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The European Journal of Neuroscience Jul 2022Evidence suggests that psychological stress has effects on decision making, but the results are inconsistent, and the influence of cortisol and other modulating factors... (Review)
Review
Evidence suggests that psychological stress has effects on decision making, but the results are inconsistent, and the influence of cortisol and other modulating factors remains unclear. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, 18 studies carried out between 2015 and 2020 that examined the effects of psychological stress on decision making and measured cortisol levels were selected. Eight studies employed uncertainty-based economic tasks, five studies used decision-making tasks in hypothetical situations that can be encountered in real life or in a specific setting and five studies employed prosocial decision tasks. Seventeen studies assessed acute stress, and two assessed chronic stress; eight evaluated the influence of sex. Most of the studies that explored the association between stress and decision making using uncertainty-based economic tasks found statistically significant differences as a function of stress exposure and the cortisol response to stress, whereas most of the studies that employed non-economic decision-making tasks in hypothetical situations did not find statistically significant differences. When prosocial decision making was evaluated, more altruistic decisions were found after acute stress, and these decisions were positively associated with cortisol. Half of the studies that assessed the role of sex observed a greater impact on decision making after stress in women. Results suggest that it is important to consider modulating factors-the type of decision-making task, the cortisol response to stress, the characteristics of the psychological stressor or the subject's sex-when trying to understand psychosocial stress phenomena.
Topics: Decision Making; Female; Humans; Hydrocortisone; Stress, Psychological; Uncertainty
PubMed: 35589606
DOI: 10.1111/ejn.15721 -
Psychological Medicine Apr 2024Decision-making capacity (DMC) among psychiatric inpatients is a pivotal clinical concern. A review by Okai et al. (2007) suggested that most psychiatric inpatients have... (Meta-Analysis)
Meta-Analysis Review
Decision-making capacity (DMC) among psychiatric inpatients is a pivotal clinical concern. A review by Okai et al. (2007) suggested that most psychiatric inpatients have DMC for treatment, and its assessment is reliable. Nevertheless, the high heterogeneity and mixed results from other studies mean there is considerable uncertainty around this topic. This study aimed to update Okai's research by conducting a systematic review with meta-analysis to address heterogeneity. We performed a systematic search across four databases, yielding 5351 results. We extracted data from 20 eligible studies on adult psychiatric inpatients, covering DMC assessments from 2006 to May 2022. A meta-analysis was conducted on 11 papers, and a quality assessment was performed. The study protocol was registered on PROSPERO (ID: CRD42022330074). The proportion of patients with DMC for treatment varied widely based on treatment setting, the specific decision and assessment methods. Reliable capacity assessment was feasible. The Mini-Mental State Examination (MMSE), Global Assessment of Function (GAF), and Brief Psychiatric Rating Scale (BPRS) predicted clinical judgments of capacity. Schizophrenia and bipolar mania were linked to the highest incapacity rates, while depression and anxiety symptoms were associated with better capacity and insight. Unemployment was the only sociodemographic factor correlated with incapacity. Assessing mental capacity is replicable, with most psychiatric inpatients able to make treatment decisions. However, this capacity varies with admission stage, formal status (involuntary or voluntary), and information provided. The severity of psychopathology is linked to mental capacity, though detailed psychopathological data are limited.
Topics: Adult; Humans; Mental Competency; Inpatients; Decision Making; Schizophrenia; Uncertainty
PubMed: 38433596
DOI: 10.1017/S0033291724000242 -
Australian Health Review : a... Jun 2021Objective Substitute decision makers (SDMs) can be required to make difficult health care decisions on behalf of individuals lacking decision-making capacity. Online...
