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Current Biology : CB Oct 2021Memory enables access to past experiences to guide future behavior. Humans can determine which memories to trust (high confidence) and which to doubt (low confidence)....
Memory enables access to past experiences to guide future behavior. Humans can determine which memories to trust (high confidence) and which to doubt (low confidence). How memory retrieval, memory confidence, and memory-guided decisions are related, however, is not understood. In particular, how confidence in memories is used in decision making is unknown. We developed a spatial memory task in which rats were incentivized to gamble their time: betting more following a correct choice yielded greater reward. Rat behavior reflected memory confidence, with higher temporal bets following correct choices. We applied machine learning to identify a memory decision variable and built a generative model of memories evolving over time that accurately predicted both choices and confidence reports. Our results reveal in rats an ability thought to exist exclusively in primates and introduce a unified model of memory dynamics, retrieval, choice, and confidence.
Topics: Animals; Choice Behavior; Decision Making; Memory; Rats; Reward
PubMed: 34473948
DOI: 10.1016/j.cub.2021.08.013 -
Community Mental Health Journal Apr 2022There is increased interest over the last decade in the use of Shared Decision Making with individuals with serious mental illness to improve engagement in treatment and...
There is increased interest over the last decade in the use of Shared Decision Making with individuals with serious mental illness to improve engagement in treatment and clinical outcomes. We conducted semi-structured qualitative interviews with 15 individuals with serious mental illness treated in an outpatient transitional care clinic serving people immediately after discharge from a psychiatric hospitalization. Parallel interviews were conducted with a variety of clinical providers (n = 9). Using latent thematic analysis, six themes were identified including: (1) Differences in the Use of SDM, (2) Consideration of Past Experiences, (3) Decisional Power Preferences, (4) Use of SDM in Psychiatry Versus Other Areas of Medicine, (5) Dignity and Disengagement, and (6) External Forces Impacting SDM. Implications for clinical practice and research using a shared decision-making approach within this treatment setting are further discussed.
Topics: Ambulatory Care Facilities; Decision Making; Decision Making, Shared; Humans; Patient Participation; Psychiatry
PubMed: 34176054
DOI: 10.1007/s10597-021-00856-z -
Proceedings of the National Academy of... Dec 2019Diffusion decision models (DDMs) are immensely successful models for decision making under uncertainty and time pressure. In the context of perceptual decision making,...
Diffusion decision models (DDMs) are immensely successful models for decision making under uncertainty and time pressure. In the context of perceptual decision making, these models typically start with two input units, organized in a neuron-antineuron pair. In contrast, in the brain, sensory inputs are encoded through the activity of large neuronal populations. Moreover, while DDMs are wired by hand, the nervous system must learn the weights of the network through trial and error. There is currently no normative theory of learning in DDMs and therefore no theory of how decision makers could learn to make optimal decisions in this context. Here, we derive such a rule for learning a near-optimal linear combination of DDM inputs based on trial-by-trial feedback. The rule is Bayesian in the sense that it learns not only the mean of the weights but also the uncertainty around this mean in the form of a covariance matrix. In this rule, the rate of learning is proportional (respectively, inversely proportional) to confidence for incorrect (respectively, correct) decisions. Furthermore, we show that, in volatile environments, the rule predicts a bias toward repeating the same choice after correct decisions, with a bias strength that is modulated by the previous choice's difficulty. Finally, we extend our learning rule to cases for which one of the choices is more likely a priori, which provides insights into how such biases modulate the mechanisms leading to optimal decisions in diffusion models.
Topics: Bayes Theorem; Brain; Decision Making; Feedback; Humans; Learning; Models, Psychological; Neurons; Self Concept; Uncertainty
PubMed: 31732671
DOI: 10.1073/pnas.1906787116 -
Journal of Medical Ethics Mar 2020In recent years, a plethora of high-profile scientific publications has been reporting about machine learning algorithms outperforming clinicians in medical diagnosis or...
