End-of-life decision making in Europe and Australia - A physician survey

Background: The frequencies with which physicians make different medical end-of-life decisions (ELDs) may differ between countries, but comparison between countries has been difficult owing to the use of dissimilar research methods. Methods: A written questionnaire was sent to a random sample of physicians from 9 specialties in 6 European countries and Australia to investigate possible differences in the frequencies of physicians' willingness to perform ELDs and to identify predicting factors. Response rates ranged from 39% to 68% (N= 10 139). Using hypothetical cases, physicians were asked whether they would ( probably) make each of 4 ELDs. Results: In all the countries, 75% to 99% of physicians would withhold chemotherapy or intensify symptom treatment at the request of a patient with terminal cancer. In most cases, more than half of all physicians would also be willing to deeply sedate such a patient until death. However, there was generally less willingness to administer drugs with the explicit intention of hastening death at the request of the patient. The most important predictor of ELDs was a request from a patient with decisional capacity (odds ratio, 2.1-140.0). Shorter patient life expectancy and uncontrollable pain were weaker predictors but were more stable across countries and across the various ELDs (odds ratios, 1.1-2.4 and 0.9-2.4, respectively). Conclusion: Cultural and legal factors seem to influence the frequencies of different ELDs and the strength of their determinants across countries, but they do not change the essence of decision making.

Physicians' attitudes towards end-of-life decisions: a comparison between seven countries

In the context of an European collaborative research project (EURELD), a study on attitudes towards medical end-of-life decisions was conducted among physicians in Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland. Australia also joined the consortium. A written questionnaire with structured questions was sent to practising physicians from specialties frequently involved in the care of dying patients. 10,139 questionnaires were studied. Response rate was equal to or larger than 50% in all countries except Italy (39%). Apart from general agreement with respect to the alleviation of pain and symptoms with possible life-shortening effect, there was large variation in support-between and within countries-for medical decision that may result in the hastening of death. A principal component factor analysis found that 58% of the variance of the responses is explained by four factors. 'Country' explained the largest part of the variation of the standardized factor scores. (c) 2004 Elsevier Ltd. All rights reserved.

Attitude-behaviour consistency: the role of group norms, attitude accessibility, and mode of behavioural decision-making

The interplay between two perspectives that have recently been applied in the attitude area-the social identity approach to attitude-behaviour relations (Terry & Hogg, 1996) and the MODE model (Fazio, 1990a)-was examined in the present research. Two experimental studies were conducted to examine the role of group norms, group identification, attitude accessibility, and mode of behavioural decision-making in the attitude-behaviour relationship. In Study I (N = 211), the effects of norms and identification on attitude-behaviour consistency as a function of attitude accessibility and mood were investigated. Study 2 (N = 354) replicated and extended the first experiment by using time pressure to manipulate mode of behavioural decision-making. As expected, the effects of norm congruency varied as a function of identification and mode of behavioural decision-making. Under conditions assumed to promote deliberative processing (neutral mood/low time pressure), high identifiers behaved in a manner consistent with the norm. No effects emerged under positive mood and high time pressure conditions. In Study 2, there was evidence that exposure to an attitude-incongruent norm resulted in attitude change only under low accessibility conditions. The results of these studies highlight the powerful role of group norms in directing individual behaviour and suggest limited support for the MODE model in this context. Copyright (C) 2003 John Wiley Sons, Ltd.

Use of complementary and alternative medicine and quality of life: changes at the end of life

The purpose of this study was to compare the physical, psychological and social dimensions associated with quality-of-life outcomes over the last year of life, between advanced cancer users and nonusers of complementary and alternative medicine. One hundred and eleven patients were identified through Queensland Cancer Registry records, and followed up every four to six weeks until close to death using standardized protocols. Outcome measures were symptom burden, psychological distress, subjective wellbeing, satisfaction with conventional medicine and need for control over treatment decisions. At the initial interview, 36 (32%) participants had used complementary/ alternative medicine the previous week; mainly vitamins, minerals and tonics and herbal remedies. Among all participants, 53 (48%) used at least one form of complementary/ alternative medicine over the study period. Only six (11%) visited alternative practitioners on a regular basis. Overall, complementary/ alternative medicine users reported higher levels of anxiety and pain, less satisfaction with conventional medicine and lower need for control over treatment decisions compared with nonusers. These differences tend to change as death approaches. A more rigorous assessment of complementary/ alternative medicine use, psychological distress, pain and subjective wellbeing among patients with advanced cancer is needed in the clinical setting.

