making outcomes. Methods Men (N=543) were 54.9 (SD=8.1) years old and 61% were African-American. The 2 (booklet type: DA vs. usual care (UC)) × 2 (delivery mode: Home vs. Clinic) randomized controlled trial assessed decisional and screening outcomes at baseline, two-months, and 13-months. Results Intention-to-treat linear regression analyses using generalized estimating equations revealed that DA participants reported improved knowledge relative to UC (B=.41, p<.05). For decisional conflict, per-protocol analyses revealed a group by time interaction (B = −.69, p<.05), indicating that DA participants were less likely to report decisional conflict at two-months compared to UC participants (OR=.49, 95% CI: .26–.91, p<.05). Conclusion This is the first randomized trial to evaluate a DA in the context of free mass screening, a challenging setting in which to make an informed decision. The DA was highly utilized by participants, improved knowledge and reduced decisional conflict. Practice implications These results are valuable in understanding ways to improve the decisions of men who seek screening and can be easily implemented within many settings. PMID:23357414

Navigating Decisional Discord: The Pediatrician’s Role When Child and Parents Disagree

PubMed Central

DuBois, James; Kodish, Eric; Wolfe, Joanne; Feudtner, Chris

2017-01-01

From the time when children enter the preteen years onward, pediatric medical decision-making can entail a complex interaction between child, parents, and pediatrician. When the child and parents disagree regarding medical decisions, the pediatrician has the challenging task of guiding the family to a final decision. Unresolved discord can affect family cohesiveness, patient adherence, and patient self-management. In this article, we outline 3 models for the pediatrician’s role in the setting of decisional discord: deference, advocative, and arbitrative. In the deference model, the pediatrician prioritizes parental decision-making authority. In the advocative model, the pediatrician advocates for the child’s preference in decision-making so long as the child’s decision is medically reasonable. In the arbitrative model, the pediatrician works to resolve the conflict in a balanced fashion. Although each model has advantages and disadvantages, the arbitrative model should serve as the initial model in nearly all settings. The arbitrative model is likely to reach the most beneficial decision in a manner that maintains family cohesiveness by respecting the authority of parents and the developing autonomy of children. We also highlight, however, occasions when the deference or advocative models may be more appropriate. Physicians should keep all 3 models available in their professional toolkit and develop the wisdom to deploy the right model for each particular clinical situation. PMID:28562285

Navigating Decisional Discord: The Pediatrician's Role When Child and Parents Disagree.

PubMed

Sisk, Bryan A; DuBois, James; Kodish, Eric; Wolfe, Joanne; Feudtner, Chris

2017-06-01

From the time when children enter the preteen years onward, pediatric medical decision-making can entail a complex interaction between child, parents, and pediatrician. When the child and parents disagree regarding medical decisions, the pediatrician has the challenging task of guiding the family to a final decision. Unresolved discord can affect family cohesiveness, patient adherence, and patient self-management. In this article, we outline 3 models for the pediatrician's role in the setting of decisional discord: deference, advocative, and arbitrative. In the deference model, the pediatrician prioritizes parental decision-making authority. In the advocative model, the pediatrician advocates for the child's preference in decision-making so long as the child's decision is medically reasonable. In the arbitrative model, the pediatrician works to resolve the conflict in a balanced fashion. Although each model has advantages and disadvantages, the arbitrative model should serve as the initial model in nearly all settings. The arbitrative model is likely to reach the most beneficial decision in a manner that maintains family cohesiveness by respecting the authority of parents and the developing autonomy of children. We also highlight, however, occasions when the deference or advocative models may be more appropriate. Physicians should keep all 3 models available in their professional toolkit and develop the wisdom to deploy the right model for each particular clinical situation. Copyright © 2017 by the American Academy of Pediatrics.

Notes on The School Psychologist as a Facilitator of Parent Involvement in Decisions Concerning Their Children: An Overview.

ERIC Educational Resources Information Center

Lapides, Joseph

This presentation discusses a rationale and set of procedures that increase parent involvement in decisions concerning their children. Decision making is viewed here as a process by which parents choose, among conflicting considerations, courses of action which are in the best interests of their children. Decisions usually imply a power…

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

PubMed

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

2014-09-16

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

Public participation in decision-making on the coverage of new antivirals for hepatitis C.

PubMed

Kieslich, Katharina; Ahn, Jeonghoon; Badano, Gabriele; Chalkidou, Kalipso; Cubillos, Leonardo; Hauegen, Renata Curi; Henshall, Chris; Krubiner, Carleigh B; Littlejohns, Peter; Lu, Lanting; Pearson, Steven D; Rid, Annette; Whitty, Jennifer A; Wilson, James

2016-08-15

Purpose - New hepatitis C medicines such as sofosbuvir underline the need to balance considerations of innovation, clinical evidence, budget impact and equity in health priority-setting. The purpose of this paper is to examine the role of public participation in addressing these considerations. Design/methodology/approach - The paper employs a comparative case study approach. It explores the experience of four countries - Brazil, England, South Korea and the USA - in making coverage decisions about the antiviral sofosbuvir and involving the public and patients in these decision-making processes. Findings - Issues emerging from public participation ac tivities include the role of the universal right to health in Brazil, the balance between innovation and budget impact in England, the effect of unethical medical practices on public perception in South Korea and the legitimacy of priority-setting processes in the USA. Providing policymakers are receptive to these issues, public participation activities may be re-conceptualized as processes that illuminate policy problems relevant to a particular context, thereby promoting an agenda-setting role for the public. Originality/value - The paper offers an empirical analysis of public involvement in the case of sofosbuvir, where the relevant considerations that bear on priority-setting decisions have been particularly stark. The perspectives that emerge suggest that public participation contributes to raising attention to issues that need to be addressed by policymakers. Public participation activities can thus contribute to setting policy agendas, even if that is not their explicit purpose. However, the actualization of this contribution is contingent on the receptiveness of policymakers.

The buck stops here: midwives and maternity care in rural Scotland.

PubMed

Harris, Fiona M; van Teijlingen, Edwin; Hundley, Vanora; Farmer, Jane; Bryers, Helen; Caldow, Jan; Ireland, Jillian; Kiger, Alice; Tucker, Janet

2011-06-01

To explore and understand what it means to provide midwifery care in remote and rural Scotland. Qualitative interviews with 72 staff from 10 maternity units, analysed via a case study approach. Remote and rural areas of Scotland. Predominantly midwives, with some additional interviews with paramedics, general surgeons, anaesthetists and GPs. Remote and rural maternity care includes a range of settings and models of care. However, the impact of rural geographies on decision-making and risk assessment is common to all settings. Making decisions and dealing with the implications of these decisions is, in many cases, done without onsite specialist support. This has implications for the skills and competencies that are needed to practice midwifery in remote and rural settings. Whereas most rural midwives reported that their skills in risk assessment and decisions to transfer were well developed and appropriate to practising in their particular settings, they perceived these decisions to be under scrutiny by urban-based colleagues and felt the need to stress their competence in the face of what they imagined to be stereotypes of rural incompetence. This study shows that skills in risk assessment and decision-making are central to high quality remote and rural midwifery care. However, linked to different perspectives on care, there is a risk that these skills can be undermined by contact with colleagues in large urban units, particularly when staff do not know each other well. There is a need to develop a professional understanding between midwives in different locations. It is important for the good working relationships between urban and rural maternity units that all midwives understand the importance of contextual knowledge in both decisions to transfer from rural locations and the position of midwives in receiving units. Multiprofessional CPD courses have been effective in bringing together teams around obstetric emergencies; we suggest that a similar format may be required in considering issues of transfer. Copyright © 2010 Elsevier Ltd. All rights reserved.

SARS and hospital priority setting: a qualitative case study and evaluation.

PubMed

Bell, Jennifer A H; Hyland, Sylvia; DePellegrin, Tania; Upshur, Ross E G; Bernstein, Mark; Martin, Douglas K

2004-12-19

Priority setting is one of the most difficult issues facing hospitals because of funding restrictions and changing patient need. A deadly communicable disease outbreak, such as the Severe Acute Respiratory Syndrome (SARS) in Toronto in 2003, amplifies the difficulties of hospital priority setting. The purpose of this study is to describe and evaluate priority setting in a hospital in response to SARS using the ethical framework 'accountability for reasonableness'. This study was conducted at a large tertiary hospital in Toronto, Canada. There were two data sources: 1) over 200 key documents (e.g. emails, bulletins), and 2) 35 interviews with key informants. Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. Participants described the types of priority setting decisions, the decision making process and the reasoning used. Although the hospital leadership made an effort to meet the conditions of 'accountability for reasonableness', they acknowledged that the decision making was not ideal. We described good practices and opportunities for improvement. 'Accountability for reasonableness' is a framework that can be used to guide fair priority setting in health care organizations, such as hospitals. In the midst of a crisis such as SARS where guidance is incomplete, consequences uncertain, and information constantly changing, where hour-by-hour decisions involve life and death, fairness is more important rather than less.

Analyses of S-Box in Image Encryption Applications Based on Fuzzy Decision Making Criterion

NASA Astrophysics Data System (ADS)

Rehman, Inayatur; Shah, Tariq; Hussain, Iqtadar

2014-06-01

In this manuscript, we put forward a standard based on fuzzy decision making criterion to examine the current substitution boxes and study their strengths and weaknesses in order to decide their appropriateness in image encryption applications. The proposed standard utilizes the results of correlation analysis, entropy analysis, contrast analysis, homogeneity analysis, energy analysis, and mean of absolute deviation analysis. These analyses are applied to well-known substitution boxes. The outcome of these analyses are additional observed and a fuzzy soft set decision making criterion is used to decide the suitability of an S-box to image encryption applications.

Teacher Talk about Student Ability and Achievement in the Era of Data-Driven Decision Making

ERIC Educational Resources Information Center

Datnow, Amanda; Choi, Bailey; Park, Vicki; St. John, Elise

2018-01-01

Background: Data-driven decision making continues to be a common feature of educational reform agendas across the globe. In many U.S. schools, the teacher team meeting is a key setting in which data use is intended to take place, with the aim of planning instruction to address students' needs. However, most prior research has not examined how the…

Problem Solving and Decision Making. MAS-105. Waste Isolation Division (WID). Management and Supervisor Training (MAST) Program.

ERIC Educational Resources Information Center

Westinghouse Electric Corp., Carlsbad, NM.

This module is part of a set of management and supervisor training (MAST) materials developed by the Department of Energy for the Waste Isolation Division. Its stated purpose is to enable trainees to solve problems and make decisions in an efficient and effective manner. The first section of the module is an introduction that includes a terminal…

The Effects of Frequency of Media Utilization on Decision Making of Media Choice

ERIC Educational Resources Information Center

Gotoh, Yasushi

2014-01-01

The purpose of this study is to use the Analytic Hierarchy Process in order to identify how frequency of media use in daily life affects decision-making in media choice. 276 university students took part in this research, They were asked to prioritize their ways of obtaining information about current affairs using sets of media such as TV, books,…

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

A Multimethod Analysis of Shared Decision-Making in Hospice Interdisciplinary Team Meetings Including Family Caregivers

PubMed Central

Washington, Karla T.; Oliver, Debra Parker; Gage, L. Ashley; Albright, David L.; Demiris, George

2015-01-01

Background Much of the existing research on shared decision-making in hospice and palliative care focuses on the provider-patient dyad; little is known about shared decision-making that is inclusive of family members of patients with advanced disease. Aim We sought to describe shared decision-making as it occurred in hospice interdisciplinary team meetings that included family caregivers as participants using video-conferencing technology. Design We conducted a multimethod study in which we used content and thematic analysis techniques to analyze video-recordings of hospice interdisciplinary team meetings (n = 100), individual interviews of family caregivers (n = 73) and hospice staff members (n = 78), and research field notes. Setting/participants Participants in the original studies from which data for this analysis were drawn were hospice family caregivers and staff members employed by one of five different community-based hospice agencies located in the Midwestern United States. Results Shared decision-making occurred infrequently in hospice interdisciplinary team meetings that included family caregivers. Barriers to shared decision-making included time constraints, communication skill deficits, unaddressed emotional needs, staff absences, and unclear role expectations. The hospice philosophy of care, current trends in health care delivery, the interdisciplinary nature of hospice teams, and the designation of a team leader/facilitator supported shared decision-making. Conclusions The involvement of family caregivers in hospice interdisciplinary team meetings using video-conferencing technology creates a useful platform for shared decision-making; however, steps must be taken to transform family caregivers from meeting attendees to shared decision-makers. PMID:26281854

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.

Combining cognitive engineering and information fusion architectures to build effective joint systems

NASA Astrophysics Data System (ADS)

Sliva, Amy L.; Gorman, Joe; Voshell, Martin; Tittle, James; Bowman, Christopher

2016-05-01

The Dual Node Decision Wheels (DNDW) architecture concept was previously described as a novel approach toward integrating analytic and decision-making processes in joint human/automation systems in highly complex sociotechnical settings. In this paper, we extend the DNDW construct with a description of components in this framework, combining structures of the Dual Node Network (DNN) for Information Fusion and Resource Management with extensions on Rasmussen's Decision Ladder (DL) to provide guidance on constructing information systems that better serve decision-making support requirements. The DNN takes a component-centered approach to system design, decomposing each asset in terms of data inputs and outputs according to their roles and interactions in a fusion network. However, to ensure relevancy to and organizational fitment within command and control (C2) processes, principles from cognitive systems engineering emphasize that system design must take a human-centered systems view, integrating information needs and decision making requirements to drive the architecture design and capabilities of network assets. In the current work, we present an approach for structuring and assessing DNDW systems that uses a unique hybrid DNN top-down system design with a human-centered process design, combining DNN node decomposition with artifacts from cognitive analysis (i.e., system abstraction decomposition models, decision ladders) to provide work domain and task-level insights at different levels in an example intelligence, surveillance, and reconnaissance (ISR) system setting. This DNDW structure will ensure not only that the information fusion technologies and processes are structured effectively, but that the resulting information products will align with the requirements of human decision makers and be adaptable to different work settings .

[Shared medical decision making in gynaecology].

PubMed

This, P; Panel, P

2010-02-01

When two options or more can be chosen in medical care, the final decision implies two steps: facts analysis, and patient evaluation of preferences. Shared Medical Decision-Making is a rational conceptual frame that can be used in such cases. In this paper, we describe the concept, its practical modalities, and the questions raised by its use. In gynaecology, many medical situations involve "sensitive preferences choice": for example, contraceptive choice, menorrhagia treatment, and approach of menopause. Some tools from the "Shared Medical Decision Making" concept are useful to structure medical consultations, to convey information, and to reveal patients preferences. Decision aid are used in clinical research settings, but some of them may also be easily used in usual practice, and help physicians to improve both quality and traceability of the decisional process. Copyright 2009 Elsevier Masson SAS. All rights reserved.

