Turning failures into successes: a methodological shortcoming in empirical research on surrogate accuracy

Decision making for incompetent patients is a much-discussed topic in bioethics. According to one influential decision making standard, the substituted judgment standard, a surrogate decision maker ought to make the decision that the incompetent patient would have made, had he or she been competent. Empirical research has been conducted in order to find out whether surrogate decision makers are sufficiently good at doing their job, as this is defined by the substituted judgment standard. This research investigates to what extent surrogates are able to predict what the patient would have preferred in the relevant circumstances. In this paper we address a methodological shortcoming evident in a significant number of studies. The mistake consists in categorizing responses that only express uncertainty as predictions that the patient would be positive to treatment, on the grounds that the clinical default is to provide treatment unless it is refused. We argue that this practice is based on confusion and that it risks damaging the research on surrogate accuracy.

An above real time training intervention for sport decision making

ObjectivesA speeded video-based decision-making training intervention was used to assess the impact of above real time training on decision-making skill in sport.Design and methodsThree groups completed pre tests and either five weeks of fast speed video training, normal speed video training or no training, followed by a post test and two retention tests in subsequent weeks. Decision accuracy was measured by awarding three, two, one, or no point(s) based on independent coach ratings of each situation.ResultsResults revealed that those trained in above real time improved performance earlier in the training intervention compared to those trained in normal speed. The above real time group also retained more of the performance improvements. The transfer test for decision accuracy showed improvement following the training intervention for all groups, trends in the data reflected a higher retention rate for the fast speed group choosing the bet option more frequently than normal and control groups.ConclusionsThe results lend support to the general use of video-based decision-making training for team invasion sports. A greater impact is that they provide a new paradigm by adapting above real time training to decision making, to create a more game-like training scenario.     

Processes of patient decision making: Theoretical and methodological issues

Abstract

There is a paucity of research studying patients' decision making processes. Traditional normative approaches investigating human decision have presented rational, analytic processing as a ‘gold standard’ for decision making with decision aids developed to facilitate such thinking. This paradigm has been challenged by the recent emergence of naturalistic decision making. Naturalistic approaches argue for techniques modelled closer to how decisions are actually made in ‘real life’. Early work in this evolving field suggests the importance of more automatic, intuitive processing such as the use of heuristic short-cuts. This paper discusses the contribution of naturalistic decision theory and assesses its usefulness as an alternative to classical decision approaches in investigating patient decision making. Approaches for measuring underlying cognitive processes are also critically discussed.     

The <Emphasis Type="Italic">Not Unreasonable</Emphasis> Standard for Assessment of Surrogates and Surrogate Decisions

Standard views on surrogate decision making present alternative ideal models of what ideal surrogates should consider in rendering a decision. They do not, however, explain the physician's responsibility to a patient who lacks decisional capacity or how a physician should regard surrogates and surrogate decisions. The authors argue that it is critical to recognize the moral difference between a patient's decisions and a surrogate's and the professional responsibilities implied by that distinction. In every case involving a patient who lacks decisional capacity, physicians and the treatment team have to make judgments about the appropriateness of both the surrogate and the surrogate's decision. They have to assess the surrogate's decisional capacity and attitude toward the patient as well as the reasons that support the surrogate's decision. This paper provides a model for acceptable surrogate decisions and a standard for blocking inappropriate surrogates. Only decisions based on widely shared reasons are allowable for surrogate refusal of highly beneficial treatment.     

