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uncertainty, decision making, stress, coping

Alicia Hamui-Sutton, Tania Vives-Varela, Samuel Gutiérrez-Barreto, Iwin Leenen, Melchor Sánchez-Mendiola
BACKGROUND: Medical uncertainty is inherently related to the practice of the physician and generally affects his or her patient care, job satisfaction, continuing education, as well as the overall goals of the health care system. In this paper, some new types of uncertainty, which extend existing typologies, are identified and the contexts and strategies to deal with them are studied. METHODS: We carried out a mixed-methods study, consisting of a qualitative and a quantitative phase...
2015: BMC Medical Education
Eduardo R Nunez, Yael Schenker, Ian D Joel, Charles F Reynolds, Mary Amanda Dew, Robert M Arnold, Amber E Barnato
OBJECTIVES: Participating in a decision to limit life support for a loved one in the ICU is associated with adverse mental health consequences for surrogate decision makers. We sought to describe acutely bereaved surrogates' experiences surrounding this decision. DESIGN: Qualitative analysis of interviews with surrogates approximately 4 weeks after a patient's death in one of six ICUs at four hospitals in Pittsburgh, PA. SUBJECTS: Adults who participated in decisions about life support in the ICU...
November 2015: Critical Care Medicine
Michelle A Mollica, Willie Underwood, Gregory G Homish, D Lynn Homish, Heather Orom
This study examined whether spiritual beliefs are associated with greater decision-making satisfaction, lower decisional conflict and decision-making difficulty with the decision-making process in newly diagnosed men with prostate cancer. Participants were 1114 men diagnosed with localized prostate cancer who had recently made their treatment decision, but had not yet been treated. We used multivariable linear regression to analyze relationships between spirituality and decision-making satisfaction, decisional conflict, and decision-making difficulty, controlling for optimism and resilience, and clinical and sociodemographic factors...
February 2016: Journal of Behavioral Medicine
Danai Papadatou, Zaira G Papaligoura, Thalia Bellali
The purpose of our phenomenological hermeneutic study was to explore the lived experiences of Greek infertile women who achieve a pregnancy through the use of sperm, oocyte, or embryo donation or surrogate motherhood. Semistructured interviews were conducted with 15 infertile women. Findings suggest that conceiving a child through assisted reproductive technologies (ART) is lived as a highly distressing experience, comprising long waiting periods for medical results, several failed attempts, and treatment options with uncertain outcomes...
February 2016: Qualitative Health Research
Kelly G Lambert, Molly M Hyer, Amanda A Rzucidlo, Timothy Bergeron, Timothy Landis, Massimo Bardi
Emotional resilience enhances an animal's ability to maintain physiological allostasis and adaptive responses in the midst of challenges ranging from cognitive uncertainty to chronic stress. In the current study, neurobiological factors related to strategic responses to uncertainty produced by prediction errors were investigated by initially profiling male rats as passive, active or flexible copers (n = 12 each group) and assigning to either a contingency-trained or non-contingency trained group. Animals were subsequently trained in a spatial learning task so that problem solving strategies in the final probe task, as well-various biomarkers of brain activation and plasticity in brain areas associated with cognition and emotional regulation, could be assessed...
2014: Frontiers in Behavioral Neuroscience
Roxana M Maffei, K Dunn, J Zhang, C E Hsu, J H Holmes
OBJECTIVE: This article describes the process undertaken to identify and validate behavioral and normative beliefs and behavioral intent based on the Theory of Reasoned Action (TRA) and applied to men between the ages of 45 and 70 in the context of their participation in shared decision-making (SDM) in medically uncertain situations. This article also discusses the preliminary results of the aforementioned processes and explores potential future uses of this information that may facilitate greater understanding, efficiency and effectiveness of clinician-patient consultations...
