Decisional Anxiety Research Articles

Predictive Contribution of Personality Traits in Career Decision-Making: A Test of the Social Cognitive Model of Career Self-Management

The current study sought to test hypotheses derived from the social cognitive model of career self-management (CSM; Lent & Brown, 2013) applied to the process of career exploration and decision-making. We examined how well personality traits, contextual factors, and social cognitive predictors, collectively, account for exploration behavior and career decision-making outcomes. Specifically, we determine the relationships between personality traits with career decision self-efficacy, career goals, and decisional criteria in a sample of 302 high school students. The participants completed domain-specific measures of four personality traits (conscientiousness, intellect/openness, extraversion, and neuroticism), social support, self-efficacy, outcome expectations, goals, level of career indecision, and decisional anxiety. The model fit the data well overall, though certain predictors were linked to the criterion variables only indirectly via mediated pathways. The structural equation model analysis suggested, consistent with previous studies, that the contribution of personality on career exploration and decision-making was mediated by sociocognitive mechanisms. Multiple group analysis suggests that neither sex nor the type of institution (state/private) that students attend determines the relationships among the variables of the proposed theoretical model. Limitations, further research, practical implications, and methodological implications for the CSM model are discussed.

Revisiting the bottleneck hypothesis: The role of sexual identity development in the career exploration and decision-making of sexual minority college students

Hetherington's (1991) “bottleneck hypothesis”, which maintains that the process of sexual identity development can hamper the career development of sexual minority college students, has received periodic study. We revisited this hypothesis using the social cognitive model of career self-management (CSM; Lent & Brown, 2013) as a theoretical framework. An online survey of 225 sexual minority and 287 heterosexual college students did not reveal a robust between-group bottleneck effect. For example, no significant mean level differences were observed between the two groups in career decision-making process and outcome variables, such as career decision-making anxiety and level of career decidedness. In addition, a CSM-based path model of career decision-making was found to be invariant across the two student groups. However, a few noteworthy within-group patterns were observed. For example, a cluster analysis suggested the presence of two sexual minority sub-groups who differed regarding level of outness and difficulties negotiating their sexual identity. The more identity-integrated cluster reported less decisional anxiety and greater decidedness than their less identity-integrated peers. Indicators of identity conflict and level of disclosure were also linked to perceived support and goals for future career exploration. The pattern of findings suggests that sexual minority identity development in college does not represent a monolithic bottleneck to career development. However, a more nuanced bottleneck effect in career decision-making may be linked to students' intrapersonal and social comfort in negotiating their sexual minority identity. Implications for the bottleneck hypothesis and further research on sexual minority students' career exploration and decision-making are discussed.

Shared decision making in cardiology: a systematic review and meta-analysis

ObjectivesTo evaluate the effectiveness of interventions to improve shared decision making (SDM) in cardiology with particular focus on patient-centred outcomes such as decisional conflict.MethodsWe searched Embase (OVID), the Cochrane library,...

Self-control in career decision-making: The roles of the hot and cool systems of gratification delay

While extant research has focused on the joint roles of distal background factors and decisional self-efficacy when investigating facilitative factors in career decision-making, knowledge regarding the role of gratification delay and its contributing systems is limited. Using a sample of U.S. individuals (n = 281), the current study longitudinally examined the structural predictions of the emotional (i.e., distress tolerance) and cognitive (i.e., time discounting) foundations of gratification delay for decisional anxiety. The results supported a mediation model in which gratification delay mediates the negative prediction of distress tolerance (Time 1) for decisional anxiety (Time 2 = Time 1 + 3 months) and the positive prediction of time discounting (Time 1) for decisional anxiety (Time 2). Additionally, gratification delay joined decisional self-efficacy in sequentially mediating these predictions. Therefore, the present study supports the utility of the gratification delay perspective in conceptualizing and facilitating the career decision-making process and provides implications for research and practice related to self-control in career decision-making.

Retiring or rewiring? Test of a social cognitive model of retirement planning.

