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

PubMed

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

2018-02-01

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

Understandings of the nature of science and decision making on science and technology based issues

NASA Astrophysics Data System (ADS)

Bell, Randy L.; Lederman, Norman G.

2003-05-01

The purpose of this investigation was to explicate the role of the nature of science in decision making on science and technology based issues and to delineate factors and reasoning associated with these types of decisions. Twenty-one volunteer participants purposively selected from the faculty of geographically diverse universities completed an open-ended questionnaire and follow-up interview designed to assess their decision making on science and technology based issues. Participants were subsequently placed in one of two groups based upon their divergent views of the nature of science as assessed by a second open-ended questionnaire and follow-up interview. Profiles of each group's decision making were then constructed, based on participants' previous responses to the decision making questionnaire and follow-up interviews. Finally, the two groups' decisions, decision influencing factors, and decision making strategies were compared. No differences were found between the decisions of the two groups, despite their disparate views of the nature of science. Participants in both groups based their decisions primarily on personal values, morals/ethics, and social concerns. While all participants considered scientific evidence in their decision making, most did not require absolute proof, even though many participants held absolute conceptions of the nature of science. Overall, the nature of science did not figure prominently in either group's decisions. These findings contrast with basic assumptions of current science education reform efforts and call for a re-examination of the goals of nature of science instruction. Developing better decision making skills - even on science and technology based issues - may involve other factors, including more value-based instruction and attention to intellectual/moral development.

Neurocognitive mechanisms underlying value-based decision-making: from core values to economic value

PubMed Central

Brosch, Tobias; Sander, David

2013-01-01

Value plays a central role in practically every aspect of human life that requires a decision: whether we choose between different consumer goods, whether we decide which person we marry or which political candidate gets our vote, we choose the option that has more value to us. Over the last decade, neuroeconomic research has mapped the neural substrates of economic value, revealing that activation in brain regions such as ventromedial prefrontal cortex (VMPFC), ventral striatum or posterior cingulate cortex reflects how much an individual values an option and which of several options he/she will choose. However, while great progress has been made exploring the mechanisms underlying concrete decisions, neuroeconomic research has been less concerned with the questions of why people value what they value, and why different people value different things. Social psychologists and sociologists have long been interested in core values, motivational constructs that are intrinsically linked to the self-schema and are used to guide actions and decisions across different situations and different time points. Core value may thus be an important determinant of individual differences in economic value computation and decision-making. Based on a review of recent neuroimaging studies investigating the neural representation of core values and their interactions with neural systems representing economic value, we outline a common framework that integrates the core value concept and neuroeconomic research on value-based decision-making. PMID:23898252

Separating Wheat from Chaff: How Secondary School Principals' Core Values and Beliefs Influence Decision-Making Related to Mandates

ERIC Educational Resources Information Center

Larsen, Donald E.; Hunter, Joseph E.

2014-01-01

Research conducted by Larsen and Hunter (2013, February) identified a clear pattern in secondary school principals' decision-making related to mandated change: more than half of participants' decisions were based on core values and beliefs, requiring value judgments. Analysis of themes revealed that more than half of administrative decisions…

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.

Neuroeconomics: The neurobiology of value-based decision-making

PubMed Central

Rangel, Antonio; Camerer, Colin; Montague, P. Read

2015-01-01

Neuroeconomics studies the neurobiological and computational basis of value-based decision-making. Its goal is to provide a biologically-based account of human behavior that can be applied in both the natural and the social sciences. In this review we propose a framework for thinking about decision-making that allows us to bring together recent findings in the field, highlight some of the most important outstanding problems, define a common lexicon that bridges the different disciplines that inform neuroeconomics, and point the way to future applications. PMID:18545266

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

PubMed

Paulus, Martin P; Yu, Angela J

2012-09-01

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

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

PubMed Central

Paulus, Martin P.; Yu, Angela J.

2012-01-01

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

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).

Understandings of the nature of science and decision making on science and technology-based issues

NASA Astrophysics Data System (ADS)

Bell, Randy Lee

Current reforms emphasize the development of scientific literacy as the principal goal of science education. The nature of science is considered a critical component of scientific literacy and is assumed to be an important factor in decision making on science and technology based issues. However, little research exists that delineates the role of the nature of science in decision making. The purpose of this investigation was to explicate the role of the nature of science in decision making on science and technology based issues and to delineate the reasoning and factors associated with these types of decisions. The 15-item, open-ended "Decision Making Questionnaire" (DMQ) based on four different scenarios concerning science and technology issues was developed to assess decision making. Twenty-one volunteer participants purposively selected from the faculty of geographically diverse universities completed the questionnaire and follow-up interviews. Participants were subsequently grouped according to their understandings of the nature of science, based on responses to a second open-ended questionnaire and follow-up interview. Profiles of each group's decision making were constructed, based on their previous responses to the DMQ and follow-up interviews. Finally, the two groups' decisions, decision making factors, and decision making strategies were compared. No differences were found between the decisions of the two groups, despite their disparate views of the nature of science. While their reasoning did not follow formal lines of argumentation, several influencing factors and general reasoning patterns were identified. Participants in both groups based their decisions primarily on personal values, morals/ethics, and social concerns. While all participants said they considered scientific evidence in their decision making, most did not require absolute "proof," even though Group B participants held more absolute conceptions of the nature of science. Overall, the nature of science did not figure prominently in either group's decisions. These findings contrast with the assumptions of the science education community and current reform efforts and call for a reexamination of the goals of nature of science instruction. Developing better decision making skills---even on science and technology based issues---may involve other factors, including more values-based instruction and attention to intellectual/moral development.

[Treatment Decision-Making Process of Cancer Patients].

PubMed

Lee, Shiu-Yu C Katie

2016-10-01

The decision-making process that is used by cancer patients to determine their treatment has become more multi-foci, difficult and complicated in recent years. This has in part been attributed to the increasing incidence rate of cancer in Taiwan and the rapid development of medical technologies and treatment modalities. Oncology nurses must assist patients and family to make informed and value-based treatment decisions. Decision-making is an information process that involves appraising one's own expectation and values based on his/her knowledge on cancer and treatment options. Because cancer treatment involves risks and uncertainties, and impacts quality of life, the treatment decision-making for cancer is often stressful, or even conflicting. This paper discusses the decision-making behaviors of cancer patients and the decisional conflict, participation, and informational needs that are involved in cancer treatment. The trend toward shared decision-making and decisional support will be also explored in order to facilitate the future development of appropriate clinical interventions and research.

The vexing problem of defining the meaning, role and measurement of values in treatment decision-making.

PubMed

Charles, Cathy; Gafni, Amiram

2014-03-01

Two international movements, evidence-based medicine (EBM) and shared decision-making (SDM) have grappled for some time with issues related to defining the meaning, role and measurement of values/preferences in their respective models of treatment decision-making. In this article, we identify and describe unresolved problems in the way that each movement addresses these issues. The starting point for this discussion is that at least two essential ingredients are needed for treatment decision-making: research information about treatment options and their potential benefits and risks; and the values/preferences of participants in the decision-making process. Both the EBM and SDM movements have encountered difficulties in defining the meaning, role and measurement of values/preferences in treatment decision-making. In the EBM model of practice, there is no clear and consistent definition of patient values/preferences and no guidance is provided on how to integrate these into an EBM model of practice. Methods advocated to measure patient values are also problematic. Within the SDM movement, patient values/preferences tend to be defined and measured in a restrictive and reductionist way as patient preferences for treatment options or attributes of options, while broader underlying value structures are ignored. In both models of practice, the meaning and expected role of physician values in decision-making are unclear. Values clarification exercises embedded in patient decision aids are suggested by SDM advocates to identify and communicate patient values/preferences for different treatment outcomes. Such exercises have the potential to impose a particular decision-making theory and/or process onto patients, which can change the way they think about and process information, potentially impeding them from making decisions that are consistent with their true values. The tasks of clarifying the meaning, role and measurement of values/preferences in treatment decision-making models such as EBM and SDM, and determining whose values ought to count are complex and difficult tasks that will not be resolved quickly. Additional conceptual thinking and research are needed to explore and clarify these issues. To date, the values component of these models remains elusive and underdeveloped.

A decision method based on uncertainty reasoning of linguistic truth-valued concept lattice

NASA Astrophysics Data System (ADS)

Yang, Li; Xu, Yang

2010-04-01

Decision making with linguistic information is a research hotspot now. This paper begins by establishing the theory basis for linguistic information processing and constructs the linguistic truth-valued concept lattice for a decision information system, and further utilises uncertainty reasoning to make the decision. That is, we first utilise the linguistic truth-valued lattice implication algebra to unify the different kinds of linguistic expressions; second, we construct the linguistic truth-valued concept lattice and decision concept lattice according to the concrete decision information system and third, we establish the internal and external uncertainty reasoning methods and talk about the rationality of them. We apply these uncertainty reasoning methods into decision making and present some generation methods of decision rules. In the end, we give an application of this decision method by an example.

Comparing and using assessments of the value of information to clinical decision-making.

PubMed Central

Urquhart, C J; Hepworth, J B

1996-01-01

This paper discusses the Value project, which assessed the value to clinical decision-making of information supplied by National Health Service (NHS) library and information services. The project not only showed how health libraries in the United Kingdom help clinicians in decision-making but also provided quality assurance guidelines for these libraries to help make their information services more effective. The paper reviews methods and results used in previous studies of the value of health libraries, noting that methodological differences appear to affect the results. The paper also discusses aspects of user involvement, categories of clinical decision-making, the value of information to present and future clinical decisions, and the combination of quantitative and qualitative assessments of value, as applied to the Value project and the studies reviewed. The Value project also demonstrated that the value placed on information depends in part on the career stage of the physician. The paper outlines the structure of the quality assurance tool kit, which is based on the findings and methods used in the Value project. PMID:8913550

Bridging the gap between science and decision making.

PubMed

von Winterfeldt, Detlof

2013-08-20

All decisions, whether they are personal, public, or business-related, are based on the decision maker's beliefs and values. Science can and should help decision makers by shaping their beliefs. Unfortunately, science is not easily accessible to decision makers, and scientists often do not understand decision makers' information needs. This article presents a framework for bridging the gap between science and decision making and illustrates it with two examples. The first example is a personal health decision. It shows how a formal representation of the beliefs and values can reflect scientific inputs by a physician to combine with the values held by the decision maker to inform a medical choice. The second example is a public policy decision about managing a potential environmental hazard. It illustrates how controversial beliefs can be reflected as uncertainties and informed by science to make better decisions. Both examples use decision analysis to bridge science and decisions. The conclusions suggest that this can be a helpful process that requires skills in both science and decision making.

Bridging the gap between science and decision making

PubMed Central

von Winterfeldt, Detlof

2013-01-01

All decisions, whether they are personal, public, or business-related, are based on the decision maker’s beliefs and values. Science can and should help decision makers by shaping their beliefs. Unfortunately, science is not easily accessible to decision makers, and scientists often do not understand decision makers’ information needs. This article presents a framework for bridging the gap between science and decision making and illustrates it with two examples. The first example is a personal health decision. It shows how a formal representation of the beliefs and values can reflect scientific inputs by a physician to combine with the values held by the decision maker to inform a medical choice. The second example is a public policy decision about managing a potential environmental hazard. It illustrates how controversial beliefs can be reflected as uncertainties and informed by science to make better decisions. Both examples use decision analysis to bridge science and decisions. The conclusions suggest that this can be a helpful process that requires skills in both science and decision making. PMID:23940310

Economic evaluation of pharmacogenomics: a value-based approach to pragmatic decision making in the face of complexity.

PubMed

Snyder, Susan R; Mitropoulou, Christina; Patrinos, George P; Williams, Marc S

2014-01-01

Evidence of the value of pharmacogenomic testing is needed to inform policymakers and clinicians for decision making related to adoption and coverage, and to facilitate prioritization for research and development. Pharmacogenomics has an important role in creating a more efficient healthcare system, and this article addresses how economic evaluation can strategically target evidence gaps for public health priorities with examples from pharmacogenomic medicine. This article begins with a review of the need for and use of economic evaluations in value-based decision making for pharmacogenomic testing. Three important gaps are described with examples demonstrating how they can be addressed: (1) projected impact of hypothetical new technology, (2) pre-implementation assessment of a specific technology, and (3) post-implementation assessment from relevant analytical stakeholder perspectives. Additional needs, challenges and approaches specific to pharmacogenomic economic evaluation in the developing world are also identified. These pragmatic approaches can provide much needed evidence to support real-world value-based decision making for pharmacogenomic-based screening and treatment strategies. © 2014 S. Karger AG, Basel.

Nurses' decision making in heart failure management based on heart failure certification status.

PubMed

Albert, Nancy M; Bena, James F; Buxbaum, Denise; Martensen, Linda; Morrison, Shannon L; Prasun, Marilyn A; Stamp, Kelly D

Research findings on the value of nurse certification were based on subjective perceptions or biased by correlations of certification status and global clinical factors. In heart failure, the value of certification is unknown. Examine the value of certification based nurses' decision-making. Cross-sectional study of nurses who completed heart failure clinical vignettes that reflected decision-making in clinical heart failure scenarios. Statistical tests included multivariable linear, logistic and proportional odds logistic regression models. Of nurses (N = 605), 29.1% were heart failure certified, 35.0% were certified in another specialty/job role and 35.9% were not certified. In multivariable modeling, nurses certified in heart failure (versus not heart failure certified) had higher clinical vignette scores (p = 0.002), reflecting higher evidence-based decision making; nurses with another specialty/role certification (versus no certification) did not (p = 0.62). Heart failure certification, but not in other specialty/job roles was associated with decisions that reflected delivery of high-quality care. Copyright © 2018 Elsevier Inc. All rights reserved.

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

PubMed

Charles, Sonya; Wolf, Allison B

2018-06-01

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

Covert shift of attention modulates the value encoding in the orbitofrontal cortex

PubMed Central

Xie, Yang; Nie, Chechang

2018-01-01

During value-based decision making, we often evaluate the value of each option sequentially by shifting our attention, even when the options are presented simultaneously. The orbitofrontal cortex (OFC) has been suggested to encode value during value-based decision making. Yet it is not known how its activity is modulated by attention shifts. We investigated this question by employing a passive viewing task that allowed us to disentangle effects of attention, value, choice and eye movement. We found that the attention modulated OFC activity through a winner-take-all mechanism. When we attracted the monkeys’ attention covertly, the OFC neuronal activity reflected the reward value of the newly attended cue. The shift of attention could be explained by a normalization model. Our results strongly argue for the hypothesis that the OFC neuronal activity represents the value of the attended item. They provide important insights toward understanding the OFC’s role in value-based decision making. PMID:29533184

Covert shift of attention modulates the value encoding in the orbitofrontal cortex.

PubMed

Xie, Yang; Nie, Chechang; Yang, Tianming

2018-03-13

During value-based decision making, we often evaluate the value of each option sequentially by shifting our attention, even when the options are presented simultaneously. The orbitofrontal cortex (OFC) has been suggested to encode value during value-based decision making. Yet it is not known how its activity is modulated by attention shifts. We investigated this question by employing a passive viewing task that allowed us to disentangle effects of attention, value, choice and eye movement. We found that the attention modulated OFC activity through a winner-take-all mechanism. When we attracted the monkeys' attention covertly, the OFC neuronal activity reflected the reward value of the newly attended cue. The shift of attention could be explained by a normalization model. Our results strongly argue for the hypothesis that the OFC neuronal activity represents the value of the attended item. They provide important insights toward understanding the OFC's role in value-based decision making. © 2018, Xie et al.

Patients' Values in Clinical Decision-Making.

PubMed

Faggion, Clovis Mariano; Pachur, Thorsten; Giannakopoulos, Nikolaos Nikitas

2017-09-01

Shared decision-making involves the participation of patient and dental practitioner. Well-informed decision-making requires that both parties understand important concepts that may influence the decision. This fourth article in a series of 4 aims to discuss the importance of patients' values when a clinical decision is made. We report on how to incorporate important concepts for well-informed, shared decision-making. Here, we present patient values as an important issue, in addition to previously established topics such as the risk of bias of a study, cost-effectiveness of treatment approaches, and a comparison of therapeutic benefit with potential side effects. We provide 2 clinical examples and suggestions for a decision tree, based on the available evidence. The information reported in this article may improve the relationship between patient and dental practitioner, resulting in more well-informed clinical decisions. Copyright © 2017 Elsevier Inc. All rights reserved.

Reactivation of Reward-Related Patterns from Single Past Episodes Supports Memory-Based Decision Making.

PubMed

Wimmer, G Elliott; Büchel, Christian

2016-03-09

Rewarding experiences exert a strong influence on later decision making. While decades of neuroscience research have shown how reinforcement gradually shapes preferences, decisions are often influenced by single past experiences. Surprisingly, relatively little is known about the influence of single learning episodes. Although recent work has proposed a role for episodes in decision making, it is largely unknown whether and how episodic experiences contribute to value-based decision making and how the values of single episodes are represented in the brain. In multiple behavioral experiments and an fMRI experiment, we tested whether and how rewarding episodes could support later decision making. Participants experienced episodes of high reward or low reward in conjunction with incidental, trial-unique neutral pictures. In a surprise test phase, we found that participants could indeed remember the associated level of reward, as evidenced by accurate source memory for value and preferences to re-engage with rewarded objects. Further, in a separate experiment, we found that high-reward objects shown as primes before a gambling task increased financial risk taking. Neurally, re-exposure to objects in the test phase led to significant reactivation of reward-related patterns. Importantly, individual variability in the strength of reactivation predicted value memory performance. Our results provide a novel demonstration that affect-related neural patterns are reactivated during later experience. Reactivation of value information represents a mechanism by which memory can guide decision making. Copyright © 2016 the authors 0270-6474/16/362868-13$15.00/0.

Value-based decision making under uncertainty in hoarding and obsessive-compulsive disorders

PubMed Central

Pushkarskaya, Helen; Tolin, David; Ruderman, Lital; Henick, Daniel; Kelly, J. MacLaren; Pittenger, Christopher; Levy, Ifat

2017-01-01

Difficulties in decision making are a core impairment in a range of disease states. For instance, both obsessive-compulsive disorder (OCD) and hoarding disorder (HD) are associated with indecisiveness, inefficient planning, and enhanced uncertainty intolerance, even in contexts unrelated to their core symptomology. We examined decision-making patterns in 19 individuals with OCD, 19 individuals with HD, 19 individuals with comorbid OCD and HD, and 57 individuals from the general population, using a well-validated choice task grounded in behavioral economic theory. Our results suggest that difficulties in decision making in individuals with OCD (with or without comorbid HD) are linked to reduced fidelity of value-based decision making (i.e. increase in inconsistent choices). In contrast, we find that performance of individuals with HD on our laboratory task is largely intact. Overall, these results support our hypothesis that decision-making impairments in OCD and HD, which can appear quite similar clinically, have importantly different underpinnings. Systematic investigation of different aspects of decision making, under varying conditions, may shed new light on commonalities between and distinctions among clinical syndromes. PMID:28864119

Decision Making and Reward in Frontal Cortex

PubMed Central

Kennerley, Steven W.; Walton, Mark E.

2011-01-01

Patients with damage to the prefrontal cortex (PFC)—especially the ventral and medial parts of PFC—often show a marked inability to make choices that meet their needs and goals. These decision-making impairments often reflect both a deficit in learning concerning the consequences of a choice, as well as deficits in the ability to adapt future choices based on experienced value of the current choice. Thus, areas of PFC must support some value computations that are necessary for optimal choice. However, recent frameworks of decision making have highlighted that optimal and adaptive decision making does not simply rest on a single computation, but a number of different value computations may be necessary. Using this framework as a guide, we summarize evidence from both lesion studies and single-neuron physiology for the representation of different value computations across PFC areas. PMID:21534649

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

PubMed

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

2016-08-01

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

Exploring patient values in medical decision making: a qualitative study.

PubMed

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

2013-01-01

Patient decisions are influenced by their personal values. However, there is a lack of clarity and attention on the concept of patient values in the clinical context despite clear emphasis on patient values in evidence-based medicine and shared decision making. The aim of the study was to explore the concept of patient values in the context of making decisions about insulin initiation among people with type 2 diabetes. We conducted individual in-depth interviews with people with type 2 diabetes who were making decisions about insulin treatment. Participants were selected purposively to achieve maximum variation. A semi-structured topic guide was used to guide the interviews which were audio-recorded and analysed using a thematic approach. We interviewed 21 participants between January 2011 and March 2012. The age range of participants was 28-67 years old. Our sample comprised 9 women and 12 men. Three main themes, 'treatment-specific values', 'life goals and philosophies', and 'personal and social background', emerged from the analysis. The patients reported a variety of insulin-specific values, which were negative and/or positive beliefs about insulin. They framed insulin according to their priorities and philosophies in life. Patients' decisions were influenced by sociocultural (e.g. religious background) and personal backgrounds (e.g. family situations). This study highlighted the need for expanding the current concept of patient values in medical decision making. Clinicians should address more than just values related to treatment options. Patient values should include patients' priorities, life philosophy and their background. Current decision support tools, such as patient decision aids, should consider these new dimensions when clarifying patient values.

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

PubMed

Nakayama, Takeo

2018-01-01

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

Decision Making Analysis: Critical Factors-Based Methodology

DTIC Science & Technology

2010-04-01

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

Modulation of Saccade Vigor during Value-Based Decision Making.

PubMed

Reppert, Thomas R; Lempert, Karolina M; Glimcher, Paul W; Shadmehr, Reza

2015-11-18

During value-based decision-making, individuals consider the various options and select the one that provides the maximum subjective value. Although the brain integrates abstract information to compute and compare these values, the only behavioral outcome is often the decision itself. However, if the options are visual stimuli, during deliberation the brain moves the eyes from one stimulus to the other. Previous work suggests that saccade vigor, i.e., peak velocity as a function of amplitude, is greater if reward is associated with the visual stimulus. This raises the possibility that vigor during the free viewing of options may be influenced by the valuation of each option. Here, humans chose between a small, immediate monetary reward and a larger but delayed reward. As the deliberation began, vigor was similar for the saccades made to the two options but diverged 0.5 s before decision time, becoming greater for the preferred option. This difference in vigor increased as a function of the difference in the subjective values that the participant assigned to the delayed and immediate options. After the decision was made, participants continued to gaze at the options, but with reduced vigor, making it possible to infer timing of the decision from the sudden drop in vigor. Therefore, the subjective value that the brain assigned to a stimulus during decision-making affected the motor system via the vigor with which the eyes moved toward that stimulus. We find that, as individuals deliberate between two rewarding options and arrive at a decision, the vigor with which they make saccades to each option reflects a real-time evaluation of that option. With deliberation, saccade vigor diverges between the two options, becoming greater for the option that the individual will eventually choose. The results suggest a shared element between the network that assigns value to a stimulus during the process of decision-making and the network that controls vigor of movements toward that stimulus. Copyright © 2015 the authors 0270-6474/15/3515369-10$15.00/0.

Modulation of Saccade Vigor during Value-Based Decision Making

PubMed Central

Lempert, Karolina M.; Glimcher, Paul W.; Shadmehr, Reza

2015-01-01

During value-based decision-making, individuals consider the various options and select the one that provides the maximum subjective value. Although the brain integrates abstract information to compute and compare these values, the only behavioral outcome is often the decision itself. However, if the options are visual stimuli, during deliberation the brain moves the eyes from one stimulus to the other. Previous work suggests that saccade vigor, i.e., peak velocity as a function of amplitude, is greater if reward is associated with the visual stimulus. This raises the possibility that vigor during the free viewing of options may be influenced by the valuation of each option. Here, humans chose between a small, immediate monetary reward and a larger but delayed reward. As the deliberation began, vigor was similar for the saccades made to the two options but diverged 0.5 s before decision time, becoming greater for the preferred option. This difference in vigor increased as a function of the difference in the subjective values that the participant assigned to the delayed and immediate options. After the decision was made, participants continued to gaze at the options, but with reduced vigor, making it possible to infer timing of the decision from the sudden drop in vigor. Therefore, the subjective value that the brain assigned to a stimulus during decision-making affected the motor system via the vigor with which the eyes moved toward that stimulus. SIGNIFICANCE STATEMENT We find that, as individuals deliberate between two rewarding options and arrive at a decision, the vigor with which they make saccades to each option reflects a real-time evaluation of that option. With deliberation, saccade vigor diverges between the two options, becoming greater for the option that the individual will eventually choose. The results suggest a shared element between the network that assigns value to a stimulus during the process of decision-making and the network that controls vigor of movements toward that stimulus. PMID:26586823

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

PubMed

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

2010-02-01

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

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

PubMed Central

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

2010-01-01

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

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

PubMed Central

Konovalov, Arkady; Krajbich, Ian

2016-01-01

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

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

PubMed

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

2016-01-01

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

On the suitability of fast and frugal heuristics for designing values clarification methods in patient decision aids: a critical analysis.

PubMed

Pieterse, Arwen H; de Vries, Marieke

2013-09-01

Increasingly, patient decision aids and values clarification methods (VCMs) are being developed to support patients in making preference-sensitive health-care decisions. Many VCMs encourage extensive deliberation about options, without solid theoretical or empirical evidence showing that deliberation is advantageous. Research suggests that simple, fast and frugal heuristic decision strategies sometimes result in better judgments and decisions. Durand et al. have developed two fast and frugal heuristic-based VCMs. To critically analyse the suitability of the 'take the best' (TTB) and 'tallying' fast and frugal heuristics in the context of patient decision making. Analysis of the structural similarities between the environments in which the TTB and tallying heuristics have been proven successful and the context of patient decision making and of the potential of these heuristic decision processes to support patient decision making. The specific nature of patient preference-sensitive decision making does not seem to resemble environments in which the TTB and tallying heuristics have proven successful. Encouraging patients to consider less rather than more relevant information potentially even deteriorates their values clarification process. Values clarification methods promoting the use of more intuitive decision strategies may sometimes be more effective. Nevertheless, we strongly recommend further theoretical thinking about the expected value of such heuristics and of other more intuitive decision strategies in this context, as well as empirical assessments of the mechanisms by which inducing such decision strategies may impact the quality and outcome of values clarification. © 2011 John Wiley & Sons Ltd.

On the suitability of fast and frugal heuristics for designing values clarification methods in patient decision aids: a critical analysis

PubMed Central

Pieterse, Arwen H.; de Vries, Marieke

2011-01-01

Abstract Background  Increasingly, patient decision aids and values clarification methods (VCMs) are being developed to support patients in making preference‐sensitive health‐care decisions. Many VCMs encourage extensive deliberation about options, without solid theoretical or empirical evidence showing that deliberation is advantageous. Research suggests that simple, fast and frugal heuristic decision strategies sometimes result in better judgments and decisions. Durand et al. have developed two fast and frugal heuristic‐based VCMs. Objective  To critically analyse the suitability of the ‘take the best’ (TTB) and ‘tallying’ fast and frugal heuristics in the context of patient decision making. Strategy  Analysis of the structural similarities between the environments in which the TTB and tallying heuristics have been proven successful and the context of patient decision making and of the potential of these heuristic decision processes to support patient decision making. Conclusion  The specific nature of patient preference‐sensitive decision making does not seem to resemble environments in which the TTB and tallying heuristics have proven successful. Encouraging patients to consider less rather than more relevant information potentially even deteriorates their values clarification process. Values clarification methods promoting the use of more intuitive decision strategies may sometimes be more effective. Nevertheless, we strongly recommend further theoretical thinking about the expected value of such heuristics and of other more intuitive decision strategies in this context, as well as empirical assessments of the mechanisms by which inducing such decision strategies may impact the quality and outcome of values clarification. PMID:21902770

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

USGS Publications Warehouse

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

2016-01-01

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

Led into temptation? Rewarding brand logos bias the neural encoding of incidental economic decisions.

PubMed

Murawski, Carsten; Harris, Philip G; Bode, Stefan; Domínguez D, Juan F; Egan, Gary F

2012-01-01

Human decision-making is driven by subjective values assigned to alternative choice options. These valuations are based on reward cues. It is unknown, however, whether complex reward cues, such as brand logos, may bias the neural encoding of subjective value in unrelated decisions. In this functional magnetic resonance imaging (fMRI) study, we subliminally presented brand logos preceding intertemporal choices. We demonstrated that priming biased participants' preferences towards more immediate rewards in the subsequent temporal discounting task. This was associated with modulations of the neural encoding of subjective values of choice options in a network of brain regions, including but not restricted to medial prefrontal cortex. Our findings demonstrate the general susceptibility of the human decision making system to apparently incidental contextual information. We conclude that the brain incorporates seemingly unrelated value information that modifies decision making outside the decision-maker's awareness.

Led into Temptation? Rewarding Brand Logos Bias the Neural Encoding of Incidental Economic Decisions

PubMed Central

Murawski, Carsten; Harris, Philip G.; Bode, Stefan; Domínguez D., Juan F.; Egan, Gary F.

2012-01-01

Human decision-making is driven by subjective values assigned to alternative choice options. These valuations are based on reward cues. It is unknown, however, whether complex reward cues, such as brand logos, may bias the neural encoding of subjective value in unrelated decisions. In this functional magnetic resonance imaging (fMRI) study, we subliminally presented brand logos preceding intertemporal choices. We demonstrated that priming biased participants' preferences towards more immediate rewards in the subsequent temporal discounting task. This was associated with modulations of the neural encoding of subjective values of choice options in a network of brain regions, including but not restricted to medial prefrontal cortex. Our findings demonstrate the general susceptibility of the human decision making system to apparently incidental contextual information. We conclude that the brain incorporates seemingly unrelated value information that modifies decision making outside the decision-maker's awareness. PMID:22479547

Passionate Rationalism: The Role of Emotion in Decision Making

ERIC Educational Resources Information Center

Lakomski, Gabriele; Evers, Colin W.

2010-01-01

Purpose: The purpose of this paper is to argue that emotion has a central role to play in rational decision making based on recent research in the neuroanatomy of emotion. As a result, traditional rational decision-making theories, including Herbert Simon's modified model of satisficing that sharply demarcates emotions and values from rationality…

Health technology assessment, value-based decision making, and innovation.

PubMed

Henshall, Chris; Schuller, Tara

2013-10-01

Identifying treatments that offer value and value for money is becoming increasingly important, with interest in how health technology assessment (HTA) and decision makers can take appropriate account of what is of value to patients and to society, and in the relationship between innovation and assessments of value. This study summarizes points from an Health Technology Assessment International (HTAi) Policy Forum discussion, drawing on presentations, discussions among attendees, and background papers. Various perspectives on value were considered; most place patient health at the core of value. Wider elements of value comprise other benefits for: patients; caregivers; the health and social care systems; and society. Most decision-making systems seek to take account of similar elements of value, although they are assessed and combined in different ways. Judgment in decisions remains important and cannot be replaced by mathematical approaches. There was discussion of the value of innovation and of the effects of value assessments on innovation. Discussion also included moving toward "progressive health system decision making," an ongoing process whereby evidence-based decisions on use would be made at various stages in the technology lifecycle. Five actions are identified: (i) development of a general framework for the definition and assessment of value; development by HTA/coverage bodies and regulators of (ii) disease-specific guidance and (iii) further joint scientific advice for industry on demonstrating value; (iv) development of a framework for progressive licensing, usage, and reimbursement; and (v) promoting work to better adapt HTA, coverage, and procurement approaches to medical devices.

Frontal, Striatal, and Medial Temporal Sensitivity to Value Distinguishes Risk-Taking from Risk-Aversive Older Adults during Decision Making.

PubMed

Goh, Joshua O S; Su, Yu-Shiang; Tang, Yong-Jheng; McCarrey, Anna C; Tereshchenko, Alexander; Elkins, Wendy; Resnick, Susan M

2016-12-07

Aging compromises the frontal, striatal, and medial temporal areas of the reward system, impeding accurate value representation and feedback processing critical for decision making. However, substantial variability characterizes age-related effects on the brain so that some older individuals evince clear neurocognitive declines whereas others are spared. Moreover, the functional correlates of normative individual differences in older-adult value-based decision making remain unclear. We performed a functional magnetic resonance imaging study in 173 human older adults during a lottery choice task in which costly to more desirable stakes were depicted using low to high expected values (EVs) of points. Across trials that varied in EVs, participants decided to accept or decline the offered stakes to maximize total accumulated points. We found that greater age was associated with less optimal decisions, accepting stakes when losses were likely and declining stakes when gains were likely, and was associated with increased frontal activity for costlier stakes. Critically, risk preferences varied substantially across older adults and neural sensitivity to EVs in the frontal, striatal, and medial temporal areas dissociated risk-aversive from risk-taking individuals. Specifically, risk-averters increased neural responses to increasing EVs as stakes became more desirable, whereas risk-takers increased neural responses with decreasing EV as stakes became more costly. Risk preference also modulated striatal responses during feedback with risk-takers showing more positive responses to gains compared with risk-averters. Our findings highlight the frontal, striatal, and medial temporal areas as key neural loci in which individual differences differentially affect value-based decision-making ability in older adults. Frontal, striatal, and medial temporal functions implicated in value-based decision processing of rewards and costs undergo substantial age-related changes. However, age effects on brain function and cognition differ across individuals. How this normative variation relates to older-adult value-based decision making is unclear. We found that although the ability make optimal decisions declines with age, there is still much individual variability in how this deterioration occurs. Critically, whereas risk-averters showed increased neural activity to increasingly valuable stakes in frontal, striatal, and medial temporal areas, risk-takers instead increased activity as stakes became more costly. Such distinct functional decision-making processing in these brain regions across normative older adults may reflect individual differences in susceptibility to age-related brain changes associated with incipient cognitive impairment. Copyright © 2016 the authors 0270-6474/16/3612498-12$15.00/0.

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

PubMed

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

2015-01-01

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

Exploring Patient Values in Medical Decision Making: A Qualitative Study

PubMed Central

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

2013-01-01

Background Patient decisions are influenced by their personal values. However, there is a lack of clarity and attention on the concept of patient values in the clinical context despite clear emphasis on patient values in evidence-based medicine and shared decision making. The aim of the study was to explore the concept of patient values in the context of making decisions about insulin initiation among people with type 2 diabetes. Methods and Findings We conducted individual in-depth interviews with people with type 2 diabetes who were making decisions about insulin treatment. Participants were selected purposively to achieve maximum variation. A semi-structured topic guide was used to guide the interviews which were audio-recorded and analysed using a thematic approach. We interviewed 21 participants between January 2011 and March 2012. The age range of participants was 28–67 years old. Our sample comprised 9 women and 12 men. Three main themes, ‘treatment-specific values’, ‘life goals and philosophies’, and ‘personal and social background’, emerged from the analysis. The patients reported a variety of insulin-specific values, which were negative and/or positive beliefs about insulin. They framed insulin according to their priorities and philosophies in life. Patients’ decisions were influenced by sociocultural (e.g. religious background) and personal backgrounds (e.g. family situations). Conclusions This study highlighted the need for expanding the current concept of patient values in medical decision making. Clinicians should address more than just values related to treatment options. Patient values should include patients’ priorities, life philosophy and their background. Current decision support tools, such as patient decision aids, should consider these new dimensions when clarifying patient values. PMID:24282518

Decision-Making under Criteria Uncertainty

NASA Astrophysics Data System (ADS)

Kureychik, V. M.; Safronenkova, I. B.

2018-05-01

Uncertainty is an essential part of a decision-making procedure. The paper deals with the problem of decision-making under criteria uncertainty. In this context, decision-making under uncertainty, types and conditions of uncertainty were examined. The decision-making problem under uncertainty was formalized. A modification of the mathematical decision support method under uncertainty via ontologies was proposed. A critical distinction of the developed method is ontology usage as its base elements. The goal of this work is a development of a decision-making method under criteria uncertainty with the use of ontologies in the area of multilayer board designing. This method is oriented to improvement of technical-economic values of the examined domain.

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

PubMed

Murray, Elisabeth A; Rudebeck, Peter H

2018-05-23

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

Evidence-Based and Value-Based Decision Making About Healthcare Design: An Economic Evaluation of the Safety and Quality Outcomes.

PubMed

Zadeh, Rana; Sadatsafavi, Hessam; Xue, Ryan

2015-01-01

This study describes a vision and framework that can facilitate the implementation of evidence-based design (EBD), scientific knowledge base into the process of the design, construction, and operation of healthcare facilities and clarify the related safety and quality outcomes for the stakeholders. The proposed framework pairs EBD with value-driven decision making and aims to improve communication among stakeholders by providing a common analytical language. Recent EBD research indicates that the design and operation of healthcare facilities contribute to an organization's operational success by improving safety, quality, and efficiency. However, because little information is available about the financial returns of evidence-based investments, such investments are readily eliminated during the capital-investment decision-making process. To model the proposed framework, we used engineering economy tools to evaluate the return on investments in six successful cases, identified by a literature review, in which facility design and operation interventions resulted in reductions in hospital-acquired infections, patient falls, staff injuries, and patient anxiety. In the evidence-based cases, calculated net present values, internal rates of return, and payback periods indicated that the long-term benefits of interventions substantially outweighed the intervention costs. This article explained a framework to develop a research-based and value-based communication language on specific interventions along the planning, design and construction, operation, and evaluation stages. Evidence-based and value-based design frameworks can be applied to communicate the life-cycle costs and savings of EBD interventions to stakeholders, thereby contributing to more informed decision makings and the optimization of healthcare infrastructures. © The Author(s) 2015.

Mind the Gap: A Case Study of Values-Based Decision Making in a Nonprofit Organization

ERIC Educational Resources Information Center

Craft, Jana L.

2013-01-01

Using an exploratory case study approach, this research examined the consistency between espoused and enacted values within a large nonprofit organization known as an ethical leader in the human services industry. This research explored ethical business culture, ethical decision making, deontological and utilitarian moral paradigms and learning…

Value-Based Reimbursement: Impact of Curtailing Physician Autonomy in Medical Decision Making.

PubMed

Gupta, Dipti; Karst, Ingolf; Mendelson, Ellen B

2016-02-01

In this article, we define value in the context of reimbursement and explore the effect of shifting reimbursement paradigms on the decision-making autonomy of a women's imaging radiologist. The current metrics used for value-based reimbursement such as report turnaround time are surrogate measures that do not measure value directly. The true measure of a physician's value in medicine is accomplishment of better health outcomes, which, in breast imaging, are best achieved with a physician-patient relationship. Complying with evidence-based medicine, which includes data-driven best clinical practices, a physician's clinical expertise, and the patient's values, will improve our science and preserve the art of medicine.

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

Optimal policy for value-based decision-making.

PubMed

Tajima, Satohiro; Drugowitsch, Jan; Pouget, Alexandre

2016-08-18

For decades now, normative theories of perceptual decisions, and their implementation as drift diffusion models, have driven and significantly improved our understanding of human and animal behaviour and the underlying neural processes. While similar processes seem to govern value-based decisions, we still lack the theoretical understanding of why this ought to be the case. Here, we show that, similar to perceptual decisions, drift diffusion models implement the optimal strategy for value-based decisions. Such optimal decisions require the models' decision boundaries to collapse over time, and to depend on the a priori knowledge about reward contingencies. Diffusion models only implement the optimal strategy under specific task assumptions, and cease to be optimal once we start relaxing these assumptions, by, for example, using non-linear utility functions. Our findings thus provide the much-needed theory for value-based decisions, explain the apparent similarity to perceptual decisions, and predict conditions under which this similarity should break down.

Optimal policy for value-based decision-making

PubMed Central

Tajima, Satohiro; Drugowitsch, Jan; Pouget, Alexandre

2016-01-01

For decades now, normative theories of perceptual decisions, and their implementation as drift diffusion models, have driven and significantly improved our understanding of human and animal behaviour and the underlying neural processes. While similar processes seem to govern value-based decisions, we still lack the theoretical understanding of why this ought to be the case. Here, we show that, similar to perceptual decisions, drift diffusion models implement the optimal strategy for value-based decisions. Such optimal decisions require the models' decision boundaries to collapse over time, and to depend on the a priori knowledge about reward contingencies. Diffusion models only implement the optimal strategy under specific task assumptions, and cease to be optimal once we start relaxing these assumptions, by, for example, using non-linear utility functions. Our findings thus provide the much-needed theory for value-based decisions, explain the apparent similarity to perceptual decisions, and predict conditions under which this similarity should break down. PMID:27535638

Do Political and Economic Choices Rely on Common Neural Substrates? A Systematic Review of the Emerging Neuropolitics Literature.

PubMed

Krastev, Sekoul; McGuire, Joseph T; McNeney, Denver; Kable, Joseph W; Stolle, Dietlind; Gidengil, Elisabeth; Fellows, Lesley K

2016-01-01

The methods of cognitive neuroscience are beginning to be applied to the study of political behavior. The neural substrates of value-based decision-making have been extensively examined in economic contexts; this might provide a powerful starting point for understanding political decision-making. Here, we asked to what extent the neuropolitics literature to date has used conceptual frameworks and experimental designs that make contact with the reward-related approaches that have dominated decision neuroscience. We then asked whether the studies of political behavior that can be considered in this light implicate the brain regions that have been associated with subjective value related to "economic" reward. We performed a systematic literature review to identify papers addressing the neural substrates of political behavior and extracted the fMRI studies reporting behavioral measures of subjective value as defined in decision neuroscience studies of reward. A minority of neuropolitics studies met these criteria and relatively few brain activation foci from these studies overlapped with regions where activity has been related to subjective value. These findings show modest influence of reward-focused decision neuroscience on neuropolitics research to date. Whether the neural substrates of subjective value identified in economic choice paradigms generalize to political choice thus remains an open question. We argue that systematically addressing the commonalities and differences in these two classes of value-based choice will be important in developing a more comprehensive model of the brain basis of human decision-making.

Do Political and Economic Choices Rely on Common Neural Substrates? A Systematic Review of the Emerging Neuropolitics Literature

PubMed Central

Krastev, Sekoul; McGuire, Joseph T.; McNeney, Denver; Kable, Joseph W.; Stolle, Dietlind; Gidengil, Elisabeth; Fellows, Lesley K.

2016-01-01

The methods of cognitive neuroscience are beginning to be applied to the study of political behavior. The neural substrates of value-based decision-making have been extensively examined in economic contexts; this might provide a powerful starting point for understanding political decision-making. Here, we asked to what extent the neuropolitics literature to date has used conceptual frameworks and experimental designs that make contact with the reward-related approaches that have dominated decision neuroscience. We then asked whether the studies of political behavior that can be considered in this light implicate the brain regions that have been associated with subjective value related to “economic” reward. We performed a systematic literature review to identify papers addressing the neural substrates of political behavior and extracted the fMRI studies reporting behavioral measures of subjective value as defined in decision neuroscience studies of reward. A minority of neuropolitics studies met these criteria and relatively few brain activation foci from these studies overlapped with regions where activity has been related to subjective value. These findings show modest influence of reward-focused decision neuroscience on neuropolitics research to date. Whether the neural substrates of subjective value identified in economic choice paradigms generalize to political choice thus remains an open question. We argue that systematically addressing the commonalities and differences in these two classes of value-based choice will be important in developing a more comprehensive model of the brain basis of human decision-making. PMID:26941703

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

Cancer care decision making in multidisciplinary meetings.

PubMed

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

2015-03-01

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

Patients Should Define Value in Health Care: A Conceptual Framework.

PubMed

Kamal, Robin N; Lindsay, Sarah E; Eppler, Sara L

2018-05-10

The main tenet of value-based health care is delivering high-quality care that is centered on the patient, improving health, and minimizing cost. Collaborative decision-making frameworks have been developed to help facilitate delivering care based on patient preferences (patient-centered care). The current value-based health care model, however, focuses on improving population health and overlooks the individuality of patients and their preferences for care. We highlight the importance of eliciting patient preferences in collaborative decision making and describe a conceptual framework that incorporates individual patients' preferences when defining value. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Effects of emotional preferences on value-based decision making are mediated by mentalizing not reward networks

PubMed Central

Evans, Simon; Fleming, Stephen M.; Dolan, Raymond J.; Averbeck, Bruno B.

2012-01-01

Real-world decision-making often involves social considerations. Consequently, the social value of stimuli can induce preferences in choice behavior. However, it is unknown how financial and social values are integrated in the brain. Here, we investigated how smiling and angry face stimuli interacted with financial reward feedback in a stochastically-rewarded decision-making task. Subjects reliably preferred the smiling faces despite equivalent reward feedback, demonstrating a socially driven bias. We fit a Bayesian reinforcement learning model to factor the effects of financial rewards and emotion preferences in individual subjects, and regressed model predictions on the trial-by-trial fMRI signal. Activity in the sub-callosal cingulate and the ventral striatum, both involved in reward learning, correlated with financial reward feedback, whereas the differential contribution of social value activated dorsal temporo-parietal junction and dorsal anterior cingulate cortex, previously proposed as components of a mentalizing network. We conclude that the impact of social stimuli on value-based decision processes is mediated by effects in brain regions partially separable from classical reward circuitry. PMID:20946058

Influence of branding on preference-based decision making.

PubMed

Philiastides, Marios G; Ratcliff, Roger

2013-07-01

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

Value Assessment at the Point of Care: Incorporating Patient Values throughout Care Delivery and a Draft Taxonomy of Patient Values.

PubMed

Armstrong, Melissa J; Mullins, C Daniel

2017-02-01

Incorporation of patient values is a key element of patient-centered care, but consistent incorporation of patient values at the point of care is lacking. Shared decision making encourages incorporation of patient values in decision making, but associated tools often lack guidance on value assessment. In addition, focusing on patient values relating only to specific decisions misses an opportunity for a more holistic approach to value assessment that could impact other aspects of clinical encounters, including health care planning, communication, and stakeholder involvement. In this commentary, we propose a taxonomy of values underlying patient decision making and provide examples of how these impact provision of health care. The taxonomy describes four categories of patient values: global, decisional, situational, and external. Global values are personal values impacting decision making at a universal level and can include value traits and life priorities. Decisional values are the values traditionally conceptualized in decision making, including considerations such as efficacy, toxicity, quality of life, convenience, and cost. Situational values are values tied to a specific moment in time that modify patients' existing global and decisional values. Finally, discussion of external values acknowledges that many patients consider values other than their own when making decisions. Recognizing the breadth of values impacting patient decision making has implications for both overall health care delivery and shared decision making because value assessments focusing only on decisional values may miss important patient considerations. This draft taxonomy highlights different values impacting decision making and facilitates a more complete value assessment at the point of care. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

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

Interval MULTIMOORA method with target values of attributes based on interval distance and preference degree: biomaterials selection

NASA Astrophysics Data System (ADS)

Hafezalkotob, Arian; Hafezalkotob, Ashkan

2017-06-01

A target-based MADM method covers beneficial and non-beneficial attributes besides target values for some attributes. Such techniques are considered as the comprehensive forms of MADM approaches. Target-based MADM methods can also be used in traditional decision-making problems in which beneficial and non-beneficial attributes only exist. In many practical selection problems, some attributes have given target values. The values of decision matrix and target-based attributes can be provided as intervals in some of such problems. Some target-based decision-making methods have recently been developed; however, a research gap exists in the area of MADM techniques with target-based attributes under uncertainty of information. We extend the MULTIMOORA method for solving practical material selection problems in which material properties and their target values are given as interval numbers. We employ various concepts of interval computations to reduce degeneration of uncertain data. In this regard, we use interval arithmetic and introduce innovative formula for interval distance of interval numbers to create interval target-based normalization technique. Furthermore, we use a pairwise preference matrix based on the concept of degree of preference of interval numbers to calculate the maximum, minimum, and ranking of these numbers. Two decision-making problems regarding biomaterials selection of hip and knee prostheses are discussed. Preference degree-based ranking lists for subordinate parts of the extended MULTIMOORA method are generated by calculating the relative degrees of preference for the arranged assessment values of the biomaterials. The resultant rankings for the problem are compared with the outcomes of other target-based models in the literature.

Dopamine modulates the neural representation of subjective value of food in hungry subjects.

PubMed

Medic, Nenad; Ziauddeen, Hisham; Vestergaard, Martin D; Henning, Elana; Schultz, Wolfram; Farooqi, I Sadaf; Fletcher, Paul C

2014-12-10

Although there is a rich literature on the role of dopamine in value learning, much less is known about its role in using established value estimations to shape decision-making. Here we investigated the effect of dopaminergic modulation on value-based decision-making for food items in fasted healthy human participants. The Becker-deGroot-Marschak auction, which assesses subjective value, was examined in conjunction with pharmacological fMRI using a dopaminergic agonist and an antagonist. We found that dopamine enhanced the neural response to value in the inferior parietal gyrus/intraparietal sulcus, and that this effect predominated toward the end of the valuation process when an action was needed to record the value. Our results suggest that dopamine is involved in acting upon the decision, providing additional insight to the mechanisms underlying impaired decision-making in healthy individuals and clinical populations with reduced dopamine levels. Copyright © 2014 the authors 0270-6474/14/3416856-09$15.00/0.

Of goals and habits: age-related and individual differences in goal-directed decision-making.

PubMed

Eppinger, Ben; Walter, Maik; Heekeren, Hauke R; Li, Shu-Chen

2013-01-01

In this study we investigated age-related and individual differences in habitual (model-free) and goal-directed (model-based) decision-making. Specifically, we were interested in three questions. First, does age affect the balance between model-based and model-free decision mechanisms? Second, are these age-related changes due to age differences in working memory (WM) capacity? Third, can model-based behavior be affected by manipulating the distinctiveness of the reward value of choice options? To answer these questions we used a two-stage Markov decision task in in combination with computational modeling to dissociate model-based and model-free decision mechanisms. To affect model-based behavior in this task we manipulated the distinctiveness of reward probabilities of choice options. The results show age-related deficits in model-based decision-making, which are particularly pronounced if unexpected reward indicates the need for a shift in decision strategy. In this situation younger adults explore the task structure, whereas older adults show perseverative behavior. Consistent with previous findings, these results indicate that older adults have deficits in the representation and updating of expected reward value. We also observed substantial individual differences in model-based behavior. In younger adults high WM capacity is associated with greater model-based behavior and this effect is further elevated when reward probabilities are more distinct. However, in older adults we found no effect of WM capacity. Moreover, age differences in model-based behavior remained statistically significant, even after controlling for WM capacity. Thus, factors other than decline in WM, such as deficits in the in the integration of expected reward value into strategic decisions may contribute to the observed impairments in model-based behavior in older adults.

Of goals and habits: age-related and individual differences in goal-directed decision-making

PubMed Central

Eppinger, Ben; Walter, Maik; Heekeren, Hauke R.; Li, Shu-Chen

2013-01-01

In this study we investigated age-related and individual differences in habitual (model-free) and goal-directed (model-based) decision-making. Specifically, we were interested in three questions. First, does age affect the balance between model-based and model-free decision mechanisms? Second, are these age-related changes due to age differences in working memory (WM) capacity? Third, can model-based behavior be affected by manipulating the distinctiveness of the reward value of choice options? To answer these questions we used a two-stage Markov decision task in in combination with computational modeling to dissociate model-based and model-free decision mechanisms. To affect model-based behavior in this task we manipulated the distinctiveness of reward probabilities of choice options. The results show age-related deficits in model-based decision-making, which are particularly pronounced if unexpected reward indicates the need for a shift in decision strategy. In this situation younger adults explore the task structure, whereas older adults show perseverative behavior. Consistent with previous findings, these results indicate that older adults have deficits in the representation and updating of expected reward value. We also observed substantial individual differences in model-based behavior. In younger adults high WM capacity is associated with greater model-based behavior and this effect is further elevated when reward probabilities are more distinct. However, in older adults we found no effect of WM capacity. Moreover, age differences in model-based behavior remained statistically significant, even after controlling for WM capacity. Thus, factors other than decline in WM, such as deficits in the in the integration of expected reward value into strategic decisions may contribute to the observed impairments in model-based behavior in older adults. PMID:24399925

Evidence for the speed-value trade-off: human and monkey decision making is magnitude sensitive.

PubMed

Pirrone, Angelo; Azab, Habiba; Hayden, Benjamin Y; Stafford, Tom; Marshall, James A R

2018-04-01

Complex natural systems from brains to bee swarms have evolved to make adaptive multifactorial decisions. Recent theoretical and empirical work suggests that many evolved systems may take advantage of common motifs across multiple domains. We are particularly interested in value sensitivity (i.e., sensitivity to the magnitude or intensity of the stimuli or reward under consideration) as a mechanism to resolve deadlocks adaptively. This mechanism favours long-term reward maximization over accuracy in a simple manner, because it avoids costly delays associated with ambivalence between similar options; speed-value trade-offs have been proposed to be evolutionarily advantageous for many kinds of decision. A key prediction of the value-sensitivity hypothesis is that choices between equally-valued options will proceed faster when the options have a high value than when they have a low value. However, value-sensitivity is not part of idealised choice models such as diffusion to bound. Here we examine two different choice behaviours in two different species, perceptual decisions in humans and economic choices in rhesus monkeys, to test this hypothesis. We observe the same value sensitivity in both human perceptual decisions and monkey value-based decisions. These results endorse the idea that neural decision systems make use of the same basic principle of value-sensitivity in order to resolve costly deadlocks and thus improve long-term reward intake.

Evidence for the speed-value trade-off: human and monkey decision making is magnitude sensitive

PubMed Central

Pirrone, Angelo; Azab, Habiba; Hayden, Benjamin Y.; Stafford, Tom; Marshall, James A. R.

2017-01-01

Complex natural systems from brains to bee swarms have evolved to make adaptive multifactorial decisions. Recent theoretical and empirical work suggests that many evolved systems may take advantage of common motifs across multiple domains. We are particularly interested in value sensitivity (i.e., sensitivity to the magnitude or intensity of the stimuli or reward under consideration) as a mechanism to resolve deadlocks adaptively. This mechanism favours long-term reward maximization over accuracy in a simple manner, because it avoids costly delays associated with ambivalence between similar options; speed-value trade-offs have been proposed to be evolutionarily advantageous for many kinds of decision. A key prediction of the value-sensitivity hypothesis is that choices between equally-valued options will proceed faster when the options have a high value than when they have a low value. However, value-sensitivity is not part of idealised choice models such as diffusion to bound. Here we examine two different choice behaviours in two different species, perceptual decisions in humans and economic choices in rhesus monkeys, to test this hypothesis. We observe the same value sensitivity in both human perceptual decisions and monkey value-based decisions. These results endorse the idea that neural decision systems make use of the same basic principle of value-sensitivity in order to resolve costly deadlocks and thus improve long-term reward intake. PMID:29682592

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

PubMed Central

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

2015-01-01

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

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.

Willingness-to-pay for a probabilistic flood forecast: a risk-based decision-making game

NASA Astrophysics Data System (ADS)

Arnal, Louise; Ramos, Maria-Helena; Coughlan de Perez, Erin; Cloke, Hannah Louise; Stephens, Elisabeth; Wetterhall, Fredrik; van Andel, Schalk Jan; Pappenberger, Florian

2016-08-01

Probabilistic hydro-meteorological forecasts have over the last decades been used more frequently to communicate forecast uncertainty. This uncertainty is twofold, as it constitutes both an added value and a challenge for the forecaster and the user of the forecasts. Many authors have demonstrated the added (economic) value of probabilistic over deterministic forecasts across the water sector (e.g. flood protection, hydroelectric power management and navigation). However, the richness of the information is also a source of challenges for operational uses, due partially to the difficulty in transforming the probability of occurrence of an event into a binary decision. This paper presents the results of a risk-based decision-making game on the topic of flood protection mitigation, called "How much are you prepared to pay for a forecast?". The game was played at several workshops in 2015, which were attended by operational forecasters and academics working in the field of hydro-meteorology. The aim of this game was to better understand the role of probabilistic forecasts in decision-making processes and their perceived value by decision-makers. Based on the participants' willingness-to-pay for a forecast, the results of the game show that the value (or the usefulness) of a forecast depends on several factors, including the way users perceive the quality of their forecasts and link it to the perception of their own performances as decision-makers.

Attitudes towards Prosthodontic Clinical Decision-Making for Edentulous Patients among South West Deanery Dental Foundation Year One Dentists

PubMed Central

Barber, Andrew; Puryer, James; Leary, Sam; McNally, Lisa; O’Sullivan, Dominic

2016-01-01

The aim of this study was to describe Dental Foundation year one dentists’ attitudes towards prosthodontic decision making for edentulous patients, and identify whether there are gender differences in these attitudes. All South West Deanery trainees were invited to take part in the study between May and June 2011 and a previously piloted questionnaire was administered to the trainees by their training programme directors. The questionnaire posed questions based upon a clinical scenario of discussing treatment options with patients. Seventy-two questionnaires were used in the analysis (91% overall response rate). Trainees perceived their own values to be less important than the patient’s values (p < 0.001) in decision making, but similar to the patient’s friend’s/relative’s values (p = 0.1). In addition, the trainees perceived the patient’s values to be less important than their friend’s/relatives (p < 0.001). Sixty-six per cent of trainees acknowledged an influence from their own personal values on their presentation of material to patients who are in the process of choosing among different treatment options, and 87% thought their edentulous patients were satisfied with the decision making process when choosing among different treatment options. Fifty-eight per cent of trainees supported a strategy of negotiation between patients and clinicians (shared decision making). There was no strong evidence to suggest gender had an influence on the attitudes towards decision making. The finding of a consensus towards shared decision making in the attitudes of trainees, and no gender differences is encouraging and is supportive of UK dental schools’ ability to foster ethical and professional values among dentists. PMID:29563454

Research-based-decision-making in Canadian health organizations: a behavioural approach.

