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.     

What a Feeling: The Role of Immediate and Anticipated Emotions in Risky Decisions

The risk‐as‐feelings hypothesis argues that many risky decisions are not only predicted by anticipated emotions, as most consequentialistic decision making theories would presume, but also by immediate emotions. Immediate emotions refer to the “hot” visceral feelings people feel as they contemplate a specific decision option at the cusp of making a decision, whereas anticipated emotions are those emotions that people forecast that they will feel once they experience possible consequences of that decision. Four studies focused on the role of both types of emotions in decisions under risk and uncertainty. Decisions were substantively predicted by immediate emotional states beyond anticipated emotions or the subjective probability attached to outcomes. Thus, risky choices may be prompted, in part, by how people feel about the “riskless” portion of the decision—specifically, the various decision options they are contemplating—rather than the potential outcomes those options may produce. Copyright © 2011 John Wiley & Sons, Ltd.     

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.     

Guilt and focusing in decision-making

In this paper we examined the impact of a specific emotion, guilt, on focusing in decision-making. Through the focusing mechanism, when making decisions, individuals tend to restrict their thoughts to what is explicitly represented in the decisional task, disregarding alternatives. In this paper, three experiments are performed to investigate whether an emotional state of guilt can critically guide individuals' focusing, and even prevailing over the focusing mechanism. Guilty emotional state was induced by asking participants to write about a guilty related life event. The emotional state was thus neither generated by nor related to the tasks used in the experiments. Results of the first two studies show that guilt affects focusing in decision-making in the case of only one explicitly specified option (a positive or a negative one). Guilty participants, when presented with a stated option that has predominantly positive characteristics, prefer other, unspecified options over the positive one. Guilty participants faced with a stated option that has predominantly negative features tend to prefer it to other, unspecified, options, instead. Finally, experiment 3 shows that guilty participants presented with two different options (a negative vs. a positive one) having different degrees of explicitness (i.e. they are not equally represented in the decision frame), focus on the negative option, even though the latter was not explicitly represented but only hinted at the end of the text. Overall, these results suggest that guilt emotion state can play a crucial role in either strengthening or reducing the focusing mechanism. Copyright © 2006 John Wiley & Sons, Ltd.     

It was intuitive,and it felt good: a daily diary study on how people feel when making decisions

ABSTRACT

In daily life, people make plenty of decisions, either intuitively or based on analysis. So far, research has examined when decision-making leads to correct or biased outcomes. In the present study, we adopted a different perspective and explored how decision-making is associated with how people feel. In an observational study, 134 healthy participants retrospectively reported on six evenings which decisions they had made during that day (total N?=?3,850 decisions). They were also asked to indicate how they had felt before/after each decision. Multilevel regression analyses revealed that (a) people reported having felt better prior to intuitive as compared to analytical decisions, (b) people reported having felt better after as compared to before the decision, and (c) this increase in positive feeling was more pronounced for intuitive decisions. The latter two associations were robust to statistically controlling for the life domain in which the decisions occurred, the decisions’ importance and ease, and daily mood. The retrospective design and the single-item measure of mood are among the limitations of this study. Altogether, the results are in line with the idea that making everyday life decisions intuitively makes people feel good.     

Control Options in Managing Strategic Decision-making Processes

Abstract

Top decision making processes are generally depicted as chaotic, unstructured, incremental or spasmodic, and protracted. In this article it is shown, based on data from 25 strategic decision processes from 12 organizations in three industry sectors, that, within certain limits, there certainly are control options in strategic decision-making processes. In addition, their use tums out to be profitable. The analyses of patterns in the use of control dimensions in the 25 cases leads to a typology of four types of decision models or strategies: the neo-rational model (n = 3), the bureaucratic model (n = 4), the arena model (n = 8) and the open-end model (n = 10). This empirical typology confirms earlier typologies based on literature.

The use of control strategies is shown to vary across industry sectors and topics of decisions and have adifferential effect. It is concluded that context and content variables have either a selection effect (some strategies do not occur in some sectors) or a optimization effect (some strategies are more effective than others in a given context).     