The Problem of Counterfactuals in Substituted Judgement Decision‐Making

The standard by which we apply decision‐making for those unable to do so for themselves is an important practical ethical issue with substantial implications for the treatment and welfare of such individuals. The approach to proxy or surrogate decision‐making based upon substituted judgement is often seen as the ideal standard to aim for but suffers from a need to provide a clear account of how to determine the validity of the proxy's judgements. Proponents have responded to this demand by providing the truth‐conditions for the substituted judgement in terms of counterfactual reasoning using a possible worlds semantics. In this paper, I show how these underpinnings fail to support the substituted judgement approach as a reasonable standard for decision‐making. Firstly, I show how this counterfactual element has been poorly interpreted. I then explain how various accounts have failed to reflect problems and limitations associated with providing an interpretation of their truth‐conditions using counterfactuals. Finally, I argue that, even when we attend to the initial problems of providing a counterfactual analysis, it still deeply problematic as a means of determining the validity of substituted judgements for two main reasons. Firstly, making determinate judgements as to the truth‐value of these judgements will often not be possible and, secondly, there is a strong requirement when interpreting many counterfactual claims to charitably accede to their being true. I conclude that substituted judgements, as interpreted through counterfactual reasoning and possible worlds semantics, do not therefore provide an adequate standard for surrogate decision‐making.     

The lure technique: Generalization and moderating effects

IntroductionThe lure technique, first studied by Joule, Gouilloux and Weber (1989), involves three stages: (1) an individual is led to make a rewarding decision to realize a given behavior; (2) he is informed of the impossibility of realizing this behavior; (3) we propose making a new less rewarding decision based on another behavior (target-request).ObjectiveFive experiments are presented in this paper that tested the effect of the delay between the two requests, whether the same experimenter or a further made the second request and whether the two requests concerned or not the same specific goal.Method and resultsIn the experiments, the rewarding decision deals with participating in a paid and interesting research project (viewing a video before answering a questionnaire) and the target-request concerns participating in an unpaid and more tedious research project (copying symbols). As expected, the participants subjected to the lure technique were significantly more numerous to accept the target-request than the participants in the control group. This effect was obtained independently of the sex of the experimenter and the participants (Experiment 1), whether the same experimenter successively makes the first and second request or the two requests are made by two different experimenters (Experiment 2). It was also obtained when the initial request and the target-request do not concern the same specific goal (Experiment 3), but it is no longer obtained when a delay separates the target-request from the announcement of the impossibility of carrying out the first decision (Experiments 4 and 5).ConclusionThe discomfort aroused by the fact of not being able to carry out the first request and pressure to reduce such discomfort was used to explain the lure technique effect.     

Experimental consideration of preference in decision making under certainty

This paper describes an experiment in decision making under certainty with multiple, conflicting objectives and continuous decision variables. Two techniques for analysing such problems are considered: one taken from the paradigm of multicriteria decision making (MCDM), a non-directed approach called the NAIVE technique, and one from the paradigm of multiattribute decision analysis (D/A), the SMART technique. While the two techniques seek and are throught to arrive at the same end—a solution which is in some sense optimal for the decision maker (DM)—the former approach implicitly incorporates DM preferences while the latter approach considers preferences explicitly. The setting is a laboratory study using a sample of university students on a three-criteria problem which is designed to study the extent to which value functions implied/assessed by the techniques are consistent with DMs' holistic ranking of alternatives. Results show that (1) the two techniques of interest show significantly better rank order correlation with holistic judgement compared with other techniques, (2) DMs prefer the non-directed MCDM approach and (3) subjects break down into two groups: those that use assessable value functions when ranking and those that do not. This implies that for small-dimensioned problems DMs may first need to be classified as to the assessability of their value functions before a solution method is chosen.     

Gaze behaviors and decision making accuracy of higher- and lower-level ice hockey referees

BackgroundGaze behaviors are often studied in athletes, but infrequently for sport officials. There is a need to better understand gaze behavior in refereeing in order to improve training and education related to visual search patterns, which have been argued to be related to decision making (Abernethy & Russell, 1987a).ObjectiveTo examine gaze behaviors, decision accuracy, and decision sensitivity (using signal detection analysis) of ice hockey referees of varying skill levels in a laboratory setting.DesignUsing an experimental design, we conducted multiple t-tests.MethodHigher-level (N = 15) and lower-level ice hockey referees (N = 15) wore a head-mounted eye movement recorder and made penalty/no penalty decisions related to ice hockey video clips on a computer screen. We recorded gaze behaviors, decision accuracy, and decision sensitivity for each participant.ResultsResults of the t-tests indicated no group differences in gaze behaviors; however, higher-level referees made significantly more accurate decisions (both accuracy and sensitivity) than lower-level referees.ConclusionHigher-level ice hockey referees are superior to lower-level referees on decision making, but referees do not differ on gaze behaviors. Possibly, higher-level referees process relevant decision making information more effectively.     

To Use or Not to Use: Male Partners' Perspectives on Decision Making About Prenatal Diagnosis

We conducted an exploratory, qualitative pilot study investigating the use of genetic counseling and prenatal genetic technologies between women and their male partners for two referral groups: pregnant women 35 years of age and over (AMA) at the time of delivery and pregnant women with an abnormal maternal serum triple screen (MSAFP3). The convenience sample consisted of 25 semistructured interviews and 50 observations of genetic counseling sessions. Male partners' styles of decision making and the way they viewed prenatal diagnosis decision making were examined. We defined three decision-making styles based on our interpretation of the data: (1) domain, (2) joint-delegated, and (3) saliency. The male partners also seemed to view prenatal diagnosis as either an information decision or an action decision and appeared to take a more active role in decision making when the decision was viewed as an action decision.     

Sex in the City: The ambiguity of female mating strategies

Abstract

The purpose of this paper is to discuss the limitations of evolutionary explanations of female mating strategies, and to present an alternative theory that accounts for the ambiguity of mating strategies throughout a woman's life. While mating strategies are considered to be discrete entities, it is clear that women's decision making in everyday life is based on mutually fused, ambiguous courses of actions. The current perspective addresses the commonality of female mating experiences while highlighting the uniqueness of each woman's mating strategy and outlines a multi-level perspective on strategies of women's reproductive decision making.     

Beyond IQ: A latent state-trait analysis of general intelligence, dynamic decision making, and implicit learning

The present study investigated cognitive performance measures beyond IQ. In particular, we investigated the psychometric properties of dynamic decision making variables and implicit learning variables and their relation with general intelligence and professional success. N = 173 employees from different companies and occupational groups completed two standard intelligence tests, two dynamic decision making tasks, and two implicit learning tasks at two measurement occasions each. We used structural equation models to test latent state-trait measurement models and the relation between constructs. The results suggest that dynamic decision making and implicit learning are substantially related with general intelligence. Furthermore, general intelligence is the best predictor for income, social status, and educational attainment. Dynamic decision making can predict supervisor ratings even beyond general intelligence.     

T-ECHO: model of decision making to explain behaviour in experiments and simulations under time pressure

Objectives: To explain the mechanisms of decision making in sports. The ‘Decision Field Theory’ by Townsend and Busemeyer ((1995). Dynamic representation of decision-making. In R. F. Port & T. von Gelder (Eds.), Mind as motion (p. 101). Cambridge: MIT Press) was applied to a ball game situation.Design/Method: A situation in basketball was simulated and used in two experiments. The simulation was realized using a local neural network (Behav. Brain Sci., 12 (1989) 435) and was based on a decision model T-ECHO (Tactical decision — Explanatory Coherence by Harmonic Optimization). Experiment 1 (n=53) tested decisions in a video-based laboratory decision task. Learning took place by watching video clips and was significantly better for implicit and explicit groups than for a control group. Experiment 2 (n=34) replicated the results by using incidental and intentional learning groups. Finally, comparisons between behaviour output of neural networks and participants' decision making were made.Results: A good fit between simulation and participant behaviour was shown. Time pressure explained preference reversals from a dynamic viewpoint.Conclusions: The use of simulations and decision experiments lead to a fruitful way to understand the mechanisms of decision making in ball games.     

Selective Exposure and News Media Brands: Implicit and Explicit Attitudes as Predictors of News Choice

ABSTRACT

Media consumers often lack the motivation, time, or cognitive capacity to select content in a deliberate way; instead, they opt for mental shortcuts. Brands are important in this regard because they simplify decision making. In the present study we investigated whether attitudes toward news media brands predict news choice. It is important that we conceptualized attitudes on two different levels: Although explicit attitudes are defined as overtly expressed, more or less deliberate evaluations, implicit attitudes are defined as automatically activated, gut-level evaluations. The supplementary use of implicit attitudes is consistent with current theorizing highlighting that deeply held and sometimes even unconscious evaluations influence media choice. Using a web-based study, we found that implicit and explicit attitudes toward television brands predicted choice. Each attitude construct predicted variance beyond that predicted by the other. We discuss implications by emphasizing the role of automatic, gut-level decision making in current high-choice media environments.     

