Predictors of decision-making style among cancer patients: An empirical test of theory

Abstract

Patient decision-making has been shown to be far from data-driven which results in serious consequences for physical health and psychological well-being. Cancer patients were found to have made their medical decisions in four ways: information-seeking, information-processing, advice-following, and ruminating. These four ways represent two routes of cognitive processing. The first two exemplify central route processing and the second two exemplify peripheral route processing. Medical decisions have also been shown to be highly influencable based on message presentation. This study represents the first step in applying social influence theory to medical decision-making. The elaboration likelihood model was used to determine whether the variables shown to have influenced routes of processing could predict which decisional style the cancer patients used. Specifically, the elaboration likelihood model of Petty and Cacioppo (1986) was applied as predictors of decisional processing style. Using a discriminant function analysis, the variables motivation (both cognitive and emotional), ability to process, and cognitive responding predicted whether cancer patients made their medical decisions using the four categories of decisional styles.     

Information giving and involvement in treatment decisions: Is more really better? Psychological effects and relation with adherence

Objectives : The aim of this study is to improve our understanding of the ways in which a medical consultation style relates to satisfaction and adherence.

Design : Participants completed questionnaires about preferred and perceived consultation styles; psychological variables such as satisfaction, anxiety and depression; and questions about taking medication. Questionnaires were completed prior to the consultation, immediately after, three months later and one year later. Doctors also completed a scale on completion of the consultation. The decisions in question related to women seeking advice about Hormone Replacement Therapy (HRT) and decisions about pain management.

Results : Patients expressed preferences for information about the treatment options and for active involvement in the decision process. The extent to which patients perceived themselves as having received information about the treatment options was a particularly consistent predictor of satisfaction. The extent to which patients perceived themselves as having been prepared for the side effects of HRT was a consistent predictor of anxiety.

Conclusions : Perceptions of the amount of information received about medical options, including information preparing individuals for potential side effects of medication, appears to be more important to satisfaction and anxiety, than actual involvement in the decision.     

The relative importance of patients’ decisional control preferences and experiences

Objective: Patients’ role in treatment decision-making can influence psychosocial and health-related outcomes (i.e. satisfaction, felt respect, adherence). We examined decisional control in a surgical context, identifying correlates of patients’ preferences and experiences.

Design: 380 patients and 7 surgeons were surveyed during initial surgical consultation visits in a low-income outpatient clinic.

Measures: Patients reported preferences for (pre-consultation) and experiences of (post-consultation) decisional control, demographics, satisfaction with care, and adherence to treatment recommendations. Surgeons rated patients’ health status.

Results: Preferences for and experiences of decisional control were unrelated, suggesting significant preference–experience misalignment. However, this misalignment did not appear to be consequential for patient outcomes. Rather, more decisional control, regardless of patients’ preferences, predicted greater satisfaction with care and greater self-reported adherence as assessed at a post-surgical appointment.

Conclusions: Decisional control predicts better outcomes for patients, regardless of their preferences for control over treatment decisions. These findings suggest that interventions should aim to increase patients’ degree of decisional control when feasible and appropriate.     

Decisional styles and risk of problem drinking or gambling

Addictive behaviours indicate a deficit in self regulation, with a general predisposition towards addiction implied by comorbid addictive behaviours. To determine whether common or differing decisional styles were associated with alcohol and gambling problems university students (n = 462) completed online the Melbourne Decision Making Questionnaire, Alcohol Use Disorders Identification Test, and the South Oaks Gambling Screen to assess their alcohol use, and gambling patterns. There was some comorbidity between those at risk for alcohol and gambling-related problems, with both groups frequenting more gaming venues, however, participants at risk for alcohol related problems differed in their decisional styles from those at risk for gambling problems. A greater risk of alcohol related problems was linked to lower vigilance scores and increased tendencies towards procrastination. A higher risk of gambling problems was associated with lower decisional self-esteem and an increased proneness to hypervigilance or panic. Therefore, while a predisposition towards addiction manifests as a preference for addictive behaviour, it is associated with different decisional styles. Problem drinkers are more likely to have an avoidant decisional style, while problem gamblers are not confident in their ability to make decisions, and their decisions feel pressured.     

