Support for management medical decisions and the nature of uncertainty in them

2021 ◽  
Author(s):  
S.Yu. Zhuleva ◽  
A.V. Kroshilin ◽  
S.V. Kroshilina
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Medical Information ◽  
General Scheme ◽  
The Body ◽  
Medical Decision ◽  
Problem Situation ◽  
Medical Decisions ◽  
Inaccurate Information ◽  
Individual Decisions

The process of making a medical decision is characterized by a lack of knowledge and inconsistency of the available information, the lack of the possibility of attracting competent medical experts, limited time resources, incomplete or inaccurate information about the patient's condition. These aspects may be the causes of medical errors, which lead to further aggravation of the problem situation. Purpose – it is necessary to define and justify managerial medical decisions and types of medical information in conditions of uncertainty, when each variant of the sets of outcomes of the situation (recommendations) has its own unique set of values. The fundamental difference between this process for medical use is the concept of the "best medical solution", in which the key role is given to the patient's state of health in obtaining and evaluating alternatives, as well as the need to take into account the time, adverse reactions of the body and the costs of implementing this solution. In the medical field, support for medical decision-making can be classified as organizational-managerial and therapeutic-diagnostic, but both are determined by the position of the person making the medical decision and are aimed at effective management of the medical institution as a whole. The article describes the causes and factors of the nature of uncertainty in the tasks of supporting medical decision-making in medical-diagnostic and organizational-managerial areas. The analysis of the features of supporting medical decision-making in conditions of uncertainty is carried out. Approaches and directions in this area, as well as the concept of “solution”, are considered. The essence of the management medical decision is reflected. The classification of management medical decisions is given, the requirements that are imposed on them are highlighted. The features of the development of management medical solutions in the conditions of incompleteness and uncertainty, the problems that arise when they are implemented in information systems are presented. The general scheme of the process of creating a management medical solution is shown. The features of making group and individual decisions are reflected. The algorithm of actions of the person making the medical decision in the conditions of uncertainty, incompleteness and risk in medical subject areas is presented.

scholarly journals Culture, Self, and Medical Decision Making in Australia and China: A Structural Model Analysis

2019 ◽  
Vol 4 (2) ◽  
pp. 238146831987101 ◽  
Author(s):  
Hankiz Dolan ◽  
Dana L. Alden ◽  
John M. Friend ◽  
Ping Yein Lee ◽  
Yew Kong Lee ◽  
...  
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Medical Information ◽  
Personal Values ◽  
Total Variance ◽  
Medical Decision ◽  
Equation Modeling ◽  
Individual Level ◽  
Study Results ◽  
Variance Explained

Objective. To explore and compare the influences of individual-level cultural values and personal attitudinal values on the desire for medical information and self-involvement in decision making in Australia and China. Methods. A total of 288 and 291 middle-aged adults from Australia and China, respectively, completed an online survey examining cultural and personal values, and their desired level of self-influence on medical decision making. Structural equation modeling was used to test 15 hypotheses relating to the effects of cultural and personal antecedents on the individual desire for influence over medical decision making. Results. Similar factors in both Australia and China (total variance explained: Australia 29%; China 35%) predicted desire for medical information, with interdependence (unstandardized path coefficient βAustralia = 0.102, P = 0.014; βChina = 0.215, P = 0.001), independence (βAustralia = 0.244, P < 0.001; βChina = 0.123, P = 0.037), and health locus of control (βAustralia = −0.140, P = 0.018; βChina = −0.138, P = 0.007) being significant and positive predictors. A desire for involvement in decisions was only predicted by power distance, which had an opposite effect of being negative for Australia and positive for China (total variance explained: Australia 11%; China 5%; βAustralia = 0.294, P < 0.001; China: βChina = −0.190, P = 0.043). National culture moderated the effect of independence on desire for medical information, which was stronger in Australia than China ( Z score = 1.687, P < 0.05). Conclusions. Study results demonstrate that in both countries, desire for medical information can be influenced by individual-level cultural and personal values, suggesting potential benefits of tailoring health communication to personal mindsets to foster informed decision making. The desired level of self-involvement in decision making was relatively independent of other cultural and personal values in both countries, suggesting caution against cultural stereotypes. Study findings also suggest that involvement preferences in decision making should be considered separately from information needs at the clinical encounter.

scholarly journals The Gray Zone: Adolescent and Young Adult Decision Support Needs for Ulcerative Colitis

