An Exploratory Study To Examine Decision Making Competency As A Measure Of Functional Performance
Authors:   , Sunderaraman Preeti , Schultheis Maria Teresa 
Published: July 2024

Decision making competency as a construct, involves selecting a choice with an optimal outcome in relation to everyday ftinctioning. The unique contribution of various decision maker characteristics to decision making competency in healthy people has been poorly understood. This understanding will enable us to better characterize this construct in various clinical populations and ultimately help clinicians and researchers devise rehabilitation strategies to teach patient's to make decisions competently. The DECIDE measure, a novel tool, was employed to measure decision making. The primary goal of the study was to examine the various contributions to decision making as measured by the DECIDE. The three aims of the study were - (1) To examine the association between cognitive abilities such as verbal comprehension, perceptual reasoning, working memory, processing speed, and executive functioning and decision making competency, (2) To examine the relationship between demographic aspects (such as education and level of income) and decision making competency, and (3) To examine the relationship between functional status/ experience and decision making competency. The secondary goal was to understand if the feasibility of using the DECIDE measure as a clinical tool in rehabilitation populations. Data from 48 healthy individuals aged between 20 to 45 years was collected. Every participant was given a standardized battery of tests such to measure various cognitive abilities, their current functional experience level and decision making competency. In addition, information related to the current mental status, reading level, the extent of anxiety, level of effort, depression and fatigue was collected. To test the first aim, three simultaneous multiple regressions were conducted with five cognitive abilities as the predictor variables and each of the three DECIDE subtests as separate outcome variables. Pearson's and Spearman's correlations were conducted to test the other two aims. Results of the first regression analysis showed that only two of the five variables - verbal comprehension index and perceptual reasoning significantly predicted DMC-comprehension. Similarly, only the working memory index significantly predicted DMC-Cognitive Reflection. No significant results were found between the cognitive abilities and DMC-Dimension Weighting. Qualitative analysis firom the user feedback revealed that approximately 20% of the participants misinterpreted the instructions for this task. This may have biased the results by creating a measurement error, and as such, the findings from this subtest cannot be reliably interpreted. No significant correlations were found when aims 2 and 3 were tested. The lack of significant findings may be related to the limited vanability in the age, levels of education, and experience in the ciirrent sample. Overall, the findings from this study showed that different cognitive abilities were uniquely contributing to different components of decision making competency. The lack of clarity in the instructions of one of the DECIDE measure' subtests raised critical questions about the construct validity of the DECIDE measure. This means that, fiirther work in refining this measure is needed. The findings from the qualitative analysis also suggest that it is important to consider an individual's age and experience in doing similar tasks while constructing questions to assess decision making competency. We conclude that further research is required before the DECIDE measure can be used as a clinical tool to assess decision making competency in patients with neurological problems.