Effects of decisional control on state anxiety and achievement

This study examines the effects of decisional control on state anxiety and cognitive performance in a true-to-life evaluative situation. The analyses were based on the mathematics achievement and state anxiety scores of a sample of 74 eighth grade students randomly assigned to either a Decisional Choice or No Choice experimental condition. Students in the Decisional Choice Condition were given a short mathematics quiz consisting of 5 items of homogeneous difficulty level and instructed to respond to any 3 out of the 5 items. The No Choice condition was essentially the same, except that the students were given only the first three problems and instructed to answer all three. Upon completion of the quiz, students were asked to respond to the Hebrew version of Spielberger's State Anxiety Scale. The findings show that both male and female students tested under Decisional Choice conditions are less anxious and attain higher mathematics scores, on average, than those tested under No Choice conditions. The data support the notion that the provision of decisional choice in an evaluative situation enhances the examinee's perceived feeling of control over the source of the threat (i.e. the mathematics examination). This, in turn, allows more favorable psychological adjustments of one's ‘interior mileau’ to outside stimuli, thereby lowering state anxiety and concomitantly raising levels of test attainment.     

Prospective incidence of first onsets and recurrences of depression in individuals at high and low cognitive risk for depression

Do negative cognitive styles provide similar vulnerability to first onsets versus recurrences of depressive disorders, and are these associations specific to depression? The authors followed for 2.5 years prospectively college freshmen (N = 347) with no initial psychiatric disorders at high-risk (HR) versus low-risk (LR) for depression on the basis of their cognitive styles. HR participants had odds of major, minor, and hopelessness depression that were 3.5-6.8 times greater than the odds for LR individuals. Negative cognitive styles were similarly predictive of first onsets and recurrences of major depression and hopelessness depression but predicted first onsets of minor depression more strongly than recurrences. The risk groups did not differ in incidence of anxiety disorders not comorbid with depression or other disorders, but HR participants were more likely to have an onset of anxiety comorbid with depression.     

Personality, emotions and coping styles: predictive value for the evolution of cancer patients

This study had a twofold goal: to define differences in psychological aspects between cancer patients and a control group and to explore the predictive value of such aspects for the evolution of the disease two years later. Firstly, personality, anxiety, anger and depression were assessed in both groups. Results of t-analyses revealed significant group differences. In personality, cancer patients had higher levels of neuroticism and lower levels of extraversion, agreeableness and conscientiousness than the control group. In emotional variables, cancer patients had higher levels of anxiety and some aspects of anger, but there were no group differences in depression levels. Secondly, applying a quasi-prospective design, the predictive value of personality, emotions and coping styles for the evolution of cancer (favourable or unfavourable) was explored using generalized linear models and logistic regression. A four-predictor logistic model was fitted: Anger Expression-In, Resignation, Self-blame and Conscientiousness, indicating that the higher Anger Expression-in, Resignation, and Self-blame scores together with a lower Conscientiousness score, the more likely it is for patients' cancer to evolve unfavourably. These results indicate the crucial role of psychological aspects for the evolution of the disease and the need to include such aspects in the design of clinical interventions.     

Differences in Unit Cohesion and Combat-Related Mental Health Problems Based on Attachment Styles in US Military Veterans

This study explored the differences in perceived unit cohesion, trauma symptoms, depression symptoms, and anxiety symptoms controlling for childhood trauma, based on attachment style in US military veterans. Previous studies have reported that higher levels of military unit cohesion, bonding through the social relationships between service members and their larger units, and secure attachment, are negatively associated with trauma symptoms, depression symptoms, and anxiety symptoms in veterans. This study examined mental health distress symptoms as well as military unit cohesion across attachment styles. Results suggest mean differences in trauma symptoms, depression symptoms, and anxiety symptoms across attachment styles. However, there was no difference in perceived unit cohesion across the four attachment styles. Those using fearful-avoidant attachment styles reported the highest mean trauma, depression, and anxiety symptoms followed by those using a dismissing-avoidant attachment style. Those using a secure attachment style reported the least mean trauma, depression, and anxiety symptoms. Implications for assessing and treating avoidant type attachment styles are discussed.     

Humor as a protective factor against anxiety and depression

Background/ObjectivesEven though humor its part of everyday life, only in the last 40 years has Psychology begun to discern its impact on mental health. The aim of this paper is to explore the role that humor styles may have as protectors against anxiety and depression and their relationship with optimism.MethodA sample of 804 participants (M = 39.28; SD = 14.71) was used to analyze the uses of humor, optimism and clinical symptoms of anxiety and depression. In addition, the influence of sociodemographic variables such as sex, geographic location, age and educational level on different uses of humor was studied. Through an analysis of structural equations, the variables that had a protective or facilitating role in depression and anxiety were analyzed.ResultsMen and women differ in the use of a more aggressive humor style, and the use of affiliative humor styles decreases with age. The structural equation model indicated a good fit to the proposed theoretical model.ConclusionsHumor is a tool of everyday life and it can act for or against an individual’s mental health.     

