Browsing by Subject "decision making"
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Item Adding Natural Frequency Data to a Decision Aid for Colorectal Cancer Screening: Results of a Randomized Trial(2013-10-22) Schwartz, Peter H.; Muriello, Paul F.; Perkins, Susan M.; Schmidt, Karen K.; Rawl, Susan M.Guidelines recommend that decision aids provide natural frequency data regarding baseline risk, risk reduction, and chances of false positives and negatives. Such quantitative information may confuse patients, especially those with low numeracy. We conducted a randomized trial to compare effects of 2 colorectal cancer (CRC) screening decision aids—one with and one without natural frequency data.Item Associations of decision making abilities with blood pressure values in older adults(Wolters Kluwer, 2020-01-01) Lamar, Melissa; Wilson, Robert S.; Yu, Lei; Stewart, Christopher C.; Bennett, David A.; Boyle, Patricia A.; Neurology, School of MedicineObjectives: Decision making, key to successful aging, has implications for financial success, physical health, and well being. While poor decision making has been linked with increased risk of mortality, age-related cognitive decline, and dementia, less is known regarding its associations with chronic disease indicators. We investigated the associations of decision making with blood pressure (BP) values [i.e., SBP, mean arterial pressure (MAP), and pulse pressure (PP), separately] in a community-based cohort study of aging. Methods: Participants were 908 nondemented older adults (age ∼81 years; 75% women) from the Rush Memory and Aging Project. Decision making was measured using questions designed to simulate materials used in financial and healthcare settings in the real world and yielded a total score and domain-specific health and financial decision making scores. Two seated and one standing BP measurement were taken with all three contributing to average SBP, MAP that is, [SBP + (2 × DBP)]/3, and PP, that is, SBP − DBP. Participants were queried about hypertension status and antihypertension medications were visually inspected and coded. Participants also underwent medical history and cognitive assessments. Results: In separate multivariable linear regression models, total decision making scores were inversely associated with SBP, MAP, and PP after adjusting for age, sex, education, antihypertension medication use, diabetes, and cumulative cardiovascular disease burden (P values = 0.03). Decision making remained associated with these BP values after additional adjustment for global cognition. Conclusion: Poorer decision making is associated with higher BP values in nondemented older adults.Item CEASE: A guide for clinicians on how to stop resuscitation efforts(ATS, 2015-03) Torke, Alexia M.; Bledsoe, Patricia; Wocial, Lucia D.; Bosslet, Gabriel T.; Helft, Paul R.; Department of Medicine, IU School of MedicineResuscitation programs such as Advanced Cardiac Life Support, Cardiac Life Support, Pediatric Advanced Life Support, and the Neonatal Resuscitation Program offer inadequate guidance to physicians who must ultimately decide when to stop resuscitation efforts. These decisions involve clinical and ethical judgments and are complicated by communication challenges, group dynamics, and family considerations. This article presents a framework, summarized in a mnemonic (CEASE: Clinical Features, Effectiveness, Ask, Stop, Explain), for how to stop resuscitation efforts and communicate that decision to clinicians and ultimately the patient’s family. Rather than a decision rule, this mnemonic represents a framework based on best evidence for when physicians are considering stopping resuscitation efforts and provides guidance on how to communicate that decision.Item A Conceptual Model of the Role of Communication in Surrogate Decision Making for Hospitalized Adults(2012-04) Torke, Alexia M.; Petronio, Sandra; Sachs, Greg A.; Helft, Paul R.; Purnell, Christianna E.OBJECTIVE: To build a conceptual model of the role of communication in decision making, based on literature from medicine, communication studies and medical ethics. METHODS: We proposed a model and described each construct in detail. We review what is known about interpersonal and patient-physician communication, described literature about surrogate-clinician communication, and discussed implications for our developing model. RESULTS: The communication literature proposes two major elements of interpersonal communication: information processing and relationship building. These elements are composed of constructs such as information disclosure and emotional support that are likely to be relevant to decision making. We propose these elements of communication impact decision making, which in turn affects outcomes for both patients and surrogates. Decision making quality may also mediate the relationship between communication and outcomes. CONCLUSION: Although many elements of the model have been studied in relation to patient-clinician communication, there is limited data about surrogate decision making. There is evidence of high surrogate distress associated with decision making that may be alleviated by communication-focused interventions. More research