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Scientific Reports Sep 2022Deciding the best action in social settings requires decision-makers to consider their and others' preferences, since the outcome depends on the actions of both....
Deciding the best action in social settings requires decision-makers to consider their and others' preferences, since the outcome depends on the actions of both. Numerous empirical investigations have demonstrated variability of behavior across individuals in strategic situations. While prosocial, moral, and emotional factors have been intensively investigated to explain this diversity, neuro-cognitive determinants of strategic decision-making and their relation with intelligence remain mostly unknown. This study presents a new model of the process of strategic decision-making in repeated interactions, first providing a precise measure of the environment's complexity, and then analyzing how this complexity affects subjects' performance and neural response. The results confirm the theoretical predictions of the model. The frequency of deviations from optimal behavior is explained by a combination of higher complexity of the strategic environment and cognitive skills of the individuals. Brain response correlates with strategic complexity, but only in the subgroups with higher cognitive skills. Furthermore, neural effects were only observed in a fronto-parietal network typically involved in single-agent tasks (the Multiple Demand Network), thus suggesting that neural processes dealing with cognitively demanding individual tasks also have a central role in interactive decision-making. Our findings contribute to understanding how cognitive factors shape strategic decision-making and may provide the neural pathway of the reported association between strategic sophistication and fluid intelligence.
Topics: Brain; Cognition; Decision Making; Emotions; Humans; Morals
PubMed: 36151117
DOI: 10.1038/s41598-022-17951-0 -
Patient Education and Counseling Jan 2023To identify decision characteristics for which SDM authors deem SDM appropriate or not, and what arguments are used. (Review)
Review
OBJECTIVE
To identify decision characteristics for which SDM authors deem SDM appropriate or not, and what arguments are used.
METHODS
We applied two search strategies: we included SDM models from an earlier review (strategy 1) and conducted a new search in eight databases to include papers other than describing an SDM model, such as original research, opinion papers and reviews (strategy 2).
RESULTS
From the 92 included papers, we identified 18 decision characteristics for which authors deemed SDM appropriate, including preference-sensitive, equipoise and decisions where patient commitment is needed in implementing the decision. SDM authors indicated limits to SDM, especially when there are immediate life-saving measures needed. We identified four decision characteristics on which authors of different papers disagreed on whether or not SDM is appropriate.
CONCLUSION
The findings of this review show the broad range of decision characteristics for which authors deem SDM appropriate, the ambiguity of some, and potential limits of SDM.
PRACTICE IMPLICATIONS
The findings can stimulate clinicians to (re)consider pursuing SDM in situations in which they did not before. Additionally, it can inform SDM campaigns and educational programs as it shows for which decision situations SDM might be more or less challenging to practice.
Topics: Humans; Decision Making, Shared; Patient Participation; Decision Making; Databases, Factual
PubMed: 36220675
DOI: 10.1016/j.pec.2022.09.015 -
Journal of Palliative Care Apr 2022Hospice and palliative care teams face numerous barriers to the meaningful involvement of patients and families in medical decision making, which limits opportunities...
Hospice and palliative care teams face numerous barriers to the meaningful involvement of patients and families in medical decision making, which limits opportunities for exploration of the very values, preferences, and goals that ideally inform serious illness care. Researchers who develop and test interventions to address these barriers have noted the complementary utility of two existing models in supporting collaborative relationships between hospice and palliative care teams and the patients and families they serve: (1) the social problem-solving model, and (2) the integrative model of shared decision making in medical encounters. This paper describes the integration and extension of these two highly synergistic models, resulting in a goal-directed model of collaborative decision making in hospice and palliative care. Directions for practice innovation and research informed by the model are discussed at length.
Topics: Decision Making; Decision Making, Shared; Goals; Hospice Care; Hospices; Humans; Palliative Care
PubMed: 34787009
DOI: 10.1177/08258597211049138 -
Nature Reviews. Neuroscience Jul 2022People with damage to the orbitofrontal cortex (OFC) have specific problems making decisions, whereas their other cognitive functions are spared. Neurophysiological... (Review)
Review
People with damage to the orbitofrontal cortex (OFC) have specific problems making decisions, whereas their other cognitive functions are spared. Neurophysiological studies have shown that OFC neurons fire in proportion to the value of anticipated outcomes. Thus, a central role of the OFC is to guide optimal decision-making by signalling values associated with different choices. Until recently, this view of OFC function dominated the field. New data, however, suggest that the OFC may have a much broader role in cognition by representing cognitive maps that can be used to guide behaviour and that value is just one of many variables that are important for behavioural control. In this Review, we critically evaluate these two alternative accounts of OFC function and examine how they might be reconciled.
Topics: Choice Behavior; Decision Making; Humans; Neurons; Prefrontal Cortex; Reward
PubMed: 35468999
DOI: 10.1038/s41583-022-00589-2 -
AMA Journal of Ethics May 2020As the field of medicine shifts from a paternalistic to a more patient-centered orientation, the dynamics of shared decision making become increasingly complicated....
