76 FR 77300 - Alaska Federal Lands Long Range Transportation Plan

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-12

... of and actions for coordinated planning and decision making among federal land management agencies... consolidate efforts through long-term coordination in transportation planning and decision-making processes... implementing projects; facilitating objective decision making for the transportation system; and developing...

New Interoperable Tools to Facilitate Decision-Making to Support Community Sustainability

EPA Science Inventory

Communities, regional planning authorities, regulatory agencies, and other decision-making bodies do not currently have adequate access to spatially explicit information crucial to making decisions that allow them to consider a full accounting of the costs, benefits, and trade-of...

In search of tools to aid logical thinking and communicating about medical decision making.

PubMed

Hunink, M G

2001-01-01

To have real-time impact on medical decision making, decision analysts need a wide variety of tools to aid logical thinking and communication. Decision models provide a formal framework to integrate evidence and values, but they are commonly perceived as complex and difficult to understand by those unfamiliar with the methods, especially in the context of clinical decision making. The theory of constraints, introduced by Eliyahu Goldratt in the business world, provides a set of tools for logical thinking and communication that could potentially be useful in medical decision making. The author used the concept of a conflict resolution diagram to analyze the decision to perform carotid endarterectomy prior to coronary artery bypass grafting in a patient with both symptomatic coronary and asymptomatic carotid artery disease. The method enabled clinicians to visualize and analyze the issues, identify and discuss the underlying assumptions, search for the best available evidence, and use the evidence to make a well-founded decision. The method also facilitated communication among those involved in the care of the patient. Techniques from fields other than decision analysis can potentially expand the repertoire of tools available to support medical decision making and to facilitate communication in decision consults.

Multi-criteria Integrated Resource Assessment (MIRA)

EPA Pesticide Factsheets

MIRA is an approach that facilitates stakeholder engagement for collaborative multi-objective decision making. MIRA is designed to facilitate and support an inclusive, explicit, transparent, iterative learning-based decision process.

Decision making about Pap test use among Korean immigrant women: A qualitative study.

PubMed

Kim, Kyounghae; Kim, Soohyun; Gallo, Joseph J; Nolan, Marie T; Han, Hae-Ra

2017-08-01

Understanding how individuals make decisions about Pap tests concerning their personal values helps health-care providers offer tailored approaches to guide patients' decision making. Yet research has largely ignored decision making about Pap tests among immigrant women who experience increased risk of cervical cancer. To explore decision making about Pap tests among Korean immigrant women. We conducted a qualitative descriptive study using 32 semi-structured, in-depth interviews with Korean immigrant women residing in a north-eastern metropolitan area. Data were audio-recorded, transcribed verbatim and analysed using inductive coding. Although most women with positive decisions made their own decisions, some women deferred to their providers, and others made decisions in collaboration with their providers and significant others. While women making positive decisions tended to consider both barriers to and facilitators of having Pap tests, women making negative decisions predominantly discussed the barriers to having Pap tests, such as modesty and differences between the South Korean and US health-care systems. The women's reflections on their decisions differed regarding their Pap test decisions. Women's desired roles in the decision-making process and reflection on their decision outcome appeared to vary, although most participants with positive decisions made their own decisions and were satisfied with their decisions. Future research should conduct longitudinal, quantitative studies to test our findings regarding decision-making processes and outcomes about Pap tests. The findings should be incorporated into cervical cancer screening practices to fulfil the unmet needs of immigrant women in patient-provider communication and to facilitate women's decision making about Pap tests. © 2016 The Authors. Health Expectations published by John Wiley & Sons Ltd.

Facilitating Leadership: A Broader Look at Data Based Interventions.

ERIC Educational Resources Information Center

Mink, Oscar G.

Rational decision making by leaders in higher education and similar institutions suffers from both a lack of relevant data and the failure to use data when it is available. The purpose of this paper is to describe a process which when applied seems to facilitate the rational decision making processes of an institution's leadership. The process…

Facilitating Adoption of News Tool to Develop Clinical Decision Making

ERIC Educational Resources Information Center

Brown, Robin T.

2017-01-01

This scholarly project was a non-experimental, pre/post-test design to (a) facilitate the voluntary adoption of the National Early Warning Score (NEWS), and (b) develop clinical decision making (CDM) in one cohort of junior level nursing students participating in a simulation lab. NEWS is an evidence-based predictive scoring tool developed by the…

Past developments and future directions for the AHP in natural resources

Treesearch

Daniel L. Schmoldt; G.A. Mendoza; Jyrki Kangas

2001-01-01

The analytic hierarchy process (AHP) possesses certain characteristics that make it a useful tool for natural resource decision making. The AHP’s capabilities include: participatory decision making, problem structuring and alternative development, group facilitation, consensus building, fairness, qualitative and quantitative information, conflict resolution, decision...

The Effectiveness of a Career Decision-Making Course

ERIC Educational Resources Information Center

Fouad, Nadya; Cotter, Elizabeth W.; Kantamneni, Neeta

2009-01-01

This study examined the effectiveness of a college career course designed to increase career decision-making confidence and facilitate career exploration. Participants were 73 students from a large Midwestern university (65.6% women, 34.4% men, mean age 18.56). Students were given questionnaires assessing career decision-making difficulties,…

How can surgeons facilitate resident intraoperative decision-making?

PubMed

Hill, Katherine A; Dasari, Mohini; Littleton, Eliza B; Hamad, Giselle G

2017-10-01

Cognitive skills such as decision-making are critical to developing operative autonomy. We explored resident decision-making using a recollection of specific examples, from the attending surgeon and resident, after laparoscopic cholecystectomy. In a separate semi-structured interview, the attending and resident both answered five questions, regarding the resident's operative roles and decisions, ways the attending helped, times when the attending operated, and the effect of the relationship between attending and resident. Themes were extracted using inductive methods. Thirty interviews were completed after 15 cases. Facilitators of decision-making included dialogue, safe struggle, and appreciation for retraction. Aberrant case characteristics, anatomic uncertainties, and time pressures provided barriers. Attending-resident mismatches included descriptions of transitioning control to the attending. Reciprocal dialogue, including concept-driven feedback, is helpful during intraoperative teaching. Unanticipated findings impede resident decision-making, and we describe differences in understanding transfers of operative control. Given these factors, we suggest that pre-operative discussions may be beneficial. Copyright © 2017 Elsevier Inc. All rights reserved.

What supports do health system organizations have in place to facilitate evidence-informed decision-making? a qualitative study

PubMed Central

2013-01-01

Background Decisions regarding health systems are sometimes made without the input of timely and reliable evidence, leading to less than optimal health outcomes. Healthcare organizations can implement tools and infrastructures to support the use of research evidence to inform decision-making. Objectives The purpose of this study was to profile the supports and instruments (i.e., programs, interventions, instruments or tools) that healthcare organizations currently have in place and which ones were perceived to facilitate evidence-informed decision-making. Methods In-depth semi-structured telephone interviews were conducted with individuals in three different types of positions (i.e., a senior management team member, a library manager, and a ‘knowledge broker’) in three types of healthcare organizations (i.e., regional health authorities, hospitals and primary care practices) in two Canadian provinces (i.e., Ontario and Quebec). The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software. Results A total of 57 interviews were conducted in 25 organizations in Ontario and Quebec. The main findings suggest that, for the healthcare organizations that participated in this study, the following supports facilitate evidence-informed decision-making: facilitating roles that actively promote research use within the organization; establishing ties to researchers and opinion leaders outside the organization; a technical infrastructure that provides access to research evidence, such as databases; and provision and participation in training programs to enhance staff’s capacity building. Conclusions This study identified the need for having a receptive climate, which laid the foundation for the implementation of other tangible initiatives and supported the use of research in decision-making. This study adds to the literature on organizational efforts that can increase the use of research evidence in decision-making. Some of the identified supports may increase the use of research evidence by decision-makers, which may then lead to more informed decisions, and hopefully to a strengthened health system and improved health. PMID:23915278

What supports do health system organizations have in place to facilitate evidence-informed decision-making? A qualitative study.

PubMed

Ellen, Moriah E; Léon, Gregory; Bouchard, Gisèle; Lavis, John N; Ouimet, Mathieu; Grimshaw, Jeremy M

2013-08-06

Decisions regarding health systems are sometimes made without the input of timely and reliable evidence, leading to less than optimal health outcomes. Healthcare organizations can implement tools and infrastructures to support the use of research evidence to inform decision-making. The purpose of this study was to profile the supports and instruments (i.e., programs, interventions, instruments or tools) that healthcare organizations currently have in place and which ones were perceived to facilitate evidence-informed decision-making. In-depth semi-structured telephone interviews were conducted with individuals in three different types of positions (i.e., a senior management team member, a library manager, and a 'knowledge broker') in three types of healthcare organizations (i.e., regional health authorities, hospitals and primary care practices) in two Canadian provinces (i.e., Ontario and Quebec). The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software. A total of 57 interviews were conducted in 25 organizations in Ontario and Quebec. The main findings suggest that, for the healthcare organizations that participated in this study, the following supports facilitate evidence-informed decision-making: facilitating roles that actively promote research use within the organization; establishing ties to researchers and opinion leaders outside the organization; a technical infrastructure that provides access to research evidence, such as databases; and provision and participation in training programs to enhance staff's capacity building. This study identified the need for having a receptive climate, which laid the foundation for the implementation of other tangible initiatives and supported the use of research in decision-making. This study adds to the literature on organizational efforts that can increase the use of research evidence in decision-making. Some of the identified supports may increase the use of research evidence by decision-makers, which may then lead to more informed decisions, and hopefully to a strengthened health system and improved health.

The factors facilitating and inhibiting effective clinical decision-making in nursing: a qualitative study

PubMed Central

Hagbaghery, Mohsen Adib; Salsali, Mahvash; Ahmadi, Fazlolah

2004-01-01

Background Nurses' practice takes place in a context of ongoing advances in research and technology. The dynamic and uncertain nature of health care environment requires nurses to be competent decision-makers in order to respond to clients' needs. Recently, the public and the government have criticized Iranian nurses because of poor quality of patient care. However nurses' views and experiences on factors that affect their clinical function and clinical decision-making have rarely been studied. Methods Grounded theory methodology was used to analyze the participants' lived experiences and their viewpoints regarding the factors affecting their clinical function and clinical decision-making. Semi-structured interviews and participant observation methods were used to gather the data. Thirty-eight participants were interviewed and twelve sessions of observation were carried out. Constant comparative analysis method was used to analyze the data. Results Five main themes emerged from the data. From the participants' points of view, "feeling competent", "being self-confident", "organizational structure", "nursing education", and "being supported" were considered as important factors in effective clinical decision-making. Conclusion As participants in this research implied, being competent and self-confident are the most important personal factors influencing nurses clinical decision-making. Also external factors such as organizational structure, access to supportive resources and nursing education have strengthening or inhibiting effects on the nurses' decisions. Individual nurses, professional associations, schools of nursing, nurse educators, organizations that employ nurses and government all have responsibility for developing and finding strategies that facilitate nurses' effective clinical decision-making. They are responsible for identifying barriers and enhancing factors within the organizational structure that facilitate nurses' clinical decision-making. PMID:15068484

Exploring differences in the use of the statin choice decision aid and diabetes medication choice decision aid in primary care.

PubMed

Ballard, Aimee Yu; Kessler, Maya; Scheitel, Marianne; Montori, Victor M; Chaudhry, Rajeev

2017-08-10

Shared decision making is essential to patient centered care, but can be difficult for busy clinicians to implement into practice. Tools have been developed to aid in shared decision making and embedded in electronic medical records (EMRs) to facilitate use. This study was undertaken to explore the patterns of use and barriers and facilitators to use of two decision aids, the Statin Choice Decision Aid (SCDA) and the Diabetes Medication Choice Decision Aid (DMCDA), in primary care practices where the decision aids are embedded in the EMR. A survey exploring factors that influenced use of each decision aid was sent to eligible primary care clinicians affiliated with the Mayo Clinic in Rochester, MN. Survey data was collected and clinician use of each decision aid via links from the EMR was tracked. The survey response rate was 40% (105/262). Log file data indicated 51% of clinicians used the SCDA and 9% of clinicians used the DMCDA. Reasons for lack of use included lack of knowledge of the EMR link, not finding the decision aids helpful, and time constraints. Survey responses indicated that use of the tool as intended was low, with many clinicians only discussing decision aid topics that they found relevant. Although guidelines for both the treatment of blood cholesterol with a statin and for the treatment of hyperglycemia in type 2 diabetes recommend shared decision making, tools that facilitate shared decision making are not routinely used even when embedded in the EMR. Even when decision aids are used, their use may not reflect patient centered care.

Implementation of a Tool to Enhance Evidence-Informed Decision Making in Public Health: Identifying Barriers and Facilitating Factors

ERIC Educational Resources Information Center

van der Heide, Iris; van der Noordt, Maaike; Proper, Karin I.; Schoemaker, Casper; van den Berg, Matthijs; Hamberg-van Reenen, Heleen H.

2016-01-01

One of the barriers regarding evidence-informed decision making is the gap between the needs of policy makers and the ways researchers present evidence. This pilot study evaluates the barriers and facilitators to the implementation of a tool to enhance transparent and unambiguous communication on scientific evidence by knowledge workers.…

"It Was the Best Decision of My Life": a thematic content analysis of former medical tourists' patient testimonials.

PubMed

Hohm, Carly; Snyder, Jeremy

2015-01-22

Medical tourism is international travel with the intention of receiving medical care. Medical tourists travel for many reasons, including cost savings, limited domestic access to specific treatments, and interest in accessing unproven interventions. Medical tourism poses new health and safety risks to patients, including dangers associated with travel following surgery, difficulty assessing the quality of care abroad, and complications in continuity of care. Online resources are important to the decision-making of potential medical tourists and the websites of medical tourism facilitation companies (companies that may or may not be affiliated with a clinic abroad and help patients plan their travel) are an important source of online information for these individuals. These websites fail to address the risks associated with medical tourism, which can undermine the informed decision-making of potential medical tourists. Less is known about patient testimonials on these websites, which can be a particularly powerful influence on decision-making. A thematic content analysis was conducted of patient testimonials hosted on the YouTube channels of four medical tourism facilitation companies. Five videos per company were viewed. The content of these videos was analyzed and themes identified and counted for each video. Ten main themes were identified. These themes were then grouped into three main categories: facilitator characteristics (e.g., mentions of the facilitator by name, reference to the price of the treatment or to cost savings); service characteristics (e.g., the quality and availability of the surgeon, the quality and friendliness of the support staff); and referrals (e.g., referrals to other potential medical tourists). These testimonials were found either not to mention risks associated with medical tourism or to claim that these risks can be effectively managed through the use of the facilitation company. The failure fully to address the risks of medical tourism can undermine the informed decision-making of potential medical tourists, particularly given the considerable influence on decision-making by patient testimonials. Regulation of these global companies is difficult, making the development of testimonials highlighting the risks of medical tourism essential. Additional research is needed on the impact of patient testimonial videos on the decision-making of potential medical tourists.

Behavioral medicine perspectives on the design of health information technology to improve decision-making, guideline adherence, and care coordination in chronic pain management.

PubMed

Midboe, Amanda M; Lewis, Eleanor T; Cronkite, Ruth C; Chambers, Dallas; Goldstein, Mary K; Kerns, Robert D; Trafton, Jodie A

2011-03-01

Development of clinical decision support systems (CDSs) has tended to focus on facilitating medication management. An understanding of behavioral medicine perspectives on the usefulness of a CDS for patient care can expand CDSs to improve management of chronic disease. The purpose of this study is to explore feedback from behavioral medicine providers regarding the potential for CDSs to improve decision-making, care coordination, and guideline adherence in pain management. Qualitative methods were used to analyze semi-structured interview responses from behavioral medicine stakeholders following demonstration of an existing CDS for opioid prescribing, ATHENA-OT. Participants suggested that a CDS could assist with decision-making by educating providers, providing recommendations about behavioral therapy, facilitating risk assessment, and improving referral decisions. They suggested that a CDS could improve care coordination by facilitating division of workload, improving patient education, and increasing consideration and knowledge of options in other disciplines. Clinical decision support systems are promising tools for improving behavioral medicine care for chronic pain.

Multicriteria decision analysis: Overview and implications for environmental decision making

USGS Publications Warehouse

Hermans, Caroline M.; Erickson, Jon D.; Erickson, Jon D.; Messner, Frank; Ring, Irene

2007-01-01

Environmental decision making involving multiple stakeholders can benefit from the use of a formal process to structure stakeholder interactions, leading to more successful outcomes than traditional discursive decision processes. There are many tools available to handle complex decision making. Here we illustrate the use of a multicriteria decision analysis (MCDA) outranking tool (PROMETHEE) to facilitate decision making at the watershed scale, involving multiple stakeholders, multiple criteria, and multiple objectives. We compare various MCDA methods and their theoretical underpinnings, examining methods that most realistically model complex decision problems in ways that are understandable and transparent to stakeholders.

Bedside nurse involvement in end-of-life decision making: a brief review of the literature.

PubMed

Erickson, Jodi

2013-01-01

Bedside nurses in the critical care setting deal with death on a regular basis. Historically, end-of-life decision making has been addressed by physicians with the family and patient, yet nurses may be a better resource for families during the decision-making process. The purpose of this article was to provide a brief review of literature surrounding end-of-life decision making. As patient advocates, nurses should be more actively involved with facilitating the end-of-life decision-making process for critically ill patients and their families.

Measuring Shared Decision Making in Psychiatric Care

PubMed Central

Salyers, Michelle P.; Matthias, Marianne S.; Fukui, Sadaaki; Holter, Mark C.; Collins, Linda; Rose, Nichole; Thompson, John; Coffman, Melinda; Torrey, William C.

2014-01-01

Objective Shared decision making is widely recognized to facilitate effective health care; tools are needed to measure the level of shared decision making in psychiatric practice. Methods A coding scheme assessing shared decision making in medical settings (1) was adapted, including creation of a manual. Trained raters analyzed 170 audio recordings of psychiatric medication check-up visits. Results Inter-rater reliability among three raters for a subset of 20 recordings ranged from 67% to 100% agreement for the presence of each of nine elements of shared decision making and 100% for the overall agreement between provider and consumer. Just over half of the decisions met minimum criteria for shared decision making. Shared decision making was not related to length of visit after controlling for complexity of decision. Conclusions The shared decision making rating scale appears to reliably assess shared decision making in psychiatric practice and could be helpful for future research, training, and implementation efforts. PMID:22854725

Decision technology.

PubMed

Edwards, W; Fasolo, B

2001-01-01

This review is about decision technology-the rules and tools that help us make wiser decisions. First, we review the three rules that are at the heart of most traditional decision technology-multi-attribute utility, Bayes' theorem, and subjective expected utility maximization. Since the inception of decision research, these rules have prescribed how we should infer values and probabilities and how we should combine them to make better decisions. We suggest how to make best use of all three rules in a comprehensive 19-step model. The remainder of the review explores recently developed tools of decision technology. It examines the characteristics and problems of decision-facilitating sites on the World Wide Web. Such sites now provide anyone who can use a personal computer with access to very sophisticated decision-aiding tools structured mainly to facilitate consumer decision making. It seems likely that the Web will be the mode by means of which decision tools will be distributed to lay users. But methods for doing such apparently simple things as winnowing 3000 options down to a more reasonable number, like 10, contain traps for unwary decision technologists. The review briefly examines Bayes nets and influence diagrams-judgment and decision-making tools that are available as computer programs. It very briefly summarizes the state of the art of eliciting probabilities from experts. It concludes that decision tools will be as important in the 21st century as spreadsheets were in the 20th.

School Characteristics Influencing the Implementation of a Data-Based Decision Making Intervention

ERIC Educational Resources Information Center

van Geel, Marieke; Visscher, Adrie J.; Teunis, Bernard

2017-01-01

There is an increasing global emphasis on using data for decision making, with a growing body of research on interventions aimed at implementing and sustaining data-based decision making (DBDM) in schools. Yet, little is known about the school features that facilitate or hinder the implementation of DBDM. Based on a literature review, the authors…

Context-Sensitive Ethics in School Psychology

ERIC Educational Resources Information Center

Lasser, Jon; Klose, Laurie McGarry; Robillard, Rachel

2013-01-01

Ethical codes and licensing rules provide foundational guidance for practicing school psychologists, but these sources fall short in their capacity to facilitate effective decision-making. When faced with ethical dilemmas, school psychologists can turn to decision-making models, but step-wise decision trees frequently lack the situation…

Vocational Decision-Making Interview. Administration Manual.

ERIC Educational Resources Information Center

Czerlinsky, Thomas; McCray, Paul M.

This guide is intended to assist rehabilitation counselors, school guidance personnel, and others involved in administering and interpreting the results of the Vocational Decision-Making Interview (VDMI). (The VDMI is a structured interview instrument that was developed to facilitate the assessment of an individual's vocational decision-making…

Decisional conflict among women considering antidepressant medication use in pregnancy.

PubMed

Walton, Georgia D; Ross, Lori E; Stewart, Donna E; Grigoriadis, Sophie; Dennis, Cindy-Lee; Vigod, Simone

2014-12-01

The purpose of this study was to examine decision-making among women considering antidepressant medication use in pregnancy. Decisional conflict was assessed using the Decisional Conflict Scale (DCS) among pregnant women considering antidepressant medication treatment (N = 40). Overall DCS and subscale scores were compared between women who were antidepressant users and non-users. Semi-structured interviews (N = 10) explored barriers and facilitators of decision-making. Twenty-one women (52 %) had moderate or high decisional conflict (DCS ≥ 25). Overall DCS scores did not differ between groups, but antidepressant use was associated with feeling more adequately informed (subscale mean 17.5, SD 17.9 vs. 42.1, SD 23.8, p = 0.001) and clear about values (subscale mean 16.7, SD 15.1 vs. 29.8, SD 24.0, p = 0.043). Barriers to decision-making were (1) difficulty weighing maternal versus infant health, (2) lack of high quality information, (3) negative external influences, and (4) emotional reactions to decision-making. Facilitators were (1) interpersonal supports, (2) accessible subspecialty care, and (3) severe depressive symptoms. Many pregnant women facing decisions regarding antidepressant medication use experience decisional conflict. Interventions that provide accurate information, assistance with weighing risks and benefits of treatment, management of problematic external influences, and emotional support may reduce decisional conflict and facilitate the decision-making process.

Key elements of optimal treatment decision-making for surgeons and older patients with colorectal or pancreatic cancer: A qualitative study.

PubMed

Geessink, Noralie H; Schoon, Yvonne; van Herk, Hanneke C P; van Goor, Harry; Olde Rikkert, Marcel G M

2017-03-01

To identify key elements of optimal treatment decision-making for surgeons and older patients with colorectal (CRC) or pancreatic cancer (PC). Six focus groups with different participants were performed: three with older CRC/PC patients and relatives, and three with physicians. Supplementary in-depth interviews were conducted in another seven patients. Framework analysis was used to identify key elements in decision-making. 23 physicians, 22 patients and 14 relatives participated. Three interacting components were revealed: preconditions, content and facilitators of decision-making. To provide optimal information about treatments' impact on an older patient's daily life, physicians should obtain an overall picture and take into account patients' frailty. Depending on patients' preferences and capacities, dividing decision-making into more sessions will be helpful and simultaneously emphasize patients' own responsibility. GPs may have a valuable contribution because of their background knowledge and supportive role. Stakeholders identified several crucial elements in the complex surgical decision-making of older CRC/PC patients. Structured qualitative research may also be of great help in optimizing other treatment directed decision-making processes. Surgeons should be trained in examining preconditions and useful facilitators in decision-making in older CRC/PC patients to optimize its content and to improve the quality of shared care. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Do Children Who Experience Regret Make Better Decisions? A Developmental Study of the Behavioral Consequences of Regret

PubMed Central

O’Connor, Eimear; McCormack, Teresa; Feeney, Aidan

2014-01-01

Although regret is assumed to facilitate good decision making, there is little research directly addressing this assumption. Four experiments (N = 326) examined the relation between children's ability to experience regret and the quality of their subsequent decision making. In Experiment 1 regret and adaptive decision making showed the same developmental profile, with both first appearing at about 7 years. In Experiments 2a and 2b, children aged 6–7 who experienced regret decided adaptively more often than children who did not experience regret, and this held even when controlling for age and verbal ability. Experiment 3 ruled out a memory-based interpretation of these findings. These findings suggest that the experience of regret facilitates children's ability to learn rapidly from bad outcomes. PMID:24773388

Cancer Counseling of Low-Income Limited English Proficient Latina Women Using Medical Interpreters: Implications for Shared Decision-Making.

PubMed

Kamara, Daniella; Weil, Jon; Youngblom, Janey; Guerra, Claudia; Joseph, Galen

2018-02-01

In cancer genetic counseling (CGC), communication across language and culture challenges the model of practice based on shared decision-making. To date, little research has examined the decision-making process of low-income, limited English proficiency (LEP) patients in CGC. This study identified communication patterns in CGC sessions with this population and assessed how these patterns facilitate or inhibit the decision-making process during the sessions. We analyzed 24 audio recordings of CGC sessions conducted in Spanish via telephone interpreters at two public hospitals. Patients were referred for risk of hereditary breast and ovarian cancer; all were offered genetic testing. Audio files were coded by two bilingual English-Spanish researchers and analyzed using conventional content analysis through an iterative process. The 24 sessions included 13 patients, 6 counselors, and 18 interpreters. Qualitative data analyses identified three key domains - Challenges Posed by Hypothetical Explanations, Misinterpretation by the Medical Interpreter, and Communication Facilitators - that reflect communication patterns and their impact on the counselor's ability to facilitate shared decision-making. Overall, we found an absence of patient participation in the decision-making process. Our data suggest that when counseling LEP Latina patients via medical interpreter, prioritizing information with direct utility for the patient and organizing information into short- and long-term goals may reduce information overload and improve comprehension for patient and interpreter. Further research is needed to test the proposed counseling strategies with this population and to assess how applicable our findings are to other populations.

Japanese cancer patient participation in and satisfaction with treatment-related decision-making: A qualitative study.

PubMed

Watanabe, Yoshiko; Takahashi, Miyako; Kai, Ichiro

2008-02-27

Over the last decade, patient involvement in treatment-related decision-making has been widely advocated in Japan, where patient-physician encounters are still under the influence of the long-standing tradition of paternalism. Despite this profound change in clinical practice, studies investigating the actual preferences of Japanese people regarding involvement in treatment-related decision-making are limited. The main objectives of this study were to (1) reveal the actual level of involvement of Japanese cancer patients in the treatment-related decision-making and their overall satisfaction with the decision-making process, and (2) consider the practical implications of increased satisfaction in cancer patients with regard to the decision-making process. We conducted semi-structured interviews with 24 Japanese cancer patients who were recruited from a cancer self-help group in Tokyo. The interviews were qualitatively analysed using the approach described by Lofland and Lofland. The analyses of the patients' interviews focused on 2 aspects: (1) who made treatment-related decisions (the physician or the patient), and (2) the informants' overall satisfaction with the decision-making process. The analyses revealed the following 5 categories of decision-making: 'patient as the active decision maker', 'doctor selection', 'wilfully entrusting the physician', 'compelled decision-making', and 'surrendering decision-making'. While the informants under the first 3 categories were fairly satisfied with the decision-making process, those under the latter 2 were extremely dissatisfied. Informants' views regarding their preferred role in the decision-making process varied substantially from complete physician control to complete patient control; the key factor for their satisfaction was the relation between their preferred involvement in decision-making and their actual level of involvement, irrespective of who the decision maker was. In order to increase patient satisfaction with regard to the treatment-related decision-making process, healthcare professionals in Japan must assess individual patient preferences and provide healthcare accordingly. Moreover, a better environment should be created in hospitals and in society to facilitate patients in expressing their preferences and appropriate resources need to be made available to facilitate their decision-making process.

How people with dementia and their families decide about moving to a care home and support their needs: development of a decision aid, a qualitative study.

PubMed

Lord, Kathryn; Livingston, Gill; Robertson, Sarah; Cooper, Claudia

2016-03-21

People with dementia and their relatives find decisions about the person with dementia living in a care home difficult. We interviewed 20 people with dementia or family carers around the time of this decision in order to design a decision-aid. Decision-makers balanced the competing priorities of remaining somewhere familiar, family's wish they remain at home, reduction of risk and effects on carer's and person with dementia's physical health. The person with dementia frequently resented their lack of autonomy as decisions about care home moves were made after insight and judgment were impaired. Family consultation usually helped carers but sometimes exacerbated tensions. Direct professional support was appreciated where it was available. There is a need for healthcare professionals to facilitate these conversations around decision-making and to include more than signposting to other organisations. There is a need for a healthcare professional facilitated decision-aid. This should detail what might change for the person with dementia and their carer, possible resources and alternatives and assist in facilitating discussion with the wider family; further research will develop and test a tool to facilitate decision making about place of care needs.

Information-sharing to promote informed choice in prenatal screening in the spirit of the SOGC clinical practice guideline: a proposal for an alternative model.

PubMed

Vanstone, Meredith; Kinsella, Elizabeth Anne; Nisker, Jeff

2012-03-01

The 2011 SOGC clinical practice guideline "Prenatal Screening for Fetal Aneuploidy in Singleton Pregnancies" recommends that clinicians offer prenatal screening to all pregnant women and provide counselling in a non-directive manner. Non-directive counselling is intended to facilitate autonomous decision-making and remove the clinician's views regarding a particular course of action. However, recent research in genetic counselling raises concerns that non-directive counselling is neither possible nor desirable, and that it may not be the best way to facilitate informed choice. We propose an alternative model of information-sharing specific to prenatal screening that combines attributes of the models of informative decision-making and shared decision-making. Our proposed model is intended to provide clinicians with a strategy to communicate information about prenatal screening in a way that facilitates a shared deliberative process and autonomous decision-making. Our proposed model may better prepare a pregnant woman to make an informed choice about participating in prenatal screening on the basis of her consideration of the medical information provided by her clinician and her particular circumstances and values.

Survey of Literature Pertaining to Decision Making Styles and Individual Factors

DTIC Science & Technology

2005-10-01

facilitation Rules of engagement (ROE) Deductive reasoning Heuristic(s) Emotion/ Affect Consensus Time pressure Rational decision making Recognition...managers are more likely to use an intuitive decision making style, while Sensing/ Feeling types use more of a rational style. These results were also...performance of the individual, team and organization. Research has indicated that a variety of individual factors affect the way in which people make

Teaching Adolescents with Mild Mental Retardation to Make Decisions in Leisure through the Use of Self-Control Techniques.

ERIC Educational Resources Information Center

Mahon, Michael J.; Bullock, Charles C.

1992-01-01

Study examined the impact of decision-making instruction which incorporated self-control techniques and instruction which provided only encouragement and verbal praise on decision making in leisure (DML) on adolescents with mild mental retardation. Results support the efficacy of the DML model in facilitating thoughtful DML for study subjects. (SM)

Just in Time: How Evidence-on-Demand Services Support Decision Making in Ontario's Child and Youth Mental Health Sector

ERIC Educational Resources Information Center

Notarianni, Maryann; Sundar, Purnima; Carter, Charles

2016-01-01

Using the best available evidence to inform decision making is important for the design or delivery of effective health-related services and broader public policy. Several studies identify barriers and facilitators to evidence-informed decision making in Canadian health settings. This paper describes how the Ontario Centre of Excellence for Child…

Self-management priority setting and decision-making in adults with multimorbidity: A narrative review of literature

PubMed Central

Bratzke, Lisa C.; Muehrer, Rebecca J.; Kehl, Karen A.; Lee, Kyoung Suk; Ward, Earlise C.; Kwekkeboom, Kristine L.

2014-01-01

Objectives The purpose of this narrative review was to synthesize current research findings related to self-management, in order to better understand the processes of priority setting and decision-making in among adults with multimorbidity. Design A narrative literature review was undertaken, synthesizing findings from published, peer-reviewed empirical studies that addressed priority setting and/or decision-making in self-management of multimorbidity. Data sources A search of PubMed, PsychINFO, CINAHL and SocIndex databases was conducted from database inception through December 2013. References lists from selected empirical studies and systematic reviews were evaluated to identify any additional relevant articles. Review methods Full text of potentially eligible articles were reviewed and selected for inclusion if they described empirical studies that addressed priority setting or decision-making in self-management of multimorbidity among adults. Two independent reviewers read each selected article and extracted relevant data to an evidence table. Processes and factors and processes of multimorbidity self-management were identified and sorted into categories of priority setting, decision-making, and facilitators/barriers. Results Thirteen articles were selected for inclusion; most were qualitative studies describing processes, facilitators, and barriers of multimorbidity self-management. The findings revealed that patients prioritize a dominant chronic illness and re-prioritize over time as conditions and treatments change; that multiple facilitators (e.g. support programs) and barriers (e.g. lack of financial resources) impact individuals’ self-management priority setting and decision-making ability; as do individual beliefs, preferences, and attitudes (e.g., perceived personal control, preferences regarding treatment). Conclusions Health care providers need to be cognizant that individuals with multimorbidity engage in day-to-day priority setting and decision-making among their multiple chronic illnesses and respective treatments. Researchers need to develop and test interventions that support day-to-day priority setting and decision-making and improve health outcomes for individuals with multimorbidity. PMID:25468131

Self-management priority setting and decision-making in adults with multimorbidity: a narrative review of literature.

PubMed

Bratzke, Lisa C; Muehrer, Rebecca J; Kehl, Karen A; Lee, Kyoung Suk; Ward, Earlise C; Kwekkeboom, Kristine L

2015-03-01

The purpose of this narrative review was to synthesize current research findings related to self-management, in order to better understand the processes of priority setting and decision-making among adults with multimorbidity. A narrative literature review was undertaken, synthesizing findings from published, peer-reviewed empirical studies that addressed priority setting and/or decision-making in self-management of multimorbidity. A search of PubMed, PsychINFO, CINAHL and SocIndex databases was conducted from database inception through December 2013. References lists from selected empirical studies and systematic reviews were evaluated to identify any additional relevant articles. Full text of potentially eligible articles were reviewed and selected for inclusion if they described empirical studies that addressed priority setting or decision-making in self-management of multimorbidity among adults. Two independent reviewers read each selected article and extracted relevant data to an evidence table. Processes and factors of multimorbidity self-management were identified and sorted into categories of priority setting, decision-making, and facilitators/barriers. Thirteen articles were selected for inclusion; most were qualitative studies describing processes, facilitators, and barriers of multimorbidity self-management. The findings revealed that patients prioritize a dominant chronic illness and re-prioritize over time as conditions and treatments change; that multiple facilitators (e.g. support programs) and barriers (e.g. lack of financial resources) impact individuals' self-management priority setting and decision-making ability; as do individual beliefs, preferences, and attitudes (e.g., perceived personal control, preferences regarding treatment). Health care providers need to be cognizant that individuals with multimorbidity engage in day-to-day priority setting and decision-making among their multiple chronic illnesses and respective treatments. Researchers need to develop and test interventions that support day-to-day priority setting and decision-making and improve health outcomes for individuals with multimorbidity. Copyright © 2014 Elsevier Ltd. All rights reserved.

[Decision Making and Electrodermal Activity].

PubMed

Kobayakawa, Mutsutaka

2016-08-01

Decision making is aided by emotions. Bodily responses, such as sweating, heartbeat, and visceral sensation, are used to monitor the emotional state during decision making. Because decision making in dairy life is complicated and cognitively demanding, these bodily signals are thought to facilitate the decision making process by assigning positive or negative values for each of the behavioral options. The sweat response in a decision making task is measured by skin conductance response (SCR). SCR in decision making is divided into two categories: anticipatory SCR is observed before making decisions, and reward/punishment SCR is observed after the outcome of the decision is perceived. Brain lesion studies in human revealed that the amygdala and ventromedial prefrontal cortex are important in decision making. Patients with lesinon in the amygdala exhibit neither the anticipatory nor reward/punishment SCRs, while patients with the ventromedial prefrontal lesions have deficits only in the anticipatory SCRs. Decision making tasks and SCR analysis have contributed to reveal the implicit aspects of decision making. Further research is necessary for clarifying the role of explicit process of decision making and its relationship with the implicit process.

Shared Decision Making Interventions: Theoretical and Empirical Evidence with Implications for Health Literacy.

PubMed

Stacey, Dawn; Hill, Sophie; McCaffery, Kirsten; Boland, Laura; Lewis, Krystina B; Horvat, Lidia

2017-01-01

Basic health literacy is required for making health decisions. The aim of this chapter is to discuss the use of shared decision making interventions for supporting patient involvement in making health decisions. The chapter provides a definition of shared decision making and discusses the link between shared decision making and the three levels of health literacy: functional, communicative/interactive, and critical. The Interprofessional Shared Decision Making Model is used to identify the various players involved: the patient, the family/surrogate/significant others, decision coach, and health care professionals. When patients are involved in shared decision making, they have better health outcomes, better healthcare experiences, and likely lower costs. Yet, their degree of involvement is influenced by their level of health literacy. Interventions to facilitate shared decision making are patient decision aids, decision coaching, and question prompt lists. Patient decision aids have been shown to improve knowledge, accurate risk perceptions, and chosen options congruent with patients' values. Decision coaching improves knowledge and patient satisfaction. Question prompts also improve satisfaction. When shared decision making interventions have been evaluated with patients presumed to have lower health literacy, they appeared to be more beneficial to disadvantaged groups compared to those with higher literacy or better socioeconomic status. However, special attention needs to be applied when designing these interventions for populations with lower literacy. Two case exemplars are provided to illustrate the design and choice of interventions to better support patients with varying levels of health literacy. Despite evidence indicating these interventions are effective for involving patients in shared decision making, few are used in routine clinical practice. To increase their uptake, implementation strategies need to overcome barriers interfering with their use. Implementation strategies include training health care professionals, adopting SDM interventions that target patients, such as patient decision aids, and monitor patients' decisional comfort using the SURE test. Integrating health literacy principles is important when developing interventions that facilitate shared decision making and essential to avoid inadvertently producing higher inequalities between patients with varying levels of health literacy.

Theory-informed design of values clarification methods: a cognitive psychological perspective on patient health-related decision making.

PubMed

Pieterse, Arwen H; de Vries, Marieke; Kunneman, Marleen; Stiggelbout, Anne M; Feldman-Stewart, Deb

2013-01-01

Healthcare decisions, particularly those involving weighing benefits and harms that may significantly affect quality and/or length of life, should reflect patients' preferences. To support patients in making choices, patient decision aids and values clarification methods (VCM) in particular have been developed. VCM intend to help patients to determine the aspects of the choices that are important to their selection of a preferred option. Several types of VCM exist. However, they are often designed without clear reference to theory, which makes it difficult for their development to be systematic and internally coherent. Our goal was to provide theory-informed recommendations for the design of VCM. Process theories of decision making specify components of decision processes, thus, identify particular processes that VCM could aim to facilitate. We conducted a review of the MEDLINE and PsycINFO databases and of references to theories included in retrieved papers, to identify process theories of decision making. We selected a theory if (a) it fulfilled criteria for a process theory; (b) provided a coherent description of the whole process of decision making; and (c) empirical evidence supports at least some of its postulates. Four theories met our criteria: Image Theory, Differentiation and Consolidation theory, Parallel Constraint Satisfaction theory, and Fuzzy-trace Theory. Based on these, we propose that VCM should: help optimize mental representations; encourage considering all potentially appropriate options; delay selection of an initially favoured option; facilitate the retrieval of relevant values from memory; facilitate the comparison of options and their attributes; and offer time to decide. In conclusion, our theory-based design recommendations are explicit and transparent, providing an opportunity to test each in a systematic manner. Copyright © 2012 Elsevier Ltd. All rights reserved.

The application of reduced-processing decision support systems to facilitate the acquisition of decision-making skills.

PubMed

Perry, Nathan C; Wiggins, Mark W; Childs, Merilyn; Fogarty, Gerard

2013-06-01

The study was designed to examine whether the availability of reduced-processing decision support system interfaces could improve the decision making of inexperienced personnel in the context of Although research into reduced-processing decision support systems has demonstrated benefits in minimizing cognitive load, these benefits have not typically translated into direct improvements in decision accuracy because of the tendency for inexperienced personnel to focus on less-critical information. The authors investigated whether reduced-processing interfaces that direct users' attention toward the most critical cues for decision making can produce improvements in decision-making performance. Novice participants made incident command-related decisions in experimental conditions that differed according to the amount of information that was available within the interface, the level of control that they could exert over the presentation of information, and whether they had received decision training. The results revealed that despite receiving training, participants improved in decision accuracy only when they were provided with an interface that restricted information access to the most critical cues. It was concluded that an interface that restricts information access to only the most critical cues in the scenario can facilitate improvements in decision performance. Decision support system interfaces that encourage the processing of the most critical cues have the potential to improve the accuracy and timeliness of decisions made by inexperienced personnel.

Research of Simple Multi-Attribute Rating Technique for Decision Support

NASA Astrophysics Data System (ADS)

Siregar, Dodi; Arisandi, Diki; Usman, Ari; Irwan, Dedy; Rahim, Robbi

2017-12-01

One of the roles of decision support system is that it can assist the decision maker in obtaining the appropriate alternative with the desired criteria, one of the methods that could apply for the decision maker is SMART method with multicriteria decision making. This multi-criteria decision-making theory has meaning where every alternative has criteria and has value and weight, and the author uses this approach to facilitate decision making with a compelling case. The problems discussed in this paper are classified into problems of a variety Multiobjective (multiple goals to be accomplished) and multicriteria (many of the decisive criteria in reaching such decisions).

Do patients want to participate in medical decision making?

PubMed

Strull, W M; Lo, B; Charles, G

1984-12-07

Although shared decision making by patients and clinicians has been advocated, little is known about the degree of participation in decision making that patients actually prefer or about clinicians' appreciation of these preferences. We administered questionnaires about three aspects of decision making to 210 hypertensive outpatients and to their 50 clinicians, who represented three types of medical practices. We found that 41% of patients preferred more information about hypertension; clinicians underestimated patient preferences for discussion about therapy in 29% of cases and overestimated 11% (k = .22); and 53% of patients preferred to participate in making decisions, while clinicians believed that their patients desired to participate in 78% of cases. Many patients who preferred not to make initial therapeutic decisions did want to participate in ongoing evaluation of therapy. Thus, clinicians underestimate patients' desire for information and discussion but overestimate patients' desire to make decisions. Awareness of this discrepancy may facilitate communication and decision making.

INTEGRATED WATERSHED MANAGEMENT: LINKING SCIENCE TO DECISION MAKING

EPA Science Inventory

This paper describes some of the challenges and benefits of taking an integrated watershed approach to achieving Clean Water Act (CWA) and Safe Drinking Water Act (SDWA) goals, and some of the activities in EPA to facilitate watershed management decision making.

How do persons with dementia participate in decision making related to health and daily care? A multi-case study

PubMed Central

2012-01-01

Background Many countries have passed laws giving patients the right to participate in decisions about health care. People with dementia cannot be assumed to be incapable of making decisions on their diagnosis alone as they may have retained cognitive abilities. The purpose of this study was to gain a better understanding of how persons with dementia participated in making decisions about health care and how their family carers and professional caregivers influenced decision making. Methods This Norwegian study had a qualitative multi-case design. The triad in each of the ten cases consisted of the person with dementia, the family carer and the professional caregiver, in all 30 participants. Inclusion criteria for the persons with dementia were: (1) 67 years or older (2) diagnosed with dementia (3) Clinical Dementia Rating score 2, moderate dementia; (3) able to communicate verbally. The family carers and professional caregivers were then asked to participate. A semi-structured interview guide was used in interviews with family carers and professional caregivers. Field notes were written after participant observation of interactions between persons with dementia and professional caregivers during morning care or activities at a day centre. How the professional caregivers facilitated decision making was the focus of the observations that varied in length from 30 to 90 minutes. The data were analyzed using framework analysis combined with a hermeneutical interpretive approach. Results Professional caregivers based their assessment of mental competence on experience and not on standardized tests. Persons with dementia demonstrated variability in how they participated in decision making. Pseudo-autonomous decision making and delegating decision making were new categories that emerged. Autonomous decision making did occur but shared decision making was the most typical pattern. Reduced mental capacity, lack of available choices or not being given the opportunity to participate led to non-involvement. Not all decisions were based on logic; personal values and relationships were also considered. Conclusions Persons with moderate dementia demonstrated variability in how they participated in decision making. Optimal involvement was facilitated by positioning them as capable of influencing decisions, assessing decision-specific competence, clarifying values and understanding the significance of relationships and context. PMID:22870952

Playing with a "Full DECK": A Creative Application of the Integrative Decision-Making Framework of Ethical Behavior

ERIC Educational Resources Information Center

Case, Jan C.; Plaisance, Pamela M.; Renfrow, Jennifer J.; Olivier, Brandi N.

2008-01-01

Rehabilitation practitioners are faced with a variety of complex ethical decisions in a dynamic, changing world. Attention to principle ethics, virtue ethics, critical thinking, and creativity are essential for best practice. This article presents one tool (DECK--Decision-Making that Enhances Counselor Know-How) to facilitate such ethical…

Protocol-based care: the standardisation of decision-making?

PubMed

Rycroft-Malone, Jo; Fontenla, Marina; Seers, Kate; Bick, Debra

2009-05-01

To explore how protocol-based care affects clinical decision-making. In the context of evidence-based practice, protocol-based care is a mechanism for facilitating the standardisation of care and streamlining decision-making through rationalising the information with which to make judgements and ultimately decisions. However, whether protocol-based care does, in the reality of practice, standardise decision-making is unknown. This paper reports on a study that explored the impact of protocol-based care on nurses' decision-making. Theoretically informed by realistic evaluation and the promoting action on research implementation in health services framework, a case study design using ethnographic methods was used. Two sites were purposively sampled; a diabetic and endocrine unit and a cardiac medical unit. Within each site, data collection included observation, postobservation semi-structured interviews with staff and patients, field notes, feedback sessions and document review. Data were inductively and thematically analysed. Decisions made by nurses in both sites were varied according to many different and interacting factors. While several standardised care approaches were available for use, in reality, a variety of information sources informed decision-making. The primary approach to knowledge exchange and acquisition was person-to-person; decision-making was a social activity. Rarely were standardised care approaches obviously referred to; nurses described following a mental flowchart, not necessarily linked to a particular guideline or protocol. When standardised care approaches were used, it was reported that they were used flexibly and particularised. While the logic of protocol-based care is algorithmic, in the reality of clinical practice, other sources of information supported nurses' decision-making process. This has significant implications for the political goal of standardisation. The successful implementation and judicious use of tools such as protocols and guidelines will likely be dependant on approaches that facilitate the development of nurses' decision-making processes in parallel to paying attention to the influence of context.

Supporting shared decision making beyond consumer-prescriber interactions: Initial development of the CommonGround fidelity scale

PubMed Central

Fukui, Sadaaki; Salyers, Michelle P.; Rapp, Charlie; Goscha, Rick; Young, Leslie; Mabry, Ally

2015-01-01

Shared decision-making has become a central tenet of recovery-oriented, person-centered mental health care, yet the practice is not always transferred to the routine psychiatric visit. Supporting the practice at the system level, beyond the interactions of consumers and medication prescribers, is needed for successful adoption of shared decision-making. CommonGround is a systemic approach, intended to be part of a larger integration of shared decision-making tools and practices at the system level. We discuss the organizational components that CommonGround uses to facilitate shared decision-making, and we present a fidelity scale to assess how well the system is being implemented. PMID:28090194

Time Management and the Military Decision Making Process

DTIC Science & Technology

1992-12-18

This monograph analyzes the military decision making process in terms of time management in order to determine if a timeline will expedite the...process. The monograph begins by establishing the importance of time and time management in planning. This section provides a general discussion of time, an...Perhaps using some of the techniques that other armies use will facilitate time management .... Time management , Decision making, Timeline, Mission analysis, Wargaming, Courses of action, OPORD, Brigade OPS.

Designing a rapid response program to support evidence-informed decision-making in the Americas region: using the best available evidence and case studies.

PubMed

Haby, Michelle M; Chapman, Evelina; Clark, Rachel; Barreto, Jorge; Reveiz, Ludovic; Lavis, John N

2016-08-18

The objective of this work was to inform the design of a rapid response program to support evidence-informed decision-making in health policy and practice for the Americas region. Specifically, we focus on the following: (1) What are the best methodological approaches for rapid reviews of the research evidence? (2) What other strategies are needed to facilitate evidence-informed decision-making in health policy and practice? and (3) How best to operationalize a rapid response program? The evidence used to inform the design of a rapid response program included (i) two rapid reviews of methodological approaches for rapid reviews of the research evidence and strategies to facilitate evidence-informed decision-making, (ii) supplementary literature in relation to the "shortcuts" that could be considered to reduce the time needed to complete rapid reviews, (iii) four case studies, and (iv) supplementary literature to identify additional operational issues for the design of the program. There is no agreed definition of rapid reviews in the literature and no agreed methodology for conducting them. Better reporting of rapid review methods is needed. The literature found in relation to shortcuts will be helpful in choosing shortcuts that maximize timeliness while minimizing the impact on quality. Evidence for other strategies that can be used concurrently to facilitate the uptake of research evidence, including evidence drawn from rapid reviews, is presented. Operational issues that need to be considered in designing a rapid response program include the implications of a "user-pays" model, the importance of recruiting staff with the right mix of skills and qualifications, and ensuring that the impact of the model on research use in decision-making is formally evaluated. When designing a new rapid response program, greater attention needs to be given to specifying the rapid review methods and reporting these in sufficient detail to allow a quality assessment. It will also be important to engage in other strategies to facilitate the uptake of the rapid reviews and to evaluate the chosen model in order to make refinements and add to the evidence base for evidence-informed decision-making.

A Framework for Facilitating Ecosystem Services-based Decision-making and the Development of Decision-making Tools

EPA Science Inventory

There is an increasing understanding that top-down regulatory and technology driven responses are not sufficient to address current and emerging environmental challenges such as climate change, sustainable communities, and environmental justice. The vast majority of environmenta...

Implementing and evaluating shared decision making in oncology practice.

PubMed

Kane, Heather L; Halpern, Michael T; Squiers, Linda B; Treiman, Katherine A; McCormack, Lauren A

2014-01-01

Engaging individuals with cancer in decision making about their treatments has received increased attention; shared decision making (SDM) has become a hallmark of patient-centered care. Although physicians indicate substantial interest in SDM, implementing SDM in cancer care is often complex; high levels of uncertainty may exist, and health care providers must help patients understand the potential risks versus benefits of different treatment options. However, patients who are more engaged in their health care decision making are more likely to experience confidence in and satisfaction with treatment decisions and increased trust in their providers. To implement SDM in oncology practice, physicians and other health care providers need to understand the components of SDM and the approaches to supporting and facilitating this process as part of cancer care. This review summarizes recent information regarding patient and physician factors that influence SDM for cancer care, outcomes resulting from successful SDM, and strategies for implementing SDM in oncology practice. We present a conceptual model illustrating the components of SDM in cancer care and provide recommendations for facilitating SDM in oncology practice. © 2014 American Cancer Society, Inc.

An innovative approach to addressing childhood obesity: a knowledge-based infrastructure for supporting multi-stakeholder partnership decision-making in Quebec, Canada.

PubMed

Addy, Nii Antiaye; Shaban-Nejad, Arash; Buckeridge, David L; Dubé, Laurette

2015-01-23

Multi-stakeholder partnerships (MSPs) have become a widespread means for deploying policies in a whole of society strategy to address the complex problem of childhood obesity. However, decision-making in MSPs is fraught with challenges, as decision-makers are faced with complexity, and have to reconcile disparate conceptualizations of knowledge across multiple sectors with diverse sets of indicators and data. These challenges can be addressed by supporting MSPs with innovative tools for obtaining, organizing and using data to inform decision-making. The purpose of this paper is to describe and analyze the development of a knowledge-based infrastructure to support MSP decision-making processes. The paper emerged from a study to define specifications for a knowledge-based infrastructure to provide decision support for community-level MSPs in the Canadian province of Quebec. As part of the study, a process assessment was conducted to understand the needs of communities as they collect, organize, and analyze data to make decisions about their priorities. The result of this process is a "portrait", which is an epidemiological profile of health and nutrition in their community. Portraits inform strategic planning and development of interventions, and are used to assess the impact of interventions. Our key findings indicate ambiguities and disagreement among MSP decision-makers regarding causal relationships between actions and outcomes, and the relevant data needed for making decisions. MSP decision-makers expressed a desire for easy-to-use tools that facilitate the collection, organization, synthesis, and analysis of data, to enable decision-making in a timely manner. Findings inform conceptual modeling and ontological analysis to capture the domain knowledge and specify relationships between actions and outcomes. This modeling and analysis provide the foundation for an ontology, encoded using OWL 2 Web Ontology Language. The ontology is developed to provide semantic support for the MSP process, defining objectives, strategies, actions, indicators, and data sources. In the future, software interacting with the ontology can facilitate interactive browsing by decision-makers in the MSP in the form of concepts, instances, relationships, and axioms. Our ontology also facilitates the integration and interpretation of community data, and can help in managing semantic interoperability between different knowledge sources. Future work will focus on defining specifications for the development of a database of indicators and an information system to help decision-makers to view, analyze and organize indicators for their community. This work should improve MSP decision-making in the development of interventions to address childhood obesity.

An Innovative Approach to Addressing Childhood Obesity: A Knowledge-Based Infrastructure for Supporting Multi-Stakeholder Partnership Decision-Making in Quebec, Canada

PubMed Central

Addy, Nii Antiaye; Shaban-Nejad, Arash; Buckeridge, David L.; Dubé, Laurette

2015-01-01

Multi-stakeholder partnerships (MSPs) have become a widespread means for deploying policies in a whole of society strategy to address the complex problem of childhood obesity. However, decision-making in MSPs is fraught with challenges, as decision-makers are faced with complexity, and have to reconcile disparate conceptualizations of knowledge across multiple sectors with diverse sets of indicators and data. These challenges can be addressed by supporting MSPs with innovative tools for obtaining, organizing and using data to inform decision-making. The purpose of this paper is to describe and analyze the development of a knowledge-based infrastructure to support MSP decision-making processes. The paper emerged from a study to define specifications for a knowledge-based infrastructure to provide decision support for community-level MSPs in the Canadian province of Quebec. As part of the study, a process assessment was conducted to understand the needs of communities as they collect, organize, and analyze data to make decisions about their priorities. The result of this process is a “portrait”, which is an epidemiological profile of health and nutrition in their community. Portraits inform strategic planning and development of interventions, and are used to assess the impact of interventions. Our key findings indicate ambiguities and disagreement among MSP decision-makers regarding causal relationships between actions and outcomes, and the relevant data needed for making decisions. MSP decision-makers expressed a desire for easy-to-use tools that facilitate the collection, organization, synthesis, and analysis of data, to enable decision-making in a timely manner. Findings inform conceptual modeling and ontological analysis to capture the domain knowledge and specify relationships between actions and outcomes. This modeling and analysis provide the foundation for an ontology, encoded using OWL 2 Web Ontology Language. The ontology is developed to provide semantic support for the MSP process, defining objectives, strategies, actions, indicators, and data sources. In the future, software interacting with the ontology can facilitate interactive browsing by decision-makers in the MSP in the form of concepts, instances, relationships, and axioms. Our ontology also facilitates the integration and interpretation of community data, and can help in managing semantic interoperability between different knowledge sources. Future work will focus on defining specifications for the development of a database of indicators and an information system to help decision-makers to view, analyze and organize indicators for their community. This work should improve MSP decision-making in the development of interventions to address childhood obesity. PMID:25625409

Is Air War College Teaching the Right Leadership Skill Sets?

DTIC Science & Technology

2008-02-15

Following are the skill sets for strategic leaders: • Critical Thinking (includes Conceptual Competence/ Decision Making / Strategic Thinking... Decision Making / Strategic Thinking) • Creative Thinking (includes Conceptual Flexibility) • Integrating internal and external environments • Long Range... Making / Strategic Thinking Yes Integrating Internal and External Environments Yes Long Range Vision Yes Team Performance Facilitation/Team Building

Shared decision-making in dementia care planning: barriers and facilitators in two European countries.

PubMed

Mariani, Elena; Vernooij-Dassen, Myrra; Koopmans, Raymond; Engels, Yvonne; Chattat, Rabih

2017-01-01

Shared decision-making (SDM) is a means of allowing people with dementia to take part in making choices, be autonomous and participate in social activities. Involving them in SDM is an important way of promoting social health. However, including families and dementia residents in decision-making can be challenging for care staff working in nursing homes. The objective of this study was to identify barriers and facilitators regarding the implementation of an SDM framework for care planning in two nursing homes, one in Italy and one in the Netherlands. Focus group interviews were conducted with healthcare professionals who, after being trained, applied the SDM framework. Content analysis was used to analyze the data. Six months after the feasibility trial, focus group interviews with healthcare professionals (n = 10 in Italy; n = 9 in the Netherlands) were held. We found 6 themes and 15 categories. Within these themes, facilitators and barriers were identified. The categories of team collaboration, communication skills and nursing home policy were found to be facilitators to the implementation process, whereas regulations, lack of funding and of involvement of family caregivers were the main barriers. Family attitudes towards SDM could be both. The main difference between countries concerned the residents' cognitive status that influenced their degree of involvement. Communication skills training for professionals, training of family caregivers, and involvement of the management in the implementation process seem to be crucial factors in successfully implementing SDM in nursing homes, and increasing the involvement of families and dementia residents in decision-making.

Mediation: a response to aid-in-dying and the Supreme Court decision.

PubMed

Saulo, M; Wagener, R J; Rothschild, I S

1998-01-01

The recent U.S. Supreme Court decision concerning aid-in-dying has drawn attention to the complexity of end-of-life care. The authors summarize the recent Supreme Court's decision and the problems surrounding this complex issue. A case study is provided to demonstrate how mediation facilitates collaborative problem solving. Finally, the authors demonstrate how nurse leaders can apply this three-stage process and its attendant principles to facilitate ethical decision making in end-of-life care.

Theories of Health Care Decision Making at the End of Life: A Meta-Ethnography.

PubMed

Kim, Kyounghae; Heinze, Katherine; Xu, Jiayun; Kurtz, Melissa; Park, Hyunjeong; Foradori, Megan; Nolan, Marie T

2017-08-01

The aim of this meta-ethnography is to appraise the types and uses of theories relative to end-of-life decision making and to develop a conceptual framework to describe end-of-life decision making among patients with advanced cancers, heart failure, and amyotrophic lateral sclerosis (ALS) and their caregivers or providers. We used PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to extract English-language articles published between January 2002 and April 2015. Forty-three articles were included. The most common theories included decision-making models ( n = 14) followed by family-centered ( n = 11) and behavioral change models ( n = 7). A conceptual framework was developed using themes including context of decision making, communication and negotiation of decision making, characteristics of decision makers, goals of decision making, options and alternatives, and outcomes. Future research should enhance and apply these theories to guide research to develop patient-centered decision-making programs that facilitate informed and shared decision making at the end of life among patients with advanced illness and their caregivers.

Genital surgery for disorders of sex development: implementing a shared decision-making approach.

PubMed

Karkazis, Katrina; Tamar-Mattis, Anne; Kon, Alexander A

2010-08-01

Ongoing controversy surrounds early genital surgery for children with disorders of sex development, making decisions about these procedures extraordinarily complex. Professional organizations have encouraged healthcare providers to adopt shared decision-making due to its broad potential to improve the decision-making process, perhaps most so when data are lacking, when there is no clear "best-choice" treatment, when decisions involve more than one choice, where each choice has both advantages and disadvantages, and where the ranking of options depends heavily on the decision-maker's values. We present a 6-step model for shared decision-making in decisions about genital surgery for disorders of sex development: (1) Set the stage and develop an appropriate team; (2) Establish preferences for information and roles in decision-making; (3) Perceive and address emotions; (4) Define concerns and values; (5) Identify options and present evidence; and (6) Share responsibility for making a decision. As long as controversy persists regarding surgery for DSD, an SDM process can facilitate the increased sharing of relevant information essential for making important health care decisions.