NASA Risk-Informed Decision Making Handbook

NASA Technical Reports Server (NTRS)

Dezfuli, Homayoon; Stamatelatos, Michael; Maggio, Gaspare; Everett, Christopher; Youngblood, Robert; Rutledge, Peter; Benjamin, Allan; Williams, Rodney; Smith, Curtis; Guarro, Sergio

2010-01-01

This handbook provides guidance for conducting risk-informed decision making in the context of NASA risk management (RM), with a focus on the types of direction-setting key decisions that are characteristic of the NASA program and project life cycles, and which produce derived requirements in accordance with existing systems engineering practices that flow down through the NASA organizational hierarchy. The guidance in this handbook is not meant to be prescriptive. Instead, it is meant to be general enough, and contain a sufficient diversity of examples, to enable the reader to adapt the methods as needed to the particular decision problems that he or she faces. The handbook highlights major issues to consider when making decisions in the presence of potentially significant uncertainty, so that the user is better able to recognize and avoid pitfalls that might otherwise be experienced.

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

Bayesian deterministic decision making: a normative account of the operant matching law and heavy-tailed reward history dependency of choices.

PubMed

Saito, Hiroshi; Katahira, Kentaro; Okanoya, Kazuo; Okada, Masato

2014-01-01

The decision making behaviors of humans and animals adapt and then satisfy an "operant matching law" in certain type of tasks. This was first pointed out by Herrnstein in his foraging experiments on pigeons. The matching law has been one landmark for elucidating the underlying processes of decision making and its learning in the brain. An interesting question is whether decisions are made deterministically or probabilistically. Conventional learning models of the matching law are based on the latter idea; they assume that subjects learn choice probabilities of respective alternatives and decide stochastically with the probabilities. However, it is unknown whether the matching law can be accounted for by a deterministic strategy or not. To answer this question, we propose several deterministic Bayesian decision making models that have certain incorrect beliefs about an environment. We claim that a simple model produces behavior satisfying the matching law in static settings of a foraging task but not in dynamic settings. We found that the model that has a belief that the environment is volatile works well in the dynamic foraging task and exhibits undermatching, which is a slight deviation from the matching law observed in many experiments. This model also demonstrates the double-exponential reward history dependency of a choice and a heavier-tailed run-length distribution, as has recently been reported in experiments on monkeys.

Does Patient Preference Measurement in Decision Aids Improve Decisional Conflict? A Randomized Trial in Men with Prostate Cancer.

PubMed

Shirk, Joseph D; Crespi, Catherine M; Saucedo, Josemanuel D; Lambrechts, Sylvia; Dahan, Ely; Kaplan, Robert; Saigal, Christopher

2017-12-01

Shared decision making (SDM) has been advocated as an approach to medical decision making that can improve decisional quality. Decision aids are tools that facilitate SDM in the context of limited physician time; however, many decision aids do not incorporate preference measurement. We aim to understand whether adding preference measurement to a standard patient educational intervention improves decisional quality and is feasible in a busy clinical setting. Men with incident localized prostate cancer (n = 122) were recruited from the Greater Los Angeles Veterans Affairs (VA) Medical Center urology clinic, Olive View UCLA Medical Center, and Harbor UCLA Medical Center from January 2011 to May 2015 and randomized to education with a brochure about prostate cancer treatment or software-based preference assessment in addition to the brochure. Men undergoing preference assessment received a report detailing the relative strength of their preferences for treatment outcomes used in review with their doctor. Participants completed instruments measuring decisional conflict, knowledge, SDM, and patient satisfaction with care before and/or after their cancer consultation. Baseline knowledge scores were low (mean 62%). The baseline mean total score on the Decisional Conflict Scale was 2.3 (±0.9), signifying moderate decisional conflict. Men undergoing preference assessment had a significantly larger decrease in decisional conflict total score (p = 0.023) and the Perceived Effective Decision Making subscale (p = 0.003) post consult compared with those receiving education only. Improvements in satisfaction with care, SDM, and knowledge were similar between groups. Individual-level preference assessment is feasible in the clinic setting. Patients with prostate cancer who undergo preference assessment are more certain about their treatment decisions and report decreased levels of decisional conflict when making these decisions.

Employee Participation--A Practical Guide.

ERIC Educational Resources Information Center

Wooden, Mark

1990-01-01

Despite the benefits of employee participation in decision making, it is not widespread. Making it work requires commitment, job security, training, access to information, communication channels, goal setting, flat organizational structures, and financial reinforcement. (SK)

The use of control charts by laypeople and hospital decision-makers for guiding decision making.

PubMed

Schmidtke, K A; Watson, D G; Vlaev, I

2017-07-01

Graphs presenting healthcare data are increasingly available to support laypeople and hospital staff's decision making. When making these decisions, hospital staff should consider the role of chance-that is, random variation. Given random variation, decision-makers must distinguish signals (sometimes called special-cause data) from noise (common-cause data). Unfortunately, many graphs do not facilitate the statistical reasoning necessary to make such distinctions. Control charts are a less commonly used type of graph that support statistical thinking by including reference lines that separate data more likely to be signals from those more likely to be noise. The current work demonstrates for whom (laypeople and hospital staff) and when (treatment and investigative decisions) control charts strengthen data-driven decision making. We present two experiments that compare people's use of control and non-control charts to make decisions between hospitals (funnel charts vs. league tables) and to monitor changes across time (run charts with control lines vs. run charts without control lines). As expected, participants more accurately identified the outlying data using a control chart than using a non-control chart, but their ability to then apply that information to more complicated questions (e.g., where should I go for treatment?, and should I investigate?) was limited. The discussion highlights some common concerns about using control charts in hospital settings.

A Dual Hesitant Fuzzy Multigranulation Rough Set over Two-Universe Model for Medical Diagnoses

PubMed Central

Zhang, Chao; Li, Deyu; Yan, Yan

2015-01-01

In medical science, disease diagnosis is one of the difficult tasks for medical experts who are confronted with challenges in dealing with a lot of uncertain medical information. And different medical experts might express their own thought about the medical knowledge base which slightly differs from other medical experts. Thus, to solve the problems of uncertain data analysis and group decision making in disease diagnoses, we propose a new rough set model called dual hesitant fuzzy multigranulation rough set over two universes by combining the dual hesitant fuzzy set and multigranulation rough set theories. In the framework of our study, both the definition and some basic properties of the proposed model are presented. Finally, we give a general approach which is applied to a decision making problem in disease diagnoses, and the effectiveness of the approach is demonstrated by a numerical example. PMID:26858772

Priority setting of ICU resources in an influenza pandemic: a qualitative study of the Canadian public's perspectives.

PubMed

Silva, Diego S; Gibson, Jennifer L; Robertson, Ann; Bensimon, Cécile M; Sahni, Sachin; Maunula, Laena; Smith, Maxwell J

2012-03-26

Pandemic influenza may exacerbate existing scarcity of life-saving medical resources. As a result, decision-makers may be faced with making tough choices about who will receive care and who will have to wait or go without. Although previous studies have explored ethical issues in priority setting from the perspective of clinicians and policymakers, there has been little investigation into how the public views priority setting during a pandemic influenza, in particular related to intensive care resources. To bridge this gap, we conducted three public town hall meetings across Canada to explore Canadian's perspectives on this ethical challenge. Town hall discussions group discussions were digitally recorded, transcribed, and analyzed using thematic analysis. Six interrelated themes emerged from the town hall discussions related to: ethical and empirical starting points for deliberation; criteria for setting priorities; pre-crisis planning; in-crisis decision-making; the need for public deliberation and input; and participants' deliberative struggle with the ethical issues. Our findings underscore the importance of public consultation in pandemic planning for sustaining public trust in a public health emergency. Participants appreciated the empirical and ethical uncertainty of decision-making in an influenza pandemic and demonstrated nuanced ethical reasoning about priority setting of intensive care resources in an influenza pandemic. Policymakers may benefit from a better understanding the public's empirical and ethical 'starting points' in developing effective pandemic plans.

Feasibility of neuro-morphic computing to emulate error-conflict based decision making.

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

Branch, Darren W.

2009-09-01

A key aspect of decision making is determining when errors or conflicts exist in information and knowing whether to continue or terminate an action. Understanding the error-conflict processing is crucial in order to emulate higher brain functions in hardware and software systems. Specific brain regions, most notably the anterior cingulate cortex (ACC) are known to respond to the presence of conflicts in information by assigning a value to an action. Essentially, this conflict signal triggers strategic adjustments in cognitive control, which serve to prevent further conflict. The most probable mechanism is the ACC reports and discriminates different types of feedback,more » both positive and negative, that relate to different adaptations. Unique cells called spindle neurons that are primarily found in the ACC (layer Vb) are known to be responsible for cognitive dissonance (disambiguation between alternatives). Thus, the ACC through a specific set of cells likely plays a central role in the ability of humans to make difficult decisions and solve challenging problems in the midst of conflicting information. In addition to dealing with cognitive dissonance, decision making in high consequence scenarios also relies on the integration of multiple sets of information (sensory, reward, emotion, etc.). Thus, a second area of interest for this proposal lies in the corticostriatal networks that serve as an integration region for multiple cognitive inputs. In order to engineer neurological decision making processes in silicon devices, we will determine the key cells, inputs, and outputs of conflict/error detection in the ACC region. The second goal is understand in vitro models of corticostriatal networks and the impact of physical deficits on decision making, specifically in stressful scenarios with conflicting streams of data from multiple inputs. We will elucidate the mechanisms of cognitive data integration in order to implement a future corticostriatal-like network in silicon devices for improved decision processing.« less

How do clinicians practise the principles of beneficence when deciding to allow or deny family presence during resuscitation?

PubMed

Giles, Tracey; de Lacey, Sheryl; Muir-Cochrane, Eimear

2018-03-01

To examine how clinicians practise the principles of beneficence when deciding to allow or deny family presence during resuscitation. Family presence during resuscitation has important benefits for family and is supported by professional bodies and the public. Yet, many clinicians restrict family access to patients during resuscitation, and rationales for decision-making are unclear. Secondary analysis of an existing qualitative data set using deductive category application of content analysis. We analysed 20 interview transcripts from 15 registered nurses, two doctors and three paramedics who had experienced family presence during resuscitation in an Australian hospital. The transcripts were analysed for incidents of beneficent decision-making when allowing or denying family presence during resuscitation. Decision-making around family presence during resuscitation occurred in time poor environments and in the absence of local institutional guidelines. Clinicians appeared to be motivated by doing "what's best" for patients and families when allowing or denying family presence during resuscitation. However, their individual interpretations of "what's best" was subjective and did not always coincide with family preferences or with current evidence that promotes family presence during resuscitation as beneficial. The decision to allow or deny family presence during resuscitation is complex, and often impacted by personal preferences and beliefs, setting norms and tensions between clinicians and consumers. As a result, many families are missing the chance to be with their loved ones at the end of life. The introduction of institutional guidelines and policies would help to establish what safe and effective practice consists of, reduce value-laden decision-making and guide beneficent decision-making. These findings highlight current deficits in decision-making around FPDR and could prompt the introduction of clinical guidelines and policies and in turn promote the equitable provision of safe, effective family-centred care during resuscitation events. © 2017 John Wiley & Sons Ltd.

Experimental analysis of multi-attribute decision-making based on Atanassov intuitionistic fuzzy sets: a discussion of anchor dependency and accuracy functions

NASA Astrophysics Data System (ADS)

Chen, Ting-Yu

2012-06-01

This article presents a useful method for relating anchor dependency and accuracy functions to multiple attribute decision-making (MADM) problems in the context of Atanassov intuitionistic fuzzy sets (A-IFSs). Considering anchored judgement with displaced ideals and solution precision with minimal hesitation, several auxiliary optimisation models have proposed to obtain the optimal weights of the attributes and to acquire the corresponding TOPSIS (the technique for order preference by similarity to the ideal solution) index for alternative rankings. Aside from the TOPSIS index, as a decision-maker's personal characteristics and own perception of self may also influence the direction in the axiom of choice, the evaluation of alternatives is conducted based on distances of each alternative from the positive and negative ideal alternatives, respectively. This article originates from Li's [Li, D.-F. (2005), 'Multiattribute Decision Making Models and Methods Using Intuitionistic Fuzzy Sets', Journal of Computer and System Sciences, 70, 73-85] work, which is a seminal study of intuitionistic fuzzy decision analysis using deduced auxiliary programming models, and deems it a benchmark method for comparative studies on anchor dependency and accuracy functions. The feasibility and effectiveness of the proposed methods are illustrated by a numerical example. Finally, a comparative analysis is illustrated with computational experiments on averaging accuracy functions, TOPSIS indices, separation measures from positive and negative ideal alternatives, consistency rates of ranking orders, contradiction rates of the top alternative and average Spearman correlation coefficients.

A Framework to Improve Surgeon Communication in High-Stakes Surgical Decisions: Best Case/Worst Case.

PubMed

Taylor, Lauren J; Nabozny, Michael J; Steffens, Nicole M; Tucholka, Jennifer L; Brasel, Karen J; Johnson, Sara K; Zelenski, Amy; Rathouz, Paul J; Zhao, Qianqian; Kwekkeboom, Kristine L; Campbell, Toby C; Schwarze, Margaret L

2017-06-01

Although many older adults prefer to avoid burdensome interventions with limited ability to preserve their functional status, aggressive treatments, including surgery, are common near the end of life. Shared decision making is critical to achieve value-concordant treatment decisions and minimize unwanted care. However, communication in the acute inpatient setting is challenging. To evaluate the proof of concept of an intervention to teach surgeons to use the Best Case/Worst Case framework as a strategy to change surgeon communication and promote shared decision making during high-stakes surgical decisions. Our prospective pre-post study was conducted from June 2014 to August 2015, and data were analyzed using a mixed methods approach. The data were drawn from decision-making conversations between 32 older inpatients with an acute nonemergent surgical problem, 30 family members, and 25 surgeons at 1 tertiary care hospital in Madison, Wisconsin. A 2-hour training session to teach each study-enrolled surgeon to use the Best Case/Worst Case communication framework. We scored conversation transcripts using OPTION 5, an observer measure of shared decision making, and used qualitative content analysis to characterize patterns in conversation structure, description of outcomes, and deliberation over treatment alternatives. The study participants were patients aged 68 to 95 years (n = 32), 44% of whom had 5 or more comorbid conditions; family members of patients (n = 30); and surgeons (n = 17). The median OPTION 5 score improved from 41 preintervention (interquartile range, 26-66) to 74 after Best Case/Worst Case training (interquartile range, 60-81). Before training, surgeons described the patient's problem in conjunction with an operative solution, directed deliberation over options, listed discrete procedural risks, and did not integrate preferences into a treatment recommendation. After training, surgeons using Best Case/Worst Case clearly presented a choice between treatments, described a range of postoperative trajectories including functional decline, and involved patients and families in deliberation. Using the Best Case/Worst Case framework changed surgeon communication by shifting the focus of decision-making conversations from an isolated surgical problem to a discussion about treatment alternatives and outcomes. This intervention can help surgeons structure challenging conversations to promote shared decision making in the acute setting.

The Impact of Process Instructions on Judges' Use of Examinee Performance Data in Angoff Standard Setting Exercises

ERIC Educational Resources Information Center

Mee, Janet; Clauser, Brian E.; Margolis, Melissa J.

2013-01-01

Despite being widely used and frequently studied, the Angoff standard setting procedure has received little attention with respect to an integral part of the process: how judges incorporate examinee performance data in the decision-making process. Without performance data, subject matter experts have considerable difficulty accurately making the…

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.

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

Subjective costs drive overly patient foraging strategies in rats on an intertemporal foraging task.