PubMed

Jbilou, Jalila; Amara, Nabil; Landry, Réjean

2007-06-01

Decision making in Health sector is affected by a several elements such as economic constraints, political agendas, epidemiologic events, managers' values and environment... These competing elements create a complex environment for decision making. Research-Based-Decision-Making (RBDM) offers an opportunity to reduce the generated uncertainty and to ensure efficacy and efficiency in health administrations. We assume that RBDM is dependant on decision makers' behaviour and the identification of the determinants of this behaviour can help to enhance research results utilization in health sector decision making. This paper explores the determinants of RBDM as a personal behaviour among managers and professionals in health administrations in Canada. From the behavioural theories and the existing literature, we build a model measuring "RBDM" as an index based on five items. These items refer to the steps accomplished by a decision maker while developing a decision which is based on evidence. The determinants of RBDM behaviour are identified using data collected from 942 health care decision makers in Canadian health organizations. Linear regression is used to model the behaviour RBDM. Determinants of this behaviour are derived from Triandis Theory and Bandura's construct "self-efficacy." The results suggest that to improve research use among managers in Canadian governmental health organizations, strategies should focus on enhancing exposition to evidence through facilitating communication networks, partnerships and links between researchers and decision makers, with the key long-term objective of developing a culture that supports and values the contribution that research can make to decision making in governmental health organizations. Nevertheless, depending on the organizational level, determinants of RBDM are different. This difference has to be taken into account if RBDM adoption is desired. Decision makers in Canadian health organizations (CHO) can help to build networks, develop partnerships between professionals locally, regionally and nationally, and also act as change agents in the dissemination and adoption of knowledge and innovations in health services. However, the research focused on knowledge use as a support to decision-making, further research is needed to identify and evaluate effective incentives and strategies to implement so as to enhance RBDM adoption among health decision makers and more theoretical development are to complete in this perspective.

The association between patient attitudes and values and the strength of consideration for contralateral prophylactic mastectomy in a population-based sample of breast cancer patients.

PubMed

Hawley, Sarah T; Griffith, Kent A; Hamilton, Ann S; Ward, Kevin C; Morrow, Monica; Janz, Nancy K; Katz, Steven J; Jagsi, Reshma

2017-12-01

Little is known about how the individual decision styles and values of breast cancer patients at the time of treatment decision making are associated with the consideration of different treatment options and specifically with the consideration of contralateral prophylactic mastectomy (CPM). Newly diagnosed patients with early-stage breast cancer who were treated in 2013-2014 were identified through the Surveillance, Epidemiology, and End Results registries of Los Angeles and Georgia and were surveyed approximately 7 months after surgery (n = 2578; response rate, 71%). The primary outcome was the consideration of CPM (strong vs less strong). The association between patients' values and decision styles and strong consideration was assessed with multivariate logistic regression. Approximately one-quarter of women (25%) reported strong/very strong consideration of CPM, and another 29% considered it moderately/weakly. Decision styles, including a rational-intuitive approach to decision making, varied. The factors most valued by women at the time of treatment decision making were as follows: avoiding worry about recurrence (82%) and reducing the need for more surgery (73%). In a multivariate analysis, patients who preferred to make their own decisions, those who valued avoiding worry about recurrence, and those who valued avoiding radiation significantly more often strongly considered CPM (P < .05), whereas those who reported being more logical and those who valued keeping their breast did so less often. Many patients considered CPM, and the consideration was associated with both decision styles and values. The variability in decision styles and values observed in this study suggests that formally evaluating these characteristics at or before the initial treatment encounter could provide an opportunity for improving patient clinician discussions. Cancer 2017;123:4547-4555. © 2017 American Cancer Society. © 2017 American Cancer Society.

American College of Emergency Physicians Ethics Manual.

PubMed

1991-10-01

Ethical concerns are a major part of the clinical practice of emergency medicine. The emergency physician must make hard choices, not only with regard to the scientific/technical aspects but also with regard to the moral aspects of caring for emergency patients. By the nature of the specialty, emergency physicians face ethical dilemmas often requiring prompt decisions with limited information. This manual identifies important moral principles and values in emergency medicine. The underlying assumption is that a knowledge of moral principles and ethical values helps the emergency physician make responsible moral choices. Neither the scientific nor the moral aspects of clinical decision making can be reduced to simple formulas. Nevertheless, decisions must be made. Emergency physicians should, therefore, be cognizant of the ethical principles that are important for emergency medicine, understand the process of ethical reasoning, and be capable of making rational moral decisions based on a stable framework of values.

Building Bridges between Perceptual and Economic Decision-Making: Neural and Computational Mechanisms.

PubMed

Summerfield, Christopher; Tsetsos, Konstantinos

2012-01-01

Investigation into the neural and computational bases of decision-making has proceeded in two parallel but distinct streams. Perceptual decision-making (PDM) is concerned with how observers detect, discriminate, and categorize noisy sensory information. Economic decision-making (EDM) explores how options are selected on the basis of their reinforcement history. Traditionally, the sub-fields of PDM and EDM have employed different paradigms, proposed different mechanistic models, explored different brain regions, disagreed about whether decisions approach optimality. Nevertheless, we argue that there is a common framework for understanding decisions made in both tasks, under which an agent has to combine sensory information (what is the stimulus) with value information (what is it worth). We review computational models of the decision process typically used in PDM, based around the idea that decisions involve a serial integration of evidence, and assess their applicability to decisions between good and gambles. Subsequently, we consider the contribution of three key brain regions - the parietal cortex, the basal ganglia, and the orbitofrontal cortex (OFC) - to perceptual and EDM, with a focus on the mechanisms by which sensory and reward information are integrated during choice. We find that although the parietal cortex is often implicated in the integration of sensory evidence, there is evidence for its role in encoding the expected value of a decision. Similarly, although much research has emphasized the role of the striatum and OFC in value-guided choices, they may play an important role in categorization of perceptual information. In conclusion, we consider how findings from the two fields might be brought together, in order to move toward a general framework for understanding decision-making in humans and other primates.

Building Bridges between Perceptual and Economic Decision-Making: Neural and Computational Mechanisms

PubMed Central

Summerfield, Christopher; Tsetsos, Konstantinos

2012-01-01

Investigation into the neural and computational bases of decision-making has proceeded in two parallel but distinct streams. Perceptual decision-making (PDM) is concerned with how observers detect, discriminate, and categorize noisy sensory information. Economic decision-making (EDM) explores how options are selected on the basis of their reinforcement history. Traditionally, the sub-fields of PDM and EDM have employed different paradigms, proposed different mechanistic models, explored different brain regions, disagreed about whether decisions approach optimality. Nevertheless, we argue that there is a common framework for understanding decisions made in both tasks, under which an agent has to combine sensory information (what is the stimulus) with value information (what is it worth). We review computational models of the decision process typically used in PDM, based around the idea that decisions involve a serial integration of evidence, and assess their applicability to decisions between good and gambles. Subsequently, we consider the contribution of three key brain regions – the parietal cortex, the basal ganglia, and the orbitofrontal cortex (OFC) – to perceptual and EDM, with a focus on the mechanisms by which sensory and reward information are integrated during choice. We find that although the parietal cortex is often implicated in the integration of sensory evidence, there is evidence for its role in encoding the expected value of a decision. Similarly, although much research has emphasized the role of the striatum and OFC in value-guided choices, they may play an important role in categorization of perceptual information. In conclusion, we consider how findings from the two fields might be brought together, in order to move toward a general framework for understanding decision-making in humans and other primates. PMID:22654730

The Value of Medicines: A Crucial but Vague Concept.

PubMed

Antoñanzas, Fernando; Terkola, Robert; Postma, Maarten

2016-12-01

Health Technology Assessment is increasingly used to evaluate the value of healthcare products and to prioritize resources; however, defining exactly what value is and how it should be measured remains a challenge. In this article, we report the results of a literature review, focusing on nine European countries, with the aim of investigating how value is defined from the perspective of different stakeholders, how definitions of value are used, and how value is incorporated into decision making. Only three articles were identified that presented definitions of value, and there was no single shared definition of value in healthcare, which appears to be a highly subjective concept. The majority of the countries investigated combine clinical assessment with economic evaluation to make reimbursement recommendations; the quality-adjusted life-year is the most commonly used measure of value but does not capture broader aspects of value that may be important to patients and healthcare systems. We describe the use of value-based pricing and multi-criteria decision analysis, two approaches to the incorporation of broader aspects of value into decision making. Overall, we have identified considerable variation in how a product's value is defined by different stakeholders. Although a universal understanding of value in healthcare is important, it is clear that current definitions are insufficient, potentially leading to inconsistent reimbursement decisions. Ultimately, the establishment of clearer policies for defining and measuring value in healthcare is needed, and is likely to lead to improvements in the consistency of decision making.

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

PubMed

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

2018-05-31

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

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.

Reasoning in the Capacity to Make Medical Decisions: The Consideration of Values

PubMed Central

Karel, Michele J.; Gurrera, Ronald J.; Hicken, Bret; Moye, Jennifer

2010-01-01

Purpose To examine the contribution of “values-based reasoning” in evaluating older adults’ capacity to make medical decisions. Design and Methods Older men with schizophrenia (n=20) or dementia (n=20), and a primary care comparison group (n=19), completed cognitive and psychiatric screening and an interview to determine their capacity to make medical decisions, which included a component on values. All of the participants were receiving treatment at Veterans Administration (VA) outpatient clinics. Results Participants varied widely in the activities and relationships they most valued, the extent to which religious beliefs would influence healthcare decisions, and in ratings of the importance of preserving quality versus length of life. Most participants preferred shared decision making with doctor, family, or both. Individuals with schizophrenia or dementia performed worse than a primary care comparison group in reasoning measured by the ability to list risks and benefits and compare choices. Individuals with dementia performed comparably to the primary care group in reasoning measured by the ability to justify choices in terms of valued abilities or activities, whereas individuals with schizophrenia performed relatively worse compared to the other two groups. Compared to primary care patients, participants with schizophrenia and with dementia were impaired on the ability to explain treatment choices in terms of valued relationships. Conclusion Medical decision making may be influenced by strongly held values and beliefs, emotions, and long life experience. To date, these issues have not been explicitly included in structured evaluations of medical decision-making capacity. This study demonstrated that it is possible to inquire of and elicit a range of healthcare related values and preferences from older adults with dementia or schizophrenia, and individuals with mild to moderate dementia may be able to discuss healthcare options in relation to their values. However, how best to incorporate a values assessment into a structured capacity evaluation deserves further research attention. PMID:20465077

A control-theory model for human decision-making

NASA Technical Reports Server (NTRS)

Levison, W. H.; Tanner, R. B.

1971-01-01

A model for human decision making is an adaptation of an optimal control model for pilot/vehicle systems. The models for decision and control both contain concepts of time delay, observation noise, optimal prediction, and optimal estimation. The decision making model was intended for situations in which the human bases his decision on his estimate of the state of a linear plant. Experiments are described for the following task situations: (a) single decision tasks, (b) two-decision tasks, and (c) simultaneous manual control and decision making. Using fixed values for model parameters, single-task and two-task decision performance can be predicted to within an accuracy of 10 percent. Agreement is less good for the simultaneous decision and control situation.

Willingness-to-pay for a probabilistic flood forecast: a risk-based decision-making game

NASA Astrophysics Data System (ADS)

Arnal, Louise; Ramos, Maria-Helena; Coughlan, Erin; Cloke, Hannah L.; Stephens, Elisabeth; Wetterhall, Fredrik; van Andel, Schalk-Jan; Pappenberger, Florian

2016-04-01

Forecast uncertainty is a twofold issue, as it constitutes both an added value and a challenge for the forecaster and the user of the forecasts. Many authors have demonstrated the added (economic) value of probabilistic forecasts over deterministic forecasts for a diversity of activities in the water sector (e.g. flood protection, hydroelectric power management and navigation). However, the richness of the information is also a source of challenges for operational uses, due partially to the difficulty to transform the probability of occurrence of an event into a binary decision. The setup and the results of a risk-based decision-making experiment, designed as a game on the topic of flood protection mitigation, called ``How much are you prepared to pay for a forecast?'', will be presented. The game was played at several workshops in 2015, including during this session at the EGU conference in 2015, and a total of 129 worksheets were collected and analysed. The aim of this experiment was to contribute to the understanding of the role of probabilistic forecasts in decision-making processes and their perceived value by decision-makers. Based on the participants' willingness-to-pay for a forecast, the results of the game showed that the value (or the usefulness) of a forecast depends on several factors, including the way users perceive the quality of their forecasts and link it to the perception of their own performances as decision-makers. Balancing avoided costs and the cost (or the benefit) of having forecasts available for making decisions is not straightforward, even in a simplified game situation, and is a topic that deserves more attention from the hydrological forecasting community in the future.

A multi-valued neutrosophic qualitative flexible approach based on likelihood for multi-criteria decision-making problems

NASA Astrophysics Data System (ADS)

Peng, Juan-juan; Wang, Jian-qiang; Yang, Wu-E.

2017-01-01

In this paper, multi-criteria decision-making (MCDM) problems based on the qualitative flexible multiple criteria method (QUALIFLEX), in which the criteria values are expressed by multi-valued neutrosophic information, are investigated. First, multi-valued neutrosophic sets (MVNSs), which allow the truth-membership function, indeterminacy-membership function and falsity-membership function to have a set of crisp values between zero and one, are introduced. Then the likelihood of multi-valued neutrosophic number (MVNN) preference relations is defined and the corresponding properties are also discussed. Finally, an extended QUALIFLEX approach based on likelihood is explored to solve MCDM problems where the assessments of alternatives are in the form of MVNNs; furthermore an example is provided to illustrate the application of the proposed method, together with a comparison analysis.

How Students' Values Are Intertwined with Decisions in a Socio-Scientific Issue

ERIC Educational Resources Information Center

Paraskeva-Hadjichambi, Demetra; Hadjichambis, Andreas Ch.; Korfiatis, Konstantinos

2015-01-01

The present study incorporated a scaffolding decision making procedure on an authentic environmental socio-scientific issue and investigated how students' decisions are intertwined with their values. Computer-based activities provided necessary information and allowed for the consideration of multiple aspects of the issue, the study of the effects…

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

PubMed

Ren, Peijia; Xu, Zeshui; Hao, Zhinan

2017-09-01

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

Assessing the usability and potential value of seasonal climate forecasts in land management decisions in the southwest UK: challenges and reflections

NASA Astrophysics Data System (ADS)

Soares, Marta Bruno

2017-06-01

The potential usability and benefits of seasonal climate forecasts (SCF) to help inform decision-making processes is widely accepted. However, the practical use of SCF in Europe is still fairly recent and, as such, current knowledge of the added benefits of SCF in supporting and improving decision-making is limited. This study is based on research conducted to co-develop a semi-operational climate service prototype - the Land Management Tool (LMTool) - with farmers in South West regions of the UK. The value of the SCF provided to the farmers was examined to help us understand the usability and (potential) value of these forecasts in farmers' decisions during the winter months of 2015/2016. The findings from the study point to the need to explore and develop (new) research methods capable of addressing the complexity of the decision-making processes, such as those in the farming sector. The farmers who used the SCF perceived it as useful and usable as it helped them change and adapt their decision-making and thus, avoid unnecessary costs. However, to fully grasp the potential value of using SCF, farmers emphasised the need for the provision of SCF for longer periods of time to allow them to build trust and confidence in the information provided. This paper contributes to ongoing discussions about how to assess the use and value of SCF in decision-making processes in a meaningful and effective way.

Models of Affective Decision Making: How Do Feelings Predict Choice?

PubMed

Charpentier, Caroline J; De Neve, Jan-Emmanuel; Li, Xinyi; Roiser, Jonathan P; Sharot, Tali

2016-06-01

Intuitively, how you feel about potential outcomes will determine your decisions. Indeed, an implicit assumption in one of the most influential theories in psychology, prospect theory, is that feelings govern choice. Surprisingly, however, very little is known about the rules by which feelings are transformed into decisions. Here, we specified a computational model that used feelings to predict choices. We found that this model predicted choice better than existing value-based models, showing a unique contribution of feelings to decisions, over and above value. Similar to the value function in prospect theory, our feeling function showed diminished sensitivity to outcomes as value increased. However, loss aversion in choice was explained by an asymmetry in how feelings about losses and gains were weighted when making a decision, not by an asymmetry in the feelings themselves. The results provide new insights into how feelings are utilized to reach a decision. © The Author(s) 2016.

Models of Affective Decision Making

PubMed Central

Charpentier, Caroline J.; De Neve, Jan-Emmanuel; Li, Xinyi; Roiser, Jonathan P.; Sharot, Tali

2016-01-01

Intuitively, how you feel about potential outcomes will determine your decisions. Indeed, an implicit assumption in one of the most influential theories in psychology, prospect theory, is that feelings govern choice. Surprisingly, however, very little is known about the rules by which feelings are transformed into decisions. Here, we specified a computational model that used feelings to predict choices. We found that this model predicted choice better than existing value-based models, showing a unique contribution of feelings to decisions, over and above value. Similar to the value function in prospect theory, our feeling function showed diminished sensitivity to outcomes as value increased. However, loss aversion in choice was explained by an asymmetry in how feelings about losses and gains were weighted when making a decision, not by an asymmetry in the feelings themselves. The results provide new insights into how feelings are utilized to reach a decision. PMID:27071751

Aging and the neuroeconomics of decision making: A review.

PubMed

Brown, Stephen B R E; Ridderinkhof, K Richard

2009-12-01

Neuroeconomics refers to a combination of paradigms derived from neuroscience, psychology, and economics for the study of decision making and is an area that has received considerable scientific attention in the recent literature. Using realistic laboratory tasks, researchers seek to study the neurocognitive processes underlying economic decision making and outcome-based decision learning, as well as individual differences in these processes and the social and affective factors that modulate them. To this point, one question has remained largely unanswered: What happens to decision-making processes and their neural substrates during aging? After all, aging is associated with neurocognitive change, which may affect outcome-based decision making. In our study, we use the subjective expected utility model-a well-established decision-making model in economics-as a descriptive framework. After a short survey of the brain areas and neurotransmitter systems associated with outcome-based decision making-and of the effects of aging thereon-we review a number of decision-making studies. Their general data pattern indicates that the decision-making process is changed by age: The elderly perform less efficiently than younger participants, as demonstrated, for instance, by the smaller total rewards that the elderly acquire in lab tasks. These findings are accounted for in terms of age-related deficiencies in the probability and value parameters of the subjective expected utility model. Finally, we discuss some implications and suggestions for future research.

Examining Teacher Evaluation Validity and Leadership Decision Making within a Standards-Based Evaluation System

ERIC Educational Resources Information Center

Kimball, Steven M.; Milanowski, Anthony

2009-01-01

Purpose: The article reports on a study of school leader decision making that examined variation in the validity of teacher evaluation ratings in a school district that has implemented a standards-based teacher evaluation system. Research Methods: Applying mixed methods, the study used teacher evaluation ratings and value-added student achievement…

Evidence-based management - healthcare manager viewpoints.

PubMed

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

2018-06-11

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

To t-Test or Not to t-Test? A p-Values-Based Point of View in the Receiver Operating Characteristic Curve Framework.

PubMed

Vexler, Albert; Yu, Jihnhee

2018-04-13

A common statistical doctrine supported by many introductory courses and textbooks is that t-test type procedures based on normally distributed data points are anticipated to provide a standard in decision-making. In order to motivate scholars to examine this convention, we introduce a simple approach based on graphical tools of receiver operating characteristic (ROC) curve analysis, a well-established biostatistical methodology. In this context, we propose employing a p-values-based method, taking into account the stochastic nature of p-values. We focus on the modern statistical literature to address the expected p-value (EPV) as a measure of the performance of decision-making rules. During the course of our study, we extend the EPV concept to be considered in terms of the ROC curve technique. This provides expressive evaluations and visualizations of a wide spectrum of testing mechanisms' properties. We show that the conventional power characterization of tests is a partial aspect of the presented EPV/ROC technique. We desire that this explanation of the EPV/ROC approach convinces researchers of the usefulness of the EPV/ROC approach for depicting different characteristics of decision-making procedures, in light of the growing interest regarding correct p-values-based applications.

Patient preferences versus physicians' judgement: does it make a difference in healthcare decision making?

PubMed

Mühlbacher, Axel C; Juhnke, Christin

2013-06-01

Clinicians and public health experts make evidence-based decisions for individual patients, patient groups and even whole populations. In addition to the principles of internal and external validity (evidence), patient preferences must also influence decision making. Great Britain, Australia and Germany are currently discussing methods and procedures for valuing patient preferences in regulatory (authorization and pricing) and in health policy decision making. However, many questions remain on how to best balance patient and public preferences with physicians' judgement in healthcare and health policy decision making. For example, how to define evaluation criteria regarding the perceived value from a patient's perspective? How do physicians' fact-based opinions also reflect patients' preferences based on personal values? Can empirically grounded theories explain differences between patients and experts-and, if so, how? This article aims to identify and compare studies that used different preference elicitation methods and to highlight differences between patient and physician preferences. Therefore, studies comparing patient preferences and physician judgements were analysed in a review. This review shows a limited amount of literature analysing and comparing patient and physician preferences for healthcare interventions and outcomes. Moreover, it shows that methodology used to compare preferences is diverse. A total of 46 studies used the following methods-discrete-choice experiments, conjoint analyses, standard gamble, time trade-offs and paired comparisons-to compare patient preferences with doctor judgements. All studies were published between 1985 and 2011. Most studies reveal a disparity between the preferences of actual patients and those of physicians. For most conditions, physicians underestimated the impact of intervention characteristics on patients' decision making. Differentiated perceptions may reflect ineffective communication between the provider and the patient. This in turn may keep physicians from fully appreciating the impact of certain medical conditions on patient preferences. Because differences exist between physicians' judgement and patient preferences, it is important to incorporate the needs and wants of the patient into treatment decisions.

How contextual issues can distort shared decision making.

PubMed

Gartlehner, Gerald; Matyas, Nina

2016-12-01

Shared decision making in medicine has become a widely promoted approach. The goal is for patients and physicians to reach a mutual, informed decision by taking into consideration scientific evidence, clinical experience, and the patient's personal values or preferences. Shared decision making, however, is not a straightforward process. In practice, it might fall short of what it promises and might even be misused to whitewash monetary motives. In this article, which summarizes a presentation given at the 17 th Annual Conference of the German Network Evidence-based Medicine on March 4 th , 2016 in Cologne, Germany, we discuss three contextual factors that in our opinion can have a tremendous impact on any informed decision making: 1) opinions and convictions of physicians or other clinicians; 2) uncertainty of the evidence regarding benefits and harms; 3) uncertainty of patients about their own values and preferences. But despite barriers and shortcomings, modern medicine currently does not have an alternative to shared decision making. Shared decision making has become a central theme in good quality health care because it has a strong ethical component. Advocates of shared decision making, however, must realize that not all patients prefer to participate in decision making. For those who do, however, we must ensure that shared decisions can be made in a neutral environment as free of biases and conflicts of interest as possible. Copyright © 2016. Published by Elsevier GmbH.

A mechanism for value-sensitive decision-making.

PubMed

Pais, Darren; Hogan, Patrick M; Schlegel, Thomas; Franks, Nigel R; Leonard, Naomi E; Marshall, James A R

2013-01-01

We present a dynamical systems analysis of a decision-making mechanism inspired by collective choice in house-hunting honeybee swarms, revealing the crucial role of cross-inhibitory 'stop-signalling' in improving the decision-making capabilities. We show that strength of cross-inhibition is a decision-parameter influencing how decisions depend both on the difference in value and on the mean value of the alternatives; this is in contrast to many previous mechanistic models of decision-making, which are typically sensitive to decision accuracy rather than the value of the option chosen. The strength of cross-inhibition determines when deadlock over similarly valued alternatives is maintained or broken, as a function of the mean value; thus, changes in cross-inhibition strength allow adaptive time-dependent decision-making strategies. Cross-inhibition also tunes the minimum difference between alternatives required for reliable discrimination, in a manner similar to Weber's law of just-noticeable difference. Finally, cross-inhibition tunes the speed-accuracy trade-off realised when differences in the values of the alternatives are sufficiently large to matter. We propose that the model, and the significant role of the values of the alternatives, may describe other decision-making systems, including intracellular regulatory circuits, and simple neural circuits, and may provide guidance in the design of decision-making algorithms for artificial systems, particularly those functioning without centralised control.

Assessment of New Approaches in Geothermal Exploration Decision Making: Preprint

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

Akar, S.; Young, K. R.

Geothermal exploration projects have significant amount of risk associated with uncertainties encountered in the discovery of the geothermal resource. Understanding when and how to proceed in an exploration program, and when to walk away from a site, are two of the largest challenges for increased geothermal deployment. Current methodologies for exploration decision making is left to subjective by subjective expert opinion which can be incorrectly biased by expertise (e.g. geochemistry, geophysics), geographic location of focus, and the assumed conceptual model. The aim of this project is to develop a methodology for more objective geothermal exploration decision making at a givenmore » location, including go-no-go decision points to help developers and investors decide when to give up on a location. In this scope, two different approaches are investigated: 1) value of information analysis (VOIA) which is used for evaluating and quantifying the value of a data before they are purchased, and 2) enthalpy-based exploration targeting based on reservoir size, temperature gradient estimates, and internal rate of return (IRR). The first approach, VOIA, aims to identify the value of a particular data when making decisions with an uncertain outcome. This approach targets the pre-drilling phase of exploration. These estimated VOIs are highly affected by the size of the project and still have a high degree of subjectivity in assignment of probabilities. The second approach, exploration targeting, is focused on decision making during the drilling phase. It starts with a basic geothermal project definition that includes target and minimum required production capacity and initial budgeting for exploration phases. Then, it uses average temperature gradient, reservoir temperature estimates, and production capacity to define targets and go/no-go limits. The decision analysis in this approach is based on achieving a minimum IRR at each phase of the project. This second approach was determined to be less subjective, since it requires less subjectivity in the input values.« less

[Breast cancer and pregnancy: decision making and the point of view of the mother].

PubMed

Eisinger, François; Noizet, Agnès

2002-09-01

For the treatment of breast cancer, modifications of decision making related to pregnancy could be assessed through three questions. Why a decision had been chosen? In that case, the hypothesis is that decisions are based on the expected utility. The theory assumes weighting and computation of complete possibilities with their associated probabilities and values. However values exhibits a wide inter-individual variation range. Therefore the predictability of choice based on this model is indeed very low. Furthermore it is likely that the willingness of pregnancy after breast cancer contains besides classic constituents of appeals of motherhood, a specific meaning of recovery both of health and femininity. The second question: who is in charge of the decision? And under the paradigm of autonomy, women' decision is, merely by itself, the right decision. The last question is how? For some situations for which foreseeing is quiet complex, the value of the process in itself is increased and could help the end-oriented or self-determined decision. Casuistic analysis could therefore improve women' decisions. The issue is not only about decision but also related to patient-physician relationship, about an issue that is not only a biomedical problem.

Using value-based total cost of ownership (TCO) measures to inform subsystem trade-offs

NASA Astrophysics Data System (ADS)

Radziwill, Nicole M.; DuPlain, Ronald F.

2010-07-01

Total Cost of Ownership (TCO) is a metric from management accounting that helps expose both the direct and indirect costs of a business decision. However, TCO can sometimes be too simplistic for "make vs. buy" decisions (or even choosing between competing design alternatives) when value and extensibility are more critical than total cost. A three-dimensional value-based TCO, which was developed to clarify product decisions for an observatory prior to Final Design Review (FDR), will be presented in this session. This value-based approach incorporates priority of requirements, satisfiability of requirements, and cost, and can be easily applied in any environment.

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.

Features of Computer-Based Decision Aids: Systematic Review, Thematic Synthesis, and Meta-Analyses.

PubMed

Syrowatka, Ania; Krömker, Dörthe; Meguerditchian, Ari N; Tamblyn, Robyn

2016-01-26

Patient information and education, such as decision aids, are gradually moving toward online, computer-based environments. Considerable research has been conducted to guide content and presentation of decision aids. However, given the relatively new shift to computer-based support, little attention has been given to how multimedia and interactivity can improve upon paper-based decision aids. The first objective of this review was to summarize published literature into a proposed classification of features that have been integrated into computer-based decision aids. Building on this classification, the second objective was to assess whether integration of specific features was associated with higher-quality decision making. Relevant studies were located by searching MEDLINE, Embase, CINAHL, and CENTRAL databases. The review identified studies that evaluated computer-based decision aids for adults faced with preference-sensitive medical decisions and reported quality of decision-making outcomes. A thematic synthesis was conducted to develop the classification of features. Subsequently, meta-analyses were conducted based on standardized mean differences (SMD) from randomized controlled trials (RCTs) that reported knowledge or decisional conflict. Further subgroup analyses compared pooled SMDs for decision aids that incorporated a specific feature to other computer-based decision aids that did not incorporate the feature, to assess whether specific features improved quality of decision making. Of 3541 unique publications, 58 studies met the target criteria and were included in the thematic synthesis. The synthesis identified six features: content control, tailoring, patient narratives, explicit values clarification, feedback, and social support. A subset of 26 RCTs from the thematic synthesis was used to conduct the meta-analyses. As expected, computer-based decision aids performed better than usual care or alternative aids; however, some features performed better than others. Integration of content control improved quality of decision making (SMD 0.59 vs 0.23 for knowledge; SMD 0.39 vs 0.29 for decisional conflict). In contrast, tailoring reduced quality of decision making (SMD 0.40 vs 0.71 for knowledge; SMD 0.25 vs 0.52 for decisional conflict). Similarly, patient narratives also reduced quality of decision making (SMD 0.43 vs 0.65 for knowledge; SMD 0.17 vs 0.46 for decisional conflict). Results were varied for different types of explicit values clarification, feedback, and social support. Integration of media rich or interactive features into computer-based decision aids can improve quality of preference-sensitive decision making. However, this is an emerging field with limited evidence to guide use. The systematic review and thematic synthesis identified features that have been integrated into available computer-based decision aids, in an effort to facilitate reporting of these features and to promote integration of such features into decision aids. The meta-analyses and associated subgroup analyses provide preliminary evidence to support integration of specific features into future decision aids. Further research can focus on clarifying independent contributions of specific features through experimental designs and refining the designs of features to improve effectiveness.

Orbital frontal cortex updates state-induced value change for decision-making.

PubMed

Baltz, Emily T; Yalcinbas, Ege A; Renteria, Rafael; Gremel, Christina M

2018-06-13

Recent hypotheses have posited that orbital frontal cortex (OFC) is important for using inferred consequences to guide behavior. Less clear is OFC's contribution to goal-directed or model-based behavior, where the decision to act is controlled by previous experience with the consequence or outcome. Investigating OFC's role in learning about changed outcomes separate from decision-making is not trivial and often the two are confounded. Here we adapted an incentive learning task to mice, where we investigated processes controlling experience-based outcome updating independent from inferred action control. We found chemogenetic OFC attenuation did not alter the ability to perceive motivational state-induced changes in outcome value but did prevent the experience-based updating of this change. Optogenetic inhibition of OFC excitatory neuron activity selectively when experiencing an outcome change disrupted the ability to update, leaving mice unable to infer the appropriate behavior. Our findings support a role for OFC in learning that controls decision-making. © 2018, Baltz et al.

How do persons with dementia participate in decision making related to health and daily care? A multi-case study

PubMed Central

2012-01-01

Background Many countries have passed laws giving patients the right to participate in decisions about health care. People with dementia cannot be assumed to be incapable of making decisions on their diagnosis alone as they may have retained cognitive abilities. The purpose of this study was to gain a better understanding of how persons with dementia participated in making decisions about health care and how their family carers and professional caregivers influenced decision making. Methods This Norwegian study had a qualitative multi-case design. The triad in each of the ten cases consisted of the person with dementia, the family carer and the professional caregiver, in all 30 participants. Inclusion criteria for the persons with dementia were: (1) 67 years or older (2) diagnosed with dementia (3) Clinical Dementia Rating score 2, moderate dementia; (3) able to communicate verbally. The family carers and professional caregivers were then asked to participate. A semi-structured interview guide was used in interviews with family carers and professional caregivers. Field notes were written after participant observation of interactions between persons with dementia and professional caregivers during morning care or activities at a day centre. How the professional caregivers facilitated decision making was the focus of the observations that varied in length from 30 to 90 minutes. The data were analyzed using framework analysis combined with a hermeneutical interpretive approach. Results Professional caregivers based their assessment of mental competence on experience and not on standardized tests. Persons with dementia demonstrated variability in how they participated in decision making. Pseudo-autonomous decision making and delegating decision making were new categories that emerged. Autonomous decision making did occur but shared decision making was the most typical pattern. Reduced mental capacity, lack of available choices or not being given the opportunity to participate led to non-involvement. Not all decisions were based on logic; personal values and relationships were also considered. Conclusions Persons with moderate dementia demonstrated variability in how they participated in decision making. Optimal involvement was facilitated by positioning them as capable of influencing decisions, assessing decision-specific competence, clarifying values and understanding the significance of relationships and context. PMID:22870952

Decision Making and Behavioral Choice during Predator Avoidance

PubMed Central

Herberholz, Jens; Marquart, Gregory D.

2012-01-01

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

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.

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

DTIC Science & Technology

2017-09-01

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

Decision-making capacity and competency in the elderly: a clinical and neuropsychological perspective.

PubMed

Moberg, Paul J; Rick, Jacqueline H

2008-01-01

With our ageing population, the number of older adults with cognitive impairment has also increased. There is both an acute and growing need for evidence-based assessments to identify their decision making capacity and competence. In the present article we (1) present definitions of decision-making capacity and competence, (2) review cognitive functions that are central to decision-making capacity as well as the methods and procedures commonly used to assess these domains, and (3) address the communication of assessment findings to patients and their loved ones. The importance of assessing decision-making capacity in the context of specific functions and of respecting the values and interests of older adults are emphasized.

Some induced intuitionistic fuzzy aggregation operators applied to multi-attribute group decision making

NASA Astrophysics Data System (ADS)

Su, Zhi-xin; Xia, Guo-ping; Chen, Ming-yuan

2011-11-01

In this paper, we define various induced intuitionistic fuzzy aggregation operators, including induced intuitionistic fuzzy ordered weighted averaging (OWA) operator, induced intuitionistic fuzzy hybrid averaging (I-IFHA) operator, induced interval-valued intuitionistic fuzzy OWA operator, and induced interval-valued intuitionistic fuzzy hybrid averaging (I-IIFHA) operator. We also establish various properties of these operators. And then, an approach based on I-IFHA operator and intuitionistic fuzzy weighted averaging (WA) operator is developed to solve multi-attribute group decision-making (MAGDM) problems. In such problems, attribute weights and the decision makers' (DMs') weights are real numbers and attribute values provided by the DMs are intuitionistic fuzzy numbers (IFNs), and an approach based on I-IIFHA operator and interval-valued intuitionistic fuzzy WA operator is developed to solve MAGDM problems where the attribute values provided by the DMs are interval-valued IFNs. Furthermore, induced intuitionistic fuzzy hybrid geometric operator and induced interval-valued intuitionistic fuzzy hybrid geometric operator are proposed. Finally, a numerical example is presented to illustrate the developed approaches.

The role of moral utility in decision making: an interdisciplinary framework.

PubMed

Tobler, Philippe N; Kalis, Annemarie; Kalenscher, Tobias

2008-12-01

What decisions should we make? Moral values, rules, and virtues provide standards for morally acceptable decisions, without prescribing how we should reach them. However, moral theories do assume that we are, at least in principle, capable of making the right decisions. Consequently, an empirical investigation of the methods and resources we use for making moral decisions becomes relevant. We consider theoretical parallels of economic decision theory and moral utilitarianism and suggest that moral decision making may tap into mechanisms and processes that have originally evolved for nonmoral decision making. For example, the computation of reward value occurs through the combination of probability and magnitude; similar computation might also be used for determining utilitarian moral value. Both nonmoral and moral decisions may resort to intuitions and heuristics. Learning mechanisms implicated in the assignment of reward value to stimuli, actions, and outcomes may also enable us to determine moral value and assign it to stimuli, actions, and outcomes. In conclusion, we suggest that moral capabilities can employ and benefit from a variety of nonmoral decision-making and learning mechanisms.

Application of construal level and value-belief norm theories to undergraduate decision-making on a wildlife socio-scientific issue

NASA Astrophysics Data System (ADS)

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

2018-06-01

One aim of science education is to develop scientific literacy for decision-making in daily life. Socio-scientific issues (SSI) and structured decision-making frameworks can help students reach these objectives. This research uses value belief norm (VBN) theory and construal level theory (CLT) to explore students' use of personal values in their decision-making processes and the relationship between abstract and concrete problematization and their decision-making. Using mixed methods, we conclude that the level of abstraction with which students problematise a prairie dog agricultural production and ecosystem preservation issue has a significant relationship to the values students used in the decision-making process. However, neither abstraction of the problem statement nor students' surveyed value orientations were significantly related to students' final decisions. These results may help inform teachers' understanding of students and their use of a structured-decision making tool in a classroom, and aid researchers in understanding if these tools help students remain objective in their analyses of complex SSIs.

Capturing Old-Growth Values for Use in Forest Decision-Making

NASA Astrophysics Data System (ADS)

Owen, Rochelle J.; Duinker, Peter N.; Beckley, Thomas M.

2009-02-01

Old-growth forests have declined significantly across the world. Decisions related to old growth are often mired in challenges of value diversity, conflict, data gaps, and resource pressures. This article describes old-growth values of citizens and groups in Nova Scotia, Canada, for integration in sustainable forest management (SFM) decision-making. The study is based on data from 76 research subjects who participated in nine field trips to forest stands. Research subjects were drawn from Aboriginal groups, environmental organizations, forestry professionals, and rural and urban publics. Diaries, group discussions, and rating sheets were used to elicit information during the field trips. Findings show that different elicitation techniques can influence the articulation of intensity with which some values are held. In addition, certain values are more often associated with old-growth than with other forest-age classes. Some values associated with old-growth are considered more important than others, and some silvicultural treatments are perceived to compromise old-growth values more than others. Demographic characteristics, such as constituency group, gender, and age, are shown to influence value priorities. Ideas on how to incorporate old-growth values into SFM decision-making are highlighted.

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

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

PubMed

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

2013-01-01

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

Orders of C2 Agility and Implications for Information and Decision-Making

DTIC Science & Technology

2013-06-01

of agility and, in particular, in discussions of resilience. Orders of agility also invite the re-examination of conceptions of value in informing...incompatible interpretations of decision-making and information. It also gives greater confidence that different conceptions of value and assessment...examination of conceptions of value in informing decision- making, leading to the exposition of a hierarchical model of nested decision-making and decision

An interval-valued 2-tuple linguistic group decision-making model based on the Choquet integral operator

NASA Astrophysics Data System (ADS)

Liu, Bingsheng; Fu, Meiqing; Zhang, Shuibo; Xue, Bin; Zhou, Qi; Zhang, Shiruo

2018-01-01

The Choquet integral (IL) operator is an effective approach for handling interdependence among decision attributes in complex decision-making problems. However, the fuzzy measures of attributes and attribute sets required by IL are difficult to achieve directly, which limits the application of IL. This paper proposes a new method for determining fuzzy measures of attributes by extending Marichal's concept of entropy for fuzzy measure. To well represent the assessment information, interval-valued 2-tuple linguistic context is utilised to represent information. Then, we propose a Choquet integral operator in an interval-valued 2-tuple linguistic environment, which can effectively handle the correlation between attributes. In addition, we apply these methods to solve multi-attribute group decision-making problems. The feasibility and validity of the proposed operator is demonstrated by comparisons with other models in illustrative example part.

[The price-based certainty of purchase influences consumer behavior for discount].

PubMed

Arihara, Katsuhiko; Ariga, Atsunori; Furuya, Takeshi

2016-04-01

Tversky & Kahneman (1981) reported that most participants decided to drive when they could save money on a low-price good as compared to when they could save on a high-price good, even though the discount prices were same. Although this irrational decision making has been interpreted as a rate-dependent estimation of value (prospect theory), this study newly proposes that it can be explained by the certainty of purchase based on the price of goods. Experiment 1 replicated the previously reported difference in decision making, and additionally demonstrated that participants' certainty of purchase was lower for a high- than a low-price good. When it was emphasized that participants' intention to purchase high- and low-price goods were equally sure, decision making did not significantly differ (Experiment 2). Furthermore, decision making differed based only on the certainty of purchase even,when prices of goods were-same (Experiment 3). Consumers' decision making may be rather rational, depending straightforwardly on the certainty of purchase that is susceptible to price.

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

PubMed

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

2016-08-01

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

Self-Organized Service Negotiation for Collaborative Decision Making

PubMed Central

Zhang, Bo; Zheng, Ziming

2014-01-01

This paper proposes a self-organized service negotiation method for CDM in intelligent and automatic manners. It mainly includes three phases: semantic-based capacity evaluation for the CDM sponsor, trust computation of the CDM organization, and negotiation selection of the decision-making service provider (DMSP). In the first phase, the CDM sponsor produces the formal semantic description of the complex decision task for DMSP and computes the capacity evaluation values according to participator instructions from different DMSPs. In the second phase, a novel trust computation approach is presented to compute the subjective belief value, the objective reputation value, and the recommended trust value. And in the third phase, based on the capacity evaluation and trust computation, a negotiation mechanism is given to efficiently implement the service selection. The simulation experiment results show that our self-organized service negotiation method is feasible and effective for CDM. PMID:25243228

Self-organized service negotiation for collaborative decision making.

PubMed

Zhang, Bo; Huang, Zhenhua; Zheng, Ziming

2014-01-01

This paper proposes a self-organized service negotiation method for CDM in intelligent and automatic manners. It mainly includes three phases: semantic-based capacity evaluation for the CDM sponsor, trust computation of the CDM organization, and negotiation selection of the decision-making service provider (DMSP). In the first phase, the CDM sponsor produces the formal semantic description of the complex decision task for DMSP and computes the capacity evaluation values according to participator instructions from different DMSPs. In the second phase, a novel trust computation approach is presented to compute the subjective belief value, the objective reputation value, and the recommended trust value. And in the third phase, based on the capacity evaluation and trust computation, a negotiation mechanism is given to efficiently implement the service selection. The simulation experiment results show that our self-organized service negotiation method is feasible and effective for CDM.

Which Social Values Are Considered in Iranian Health System?

PubMed

Rashidian, Arash; Arab, Mohammad; Vaez Mahdavi, Mohammadreza; Ashtarian, Koimars; Mostafavi, Hakimeh

2018-05-01

Health systems have a set of limited resources for meeting the needs of communities. Health priority setting based on criteria and values is inevitable in such situation. This paper aims to identify the social values that are considered in Iranian health system. This qualitative study was conducted in 3 steps including collecting national documents and literature review, interviewing key informants, and a 2 round Delphi. Interviews and documents were analyzed through thematic framework analysis. Statistical guidance was applied for determining consensus cut-off in Delphi technique. Five social values including freedom of choice, equity, solidarity, severity of disease(s), and burden of disease(s) were considered more important than other values in the health priority setting decisions. Moreover, 2 non-value based factors including conflict of interest and lobbying had a high effect on decision making. Most health policy makers decide based on Egalitarian school, but restriction of resources in the country decreases the outcome. Moreover, personal judgments and preferences sometimes affect their decisions. It seems that developing a value-based framework and making it as a national guidance could have affirmative effect on health administers decisions. © 2018 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How can we best respect patient autonomy in breast cancer treatment decisions?

PubMed Central

Martinez, Kathryn A; Kurian, Allison W

2015-01-01

SUMMARY Helping patients to maximize their autonomy in breast cancer decision-making is an important aspect of patient-centered care. Shared decision-making is a strategy that aims to maximize patient autonomy by integrating the values and preferences of the patient with the biomedical expertise of the physician. Application of this approach in breast cancer decision-making has not been uniform across cancer-specific interventions (e.g., surgery, chemotherapy), and in some circumstances may present challenges to evidence-based care delivery. Increasingly precise estimates of individual patients’ risk of recurrence and commensurate predicted benefit from certain therapies hold significant promise in helping patients exercise autonomous decision-making for their breast cancer care, yet will also likely complicate decision-making for certain subgroups of patients. PMID:25733982

Psychopathic individuals exhibit but do not avoid regret during counterfactual decision making.

PubMed

Baskin-Sommers, Arielle; Stuppy-Sullivan, Allison M; Buckholtz, Joshua W

2016-12-13

Psychopathy is associated with persistent antisocial behavior and a striking lack of regret for the consequences of that behavior. Although explanatory models for psychopathy have largely focused on deficits in affective responsiveness, recent work indicates that aberrant value-based decision making may also play a role. On that basis, some have suggested that psychopathic individuals may be unable to effectively use prospective simulations to update action value estimates during cost-benefit decision making. However, the specific mechanisms linking valuation, affective deficits, and maladaptive decision making in psychopathy remain unclear. Using a counterfactual decision-making paradigm, we found that individuals who scored high on a measure of psychopathy were as or more likely than individuals low on psychopathy to report negative affect in response to regret-inducing counterfactual outcomes. However, despite exhibiting intact affective regret sensitivity, they did not use prospective regret signals to guide choice behavior. In turn, diminished behavioral regret sensitivity predicted a higher number of prior incarcerations, and moderated the relationship between psychopathy and incarceration history. These findings raise the possibility that maladaptive decision making in psychopathic individuals is not a consequence of their inability to generate or experience negative emotions. Rather, antisocial behavior in psychopathy may be driven by a deficit in the generation of forward models that integrate information about rules, costs, and goals with stimulus value representations to promote adaptive behavior.

Psychopathic individuals exhibit but do not avoid regret during counterfactual decision making

PubMed Central

Baskin-Sommers, Arielle; Stuppy-Sullivan, Allison M.; Buckholtz, Joshua W.

2016-01-01

Psychopathy is associated with persistent antisocial behavior and a striking lack of regret for the consequences of that behavior. Although explanatory models for psychopathy have largely focused on deficits in affective responsiveness, recent work indicates that aberrant value-based decision making may also play a role. On that basis, some have suggested that psychopathic individuals may be unable to effectively use prospective simulations to update action value estimates during cost–benefit decision making. However, the specific mechanisms linking valuation, affective deficits, and maladaptive decision making in psychopathy remain unclear. Using a counterfactual decision-making paradigm, we found that individuals who scored high on a measure of psychopathy were as or more likely than individuals low on psychopathy to report negative affect in response to regret-inducing counterfactual outcomes. However, despite exhibiting intact affective regret sensitivity, they did not use prospective regret signals to guide choice behavior. In turn, diminished behavioral regret sensitivity predicted a higher number of prior incarcerations, and moderated the relationship between psychopathy and incarceration history. These findings raise the possibility that maladaptive decision making in psychopathic individuals is not a consequence of their inability to generate or experience negative emotions. Rather, antisocial behavior in psychopathy may be driven by a deficit in the generation of forward models that integrate information about rules, costs, and goals with stimulus value representations to promote adaptive behavior. PMID:27911790

Features of Computer-Based Decision Aids: Systematic Review, Thematic Synthesis, and Meta-Analyses

PubMed Central

Krömker, Dörthe; Meguerditchian, Ari N; Tamblyn, Robyn

2016-01-01

Background Patient information and education, such as decision aids, are gradually moving toward online, computer-based environments. Considerable research has been conducted to guide content and presentation of decision aids. However, given the relatively new shift to computer-based support, little attention has been given to how multimedia and interactivity can improve upon paper-based decision aids. Objective The first objective of this review was to summarize published literature into a proposed classification of features that have been integrated into computer-based decision aids. Building on this classification, the second objective was to assess whether integration of specific features was associated with higher-quality decision making. Methods Relevant studies were located by searching MEDLINE, Embase, CINAHL, and CENTRAL databases. The review identified studies that evaluated computer-based decision aids for adults faced with preference-sensitive medical decisions and reported quality of decision-making outcomes. A thematic synthesis was conducted to develop the classification of features. Subsequently, meta-analyses were conducted based on standardized mean differences (SMD) from randomized controlled trials (RCTs) that reported knowledge or decisional conflict. Further subgroup analyses compared pooled SMDs for decision aids that incorporated a specific feature to other computer-based decision aids that did not incorporate the feature, to assess whether specific features improved quality of decision making. Results Of 3541 unique publications, 58 studies met the target criteria and were included in the thematic synthesis. The synthesis identified six features: content control, tailoring, patient narratives, explicit values clarification, feedback, and social support. A subset of 26 RCTs from the thematic synthesis was used to conduct the meta-analyses. As expected, computer-based decision aids performed better than usual care or alternative aids; however, some features performed better than others. Integration of content control improved quality of decision making (SMD 0.59 vs 0.23 for knowledge; SMD 0.39 vs 0.29 for decisional conflict). In contrast, tailoring reduced quality of decision making (SMD 0.40 vs 0.71 for knowledge; SMD 0.25 vs 0.52 for decisional conflict). Similarly, patient narratives also reduced quality of decision making (SMD 0.43 vs 0.65 for knowledge; SMD 0.17 vs 0.46 for decisional conflict). Results were varied for different types of explicit values clarification, feedback, and social support. Conclusions Integration of media rich or interactive features into computer-based decision aids can improve quality of preference-sensitive decision making. However, this is an emerging field with limited evidence to guide use. The systematic review and thematic synthesis identified features that have been integrated into available computer-based decision aids, in an effort to facilitate reporting of these features and to promote integration of such features into decision aids. The meta-analyses and associated subgroup analyses provide preliminary evidence to support integration of specific features into future decision aids. Further research can focus on clarifying independent contributions of specific features through experimental designs and refining the designs of features to improve effectiveness. PMID:26813512

Decision Making in Health and Medicine

NASA Astrophysics Data System (ADS)

Hunink, Myriam; Glasziou, Paul; Siegel, Joanna; Weeks, Jane; Pliskin, Joseph; Elstein, Arthur; Weinstein, Milton C.

2001-11-01

Decision making in health care means navigating through a complex and tangled web of diagnostic and therapeutic uncertainties, patient preferences and values, and costs. In addition, medical therapies may include side effects, surgery may lead to undesirable complications, and diagnostic technologies may produce inconclusive results. In many clinical and health policy decisions it is necessary to counterbalance benefits and risks, and to trade off competing objectives such as maximizing life expectancy vs optimizing quality of life vs minimizing the required resources. This textbook plots a clear course through these complex and conflicting variables. It clearly explains and illustrates tools for integrating quantitative evidence-based data and subjective outcome values in making clinical and health policy decisions. An accompanying CD-ROM features solutions to the exercises, PowerPoint® presentations of the illustrations, and sample models and tables.

A FRAMEWORK FOR THE ASSESSMENT OF WILDLIFE HABITAT VALUE OF NEW ENGLAND SALT MARSHES

EPA Science Inventory

Resource managers are frequently asked to make decisions that affect the protection and restoration of wetland habitats. The desire is often to base at least some part of this decision process on an assessment of wildlife habitat value, an acknowledged and important wetland func...

Decision aids for people facing health treatment or screening decisions.

PubMed

Stacey, Dawn; Légaré, France; Col, Nananda F; Bennett, Carol L; Barry, Michael J; Eden, Karen B; Holmes-Rovner, Margaret; Llewellyn-Thomas, Hilary; Lyddiatt, Anne; Thomson, Richard; Trevena, Lyndal; Wu, Julie H C

2014-01-28

Decision aids are intended to help people participate in decisions that involve weighing the benefits and harms of treatment options often with scientific uncertainty. To assess the effects of decision aids for people facing treatment or screening decisions. For this update, we searched from 2009 to June 2012 in MEDLINE; CENTRAL; EMBASE; PsycINFO; and grey literature. Cumulatively, we have searched each database since its start date including CINAHL (to September 2008). We included published randomized controlled trials of decision aids, which are interventions designed to support patients' decision making by making explicit the decision, providing information about treatment or screening options and their associated outcomes, compared to usual care and/or alternative interventions. We excluded studies of participants making hypothetical decisions. Two review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. The primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were:A) 'choice made' attributes;B) 'decision-making process' attributes.Secondary outcomes were behavioral, health, and health-system effects. We pooled results using mean differences (MD) and relative risks (RR), applying a random-effects model. This update includes 33 new studies for a total of 115 studies involving 34,444 participants. For risk of bias, selective outcome reporting and blinding of participants and personnel were mostly rated as unclear due to inadequate reporting. Based on 7 items, 8 of 115 studies had high risk of bias for 1 or 2 items each.Of 115 included studies, 88 (76.5%) used at least one of the IPDAS effectiveness criteria: A) 'choice made' attributes criteria: knowledge scores (76 studies); accurate risk perceptions (25 studies); and informed value-based choice (20 studies); and B) 'decision-making process' attributes criteria: feeling informed (34 studies) and feeling clear about values (29 studies).A) Criteria involving 'choice made' attributes:Compared to usual care, decision aids increased knowledge (MD 13.34 out of 100; 95% confidence interval (CI) 11.17 to 15.51; n = 42). When more detailed decision aids were compared to simple decision aids, the relative improvement in knowledge was significant (MD 5.52 out of 100; 95% CI 3.90 to 7.15; n = 19). Exposure to a decision aid with expressed probabilities resulted in a higher proportion of people with accurate risk perceptions (RR 1.82; 95% CI 1.52 to 2.16; n = 19). Exposure to a decision aid with explicit values clarification resulted in a higher proportion of patients choosing an option congruent with their values (RR 1.51; 95% CI 1.17 to 1.96; n = 13).B) Criteria involving 'decision-making process' attributes:Decision aids compared to usual care interventions resulted in:a) lower decisional conflict related to feeling uninformed (MD -7.26 of 100; 95% CI -9.73 to -4.78; n = 22) and feeling unclear about personal values (MD -6.09; 95% CI -8.50 to -3.67; n = 18);b) reduced proportions of people who were passive in decision making (RR 0.66; 95% CI 0.53 to 0.81; n = 14); andc) reduced proportions of people who remained undecided post-intervention (RR 0.59; 95% CI 0.47 to 0.72; n = 18).Decision aids appeared to have a positive effect on patient-practitioner communication in all nine studies that measured this outcome. For satisfaction with the decision (n = 20), decision-making process (n = 17), and/or preparation for decision making (n = 3), those exposed to a decision aid were either more satisfied, or there was no difference between the decision aid versus comparison interventions. No studies evaluated decision-making process attributes for helping patients to recognize that a decision needs to be made, or understanding that values affect the choice.C) Secondary outcomes Exposure to decision aids compared to usual care reduced the number of people of choosing major elective invasive surgery in favour of more conservative options (RR 0.79; 95% CI 0.68 to 0.93; n = 15). Exposure to decision aids compared to usual care reduced the number of people choosing to have prostate-specific antigen screening (RR 0.87; 95% CI 0.77 to 0.98; n = 9). When detailed compared to simple decision aids were used, fewer people chose menopausal hormone therapy (RR 0.73; 95% CI 0.55 to 0.98; n = 3). For other decisions, the effect on choices was variable.The effect of decision aids on length of consultation varied from 8 minutes shorter to 23 minutes longer (median 2.55 minutes longer) with 2 studies indicating statistically-significantly longer, 1 study shorter, and 6 studies reporting no difference in consultation length. Groups of patients receiving decision aids do not appear to differ from comparison groups in terms of anxiety (n = 30), general health outcomes (n = 11), and condition-specific health outcomes (n = 11). The effects of decision aids on other outcomes (adherence to the decision, costs/resource use) were inconclusive. There is high-quality evidence that decision aids compared to usual care improve people's knowledge regarding options, and reduce their decisional conflict related to feeling uninformed and unclear about their personal values. There is moderate-quality evidence that decision aids compared to usual care stimulate people to take a more active role in decision making, and improve accurate risk perceptions when probabilities are included in decision aids, compared to not being included. There is low-quality evidence that decision aids improve congruence between the chosen option and the patient's values.New for this updated review is further evidence indicating more informed, values-based choices, and improved patient-practitioner communication. There is a variable effect of decision aids on length of consultation. Consistent with findings from the previous review, decision aids have a variable effect on choices. They reduce the number of people choosing discretionary surgery and have no apparent adverse effects on health outcomes or satisfaction. The effects on adherence with the chosen option, cost-effectiveness, use with lower literacy populations, and level of detail needed in decision aids need further evaluation. Little is known about the degree of detail that decision aids need in order to have a positive effect on attributes of the choice made, or the decision-making process.

The value of foresight: how prospection affects decision-making.

PubMed

Pezzulo, Giovanni; Rigoli, Francesco

2011-01-01

Traditional theories of decision-making assume that utilities are based on the intrinsic value of outcomes; in turn, these values depend on associations between expected outcomes and the current motivational state of the decision-maker. This view disregards the fact that humans (and possibly other animals) have prospection abilities, which permit anticipating future mental processes and motivational and emotional states. For instance, we can evaluate future outcomes in light of the motivational state we expect to have when the outcome is collected, not (only) when we make a decision. Consequently, we can plan for the future and choose to store food to be consumed when we expect to be hungry, not immediately. Furthermore, similarly to any expected outcome, we can assign a value to our anticipated mental processes and emotions. It has been reported that (in some circumstances) human subjects prefer to receive an unavoidable punishment immediately, probably because they are anticipating the dread associated with the time spent waiting for the punishment. This article offers a formal framework to guide neuroeconomic research on how prospection affects decision-making. The model has two characteristics. First, it uses model-based Bayesian inference to describe anticipation of cognitive and motivational processes. Second, the utility-maximization process considers these anticipations in two ways: to evaluate outcomes (e.g., the pleasure of eating a pie is evaluated differently at the beginning of a dinner, when one is hungry, and at the end of the dinner, when one is satiated), and as outcomes having a value themselves (e.g., the case of dread as a cost of waiting for punishment). By explicitly accounting for the relationship between prospection and value, our model provides a framework to reconcile the utility-maximization approach with psychological phenomena such as planning for the future and dread.