Using the social cognitive model of career self-management (CSM; Lent & Brown, 2013), we examined theory-based predictors of retirement planning goals, decisional anxiety, and level of decidedness. Participants were 525 older workers in the United States and Canada. We first examined the psychometric properties of new or revised social cognitive measures linked to retirement planning with part of the sample (n = 200) and then tested the stability of the factor structure with the remainder of the sample (n = 325). The measurement and structural models indicated good overall model-data fit in the larger sample and across most grouping variables (nationality, income level, and gender), and support was found for most of the paths predicting retirement planning, decisional anxiety, and level of decidedness. However, some gender differences were found in aspects of self-efficacy (confidence at time vs. financial management) that were predictive of decidedness. We consider the implications of the findings for future research and practice directions applying the social cognitive model to retirement planning. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Patient accrual and understanding of informed consent in a two-stage consent design.

We previously introduced the concept of "two-stage" (or "just-in-time") informed consent for randomized trials with usual care control. We argued that conducting consent in two stages-splitting information about research procedures from information about the experimental intervention-would reduce the decisional anxiety, confusion, and information overload commonly associated with informed consent. We implemented two-stage consent in a low-stakes randomized trial of a mindfulness meditation intervention for procedural distress in patients undergoing prostate biopsy. Here, we report accrual rates and patient understanding of the consent process. Patients approached for consent for the biopsy trial were asked to complete the standard "Quality of Informed Consent" questionnaire to assess their knowledge and understanding of the trial. Accrual was excellent with 108 of 110 (98%) patients approached for consent signing first-stage consent. All 51 patients randomized to the experimental arm and who later presented for biopsy signed second-stage consent and received the mindfulness intervention. Quality of Informed Consent data were available for 48 patients assigned to the mindfulness treatment arm and 44 controls. The mean Quality of Informed Consent score was similar in the meditation and control arms with and overall mean of 75 (95% confidence interval = 74-76) for the knowledge section and 86 (95% confidence interval = 81-90) for understanding, comparable to the normative scores of 80 and 88. On further analysis and patient interview, two of the Quality of Informed Consent questions were found to be misleading in the context of a two-stage consent study for a mindfulness intervention. Excluding these questions increased knowledge scores to 88 (95% confidence interval = 87-90). We found promising data that two-stage consent facilitated accrual without compromising patient understanding of randomized trials or compliance with allocated treatment. Further research is needed incorporating randomized comparison of two-stage consent to standard consent approaches, measuring patient anxiety and distress as an outcome, using suitable modifications to the Quality of Informed Consent questionnaire and trials with higher stakes.

Shared Decision Making in Surgery: A Meta-Analysis of Existing Literature.

Shared decision making (SDM) is a popular care paradigm between patients and clinicians to facilitate treatment agreement by building consensus and sharing information. Decisional aids (DAs) are tools frequently used in SDM for improving knowledge sharing and facilitating the decision process. The use and outcomes of decisional aids in surgery, however, have not been investigated. This study investigates whether SDM in surgery benefits any type of surgical patient compared with non-SDM treatment using patient-defined outcomes, such as an increase in knowledge and decisional satisfaction, as well as decreased decisional regret and anxiety. The search strategy was developed with a medical librarian to address the question of whether SDM in surgery benefits any type of surgical patient compared with non-SDM treatment using patient-defined outcomes. Seven databases (Medline [Ovid], Embase [Ovid], Cochrane [Wiley], Africa-Wide [EBSCO], Global Health [Ovid], Global Index Medicus (WHO), Web of Science [Clarivate Analytics]) were searched from inception until September 9th, 2019, with no language restriction. A two-person title and abstract screen was performed, followed by a full-text publication review. A DerSimonian-Laird random effects model was used for the meta-analysis, with heterogeneity established. Mean and standard deviation were collected for all study outcomes. Study eligibility was determined with strict inclusion and exclusion criteria. Study quality was assessed using the Cochrane Bias Risk Assessment Tool. In total, 6060 studies were retrieved. After duplicates were removed, 5303 titles and abstracts were screened, and of 356 full texts reviewed, 42 studies were included in the analysis. Heterogeneity was high in three of six variables (surgery chosen, decisional conflict, and knowledge gained), moderate in two (decisional anxiety and decisional satisfaction), and low in one (decisional regret). For all except the rates of surgical intervention, the results for decisional conflict, knowledge gained, decisional satisfaction, and decisional anxiety were significant at a 95% confidence interval. Decisional conflict decreased in 20/24 of the papers that recorded it; rates of choosing surgery decreased in 8 of the 11; and patient knowledge increased in 19 of the 22 that recorded it. The majority of papers had risk of bias, however, with the evidence of generally low quality. The results suggest that SDM in surgery is associated with greater quality of patient satisfaction and value agreement, leading to decreased conflict and anxiety, and increased knowledge and translation. This data is useful in guiding the development of SDM protocols for use in surgical disciplines. Registered on PROSPERO-ID: CRD42018097286 [13].