As the field of medicine shifts from a paternalistic to a more patient-centered orientation, the dynamics of shared decision making become increasingly complicated. International globalization and national socioeconomic differences have added unintended difficulties to culturally sensitive communication between physician and patient, which can contribute to the growing erosion of clinician empathy. This article offers a strategy for teaching students how to enter into conversations about shared decision making by bolstering their empathy as a result of exposing them to the many variables outside of their patients' control. Patients' historical and cultural context, gender identity, sexual orientation, and common assumptions about clinicians as well as institutional biases can severely limit students' ability to integrate patients' value-laden preferences into shared decision making about health care.
Topics: Communication; Decision Making; Decision Making, Shared; Female; Gender Identity; Humans; Male; Patient Participation; Physician-Patient Relations
PubMed: 32449654
DOI: 10.1001/amajethics.2020.388 -
Journal of Evaluation in Clinical... Jun 2021In recent years there has been an explosion of interest in Artificial Intelligence (AI) both in health care and academic philosophy. This has been due mainly to the rise...
In recent years there has been an explosion of interest in Artificial Intelligence (AI) both in health care and academic philosophy. This has been due mainly to the rise of effective machine learning and deep learning algorithms, together with increases in data collection and processing power, which have made rapid progress in many areas. However, use of this technology has brought with it philosophical issues and practical problems, in particular, epistemic and ethical. In this paper the authors, with backgrounds in philosophy, maternity care practice and clinical research, draw upon and extend a recent framework for shared decision-making (SDM) that identified a duty of care to the client's knowledge as a necessary condition for SDM. This duty entails the responsibility to acknowledge and overcome epistemic defeaters. This framework is applied to the use of AI in maternity care, in particular, the use of machine learning and deep learning technology to attempt to enhance electronic fetal monitoring (EFM). In doing so, various sub-kinds of epistemic defeater, namely, transparent, opaque, underdetermined, and inherited defeaters are taxonomized and discussed. The authors argue that, although effective current or future AI-enhanced EFM may impose an epistemic obligation on the part of clinicians to rely on such systems' predictions or diagnoses as input to SDM, such obligations may be overridden by inherited defeaters, caused by a form of algorithmic bias. The existence of inherited defeaters implies that the duty of care to the client's knowledge extends to any situation in which a clinician (or anyone else) is involved in producing training data for a system that will be used in SDM. Any future AI must be capable of assessing women individually, taking into account a wide range of factors including women's preferences, to provide a holistic range of evidence for clinical decision-making.
Topics: Artificial Intelligence; Decision Making; Decision Making, Shared; Deep Learning; Female; Humans; Maternal Health Services; Pregnancy
PubMed: 33188540
DOI: 10.1111/jep.13515 -
Nature Communications Jul 2022Humans differ in their capability to judge choice accuracy via confidence judgments. Popular signal detection theoretic measures of metacognition, such as M-ratio, do...
Humans differ in their capability to judge choice accuracy via confidence judgments. Popular signal detection theoretic measures of metacognition, such as M-ratio, do not consider the dynamics of decision making. This can be problematic if response caution is shifted to alter the tradeoff between speed and accuracy. Such shifts could induce unaccounted-for sources of variation in the assessment of metacognition. Instead, evidence accumulation frameworks consider decision making, including the computation of confidence, as a dynamic process unfolding over time. Using simulations, we show a relation between response caution and M-ratio. We then show the same pattern in human participants explicitly instructed to focus on speed or accuracy. Finally, this association between M-ratio and response caution is also present across four datasets without any reference towards speed. In contrast, when data are analyzed with a dynamic measure of metacognition, v-ratio, there is no effect of speed-accuracy tradeoff.
Topics: Decision Making; Humans; Judgment; Metacognition
PubMed: 35864100
DOI: 10.1038/s41467-022-31727-0 -
ELife Oct 2022Models based on normative principles have played a major role in our understanding of how the brain forms decisions. However, these models have typically been derived...
Models based on normative principles have played a major role in our understanding of how the brain forms decisions. However, these models have typically been derived for simple, stable conditions, and their relevance to decisions formed under more naturalistic, dynamic conditions is unclear. We previously derived a normative decision model in which evidence accumulation is adapted to fluctuations in the evidence-generating process that occur during a single decision (Glaze et al., 2015), but the evolution of commitment rules (e.g. thresholds on the accumulated evidence) under dynamic conditions is not fully understood. Here, we derive a normative model for decisions based on changing contexts, which we define as changes in evidence quality or reward, over the course of a single decision. In these cases, performance (reward rate) is maximized using decision thresholds that respond to and even anticipate these changes, in contrast to the static thresholds used in many decision models. We show that these adaptive thresholds exhibit several distinct temporal motifs that depend on the specific predicted and experienced context changes and that adaptive models perform robustly even when implemented imperfectly (noisily). We further show that decision models with adaptive thresholds outperform those with constant or urgency-gated thresholds in accounting for human response times on a task with time-varying evidence quality and average reward. These results further link normative and neural decision-making while expanding our view of both as dynamic, adaptive processes that update and use expectations to govern both deliberation and commitment.