The Value of Foresight: How Prospection Affects Decision-Making

PubMed Central

Pezzulo, Giovanni; Rigoli, Francesco

2011-01-01

Traditional theories of decision-making assume that utilities are based on the intrinsic value of outcomes; in turn, these values depend on associations between expected outcomes and the current motivational state of the decision-maker. This view disregards the fact that humans (and possibly other animals) have prospection abilities, which permit anticipating future mental processes and motivational and emotional states. For instance, we can evaluate future outcomes in light of the motivational state we expect to have when the outcome is collected, not (only) when we make a decision. Consequently, we can plan for the future and choose to store food to be consumed when we expect to be hungry, not immediately. Furthermore, similarly to any expected outcome, we can assign a value to our anticipated mental processes and emotions. It has been reported that (in some circumstances) human subjects prefer to receive an unavoidable punishment immediately, probably because they are anticipating the dread associated with the time spent waiting for the punishment. This article offers a formal framework to guide neuroeconomic research on how prospection affects decision-making. The model has two characteristics. First, it uses model-based Bayesian inference to describe anticipation of cognitive and motivational processes. Second, the utility-maximization process considers these anticipations in two ways: to evaluate outcomes (e.g., the pleasure of eating a pie is evaluated differently at the beginning of a dinner, when one is hungry, and at the end of the dinner, when one is satiated), and as outcomes having a value themselves (e.g., the case of dread as a cost of waiting for punishment). By explicitly accounting for the relationship between prospection and value, our model provides a framework to reconcile the utility-maximization approach with psychological phenomena such as planning for the future and dread. PMID:21747755

Consensus Building: A Key to School Transformation

ERIC Educational Resources Information Center

Baron, Daniel

2008-01-01

Consensus-based decision making can turn faculty meetings into meaningful and productive work sessions in which faculty members know that their input is respected and valued and important decisions are made. Reaching consensus has different meanings in different contexts. Decisions are made "by consensus" when the decision affects the entire…

Changing Patients' Treatment Preferences and Values with a Decision Aid for Type 2 Diabetes Mellitus: Results from the Treatment Arm of a Randomized Controlled Trial.

PubMed

Bailey, Robert A; Shillington, Alicia C; Harshaw, Qing; Funnell, Martha M; VanWingen, Jeffrey; Col, Nananda

2018-04-01

Failure to intensify treatment for type 2 diabetes mellitus (T2DM) when indicated, or clinical inertia, is a major obstacle to achieving optimal glucose control. This study investigates the impact of a values-focused patient decision aid (PDA) for T2DM antihyperglycemic agent intensification on patient values related to domains important in decision-making and preferred treatments. Patients with poorly controlled T2DM who were taking a metformin-containing regimen were recruited through physicians to access a PDA presenting evidence-based information on T2DM and antihyperglycemic agent class options. Participants' preferences for treatment, decision-making, and the relative importance they placed on various values related to treatment options (e.g., dosing, weight gain, side effects) were assessed before and after interacting with the PDA. Changes from baseline were calculated (post-PDA minus pre-PDA difference) and assessed in univariate generalized linear models exploring associations with patients' personal values. Analyses included 114 diverse patients from 27 clinics across the US. The importance of avoiding injections, concern about hypoglycemia, and taking medications only once a day significantly decreased after interacting with the PDA [- 1.1 (p = 0.002), - 1.3 (p < 0.001), - 1.1 (p = 0.004), respectively], while the importance of taking medications that avoided weight gain increased [0.8 (p = 0.004)]. Prior to viewing the PDA, most patients (58.8%) had not begun thinking about the decision of adding a medication, and few (12.3%) indicated that they had already made a decision. Post-PDA, 46.5% could state a medication preference. The values-focused PDA for T2DM medication intensification prepared patients to make a shared decision with their clinician and changed patients' values regarding what was important in making that decision. Helping patients understand their options and underlying values can promote shared decision-making and may reduce clinical inertia delaying treatment intensification. Janssen Scientific Affairs, LLC.

Frequencies of decision making and monitoring in adaptive resource management

PubMed Central

Johnson, Fred A.

2017-01-01

Adaptive management involves learning-oriented decision making in the presence of uncertainty about the responses of a resource system to management. It is implemented through an iterative sequence of decision making, monitoring and assessment of system responses, and incorporating what is learned into future decision making. Decision making at each point is informed by a value or objective function, for example total harvest anticipated over some time frame. The value function expresses the value associated with decisions, and it is influenced by system status as updated through monitoring. Often, decision making follows shortly after a monitoring event. However, it is certainly possible for the cadence of decision making to differ from that of monitoring. In this paper we consider different combinations of annual and biennial decision making, along with annual and biennial monitoring. With biennial decision making decisions are changed only every other year; with biennial monitoring field data are collected only every other year. Different cadences of decision making combine with annual and biennial monitoring to define 4 scenarios. Under each scenario we describe optimal valuations for active and passive adaptive decision making. We highlight patterns in valuation among scenarios, depending on the occurrence of monitoring and decision making events. Differences between years are tied to the fact that every other year a new decision can be made no matter what the scenario, and state information is available to inform that decision. In the subsequent year, however, in 3 of the 4 scenarios either a decision is repeated or monitoring does not occur (or both). There are substantive differences in optimal values among the scenarios, as well as the optimal policies producing those values. Especially noteworthy is the influence of monitoring cadence on valuation in some years. We highlight patterns in policy and valuation among the scenarios, and discuss management implications and extensions. PMID:28800591

Frequencies of decision making and monitoring in adaptive resource management

USGS Publications Warehouse

Williams, Byron K.; Johnson, Fred A.

2017-01-01

Adaptive management involves learning-oriented decision making in the presence of uncertainty about the responses of a resource system to management. It is implemented through an iterative sequence of decision making, monitoring and assessment of system responses, and incorporating what is learned into future decision making. Decision making at each point is informed by a value or objective function, for example total harvest anticipated over some time frame. The value function expresses the value associated with decisions, and it is influenced by system status as updated through monitoring. Often, decision making follows shortly after a monitoring event. However, it is certainly possible for the cadence of decision making to differ from that of monitoring. In this paper we consider different combinations of annual and biennial decision making, along with annual and biennial monitoring. With biennial decision making decisions are changed only every other year; with biennial monitoring field data are collected only every other year. Different cadences of decision making combine with annual and biennial monitoring to define 4 scenarios. Under each scenario we describe optimal valuations for active and passive adaptive decision making. We highlight patterns in valuation among scenarios, depending on the occurrence of monitoring and decision making events. Differences between years are tied to the fact that every other year a new decision can be made no matter what the scenario, and state information is available to inform that decision. In the subsequent year, however, in 3 of the 4 scenarios either a decision is repeated or monitoring does not occur (or both). There are substantive differences in optimal values among the scenarios, as well as the optimal policies producing those values. Especially noteworthy is the influence of monitoring cadence on valuation in some years. We highlight patterns in policy and valuation among the scenarios, and discuss management implications and extensions.

Multialternative drift-diffusion model predicts the relationship between visual fixations and choice in value-based decisions.

PubMed

Krajbich, Ian; Rangel, Antonio

2011-08-16

How do we make decisions when confronted with several alternatives (e.g., on a supermarket shelf)? Previous work has shown that accumulator models, such as the drift-diffusion model, can provide accurate descriptions of the psychometric data for binary value-based choices, and that the choice process is guided by visual attention. However, the computational processes used to make choices in more complicated situations involving three or more options are unknown. We propose a model of trinary value-based choice that generalizes what is known about binary choice, and test it using an eye-tracking experiment. We find that the model provides a quantitatively accurate description of the relationship between choice, reaction time, and visual fixation data using the same parameters that were estimated in previous work on binary choice. Our findings suggest that the brain uses similar computational processes to make binary and trinary choices.

The Computational Complexity of Valuation and Motivational Forces in Decision-Making Processes.

PubMed

Redish, A David; Schultheiss, Nathan W; Carter, Evan C

2016-01-01

The concept of value is fundamental to most theories of motivation and decision making. However, value has to be measured experimentally. Different methods of measuring value produce incompatible valuation hierarchies. Taking the agent's perspective (rather than the experimenter's), we interpret the different valuation measurement methods as accessing different decision-making systems and show how these different systems depend on different information processing algorithms. This identifies the translation from these multiple decision-making systems into a single action taken by a given agent as one of the most important open questions in decision making today. We conclude by looking at how these different valuation measures accessing different decision-making systems can be used to understand and treat decision dysfunction such as in addiction.

Absolutely relative or relatively absolute: violations of value invariance in human decision making.

PubMed

Teodorescu, Andrei R; Moran, Rani; Usher, Marius

2016-02-01

Making decisions based on relative rather than absolute information processing is tied to choice optimality via the accumulation of evidence differences and to canonical neural processing via accumulation of evidence ratios. These theoretical frameworks predict invariance of decision latencies to absolute intensities that maintain differences and ratios, respectively. While information about the absolute values of the choice alternatives is not necessary for choosing the best alternative, it may nevertheless hold valuable information about the context of the decision. To test the sensitivity of human decision making to absolute values, we manipulated the intensities of brightness stimuli pairs while preserving either their differences or their ratios. Although asked to choose the brighter alternative relative to the other, participants responded faster to higher absolute values. Thus, our results provide empirical evidence for human sensitivity to task irrelevant absolute values indicating a hard-wired mechanism that precedes executive control. Computational investigations of several modelling architectures reveal two alternative accounts for this phenomenon, which combine absolute and relative processing. One account involves accumulation of differences with activation dependent processing noise and the other emerges from accumulation of absolute values subject to the temporal dynamics of lateral inhibition. The potential adaptive role of such choice mechanisms is discussed.

An Evidence-Based Medicine Approach to Antihyperglycemic Therapy in Diabetes Mellitus to Overcome Overtreatment.

PubMed

Makam, Anil N; Nguyen, Oanh K

2017-01-10

Overtreatment is pervasive in medicine and leads to potential patient harms and excessive costs in health care. Although evidence-based medicine is often derided as practice by rote algorithmic medicine, the appropriate application of key evidence-based medicine principles in clinical decision making is fundamental to preventing overtreatment and promoting high-value, individualized patient-centered care. Specifically, this article discusses the importance of (1) using absolute rather than relative estimates of benefits to inform treatment decisions; (2) considering the time horizon to benefit of treatments; (3) balancing potential harms and benefits; and (4) using shared decision making by physicians to incorporate the patient's values and preferences into treatment decisions. Here, we illustrate the application of these principles to considering the decision of whether or not to recommend intensive glycemic control to patients to minimize microvascular and cardiovascular complications in type 2 diabetes mellitus. Through this lens, this example will illustrate how an evidence-based medicine approach can be used to individualize glycemic goals and prevent overtreatment, and can serve as a template for applying evidence-based medicine to inform treatment decisions for other conditions to optimize health and individualize patient care. © 2017 American Heart Association, Inc.

Cost-effectiveness thresholds: pros and cons.

PubMed

Bertram, Melanie Y; Lauer, Jeremy A; De Joncheere, Kees; Edejer, Tessa; Hutubessy, Raymond; Kieny, Marie-Paule; Hill, Suzanne R

2016-12-01

Cost-effectiveness analysis is used to compare the costs and outcomes of alternative policy options. Each resulting cost-effectiveness ratio represents the magnitude of additional health gained per additional unit of resources spent. Cost-effectiveness thresholds allow cost-effectiveness ratios that represent good or very good value for money to be identified. In 2001, the World Health Organization's Commission on Macroeconomics in Health suggested cost-effectiveness thresholds based on multiples of a country's per-capita gross domestic product (GDP). In some contexts, in choosing which health interventions to fund and which not to fund, these thresholds have been used as decision rules. However, experience with the use of such GDP-based thresholds in decision-making processes at country level shows them to lack country specificity and this - in addition to uncertainty in the modelled cost-effectiveness ratios - can lead to the wrong decision on how to spend health-care resources. Cost-effectiveness information should be used alongside other considerations - e.g. budget impact and feasibility considerations - in a transparent decision-making process, rather than in isolation based on a single threshold value. Although cost-effectiveness ratios are undoubtedly informative in assessing value for money, countries should be encouraged to develop a context-specific process for decision-making that is supported by legislation, has stakeholder buy-in, for example the involvement of civil society organizations and patient groups, and is transparent, consistent and fair.

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

PubMed

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

2017-06-01

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

Evidence-based librarianship: an overview.

PubMed

Eldredge, J D

2000-10-01

To demonstrate how the core characteristics of both evidence-based medicine (EBM) and evidence-based health care (EBHC) can be adapted to health sciences librarianship. Narrative review essay involving development of a conceptual framework. The author describes the central features of EBM and EBHC. Following each description of a central feature, the author then suggests ways that this feature applies to health sciences librarianship. First, the decision-making processes of EBM and EBHC are compatible with health sciences librarianship. Second, the EBM and EBHC values of favoring rigorously produced scientific evidence in decision making are congruent with the core values of librarianship. Third, the hierarchical levels of evidence can be applied to librarianship with some modifications. Library researchers currently favor descriptive-survey and case-study methods over systematic reviews, randomized controlled trials, or other higher levels of evidence. The library literature nevertheless contains diverse examples of randomized controlled trials, controlled-comparison studies, and cohort studies conducted by health sciences librarians. Health sciences librarians are confronted with making many practical decisions. Evidence-based librarianship offers a decision-making framework, which integrates the best available research evidence. By employing this framework and the higher levels of research evidence it promotes, health sciences librarians can lay the foundation for more collaborative and scientific endeavors.

Evidence-based librarianship: an overview

PubMed Central

Eldredge, Jonathan D.

2000-01-01

Objective: To demonstrate how the core characteristics of both evidence-based medicine (EBM) and evidence-based health care (EBHC) can be adapted to health sciences librarianship. Method: Narrative review essay involving development of a conceptual framework. The author describes the central features of EBM and EBHC. Following each description of a central feature, the author then suggests ways that this feature applies to health sciences librarianship. Results: First, the decision-making processes of EBM and EBHC are compatible with health sciences librarianship. Second, the EBM and EBHC values of favoring rigorously produced scientific evidence in decision making are congruent with the core values of librarianship. Third, the hierarchical levels of evidence can be applied to librarianship with some modifications. Library researchers currently favor descriptive-survey and case-study methods over systematic reviews, randomized controlled trials, or other higher levels of evidence. The library literature nevertheless contains diverse examples of randomized controlled trials, controlled-comparison studies, and cohort studies conducted by health sciences librarians. Conclusions: Health sciences librarians are confronted with making many practical decisions. Evidence-based librarianship offers a decision-making framework, which integrates the best available research evidence. By employing this framework and the higher levels of research evidence it promotes, health sciences librarians can lay the foundation for more collaborative and scientific endeavors. PMID:11055296

Reducing Subjectivity in Geothermal Exploration Decision Making (Presentation); NREL(National Renewable Energy Laboratory)

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

Akar, S.; Young, K.

Geothermal exploration projects have a significant amount of risk associated with uncertainties encountered in the discovery of the geothermal resource. Two of the largest challenges for increased geothermal deployment are 1) understanding when and how to proceed in an exploration program, and 2) when to walk away from a site. Current methodologies for exploration decision-making are formulatedby subjective expert opinion which can be incorrectly biased by expertise (e.g. geochemistry, geophysics), geographic location of focus, and the assumed conceptual model. The aim of this project is to develop a methodology for more objective geothermal exploration decision making at a given location,more » including go/no-go decision points to help developers and investors decide when to give up on alocation. In this scope, two different approaches are investigated: 1) value of information analysis (VOIA) which is used for evaluating and quantifying the value of a data before they are purchased, and 2) enthalpy-based exploration targeting based on reservoir size, temperature gradient estimates, and internal rate of return (IRR). The first approach, VOIA, aims to identify the value of aparticular data when making decisions with an uncertain outcome. This approach targets the pre-drilling phase of exploration. These estimated VOIs are highly affected by the size of the project and still have a high degree of subjectivity in assignment of probabilities. The second approach, exploration targeting, is focused on decision making during the drilling phase. It starts with a basicgeothermal project definition that includes target and minimum required production capacity and initial budgeting for exploration phases. Then, it uses average temperature gradient, reservoir temperature estimates, and production capacity to define targets and go/no-go limits. The decision analysis in this approach is based on achieving a minimum IRR at each phase of the project. This secondapproach was determined to be less subjective, since numerical inputs come from the collected data. And it helps to facilitate communication between project managers and exploration geologists in making objective go/no-go decisions throughout the different project phases.« less

Guidelines and Value-Based Decision Making: An Evolving Role for Payers.

PubMed

McCauley, Janet L

2015-01-01

Payers use evidence-based guidelines to promote effective health diagnoses and treatments for their members and to ensure that members are not subject to harmful or wasteful care. Payer guidelines inform coverage, but the content of these guidelines relies on the same evidentiary base as clinical treatment guidelines. Recent strategies to foster value through benefit design and alternative reimbursement methodologies illustrate emerging applications for evidence-based guidelines. The current focus on cost effectiveness within health technology assessment, comparative effectiveness research in collaboration with payers, and transparency around payer evidence assessment could better align payers' interests in evidence-based care with those of other stakeholders. The move to value in health care will depend upon credible clinical evidence to enable informed decision making. ©2015 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

Fuzzy decision-making framework for treatment selection based on the combined QUALIFLEX-TODIM method

NASA Astrophysics Data System (ADS)

Ji, Pu; Zhang, Hong-yu; Wang, Jian-qiang

2017-10-01

Treatment selection is a multi-criteria decision-making problem of significant concern in the medical field. In this study, a fuzzy decision-making framework is established for treatment selection. The framework mitigates information loss by introducing single-valued trapezoidal neutrosophic numbers to denote evaluation information. Treatment selection has multiple criteria that remarkably exceed the alternatives. In consideration of this characteristic, the framework utilises the idea of the qualitative flexible multiple criteria method. Furthermore, it considers the risk-averse behaviour of a decision maker by employing a concordance index based on TODIM (an acronym in Portuguese of interactive and multi-criteria decision-making) method. A sensitivity analysis is performed to illustrate the robustness of the framework. Finally, a comparative analysis is conducted to compare the framework with several extant methods. Results indicate the advantages of the framework and its better performance compared with the extant methods.

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

PubMed

Megregian, Michele; Nieuwenhuijze, Marianne

2018-05-18

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

Patient Experience-based Value Sets: Are They Stable?

PubMed

Pickard, A Simon; Hung, Yu-Ting; Lin, Fang-Ju; Lee, Todd A

2017-11-01

Although societal preference weights are desirable to inform resource-allocation decision-making, patient experienced health state-based value sets can be useful for clinical decision-making, but context may matter. To estimate EQ-5D value sets using visual analog scale (VAS) ratings for patients undergoing knee replacement surgery and compare the estimates before and after surgery. We used the Patient Reported Outcome Measures data collected by the UK National Health Service on patients undergoing knee replacement from 2009 to 2012. Generalized least squares regression models were used to derive value sets based on the EQ-5D-3 level using a development sample before and after surgery, and model performance was examined using a validation sample. A total of 90,450 preoperative and postoperative valuations were included. For preoperative valuations, the largest decrement in VAS values was associated with the dimension of anxiety/depression, followed by self-care, mobility, usual activities, and pain/discomfort. However, pain/discomfort had a greater impact on VAS value decrement in postoperative valuations. Compared with preoperative health problems, postsurgical health problems were associated with larger value decrements, with significant differences in several levels and dimensions, including level 2 of mobility, level 2/3 of usual activities, level 3 of pain/discomfort, and level 3 of anxiety/depression. Similar results were observed across subgroups stratified by age and sex. Findings suggest patient experience-based value sets are not stable (ie, context such as timing matters). However, the knowledge that lower values are assigned to health states postsurgery compared with presurgery may be useful for the patient-doctor decision-making process.

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.

Community Bioethics: The Health Decisions Community Council.

ERIC Educational Resources Information Center

Gallegos, Tom; Mrgudic, Kate

1993-01-01

Sees health care decision making posing variety of complex issues for individuals, families, and providers. Describes Health Decisions Community Council (HDCC), community-based bioethics committee established to offer noninstitutional forum for discussion of health care dilemmas. Notes that social work skills and values for autonomy and…

Structured decision making as a conceptual framework to identify thresholds for conservation and management

USGS Publications Warehouse

Martin, J.; Runge, M.C.; Nichols, J.D.; Lubow, B.C.; Kendall, W.L.

2009-01-01

Thresholds and their relevance to conservation have become a major topic of discussion in the ecological literature. Unfortunately, in many cases the lack of a clear conceptual framework for thinking about thresholds may have led to confusion in attempts to apply the concept of thresholds to conservation decisions. Here, we advocate a framework for thinking about thresholds in terms of a structured decision making process. The purpose of this framework is to promote a logical and transparent process for making informed decisions for conservation. Specification of such a framework leads naturally to consideration of definitions and roles of different kinds of thresholds in the process. We distinguish among three categories of thresholds. Ecological thresholds are values of system state variables at which small changes bring about substantial changes in system dynamics. Utility thresholds are components of management objectives (determined by human values) and are values of state or performance variables at which small changes yield substantial changes in the value of the management outcome. Decision thresholds are values of system state variables at which small changes prompt changes in management actions in order to reach specified management objectives. The approach that we present focuses directly on the objectives of management, with an aim to providing decisions that are optimal with respect to those objectives. This approach clearly distinguishes the components of the decision process that are inherently subjective (management objectives, potential management actions) from those that are more objective (system models, estimates of system state). Optimization based on these components then leads to decision matrices specifying optimal actions to be taken at various values of system state variables. Values of state variables separating different actions in such matrices are viewed as decision thresholds. Utility thresholds are included in the objectives component, and ecological thresholds may be embedded in models projecting consequences of management actions. Decision thresholds are determined by the above-listed components of a structured decision process. These components may themselves vary over time, inducing variation in the decision thresholds inherited from them. These dynamic decision thresholds can then be determined using adaptive management. We provide numerical examples (that are based on patch occupancy models) of structured decision processes that include all three kinds of thresholds. ?? 2009 by the Ecological Society of America.

Shared Decision-Making and Patient Empowerment in Preventive Cardiology.

PubMed

Kambhampati, Swetha; Ashvetiya, Tamara; Stone, Neil J; Blumenthal, Roger S; Martin, Seth S

2016-05-01

Shared decision-making, central to evidence-based medicine and good patient care, begins and ends with the patient. It is the process by which a clinician and a patient jointly make a health decision after discussing options, potential benefits and harms, and considering the patient's values and preferences. Patient empowerment is crucial to shared decision-making and occurs when a patient accepts responsibility for his or her health. They can then learn to solve their own problems with information and support from professionals. Patient empowerment begins with the provider acknowledging that patients are ultimately in control of their care and aims to increase a patient's capacity to think critically and make autonomous, informed decisions about their health. This article explores the various components of shared decision-making in scenarios such as hypertension and hyperlipidemia, heart failure, and diabetes. It explores barriers and the potential for improving medication adherence, disease awareness, and self-management of chronic disease.

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

Changing Times, Complex Decisions: Presidential Values and Decision Making

ERIC Educational Resources Information Center

Hornak, Anne M.; Garza Mitchell, Regina L.

2016-01-01

Objective: The objective of this article is to delve more deeply into the thought processes of the key decision makers at community colleges and understand how they make decisions. Specifically, this article focuses on the role of the community college president's personal values in decision making. Method: We conducted interviews with 13…

Value encoding in single neurons in the human amygdala during decision making.

PubMed

Jenison, Rick L; Rangel, Antonio; Oya, Hiroyuki; Kawasaki, Hiroto; Howard, Matthew A

2011-01-05

A growing consensus suggests that the brain makes simple choices by assigning values to the stimuli under consideration and then comparing these values to make a decision. However, the network involved in computing the values has not yet been fully characterized. Here, we investigated whether the human amygdala plays a role in the computation of stimulus values at the time of decision making. We recorded single neuron activity from the amygdala of awake patients while they made simple purchase decisions over food items. We found 16 amygdala neurons, located primarily in the basolateral nucleus that responded linearly to the values assigned to individual items.

The value of decision models: Using ecologically based invasive plant management as an example

USDA-ARS?s Scientific Manuscript database

Humans have both fast and slow thought processes which influence our judgment and decision-making. The fast system is intuitive and valuable for decisions which do not require multiple steps or the application of logic or statistics. However, many decisions in natural resources are complex and req...

The Computational Complexity of Valuation and Motivational Forces in Decision-Making Processes

PubMed Central

Schultheiss, Nathan W.; Carter, Evan C.

2015-01-01

The concept of value is fundamental to most theories of motivation and decision making. However, value has to be measured experimentally. Different methods of measuring value produce incompatible valuation hierarchies. Taking the agent’s perspective (rather than the experimenter’s), we interpret the different valuation measurement methods as accessing different decision-making systems and show how these different systems depend on different information processing algorithms. This identifies the translation from these multiple decision-making systems into a single action taken by a given agent as one of the most important open questions in decision making today. We conclude by looking at how these different valuation measures accessing different decision-making systems can be used to understand and treat decision dysfunction such as in addiction. PMID:25981912

The neural correlates of risky decision making across short and long runs

PubMed Central

Rao, Li-Lin; Dunn, John C.; Zhou, Yuan; Li, Shu

2015-01-01

People frequently change their preferences for options of gambles which they play once compared to those they play multiple times. In general, preferences for repeated play gambles are more consistent with the expected values of the options. According to the one-process view, the change in preference is due to a change in the structure of the gamble that is relevant to decision making. According to the two-process view, the change is attributable to a shift in the decision making strategy that is used. To adjudicate between these two theories, we asked participants to choose between gambles played once or 100 times, and to choose between them based on their expected value. Consistent with the two-process theory, we found a set of brain regions that were sensitive to the extent of behavioral change between single and aggregated play and also showed significant (de)activation in the expected value choice task. These results support the view that people change their decision making strategies for risky choice considered once or multiple times. PMID:26516095

Dopamine Receptor-Specific Contributions to the Computation of Value.

PubMed

Burke, Christopher J; Soutschek, Alexander; Weber, Susanna; Raja Beharelle, Anjali; Fehr, Ernst; Haker, Helene; Tobler, Philippe N

2018-05-01

Dopamine is thought to play a crucial role in value-based decision making. However, the specific contributions of different dopamine receptor subtypes to the computation of subjective value remain unknown. Here we demonstrate how the balance between D1 and D2 dopamine receptor subtypes shapes subjective value computation during risky decision making. We administered the D2 receptor antagonist amisulpride or placebo before participants made choices between risky options. Compared with placebo, D2 receptor blockade resulted in more frequent choice of higher risk and higher expected value options. Using a novel model fitting procedure, we concurrently estimated the three parameters that define individual risk attitude according to an influential theoretical account of risky decision making (prospect theory). This analysis revealed that the observed reduction in risk aversion under amisulpride was driven by increased sensitivity to reward magnitude and decreased distortion of outcome probability, resulting in more linear value coding. Our data suggest that different components that govern individual risk attitude are under dopaminergic control, such that D2 receptor blockade facilitates risk taking and expected value processing.

Considering patient values and treatment preferences enhances patient involvement in rectal cancer treatment decision making.

PubMed

Kunneman, Marleen; Marijnen, Corrie A M; Baas-Thijssen, Monique C M; van der Linden, Yvette M; Rozema, Tom; Muller, Karin; Geijsen, Elisabeth D; Stiggelbout, Anne M; Pieterse, Arwen H

2015-11-01

The shared decision making (SDM) model states that patients' values and preferences should be clarified to choose a strategy that best fits the patient. This study aimed to assess whether values and preferences of rectal cancer patients are voiced and considered in deciding about preoperative radiotherapy (PRT), and whether this makes patients feel more involved in treatment decision making. Pre-treatment consultations of radiation oncologists and patients eligible for PRT were audiotaped (N=90). Tapes were transcribed and coded to identify patients' values and treatment preferences. Patients filled in a post-consultation questionnaire on their perceived involvement in decision making (N=60). Patients' values were voiced for 62/611 of benefits/harms addressed (10%), in 38/90 consultations (42%; maximum 4 values per consultation), and most often related to major long-term treatment outcomes. Patients' treatment preferences were discussed in 20/90 consultations (22%). In 16/90 consultations (18%), the oncologists explicitly indicated to consider patients' values or preferences. Patients perceived a significantly more active role in decision making if their values or preferences had been voiced or considered. Patients' values and treatment preferences are voiced or considered in a minority of consultations. If they are, this increases patients' perceived involvement in the decision making process. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Women's Values and Preferences for Thromboprophylaxis during Pregnancy: A Comparison of Direct-choice and Decision Analysis using Patient Specific Utilities

PubMed Central

Eckman, Mark H.; Alonso-Coello, Pablo; Guyatt, Gordon H.; Ebrahim, Shanil; Tikkinen, Kari A.O.; Lopes, Luciane Cruz; Neumann, Ignacio; McDonald, Sarah D.; Zhang, Yuqing; Zhou, Qi; Akl, Elie A.; Jacobsen, Ann Flem; Santamaría, Amparo; Annichino-Bizzacchi, Joyce Maria; Bitar, Wael; Sandset, Per Morten; Bates, Shannon M.

2016-01-01

Background Women with a history of venous thromboembolism (VTE) have an increased recurrence risk during pregnancy. Low molecular weight heparin (LMWH) reduces this risk, but is costly, burdensome, and may increase risk of bleeding. The decision to start thromboprophylaxis during pregnancy is sensitive to women's values and preferences. Our objective was to compare women's choices using a holistic approach in which they were presented all of the relevant information (direct-choice) versus a personalized decision analysis in which a mathematical model incorporated their preferences and VTE risk to make a treatment recommendation. Methods Multicenter, international study. Structured interviews were on women with a history of VTE who were pregnant, planning, or considering pregnancy. Women indicated their willingness to receive thromboprophylaxis based on scenarios using personalized estimates of VTE recurrence and bleeding risks. We also obtained women's values for health outcomes using a visual analog scale. We performed individualized decision analyses for each participant and compared model recommendations to decisions made when presented with the direct-choice exercise. Results Of the 123 women in the study, the decision model recommended LMWH for 51 women and recommended against LMWH for 72 women. 12% (6/51) of women for whom the decision model recommended thromboprophylaxis chose not to take LMWH; 72% (52/72) of women for whom the decision model recommended against thromboprophylaxis chose LMWH. Conclusions We observed a high degree of discordance between decisions in the direct-choice exercise and decision model recommendations. Although which approach best captures individuals’ true values remains uncertain, personalized decision support tools presenting results based on personalized risks and values may improve decision making. PMID:26033397

Women's values and preferences for thromboprophylaxis during pregnancy: a comparison of direct-choice and decision analysis using patient specific utilities.

PubMed

Eckman, Mark H; Alonso-Coello, Pablo; Guyatt, Gordon H; Ebrahim, Shanil; Tikkinen, Kari A O; Lopes, Luciane Cruz; Neumann, Ignacio; McDonald, Sarah D; Zhang, Yuqing; Zhou, Qi; Akl, Elie A; Jacobsen, Ann Flem; Santamaría, Amparo; Annichino-Bizzacchi, Joyce Maria; Bitar, Wael; Sandset, Per Morten; Bates, Shannon M

2015-08-01

Women with a history of venous thromboembolism (VTE) have an increased recurrence risk during pregnancy. Low molecular weight heparin (LMWH) reduces this risk, but is costly, burdensome, and may increase risk of bleeding. The decision to start thromboprophylaxis during pregnancy is sensitive to women's values and preferences. Our objective was to compare women's choices using a holistic approach in which they were presented all of the relevant information (direct-choice) versus a personalized decision analysis in which a mathematical model incorporated their preferences and VTE risk to make a treatment recommendation. Multicenter, international study. Structured interviews were on women with a history of VTE who were pregnant, planning, or considering pregnancy. Women indicated their willingness to receive thromboprophylaxis based on scenarios using personalized estimates of VTE recurrence and bleeding risks. We also obtained women's values for health outcomes using a visual analog scale. We performed individualized decision analyses for each participant and compared model recommendations to decisions made when presented with the direct-choice exercise. Of the 123 women in the study, the decision model recommended LMWH for 51 women and recommended against LMWH for 72 women. 12% (6/51) of women for whom the decision model recommended thromboprophylaxis chose not to take LMWH; 72% (52/72) of women for whom the decision model recommended against thromboprophylaxis chose LMWH. We observed a high degree of discordance between decisions in the direct-choice exercise and decision model recommendations. Although which approach best captures individuals' true values remains uncertain, personalized decision support tools presenting results based on personalized risks and values may improve decision making. Copyright © 2015 Elsevier Ltd. All rights reserved.

Neuroeconomics: cross-currents in research on decision-making.

PubMed

Sanfey, Alan G; Loewenstein, George; McClure, Samuel M; Cohen, Jonathan D

2006-03-01

Despite substantial advances, the question of how we make decisions and judgments continues to pose important challenges for scientific research. Historically, different disciplines have approached this problem using different techniques and assumptions, with few unifying efforts made. However, the field of neuroeconomics has recently emerged as an inter-disciplinary effort to bridge this gap. Research in neuroscience and psychology has begun to investigate neural bases of decision predictability and value, central parameters in the economic theory of expected utility. Economics, in turn, is being increasingly influenced by a multiple-systems approach to decision-making, a perspective strongly rooted in psychology and neuroscience. The integration of these disparate theoretical approaches and methodologies offers exciting potential for the construction of more accurate models of decision-making.

Assessing decision quality in patient-centred care requires a preference-sensitive measure

PubMed Central

Kaltoft, Mette; Cunich, Michelle; Salkeld, Glenn; Dowie, Jack

2014-01-01

A theory-based instrument for measuring the quality of decisions made using any form of decision technology, including both decision-aided and unaided clinical consultations is required to enable person- and patient-centred care and to respond positively to individual heterogeneity in the value aspects of decision making. Current instruments using the term ‘decision quality’ have adopted a decision- and thus condition-specific approach. We argue that patient-centred care requires decision quality to be regarded as both preference-sensitive across multiple relevant criteria and generic across all conditions and decisions. MyDecisionQuality is grounded in prescriptive multi criteria decision analysis and employs a simple expected value algorithm to calculate a score for the quality of a decision that combines, in the clinical case, the patient’s individual preferences for eight quality criteria (expressed as importance weights) and their ratings of the decision just taken on each of these criteria (expressed as performance rates). It thus provides an index of decision quality that encompasses both these aspects. It also provides patients with help in prioritizing quality criteria for future decision making by calculating, for each criterion, the Incremental Value of Perfect Rating, that is, the increase in their decision quality score that would result if their performance rating on the criterion had been 100%, weightings unchanged. MyDecisionQuality, which is a web-based generic and preference-sensitive instrument, can constitute a key patient-reported measure of the quality of the decision-making process. It can provide the basis for future decision improvement, especially when the clinician (or other stakeholders) completes the equivalent instrument and the extent and nature of concordance and discordance can be established. Apart from its role in decision preparation and evaluation, it can also provide real time and relevant documentation for the patient’s record. PMID:24335587

Systematic review of the empirical investigation of resources to support decision-making regarding BRCA1 and BRCA2 genetic testing in women with breast cancer.

PubMed

Grimmett, Chloe; Pickett, Karen; Shepherd, Jonathan; Welch, Karen; Recio-Saucedo, Alejandra; Streit, Elke; Seers, Helen; Armstrong, Anne; Cutress, Ramsey I; Evans, D Gareth; Copson, Ellen; Meiser, Bettina; Eccles, Diana; Foster, Claire

2018-05-01

Identify existing resources developed and/or evaluated empirically in the published literature designed to support women with breast cancer making decisions regarding genetic testing for BRCA1/2 mutations. Systematic review of seven electronic databases. Studies were included if they described or evaluated resources that were designed to support women with breast cancer in making a decision to have genetic counselling or testing for familial breast cancer. Outcome and process evaluations, using any type of study design, as well as articles reporting the development of decision aids, were eligible for inclusion. Total of 9 publications, describing 6 resources were identified. Resources were effective at increasing knowledge or understanding of hereditary breast cancer. Satisfaction with resources was high. There was no evidence that any resource increased distress, worry or decisional conflict. Few resources included active functionalities for example, values-based exercises, to support decision-making. Tailored resources supporting decision-making may be helpful and valued by patients and increase knowledge of hereditary breast cancer, without causing additional distress. Clinicians should provide supportive written information to patients where it is available. However, there is a need for robustly developed decision tools to support decision-making around genetic testing in women with breast cancer. Copyright © 2017 Elsevier B.V. All rights reserved.

Decision Making, Self-Efficacy, and the Place of Career Education in Elementary School Social Studies

ERIC Educational Resources Information Center

Gallavan, Nancy P.

2003-01-01

In 1960, Shirley Engle identified the primary purposes or "heart of social studies instruction" as educating citizens living in a democracy and teaching them the process of decision making based on values formulation through genuine problem solving. Engle's recommendations for helping students to confront and comprehend today's complex issues…

Carpal tunnel syndrome: assessment of surgeon and patient preferences and priorities for decision-making.

PubMed

Hageman, Michiel G J S; Kinaci, Ahmet; Ju, Kevin; Guitton, Thierry G; Mudgal, Chaitanya S; Ring, David

2014-09-01

This study tested the null hypothesis that there are no differences between the preferences of hand surgeons and those patients with carpal tunnel syndrome (CTS) facing decisions about management of CTS (ie, the preferred content of a decision aid). One hundred three hand surgeons of the Science of Variation Group and 79 patients with CTS completed a survey about their priorities and preferences in decision making regarding the management of CTS. The questionnaire was structured according the Ottawa Decision Support Framework for the development of a decision aid. Important areas on which patient and hand surgeon interests differed included a preference for nonpainful, nonoperative treatment and confirmation of the diagnosis with electrodiagnostic testing. For patients, the main disadvantage of nonoperative treatment was that it was likely to be only palliative and temporary. Patients preferred, on average, to take the lead in decision making, whereas physicians preferred shared decision making. Patients and physicians agreed on the value of support from family and other physicians in the decision-making process. There were some differences between patient and surgeon priorities and preferences regarding decision making for CTS, particularly the risks and benefits of diagnostic and therapeutic procedures. Information that helps inform patients of their options based on current best evidence might help patients understand their own preferences and values, reduce decisional conflict, limit surgeon-to-surgeon variations, and improve health. Copyright © 2014 American Society for Surgery of the Hand. All rights reserved.

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

Using family paradigms to improve evidence-based practice.

PubMed

Hidecker, Mary Jo Cooley; Jones, Rebecca S; Imig, David R; Villarruel, Francisco A

2009-08-01

Evidence-based practice (EBP) describes clinical decision making using research, clinical experience, and client values. For family-centered practices, the client's family is integral to this process. This article proposes that using family paradigms, a family science framework, may help elicit and understand client/family values within family-centered EBP. This article describes the family paradigms framework: 4 classic paradigms of "closed," "random," "open," and "synchronous." Its applicability to family-centered EBP is proposed using augmentative and alternative communication examples. A family-centered approach to EBP requires families to be an integral part of clinical decision making, but some families may need assistance in enumerating their views and values. Family paradigms (which consider how a family uses its resources of time, space, energy, and material in the pursuit of its goals of control, affect, meaning, and content) may be a way to elicit family values and preferences relevant to clinical decisions. Family and client values can be incorporated throughout the EBP steps. Considering family paradigms may increase awareness and understanding of how families' views of their goals and resources affect clinical decisions. Further research is needed into both the processes and effectiveness of using family paradigms to conduct family-centered EBP.

Values in Literature: Primary.

ERIC Educational Resources Information Center

Sterling, Mary Ellen

Offering students some thinking and coping tools they can use to make sound decisions based on strong values, this resource book presents numerous selections from children's literature and suggested activities and projects. The book begins with a brief introduction, advice to teachers on using the book, ways to make the classroom more conducive to…

Clarifying values: an updated review

PubMed Central

2013-01-01

Background Consensus guidelines have recommended that decision aids include a process for helping patients clarify their values. We sought to examine the theoretical and empirical evidence related to the use of values clarification methods in patient decision aids. Methods Building on the International Patient Decision Aid Standards (IPDAS) Collaboration’s 2005 review of values clarification methods in decision aids, we convened a multi-disciplinary expert group to examine key definitions, decision-making process theories, and empirical evidence about the effects of values clarification methods in decision aids. To summarize the current state of theory and evidence about the role of values clarification methods in decision aids, we undertook a process of evidence review and summary. Results Values clarification methods (VCMs) are best defined as methods to help patients think about the desirability of options or attributes of options within a specific decision context, in order to identify which option he/she prefers. Several decision making process theories were identified that can inform the design of values clarification methods, but no single “best” practice for how such methods should be constructed was determined. Our evidence review found that existing VCMs were used for a variety of different decisions, rarely referenced underlying theory for their design, but generally were well described in regard to their development process. Listing the pros and cons of a decision was the most common method used. The 13 trials that compared decision support with or without VCMs reached mixed results: some found that VCMs improved some decision-making processes, while others found no effect. Conclusions Values clarification methods may improve decision-making processes and potentially more distal outcomes. However, the small number of evaluations of VCMs and, where evaluations exist, the heterogeneity in outcome measures makes it difficult to determine their overall effectiveness or the specific characteristics that increase effectiveness. PMID:24625261

The Pathways fertility preservation decision aid website for women with cancer: development and field testing.

PubMed

Woodard, Terri L; Hoffman, Aubri S; Covarrubias, Laura A; Holman, Deborah; Schover, Leslie; Bradford, Andrea; Hoffman, Derek B; Mathur, Aakrati; Thomas, Jerah; Volk, Robert J

2018-02-01

To improve survivors' awareness and knowledge of fertility preservation counseling and treatment options, this study engaged survivors and providers to design, develop, and field-test Pathways: a fertility preservation patient decision aid website for young women with cancer©. Using an adapted user-centered design process, our stakeholder advisory group and research team designed and optimized the Pathways patient decision aid website through four iterative cycles of review and revision with clinicians (n = 21) and survivors (n = 14). Field-testing (n = 20 survivors) assessed post-decision aid scores on the Fertility Preservation Knowledge Scale, feasibility of assessing women's decision-making values while using the website, and website usability/acceptability ratings. Iterative stakeholder engagement optimized the Pathways decision aid website to meet survivors' and providers' needs, including providing patient-friendly information and novel features such as interactive value clarification exercises, testimonials that model shared decision making, financial/referral resources, and a printable personal summary. Survivors scored an average of 8.2 out of 13 (SD 1.6) on the Fertility Preservation Knowledge Scale. They rated genetic screening and having a biological child as strong factors in their decision-making, and 71% indicated a preference for egg freezing. Most women (> 85%) rated Pathways favorably, and all women (100%) said they would recommend it to other women. The Pathways decision aid is a usable and acceptable tool to help women learn about fertility preservation. The Pathways decision aid may help women make well-informed values-based decisions and prevent future infertility-related distress.

How do patients between the age of 65 and 75 use a web-based decision aid for treatment choice in localized prostate cancer?

PubMed

Schrijvers, Jessie; Vanderhaegen, Joke; Van Poppel, Hendrik; Haustermans, Karin; Van Audenhove, Chantal

2013-08-01

This study was designed to evaluate the use of a web-based decision aid by a 65plus patient group in their decision-making process for treatment of localized prostate cancer. Of particular interest was the use of technology features such as patients' statements, comparative tables, and a values clarification tool. One hundred men from the University Hospital of Leuven campus, Gasthuisberg, were invited to use the web-based decision aid in their decision-making process. Twenty-six men were excluded based on non- or limited use of the decision aid. Of the remaining 74 men, user specifications, decision aid surfing characteristics by means of web-log data, and especially the use of technology features were analyzed. Men spent on average 30 minutes on the web-based decision aid. Most time was spent on the pages with information on treatment options. These pages were also most frequently accessed. The use of the feature 'comparative tables' was the highest, followed by the 'values clarification tool'. According to age (<70 or >70 years) differences were observed for the time spent on the decision aid, the pages accessed, and the use of the technology features. Despite concerns about the usability of a web-based decision aid for elderly patients, these results indicated that the majority of 65plus persons with good internet skills use a web-based decision aid as well as its incorporated technology features. © 2013 Wiley Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

Expected Utility Based Decision Making under Z-Information and Its Application.

PubMed

Aliev, Rashad R; Mraiziq, Derar Atallah Talal; Huseynov, Oleg H

2015-01-01

Real-world decision relevant information is often partially reliable. The reasons are partial reliability of the source of information, misperceptions, psychological biases, incompetence, and so forth. Z-numbers based formalization of information (Z-information) represents a natural language (NL) based value of a variable of interest in line with the related NL based reliability. What is important is that Z-information not only is the most general representation of real-world imperfect information but also has the highest descriptive power from human perception point of view as compared to fuzzy number. In this study, we present an approach to decision making under Z-information based on direct computation over Z-numbers. This approach utilizes expected utility paradigm and is applied to a benchmark decision problem in the field of economics.

Development of a decision aid for energy resource management for the Navajo Nation incorporating environmental cultural values

NASA Astrophysics Data System (ADS)

Necefer, Len Edward

Decision-making surrounding pathways of future energy resource management are complexity and requires balancing tradeoffs of multiple environmental, social, economic, and technical outcomes. Technical decision aid can provide a framework for informed decision making, allowing individuals to better understand the tradeoff between resources, technology, energy services, and prices. While technical decision aid have made significant advances in evaluating these quantitative aspects of energy planning and performance, they have not been designed to incorporate human factors, such as preferences and behavior that are informed by cultural values. Incorporating cultural values into decision tools can provide not only an improved decision framework for the Navajo Nation, but also generate new insights on how these perspective can improve decision making on energy resources. Ensuring these aids are a cultural fit for each context has the potential to increase trust and promote understanding of the tradeoffs involved in energy resource management. In this dissertation I present the development of a technical tool that explicitly addresses cultural and spiritual values and experimentally assesses their influence on the preferences and decision making of Navajo citizens. Chapter 2 describes the results of a public elicitation effort to gather information about stakeholder views and concerns related to energy development in the Navajo Nation in order to develop a larger sample survey and a decision-support tool that links techno-economic energy models with sociocultural attributes. Chapter 3 details the methods of developing the energy decision aid and its underlying assumptions for alternative energy projects and their impacts. This tool also provides an alternative to economic valuation of cultural impacts based upon an ordinal index tied to environmental impacts. Chapter 4 details the the influence of various cultural, environmental, and economic outcome information provided through the developed decision aid on beliefs and preferences related to the type and scale of energy development, trust of decision makers, and larger concern for environmental protection. Finally, chapter 5 presents concluding thoughts future research and on how technical-social decision tools can provide a means ensuring effective decision making on the Navajo Nation and other American Indian communities.

Valuing information for sewer replacement decisions.

PubMed

van Riel, Wouter; Langeveld, Jeroen; Herder, Paulien; Clemens, François

Decision-making for sewer asset management is partially based on intuition and often lacks explicit argumentation, hampering decision transparency and reproducibility. This is not to be preferred in light of public accountability and cost-effectiveness. It is unknown to what extent each decision criterion is appreciated by decision-makers. Further insight into this relative importance improves understanding of decision-making of sewer system managers. As such, a digital questionnaire (response ratio 43%), containing pairwise comparisons between 10 relevant information sources, was sent to all 407 municipalities in the Netherlands to analyse the relative importance and assess whether a shared frame of reasoning is present. Thurstone's law of comparative judgment was used for analysis, combined with several consistency tests. Results show that camera inspections were valued highest, while pipe age was considered least important. The respondents were pretty consistent per individual and also showed consistency as a group. This indicated a common framework of reasoning among the group. The feedback of the group showed, however, the respondents found it difficult to make general comparisons without having a context. This indicates decision-making in practice is more likely to be steered by other mechanisms than purely combining information sources.

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

PubMed

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

2016-05-01

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

Gender and Values: What Is the Impact on Decision Making?

ERIC Educational Resources Information Center

Crow, Stephen M.; And Others

1991-01-01

Linkages among gender, decision making, and values related to moral development and equity/equality are studied for 54 graduate and 186 undergraduate business school students (48 percent females) attending a Southern urban university. Results illustrate gender-related differences in value systems, weights of decision issues, and decisions. Future…

Cost-effectiveness analyses and their role in improving healthcare strategies.

PubMed

Rodriguez, Maria I; Caughey, Aaron B

2013-12-01

In this era of healthcare reform, attention is focused on increasing the quality of care and access to services, while simultaneously reducing the cost. Economic evaluations can play an important role in translating research to evidence-based practice and policy. Cost-effectiveness analysis (CEA) and its utility for clinical and policy decision making among U.S. obstetricians and gynecologists is reviewed. Three case examples demonstrating the value of this methodology in decision making are considered. A discussion of the methodologic principles of CEA, the advantages, and the limitations of the methodology are presented. CEA can play an important role in evidence-based decision making, with value for clinicians and policy makers alike. These studies are of particular interest in the field of obstetrics and gynecology, in which uncertainty from epidemiologic or clinical trials exists, or multiple perspectives need to be considered (maternal, neonatal, and societal). As with all research, it is essential that economic evaluations are conducted according to established methodologic standards. Interpretation and application of results should occur with a clear understanding of both the value and the limitations of economic evaluations.

Discussing uncertainty and risk in primary care: recommendations of a multi-disciplinary panel regarding communication around prostate cancer screening.

PubMed

Wilkes, Michael; Srinivasan, Malathi; Cole, Galen; Tardif, Richard; Richardson, Lisa C; Plescia, Marcus

2013-11-01

Shared decision making improves value-concordant decision-making around prostate cancer screening (PrCS). Yet, PrCS discussions remain complex, challenging and often emotional for physicians and average-risk men. In July 2011, the Centers for Disease Control and Prevention convened a multidisciplinary expert panel to identify priorities for funding agencies and development groups to promote evidence-based, value-concordant decisions between men at average risk for prostate cancer and their physicians. Two-day multidisciplinary expert panel in Atlanta, Georgia, with structured discussions and formal consensus processes. Sixteen panelists represented diverse specialties (primary care, medical oncology, urology), disciplines (sociology, communication, medical education, clinical epidemiology) and market sectors (patient advocacy groups, Federal funding agencies, guideline-development organizations). Panelists used guiding interactional and evaluation models to identify and rate strategies that might improve PrCS discussions and decisions for physicians, patients and health systems/society. Efficacy was defined as the likelihood of each strategy to impact outcomes. Effort was defined as the relative amount of effort to develop, implement and sustain the strategy. Each strategy was rated (1-7 scale; 7 = maximum) using group process software (ThinkTank(TM)). For each group, intervention strategies were grouped as financial/regulatory, educational, communication or attitudinal levers. For each strategy, barriers were identified. Highly ranked strategies to improve value-concordant shared decision-making (SDM) included: changing outpatient clinic visit reimbursement to reward SDM; development of evidence-based, technology-assisted, point-of-service tools for physicians and patients; reframing confusing prostate cancer screening messages; providing pre-visit decision support interventions; utilizing electronic health records to promote benchmarking/best practices; providing additional training for physicians around value-concordant decision-making; and using re-accreditation to promote training. Conference outcomes present an expert consensus of strategies likely to improve value-concordant prostate cancer screening decisions. In addition, the methodology used to obtain agreement provides a model of successful collaboration around this and future controversial cancer screening issues, which may be of interest to funding agencies, educators and policy makers.

Cost–effectiveness thresholds: pros and cons

PubMed Central

Lauer, Jeremy A; De Joncheere, Kees; Edejer, Tessa; Hutubessy, Raymond; Kieny, Marie-Paule; Hill, Suzanne R

2016-01-01

Abstract Cost–effectiveness analysis is used to compare the costs and outcomes of alternative policy options. Each resulting cost–effectiveness ratio represents the magnitude of additional health gained per additional unit of resources spent. Cost–effectiveness thresholds allow cost–effectiveness ratios that represent good or very good value for money to be identified. In 2001, the World Health Organization’s Commission on Macroeconomics in Health suggested cost–effectiveness thresholds based on multiples of a country’s per-capita gross domestic product (GDP). In some contexts, in choosing which health interventions to fund and which not to fund, these thresholds have been used as decision rules. However, experience with the use of such GDP-based thresholds in decision-making processes at country level shows them to lack country specificity and this – in addition to uncertainty in the modelled cost–effectiveness ratios – can lead to the wrong decision on how to spend health-care resources. Cost–effectiveness information should be used alongside other considerations – e.g. budget impact and feasibility considerations – in a transparent decision-making process, rather than in isolation based on a single threshold value. Although cost–effectiveness ratios are undoubtedly informative in assessing value for money, countries should be encouraged to develop a context-specific process for decision-making that is supported by legislation, has stakeholder buy-in, for example the involvement of civil society organizations and patient groups, and is transparent, consistent and fair. PMID:27994285

A Value-Based Hierarchy of Objectives for Military Decision-Making

DTIC Science & Technology

1991-09-01

r"EHICS, ZECISION MAKING, DECISION THEORY ,ý LEADERSHIP , 101 LEAERSHIP TRAINIING) ` ~16. PRICI CODE 17. SfCURITY CLA SIPIATIOW 18. SECURITY...29, Just- War Theory ................ I..............30 Jus ad bellum............................ .32 Jus in bello.................33...professional competence, and elements of just war theory such as proportionality and discrimination. A review of the relevant literature on just war theory

High-Value Consults: A Curriculum to Promote Point-of-Care, Evidence-Based Recommendations.

PubMed

Nandiwada, Deepa Rani; Kohli, Amar; McNamara, Megan; Smith, Kenneth J; Zimmer, Shanta; McNeil, Melissa; Spagnoletti, Carla; Rubio, Doris; Berlacher, Kathryn

2017-10-01

In an era when value-based care is paramount, teaching trainees to explicitly communicate the evidence behind recommendations fosters high-value care (HVC) in the consultation process. To implement an HVC consult curriculum highlighting the need for clear consult questions, evidence-based recommendations to improve consult teaching, clinical decision-making, and the educational value of consults. A pilot curriculum was implemented for residents on cardiology consult electives utilizing faculty and fellows as evidence-based medicine (EBM) coaches. The curriculum included an online module, an EBM teaching point template, EBM presentations on rounds, and "coach" feedback on notes. A total of 15 residents and 4 fellows on cardiology consults participated, and 87% (13 of 15) of residents on consults felt the curriculum was educationally valuable. A total of 80% (72 of 90) of residents on general medicine rotations responded to the survey, and 25 of 72 residents (35%) had a consult with the EBM template. General medicine teams felt the EBM teaching points affected clinical decision-making (48%, 12 of 25) and favored dissemination of the curriculum (90%, 72 of 80). Checklist-guided chart review showed a 22% improvement in evidence-based summaries behind recommendations (7 of 36 precurriculum to 70 of 146 charts postcurriculum, P  = .015). The HVC consult curriculum during a cardiology elective was perceived by residents to influence clinical decision-making and evidence-based recommendations, and was found to be educationally valuable on both parties in the consult process.

Value judgements in the decision-making process for the elderly patient.

PubMed

Ubachs-Moust, J; Houtepen, R; Vos, R; ter Meulen, R

2008-12-01

The question of whether old age should or should not play a role in medical decision-making for the elderly patient is regularly debated in ethics and medicine. In this paper we investigate exactly how age influences the decision-making process. To explore the normative argumentation in the decisions regarding an elderly patient we make use of the argumentation model advanced by Toulmin. By expanding the model in order to identify normative components in the argumentation process it is possible to analyse the way that age-related value judgements influence the medical decision-making process. We apply the model to practice descriptions made by medical students after they had attended consultations and meetings in medical practice during their clinical training. Our results show the pervasive character of age-related value judgements. They influence the physician's decision in several ways and at several points in the decision-making process. Such explicit value judgements were not exclusively used for arguments against further diagnosis or treatment of older patients. We found no systematic "ageist" pattern in the clinical decisions by physicians. Since age plays such an important, yet hidden role in the medical decision-making process, we make a plea for revealing such normative argumentation in order to gain transparency and accountability in this process. An explicit deliberative approach will make the medical decision-making process more transparent and improve the physician-patient relationship, creating confidence and trust, which are at the heart of medical practice.

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

PubMed

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

2017-10-06

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

Categorization = Decision Making + Generalization

PubMed Central

Seger, Carol A; Peterson, Erik J.

2013-01-01

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

A Simplified Version of the Fuzzy Decision Method and its Comparison with the Paraconsistent Decision Method

NASA Astrophysics Data System (ADS)

de Carvalho, Fábio Romeu; Abe, Jair Minoro

2010-11-01

Two recent non-classical logics have been used to make decision: fuzzy logic and paraconsistent annotated evidential logic Et. In this paper we present a simplified version of the fuzzy decision method and its comparison with the paraconsistent one. Paraconsistent annotated evidential logic Et, introduced by Da Costa, Vago and Subrahmanian (1991), is capable of handling uncertain and contradictory data without becoming trivial. It has been used in many applications such as information technology, robotics, artificial intelligence, production engineering, decision making etc. Intuitively, one Et logic formula is type p(a, b), in which a and b belong to [0, 1] (real interval) and represent respectively the degree of favorable evidence (or degree of belief) and the degree of contrary evidence (or degree of disbelief) found in p. The set of all pairs (a; b), called annotations, when plotted, form the Cartesian Unitary Square (CUS). This set, containing a similar order relation of real number, comprises a network, called lattice of the annotations. Fuzzy logic was introduced by Zadeh (1965). It tries to systematize the knowledge study, searching mainly to study the fuzzy knowledge (you don't know what it means) and distinguish it from the imprecise one (you know what it means, but you don't know its exact value). This logic is similar to paraconsistent annotated one, since it attributes a numeric value (only one, not two values) to each proposition (then we can say that it is an one-valued logic). This number translates the intensity (the degree) with which the preposition is true. Let's X a set and A, a subset of X, identified by the function f(x). For each element x∈X, you have y = f(x)∈[0, 1]. The number y is called degree of pertinence of x in A. Decision making theories based on these logics have shown to be powerful in many aspects regarding more traditional methods, like the one based on Statistics. In this paper we present a first study for a simplified version of decision making theory based on Fuzzy Logic (SVMFD) and a comparison with the Paraconsistent Decision Method (PDM) based on Paraconsistent Annotated Evidential Logic Eτ, already presented and summarized in this paper. An example showing the two methods is presented in the paper, as well as a comparison between them.

Evidence-based practice of transfusion medicine: is it possible and what do the words mean?

