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The International Journal of Social... Jun 2023Shared decision making (SDM) is a health communication model promoting patient-centered care that has not been routinely utilized in mental health. Inconsistent... (Review)
Review
BACKGROUND
Shared decision making (SDM) is a health communication model promoting patient-centered care that has not been routinely utilized in mental health. Inconsistent definitions, models, measurement tools, and lack of sufficient evidence for the effectiveness of SDM interventions are potential contributors to the limited use of SDM in mental health.
AIMS
(1) Provide the first systematic analysis of global development trends and challenges of SDM research; (2) clarify the meaning, role, and measurement of SDM in mental health; (3) create a theoretical framework for key effective SDM components to guide future development and implementation of SDM interventions.
METHODS
A comprehensive search strategy was conducted in CINAHL, PubMed, Scopus, MEDLINE, EMBASE, Cochrane Library, Web of Science, Scopus, and PsycInfo. Included reviews focused on SDM interventions for prevention and/or treatment of mental illness in adults. A narrative synthesis was performed to capture the range of interventions, populations, measurement tools, comparisons, and outcomes.
RESULTS
10 systematic reviews of SDM in mental health were included with 100 nested studies spanning from 2006 to 2020. All reviews focused on dyadic and psychopharmacological decision-making. Primary outcomes of SDM in mental health interventions include treatment satisfaction, medication adherence, symptom severity, quality of life, and hospital readmissions. Participant-related factors unique to SDM in mental health, such as stigma and mental capacity, were not reported.
CONCLUSIONS
The current landscape of SDM in mental health is overwhelmingly disconnected from the needs and experiences of potential end-users; clients, clinicians, and family members. Most SDM interventions and tools were adapted from physical health and are mainly geared to psychopharmacological decision-making. The SDM in Mental Health Framework (SDM-MH), developed here, expands the scope of decisions to non-psychopharmacological discussions, diversifies the pool of SDM participants and settings, and offers potential primary target outcomes of SDM in mental health to reduce heterogeneity across studies.
Topics: Adult; Humans; Decision Making; Decision Making, Shared; Patient Participation; Mental Health; Quality of Life
PubMed: 36680367
DOI: 10.1177/00207640221140291 -
ELife Sep 2020Human decisions are based on finite information, which makes them inherently imprecise. But what determines the degree of such imprecision? Here, we develop an efficient...
Human decisions are based on finite information, which makes them inherently imprecise. But what determines the degree of such imprecision? Here, we develop an efficient coding framework for higher-level cognitive processes in which information is represented by a finite number of discrete samples. We characterize the sampling process that maximizes perceptual accuracy or fitness under the often-adopted assumption that full adaptation to an environmental distribution is possible, and show how the optimal process differs when detailed information about the current contextual distribution is costly. We tested this theory on a numerosity discrimination task, and found that humans efficiently adapt to contextual distributions, but in the way predicted by the model in which people must economize on environmental information. Thus, understanding decision behavior requires that we account for biological restrictions on information coding, challenging the often-adopted assumption of precise prior knowledge in higher-level decision systems.
Topics: Adult; Algorithms; Choice Behavior; Decision Making; Female; Humans; Male; Models, Psychological; Task Performance and Analysis; Young Adult
PubMed: 32930663
DOI: 10.7554/eLife.54962 -
ELife Nov 2021Sex-based modulation of cognitive processes could set the stage for individual differences in vulnerability to neuropsychiatric disorders. While value-based decision...
Sex-based modulation of cognitive processes could set the stage for individual differences in vulnerability to neuropsychiatric disorders. While value-based decision making processes in particular have been proposed to be influenced by sex differences, the overall correct performance in decision making tasks often show variable or minimal differences across sexes. Computational tools allow us to uncover latent variables that define different decision making approaches, even in animals with similar correct performance. Here, we quantify sex differences in mice in the latent variables underlying behavior in a classic value-based decision making task: a restless two-armed bandit. While male and female mice had similar accuracy, they achieved this performance via different patterns of exploration. Male mice tended to make more exploratory choices overall, largely because they appeared to get 'stuck' in exploration once they had started. Female mice tended to explore less but learned more quickly during exploration. Together, these results suggest that sex exerts stronger influences on decision making during periods of learning and exploration than during stable choices. Exploration during decision making is altered in people diagnosed with addictions, depression, and neurodevelopmental disabilities, pinpointing the neural mechanisms of exploration as a highly translational avenue for conferring sex-modulated vulnerability to neuropsychiatric diagnoses.