Toward Optimal Decision Making among Vulnerable Patients Referred for Cardiac Surgery: A Qualitative Analysis of Patient and Provider Perspectives.

PubMed

Gainer, Ryan A; Curran, Janet; Buth, Karen J; David, Jennie G; Légaré, Jean-Francois; Hirsch, Gregory M

2017-07-01

Comprehension of risks, benefits, and alternative treatment options has been shown to be poor among patients referred for cardiac interventions. Patients' values and preferences are rarely explicitly sought. An increasing proportion of frail and older patients are undergoing complex cardiac surgical procedures with increased risk of both mortality and prolonged institutional care. We sought input from patients and caregivers to determine the optimal approach to decision making in this vulnerable patient population. Focus groups were held with both providers and former patients. Three focus groups were convened for Coronary Artery Bypass Graft (CABG), Valve, or CABG +Valve patients ≥ 70 y old (2-y post-op, ≤ 8-wk post-op, complicated post-op course) (n = 15). Three focus groups were convened for Intermediate Medical Care Unit (IMCU) nurses, Intensive Care Unit (ICU) nurses, surgeons, anesthesiologists and cardiac intensivists (n = 20). We used a semi-structured interview format to ask questions surrounding the informed consent process. Transcribed audio data was analyzed to develop consistent and comprehensive themes. We identified 5 main themes that influence the decision making process: educational barriers, educational facilitators, patient autonomy and perceived autonomy, patient and family expectations of care, and decision making advocates. All themes were influenced by time constraints experienced in the current consent process. Patient groups expressed a desire to receive information earlier in their care to allow time to identify personal values and preferences in developing plans for treatment. Both groups strongly supported a formal approach for shared decision making with a decisional coach to provide information and facilitate communication with the care team. Identifying the barriers and facilitators to patient and caretaker engagement in decision making is a key step in the development of a structured, patient-centered SDM approach. Intervention early in the decision process, the use of individualized decision aids that employ graphic risk presentations, and a dedicated decisional coach were identified by patients and providers as approaches with a high potential for success. The impact of such a formalized shared decision making process in cardiac surgery on decisional quality will need to be formally assessed. Given the trend toward older and frail patients referred for complex cardiac procedures, the need for an effective shared decision making process is compelling.

78 FR 46325 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-31

... to facilitate informed decision making regarding deposit accounts offered at depository institutions... information, such as account numbers or social security numbers, should not be included. FOR FURTHER... consumer ability to make informed decisions regarding deposit accounts by requiring uniformity in the...

Praises & Nudges: A Case of District-Wide Change.

ERIC Educational Resources Information Center

Doyle, Richard; And Others

This paper describes the processes and outcomes experienced by the Marshalltown Community School District (Iowa) as it implemented a shared decision-making, school-improvement program. A district Shared Decision Making (SDM) Team and School Improvement Program (SIP) teams were trained to facilitate greater staff participation in the…

Patchy 'coherence': using normalization process theory to evaluate a multi-faceted shared decision making implementation program (MAGIC).

PubMed

Lloyd, Amy; Joseph-Williams, Natalie; Edwards, Adrian; Rix, Andrew; Elwyn, Glyn

2013-09-05

Implementing shared decision making into routine practice is proving difficult, despite considerable interest from policy-makers, and is far more complex than merely making decision support interventions available to patients. Few have reported successful implementation beyond research studies. MAking Good Decisions In Collaboration (MAGIC) is a multi-faceted implementation program, commissioned by The Health Foundation (UK), to examine how best to put shared decision making into routine practice. In this paper, we investigate healthcare professionals' perspectives on implementing shared decision making during the MAGIC program, to examine the work required to implement shared decision making and to inform future efforts. The MAGIC program approached implementation of shared decision making by initiating a range of interventions including: providing workshops; facilitating development of brief decision support tools (Option Grids); initiating a patient activation campaign ('Ask 3 Questions'); gathering feedback using Decision Quality Measures; providing clinical leads meetings, learning events, and feedback sessions; and obtaining executive board level support. At 9 and 15 months (May and November 2011), two rounds of semi-structured interviews were conducted with healthcare professionals in three secondary care teams to explore views on the impact of these interventions. Interview data were coded by two reviewers using a framework derived from the Normalization Process Theory. A total of 54 interviews were completed with 31 healthcare professionals. Partial implementation of shared decision making could be explained using the four components of the Normalization Process Theory: 'coherence,' 'cognitive participation,' 'collective action,' and 'reflexive monitoring.' Shared decision making was integrated into routine practice when clinical teams shared coherent views of role and purpose ('coherence'). Shared decision making was facilitated when teams engaged in developing and delivering interventions ('cognitive participation'), and when those interventions fit with existing skill sets and organizational priorities ('collective action') resulting in demonstrable improvements to practice ('reflexive monitoring'). The implementation process uncovered diverse and conflicting attitudes toward shared decision making; 'coherence' was often missing. The study showed that implementation of shared decision making is more complex than the delivery of patient decision support interventions to patients, a portrayal that often goes unquestioned. Normalizing shared decision making requires intensive work to ensure teams have a shared understanding of the purpose of involving patients in decisions, and undergo the attitudinal shifts that many health professionals feel are required when comprehension goes beyond initial interpretations. Divergent views on the value of engaging patients in decisions remain a significant barrier to implementation.

Patchy ‘coherence’: using normalization process theory to evaluate a multi-faceted shared decision making implementation program (MAGIC)

PubMed Central

2013-01-01

Background Implementing shared decision making into routine practice is proving difficult, despite considerable interest from policy-makers, and is far more complex than merely making decision support interventions available to patients. Few have reported successful implementation beyond research studies. MAking Good Decisions In Collaboration (MAGIC) is a multi-faceted implementation program, commissioned by The Health Foundation (UK), to examine how best to put shared decision making into routine practice. In this paper, we investigate healthcare professionals’ perspectives on implementing shared decision making during the MAGIC program, to examine the work required to implement shared decision making and to inform future efforts. Methods The MAGIC program approached implementation of shared decision making by initiating a range of interventions including: providing workshops; facilitating development of brief decision support tools (Option Grids); initiating a patient activation campaign (‘Ask 3 Questions’); gathering feedback using Decision Quality Measures; providing clinical leads meetings, learning events, and feedback sessions; and obtaining executive board level support. At 9 and 15 months (May and November 2011), two rounds of semi-structured interviews were conducted with healthcare professionals in three secondary care teams to explore views on the impact of these interventions. Interview data were coded by two reviewers using a framework derived from the Normalization Process Theory. Results A total of 54 interviews were completed with 31 healthcare professionals. Partial implementation of shared decision making could be explained using the four components of the Normalization Process Theory: ‘coherence,’ ‘cognitive participation,’ ‘collective action,’ and ‘reflexive monitoring.’ Shared decision making was integrated into routine practice when clinical teams shared coherent views of role and purpose (‘coherence’). Shared decision making was facilitated when teams engaged in developing and delivering interventions (‘cognitive participation’), and when those interventions fit with existing skill sets and organizational priorities (‘collective action’) resulting in demonstrable improvements to practice (‘reflexive monitoring’). The implementation process uncovered diverse and conflicting attitudes toward shared decision making; ‘coherence’ was often missing. Conclusions The study showed that implementation of shared decision making is more complex than the delivery of patient decision support interventions to patients, a portrayal that often goes unquestioned. Normalizing shared decision making requires intensive work to ensure teams have a shared understanding of the purpose of involving patients in decisions, and undergo the attitudinal shifts that many health professionals feel are required when comprehension goes beyond initial interpretations. Divergent views on the value of engaging patients in decisions remain a significant barrier to implementation. PMID:24006959

Shared Decision Making at the Limit of Viability: A Blueprint for Physician Action

PubMed Central

2016-01-01

Objective To document interactions during the antenatal consultation between parents and neonatologist that parents linked to their satisfaction with their participation in shared decision making for their infant at risk of being born at the limit of viability. Methods This multiple-case ethnomethodological qualitative research study, included mothers admitted for a threatened premature delivery between 200/7 and 266/7 weeks gestation, the father, and the staff neonatologist conducting the clinical antenatal consultation. Content analysis of an audiotaped post-antenatal consultation interview with parents obtained their satisfaction scores as well as their comments on physician actions that facilitated their desired participation. Results Five cases, each called a “system—infant at risk”, included 10 parents and 6 neonatologists. From the interviews emerged a blueprint for action by physicians, including communication strategies that parents say facilitated their participation in decision making; such as building trustworthy physician-parent relationships, providing "balanced" information, offering choices, and allowing time to think. Conclusion Parent descriptions indicate that the opportunity to participate to their satisfaction in the clinical antenatal consultation depends on how the physician interacts with them. Practice implications The parent-identified communication strategies facilitate shared decision making regarding treatment in the best interest of the infant at risk to be born at the limit of viability. PMID:27893823

Training conservation practitioners to be better decision makers

USGS Publications Warehouse

Johnson, Fred A.; Eaton, Mitchell J.; Williams, James H.; Jensen, Gitte H.; Madsen, Jesper

2015-01-01

Traditional conservation curricula and training typically emphasizes only one part of systematic decision making (i.e., the science), at the expense of preparing conservation practitioners with critical skills in values-setting, working with decision makers and stakeholders, and effective problem framing. In this article we describe how the application of decision science is relevant to conservation problems and suggest how current and future conservation practitioners can be trained to be better decision makers. Though decision-analytic approaches vary considerably, they all involve: (1) properly formulating the decision problem; (2) specifying feasible alternative actions; and (3) selecting criteria for evaluating potential outcomes. Two approaches are available for providing training in decision science, with each serving different needs. Formal education is useful for providing simple, well-defined problems that allow demonstrations of the structure, axioms and general characteristics of a decision-analytic approach. In contrast, practical training can offer complex, realistic decision problems requiring more careful structuring and analysis than those used for formal training purposes. Ultimately, the kinds and degree of training necessary depend on the role conservation practitioners play in a decision-making process. Those attempting to facilitate decision-making processes will need advanced training in both technical aspects of decision science and in facilitation techniques, as well as opportunities to apprentice under decision analysts/consultants. Our primary goal should be an attempt to ingrain a discipline for applying clarity of thought to all decisions.

Stress-induced cortisol facilitates threat-related decision making among police officers.

PubMed

Akinola, Modupe; Mendes, Wendy Berry

2012-02-01

Previous research suggests that cortisol can affect cognitive functions such as memory, decision making, and attentiveness to threat-related cues. Here, we examine whether increases in cortisol, brought on by an acute social stressor, influence threat-related decision making. Eighty-one police officers completed a standardized laboratory stressor and then immediately completed a computer simulated decision-making task designed to examine decisions to accurately shoot or not shoot armed and unarmed Black and White targets. Results indicated that police officers who had larger cortisol increases to the social-stress task subsequently made fewer errors when deciding to shoot armed Black targets relative to armed White targets, suggesting that hypothalamic pituitary adrenal (HPA) activation may exacerbate vigilance for threat cues. We conclude with a discussion of the implications of threat-initiated decision making.

Demonstrating Empathy: A Phenomenological Study of Instructional Designers Making Instructional Strategy Decisions for Adult Learners

ERIC Educational Resources Information Center

Vann, Linda S.

2017-01-01

Instructional designers are tasked with making instructional strategy decisions to facilitate achievement of learning outcomes as part of their professional responsibilities. While the instructional design process includes learner analysis, that analysis alone does not embody opportunities to assist instructional designers with demonstrations of…

Office of Environmental Information (OEI) Tribal Strategy: Partnership to Support Environmental Information and Decision-Making in Indian Country and Alaska Native Villages

EPA Pesticide Factsheets

This draft strategy provides a description of goals OEI seeks to accomplish to support tribal information and environmental decision-making. States objectives to facilitate and strengthen tribal capacity to collect, analyze and share data.

Information Input and Performance in Small Decision Making Groups.

ERIC Educational Resources Information Center

Ryland, Edwin Holman

It was hypothesized that increases in the amount and specificity of information furnished to a discussion group would facilitate group decision making and improve other aspects of group and individual performance. Procedures in testing these assumptions included varying the amounts of statistics, examples, testimony, and augmented information…

Decision Facilitator for Launch Operations using Intelligent Agents

NASA Technical Reports Server (NTRS)

Thirumalainambi, Rajkumar; Bardina, Jorge

2005-01-01

Launch operations require millions of micro-decisions which contribute to the macro decision of 'Go/No-Go' for a launch. Knowledge workers"(such as managers and technical professionals) need information in a timely precise manner as it can greatly affect mission success. The intelligent agent (web search agent) uses the words of a hypertext markup language document which is connected through the internet. The intelligent agent's actions are to determine if its goal of seeking a website containing a specified target (e.g., keyword or phrase), has been met. There are few parameters that should be defined for the keyword search like "Go" and "No-Go". Instead of visiting launch and range decision making servers individually, the decision facilitator constantly connects to all servers, accumulating decisions so the final decision can be decided in a timely manner. The facilitator agent uses the singleton design pattern, which ensures that only a single instance of the facilitator agent exists at one time. Negotiations could proceed between many agents resulting in a final decision. This paper describes details of intelligent agents and their interaction to derive an unified decision support system.

Barriers, facilitators and views about next steps to implementing supports for evidence-informed decision-making in health systems: a qualitative study.

PubMed

Ellen, Moriah E; Léon, Grégory; Bouchard, Gisèle; Ouimet, Mathieu; Grimshaw, Jeremy M; Lavis, John N

2014-12-05

Mobilizing research evidence for daily decision-making is challenging for health system decision-makers. In a previous qualitative paper, we showed the current mix of supports that Canadian health-care organizations have in place and the ones that are perceived to be helpful to facilitate the use of research evidence in health system decision-making. Factors influencing the implementation of such supports remain poorly described in the literature. Identifying the barriers to and facilitators of different interventions is essential for implementation of effective, context-specific, supports for evidence-informed decision-making (EIDM) in health systems. The purpose of this study was to identify (a) barriers and facilitators to implementing supports for EIDM in Canadian health-care organizations, (b) views about emerging development of supports for EIDM, and (c) views about the priorities to bridge the gaps in the current mix of supports that these organizations have in place. This qualitative study was conducted in three types of health-care organizations (regional health authorities, hospitals, and primary care practices) in two Canadian provinces (Ontario and Quebec). Fifty-seven in-depth semi-structured telephone interviews were conducted with senior managers, library managers, and knowledge brokers from health-care organizations that have already undertaken strategic initiatives in knowledge translation. The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software. Limited resources (i.e., money or staff), time constraints, and negative attitudes (or resistance) toward change were the most frequently identified barriers to implementing supports for EIDM. Genuine interest from health system decision-makers, notably their willingness to invest money and resources and to create a knowledge translation culture over time in health-care organizations, was the most frequently identified facilitator to implementing supports for EIDM. The most frequently cited views about emerging development of supports for EIDM were implementing accessible and efficient systems to support the use of research in decision-making (e.g., documentation and reporting tools, communication tools, and decision support tools) and developing and implementing an infrastructure or position where the accountability for encouraging knowledge use lies. The most frequently stated priorities for bridging the gaps in the current mix of supports that these organizations have in place were implementing technical infrastructures to support research use and to ensure access to research evidence and establishing formal or informal ties to researchers and knowledge brokers outside the organization who can assist in EIDM. These results provide insights on the type of practical implementation imperatives involved in supporting EIDM.

Decision Making on Medical Innovations in a Changing Health Care Environment: Insights from Accountable Care Organizations and Payers on Personalized Medicine and Other Technologies.

PubMed

Trosman, Julia R; Weldon, Christine B; Douglas, Michael P; Deverka, Patricia A; Watkins, John B; Phillips, Kathryn A

2017-01-01

New payment and care organization approaches, such as those of accountable care organizations (ACOs), are reshaping accountability and shifting risk, as well as decision making, from payers to providers, within the Triple Aim context of health reform. The Triple Aim calls for improving experience of care, improving health of populations, and reducing health care costs. To understand how the transition to the ACO model impacts decision making on adoption and use of innovative technologies in the era of accelerating scientific advancement of personalized medicine and other innovations. We interviewed representatives from 10 private payers and 6 provider institutions involved in implementing the ACO model (i.e., ACOs) to understand changes, challenges, and facilitators of decision making on medical innovations, including personalized medicine. We used the framework approach of qualitative research for study design and thematic analysis. We found that representatives from the participating payer companies and ACOs perceive similar challenges to ACOs' decision making in terms of achieving a balance between the components of the Triple Aim-improving care experience, improving population health, and reducing costs. The challenges include the prevalence of cost over care quality considerations in ACOs' decisions and ACOs' insufficient analytical and technology assessment capacity to evaluate complex innovations such as personalized medicine. Decision-making facilitators included increased competition across ACOs and patients' interest in personalized medicine. As new payment models evolve, payers, ACOs, and other stakeholders should address challenges and leverage opportunities to arm ACOs with robust, consistent, rigorous, and transparent approaches to decision making on medical innovations. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Decision-Making on Medical Innovations in a Changing Healthcare Environment: Insights from Accountable Care Organizations and Payers on Personalized Medicine and Other Technologies

PubMed Central

Trosman, Julia R.; Weldon, Christine B.; Douglas, Michael P.; Deverka, Patricia A.; Watkins, John; Phillips, Kathryn A.

2016-01-01

Background New payment and care organization approaches, such as the Accountable Care Organization (ACO), are reshaping accountability and shifting risk, as well as decision-making, from payers to providers, under the Triple Aim of health reform. The Triple Aim calls for improving experience of care, improving health of populations and reducing healthcare costs. In the era of accelerating scientific advancement of personalized medicine and other innovations, it is critical to understand how the transition to the ACO model impacts decision-making on adoption and utilization of innovative technologies. Methods We interviewed representatives from ten private payers and six provider institutions involved in implementing the ACO model (i.e. ACOs) to understand changes, challenges and facilitators of decision-making on medical innovations, including personalized medicine. We used the framework approach of qualitative research for study design and thematic analysis. Results We found that representatives from the participating payer companies and ACOs perceive similar challenges to ACOs’ decision-making in terms of achieving a balance between the components of the Triple Aim – improving care experience, improving population health and reducing costs. The challenges include the prevalence of cost over care quality considerations in ACOs’ decisions and ACOs’ insufficient analytical and technology assessment capacity to evaluate complex innovations such as personalized medicine. Decision-making facilitators included increased competition across ACOs and patients’ interest in personalized medicine. Conclusions As new payment models evolve, payers, ACOs and other stakeholders should address challenges and leverage opportunities to arm ACOs with robust, consistent, rigorous and transparent approaches to decision-making on medical innovations. PMID:28212967

What are the decision-making preferences of patients in vascular surgery? A mixed-methods study.

PubMed

Santema, T B Katrien; Stoffer, E Anniek; Kunneman, Marleen; Koelemay, Mark J W; Ubbink, Dirk T

2017-02-10

Shared decision-making (SDM) has been advocated as the preferred method of choosing a suitable treatment option. However, patient involvement in treatment decision-making is not yet common practice in the field of vascular surgery. The aim of this mixed-methods study was to explore patients' decision-making preferences and to investigate which facilitators and barriers patients perceive as important for the application of SDM in vascular surgery. Patients were invited to participate after visiting the vascular surgical outpatient clinic of an Academic Medical Center in the Netherlands. A treatment decision was made during the consultation for an abdominal aortic aneurysm or peripheral arterial occlusive disease. Patients filled in a number of questionnaires (quantitative part) and a random subgroup of patients participated in an in-depth interview (qualitative part). A total of 67 patients participated in this study. 58 per cent of them (n=39) indicated that they preferred a shared role in decision-making. In more than half of the patients (55%; n=37) their preferred role was in disagreement with what they had experienced. 31 per cent of the patients (n=21) preferred a more active role in the decision-making process than they had experienced. Patients indicated a good patient-doctor relationship as an important facilitator for the application of SDM. The vast majority of vascular surgical patients preferred, but did not experience a shared role in the decision-making process, although the concept of SDM was insufficiently clear to some patients. This emphasises the importance of explaining the concept of SDM and implementing it in the clinical encounter. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Evidence-informed decision-making by professionals working in addiction agencies serving women: a descriptive qualitative study.

PubMed

Jack, Susan M; Dobbins, Maureen; Sword, Wendy; Novotna, Gabriela; Brooks, Sandy; Lipman, Ellen L; Niccols, Alison

2011-11-07

Effective approaches to the prevention and treatment of substance abuse among mothers have been developed but not widely implemented. Implementation studies suggest that the adoption of evidence-based practices in the field of addictions remains low. There is a need, therefore, to better understand decision making processes in addiction agencies in order to develop more effective approaches to promote the translation of knowledge gained from addictions research into clinical practice. A descriptive qualitative study was conducted to explore: 1) the types and sources of evidence used to inform practice-related decisions within Canadian addiction agencies serving women; 2) how decision makers at different levels report using research evidence; and 3) factors that influence evidence-informed decision making. A purposeful sample of 26 decision-makers providing addiction treatment services to women completed in-depth qualitative interviews. Interview data were coded and analyzed using directed and summative content analysis strategies as well as constant comparison techniques. Across all groups, individuals reported locating and using multiple types of evidence to inform decisions. Some decision-makers rely on their experiential knowledge of addiction and recovery in decision-making. Research evidence is often used directly in decision-making at program management and senior administrative levels. Information for decision-making is accessed from a range of sources, including web-based resources and experts in the field. Individual and organizational facilitators and barriers to using research evidence in decision making were identified. There is support at administrative levels for integrating EIDM in addiction agencies. Knowledge transfer and exchange strategies should be focussed towards program managers and administrators and include capacity building for locating, appraising and using research evidence, knowledge brokering, and for partnering with universities. Resources are required to maintain web-based databases of searchable evidence to facilitate access to research evidence. A need exists to address the perception that there is a paucity of research evidence available to inform program decisions. Finally, there is a need to consider how experiential knowledge influences decision-making and what guidance research evidence has to offer regarding the implementation of different treatment approaches within the field of addictions.

Evidence-informed decision-making by professionals working in addiction agencies serving women: a descriptive qualitative study

PubMed Central

2011-01-01

Background Effective approaches to the prevention and treatment of substance abuse among mothers have been developed but not widely implemented. Implementation studies suggest that the adoption of evidence-based practices in the field of addictions remains low. There is a need, therefore, to better understand decision making processes in addiction agencies in order to develop more effective approaches to promote the translation of knowledge gained from addictions research into clinical practice. Methods A descriptive qualitative study was conducted to explore: 1) the types and sources of evidence used to inform practice-related decisions within Canadian addiction agencies serving women; 2) how decision makers at different levels report using research evidence; and 3) factors that influence evidence-informed decision making. A purposeful sample of 26 decision-makers providing addiction treatment services to women completed in-depth qualitative interviews. Interview data were coded and analyzed using directed and summative content analysis strategies as well as constant comparison techniques. Results Across all groups, individuals reported locating and using multiple types of evidence to inform decisions. Some decision-makers rely on their experiential knowledge of addiction and recovery in decision-making. Research evidence is often used directly in decision-making at program management and senior administrative levels. Information for decision-making is accessed from a range of sources, including web-based resources and experts in the field. Individual and organizational facilitators and barriers to using research evidence in decision making were identified. Conclusions There is support at administrative levels for integrating EIDM in addiction agencies. Knowledge transfer and exchange strategies should be focussed towards program managers and administrators and include capacity building for locating, appraising and using research evidence, knowledge brokering, and for partnering with universities. Resources are required to maintain web-based databases of searchable evidence to facilitate access to research evidence. A need exists to address the perception that there is a paucity of research evidence available to inform program decisions. Finally, there is a need to consider how experiential knowledge influences decision-making and what guidance research evidence has to offer regarding the implementation of different treatment approaches within the field of addictions. PMID:22059528

Integration of professional judgement and decision-making in high-level adventure sports coaching practice.

PubMed

Collins, Loel; Collins, Dave

2015-01-01

This study examined the integration of professional judgement and decision-making processes in adventure sports coaching. The study utilised a thematic analysis approach to investigate the decision-making practices of a sample of high-level adventure sports coaches over a series of sessions. Results revealed that, in order to make judgements and decisions in practice, expert coaches employ a range of practical and pedagogic management strategies to create and opportunistically use time for decision-making. These approaches include span of control and time management strategies to facilitate the decision-making process regarding risk management, venue selection, aims, objectives, session content, and differentiation of the coaching process. The implication for coaches, coach education, and accreditation is the recognition and training of the approaches that "create time" for the judgements in practice, namely "creating space to think". The paper concludes by offering a template for a more expertise-focused progression in adventure sports coaching.

[Treatment Decision-Making Process of Cancer Patients].

PubMed

Lee, Shiu-Yu C Katie

2016-10-01

The decision-making process that is used by cancer patients to determine their treatment has become more multi-foci, difficult and complicated in recent years. This has in part been attributed to the increasing incidence rate of cancer in Taiwan and the rapid development of medical technologies and treatment modalities. Oncology nurses must assist patients and family to make informed and value-based treatment decisions. Decision-making is an information process that involves appraising one's own expectation and values based on his/her knowledge on cancer and treatment options. Because cancer treatment involves risks and uncertainties, and impacts quality of life, the treatment decision-making for cancer is often stressful, or even conflicting. This paper discusses the decision-making behaviors of cancer patients and the decisional conflict, participation, and informational needs that are involved in cancer treatment. The trend toward shared decision-making and decisional support will be also explored in order to facilitate the future development of appropriate clinical interventions and research.

Shared decision making in the management of children with newly diagnosed immune thrombocytopenia.

PubMed

Beck, Carolyn E; Boydell, Katherine M; Stasiulis, Elaine; Blanchette, Victor S; Llewellyn-Thomas, Hilary; Birken, Catherine S; Breakey, Vicky R; Parkin, Patricia C

2014-10-01

This study aimed to examine the treatment decision-making process for children hospitalized with newly diagnosed immune thrombocytopenia (ITP). Using focus groups, we studied children with ITP, parents of children with ITP, and health care professionals, inquiring about participants' experience with decision support and decision making in newly diagnosed ITP. Data were examined using thematic analysis. Themes that emerged from children were feelings of "anxiety, fear, and confusion"; the need to "understand information"; and "treatment choice," the experience of which was age dependent. For parents, "anxiety, fear, and confusion" was a dominant theme; "treatment choice" revealed that participants felt directed toward intravenous immune globulin (IVIG) for initial treatment. For health care professionals, "comfort level" highlighted factors contributing to professionals' comfort with offering options; "assumptions" were made about parental desire for participation in shared decision making (SDM) and parental acceptance of treatment options; "providing information" was informative regarding modes of facilitating SDM; and "treatment choice" revealed a discrepancy between current practice (directed toward IVIG) and the ideal of SDM. At our center, families of children with newly diagnosed ITP are not experiencing SDM. Our findings support the implementation of SDM to facilitate patient-centered care for the management of pediatric ITP.

Clinical decision-making to facilitate appropriate patient management in chiropractic practice: 'the 3-questions model'.

PubMed

Amorin-Woods, Lyndon G; Parkin-Smith, Gregory F

2012-03-14

A definitive diagnosis in chiropractic clinical practice is frequently elusive, yet decisions around management are still necessary. Often, a clinical impression is made after the exclusion of serious illness or injury, and care provided within the context of diagnostic uncertainty. Rather than focussing on labelling the condition, the clinician may choose to develop a defendable management plan since the response to treatment often clarifies the diagnosis. This paper explores the concept and elements of defensive problem-solving practice, with a view to developing a model of agile, pragmatic decision-making amenable to real-world application. A theoretical framework that reflects the elements of this approach will be offered in order to validate the potential of a so called '3-Questions Model'; Clinical decision-making is considered to be a key characteristic of any modern healthcare practitioner. It is, thus, prudent for chiropractors to re-visit the concept of defensible practice with a view to facilitate capable clinical decision-making and competent patient examination skills. In turn, the perception of competence and trustworthiness of chiropractors within the wider healthcare community helps integration of chiropractic services into broader healthcare settings.

Stakeholders apply the GRADE evidence-to-decision framework to facilitate coverage decisions.

PubMed

Dahm, Philipp; Oxman, Andrew D; Djulbegovic, Benjamin; Guyatt, Gordon H; Murad, M Hassan; Amato, Laura; Parmelli, Elena; Davoli, Marina; Morgan, Rebecca L; Mustafa, Reem A; Sultan, Shahnaz; Falck-Ytter, Yngve; Akl, Elie A; Schünemann, Holger J

2017-06-01

Coverage decisions are complex and require the consideration of many factors. A well-defined, transparent process could improve decision-making and facilitate decision-maker accountability. We surveyed key US-based stakeholders regarding their current approaches for coverage decisions. Then, we held a workshop to test an evidence-to-decision (EtD) framework for coverage based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. A total of 42 individuals (including 19 US stakeholders as well as international health policymakers and GRADE working group members) attended the workshop. Of the 19 stakeholders, 14 (74%) completed the survey before the workshop. Almost all of their organizations (13 of 14; 93%) used systematic reviews for coverage decision-making; few (2 of 14; 14%) developed their own evidence synthesis; a majority (9 of 14; 64%) rated the certainty of evidence (using various systems); almost all (13 of 14; 93%) denied formal consideration of resource use; and half (7 of 14; 50%) reported explicit criteria for decision-making. At the workshop, stakeholders successfully applied the EtD framework to four case studies and provided narrative feedback, which centered on contextual factors affecting coverage decisions in the United States, the need for reliable data on subgroups of patients, and the challenge of decision-making without formal consideration of resource use. Stakeholders successfully applied the EtD framework to four case studies and highlighted contextual factors affecting coverage decisions and affirmed its value. Their input informed the further development of a revised EtD framework, now publicly available (http://gradepro.org/). Published by Elsevier Inc.

Data-Driven Decision-Making: Facilitating Teacher Use of Student Data to Inform Classroom Instruction

ERIC Educational Resources Information Center

Schifter, Catherine C.; Natarajan, Uma; Ketelhut, Diane Jass; Kirchgessner, Amanda

2014-01-01

Data-driven decision making is essential in K-12 education today, but teachers often do not know how to make use of extensive data sets. Research shows that teachers are not taught how to use extensive data (i.e., multiple data sets) to reflect on student progress or to differentiate instruction. This paper presents a process used in an National…

Psychotropic Medication Management in a Residential Group Care Program

ERIC Educational Resources Information Center

Spellman, Douglas F.; Griffith, Annette K.; Huefner, Jonathan C.; Wise, Neil, III; McElderry, Ellen; Leslie, Laurel K.

2010-01-01

This article presents a psychotropic medication management approach that is used within a residential care program. The approach is used to assess medications at youths' times of entry and to facilitate decision making during care. Data from a typical case study have indicated that by making medication management decisions slowly, systematically,…

Internet-Based Self-Help Career Assessments and Interventions: Challenges and Implications for Evidence-Based Career Counseling

ERIC Educational Resources Information Center

Gati, Itamar; Asulin-Peretz, Lisa

2011-01-01

A major characteristic of the 21st century with significant implications on career decision making is the growing prevalence of Information and Communication Technologies (ICTs). Challenges involving ICT-based self-assessment and self-help interventions aimed at facilitating career decision making are discussed. Specifically, this article focuses…

Stakeholder views of management and decision support tools to integrate climate change into Great Lakes Lake Whitefish management

USGS Publications Warehouse

Lynch, Abigail J.; Taylor, William W.; McCright, Aaron M.

2016-01-01

Decision support tools can aid decision making by systematically incorporating information, accounting for uncertainties, and facilitating evaluation between alternatives. Without user buy-in, however, decision support tools can fail to influence decision-making processes. We surveyed fishery researchers, managers, and fishers affiliated with the Lake Whitefish Coregonus clupeaformis fishery in the 1836 Treaty Waters of Lakes Huron, Michigan, and Superior to assess opinions of current and future management needs to identify barriers to, and opportunities for, developing a decision support tool based on Lake Whitefish recruitment projections with climate change. Approximately 64% of 39 respondents were satisfied with current management, and nearly 85% agreed that science was well integrated into management programs. Though decision support tools can facilitate science integration into management, respondents suggest that they face significant implementation barriers, including lack of political will to change management and perceived uncertainty in decision support outputs. Recommendations from this survey can inform development of decision support tools for fishery management in the Great Lakes and other regions.

Decision-making in nursing practice: An integrative literature review.

PubMed

Nibbelink, Christine W; Brewer, Barbara B

2018-03-01

To identify and summarise factors and processes related to registered nurses' patient care decision-making in medical-surgical environments. A secondary goal of this literature review was to determine whether medical-surgical decision-making literature included factors that appeared to be similar to concepts and factors in naturalistic decision making (NDM). Decision-making in acute care nursing requires an evaluation of many complex factors. While decision-making research in acute care nursing is prevalent, errors in decision-making continue to lead to poor patient outcomes. Naturalistic decision making may provide a framework for further exploring decision-making in acute care nursing practice. A better understanding of the literature is needed to guide future research to more effectively support acute care nurse decision-making. PubMed and CINAHL databases were searched, and research meeting criteria was included. Data were identified from all included articles, and themes were developed based on these data. Key findings in this review include nursing experience and associated factors; organisation and unit culture influences on decision-making; education; understanding patient status; situation awareness; and autonomy. Acute care nurses employ a variety of decision-making factors and processes and informally identify experienced nurses to be important resources for decision-making. Incorporation of evidence into acute care nursing practice continues to be a struggle for acute care nurses. This review indicates that naturalistic decision making may be applicable to decision-making nursing research. Experienced nurses bring a broad range of previous patient encounters to their practice influencing their intuitive, unconscious processes which facilitates decision-making. Using naturalistic decision making as a conceptual framework to guide research may help with understanding how to better support less experienced nurses' decision-making for enhanced patient outcomes. © 2017 John Wiley & Sons Ltd.

Patient Preferences regarding Shared Decision-making in the Emergency Department: Findings from a multi-site survey.

PubMed

Schoenfeld, Elizabeth M; Kanzaria, Hemal K; Quigley, Denise D; Marie, Peter St; Nayyar, Nikita; Sabbagh, Sarah H; Gress, Kyle L; Probst, Marc A

2018-06-13

As Shared Decision-Making (SDM) has received increased attention as a method to improve the patient-centeredness of emergency department (ED) care, we sought to determine patients' desired level of involvement in medical decisions and their perceptions of potential barriers and facilitators to SDM in the ED. We surveyed a cross-sectional sample of adult ED patients at three academic medical centers across the United States. The survey included 32 items regarding patient involvement in medical decisions including a modified Control Preference Scale (CPS) and questions about barriers and facilitators to SDM in the ED. Items were developed and refined based on prior literature and qualitative interviews with ED patients. Research assistants administered the survey in person. Of 797 patients approached, 661 (83%) agreed to participate. Participants were 52% female, 45% white, and 30% Hispanic. The majority of respondents (85-92%, depending on decision type) expressed a desire for some degree of involvement in decision-making in the ED, while 8-15% preferred to leave decision-making to their physician alone. Ninety-eight percent wanted to be involved with decisions when "something serious is going on." The majority of patients (94%) indicated that self-efficacy was not a barrier to SDM in the ED. However, most patients (55%) reported a tendency to defer to the physician's decision-making during an ED visit, with about half reporting they would wait for a physician to ask them to be involved. We found the majority of ED patients in our large, diverse sample wanted to be involved in medical decisions, especially in the case of a "serious" medical problem, and felt that they had the ability to do so. Nevertheless, many patients were unlikely to actively seek involvement and defaulted to allowing the physician to make decisions during the ED visit. After fully explaining the consequences of a decision, clinicians should make an effort to explicitly ascertain patients' desired level of involvement in decision-making. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Negotiation and Decision Making with Collaborative Software: How MarineMap 'Changed the Game' in California's Marine Life Protected Act Initiative.

PubMed

Cravens, Amanda E

2016-02-01

Environmental managers and planners have become increasingly enthusiastic about the potential of decision support tools (DSTs) to improve environmental decision-making processes as information technology transforms many aspects of daily life. Discussions about DSTs, however, rarely recognize the range of ways software can influence users' negotiation, problem-solving, or decision-making strategies and incentives, in part because there are few empirical studies of completed processes that used technology. This mixed-methods study-which draws on data from approximately 60 semi-structured interviews and an online survey--examines how one geospatial DST influenced participants' experiences during a multi-year marine planning process in California. Results suggest that DSTs can facilitate communication by creating a common language, help users understand the geography and scientific criteria in play during the process, aid stakeholders in identifying shared or diverging interests, and facilitate joint problem solving. The same design features that enabled the tool to aid in decision making, however, also presented surprising challenges in certain circumstances by, for example, making it difficult for participants to discuss information that was not spatially represented on the map-based interface. The study also highlights the importance of the social context in which software is developed and implemented, suggesting that the relationship between the software development team and other participants may be as important as technical software design in shaping how DSTs add value. The paper concludes with considerations to inform the future use of DSTs in environmental decision-making processes.

Negotiation and Decision Making with Collaborative Software: How MarineMap `Changed the Game' in California's Marine Life Protected Act Initiative

NASA Astrophysics Data System (ADS)

Cravens, Amanda E.

2016-02-01

Environmental managers and planners have become increasingly enthusiastic about the potential of decision support tools (DSTs) to improve environmental decision-making processes as information technology transforms many aspects of daily life. Discussions about DSTs, however, rarely recognize the range of ways software can influence users' negotiation, problem-solving, or decision-making strategies and incentives, in part because there are few empirical studies of completed processes that used technology. This mixed-methods study—which draws on data from approximately 60 semi-structured interviews and an online survey—examines how one geospatial DST influenced participants' experiences during a multi-year marine planning process in California. Results suggest that DSTs can facilitate communication by creating a common language, help users understand the geography and scientific criteria in play during the process, aid stakeholders in identifying shared or diverging interests, and facilitate joint problem solving. The same design features that enabled the tool to aid in decision making, however, also presented surprising challenges in certain circumstances by, for example, making it difficult for participants to discuss information that was not spatially represented on the map-based interface. The study also highlights the importance of the social context in which software is developed and implemented, suggesting that the relationship between the software development team and other participants may be as important as technical software design in shaping how DSTs add value. The paper concludes with considerations to inform the future use of DSTs in environmental decision-making processes.

Provider perspectives on the utility of a colorectal cancer screening decision aid for facilitating shared decision making.

PubMed

Schroy, Paul C; Mylvaganam, Shamini; Davidson, Peter

2014-02-01

Decision aids for colorectal cancer (CRC) screening have been shown to enable patients to identify a preferred screening option, but the extent to which such tools facilitate shared decision making (SDM) from the perspective of the provider is less well established. Our goal was to elicit provider feedback regarding the impact of a CRC screening decision aid on SDM in the primary care setting. Cross-sectional survey. Primary care providers participating in a clinical trial evaluating the impact of a novel CRC screening decision aid on SDM and adherence. Perceptions of the impact of the tool on decision-making and implementation issues. Twenty-nine of 42 (71%) eligible providers responded, including 27 internists and two nurse practitioners. The majority (>60%) felt that use of the tool complimented their usual approach, increased patient knowledge, helped patients identify a preferred screening option, improved the quality of decision making, saved time and increased patients' desire to get screened. Respondents were more neutral is their assessment of whether the tool improved the overall quality of the patient visit or patient satisfaction. Fewer than 50% felt that the tool would be easy to implement into their practices or that it would be widely used by their colleagues. Decision aids for CRC screening can improve the quality and efficiency of SDM from the provider perspective but future use is likely to depend on the extent to which barriers to implementation can be addressed. © 2011 John Wiley & Sons Ltd.

Development and initial evaluation of a treatment decision dashboard.

PubMed

Dolan, James G; Veazie, Peter J; Russ, Ann J

2013-04-21

For many healthcare decisions, multiple alternatives are available with different combinations of advantages and disadvantages across several important dimensions. The complexity of current healthcare decisions thus presents a significant barrier to informed decision making, a key element of patient-centered care.Interactive decision dashboards were developed to facilitate decision making in Management, a field marked by similarly complicated choices. These dashboards utilize data visualization techniques to reduce the cognitive effort needed to evaluate decision alternatives and a non-linear flow of information that enables users to review information in a self-directed fashion. Theoretically, both of these features should facilitate informed decision making by increasing user engagement with and understanding of the decision at hand. We sought to determine if the interactive decision dashboard format can be successfully adapted to create a clinically realistic prototype patient decision aid suitable for further evaluation and refinement. We created a computerized, interactive clinical decision dashboard and performed a pilot test of its clinical feasibility and acceptability using a multi-method analysis. The dashboard summarized information about the effectiveness, risks of side effects and drug-drug interactions, out-of-pocket costs, and ease of use of nine analgesic treatment options for knee osteoarthritis. Outcome evaluations included observations of how study participants utilized the dashboard, questionnaires to assess usability, acceptability, and decisional conflict, and an open-ended qualitative analysis. The study sample consisted of 25 volunteers - 7 men and 18 women - with an average age of 51 years. The mean time spent interacting with the dashboard was 4.6 minutes. Mean evaluation scores on scales ranging from 1 (low) to 7 (high) were: mechanical ease of use 6.1, cognitive ease of use 6.2, emotional difficulty 2.7, decision-aiding effectiveness 5.9, clarification of values 6.5, reduction in decisional uncertainty 6.1, and provision of decision-related information 6.0. Qualitative findings were similarly positive. Interactive decision dashboards can be adapted for clinical use and have the potential to foster informed decision making. Additional research is warranted to more rigorously test the effectiveness and efficiency of patient decision dashboards for supporting informed decision making and other aspects of patient-centered care, including shared decision making.

Economic evaluations of health technologies in Dutch healthcare decision-making: a qualitative study of the current and potential use, barriers, and facilitators.

PubMed

Roseboom, Kitty J; van Dongen, Johanna M; Tompa, Emile; van Tulder, Maurits W; Bosmans, Judith E

2017-01-26

The use of economic evaluations in healthcare decision-making can potentially help decision-makers in allocating scarce resources as efficiently as possible. Over a decade ago, the use of such studies was found to be limited in Dutch healthcare decision-making, but their current use is unknown. Therefore, this study aimed to provide insight into the current and potential use of economic evaluations in Dutch healthcare decision-making and to identify barriers and facilitators to the use of such studies. Interviews containing semi-structured and structured questions were conducted among Dutch healthcare decision-makers. Participants were purposefully selected and special efforts were made to include decision-makers working at the macro- (national), meso- (local/regional), and micro-level (patient setting). During the interviews, a topic list was used that was based on the research questions and a literature search, and was developed in consultation with the Dutch National Healthcare Institute. Responses to the semi-structured questions were analyzed using a constant comparative approach. As for the structured questions, participants' definitions of various economic evaluation concepts were scored as either being "correct" or "incorrect" by two researchers, and summary statistics were prepared. Sixteen healthcare decision-makers were interviewed and two health economists. Decision-makers' knowledge of economic evaluations was only modest, and their current use appeared to be limited. Nonetheless, decision-makers recognized the importance of economic evaluations and saw several opportunities for extending their use at the macro- and meso-level, but not at the micro-level. The disparity between the limited use and recognition of the importance of economic evaluations is likely due to the many barriers decision-makers experience preventing their use (e.g. lack of resources, lack of formal willingness-to-pay threshold). Possible facilitators for extending the use of economic evaluations include, amongst others, educating decision-makers and the general population about economic evaluations and presenting economic evaluation results in a clearer and more understandable way. This study demonstrated that the current use and impact of economic evaluations in Dutch healthcare decision-making is limited at best. Therefore, strategies are needed to overcome the barriers that currently prevent economic evaluations from being used extensively.

Right For Me: protocol for a cluster randomised trial of two interventions for facilitating shared decision-making about contraceptive methods

PubMed Central

Thompson, Rachel; Manski, Ruth; Donnelly, Kyla Z; Stevens, Gabrielle; Agusti, Daniela; Banach, Michelle; Boardman, Maureen B; Brady, Pearl; Colón Bradt, Christina; Foster, Tina; Johnson, Deborah J; Li, Zhongze; Norsigian, Judy; Nothnagle, Melissa; Olson, Ardis L; Shepherd, Heather L; Stern, Lisa F; Tosteson, Tor D; Trevena, Lyndal; Upadhya, Krishna K; Elwyn, Glyn

2017-01-01

Introduction Despite the observed and theoretical advantages of shared decision-making in a range of clinical contexts, including contraceptive care, there remains a paucity of evidence on how to facilitate its adoption. This paper describes the protocol for a study to assess the comparative effectiveness of patient-targeted and provider-targeted interventions for facilitating shared decision-making about contraceptive methods. Methods and analysis We will conduct a 2×2 factorial cluster randomised controlled trial with four arms: (1) video+prompt card, (2) decision aids+training, (3) video+prompt card and decision aids+training and (4) usual care. The clusters will be clinics in USA that deliver contraceptive care. The participants will be people who have completed a healthcare visit at a participating clinic, were assigned female sex at birth, are aged 15–49 years, are able to read and write English or Spanish and have not previously participated in the study. The primary outcome will be shared decision-making about contraceptive methods. Secondary outcomes will be the occurrence of a conversation about contraception in the healthcare visit, satisfaction with the conversation about contraception, intended contraceptive method(s), intention to use a highly effective method, values concordance of the intended method(s), decision regret, contraceptive method(s) used, use of a highly effective method, use of the intended method(s), adherence, satisfaction with the method(s) used, unintended pregnancy and unwelcome pregnancy. We will collect study data via longitudinal patient surveys administered immediately after the healthcare visit, four weeks later and six months later. Ethics and dissemination We will disseminate results via presentations at scientific and professional conferences, papers published in peer-reviewed, open-access journals and scientific and lay reports. We will also make an anonymised copy of the final participant-level dataset available to others for research purposes. Trial registration number ClinicalTrials.gov Identifier: NCT02759939. PMID:29061624

Factors and outcomes of decision making for cancer clinical trial participation.

PubMed

Biedrzycki, Barbara A

2011-09-01

To describe factors and outcomes related to the decision-making process regarding participation in a cancer clinical trial. Cross-sectional, descriptive. Urban, academic, National Cancer Institute-designated comprehensive cancer center in the mid-Atlantic United States. 197 patients with advanced gastrointestinal cancer. Mailed survey using one investigator-developed instrument, eight instruments used in published research, and a medical record review. disease context, sociodemographics, hope, quality of life, trust in healthcare system, trust in health professional, preference for research decision control, understanding risks, and information. decision to accept or decline research participation and satisfaction with this decision. All of the factors within the Research Decision Making Model together predicted cancer clinical trial participation and satisfaction with this decision. The most frequently preferred decision-making style for research participation was shared (collaborative) (83%). Multiple factors affect decision making for cancer clinical trial participation and satisfaction with this decision. Shared decision making previously was an unrecognized factor and requires further investigation. Enhancing the process of research decision making may facilitate an increase in cancer clinical trial enrollment rates. Oncology nurses have unique opportunities as educators and researchers to support shared decision making by those who prefer this method for deciding whether to accept or decline cancer clinical trial participation.

Nanomaterial categorization for assessing risk potential to facilitate regulatory decision-making.

PubMed

Godwin, Hilary; Nameth, Catherine; Avery, David; Bergeson, Lynn L; Bernard, Daniel; Beryt, Elizabeth; Boyes, William; Brown, Scott; Clippinger, Amy J; Cohen, Yoram; Doa, Maria; Hendren, Christine Ogilvie; Holden, Patricia; Houck, Keith; Kane, Agnes B; Klaessig, Frederick; Kodas, Toivo; Landsiedel, Robert; Lynch, Iseult; Malloy, Timothy; Miller, Mary Beth; Muller, Julie; Oberdorster, Gunter; Petersen, Elijah J; Pleus, Richard C; Sayre, Philip; Stone, Vicki; Sullivan, Kristie M; Tentschert, Jutta; Wallis, Philip; Nel, Andre E

2015-01-01

For nanotechnology to meet its potential as a game-changing and sustainable technology, it is important to ensure that the engineered nanomaterials and nanoenabled products that gain entry to the marketplace are safe and effective. Tools and methods are needed for regulatory purposes to allow rapid material categorization according to human health and environmental risk potential, so that materials of high concern can be targeted for additional scrutiny, while material categories that pose the least risk can receive expedited review. Using carbon nanotubes as an example, we discuss how data from alternative testing strategies can be used to facilitate engineered nanomaterial categorization according to risk potential and how such an approach could facilitate regulatory decision-making in the future.

Multiple perspectives on shared decision-making and interprofessional collaboration in mental healthcare.

PubMed

Chong, Wei Wen; Aslani, Parisa; Chen, Timothy F

2013-05-01

Shared decision-making is an essential element of patient-centered care in mental health. Since mental health services involve healthcare providers from different professions, a multiple perspective to shared decision-making may be valuable. The objective of this study was to explore the perceptions of different healthcare professionals on shared decision-making and current interprofessional collaboration in mental healthcare. Semi-structured interviews were conducted with 31 healthcare providers from a range of professions, which included medical practitioners (psychiatrists, general practitioners), pharmacists, nurses, occupational therapists, psychologists and social workers. Findings indicated that healthcare providers supported the notion of shared decision-making in mental health, but felt that it should be condition dependent. Medical practitioners advocated a more active participation from consumers in treatment decision-making; whereas other providers (e.g. pharmacists, occupational therapists) focused more toward acknowledging consumers' needs in decisions, perceiving themselves to be in an advisory role in supporting consumers' decision-making. Although healthcare providers acknowledged the importance of interprofessional collaboration, only a minority discussed it within the context of shared decision-making. In conclusion, healthcare providers appeared to have differing perceptions on the level of consumer involvement in shared decision-making. Interprofessional roles to facilitate shared decision-making in mental health need to be acknowledged, understood and strengthened, before an interprofessional approach to shared decision-making in mental health can be effectively implemented.

Perspectives of adolescents on decision making about participation in a biobank study: a pilot study.

PubMed

Grootens-Wiegers, Petronella; Visser, Eline G; van Rossum, Annemarie M C; van Waardhuizen, Claudia N; de Wildt, Saskia N; Sweep, Boudewijn; van den Broek, Jos M; de Vries, Martine C

2017-01-01

To be able to truly involve adolescents in decision making about clinical research participation, we need more insight in the perspective of adolescents themselves. To this end, adolescents in an ongoing biobank study were consulted to test a tentative decision assessment tool. The perspectives of adolescents (n=8) concerning participation in decision making for research participation were explored in interviews with a tentative tool, which covered six topics: information material usage, understanding, disease perceptions, anxiety, decision-making process and role sharing. All adolescents unequivocally expressed the desire to be involved in decision making, but also wanted advice from their parents. The extent of the preferred role of adolescent versus parents varied between individuals. In decision making, adolescents relied on parents for information. More than half hardly used the information material. Adolescents in our study preferred a shared decision-making process. The extent of sharing varied between individuals. The decision assessment tool was a fruitful starting point to discuss adolescents' perspectives and may aid in tailoring the situation to the individual to achieve optimal participation practices. Consulting adolescents about their preferences concerning decision making using the tool will facilitate tailoring of the shared decision-making process and optimising the developing autonomy of minors.

Decision insight into stakeholder conflict for ERN.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Siirola, John; Tidwell, Vincent Carroll; Benz, Zachary O.

Participatory modeling has become an important tool in facilitating resource decision making and dispute resolution. Approaches to modeling that are commonly used in this context often do not adequately account for important human factors. Current techniques provide insights into how certain human activities and variables affect resource outcomes; however, they do not directly simulate the complex variables that shape how, why, and under what conditions different human agents behave in ways that affect resources and human interactions related to them. Current approaches also do not adequately reveal how the effects of individual decisions scale up to have systemic level effectsmore » in complex resource systems. This lack of integration prevents the development of more robust models to support decision making and dispute resolution processes. Development of integrated tools is further hampered by the fact that collection of primary data for decision-making modeling is costly and time consuming. This project seeks to develop a new approach to resource modeling that incorporates both technical and behavioral modeling techniques into a single decision-making architecture. The modeling platform is enhanced by use of traditional and advanced processes and tools for expedited data capture. Specific objectives of the project are: (1) Develop a proof of concept for a new technical approach to resource modeling that combines the computational techniques of system dynamics and agent based modeling, (2) Develop an iterative, participatory modeling process supported with traditional and advance data capture techniques that may be utilized to facilitate decision making, dispute resolution, and collaborative learning processes, and (3) Examine potential applications of this technology and process. The development of this decision support architecture included both the engineering of the technology and the development of a participatory method to build and apply the technology. Stakeholder interaction with the model and associated data capture was facilitated through two very different modes of engagement, one a standard interface involving radio buttons, slider bars, graphs and plots, while the other utilized an immersive serious gaming interface. The decision support architecture developed through this project was piloted in the Middle Rio Grande Basin to examine how these tools might be utilized to promote enhanced understanding and decision-making in the context of complex water resource management issues. Potential applications of this architecture and its capacity to lead to enhanced understanding and decision-making was assessed through qualitative interviews with study participants who represented key stakeholders in the basin.« less

The Influence of Temporal Orientation and Affective Frame on use of Ethical Decision-Making Strategies

PubMed Central

Martin, Laura E.; Stenmark, Cheryl K.; Thiel, Chase E.; Antes, Alison L.; Mumford, Michael D.; Connelly, Shane; Devenport, Lynn D.

2011-01-01

This study examined the role of temporal orientation and affective frame in the execution of ethical decision-making strategies. In reflecting on a past experience or imagining a future experience, participants thought about experiences that they considered either positive or negative. The participants recorded their thinking about that experience by responding to several questions, and their responses were content-analyzed for the use of ethical decision-making strategies. The findings indicated that a future temporal orientation was associated with greater strategy use. Likewise, a positive affective frame was associated with greater strategy use. Future orientation may permit better strategy execution than a past orientation because it facilitates more objective, balanced contemplation of the reflected-upon situation, and minimizes potential self-threat associated with past behavior. A positive affective frame likely improves strategy execution because it facilitates active analysis of the experience. Future directions and implications of these findings are discussed. PMID:21572582

Temporal lobe epilepsy surgery: what do patients want to know?

PubMed

Choi, Hyunmi; Pargeon, Kim; Bausell, Rebecca; Wong, John B; Mendiratta, Anil; Bakken, Suzanne

2011-11-01

Patients with pharmacoresistant temporal lobe epilepsy (TLE) contemplating brain surgery must make a complex treatment decision involving trade-offs. Patient decision aids, containing information on the risks and benefits of treatment interventions, increase patient knowledge and facilitate shared decision making between patients and physicians. We conducted five focus groups to describe the information patients need to make informed decisions about TLE surgery. Twenty patients who had undergone TLE surgery described the information used in their decision-making process, and evaluated the potential for a patient decision aid to assist other patients who are considering surgery. Thematic analysis revealed information needs that were both experiential (i.e., learning about other patients' experiences through testimonials) and factual (i.e., individualized statistical information). Patients also made suggestions on how this information should be delivered to patients. These data will accelerate the development of a patient decision aid designed to assist TLE patients in their decision making about epilepsy surgery. Copyright © 2011 Elsevier Inc. All rights reserved.

75 FR 6237 - Self-Regulatory Organizations; International Securities Exchange, LLC; Notice of Filing of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-08

... additional one hour after the decision making cut off time of 5:30 p.m. to submit a CEA to the various.... The Exchange will continue to enforce the 5:30 p.m. decision making requirement, while also allowing..., processing information with respect to, and facilitating transactions in securities, to remove impediments to...

The Validation of the Caretaker Readiness Questionnaire: Factors Related to Caretaker Knowledge and Opinions of Exceptional Student Education Services

ERIC Educational Resources Information Center

Wimes, Cassaundra T.

2009-01-01

This study sought to validate measures of caretaker readiness to facilitate meaningful participation in the Exceptional Student Education (ESE) educational decision-making process. School districts have encountered great difficulty in achieving the federal standards for meaningful participation in educational decision making due to a lack of…

Public Marketing: An Alternative Policy Decision-Making Idea for Small Cities. Community Development Research Series.

ERIC Educational Resources Information Center

Meyers, James; And Others

The concept of public marketing presents a strategy for the systems approach to community development that would facilitate the community decision making process via improved communication. Basic aspects of the social marketing process include: (1) product policy; (2) channels of distribution; (3) pricing (perceived price vs quality and quantity…

The Academic Game. A Simulation of Policy-Making in a University For 8 to 20 Players.

ERIC Educational Resources Information Center

Jaques, David

The Academic Game, considered a valuable exercise for academics and administrators in investigating some of the problems of decision-making and possible ways of facilitating organizational decisions, is described. The major objective of the game is to achieve on agreed promotion policy. The roles and organization structure are designed to ensure…

Examining Data-Driven Decision Making in Private/Religious Schools

ERIC Educational Resources Information Center

Hanks, Jason Edward

2011-01-01

The purpose of this study was to investigate non-mandated data-driven decision making in private/religious schools. The school culture support of data use, teacher use of data, leader facilitation of using data, and the availability of data were investigated in three schools. A quantitative survey research design was used to explore the research…

Linguistic multi-criteria decision-making with representing semantics by programming

NASA Astrophysics Data System (ADS)

Yang, Wu-E.; Ma, Chao-Qun; Han, Zhi-Qiu

2017-01-01

A linguistic multi-criteria decision-making method is introduced. In this method, a maximising discrimination programming assigns the semanteme values to linguistic variables to represent their semantics. Incomplete preferences from using linguistic information are expressed by the constraints of the model. Such assignment can amplify the difference between alternatives. Thus, the discrimination of the decision model is increased, which facilitates the decision-maker to rank or order the alternatives for making a decision. We also discuss the parameter setting and its influence, and use an application example to illustrate the proposed method. Further, the results with three types of semantic structure highlight the ability of the method in handling different semantic structures.

Family planning decisions for parents of children with a rare genetic condition: A scoping review.

PubMed

Gee, Melanie; Piercy, Hilary; Machaczek, Katarzyna

2017-12-01

Expansion of newborn screening programmes increases the complexity around reproductive choices, both in terms of the increased number of parents faced with making reproductive decisions from the earliest days of their affected child's life, and the number of conditions for which such decisions have to be made. We conducted a scoping review to explore: (i) reproductive decision-making among parents of children with recessive genetic conditions; and, (ii) the involvement of healthcare services in facilitating and supporting those decisions. Systematic search processes involved seven bibliographic databases, citation, and grey literature searches. From an initial total of 311 identified articles, seven met the inclusion criteria and were included in the review. The extracted data were organised around three themes: factors influencing reproductive decisions taken by parents, how those factors changed over time, and the involvement of healthcare services in supporting and facilitating reproductive decisions. Most studies focused on attitudes towards, and uptake of, pre-natal diagnosis (PND) and termination. None of the studies considered the wider range of reproductive choices facing all parents, including those of children with conditions for whom PND and termination is not available or where good health outcomes make these options less justifiable. The literature provided little insight into the role of healthcare staff in providing family planning support for these parents. There is a need to better understand the support parents need in their decision-making, and who is best placed to provide that support. Copyright © 2017 Elsevier B.V. All rights reserved.

Spillover Effects of Loss of Control on Risky Decision-Making

PubMed Central

Beisswingert, Birgit M.; Zhang, Keshun; Goetz, Thomas; Fischbacher, Urs

2016-01-01

Decision making in risky situations is frequently required in our everyday lives and has been shown to be influenced by various factors, some of which are independent of the risk context. Based on previous findings and theories about the central role of perceptions of control and their impact on subsequent settings, spillover effects of subjective loss of control on risky decision-making are assumed. After developing an innovative experimental paradigm for inducing loss of control, its hypothesized effects on risky decision-making are investigated. Partially supporting the hypotheses, results demonstrated no increased levels of risk perceptions but decreased risk-taking behavior following experiences of loss of control. Thus, this study makes a methodological contribution by proposing a newly developed experimental paradigm facilitating further research on the effects of subjective loss of control, and additionally provides partial evidence for the spillover effects of loss of control experiences on risky decision-making. PMID:26930066

Effect of emotional arousal on inter-temporal decision-making: an fMRI study.

