Rational Decision Making in Psychiatry: Evidence-Based Psychiatry is Just the Start

1997 ◽  
Vol 171 (3) ◽  
pp. 226-227 ◽  
Author(s):  
Trevor A. Sheldon ◽  
Simon M. Gilbody
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Systematic Approach ◽  
Research Evidence ◽  
Scientific Basis ◽  
Evidence Based ◽  
Rational Decision ◽  
Rational Decision Making ◽  
Chief Of Staff ◽  
Patterns Of Practice

Geddes and Harrison make the case simply and persuasively for the value of a systematic approach to identifying and applying research evidence in clinical practice. No sensible psychiatrist, nurse or other therapist can justify a situation where patterns of practice are overly influenced by fashion, tradition, what the chief of staff happens to believe, or what the adverts claim, independent of the scientific basis, as represented by the results of valid experimental research.

The debate over rational decision making in evidence-based medicine: Implications for evidence-informed policy

2019 ◽  
Author(s):  
Christopher R. Sheldrick ◽  
Justeen Hyde ◽  
Laurel K. Leslie ◽  
Thomas Mackie
Keyword(s):  
Decision Making ◽  
Evidence Based Medicine ◽  
Research Evidence ◽  
Evidence Based ◽  
Rational Decision ◽  
Decision Sciences ◽  
Rational Decision Making ◽  
Based Medicine ◽  
Rational Decisions

Many of the resources developed to promote the use of evidence in policy aspire to an ideal of rational decision making, yet their basis in the decision sciences is often unclear. Tracing the historical development of evidence-informed policy to its roots in evidence-based medicine (EBM), we distinguish between two understandings of how research evidence may be applied. Advocates for EBM all seek to use research evidence to optimise clinical care. However, some proponents argue that ‘uptake' of research evidence should be direct and universal, for example through wide-scale implementation of ‘evidence-based practices'. In contrast, other conceptualisations of EBM are rooted in expected utility theory, which defines rational decisions as choices that are expected to result in the greatest benefit. Applying this theory to medical care, clinical decision-making models clearly demonstrate that rational decisions require not only a range of relevant evidence, but also expertise to inform judgments regarding the credibility of estimates and to assess fit-to-context, and stakeholder preferences and values to weigh trade-offs among competing outcomes. Using these models as exemplars, we argue that attempts to apply research evidence directly to practice or policy without consideration of expert judgement or preferences and values reflect fundamental misconceptions about the theory of rational decision making that can impede implementation. In turn, the decision sciences highlight the need to consider the role of expertise and judgment when interpreting research evidence, the role of preferences and values when applying it to specific decisions, and the practical limits imposed by the uncertainty inherent in each.<br /><br />key messages<br /><ol><li>Uncertainty is inherent to research evidence and to decision making.</li><br /><li>Rational decisions require judgment to interpret evidence and stakeholder values to apply evidence.</li><br /><li>Decisions can be sensitive to evidence, expertise, and/or preferences and values to varying degrees.</li><br /></ol>

scholarly journals Adoption of the concept of person-centred care into discourse in Europe: a systematic literature review

2021 ◽  
Vol 35 (9) ◽  
pp. 265-280 ◽  
Author(s):  
Kristina Rosengren ◽  
Petra Brannefors ◽  
Eric Carlstrom
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Literature Review ◽  
Systematic Approach ◽  
Grey Literature ◽  
Quality Of Healthcare ◽  
Healthcare Systems ◽  
Evidence Based ◽  
Content Type ◽  
Healthcare Settings

PurposeThis study aims to describe how person-centred care, as a concept, has been adopted into discourse in 23 European countries in relation to their healthcare systems (Beveridge, Bismarck, out of pocket).Design/methodology/approachA literature review inspired by the SPICE model, using both scientific studies (CINHAL, Medline, Scopus) and grey literature (Google), was conducted. A total of 1,194 documents from CINHAL (n = 139), Medline (n = 245), Scopus (n = 493) and Google (n = 317) were analysed for content and scope of person-centred care in each country. Countries were grouped based on healthcare systems.FindingsResults from descriptive statistics (percentage, range) revealed that person-centred care was most common in the United Kingdom (n = 481, 40.3%), Sweden (n = 231, 19.3%), the Netherlands (n = 80, 6.7%), Northern Ireland (n = 79, 6.6%) and Norway (n = 61, 5.1%) compared with Poland (0.6%), Hungary (0.5%), Greece (0.4%), Latvia (0.4%) and Serbia (0%). Based on healthcare systems, seven out of ten countries with the Beveridge model used person-centred care backed by scientific literature (n = 999), as opposed to the Bismarck model, which was mostly supported by grey literature (n = 190).Practical implicationsAdoption of the concept of person-centred care into discourse requires a systematic approach at the national (politicians), regional (guidelines) and local (specific healthcare settings) levels visualised by decision-making to establish a well-integrated phenomenon in Europe.Social implicationsEvidence-based knowledge as well as national regulations regarding person-centred care are important tools to motivate the adoption of person-centred care in clinical practice. This could be expressed by decision-making at the macro (law, mission) level, which guides the meso (policies) and micro (routines) levels to adopt the scope and content of person-centred care in clinical practice. However, healthcare systems (Beveridge, Bismarck and out-of-pocket) have different structures and missions owing to ethical approaches. The quality of healthcare supported by evidence-based knowledge enables the establishment of a well-integrated phenomenon in European healthcare.Originality/valueOur findings clarify those countries using the Beveridge healthcare model rank higher on accepting/adopting the concept of person-centered care in discourse. To adopt the concept of person-centred care in discourse requires a systematic approach at all levels in the organisation—from the national (politicians) and regional (guideline) to the local (specific healthcare settings) levels of healthcare.

