-
Medicine, Health Care, and Philosophy Mar 2024During the last decades, shared decision making (SDM) has become a very popular model for the physician-patient relationship. SDM can refer to a process (making a...
During the last decades, shared decision making (SDM) has become a very popular model for the physician-patient relationship. SDM can refer to a process (making a decision in a shared way) and a product (making a shared decision). In the literature, by far most attention is devoted to the process. In this paper, I investigate the product, wondering what is involved by a medical decision being shared. I argue that the degree to which a decision to implement a medical alternative is shared should be determined by taking into account six considerations: (i) how the physician and the patient rank that alternative, (ii) the individual preference scores the physician and the patient (would) assign to that alternative, (iii) the similarity of the preference scores, (iv) the similarity of the rankings, (v) the total concession size, and (vi) the similarity of the concession sizes. I explain why shared medical decisions are valuable, and sketch implications of the analysis for the physician-patient relationship.
Topics: Humans; Patient Participation; Decision Making, Shared; Physician-Patient Relations; Physicians; Decision Making
PubMed: 38010578
DOI: 10.1007/s11019-023-10179-3 -
BMJ Quality & Safety Feb 2022
Topics: Decision Making; Decision Making, Shared; Humans; Patient Participation
PubMed: 34162755
DOI: 10.1136/bmjqs-2021-013533 -
Primary Dental Journal Dec 2020Engaging patients in shared decision making (SDM) is a professional requirement since the Montgomery ruling in 2015. Endodontic treatments present a specific challenge...
Engaging patients in shared decision making (SDM) is a professional requirement since the Montgomery ruling in 2015. Endodontic treatments present a specific challenge to achieving SDM, both for the clinician and the patient. The treatments are often perceived as more challenging to complete by the clinician, and the assessment of risk and likely outcome requires a deep understanding of the (limited) evidence base. For the patient, decisions can be required at a time of acute symptoms and prolonged treatments. There are health literacy demands in comparison to some less complex dental treatments. Treatment decisions may be based more on inherent biases and prior experiences than objective probabilities. This article discusses options and supports effective shared decision making in endodontic treatment.
Topics: Decision Making; Decision Making, Shared; Dental Care; Endodontics; Humans; Patient Participation
PubMed: 33225852
DOI: 10.1177/2050168420963303 -
Zeitschrift Fur Evidenz, Fortbildung... Jun 2022Although there have been breakthroughs in patients' rights and informed consent legislation in Iran during the last few years, there is still no policy regarding shared...
Although there have been breakthroughs in patients' rights and informed consent legislation in Iran during the last few years, there is still no policy regarding shared decision-making (SDM). Besides, SDM training and clinical implementation initiatives remain scarce within the country. In this article, we aim to provide an update on the current state of SDM in Iran and discuss future directions. Lastly, we propose an SDM model adapted to the Iranian context, through a consensus-building process with Iranian clinicians and SDM experts, to assist in its implementation in a culturally sensitive manner.
Topics: Decision Making; Decision Making, Shared; Germany; Humans; Iran; Patient Participation
PubMed: 35606310
DOI: 10.1016/j.zefq.2022.05.001 -
Journal of Personality and Social... Nov 2023Scarcity often encourages decisions that favor the present over the future. While prevailing theories largely attribute these decisions to myopic, impulsive decision...
Scarcity often encourages decisions that favor the present over the future. While prevailing theories largely attribute these decisions to myopic, impulsive decision making, five studies find support for an alternative, less prevalent perspective. We introduce the time horizon of threatened needs as an important determinant of scarcity's effect on intertemporal choice, demonstrating that people's decisions under scarcity reflect attempts to address threatened needs. Data from the Federal Reserve Bank of Philadelphia (Study 1) and preregistered studies ( = 10,297) show that time horizon moderates intertemporal decisions under scarcity. Study 2 manipulates scarcity perceptions among people engaged to be married, leading to increased preferences for sooner outcomes when wedding dates have shorter time horizons and a significant reversal when wedding dates have longer time horizons. Study 3 demonstrates that time horizon predicts intertemporal choice only when the intertemporal choice can help address threatened needs. Study 4 holds expense salience constant and replicates the moderation by time horizon using a paradigm that manipulates both scarcity and time horizon. Study 5 introduces multiple needs that vary in time horizon and importance, finding that decisions under scarcity reflect consideration of both the importance and temporal proximity of needs. These findings align with the perspective that people facing scarcity attempt to make decisions that are contextually appropriate. This work underscores the importance of understanding contextual variation in experiences of scarcity, suggests that decision making under scarcity is less thoughtless than presumed by the impulsive, myopic account, and offers recommendations for interventions for changing behavior under scarcity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Topics: Humans; Time Factors; Impulsive Behavior; Choice Behavior; Delay Discounting; Reward; Decision Making
PubMed: 37707481
DOI: 10.1037/pspa0000353 -
Dementia (London, England) Nov 2023Little is known about the decision-making processes around seeking more supportive care for dementia. Persons with dementia are often left out of decision-making...