PubMed

Sohn, Jin-Hun; Kim, Hyo-Eun; Sohn, Sunju; Seok, Ji-Woo; Choi, Damee; Watanuki, Shigeki

2015-03-07

Previous research has shown that emotion can significantly impact decision-making in humans. The current study examined whether or not and how situationally induced emotion influences people to make inter-temporal choices. Affective pictures were used as experiment stimuli to provoke emotion, immediately followed by subjects' performance of a delay-discounting task to measure impulsivity during functional magnetic resonance imaging. Results demonstrate a subsequent process of increased impulsive decision-making following a prior exposure to both high positive and negative arousal stimuli, compared to the experiment subjects' experiences with neutral stimuli. Findings indicate that increased impulsive decision-making behaviors can occur with high arousal and can be characterized by decreased activities in the cognitive control regions such as prefronto-parietal regions. These results suggest that 'stabilization of high emotional arousal' may facilitate a reduction of impulsive decision-making and implementation of longer term goals.

A canonical theory of dynamic decision-making.

PubMed

Fox, John; Cooper, Richard P; Glasspool, David W

2013-01-01

Decision-making behavior is studied in many very different fields, from medicine and economics to psychology and neuroscience, with major contributions from mathematics and statistics, computer science, AI, and other technical disciplines. However the conceptualization of what decision-making is and methods for studying it vary greatly and this has resulted in fragmentation of the field. A theory that can accommodate various perspectives may facilitate interdisciplinary working. We present such a theory in which decision-making is articulated as a set of canonical functions that are sufficiently general to accommodate diverse viewpoints, yet sufficiently precise that they can be instantiated in different ways for specific theoretical or practical purposes. The canons cover the whole decision cycle, from the framing of a decision based on the goals, beliefs, and background knowledge of the decision-maker to the formulation of decision options, establishing preferences over them, and making commitments. Commitments can lead to the initiation of new decisions and any step in the cycle can incorporate reasoning about previous decisions and the rationales for them, and lead to revising or abandoning existing commitments. The theory situates decision-making with respect to other high-level cognitive capabilities like problem solving, planning, and collaborative decision-making. The canonical approach is assessed in three domains: cognitive and neuropsychology, artificial intelligence, and decision engineering.

A Canonical Theory of Dynamic Decision-Making

PubMed Central

Fox, John; Cooper, Richard P.; Glasspool, David W.

2012-01-01

Decision-making behavior is studied in many very different fields, from medicine and economics to psychology and neuroscience, with major contributions from mathematics and statistics, computer science, AI, and other technical disciplines. However the conceptualization of what decision-making is and methods for studying it vary greatly and this has resulted in fragmentation of the field. A theory that can accommodate various perspectives may facilitate interdisciplinary working. We present such a theory in which decision-making is articulated as a set of canonical functions that are sufficiently general to accommodate diverse viewpoints, yet sufficiently precise that they can be instantiated in different ways for specific theoretical or practical purposes. The canons cover the whole decision cycle, from the framing of a decision based on the goals, beliefs, and background knowledge of the decision-maker to the formulation of decision options, establishing preferences over them, and making commitments. Commitments can lead to the initiation of new decisions and any step in the cycle can incorporate reasoning about previous decisions and the rationales for them, and lead to revising or abandoning existing commitments. The theory situates decision-making with respect to other high-level cognitive capabilities like problem solving, planning, and collaborative decision-making. The canonical approach is assessed in three domains: cognitive and neuropsychology, artificial intelligence, and decision engineering. PMID:23565100

Improving Access to and Understanding of Regulations through Taxonomies

ERIC Educational Resources Information Center

Cheng, Chin Pang; Lau. Gloria T.; Law, Kincho H.; Pan, Jiayi; Jones, Albert

2009-01-01

Industrial taxonomies have the potential to automate information retrieval, facilitate interoperability and, most importantly, improve decision making - decisions that must comply with existing government regulations and codes of practice. However, it is difficult to find those regulations and codes most relevant to a particular decision, even…

Multi-criteria decision analysis for health technology assessment in Canada: insights from an expert panel discussion.

PubMed

Diaby, Vakaramoko; Goeree, Ron; Hoch, Jeffrey; Siebert, Uwe

2015-02-01

Multi-criteria decision analysis (MCDA), a decision-making tool, has received increasing attention in recent years, notably in the healthcare field. For Canada, it is unclear whether and how MCDA should be incorporated into the existing health technology assessment (HTA) decision-making process. To facilitate debate on improving HTA decision-making in Canada, a workshop was held in conjunction with the 8th World Congress on Health Economics of the International Health Economics Association in Toronto, Canada in July 2011. The objective of the workshop was to discuss the potential benefits and challenges related to the use of MCDA for HTA decision-making in Canada. This paper summarizes and discusses the recommendations of an expert panel convened at the workshop to discuss opportunities and concerns with reference to the implementation of MCDA in Canada.

Decision-making of older patients in context of the doctor-patient relationship: a typology ranging from "self-determined" to "doctor-trusting" patients.

PubMed

Wrede-Sach, Jennifer; Voigt, Isabel; Diederichs-Egidi, Heike; Hummers-Pradier, Eva; Dierks, Marie-Luise; Junius-Walker, Ulrike

2013-01-01

Background. This qualitative study aims to gain insight into the perceptions and experiences of older patients with regard to sharing health care decisions with their general practitioners. Patients and Methods. Thirty-four general practice patients (≥70 years) were asked about their preferences and experiences concerning shared decision making with their doctors using qualitative semistructured interviews. All interviews were analysed according to principles of content analysis. The resulting categories were then arranged into a classification grid to develop a typology of preferences for participating in decision-making processes. Results. Older patients generally preferred to make decisions concerning everyday life rather than medical decisions, which they preferred to leave to their doctors. We characterised eight different patient types based on four interdependent positions (self-determination, adherence, information seeking, and trust). Experiences of a good doctor-patient relationship were associated with trust, reliance on the doctor for information and decision making, and adherence. Conclusion. Owing to the varied patient decision-making types, it is not easy for doctors to anticipate the desired level of patient involvement. However, the decision matter and the self-determination of patients provide good starting points in preparing the ground for shared decision making. A good relationship with the doctor facilitates satisfying decision-making experiences.

Caring and Sharing: Becoming a Peer Facilitator.

ERIC Educational Resources Information Center

Myrick, Robert D.; Erney, Tom

This book contains information and skill-building activities designed to train adolescents as peer facilitators. The first chapter describes peer facilitation and provides an overview of the book. The second chapter discusses principles, concepts, and ideas to help better understand how people learn, make decisions, change, and develop their own…

Perceptions of shared decision making and decision aids among rural primary care clinicians.

PubMed

King, Valerie J; Davis, Melinda M; Gorman, Paul N; Rugge, J Bruin; Fagnan, L J

2012-01-01

Shared decision making (SDM) and decision aids (DAs) increase patients' involvement in health care decisions and enhance satisfaction with their choices. Studies of SDM and DAs have primarily occurred in academic centers and large health systems, but most primary care is delivered in smaller practices, and over 20% of Americans live in rural areas, where poverty, disease prevalence, and limited access to care may increase the need for SDM and DAs. To explore perceptions and practices of rural primary care clinicians regarding SDM and DAs. Cross-sectional survey. Setting and Participants Primary care clinicians affiliated with the Oregon Rural Practice-based Research Network. Surveys were returned by 181 of 231 eligible participants (78%); 174 could be analyzed. Two-thirds of participants were physicians, 84% practiced family medicine, and 55% were male. Sixty-five percent of respondents were unfamiliar with the term shared decision making, but following definition, 97% reported that they found the approach useful for conditions with multiple treatment options. Over 90% of clinicians perceived helping patients make decisions regarding chronic pain and health behavior change as moderate/hard in difficulty. Although 69% of respondents preferred that patients play an equal role in making decisions, they estimate that this happens only 35% of the time. Time was reported as the largest barrier to engaging in SDM (63%). Respondents were receptive to using DAs to facilitate SDM in print- (95%) or web-based formats (72%), and topic preference varied by clinician specialty and decision difficulty. Rural clinicians recognized the value of SDM and were receptive to using DAs in multiple formats. Integration of DAs to facilitate SDM in routine patient care may require addressing practice operation and reimbursement.

A new web-based framework development for fuzzy multi-criteria group decision-making.

PubMed

Hanine, Mohamed; Boutkhoum, Omar; Tikniouine, Abdessadek; Agouti, Tarik

2016-01-01

Fuzzy multi-criteria group decision making (FMCGDM) process is usually used when a group of decision-makers faces imprecise data or linguistic variables to solve the problems. However, this process contains many methods that require many time-consuming calculations depending on the number of criteria, alternatives and decision-makers in order to reach the optimal solution. In this study, a web-based FMCGDM framework that offers decision-makers a fast and reliable response service is proposed. The proposed framework includes commonly used tools for multi-criteria decision-making problems such as fuzzy Delphi, fuzzy AHP and fuzzy TOPSIS methods. The integration of these methods enables taking advantages of the strengths and complements each method's weakness. Finally, a case study of location selection for landfill waste in Morocco is performed to demonstrate how this framework can facilitate decision-making process. The results demonstrate that the proposed framework can successfully accomplish the goal of this study.

Family Communication about End-of-Life Decisions and the Enactment of the Decision-Maker Role.

PubMed

Trees, April R; Ohs, Jennifer E; Murray, Meghan C

2017-06-07

End-of-life (EOL) decisions in families are complex and emotional sites of family interaction necessitating family members coordinate roles in the EOL decision-making process. How family members in the United States enact the decision-maker role in EOL decision situations was examined through in-depth interviews with 22 individuals who participated in EOL decision-making for a family member. A number of themes emerged from the data with regard to the enactment of the decision-maker role. Families varied in how decision makers enacted the role in relation to collective family input, with consulting, informing and collaborating as different patterns of behavior. Formal family roles along with gender- and age-based roles shaped who took on the decision-maker role. Additionally, both family members and medical professionals facilitated or undermined the decision-maker's role enactment. Understanding the structure and enactment of the decision-maker role in family interaction provides insight into how individuals and/or family members perform the decision-making role within a cultural context that values autonomy and self-determination in combination with collective family action in EOL decision-making.

Development of a Shared Decision Making coding system for analysis of patient-healthcare provider encounters

PubMed Central

Clayman, Marla L.; Makoul, Gregory; Harper, Maya M.; Koby, Danielle G.; Williams, Adam R.

2012-01-01

Objectives Describe the development and refinement of a scheme, Detail of Essential Elements and Participants in Shared Decision Making (DEEP-SDM), for coding Shared Decision Making (SDM) while reporting on the characteristics of decisions in a sample of patients with metastatic breast cancer. Methods The Evidence-Based Patient Choice instrument was modified to reflect Makoul and Clayman’s Integrative Model of SDM. Coding was conducted on video recordings of 20 women at the first visit with their medical oncologists after suspicion of disease progression. Noldus Observer XT v.8, a video coding software platform, was used for coding. Results The sample contained 80 decisions (range: 1-11), divided into 150 decision making segments. Most decisions were physician-led, although patients and physicians initiated similar numbers of decision-making conversations. Conclusion DEEP-SDM facilitates content analysis of encounters between women with metastatic breast cancer and their medical oncologists. Despite the fractured nature of decision making, it is possible to identify decision points and to code each of the Essential Elements of Shared Decision Making. Further work should include application of DEEP-SDM to non-cancer encounters. Practice Implications: A better understanding of how decisions unfold in the medical encounter can help inform the relationship of SDM to patient-reported outcomes. PMID:22784391

A potential role of reward and punishment in the facilitation of the emotion-cognition dichotomy in the Iowa Gambling Task.

PubMed

Singh, Varsha

2013-01-01

The Iowa Gambling Task (IGT) is based on the assumption that a decision maker is equally motivated to seek reward and avoid punishment, and that decision making is governed solely by the intertemporal attribute (i.e., preference for an option that produces an immediate outcome instead of one that yields a delayed outcome is believed to reflect risky decision making and is considered a deficit). It was assumed in the present study that the emotion- and cognition-based processing dichotomy manifests in the IGT as reward and punishment frequency and the intertemporal attribute. It was further proposed that the delineation of emotion- and cognition-based processing is contingent upon reward and punishment as manifested in the frame of the task (variant type) and task motivation (instruction type). The effects of IGT variant type (reward vs. punishment) and instruction type (task motivation induced by instruction types: reward, punishment, reward and punishment, or no hint) on the intertemporal and frequency attributes of IGT decision-making were analyzed. Decision making in the reward variant was equally governed by both attributes, and significantly affected by instruction type, while decision making in the punishment variant was differentially affected by the two attributes and not significantly impacted by instruction type. These results suggest that reward and punishment manifested via task frame as well as the task motivation may facilitate the differentiation of emotion- and cognition-based processing in the IGT.

A potential role of reward and punishment in the facilitation of the emotion-cognition dichotomy in the Iowa Gambling Task

PubMed Central

Singh, Varsha

2013-01-01

The Iowa Gambling Task (IGT) is based on the assumption that a decision maker is equally motivated to seek reward and avoid punishment, and that decision making is governed solely by the intertemporal attribute (i.e., preference for an option that produces an immediate outcome instead of one that yields a delayed outcome is believed to reflect risky decision making and is considered a deficit). It was assumed in the present study that the emotion- and cognition-based processing dichotomy manifests in the IGT as reward and punishment frequency and the intertemporal attribute. It was further proposed that the delineation of emotion- and cognition-based processing is contingent upon reward and punishment as manifested in the frame of the task (variant type) and task motivation (instruction type). The effects of IGT variant type (reward vs. punishment) and instruction type (task motivation induced by instruction types: reward, punishment, reward and punishment, or no hint) on the intertemporal and frequency attributes of IGT decision-making were analyzed. Decision making in the reward variant was equally governed by both attributes, and significantly affected by instruction type, while decision making in the punishment variant was differentially affected by the two attributes and not significantly impacted by instruction type. These results suggest that reward and punishment manifested via task frame as well as the task motivation may facilitate the differentiation of emotion- and cognition-based processing in the IGT. PMID:24381567

Prospective Architectures for Onboard vs Cloud-Based Decision Making for Unmanned Aerial Systems

NASA Technical Reports Server (NTRS)

Sankararaman, Shankar; Teubert, Christopher

2017-01-01

This paper investigates propsective architectures for decision-making in unmanned aerial systems. When these unmanned vehicles operate in urban environments, there are several sources of uncertainty that affect their behavior, and decision-making algorithms need to be robust to account for these different sources of uncertainty. It is important to account for several risk-factors that affect the flight of these unmanned systems, and facilitate decision-making by taking into consideration these various risk-factors. In addition, there are several technical challenges related to autonomous flight of unmanned aerial systems; these challenges include sensing, obstacle detection, path planning and navigation, trajectory generation and selection, etc. Many of these activities require significant computational power and in many situations, all of these activities need to be performed in real-time. In order to efficiently integrate these activities, it is important to develop a systematic architecture that can facilitate real-time decision-making. Four prospective architectures are discussed in this paper; on one end of the spectrum, the first architecture considers all activities/computations being performed onboard the vehicle whereas on the other end of the spectrum, the fourth and final architecture considers all activities/computations being performed in the cloud, using a new service known as Prognostics as a Service that is being developed at NASA Ames Research Center. The four different architectures are compared, their advantages and disadvantages are explained and conclusions are presented.

The School Psychologist as a Facilitator of Parent Involvement in Decisions Concerning Their Children. An Overview.

ERIC Educational Resources Information Center

Lapides, Joseph

Factors influencing decision making are reviewed, and strategies which a school psychologist can use to increase parent involvement in decisions about their handicapped children are delineated. It is explained that four types of interventions are effective in promoting parental involvement: decision counseling, the balance sheet schema to help…

Models based on value and probability in health improve shared decision making.

PubMed

Ortendahl, Monica

2008-10-01

Diagnostic reasoning and treatment decisions are a key competence of doctors. A model based on values and probability provides a conceptual framework for clinical judgments and decisions, and also facilitates the integration of clinical and biomedical knowledge into a diagnostic decision. Both value and probability are usually estimated values in clinical decision making. Therefore, model assumptions and parameter estimates should be continually assessed against data, and models should be revised accordingly. Introducing parameter estimates for both value and probability, which usually pertain in clinical work, gives the model labelled subjective expected utility. Estimated values and probabilities are involved sequentially for every step in the decision-making process. Introducing decision-analytic modelling gives a more complete picture of variables that influence the decisions carried out by the doctor and the patient. A model revised for perceived values and probabilities by both the doctor and the patient could be used as a tool for engaging in a mutual and shared decision-making process in clinical work.

A Pilot Study of Neonatologists' Decision-Making Roles in Delivery Room Resuscitation Counseling for Periviable Births.

PubMed

Tucker Edmonds, Brownsyne; McKenzie, Fatima; Panoch, Janet E; White, Douglas B; Barnato, Amber E

2016-07-01

Relatively little is known about neonatologists' roles in helping families navigate the difficult decision to attempt or withhold resuscitation for a neonate delivering at the threshold of viability. Therefore, we aimed to describe the "decision-making role" of neonatologists in simulated periviable counseling sessions. We conducted a qualitative content analysis of audio-recorded simulation encounters and post-encounter debriefing interviews collected as part of a single-center simulation study of neonatologists' resuscitation counseling practices in the face of ruptured membranes at 23 weeks gestation. We trained standardized patients to request a recommendation if the physician presented multiple treatment options. We coded each encounter for communication behaviors, applying an adapted, previously developed coding scheme to classify physicians into four decision-making roles (informative, facilitative, collaborative, or directive). We also coded post-simulation debriefing interviews for responses to the open-ended prompt: "During this encounter, what did you feel was your role in the management decision-making process?" Fifteen neonatologists (33% of the division) participated in the study; audio-recorded debriefing interviews were available for 13. We observed 9 (60%) take an informative role, providing medical information only; 2 (13%) take a facilitative role, additionally eliciting the patient's values; 3 (20%) take a collaborative role, additionally engaging the patient in deliberation and providing a recommendation; and 1 (7%) take a directive role, making a treatment decision independent of the patient. Almost all (10/13, 77%) of the neonatologists described their intended role as informative. Neonatologists did not routinely elicit preferences, engage in deliberation, or provide treatment recommendations-even in response to requests for recommendations. These findings suggest there may be a gap between policy recommendations calling for shared decision making and actual clinical practice.

Values, Valuing, and Evaluation. Research on Evaluation Program, Paper and Report Series. Interim Draft.

ERIC Educational Resources Information Center

Gephart, William J.

The paper discusses the meaning of value and valuing, their roles in evaluation, and the potency of value systems in problem solving logic. Evaluation is defined as a process for facilitating decision making. A decision making situation occurs when there are options which are impossible to treat equivalently, and there is an impact in the…

The Keirsey Temperament Model: A Model for Helping Educational Administrators Facilitate Ethical Decision Making

ERIC Educational Resources Information Center

Mills, Roxanne

2006-01-01

Administrators in any field are often called upon to make decisions involving ethical considerations, but are not always well prepared or prone to do so. This situation of being faced with ethical concerns is perhaps more true for educational administrators than for leaders in other arenas. Not only are administrators at school, since they deal…

Children's participation in consultations and decision-making at health service level: a review of the literature.

PubMed

Coyne, Imelda

2008-11-01

The past decade has seen a growing recognition in Ireland and internationally that children and young people have a right to participate in matters that affect their lives. To critique the research literature on children's, parents and healthcare professionals' experiences of children's participation in consultations and decision-making within the healthcare setting. The literature was obtained from electronic databases, books, and journals focusing on work published in between 1993 and 2007. Despite the importance of consulting with sick children, their views are rarely sought nor acknowledged within the healthcare setting. Children are rarely involved in decision-making process and appear to occupy a marginalized position in healthcare encounters. Healthcare professionals and parents play a significant influence on whether children's efforts to participate are facilitated and supported in the hospital setting. There is a need for further research to explore health professionals' and parents' perspectives on children's participation in consultations and decision-making, as clearly they have reservations/concerns about children's active involvement in such matters. This information could be used to develop guidelines that will assist professionals and parents in facilitating and supporting children's participation.

'Sometimes people let love conquer them': how love, intimacy, and trust in relationships between men who have sex with men influence perceptions of sexual risk and sexual decision-making.

PubMed

Goldenberg, Tamar; Finneran, Catherine; Andes, Karen L; Stephenson, Rob

2015-01-01

Men who have sex with men account for a disproportionate burden of HIV incidence in the USA. Although much research has examined the drivers of sexual risk-taking, the emotional contexts in which men make sexual decisions has received little attention. In this three-phase, 10-week longitudinal qualitative study involving 25 gay and bisexual men, we used timeline-based interviews and quantitative web-based diaries about sexual and/or dating partners to examine how emotions influence HIV risk perceptions and sexual decision-making. Participants described love, intimacy, and trust as reducing HIV risk perceptions and facilitating engagement in condomless anal intercourse. Lust was not as linked with risk perceptions, but facilitated non condom-use through an increased willingness to engage in condomless anal intercourse, despite perceptions of risk. Results indicate that gay and bisexual men do not make sexual decisions in an emotional vacuum. Emotions influence perceptions of risk so that they do not necessarily align with biological risk factors. Emotional influences, especially the type and context of emotions, are important to consider to improve HIV prevention efforts among gay and bisexual men.

'Walking the tightrope': The role of peer support workers in facilitating consumers' participation in decision-making.

PubMed

Cleary, Michelle; Raeburn, Toby; Escott, Phil; West, Sancia; Lopez, Violeta

2018-05-09

In adult mental health services, the participation of consumers is essential. The aim of this study was to explore the challenges faced by peer support workers when involving mental health consumers in decision-making about their care and the strategies they employed to overcome these challenges so as to improve mental health consumers' participation in decision-making and recovery. Semi-structured individual interviews were conducted with six peer support workers currently employed in psychiatric hospitals and/or community mental health systems. Thematic analysis identified challenges related to role definition, power imbalance, doctor-centric medical approaches to care, and lack of resources. Strategies to overcome these challenges that were reported, included the following: facilitating meaningful involvement for service users, appropriate use of the lived experience, building relationships and communication, promoting rights and advocacy, and promoting professionalism of peer support workers (PSWs). Nursing staff need ongoing support and education to understand and value the varied roles of PSWs and thereby empower PSWs to engage in enhancing consumer decision-making. The roles of the PSWs should be viewed as complementary, and greater appreciation and understanding of roles would better support recovery-oriented care. © 2018 Australian College of Mental Health Nurses Inc.

Promoting Shared Decision Making in Disorders of Sex Development (DSD): Decision Aids and Support Tools.

PubMed

Siminoff, L A; Sandberg, D E

2015-05-01

Specific complaints and grievances from adult patients with disorders of sex development (DSD), and their advocates center around the lack of information or misinformation they were given about their condition and feeling stigmatized and shamed by the secrecy surrounding their condition and its management. Many also attribute poor sexual function to damaging genital surgery and/or repeated, insensitive genital examinations. These reports suggest the need to reconsider the decision-making process for the treatment of children born with DSD. This paper proposes that shared decision making, an important concept in adult health care, be operationalized for the major decisions commonly encountered in DSD care and facilitated through the utilization of decision aids and support tools. This approach may help patients and their families make informed decisions that are better aligned with their personal values and goals. It may also lead to greater confidence in decision making with greater satisfaction and less regret. A brief review of the past and current approach to DSD decision making is provided, along with a review of shared decision making and decision aids and support tools. A case study explores the need and potential utility of this suggested new approach. © Georg Thieme Verlag KG Stuttgart · New York.

Cultural influences on the physician-patient encounter: The case of shared treatment decision-making.

PubMed

Charles, Cathy; Gafni, Amiram; Whelan, Tim; O'Brien, Mary Ann

2006-11-01

In this paper we discuss the influence of culture on the process of treatment decision-making, and in particular, shared treatment decision-making in the physician-patient encounter. We explore two key issues: (1) the meaning of culture and the ways that it can affect treatment decision-making; (2) cultural issues and assumptions underlying the development and use of treatment decision aids. This is a conceptual paper. Based on our knowledge and reading of the key literature in the treatment decision-making field, we looked for written examples where cultural influences were taken into account when discussing the physician-patient encounter and when designing instruments (decision aids) to help patients participate in making decisions. Our assessment of the situation is that to date, and with some recent exceptions, research in the above areas has not been culturally sensitive. We suggest that more research attention should be focused on exploring potential cultural variations in the meaning of and preferences for shared decision-making as well as on the applicability across cultural groups of decision aids developed to facilitate patient participation in treatment decision-making with physicians. Both patients and physicians need to be aware of the cultural assumptions underlying the development and use of decision aids and assess their cultural sensitivity to the needs and preferences of patients in diverse cultural groups.

Development of a model to guide decision making in amyotrophic lateral sclerosis multidisciplinary care.

PubMed

Hogden, Anne; Greenfield, David; Nugus, Peter; Kiernan, Matthew C

2015-10-01

Patients with amyotrophic lateral sclerosis (ALS) face numerous decisions for symptom management and quality of life. Models of decision making in chronic disease and cancer care are insufficient for the complex and changing needs of patients with ALS . The aim was to examine the question: how can decision making that is both effective and patient-centred be enacted in ALS multidisciplinary care? Fifty-four respondents (32 health professionals, 14 patients and eight carers) from two specialized ALS multidisciplinary clinics participated in semi-structured interviews. Interviews were transcribed, coded and analysed thematically. Comparison of stakeholder perspectives revealed six key themes of ALS decision making. These were the decision-making process; patient-centred focus; timing and planning; information sources; engagement with specialized ALS services; and access to non-specialized services. A model, embedded in the specialized ALS multidisciplinary clinic, was derived to guide patient decision making. The model is cyclic, with four stages: 'Participant Engagement'; 'Option Information'; 'Option Deliberation'; and 'Decision Implementation'. Effective and patient-centred decision making is enhanced by the structure of the specialized ALS clinic, which promotes patients' symptom management and quality of life goals. However, patient and carer engagement in ALS decision making is tested by the dynamic nature of ALS, and patient and family distress. Our model optimizes patient-centred decision making, by incorporating patients' cyclic decision-making patterns and facilitating carer inclusion in decision processes. The model captures the complexities of patient-centred decision making in ALS. The framework can assist patients and carers, health professionals, researchers and policymakers in this challenging disease environment. © 2013 John Wiley & Sons Ltd.

A qualitative exploration of treatment decision-making role preference in adult asthma patients.

PubMed

Caress, Ann-Louise; Luker, Karen; Woodcock, Ashley; Beaver, Kinta

2002-09-01

To explore preferred treatment decision-making roles, and rationales for role preference, and to identify perceived facilitators to and barriers from attaining preferred role. Qualitative design. One secondary care and four primary care sites in North-west England. Purposive sample of 32 adult asthma patients with varied socio-economic backgrounds and disease severity. Tape-recorded focused-conversation style interviews. Interview topic guide derived from the literature. Sort cards employed to provide the focus for exploration of role preferences. Active (n = 7), collaborative (n = 11) and passive (n = 14) decisional role preferences were identified. Respondents cited level of knowledge; trust; duration of condition; severity of condition at the decisional juncture; lifelong nature of asthma; a perception that 'it is my body'; characteristics of the individual and their response to health professionals as influencing role preference. Perceived facilitators and barriers to participation included condition-related knowledge, practical issues (e.g. lack of time during consultation) and clinicians' interpersonal skills. Most respondents wished to contribute to or feel involved in treatment decision-making, but not necessarily to control it. Some hindrances to participation would be amenable to intervention. The quality of the provider-patient relationship is central to facilitating participation.

Understanding Meta-Decisions: The Key To Effecting Organizational Change. A Model for Analyzing Decision Making Within Organizations

ERIC Educational Resources Information Center

Billings, Charles R.

1974-01-01

Proposes a behavioral model for analyzing the decisionmaking process within organizations. The model is designed to facilitate the impact of members on those organizations. Examples and illustrations are cited. (WM)

Development and initial evaluation of a treatment decision dashboard

PubMed Central

2013-01-01

Background For many healthcare decisions, multiple alternatives are available with different combinations of advantages and disadvantages across several important dimensions. The complexity of current healthcare decisions thus presents a significant barrier to informed decision making, a key element of patient-centered care. Interactive decision dashboards were developed to facilitate decision making in Management, a field marked by similarly complicated choices. These dashboards utilize data visualization techniques to reduce the cognitive effort needed to evaluate decision alternatives and a non-linear flow of information that enables users to review information in a self-directed fashion. Theoretically, both of these features should facilitate informed decision making by increasing user engagement with and understanding of the decision at hand. We sought to determine if the interactive decision dashboard format can be successfully adapted to create a clinically realistic prototype patient decision aid suitable for further evaluation and refinement. Methods We created a computerized, interactive clinical decision dashboard and performed a pilot test of its clinical feasibility and acceptability using a multi-method analysis. The dashboard summarized information about the effectiveness, risks of side effects and drug-drug interactions, out-of-pocket costs, and ease of use of nine analgesic treatment options for knee osteoarthritis. Outcome evaluations included observations of how study participants utilized the dashboard, questionnaires to assess usability, acceptability, and decisional conflict, and an open-ended qualitative analysis. Results The study sample consisted of 25 volunteers - 7 men and 18 women - with an average age of 51 years. The mean time spent interacting with the dashboard was 4.6 minutes. Mean evaluation scores on scales ranging from 1 (low) to 7 (high) were: mechanical ease of use 6.1, cognitive ease of use 6.2, emotional difficulty 2.7, decision-aiding effectiveness 5.9, clarification of values 6.5, reduction in decisional uncertainty 6.1, and provision of decision-related information 6.0. Qualitative findings were similarly positive. Conclusions Interactive decision dashboards can be adapted for clinical use and have the potential to foster informed decision making. Additional research is warranted to more rigorously test the effectiveness and efficiency of patient decision dashboards for supporting informed decision making and other aspects of patient-centered care, including shared decision making. PMID:23601912

Conceptual framework of knowledge management for ethical decision-making support in neonatal intensive care.

PubMed

Frize, Monique; Yang, Lan; Walker, Robin C; O'Connor, Annette M

2005-06-01

This research is built on the belief that artificial intelligence estimations need to be integrated into clinical social context to create value for health-care decisions. In sophisticated neonatal intensive care units (NICUs), decisions to continue or discontinue aggressive treatment are an integral part of clinical practice. High-quality evidence supports clinical decision-making, and a decision-aid tool based on specific outcome information for individual NICU patients will provide significant support for parents and caregivers in making difficult "ethical" treatment decisions. In our approach, information on a newborn patient's likely outcomes is integrated with the physician's interpretation and parents' perspectives into codified knowledge. Context-sensitive content adaptation delivers personalized and customized information to a variety of users, from physicians to parents. The system provides structuralized knowledge translation and exchange between all participants in the decision, facilitating collaborative decision-making that involves parents at every stage on whether to initiate, continue, limit, or terminate intensive care for their infant.

Information giving and decision-making in patients with advanced cancer: a systematic review.

PubMed

Gaston, Christine M; Mitchell, Geoffrey

2005-11-01

Patients with advanced, non-curable cancer face difficult decisions on further treatment, where a small increase in survival time must be balanced against the toxicity of the treatment. If patients want to be involved in these decisions, in keeping with current notions of autonomy and empowerment, they also require to be adequately informed both on the treatments proposed and on their own disease status and prognosis. A systematic review was performed on decision-making and information provision in patients with advanced cancer. Studies of interventions to improve information giving and encourage participation in decision-making were reviewed, including both randomised controlled trials and uncontrolled studies. Almost all patients expressed a desire for full information, but only about two-thirds wished to participate actively in decision-making. Higher educational level, younger age and female sex were predictive of a desire to participate in decision-making. Active decision-making was more common in patients with certain cancers (e.g. breast) than others (e.g. prostate). A number of simple interventions including question prompt sheets, audio-taping of consultations and patient decision aids have been shown to facilitate such involvement.

A cross-sectional survey of supports for evidence-informed decision-making in healthcare organisations: a research protocol.

PubMed

Ouimet, Mathieu; Lavis, John N; Léon, Grégory; Ellen, Moriah E; Bédard, Pierre-Olivier; Grimshaw, Jeremy M; Gagnon, Marie-Pierre

2014-10-09

This protocol builds on the development of a) a framework that identified the various supports (i.e. positions, activities, interventions) that a healthcare organisation or health system can implement for evidence-informed decision-making (EIDM) and b) a qualitative study that showed the current mix of supports that some Canadian healthcare organisations have in place and the ones that are perceived to facilitate the use of research evidence in decision-making. Based on these findings, we developed a web survey to collect cross-sectional data about the specific supports that regional health authorities and hospitals in two Canadian provinces (Ontario and Quebec) have in place to facilitate EIDM. This paper describes the methods for a cross-sectional web survey among 32 regional health authorities and 253 hospitals in the provinces of Quebec and Ontario (Canada) to collect data on the current mix of organisational supports that these organisations have in place to facilitate evidence-informed decision-making. The data will be obtained through a two-step survey design: a 10-min survey among CEOs to identify key units and individuals in regard to our objectives (step 1) and a 20-min survey among managers of the key units identified in step 1 to collect information about the activities performed by their unit regarding the acquisition, assessment, adaptation and/or dissemination of research evidence in decision-making (step 2). The study will target three types of informants: CEOs, library/documentation centre managers and all other key managers whose unit is involved in the acquisition, assessment, adaptation/packaging and/or dissemination of research evidence in decision-making. We developed an innovative data collection system to increase the likelihood that only the best-informed respondent available answers each survey question. The reporting of the results will be done using descriptive statistics of supports by organisation type and by province. This study will be the first to collect and report large-scale cross-sectional data on the current mix of supports health system organisations in the two most populous Canadian provinces have in place for evidence-informed decision-making. The study will also provide useful information to researchers on how to collect organisation-level data with reduced risk of self-reporting bias.

Decision-making in palliative care: a reflective case study.

PubMed

Birchall, Melissa

2005-01-01

Critical examination of the processes by which we as nurses judge and reach clinical decisions is important. It facilitates the maintenance and refinement of good standards of nursing care and the pinpointing of areas where improvement is needed. In turn this potentially could support broader validation of nurse expertise and contribute to emancipation of the nursing profession. As pure theory, clinical decision-making may appear abstract and alien to nurses struggling in 'the swampy lowlands' (Schon 1983) of the realities of practice. This paper explores some of the key concepts in decision-making theory by introducing, then integrating, them in a reflective case study. The case study, which examines a 'snapshot' of the patient and practitioner's journey, interwoven with theory surrounding clinical decision-making, may aid understanding and utility of concepts and theories in practice.

What perceptions do patients have of decision making (DM)? Toward an integrative patient-centered care model. A qualitative study using focus-group interviews.

PubMed

Moreau, Alain; Carol, Laurent; Dedianne, Marie Cécile; Dupraz, Christian; Perdrix, Corinne; Lainé, Xavier; Souweine, Gilbert

2012-05-01

To understand patients' perceptions of decision making and identify relationships among decision-making models. This qualitative study was made up of four focus group interviews (elderly persons, users of health support groups, students, and rural inhabitants). Participants were asked to report their perceptions of decision making in three written clinical scenarios (hypertension, breast cancer, prostate cancer). The analysis was based on the principles of grounded theory. Most patients perceived decision making as shared decision making, a deliberative question-response interaction with the physician that allowed patients to be experts in obtaining clearer information, participating in the care process, and negotiating compromises with physician preferences. Requesting second opinions allowed patients to maintain control, even within the paternalistic model preferred by elderly persons. Facilitating factors (trust, qualitative non-verbal communication, time to think) and obstacles (serious/emergency situations, perceived inadequate scientific competence, problems making requests, fear of knowing) were also part of shared decision making. In the global concept of patient-centered care, shared decision making can be flexible and can integrate paternalistic and informative models. Physicians' expertise should be associated with biomedical and relational skills through listening to, informing, and advising patients, and by supporting patients' choices. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Risk perception & strategic decision making :general insights, a framework, and specific application to electricity generation using nuclear energy.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brewer, Jeffrey D.

The objective of this report is to promote increased understanding of decision making processes and hopefully to enable improved decision making regarding high-consequence, highly sophisticated technological systems. This report brings together insights regarding risk perception and decision making across domains ranging from nuclear power technology safety, cognitive psychology, economics, science education, public policy, and neural science (to name a few). It forms them into a unique, coherent, concise framework, and list of strategies to aid in decision making. It is suggested that all decision makers, whether ordinary citizens, academics, or political leaders, ought to cultivate their abilities to separate themore » wheat from the chaff in these types of decision making instances. The wheat includes proper data sources and helpful human decision making heuristics; these should be sought. The chaff includes ''unhelpful biases'' that hinder proper interpretation of available data and lead people unwittingly toward inappropriate decision making ''strategies''; obviously, these should be avoided. It is further proposed that successfully accomplishing the wheat vs. chaff separation is very difficult, yet tenable. This report hopes to expose and facilitate navigation away from decision-making traps which often ensnare the unwary. Furthermore, it is emphasized that one's personal decision making biases can be examined, and tools can be provided allowing better means to generate, evaluate, and select among decision options. Many examples in this report are tailored to the energy domain (esp. nuclear power for electricity generation). The decision making framework and approach presented here are applicable to any high-consequence, highly sophisticated technological system.« less

Notes on The School Psychologist as a Facilitator of Parent Involvement in Decisions Concerning Their Children: An Overview.

ERIC Educational Resources Information Center

Lapides, Joseph

This presentation discusses a rationale and set of procedures that increase parent involvement in decisions concerning their children. Decision making is viewed here as a process by which parents choose, among conflicting considerations, courses of action which are in the best interests of their children. Decisions usually imply a power…

Decision Aid for Cigarette Smokers Scheduled for Elective Surgery.

PubMed

Warner, David O; LeBlanc, Annie; Kadimpati, Sandeep; Vickers, Kristin S; Shi, Yu; Montori, Victor M

2015-07-01

Decision aids can increase patient involvement in decision-making about health care. The study goal was to develop and test a decision aid for use by clinicians in discussion options for changing smoking behavior before and after elective surgery. In formative work, a decision aid was designed to facilitate patient-clinician discussion regarding three options: continue smoking, attempt a period of temporary abstinence, and attempt to quit smoking for good. A randomized, two-group pilot study was then conducted in smokers evaluated in preparation for elective surgery in a preoperative clinic to test the hypothesis that the decision aid would improve measures of decisional quality compared with usual care. The final decision aid consisted of three laminated cards. The front of each card included a colorful graphic describing each choice; the reverse including two to three pros and cons for each decision, a simple graphic illustrating the effects of smoking on the body, and a motivational phrase. In the randomized trial of 130 patients, the decision aid significantly (P < 0.05) improved measures of decisional quality and patient involvement in decision making (Cohen's d effect sizes of 0.76 and 1.20 for the Decisional Conflict Scale and Observing PatienT involvement In decisiON-making scale, respectively). However, the decision aid did not affect any aspect of perioperative smoking behavior, including the distribution of or adherence to choices. Although the use of a decision aid to facilitate clinician-patient discussions regarding tobacco use around the time of surgery substantially improved measures of decisional quality, it alone did not change perioperative tobacco use behavior.

Decision-Making of Older Patients in Context of the Doctor-Patient Relationship: A Typology Ranging from “Self-Determined” to “Doctor-Trusting” Patients

PubMed Central

Voigt, Isabel; Diederichs-Egidi, Heike; Hummers-Pradier, Eva; Dierks, Marie-Luise; Junius-Walker, Ulrike

2013-01-01

Background. This qualitative study aims to gain insight into the perceptions and experiences of older patients with regard to sharing health care decisions with their general practitioners. Patients and Methods. Thirty-four general practice patients (≥70 years) were asked about their preferences and experiences concerning shared decision making with their doctors using qualitative semistructured interviews. All interviews were analysed according to principles of content analysis. The resulting categories were then arranged into a classification grid to develop a typology of preferences for participating in decision-making processes. Results. Older patients generally preferred to make decisions concerning everyday life rather than medical decisions, which they preferred to leave to their doctors. We characterised eight different patient types based on four interdependent positions (self-determination, adherence, information seeking, and trust). Experiences of a good doctor-patient relationship were associated with trust, reliance on the doctor for information and decision making, and adherence. Conclusion. Owing to the varied patient decision-making types, it is not easy for doctors to anticipate the desired level of patient involvement. However, the decision matter and the self-determination of patients provide good starting points in preparing the ground for shared decision making. A good relationship with the doctor facilitates satisfying decision-making experiences. PMID:23691317

Curriculum: Big Decisions--Making Healthy, Informed Choices about Sex

ERIC Educational Resources Information Center

Davis, Melanie

2009-01-01

Big Decisions is a 10-lesson abstinence-plus curriculum for ages 12-18 that emphasizes sex as a big decision, abstinence as the healthiest choice, and the mandate that sexually active teens use condoms and be tested for sexually transmitted diseases. This program can be implemented with limited resources and facilitator training when abstinence…

Clinical decision-making of rural novice nurses.

PubMed

Seright, T J

2011-01-01

Nurses in rural settings are often the first to assess and interpret the patient's clinical presentations. Therefore, an understanding of how nurses experience decision-making is important in terms of educational preparation, resource allocation to rural areas, institutional cultures, and patient outcomes. Theory development was based on the in-depth investigation of 12 novice nurses practicing in rural critical access hospitals in a north central state. This grounded theory study consisted of face-to-face interviews with 12 registered nurses, nine of whom were observed during their work day. The participants were interviewed a second time, as a method of member checking, and during this interview they reviewed their transcripts, the emerging themes and categories. Directors of nursing from both the research sites and rural hospitals not involved in the study, experienced researchers, and nurse educators facilitated triangulation of the findings. 'Sociocentric rationalizing' emerged as the central phenomenon and referred to the sense of belonging and agency which impacted the decision-making in this small group of novice nurses in rural critical access hospitals. The observed consequences, which were conceptualized during the axial coding process and were derived from observations and interviews of the 12 novice nurses in this study include: (1) gathering information before making a decision included assessment of: the credibility of co-workers, patients' subjective and objective data, and one's own past and current experiences; (2) conferring with co-workers as a direct method of confirming/denying decisions being made was considered more realistic and expedient than policy books and decision trees; (3) rural practicum clinical experiences, along with support after orientation, provide for transition to the rural nurse role; (4) involved directors of nursing served as both models and protectors of novice nurses placed in high accountability positions early in their careers. These novice nurses were often working with a limited staff, while managing an ever-changing census and acuity of patients. The significance of interdependence and welcoming relationships with their co-workers and directors of nursing was pivotal in the clinical decision-making process. Despite access to a number of resources at their disposal (including policy books, decision trees, standing orders, textbooks, and in some cases internet resources), the 12 nurses in this study indicated collaboration with co-workers was a major means of facilitating their decision-making. Rural novice nurses require facilitation of social skills as much as critical thinking skills both within their programs of nursing and during their new employee orientation; however, decision-making must be guided by more experienced nurses who are willing to mentor novice nurses and advise them to to reflect upon their decisions as they care for patients using evidenced based practice. In a rural setting, this is especially important because novice nurses are tasked early in their career with decision-making, which often involves ill-structured problems set in dynamic and changing environments, in high-stakes situations where patient safety is a concern.

The Role of Evidence-Based Research in the Decision-Making Process as Perceived by Local Board of Education Policymakers in West Virginia

ERIC Educational Resources Information Center

Hoylman, Elizabeth Anne

2017-01-01

This non-experimental, descriptive study explored the perceptions of PK-12 policymakers in West Virginia regarding the sources of information they use in the decision-making process; whether and how evidence-based research is relied upon; whether evidence-based research is considered credible and usable; and what barriers, facilitators, and…

Right For Me: protocol for a cluster randomised trial of two interventions for facilitating shared decision-making about contraceptive methods.

PubMed

Thompson, Rachel; Manski, Ruth; Donnelly, Kyla Z; Stevens, Gabrielle; Agusti, Daniela; Banach, Michelle; Boardman, Maureen B; Brady, Pearl; Colón Bradt, Christina; Foster, Tina; Johnson, Deborah J; Li, Zhongze; Norsigian, Judy; Nothnagle, Melissa; Olson, Ardis L; Shepherd, Heather L; Stern, Lisa F; Tosteson, Tor D; Trevena, Lyndal; Upadhya, Krishna K; Elwyn, Glyn

2017-10-22

Despite the observed and theoretical advantages of shared decision-making in a range of clinical contexts, including contraceptive care, there remains a paucity of evidence on how to facilitate its adoption. This paper describes the protocol for a study to assess the comparative effectiveness of patient-targeted and provider-targeted interventions for facilitating shared decision-making about contraceptive methods. We will conduct a 2×2 factorial cluster randomised controlled trial with four arms: (1) video+prompt card, (2) decision aids+training, (3) video+prompt card and decision aids+training and (4) usual care. The clusters will be clinics in USA that deliver contraceptive care. The participants will be people who have completed a healthcare visit at a participating clinic, were assigned female sex at birth, are aged 15-49 years, are able to read and write English or Spanish and have not previously participated in the study. The primary outcome will be shared decision-making about contraceptive methods. Secondary outcomes will be the occurrence of a conversation about contraception in the healthcare visit, satisfaction with the conversation about contraception, intended contraceptive method(s), intention to use a highly effective method, values concordance of the intended method(s), decision regret, contraceptive method(s) used, use of a highly effective method, use of the intended method(s), adherence, satisfaction with the method(s) used, unintended pregnancy and unwelcome pregnancy. We will collect study data via longitudinal patient surveys administered immediately after the healthcare visit, four weeks later and six months later. We will disseminate results via presentations at scientific and professional conferences, papers published in peer-reviewed, open-access journals and scientific and lay reports. We will also make an anonymised copy of the final participant-level dataset available to others for research purposes. ClinicalTrials.gov Identifier: NCT02759939. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The loss of reason in patient decision aid research: do checklists damage the quality of informed choice interventions?

PubMed

Bekker, Hilary L

2010-03-01

To discuss whether using the International Patient Decision Aids Standards (IPDAS) Collaboration checklist as a gold standard to judge interventions' quality is premature and potentially detrimental to the validity of resources designed to help patients make treatment choices. Conceptual review integrating the science behind individuals' decision making with the demands of designing complex, healthcare interventions. Patient decision aids are promoted as interventions to help professionals engage in shared and/or patient-centred care. The IPDAS domains were informed by experts' opinions of best practice. Decision scientists study how individuals make decisions, what biases their choices and how best to support decisions. There is debate from decision scientists about which component parts are the active ingredients that help people make decisions. Interventions to help patients make choices have different purposes, component parts and outcomes to those facilitating professional-patient communications. The IPDAS checklist will change to respond to new evidence from the decision sciences. Adhering uncritically to the IPDAS checklist may reduce service variation but is not sufficient to ensure interventions enable good patient decision making. Developers must be encouraged to reason about the IPDAS checklist to identify those component parts that do (not) meet their intervention's purpose. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

Factors affecting evidence-based decision making in local health departments.

PubMed

Sosnowy, Collette D; Weiss, Linda J; Maylahn, Christopher M; Pirani, Sylvia J; Katagiri, Nancy J

2013-12-01

Data indicating the extent to which evidence-based decision making (EBDM) is used in local health departments (LHDs) are limited. This study aims to determine use of decision-making processes by New York State LHD leaders and upper-level staff and identify facilitators and barriers to the use of EBDM in LHDs. The New York Public Health Practice-Based Research Network implemented a mixed-methods study in 31 LHDs. There were 20 individual interviews; five small-group interviews (two or three participants each); and two focus groups (eight participants each) conducted with people who had decision-making authority. Information was obtained about each person's background and position, decision-making responsibilities, how decisions are made within their LHD, knowledge and experience with EBDM, use of each step of the EBDM process, and barriers and facilitators to EBDM implementation. Data were collected from June to November 2010 and analyzed in 2011. Overall, participants supported EBDM and expressed a desire to increase their department's use of it. Although most people understood the concept, a relatively small number had substantial expertise and experience with its practice. Many indicated that they applied EBDM unevenly. Factors associated with use of EBDM included strong leadership; workforce capacity (number and skills); resources; funding and program mandates; political support; and access to data and program models suitable to community conditions. EBDM is used inconsistently in LHDs in New York. Despite knowledge and interest among LHD leadership, the LHD capacity, resources, appropriate programming, and other issues serve as impediments to EBDM and optimal implementation of evidence-based strategies. Published by Elsevier Inc.

Patient decision aids in routine maternity care: Benefits, barriers, and new opportunities.

PubMed

Stevens, Gabrielle; Thompson, Rachel; Watson, Bernadette; Miller, Yvette D

2016-02-01

Participation in decision-making, supported by comprehensive and quality information provision, is increasingly emphasised as a priority for women in maternity care. Patient decision aids are tools that can offer women greater access to information and guidance to participate in maternity care decision-making. Relative to their evaluation in controlled settings, the implementation of patient decision aids in routine maternity care has received little attention and our understanding of which approaches may be effective is limited. This paper critically discusses the application of patient decision aids in routine maternity care and explores viable solutions for promoting their successful uptake. A range of patient decision aids have been developed for use within maternity care, and controlled trials have highlighted their positive impact on the decision-making process for women. Nevertheless, evidence of successful patient decision aid implementation in real world health care settings is lacking due to practical and ideological barriers that exist. Patient-directed social marketing campaigns are a relatively novel approach to patient decision aid delivery that may facilitate their adoption in maternity care, at least in the short-term, by overcoming common implementation barriers. Social marketing may also be particularly well suited to maternity care, given the unique characteristics of this health context. The potential of social marketing campaigns to facilitate patient decision aid adoption in maternity care highlights the need for pragmatic trials to evaluate their effectiveness. Identifying which sub-groups of women are more or less likely to respond to these strategies will further direct implementation. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Decision support systems in health economics.

PubMed

Quaglini, S; Dazzi, L; Stefanelli, M; Barosi, G; Marchetti, M

1999-08-01

This article describes a system addressed to different health care professionals for building, using, and sharing decision support systems for resource allocation. The system deals with selected areas, namely the choice of diagnostic tests, the therapy planning, and the instrumentation purchase. Decision support is based on decision-analytic models, incorporating an explicit knowledge representation of both the medical domain knowledge and the economic evaluation theory. Application models are built on top of meta-models, that are used as guidelines for making explicit both the cost and effectiveness components. This approach improves the transparency and soundness of the collaborative decision-making process and facilitates the result interpretation.

Brain mechanisms for perceptual and reward-related decision-making.

PubMed

Deco, Gustavo; Rolls, Edmund T; Albantakis, Larissa; Romo, Ranulfo

2013-04-01

Phenomenological models of decision-making, including the drift-diffusion and race models, are compared with mechanistic, biologically plausible models, such as integrate-and-fire attractor neuronal network models. The attractor network models show how decision confidence is an emergent property; and make testable predictions about the neural processes (including neuronal activity and fMRI signals) involved in decision-making which indicate that the medial prefrontal cortex is involved in reward value-based decision-making. Synaptic facilitation in these models can help to account for sequential vibrotactile decision-making, and for how postponed decision-related responses are made. The randomness in the neuronal spiking-related noise that makes the decision-making probabilistic is shown to be increased by the graded firing rate representations found in the brain, to be decreased by the diluted connectivity, and still to be significant in biologically large networks with thousands of synapses onto each neuron. The stability of these systems is shown to be influenced in different ways by glutamatergic and GABAergic efficacy, leading to a new field of dynamical neuropsychiatry with applications to understanding schizophrenia and obsessive-compulsive disorder. The noise in these systems is shown to be advantageous, and to apply to similar attractor networks involved in short-term memory, long-term memory, attention, and associative thought processes. Copyright © 2012 Elsevier Ltd. All rights reserved.

Influences of Transportation on Health Decision-Making and Self-Management Behaviors among Older Adults with Chronic Conditions.

PubMed

Ruggiano, Nicole; Shtompel, Natalia; Whiteman, Karen; Sias, Kathy

2017-01-01

Although transportation has been established as a facilitator/barrier to health self-management, little is known about how the context of transportation shapes health self-management behaviors and decision-making among older adults with chronic conditions. This study interviewed 37 older adults with chronic conditions in Florida to examine their perspectives about how transportation influences their chronic care self-management. The data were systematically analyzed for themes. The thematic findings revealed how transportation intersected with participants' everyday experiences with chronic health self-management, how they evaluated transportation as part of the process of making decisions about health, and how creative problem-solving about transportation became an additional health self-management activity for addressing their complex needs. These findings suggest that the context of transportation goes beyond a basic facilitator/barrier for health and enhance our understanding about how transportation services and policies may be changed to better address the needs of older adults with chronic conditions.

Facilitating participatory multilevel decision-making by using interactive mental maps.

PubMed

Pfeiffer, Constanze; Glaser, Stephanie; Vencatesan, Jayshree; Schliermann-Kraus, Elke; Drescher, Axel; Glaser, Rüdiger

2008-11-01

Participation of citizens in political, economic or social decisions is increasingly recognized as a precondition to foster sustainable development processes. Since spatial information is often important during planning and decision making, participatory mapping gains in popularity. However, little attention has been paid to the fact that information must be presented in a useful way to reach city planners and policy makers. Above all, the importance of visualisation tools to support collaboration, analytical reasoning, problem solving and decision-making in analysing and planning processes has been underestimated. In this paper, we describe how an interactive mental map tool has been developed in a highly interdisciplinary disaster management project in Chennai, India. We moved from a hand drawn mental maps approach to an interactive mental map tool. This was achieved by merging socio-economic and geospatial data on infrastructure, local perceptions, coping and adaptation strategies with remote sensing data and modern technology of map making. This newly developed interactive mapping tool allowed for insights into different locally-constructed realities and facilitated the communication of results to the wider public and respective policy makers. It proved to be useful in visualising information and promoting participatory decision-making processes. We argue that the tool bears potential also for health research projects. The interactive mental map can be used to spatially and temporally assess key health themes such as availability of, and accessibility to, existing health care services, breeding sites of disease vectors, collection and storage of water, waste disposal, location of public toilets or defecation sites.

Frozen section pathology for decision making in parotid surgery.

PubMed

Olsen, Kerry D; Moore, Eric J; Lewis, Jean E

2013-12-01

For parotid lesions, the high accuracy and utility of intraoperative frozen section (FS) pathology, compared with permanent section pathology, facilitates intraoperative decision making about the extent of surgery required. To demonstrate the accuracy and utility of FS pathology of parotid lesions as one factor in intraoperative decision making. Retrospective review of patients undergoing parotidectomy at a tertiary care center. Evaluation of the accuracy of FS pathology for parotid surgery by comparing FS pathology results with those of permanent section. Documented changes from FS to permanent section in 1339 parotidectomy pathology reports conducted from January 1, 2000, through December 31, 2009, included 693 benign and 268 primary and metastatic malignant tumors. Changes in diagnosis were found from benign to malignant (n = 11) and malignant to benign (n = 2). Sensitivity and specificity of a malignant diagnosis were 98.5% and 99.0%, respectively. Other changes were for lymphoma vs inflammation or lymphoma typing (n = 89) and for confirmation of or change in tumor type for benign (n = 36) or malignant (n = 69) tumors. No case changed from low- to high-grade malignant tumor. Only 4 cases that changed from FS to permanent section would have affected intraoperative decision making. Three patients underwent additional surgery 2 to 3 weeks later. Overall, only 1 patient was overtreated (lymphoma initially deemed carcinoma). Frozen section pathology for parotid lesions has high accuracy and utility in intraoperative decision making, facilitating timely complete procedures.

Driving with roadmaps and dashboards: using information resources to structure the decision models in service organizations.

PubMed

Chorpita, Bruce F; Bernstein, Adam; Daleiden, Eric L

2008-03-01

This paper illustrates the application of design principles for tools that structure clinical decision-making. If the effort to implement evidence-based practices in community services organizations is to be effective, attention must be paid to the decision-making context in which such treatments are delivered. Clinical research trials commonly occur in an environment characterized by structured decision making and expert supports. Technology has great potential to serve mental health organizations by supporting these potentially important contextual features of the research environment, through organization and reporting of clinical data into interpretable information to support decisions and anchor decision-making procedures. This article describes one example of a behavioral health reporting system designed to facilitate clinical and administrative use of evidence-based practices. The design processes underlying this system-mapping of decision points and distillation of performance information at the individual, caseload, and organizational levels-can be implemented to support clinical practice in a wide variety of settings.

Parental Explicit Heuristics in Decision-making for Children With Life-threatening Illnesses

PubMed Central

Renjilian, Chris B.; Womer, James W.; Carroll, Karen W.; Kang, Tammy I.

2013-01-01

OBJECTIVE: To identify and illustrate common explicit heuristics (decision-making aids or shortcuts expressed verbally as terse rules of thumb, aphorisms, maxims, or mantras and intended to convey a compelling truth or guiding principle) used by parents of children with life-threatening illnesses when confronting and making medical decisions. METHODS: Prospective cross-sectional observational study of 69 parents of 46 children who participated in the Decision-making in Pediatric Palliative Care Study between 2006 and 2008 at the Children’s Hospital of Philadelphia. Parents were guided individually through a semistructured in-depth interview about their experiences and thoughts regarding making medical decisions on behalf of their ill children, and the transcribed interviews were qualitatively analyzed. RESULTS: All parents in our study employed explicit heuristics in interviews about decision-making for their children, with the number of identified explicit heuristics used by an individual parent ranging from tens to hundreds. The heuristics served 5 general functions: (1) to depict or facilitate understanding of a complex situation; (2) to clarify, organize, and focus pertinent information and values; (3) to serve as a decision-making compass; (4) to communicate with others about a complex topic; and (5) to justify a choice. CONCLUSIONS: Explicit heuristics played an important role in decision-making and communication about decision-making in our population of parents. Recognizing explicit heuristics in parent interactions and understanding their content and functions can aid clinicians in their efforts to partner with parents in the decision-making process. PMID:23319524

Parental explicit heuristics in decision-making for children with life-threatening illnesses.

PubMed

Renjilian, Chris B; Womer, James W; Carroll, Karen W; Kang, Tammy I; Feudtner, Chris

2013-02-01

To identify and illustrate common explicit heuristics (decision-making aids or shortcuts expressed verbally as terse rules of thumb, aphorisms, maxims, or mantras and intended to convey a compelling truth or guiding principle) used by parents of children with life-threatening illnesses when confronting and making medical decisions. Prospective cross-sectional observational study of 69 parents of 46 children who participated in the Decision-making in Pediatric Palliative Care Study between 2006 and 2008 at the Children's Hospital of Philadelphia. Parents were guided individually through a semistructured in-depth interview about their experiences and thoughts regarding making medical decisions on behalf of their ill children, and the transcribed interviews were qualitatively analyzed. All parents in our study employed explicit heuristics in interviews about decision-making for their children, with the number of identified explicit heuristics used by an individual parent ranging from tens to hundreds. The heuristics served 5 general functions: (1) to depict or facilitate understanding of a complex situation; (2) to clarify, organize, and focus pertinent information and values; (3) to serve as a decision-making compass; (4) to communicate with others about a complex topic; and (5) to justify a choice. Explicit heuristics played an important role in decision-making and communication about decision-making in our population of parents. Recognizing explicit heuristics in parent interactions and understanding their content and functions can aid clinicians in their efforts to partner with parents in the decision-making process.

