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Trials Apr 2021Clinical trial recruitment is a continuing challenge for medical researchers. Previous efforts to improve study recruitment have rarely been informed by theories of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Clinical trial recruitment is a continuing challenge for medical researchers. Previous efforts to improve study recruitment have rarely been informed by theories of human decision making and behavior change. We investigate the trial recruitment strategies reported by study recruiters, guided by two influential theoretical frameworks: shared decision-making (SDM) and the Theoretical Domains Framework (TDF) in order to explore the utility of these frameworks in trial recruitment.
METHODS
We interviewed all nine active study recruiters from a multi-site, open-label pilot trial assessing the feasibility of a large-scale randomized trial. Recruiters were primarily nurses or master's-level research assistants with a range of 3 to 30 years of experience. The semi-structured interviews included questions about the typical recruitment encounter, questions concerning the main components of SDM (e.g. verifying understanding, directive vs. non-directive style), and questions investigating the barriers to and drivers of their recruitment activities, based on the TDF. We used directed content analysis to code quotations into TDF domains, followed by inductive thematic analysis to code quotations into sub-themes within domains and overarching themes across TDF domains. Responses to questions related to SDM were aggregated according to level of endorsement and informed the thematic analysis.
RESULTS
The analysis helped to identify 28 sub-themes across 11 domains. The sub-themes were organized into six overarching themes: coordinating between people, providing guidance to recruiters about challenges, providing resources to recruiters, optimizing study flow, guiding the recruitment decision, and emphasizing the benefits to participation. The SDM analysis revealed recruiters were able to view recruitment interactions as successful even when enrollment did not proceed, and most recruiters took a non-directive (i.e. providing patients with balanced information on available options) or mixed approach over a directive approach (i.e. focus on enrolling patient in study). Most of the core SDM constructs were frequently endorsed.
CONCLUSIONS
Identified sub-themes can be linked to TDF domains for which effective behavior change interventions are known, yielding interventions that can be evaluated as to whether they improve recruitment. Despite having no formal training in shared decision-making, study recruiters reported practices consistent with many elements of SDM. The development of SDM training materials specific to trial recruitment could improve the informed decision-making process for patients.
Topics: Decision Making; Decision Making, Shared; Health Personnel; Humans; Patient Participation
PubMed: 33883012
DOI: 10.1186/s13063-021-05257-x -
ELife Sep 2021Actions often require the selection of a specific goal amongst a range of possibilities, like when a softball player must precisely position her glove to field a...
Actions often require the selection of a specific goal amongst a range of possibilities, like when a softball player must precisely position her glove to field a fast-approaching ground ball. Previous studies have suggested that during goal uncertainty the brain prepares for all potential goals in parallel and averages the corresponding motor plans to command an intermediate movement that is progressively refined as additional information becomes available. Although intermediate movements are widely observed, they could instead reflect a neural decision about the single best action choice given the uncertainty present. Here we systematically dissociate these possibilities using novel experimental manipulations and find that when confronted with uncertainty, humans generate a motor plan that optimizes task performance rather than averaging potential motor plans. In addition to accurate predictions of population-averaged changes in motor output, a novel computational model based on this performance-optimization theory accounted for a majority of the variance in individual differences between participants. Our findings resolve a long-standing question about how the brain selects an action to execute during goal uncertainty, providing fundamental insight into motor planning in the nervous system.
Topics: Adolescent; Adult; Brain; Decision Making; Female; Humans; Male; Models, Biological; Movement; Uncertainty; Young Adult
PubMed: 34486520
DOI: 10.7554/eLife.67019 -
Current Opinion in Neurobiology Dec 2012Over the past decade, neuroeconomics studies utilizing neurophysiology methods (fMRI or EEG) have flourished, revealing the neural basis of 'boundedly rational' or... (Review)
Review
Over the past decade, neuroeconomics studies utilizing neurophysiology methods (fMRI or EEG) have flourished, revealing the neural basis of 'boundedly rational' or 'irrational' decision-making that violates normative theory. The next question is how modulatory neurotransmission is involved in these central processes. Here I focused on recent efforts to understand how central monoamine transmission is related to nonlinear probability weighting and loss aversion, central features of prospect theory, which is a leading alternative to normative theory for decision-making under risk. Circumstantial evidence suggests that dopamine tone might be related to distortion of subjective reward probability and noradrenaline and serotonin tone might influence aversive emotional reaction to potential loss.
Topics: Biogenic Monoamines; Brain; Choice Behavior; Decision Making; Economics, Behavioral; Humans; Neurobiology; Risk-Taking
PubMed: 22749131
DOI: 10.1016/j.conb.2012.06.003 -
Sensors (Basel, Switzerland) Jun 2022The Pythagorean fuzzy sets conveniently capture unreliable, ambiguous, and uncertain information, especially in problems involving multiple and opposing criteria....
