-
Journal of Child Health Care : For... Jun 2023Parents of children born with complex life-threatening chronic conditions (CLTCs) experience an uncertain trajectory that requires critical decision making. Along this...
Parents of children born with complex life-threatening chronic conditions (CLTCs) experience an uncertain trajectory that requires critical decision making. Along this trajectory, hope plays an influential but largely unexplored role; therefore, this qualitative descriptive study explores how parent and provider hope may influence decision making and care of a child born with CLTCs. A total of 193 interviews from 46 individuals (parents, nurses, physicians, and nurse practitioners) responsible for the care of 11 infants with complex congenital heart disease (CCHD) were analyzed to understand how hope features in experiences related to communication, relationships, and emotions that influence decision making. Overall, parental hope remained strong and played a pivotal role in parental decision making. Parents and professional healthcare providers expressed a range of emotions that appeared to be integrally linked to hope and affected decision making. Providers and parents brought their own judgments, perceptions, and measure of hope to relationships, when there was common ground for expressing, and having, hope, shared decision making was more productive and they developed more effective relationships and communication. Relationships between parents and providers were particularly influenced by and contributory to hope. Communication between parents and providers was also responsible for and responsive to hope.
Topics: Humans; Infant; Communication; Decision Making; Emotions; Parents; Qualitative Research; Uncertainty
PubMed: 34967680
DOI: 10.1177/13674935211059041 -
Patient Education and Counseling Jul 2022Purposeful SDM posits four modes of shared decision making (SDM). The use of each mode depends on the type of problem of care that is being addressed. We sought to...
OBJECTIVES
Purposeful SDM posits four modes of shared decision making (SDM). The use of each mode depends on the type of problem of care that is being addressed. We sought to identify how current observer-based SDM measures apply to each mode of Purposeful SDM.
METHODS
Four coders, working independently, evaluated 192 items pertaining to 12 observer-based SDM process measures. They classified the items into 6 themes that vary across Purposeful SDM modes and then into one of the four modes (weighing, negotiating, problem-solving, developing insight). Disagreements were resolved by consensus.
RESULTS
The items were classified as pertaining to the following themes: problem (28), roles/participation (84), options (62), preferences (21), decision (15), and evaluation (6). They were then classified as pertaining particularly to the SDM modes of weighing (54), negotiating (5), problem-solving (0), and developing insight (0) modes, with 191 items applying broadly to all modes of Purposeful SDM.
CONCLUSIONS
Observer-based SDM measures describe behaviors pertinent to all modes but lack items sensitive to behaviors particular to some modes of SDM.
PRACTICE IMPLICATIONS
New or revised observer-based measures of the SDM process could help estimate the extent to which the appropriate SDM mode is being used to address the patient's problem.
Topics: Decision Making; Decision Making, Shared; Humans; Negotiating; Patient Participation; Problem Solving; Process Assessment, Health Care
PubMed: 34802881
DOI: 10.1016/j.pec.2021.11.001 -
Trends in Neurosciences Oct 2020Animals and humans evolved sophisticated nervous systems that endowed them with the ability to form internal-models or beliefs and make predictions about the future to... (Review)
Review
Animals and humans evolved sophisticated nervous systems that endowed them with the ability to form internal-models or beliefs and make predictions about the future to survive and flourish in a world in which future outcomes are often uncertain. Crucial to this capacity is the ability to adjust behavioral and learning policies in response to the level of uncertainty. Until recently, the neuronal mechanisms that could underlie such uncertainty-guided control have been largely unknown. In this review, I discuss newly discovered neuronal circuits in primates that represent uncertainty about future rewards and propose how they guide information-seeking, attention, decision-making, and learning to help us survive in an uncertain world. Lastly, I discuss the possible relevance of these findings to learning in artificial systems.
Topics: Animals; Attention; Choice Behavior; Decision Making; Learning; Reward; Uncertainty
PubMed: 32736849
DOI: 10.1016/j.tins.2020.06.009 -
Patient Education and Counseling May 2023The purpose of this review is to explore the breadth of research conducted on SDM in the care of Black patients. (Review)
Review
OBJECTIVE
The purpose of this review is to explore the breadth of research conducted on SDM in the care of Black patients.
