-
Surgery Aug 2020Surgical patients incur preventable harm from cognitive and judgment errors made under time constraints and uncertainty regarding patients' diagnoses and predicted...
BACKGROUND
Surgical patients incur preventable harm from cognitive and judgment errors made under time constraints and uncertainty regarding patients' diagnoses and predicted response to treatment. Decision analysis and techniques of reinforcement learning theoretically can mitigate these challenges but are poorly understood and rarely used clinically. This review seeks to promote an understanding of decision analysis and reinforcement learning by describing their use in the context of surgical decision-making.
METHODS
Cochrane, EMBASE, and PubMed databases were searched from their inception to June 2019. Included were 41 articles about cognitive and diagnostic errors, decision-making, decision analysis, and machine-learning. The articles were assimilated into relevant categories according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.
RESULTS
Requirements for time-consuming manual data entry and crude representations of individual patients and clinical context compromise many traditional decision-support tools. Decision analysis methods for calculating probability thresholds can inform population-based recommendations that jointly consider risks, benefits, costs, and patient values but lack precision for individual patient-centered decisions. Reinforcement learning, a machine-learning method that mimics human learning, can use a large set of patient-specific input data to identify actions yielding the greatest probability of achieving a goal. This methodology follows a sequence of events with uncertain conditions, offering potential advantages for personalized, patient-centered decision-making. Clinical application would require secure integration of multiple data sources and attention to ethical considerations regarding liability for errors and individual patient preferences.
CONCLUSION
Traditional decision-support tools are ill-equipped to accommodate time constraints and uncertainty regarding diagnoses and the predicted response to treatment, both of which often impair surgical decision-making. Decision analysis and reinforcement learning have the potential to play complementary roles in delivering high-value surgical care through sound judgment and optimal decision-making.
Topics: Attitude to Health; Clinical Decision-Making; Decision Making, Shared; Decision Support Techniques; Decision Trees; Electronic Health Records; Humans; Machine Learning; Numbers Needed To Treat; Patient Preference; Patient-Centered Care; Surgical Procedures, Operative
PubMed: 32540036
DOI: 10.1016/j.surg.2020.04.049 -
The Annals of Thoracic Surgery Aug 2022The United Kingdom National Institute for Health and Care Excellence guidelines recommend that patients and professionals make shared decisions between surgery and... (Review)
Review
BACKGROUND
The United Kingdom National Institute for Health and Care Excellence guidelines recommend that patients and professionals make shared decisions between surgery and stereotactic ablative radiotherapy (SABR) when treating early-stage non-small cell lung cancer (NSCLC). Variation by center suggests treatment decisions may be disproportionately influenced by clinician judgment and treatment availability rather than by patient preference. This systematic review critically evaluates studies of patient and clinician preferences for treatment of early-stage NSCLC.
METHODS
Primary empirical research up to April 30, 2020, was identified from searches of MEDLINE, Embase, PsycInfo, and Web of Science databases. Data extracted included study characteristics and methods, preferences for NSCLC treatment, and involvement in decision making and risk of bias using the Mixed Methods Appraisal Tool. Findings were synthesized using descriptive data and narrative synthesis.
RESULTS
Included in the review were 23 studies, of which 18 measured patient preferences, 4 clinician preferences, and 1 both clinician and patient preferences. Patients and clinicians were both most likely to prefer a collaborative role in treatment decisions. Most patients did not recall there being a choice between surgery or SABR options and thus experienced minimal decisional conflict.
CONCLUSIONS
For professionals to support patients in making informed, value-based decisions about NSCLC treatments, better quality evidence is needed of the clinical and quality of life trade-offs for both surgery and SABR.
Topics: Carcinoma, Non-Small-Cell Lung; Decision Making; Decision Making, Shared; Humans; Lung Neoplasms; Neoplasm Staging; Quality of Life; Small Cell Lung Carcinoma
PubMed: 33581150
DOI: 10.1016/j.athoracsur.2021.01.046 -
BMC Health Services Research Apr 2015To explore the likely influence and impact of shared decision-making on medical malpractice litigation and patients' intentions to initiate litigation. (Review)
Review
BACKGROUND
To explore the likely influence and impact of shared decision-making on medical malpractice litigation and patients' intentions to initiate litigation.
METHODS
We included all observational, interventional and qualitative studies published in all languages, which assessed the effect or likely influence of shared decision-making or shared decision-making interventions on medical malpractice litigation or on patients' intentions to litigate. The following databases were searched from inception until January 2014: CINAHL, Cochrane Register of Controlled Trials, Cochrane Database of Systematic Reviews, EMBASE, HMIC, Lexis library, MEDLINE, NHS Economic Evaluation Database, Open SIGLE, PsycINFO and Web of Knowledge. We also hand searched reference lists of included studies and contacted experts in the field. Downs & Black quality assessment checklist, the Critical Appraisal Skill Programme qualitative tool, and the Critical Appraisal Guidelines for single case study research were used to assess the quality of included studies.