PubMed

Vamvakas, Eleftherios C

2004-10-01

Evidence-based medicine (EBM) optimizes clinical decision making by dictating that clinical decisions be based on the best available research evidence and by integrating best research evidence with clinical expertise and patient values. Several rankings of the strength of the evidence generated from different types of clinical research designs have been presented, and, in addressing a particular problem, clinicians can base their decision making on the types of clinical reports that have been published, along with an assessment of the strengths and weaknesses of each study. At a policy level, the concept of EBM would dictate that policy decisions also be made based on the best available research evidence. In transfusion medicine, however, decisions are based on a broader range of inputs, and the criteria for evaluating the efficacy and/or cost-effectiveness of proposed interventions differ from those used in other areas. Reasons why policy decisions are often based on considerations other than the best research evidence include public expectations about transfusion safety and proposals for applying the precautionary principle to transfusion medicine. Using the debate over the appropriateness of introducing universal white-cell reduction as an example, this review describes 2 perspectives for assessing evidence and/or making clinical or policy decisions: the evidence-based approach and the precautionary-principle approach; and also considers whether decisions in transfusion medicine can be truly evidence based.

Distinct and Overlapping Brain Areas Engaged during Value-Based, Mathematical, and Emotional Decision Processing

PubMed Central

Hsu, Chun-Wei; Goh, Joshua O. S.

2016-01-01

When comparing between the values of different choices, human beings can rely on either more cognitive processes, such as using mathematical computation, or more affective processes, such as using emotion. However, the neural correlates of how these two types of processes operate during value-based decision-making remain unclear. In this study, we investigated the extent to which neural regions engaged during value-based decision-making overlap with those engaged during mathematical and emotional processing in a within-subject manner. In a functional magnetic resonance imaging experiment, participants viewed stimuli that always consisted of numbers and emotional faces that depicted two choices. Across tasks, participants decided between the two choices based on the expected value of the numbers, a mathematical result of the numbers, or the emotional face stimuli. We found that all three tasks commonly involved various cortical areas including frontal, parietal, motor, somatosensory, and visual regions. Critically, the mathematical task shared common areas with the value but not emotion task in bilateral striatum. Although the emotion task overlapped with the value task in parietal, motor, and sensory areas, the mathematical task also evoked responses in other areas within these same cortical structures. Minimal areas were uniquely engaged for the value task apart from the other two tasks. The emotion task elicited a more expansive area of neural activity whereas value and mathematical task responses were in more focal regions. Whole-brain spatial correlation analysis showed that valuative processing engaged functional brain responses more similarly to mathematical processing than emotional processing. While decisions on expected value entail both mathematical and emotional processing regions, mathematical processes have a more prominent contribution particularly in subcortical processes. PMID:27375466

Distinct and Overlapping Brain Areas Engaged during Value-Based, Mathematical, and Emotional Decision Processing.

PubMed

Hsu, Chun-Wei; Goh, Joshua O S

2016-01-01

When comparing between the values of different choices, human beings can rely on either more cognitive processes, such as using mathematical computation, or more affective processes, such as using emotion. However, the neural correlates of how these two types of processes operate during value-based decision-making remain unclear. In this study, we investigated the extent to which neural regions engaged during value-based decision-making overlap with those engaged during mathematical and emotional processing in a within-subject manner. In a functional magnetic resonance imaging experiment, participants viewed stimuli that always consisted of numbers and emotional faces that depicted two choices. Across tasks, participants decided between the two choices based on the expected value of the numbers, a mathematical result of the numbers, or the emotional face stimuli. We found that all three tasks commonly involved various cortical areas including frontal, parietal, motor, somatosensory, and visual regions. Critically, the mathematical task shared common areas with the value but not emotion task in bilateral striatum. Although the emotion task overlapped with the value task in parietal, motor, and sensory areas, the mathematical task also evoked responses in other areas within these same cortical structures. Minimal areas were uniquely engaged for the value task apart from the other two tasks. The emotion task elicited a more expansive area of neural activity whereas value and mathematical task responses were in more focal regions. Whole-brain spatial correlation analysis showed that valuative processing engaged functional brain responses more similarly to mathematical processing than emotional processing. While decisions on expected value entail both mathematical and emotional processing regions, mathematical processes have a more prominent contribution particularly in subcortical processes.

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

PubMed

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

2009-05-01

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

How much are you prepared to PAY for a forecast?

NASA Astrophysics Data System (ADS)

Arnal, Louise; Coughlan, Erin; Ramos, Maria-Helena; Pappenberger, Florian; Wetterhall, Fredrik; Bachofen, Carina; van Andel, Schalk Jan

2015-04-01

Probabilistic hydro-meteorological forecasts are a crucial element of the decision-making chain in the field of flood prevention. The operational use of probabilistic forecasts is increasingly promoted through the development of new novel state-of-the-art forecast methods and numerical skill is continuously increasing. However, the value of such forecasts for flood early-warning systems is a topic of diverging opinions. Indeed, the word value, when applied to flood forecasting, is multifaceted. It refers, not only to the raw cost of acquiring and maintaining a probabilistic forecasting system (in terms of human and financial resources, data volume and computational time), but also and most importantly perhaps, to the use of such products. This game aims at investigating this point. It is a willingness to pay game, embedded in a risk-based decision-making experiment. Based on a ``Red Cross/Red Crescent, Climate Centre'' game, it is a contribution to the international Hydrologic Ensemble Prediction Experiment (HEPEX). A limited number of probabilistic forecasts will be auctioned to the participants; the price of these forecasts being market driven. All participants (irrespective of having bought or not a forecast set) will then be taken through a decision-making process to issue warnings for extreme rainfall. This game will promote discussions around the topic of the value of forecasts for decision-making in the field of flood prevention.

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

PubMed

Butt, Muhammad Arif; Akram, Muhammad

2016-01-01

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

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

PubMed

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

2002-01-01

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

Adaptive resource management and the value of information

USGS Publications Warehouse

Williams, Byron K.; Eaton, Mitchell J.; Breininger, David R.

2011-01-01

The value of information is a general and broadly applicable concept that has been used for several decades to aid in making decisions in the face of uncertainty. Yet there are relatively few examples of its use in ecology and natural resources management, and almost none that are framed in terms of the future impacts of management decisions. In this paper we discuss the value of information in a context of adaptive management, in which actions are taken sequentially over a timeframe and both future resource conditions and residual uncertainties about resource responses are taken into account. Our objective is to derive the value of reducing or eliminating uncertainty in adaptive decision making. We describe several measures of the value of information, with each based on management objectives that are appropriate for adaptive management. We highlight some mathematical properties of these measures, discuss their geometries, and illustrate them with an example in natural resources management. Accounting for the value of information can help to inform decisions about whether and how much to monitor resource conditions through time.

Adaptive resource management and the value of information

USGS Publications Warehouse

Williams, B.K.; Eaton, M.J.; Breininger, D.R.

2011-01-01

The value of information is a general and broadly applicable concept that has been used for several decades to aid in making decisions in the face of uncertainty. Yet there are relatively few examples of its use in ecology and natural resources management, and almost none that are framed in terms of the future impacts of management decisions. In this paper we discuss the value of information in a context of adaptive management, in which actions are taken sequentially over a timeframe and both future resource conditions and residual uncertainties about resource responses are taken into account. Our objective is to derive the value of reducing or eliminating uncertainty in adaptive decision making. We describe several measures of the value of information, with each based on management objectives that are appropriate for adaptive management. We highlight some mathematical properties of these measures, discuss their geometries, and illustrate them with an example in natural resources management. Accounting for the value of information can help to inform decisions about whether and how much to monitor resource conditions through time. ?? 2011.

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2015-01-01

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

Family Communication about End-of-Life Decisions and the Enactment of the Decision-Maker Role.

PubMed

Trees, April R; Ohs, Jennifer E; Murray, Meghan C

2017-06-07

End-of-life (EOL) decisions in families are complex and emotional sites of family interaction necessitating family members coordinate roles in the EOL decision-making process. How family members in the United States enact the decision-maker role in EOL decision situations was examined through in-depth interviews with 22 individuals who participated in EOL decision-making for a family member. A number of themes emerged from the data with regard to the enactment of the decision-maker role. Families varied in how decision makers enacted the role in relation to collective family input, with consulting, informing and collaborating as different patterns of behavior. Formal family roles along with gender- and age-based roles shaped who took on the decision-maker role. Additionally, both family members and medical professionals facilitated or undermined the decision-maker's role enactment. Understanding the structure and enactment of the decision-maker role in family interaction provides insight into how individuals and/or family members perform the decision-making role within a cultural context that values autonomy and self-determination in combination with collective family action in EOL decision-making.

Chimpanzees and Bonobos Exhibit Emotional Responses to Decision Outcomes

PubMed Central

Rosati, Alexandra G.; Hare, Brian

2013-01-01

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

Value choices and considerations when limiting intensive care treatment: a qualitative study.

PubMed

Halvorsen, K; Førde, R; Nortvedt, P

2009-01-01

To shed light on the values and considerations that affect the decision-making processes and the decisions to limit intensive care treatment. Qualitative methodology with participant observation and in-depth interviews, with an emphasis on eliciting the underlying rationale of the clinicians' actions and choices when limiting treatment. Informants perceived over-treatment in intensive care medicine as a dilemma. One explanation was that the decision-making base was somewhat uncertain, complex and difficult. The informants claimed that those responsible for taking decisions from the admitting ward prolonged futile treatment because they may bear guilt or responsibility for something that had gone wrong during the course of treatment. The assessments of the patient's situation made by physicians from the admitting ward were often more organ-oriented and the expectations were less realistic than those of clinicians in the intensive care unit who frequently had a more balanced and overall perspective. Aspects such as the personality and the speciality of those involved, the culture of the unit and the degree of interdisciplinary cooperation were important issues in the decision-making processes. Under-communicated considerations jeopardise the principle of equal treatment. If intensive care patients are to be ensured equal treatment, strategies for interdisciplinary, transparent and appropriate decision-making processes must be developed in which open and hidden values are rendered visible, power structures disclosed, employees respected and the various perspectives of the treatment given their legitimate place.

Caudate Microstimulation Increases Value of Specific Choices.

PubMed

Santacruz, Samantha R; Rich, Erin L; Wallis, Joni D; Carmena, Jose M

2017-11-06

Value-based decision-making involves an assessment of the value of items available and the actions required to obtain them. The basal ganglia are highly implicated in action selection and goal-directed behavior [1-4], and the striatum in particular plays a critical role in arbitrating between competing choices [5-9]. Previous work has demonstrated that neural activity in the caudate nucleus is modulated by task-relevant action values [6, 8]. Nonetheless, how value is represented and maintained in the striatum remains unclear since decision-making in these tasks relied on spatially lateralized responses, confounding the ability to generalize to a more abstract choice task [6, 8, 9]. Here, we investigate striatal value representations by applying caudate electrical stimulation in macaque monkeys (n = 3) to bias decision-making in a task that divorces the value of a stimulus from motor action. Electrical microstimulation is known to induce neural plasticity [10, 11], and caudate microstimulation in primates has been shown to accelerate associative learning [12, 13]. Our results indicate that stimulation paired with a particular stimulus increases selection of that stimulus, and this effect was stimulus dependent and action independent. The modulation of choice behavior using microstimulation was best modeled as resulting from changes in stimulus value. Caudate neural recordings (n = 1) show that changes in value-coding neuron activity are stimulus value dependent. We argue that caudate microstimulation can differentially increase stimulus values independent of action, and unilateral manipulations of value are sufficient to mediate choice behavior. These results support potential future applications of microstimulation to correct maladaptive plasticity underlying dysfunctional decision-making related to neuropsychiatric conditions. Copyright © 2017 Elsevier Ltd. All rights reserved.

Parental Moral Distress and Moral Schism in the Neonatal ICU.

PubMed

Foe, Gabriella; Hellmann, Jonathan; Greenberg, Rebecca A

2018-05-25

Ethical dilemmas in critical care may cause healthcare practitioners to experience moral distress: incoherence between what one believes to be best and what occurs. Given that paediatric decision-making typically involves parents, we propose that parents can also experience moral distress when faced with making value-laden decisions in the neonatal intensive care unit. We propose a new concept-that parents may experience "moral schism"-a genuine uncertainty regarding a value-based decision that is accompanied by emotional distress. Schism, unlike moral distress, is not caused by barriers to making and executing a decision that is deemed to be best by the decision-makers but rather an encounter of significant internal struggle. We explore factors that appear to contribute to both moral distress and "moral schism" for parents: the degree of available support, a sense of coherence of the situation, and a sense of responsibility. We propose that moral schism is an underappreciated concept that needs to be explicated and may be more prevalent than moral distress when exploring decision-making experiences for parents. We also suggest actions of healthcare providers that may help minimize parental "moral schism" and moral distress.

Comprehensible knowledge model creation for cancer treatment decision making.

PubMed

Afzal, Muhammad; Hussain, Maqbool; Ali Khan, Wajahat; Ali, Taqdir; Lee, Sungyoung; Huh, Eui-Nam; Farooq Ahmad, Hafiz; Jamshed, Arif; Iqbal, Hassan; Irfan, Muhammad; Abbas Hydari, Manzar

2017-03-01

A wealth of clinical data exists in clinical documents in the form of electronic health records (EHRs). This data can be used for developing knowledge-based recommendation systems that can assist clinicians in clinical decision making and education. One of the big hurdles in developing such systems is the lack of automated mechanisms for knowledge acquisition to enable and educate clinicians in informed decision making. An automated knowledge acquisition methodology with a comprehensible knowledge model for cancer treatment (CKM-CT) is proposed. With the CKM-CT, clinical data are acquired automatically from documents. Quality of data is ensured by correcting errors and transforming various formats into a standard data format. Data preprocessing involves dimensionality reduction and missing value imputation. Predictive algorithm selection is performed on the basis of the ranking score of the weighted sum model. The knowledge builder prepares knowledge for knowledge-based services: clinical decisions and education support. Data is acquired from 13,788 head and neck cancer (HNC) documents for 3447 patients, including 1526 patients of the oral cavity site. In the data quality task, 160 staging values are corrected. In the preprocessing task, 20 attributes and 106 records are eliminated from the dataset. The Classification and Regression Trees (CRT) algorithm is selected and provides 69.0% classification accuracy in predicting HNC treatment plans, consisting of 11 decision paths that yield 11 decision rules. Our proposed methodology, CKM-CT, is helpful to find hidden knowledge in clinical documents. In CKM-CT, the prediction models are developed to assist and educate clinicians for informed decision making. The proposed methodology is generalizable to apply to data of other domains such as breast cancer with a similar objective to assist clinicians in decision making and education. Copyright © 2017 Elsevier Ltd. All rights reserved.

Computer-Based Aids for Learning, Job Performance, and Decision Making in Military Applications: Emergent Technology and Challenges

DTIC Science & Technology

2003-10-01

paper, which addresses the following questions: Is it worth it? What do we know about the value of technology applications in learning ( education and......fax) fletcher@ida.org SUMMARY Technology -based systems for education , training, and performance aiding (including decision aiding) may pose the

Beyond Relativism to Ethical Decision-Making

ERIC Educational Resources Information Center

Walker, Keith D.; Donlevy, J. Kent

2006-01-01

This article examines the ethical conundrum of educational decision makers when faced with a plethora of conflicting value-based decisions. It offers an analysis of a well-known fable as the foil to demonstrate the problematic nature of ethical relativism and postmodern ethics in resolving that conundrum, while advocating the use of five core…

Counterfactual Processing of Economic Action-Outcome Alternatives in Obsessive-Compulsive Disorder: Further Evidence of Impaired Goal-Directed Behavior

PubMed Central

Gillan, Claire M.; Morein-Zamir, Sharon; Kaser, Muzaffer; Fineberg, Naomi A.; Sule, Akeem; Sahakian, Barbara J.; Cardinal, Rudolf N.; Robbins, Trevor W.

2014-01-01

Background Obsessive-compulsive disorder (OCD) is a disorder of automatic, uncontrollable behaviors and obsessive rumination. There is evidence that OCD patients have difficulties performing goal-directed actions, instead exhibiting repetitive stimulus-response habit behaviors. This might result from the excessive formation of stimulus-response habit associations or from an impairment in the ability to use outcome value to guide behavior. We investigated the latter by examining counterfactual decision making, which is the ability to use comparisons of prospective action-outcome scenarios to guide economic choice. Methods We tested decision making (forward counterfactual) and affective responses (backward counterfactual) in 20 OCD patients and 20 matched healthy control subjects using an economic choice paradigm that previously revealed attenuation of both the experience and avoidance of counterfactual emotion in schizophrenia patients and patients with orbitofrontal cortex lesions. Results The use of counterfactual comparison to guide decision making was diminished in OCD patients, who relied primarily on expected value. Unlike the apathetic affective responses previously shown to accompany this decision style, OCD patients reported increased emotional responsivity to the outcomes of their choices and to the counterfactual comparisons that typify regret and relief. Conclusions Obsessive-compulsive disorder patients exhibit a pattern of decision making consistent with a disruption in goal-directed forward modeling, basing decisions instead on the temporally present (and more rational) calculation of expected value. In contrast to this style of decision making, emotional responses in OCD were more extreme and reactive than control subjects. These results are in line with an account of disrupted goal-directed cognitive control in OCD. PMID:23452663

Narrative Interest Standard: A Novel Approach to Surrogate Decision-Making for People With Dementia.

PubMed

Wilkins, James M

2017-06-17

Dementia is a common neurodegenerative process that can significantly impair decision-making capacity as the disease progresses. When a person is found to lack capacity to make a decision, a surrogate decision-maker is generally sought to aid in decision-making. Typical bases for surrogate decision-making include the substituted judgment standard and the best interest standard. Given the heterogeneous and progressive course of dementia, however, these standards for surrogate decision-making are often insufficient in providing guidance for the decision-making for a person with dementia, escalating the likelihood of conflict in these decisions. In this article, the narrative interest standard is presented as a novel and more appropriate approach to surrogate decision-making for people with dementia. Through case presentation and ethical analysis, the standard mechanisms for surrogate decision-making for people with dementia are reviewed and critiqued. The narrative interest standard is then introduced and discussed as a dementia-specific model for surrogate decision-making. Through incorporation of elements of a best interest standard in focusing on the current benefit-burden ratio and elements of narrative to provide context, history, and flexibility for values and preferences that may change over time, the narrative interest standard allows for elaboration of an enriched context for surrogate decision-making for people with dementia. More importantly, however, a narrative approach encourages the direct contribution from people with dementia in authoring the story of what matters to them in their lives.

"It's like playing with your destiny": Bosnian immigrants' views of advance directives and end-of-life decision-making.

PubMed

Searight, H Russell; Gafford, Jennifer

2005-07-01

Patient autonomy is a primary value in US health care. It is assumed that patients want to be fully and directly informed about serious health conditions and want to engage in advance planning about medical care at the end-of-life. Written advance directives and proxy decision-makers are vehicles to promote autonomy when patients are no longer able to represent their wishes. Cross-cultural studies have raised questions about the universal acceptance of these health care values among all ethnicities. In the current investigation, Bosnian immigrants were interviewed about their views of physician-patient communication, advance directives, and locus of decision-making in serious illness. Many of the respondents indicated that they did not want to be directly informed of a serious illness. There was an expressed preference for physician- or family-based health care decisions. Advance directives and formally appointed proxies were typically seen as unnecessary and inconsistent with many respondents' personal values. The findings suggest that the value of individual autonomy and control over the health care decisions may not be applicable to cultures with a collectivist orientation.

The conscious mind and its emergent properties; an analysis based on decision theory.

PubMed

Morris, James A

2011-08-01

The process of conscious and unconscious decision making is analyzed using decision theory. An essential part of an optimum decision strategy is the assessment of values and costs associated with correct and incorrect decisions. In the case of unconscious decisions this involves an automatic process akin to computation using numerical values. But for conscious decisions the conscious mind must experience the outcome of the decision as pleasure or pain. It is suggested that the rules of behavior are programmed in our genes but modified by experience of the society in which we are reared. Our unconscious then uses the rules to reward or punish our conscious mind for the decisions it makes. This is relevant to concepts of altruism and religion in society. It is consistent with the observation that we prefer beauty to utility. The decision theory equations also explain the paradox that a single index of happiness can be applied in society. The symptoms of mental illness can be due to appropriate or inappropriate action by the unconscious. The former indicates a psychological conflict between conscious and unconscious decision making. Inappropriate action indicates that a pathological process has switched on genetic networks that should be switched off. Copyright © 2011 Elsevier Ltd. All rights reserved.

Health State Utility Values for Age-Related Macular Degeneration: Review and Advice.

PubMed

Butt, Thomas; Tufail, Adnan; Rubin, Gary

2017-02-01

Health state utility values are a major source of uncertainty in economic evaluations of interventions for age-related macular degeneration (AMD). This review identifies and critiques published utility values and methods for eliciting de novo utility values in AMD. We describe how utility values have been used in healthcare decision making and provide guidance on the choice of utility values for future economic evaluations for AMD. Literature was searched using PubMed, and health technology assessments (HTA) were searched using HTA agency websites to identify articles reporting utility values or approaches to derive utility values in AMD and articles applying utilities for use in healthcare decision making relating to treatments for AMD. A total of 70 studies qualified for data extraction, 22 of which were classified as containing utility values and/or elicitation methods, and 48 were classified as using utility values in decision making. A large number of studies have elicited utility values for AMD, although those applied to decision making have focused on a few of these. There is an appreciation of the challenges in the measurement and valuation of health states, with recent studies addressing challenges such as the insensitivity of generic health-related quality of life (HRQoL) questionnaires and utility in the worse-seeing eye. We would encourage careful consideration when choosing utility values in decision making and an explicit critique of their applicability to the decision problem.

Organizational values in the provision of access to care for the uninsured

PubMed Central

Harrison, Krista Lyn; Taylor, Holly A.

2017-01-01

Background For the last 20 years, health provider organizations have made efforts to align mission, values, and everyday practices to ensure high-quality, high-value, and ethical care. However, little attention has been paid to the organizational values and practices of community-based programs that organize and facilitate access to care for uninsured populations. This study aimed to identify and describe organizational values relevant to resource allocation and policy decisions that affect the services offered to members, using the case of community access programs: county-based programs that provide access to care for the uninsured working poor. Methods Comparative and qualitative case study methodology was used, including document review, observations, and key informant interviews, at two geographically diverse programs. Results Nine values were identified as relevant to decision making: stewardship, quality care, access to care, service to others, community well-being, member independence, organizational excellence, decency, and fairness. The way these values were deployed in resource allocation decisions that affected services offered to the uninsured are illustrated in one example per site. Conclusions This study addresses the previous dearth in the literature regarding an empirical description of organizational values employed in decision making of community organizations. To assess the transferability of the values identified, we compared our empirical results to prior empirical and conceptual work in the United States and internationally and found substantial alignment. Future studies can examine whether the identified organizational values are reflective of those at other health care organizations. PMID:28781981

The value of innovation in decision-making in health care in Central Eastern Europe - The Sixth International Conference, 2 June 2017, Belgrade, Serbia.

PubMed

Novakovic, Tanja; Martin, Antony P; Parker, Mark; Ferrario, Alessandra; Vukovic, Simo; Łanda, Krzysztof; Duba, Jaroslav; Dankó, Dávid; Kotsopoulos, Nikolaos; Godman, Brian; Ristic, Jelena; Stefanovic, Danka; Tesic, Danka

2017-12-01

The Pharmacoeconomics Section of the Pharmaceutical Association of Serbia organised a one day international conference on the value of innovation in decision-making in health care in Central and Eastern Europe. The focus of the conference was on reimbursement decisions for medicines using health technology assessment and the use of managed entry agreements (MEAs). The objectives of this conference were firstly to discuss the challenges and opportunities with the use of MEAs in Central and Eastern European countries; secondly the role of patient registries especially with outcome based schemes, and finally new approaches to improve accessibility to new medicines including better managing their entry.

Empowerment Failure: How Shortcomings in Physician Communication Unwittingly Undermine Patient Autonomy.

PubMed

Ubel, Peter A; Scherr, Karen A; Fagerlin, Angela

2017-11-01

Many health care decisions depend not only upon medical facts, but also on value judgments-patient goals and preferences. Until recent decades, patients relied on doctors to tell them what to do. Then ethicists and others convinced clinicians to adopt a paradigm shift in medical practice, to recognize patient autonomy, by orienting decision making toward the unique goals of individual patients. Unfortunately, current medical practice often falls short of empowering patients. In this article, we reflect on whether the current state of medical decision making effectively promotes patients' health care goals. We base our reflections, in part, on research in which we observed physicians making earnest efforts to partner with patients in making treatment decisions, but still struggling to empower patients-failing to communicate clearly to patients about decision-relevant information, overwhelming patients with irrelevant information, overlooking when patients' emotions made it hard to engage in choices, and making recommendations before discussing patients' goals.

Livestock grazing, wildlife habitat, and rangeland values

Treesearch

Paul R. Krausman; David E. Naugle; Michael R. Frisina; Rick Northrup; Vernon C. Bleich; William M. Block; Mark C. Wallace; Jeffrey D. Wright

2009-01-01

Livestock managers make and implement grazing management decisions to achieve a variety of objectives including livestock production, sustainable grazing, and wildlife habitat enhancement. Assessed values of grazing lands and ranches are often based on aesthetics and wildlife habitat or recreational values, which can exceed agricultural values, thus providing...

Value of information analysis for interventional and counterfactual Bayesian networks in forensic medical sciences.

PubMed

Constantinou, Anthony Costa; Yet, Barbaros; Fenton, Norman; Neil, Martin; Marsh, William

2016-01-01

Inspired by real-world examples from the forensic medical sciences domain, we seek to determine whether a decision about an interventional action could be subject to amendments on the basis of some incomplete information within the model, and whether it would be worthwhile for the decision maker to seek further information prior to suggesting a decision. The method is based on the underlying principle of Value of Information to enhance decision analysis in interventional and counterfactual Bayesian networks. The method is applied to two real-world Bayesian network models (previously developed for decision support in forensic medical sciences) to examine the average gain in terms of both Value of Information (average relative gain ranging from 11.45% and 59.91%) and decision making (potential amendments in decision making ranging from 0% to 86.8%). We have shown how the method becomes useful for decision makers, not only when decision making is subject to amendments on the basis of some unknown risk factors, but also when it is not. Knowing that a decision outcome is independent of one or more unknown risk factors saves us from the trouble of seeking information about the particular set of risk factors. Further, we have also extended the assessment of this implication to the counterfactual case and demonstrated how answers about interventional actions are expected to change when some unknown factors become known, and how useful this becomes in forensic medical science. Copyright © 2015 Elsevier B.V. All rights reserved.

Decision making.

PubMed

Chambers, David W

2011-01-01

A decision is a commitment of resources under conditions of risk in expectation of the best future outcome. The smart decision is always the strategy with the best overall expected value-the best combination of facts and values. Some of the special circumstances involved in decision making are discussed, including decisions where there are multiple goals, those where more than one person is involved in making the decision, using trigger points, framing decisions correctly, commitments to lost causes, and expert decision makers. A complex example of deciding about removal of asymptomatic third molars, with and without an EBD search, is discussed.

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.

Do personal stories make patient decision aids more effective? A critical review of theory and evidence

PubMed Central

2013-01-01

Background Patient decision aids support people to make informed decisions between healthcare options. Personal stories provide illustrative examples of others’ experiences and are seen as a useful way to communicate information about health and illness. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in non-narrative prose. It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions. Methods A survey of primary empirical research employing a systematic review method investigated the effect of patient decision aids with or without a personal story on people’s healthcare judgements and decisions. Searches were carried out between 2005-2012 of electronic databases (Medline, PsycINFO), and reference lists of identified articles, review articles, and key authors. A narrative analysis described and synthesised findings. Results Of 734 citations identified, 11 were included describing 13 studies. All studies found participants’ judgments and/or decisions differed depending on whether or not their decision aid included a patient story. Knowledge was equally facilitated when the decision aids with and without stories had similar information content. Story-enhanced aids may help people recall information over time and/or their motivation to engage with health information. Personal stories affected both “system 1” (e.g., less counterfactual reasoning, more emotional reactions and perceptions) and “system 2” (e.g., more perceived deliberative decision making, more stable evaluations over time) decision-making strategies. Findings exploring associations with narrative communications, decision quality measures, and different levels of literacy and numeracy were mixed. The pattern of findings was similar for both experimental and real-world studies. Conclusions There is insufficient evidence that adding personal stories to decision aids increases their effectiveness to support people’s informed decision making. More rigorous research is required to elicit evidence about the type of personal story that a) encourages people to make more reasoned decisions, b) discourages people from making choices based on another’s values, and c) motivates people equally to engage with healthcare resources. PMID:24625283

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.

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

ERIC Educational Resources Information Center

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

2018-01-01

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

A Decision-Making Method with Grey Multi-Source Heterogeneous Data and Its Application in Green Supplier Selection

PubMed Central

Dang, Yaoguo; Mao, Wenxin

2018-01-01

In view of the multi-attribute decision-making problem that the attribute values are grey multi-source heterogeneous data, a decision-making method based on kernel and greyness degree is proposed. The definitions of kernel and greyness degree of an extended grey number in a grey multi-source heterogeneous data sequence are given. On this basis, we construct the kernel vector and greyness degree vector of the sequence to whiten the multi-source heterogeneous information, then a grey relational bi-directional projection ranking method is presented. Considering the multi-attribute multi-level decision structure and the causalities between attributes in decision-making problem, the HG-DEMATEL method is proposed to determine the hierarchical attribute weights. A green supplier selection example is provided to demonstrate the rationality and validity of the proposed method. PMID:29510521

A Decision-Making Method with Grey Multi-Source Heterogeneous Data and Its Application in Green Supplier Selection.

PubMed

Sun, Huifang; Dang, Yaoguo; Mao, Wenxin

2018-03-03

In view of the multi-attribute decision-making problem that the attribute values are grey multi-source heterogeneous data, a decision-making method based on kernel and greyness degree is proposed. The definitions of kernel and greyness degree of an extended grey number in a grey multi-source heterogeneous data sequence are given. On this basis, we construct the kernel vector and greyness degree vector of the sequence to whiten the multi-source heterogeneous information, then a grey relational bi-directional projection ranking method is presented. Considering the multi-attribute multi-level decision structure and the causalities between attributes in decision-making problem, the HG-DEMATEL method is proposed to determine the hierarchical attribute weights. A green supplier selection example is provided to demonstrate the rationality and validity of the proposed method.

When is enough evidence enough? - Using systematic decision analysis and value-of-information analysis to determine the need for further evidence.

PubMed

Siebert, Uwe; Rochau, Ursula; Claxton, Karl

2013-01-01

Decision analysis (DA) and value-of-information (VOI) analysis provide a systematic, quantitative methodological framework that explicitly considers the uncertainty surrounding the currently available evidence to guide healthcare decisions. In medical decision making under uncertainty, there are two fundamental questions: 1) What decision should be made now given the best available evidence (and its uncertainty)?; 2) Subsequent to the current decision and given the magnitude of the remaining uncertainty, should we gather further evidence (i.e., perform additional studies), and if yes, which studies should be undertaken (e.g., efficacy, side effects, quality of life, costs), and what sample sizes are needed? Using the currently best available evidence, VoI analysis focuses on the likelihood of making a wrong decision if the new intervention is adopted. The value of performing further studies and gathering additional evidence is based on the extent to which the additional information will reduce this uncertainty. A quantitative framework allows for the valuation of the additional information that is generated by further research, and considers the decision maker's objectives and resource constraints. Claxton et al. summarise: "Value of information analysis can be used to inform a range of policy questions including whether a new technology should be approved based on existing evidence, whether it should be approved but additional research conducted or whether approval should be withheld until the additional evidence becomes available." [Claxton K. Value of information entry in Encyclopaedia of Health Economics, Elsevier, forthcoming 2014.] The purpose of this tutorial is to introduce the framework of systematic VoI analysis to guide further research. In our tutorial article, we explain the theoretical foundations and practical methods of decision analysis and value-of-information analysis. To illustrate, we use a simple case example of a foot ulcer (e.g., with diabetes) as well as key references from the literature, including examples for the use of the decision-analytic VoI framework by health technology assessment agencies to guide further research. These concepts may guide stakeholders involved or interested in how to determine whether or not and, if so, which additional evidence is needed to make decisions. Copyright © 2013. Published by Elsevier GmbH.

The value of forecasting key-decision variables for rain-fed farming

NASA Astrophysics Data System (ADS)

Winsemius, Hessel; Werner, Micha

2013-04-01

Rain-fed farmers are highly vulnerable to variability in rainfall. Timely knowledge of the onset of the rainy season, the expected amount of rainfall and the occurrence of dry spells can help rain-fed farmers to plan the cropping season. Seasonal probabilistic weather forecasts may provide such information to farmers, but need to provide reliable forecasts of key variables with which farmers can make decisions. In this contribution, we present a new method to evaluate the value of meteorological forecasts in predicting these key variables. The proposed method measures skill by assessing whether a forecast was useful to this decision. This is done by taking into account the required accuracy of timing of the event to make the decision useful. The method progresses the estimate of forecast skill to forecast value by taking into account the required accuracy that is needed to make the decision valuable, based on the cost/loss ratio of possible decisions. The method is applied over the Limpopo region in Southern Africa. We demonstrate the method using the example of temporary water harvesting techniques. Such techniques require time to construct and must be ready long enough before the occurrence of a dry spell to be effective. The value of the forecasts to the decision used as an example is shown to be highly sensitive to the accuracy in the timing of forecasted dry spells, and the tolerance in the decision to timing error. The skill with which dry spells can be predicted is shown to be higher in some parts of the basin, indicating that these forecasts have higher value for the decision in those parts than in others. Through assessing the skill of forecasting key decision variables to the farmers we show that it is easier to understand if the forecasts have value in reducing risk, or if other adaptation strategies should be implemented.

Breaking the sound barrier: exploring parents' decision-making process of cochlear implants for their children.

PubMed

Chang, Pamara F

2017-08-01

To understand the dynamic experiences of parents undergoing the decision-making process regarding cochlear implants for their child(ren). Thirty-three parents of d/Deaf children participated in semi-structured interviews. Interviews were digitally recorded, transcribed, and coded using iterative and thematic coding. The results from this study reveal four salient topics related to parents' decision-making process regarding cochlear implantation: 1) factors parents considered when making the decision to get the cochlear implant for their child (e.g., desire to acculturate child into one community), 2) the extent to which parents' communities influence their decision-making (e.g., norms), 3) information sources parents seek and value when decision-making (e.g., parents value other parent's experiences the most compared to medical or online sources), and 4) personal experiences with stigma affecting their decision to not get the cochlear implant for their child. This study provides insights into values and perspectives that can be utilized to improve informed decision-making, when making risky medical decisions with long-term implications. With thorough information provisions, delineation of addressing parents' concerns and encompassing all aspects of the decision (i.e., medical, social and cultural), health professional teams could reduce the uncertainty and anxiety for parents in this decision-making process for cochlear implantation. Copyright © 2017 Elsevier B.V. All rights reserved.

Expected p-values in light of an ROC curve analysis applied to optimal multiple testing procedures.

PubMed

Vexler, Albert; Yu, Jihnhee; Zhao, Yang; Hutson, Alan D; Gurevich, Gregory

2017-01-01

Many statistical studies report p-values for inferential purposes. In several scenarios, the stochastic aspect of p-values is neglected, which may contribute to drawing wrong conclusions in real data experiments. The stochastic nature of p-values makes their use to examine the performance of given testing procedures or associations between investigated factors to be difficult. We turn our focus on the modern statistical literature to address the expected p-value (EPV) as a measure of the performance of decision-making rules. During the course of our study, we prove that the EPV can be considered in the context of receiver operating characteristic (ROC) curve analysis, a well-established biostatistical methodology. The ROC-based framework provides a new and efficient methodology for investigating and constructing statistical decision-making procedures, including: (1) evaluation and visualization of properties of the testing mechanisms, considering, e.g. partial EPVs; (2) developing optimal tests via the minimization of EPVs; (3) creation of novel methods for optimally combining multiple test statistics. We demonstrate that the proposed EPV-based approach allows us to maximize the integrated power of testing algorithms with respect to various significance levels. In an application, we use the proposed method to construct the optimal test and analyze a myocardial infarction disease dataset. We outline the usefulness of the "EPV/ROC" technique for evaluating different decision-making procedures, their constructions and properties with an eye towards practical applications.

Important medical decisions: Using brief motivational interviewing to enhance patients' autonomous decision-making.

PubMed

Pantalon, Michael V; Sledge, William H; Bauer, Stephen F; Brodsky, Beth; Giannandrea, Stephanie; Kay, Jerald; Lazar, Susan G; Mellman, Lisa A; Offenkrantz, William C; Oldham, John; Plakun, Eric M; Rockland, Lawrence H

2013-03-01

The use of motivational interviewing (MI) when the goals of patient and physician are not aligned is examined. A clinical example is presented of a patient who, partly due to anxiety and fear, wants to opt out of further evaluation of his hematuria while the physician believes that the patient must follow up on the finding of hematuria. As patients struggle in making decisions about their medical care, physician interactions can become strained and medical care may become compromised. Physicians sometimes rely on their authority within the doctor-patient relationship to assist patients in making decisions. These methods may be ineffective when there is a conflict in motivations or goals, such as with patient ambivalence and resistance. Furthermore, the values of patient autonomy may conflict with the values of beneficence. A patient simulation exercise is used to demonstrate the value of MI in addressing the motivations of a medical patient when autonomy is difficult to realize because of a high level of resistance to change due to fear. The salience of MI in supporting the value of patient autonomy without giving up the value of beneficence is discussed by providing a method of evaluating the patient's best interests by psychotherapeutically addressing his anxious, fear-based ambivalence.

Conceptual framework of knowledge management for ethical decision-making support in neonatal intensive care.

PubMed

Frize, Monique; Yang, Lan; Walker, Robin C; O'Connor, Annette M

2005-06-01

This research is built on the belief that artificial intelligence estimations need to be integrated into clinical social context to create value for health-care decisions. In sophisticated neonatal intensive care units (NICUs), decisions to continue or discontinue aggressive treatment are an integral part of clinical practice. High-quality evidence supports clinical decision-making, and a decision-aid tool based on specific outcome information for individual NICU patients will provide significant support for parents and caregivers in making difficult "ethical" treatment decisions. In our approach, information on a newborn patient's likely outcomes is integrated with the physician's interpretation and parents' perspectives into codified knowledge. Context-sensitive content adaptation delivers personalized and customized information to a variety of users, from physicians to parents. The system provides structuralized knowledge translation and exchange between all participants in the decision, facilitating collaborative decision-making that involves parents at every stage on whether to initiate, continue, limit, or terminate intensive care for their infant.

Choosing treatment and screening options congruent with values: Do decision aids help? Sub-analysis of a systematic review.

PubMed

Munro, Sarah; Stacey, Dawn; Lewis, Krystina B; Bansback, Nick

2016-04-01

To understand how well patients make value congruent decisions with and without patient decision aids (PtDAs) for screening and treatment options, and identify issues with its measurement and evaluation. A sub-analysis of trials included in the 2014 Cochrane Review of Decision Aids. Eligible trials measured value congruence with chosen option. Two reviewers independently screened 115 trials. Among 18 included trials, 8 (44%) measured value congruence using the Multidimensional Measure of Informed Choice (MMIC), 7 (39%) used heterogeneous methods, and 3 (17%) used unclear methods. Pooled results of trials that used heterogeneous measures were statistically non-significant (n=3). Results from trials that used the MMIC suggest patients are 48% more likely to make value congruent decisions when exposed to a PtDA for a screening decision (RR 1.48, 95% CI 1.01 to 2.16, n=8). Patients struggle to make value congruent decisions, but PtDAs may help. While the absolute improvement is relatively small it may be underestimated due to sample size issues, definitions, and heterogeneity of measures. Current approaches are inadequate to support patients making decisions that are consistent with their values. There is some evidence that PtDAs support patients with achieving values congruent decisions for screening choices. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Shared decision making after severe stroke-How can we improve patient and family involvement in treatment decisions?

PubMed

Visvanathan, Akila; Dennis, Martin; Mead, Gillian; Whiteley, William N; Lawton, Julia; Doubal, Fergus Neil

2017-12-01

People who are well may regard survival with disability as being worse than death. However, this is often not the case when those surviving with disability (e.g. stroke survivors) are asked the same question. Many routine treatments provided after an acute stroke (e.g. feeding via a tube) increase survival, but with disability. Therefore, clinicians need to support patients and families in making informed decisions about the use of these treatments, in a process termed shared decision making. This is challenging after acute stroke: there is prognostic uncertainty, patients are often too unwell to participate in decision making, and proxies may not know the patients' expressed wishes (i.e. values). Patients' values also change over time and in different situations. There is limited evidence on successful methods to facilitate this process. Changes targeted at components of shared decision making (e.g. decision aids to provide information and discussing patient values) increase patient satisfaction. How this influences decision making is unclear. Presumably, a "shared decision-making tool" that introduces effective changes at various stages in this process might be helpful after acute stroke. For example, by complementing professional judgement with predictions from prognostic models, clinicians could provide information that is more accurate. Decision aids that are personalized may be helpful. Further qualitative research can provide clinicians with a better understanding of patient values and factors influencing this at different time points after a stroke. The evaluation of this tool in its success to achieve outcomes consistent with patients' values may require more than one clinical trial.

Fidelity of the representation of value in decision-making

PubMed Central

Dowding, Ben A.

2017-01-01

The ability to make optimal decisions depends on evaluating the expected rewards associated with different potential actions. This process is critically dependent on the fidelity with which reward value information can be maintained in the nervous system. Here we directly probe the fidelity of value representation following a standard reinforcement learning task. The results demonstrate a previously-unrecognized bias in the representation of value: extreme reward values, both low and high, are stored significantly more accurately and precisely than intermediate rewards. The symmetry between low and high rewards pertained despite substantially higher frequency of exposure to high rewards, resulting from preferential exploitation of more rewarding options. The observed variation in fidelity of value representation retrospectively predicted performance on the reinforcement learning task, demonstrating that the bias in representation has an impact on decision-making. A second experiment in which one or other extreme-valued option was omitted from the learning sequence showed that representational fidelity is primarily determined by the relative position of an encoded value on the scale of rewards experienced during learning. Both variability and guessing decreased with the reduction in the number of options, consistent with allocation of a limited representational resource. These findings have implications for existing models of reward-based learning, which typically assume defectless representation of reward value. PMID:28248958

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

PubMed

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

2016-03-01

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

Alterations in choice behavior by manipulations of world model.

PubMed

Green, C S; Benson, C; Kersten, D; Schrater, P

2010-09-14

How to compute initially unknown reward values makes up one of the key problems in reinforcement learning theory, with two basic approaches being used. Model-free algorithms rely on the accumulation of substantial amounts of experience to compute the value of actions, whereas in model-based learning, the agent seeks to learn the generative process for outcomes from which the value of actions can be predicted. Here we show that (i) "probability matching"-a consistent example of suboptimal choice behavior seen in humans-occurs in an optimal Bayesian model-based learner using a max decision rule that is initialized with ecologically plausible, but incorrect beliefs about the generative process for outcomes and (ii) human behavior can be strongly and predictably altered by the presence of cues suggestive of various generative processes, despite statistically identical outcome generation. These results suggest human decision making is rational and model based and not consistent with model-free learning.

Alterations in choice behavior by manipulations of world model

PubMed Central

Green, C. S.; Benson, C.; Kersten, D.; Schrater, P.

2010-01-01

How to compute initially unknown reward values makes up one of the key problems in reinforcement learning theory, with two basic approaches being used. Model-free algorithms rely on the accumulation of substantial amounts of experience to compute the value of actions, whereas in model-based learning, the agent seeks to learn the generative process for outcomes from which the value of actions can be predicted. Here we show that (i) “probability matching”—a consistent example of suboptimal choice behavior seen in humans—occurs in an optimal Bayesian model-based learner using a max decision rule that is initialized with ecologically plausible, but incorrect beliefs about the generative process for outcomes and (ii) human behavior can be strongly and predictably altered by the presence of cues suggestive of various generative processes, despite statistically identical outcome generation. These results suggest human decision making is rational and model based and not consistent with model-free learning. PMID:20805507

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.

Value-based decision making via sequential sampling with hierarchical competition and attentional modulation

PubMed Central

2017-01-01

In principle, formal dynamical models of decision making hold the potential to represent fundamental computations underpinning value-based (i.e., preferential) decisions in addition to perceptual decisions. Sequential-sampling models such as the race model and the drift-diffusion model that are grounded in simplicity, analytical tractability, and optimality remain popular, but some of their more recent counterparts have instead been designed with an aim for more feasibility as architectures to be implemented by actual neural systems. Connectionist models are proposed herein at an intermediate level of analysis that bridges mental phenomena and underlying neurophysiological mechanisms. Several such models drawing elements from the established race, drift-diffusion, feedforward-inhibition, divisive-normalization, and competing-accumulator models were tested with respect to fitting empirical data from human participants making choices between foods on the basis of hedonic value rather than a traditional perceptual attribute. Even when considering performance at emulating behavior alone, more neurally plausible models were set apart from more normative race or drift-diffusion models both quantitatively and qualitatively despite remaining parsimonious. To best capture the paradigm, a novel six-parameter computational model was formulated with features including hierarchical levels of competition via mutual inhibition as well as a static approximation of attentional modulation, which promotes “winner-take-all” processing. Moreover, a meta-analysis encompassing several related experiments validated the robustness of model-predicted trends in humans’ value-based choices and concomitant reaction times. These findings have yet further implications for analysis of neurophysiological data in accordance with computational modeling, which is also discussed in this new light. PMID:29077746

Value-based decision making via sequential sampling with hierarchical competition and attentional modulation.

PubMed

Colas, Jaron T

2017-01-01

In principle, formal dynamical models of decision making hold the potential to represent fundamental computations underpinning value-based (i.e., preferential) decisions in addition to perceptual decisions. Sequential-sampling models such as the race model and the drift-diffusion model that are grounded in simplicity, analytical tractability, and optimality remain popular, but some of their more recent counterparts have instead been designed with an aim for more feasibility as architectures to be implemented by actual neural systems. Connectionist models are proposed herein at an intermediate level of analysis that bridges mental phenomena and underlying neurophysiological mechanisms. Several such models drawing elements from the established race, drift-diffusion, feedforward-inhibition, divisive-normalization, and competing-accumulator models were tested with respect to fitting empirical data from human participants making choices between foods on the basis of hedonic value rather than a traditional perceptual attribute. Even when considering performance at emulating behavior alone, more neurally plausible models were set apart from more normative race or drift-diffusion models both quantitatively and qualitatively despite remaining parsimonious. To best capture the paradigm, a novel six-parameter computational model was formulated with features including hierarchical levels of competition via mutual inhibition as well as a static approximation of attentional modulation, which promotes "winner-take-all" processing. Moreover, a meta-analysis encompassing several related experiments validated the robustness of model-predicted trends in humans' value-based choices and concomitant reaction times. These findings have yet further implications for analysis of neurophysiological data in accordance with computational modeling, which is also discussed in this new light.

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.

[Ethics, empiricism and uncertainty].

PubMed

Porz, R; Zimmermann, H; Exadaktylos, A K

2011-01-01

Accidents can lead to difficult boundary situations. Such situations often take place in the emergency units. The medical team thus often and inevitably faces professional uncertainty in their decision-making. It is essential to communicate these uncertainties within the medical team, instead of downplaying or overriding existential hurdles in decision-making. Acknowledging uncertainties might lead to alert and prudent decisions. Thus uncertainty can have ethical value in treatment or withdrawal of treatment. It does not need to be covered in evidence-based arguments, especially as some singular situations of individual tragedies cannot be grasped in terms of evidence-based medicine. © Georg Thieme Verlag KG Stuttgart · New York.

Developing an institutional framework to incorporate ecosystem services into decision making-Proceedings of a workshop

USGS Publications Warehouse

Hogan, Dianna; Arthaud, Greg; Brookshire, David; Gunther, Tom; Pincetl, Stephanie; Shapiro, Carl; Van Horne, Bea

2011-01-01

The appropriate use of institutional structures, including markets, to integrate ecosystem services into decision making depends on the players and characteristics of the specific situation (such as stakeholders, the ecosystem, resources, and the political environment). Incorporating ecosystem service values into decisions requires consideration of place-based social, cultural, economic, and landscape characteristics and institutions. Thus, a single, prescribed solution will not work-various institutional strategies must be used in different situations. Market-based approaches require appropriate regulations, monitoring, and enforcement, depending on the situation and place. Further, market approaches will need to be coupled with nonmarket approaches into an integrated institutional framework.

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

PubMed

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

2014-12-12

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

Value of information analysis in healthcare: a review of principles and applications.

PubMed

Tuffaha, Haitham W; Gordon, Louisa G; Scuffham, Paul A

2014-06-01

Economic evaluations are increasingly utilized to inform decisions in healthcare; however, decisions remain uncertain when they are not based on adequate evidence. Value of information (VOI) analysis has been proposed as a systematic approach to measure decision uncertainty and assess whether there is sufficient evidence to support new technologies. The objective of this paper is to review the principles and applications of VOI analysis in healthcare. Relevant databases were systematically searched to identify VOI articles. The findings from the selected articles were summarized and narratively presented. Various VOI methods have been developed and applied to inform decision-making, optimally designing research studies and setting research priorities. However, the application of this approach in healthcare remains limited due to technical and policy challenges. There is a need to create more awareness about VOI analysis, simplify its current methods, and align them with the needs of decision-making organizations.

Value-Based Assessment of New Medical Technologies: Towards a Robust Methodological Framework for the Application of Multiple Criteria Decision Analysis in the Context of Health Technology Assessment.

PubMed

Angelis, Aris; Kanavos, Panos

2016-05-01

In recent years, multiple criteria decision analysis (MCDA) has emerged as a likely alternative to address shortcomings in health technology assessment (HTA) by offering a more holistic perspective to value assessment and acting as an alternative priority setting tool. In this paper, we argue that MCDA needs to subscribe to robust methodological processes related to the selection of objectives, criteria and attributes in order to be meaningful in the context of healthcare decision making and fulfil its role in value-based assessment (VBA). We propose a methodological process, based on multi-attribute value theory (MAVT) methods comprising five distinct phases, outline the stages involved in each phase and discuss their relevance in the HTA process. Importantly, criteria and attributes need to satisfy a set of desired properties, otherwise the outcome of the analysis can produce spurious results and misleading recommendations. Assuming the methodological process we propose is adhered to, the application of MCDA presents three very distinct advantages to decision makers in the context of HTA and VBA: first, it acts as an instrument for eliciting preferences on the performance of alternative options across a wider set of explicit criteria, leading to a more complete assessment of value; second, it allows the elicitation of preferences across the criteria themselves to reflect differences in their relative importance; and, third, the entire process of preference elicitation can be informed by direct stakeholder engagement, and can therefore reflect their own preferences. All features are fully transparent and facilitate decision making.

Distinguishing values from science in decision making: Setting harvest quotas for mountain lions in Montana

USGS Publications Warehouse

Mitchell, Michael S.; Cooley, Hilary; Gude, Justin A.; Kolbe, Jay; Nowak, J. Joshua; Proffitt, Kelly M.; Sells, Sarah N.; Thompson, Mike

2018-01-01

The relative roles of science and human values can be difficult to distinguish when informal processes are used to make complex and contentious decisions in wildlife management. Structured Decision Making (SDM) offers a formal process for making such decisions, where scientific results and concepts can be disentangled from the values of differing stakeholders. We used SDM to formally integrate science and human values for a citizen working group of ungulate hunting advocates, lion hunting advocates, and outfitters convened to address the contentious allocation of harvest quotas for mountain lions (Puma concolor) in west‐central Montana, USA, during 2014. A science team consisting of mountain lion biologists and population ecologists convened to support the working group. The science team used integrated population models that incorporated 4 estimates of mountain lion density to estimate population trajectories for 5 alternative harvest quotas developed by the working group. Results of the modeling predicted that effects of each harvest quota were consistent across the 4 density estimates; harvest quotas affected predicted population trajectories for 5 years after implementation but differences were not strong. Based on these results, the focus of the working group changed to differences in values among stakeholders that were the true impediment to allocating harvest quotas. By distinguishing roles of science and human values in this process, the working group was able to collaboratively recommend a compromise solution. This solution differed little from the status quo that had been the focus of debate, but the SDM process produced understanding and buy‐in among stakeholders involved, reducing disagreements, misunderstanding, and unproductive arguments founded on informal application of scientific data and concepts. Whereas investments involved in conducting SDM may be unnecessary for many decisions in wildlife management, the investment may be beneficial for complex, contentious, and multiobjective decisions that integrate science and human values.

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

PubMed

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

2016-12-15

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

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

PubMed Central

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

2016-01-01

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

Distinct alterations in value-based decision-making and cognitive control in suicide attempters: toward a dual neurocognitive model.

PubMed

Richard-Devantoy, Stéphane; Olié, Emilie; Guillaume, Sébastien; Bechara, Antoine; Courtet, Philippe; Jollant, Fabrice

2013-12-01

The literature suggests that many suicide attempters show impairment in both decision-making and cognitive control. However, it is not clear if these deficits are linked to each other, and if they may be related to more basic alterations in attention. This is a relevant question in the perspective of future interventions targeting cognitive deficits to prevent suicidal acts. Two different populations of patients with histories of suicide attempts were assessed (N=142 and 119). The Iowa Gambling Task (IGT) was used to measure decision-making in both populations. We used a D2 cancellation task and a verbal working memory task in population 1; the Stroop test, the N-Back task, the Trail Making Test, and the Hayling Sentence Completion test in population 2. Regarding decision-making, we only found a small negative correlation between the Hayling test error score (r=-0.24; p=0.01), and the net score from the second half of the IGT. In contrast, working memory, cognitive flexibility and cognitive inhibition measures were largely inter-correlated. Most patients were medicated. Only patients with mood disorders. These results add to previous findings suggesting that the neurocognitive vulnerability to suicidal behavior may rely on impairments in two distinct anatomical systems, one processing value-based decision-making (associated with ventral prefrontal cortex, among others) and one underlying cognitive control (associated with more dorsal prefrontal regions). This distinction may result in tailored-made cognitive interventions. Copyright © 2013 Elsevier B.V. All rights reserved.

BUILD: A community development simulation game, appendix A

NASA Technical Reports Server (NTRS)

Orlando, J. A.; Pennington, A. J.

1973-01-01

The computer based urban decision-making game BUILD is described. BUILD is aimed at: (1) allowing maximum expression of value positions by participants through resolution of intense, task-oriented conflicts: (2) heuristically gathering information on both the technical and social functioning of the city through feedback from participants: (3) providing community participants with access to technical expertise in urban decision making, and to expose professionals to the value positions of the community: and (4) laying the groundwork for eventual development of an actual policy making tool. A brief description of the roles, sample input/output formats, an initial scenario, and information on accessing the game through a time-sharing system are included.

Uncertainty in sample estimates and the implicit loss function for soil information.

NASA Astrophysics Data System (ADS)

Lark, Murray

2015-04-01

One significant challenge in the communication of uncertain information is how to enable the sponsors of sampling exercises to make a rational choice of sample size. One way to do this is to compute the value of additional information given the loss function for errors. The loss function expresses the costs that result from decisions made using erroneous information. In certain circumstances, such as remediation of contaminated land prior to development, loss functions can be computed and used to guide rational decision making on the amount of resource to spend on sampling to collect soil information. In many circumstances the loss function cannot be obtained prior to decision making. This may be the case when multiple decisions may be based on the soil information and the costs of errors are hard to predict. The implicit loss function is proposed as a tool to aid decision making in these circumstances. Conditional on a logistical model which expresses costs of soil sampling as a function of effort, and statistical information from which the error of estimates can be modelled as a function of effort, the implicit loss function is the loss function which makes a particular decision on effort rational. In this presentation the loss function is defined and computed for a number of arbitrary decisions on sampling effort for a hypothetical soil monitoring problem. This is based on a logistical model of sampling cost parameterized from a recent geochemical survey of soil in Donegal, Ireland and on statistical parameters estimated with the aid of a process model for change in soil organic carbon. It is shown how the implicit loss function might provide a basis for reflection on a particular choice of sample size by comparing it with the values attributed to soil properties and functions. Scope for further research to develop and apply the implicit loss function to help decision making by policy makers and regulators is then discussed.

Values based decision making: a tool for achieving the goals of healthcare.

PubMed

Mills, Anne E; Spencer, Edward M

2005-03-01

The recognition that the success of the healthcare organization depends on its achievement of two interrelated goals is a relatively recent phenomenon. In its mid-history the healthcare organization was largely able to ignore cost issues. In its latter history, many would argue that it ignored its quality goals as it pursued its cost goals (15). Either approach, given declining revenues and a competitive landscape, is incompatible with continued responsible operation. If this is true, then tools that were appropriate when the healthcare organization was focused on the achievement of one or another of these goals are not adequate as the healthcare organization seeks to achieve both goals together. Thus, new perspectives and new tools must be found that help the organization address two intimately related but sometimes conflicting goals. Values based decision-making can be the perspective needed, and organization ethics is one tool that can be of use in supporting it within the institution. But there are caveats. In order for values based decision-making to be effective, leadership must take an active role in promoting its use. It must relinquish a degree of control and it must begin to trust its stakeholders to make decisions within the context of the organization's values and goals. This can be extremely difficult, as control by senior management is often seen as the only effective means of ensuring that correct decisions are made. There are additional difficulties in the healthcare organization. Control rests within two groups and the healthcare organization is operating in an environment in which variance elimination is emphasized as a means of controlling costs. This may be an appealing notion for revenue strapped healthcare organization leaders, but it implies greater control exerted by managers, not less. Relinquishing any degree of control is a frightening prospect, but it has been done successfully. An excellent example of leadership encouraging decisions based on values was presented by a unit administrator frustrated by the hierarchical structure and ponderous rituals of a traditional intensive care unit. Invoking a management tool called "the balanced scorecard" (which recognizes the multiplicity of goals and values in any organization) he identified the goals and values of the unit, and with the help and input of his staff he restructured it into functional multidisciplinary "teams" organized around tasks and goals which were based on values. The transformation of identities of unit members from their job description to their accomplishments improved both the efficiency of the unit and its morale--as well as resulting in cost savings. In this example teams had to learn to work together, collaborate and disregard the fear of doing things differently. Staff had to be motivated and feedback was necessary to ensure goals rather then rules were being meet. The balanced scorecard was implemented with mechanisms to support the communication and collaboration necessary to achieve the goals of the unit. The experiment was successful, but only because leadership recognized that multiple goals and multiple values were involved, that were explicitly articulated with the priority of excellent care. But once leadership was sure that "shared vision" existed leadership was able to trust staff to make appropriate decisions to realize that vision.