PubMed

Wikenheiser, Andrew M; Stephens, David W; Redish, A David

2013-05-14

Laboratory studies of decision making often take the form of two-alternative, forced-choice paradigms. In natural settings, however, many decision problems arise as stay/go choices. We designed a foraging task to test intertemporal decision making in rats via stay/go decisions. Subjects did not follow the rate-maximizing strategy of choosing only food items associated with short delays. Instead, rats were often willing to wait for surprisingly long periods, and consequently earned a lower rate of food intake than they might have by ignoring long-delay options. We tested whether foraging theory or delay discounting models predicted the behavior we observed but found that these models could not account for the strategies subjects selected. Subjects' behavior was well accounted for by a model that incorporated a cost for rejecting potential food items. Interestingly, subjects' cost sensitivity was proportional to environmental richness. These findings are at odds with traditional normative accounts of decision making but are consistent with retrospective considerations having a deleterious influence on decisions (as in the "sunk-cost" effect). More broadly, these findings highlight the utility of complementing existing assays of decision making with tasks that mimic more natural decision topologies.

Subjective costs drive overly patient foraging strategies in rats on an intertemporal foraging task

PubMed Central

Wikenheiser, Andrew M.; Stephens, David W.; Redish, A. David

2013-01-01

Laboratory studies of decision making often take the form of two-alternative, forced-choice paradigms. In natural settings, however, many decision problems arise as stay/go choices. We designed a foraging task to test intertemporal decision making in rats via stay/go decisions. Subjects did not follow the rate-maximizing strategy of choosing only food items associated with short delays. Instead, rats were often willing to wait for surprisingly long periods, and consequently earned a lower rate of food intake than they might have by ignoring long-delay options. We tested whether foraging theory or delay discounting models predicted the behavior we observed but found that these models could not account for the strategies subjects selected. Subjects’ behavior was well accounted for by a model that incorporated a cost for rejecting potential food items. Interestingly, subjects’ cost sensitivity was proportional to environmental richness. These findings are at odds with traditional normative accounts of decision making but are consistent with retrospective considerations having a deleterious influence on decisions (as in the “sunk-cost” effect). More broadly, these findings highlight the utility of complementing existing assays of decision making with tasks that mimic more natural decision topologies. PMID:23630289

A focus group study investigating medical decision making in octogenarians of high socioeconomic status with successful outcomes following cardiac surgery.

PubMed

Oldroyd, John C; Levinson, Michele R; Stephenson, Gemma; Rouse, Alice; Leeuwrik, Tina

2014-09-01

To explore medical decision making in octogenarians having cardiac surgery. Five focus groups conducted in a private hospital setting with octogenarians of high socioeconomic status who had successful cardiac surgery in the previous 3-13 months. Octogenarian's motivations for having cardiac surgery include survival, relief of symptoms, convenience and improving quality of life. The decision to have surgery involved clinical advice by doctors that the time had come to take up a surgical option. Patient's decisions did not take into account alternative treatment options either because these had not been presented by doctors or because medical management had failed. The final decision was made by patients. Decisions to have cardiac surgery in octogenarians are made by patients after discussions with family based on their risks as communicated by their doctors. This underlines the importance of effective risk communication by doctors to help patients make appropriate medical decisions. © 2013 The Authors. Australasian Journal on Ageing © 2013 ACOTA.

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.

A qualitative metasynthesis: family involvement in decision making for people with dementia in residential aged care.

PubMed

Petriwskyj, Andrea; Gibson, Alexandra; Parker, Deborah; Banks, Susan; Andrews, Sharon; Robinson, Andrew

2014-06-01

Involving people in decisions about their care is good practice and ensures optimal outcomes. Despite considerable research, in practice family involvement in decision making can be challenging for both care staff and families. The aim of this review was to identify and appraise existing knowledge about family involvement in decision making for people with dementia living in residential aged care. The present Joanna Briggs Institute meta-synthesis considered studies that investigate involvement of family members in decision making for people with dementia in residential aged care settings. While quantitative and qualitative studies were included in the review, this article presents the qualitative findings. A comprehensive search of studies was conducted in 15 electronic databases. The search was limited to papers published in English, from 1990 to 2013. Twenty-six studies were identified as relevant for this review; 16 were qualitative papers reporting on 15 studies. Two independent reviewers assessed the studies for methodological validity and extracted the data using the standardized Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). The findings were synthesized using JBI-QARI. The findings related to the decisions encountered and made by family surrogates, family perceptions of, and preferences for, their role/s, factors regarding treatment decisions and the collaborative decision-making process, and outcomes for family decision makers. Results indicate varied and complex experiences and multiple factors influencing decision making. Communication and contacts between staff and families and the support available for families should be addressed, as well as the role of different stakeholders in decisions.

Information and decision-making needs among people with mental disorders: a systematic review of the literature.

PubMed

Tlach, Lisa; Wüsten, Caroline; Daubmann, Anne; Liebherz, Sarah; Härter, Martin; Dirmaier, Jörg

2015-12-01

Assessment of users' information and decision-making needs is one key step in the development of decision-support interventions. To identify patients' information and decision-making needs as a pre-requisite for the development of high-quality web-based patient decision aids (PtDAs) for common mental disorders. A systematic MEDLINE search for papers published until December 2012 was conducted, and reference lists of included articles and relevant reviews were searched. Original studies containing data on information or decision-making needs of adults with depression, anxiety disorders, somatoform disorders, alcohol-related disorders and schizophrenia were included. Data extraction was performed using a standardized form, and data synthesis was conducted using a theory-based deductive approach by two independent reviewers. Studies were quality assessed using the Mixed Methods Appraisal Tool. Twelve studies were included focusing on information needs or the identification of decisions patients with depression and schizophrenia were facing. No studies were found for the other mental disorders. Overall, seven information needs categories were identified with the topics 'basic facts', 'treatment' and 'coping' being of major relevance. Six decision categories were identified of which decisions on 'medication' and 'treatment setting' were most often classified. This review reveals that patients with schizophrenia and depression show extensive information and decision-making needs. The identified needs can initially inform the design of PtDAs for schizophrenia and depression. However, there is an urgent need to investigate information and decision-making needs among patients with other mental disorders. © 2014 John Wiley & Sons Ltd.

Interpretable Decision Sets: A Joint Framework for Description and Prediction

PubMed Central

Lakkaraju, Himabindu; Bach, Stephen H.; Jure, Leskovec

2016-01-01

One of the most important obstacles to deploying predictive models is the fact that humans do not understand and trust them. Knowing which variables are important in a model’s prediction and how they are combined can be very powerful in helping people understand and trust automatic decision making systems. Here we propose interpretable decision sets, a framework for building predictive models that are highly accurate, yet also highly interpretable. Decision sets are sets of independent if-then rules. Because each rule can be applied independently, decision sets are simple, concise, and easily interpretable. We formalize decision set learning through an objective function that simultaneously optimizes accuracy and interpretability of the rules. In particular, our approach learns short, accurate, and non-overlapping rules that cover the whole feature space and pay attention to small but important classes. Moreover, we prove that our objective is a non-monotone submodular function, which we efficiently optimize to find a near-optimal set of rules. Experiments show that interpretable decision sets are as accurate at classification as state-of-the-art machine learning techniques. They are also three times smaller on average than rule-based models learned by other methods. Finally, results of a user study show that people are able to answer multiple-choice questions about the decision boundaries of interpretable decision sets and write descriptions of classes based on them faster and more accurately than with other rule-based models that were designed for interpretability. Overall, our framework provides a new approach to interpretable machine learning that balances accuracy, interpretability, and computational efficiency. PMID:27853627

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.

Decision Making in Armored Platoon Command

DTIC Science & Technology

1990-07-01

throughout the study, the Critical Decision method was again useful. We applied it differently in this study, focusing more on situational awareness...Additional work with the Critical Decision method may provide the sharpest insights into the nature of expert-novice differences in real world settings...cwre contrasted to traditional decision--akinL ’ I iteca-turo. Training methods were recommended that would in- corporate the i:mplications of the

Cognitive synergy in groups and group-to-individual transfer of decision-making competencies

PubMed Central

Curşeu, Petru L.; Meslec, Nicoleta; Pluut, Helen; Lucas, Gerardus J. M.

2015-01-01

In a field study (148 participants organized in 38 groups) we tested the effect of group synergy and one's position in relation to the collaborative zone of proximal development (CZPD) on the change of individual decision-making competencies. We used two parallel sets of decision tasks reported in previous research to test rationality and we evaluated individual decision-making competencies in the pre-group and post-group conditions as well as group rationality (as an emergent group level phenomenon). We used multilevel modeling to analyze the data and the results showed that members of synergetic groups had a higher cognitive gain as compared to members of non-synergetic groups, while highly rational members (members above the CZPD) had lower cognitive gains compared to less rational group members (members situated below the CZPD). These insights extend the literature on group-to-individual transfer of learning and have important practical implications as they show that group dynamics influence the development of individual decision-making competencies. PMID:26441750

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

PubMed

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

2014-01-01

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

Cognitive synergy in groups and group-to-individual transfer of decision-making competencies.

PubMed

Curşeu, Petru L; Meslec, Nicoleta; Pluut, Helen; Lucas, Gerardus J M

2015-01-01

In a field study (148 participants organized in 38 groups) we tested the effect of group synergy and one's position in relation to the collaborative zone of proximal development (CZPD) on the change of individual decision-making competencies. We used two parallel sets of decision tasks reported in previous research to test rationality and we evaluated individual decision-making competencies in the pre-group and post-group conditions as well as group rationality (as an emergent group level phenomenon). We used multilevel modeling to analyze the data and the results showed that members of synergetic groups had a higher cognitive gain as compared to members of non-synergetic groups, while highly rational members (members above the CZPD) had lower cognitive gains compared to less rational group members (members situated below the CZPD). These insights extend the literature on group-to-individual transfer of learning and have important practical implications as they show that group dynamics influence the development of individual decision-making competencies.

Facilitating access to pre-processed research evidence in public health

PubMed Central

2010-01-01

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

Inhibition of Pre-Supplementary Motor Area by Continuous Theta Burst Stimulation Leads to More Cautious Decision-making and More Efficient Sensory Evidence Integration.

PubMed

Tosun, Tuğçe; Berkay, Dilara; Sack, Alexander T; Çakmak, Yusuf Ö; Balcı, Fuat

2017-08-01

Decisions are made based on the integration of available evidence. The noise in evidence accumulation leads to a particular speed-accuracy tradeoff in decision-making, which can be modulated and optimized by adaptive decision threshold setting. Given the effect of pre-SMA activity on striatal excitability, we hypothesized that the inhibition of pre-SMA would lead to higher decision thresholds and an increased accuracy bias. We used offline continuous theta burst stimulation to assess the effect of transient inhibition of the right pre-SMA on the decision processes in a free-response two-alternative forced-choice task within the drift diffusion model framework. Participants became more cautious and set higher decision thresholds following right pre-SMA inhibition compared with inhibition of the control site (vertex). Increased decision thresholds were accompanied by an accuracy bias with no effects on post-error choice behavior. Participants also exhibited higher drift rates as a result of pre-SMA inhibition compared with the vertex inhibition. These results, in line with the striatal theory of speed-accuracy tradeoff, provide evidence for the functional role of pre-SMA activity in decision threshold modulation. Our results also suggest that pre-SMA might be a part of the brain network associated with the sensory evidence integration.

The contribution of apathy and increased learning trials to risky decision-making in Parkinson's disease.

PubMed

Buelow, Melissa T; Frakey, Laura L; Grace, Janet; Friedman, Joseph H

2014-02-01

Impairments in executive functioning are commonly found in Parkinson's disease (PD); however, the research into risky decision making has been mixed. The present study sought to investigate three potential hypotheses: difficulty learning the task probabilities, levodopa equivalent dose (LED), and the presence of apathy. Twenty-four individuals with idiopathic PD and 13 healthy controls completed the Frontal Systems Behavior Scale to assess current apathy, the Iowa Gambling Task, and the Balloon Analog Risk Task (BART). Results indicated that individuals with PD selected more from Deck B, a disadvantageous deck. However, with an additional set of trials, participants with PD and apathy selected more from the most risky deck (Deck A). Apathy was not related to the BART, and LED was not related to either task. Results indicate that apathy is associated with decision-making in PD, and providing additional learning trials can improve decision-making in PD without apathy.

Processing of social and monetary rewards in the human striatum.

PubMed

Izuma, Keise; Saito, Daisuke N; Sadato, Norihiro

2008-04-24

Despite an increasing focus on the neural basis of human decision making in neuroscience, relatively little attention has been paid to decision making in social settings. Moreover, although human social decision making has been explored in a social psychology context, few neural explanations for the observed findings have been considered. To bridge this gap and improve models of human social decision making, we investigated whether acquiring a good reputation, which is an important incentive in human social behaviors, activates the same reward circuitry as monetary rewards. In total, 19 subjects participated in functional magnetic resonance imaging (fMRI) experiments involving monetary and social rewards. The acquisition of one's good reputation robustly activated reward-related brain areas, notably the striatum, and these overlapped with the areas activated by monetary rewards. Our findings support the idea of a "common neural currency" for rewards and represent an important first step toward a neural explanation for complex human social behaviors.

Scalable methodology for large scale building energy improvement: Relevance of calibration in model-based retrofit analysis

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

Heo, Yeonsook; Augenbroe, Godfried; Graziano, Diane

2015-05-01

The increasing interest in retrofitting of existing buildings is motivated by the need to make a major contribution to enhancing building energy efficiency and reducing energy consumption and CO2 emission by the built environment. This paper examines the relevance of calibration in model-based analysis to support decision-making for energy and carbon efficiency retrofits of individual buildings and portfolios of buildings. The authors formulate a set of real retrofit decision-making situations and evaluate the role of calibration by using a case study that compares predictions and decisions from an uncalibrated model with those of a calibrated model. The case study illustratesmore » both the mechanics and outcomes of a practical alternative to the expert- and time-intense application of dynamic energy simulation models for large-scale retrofit decision-making under uncertainty.« less

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

Shared decision making in Swedish community mental health services - an evaluation of three self-reporting instruments.

PubMed

Rosenberg, David; Schön, Ulla-Karin; Nyholm, Maria; Grim, Katarina; Svedberg, Petra

2017-04-01

Despite the potential impact of shared decision making on users satisfaction with care and quality in health care decisions, there is a lack of knowledge and skills regarding how to work with shared decision making among health care providers. The aim of this study was to evaluate the psychometric properties of three instruments that measure varied dimensions of shared decision making, based on self-reports by clients, in a Swedish community mental health context. The study sample consisted of 121 clients with experience of community mental health care, and involved in a wide range of decisions regarding both social support and treatment. The questionnaires were examined for face and content validity, internal consistency, test-retest reliability and construct validity. The instruments displayed good face and content validity, satisfactory internal consistency and a moderate to good level of stability in test-retest reliability with fair to moderate construct correlations, in a sample of clients with serious mental illness and experience of community mental health services in Sweden. The questionnaires are considered to be relevant to the decision making process, user-friendly and appropriate in a Swedish community mental health care context. They functioned well in settings where non-medical decisions, regarding social and support services, are the primary focus. The use of instruments that measure various dimensions of the self-reported experience of clients, can be a key factor in developing knowledge of how best to implement shared decision making in mental health services.