Social-cognitive predictors of career exploration and decision-making: Longitudinal test of the career self-management model.

We tested the social-cognitive model of career self-management (Lent & Brown, 2013) using a longitudinal design. Participants were 420 college students who completed measures of career exploration and decision-making self-efficacy, outcome expectations, social support, goals, and actions, along with trait conscientiousness, at 2 time points roughly 4 months apart, near the beginning and middle of an academic year. They also reported their level of career decidedness and decisional anxiety at both of these time points as well as near the end of the academic year (about 3 months after the 2nd assessment). The model provided good overall fit to the data and accounted for substantial portions of the variance in engagement in exploratory actions and in the 2 decisional outcomes (decidedness and decisional anxiety) over time. The findings also supported the hypothesized bidirectional paths of the decisional outcomes to self-efficacy and outcome expectations. We consider implications of the findings for the social-cognitive model as well as for future research and practice. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Just-in-time consent: The ethical case for an alternative to traditional informed consent in randomized trials comparing an experimental intervention with usual care.

Informed consent for randomized trials often causes significant and persistent anxiety, distress and confusion to patients. Where an experimental treatment is compared to a standard care control, much of this burden is potentially avoidable in the control group. We propose a "just-in-time" consent in which consent discussions take place in two stages: an initial consent to research from all participants and a later specific consent to randomized treatment only from those assigned to the experimental intervention. All patients are first approached and informed about research procedures, such as questionnaires or tests. They are also informed that they might be randomly selected to receive an experimental treatment and that, if selected, they can learn more about the treatment and decide whether or not to accept it at that time. After randomization, control patients undergo standard clinical consent whereas patients randomized to the experimental procedure undergo a second consent discussion. Analysis would be by intent-to-treat, which protects the trial from selection bias, although not from poor acceptance of experimental treatment. The advantages of just-in-time consent stem from the fact that only patients randomized to the experimental treatment are subject to a discussion of that intervention. We hypothesize that this will reduce much of the patient's burden associated with the consent process, such as decisional anxiety, confusion and information overload. We recommend well-controlled studies to compare just-in-time and traditional consent, with endpoints to include characteristics of participants, distress and anxiety and participants' understanding of research procedures.

Advertising Implications of Millennials' Motives and Device-Platform Consideration Sets: An Exploratory Study

abstractComprising between 25 to 30 percent of the population with huge and growing purchasing power, Millennials, as a demographic group, are of great interest to advertisers and media companies alike. Their traits and characteristics have been studied extensively. This fact notwithstanding, reaching millennials continues to be a challenge. Based on Grounded Theory, the cohort's mind-set, behavioral tendencies as well as their perceived device-platform cognitive fit and device-platform consideration sets are explored. The study provides a window into the innovation-adoption process they go through, contributing to device-platform choice theory. The findings suggest that Millennials have an over-arching concern about availability/connectivity, responsiveness and reliability of internet access, followed by convergence across-platforms. The cohort exhibits control and decision anxiety over devices and platforms.

Applying the social cognitive model of career self-management to career exploration and decision-making

We present two studies applying the social cognitive model of career self-management (Lent & Brown, 2013) to career exploration and decision-making outcomes in college students. In the first study (N=180 college students), we developed a new, brief measure of career exploration and decision-making self-efficacy for use in subsequent model testing. The measure yielded two factors, decisional self-efficacy and coping efficacy, with adequate internal consistency reliability estimates. The decisional self-efficacy factor related strongly to an established measure of career decision self-efficacy and produced theory consistent relations with measures of outcome expectations, social support, conscientiousness, exploration goals, prior engagement in career exploration, decisional anxiety, and level of career decidedness. In the second study (N=215 college students), we re-examined the factor structure of the new self-efficacy measure and used it to assess the tenability of the self-management model in a path analysis predicting exploration goals, decisional anxiety, and career decidedness. The model fit the data well overall, though certain predictors were linked to the criterion variables only indirectly via mediated pathways. Implications of the findings for the social cognitive model as well as for future research and practice are considered.

