Objective: The Physician's Order for Scope of Treatment (POST) indicates patient preferences regarding cardiopulmonary resuscitation (CPR), levels of care, and fluids/nutrition provision decisions. ...When patients become incapacitated, 'surrogates' often collaborate with physicians on POST decisions. Surrogates may vary in their willingness to collaborate, which can be problematic when physicians expect shared decision-making. No research has yet investigated collaborative decision-making among surrogates on the POST. This study investigated how six psychological variables predicted participants' desires for collaboration when completing an online decision-making task.
Methods: Participants served as hypothetical surrogates and made decisions for another person on the three sections of the West Virginia POST. One-hundred-and-seventy-two adults were recruited from Amazon Mechanical Turk.
Results: The six variables contributed significantly to the prediction of collaborative willingness, F (6, 163) = 5.29, p < .001, R
2
= 0.19. Two variables uniquely contributed: confidence and consideration of future consequences. The model most strongly predicted collaborative willingness for the CPR decision.
Conclusion: This study provides a novel examination of under-researched areas: surrogate collaborative willingness and the POST. Differing risks associated with the three POST decisions may influence how surrogates value collaboration. Ways to enhance collaborative willingness when making POST decisions are discussed.
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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.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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494.
Judgment and Decision Making Fischhoff, Baruch; Broomell, Stephen B
Annual review of psychology,
01/2020, Volume:
71, Issue:
1
Journal Article
Peer reviewed
Open access
The science of judgment and decision making involves three interrelated forms of research: analysis of the decisions people face, description of their natural responses, and interventions meant to ...help them do better. After briefly introducing the field's intellectual foundations, we review recent basic research into the three core elements of decision making: judgment, or how people predict the outcomes that will follow possible choices; preference, or how people weigh those outcomes; and choice, or how people combine judgments and preferences to reach a decision. We then review research into two potential sources of behavioral heterogeneity: individual differences in decision-making competence and developmental changes across the life span. Next, we illustrate applications intended to improve individual and organizational decision making in health, public policy, intelligence analysis, and risk management. We emphasize the potential value of coupling analytical and behavioral research and having basic and applied research inform one another.
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Osteoarthritis Hunter, David J; Bierma-Zeinstra, Sita
The Lancet (British edition),
04/2019, Volume:
393, Issue:
10182
Journal Article
Peer reviewed
Osteoarthritis is a leading cause of disability and source of societal cost in older adults. With an ageing and increasingly obese population, this syndrome is becoming even more prevalent than in ...previous decades. In recent years, we have gained important insights into the cause and pathogenesis of pain in osteoarthritis. The diagnosis of osteoarthritis is clinically based despite the widespread overuse of imaging methods. Management should be tailored to the presenting individual and focus on core treatments, including self-management and education, exercise, and weight loss as relevant. Surgery should be reserved for those that have not responded appropriately to less invasive methods. Prevention and disease modification are areas being targeted by various research endeavours, which have indicated great potential thus far. This narrative Seminar provides an update on the pathogenesis, diagnosis, management, and future research on osteoarthritis for a clinical audience.
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Research Summary: How can strategic decision makers overcome inertia when dealing with change? In this article we argue that cognitive flexibility (i.e., the ability to match the type of cognitive ...processing with the type of problem at hand) enables decision makers to achieve significantly higher decision-making performance. We show that superior decision-making performance is associated with using semiautomatic Type 1 cognitive processes when faced with well-structured problems, and more deliberative Type 2 processes when faced with illstructured problems. Our findings shed light on the individual-level mechanism behind organizational adaptation and complement recent work on strategic inertia. In addition, our findings extend management studies that have stressed the relevance of cognitive flexibility for responding to the demands of increasingly open, flexible, and rapidly changing organizations. Managerial Summary: Humans are creatures of habits. We tend to prefer known courses of action over new ones. In many cases, habits are good. However, when things change in unpredictable ways, the past may not be good guidance for the future. We argue that "cognitive flexibility"—the ability of understanding when to rely on habits vs. when to explore new courses of action—enables managers to switch from a "fast" decision mode, based on habits, to a "slow," more deliberate decision mode that facilitates the exploration of new courses of action. Managers high in cognitive flexibility reflect on the situation at hand, recognize and value diversity in viewpoints, and integrate such diversity in their own decision processes. By valuing diversity, they are more likely to overcome inertia.