How Participatory Should Environmental Governance Be? Testing the Applicability of the Vroom-Yetton-Jago Model in Public Environmental Decision-Making

NASA Astrophysics Data System (ADS)

Lührs, Nikolas; Jager, Nicolas W.; Challies, Edward; Newig, Jens

2018-02-01

Public participation is potentially useful to improve public environmental decision-making and management processes. In corporate management, the Vroom-Yetton-Jago normative decision-making model has served as a tool to help managers choose appropriate degrees of subordinate participation for effective decision-making given varying decision-making contexts. But does the model recommend participatory mechanisms that would actually benefit environmental management? This study empirically tests the improved Vroom-Jago version of the model in the public environmental decision-making context. To this end, the key variables of the Vroom-Jago model are operationalized and adapted to a public environmental governance context. The model is tested using data from a meta-analysis of 241 published cases of public environmental decision-making, yielding three main sets of findings: (1) The Vroom-Jago model proves limited in its applicability to public environmental governance due to limited variance in its recommendations. We show that adjustments to key model equations make it more likely to produce meaningful recommendations. (2) We find that in most of the studied cases, public environmental managers (implicitly) employ levels of participation close to those that would have been recommended by the model. (3) An ANOVA revealed that such cases, which conform to model recommendations, generally perform better on stakeholder acceptance and environmental standards of outputs than those that diverge from the model. Public environmental management thus benefits from carefully selected and context-sensitive modes of participation.

How Participatory Should Environmental Governance Be? Testing the Applicability of the Vroom-Yetton-Jago Model in Public Environmental Decision-Making.

PubMed

Lührs, Nikolas; Jager, Nicolas W; Challies, Edward; Newig, Jens

2018-02-01

Public participation is potentially useful to improve public environmental decision-making and management processes. In corporate management, the Vroom-Yetton-Jago normative decision-making model has served as a tool to help managers choose appropriate degrees of subordinate participation for effective decision-making given varying decision-making contexts. But does the model recommend participatory mechanisms that would actually benefit environmental management? This study empirically tests the improved Vroom-Jago version of the model in the public environmental decision-making context. To this end, the key variables of the Vroom-Jago model are operationalized and adapted to a public environmental governance context. The model is tested using data from a meta-analysis of 241 published cases of public environmental decision-making, yielding three main sets of findings: (1) The Vroom-Jago model proves limited in its applicability to public environmental governance due to limited variance in its recommendations. We show that adjustments to key model equations make it more likely to produce meaningful recommendations. (2) We find that in most of the studied cases, public environmental managers (implicitly) employ levels of participation close to those that would have been recommended by the model. (3) An ANOVA revealed that such cases, which conform to model recommendations, generally perform better on stakeholder acceptance and environmental standards of outputs than those that diverge from the model. Public environmental management thus benefits from carefully selected and context-sensitive modes of participation.

Evolutionary Algorithm Based Automated Reverse Engineering and Defect Discovery

DTIC Science & Technology

2007-09-21

a previous application of a GP as a data mining function to evolve fuzzy decision trees symbolically [3-5], the terminal set consisted of fuzzy...of input and output information is required. In the case of fuzzy decision trees, the database represented a collection of scenarios about which the...fuzzy decision tree to be evolved would make decisions . The database also had entries created by experts representing decisions about the scenarios

A Z-number-based decision making procedure with ranking fuzzy numbers method

NASA Astrophysics Data System (ADS)

Mohamad, Daud; Shaharani, Saidatull Akma; Kamis, Nor Hanimah

2014-12-01

The theory of fuzzy set has been in the limelight of various applications in decision making problems due to its usefulness in portraying human perception and subjectivity. Generally, the evaluation in the decision making process is represented in the form of linguistic terms and the calculation is performed using fuzzy numbers. In 2011, Zadeh has extended this concept by presenting the idea of Z-number, a 2-tuple fuzzy numbers that describes the restriction and the reliability of the evaluation. The element of reliability in the evaluation is essential as it will affect the final result. Since this concept can still be considered as new, available methods that incorporate reliability for solving decision making problems is still scarce. In this paper, a decision making procedure based on Z-numbers is proposed. Due to the limitation of its basic properties, Z-numbers will be first transformed to fuzzy numbers for simpler calculations. A method of ranking fuzzy number is later used to prioritize the alternatives. A risk analysis problem is presented to illustrate the effectiveness of this proposed procedure.

Priority setting: what constitutes success? A conceptual framework for successful priority setting.

PubMed

Sibbald, Shannon L; Singer, Peter A; Upshur, Ross; Martin, Douglas K

2009-03-05

The sustainability of healthcare systems worldwide is threatened by a growing demand for services and expensive innovative technologies. Decision makers struggle in this environment to set priorities appropriately, particularly because they lack consensus about which values should guide their decisions. One way to approach this problem is to determine what all relevant stakeholders understand successful priority setting to mean. The goal of this research was to develop a conceptual framework for successful priority setting. Three separate empirical studies were completed using qualitative data collection methods (one-on-one interviews with healthcare decision makers from across Canada; focus groups with representation of patients, caregivers and policy makers; and Delphi study including scholars and decision makers from five countries). This paper synthesizes the findings from three studies into a framework of ten separate but interconnected elements germane to successful priority setting: stakeholder understanding, shifted priorities/reallocation of resources, decision making quality, stakeholder acceptance and satisfaction, positive externalities, stakeholder engagement, use of explicit process, information management, consideration of values and context, and revision or appeals mechanism. The ten elements specify both quantitative and qualitative dimensions of priority setting and relate to both process and outcome components. To our knowledge, this is the first framework that describes successful priority setting. The ten elements identified in this research provide guidance for decision makers and a common language to discuss priority setting success and work toward improving priority setting efforts.

Shared decision-making and interprofessional collaboration in mental healthcare: a qualitative study exploring perceptions of barriers and facilitators.

PubMed

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

2013-09-01

Shared decision-making and interprofessional collaboration are important approaches to achieving consumer-centered care. The concept of shared decision-making has been expanded recently to include the interprofessional healthcare team. This study explored healthcare providers' perceptions of barriers and facilitators to both shared decision-making and interprofessional collaboration in mental healthcare. Semi-structured interviews were conducted with 31 healthcare providers, including medical practitioners (psychiatrists, general practitioners), pharmacists, nurses, occupational therapists, psychologists and social workers. Healthcare providers identified several factors as barriers to, and facilitators of shared decision-making that could be categorized into three major themes: factors associated with mental health consumers, factors associated with healthcare providers and factors associated with healthcare service delivery. Consumers' lack of competence to participate was frequently perceived by mental health specialty providers to be a primary barrier to shared decision-making, while information provision on illness and treatment to consumers was cited by healthcare providers from all professions to be an important facilitator of shared decision-making. Whilst healthcare providers perceived interprofessional collaboration to be influenced by healthcare provider, environmental and systemic factors, emphasis of the factors differed among healthcare providers. To facilitate interprofessional collaboration, mental health specialty providers emphasized the importance of improving mental health expertise among general practitioners and community pharmacists, whereas general health providers were of the opinion that information sharing between providers and healthcare settings was the key. The findings of this study suggest that changes may be necessary at several levels (i.e. consumer, provider and environment) to implement effective shared decision-making and interprofessional collaboration in mental healthcare.

Attitudes and Decision Making Related to Pregnancy Among Young Women with Cystic Fibrosis.

PubMed

Kazmerski, Traci M; Gmelin, Theresa; Slocum, Breonna; Borrero, Sonya; Miller, Elizabeth

2017-04-01

Introduction The number of female patients with CF able to consider pregnancy has increased with improved therapies. This study explored attitudes and decision making regarding pregnancy among young women with CF. Methods Twenty-two women with CF ages 18-30 years completed semi-structured, in-person interviews exploring experiences with preconception counseling and reproductive care in the CF setting. Interviews were audio-recorded, transcribed, and coded using a thematic analysis approach. Results Participants indicated CF is a major factor in pregnancy decision making. Although women acknowledged that CF influences attitudes toward pregnancy, many expressed confusion about how CF can affect fertility/pregnancy. Many perceived disapproval from CF providers regarding pregnancy and were dissatisfied with reproductive care in the CF setting. Discussion Young female patients with CF reported poor understanding of the effect of CF on fertility and pregnancy and limited preconception counseling in CF care. Improvements in female sexual and reproductive health care in CF are warranted.

Do educational interventions improve nurses' clinical decision making and judgement? A systematic review.

PubMed

Thompson, Carl; Stapley, Sally

2011-07-01

Despite the growing popularity of decision making in nursing curricula, the effectiveness of educational interventions to improve nursing judgement and decision making is unknown. We sought to synthesise and summarise the comparative evidence for educational interventions to improve nursing judgements and clinical decisions. A systematic review. Electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL and PsycINFO, Social Sciences Citation Index, OpenSIGLE conference proceedings and hand searching nursing journals. Studies published since 1960, reporting any educational intervention that aimed to improve nurses' clinical judgements or decision making were included. Studies were assessed for relevance and quality. Data extracted included study design; educational setting; the nature of participants; whether the study was concerned with the clinical application of skills or the application of theory; the type of decision targeted by the intervention (e.g. diagnostic reasoning) and whether the evaluation of the intervention focused on efficacy or effectiveness. A narrative approach to study synthesis was used due to heterogeneity in interventions, study samples, outcomes and settings and incomplete reporting of effect sizes. From 5262 initial citations 24 studies were included in the review. A variety of educational approaches were reported. Study quality and content reporting was generally poor. Pedagogical theories were widely used but use of decision theory (with the exception of subjective expected utility theory implicit in decision analysis) was rare. The effectiveness and efficacy of interventions was mixed. Educational interventions to improve nurses' judgements and decisions are complex and the evidence from comparative studies does little to reduce the uncertainty about 'what works'. Nurse educators need to pay attention to decision, as well as pedagogical, theory in the design of interventions. Study design and reporting requires improvement to maximise the information contained in reports of educational interventions. Copyright © 2011 Elsevier Ltd. All rights reserved.

Life cycle impact assessment weights to support environmentally preferable purchasing in the United States.

PubMed

Gloria, Thomas P; Lippiatt, Barbara C; Cooper, Jennifer

2007-11-01

LCA is a quantitative method for understanding the environmental impacts of a product, yet all product purchasing decisions are ultimately subjective. Weights are the nexus between the quantitative results of LCA and the values-based, subjective choices of decision makers. In May 2007, NIST introduced a new optional weight set in Version 4.0 of the BEES software. Three key points about this new optional weight set are the basis for discussion in this paper: The new weight set was created specifically in the context of BEES. It is intended to support a practical method to assist environmentally preferable purchasing in the United States based on LCIA results. This is in contrast to the weight sets currently in BEES, which are based on generalist perspectives. The new weight set was created by a multi-stakeholder panel via the AHP method, and is a synthesis of panelists' perspectives on the relative importance of each environmental impact category in BEES. The weight set draws on each panelist's personal and professional understanding of, and value attributed to, each impact category. While the synthesized weight set may not equally satisfy each panelist's view of impact importance, it does reflect contemporary values in applying LCAto real world decisions, and represents one approach others can learn from in producing weight sets. The new weight set offers BEES users an additional option for synthesizing and comparing the environmental performance of building products and making purchasing decisions. In so doing, it strengthens the decision-making process, which is important when making product comparisons in the public domain. The Weight Set: Across all panelists and with explicit consideration of all time horizons, anthropogenic contributions to global warming, weighted at 29%, was judged most important, yet not so important that decisions can be made solely on the basis of this impact. A strong tail of other concerns include fossil fuel depletion (10%), criteria air pollutants (9%), water intake/use (8%), human health cancerous effects (8%), ecological toxicity (7%), eutrophication of water bodies (6%), land use (6%), and human health noncancerous effects (5%). Also of interest are the identified impact areas of concern assigned the lowest weights: smog formation (4%), indoor air quality (3%), acidification (3%), and ozone depletion (2%). Their low weights may indicate that there is not as much immediate concern or that the remedial actions associated with the impact for the most part are underway.

Fuzzy set methods for object recognition in space applications

NASA Technical Reports Server (NTRS)

Keller, James M.

1991-01-01

Progress on the following tasks is reported: (1) fuzzy set-based decision making methodologies; (2) feature calculation; (3) clustering for curve and surface fitting; and (4) acquisition of images. The general structure for networks based on fuzzy set connectives which are being used for information fusion and decision making in space applications is described. The structure and training techniques for such networks consisting of generalized means and gamma-operators are described. The use of other hybrid operators in multicriteria decision making is currently being examined. Numerous classical features on image regions such as gray level statistics, edge and curve primitives, texture measures from cooccurrance matrix, and size and shape parameters were implemented. Several fractal geometric features which may have a considerable impact on characterizing cluttered background, such as clouds, dense star patterns, or some planetary surfaces, were used. A new approach to a fuzzy C-shell algorithm is addressed. NASA personnel are in the process of acquiring suitable simulation data and hopefully videotaped actual shuttle imagery. Photographs have been digitized to use in the algorithms. Also, a model of the shuttle was assembled and a mechanism to orient this model in 3-D to digitize for experiments on pose estimation is being constructed.

New care home admission following hospitalisation: How do older people, families and professionals make decisions about discharge destination? A case study narrative analysis.

PubMed

Rhynas, Sarah J; Garrido, Azucena Garcia; Burton, Jennifer K; Logan, Gemma; MacArthur, Juliet

2018-03-24

To gain an in-depth understanding of the decision-making processes involved in the discharge of older people admitted to hospital from home and discharged to a care home, as described in the case records. The decision for an older person to move into a care home is significant and life-changing. The discharge planning literature for older people highlights the integral role of nurses in supporting and facilitating effective discharge. However, little research has been undertaken to explore the experiences of those discharged from hospital to a care home or the processes involved in decision-making. A purposive sample of 10 cases was selected from a cohort of 100 individuals admitted to hospital from home and discharged to a care home. Cases were selected to highlight important personal, relational and structural factors thought to affect the decision-making process. Narrative case studies were created and were thematically analysed to explore the perspectives of each stakeholder group and the conceptualisations of risk which influenced decision-making. Care home discharge decision-making is a complex process involving stakeholders with a range of expertise, experience and perspectives. Decisions take time and considerable involvement of families and the multidisciplinary team. There were significant deficits in documentation which limit the understanding of the process and the patient's voice is often absent from case records. The experiences of older people, families and multidisciplinary team members making care home decisions in the hospital setting require further exploration to identify and define best practice. Nurses have a critical role in the involvement of older people making discharge decisions in hospital, improved documentation of the patient's voice is essential. Health and social care systems must allow older people time to make significant decisions about their living arrangements, adapting to changing medical and social needs. © 2018 John Wiley & Sons Ltd.

Using Sanctioned Athletics Programs to Understand Stakeholders' Perceived Influence in Decisions at Major Research Universities

ERIC Educational Resources Information Center

Hirko, Scott

2011-01-01

This study set out to learn more about the perceived influence of stakeholders on academic decisions affecting intercollegiate athletics, with the intent that such knowledge would help provide useful implications for future leaders making decisions that impact unique student populations. As an area of research, the semi-autonomous unit of…

Logical-Rule Models of Classification Response Times: A Synthesis of Mental-Architecture, Random-Walk, and Decision-Bound Approaches

ERIC Educational Resources Information Center

Fific, Mario; Little, Daniel R.; Nosofsky, Robert M.