Surviving Surrogate Decision-Making: What Helps and Hampers the Experience of Making Medical Decisions for Others

PubMed Central

Starks, Helene; Taylor, Janelle S.; Hopley, Elizabeth K.; Fryer-Edwards, Kelly

2007-01-01

BACKGROUND A majority of end-of-life medical decisions are made by surrogate decision-makers who have varying degrees of preparation and comfort with their role. Having a seriously ill family member is stressful for surrogates. Moreover, most clinicians have had little training in working effectively with surrogates. OBJECTIVES To better understand the challenges of decision-making from the surrogate’s perspective. DESIGN Semistructured telephone interview study of the experience of surrogate decision-making. PARTICIPANTS Fifty designated surrogates with previous decision-making experience. APPROACH We asked surrogates to describe and reflect on their experience of making medical decisions for others. After coding transcripts, we conducted a content analysis to identify and categorize factors that made decision-making more or less difficult for surrogates. RESULTS Surrogates identified four types of factors: (1) surrogate characteristics and life circumstances (such as coping strategies and competing responsibilities), (2) surrogates’ social networks (such as intrafamily discord about the “right” decision), (3) surrogate–patient relationships and communication (such as difficulties with honoring known preferences), and (4) surrogate–clinician communication and relationship (such as interacting with a single physician whom the surrogate recognizes as the clinical spokesperson vs. many clinicians). CONCLUSIONS These data provide insights into the challenges that surrogates encounter when making decisions for loved ones and indicate areas where clinicians could intervene to facilitate the process of surrogate decision-making. Clinicians may want to include surrogates in advance care planning prior to decision-making, identify and address surrogate stressors during decision-making, and designate one person to communicate information about the patient’s condition, prognosis, and treatment options. PMID:17619223

Teaching metacognition in clinical decision-making using a novel mnemonic checklist: an exploratory study

PubMed Central

Chew, Keng Sheng; Durning, Steven J; van Merriënboer, Jeroen JG

2016-01-01

INTRODUCTION Metacognition is a cognitive debiasing strategy that clinicians can use to deliberately detach themselves from the immediate context of a clinical decision, which allows them to reflect upon the thinking process. However, cognitive debiasing strategies are often most needed when the clinician cannot afford the time to use them. A mnemonic checklist known as TWED (T = threat, W = what else, E = evidence and D = dispositional factors) was recently created to facilitate metacognition. This study explores the hypothesis that the TWED checklist improves the ability of medical students to make better clinical decisions. METHODS Two groups of final-year medical students from Universiti Sains Malaysia, Malaysia, were recruited to participate in this quasi-experimental study. The intervention group (n = 21) received educational intervention that introduced the TWED checklist, while the control group (n = 19) received a tutorial on basic electrocardiography. Post-intervention, both groups received a similar assessment on clinical decision-making based on five case scenarios. RESULTS The mean score of the intervention group was significantly higher than that of the control group (18.50 ± 4.45 marks vs. 12.50 ± 2.84 marks, p < 0.001). In three of the five case scenarios, students in the intervention group obtained higher scores than those in the control group. CONCLUSION The results of this study support the use of the TWED checklist to facilitate metacognition in clinical decision-making. PMID:26778635

Protection, participation and protection through participation: young people with intellectual disabilities and decision making in the family context.

PubMed

Saaltink, R; MacKinnon, G; Owen, F; Tardif-Williams, C

2012-11-01

Research suggests that persons with intellectual disabilities (ID) are expected to be more compliant than persons without disabilities and that expectations for compliance begin in childhood. No study, however, seems yet to have included a primary focus on the participatory rights, or rights to express opinions, desires and preferences and to be heard and taken seriously in decision making among young people with ID who are not yet considered legally adult. The purpose of the two current studies was to explore how the right to participation is negotiated for young people with ID in a family context and to determine family members' recommendations for strategies to facilitate the participation of young people with ID. In the first study, four young people with ID, their mothers and two siblings from four families took part in semi-structured interviews about decision making in the family context. In the second study, a mother and daughter from the first study discussed and developed strategies to promote participation for young people with ID. In the first study, all participants communicated that young people with ID follow an age-typical yet restricted pattern of participation in decisions about their lives. Young people's participation was consistently framed by familial norms and values as well as their families' desire to protect them. In the second study, both participants suggested communication about the outcomes of real or imagined decisions would help young family members rehearse decision-making strategies that would facilitate their autonomy while remaining within the bounds of familial norms, values and perceptions of safety. Although young people with ID may make fewer independent decisions about their lives than typically developing peers, support in decision making can enable both increased protection and independence. © 2012 The Authors. Journal of Intellectual Disability Research © 2012 Blackwell Publishing Ltd.

78 FR 77549 - Revise Notice of Intent for an Environmental Impact Statement: State Route (SR) 95 Realignment...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-23

...), intend to use a tiered process to facilitate project decision-making. This notice revises the NOI that... study. If the Record of Decision indicates that FHWA has selected one of the alternative corridors as...

Decision Making and Ratio Processing in Patients with Mild Cognitive Impairment.

PubMed

Pertl, Marie-Theres; Benke, Thomas; Zamarian, Laura; Delazer, Margarete

2015-01-01

Making advantageous decisions is important in everyday life. This study aimed at assessing how patients with mild cognitive impairment (MCI) make decisions under risk. Additionally, it investigated the relationship between decision making, ratio processing, basic numerical abilities, and executive functions. Patients with MCI (n = 22) were compared with healthy controls (n = 29) on a complex task of decision making under risk (Game of Dice Task-Double, GDT-D), on two tasks evaluating basic decision making under risk, on a task of ratio processing, and on several neuropsychological background tests. Patients performed significantly lower than controls on the GDT-D and on ratio processing, whereas groups performed comparably on basic decision tasks. Specifically, in the GDT-D, patients obtained lower net scores and lower mean expected values, which indicate a less advantageous performance relative to that of controls. Performance on the GDT-D correlated significantly with performance in basic decision tasks, ratio processing, and executive-function measures when the analysis was performed on the whole sample. Patients with MCI make sub-optimal decisions in complex risk situations, whereas they perform at the same level as healthy adults in simple decision situations. Ratio processing and executive functions have an impact on the decision-making performance of both patients and healthy older adults. In order to facilitate advantageous decisions in complex everyday situations, information should be presented in an easily comprehensible form and cognitive training programs for patients with MCI should focus--among other abilities--on executive functions and ratio processing.

A decision technology system for health care electronic commerce.

PubMed

Forgionne, G A; Gangopadhyay, A; Klein, J A; Eckhardt, R

1999-08-01

Mounting costs have escalated the pressure on health care providers and payers to improve decision making and control expenses. Transactions to form the needed decision data will routinely flow, often electronically, between the affected parties. Conventional health care information systems facilitate flow, process transactions, and generate useful decision information. Typically, such support is offered through a series of stand-alone systems that lose much useful decision knowledge and wisdom during health care electronic commerce (e-commerce). Integrating the stand-alone functions can enhance the quality and efficiency of the segmented support, create synergistic effects, and augment decision-making performance and value for both providers and payers. This article presents an information system that can provide complete and integrated support for e-commerce-based health care decision making. The article describes health care e-commerce, presents the system, examines the system's potential use and benefits, and draws implications for health care management and practice.

Factors influencing decision-making role preferences: A qualitative study of Malaysian patients with type 2 diabetes during insulin initiation.

PubMed

Lee, Yew Kong; Low, Wah Yun; Lee, Ping Yein; Ng, Chirk Jenn

2015-05-01

Patient decision-making role preference (DMRP) is a patient's preferred degree of control when making medical decisions. This descriptive qualitative study aimed to explore Malaysian patients' views on their DMRP. Between January 2011 and March 2012, 22 individual face-to-face in-depth interviews were conducted with patients with type 2 diabetes who were deciding about insulin initiation. The interviews were audio-recorded and analysed using a thematic approach. The age range of participants was 28-67 years old with 11 men. Ten patients preferred to make the decision themselves, six patients indicated that the clinician should make the decision and only one patient expressed a preference for a collaborative role. The following factors influenced DMRP: trust in clinicians, responsibility for diabetes care, level of knowledge and awareness, involvement of family and personal characteristics. In conclusion, the concept of shared decision-making is still alien, and a more participative communication style might help to facilitate patients' expression of DMRP. © 2014 Wiley Publishing Asia Pty Ltd.

Clinical decision-making by midwives: managing case complexity.

PubMed

Cioffi, J; Markham, R

1997-02-01

In making clinical judgements, it is argued that midwives use 'shortcuts' or heuristics based on estimated probabilities to simplify the decision-making task. Midwives (n = 30) were given simulated patient assessment situations of high and low complexity and were required to think aloud. Analysis of verbal protocols showed that subjective probability judgements (heuristics) were used more frequently in the high than low complexity case and predominated in the last quarter of the assessment period for the high complexity case. 'Representativeness' was identified more frequently in the high than in the low case, but was the dominant heuristic in both. Reports completed after each simulation suggest that heuristics based on memory for particular conditions affect decisions. It is concluded that midwives use heuristics, derived mainly from their clinical experiences, in an attempt to save cognitive effort and to facilitate reasonably accurate decisions in the decision-making process.

Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice.

PubMed

Hajjaj, F M; Salek, M S; Basra, M K A; Finlay, A Y

2010-05-01

This article reviews an aspect of daily clinical practice which is of critical importance in virtually every clinical consultation, but which is seldom formally considered. Non-clinical influences on clinical decision-making profoundly affect medical decisions. These influences include patient-related factors such as socioeconomic status, quality of life and patient's expectations and wishes, physician-related factors such as personal characteristics and interaction with their professional community, and features of clinical practice such as private versus public practice as well as local management policies. This review brings together the different strands of knowledge concerning non-clinical influences on clinical decision-making. This aspect of decision-making may be the biggest obstacle to the reality of practising evidence-based medicine. It needs to be understood in order to develop clinical strategies that will facilitate the practice of evidence-based medicine.

How to introduce medical ethics at the bedside - Factors influencing the implementation of an ethical decision-making model.

PubMed

Meyer-Zehnder, Barbara; Albisser Schleger, Heidi; Tanner, Sabine; Schnurrer, Valentin; Vogt, Deborah R; Reiter-Theil, Stella; Pargger, Hans

2017-02-23

As the implementation of new approaches and procedures of medical ethics is as complex and resource-consuming as in other fields, strategies and activities must be carefully planned to use the available means and funds responsibly. Which facilitators and barriers influence the implementation of a medical ethics decision-making model in daily routine? Up to now, there has been little examination of these factors in this field. A medical ethics decision-making model called METAP was introduced on three intensive care units and two geriatric wards. An evaluation study was performed from 7 months after deployment of the project until two and a half years. Quantitative and qualitative methods including a questionnaire, semi-structured face-to-face and group-interviews were used. Sixty-three participants from different professional groups took part in 33 face-to-face and 9 group interviews, and 122 questionnaires could be analysed. The facilitating factors most frequently mentioned were: acceptance and presence of the model, support given by the medical and nursing management, an existing or developing (explicit) ethics culture, perception of a need for a medical ethics decision-making model, and engaged staff members. Lack of presence and acceptance, insufficient time resources and staff, poor inter-professional collaboration, absence of ethical competence, and not recognizing ethical problems were identified as inhibiting the implementation of the METAP model. However, the results of the questionnaire as well as of explicit inquiry showed that the respondents stated to have had enough time and staff available to use METAP if necessary. Facilitators and barriers of the implementation of a medical ethics decision-making model are quite similar to that of medical guidelines. The planning for implementing an ethics model or guideline can, therefore, benefit from the extensive literature and experience concerning the implementation of medical guidelines. Lack of time and staff can be overcome when people are convinced that the benefits justify the effort.

Difficult Decisions: A Qualitative Exploration of the Statistical Decision Making Process from the Perspectives of Psychology Students and Academics

PubMed Central

Allen, Peter J.; Dorozenko, Kate P.; Roberts, Lynne D.

2016-01-01

Quantitative research methods are essential to the development of professional competence in psychology. They are also an area of weakness for many students. In particular, students are known to struggle with the skill of selecting quantitative analytical strategies appropriate for common research questions, hypotheses and data types. To begin understanding this apparent deficit, we presented nine psychology undergraduates (who had all completed at least one quantitative methods course) with brief research vignettes, and asked them to explicate the process they would follow to identify an appropriate statistical technique for each. Thematic analysis revealed that all participants found this task challenging, and even those who had completed several research methods courses struggled to articulate how they would approach the vignettes on more than a very superficial and intuitive level. While some students recognized that there is a systematic decision making process that can be followed, none could describe it clearly or completely. We then presented the same vignettes to 10 psychology academics with particular expertise in conducting research and/or research methods instruction. Predictably, these “experts” were able to describe a far more systematic, comprehensive, flexible, and nuanced approach to statistical decision making, which begins early in the research process, and pays consideration to multiple contextual factors. They were sensitive to the challenges that students experience when making statistical decisions, which they attributed partially to how research methods and statistics are commonly taught. This sensitivity was reflected in their pedagogic practices. When asked to consider the format and features of an aid that could facilitate the statistical decision making process, both groups expressed a preference for an accessible, comprehensive and reputable resource that follows a basic decision tree logic. For the academics in particular, this aid should function as a teaching tool, which engages the user with each choice-point in the decision making process, rather than simply providing an “answer.” Based on these findings, we offer suggestions for tools and strategies that could be deployed in the research methods classroom to facilitate and strengthen students' statistical decision making abilities. PMID:26909064

Difficult Decisions: A Qualitative Exploration of the Statistical Decision Making Process from the Perspectives of Psychology Students and Academics.

PubMed

Allen, Peter J; Dorozenko, Kate P; Roberts, Lynne D

2016-01-01

Quantitative research methods are essential to the development of professional competence in psychology. They are also an area of weakness for many students. In particular, students are known to struggle with the skill of selecting quantitative analytical strategies appropriate for common research questions, hypotheses and data types. To begin understanding this apparent deficit, we presented nine psychology undergraduates (who had all completed at least one quantitative methods course) with brief research vignettes, and asked them to explicate the process they would follow to identify an appropriate statistical technique for each. Thematic analysis revealed that all participants found this task challenging, and even those who had completed several research methods courses struggled to articulate how they would approach the vignettes on more than a very superficial and intuitive level. While some students recognized that there is a systematic decision making process that can be followed, none could describe it clearly or completely. We then presented the same vignettes to 10 psychology academics with particular expertise in conducting research and/or research methods instruction. Predictably, these "experts" were able to describe a far more systematic, comprehensive, flexible, and nuanced approach to statistical decision making, which begins early in the research process, and pays consideration to multiple contextual factors. They were sensitive to the challenges that students experience when making statistical decisions, which they attributed partially to how research methods and statistics are commonly taught. This sensitivity was reflected in their pedagogic practices. When asked to consider the format and features of an aid that could facilitate the statistical decision making process, both groups expressed a preference for an accessible, comprehensive and reputable resource that follows a basic decision tree logic. For the academics in particular, this aid should function as a teaching tool, which engages the user with each choice-point in the decision making process, rather than simply providing an "answer." Based on these findings, we offer suggestions for tools and strategies that could be deployed in the research methods classroom to facilitate and strengthen students' statistical decision making abilities.

‘Sometimes people let love conquer them’: how love, intimacy, and trust in relationships between men who have sex with men influence perceptions of sexual risk and sexual decision-making

PubMed Central

Goldenberg, Tamar; Finneran, Catherine; Andes, Karen L.; Stephenson, Rob

2015-01-01

Men who have sex with men account for a disproportionate burden of HIV incidence in the USA. Although much research has examined the drivers of sexual risk-taking, the emotional contexts in which men make sexual decisions has received little attention. In this three-phase, 10-week longitudinal qualitative study involving 25 gay and bisexual men, we used timeline-based interviews and quantitative web-based diaries about sexual and/or dating partners to examine how emotions influence HIV risk perceptions and sexual decision-making. Participants described love, intimacy, and trust as reducing HIV risk perceptions and facilitating engagement in condomless anal intercourse. Lust was not as linked with risk perceptions, but facilitated non condom-use through an increased willingness to engage in condomless anal intercourse, despite perceptions of risk. Results indicate that gay and bisexual men do not make sexual decisions in an emotional vacuum. Emotions influence perceptions of risk so that they do not necessarily align with biological risk factors. Emotional influences, especially the type and context of emotions, are important to consider to improve HIV prevention efforts among gay and bisexual men. PMID:25465292

Decision-making among patients and their family in ALS care: a review.

PubMed

Foley, Geraldine; Hynes, Geralyn

2018-05-01

Practice guidelines in ALS care emphasise the role of the patient and their family in the decision-making process. We aimed to examine the ALS patient/family relationship in the decision-making process and to ascertain how patients and their family can shape one another's decisions pertaining to care. We conducted a review of peer-reviewed empirical research, published in full and in English between January 2007 and January 2017, relating to care decision-making among ALS patients and their family. Database sources included: Medline; CINAHL; AMED; PsycINFO; PsycARTICLES; and Social Sciences Full Text. A narrative synthesis was undertaken. Forty-seven studies from the empirical literature were extracted. The family viewpoint was captured primarily from family members with direct care-giving duties. Patients' cognitive status was not routinely assessed. The findings revealed that the decision-making process in ALS care can be contoured by patients' and family caregivers' perceived responsibilities to one another and to the wider family. Greater attention to family member roles beyond the primary caregiver role is needed. Strategies that integrate cognitively-impaired patients into the family decision-making process require investigation. Identification of the domains in which ALS patients and their family members support one another in the decision-making process could facilitate the development of patient/family decision-making tools in ALS care.

Shared decision making: what do clinicians need to know and why should they bother?

PubMed

Hoffmann, Tammy C; Légaré, France; Simmons, Magenta B; McNamara, Kevin; McCaffery, Kirsten; Trevena, Lyndal J; Hudson, Ben; Glasziou, Paul P; Del Mar, Christopher B

2014-07-07

Shared decision making enables a clinician and patient to participate jointly in making a health decision, having discussed the options and their benefits and harms, and having considered the patient's values, preferences and circumstances. It is not a single step to be added into a consultation, but a process that can be used to guide decisions about screening, investigations and treatments. The benefits of shared decision making include enabling evidence and patients' preferences to be incorporated into a consultation; improving patient knowledge, risk perception accuracy and patient-clinician communication; and reducing decisional conflict, feeling uninformed and inappropriate use of tests and treatments. Various approaches can be used to guide clinicians through the process. We elaborate on five simple questions that can be used: What will happen if the patient waits and watches? What are the test or treatment options? What are the benefits and harms of each option? How do the benefits and harms weigh up for the patient? Does the patient have enough information to make a choice? Although shared decision making can occur without tools, various types of decision support tools now exist to facilitate it. Misconceptions about shared decision making are hampering its implementation. We address the barriers, as perceived by clinicians. Despite numerous international initiatives to advance shared decision making, very little has occurred in Australia. Consequently, we are lagging behind many other countries and should act urgently.

Shared decision making in chronic care in the context of evidence based practice in nursing.

PubMed

Friesen-Storms, Jolanda H H M; Bours, Gerrie J J W; van der Weijden, Trudy; Beurskens, Anna J H M

2015-01-01

In the decision-making environment of evidence-based practice, the following three sources of information must be integrated: research evidence of the intervention, clinical expertise, and the patient's values. In reality, evidence-based practice usually focuses on research evidence (which may be translated into clinical practice guidelines) and clinical expertise without considering the individual patient's values. The shared decision-making model seems to be helpful in the integration of the individual patient's values in evidence-based practice. We aim to discuss the relevance of shared decision making in chronic care and to suggest how it can be integrated with evidence-based practice in nursing. We start by describing the following three possible approaches to guide the decision-making process: the paternalistic approach, the informed approach, and the shared decision-making approach. Implementation of shared decision making has gained considerable interest in cases lacking a strong best-treatment recommendation, and when the available treatment options are equivalent to some extent. We discuss that in chronic care it is important to always invite the patient to participate in the decision-making process. We delineate the following six attributes of health care interventions in chronic care that influence the degree of shared decision making: the level of research evidence, the number of available intervention options, the burden of side effects, the impact on lifestyle, the patient group values, and the impact on resources. Furthermore, the patient's willingness to participate in shared decision making, the clinical expertise of the nurse, and the context in which the decision making takes place affect the shared decision-making process. A knowledgeable and skilled nurse with a positive attitude towards shared decision making—integrated with evidence-based practice—can facilitate the shared decision-making process. We conclude that nurses as well as other health care professionals in chronic care should integrate shared decision making with evidence-based practice to deliver patient-centred care. Copyright © 2014 Elsevier Ltd. All rights reserved.

Development of shared decision-making resources to help inform difficult healthcare decisions: An example focused on dysvascular partial foot and transtibial amputations.

PubMed

Quigley, Matthew; Dillon, Michael P; Fatone, Stefania

2018-02-01

Shared decision making is a consultative process designed to encourage patient participation in decision making by providing accurate information about the treatment options and supporting deliberation with the clinicians about treatment options. The process can be supported by resources such as decision aids and discussion guides designed to inform and facilitate often difficult conversations. As this process increases in use, there is opportunity to raise awareness of shared decision making and the international standards used to guide the development of quality resources for use in areas of prosthetic/orthotic care. To describe the process used to develop shared decision-making resources, using an illustrative example focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Development process: The International Patient Decision Aid Standards were used to guide the development of the decision aid and discussion guide focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Examples from these shared decision-making resources help illuminate the stages of development including scoping and design, research synthesis, iterative development of a prototype, and preliminary testing with patients and clinicians not involved in the development process. Lessons learnt through the process, such as using the International Patient Decision Aid Standards checklist and development guidelines, may help inform others wanting to develop similar shared decision-making resources given the applicability of shared decision making to many areas of prosthetic-/orthotic-related practice. Clinical relevance Shared decision making is a process designed to guide conversations that help patients make an informed decision about their healthcare. Raising awareness of shared decision making and the international standards for development of high-quality decision aids and discussion guides is important as the approach is introduced in prosthetic-/orthotic-related practice.

Integrating local, expert, and practical knowledge in community remediation and revitalization

EPA Science Inventory

Researchers and natural resource managers often develop tools and methods to facilitate the inclusion of science in local environmental decision-making. The eternal hope is to find that model or concept that provides the “right” information to support these decisions....

Making better decisions in groups

PubMed Central

Frith, Chris D.

2017-01-01

We review the literature to identify common problems of decision-making in individuals and groups. We are guided by a Bayesian framework to explain the interplay between past experience and new evidence, and the problem of exploring the space of hypotheses about all the possible states that the world could be in and all the possible actions that one could take. There are strong biases, hidden from awareness, that enter into these psychological processes. While biases increase the efficiency of information processing, they often do not lead to the most appropriate action. We highlight the advantages of group decision-making in overcoming biases and searching the hypothesis space for good models of the world and good solutions to problems. Diversity of group members can facilitate these achievements, but diverse groups also face their own problems. We discuss means of managing these pitfalls and make some recommendations on how to make better group decisions. PMID:28878973

Depression and Anxiety During Pregnancy: Evaluating the Literature in Support of Clinical Risk-Benefit Decision-Making.

PubMed

Dalke, Katharine Baratz; Wenzel, Amy; Kim, Deborah R

2016-06-01

Depression and anxiety during pregnancy are common, and patients and providers are faced with complex decisions regarding various treatment modalities. A structured discussion of the risks and benefits of options with the patient and her support team is recommended to facilitate the decision-making process. This clinically focused review, with emphasis on the last 3 years of published study data, evaluates the major risk categories of medication treatments, namely pregnancy loss, physical malformations, growth impairment, behavioral teratogenicity, and neonatal toxicity. Nonpharmacological treatment options, including neuromodulation and psychotherapy, are also briefly reviewed. Specific recommendations, drawn from the literature and the authors' clinical experience, are also offered to help guide the clinician in decision-making.

Option Grids to facilitate shared decision making for patients with Osteoarthritis of the knee: protocol for a single site, efficacy trial.

PubMed

Marrin, Katy; Wood, Fiona; Firth, Jill; Kinsey, Katharine; Edwards, Adrian; Brain, Kate E; Newcombe, Robert G; Nye, Alan; Pickles, Timothy; Hawthorne, Kamila; Elwyn, Glyn

2014-04-07

Despite policy interest, an ethical imperative, and evidence of the benefits of patient decision support tools, the adoption of shared decision making (SDM) in day-to-day clinical practice remains slow and is inhibited by barriers that include culture and attitudes; resources and time pressures. Patient decision support tools often require high levels of health and computer literacy. Option Grids are one-page evidence-based summaries of the available condition-specific treatment options, listing patients' frequently asked questions. They are designed to be sufficiently brief and accessible enough to support a better dialogue between patients and clinicians during routine consultations. This paper describes a study to assess whether an Option Grid for osteoarthritis of the knee (OA of the knee) facilitates SDM, and explores the use of Option Grids by patients disadvantaged by language or poor health literacy. This will be a stepped wedge exploratory trial involving 72 patients with OA of the knee referred from primary medical care to a specialist musculoskeletal service in Oldham. Six physiotherapists will sequentially join the trial and consult with six patients using usual care procedures. After a period of brief training in using the Option Grid, the same six physiotherapists will consult with six further patients using an Option Grid in the consultation. The primary outcome will be efficacy of the Option Grid in facilitating SDM as measured by observational scores using the OPTION scale. Comparisons will be made between patients who have received the Option Grid and those who received usual care. A Decision Quality Measure (DQM) will assess quality of decision making. The health literacy of patients will be measured using the REALM-R instrument. Consultations will be observed and audio-recorded. Interviews will be conducted with the physiotherapists, patients and any interpreters present to explore their views of using the Option Grid. Option Grids offer a potential solution to the barriers to implementing traditional decision aids into routine clinical practice. The study will assess whether Option Grids can facilitate SDM in day-to-day clinical practice and explore their use with patients disadvantaged by language or poor health literacy. Current Controlled Trials ISRCTN94871417.

Multi-criteria group decision making for evaluating the performance of e-waste recycling programs under uncertainty.

PubMed

Wibowo, Santoso; Deng, Hepu

2015-06-01

This paper presents a multi-criteria group decision making approach for effectively evaluating the performance of e-waste recycling programs under uncertainty in an organization. Intuitionistic fuzzy numbers are used for adequately representing the subjective and imprecise assessments of the decision makers in evaluating the relative importance of evaluation criteria and the performance of individual e-waste recycling programs with respect to individual criteria in a given situation. An interactive fuzzy multi-criteria decision making algorithm is developed for facilitating consensus building in a group decision making environment to ensure that all the interest of individual decision makers have been appropriately considered in evaluating alternative e-waste recycling programs with respect to their corporate sustainability performance. The developed algorithm is then incorporated into a multi-criteria decision support system for making the overall performance evaluation process effectively and simple to use. Such a multi-criteria decision making system adequately provides organizations with a proactive mechanism for incorporating the concept of corporate sustainability into their regular planning decisions and business practices. An example is presented for demonstrating the applicability of the proposed approach in evaluating the performance of e-waste recycling programs in organizations. Copyright © 2015 Elsevier Ltd. All rights reserved.

Shared decision making and use of decision AIDS for localized prostate cancer : perceptions from radiation oncologists and urologists.

PubMed

Wang, Elyn H; Gross, Cary P; Tilburt, Jon C; Yu, James B; Nguyen, Paul L; Smaldone, Marc C; Shah, Nilay D; Abouassally, Robert; Sun, Maxine; Kim, Simon P

2015-05-01

The current attitudes of prostate cancer specialists toward decision aids and their use in clinical practice to facilitate shared decision making are poorly understood. To assess attitudes toward decision aids and their dissemination in clinical practice. A survey was mailed to a national random sample of 1422 specialists (711 radiation oncologists and 711 urologists) in the United States from November 1, 2011, through April 30, 2012. Respondents were asked about familiarity, perceptions, and use of decision aids for clinically localized prostate cancer and trust in various professional societies in developing decision aids. The Pearson χ2 test was used to test for bivariate associations between physician characteristics and outcomes. Similar response rates were observed for radiation oncologists and urologists (44.0% vs 46.1%; P=.46). Although most respondents had some familiarity with decision aids, only 35.5% currently use a decision aid in clinic practice. The most commonly cited barriers to decision aid use included the perception that their ability to estimate the risk of recurrence was superior to that of decision aids (7.7% in those not using decision aids and 26.2% in those using decision aids; P<.001) and the concern that patients could not process information from a decision aid (7.6% in those not using decision aids and 23.7% in those using decision aids; P<.001). In assessing trust in decision aids established by various professional medical societies, specialists consistently reported trust in favor of their respective organizations, with 9.2% being very confident and 59.2% being moderately confident (P=.01). Use of decision aids among specialists treating patients with prostate cancer is relatively low. Efforts to address barriers to clinical implementation of decision aids may facilitate greater shared decision making for patients diagnosed as having prostate cancer.

Cynefin as Reference Framework to Facilitate Insight and Decision-Making in Complex Contexts of Biomedical Research.

PubMed

Kempermann, Gerd

2017-01-01

The Cynefin scheme is a concept of knowledge management, originally devised to support decision making in management, but more generally applicable to situations, in which complexity challenges the quality of insight, prediction, and decision. Despite the fact that life itself, and especially the brain and its diseases, are complex to the extent that complexity could be considered their cardinal feature, complex problems in biomedicine are often treated as if they were actually not more than the complicated sum of solvable sub-problems. Because of the emergent properties of complex contexts this is not correct. With a set of clear criteria Cynefin helps to set apart complex problems from "simple/obvious," "complicated," "chaotic," and "disordered" contexts in order to avoid misinterpreting the relevant causality structures. The distinction comes with the insight, which specific kind of knowledge is possible in each of these categories and what are the consequences for resulting decisions and actions. From student's theses over the publication and grant writing process to research politics, misinterpretation of complexity can have problematic or even dangerous consequences, especially in clinical contexts. Conceptualization of problems within a straightforward reference language like Cynefin improves clarity and stringency within projects and facilitates communication and decision-making about them.

Memory states influence value-based decisions.

PubMed

Duncan, Katherine D; Shohamy, Daphna

2016-11-01

Using memory to guide decisions allows past experience to improve future outcomes. However, the circumstances that modulate how and when memory influences decisions are not well understood. Here, we report that the use of memories to guide decisions depends on the context in which these decisions are made. We show that decisions made in the context of familiar images are more likely to be influenced by past events than are decisions made in the context of novel images (Experiment 1), that this bias persists even when a temporal gap is introduced between the image presentation and the decision (Experiment 2), and that contextual novelty facilitates value learning whereas familiarity facilitates the retrieval and use of previously learned values (Experiment 3). These effects are consistent with neurobiological and computational models of memory, which propose that familiar images evoke a lingering "retrieval state" that facilitates the recollection of other episodic memories. Together, these experiments highlight the importance of episodic memory for decision-making and provide an example of how computational and neurobiological theories can lead to new insights into how and when different types of memories guide our choices. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Decision making in cancer primary prevention and chemoprevention.

PubMed

Gorin, Sherri Sheinfeld; Wang, Catharine; Raich, Peter; Bowen, Deborah J; Hay, Jennifer

2006-12-01

We know very little about how individuals decide to undertake, maintain, or discontinue cancer primary prevention or chemoprevention. The aims of this article are to (a) examine whether and, if so, how traditional health behavior change models are relevant for decision making in this area; (b) review the application of decision aids to forming specific, personal choices between options; and (c) identify the challenges of evaluating these decision processes to suggest areas for future research. Theoretical models and frameworks derived from the health behavior change and decision-making fields were applied to cancer primary prevention choices. Decision aids for the human papillomavirus (HPV) vaccine, Hormone Replacement Therapy (HRT), and tamoxifen were systematically examined. Traditional concepts such as decisional balance and cues to action are relevant to understanding cancer primary prevention choices; Motivational Interviewing, Self-Determination Theory, and the Preventive Health Model may also explain the facilitators of decision making. There are no well-tested HPV vaccine decision aids, although there have been some studies on aids for HPV testing. There are several effective decision aids for HRT and tamoxifen; evidence-based decision aid components have also been identified. Additional theory-based empirical research on decision making in cancer primary prevention and chemoprevention, particularly at the interface of psychology and behavioral economics, is suggested.

The medical decision model and decision maker tools for management of radiological and nuclear incidents.

PubMed

Koerner, John F; Coleman, C Norman; Murrain-Hill, Paula; FitzGerald, Denis J; Sullivan, Julie M

2014-06-01

Effective decision making during a rapidly evolving emergency such as a radiological or nuclear incident requires timely interim decisions and communications from onsite decision makers while further data processing, consultation, and review are ongoing by reachback experts. The authors have recently proposed a medical decision model for use during a radiological or nuclear disaster, which is similar in concept to that used in medical care, especially when delay in action can have disastrous effects. For decision makers to function most effectively during a complex response, they require access to onsite subject matter experts who can provide information, recommendations, and participate in public communication efforts. However, in the time before this expertise is available or during the planning phase, just-in-time tools are essential that provide critical overview of the subject matter written specifically for the decision makers. Recognizing the complexity of the science, risk assessment, and multitude of potential response assets that will be required after a nuclear incident, the Office of the Assistant Secretary for Preparedness and Response, in collaboration with other government and non-government experts, has prepared a practical guide for decision makers. This paper illustrates how the medical decision model process could facilitate onsite decision making that includes using the deliberative reachback process from science and policy experts and describes the tools now available to facilitate timely and effective incident management.

Shared decision making or paternalism in nursing consultations? A qualitative study of primary care asthma nurses’ views on sharing decisions with patients regarding inhaler device selection

PubMed Central

Upton, Jane; Fletcher, Monica; Madoc‐Sutton, Hazel; Sheikh, Aziz; Caress, Ann‐Louise; Walker, Samantha

2011-01-01

Abstract Background  Although patients with asthma would like more involvement in the decision‐making process, and UK government policy concerning chronic conditions supports shared decision making, it is not widely used in practice. Objective  To investigate how nurses approach decision making in relation to inhaler choice and long‐term inhaler use within a routine asthma consultation and to better understand the barriers and facilitators to shared decision making in practice. Setting and participants  Semi‐structured interviews were conducted with post‐registration, qualified nurses who routinely undertook asthma consultations and were registered on a respiratory course. Interviews were recorded, transcribed and analysed using the Framework approach. Results  Twenty participants were interviewed. Despite holding positive views about shared decision making, limited shared decision making was reported. Opportunities for patients to share decisions were only offered in relation to inhaler device, which were based on the nurse’s pre‐selected recommendations. Giving patients this ‘choice’ was seen as key to improving adherence. Discussion  There is a discrepancy between nurses’ understanding of shared decision making and the depictions of shared decision making presented in the academic literature and NHS policy. In this study, shared decision making was used as a tool to support the nurses’ agenda, rather than as a natural expression of equality between the nurse and patient. Conclusion  There is a misalignment between the goals of practice nurses and the rhetoric regarding patient empowerment. Shared decision making may therefore only be embraced if it improves patient outcomes. This study indicates attitudinal shifts and improvements in knowledge of ‘shared decision‐making’ are needed if policy dictates are to be realised. PMID:21323822

Enhanced decision making through neuroscience

NASA Astrophysics Data System (ADS)

Szu, Harold; Jung, TP; Makeig, Scott

2012-06-01

We propose to enhance the decision making of pilot, co-pilot teams, over a range of vehicle platforms, with the aid of neuroscience. The goal is to optimize this collaborative decision making interplay in time-critical, stressful situations. We will research and measure human facial expressions, personality typing, and brainwave measurements to help answer questions related to optimum decision-making in group situations. Further, we propose to examine the nature of intuition in this decision making process. The brainwave measurements will be facilitated by a University of California, San Diego (UCSD) developed wireless Electroencephalography (EEG) sensing cap. We propose to measure brainwaves covering the whole head area with an electrode density of N=256, and yet keep within the limiting wireless bandwidth capability of m=32 readouts. This is possible because solving Independent Component Analysis (ICA) and finding the hidden brainwave sources allow us to concentrate selective measurements with an organized sparse source -->s sensing matrix [Φs], rather than the traditional purely random compressive sensing (CS) matrix[Φ].

Use of a web-based survey to facilitate shared decision making for patients eligible for cancer screening.

PubMed

Brackett, Charles D; Kearing, Stephen

2015-04-01

Our aim was to facilitate shared decision making (SDM) during preventive visits by utilizing a web-based survey system to offer colorectal cancer (CRC) and prostate cancer screening decision aids (DAs) to appropriately identified patients prior to the visit. Patients completed a web-based questionnaire before their preventive medicine appointment. Age- and gender-appropriate patients completed additional questions to determine eligibility for CRC or prostate-specific antigen (PSA) screening. Eligible patients were offered a choice of video or print DA, and completed questions assessing their knowledge, values, and preferences regarding the screening decision. Responses were summarized and fed forward to clinician and patient reports. Overall, 11,493 CRC and 4,384 PSA questionnaires were completed. Patient responses were used to identify those eligible for cancer-screening DAs: 2,187 (19 %) for CRC and 2,962 (68 %) for PSA; 15 % of eligible patients requested a DA. Many patients declined a DA because they indicated they "already know enough to make their decision" (34 % for CRC, 46 % for PSA). A web-based questionnaire provides an efficient means to identify patients eligible for cancer screening decisions and to offer them DAs before an appointment. Pre-visit use of DAs along with reports giving feedback to patients and clinicians provides an opportunity for SDM to occur at the visit.

Decision Neuroscience: Neuroeconomics

PubMed Central

Smith, David V.; Huettel, Scott A.

2012-01-01

Few aspects of human cognition are more personal than the choices we make. Our decisions – from the mundane to the impossibly complex – continually shape the courses of our lives. In recent years, researchers have applied the tools of neuroscience to understand the mechanisms that underlie decision making, as part of the new discipline of decision neuroscience. A primary goal of this emerging field has been to identify the processes that underlie specific decision variables, including the value of rewards, the uncertainty associated with particular outcomes, and the consequences of social interactions. Recent work suggests potential neural substrates that integrate these variables, potentially reflecting a common neural currency for value, to facilitate value comparisons. Despite the successes of decision neuroscience research for elucidating brain mechanisms, significant challenges remain. These include building new conceptual frameworks for decision making, integrating research findings across disparate techniques and species, and extending results from neuroscience to shape economic theory. To overcome these challenges, future research will likely focus on interpersonal variability in decision making, with the eventual goal of creating biologically plausible models for individual choice. PMID:22754602

End-of-life decision making by family caregivers of persons with advanced dementia: A literature review of decision aids.

PubMed

Xie, Bo; Berkley, Amy S; Kwak, Jung; Fleischmann, Kenneth R; Champion, Jane Dimmitt; Koltai, Kolina S

2018-01-01

To investigate existing knowledge in the literature about end-of-life decision making by family caregivers of persons with dementia, focusing on decision aids for caregivers of persons with advanced dementia, and to identify gaps in the literature that can guide future research. A literature review through systematic searches in PubMed, CINAHL Plus with Full Text, and PsycINFO was conducted in February 2018; publications with full text in English and published in the past 10 years were selected in multiple steps. The final sample included five decision aids with predominantly Caucasian participants; three of them had control groups, and three used audiovisual technology in presenting the intervention materials. No other technology was used in any intervention. Existing interventions lacked tailoring of information to caregivers' preferences for different types and amounts of information necessary to make decisions consistent with patients' values. Research is needed in exploring the use of technology in decision aids that could provide tailored information to facilitate caregivers' decision making. More diverse samples are needed.

The future in clinical genetics: affective forecasting biases in patient and clinician decision making.

PubMed

Peters, S A; Laham, S M; Pachter, N; Winship, I M

2014-04-01

When clinicians facilitate and patients make decisions about predictive genetic testing, they often base their choices on the predicted emotional consequences of positive and negative test results. Research from psychology and decision making suggests that such predictions may often be biased. Work on affective forecasting-predicting one's future emotional states-shows that people tend to overestimate the impact of (especially negative) emotional events on their well-being; a phenomenon termed the impact bias. In this article, we review the causes and consequences of the impact bias in medical decision making, with a focus on applying such findings to predictive testing in clinical genetics. We also recommend strategies for reducing the impact bias and consider the ethical and practical implications of doing so. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

DECISION-MAKING ALIGNED WITH RAPID-CYCLE EVALUATION IN HEALTH CARE.

PubMed

Schneeweiss, Sebastian; Shrank, William H; Ruhl, Michael; Maclure, Malcolm

2015-01-01

Availability of real-time electronic healthcare data provides new opportunities for rapid-cycle evaluation (RCE) of health technologies, including healthcare delivery and payment programs. We aim to align decision-making processes with stages of RCE to optimize the usefulness and impact of rapid results. Rational decisions about program adoption depend on program effect size in relation to externalities, including implementation cost, sustainability, and likelihood of broad adoption. Drawing on case studies and experience from drug safety monitoring, we examine how decision makers have used scientific evidence on complex interventions in the past. We clarify how RCE alters the nature of policy decisions; develop the RAPID framework for synchronizing decision-maker activities with stages of RCE; and provide guidelines on evidence thresholds for incremental decision-making. In contrast to traditional evaluations, RCE provides early evidence on effectiveness and facilitates a stepped approach to decision making in expectation of future regularly updated evidence. RCE allows for identification of trends in adjusted effect size. It supports adapting a program in midstream in response to interim findings, or adapting the evaluation strategy to identify true improvements earlier. The 5-step RAPID approach that utilizes the cumulating evidence of program effectiveness over time could increase policy-makers' confidence in expediting decisions. RCE enables a step-wise approach to HTA decision-making, based on gradually emerging evidence, reducing delays in decision-making processes after traditional one-time evaluations.

Decision-Making, Cognitive Distortions and Alcohol Use in Adolescent Problem and Non-problem Gamblers: An Experimental Study.

PubMed

Ciccarelli, Maria; Griffiths, Mark D; Nigro, Giovanna; Cosenza, Marina

2016-12-01

In the psychological literature, many studies have investigated the neuropsychological and behavioral changes that occur developmentally during adolescence. These studies have consistently observed a deficit in the decision-making ability of children and adolescents. This deficit has been ascribed to incomplete brain development. The same deficit has also been observed in adult problem and pathological gamblers. However, to date, no study has examined decision-making in adolescents with and without gambling problems. Furthermore, no study has ever examined associations between problem gambling, decision-making, cognitive distortions and alcohol use in youth. To address these issues, 104 male adolescents participated in this study. They were equally divided in two groups, problem gamblers and non-problem gamblers, based on South Oaks Gambling Screen Revised for Adolescents scores. All participants performed the Iowa gambling task and completed the Gambling Related Cognitions Scale and the alcohol use disorders identification test. Adolescent problem gamblers displayed impaired decision-making, reported high cognitive distortions, and had more problematic alcohol use compared to non-problem gamblers. Strong correlations between problem gambling, alcohol use, and cognitive distortions were observed. Decision-making correlated with interpretative bias. This study demonstrated that adolescent problem gamblers appear to have the same psychological profile as adult problem gamblers and that gambling involvement can negatively impact on decision-making ability that, in adolescence, is still developing. The correlations between interpretative bias and decision-making suggested that the beliefs in the ability to influence gambling outcomes may facilitate decision-making impairment.

Decision-Making of Patients With Implantable Cardioverter-Defibrillators at End of Life: Family Members' Experiences.

PubMed

Lee, Mei Ching; Sulmasy, Daniel P; Gallo, Joseph; Kub, Joan; Hughes, Mark T; Russell, Stuart; Kellogg, Anela; Owens, Sharon G; Terry, Peter; Nolan, Marie T

2017-07-01

Many patients with advanced heart failure (HF) experience the life-extending benefits of implantable cardioverter-defibrillators (ICD), but at the end stage of HF, patients may experience shocks with increasing frequency and change the plan for end-of-life (EOL) care including the deactivation of the ICD. This report describes family members' experiences of patients with ICD making decisions at EOL. Understanding the decision-making of patients with ICD at EOL can promote informed decision-making and improve the quality of EOL care. This pilot study used a mixed methods approach to test the effects of a nurse-guided discussion in decision-making about ICD deactivation (turning off the defibrillation function) at the EOL. Interviews were conducted, audiotaped, and transcribed in 2012 to 2013 with 6 family members of patients with advanced HF and ICDs. Three researchers coded the data and identified themes in 2014. Three main themes described family members' experiences related to patients having HF with ICDs making health-care decision at EOL: decision-making preferences, patients' perception on ICD deactivation, and communication methods. Health-care providers need to have knowledge of patients' decision-making preferences. Preferences for decision-making include the allowing of appropriate people to involve and encourages direct conversation with family members even when advance directives is completed. Information of ICD function and the option of deactivation need to be clearly delivered to patients and family members. Education and guidelines will facilitate the communication of the preferences of EOL care.

Digital technology and clinical decision making in depression treatment: Current findings and future opportunities.

PubMed

Hallgren, Kevin A; Bauer, Amy M; Atkins, David C

2017-06-01

Clinical decision making encompasses a broad set of processes that contribute to the effectiveness of depression treatments. There is emerging interest in using digital technologies to support effective and efficient clinical decision making. In this paper, we provide "snapshots" of research and current directions on ways that digital technologies can support clinical decision making in depression treatment. Practical facets of clinical decision making are reviewed, then research, design, and implementation opportunities where technology can potentially enhance clinical decision making are outlined. Discussions of these opportunities are organized around three established movements designed to enhance clinical decision making for depression treatment, including measurement-based care, integrated care, and personalized medicine. Research, design, and implementation efforts may support clinical decision making for depression by (1) improving tools to incorporate depression symptom data into existing electronic health record systems, (2) enhancing measurement of treatment fidelity and treatment processes, (3) harnessing smartphone and biosensor data to inform clinical decision making, (4) enhancing tools that support communication and care coordination between patients and providers and within provider teams, and (5) leveraging treatment and outcome data from electronic health record systems to support personalized depression treatment. The current climate of rapid changes in both healthcare and digital technologies facilitates an urgent need for research, design, and implementation of digital technologies that explicitly support clinical decision making. Ensuring that such tools are efficient, effective, and usable in frontline treatment settings will be essential for their success and will require engagement of stakeholders from multiple domains. © 2017 Wiley Periodicals, Inc.

Navigating the boundary of science for decision making at the state and local level

NASA Astrophysics Data System (ADS)

Gonzales, L. M.; Wood, C.; Boland, M. A.; Rose, C. A.

2015-12-01

Scientific information should play a vital role in many decision making processes, yet issues incorporating geoscience information often arise due to inherent differences between how scientists and decision makers operate. Decision makers and scientists have different priorities, produce work at different rates, and often lack an understanding of each others' institutional constraints. Boundary organizations, entities that facilitate collaboration and information flow across traditional boundaries such as that between scientists and decision makers, are in a unique position to improve the dialogue between disparate groups. The American Geosciences Institute (AGI), a nonprofit federation of 50 geoscience societies and organizations, is linking the geoscience and decision-making communities through its Critical Issues Program. AGI's Critical Issues program has first-hand experience in improving the transfer of information across the science-decision making boundary, particularly in areas pertaining to water resources and hazards. This presentation will focus on how, by collaborating with organizations representing the decision making and geoscience communities to inform our program development, we have created our three main content types - website, webinar series, and research database - to better meet the needs of the decision-making process. The program presents existing geoscience information in a way that makes the interconnected nature of geoscience topics more easily understood, encourages discussion between the scientific and decision-making communities, and has established a trusted source of impartial geoscience information. These efforts have focused on state and local decision makers—groups that increasingly influence climate and risk-related decisions, yet often lack the resources to access and understand geoscience information.

Predicting species distributions for conservation decisions

PubMed Central

Guisan, Antoine; Tingley, Reid; Baumgartner, John B; Naujokaitis-Lewis, Ilona; Sutcliffe, Patricia R; Tulloch, Ayesha I T; Regan, Tracey J; Brotons, Lluis; McDonald-Madden, Eve; Mantyka-Pringle, Chrystal; Martin, Tara G; Rhodes, Jonathan R; Maggini, Ramona; Setterfield, Samantha A; Elith, Jane; Schwartz, Mark W; Wintle, Brendan A; Broennimann, Olivier; Austin, Mike; Ferrier, Simon; Kearney, Michael R; Possingham, Hugh P; Buckley, Yvonne M

2013-01-01

Species distribution models (SDMs) are increasingly proposed to support conservation decision making. However, evidence of SDMs supporting solutions for on-ground conservation problems is still scarce in the scientific literature. Here, we show that successful examples exist but are still largely hidden in the grey literature, and thus less accessible for analysis and learning. Furthermore, the decision framework within which SDMs are used is rarely made explicit. Using case studies from biological invasions, identification of critical habitats, reserve selection and translocation of endangered species, we propose that SDMs may be tailored to suit a range of decision-making contexts when used within a structured and transparent decision-making process. To construct appropriate SDMs to more effectively guide conservation actions, modellers need to better understand the decision process, and decision makers need to provide feedback to modellers regarding the actual use of SDMs to support conservation decisions. This could be facilitated by individuals or institutions playing the role of ‘translators’ between modellers and decision makers. We encourage species distribution modellers to get involved in real decision-making processes that will benefit from their technical input; this strategy has the potential to better bridge theory and practice, and contribute to improve both scientific knowledge and conservation outcomes. PMID:24134332

Using the TPACK Framework to Facilitate Decision Making on Instructional Technologies

ERIC Educational Resources Information Center

Sobel, Karen; Grotti, Margaret G.

2013-01-01

Technological pedagogical content knowledge ("TPACK") is a theoretical framework used primarily in the field of education to facilitate the integration of technology into educational endeavors. This framework can be particularly valuable to librarians, who are heavy users of technology, and can provide a structure that can help…

Authentic Leadership: Practical Reflexivity, Self-Awareness, and Self-Authorship

ERIC Educational Resources Information Center

Eriksen, Matthew

2009-01-01

This assignment provides a process to facilitate student engagement in practical reflexivity and self-authorship through which students develop the self-awareness that is required to be an authentic and effective leader. It facilitates the development of students' personal leadership principles, which help guide their decision making and actions,…

Management Basics for Minority Women. Facilitator's Manual.

ERIC Educational Resources Information Center

Jackson, Stanlie M., Ed.

This facilitator's manual consists of guidelines and materials for use in conducting a workshop dealing with three management basics for minority women--communication, decision making, and interpersonal skills. Covered in the first half of the manual are the following aspects of implementing the workshop: background on the need for and development…

‘They leave at least believing they had a part in the discussion’: Understanding decision aid use and patient–clinician decision-making through qualitative research

PubMed Central

Tiedje, Kristina; Shippee, Nathan D.; Johnson, Anna M.; Flynn, Priscilla M.; Finnie, Dawn M.; Liesinger, Juliette T.; May, Carl R.; Olson, Marianne E.; Ridgeway, Jennifer L.; Shah, Nilay D.; Yawn, Barbara P.; Montori, Victor M.

2013-01-01

Objective This study explores how patient decision aids (DAs) for antihyperglycemic agents and statins, designed for use during clinical consultations, are embedded into practice, examining how patients and clinicians understand and experience DAs in primary care visits. Methods We conducted semistructured in-depth interviews with patients (n = 22) and primary care clinicians (n = 19), and videorecorded consultations (n = 44). Two researchers coded all transcripts. Inductive analyses guided by grounded theory led to the identification of themes. Video and interview data were compared and organized by themes. Results DAs used during consultations became flexible artifacts, incorporated into existing decision making roles for clinicians (experts, authority figures, persuaders, advisors) and patients (drivers of healthcare, learners, partners). DAs were applied to different decision making steps (deliberation, bargaining, convincing, case assessment), and introduced into an existing knowledge context (participants’ literacy regarding shared decision-making (SDM) and DAs). Conclusion DAs’ flexible use during consultations effectively provided space for discussion, even when SDM was not achieved. DAs can be used within any decision-making model. Practice implications Clinician training in DA use and SDM practice may be needed to facilitate DA implementation and promote more ideal-type forms of sharing in decision making. PMID:23598292

Neural reactivation links unconscious thought to decision-making performance.

PubMed

Creswell, John David; Bursley, James K; Satpute, Ajay B

2013-12-01

Brief periods of unconscious thought (UT) have been shown to improve decision making compared with making an immediate decision (ID). We reveal a neural mechanism for UT in decision making using blood oxygen level-dependent (BOLD) functional magnetic resonance imaging. Participants (N = 33) encoded information on a set of consumer products (e.g. 48 attributes describing four different cars), and we manipulated whether participants (i) consciously thought about this information (conscious thought), (ii) completed a difficult 2-back working memory task (UT) or (iii) made an immediate decision about the consumer products (ID) in a within-subjects blocked design. To differentiate UT neural activity from 2-back working memory neural activity, participants completed an independent 2-back task and this neural activity was subtracted from neural activity occurring during the UT 2-back task. Consistent with a neural reactivation account, we found that the same regions activated during the encoding of complex decision information (right dorsolateral prefrontal cortex and left intermediate visual cortex) continued to be activated during a subsequent 2-min UT period. Moreover, neural reactivation in these regions was predictive of subsequent behavioral decision-making performance after the UT period. These results provide initial evidence for post-encoding unconscious neural reactivation in facilitating decision making.

Neural reactivation links unconscious thought to decision-making performance

PubMed Central

Bursley, James K.; Satpute, Ajay B.

2013-01-01

Brief periods of unconscious thought (UT) have been shown to improve decision making compared with making an immediate decision (ID). We reveal a neural mechanism for UT in decision making using blood oxygen level-dependent (BOLD) functional magnetic resonance imaging. Participants (N = 33) encoded information on a set of consumer products (e.g. 48 attributes describing four different cars), and we manipulated whether participants (i) consciously thought about this information (conscious thought), (ii) completed a difficult 2-back working memory task (UT) or (iii) made an immediate decision about the consumer products (ID) in a within-subjects blocked design. To differentiate UT neural activity from 2-back working memory neural activity, participants completed an independent 2-back task and this neural activity was subtracted from neural activity occurring during the UT 2-back task. Consistent with a neural reactivation account, we found that the same regions activated during the encoding of complex decision information (right dorsolateral prefrontal cortex and left intermediate visual cortex) continued to be activated during a subsequent 2-min UT period. Moreover, neural reactivation in these regions was predictive of subsequent behavioral decision-making performance after the UT period. These results provide initial evidence for post-encoding unconscious neural reactivation in facilitating decision making. PMID:23314012

Risk Taking and Decision Making in Kidney Paired Donation: A Qualitative Study by Semistructured Interviews.

PubMed

Baines, L S; Dulku, H; Jindal, R M; Papalois, V

2018-06-01

Despite excellent outcomes of kidney paired donation (KPD), little is known about how a patient's frame (apply cognitive bias) or weight (attribute value) and concerns relating to risk, justice, and equity affect his or her decision-making process. A pilot study consisting of 3 KPD transplant recipients and 3 KPD kidney donors in the last year was conducted to identify and explore themes in decision making and risk taking. The pilot study was followed by the main study comprised of 20 recipients who had already undergone KPD transplantation and 20 donors who had undergone donor nephrectomy. We conducted semistructured interviews in this cohort and analyzed the data thematically. Each donor-recipient pair was interviewed together to facilitate dyadic conversation and provide deeper insight into the decision-making process leading to transplant and donation. Common themes to both recipient and donor decision making included quality of life; characteristics of the unknown donor and post-transplant expectations. Recipient-specific themes included failure to reach life span milestones, experiences of fellow patients, and altruistic desire to expand the donor pool. Donor-specific themes included balancing existing life commitments with the recipient's need for a kidney, equity and mental accounting in kidney exchange (comparable quality of the kidney received versus the kidney donated), and logistical justice for the recipient. Donors and recipients frame and weight the concepts of risk, justice, and equity differently. This may have direct implications to facilitating patient-centered communication and engagement in KPD pairs. Copyright © 2018 Elsevier Inc. All rights reserved.

Facilitating access to pre-processed research evidence in public health

PubMed Central

2010-01-01

Background Evidence-informed decision making is accepted in Canada and worldwide as necessary for the provision of effective health services. This process involves: 1) clearly articulating a practice-based issue; 2) searching for and accessing relevant evidence; 3) appraising methodological rigor and choosing the most synthesized evidence of the highest quality and relevance to the practice issue and setting that is available; and 4) extracting, interpreting, and translating knowledge, in light of the local context and resources, into practice, program and policy decisions. While the public health sector in Canada is working toward evidence-informed decision making, considerable barriers, including efficient access to synthesized resources, exist. Methods In this paper we map to a previously developed 6 level pyramid of pre-processed research evidence, relevant resources that include public health-related effectiveness evidence. The resources were identified through extensive searches of both the published and unpublished domains. Results Many resources with public health-related evidence were identified. While there were very few resources dedicated solely to public health evidence, many clinically focused resources include public health-related evidence, making tools such as the pyramid, that identify these resources, particularly helpful for public health decisions makers. A practical example illustrates the application of this model and highlights its potential to reduce the time and effort that would be required by public health decision makers to address their practice-based issues. Conclusions This paper describes an existing hierarchy of pre-processed evidence and its adaptation to the public health setting. A number of resources with public health-relevant content that are either freely accessible or requiring a subscription are identified. This will facilitate easier and faster access to pre-processed, public health-relevant evidence, with the intent of promoting evidence-informed decision making. Access to such resources addresses several barriers identified by public health decision makers to evidence-informed decision making, most importantly time, as well as lack of knowledge of resources that house public health-relevant evidence. PMID:20181270

Shared Decision-Making as the Future of Emergency Cardiology.

PubMed

Probst, Marc A; Noseworthy, Peter A; Brito, Juan P; Hess, Erik P

2018-02-01

Shared decision-making is playing an increasingly large role in emergency cardiovascular care. Although there are many challenges to successfully performing shared decision-making in the emergency department, there are numerous clinical scenarios in which it should be used. In this article, we explore new research and emerging decision aids in the following emergency care scenarios: (1) low-risk chest pain; (2) new-onset atrial fibrillation; and (3) moderate-risk syncope. These decision aids are designed to engage patients and facilitate shared decision-making for specific treatment and disposition (admit vs discharge) decisions. We then offer a 3-step, practical approach to performing shared decision-making in the acute care setting, on the basis of broad stakeholder input and previous conceptual work. Step 1 involves simply acknowledging that a clinical decision needs to be made. Step 2 involves a shared discussion about the working diagnosis and the options for care in the context of the patient's values, preferences, and circumstances. The third and final step requires the patient and provider to agree on a plan of action regarding further medical care. The implementation of shared decision-making in emergency cardiology has the potential to shift the paradigm of clinical practice from paternalism toward mutualism and improve the quality and experience of care for our patients. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Evidence summaries (decision boxes) to prepare clinicians for shared decision-making with patients: a mixed methods implementation study.

PubMed

Giguere, Anik M C; Labrecque, Michel; Haynes, R Brian; Grad, Roland; Pluye, Pierre; Légaré, France; Cauchon, Michel; Greenway, Matthew; Carmichael, Pierre-Hugues

2014-10-05

Decision boxes (Dboxes) provide clinicians with research evidence about management options for medical questions that have no single best answer. Dboxes fulfil a need for rapid clinical training tools to prepare clinicians for clinician-patient communication and shared decision-making. We studied the barriers and facilitators to using the Dbox information in clinical practice. We used a mixed methods study with sequential explanatory design. We recruited family physicians, residents, and nurses from six primary health-care clinics. Participants received eight Dboxes covering various questions by email (one per week). For each Dbox, they completed a web questionnaire to rate clinical relevance and cognitive impact and to assess the determinants of their intention to use what they learned from the Dbox to explain to their patients the advantages and disadvantages of the options, based on the theory of planned behaviour (TPB). Following the 8-week delivery period, we conducted focus groups with clinicians and interviews with clinic administrators to explore contextual factors influencing the use of the Dbox information. One hundred clinicians completed the web surveys. In 54% of the 496 questionnaires completed, they reported that their practice would be improved after having read the Dboxes, and in 40%, they stated that they would use this information for their patients. Of those who would use the information for their patients, 89% expected it would benefit their patients, especially in that it would allow the patient to make a decision more in keeping with his/her personal circumstances, values, and preferences. They intended to use the Dboxes in practice (mean 5.6±1.2, scale 1-7, with 7 being "high"), and their intention was significantly related to social norm, perceived behavioural control, and attitude according to the TPB (P<0.0001). In focus groups, clinicians mentioned that co-interventions such as patient decision aids and training in shared decision-making would facilitate the use of the Dbox information. Some participants would have liked a clear "bottom line" statement for each Dbox and access to printed Dboxes in consultation rooms. Dboxes are valued by clinicians. Tailoring of Dboxes to their needs would facilitate their implementation in practice.

Preparing Students for the Future: Making Career Development a Priority.

ERIC Educational Resources Information Center

Hughey, Kenneth F.; Hughey, Judith K.

1999-01-01

Presents information relevant to school counseling about the implications of work changes. Outlines foundational guides for student success: improving decision making, learning about career paths, acquiring employability skills, and developing lifelong learning attitudes. Describes activities to facilitate career development. (SK)

76 FR 12271 - Human Reliability Program: Identification of Reviewing Official

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-07

... authority to issue a final written decision to recertify or revoke the certification of an individual in the... and facilitates timely final agency decision-making. This amendment modifies internal agency... identify, in a timely manner, individuals whose judgment may be impaired by physical or mental/personality...