Objective Substitute decision makers (SDMs) can be required to make difficult health care decisions on behalf of individuals lacking decision-making capacity. Online resources may be helpful in preparing and supporting SDMs. This study systematically explored the frequency, content and usability of Australian online resources containing health care substitute decision-making content written for consumers. Methods In April 2019, Google searches were conducted to identify online resources containing health care substitute decision-making content for consumers. Analysis comprised mapping resource characteristics, including target audience (individual-specific, SDM-specific, mixed) and thematic analysis of content. Usability was assessed using the Patient Education Materials Assessment Tool (PEMAT). Results Of the 61 resources identified, the most frequent were webpages (57%), individual-specific (43%) and those produced by government organisations (31%). Only 15 resources (24%) were written for SDMs. Content themes identified were: defining the scope of the SDM role (93%); recommended traits or characteristics of SDMs (80%); instructions or principles regarding standards for decision making (75%); duties of SDMs (70%); and supports (46%), rights (16%), barriers (8%) and benefits (5%) for SDMs. The median (interquartile range) PEMAT scores (out of 100) were 66 (27) for understandability and 60 (55) for actionability. Conclusions SDMs have a vital role in making decisions for people lacking decision-making capacity. Online resources are a potential source of information and support for SDMs in Australia. This study identified key gaps in availability, content and usability of existing SDM resources, highlighting the need for the further development of such resources. We suggest that future resource development include SDMs in the design and evaluation processes. What is known about the topic? An aging population and a greater need for decisions to be made on behalf of others who lack capacity means that health care substitute decision-making is occurring more frequently. Appointing one or more SDMs may occur as part of the advance care planning process. However, being a healthcare SDM can be difficult and stressful. People frequently use the Internet to search for health-related information. What does this paper add? This paper systematically examined the frequency, content and usability of existing Australian online resources with substitute decision-making content written for a consumer audience in English, and identified key gaps in online resources available to support SDMs. What are the implications for practitioners? Although there is a need for resources written for SDMs, authors of online resources need to pay careful attention to the purpose, content and usability of their resource. Future resource development should include input from SDMs and involve them in evaluation to assess whether the resources meet target audience needs.
Topics: Advance Care Planning; Aged; Australia; Decision Making; Delivery of Health Care; Humans
PubMed: 33472740
DOI: 10.1071/AH20070 -
Patient Education and Counseling Jan 2023To summarize how Asian Americans negotiate involvement in shared decision-making (SDM) with their providers, the cultural influences on SDM, and perceived barriers and... (Review)
Review
OBJECTIVE
To summarize how Asian Americans negotiate involvement in shared decision-making (SDM) with their providers, the cultural influences on SDM, and perceived barriers and facilitators to SDM.
METHODS
This is a systematic review of qualitative studies. We searched six electronic databases and sources of gray literature until March 2021. Two reviewers independently screened studies, performed quality appraisal, and data extraction. Meta-synthesis was performed to summarize themes using a three-step approach.
RESULTS
Twenty studies with 675 participants were included. We abstracted 275 initial codes and grouped these into 19 subthemes and 4 major themes: (1) negotiating power and differing expectations in SDM; (2) cultural influences on SDM; (3) importance of social support in SDM; and (4) supportive factors for facilitating SDM.
CONCLUSIONS
Asian Americans have important perspectives, needs, and preferences regarding SDM that impacts how they engage with the provider on medical decisions and their perception of the quality of their care.
PRACTICE IMPLICATIONS
Asian American patients valued good communication and sufficient time with their provider, and that it is important for health professionals to understand patients' desired level of involvement in the SDM process and in the final decision, and who should be involved in SDM beyond the patient.
OTHER
This systematic review was registered on PROSPERO (CRD42021241665).
Topics: Humans; Asian; Decision Making, Shared; Qualitative Research; Health Personnel; Delivery of Health Care; Patient Participation; Decision Making
PubMed: 36344320
DOI: 10.1016/j.pec.2022.10.350 -
The Journal of Cardiovascular Nursing 2018Heart failure follows a highly variable and difficult course. Patients face complex decisions, including treatment with implantable cardiac defibrillators, mechanical...
BACKGROUND
Heart failure follows a highly variable and difficult course. Patients face complex decisions, including treatment with implantable cardiac defibrillators, mechanical circulatory support, and heart transplantation. The course of decision-making across multiple treatments is unclear yet integral to providing informed and shared decision-making. Recognizing commonalities across treatment decisions could help nurses and physicians to identify opportunities to introduce discussions and support shared decision-making.
OBJECTIVE
The specific aims of this review are to examine complex treatment decision-making, specifically implantable cardiac defibrillators, ventricular assist device, and cardiac transplantation, and to recognize commonalities and key points in the decisional process.
METHODS
MEDLINE, CINAHL, PsycINFO, and Web of Science were searched for English-language studies that included qualitative findings reflecting the complexity of heart failure decision-making. Using a 3-step process, findings were synthesized into themes and subthemes.