2010-01-01

We formalize and provide tests of a set of logical-rule models for predicting perceptual classification response times (RTs) and choice probabilities. The models are developed by synthesizing mental-architecture, random-walk, and decision-bound approaches. According to the models, people make independent decisions about the locations of stimuli…

Rural and remote young people's health career decision making within a health workforce development program: a qualitative exploration.

PubMed

Kumar, Koshila; Jones, Debra; Naden, Kathryn; Roberts, Chris

2015-01-01

One strategy aimed at resolving ongoing health workforce shortages in rural and remote settings has been to implement workforce development initiatives involving the early activation and development of health career aspirations and intentions among young people in these settings. This strategy aligns with the considerable evidence showing that rural background is a strong predictor of rural practice intentions and preferences. The Broken Hill Regional Health Career Academy Program (BHRHCAP) is an initiative aimed at addressing local health workforce challenges by helping young people in the region develop and further their health career aspirations and goals. This article reports the factors impacting on rural and remote youths' health career decision-making within the context of a health workforce development program. Data were collected using interviews and focus groups with a range of stakeholders involved in the BHRHCAP including local secondary school students, secondary school teachers, career advisors, school principals, parents, and pre-graduate health students undertaking a clinical placement in Broken Hill, and local clinicians. Data interpretation was informed by the theoretical constructs articulated within socio cognitive career theory. Young people's career decision-making in the context of a local health workforce development program was influenced by a range of personal, contextual and experiential factors. These included personal factors related to young people's career goals and motivations and their confidence to engage in career decision-making, contextual factors related to BHRHCAP program design and structure as well as the visibility and accessibility of health career pathways in a rural setting, and experiential factors related to the interaction and engagement between young people and role models or influential others in the health and education sectors. This study provided theoretical insight into the broader range of interrelating and complex personal, contextual and experiential factors impacting on rural and remote youths' career decision-making within a health workforce development initiative.

Shared decision making in endocrinology: present and future directions.

PubMed

Rodriguez-Gutierrez, Rene; Gionfriddo, Michael R; Ospina, Naykky Singh; Maraka, Spyridoula; Tamhane, Shrikant; Montori, Victor M; Brito, Juan P

2016-08-01

In medicine and endocrinology, there are few clinical circumstances in which clinicians can accurately predict what is best for their patients. As a result, patients and clinicians frequently have to make decisions about which there is uncertainty. Uncertainty results from limitations in the research evidence, unclear patient preferences, or an inability to predict how treatments will fit into patients' daily lives. The work that patients and clinicians do together to address the patient's situation and engage in a deliberative dialogue about reasonable treatment options is often called shared decision making. Decision aids are evidence-based tools that facilitate this process. Shared decision making is a patient-centred approach in which clinicians share information about the benefits, harms, and burden of different reasonable diagnostic and treatment options, and patients explain what matters to them in view of their particular values, preferences, and personal context. Beyond the ethical argument in support of this approach, decision aids have been shown to improve patients' knowledge about the available options, accuracy of risk estimates, and decisional comfort. Decision aids also promote patient participation in the decision-making process. Despite accumulating evidence from clinical trials, policy support, and expert recommendations in endocrinology practice guidelines, shared decision making is still not routinely implemented in endocrine practice. Additional work is needed to enrich the number of available tools and to implement them in practice workflows. Also, although the evidence from randomised controlled trials favours the use of this shared decision making in other settings, populations, and illnesses, the effect of this approach has been studied in a few endocrine disorders. Future pragmatic trials are needed to explore the effect and feasibility of shared decision making implementation into routine endocrinology and primary care practice. With the available evidence, however, endocrinologists can now start to practice shared decision making, partner with their patients, and use their expertise to formulate treatment plans that reflect patient preferences and are more likely to fit into the context of patients' lives. In this Personal View, we describe shared decision making, the evidence behind the approach, and why and how both endocrinologists and their patients could benefit from this approach. Copyright © 2016 Elsevier Ltd. All rights reserved.

Decision making about pre-medication to children.

PubMed

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

2008-11-01

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

Risky decision making in Attention-Deficit/Hyperactivity Disorder: A meta-regression analysis.

PubMed

Dekkers, Tycho J; Popma, Arne; Agelink van Rentergem, Joost A; Bexkens, Anika; Huizenga, Hilde M

2016-04-01

ADHD has been associated with various forms of risky real life decision making, for example risky driving, unsafe sex and substance abuse. However, results from laboratory studies on decision making deficits in ADHD have been inconsistent, probably because of between study differences. We therefore performed a meta-regression analysis in which 37 studies (n ADHD=1175; n Control=1222) were included, containing 52 effect sizes. The overall analysis yielded a small to medium effect size (standardized mean difference=.36, p<.001, 95% CI [.22, .51]), indicating that groups with ADHD showed more risky decision making than control groups. There was a trend for a moderating influence of co-morbid Disruptive Behavior Disorders (DBD): studies including more participants with co-morbid DBD had larger effect sizes. No moderating influence of co-morbid internalizing disorders, age or task explicitness was found. These results indicate that ADHD is related to increased risky decision making in laboratory settings, which tended to be more pronounced if ADHD is accompanied by DBD. We therefore argue that risky decision making should have a more prominent role in research on the neuropsychological and -biological mechanisms of ADHD, which can be useful in ADHD assessment and intervention. Copyright © 2016 Elsevier Ltd. All rights reserved.

Impaired cognition and decision-making in bipolar depression but no 'affective bias' evident.

PubMed

Rubinsztein, J S; Michael, A; Underwood, B R; Tempest, M; Sahakian, B J

2006-05-01

Depression is usually the predominant affective state in bipolar disorder. There are few studies, with discrepant views, examining the extent of cognitive impairment in patients with bipolar depression. To our knowledge, there are no previous studies examining decision-making ability or whether there is an affective attentional bias in bipolar depression. We ascertained 24 depressed bipolar I patients from acute psychiatric hospital wards and out-patient clinics and 26 age- and IQ-matched healthy controls. Using computerized tests we evaluated their performance on 'neutral' (non-emotional) cognitive tasks (i.e. memory, attention and executive function) and on novel tasks of emotional cognition (i.e. the decision-making task and the affective go/no-go task). Accuracy measures were significantly impaired on tests of visual and spatial recognition and attentional set-shifting in bipolar depression compared with age- and IQ-matched controls. The quality of decision-making was also significantly impaired in the patients. A mood-congruent attentional bias for 'sad' targets was not evident on the affective go/no-go task. We found widespread evidence of significant cognitive impairment and impaired quality of decision-making in symptomatically severe depressed bipolar patients. This cognitive impairment may contribute to difficulties with daily living, decision-making and the ability to engage and comply with psychological and drug treatments.

The Evolution of an Interprofessional Shared Decision-Making Research Program: Reflective Case Study of an Emerging Paradigm

PubMed Central

Menear, Matthew; Stacey, Dawn; Brière, Nathalie; Légaré, France

2016-01-01

Introduction: Healthcare research increasingly focuses on interprofessional collaboration and on shared decision making, but knowledge gaps remain about effective strategies for implementing interprofessional collaboration and shared decision-making together in clinical practice. We used Kuhn’s theory of scientific revolutions to reflect on how an integrated interprofessional shared decision-making approach was developed and implemented over time. Methods: In 2007, an interdisciplinary team initiated a new research program to promote the implementation of an interprofessional shared decision-making approach in clinical settings. For this reflective case study, two new team members analyzed the team’s four projects, six research publications, one unpublished and two published protocols and organized them into recognizable phases according to Kuhn’s theory. Results: The merging of two young disciplines led to challenges characteristic of emerging paradigms. Implementation of interprofessional shared-decision making was hindered by a lack of conceptual clarity, a dearth of theories and models, little methodological guidance, and insufficient evaluation instruments. The team developed a new model, identified new tools, and engaged knowledge users in a theory-based approach to implementation. However, several unresolved challenges remain. Discussion: This reflective case study sheds light on the evolution of interdisciplinary team science. It offers new approaches to implementing emerging knowledge in the clinical context. PMID:28435417

Why orphan drug coverage reimbursement decision-making needs patient and public involvement.

PubMed

Douglas, Conor M W; Wilcox, Elizabeth; Burgess, Michael; Lynd, Larry D

2015-05-01

Recently there has been an increase in the active involvement of publics and patients in healthcare and research, which is extending their roles beyond the passive recipients of medicines. However, there has been noticeably less work engaging them into decision-making for healthcare rationing exercises, priority setting, health technology assessment, and coverage decision-making. This is particularly evident in reimbursement decision-making for 'orphan drugs' or drugs for rare diseases. Medicinal products for rare disease offer particular challenges in coverage decision-making because they often lack the 'evidence of efficacy' profiles of common drugs that have been trialed on larger populations. Furthermore, many of these drugs are priced in the high range, and with limited health care budgets the prospective opportunity costs of funding them means that those resources cannot be allocated elsewhere. Here we outline why decision-making for drugs for rare diseases could benefit from increased levels of publics and patients involvement, suggest some possible forms that involvement could take, and advocate for empirical experimentation in this area to evaluate the effects of such involvement. Focus is given to the Canadian context in which we are based; however, potentialities and challenges relating to involvement in this area are likely to be similar elsewhere. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

The Evolution of an Interprofessional Shared Decision-Making Research Program: Reflective Case Study of an Emerging Paradigm.

PubMed

Dogba, Maman Joyce; Menear, Matthew; Stacey, Dawn; Brière, Nathalie; Légaré, France

2016-07-19

Healthcare research increasingly focuses on interprofessional collaboration and on shared decision making, but knowledge gaps remain about effective strategies for implementing interprofessional collaboration and shared decision-making together in clinical practice. We used Kuhn's theory of scientific revolutions to reflect on how an integrated interprofessional shared decision-making approach was developed and implemented over time. In 2007, an interdisciplinary team initiated a new research program to promote the implementation of an interprofessional shared decision-making approach in clinical settings. For this reflective case study, two new team members analyzed the team's four projects, six research publications, one unpublished and two published protocols and organized them into recognizable phases according to Kuhn's theory. The merging of two young disciplines led to challenges characteristic of emerging paradigms. Implementation of interprofessional shared-decision making was hindered by a lack of conceptual clarity, a dearth of theories and models, little methodological guidance, and insufficient evaluation instruments. The team developed a new model, identified new tools, and engaged knowledge users in a theory-based approach to implementation. However, several unresolved challenges remain. This reflective case study sheds light on the evolution of interdisciplinary team science. It offers new approaches to implementing emerging knowledge in the clinical context.

Rough Evaluation Structure: Application of Rough Set Theory to Generate Simple Rules for Inconsistent Preference Relation

NASA Astrophysics Data System (ADS)

Gehrmann, Andreas; Nagai, Yoshimitsu; Yoshida, Osamu; Ishizu, Syohei

Since management decision-making becomes complex and preferences of the decision-maker frequently becomes inconsistent, multi-attribute decision-making problems were studied. To represent inconsistent preference relation, the concept of evaluation structure was introduced. We can generate simple rules to represent inconsistent preference relation by the evaluation structures. Further rough set theory for the preference relation was studied and the concept of approximation was introduced. One of our main aims of this paper is to introduce a concept of rough evaluation structure for representing inconsistent preference relation. We apply rough set theory to the evaluation structure, and develop a method for generating simple rules for inconsistent preference relations. In this paper, we introduce concepts of totally ordered information system, similarity class of preference relation, upper and lower approximation of preference relations. We also show the properties of rough evaluation structure and provide a simple example. As an application of rough evaluation structure, we analyze questionnaire survey of customer preferences about audio players.

Cynefin as Reference Framework to Facilitate Insight and Decision-Making in Complex Contexts of Biomedical Research.

PubMed

Kempermann, Gerd

2017-01-01

The Cynefin scheme is a concept of knowledge management, originally devised to support decision making in management, but more generally applicable to situations, in which complexity challenges the quality of insight, prediction, and decision. Despite the fact that life itself, and especially the brain and its diseases, are complex to the extent that complexity could be considered their cardinal feature, complex problems in biomedicine are often treated as if they were actually not more than the complicated sum of solvable sub-problems. Because of the emergent properties of complex contexts this is not correct. With a set of clear criteria Cynefin helps to set apart complex problems from "simple/obvious," "complicated," "chaotic," and "disordered" contexts in order to avoid misinterpreting the relevant causality structures. The distinction comes with the insight, which specific kind of knowledge is possible in each of these categories and what are the consequences for resulting decisions and actions. From student's theses over the publication and grant writing process to research politics, misinterpretation of complexity can have problematic or even dangerous consequences, especially in clinical contexts. Conceptualization of problems within a straightforward reference language like Cynefin improves clarity and stringency within projects and facilitates communication and decision-making about them.

Junior doctors' extended work hours and the effects on their performance: the Irish case.

PubMed

Flinn, Fiona; Armstrong, Claire

2011-04-01

To explore the relationship between junior doctors' long working hours and their performance in a variety of cognitive and clinical decision-making tests. Also, to consider the implications of performance decrements in such tests for healthcare quality. A within-subject design was used to eliminate variation related to individual differences. Each participant was tested twice, once post call and once rested. At each session, participants were tested on cognitive functioning and clinical decision-making. The study was based on six acute Irish hospitals during 2008. Thirty junior hospital doctors, ages ranged from 23 to 30 years; of them, 17 of the participants were female and 13 were male. Measures Cognitive functioning was measured by the MindStreams Global Assessment Battery (NeuroTrax Corp., NY, USA). This is a set of computerized tests, designed for use in medical settings, that assesses performance in memory, executive function, visual spatial perception, verbal function, attention, information processing speed and motor skills. Clinical decision-making was tested using Key Features Problems. Each Key Features Problem consists of a case scenario and then three to four questions about this scenario. In an effort to make it more realistic, the speed with which participants completed the three problems was also recorded. Participants' global cognitive scores, attention, information processing speed and motor skills were significantly worse post call than when rested. They also took longer to complete clinical decision-making questions in the post-call condition and obtained lower scores than when rested. There are significant negative changes in doctors' cognitive functioning and clinical decision-making performance that appear to be attributable to long working hours. This therefore raises the important question of whether working long hours decreases healthcare quality and compromises patient safety.

The Mental Capacity Act: 'Best interests'-a review of the literature.

PubMed

Marshall, Helen; Sprung, Sally

2017-08-02

The Mental Capacity Act (MCA) is statutory legislation introduced in 2007 in order to provide a consistent, robust framework with the aim to protect and empower people to make decisions themselves. However, an assessment as per the MCA may demonstrate that a person is lacking mental capacity and therefore unable to make an autonomous decision at the time it needs to be made. In this case, a 'best interests' decision may be made on their behalf, ensuring their wishes and beliefs are at the centre of the decision-making process. When making a best interests decision, a health practitioner must follow the guidance as set out in the MCA legislation to ensure fair and consistent approaches to safeguard and provide assurance that the outcome is truly the best decision for the individual. This review of the literature supports the findings of a 2014 post-legislative review by the House of Lords, which concluded the principles of the MCA are not sufficiently embedded into the practice of all health practitioners, due to a lack of knowledge, awareness and understanding. However, the evidence base also appreciates making a decision on behalf of another person can be a stressful, complex and intricate process when further support may be required from the wider multidisciplinary team, including potentially seeking legal advice.