2020 ◽  
Vol 5 (2) ◽  
pp. 238146832094070
Author(s):  
Andrea Meisman ◽  
Nancy M. Daraiseh ◽  
Phil Minar ◽  
Marlee Saxe ◽  
Ellen A. Lipstein
Keyword(s):  
Ulcerative Colitis ◽  
Decision Making ◽  
Decision Support ◽  
Focus Groups ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Support Needs ◽  
Final Decision ◽  
Care Providers ◽  
Medical Decisions

Purpose. To understand the medical decision support needs specific to adolescents and young adults (AYAs) with ulcerative colitis (UC) and inform development of a decision support tool addressing AYAs’ preferences. Methods. We conducted focus groups with AYAs with UC and mentors from a pediatric inflammatory bowel disease clinic’s peer mentoring program. Focus groups were led by a single trained facilitator using a semistructured guide aimed at eliciting AYAs’ roles in medical decision making and perceived decision support needs. All focus groups were audio recorded, transcribed, and coded by the research team. Data were analyzed using content analysis and the immersion crystallization method. Results. The facilitator led six focus groups: one group with peer mentors aged 18 to 24 years, three groups with patients aged 14 to 17 years, and two groups with patients aged 18 to 24 years. Decision timing and those involved in decision making were identified as interacting components of treatment decision making. Treatment decisions by AYAs were further based on timing, location (inpatient v. outpatient), and family preference for making decisions during or outside of clinic. AYAs involved parents and health care providers in medical decisions, with older participants describing themselves as “final decision makers.” Knowledge and experience were facilitators identified to participating in medical decision making. Conclusions. AYAs with UC experience changes to their roles in medical decisions over time. The support needs identified will inform the development of strategies, such as decision support tools, to help AYAs with chronic conditions develop and use skills needed for participating in medical decision making.

scholarly journals The role of non-medical factors in physicians’ decision-making process in a pediatric telemedicine service

2019 ◽  
Vol 26 (2) ◽  
pp. 1152-1176 ◽  
Author(s):  
Motti Haimi ◽  
Shuli Brammli-Greenberg ◽  
Yehezkel Waisman ◽  
Nili Stein ◽  
Orna Baron-Epel
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Decision Making Process ◽  
Medical Decisions ◽  
Telemedicine Service ◽  
Medical Factors ◽  
Complex Process ◽  
Clinical Scenarios

The complex process of medical decision-making is prone also to medically extraneous influences or “non-medical” factors. We aimed to investigate the possible role of non-medical factors in doctors’ decision-making process in a telemedicine setting. Interviews with 15 physicians who work in a pediatric telemedicine service were conducted. Those included a qualitative section, in which the physicians were asked about the role of non-medical factors in their decisions. Their responses to three clinical scenarios were also analyzed. In an additional quantitative section, a random sample of 339 parent -physician consultations, held during 2014–2017, was analyzed retrospectively. Various non-medical factors were identified with respect to their possible effect on primary and secondary decisions, the accuracy of diagnosis, and “reasonability” of the decisions. Various non-medical factors were found to influence physicians’ decisions. Those factors were related to the child, the applying parent, the physician, the interaction between the doctor and parents, the shift, and to demographic considerations, and were also found to influence the ability to make an accurate diagnosis and “reasonable” decisions. Our conclusion was that non-medical factors have an impact on doctor’s decisions, even in the setting of telemedicine, and should be considered for improving medical decisions in this milieu.

Importance of Faith on Medical Decisions Regarding Cancer Care

2003 ◽  
Vol 21 (7) ◽  
pp. 1379-1382 ◽  
Author(s):  
Gerard A. Silvestri ◽  
Sommer Knittig ◽  
James S. Zoller ◽  
Paul J. Nietert
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Formal Education ◽  
Treatment Decisions ◽  
Medical Decision ◽  
Advanced Lung Cancer ◽  
Medical Decisions ◽  
Future Studies ◽  
Medical Oncologists ◽  
Individual Decisions