Topics: Animals; Anxiety; Choice Behavior; Decision Making; Exploratory Behavior; Female; Male; Mice; Reward; Sex Factors
PubMed: 34796870
DOI: 10.7554/eLife.69748 -
International Journal of Environmental... Nov 2022Risk and loss aversion are phenomena with an important influence on decision-making, especially in economic contexts. At present, it remains unclear whether both are... (Review)
Review
Risk and loss aversion are phenomena with an important influence on decision-making, especially in economic contexts. At present, it remains unclear whether both are related, as well as whether they could have an emotional origin. The objective of this review, following the PRISMA statements, is to find consistencies in the genetic bases of risk and loss aversion with the aim of understanding their nature and shedding light on the above issues. A total of 23 empirical research met the inclusion criteria and were included from PubMed and ScienceDirect. All of them reported genetic measures from human samples and studied risk and loss aversion within an economic framework. The results for risk aversion, although with many limitations, attributed mainly to their heterogeneity and the lack of control in the studies, point to the implication of multiple polymorphisms related to the regulation of the serotonergic and dopaminergic pathways. In general, studies found the highest levels of risk aversion were associated with alleles that are linked to lower (higher) sensitivity or levels of dopamine (serotonin). For loss aversion, the scarcity of results prevents us from drawing clear conclusions, although the limited evidence seems to point in the same direction as for risk aversion. Therefore, it seems that risk aversion could have a stable genetical base which, in turn, is closely linked to emotions, but more research is needed to answer whether this phenomenon is related to loss aversion, as well as if the latter could also have an emotional origin. We also provide recommendations for future studies on genetics and economic behavior.
Topics: Humans; Affect; Emotions; Polymorphism, Genetic; Dopamine; Alleles; Decision Making
PubMed: 36361187
DOI: 10.3390/ijerph192114307 -
Journal of Neuroscience Research Jun 2020Goal-directed and habitual decision-making are fundamental processes that support the ongoing adaptive behavior. There is a growing interest in examining their... (Review)
Review
Goal-directed and habitual decision-making are fundamental processes that support the ongoing adaptive behavior. There is a growing interest in examining their disruption in psychiatric disease, often with a focus on a disease shifting control from one process to the other, usually a shift from goal-directed to habitual control. However, several different experimental procedures can be used to probe whether decision-making is under goal-directed or habitual control, including outcome devaluation and contingency degradation. These different experimental procedures may recruit diverse behavioral and neural processes. Thus, there are potentially many opportunities for these disease phenotypes to manifest as alterations to both goal-directed and habitual controls. In this review, we highlight the examples of behavioral and neural circuit divergence and similarity, and suggest that interpretation based on behavioral processes recruited during testing may leave more room for goal-directed and habitual decision-making to coexist. Furthermore, this may improve our understanding of precisely what the involved neural mechanisms underlying aspects of goal-directed and habitual behavior are, as well as how disease affects behavior and these circuits.
Topics: Animals; Brain; Decision Making; Goals; Habits
PubMed: 31642551
DOI: 10.1002/jnr.24545 -
Neuropharmacology Jul 2019Ever-increasing evidence suggests that substance use disorder is mediated by decision-making processes, and as such, providing nondrug alternatives can shift maladaptive...