Prime Minister Leadership Styles in Foreign Policy Decision-Making: A Framework for Research

Although the institutional contexts of prime ministers in parliamentary democracies and of U.S. presidents are very different, both types of executive leaders influence the decision-making processes through their leadership styles. Leadership style includes how the leaders relate to those around them, how they like to receive information, and how they make up their minds. While there are numerous empirical studies and theoretical frameworks on the leadership styles of U.S. presidents, few studies of prime ministers are concerned with personality and styles of leadership. This paper reviews the literature on U.S. presidential styles and on organizational leadership in order to construct a framework for the study of prime minister leadership styles. Components of the proposed framework are illustrated with examples of British prime ministers and German chancellors. In addition, categories of dependent variables to be explained by leadership style are discussed. I argue that leadership style has the greatest impact on the decision-making process and that although the direct effect of leadership style on foreign policy behavior is less, leadership style indirectly influences foreign policy through the decision-making process.     

A longitudinal study of the development of anticipatory nausea and vomiting in cancer chemotherapy patients: the role of absorption and autonomic perception.

We interviewed 70 cancer patients receiving chemotherapy at home before their second treatment session to obtain baseline measures of absorption, autonomic perception, depression, state-trait anxiety, and basic demographic information. Patients were then interviewed before each of their next six treatment sessions, at which time measures of depression, state anxiety, severity and duration of postchemotherapy nausea and/or vomiting (PCNV), and experience of anticipatory nausea and/or vomiting (ANV) were obtained. Previous findings suggesting that motion sickness, trait anxiety, depression, sex of subject, and age are predictors of the development of ANV were not replicated. Patients with ANV did score significantly higher on measures of absorption and autonomic perception than patients who did not develop ANV. Those variables hypothesized to mediate conditioning (i.e., toxicity of treatment drugs, severity of PCNV, levels of state anxiety) accurately predicted which patients developed ANV. Absorption and autonomic perception added significantly to the prediction.     

Lack of a close confidant: prevalence and correlates in a medically underserved primary care sample

The present study examined prevalence of lack of a close confidant in a medically underserved primary care sample, and evaluated demographic, medical, and psychological correlates of patients' deficits in close, personal contact. Adult patients (n = 413) reported on confidant status and symptoms of depression and anxiety. Sociodemographic and medical information were obtained through chart review. One-quarter of patients endorsed lack of a close confidant. Past month anxiety and depression symptoms, but not medical status, were associated with unmet socioemotional needs. Implications for primary healthcare interventions are discussed.     

Decision-making capacity in elderly, terminally ill patients with cancer

Despite the importance and complexity of evaluating decision-making capacity at the end of life, little research has focused on terminally ill patients' decision-making ability. The purpose of this study was to explore the decision-making capacity of elderly, terminally ill patients and the psychological and physical factors that affect decision making. Decision-making capacity and cognitive abilities were assessed using four measures: the Hopkins Competency Assessment Kit, the Bechara Gambling Task, the Concept Assessment Kit, and the Mini Mental Status Exam. In addition, symptoms of depression, level of physical functioning, and extent of physical symptoms were evaluated in order to identify correlates of decision-making ability. Two samples were compared: elderly, terminally ill patients with cancer (n = 43) and elderly, physically healthy adults living in supportive community residence (n = 35). Results revealed significantly poorer decision-making abilities among the terminal ill sample compared with healthy comparisons, but no association between demographic variables (e.g., age, race, or education) or clinical variables (depression or physical symptoms) and decision making. Implications for evaluating decision-making capacity are addressed.     

Sun protective behaviour,optimism bias,and the transtheoretical model of behaviour change

This study investigated the relationship between sun protective behaviours and three psychological variables influencing health behaviour: decisional balance, optimism bias, and the transtheoretical model of behaviour change. Two hundred participants completed the ‘Readiness to Alter Sun Protective Behaviour’ questionnaire, and a short questionnaire investigating optimism bias, decisional balance, attitudes, and experiences of sun protection and skin cancer. Participants were evenly distributed between the precontemplation, contemplation, and action stages. Participants in the action stage were significantly more likely to endorse the perceived advantages associated with sun protective behaviour than participants in the precontemplation and contemplation stages. They also reported sunbathing significantly less—and being more concerned about contracting skin cancer—than participants in the earlier stages. Decisional balance and optimism bias scores varied systematically across the stages of change; however, decisional balance was the only significant psychological predictor of sun protective behaviours. Optimism bias was greatest in the precontemplation stage, whereas the action stage was characterised by more positive attitudes to sun protection. This suggests that knowledge of the real risks of skin cancer might be a precursor to behaviour change, but only a change in attitudes results in a move to the action stage and measurable behaviour change.     

