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Shared and Supported Decision Making in Medication in a Mental Health Setting: How Far Have We Come?Community Mental Health Journal Nov 2021Personalised care involves shared decision making (SDM) across all levels including choice in medication. However, there are a number of barriers which prevent its...
Personalised care involves shared decision making (SDM) across all levels including choice in medication. However, there are a number of barriers which prevent its effective implementation in routine mental health settings. Therefore, we undertook a study to benchmark current practice across clinical services of a large urban mental health provider. The study formed part of the trust-wide 'Supported Decision Making in Medication' Co-Production Project and aims to inform future recommendations in delivering against contemporary best practice, guidance and policy. A survey exploring the views and experiences of service users and prescribers on shared and supported decision-making in medication was carried out in West London NHS Trust. Questionnaires were fully co-designed and co-delivered by a group of health professionals and individuals with lived experience. There were 100 responses from service users and 35 from prescribers. There was some good practice where both parties reported good quality conversations concerning dialogic styles, collaborative process, information provided and range of choice offered. However, prescriber's perception of their practice was not always mirrored by service user feedback whose experiences often depended upon the prescriber, the time available or the part of the service. Generally, service user experience fell short of the good practice cited by clinicians though there was noticeable variability. Commitment from organizations and increasing understanding from practitioners are vital in transforming SDM from rhetoric into reality. From our findings a further challenge is to ensure that prescribers and service users have the time, information and tools to implement it consistently.
Topics: Decision Making; Decision Making, Shared; Health Personnel; Humans; Mental Health; Mental Health Services
PubMed: 33544295
DOI: 10.1007/s10597-021-00780-2 -
Scientific Reports Jul 2020The influence of affective states on decision-making is likely to be complex. Negative states resulting from experience of punishing events have been hypothesised to...
The influence of affective states on decision-making is likely to be complex. Negative states resulting from experience of punishing events have been hypothesised to generate enhanced expectations of future punishment and 'pessimistic'/risk-averse decisions. However, they may also influence how decision-outcomes are valued. Such influences may further depend on whether decisions at hand are germane to the rewards or punishers that induced the affective state in the first place. Here we attempt to dissect these influences by presenting either many or few rewards or punishers of different types (sucrose vs air-puff; 50 kHz vs 22 kHz ultrasonic vocalisations) to rats, and investigating their subsequent decisions in a judgement bias task that employed sucrose and air-puff as decision outcomes. Rats that received many sucrose pellets prior to testing were more risk-averse than those receiving many air-puffs. Ultrasonic vocalisations did not alter decision-making. Computational analysis revealed a higher weighting of punishers relative to rewards (in agreement with findings from a separate behavioural task) and a bias towards the risk-averse response following pre-test sucrose compared to pre-test air-puff. Thus, in this study reward and punisher manipulation of affective state appeared to alter decision-making by influencing both expectation and valuation of decision-outcomes in a domain-specific way.
Topics: Affect; Animals; Behavior, Animal; Choice Behavior; Cognition; Decision Making; Judgment; Male; Punishment; Rats; Reward; Sound; Sucrose
PubMed: 32678247
DOI: 10.1038/s41598-020-68737-1 -
Neuron Oct 2018Major changes are underway in the field of perceptual decision-making. Single-neuron studies have given way to population recordings with identified cell types,... (Review)
Review
Major changes are underway in the field of perceptual decision-making. Single-neuron studies have given way to population recordings with identified cell types, traditional analyses have been extended to accommodate these large and diverse collections of neurons, and novel methods of neural disruption have provided insights about causal circuits. Further, the field has expanded to include multiple new species: rodents and invertebrates, for example, have been instrumental in demonstrating the importance of internal state on neural responses. Finally, a renewed interest in ethological stimuli prompted development of new behaviors, frequently analyzed by new, automated movement tracking methods. Taken together, these advances constitute a seismic shift in both our approach and understanding of how incoming sensory signals are used to guide decisions.
Topics: Animals; Brain; Computer Simulation; Decision Making; Humans; Models, Neurological; Neurons
PubMed: 30359608
DOI: 10.1016/j.neuron.2018.10.017 -
PLoS Computational Biology May 2022A large literature has accumulated suggesting that human and animal decision making is driven by at least two systems, and that important functions of these systems can...