The Pythagorean fuzzy sets conveniently capture unreliable, ambiguous, and uncertain information, especially in problems involving multiple and opposing criteria. Pythagorean fuzzy sets are one of the popular generalizations of the intuitionistic fuzzy sets. They are instrumental in expressing and managing hesitant under uncertain environments, so they have been involved extensively in a diversity of scientific fields. This paper proposes a new Pythagorean entropy for Multi-Criteria Decision-Analysis (MCDA) problems. The entropy measures the fuzziness of two fuzzy sets and has an influential position in fuzzy functions. The more comprehensive the entropy, the more inadequate the ambiguity, so the decision-making established on entropy is beneficial. The COmplex PRoportional ASsessment (COPRAS) method is used to tackle uncertainty issues in MCDA and considers the singularity of one alternative over the rest of them. This can be enforced to maximize and minimize relevant criteria in an assessment where multiple opposing criteria are considered. Using the Pythagorean sets, we represent a decisional problem solution by using the COPRAS approach and the new Entropy measure.
Topics: Decision Making; Entropy; Fuzzy Logic; Uncertainty
PubMed: 35808377
DOI: 10.3390/s22134879 -
JCO Clinical Cancer Informatics Dec 2018Shared decision making (SDM) and patient-centered care require patients to actively participate in the decision-making process. Yet with the increasing number and... (Review)
Review
Shared decision making (SDM) and patient-centered care require patients to actively participate in the decision-making process. Yet with the increasing number and complexity of cancer treatment options, it can be a challenge for patients to evaluate clinical information and make risk-benefit trade-offs to choose the most appropriate treatment. Clinicians face time constraints and communication challenges, which can further hamper the SDM process. In this article, we review patient decision aids (PDAs) as a means of supporting SDM by presenting clinical information and risk data to patients in a format that is accessible and easy to understand. We outline the benefits and limitations of PDAs as well as the challenges in their development, such as a lengthy and complex development process and implementation obstacles. Lastly, we discuss future trends and how change on multiple levels-PDA developers, clinicians, hospital administrators, and health care insurers-can support the use of PDAs and consequently SDM. Through this multipronged approach, patients can be empowered to take an active role in their health and choose treatments that are in line with their values.
Topics: Decision Making; Decision Support Techniques; Humans; Patient-Centered Care
PubMed: 30652607
DOI: 10.1200/CCI.18.00013 -
Trends in Neurosciences Feb 2022Suboptimal decision-making strategies have been proposed to contribute to the pathophysiology of addiction. Decision-making, however, arises from a collection of... (Review)
Review
Suboptimal decision-making strategies have been proposed to contribute to the pathophysiology of addiction. Decision-making, however, arises from a collection of computational components that can independently influence behavior. Disruptions in these different components can lead to decision-making deficits that appear similar behaviorally, but differ at the computational, and likely the neurobiological, level. Here, we discuss recent studies that have used computational approaches to investigate the decision-making processes underlying addiction. Studies in animal models have found that value updating following positive, but not negative, outcomes is predictive of drug use, whereas value updating following negative, but not positive, outcomes is disrupted following drug self-administration. We contextualize these findings with studies on the circuit and biological mechanisms of decision-making to develop a framework for revealing the biobehavioral mechanisms of addiction.
Topics: Animals; Behavior, Addictive; Decision Making; Humans; Reinforcement, Psychology; Substance-Related Disorders
PubMed: 34920884
DOI: 10.1016/j.tins.2021.11.007 -
Journal of Neurophysiology Nov 2010To provide a fundamental basis for understanding decision-making and decision confidence, we analyze a neuronal spiking attractor-based model of decision-making. The...
To provide a fundamental basis for understanding decision-making and decision confidence, we analyze a neuronal spiking attractor-based model of decision-making. The model predicts probabilistic decision-making with larger neuronal responses and larger functional magnetic resonance imaging (fMRI) blood-oxygen-level-dependent (BOLD) responses on correct than on error trials because the spiking noise-influenced decision attractor state of the network is consistent with the external evidence. Moreover, the model predicts that the neuronal activity and the BOLD response will become larger on correct trials as the discriminability ΔI increases and confidence increases and will become smaller as confidence decreases on error trials as ΔI increases. Confidence is thus an emergent property of the model. In an fMRI study of an olfactory decision-making task, we confirm these predictions for cortical areas including medial prefrontal cortex and the cingulate cortex implicated in choice decision-making, showing a linear increase in the BOLD signal with ΔI on correct trials, and a linear decrease on error trials. These effects were not found in a control area, the orbitofrontal cortex, where reward value useful for the choice is represented on a continuous scale but that is not implicated in the choice itself. This provides a unifying approach to decision-making and decision confidence and to how spiking-related noise affects choice, confidence, synaptic and neuronal activity, and fMRI signals.