Inside the Black Box: Tracking Decision-Making in an Action Research Study

ERIC Educational Resources Information Center

Smith, Cathryn

2017-01-01

Action research has been described as "designing the plane while flying it" (Herr & Anderson, 2005, p. 69). A black box documented the researcher's decisions while facilitating leadership development sessions with teacher leaders. Ten process folio steps informed the study through six iterations. Planning steps included a design…

Impact of a decision-support tool on decision making at the district level in Kenya

PubMed Central

2013-01-01

Background In many countries, the responsibility for planning and delivery of health services is devolved to the subnational level. Health programs, however, often fall short of efficient use of data to inform decisions. As a result, programs are not as effective as they can be at meeting the health needs of the populations they serve. In Kenya, a decision-support tool, the District Health Profile (DHP) tool was developed to integrate data from health programs, primarily HIV, at the district level and to enable district health management teams to review and monitor program progress for specific health issues to make informed service delivery decisions. Methods Thirteen in-depth interviews were conducted with ten tool users and three non-users in six districts to qualitatively assess the process of implementing the tool and its effect on data-informed decision making at the district level. The factors that affected use or non-use of the tool were also investigated. Respondents were selected via convenience sample from among those that had been trained to use the DHP tool except for one user who was self-taught to use the tool. Selection criteria also included respondents from urban districts with significant resources as well as respondents from more remote, under-resourced districts. Results Findings from the in-depth interviews suggest that among those who used it, the DHP tool had a positive effect on data analysis, review, interpretation, and sharing at the district level. The automated function of the tool allowed for faster data sharing and immediate observation of trends that facilitated data-informed decision making. All respondents stated that the DHP tool assisted them to better target existing services in need of improvement and to plan future services, thus positively influencing program improvement. Conclusions This paper stresses the central role that a targeted decision-support tool can play in making data aggregation, analysis, and presentation easier and faster. The visual synthesis of data facilitates the use of information in health decision making at the district level of a health system and promotes program improvement. The experience in Kenya can be applied to other countries that face challenges making district-level, data-informed decisions with data from fragmented information systems. PMID:24011028

A web-based tool to support shared decision making for people with a psychotic disorder: randomized controlled trial and process evaluation.

PubMed

van der Krieke, Lian; Emerencia, Ando C; Boonstra, Nynke; Wunderink, Lex; de Jonge, Peter; Sytema, Sjoerd

2013-10-07

Mental health policy makers encourage the development of electronic decision aids to increase patient participation in medical decision making. Evidence is needed to determine whether these decision aids are helpful in clinical practice and whether they lead to increased patient involvement and better outcomes. This study reports the outcome of a randomized controlled trial and process evaluation of a Web-based intervention to facilitate shared decision making for people with psychotic disorders. The study was carried out in a Dutch mental health institution. Patients were recruited from 2 outpatient teams for patients with psychosis (N=250). Patients in the intervention condition (n=124) were provided an account to access a Web-based information and decision tool aimed to support patients in acquiring an overview of their needs and appropriate treatment options provided by their mental health care organization. Patients were given the opportunity to use the Web-based tool either on their own (at their home computer or at a computer of the service) or with the support of an assistant. Patients in the control group received care as usual (n=126). Half of the patients in the sample were patients experiencing a first episode of psychosis; the other half were patients with a chronic psychosis. Primary outcome was patient-perceived involvement in medical decision making, measured with the Combined Outcome Measure for Risk Communication and Treatment Decision-making Effectiveness (COMRADE). Process evaluation consisted of questionnaire-based surveys, open interviews, and researcher observation. In all, 73 patients completed the follow-up measurement and were included in the final analysis (response rate 29.2%). More than one-third (48/124, 38.7%) of the patients who were provided access to the Web-based decision aid used it, and most used its full functionality. No differences were found between the intervention and control conditions on perceived involvement in medical decision making (COMRADE satisfaction with communication: F1,68=0.422, P=.52; COMRADE confidence in decision: F1,67=0.086, P=.77). In addition, results of the process evaluation suggest that the intervention did not optimally fit in with routine practice of the participating teams. The development of electronic decision aids to facilitate shared medical decision making is encouraged and many people with a psychotic disorder can work with them. This holds for both first-episode patients and long-term care patients, although the latter group might need more assistance. However, results of this paper could not support the assumption that the use of electronic decision aids increases patient involvement in medical decision making. This may be because of weak implementation of the study protocol and a low response rate.

Medical decision-making in children and adolescents: developmental and neuroscientific aspects.

PubMed

Grootens-Wiegers, Petronella; Hein, Irma M; van den Broek, Jos M; de Vries, Martine C

2017-05-08

Various international laws and guidelines stress the importance of respecting the developing autonomy of children and involving minors in decision-making regarding treatment and research participation. However, no universal agreement exists as to at what age minors should be deemed decision-making competent. Minors of the same age may show different levels of maturity. In addition, patients deemed rational conversation-partners as a child can suddenly become noncompliant as an adolescent. Age, context and development all play a role in decision-making competence. In this article we adopt a perspective on competence that specifically focuses on the impact of brain development on the child's decision-making process. We believe that the discussion on decision-making competence of minors can greatly benefit from a multidisciplinary approach. We adopted such an approach in order to contribute to the understanding on how to deal with children in decision-making situations. Evidence emerging from neuroscience research concerning the developing brain structures in minors is combined with insights from various other fields, such as psychology, decision-making science and ethics. Four capacities have been described that are required for (medical) decision-making: (1) communicating a choice; (2) understanding; (3) reasoning; and (4) appreciation. Each capacity is related to a number of specific skills and abilities that need to be sufficiently developed to support the capacity. Based on this approach it can be concluded that at the age of 12 children can have the capacity to be decision-making competent. However, this age coincides with the onset of adolescence. Early development of the brain's reward system combined with late development of the control system diminishes decision-making competence in adolescents in specific contexts. We conclude that even adolescents possessing capacities required for decision-making, may need support of facilitating environmental factors. This paper intends to offer insight in neuroscientific mechanisms underlying the medical decision-making capacities in minors and to stimulate practices for optimal involvement of minors. Developing minors become increasingly capable of decision-making, but the neurobiological development in adolescence affects competence in specific contexts. Adequate support should be offered in order to create a context in which minors can make competently make decisions.

Exploring decision-making for environmental health services: perspectives from four cities.

PubMed

Hunt, C; Lewin, S

2000-01-01

Increasing resources are being allocated to environmental health monitoring, especially for developing methods and collecting data to construct environmental health indicators (EHIs). Yet, little research has focused on understanding how communities and service providers make decisions with regard to environmental health priorities and the role of indicators in this process. This paper presents insights regarding local decision-making that arose from a project to test the feasibility of using community-based EHIs to facilitate communication between the providers and the recipients of environmental services in four developing-country cities. The results of the study indicate that decision-making for environmental health services is complex and iterative rather than rational and linear. Contextual and process factors play an important role. These factors include the morale of service providers, the extent of collaboration between service agencies, the priorities of different community groups and relations between service providers and communities. Scientific information, in the form of EHIs, did not appear to be a key element of decision-making in the settings studied. As tools, EHIs are unlikely to become part of the decision-making process unless they are integrated with local agendas and backed by strong local representation.

Aviation System Safety and Pilot Risk Perception: Implications for Enhancing Decision-Making Skills

NASA Technical Reports Server (NTRS)

Green, Mavis F.

2001-01-01

This research explores risk perception in a defined population of flight instructors and the implications of these views for flight training. Flight instructors and students engaged in collegiate aviation flight training were interviewed for this qualitative study. Thirty-three percent of the instructors interviewed reported that flying is not a risky activity. This is important because research identifies risk perception as one factor influencing instructional choices. These choices can then impact the subsequent decision-making processes of flight students. Facilitating pilot decision-making through the use of an appropriate type of learning that incorporates the modeling of consensually validated cognitive procedures and risk management processes is discussed.

Decision-making process of Kala Azar care: results from a qualitative study carried out in disease endemic areas of Nepal

PubMed Central

2013-01-01

Background Analysis of consumer decision making in the health sector is a complex process of comparing feasible alternatives and evaluating the levels of satisfaction associated with the relevant options. This paper makes an attempt to understand how and why consumers make specific decisions, what motivates them to adopt a specific health intervention, and what features they find attractive in each of the options. Method The study used a descriptive-explanatory design to analyze the factors determining the choices of healthcare providers. Information was collected through focus group discussions and in-depth interviews. Results The results suggest that the decision making related to seeking healthcare for Kala Azar (KA) treatment is a complex, interactive process. Patients and family members follow a well-defined road map for decision making. The process of decision making starts from the recognition of healthcare needs and is then modified by a number of other factors, such as indigenous knowledge, healthcare alternatives, and available resources. Household and individual characteristics also play important roles in facilitating the process of decision making. The results from the group discussions and in-depth interviews are consistent with the idea that KA patients and family members follow the rational approach of weighing the costs against the benefits of using specific types of medical care. Conclusion The process of decision making related to seeking healthcare follows a complex set of steps and many of the potential factors affect the decision making in a non-linear fashion. Our analysis suggests that it is possible to derive a generalized road map of the decision-making process starting from the recognition of healthcare needs, and then modifying it to show the influences of indigenous knowledge, healthcare alternatives, and available resources. PMID:23849617

Decision-making process of Kala Azar care: results from a qualitative study carried out in disease endemic areas of Nepal.

PubMed

Adhikari, Shiva Raj; Supakankunti, Siripen; Khan, M Mahmud

2013-07-12

Analysis of consumer decision making in the health sector is a complex process of comparing feasible alternatives and evaluating the levels of satisfaction associated with the relevant options. This paper makes an attempt to understand how and why consumers make specific decisions, what motivates them to adopt a specific health intervention, and what features they find attractive in each of the options. The study used a descriptive-explanatory design to analyze the factors determining the choices of healthcare providers. Information was collected through focus group discussions and in-depth interviews. The results suggest that the decision making related to seeking healthcare for Kala Azar (KA) treatment is a complex, interactive process. Patients and family members follow a well-defined road map for decision making. The process of decision making starts from the recognition of healthcare needs and is then modified by a number of other factors, such as indigenous knowledge, healthcare alternatives, and available resources. Household and individual characteristics also play important roles in facilitating the process of decision making. The results from the group discussions and in-depth interviews are consistent with the idea that KA patients and family members follow the rational approach of weighing the costs against the benefits of using specific types of medical care. The process of decision making related to seeking healthcare follows a complex set of steps and many of the potential factors affect the decision making in a non-linear fashion. Our analysis suggests that it is possible to derive a generalized road map of the decision-making process starting from the recognition of healthcare needs, and then modifying it to show the influences of indigenous knowledge, healthcare alternatives, and available resources.

Older Adults and Chronic Kidney Disease Decision Making by Primary Care Physicians: A Scholarly Review and Research Agenda

PubMed Central

Dale, William; Stankus, Nicole; Sachs, Greg A.

2008-01-01

Background Chronic kidney disease (CKD) is a growing public health concern that overwhelmingly affects older adults. National guidelines have called for earlier referral of CKD patients, but it is unclear how these should apply to older adults. Objective This scholarly review aims to explore the current literature about upstream referral decisions for CKD within the context of decisions about initiation of dialysis and general referral decisions. The authors propose a model for understanding the referral process and discuss future directions for research to guide decision making for older patients with CKD. Results While age has been shown to be influential in decisions to refer patients for dialysis and other medical therapies, the role of other patient factors such as competing medical co-morbidities, functional loss, or cognitive impairment in the decision making of physicians has been less well elucidated, particularly for CKD. Conclusions More information is needed on the decision-making behavior of physicians for upstream referral decisions like those being advocated for CKD. Exploring the role of geriatric factors like cognitive and functional status may help facilitate more appropriate use of resources and improve patient outcomes. PMID:18175190

Neonatologists can impede or support parents' participation in decision-making during medical rounds in neonatal intensive care units.

PubMed

Axelin, Anna; Outinen, Jyri; Lainema, Kirsi; Lehtonen, Liisa; Franck, Linda S

2018-05-03

We explored the dynamics of neonatologist-parent communication and decision-making during medical rounds in a level three neonatal intensive care unit. This was a qualitative study, with an ethnographic approach, that was conducted at Turku University Hospital, Finland, from 2013-2014. We recruited eight mothers and seven couples, their 11 singletons and four sets of twins and two neonatologists and observed and video recorded 15 medical rounds. The infants were born at 23+5 to 40+1 weeks and the parents were aged 24-47. The neonatologists and parents were interviewed separately after the rounds. Four patterns of interaction emerged. The collaborative pattern was most consistent, with the ideal of shared decision-making, as the parents' preferences were genuinely and visibly integrated into the treatment decisions. In the neonatologist-led interactional pattern, the decision-making process was only somewhat inclusive of the parents' observations and preferences. The remaining two patterns, emergency and disconnected, were characterised by a paternalistic decision-making model where the parents' observations and preferences had minimal to no influence on the communication or decision-making. The neonatologists played a central role in facilitating parental participation and their interaction during medical rounds were characterised by the level of parent participation in decision-making. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Distributed decision-making in electric power system transmission maintenance scheduling using multi-agent systems (MAS)

NASA Astrophysics Data System (ADS)

Zhang, Zhong

In this work, motivated by the need to coordinate transmission maintenance scheduling among a multiplicity of self-interested entities in restructured power industry, a distributed decision support framework based on multiagent negotiation systems (MANS) is developed. An innovative risk-based transmission maintenance optimization procedure is introduced. Several models for linking condition monitoring information to the equipment's instantaneous failure probability are presented, which enable quantitative evaluation of the effectiveness of maintenance activities in terms of system cumulative risk reduction. Methodologies of statistical processing, equipment deterioration evaluation and time-dependent failure probability calculation are also described. A novel framework capable of facilitating distributed decision-making through multiagent negotiation is developed. A multiagent negotiation model is developed and illustrated that accounts for uncertainty and enables social rationality. Some issues of multiagent negotiation convergence and scalability are discussed. The relationships between agent-based negotiation and auction systems are also identified. A four-step MAS design methodology for constructing multiagent systems for power system applications is presented. A generic multiagent negotiation system, capable of inter-agent communication and distributed decision support through inter-agent negotiations, is implemented. A multiagent system framework for facilitating the automated integration of condition monitoring information and maintenance scheduling for power transformers is developed. Simulations of multiagent negotiation-based maintenance scheduling among several independent utilities are provided. It is shown to be a viable alternative solution paradigm to the traditional centralized optimization approach in today's deregulated environment. This multiagent system framework not only facilitates the decision-making among competing power system entities, but also provides a tool to use in studying competitive industry relative to monopolistic industry.

Decision blocks: A tool for automating decision making in CLIPS

NASA Technical Reports Server (NTRS)

Eick, Christoph F.; Mehta, Nikhil N.

1991-01-01

The human capability of making complex decision is one of the most fascinating facets of human intelligence, especially if vague, judgemental, default or uncertain knowledge is involved. Unfortunately, most existing rule based forward chaining languages are not very suitable to simulate this aspect of human intelligence, because of their lack of support for approximate reasoning techniques needed for this task, and due to the lack of specific constructs to facilitate the coding of frequently reoccurring decision block to provide better support for the design and implementation of rule based decision support systems. A language called BIRBAL, which is defined on the top of CLIPS, for the specification of decision blocks, is introduced. Empirical experiments involving the comparison of the length of CLIPS program with the corresponding BIRBAL program for three different applications are surveyed. The results of these experiments suggest that for decision making intensive applications, a CLIPS program tends to be about three times longer than the corresponding BIRBAL program.

Using health outcomes data to inform decision-making: formulary committee perspective.

PubMed

Janknegt, R

2001-01-01

When healthcare resources are limited, decisions about the treatments to fund can be complex and difficult to make, involving the careful balancing of multiple factors. The decisions taken may have far-reaching consequences affecting many people. Clearly, decisions such as the choice of products on a formulary must be taken using a selection process that is fully transparent and that can be justified to all parties concerned. Although everyone would agree that drug selection should be a rational process that follows the guidelines of evidence-based medicine, many other factors may play a role in decision-making. Although some of these are explicit and rational, others are less clearly defined, and decision-makers may be unaware of the influence exerted by some of these factors. In order to facilitate transparent decision-making that makes rational use of health outcomes information, the System of Objectified Judgement Analysis (SOJA) has been developed by the author. SOJA includes interactive software that combines the quality advantages of the 'top-down' approach to drug selection, based on a thorough literature review, with the compliance advantages of a 'bottom-up' approach, where the final decision is made by the individual formulary committee and not by the authors of the review. The SOJA method, based on decision-making processes in economics, ensures that health outcomes information is given appropriate weight. Such approaches are valuable tools in discussions about product selection for formularies.

The Business of Co-Production: Assessing Efforts to Bridge Science and Decision-Making for Adaptation in California

NASA Astrophysics Data System (ADS)

Webber, S.; MacDonald, G. M.

2016-12-01

The last decades have seen scholars argue for a greater integration of science and decision-making in order to more effectively respond to climate change. It has been suggested that overcoming the gap between science, on the one hand, and policy-making and management, on the other, requires building bridges through methods of co-production, creating actionable science, or through boundary organizations. In this paper, we review attempts at co-production for policy-making and management in the context of climate change adaptation in California. Building on field research, including numerous interviews conducted with scientists and decision-makers who are co-producers of adaptation projects, we make three arguments. First, we show that an emphasis on co-production and science-informed climate change adaptation decision-making has bolstered a contract-oriented, and decentralized network-based model of producing climate science. Second, reviewing successes and failures in co-production - as reported in interviews - indicates that it is principally in cases of neatly defined, and spatially and temporarily narrow decision-making contexts, and with highly motivated decision-makers, that climate science is used. Finally, we suggest that the ideas of co-production and actionable science may have increased the institutional and organizational burden at the science-decision interface, lengthening the boundary-organization-chain rather than necessarily facilitating adaptive policy-making and management.

Finding common ground to achieve a "good death": family physicians working with substitute decision-makers of dying patients. A qualitative grounded theory study.

PubMed

Tan, Amy; Manca, Donna

2013-01-22

Substitute decision-makers are integral to the care of dying patients and make many healthcare decisions for patients. Unfortunately, conflict between physicians and surrogate decision-makers is not uncommon in end-of-life care and this could contribute to a "bad death" experience for the patient and family. We aim to describe Canadian family physicians' experiences of conflict with substitute decision-makers of dying patients to identify factors that may facilitate or hinder the end-of-life decision-making process. This insight will help determine how to best manage these complex situations, ultimately improving the overall care of dying patients. Grounded Theory methodology was used with semi-structured interviews of family physicians in Edmonton, Canada, who experienced conflict with substitute decision-makers of dying patients. Purposeful sampling included maximum variation and theoretical sampling strategies. Interviews were audio-taped, and transcribed verbatim. Transcripts, field notes and memos were coded using the constant-comparative method to identify key concepts until saturation was achieved and a theoretical framework emerged. Eleven family physicians with a range of 3 to 40 years in clinical practice participated.The family physicians expressed a desire to achieve a "good death" and described their role in positively influencing the experience of death.Finding Common Ground to Achieve a "Good Death" for the Patient emerged as an important process which includes 1) Building Mutual Trust and Rapport through identifying key players and delivering manageable amounts of information, 2) Understanding One Another through active listening and ultimately, and 3) Making Informed, Shared Decisions. Facilitators and barriers to achieving Common Ground were identified. Barriers were linked to conflict. The inability to resolve an overt conflict may lead to an impasse at any point. A process for Resolving an Impasse is described. A novel framework for developing Common Ground to manage conflicts during end-of-life decision-making discussions may assist in achieving a "good death". These results could aid in educating physicians, learners, and the public on how to achieve productive collaborative relationships during end-of-life decision-making for dying patients, and ultimately improve their deaths.

Customer Decision Making in Web Services with an Integrated P6 Model

NASA Astrophysics Data System (ADS)

Sun, Zhaohao; Sun, Junqing; Meredith, Grant

Customer decision making (CDM) is an indispensable factor for web services. This article examines CDM in web services with a novel P6 model, which consists of the 6 Ps: privacy, perception, propensity, preference, personalization and promised experience. This model integrates the existing 6 P elements of marketing mix as the system environment of CDM in web services. The new integrated P6 model deals with the inner world of the customer and incorporates what the customer think during the DM process. The proposed approach will facilitate the research and development of web services and decision support systems.

A delicate subject: The impact of cultural factors on neonatal and perinatal decision making.

PubMed

Van McCrary, S; Green, H C; Combs, A; Mintzer, J P; Quirk, J G

2014-01-01

The neonatal intensive care unit (NICU) is a high-stress environment for both families and health care providers that can sometimes make appropriate medical decisions challenging. We present a review article of non-medical barriers to effective decision making in the NICU, including: miscommunication, mixed messages, denial, comparative social and cultural influences, and the possible influence of perceived legal issues and family reliance on information from the Internet. As examples of these barriers, we describe and discuss two cases that occurred simultaneously in the same NICU where decisions were influenced by social and cultural differences that were misunderstood by both medical staff and patients' families. The resulting stress and emotional discomfort created an environment with sub-optimal relationships between patients' families and health care providers. We provide background on the sources of conflict in these particular cases. We also offer suggestions for possible amelioration of similar conflicts with the twin goals of facilitating compassionate decision making in NICU settings and promoting enhanced well-being of both families and providers.

Understanding the Harms and Benefits of Cancer Screening: A Model of Factors That Shape Informed Decision Making.

PubMed

Petrova, Dafina; Garcia-Retamero, Rocio; Cokely, Edward T

2015-10-01

Decisions about cancer screenings often involve the consideration of complex and counterintuitive evidence. We investigated psychological factors that promote the comprehension of benefits and harms associated with common cancer screenings and their influence on shared decision making. In experiment 1, 256 men received information about PSA-based prostate cancer screening. In experiment 2, 355 women received information about mammography-based breast cancer screening. In both studies, information about potential screening outcomes was provided in 1 of 3 formats: text, a fact box, or a visual aid (e.g., mortality with and without screening and rate of overdiagnosis). We modeled the interplay of comprehension, perceived risks and benefits, intention to participate in screening, and desire for shared decision making. Generally, visual aids were the most effective format, increasing comprehension by up to 18%. Improved comprehension was associated with 1) superior decision making (e.g., fewer intentions to participate in screening when it offered no benefit) and 2) more desire to share in decision making. However, comprehension of the evidence had a limited effect on experienced emotions, risk perceptions, and decision making among those participants who felt that the consequences of cancer were extremely severe. Even when information is counterintuitive and requires the integration of complex harms and benefits, user-friendly risk communications can facilitate comprehension, improve high-stakes decisions, and promote shared decision making. However, previous beliefs about the effectiveness of screening or strong fears about specific cancers may interfere with comprehension and informed decision making. © The Author(s) 2015.

Making the Most of Continuing Medical Education: Evidence of Transformative Learning During a Course in Evidence-Based Medicine and Decision Making.

PubMed

Sokol, Randi G; Shaughnessy, Allen F

2018-01-01

Continuing medical information courses have been criticized for not promoting behavior change among their participants. For behavior change to occur, participants often need to consciously reject previous ideas and transform their way of thinking. Transformational learning is a process that cultivates deep emotional responses and can lead to cognitive and behavioral change in learners, potentially facilitating rich learning experiences and expediting knowledge translation. We explored participants' experiences at a 2-day conference designed to support transformative learning as they encounter new concepts within Information Mastery, which challenge their previous frameworks around the topic of medical decision making. Using the lens of transformative learning theory, we asked: how does Information Mastery qualitatively promote perspective transformation and hence behavior change? We used a hermeneutic phenomenologic approach to capture the lived experience of 12 current and nine previous attendees of the "Information Mastery" course through individual interviews, focus groups, and observation. Data were thematically analyzed. Both prevoius and current conference attendees described how the delivery of new concepts about medical decision making evoked strong emotional responses, facilitated personal transformation, and propelled expedited behavior change around epistemological, moral, and information management themes, resulting in a newfound sense of self-efficacy, confidence, and ownership in their ability to make medical decisions. When the topic area holds the potential to foster a qualitative reframing of learners' guiding paradigms and worldviews, attention should be paid to supporting learners' personalized meaning-making process through transformative learning opportunities to promote translation into practice.

Decision making, cognitive distortions and emotional distress: A comparison between pathological gamblers and healthy controls.

PubMed

Ciccarelli, Maria; Griffiths, Mark D; Nigro, Giovanna; Cosenza, Marina

2017-03-01

The etiology of problem gambling is multifaceted and complex. Among others factors, poor decision making, cognitive distortions (i.e., irrational beliefs about gambling), and emotional factors (e.g., negative mood states) appear to be among the most important factors in the development and maintenance of problem gambling. Although empirical evidence has suggested that cognitive distortions facilitate gambling and negative emotions are associated with gambling, the interplay between cognitive distortions, emotional states, and decision making in gambling remains unexplored. Pathological gamblers (N = 54) and healthy controls (N = 54) completed the South Oaks Gambling Screen (SOGS), the Iowa Gambling Task (IGT), the Gambling Related Cognitions Scale (GRCS), and the Depression Anxiety Stress Scale (DASS-21). Compared to healthy controls, pathological gamblers showed poorer decision making and reported higher scores on measures assessing cognitive distortions and emotional distress. All measures were positively associated with gambling severity. A significant negative correlation between decision making and cognitive distortions was also observed. No associations were found between poor decision making and emotional distress. Logistic regression analysis indicated that cognitive distortions, emotional distress, and poor decision making were significant predictors of problem gambling. The use of self-report measures and the absence of female participants limit the generalizability of the reported findings. The present study is the first to demonstrate the mutual influence between irrational beliefs and poor decision making, as well as the role of cognitive bias, emotional distress, and poor decision making in gambling disorder. Copyright © 2016 Elsevier Ltd. All rights reserved.

Shared decision making: empowering the bedside nurse.

PubMed

Slack, Stephanie M; Boguslawski, Jean M; Eickhoff, Rachel M; Klein, Kristi A; Pepin, Teresa M; Schrandt, Kevin; Wise, Carrie A; Zylstra, Jody A

2005-12-01

Shared decision making is a process that has empowered specialty nurses at the Mayo Clinic in Rochester, MN, to solve a practice concern. Staff nurses recognized a lack of concise, collated information available that described what nurses need to know when caring for patients receiving chemotherapy. Many aspects of the administration process were knowledge and experience based and not easily retrievable. The Hematology/Oncology/Blood and Marrow Transplant Clinical Practice Committee identified this as a significant practice issue. Ideas were brainstormed regarding how to make the information available to nursing colleagues. The Chemotherapy Yellow Pages is a resource that was developed to facilitate the rapid retrieval of pertinent information for bedside nurses. The content of this article outlines a'model of shared decision making and the processes used to address and resolve the practice concern.

Configural displays can improve nutrition-related. decisions: an application of the proximity compatibility principle.

PubMed

Marino, Christopher J; Mahan, Robert R

2005-01-01

The nutrition label format currently used by consumers to make dietary-related decisions presents significant information-processing demands for integration-based decisions; however, those demands were not considered as primary factors when the format was adopted. Labels designed in accordance with known principles of cognitive psychology might enhance the kind of decision making that food labeling was intended to facilitate. Three experiments were designed on the basis of the proximity compatibility principle (PCP) to investigate the relationship between nutrition label format and decision making; the experiments involved two types of integration decisions and one type of filtering decision. Based on the PCP, decision performance was measured to test the overall hypothesis that matched task-display tandems would result in better decision performance than would mismatched tandems. In each experiment, a statistically significant increase in mean decision performance was found when the display design was cognitively matched to the demands of the task. Combined, the results from all three experiments support the general hypothesis that task-display matching is a design principle that may enhance the utility of nutrition labeling in nutrition-related decision making. Actual or potential applications of this research include developing robust display solutions that aid in less effortful assimilation of nutrition-related information for consumers.

Bioethics and the whole: pluralism, consensus, and the transmutation of bioethical methods into gold.

PubMed

Martin, P A

1999-01-01

Arguing that a consensus-based method of bioethical decision making can transform ethical pluralism into an ethical whole, author examines the theory of three consensus-based models--clinical pragmatism, ethics facilitation, and mediation--and develops a practical guide to ethics facilitation that includes a hypothetical case.

Using TELOS for the planning of the information system audit

NASA Astrophysics Data System (ADS)

Drljaca, D. P.; Latinovic, B.

2018-01-01

This paper intent is to analyse different aspects of information system audit and to synthesise them into the feasibility study report in order to facilitate decision making and planning of information system audit process. The TELOS methodology provides a comprehensive and holistic review for making feasibility study in general. This paper examines the use of TELOS in the identification of possible factors that may influence the decision on implementing information system audit. The research question relates to TELOS provision of sufficient information to decision makers to plan an information system audit. It was found that the TELOS methodology can be successfully applied in the process of approving and planning of information system audit. The five aspects of the feasibility study, if performed objectively, can provide sufficient information to decision makers to commission an information system audit, and also contribute better planning of the audit. Using TELOS methodology can assure evidence-based and cost-effective decision-making process and facilitate planning of the audit. The paper proposes an original approach, not examined until now. It is usual to use TELOS for different purposes and when there is a need for conveying of the feasibility study, but not in the planning of the information system audit. This gives originality to the paper and opens further research questions about evaluation of the feasibility study and possible research on comparative and complementary methodologies.

Young breast cancer patients' involvement in treatment decisions: the major role played by decision-making about surgery.

PubMed

Seror, Valérie; Cortaredona, Sébastien; Bouhnik, Anne-Deborah; Meresse, Mégane; Cluze, Camille; Viens, Patrice; Rey, Dominique; Peretti-Watel, Patrick

2013-11-01

The objective of this study is to investigate young breast cancer patients' preferred and actual involvement in decision-making about surgery, chemotherapy, and adjuvant endocrine therapy (AET). A total of 442 women aged 18-40 years at the time of the diagnosis participated in the region-wide ELIPPSE40 cohort study (southeastern France). Logistic regression analyses were performed on various factors possibly affecting patients' preferred and perceived involvement in the decisions about their cancer treatment. The women's mean age was 36.8 years at enrollment. Preference for a fully passive role in decision-making was stated by 20.7% of them. It was favored by regular breast surveillance (p = 0.04) and positive experience of being informed about cancer diagnosis (p = 0.02). Patients' preferences were independently associated with their reported involvement in decision-making about surgery (p = 0.01). A fully passive role in decision-making about chemotherapy and AET was more likely to be reported by patients who perceived their involvement in decision-making about surgery as having been fully passive (adjusted odds ratio = 4.8, CI95% [2.7-8.7], and adjusted odds ratio = 9.8, CI95% [3.3-29.2], respectively). This study shows a significant relationship between the use of antidepressants and involvement in decision-making about surgery, and confirms the relationship between impaired quality of life (in the psychological domain) and a fully passive role in decisions about cancer treatment. Patients' involvement in decision-making about chemotherapy and AET was strongly influenced by their experience of decision-making about surgery, regardless of their tumor stage and history of breast or ovarian cancer. When decisions are being made about surgery, special attention should be paid to facilitating breast cancer patients' involvement in the decision-making. Copyright © 2013 John Wiley & Sons, Ltd.

Choosing an Advanced Therapy in Parkinson's Disease; is it an Evidence-Based Decision in Current Practice?

PubMed

Nijhuis, Frouke A P; van Heek, Jolien; Bloem, Bastiaan R; Post, Bart; Faber, Marjan J

2016-07-25

In advanced Parkinson's disease (PD), neurologists and patients face a complex decision for an advanced therapy. When choosing a treatment, the best available evidence should be combined with the professional's expertise and the patient's preferences. The objective of this study was to explore current decision-making in advanced PD. We conducted focus group discussions and individual interviews with patients (N = 20) who had received deep brain stimulation, Levodopa-Carbidopa intestinal gel, or subcutaneous apomorphine infusion, and with their caregivers (N = 16). Furthermore, we conducted semi-structured interviews with neurologists (N = 7) and PD nurse specialists (N = 3) to include the perspectives of all key players in this decision-making process. Data were analyzed by two researchers using a qualitative thematic analysis approach. Four themes representing current experiences with the decision-making process were identified: 1) information and information needs, 2) factors influencing treatment choice and individual decision strategies, 3) decision-making roles, and 4) barriers and facilitators to shared decision-making (SDM). Patient preferences were taken into account, however patients were not always provided with adequate information. The professional's expertise influenced the decision-making process in both positive and negative ways. Although professionals and patients considered SDM essential for the decision of an advanced treatment, they mentioned several barriers for the implementation in current practice. In this study we found several factors explaining why in current practice, evidence-based decision-making in advanced PD is not optimal. An important first step would be to develop objective information on all treatment options.

Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study

PubMed Central

Schön, Ulla-Karin; Grim, Katarina; Wallin, Lars; Rosenberg, David; Svedberg, Petra

2018-01-01

ABSTRACT Purpose: Shared decision making, SDM, in psychiatric services, supports users to experience a greater sense of involvement in treatment, self-efficacy, autonomy and reduced coercion. Decision tools adapted to the needs of users have the potential to support SDM and restructure how users and staff work together to arrive at shared decisions. The aim of this study was to describe and analyse the implementation process of an SDM intervention for users of psychiatric services in Sweden. Method: The implementation was studied through a process evaluation utilizing both quantitative and qualitative methods. In designing the process evaluation for the intervention, three evaluation components were emphasized: contextual factors, implementation issues and mechanisms of impact. Results: The study addresses critical implementation issues related to decision-making authority, the perceived decision-making ability of users and the readiness of the service to increase influence and participation. It also emphasizes the importance of facilitation, as well as suggesting contextual adaptations that may be relevant for the local organizations. Conclusion: The results indicate that staff perceived the decision support tool as user-friendly and useful in supporting participation in decision-making, and suggest that such concrete supports to participation can be a factor in implementation if adequate attention is paid to organizational contexts and structures. PMID:29405889

Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study.

PubMed

Schön, Ulla-Karin; Grim, Katarina; Wallin, Lars; Rosenberg, David; Svedberg, Petra

2018-12-01

Shared decision making, SDM, in psychiatric services, supports users to experience a greater sense of involvement in treatment, self-efficacy, autonomy and reduced coercion. Decision tools adapted to the needs of users have the potential to support SDM and restructure how users and staff work together to arrive at shared decisions. The aim of this study was to describe and analyse the implementation process of an SDM intervention for users of psychiatric services in Sweden. The implementation was studied through a process evaluation utilizing both quantitative and qualitative methods. In designing the process evaluation for the intervention, three evaluation components were emphasized: contextual factors, implementation issues and mechanisms of impact. The study addresses critical implementation issues related to decision-making authority, the perceived decision-making ability of users and the readiness of the service to increase influence and participation. It also emphasizes the importance of facilitation, as well as suggesting contextual adaptations that may be relevant for the local organizations. The results indicate that staff perceived the decision support tool as user-friendly and useful in supporting participation in decision-making, and suggest that such concrete supports to participation can be a factor in implementation if adequate attention is paid to organizational contexts and structures.

75 FR 45584 - Planning and Establishment of State-Level Exchanges; Request for Comments Regarding Exchange...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-03

... Act): (1) Facilitate the purchase of qualified health plans (QHPs); (2) provide for the establishment... Federal government for their State? When will this decision be made? Can planning grants assist in identifying and assessing relevant factors and making this decision? 2. To what extent have States already...

An Innovative Spreadsheet Application to Teach Management Science Decision Criteria

ERIC Educational Resources Information Center

Hozak, Kurt

2018-01-01

This article describes a Microsoft Excel-based application that uses humorous voice synthesis and timed competition to make it more fun and engaging to learn management science decision criteria. In addition to providing immediate feedback and easily customizable tips that facilitate self-learning, the software randomly generates both the problem…

Faculty Sense of Agency in Decisions about Work and Family

ERIC Educational Resources Information Center

O'Meara, KerryAnn; Campbell, Corbin M.

2011-01-01

Over the last decade, many research universities have adopted policies and support mechanisms to help academic parents balance work and family. This study sought to understand what facilitates faculty agency in making decisions about work and family, including parental leave. We conducted 20 interviews with 5 men and 15 women at a research…

Enhancing stakeholder involvement in environmental decision making: Active Response Geographic Information System

DOE Office of Scientific and Technical Information (OSTI.GOV)

Faber, B.G.; Thomas, V.L.; Thomas, M.R.

This paper describes a spatial decision support system that facilitates land-related negotiations and resolving conflicts. This system, called Active Response Geographic Information System (AR/GIS), uses a geographic information system to examine land resource management issues which involve multiple stakeholder groups. In this process, participants are given the opportunity and tools needed to share ideas in a facilitated land resource allocation negotiation session. Participants are able to assess current land status, develop objectives, propose alternative planning scenarios, and evaluate the effects or impacts of each alternative. AR/GIS is a unique tool that puts geographic information directly at the fingertips of non-technicalmore » policy analysts, decision makers, and representatives of stakeholder groups during the negotiation process. AR/GIS enhances individual comprehension and ownership of the decision making process and increasing the efficiency and effectiveness of group debate. It is most beneficial to planning tasks which are inherently geographic in nature, which require consideration of a large number of physical constraints and economic implications, and which involve publicly sensitive tradeoffs.« less

Learning together for effective collaboration in school-based occupational therapy practice.

PubMed

Villeneuve, Michelle A; Shulha, Lyn M

2012-12-01

School-based occupational therapy (SBOT) practice takes place within a complex system that includes service recipients, service providers, and program decision makers across health and education sectors. Despite the promotion of collaborative consultation at a policy level, there is little practical guidance about how to coordinate multi-agency service and interprofessional collaboration among these stakeholders. This paper reports on a process used to engage program administrators in an examination of SBOT collaborative consultation practice in one region of Ontario to provide an evidence-informed foundation for decision making about implementation of these services. Within an appreciative inquiry framework (Cooperrider, Whitney, & Stavros, 2008), Developmental Work Research methods (Engeström, 2000) were used to facilitate shared learning for improved SBOT collaborative consultation. Program administrators participated alongside program providers and service recipients in a series of facilitated workshops to develop principles that will guide future planning and decision making about the delivery of SBOT services. Facilitated discussion among stakeholders led to the articulation of 12 principles for effective collaborative practice. Program administrators used their shared understanding to propose a new model for delivering SBOT services. Horizontal and vertical learning across agency and professional boundaries led to the development of powerful solutions for program improvement.

Identifying design considerations for a shared decision aid for use at the point of outpatient clinical care: An ethnographic study at an inner city clinic.

PubMed

Hajizadeh, Negin; Perez Figueroa, Rafael E; Uhler, Lauren M; Chiou, Erin; Perchonok, Jennifer E; Montague, Enid

2013-03-06

Computerized decision aids could facilitate shared decision-making at the point of outpatient clinical care. The objective of this study was to investigate whether a computerized shared decision aid would be feasible to implement in an inner-city clinic by evaluating the current practices in shared decision-making, clinicians' use of computers, patient and clinicians' attitudes and beliefs toward computerized decision aids, and the influence of time on shared decision-making. Qualitative data analysis of observations and semi-structured interviews with patients and clinicians at an inner-city outpatient clinic. The findings provided an exploratory look at the prevalence of shared decision-making and attitudes about health information technology and decision aids. A prominent barrier to clinicians engaging in shared decision-making was a lack of perceived patient understanding of medical information. Some patients preferred their clinicians make recommendations for them rather than engage in formal shared decision-making. Health information technology was an integral part of the clinic visit and welcomed by most clinicians and patients. Some patients expressed the desire to engage with health information technology such as viewing their medical information on the computer screen with their clinicians. All participants were receptive to the idea of a decision aid integrated within the clinic visit although some clinicians were concerned about the accuracy of prognostic estimates for complex medical problems. We identified several important considerations for the design and implementation of a computerized decision aid including opportunities to: bridge clinician-patient communication about medical information while taking into account individual patients' decision-making preferences, complement expert clinician judgment with prognostic estimates, take advantage of patient waiting times, and make tasks involved during the clinic visit more efficient. These findings should be incorporated into the design and implementation of a computerized shared decision aid at an inner-city hospital.

Facilitators and barriers of independent decisions by midwives during labor and birth.

PubMed

Everly, Marcee C

2012-01-01

The purpose of this study was to explore the factors that affect labor management decisions of midwives in hospitals and freestanding birth centers. A qualitative study was conducted using one-on-one tape recorded interviews of midwives who had experience managing labor and birth in both hospitals and freestanding birth centers. Ten interviews consisting of several open-ended questions were conducted, coded, and analyzed in a stepwise fashion to identify codes, categories, and themes. Seven participants reviewed the final framework and confirmed credibility and trustworthiness. Four overall themes were identified: trust birth, the woman, the environment, and the labor team. When making labor management decisions, midwives are affected by their trust in birth, the woman, the health care team, and the birth environment. Midwives report more resistance when making labor management decisions in hospitals. The findings of this study provide insight into both the decision making of midwives and how factors in different environments, in this case hospitals and freestanding birth centers, influence the ability of midwives to make independent labor management decisions. © 2011 by the American College of Nurse-Midwives.

Moral imagination: Facilitating prosocial decision-making through scene imagery and theory of mind.

PubMed

Gaesser, Brendan; Keeler, Kerri; Young, Liane

2018-02-01

How we imagine and subjectively experience the future can inform how we make decisions in the present. Here, we examined a prosocial effect of imagining future episodes in motivating moral decisions about helping others in need, as well as the underlying cognitive mechanisms. Across three experiments we found that people are more willing to help others in specific situations after imagining helping them in those situations. Manipulating the spatial representation of imagined future episodes in particular was effective at increasing intentions to help others, suggesting that scene imagery plays an important role in the prosocial effect of episodic simulation. Path modeling analyses revealed that episodic simulation interacts with theory of mind in facilitating prosocial responses but can also operate independently. Moreover, we found that our manipulations of the imagined helping episode increased actual prosocial behavior, which also correlated with changes in reported willingness to help. Based on these findings, we propose a new model that begins to capture the multifaceted mechanisms by which episodic simulation contributes to prosocial decision-making, highlighting boundaries and promising future directions to explore. Implications for research in moral cognition, imagination, and patients with impairments in episodic simulation are discussed. Copyright © 2017 Elsevier B.V. All rights reserved.

Introducing StatHand: A Cross-Platform Mobile Application to Support Students' Statistical Decision Making.

PubMed

Allen, Peter J; Roberts, Lynne D; Baughman, Frank D; Loxton, Natalie J; Van Rooy, Dirk; Rock, Adam J; Finlay, James

2016-01-01

Although essential to professional competence in psychology, quantitative research methods are a known area of weakness for many undergraduate psychology students. Students find selecting appropriate statistical tests and procedures for different types of research questions, hypotheses and data types particularly challenging, and these skills are not often practiced in class. Decision trees (a type of graphic organizer) are known to facilitate this decision making process, but extant trees have a number of limitations. Furthermore, emerging research suggests that mobile technologies offer many possibilities for facilitating learning. It is within this context that we have developed StatHand, a free cross-platform application designed to support students' statistical decision making. Developed with the support of the Australian Government Office for Learning and Teaching, StatHand guides users through a series of simple, annotated questions to help them identify a statistical test or procedure appropriate to their circumstances. It further offers the guidance necessary to run these tests and procedures, then interpret and report their results. In this Technology Report we will overview the rationale behind StatHand, before describing the feature set of the application. We will then provide guidelines for integrating StatHand into the research methods curriculum, before concluding by outlining our road map for the ongoing development and evaluation of StatHand.

From research to evidence-informed decision making: a systematic approach

PubMed Central

Poot, Charlotte C; van der Kleij, Rianne M; Brakema, Evelyn A; Vermond, Debbie; Williams, Siân; Cragg, Liza; van den Broek, Jos M; Chavannes, Niels H

2018-01-01

Abstract Background Knowledge creation forms an integral part of the knowledge-to-action framework aimed at bridging the gap between research and evidence-informed decision making. Although principles of science communication, data visualisation and user-centred design largely impact the effectiveness of communication, their role in knowledge creation is still limited. Hence, this article aims to provide researchers a systematic approach on how knowledge creation can be put into practice. Methods A systematic two-phased approach towards knowledge creation was formulated and executed. First, during a preparation phase the purpose and audience of the knowledge were defined. Subsequently, a developmental phase facilitated how the content is ‘said’ (language) and communicated (channel). This developmental phase proceeded via two pathways: a translational cycle and design cycle, during which core translational and design components were incorporated. The entire approach was demonstrated by a case study. Results The case study demonstrated how the phases in this systematic approach can be operationalised. It furthermore illustrated how created knowledge can be delivered. Conclusion The proposed approach offers researchers a systematic, practical and easy-to-implement tool to facilitate effective knowledge creation towards decision-makers in healthcare. Through the integration of core components of knowledge creation evidence-informed decision making will ultimately be optimized. PMID:29538728

Family and physician influence on asthma research participation decisions for adolescents: the effects of adolescent gender and research risk.

PubMed

Brody, Janet L; Scherer, David G; Annett, Robert D; Turner, Charles; Dalen, Jeanne

2006-08-01

There is considerable ethical and legal ambiguity surrounding the role of adolescents in the decision-making process for research participation. Depending on the nature of the study and the regulations involved, adolescents may have independent responsibility for providing informed consent, they may be asked to provide their assent, or they may be completely excluded from the decision-making process. This study examined parent and adolescent perceptions of decision-making authority and sources of influence on adolescent research participation decisions, and examined whether perceptions of influence differed based on adolescent gender and level of research risk. Adolescents (n = 36) with asthma and their parents reviewed 9 pediatric research protocols, decided whether they would choose to participate, rated the extent they would be responsible for the actual decision, and indicated the ability of family and physician to influence their decisions. Multivariate analyses of variance were used to evaluate differences in perceptions of decision-making authority and sources of influence on the decisions. Adolescents were less willing to cede decision making authority to parents than parents anticipated. Parents and adolescents acknowledged a greater openness to influence from physicians than from family for above minimal risk studies. Parents were more willing to consider opinions from male adolescents. Adolescents desire responsibility for research participation decisions, though parents may not share these views. Physicians' views on research participation are important to families, especially for above minimal risk studies. Parents may grant more decision-making autonomy to adolescent males than to females. Researchers, physicians, and institutions play a key role in facilitating the ethical enrollment of adolescents into biomedical research. Educational, policy, and oversight processes that support both adolescent autonomy and parental responsibility for research participation decision-making in biomedical research are discussed.

Health technology funding decision-making processes around the world: the same, yet different.

PubMed

Stafinski, Tania; Menon, Devidas; Philippon, Donald J; McCabe, Christopher

2011-06-01

All healthcare systems routinely make resource allocation decisions that trade off potential health gains to different patient populations. However, when such trade-offs relate to the introduction of new, promising health technologies, perceived 'winners' and 'losers' are more apparent. In recent years, public scrutiny over such decisions has intensified, raising the need to better understand how they are currently made and how they might be improved. The objective of this paper is to critically review and compare current processes for making health technology funding decisions at the regional, state/provincial and national level in 20 countries. A comprehensive search for published, peer-reviewed and grey literature describing actual national, state/provincial and regional/institutional technology decision-making processes was conducted. Information was extracted by two independent reviewers and tabulated to facilitate qualitative comparative analyses. To identify strengths and weaknesses of processes identified, websites of corresponding organizations were searched for commissioned reviews/evaluations, which were subsequently analysed using standard qualitative methods. A total of 21 national, four provincial/state and six regional/institutional-level processes were found. Although information on each one varied, they could be grouped into four sequential categories: (i) identification of the decision problem; (ii) information inputs; (iii) elements of the decision-making process; and (iv) public accountability and decision implementation. While information requirements of all processes appeared substantial and decision-making factors comprehensive, the way in which they were utilized was often unclear, as were approaches used to incorporate social values or equity arguments into decisions. A comprehensive inventory of approaches to implementing the four main components of all technology funding decision-making processes was compiled, from which areas for future work or research aimed at improving the acceptability of decisions were identified. They include the explication of decision criteria and social values underpinning processes.

Development of an evidence-based decision pathway for vestibular schwannoma treatment options.

PubMed

Linkov, Faina; Valappil, Benita; McAfee, Jacob; Goughnour, Sharon L; Hildrew, Douglas M; McCall, Andrew A; Linkov, Igor; Hirsch, Barry; Snyderman, Carl

To integrate multiple sources of clinical information with patient feedback to build evidence-based decision support model to facilitate treatment selection for patients suffering from vestibular schwannomas (VS). This was a mixed methods study utilizing focus group and survey methodology to solicit feedback on factors important for making treatment decisions among patients. Two 90-minute focus groups were conducted by an experienced facilitator. Previously diagnosed VS patients were recruited by clinical investigators at the University of Pittsburgh Medical Center (UPMC). Classical content analysis was used for focus group data analysis. Providers were recruited from practices within the UPMC system and were surveyed using Delphi methods. This information can provide a basis for multi-criteria decision analysis (MCDA) framework to develop a treatment decision support system for patients with VS. Eight themes were derived from these data (focus group + surveys): doctor/health care system, side effects, effectiveness of treatment, anxiety, mortality, family/other people, quality of life, and post-operative symptoms. These data, as well as feedback from physicians were utilized in building a multi-criteria decision model. The study illustrated steps involved in the development of a decision support model that integrates evidence-based data and patient values to select treatment alternatives. Studies focusing on the actual development of the decision support technology for this group of patients are needed, as decisions are highly multifactorial. Such tools have the potential to improve decision making for complex medical problems with alternate treatment pathways. Copyright © 2016 Elsevier Inc. All rights reserved.

The use of control charts by laypeople and hospital decision-makers for guiding decision making.

PubMed

Schmidtke, K A; Watson, D G; Vlaev, I

2017-07-01

Graphs presenting healthcare data are increasingly available to support laypeople and hospital staff's decision making. When making these decisions, hospital staff should consider the role of chance-that is, random variation. Given random variation, decision-makers must distinguish signals (sometimes called special-cause data) from noise (common-cause data). Unfortunately, many graphs do not facilitate the statistical reasoning necessary to make such distinctions. Control charts are a less commonly used type of graph that support statistical thinking by including reference lines that separate data more likely to be signals from those more likely to be noise. The current work demonstrates for whom (laypeople and hospital staff) and when (treatment and investigative decisions) control charts strengthen data-driven decision making. We present two experiments that compare people's use of control and non-control charts to make decisions between hospitals (funnel charts vs. league tables) and to monitor changes across time (run charts with control lines vs. run charts without control lines). As expected, participants more accurately identified the outlying data using a control chart than using a non-control chart, but their ability to then apply that information to more complicated questions (e.g., where should I go for treatment?, and should I investigate?) was limited. The discussion highlights some common concerns about using control charts in hospital settings.

Questionnaire-Based Maladaptive Decision-Coping Patterns Involved in Binge Eating Among 1013 College Students

PubMed Central

Yan, Wan-Sen; Zhang, Ran-Ran; Lan, Yan; Li, Zhi-Ming; Li, Yong-Hui

2018-01-01

Binge Eating Disorder (BED), considered a public health problem because of its impact on psychiatric, physical, and social functioning, merits much attention given its elevation to an independent diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Similar with substance use disorders, some neuropsychological and personality constructs are potentially implicated in the onset and development of BED, in which poor decision-making has been suggested to facilitate overeating and BED. The objective of this study was to investigate the associations between decision-coping patterns, monetary decision-making, and binge-eating behavior in young adults. A sample of 1013 college students, equally divided into binge-eating and non-binge-eating groups according to the scores on the Binge Eating Scale (BES), were administered multiple measures of decision-making including the Melbourne Decision-Making Questionnaire (MDMQ), the Delay-discounting Test (DDT), and the Probability Discounting Test (PDT). Compared with the non-binge-eating group, the binge-eating group displayed elevated scores on maladaptive decision-making patterns including Procrastination, Buck-passing, and Hypervigilance. Logistic regression model revealed that only Procrastination positively predicted binge eating. These findings suggest that different dimensions of decision-making may be distinctly linked to binge eating among young adults, with Procrastination putatively identified as a risk trait in the development of overeating behavior, which might promote a better understanding of this disorder. PMID:29765343

Decision making technical support study for the US Army's Chemical Stockpile Disposal Program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Feldman, D.L.; Dobson, J.E.

1990-08-01

This report examines the adequacy of current command and control systems designed to make timely decisions that would enable sufficient warning and protective response to an accident at the Edgewood area of Aberdeen Proving Ground (APG), Maryland, and at Pine Bluff Arsenal (PBA), Arkansas. Institutional procedures designed to facilitate rapid accident assessment, characterization, warning, notification, and response after the onset of an emergency and computer-assisted decision-making aids designed to provide salient information to on- and-off-post emergency responders are examined. The character of emergency decision making at APG and PBA, as well as potential needs for improvements to decision-making practices, procedures,more » and automated decision-support systems (ADSSs), are described and recommendations are offered to guide equipment acquisition and improve on- and off-post command and control relationships. We recommend that (1) a continued effort be made to integrate on- and off-post command control, and decision-making procedures to permit rapid decision making; (2) the pathways for alert and notification among on- and off-post officials be improved and that responsibilities and chain of command among off-post agencies be clarified; (3) greater attention be given to organizational and social context factors that affect the adequacy of response and the likelihood that decision-making systems will work as intended; and (4) faster improvements be made to on-post ADSSs being developed at APG and PBA, which hold considerable promise for depicting vast amounts of information. Phased development and procurement of computer-assisted decision-making tools should be undertaken to balance immediate needs against available resources and to ensure flexibility, equity among sites, and compatibility among on- and off-post systems. 112 refs., 6 tabs.« less

“The problem often is that we do not have a family spokesperson but a spokesgroup”: Family Member Informal Roles in End-of-Life Decision-Making in Adult ICUs

PubMed Central

Quinn, Jill R.; Schmitt, Madeline; Baggs, Judith Gedney; Norton, Sally A.; Dombeck, Mary T.; Sellers, Craig R.

2013-01-01

Background To support the process of effective family decision-making, it is important to recognize and understand informal roles various family members may play in the end-of-life decision-making process. Objective The purpose of this study was to describe some informal roles consistently enacted by family members involved in the process of end-of-life decision-making in intensive care units (ICUs). Methods Ethnographic study. Data were collected via participant observation with field notes and semi-structured interviews on four ICUs in an academic health center in the mid-Atlantic United States from 2001 to 2004. The units studied were a medical ICU, a surgical ICU, a burn and trauma ICU, and a cardiovascular ICU. Participants Participants included health care clinicians, patients, and family members. Results Informal roles for family members consistently observed were:, Primary Caregiver, Primary Decision Maker, Family Spokesperson, Out-of-Towner, Patient Wishes Expert, Protector, Vulnerable Member, and Health Care Expert. The identified informal roles were part of family decision making processes, and each role was part of a potentially complicated family dynamic for end-of-life decision-making within the family system, and between the family and health care domains. Conclusions These informal roles reflect the diverse responses to demands for family decision making in what is usually a novel and stressful situation. Identification and description of these family member informal roles can assist clinicians to recognize and understand the functions of these roles in family decision making at the end-of-life, and guide development of strategies to support and facilitate increased effectiveness of family discussions and decision-making processes. PMID:22210699

Value Assessment at the Point of Care: Incorporating Patient Values throughout Care Delivery and a Draft Taxonomy of Patient Values.

PubMed

Armstrong, Melissa J; Mullins, C Daniel

2017-02-01

Incorporation of patient values is a key element of patient-centered care, but consistent incorporation of patient values at the point of care is lacking. Shared decision making encourages incorporation of patient values in decision making, but associated tools often lack guidance on value assessment. In addition, focusing on patient values relating only to specific decisions misses an opportunity for a more holistic approach to value assessment that could impact other aspects of clinical encounters, including health care planning, communication, and stakeholder involvement. In this commentary, we propose a taxonomy of values underlying patient decision making and provide examples of how these impact provision of health care. The taxonomy describes four categories of patient values: global, decisional, situational, and external. Global values are personal values impacting decision making at a universal level and can include value traits and life priorities. Decisional values are the values traditionally conceptualized in decision making, including considerations such as efficacy, toxicity, quality of life, convenience, and cost. Situational values are values tied to a specific moment in time that modify patients' existing global and decisional values. Finally, discussion of external values acknowledges that many patients consider values other than their own when making decisions. Recognizing the breadth of values impacting patient decision making has implications for both overall health care delivery and shared decision making because value assessments focusing only on decisional values may miss important patient considerations. This draft taxonomy highlights different values impacting decision making and facilitates a more complete value assessment at the point of care. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

An Introspective Critique of Past, Present, and Future USGS Decision Support

NASA Astrophysics Data System (ADS)

Neff, B. P.; Pavlick, M.

2017-12-01

In response to increasing scrutiny of publicly funded science, the Water Mission Area of USGS is shifting its approach for informing decisions that affect the country. Historically, USGS has focused on providing sound science on cutting edge, societally relevant issues with the expectation that decision makers will take action on this information. In practice, scientists often do not understand or focus on the needs of decision makers and decision makers often cannot or do not utilize information produced by scientists. The Water Mission Area of USGS has recognized that it can better serve the taxpayer by delivering information more relevant to decision making in a form more conducive to its use. To this end, the Water Mission Area of USGS is seeking greater integration with the decision making process to better inform what information it produces. In addition, recognizing that the transfer of scientific knowledge to decision making is fundamentally a social process, USGS is embracing the use of social science to better inform how it delivers scientific information and facilitates its use. This study utilizes qualitative methods to document the evolution of decision support at USGS and provide a rationale for a shift in direction. Challenges to implementation are identified and collaborative opportunities to improve decision making are discussed.

Making the Connection between Environmental Science and Decision Making

NASA Astrophysics Data System (ADS)

Woodhouse, C. A.; Crimmins, M.; Ferguson, D. B.; Garfin, G. M.; Scott, C. A.

2011-12-01

As society is confronted with population growth, limited resources, and the impacts of climate variability and change, it is vital that institutions of higher education promote the development of professionals who can work with decision-makers to incorporate scientific information into environmental planning and management. Skills for the communication of science are essential, but equally important is the ability to understand decision-making contexts and engage with resource managers and policy makers. It is increasingly being recognized that people who understand the linkages between science and decision making are crucial if science is to better support planning and policy. A new graduate-level seminar, "Making the Connection between Environmental Science and Decision Making," is a core course for a new post-baccalaureate certificate program, Connecting Environmental Science and Decision Making at the University of Arizona. The goal of the course is to provide students with a basic understanding of the dynamics between scientists and decision makers that result in scientific information being incorporated into environmental planning, policy, and management decisions. Through readings from the environmental and social sciences, policy, and planning literature, the course explores concepts including scientific information supply and demand, boundary organizations, co-production of knowledge, platforms for engagement, and knowledge networks. Visiting speakers help students understand some of the challenges of incorporating scientific information into planning and decision making within institutional and political contexts. The course also includes practical aspects of two-way communication via written, oral, and graphical presentations as well as through the interview process to facilitate the transfer of scientific information to decision makers as well as to broader audiences. We aspire to help students develop techniques that improve communication and understanding between scientists and decision-makers, leading to enhanced outcomes in the fields of climate science, water resources, and ecosystem services.

Data-Driven Decision Making in Out-of-School Time Programs. Part 6 in a Series on Implementing Evidence-Based Practices in Out-of-School Time Programs: The Role of Organization-Level Activities. Research-to-Results Brief. Publication #2009-34

ERIC Educational Resources Information Center

Bandy, Tawana; Burkhauser, Mary; Metz, Allison J. R.

2009-01-01

Although many program managers look to data to inform decision-making and manage their programs, high-quality program data may not always be available. Yet such data are necessary for effective program implementation. The use of high-quality data facilitates program management, reduces reliance on anecdotal information, and ensures that data are…

Software for rapid prototyping in the pharmaceutical and biotechnology industries.

PubMed

Kappler, Michael A

2008-05-01

The automation of drug discovery methods continues to develop, especially techniques that process information, represent workflow and facilitate decision-making. The magnitude of data and the plethora of questions in pharmaceutical and biotechnology research give rise to the need for rapid prototyping software. This review describes the advantages and disadvantages of three solutions: Competitive Workflow, Taverna and Pipeline Pilot. Each of these systems processes large amounts of data, integrates diverse systems and assists novice programmers and human experts in critical decision-making steps.

