-
Brazilian Journal of Physical Therapy 2022Shared decision making is a means of translating evidence into practice and facilitating patient-centred care by helping patients to become more active in the... (Review)
Review
BACKGROUND
Shared decision making is a means of translating evidence into practice and facilitating patient-centred care by helping patients to become more active in the decision-making process. Shared decision making is a collaborative process that involves patients and clinicians making health-related decisions after discussing the available options; the benefits and harms of each option; and considering the patient's values, preferences, and personal circumstances.
METHODS
This paper describes what shared decision making is, why it is important, when it is appropriate, and key elements. We report on physical therapists' current use of and attitudes to shared decision making and explore factors that influence its uptake. Lastly, we examine what is needed to promote greater use of this approach.
RESULTS
Key elements in the shared decision making process are: identifying the problem that requires a decision; providing an explanation of the health problem, including, where appropriate, the natural history of the condition; discussing the available options and the potential benefits and harms of each option; eliciting the patient's values, preferences, and expectations; and assisting the patient to weigh up the options to reach an informed decision. When applied in practice, shared decision making has been found to improve patient-clinician communication; improve patients' accuracy of their expectations of intervention benefits and harms, involvement in decision-making, and feeling of being informed; and increase both patients' and clinicians' satisfaction with care.
CONCLUSION
Despite physical therapists' enthusiasm for shared decision making, uptake of this approach has been slow. Multi-level strategies and behaviour change are required to encourage and support the sustainable incorporation of shared decision making in practice.
Topics: Decision Making; Decision Making, Shared; Humans; Patient Participation; Patient-Centered Care; Physical Therapy Modalities
PubMed: 35063699
DOI: 10.1016/j.bjpt.2021.100382 -
Journal of Geriatric Oncology Apr 2021Shared decision-making in cancer care, where we move away from the paternalistic "the doctor knows best" attitude to involving the patient in decisions regarding her or... (Review)
Review
Shared decision-making in cancer care, where we move away from the paternalistic "the doctor knows best" attitude to involving the patient in decisions regarding her or his health, is now universally accepted in western societies. However, in many situations this is easier said than done. For instance, if the interaction with the patient is not performed in a skillful manner, shared decision-making can make the patient feel unsafe - shouldn't the specialist know how to treat a serious disease such as cancer? Why would the doctor ask the patient about this? In other cases, what the patient wants in unrealistic, for example a severely frail patient aged 85 years with more than one life-limiting comorbidity who is diagnosed with an advanced cancer and has a goal of living to be at least 100 years. And what does a patient with advanced dementia want in the context of a cancer disease? In this perspectives piece, we will describe different scenarios that may arise within geriatric oncology and shared decision-making, make recommendations about how to handle such situations, and provide some food for thought.
Topics: Aged; Comorbidity; Decision Making; Decision Making, Shared; Female; Humans; Male; Neoplasms; Physician-Patient Relations; Physicians
PubMed: 32839118
DOI: 10.1016/j.jgo.2020.08.001 -
Neuroscience and Biobehavioral Reviews May 2020The scientific study of animal affect (emotion) is an area of growing interest. Whilst research on mechanism and causation has predominated, the study of function is... (Review)
Review
The scientific study of animal affect (emotion) is an area of growing interest. Whilst research on mechanism and causation has predominated, the study of function is less advanced. This is not due to a lack of hypotheses; in both humans and animals, affective states are frequently proposed to play a pivotal role in coordinating adaptive responses and decisions. However, exactly how they might do this (what processes might implement this function) is often left rather vague. Here we propose a framework for integrating animal affect and decision-making that is couched in modern decision theory and employs an operational definition that aligns with dimensional concepts of core affect and renders animal affect empirically tractable. We develop a model of how core affect, including short-term (emotion-like) and longer-term (mood-like) states, influence decision-making via processes that we label affective options, affective predictions, and affective outcomes and which correspond to similar concepts in schema of the links between human emotion and decision-making. Our framework is generalisable across species and generates questions for future research.
Topics: Affect; Animals; Behavior, Animal; Decision Making; Models, Biological
PubMed: 31991192
DOI: 10.1016/j.neubiorev.2020.01.025 -
Cognitive Science Jan 2023Though individual categorization or decision processes have been studied separately in many previous investigations, few studies have investigated how they interact by...
Though individual categorization or decision processes have been studied separately in many previous investigations, few studies have investigated how they interact by using a two-stage task of first categorizing and then deciding. To address this issue, we investigated a categorization-decision task in two experiments. In both, participants were shown six faces varying in width, first asked to categorize the faces, and then decide a course of action for each face. Each experiment was designed to include three groups, and for each group, we manipulated the probabilistic contingencies between stimulus, category assignments, and decision consequences. For each group, each participant received three different sequences of category response, category feedback, decision response, and decision feedback. We found that participants were only partially responsive in the appropriate directions to the contingencies assigned to each group. Comparisons of results from different sequences provided evidence for empirical interference effects of categorization on decisions. The empirical interference effect is defined as the difference between the probability of taking a hostile action in decision-alone conditions and the total probability of taking a hostile action in categorization-decision conditions. To test competing accounts for multiple empirical results, including two-stage choice probabilities and empirical interference effects, we compared a quantum cognition model versus a two-stage exemplar categorization model at both aggregate and individual levels. Using a Bayesian information criterion, we found that the quantum model provided an overall better model fit than the exemplar model. Although both models predicted empirical interference effects, the exemplar model was able to generate probabilistic deviation by incorporating category information of the first stage into the feature representation of the subsequent decision stage, while the quantum model produced interference effect by superposition, measurement, and quantum entanglement.
