Subjective evaluation and allocation of resources in routine decision making

Routine decision making is a process of identifying goals, evaluating alternatives, and formulating appropriate strategies for attaining these goals. The latter two stages of this process were examined in a two-part experiment. In the first part, subjects scaled alternative combinations of the resources required for goal attainment. The results showed that an explicitly defined goal directly influenced the utility of resources. In essence, mean utilities were equivalent to point estimates of cost-benefit analyses. In the second part, subjects performed a decision-making task, allocating the initial resource combinations to achieve an explicitly defined goal. Task performance was modeled with linear programming techniques which provide a means of evaluating both the subjects' decisions and the process of resource allocation and strategy formulation. Results indicated that only 1 of 12 subjects allocated resources optimally in making decisions, even though all of the subjects had appropriately scaled the utility of these resources in the first part of the experiment. Moreover, half the subjects failed to utilize the maximum available resources in making their decisions. This outcome is discussed in terms of the memory and attentional constraints on routine decision-making processes. The results suggest that these constraints are most severe at the time of strategy formulation, even when the utility of resources and the explicit goal are known.     

The current environment for medical decision making: Alternative efficiency concepts and decision motivation

Health services delivery is rapidly changing in the U.S. and along with it the incentives and motives for making decisions about the use of services. This paper discusses the economic criteria for making good decisions from both individual and social perspectives. The position is taken that individual criteria for decision-making efficiency in health services is quite different from social efficiency criteria but the two perspectives can be viewed as complementary. These criteria are used to examine current developments in health services, including aggressively competitive managed care. The analysis concludes that current directions may be in conflict with both social and individual efficiency. Alternative public policies are required to alter motives and incentives such that decisions better meet the complementary efficiency criteria.Originally prepared for presentation at the Annual Meeting of the American Association for the Advancement of Science, Atlanta, Georgia, February 17, 1995, as part of the symposium Cognitive Interpersonal, and Societal Influences on Medical Decision Making (A. M. Isen and B. S. Moore, Chairs).     

Subjective valuation and asymmetrical motivational systems: implications of scope insensitivity for decision making

Studies using the Iowa Gambling Task have revealed individual differences in performance on the task. In this study, we tested the hypothesis that approach and avoidance motivations influence decision making through the process of subjective valuation. We examined the implications of a high sensitivity to gains or losses from two perspectives which we labeled scalar multiplication and valuation by feeling. Using two versions of the Iowa Gambling Task, we find evidence supporting the view that asymmetry in the systems regulating approach and avoidance leads to systematic biases that translate to differences in performance. Specifically, we find that high sensitivity in the Behavioral Activation System (BAS) translates to valuation by feeling and insensitivity to scope in the domain of gains, while high sensitivity in the Behavioral Inhibition System (BIS) translates to valuation by feeling and insensitivity to scope in the domain of losses. The basis for these findings is discussed. Copyright © 2007 John Wiley & Sons, Ltd.     

Preferences for involvement in medical decision making: comparing British and German views

Despite beneficial outcomes of patients' involvement in medical decision processes, it has been claimed that patients are generally not interested in medical decision making (MDM). Whereas current research focuses on actual MDM, this research explored the impact of nationality and perceptual processes of MDM. Preferences for involvement in decision making were examined in a sample of 204 German and 143 British university students. Hierarchical multiple regressions were employed to explore the link between socio-demographic information, individuals' perceived relationship with their GP, Health Locus of Control - Powerful Others, perceptions regarding the frequency and sufficiency of information provision and involvement in MDM, and individuals' preferred level of involvement and information. A significant amount of the variance in individuals preferences for involvement could be explained (Adjusted R2 = .59, p < .001). Independent t-test analyses showed that British and German perceptions of care differed significantly on a variety of different measures. Separate analyses for the German and British group highlighted cross-national differences in care and preferences for involvement. The study suggests that preferences to become involved might depend more on perceptual processes than actual involvement in decision making, and that communication and national health policy could play an important role.     

Effort and demand logic in medical decision making

Medical decisions, including diagnosis, prognosis, and disease classification, must often be made on the basis of incomplete or unsatisfactory information. Data which are essential to the care of one patient may be unobtainable for technical or ethical reasons in another patient. For this reason the principles of controlled experimentation may be impossible to satisfy in human studies. In this paper, some formal aspects of medical decision making are discussed. Special operators for the intuitive concepts of ‘certainty’, ‘demand’, and ‘effort’, akin to the operators of modal logic, are used to accommodate the technical and ethical limitations on human studies. Theorems are stated and proved which show how this system handles incomplete information. The embryogenesis of the human heart is presented as a sample problem in classification.     

