EEG Correlates of Moral Decision-Making: Effect of Choices and Offers Types

Background: Moral decision-making consists of a complex process requiring individuals to evaluate potential consequences of personal and social decisions, including applied organizational contexts.Methods: This research aims to investigate the behavioral (offer responses and reaction times, RTs) and electrophysiological (EEG) correlates underlying moral decision-making during three different choice conditions (professional fit, company fit, and social fit) and offers (fair, unfair, and neutral).Results: An increase of delta and theta frontal activity (related to emotional behavior and processes) and beta frontal and central activity (linked to cognitive and attentional processes) was found. A left beta, delta, and theta frontal activity was observed for fair offers in professional fit conditions, while increased right frontal delta and theta activity was found in response to unfair offers in company fit conditions. Also, an increase of left delta and theta parietal activity for unfair offers in social fit condition was detected. Finally, higher accepted responses were found for fair and neutral offers in professional and social fit conditions, with increased RTs for unfair offers suggesting decisions' cognitive load and complexity.Conclusions: By revealing a greater involvement of left and right frontal areas in decision-making processes based on choices and offers, personal interest evaluations and emotional values, and of parietal areas in more prosocial and altruistic moral behavior, current findings provide information about the neural and behavioral correlates underlying company moral behavior.

Probability and informed consent

In this paper, we illustrate some serious difficulties involved in conveying information about uncertain risks and securing informed consent for risky interventions in a clinical setting. We argue that in order to secure informed consent for a medical intervention, physicians often need to do more than report a bare, numerical probability value. When probabilities are given, securing informed consent generally requires communicating how probability expressions are to be interpreted and communicating something about the quality and quantity of the evidence for the probabilities reported. Patients may also require guidance on how probability claims may or may not be relevant to their decisions, and physicians should be ready to help patients understand these issues.

How people reason with counterfactual and causal explanations for Artificial Intelligence decisions in familiar and unfamiliar domains

Few empirical studies have examined how people understand counterfactual explanations for other people's decisions, for example, "if you had asked for a lower amount, your loan application would have been approved". Yet many current Artificial Intelligence (AI) decision support systems rely on counterfactual explanations to improve human understanding and trust. We compared counterfactual explanations to causal ones, i.e., "because you asked for a high amount, your loan application was not approved", for an AI's decisions in a familiar domain (alcohol and driving) and an unfamiliar one (chemical safety) in four experiments (n = 731). Participants were shown inputs to an AI system, its decisions, and an explanation for each decision; they attempted to predict the AI's decisions, or to make their own decisions. Participants judged counterfactual explanations more helpful than causal ones, but counterfactuals did not improve the accuracy of their predictions of the AI's decisions more than causals (Experiment 1). However, counterfactuals improved the accuracy of participants' own decisions more than causals (Experiment 2). When the AI's decisions were correct (Experiments 1 and 2), participants considered explanations more helpful and made more accurate judgements in the familiar domain than in the unfamiliar one; but when the AI's decisions were incorrect, they considered explanations less helpful and made fewer accurate judgements in the familiar domain than the unfamiliar one, whether they predicted the AI's decisions (Experiment 3a) or made their own decisions (Experiment 3b). The results corroborate the proposal that counterfactuals provide richer information than causals, because their mental representation includes more possibilities.

Differences in decisions affected by cognitive biases: examining human values, need for cognition, and numeracy

A better understanding of factors that can affect preferences and choices may contribute to more accurate decision-making. Several studies have investigated the effects of cognitive biases on decision-making and their relationship with cognitive abilities and thinking dispositions. While studies on behaviour, attitude, personality, and health worries have examined their relationship with human values, research on cognitive bias has not investigated its relationship to individual differences in human values. The purpose of this study was to explore individual differences in biased choices, examining the relationships of the human values self-direction, conformity, power, and universalism with the anchoring effect, the framing effect, the certainty effect, and the outcome bias, as well as the mediation of need for cognition and the moderation of numeracy in these relationships. We measured individual differences and within-participant effects with an online questionnaire completed by 409 Brazilian participants, with an age range from 18 to 80 years, 56.7% female, and 43.3% male. The cognitive biases studied consistently influenced choices and preferences. However, the biases showed distinct relationships with the individual differences investigated, indicating the involvement of diverse psychological mechanisms. For example, people who value more self-direction were less affected only by anchoring. Hence, people more susceptible to one bias were not similarly susceptible to another. This can help in research on how to weaken or strengthen cognitive biases and heuristics.

Can I speak to the manager? The gender dynamics of decision-making in Kenyan maize plots

Gender and social inclusion efforts in agricultural development are focused on making uptake of agricultural technologies more equitable. Yet research looking at how gender relations influence technology uptake often assumes that men and women within a household make farm management decisions as individuals. Relatively little is understood about the dynamics of agricultural decision-making within dual-adult households where individuals' management choices are likely influenced by others in the household. This study used vignettes to examine decision-making related to maize plot management in 698 dual-adult households in rural Kenya. The results indicated a high degree of joint management of maize plots (55%), although some management decisions-notably those related to purchased inputs-were slightly more likely to be controlled by men, while other decisions-including those related to hiring of labor and maize end uses-were more likely to be made by women. The prevalence of joint decision-making underscores the importance of ensuring that both men's and women's priorities and needs are reflected in design and marketing of interventions to support maize production, including those related to seed systems, farmer capacity building, and input delivery.

