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A weighted constraint satisfaction approach to human goal-directed decision making.

ABSTRACT: When we plan for long-range goals, proximal information cannot be exploited in a blindly myopic way, as relevant future information must also be considered. But when a subgoal must be resolved first, irrelevant future information should not interfere with the processing of more proximal, subgoal-relevant information. We explore the idea that decision making in both situations relies on the flexible modulation of the degree to which different pieces of information under consideration are weighted, rather than explicitly decomposing a problem into smaller parts and solving each part independently. We asked participants to find the shortest goal-reaching paths in mazes and modeled their initial path choices as a noisy, weighted information integration process. In a base task where choosing the optimal initial path required weighting starting-point and goal-proximal factors equally, participants did take both constraints into account, with participants who made more accurate choices tending to exhibit more balanced weighting. The base task was then embedded as an initial subtask in a larger maze, where the same two factors constrained the optimal path to a subgoal, and the final goal position was irrelevant to the initial path choice. In this more complex task, participants' choices reflected predominant consideration of the subgoal-relevant constraints, but also some influence of the initially-irrelevant final goal. More accurate participants placed much less weight on the optimality-irrelevant goal and again tended to weight the two initially-relevant constraints more equally. These findings suggest that humans may rely on a graded, task-sensitive weighting of multiple constraints to generate approximately optimal decision outcomes in both hierarchical and non-hierarchical goal-directed tasks.

SUBMITTER: Li Y

PROVIDER: S-EPMC9255770 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background/objectiveSurrogate decision makers for patients with intracerebral hemorrhage (ICH) are frequently asked to make difficult decisions on use of life-sustaining treatments. We explored ICH surrogate satisfaction with decision making and experience of decision regret using validated measures in a prospective multicenter study.MethodsCases of non-traumatic ICH were enrolled from three hospitals (September 2015-December 2016), and surrogate decision makers were invited to complete a self-administered survey. The primary outcome was the 10-item decision-making subscale of the Family Satisfaction in the Intensive Care Unit scale (FSICU-DM, range 0-100, higher is greater satisfaction), and the secondary outcome was the decision regret scale (range 0-100, higher is greater regret). Linear regression models were used to assess the association between satisfaction with decision making and pre-specified covariates using manual backward selection.ResultsA total of 73 surrogates were approached for participation (in person or mail), with 48 surrogates returning a completed survey (median surrogate age 60.5 years, 63% female, 77% white). Patients had a median age of 72.5, 54% were female, with a median admission Glasgow coma scale of 10, in-hospital mortality of 31%, and 56% with an in-hospital DNR order. Physicians commonly made treatment recommendation (> 50%) regarding brain surgery or transitions to comfort measures, but rarely made recommendations (< 20%) regarding DNR orders. Surrogate satisfaction with decision making was generally high (median FSICU-DM 85, IQR 57.5-95). Factors associated with higher satisfaction on multivariable analysis included greater use of shared decision making (P < 0.0001), younger patient age (p = 0.02), ICH score of 3 or higher (p = 0.03), and surrogate relationship (spouse vs. other, p = 0.02). Timing of DNR orders was not associated with satisfaction (P > 0.25). Decision regret scores were generally low (median 12.5, IQR 0-31.3).ConclusionsConsidering the severity and abruptness of ICH, it is reassuring that surrogate satisfaction with decision making was generally high and regret was generally low. However, more work is needed to define the appropriate outcome measures and optimal methods of recruitment for studies of surrogate decision makers of ICH patients.

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A weighted constraint satisfaction approach to human goal-directed decision making.

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