Purpose: Decisions regarding cancer treatment choices can be difficult. Several factors may influence the decision to undergo treatment. One poorly understood factor is the influence of a patient’s faith on how they make medical decisions. We compared the importance of faith on treatment decisions among doctors, patients, and patient caregivers. Methods: One hundred patients with advanced lung cancer, their caregivers, and 257 medical oncologists were interviewed. Participants were asked to rank the importance of the following factors that might influence treatment decisions: cancer doctor’s recommendation, faith in God, ability of treatment to cure disease, side effects, family doctor’s recommendation, spouse’s recommendation, and children’s recommendation. Results: All three groups ranked the oncologist’s recommendation as most important. Patients and caregivers ranked faith in God second, whereas physicians placed it last (P < .0001). Patients who placed a high priority on faith in God had less formal education (P < .0001). Conclusion: Patients and caregivers agree on the factors that are important in deciding treatment for advanced lung cancer but differ substantially from doctors. All agree that the oncologist’s recommendation is most important. This is the first study to demonstrate that, for some, faith is an important factor in medical decision making, more so than even the efficacy of treatment. If faith plays an important role in how some patients decide treatment, and physicians do not account for it, the decision-making process may be unsatisfactory to all involved. Future studies should clarify how faith influences individual decisions regarding treatment.

Patients' Desire to Participate in Decision-Making in Psychiatry: A Questionnaire Survey in Japan

2000 ◽  
Vol 86 (2) ◽  
pp. 389-399 ◽  
Author(s):  
Chieko Hasui ◽  
Miki Hayashi ◽  
Atsuko Tomoda ◽  
Maki Kohro ◽  
Kyoko Tanaka ◽  
...  
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Medical Information ◽  
Psychiatric Patients ◽  
Educational Background ◽  
The Self ◽  
Case Vignette ◽  
Medical Decision ◽  
Personality Factors ◽  
Types Of Information

Japanese national sentiment has been described as paternalistic, which has potentially wide-ranging implications for the manner in which psychiatric patients should participate in medical decision-making. To examine the extent and possible determinants of the desire to participate in medical decision-making among Japanese people, we distributed a packet of questionnaires to 747 (nonmedical) university students and 114 of their parents. The questionnaires included an imaginary case vignette of psychotic depression. The participants were asked whether they would want various types of medical information, i.e., diagnosis, aetiology, treatment, outcomes, medical charts, etc., disclosed to them were they in such a psychiatric condition. Also included was the 1995 Scale for Independent and Interdependent Construal of the Self by Kiuchi. More than half of the participants wanted all the types of medical information disclosed to them. Those participants who wanted to have all types of information disclosed to them ( n = 413) as compared to those who did not want to know at least one type of information ( n = 445), tended to be male and to have an educational background in psychiatry (9.7% vs 5.4%) as well as an assertive attitude as indicated by a higher score on Independence on the Scale for Independence and Interdependent Construal of the Self. These results suggest that the Japanese in this sample are more likely to want to make an autonomous contribution to the psychiatric decision-making process and that less desire for information can be predicted by some demographic and personality factors.

Medical Epistemology

2018 ◽  
pp. 45-55
Author(s):  
Erwin B. Montgomery
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Modus Tollens ◽  
Medical Epistemology ◽  
Medical Decisions ◽  
Cause And Effect ◽  
Practical Syllogism ◽  
New Knowledge ◽  
Cutoff Threshold

Deductive approaches in medical decision-making have an air of certainty borrowed from philosophical deduction, as for example, in the hypothetico-deductive approach. However, deduction, although certain, is limited because it cannot contribute to new knowledge other than proving some claims to knowledge as false (using modus tollens). Syllogistic deduction requires modification to gain utility, such as the partial and practical syllogisms. However, these forms are logically invalid in that they do not ensure certainty in the conclusions. The partial syllogism can be rendered more certain by the use of probability. However, the necessity of a medical decision requires dichotomization of the continuous probability variable. A cutoff threshold applied to the probability is necessary to enable a dichotomous decision, such as whether to treat or not treat a patient. The practical syllogism introduces the notion of cause and effect, which also may influence medical decisions, although often in a counterproductive manner.

scholarly journals Use of Tablets and Smartphones to Support Medical Decision Making in US Adults: Cross-Sectional Study (Preprint)

2020 ◽  
Author(s):  
Aisha Langford ◽  
Kerli Orellana ◽  
Jolaade Kalinowski ◽  
Carolyn Aird ◽  
Nancy Buderer
Keyword(s):  
Decision Making ◽  
Health Information ◽  
Medical Decision Making ◽  
Electronic Devices ◽  
Sociodemographic Factors ◽  
Medical Decision ◽  
Health And Wellness ◽  
Medical Decisions ◽  
Cross Sectional ◽  
Lower Odds