2012: Methods of Information in Medicine
Ana Santos-Ruiz, M Carmen Garcia-Rios, José Carlos Fernandez-Sanchez, Miguel Perez-Garcia, Miguel Angel Muñoz-García, Maria Isabel Peralta-Ramirez
In recent studies showing how stress can affect an individual's decision-making process, the cognitive component of decision-making could also be considered a coping resource available to individuals when faced with a stressful situation. The Iowa Gambling Task (IGT) constitutes the standard test for the assessment of decision-making skills under conditions of uncertainty. Responses of the hypothalamic-pituitary-adrenal (HPA) axis to psychosocial stress, in turn, have been estimated by means of cortisol measurements...
December 2012: Psychoneuroendocrinology
Lori Harwood, Barbara Wilson, Jessica Sontrop, Alexander M Clark
AIM:   This article is a report of a study examining the relationships between chronic kidney disease stressors and coping strategies with dialysis modality. BACKGROUND:   People with chronic kidney disease are given information to enable dialysis modality choice. This education increases awareness and may alleviate concerns and stress. Disease-related stressors and coping may affect dialysis selection. Understanding the influence of stress and coping on dialysis choices will assist in providing responsive programmes...
November 2012: Journal of Advanced Nursing
Victoria A Miller, Mary Frances Luce, Robert M Nelson
OBJECTIVE: To examine the relationship of external influence to parental distress when making a decision about research or treatment for a child with a life-threatening illness and to test potential moderators of this relationship. METHODS: Parents (n = 219) who made a decision about research or treatment for a child completed measures of external influence, distress, decision-making preference, and coping. RESULTS: More external influence was associated with more hostility, uncertainty, and confusion...
November 2011: Journal of Pediatric Psychology
Israel Waismel-Manor, Gal Ifergane, Hagit Cohen
Faced with stressful experiences, such as uncertainty or novelty, the adrenal glands secrete glucocorticoid hormones to help us cope with stress. Since many decision-making situations are stressful, there is reason to believe that voting is a stressful event. In this study, we asked voters in Israel's national election (N=113) to report on their general affective state immediately before entering the polling place using the Positive Affect Negative Affect Schedule (PANAS) and to provide us with a saliva sample through which we could evaluate their cortisol levels...
November 2011: European Neuropsychopharmacology: the Journal of the European College of Neuropsychopharmacology
Johanna Shapiro, John Astin, Shauna L Shapiro, Daniel Robitshek, Deane H Shapiro
Although the quest for active control and mastery can be seen as a central thread that ties together important aspects of human experience, we are frequently confronted with the reality that much of what is encountered in life lies outside our active instrumental control. Control must involve finding healthy and life-affirming ways to exercise personal mastery, and identifying constructive ways to respond to the lack of control that pervades the human condition. In this article we explore a number of professional areas in which physicians may experience significant feelings of loss or lack of personal control-difficult encounters with patients, dealing with patient nonadherence, end-of-life care, confronting the uncertainty and ambiguity that are frequently a part of illness, as well as institutional and systemic factors that can result in loss of various forms of autonomy and control over decision-making...
March 2011: Families, Systems & Health: the Journal of Collaborative Family Healthcare
Elizabeth A Gill, Melanie Morgan
This study sought to understand how older adults make sense of the challenges of aging. In particular, the move to a care-related facility provides a context for the study of how uncertainty, ambivalence, and other concerns connected with the aging process are conceptualized by older adults. Furthermore, how older adults communicate about and cope with these challenges was examined. Babrow's (1992, 2007) problematic integration theory provides a framework for this research. A qualitative study employing in-depth interviews with 44 older adults from two continuum-of-care facilities was conducted...
June 2011: Health Communication
Matthew J Shanahan, Richard W J Neufeld
Coping with stress through 'decisional control' - positioning oneself in a multifaceted stressing situation so as to minimize the likelihood of an untoward event - is modelled within a tree-structure scenario, whose architecture hierarchically nests elements of varying threat. Analytic and simulation platforms quantify the game-like interplay of cognitive demands and threat reduction. When elements of uncertainty enter the theoretical structure, specifically at more subordinate levels of the hierarchy, the mathematical expectation of threat is particularly exacerbated...