Risking Everything in Obsessive–Compulsive Disorder: An Analogue Decision-Making Study

An experiment examined decision-making processes among nonclinical participants with low or high levels of OCD symptomatology (N?=?303). To better simulate the decision environments that are most likely to be problematic for clients with OCD, we employed decision tasks that incorporated “black swan” options that have a very low probability but involve substantial loss. When faced with a choice between a safer option that involved no risk of loss or a riskier alternative with a very low probability of substantial loss, most participants chose the safer option regardless of OCD symptom level. However, when faced with choices between options that had similar expected values to the previous choices, but where each option had some low risk of a substantial loss, there was a significant shift towards riskier decisions. These effects were stronger when the task involved a contamination based, health-relevant decision task as compared to one with financial outcomes. The results suggest that both low and high symptom OC participants approach decisions involving risk-free options and decisions involving risky alternatives in qualitatively different ways. There was some evidence that measures of impulsivity were better predictors of the shift to risky decision making than OCD symptomatology.

     

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.     

No expectation bias in elite-level cricket umpires’ leg-before-wicket (LBW) decisions according to batting order position

ObjectivesPrevious studies have shown that sport officials’ decisions can be impacted by biases associated with expectations. The aim of this study was to determine whether elite cricket umpires’ decisions are also influenced by expectations associated with batter skill.MethodsLBW decisions (n = 5578) from actual elite level cricket matches in Australia between 2009 and 2016 were analysed in a multi-level binomial logistic regression paradigm. In our first model, we predicted the likelihood that an umpire will answer ‘out’ for batters in the top order (1–4), middle order (5–7), and low order (8-11). In our second model, we controlled for the correctness of a decision.ResultsUmpires were more likely to respond ‘out’ as the batting order progressed, however this did not appear to be due to biased decision-making. Instead, as batting order progressed, batters were more likely to actually be ‘out’.ConclusionsCricket umpires do not seem to be impacted by expectation bias associated with batting order. This study highlights the importance of controlling for the correctness of a decision when exploring bias in sport officials’ decisions.     

Take the first heuristic, self-efficacy, and decision-making in sport

Can taking the first (TTF) option in decision-making lead to the best decisions in sports contexts? And, is one's decision-making self-efficacy in that context linked to TTF decisions? The purpose of this study was to examine the role of the TTF heuristic and self-efficacy in decision-making on a simulated sports task. Undergraduate and graduate students (N = 72) participated in the study and performed 13 trials in each of two video-based basketball decision tasks. One task required participants to verbally generate options before making a final decision on what to do next, while the other task simply asked participants to make a decision regarding the next move as quickly as possible. Decision-making self-efficacy was assessed using a 10-item questionnaire comprising various aspects of decision-making in basketball. Participants also rated their confidence in the final decision. Results supported many of the tenets of the TTF heuristic, such that people used the heuristic on a majority of the trials (70%), earlier generated options were better than later ones, first options were meaningfully generated, and final options were meaningfully selected. Results did not support differences in dynamic inconsistency or decision confidence based on the number of options. Findings also supported the link between self-efficacy and the TTF heuristic. Participants with higher self-efficacy beliefs used TTF more frequently and generated fewer options than those with low self-efficacy. Thus, not only is TTF an important heuristic when making decisions in dynamic, time-pressure situations, but self-efficacy plays an influential role in TTF.     