45 CFR 96.125 - Primary prevention.

Code of Federal Regulations, 2010 CFR

2010-10-01

... interaction between the educator/facilitator and the participants is the basis of its activities. Activities under this strategy aim to affect critical life and social skills, including decision-making, refusal...

Positive consequences of conflict on decision making: when a conflict mindset facilitates choice.

PubMed

Savary, Jennifer; Kleiman, Tali; Hassin, Ran R; Dhar, Ravi

2015-02-01

Much research has shown that conflict is aversive and leads to increased choice deferral. In contrast, we have proposed that conflict can be beneficial. Specifically, exposure to nonconscious goal conflict can activate a mindset (a set of cognitive procedures) that facilitates the systematic processing of information without triggering the associated costs, such as negative affect and stress. In a conflict mindset, people should be better able to make tradeoffs and resolve choice conflict. We tested this proposition in 4 experiments, and demonstrated that priming conflicting goals before a decision increases choice in domains unrelated to the primed conflict. We further demonstrated that increased choice occurs because people in a conflict mindset process choice information more systematically, and we rule out several alternative explanations for the results.

A Multimethod Analysis of Shared Decision-Making in Hospice Interdisciplinary Team Meetings Including Family Caregivers

PubMed Central

Washington, Karla T.; Oliver, Debra Parker; Gage, L. Ashley; Albright, David L.; Demiris, George

2015-01-01

Background Much of the existing research on shared decision-making in hospice and palliative care focuses on the provider-patient dyad; little is known about shared decision-making that is inclusive of family members of patients with advanced disease. Aim We sought to describe shared decision-making as it occurred in hospice interdisciplinary team meetings that included family caregivers as participants using video-conferencing technology. Design We conducted a multimethod study in which we used content and thematic analysis techniques to analyze video-recordings of hospice interdisciplinary team meetings (n = 100), individual interviews of family caregivers (n = 73) and hospice staff members (n = 78), and research field notes. Setting/participants Participants in the original studies from which data for this analysis were drawn were hospice family caregivers and staff members employed by one of five different community-based hospice agencies located in the Midwestern United States. Results Shared decision-making occurred infrequently in hospice interdisciplinary team meetings that included family caregivers. Barriers to shared decision-making included time constraints, communication skill deficits, unaddressed emotional needs, staff absences, and unclear role expectations. The hospice philosophy of care, current trends in health care delivery, the interdisciplinary nature of hospice teams, and the designation of a team leader/facilitator supported shared decision-making. Conclusions The involvement of family caregivers in hospice interdisciplinary team meetings using video-conferencing technology creates a useful platform for shared decision-making; however, steps must be taken to transform family caregivers from meeting attendees to shared decision-makers. PMID:26281854

A multimethod analysis of shared decision-making in hospice interdisciplinary team meetings including family caregivers.

PubMed

Washington, Karla T; Oliver, Debra Parker; Gage, L Ashley; Albright, David L; Demiris, George

2016-03-01

Much of the existing research on shared decision-making in hospice and palliative care focuses on the provider-patient dyad; little is known about shared decision-making that is inclusive of family members of patients with advanced disease. We sought to describe shared decision-making as it occurred in hospice interdisciplinary team meetings that included family caregivers as participants using video-conferencing technology. We conducted a multimethod study in which we used content and thematic analysis techniques to analyze video-recordings of hospice interdisciplinary team meetings (n = 100), individual interviews of family caregivers (n = 73) and hospice staff members (n = 78), and research field notes. Participants in the original studies from which data for this analysis were drawn were hospice family caregivers and staff members employed by one of five different community-based hospice agencies located in the Midwestern United States. Shared decision-making occurred infrequently in hospice interdisciplinary team meetings that included family caregivers. Barriers to shared decision-making included time constraints, communication skill deficits, unaddressed emotional needs, staff absences, and unclear role expectations. The hospice philosophy of care, current trends in healthcare delivery, the interdisciplinary nature of hospice teams, and the designation of a team leader/facilitator supported shared decision-making. The involvement of family caregivers in hospice interdisciplinary team meetings using video-conferencing technology creates a useful platform for shared decision-making; however, steps must be taken to transform family caregivers from meeting attendees to shared decision-makers. © The Author(s) 2015.

Conceptualizing Surrogate Decision-Making at End of Life in the Intensive Care Unit using Cognitive Task Analysis

PubMed Central

Dionne-Odom, J. Nicholas; Willis, Danny G.; Bakitas, Marie; Crandall, Beth; Grace, Pamela J.

2014-01-01

Background Surrogate decision-makers (SDMs) face difficult decisions at end of life (EOL) for decisionally incapacitated intensive care unit (ICU) patients. Purpose Identify and describe the underlying psychological processes of surrogate decision-making for adults at EOL in the ICU. Method Qualitative case study design using a cognitive task analysis (CTA) interviewing approach. Participants were recruited from October 2012 to June 2013 from an academic tertiary medical center’s ICU located in the rural Northeastern United States. Nineteen SDMs for patients who had died in the ICU completed in-depth semi-structured CTA interviews. Discussion The conceptual framework formulated from data analysis reveals that three underlying, iterative, psychological dimensions: gist impressions, distressing emotions, and moral intuitions impact a SDM’s judgment about the acceptability of either the patient’s medical treatments or his or her condition. Conclusion The framework offers initial insights about the underlying psychological processes of surrogate decision-making and may facilitate enhanced decision support for SDMs. PMID:25982772

Conceptualizing surrogate decision making at end of life in the intensive care unit using cognitive task analysis.

PubMed

Dionne-Odom, J Nicholas; Willis, Danny G; Bakitas, Marie; Crandall, Beth; Grace, Pamela J

2015-01-01

Surrogate decision makers (SDMs) face difficult decisions at end of life (EOL) for decisionally incapacitated intensive care unit (ICU) patients. To identify and describe the underlying psychological processes of surrogate decision making for adults at EOL in the ICU. Qualitative case study design using a cognitive task analysis interviewing approach. Participants were recruited from October 2012 to June 2013 from an academic tertiary medical center's ICU located in the rural Northeastern United States. Nineteen SDMs for patients who had died in the ICU completed in-depth semistructured cognitive task analysis interviews. The conceptual framework formulated from data analysis reveals that three underlying, iterative, psychological dimensions (gist impressions, distressing emotions, and moral intuitions) impact an SDM's judgment about the acceptability of either the patient's medical treatments or his or her condition. The framework offers initial insights about the underlying psychological processes of surrogate decision making and may facilitate enhanced decision support for SDMs. Copyright © 2015 Elsevier Inc. All rights reserved.

Shared decision making after severe stroke-How can we improve patient and family involvement in treatment decisions?

PubMed

Visvanathan, Akila; Dennis, Martin; Mead, Gillian; Whiteley, William N; Lawton, Julia; Doubal, Fergus Neil

2017-12-01

People who are well may regard survival with disability as being worse than death. However, this is often not the case when those surviving with disability (e.g. stroke survivors) are asked the same question. Many routine treatments provided after an acute stroke (e.g. feeding via a tube) increase survival, but with disability. Therefore, clinicians need to support patients and families in making informed decisions about the use of these treatments, in a process termed shared decision making. This is challenging after acute stroke: there is prognostic uncertainty, patients are often too unwell to participate in decision making, and proxies may not know the patients' expressed wishes (i.e. values). Patients' values also change over time and in different situations. There is limited evidence on successful methods to facilitate this process. Changes targeted at components of shared decision making (e.g. decision aids to provide information and discussing patient values) increase patient satisfaction. How this influences decision making is unclear. Presumably, a "shared decision-making tool" that introduces effective changes at various stages in this process might be helpful after acute stroke. For example, by complementing professional judgement with predictions from prognostic models, clinicians could provide information that is more accurate. Decision aids that are personalized may be helpful. Further qualitative research can provide clinicians with a better understanding of patient values and factors influencing this at different time points after a stroke. The evaluation of this tool in its success to achieve outcomes consistent with patients' values may require more than one clinical trial.

Towards ethical decision support and knowledge management in neonatal intensive care.

PubMed

Yang, L; Frize, M; Eng, P; Walker, R; Catley, C

2004-01-01

Recent studies in neonatal medicine, clinical nursing, and cognitive psychology have indicated the need to augment current decision-making practice in neonatal intensive care units with computerized, intelligent decision support systems. Rapid progress in artificial intelligence and knowledge management facilitates the design of collaborative ethical decision-support tools that allow clinicians to provide better support for parents facing inherently difficult choices, such as when to withdraw aggressive treatment. The appropriateness of using computers to support ethical decision-making is critically analyzed through research and literature review. In ethical dilemmas, multiple diverse participants need to communicate and function as a team to select the best treatment plan. In order to do this, physicians require reliable estimations of prognosis, while parents need a highly useable tool to help them assimilate complex medical issues and address their own value system. Our goal is to improve and structuralize the ethical decision-making that has become an inevitable part of modern neonatal care units. The paper contributes to clinical decision support by outlining the needs and basis for ethical decision support and justifying the proposed development efforts.

What Do the Stats Tell Us? Engaging Elementary Children in Probabilistic Reasoning Based on Data Analysis

ERIC Educational Resources Information Center

Hourigan, Mairéad; Leavy, Aisling

2016-01-01

As part of Japanese Lesson study research focusing on "comparing and describing likelihoods", fifth grade elementary students used real-world data in decision-making. Sporting statistics facilitated opportunities for informal inference, where data were used to make and justify predictions.

Translating Evidence to Facilitate Shared Decision Making: Development and Usability of a Consult Decision Aid Prototype.

PubMed

Stacey, Dawn; Légaré, France; Lyddiatt, Anne; Giguere, Anik M C; Yoganathan, Manosila; Saarimaki, Anton; Pardo, Jordi Pardo; Rader, Tamara; Tugwell, Peter

2016-12-01

The purpose of this study was to translate evidence from Cochrane Reviews into a format that can be used to facilitate shared decision making during the consultation, namely patient decision aids. A systematic development process (a) established a stakeholder committee; (b) developed a prototype according to the International Patient Decision Aid Standards; (c) applied the prototype to a Cochrane Review and used an interview-guided survey to evaluate acceptability/usability; (d) created 12 consult decision aids; and (e) used a Delphi process to reach consensus on considerations for creating a consult decision aid. The 1-page prototype includes (a) a title specifying the decision; (b) information on the health condition, options, benefits/harms with probabilities; (c) an explicit values clarification exercise; and (d) questions to screen for decisional conflict. Hyperlinks provide additional information on definitions, probabilities presented graphically, and references. Fourteen Cochrane Consumer Network members and Cochrane Editorial Unit staff participated. Thirteen reported that it would help patient/clinician discussions and were willing to use and/or recommend it. Seven indicated the right amount of information, six not enough, and one too much. Changes to the prototype were more links to definitions, more white space, and details on GRADE evidence ratings. Creating 12 consult decision aids took about 4 h each. We identified ten considerations when selecting Cochrane Reviews for creating consult decision aids. Using a systematic process, we developed a consult decision aid prototype to be populated with evidence from Cochrane Reviews. It was acceptable and easy to apply. Future studies will evaluate implementation of consult decision aids.

Uncovering the decision-making work of transferring dying patients home from critical care units: An integrative review.

PubMed

Lin, Yanxia; Myall, Michelle; Jarrett, Nikki

2017-12-01

To understand how decisions are made to transfer dying patients home from critical care units. Many people prefer a home death, but a high proportion die in critical care units. Transferring dying patients home is recognized to be complex but transfer decision-making itself remains unclear. Integrative review. Seven bibliographic databases (origin-2015), grey literature and reference lists were searched. An integrative review method was used to synthesize data from diverse sources. Papers were selected through title and abstract screening and full-text reviewing, using inclusion and exclusion criteria derived from review questions. Following quality appraisal, data were extracted and synthesized using normalization process theory as a framework. The number of patients transferred home ranged from 1-346, with most papers reporting on the transfer of one or two patients. Four themes regarding transfer decision-making work were generated: divergent views and practice, multiple stakeholders' involvement in decision-making, collective work and limited understanding of individuals' experiences. The practice of transferring patients home to die and its decision-making varies internationally and is usually influenced by the care system, culture or religion. It is less common to transfer patients home to die from critical care units in western societies. A better understanding of the decision-making work was obtained but mainly from the perspective of hospital-based healthcare professionals. Further research is needed to develop decision-making practice guidance to facilitate patients' wishes to die at home. © 2017 John Wiley & Sons Ltd.

To Share or Not to Share: Malaysian Healthcare Professionals' Views on Localized Prostate Cancer Treatment Decision Making Roles.

PubMed

Lee, Yew Kong; Lee, Ping Yein; Cheong, Ai Theng; Ng, Chirk Jenn; Abdullah, Khatijah Lim; Ong, Teng Aik; Razack, Azad Hassan Abdul

2015-01-01

To explore the views of Malaysian healthcare professionals (HCPs) on stakeholders' decision making roles in localized prostate cancer (PCa) treatment. Qualitative interviews and focus groups were conducted with HCPs treating PCa. Data was analysed using a thematic approach. Four in-depth interviews and three focus group discussions were conducted between December 2012 and March 2013 using a topic guide. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. The participants comprised private urologists (n = 4), government urologists (n = 6), urology trainees (n = 6), government policy maker (n = 1) and oncologists (n = 3). HCP perceptions of the roles of the three parties involved (HCPs, patients, family) included: HCP as the main decision maker, HCP as a guide to patients' decision making, HCP as a facilitator to family involvement, patients as main decision maker and patient prefers HCP to decide. HCPs preferred to share the decision with patients due to equipoise between prostate treatment options. Family culture was important as family members often decided on the patient's treatment due to Malaysia's close-knit family culture. A range of decision making roles were reported by HCPs. It is thus important that stakeholder roles are clarified during PCa treatment decisions. HCPs need to cultivate an awareness of sociocultural norms and family dynamics when supporting non-Western patients in making decisions about PCa.

To Share or Not to Share: Malaysian Healthcare Professionals' Views on Localized Prostate Cancer Treatment Decision Making Roles

PubMed Central

Lee, Yew Kong; Lee, Ping Yein; Cheong, Ai Theng; Ng, Chirk Jenn; Abdullah, Khatijah Lim; Ong, Teng Aik; Razack, Azad Hassan Abdul

2015-01-01

Aim To explore the views of Malaysian healthcare professionals (HCPs) on stakeholders’ decision making roles in localized prostate cancer (PCa) treatment. Methods Qualitative interviews and focus groups were conducted with HCPs treating PCa. Data was analysed using a thematic approach. Four in-depth interviews and three focus group discussions were conducted between December 2012 and March 2013 using a topic guide. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Findings The participants comprised private urologists (n = 4), government urologists (n = 6), urology trainees (n = 6), government policy maker (n = 1) and oncologists (n = 3). HCP perceptions of the roles of the three parties involved (HCPs, patients, family) included: HCP as the main decision maker, HCP as a guide to patients’ decision making, HCP as a facilitator to family involvement, patients as main decision maker and patient prefers HCP to decide. HCPs preferred to share the decision with patients due to equipoise between prostate treatment options. Family culture was important as family members often decided on the patient’s treatment due to Malaysia’s close-knit family culture. Conclusions A range of decision making roles were reported by HCPs. It is thus important that stakeholder roles are clarified during PCa treatment decisions. HCPs need to cultivate an awareness of sociocultural norms and family dynamics when supporting non-Western patients in making decisions about PCa. PMID:26559947

Human Sexuality. A Resource Guide for Parents and Teachers on Teaching...High School Level.

ERIC Educational Resources Information Center

Utah State Office of Education, Salt Lake City.

This guide provides information and resources that will facilitate parents' ability to help adolescents understand human sexuality within the context of home and family values and ideals. It provides teachers with resources to facilitate the decision making process. Contents are organized within a framework of objectives and guidelines for both…

A Web-Based Tool to Support Shared Decision Making for People With a Psychotic Disorder: Randomized Controlled Trial and Process Evaluation

PubMed Central

Emerencia, Ando C; Boonstra, Nynke; Wunderink, Lex; de Jonge, Peter; Sytema, Sjoerd

2013-01-01

Background Mental health policy makers encourage the development of electronic decision aids to increase patient participation in medical decision making. Evidence is needed to determine whether these decision aids are helpful in clinical practice and whether they lead to increased patient involvement and better outcomes. Objective This study reports the outcome of a randomized controlled trial and process evaluation of a Web-based intervention to facilitate shared decision making for people with psychotic disorders. Methods The study was carried out in a Dutch mental health institution. Patients were recruited from 2 outpatient teams for patients with psychosis (N=250). Patients in the intervention condition (n=124) were provided an account to access a Web-based information and decision tool aimed to support patients in acquiring an overview of their needs and appropriate treatment options provided by their mental health care organization. Patients were given the opportunity to use the Web-based tool either on their own (at their home computer or at a computer of the service) or with the support of an assistant. Patients in the control group received care as usual (n=126). Half of the patients in the sample were patients experiencing a first episode of psychosis; the other half were patients with a chronic psychosis. Primary outcome was patient-perceived involvement in medical decision making, measured with the Combined Outcome Measure for Risk Communication and Treatment Decision-making Effectiveness (COMRADE). Process evaluation consisted of questionnaire-based surveys, open interviews, and researcher observation. Results In all, 73 patients completed the follow-up measurement and were included in the final analysis (response rate 29.2%). More than one-third (48/124, 38.7%) of the patients who were provided access to the Web-based decision aid used it, and most used its full functionality. No differences were found between the intervention and control conditions on perceived involvement in medical decision making (COMRADE satisfaction with communication: F1,68=0.422, P=.52; COMRADE confidence in decision: F1,67=0.086, P=.77). In addition, results of the process evaluation suggest that the intervention did not optimally fit in with routine practice of the participating teams. Conclusions The development of electronic decision aids to facilitate shared medical decision making is encouraged and many people with a psychotic disorder can work with them. This holds for both first-episode patients and long-term care patients, although the latter group might need more assistance. However, results of this paper could not support the assumption that the use of electronic decision aids increases patient involvement in medical decision making. This may be because of weak implementation of the study protocol and a low response rate. Trial Registration Dutch Trial Register (NTR) trial number: 10340; http://www.trialregister.nl/trialreg/admin/rctsearch.asp?Term=10340 (Archived by WebCite at http://www.webcitation.org/6Jj5umAeS). PMID:24100091

Effects of age-related differences in empathy on social economic decision-making.

PubMed

Beadle, Janelle N; Paradiso, Sergio; Kovach, Christopher; Polgreen, Linnea; Denburg, Natalie L; Tranel, Daniel

2012-05-01

The ways in which aging affects social economic decision-making is a central issue in the psychology of aging. To examine age-related differences in social economic decision-making as a function of empathy, 80 healthy volunteers participated in the Repeated Fixed Opponent Ultimatum Game (UG-R). Previous economic decision-making research has shown that in younger adults empathy is associated with prosocial behavior. The effects of empathy on older adult social economic decision-making are not well understood. On each of 20 consecutive trials in the UG-R, one player ("Proposer") splits $10 with another player ("Responder") who chooses either to accept (whereby both receive the proposed division) or reject (whereby neither receives anything). Trait cognitive and emotional empathy were measured using the Interpersonal Reactivity Index. UG-R data were examined as a function of age and cognitive empathy. For "unfair" offers (i.e. offers less than $5), older Responders with high cognitive empathy showed less prosocial behavior and obtained greater payoffs than younger Responders with high cognitive empathy. High levels of cognitive empathy may differentially affect economic decision-making behavior in younger and older adults. For older adults, high cognitive empathy may play a role in obtaining high financial payoffs while for younger adults it may instead be involved in facilitating social relationships.

Decision-Making Process Related to Participation in Phase I Clinical Trials: A Nonsystematic Review of the Existing Evidence.

PubMed

Gorini, Alessandra; Mazzocco, Ketti; Pravettoni, Gabriella

2015-01-01

Due to the lack of other treatment options, patient candidates for participation in phase I clinical trials are considered the most vulnerable, and many ethical concerns have emerged regarding the informed consent process used in the experimental design of such trials. Starting with these considerations, this nonsystematic review is aimed at analyzing the decision-making processes underlying patients' decision about whether to participate (or not) in phase I trials in order to clarify the cognitive and emotional aspects most strongly implicated in this decision. Considering that there is no uniform decision calculus and that many different variables other than the patient-physician relationship (including demographic, clinical, and personal characteristics) may influence patients' preferences for and processing of information, we conclude that patients' informed decision-making can be facilitated by creating a rigorously developed, calibrated, and validated computer tool modeled on each single patient's knowledge, values, and emotional and cognitive decisional skills. Such a tool will also help oncologists to provide tailored medical information that is useful to improve the shared decision-making process, thereby possibly increasing patient participation in clinical trials. © 2015 S. Karger AG, Basel.

How do we trust strangers? The neural correlates of decision making and outcome evaluation of generalized trust

PubMed Central

Wang, Yiwen; Zhang, Zhen; Jing, Yiming; Valadez, Emilio A.

2016-01-01

This study investigates the brain correlates of decision making and outcome evaluation of generalized trust (i.e. trust in unfamiliar social agents)—a core component of social capital which facilitates civic cooperation and economic exchange. We measured 18 (9 male) Chinese participants’ event-related potentials while they played the role of the trustor in a one-shot trust game with unspecified social agents (trustees) allegedly selected from a large representative sample. At the decision-making phase, greater N2 amplitudes were found for trustors’ distrusting decisions compared to trusting decisions, which may reflect greater cognitive control exerted to distrust. Source localization identified the precentral gyrus as one possible neuronal generator of this N2 component. At the outcome evaluation phase, principal components analysis revealed that the so called feedback-related negativity was in fact driven by a reward positivity, which was greater in response to gain feedback compared to loss feedback. This reduced reward positivity following loss feedback may indicate that the absence of reward for trusting decisions was unexpected by the trustor. In addition, we found preliminary evidence suggesting that the decision-making processes may differ between high trustors and low trustors. PMID:27317927

Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care.

PubMed

Coxeter, Peter; Del Mar, Chris B; McGregor, Leanne; Beller, Elaine M; Hoffmann, Tammy C

2015-11-12

Shared decision making is an important component of patient-centred care. It is a set of communication and evidence-based practice skills that elicits patients' expectations, clarifies any misperceptions and discusses the best available evidence for benefits and harms of treatment. Acute respiratory infections (ARIs) are one of the most common reasons for consulting in primary care and obtaining prescriptions for antibiotics. However, antibiotics offer few benefits for ARIs, and their excessive use contributes to antibiotic resistance - an evolving public health crisis. Greater explicit consideration of the benefit-harm trade-off within shared decision making may reduce antibiotic prescribing for ARIs in primary care. To assess whether interventions that aim to facilitate shared decision making increase or reduce antibiotic prescribing for ARIs in primary care. We searched CENTRAL (2014, Issue 11), MEDLINE (1946 to November week 3, 2014), EMBASE (2010 to December 2014) and Web of Science (1985 to December 2014). We searched for other published, unpublished or ongoing trials by searching bibliographies of published articles, personal communication with key trial authors and content experts, and by searching trial registries at the National Institutes of Health and the World Health Organization. Randomised controlled trials (RCTs) (individual level or cluster-randomised), which evaluated the effectiveness of interventions that promote shared decision making (as the focus or a component of the intervention) about antibiotic prescribing for ARIs in primary care. Two review authors independently extracted and collected data. Antibiotic prescribing was the primary outcome, and secondary outcomes included clinically important adverse endpoints (e.g. re-consultations, hospital admissions, mortality) and process measures (e.g. patient satisfaction). We assessed the risk of bias of all included trials and the quality of evidence. We contacted trial authors to obtain missing information where available. We identified 10 published reports of nine original RCTs (one report was a long-term follow-up of the original trial) in over 1100 primary care doctors and around 492,000 patients.The main risk of bias came from participants in most studies knowing whether they had received the intervention or not, and we downgraded the rating of the quality of evidence because of this.We meta-analysed data using a random-effects model on the primary and key secondary outcomes and formally assessed heterogeneity. Remaining outcomes are presented narratively.There is moderate quality evidence that interventions that aim to facilitate shared decision making reduce antibiotic use for ARIs in primary care (immediately after or within six weeks of the consultation), compared with usual care, from 47% to 29%: risk ratio (RR) 0.61, 95% confidence interval (CI) 0.55 to 0.68. Reduction in antibiotic prescribing occurred without an increase in patient-initiated re-consultations (RR 0.87, 95% CI 0.74 to 1.03, moderate quality evidence) or a decrease in patient satisfaction with the consultation (OR 0.86, 95% CI 0.57 to 1.30, low quality evidence). There were insufficient data to assess the effects of the intervention on sustained reduction in antibiotic prescribing, adverse clinical outcomes (such as hospital admission, incidence of pneumonia and mortality), or measures of patient and caregiver involvement in shared decision making (such as satisfaction with the consultation; regret or conflict with the decision made; or treatment compliance following the decision). No studies assessed antibiotic resistance in colonising or infective organisms. Interventions that aim to facilitate shared decision making reduce antibiotic prescribing in primary care in the short term. Effects on longer-term rates of prescribing are uncertain and more evidence is needed to determine how any sustained reduction in antibiotic prescribing affects hospital admission, pneumonia and death.

Core domains of shared decision-making during psychiatric visits: scientific and preference-based discussions.

PubMed

Fukui, Sadaaki; Matthias, Marianne S; Salyers, Michelle P

2015-01-01

Shared decision-making (SDM) is imperative to person-centered care, yet little is known about what aspects of SDM are targeted during psychiatric visits. This secondary data analysis (191 psychiatric visits with 11 providers, coded with a validated SDM coding system) revealed two factors (scientific and preference-based discussions) underlying SDM communication. Preference-based discussion occurred less. Both provider and consumer initiation of SDM elements and decision complexity were associated with greater discussions in both factors, but were more strongly associated with scientific discussion. Longer visit length correlated with only scientific discussion. Providers' understanding of core domains could facilitate engaging consumers in SDM.

Positive feelings facilitate working memory and complex decision making among older adults.

PubMed

Carpenter, Stephanie M; Peters, Ellen; Västfjäll, Daniel; Isen, Alice M

2013-01-01

The impact of induced mild positive feelings on working memory and complex decision making among older adults (aged 63-85) was examined. Participants completed a computer administered card task in which participants could win money if they chose from "gain" decks and lose money if they chose from "loss" decks. Individuals in the positive-feeling condition chose better than neutral-feeling participants and earned more money overall. Participants in the positive-feeling condition also demonstrated improved working-memory capacity. These effects of positive-feeling induction have implications for affect theory, as well as, potentially, practical implications for people of all ages dealing with complex decisions.

An Exploration of Closure as a Factor Influencing Group Member Satisfaction: Implications for Applications of Group Support Technology in Education.

ERIC Educational Resources Information Center

Small, Ruth V.; Venkatesh, Murali

Research that identifies factors that facilitate information processing and enhance performance without reducing group confidence and decision satisfaction may influence future development of groupwork systems. This paper contains a review of the literature on cognitive and motivational issues in both group decision-making and learning contexts…

Collaboration via E-Mail and Internet Relay Chat: Understanding Time and Technology.

ERIC Educational Resources Information Center

Duin, Ann Hill; Archee, Ray

1996-01-01

Examines how college students working across distances used e-mail and Internet Relay Chat (IRC) to facilitate their collaboration and decision-making processes. Finds that students came to a decision more quickly using e-mail than with IRC, and when IRC was slow, students reverted to a series of rapid-fire e-mail messages. (RS)

75 FR 45494 - Implementation of Section 224 of the Act; a National Broadband Plan for Our Future

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-03

... attachers make informed decisions and should facilitate the attachment process. If a utility denies an... forward, and whether utilities' decisions regarding the use of boxing and bracketing should also be made... nondiscriminatory access to any pole, duct, conduit, or right-of-way owned or controlled by a utility. However, the...

Choice and Decision Processes and Careers. Information Series No. 7.

ERIC Educational Resources Information Center

Tiedeman, David V.; Miller-Tiedeman, Anna

The state of the art review depicts comprehension of choice and decision making as knowable and demonstrates that something is already known about both processes and how to facilitate their comprehension. The assumption is made that deciding to choose, choosing to decide, deciding in order to choose, and choosing in order to decide must be…

Treatment decision-making in chronic diseases: What are the family members' roles, needs and attitudes? A systematic review.

PubMed

Lamore, Kristopher; Montalescot, Lucile; Untas, Aurélie

2017-12-01

This systematic review aims to examine the roles of family members (FMs) in treatment decision-making for adult patients without cognitive or psychiatric disorders affecting their ability to participate in decision-making. A comprehensive, systematic search of the Cochrane Library, PsycINFO, PubMed and ScienceDirect databases, with relevant keywords, was conducted. Two authors evaluated the eligibility of the studies independently, then cross-checked for accuracy. The quality of included studies were assessed using standardized criteria. Out of the 12.137 studies identified, 40 were included. Results highlighted the different roles and influences FMs have in the decision-making process. Moreover, several factors ranging from personal to cultural and family-related factors influence their level of involvement. Regardless of the illness, some similarities in family influence exist (e.g., social support). However, the type of family involvement varies according to the illness, the treatment choice and the patients' culture. FMs have an important role in the decision-making process. In fact, the final decision is often made by the patients after consulting their families. FMs can support both patients and medical teams, and thus facilitate the process. Physicians should include FMs in treatment decision-making when the patients and their FMs wish to be included. Copyright © 2017 Elsevier B.V. All rights reserved.

Decision making in high-velocity environments: implications for healthcare.

PubMed

Stepanovich, P L; Uhrig, J D

1999-01-01

Healthcare can be considered a high-velocity environment and, as such, can benefit from research conducted in other industries regarding strategic decision making. Strategic planning is not only relevant to firms in high-velocity environments, but is also important for high performance and survival. Specifically, decision-making speed seems to be instrumental in differentiating between high and low performers; fast decision makers outperform slow decision makers. This article outlines the differences between fast and slow decision makers, identifies five paralyses that can slow decision making in healthcare, and outlines the role of a planning department in circumventing these paralyses. Executives can use the proposed planning structure to improve both the speed and quality of strategic decisions. The structure uses planning facilitators to avoid the following five paralyses: 1. Analysis. Decision makers can no longer afford the luxury of lengthy, detailed analysis but must develop real-time systems that provide appropriate, timely information. 2. Alternatives. Many alternatives (beyond the traditional two or three) need to be considered and the alternatives must be evaluated simultaneously. 3. Group Think. Decision makers must avoid limited mind-sets and autocratic leadership styles by seeking out independent, knowledgeable counselors. 4. Process. Decision makers need to resolve conflicts through "consensus with qualification," as opposed to waiting for everyone to come on board. 5. Separation. Successful implementation requires a structured process that cuts across disciplines and levels.

Making the case for evidence-based design in healthcare: a descriptive case study of organizational decision making.

PubMed

Shoemaker, Lorie K; Kazley, Abby Swanson; White, Andrea

2010-01-01

The aim of this study was to describe the organizational decision-making process used in the selection of evidence-based design (EBD) concepts, the criteria used to make these decisions, and the extent to which leadership style may have influenced the decision-making process. Five research questions were formulated to frame the direction of this study, including: (1) How did healthcare leaders learn of innovations in design? (2) How did healthcare leaders make decisions in the selection of healthcare design concepts? (3) What criteria did healthcare leaders use in the decision-making process? (4) How did healthcare leaders consider input from the staff in design decisions? and (5) To what extent did the leadership style of administrators affect the outcomes of the decision-making process? Current issues affecting healthcare in the community led the principal investigator's organization to undertake an ambitious facilities expansion project. As part of its planning process, the organization learned of EBD principles that seemingly had a positive impact on patient care and safety and staff working conditions. Although promising, a paucity of empirical research addressed the cost/benefit of incorporating many EBD concepts into one hospital setting, and there was no research that articulated the organizational decision-making process used by healthcare administrators when considering the use of EBD in expansion projects. A mixed-method, descriptive, qualitative, single-case study and quantitative design were used to address the five research questions. The Systems Research Organizing Model provided the theoretical framework. A variety of data collection methods was used, including interviews of key respondents, the review of documentary evidence, and the Multifactor Leadership Questionnaire. A participatory process was used throughout the design decision phases, involving staff at all levels of the organization. The Internet and architects facilitated learning about EBD. Financial considerations were a factor in decision making. The prevalence of the transformational leadership style among the organization's administrators exceeded the U.S. mean.

Bringing science to the table: Case studies in science-informed decision making on climate change and beyond

NASA Astrophysics Data System (ADS)

Goldman, G. T.; Phartiyal, P.; Mulvey, K.

2016-12-01

Federal government officials often rely on the research and advice of scientists to inform their decision making around climate change and other complex topics. Decision makers, however, are constrained by the time and accessibility needed to obtain and incorporate scientific information. At the same time, scientists have limited capacity and incentive to devote significant time to communicating their science to decision makers. The Union of Concerned Scientists has employed several strategies to produce policy-relevant scientific work and to facilitate engagement between scientists and decision makers across research areas. This talk will feature lessons learned and key strategies for science-informed decision making around climate change and other areas of the geosciences. Case studies will include conducting targeted sea level rise studies to inform rulemaking at federal agencies, bringing science to policy discussions on hydraulic fracturing, and leveraging the voice of the scientific community on specific policy proposals around climate change disclosure of companies. Recommendations and lessons learned for producing policy-relevant science and effectively communicating it with decision makers will be offered.

The neglected topic: presentation of cost information in patient decision AIDS.

PubMed

Blumenthal-Barby, J S; Robinson, Emily; Cantor, Scott B; Naik, Aanand D; Russell, Heidi Voelker; Volk, Robert J

2015-05-01

Costs are an important component of patients' decision making, but a comparatively underemphasized aspect of formal shared decision making. We hypothesized that decision aids also avoid discussion of costs, despite their being tools designed to facilitate shared decision making about patient-centered outcomes. We sought to define the frequency of cost-related information and identify the common modes of presenting cost and cost-related information in the 290 decision aids catalogued in the Ottawa Hospital Research Institute's Decision Aid Library Inventory (DALI) system. We found that 56% (n = 161) of the decision aids mentioned cost in some way, but only 13% (n = 37) gave a specific price or range of prices. We identified 9 different ways in which cost was mentioned. The most common approach was as a "pro" of one of the treatment options (e.g., "you avoid the cost of medication"). Of the 37 decision aids that gave specific prices or ranges of prices for treatment options, only 2 were about surgery decisions despite the fact that surgery decision aids were the most common. Our findings suggest that presentation of cost information in decision aids is highly variable. Evidence-based guidelines should be developed by the International Patient Decision Aid Standards (IPDAS) Collaboration. © The Author(s) 2015.

Service users' experiences of participation in decision making in mental health services.

PubMed

Dahlqvist Jönsson, P; Schön, U-K; Rosenberg, D; Sandlund, M; Svedberg, P

2015-11-01

Despite the potential positive impact of shared decision making on service users knowledge and experience of decisional conflict, there is a lack of qualitative research on how participation in decision making is promoted from the perspective of psychiatric service users. This study highlights the desire of users to participate more actively in decision making and demonstrates that persons with SMI struggle to be seen as competent and equal partners in decision-making situations. Those interviewed did not feel that their strengths, abilities and needs were being recognized, which resulted in a feeling of being omitted from involvement in decision-making situations. The service users describe some essential conditions that could work to promote participation in decision making. These included having personal support, having access to knowledge, being involved in a dialogue and clarity about responsibilities. Mental health nurses can play an essential role for developing and implementing shared decision making as a tool to promote recovery-oriented mental health services. Service user participation in decision making is considered an essential component of recovery-oriented mental health services. Despite the potential of shared decision making to impact service users knowledge and positively influence their experience of decisional conflict, there is a lack of qualitative research on how participation in decision making is promoted from the perspective of psychiatric service users. In order to develop concrete methods that facilitate shared decision making, there is a need for increased knowledge regarding the users' own perspective. The aim of this study was to explore users' experiences of participation in decisions in mental health services in Sweden, and the kinds of support that may promote participation. Constructivist Grounded Theory (CGT) was utilized to analyse group and individual interviews with 20 users with experience of serious mental illness. The core category that emerged in the analysis described a 'struggle to be perceived as a competent and equal person' while three related categories including being the underdog, being controlled and being omitted described the difficulties of participating in decisions. The data analysis resulted in a model that describes internal and external conditions that influence the promotion of participation in decision making. The findings offer new insights from a user perspective and these can be utilized to develop and investigate concrete methods in order to promote user's participation in decisions. © 2015 John Wiley & Sons Ltd.

"Watching time tick by…": Decision making for Duchenne muscular dystrophy trials.

PubMed

Peay, Holly L; Scharff, Hadar; Tibben, Aad; Wilfond, Benjamin; Bowie, Janice; Johnson, Joanna; Nagaraju, Kanneboyina; Escolar, Diana; Piacentino, Jonathan; Biesecker, Barbara B

2016-01-01

This interview study explored clinicians' perspectives and parents' decision making about children's participation in Duchenne muscular dystrophy (DMD) clinical trials. Data from semi-structured interviews conducted with clinicians and parents in U.S. or Canada were assessed using thematic analysis. Eleven clinicians involved in ten trials and fifteen parents involved in six trials were interviewed. Parents described benefit-risk assessments using information from advocacy, peers, professionals, and sponsors. Strong influence was attributed to the progressive nature of DMD. Most expected direct benefit. Few considered the possibility of trial failure. Most made decisions to participate before the informed consent (IC) process, but none-the-less perceived informed choice with little to lose for potential gain. Clinicians described more influence on parental decisions than attributed by parents. Clinicians felt responsible to facilitate IC while maintaining hope. Both clinicians and parents reported criticisms about the IC process and regulatory barriers. The majority of parents described undertaking benefit-risk assessments that led to informed choices that offered psychological and potential disease benefits. Parents' high expectations influenced their decisions while also reflecting optimism. Clinicians felt challenged in balancing parents' expectations and likely outcomes. Prognosis-related pressures coupled with decision making prior to IC suggest an obligation to ensure educational materials are understandable and accurate, and to consider an expanded notion of IC timeframes. Anticipatory guidance about potential trial failure might facilitate parents' deliberations while aiding clinicians in moderating overly-optimistic motivations. Regulators and industry should appreciate special challenges in progressive disorders, where doing nothing was equated with doing harm. Copyright © 2015 Elsevier Inc. All rights reserved.

Analytical group decision making in natural resources: Methodology and application

USGS Publications Warehouse

Schmoldt, D.L.; Peterson, D.L.

2000-01-01

Group decision making is becoming increasingly important in natural resource management and associated scientific applications, because multiple values are treated coincidentally in time and space, multiple resource specialists are needed, and multiple stakeholders must be included in the decision process. Decades of social science research on decision making in groups have provided insights into the impediments to effective group processes and on techniques that can be applied in a group context. Nevertheless, little integration and few applications of these results have occurred in resource management decision processes, where formal groups are integral, either directly or indirectly. A group decision-making methodology is introduced as an effective approach for temporary, formal groups (e.g., workshops). It combines the following three components: (1) brainstorming to generate ideas; (2) the analytic hierarchy process to produce judgments, manage conflict, enable consensus, and plan for implementation; and (3) a discussion template (straw document). Resulting numerical assessments of alternative decision priorities can be analyzed statistically to indicate where group member agreement occurs and where priority values are significantly different. An application of this group process to fire research program development in a workshop setting indicates that the process helps focus group deliberations; mitigates groupthink, nondecision, and social loafing pitfalls; encourages individual interaction; identifies irrational judgments; and provides a large amount of useful quantitative information about group preferences. This approach can help facilitate scientific assessments and other decision-making processes in resource management.

Structuring Disaster Recovery Infrastructure Decisions: Lessons from Boulder County's 2013 Flood Recovery

NASA Astrophysics Data System (ADS)

Clavin, C.; Petropoulos, Z.

2017-12-01

Recovery phase decision making processes, as compared to mitigation and response phase decision making processes, require communities make significant financial and capital decisions in the months after a disaster. Collectively, these investments may significantly contribute to the resilience of a community to future hazards. Pre-disaster administrative decisions are well-established within existing planning processes. Post-event recovery requires community decision makers to quickly evaluate technical proposals and manage significant recovery financial resources to ensure their community rebuilds in a manner that will be more resilient to future events. These technical and administrative hurdles in the aftermath of a disaster create a challenging atmosphere to make sound, scientifically-informed decisions leading to resilient recovery. In September 2013, a 1,000-year rain event that resulted in flooding throughout the Front Range of Colorado, significantly impacting Boulder County. While the event is long past, disaster recovery efforts still continue in parts of Boulder County. Boulder County officials formed a county collaborative that adapted the NIST Community Resilience Planning Guide for Buildings and Infrastructure Systems to facilitate a goals-based multi-criteria decision making process. Rather than use hazard-based information to guide infrastructure design, the county's decision process established time-to-recovery goals for infrastructure systems that were used as criteria for project design. This presentation explores the decision-making process employed by Boulder County to specify design standards for resilient rebuilding of infrastructure systems and examine how this infrastructure planning model could be extrapolated to other situations where there is uncertainty regarding future infrastructure design standards.

Direct-to-consumer advertising and its utility in health care decision making: a consumer perspective.

PubMed

Deshpande, Aparna; Menon, Ajit; Perri, Matthew; Zinkhan, George

2004-01-01

The growth in direct-to-consumer advertising(DTCA)over the past two decades has facilitated the communication of prescription drug information directly to consumers. Data from a 1999 national survey are employed to determine the factors influencing consumers' opinions of the utility of DTC ads for health care decision making. We also analyze whether consumers use DTC ad information in health care decision making and who are the key drivers of such information utilization. The study results suggest that consumers have positive opinions of DTCA utility, varying across demographics and perceptions of certain advertisement features. Specifically, consumers value information about both risks and benefits, but the perception of risk information is more important in shaping opinions of ad utility than the perception of benefit information. Consumers still perceive, however that the quality of benefit information in DTC ads is better than that of risk information. Opinions about ad utility significantly influence whether information from DTC ads is used in health care decision making.

Health technology assessment in Saudi Arabia.

PubMed

Al-Aqeel, Sinaa

2018-05-16

The Saudi government, similar to any other government, is committed to making public spending more efficient, using resources more effectively, and limiting waste. Health technology assessment (HTA) is a tool that informs policy and decision makers regarding the formulation of safe and effective policies that are patient-focused and help to achieve efficiency when allocating limited health-care resources. Areas covered: After a brief description of HTA in the international context, this review provides a brief introduction to Saudi Arabia's health-care system, followed by a delineation of the decision maker(s) and influencers and the decision-making process for pricing and reimbursement. The article then discusses the current status of HTA in Saudi Arabia and proposes four strategic objectives that can form the first step in the development of a formal HTA process. Expert commentary: In Saudi Arabia, facilitators for incorporating HTA into the decision-making process exist. Future local research is needed to guide the implementation of full HTA.

Health behavior change in advance care planning: an agent-based model.

PubMed

Ernecoff, Natalie C; Keane, Christopher R; Albert, Steven M

2016-02-29

A practical and ethical challenge in advance care planning research is controlling and intervening on human behavior. Additionally, observing dynamic changes in advance care planning (ACP) behavior proves difficult, though tracking changes over time is important for intervention development. Agent-based modeling (ABM) allows researchers to integrate complex behavioral data about advance care planning behaviors and thought processes into a controlled environment that is more easily alterable and observable. Literature to date has not addressed how best to motivate individuals, increase facilitators and reduce barriers associated with ACP. We aimed to build an ABM that applies the Transtheoretical Model of behavior change to ACP as a health behavior and accurately reflects: 1) the rates at which individuals complete the process, 2) how individuals respond to barriers, facilitators, and behavioral variables, and 3) the interactions between these variables. We developed a dynamic ABM of the ACP decision making process based on the stages of change posited by the Transtheoretical Model. We integrated barriers, facilitators, and other behavioral variables that agents encounter as they move through the process. We successfully incorporated ACP barriers, facilitators, and other behavioral variables into our ABM, forming a plausible representation of ACP behavior and decision-making. The resulting distributions across the stages of change replicated those found in the literature, with approximately half of participants in the action-maintenance stage in both the model and the literature. Our ABM is a useful method for representing dynamic social and experiential influences on the ACP decision making process. This model suggests structural interventions, e.g. increasing access to ACP materials in primary care clinics, in addition to improved methods of data collection for behavioral studies, e.g. incorporating longitudinal data to capture behavioral dynamics.

Evaluator-blinded trial evaluating nurse-led immunotherapy DEcision Coaching In persons with relapsing-remitting Multiple Sclerosis (DECIMS) and accompanying process evaluation: study protocol for a cluster randomised controlled trial.

PubMed

Rahn, Anne Christin; Köpke, Sascha; Kasper, Jürgen; Vettorazzi, Eik; Mühlhauser, Ingrid; Heesen, Christoph

2015-03-21

Multiple sclerosis is a chronic neurological condition usually starting in early adulthood and regularly leading to severe disability. Immunotherapy options are growing in number and complexity, while costs of treatments are high and adherence rates remain low. Therefore, treatment decision-making has become more complex for patients. Structured decision coaching, based on the principles of evidence-based patient information and shared decision-making, has the potential to facilitate participation of individuals in the decision-making process. This cluster randomised controlled trial follows the assumption that decision coaching by trained nurses, using evidence-based patient information and preference elicitation, will facilitate informed choices and induce higher decision quality, as well as better decisional adherence. The decision coaching programme will be evaluated through an evaluator-blinded superiority cluster randomised controlled trial, including 300 patients with suspected or definite relapsing-remitting multiple sclerosis, facing an immunotherapy decision. The clusters are 12 multiple sclerosis outpatient clinics in Germany. Further, the trial will be accompanied by a mixed-methods process evaluation and a cost-effectiveness study. Nurses in the intervention group will be trained in shared decision-making, coaching, and evidence-based patient information principles. Patients who meet the inclusion criteria will receive decision coaching (intervention group) with up to three face-to-face coaching sessions with a trained nurse (decision coach) or counselling as usual (control group). Patients in both groups will be given access to an evidence-based online information tool. The primary outcome is 'informed choice' after six months, assessed with the multi-dimensional measure of informed choice including the sub-dimensions risk knowledge (questionnaire), attitude concerning immunotherapy (questionnaire), and immunotherapy uptake (telephone survey). Secondary outcomes include decisional conflict, adherence to immunotherapy decisions, autonomy preference, planned behaviour, coping self-efficacy, and perceived involvement in coaching and decisional encounters. Safety outcomes are comprised of anxiety and depression and disease-specific quality of life. This trial will assess the effectiveness of a new model of patient decision support concerning MS-immunotherapy options. The delegation of treatment information provision from physicians to trained nurses bears the potential to change current doctor-focused practice in Germany. Current Controlled Trials (identifier: ISRCTN37929939 ), May 27, 2014.

Development and field testing of a decision support tool to facilitate shared decision making in contraceptive counseling.

PubMed

Dehlendorf, Christine; Fitzpatrick, Judith; Steinauer, Jody; Swiader, Lawrence; Grumbach, Kevin; Hall, Cara; Kuppermann, Miriam

2017-07-01

We developed and formatively evaluated a tablet-based decision support tool for use by women prior to a contraceptive counseling visit to help them engage in shared decision making regarding method selection. Drawing upon formative work around women's preferences for contraceptive counseling and conceptual understanding of health care decision making, we iteratively developed a storyboard and then digital prototypes, based on best practices for decision support tool development. Pilot testing using both quantitative and qualitative data and cognitive testing was conducted. We obtained feedback from patient and provider advisory groups throughout the development process. Ninety-six percent of women who used the tool in pilot testing reported that it helped them choose a method, and qualitative interviews indicated acceptability of the tool's content and presentation. Compared to the control group, women who used the tool demonstrated trends toward increased likelihood of complete satisfaction with their method. Participant responses to cognitive testing were used in tool refinement. Our decision support tool appears acceptable to women in the family planning setting. Formative evaluation of the tool supports its utility among patients making contraceptive decisions, which can be further evaluated in a randomized controlled trial. Copyright © 2017 Elsevier B.V. All rights reserved.

[Shared decision-making in acute psychiatric medicine : Contraindication or a challenge?

PubMed

Heres, S; Hamann, J

2017-09-01

The concept of shared decision-making (SDM) has existed since the 1990s in multiple fields of somatic medicine but has only been poorly applied in psychiatric clinical routine despite broad acceptance and promising outcomes in clinical studies on its positive effects. The concept itself and its practicability in mental health are carefully assessed and strategies for its future implementation in psychiatric medicine are presented in this article. Ongoing clinical studies probing some of those strategies are further outlined. On top of the ubiquitous shortage of time in clinical routine, psychiatrists report their concern about patients' limited abilities in sharing decisions and their own fear of potentially harmful decisions resulting from a shared process. Misinterpretation of shared decision-making restricting the health care professional to rather an informed choice scenario and their own adhesion to the traditional paternalistic decision-making approach further add to SDM's underutilization. Those hurdles could be overcome by communication skill workshops for all mental health care professionals, including nursing personnels, psychologists, social workers and physicians, as well as the use of decision aids and training courses for patients to motivate and empower them in sharing decisions with the medical staff. By this, the patient-centered treatment approach demanded by guidelines, carers and users could be further facilitated in psychiatric clinical routine.

Overdue choices: how information and role in decision-making influence women's preferences for induction for prolonged pregnancy.

PubMed

Stevens, Gabrielle; Miller, Yvette D

2012-09-01

Enabling women to make informed decisions is a crucial component of consumer-focused maternity care. Current evidence suggests that health care practitioners' communication of care options may not facilitate patient involvement in decision-making. The aim of this study was to investigate the effect of specific variations in health caregiver communication on women's preferences for induction of labor for prolonged pregnancy. A convenience sample of 595 female participants read a hypothetical scenario in which an obstetrician discusses induction of labor with a pregnant woman. Information provided on induction and the degree of encouragement for the woman's involvement in decision-making was manipulated to create four experimental conditions. Participants indicated preference with respect to induction, their perceptions of the quality of information received, and other potential moderating factors. Participants who received information that was directive in favor of medical intervention were significantly more likely to prefer induction than those given nondirective information. No effect of level of involvement in decision-making was found. Participants' general trust in doctors moderated the relationship between health caregiver communication and preferences for induction, such that the influence of information provided on preferences for induction differed across levels of involvement in decision-making for women with a low trust in doctors, but not for those with high trust. Many women were not aware of the level of information required to make an informed decision. Our findings highlight the potential value of strategies such as patient decision aids and health care professional education to improve the quality of information available to women and their capacity for informed decision-making during pregnancy and birth. © 2012, Copyright the Authors Journal compilation © 2012, Wiley Periodicals, Inc.

A qualitative study of women's decision-making at the end of IVF treatment.

PubMed

Peddie, V L; van Teijlingen, E; Bhattacharya, S

2005-07-01

The decision not to pursue further in vitro fertilization (IVF) after one or more unsuccessful attempts is an important and often difficult one for couples. Relatively little is known about the woman's perception of this decision-making process. The aim of this study was to examine patients' perspectives of decision-making, including circumstances influencing it and satisfaction with the decision-making process. Semi-structured interviews were conducted with a purposive sample of 25 women who had decided to end treatment after unsuccessful IVF treatment. Interviews were tape-recorded and transcribed by means of thematic analysis using the open coding technique. Women experienced difficulty in accepting that their infertility would remain unresolved. Many felt that they had started with unrealistic expectations of treatment success and felt vulnerable to the pressures of both the media and society. Although the decision to end treatment was difficult, it offered many women a way out of the emotional distress caused by IVF; however, the process of decision-making created a sense of 'confrontation' for the women in which they had to address issues they had previously avoided. Adoptive parents perceived less societal pressure than those who remained childless. Efforts to improve the psychological preparation of couples who decide to end IVF treatment should be directed towards examination of the existing system of consultation, which has certain limitations in terms of the quality of communication and the provision of post-treatment support. Further efforts to develop strategies, which facilitate the decision-making process, should be considered.

Understanding decision-making towards housework among women with upper limb repetitive strain injury.

PubMed

Cheung, Therma W C; Clemson, Lindy; O'Loughlin, Kate; Shuttleworth, Russell

2016-02-01

Among women with upper limb repetitive strain injury (RSI), occupational therapy interventions include education to facilitate ergonomic practices in housework. From a client-centred perspective, an understanding of women's decision-making about housework is needed to design effective occupational therapy programmes. This study addresses a gap in research in this area by exploring women's views about changing housework habits. The aim was to construct a conceptual representation to explain decision-making in housework by drawing on experiences of a sample of Singapore Chinese women with upper limb RSI from one hand therapy clinic. Based on a constructivist grounded theory methodology, data were collected through in-depth interviewing with 15 women. Interviews were audiotaped and transcribed. Data were analysed with line by line coding, focussed coding and axial coding with constant comparison throughout data collection. Decision-making in housework among these women involved three main themes: (i) emotional attachment to housework; (ii) cognitively informed decision; and (iii) emotionally influenced decision. Women with upper limb RSI had to make cognitive decisions for or against a change in housework to manage their condition. However, the women's cognitively informed decisions were shaped by their emotional attachment to housework. As such, they experienced strong emotional barriers to changing their housework practices even when they had cognitively accepted the necessity and possibility of making a change. Therapists need to be aware that counselling to address the emotional barriers experienced by women is important during ergonomic education. © 2016 Occupational Therapy Australia.

Enhancing decision making about participation in cancer clinical trials: development of a question prompt list

PubMed Central

Brown, Richard F.; Shuk, Elyse; Leighl, Natasha; Butow, Phyllis; Ostroff, Jamie; Edgerson, Shawna; Tattersall, Martin

2016-01-01

Purpose Slow accrual to cancer clinical trials impedes the progress of effective new cancer treatments. Poor physician–patient communication has been identified as a key contributor to low trial accrual. Question prompt lists (QPLs) have demonstrated a significant promise in facilitating communication in general, surgical, and palliative oncology settings. These simple patient interventions have not been tested in the oncology clinical trial setting. We aimed to develop a targeted QPL for clinical trials (QPL-CT). Method Lung, breast, and prostate cancer patients who either had (trial experienced) or had not (trial naive) participated in a clinical trial were invited to join focus groups to help develop and explore the acceptability of a QPL-CT. Focus groups were audio-recorded and transcribed. A research team, including a qualitative data expert, analyzed these data to explore patients’ decision-making processes and views about the utility of the QPL-CT prompt to aid in trial decision making. Results Decision making was influenced by the outcome of patients’ comparative assessment of perceived risks versus benefits of a trial, and the level of trust patients had in their doctors’ recommendation about the trial. Severity of a patient’s disease influenced trial decision making only for trial-naive patients. Conclusion Although patients were likely to prefer a paternalistic decision-making style, they expressed valuation of the QPL as an aid to decision making. QPL-CT utility extended beyond the actual consultation to include roles both before and after the clinical trial discussion. PMID:20593202

SmartStaff: A Support Concept for Staff Planning

DTIC Science & Technology

2000-11-01

facilitated time management and decreased the ambiguities of the plans presented. However, the quality of the final plan did not improve. Team decision making, Team Planning, Group Support Systems, Task Group Staff

Law and Order: Conflict and Dissent in the Primary Grades

ERIC Educational Resources Information Center

Weaver, V. Phillips

1971-01-01

Participation in decision making, role playing, inquiry into community current events, and study of law and order in urban units facilitate learning concepts of law, order, conflict, and dissent. (VW)

Do personal stories make patient decision aids more effective? A critical review of theory and evidence

PubMed Central

2013-01-01

Background Patient decision aids support people to make informed decisions between healthcare options. Personal stories provide illustrative examples of others’ experiences and are seen as a useful way to communicate information about health and illness. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in non-narrative prose. It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions. Methods A survey of primary empirical research employing a systematic review method investigated the effect of patient decision aids with or without a personal story on people’s healthcare judgements and decisions. Searches were carried out between 2005-2012 of electronic databases (Medline, PsycINFO), and reference lists of identified articles, review articles, and key authors. A narrative analysis described and synthesised findings. Results Of 734 citations identified, 11 were included describing 13 studies. All studies found participants’ judgments and/or decisions differed depending on whether or not their decision aid included a patient story. Knowledge was equally facilitated when the decision aids with and without stories had similar information content. Story-enhanced aids may help people recall information over time and/or their motivation to engage with health information. Personal stories affected both “system 1” (e.g., less counterfactual reasoning, more emotional reactions and perceptions) and “system 2” (e.g., more perceived deliberative decision making, more stable evaluations over time) decision-making strategies. Findings exploring associations with narrative communications, decision quality measures, and different levels of literacy and numeracy were mixed. The pattern of findings was similar for both experimental and real-world studies. Conclusions There is insufficient evidence that adding personal stories to decision aids increases their effectiveness to support people’s informed decision making. More rigorous research is required to elicit evidence about the type of personal story that a) encourages people to make more reasoned decisions, b) discourages people from making choices based on another’s values, and c) motivates people equally to engage with healthcare resources. PMID:24625283

[Transparency in public health decision-making].

PubMed

García-Altés, Anna; Argimon, Josep M

2016-11-01

Improving the quality and transparency of governmental healthcare decision-making has an impact on the health of the population through policies, organisational management and clinical practice. Moreover, the comparison between healthcare centres and the transparent feedback of results to professionals and to the wider public contribute directly to improved results. The "Results Centre" of the Catalan healthcare system measures and disseminates the results achieved by the different healthcare centres in order to facilitate a shared decision-making process, thereby enhancing the quality of healthcare provided to the population of Catalonia (Spain). This is a pioneering initiative in Spain and is aligned with the most advanced countries in terms of policies of transparency and accountability. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Assessing the predictive power of psychological empowerment and health literacy for older patients' participation in health care: a cross-sectional population-based study.

PubMed

Sak, Gabriele; Rothenfluh, Fabia; Schulz, Peter J

2017-02-20

Research has confirmed a positive link between patient involvement in decision-making and improvements in health outcomes. The objective of this study was to examine the roles of psychological empowerment and health literacy on the elderly's willingness to engage in treatment decisions. A self-administered questionnaire was completed by a randomly selected sample of Swiss adults aged 65-80 years old (N = 826). Multivariate logistic regression was applied to determine the contribution of health literacy, psychological empowerment, and trust in physician on participants' preference to be active, collaborative or passive in decision-making. Most of the survey respondents preferred some participation in dealing with health related decisions (collaborative: 51%, and active: 35.6%). More than two-thirds of the sample was satisfied with their current involvement in medical decision-making (72.7%). Roughly one-fifth (18.8%) wished to attain a more active engagement than currently experienced, and the remainder of the sample preferred the opposite (8.5%). Due to higher reported levels of psychological empowerment and health literacy, Swiss-German seniors significantly preferred and assumed higher participation in medical decisions than Swiss-Italians. Psychological empowerment correlated with older adults' preferred and perceived involvement in medical decision-making. However, health literacy only predicted actual involvement in the last treatment decision that had to be made, differentiating only the active from the passive involvement group. Additionally, this research showed that health literacy mediated the relationship between psychological empowerment and the actual involvement in the last treatment decision that had to be made by the participant. Trust in physician and age appeared to be barriers to involvement, whereas education served as a facilitator. As older adults' health literacy plays a role in individuals' willingness to attain an active role in health care decision-making, public health efforts should aim at developing programs and appropriate information that facilitate this process, especially for individuals with moderate or lower levels of health literacy. The current investigation showed that adequate health literacy levels are essential (but not sufficient) in order to reach higher rates of participation in the healthcare context. This research complements past evidence by adding knowledge on the psychosocial antecedents, and their combined effects on patients' involvement in healthcare.