Attention as foraging for information and value

PubMed Central

Manohar, Sanjay G.; Husain, Masud

2013-01-01

What is the purpose of attention? One avenue of research has led to the proposal that attention might be crucial for gathering information about the environment, while other lines of study have demonstrated how attention may play a role in guiding behavior to rewarded options. Many experiments that study attention require participants to make a decision based on information acquired discretely at one point in time. In real-world situations, however, we are usually not presented with information about which option to select in such a manner. Rather we must initially search for information, weighing up reward values of options before we commit to a decision. Here, we propose that attention plays a role in both foraging for information and foraging for value. When foraging for information, attention is guided toward the unknown. When foraging for reward, attention is guided toward high reward values, allowing decision-making to proceed by accept-or-reject decisions on the currently attended option. According to this account, attention can be regarded as a low-cost alternative to moving around and physically interacting with the environment—“teleforaging”—before a decision is made to interact physically with the world. To track the timecourse of attention, we asked participants to seek out and acquire information about two gambles by directing their gaze, before choosing one of them. Participants often made multiple refixations on items before making a decision. Their eye movements revealed that early in the trial, attention was guided toward information, i.e., toward locations that reduced uncertainty about value. In contrast, late in the trial, attention was guided by expected value of the options. At the end of the decision period, participants were generally attending to the item they eventually chose. We suggest that attentional foraging shifts from an uncertainty-driven to a reward-driven mode during the evolution of a decision, permitting decisions to be made by an engage-or-search strategy. PMID:24204335

Evidence, research, knowledge: a call for conceptual clarity.

PubMed

Scott-Findlay, Shannon; Pollock, Carolee

2004-01-01

To dispel some of the conceptual confusion in the field of evidence-based practice that has resulted from the overlapping use of the terms research, evidence, and knowledge. Theoretical discussion. Often the terms research and knowledge are used as synonyms for evidence, but the overlap is never complete. The term evidence has long been understood to mean the findings of research. Recent attempts to broaden the definition of evidence to include clinical experience and experiential knowledge have been misguided. Broadening our understanding of the basis for clinical decision making and conceptualizing evidence are quite different tasks. Other factors (not other forms of evidence) do shape the clinical decision-making process, but they are not evidence. We might better term them knowledge. Confusing evidence with these other factors has hindered research and the improvement of clinical decision making in health care. We argue that this confusion results from the use of the term evidence when we really mean either research findings or knowledge. In this article, we have argued for specificity in the use of the term evidence. We urge the restriction of the term evidence to research findings, and while we acknowledge the importance of other influences on the clinical decision-making process, we insist that they are not evidence. The time has come to value personal experience and experiential knowledge for what they are-we should not have to disguise them as types of evidence for them to be deemed of any value. Being specific to language, the goal is to improve clinical decision making by increasing practitioners' reliance on research findings (evidence) while acknowledging (and valuing) the important part played by other forms of knowledge in the decision-making process. The distinctions are important.

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.

Counterfactual processing of economic action-outcome alternatives in obsessive-compulsive disorder: further evidence of impaired goal-directed behavior.

PubMed

Gillan, Claire M; Morein-Zamir, Sharon; Kaser, Muzaffer; Fineberg, Naomi A; Sule, Akeem; Sahakian, Barbara J; Cardinal, Rudolf N; Robbins, Trevor W

2014-04-15

Obsessive-compulsive disorder (OCD) is a disorder of automatic, uncontrollable behaviors and obsessive rumination. There is evidence that OCD patients have difficulties performing goal-directed actions, instead exhibiting repetitive stimulus-response habit behaviors. This might result from the excessive formation of stimulus-response habit associations or from an impairment in the ability to use outcome value to guide behavior. We investigated the latter by examining counterfactual decision making, which is the ability to use comparisons of prospective action-outcome scenarios to guide economic choice. We tested decision making (forward counterfactual) and affective responses (backward counterfactual) in 20 OCD patients and 20 matched healthy control subjects using an economic choice paradigm that previously revealed attenuation of both the experience and avoidance of counterfactual emotion in schizophrenia patients and patients with orbitofrontal cortex lesions. The use of counterfactual comparison to guide decision making was diminished in OCD patients, who relied primarily on expected value. Unlike the apathetic affective responses previously shown to accompany this decision style, OCD patients reported increased emotional responsivity to the outcomes of their choices and to the counterfactual comparisons that typify regret and relief. Obsessive-compulsive disorder patients exhibit a pattern of decision making consistent with a disruption in goal-directed forward modeling, basing decisions instead on the temporally present (and more rational) calculation of expected value. In contrast to this style of decision making, emotional responses in OCD were more extreme and reactive than control subjects. These results are in line with an account of disrupted goal-directed cognitive control in OCD. Copyright © 2014 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

The Fox and the Grapes-How Physical Constraints Affect Value Based Decision Making.

PubMed

Gross, Jörg; Woelbert, Eva; Strobel, Martin

2015-01-01

One fundamental question in decision making research is how humans compute the values that guide their decisions. Recent studies showed that people assign higher value to goods that are closer to them, even when physical proximity should be irrelevant for the decision from a normative perspective. This phenomenon, however, seems reasonable from an evolutionary perspective. Most foraging decisions of animals involve the trade-off between the value that can be obtained and the associated effort of obtaining. Anticipated effort for physically obtaining a good could therefore affect the subjective value of this good. In this experiment, we test this hypothesis by letting participants state their subjective value for snack food while the effort that would be incurred when reaching for it was manipulated. Even though reaching was not required in the experiment, we find that willingness to pay was significantly lower when subjects wore heavy wristbands on their arms. Thus, when reaching was more difficult, items were perceived as less valuable. Importantly, this was only the case when items were physically in front of the participants but not when items were presented as text on a computer screen. Our results suggest automatic interactions of motor and valuation processes which are unexplored to this date and may account for irrational decisions that occur when reward is particularly easy to reach.

The Fox and the Grapes—How Physical Constraints Affect Value Based Decision Making

PubMed Central

Strobel, Martin

2015-01-01

One fundamental question in decision making research is how humans compute the values that guide their decisions. Recent studies showed that people assign higher value to goods that are closer to them, even when physical proximity should be irrelevant for the decision from a normative perspective. This phenomenon, however, seems reasonable from an evolutionary perspective. Most foraging decisions of animals involve the trade-off between the value that can be obtained and the associated effort of obtaining. Anticipated effort for physically obtaining a good could therefore affect the subjective value of this good. In this experiment, we test this hypothesis by letting participants state their subjective value for snack food while the effort that would be incurred when reaching for it was manipulated. Even though reaching was not required in the experiment, we find that willingness to pay was significantly lower when subjects wore heavy wristbands on their arms. Thus, when reaching was more difficult, items were perceived as less valuable. Importantly, this was only the case when items were physically in front of the participants but not when items were presented as text on a computer screen. Our results suggest automatic interactions of motor and valuation processes which are unexplored to this date and may account for irrational decisions that occur when reward is particularly easy to reach. PMID:26061087

Identification of the Criteria for Decision Making of Cut-Away Peatland Reuse

NASA Astrophysics Data System (ADS)

Padur, Kadi; Ilomets, Mati; Põder, Tõnis

2017-03-01

The total area of abandoned milled peatlands which need to be rehabilitated for sustainable land-use is nearly 10,000 ha in Estonia. According to the agreement between Estonia and the European Union, Estonia has to create suitable conditions for restoration of 2000 ha of abandoned cut-away peatlands by 2023. The decisions on rehabilitation of abandoned milled peatlands have so far relied on a limited knowledgebase with unestablished methodologies, thus the decision making process needs a significant improvement. This study aims to improve the methodology by identifying the criteria for optimal decision making to ensure sustainable land use planning after peat extraction. Therefore relevant environmental, social and economic restrictive and weighted comparison criteria, which assess reuse alternatives suitability for achieving the goal, is developed in cooperation with stakeholders. Restrictive criteria are arranged into a decision tree to help to determine the implementable reuse alternatives in various situations. Weighted comparison criteria are developed in cooperation with stakeholders to rank the reuse alternatives. The comparison criteria are organised hierarchically into a value tree. In the situation, where the selection of a suitable rehabilitation alternative for a specific milled peatland is going to be made, the weighted comparison criteria values need to be identified and the presented approach supports the optimal and transparent decision making. In addition to Estonian context the general results of the study could also be applied to a cut-away peatlands in other regions with need-based site-dependent modifications of criteria values and weights.

Identification of the Criteria for Decision Making of Cut-Away Peatland Reuse.

PubMed

Padur, Kadi; Ilomets, Mati; Põder, Tõnis

2017-03-01

The total area of abandoned milled peatlands which need to be rehabilitated for sustainable land-use is nearly 10,000 ha in Estonia. According to the agreement between Estonia and the European Union, Estonia has to create suitable conditions for restoration of 2000 ha of abandoned cut-away peatlands by 2023. The decisions on rehabilitation of abandoned milled peatlands have so far relied on a limited knowledgebase with unestablished methodologies, thus the decision making process needs a significant improvement. This study aims to improve the methodology by identifying the criteria for optimal decision making to ensure sustainable land use planning after peat extraction. Therefore relevant environmental, social and economic restrictive and weighted comparison criteria, which assess reuse alternatives suitability for achieving the goal, is developed in cooperation with stakeholders. Restrictive criteria are arranged into a decision tree to help to determine the implementable reuse alternatives in various situations. Weighted comparison criteria are developed in cooperation with stakeholders to rank the reuse alternatives. The comparison criteria are organised hierarchically into a value tree. In the situation, where the selection of a suitable rehabilitation alternative for a specific milled peatland is going to be made, the weighted comparison criteria values need to be identified and the presented approach supports the optimal and transparent decision making. In addition to Estonian context the general results of the study could also be applied to a cut-away peatlands in other regions with need-based site-dependent modifications of criteria values and weights.

A decision technology system for health care electronic commerce.

PubMed

Forgionne, G A; Gangopadhyay, A; Klein, J A; Eckhardt, R

1999-08-01

Mounting costs have escalated the pressure on health care providers and payers to improve decision making and control expenses. Transactions to form the needed decision data will routinely flow, often electronically, between the affected parties. Conventional health care information systems facilitate flow, process transactions, and generate useful decision information. Typically, such support is offered through a series of stand-alone systems that lose much useful decision knowledge and wisdom during health care electronic commerce (e-commerce). Integrating the stand-alone functions can enhance the quality and efficiency of the segmented support, create synergistic effects, and augment decision-making performance and value for both providers and payers. This article presents an information system that can provide complete and integrated support for e-commerce-based health care decision making. The article describes health care e-commerce, presents the system, examines the system's potential use and benefits, and draws implications for health care management and practice.

Effect of social influence on effort-allocation for monetary rewards.

PubMed

Gilman, Jodi M; Treadway, Michael T; Curran, Max T; Calderon, Vanessa; Evins, A Eden

2015-01-01

Though decades of research have shown that people are highly influenced by peers, few studies have directly assessed how the value of social conformity is weighed against other types of costs and benefits. Using an effort-based decision-making paradigm with a novel social influence manipulation, we measured how social influence affected individuals' decisions to allocate effort for monetary rewards during trials with either high or low probability of receiving a reward. We found that information about the effort-allocation of peers modulated participant choices, specifically during conditions of low probability of obtaining a reward. This suggests that peer influence affects effort-based choices to obtain rewards especially under conditions of risk. This study provides evidence that people value social conformity in addition to other costs and benefits when allocating effort, and suggests that neuroeconomic studies that assess trade-offs between effort and reward should consider social environment as a factor that can influence decision-making.

Using gaming to help nursing students understand ethics.

PubMed

Metcalf, Barbara L; Yankou, Dawn

2003-05-01

The authors developed an ethics game that uses specially designed ethical situations for students to consider. Two students argue a course of action based on the scenario and defend that action using content discussed in class. Substantive issues include decision-making models, values as they pertain to the situation, professional responsibilities, ethical principles, social expectations, and legal requirements. Points are awarded based on how compelling each argument is. All students have an opportunity to participate. The benefits of using the game are that students gain confidence in their ability to defend an ethical decision, are able to see ethical situations from more than one perspective, and have an opportunity to clarify values. In addition, ethical principles and decision-making models are brought to life in a fun way. Difficulties involved in using the game include class size and limited time between the students learning course content and using it in the game.

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

PubMed

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

2013-04-01

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

Aggregation operators of neutrosophic linguistic numbers for multiple attribute group decision making.

PubMed

Ye, Jun

2016-01-01

Based on the concept of neutrosophic linguistic numbers (NLNs) in symbolic neutrosophic theory presented by Smarandache in 2015, the paper firstly proposes basic operational laws of NLNs and the expected value of a NLN to rank NLNs. Then, we propose the NLN weighted arithmetic average (NLNWAA) and NLN weighted geometric average (NLNWGA) operators and discuss their properties. Further, we establish a multiple attribute group decision-making (MAGDM) method by using the NLNWAA and NLNWGA operators under NLN environment. Finally, an illustrative example on a decision-making problem of manufacturing alternatives in the flexible manufacturing system is given to show the application of the proposed MAGDM method.

Cultural targeting and tailoring of shared decision making technology: a theoretical framework for improving the effectiveness of patient decision aids in culturally diverse groups.

PubMed

Alden, Dana L; Friend, John; Schapira, Marilyn; Stiggelbout, Anne

2014-03-01

Patient decision aids are known to positively impact outcomes critical to shared decision making (SDM), such as gist knowledge and decision preparedness. However, research on the potential improvement of these and other important outcomes through cultural targeting and tailoring of decision aids is very limited. This is the case despite extensive evidence supporting use of cultural targeting and tailoring to improve the effectiveness of health communications. Building on prominent psychological theory, we propose a two-stage framework incorporating cultural concepts into the design process for screening and treatment decision aids. The first phase recommends use of cultural constructs, such as collectivism and individualism, to differentially target patients whose cultures are known to vary on these dimensions. Decision aid targeting is operationalized through use of symbols and values that appeal to members of the given culture. Content dimensions within decision aids that appear particularly appropriate for targeting include surface level visual characteristics, language, beliefs, attitudes and values. The second phase of the framework is based on evidence that individuals vary in terms of how strongly cultural norms influence their approach to problem solving and decision making. In particular, the framework hypothesizes that differences in terms of access to cultural mindsets (e.g., access to interdependent versus independent self) can be measured up front and used to tailor decision aids. Thus, the second phase in the framework emphasizes the importance of not only targeting decision aid content, but also tailoring the information to the individual based on measurement of how strongly he/she is connected to dominant cultural mindsets. Overall, the framework provides a theory-based guide for researchers and practitioners who are interested in using cultural targeting and tailoring to develop and test decision aids that move beyond a "one-size fits all" approach and thereby, improve SDM in our multicultural world. Copyright © 2014 Elsevier Ltd. All rights reserved.

Naturalistic Decision Making for Power System Operators

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

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

2010-02-01

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

Health economic evaluations in reimbursement decision making in the Netherlands: time to take it seriously?

PubMed

Franken, Margreet; Koopmanschap, Marc; Steenhoek, Adri

2014-01-01

Health technology assessment already informed Dutch policymaking in the early 1980s. Evidence of health economic evaluations is, however, only systematically used in drug reimbursement decision making. Outpatient drugs with an added therapeutic value and expensive specialist drugs require evidence from an economic evaluation. Due to many exemptions, however, the availability of evidence of health economic evaluations remains rather low. Although the Dutch reimbursement agency suggested a cost-effectiveness threshold range depending on the severity of the disease (i.e., €10,000 - 80,000 per Quality Adjusted Life Year), it was never confirmed nor endorsed by the Ministry of Health. It is highly questionable whether health economic evaluations currently play a role in actual Dutch reimbursement decision making. Although the requirements exist in policy procedures, recent cases show that Dutch policymakers experience great difficulties in putting restrictions on reimbursement based on evidence from health economic evaluations. The near future will show whether the need will increase to base decisions on societal value for money, and whether Dutch policymakers show the courage to take health economic evaluations seriously. Copyright © 2014. Published by Elsevier GmbH.

A Bayesian paradigm for decision-making in proof-of-concept trials.

PubMed

Pulkstenis, Erik; Patra, Kaushik; Zhang, Jianliang

2017-01-01

Decision-making is central to every phase of drug development, and especially at the proof of concept stage where risk and evidence must be weighed carefully, often in the presence of significant uncertainty. The decision to proceed or not to large expensive Phase 3 trials has significant implications to both patients and sponsors alike. Recent experience has shown that Phase 3 failure rates remain high. We present a flexible Bayesian quantitative decision-making paradigm that evaluates evidence relative to achieving a multilevel target product profile. A framework for operating characteristics is provided that allows the drug developer to design a proof-of-concept trial in light of its ability to support decision-making rather than merely achieve statistical significance. Operating characteristics are shown to be superior to traditional p-value-based methods. In addition, discussion related to sample size considerations, application to interim futility analysis and incorporation of prior historical information is evaluated.

A risk-based decision support framework for selection of appropriate safety measure system for underground coal mines.

PubMed

Samantra, Chitrasen; Datta, Saurav; Mahapatra, Siba Sankar

2017-03-01

In the context of underground coal mining industry, the increased economic issues regarding implementation of additional safety measure systems, along with growing public awareness to ensure high level of workers safety, have put great pressure on the managers towards finding the best solution to ensure safe as well as economically viable alternative selection. Risk-based decision support system plays an important role in finding such solutions amongst candidate alternatives with respect to multiple decision criteria. Therefore, in this paper, a unified risk-based decision-making methodology has been proposed for selecting an appropriate safety measure system in relation to an underground coal mining industry with respect to multiple risk criteria such as financial risk, operating risk, and maintenance risk. The proposed methodology uses interval-valued fuzzy set theory for modelling vagueness and subjectivity in the estimates of fuzzy risk ratings for making appropriate decision. The methodology is based on the aggregative fuzzy risk analysis and multi-criteria decision making. The selection decisions are made within the context of understanding the total integrated risk that is likely to incur while adapting the particular safety system alternative. Effectiveness of the proposed methodology has been validated through a real-time case study. The result in the context of final priority ranking is seemed fairly consistent.

Staged decision making based on probabilistic forecasting

NASA Astrophysics Data System (ADS)

Booister, Nikéh; Verkade, Jan; Werner, Micha; Cranston, Michael; Cumiskey, Lydia; Zevenbergen, Chris

2016-04-01

Flood forecasting systems reduce, but cannot eliminate uncertainty about the future. Probabilistic forecasts explicitly show that uncertainty remains. However, as - compared to deterministic forecasts - a dimension is added ('probability' or 'likelihood'), with this added dimension decision making is made slightly more complicated. A technique of decision support is the cost-loss approach, which defines whether or not to issue a warning or implement mitigation measures (risk-based method). With the cost-loss method a warning will be issued when the ratio of the response costs to the damage reduction is less than or equal to the probability of the possible flood event. This cost-loss method is not widely used, because it motivates based on only economic values and is a technique that is relatively static (no reasoning, yes/no decision). Nevertheless it has high potential to improve risk-based decision making based on probabilistic flood forecasting because there are no other methods known that deal with probabilities in decision making. The main aim of this research was to explore the ways of making decision making based on probabilities with the cost-loss method better applicable in practice. The exploration began by identifying other situations in which decisions were taken based on uncertain forecasts or predictions. These cases spanned a range of degrees of uncertainty: from known uncertainty to deep uncertainty. Based on the types of uncertainties, concepts of dealing with situations and responses were analysed and possible applicable concepts where chosen. Out of this analysis the concepts of flexibility and robustness appeared to be fitting to the existing method. Instead of taking big decisions with bigger consequences at once, the idea is that actions and decisions are cut-up into smaller pieces and finally the decision to implement is made based on economic costs of decisions and measures and the reduced effect of flooding. The more lead-time there is in flood event management, the more damage can be reduced. And with decisions based on probabilistic forecasts, partial decisions can be made earlier in time (with a lower probability) and can be scaled up or down later in time when there is more certainty; whether the event takes place or not. Partial decisions are often more cheap, or shorten the final mitigation-time at the moment when there is more certainty. The proposed method is tested on Stonehaven, on the Carron River in Scotland. Decisions to implement demountable defences in the town are currently made based on a very short lead-time due to the absence of certainty. Application showed that staged decision making is possible and gives the decision maker more time to respond to a situation. The decision maker is able to take a lower regret decision with higher uncertainty and less related negative consequences. Although it is not possible to quantify intangible effects, it is part of the analysis to reduce these effects. Above all, the proposed approach has shown to be a possible improvement in economic terms and opens up possibilities of more flexible and robust decision making.

Impaired Expected Value Computations Coupled With Overreliance on Stimulus-Response Learning in Schizophrenia.

PubMed

Hernaus, Dennis; Gold, James M; Waltz, James A; Frank, Michael J

2018-04-03

While many have emphasized impaired reward prediction error signaling in schizophrenia, multiple studies suggest that some decision-making deficits may arise from overreliance on stimulus-response systems together with a compromised ability to represent expected value. Guided by computational frameworks, we formulated and tested two scenarios in which maladaptive representations of expected value should be most evident, thereby delineating conditions that may evoke decision-making impairments in schizophrenia. In a modified reinforcement learning paradigm, 42 medicated people with schizophrenia and 36 healthy volunteers learned to select the most frequently rewarded option in a 75-25 pair: once when presented with a more deterministic (90-10) pair and once when presented with a more probabilistic (60-40) pair. Novel and old combinations of choice options were presented in a subsequent transfer phase. Computational modeling was employed to elucidate contributions from stimulus-response systems (actor-critic) and expected value (Q-learning). People with schizophrenia showed robust performance impairments with increasing value difference between two competing options, which strongly correlated with decreased contributions from expected value-based learning (Q-learning). Moreover, a subtle yet consistent contextual choice bias for the probabilistic 75 option was present in people with schizophrenia, which could be accounted for by a context-dependent reward prediction error in the actor-critic. We provide evidence that decision-making impairments in schizophrenia increase monotonically with demands placed on expected value computations. A contextual choice bias is consistent with overreliance on stimulus-response learning, which may signify a deficit secondary to the maladaptive representation of expected value. These results shed new light on conditions under which decision-making impairments may arise. Copyright © 2018 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

An integrated model of decision-making in health contexts: the role of science education in health education

NASA Astrophysics Data System (ADS)

Arnold, Julia C.

2018-03-01

Health education is to foster health literacy, informed decision-making and to promote health behaviour. To date, there are several models that seek to explain health behaviour (e.g. the Theory of Planned Behaviour or the Health Belief Model). These models include motivational factors (expectancies and values) that play a role in decision-making in health contexts. In this theoretical paper, it is argued that none of these models makes consequent use of expectancy-value pairs. It is further argued that in order to make these models fruitful for science education and for informed decision-making, models should systematically incorporate knowledge as part of the decision-making process. To fill this gap, this theoretical paper introduces The Integrated Model of Decision-Making in Health Contexts. This model includes three types of knowledge (system health knowledge, action-related health knowledge and effectiveness health knowledge) as influencing factors for motivational factors (perceived health threat, attitude towards health action, attitude towards health outcome and subjective norm) that are formed of expectancy-value pairs and lead to decisions. The model's potential for health education in science education as well as research implications is discussed.

Selecting the Acceptance Criteria of Medicines in the Reimbursement List of Public Health Insurance of Iran, Using the "Borda" Method: a Pilot Study.

PubMed

Viyanchi, Amir; Rasekh, Hamid Reza; Rajabzadeh Ghatari, Ali; SafiKhani, Hamid Reza

2015-01-01

Decision-making for medicines to be accepted in Iran's public health insurance reimbursement list is a complex process and involves factors, which should be considered in applying a coverage for medicine costs. These processes and factors are not wholly assessed, while assessment of these factors is an essential need for getting a transparent and evidence-based approach toward medicine reimbursement in Iran. This paper aims to show an evidence-based approach toward medicine selection criteria to inform the medical reimbursement decision makers in Iranian health insurance organizations. To explore an adaptable decision-making framework while incorporating a method called "Borda" in medicine reimbursement assessment, we used the help of an expert group including decision makers and clinical researchers who are also policy makers to appraise the five chief criteria that have three sub criteria (Precision, Interpretability, and Cost). Also software "Math-lab"7, "SPSS" 17 and Excel 2007 were used in this study. "Borda" estimates the amount of perceived values from different criteria and creates a range from one to five while providing a comprehensive measurement of a large spectrum of criteria. Participants reported that the framework provided an efficient approach to systematic consideration in a pragmatic format consisting of many parts to guide decision-makings, including criteria and value (a model with the core of Borda) and evidences (medicine reimbursement based on criteria). The most important criterion for medicine acceptance in health insurance companies, in Iran, is the "life-threatening" factor and "evidence quality" is accounted as the fifth important factor. This pilot study showed the usefulness of incorporating Borda in medicine reimbursement decisions to support a transparent and systematic appraisal of health insurance companies' deeds. Further research is needed to advance Borda-based approaches that are effective on health insurance decision making.

Selecting the Acceptance Criteria of Medicines in the Reimbursement List of Public Health Insurance of Iran, Using the “Borda” Method: a Pilot Study

PubMed Central

Viyanchi, Amir; Rasekh, Hamid Reza; Rajabzadeh Ghatari, Ali; SafiKhani, Hamid Reza

2015-01-01

Decision-making for medicines to be accepted in Iran’s public health insurance reimbursement list is a complex process and involves factors, which should be considered in applying a coverage for medicine costs. These processes and factors are not wholly assessed, while assessment of these factors is an essential need for getting a transparent and evidence-based approach toward medicine reimbursement in Iran. This paper aims to show an evidence-based approach toward medicine selection criteria to inform the medical reimbursement decision makers in Iranian health insurance organizations. To explore an adaptable decision-making framework while incorporating a method called “Borda” in medicine reimbursement assessment, we used the help of an expert group including decision makers and clinical researchers who are also policy makers to appraise the five chief criteria that have three sub criteria (Precision, Interpretability, and Cost). Also software “Math-lab”7, “SPSS” 17 and Excel 2007 were used in this study. “Borda” estimates the amount of perceived values from different criteria and creates a range from one to five while providing a comprehensive measurement of a large spectrum of criteria. Participants reported that the framework provided an efficient approach to systematic consideration in a pragmatic format consisting of many parts to guide decision-makings, including criteria and value (a model with the core of Borda) and evidences (medicine reimbursement based on criteria). The most important criterion for medicine acceptance in health insurance companies, in Iran, is the "life-threatening" factor and "evidence quality" is accounted as the fifth important factor. This pilot study showed the usefulness of incorporating Borda in medicine reimbursement decisions to support a transparent and systematic appraisal of health insurance companies' deeds. Further research is needed to advance Borda-based approaches that are effective on health insurance decision making. PMID:26664402

Basic physiological systems indicator's informative assessment for children and adolescents obesity diagnosis tasks

NASA Astrophysics Data System (ADS)

Marukhina, O. V.; Berestneva, O. G.; Emelyanova, Yu A.; Romanchukov, S. V.; Petrova, L.; Lombardo, C.; Kozlova, N. V.

2018-05-01

The healthcare computerization creates opportunities to the clinical decision support system development. In the course of diagnosis, doctor manipulates a considerable amount of data and makes a decision in the context of uncertainty basing upon the first-hand experience and knowledge. The situation is exacerbated by the fact that the knowledge scope in medicine is incrementally growing, but the decision-making time does not increase. The amount of medical malpractice is growing and it leads to various negative effects, even the mortality rate increase. IT-solution's development for clinical purposes is one of the most promising and efficient ways to prevent these effects. That is why the efforts of many IT specialists are directed to the doctor's heuristics simulating software or expert-based medical decision-making algorithms development. Thus, the objective of this study is to develop techniques and approaches for the body physiological system's informative value assessment index for the obesity degree evaluation based on the diagnostic findings.

Rationality, emotions and ethics: Towards better environmental decision making

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

Andrews, W.J.

1995-12-31

A common view among rationally-oriented individuals is that environmental decision-making would be better if it were based more on science and less on emotion. This is too simplistic. Science alone is not wisdom. The best decisions come from the integration of rationality, emotion and ethics. Each of us makes each decision on the basis of a unique, personal combination of these factors. Yet, typically man is unbalanced, valuing only one of these factors and even denigrating one or both of the others. This is at the root of the personal and social inability to live in harmony with oneself andmore » with nature. The highest forms of each of these factors truth (rationality), love (emotions) and goodness (ethics) are different ways of expressing the same thing. Only by allowing oneself to integrate and honor each of these factors in both individual and social decision-making will one improve environmental decisions. An example in the area of social decision-making is the need for much more innovative mechanisms for public participation.« less

The suggestible brain: posthypnotic effects on value-based decision-making

PubMed Central

Stelzel, Christine; Krutiak, Harald; Magrabi, Amadeus; Steimke, Rosa; Paschke, Lena M.; Kathmann, Norbert; Walter, Henrik

2014-01-01

Hypnosis can affect perception, motor function and memory. However, so far no study using neuroimaging has investigated whether hypnosis can influence reward processing and decision-making. Here, we assessed whether posthypnotic suggestions can diminish the attractiveness of unhealthy food and whether this is more effective than diminishing attractiveness by one’s own effort via autosuggestion. In total, 16 participants were hypnotized and 16 others were instructed to associate a color cue (blue or green) with disgust regarding specific snacks (sweet or salty). Afterwards, participants bid for snack items shown on an either blue or green background during functional magnetic resonance imaging measurement. Both hypnosis and autosuggestion successfully devalued snacks. This was indicated by participants’ decision-making, their self-report and by decreased blood oxygen level-dependent signal in the ventromedial prefrontal cortex (vmPFC), a region known to represent value. Different vmPFC subregions coded for cue and snack type. The cue had significantly stronger effects on vmPFC after hypnosis than after autosuggestion, indicating that hypnosis was more effective in genuinely reducing value. Supporting previous findings, the precuneus was involved in the hypnotic effects by encoding whether a snack was sweet or salty during hypnotic cue presentation. Our results demonstrate that posthypnotic suggestions can influence valuation and decision-making. PMID:23887809

Arriba-lib: association of an evidence-based electronic library of decision aids with communication and decision-making in patients and primary care physicians.

PubMed

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

2012-03-01

In shared decision-making, patients are empowered to actively ask questions and participate in decisions about their healthcare based on their preferences and values. Decision aids should help patients make informed choices among diagnostic or treatment options by delivering evidence-based information on options and outcomes; however, they have rarely been field tested, especially in the primary care context. We therefore evaluated associations between the use of an interactive, transactional and evidence-based library of decision aids (arriba-lib) and communication and decision-making in patients and physicians in the primary care context. Our electronic library of decision aids ('arriba-lib') includes evidence-based modules for cardiovascular prevention, diabetes, coronary heart disease, atrial fibrillation and depression. Twenty-nine primary care physicians recruited 192 patients. We used questionnaires to ask patients and physicians about their experiences with and attitudes towards the programme. Patients were interviewed via telephone 2 months after the consultation. Data were analysed by general estimation equations, cross tab analyses and by using effect sizes. Only a minority (8.9%) of the consultations were felt to be too long because physicians said consultations were unacceptably extended by arriba-lib. We found a negative association between the detailedness of the discussion of the clinical problem's definition and the age of the patients. Physicians discuss therapeutic options in less detail with patients who have a formal education of less than 8 years. Patients who were counselled by a physician with no experience in using a decision aid more often reported that they do not remember being counselled with the help of a decision aid or do not wish to be counselled again with a decision aid. Arriba-lib has positive associations to the decision-making process in patients and physicians. It can also be used with older age groups and patients with less formal education. Physicians seem to adapt their counselling strategy to different patient groups. Prior experience with the use of decision aids has an influence on the acceptance of arriba-lib in patients but not on their decision-making or decision implementation. © 2012 The Authors. International Journal of Evidence-Based Healthcare © 2012 The Joanna Briggs Institute.

The normalization heuristic: an untested hypothesis that may misguide medical decisions.

PubMed

Aberegg, Scott K; O'Brien, James M

2009-06-01

Medical practice is increasingly informed by the evidence from randomized controlled trials. When such evidence is not available, clinical hypotheses based on pathophysiological reasoning and common sense guide clinical decision making. One commonly utilized general clinical hypothesis is the assumption that normalizing abnormal laboratory values and physiological parameters will lead to improved patient outcomes. We refer to the general use of this clinical hypothesis to guide medical therapeutics as the "normalization heuristic". In this paper, we operationally define this heuristic and discuss its limitations as a rule of thumb for clinical decision making. We review historical and contemporaneous examples of normalization practices as empirical evidence for the normalization heuristic and to highlight its frailty as a guide for clinical decision making.

Autonomy and couples' joint decision-making in healthcare.

PubMed

Osamor, Pauline E; Grady, Christine

2018-01-11

Respect for autonomy is a key principle in bioethics. However, respecting autonomy in practice is complex because most people define themselves and make decisions influenced by a complex network of social relationships. The extent to which individual autonomy operates for each partner within the context of decision-making within marital or similar relationships is largely unexplored. This paper explores issues related to decision-making by couples (couples' joint decision-making) for health care and the circumstances under which such a practice should be respected as compatible with autonomous decision-making. We discuss the concept of autonomy as it applies to persons and to actions, human interdependency and gender roles in decision-making, the dynamics and outcomes of couples' joint decision-making, and the ethics of couples' joint decision-making. We believe that the extent to which couples' joint decision-making might be deemed ethically acceptable will vary depending on the context. Given that in many traditional marriages the woman is the less dominant partner, we consider a spectrum of scenarios of couples' joint decision-making about a woman's own health care that move from those that are acceptably autonomous to those that are not consistent with respecting the woman's autonomous decision-making. To the extent that there is evidence that both members of a couple understand a decision, intend it, and that neither completely controls the other, couples' joint decision-making should be viewed as consistent with the principle of respect for the woman's autonomy. At the other end of the spectrum are decisions made by the man without the woman's input, representing domination of one partner by the other. We recommend viewing the dynamics of couples' joint decision-making as existing on a continuum of degrees of autonomy. This continuum-based perspective implies that couples' joint decision-making should not be taken at face value but should be assessed against the specific cultural, ethnic, and religious backgrounds and personal circumstances of the individuals in question.

Providing guidance for genomics-based cancer treatment decisions: insights from stakeholder engagement for post-prostatectomy radiation therapy.

PubMed

Abe, James; Lobo, Jennifer M; Trifiletti, Daniel M; Showalter, Timothy N

2017-08-24

Despite the emergence of genomics-based risk prediction tools in oncology, there is not yet an established framework for communication of test results to cancer patients to support shared decision-making. We report findings from a stakeholder engagement program that aimed to develop a framework for using Markov models with individualized model inputs, including genomics-based estimates of cancer recurrence probability, to generate personalized decision aids for prostate cancer patients faced with radiation therapy treatment decisions after prostatectomy. We engaged a total of 22 stakeholders, including: prostate cancer patients, urological surgeons, radiation oncologists, genomic testing industry representatives, and biomedical informatics faculty. Slides were at each meeting to provide background information regarding the analytical framework. Participants were invited to provide feedback during the meeting, including revising the overall project aims. Stakeholder meeting content was reviewed and summarized by stakeholder group and by theme. The majority of stakeholder suggestions focused on aspects of decision aid design and formatting. Stakeholders were enthusiastic about the potential value of using decision analysis modeling with personalized model inputs for cancer recurrence risk, as well as competing risks from age and comorbidities, to generate a patient-centered tool to assist decision-making. Stakeholders did not view privacy considerations as a major barrier to the proposed decision aid program. A common theme was that decision aids should be portable across multiple platforms (electronic and paper), should allow for interaction by the user to adjust model inputs iteratively, and available to patients both before and during consult appointments. Emphasis was placed on the challenge of explaining the model's composite result of quality-adjusted life years. A range of stakeholders provided valuable insights regarding the design of a personalized decision aid program, based upon Markov modeling with individualized model inputs, to provide a patient-centered framework to support for genomic-based treatment decisions for cancer patients. The guidance provided by our stakeholders may be broadly applicable to the communication of genomic test results to patients in a patient-centered fashion that supports effective shared decision-making that represents a spectrum of personal factors such as age, medical comorbidities, and individual priorities and values.

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

NASA Astrophysics Data System (ADS)

Flaming, Susan C.

2007-12-01

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

Decision Making Under Uncertainty

DTIC Science & Technology

2010-11-01

A sound approach to rational decision making requires a decision maker to establish decision objectives, identify alternatives, and evaluate those...often violate the axioms of rationality when making decisions under uncertainty. The systematic description of such observations may lead to the...which leads to “anchoring” on the initial value. The fact that individuals have been shown to deviate from rationality when making decisions

Multiple-attribute group decision making with different formats of preference information on attributes.

PubMed

Xu, Zeshui

2007-12-01

Interval utility values, interval fuzzy preference relations, and interval multiplicative preference relations are three common uncertain-preference formats used by decision-makers to provide their preference information in the process of decision making under fuzziness. This paper is devoted in investigating multiple-attribute group-decision-making problems where the attribute values are not precisely known but the value ranges can be obtained, and the decision-makers provide their preference information over attributes by three different uncertain-preference formats i.e., 1) interval utility values; 2) interval fuzzy preference relations; and 3) interval multiplicative preference relations. We first utilize some functions to normalize the uncertain decision matrix and then transform it into an expected decision matrix. We establish a goal-programming model to integrate the expected decision matrix and all three different uncertain-preference formats from which the attribute weights and the overall attribute values of alternatives can be obtained. Then, we use the derived overall attribute values to get the ranking of the given alternatives and to select the best one(s). The model not only can reflect both the subjective considerations of all decision-makers and the objective information but also can avoid losing and distorting the given objective and subjective decision information in the process of information integration. Furthermore, we establish some models to solve the multiple-attribute group-decision-making problems with three different preference formats: 1) utility values; 2) fuzzy preference relations; and 3) multiplicative preference relations. Finally, we illustrate the applicability and effectiveness of the developed models with two practical examples.

Values-Based Leadership: College Leaders' Perceptions on Maintaining Values in Decision Making

ERIC Educational Resources Information Center

Buckner, Ramona K.

2013-01-01

The purpose of this study was to explore college leaders' experiences negotiating conflicts between personal and organizational values. This qualitative study utilized symbolic interactionism and involved interviews with five college campus leaders from various institutions. Analysis of interviews, observations, field notes and artifacts revealed…

Personal Values and Mission Statement: A Reflective Activity to Aid Moral Development

ERIC Educational Resources Information Center

Laird-Magee, Tyler; Gayle, Barbra Mae; Preiss, Raymond

2015-01-01

Personal values guide ethical decision-making behaviors. Business professors have traditionally addressed undergraduate ethics-based learning through a learn ethics approach using case studies, simulations, presentations, and other activities. Few offer a live ethics orientation requiring completion of a personal values self-assessment and…

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

PubMed

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

2014-11-01

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

The utility of a Personal Values Report for medical decision-making.

PubMed

Henderson, W; Corke, C

2015-09-01

Our aim was to determine if a patient's Personal Values Report (PVR) has a positive impact on a doctor's decisions regarding treatment. We conducted a prospective cohort study delivering a short, web-based hypothetical case-centred questionnaire to intensive care doctors practising in Australia and New Zealand. One hundred and twenty-four intensive care consultants and registrars agreed to participate in an online questionnaire in two routine mailings between November 2013 and February 2014. We evaluated the effect of a PVR on clinical decision-making in a case-based scenario. In addition, participants rated the utility of the PVR on their decision-making process. Participants were presented with a difficult scenario in a frail elderly man where death was almost inevitable without aggressive support but survival with severe disability was possible with significant intervention. Most doctors (52.4%) elected to continue ventilation and admit to ICU. After the PVR was made available, only 8.1% of doctors continued to choose to admit the patient to the ICU. In all cases where admission to the ICU was chosen after seeing the PVR, the admission to the ICU was stated to be to permit family to arrive before withdrawing support (an approach which was consistent with the values stated in the PVR). One hundred and twenty-one of the 124 participants (97.6%) agreed or strongly agreed that the PVR helped them get an understanding of the patient's wishes, whereas none of the participants (0%) were unsure, disagreed or strongly disagreed with this statement. The remaining 2.4% did not answer the question. It is surmised that PVRs pre-written by patients are potentially an effective and valuable tool for use in helping doctors make decisions regarding patient care.

Physician, Patient and Contextual Factors Affecting Treatment Decisions in Older Adults with Cancer: A Literature Review

PubMed Central

Tariman, J. D.; Berry, D. L.; Cochrane, B.; Doorenbos, A.; Schepp, K.

2010-01-01

Purpose/Objectives To review physician, patient, and contextual factors that affect treatment decision-making in older adults diagnosed with cancer and relate these factors to theoretical models of decision-making. Data Sources PubMed (1966-April 2010), PsycINFO (1967-April 2010) and CINAHL (1982-April 2010) databases were searched to access relevant medical, psychological and nursing literature. Data Synthesis Physician factors in treatment decisions include physician personal beliefs and values, expertise, practice type, perception of lowered life expectancy, medical factors, power, and communication style. Patient factors include personal beliefs and values, ethnicity, decisional control preferences, previous health-related experience, perception of the decision-making process, and personal factors. Contextual factors include availability of caregiver, lack of insurance, poor financial status, and geographical barrier. The interplay of physician, patient, and contextual factors are not well understood. Existing models of decision-making are not sufficient to explicate TDM process in older adults diagnosed with cancer. Conclusions Clinical studies in older adult patient population using a longitudinal and prospective design are needed to examine real-time interplay of patient, physician, and contextual factors and to better understand how these divergent factors influenced actual treatment decisions. Implications for Nursing Oncology nurses can advocate for a patient’s autonomy during TDM by coaching them to seek evidence-based discussion of various treatment options, benefits and risks assessments, and truthful discussion of the probability of success for each treatment option from their physicians. Oncology nurses must promote an informed treatment decisions that are consistent with a patient’s personal preference and values within the limits of the patient’s personal contexts. PMID:22201670

Trial-Type Dependent Frames of Reference for Value Comparison

PubMed Central

Hunt, Laurence T.; Woolrich, Mark W.; Rushworth, Matthew F. S.; Behrens, Timothy E. J.

2013-01-01

A central question in cognitive neuroscience regards the means by which options are compared and decisions are resolved during value-guided choice. It is clear that several component processes are needed; these include identifying options, a value-based comparison, and implementation of actions to execute the decision. What is less clear is the temporal precedence and functional organisation of these component processes in the brain. Competing models of decision making have proposed that value comparison may occur in the space of alternative actions, or in the space of abstract goods. We hypothesized that the signals observed might in fact depend upon the framing of the decision. We recorded magnetoencephalographic data from humans performing value-guided choices in which two closely related trial types were interleaved. In the first trial type, each option was revealed separately, potentially causing subjects to estimate each action's value as it was revealed and perform comparison in action-space. In the second trial type, both options were presented simultaneously, potentially leading to comparison in abstract goods-space prior to commitment to a specific action. Distinct activity patterns (in distinct brain regions) on the two trial types demonstrated that the observed frame of reference used for decision making indeed differed, despite the information presented being formally identical, between the two trial types. This provides a potential reconciliation of conflicting accounts of value-guided choice. PMID:24068906

Use of evidence-based management in healthcare administration decision-making.

PubMed

Guo, Ruiling; Berkshire, Steven D; Fulton, Lawrence V; Hermanson, Patrick M

2017-07-03

Purpose The purpose of this paper is to examine whether healthcare leaders use evidence-based management (EBMgt) when facing major decisions and what types of evidence healthcare administrators consult during their decision-making. This study also intends to identify any relationship that might exist among adoption of EBMgt in healthcare management, attitudes towards EBMgt, demographic characteristics and organizational characteristics. Design/methodology/approach A cross-sectional study was conducted among US healthcare leaders. Spearman's correlation and logistic regression were performed using the Statistical Package for the Social Sciences (SPSS) 23.0. Findings One hundred and fifty-four healthcare leaders completed the survey. The study results indicated that 90 per cent of the participants self-reported having used an EBMgt approach for decision-making. Professional experiences (87 per cent), organizational data (84 per cent) and stakeholders' values (63 per cent) were the top three types of evidence consulted daily and weekly for decision-making. Case study (75 per cent) and scientific research findings (75 per cent) were the top two types of evidence consulted monthly or less than once a month. An exploratory, stepwise logistic regression model correctly classified 75.3 per cent of all observations for a dichotomous "use of EBMgt" response variable using three independent variables: attitude towards EBMgt, number of employees in the organization and the job position. Spearman's correlation indicated statistically significant relationships between healthcare leaders' use of EBMgt and healthcare organization bed size ( r s = 0.217, n = 152, p < 0.01), attitude towards EBMgt ( r s = 0.517, n = 152, p < 0.01), and the number of organization employees ( r s = 0.195, n = 152, p = 0.016). Originality/value This study generated new research findings on the practice of EBMgt in US healthcare administration decision-making.

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

PubMed

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

2013-09-01

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

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.

A randomized study of telephonic care support in populations at risk for musculoskeletal preference-sensitive surgeries.

PubMed

Veroff, David R; Ochoa-Arvelo, Tamara; Venator, Benjamin

2013-02-07

The rate of elective surgeries varies dramatically by geography in the United States. For many of these surgeries, there is not clear evidence of their relative merits over alternate treatment choices and there are significant tradeoffs in short- and long-term risks and benefits of selecting one treatment option over another. Conditions and symptoms for which there is this lack of a single clear evidence-based treatment choice present great opportunities for patient and provider collaboration on decision making; back pain and joint osteoarthritis are two such ailments. A number of decision aids are in active use to encourage this shared decision-making process. Decision aids have been assessed in formal studies that demonstrate increases in patient knowledge, increases in patient-provider engagement, and reduction in surgery rates. These studies have not widely demonstrated the added benefit of health coaching in support of shared decision making nor have they commonly provided strong evidence of cost reductions. In order to add to this evidence base, we undertook a comparative study testing the relative impact on health utilization and costs of active outreach through interactive voice response technology to encourage health coaching in support of shared decision making in comparison to mailed outreach or no outreach. This study focused on individuals with back pain or joint pain. We conducted four waves of stratified randomized comparisons for individuals with risk for back, hip, or knee surgery who did not have claims-based evidence of one or more of five chronic conditions and were eligible for population care management services within three large regional health plans in the United States. An interactive voice response (IVR) form of outreach that included the capability for individuals to directly connect with health coaches telephonically, known as AutoDialog(®), was compared to a control (mailed outreach or natural levels of inbound calling depending on the study wave). In total, the study include 24,167 adults with commercial and Medicare Advantage private coverage at three health plans and at risk for lumbar back surgery, hip repair/replacement, or knee repair/replacement. Interactive voice response outreach led to 10.7 (P-value < .0001) times as many inbound calls within 30 days as the control. Over 180 days, the IVR group ("intervention") had 67 percent (P-value < .0001) more health coach communications and agreed to be sent 3.2 (P-value < .0001) time as many DVD- and/or booklet-based decision aids. Targeted surgeries were reduced by 6.7 percent (P-value = .6039). Overall costs were lower by 4.9 percent (P-value = .055). Costs that were not related to maternity, cancer, trauma and substance abuse ("actionable costs") were reduced by 6.5 percent (P-value = .0286). IVR with a transfer-to-health coach-option significantly increased levels of health coaching compared to mailed or no outreach and lead to significantly reduced actionable medical costs. Providing high levels of health coaching to individuals with these types of risks appears to have produced important levels of actionable medical cost reductions. We believe this impact resulted from more informed and engaged health care decision making.

Creating value for participants in multistakeholder alliances: The shifting importance of leadership and collaborative decision-making over time.

PubMed

D'Aunno, Thomas; Alexander, Jeffrey A; Jiang, Lan

Multistakeholder alliances that bring together diverse organizations to work on health-related issues are playing an increasingly prominent role in the U.S. health care system. Prior research shows that collaborative decision-making and effective leadership are related to members' perceptions of value for their participation in alliances. Yet, we know little about how collaborative decision-making and leadership might matter over time in multistakeholder alliances. The aim of this study was to advance understanding of the role of collaborative decision-making and leadership in individuals' assessments of the benefits and costs of their participation in multistakeholder alliances over time. We draw on data collected from three rounds of surveys of alliance members (2007-2012) who participated in the Robert Wood Johnson Foundation's Aligning Forces for Quality program. Results from regression analyses indicate that individuals' perceptions of value for their participation in alliances shift over time: Perceived value is higher with collaborative decision-making when alliances are first formed and higher with more effective leadership as time passes after alliance formation. Leaders of multistakeholder alliances may need to vary their behavior over time, shifting their emphasis from inclusive decision-making to task achievement.

Bioethics for clinicians: 18. Aboriginal cultures

PubMed Central

Ellerby, Jonathan H.; McKenzie, John; McKay, Stanley; Gariépy, Gilbert J.; Kaufert, Joseph M.

2000-01-01

Although philosophies and practices analogous to bioethics exist in Aboriginal cultures, the terms and categorical distinctions of "ethics" and "bioethics" do not generally exist. In this article we address ethical values appropriate to Aboriginal patients, rather than a preconceived "Aboriginal bioethic." Aboriginal beliefs are rooted in the context of oral history and culture. For Aboriginal people, decision-making is best understood as a process and not as the correct interpretation of a unified code. Aboriginal cultures differ from religious and cultural groups that draw on Scripture and textual foundations for their ethical beliefs and practices. Aboriginal ethical values generally emphasize holism, pluralism, autonomy, community- or family-based decision-making, and the maintenance of quality of life rather than the exclusive pursuit of a cure. Most Aboriginal belief systems also emphasize achieving balance and wellness within the domains of human life (mental, physical, emotional and spiritual). Although these bioethical tenets are important to understand and apply, examining specific applications in detail is not as useful as developing a more generalized understanding of how to approach ethical decision-making with Aboriginal people. Aboriginal ethical decisions are often situational and highly dependent on the values of the individual within the context of his or her family and community. PMID:11033715

Bioethics for clinicians: 18. Aboriginal cultures.

PubMed

Ellerby, J H; McKenzie, J; McKay, S; Gariépy, G J; Kaufert, J M

2000-10-03

Although philosophies and practices analogous to bioethics exist in Aboriginal cultures, the terms and categorical distinctions of "ethics" and "bioethics" do not generally exist. In this article we address ethical values appropriate to Aboriginal patients, rather than a preconceived "Aboriginal bioethic." Aboriginal beliefs are rooted in the context of oral history and culture. For Aboriginal people, decision-making is best understood as a process and not as the correct interpretation of a unified code. Aboriginal cultures differ from religious and cultural groups that draw on Scripture and textual foundations for their ethical beliefs and practices. Aboriginal ethical values generally emphasize holism, pluralism, autonomy, community- or family-based decision-making, and the maintenance of quality of life rather than the exclusive pursuit of a cure. Most Aboriginal belief systems also emphasize achieving balance and wellness within the domains of human life (mental, physical, emotional and spiritual). Although these bioethical tenets are important to understand and apply, examining specific applications in detail is not as useful as developing a more generalized understanding of how to approach ethical decision-making with Aboriginal people. Aboriginal ethical decisions are often situational and highly dependent on the values of the individual within the context of his or her family and community.

Visualization-based decision support for value-driven system design

NASA Astrophysics Data System (ADS)

Tibor, Elliott

In the past 50 years, the military, communication, and transportation systems that permeate our world, have grown exponentially in size and complexity. The development and production of these systems has seen ballooning costs and increased risk. This is particularly critical for the aerospace industry. The inability to deal with growing system complexity is a crippling force in the advancement of engineered systems. Value-Driven Design represents a paradigm shift in the field of design engineering that has potential to help counteract this trend. The philosophy of Value-Driven Design places the desires of the stakeholder at the forefront of the design process to capture true preferences and reveal system alternatives that were never previously thought possible. Modern aerospace engineering design problems are large, complex, and involve multiple levels of decision-making. To find the best design, the decision-maker is often required to analyze hundreds or thousands of combinations of design variables and attributes. Visualization can be used to support these decisions, by communicating large amounts of data in a meaningful way. Understanding the design space, the subsystem relationships, and the design uncertainties is vital to the advancement of Value-Driven Design as an accepted process for the development of more effective, efficient, robust, and elegant aerospace systems. This research investigates the use of multi-dimensional data visualization tools to support decision-making under uncertainty during the Value-Driven Design process. A satellite design system comprising a satellite, ground station, and launch vehicle is used to demonstrate effectiveness of new visualization methods to aid in decision support during complex aerospace system design. These methods are used to facilitate the exploration of the feasible design space by representing the value impact of system attribute changes and comparing the results of multi-objective optimization formulations with a Value-Driven Design formulation. The visualization methods are also used to assist in the decomposition of a value function, by representing attribute sensitivities to aid with trade-off studies. Lastly, visualization is used to enable greater understanding of the subsystem relationships, by displaying derivative-based couplings, and the design uncertainties, through implementation of utility theory. The use of these visualization methods is shown to enhance the decision-making capabilities of the designer by granting them a more holistic view of the complex design space.

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

PubMed

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

2017-04-01

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

Clinical decision making and the expected value of information.

PubMed

Willan, Andrew R

2007-01-01

The results of the HOPE study, a randomized clinical trial, provide strong evidence that 1) ramipril prevents the composite outcome of cardiovascular death, myocardial infarction or stroke in patients who are at high risk of a cardiovascular event and 2) ramipril is cost-effective at a threshold willingness-to-pay of $10,000 to prevent an event of the composite outcome. In this report the concept of the expected value of information is used to determine if the information provided by the HOPE study is sufficient for decision making in the US and Canada. and results Using the cost-effectiveness data from a clinical trial, or from a meta-analysis of several trials, one can determine, based on the number of future patients that would benefit from the health technology under investigation, the expected value of sample information (EVSI) of a future trial as a function of proposed sample size. If the EVSI exceeds the cost for any particular sample size then the current information is insufficient for decision making and a future trial is indicated. If, on the other hand, there is no sample size for which the EVSI exceeds the cost, then there is sufficient information for decision making and no future trial is required. Using the data from the HOPE study these concepts are applied for various assumptions regarding the fixed and variable cost of a future trial and the number of patients who would benefit from ramipril. Expected value of information methods provide a decision-analytic alternative to the standard likelihood methods for assessing the evidence provided by cost-effectiveness data from randomized clinical trials.

[Medical expert systems and clinical needs].

PubMed

Buscher, H P

1991-10-18

The rapid expansion of computer-based systems for problem solving or decision making in medicine, the so-called medical expert systems, emphasize the need for reappraisal of their indication and value. Where specialist knowledge is required, in particular where medical decisions are susceptible to error these systems will probably serve as a valuable support. In the near future computer-based systems should be able to aid the interpretation of findings of technical investigations and the control of treatment, especially where rapid reactions are necessary despite the need of complex analysis of investigated parameters. In the distant future complete support of diagnostic procedures from the history to final diagnosis is possible. It promises to be particularly attractive for the diagnosis of seldom diseases, for difficult differential diagnoses, and in the decision making in the case of expensive, risky or new diagnostic or therapeutic methods. The physician needs to be aware of certain dangers, ranging from misleading information up to abuse. Patient information depends often on subjective reports and error-prone observations. Although basing on problematic knowledge computer-born decisions may have an imperative effect on medical decision making. Also it must be born in mind that medical decisions should always combine the rational with a consideration of human motives.

Decision making as a window on cognition.

PubMed

Shadlen, Michael N; Kiani, Roozbeh

2013-10-30

A decision is a commitment to a proposition or plan of action based on information and values associated with the possible outcomes. The process operates in a flexible timeframe that is free from the immediacy of evidence acquisition and the real time demands of action itself. Thus, it involves deliberation, planning, and strategizing. This Perspective focuses on perceptual decision making in nonhuman primates and the discovery of neural mechanisms that support accuracy, speed, and confidence in a decision. We suggest that these mechanisms expose principles of cognitive function in general, and we speculate about the challenges and directions before the field. Copyright © 2013 Elsevier Inc. All rights reserved.

Talking Points: Women's Information Needs for Informed Decision-Making About Noninvasive Prenatal Testing for Down Syndrome.

PubMed

Dane, Aimée C; Peterson, Madelyn; Miller, Yvette D

2018-03-17

Adequate knowledge is a vital component of informed decision-making; however, we do not know what information women value when making decisions about noninvasive prenatal testing (NIPT). The current study aimed to identify women's information needs for decision-making about NIPT as a first-tier, non-contingent test with out-of-pocket expense and, in turn, inform best practice by specifying the information that should be prioritized when providing pre-test counseling to women in a time-limited scenario or space-limited decision support tool. We asked women (N = 242) in Australia to indicate the importance of knowing 24 information items when making a decision about NIPT and to choose two information items they would most value. Our findings suggest that women value having complete information when making decisions about NIPT. Information about the accuracy of NIPT and the pros and cons of NIPT compared to other screening and invasive tests were perceived to be most important. The findings of this study can be used to maximize the usefulness of time-limited discussions or space-limited decision support tools, but should not be routinely relied upon as a replacement for provision of full and tailored information when feasible.

A systematic and critical review of the evolving methods and applications of value of information in academia and practice.

PubMed

Steuten, Lotte; van de Wetering, Gijs; Groothuis-Oudshoorn, Karin; Retèl, Valesca

2013-01-01

This article provides a systematic and critical review of the evolving methods and applications of value of information (VOI) in academia and practice and discusses where future research needs to be directed. Published VOI studies were identified by conducting a computerized search on Scopus and ISI Web of Science from 1980 until December 2011 using pre-specified search terms. Only full-text papers that outlined and discussed VOI methods for medical decision making, and studies that applied VOI and explicitly discussed the results with a view to informing healthcare decision makers, were included. The included papers were divided into methodological and applied papers, based on the aim of the study. A total of 118 papers were included of which 50 % (n = 59) are methodological. A rapidly accumulating literature base on VOI from 1999 onwards for methodological papers and from 2005 onwards for applied papers is observed. Expected value of sample information (EVSI) is the preferred method of VOI to inform decision making regarding specific future studies, but real-life applications of EVSI remain scarce. Methodological challenges to VOI are numerous and include the high computational demands, dealing with non-linear models and interdependency between parameters, estimations of effective time horizons and patient populations, and structural uncertainties. VOI analysis receives increasing attention in both the methodological and the applied literature bases, but challenges to applying VOI in real-life decision making remain. For many technical and methodological challenges to VOI analytic solutions have been proposed in the literature, including leaner methods for VOI. Further research should also focus on the needs of decision makers regarding VOI.

