Medical Decision-Making: An Argument for Narrative and Metaphor

This study examines the processes ofdecision-making used by intensive care(critical care) specialists. Ninety-ninespecialists completed a questionnaire involvingthree clinical cases, using a novel methodologyinvestigating the role of uncertainty andtemporal-related factors, and exploring a rangeof ethical issues. Validation and triangulationof the results was done via a comparison studywith a medically lay, but highly informed groupof 37 law students. For both study groups,constructing reasons for a decision was largelyan interpretative and imaginative exercise thatwent beyond the data (as presented), commonlyresulting in different reasons supporting thesame conclusions and similar reasons supportingopposite conclusions. The skills of ethicalimagination and interpretation were related toan individual's prior lived experience,construed in the broadest sense. Application ofthese skills of ethical imagination andinterpretation always occurred, to some degree,in a state of uncertainty and almost alwaysinvolved temporal relationships.Using these results, a theory of ethicaldecision-making is proffered. Three levels ortypes of reasoning processes may be present.Type I decision-making involves the applicationof rules, usually in a deductive fashion. TypeII decision-making is characterised by aprocess where a plurality of reasons arebalanced, weighed and sifted with each other.Type III decision-making is intimately linkedwith respondents lived experiences and `crafts'the content of type I and II reasoningprocesses, via the application of ethicalimagination and interpretation. Relationshipsbetween these three types of reasoningprocesses, and with narrative ethics, are alsodiscussed.     

Risk-sensitive choice in humans as a function of an earnings budget

Risky choice in 3 adult humans was investigated across procedural manipulations designed to model energy-budget manipulations conducted with nonhumans. Subjects were presented with repeated choices between a fixed and a variable number of points. An energy budget was simulated by use of an earnings budget, defined as the number of points needed within a block of trials for points to be exchanged for money. During positive earnings-budget conditions, exclusive preference for the fixed option met the earnings requirement. During negative earnings-budget conditions, exclusive preference for the certain option did not meet the earnings requirement, but choice for the variable option met the requirement probabilistically. Choice was generally risk averse (the fixed option was preferred) when the earnings budget was positive and risk prone (the variable option was preferred) when the earnings budget was negative. Furthermore, choice was most risk prone during negative earnings-budget conditions in which the earnings requirement was most stringent. Local choice patterns were also frequently consistent with the predictions of a dynamic optimization model, indicating that choice was simultaneously sensitive to short-term choice contingencies, current point earnings, and the earnings requirement. Overall, these results show that the patterns of risky choice generated by energy-budget variables can also be produced by choice contingencies that do not involve immediate survival, and that risky choice in humans may be similar to that shown in nonhumans when choice is studied under analogous experimental conditions.     

大学生同一性与职业探索、职业决策困难的关系

采用问卷法对439名大学生的同一性与职业探索、职业决策困难的关系进行了研究.研究结果表明:(1)不同同一性地位类型的大学生在职业探索上存在显著差异,环境探索和自我探索两个维度的得分都呈现出达成型>延缓型>早闭型>混乱型的趋势,同一性地位越高,职业探索得分越高.(2)不同同一性地位类型的大学生在职业决策困难上存在显著差异,职业决策困难各维度得分及各维度平均分上大致呈现出同一性地位越高,职业决策困难得分越低的趋势.     

实施子宫切除手术中的人文关怀

子宫切除术是妇科手术中的一种常见术式,随临床技术的发展,目前已有许多可供选择的不同方式。实施子宫切除手术中,临床医生应采用哲学的辩证思维方法并尊重患者的自主选择,全面客观地评估患者的情况;更多从人文关怀的角度出发,做出符合患者个体术式的决策,力争达到最佳的治疗效果。     