In recent years, a plethora of high-profile scientific publications has been reporting about machine learning algorithms outperforming clinicians in medical diagnosis or treatment recommendations. This has spiked interest in deploying relevant algorithms with the aim of enhancing decision-making in healthcare. In this paper, we argue that instead of straightforwardly enhancing the decision-making capabilities of clinicians and healthcare institutions, deploying machines learning algorithms entails trade-offs at the epistemic and the normative level. Whereas involving machine learning might improve the accuracy of medical diagnosis, it comes at the expense of opacity when trying to assess the reliability of given diagnosis. Drawing on literature in social epistemology and moral responsibility, we argue that the uncertainty in question potentially undermines the epistemic authority of clinicians. Furthermore, we elucidate potential pitfalls of involving machine learning in healthcare with respect to paternalism, moral responsibility and fairness. At last, we discuss how the deployment of machine learning algorithms might shift the evidentiary norms of medical diagnosis. In this regard, we hope to lay the grounds for further ethical reflection of the opportunities and pitfalls of machine learning for enhancing decision-making in healthcare.
Topics: Decision Making; Delivery of Health Care; Ethics, Medical; Humans; Morals; Paternalism; Reproducibility of Results; Uncertainty
PubMed: 31748206
DOI: 10.1136/medethics-2019-105586 -
Journal of Experimental Psychology.... Jun 2023Human adolescence is characterized by a suite of changes in decision-making and emotional regulation that promote risky and impulsive behavior. Accumulating evidence...
Human adolescence is characterized by a suite of changes in decision-making and emotional regulation that promote risky and impulsive behavior. Accumulating evidence suggests that behavioral and physiological shifts seen in human adolescence are shared by some primates, yet it is unclear if the same cognitive mechanisms are recruited. We examined developmental changes in risky choice, intertemporal choice, and emotional responses to decision outcomes in chimpanzees, our closest-living relatives. We found that adolescent chimpanzees were more risk-seeking than adults, as in humans. However, chimpanzees showed no developmental change in intertemporal choice, unlike humans, although younger chimpanzees did exhibit elevated emotional reactivity to waiting compared to adults. Comparisons of cortisol and testosterone indicated robust age-related variation in these biomarkers, and patterns of individual differences in choices, emotional reactivity, and hormones also supported a developmental dissociation between risk and choice impulsivity. These results show that some but not all core features of human adolescent decision-making are shared with chimpanzees. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Topics: Adult; Adolescent; Animals; Humans; Decision Making; Pan troglodytes; Impulsive Behavior; Emotions; Risk-Taking
PubMed: 36689365
DOI: 10.1037/xge0001347 -
International Journal of Environmental... Jan 2021. To gain insight into the current state-of-the-art of shared decision making (SDM) during decisions related to pre and postoperative care process regarding primary... (Review)
Review
. To gain insight into the current state-of-the-art of shared decision making (SDM) during decisions related to pre and postoperative care process regarding primary total knee replacement (TKR). . A scoping review was performed to synthesize existing scientific research regarding (1) decisional needs and preferences of patients preparing for, undergoing and recovering from TKR surgery, (2) the relation between TKR decision-support interventions and SDM elements (i.e., team talk, option talk, and decision talk), (3) the extent to which TKR decision-support interventions address patients' decisional needs and preferences. . 2526 articles were identified, of which 17 articles met the inclusion criteria. Of the 17 articles, ten had a qualitative study design and seven had a quantitative study design. All included articles focused on the decision whether to undergo TKR surgery or not. Ten articles (all qualitative) examined patients' decisional needs and preferences. From these, we identified four domains that affected the patients' decision to undergo TKR: (1) personal factors, (2) external factors, (3) information sources and (4) preferences towards outcome prediction. Seven studies (5) randomized controlled trials and 2 cohort studies) used quantitative analyses to probe the effect of decision aids on SDM and/or clinical outcomes. In general, existing decision aids did not appear to be tailored to patient needs and preferences, nor were the principles of SDM well-articulated in the design of decision aids. SDM in TKR care is understudied; existing research appears to be narrow in scope with limited relevance to established SDM principles and the decisional needs of patients undertaking TKR surgery.