November 2010: British Journal of Mathematical and Statistical Psychology
A Baverstock, F Finlay
AIMS: To describe how paediatric consultants report dealing with child and neonatal deaths as part of their daily work. BACKGROUND: Paediatric consultants are involved with children and their families facing death through illness. This study focused on consultant's involvement around the time of death including: decision making and its associated difficulties, talking to parents and the use of coping strategies. Consultants with more than 5 years experience were asked what experience has taught them and consultants with less that 5 years experience were asked what they felt was the biggest change from being a registrar...
November 2008: Child: Care, Health and Development
Maya Shaha, Carol L Cox, Kirsi Talman, Daniel Kelly
PURPOSE: The aim of this paper was to identify and explore the literature for key aspects of uncertainty experienced by patients who have been diagnosed with breast, prostate, or colorectal cancer. ORGANIZING CONSTRUCT: Throughout the cancer journey important decisions are made about treatments, symptom control, and supportive care and many approaches have been adopted to examine coping and uncertainty associated with a cancer diagnosis. Uncertainty and its associated attributes, such as stress or anxiety, fluctuate across the disease trajectory...
2008: Journal of Nursing Scholarship
Tanya Z Martens, Jessica D Emed
OBJECTIVE: To explore the unique experiences, challenges, and coping strategies of pregnant women diagnosed with thrombophilia and who are on daily heparin injections. DESIGN: A qualitative, descriptive approach with semistructured interviews was used. PARTICIPANTS AND SETTING: Nine women from the thrombosis clinic of a large university-affiliated hospital in Montreal, Canada, participated in the study. DATA ANALYSIS: Thematic analysis was used throughout the processes of interviewing, transcribing, and reviewing the data...
January 2007: Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN
Keung-Sum Chan, Sheila Twinn
AIMS: The aim of this study was to identify the major stressors affecting Chinese adults whose partner had been admitted to an intensive care unit and to understand the major coping strategies employed to manage such stressors. BACKGROUND: Recently a greater number of patients of higher acuity have been admitted to intensive care units and survive lengthy illnesses of an unpredictable course. Such critical illnesses have been identified as a major life event to family members of these patients...
January 2007: Journal of Clinical Nursing
Joan Garity
Most nursing home research has focused on predictors for placement, the placement decision-making process, or the effects of placement on the nursing home resident. Little research is available on family caregivers' experiences after placing their loved ones in a nursing home. The purpose of this qualitative study was to identify how family caregivers coped with the burden of post-nursing home placement of a family member with Alzheimer's disease (AD). Several factors that positively or negatively affected coping among family caregivers were identified...
June 2006: Journal of Gerontological Nursing
Cordula M Wetzel, Roger L Kneebone, Maria Woloshynowych, Debra Nestel, Krishna Moorthy, Jane Kidd, Ara Darzi
BACKGROUND: Although the general literature on stress and performance is extensive, little is known about specific effects of stress in surgical practice. This qualitative study explored key surgical stressors, their impact on performance, and coping strategies used by surgeons. METHODS: Individual in-depth semistructured interviews with surgeons were analyzed by 2 researchers independently. Key themes were discussed within the research team. RESULTS: Sixteen interviews were performed, including interviews with consultants (n = 9) and surgeons in training (n = 7)...
January 2006: American Journal of Surgery
Petur Petursson
OBJECTIVE: To study the reasons cited by Icelandic general practitioners for their "non-pharmacological" prescribing of antibiotics. DESIGN: A qualitative interview study with research dialogues guided by the Vancouver School of doing phenomenology. SETTING: General practice. Participants A total of 16 general practitioners: 11 in the maximum variety sample and 5 in the theoretical sample. RESULTS: The most important reasons for prescribing antibiotics in situations with low pharmacological indications (non-pharmacological prescribing) were an unstable doctor-patient relationship due to lack of continuity of care, patient pressure in a stress-loaded society, the doctor's personal characteristics, particularly zeal and readiness to serve, and, finally, the insecurity and uncertainty of the doctor who falls back on the prescription as a coping strategy in a difficult situation...
June 2005: Scandinavian Journal of Primary Health Care
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