Decision making in real life (original) (raw)

Decision making in the cancer context: An introduction to the special series

Annals of Behavioral Medicine, 2006

, the Cancer Special Interest Group of the Society of Behavioral Medicine (SBM) held a Pre-Conference Scientific Meeting on "Decision-Making in the Cancer Context-Translation from Basic Science through Population Health." The overall goals of the meeting were to come to a better understanding of behavioral science approaches to investigating decision making and to evaluate innovative models of patient decision support delivery, as well as to consider the population health applications of this work. The Pre-Conference Scientific Meeting considered (a) basic and behavioral issues in the affective and social dimensions of patient decision making and decision support; (b) approaches to shared decision making and patient decision support; (c) the role of values perspectives and bioethics related to shared decision making, for individuals and health care providers; and (d) models of delivery to support

Evidence-based patient choice: a prostate cancer decision aid in plain language

BMC medical informatics and decision making, 2005

Decision aids (DA) to assist patients in evaluating treatment options and sharing in decision making have proliferated in recent years. Most require high literacy and do not use plain language principles. We describe one of the first attempts to design a decision aid using principles from reading research and document design. The plain language DA prototype addressed treatment decisions for localized prostate cancer. Evaluation assessed impact on knowledge, decisions, and discussions with doctors in men newly diagnosed with prostate cancer. Document development steps included preparing an evidence-based DA in standard medical parlance, iteratively translating it to emphasize shared decision making and plain language in three formats (booklet, Internet, and audio-tape). Scientific review of medical content was integrated with expert health literacy review of document structure and design. Formative evaluation methods included focus groups (n = 4) and survey of a new sample of men new...

Pilot Study of a Utilities-Based Treatment Decision Intervention for Prostate Cancer Patients

Clinical Prostate Cancer, 2002

This pilot study evaluates a shared decision-making approach to individual decision making in localized prostate cancer care. The approach is based on a decision analytic model that incorporates patient utilities, ie, patient preferences among possible health states that might occur with prostate cancer treatments. Data on comorbidities, histologic grade of the biopsy, and age were obtained for 13 patients with newly diagnosed localized prostate cancer who received care in a Veterans Administration medical center. Using a standard gamble technique, interviewers obtained patient utilities for 5 distinct health states related to prostate cancer treatment. Utilities and patient clinical and pathologic characteristics were incorporated into the decision analytic model, and the derived quality-adjusted life expectancies were shared with the treating urologist before the first patient-physician discussion about treatment options. The results of the pilot study raised 2 major concerns. First, 4 patients had utility scores of 1.0 for all of the possible health states, and 7 patients had inconsistent utilities in which they rated both impotence and incontinence as a better health state than having just one of these problems. Second, the model recommended radiation therapy to individuals with a broad range of clinical characteristics, pathologic findings, and utility scores. Many of the patients who were recommended radiation therapy by the model received discordant recommendations from the treating urologist. Future refinements of both the utility assessment exercise and decision analytic model may be needed before the feasibility of the model in the clinical setting can be determined.

Clinical decision-making: physicians' preferences and experiences

2007

Background: Shared decision-making has been advocated; however there are relatively few studies on physician preferences for, and experiences of, different styles of clinical decision-making as most research has focused on patient preferences and experiences. The objectives of this study were to determine 1) physician preferences for different styles of clinical decision-making; 2) styles of clinical decision-making physicians perceive themselves as practicing; and 3) the congruence between preferred and perceived style. In addition we sought to determine physician perceptions of the availability of time in visits, and their role in encouraging patients to look for health information.

Treatment decision-making strategies and influences in patients with localized prostate carcinoma

