Processes of patient decision making: Theoretical and methodological issues

There is a paucity of research studying patients' decision making processes. Traditional normative approaches investigating human decision have presented rational, analytic processing as a 'gold standard' for decision making with decision aids developed to facilitate such thinking. This paradigm has been challenged by the recent emergence of naturalistic decision making. Naturalistic approaches argue for techniques modelled closer to how decisions are actually made in 'real life'. Early work in this evolving field suggests the importance of more automatic, intuitive processing such as the use of heuristic short-cuts. This paper discusses the contribution of naturalistic decision theory and assesses its usefulness as an alternative to classical decision approaches in investigating patient decision making. Approaches for measuring underlying cognitive processes are also critically discussed.