Faculty Opinions recommendation of Patient responsibility for medical decision making and risky treatment options.

2010 ◽  
Author(s):  
Carl-Fredrik Burman
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Treatment Options ◽  
Medical Decision

scholarly journals Implicit persuasion in medical decision-making

2018 ◽  
Vol 7 (2) ◽  
pp. 209-227
Author(s):  
Ellen G. Engelhardt ◽  
Arwen H. Pieterse ◽  
Anne M. Stiggelbout
Keyword(s):  
Decision Making ◽  
Patient Participation ◽  
Medical Decision Making ◽  
Treatment Options ◽  
Medical Decision ◽  
Potential Pitfall ◽  
Participation In Decision Making

Abstract If the arguments to support a recommendation are partly implicit, the free exchange of ideas between discussants can be hampered. In this paper, we will focus on the potential pitfall for clinicians when informing patients about treatment options: implicit persuasion. We will describe a set of implicitly persuasive behaviors observed during decision-making consultations, and reflect on how these behaviors could undermine efforts to stimulate patient participation in decision-making. We will also reflect on possible explanations for why clinicians exhibit such behaviors.

Abstract 324: Medical Decision-Making: Preferences and Practices in the Year following Acute Myocardial Infarction

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Erica S Spatz ◽  
Daniel D Matlock ◽  
Yan Li ◽  
John A Spertus ◽  
Harlan M Krumholz
Keyword(s):  
Decision Making ◽  
Patient Preferences ◽  
Medical Decision Making ◽  
Treatment Options ◽  
Likert Scale ◽  
Medical Decision ◽  
Individual Preferences ◽  
Baseline Preference ◽  
The Stability ◽  
Over Time

Background: Patients vary in their desire to participate in medical decision-making (MDM), with some preferring passive roles and others preferring shared or autonomous roles. Yet little is known about the stability of patient preferences over time and whether patient preferences are aligned with how they actually experience the MDM process. We sought to determine the stability of MDM preferences for patients hospitalized with an AMI and assess whether there is concordance between the patient’s preference and their experience with care. Methods: In TRIUMPH, a 24-center, prospective US study of AMI patients, MDM preferences were assessed both at the time of hospitalization and one year later (n=2071). MDM preferences were assessed by the question, “Given the information about the risks and benefits of the treatment options, who should decide which treatment option should be selected? We categorized responses from a 5-item Likert scale into: passive (“doctor alone/mostly the doctor”), or shared/active (“doctor and you equally/mostly you or you alone”) and compared responses between baseline and 12-months following AMI. We assessed concordance between baseline MDM preferences with the patients’ perceived level of participation in MDM at 1 month with the question, “Who was responsible for making health decisions regarding the current treatment of your heart condition?” using the same 5-item Likert scale and categorization. Results: Over 2/3 of patients preferred shared/active MDM both at the time of their AMI (1446, 69.8%) and 1 year later (1411, 68.1%). However, individual preferences varied over time. Among patients with a baseline preference for shared/active MDM, 374 (25.9%) preferred passive participation 1 year later. Among patients preferring passive participation at the time of their AMI, 339 (54.2%) preferred a shared/active participatory role 1 year later. Comparing desired and perceived roles in MDM, only 54.5% of patients reported, at 1 month, an MDM process that was concordant with their baseline preferences. Among patients with a baseline preference for shared/active MDM, 48.3% reported experiencing a passive role in MDM 1 month following AMI. Among patients preferring a passive role at baseline, 39.3% reported experiencing a shared/active MDM process. Conclusion: Individual preferences for participation in MDM during and after AMI vary, with the majority preferring a shared/active role. These preferences change over time, highlighting the need for continual assessment. In the month following an AMI, half of patients experienced an MDM process that was not consistent with their stated preferences.

scholarly journals In silico study of medical decision-making for rare diseases: heterogeneity of decision-makers in a population improves overall benefit

2018 ◽  
Author(s):  
Juan Wang ◽  
Ryo Yamada
Keyword(s):  
Decision Making ◽  
Success Rate ◽  
Rare Diseases ◽  
Medical Decision Making ◽  
Treatment Options ◽  
Decision Makers ◽  
Medical Decision ◽  
Clinical Settings ◽  
Limited Information ◽  
Decision Strategy

Background: Medical decision-making is difficult when information is limited due to rareness. For example, there are two treatment options for patients affected by a rare disease with high lethality. The information about both treatment effects is unavailable or very limited. Patients are inclined to accept one of the interventions rather than waiting for death, but they are reluctant to be assigned the inferior one. While a single patient selects one treatment that seems better based on the limited information, he or she loses the chance to select the other treatment, which may be the better option. This is the so-called dilemma between exploitation (enjoying the benefits of using current knowledge) and exploration (taking the risk to obtain new knowledge). In clinical settings, the statistical advice for individual patients seems to be the maximum expected success rate or something equivalent and patients’ selections tend to be homogeneous, which does not solve the dilemma. In this study, our aim is to investigate the effects of the heterogeneity of decision-makers in the decision process. Methods: Here, we proposed a decision strategy that introduced the heterogeneity of decision-makers by considering patients’ self-decisions where the patients’ heterogeneous attitudes towards the treatment are integrated into the probabilistic utility function based on the Beta Bayesian posterior. Based on the context of two-armed bandit treatment options with limited information, we compared the overall success rate of treatment between our heterogeneous decision strategy and a homogeneous decision strategy that is defined to select the treatment with the largest posterior mean. Results: The heterogeneity of decision-makers in a population improved the overall benefit of treatment under some conditions. Discussion: In clinical settings, there exists heterogeneity of decision-making among patients. Our study investigated a targeting strategy by respecting the self-decision of all individuals and found that the heterogeneity of decision-making can improve the overall benefit under some conditions. In addition, this outperformance may suggest that heterogeneity of decision-making is of importance to human beings. Besides the ethical merit, our findings provide meaningful ideas for better strategies towards decision-making dilemmas in clinical settings for rare diseases or cases where only limited information is available. It would be further suggested to investigate the effects of heterogeneity of decision-making in other fashions, such as genetic heterogeneity and phenotypic heterogeneity.