Scrutinizing the Emotional Nature of Intuitive Coherence Judgments

Dual‐system models propose that cognitive processing can occur either intuitively or deliberately. Unlike deliberate decision strategies, intuitive ones are assumed to have an emotional component attached to the decision process. We tested if intuitive decisions are indeed accompanied by an emotional response while deliberate decisions are not. Specifically, we conducted a psychophysiological study in which participants were instructed to decide either intuitively or deliberately if three simultaneously presented words were semantically coherent or incoherent (triad task). The degree of emotionality of these two decision strategies (intuitive vs. deliberate) was compared using changes in electrodermal activity (EDA) and the reaction time (RT) effect of an affective priming paradigm as primary measurements. Based on a valence‐arousal model, our results revealed that intuitive and deliberate judgments do not differ as to their emotional valence but that they do differ in emotional arousal. Most notably, sympathetic activation during intuitive judgments was significantly lower compared to sympathetic activation during deliberate judgments. Our results reflect that a relaxed state of mind—manifested in low sympathetic activity—could underlie the holistic processing that is assumed to facilitate the proliferation of semantic associations during coherence judgments. This suggests that coherence judgments made under an (instructed) intuitive decision mode have a specific psychophysiological signature and that arousal is the differentiating component between intuitive and deliberate decision strategies. © 2016 The Authors Journal of Behavioral Decision Making Published by John Wiley & Sons Ltd.     

Should I Drive Today? Development of a daily driving decisions model for older adults

BackgroundOlder adults in communities make daily decisions about how to meet their transportation needs so they can access services and stay socially connected. With the aging of populations in developed countries, the travel decisions of older adults will have increasing impacts. Research studies have identified different sets of factors that contribute to certain travel decisions, but little research has been directed towards understanding how individuals select information from all available factors, what information they include in their decisions under different circumstances, and the processes they use in making their transportation decisions.MethodsThis exploratory study involved 20 men and 17 women, mean age 78.6 years (range 70–96), who drove weekly. All participants were involved in each phase of the 3-phase study. In Phase 1, a review of the literature and interviews with the participants was used to collect information, and inductive thematic analysis was employed to construct a draft conceptual model of older driver decision-making. In Phase 2, participants completed a stated preference task of written scenarios to demonstrate their decision-making strategies. Results were tabulated and used to refine a final Daily Driving Decisions model. In Phase 3, a card sorting decision task was used to test the model with participants.ResultsThe final dynamic Daily Driving Decisions Model was confirmed to describe decision processes used by the participants in making decisions about how they would meet their transportation needs. The model describes three categories of factors used in decisions, labelled Motivators, Constraint/Enablers and Context, each containing four attribute themes. A significant finding was the variable use of the same item to either constrain or enable the decision to drive depending on the variation of other factors in the scenario. Participants demonstrated use of compensatory and noncompensatory (heuristic, habitual) decision processes that were accommodated by the model.ConclusionThe proposed Daily Driving Decisions Model addresses a gap in our understanding of how older drivers make their decisions about meeting their transportation needs. The model presents a template for classifying the types of information used, ignored or discarded by older adults, and the pathways that they take to arrive at their decisions. The model provides opportunities for further research in testing the influence of other factors such as urban/rural residence, income, health status and culture on driving decisions. Further, the model can be used by practitioners to gain insight into the decision-making behaviours of individuals and to develop interventions to enhance their decision-making skills.     

On the Spot Ethical Decision-Making in CBRN (Chemical,Biological, Radiological or Nuclear Event) Response

First responders to chemical, biological, radiological, or nuclear (CBRN) events face decisions having significant human consequences. Some operational decisions are supported by standard operating procedures, yet these may not suffice for ethical decisions. Responders will be forced to weigh their options, factoring-in contextual peculiarities; they will require guidance on how they can approach novel (indeed unique) ethical problems: they need strategies for “on the spot” ethical decision making. The primary aim of this paper is to examine how first responders should approach on the spot ethical decision-making amid the stress and uncertainty of a CBRN event. Drawing on the long-term professional CBRN experience of one of the authors, this paper sets out a series of practical ethical dilemmas potentially arising in the context of a large-scale chemical incident. We propose a broadly consequentialist approach to on the spot ethical decision-making, but one which incorporates ethical values and rights as “side-constraints”.     