RESULTS
Twelve articles met criteria for inclusion. Participants included patients, caregivers, and clinicians and included decisions to undergo and decline treatment. Emergent themes were "processing the decision," "timing and prognostication," and "considering the future." Subthemes described how participants received and understood information about the therapy, making and changing a treatment decision, timing their decision and gauging health status outcomes in the context of their decision, the influence of a life or death decision, and the future as a factor in their decisional process.
CONCLUSIONS
Commonalities were present across therapies, which involved the timing of discussions, the delivery of information, and considerations of the future. Exploring this further could help support patient-centered care and optimize shared decision-making interventions.
Topics: Decision Making; Heart Failure; Humans; Patient Education as Topic; Patient Participation; Personal Autonomy; Prognosis; Quality of Life; Time Factors
PubMed: 29232275
DOI: 10.1097/JCN.0000000000000453 -
Journal of Medical Internet Research Jan 2016Patient information and education, such as decision aids, are gradually moving toward online, computer-based environments. Considerable research has been conducted to... (Meta-Analysis)
Meta-Analysis Review
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.
Topics: Adult; Computers; Decision Making; Decision Support Techniques; Humans; Multimedia; Online Systems; Social Support; Systems Integration
PubMed: 26813512
DOI: 10.2196/jmir.4982 -
Patient Education and Counseling May 2023The purpose of this review is to explore the breadth of research conducted on SDM in the care of Black patients. (Review)
Review
OBJECTIVE
The purpose of this review is to explore the breadth of research conducted on SDM in the care of Black patients.
METHODS
We conducted a scoping review following the methodological framework outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. We searched articles related to original research on SDM in the care of Black patients in October 2022 using PubMed, Embase, and Google Scholar databases. Articles of all study designs (quantitative and qualitative), published or translated into English, were included. A standardized data extraction form and thematic analysis were used to facilitate data extraction by two independent reviewers.
RESULTS
After removal of duplicates and screening, 30 articles were included in the final analysis. Black patients and clinician were found to not share the same understanding of SDM, and patients highly valued SDM in their care. Interventions to improve SDM yielded mixed results to enhance intent, participation in SDM, as well as health outcomes. Decision aids were the most effective form of intervention to enhance SDM. The most common barrier to SDM was patient-clinician communication, and was exacerbated by racial discordance, clinician mistrust, past experiences, and paternalistic clinician-patient dynamics.
CONCLUSIONS
SDM has the potential to improve health outcomes in Black patients when implemented contextually within Black patients' experiences and concerns. Significant barriers such as clinician mistrust exist, and the overall perception in the Black community is that SDM does not occur sufficiently. Barriers to SDM seem to be most pronounced when there is patient-clinician racial discordance. Several interventions aimed at improving SDM with Black patients have shown mixed results. Future studies should evaluate larger-scale interventions with longer follow-up. Practice implications Shared decision making (SDM) has been proposed as a useful tool for improving quality and equity in Black patients' care. However, Black patients experience lower rates of SDM compared to other populations. SDM has the potential to improve health outcomes in Black patients when implemented contextually within Black patients' experiences and concerns.
Topics: Humans; Decision Making, Shared; Decision Making; Patient Participation; Black People; Communication
PubMed: 36739706
DOI: 10.1016/j.pec.2023.107646 -
PloS One 2017With rising healthcare costs comes an increasing demand for evidence-informed resource allocation using economic evaluations worldwide. Furthermore, standardization of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
With rising healthcare costs comes an increasing demand for evidence-informed resource allocation using economic evaluations worldwide. Furthermore, standardization of costing and reporting methods both at international and national levels are imperative to make economic evaluations a valid tool for decision-making. The aim of this review is to assess the availability and consistency of costing evidence that could be used for decision-making in Austria. It describes systematically the current economic evaluation and costing studies landscape focusing on the applied costing methods and their reporting standards. Findings are discussed in terms of their likely impacts on evidence-based decision-making and potential suggestions for areas of development.
METHODS
A systematic literature review of English and German language peer-reviewed as well as grey literature (2004-2015) was conducted to identify Austrian economic analyses. The databases MEDLINE, EMBASE, SSCI, EconLit, NHS EED and Scopus were searched. Publication and study characteristics, costing methods, reporting standards and valuation sources were systematically synthesised and assessed.