Data-driven investment and performance management in the livestock sector

Evidence-based decision-making is now axiomatic in many sectors and has become increasingly important in prioritising development in low- and middle-income countries. In the livestock development sector, there has been a lack of data on health and production required to establish an evidence base. Thus, much strategic and policy decision-making has been based on the more subjective grounds of opinion, expert or otherwise. However, there is now a trend towards a more data-driven approach for such decisions. The Centre for Supporting Evidence-Based Interventions in Livestock was established in Edinburgh by the Bill and Melinda Gates Foundation in 2016, to collate and publish livestock health and production data, lead a community of practice to harmonise livestock-data-related methodologies, and develop and monitor performance indicators for livestock investments.

Confronting a post-pandemic new-normal-threats and opportunities to trust-based relationships in natural resource science and management

Natural resource governance is inherently complex owing to the socio-ecological systems in which it is embedded. Working arrangements have been fundamentally transformed throughout the COVID-19 pandemic with potential negative impacts on trust-based social networks foundational to resource management and transboundary governance. To inform development of a post-pandemic new-normal in resource management, we examined trust relationships using the Laurentian Great Lakes of North America as a case study. 82.9% (n = 97/117) of Great Lakes fishery managers and scientists surveyed indicated that virtual engagement was effective for maintaining well-established relationships during the pandemic; however, 76.7% (n = 89/116) of respondents indicated in-person engagement to be more effective than virtual engagement for building and maintaining trust. Despite some shortcomings, virtual or remote engagement presents opportunities, such as: (1) care and nurturing of well-established long-term relationships; (2) short-term (1-3 years) trust maintenance; (3) peer-peer or mentor-mentee coordination; (4) supplemental communications; (5) producer-push knowledge dissemination; and, if done thoughtfully, (6) enhancing diversity, equity, and inclusion. Without change, pre-pandemic trust-based relationships foundational to cooperative, multinational, resource management are under threat.

Principal Investigators' Priorities and Perceived Barriers and Facilitators When Making Decisions About Conducting Essential Research in the COVID-19 Pandemic

At the onset of the COVID-19 pandemic in the United States, stay-at-home orders disrupted normal research operations. Principal investigators (PIs) had to make decisions about conducting and staffing essential research under unprecedented, rapidly changing conditions. These decisions also had to be made amid other substantial work and life stressors, like pressures to be productive and staying healthy. Using survey methods, we asked PIs funded by the National Institutes of Health and the National Science Foundation (N = 930) to rate how they prioritized different considerations, such as personal risks, risks to research personnel, and career consequences, when making decisions. They also reported how difficult they found these choices and associated symptoms of stress. Using a checklist, PIs indicated those factors in their research environments that made their decisions easier (i.e., facilitators) or more difficult (i.e., barriers) to make. Finally, PIs also indicated how satisfied they were with their decisions and management of research during the disruption. Descriptive statistics summarize PIs' responses and inferential tests explore whether responses varied by academic rank or gender. PIs overall reported prioritizing the well-being and perspectives of research personnel, and they perceived more facilitators than barriers. Early-career faculty, however, rated concerns about their careers and productivity as higher priorities compared to their senior counterparts. Early-career faculty also perceived greater difficulty and stress, more barriers, fewer facilitators, and had less satisfaction with their decisions. Women rated several interpersonal concerns about their research personnel more highly than men and reported greater stress. The experience and perceptions of researchers during the COVID-19 pandemic can inform policies and practices when planning for future crises and recovering from the pandemic.

Factors that influence women's decision on infant feeding: An integrative review

BACKGROUND

Many women stop breastfeeding earlier than what they intended prior to birth. Although there are many studies that focus on the factors that influence women's antenatal breastfeeding decisions, the factors that influence women's decisions during the continuum of antenatal and postnatal period are less known.

AIM

To understand and synthesise the contemporary factors that influence women's decisions on infant feeding from the antenatal period and across the breastfeeding continuum.

METHOD

Five online databases (CINAHL, Medline, PubMed, Scopus and Web of Science) were searched. We included original search articles that were published since 2015 to August 2021 and were available in English. The framework of Whittemore and Knafl was used to guide this integrative literature review. Out of the 872 articles identified, 14 studies met the inclusion criteria of our study. We used theory of birth territory and midwifery guardianship to synthesise the interactions between the themes.

FINDINGS

Five main themes were identified: (a) Women's own views, (b) Family and friend's preferences and advice, (c) Health professional's preference, advice and practice, (d) Sociocultural norms, and (e) Media representation. The interaction between the themes was explained based on women's intrinsic and extrinsic power outlined in the birth territory and midwifery guardianship theory.

CONCLUSION

The factors that influence women's decisions towards infant feeding methods are complex and multi-dimensional. Promoting and supporting women towards breastfeeding need to focus on the factors that are tailored for a woman within her social network where she can feel safe about her breastfeeding decisions.