Finding common ground to achieve a “good death”: family physicians working with substitute decision-makers of dying patients. A qualitative grounded theory study

PubMed Central

2013-01-01

Background Substitute decision-makers are integral to the care of dying patients and make many healthcare decisions for patients. Unfortunately, conflict between physicians and surrogate decision-makers is not uncommon in end-of-life care and this could contribute to a “bad death” experience for the patient and family. We aim to describe Canadian family physicians’ experiences of conflict with substitute decision-makers of dying patients to identify factors that may facilitate or hinder the end-of-life decision-making process. This insight will help determine how to best manage these complex situations, ultimately improving the overall care of dying patients. Methods Grounded Theory methodology was used with semi-structured interviews of family physicians in Edmonton, Canada, who experienced conflict with substitute decision-makers of dying patients. Purposeful sampling included maximum variation and theoretical sampling strategies. Interviews were audio-taped, and transcribed verbatim. Transcripts, field notes and memos were coded using the constant-comparative method to identify key concepts until saturation was achieved and a theoretical framework emerged. Results Eleven family physicians with a range of 3 to 40 years in clinical practice participated. The family physicians expressed a desire to achieve a “good death” and described their role in positively influencing the experience of death. Finding Common Ground to Achieve a “Good Death” for the Patient emerged as an important process which includes 1) Building Mutual Trust and Rapport through identifying key players and delivering manageable amounts of information, 2) Understanding One Another through active listening and ultimately, and 3) Making Informed, Shared Decisions. Facilitators and barriers to achieving Common Ground were identified. Barriers were linked to conflict. The inability to resolve an overt conflict may lead to an impasse at any point. A process for Resolving an Impasse is described. Conclusions A novel framework for developing Common Ground to manage conflicts during end-of-life decision-making discussions may assist in achieving a “good death”. These results could aid in educating physicians, learners, and the public on how to achieve productive collaborative relationships during end-of-life decision-making for dying patients, and ultimately improve their deaths. PMID:23339822

A proposed approach for quantitative benefit-risk assessment in diagnostic radiology guideline development: the American College of Radiology Appropriateness Criteria Example.

PubMed

Agapova, Maria; Bresnahan, Brian B; Higashi, Mitchell; Kessler, Larry; Garrison, Louis P; Devine, Beth

2017-02-01

The American College of Radiology develops evidence-based practice guidelines to aid appropriate utilization of radiological procedures. Panel members use expert opinion to weight trade-offs and consensus methods to rate appropriateness of imaging tests. These ratings include an equivocal range, assigned when there is disagreement about a technology's appropriateness and the evidence base is weak or for special circumstances. It is not clear how expert consensus merges with the evidence base to arrive at an equivocal rating. Quantitative benefit-risk assessment (QBRA) methods may assist decision makers in this capacity. However, many methods exist and it is not clear which methods are best suited for this application. We perform a critical appraisal of QBRA methods and propose several steps that may aid in making transparent areas of weak evidence and barriers to consensus in guideline development. We identify QBRA methods with potential to facilitate decision making in guideline development and build a decision aid for selecting among these methods. This study identified 2 families of QBRA methods suited to guideline development when expert opinion is expected to contribute substantially to decision making. Key steps to deciding among QBRA methods involve identifying specific benefit-risk criteria and developing a state-of-evidence matrix. For equivocal ratings assigned for reasons other than disagreement or weak evidence base, QBRA may not be needed. In the presence of disagreement but the absence of a weak evidence base, multicriteria decision analysis approaches are recommended; and in the presence of weak evidence base and the absence of disagreement, incremental net health benefit alone or combined with multicriteria decision analysis is recommended. Our critical appraisal further extends investigation of the strengths and limitations of select QBRA methods in facilitating diagnostic radiology clinical guideline development. The process of using the decision aid exposes and makes transparent areas of weak evidence and barriers to consensus. © 2016 John Wiley & Sons, Ltd.

Competence to Complete Psychiatric Advance Directives: Effects of Facilitated Decision Making

PubMed Central

Swanson, Jeffrey W.; Appelbaum, Paul S.; Swartz, Marvin S.; Ferron, Joelle; Van Dorn, Richard A.; Wagner, H. Ryan

2013-01-01

Psychiatric advance directives (PADs) statutes presume competence to complete these documents, but the range and dimensions of decisional competence among people who actually complete PADs is unknown. This study examines clinical and neuropsychological correlates of performance on a measure to assess competence to complete PADs and investigates the effects of a facilitated PAD intervention on decisional capacity. N = 469 adults with psychotic disorders were interviewed at baseline and then randomly assigned to either a control group in which they received written materials about PADs or to an intervention group in which they were offered an opportunity to meet individually with a trained facilitator to create a PAD. At baseline, domains on the Decisional Competence Assessment Tool for PADs (DCAT-PAD) were most strongly associated with IQ, verbal memory, abstract thinking, and psychiatric symptoms. At one-month follow-up, participants in the intervention group showed more improvement on the DCAT-PAD than controls, particularly among participants with pre-morbid IQ estimates below the median of 100. The results suggest that PAD facilitation is an effective method to boost competence of cognitively-impaired clients to write PADs and make treatment decisions within PADs, thereby maximizing the chances their advance directives will be valid. PMID:17294136

[Evidence-based Risk and Benefit Communication for Shared Decision Making].

PubMed

Nakayama, Takeo

2018-01-01

　Evidence-based medicine (EBM) can be defined as "the integration of the best research evidence with clinical expertise and a patient's unique values and circumstances". However, even with the best research evidence, many uncertainties can make clinical decisions difficult. As the social requirement of respecting patient values and preferences has been increasingly recognized, shared decision making (SDM) and consensus development between patients and clinicians have attracted attention. SDM is a process by which patients and clinicians make decisions and arrive at a consensus through interactive conversations and communications. During the process of SDM, patients and clinicians share information with each other on the goals they hope to achieve and responsibilities in meeting those goals. From the clinician's standpoint, information regarding the benefits and risks of potential treatment options based on current evidence and professional experience is provided to patients. From the patient's standpoint, information on personal values, preferences, and social roles is provided to clinicians. SDM is a sort of "wisdom" in the context of making autonomous decisions in uncertain, difficult situations through interactions and cooperation between patients and clinicians. Joint development of EBM and SDM will help facilitate patient-clinician relationships and improve the quality of healthcare.

Decision-making regarding organ donation in Korean adults: A grounded-theory study.

PubMed

Yeun, Eun Ja; Kwon, Young Mi; Kim, Jung A

2015-06-01

The aim of this study was to identify the hidden patterns of behavior leading toward the decision to donate organs. Thirteen registrants at the Association for Organ Sharing in Korea were recruited. Data were collected using in-depth interview and the interview transcripts were analyzed using Glaserian grounded-theory methodology. The main problem of participants was "body attachment" and the core category (management process) was determined to be "pursuing life." The theme consisted of four phases, which were: "hesitating," "investigating," "releasing," and "re-discovering. " Therefore, to increase organ donations, it is important to find a strategy that will create positive attitudes about organ donation through education and public relations. These results explain and provide a deeper understanding of the main problem that Korean people have about organ donation and their management of decision-making processes. These findings can help care providers to facilitate the decision-making process and respond to public needs while taking into account the sociocultural context within which decisions are made. © 2014 Wiley Publishing Asia Pty Ltd.

Prefrontal contributions to metacognition in perceptual decision-making

PubMed Central

Fleming, Stephen M.; Huijgen, Josefien; Dolan, Raymond J.

2012-01-01

Neuroscience has made considerable progress in understanding the neural substrates supporting cognitive performance in a number of domains, including memory, perception and decision-making. In contrast, how the human brain generates metacognitive awareness of task performance remains unclear. Here, we address this question by asking participants to perform perceptual decisions while providing concurrent metacognitive reports, during fMRI scanning. We show that activity in right rostrolateral prefrontal cortex (rlPFC) satisfies three constraints for a role in metacognitive aspects of decision-making. Right rlPFC showed greater activity during self-report compared to a matched control condition; activity in this region correlated with reported confidence; and the strength of the relationship between activity and confidence predicted metacognitive ability across individuals. In addition, functional connectivity between right rlPFC and both contralateral PFC and visual cortex increased during metacognitive reports. We discuss these findings in a theoretical framework where rlPFC re-represents object-level decision uncertainty to facilitate metacognitive report. PMID:22553018

Structured reports of videofluoroscopic swallowing studies have the potential to improve overall report quality compared to free text reports.

PubMed

Schoeppe, Franziska; Sommer, Wieland H; Haack, Mareike; Havel, Miriam; Rheinwald, Marika; Wechtenbruch, Juliane; Fischer, Martin R; Meinel, Felix G; Sabel, Bastian O; Sommer, Nora N

2018-01-01

To compare free text (FTR) and structured reports (SR) of videofluoroscopic swallowing studies (VFSS) and evaluate satisfaction of referring otolaryngologists and speech therapists. Both standard FTR and SR of 26 patients with VFSS were acquired. A dedicated template focusing on oropharyngeal phases was created for SR using online software with clickable decision-trees and concomitant generation of semantically structured reports. All reports were evaluated regarding overall quality and content, information extraction and clinical decision support (10-point Likert scale (0 = I completely disagree, 10 = I completely agree)). Two otorhinolaryngologists and two speech therapists evaluated FTR and SR. SR received better ratings than FTR in all items. SR were perceived to contain more details on the swallowing phases (median rating: 10 vs. 5; P < 0.001), penetration and aspiration (10 vs. 5; P < 0.001) and facilitated information extraction compared to FTR (10 vs. 4; P < 0.001). Overall quality was rated significantly higher in SR than FTR (P < 0.001). SR of VFSS provide more detailed information and facilitate information extraction. SR better assist in clinical decision-making, might enhance the quality of the report and, thus, are recommended for the evaluation of VFSS. • Structured reports on videofluoroscopic exams of deglutition lead to improved report quality. • Information extraction is facilitated when using structured reports based on decision trees. • Template-based reports add more value to clinical decision-making than free text reports. • Structured reports receive better ratings by speech therapists and otolaryngologists. • Structured reports on videofluoroscopic exams may improve the comparability between exams.

New care home admission following hospitalisation: How do older people, families and professionals make decisions about discharge destination? A case study narrative analysis.

PubMed

Rhynas, Sarah J; Garrido, Azucena Garcia; Burton, Jennifer K; Logan, Gemma; MacArthur, Juliet

2018-03-24

To gain an in-depth understanding of the decision-making processes involved in the discharge of older people admitted to hospital from home and discharged to a care home, as described in the case records. The decision for an older person to move into a care home is significant and life-changing. The discharge planning literature for older people highlights the integral role of nurses in supporting and facilitating effective discharge. However, little research has been undertaken to explore the experiences of those discharged from hospital to a care home or the processes involved in decision-making. A purposive sample of 10 cases was selected from a cohort of 100 individuals admitted to hospital from home and discharged to a care home. Cases were selected to highlight important personal, relational and structural factors thought to affect the decision-making process. Narrative case studies were created and were thematically analysed to explore the perspectives of each stakeholder group and the conceptualisations of risk which influenced decision-making. Care home discharge decision-making is a complex process involving stakeholders with a range of expertise, experience and perspectives. Decisions take time and considerable involvement of families and the multidisciplinary team. There were significant deficits in documentation which limit the understanding of the process and the patient's voice is often absent from case records. The experiences of older people, families and multidisciplinary team members making care home decisions in the hospital setting require further exploration to identify and define best practice. Nurses have a critical role in the involvement of older people making discharge decisions in hospital, improved documentation of the patient's voice is essential. Health and social care systems must allow older people time to make significant decisions about their living arrangements, adapting to changing medical and social needs. © 2018 John Wiley & Sons Ltd.

Toward theoretical understanding of the fertility preservation decision-making process: examining information processing among young women with cancer.

PubMed

Hershberger, Patricia E; Finnegan, Lorna; Altfeld, Susan; Lake, Sara; Hirshfeld-Cytron, Jennifer

2013-01-01

Young women with cancer now face the complex decision about whether to undergo fertility preservation. Yet little is known about how these women process information involved in making this decision. The purpose of this article is to expand theoretical understanding of the decision-making process by examining aspects of information processing among young women diagnosed with cancer. Using a grounded theory approach, 27 women with cancer participated in individual, semistructured interviews. Data were coded and analyzed using constant-comparison techniques that were guided by 5 dimensions within the Contemplate phase of the decision-making process framework. In the first dimension, young women acquired information primarily from clinicians and Internet sources. Experiential information, often obtained from peers, occurred in the second dimension. Preferences and values were constructed in the third dimension as women acquired factual, moral, and ethical information. Women desired tailored, personalized information that was specific to their situation in the fourth dimension; however, women struggled with communicating these needs to clinicians. In the fifth dimension, women offered detailed descriptions of clinician behaviors that enhance or impede decisional debriefing. Better understanding of theoretical underpinnings surrounding women's information processes can facilitate decision support and improve clinical care.

Managing resources in NHS dentistry: the views of decision-makers in primary care organisations.

PubMed

Holmes, R D; Donaldson, C; Exley, C; Steele, J G

2008-09-27

To investigate priority setting and decision-making in primary care organisations and to determine how resources are managed in order to meet the oral health needs of local populations. This is a qualitative study. The purposive sample comprised twelve dental public health consultants and six senior finance representatives from contrasting care systems across the United Kingdom. Participants completed a written information sheet followed by a recorded semi-structured telephone interview. Conversations were professionally transcribed verbatim and analysed independently by two investigators using the constant comparative method. The emergent themes focused upon: the role of participants in decision-making; professional relationships; managing change; information needs; and identifying and managing priorities. There was wide interpretation with respect to participants' roles and perceived information needs for decision-making and commissioning. A unifying factor was the importance placed by participants upon trust and the influence of individuals on the success of relationships forged between primary care organisations and general dental practitioners. To facilitate decision-making in primary care organisations, commissioners and managers could engage further with practitioners and incorporate them into commissioning and resource allocation processes. Greater clarity is required regarding the role of dental public health consultants within primary care organisations and commissioning decisions.

A rapidly changing global medicines environment: How adaptable are funding decision-making systems?

PubMed

Leopold, Christine; Morgan, Steven G; Wagner, Anita K

2017-06-01

With the launch of very highly priced therapies and sudden price increases of generics, pressures on health systems have drastically increased. We aimed to elicit opinions of key decision makers responsible for national assessment and funding decisions on their experiences to adapt to these new realities. Through interviews with decision makers of pharmaceutical assessment and/or funding agencies, we describe the challenges systems are currently facing, systems' responses and systems' characteristics facilitating or hindering responses to changes and overarching topics for the future. Among the most common challenges are increased funding pressures, increased uncertainty and lack of transparency in decision-making. Systems' responses include utilization management, changing of assessment processes, stakeholder engagement and a focus on outcomes and on coordinated negotiations. Integrated delivery systems, fixed health care budgets and geographic and historical characteristics facilitate or sometimes hinder responses to change. Future policy emphasis lays on expanding data structures, managing the exit of drugs funded early, and implementing processes for communications with patients and the public. Going forward emphasis has to be given to structured communications with all stakeholders with a specific emphasis on the broader public and patients about financial limits and priority setting in health care. Copyright © 2017 Elsevier B.V. All rights reserved.

Challenges in shared decision making in advanced cancer care: a qualitative longitudinal observational and interview study.

PubMed

Brom, Linda; De Snoo-Trimp, Janine C; Onwuteaka-Philipsen, Bregje D; Widdershoven, Guy A M; Stiggelbout, Anne M; Pasman, H Roeline W

2017-02-01

Patients' preferences and expectations should be taken into account in treatment decision making in the last phase of life. Shared decision making (SDM) is regarded as a way to give the patient a central role in decision making. Little is known about how SDM is used in clinical practice in advanced cancer care. To examine whether and how the steps of SDM can be recognized in decision making about second- and third-line chemotherapy. Fourteen advanced cancer patients were followed over time using face-to-face in-depth interviews and observations of the patients' out-clinic visits. Interviews and outpatient clinic visits in which treatment options were discussed or decisions made were transcribed verbatim and analysed using open coding. Patients were satisfied with the decision-making process, but the steps of SDM were barely seen in daily practice. The creation of awareness about available treatment options by physicians was limited and not discussed in an equal way. Patients' wishes and concerns were not explicitly assessed, which led to different expectations about improved survival from subsequent lines of chemotherapy. To reach SDM in daily practice, physicians should create awareness of all treatment options, including forgoing treatment, and communicate the risk of benefit and harm. Open and honest communication is needed in which patients' expectations and concerns are discussed. Through this, the difficult process of decision making in the last phase of life can be facilitated and the focus on the best care for the specific patient is strengthened. © 2015 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

How Surrogate Decision-Makers for Patients With Chronic Critical Illness Perceive and Carry Out Their Role.

PubMed

Li, Lingsheng; Nelson, Judith E; Hanson, Laura C; Cox, Christopher E; Carson, Shannon S; Chai, Emily J; Keller, Kristine L; Tulsky, James A; Danis, Marion

2018-05-01

Family members commonly make medical decision for patients with chronic critical illness. This study examines how family members approach this decision-making role in real time. Qualitative analysis of interviews with family members in the intervention arm of a randomized controlled communication trial. Medical ICUs at four U.S. hospitals. Family members of patients with chronic critical illness (adults mechanically ventilated for ≥ 7 d and expected to remain ventilated and survive for ≥ 72 hr) who participated in the active arm of a communication intervention study. Family members participated in at least two content-guided, informational, and emotional support meetings led by a palliative care physician and nurse practitioner. Grounded theory was used for qualitative analysis of 66 audio recordings of meetings with 51 family members. Family members perceived their role in four main ways: voice of the patient, advocate for the patient, advocate for others, and advocate for oneself. Their decision-making was characterized by balancing goals, sharing their role, keeping perspective, remembering previous experiences, finding sources of strength, and coping with various burdens. Family members take a multifaceted approach as they participate in decision-making. Understanding how surrogates perceive and act in their roles may facilitate shared decision-making among clinicians and families during critical care.

The relationship between female adolescent self-esteem, decision making, and contraceptive behavior.

PubMed

Commendador, Kathleen

2007-11-01

To examine the relationship between female adolescent self-esteem, decision making, and contraceptive behavior in multiethnic, 14- to 17-year-olds, residing on the Big Island of Hawaii. This was a descriptive cross-sectional survey design using a convenience sample of 98 female adolescents aged 14-17 who came to five different clinics on the Big Island of Hawaii for health care. Along with a brief demographic questionnaire, global self-esteem was measured by Rosenberg's Self-Esteem Scale, decision making was measured by the Flinders Adolescent Decision Making Questionnaire, and sexual activity and contraception use was measured by a nonnormed Sexual History and Contraceptive Use Questionnaire developed for this study. Descriptive statistics, logistic regression, and correlations were used to analyze associations and correlations between age, global self-esteem, decision self-esteem, decision coping (vigilant and maladaptive), and contraceptive use for sexually active female adolescents. No significant associations or correlations were found between age, global self-esteem, decision self-esteem, decision coping (vigilance), and the decision to use contraception in sexually active adolescent females. There was, however, significant negative correlation (p < .05) between overall maladaptive decision making and contraceptive use in sexually active female adolescents. This suggests that sexually active adolescent females with higher maladaptive scores are less likely to use contraception. There was also significant association (p < .05) between maladaptive decision making in contraceptive use and sexually active female adolescents. For every one unit increase on the maladaptive scale, the odds of using contraception were estimated to decrease by 7%. Adolescence is a period of transition that involves biological, cognitive, psychological, and social changes. During the vulnerable transition period of adolescence, decisions relating to contraception may occur. Interventions focused on improving decision-making skills and stimulating thinking around not only sexual issues but also on relationship and communication in adolescent issues may facilitate more competent decision making. Understanding the relationship between female adolescent self-esteem, decision making, and contraceptive behavior has contributed to the knowledge base about female contraceptive behavior. Gaining further insight into these relationships will help healthcare professionals provide counseling and health care to female adolescents.

Promoting the rights and responsibilities of children: a South Australian example.

PubMed

George, Emma; Schmidt, Casey; Vella, Grace; McDonagh, Imelda

2017-03-01

In 2014, the Parafield Gardens Children's Centre for Early Childhood Development and Parenting was recognised as a Global Peace School - Early Years (GPSEY). During the recognition process, a project promoting the rights and responsibilities of children and families was facilitated. Partnering with children and families in decision making was a project priority. Young children had an active role in decision making. Through age-appropriate activities and discussions, children and families developed deeper understanding of child rights, peace building, global awareness and social inclusion. Educational staff were supported to enhance this child rights focus. A GPSEY recognition celebration acknowledged child rights and the community's cultural diversity. The outcome of GPSEY recognition is significant but the process that fostered community ownership, participation and social inclusion is worth noting. Involving children in decision making and development promotes their rights and responsibilities; this can make a positive difference for children locally, and globally.

The Composition of Normative Groups and Diagnostic Decision Making: Shooting Ourselves in the Foot

ERIC Educational Resources Information Center

Pena, Elizabeth D.; Spaulding, Tammie J.; Plante, Elena

2006-01-01

Purpose: The normative group of a norm-referenced test is intended to provide a basis for interpreting test scores. However, the composition of the normative group may facilitate or impede different types of diagnostic interpretations. This article considers who should be included in a normative sample and how this decision must be made relative…

What Makes Teachers Use Technology in the Classroom? Exploring the Factors Affecting Facilitation of Technology with a Korean Sample

ERIC Educational Resources Information Center

Baek, Youngkyun; Jung, Jaeyeob; Kim, Bokyeong

2008-01-01

The purpose of this study was to identify factors influencing teachers' decisions about using technology in the classroom setting and examine the degree to which teaching experience affects these decisions. Specifically, the items employed in this study were derived from the teachers' perceptions of technology use. We discovered six factors which…

Agent-based Decision Support System for the Third Generation Distributed Dynamic Decision-making (DDD-III) Simulator

DTIC Science & Technology

2004-06-01

suitable form of organizational adaptation is effective organizational diagnosis and analysis. The organizational diagnosis and analysis involve...related to the mission environment, organizational structure, and strategy is imperative for an effective and efficient organizational diagnosis . The...not easily articulated nor expressed otherwise. These displays are crucial to facilitate effective organizational diagnosis and analysis, and

High Levels of Decisional Conflict and Decision Regret When Making Decisions About Biologics.

PubMed

Lipstein, Ellen A; Lovell, Daniel J; Denson, Lee A; Kim, Sandra C; Spencer, Charles; Ittenbach, Richard F; Britto, Maria T

2016-12-01

The aim of the study was to understand the association between parents' perceptions of the decision process and the decision outcomes in decisions about the use of biologics in pediatric chronic conditions. We mailed surveys to parents of children with inflammatory bowel disease or juvenile idiopathic arthritis who had started treatment with biologics in the prior 2 years and were treated at either of 2 children's hospitals. The survey included measures of the decision process, including decision control and physician engagement, and decision outcomes, including conflict and regret. We used means and frequencies to assess the response distributions. General linear models were used to test the associations between decision process and decision outcomes. We had 201 respondents (response rate 54.9%). Approximately 47.0% reported using shared decision making. Each physician engagement behavior was experienced by the majority of parents, with the highest percentage reporting that their child's physician used language they understood and listened to them. Approximately 48.5% of parents had decisional conflict scores of 25 or greater, indicating high levels of conflict. Approximately 28.2% had no regret, 31.8% had mild regret, and the remaining 40.0% had moderate to severe regret. Shared decision making was not associated with improved decisional conflict, but physician engagement behaviors were associated with both decisional conflict and regret. Improving decision outcomes will require more than just focusing on who parents perceive as controlling the final decision. Developing interventions that facilitate specific physician engagement behaviors may decrease parents' distress around decision making and improve decision outcomes.

Embedding health policy and systems research into decision-making processes in low- and middle-income countries

PubMed Central

2013-01-01

Attention is increasingly directed to bridging the gap between the production of knowledge and its use for health decision-making in low- and middle-income countries (LMICs). An important and underdeveloped area of health policy and systems research (HPSR) is the organization of this process. Drawing from an interdisciplinary conception of embeddedness, a literature review was conducted to identify examples of embedded HPSR used to inform decision-making in LMICs. The results of the literature review were organized according to the World Health Organization’s Building Blocks Framework. Next, a conceptual model was created to illustrate the arrangement of organizations that produce embedded HPSR and the characteristics that facilitate its uptake into the arena of decision-making. We found that multiple forces converge to create context-specific pathways through which evidence enters into decision-making. Depending on the decision under consideration, the literature indicates that decision-makers may call upon an intricate combination of actors for sourcing HPSR. While proximity to decision-making does have advantages, it is not the position of the organization within the network, but rather the qualities the organization possesses, that enable it to be embedded. Our findings suggest that four qualities influence embeddedness: reputation, capacity, quality of connections to decision-makers, and quantity of connections to decision-makers and others. In addition to this, the policy environment (e.g. the presence of legislation governing the use of HPSR, presence of strong civil society, etc.) strongly influences uptake. Through this conceptual model, we can understand which conditions are likely to enhance uptake of HPSR in LMIC health systems. This raises several important considerations for decision-makers and researchers about the arrangement and interaction of evidence-generating organizations in health systems. PMID:23924162

Embedding health policy and systems research into decision-making processes in low- and middle-income countries.

PubMed

Koon, Adam D; Rao, Krishna D; Tran, Nhan T; Ghaffar, Abdul

2013-08-08

Attention is increasingly directed to bridging the gap between the production of knowledge and its use for health decision-making in low- and middle-income countries (LMICs). An important and underdeveloped area of health policy and systems research (HPSR) is the organization of this process. Drawing from an interdisciplinary conception of embeddedness, a literature review was conducted to identify examples of embedded HPSR used to inform decision-making in LMICs. The results of the literature review were organized according to the World Health Organization's Building Blocks Framework. Next, a conceptual model was created to illustrate the arrangement of organizations that produce embedded HPSR and the characteristics that facilitate its uptake into the arena of decision-making. We found that multiple forces converge to create context-specific pathways through which evidence enters into decision-making. Depending on the decision under consideration, the literature indicates that decision-makers may call upon an intricate combination of actors for sourcing HPSR. While proximity to decision-making does have advantages, it is not the position of the organization within the network, but rather the qualities the organization possesses, that enable it to be embedded. Our findings suggest that four qualities influence embeddedness: reputation, capacity, quality of connections to decision-makers, and quantity of connections to decision-makers and others. In addition to this, the policy environment (e.g. the presence of legislation governing the use of HPSR, presence of strong civil society, etc.) strongly influences uptake. Through this conceptual model, we can understand which conditions are likely to enhance uptake of HPSR in LMIC health systems. This raises several important considerations for decision-makers and researchers about the arrangement and interaction of evidence-generating organizations in health systems.

I don't want to be the one saying 'we should just let him die': intrapersonal tensions experienced by surrogate decision makers in the ICU.

PubMed

Schenker, Yael; Crowley-Matoka, Megan; Dohan, Daniel; Tiver, Greer A; Arnold, Robert M; White, Douglas B

2012-12-01

Although numerous studies have addressed external factors associated with difficulty in surrogate decision making, intrapersonal sources of tension are an important element of decision making that have received little attention. To characterize key intrapersonal tensions experienced by surrogate decision makers in the intensive care unit (ICU), and explore associated coping strategies. Qualitative interview study. Thirty surrogates from five ICUs at two hospitals in Pittsburgh, Pennsylvania, who were actively involved in making life-sustaining treatment decisions for a critically ill loved one. We conducted in-depth, semi-structured interviews with surrogates, focused on intrapersonal tensions, role challenges, and coping strategies. We analyzed transcripts using constant comparative methods. Surrogates experience significant emotional conflict between the desire to act in accordance with their loved one's values and 1) not wanting to feel responsible for a loved one's death, 2) a desire to pursue any chance of recovery, and 3) the need to preserve family well-being. Associated coping strategies included 1) recalling previous discussions with a loved one, 2) sharing decisions with family members, 3) delaying or deferring decision making, 4) spiritual/religious practices, and 5) story-telling. Surrogates' struggle to reconcile personal and family emotional needs with their loved ones' wishes, and utilize common coping strategies to combat intrapersonal tensions. These data suggest reasons surrogates may struggle to follow a strict substituted judgment standard. They also suggest ways clinicians may improve decision making, including attending to surrogates' emotions, facilitating family decision making, and eliciting potential emotional conflicts and spiritual needs.

Barriers and facilitators to orthopaedic surgeons’ uptake of decision aids for total knee arthroplasty: a qualitative study

PubMed Central

Nelson, Elizabeth; Scott, Anthony; French, Simon; Choong, Peter; Dowsey, Michelle

2017-01-01

Objectives The demand for total knee arthroplasty (TKA) is increasing. Differentiating who will derive a clinically meaningful improvement from TKA from others is a key challenge for orthopaedic surgeons. Decision aids can help surgeons select appropriate candidates for surgery, but their uptake has been low. The aim of this study was to explore the barriers and facilitators to decision aid uptake among orthopaedic surgeons. Design A qualitative study involving face-to-face interviews. Questions were constructed on the Theoretical Domains Framework to systematically explore barriers and facilitators. Setting One tertiary hospital in Australia. Participants Twenty orthopaedic surgeons performing TKA. Outcome measures Beliefs underlying similar interview responses were identified and grouped together as themes describing relevant barriers and facilitators to uptake of decision aids. Results While prioritising their clinical acumen, surgeons believed a decision aid could enhance communication and patient informed consent. Barriers identified included the perception that one’s patient outcomes were already optimal; a perceived lack of non-operative alternatives for the management of end-stage osteoarthritis, concerns about mandatory cut-offs for patient-centred care and concerns about the medicolegal implications of using a decision aid. Conclusions Multifaceted implementation interventions are required to ensure that orthopaedic surgeons are ready, willing and able to use a TKA decision aid. Audit/feedback to address current decision-making biases such as overconfidence may enhance readiness to uptake. Policy changes and/or incentives may enhance willingness to uptake. Finally, the design/implementation of effective non-operative treatments may enhance ability to uptake by ensuring that surgeons have the resources they need to carry out decisions. PMID:29133333

Shared decision making in endocrinology: present and future directions.

PubMed

Rodriguez-Gutierrez, Rene; Gionfriddo, Michael R; Ospina, Naykky Singh; Maraka, Spyridoula; Tamhane, Shrikant; Montori, Victor M; Brito, Juan P

2016-08-01

In medicine and endocrinology, there are few clinical circumstances in which clinicians can accurately predict what is best for their patients. As a result, patients and clinicians frequently have to make decisions about which there is uncertainty. Uncertainty results from limitations in the research evidence, unclear patient preferences, or an inability to predict how treatments will fit into patients' daily lives. The work that patients and clinicians do together to address the patient's situation and engage in a deliberative dialogue about reasonable treatment options is often called shared decision making. Decision aids are evidence-based tools that facilitate this process. Shared decision making is a patient-centred approach in which clinicians share information about the benefits, harms, and burden of different reasonable diagnostic and treatment options, and patients explain what matters to them in view of their particular values, preferences, and personal context. Beyond the ethical argument in support of this approach, decision aids have been shown to improve patients' knowledge about the available options, accuracy of risk estimates, and decisional comfort. Decision aids also promote patient participation in the decision-making process. Despite accumulating evidence from clinical trials, policy support, and expert recommendations in endocrinology practice guidelines, shared decision making is still not routinely implemented in endocrine practice. Additional work is needed to enrich the number of available tools and to implement them in practice workflows. Also, although the evidence from randomised controlled trials favours the use of this shared decision making in other settings, populations, and illnesses, the effect of this approach has been studied in a few endocrine disorders. Future pragmatic trials are needed to explore the effect and feasibility of shared decision making implementation into routine endocrinology and primary care practice. With the available evidence, however, endocrinologists can now start to practice shared decision making, partner with their patients, and use their expertise to formulate treatment plans that reflect patient preferences and are more likely to fit into the context of patients' lives. In this Personal View, we describe shared decision making, the evidence behind the approach, and why and how both endocrinologists and their patients could benefit from this approach. Copyright © 2016 Elsevier Ltd. All rights reserved.

Rockfall Hazard Process Assessment : [Project Summary

DOT National Transportation Integrated Search

2017-10-01

The Montana Department of Transportation (MDT) implemented its Rockfall Hazard Rating System (RHRS) between 2003 and 2005, obtaining information on the state's rock slopes and their associated hazards. The RHRS data facilitated decision-making in an ...

31 CFR 538.407 - Facilitation by a United States person.

Code of Federal Regulations, 2010 CFR

2010-07-01

... planning; decision making; designing, ordering or transporting goods; and financial, insurance, and other... pursuant to this part. (d) No U.S. person may refer to a foreign person purchase orders, requests for bids...

Superfund and Technology Liaison Program Fact Sheet

EPA Pesticide Factsheets

The Superfund and Technology Liaison (STL) Program was established to facilitate regional access to ORD laboratories, provide technical support, and assist with the integration of science and technology into decision-making for hazardous waste programs.

Principles of shared decision-making within teams.

PubMed

Jacobs, Jeffrey P; Wernovsky, Gil; Cooper, David S; Karl, Tom R

2015-12-01

In the domain of paediatric and congenital cardiac care, the stakes are huge. Likewise, the care of these children assembles a group of "A+ personality" individuals from the domains of cardiac surgery, cardiology, anaesthesiology, critical care, and nursing. This results in an environment that has opportunity for both powerful collaboration and powerful conflict. Providers of healthcare should avoid conflict when it has no bearing on outcome, as it is clearly a squandering of individual and collective political capital. Outcomes after cardiac surgery are now being reported transparently and publicly. In the present era of transparency, one may wonder how to balance the following potentially competing demands: quality healthcare, transparency and accountability, and teamwork and shared decision-making. An understanding of transparency and public reporting in the domain of paediatric cardiac surgery facilitates the implementation of a strategy for teamwork and shared decision-making. In January, 2015, the Society of Thoracic Surgeons (STS) began to publicly report outcomes of paediatric and congenital cardiac surgery using the 2014 Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) Mortality Risk Model. The 2014 STS-CHSD Mortality Risk Model facilitates description of Operative Mortality adjusted for procedural and patient-level factors. The need for transparency in reporting of outcomes can create pressure on healthcare providers to implement strategies of teamwork and shared decision-making to assure outstanding results. A simple strategy of shared decision-making was described by Tom Karl and was implemented in multiple domains by Jeff Jacobs and David Cooper. In a critical-care environment, it is not unusual for healthcare providers to disagree about strategies of management of patients. When two healthcare providers disagree, each provider can classify the disagreement into three levels: • SDM Level 1 Decision: "We disagree but it really does not matter, so do whatever you desire!" • SDM Level 2 Decision: "We disagree and I believe it matters, but I am OK if you do whatever you desire!!" • SDM Level 3 Decision: "We disagree and I must insist (diplomatically and politely) that we follow the strategy that I am proposing!!!!!!" SDM Level 1 Decisions and SDM Level 2 Decisions typically do not create stress on the team, especially when there is mutual purpose and respect among the members of the team. SDM Level 3 Decisions are the real challenge. Periodically, the healthcare team is faced with such Level 3 Decisions, and teamwork and shared decision-making may be challenged. Teamwork is a learned behaviour, and mentorship is critical to achieve a properly balanced approach. If we agree to leave our egos at the door, then, in the final analysis, the team will benefit and we will set the stage for optimal patient care. In the environment of strong disagreement, true teamwork and shared decision-making are critical to preserve the unity and strength of the multi-disciplinary team and simultaneously provide excellent healthcare.

Using Option Grids: steps toward shared decision-making for neonatal circumcision.

PubMed

Fay, Mary; Grande, Stuart W; Donnelly, Kyla; Elwyn, Glyn

2016-02-01

To assess the impact, acceptability and feasibility of a short encounter tool designed to enhance the process of shared decision-making and parental engagement. We analyzed video-recordings of clinical encounters, half undertaken before and half after a brief intervention that trained four clinicians how to use Option Grids, using an observer-based measure of shared decision-making. We also analyzed semi-structured interviews conducted with the clinicians four weeks after their exposure to the intervention. Observer OPTION(5) scores were higher at post-intervention, with a mean of 33.9 (SD=23.5) compared to a mean of 16.1 (SD=7.1) for pre-intervention, a significant difference of 17.8 (95% CI: 2.4, 33.2). Prior to using the intervention, clinicians used a consent document to frame circumcision as a default practice. Encounters with the Option Grid conferred agency to both parents and clinicians, and facilitated shared decision-making. Clinician reported recognizing the tool's positive effect on their communication process. Tools such as Option Grids have the potential to make it easier for clinicians to achieve shared decision-making. Encounter tools have the potential to change practice. More research is needed to test their feasibility in routine practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Effects of Age-related Differences in Empathy on Social Economic Decision-Making

PubMed Central

Beadle, Janelle N.; Paradiso, Sergio; Kovach, Christopher; Polgreen, Linnea; Denburg, Natalie; Tranel, Daniel

2012-01-01

Background The ways in which aging affects social economic decision-making is a central issue in the psychology of aging. To examine age-related differences in social economic decision-making as a function of empathy, 80 healthy volunteers participated in the Repeated Fixed Opponent Ultimatum Game (UG-R). Previous economic decision making research has shown that in younger adults empathy is associated with prosocial behavior. The effects of empathy on older adult social economic decision-making are not well understood. Methods On each of 20 consecutive trials in the UG-R, one player (“Proposer”) splits ten dollars with another player (“Responder”) who chooses either to accept (whereby both receive the proposed division) or reject (whereby neither receives anything). Trait cognitive and emotional empathy were measured using the Interpersonal Reactivity Index. Results UG-R data were examined as a function of age and cognitive empathy. For unfair offers (i.e., offers less than $5), older Responders with high cognitive empathy showed less prosocial behavior and obtained greater payoffs than younger Responders with high cognitive empathy. Conclusions High levels of cognitive empathy may differentially affect economic decision making behavior in younger and older adults. For older adults, high cognitive empathy may be involved in obtaining high financial payoffs while for younger adults it may instead facilitate social relationships. PMID:22237008

Towards an integrated approach to natural hazards risk assessment using GIS: with reference to bushfires.

PubMed

Chen, Keping; Blong, Russell; Jacobson, Carol

2003-04-01

This paper develops a GIS-based integrated approach to risk assessment in natural hazards, with reference to bushfires. The challenges for undertaking this approach have three components: data integration, risk assessment tasks, and risk decision-making. First, data integration in GIS is a fundamental step for subsequent risk assessment tasks and risk decision-making. A series of spatial data integration issues within GIS such as geographical scales and data models are addressed. Particularly, the integration of both physical environmental data and socioeconomic data is examined with an example linking remotely sensed data and areal census data in GIS. Second, specific risk assessment tasks, such as hazard behavior simulation and vulnerability assessment, should be undertaken in order to understand complex hazard risks and provide support for risk decision-making. For risk assessment tasks involving heterogeneous data sources, the selection of spatial analysis units is important. Third, risk decision-making concerns spatial preferences and/or patterns, and a multicriteria evaluation (MCE)-GIS typology for risk decision-making is presented that incorporates three perspectives: spatial data types, data models, and methods development. Both conventional MCE methods and artificial intelligence-based methods with GIS are identified to facilitate spatial risk decision-making in a rational and interpretable way. Finally, the paper concludes that the integrated approach can be used to assist risk management of natural hazards, in theory and in practice.

How parents and physicians experience end-of-life decision-making for children with profound intellectual and multiple disabilities.

PubMed

Zaal-Schuller, I H; Willems, D L; Ewals, F V P M; van Goudoever, J B; de Vos, M A

2016-12-01

End-of-life decisions (EoLD) often concern children with profound intellectual and multiple disabilities (PIMD). Yet, little is known about how parents and physicians discuss and make these decisions. The objective of this research was to investigate the experiences of the parents and the involved physician during the end-of-life decision-making (EoLDM) process for children with PIMD. In a retrospective, qualitative study, we conducted semi-structured interviews with the physicians and parents of 14 children with PIMD for whom an EoLD was made within the past two years. A long-lasting relationship appeared to facilitate the EoLDM process, although previous negative healthcare encounters could also lead to distrust. Parents and physicians encountered disagreements during the EoLDM process, but these disagreements could also improve the decision-making process. Most parents, as well as most physicians, considered the parents to be the experts on their child. In making an EoLD, both parents and physicians preferred a shared decision-making approach, although they differed in what they actually meant by this concept. The EoLDM process for children with PIMD can be improved if physicians are more aware of the specific situation and of the roles and expectations of the parents of children with PIMD. Copyright © 2016 Elsevier Ltd. All rights reserved.

Bayesian design of decision rules for failure detection

NASA Technical Reports Server (NTRS)

Chow, E. Y.; Willsky, A. S.

1984-01-01

The formulation of the decision making process of a failure detection algorithm as a Bayes sequential decision problem provides a simple conceptualization of the decision rule design problem. As the optimal Bayes rule is not computable, a methodology that is based on the Bayesian approach and aimed at a reduced computational requirement is developed for designing suboptimal rules. A numerical algorithm is constructed to facilitate the design and performance evaluation of these suboptimal rules. The result of applying this design methodology to an example shows that this approach is potentially a useful one.

The Role of Evidence in the Decision-Making Process of Selecting Essential Medicines in Developing Countries: The Case of Tanzania

PubMed Central

Mori, Amani Thomas; Kaale, Eliangiringa Amos; Ngalesoni, Frida; Norheim, Ole Frithjof; Robberstad, Bjarne

2014-01-01

Background Insufficient access to essential medicines is a major health challenge in developing countries. Despite the importance of Standard Treatment Guidelines and National Essential Medicine Lists in facilitating access to medicines, little is known about how they are updated. This study aims to describe the process of updating the Standard Treatment Guidelines and National Essential Medicine List in Tanzania and further examines the criteria and the underlying evidence used in decision-making. Methods This is a qualitative study in which data were collected by in-depth interviews and document reviews. Interviews were conducted with 18 key informants who were involved in updating the Standard Treatment Guidelines and National Essential Medicine List. We used a thematic content approach to analyse the data. Findings The Standard Treatment Guidelines and National Essential Medicine List was updated by committees of experts who were recruited mostly from referral hospitals and the Ministry of Health and Social Welfare. Efficacy, safety, availability and affordability were the most frequently utilised criteria in decision-making, although these were largely based on experience rather than evidence. In addition, recommendations from international guidelines and medicine promotions also influenced decision-making. Cost-effectiveness, despite being an important criterion for formulary decisions, was not utilised. Conclusions Recent decisions about the selection of essential medicines in Tanzania were made by committees of experts who largely used experience and discretionary judgement, leaving evidence with only a limited role in decision-making process. There may be several reasons for the current limited use of evidence in decision-making, but one hypothesis that remains to be explored is whether training experts in evidence-based decision-making would lead to a better and more explicit use of evidence. PMID:24416293

The role of evidence in the decision-making process of selecting essential medicines in developing countries: the case of Tanzania.

PubMed

Mori, Amani Thomas; Kaale, Eliangiringa Amos; Ngalesoni, Frida; Norheim, Ole Frithjof; Robberstad, Bjarne

2014-01-01

Insufficient access to essential medicines is a major health challenge in developing countries. Despite the importance of Standard Treatment Guidelines and National Essential Medicine Lists in facilitating access to medicines, little is known about how they are updated. This study aims to describe the process of updating the Standard Treatment Guidelines and National Essential Medicine List in Tanzania and further examines the criteria and the underlying evidence used in decision-making. This is a qualitative study in which data were collected by in-depth interviews and document reviews. Interviews were conducted with 18 key informants who were involved in updating the Standard Treatment Guidelines and National Essential Medicine List. We used a thematic content approach to analyse the data. The Standard Treatment Guidelines and National Essential Medicine List was updated by committees of experts who were recruited mostly from referral hospitals and the Ministry of Health and Social Welfare. Efficacy, safety, availability and affordability were the most frequently utilised criteria in decision-making, although these were largely based on experience rather than evidence. In addition, recommendations from international guidelines and medicine promotions also influenced decision-making. Cost-effectiveness, despite being an important criterion for formulary decisions, was not utilised. Recent decisions about the selection of essential medicines in Tanzania were made by committees of experts who largely used experience and discretionary judgement, leaving evidence with only a limited role in decision-making process. There may be several reasons for the current limited use of evidence in decision-making, but one hypothesis that remains to be explored is whether training experts in evidence-based decision-making would lead to a better and more explicit use of evidence.

Decision Support and Shared Decision Making About Active Surveillance Versus Active Treatment Among Men Diagnosed with Low-Risk Prostate Cancer: a Pilot Study.

PubMed

Myers, Ronald E; Leader, Amy E; Censits, Jean Hoffman; Trabulsi, Edouard J; Keith, Scott W; Petrich, Anett M; Quinn, Anna M; Den, Robert B; Hurwitz, Mark D; Lallas, Costas D; Hegarty, Sarah E; Dicker, Adam P; Zeigler-Johnson, Charnita M; Giri, Veda N; Ayaz, Hasan; Gomella, Leonard G

2018-02-01

This study aimed to explore the effects of a decision support intervention (DSI) and shared decision making (SDM) on knowledge, perceptions about treatment, and treatment choice among men diagnosed with localized low-risk prostate cancer (PCa). At a multidisciplinary clinic visit, 30 consenting men with localized low-risk PCa completed a baseline survey, had a nurse-mediated online DS session to clarify preference for active surveillance (AS) or active treatment (AT), and met with clinicians for SDM. Participants also completed a follow-up survey at 30 days. We assessed change in treatment knowledge, decisional conflict, and perceptions and identified predictors of AS. At follow-up, participants exhibited increased knowledge (p < 0.001), decreased decisional conflict (p < 0.001), and more favorable perceptions of AS (p = 0.001). Furthermore, 25 of the 30 participants (83 %) initiated AS. Increased family and clinician support predicted this choice (p < 0.001). DSI/SDM prepared patients to make an informed decision. Perceived support of the decision facilitated patient choice of AS.

Comparisons of guardianship laws and surrogate decision-making practices in China, Japan, Thailand and Australia: a review by the Asia Consortium, International Psychogeriatric Association (IPA) capacity taskforce.

PubMed

Tsoh, Joshua; Peisah, Carmelle; Narumoto, Jin; Wongpakaran, Nahathai; Wongpakaran, Tinakon; O'Neill, Nick; Jiang, Tao; Ogano, Shoichi; Mimura, Masaru; Kato, Yuka; Chiu, Helen

2015-06-01

The International Psychogeriatric Association (IPA) capacity taskforce was established to promote the autonomy, proper access to care, and dignity of persons with decision-making disabilities (DMDs) across nations. The Asia Consortium of the taskforce was established to pursue these goals in the Asia-Pacific region. This paper is part of the Asia Consortium's initiative to promote understanding and advocacy in regard to surrogate decision-making across the region. The current guardianship laws are compared, and jurisdictional variations in the processes for proxy decision-making to support persons with DMDs and other health and social needs in China, Japan, Thailand, and Australia are explored. The different Asia-Pacific countries have various proxy decision-making mechanisms in place for persons with DMDs, which are both formalized according to common law, civil law, and other legislation, and shaped by cultural practices. Various processes for guardianship and mechanisms for medical decision-making and asset management exist across the region. Processes that are still evolving across the region include those that facilitate advanced planning as a result of the paucity of legal structures for enduring powers of attorney (EPA) and guardianship in some regions, and the struggle to achieve consensual positions in regard to end-of-life decision-making. Formal processes for supporting decision-making are yet to be developed. The diverse legal approaches to guardianship and administration must be understood to meet the challenges of the rapidly ageing population in the Asia-Pacific region. Commonalities in the solutions and difficulties faced in encountering these challenges have global significance.

The disruption management model.

PubMed

McAlister, James

2011-10-01

Within all organisations, business continuity disruptions present a set of dilemmas that managers may not have dealt with before in their normal daily duties. The disruption management model provides a simple but effective management tool to enable crisis management teams to stay focused on recovery in the midst of a business continuity incident. The model has four chronological primary headlines, which steer the team through a quick-time crisis decision-making process. The procedure facilitates timely, systematic, rationalised and justified decisions, which can withstand post-event scrutiny. The disruption management model has been thoroughly tested within an emergency services environment and is proven to significantly support clear and concise decision making in a business continuity context.

The role of depression pharmacogenetic decision support tools in shared decision making.

PubMed

Arandjelovic, Katarina; Eyre, Harris A; Lenze, Eric; Singh, Ajeet B; Berk, Michael; Bousman, Chad

2017-10-29

Patients discontinue antidepressant medications due to lack of knowledge, unrealistic expectations, and/or unacceptable side effects. Shared decision making (SDM) invites patients to play an active role in their treatment and may indirectly improve outcomes through enhanced engagement in care, adherence to treatment, and positive expectancy of medication outcomes. We believe decisional aids, such as pharmacogenetic decision support tools (PDSTs), facilitate SDM in the clinical setting. PDSTs may likewise predict drug tolerance and efficacy, and therefore adherence and effectiveness on an individual-patient level. There are several important ethical considerations to be navigated when integrating PDSTs into clinical practice. The field requires greater empirical research to demonstrate clinical utility, and the mechanisms thereof, as well as exploration of the ethical use of these technologies.

[Decision Making Experience on Breast Reconstruction for Women with Breast Cancer].

PubMed

Yi, Myungsun; Joung, Woo Joung; Park, Eun Young; Kwon, Eun Jin; Kim, Haejin; Seo, Ji Young

2016-12-01

The purpose of this study was to explore decision making experiences of Korean women with breast cancer who underwent breast reconstruction with/after a mastectomy. Data were collected during 2015-2016 through individual in-depth interviews with 10 women who had both mastectomy and breast reconstruction, and analyzed using phenomenological method to identify essential themes on experiences of making a decision to have breast reconstruction. Five theme clusters emerged. First, "expected loss of sexuality and discovery of autonomy" illustrates various aims of breast reconstruction. Second, "holding tight to the reputation of doctors amid uncertainty" specifies the importance of a trust relationship with their physician despite a lack of information. Third, "family members to step back in position" describes support or opposition from family members in the decision making process. Fourth, "bewilderment due to the paradox of appearance-oriented views" illustrates paradoxical environment, resulting in confusion and anger. Lastly, "decision to be made quickly with limited time to oneself" describes the crazy whirling process of decision making. Findings highlight aims, worries, barriers, and facilitators that women with breast cancer experience when making a decision about breast reconstruction. Deciding on breast reconstruction was not only a burden for women in a state of shock with a diagnosis of breast cancer, but also an opportunity to decide to integrate their body, femininity, and self which might be wounded from a mastectomy. These findings will help oncology professionals provide effective educational counselling before the operation to promote higher satisfaction after the operation.

Decision support in vaccination policies.

PubMed

Piso, B; Wild, C

2009-10-09

Looking across boarders reveals that the national immunization programs of various countries differ in their vaccination schedules and decisions regarding the implementation and funding of new vaccines. The aim of this review is to identify decision aids and crucial criteria for a rational decision-making process on vaccine introduction and to develop a theoretical framework for decision-making based on available literature. Systematic literature search supplemented by hand-search. We identified five published decision aids for vaccine introduction and program planning in industrialized countries. Their comparison revealed an overall similarity with some differences in the approach as well as criteria. Burden of disease and vaccine characteristics play a key role in all decision aids, but authors vary in their views on the significance of cost-effectiveness analyses. Other relevant factors that should be considered before vaccine introduction are discussed to highly differing extents. These factors include the immunization program itself as well as its conformity with other programs, its feasibility, acceptability, and equity, as well as ethical, legal and political considerations. Assuming that the most comprehensive framework possible will not provide a feasible tool for decision-makers, we suggest a stepwise procedure. Though even the best rational approach and most comprehensive evaluation is limited by remaining uncertainties, frameworks provide at least a structured approach to evaluate the various aspects of vaccine implementation decision-making. This process is essential in making consistently sound decisions and will facilitate the public's confidence in the decision and its realization.

The accuracy and consistency of rural, remote and outpost triage nurse decision making in one Western Australia Country Health Service Region.

PubMed

Ekins, Kylie; Morphet, Julia

2015-11-01

The Australasian Triage Scale aims to ensure that the triage category allocated, reflects the urgency with which the patient needs medical assistance. This is dependent on triage nurse accuracy in decision making. The Australasian Triage Scale also aims to facilitate triage decision consistency between individuals and organisations. Various studies have explored the accuracy and consistency of triage decisions throughout Australia, yet no studies have specifically focussed on triage decision making in rural health services. Further, no standard has been identified by which accuracy or consistency should be measured. Australian emergency departments are measured against a set of standard performance indicators, including time from triage to patient review, and patient length of stay. There are currently no performance indicators for triage consistency. An online questionnaire was developed to collect demographic data and measure triage accuracy and consistency. The questionnaire utilised previously validated triage scenarios.(1) Triage decision accuracy was measured, and consistency was compared by health site type using Fleiss' kappa. Forty-six triage nurses participated in this study. The accuracy of participants' triage decision-making decreased with each less urgent triage category. Post-graduate qualifications had no bearing on triage accuracy. There was no significant difference in the consistency of decision-making between paediatric and adult scenarios. Overall inter-rater agreement using Fleiss' kappa coefficient, was 0.4. This represents a fair-to-good level of inter-rater agreement. A standard definition of accuracy and consistency in triage nurse decision making is required. Inaccurate triage decisions can result in increased morbidity and mortality. It is recommended that emergency department performance indicator thresholds be utilised as a benchmark for national triage consistency. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Impact of clinical and health services research projects on decision-making: a qualitative study.

PubMed

Solans-Domènech, Maite; Adam, Paula; Guillamón, Imma; Permanyer-Miralda, Gaietà; Pons, Joan M V; Escarrabill, Joan

2013-05-10

This article reports on the impact assessment experience of a funding program of non-commercial clinical and health services research. The aim was to assess the level of implementation of results from a subgroup of research projects (on respiratory diseases), and to detect barriers (or facilitators) in the translation of new knowledge to informed decision-making. A qualitative study was performed. The sample consisted of six projects on respiratory diseases funded by the Agency for Health Quality and Assessment of Catalonia between 1996 and 2004. Semi-structured interviews to key informants including researchers and healthcare decision-makers were carried out. Interviews were recorded, transcribed verbatim and analysed on an individual (key informant) and group (project) basis. In addition, the differences between achieved and expected impacts were described. Twenty-three semi-structured interviews were conducted. Most participants indicated changes in health services or clinical practice had resulted from research. The channels used to transfer new knowledge were mainly conventional ones, but also in less explicit ways, such as with the involvement of local scientific societies, or via debates and discussions with colleagues and local leaders. The barriers and facilitators identified were mostly organizational (in research management, and clinical and healthcare practice), although there were also some related to the nature of the research as well as personal factors. Both the expected and achieved impacts enabled the identification of the gaps between what is expected and what is truly achieved. In this study and according to key informants, the impact of these research projects on decision-making can be direct (the application of a finding or innovation) or indirect, contributing to a more complex change in clinical practice and healthcare organization, both having other contextual factors. The channels used to transfer this new knowledge to clinical practice are complex. Local scientific societies and the relationships between researchers and decision-makers can play a very important role. Specifically, the relationships between managers and research teams and the mutual knowledge of their activity have shown to be effective in applying research funding to practice and decision-making. Finally the facilitating factors and barriers identified by the respondents are closely related to the idiosyncrasy of the human relations between the different stakeholders involved.

Impact of clinical and health services research projects on decision-making: a qualitative study

PubMed Central

2013-01-01

Background This article reports on the impact assessment experience of a funding program of non-commercial clinical and health services research. The aim was to assess the level of implementation of results from a subgroup of research projects (on respiratory diseases), and to detect barriers (or facilitators) in the translation of new knowledge to informed decision-making. Methods A qualitative study was performed. The sample consisted of six projects on respiratory diseases funded by the Agency for Health Quality and Assessment of Catalonia between 1996 and 2004. Semi-structured interviews to key informants including researchers and healthcare decision-makers were carried out. Interviews were recorded, transcribed verbatim and analysed on an individual (key informant) and group (project) basis. In addition, the differences between achieved and expected impacts were described. Results Twenty-three semi-structured interviews were conducted. Most participants indicated changes in health services or clinical practice had resulted from research. The channels used to transfer new knowledge were mainly conventional ones, but also in less explicit ways, such as with the involvement of local scientific societies, or via debates and discussions with colleagues and local leaders. The barriers and facilitators identified were mostly organizational (in research management, and clinical and healthcare practice), although there were also some related to the nature of the research as well as personal factors. Both the expected and achieved impacts enabled the identification of the gaps between what is expected and what is truly achieved. Conclusions In this study and according to key informants, the impact of these research projects on decision-making can be direct (the application of a finding or innovation) or indirect, contributing to a more complex change in clinical practice and healthcare organization, both having other contextual factors. The channels used to transfer this new knowledge to clinical practice are complex. Local scientific societies and the relationships between researchers and decision-makers can play a very important role. Specifically, the relationships between managers and research teams and the mutual knowledge of their activity have shown to be effective in applying research funding to practice and decision-making. Finally the facilitating factors and barriers identified by the respondents are closely related to the idiosyncrasy of the human relations between the different stakeholders involved. PMID:23663364

Interpreting patient decisional conflict scores: behavior and emotions in decisions about treatment.

PubMed

Knops, Anouk M; Goossens, Astrid; Ubbink, Dirk T; Legemate, Dink A; Stalpers, Lukas J; Bossuyt, Patrick M

2013-01-01

Patient decision aids facilitate treatment decisions. They are often evaluated in terms of their effect on decisional conflict, as measured by the Decisional Conflict Scale (DCS). It is unclear to what extent lower DCS scores are accompanied by observable patient behavior or emotions. To help interpret DCS scores. In a Dutch university hospital, statements on behaviors or emotions during decision making were collected from asymptomatic aneurysm patients and healthy employees. Subsequently, they rated the intensity of decisional conflict that each statement expresses on a 1 to 10 scale. Selected statements were prospectively tested in aneurysm patients and cancer patients facing treatment dilemmas. Associations between patients' DCS scores and reported behavior and emotions were analyzed using logistic regression analysis. Participants provided 363 statements on behaviors and emotions during decision making, of which 28 were mentioned more than 4 times. Nine forms of behavior and emotions were selected as they were graded with the least variable median ratings of intensity of decisional conflict. Among 100 patients facing a treatment dilemma, each point increase in DCS lowered their odds for "immediately making the decision" (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.93-0.98), whereas the odds of "fretting regularly" (OR, 1.05; 95% CI, 1.02-1.08) and "feeling nervous when thinking of the decision" (OR, 1.04; 95% CI, 1.01-1.06) where higher. A decrease in decisional conflict scores leads to less decision postponing behavior, fretting, and nervousness. Research should focus on which DCS scores are needed to make deliberate decisions and which scores hinder patients in decision making.

Adverse outcome pathway (AOP) development II: Best practices

EPA Science Inventory

Organization of existing and emerging toxicological knowledge into adverse outcome pathway (AOP) descriptions can facilitate greater application of mechanistic data, including high throughput in vitro, high content omics and imaging, and biomarkers, in risk-based decision-making....

Teamwork and team decision-making at multidisciplinary cancer conferences: barriers, facilitators, and opportunities for improvement.

PubMed

Lamb, Benjamin W; Sevdalis, Nick; Arora, Sonal; Pinto, Anna; Vincent, Charles; Green, James S A

2011-09-01

Anecdotally, multidisciplinary cancer conferences (MCCs) do not always function optimally. MCC members' experiences with and attitudes toward MCCs are explored, and barriers to and facilitators of effective team-working are identified. A total of 19 semistructured interviews were conducted with surgeons, oncologists, nurses, and administrators. Interviews explored participants' opinions on MCC attendance, information presentation, case discussion, leadership, team decision-making, and possible improvements to MCC meetings. Nonattendance was associated with not having protected time to attend the MCC. Contributions to MCC discussions were unequal among the participants, and patient-centered information was ignored. Good leadership was necessary to foster inclusive case discussion. Members were positive about MCCs, but protected time, improved case selection, and working in a more structured way were possible improvements. Results are consistent with previous research: Members of the MCC are positive about the benefits of MCCs, although improving the way MCCs work is a goal.

Within- and across-trial dynamics of human EEG reveal cooperative interplay between reinforcement learning and working memory.

PubMed

Collins, Anne G E; Frank, Michael J

2018-03-06

Learning from rewards and punishments is essential to survival and facilitates flexible human behavior. It is widely appreciated that multiple cognitive and reinforcement learning systems contribute to decision-making, but the nature of their interactions is elusive. Here, we leverage methods for extracting trial-by-trial indices of reinforcement learning (RL) and working memory (WM) in human electro-encephalography to reveal single-trial computations beyond that afforded by behavior alone. Neural dynamics confirmed that increases in neural expectation were predictive of reduced neural surprise in the following feedback period, supporting central tenets of RL models. Within- and cross-trial dynamics revealed a cooperative interplay between systems for learning, in which WM contributes expectations to guide RL, despite competition between systems during choice. Together, these results provide a deeper understanding of how multiple neural systems interact for learning and decision-making and facilitate analysis of their disruption in clinical populations.