Cancer, 2005

BACKGROUNDPatients diagnosed with localized prostate carcinoma need to interpret complicated medical information to make an informed treatment selection from among treatments that have comparable efficacy but differing side effects. The authors reported initial results for treatment decision-making strategies among men receiving definitive treatment for localized prostate carcinoma.Patients diagnosed with localized prostate carcinoma need to interpret complicated medical information to make an informed treatment selection from among treatments that have comparable efficacy but differing side effects. The authors reported initial results for treatment decision-making strategies among men receiving definitive treatment for localized prostate carcinoma.METHODSOne hundred nineteen men treated with radical prostatectomy (44%) or brachytherapy (56%) consented to participate. Guided by a cognitive-affective theoretic framework, the authors assessed differences in decision-making strategies, and treatment and disease-relevant beliefs and affects, in addition to demographic and clinical variables.One hundred nineteen men treated with radical prostatectomy (44%) or brachytherapy (56%) consented to participate. Guided by a cognitive-affective theoretic framework, the authors assessed differences in decision-making strategies, and treatment and disease-relevant beliefs and affects, in addition to demographic and clinical variables.RESULTSApproximately half of patients reported difficulty (49%) and distress (45%) while making treatment decisions, but no regrets (74%) regarding the treatment choice they made. Patients who underwent prostatectomy were younger, were more likely to be employed, had worse tumor grade, and had a shorter time since diagnosis (P < 0.01) compared with patients who did not undergo prostatectomy. In multivariate analyses, compared with patients who received radical prostatectomy, patients who received brachytherapy were more likely to say that they chose this treatment because it was “the least invasive” and they “wanted to avoid surgery” (P < 0.0001).Approximately half of patients reported difficulty (49%) and distress (45%) while making treatment decisions, but no regrets (74%) regarding the treatment choice they made. Patients who underwent prostatectomy were younger, were more likely to be employed, had worse tumor grade, and had a shorter time since diagnosis (P < 0.01) compared with patients who did not undergo prostatectomy. In multivariate analyses, compared with patients who received radical prostatectomy, patients who received brachytherapy were more likely to say that they chose this treatment because it was “the least invasive” and they “wanted to avoid surgery” (P < 0.0001).CONCLUSIONSIn general, patients who received brachytherapy chose this treatment because of quality of life considerations, whereas “cure” and complete removal of the tumor were the main motivations for patients selecting radical prostatectomy. Long-term data are needed to evaluate distress and decisional regret as patients experience treatment-related chronic side effects and efficacy outcomes. Decision-making aids or other interventions to reduce decisional difficulty and emotional distress during decision making were indicated. Cancer 2005. © 2005 American Cancer Society.In general, patients who received brachytherapy chose this treatment because of quality of life considerations, whereas “cure” and complete removal of the tumor were the main motivations for patients selecting radical prostatectomy. Long-term data are needed to evaluate distress and decisional regret as patients experience treatment-related chronic side effects and efficacy outcomes. Decision-making aids or other interventions to reduce decisional difficulty and emotional distress during decision making were indicated. Cancer 2005. © 2005 American Cancer Society.

The art and science of medical decision making

The Journal of Pediatrics, 1984

TIlE IIALLMARK OF A GOOD PitYSICIAN iS the ability to make sound clinical judgments. Traditionally this has been considered an artful and intuitive process neither subject to theoretical analysis nor to be captured in a formal quantitative model. In 1959 Ledley and Lusted, ~ in a seminal article, introduced the idea that a science of medical decision making could be reasonably founded in symbolic logic, probabili!y theory, and value theory: They proposed that computer-based Statistical models could enhance the diagnostic and therapeutic skills of the physician. Subsequently, numerous authors ha~'e documented the deficiencies of the physician as an intuitive decision maker and have described formal quantitative models that in selected circumstances outperform physicians in clinical diagnosis. Widespread acceptance of these models did not occur. It was argued that the process Could only evaluate but not improye treatment, and could not adequately incorporate patient values into decision making. "In addition, physicians and their patients greatly value sound clinical judgment. Any attack on the quality of that skill may diminish the role of the physician in the diagnostic process. Recently, the iremendous growth of medical information, the demand for cost-effective solutions, and the growing need to explicitly justify clinical decisions to utilization review committees, third-party payers, and health policy makers have made medical decisions complex and, frequently, confounding. At the same time, computers and formal decision-making models have become more sophisticated and accessible to physicians. It has become apparent that the concept of the physician as an intuitive decision maker and the potential role of the computer in improving clinical decisions are compatible. We discuss (1) the interface between intuitive decision making and the use of computer-based models and data bases (collectively called deizision support systems); (2) the

Clinical decision-making: Patients' preferences and experiences

Patient education and counseling, 2007

Objective: To determine the congruence between patients' preferred style of clinical decision-making and the style they usually experienced and whether this congruence was associated with socio-economic status and/or the perceived quality of care provided by the respondent's regular doctor. Methods: Cross-sectional survey of the American public using computer-assisted telephone interviewing. Results: Three thousand two hundred and nine interviews were completed (completion rate 72%). Sixty-two percent of respondents preferred shared decision-making, 28% preferred consumerism and 9% preferred paternalism. Seventy percent experienced their preferred style of clinical decision-making. Experiencing the preferred style was associated with high income (OR, 1.59; 95% CI, 1.16-2.16) and having a regular doctor who was perceived as providing excellent or very good care (OR, 2.39; 95% CI, 1.83-3.11). Conclusion: Both socio-economic status and having a regular doctor whom the respondent rated highly are independently associated with patients experiencing their preferred style of clinical decision-making. Practice implications: Systems which promote continuity of care and the development of an on-going doctor-patient relationship may promote equity in health care, by helping patients experience their preferred style of clinical decision-making. #

