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Health Expectations : An International... Oct 2020Shared decision making (SDM) has been increasingly implemented to improve health-care outcomes. Despite the mixed efficacy of SDM to provide better patient-guided care,... (Review)
Review
BACKGROUND
Shared decision making (SDM) has been increasingly implemented to improve health-care outcomes. Despite the mixed efficacy of SDM to provide better patient-guided care, its use in surgery has not been studied. The aim of this study was to systematically review SDM application in surgery.
DESIGN
The search strategy, developed with a medical librarian, included nine databases from inception until June 2019. After a 2-person title and abstract screen, full-text publications were analysed. Data collected included author, year, surgical discipline, location, study duration, type of decision aid, survey methodology and variable outcomes. Quantitative and qualitative cross-sectional studies, as well as RCTs, were included.
RESULTS
A total of 6060 studies were retrieved. A total of 148 were included in the final review. The majority of the studies were in plastic surgery, followed by general surgery and orthopaedics. The use of SDM decreased surgical intervention rate (12 of 22), decisional conflict (25 of 29), and decisional regret (5 of 5), and increased decisional satisfaction (17 of 21), knowledge (33 of 35), SDM preference (13 of 16), and physician trust (4 of 6). Time increase per patient encounter was inconclusive. Cross-sectional studies showed that patients prefer shared treatment and surgical treatment varied less. The results of SDM per type of decision aid vary in terms of their outcome.
CONCLUSION
SDM in surgery decreases decisional conflict, anxiety and surgical intervention rates, while increasing knowledge retained decisional satisfaction, quality and physician trust. Surgical patients also appear to prefer SDM paradigms. SDM appears beneficial in surgery and therefore worth promoting and expanding in use.
Topics: Cross-Sectional Studies; Decision Making; Decision Making, Shared; Humans; Patient Participation; Patients
PubMed: 32700367
DOI: 10.1111/hex.13105 -
BMC Women's Health Feb 2023The decision to undergo non-urgent egg freezing (EF) is complex for patients and providers supporting them. Though prior studies have explored patient perspectives, no...
BACKGROUND
The decision to undergo non-urgent egg freezing (EF) is complex for patients and providers supporting them. Though prior studies have explored patient perspectives, no study has also included the separate perspectives of providers.
METHODS
This qualitative study involved semi-structured individual interviews exploring the decision to undergo EF. Participants included patients considering EF at one academic fertility clinic and providers who counsel patients about EF from across Canada. Data analysis was accomplished using thematic analysis. Data saturation was met after interviewing 13 providers and 12 patients.
FINDINGS
Four themes were identified and explored, illuminating ways in which patients and providers navigate decision-making around EF: (1) patients viewed EF as a 'back-up plan' for delaying the decision about whether to have children, while providers were hesitant to present EF in this way given the uncertainty of success; (2) providers viewed ovarian reserve testing as essential while patients believed it unnecessarily complicated the decision; (3) patients and providers cited a need for change in broader societal attitudes regarding EF since social stigma was a significant barrier to decision-making; and (4) commonality and peer support were desired by patients to assist in their decision, although some providers were hesitant to recommend this to patients.
CONCLUSIONS
In conclusion, the decision to undergo EF is complex and individual patient values play a significant role. In some areas, there is disconnect between providers and patients in their views on how to navigate EF decision-making, and these should be addressed in discussions between providers and patients to improve shared decision-making.
Topics: Child; Humans; Fertility Preservation; Decision Making; Qualitative Research; Decision Making, Shared; Canada
PubMed: 36755254
DOI: 10.1186/s12905-023-02189-3 -
Philosophical Transactions of the Royal... Mar 2021The experimental investigation of decision-making in humans relies on two distinct types of paradigms, involving either description- or experience-based choices. In... (Review)
Review
The experimental investigation of decision-making in humans relies on two distinct types of paradigms, involving either description- or experience-based choices. In description-based paradigms, decision variables (i.e. payoffs and probabilities) are explicitly communicated by means of symbols. In experience-based paradigms decision variables are learnt from trial-by-trial feedback. In the decision-making literature, 'description-experience gap' refers to the fact that different biases are observed in the two experimental paradigms. Remarkably, well-documented biases of description-based choices, such as under-weighting of rare events and loss aversion, do not apply to experience-based decisions. Here, we argue that the description-experience gap represents a major challenge, not only to current decision theories, but also to the neuroeconomics research framework, which relies heavily on the translation of neurophysiological findings between human and non-human primate research. In fact, most non-human primate neurophysiological research relies on behavioural designs that share features of both description- and experience-based choices. As a consequence, it is unclear whether the neural mechanisms built from non-human primate electrophysiology should be linked to description-based or experience-based decision-making processes. The picture is further complicated by additional methodological gaps between human and non-human primate neuroscience research. After analysing these methodological challenges, we conclude proposing new lines of research to address them. This article is part of the theme issue 'Existence and prevalence of economic behaviours among non-human primates'.