Styles of decision making and their use: An empirical study

As interest has increased in teaching decision-making skills, so the need has grown for an empirically-derived classification system of decision-making behaviours. Six styles of decision making were accordingly isolated and validated by content analysis. Using cluster analysis, the styles were found to group into types along a passive-active continuum of involvement in the decision. Use of style was found to vary across situations, and to be related to the decision's perceived importance and the decision-maker's control in the situation.     

Applying the social cognitive model of career self-management to career exploration and decision-making

We present two studies applying the social cognitive model of career self-management (Lent & Brown, 2013) to career exploration and decision-making outcomes in college students. In the first study (N = 180 college students), we developed a new, brief measure of career exploration and decision-making self-efficacy for use in subsequent model testing. The measure yielded two factors, decisional self-efficacy and coping efficacy, with adequate internal consistency reliability estimates. The decisional self-efficacy factor related strongly to an established measure of career decision self-efficacy and produced theory consistent relations with measures of outcome expectations, social support, conscientiousness, exploration goals, prior engagement in career exploration, decisional anxiety, and level of career decidedness. In the second study (N = 215 college students), we re-examined the factor structure of the new self-efficacy measure and used it to assess the tenability of the self-management model in a path analysis predicting exploration goals, decisional anxiety, and career decidedness. The model fit the data well overall, though certain predictors were linked to the criterion variables only indirectly via mediated pathways. Implications of the findings for the social cognitive model as well as for future research and practice are considered.     

Decision-making styles and mental health—A person-oriented approach through clustering

Previous research examining the associations between decision-making styles and mental health has neglected to look at the configurations of styles. The study identifies mutually exclusive groups of people according to their combination of the five decision-making styles and examines the differences between them in mental health-related variables in two studies. In Study 1, decision-making styles, mental health indicators (well-being, depression, stress) and socio-psychological protective factors (resilience, optimism, social support) were examined in university students in two rounds 1 year apart. A cluster analysis revealed three distinct decision profiles—independent/nonintuitive, avoidant/spontaneous and rational/nonavoidant. The best values of mental health-related variables were found in the rational/nonavoidant profile and the most negative values in the avoidant/spontaneous profile. The decision-making styles were stable after 1 year although they were not able to explain changes in mental health-related variables. Study 2 identified three similar clusters in a more general sample—spontaneous/irrational, dependent/avoidant and rational/nonavoidant—with the lowest level of psychological distress symptoms in the rational/nonavoidant cluster. The study highlights the usefulness of combinations of decision-making styles with regard to mental health as well as noting their specificity according to sample characteristics.     

Comparison of optimal cutoff points for single and multiple tests in personnel selection

This paper compares the determination of optimal cutoff points for single and multiple tests in the field of personnel selection. Decisional skills of predictor tests composing the multiple test are assumed to be endogenous variables that depend on the cutting points to be set. It is shown how the predictor cutoffs and the collective decision rule are determined dependently by maximizing the multiple test's common expected utility. Our main result specifies the condition that determines the relationship between the optimal cutoff points for single and multiple tests, given the number of predictor tests, the collective decision rule (aggregation procedure of predictor tests' recommendations) and the function relating the tests' decisional skills to the predictor cutoff points. The proposed dichotomous decision-making method is illustrated by an empirical example of selecting trainees by means of the Assessment Center method.     

The Development and Validation of the Rational and Intuitive Decision Styles Scale

Decision styles reflect the typical manner by which individuals make decisions. The purpose of this research was to develop and validate a decision style scale that addresses conceptual and psychometric problems with current measures. The resulting 10-item scale captures a broad range of the rational and intuitive styles construct domain. Results from 5 independent samples provide initial support for the dimensionality and reliability of the new scale, as demonstrated by a clear factor structure and high internal consistency. In addition, our results show evidence of convergent and discriminant validity through expected patterns of correlations across decision-making individual differences and the International Personality Item Pool (IPIP) Big Five traits. Research domains that would benefit from incorporating the concept of decision styles are discussed.     

Gender,Affiliation, and Control in Physician–Patient Encounters

This study investigates the effects of physician gender and communication styles on participant responses to physicians. Participants were 146 mostly low-income students (50% Caucasian, 50% African-American) who each viewed one of four videotapes of physicians varying in communication style (affiliative, controlling) and gender (male, female). The affiliative communication style evoked the greatest levels of participant satisfaction, trust, self-disclosure, and compliance. Physician gender did not significantly affect these variables. Participants' recall of medical information showed an interaction: When the physician was male, participants recalled more when he was controlling than when he was affiliative; when the physician was female, communication style did not affect participant recall. Results suggest that physician communication style is more important than gender in determining patient response.