Modes of Decision Making Used by Nursing Home Residents and their Families When Confronted with Potential Hospital Readmission

The purpose of the current study was to characterize the decision-making processes used by nursing home (NH) residents and their families when confronted with an acute change in condition and the choice of transfer to the hospital or treatment in the NH. Using cognitive task analysis,96 residents and 75 family members from 19 NHs were asked how they would make this choice. Fifty-one residents (53%) and 61 family members (81%) used a deliberative mode characterized by seeking information and weighing risks and benefits. Ten residents (10%) and five family members (7%) used a predominantly emotion-based mode characterized by references to feelings and prior experiences in these facilities. Thirty-six residents (38%) and nine family members (12%) delegated the decision to a family member or provider. Age and resident/family status were associated with mode used; transfer choice,gender,religion,education,and ethnic group were not. Although classic theories of information processing posit two modes of decision making,deliberative and affective,the current data suggest a third mode,that of delegating the decision to trusted others,particularly family members and providers.