The place of prudence in medical decision making

In the world of practical affairs in general, no less than in the matter of medicalethical decision making, there is place for the possession of the classical virtue of prudence. Most persons involved in making such decisions are interested exclusively in solving a case, and ignore the importance of growing in virtue and character at the same time while having their decision reflect prudential reasoning. A study of the virtue of prudence shows that it is a much misunderstood virtue, and requires deeper penetration into its meaning to grasp its place in humanizing medical decisions.     

An outcomes model of medical decision making

In the traditional fix-it model of medical decision making, the identified problem is typically characterized by a diagnosis that indicates a deviation from normalcy. When a medical problem is multifaceted and the available interventions are only partially effective, a broader vision of the health care endeavor is needed. What matters to the patient, and what should matter to the practitioner, is the patient's future possibilities. More specifically, what is important is the character of the alternative futures that the patient could have and choosing among them so as to achieve the best future possible, with the ranking of outcomes determined by the patient's preferences. This paper describes the fix-it model, presents and defends the outcomes-based model, and demonstrates that the latter is useful in developing normative conceptions of informed consent and decision making and in establishing a basis for societal involvement in the decision making process. Finally, several shortcomings of the model will be acknowledged.     

Effectiveness of the GOFER course in decision making for high school students

The paper describes and evaluates the GOFER course in decision making for high school students (Mann, Harmoni and Power, 1988). The course was based on principles from the conflict theory of decision making (Janis and Mann, 1977) and was designed to provide adolescents with an understanding of factors that produce good and poor decision making as well as knowledge and practice of sound decision skills. Two evaluation studies were conducted to examine effectiveness of the course. Study 1 was conducted with young adolescents (12 year olds). It found a significant difference between students trained in the course and a control group on measures of self-esteem as a decision maker, self reported decision habits and knowledge of decision strategy. Study 2 was conducted with mid-adolescents (15 year olds). It, too, found a significant difference between students who took the course and a control group on measures of self esteem as a decision maker and self-reported decision habits. It is concluded that while the evaluation study fell short of an ideal test, the GOFER course met the criteria of improving student knowledge, raising confidence in decision making and changing self reported decision habits.     

Assessing the roles of change discrimination and luminance integration: evidence for a hybrid race model of perceptual decision making in luminance discrimination

Many models of perceptual processing assume that participants integrate stimulus evidence over time, for example, random walk models. This class of models is tested in a luminance discrimination paradigm in which the onsets of the stimuli are either instantaneous (stepped) or slowly ramped. The ramped portion of ramped stimuli occurs prior to the stepped stimuli onsets. Consequently, there is more luminance energy in ramped stimuli. Therefore, if participants integrate luminance energy, they should perform better to ramped stimuli. This did not occur in 4 experiments. Participants performed better to stepped stimuli than ramped stimuli in earlier foreperiods and the reverse in later foreperiods. A new model is proposed in which participants monitor both integrated luminance energy and quick temporal changes in luminance, but they do so in a serial fashion. First, participants monitor temporal changes in luminance; later, they monitor integrated luminance energy.     

'Fairness and reasonableness of the child's decision:' a proposed legal standard for children's participation in medical decision making.

Using as illustration the case of Nikolas E., a six-year-old child with HIV/AIDS, this article considers the competing rights of children, parents, and state in cases involving pediatric medical disputes. The article outlines arguments in favor of and against children's participation in medical decisions and describes legal standards currently used in resolving pediatric medical disputes. The article then proposes adoption of a new legal standard described as the 'fairness and reasonableness of the child's decision,' and articulates advantages and disadvantages of such an approach, as well as the factors that should be considered in implementing the standard. Finally, the article argues for a methodology for including children's wishes in pediatric medical decision making that is based upon Monahan and Walker's model for including social science evidence in legal contexts and evaluates alternative strategies for including children meaningfully in the process of making medical decisions that affect them.     

Mental workload while driving: effects on visual search,discrimination, and decision making

The effects of mental workload on visual search and decision making were studied in real traffic conditions with 12 participants who drove an instrumented car. Mental workload was manipulated by having participants perform several mental tasks while driving. A simultaneous visual-detection and discrimination test was used as performance criteria. Mental tasks produced spatial gaze concentration and visual-detection impairment, although no tunnel vision occurred. According to ocular behavior analysis, this impairment was due to late detection and poor identification more than to response selection. Verbal acquisition tasks were innocuous compared with production tasks, and complex conversations, whether by phone or with a passenger, are dangerous for road safety.