The influence of gene expression profiling on decisional conflict in decision making for early-stage breast cancer chemotherapy.

PubMed

MacDonald, Karen V; Bombard, Yvonne; Deal, Ken; Trudeau, Maureen; Leighl, Natasha; Marshall, Deborah A

2016-07-01

Women with early-stage breast cancer, of whom only 15% will experience a recurrence, are often conflicted or uncertain about taking chemotherapy. Gene expression profiling (GEP) of tumours informs risk prediction, potentially affecting treatment decisions. We examined whether receiving a GEP test score reduces decisional conflict in chemotherapy treatment decision making. A general population sample of 200 women completed the decisional conflict scale (DCS) at baseline (no GEP test score scenario) and after (scenario with GEP test score added) completing a discrete choice experiment survey for early-stage breast cancer chemotherapy. We scaled the 16-item DCS total scores and subscores from 0 to 100 and calculated means, standard deviations and change in scores, with significance (p < 0.05) based on matched pairs t-tests. We identified five respondent subgroups based on preferred treatment option; almost 40% did not change their chemotherapy decision after receiving GEP testing information. Total score and all subscores (uncertainty, informed, values clarity, support, and effective decision) decreased significantly in the respondent subgroup who were unsure about taking chemotherapy initially but changed to no chemotherapy (n =33). In the subgroup of respondents (n = 25) who chose chemotherapy initially but changed to unsure, effective decision subscore increased significantly. In the overall sample, changes in total and all subscores were non-significant. GEP testing adds value for women initially unsure about chemotherapy treatment with a decrease in decisional conflict. However, for women who are confident about their treatment decisions, GEP testing may not add value. Decisions to request GEP testing should be personalised based on patient preferences. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Physician perspectives on the impact of patient preferences and the role of next-of-kin of patients in evidence-based decision-making: A qualitative interview study from oncology].

PubMed

Salloch, Sabine; Otte, Ina C; Reinacher-Schick, Anke; Vollmann, Jochen

2018-04-01

The impact of patient preferences in evidence-based medicine is a complex issue which touches on theoretical questions as well as medical practice in the clinical context. The interaction between evidence-based recommendations and value-related patient preferences in clinical practice is, however, highly complex and requires not only medical knowledge but social, psychological and communicative competencies on the side of the physician. The multi-layered process of oncology physicians' clinical decision-making was explored in 14 semi-structured interviews with respect to a first diagnosis of a pancreatic adenocarcinoma. A case vignette was used and the Q method ("card sorting") was applied to analyze the influence of different factors (such as evidence, patient preferences and the role of relatives) on physicians' deliberations. Content analysis (Mayring) was performed. The results show that the participating oncologists consider patient preferences as an important guidance which, however, is limited on certain occasions where the physicians assume a leadership role in decision-making. From the interviewees' perspectives, the preferences of the patients' relatives are likewise of high importance because debilitating oncologic treatments can only be carried out if patients have both social and psychological support. There is a need for an ongoing reflection of the physicians' own values and due consideration of the patients' social role within the context of shared decision-making. Copyright © 2018. Published by Elsevier GmbH.

The lost value of groundwater and its influence on environmental decision making.

PubMed

Paleologos, Evan K

2008-08-01

A critical aspect in establishing environmental policies lies in the proper assessment of the value of the resource being affected. Standard risk assessment analyses calculate the cost of pollution as consisting, solely, of the cost to remediate a site. This traditional definition is extended here to include the lost value of groundwater. These concepts and their impact on decision-making analyses are illustrated through the case of municipal waste landfills. Based on data from existing polluting sites, a simple cost-benefit probabilistic analysis is conducted first, which equates, as is the practice, the cost of pollution to that of remediation. This leads rationally to selection of the lowest-protection technology. Using plausible arguments the reduction in value of groundwater from potable high-quality water to irrigation water, which is what is returned after remediation, is argued. The arguments consist of: (a) the ratio of the subsidized prices of drinking to irrigation water reflects the relative value of the use of water; (b) the amount paid for remediation, in each case, represents, at a minimum, the value of the water recovered; and (c) the lost value of groundwater equals the value of drinking water minus the value of irrigation water. Incorporation of this lost value of groundwater is sufficient to drastically alter the conclusions of the decision-making analysis and make the highest level technology the most rational and profitable alternative. The broader point of this article lies in that proper accounting of environmental costs is necessary in order to alter environmental policies and practices.

Using multi-species occupancy models in structured decision making on managed lands

USGS Publications Warehouse

Sauer, John R.; Blank, Peter J.; Zipkin, Elise F.; Fallon, Jane E.; Fallon, Frederick W.

2013-01-01

Land managers must balance the needs of a variety of species when manipulating habitats. Structured decision making provides a systematic means of defining choices and choosing among alternative management options; implementation of a structured decision requires quantitative approaches to predicting consequences of management on the relevant species. Multi-species occupancy models provide a convenient framework for making structured decisions when the management objective is focused on a collection of species. These models use replicate survey data that are often collected on managed lands. Occupancy can be modeled for each species as a function of habitat and other environmental features, and Bayesian methods allow for estimation and prediction of collective responses of groups of species to alternative scenarios of habitat management. We provide an example of this approach using data from breeding bird surveys conducted in 2008 at the Patuxent Research Refuge in Laurel, Maryland, evaluating the effects of eliminating meadow and wetland habitats on scrub-successional and woodland-breeding bird species using summed total occupancy of species as an objective function. Removal of meadows and wetlands decreased value of an objective function based on scrub-successional species by 23.3% (95% CI: 20.3–26.5), but caused only a 2% (0.5, 3.5) increase in value of an objective function based on woodland species, documenting differential effects of elimination of meadows and wetlands on these groups of breeding birds. This approach provides a useful quantitative tool for managers interested in structured decision making.

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

PubMed

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

2015-06-11

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

An Ecosystem Service Evaluation Tool to Support Ridge-to-Reef Management and Conservation in Hawaii

NASA Astrophysics Data System (ADS)

Oleson, K.; Callender, T.; Delevaux, J. M. S.; Falinski, K. A.; Htun, H.; Jin, G.

2014-12-01

Faced with increasing anthropogenic stressors and diverse stakeholders, local managers are adopting a ridge-to-reef and multi-objective management approach to restore declining coral reef health state. An ecosystem services framework, which integrates ecological indicators and stakeholder values, can foster more applied and integrated research, data collection, and modeling, and thus better inform the decision-making process and realize decision outcomes grounded in stakeholders' values. Here, we describe a research program that (i) leverages remotely sensed and empirical data to build an ecosystem services-based decision-support tool geared towards ridge-to-reef management; and (ii) applies it as part of a structured, value-based decision-making process to inform management in west Maui, a NOAA coral reef conservation priority site. The tool links terrestrial and marine biophysical models in a spatially explicit manner to quantify and map changes in ecosystem services delivery resulting from management actions, projected climate change impacts, and adaptive responses. We couple model outputs with localized valuation studies to translate ecosystem service outcomes into benefits and their associated socio-cultural and/or economic values. Managers can use this tool to run scenarios during their deliberations to evaluate trade-offs, cost-effectiveness, and equity implications of proposed policies. Ultimately, this research program aims at improving the effectiveness, efficiency, and equity outcomes of ecosystem-based management. This presentation will describe our approach, summarize initial results from the terrestrial modeling and economic valuations for west Maui, and highlight how this decision support tool benefits managers in west Maui.

Advance Care Planning Beyond Advance Directives: Perspectives from Patients and Surrogates

PubMed Central

McMahan, Ryan; Knight, Sara J.; Fried, Terri R.; Sudore, Rebecca L.

2014-01-01

Context Advance care planning (ACP) has focused on documenting life-sustaining treatment preferences in advance directives (ADs). ADs alone may be insufficient to prepare diverse patients and surrogates for complex medical decisions. Objectives To understand what steps best prepare patients and surrogates for decision making. Methods We conducted 13 English/Spanish focus groups with participants from a Veterans Affairs and county hospital and the community. Seven groups included patients (n=38) aged ≥65 years, who reported making serious medical decisions. Six separate groups included surrogates (n=31), aged ≥18 years, who made decisions for others. Semi-structured focus groups asked what activities best prepared participants for decision making. Two investigators independently coded data and performed thematic content analysis. Disputes were resolved by consensus. Results Mean±SD patient age was 78±8 years and 61% were non-white. Mean±SD surrogate age was 57±10 years and 91% were non-white. Qualitative analysis identified four overarching themes about how to best prepare for decision making: 1) identify values based on past experiences and quality of life, 2) choose surrogates wisely and verify they understand their role, 3) decide whether to grant leeway in surrogate decision making, and 4) inform other family and friends of one's wishes to prevent conflict. Conclusion Beyond ADs, patients and surrogates recommend several additional steps to prepare for medical decision making including using past experiences to identify values, verifying the surrogate understands their role, deciding whether to grant surrogates leeway, and informing other family and friends of one's wishes. Future ACP interventions should consider incorporating these additional ACP activities. PMID:23200188

A general theory of intertemporal decision-making and the perception of time.

PubMed

Namboodiri, Vijay M K; Mihalas, Stefan; Marton, Tanya M; Hussain Shuler, Marshall G

2014-01-01

Animals and humans make decisions based on their expected outcomes. Since relevant outcomes are often delayed, perceiving delays and choosing between earlier vs. later rewards (intertemporal decision-making) is an essential component of animal behavior. The myriad observations made in experiments studying intertemporal decision-making and time perception have not yet been rationalized within a single theory. Here we present a theory-Training-Integrated Maximized Estimation of Reinforcement Rate (TIMERR)-that explains a wide variety of behavioral observations made in intertemporal decision-making and the perception of time. Our theory postulates that animals make intertemporal choices to optimize expected reward rates over a limited temporal window which includes a past integration interval-over which experienced reward rate is estimated-as well as the expected delay to future reward. Using this theory, we derive mathematical expressions for both the subjective value of a delayed reward and the subjective representation of the delay. A unique contribution of our work is in finding that the past integration interval directly determines the steepness of temporal discounting and the non-linearity of time perception. In so doing, our theory provides a single framework to understand both intertemporal decision-making and time perception.

A general theory of intertemporal decision-making and the perception of time

PubMed Central

Namboodiri, Vijay M. K.; Mihalas, Stefan; Marton, Tanya M.; Hussain Shuler, Marshall G.

2014-01-01

Animals and humans make decisions based on their expected outcomes. Since relevant outcomes are often delayed, perceiving delays and choosing between earlier vs. later rewards (intertemporal decision-making) is an essential component of animal behavior. The myriad observations made in experiments studying intertemporal decision-making and time perception have not yet been rationalized within a single theory. Here we present a theory—Training-Integrated Maximized Estimation of Reinforcement Rate (TIMERR)—that explains a wide variety of behavioral observations made in intertemporal decision-making and the perception of time. Our theory postulates that animals make intertemporal choices to optimize expected reward rates over a limited temporal window which includes a past integration interval—over which experienced reward rate is estimated—as well as the expected delay to future reward. Using this theory, we derive mathematical expressions for both the subjective value of a delayed reward and the subjective representation of the delay. A unique contribution of our work is in finding that the past integration interval directly determines the steepness of temporal discounting and the non-linearity of time perception. In so doing, our theory provides a single framework to understand both intertemporal decision-making and time perception. PMID:24616677

A Novel Group Decision-Making Method Based on Sensor Data and Fuzzy Information.

PubMed

Bai, Yu-Ting; Zhang, Bai-Hai; Wang, Xiao-Yi; Jin, Xue-Bo; Xu, Ji-Ping; Su, Ting-Li; Wang, Zhao-Yang

2016-10-28

Algal bloom is a typical phenomenon of the eutrophication of rivers and lakes and makes the water dirty and smelly. It is a serious threat to water security and public health. Most scholars studying solutions for this pollution have studied the principles of remediation approaches, but few have studied the decision-making and selection of the approaches. Existing research uses simplex decision-making information which is highly subjective and uses little of the data from water quality sensors. To utilize these data and solve the rational decision-making problem, a novel group decision-making method is proposed using the sensor data with fuzzy evaluation information. Firstly, the optimal similarity aggregation model of group opinions is built based on the modified similarity measurement of Vague values. Secondly, the approaches' ability to improve the water quality indexes is expressed using Vague evaluation methods. Thirdly, the water quality sensor data are analyzed to match the features of the alternative approaches with grey relational degrees. This allows the best remediation approach to be selected to meet the current water status. Finally, the selection model is applied to the remediation of algal bloom in lakes. The results show this method's rationality and feasibility when using different data from different sources.

HOW STUDENTS USE VALUES IN DECISION-MAKING.

ERIC Educational Resources Information Center

VARENHORST, BARBARA B.

HIGH SCHOOL STUDENTS ARE EXAMINING AND INTERNALIZING VALUES. THEIR FEAR OF COMMITMENT TO ANYTHING DEVIATING FROM ACCEPTED VALUES MAY HINDER THEIR CLARIFICATION OF PERSONAL GOALS AND VALUES. THE DECISION-MAKING PROCESS SHOULD BE AN IMPORTANT PART OF THE GUIDANCE PROGRAM. STANDARD QUESTIONNAIRES DO NOT PROVIDE INFORMATION ABOUT SPECIFIC FACTORS…

A critical narrative analysis of shared decision-making in acute inpatient mental health care.

PubMed

Stacey, Gemma; Felton, Anne; Morgan, Alastair; Stickley, Theo; Willis, Martin; Diamond, Bob; Houghton, Philip; Johnson, Beverley; Dumenya, John

2016-01-01

Shared decision-making (SDM) is a high priority in healthcare policy and is complementary to the recovery philosophy in mental health care. This agenda has been operationalised within the Values-Based Practice (VBP) framework, which offers a theoretical and practical model to promote democratic interprofessional approaches to decision-making. However, these are limited by a lack of recognition of the implications of power implicit within the mental health system. This study considers issues of power within the context of decision-making and examines to what extent decisions about patients' care on acute in-patient wards are perceived to be shared. Focus groups were conducted with 46 mental health professionals, service users, and carers. The data were analysed using the framework of critical narrative analysis (CNA). The findings of the study suggested each group constructed different identity positions, which placed them as inside or outside of the decision-making process. This reflected their view of themselves as best placed to influence a decision on behalf of the service user. In conclusion, the discourse of VBP and SDM needs to take account of how differentials of power and the positioning of speakers affect the context in which decisions take place.

Responding to surrogate requests that seem inconsistent with a patient's living will.

PubMed

Vig, Elizabeth K; Sudore, Rebecca L; Berg, Karina M; Fromme, Erik K; Arnold, Robert M

2011-11-01

Clinicians may feel conflicted when a patient's legal decision maker is making decisions that seem inconsistent with a patient's living will. We provide evidence-based information to help clinicians consider whether a surrogate's inconsistent decisions are ethically appropriate. Surrogates are not flawless translators of their loved one's preferences; they are influenced by their own hopes and the current clinical context. Patients may be aware of this, are often concerned about burdening their loved ones, and often grant their surrogates leeway in interpreting their wishes. When appropriate, clinicians should respect surrogates' interpretations of patient values and take steps to decrease surrogate stress during the decision-making process. Finally, if clinicians are cognizant of their own values and preferences, they may recognize how these may affect their responses to certain clinical cases. Copyright © 2011 U.S. Cancer Pain Relief Committee. All rights reserved.

How should treatment costs impact on physician's decisions?

PubMed

Neymark, N

1999-01-01

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

Withdrawal of anticancer therapy in advanced disease: a systematic literature review.

PubMed

Clarke, G; Johnston, S; Corrie, P; Kuhn, I; Barclay, S

2015-11-11

Current guidelines set out when to start anticancer treatments, but not when to stop as the end of life approaches. Conventional cytotoxic agents are administered intravenously and have major life-threatening toxicities. Newer drugs include molecular targeted agents (MTAs), in particular, small molecule kinase-inhibitors (KIs), which are administered orally. These have fewer life-threatening toxicities, and are increasingly used to palliate advanced cancer, generally offering additional months of survival benefit. MTAs are substantially more expensive, between £2-8 K per month, and perceived as easier to start than stop. A systematic review of decision-making concerning the withdrawal of anticancer drugs towards the end of life within clinical practice, with a particular focus on MTAs. Nine electronic databases searched. PRISMA guidelines followed. Forty-two studies included. How are decisions made? Decision-making was shared and ongoing, including stopping, starting and trying different treatments. Oncologists often experienced 'professional role dissonance' between their self-perception as 'treaters', and talking about end of life care. Why are decisions made? Clinical factors: disease progression, worsening functional status, treatment side-effects. Non-clinical factors: physicians' personal experience, values, emotions. Some patients continued treatment to maintain 'hope', often reflecting limited understanding of palliative goals. When are decisions made? Limited evidence reveals patients' decisions based upon quality of life benefits. Clinicians found timing withdrawal particularly challenging. Who makes the decisions? Decisions were based within physician-patient interaction. Oncologists report that decisions around stopping chemotherapy treatment are challenging, with limited evidence-based guidance outside of clinical trial protocols. The increasing availability of oral MTAs is transforming the management of incurable cancer; blurring boundaries between active treatment and palliative care. No studies specifically addressing decision-making around stopping MTAs in clinical practice were identified. There is a need to develop an evidence base to support physicians and patients with decision-making around the withdrawal of these high cost treatments.

Field studies in pesticide registration: questioning the answers.

PubMed

Montforts, Mark H M M; de Jong, Frank M W

2007-01-01

The principal conclusion of a workshop in October 2005 at RIVM (Bilthoven, The Netherlands) on the assessment of field studies with pesticides for authorization is that the lack of a definition of acceptability of effects is recognized as a problem by all stakeholders: Industry, risk assessors, and regulators. Because of this lack of definition in the legislation, it is unclear what critical effect values should be assessed in field studies. Despite the extensive documentation on field study performance, the decision making is not based on justifiable scientific opinions or publicly shared values but on technical limitations of the test design instead. In the workshop, research was identified that should result in a scientific basis for value judgments applied in decision making.

Use of economic evaluation in decision making: evidence and recommendations for improvement.

PubMed

Simoens, Steven

2010-10-22

Information about the value for money of a medicine as derived from an economic evaluation can be used for decision-making purposes by policy makers, healthcare payers, healthcare professionals and pharmaceutical companies. This article illustrates the use of economic evaluation by decision makers and formulates a number of recommendations to enhance the use of such evaluations for decision-making purposes. Over the last decades, there has been a substantial increase in the number of economic evaluations assessing the value for money of medicines. Economic evaluation is used by policy makers and healthcare payers to inform medicine pricing/reimbursement decisions in more and more countries. It is a suitable tool to evaluate medicines and to present information about their value for money to decision makers in a familiar format. In order to fully exploit the use of economic evaluation for decision-making purposes, researchers need to take care to conduct such economic evaluations according to methodologically sound principles. Additionally, researchers need to take into account the decision-making context. They need to identify the various objectives that decision makers pursue and discuss how decision makers can use study findings to attain these objectives. These issues require further attention from researchers, policy makers, healthcare payers, healthcare professionals and pharmaceutical companies with a view to optimizing the use of economic evaluation in decision making.

Mergers and acquisitions: director and consultant liability exposure.

PubMed

Waxman, J M

1995-02-01

Corporate directors and their consultants must make decisions in an uncertain and changing health care environment. The losses each may face as a result of an incomplete analysis of the true value of the entities involved in mergers or acquisitions may extend beyond the failure of the transaction to the creation of personal liability as well. Accordingly, objective, careful, detailed, and fair decision-making based upon adequate information is more critical than ever for directors if they are to be able to take advantage of the business judgment rule, and also for consultants to avoid their own liability when transactions fail to deliver the values they have estimated.

Using health technology assessment to assess the value of new medicines: results of a systematic review and expert consultation across eight European countries.

PubMed

Angelis, Aris; Lange, Ansgar; Kanavos, Panos

2018-01-01

Although health technology assessment (HTA) systems base their decision making process either on economic evaluations or comparative clinical benefit assessment, a central aim of recent approaches to value measurement, including value based assessment and pricing, points towards the incorporation of supplementary evidence and criteria that capture additional dimensions of value. To study the practices, processes and policies of value-assessment for new medicines across eight European countries and the role of HTA beyond economic evaluation and clinical benefit assessment. A systematic (peer review and grey) literature review was conducted using an analytical framework examining: (1) 'Responsibilities and structure of HTA agencies'; (2) 'Evidence and evaluation criteria considered in HTAs'; (3) 'Methods and techniques applied in HTAs'; and (4) 'Outcomes and implementation of HTAs'. Study countries were France, Germany, England, Sweden, Italy, Netherlands, Poland and Spain. Evidence from the literature was validated and updated through two rounds of feedback involving primary data collection from national experts. All countries assess similar types of evidence; however, the specific criteria/endpoints used, their level of provision and requirement, and the way they are incorporated (e.g. explicitly vs. implicitly) varies across countries, with their relative importance remaining generally unknown. Incorporation of additional 'social value judgements' (beyond clinical benefit assessment) and economic evaluation could help explain heterogeneity in coverage recommendations and decision-making. More comprehensive and systematic assessment procedures characterised by increased transparency, in terms of selection of evaluation criteria, their importance and intensity of use, could lead to more rational evidence-based decision-making, possibly improving efficiency in resource allocation, while also raising public confidence and fairness.

Disruptions in effort-based decision-making and consummatory behavior following antagonism of the dopamine D2 receptor.

PubMed

Robles, Cindee F; Johnson, Alexander W

2017-03-01

Dopamine is known to influence motivational processes, however the precise role of this neurotransmitter remains a contentious issue. In the current study we sought to further characterize dopamine signaling in reward-based decision-making and consummatory behavior in mice, via lateral ventricle infusion of the dopamine D2 receptor antagonist eticlopride. In Experiment 1, we examined effort-based decision-making, in which mice had a choice between one lever, where a single response led to the delivery of a low value reward (2% sucrose); and a second lever, which led to a higher value reward (20% sucrose) that gradually required more effort to obtain. As the response schedule for the high value reward became more strict, low dose (4μg in 0.5μl) central infusions of eticlopride biased preference away from the high value reward, and toward the lever that led to the low value reward. Similarly, a higher dose of eticlopride (8μg in 0.5μl) also disrupted choice responding for the high value reward, however it did so by increasing omissions. In Experiment 2, we assessed the effects of eticlopride on consumption of 20% sucrose. The antagonist led to a dose-dependent reduction in intake, and through an analysis of licking microstructure, it was revealed that this in part reflected a reduction in the motivation to engage in consummatory behavior, rather than alterations in the evaluation of the reward. These results suggest that disruptions in D2 receptor signaling reduce the willingness to engage in effortful operant responding and consumption of a desirable outcome. Copyright © 2016 Elsevier B.V. All rights reserved.

Decision-making impairments in the context of intact reward sensitivity in schizophrenia.

PubMed

Heerey, Erin A; Bell-Warren, Kimberly R; Gold, James M

2008-07-01

Deficits in motivated behavior and decision-making figure prominently in the behavioral syndrome that characterizes schizophrenia and are difficult both to treat and to understand. One explanation for these deficits is that schizophrenia decreases sensitivity to rewards in the environment. An alternate explanation is that sensitivity to rewards is intact but that poor integration of affective with cognitive information impairs the ability to use this information to guide behavior. We tested reward sensitivity with a modified version of an existing signal detection task with asymmetric reinforcement and decision-making with a probabilistic decision-making task in 40 participants with schizophrenia and 26 healthy participants. Results showed normal sensitivity to reward in participants with schizophrenia but differences in choice patterns on the decision-making task. A logistic regression model of the decision-making data showed that participants with schizophrenia differed from healthy participants in the ability to weigh potential outcomes, specifically potential losses, when choosing between competing response options. Deficits in working memory ability accounted for group differences in ability to use potential outcomes during decision-making. These results suggest that the implicit mechanisms that drive reward-based learning are surprisingly intact in schizophrenia but that poor ability to integrate cognitive and affective information when calculating the value of possible choices might hamper the ability to use such information during explicit decision-making.

Putting the value into biosimilar decision making: the judgment value criteria.

PubMed

Mendes de Abreu, Mirhelen; Strand, Vibeke; Levy, Roger Abramino; Araujo, Denizar Vianna

2014-06-01

Uncertainties remain the key issue surrounding biosimilars, although decisions regarding their use must be made. The challenges for policymakers, doctors, patients and others seeking to navigate in the uncharted waters of biosimilars must be clarified. At the most basic level, scientific understanding of the issue remains limited and when making decisions, policymakers must consider all those affected by health policy decisions, particularly the ultimate recipients of these medicines: the patients. The biosimilar-value chain relies on measurement of comparabilities. The goal is to demonstrate how, from a molecular perspective, closely similar they are or are not and how potential small differences may be relevant to clinical outcomes. To critically understand these points, this conceptual paper will present a knowledge-value chain and discuss each dimension assigning value in the decision making process re-utilization of biosimilars. Copyright © 2014 Elsevier B.V. All rights reserved.

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

PubMed

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

2010-07-14

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

Stability of Work Values: Individual Differences and Relationship with Decision Making.

ERIC Educational Resources Information Center

Ravlin, Elizabeth C.; And Others

Values in the workplace have long been a topic of interest for both researchers in organizational behavior and management practitioners alike. Values are believed to be deeply internalized standards for personal behavior because they are based on a person's experience. Relatively little attention has been paid to the processes relating to…

Activation of the cannabinoid system in the nucleus accumbens affects effort-based decision making.

PubMed

Fatahi, Zahra; Haghparast, Abbas

2018-02-01

Effort-based decision making addresses how we make an action choice based on an integration of action and goal values. The nucleus accumbens (NAc) is implicated in allowing an animal to overcome effort constraints to obtain greater benefits, and it has been previously shown that cannabis derivatives may affect such processes. Therefore, in this study, we intend to evaluate the involvement of the cannabinoid system in the entire NAc on effort-based decision making. Rats were trained in a T-maze cost-benefit decision making the task in which they could choose either to climb a barrier to obtain a large reward in one arm or run into the other arm without a barrier to obtaining a small reward. Following training, the animals were bilaterally implanted with guide cannulae in the NAc. On test day, rats received cannabinoid agonist (Win 55,212-2; 2, 10 and 50μM) and/or antagonist (AM251; 45μM), afterward percentage of large reward choice and latency of reward attainment were investigated. Results revealed that the administration of cannabinoid agonist led to decrease of large reward choice percentage such that the animals preferred to receive a small reward with low effort instead of receiving a large reward with high effort. The administration of antagonist solely did not affect effort-based decision making, but did attenuate the Win 55,212-2-induced impairments in effort allocation. In agonist-treated animals, the latency of reward collection increased. Moreover, when the effort was equated on both arms, the animals returned to choosing large reward showing that obtained results were not caused by spatial memory impairment. Our finding suggested that activation of the cannabinoid system in the NAc impaired effort-based decision making and led to rats were less willing to invest the physical effort to gain large reward. Copyright © 2017 Elsevier Inc. All rights reserved.

Values in Health Policy – A Concept Analysis

PubMed Central

Shams, Lida; Akbari Sari, Ali; Yazdani, Shahram

2016-01-01

Background: Despite the significant role "values" play in decision-making no definition or attributes regarding the concept have been provided in health policy-making. This study aimed to clarify the defining attributes of a concept of value and its irrelevant structures in health policy-making. We anticipate our findings will help reduce the semantic ambiguities associated with the use of "values" and other concepts such as principles, criteria, attitudes, and beliefs. Methods: An extensive search of literature was carried out using electronic data base and library. The overall search strategy yielded about 1540 articles and 450 additional records. Based on traditional qualitative research, studies were purposefully selected and the coding of articles continued until data saturation was reached. Accordingly, 31 articles, 2 books, and 5 other documents were selected for the review. We applied Walker and Avant’s method of concept analysis in studying the phenomenon. Definitions, applications, attributes, antecedents, and consequences of the concept of "value in health policy-making" were extracted. We also identified similarities and differences that exist between and within them. Results: We identified eight major attributes of "value in health policy-making": ideological origin, affect one’s choices, more resistant to change over time, source of motivation, ability to sacrifice one’s interest, goal-oriented nature for community, trans-situational and subjectivity. Other features pinpointed include alternatives, antecedents, and consequences. Alternative, antecedents and consequences case may have more or fewer attributes or may lack one of these attributes and at the same time have other distinctive ones. Conclusion: Despite the use of the value framework, ambiguities still persist in providing definition of the concept value in health policy-making. Understanding the concept of value in health policy-making may provide extra theoretical support to decision-makers in their policy-making process, to help avoid poor policy formulation and wastage of limited resources. PMID:27801357

Is the Evaluation of the Students' Values Possible? An Integrated Approach to Determining the Weights of Students' Personal Goals Using Multiple-Criteria Methods

ERIC Educational Resources Information Center

Dadelo, Stanislav; Turskis, Zenonas; Zavadskas, Edmundas Kazimieras; Kacerauskas, Tomas; Dadeliene, Ruta

2016-01-01

To maximize the effectiveness of a decision, it is necessary to support decision-making with integrated methods. It can be assumed that subjective evaluation (considering only absolute values) is only remotely connected with the evaluation of real processes. Therefore, relying solely on these values in process management decision-making would be a…

Studies on Interpretive Structural Model for Forest Ecosystem Management Decision-Making

NASA Astrophysics Data System (ADS)

Liu, Suqing; Gao, Xiumei; Zen, Qunying; Zhou, Yuanman; Huang, Yuequn; Han, Weidong; Li, Linfeng; Li, Jiping; Pu, Yingshan

Characterized by their openness, complexity and large scale, forest ecosystems interweave themselves with social system, economic system and other natural ecosystems, thus complicating both their researches and management decision-making. According to the theories of sustainable development, hierarchy-competence levels, cybernetics and feedback, 25 factors have been chosen from human society, economy and nature that affect forest ecosystem management so that they are systematically analyzed via developing an interpretive structural model (ISM) to reveal their relationships and positions in the forest ecosystem management. The ISM consists of 7 layers with the 3 objectives for ecosystem management being the top layer (the seventh layer). The ratio between agricultural production value and industrial production value as the bases of management decision-making in forest ecosystems becomes the first layer at the bottom because it has great impacts on the values of society and the development trends of forestry, while the factors of climatic environments, intensive management extent, management measures, input-output ratio as well as landscape and productivity are arranged from the second to sixth layers respectively.

End of Life in a Haitian American, Faith-Based Community: Caring for Family and Communal Unity.

PubMed

Ladd, Susan Charlotte; Gordon, Shirley C

This article presents two models resulting from a grounded theory study of the end-of-life decision-making process for Haitian Americans. Successful access to this vulnerable population was achieved through the faith-based community. The first model describes this faith-based community of Haitian Americans. The second model describes the process used by families in this community who must make end-of-life healthcare decisions. Implications for nursing practice and caring science include a need to improve the congruence between the nursing care provided at this vulnerable time and the cultural values of a population.

Science Consistency Reviews A Primer for Application

Treesearch

James M. Guldin; David Cawrse; Russell Graham; Miles Hemstrom; Linda Joyce; Steve Kessler; Ranotta McNair; George Peterson; Charles G. Shaw; Peter Stine; Mark Twery; Jeffrey Walter

2003-01-01

Concern over Federal land management decisions has grown in recent years. Public debates over activities on Federal land have been contentious, especially regarding management of national forests. Decisions on the management and use of national forest lands are based on many different considerations and values. Although Federal land managers can make choices concerning...

Greater decision-making competence is associated with greater expected-value sensitivity, but not overall risk taking: an examination of concurrent validity.

PubMed

Parker, Andrew M; Weller, Joshua A

2015-01-01

Decision-making competence reflects individual differences in the susceptibility to committing decision-making errors, measured using tasks common from behavioral decision research (e.g., framing effects, under/overconfidence, following decision rules). Prior research demonstrates that those with higher decision-making competence report lower incidence of health-risking and antisocial behaviors, but there has been less focus on intermediate processes that may impact real-world decisions, and, in particular, those implicated by normative models. Here we test the associations between measures of youth decision-making competence (Y-DMC) and one such process, the degree to which individuals make choices consistent with maximizing expected value (EV). Using a task involving hypothetical gambles, we find that greater EV sensitivity is associated with greater Y-DMC. Higher Y-DMC scores are associated with (a) choosing risky options when EV favors those options and (b) avoiding risky options when EV favors a certain option. This relationship is stronger for gambles that involved potential losses. The results suggest that Y-DMC captures decision processes consistent with standard normative evaluations of risky decisions.

The Multi-Attribute Group Decision-Making Method Based on Interval Grey Trapezoid Fuzzy Linguistic Variables.

PubMed

Yin, Kedong; Wang, Pengyu; Li, Xuemei

2017-12-13

With respect to multi-attribute group decision-making (MAGDM) problems, where attribute values take the form of interval grey trapezoid fuzzy linguistic variables (IGTFLVs) and the weights (including expert and attribute weight) are unknown, improved grey relational MAGDM methods are proposed. First, the concept of IGTFLV, the operational rules, the distance between IGTFLVs, and the projection formula between the two IGTFLV vectors are defined. Second, the expert weights are determined by using the maximum proximity method based on the projection values between the IGTFLV vectors. The attribute weights are determined by the maximum deviation method and the priorities of alternatives are determined by improved grey relational analysis. Finally, an example is given to prove the effectiveness of the proposed method and the flexibility of IGTFLV.

Development of a tool to improve the quality of decision making in atrial fibrillation

PubMed Central

2011-01-01

Background Decision-making about appropriate therapy to reduce the stroke risk associated with non-valvular atrial fibrillation (NVAF) involves the consideration of trade-offs among the benefits, risks, and inconveniences of different treatment options. The objective of this paper is to describe the development of a decision support tool for NVAF based on the provision of individualized risk estimates for stroke and bleeding and on preparing patients to communicate with their physicians about their values and potential treatment options. Methods We developed a tool based on the principles of the International Patient Decision Aids Standards. The tool focuses on the patient-physician dyad as the decision-making unit and emphasizes improving the interaction between the two. It is built on the recognition that the application of patient values to a specific treatment decision is complex and that the final treatment choice is best made through a process of patient-clinician communication. Results The tool provides education incorporating patients ' illness perceptions to explain the relationship between NVAF and stroke, and then presents individualized risk estimates, derived using separate risk calculators for stroke and bleeding over a clinically meaningful time period (5 years) associated with no treatment, aspirin, and warfarin. Sequelae of both stroke and bleeding outcomes are also described. Patients are encouraged to verbalize how they value the incremental risks and benefits associated with each option and write down specific concerns to address with their physician. A physician prompt to encourage patients to discuss their opinions is included as part of the decision support tool. In pilot testing with 11 participants (mean age 78 ± 9 years, 64% with ≤ high-school education), 8 (72%) rated ease of completion as "very easy," and 9 (81%) rated amount of information as "just right." Conclusions The risks and benefits of different treatment options for reduction of stroke in NVAF vary widely according to patients' comorbidities. This tool facilitates the provision of individualized outcome data and encourages patients to communicate with their physicians about these risks and benefits. Future studies will examine whether use of the tool is associated with improved quality of decision making. PMID:21977943

Data-Based Decision Making in Education: Challenges and Opportunities

ERIC Educational Resources Information Center

Schildkamp, Kim, Ed.; Lai, Mei Kuin, Ed.; Earl, Lorna, Ed.

2013-01-01

In a context where schools are held more and more accountable for the education they provide, data-based decision making has become increasingly important. This book brings together scholars from several countries to examine data-based decision making. Data-based decision making in this book refers to making decisions based on a broad range of…

A dynamic code for economic object valuation in prefrontal cortex neurons

PubMed Central

Tsutsui, Ken-Ichiro; Grabenhorst, Fabian; Kobayashi, Shunsuke; Schultz, Wolfram

2016-01-01

Neuronal reward valuations provide the physiological basis for economic behaviour. Yet, how such valuations are converted to economic decisions remains unclear. Here we show that the dorsolateral prefrontal cortex (DLPFC) implements a flexible value code based on object-specific valuations by single neurons. As monkeys perform a reward-based foraging task, individual DLPFC neurons signal the value of specific choice objects derived from recent experience. These neuronal object values satisfy principles of competitive choice mechanisms, track performance fluctuations and follow predictions of a classical behavioural model (Herrnstein’s matching law). Individual neurons dynamically encode both, the updating of object values from recently experienced rewards, and their subsequent conversion to object choices during decision-making. Decoding from unselected populations enables a read-out of motivational and decision variables not emphasized by individual neurons. These findings suggest a dynamic single-neuron and population value code in DLPFC that advances from reward experiences to economic object values and future choices. PMID:27618960

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

PubMed

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

2018-01-01

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

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

PubMed Central

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

2018-01-01

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

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.

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

PubMed

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

2017-01-01

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

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

PubMed Central

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

2017-01-01

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

Values, Valuing, and Evaluation. Research on Evaluation Program, Paper and Report Series. Interim Draft.

ERIC Educational Resources Information Center

Gephart, William J.

The paper discusses the meaning of value and valuing, their roles in evaluation, and the potency of value systems in problem solving logic. Evaluation is defined as a process for facilitating decision making. A decision making situation occurs when there are options which are impossible to treat equivalently, and there is an impact in the…

Development and preliminary user testing of the DCIDA (Dynamic computer interactive decision application) for 'nudging' patients towards high quality decisions.

PubMed

Bansback, Nick; Li, Linda C; Lynd, Larry; Bryan, Stirling

2014-08-01

Patient decision aids (PtDA) are developed to facilitate informed, value-based decisions about health. Research suggests that even when informed with necessary evidence and information, cognitive errors can prevent patients from choosing the option that is most congruent with their own values. We sought to utilize principles of behavioural economics to develop a computer application that presents information from conventional decision aids in a way that reduces these errors, subsequently promoting higher quality decisions. The Dynamic Computer Interactive Decision Application (DCIDA) was developed to target four common errors that can impede quality decision making with PtDAs: unstable values, order effects, overweighting of rare events, and information overload. Healthy volunteers were recruited to an interview to use three PtDAs converted to the DCIDA on a computer equipped with an eye tracker. Participants were first used a conventional PtDA, and then subsequently used the DCIDA version. User testing was assessed based on whether respondents found the software both usable: evaluated using a) eye-tracking, b) the system usability scale, and c) user verbal responses from a 'think aloud' protocol; and useful: evaluated using a) eye-tracking, b) whether preferences for options were changed, and c) and the decisional conflict scale. Of the 20 participants recruited to the study, 11 were male (55%), the mean age was 35, 18 had at least a high school education (90%), and 8 (40%) had a college or university degree. Eye-tracking results, alongside a mean system usability scale score of 73 (range 68-85), indicated a reasonable degree of usability for the DCIDA. The think aloud study suggested areas for further improvement. The DCIDA also appeared to be useful to participants wherein subjects focused more on the features of the decision that were most important to them (21% increase in time spent focusing on the most important feature). Seven subjects (25%) changed their preferred option when using DCIDA. Preliminary results suggest that DCIDA has potential to improve the quality of patient decision-making. Next steps include larger studies to test individual components of DCIDA and feasibility testing with patients making real decisions.

[Modeling in value-based medicine].

PubMed

Neubauer, A S; Hirneiss, C; Kampik, A

2010-03-01

Modeling plays an important role in value-based medicine (VBM). It allows decision support by predicting potential clinical and economic consequences, frequently combining different sources of evidence. Based on relevant publications and examples focusing on ophthalmology the key economic modeling methods are explained and definitions are given. The most frequently applied model types are decision trees, Markov models, and discrete event simulation (DES) models. Model validation includes besides verifying internal validity comparison with other models (external validity) and ideally validation of its predictive properties. The existing uncertainty with any modeling should be clearly stated. This is true for economic modeling in VBM as well as when using disease risk models to support clinical decisions. In economic modeling uni- and multivariate sensitivity analyses are usually applied; the key concepts here are tornado plots and cost-effectiveness acceptability curves. Given the existing uncertainty, modeling helps to make better informed decisions than without this additional information.

Decisions in Motion: Decision Dynamics during Intertemporal Choice reflect Subjective Evaluation of Delayed Rewards

NASA Astrophysics Data System (ADS)

O'Hora, Denis; Carey, Rachel; Kervick, Aoife; Crowley, David; Dabrowski, Maciej

2016-02-01

People tend to discount rewards or losses that occur in the future. Such delay discounting has been linked to many behavioral and health problems, since people choose smaller short-term gains over greater long-term gains. We investigated whether the effect of delays on the subjective value of rewards is expressed in how people move when they make choices. Over 600 patrons of the RISK LAB exhibition hosted by the Science Gallery DublinTM played a short computer game in which they used a computer mouse to choose between amounts of money at various delays. Typical discounting effects were observed and decision dynamics indicated that choosing smaller short-term rewards became easier (i.e., shorter response times, tighter trajectories, less vacillation) as the delays until later rewards increased. Based on a sequence of choices, subjective values of delayed outcomes were estimated and decision dynamics during initial choices predicted these values. Decision dynamics are affected by subjective values of available options and thus provide a means to estimate such values.

Financial management and dental school equity, Part II: Tactics.

PubMed

Chambers, David W; Bergstrom, Roy

2004-04-01

Financial management includes all processes that build organizations' equity through accumulating assets in strategically important areas. The tactical aspects of financial management are budget deployment and monitoring. Budget deployment is the process of making sure that costs are fairly allocated. Budget monitoring addresses issues of effective uses and outcomes of resources. This article describes contemporary deployment and monitoring mechanisms, including revenue positive and marginal analysis, present value, program phases, options logic, activity-based costing, economic value added, cost of quality, variance reconciliation, and balanced scorecards. The way financial decisions are framed affects comparative decision-making and even influences the arithmetic of accounting. Familiarity with these concepts should make it possible for dental educators to more fully participate in discussions about the relationships between budgeting and program strategy.

Decision Neuroscience: Neuroeconomics

PubMed Central

Smith, David V.; Huettel, Scott A.

2012-01-01

Few aspects of human cognition are more personal than the choices we make. Our decisions – from the mundane to the impossibly complex – continually shape the courses of our lives. In recent years, researchers have applied the tools of neuroscience to understand the mechanisms that underlie decision making, as part of the new discipline of decision neuroscience. A primary goal of this emerging field has been to identify the processes that underlie specific decision variables, including the value of rewards, the uncertainty associated with particular outcomes, and the consequences of social interactions. Recent work suggests potential neural substrates that integrate these variables, potentially reflecting a common neural currency for value, to facilitate value comparisons. Despite the successes of decision neuroscience research for elucidating brain mechanisms, significant challenges remain. These include building new conceptual frameworks for decision making, integrating research findings across disparate techniques and species, and extending results from neuroscience to shape economic theory. To overcome these challenges, future research will likely focus on interpersonal variability in decision making, with the eventual goal of creating biologically plausible models for individual choice. PMID:22754602

Heuristics and Biases in Military Decision Making

DTIC Science & Technology

2010-10-01

rationality and is based on a linear, step-based model that generates a specific course of action and is useful for the examination of problems that...exhibit stability and are underpinned by assumptions of “technical- rationality .”5 The Army values MDMP as the sanctioned approach for solving...theory) which sought to describe human behavior as a rational maximization of cost-benefit decisions, Kahne- man and Tversky provided a simple

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

PubMed

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

2018-05-01

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

Expert Knowledge-Based Automatic Sleep Stage Determination by Multi-Valued Decision Making Method

NASA Astrophysics Data System (ADS)

Wang, Bei; Sugi, Takenao; Kawana, Fusae; Wang, Xingyu; Nakamura, Masatoshi

In this study, an expert knowledge-based automatic sleep stage determination system working on a multi-valued decision making method is developed. Visual inspection by a qualified clinician is adopted to obtain the expert knowledge database. The expert knowledge database consists of probability density functions of parameters for various sleep stages. Sleep stages are determined automatically according to the conditional probability. Totally, four subjects were participated. The automatic sleep stage determination results showed close agreements with the visual inspection on sleep stages of awake, REM (rapid eye movement), light sleep and deep sleep. The constructed expert knowledge database reflects the distributions of characteristic parameters which can be adaptive to variable sleep data in hospitals. The developed automatic determination technique based on expert knowledge of visual inspection can be an assistant tool enabling further inspection of sleep disorder cases for clinical practice.

IBM's Health Analytics and Clinical Decision Support.

PubMed

Kohn, M S; Sun, J; Knoop, S; Shabo, A; Carmeli, B; Sow, D; Syed-Mahmood, T; Rapp, W

2014-08-15

This survey explores the role of big data and health analytics developed by IBM in supporting the transformation of healthcare by augmenting evidence-based decision-making. Some problems in healthcare and strategies for change are described. It is argued that change requires better decisions, which, in turn, require better use of the many kinds of healthcare information. Analytic resources that address each of the information challenges are described. Examples of the role of each of the resources are given. There are powerful analytic tools that utilize the various kinds of big data in healthcare to help clinicians make more personalized, evidenced-based decisions. Such resources can extract relevant information and provide insights that clinicians can use to make evidence-supported decisions. There are early suggestions that these resources have clinical value. As with all analytic tools, they are limited by the amount and quality of data. Big data is an inevitable part of the future of healthcare. There is a compelling need to manage and use big data to make better decisions to support the transformation of healthcare to the personalized, evidence-supported model of the future. Cognitive computing resources are necessary to manage the challenges in employing big data in healthcare. Such tools have been and are being developed. The analytic resources, themselves, do not drive, but support healthcare transformation.

Understanding medical decision making in hand surgery.

PubMed

Myers, John; McCabe, Steven J

2005-10-01

The practice of medicine takes place in an environment of uncertainty. Expected value decision making, prospect theory, and regret theory are three theories of decision making under uncertainty that may be used to help us learn how patients and physicians make decisions. These theories form the underpinnings of decision analysis and provide the opportunity to introduce the broad discipline of decision science. Because decision analysis and economic analysis are underrepresented in upper extremity surgery, the authors believe these are important areas for future research.

Possibility-induced simplified neutrosophic aggregation operators and their application to multi-criteria group decision-making

NASA Astrophysics Data System (ADS)

Şahin, Rıdvan; Liu, Peide

2017-07-01

Simplified neutrosophic set (SNS) is an appropriate tool used to express the incompleteness, indeterminacy and uncertainty of the evaluation objects in decision-making process. In this study, we define the concept of possibility SNS including two types of information such as the neutrosophic performance provided from the evaluation objects and its possibility degree using a value ranging from zero to one. Then by extending the existing neutrosophic information, aggregation models for SNSs that cannot be used effectively to fusion the two different information described above, we propose two novel neutrosophic aggregation operators considering possibility, which are named as a possibility-induced simplified neutrosophic weighted arithmetic averaging operator and possibility-induced simplified neutrosophic weighted geometric averaging operator, and discuss their properties. Moreover, we develop a useful method based on the proposed aggregation operators for solving a multi-criteria group decision-making problem with the possibility simplified neutrosophic information, in which the weights of decision-makers and decision criteria are calculated based on entropy measure. Finally, a practical example is utilised to show the practicality and effectiveness of the proposed method.

A Radical Conception of the Role of Values in Curriculum: "Praxis".

ERIC Educational Resources Information Center

Macdonald, James B.; Clark, Dwight F.

The focus of this paper is on curriculum praxis, or the reflective transaction of curriculum decisions one makes and acts upon, and from which value judgements may be located, clarified, and inferred. The major topic is how values and value judgements relate to curriculum praxis and how they relate to other curriculum decision-making systems. A…

Patient involvement in health care decision making: a review.

PubMed

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

2014-01-01

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

Rethinking autonomy: decision making between patient and surgeon in advanced illnesses

PubMed Central

Hinshaw, Daniel B.

2016-01-01

Patients with advanced illness such as advanced stage cancer presenting with the need for possible surgical intervention can be some of the most challenging cases for a surgeon. Often there are multiple factors influencing the decisions made. For patients they are facing not just the effects of the disease on their body, but the stark realization that the disease will also limit their life. Not only are these factors a consideration when patients are making decisions, but also the desire to make the decision that is best for themselves, the autonomous decision. Also included in this process for the patient facing the possible need for an intervention is the surgeon. While patient autonomy remains one of the main principles within medicine, guiding treatment decisions, there is also the surgeon’s autonomy to be considered. Surgeons determine if there is even a possible intervention to be offered to patients, a decision making process that respects surgeons’ autonomous choices and includes elements of paternalism as surgeons utilize their expertise to make decisions. Included in the treatment decisions that are made and the care of the patient is the impact patients’ outcomes have on the surgeon, the inherent drive to be the best for the patient and desire for good outcomes for the patient. While both the patient’s and surgeon’s autonomy are a dynamic interface influencing decision making, the main goal for the patient facing a palliative procedure is that of making treatment decisions based on the concept of shared decision making, always giving primary consideration to the patient’s goals and values. Lastly, regardless of the decision made, it is the responsibility of surgeons to their patients to be a source of support through this challenging time. PMID:27004224

Stakeholders apply the GRADE evidence-to-decision framework to facilitate coverage decisions.

PubMed

Dahm, Philipp; Oxman, Andrew D; Djulbegovic, Benjamin; Guyatt, Gordon H; Murad, M Hassan; Amato, Laura; Parmelli, Elena; Davoli, Marina; Morgan, Rebecca L; Mustafa, Reem A; Sultan, Shahnaz; Falck-Ytter, Yngve; Akl, Elie A; Schünemann, Holger J

2017-06-01

Coverage decisions are complex and require the consideration of many factors. A well-defined, transparent process could improve decision-making and facilitate decision-maker accountability. We surveyed key US-based stakeholders regarding their current approaches for coverage decisions. Then, we held a workshop to test an evidence-to-decision (EtD) framework for coverage based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. A total of 42 individuals (including 19 US stakeholders as well as international health policymakers and GRADE working group members) attended the workshop. Of the 19 stakeholders, 14 (74%) completed the survey before the workshop. Almost all of their organizations (13 of 14; 93%) used systematic reviews for coverage decision-making; few (2 of 14; 14%) developed their own evidence synthesis; a majority (9 of 14; 64%) rated the certainty of evidence (using various systems); almost all (13 of 14; 93%) denied formal consideration of resource use; and half (7 of 14; 50%) reported explicit criteria for decision-making. At the workshop, stakeholders successfully applied the EtD framework to four case studies and provided narrative feedback, which centered on contextual factors affecting coverage decisions in the United States, the need for reliable data on subgroups of patients, and the challenge of decision-making without formal consideration of resource use. Stakeholders successfully applied the EtD framework to four case studies and highlighted contextual factors affecting coverage decisions and affirmed its value. Their input informed the further development of a revised EtD framework, now publicly available (http://gradepro.org/). Published by Elsevier Inc.

PGA/MOEAD: a preference-guided evolutionary algorithm for multi-objective decision-making problems with interval-valued fuzzy preferences

NASA Astrophysics Data System (ADS)

Luo, Bin; Lin, Lin; Zhong, ShiSheng

2018-02-01

In this research, we propose a preference-guided optimisation algorithm for multi-criteria decision-making (MCDM) problems with interval-valued fuzzy preferences. The interval-valued fuzzy preferences are decomposed into a series of precise and evenly distributed preference-vectors (reference directions) regarding the objectives to be optimised on the basis of uniform design strategy firstly. Then the preference information is further incorporated into the preference-vectors based on the boundary intersection approach, meanwhile, the MCDM problem with interval-valued fuzzy preferences is reformulated into a series of single-objective optimisation sub-problems (each sub-problem corresponds to a decomposed preference-vector). Finally, a preference-guided optimisation algorithm based on MOEA/D (multi-objective evolutionary algorithm based on decomposition) is proposed to solve the sub-problems in a single run. The proposed algorithm incorporates the preference-vectors within the optimisation process for guiding the search procedure towards a more promising subset of the efficient solutions matching the interval-valued fuzzy preferences. In particular, lots of test instances and an engineering application are employed to validate the performance of the proposed algorithm, and the results demonstrate the effectiveness and feasibility of the algorithm.

Risk-seeking for losses is associated with 5-HTTLPR, but not with transient changes in 5-HT levels.

PubMed

Neukam, Philipp T; Kroemer, Nils B; Deza Araujo, Yacila I; Hellrung, Lydia; Pooseh, Shakoor; Rietschel, Marcella; Witt, Stephanie H; Schwarzenbolz, Uwe; Henle, Thomas; Smolka, Michael N

2018-05-05

Serotonin (5-HT) plays a key role in different aspects of value-based decision-making. A recent framework proposed that tonic 5-HT (together with dopamine, DA) codes future average reward expectations, providing a baseline against which possible choice outcomes are compared to guide decision-making. To test whether high 5-HT levels decrease loss aversion, risk-seeking for gains, and risk-seeking for losses. In a first session, 611 participants were genotyped for 5-HTTLPR and performed a mixed gambles (MGA) task and two probability discounting tasks for gains and losses, respectively (PDG/PDL). Afterwards, a subsample of 105 participants (44 with S/S, 6 with S/L, 55 with L/L genotype) completed the pharmacological study using a crossover design with tryptophan depletion (ATD), loading (ATL), and balanced (BAL) conditions. The same decision constructs were assessed. We found increased risk-seeking for losses in S/S compared to L/L individuals at the first visit (p = 0.002). Neither tryptophan depletion nor loading affected decision-making, nor did we observe an interaction between intervention and 5-HTTLPR genotype. Our data do not support the idea that transient changes of tonic 5-HT affect value-based decision-making. We provide evidence for an association of 5-HTTLPR with risk-seeking for losses, independent of acute 5-HT levels. This indicates that the association of 5-HTTLPR and risk-seeking for losses is mediated via other mechanisms, possibly by differences in the structural development of neural circuits of the 5-HT system during early life phases.

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

PubMed

Scott, Vera; Gilson, Lucy

2017-09-15

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

Key stakeholders' perceptions of the acceptability and usefulness of a tablet-based tool to improve communication and shared decision making in ICUs.

PubMed

Ernecoff, Natalie C; Witteman, Holly O; Chon, Kristen; Chen, Yanquan Iris; Buddadhumaruk, Praewpannarai; Chiarchiaro, Jared; Shotsberger, Kaitlin J; Shields, Anne-Marie; Myers, Brad A; Hough, Catherine L; Carson, Shannon S; Lo, Bernard; Matthay, Michael A; Anderson, Wendy G; Peterson, Michael W; Steingrub, Jay S; Arnold, Robert M; White, Douglas B

2016-06-01

Although barriers to shared decision making in intensive care units are well documented, there are currently no easily scaled interventions to overcome these problems. We sought to assess stakeholders' perceptions of the acceptability, usefulness, and design suggestions for a tablet-based tool to support communication and shared decision making in ICUs. We conducted in-depth semi-structured interviews with 58 key stakeholders (30 surrogates and 28 ICU care providers). Interviews explored stakeholders' perceptions about the acceptability of a tablet-based tool to support communication and shared decision making, including the usefulness of modules focused on orienting families to the ICU, educating them about the surrogate's role, completing a question prompt list, eliciting patient values, educating about treatment options, eliciting perceptions about prognosis, and providing psychosocial support resources. The interviewer also elicited stakeholders' design suggestions for such a tool. We used constant comparative methods to identify key themes that arose during the interviews. Overall, 95% (55/58) of participants perceived the proposed tool to be acceptable, with 98% (57/58) of interviewees finding six or more of the seven content domains acceptable. Stakeholders identified several potential benefits of the tool including that it would help families prepare for the surrogate role and for family meetings as well as give surrogates time and a framework to think about the patient's values and treatment options. Key design suggestions included: conceptualize the tool as a supplement to rather than a substitute for surrogate-clinician communication; make the tool flexible with respect to how, where, and when surrogates can access the tool; incorporate interactive exercises; use video and narration to minimize the cognitive load of the intervention; and build an extremely simple user interface to maximize usefulness for individuals with low computer literacy. There is broad support among stakeholders for the use of a tablet-based tool to improve communication and shared decision making in ICUs. Eliciting the perspectives of key stakeholders early in the design process yielded important insights to create a tool tailored to the needs of surrogates and care providers in ICUs. Copyright © 2016 Elsevier Inc. All rights reserved.

Decision making in recurrent neuronal circuits.

PubMed

Wang, Xiao-Jing

2008-10-23

Decision making has recently emerged as a central theme in neurophysiological studies of cognition, and experimental and computational work has led to the proposal of a cortical circuit mechanism of elemental decision computations. This mechanism depends on slow recurrent synaptic excitation balanced by fast feedback inhibition, which not only instantiates attractor states for forming categorical choices but also long transients for gradually accumulating evidence in favor of or against alternative options. Such a circuit endowed with reward-dependent synaptic plasticity is able to produce adaptive choice behavior. While decision threshold is a core concept for reaction time tasks, it can be dissociated from a general decision rule. Moreover, perceptual decisions and value-based economic choices are described within a unified framework in which probabilistic choices result from irregular neuronal activity as well as iterative interactions of a decision maker with an uncertain environment or other unpredictable decision makers in a social group.

Evaluation and selection of decision-making methods to assess landfill mining projects.

