Daley Carly N, Cornet Victor P, Toscos Tammy R, Bolchini Davide P, Mirro Michael J, Holden Richard J
J Cardiovasc Nurs. 2022;37(2):167-176. doi: 10.1097/JCN.0000000000000778.
Every day, older adults living with heart failure make decisions regarding their health that may ultimately affect their disease trajectory. Experts describe these decisions as instances of naturalistic decision making influenced by the surrounding social and physical environment and involving shifting goals, high stakes, and the involvement of others.
This study applied a naturalistic decision-making approach to better understand everyday decision making by older adults with heart failure.
We present a cross-sectional qualitative field research study using a naturalistic decision-making conceptual model and critical incident technique to study health-related decision making. The study recruited 24 older adults with heart failure and 14 of their accompanying support persons from an ambulatory cardiology center. Critical incident interviews were performed and qualitatively analyzed to understand in depth how individuals made everyday health-related decisions.
White, male (66.7%), older adults' decision making accorded with a preliminary conceptual model of naturalistic decision making occurring in phases of monitoring, interpreting, and acting, both independently and in sequence, for various decisions. Analyses also uncovered that there are barriers and strategies affecting the performance of these phases, other actors can play important roles, and health decisions are made in the context of personal priorities, values, and emotions.
Study findings lead to an expanded conceptual model of naturalistic decision making by older adults with heart failure. In turn, the model bears implications for future research and the design of interventions grounded in the realities of everyday decision making.
每天，患有心力衰竭的老年人都会做出有关自身健康的决定，这些决定最终可能会影响他们的疾病发展轨迹。专家们将这些决定描述为自然决策的实例，受到周围社会和物理环境的影响，涉及不断变化的目标、高风险以及他人的参与。
本研究采用自然决策方法，以更好地理解老年心力衰竭患者的日常决策。
我们开展了一项横断面定性实地研究，使用自然决策概念模型和关键事件技术来研究与健康相关的决策。该研究从一个门诊心脏病中心招募了24名老年心力衰竭患者及其14名陪同的支持人员。进行了关键事件访谈并进行定性分析，以深入了解个体如何做出日常与健康相关的决策。
白人男性（66.7%）老年人的决策符合自然决策的初步概念模型，该模型在监测、解释和行动阶段独立且依次发生，用于各种决策。分析还发现，存在影响这些阶段执行的障碍和策略，其他行为者可以发挥重要作用，并且健康决策是在个人优先事项、价值观和情感的背景下做出的。
研究结果导致了老年心力衰竭患者自然决策概念模型的扩展。反过来，该模型对未来的研究以及基于日常决策现实的干预措施设计具有启示意义。