Topics: Arthroplasty, Replacement, Knee; Decision Making; Decision Making, Shared; Humans; Patient Participation; Qualitative Research
PubMed: 33466879
DOI: 10.3390/ijerph18020668 -
BMJ Paediatrics Open Apr 2023Children with medical complexity is an increasing population whose parents and healthcare providers face multiple decisions. Shared decision-making is a process where... (Review)
Review
BACKGROUND
Children with medical complexity is an increasing population whose parents and healthcare providers face multiple decisions. Shared decision-making is a process where patients, their families and healthcare providers collaborate to make decisions based on clinical evidence and informed preferences of the family. Shared decision-making has benefits for the child, family and healthcare providers, including improved parental understanding of the child's difficulties, increased participation, improved coping skills and more efficient healthcare use. It is, however, poorly implemented.
AIMS AND METHODS
A scoping review was conducted to explore shared decision-making for children with medical complexity in community health services, including how shared decision-making is defined in research, how it is implemented, including barriers and facilitators and recommendations for research. Six databases were systematically searched for papers published in English up to May 2022: Medline, CINAHL, EMBASE, PsycINFO, PubMed, Cochrane Database of Systematic Reviews and sources of grey literature. The review is reported according to the Preferred Reporting Items for Scoping Reviews.
RESULTS
Thirty sources met the inclusion criteria. Most factors can either be a facilitator or barrier to shared decision-making depending on the context. Two significant barriers to shared decision-making in this population include uncertainty about the child's diagnosis, prognosis, and treatment options and the presence of hierarchy and power imbalance during clinical encounters with healthcare providers. Further influencing factors include continuity of care, the availability of accurate, accessible, adequate, and balanced information and the interpersonal and communication skills of parents and healthcare providers.
CONCLUSION
Uncertainty about diagnosis, prognosis and treatment outcomes for children with medical complexity are additional challenges to the known barriers and facilitators to shared decision-making in community health services. Effective implementation of shared decision-making requires advancement of the evidence base for children with medical complexity, reducing power imbalance in clinical encounters, improving continuity of care, and improving the availability and accessibility of information resources.
Topics: Humans; Child; Decision Making; Systematic Reviews as Topic; Decision Making, Shared; Patient Participation; Community Health Services
PubMed: 37012004
DOI: 10.1136/bmjpo-2023-001866 -
International Journal of Surgery... Mar 2020Discovering IF (incidental findings) during surgery results in ethical and legal dilemmas for the surgeon, especially those in training or recently qualified. The... (Review)
Review
BACKGROUND
Discovering IF (incidental findings) during surgery results in ethical and legal dilemmas for the surgeon, especially those in training or recently qualified. The situation is further compounded as these can occur in an emergency. The immediacy of making the correct decision can be paramount for both the surgeon and the patient.
METHODS
Firstly, this article will review the ethical and legal frameworks of IF during surgery for those unfamiliar on the literature. Secondly, it will evaluate the use of a proposed IF tool to illustrate the decision-making processes in published case reports for those unfamiliar to the process. After the above two have been completed, a decision-making IF guidance tool will be constructed, which could help educate trainee surgeons.
RESULTS
The ethical and legal frameworks include the Hippocratic oath, domestic and European legislation, case law, civil and criminal laws. In the evaluated case reports there were IF which were either life-threatening or affecting the immediate life of the patients. 90% of the cases were emergency and 10% were elective operations. Using the proposed IF tool and combining it with peer-reviewed published best practice, 60% of the cases were correct in their intra-operative decision-making. This demonstrates the need of some type of guidance on the subject. As a consequence of these results, the article describes the construction of an IF decision-making guidance tool. The essential components of the guidance tool involve decision-making, the inference from other medical fields, ethical and legal elements, the available experience, skills and specialist knowledge at the time, best clinical practice and post-operative management and counselling.