PubMed

Hermann, Robert; Baumgartner, Rupert J; Vorbach, Stefan; Ragossnig, Arne; Pomberger, Roland

2015-09-01

For the first time in Austria, fundamental technological and economic studies on recovering secondary raw materials from large landfills have been carried out, based on the 'LAMIS - Landfill Mining Austria' pilot project. A main focus of the research - and the subject of this article - was to develop an assessment or decision-making procedure that allows landfill owners to thoroughly examine the feasibility of a landfill mining project in advance. Currently there are no standard procedures that would sufficiently cover all the multiple-criteria requirements. The basic structure of the multiple attribute decision making process was used to narrow down on selection, conceptual design and assessment of suitable procedures. Along with a breakdown into preliminary and main assessment, the entire foundation required was created, such as definitions of requirements to an assessment method, selection and accurate description of the various assessment criteria and classification of the target system for the present 'landfill mining' vs. 'retaining the landfill in after-care' decision-making problem. Based on these studies, cost-utility analysis and the analytical-hierarchy process were selected from the range of multiple attribute decision-making procedures and examined in detail. Overall, both methods have their pros and cons with regard to their use for assessing landfill mining projects. Merging these methods or connecting them with single-criteria decision-making methods (like the net present value method) may turn out to be reasonable and constitute an appropriate assessment method. © The Author(s) 2015.

Linking dynamic patterns of neural activity in orbitofrontal cortex with decision making.

PubMed

Rich, Erin L; Stoll, Frederic M; Rudebeck, Peter H

2018-04-01

Humans and animals demonstrate extraordinary flexibility in choice behavior, particularly when deciding based on subjective preferences. We evaluate options on different scales, deliberate, and often change our minds. Little is known about the neural mechanisms that underlie these dynamic aspects of decision-making, although neural activity in orbitofrontal cortex (OFC) likely plays a central role. Recent evidence from studies in macaques shows that attention modulates value responses in OFC, and that ensembles of OFC neurons dynamically signal different options during choices. When contexts change, these ensembles flexibly remap to encode the new task. Determining how these dynamic patterns emerge and relate to choices will inform models of decision-making and OFC function. Copyright © 2017 Elsevier Ltd. All rights reserved.

Explaining Moral Behavior.

PubMed

Osman, Magda; Wiegmann, Alex

2017-03-01

In this review we make a simple theoretical argument which is that for theory development, computational modeling, and general frameworks for understanding moral psychology researchers should build on domain-general principles from reasoning, judgment, and decision-making research. Our approach is radical with respect to typical models that exist in moral psychology that tend to propose complex innate moral grammars and even evolutionarily guided moral principles. In support of our argument we show that by using a simple value-based decision model we can capture a range of core moral behaviors. Crucially, the argument we propose is that moral situations per se do not require anything specialized or different from other situations in which we have to make decisions, inferences, and judgments in order to figure out how to act.

Pavlovian valuation systems in learning and decision making

PubMed Central

Clark, Jeremy J.; Hollon, Nick G.; Phillips, Paul E. M.

2012-01-01

Environmental stimuli guide value-based decision making, but can do so through cognitive representation of outcomes or through general-incentive properties attributed to the cues themselves. We assert that these differences are conferred through the use of alternative associative structures differing in computational intensity. Using this framework, we review scientific evidence to discern the neural substrates of these assumed separable processes. We suggest that the contribution of the mesolimbic dopamine system to Pavlovian valuation is restricted to an affective system that is only updated through experiential feedback of stimulus-outcome pairing, whereas the orbitofrontal cortex contributes to an alternative system capable of inferential reasoning. Finally we discuss the interactions and convergence of these systems and their implications for decision making and its pathology. PMID:22749132

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

NASA Astrophysics Data System (ADS)

Gresch, Helge; Bögeholz, Susanne

2013-04-01

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

Values Clarification and the Summer-Camp Counselor

ERIC Educational Resources Information Center

Cullinane, William; Santosuosso, John J.

1976-01-01

The decision to use values clarification techniques at a staff orientation for camp counselors was based upon a firm belief that they would ultimately foster harmony, understanding and love, plus a feeling of togetherness that would make the activities program at Camp Fatima in New Hampshire its most successful. (Author/RK)

Incorporating Ideological Context in Counseling Couples Experiencing Infertility

ERIC Educational Resources Information Center

Burnett, Judith A.; Panchal, Krishna

2008-01-01

This article describes the influence of ideological values on couples' experience of infertility. Contextual issues are considered in terms of how they influence medical decision making as well as emotional factors. Strength-based counseling interventions that attend to couples' diverse values are described. Last, implications for counselors,…

Prospect theory on the brain? Toward a cognitive neuroscience of decision under risk.

PubMed

Trepel, Christopher; Fox, Craig R; Poldrack, Russell A

2005-04-01

Most decisions must be made without advance knowledge of their consequences. Economists and psychologists have devoted much attention to modeling decisions made under conditions of risk in which options can be characterized by a known probability distribution over possible outcomes. The descriptive shortcomings of classical economic models motivated the development of prospect theory (D. Kahneman, A. Tversky, Prospect theory: An analysis of decision under risk. Econometrica, 4 (1979) 263-291; A. Tversky, D. Kahneman, Advances in prospect theory: Cumulative representation of uncertainty. Journal of Risk and Uncertainty, 5 (4) (1992) 297-323) the most successful behavioral model of decision under risk. In the prospect theory, subjective value is modeled by a value function that is concave for gains, convex for losses, and steeper for losses than for gains; the impact of probabilities are characterized by a weighting function that overweights low probabilities and underweights moderate to high probabilities. We outline the possible neural bases of the components of prospect theory, surveying evidence from human imaging, lesion, and neuropharmacology studies as well as animal neurophysiology studies. These results provide preliminary suggestions concerning the neural bases of prospect theory that include a broad set of brain regions and neuromodulatory systems. These data suggest that focused studies of decision making in the context of quantitative models may provide substantial leverage towards a fuller understanding of the cognitive neuroscience of decision making.

Analytical group decision making in natural resources: methodology and application

Treesearch

Daniel L. Schmoldt; David L. Peterson

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...

Economic assessment of the use value of geospatial information

USGS Publications Warehouse

Bernknopf, Richard L.; Shapiro, Carl D.

2015-01-01

Geospatial data inform decision makers. An economic model that involves application of spatial and temporal scientific, technical, and economic data in decision making is described. The value of information (VOI) contained in geospatial data is the difference between the net benefits (in present value terms) of a decision with and without the information. A range of technologies is used to collect and distribute geospatial data. These technical activities are linked to examples that show how the data can be applied in decision making, which is a cultural activity. The economic model for assessing the VOI in geospatial data for decision making is applied to three examples: (1) a retrospective model about environmental regulation of agrochemicals; (2) a prospective model about the impact and mitigation of earthquakes in urban areas; and (3) a prospective model about developing private–public geospatial information for an ecosystem services market. Each example demonstrates the potential value of geospatial information in a decision with uncertain information.

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

PubMed

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

2015-12-01

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

Use of a web-based survey to facilitate shared decision making for patients eligible for cancer screening.

PubMed

Brackett, Charles D; Kearing, Stephen

2015-04-01

Our aim was to facilitate shared decision making (SDM) during preventive visits by utilizing a web-based survey system to offer colorectal cancer (CRC) and prostate cancer screening decision aids (DAs) to appropriately identified patients prior to the visit. Patients completed a web-based questionnaire before their preventive medicine appointment. Age- and gender-appropriate patients completed additional questions to determine eligibility for CRC or prostate-specific antigen (PSA) screening. Eligible patients were offered a choice of video or print DA, and completed questions assessing their knowledge, values, and preferences regarding the screening decision. Responses were summarized and fed forward to clinician and patient reports. Overall, 11,493 CRC and 4,384 PSA questionnaires were completed. Patient responses were used to identify those eligible for cancer-screening DAs: 2,187 (19 %) for CRC and 2,962 (68 %) for PSA; 15 % of eligible patients requested a DA. Many patients declined a DA because they indicated they "already know enough to make their decision" (34 % for CRC, 46 % for PSA). A web-based questionnaire provides an efficient means to identify patients eligible for cancer screening decisions and to offer them DAs before an appointment. Pre-visit use of DAs along with reports giving feedback to patients and clinicians provides an opportunity for SDM to occur at the visit.

Classification images reveal decision variables and strategies in forced choice tasks

PubMed Central

Pritchett, Lisa M.; Murray, Richard F.

2015-01-01

Despite decades of research, there is still uncertainty about how people make simple decisions about perceptual stimuli. Most theories assume that perceptual decisions are based on decision variables, which are internal variables that encode task-relevant information. However, decision variables are usually considered to be theoretical constructs that cannot be measured directly, and this often makes it difficult to test theories of perceptual decision making. Here we show how to measure decision variables on individual trials, and we use these measurements to test theories of perceptual decision making more directly than has previously been possible. We measure classification images, which are estimates of templates that observers use to extract information from stimuli. We then calculate the dot product of these classification images with the stimuli to estimate observers' decision variables. Finally, we reconstruct each observer's “decision space,” a map that shows the probability of the observer’s responses for all values of the decision variables. We use this method to examine decision strategies in two-alternative forced choice (2AFC) tasks, for which there are several competing models. In one experiment, the resulting decision spaces support the difference model, a classic theory of 2AFC decisions. In a second experiment, we find unexpected decision spaces that are not predicted by standard models of 2AFC decisions, and that suggest intrinsic uncertainty or soft thresholding. These experiments give new evidence regarding observers’ strategies in 2AFC tasks, and they show how measuring decision variables can answer long-standing questions about perceptual decision making. PMID:26015584

Evaluation of weather-based rice yield models in India.

PubMed

Sudharsan, D; Adinarayana, J; Reddy, D Raji; Sreenivas, G; Ninomiya, S; Hirafuji, M; Kiura, T; Tanaka, K; Desai, U B; Merchant, S N

2013-01-01

The objective of this study was to compare two different rice simulation models--standalone (Decision Support System for Agrotechnology Transfer [DSSAT]) and web based (SImulation Model for RIce-Weather relations [SIMRIW])--with agrometeorological data and agronomic parameters for estimation of rice crop production in southern semi-arid tropics of India. Studies were carried out on the BPT5204 rice variety to evaluate two crop simulation models. Long-term experiments were conducted in a research farm of Acharya N G Ranga Agricultural University (ANGRAU), Hyderabad, India. Initially, the results were obtained using 4 years (1994-1997) of data with weather parameters from a local weather station to evaluate DSSAT simulated results with observed values. Linear regression models used for the purpose showed a close relationship between DSSAT and observed yield. Subsequently, yield comparisons were also carried out with SIMRIW and DSSAT, and validated with actual observed values. Realizing the correlation coefficient values of SIMRIW simulation values in acceptable limits, further rice experiments in monsoon (Kharif) and post-monsoon (Rabi) agricultural seasons (2009, 2010 and 2011) were carried out with a location-specific distributed sensor network system. These proximal systems help to simulate dry weight, leaf area index and potential yield by the Java based SIMRIW on a daily/weekly/monthly/seasonal basis. These dynamic parameters are useful to the farming community for necessary decision making in a ubiquitous manner. However, SIMRIW requires fine tuning for better results/decision making.

Defense Resource Planning Under Uncertainty: An Application of Robust Decision Making to Munitions Mix Planning

DTIC Science & Technology

2016-02-01

In addition , the parser updates some parameters based on uncertainties. For example, Analytica was very slow to update Pk values based on...moderate range. The additional security environments helped to fill gaps in lower severity. Weapons Effectiveness Pk values were modified to account for two...project is to help improve the value and character of defense resource planning in an era of growing uncertainty and complex strategic challenges

Structured decision making for managing pneumonia epizootics in bighorn sheep

USGS Publications Warehouse

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

2016-01-01

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

The Impact of Health and Financial Literacy on Decision Making in Community-Based Older Adults

PubMed Central

James, Bryan D.; Boyle, Patricia A.; Bennett, Jarred S.; Bennett, David A.

2012-01-01

Background Health and financial literacy have been linked to the health and well-being of older adults, yet there are few data on how health and financial literacy actually impact decision making regarding healthcare and economic choices in advanced age. Objective To examine the association of health and financial literacy with decision making in older adults. Method Data came from 525 community-dwelling older persons without dementia from the Rush Memory and Aging Project, an ongoing longitudinal study of aging. Health and financial literacy were assessed via a series of questions designed to measure comprehension of health and financial information and concepts. The two scores were averaged to yield a total literacy score. A modified, 12-item version of the Decision-Making Competence Assessment Tool was used to measure financial and healthcare decision making (6 items each), using materials designed to approximate those used in real world settings. All 12 items were summed to yield a total decision-making score. Associations were tested via linear regression models adjusted for age, sex and education. Secondary models adjusted for global cognitive function, income, depression and chronic medical conditions. Results On average, participants correctly answered 67% of the literacy questions (health literacy = 61.6%, SD = 18.8% and financial literacy = 72.5%, SD = 16.0%). After adjustment for cognitive function, the total literacy score was positively associated with the decision-making total score (estimate = 0.64, SE = 0.08, p < 0.001), as well as healthcare (estimate = 0.37, SE = 0.5, p < 0.001) and financial decision making (estimate = 0.28, SE = 0.05, p < 0.001). Further, total literacy, health and financial literacy all were independently associated with decision making in models adjusted for covariates including income, depression, and chronic medical conditions (all p values < 0.001). Finally, there was evidence of effect modification such that the beneficial association between literacy and healthcare decision making was stronger among older persons, poorer persons and persons at the lower ranges of cognitive ability. Conclusion Among community based older persons without dementia, higher levels of health and financial literacy were associated with better decision making, suggesting that improvements in literacy could facilitate better decision making and lead to better health and quality of life in later years. PMID:22739454

The impact of health and financial literacy on decision making in community-based older adults.

PubMed

James, Bryan D; Boyle, Patricia A; Bennett, Jarred S; Bennett, David A

2012-01-01

Health and financial literacy have been linked to the health and well-being of older adults, yet there are few data on how health and financial literacy actually impact decision making regarding healthcare and economic choices in advanced age. To examine the association of health and financial literacy with decision making in older adults. Data came from 525 community-dwelling older persons without dementia from the Rush Memory and Aging Project, an ongoing longitudinal study of aging. Health and financial literacy were assessed via a series of questions designed to measure comprehension of health and financial information and concepts. The two scores were averaged to yield a total literacy score. A modified, 12-item version of the Decision-Making Competence Assessment Tool was used to measure financial and healthcare decision making (6 items each), using materials designed to approximate those used in real world settings. All 12 items were summed to yield a total decision-making score. Associations were tested via linear regression models adjusted for age, sex and education. Secondary models adjusted for global cognitive function, income, depression and chronic medical conditions. On average, participants correctly answered 67% of the literacy questions (health literacy = 61.6%, SD = 18.8% and financial literacy = 72.5%, SD = 16.0%). After adjustment for cognitive function, the total literacy score was positively associated with the decision-making total score (estimate = 0.64, SE = 0.08, p < 0.001), as well as healthcare (estimate = 0.37, SE = 0.5, p < 0.001) and financial decision making (estimate = 0.28, SE = 0.05, p < 0.001). Further, total literacy, health and financial literacy all were independently associated with decision making in models adjusted for covariates including income, depression, and chronic medical conditions (all p values < 0.001). Finally, there was evidence of effect modification such that the beneficial association between literacy and healthcare decision making was stronger among older persons, poorer persons and persons at the lower ranges of cognitive ability. Among community based older persons without dementia, higher levels of health and financial literacy were associated with better decision making, suggesting that improvements in literacy could facilitate better decision making and lead to better health and quality of life in later years. Copyright © 2012 S. Karger AG, Basel.

Eyes on the prize: reflections on the impact of the evolving digital ecology on the librarian as expert intermediary and knowledge coach, 1969-2009.

PubMed

Homan, J Michael

2010-01-01

The 2009 Janet Doe Lecture reflects on the continuing value and increasing return on investment of librarian-mediated services in the constantly evolving digital ecology and complex knowledge environment of the health sciences. The interrelationship of knowledge, decision making based on knowledge, technology used to access and retrieve knowledge, and the important linkage roles of expert librarian intermediaries is examined. Professional experiences from 1969 to 2009, occurring during a time of unprecedented changes in the digital ecology of librarianship, are the base on which the evolving role and value of librarians as knowledge coaches and expert intermediaries are examined. Librarian-mediated services linking knowledge and critical decision making in health care have become more valuable than ever as technology continues to reshape an increasingly complex knowledge environment.

Decision Making Regarding the Place of End-of-Life Cancer Care: The Burden on Bereaved Families and Related Factors.

PubMed

Yamamoto, Sena; Arao, Harue; Masutani, Eiko; Aoki, Miwa; Kishino, Megumi; Morita, Tatsuya; Shima, Yasuo; Kizawa, Yoshiyuki; Tsuneto, Satoru; Aoyama, Maho; Miyashita, Mitsunori

2017-05-01

Decision making regarding the place of end-of-life (EOL) care is an important issue for patients with terminal cancer and their families. It often requires surrogate decision making, which can be a burden on families. To explore the burden on the family of patients dying from cancer related to the decisions they made about the place of EOL care and investigate the factors affecting this burden. This was a cross-sectional mail survey using a self-administered questionnaire. Participants were 700 bereaved family members of patients with cancer from 133 palliative care units in Japan. The questionnaire covered decisional burdens, depression, grief, and the decision-making process. Participants experienced emotional pressure as the highest burden. Participants with a high decisional burden reported significantly higher scores for depression and grief (both P < 0.001). Multiple regression analyses revealed that higher burden was associated with selecting a place of EOL care that differed from that desired by participants (P < 0.001) and patients (P = 0.034), decision making without knowing the patient's wishes and values (P < 0.001) and without participants sharing their wishes and values with the patient's doctors and/or nurses (P = 0.022), and making the decision because of a due date for discharge from a former facility or hospital (P = 0.005). Decision making regarding the place of EOL care was recalled as burdensome for family decision makers. An early decision-making process that incorporates sharing patients' and family members' values that are relevant to the desired place of EOL care is important. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Changing hospitals, choosing chemotherapy and deciding you've made the right choice: Understanding the role of online support groups in different health decision-making activities.

PubMed

Sillence, Elizabeth; Bussey, Lauren

2017-05-01

To investigate the ways in which people use online support groups (OSGs) in relation to their health decision-making and to identify the key features of the resource that support those activities. Eighteen participants who used OSGs for a range of health conditions participated in qualitative study in which they were interviewed about their experiences of using OSGs in relation to decision-making. Exploration of their experiences was supported by discussion of illustrative quotes. Across the health conditions OSGs supported two main decision-making activities: (i) prompting decision making and (ii) evaluating and confirming decisions already made. Depending on the activity, participants valued information about the process, the experience and the outcome of patient narratives. The importance of forum interactivity was highlighted in relation to advice-seeking and the selection of relevant personal experiences. People use OSGs in different ways to support their health related decision-making valuing the different content types of the narratives and the interactivity provided by the resource. Engaging with OSGs helps people in a number of different ways in relation to decision-making. However, it only forms one part of people's decision-making strategies and appropriate resources should be signposted where possible. Copyright © 2017 Elsevier B.V. All rights reserved.

Assessing the Value of Frost Forecasts to Orchardists: A Dynamic Decision-Making Approach.

NASA Astrophysics Data System (ADS)

Katz, Richard W.; Murphy, Allan H.; Winkler, Robert L.

1982-04-01

The methodology of decision analysis is used to investigate the economic value of frost (i.e., minimum temperature) forecasts to orchardists. First, the fruit-frost situation and previous studies of the value of minimum temperature forecasts in this context are described. Then, after a brief overview of decision analysis, a decision-making model for the fruit-frost problem is presented. The model involves identifying the relevant actions and events (or outcomes), specifying the effect of taking protective action, and describing the relationships among temperature, bud loss, and yield loss. A bivariate normal distribution is used to model the relationship between forecast and observed temperatures, thereby characterizing the quality of different types of information. Since the orchardist wants to minimize expenses (or maximize payoffs) over the entire frost-protection season and since current actions and outcomes at any point in the season are related to both previous and future actions and outcomes, the decision-making problem is inherently dynamic in nature. As a result, a class of dynamic models known as Markov decision processes is considered. A computational technique called dynamic programming is used in conjunction with these models to determine the optimal actions and to estimate the value of meteorological information.Some results concerning the value of frost forecasts to orchardists in the Yakima Valley of central Washington are presented for the cases of red delicious apples, bartlett pears, and elberta peaches. Estimates of the parameter values in the Markov decision process are obtained from relevant physical and economic data. Twenty years of National Weather Service forecast and observed temperatures for the Yakima key station are used to estimate the quality of different types of information, including perfect forecasts, current forecasts, and climatological information. The orchardist's optimal actions over the frost-protection season and the expected expenses associated with the use of such information are determined using a dynamic programming algorithm. The value of meteorological information is defined as the difference between the expected expense for the information of interest and the expected expense for climatological information. Over the entire frost-protection season, the value estimates (in 1977 dollars) for current forecasts were $808 per acre for red delicious apples, $492 per acre for bartlett pears, and $270 per acre for elberta peaches. These amounts account for 66, 63, and 47%, respectively, of the economic value associated with decisions based on perfect forecasts. Varying the quality of the minimum temperature forecasts reveals that the relationship between the accuracy and value of such forecasts is nonlinear and that improvements in current forecasts would not be as significant in terms of economic value as were comparable improvements in the past.Several possible extensions of this study of the value of frost forecasts to orchardists are briefly described. Finally, the application of the dynamic model formulated in this paper to other decision-making problems involving the use of meteorological information is mentioned.

Plasticity of Decision-Making Abilities Among Maltreated Adolescents: Evidence From a Random Controlled Trial

PubMed Central

Weller, Joshua A.; Leve, Leslie D.; Kim, Hyoun K.; Bhimji, Jabeene; Fisher, Philip A.

2014-01-01

Childhood maltreatment has lasting negative effects throughout the lifespan. Early intervention research has demonstrated that these effects can be remediated through skill-based, family-centered interventions. However, less is known about plasticity during adolescence, and whether interventions are effective many years after children experience maltreatment. This study investigated this question by examining adolescent girls’ ability to make advantageous decisions in the face of risk using a validated decision-making task; performance on this task has been associated with key neural regions involved in affective processing and executive functioning. Maltreated foster girls (n = 92), randomly assigned at age 11 to either an intervention designed to prevent risk-taking behaviors or services as usual (SAU), and non-maltreated age and SES-matched girls living with their biological parent(s) (n = 80), completed a decision-making task (at age 15–17) that assessed risk-taking and sensitivity to expected value, an index of advantageous decision-making. Girls in the SAU condition demonstrated the greatest decision-making difficulties, primarily for risks to avoid losses. In the SAU group, frequency of neglect was related to greater difficulties in this area. Girls in the intervention condition with less neglect performed similarly to non-maltreated peers. This research suggests that early maltreatment may impact decision-making abilities into adolescence and that enriched environments during early adolescence provide a window of plasticity that may ameliorate these negative effects. PMID:25997770

Stochastic satisficing account of confidence in uncertain value-based decisions

PubMed Central

Bahrami, Bahador; Keramati, Mehdi

2018-01-01

Every day we make choices under uncertainty; choosing what route to work or which queue in a supermarket to take, for example. It is unclear how outcome variance, e.g. uncertainty about waiting time in a queue, affects decisions and confidence when outcome is stochastic and continuous. How does one evaluate and choose between an option with unreliable but high expected reward, and an option with more certain but lower expected reward? Here we used an experimental design where two choices’ payoffs took continuous values, to examine the effect of outcome variance on decision and confidence. We found that our participants’ probability of choosing the good (high expected reward) option decreased when the good or the bad options’ payoffs were more variable. Their confidence ratings were affected by outcome variability, but only when choosing the good option. Unlike perceptual detection tasks, confidence ratings correlated only weakly with decisions’ time, but correlated with the consistency of trial-by-trial choices. Inspired by the satisficing heuristic, we propose a “stochastic satisficing” (SSAT) model for evaluating options with continuous uncertain outcomes. In this model, options are evaluated by their probability of exceeding an acceptability threshold, and confidence reports scale with the chosen option’s thus-defined satisficing probability. Participants’ decisions were best explained by an expected reward model, while the SSAT model provided the best prediction of decision confidence. We further tested and verified the predictions of this model in a second experiment. Our model and experimental results generalize the models of metacognition from perceptual detection tasks to continuous-value based decisions. Finally, we discuss how the stochastic satisficing account of decision confidence serves psychological and social purposes associated with the evaluation, communication and justification of decision-making. PMID:29621325

Primary motor cortex contributes to the implementation of implicit value-based rules during motor decisions.

PubMed

Derosiere, Gerard; Zénon, Alexandre; Alamia, Andrea; Duque, Julie

2017-02-01

In the present study, we investigated the functional contribution of the human primary motor cortex (M1) to motor decisions. Continuous theta burst stimulation (cTBS) was used to alter M1 activity while participants performed a decision-making task in which the reward associated with the subjects' responses (right hand finger movements) depended on explicit and implicit value-based rules. Subjects performed the task over two consecutive days and cTBS occurred in the middle of Day 2, once the subjects were just about to implement implicit rules, in addition to the explicit instructions, to choose their responses, as evident in the control group (cTBS over the right somatosensory cortex). Interestingly, cTBS over the left M1 prevented subjects from implementing the implicit value-based rule while its implementation was enhanced in the group receiving cTBS over the right M1. Hence, cTBS had opposite effects depending on whether it was applied on the contralateral or ipsilateral M1. The use of the explicit value-based rule was unaffected by cTBS in the three groups of subject. Overall, the present study provides evidence for a functional contribution of M1 to the implementation of freshly acquired implicit rules, possibly through its involvement in a cortico-subcortical network controlling value-based motor decisions. Copyright © 2016 Elsevier Inc. All rights reserved.

Stock and option portfolio using fuzzy logic approach

NASA Astrophysics Data System (ADS)

Sumarti, Novriana; Wahyudi, Nanang

2014-03-01

Fuzzy Logic in decision-making process has been widely implemented in various problems in industries. It is the theory of imprecision and uncertainty that was not based on probability theory. Fuzzy Logic adds values of degree between absolute true and absolute false. It starts with and builds on a set of human language rules supplied by the user. The fuzzy systems convert these rules to their mathematical equivalents. This could simplify the job of the system designer and the computer, and results in much more accurate representations of the way systems behave in the real world. In this paper we examine the decision making process of stock and option trading by the usage of MACD (Moving Average Convergence Divergence) technical analysis and Option Pricing with Fuzzy Logic approach. MACD technical analysis is for the prediction of the trends of underlying stock prices, such as bearish (going downward), bullish (going upward), and sideways. By using Fuzzy C-Means technique and Mamdani Fuzzy Inference System, we define the decision output where the value of MACD is high then decision is "Strong Sell", and the value of MACD is Low then the decision is "Strong Buy". We also implement the fuzzification of the Black-Scholes option-pricing formula. The stock and options methods are implemented on a portfolio of one stock and its options. Even though the values of input data, such as interest rates, stock price and its volatility, cannot be obtain accurately, these fuzzy methods can give a belief degree of the calculated the Black-Scholes formula so we can make the decision on option trading. The results show the good capability of the methods in the prediction of stock price trends. The performance of the simulated portfolio for a particular period of time also shows good return.

An exploration of decision aid effectiveness: the impact of promoting affective vs. deliberative processing on a health-related decision.

PubMed

Davis, Esther L; McCaffery, Kirsten; Mullan, Barbara; Juraskova, Ilona

2015-12-01

Decision aids (DAs) are non-directive communication tools that help patients make value-consistent health-care decisions. However, most DAs have been developed without an explicit theoretical framework, resulting in a lack of understanding of how DAs achieve outcomes. To investigate the effect of promoting affective vs. deliberative processing on DA effectiveness based on dual-process theory. One hundred and forty-eight female university students participated in a randomized controlled experiment with three conditions: emotion-focused, information-focused and control. Preference-value consistency, knowledge, decisional conflict and satisfaction were compared across the conditions using planned contrast analyses. The intervention comprised two different DAs and instructional manipulations. The emotion-focused condition received a modified DA with affective content and instructions to induce an affective reaction. The information-focused and control conditions received the same DA without the affective content. The information-focused condition received additional instructions to induce deliberative processing. Controlling for the experiment-wise error rate at P < 0.017, the emotion-focused and information-focused conditions had significantly higher decisional satisfaction than the control condition (P < 0.001). The emotion-focused condition did not demonstrate preference-value consistency. There were no significant differences for decisional conflict and knowledge. Results suggest that the promotion of affective processing may hinder value-consistent decision making, while deliberative processing may enhance decisional satisfaction. This investigation of the effect of affective and deliberative processes in DA-supported decision making has implications for the design and use of DAs. DA effectiveness may be enhanced by incorporating a simple instruction to focus on the details of the information. © 2014 John Wiley & Sons Ltd.

Neural mechanisms associated with treatment decision making: An fMRI study.

PubMed

Abidi, Malek; Bruce, Jared; Le Blanche, Alain; Bruce, Amanda; Jarmolowicz, David P; Csillik, Antonia; Thai, N Jade; Lim, Seung-Lark; Heinzlef, Olivier; de Marco, Giovanni

2018-04-23

Great progress has been made in understanding how people make financial decisions. However, there is little research on how people make health and treatment choices. Our study aimed to examine how participants weigh benefits (reduction in disease progression) and probability of risk (medications' side effects) when making hypothetical treatment decisions, and to identify the neural networks implicated in this process. Fourteen healthy participants were recruited to perform a treatment decision probability discounting task using MRI. Behavioral responses and skin conductance responses (SCRs) were measured. A whole brain analysis were performed to compare activity changes between "mild" and "severe" medications' side effects conditions. Then, orbitofrontal cortex (OFC), ventral striatum (VS), amygdala and insula were chosen for effective connectivity analysis. Behavioral data showed that participants are more likely to refuse medication when side effects are high and efficacy is low. SCRs values were significantly higher when people made medication decisions in the severe compared to mild condition. Functionally, OFC and VS were activated in the mild condition and were associated with increased likehood of choosing to take medication (higher area under the curve "AUC" side effects/efficacy). These regions also demonstrated an increased effective connectivity when participants valued treatment benefits. By contrast, the OFC, insula and amygdala were activated in the severe condition and were associated with and increased likelihood to refuse treatment. These regions showed enhanced effective connectivity when participants were confronted with increased side effects severity. This is the first study to examine the behavioral and neural bases of medical decision making. Copyright © 2018 Elsevier B.V. All rights reserved.

Tools to Promote Shared Decision Making in Serious Illness: A Systematic Review.

PubMed

Austin, C Adrian; Mohottige, Dinushika; Sudore, Rebecca L; Smith, Alexander K; Hanson, Laura C

2015-07-01

Serious illness impairs function and threatens survival. Patients facing serious illness value shared decision making, yet few decision aids address the needs of this population. To perform a systematic review of evidence about decision aids and other exportable tools that promote shared decision making in serious illness, thereby (1) identifying tools relevant to the treatment decisions of seriously ill patients and their caregivers, (2) evaluating the quality of evidence for these tools, and (3) summarizing their effect on outcomes and accessibility for clinicians. We searched PubMed, CINAHL, and PsychInfo from January 1, 1995, through October 31, 2014, and identified additional studies from reference lists and other systematic reviews. Clinical trials with random or nonrandom controls were included if they tested print, video, or web-based tools for advance care planning (ACP) or decision aids for serious illness. We extracted data on the study population, design, results, and risk for bias using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Each tool was evaluated for its effect on patient outcomes and accessibility. Seventeen randomized clinical trials tested decision tools in serious illness. Nearly all the trials were of moderate or high quality and showed that decision tools improve patient knowledge and awareness of treatment choices. The available tools address ACP, palliative care and goals of care communication, feeding options in dementia, lung transplant in cystic fibrosis, and truth telling in terminal cancer. Five randomized clinical trials provided further evidence that decision tools improve ACP documentation, clinical decisions, and treatment received. Clinicians can access and use evidence-based tools to engage seriously ill patients in shared decision making. This field of research is in an early stage; future research is needed to develop novel decision aids for other serious diagnoses and key decisions. Health care delivery organizations should prioritize the use of currently available tools that are evidence based and effective.

Fertility preservation and cancer: Challenges for adolescent and young adult patients

PubMed Central

Benedict, Catherine; Thom, Bridgette; Kelvin, Joanne

2016-01-01

Purpose of review With increasing survival rates, fertility is an important quality of life concern for many young cancer patients. There is a critical need for improvements in clinical care to ensure patients are well informed about infertility risks and fertility preservation (FP) options and to support them in their reproductive decision-making prior to treatment. Recent findings A number of barriers prevent fertility from being adequately addressed in the clinical context. Providers’ and patients’ incomplete or inaccurate understanding of infertility risks exacerbate patients’ reproductive concerns. For female patients in particular, making decisions about FP before treatment often leads to decision conflict, reducing the likelihood of making informed, values-based decisions, and post-treatment regret and distress. Recent empirically-based interventions to improve provider training around fertility issues and to support patient decision-making about FP show promise. Summary Providers should be knowledgeable about the infertility risks associated with cancer therapies and proactively address fertility with all patients who might one day wish to have a child. Comprehensive counseling should also include related issues such as contraceptive use and health implications of early menopause, regardless of desire for future children. Although the negative psychosocial impact of cancer-related infertility is now well accepted, limited work has been done to explore how to improve clinical management of fertility issues in the context of cancer care. Evidence-based interventions should be developed to address barriers and provide psychosocial and decision-making support to patients who are concerned about their fertility and interested in FP options. PMID:26730794

DELPHI AND VALUES,

DTIC Science & Technology

MANAGEMENT PLANNING AND CONTROL, DECISION MAKING), (* DECISION MAKING , GROUP DYNAMICS), (*GROUP DYNAMICS, ATTITUDES(PSYCHOLOGY)), REASONING, REACTION(PSYCHOLOGY), PUBLIC OPINION, PERFORMANCE(HUMAN), QUESTIONNAIRES, FEEDBACK

Facilitating informed choice in prenatal testing: how well are we doing?

PubMed

Marteau, T M; Dormandy, E

2001-01-01

There is a consensus that prenatal testing services need to provide the information and support necessary for women to make informed choices about prenatal testing. Informed choices are those based on relevant information that reflect the decision-maker's values. To date, most research has focused on the information provided to women deciding whether to undergo tests. This has highlighted the poor quality of information provided to many women. There is agreement on the need to provide information on three key aspects of any test: the condition for which testing is being offered, characteristics of the test, and the implications of testing. Very little research has been conducted on decisions after the diagnosis of a fetal abnormality and how information and emotional and decisional support are and should be provided. Research is now needed in four key areas: first, on the optimal ways of organizing services to facilitate choices that are not only based on relevant information, but also reflect the decision-maker's values; second, on the most effective ways of framing information needed for the different decisions involved in prenatal testing; third, on the most effective media in which to deliver information; and, fourth, to identify aspects of counseling that facilitate informed choices following diagnoses of fetal abnormality. If we value women's ability to make informed choices about prenatal tests as highly as we value reliable laboratory tests, evidence-based quality standards need to be developed for the information and support women are given at all stages of the process of prenatal testing.

Using Virtual Reality to Assess Ethical Decisions in Road Traffic Scenarios: Applicability of Value-of-Life-Based Models and Influences of Time Pressure.

PubMed

Sütfeld, Leon R; Gast, Richard; König, Peter; Pipa, Gordon

2017-01-01

Self-driving cars are posing a new challenge to our ethics. By using algorithms to make decisions in situations where harming humans is possible, probable, or even unavoidable, a self-driving car's ethical behavior comes pre-defined. Ad hoc decisions are made in milliseconds, but can be based on extensive research and debates. The same algorithms are also likely to be used in millions of cars at a time, increasing the impact of any inherent biases, and increasing the importance of getting it right. Previous research has shown that moral judgment and behavior are highly context-dependent, and comprehensive and nuanced models of the underlying cognitive processes are out of reach to date. Models of ethics for self-driving cars should thus aim to match human decisions made in the same context. We employed immersive virtual reality to assess ethical behavior in simulated road traffic scenarios, and used the collected data to train and evaluate a range of decision models. In the study, participants controlled a virtual car and had to choose which of two given obstacles they would sacrifice in order to spare the other. We randomly sampled obstacles from a variety of inanimate objects, animals and humans. Our model comparison shows that simple models based on one-dimensional value-of-life scales are suited to describe human ethical behavior in these situations. Furthermore, we examined the influence of severe time pressure on the decision-making process. We found that it decreases consistency in the decision patterns, thus providing an argument for algorithmic decision-making in road traffic. This study demonstrates the suitability of virtual reality for the assessment of ethical behavior in humans, delivering consistent results across subjects, while closely matching the experimental settings to the real world scenarios in question.

Using Virtual Reality to Assess Ethical Decisions in Road Traffic Scenarios: Applicability of Value-of-Life-Based Models and Influences of Time Pressure

PubMed Central

Sütfeld, Leon R.; Gast, Richard; König, Peter; Pipa, Gordon

2017-01-01

Self-driving cars are posing a new challenge to our ethics. By using algorithms to make decisions in situations where harming humans is possible, probable, or even unavoidable, a self-driving car's ethical behavior comes pre-defined. Ad hoc decisions are made in milliseconds, but can be based on extensive research and debates. The same algorithms are also likely to be used in millions of cars at a time, increasing the impact of any inherent biases, and increasing the importance of getting it right. Previous research has shown that moral judgment and behavior are highly context-dependent, and comprehensive and nuanced models of the underlying cognitive processes are out of reach to date. Models of ethics for self-driving cars should thus aim to match human decisions made in the same context. We employed immersive virtual reality to assess ethical behavior in simulated road traffic scenarios, and used the collected data to train and evaluate a range of decision models. In the study, participants controlled a virtual car and had to choose which of two given obstacles they would sacrifice in order to spare the other. We randomly sampled obstacles from a variety of inanimate objects, animals and humans. Our model comparison shows that simple models based on one-dimensional value-of-life scales are suited to describe human ethical behavior in these situations. Furthermore, we examined the influence of severe time pressure on the decision-making process. We found that it decreases consistency in the decision patterns, thus providing an argument for algorithmic decision-making in road traffic. This study demonstrates the suitability of virtual reality for the assessment of ethical behavior in humans, delivering consistent results across subjects, while closely matching the experimental settings to the real world scenarios in question. PMID:28725188

[Shared decision making in patients with diabetes mellitus].

PubMed

Serrano, Valentina; Larrea-Mantilla, Laura; Rodríguez-Gutiérrez, René; Spencer-Bonilla, Gabriela; Málaga, Germán; Hargraves, Ian; Montori, Víctor M

2017-05-01

Patients with diabetes mellitus often have several medical problems and carry a burden imposed by their illness and treatment. Health care often ignores the values, preferences and context of patients, leading to treatments that do not fit into patients’ overwhelmed lives. Shared Decision Making (SDM) emerges as a way to answer the question: “What’s best for the patient?”. SDM promotes an empathic conversation between patients and clinicians that integrates the best evidence available with their values, preferences and context. We discuss three SDM approaches for patients with diabetes: one focused on sharing information, another on making choices, and a third one on helping patients and clinicians to talk about how to address the problems of living with diabetes and its comorbidities. Despite the benefits demonstrated in studies conducted in the U.S. and Europe, the implementation of SDM continues to be a challenge. In Latin America, healthcare and socio-economic conditions render the implementation of SDM more challenging. Research aimed to respond to this challenge is necessary. Meanwhile, clinicians can practice SDM by sharing evidence-based information, giving voice to patients’ values and preferences in making choices, and creating empathic conversations aimed at decisions aligned with patients’ context, dreams, goals, and life expectations.

Site-Based Management: Avoiding Disaster While Sharing Decision Making.

ERIC Educational Resources Information Center

Sorenson, Larry Dean

This paper argues that many site-based management practices do not represent true empowerment and are not founded on a consensual framework of values, goals, and priorities developed by educational stakeholders. In addition, they often lack clearly stated operating principles. The paper distinguishes between site-based management (SBM) and…

Faculty Training in Evidence-Based Medicine: Improving Evidence Acquisition and Critical Appraisal

ERIC Educational Resources Information Center

Nicholson, Laura J.; Warde, Carole M.; Boker, John R.

2007-01-01

Introduction: Evidence-based medicine (EBM) integrates published clinical evidence with patient values and clinical expertise, the output of which is informed medical decision making. Key skills for evidence-based practice include acquisition and appraisal of clinical information. Faculty clinicians often lack expertise in these skills and are…

Emotion and decision making: multiple modulatory neural circuits.

PubMed

Phelps, Elizabeth A; Lempert, Karolina M; Sokol-Hessner, Peter

2014-01-01

Although the prevalent view of emotion and decision making is derived from the notion that there are dual systems of emotion and reason, a modulatory relationship more accurately reflects the current research in affective neuroscience and neuroeconomics. Studies show two potential mechanisms for affect's modulation of the computation of subjective value and decisions. Incidental affective states may carry over to the assessment of subjective value and the decision, and emotional reactions to the choice may be incorporated into the value calculation. In addition, this modulatory relationship is reciprocal: Changing emotion can change choices. This research suggests that the neural mechanisms mediating the relation between affect and choice vary depending on which affective component is engaged and which decision variables are assessed. We suggest that a detailed and nuanced understanding of emotion and decision making requires characterizing the multiple modulatory neural circuits underlying the different means by which emotion and affect can influence choices.

[The role of epidemiology in the process of decision-making].

PubMed

Prost, A

1997-01-01

Epidemiology is the method of choice for quantifying and interpreting health phenomena, placing them into perspective to allow trend analysis and projections. It is a tool for analysis, evaluation and forecasting and is thus indispensable in the decision-making process. However, this comprehensive technique has its limitations since health is the result of complex interactions: individual requirements do not always correspond to the overall needs of the community; consideration has to be given to solidarity and the necessity for cost-sharing; and the decision process is strongly influenced by social, cultural, religious and political factors which defy quantification and, on occasion, any rational course of action. Each indicator only takes into account one aspect of the situation and the pertinent indicator should therefore be carefully selected. At the same time, any choice implicitly signifies value judgements-often unnoticed-which need to be balanced and validated in relation to the ethical values of the community in order to be of any assistance to decision-making. Decision-making is a qualitative political process which, although based on the quantitative analysis supplied by epidemiology, cannot be limited to it. Each approach enhance the other, but they should not be confused if freedom to act is to be preserved from being locked into some kind of mechanical process that is unacceptable both to man and to society.

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.

Overlapping Risky Decision-Making and Olfactory Processing Ability in HIV-Infected Individuals.

PubMed

Jackson, Christopher; Rai, Narayan; McLean, Charlee K; Hipolito, Maria Mananita S; Hamilton, Flora Terrell; Kapetanovic, Suad; Nwulia, Evaristus A

2017-09-01

Given neuroimaging evidences of overlap in the circuitries for decision-making and olfactory processing, we examined the hypothesis that impairment in psychophysical tasks of olfaction would independently predict poor performances on Iowa Gambling Task (IGT), a laboratory task that closely mimics real-life decision-making, in a US cohort of HIV-infected (HIV+) individuals. IGT and psychophysical tasks of olfaction were administered to a Washington DC-based cohort of largely African American HIV+ subjects (N=100), and to a small number of demographically-matched non-HIV healthy controls (N=43) from a different study. Constructs of olfactory ability and decision-making were examined through confirmatory factor analysis (CFA). Structural equation models (SEMs) were used to evaluate the validity of the path relationship between these two constructs. The 100 HIV+ participants (56% female; 96% African Americans; median age = 48 years) had median CD4 count of 576 cells/μl and median HIV RNA viral load <48 copies per milliliter. Majority of HIV+ participants performed randomly throughout the course of IGT tasks, and failed to demonstrate a learning curve. Confirmatory factor analysis provided support for a unidimensional factor underlying poor performances on IGT. Nomological validity for correlations between olfactory ability and IGT performance was confirmed through SEM. Finally, factor scores of olfactory ability and IGT performance strongly predicted 6 months history of drug use, while olfaction additionally predicted hallucinogen use. This study suggests that combination of simple, office-based tasks of olfaction and decision-making may identify those HIV+ individuals who are more prone to risky decision-making. This finding may have significant clinical, public health value if joint impairments in olfaction and IGT task correlates with more decreased activity in brain regions relevant to decision-making.

Health care priority setting in Norway a multicriteria decision analysis

PubMed Central

2012-01-01

Background Priority setting in population health is increasingly based on explicitly formulated values. The Patients Rights Act of the Norwegian tax-based health service guaranties all citizens health care in case of a severe illness, a proven health benefit, and proportionality between need and treatment. This study compares the values of the country's health policy makers with these three official principles. Methods In total 34 policy makers participated in a discrete choice experiment, weighting the relative value of six policy criteria. We used multi-variate logistic regression with selection as dependent valuable to derive odds ratios for each criterion. Next, we constructed a composite league table - based on the sum score for the probability of selection - to rank potential interventions in five major disease areas. Results The group considered cost effectiveness, large individual benefits and severity of disease as the most important criteria in decision making. Priority interventions are those related to cardiovascular diseases and respiratory diseases. Less attractive interventions rank those related to mental health. Conclusions Norwegian policy makers' values are in agreement with principles formulated in national health laws. Multi-criteria decision approaches may provide a tool to support explicit allocation decisions. PMID:22335815

Health care priority setting in Norway a multicriteria decision analysis.

PubMed

Defechereux, Thierry; Paolucci, Francesco; Mirelman, Andrew; Youngkong, Sitaporn; Botten, Grete; Hagen, Terje P; Niessen, Louis W

2012-02-15

Priority setting in population health is increasingly based on explicitly formulated values. The Patients Rights Act of the Norwegian tax-based health service guaranties all citizens health care in case of a severe illness, a proven health benefit, and proportionality between need and treatment. This study compares the values of the country's health policy makers with these three official principles. In total 34 policy makers participated in a discrete choice experiment, weighting the relative value of six policy criteria. We used multi-variate logistic regression with selection as dependent valuable to derive odds ratios for each criterion. Next, we constructed a composite league table - based on the sum score for the probability of selection - to rank potential interventions in five major disease areas. The group considered cost effectiveness, large individual benefits and severity of disease as the most important criteria in decision making. Priority interventions are those related to cardiovascular diseases and respiratory diseases. Less attractive interventions rank those related to mental health. Norwegian policy makers' values are in agreement with principles formulated in national health laws. Multi-criteria decision approaches may provide a tool to support explicit allocation decisions.

Administrative Leadership. Effective and Responsive Decision Making in Higher Education.

ERIC Educational Resources Information Center

Dressel, Paul L.

Administrative leadership is examined with focus on the processes and problems of campus decision-making. Chapters include: the need for administrators; morals, ethics, and values in higher education; improving administrative communication; conceptions of decision-making; focusing administration interest; understanding external influences,…

Determining the optimum strategy of techniques from the municipal solid waste management hierarchy to maximize social value. Master`s thesis

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

Still, C.M.

1996-12-01

The primary waste management alternatives are source reduction, recycling, composting, incineration, and landfilling. Often waste management policies are based entirely on technical considerations and ignore that actual disposal practices depend on individuals` attitudes and behaviors. This research formulated a decision analysis model that incorporates social value measures to determine the waste management strategy that maximizes the individuals` willingness to participate. The social values that are important and that were considered in the decision support model to assist with making decisions about solid waste management were convenience, feeling good about reducing waste, feeling good about leaving a good environment for futuremore » generations, and the value of recreation programs that can be provided with profit from a recycling program.« less

Accuracy of 'My Gut Feeling:' Comparing System 1 to System 2 Decision-Making for Acuity Prediction, Disposition and Diagnosis in an Academic Emergency Department.

PubMed

Cabrera, Daniel; Thomas, Jonathan F; Wiswell, Jeffrey L; Walston, James M; Anderson, Joel R; Hess, Erik P; Bellolio, M Fernanda

2015-09-01

Current cognitive sciences describe decision-making using the dual-process theory, where a System 1 is intuitive and a System 2 decision is hypothetico-deductive. We aim to compare the performance of these systems in determining patient acuity, disposition and diagnosis. Prospective observational study of emergency physicians assessing patients in the emergency department of an academic center. Physicians were provided the patient's chief complaint and vital signs and allowed to observe the patient briefly. They were then asked to predict acuity, final disposition (home, intensive care unit (ICU), non-ICU bed) and diagnosis. A patient was classified as sick by the investigators using previously published objective criteria. We obtained 662 observations from 289 patients. For acuity, the observers had a sensitivity of 73.9% (95% CI [67.7-79.5%]), specificity 83.3% (95% CI [79.5-86.7%]), positive predictive value 70.3% (95% CI [64.1-75.9%]) and negative predictive value 85.7% (95% CI [82.0-88.9%]). For final disposition, the observers made a correct prediction in 80.8% (95% CI [76.1-85.0%]) of the cases. For ICU admission, emergency physicians had a sensitivity of 33.9% (95% CI [22.1-47.4%]) and a specificity of 96.9% (95% CI [94.0-98.7%]). The correct diagnosis was made 54% of the time with the limited data available. System 1 decision-making based on limited information had a sensitivity close to 80% for acuity and disposition prediction, but the performance was lower for predicting ICU admission and diagnosis. System 1 decision-making appears insufficient for final decisions in these domains but likely provides a cognitive framework for System 2 decision-making.

Young adults' decision making surrounding heavy drinking: a multi-staged model of planned behaviour.

PubMed

Northcote, Jeremy

2011-06-01

This paper examines the real life contexts in which decisions surrounding heavy drinking are made by young adults (that is, on occasions when five or more alcoholic drinks are consumed within a few hours). It presents a conceptual model that views such decision making as a multi-faceted and multi-staged process. The mixed method study draws on purposive data gathered through direct observation of eight social networks consisting of 81 young adults aged between 18 and 25 years in Perth, Western Australia, including in-depth interviews with 31 participants. Qualitative and some basic quantitative data were gathered using participant observation and in-depth interviews undertaken over an eighteen month period. Participants explained their decision to engage in heavy drinking as based on a variety of factors. These elements relate to socio-cultural norms and expectancies that are best explained by the theory of planned behaviour. A framework is proposed that characterises heavy drinking as taking place in a multi-staged manner, with young adults having: 1. A generalised orientation to the value of heavy drinking shaped by wider influences and norms; 2. A short-term orientation shaped by situational factors that determines drinking intentions for specific events; and 3. An evaluative orientation shaped by moderating factors. The value of qualitative studies of decision making in real life contexts is advanced to complement the mostly quantitative research that dominates research on alcohol decision making. Copyright © 2011 Elsevier Ltd. All rights reserved.

An Evidence Framework for Off-Patent Pharmaceutical Review (EFOR) for Health Technology Assessment in Emerging Markets.

PubMed

Brixner, Diana; Kaló, Zoltán; Maniadakis, Nikos; Kim, Kyoo; Wijaya, Kalman

2018-03-29

This article introduces an Evidence Framework for Off-Patent Pharmaceutical Review (EFOR), which establishes value-based criteria in a template that manufacturers use to provide evidence showing how their products meet those criteria. Health authorities in emerging markets can then use the evidence presented in the EFOR to evaluate off-patent pharmaceuticals (OPPs) in a consistent, transparent, and evidence-based manner to support policy decisions, including pricing, reimbursement, formulary listing, and drug procurement. A literature search found no multi-criteria evidence framework for evaluating OPPs in emerging markets. An International Outcomes Research Board (IORB) of academia and industry experts conducted extensive research, meetings, and workshops to define high-priority criteria to incorporate into an evidence-based health technology assessment (HTA) tool using the multi-criteria decision analysis (MCDA) technique. The resulting framework was further tailored for country-specific needs in workshops in three emerging countries (Kazakhstan, Vietnam, and Indonesia). The IORB defined nine criteria four categories (Product, Manufacturing, Service, and Value Assessment), which OPP manufacturers can use to provide evidence for reimbursement and health policy decision making. Then the IORB developed the EFOR as a base case document, which can be adapted and used as a template by health authorities in emerging countries. Emerging countries have a significant need for an HTA tool that balances affordability with accurate evidence showing the value differentiation of OPPs. The value attributes in this setting often are different from those in developed markets, which emphasize new products and have high regulation and manufacturing standards. The EFOR is an easy-to-use, adaptable framework that emerging countries can use to increase the consistency, transparency, and effectiveness of drug decision making. The open source EFOR is available as Supplemental Materials. Copyright © 2018. Published by Elsevier Inc.

Extending the Boundaries of Debate Theory: A Value-Bounded Policy Decision Making Paradigm.

ERIC Educational Resources Information Center

Thomas, David A.; Corsi, Jerome R.

The purpose of this paper is to propose a new, synthetic paradigm for debate analysis and decision making that features the policy systems approach within a context of values as boundaries for decision. As background for the proposed theory, the paper (1) summarizes the notions of paradigm formation and shifts initially presented by T. Kuhn; (2)…

Value of information and pricing new healthcare interventions.

PubMed

Willan, Andrew R; Eckermann, Simon

2012-06-01

Previous application of value-of-information methods to optimal clinical trial design have predominantly taken a societal decision-making perspective, implicitly assuming that healthcare costs are covered through public expenditure and trial research is funded by government or donation-based philanthropic agencies. In this paper, we consider the interaction between interrelated perspectives of a societal decision maker (e.g. the National Institute for Health and Clinical Excellence [NICE] in the UK) charged with the responsibility for approving new health interventions for reimbursement and the company that holds the patent for a new intervention. We establish optimal decision making from societal and company perspectives, allowing for trade-offs between the value and cost of research and the price of the new intervention. Given the current level of evidence, there exists a maximum (threshold) price acceptable to the decision maker. Submission for approval with prices above this threshold will be refused. Given the current level of evidence and the decision maker's threshold price, there exists a minimum (threshold) price acceptable to the company. If the decision maker's threshold price exceeds the company's, then current evidence is sufficient since any price between the thresholds is acceptable to both. On the other hand, if the decision maker's threshold price is lower than the company's, then no price is acceptable to both and the company's optimal strategy is to commission additional research. The methods are illustrated using a recent example from the literature.

Principals Value-Informed Decision Making, Intrapersonal Moral Discord, and Pathways to Resolution: The Complexities of Moral Leadership Praxis

ERIC Educational Resources Information Center

Frick, William C.

2009-01-01

Purpose: This research seeks to explore the inevitable internal struggle experienced by school leaders when making ethically-informed judgments. The study acquired principals' intimate reflections about professional decision making in response to personal versus organizational and/or professional value discrepancy as identified in the ethic of the…

Advancements in Risk-Informed Performance-Based Asset Management for Commercial Nuclear Power Plants

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

Liming, James K.; Ravindra, Mayasandra K.

2006-07-01

Over the past several years, ABSG Consulting Inc. (ABS Consulting) and the South Texas Project Nuclear Operating Company (STPNOC) have developed a decision support process and associated software for risk-informed, performance-based asset management (RIPBAM) of nuclear power plant facilities. RIPBAM applies probabilistic risk assessment (PRA) tools and techniques in the realm of plant physical and financial asset management. The RIPBAM process applies a tiered set of models and supporting performance measures (or metrics) that can ultimately be applied to support decisions affecting the allocation and management of plant resources (e.g., funding, staffing, scheduling, etc.). In general, the ultimate goal ofmore » the RIPBAM process is to continually support decision-making to maximize a facility's net present value (NPV) and long-term profitability for its owners. While the initial applications of RIPBAM have been for nuclear power stations, the methodology can easily be adapted to other types of power station or complex facility decision-making support. RIPBAM can also be designed to focus on performance metrics other than NPV and profitability (e.g., mission reliability, operational availability, probability of mission success per dollar invested, etc.). Recent advancements in the RIPBAM process focus on expanding the scope of previous RIPBAM applications to include not only operations, maintenance, and safety issues, but also broader risk perception components affecting plant owner (stockholder), operator, and regulator biases. Conceptually, RIPBAM is a comprehensive risk-informed cash flow model for decision support. It originated as a tool to help manage plant refueling outage scheduling, and was later expanded to include the full spectrum of operations and maintenance decision support. However, it differs from conventional business modeling tools in that it employs a systems engineering approach with broadly based probabilistic analysis of organizational 'value streams'. The scope of value stream inclusion in the process can be established by the user, but in its broadest applications, RIPBAM can be used to address how risk perceptions of plant owners and regulators are impacted by plant performance. Plant staffs can expand and refine RIPBAM models scope via a phased program of activities over time. This paper shows how the multi-metric uncertainty analysis feature of RIPBAM can apply a wide spectrum of decision-influencing factors to support decisions designed to maximize the probability of achieving, maintaining, and improving upon plant goals and objectives. In this paper, the authors show how this approach can be extremely valuable to plant owners and operators in supporting plant value-impacting decision-making processes. (authors)« less

Analyzing Individual Decision Making Versus Group Decision Making for Alternative Selection

DTIC Science & Technology

2008-06-01

35 SDVF Single Dimensional Value Function . . . . . . . . . . . . . 44 ENAER Empresa Nacional de Aeronautica... de - viate further from balanced strategies than do individuals” [16]. Kocher and Sutter compared decisions by individuals and groups in beauty...Michaelsen, Watson, and Black de - termined that there have been no studies on individual versus group decision making that provided any significant

Modulating activity in the prefrontal cortex changes decision-making for risky gains and losses: a transcranial direct current stimulation study.

PubMed

Ye, Hang; Chen, Shu; Huang, Daqiang; Wang, Siqi; Luo, Jun

2015-06-01

When making choices under uncertainty, people usually consider both the risks and benefits of each option. Previous studies have found that weighing of risks and benefits during decision-making involves a complex neural network that includes the dorsolateral prefrontal cortex (DLPFC), but the causal effect of this network on risk decision-making has remained unclear. This experiment was based on a risk-measurement table designed to provide a direct measure of risk preference, with a weighted value of the choices (denoted as weighted risk aversion, WRA) as an index of the participant's degree of risk aversion. We studied whether bifrontal transcranial direct current stimulation (tDCS) applied over the right and left prefrontal cortex can change the balance of risky vs. safe responses under both gain frame and loss frame. A total of 60 volunteers performed risk tasks while receiving either anodal over the right with cathodal over the left DLPFC, anodal over the left with cathodal over the right DLPFC, or sham stimulation. The participants tended to choose more risky options in the gain frame and more safe options in the loss frame after the right anodal/left cathodal tDCS. We also found that right anodal/left cathodal tDCS significantly decreased the WRA values compared with those associated with sham stimulation. These findings extend the notion that DLPFC activity is critical for risk decision-making, indicating an asymmetric role of the right DLPFC in the gain frame vs. the loss frame of risk decision-making. Copyright © 2015 Elsevier B.V. All rights reserved.