Topics: Animals; Choice Behavior; Decision Making; Primates; Uncertainty
PubMed: 33423626
DOI: 10.1098/rstb.2019.0665 -
Japan Journal of Nursing Science : JJNS Oct 2020Shared decision making for adults with severe mental illness has increasingly attracted attention. However, this concept has not been comprehensively clarified. This... (Review)
Review
AIM
Shared decision making for adults with severe mental illness has increasingly attracted attention. However, this concept has not been comprehensively clarified. This review aimed to clarify a concept of shared decision making for adults with severe mental illness such as schizophrenia, depression, and bipolar disorder, and propose an adequate definition.
METHODS
Rodgers' evolutionary concept analysis was used. MEDLINE, PsychINFO, and CINAHL were searched for articles written in English and published between 2010 and November 2019. The search terms were "psychiatr*" or "mental" or "schizophren*" or "depression" or "bipolar disorder", combined with "shared decision making". In total, 70 articles met the inclusion criteria. An inductive approach was used to identify themes and sub-themes related to shared decision making for adults with severe mental illness. Surrogate terms and a definition of the concept were also described.
RESULTS
Four key attributes were identified: user-professional relationship, communication process, user-friendly visualization, and broader stakeholder approach. Communication process was the densest attribute, which consisted of five phases: goal sharing, information sharing, deliberation, mutual agreement, and follow-up. The antecedents as prominent predisposing factors were long-term complex illness, power imbalance, global trend, users' desire, concerns, and stigma. The consequences included decision-related outcomes, users' changes, professionals' changes, and enhanced relationship.
CONCLUSIONS
Shared decision making for adults with severe mental illness is a communication process, involving both user-friendly visualization techniques and broader stakeholders. The process may overcome traditional power imbalance and encourage changes among both users and professionals that could enhance the dyadic relationship.
Topics: Adult; Communication; Decision Making; Decision Making, Shared; Humans; Schizophrenia
PubMed: 32761783
DOI: 10.1111/jjns.12365 -
Scientific Reports Jun 2022Affective experience has an important role in decision-making with recent theories suggesting a modulatory role of affect in ongoing subjective value computations....
Affective experience has an important role in decision-making with recent theories suggesting a modulatory role of affect in ongoing subjective value computations. However, it is unclear how varying expectations and uncertainty dynamically influence affective experience and how dynamic representation of affect modulates risky choices. Using hierarchical Bayesian modeling on data from a risky choice task (N = 101), we find that the temporal integration of recently encountered choice parameters (expected value, uncertainty, and prediction errors) shapes affective experience and impacts subsequent choice behavior. Specifically, self-reported arousal prior to choice was associated with increased loss aversion, risk aversion, and choice consistency. Taken together, these findings provide clear behavioral evidence for continuous affective modulation of subjective value computations during risky decision-making.
Topics: Affect; Arousal; Bayes Theorem; Choice Behavior; Decision Making; Humans; Risk-Taking
PubMed: 35739234
DOI: 10.1038/s41598-022-14810-w -
Health Psychology : Official Journal of... Apr 2020Using an online decision aid developed to support parental decision making about newborn genomic sequencing, we tested whether adding a values clarification exercise to... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Using an online decision aid developed to support parental decision making about newborn genomic sequencing, we tested whether adding a values clarification exercise to educational content would improve decision making outcomes and influence intention to pursue genomic sequencing. We also examined whether the effect of values clarification varied depending on one's health literacy level.