Predicting Coma Trajectories: The Impact of Bias and Noise on Shared Decisions

Coma trajectories are characterized by quick awakening or protracted awakening. Outcome is bookended by restored functionality or permanent cognitively and physically debilitated states. Given the stakes, prognostication cannot be easily questioned as a judgment call, and a scientific underpinning is elemental. Conventional wisdom in determining coma-outcome trajectories posits that (1) predictive models are better than personal experiences, (2) self-fulfilling prophesy is unchecked and driven by nihilism, with little regard for prior probability outcomes, and (3) recovery is impacted by patients’ prior wishes and preexisting medical conditions—but also by what families are told about the patient’s state and anticipated clinical course. Moreover, a predicted good outcome can be offset by a major subsequent complication, or a predicted poor outcome can be offset by aggressive care. This article examines some of these concepts, including how we decide on aggressiveness of care, how we judge quality of life, and the impact on outcome. Most patients who awaken quickly do well and can resume their pretrauma injury lives. In worse off, slow-to-awaken patients, outcomes are a mixed bag of limited innate resilience, depleted cognitive and physical reserves, and adjusted quality of life. Bias and noise are factors not easily measured in outcome prediction, but their influence on recovery trajectories raises some troubling issues.

Preparation and Practice of the Necessary Documents in Hospital for the "Act on Decision of Life-Sustaining Treatment for Patients at the End-of-Life"

Purpose

Six forms relating to decisions on life-sustaining treatment (LST) for patients at the end-of-life (EOL) in hospital are required by the “Act on Decision of LST for Patients at the EOL.” We investigated the preparation and creation status of these documents from the database of the National Agency for Management of LST.

Materials and Methods

We analyzed the contents and details of each document necessary for decisions on LST, and the creation status of forms. We defined patients completing form 1 as “self-determined” of LST, and those whose family members had completed form 11/12 as “family decision” of LST. According to the determination subject, we compared the four items of LST on form 13 (the paper of implementation of LST) and the documentation time interval between forms.

Results

The six forms require information about the patient, doctor, specialized doctor, family members, institution, decision for LST, and intention to use hospice services. Of 44,381 who had completed at least one document, 36,693 patients had form 13. Among them, 11,531, 10,976, and 12,551 people completed forms 1, 11, and 12, respectively. The documentation time interval from forms 1, 11, or 12 to form 13 was 8.6±13.6 days, 1.0±9.5 days, and 1.5±9.7 days, respectively.

Conclusion

The self-determination rate of LST was 31% and the mean time interval from self-determination to implementation of LST was 8.6 days. The creation of these forms still takes place when the patients are close to death.

[Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise]

BACKGROUND

Although several tools to evaluate the credibility of health care guidelines exist, guidance on practical steps for developing guidelines is lacking. We systematically compiled a comprehensive checklist of items linked to relevant resources and tools that guideline developers could consider, without the expectation that every guideline would address each item.

METHODS

We searched data sources, including manuals of international guideline developers, literature on guidelines for guidelines (with a focus on methodology reports from international and national agencies, and professional societies) and recent articles providing systematic guidance. We reviewed these sources in duplicate, extracted items for the checklist using a sensitive approach and developed overarching topics relevant to guidelines. In an iterative process, we reviewed items for duplication and omissions and involved experts in guideline development for revisions and suggestions for items to be added.

RESULTS

We developed a checklist with 18 topics and 146 items and a webpage to facilitate its use by guideline developers. The topics and included items cover all stages of the guideline enterprise, from the planning and formulation of guidelines, to their implementation and evaluation. The final checklist includes links to training materials as well as resources with suggested methodology for applying the items.

INTERPRETATION

The checklist will serve as a resource for guideline developers. Consideration of items on the checklist will support the development, implementation and evaluation of guidelines. We will use crowdsourcing to revise the checklist and keep it up to date.

The social meanings of choice in living-with advanced breast cancer

Individual choice is valorised as a core social value; yet the necessity and desirability of making choices takes on new significance for people living with incurable cancer who are required to make often difficult decisions about treatment, care and family life, amidst considerable vulnerability and precariousness. There has been comparatively little exploration of how choice is negotiated and made meaningful under the spectre of incurability and a contracted future. In this paper, drawing on multiple qualitative interviews with 38 women with metastatic breast cancer, we explore how they experience and give meaning to choice in relation to their health (and beyond) in their daily lives. Our analysis highlights that while exercising choice was sometimes a concealed or silent pursuit, choice was always a socially negotiated and temporally unfolding process, nested within relational and interpersonal dynamics. Choices were also often constrained, even foreclosed, due to situational and relational dynamics. Yet even in the absence of choice, the idea of choice-as-control was discursively embraced by women. We argue that greater attention is needed to the affective, temporal and economic dimensions of choice, and how treatment decisions are asymmetrically structured when considered within the normative context of cancer.

The influence of online health information on health decisions: A systematic review

OBJECTIVES

This systematic review assessed the influence of online health information (OHI) search behaviour on health and medical decisions.