RESULTS
6562 records were screened and 19 articles were retrieved for full-text review. Five studies wee included in the review. Due to the number and heterogeneity of included studies, we conducted a narrative synthesis adapted from the ESRC guidance for narrative synthesis. Four themes emerged. The analysis confirms the absence of empirical data necessary to determine whether or not shared decision-making promoted in the clinical encounter can reduce litigation. Three out of five included studies provide retrospective and simulated data suggesting that ignoring or failing to diagnose patient preferences, particularly when no effort has been made to inform and support understanding of possible harms and benefits, puts clinicians at a higher risk of litigation. Simulated scenarios suggest that documenting the use of decision support interventions in patients' notes could offer some level of medico-legal protection. Our analysis also indicated that a sizeable proportion of clinicians prefer ordering more tests and procedures, irrespective of patient informed preferences, as protection against litigation.
CONCLUSIONS
Given the lack of empirical data, there is insufficient evidence to determine whether or not shared decision-making and the use of decision support interventions can reduce medical malpractice litigation. Further investigation is required.
TRIAL REGISTRATION
This review was registered on PROSPERO.
REGISTRATION NUMBER
CRD42012002367 .
Topics: Adult; Aged; Aged, 80 and over; Decision Making; Female; Humans; Informed Consent; Male; Malpractice; Middle Aged; Retrospective Studies; Young Adult
PubMed: 25927953
DOI: 10.1186/s12913-015-0823-2 -
Palliative Medicine Dec 2016Policy guidance and bioethical literature urge the involvement of adolescents in decisions about their healthcare. It is uncertain how roles and expectations of... (Review)
Review
BACKGROUND
Policy guidance and bioethical literature urge the involvement of adolescents in decisions about their healthcare. It is uncertain how roles and expectations of adolescents, parents and healthcare professionals influence decision-making and to what extent this is considered in guidance.
AIMS
To identify recent empirical research on decision-making regarding care and treatment in adolescent cancer: (1) to synthesise evidence to define the role of adolescents, parents and healthcare professionals in the decision-making process and (2) to identify gaps in research.
DESIGN
A narrative systematic review of qualitative, quantitative and mixed-methods research. We adopted a textual approach to synthesis, using a theoretical framework of interactionism to interpret findings.
DATA SOURCES
The databases MEDLINE, PsycINFO, SCOPUS, EMBASE and CINHAL were searched from 2001 through May 2015 for publications on decision-making for adolescents (13-19 years) with cancer.
RESULTS
Twenty-eight articles were identified. Adolescents and parents initially find it difficult to participate in decision-making due to a lack of options in the face of protocol-driven care. Parent and adolescent preferences for information and response to loss of control vary between individuals and over time. No studies indicate parental or adolescent preference for a high degree of independence in decision-making.
CONCLUSION
Striving to make parents and adolescents fully informed or urge them towards more independence than they prefer may add to distress and confusion. This may interfere with their ability to participate in their preferred way in decisions about care and treatment. Future research should include analysis of on-ground interactions among parents, adolescents and clinicians across the trajectory.
Topics: Adolescent; Decision Making; Humans; Narration; Neoplasms; Parents; Research
PubMed: 27160700
DOI: 10.1177/0269216316648072 -
BMJ Open Aug 2022Decision aids (DAs) for clients in home and community care can support shared decision-making (SDM) with patients, healthcare teams and informal caregivers. We aimed to...
OBJECTIVES
Decision aids (DAs) for clients in home and community care can support shared decision-making (SDM) with patients, healthcare teams and informal caregivers. We aimed to identify DAs developed for home and community care, verify their adherence to international DA criteria and explore the involvement of interprofessional teams in their development and use.
DESIGN
Systematic review reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
DATA SOURCES
Six electronic bibliographic databases (MEDLINE, Embase, CINAHL Plus, Web of Science, PsycINFO and the Cochrane Library) from inception to November 2019, social media and grey literature websites up to January 2021.
ELIGIBILITY CRITERIA
DAs designed for home and community care settings or including home care or community services as options.
DATA EXTRACTION AND SYNTHESIS
Two reviewers independently reviewed citations. Analysis consisted of a narrative synthesis of outcomes and a thematic analysis. DAs were appraised using the International Patient Decision Aid Standards (IPDAS). We collected information on the involvement of interprofessional teams, including nurses, in their development and use.
RESULTS
After reviewing 10 337 database citations and 924 grey literature citations, we extracted characteristics of 33 included DAs. DAs addressed a variety of decision points. Nearly half (42%) were relevant to older adults. Several DAs did not meet IPDAS criteria. Involvement of nurses and interprofessional teams in the development and use of DAs was minimal (33.3% of DAs).