CONCLUSIONS
On finding an IF during surgery, the surgeon must balance the ethical dilemmas of autonomy, beneficence, justice, and non-maleficence for the patient. This is further complicated by applying these principals to current civil and criminal laws. By constructing an IF guidance tool may assist in improving patient safety and help the trainee and newly qualified surgeon and his team to come to the correct decisions in the best interests of the patient.
Topics: Decision Making; Humans; Incidental Findings; Surgical Procedures, Operative
PubMed: 32014592
DOI: 10.1016/j.ijsu.2020.01.141 -
Annals of Family Medicine 2023The extent of shared decision making (SDM) use in the care of Black patients is limited. We explored preferences, needs, and challenges of Black patients to enhance SDM...
OBJECTIVE
The extent of shared decision making (SDM) use in the care of Black patients is limited. We explored preferences, needs, and challenges of Black patients to enhance SDM offerings.
METHODS
We performed interviews with 32 Black patients receiving type 2 diabetes care in safety-net primary care practices caring predominantly for Black people.
RESULTS
The following 4 themes emerged: preference for humanistic communication, need to account for the role of family in decision making, need for medical information sharing, and mistrust of clinicians.
CONCLUSION
Given the dearth of research on SDM among ethnic and racial minorities, this study offers patient-perspective recommendations to improve SDM offerings for Black patients in primary care settings. To enhance SDM with Black patients, acknowledgment of the importance of storytelling as a strategy, to place medical information in a context that makes it meaningful and memorable, is recommended. Triadic SDM, in which family members are centrally involved in decision making, is preferred over classical dyadic SDM. There is a need to reconsider the universalism assumption underlying contemporary SDM models and the relevancy of current SDM practices that were developed mostly without the feedback of participants of ethnic, racial, and cultural minorities. "Online First" article.
Topics: Humans; Decision Making, Shared; Black or African American; Decision Making; Diabetes Mellitus, Type 2; Patient Participation
PubMed: 36750357
DOI: 10.1370/afm.2943 -
Supportive Care in Cancer : Official... Dec 2022Shared decision making (SDM) among the oncology population is highly important due to complex screening and treatment decisions. SDM among patients with cancer,... (Review)
Review
PURPOSE
Shared decision making (SDM) among the oncology population is highly important due to complex screening and treatment decisions. SDM among patients with cancer, caregivers, and clinicians has gained more attention and importance, yet few articles have systematically examined SDM, specifically in the adult oncology population. This review aims to explore SDM within the oncology literature and help identify major gaps and concerns, with the goal to provide guidance in the development of clear SDM definitions and interventions.
METHODS
We conducted a scoping review using the Arksey and O'Malley approach along with the PRISMA Extension for Scoping Reviews Checklist. A systematic search was conducted in four databases that included publications since 2016.
RESULTS
Of the 364 initial articles, eleven publications met the inclusion criteria. We included articles that were original research, cancer related, and focused on shared decision making. Most studies were limited in defining SDM and operationalizing a model of SDM. There were several concerns revealed related to SDM: (1) racial inequality, (2) quality and preference of the patient, caregiver, and clinician communication is important, and (3) the use of a decision-making aid or tool provides value to the patient experience.
CONCLUSION
Inconsistencies regarding the meaning and operationalization of SDM and inequality of the SDM process among patients from different racial/ethnic backgrounds impact the health and quality of care patients receive. Future studies should clearly and consistently define the meaning of SDM and develop decision aids that incorporate bidirectional, interactive communication between patients, caregivers, and clinicians that account for the diversity of racial, ethnic, and sociocultural backgrounds and preferences.
Topics: Adult; Humans; United States; Decision Making, Shared; Decision Making; Patient Participation; Medical Oncology; Neoplasms
PubMed: 36585510
DOI: 10.1007/s00520-022-07556-8