METHODS

Eligible studies were identified by searching electronic databases PubMed, Scopus, and CINAHL in February 2020 for studies reporting OHI search behaviour and its influence on health decisions. Information was extracted pertaining to either consumers' (self-reported) perceptions of the influence of OHI on decision-making or the association between online search behaviour and health decision-making.

RESULTS

A total of 3995 articles were screened, with 48 included in the final analysis. The reviewed studies indicated that OHI assisted in making subsequent health related decisions such as asking questions during a consultation, increased professional visits, improved adherence to the advice of a physician, being more compliant with taking medication, and improved self-care.

CONCLUSION

Consumers largely used OHI to support information provided by their physicians. The strength of the patient-provider relationship was considered important in moderating the potential negative outcomes of OHI.

PRACTICE IMPLICATIONS

Health care systems have a unique opportunity to direct OHI search behaviours towards empowering consumers to engage as an informed, active and joint decision-maker in their own health care.

The cognitive science of COVID-19: Acceptance, denial, and belief change

Because the spread of pandemics depends heavily on human choices and behaviors, dealing with COVID-19 requires insights from cognitive science which integrates psychology, neuroscience, computer modeling, philosophy, anthropology, and linguistics. Cognitive models can explain why scientists adopt hypotheses about the causes and treatments of disease based on explanatory coherence. Irrational deviations from good reasoning are explained by motivated inference in which conclusions are influenced by personal goals that contribute to emotional coherence. Decisions about COVID-19 can also be distorted by well-known psychological and neural mechanisms. Cognitive science provides advice about how to improve human behavior in pandemics by changing beliefs and by improving behaviors that result from intention-action gaps.

How do people think about later life when making workplace pension saving decisions?

While behavioural economists posit that 'present bias' influences adults' propensity to save, we know very little about the cultural frameworks and internalised rationalities that people apply in real life contexts when making pension choices. This paper investigates how people anticipate the future when they make decisions about workplace pensions, considering whether they think about later life at all; if so, how they conceptualise it; and how these views shape their saving behaviour. These are important questions in the UK where private pension saving is essential to provide for old age, yet an estimated 12 million people do not invest enough for income adequacy in later life. We investigate this issue through in-depth interviews with 42 full time employees aged between 20 and 50 years, working for three large employers - a privileged group facing relatively few structural barriers to saving. Later life was considered to be a distinct and uncertain phase in the long-term future, and thinking about it was uncomfortable. Most participants were unable to imagine what retirement might be like for them. People's thoughts about the future were disconnected from their pension saving decisions, even for those who were saving at higher levels. Instead people focussed on what they can afford in the present, prioritising stability and current standard of life over long-term saving; even the people who save do so because they feel they can afford to without jeopardising their standard of living. We expect that if those in our sample with their relative advantages did not connect their present pension actions to their long term futures, this disconnect may be amplified in less privileged and more precarious groups, who have many more demands on their immediate income and far more uncertain futures. We argue that what has previously been identified as an unconscious 'present bias' is instead a conscious and culturally constructed mechanism that embeds everyday structural privileges into long-term savings.

Impact of the Covid-19 pandemic on perceptions and behaviors of university students in Vietnam

This article presents a novel data set on perceptions and behaviors of university students collected after the beginning of the Covid-19 outbreak in Vietnam. Our questionnaire design is based on employing both qualitative interview with students and survey of SARS literature, probing into the sensitivity of students toward the crisis in making crucial decisions of daily routines, as well as future travel plans in presence of a grave health concern. The data set consists of 440 valid responses from Vietnamese university students through Internet platforms (Facebook, Google Form). Besides descriptive statistics, this article also includes the results of explanatory factor analysis, which may serve as a good reference for future studies.

Equine influenza vaccination as reported by horse owners and factors influencing their decision to vaccinate or not

BACKGROUND

Equine influenza virus is a highly contagious respiratory pathogen that causes pyrexia, anorexia, lethargy and coughing in immunologically naïve horses. Vaccines against equine influenza are available and vaccination is mandatory for horses that participate in affiliated competitions, but this group forms a small proportion of the total horse population. The aims of this study were to: i) identify the equine influenza vaccination rate as reported in 2016 by horse owners in the United Kingdom (UK); ii) examine the demographics of owners and horses which were associated with significantly lower influenza vaccination rates and iii) explore factors that influence horse owners' decisions around influenza vaccine uptake.

RESULTS

Responses from 4837 UK horse owners who were responsible for 10,501 horses were analysed. An overall equine influenza vaccination rate of 80% (8385/10501) was reported. Several owner demographic characteristics were associated with significantly lower (p<0.05) reported equine influenza vaccination rates including: some geographical locations, increasing horse owner age, annual household income of less that £15,000 and owning more than one horse. Horse-related features which were associated with significantly lower reported equine influenza vaccination rates included age ranges of <4 years and > 20 years, use as a companion or breeding animal or leaving their home premises either never or at most once a year. The most common reasons cited for failing to vaccinate horses was no competition activity, lack of exposure to influenza and expense of vaccines. In contrast, the most common underlying reasons given by horse owners who vaccinated their horse were protection of the individual horse against disease, veterinary advice and to protect the national herd. Owners of vaccinated horses had less previous experience of an influenza outbreak or adverse reaction to vaccination compared with owners of unvaccinated horses.

