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American Journal of Kidney Diseases :... May 2022
Topics: Decision Making; Decision Making, Shared; Humans; Patient Participation
PubMed: 35115190
DOI: 10.1053/j.ajkd.2021.10.005 -
NeuroImage Dec 2022Many real-world situations require navigating decisions for both reward and threat. While there has been significant progress in understanding mechanisms of...
Many real-world situations require navigating decisions for both reward and threat. While there has been significant progress in understanding mechanisms of decision-making and mediating neurocircuitry separately for reward and threat, there is limited understanding of situations where reward and threat contingencies compete to create approach-avoidance conflict (AAC). Here, we leverage computational learning models, independent component analysis (ICA), and multivariate pattern analysis (MVPA) approaches to understand decision-making during a novel task that embeds concurrent reward and threat learning and manipulates congruency between reward and threat probabilities. Computational modeling supported a modified reinforcement learning model where participants integrated reward and threat value into a combined total value according to an individually varying policy parameter, which was highly predictive of decisions to approach reward vs avoid threat during trials where the highest reward option was also the highest threat option (i.e., approach-avoidance conflict). ICA analyses demonstrated unique roles for salience, frontoparietal, medial prefrontal, and inferior frontal networks in differential encoding of reward vs threat prediction error and value signals. The left frontoparietal network uniquely encoded degree of conflict between reward and threat value at the time of choice. MVPA demonstrated that delivery of reward and threat could accurately be decoded within salience and inferior frontal networks, respectively, and that decisions to approach reward vs avoid threat were predicted by the relative degree to which these reward vs threat representations were active at the time of choice. This latter result suggests that navigating AAC decisions involves generating mental representations for possible decision outcomes, and relative activation of these representations may bias subsequent decision-making towards approaching reward or avoiding threat accordingly.
Topics: Humans; Choice Behavior; Decision Making; Reward; Reinforcement, Psychology; Neural Networks, Computer
PubMed: 36283543
DOI: 10.1016/j.neuroimage.2022.119709 -
Current Opinion in Anaesthesiology Feb 2023Development of advanced and minimally invasive surgical procedures is providing treatment opportunities to older and higher risk patients. This has also led to highly... (Review)
Review
PURPOSE OF REVIEW
Development of advanced and minimally invasive surgical procedures is providing treatment opportunities to older and higher risk patients. This has also led to highly specialized physicians and a need for better communication and planning with the patients and within the care team.
RECENT FINDINGS
In the field of cardiac surgery, the heart team model has been advocated and implemented as a vehicle to optimize decision making prior to procedure, care during the procedure and in the recovery process. The goal is to provide a treatment path that prioritizes the patient's goals and to anticipate and minimize complications.
SUMMARY
In this review, we discuss the concepts of shared decision making (SDM) and implementation science in the context of the complex cardiac patient. We also review the most recent evidence for their use in cardiac surgery. We argue that a team model not only bridges knowledge gaps but provides a multidisciplinary environment for the practice of SDM and implementation of evidence-based practices. Be believe this will provide patients with a better experience as they navigate their care and improve their medical outcomes as well.
Topics: Humans; Decision Making, Shared; Thoracic Surgery; Decision Making
PubMed: 36550605
DOI: 10.1097/ACO.0000000000001213 -
CJEM Mar 2022
Topics: Decision Making; Decision Making, Shared; Humans; Patient Participation
PubMed: 34792794
DOI: 10.1007/s43678-021-00231-7 -
International Journal of Law and... 2019A person's capacity to process advice is an important aspect of decision making in the real world. For example, in decisions about treatment, the way patients respond to... (Review)
Review
A person's capacity to process advice is an important aspect of decision making in the real world. For example, in decisions about treatment, the way patients respond to the advice of family, friends and medical professionals may be used (intentionally or otherwise) as a marker of the "use or weigh" requirement of decision-making capacity. Here we explore neuroscientific research on decision-making to identify features of advice-taking that help conceptualize this requirement. We focus on studies of the neural and computational basis of decision-making in laboratory settings. These studies originally investigated simple perceptual decisions about ambiguous stimuli, but have more recently been extended to more complex "value-based" decisions involving the comparison of subjective preferences. Value-based decisions are a useful model system for capacity-related decision-making as they do not have an objectively 'correct' answer and are instead based on subjective preferences. In this context, advice-taking can be seen as a process in which new evidence for one or other option is integrated, leading to altered behaviour or choices. We use this framework to distinguish between different types of advice-taking: private compliance consists of updating one's privately held beliefs based on new evidence, whereas in the case of public compliance, people change their behaviour at a surface level without shifting their privately-held beliefs. Importantly, both types of advice-taking may lead to similar outcomes but rely on different decision processes. We suggest that understanding how multiple mechanisms drive advice-taking holds promise for targeting decision-making support and improving our understanding of the use and weigh requirement in cases of contested capacity.