A large literature has accumulated suggesting that human and animal decision making is driven by at least two systems, and that important functions of these systems can be captured by reinforcement learning algorithms. The "model-free" system caches and uses stimulus-value or stimulus-response associations, and the "model-based" system implements more flexible planning using a model of the world. However, it is not clear how the two systems interact during deliberation and how a single decision emerges from this process, especially when they disagree. Most previous work has assumed that while the systems operate in parallel, they do so independently, and they combine linearly to influence decisions. Using an integrated reinforcement learning/drift-diffusion model, we tested the hypothesis that the two systems interact in a non-linear fashion similar to other situations with cognitive conflict. We differentiated two forms of conflict: action conflict, a binary state representing whether the systems disagreed on the best action, and value conflict, a continuous measure of the extent to which the two systems disagreed on the difference in value between the available options. We found that decisions with greater value conflict were characterized by reduced model-based control and increased caution both with and without action conflict. Action conflict itself (the binary state) acted in the opposite direction, although its effects were less prominent. We also found that between-system conflict was highly correlated with within-system conflict, and although it is less clear a priori why the latter might influence the strength of each system above its standard linear contribution, we could not rule it out. Our work highlights the importance of non-linear conflict effects, and provides new constraints for more detailed process models of decision making. It also presents new avenues to explore with relation to disorders of compulsivity, where an imbalance between systems has been implicated.
Topics: Algorithms; Animals; Decision Making; Reinforcement, Psychology
PubMed: 35511764
DOI: 10.1371/journal.pcbi.1010047 -
Pediatric Emergency Care Dec 2021Decisions about the management of febrile infants ≤60 days old may be well suited for shared decision making (SDM). Our objectives were to learn about parents'...
OBJECTIVES
Decisions about the management of febrile infants ≤60 days old may be well suited for shared decision making (SDM). Our objectives were to learn about parents' experiences with receiving and understanding information in the emergency department (ED) and their perspectives on SDM, including for decisions about lumbar puncture (LP).
METHODS
We conducted semistructured interviews with 23 parents of febrile infants ≤60 days old evaluated in the pediatric ED at an urban, academic medical center. Interviews assessed parents' experiences in the ED and their perspectives on communication and SDM. Two investigators coded the interview transcripts, refined codes, and identified themes using the constant comparative method.
RESULTS
Parents' unmet need for information negatively impacted parents' understanding, stress, and trust in the physician. Themes for parents' perspectives on SDM included the following: (1) giving parents the opportunity to express their opinions and concerns builds confidence in the decision making process, (2) parents' preferences for participation in decision making vary considerably, and (3) different perceptions about risks influence parents' preferences about having their infant undergo an LP. Although some parents would defer decision making to the physician, they still wanted to be able to express their opinions. Other parents wanted to have the final say in decision making. Parents valued risks and benefits of having their child undergo an LP differently, which influenced their preferences.
CONCLUSIONS
Physicians need to adequately inform parents to facilitate parents' understanding of information and gain their trust. Shared decision making may be warranted for decisions about whether to perform an LP, although parents' preferences for participating in decision making vary.
Topics: Child; Communication; Decision Making; Decision Making, Shared; Fever; Humans; Infant; Parents; Qualitative Research
PubMed: 31977772
DOI: 10.1097/PEC.0000000000001977 -
Philosophical Transactions of the Royal... Mar 2009This paper reviews the literature on leadership in vertebrate groups, including recent work on human groups, before presenting the results of three new experiments... (Review)
Review
This paper reviews the literature on leadership in vertebrate groups, including recent work on human groups, before presenting the results of three new experiments looking at leadership and decision making in small and large human groups. In experiment 1, we find that both group size and the presence of uninformed individuals can affect the speed with which small human groups (eight people) decide between two opposing directional preferences and the likelihood of the group splitting. In experiment 2, we show that the spatial positioning of informed individuals within small human groups (10 people) can affect the speed and accuracy of group motion. We find that having a mixture of leaders positioned in the centre and on the edge of a group increases the speed and accuracy with which the group reaches their target. In experiment 3, we use large human crowds (100 and 200 people) to demonstrate that the trends observed from earlier work using small human groups can be applied to larger crowds. We find that only a small minority of informed individuals is needed to guide a large uninformed group. These studies build upon important theoretical and empirical work on leadership and decision making in animal groups.
Topics: Consensus; Decision Making; Humans; Leadership; Social Behavior
PubMed: 19073481
DOI: 10.1098/rstb.2008.0233 -
NeuroImage Dec 2022Many real-world situations require navigating decisions for both reward and threat. While there has been significant progress in understanding mechanisms of...
Many real-world situations require navigating decisions for both reward and threat. While there has been significant progress in understanding mechanisms of decision-making and mediating neurocircuitry separately for reward and threat, there is limited understanding of situations where reward and threat contingencies compete to create approach-avoidance conflict (AAC). Here, we leverage computational learning models, independent component analysis (ICA), and multivariate pattern analysis (MVPA) approaches to understand decision-making during a novel task that embeds concurrent reward and threat learning and manipulates congruency between reward and threat probabilities. Computational modeling supported a modified reinforcement learning model where participants integrated reward and threat value into a combined total value according to an individually varying policy parameter, which was highly predictive of decisions to approach reward vs avoid threat during trials where the highest reward option was also the highest threat option (i.e., approach-avoidance conflict). ICA analyses demonstrated unique roles for salience, frontoparietal, medial prefrontal, and inferior frontal networks in differential encoding of reward vs threat prediction error and value signals. The left frontoparietal network uniquely encoded degree of conflict between reward and threat value at the time of choice. MVPA demonstrated that delivery of reward and threat could accurately be decoded within salience and inferior frontal networks, respectively, and that decisions to approach reward vs avoid threat were predicted by the relative degree to which these reward vs threat representations were active at the time of choice. This latter result suggests that navigating AAC decisions involves generating mental representations for possible decision outcomes, and relative activation of these representations may bias subsequent decision-making towards approaching reward or avoiding threat accordingly.