scholarly journals In silico study of medical decision-making for rare diseases: heterogeneity of decision-makers in a population improves overall benefit

2018 ◽  
Author(s):  
Juan Wang ◽  
Ryo Yamada
Keyword(s):  
Decision Making ◽  
Success Rate ◽  
Rare Diseases ◽  
Medical Decision Making ◽  
Treatment Options ◽  
Decision Makers ◽  
Medical Decision ◽  
Clinical Settings ◽  
Limited Information ◽  
Decision Strategy

Background: Medical decision-making is difficult when information is limited due to rareness. For example, there are two treatment options for patients affected by a rare disease with high lethality. The information about both treatment effects is unavailable or very limited. Patients are inclined to accept one of the interventions rather than waiting for death, but they are reluctant to be assigned the inferior one. While a single patient selects one treatment that seems better based on the limited information, he or she loses the chance to select the other treatment, which may be the better option. This is the so-called dilemma between exploitation (enjoying the benefits of using current knowledge) and exploration (taking the risk to obtain new knowledge). In clinical settings, the statistical advice for individual patients seems to be the maximum expected success rate or something equivalent and patients’ selections tend to be homogeneous, which does not solve the dilemma. In this study, our aim is to investigate the effects of the heterogeneity of decision-makers in the decision process. Methods: Here, we proposed a decision strategy that introduced the heterogeneity of decision-makers by considering patients’ self-decisions where the patients’ heterogeneous attitudes towards the treatment are integrated into the probabilistic utility function based on the Beta Bayesian posterior. Based on the context of two-armed bandit treatment options with limited information, we compared the overall success rate of treatment between our heterogeneous decision strategy and a homogeneous decision strategy that is defined to select the treatment with the largest posterior mean. Results: The heterogeneity of decision-makers in a population improved the overall benefit of treatment under some conditions. Discussion: In clinical settings, there exists heterogeneity of decision-making among patients. Our study investigated a targeting strategy by respecting the self-decision of all individuals and found that the heterogeneity of decision-making can improve the overall benefit under some conditions. In addition, this outperformance may suggest that heterogeneity of decision-making is of importance to human beings. Besides the ethical merit, our findings provide meaningful ideas for better strategies towards decision-making dilemmas in clinical settings for rare diseases or cases where only limited information is available. It would be further suggested to investigate the effects of heterogeneity of decision-making in other fashions, such as genetic heterogeneity and phenotypic heterogeneity.

scholarly journals In silico study of medical decision-making for rare diseases: heterogeneity of decision-makers in a population improves overall benefit

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e5677
Author(s):  
Juan Wang ◽  
Ryo Yamada
Keyword(s):  
Decision Making ◽  
Success Rate ◽  
Rare Diseases ◽  
Medical Decision Making ◽  
Treatment Options ◽  
Decision Makers ◽  
Medical Decision ◽  
Clinical Settings ◽  
Limited Information ◽  
Decision Strategy

Background Medical decision-making is difficult when information is limited due to its rareness. For example, there are two treatment options for patients affected by a rare disease with high lethality. The information about both treatment effects is unavailable or very limited. Patients are inclined to accept one of the interventions rather than waiting for death, but they are reluctant to be assigned the inferior one. While a single patient selects one treatment that seems better based on the limited information, he or she loses the chance to select the other treatment, which may be the better option. This is the so-called dilemma between exploitation (enjoying the benefits of using current knowledge) and exploration (taking the risk to obtain new knowledge). In clinical settings, the statistical advice for individual patients seems to be the maximum expected success rate or something equivalent and patients’ selections tend to be homogeneous, which does not solve the dilemma. In this study, our aim is to investigate the effects of the heterogeneity of decision-makers in the decision process. Methods Here, we proposed a decision strategy that introduced the heterogeneity of decision-makers by considering patients’ self-decisions where the patients’ heterogeneous attitudes towards the treatment are integrated into the probabilistic utility function based on the Beta Bayesian posterior. Based on the context of two-armed bandit treatment options with limited information, we compared the overall success rate of treatment between our heterogeneous decision strategy and a homogeneous decision strategy that is defined to select the treatment with the largest posterior mean. Results The heterogeneity of decision-makers in a population improved the overall benefit of treatment under some conditions. Discussion In clinical settings, there exists heterogeneity of decision-making among patients. Our study investigated a targeting strategy by respecting the self-decision of all individuals and found that the heterogeneity of decision-making can improve the overall benefit under some conditions. In addition, this outperformance may suggest that heterogeneity of decision-making is of importance to human beings. Besides the ethical merit, our findings provide meaningful ideas for better strategies towards decision-making dilemmas in clinical settings for rare diseases or cases where only limited information is available. Furthermore, it is suggested to investigate the effects of heterogeneity of decision-making in other fashions, such as genetic heterogeneity and phenotypic heterogeneity.

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