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To assess shared decision-making (SDM) knowledge, attitude and application among health professionals involved in breast cancer (BC) treatment.
A cross-sectional study based on an online ...questionnaire, sent by several professional societies to health professionals involved in BC management. There were 26 questions which combined demographic and professional data with some items measured on a Likert-type scale.
The participation (459/541; 84.84%) and completion (443/459; 96.51%) rates were high. Participants strongly agreed or agreed in 69.57% (16/23) of their responses. The majority stated that they knew of SDM (mean 4.43 (4.36-4.55)) and were in favour of its implementation (mean 4.58 (4.51-4.64)). They highlighted that SDM practice was not adequate due to lack of resources (3.46 (3.37-3.55)) and agreed on policies that improved its implementation (3.96 (3.88-4.04)). The main advantage of SDM for participants was patient satisfaction (38%), and the main disadvantage was the patients' paucity of knowledge to understand their disease (24%). The main obstacle indicated was the lack of time and resources (40%).
New policies must be designed for adequate training of professionals in integrating SDM in clinical practice, preparing them to use SDM with adequate resources and time provided.
Decision aids have been overall successful in improving the quality of health decision making. However, it is unclear whether the impact of the results of using decision aids also apply to older ...people (aged 65+). We sought to systematically review randomized controlled trials (RCTs) and clinical controlled trials (CCTs) evaluating the efficacy of decision aids as compared to usual care or alternative intervention(s) for older adults facing treatment, screening or care decisions.
A systematic search of (1) a Cochrane review of decision aids and (2) MEDLINE, Embase, PsycINFO, Cochrane library central registry of studies and Cinahl. We included published RCTs/CCTs of interventions designed to improve shared decision making (SDM) by older adults (aged 65+) and RCTs/CCTs that analysed the effect of the intervention in a subgroup with a mean age of 65+. Based on the International Patient Decision aid Standards (IPDAS), the primary outcomes were attributes of the decision and the decision process. Other behavioral, health, and health system effects were considered as secondary outcomes. If data could be pooled, a meta-analysis was conducted. Data for which meta-analysis was not possible were synthesized qualitatively.
The search strategy yielded 11,034 references. After abstract and full text screening, 22 papers were included. Decision aids performed better than control resp. usual care interventions by increasing knowledge and accurate risk perception in older people (decision attributes). With regard to decision process attributes, decision aids resulted in lower decisional conflict and more patient participation.
This review shows promising results on the effectiveness of decision aids for older adults. Decision aids improve older adults' knowledge, increase their risk perception, decrease decisional conflict and seem to enhance participation in SDM. It must however be noted that the body of literature on the effectiveness of decision aids for older adults is still in its infancy. Only one decision aid was specifically developed for older adults, and the mean age in most studies was between 65 and 70, indicating that the oldest-old were not included. Future research should expand on the design, application and evaluation of decision aids for older, more vulnerable adults.
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Sleep loss impacts a broad range of brain and cognitive functions. However, how sleep deprivation affects risky decision‐making remains inconclusive. This study used functional MRI to examine the ...impact of one night of total sleep deprivation (TSD) on risky decision‐making behavior and the underlying brain responses in healthy adults. In this study, we analyzed data from N = 56 participants in a strictly controlled 5‐day and 4‐night in‐laboratory study using a modified Balloon Analogue Risk Task. Participants completed two scan sessions in counter‐balanced order, including one scan during rested wakefulness (RW) and another scan after one night of TSD. Results showed no differences in participants' risk‐taking propensity and risk‐induced activation between RW and TSD. However, participants showed significantly reduced neural activity in the anterior cingulate cortex and bilateral insula for loss outcomes, and in bilateral putamen for win outcomes during TSD compared with RW. Moreover, risk‐induced activation in the insula negatively correlated with participants' risk‐taking propensity during RW, while no such correlations were observed after TSD. These findings suggest that sleep loss may impact risky decision‐making by attenuating neural responses to decision outcomes and impairing brain‐behavior associations.
Previous studies have suggested that sleep loss affects various neurobehavioral functions including decision‐making. However, the impact of sleep deprivation on risky decision‐making remains controversial. This study examined the impact of total sleep deprivation on risky decision‐making in the brain through a modified Balloon Analogue Risk Task. Results demonstrate that sleep loss may impact risky decision‐making by attenuating the brain's responses to the decision outcomes and impairing the relationship between brain and behavior.
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