Ever-increasing evidence suggests that substance use disorder is mediated by decision-making processes, and as such, providing nondrug alternatives can shift maladaptive preferences away from drug reinforcers, such as cocaine. Of note, a recent hypothesis suggests that preference for cocaine is simply a byproduct of cocaine intake, such that the 'direct' effects of cocaine weaken the impact of non-drug alternatives while measuring choice. Conversely, existing quantitative theories of decision-making suggest preference is determined by various dimensions of concurrent reinforcers that in turn determine the relative value of available alternatives. Toward teasing apart the conflicting theories above, we developed a novel drug-choice procedure to control for reinforcer frequency and magnitude (two reinforcer dimensions well known to influence preference) that consequently controls for overall cocaine intake. As predicted by quantitative choice theory, results suggest that cocaine intake and preference are dissociable while measuring choice, with reinforcer frequency and magnitude having independent influence on the relative value of choice alternatives. Furthermore, we demonstrate that the choice procedure is sensitive to various manipulations known to alter cocaine reinforcement, all while keeping cocaine intake constant. Finally, the results point to the process of economic substitution as an important avenue of future neurobehavioral investigation toward the improvement of behavioral and pharmacological therapies for substance use disorders. Overall, the proposed choice procedure will allow for improved isolation of the neurobehavioral processes that mediate drug-associated decision-making in future studies.
Topics: Animals; Cocaine; Decision Making; Dopamine Uptake Inhibitors; Dose-Response Relationship, Drug; Eating; Rats; Rats, Sprague-Dawley; Reinforcement, Psychology; Self Administration
PubMed: 30905612
DOI: 10.1016/j.neuropharm.2019.03.025 -
BMC Psychiatry Oct 2023Shared decision making is a process where patients and clinicians collaborate to make treatment choices based on the patients' preferences and best available evidence....
BACKGROUND
Shared decision making is a process where patients and clinicians collaborate to make treatment choices based on the patients' preferences and best available evidence. The implementation of shared decision making remains limited for patients with psychotic disorders despite being recommended at policy level, being advocated as ethical right and wanted by the patient's. A barrier to implementation that is often mentioned is reduced decision-making capacity among patients. The challenges of implementing shared decision making highlights a need for more knowledge on shared decision making for these patients. Moreover, the association between patient-related characteristics and shared decision making is unclear, and further research have been suggested. More knowledge of factors associated with involvement in shared decision making can enhance understanding and help to empower patients in the decision-making process. The current study examined the extent of reported shared decision making among patients with a psychotic disorder in mental health care and factors associated with shared decision making.
METHODS
This study included 305 participants with a psychotic disorder from 39 clinical inpatient and outpatient sites across Norway. Shared decision making was assessed using the CollaboRATE survey. A linear mixed model was estimated to assess characteristics associated with shared decision making scores.
RESULTS
The CollaboRATE mean score was 6.3 (ranging from 0 to 9), the top score was 14.1% and increased global satisfaction with services was significantly associated with a higher level of shared decision making (regression coefficient 0.27, 95% confidence interval (0.23; 0.32), p < 0.001).
CONCLUSIONS
The low top score shows that few patients felt that they received the highest possible quality of shared decision making, indicating that many patients found room for improvement. This suggests that services for patients with psychotic disorders should be designed to give them a greater role in decision making. Shared decision making might play a key role in mental health care, ensuring that patients with psychotic disorders are satisfied with the services provided.
TRIAL REGISTRATION
NCT03271242, date of registration: 5 Sept. 2017.
Topics: Humans; Decision Making, Shared; Cross-Sectional Studies; Psychotic Disorders; Inpatients; Outpatients; Decision Making; Patient Participation
PubMed: 37833737
DOI: 10.1186/s12888-023-05257-y -
International Journal of Law and... 2019A person's capacity to process advice is an important aspect of decision making in the real world. For example, in decisions about treatment, the way patients respond to... (Review)
Review
A person's capacity to process advice is an important aspect of decision making in the real world. For example, in decisions about treatment, the way patients respond to the advice of family, friends and medical professionals may be used (intentionally or otherwise) as a marker of the "use or weigh" requirement of decision-making capacity. Here we explore neuroscientific research on decision-making to identify features of advice-taking that help conceptualize this requirement. We focus on studies of the neural and computational basis of decision-making in laboratory settings. These studies originally investigated simple perceptual decisions about ambiguous stimuli, but have more recently been extended to more complex "value-based" decisions involving the comparison of subjective preferences. Value-based decisions are a useful model system for capacity-related decision-making as they do not have an objectively 'correct' answer and are instead based on subjective preferences. In this context, advice-taking can be seen as a process in which new evidence for one or other option is integrated, leading to altered behaviour or choices. We use this framework to distinguish between different types of advice-taking: private compliance consists of updating one's privately held beliefs based on new evidence, whereas in the case of public compliance, people change their behaviour at a surface level without shifting their privately-held beliefs. Importantly, both types of advice-taking may lead to similar outcomes but rely on different decision processes. We suggest that understanding how multiple mechanisms drive advice-taking holds promise for targeting decision-making support and improving our understanding of the use and weigh requirement in cases of contested capacity.