Assessment of the Feasibility and Impact of Shared Decision Making in Prostate Cancer

Urology, 1998

To assess the feasibility and patient impact of using standardized video presentations concernIng alternative treatments for managing localized prostate cancer. Methods. One hundred eleven men with newly diagnosed localized prostate cancer were shown a video tape concerning the risks and benefits of four treatment options: radical surgery, external beam radiation, hormonal therapy, and. watchful waiting. The impact of the -video presentation was assessed using a questionnaire completed by the patient before and after viewing the video and again following a discussion with his treating physician. Results. Patients demonstrated significant increases in their understanding of treatment options to manage prostate cancer after viewing the video presentation. Treating physicians confirmed the increased sophistication of their patients' knowledge of their disease and the potential outcomes associated with alternative treatments. Conclusions. Standardized video presentations of treatment alternatives for prostate cancer can be incorporated into busy office practices. Both patients and physicians benefit from the increased level of understanding that allows physician/patient discussions to focus on the critical risk/benefit tradeoffs rather than simply describing treatment alternatives.

Decision Counseling in Cancer Prevention and Control

Health Psychology, 2005

Informed and shared decision making are hallmarks of quality medical care. Although decision aids (e.g., brochures, decision boards, videos, interactive computer programs) can impart useful information, there is a dearth of work on theory-based approaches that help people clarify preferences and select a favored alternative. Decision counseling is a novel method that has been developed to address this need. In a decision counseling session, provider and patient identify personal values associated with decision alternatives, weigh the influence of relevant factors, clarify preference, and select an option from available alternatives. Decision counseling is described here in relation to 3 decision-making situations (i.e., having cancer screening, being tested for cancer risk, and joining a cancer chemoprevention trial). Preliminary findings suggest that decision counseling can help to clarify personal preferences related to health behavior choices and, thus, facilitate achievement of the ideals of informed and shared decision making.

Understanding Medical Decision-making in Prostate Cancer Care

American journal of men's health, 2018

The availability of several treatment options for prostate cancer creates a situation where patients may need to come to a shared decision with their health-care team regarding their care. Shared decision-making (SDM) is the concept of a patient and a health-care professional collaborating to make decisions about the patient's treatment course. Nurse navigators (NNs) are health-care professionals often involved in the SDM process. The current project sought to evaluate the way in which patients with prostate cancer make decisions regarding their care and to determine patients' perspectives of the role of the NN in the SDM process. Eleven participants were recruited from the Prostate Assessment Centre by a NN. They were interviewed via telephone and their responses were analyzed using thematic analysis. Five interacting factors were determined to influence the way participants made decisions including level of anxiety, desire to maintain normalcy, support system quality, expo...

A personalized decision aid for prostate cancer shared decision making

BMC Medical Informatics and Decision Making, 2021

Background A shared decision-making model is preferred for engaging prostate cancer patients in treatment decisions. However, the process of assessing an individual’s preferences and values is challenging and not formalized. The purpose of this study is to develop an automated decision aid for patient-centric treatment decision-making using decision analysis, preference thresholds and value elicitations to maximize the compatibility between a patient’s treatment expectations and outcome. Methods A template for patient-centric medical decision-making was constructed. The inputs included prostate cancer risk group, pre-treatment health state, treatment alternatives (primarily focused on radiation in this model), side effects (erectile dysfunction, urinary incontinence, nocturia and bowel incontinence), and treatment success (5-year freedom from biochemical failure). A linear additive value function was used to combine the values for each attribute (side effects, success and the altern...

Uncertainty in Medical Decision Making: knowing how little you know

Making decisions about the care of individual patients is fundamental to health care. For each patient, many decisions have to be made. In the emergency room, for example, a doctor should decide which patient to see first, decide whether an x-ray should be made of an injured ankle, and decide how this specific ankle fracture of this specific patient should be treated. Medical training is focused on acquiring the knowledge and experience to make such decisions. Other factors that are essential for patient care, including empathy and technical abilities, also involve decision making. For example, in the outpatient clinic, a trade-off is needed when one patient needs more time and empathy, but the waiting room is packed and the physician is an hour behind schedule. In the operating room, a surgeon must decide whether to proceed with a complicated laparoscopic procedure to remove a gall bladder, to convert to an open procedure, or to ask a more experienced surgeon for help.