METHOD
In an online experiment, women and men aged 18 to 44 who were either pregnant or had a pregnant partner, were currently trying to get pregnant, or were preparing for a pregnancy within the next 2 years were randomly assigned to complete either a decision aid with educational information about newborn genomic sequencing or a decision aid with the same educational information and a values clarification exercise.
RESULTS
Of the 1,000 participants who completed the decision aid, those who completed the values clarification exercise reported less decision regret, (1, 995) = 6.19, = .01, and were clearer about their personal values, (1, 995) = 6.39, = .01. Moderation analyses revealed that the benefit of values clarification on decisional conflict was particularly evident among participants with lower health literacy, = -3.94, = 1.67, = -2.36, = .018. There was not a significant moderation effect of health literacy and decision aid condition on decision regret.
CONCLUSIONS
Adding a values clarification exercise to decision aids for parents making decisions about genomic sequencing may improve the decision-making experience and provide some benefit to individuals with lower health literacy. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Topics: Adult; Decision Making; Female; Genomics; Humans; Infant, Newborn; Male; Parents
PubMed: 31886693
DOI: 10.1037/hea0000829 -
BMJ Evidence-based Medicine Aug 2023
Topics: Humans; Decision Making, Shared; Decision Making; Physician-Patient Relations
PubMed: 36522136
DOI: 10.1136/bmjebm-2022-112089 -
Medical Decision Making : An... Aug 2022Applying both theoretical perspectives and empirical evidence, we address 2 key questions regarding shared decision making (SDM): 1) When should SDM be more patient...
Applying both theoretical perspectives and empirical evidence, we address 2 key questions regarding shared decision making (SDM): 1) When should SDM be more patient driven, and when should it be more provider driven? and 2) Should health care providers match their SDM style/strategy to patient needs and preferences? Self-determination theory, for example, posits a distinction between autonomy and independence. A patient may autonomously seek their health care provider's input and guidance, perhaps due to low perceived competence, low coping resources, or high emotional arousal. Given their need state, they may autonomously require nonindependence. In this case, it may be more patient centered and need supportive to provide more provider-driven care. We discuss how other patient characteristics such as personality attributes, motivational state, and the course of illness and other parameters such as time available for an encounter may inform optimal provider decision-making style and strategy. We conclude that for some types of patients and clinical circumstances, a more provider-driven approach to decision making may be more practical, ethical, and efficacious. Thus, while all decision making should be patient centered (i.e., it should consider patient needs and preferences), it does not always have to be patient driven. We propose a flexible model of SDM whereby practitioners are encouraged to tailor their decision making behaviors to patient needs, preferences, and other attributes. Studies are needed to test whether matching decision-making behavior based on patient states and traits (i.e., achieving concordance) is more effective than simply providing all patients with the same type of decision making, which could be tested using matching/mismatching designs.
Topics: Decision Making; Decision Making, Shared; Health Personnel; Humans; Patient Participation; Physician-Patient Relations
PubMed: 34784805
DOI: 10.1177/0272989X211058068 -
Journal of Vision May 2023Human decision-making and self-reflection often depend on context and internal biases. For instance, decisions are often influenced by preceding choices, regardless of...
Human decision-making and self-reflection often depend on context and internal biases. For instance, decisions are often influenced by preceding choices, regardless of their relevance. It remains unclear how choice history influences different levels of the decision-making hierarchy. We used analyses grounded in information and detection theories to estimate the relative strength of perceptual and metacognitive history biases and to investigate whether they emerge from common/unique mechanisms. Although both perception and metacognition tended to be biased toward previous responses, we observed novel dissociations that challenge normative theories of confidence. Different evidence levels often informed perceptual and metacognitive decisions within observers, and response history distinctly influenced first- (perceptual) and second- (metacognitive) order decision-parameters, with the metacognitive bias likely to be strongest and most prevalent in the general population. We propose that recent choices and subjective confidence represent heuristics, which inform first- and second-order decisions in the absence of more relevant evidence.
Topics: Humans; Metacognition; Decision Making; Heuristics
PubMed: 37200046
DOI: 10.1167/jov.23.5.14 -
The Journal of Adolescent Health :... Jul 2021
Topics: Adolescent; Decision Making; Decision Making, Shared; Humans; Patient Participation
PubMed: 34172143
DOI: 10.1016/j.jadohealth.2021.04.009