is needed to test the relationships proposed in the model. PRACTICE IMPLICATIONS: Good communication with surrogates may improve both the quality of medical decisions and outcomes for the patient and surrogate.Item Control Theoretical Modeling of Trust-Based Decision Making in Food-Energy-Water Management(Springer, 2021) Uslu, Suleyman; Kaur, Davinder; Rivera, Samuel J.; Durresi, Arjan; Babbar-Sebens, Meghna; Tilt, Jenna H.; Computer and Information Science, School of ScienceWe propose a hybrid Human-Machine decision making to manage Food-Energy-Water resources. In our system trust among human actors during decision making is measured and managed. Furthermore, such trust is used to pressure human actors to choose among the solutions generated by algorithms that satisfy the community’s preferred trade-offs among various objectives. We model the trust-based loops in decision making by using control theory. In this system, the feedback information is the trust pressure that actors receive from peers. Using control theory, we studied the dynamics of the trust of an actor. Then, we presented the modeling of the change of solution distances. In both scenarios, we also calculated the settling times and the stability using the transfer functions and their Z-transforms as the number of rounds to show whether and when the decision making is finalized.Item Decision Making for Managing Community Flood Risks: Perspectives of United States Floodplain Managers(Springer, 2021-10) Tyler, Jenna; Sadiq, Abdul-Akeem; Noonan, Douglas S.; Entress, Rebecca M.; School of Public and Environmental AffairsTo reduce flood losses, floodplain managers make decisions on how to effectively manage their community’s flood risks. While there is a growing body of research that examines how individuals and households make decisions to manage their flood risks, far less attention has been directed at understanding the decision-making processes for flood management at the community level. This study aimed to narrow this research gap by examining floodplain managers’ perceptions of the quality of their community’s flood management decision-making processes. Data gathered from interviews with 200 floodplain managers in the United States indicate that most floodplain managers perceive their community’s flood management decision-making processes to be good. The results also indicate that communities participating in the Federal Emergency Management Agency’s Community Rating System, as well as communities with a higher level of concern for flooding and a lower poverty rate, are significantly more likely to report better flood management decision-making processes.Item The Family Navigator: A pilot intervention to support intensive care unit family surrogates(American Association of Critical Care Nurses, 2016-11) Torke, Alexia M.; Wocial, Lucia D.; Johns, Shelley A.; Sachs, Greg A.; Callahan, Christopher M.; Bosslet, Gabriel T.; Slaven, James E.; Perkins, Susan M.; Hickman, Susan E.; Montz, Kianna; Burke, Emily; Medicine, School of MedicineBackground Although communication problems between family surrogates and intensive care unit (ICU) clinicians have been documented, there are few effective interventions. Nurses have the potential to play an expanded role in ICU communication and decision making. Objectives To conduct a pilot randomized controlled trial of the Family Navigator (FN), a distinct nursing role to address family members’ unmet communication needs early in an ICU stay. Methods An inter-disciplinary team developed the FN protocol. A randomized controlled pilot intervention trial of the FN was performed in a tertiary referral hospital ICU to test the feasibility and acceptability of the intervention. The intervention addressed informational and emotional communication needs through daily contact using structured clinical updates, emotional and informational support modules, family meeting support and follow-up phone calls. Results Twenty-six surrogate/patient pairs (13 per study arm) were enrolled. Surrogates randomized to the intervention had contact with the FN 90% or more of eligible patient days. All surrogates agreed or strongly agreed that they would recommend the FN to other families. Open-ended comments from both surrogates and clinicians were uniformly positive. For both groups, 100% of baseline data collection interviews and 81% of 6–8 week follow-up interviews were completed. Conclusions A fully integrated nurse empowered to facilitate decision making is a feasible intervention in the ICU setting. It is well-received by ICU families and staff. A larger randomized controlled trial is needed to demonstrate an impact on important outcomes, such as surrogate well-being and decision quality.Item Grouping Promotes Equality: The Effect of Recipient Grouping on Allocation of Limited Medical Resources(Sage, 2015) Colby, Helen A.; DeWitt, Jeff; Chapman, Gretchen B.; Kelley School of Business - IndianapolisDecisions about allocation of scarce resources, such as transplant organs, often entail a trade-off between efficiency (i.e., maximizing the total benefit) and fairness (i.e., dividing resources equally). In three studies, we used a hypothetical scenario for transplant-organ allocation to examine allocation to groups versus individuals. Study 1 demonstrated that allocation to individuals is more efficient than allocation to groups. Study 2 identified a factor that triggers the use of fairness over efficiency: presenting the beneficiaries as one arbitrary group rather than two. Specifically, when beneficiaries were presented as one group, policymakers tended to allocate resources efficiently, maximizing total benefit. However, when beneficiaries were divided into two arbitrary groups (by hospital name), policymakers divided resources more equally across the groups, sacrificing efficiency. Study 3 replicated this effect using a redundant attribute (prognosis) to create groups and found evidence for a mediator of the grouping effect—the use of individualizing information to rationalize a more equitable allocation decision.Item Impact of Race and Sex on Pain Management by Medical Trainees: A Mixed Methods Pilot Study of Decision Making and Awareness of Influence(Wiley, 2015-02) Hollingshead, Nicole A.; Matthias, Marianne S.; Bair, Matthew J.; Hirsh, Adam T.; Department of Psychology, IU School of ScienceObjective Previous research suggests female and black patients receive less optimal treatment for their chronic pain compared with male and white patients. Provider-related factors are hypothesized to contribute to unequal treatment, but these factors have not been examined extensively. This mixed methods investigation examined the influence of patients' demographic characteristics on providers' treatment decisions and providers' awareness of these influences on their treatment decisions. Methods Twenty medical trainees made treatment decisions (opioid, antidepressant, physical therapy) for 16 virtual patients with chronic low back pain; patient sex and race were manipulated across patients. Participants then indicated from a provided list the factors that influenced their treatment decisions, including patient demographics. Finally, individual interviews were conducted to discuss the role of patient demographics on providers' clinical decisions. Results Individual regression analyses indicated that 30% of participants were reliably influenced by patient sex and 15% by patient race when making their decisions (P < 0.05 or P < 0.10). Group analyses indicated that white patients received higher antidepressant recommendations, on average, than black patients (P < 0.05). Half of the medical trainees demonstrated awareness of the influence of demographic characteristics on their decision making. Participants, regardless of whether they were influenced by patients' demographics, discussed themes related to patient sex and race; however, participants' discussion of patient demographics in the interviews did not always align with their online study results. Conclusions These findings suggest there is a considerable variability in the extent to which medical trainees are influenced by patient demographics and their awareness of these decision making influences.Item Inter-rater reliability and prospective validation of a clinical prediction rule for SARS-CoV-2 infection(Wiley, 2021-07) Nevel, Adam E.; Kline, Jeffrey A.; Emergency Medicine, School of MedicineObjectives Accurate estimation of the risk of SARS-CoV-2 infection based on bedside data alone has importance to Emergency Department (ED) operations and throughput. The 13 item CORC (COVID [or coronavirus] Rule-out Criteria) rule had good overall diagnostic accuracy in retrospective derivation and validation. The objective of this study was to prospectively test the inter-rater-reliability and diagnostic accuracy of the CORC score and rule (score ≤0 negative, >0 positive), and compare the CORC rule performance with physician gestalt. Methods This non-interventional study was conducted at an urban academic ED from February-March 2021. Two practitioners were approached by research coordinators and asked to independently complete a form capturing the CORC criteria for their shared patient, and their gestalt binary prediction of the SARS-CoV-2 test result and confidence (0-100%). The criterion standard for SARS-CoV-2 was from rt-PCR performed on a nasopharyngeal swab. The primary analysis was from weighted Cohen’s K and likelihood ratios (LR). Results For 928 patients, agreement between observers was good for the total CORC score, K = 0.613 (0.579-0.646) and for the CORC rule K = 0.644 (0.591-0.697). The agreement for clinician gestalt binary determination of SARs-CoV-2 status was K = 0.534, (95% CI 0.437-0.632) with median confidence of 76% (1st-3rd quartile: 66-88.5). For 425 patients who had the criterion standard, a negative CORC rule (both observers scored CORC <0), the sensitivity was 88%, specificity 51%, with a LR(-) = 0.24 (95% CI 0.10-0.50). Among patients with a mean CORC score >4, the prevalence of a positive SARS-CoV-2 test was 58% (28-85%) and LR(+) = 13.1 (4.5-37.2). Clinician gestalt demonstrated a sensitivity of 51%, specificity of 86% with a LR(-) = 0.57 (0.39-0.74). Conclusion In this prospective study, the CORC score and rule demonstrated good inter-rater reliability and reproducible diagnostic accuracy for estimating the pretest probability of SARs-CoV-2 infection.