CONCLUSION
DAs concerned a variety of decisions, especially those related to older people. This reflects the complexity of decisions and need for better support in this sector. There is little evidence about the involvement of interprofessional teams in the development and use of DAs in home and community care settings. An interprofessional approach to designing DAs for home care could facilitate SDM with people being cared for by teams.
PROSPERO REGISTRATION NUMBER
CRD42020169450.
Topics: Aged; Decision Making; Decision Making, Shared; Decision Support Techniques; Home Care Services; Humans; Patient Care Team; Patient Participation
PubMed: 36129731
DOI: 10.1136/bmjopen-2022-061215 -
PloS One 2023Decision Avoidance (DA) strategies allow people to forego or abandon effortful deliberation by postponing, bypassing, or delegating a decision. DA is thought to reduce... (Meta-Analysis)
Meta-Analysis
Decision Avoidance (DA) strategies allow people to forego or abandon effortful deliberation by postponing, bypassing, or delegating a decision. DA is thought to reduce regret, primarily by allowing decision makers to evade personal responsibility for potential negative outcomes. We tested this relation between DA and post-decision regret in a multilevel meta-analysis of 59 effect estimates coming from 13 papers. Five DA strategies were considered: status quo preservation, action omission, inaction inertia, choice delegation and choice deferral. Across all effects and DA strategies, there was a non-significant trend toward DA reducing regret (Hedges' g = -0.23, p = 0.063). When assessing individual strategies, we found that only status quo preservation reduced regret reliably (Hedges' g = -0.45, p = 0.006). The relationship between DA and regret was unclear for the other DA strategies. We tested a number of moderators for the effect. Only 'previous experience' (i.e., the outcome of a previous decision) influenced the relation between DA and regret reliably. That is, if participants choose the DA option when the same choice previously led to a negative outcome, regret is actually enhanced. Overall, there is clear evidence that status quo preservation can reduce regret, but it is currently unclear whether the same holds for other DA strategies.
Topics: Humans; Decision Making; Emotions; Social Behavior; Apathy; Surveys and Questionnaires
PubMed: 37831709
DOI: 10.1371/journal.pone.0292857 -
Resuscitation Nov 2019During resuscitation decisions are made frequently and based on limited information in a stressful environment.
BACKGROUND
During resuscitation decisions are made frequently and based on limited information in a stressful environment.
AIM
This systematic review aimed to identify human factors affecting decision-making in challenging or stressful situations in resuscitation. The secondary aim was to identify methods of improving decision-making performance under stress.
METHODS
The databases PubMed, EMBASE and The Cochrane Library were searched from their commencement to the 13th of April 2019. MeSH terms and key words were combined (Stress* OR "human factor") AND Decision. Articles were included if they involved decision makers in medicine where decisions were made under challenging circumstances, with a comparator group and an outcome measure relating to change in decision-making performance.
RESULTS
22,368 records in total were initially identified, from which 82 full text studies were reviewed and 16 finally included. The included studies ranged from 1995 to 2018 and included a total of 570 participants. The studies were conducted in several different countries and settings, with participants of varying experience and backgrounds. Of the 16 studies, 5 were randomised controlled trials, 3 of which were deemed to have a high risk of bias. The stressors identified were (i) illness severity (ii) socio-evaluative, (iii) noise, (iv) fatigue. The mitigators identified were (i) cognitive aids including checklists, (ii) stress management training and (iii) meditation.
CONCLUSIONS
Human factors contributing to decision-making during resuscitation are identified and can be mitigated by tailored stress training and cognitive aids. Understanding these factors may have implications for clinician education and the development of decision-support tools.
Topics: Cardiopulmonary Resuscitation; Decision Making; Decision Support Techniques; Humans; Injury Severity Score; Severity of Illness Index; Stress, Psychological
PubMed: 31562904
DOI: 10.1016/j.resuscitation.2019.09.023 -
BMC Medical Ethics Aug 2023Shared decision making (SDM) and advance care planning (ACP) are important evidence and ethics based concepts that can be translated in communication tools to aid the...
BACKGROUND AND AIMS
Shared decision making (SDM) and advance care planning (ACP) are important evidence and ethics based concepts that can be translated in communication tools to aid the treatment decision-making process. Although both have been recommended in the care of patients with risks of complications, they have not yet been described as two components of one single process. In this paper we aim to (1) assess how SDM and ACP is being applied, choosing patients with aortic stenosis with high and moderate treatment complication risks such as bleeding or stroke as an example, and (2) propose a model to best combine the two concepts and integrate them in the care process.