Topics: Humans; Decision Making; Reward; Reaction Time; Brain; Adaptation, Physiological
PubMed: 36282065
DOI: 10.7554/eLife.79824 -
Journal of Evaluation in Clinical... Aug 2021Shared decision-making (SDM) is considered the "final stage" that completes the implementation of evidence-based medicine. Yet, it is also considered the most neglected...
BACKGROUND
Shared decision-making (SDM) is considered the "final stage" that completes the implementation of evidence-based medicine. Yet, it is also considered the most neglected stage. SDM shifts the epistemological authority of medical knowledge to one that deliberately includes patients' values and preferences. Although this redefines the work of the clinical encounter, it remains unclear what a shared decision is and how it is practiced.
AIM
The aim of this paper is to describe how healthcare professionals manoeuvre the nuances of decision-making that shape SDM. We identify barriers to SDM and collect strategies to help healthcare professionals think beyond existing solution pathways and overcome barriers to SDM.
METHODS
Semi-structured interviews were conducted with 68 healthcare professionals from psychiatry, internal medicine, intensive care medicine, obstetrics and orthopaedics and 15 patients.
RESULTS
This study found that healthcare professionals conceptualize SDM in different ways, which indicates a lack of consensus about its meaning. We identified five barriers that limit manoeuvring space for SDM and contest the feasibility of a uniform, normative SDM model. Three identified barriers: (a) "not all patients want new role," (b) "not all patients can adopt new role," and (c) "attitude," were linked to strategies focused on the knowledge, skills and attitudes of individual healthcare professionals. However, systemic barriers: (d) "prioritization of medical issues" and (e) "lack of time" render such individual-focused strategies insufficient.
CONCLUSION
There is a need for a more nuanced understanding of SDM as a "graded" framework that allows for flexibility in decision-making styles to accommodate patient's unique preferences and needs and to expand the manoeuvring space for decision-making. The strategies in this study show how our understanding of SDM as a process of multi-dyadic interactions that spatially exceed the consulting room offers new avenues to make SDM workable in contemporary medicine.
Topics: Attitude of Health Personnel; Decision Making; Decision Making, Shared; Female; Health Personnel; Humans; Obstetrics; Patient Participation; Pregnancy
PubMed: 33164316
DOI: 10.1111/jep.13507 -
Journal of General Internal Medicine Sep 2022Research on shared decision-making (SDM) has mainly focused on decisions about treatment (e.g., medication or surgical procedures). Little is known about the...
BACKGROUNDS
Research on shared decision-making (SDM) has mainly focused on decisions about treatment (e.g., medication or surgical procedures). Little is known about the decision-making process for the numerous other decisions in consultations.
OBJECTIVES
We assessed to what extent patients are actively involved in different decision types in medical specialist consultations and to what extent this was affected by medical specialist, patient, and consultation characteristics.
DESIGN
Analysis of video-recorded encounters between medical specialists and patients at a large teaching hospital in the Netherlands.
PARTICIPANTS
Forty-one medical specialists (28 male) from 18 specialties, and 781 patients.
MAIN MEASURE
Two independent raters classified decisions in the consultations in decision type (main or other) and decision category (diagnostic tests, treatment, follow-up, or other advice) and assessed the decision-making behavior for each decision using the Observing Patient Involvement (OPTION) instrument, ranging from 0 (no SDM) to 100 (optimal SDM). Scheduled and realized consultation duration were recorded.
KEY RESULT
In the 727 consultations, the mean (SD) OPTION score for the main decision was higher (16.8 (17.1)) than that for the other decisions (5.4 (9.0), p < 0.001). The main decision OPTION scores for treatment decisions (n = 535, 19.2 (17.3)) were higher than those for decisions about diagnostic tests (n = 108, 14.6 (16.8)) or follow-up (n = 84, 3.8 (8.1), p < 0.001). This difference remained significant in multilevel analyses. Longer consultation duration was the only other factor significantly associated with higher OPTION scores (p < 0.001).
CONCLUSION
Most of the limited patient involvement was observed in main decisions (versus others) and in treatment decisions (versus diagnostic, follow-up, and advice). SDM was associated with longer consultations. Physicians' SDM training should help clinicians to tailor promotion of patient involvement in different types of decisions. Physicians and policy makers should allow sufficient consultation time to support the application of SDM in clinical practice.
Topics: Decision Making; Decision Making, Shared; Humans; Male; Medicine; Netherlands; Patient Participation; Physician-Patient Relations; Referral and Consultation
PubMed: 35037173
DOI: 10.1007/s11606-021-07221-6