Interprofessional practice and decision support: an organizational framework applied to a mental health setting.

PubMed

Campbell, Susan; Stowe, Karen; Ozanne, Elissa M

2011-11-01

Decision support as a means to assist people in making healthcare decisions has been discussed extensively in the medical literature. However, the potential for use of decision support and decision aids with people with psychiatric disabilities in order to promote recovery has only begun to be researched and discussed in the mental health literature. Organizational factors that foster interprofessional practice within a decision support environment focused on mental health issues are examined in this paper.

Effect of counseling quality on anxiety, grief, and coping after second-trimester abortion for pregnancy complications.

PubMed

Kerns, Jennifer L; Mengesha, Biftu; McNamara, Blair C; Cassidy, Arianna; Pearlson, Geffan; Kuppermann, Miriam

2018-06-01

We sought to explore the relationship between counseling quality, measured by shared decision making and decision satisfaction, and psychological outcomes (anxiety, grief, and posttraumatic stress) after second-trimester abortion for pregnancy complications. We conducted a cross-sectional study of women who underwent second-trimester abortion for complications. We recruited participants from Facebook and online support groups and surveyed them about counseling experiences and psychosocial issues. We used multivariate linear regression to evaluate relationships between counseling quality and psychological outcomes. We analyzed data from 145 respondents. Shared decision making and decision satisfaction scores were positively and strongly correlated in bivariate analysis (r=0.7, p<.0001), as were posttraumatic stress and grief scores (r=0.7, p<.0001). In the adjusted analysis, higher decision satisfaction was associated with lower grief and posttraumatic stress scores (p=.02 and p=.01, respectively) and higher shared decision making was associated with lower posttraumatic stress scores (p=.01). Decision satisfaction and shared decision making have a positive effect on psychological outcomes after second-trimester abortion for pregnancy complications. Counseling quality may be especially important in this setting given the sensitive nature of decisions regarding pregnancy termination for complications. These results highlight the importance of patient-centered counseling for women seeking pregnancy termination. Copyright © 2018. Published by Elsevier Inc.

Themes in the literature related to cardiovascular disease risk reduction.

PubMed

Cohen, Shannon Munro; Kataoka-Yahiro, Merle

2009-01-01

This article aimed to identify themes in the literature related to patient-healthcare provider beliefs, barriers to adherence, and interventions pertaining to cardiovascular disease risk reduction. Twenty quantitative and qualitative primary research studies including 2 meta-analyses published between 1995 and 2008 were analyzed for themes and practice implications to synthesize existing research on cardiovascular disease risk reduction. Databases searched included EBSCO, CINAHL, MEDLINE, ScienceDirect, HealthSource, and PsychLit using the search terms patient- provider adherence, adherence and shared decision making, adherence and decision support, patient- provider goal setting, and cardiovascular disease risk reduction. The emergent themes found in this literature review included (1) complex medication regimens; (2) risk perception, quality of life, and competing priorities; (3) motivation for change; (4) provider clinical inertia; and (5) goal setting, feedback, and reminders. Studies reporting the highest rates of adherence to cardiovascular disease risk reduction recommendations incorporated patient-provider goal setting and decision support, self-management techniques, and personalized printed communication. Goal setting in cardiovascular disease risk reduction is a relatively unexplored area and is an important component of shared decision making and adherence to cardiovascular disease health recommendations. The following review will address the 5 themes identified in more detail and provide a basis for improved clinical practice.

Virtual Beach Manager Toolset

EPA Science Inventory

The Virtual Beach Manager Toolset (VB) is a set of decision support software tools 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 tools are being developed under the umbrella of...

Decision making in high-velocity environments: implications for healthcare.

PubMed

Stepanovich, P L; Uhrig, J D

1999-01-01

Healthcare can be considered a high-velocity environment and, as such, can benefit from research conducted in other industries regarding strategic decision making. Strategic planning is not only relevant to firms in high-velocity environments, but is also important for high performance and survival. Specifically, decision-making speed seems to be instrumental in differentiating between high and low performers; fast decision makers outperform slow decision makers. This article outlines the differences between fast and slow decision makers, identifies five paralyses that can slow decision making in healthcare, and outlines the role of a planning department in circumventing these paralyses. Executives can use the proposed planning structure to improve both the speed and quality of strategic decisions. The structure uses planning facilitators to avoid the following five paralyses: 1. Analysis. Decision makers can no longer afford the luxury of lengthy, detailed analysis but must develop real-time systems that provide appropriate, timely information. 2. Alternatives. Many alternatives (beyond the traditional two or three) need to be considered and the alternatives must be evaluated simultaneously. 3. Group Think. Decision makers must avoid limited mind-sets and autocratic leadership styles by seeking out independent, knowledgeable counselors. 4. Process. Decision makers need to resolve conflicts through "consensus with qualification," as opposed to waiting for everyone to come on board. 5. Separation. Successful implementation requires a structured process that cuts across disciplines and levels.

Physician consideration of patients' out-of-pocket costs in making common clinical decisions.

PubMed

Pham, Hoangmai H; Alexander, G Caleb; O'Malley, Ann S

2007-04-09

Patients face growing cost-sharing through higher deductibles and other out-of-pocket (OP) expenses, with uncertain effects on clinical decision making. We analyzed data on 6628 respondents to the nationally representative 2004-2005 Community Tracking Study Physician Survey to examine how frequently physicians report considering their insured patients' OP expenses when prescribing drugs, selecting diagnostic tests, and choosing inpatient vs outpatient care settings. Responses were dichotomized as always/usually vs sometimes/rarely/never. In separate multivariate logistic regressions, we examined associations between physicians' reported frequency of considering OP costs for each type of decision and characteristics of individual physicians and their practices. Seventy-eight percent of physicians reported routinely considering OP costs when prescribing drugs, while 51.2% reported doing so when selecting care settings, and 40.2% when selecting diagnostic tests. In adjusted analyses, primary care physicians were more likely than medical specialists to consider patients' OP costs in choosing prescription drugs (85.3% vs 74.5%) (P<.001), care settings (53.9% vs 43.1%) (P<.001), and diagnostic tests (46.3% vs 29.9%) (P<.001). Physicians working in large groups or health maintenance organizations were more likely to consider OP costs in prescribing generic drugs (P<.001 for comparisons with solo and 2-person practices), but those in solo or 2-person practices were more likely to do so in choosing tests and care settings (P<.05 for all comparisons with other practice types). Physicians providing at least 10 hours of charity care a month were more likely than those not providing any to consider OP costs in both diagnostic testing (40.7% vs 35.8%) (P<.001) and care setting decisions (51.4% vs 47.6%) (P<.005). Cost-sharing arrangements targeting patients are likely to have limited effects in safely reducing health care spending because physicians do not routinely consider patients' OP costs when making decisions regarding more expensive medical services.

Use of the recognition heuristic depends on the domain's recognition validity, not on the recognition validity of selected sets of objects.

PubMed

Pohl, Rüdiger F; Michalkiewicz, Martha; Erdfelder, Edgar; Hilbig, Benjamin E

2017-07-01

According to the recognition-heuristic theory, decision makers solve paired comparisons in which one object is recognized and the other not by recognition alone, inferring that recognized objects have higher criterion values than unrecognized ones. However, success-and thus usefulness-of this heuristic depends on the validity of recognition as a cue, and adaptive decision making, in turn, requires that decision makers are sensitive to it. To this end, decision makers could base their evaluation of the recognition validity either on the selected set of objects (the set's recognition validity), or on the underlying domain from which the objects were drawn (the domain's recognition validity). In two experiments, we manipulated the recognition validity both in the selected set of objects and between domains from which the sets were drawn. The results clearly show that use of the recognition heuristic depends on the domain's recognition validity, not on the set's recognition validity. In other words, participants treat all sets as roughly representative of the underlying domain and adjust their decision strategy adaptively (only) with respect to the more general environment rather than the specific items they are faced with.

Introduction of new technologies and decision making processes: a framework to adapt a Local Health Technology Decision Support Program for other local settings.

PubMed

Poulin, Paule; Austen, Lea; Scott, Catherine M; Poulin, Michelle; Gall, Nadine; Seidel, Judy; Lafrenière, René

2013-01-01

Introducing new health technologies, including medical devices, into a local setting in a safe, effective, and transparent manner is a complex process, involving many disciplines and players within an organization. Decision making should be systematic, consistent, and transparent. It should involve translating and integrating scientific evidence, such as health technology assessment (HTA) reports, with context-sensitive evidence to develop recommendations on whether and under what conditions a new technology will be introduced. However, the development of a program to support such decision making can require considerable time and resources. An alternative is to adapt a preexisting program to the new setting. We describe a framework for adapting the Local HTA Decision Support Program, originally developed by the Department of Surgery and Surgical Services (Calgary, AB, Canada), for use by other departments. The framework consists of six steps: 1) development of a program review and adaptation manual, 2) education and readiness assessment of interested departments, 3) evaluation of the program by individual departments, 4) joint evaluation via retreats, 5) synthesis of feedback and program revision, and 6) evaluation of the adaptation process. Nine departments revised the Local HTA Decision Support Program and expressed strong satisfaction with the adaptation process. Key elements for success were identified. Adaptation of a preexisting program may reduce duplication of effort, save resources, raise the health care providers' awareness of HTA, and foster constructive stakeholder engagement, which enhances the legitimacy of evidence-informed recommendations for introducing new health technologies. We encourage others to use this framework for program adaptation and to report their experiences.

Multi-criteria development and incorporation into decision tools for health technology adoption.

PubMed

Poulin, Paule; Austen, Lea; Scott, Catherine M; Waddell, Cameron D; Dixon, Elijah; Poulin, Michelle; Lafrenière, René

2013-01-01

When introducing new health technologies, decision makers must integrate research evidence with local operational management information to guide decisions about whether and under what conditions the technology will be used. Multi-criteria decision analysis can support the adoption or prioritization of health interventions by using criteria to explicitly articulate the health organization's needs, limitations, and values in addition to evaluating evidence for safety and effectiveness. This paper seeks to describe the development of a framework to create agreed-upon criteria and decision tools to enhance a pre-existing local health technology assessment (HTA) decision support program. The authors compiled a list of published criteria from the literature, consulted with experts to refine the criteria list, and used a modified Delphi process with a group of key stakeholders to review, modify, and validate each criterion. In a workshop setting, the criteria were used to create decision tools. A set of user-validated criteria for new health technology evaluation and adoption was developed and integrated into the local HTA decision support program. Technology evaluation and decision guideline tools were created using these criteria to ensure that the decision process is systematic, consistent, and transparent. This framework can be used by others to develop decision-making criteria and tools to enhance similar technology adoption programs. The development of clear, user-validated criteria for evaluating new technologies adds a critical element to improve decision-making on technology adoption, and the decision tools ensure consistency, transparency, and real-world relevance.

Setting and meeting priorities in Indigenous health research in Australia and its application in the Cooperative Research Centre for Aboriginal health.

PubMed

Monk, Johanna M; Rowley, Kevin G; Anderson, Ian Ps

2009-11-20

Priority setting is about making decisions. Key issues faced during priority setting processes include identifying who makes these decisions, who sets the criteria, and who benefits. The paper reviews the literature and history around priority setting in research, particularly in Aboriginal health research. We explore these issues through a case study of the Cooperative Research Centre for Aboriginal Health (CRCAH)'s experience in setting and meeting priorities.Historically, researchers have made decisions about what research gets done. Pressures of growing competition for research funds and an increased public interest in research have led to demands that appropriate consultation with stakeholders is conducted and that research is of benefit to the wider society. Within Australian Aboriginal communities, these demands extend to Aboriginal control of research to ensure that Aboriginal priorities are met.In response to these demands, research priorities are usually agreed in consultation with stakeholders at an institutional level and researchers are asked to develop relevant proposals at a project level. The CRCAH's experience in funding rounds was that scientific merit was given more weight than stakeholders' priorities and did not necessarily result in research that met these priorities. After reviewing these processes in 2004, the CRCAH identified a new facilitated development approach. In this revised approach, the setting of institutional priorities is integrated with the development of projects in a way that ensures the research reflects stakeholder priorities.This process puts emphasis on identifying projects that reflect priorities prior to developing the quality of the research, rather than assessing the relevance to priorities and quality concurrently. Part of the CRCAH approach is the employment of Program Managers who ensure that stakeholder priorities are met in the development of research projects. This has enabled researchers and stakeholders to come together to collaboratively develop priority-driven research. Involvement by both groups in project development has been found to be essential in making decisions that will lead to robust and useful research.

Decision-making under risk in children, adolescents, and young adults.

PubMed

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

2011-01-01

Adolescents often make risky and impulsive decisions. Such behavior has led to the common assumption that a dysfunction in risk-related decision-making peaks during this age. Differences in how risk has been defined across studies, however, make it difficult to draw conclusions about developmental changes in risky decision-making. Here, we developed a non-symbolic economic decision-making task that can be used across a wide age span and that uses coefficient of variation (CV) in reward as an index of risk. We found that young children showed the strongest preference for risky compared to sure bet options of equal expected value, adolescents were intermediate in their risk preference, and young adults showed the strongest risk aversion. Furthermore, children's preference for the risky option increased for larger CVs, while adolescents and young adults showed the opposite pattern, favoring the sure bet more often as CV increased. Finally, when faced with two gambles in a risk-return tradeoff, all three age groups exhibited a greater preference for the option with the lower risk and return as the disparity in risk between the two options increased. These findings demonstrate clear age-related differences in economic risk preferences that vary with choice set and risk. Importantly, adolescence appears to represent an intermediate decision-making phenotype along the transition from childhood to adulthood, rather than an age of heightened preference for economic risk.

Decision-Making Under Risk in Children, Adolescents, and Young Adults

PubMed Central

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

2011-01-01

Adolescents often make risky and impulsive decisions. Such behavior has led to the common assumption that a dysfunction in risk-related decision-making peaks during this age. Differences in how risk has been defined across studies, however, make it difficult to draw conclusions about developmental changes in risky decision-making. Here, we developed a non-symbolic economic decision-making task that can be used across a wide age span and that uses coefficient of variation (CV) in reward as an index of risk. We found that young children showed the strongest preference for risky compared to sure bet options of equal expected value, adolescents were intermediate in their risk preference, and young adults showed the strongest risk aversion. Furthermore, children's preference for the risky option increased for larger CVs, while adolescents and young adults showed the opposite pattern, favoring the sure bet more often as CV increased. Finally, when faced with two gambles in a risk–return tradeoff, all three age groups exhibited a greater preference for the option with the lower risk and return as the disparity in risk between the two options increased. These findings demonstrate clear age-related differences in economic risk preferences that vary with choice set and risk. Importantly, adolescence appears to represent an intermediate decision-making phenotype along the transition from childhood to adulthood, rather than an age of heightened preference for economic risk. PMID:21687443

Correlates of unmet need for contraception in Bangladesh: does couples' concordance in household decision making matter?