Maladaptive Decision Making in Adults with a History of Adolescent Alcohol use, in a Preclinical Model, Is Attributable to the Compromised Assignment of Incentive Value during Stimulus-Reward Learning.

PubMed

Kruse, Lauren C; Schindler, Abigail G; Williams, Rapheal G; Weber, Sophia J; Clark, Jeremy J

2017-01-01

According to recent WHO reports, alcohol remains the number one substance used and abused by adolescents, despite public health efforts to curb its use. Adolescence is a critical period of biological maturation where brain development, particularly the mesocorticolimbic dopamine system, undergoes substantial remodeling. These circuits are implicated in complex decision making, incentive learning and reinforcement during substance use and abuse. An appealing theoretical approach has been to suggest that alcohol alters the normal development of these processes to promote deficits in reinforcement learning and decision making, which together make individuals vulnerable to developing substance use disorders in adulthood. Previously we have used a preclinical model of voluntary alcohol intake in rats to show that use in adolescence promotes risky decision making in adulthood that is mirrored by selective perturbations in dopamine network dynamics. Further, we have demonstrated that incentive learning processes in adulthood are also altered by adolescent alcohol use, again mirrored by changes in cue-evoked dopamine signaling. Indeed, we have proposed that these two processes, risk-based decision making and incentive learning, are fundamentally linked through dysfunction of midbrain circuitry where inputs to the dopamine system are disrupted by adolescent alcohol use. Here, we test the behavioral predictions of this model in rats and present the findings in the context of the prevailing literature with reference to the long-term consequences of early-life substance use on the vulnerability to develop substance use disorders. We utilize an impulsive choice task to assess the selectivity of alcohol's effect on decision-making profiles and conditioned reinforcement to parse out the effect of incentive value attribution, one mechanism of incentive learning. Finally, we use the differential reinforcement of low rates of responding (DRL) task to examine the degree to which behavioral disinhibition may contribute to an overall decision-making profile. The findings presented here support the proposition that early life alcohol use selectively alters risk-based choice behavior through modulation of incentive learning processes, both of which may be inexorably linked through perturbations in mesolimbic circuitry and may serve as fundamental vulnerabilities to the development of substance use disorders.

Maladaptive Decision Making in Adults with a History of Adolescent Alcohol use, in a Preclinical Model, Is Attributable to the Compromised Assignment of Incentive Value during Stimulus-Reward Learning

PubMed Central

Kruse, Lauren C.; Schindler, Abigail G.; Williams, Rapheal G.; Weber, Sophia J.; Clark, Jeremy J.

2017-01-01

According to recent WHO reports, alcohol remains the number one substance used and abused by adolescents, despite public health efforts to curb its use. Adolescence is a critical period of biological maturation where brain development, particularly the mesocorticolimbic dopamine system, undergoes substantial remodeling. These circuits are implicated in complex decision making, incentive learning and reinforcement during substance use and abuse. An appealing theoretical approach has been to suggest that alcohol alters the normal development of these processes to promote deficits in reinforcement learning and decision making, which together make individuals vulnerable to developing substance use disorders in adulthood. Previously we have used a preclinical model of voluntary alcohol intake in rats to show that use in adolescence promotes risky decision making in adulthood that is mirrored by selective perturbations in dopamine network dynamics. Further, we have demonstrated that incentive learning processes in adulthood are also altered by adolescent alcohol use, again mirrored by changes in cue-evoked dopamine signaling. Indeed, we have proposed that these two processes, risk-based decision making and incentive learning, are fundamentally linked through dysfunction of midbrain circuitry where inputs to the dopamine system are disrupted by adolescent alcohol use. Here, we test the behavioral predictions of this model in rats and present the findings in the context of the prevailing literature with reference to the long-term consequences of early-life substance use on the vulnerability to develop substance use disorders. We utilize an impulsive choice task to assess the selectivity of alcohol’s effect on decision-making profiles and conditioned reinforcement to parse out the effect of incentive value attribution, one mechanism of incentive learning. Finally, we use the differential reinforcement of low rates of responding (DRL) task to examine the degree to which behavioral disinhibition may contribute to an overall decision-making profile. The findings presented here support the proposition that early life alcohol use selectively alters risk-based choice behavior through modulation of incentive learning processes, both of which may be inexorably linked through perturbations in mesolimbic circuitry and may serve as fundamental vulnerabilities to the development of substance use disorders. PMID:28790900

A web-based multicriteria evaluation of spatial trade-offs between environmental and economic implications from hydraulic fracturing in a shale gas region in Ohio.

PubMed

Liu, X; Gorsevski, P V; Yacobucci, M M; Onasch, C M

2016-06-01

Planning of shale gas infrastructure and drilling sites for hydraulic fracturing has important spatial implications. The evaluation of conflicting and competing objectives requires an explicit consideration of multiple criteria as they have important environmental and economic implications. This study presents a web-based multicriteria spatial decision support system (SDSS) prototype with a flexible and user-friendly interface that could provide educational or decision-making capabilities with respect to hydraulic fracturing site selection in eastern Ohio. One of the main features of this SDSS is to emphasize potential trade-offs between important factors of environmental and economic ramifications from hydraulic fracturing activities using a weighted linear combination (WLC) method. In the prototype, the GIS-enabled analytical components allow spontaneous visualization of available alternatives on maps which provide value-added features for decision support processes and derivation of final decision maps. The SDSS prototype also facilitates nonexpert participation capabilities using a mapping module, decision-making tool, group decision module, and social media sharing tools. The logical flow of successively presented forms and standardized criteria maps is used to generate visualization of trade-off scenarios and alternative solutions tailored to individual user's preferences that are graphed for subsequent decision-making.

SIGI: An Interactive Aid to Career Decision Making.

ERIC Educational Resources Information Center

Katz, Martin R.

1980-01-01

The System of Interactive Guidance and Information (SIGI) helps students make informed and rational career decisions. Interacting with a computer, students examine values, identify and explore options, gain and interpret relevant information, master strategies for decision making, and formulate plans of action. Extensively field-tested, SIGI has…

Societal values in the allocation of healthcare resources: is it all about the health gain?

PubMed

Stafinski, Tania; Menon, Devidas; Marshall, Deborah; Caulfield, Timothy

2011-01-01

Over the past decade, public distrust in unavoidable value-laden decisions on the allocation of resources to new health technologies has grown. In response, healthcare organizations have made considerable efforts to improve their acceptability by increasing transparency in decision-making processes. However, the social value judgments (distributive preferences of the public) embedded in them have yet to be defined. While the need to explicate such judgments has become widely recognized, the most appropriate approach to accomplishing this remains unclear. The aims of this review were to identify factors around which distributive preferences of the public have been sought, create a list of social values proposed or used in current resource allocation decision-making processes for new health technologies, and review approaches to eliciting such values from the general public. Social values proposed or used in making resource allocation decisions for new health technologies were identified through three approaches: (i) a comprehensive review of published, peer-reviewed, empirical studies of public preferences for the distribution of healthcare; (ii) an analysis of non-technical factors or social value statements considered by technology funding decision-making processes in Canada and abroad; and (iii) a review of appeals to funding decisions on grounds in part related to social value judgments. A total of 34 empirical studies, 10 technology funding decision-making processes, and 12 appeals to decisions were identified and reviewed. The key factors/patient characteristics addressed through policy statements and around which distributive preferences of the public have been sought included severity of illness, immediate need, age (and its relationship to lifetime health), health gain (amount and final outcome/health state), personal responsibility for illness, caregiving responsibilities, and number of patients who could benefit (rarity). Empirical studies typically examined the importance of these factors in isolation. Therefore, the extent to which preferences around one factor may be modified in the presence of others is still unclear. Research that seeks to clarify interactions among factors by asking the public to weigh several of them at once is needed to ensure the relevance of elicited preferences to real-world technology funding decisions.

[Decision Making and Electrodermal Activity].

PubMed

Kobayakawa, Mutsutaka

2016-08-01

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

Fault Management in an Objectives-Based/Risk-Informed View of Safety and Mission Success

NASA Technical Reports Server (NTRS)

Groen, Frank

2012-01-01

Theme of this talk: (1) Net-benefit of activities and decisions derives from objectives (and their priority) -- similarly: need for integration, value of technology/capability. (2) Risk is a lack of confidence that objectives will be met. (2a) Risk-informed decision making requires objectives. (3) Consideration of objectives is central to recent guidance.

Perceptions of shared decision making and decision aids among rural primary care clinicians.

PubMed

King, Valerie J; Davis, Melinda M; Gorman, Paul N; Rugge, J Bruin; Fagnan, L J

2012-01-01

Shared decision making (SDM) and decision aids (DAs) increase patients' involvement in health care decisions and enhance satisfaction with their choices. Studies of SDM and DAs have primarily occurred in academic centers and large health systems, but most primary care is delivered in smaller practices, and over 20% of Americans live in rural areas, where poverty, disease prevalence, and limited access to care may increase the need for SDM and DAs. To explore perceptions and practices of rural primary care clinicians regarding SDM and DAs. Cross-sectional survey. Setting and Participants Primary care clinicians affiliated with the Oregon Rural Practice-based Research Network. Surveys were returned by 181 of 231 eligible participants (78%); 174 could be analyzed. Two-thirds of participants were physicians, 84% practiced family medicine, and 55% were male. Sixty-five percent of respondents were unfamiliar with the term shared decision making, but following definition, 97% reported that they found the approach useful for conditions with multiple treatment options. Over 90% of clinicians perceived helping patients make decisions regarding chronic pain and health behavior change as moderate/hard in difficulty. Although 69% of respondents preferred that patients play an equal role in making decisions, they estimate that this happens only 35% of the time. Time was reported as the largest barrier to engaging in SDM (63%). Respondents were receptive to using DAs to facilitate SDM in print- (95%) or web-based formats (72%), and topic preference varied by clinician specialty and decision difficulty. Rural clinicians recognized the value of SDM and were receptive to using DAs in multiple formats. Integration of DAs to facilitate SDM in routine patient care may require addressing practice operation and reimbursement.

Challenges in Measuring Cost and Value in Oncology: Making It Personal.

PubMed

Yu, Peter P

2016-01-01

Oncology patients often find themselves facing an incurable disease with limited treatment options and increasing patient fragility. The importance of patient preferences and values increases in shared decision making especially when the cost of cancer care is continuing its steep rise. As our understanding of cancer systems biology increases, we are justifiably optimistic about therapeutic improvements but recognize that this has complicated the traditional Food and Drug Administration approval of drug indications based on organ-specific cancer for a particular drug. Dynamic and agile clinical guidelines that reflect a rapidly changing knowledge base for decision-making support are needed. The American Society of Clinical Oncology (ASCO) has been working on three initiatives to tackle these complex issues. The first initiative is ASCO's collaboration with other international organizations to create a framework to assess drugs for the World Health Organization's Essential Medicines List, including nongenerics. The second initiative aims to define clinically meaningful outcomes as precision medicine expands the definition of cancers, leading to increased demand for the use of targeted drugs as single agents or in combination. The third initiative is ASCO's value framework, published in 2015, focusing on patient-physician shared decision making. The framework incorporates three parameters: 1) the meaningfulness of the clinical benefit, 2) the toxicity of the treatment, and 3) the patient's financial out-of-pocket cost. ASCO is concerned about the rising cost of cancer care when the clinical complexity and the pace of change in oncology are accelerating, and it is committed to help improve patient outcomes and value in cancer care as well as to engage the broader health care community in a process of collaborative improvement. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Too Soon to Give Up? Re-examining the Value of Advance Directives

PubMed Central

Levi, Benjamin H.; Green, Michael J.

2013-01-01

In the face of mounting criticism against advance directives, we describe how a novel, computer-based decision aid addresses some of these important concerns. This decision aid, Making Your Wishes Known: Planning Your Medical Future, translates an individual’s values and goals into a meaningful advance directive that explicitly reflects their healthcare wishes and outlines a plan for how they wish to be treated. It does this by 1) educating users about advance care planning; 2) helping individuals identify, clarify, and prioritize factors that influence their decision-making about future medical conditions; 3) explaining common end-of-life medical conditions and life-sustaining treatment; 4) helping users articulate a coherent set of wishes with regard to advance care planning—in the form of an advance directive readily interpretable by physicians; and 5) helping individuals both choose a spokesperson, and prepare to engage family, friends, and healthcare providers in discussions about advance care planning. PMID:20379910

Making the Right Treatment Decision Requires Consideration of Utility and Reconsideration of Value.

PubMed

Rossi, Michael J; Lubowitz, James H; Brand, Jefferson C; Provencher, Matthew T

2017-02-01

To achieve a good clinical outcome, arthroscopic and related surgeons must choose the proper treatment, and the basis of this choice is accurate diagnosis. Generally, our clinical focus is on outcome, but outcome is achieved after the fact. While this seems obvious, arthroscopic and related surgeons-and our patients who participate in shared decision making-evaluate the utility, or usefulness, of potential treatments based on desired and expected benefits versus potential risks. Today, cost is frequently considered as a determinant of value in medicine and may be applied to the decision analysis, but if an individual patient perceives health to be priceless, cost becomes irrelevant. In the end, an individual patient's satisfaction is determined on a case-by-case basis. Proper choice of treatment cannot be formulaic. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Developpement energetique par modelisation et intelligence territoriale: Un outil de prise de decision participative pour le developpement durable des projets eoliens

NASA Astrophysics Data System (ADS)

Vazquez Rascon, Maria de Lourdes

This thesis focuses on the implementation of a participatory and transparent decision making tool about the wind farm projects. This tool is based on an (argumentative) framework that reflects the stakeholder's values systems involved in these projects and it employs two multicriteria methods: the multicriteria decision aide and the participatory geographical information systems, making it possible to represent this value systems by criteria and indicators to be evaluated. The stakeholder's values systems will allow the inclusion of environmental, economic and social-cultural aspects of wind energy projects and, thus, a sustainable development wind projects vision. This vision will be analyzed using the 16 sustainable principles included in the Quebec's Sustainable Development Act. Four specific objectives have been instrumented to favor a logical completion work, and to ensure the development of a successfultool : designing a methodology to couple the MCDA and participatory GIS, testing the developed methodology by a case study, making a robustness analysis to address strategic issues and analyzing the strengths, weaknesses, opportunities and threads of the developed methodology. Achieving the first goal allowed us to obtain a decision-making tool called Territorial Intelligence Modeling for Energy Development (TIMED approach). The TIMED approach is visually represented by a figure expressing the idea of a co-construction decision and where ail stakeholders are the focus of this methodology. TIMED is composed of four modules: Multi-Criteria decision analysis, participatory geographic Information systems, active involvement of the stakeholders and scientific knowledge/local knowledge. The integration of these four modules allows for the analysis of different implementation scenarios of wind turbines in order to choose the best one based on a participatory and transparent decision-making process that takes into account stakeholders' concerns. The second objective enabled the testing of TIMED in an ex-post experience of a wind farm in operation since 2006. In this test, II people participated representing four stakeholder' categories: the private sector, the public sector, experts and civil society. This test allowed us to analyze the current situation in which wind projects are currently developed in Quebec. The concerns of some stakeholders regarding situations that are not considered in the current context were explored through a third goal. This third objective allowed us to make simulations taking into account the assumptions of strategic levels. Examples of the strategic level are the communication tools used to approach the host community and the park property type. Finally, the fourth objective, a SWOT analysis with the participation of eight experts, allowed us to verify the extent to which TIMED approach succeeded in constructing four fields for participatory decision-making: physical, intellectual, emotional and procedural. From these facts, 116 strengths, 28 weaknesses, 32 constraints and 54 opportunities were identified. Contributions, applications, limitations and extensions of this research are based on giving a participatory decision-making methodology taking into account socio-cultural, environmental and economic variables; making reflection sessions on a wind farm in operation; acquiring MCDA knowledge for participants involved in testing the proposed methodology; taking into account the physical, intellectual, emotional and procedural spaces to al1iculate a participatory decision; using the proposed methodology in renewable energy sources other than wind; the need to an interdisciplinary team for the methodology application; access to quality data; access to information technologies; the right to public participation; the neutrality of experts; the relationships between experts and non-experts; cultural constraints; improvement of designed indicators; the implementation of a Web platform for participatory decision-making and writing a manual on the use of the developed methodology. Keywords: wind farm, multicriteria decision, geographic information systems, TIMED approach, sustainable wind energy projects development, renewable energy, social participation, robustness concern, SWOT analysis.

13 CFR 120.172 - Flood-plain and wetlands management.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 8-step decision making process with respect to: (1) Construction or acquisition of anything, other than a building; (2) Repair and restoration equal to more than 50% of the market value of a building... base floodplain; (2) Repairs, other than to buildings, that are less than 50% of the market value; (3...

13 CFR 120.172 - Flood-plain and wetlands management.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 8-step decision making process with respect to: (1) Construction or acquisition of anything, other than a building; (2) Repair and restoration equal to more than 50% of the market value of a building... base floodplain; (2) Repairs, other than to buildings, that are less than 50% of the market value; (3...

13 CFR 120.172 - Flood-plain and wetlands management.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 8-step decision making process with respect to: (1) Construction or acquisition of anything, other than a building; (2) Repair and restoration equal to more than 50% of the market value of a building... base floodplain; (2) Repairs, other than to buildings, that are less than 50% of the market value; (3...

13 CFR 120.172 - Flood-plain and wetlands management.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 8-step decision making process with respect to: (1) Construction or acquisition of anything, other than a building; (2) Repair and restoration equal to more than 50% of the market value of a building... base floodplain; (2) Repairs, other than to buildings, that are less than 50% of the market value; (3...

Moral Development and Ethical Decision-Making: Theory and Faddism.

ERIC Educational Resources Information Center

Shaver, James P.

The author is concerned that teaching strategies based on the values clarification approach (VCA) and on Kohlberg's stage theory of moral development might be premature. The VCA has been adopted widely despite concerns about threats to privacy of participating students, infringement on rights of parents to shape their children's values, and…

Towards Becoming a Values-Based Organization

ERIC Educational Resources Information Center

Brandes, Pauline J.; Stuber, Lorinda

2004-01-01

This paper describes the journey of a mid-size community college towards developing and institutionalizing a core set of values into the culture. The aim is to establish a common guidepost to integrate planning, decision-making and behaviour within the learning community of Red Deer College (RDC). Consultative process was used to engage staff and…

The adaptive decision-making, risky decision, and decision-making style of Internet gaming disorder.

PubMed

Ko, C-H; Wang, P-W; Liu, T-L; Chen, C-S; Yen, C-F; Yen, J-Y

2017-07-01

Persistent gaming, despite acknowledgment of its negative consequences, is a major criterion for individuals with Internet gaming disorder (IGD). This study evaluated the adaptive decision-making, risky decision, and decision-making style of individuals with IGD. We recruited 87 individuals with IGD and 87 without IGD (matched controls). All participants underwent an interview based on the Diagnostic and Statistical Manual of Mental Disorders (5th Edition) diagnostic criteria for IGD and completed an adaptive decision-making task; the Preference for Intuition and Deliberation Scale, Chen Internet Addiction Scale, and Barratt Impulsivity Scale were also assessed on the basis of the information from the diagnostic interviews. The results demonstrated that the participants in both groups tend to make more risky choices in advantage trials where their expected value (EV) was more favorable than those of the riskless choice. The tendency to make a risky choice in advantage trials was stronger among IGD group than that among controls. Participants of both groups made more risky choices in the loss domain, a risky option to loss more versus sure loss option, than they did in the gain domain, a risky option to gain more versus sure gain. Furthermore, the participants with IGD made more risky choices in the gain domain than did the controls. Participants with IGD showed higher and lower preferences for intuitive and deliberative decision-making styles, respectively, than controls and their preferences for intuition and deliberation were positively and negatively associated with IGD severity, respectively. These results suggested that individuals with IGD have elevated EV sensitivity for decision-making. However, they demonstrated risky preferences in the gain domain and preferred an intuitive rather than deliberative decision-making style. This might explain why they continue Internet gaming despite negative consequences. Thus, therapists should focus more on decision-making styles and promote deliberative thinking processes to mitigate the long-term negative consequences of IGD. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Neurons in the Frontal Lobe Encode the Value of Multiple Decision Variables

PubMed Central

Kennerley, Steven W.; Dahmubed, Aspandiar F.; Lara, Antonio H.; Wallis, Jonathan D.

2009-01-01

A central question in behavioral science is how we select among choice alternatives to obtain consistently the most beneficial outcomes. Three variables are particularly important when making a decision: the potential payoff, the probability of success, and the cost in terms of time and effort. A key brain region in decision making is the frontal cortex as damage here impairs the ability to make optimal choices across a range of decision types. We simultaneously recorded the activity of multiple single neurons in the frontal cortex while subjects made choices involving the three aforementioned decision variables. This enabled us to contrast the relative contribution of the anterior cingulate cortex (ACC), the orbito-frontal cortex, and the lateral prefrontal cortex to the decision-making process. Neurons in all three areas encoded value relating to choices involving probability, payoff, or cost manipulations. However, the most significant signals were in the ACC, where neurons encoded multiplexed representations of the three different decision variables. This supports the notion that the ACC is an important component of the neural circuitry underlying optimal decision making. PMID:18752411

Clinical factors and the decision to transfuse chronic dialysis patients.

PubMed

Whitman, Cynthia B; Shreay, Sanatan; Gitlin, Matthew; van Oijen, Martijn G H; Spiegel, Brennan M R

2013-11-01

Red blood cell transfusion was previously the principle therapy for anemia in CKD but became less prevalent after the introduction of erythropoiesis-stimulating agents. This study used adaptive choice-based conjoint analysis to identify preferences and predictors of transfusion decision-making in CKD. A computerized adaptive choice-based conjoint survey was administered between June and August of 2012 to nephrologists, internists, and hospitalists listed in the American Medical Association Masterfile. The survey quantified the relative importance of 10 patient attributes, including hemoglobin levels, age, occult blood in stool, severity of illness, eligibility for transplant, iron indices, erythropoiesis-stimulating agents, cardiovascular disease, and functional status. Triggers of transfusions in common dialysis scenarios were studied, and based on adaptive choice-based conjoint-derived preferences, relative importance by performing multivariable regression to identify predictors of transfusion preferences was assessed. A total of 350 providers completed the survey (n=305 nephrologists; mean age=46 years; 21% women). Of 10 attributes assessed, absolute hemoglobin level was the most important driver of transfusions, accounting for 29% of decision-making, followed by functional status (16%) and cardiovascular comorbidities (12%); 92% of providers transfused when hemoglobin was 7.5 g/dl, independent of other factors. In multivariable regression, Veterans Administration providers were more likely to transfuse at 8.0 g/dl (odds ratio, 5.9; 95% confidence interval, 1.9 to 18.4). Although transplant eligibility explained only 5% of decision-making, nephrologists were five times more likely to value it as important compared with non-nephrologists (odds ratio, 5.2; 95% confidence interval, 2.4 to 11.1). Adaptive choice-based conjoint analysis was useful in predicting influences on transfusion decisions. Hemoglobin level, functional status, and cardiovascular comorbidities most strongly influenced transfusion decision-making, but preference variations were observed among subgroups.

Incompetent Patients, Substitute Decision Making, and Quality of Life: Some Ethical Considerations

PubMed Central

Kluge, Eike-Henner W.

2008-01-01

One of the most difficult situations facing physicians involves decision making by substitute decision makers for patients who have never been competent. This paper begins with a brief examination of the ethics of substitute decision making for previously competent patients. It then applies the results to substitute decision making for patients who have never been competent, and critically analyzes 5 models of substitute decision making for such patients, showing why each either contravenes basic ethical principles or fails to guarantee the use of ethically appropriate values. It concludes by sketching a modified objective reasonable person standard for substitute decision making that avoids valuational difficulties and allows for a protocol that satisfies ethical principles. PMID:19099031

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

PubMed Central

2014-01-01

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

Patient Involvement in Health Care Decision Making: A Review

PubMed Central

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

2014-01-01

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

Communication about colorectal cancer screening in Britain: public preferences for an expert recommendation.

PubMed

Waller, J; Macedo, A; von Wagner, C; Simon, A E; Jones, C; Hammersley, V; Weller, D; Wardle, J; Campbell, C

2012-12-04

Informed decision-making approaches to cancer screening emphasise the importance of decisions being determined by individuals' own values and preferences. However, advice from a trusted source may also contribute to autonomous decision-making. This study examined preferences regarding a recommendation from the NHS and information provision in the context of colorectal cancer (CRC) screening. In face-to-face interviews, a population-based sample of adults across Britain (n=1964; age 50-80 years) indicated their preference between: (1) a strong recommendation to participate in CRC screening, (2) a recommendation alongside advice to make an individual decision, and (3) no recommendation but advice to make an individual decision. Other measures included trust in the NHS and preferences for information on benefits and risks. Most respondents (84%) preferred a recommendation (47% strong recommendation, 37% recommendation plus individual decision-making advice), but the majority also wanted full information on risks (77%) and benefits (78%). Men were more in favour of a recommendation than women (86% vs 81%). Trust in the NHS was high overall, but the minority who expressed low trust were less likely to want a recommendation. Most British adults want full information on risks and benefits of screening but they also want a recommendation from an authoritative source. An 'expert' view may be an important part of autonomous health decision-making.

A new approach to assess gambling-like behavior in laboratory rats: using intracranial self-stimulation as a positive reinforcer

PubMed Central

Tedford, Stephanie E.; Holtz, Nathan A.; Persons, Amanda L.; Napier, T. Celeste

2014-01-01

Pathological gambling is one manifestation of impulse control disorders. The biological underpinnings of these disorders remain elusive and treatment is far from ideal. Animal models of impulse control disorders are a critical research tool for understanding this condition and for medication development. Modeling such complex behaviors is daunting, but by its deconstruction, scientists have recapitulated in animals critical aspects of gambling. One aspect of gambling is cost/benefit decision-making wherein one weighs the anticipated costs and expected benefits of a course of action. Risk/reward, delay-based and effort-based decision-making all represent cost/benefit choices. These features are studied in humans and have been translated to animal protocols to measure decision-making processes. Traditionally, the positive reinforcer used in animal studies is food. Here, we describe how intracranial self-stimulation can be used for cost/benefit decision-making tasks and overview our recent studies showing how pharmacological therapies alter these behaviors in laboratory rats. We propose that these models may have value in screening new compounds for the ability to promote and prevent aspects of gambling behavior. PMID:24966822

Imitation versus payoff: Duality of the decision-making process demonstrates criticality and consensus formation

NASA Astrophysics Data System (ADS)

Turalska, M.; West, B. J.

2014-11-01

We consider a dual model of decision making, in which an individual forms its opinion based on contrasting mechanisms of imitation and rational calculation. The decision-making model (DMM) implements imitating behavior by means of a network of coupled two-state master equations that undergoes a phase transition at a critical value of a control parameter. The evolutionary spatial game, being a generalization of the prisoner's dilemma game, is used to determine in objective fashion the cooperative or anticooperative strategy adopted by individuals. Interactions between two sources of dynamics increases the domain of initial states attracted to phase transition dynamics beyond that of the DMM network in isolation. Additionally, on average the influence of the DMM on the game increases the final observed fraction of cooperators in the system.

"To Thine Own Self Be True": Values, Framing, and Voter Decision-Making Strategies.

ERIC Educational Resources Information Center

Shah, Dhavan V.; And Others

1996-01-01

Builds on multidisciplinary research on framing, motivation, and decision making to examine the relationships among media frames, individual interpretations of issues, and voter decision making. Shows how two groups, evangelical Christians and undergraduates, responded to simulated newspaper articles on election candidates. Finds that media frames…

Discretion in Student Discipline: Insight into Elementary Principals' Decision Making

ERIC Educational Resources Information Center

Findlay, Nora M.

2015-01-01

Little research exists that examines the exercise of discretion by principals in their disciplinary decision making. This study sought to understand the application of values by principals as they engage in student disciplinary decision making within legally fixed parameters of their administrative discretion. This qualitative methodology used…

IBM’s Health Analytics and Clinical Decision Support

PubMed Central

Sun, J.; Knoop, S.; Shabo, A.; Carmeli, B.; Sow, D.; Syed-Mahmood, T.; Rapp, W.

2014-01-01

Summary Objectives This survey explores the role of big data and health analytics developed by IBM in supporting the transformation of healthcare by augmenting evidence-based decision-making. Methods Some problems in healthcare and strategies for change are described. It is argued that change requires better decisions, which, in turn, require better use of the many kinds of healthcare information. Analytic resources that address each of the information challenges are described. Examples of the role of each of the resources are given. Results There are powerful analytic tools that utilize the various kinds of big data in healthcare to help clinicians make more personalized, evidenced-based decisions. Such resources can extract relevant information and provide insights that clinicians can use to make evidence-supported decisions. There are early suggestions that these resources have clinical value. As with all analytic tools, they are limited by the amount and quality of data. Conclusion Big data is an inevitable part of the future of healthcare. There is a compelling need to manage and use big data to make better decisions to support the transformation of healthcare to the personalized, evidence-supported model of the future. Cognitive computing resources are necessary to manage the challenges in employing big data in healthcare. Such tools have been and are being developed. The analytic resources, themselves, do not drive, but support healthcare transformation. PMID:25123736

Response time distributions in rapid chess: a large-scale decision making experiment.

PubMed

Sigman, Mariano; Etchemendy, Pablo; Slezak, Diego Fernández; Cecchi, Guillermo A

2010-01-01

Rapid chess provides an unparalleled laboratory to understand decision making in a natural environment. In a chess game, players choose consecutively around 40 moves in a finite time budget. The goodness of each choice can be determined quantitatively since current chess algorithms estimate precisely the value of a position. Web-based chess produces vast amounts of data, millions of decisions per day, incommensurable with traditional psychological experiments. We generated a database of response times (RTs) and position value in rapid chess games. We measured robust emergent statistical observables: (1) RT distributions are long-tailed and show qualitatively distinct forms at different stages of the game, (2) RT of successive moves are highly correlated both for intra- and inter-player moves. These findings have theoretical implications since they deny two basic assumptions of sequential decision making algorithms: RTs are not stationary and can not be generated by a state-function. Our results also have practical implications. First, we characterized the capacity of blunders and score fluctuations to predict a player strength, which is yet an open problem in chess softwares. Second, we show that the winning likelihood can be reliably estimated from a weighted combination of remaining times and position evaluation.

Response Time Distributions in Rapid Chess: A Large-Scale Decision Making Experiment

PubMed Central

Sigman, Mariano; Etchemendy, Pablo; Slezak, Diego Fernández; Cecchi, Guillermo A.

2010-01-01

Rapid chess provides an unparalleled laboratory to understand decision making in a natural environment. In a chess game, players choose consecutively around 40 moves in a finite time budget. The goodness of each choice can be determined quantitatively since current chess algorithms estimate precisely the value of a position. Web-based chess produces vast amounts of data, millions of decisions per day, incommensurable with traditional psychological experiments. We generated a database of response times (RTs) and position value in rapid chess games. We measured robust emergent statistical observables: (1) RT distributions are long-tailed and show qualitatively distinct forms at different stages of the game, (2) RT of successive moves are highly correlated both for intra- and inter-player moves. These findings have theoretical implications since they deny two basic assumptions of sequential decision making algorithms: RTs are not stationary and can not be generated by a state-function. Our results also have practical implications. First, we characterized the capacity of blunders and score fluctuations to predict a player strength, which is yet an open problem in chess softwares. Second, we show that the winning likelihood can be reliably estimated from a weighted combination of remaining times and position evaluation. PMID:21031032

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

PubMed Central

Nakao, Takashi; Ohira, Hideki; Northoff, Georg

2012-01-01

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

Values in Health Policy - A Concept Analysis.

PubMed

Shams, Lida; Akbari Sari, Ali; Yazdani, Shahram

2016-08-17

Despite the significant role "values" play in decision-making no definition or attributes regarding the concept have been provided in health policy-making. This study aimed to clarify the defining attributes of a concept of value and its irrelevant structures in health policy-making. We anticipate our findings will help reduce the semantic ambiguities associated with the use of "values" and other concepts such as principles, criteria, attitudes, and beliefs. An extensive search of literature was carried out using electronic data base and library. The overall search strategy yielded about 1540 articles and 450 additional records. Based on traditional qualitative research, studies were purposefully selected and the coding of articles continued until data saturation was reached. Accordingly, 31 articles, 2 books, and 5 other documents were selected for the review. We applied Walker and Avant's method of concept analysis in studying the phenomenon. Definitions, applications, attributes, antecedents, and consequences of the concept of "value in health policy-making" were extracted. We also identified similarities and differences that exist between and within them. We identified eight major attributes of "value in health policy-making": ideological origin, affect one's choices, more resistant to change over time, source of motivation, ability to sacrifice one's interest, goal-oriented nature for community, trans-situational and subjectivity. Other features pinpointed include alternatives, antecedents, and consequences. Alternative, antecedents and consequences case may have more or fewer attributes or may lack one of these attributes and at the same time have other distinctive ones. Despite the use of the value framework, ambiguities still persist in providing definition of the concept value in health policy-making. Understanding the concept of value in health policy-making may provide extra theoretical support to decision-makers in their policy-making process, to help avoid poor policy formulation and wastage of limited resources. © 2016 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Relying on Your Own Best Judgment: Imputing Values to Missing Information in Decision Making.

ERIC Educational Resources Information Center

Johnson, Richard D.; And Others

Processes involved in making estimates of the value of missing information that could help in a decision making process were studied. Hypothetical purchases of ground beef were selected for the study as such purchases have the desirable property of quantifying both the price and quality. A total of 150 students at the University of Iowa rated the…

Evidence, values, guidelines and rational decision-making.

PubMed

Barrett, Bruce

2012-02-01

Medical decision-making involves choices, which can lead to benefits or to harms. Most benefits and harms may or may not occur, and can be minor or major when they do. Medical research, especially randomized controlled trials, provides estimates of chance of occurrence and magnitude of event. Because there is no universally accepted method for weighing harms against benefits, and because the ethical principle of autonomy mandates informed choice by patient, medical decision-making is inherently an individualized process. It follows that the practice of aiming for universal implementation of standardized guidelines is irrational and unethical. Irrational because the possibility of benefits is implicitly valued more than the possibility of comparable harms, and unethical because guidelines remove decision making from the patient and give it instead to a physician, committee or health care system. This essay considers the cases of cancer screening and diabetes management, where guidelines often advocate universal implementation, without regard to informed choice and individual decision-making.

What is a good medical decision? A research agenda guided by perspectives from multiple stakeholders.

PubMed

Hamilton, Jada G; Lillie, Sarah E; Alden, Dana L; Scherer, Laura; Oser, Megan; Rini, Christine; Tanaka, Miho; Baleix, John; Brewster, Mikki; Craddock Lee, Simon; Goldstein, Mary K; Jacobson, Robert M; Myers, Ronald E; Zikmund-Fisher, Brian J; Waters, Erika A

2017-02-01

Informed and shared decision making are critical aspects of patient-centered care, which has contributed to an emphasis on decision support interventions to promote good medical decision making. However, researchers and healthcare providers have not reached a consensus on what defines a good decision, nor how to evaluate it. This position paper, informed by conference sessions featuring diverse stakeholders held at the 2015 Society of Behavioral Medicine and Society for Medical Decision Making annual meetings, describes key concepts that influence the decision making process itself and that may change what it means to make a good decision: interpersonal factors, structural constraints, affective influences, and values clarification methods. This paper also proposes specific research questions within each of these priority areas, with the goal of moving medical decision making research to a more comprehensive definition of a good medical decision, and enhancing the ability to measure and improve the decision making process.

Orthogonal search-based rule extraction for modelling the decision to transfuse.

PubMed

Etchells, T A; Harrison, M J

2006-04-01

Data from an audit relating to transfusion decisions during intermediate or major surgery were analysed to determine the strengths of certain factors in the decision making process. The analysis, using orthogonal search-based rule extraction (OSRE) from a trained neural network, demonstrated that the risk of tissue hypoxia (ROTH) assessed using a 100-mm visual analogue scale, the haemoglobin value (Hb) and the presence or absence of on-going haemorrhage (OGH) were able to reproduce the transfusion decisions with a joint specificity of 0.96 and sensitivity of 0.93 and a positive predictive value of 0.9. The rules indicating transfusion were: 1. ROTH > 32 mm and Hb < 94 g x l(-1); 2. ROTH > 13 mm and Hb < 87 g x l(-1); 3. ROTH > 38 mm, Hb < 102 g x l(-1) and OGH; 4. Hb < 78 g x l(-1).

Limitations and opportunities for the social cost of carbon (Invited)

NASA Astrophysics Data System (ADS)

Rose, S. K.

2010-12-01

Estimates of the marginal value of carbon dioxide-the social cost of carbon (SCC)-were recently adopted by the U.S. Government in order to satisfy requirements to value estimated GHG changes of new federal regulations. However, the development and use of SCC estimates of avoided climate change impacts comes with significant challenges and controversial decisions. Fortunately, economics can provide some guidance for conceptually appropriate estimates. At the same time, economics defaults to a benefit-cost decision framework to identify socially optimal policies. However, not all current policy decisions are benefit-cost based, nor depend on monetized information, or even have the same threshold for information. While a conceptually appropriate SCC is a useful metric, how far can we take it? This talk discusses potential applications of the SCC, limitations based on the state of research and methods, as well as opportunities for among other things consistency with climate risk management and research and decision-making tools.

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.

Bayesian imperfect information analysis for clinical recurrent data

PubMed Central

Chang, Chih-Kuang; Chang, Chi-Chang

2015-01-01

In medical research, clinical practice must often be undertaken with imperfect information from limited resources. This study applied Bayesian imperfect information-value analysis to realistic situations to produce likelihood functions and posterior distributions, to a clinical decision-making problem for recurrent events. In this study, three kinds of failure models are considered, and our methods illustrated with an analysis of imperfect information from a trial of immunotherapy in the treatment of chronic granulomatous disease. In addition, we present evidence toward a better understanding of the differing behaviors along with concomitant variables. Based on the results of simulations, the imperfect information value of the concomitant variables was evaluated and different realistic situations were compared to see which could yield more accurate results for medical decision-making. PMID:25565853

Prediction Error Representation in Individuals With Generalized Anxiety Disorder During Passive Avoidance.

PubMed

White, Stuart F; Geraci, Marilla; Lewis, Elizabeth; Leshin, Joseph; Teng, Cindy; Averbeck, Bruno; Meffert, Harma; Ernst, Monique; Blair, James R; Grillon, Christian; Blair, Karina S

2017-02-01

Deficits in reinforcement-based decision making have been reported in generalized anxiety disorder. However, the pathophysiology of these deficits is largely unknown; published studies have mainly examined adolescents, and the integrity of core functional processes underpinning decision making remains undetermined. In particular, it is unclear whether the representation of reinforcement prediction error (PE) (the difference between received and expected reinforcement) is disrupted in generalized anxiety disorder. This study addresses these issues in adults with the disorder. Forty-six unmedicated individuals with generalized anxiety disorder and 32 healthy comparison subjects group-matched on IQ, gender, and age performed a passive avoidance task while undergoing functional MRI. Data analyses were performed using a computational modeling approach. Behaviorally, individuals with generalized anxiety disorder showed impaired reinforcement-based decision making. Imaging results revealed that during feedback, individuals with generalized anxiety disorder relative to healthy subjects showed a reduced correlation between PE and activity within the ventromedial prefrontal cortex, ventral striatum, and other structures implicated in decision making. In addition, individuals with generalized anxiety disorder relative to healthy participants showed a reduced correlation between punishment PEs, but not reward PEs, and activity within the left and right lentiform nucleus/putamen. This is the first study to identify computational impairments during decision making in generalized anxiety disorder. PE signaling is significantly disrupted in individuals with the disorder and may lead to their decision-making deficits and excessive worry about everyday problems by disrupting the online updating ("reality check") of the current relationship between the expected values of current response options and the actual received rewards and punishments.

Decisions in Motion: Decision Dynamics during Intertemporal Choice reflect Subjective Evaluation of Delayed Rewards

PubMed Central

O’Hora, Denis; Carey, Rachel; Kervick, Aoife; Crowley, David; Dabrowski, Maciej

2016-01-01

People tend to discount rewards or losses that occur in the future. Such delay discounting has been linked to many behavioral and health problems, since people choose smaller short-term gains over greater long-term gains. We investigated whether the effect of delays on the subjective value of rewards is expressed in how people move when they make choices. Over 600 patrons of the RISK LAB exhibition hosted by the Science Gallery DublinTM played a short computer game in which they used a computer mouse to choose between amounts of money at various delays. Typical discounting effects were observed and decision dynamics indicated that choosing smaller short-term rewards became easier (i.e., shorter response times, tighter trajectories, less vacillation) as the delays until later rewards increased. Based on a sequence of choices, subjective values of delayed outcomes were estimated and decision dynamics during initial choices predicted these values. Decision dynamics are affected by subjective values of available options and thus provide a means to estimate such values. PMID:26867497

The role of decision analysis in informed consent: choosing between intuition and systematicity.

PubMed

Ubel, P A; Loewenstein, G

1997-03-01

An important goal of informed consent is to present information to patients so that they can decide which medical option is best for them, according to their values. Research in cognitive psychology has shown that people are rapidly overwhelmed by having to consider more than a few options in making choices. Decision analysis provides a quantifiable way to assess patients' values, and it eliminates the burden of integrating these values with probabilistic information. In this paper we evaluate the relative importance of intuition and systematicity in informed consent. We point out that there is no gold standard for optimal decision making in decisions that hinge on patient values. We also point out that in some such situations it is too early to assume that the benefits of systematicity outweigh the benefits of intuition. Research is needed to address the question of which situations favor the use of intuitive approaches of decision making and which call for a more systematic approach.

78 FR 43926 - Solicitation for a Cooperative Agreement-Evidence-Based Decision Making in State and Local...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-22

...--Evidence-Based Decision Making in State and Local Criminal Justice Systems: Planning and Development for... Evidence-Based Decision Making (EBDM) in Local Criminal Justice Systems initiative. It will require the... will also revise ``A Framework for Evidence- Based Decision Making in Local Criminal Justice Systems...

Data quality system using reference dictionaries and edit distance algorithms

NASA Astrophysics Data System (ADS)

Karbarz, Radosław; Mulawka, Jan

2015-09-01

The real art of management it is important to make smart decisions, what in most of the cases is not a trivial task. Those decisions may lead to determination of production level, funds allocation for investments etc. Most of the parameters in decision-making process such as: interest rate, goods value or exchange rate may change. It is well know that these parameters in the decision-making are based on the data contained in datamarts or data warehouse. However, if the information derived from the processed data sets is the basis for the most important management decisions, it is required that the data is accurate, complete and current. In order to achieve high quality data and to gain from them measurable business benefits, data quality system should be used. The article describes the approach to the problem, shows the algorithms in details and their usage. Finally the test results are provide. Test results show the best algorithms (in terms of quality and quantity) for different parameters and data distribution.

Eyes on the prize: reflections on the impact of the evolving digital ecology on the librarian as expert intermediary and knowledge coach, 1969–2009*

PubMed Central

Homan, J. Michael

2010-01-01

Objective: The 2009 Janet Doe Lecture reflects on the continuing value and increasing return on investment of librarian-mediated services in the constantly evolving digital ecology and complex knowledge environment of the health sciences. Setting: The interrelationship of knowledge, decision making based on knowledge, technology used to access and retrieve knowledge, and the important linkage roles of expert librarian intermediaries is examined. Methodology: Professional experiences from 1969 to 2009, occurring during a time of unprecedented changes in the digital ecology of librarianship, are the base on which the evolving role and value of librarians as knowledge coaches and expert intermediaries are examined. Conclusion: Librarian-mediated services linking knowledge and critical decision making in health care have become more valuable than ever as technology continues to reshape an increasingly complex knowledge environment. PMID:20098655

Deep brain stimulation of the subthalamic nucleus modulates sensitivity to decision outcome value in Parkinson’s disease

NASA Astrophysics Data System (ADS)

Seymour, Ben; Barbe, Michael; Dayan, Peter; Shiner, Tamara; Dolan, Ray; Fink, Gereon R.

2016-09-01

Deep brain stimulation (DBS) of the subthalamic nucleus in Parkinson’s disease is known to cause a subtle but important adverse impact on behaviour, with impulsivity its most widely reported manifestation. However, precisely which computational components of the decision process are modulated is not fully understood. Here we probe a number of distinct subprocesses, including temporal discount, outcome utility, instrumental learning rate, instrumental outcome sensitivity, reward-loss trade-offs, and perseveration. We tested 22 Parkinson’s Disease patients both on and off subthalamic nucleus deep brain stimulation (STN-DBS), while they performed an instrumental learning task involving financial rewards and losses, and an inter-temporal choice task for financial rewards. We found that instrumental learning performance was significantly worse following stimulation, due to modulation of instrumental outcome sensitivity. Specifically, patients became less sensitive to decision values for both rewards and losses, but without any change to the learning rate or reward-loss trade-offs. However, we found no evidence that DBS modulated different components of temporal impulsivity. In conclusion, our results implicate the subthalamic nucleus in a modulation of outcome value in experience-based learning and decision-making in Parkinson’s disease, suggesting a more pervasive role of the subthalamic nucleus in the control of human decision-making than previously thought.

Deep brain stimulation of the subthalamic nucleus modulates sensitivity to decision outcome value in Parkinson’s disease

PubMed Central

Seymour, Ben; Barbe, Michael; Dayan, Peter; Shiner, Tamara; Dolan, Ray; Fink, Gereon R.

2016-01-01

Deep brain stimulation (DBS) of the subthalamic nucleus in Parkinson’s disease is known to cause a subtle but important adverse impact on behaviour, with impulsivity its most widely reported manifestation. However, precisely which computational components of the decision process are modulated is not fully understood. Here we probe a number of distinct subprocesses, including temporal discount, outcome utility, instrumental learning rate, instrumental outcome sensitivity, reward-loss trade-offs, and perseveration. We tested 22 Parkinson’s Disease patients both on and off subthalamic nucleus deep brain stimulation (STN-DBS), while they performed an instrumental learning task involving financial rewards and losses, and an inter-temporal choice task for financial rewards. We found that instrumental learning performance was significantly worse following stimulation, due to modulation of instrumental outcome sensitivity. Specifically, patients became less sensitive to decision values for both rewards and losses, but without any change to the learning rate or reward-loss trade-offs. However, we found no evidence that DBS modulated different components of temporal impulsivity. In conclusion, our results implicate the subthalamic nucleus in a modulation of outcome value in experience-based learning and decision-making in Parkinson’s disease, suggesting a more pervasive role of the subthalamic nucleus in the control of human decision-making than previously thought. PMID:27624437

Evidence-Based Practice: A Framework for Making Effective Decisions

ERIC Educational Resources Information Center

Spencer, Trina D.; Detrich, Ronnie; Slocum, Timothy A.

2012-01-01

The research to practice gap in education has been a long-standing concern. The enactment of No Child Left Behind brought increased emphasis on the value of using scientifically based instructional practices to improve educational outcomes. It also brought education into the broader evidence-based practice movement that started in medicine and has…

SIGI: A Computer-Based System of Interactive Guidance and Information.

ERIC Educational Resources Information Center

Educational Testing Service, Princeton, NJ.

This pamphlet describes SIGI, a computer-based System of Interactive Guidance and Information designed to help students in community and junior colleges make career decisions. SIGI is based on a humanistic philosophy, a theory of guidance that emphasizes individual values, a vast store of occupational data, and a strategy for processing…

The Value of Fidelity of Implementation Criteria to Evaluate School-Based Science Curriculum Innovations

ERIC Educational Resources Information Center

Lee, Yew-Jin; Chue, Shien

2013-01-01

School-based curriculum innovations, including those in science education, are usually not adequately evaluated, if at all. Furthermore, current procedures and instruments for programme evaluations are often unable to support evidence-based decision-making. We suggest that adopting fidelity of implementation (FOI) criteria from healthcare research…

Ethically-based clinical decision-making in physical therapy: process and issues.

PubMed

Finch, Elspeth; Geddes, E Lynne; Larin, Hélène

2005-01-01

The identification and consideration of relevant ethical issues in clinical decision-making, and the education of health care professionals (HCPs) in these skills are key factors in providing quality health care. This qualitative study explores the way in which physical therapists (PTs) integrate ethical issues into clinical practice decisions and identifies ethical themes used by PTs. A purposive sample of eight PTs was asked to describe a recent ethically-based clinical decision. Transcribed interviews were coded and themes identified related to the following categories: 1) the integration of ethical issues in the clinical decision-making process, 2) patient welfare, 3) professional ethos of the PT, and 4) health care economics and business practices. Participants readily described clinical situations involving ethical issues but rarely identified specific conflicting ethical issues in their description. Ethical dilemmas were more frequently resolved when there were fewer emotional sequelae associated with the dilemma, and the PT had a clear understanding of professional ethos, valued patient autonomy, and explored a variety of alternative actions before implementing one. HCP students need to develop a clear professional ethos and an increased understanding of the economic factors that will present ethical issues in practice.

Establishing the effectiveness of patient decision aids: key constructs and measurement instruments

PubMed Central

2013-01-01

Background Establishing the effectiveness of patient decision aids (PtDA) requires evidence that PtDAs improve the quality of the decision-making process and the quality of the choice made, or decision quality. The aim of this paper is to review the theoretical and empirical evidence for PtDA effectiveness and discuss emerging practical and research issues in the measurement of effectiveness. Methods This updated overview incorporates: a) an examination of the instruments used to measure five key decision-making process constructs (i.e., recognize decision, feel informed about options and outcomes, feel clear about goals and preferences, discuss goals and preferences with health care provider, and be involved in decisions) and decision quality constructs (i.e., knowledge, realistic expectations, values-choice agreement) within the 86 trials in the Cochrane review; and b) a summary of the 2011 Cochrane Collaboration’s review of PtDAs for these key constructs. Data on the constructs and instruments used were extracted independently by two authors from the 86 trials and any disagreements were resolved by discussion, with adjudication by a third party where required. Results The 86 studies provide considerable evidence that PtDAs improve the decision-making process and decision quality. A majority of the studies (76/86; 88%) measured at least one of the key decision-making process or decision quality constructs. Seventeen different measurement instruments were used to measure decision-making process constructs, but no single instrument covered all five constructs. The Decisional Conflict Scale was most commonly used (n = 47), followed by the Control Preference Scale (n = 9). Many studies reported one or more constructs of decision quality, including knowledge (n = 59), realistic expectation of risks and benefits (n = 21), and values-choice agreement (n = 13). There was considerable variability in how values-choice agreement was defined and determined. No study reported on all key decision-making process and decision quality constructs. Conclusions Evidence of PtDA effectiveness in improving the quality of the decision-making process and decision quality is strong and growing. There is not, however, consensus or standardization of measurement for either the decision-making process or decision quality. Additional work is needed to develop and evaluate measurement instruments and further explore theoretical issues to advance future research on PtDA effectiveness. PMID:24625035

Establishing the effectiveness of patient decision aids: key constructs and measurement instruments.

PubMed

Sepucha, Karen R; Borkhoff, Cornelia M; Lally, Joanne; Levin, Carrie A; Matlock, Daniel D; Ng, Chirk Jenn; Ropka, Mary E; Stacey, Dawn; Joseph-Williams, Natalie; Wills, Celia E; Thomson, Richard

2013-01-01

Establishing the effectiveness of patient decision aids (PtDA) requires evidence that PtDAs improve the quality of the decision-making process and the quality of the choice made, or decision quality. The aim of this paper is to review the theoretical and empirical evidence for PtDA effectiveness and discuss emerging practical and research issues in the measurement of effectiveness. This updated overview incorporates: a) an examination of the instruments used to measure five key decision-making process constructs (i.e., recognize decision, feel informed about options and outcomes, feel clear about goals and preferences, discuss goals and preferences with health care provider, and be involved in decisions) and decision quality constructs (i.e., knowledge, realistic expectations, values-choice agreement) within the 86 trials in the Cochrane review; and b) a summary of the 2011 Cochrane Collaboration's review of PtDAs for these key constructs. Data on the constructs and instruments used were extracted independently by two authors from the 86 trials and any disagreements were resolved by discussion, with adjudication by a third party where required. The 86 studies provide considerable evidence that PtDAs improve the decision-making process and decision quality. A majority of the studies (76/86; 88%) measured at least one of the key decision-making process or decision quality constructs. Seventeen different measurement instruments were used to measure decision-making process constructs, but no single instrument covered all five constructs. The Decisional Conflict Scale was most commonly used (n = 47), followed by the Control Preference Scale (n = 9). Many studies reported one or more constructs of decision quality, including knowledge (n = 59), realistic expectation of risks and benefits (n = 21), and values-choice agreement (n = 13). There was considerable variability in how values-choice agreement was defined and determined. No study reported on all key decision-making process and decision quality constructs. Evidence of PtDA effectiveness in improving the quality of the decision-making process and decision quality is strong and growing. There is not, however, consensus or standardization of measurement for either the decision-making process or decision quality. Additional work is needed to develop and evaluate measurement instruments and further explore theoretical issues to advance future research on PtDA effectiveness.

Values and the Scientific Culture of Behavior Analysis

PubMed Central

Ruiz, Maria R; Roche, Bryan

2007-01-01

As scientists and practitioners, behavior analysts must make frequent decisions that affect many lives. Scientific principles have been our guide as we work to promote effective action across a broad spectrum of cultural practices. Yet scientific principles alone may not be sufficient to guide our decision making in cases with potentially conflicting outcomes. In such cases, values function as guides to work through ethical conflicts. We will examine two ethical systems, radical behaviorism and functional contextualism, from which to consider the role of values in behavior analysis, and discuss potential concerns. Finally, we propose philosophical pragmatism, focusing on John Dewey's notions of community and dialogue, as a tradition that can help behavior analysts to integrate talk about values and scientific practices in ethical decision making. PMID:22478484

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.

Ethical Decision-Making and Ethical Responding: An Analysis and Critique of Various Approaches through Case Study

ERIC Educational Resources Information Center

Sun, Jing-Ping

2011-01-01

For three decades, the scholars in the area of values in educational administration and the moral dimension of leadership have conceptually argued for and empirically explored the centrality of values to educational administration. This centrality may be expressed as the roles and nature of values in decision-making and conflict resolution.…

Health care decision making autonomy of women from rural districts of Southern Ethiopia: a community based cross-sectional study

PubMed Central

Alemayehu, Mihiretu; Meskele, Mengistu

2017-01-01

Introduction Millions of women have little health care decision making autonomy in many cultures and tribes. African women are often perceived to have little participation in health care decisions. However, little has been investigated to identify factors contributing to decision making autonomy. Hence, it is important to obtain information on the contributing factors of decision making autonomy and disparities across different socio-cultural contexts. Methodology A cross-sectional study was conducted in Wolaita and Dawro zones, Southern Ethiopia from February to March 2015. A total of 967 women were selected through multistage sampling. A survey was administered face-to-face through an interview format. EpiData v1.4.4.0 and SPSS version 20 were used to enter and analyze data, respectively. Proportions and means were used to describe the study population. Variables with P-value <0.2 in bivariate analysis were selected for multivariable regression. Finally, variables with P-value <0.05 in multivariable logistic regressions were identified as independent predictors. Odds ratios along with confidence intervals were used to determine the presence of association. Result It was determined that 58.4% of women have autonomy, while 40.9% of study participants’ health care decisions were made by their husbands. The husband’s education (adjusted odds ratio [AOR] =1.91 [1.10, 3.32]), wealth index (AOR =0.62 [0.42, 0.92]), age (AOR =2.42 [1.35, 4.32] and AOR =7 [3.45, 14.22]), family size (AOR =0.53 [0.33, 0.85] and AOR =0.42 [0.23, 0.75]), and occupation (AOR =1.66 [1.14, 2.41]), were predictors of health care decision making autonomy. Conclusion Even though every woman has the right to participate in her own health care decision making, more than two fifths of them have no role in making health care decisions about their own health. Husbands play a major role in making health care decisions about their wives. A comprehensive strategy needs to be implemented in order to empower women, as well as to challenge the traditional male dominance. Special attention has to be given to women living in rural areas in order to reduce their dependency through education and income generating activities. PMID:28458582

Health care decision making autonomy of women from rural districts of Southern Ethiopia: a community based cross-sectional study.

PubMed

Alemayehu, Mihiretu; Meskele, Mengistu

2017-01-01

Millions of women have little health care decision making autonomy in many cultures and tribes. African women are often perceived to have little participation in health care decisions. However, little has been investigated to identify factors contributing to decision making autonomy. Hence, it is important to obtain information on the contributing factors of decision making autonomy and disparities across different socio-cultural contexts. A cross-sectional study was conducted in Wolaita and Dawro zones, Southern Ethiopia from February to March 2015. A total of 967 women were selected through multistage sampling. A survey was administered face-to-face through an interview format. EpiData v1.4.4.0 and SPSS version 20 were used to enter and analyze data, respectively. Proportions and means were used to describe the study population. Variables with P -value <0.2 in bivariate analysis were selected for multivariable regression. Finally, variables with P -value <0.05 in multivariable logistic regressions were identified as independent predictors. Odds ratios along with confidence intervals were used to determine the presence of association. It was determined that 58.4% of women have autonomy, while 40.9% of study participants' health care decisions were made by their husbands. The husband's education (adjusted odds ratio [AOR] =1.91 [1.10, 3.32]), wealth index (AOR =0.62 [0.42, 0.92]), age (AOR =2.42 [1.35, 4.32] and AOR =7 [3.45, 14.22]), family size (AOR =0.53 [0.33, 0.85] and AOR =0.42 [0.23, 0.75]), and occupation (AOR =1.66 [1.14, 2.41]), were predictors of health care decision making autonomy. Even though every woman has the right to participate in her own health care decision making, more than two fifths of them have no role in making health care decisions about their own health. Husbands play a major role in making health care decisions about their wives. A comprehensive strategy needs to be implemented in order to empower women, as well as to challenge the traditional male dominance. Special attention has to be given to women living in rural areas in order to reduce their dependency through education and income generating activities.