Topics: Humans; Choice Behavior; Decision Making; Reward; Reinforcement, Psychology; Neural Networks, Computer
PubMed: 36283543
DOI: 10.1016/j.neuroimage.2022.119709 -
Trends in Neurosciences Jan 2016Human choice behaviors during social interactions often deviate from the predictions of game theory. This might arise partly from the limitations in the cognitive... (Review)
Review
Human choice behaviors during social interactions often deviate from the predictions of game theory. This might arise partly from the limitations in the cognitive abilities necessary for recursive reasoning about the behaviors of others. In addition, during iterative social interactions, choices might change dynamically as knowledge about the intentions of others and estimates for choice outcomes are incrementally updated via reinforcement learning. Some of the brain circuits utilized during social decision making might be general-purpose and contribute to isomorphic individual and social decision making. By contrast, regions in the medial prefrontal cortex (mPFC) and temporal parietal junction (TPJ) might be recruited for cognitive processes unique to social decision making.
Topics: Decision Making; Game Theory; Humans; Interpersonal Relations; Prefrontal Cortex; Reinforcement, Psychology
PubMed: 26688301
DOI: 10.1016/j.tins.2015.11.002 -
Genes Nov 2021Greater scrutiny and demands for innovation and increased productivity place pressures on scientists. Forensic genetics is advancing at a rapid pace but can only do so...
Greater scrutiny and demands for innovation and increased productivity place pressures on scientists. Forensic genetics is advancing at a rapid pace but can only do so responsibly, usefully, and acceptably within ethical and legal boundaries. We argue that such boundaries require that forensic scientists embrace 'ethics as lived practice'. As a starting point, we critically discuss 'thin' ethics in forensic genetics, which lead to a myopic focus on procedures, and to seeing 'privacy' as the sole ethical concern and technology as a mere tool. To overcome 'thin' ethics in forensic genetics, we instead propose understanding ethics as an intrinsic part of the lived practice of a scientist. Therefore, we explore, within the context of three case studies of emerging forensic genetics technologies, ethical aspects of decision-making in forensic genetics research and in technology use. We discuss the creation, curation, and use of databases, and the need to engage with societal and policing contexts of forensic practice. We argue that open communication is a vital ethical aspect. Adoption of 'ethics as lived practice' supports the development of anticipatory capacity-empowering scientists to understand, and act within ethical and legal boundaries, incorporating the operational and societal impacts of their daily decisions, and making visible ethical decision making in scientific practice.
Topics: Decision Making; Forensic Genetics; Forensic Sciences; Humans
PubMed: 34946816
DOI: 10.3390/genes12121868 -
Topics in Cognitive Science Jul 2022Scientists studying decision-making often provide a set of choices, each specified with values or distributions of values, and probabilities or distributions of...
Scientists studying decision-making often provide a set of choices, each specified with values or distributions of values, and probabilities or distributions of probabilities. For example, "Would you prefer $100 with probability 1.0 or $1 with probability .9 and $1,000 with probability 0.1?" Other decision research examines choices made in the absence of most quantitative information; for example, "Would you prefer a Ford now or a Porsche a year from now?," "Which food would you prefer," but models the findings with precise quantitative assumptions. Yet other research does neither; for example, modeling verbally stated choices with verbally stated heuristics. This article asks about the relevance of the first two research approaches for much of the decision-making made in life. The use of quantitative research and modeling is unsurprising, given that this approach underlies most of science. In life, values and probabilities are almost always partly or wholly vague and qualitative rather than quantitative. For example, when deciding which house to buy, there are relevant features such as size, color, neighborhood schools, construction materials, attractiveness, and many more, but the decision-maker finds it difficult and of little use to assign these precise values or weights. Nonetheless, humans have evolved to make decisions in such vaguely specified settings. I provide an example showing how a very high degree of uncertainty can defeat the application of quantitative decision-making, but such a demonstration is not critical if quantitative research and modeling produce a good understanding of and a good approximation to decision-making in the natural environment. This perspective addresses these issues.
Topics: Decision Making; Heuristics; Humans; Probability; Uncertainty
PubMed: 34050714
DOI: 10.1111/tops.12541