Elders Preferences in Care Decisions
Ontology highlight
ABSTRACT:
DISEASE(S): Decision Making,Colon Cancer,Patient-centered Care,Early Detection Of Cancer,Colonic Neoplasms
PROVIDER: 2123633 | ecrin-mdr-crc |
REPOSITORIES: ECRIN MDR
Similar Datasets
Project description:This project aims to examine the impact of different interventions designed to help individualize colorectal cancer (CRC) screening decisions in adults aged 76-85. Clinicians will be assigned by chance to one of two arms. In the Intervention arm, clinician participants will complete a training course and will also be notified of patients in the target age group who are due for a discussion about CRC screening. In the Comparator arm, clinician participants will be notified of their patients in the target age group with an upcoming visit who are due for a discussion about CRC screening. The investigators expect that patients seen by clinicians in the intervention arm will report more involvement in the decision making process, be more knowledgeable about the risks and benefits of CRC screening, and will have better quality decisions. Further, the investigators expect that the physicians in the intervention arm will have greater confidence in and demonstrate more skills for conducting shared decision making conversations as compared to those in the control arm.
| 2306304 | ecrin-mdr-crc
Project description:Hard decisions between equally valued alternatives can result in preference changes, meaning that subsequent valuations for chosen items increase and decrease for rejected items. Previous research suggests that this phenomenon is a consequence of cognitive dissonance reduction after the decision, induced by the mismatch between initial preferences and decision outcomes. In contrast, this functional magnetic resonance imaging and eye-tracking study with male and female human participants found that preferences are already updated online during the process of decision-making. Preference changes were predicted from activity in left dorsolateral prefrontal cortex and precuneus while making hard decisions. Fixation durations during this phase predicted both choice outcomes and subsequent preference changes. These preference adjustments became behaviorally relevant only for choices that were remembered and were in turn associated with hippocampus activity. Our results suggest that preferences evolve dynamically as decisions arise, potentially as a mechanism to prevent stalemate situations in underdetermined decision scenarios.SIGNIFICANCE STATEMENT Most theories of decision-making assume that we always choose the best option available, based on a set of stable preferences. However, what happens for hard decisions when the available options are preferred equally? We show that in such stalemate situations, decision-makers adjust their preferences dynamically during the process of decision-making, and these preference adjustments are predicted by a left prefrontal-parietal network. We also show that eye movements during decision-making are predictive of the magnitude of the upcoming value change. Our results suggest that preferences are dynamic, adjusted every time a hard decision is made, prompting a re-evaluation of existing frameworks of decision-making.
| S-EPMC6343649 | biostudies-literature
Project description:ObjectiveTo describe the end-of-life care preferences of individuals, and to examine the influence of age and gender on these preferences.Design, setting and participantsA retrospective cohort study was conducted. Participants included all adults (≥21 years old) (n=3380) who had completed a statement of their preferences as part of a national Advance Care Planning (ACP) programme in Singapore. Data were extracted from the national and Tan Tock Seng Hospital ACP database.Main measuresEnd-of-life care preferences were obtained from the ACP document and differentiated by health status (healthy, chronically ill or diagnosed with advanced illnesses). To analyse the data, descriptive statistics and logistic regression analysis were used.ResultsAcross healthy and chronically ill patients, the majority did not opt for cardiopulmonary resuscitation (CPR) or other life-sustaining measures. Among individuals with advanced illnesses, 94% preferred not to attempt CPR but 69% still preferred to receive some form of active medical treatment. Approximately 40% chose to be cared for, and to die at home. Age and sex significantly predict preferences in those with advanced illnesses. Older age (>=75 years) showed higher odds for home as preferred place of care (OR 1.52; 95% CI 1.23 to 1.89) and place of death (OR 1.29; 95% CI 1.03 to 1.61) and lower odds for CPR (OR 0.31; 95% CI 0.18 to 0.54) and full treatment (OR 0.32; 95% CI 0.17 to 0.62). Being female was associated with lower odds for home as preferred place of care (OR 0.69; 95% CI 0.57 to 0.84) and place of death (OR 0.70; 95% CI 0.57 to 0.85) and higher odds for full treatment (OR 2.35; 95% CI 1.18 to 4.68).ConclusionThe majority preferred to not proceed with life-sustaining treatments, but there was still a strong preference to receive some form of limited treatment. Better understanding of end-of-life care preferences through ACP can better guide end-of-life care programme planning, and resource allocation decisions.