Self-reported reasons for moral decisions

Many investigations of moral decision-making employ hypothetical scenarios in which each participant has to choose between two options. One option is usually deemed “utilitarian” and the other either “non-utilitarian” or “deontological”. Very little has been done to establish the validity of such measures. It is unclear what they measure, let alone how well they do so. In this exploratory study, participants were asked about the reasons for their decisions in six hypothetical scenarios. Various concerns contributed to each decision. Action decisions occurred when utilitarian concerns dominated. Bystanding decisions resulted from different concerns or combinations of concerns dominating in different situations, with utilitarianism usually among participants’ concerns. None of the labels usually used for either decision therefore seems entirely appropriate. Five concerns were identified as necessary and sufficient to predict over 85% of participants’ decisions. This suggests great promise for future research, particularly in investigation of real-world moral decisions.     

Psychometric properties of the Chinese version of the End-of-Life Decision-Making and Staff Stress Questionnaire

Background/objectiveThe goal of this study is to establish a Chinese version of the End-of-Life Decision Making and Associated Staff Stress Questionnaire to assess its reliability and validity.MethodA sample of 119 Intensive Care Unit physicians and 485 nurses in China completed the questionnaire, along with questionnaires assessing motional exhaustion subscale, Stress Overload Scale, and other variables associated with end-of-life decision.ResultsSeven factors obtained via exploratory factor analysis could explain 70.61% of the total variance. Confirmatory factor analysis demonstrated an acceptable model fit with Root Mean Square Error of Approximation (RMSEA) being .078 and Standardized Root Mean Square Residual (SRMR) being .066. Validity evidence based on relationships with other variables was provided by positive or negative correlations between the questionnaire subscales and emotional exhaustion, stress overload, and other variables associated with end-of-life decision. The average content validity index was .96. The Cronbach’s α and test–retest reliability was outstanding.ConclusionsThe Chinese version of the End-of-Life Decision Making and Associated Staff Stress Questionnaire is a reliable and valid instrument for measuring the facilitators and hinders to facilitate the end-of-life decision-making, communication and the associated pressure perceived by relevant Intensive Care Unit medical staff among the Chinese population.     

‘If something doesn’t look right,go find out why’: how intuitive decision making is accomplished in police first-response

ABSTRACT

Intuition is an important mechanism by which organizational actors make significant decisions; however, precisely how intuitive decisions are taken is not well understood and hence is worthy of closer scrutiny. First-response decisions, because of the conditions under which they are executed, offer researchers an interesting and relevant context for the study of intuitive decision making in organizations. We used qualitative methods to explore how “peak performing” police officers used intuition in first-response decisions. Our findings show that intuition’s role in first-response occurs in two differing but complementary ways: “recognition-based intuition” and “intuition-based inquiry”. This finding builds on previous intuition research and informs current debates in behavioural sciences regarding “default-intervention” versus “parallel-competitive” variants of dual-process theory; it also reveals how a complex and situated mix of intuition and analysis can guide effective decision making and support peak performance in uncertain, dynamic and complex environments that typify many organizational decision processes. Our findings contribute to intuition research by extending the current theory of “intuition-as-expertise” in going beyond a simple “recognize-and-respond” model. We propose a “Perceiving-Knowing-Enacting-Closing” framework which captures the complex role that intuition in combination with analysis plays in police first-response decisions, and discuss implications for decision-making policies and practices in organizations.     

For the Win: Risk‐Sensitive Decision‐Making in Teams

Risk‐sensitivity theory predicts that decision‐makers should prefer high‐risk options in high need situations when low‐risk options will not meet these needs. Recent attempts to adopt risk‐sensitivity as a framework for understanding human decision‐making have been promising. However, this research has focused on individual‐level decision‐making, has not examined behavior in naturalistic settings, and has not examined the influence of multiple levels of need on decision‐making under risk. We examined group‐level risk‐sensitive decision‐making in two American football leagues: the National Football League (NFL) and the National College Athletic Association (NCAA) Division I. Play decisions from the 2012 NFL (Study 1; N = 33 944), 2013 NFL (Study 2; N = 34 087), and 2012 NCAA (Study 3; N = 15 250) regular seasons were analyzed. Results demonstrate that teams made risk‐sensitive decisions based on two distinct needs: attaining first downs (a key proximate goal in football) and acquiring points above parity. Evidence for risk‐sensitive decisions was particularly strong when motivational needs were most salient. These findings are the first empirical demonstration of team risk‐sensitivity in a naturalistic organizational setting. Copyright © 2016 John Wiley & Sons, Ltd.     