METHODS
We conducted a scoping review following the methodological framework outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. We searched articles related to original research on SDM in the care of Black patients in October 2022 using PubMed, Embase, and Google Scholar databases. Articles of all study designs (quantitative and qualitative), published or translated into English, were included. A standardized data extraction form and thematic analysis were used to facilitate data extraction by two independent reviewers.
RESULTS
After removal of duplicates and screening, 30 articles were included in the final analysis. Black patients and clinician were found to not share the same understanding of SDM, and patients highly valued SDM in their care. Interventions to improve SDM yielded mixed results to enhance intent, participation in SDM, as well as health outcomes. Decision aids were the most effective form of intervention to enhance SDM. The most common barrier to SDM was patient-clinician communication, and was exacerbated by racial discordance, clinician mistrust, past experiences, and paternalistic clinician-patient dynamics.
CONCLUSIONS
SDM has the potential to improve health outcomes in Black patients when implemented contextually within Black patients' experiences and concerns. Significant barriers such as clinician mistrust exist, and the overall perception in the Black community is that SDM does not occur sufficiently. Barriers to SDM seem to be most pronounced when there is patient-clinician racial discordance. Several interventions aimed at improving SDM with Black patients have shown mixed results. Future studies should evaluate larger-scale interventions with longer follow-up. Practice implications Shared decision making (SDM) has been proposed as a useful tool for improving quality and equity in Black patients' care. However, Black patients experience lower rates of SDM compared to other populations. SDM has the potential to improve health outcomes in Black patients when implemented contextually within Black patients' experiences and concerns.
Topics: Humans; Decision Making, Shared; Decision Making; Patient Participation; Black People; Communication
PubMed: 36739706
DOI: 10.1016/j.pec.2023.107646 -
The Journal of Neuroscience : the... Jun 2021A successful class of models link decision-making to brain signals by assuming that evidence accumulates to a decision threshold. These evidence accumulation models have...
A successful class of models link decision-making to brain signals by assuming that evidence accumulates to a decision threshold. These evidence accumulation models have identified neuronal activity that appears to reflect sensory evidence and decision variables that drive behavior. More recently, an additional evidence-independent and time-variant signal, called urgency, has been hypothesized to accelerate decisions in the face of insufficient evidence. However, most decision-making paradigms tested with fMRI or EEG in humans have not been designed to disentangle evidence accumulation from urgency. Here we use a face-morphing decision-making task in combination with EEG and a hierarchical Bayesian model to identify neural signals related to sensory and decision variables, and to test the urgency-gating model. Forty females and 34 males took part (mean age, 23.4 years). We find that an evoked potential time locked to the decision, the centroparietal positivity, reflects the decision variable from the computational model. We further show that the unfolding of this signal throughout the decision process best reflects the product of sensory evidence and an evidence-independent urgency signal. Urgency varied across subjects, suggesting that it may represent an individual trait. Our results show that it is possible to use EEG to distinguish neural signals related to sensory evidence accumulation, decision variables, and urgency. These mechanisms expose principles of cognitive function in general and may have applications to the study of pathologic decision-making such as in impulse control and addictive disorders. Perceptual decisions are often described by a class of models that assumes that sensory evidence accumulates gradually over time until a decision threshold is reached. In the present study, we demonstrate that an additional urgency signal impacts how decisions are formed. This endogenous signal encourages one to respond as time elapses. We found that neural decision signals measured by EEG reflect the product of sensory evidence and an evidence-independent urgency signal. A nuanced understanding of human decisions, and the neural mechanisms that support it, can improve decision-making in many situations and potentially ameliorate dysfunction when it has gone awry.
Topics: Adult; Bayes Theorem; Brain; Decision Making; Electroencephalography; Female; Humans; Male
PubMed: 34035140
DOI: 10.1523/JNEUROSCI.2551-20.2021 -
Archivos Argentinos de Pediatria Feb 2023
Topics: Humans; Decision Making, Shared; Decision Making
PubMed: 36194616
DOI: 10.5546/aap.2022-02754.eng -
PLoS Computational Biology Jan 2022The replay of task-relevant trajectories is known to contribute to memory consolidation and improved task performance. A wide variety of experimental data show that the...
