{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T23:05:12Z","timestamp":1777590312133,"version":"3.51.4"},"reference-count":43,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T00:00:00Z","timestamp":1773446400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"FCT\u2014Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","award":["UID\/05105\/2025"],"award-info":[{"award-number":["UID\/05105\/2025"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Information"],"abstract":"<jats:p>Scarcity of healthcare resources requires prioritisation decisions that raise complex ethical, economic, and social challenges. While normative frameworks provide guidance on how such decisions ought to be made, growing evidence suggests that individuals differ substantially in how they approach morally charged allocation choices. This study investigates heterogeneity in decision-making styles and support for healthcare prioritisation criteria using an interdisciplinary approach that integrates health economics, social psychology, and computational methods to identify latent decision-making profiles among a sample of adults residing in Portugal. Data were collected from adults residing in Portugal using a structured online questionnaire comprising socio-demographic characteristics, decision-making styles, and preferences elicited through twenty hypothetical healthcare rationing scenarios. The results reveal three meaningful decision-making profiles characterised by different combinations of cognitive styles and ethical prioritisation patterns: analytically oriented decision-makers prioritising health gains; intuitive, context-sensitive decision-makers balancing clinical and social criteria; heuristic-driven decision-makers relying on simpler or less differentiated heuristics. These findings demonstrate that, within this sample, healthcare prioritisation preferences are shaped by systematic variations in decision style rather than a single moral or rational framework. By linking behavioural heterogeneity with ethical decision-making, this study contributes to theoretical debates on healthcare rationing and demonstrates the value of clustering techniques for uncovering latent structures in complex decision data. The results provide insights relevant for the design of decision-support systems and rationing policies, which may be adapted to accommodate heterogeneous decision styles in comparable settings.<\/jats:p>","DOI":"10.3390\/info17030287","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T10:10:43Z","timestamp":1773655843000},"page":"287","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Profiling Decision-Making Styles Under Healthcare Resource Scarcity: An Interdisciplinary Clustering Approach"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2021-9141","authenticated-orcid":false,"given":"Micaela","family":"Pinho","sequence":"first","affiliation":[{"name":"Research on Economics, Management and Information Technologies (REMIT), Portucalense University, 4200-072 Porto, Portugal"},{"name":"Portucalense Legal Institute (IJP), Portucalense University, 4200-072 Porto, Portugal"},{"name":"Research Unit in Governance, Competitiveness and Public Policy (GOVCOPP), Aveiro University, 3810-193 Aveiro, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4418-2590","authenticated-orcid":false,"given":"F\u00e1tima","family":"Leal","sequence":"additional","affiliation":[{"name":"Research on Economics, Management and Information Technologies (REMIT), Portucalense University, 4200-072 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5305-7620","authenticated-orcid":false,"given":"Isabel","family":"Miguel","sequence":"additional","affiliation":[{"name":"RISE-Health (RISE-Health@UPT), Portucalense University, 4200-072 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,14]]},"reference":[{"key":"ref_1","unstructured":"Arrow, K.J. (1963). Uncertainty and the welfare economics of medical care. Uncertainty in Economics, Elsevier."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1002\/(SICI)1099-1050(199703)6:2<117::AID-HEC256>3.0.CO;2-B","article-title":"Intergenerational equity: An exploration of the \u2018fair innings\u2019 argument","volume":"6","author":"Williams","year":"1997","journal-title":"Health Econ."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/0167-6296(93)90004-X","article-title":"Equity and equality in health and health care","volume":"12","author":"Culyer","year":"1993","journal-title":"J. Health Econ."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1023\/A:1011387524579","article-title":"Utilitarianism and the measurement and aggregation of quality\u2013adjusted life years","volume":"9","author":"Dolan","year":"2001","journal-title":"Health Care Anal."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1002\/hec.924","article-title":"QALY maximisation and people\u2019s preferences: A methodological review of the literature","volume":"14","author":"Dolan","year":"2005","journal-title":"Health Econ."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1136\/jme.27.4.275","article-title":"Equity-some theory and its policy implications","volume":"27","author":"Culyer","year":"2001","journal-title":"J. Med. Ethics"},{"key":"ref_7","unstructured":"Daniels, N., and Sabin, J.E. (2008). Setting Limits Fairly: Learning to Share Resources for Health, Oxford University Press."