Integrating Research Into the Clinic

2002 ◽  
Vol 92 (2) ◽  
pp. 115-122 ◽  
Author(s):  
Anne-Maree Keenan ◽  
Anthony C. Redmond
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Research Evidence ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Research Process ◽  
Decision Making Process ◽  
Evidence Based ◽  
Clinical Environment ◽  
The Individual

This paper is the first in a series of three aimed at introducing clinicians to current concepts in research, and outlining how they may be able to apply these concepts to their own clinical practice. It has become evident in recent years that while many practitioners may not want to become actively involved in the research process, simply keeping abreast of the burgeoning publication base will create new demands on their time, and will often require the acquisition of new skills. This series introduces the philosophies of integrating what sometimes may appear to be abstract research into the realities of the clinical environment. It will provide practitioners with an accessible summary of the tools required in order to understand the research process. For some, it is hoped this series may provide some impetus for the contemplative practitioner to become a more active participant in the research process. This first paper addresses how the evidence based practice (EBP) revolution can be used to empower the individual practitioner and how good quality evidence can improve the overall clinical decision making process. It also suggests key strategies by which the clinician may try to enhance their clinical decision making process and make research evidence more applicable to their day to day clinical practice. (J Am Podiatr Med Assoc 92(2): 115-122, 2002)

What Does Evidence-Based Practice Mean to You? A Follow-Up Study Examining School-Based Speech-Language Pathologists' Perspectives on Evidence-Based Practice

2020 ◽  
Vol 29 (2) ◽  
pp. 688-704
Author(s):  
Katrina Fulcher-Rood ◽  
Anny Castilla-Earls ◽  
Jeff Higginbotham
Keyword(s):  
Clinical Practice ◽  
Research Evidence ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Speech Language Pathologists ◽  
School Based ◽  
Research Findings ◽  
Ebp Implementation

Purpose The current investigation is a follow-up from a previous study examining child language diagnostic decision making in school-based speech-language pathologists (SLPs). The purpose of this study was to examine the SLPs' perspectives regarding the use of evidence-based practice (EBP) in their clinical work. Method Semistructured phone interviews were conducted with 25 school-based SLPs who previously participated in an earlier study by Fulcher-Rood et al. 2018). SLPs were asked questions regarding their definition of EBP, the value of research evidence, contexts in which they implement scientific literature in clinical practice, and the barriers to implementing EBP. Results SLPs' definitions of EBP differed from current definitions, in that SLPs only included the use of research findings. SLPs seem to discuss EBP as it relates to treatment and not assessment. Reported barriers to EBP implementation were insufficient time, limited funding, and restrictions from their employment setting. SLPs found it difficult to translate research findings to clinical practice. SLPs implemented external research evidence when they did not have enough clinical expertise regarding a specific client or when they needed scientific evidence to support a strategy they used. Conclusions SLPs appear to use EBP for specific reasons and not for every clinical decision they make. In addition, SLPs rely on EBP for treatment decisions and not for assessment decisions. Educational systems potentially present other challenges that need to be considered for EBP implementation. Considerations for implementation science and the research-to-practice gap are discussed.

Resource-rational decision making

2021 ◽  
Vol 41 ◽  
pp. 15-21
Author(s):  
Rahul Bhui ◽  
Lucy Lai ◽  
Samuel J Gershman
Keyword(s):  
Decision Making ◽  
Rational Decision ◽  
Rational Decision Making

Author reply: Empathy Does Provide Rational Support for Decisions. But Is It the Right Decision?

2012 ◽  
Vol 4 (1) ◽  
pp. 96-97 ◽  
Author(s):  
Fritz Breithaupt
Keyword(s):  
Decision Making ◽  
Rational Decision ◽  
Author Reply ◽  
Rational Decision Making ◽  
Rational Support ◽  
The One ◽  
The Right

This article examines the relation of empathy and rational judgment. When people observe a conflict most are quick to side with one of the parties. Once a side has been taken, empathy with that party further solidifies this choice. Hence, it will be suggested that empathy is not neutral to judgment and rational decision-making. This does not mean, however, that the one who empathizes will necessarily have made the best choice.

Evidential Decision Theory

2021 ◽  
Author(s):  
Arif Ahmed
Keyword(s):  
Decision Making ◽  
Decision Theory ◽  
Rational Decision ◽  
Evidential Decision Theory ◽  
Radical Theory ◽  
Rational Decision Making ◽  
Evidential Decision ◽  
Theoretic Foundations

Evidential Decision Theory is a radical theory of rational decision-making. It recommends that instead of thinking about what your decisions *cause*, you should think about what they *reveal*. This Element explains in simple terms why thinking in this way makes a big difference, and argues that doing so makes for *better* decisions. An appendix gives an intuitive explanation of the measure-theoretic foundations of Evidential Decision Theory.

Toward More Rational Decision Making

1988 ◽  
pp. 257-283
Author(s):  
Michael R. Gottfredson ◽  
Don M. Gottfredson
Keyword(s):  
Decision Making ◽  
Rational Decision ◽  
Rational Decision Making
Sign in / Sign up

Export Citation Format

Share Document