CONCLUSIONS

This study documented a high rate of equine influenza vaccination as reported by owners in a substantial number of horses in the UK, but this does not reflect the level of protection. Sub-populations of horses which were less likely to be vaccinated and the factors that influence each owner's decision around vaccination of their horses against equine influenza were identified, but may alter following the 2019 European influenza outbreak. This information may nevertheless help veterinary surgeons identify "at-risk" patients and communicate more personalised advice to their horse-owning clients. It may also influence educational campaigns about equine influenza directed to horse owners, which aim to improve uptake of vaccination against this pathogen.

Classifying human wellbeing values for planning the conservation and use of natural resources

Understanding how values interact is fundamental to planning the conservation and use of natural resources. However, practitioners who apply value classifications use a diversity of approaches. Does this matter? In answering this question, we propose that well-constructed classifications contribute to planning by: clarifying definitions and underlying concepts; providing a basis for assessing synergies and trade-offs; explaining some ethical constraints, including aspects of governance and power; and providing a framework for cross-cultural analysis. To test these propositions we develop complementary value classifications for end state values and principles together with supporting theory, assumptions, and criteria. The proposed classifications are then compared with alternatives including those based on 'needs', 'capabilities', and total economic value. We find that the alternatives fail against key criteria and this hampers their capacity to fulfil the four roles proposed above. Therefore, we conclude that although value classifications are important and may vary depending on purpose, they need to be well-constructed - that is, supporting theory, assumptions, and criteria should be explicit.

Rising to the medication's requirements: The experience of elderly cancer patients receiving palliative chemotherapy in the elective oncogeriatrics field

A new subfield of oncology has emerged in the last twenty years to raise awareness and address the specific needs of elderly cancer patients, a population that was long neglected in oncology. We sought to understand the individual experiences, as well as moral and social implications of considering elderly cancer patients as "treatable". Following an anthropological critical interpretative approach focusing on practical and symbolic effects of chemotherapy in a rapidly evolving medical field, we conducted 20 semi-structured interviews and observations of medicine storage places at home among elderly cancer patients aged 70 and over in a clearly incurable situation receiving palliative chemotherapy. We used photographs representing paths as triggers in interviews, and compared the patients' views with those of 12 health professionals in oncology during a brief open-ended interview. Elderly cancer patients consider themselves to be survivors and fighters. Their long trajectory is a result of their successful struggle and tolerance of the treatments allowing them to carry on. They continually observe their physical ability and test their resistance, they resist complaining and are grateful to have cancer at a late stage of life. By highlighting their active life rather than the treatment inconveniences, they show they are "young elderly" persons, capable of keeping active physically. They are treated precisely because they demonstrated that they had the physical and moral capacity to take the hit of the chemotherapy to their bodies and had the will to fight. The development of oncogeriatrics has enabled the treatment of the fittest cancer patients over 70, but the ethical debate to treat some elderly patients and not others, and decisions of therapeutic abstention facing frail elderly cancer patients remains an issue rarely discussed. This aspect should not be eluded by the important progress achieved in medicine facing cancer.

Women generating narratives after an unwanted prenatal diagnosis result: randomized controlled trial

We have defined a psychological intervention based on cognitive narrative therapy and the Ottawa decision framework to reduce adjustment problems following a termination of pregnancy (TOP) after a positive prenatal diagnosis (PND). The intervention is composed of four sessions: decision, subjectivation, metaphorization, and projecting. This study aims to assess the effectiveness of a cognitive narrative intervention to prevent depression and anxiety symptoms after TOP. The intervention was accepted by 24 participants. The outcome is compared with a control group of 67 women who also terminated a pregnancy after PND. Participants were from several Portuguese institutions; 64.4% had a genetic and 35.6% had ultrasound diagnosis; the mean age was 30.0 years and the mean gestational age was 19 weeks. There are two evaluations: a baseline at the 15th day and a sixth month follow-up after TOP, using Beck Depression Inventory, Zung Anxiety Scale, Perinatal Grief Scale, and an instrument capturing participant satisfaction. Six months after TOP, there is a lower mean of anxiety and depression (p < 0.05), between groups, with effect sizes on the follow-up of 0.54 for depression, 0.41 for anxiety, and 0.23 for perinatal grief. This intervention has very positive effects on women mental health, and we emphasize the importance of the meaning-making process in the context of terminating a wanted pregnancy.

Ending on a positive: Examining the role of safety leadership decisions, behaviours and actions in a safety critical situation

Safety leadership is an important factor in supporting safe performance in the workplace. The present case study examined the role of safety leadership during the Bingham Canyon Mine high-wall failure, a significant mining incident in which no fatalities or injuries were incurred. The Critical Decision Method (CDM) was used in conjunction with a self-reporting approach to examine safety leadership in terms of decisions, behaviours and actions that contributed to the incidents' safe outcome. Mapping the analysis onto Rasmussen's Risk Management Framework (Rasmussen, 1997), the findings demonstrate clear links between safety leadership decisions, and emergent behaviours and actions across the work system. Communication and engagement based decisions featured most prominently, and were linked to different leadership practices across the work system. Further, a core sub-set of CDM decision elements were linked to the open flow and exchange of information across the work system, which was critical to supporting the safe outcome. The findings provide practical implications for the development of safety leadership capability to support safety within the mining industry.

