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BMJ Quality & Safety Feb 2022
Topics: Decision Making; Decision Making, Shared; Humans; Patient Participation
PubMed: 34162755
DOI: 10.1136/bmjqs-2021-013533 -
Zeitschrift Fur Evidenz, Fortbildung... Jun 2022The aim of this paper is to provide an overview of the current state of the art concerning patient-centred care (PCC), shared decision-making (SDM), and patient... (Review)
Review
The aim of this paper is to provide an overview of the current state of the art concerning patient-centred care (PCC), shared decision-making (SDM), and patient involvement in health care in Italy, by updating the previous versions of the review. In the past 5 years some progress has been made towards a higher involvement of patients in their health care and patient-centredness into the national health care system. The updated scoping literature search focused on articles reporting primary data collected in Italy and showed a great increase in the number of publications. Nonetheless, the research efforts are still relatively sporadic compared to other countries especially as for evaluations of interventions and, most notably, they are not driven by a consistent effort to promote SDM and PCC in clinical practice.
Topics: Decision Making; Decision Making, Shared; Germany; Humans; Italy; Patient Participation
PubMed: 35618622
DOI: 10.1016/j.zefq.2022.05.004 -
Psychiatry Research. Neuroimaging Nov 2021The experience of doubt, the lack of confidence in one's perceptions, internal states, memory and attention, can be due to the variability in occurrence of a phenomenon...
The experience of doubt, the lack of confidence in one's perceptions, internal states, memory and attention, can be due to the variability in occurrence of a phenomenon or can be driven by the internal experience of uncertainty based on subjective evaluation of the environment. Although the experience of some doubt is adaptive in normal cognitive functioning, excessive doubt can significantly impair decision-making and in extreme cases give rise to psychopathology. Although neuroimaging studies have provided some insight into the network of brain areas that is engaged when decision-making involves uncertainty, it remains unclear if dysfunction in these areas also gives rise to the experience and pathological expression of doubt. This study examined the neural correlates of doubt using neuroimaging during the performance of a forced-choice perceptual decision-making task under varying levels of uncertainty in participants who reported either low or high doubt. Participants reporting high doubt exhibited increased activation in the bilateral inferior parietal lobule (IPL) during perceptual decision-making which was not observed in participants who reported low doubt. Furthermore, activity in the IPL in high doubt participants was associated with clinical measures of doubt and showed functional connectivity differences between the high and low doubt groups. The findings of the current study suggest a key role of the IPL and provide a network of brain regions that may play a role in the experience and expression of doubt.
Topics: Brain; Brain Mapping; Decision Making; Humans; Magnetic Resonance Imaging; Uncertainty
PubMed: 34464764
DOI: 10.1016/j.pscychresns.2021.111370 -
Health Affairs (Project Hope) Mar 2020
Topics: Decision Making; Decision Making, Shared; Humans; Patient Participation; Policy
PubMed: 32119606
DOI: 10.1377/hlthaff.2019.01783 -
Journal of Clinical Epidemiology Jan 2022To explore and characterize published evidence on the ways decision analysis has been used to inform shared decision-making. (Review)
Review
OBJECTIVE
To explore and characterize published evidence on the ways decision analysis has been used to inform shared decision-making.
STUDY DESIGN AND SETTING
For this scoping review, we searched five bibliographic databases (from inception until February 2021), reference lists of included studies, trial registries, a thesis database and websites of relevant interest groups. Studies were eligible if they evaluated the application of decision analysis in a shared decision-making encounter. Pairs of reviewers independently screened and selected studies for inclusion, extracted study information using a data extraction form developed by the research team and assessed risk of bias for all studies with an experimental or quasi-experimental design. Data were narratively synthesized.
RESULTS
We identified 27 studies that varied greatly with regard to their patient population, design, content and delivery. A range of outcomes were evaluated to explore the effectiveness and acceptability of decision analytic interventions, with little information about the implementation process. Most studies found that decision analysis was broadly beneficial.
CONCLUSION
Despite the compelling rationale on the potential for decision analysis to support shared decision-making, rigorous randomized controlled trials are needed to confirm these interventions' effectiveness, while qualitative studies should seek to understand their potential implementation.
Topics: Decision Making; Decision Making, Shared; Decision Support Techniques; Humans
PubMed: 34628018
DOI: 10.1016/j.jclinepi.2021.10.001 -
Trends in Neurosciences Feb 2022Suboptimal decision-making strategies have been proposed to contribute to the pathophysiology of addiction. Decision-making, however, arises from a collection of... (Review)
Review
Suboptimal decision-making strategies have been proposed to contribute to the pathophysiology of addiction. Decision-making, however, arises from a collection of computational components that can independently influence behavior. Disruptions in these different components can lead to decision-making deficits that appear similar behaviorally, but differ at the computational, and likely the neurobiological, level. Here, we discuss recent studies that have used computational approaches to investigate the decision-making processes underlying addiction. Studies in animal models have found that value updating following positive, but not negative, outcomes is predictive of drug use, whereas value updating following negative, but not positive, outcomes is disrupted following drug self-administration. We contextualize these findings with studies on the circuit and biological mechanisms of decision-making to develop a framework for revealing the biobehavioral mechanisms of addiction.
Topics: Animals; Behavior, Addictive; Decision Making; Humans; Reinforcement, Psychology; Substance-Related Disorders
PubMed: 34920884
DOI: 10.1016/j.tins.2021.11.007 -
The American Journal of Bioethics : AJOB Jul 2022
Topics: Algorithms; Artificial Intelligence; Decision Making; Humans; Morals
PubMed: 35737501
DOI: 10.1080/15265161.2022.2075968 -
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 -
Heart (British Cardiac Society) Dec 2022
Topics: Humans; Intention; Decision Making; Decision Making, Shared; Patient Participation
PubMed: 36104221
DOI: 10.1136/heartjnl-2022-321482