Self-perceptions of decision making competence in Spanish football players

Background: It is known that competence to make decisions is a fundamental aspect of sport competition. Objective:This study has analyzed the decision profile of a sample of Spanish football players of different levels of expertise. Methods: 690 Spanish football players of national and international level completed the decision making questionnaire, which cover three dimensions - perceived decision competence, decision anxiety and commitment with decision learning. MANCOVA and ANOVA analysis were carried out to analyse the differences in each dimension based on the level of expertise. Results: Results showed that perception of decision making competence increased and the anxiety decreased with the level of expertise. Conclusions: This study confirmed the usefulness of this questionnaire in the process of training for coaches and sport psychologists.

Testing the Effects of a Decision Aid for Prostate Cancer Screening

There is an ever-growing trend toward more patient involvement in making health care decisions. This trend has been accompanied by the development of “informed decision-making” interventions to help patients become more engaged and comfortable with making these decisions. We describe the effects of a prostate cancer screening decision aid on knowledge, beliefs about screening, risk perception, control preferences, decisional conflict, and decisional anxiety. Data were collected from 200 males aged 50–70 years in the general population who randomly were assigned to exposure to the decision aid or no exposure as a control condition. A Solomon four-group design was used to test for possible pretest sensitization effects and to assess the effects of exposure to the decision aid. No significant pretest sensitization effects were found. Analysis of the exposure effects found that knowledge increased significantly for those exposed to the decision aid compared with those unexposed. Exposure to the decision aid also had some influence on decreasing both decisional conflict and decisional anxiety. Decision aids can play an important role in increasing patients' knowledge and decreasing anxiety when asked to make health care decisions.

Influence of a patient decision aid on decisional conflict related to PSA testing: A structural equation model.

To examine the impact of a decision aid (DA) designed to promote informed decision making for screening with the prostate-specific antigen (PSA) test and to test a theoretical model of factors influencing decisional conflict. Structural equation modeling examined pathways between DA exposure, knowledge, schema, prostate cancer risk perceptions, decisional anxiety, and decisional conflict. Sample participants included 200 men from the general population (exclusive of African Americans) and 200 African American men. Half of the men in each subsample were randomly assigned to receive the DA. Decisional conflict regarding prostate cancer screening. The DA influences level of decisional conflict by increasing patient knowledge. This effect of knowledge on decisional conflict is indirect, however, through an association with greater perceived risk and lower decisional anxiety. Also, positive PSA schema was associated with lower decisional anxiety and decisional conflict. It is important that exposure to the DA had no impact on PSA schema. Schemas about testing must be considered in developing messages about the risks and benefits of testing. If schemas are counter to message content, mechanisms for modifying schemas must be incorporated into interventions.

The role of self-esteem and anxiety in decision making for self versus others in relationships

Previous research has documented a tendency for people to make more risk-seeking decisions for others than for themselves in relationship scenarios. Two experiments investigated whether this self–other difference is moderated by participants' self-esteem and anxiety levels. In Experiment 1, lower self-esteem and higher anxiety levels were associated with more risk-averse choices for personal decisions but not for decisions for others. Therefore, participants with lower self-esteem/higher anxiety showed greater self–other differences in comparison to participants with higher self-esteem/lower anxiety levels. Experiment 2 demonstrated that this effect was largely mediated by participants' expectations of success and feelings about potential negative outcomes. These results are discussed in the context of “threats to the self,” with a central role played by anxiety and self-esteem threats in personal decision making but not in decision making for others. Copyright © 2005 John Wiley & Sons, Ltd.

The Effects of Gender on Career Decision Problems in Young Adults

The authors investigated gender differences in psychological problems in the career decision making (CDM) process of young adults. Specifically, problems with decision anxiety, life‐goal awareness, luck‐fate orientation, authority orientation, and secondary gain motivation were investigated. Methodology involved administering the Career Decision Diagnostic Assessment (CDDA) instrument to 1,006 college students from four universities. Results indicated no gender differences in global levels of problems in CDM. Women reported more problems with life‐goal awareness and authority orientation than did men. Men reported more problems with secondary gain motivations than did women. The results are discussed in terms of implications for gender‐differentiated career counseling.