Integrating emotion and other nonrational factors into ethics education and training in professional psychology

ABSTRACT

Any professional or scientific discipline has a responsibility to do what it can to ensure ethical behavior on the part of its members. In this context, this paper outlines and explores the criticism that to date the emphasis in ethics training in professional psychology, as with other disciplines, has been on the rational elements of ethical decision making, with insufficient attention to the role of emotions and other nonrational elements. After a brief outline of some of the historical background to the development and understanding of ethical decision making, relevant theoretical and empirical literature on the influence of emotional and other nonrational factors on our ethical decisions is reviewed. The implications of this literature for ethics education and training are outlined, particularly with respect to the use of case studies. An integrative approach is proposed, and conclusions and recommendations are offered with respect to such an approach.     

Do we make decisions for other people based on our predictions of their preferences? evidence from financial and medical scenarios involving risk

Abstract

The ways in which the decisions we make for others differ from the ones we make for ourselves has received much attention in the literature, although less is known about their relationship to our predictions of the recipient’s preferences. The latter question is of particular importance given real-world occurrences of surrogate decision-making which require surrogates to consider the recipient’s preferences. We conducted three experiments which explore this relationship in the medical and financial domains. Although there were mean discrepancies between surrogate predictions and choices, we identified a predictive relationship between the two. Moreover, when participants took high risks for themselves, it seems that they were not willing to do so for others, even when they believed that the recipient’s preferences were similar to their own. We discuss these findings relative to current theories and real-world instances of surrogate decision-making.     

Processing of emotional meaning in anxiety

Abstract

Previous research has indicated that anxiety and depressive states do not lead to speeding of lexical decisions for mood-congruent words. Theoretical considerations, and some data, suggest that such mood-congruent speeding effects should be more apparent in affective decisions. In three experiments we found no evidence that anxious subjects are faster when making affective decisions for congruent (threatening) words, whether or not these subjects had been recently exposed to the same words. It is concluded that the processes involved in the attentional and interpretive processing of threatening stimuli by anxious subjects are different from those involved when making a conscious decision about emotional meaning.     

Damage Compounded: Disparities,Distrust, and Disparate Impact in End-of-Life Conflict Resolution Policies

For a little more than a decade, professional organizations and healthcare institutions have attempted to develop guidelines and policies to deal with seemingly intractable conflicts that arise between clinicians and patients (or their proxies) over appropriate use of aggressive life-sustaining therapies in the face of low expectations of medical benefit. This article suggests that, although such efforts at conflict resolution are commendable on many levels, inadequate attention has been given to their potential negative effects upon particular groups of patients/proxies. Based on the well-documented tendency among many African Americans to prefer more aggressive end-of-life medical interventions, it is proposed that the use of institutional policy to break decision making impasse in cases for which aggressive treatment is deemed “medically inappropriate” will fall disproportionately on that group. Finally, it is suggested that the development and application of institutional conflict-resolution policies should be evaluated in the context of historical and current experiences of marginalization and disempowerment, lest such policies exacerbate that experience.     

The Effects of Alternative Labels on Decision Behavior: The Case of Corporate Site Selection Decisions

The influence of alternative labels on decision processes and outcomes were examined in a multidimensional decision task with realistic decision information and experienced decision makers. Based on prior research, it was predicted that labels would influence selection and ratings of decision alternatives, as well as the extent of information search and the information search strategies. Subjects (n = 26) experienced in making and/or aiding business relocation decisions completed two computer controlled site selection tasks: one with labeled locations and one with unlabeled locations. Results indicated that labeling influenced both decision processes and location ratings. An interaction between order of task completion and labeling suggested that labeling effects on decision making may be minimized if an unlabeled task is completed prior to a labeled task. Implications and limitations are discussed in terms of labeling effects and decision quality.