Topics: Brain; Brain Mapping; Decision Making; Humans; Magnetic Resonance Imaging; Models, Neurological; Neurons; Reward
PubMed: 20810685
DOI: 10.1152/jn.00571.2010 -
PloS One 2015It is common for individuals to engage in taxing cognitive activity for prolonged periods of time, resulting in cognitive fatigue that has the potential to produce...
OBJECTIVE
It is common for individuals to engage in taxing cognitive activity for prolonged periods of time, resulting in cognitive fatigue that has the potential to produce significant effects in behaviour and decision making. We sought to examine whether cognitive fatigue modulates economic decision making.
METHODS
We employed a between-subject manipulation design, inducing fatigue through 60 to 90 minutes of taxing cognitive engagement against a control group that watched relaxing videos for a matched period of time. Both before and after the manipulation, participants engaged in two economic decision making tasks (one for gains and one for losses). The analyses focused on two areas of economic decision making--preferences and choice strategies. Uncertainty preferences (risk and ambiguity) were quantified as premium values, defined as the degree and direction in which participants alter the valuation of the gamble in comparison to the certain option. The strategies that each participant engaged in were quantified through a choice strategy metric, which contrasts the degree to which choice behaviour relies upon available satisficing or maximizing information. We separately examined these metrics for alterations within both the gains and losses domains, through the two choice tasks.
RESULTS
The fatigue manipulation resulted in significantly greater levels of reported subjective fatigue, with correspondingly higher levels of reported effort during the cognitively taxing activity. Cognitive fatigue did not alter uncertainty preferences (risk or ambiguity) or informational strategies, in either the gains or losses domains. Rather, cognitive fatigue resulted in greater test-retest variability across most of our economic measures. These results indicate that cognitive fatigue destabilizes economic decision making, resulting in inconsistent preferences and informational strategies that may significantly reduce decision quality.
Topics: Adult; Choice Behavior; Cognition; Decision Making; Economics, Behavioral; Fatigue; Female; Humans; Male; Risk-Taking; Surveys and Questionnaires; Young Adult
PubMed: 26230404
DOI: 10.1371/journal.pone.0132022 -
BMC Geriatrics Nov 2022As care homes play an important role in the lives of an increasing number of older people, it is pivotal to understand how residents' and their families engage in... (Review)
Review
BACKGROUND
As care homes play an important role in the lives of an increasing number of older people, it is pivotal to understand how residents' and their families engage in decision-making about their care and support. Internationally, there is an increasing emphasis in long-term care settings on the right of residents to be actively involved in all aspects of decision-making about their care and support. However, the steps necessary to achieving a culture of shared decision-making in long-term care settings remain unclear. The aim of this literature review is to summarise what is known in the literature about the factors that influence care home residents' and families' engagement with decision-making about their care and support.
METHODS
An integrative literature reviews was carried out, guided by the methodological framework proposed by Whittemore and Knafl (2005). CINAHL, Medline Ovid and ProQuest Health and Medical databases were searched for relevant articles from 2011 to 2021. A three-step method was used, including the use of reference and citation management software to manage search results and identify duplicate citations. Abstracts and full texts were reviewed by two reviewers. Details of the selected articles were then extracted using the Data Extraction Form.
RESULTS
In total, 913 articles were located and 22 studies were included in the final analysis. The thematic analysis identified three main themes that illustrate the complexities of shared decision-making in care homes: (a) a positive culture of collaborative and reciprocal relationships; (b) a willingness to engage and a willingness to become engaged; and (c) communicating with intent to share and support rather than inform and direct.
CONCLUSION
The implementation of shared decision-making in care homes is highly dependent on the support and nurturing of collaborative and reciprocal relationships between residents, families, and staff. Part of this process includes ascertaining the willingness of residents and families to become engaged in shared decision-making. Communication skills training for staff and guided approaches that view decision-making as a supportive process rather than a once off event are essential prerequisites for implementation.
Topics: Humans; Aged; Decision Making; Long-Term Care; Decision Making, Shared
PubMed: 36396991
DOI: 10.1186/s12877-022-03503-8 -
Current Biology : CB Oct 2008Studying the neural basis of decision-making has largely taken one of two paths: one has involved cell-by-cell characterization of neuronal circuits in invertebrates;... (Review)
Review
Studying the neural basis of decision-making has largely taken one of two paths: one has involved cell-by-cell characterization of neuronal circuits in invertebrates; and the other, single-unit studies of monkeys performing cognitive tasks. Here I shall attempt to bring these two disparate approaches together.
Topics: Animals; Decision Making; Neurons
PubMed: 18957243
DOI: 10.1016/j.cub.2008.07.081