| S-EPMC6367977 | biostudies-literature
Project description:To assess the influence of patient preferences and urologist recommendations in treatment decisions for clinically localized prostate cancer.We enrolled 257 men with clinically localized prostate cancer (prostate-specific antigen <20; Gleason score 6 or 7) seen by urologists (primarily residents and fellows) in 4 Veterans Affairs medical centers. We measured patients' baseline preferences prior to their urology appointments, including initial treatment preference, cancer-related anxiety, and interest in sex. In longitudinal follow-up, we determined which treatment patients received. We used hierarchical logistic regression to determine the factors that predicted treatment received (active treatment v. active surveillance) and urologist recommendations. We also conducted a directed content analysis of recorded clinical encounters to determine if urologists discussed patients' interest in sex.Patients' initial treatment preferences did not predict receipt of active treatment versus surveillance, ??2(4) = 3.67, P = 0.45. Instead, receipt of active treatment was predicted primarily by urologists' recommendations, ??2(2) = 32.81, P < 0.001. Urologists' recommendations, in turn, were influenced heavily by medical factors (age and Gleason score) but were unrelated to patient preferences, ??2(6) = 0, P = 1. Urologists rarely discussed patients' interest in sex (<15% of appointments).Patients' treatment decisions were based largely on urologists' recommendations, which, in turn, were based on medical factors (age and Gleason score) and not on patients' personal views of the relative pros and cons of treatment alternatives.
| S-EPMC5587215 | biostudies-other
Project description:BackgroundMedical maximizing-minimizing (MM) preferences predict a variety of medical decisions. We tested whether informing people about their MM preferences and asking them to reflect on the pros and cons of that preference would improve medical decisions when clear clinical recommendations exist.MethodsWe surveyed 1219 US adults age 40+ that were sampled to ensure a 50%/50% distribution of medical maximizers versus minimizers. Participants either received no MM feedback (Control) or received feedback about their MM type and instructions to reflect on how that MM type can be helpful in some circumstances and problematic in others (Reflection). All participants then completed five hypothetical decision scenarios regarding low-value care services (e.g., head computed tomography scan for mild concussion) and three about high-value care (e.g., flu vaccination).ResultsThere were no significant differences between the Control and Reflection groups in five of eight scenarios. In three scenarios (two low-benefit and one high-benefit), we observed small effects in the nonhypothesized direction for the MM subgroup least likely to follow the recommendation (e.g., maximizers in the Reflection group were more likely to request low-benefit care).ConclusionsAsking people to reflect on their MM preferences may be a counterproductive strategy for optimizing patient decision making around quality of care.
| S-EPMC7863160 | biostudies-literature
Project description: Not available
| S-EPMC192849 | biostudies-literature
Project description:Development of blocking oligos for avoiding non-target amplification in amplicon sequencing
| PRJNA663775 | ENA
Project description:Justice systems delegate punishment decisions to groups in the belief that the aggregation of individuals' preferences facilitates judiciousness. However, group dynamics may also lead individuals to relinquish moral responsibility by conforming to the majority's preference for punishment. Across five experiments (N = 399), we find Victims and Jurors tasked with restoring justice become increasingly punitive (by as much as 40%) as groups express a desire to punish, with every additional punisher augmenting an individual's punishment rates. This influence is so potent that knowing about a past group's preference continues swaying decisions even when they cannot affect present outcomes. Using computational models of decision-making, we test long-standing theories of how groups influence choice. We find groups induce conformity by making individuals less cautious and more impulsive, and by amplifying the value of punishment. However, compared to Victims, Jurors are more sensitive to moral violation severity and less readily swayed by the group. Conformity to a group's punitive preference also extends to weightier moral violations such as assault and theft. Our results demonstrate that groups can powerfully shift an individual's punitive preference across a variety of contexts, while additionally revealing the cognitive mechanisms by which social influence alters moral values.
| S-EPMC6690944 | biostudies-literature
Project description:IntroductionTo assess bounds of shared decision making in orthopaedic surgery, we conducted an exploratory study to examine the extent to which patients want to be involved in decision making in the management of a musculoskeletal condition.MethodsOne hundred fifteen patients at an orthopaedic surgery clinic were asked to rate preferred level of involvement in 25 common theoretical clinical decisions (passive [0], semipassive [1 to 4], equally shared involvement between patient and surgeon [5], semiactive [6 to 9], active [10]).ResultsPatients preferred semipassive roles in 92% of decisions assessed. Patients wanted to be most involved in scheduling surgical treatments (4.75 ± 2.65) and least involved in determining incision sizes (1.13 ± 1.98). No difference exists in desired decision-making responsibility between patients who had undergone orthopaedic surgery previously and those who had not. Younger and educated patients preferred more decision-making responsibility. Those with Medicare desired more passive roles.DiscussionDespite the importance of shared decision making on delivering patient-centered care, our results suggest that patients do not prefer to share all decisions.
| S-EPMC8080702 | biostudies-literature
Project description:Recent findings suggest a bidirectional relationship between preferences and choices such that what is chosen can become preferred. Yet, it is still commonly held that preferences for individual items are maintained, such as caching a separate value estimate for each experienced option. Instead, we propose that all possible choice options and preferences are represented in a shared, continuous, multidimensional space that supports generalization. Decision making is cast as a learning process that seeks to align choices and preferences to maintain coherency. We formalized an error-driven learning model that updates preferences to align with past choices, which makes repeating those and related choices more likely in the future. The model correctly predicts that making a free choice increases preferences along related attributes. For example, after choosing a political candidate based on trivial information (e.g., they like cats), voters' views on abortion, immigration, and trade subsequently shifted to match their chosen candidate.
| S-EPMC7315129 | biostudies-literature