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1770","DOI":"10.1177\/07334648231157368","article-title":"Psychological well-being relates to Healthcare and Financial decision making in a study of predominantly white older adults","volume":"42","author":"Glover","year":"2023","journal-title":"J. Appl. Gerontol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1080\/00223980.2024.2369618","article-title":"Decision-making styles in medical students and healthcare professionals: The roles of personality traits and socio-emotional intelligence factors","volume":"159","year":"2025","journal-title":"J. Psychol."},{"key":"ref_10","unstructured":"Kahneman, D. (2011). Thinking, Fast and Slow, Farrar, Straus and Giroux."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Leonard, T.C., Thaler, R.H., and Sunstein, C.R. (2008). Nudge: Improving Decisions About Health, Wealth, and Happiness, Yale University Press.","DOI":"10.1007\/s10602-008-9056-2"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1056\/NEJM199605023341807","article-title":"Cost-effectiveness analysis in a setting of budget constraints\u2014Is it equitable?","volume":"334","author":"Ubel","year":"1996","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1016\/j.jval.2019.06.014","article-title":"Multicriteria decision analysis to support health technology assessment agencies: Benefits, limitations, and the way forward","volume":"22","author":"Baltussen","year":"2019","journal-title":"Value Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.puhe.2022.06.004","article-title":"Community preferences for the allocation of scarce healthcare resources during the COVID-19 pandemic: A review of the literature","volume":"209","author":"Dowling","year":"2022","journal-title":"Public Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1111\/bjhp.12640","article-title":"Distributive justice criteria and social categorization processes predict healthcare allocation bias","volume":"28","author":"Madeira","year":"2023","journal-title":"Br. J. Health Psychol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1017\/S1744133118000403","article-title":"Attitudes of health professionals concerning bedside rationing criteria: A survey from Portugal","volume":"15","author":"Pinho","year":"2020","journal-title":"Health Econ. Policy Law"},{"key":"ref_17","first-page":"28","article-title":"The challenge posed by the COVID-19 pandemic: How to decide who deserves life-saving medical devices?","volume":"26","author":"Pinho","year":"2021","journal-title":"Int. J. Health Gov."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"de Fine Licht, J., and Naurin, D. (2015). Open decision-making procedures and public legitimacy. Secrecy and Publicity in Votes and Debates, Cambridge University Press.","DOI":"10.1017\/CBO9781316015360.007"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1017\/S0007123413000148","article-title":"Political legitimacy in the real normative world: The priority of morality and the autonomy of the political","volume":"45","author":"Erman","year":"2015","journal-title":"Br. J. Political Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1080\/00223891.2015.1132426","article-title":"The development and validation of the rational and intuitive decision styles scale","volume":"98","author":"Hamilton","year":"2016","journal-title":"J. Personal. Assess."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Moyano-D\u00edaz, E., and Mendoza-Llanos, R. (2021). Yes! Maximizers maximize almost everything: The decision-making style is consistent in different decision domains. Front. Psychol., 12.","DOI":"10.3389\/fpsyg.2021.663064"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Hastie, T., Tibshirani, R., and Friedman, J. (2009). The Elements of Statistical Learning, Springer.","DOI":"10.1007\/978-0-387-84858-7"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1016\/j.patrec.2009.09.011","article-title":"Data clustering: 50 years beyond K-means","volume":"31","author":"Jain","year":"2010","journal-title":"Pattern Recognit. Lett."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Loftus, T.J., Shickel, B., Balch, J.A., Tighe, P.J., Abbott, K.L., Fazzone, B., Anderson, E.M., Rozowsky, J., Ozrazgat-Baslanti, T., and Ren, Y. (2022). Phenotype clustering in health care: A narrative review for clinicians. Front. Artif. Intell., 5.","DOI":"10.3389\/frai.2022.842306"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1093\/aje\/kwae030","article-title":"Using unsupervised clustering approaches to identify common mental health profiles and associated mental health-care service-use patterns in Ontario, Canada","volume":"193","author":"Orchard","year":"2024","journal-title":"Am. J. Epidemiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s44196-024-00568-8","article-title":"Optimizing patient stratification in healthcare: A comparative analysis of clustering algorithms for ehr data","volume":"17","author":"Aljohani","year":"2024","journal-title":"Int. J. Comput. Intell. Syst."