Little is known about the decision-making processes around seeking more supportive care for dementia. Persons with dementia are often left out of decision-making regarding seeking more supportive care as their dementia progresses. This paper provides a description of findings from the Decision-making in Alzheimer's Research project (DMAR) investigating the process of decision-making about transitions to more supportive care. We conducted 61 qualitative interviews with two stakeholder groups: 24 persons with dementia, and 37 informal caregivers to explore supportive care decisions and associated decision-making factors from the perspectives of persons with dementia and their caregivers. We identified four main decisions that persons with dementia and their informal caregivers played a role in: (1) sharing household responsibilities; (2) limiting routine daily activities; (3) bringing in formal support; and (4) moving to a care facility. Based on our findings we developed a schematized roadmap of decision-making that we used to guide the discussion of our findings. Four crosscutting themes emerged from our analysis: unknowns and uncertainties, maintaining life as you know it, there's no place like home and resource constraints. These results will be incorporated into the development of instruments whose goal is to identify preferences of persons with dementia and their caregivers, in order to include persons with dementia in care decisions even as their dementia progresses.
Topics: Humans; Decision Making; Caregivers; Dementia; Uncertainty
PubMed: 37656956
DOI: 10.1177/14713012231193139 -
Annals of the New York Academy of... Mar 2020Decision making is a fundamental cognitive function, which not only determines our day-to-day choices but also shapes the trajectories of our movements, our lives, and... (Review)
Review
Decision making is a fundamental cognitive function, which not only determines our day-to-day choices but also shapes the trajectories of our movements, our lives, and our societies. While immense progress has been made in recent years on our understanding of the mechanisms underlying decision making, research on this topic is still largely split into two halves. Good-based models largely state that decisions are made between representations of abstract value associated with available options; while action-based models largely state that decisions are made at the level of action representations. These models are further divided between those that state that a decision is made before an action is specified, and those that regard decision making as an evolving process that continues until movement completion. Here, we review computational models, behavioral findings, and results from neural recordings associated with these frameworks. In synthesizing this literature, we submit that decision making is best understood as a continuous, graded, and distributed process that traverses a landscape of behaviorally relevant options, from their presentation until movement completion. Identifying and understanding the intimate links between decision making and action processing has important implications for the study of complex, goal-directed behaviors such as social communication, and for elucidating the underlying mechanisms by which decisions are formed.
Topics: Cognition; Computer Simulation; Decision Making; Humans; Movement
PubMed: 30312476
DOI: 10.1111/nyas.13973 -
Topics in Cognitive Science Jul 2022Scientists studying decision-making often provide a set of choices, each specified with values or distributions of values, and probabilities or distributions of...
Scientists studying decision-making often provide a set of choices, each specified with values or distributions of values, and probabilities or distributions of probabilities. For example, "Would you prefer $100 with probability 1.0 or $1 with probability .9 and $1,000 with probability 0.1?" Other decision research examines choices made in the absence of most quantitative information; for example, "Would you prefer a Ford now or a Porsche a year from now?," "Which food would you prefer," but models the findings with precise quantitative assumptions. Yet other research does neither; for example, modeling verbally stated choices with verbally stated heuristics. This article asks about the relevance of the first two research approaches for much of the decision-making made in life. The use of quantitative research and modeling is unsurprising, given that this approach underlies most of science. In life, values and probabilities are almost always partly or wholly vague and qualitative rather than quantitative. For example, when deciding which house to buy, there are relevant features such as size, color, neighborhood schools, construction materials, attractiveness, and many more, but the decision-maker finds it difficult and of little use to assign these precise values or weights. Nonetheless, humans have evolved to make decisions in such vaguely specified settings. I provide an example showing how a very high degree of uncertainty can defeat the application of quantitative decision-making, but such a demonstration is not critical if quantitative research and modeling produce a good understanding of and a good approximation to decision-making in the natural environment. This perspective addresses these issues.
Topics: Decision Making; Heuristics; Humans; Probability; Uncertainty
PubMed: 34050714
DOI: 10.1111/tops.12541 -
Heart (British Cardiac Society) Dec 2022
Topics: Humans; Intention; Decision Making; Decision Making, Shared; Patient Participation
PubMed: 36104221
DOI: 10.1136/heartjnl-2022-321482 -
Cognitive Research: Principles and... Jul 2022The tendency to devaluate delayed rewards, a phenomenon referred to as 'discounting behaviour', has been studied by wide-ranging research examining individuals choosing...
The tendency to devaluate delayed rewards, a phenomenon referred to as 'discounting behaviour', has been studied by wide-ranging research examining individuals choosing between sooner but smaller or later but larger rewards. Despite the fact that many real-life choices are embedded in a social context, the question of whether or not social collaboration can have an impact on such choices has not been addressed empirically. With this research, we aimed to fill this gap experimentally by implementing a novel choice selection procedure in order to study the interactive dynamics between two participants. This selection procedure allowed us to dissect the sequence of decision-making into its elements, starting from the very first individual preference to the solution of possible conflicting preferences in the dyad. In Experiment 1, we studied group decision-making on classical intertemporal choices to reveal the possible benefit of social collaboration on discounting and identified that the knowledge of the social situation in collective decision-making causes a reduction in discounting. In a pre-registered Experiment 2, we compared classical intertemporal choices with choices in a gamified version of a discounting paradigm in which the participants had a real-time experience trial by trial and for which a normative reference was present. We found that collective decision-making had a substantial impact on intertemporal decision-making, but was shaped by different types of choices. Classical intertemporal choices were rather susceptible to the contextual factors of decision-making, whereas in the gamified version that included a normative reference the decisions were reliably influenced by social collaboration and resulted in a lower discounting. The results in this paradigm replicate our original findings from former research.
Topics: Decision Making; Delay Discounting; Humans; Reward; Social Environment; Time Factors
PubMed: 35900639
DOI: 10.1186/s41235-022-00422-5