Information Presentation in Decision and Risk Analysis: Answered, Partly Answered, and Unanswered Questions

For the last 30 years, researchers in risk analysis, decision analysis, and economics have consistently proven that decisionmakers employ different processes for evaluating and combining anticipated and actual losses, gains, delays, and surprises. Although rational models generally prescribe a consistent response, people's heuristic processes will sometimes lead them to be inconsistent in the way they respond to information presented in theoretically equivalent ways. We point out several promising future research directions by listing and detailing a series of answered, partly answered, and unanswered questions.

To tell or not to tell: A qualitative interview study on disclosure decisions among children with inflammatory bowel disease

RATIONALE

Living with a chronic illness poses many challenges, especially during the adolescent stage of development. Few studies have explored young people's experiences of talking about their illness and how they go about deciding if and when they should tell others about their condition.

OBJECTIVE

Our study sought the perspectives of Canadian children and adolescents living with inflammatory bowel disease (IBD) to determine how they go about deciding if and when to tell others about their illness.

METHODS

Twenty-five participants with IBD, ranging in age from 10 to 17 years old, were interviewed about their experiences.

RESULTS

Our participants highlighted that they generally preferred to conceal their illness. However, when they did disclose, they drew on a diverse range of contextual factors such as their knowledge of the illness as well as the severity of their illness, to make the decision. They also highlighted that one of the main challenges they experience is dealing with negative reactions to the news of their illness. This paper presents a decision-making model describing how children decide whether to disclose or conceal their IBD.

CONCLUSION

Our study illustrates that for children and adolescents, managing others' knowledge about their illness has important implications for illness identity management. We argue that knowledge of how children with IBD make disclosure decisions is an important part of understanding the social experience of having IBD, and in creating environments that allow them to adapt to life with IBD. Our study clearly highlights the need for specific programs to be implemented to normalize IBD and to create supportive environments for children and adolescents diagnosed with IBD.

Nursing staff and euthanasia in the Netherlands. A nation-wide survey on attitudes and involvement in decision making and the performance of euthanasia

OBJECTIVES

To give insight into Dutch nursing staff's attitudes and involvement regarding euthanasia.

METHODS

The sample was recruited from a nation-wide existent research panel of registered nurses and certified nursing assistants. Descriptive analyses and multivariate logistic regression analyses were performed.

RESULTS

587 respondents (response of 65%) completed the questionnaire. The majority (83%) state that physicians have to discuss the decision about euthanasia with the nurses involved. Besides, 69% state that a physician should discuss a euthanasia request with nurses who have regular contact with a patient. Nursing staff who have religious or other beliefs that they consider important for their attitude towards end-of-life decisions, and staff working in a hospital or home care, are most likely to have this opinion. Being present during the euthanasia is quite unusual: only a small group (7%) report that this has ever been the case in their entire working life. Seven% (incorrectly) think they are allowed to administer the lethal drugs.

CONCLUSION

The majority want to be involved in decision-making processes about euthanasia. Not all are aware that they are not legally allowed to administer the lethal drugs.

PRACTICE IMPLICATIONS

Nursing staff should be informed of relevant existing legislation and professional guidelines.

Choosing treatment and screening options congruent with values: Do decision aids help? Sub-analysis of a systematic review

OBJECTIVE

To understand how well patients make value congruent decisions with and without patient decision aids (PtDAs) for screening and treatment options, and identify issues with its measurement and evaluation.

METHODS

A sub-analysis of trials included in the 2014 Cochrane Review of Decision Aids. Eligible trials measured value congruence with chosen option. Two reviewers independently screened 115 trials.

RESULTS

Among 18 included trials, 8 (44%) measured value congruence using the Multidimensional Measure of Informed Choice (MMIC), 7 (39%) used heterogeneous methods, and 3 (17%) used unclear methods. Pooled results of trials that used heterogeneous measures were statistically non-significant (n=3). Results from trials that used the MMIC suggest patients are 48% more likely to make value congruent decisions when exposed to a PtDA for a screening decision (RR 1.48, 95% CI 1.01 to 2.16, n=8).

CONCLUSION

Patients struggle to make value congruent decisions, but PtDAs may help. While the absolute improvement is relatively small it may be underestimated due to sample size issues, definitions, and heterogeneity of measures.

PRACTICE IMPLICATIONS

Current approaches are inadequate to support patients making decisions that are consistent with their values. There is some evidence that PtDAs support patients with achieving values congruent decisions for screening choices.

Decisions, choice and shared decision making in antenatal clinics: An observational study

OBJECTIVE

The UK Government has prioritised shared decision making (SDM) and choice in maternity services, but no studies have explored the breadth of antenatal decisions or the feasibility of this aspiration. This study aimed to describe the decisions made, investigate the factors associated with choice and explore SDM practice.