BACKGROUND Tablet and smartphone ownership have increased among US adults over the past decade. However, the degree to which people use mobile devices to help them make medical decisions remains unclear. OBJECTIVE The objective of this study is to explore factors associated with self-reported use of tablets or smartphones to support medical decision making in a nationally representative sample of US adults. METHODS Cross-sectional data from participants in the 2018 Health Information National Trends Survey (HINTS 5, Cycle 2) were evaluated. There were 3504 responses in the full HINTS 5 Cycle 2 data set; 2321 remained after eliminating respondents who did not have complete data for all the variables of interest. The primary outcome was use of a tablet or smartphone to help make a decision about how to treat an illness or condition. Sociodemographic factors including gender, race/ethnicity, and education were evaluated. Additionally, mobile health (mHealth)- and electronic health (eHealth)-related factors were evaluated including (1) the presence of health and wellness apps on a tablet or smartphone, (2) use of electronic devices other than tablets and smartphones to monitor health (eg, Fitbit, blood glucose monitor, and blood pressure monitor), and (3) whether people shared health information from an electronic monitoring device or smartphone with a health professional within the last 12 months. Descriptive and inferential statistics were conducted using SAS version 9.4. Weighted population estimates and standard errors, univariate odds ratios, and 95% CIs were calculated, comparing respondents who used tablets or smartphones to help make medical decisions (n=944) with those who did not (n=1377), separately for each factor. Factors of interest with a <i>P</i> value of &lt;.10 were included in a subsequent multivariable logistic regression model. RESULTS Compared with women, men had lower odds of reporting that a tablet or smartphone helped them make a medical decision. Respondents aged 75 and older also had lower odds of using a tablet or smartphone compared with younger respondents aged 18-34. By contrast, those who had health and wellness apps on tablets or smartphones, used other electronic devices to monitor health, and shared information from devices or smartphones with health care professionals had higher odds of reporting that tablets or smartphones helped them make a medical decision, compared with those who did not. CONCLUSIONS A limitation of this research is that information was not available regarding the specific health condition for which a tablet or smartphone helped people make a decision or the type of decision made (eg, surgery, medication changes). In US adults, mHealth and eHealth use, and also certain sociodemographic factors are associated with using tablets or smartphones to support medical decision making. Findings from this study may inform future mHealth and other digital health interventions designed to support medical decision making.

From Medical Data to Health Knowledge

1987 ◽  
Vol 26 (01) ◽  
pp. 3-12 ◽  
Author(s):  
J. M. Martin ◽  
L. Benamghar ◽  
B. Junod ◽  
P. Marrel
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Health Knowledge ◽  
Medical Information ◽  
Computer Systems ◽  
Medical Knowledge ◽  
Medical Data ◽  
Medical Decision ◽  
Decision Making Process ◽  
The Way

SummaryThe problems of assisting in the medical decision-making process are attracting more and more attention.Actually a certain number of computer systems have considerably improved the availability of medical data. However, we encounter some difficulties when extending these systems. In order to surmount these problems, it is necessary to proceed further in the analysis and comprehension of medical information and processes.To accomplish this goal, it is necessary to have a better understanding of the way in which a group of medical data is derived from one piece of medical knowledge and also how a chunk of medical knowledge is related to its corresponding medical data.This article is a beginning in the study of the transition from medical data to health knowledge, and this transition represents only part of the global entity, the nature, the representation, and use of medical information.

Surrogate’s Personal Sense of Duty as a Crucial Element in Medical Decision Making

2021 ◽  
pp. 7-26
Author(s):  
Chris Feudtner ◽  
Theodore E. Schall ◽  
Douglas L. Hill
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Adult Child ◽  
Decision Makers ◽  
Medical Decision ◽  
Single Event ◽  
Medical Decisions ◽  
The Social ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

Surrogates who must make medical decisions for other people—most often, loved ones—face difficult challenges not acknowledged in current models of medical decision making. Furthermore, medical decisions are typically not a single event, but an ongoing event that evolves over time. This chapter presents a broader conceptualization of medical decision making, highlighting that (1) surrogate decision makers often face multiple problems, not a single clear problem; (2) the path to the decision maker’s desired goal is often unclear and often constrained by past decisions; (3) the social relationships between the surrogate and the patient (parent, adult child, spouse) influence the decision making as surrogates try to fulfill their role as a good parent, good son/daughter, or good spouse; and (4) surrogate decision makers often judge themselves negatively in ways that influence their decisions and the outcome. Clinicians who recognize these complex influences on surrogate decision making may be better able to support surrogates through this difficult process.

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