Topics: Choice Behavior; Cognitive Neuroscience; Compliance; Decision Making; Humans; Judgment; Mental Competency; Metacognition
PubMed: 31785723
DOI: 10.1016/j.ijlp.2019.101504 -
Scientific Reports Jun 2021Successful responding to acutely threatening situations requires adequate approach-avoidance decisions. However, it is unclear how threat-induced states-like...
Successful responding to acutely threatening situations requires adequate approach-avoidance decisions. However, it is unclear how threat-induced states-like freezing-related bradycardia-impact the weighing of the potential outcomes of such value-based decisions. Insight into the underlying computations is essential, not only to improve our models of decision-making but also to improve interventions for maladaptive decisions, for instance in anxiety patients and first-responders who frequently have to make decisions under acute threat. Forty-two participants made passive and active approach-avoidance decisions under threat-of-shock when confronted with mixed outcome-prospects (i.e., varying money and shock amounts). Choice behavior was best predicted by a model including individual action-tendencies and bradycardia, beyond the subjective value of the outcome. Moreover, threat-related bradycardia (high-vs-low threat) interacted with subjective value, depending on the action-context (passive-vs-active). Specifically, in action-contexts incongruent with participants' intrinsic action-tendencies, stronger bradycardia related to diminished effects of subjective value on choice across participants. These findings illustrate the relevance of testing approach-avoidance decisions in relatively ecologically valid conditions of acute and primarily reinforced threat. These mechanistic insights into approach-avoidance conflict-resolution may inspire biofeedback-related techniques to optimize decision-making under threat. Critically, the findings demonstrate the relevance of incorporating internal psychophysiological states and external action-contexts into models of approach-avoidance decision-making.
Topics: Adolescent; Adult; Anxiety; Autonomic Nervous System; Avoidance Learning; Biofeedback, Psychology; Bradycardia; Choice Behavior; Conflict, Psychological; Decision Making; Emotions; Female; Freezing; Hippocampus; Humans; Learning; Male; Negotiating; Psychophysiology; Reinforcement, Psychology; Sensitivity and Specificity; Young Adult
PubMed: 34103543
DOI: 10.1038/s41598-021-90968-z -
Neuroscience and Biobehavioral Reviews Apr 2023Making effective decisions during approach-avoidance conflict is critical in daily life. Aberrant decision-making during approach-avoidance conflict is evident in a... (Review)
Review
Making effective decisions during approach-avoidance conflict is critical in daily life. Aberrant decision-making during approach-avoidance conflict is evident in a range of psychological disorders, including anxiety, depression, trauma-related disorders, substance use disorders, and alcohol use disorders. To help clarify etiological pathways and reveal novel intervention targets, clinical research into decision-making is increasingly adopting a computational psychopathology approach. This approach uses mathematical models that can identify specific decision-making related processes that are altered in mental health disorders. In our review, we highlight foundational approach-avoidance conflict research, followed by more in-depth discussion of computational approaches that have been used to model behavior in these tasks. Specifically, we describe the computational models that have been applied to approach-avoidance conflict (e.g., drift-diffusion, active inference, and reinforcement learning models), and provide resources to guide clinical researchers who may be interested in applying computational modeling. Finally, we identify notable gaps in the current literature and potential future directions for computational approaches aimed at identifying mechanisms of approach-avoidance conflict in psychopathology.
Topics: Humans; Decision Making; Alcoholism; Anxiety Disorders; Learning; Anxiety; Avoidance Learning
PubMed: 36804398
DOI: 10.1016/j.neubiorev.2023.105103