METHODS

Cross-sectional audio-recording of consultations in a UK district general hospital. Multi-level regression models were used to investigate associations between choice and doctor, patient, consultation and decision variables.

RESULTS

585 decisions were documented with a mean of 3.0 (SD 1.5) per consultation. No choice was offered in 75% of decisions. Choice was associated with the decision topic, consultation length, Royal College membership status and presence on the specialist register.

CONCLUSIONS

Without a choice, it will be challenging for a patient and their healthcare profession to truly share decisions.

PRACTICE IMPLICATIONS

If universal SDM is the aim, then further work is required to understand the factors impacting choice availability and SDM, while engaging and supporting healthcare professionals to offer options and share decisions with patients.

Measuring patient-centered care: An updated systematic review of how studies define and report concordance between patients' preferences and medical treatments

OBJECTIVE

The purpose was to examine recent advances in measuring value concordance and to highlight best practices.

METHODS

The paper updates a prior systematic review. A systematic review of the literature from 2008 to 2012 identified articles that reported a relationship between patients' preferences concerning health outcomes and/or medical treatments, and treatment (intended or actual). Relevant articles were independently abstracted by two reviewers.

RESULTS

The search identified 3635 unique citations, the full text of 187 articles was examined, and 63 articles covering 61 studies were included, nearly a third more articles than identified in the original review. There were 72 different value concordance calculations, the majority of which were clearly reported with significance. More studies assessed knowledge, reported on the association between value concordance and knowledge, and included a decision aid compared to those in the original review.

CONCLUSION

There is increased reporting of value concordance in the literature. However, large differences exist in the way that the measure is defined and calculated. The variability makes it difficult to draw conclusions about the quality of care across studies.

PRACTICE IMPLICATIONS

Value concordance is a critical component of patient-centered care, and further attention is needed to establish standards for measurement and reporting.

Greater professional empathy leads to higher agreement about decisions made in the consultation

OBJECTIVE

To examine the relationship between professional expression of empathy and agreement about decisions made in the consultation.

METHODS

Consultations between 86 individuals with diabetes and four dieticians were audio-recorded. Immediately following consultations patients and dieticians independently reported decisions made in a booklet. Audio-recordings were coded directly for empathy using an amended version of the empathic communication coding system (ECCS).

RESULTS

Empathy correlated significantly with patient and professional agreement about decisions made in the consultation (τ=.283, p=.0005). Multiple regression analysis indicates that for each dietician the greater the empathy the higher the level of agreement about decisions (p<.0005). Professional empathic response to patients statements of challenge was a significant factor in increasing agreement about decisions (p=.008).

CONCLUSION

Results support the hypothesis that greater professional empathy will result in greater agreement about decisions made in consultations.

PRACTICE IMPLICATIONS

Findings have implications for empathy training and provide guidance on the communication skills needed to support expression of empathy. Patient and professional agreement about decisions made provides a simple marker of effectiveness and highlights the importance of empathy as a seminal component of professional communication skills during a patient consultation.

Out of control mortality matters: the effect of perceived uncontrollable mortality risk on a health-related decision

Prior evidence from the public health literature suggests that both control beliefs and perceived threats to life are important for health behaviour. Our previously presented theoretical model generated the more specific hypothesis that uncontrollable, but not controllable, personal mortality risk should alter the payoff from investment in health protection behaviours. We carried out three experiments to test whether altering the perceived controllability of mortality risk would affect a health-related decision. Experiment 1 demonstrated that a mortality prime could be used to alter a health-related decision: the choice between a healthier food reward (fruit) and an unhealthy alternative (chocolate). Experiment 2 demonstrated that it is the controllability of the mortality risk being primed that generates the effect, rather than mortality risk per se. Experiment 3 showed that the effect could be seen in a surreptitious experiment that was not explicitly health related. Our results suggest that perceptions about the controllability of mortality risk may be an important factor in people's health-related decisions. Thus, techniques for adjusting perceptions about mortality risk could be important tools for use in health interventions. More importantly, tackling those sources of mortality that people perceive to be uncontrollable could have a dual purpose: making neighbourhoods and workplaces safer would have the primary benefit of reducing uncontrollable mortality risk, which could lead to a secondary benefit from improved health behaviours.

Predictors of bariatric surgery among an interested population

BACKGROUND

Severely obese patients considering bariatric surgery face a difficult decision given the tradeoff between the benefits and risks of surgery. The objectives of this study was to study the forces driving this decision and improve our understanding of the decision-making process.

METHODS

A 64-item survey was developed to assess factors in the decision-making process for bariatric surgery. The survey included the decisional conflict scale, decision self-efficacy scale, EuroQol 5D, and the standard gamble. Patients were recruited from a regularly scheduled bariatric surgery interest group meeting associated with a large, university-based bariatric practice and administered a survey at the conclusion of the interest group. Logistic regression models were used to predict who pursued or still planned to pursue surgery at 12 months.