Topics: Choice Behavior; Cognitive Neuroscience; Compliance; Decision Making; Humans; Judgment; Mental Competency; Metacognition
PubMed: 31785723
DOI: 10.1016/j.ijlp.2019.101504 -
Shared and Supported Decision Making in Medication in a Mental Health Setting: How Far Have We Come?Community Mental Health Journal Nov 2021Personalised care involves shared decision making (SDM) across all levels including choice in medication. However, there are a number of barriers which prevent its...
Personalised care involves shared decision making (SDM) across all levels including choice in medication. However, there are a number of barriers which prevent its effective implementation in routine mental health settings. Therefore, we undertook a study to benchmark current practice across clinical services of a large urban mental health provider. The study formed part of the trust-wide 'Supported Decision Making in Medication' Co-Production Project and aims to inform future recommendations in delivering against contemporary best practice, guidance and policy. A survey exploring the views and experiences of service users and prescribers on shared and supported decision-making in medication was carried out in West London NHS Trust. Questionnaires were fully co-designed and co-delivered by a group of health professionals and individuals with lived experience. There were 100 responses from service users and 35 from prescribers. There was some good practice where both parties reported good quality conversations concerning dialogic styles, collaborative process, information provided and range of choice offered. However, prescriber's perception of their practice was not always mirrored by service user feedback whose experiences often depended upon the prescriber, the time available or the part of the service. Generally, service user experience fell short of the good practice cited by clinicians though there was noticeable variability. Commitment from organizations and increasing understanding from practitioners are vital in transforming SDM from rhetoric into reality. From our findings a further challenge is to ensure that prescribers and service users have the time, information and tools to implement it consistently.
Topics: Decision Making; Decision Making, Shared; Health Personnel; Humans; Mental Health; Mental Health Services
PubMed: 33544295
DOI: 10.1007/s10597-021-00780-2 -
Trends in Cognitive Sciences Nov 2016A growing literature demonstrates that using a foreign language affects choice. This is surprising because if people understand their options, choice should be language... (Review)
Review
A growing literature demonstrates that using a foreign language affects choice. This is surprising because if people understand their options, choice should be language independent. Here, we review the impact of using a foreign language on risk, inference, and morality, and discuss potential explanations, including reduced emotion, psychological distance, and increased deliberation.
Topics: Choice Behavior; Decision Making; Emotions; Humans; Language; Morals
PubMed: 27600315
DOI: 10.1016/j.tics.2016.08.004 -
Health Expectations : An International... Oct 2020It is not clear whether clinical practice guidelines (CPGs) and consensus statements (CSs) are adequately promoting shared decision making (SDM). (Review)
Review
BACKGROUND
It is not clear whether clinical practice guidelines (CPGs) and consensus statements (CSs) are adequately promoting shared decision making (SDM).
OBJECTIVE
To evaluate the recommendations about SDM in CPGs and CSs concerning breast cancer (BC) treatment.
SEARCH STRATEGY
Following protocol registration (Prospero no.: CRD42018106643), CPGs and CSs on BC treatment were identified, without language restrictions, through systematic search of bibliographic databases (MEDLINE, EMBASE, Web of Science, Scopus, CDSR) and online sources (12 guideline databases and 51 professional society websites) from January 2010 to December 2019.
INCLUSION CRITERIA
CPGs and CSs on BC treatment were selected whether published in a journal or in an online document.