By-Person Factor Analysis in Clinical Ethical Decision Making: Q Methodology in End-of-Life Care Decisions

Objective: To determine the usefulness of Q methodology to locate and describe shared subjective influences on clinical decision making among participant physicians using hypothetical cases containing common ethical issues.

Design: Qualitative study using by-person factor analysis of subjective Q sort data matrix.

Setting: University medical center.

Participants: Convenience sample of internal medicine attending physicians and house staff (n = 35) at one midwestern academic health sciences center.

Interventions: Presented with four hypothetical cases involving urgent decision making near the end of life, participants selected one of three specific clinical actions offered for each case. Immediately afterward and while considering their decision, each respondent sorted twenty-five subjective self-referent items in terms of the influence of each statement on their decision-making process. By-person factor analysis, where participants are defined as variates, yielded information about the attitudinal background the physicians brought to their consideration of each hypothetical case. We performed a second-order factor analysis on all of the subjective viewpoints to determine if a smaller core of shared attitudes existed across some or all of the four case vignettes. Factor scores for each item and post-sort comments from interviews conducted individually with each respondent guided the interpretation of ethical perspective used by these respondents in making clinical decisions about the cases.

Measurements and Main Results: Second-order factor analysis on seventeen viewpoints used by physicians in the four hypothetical urgent decision cases revealed three moderately correlated (r ² < 40%) subjective core attitudinal guides used broadly among all the cases and among sixteen of the seventeen original factors. Across all the cases, our participants were guided in general by: (1) patient-focused beneficence, (2) a patient- and surrogate-focused perspective that includes risk avoidance, and (3) best interest of the patient guided by ethical values. Economic impact on the physician, expediency in resolution of the situation, and the expense of medical treatment were not found to be influential determinants in this study.

Conclusions: Q sorting and by-person factor analysis are useful qualitative methodological tools to study the complex structure of subjective attitudes that influence physicians in making medical decisions. This study revealed the subjective viewpoints used by our physician participants as they made ethically challenging treatment decisions. The three second-order factors identified here are grounded in current bioethical values as well as the personal traits of physicians. The participants' decision methods appear to resemble casuistry more than principle-based decision making. Generalizability of results will require further studies.     

Identifying and Addressing Barriers to Treatment Decision‐making in Bipolar II Disorder: Clinicians’ Perspective

Objective

Treatment decision‐making in bipolar II disorder is complex due to limited evidence on treatment efficacy and potentially burdensome side‐effects of options. Thus, involving patients and negotiating treatment options with them is necessary to ensure that final treatment decisions balance both clinician and patient preferences. This study qualitatively explored clinician views on (a) effective treatment decision‐making, unmet patient needs for (b) decision‐support and (c) information.

Method

Qualitative semi‐structured interviews with 20 practising clinicians (n = 10 clinical psychologists, n = 6 general practitioners, n = 4 psychiatrists) with experience treating adult outpatients with bipolar II disorder were conducted. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Self‐report professional experience, and clinician preferences for patient decision‐making involvement were also assessed.

Results

Qualitative analyses yielded two inter‐related themes: (a) challenges and barriers to decision‐making and (b) facilitators of clinician decision‐making. Symptom severity, negative family attitudes, system‐based factors, and information gaps were thought to pose challenges to decision‐making. By contrast, decision‐making was supported by patient information, family involvement and patient‐centredness, and a strong therapeutic relationship. Clinician views varied depending on their professional background (medical vs clinical psychologist), patient involvement preferences, and whether the clinician was a bipolar specialist.

Conclusions

Whilst clinicians uniformly recognise the importance of involving patients in informed treatment decision‐making, active patient participation is hampered by unmet informational and decision‐support needs. Current findings inform a number of bipolar II disorder‐specific, clinician‐endorsed strategies for facilitating patient decision‐making, which can inform the development of targeted patient decision‐support resources for use in this setting.