RESULTS

200 patients were recruited over an 8-month period. Mean age was 45 years; mean BMI was 48 kg/m(2), and 77% were female. The 12-month follow-up rate was 95%. At 12 months, 33 patients (17.6%) had surgery and 30 (16.0%) still planned to have surgery. There was no association between age, gender, or obesity-associated conditions and surgery or plan to have surgery. Patients having surgery or still planning to have surgery had significantly worse scores for quality of life and better scores for decisional conflict (indicating readiness to make a decision).

CONCLUSION

The decision to have bariatric surgery is strongly associated with patients' perceptions of their current quality of life. In addition, lower decisional conflict and higher self-efficacy are predictive of surgery. Interestingly, factors that clinicians might consider important, such as gender, age, and the presence of obesity-associated co-morbidities did not influence patients' decisions.

Open parallel cooperative and competitive decision processes: a potential provenance for quantum probability decision models

In recent years quantum probability models have been used to explain many aspects of human decision making, and as such quantum models have been considered a viable alternative to Bayesian models based on classical probability. One criticism that is often leveled at both kinds of models is that they lack a clear interpretation in terms of psychological mechanisms. In this paper we discuss the mechanistic underpinnings of a quantum walk model of human decision making and response time. The quantum walk model is compared to standard sequential sampling models, and the architectural assumptions of both are considered. In particular, we show that the quantum model has a natural interpretation in terms of a cognitive architecture that is both massively parallel and involves both co-operative (excitatory) and competitive (inhibitory) interactions between units. Additionally, we introduce a family of models that includes aspects of the classical and quantum walk models.

STRUCTURAL AND HIDDEN BARRIERS TO A LOCAL PRIMARY HEALTH CARE INFRASTRUCTURE: AUTONOMY, DECISIONS ABOUT PRIMARY HEALTH CARE, AND THE CENTRALITY AND SIGNIFICANCE OF POWER

PURPOSE

To examine a local primary health care infrastructure and the reality of primary health care from the perspective of residents of a small, urban community in the southern United States.

METHODOLOGY/APPROACH

Data derive from 13 semi-structured focus groups, plus three semi-structured interviews, and were analyzed inductively consistent with a grounded theory approach.

FINDINGS

Structural barriers to the local primary health care infrastructure include transportation, clinic and appointment wait time, and co-payments and health insurance. Hidden barriers consist of knowledge about local health care services, non-physician gatekeepers, and fear of medical care. Community residents have used home remedies and the emergency department at the local academic medical center to manage these structural and hidden barriers.

RESEARCH LIMITATIONS/IMPLICATIONS

Findings might not generalize to primary health care infrastructures in other communities, respondent perspectives can be biased, and the data are subject to various interpretations and conceptual and thematic frameworks. Nevertheless, the structural and hidden barriers to the local primary health care infrastructure have considerably diminished the autonomy community residents have been able to exercise over their decisions about primary health care, ultimately suggesting that efforts concerned with increasing the access of medically underserved groups to primary health care in local communities should recognize the centrality and significance of power.

ORIGINALITY/VALUE

This study addresses a gap in the sociological literature regarding the impact of specific barriers to primary health care among medically underserved groups.

When sounds look right and images sound correct: cross-modal coherence enhances claims of pattern presence

How do people decide whether a stimulus contains a pattern? One possibility is that they rely on a global, non-specific signal of coherence. Interestingly, this signal might reflect a combination of different stimulus sources. Consequently, the coherence of one stimulus might influence decisions about coherence of a second, unrelated stimulus. We explored this possibility in three experiments in which participants judged the presence of a pattern in targets from one sensory modality, while being exposed in the background to incidental coherent and incoherent stimuli in a different modality (visual→auditory, auditory→visual). Across all three experiments, using a variety of judgments, coherence of incidental background cross-modal patterns enhanced claims of pattern presence. These findings advance our understanding of how people judge order in the structured as well as in the unstructured world.

Can children with spina bifida and muscular dystrophy participate in their own health status evaluations?

BACKGROUND

The outcomes movement has emphasized the importance of the patient in evaluating treatment outcome. However, concern has been raised about the ability of children, particularly those with multisystem disease, to evaluate their disability.

PURPOSE

To determine whether children with spina bifida and muscular dystrophy and their parents agree when asked about the relative difficulty of daily activities and the severity of symptoms experienced by the child.

METHODS

First, a list of symptoms and activity restrictions was generated from the literature, clinicians, and interviews with families with spina bifida and muscular dystrophy. Second, another group of parents and children with spina bifida (with hip dislocation or scoliosis) and with muscular dystrophy (with scoliosis), including those before and after surgery, independently rated the severity and importance of their objective and subjective complaints.

RESULTS

The correlation between parents and their children was high for both objective (median Spearman's = 0.70; standard deviation [SD] = ±0.17; range = -0.05-1.00) and subjective (median Spearman's = 0.76; SD = ±0.14; range = 0.13-1.00) complaints, with an overall excellent level of agreement (Kappa = 0.75; 95% confidence interval [CI]: 0.73, 0.76).

CONCLUSION

Children with spina bifida and muscular dystrophy are capable of understanding and assessing their disability.