The replay of task-relevant trajectories is known to contribute to memory consolidation and improved task performance. A wide variety of experimental data show that the content of replayed sequences is highly specific and can be modulated by reward as well as other prominent task variables. However, the rules governing the choice of sequences to be replayed still remain poorly understood. One recent theoretical suggestion is that the prioritization of replay experiences in decision-making problems is based on their effect on the choice of action. We show that this implies that subjects should replay sub-optimal actions that they dysfunctionally choose rather than optimal ones, when, by being forgetful, they experience large amounts of uncertainty in their internal models of the world. We use this to account for recent experimental data demonstrating exactly pessimal replay, fitting model parameters to the individual subjects' choices.
Topics: Computational Biology; Decision Making; Humans; Memory Consolidation; Models, Neurological; Optimism; Pessimism; Uncertainty
PubMed: 35020718
DOI: 10.1371/journal.pcbi.1009634 -
Neuron Jul 2022Corticostriatal circuits represent value and choice during value-guided decision making. In this issue of Neuron, Balewski et al. (2022) show that caudate nucleus and...
Corticostriatal circuits represent value and choice during value-guided decision making. In this issue of Neuron, Balewski et al. (2022) show that caudate nucleus and orbitofrontal cortex use distinct value signals during choice, which are consistent with two parallel valuation mechanisms, one fast, one slow.
Topics: Caudate Nucleus; Choice Behavior; Decision Making; Neurons; Prefrontal Cortex; Reward
PubMed: 35797959
DOI: 10.1016/j.neuron.2022.06.011 -
Cognition Feb 2024Despite the importance of uncertainty in decision-making, few published studies have examined how individuals make moral judgments under uncertainty. Across four...
Despite the importance of uncertainty in decision-making, few published studies have examined how individuals make moral judgments under uncertainty. Across four experiments (N = 445), we examined whether a relatively small shift in probability affected participants' judgments of both moral acceptability and choice. Overall, reading dilemmas where the characters were either certain or likely to die, the probability of the sacrificed individual and the group at risk dying both had independent effects on participants' responses. That is, participants were more accepting of sacrificing the individual if they were not certain to die, but less accepting if the group was only likely to die when the individual was not sacrificed. Furthermore, a number of participants made acceptability ratings that did not match the action they endorsed, either finding the sacrificial decision more acceptable but refusing to make it, or choosing the sacrificial decision while viewing it as less acceptable. Many participants also stated that this was because they recognised a crucial difference between what they viewed as morally acceptable in a dilemma and what they were actually willing to do. Such mismatches may reflect the sensitivity and complexity of the moral principles that individuals employ during their moral decision-making.
Topics: Humans; Decision Making; Uncertainty; Judgment; Morals; Moral Obligations
PubMed: 38101081
DOI: 10.1016/j.cognition.2023.105692 -
Pediatrics Nov 2022To develop recommendations for pediatric shared decision-making (SDM).
OBJECTIVE
To develop recommendations for pediatric shared decision-making (SDM).
METHODS
We conducted a Delphi method study from 2020 to 2021 with an international panel (n = 21) of clinicians, researchers, and parents with expertise in pediatric SDM. We conducted semistructured interviews to identify the key processes of pediatric SDM. We coded the interviews using content analysis and developed a questionnaire on the potential processes of pediatric SDM. Using a Likert scale, panelists evaluated each process twice, once for simple decisions and once for complex decisions. Panelists were provided with a summary of the results and evaluated each process again. The processes that were agreed on for simple and complex decisions were reported as "fundamental processes." The processes that were agreed on for complex decisions were reported as "additional processes."
RESULTS
A total of 79 recommendations were developed, including 29 fundamental processes and 14 additional processes for complex decisions. A recurring theme was the importance of personalizing the decision-making process. For example, the panel recommended that physicians should assess the family and child's desired roles in the decision-making process, assess their desired level of directiveness, and elicit and clarify their values, preferences, and goals. The panel also disagreed on several subprocesses, such as how to determine the child's role and the appropriate level of directiveness.
CONCLUSIONS
An international expert panel developed recommendations for pediatric SDM for both simple and complex decisions. The recommendations highlight the importance of personalizing the decision-making process.
Topics: Child; Humans; Decision Making, Shared; Parents; Decision Making; Patient Participation
PubMed: 36217896
DOI: 10.1542/peds.2022-057978