METHODS
In order to assess how SDM and ACP is applied in usual care, we have performed a systematic literature review. The included studies have been analysed by means of thematic analysis as well as abductive reasoning to determine which SDM and ACP steps are applied as well as to propose a model of combining the two concepts into one process.
RESULTS
The search in Medline, Cinahl, Embase, Scopus, Web of science, Psychinfo and Cochrane revealed 15 studies. Eleven describe various steps of SDM while four studies discuss the documentation of goals of care. Based on the review results and existing evidence we propose a model that combines SDM and ACP in one process for a complete patient informed choice.
CONCLUSION
To be able to make informed choices about immediate and future care, patients should be engaged in both SDM and ACP decision-making processes. This allows for an iterative process in which each important decision-maker can share their expertise and concerns regarding the care planning and advance care planning. This would help to better structure and prioritize information while creating a trustful and respectful relationship between the participants. PROSPERO 2019. CRD42019124575.
Topics: Humans; Decision Making; Decision Making, Shared; Advance Care Planning; Records; Documentation; Patient Participation
PubMed: 37580704
DOI: 10.1186/s12910-023-00944-7 -
Health Expectations : An International... Dec 2015Assessment of users' information and decision-making needs is one key step in the development of decision-support interventions. (Review)
Review
BACKGROUND
Assessment of users' information and decision-making needs is one key step in the development of decision-support interventions.
OBJECTIVE
To identify patients' information and decision-making needs as a pre-requisite for the development of high-quality web-based patient decision aids (PtDAs) for common mental disorders.
SEARCH STRATEGY
A systematic MEDLINE search for papers published until December 2012 was conducted, and reference lists of included articles and relevant reviews were searched.
INCLUSION CRITERIA
Original studies containing data on information or decision-making needs of adults with depression, anxiety disorders, somatoform disorders, alcohol-related disorders and schizophrenia were included.
DATA EXTRACTION AND SYNTHESIS
Data extraction was performed using a standardized form, and data synthesis was conducted using a theory-based deductive approach by two independent reviewers. Studies were quality assessed using the Mixed Methods Appraisal Tool.
MAIN RESULTS
Twelve studies were included focusing on information needs or the identification of decisions patients with depression and schizophrenia were facing. No studies were found for the other mental disorders. Overall, seven information needs categories were identified with the topics 'basic facts', 'treatment' and 'coping' being of major relevance. Six decision categories were identified of which decisions on 'medication' and 'treatment setting' were most often classified.
CONCLUSIONS
This review reveals that patients with schizophrenia and depression show extensive information and decision-making needs. The identified needs can initially inform the design of PtDAs for schizophrenia and depression. However, there is an urgent need to investigate information and decision-making needs among patients with other mental disorders.
Topics: Decision Making; Decision Support Techniques; Humans; Information Seeking Behavior; Mental Disorders
PubMed: 25145796
DOI: 10.1111/hex.12251 -
BMC Women's Health Dec 2023Although there are calls for women's empowerment and gender equity globally, there are still large disparities regarding women's autonomy in healthcare decision making....
OBJECTIVES
Although there are calls for women's empowerment and gender equity globally, there are still large disparities regarding women's autonomy in healthcare decision making. The autonomy of women is believed to be crucial in improving their health-related outcomes. This review discusses factors that influence autonomy among women in healthcare decision making.
DESIGN
Systematic review.
DATA SOURCES
PubMed, Web of Science and Scopus were searched from 2017-2022.
ELIGIBILITY CRITERIA
The inclusion criteria include original articles, case studies and reports that has been written in the English Language, while manuscripts with no full article, reviews, newspaper reports, grey literatures, and articles that did not answer the review objectives were excluded.
DATA EXTRACTION AND SYNTHESIS
We carried out data extraction using a standardized data extraction form, that has been organized using Microsoft Excel. A narrative synthesis was carried out to combine the findings of all included articles.
RESULTS
A total of 70 records were identified and 18 were reviewed, yielding eight articles to be included in the accepted list of studies. All studies were conducted in developing countries and most of the studies were cross sectional. Factors that were associated with women's autonomy in healthcare decision making were age, women's education and occupation, husbands'/partners' education and occupation, residential location or region of residence, household wealth index as well as culture and religion.
CONCLUSIONS
Identification of these factors may help stakeholders in improving women's autonomy in healthcare decision making. Policymakers play a crucial role in healthcare decision making by enacting laws and policies that protect women's rights, promoting gender-sensitive healthcare services, ensuring access to comprehensive information, promoting health education, and supporting vulnerable populations. These efforts ensure women's autonomy including able to access to unbiased and effective healthcare services.
Topics: Female; Humans; Women's Rights; Socioeconomic Factors; Gender Identity; Decision Making; Delivery of Health Care; Personal Autonomy
PubMed: 38042837
DOI: 10.1186/s12905-023-02792-4