What do Patients Prefer: Informed Consent Models for Genetic Carrier Testing

The recent increased number of conditions for which patients can undergo genetic carrier testing raises the question of how best to obtain pre-test informed consent. Clinical approaches vary from a minimalist model to a model where patients are given detailed information about all conditions to be screened for. Few data exist as to patient preferences, or how information impacts decision-making. Eight high-literacy focus groups were conducted to assess the knowledge and preferences of pregnant patients and their male partners. Most groups indicated that some balance between details and brevity was optimal, recognizing that anxiety can occur when patients are provided with too much information and that the wide range of tests offered during pregnancy often led to confusion. Critical areas for the informed consent process included (1) details about the conditions and risk of being a carrier, (2) logistics of testing, (3) next steps if the test is positive, and (4) prognosis, options and resources if the child were to be affected with a disorder. It will be useful to develop model consent programs and prospectively assess their impact on informed consent and patient satisfaction, both when positive and negative results are received.     

决策与推理的双系统——启发式系统和分析系统

近来,在决策与推理的研究中,研究者提出了双系统作用模型：基于直觉的启发式系统和基于理性的分析系统。启发式系统加工速度较快,不占用或占用很少的心理资源,容易受背景相似性、刻板印象的影响;分析系统加工速度慢,占用较多的心理资源,遵从逻辑和规则,而且两个系统有不同进化历史和神经基础。该文根据已有的相关研究,综述了双系统在决策与推理中可能的作用机制、相互关系、个体差异,同时指出了目前研究存在的不足     

旅游信息特征对旅游决策影响的实验研究

本研究探讨了旅游信息特征对旅游者旅游决策的影响。研究表明,在旅游决策过程中,信息框架对旅游决策的结果,具有非常显著的影响,正面框架比负面框架,导致了更大额度的旅游消费决策;信息可信性对旅游决策的结果,也具有非常显著的影响,可信性高的信息,导致了较高额度的旅游消费选择。     

Motivated information processing and group decision-making: Effects of process accountability on information processing and decision quality

Integrating dual-process models [Chaiken, S., & Trope, Y. (Eds.). (1999). Dual-process theories in social psychology. NewYork: Guilford Press] with work on information sharing and group decision-making [Stasser, G., & Titus, W. (1985). Pooling of unshared information in group decision making: biased information sampling during discussion. Journal of Personality and Social Psychology, 48, 1467-1478.], we predicted that groups with high epistemic motivation engage in more information-driven and less preference-driven interaction, and achieve better decisions. An experiment manipulating process accountability showed that groups under process accountability experienced greater need for more information, repeated unshared information more often, and more often chose the correct decision alternative. Mediation analysis established that epistemic motivation produced high quality decisions because it stimulated systematic information processing. Results also revealed that preference heterogeneity stimulated information-driven interaction and led to higher decision quality.     

从对框架效应的分析看风险决策的神经基础

对风险决策的研究近年来一直是微观经济学和心理学的热门,但是从传统的决策理论到主张有限理性的预期理论大多是对决策行为的研究,决策的心理机制一直是无法解释的黑箱子。令人兴奋的是近几年来神经科学家及其他领域的学者开始用先进的神经心理学的方法来研究风险决策,试图理解神经过程调节风险决策行为的方式。文章从分析违背“不变性”原则的框架效应入手,从正反框架、确定选择和风险选择、风险规避和风险寻求、高估小概率事件几个方面,全面分析风险决策可能的神经基础。在总结已有研究的基础上提出了把风险决策研究扩展到不确定决策,把风险决策中的一次决策研究扩展到多次决策的研究思路     

大学生职业决策和自尊、成就动机的关系

在应用自尊量表(SES)和成就动机量表(AMS)对106名大学生(男生46名,女生60名)进行调查的基础上,通过设计框架性职业决策情景,探究了大学生职业决策和自尊、成就动机的关系。结果发现:(1)成就动机中避免失败变量与框架效应的交互作用对大学生职业决策倾向性有显著性影响;(2)自尊水平对大学生职业决策倾向性存在显著性作用;(3)框架效应在大学生职业决策中发生作用,对大学生的职业决策倾向性有显著的影响。