RESULTS
A total of 93 studies were included. 87% were journal articles, 13% were reports. 41% of all studies were full economic evaluations, mostly cost-effectiveness analyses. Based on relevant standards the most commonly observed limitations were that 60% of the studies did not clearly state an analytical perspective, 25% of the studies did not provide the year of costing, 27% did not comprehensively list all valuation sources, and 38% did not report all applied unit costs.
CONCLUSION
There are substantial inconsistencies in the costing methods and reporting standards in economic analyses in Austria, which may contribute to a low acceptance and lack of interest in economic evaluation-informed decision making. To improve comparability and quality of future studies, national costing guidelines should be updated with more specific methodological guidance and a national reference cost library should be set up to allow harmonisation of valuation methods.
Topics: Austria; Decision Making; Health Care Costs; Humans; Publications; Research Report
PubMed: 28806728
DOI: 10.1371/journal.pone.0183116 -
International Journal of Environmental... May 2020The aim of this systematic review conducted in the topic of youth team-sports players was three-fold: (i) Analyze the variations of decision-making processes between...
The aim of this systematic review conducted in the topic of youth team-sports players was three-fold: (i) Analyze the variations of decision-making processes between low- and high-level youth players; (ii) analyze the variations of decision-making processes between different age groups; and (iii) analyze the effects of decision-making training-based programs on youth players. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, this systematic review searched for studies on PubMed, ScienceDirect, Academic Search Complete, SPORTDiscus, and Taylor & Francis Online. The search returned 6215 papers. After screening the records against set criteria, 26 articles were fully reviewed. From the included studies, 9 were focused on comparing the decision-making process between low- and high-level players, 6 compared the decisions made by players from different age categories, and 11 analyzed the effects of decision-making-based training programs on youth players. Comparisons between high- and low-level players suggested that high-level and most talented players present a greater accuracy in the cognitive and executive answers to the game as well as being more adjustable to more complex situations. Considering the comparisons between age groups, a tendency of older players to execute more accurate decisions in the game and to have better tactical knowledge and behavior was observed. Finally, the effects of decision-making training programs suggest a beneficial effect employing practical scenarios (mainly based on small-sided and conditioned games), primarily improving passing decisions and execution. However, the benefits of interventions using videos are not clear.
Topics: Adolescent; Athletic Performance; Child; Decision Making; Humans; Youth Sports
PubMed: 32471126
DOI: 10.3390/ijerph17113803 -
International Journal of Medical... May 2021Decision Aid systems (DAs) provide information on the pros and cons of mammography. This study aimed to review the research on mammography DAs, synthesize the findings... (Review)
Review
PURPOSE
Decision Aid systems (DAs) provide information on the pros and cons of mammography. This study aimed to review the research on mammography DAs, synthesize the findings related to their outcomes and characteristics, and address the existed research gap.
METHODS
Relevant studies were identified through a comprehensive search on some e-databases, including PubMed, EMBASE, Scopus, and Web of Science in August 2020; by searching the keywords of "Breast cancer", "Screening", and "Decision aid systems" as well as their synonyms in the titles and abstracts of the papers with no time limits. Among the selected English journal papers with the interventional study design, those measuring outcome values of using mammography DAs were recognized as eligible for being included in this review.
RESULTS
The systematic search results in 16 DAs regarding mammography that were designed and then evaluated from 18 selected studies. The results showed that DAs provide improvements in knowledge and informed choice, the decreased decisional conflicts and decisional confidence, almost without changing any attitude towards mammography, mammography participation rates, psychological issues, anticipated regret, and perceived risk of breast cancer. The DAs' effects on women's inclination to screening were divergent. In other words, the DAs affect individuals' inclination in rare cases; however, on occasion, they could affect women's decision to undergo screening.
CONCLUSION
DAs could correct the bias attached to the existing knowledge on mammography and breast cancer in women so that they are more likely to make a precise decision. Additionally, it might be of central importance in shared decision-making and assisting health providers, in order to promote the quality of care. Accordingly, performing more studies is needed to develop more professional DAs in various countries with different facilities, cultures, and languages.
Topics: Breast Neoplasms; Decision Making; Decision Support Techniques; Early Detection of Cancer; Female; Humans; Mammography; Patient Participation
PubMed: 33640838
DOI: 10.1016/j.ijmedinf.2021.104406