The influence of national culture on the level and outcome of IS decision making in the IS maintenance/redevelopment decision

Would the outcome of a Global multinational organization’s decision be the same if the same decision were to be made in different countries throughout the world? Within the same organization, we propose that national cultural differences can influence decision making in different countries and cultural clusters. While much work has been done on organizational cultural influences, this study examines the influence that national culture has on organizational decision making in respect to the evolution/redevelopment decision that organizations face when a system is believed to be entering the obsolescence phase. Building on findings from the Globe research program, we show by empirical testing of a theoretical model that national cultural dimensions are significantly associated with a) the outcome of the decision to enhance or re-develop a system, and b) the organizational level at which such decisions are made. This research is significant as a means to improve management decision making, particularly with regard to the enhancement versus re-development decision. The research suggests that a relatively uniform sub-culture exists across the global IS project level but that national cultural dimensions play a more important role in determining the organizational management level at which decisions are made.

Linking job insecurity to negative decision making: The mediating role of job tension

Job insecurity has increased markedly in the developed economies of the world (Gray, 2002). The effects of job insecurity on individual employees and on organisational outcomes, however, are controversial. For instance, Greenhalgh and Rosenblatt (1984) point out that job insecurity can result in increased work effort, while Dekker and Schaufeli, (1995) argue that insecurity leads to stress and decreased performance. In this paper, we outline a study examining the indirect impact of job insecurity on decision-making, via job-related tension. Based on a web survey involving 217 participants, we found that job insecurity indirectly increased the adoption of negative decision-making strategies by increasing employees’ level of job-related tension. Limitations and implications for theory and managers are also discussed.

Virtual training environments to improve train driver's crisis decision making

This paper reports on a current research project in which virtual reality simulators are being investigated as a means of simulating hazardous Rail work conditions in order to allow train drivers to practice decision-making under stress. When working under high stress conditions train drivers need to move beyond procedural responses into a response activated through their own problem-solving and decision-making skills. This study focuses on the use of stress inoculation training which aims to build driver’s confidence in the use of new decision-making skills by being repeatedly required to respond to hazardous driving conditions. In particular, the study makes use of a train cab driving simulator to reproduce potentially stress inducing real-world scenarios. Initial pilot research has been undertaken in which drivers have experienced the training simulation and subsequently completed surveys on the level of immersion experienced. Concurrently drivers have also participated in a velocity perception experiment designed to objectively measure the fidelity of the virtual training environment. Baseline data, against which decision-making skills post training will be measured, is being gathered via cognitive task analysis designed to identify primary decision requirements for specific rail events. While considerable efforts have been invested in improving Virtual Reality technology, little is known about how to best use this technology for training personnel to respond to workplace conditions in the Rail Industry. To enable the best use of simulators for training in the Rail context the project aims to identify those factors within virtual reality that support required learning outcomes and use this information to design training simulations that reliably and safely train staff in required workplace accident response skills.

The influence of financial participation and participation in decision-making on employee job attitudes

This study investigates the direct and indirect effects of financial participation (FP) and participation in decision-making (PDM) on employee job attitudes. The central premise is that both financial participation and participation in decision-making have effects on job attitudes, such as integration, involvement and commitment, perceived pay equity, performance-reward contingencies, satisfaction and motivation. After reviewing the theoretical and empirical literature and testing two theoretical frameworks, developed by Long (1978a) and Florkowski ( 1989), a new model was constructed to consider a combined effects of both FP and PDM, herein referred to as employee participation (EP). The underpinning of the model is based on the assumption that both ( a) the combination of financial participation and participation in decision-making ('employee participation'), and (b) participation in decision-making produce favourable effects on employee job attitudes. The test of the new model showed that employee participation does not produce more favourable effects on employee job attitudes, than does participation in decision-making on its own. The data were gathered from a questionnaire study administered in a large British retail organization that operates two types of ownership schemes - profit-sharing and SAYE schemes.