PubMed

Uddin, Jalal; Pulok, Mohammad Habibullah; Sabah, Md Nasim-Us

2016-07-01

A large body of literature has highlighted that women's household decision-making power is associated with better reproductive health outcomes, while most of the studies tend to measure such power from only women's point of view. Using both husband's and wife's matched responses to decision-making questions, this study examined the association between couples' concordant and discordant decision makings, and wife's unmet need for contraception in Bangladesh. This study used couple's data set (n=3336) from Bangladesh Demographic and Health Survey of 2007. Multivariate logistic regression was used to examine the likelihood of unmet need for contraception among married women of reproductive age. Study results suggested that couples who support the equalitarian power structure seemed to be more powerful in meeting the unmet demand for contraception. Logistic regression analysis revealed that compared to couple's concordant joint decision making, concordance in husband-only or other's involvement in decision making was associated with higher odds of unmet need for contraception. Wives exposed to family planning information discussed family planning more often with husbands, and those from richest households were less likely to have unmet need for contraception. Couple's concordant joint decision making, reflecting the concept of equalitarian power structure, appeared to be a significant analytic category. Policy makers in the field of family planning may promote community-based outreach programs and communication campaigns for family planning focusing on egalitarian gender roles in the household. Copyright © 2016 Elsevier Inc. All rights reserved.

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.

How have systematic priority setting approaches influenced policy making? A synthesis of the current literature.

PubMed

Kapiriri, Lydia; Razavi, Donya

2017-09-01

There is a growing body of literature on systematic approaches to healthcare priority setting from various countries and different levels of decision making. This paper synthesizes the current literature in order to assess the extent to which program budgeting and marginal analysis (PBMA), burden of disease & cost-effectiveness analysis (BOD/CEA), multi-criteria decision analysis (MCDA), and accountability for reasonableness (A4R), are reported to have been institutionalized and influenced policy making and practice. We searched for English language publications on health care priority setting approaches (2000-2017). Our sources of literature included PubMed and Ovid databases (including Embase, Global Health, Medline, PsycINFO, EconLit). Of the four approaches PBMA and A4R were commonly applied in high income countries while BOD/CEA was exclusively applied in low income countries. PBMA and BOD/CEA were most commonly reported to have influenced policy making. The explanations for limited adoption of an approach were related to its complexity, poor policy maker understanding and resource requirements. While systematic approaches have the potential to improve healthcare priority setting; most have not been adopted in routine policy making. The identified barriers call for sustained knowledge exchange between researchers and policy-makers and development of practical guidelines to ensure that these frameworks are more accessible, applicable and sustainable in informing policy making. Copyright © 2017 Elsevier B.V. All rights reserved.

Analytical group decision making in natural resources: Methodology and application

USGS Publications Warehouse

Schmoldt, D.L.; Peterson, D.L.

2000-01-01

Group decision making is becoming increasingly important in natural resource management and associated scientific applications, because multiple values are treated coincidentally in time and space, multiple resource specialists are needed, and multiple stakeholders must be included in the decision process. Decades of social science research on decision making in groups have provided insights into the impediments to effective group processes and on techniques that can be applied in a group context. Nevertheless, little integration and few applications of these results have occurred in resource management decision processes, where formal groups are integral, either directly or indirectly. A group decision-making methodology is introduced as an effective approach for temporary, formal groups (e.g., workshops). It combines the following three components: (1) brainstorming to generate ideas; (2) the analytic hierarchy process to produce judgments, manage conflict, enable consensus, and plan for implementation; and (3) a discussion template (straw document). Resulting numerical assessments of alternative decision priorities can be analyzed statistically to indicate where group member agreement occurs and where priority values are significantly different. An application of this group process to fire research program development in a workshop setting indicates that the process helps focus group deliberations; mitigates groupthink, nondecision, and social loafing pitfalls; encourages individual interaction; identifies irrational judgments; and provides a large amount of useful quantitative information about group preferences. This approach can help facilitate scientific assessments and other decision-making processes in resource management.

Presenting health risk information in different formats: the effect on participants' cognitive and emotional evaluation and decisions.

PubMed

Timmermans, Daniëlle R M; Ockhuysen-Vermey, Caroline F; Henneman, Lidewij

2008-12-01

Effective communication of health risks plays an important role in enabling patients to make adequate decisions. There is little--though contradictory--evidence to indicate which format is most effective for communicating risks, and which risk format is preferred by counselees. In an experiment, subjects were presented health scenarios and risk information in different formats (percentages, frequencies, and population figures) and asked to evaluate the risks and make a decision based on these. Different risk formats had different effects on respondents' evaluation of the health risks presented. Contrary to our expectation, population figures were not evaluated as being the easiest format for all decision problems. Population figures were shown to have the biggest affective impact, and risks presented as population figures were also evaluated as significantly greater than the risks presented in other formats. The format of the presented risks influenced their decision in only one out of four decision-making situations, although in a second situation there was a similar trend. This study suggests that the risk format plays a role in the decision-making process, although it remains unclear which format is the most effective in terms of understanding. More experimental studies based on a theoretical analysis of the factors that promote effective risk communication are needed in the general population as well as in clinical settings with patients actually experiencing the risks and making the decisions.

State dependent optimization of measurement policy

NASA Astrophysics Data System (ADS)

Konkarikoski, K.

2010-07-01

Measurements are the key to rational decision making. Measurement information generates value, when it is applied in the decision making. An investment cost and maintenance costs are associated with each component of the measurement system. Clearly, there is - under a given set of scenarios - a measurement setup that is optimal in expected (discounted) utility. This paper deals how the measurement policy optimization is affected by different system states and how this problem can be tackled.

Do Upper Extremity Trauma Patients Have Different Preferences for Shared Decision-making Than Patients With Nontraumatic Conditions?

PubMed

Hageman, Michiel G J S; Reddy, Rajesh; Makarawung, Dennis J S; Briet, Jan Paul; van Dijk, C Niek; Ring, David

2015-11-01

Shared decision-making is a combination of expertise, available scientific evidence, and the preferences of the patient and surgeon. Some surgeons contend that patients are less capable of participating in decisions about traumatic conditions than nontraumatic conditions. (1) Do patients with nontraumatic conditions have different preferences for shared decision-making when compared with those who sustained acute trauma? (2) Do disability, symptoms of depression, and self-efficacy correlate with preference for shared decision-making? In this prospective, comparative trial, we evaluated a total of 133 patients presenting to the outpatient practices of two university-based hand surgeons with traumatic or nontraumatic hand and upper extremity illnesses or conditions. Each patient completed questionnaires measuring their preferred role in healthcare decision-making (Control Preferences Scale [CPS]), symptoms of depression (Patients' Health Questionnaire), and pain self-efficacy (confidence that one can achieve one's goals despite pain; measured using the Pain Self-efficacy Questionnaire). Patients also completed a short version of the Disabilities of the Arm, Shoulder, and Hand questionnaire and an ordinal rating of pain intensity. There was no difference in decision-making preferences between patients with traumatic (CPS: 3 ± 2) and nontraumatic conditions (CPS: 3 ± 1 mean difference = 0.2 [95% confidence interval, -0.4 to 0.7], p = 0.78) with most patients (95 versus 38) preferring shared decision-making. More educated patients preferred a more active role in decision-making (beta = -0.1, r = 0.08, p = 0.001); however, differences in levels of disability, pain and function, depression, and pain-related self-efficacy were not associated with differences in patients' preferences in terms of shared decision-making. Patients who sustained trauma have on average the same preference for shared decision-making compared with patients who sustained no trauma. Now that we know the findings of this study, clinicians might be motivated to share their expertise about the treatment options, potential outcomes, benefits, and harms with the patient and to discuss their preference as well in a semiacute setting, resulting in a shared decision.

Setting priorities in health care organizations: criteria, processes, and parameters of success.

PubMed

Gibson, Jennifer L; Martin, Douglas K; Singer, Peter A

2004-09-08

Hospitals and regional health authorities must set priorities in the face of resource constraints. Decision-makers seek practical ways to set priorities fairly in strategic planning, but find limited guidance from the literature. Very little has been reported from the perspective of Board members and senior managers about what criteria, processes and parameters of success they would use to set priorities fairly. We facilitated workshops for board members and senior leadership at three health care organizations to assist them in developing a strategy for fair priority setting. Workshop participants identified 8 priority setting criteria, 10 key priority setting process elements, and 6 parameters of success that they would use to set priorities in their organizations. Decision-makers in other organizations can draw lessons from these findings to enhance the fairness of their priority setting decision-making. Lessons learned in three workshops fill an important gap in the literature about what criteria, processes, and parameters of success Board members and senior managers would use to set priorities fairly.

PROMISE AND PLAUSIBILITY: HEALTH TECHNOLOGY ADOPTION DECISIONS WITH LIMITED EVIDENCE.

PubMed

Campbell, Bruce; Knox, Paul

2016-01-01

The adoption of new medical devices and diagnostics is often hampered by lack of published evidence which makes conventional health technology assessment (HTA) difficult. We now have 5 years' experience of the Medical Technologies Advisory Committee of the National Institute for Health and Care Excellence (NICE) in the United Kingdom, addressing this problem. This committee assesses devices and diagnostics against claims of advantage, to produce guidance on adoption for the health service. We have reflected on the practical, technical, and intellectual processes we have used in developing guidance for the health service. When scientific and clinical evidence is sparse, promise and plausibility play an increased part in decision-making. Drivers of promise include a clear design and mechanism of action, the possibility of radical improvement in care and/or resource use, and improving health outcomes for large numbers of patients. Plausibility relates to judgements about the whether the promise is likely to be delivered in a "real world" setting. Promise and plausibility need to be balanced against the amount of evidence available. We examine the influence they may have on decision-making compared with other factors such as risk and cost. Decisions about adoption of new devices and diagnostics with little evidence are influenced by judgements of their promise and the plausibility of claims that they will provide benefits in a real-world setting. This kind of decision making needs to be transparent and this article explains how these influences can be balanced against the use of more familiar criteria.

Rational Risk-Benefit Decision-Making in the Setting of Military Mefloquine Policy.

PubMed

Nevin, Remington L

2015-01-01

Mefloquine is an antimalarial drug that has been commonly used in military settings since its development by the US military in the late 1980s. Owing to the drug's neuropsychiatric contraindications and its high rate of inducing neuropsychiatric symptoms, which are contraindications to the drug's continued use, the routine prescribing of mefloquine in military settings may be problematic. Due to these considerations and to recent concerns of chronic and potentially permanent psychiatric and neurological sequelae arising from drug toxicity, military prescribing of mefloquine has recently decreased. In settings where mefloquine remains available, policies governing prescribing should reflect risk-benefit decision-making informed by the drug's perceived benefits and by consideration both of the risks identified in the drug's labeling and of specific military risks associated with its use. In this review, these risks are identified and recommendations are made for the rational prescribing of the drug in light of current evidence.

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

NASA Astrophysics Data System (ADS)

Hearn, Kelda L.; Zhang, Yanqing

2001-03-01

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

Decision aids for randomised controlled trials: a qualitative exploration of stakeholders’ views

PubMed Central

Gillies, Katie; Skea, Zoë C; Campbell, Marion K

2014-01-01

Objectives To explore stakeholders’ perceptions of decision aids designed to support the informed consent decision-making process for randomised controlled trials. Design Qualitative semistructured interviews. Participants were provided with prototype trial decision aids in advance to stimulate discussion. Interviews were analysed using an established interpretive approach. Participants 23 stakeholders: Trial Managers (n=5); Research Nurses (n=5); Ethics Committee Chairs (n=5); patients (n=4) and Clinical Principal Investigators (n=4). Setting Embedded within two ongoing randomised controlled trials. All interviews conducted with UK-based participants. Results Certain key aspects (eg, values clarification exercises, presentation of probabilities, experiences of others and balance of options) in the prototype decision aids were perceived by all stakeholders as having a significant advantage (over existing patient information leaflets) in terms of supporting well informed appropriate decisions. However, there were some important differences between the stakeholder groups on specific content (eg, language used in the section on positive and negative features of taking part in a trial and the overall length of the trial decision aids). Generally the stakeholders believed trial decision aids have the potential to better engage potential participants in the decision-making process and allow them to make more personally relevant decisions about their participation. Conclusions Compared to existing patient information leaflets, stakeholders perceived decision aids for trial participation to have the potential to promote a more ‘informed’ decision-making process. Further efforts to develop, refine and formally evaluate trial decision aids should be explored. PMID:25138811

Information and Decision-Making Needs Among People with Anxiety Disorders: Results of an Online Survey.

PubMed

Liebherz, Sarah; Härter, Martin; Dirmaier, Jörg; Tlach, Lisa

2015-12-01

People with anxiety disorders are faced with treatment decisions considerably affecting their life. Patient decision aids are aimed at enabling patients to deliberate treatment options based on individual values and to participate in medical decisions. This is the first study to determine patients' information and decision-making needs as a pre-requisite for the development of patient decision aids for anxiety disorders. An online cross-sectional survey was conducted between January and April 2013 on the e-health portal http://www.psychenet.de by using a self-administered questionnaire with items on internet use, online health information needs, role in decision making and important treatment decisions. Descriptive and inferential statistical as well as qualitative data analyses were performed. A total of 60 people with anxiety disorders with a mean age of 33.3 years (SD 10.5) participated in the survey. The most prevalent reasons for online health information search were the need for general information on anxiety disorders, the search for a physician or psychiatrist and the insufficiency of information given by the healthcare provider. Respondents experienced less shared and more autonomous decisions than they preferred. They assessed decisions on psychotherapy, medication, and treatment setting (inpatient or outpatient) as the most difficult decisions. Our results confirm the importance of offering patient decision aids for people with anxiety disorders that encourage patients to participate in decision making by providing information about the pros and cons of evidence-based treatment options.

Socioeconomic Differences in Informed Decisions About Down Syndrome Screening: A Systematic Review and Research Agenda.

PubMed

Smith, Sian K; Sousa, Mariana S; Essink-Bot, Marie-Louise; Halliday, Jane; Peate, Michelle; Fransen, Mirjam

2016-08-01

Supporting pregnant women to make informed choices about Down syndrome screening is widely endorsed. We reviewed the literature on: (a) the association between socioeconomic position and informed choices and decision-making about Down syndrome screening, and (b) the possible mediating variables (e.g., health literacy, numeracy skills, behavioral and communication variables) that might explain the relationship. EMBASE, MEDLINE, PubMed, CINAHL, and PsycINFO were searched from January 1999 to September 2014. The methodological quality of studies was determined by predefined criteria regarding the research aims, study design, study population and setting, measurement tools, and statistical analysis. A total of 33 studies met the inclusion criteria. Women from lower socioeconomic groups experience greater difficulties making informed choices about Down syndrome screening compared to women from higher socioeconomic groups. Most studies focus on individual dimensions of informed decision-making rather than assessing elements in conjunction with one another. Few studies have explored why there are socioeconomic differences in women's ability to make informed screening decisions. Future work is needed to identify mediating variables in this pathway. Systematic evidence-based intervention development to improve communication, understanding, and decision-making about Down syndrome screening is needed to ensure that women have an equal opportunity to make an informed choice about screening regardless of their socioeconomic position.

Who Shall Teach Young Children in Multiple Settings?

ERIC Educational Resources Information Center

Roderick, Jessie A.