Topics: Humans; Bayes Theorem; Cognition; Probability; Decision Making
PubMed: 36655984
DOI: 10.1111/cogs.13235 -
Therapeutische Umschau. Revue... 2022
Topics: Decision Making; Decision Making, Shared; Humans; Patient Participation
PubMed: 36164736
DOI: 10.1024/0040-5930/a001374 -
British Journal of Anaesthesia Feb 2022Uncertainty is the defining state of the first minutes and hours of a mass casualty event, yet decisions must be taken and actions must happen before the picture is...
Uncertainty is the defining state of the first minutes and hours of a mass casualty event, yet decisions must be taken and actions must happen before the picture is complete. To move forwards in face of uncertainty, we must acknowledge that there will be insufficient information for us to be comfortable in our decisions and actions. We discuss here a range of solutions that allow us to tolerate, even flourish, in the midst of uncertainty.
Topics: Decision Making; Humans; Mass Casualty Incidents; Time Factors; Uncertainty
PubMed: 34823876
DOI: 10.1016/j.bja.2021.10.024 -
Topics in Cognitive Science Jan 2022Humans make decisions in dynamic environments (increasingly complex, highly uncertain, and changing situations) by searching for potential alternatives sequentially over...
Humans make decisions in dynamic environments (increasingly complex, highly uncertain, and changing situations) by searching for potential alternatives sequentially over time, to determine the best option at a precise moment. Surprisingly, the field of behavioral decision making has little to offer in terms of theoretical principles and practical guidelines on how people make decisions in dynamic situations. My research program aims to fill in this gap by developing theoretical understandings of decision processes as well as practical demonstrations of how these theoretical developments can improve human dynamic decision making. Throughout my research career, I have helped create, test, and improve a general theory of dynamic decision making, instance-based learning theory, IBLT. The methods I have used to contribute to IBLT are (1) laboratory experiments that rely on dynamic games in which humans make choices over time and space, individually and in teams, and from which we extrapolate robust phenomena and behavioral insights; and (2) computational, actionable cognitive models, which specify the decision-making process and the cognitive mechanisms involved into a computational algorithm. The combination of these methods spawned novel applications in areas such as cybersecurity, phishing, climate change, and human-machine interactions. In this paper, I will take you through my own intellectual exploratory experience of computational modeling of human decision processes, and how the integration of experimental work and cognitive modeling helped in discovering and uncovering the field of dynamic decision making.
Topics: Decision Making; Humans; Learning; Uncertainty
PubMed: 34767300
DOI: 10.1111/tops.12581 -
Biological Psychiatry May 2022Obesity is a heterogeneous condition that is affected by physiological, behavioral, and environmental factors. Value-based decision making is a useful framework for... (Review)
Review
Obesity is a heterogeneous condition that is affected by physiological, behavioral, and environmental factors. Value-based decision making is a useful framework for integrating these factors at the individual level. The disciplines of behavioral economics and reinforcement learning provide tools for identifying specific cognitive and motivational processes that may contribute to the development and maintenance of obesity. Neuroeconomics complements these disciplines by studying the neural mechanisms underlying these processes. We surveyed recent literature on individual decision characteristics that are most frequently implicated in obesity: discounting the value of future outcomes, attitudes toward uncertainty, and learning from rewards and punishments. Our survey highlighted both consistent and inconsistent behavioral findings. These findings underscore the need to examine multiple processes within individuals to identify unique behavioral profiles associated with obesity. Such individual characterization will inform future studies on the neurobiology of obesity as well as the design of effective interventions that are individually tailored.
Topics: Decision Making; Humans; Neurobiology; Obesity; Reinforcement, Psychology; Reward
PubMed: 34861975
DOI: 10.1016/j.biopsych.2021.09.019 -
International Journal of Environmental... May 2022Patient-centered care is the delivery of care that is unique to each patient, individualized to their needs, and established through a shared patient-clinician...
Patient-centered care is the delivery of care that is unique to each patient, individualized to their needs, and established through a shared patient-clinician decision-making process [...].
Topics: Decision Making; Decision Making, Shared; Delivery of Health Care; Health Literacy; Humans; Patient Participation; Patient-Centered Care
PubMed: 35682094
DOI: 10.3390/ijerph19116510 -
Neuron Oct 2019To understand decision-making behavior in simple, controlled environments, Bayesian models are often useful. First, optimal behavior is always Bayesian. Second, even... (Review)
Review
To understand decision-making behavior in simple, controlled environments, Bayesian models are often useful. First, optimal behavior is always Bayesian. Second, even when behavior deviates from optimality, the Bayesian approach offers candidate models to account for suboptimalities. Third, a realist interpretation of Bayesian models opens the door to studying the neural representation of uncertainty. In this tutorial, we review the principles of Bayesian models of decision making and then focus on five case studies with exercises. We conclude with reflections and future directions.
Topics: Bayes Theorem; Decision Making; Humans; Models, Psychological; Uncertainty
PubMed: 31600512
DOI: 10.1016/j.neuron.2019.09.037