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Rouco, A., Silva, F., Soares, B., Albuquerque, D., Gouveia, C., Br\u00e1s, S., and Pinho, P. (2024). Detection of random body movements using clustering-based methods in bioradar systems. Information, 15.","DOI":"10.3390\/info15100584"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Yang, W.C., Lai, J.P., Liu, Y.H., Lin, Y.L., Hou, H.P., and Pai, P.F. (2023). Using medical data and clustering techniques for a smart healthcare system. Electronics, 13.","DOI":"10.3390\/electronics13010140"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2588961","DOI":"10.1080\/0886022X.2025.2588961","article-title":"Data-driven cluster analysis identifies three clinical phenotypes in hemodialysis patients","volume":"47","author":"Chen","year":"2025","journal-title":"Ren. Fail."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Nalinthasnai, N., Thammasudjarit, R., Tassaneyasin, T., Eksombatchai, D., Sungkanuparph, S., Boonsarngsuk, V., Sutherasan, Y., Junhasavasdikul, D., Theerawit, P., and Petnak, T. (2025). Unsupervised machine learning clustering approach for hospitalized COVID-19 pneumonia patients. Bmc Pulm. Med., 25.","DOI":"10.1186\/s12890-025-03536-w"},{"key":"ref_31","first-page":"227","article-title":"Cluster Analysis in Data-Driven Management and Decisions","volume":"2","author":"Sun","year":"2017","journal-title":"J. Manag. Sci. Eng."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Nayak, S., and Khilar, P.M. (2025). Handling Missing Data in Healthcare with Fuzzy Clustering Imputation, CRC Press.","DOI":"10.1201\/9781003531043-13"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1080\/00207543.2024.2309312","article-title":"AI-enhanced robust method for integrated healthcare resource pre-positioning and patient scheduling","volume":"63","author":"Liu","year":"2025","journal-title":"Int. J. Prod. Res."},{"key":"ref_34","first-page":"122","article-title":"Strategic Improved K-Means Clustering in Mining Blood Donor Data Analysis and IoT-based Allocation","volume":"13","author":"Tiwari","year":"2024","journal-title":"J. Intell. Syst. Internet Things"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1007\/978-981-95-0269-1_194","article-title":"AI-Powered Data-Driven Resource Allocation and Scenario Planning for Healthcare Systems","volume":"Volume 1466","author":"Anandan","year":"2026","journal-title":"Lecture Notes in Electrical Engineering"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"112419","DOI":"10.1016\/j.ecolind.2024.112419","article-title":"Revealing the heterogeneity of socio-economic impacts on resource-environmental pressure: A novel three-dimensional framework applied to the Yellow River Basin","volume":"166","author":"Cheng","year":"2024","journal-title":"Ecol. Indic."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1177\/0013164495055005017","article-title":"Decision-making style: The development and assessment of a new measure","volume":"55","author":"Scott","year":"1995","journal-title":"Educ. Psychol. Meas."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Guerreiro, C., Leal, F., and Pinho, M. (2025). Synthetic Data Generation for Binary and Multi-Class Classification in the Health Domain. Information, 16.","DOI":"10.3390\/info16110986"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1177\/0272989X15575518","article-title":"Adapting Scott and Bruce\u2019s general decision-making style inventory to patient decision making in provider choice","volume":"35","author":"Fischer","year":"2015","journal-title":"Med. Decis. Mak."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Douma, L.N., Uiters, E., and Timmermans, D.R. (2020). Decision-making styles in the context of colorectal cancer screening. BMC Psychol., 8.","DOI":"10.1186\/s40359-020-0381-1"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/s40271-014-0063-2","article-title":"A systematic review of stated preference studies reporting public preferences for healthcare priority setting","volume":"7","author":"Whitty","year":"2014","journal-title":"Patient-Patient-Centered Outcomes Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"34066","DOI":"10.1038\/s41598-025-14363-8","article-title":"An intelligent community-based system for healthcare prioritisation","volume":"15","author":"Pinho","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1007\/s11299-025-00345-w","article-title":"The relationship between human values and support for distributive approaches in healthcare rationing: An exploratory study","volume":"24","author":"Miguel","year":"2025","journal-title":"Mind Soc."}],"container-title":["Information"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2078-2489\/17\/3\/287\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T10:43:06Z","timestamp":1773657786000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2078-2489\/17\/3\/287"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,14]]},"references-count":43,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["info17030287"],"URL":"https:\/\/doi.org\/10.3390\/info17030287","relation":{},"ISSN":["2078-2489"],"issn-type":[{"value":"2078-2489","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,14]]}}}