1987-01-01

Discusses the qualities that educators need to function effectively in a range of child care settings (multiple settings) such as traditional schools, shopping malls, industrial establishments and museums. Decision-making skills, sensitive communicative skills, interest in continuing to learn, and questioning of practice are among the qualities…

Affective and cognitive mechanisms of risky decision making.

PubMed

Shimp, Kristy G; Mitchell, Marci R; Beas, B Sofia; Bizon, Jennifer L; Setlow, Barry

2015-01-01

The ability to make advantageous decisions under circumstances in which there is a risk of adverse consequences is an important component of adaptive behavior; however, extremes in risk taking (either high or low) can be maladaptive and are characteristic of a number of neuropsychiatric disorders. To better understand the contributions of various affective and cognitive factors to risky decision making, cohorts of male Long-Evans rats were trained in a "Risky Decision making Task" (RDT), in which they made discrete trial choices between a small, "safe" food reward and a large, "risky" food reward accompanied by varying probabilities of footshock. Experiment 1 evaluated the relative contributions of the affective stimuli (i.e., punishment vs. reward) to RDT performance by parametrically varying the magnitudes of the footshock and large reward. Varying the shock magnitude had a significant impact on choice of the large, "risky" reward, such that greater magnitudes were associated with reduced choice of the large reward. In contrast, varying the large, "risky" reward magnitude had minimal influence on reward choice. Experiment 2 compared individual variability in RDT performance with performance in an attentional set shifting task (assessing cognitive flexibility), a delayed response task (assessing working memory), and a delay discounting task (assessing impulsive choice). Rats characterized as risk averse in the RDT made more perseverative errors on the set shifting task than did their risk taking counterparts, whereas RDT performance was not related to working memory abilities or impulsive choice. In addition, rats that showed greater delay discounting (greater impulsive choice) showed corresponding poorer performance in the working memory task. Together, these results suggest that reward-related decision making under risk of punishment is more strongly influenced by the punishment than by the reward, and that risky and impulsive decision making are associated with distinct components of executive function. Copyright © 2014 Elsevier Inc. All rights reserved.

Affective and cognitive mechanisms of risky decision making

PubMed Central

Shimp, Kristy G.; Mitchell, Marci R.; Beas, B. Sofia; Bizon, Jennifer L.; Setlow, Barry

2014-01-01

The ability to make advantageous decisions under circumstances in which there is a risk of adverse consequences is an important component of adaptive behavior; however, extremes in risk taking (either high or low) can be maladaptive and are characteristic of a number of neuropsychiatric disorders. To better understand the contributions of various affective and cognitive factors to risky decision making, cohorts of male Long-Evans rats were trained in a “Risky Decision making Task” (RDT), in which they made discrete trial choices between a small, “safe” food reward and a large, “risky” food reward accompanied by varying probabilities of footshock. Experiment 1 evaluated the relative contributions of the affective stimuli (i.e., punishment vs. reward) to RDT performance by parametrically varying the magnitudes of the footshock and large reward. Varying the shock magnitude had a significant impact on choice of the large, “risky” reward, such that greater magnitudes were associated with reduced choice of the large reward. In contrast, varying the large, “risky” reward magnitude had minimal influence on reward choice. Experiment 2 compared individual variability in RDT performance with performance in an attentional set shifting task (assessing cognitive flexibility), a delayed response task (assessing working memory), and a delay discounting task (assessing impulsive choice). Rats characterized as risk averse in the RDT made more perseverative errors on the set shifting task than did their risk taking counterparts, whereas RDT performance was not related to working memory abilities or impulsive choice. In addition, rats that showed greater delay discounting (greater impulsive choice) showed corresponding poorer performance in the working memory task. Together, these results suggest that reward-related decision making under risk of punishment is more strongly influenced by the punishment than by the reward, and that risky and impulsive decision making are associated with distinct components of executive function. PMID:24642448

Economics of Obesity — Learning from the Past to Contribute to a Better Future

PubMed Central

Ananthapavan, Jaithri; Sacks, Gary; Moodie, Marj; Carter, Rob

2014-01-01

The discipline of economics plays a varied role in informing the understanding of the problem of obesity and the impact of different interventions aimed at addressing it. This paper discusses the causes of the obesity epidemic from an economics perspective, and outlines various justifications for government intervention in this area. The paper then focuses on the potential contribution of health economics in supporting resource allocation decision making for obesity prevention/treatment. Although economic evaluations of single interventions provide useful information, evaluations undertaken as part of a priority setting exercise provide the greatest scope for influencing decision making. A review of several priority setting examples in obesity prevention/treatment indicates that policy (as compared with program-based) interventions, targeted at prevention (as compared with treatment) and focused “upstream” on the food environment, are likely to be the most cost-effective options for change. However, in order to further support decision makers, several methodological advances are required. These include the incorporation of intervention costs/benefits outside the health sector, the addressing of equity impacts, and the increased engagement of decision makers in the priority setting process. PMID:24736685

Priority setting of ICU resources in an influenza pandemic: a qualitative study of the Canadian public's perspectives

PubMed Central

2012-01-01

Background Pandemic influenza may exacerbate existing scarcity of life-saving medical resources. As a result, decision-makers may be faced with making tough choices about who will receive care and who will have to wait or go without. Although previous studies have explored ethical issues in priority setting from the perspective of clinicians and policymakers, there has been little investigation into how the public views priority setting during a pandemic influenza, in particular related to intensive care resources. Methods To bridge this gap, we conducted three public town hall meetings across Canada to explore Canadian's perspectives on this ethical challenge. Town hall discussions group discussions were digitally recorded, transcribed, and analyzed using thematic analysis. Results Six interrelated themes emerged from the town hall discussions related to: ethical and empirical starting points for deliberation; criteria for setting priorities; pre-crisis planning; in-crisis decision-making; the need for public deliberation and input; and participants' deliberative struggle with the ethical issues. Conclusions Our findings underscore the importance of public consultation in pandemic planning for sustaining public trust in a public health emergency. Participants appreciated the empirical and ethical uncertainty of decision-making in an influenza pandemic and demonstrated nuanced ethical reasoning about priority setting of intensive care resources in an influenza pandemic. Policymakers may benefit from a better understanding the public's empirical and ethical 'starting points' in developing effective pandemic plans. PMID:22449119

Decision theory applied to image quality control in radiology.

PubMed

Lessa, Patrícia S; Caous, Cristofer A; Arantes, Paula R; Amaro, Edson; de Souza, Fernando M Campello

2008-11-13

The present work aims at the application of the decision theory to radiological image quality control (QC) in diagnostic routine. The main problem addressed in the framework of decision theory is to accept or reject a film lot of a radiology service. The probability of each decision of a determined set of variables was obtained from the selected films. Based on a radiology service routine a decision probability function was determined for each considered group of combination characteristics. These characteristics were related to the film quality control. These parameters were also framed in a set of 8 possibilities, resulting in 256 possible decision rules. In order to determine a general utility application function to access the decision risk, we have used a simple unique parameter called r. The payoffs chosen were: diagnostic's result (correct/incorrect), cost (high/low), and patient satisfaction (yes/no) resulting in eight possible combinations. Depending on the value of r, more or less risk will occur related to the decision-making. The utility function was evaluated in order to determine the probability of a decision. The decision was made with patients or administrators' opinions from a radiology service center. The model is a formal quantitative approach to make a decision related to the medical imaging quality, providing an instrument to discriminate what is really necessary to accept or reject a film or a film lot. The method presented herein can help to access the risk level of an incorrect radiological diagnosis decision.

To pass or to fail? Understanding the factors considered by faculty in the clinical evaluation of nursing students.

PubMed

DeBrew, Jacqueline Kayler; Lewallen, Lynne Porter

2014-04-01

Making the decision to pass or to fail a nursing student is difficult for nurse educators, yet one that all educators face at some point in time. To make this decision, nurse educators draw from their past experiences and personal reflections on the situation. Using the qualitative method of critical incident technique, the authors asked educators to describe a time when they had to make a decision about whether to pass or fail a student in the clinical setting. The findings describe student and faculty factors important in clinical evaluation decisions, demonstrate the benefits of reflective practice to nurse educators, and support the utility of critical incident technique not only as research methodology, but also as a technique for reflective practice. Copyright © 2013 Elsevier Ltd. All rights reserved.

Designing Tools for Supporting User Decision-Making in e-Commerce

NASA Astrophysics Data System (ADS)

Sutcliffe, Alistair; Al-Qaed, Faisal

The paper describes a set of tools designed to support a variety of user decision-making strategies. The tools are complemented by an online advisor so they can be adapted to different domains and users can be guided to adopt appropriate tools for different choices in e-commerce, e.g. purchasing high-value products, exploring product fit to users’ needs, or selecting products which satisfy requirements. The tools range from simple recommenders to decision support by interactive querying and comparison matrices. They were evaluated in a scenario-based experiment which varied the users’ task and motivation, with and without an advisor agent. The results show the tools and advisor were effective in supporting users and agreed with the predictions of ADM (adaptive decision making) theory, on which the design of the tools was based.

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

NASA Astrophysics Data System (ADS)

Li, Yongchang

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

Perspectives of decision-making in requests for euthanasia: a qualitative research among patients, relatives and treating physicians in the Netherlands.

PubMed

Dees, Marianne K; Vernooij-Dassen, Myrra J; Dekkers, Wim J; Elwyn, Glyn; Vissers, Kris C; van Weel, Chris

2013-01-01

Euthanasia has been legally performed in the Netherlands since 2002. Respect for patient's autonomy is the underpinning ethical principal. However, patients have no right to euthanasia, and physicians have no obligation to provide it. Although over 3000 cases are conducted per year in the Netherlands, there is little known about how decision-making occurs and no guidance to support this difficult aspect of clinical practice. To explore the decision-making process in cases where patients request euthanasia and understand the different themes relevant to optimise this decision-making process. A qualitative thematic analysis of interviews with patients making explicit requests for euthanasia, most-involved relative(s) and treating physician. Thirty-two cases, 31 relatives and 28 treating physicians. Settings were patients' and relatives' homes and physicians' offices. Five main themes emerged: (1) initiation of sharing views and values about euthanasia, (2) building relationships as part of the negotiation, (3) fulfilling legal requirements, (4) detailed work of preparing and performing euthanasia and (5) aftercare and closing. A patient's request for euthanasia entails a complex process that demands emotional work by all participants. It is characterised by an intensive period of sharing information, relationship building and negotiation in order to reach agreement. We hypothesise that making decisions about euthanasia demands a proactive approach towards participants' preferences and values regarding end of life, towards the needs of relatives, towards the burden placed on physicians and a careful attention to shared decision-making. Future research should address the communicational skills professionals require for such complex decision-making.

Development and field testing of a decision support tool to facilitate shared decision making in contraceptive counseling.

PubMed

Dehlendorf, Christine; Fitzpatrick, Judith; Steinauer, Jody; Swiader, Lawrence; Grumbach, Kevin; Hall, Cara; Kuppermann, Miriam

2017-07-01

We developed and formatively evaluated a tablet-based decision support tool for use by women prior to a contraceptive counseling visit to help them engage in shared decision making regarding method selection. Drawing upon formative work around women's preferences for contraceptive counseling and conceptual understanding of health care decision making, we iteratively developed a storyboard and then digital prototypes, based on best practices for decision support tool development. Pilot testing using both quantitative and qualitative data and cognitive testing was conducted. We obtained feedback from patient and provider advisory groups throughout the development process. Ninety-six percent of women who used the tool in pilot testing reported that it helped them choose a method, and qualitative interviews indicated acceptability of the tool's content and presentation. Compared to the control group, women who used the tool demonstrated trends toward increased likelihood of complete satisfaction with their method. Participant responses to cognitive testing were used in tool refinement. Our decision support tool appears acceptable to women in the family planning setting. Formative evaluation of the tool supports its utility among patients making contraceptive decisions, which can be further evaluated in a randomized controlled trial. Copyright © 2017 Elsevier B.V. All rights reserved.

Characterizing uncertain sea-level rise projections to support investment decisions.

PubMed

Sriver, Ryan L; Lempert, Robert J; Wikman-Svahn, Per; Keller, Klaus

2018-01-01

Many institutions worldwide are considering how to include uncertainty about future changes in sea-levels and storm surges into their investment decisions regarding large capital infrastructures. Here we examine how to characterize deeply uncertain climate change projections to support such decisions using Robust Decision Making analysis. We address questions regarding how to confront the potential for future changes in low probability but large impact flooding events due to changes in sea-levels and storm surges. Such extreme events can affect investments in infrastructure but have proved difficult to consider in such decisions because of the deep uncertainty surrounding them. This study utilizes Robust Decision Making methods to address two questions applied to investment decisions at the Port of Los Angeles: (1) Under what future conditions would a Port of Los Angeles decision to harden its facilities against extreme flood scenarios at the next upgrade pass a cost-benefit test, and (2) Do sea-level rise projections and other information suggest such conditions are sufficiently likely to justify such an investment? We also compare and contrast the Robust Decision Making methods with a full probabilistic analysis. These two analysis frameworks result in similar investment recommendations for different idealized future sea-level projections, but provide different information to decision makers and envision different types of engagement with stakeholders. In particular, the full probabilistic analysis begins by aggregating the best scientific information into a single set of joint probability distributions, while the Robust Decision Making analysis identifies scenarios where a decision to invest in near-term response to extreme sea-level rise passes a cost-benefit test, and then assembles scientific information of differing levels of confidence to help decision makers judge whether or not these scenarios are sufficiently likely to justify making such investments. Results highlight the highly-localized and context dependent nature of applying Robust Decision Making methods to inform investment decisions.

Characterizing uncertain sea-level rise projections to support investment decisions

PubMed Central

Lempert, Robert J.; Wikman-Svahn, Per; Keller, Klaus

2018-01-01

Many institutions worldwide are considering how to include uncertainty about future changes in sea-levels and storm surges into their investment decisions regarding large capital infrastructures. Here we examine how to characterize deeply uncertain climate change projections to support such decisions using Robust Decision Making analysis. We address questions regarding how to confront the potential for future changes in low probability but large impact flooding events due to changes in sea-levels and storm surges. Such extreme events can affect investments in infrastructure but have proved difficult to consider in such decisions because of the deep uncertainty surrounding them. This study utilizes Robust Decision Making methods to address two questions applied to investment decisions at the Port of Los Angeles: (1) Under what future conditions would a Port of Los Angeles decision to harden its facilities against extreme flood scenarios at the next upgrade pass a cost-benefit test, and (2) Do sea-level rise projections and other information suggest such conditions are sufficiently likely to justify such an investment? We also compare and contrast the Robust Decision Making methods with a full probabilistic analysis. These two analysis frameworks result in similar investment recommendations for different idealized future sea-level projections, but provide different information to decision makers and envision different types of engagement with stakeholders. In particular, the full probabilistic analysis begins by aggregating the best scientific information into a single set of joint probability distributions, while the Robust Decision Making analysis identifies scenarios where a decision to invest in near-term response to extreme sea-level rise passes a cost-benefit test, and then assembles scientific information of differing levels of confidence to help decision makers judge whether or not these scenarios are sufficiently likely to justify making such investments. Results highlight the highly-localized and context dependent nature of applying Robust Decision Making methods to inform investment decisions. PMID:29414978