DATA EXTRACTION AND SYNTHESIS
A 31-item SDM quality assessment tool was developed and used to extract data in duplicate.
MAIN RESULTS
There were 167 relevant CPGs (139) and CSs (28); SDM was reported in only 40% of the studies. SDM was reported more often in recent publications after 2015 (42/101 (41.6 %) vs 46/66 (69.7 %), P = .0003) but less often in medical journal publications (44/101 (43.5 %) vs 17/66 (25.7 %), P = .009). In CPGs and CSs with SDM, only 8/66 (12%) met one-fifth (6 of 31) of the quality items; only 14/66 (8%) provided clear and precise SDM recommendations.
DISCUSSION AND CONCLUSIONS
SDM descriptions and recommendations in CPGs and CSs concerning BC treatment need improvement. SDM was more frequently reported in CPGs and CSs in recent years, but surprisingly it was less often covered in medical journals, a feature that needs attention.
Topics: Bibliometrics; Breast Neoplasms; Consensus; Decision Making; Decision Making, Shared; Female; Humans; Language
PubMed: 32748514
DOI: 10.1111/hex.13112 -
International Journal of Older People... Jan 2023Transitions to long-term care are challenging for individuals and often associated with a loss of autonomy. Positive experiences are noted, especially when decisions... (Review)
Review
BACKGROUND
Transitions to long-term care are challenging for individuals and often associated with a loss of autonomy. Positive experiences are noted, especially when decisions involve the individual in a person-centred way which are respectful of the person's human rights. One approach which facilitates self-determination during a transitional period is shared decision-making, but there is a lack of clarity on the nature and extent of research evidence in this area.
OBJECTIVE
The purpose of this scoping review is to identify and document research related to shared decision-making and transitioning to long-term care.
METHODS
A comprehensive search in CINAHL, Medline and Psych-info identified papers which included evidence of shared decision-making during transitions to a long-term care setting. The review following the JBI and PAGER framework for scoping reviews. Data were extracted, charted and analysed according to patterns, advances, gaps, research recommendations and evidence for practice.
RESULTS
Eighteen papers met the inclusion criteria. A body of knowledge was identified encompassing the pattern advancements in shared decision-making during transitions to long-term care, representing developments in both the evidence base and methodological approaches. Further patterns offer evidence of the facilitators and barriers experienced by the person, their families and the professional's involved.
CONCLUSIONS
The evidence identified the complexity of such decision-making with efforts to engage in shared decision-making often constrained by the availability of resources, the skills of professionals and time. The findings recognise the need for partnership and person-centred approaches to optimise transitions. The review demonstrates evidence of approaches that can inform future practice and research to support all adult populations who may be faced with a transitional decision to actively participate in decision-making.
Topics: Humans; Long-Term Care; Decision Making, Shared; Decision Making
PubMed: 36480119
DOI: 10.1111/opn.12518 -
ELife Feb 2023Perceptual decisions are biased toward higher-value options when overall gains can be improved. When stimuli demand immediate reactions, the neurophysiological decision...
Perceptual decisions are biased toward higher-value options when overall gains can be improved. When stimuli demand immediate reactions, the neurophysiological decision process dynamically evolves through distinct phases of growing anticipation, detection, and discrimination, but how value biases are exerted through these phases remains unknown. Here, by parsing motor preparation dynamics in human electrophysiology, we uncovered a multiphasic pattern of countervailing biases operating in speeded decisions. Anticipatory preparation of higher-value actions began earlier, conferring a 'starting point' advantage at stimulus onset, but the delayed preparation of lower-value actions was steeper, conferring a value-opposed buildup-rate bias. This, in turn, was countered by a transient deflection toward the higher-value action evoked by stimulus detection. A neurally-constrained process model featuring anticipatory urgency, biased detection, and accumulation of growing stimulus-discriminating evidence, successfully captured both behavior and motor preparation dynamics. Thus, an intricate interplay of distinct biasing mechanisms serves to prioritise time-constrained perceptual decisions.
Topics: Humans; Decision Making; Reaction Time; Choice Behavior; Bias
PubMed: 36779966
DOI: 10.7554/eLife.67711