American Association for the Surgery of Trauma Organ Injury Scaling: 50th anniversary review article of the Journal of Trauma.

PubMed

Moore, Ernest E; Moore, Frederick A

2010-12-01

The purpose of a scaling system for specific injuries is to provide a common language to facilitate the clinical decisions and the investigative basis for this decision making. This brief overview describes the evolution of the Organ Injury Scaling (OIS) system developed by the American Association for the Surgery of Trauma. The OIS system is based on the magnitude of anatomic disruption and is graded as 1 (minimal), 2 (mild), 3 (moderate), 4 (severe), 5 (massive), and 6 (lethal). To date, the American Association for the Surgery of Trauma OIS system has been developed for visceral and vascular injuries of the neck, chest, abdomen, and extremities. The fundamental objective of OIS is to provide a common language to describe specific organ injuries. The primary purpose of OIS is to facilitate clinical decision making and the necessary research endeavors to improve this process. A good example of this concept is the tumor, node, metastasis classification for solid organ malignancies: a system used worldwide to guide patient care and clinical investigation.

Gender Differences in Bladder Cancer Treatment Decision Making.

PubMed

Pozzar, Rachel A; Berry, Donna L

2017-03-01

To explore gender differences in bladder cancer treatment decision making.
. Secondary qualitative analysis of interview transcripts.
. One multidisciplinary genitourinary oncology clinic (Dana-Farber Cancer Institute) and two urology clinics (Brigham and Women's Hospital and Beth Israel Deaconess Medical Center) in Boston, MA.
. As part of the original study, 45 men and 15 women with bladder cancer participated in individual interviews. Participants were primarily Caucasian, and most had at least some college education.
. Word frequency reports were used to identify thematic differences between the men's and women's statements. Line-by-line coding of constructs prevalent among women was then performed on all participants in NVivo 9. Coding results were compared between genders using matrix coding queries.
. The role of family in the decision-making process was found to be a dominant theme for women but not for men. Women primarily described family members as facilitators of bladder cancer treatment-related decisions, but men were more likely to describe family in a nonsupportive role.
. The results suggest that influences on the decision-making process are different for men and women with bladder cancer. Family may play a particularly important role for women faced with bladder cancer treatment-related decisions.
. Clinical nurses who care for individuals with bladder cancer should routinely assess patients' support systems and desired level of family participation in decision making. For some people with bladder cancer, family may serve as a stressor. Nurses should support the decision-making processes of all patients and be familiar with resources that can provide support to patients who do not receive it from family.

Lay Consultations in Heart Failure Symptom Evaluation.

PubMed

Reeder, Katherine M; Sims, Jessica L; Ercole, Patrick M; Shetty, Shivan S; Wallendorf, Michael

2017-01-01

Lay consultations can facilitate or impede healthcare. However, little is known about how lay consultations for symptom evaluation affect treatment decision-making. The purpose of this study was to explore the role of lay consultations in symptom evaluation prior to hospitalization among patients with heart failure. Semi-structured interviews were conducted with 60 patients hospitalized for acute decompensated heart failure. Chi-square and Fisher's exact tests, along with logistic regression were used to characterize lay consultations in this sample. A large proportion of patients engaged in lay consultations for symptom evaluation and decision-making before hospitalization. Lay consultants provided attributions and advice and helped make the decision to seek medical care. Men consulted more often with their spouse than women, while women more often consulted with adult children. Findings have implications for optimizing heart failure self-management interventions, improving outcomes, and reducing hospital readmissions.

SUPPORT Tools for evidence-informed health Policymaking (STP) 16: Using research evidence in balancing the pros and cons of policies

PubMed Central

2009-01-01

This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. In this article, we address the use of evidence to inform judgements about the balance between the pros and cons of policy and programme options. We suggest five questions that can be considered when making these judgements. These are: 1. What are the options that are being compared? 2. What are the most important potential outcomes of the options being compared? 3. What is the best estimate of the impact of the options being compared for each important outcome? 4. How confident can policymakers and others be in the estimated impacts? 5. Is a formal economic model likely to facilitate decision making? PMID:20018106

Communicating about resuscitation: problems and prospects.

PubMed

Ventres, W B

1993-01-01

The Patient Self-Determination Act of 1991 implicitly encourages physicians to discuss advance directives and no-code orders with their patients. The medical literature to date, however, has done little to place resuscitative decision making in the context of how physicians, patients, and families communicate with one another. This paper investigates how interactions between involved parties affect the process and outcome of this decision making. Participant observation and open-ended interviews were conducted with patients, their families, resident physicians, and family medicine faculty members. This report describes three social and cultural issues that commonly influence and shape the process of do-not-resuscitate decision making: judging competency and capacity, dealing with uncertainty, and recognizing attitudes toward death. Improved understanding of the communicative process can facilitate the establishment of meaningful, therapeutic alliances between physicians, patients, and families at an influential juncture in the family life cycle.

Joint Command Decision Support for the 21st Century (JCDS 21) Technology Demonstration (TD) Project: Concept of Operations (CONOPs)

DTIC Science & Technology

2008-04-08

decision making. It 29 identified that it is equally critical for a Command and Control system to facilitate temporal mixing (the ability to integrate...Decision Superiority. They might well be characterized as a set of stocks. It follows that a holistic appreciation, continuous monitoring of market ...retained the following working defintion of EBO: “Operations designed to influence the long- or short-term state of a system through the achievement of

Trajectory selection for the Mariner Jupiter/Saturn 1977 project

NASA Technical Reports Server (NTRS)

Dyer, J. S.; Miles, R. F., Jr.

1974-01-01

The use of decision analysis to facilitate a group decision-making problem in the selection of trajectories for the two spacecraft of the Mariner Jupiter/Saturn 1977 Project. A set of 32 candidate trajectory pairs was developed. Cardinal utility function values were assigned to the trajectory pairs, and the data and statistics derived from collective choice rules were used in selecting the science-preferred trajectory pair.

Web-services-based spatial decision support system to facilitate nuclear waste siting

NASA Astrophysics Data System (ADS)

Huang, L. Xinglai; Sheng, Grant

2006-10-01

The availability of spatial web services enables data sharing among managers, decision and policy makers and other stakeholders in much simpler ways than before and subsequently has created completely new opportunities in the process of spatial decision making. Though generally designed for a certain problem domain, web-services-based spatial decision support systems (WSDSS) can provide a flexible problem-solving environment to explore the decision problem, understand and refine problem definition, and generate and evaluate multiple alternatives for decision. This paper presents a new framework for the development of a web-services-based spatial decision support system. The WSDSS is comprised of distributed web services that either have their own functions or provide different geospatial data and may reside in different computers and locations. WSDSS includes six key components, namely: database management system, catalog, analysis functions and models, GIS viewers and editors, report generators, and graphical user interfaces. In this study, the architecture of a web-services-based spatial decision support system to facilitate nuclear waste siting is described as an example. The theoretical, conceptual and methodological challenges and issues associated with developing web services-based spatial decision support system are described.

A systematic review of decision aids that facilitate elements of shared decision-making in chronic illnesses: a review protocol.

PubMed

Wieringa, Thomas H; Kunneman, Marleen; Rodriguez-Gutierrez, Rene; Montori, Victor M; de Wit, Maartje; Smets, Ellen M A; Schoonmade, Linda J; Spencer-Bonilla, Gabriela; Snoek, Frank J

2017-08-07

Shared decision-making (SDM) is a patient-centred approach in which clinicians and patients work side-by-side to decide together on the best course of action for each patient's particular situation. Six key elements of SDM can be distinguished: situation diagnosis, choice awareness, option clarification, discussion of harms and benefits, deliberation of patient preferences and making the decision. Decision aids (DAs) are tools that facilitate SDM. The impact of DAs for chronic illnesses on SDM, clinical and patient reported outcomes remains uncertain. We will perform a systematic review aiming to describe (a) which SDM elements are incorporated in DAs for adult patients with chronic conditions and (b) the effects of DA use on SDM, clinical and patient reported outcomes. This manuscript reports on the protocol for this systematic review. The following databases will be searched for relevant articles: PubMed, Embase, Web of Science, CINAHL and PsycINFO, from their inception to October 2016. We will ascertain ongoing research by querying experts and searching trial registries. To enhance feasibility, we will limit the review to randomized controlled trials (RCTs) including patients with chronic cardiovascular and/or respiratory diseases and/or diabetes. SDM elements incorporated in DAs, DA effects and DA itself will be described. This study will characterize DAs for chronic illness and will provide an overview of their effects on SDM, clinical and patient reported outcomes. We anticipate this review will bring to light knowledge gaps and inform further research into the design and use of DAs for patients with chronic conditions. PROSPERO registration number: CRD42016050320 .

Research-based-decision-making in Canadian health organizations: a behavioural approach.

PubMed

Jbilou, Jalila; Amara, Nabil; Landry, Réjean

2007-06-01

Decision making in Health sector is affected by a several elements such as economic constraints, political agendas, epidemiologic events, managers' values and environment... These competing elements create a complex environment for decision making. Research-Based-Decision-Making (RBDM) offers an opportunity to reduce the generated uncertainty and to ensure efficacy and efficiency in health administrations. We assume that RBDM is dependant on decision makers' behaviour and the identification of the determinants of this behaviour can help to enhance research results utilization in health sector decision making. This paper explores the determinants of RBDM as a personal behaviour among managers and professionals in health administrations in Canada. From the behavioural theories and the existing literature, we build a model measuring "RBDM" as an index based on five items. These items refer to the steps accomplished by a decision maker while developing a decision which is based on evidence. The determinants of RBDM behaviour are identified using data collected from 942 health care decision makers in Canadian health organizations. Linear regression is used to model the behaviour RBDM. Determinants of this behaviour are derived from Triandis Theory and Bandura's construct "self-efficacy." The results suggest that to improve research use among managers in Canadian governmental health organizations, strategies should focus on enhancing exposition to evidence through facilitating communication networks, partnerships and links between researchers and decision makers, with the key long-term objective of developing a culture that supports and values the contribution that research can make to decision making in governmental health organizations. Nevertheless, depending on the organizational level, determinants of RBDM are different. This difference has to be taken into account if RBDM adoption is desired. Decision makers in Canadian health organizations (CHO) can help to build networks, develop partnerships between professionals locally, regionally and nationally, and also act as change agents in the dissemination and adoption of knowledge and innovations in health services. However, the research focused on knowledge use as a support to decision-making, further research is needed to identify and evaluate effective incentives and strategies to implement so as to enhance RBDM adoption among health decision makers and more theoretical development are to complete in this perspective.

Harnessing Information Technology to Inform Patients Facing Routine Decisions: Cancer Screening as a Test Case.

PubMed

Krist, Alex H; Woolf, Steven H; Hochheimer, Camille; Sabo, Roy T; Kashiri, Paulette; Jones, Resa M; Lafata, Jennifer Elston; Etz, Rebecca S; Tu, Shin-Ping

2017-05-01

Technology could transform routine decision making by anticipating patients' information needs, assessing where patients are with decisions and preferences, personalizing educational experiences, facilitating patient-clinician information exchange, and supporting follow-up. This study evaluated whether patients and clinicians will use such a decision module and its impact on care, using 3 cancer screening decisions as test cases. Twelve practices with 55,453 patients using a patient portal participated in this prospective observational cohort study. Participation was open to patients who might face a cancer screening decision: women aged 40 to 49 who had not had a mammogram in 2 years, men aged 55 to 69 who had not had a prostate-specific antigen test in 2 years, and adults aged 50 to 74 overdue for colorectal cancer screening. Data sources included module responses, electronic health record data, and a postencounter survey. In 1 year, one-fifth of the portal users (11,458 patients) faced a potential cancer screening decision. Among these patients, 20.6% started and 7.9% completed the decision module. Fully 47.2% of module completers shared responses with their clinician. After their next office visit, 57.8% of those surveyed thought their clinician had seen their responses, and many reported the module made their appointment more productive (40.7%), helped engage them in the decision (47.7%), broadened their knowledge (48.1%), and improved communication (37.5%). Many patients face decisions that can be anticipated and proactively facilitated through technology. Although use of technology has the potential to make visits more efficient and effective, cultural, workflow, and technical changes are needed before it could be widely disseminated. © 2017 Annals of Family Medicine, Inc.

Understanding evidence: a statewide survey to explore evidence-informed public health decision-making in a local government setting.

PubMed

Armstrong, Rebecca; Waters, Elizabeth; Moore, Laurence; Dobbins, Maureen; Pettman, Tahna; Burns, Cate; Swinburn, Boyd; Anderson, Laurie; Petticrew, Mark

2014-12-14

The value placed on types of evidence within decision-making contexts is highly dependent on individuals, the organizations in which the work and the systems and sectors they operate in. Decision-making processes too are highly contextual. Understanding the values placed on evidence and processes guiding decision-making is crucial to designing strategies to support evidence-informed decision-making (EIDM). This paper describes how evidence is used to inform local government (LG) public health decisions. The study used mixed methods including a cross-sectional survey and interviews. The Evidence-Informed Decision-Making Tool (EvIDenT) survey was designed to assess three key domains likely to impact on EIDM: access, confidence, and organizational culture. Other elements included the usefulness and influence of sources of evidence (people/groups and resources), skills and barriers, and facilitators to EIDM. Forty-five LGs from Victoria, Australia agreed to participate in the survey and up to four people from each organization were invited to complete the survey (n = 175). To further explore definitions of evidence and generate experiential data on EIDM practice, key informant interviews were conducted with a range of LG employees working in areas relevant to public health. In total, 135 responses were received (75% response rate) and 13 interviews were conducted. Analysis revealed varying levels of access, confidence and organizational culture to support EIDM. Significant relationships were found between domains: confidence, culture and access to research evidence. Some forms of evidence (e.g. community views) appeared to be used more commonly and at the expense of others (e.g. research evidence). Overall, a mixture of evidence (but more internal than external evidence) was influential in public health decision-making in councils. By comparison, a mixture of evidence (but more external than internal evidence) was deemed to be useful in public health decision-making. This study makes an important contribution to understanding how evidence is used within the public health LG context. ACTRN12609000953235.

Designing and evaluating an interprofessional shared decision-making and goal-setting decision aid for patients with diabetes in clinical care--systematic decision aid development and study protocol.

PubMed

Yu, Catherine H; Stacey, Dawn; Sale, Joanna; Hall, Susan; Kaplan, David M; Ivers, Noah; Rezmovitz, Jeremy; Leung, Fok-Han; Shah, Baiju R; Straus, Sharon E

2014-01-22

Care of patients with diabetes often occurs in the context of other chronic illness. Competing disease priorities and competing patient-physician priorities present challenges in the provision of care for the complex patient. Guideline implementation interventions to date do not acknowledge these intricacies of clinical practice. As a result, patients and providers are left overwhelmed and paralyzed by the sheer volume of recommendations and tasks. An individualized approach to the patient with diabetes and multiple comorbid conditions using shared decision-making (SDM) and goal setting has been advocated as a patient-centred approach that may facilitate prioritization of treatment options. Furthermore, incorporating interprofessional integration into practice may overcome barriers to implementation. However, these strategies have not been taken up extensively in clinical practice. To systematically develop and test an interprofessional SDM and goal-setting toolkit for patients with diabetes and other chronic diseases, following the Knowledge to Action framework. 1. Feasibility study: Individual interviews with primary care physicians, nurses, dietitians, pharmacists, and patients with diabetes will be conducted, exploring their experiences with shared decision-making and priority-setting, including facilitators and barriers, the relevance of a decision aid and toolkit for priority-setting, and how best to integrate it into practice.2. Toolkit development: Based on this data, an evidence-based multi-component SDM toolkit will be developed. The toolkit will be reviewed by content experts (primary care, endocrinology, geriatricians, nurses, dietitians, pharmacists, patients) for accuracy and comprehensiveness.3. Heuristic evaluation: A human factors engineer will review the toolkit and identify, list and categorize usability issues by severity.4. Usability testing: This will be done using cognitive task analysis.5. Iterative refinement: Throughout the development process, the toolkit will be refined through several iterative cycles of feedback and redesign. Interprofessional shared decision-making regarding priority-setting with the use of a decision aid toolkit may help prioritize care of individuals with multiple comorbid conditions. Adhering to principles of user-centered design, we will develop and refine a toolkit to assess the feasibility of this approach.

Designing and evaluating an interprofessional shared decision-making and goal-setting decision aid for patients with diabetes in clinical care - systematic decision aid development and study protocol

PubMed Central

2014-01-01

Background Care of patients with diabetes often occurs in the context of other chronic illness. Competing disease priorities and competing patient-physician priorities present challenges in the provision of care for the complex patient. Guideline implementation interventions to date do not acknowledge these intricacies of clinical practice. As a result, patients and providers are left overwhelmed and paralyzed by the sheer volume of recommendations and tasks. An individualized approach to the patient with diabetes and multiple comorbid conditions using shared decision-making (SDM) and goal setting has been advocated as a patient-centred approach that may facilitate prioritization of treatment options. Furthermore, incorporating interprofessional integration into practice may overcome barriers to implementation. However, these strategies have not been taken up extensively in clinical practice. Objectives To systematically develop and test an interprofessional SDM and goal-setting toolkit for patients with diabetes and other chronic diseases, following the Knowledge to Action framework. Methods 1. Feasibility study: Individual interviews with primary care physicians, nurses, dietitians, pharmacists, and patients with diabetes will be conducted, exploring their experiences with shared decision-making and priority-setting, including facilitators and barriers, the relevance of a decision aid and toolkit for priority-setting, and how best to integrate it into practice. 2. Toolkit development: Based on this data, an evidence-based multi-component SDM toolkit will be developed. The toolkit will be reviewed by content experts (primary care, endocrinology, geriatricians, nurses, dietitians, pharmacists, patients) for accuracy and comprehensiveness. 3. Heuristic evaluation: A human factors engineer will review the toolkit and identify, list and categorize usability issues by severity. 4. Usability testing: This will be done using cognitive task analysis. 5. Iterative refinement: Throughout the development process, the toolkit will be refined through several iterative cycles of feedback and redesign. Discussion Interprofessional shared decision-making regarding priority-setting with the use of a decision aid toolkit may help prioritize care of individuals with multiple comorbid conditions. Adhering to principles of user-centered design, we will develop and refine a toolkit to assess the feasibility of this approach. PMID:24450385

How does the context and design of participatory decision-making processes affect their outcomes? Evidence from sustainable land management in global drylands.

NASA Astrophysics Data System (ADS)

de Vente, Joris; Reed, Mark; Stringer, Lindsay; Valente, Sandra; Newig, Jens

2014-05-01

It is widely accepted that the design of participatory processes in environmental management needs to be adapted to local contexts. Yet, it is not clear which elements of process design are universal, making it difficult to design processes that deliver beneficial outcomes across different contexts. We used empirical evidence to analyse the extent to which context and process design can enable or impede stakeholder participation and facilitate beneficial environmental and social outcomes in a range of decision-making contexts where stakeholders are engaged in environmental management. To explore the role of national-scale context on the outcomes of participatory processes, we interviewed facilitators from a process that was replicated across 13 dryland study sites around the world, which focussed on selecting Sustainable Land Management (SLM) options in close collaboration with stakeholders. To explore the role of process design and local context, we interviewed participants and facilitators in 11 case studies in Spain and Portugal in which different process designs were used. Interview data were analysed using a combination of quantitative and qualitative approaches to characterise relationships between process design, context and process outcomes. The similarity of outcomes across the 13 international study sites suggested that the national socio-cultural context in which a participatory process is conducted has little impact on its outcomes. However, analysis of cases from Spain and Portugal showed that some aspects of local context may affect outcomes. Having said this, factors associated with process design and participant selection played a more significant role in influencing outcomes in both countries. Processes that led to more beneficial outcomes for the environment and/or participants were likely to include: the legitimate representation of stakeholders; professional facilitation including structured methods for eliciting and aggregating information and balancing power dynamics between participants; and the provision of information and decision-making power to all participants. Participatory processes initiated or facilitated by government bodies led to significantly less trust, information gain, learning, and flexible solutions. However, in these processes, decisions were more acceptable to and likely to be implemented by governments and by those who had to apply them on the ground. These findings provide a solid empirical basis for best practice in the design of participatory processes in SLM in a number of contexts internationally, which if followed, increase the likelihood of providing beneficial environmental and social outcomes for those involved.

The development of an online decision aid to support persons having a genetic predisposition to cancer and their partners during reproductive decision-making: a usability and pilot study.

PubMed

Reumkens, Kelly; Tummers, Marly H E; Gietel-Habets, Joyce J G; van Kuijk, Sander M J; Aalfs, Cora M; van Asperen, Christi J; Ausems, Margreet G E M; Collée, Margriet; Dommering, Charlotte J; Kets, C Marleen; van der Kolk, Lizet E; Oosterwijk, Jan C; Tjan-Heijnen, Vivianne C G; van der Weijden, Trudy; de Die-Smulders, Christine E M; van Osch, Liesbeth A D M

2018-05-30

An online decision aid to support persons having a genetic predisposition to cancer and their partners during reproductive decision-making was developed. A two-phase usability test was conducted among 12 couples (N = 22; 2 persons participated without their partner) at risk for hereditary cancer and 15 health care providers. Couples and health care providers expressed similar suggestions for improvements, and evaluated the modified decision aid as acceptable, easy to use, and comprehensible. The final decision aid was pilot tested (N = 16) with paired sample t tests comparing main outcomes (decisional conflict, knowledge, realistic expectations regarding the reproductive options and decision self-efficacy) before (T0), immediately (T1) and 2 weeks after (T2) use of the decision aid. Pilot testing indicated decreased decisional conflict scores, increased knowledge, and improved realistic expectations regarding the reproductive options, at T1 and T2. No effect was found for couples' decision self-efficacy. The positive findings during usability testing were thus reflected in the pilot study. The decision aid will be further evaluated in a nationwide pretest-posttest study to facilitate implementation in the onco-genetic counselling setting. Ultimately, it is expected that the decision aid will enable end-users to make an informed decision.

Dynamic fluctuations in dopamine efflux in the prefrontal cortex and nucleus accumbens during risk-based decision making.

PubMed

St Onge, Jennifer R; Ahn, Soyon; Phillips, Anthony G; Floresco, Stan B

2012-11-21

Mesocorticolimbic dopamine (DA) has been implicated in cost/benefit decision making about risks and rewards. The prefrontal cortex (PFC) and nucleus accumbens (NAc) are two DA terminal regions that contribute to decision making in distinct manners. However, how fluctuations of tonic DA levels may relate to different aspects of decision making remains to be determined. The present study measured DA efflux in the PFC and NAc with microdialysis in well trained rats performing a probabilistic discounting task. Selection of a small/certain option always delivered one pellet, whereas another, large/risky option yielded four pellets, with probabilities that decreased (100-12.5%) or increased (12.5-100%) across four blocks of trials. Yoked-reward groups were also included to control for reward delivery. PFC DA efflux during decision making decreased or increased over a session, corresponding to changes in large/risky reward probabilities. Similar profiles were observed from yoked-rewarded rats, suggesting that fluctuations in PFC DA reflect changes in the relative rate of reward received. NAc DA efflux also showed decreasing/increasing trends over the session during both tasks. However, DA efflux was higher during decision making on free- versus forced-choice trials and during periods of greater reward uncertainty. Moreover, changes in NAc DA closely tracked shifts in choice biases. These data reveal dynamic and dissociable fluctuations in PFC and NAc DA transmission associated with different aspects of risk-based decision making. PFC DA may signal changes in reward availability that facilitates modification of choice biases, whereas NAc DA encodes integrated signals about reward rates, uncertainty, and choice, reflecting implementation of decision policies.

Effective Monitoring and Control of Outsourced Software Development Projects

NASA Astrophysics Data System (ADS)

Ponisio, Laura; Vruggink, Peter

In our study of four outsourcing projects we discover mechanisms to support managerial decision making during software development processes. We report on Customer Office, a framework used in practice that facilitates reasoning about projects by highlighting information paths and making co-ordination issues explicit. The results suggest a key role of modularisation and standardisation to assist in value creation, by facilitating information flow and keeping the overview of the project. The practical implications of our findings are guidelines for managing outsourcing projects such as to have a modularised view of the project based on knowledge domains and to standardise co-ordination operations.

Right choice, right time: Evaluation of an online decision aid for youth depression.

PubMed

Simmons, Magenta B; Elmes, Aurora; McKenzie, Joanne E; Trevena, Lyndal; Hetrick, Sarah E

2017-08-01

Appropriate treatment for youth depression is an important public health priority. Shared decision making has been recommended, yet no decision aids exist to facilitate this. The main objective of this study was to evaluate an online decision aid for youth depression. An uncontrolled cohort study with pre-decision, immediately post-decision and follow-up measurements. Young people (n=66) aged 12-25 years with mild, mild-moderate or moderate-severe depression were recruited from two enhanced primary care services. Online decision aid with evidence communication, preference elicitation and decision support components. The main outcome measures were ability to make a decision; whether the decision was in line with clinical practice guidelines, personal preferences and values; decisional conflict; perceived involvement; satisfaction with decision; adherence; and depression scores at follow-up. After using the decision aid, clients were more likely to make a decision in line with guideline recommendations (93% vs 70%; P=.004), were more able to make a decision (97% vs 79%; P=.022), had significantly reduced decisional conflict (17.8 points lower (95% CI: 13.3-22.9 points lower) on the Decisional Conflict Scale (range 0-100)) and felt involved and satisfied with their decision. At follow-up, clients had significantly reduced depression symptoms (2.7 points lower (95% CI: 1.3-4.0 points lower) on the Patient Health Questionnaire nine-item scale (range 0-27)) and were adherent to 88% (95% CI: 82%-94%) of treatment courses. A decision aid for youth depression can help ensure evidence-based, client-centred care, promoting collaboration in this often difficult to engage population. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Graphics to facilitate informative discussion and team decision making

DOE PAGES

Anderson-Cook, Christine M.; Lu, Lu

2018-03-25

Everyone knows the expression “A picture is worth a thousand words,” and this effectively summarizes the ability of graphical summaries to convey information and persuade. However, in many cases, the goal for the right visualization is to encourage and guide discussion while helping focus a team to make carefully considered, defensible, and data-driven decisions. The aims of graphics differ if we are trying to communicate the merits of a single choice versus outlining several contending alternatives for further comparison and discussion. These choices each have their own strengths and weaknesses depending on how we value different criteria. They also servemore » different purposes at various stages of decision making. Often the role of statisticians is not to provide a single answer but to provide rich information and summaries in a manageable and compact form to enable productive discussion among team members. Through a series of diverse examples, this work present principles and strategies for encouraging discussion and informed decision making and discuss how they can be integrated with versatile use of graphical tools for examining multiple objectives, framing trade-offs between alternatives, and examining the impact of subjective priorities and uncertainty on the final decision.« less

Introduction to health economics and decision-making: Is economics relevant for the frontline clinician?

PubMed

Goeree, Ron; Diaby, Vakaramoko

2013-12-01

In a climate of escalating demands for new health care services and significant constraints on new resources, the disciplines of health economics and health technology assessment (HTA) have increasingly been turned to as explicit evidence-based frameworks to help make tough health care access and reimbursement decisions. Health economics is the discipline of economics concerned with the efficient allocation of health care resources, essentially trying to maximize health benefits to society contingent upon available resources. HTA is a broader field drawing upon several disciplines, but which relies heavily upon the tools of health economics and economic evaluation. Traditionally, health economics and economic evaluation have been widely used at the political (macro) and local (meso) decision-making levels, and have progressively had an important role even at informing individual clinical decisions (micro level). The aim of this paper is to introduce readers to health economics and discuss its relevance to frontline clinicians. Particularly, the content of the paper will facilitate clinicians' understanding of the link between economics and their medical practice, and how clinical decision-making reflects on health care resource allocation. Copyright © 2013 Elsevier Ltd. All rights reserved.

Graphics to facilitate informative discussion and team decision making

DOE Office of Scientific and Technical Information (OSTI.GOV)

Anderson-Cook, Christine M.; Lu, Lu

Everyone knows the expression “A picture is worth a thousand words,” and this effectively summarizes the ability of graphical summaries to convey information and persuade. However, in many cases, the goal for the right visualization is to encourage and guide discussion while helping focus a team to make carefully considered, defensible, and data-driven decisions. The aims of graphics differ if we are trying to communicate the merits of a single choice versus outlining several contending alternatives for further comparison and discussion. These choices each have their own strengths and weaknesses depending on how we value different criteria. They also servemore » different purposes at various stages of decision making. Often the role of statisticians is not to provide a single answer but to provide rich information and summaries in a manageable and compact form to enable productive discussion among team members. Through a series of diverse examples, this work present principles and strategies for encouraging discussion and informed decision making and discuss how they can be integrated with versatile use of graphical tools for examining multiple objectives, framing trade-offs between alternatives, and examining the impact of subjective priorities and uncertainty on the final decision.« less

Integrated System of Structural Health Monitoring and Intelligent Management for a Cable-Stayed Bridge

PubMed Central

Chen, Bin; Wang, Xu; Sun, Dezhang; Xie, Xu

2014-01-01

It is essential to construct structural health monitoring systems for large important bridges. Zhijiang Bridge is a cable-stayed bridge that was built recently over the Hangzhou Qiantang River (the largest river in Zhejiang Province). The length of Zhijiang Bridge is 478 m, which comprises an arched twin-tower space and a twin-cable plane structure. As an example, the present study describes the integrated system of structural health monitoring and intelligent management for Zhijiang Bridge, which comprises an information acquisition system, data management system, evaluation and decision-making system, and application service system. The monitoring components include the working environment of the bridge and various factors that affect bridge safety, such as the stress and strain of the main bridge structure, vibration, cable force, temperature, and wind speed. In addition, the integrated system includes a forecasting and decision-making module for real-time online evaluation, which provides warnings and makes decisions based on the monitoring information. From this, the monitoring information, evaluation results, maintenance decisions, and warning information can be input simultaneously into the bridge monitoring center and traffic emergency center to share the monitoring data, thereby facilitating evaluations and decision making using the system. PMID:25140342

Integrated system of structural health monitoring and intelligent management for a cable-stayed bridge.

PubMed

Chen, Bin; Wang, Xu; Sun, Dezhang; Xie, Xu

2014-01-01

It is essential to construct structural health monitoring systems for large important bridges. Zhijiang Bridge is a cable-stayed bridge that was built recently over the Hangzhou Qiantang River (the largest river in Zhejiang Province). The length of Zhijiang Bridge is 478 m, which comprises an arched twin-tower space and a twin-cable plane structure. As an example, the present study describes the integrated system of structural health monitoring and intelligent management for Zhijiang Bridge, which comprises an information acquisition system, data management system, evaluation and decision-making system, and application service system. The monitoring components include the working environment of the bridge and various factors that affect bridge safety, such as the stress and strain of the main bridge structure, vibration, cable force, temperature, and wind speed. In addition, the integrated system includes a forecasting and decision-making module for real-time online evaluation, which provides warnings and makes decisions based on the monitoring information. From this, the monitoring information, evaluation results, maintenance decisions, and warning information can be input simultaneously into the bridge monitoring center and traffic emergency center to share the monitoring data, thereby facilitating evaluations and decision making using the system.

Prehospital Trauma Triage Decision-making: A Model of What Happens between the 9-1-1 Call and the Hospital.

PubMed

Jones, Courtney Marie Cora; Cushman, Jeremy T; Lerner, E Brooke; Fisher, Susan G; Seplaki, Christopher L; Veazie, Peter J; Wasserman, Erin B; Dozier, Ann; Shah, Manish N

2016-01-01

We describe the decision-making process used by emergency medical services (EMS) providers in order to understand how 1) injured patients are evaluated in the prehospital setting; 2) field triage criteria are applied in-practice; and 3) selection of a destination hospital is determined. We conducted separate focus groups with advanced and basic life support providers from rural and urban/suburban regions. Four exploratory focus groups were conducted to identify overarching themes and five additional confirmatory focus groups were conducted to verify initial focus group findings and provide additional detail regarding trauma triage decision-making and application of field triage criteria. All focus groups were conducted by a public health researcher with formal training in qualitative research. A standardized question guide was used to facilitate discussion at all focus groups. All focus groups were audio-recorded and transcribed. Responses were coded and categorized into larger domains to describe how EMS providers approach trauma triage and apply the Field Triage Decision Scheme. We conducted 9 focus groups with 50 EMS providers. Participants highlighted that trauma triage is complex and there is often limited time to make destination decisions. Four overarching domains were identified within the context of trauma triage decision-making: 1) initial assessment; 2) importance of speed versus accuracy; 3) usability of current field triage criteria; and 4) consideration of patient and emergency care system-level factors. Field triage is a complex decision-making process which involves consideration of many patient and system-level factors. The decision model presented in this study suggests that EMS providers place significant emphasis on speed of decisions, relying on initial impressions and immediately observable information, rather than precise measurement of vital signs or systematic application of field triage criteria.

Economic evaluation of pharmacogenomics: a value-based approach to pragmatic decision making in the face of complexity.

PubMed

Snyder, Susan R; Mitropoulou, Christina; Patrinos, George P; Williams, Marc S

2014-01-01

Evidence of the value of pharmacogenomic testing is needed to inform policymakers and clinicians for decision making related to adoption and coverage, and to facilitate prioritization for research and development. Pharmacogenomics has an important role in creating a more efficient healthcare system, and this article addresses how economic evaluation can strategically target evidence gaps for public health priorities with examples from pharmacogenomic medicine. This article begins with a review of the need for and use of economic evaluations in value-based decision making for pharmacogenomic testing. Three important gaps are described with examples demonstrating how they can be addressed: (1) projected impact of hypothetical new technology, (2) pre-implementation assessment of a specific technology, and (3) post-implementation assessment from relevant analytical stakeholder perspectives. Additional needs, challenges and approaches specific to pharmacogenomic economic evaluation in the developing world are also identified. These pragmatic approaches can provide much needed evidence to support real-world value-based decision making for pharmacogenomic-based screening and treatment strategies. © 2014 S. Karger AG, Basel.

External factors affecting decision-making and use of evidence in an Australian public health policy environment.

PubMed

Zardo, Pauline; Collie, Alex; Livingstone, Charles

2014-05-01

This study examined external factors affecting policy and program decision-making in a specific public health policy context: injury prevention and rehabilitation compensation in the Australian state of Victoria. The aim was twofold: identify external factors that affect policy and program decision-making in this specific context; use this evidence to inform targeting of interventions aimed at increasing research use in this context. Qualitative interviews were undertaken from June 2011 to January 2012 with 33 employees from two state government agencies. Key factors identified were stakeholder feedback and action, government and ministerial input, legal feedback and action, injured persons and the media. The identified external factors were able to significantly influence policy and program decision-making processes: acting as both barriers and facilitators, depending on the particular issue at hand. The factors with the most influence were the Minister and government, lawyers, and agency stakeholders, particularly health providers, trade unions and employer groups. This research revealed that interventions aimed at increasing use of research in this context must target and harness the influence of these groups. This research provides critical insights for researchers seeking to design interventions to increase use of research in policy environments and influence decision-making in Victorian injury prevention and rehabilitation compensation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Parent participation in decision-making in health-care services for children: an integrative review.

PubMed

Aarthun, Antje; Akerjordet, Kristin

2014-03-01

To describe and synthesize previous research on parents' perceptions of their participation in decision making in child health-care services. Health policy in the area of user involvement emphasizes parent participation in decision-making (DM), thus ensuring that services are provided in accordance with their child's needs and enhancing parents' control over their child's health-care services. A systematic literature search, covering the period January 2000 to February 2011, found 18 studies that met the inclusion criteria. The analysis process involved data extraction, reduction, comparison and synthesizing. Three themes emerged: (1) relational factors and interdependence, (2) personal factors and attitudes and (3) organisational factors. Parents highlighted the importance of the parent-health professional relationship, professionals' competence and the possibility of varying the degree of participation in decision making. Challenges involved asymmetry in authority and power, professionals' attitudes and competence and organisational shortcomings in health-care services. Health professionals need to become more aware of their critical role and responsibility in involving parents in DM. Health professionals' attitudes and competence can be improved by knowledge of user involvement and research and facilitating the inclusion of parents in decision making by influencing the culture, routines and resources in the health service. © 2012 John Wiley & Sons Ltd.

The Impact of Health and Financial Literacy on Decision Making in Community-Based Older Adults

PubMed Central

James, Bryan D.; Boyle, Patricia A.; Bennett, Jarred S.; Bennett, David A.

2012-01-01

Background Health and financial literacy have been linked to the health and well-being of older adults, yet there are few data on how health and financial literacy actually impact decision making regarding healthcare and economic choices in advanced age. Objective To examine the association of health and financial literacy with decision making in older adults. Method Data came from 525 community-dwelling older persons without dementia from the Rush Memory and Aging Project, an ongoing longitudinal study of aging. Health and financial literacy were assessed via a series of questions designed to measure comprehension of health and financial information and concepts. The two scores were averaged to yield a total literacy score. A modified, 12-item version of the Decision-Making Competence Assessment Tool was used to measure financial and healthcare decision making (6 items each), using materials designed to approximate those used in real world settings. All 12 items were summed to yield a total decision-making score. Associations were tested via linear regression models adjusted for age, sex and education. Secondary models adjusted for global cognitive function, income, depression and chronic medical conditions. Results On average, participants correctly answered 67% of the literacy questions (health literacy = 61.6%, SD = 18.8% and financial literacy = 72.5%, SD = 16.0%). After adjustment for cognitive function, the total literacy score was positively associated with the decision-making total score (estimate = 0.64, SE = 0.08, p < 0.001), as well as healthcare (estimate = 0.37, SE = 0.5, p < 0.001) and financial decision making (estimate = 0.28, SE = 0.05, p < 0.001). Further, total literacy, health and financial literacy all were independently associated with decision making in models adjusted for covariates including income, depression, and chronic medical conditions (all p values < 0.001). Finally, there was evidence of effect modification such that the beneficial association between literacy and healthcare decision making was stronger among older persons, poorer persons and persons at the lower ranges of cognitive ability. Conclusion Among community based older persons without dementia, higher levels of health and financial literacy were associated with better decision making, suggesting that improvements in literacy could facilitate better decision making and lead to better health and quality of life in later years. PMID:22739454

The impact of health and financial literacy on decision making in community-based older adults.

PubMed

James, Bryan D; Boyle, Patricia A; Bennett, Jarred S; Bennett, David A

2012-01-01

Health and financial literacy have been linked to the health and well-being of older adults, yet there are few data on how health and financial literacy actually impact decision making regarding healthcare and economic choices in advanced age. To examine the association of health and financial literacy with decision making in older adults. Data came from 525 community-dwelling older persons without dementia from the Rush Memory and Aging Project, an ongoing longitudinal study of aging. Health and financial literacy were assessed via a series of questions designed to measure comprehension of health and financial information and concepts. The two scores were averaged to yield a total literacy score. A modified, 12-item version of the Decision-Making Competence Assessment Tool was used to measure financial and healthcare decision making (6 items each), using materials designed to approximate those used in real world settings. All 12 items were summed to yield a total decision-making score. Associations were tested via linear regression models adjusted for age, sex and education. Secondary models adjusted for global cognitive function, income, depression and chronic medical conditions. On average, participants correctly answered 67% of the literacy questions (health literacy = 61.6%, SD = 18.8% and financial literacy = 72.5%, SD = 16.0%). After adjustment for cognitive function, the total literacy score was positively associated with the decision-making total score (estimate = 0.64, SE = 0.08, p < 0.001), as well as healthcare (estimate = 0.37, SE = 0.5, p < 0.001) and financial decision making (estimate = 0.28, SE = 0.05, p < 0.001). Further, total literacy, health and financial literacy all were independently associated with decision making in models adjusted for covariates including income, depression, and chronic medical conditions (all p values < 0.001). Finally, there was evidence of effect modification such that the beneficial association between literacy and healthcare decision making was stronger among older persons, poorer persons and persons at the lower ranges of cognitive ability. Among community based older persons without dementia, higher levels of health and financial literacy were associated with better decision making, suggesting that improvements in literacy could facilitate better decision making and lead to better health and quality of life in later years. Copyright © 2012 S. Karger AG, Basel.

Demographics of reintroduced populations: estimation, modeling, and decision analysis

USGS Publications Warehouse

Converse, Sarah J.; Moore, Clinton T.; Armstrong, Doug P.

2013-01-01

Reintroduction can be necessary for recovering populations of threatened species. However, the success of reintroduction efforts has been poorer than many biologists and managers would hope. To increase the benefits gained from reintroduction, management decision making should be couched within formal decision-analytic frameworks. Decision analysis is a structured process for informing decision making that recognizes that all decisions have a set of components—objectives, alternative management actions, predictive models, and optimization methods—that can be decomposed, analyzed, and recomposed to facilitate optimal, transparent decisions. Because the outcome of interest in reintroduction efforts is typically population viability or related metrics, models used in decision analysis efforts for reintroductions will need to include population models. In this special section of the Journal of Wildlife Management, we highlight examples of the construction and use of models for informing management decisions in reintroduced populations. In this introductory contribution, we review concepts in decision analysis, population modeling for analysis of decisions in reintroduction settings, and future directions. Increased use of formal decision analysis, including adaptive management, has great potential to inform reintroduction efforts. Adopting these practices will require close collaboration among managers, decision analysts, population modelers, and field biologists.

Improving Health Care Provider Communication in End-of-Life Decision-Making.

PubMed

Wilson, Tracey; Haut, Cathy; Akintade, Bimbola

2017-01-01

Critical care providers are responsible for many aspects of patient care, primarily focusing on preserving life. However, nearly 40% of patients who are admitted to an adult critical care unit will not survive. Initiating a conversation about end-of-life decision-making is a daunting task. Often, health care providers are not trained, experienced, or comfortable facilitating these conversations. This article describes a quality improvement project that identified current views on end-of-life communication in the intensive care unit and potential barriers that obstruct open discussion, and offering strategies for improvement. ©2017 American Association of Critical-Care Nurses.

Toward theoretical understanding of the fertility preservation decision-making process: Examining information processing among young women with cancer

PubMed Central

Hershberger, Patricia E.; Finnegan, Lorna; Altfeld, Susan; Lake, Sara; Hirshfeld-Cytron, Jennifer

2014-01-01

Background Young women with cancer now face the complex decision about whether to undergo fertility preservation. Yet little is known about how these women process information involved in making this decision. Objective The purpose of this paper is to expand theoretical understanding of the decision-making process by examining aspects of information processing among young women diagnosed with cancer. Methods Using a grounded theory approach, 27 women with cancer participated in individual, semi-structured interviews. Data were coded and analyzed using constant-comparison techniques that were guided by five dimensions within the Contemplate phase of the decision-making process framework. Results In the first dimension, young women acquired information primarily from clinicians and Internet sources. Experiential information, often obtained from peers, occurred in the second dimension. Preferences and values were constructed in the third dimension as women acquired factual, moral, and ethical information. Women desired tailored, personalized information that was specific to their situation in the fourth dimension; however, women struggled with communicating these needs to clinicians. In the fifth dimension, women offered detailed descriptions of clinician behaviors that enhance or impede decisional debriefing. Conclusion Better understanding of theoretical underpinnings surrounding women’s information processes can facilitate decision support and improve clinical care. PMID:24552086

Technosocial Predictive Analytics in Support of Naturalistic Decision Making

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sanfilippo, Antonio P.; Cowell, Andrew J.; Malone, Elizabeth L.

2009-06-23

A main challenge we face in fostering sustainable growth is to anticipate outcomes through predictive and proactive across domains as diverse as energy, security, the environment, health and finance in order to maximize opportunities, influence outcomes and counter adversities. The goal of this paper is to present new methods for anticipatory analytical thinking which address this challenge through the development of a multi-perspective approach to predictive modeling as a core to a creative decision making process. This approach is uniquely multidisciplinary in that it strives to create decision advantage through the integration of human and physical models, and leverages knowledgemore » management and visual analytics to support creative thinking by facilitating the achievement of interoperable knowledge inputs and enhancing the user’s cognitive access. We describe a prototype system which implements this approach and exemplify its functionality with reference to a use case in which predictive modeling is paired with analytic gaming to support collaborative decision-making in the domain of agricultural land management.« less

Information Extraction Using Controlled English to Support Knowledge-Sharing and Decision-Making

DTIC Science & Technology

2012-06-01

or language variants. CE-based information extraction will greatly facilitate the processes in the cognitive and social domains that enable forces...terminology or language variants. CE-based information extraction will greatly facilitate the processes in the cognitive and social domains that...processor is run to turn the atomic CE into a more “ stylistically felicitous” CE, using techniques such as: aggregating all information about an entity

Knowledge sharing to facilitate regulatory decision-making in regard to alternatives to animal testing: Report of an EPAA workshop.

PubMed

Ramirez, Tzutzuy; Beken, Sonja; Chlebus, Magda; Ellis, Graham; Griesinger, Claudius; De Jonghe, Sandra; Manou, Irene; Mehling, Annette; Reisinger, Kerstin; Rossi, Laura H; van Benthem, Jan; van der Laan, Jan Willem; Weissenhorn, Renate; Sauer, Ursula G

2015-10-01

The European Partnership for Alternative Approaches to Animal Testing (EPAA) convened a workshop Knowledge sharing to facilitate regulatory decision-making. Fifty invited participants from the European Commission, national and European agencies and bodies, different industry sectors (chemicals, cosmetics, fragrances, pharmaceuticals, vaccines), and animal protection organizations attended the workshop. Four case studies exemplarily revealed which procedures are in place to obtain regulatory acceptance of new test methods in different sectors. Breakout groups discussed the status quo identifying the following facilitators for regulatory acceptance of alternatives to animal testing: Networking and communication (including cross-sector collaboration, international cooperation and harmonization); involvement of regulatory agencies from the initial stages of test method development on; certainty on prerequisites for test method acceptance including the establishment of specific criteria for regulatory acceptance. Data sharing and intellectual property issues affect many aspects of test method development, validation and regulatory acceptance. In principle, all activities should address replacement, reduction and refinement methods (albeit animal testing is generally prohibited in the cosmetics sector). Provision of financial resources and education support all activities aiming at facilitating the acceptance and use of alternatives to animal testing. Overall, workshop participants recommended building confidence in new methodologies by applying and gaining experience with them. Copyright © 2015 Elsevier Inc. All rights reserved.

Assessing Option Grid® practicability and feasibility for facilitating shared decision making: An exploratory study.

PubMed

Tsulukidze, Maka; Grande, Stuart W; Gionfriddo, Michael R

2015-07-01

To assess the feasibility of Option Grids(®)for facilitating shared decision making (SDM) in simulated clinical consultations and explore clinicians' views on their practicability. We used mixed methods approach to analyze clinical consultations using the Observer OPTION instrument and thematic analysis for follow-up interviews with clinicians. Clinicians achieved high scores on information sharing and low scores on preference elicitation and integration. Four themes were identified: (1) Barriers affect practicability of Option Grids(®); (2) Option Grids(®) facilitate the SDM process; (3) Clinicians are aware of the gaps in their practice of SDM; (4) Training and ongoing feedback on the optimal use of Option Grids(®) are necessary. Use of Option Grids(®) by clinicians with background knowledge in SDM did not facilitate optimal levels of competency on the SDM core concepts of preference elicitation and integration. Future research must evaluate the impact of training on the use of Option Grids(®), and explore how best to help clinicians bridge the gap between knowledge and action. Clinicians proficiently imparting information in simulations struggled to elicit and integrate patient preferences - understanding this gap and developing strategies to close it are the next steps for implementing SDM into clinical practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Structured decision making for managing pneumonia epizootics in bighorn sheep

USGS Publications Warehouse

Sells, Sarah N.; Mitchell, Michael S.; Edwards, Victoria L.; Gude, Justin A.; Anderson, Neil J.

2016-01-01

Good decision-making is essential to conserving wildlife populations. Although there may be multiple ways to address a problem, perfect solutions rarely exist. Managers are therefore tasked with identifying decisions that will best achieve desired outcomes. Structured decision making (SDM) is a method of decision analysis used to identify the most effective, efficient, and realistic decisions while accounting for values and priorities of the decision maker. The stepwise process includes identifying the management problem, defining objectives for solving the problem, developing alternative approaches to achieve the objectives, and formally evaluating which alternative is most likely to accomplish the objectives. The SDM process can be more effective than informal decision-making because it provides a transparent way to quantitatively evaluate decisions for addressing multiple management objectives while incorporating science, uncertainty, and risk tolerance. To illustrate the application of this process to a management need, we present an SDM-based decision tool developed to identify optimal decisions for proactively managing risk of pneumonia epizootics in bighorn sheep (Ovis canadensis) in Montana. Pneumonia epizootics are a major challenge for managers due to long-term impacts to herds, epistemic uncertainty in timing and location of future epizootics, and consequent difficulty knowing how or when to manage risk. The decision tool facilitates analysis of alternative decisions for how to manage herds based on predictions from a risk model, herd-specific objectives, and predicted costs and benefits of each alternative. Decision analyses for 2 example herds revealed that meeting management objectives necessitates specific approaches unique to each herd. The analyses showed how and under what circumstances the alternatives are optimal compared to other approaches and current management. Managers can be confident that these decisions are effective, efficient, and realistic because they explicitly account for important considerations managers implicitly weigh when making decisions, including competing management objectives, uncertainty in potential outcomes, and risk tolerance.

[Clinical bioethics for primary health care].

PubMed

González-de Paz, L

2013-01-01

The clinical decision making process with ethical implications in the area of primary healthcare differs from other healthcare areas. From the ethical perspective it is important to include these issues in the decision making model. This dissertation explains the need for a process of bioethical deliberation for Primary Healthcare, as well as proposing a method for doing so. The decision process method, adapted to this healthcare area, is flexible and requires a more participative Healthcare System. This proposal involves professionals and the patient population equally, is intended to facilitate the acquisition of responsibility for personal and community health. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

Helping pregnant teenagers.

PubMed Central

Bluestein, D; Starling, M E

1994-01-01

Teenagers who are pregnant face many difficult issues, and counseling by physicians can be an important source of help. We suggest guidelines for this counseling, beginning with a review of the scope and consequences of adolescent pregnancy. Communication strategies should be aimed at building rapport with techniques such as maintaining confidentiality, avoiding judgmental stances, and gearing communication to cognitive maturity. Techniques for exploring family relationships are useful because these relationships are key influences on subsequent decisions and behaviors. We discuss topics related to abortion and childbearing, such as safety, facilitation of balanced decision making, the use of prenatal care, and the formulation of long-term plans. Physicians who can effectively discuss these topics can help pregnant teenagers make informed decisions and improve their prospects for the future. PMID:7941531

UT Biomedical Informatics Lab (BMIL) probability wheel

NASA Astrophysics Data System (ADS)

Huang, Sheng-Cheng; Lee, Sara; Wang, Allen; Cantor, Scott B.; Sun, Clement; Fan, Kaili; Reece, Gregory P.; Kim, Min Soon; Markey, Mia K.

A probability wheel app is intended to facilitate communication between two people, an "investigator" and a "participant", about uncertainties inherent in decision-making. Traditionally, a probability wheel is a mechanical prop with two colored slices. A user adjusts the sizes of the slices to indicate the relative value of the probabilities assigned to them. A probability wheel can improve the adjustment process and attenuate the effect of anchoring bias when it is used to estimate or communicate probabilities of outcomes. The goal of this work was to develop a mobile application of the probability wheel that is portable, easily available, and more versatile. We provide a motivating example from medical decision-making, but the tool is widely applicable for researchers in the decision sciences.

KNOW ESSENTIALS: a tool for informed decisions in the absence of formal HTA systems.

PubMed

Mathew, Joseph L

2011-04-01

Most developing countries and resource-limited settings lack robust health technology assessment (HTA) systems. Because the development of locally relevant HTA is not immediately viable, and the extrapolation of external HTA is inappropriate, a new model for evaluating health technologies is required. The aim of this study was to describe the development and application of KNOW ESSENTIALS, a tool facilitating evidence-based decisions on health technologies by stakeholders in settings lacking formal HTA systems. Current HTA methodology was examined through literature search. Additional issues relevant to resource-limited settings, but not adequately addressed in current methodology, were identified through further literature search, appraisal of contextually relevant issues, discussion with healthcare professionals familiar with the local context, and personal experience. A set of thirteen elements important for evidence-based decisions was identified, selected and combined into a tool with the mnemonic KNOW ESSENTIALS. Detailed definitions for each element, coding for the elements, and a system to evaluate a given health technology using the tool were developed. Developing countries and resource-limited settings face several challenges to informed decision making. Models that are relevant and applicable in high-income countries are unlikely in such settings. KNOW ESSENTIALS is an alternative that facilitates evidence-based decision making by stakeholders without formal expertise in HTA. The tool could be particularly useful, as an interim measure, in healthcare systems that are developing HTA capacity. It could also be useful anywhere when rapid evidence-based decisions on health technologies are required.

Prognostic Factors and Decision Tree for Long-term Survival in Metastatic Uveal Melanoma.

PubMed

Lorenzo, Daniel; Ochoa, María; Piulats, Josep Maria; Gutiérrez, Cristina; Arias, Luis; Català, Jaum; Grau, María; Peñafiel, Judith; Cobos, Estefanía; Garcia-Bru, Pere; Rubio, Marcos Javier; Padrón-Pérez, Noel; Dias, Bruno; Pera, Joan; Caminal, Josep Maria

2017-12-04

The purpose of this study was to demonstrate the existence of a bimodal survival pattern in metastatic uveal melanoma. Secondary aims were to identify the characteristics and prognostic factors associated with long-term survival and to develop a clinical decision tree. The medical records of 99 metastatic uveal melanoma patients were retrospectively reviewed. Patients were classified as either short (≤ 12 months) or long-term survivors (> 12 months) based on a graphical interpretation of the survival curve after diagnosis of the first metastatic lesion. Ophthalmic and oncological characteristics were assessed in both groups. Of the 99 patients, 62 (62.6%) were classified as short-term survivors, and 37 (37.4%) as long-term survivors. The multivariate analysis identified the following predictors of long-term survival: age ≤ 65 years (p=0.012) and unaltered serum lactate dehydrogenase levels (p=0.018); additionally, the size (smaller vs. larger) of the largest liver metastasis showed a trend towards significance (p=0.063). Based on the variables significantly associated with long-term survival, we developed a decision tree to facilitate clinical decision-making. The findings of this study demonstrate the existence of a bimodal survival pattern in patients with metastatic uveal melanoma. The presence of certain clinical characteristics at diagnosis of distant disease is associated with long-term survival. A decision tree was developed to facilitate clinical decision-making and to counsel patients about the expected course of disease.

Can conservation contracts co-exist with change? Payment for ecosystem services in the context of adaptive decision-making and sustainability.

PubMed

Hayes, Tanya; Murtinho, Felipe; Cárdenas Camacho, Luis Mario; Crespo, Patricio; McHugh, Sarah; Salmerón, David

2015-01-01

This paper considers the ability of payment for ecosystem services (PES) programs to operate in the context of dynamic and complex social-ecological systems. Drawing on the experiences of two different PES programs in Latin America, we examine how PES institutions fit with the tenets of adaptive decision-making for sustainable resource management. We identify how the program goals and the connection to the market influence the incentive structure, information gathering, learning and feedback processes, and the structure of decision-making rights, specifically the ability to make and modify resource-use rules. Although limited in their generalizability, findings from the two case studies suggest a tension between the contractual model of PES and adaptive decision-making in natural resource systems. PES programs are not inherently decentralized, flexible management tools, as PES contracts tend to restrict decision-making rights and offer minimal flexibility mechanisms to change resource-use practices over the duration of the contract period. Furthermore, PES design and flexibility is heavily dependent on the goals and mission of the buyer and the respective market. If PES is to facilitate sustainable resource management, greater attention is needed to assess how the institutional design of the PES contracts influence the motivation and capacity of participants and program officers alike to adaptively manage the respective resource systems.

Can Conservation Contracts Co-exist with Change? Payment for Ecosystem Services in the Context of Adaptive Decision-Making and Sustainability

NASA Astrophysics Data System (ADS)

Hayes, Tanya; Murtinho, Felipe; Cárdenas Camacho, Luis Mario; Crespo, Patricio; McHugh, Sarah; Salmerón, David

2015-01-01

This paper considers the ability of payment for ecosystem services (PES) programs to operate in the context of dynamic and complex social-ecological systems. Drawing on the experiences of two different PES programs in Latin America, we examine how PES institutions fit with the tenets of adaptive decision-making for sustainable resource management. We identify how the program goals and the connection to the market influence the incentive structure, information gathering, learning and feedback processes, and the structure of decision-making rights, specifically the ability to make and modify resource-use rules. Although limited in their generalizability, findings from the two case studies suggest a tension between the contractual model of PES and adaptive decision-making in natural resource systems. PES programs are not inherently decentralized, flexible management tools, as PES contracts tend to restrict decision-making rights and offer minimal flexibility mechanisms to change resource-use practices over the duration of the contract period. Furthermore, PES design and flexibility is heavily dependent on the goals and mission of the buyer and the respective market. If PES is to facilitate sustainable resource management, greater attention is needed to assess how the institutional design of the PES contracts influence the motivation and capacity of participants and program officers alike to adaptively manage the respective resource systems.

An intelligent, knowledge-based multiple criteria decision making advisor for systems design

NASA Astrophysics Data System (ADS)

Li, Yongchang

In systems engineering, design and operation of systems are two main problems which always attract researcher's attentions. The accomplishment of activities in these problems often requires proper decisions to be made so that the desired goal can be achieved, thus, decision making needs to be carefully fulfilled in the design and operation of systems. Design is a decision making process which permeates through out the design process, and is at the core of all design activities. In modern aircraft design, more and more attention is paid to the conceptual and preliminary design phases so as to increase the odds of choosing a design that will ultimately be successful at the completion of the design process, therefore, decisions made during these early design stages play a critical role in determining the success of a design. Since aerospace systems are complex systems with interacting disciplines and technologies, the Decision Makers (DMs) dealing with such design problems are involved in balancing the multiple, potentially conflicting attributes/criteria, transforming a large amount of customer supplied guidelines into a solidly defined set of requirement definitions. Thus, one could state with confidence that modern aerospace system design is a Multiple Criteria Decision Making (MCDM) process. A variety of existing decision making methods are available to deal with this type of decision problems. The selection of the most appropriate decision making method is of particular importance since inappropriate decision methods are likely causes of misleading engineering design decisions. With no sufficient knowledge about each of the methods, it is usually difficult for the DMs to find an appropriate analytical model capable of solving their problems. In addition, with the complexity of the decision problem and the demand for more capable methods increasing, new decision making methods are emerging with time. These various methods exacerbate the difficulty of the selection of an appropriate decision making method. Furthermore, some DMs may be exclusively using one or two specific methods which they are familiar with or trust and not realizing that they may be inappropriate to handle certain classes of the problems, thus yielding erroneous results. These issues reveal that in order to ensure a good decision a suitable decision method should be chosen before the decision making process proceeds. The first part of this dissertation proposes an MCDM process supported by an intelligent, knowledge-based advisor system referred to as Multi-Criteria Interactive Decision-Making Advisor and Synthesis process (MIDAS), which is able to facilitate the selection of the most appropriate decision making method and which provides insight to the user for fulfilling different preferences. The second part of this dissertation presents an autonomous decision making advisor which is capable of dealing with ever-evolving real time information and making autonomous decisions under uncertain conditions. The advisor encompasses a Markov Decision Process (MDP) formulation which takes uncertainty into account when determines the best action for each system state. (Abstract shortened by UMI.)

Assessing Patient Participation in Health Policy Decision-Making in Cyprus

PubMed Central

Souliotis, Kyriakos; Agapidaki, Eirini; Peppou, Lily Evangelia; Tzavara, Chara; Samoutis, George; Theodorou, Mamas

2016-01-01

Although the importance of patient participation in the design and evaluation of health programs and services is well-documented, there is scarcity of research with regard to patient association (PA) participation in health policy decision-making processes. To this end, the present study aimed to validate further a previously developed instrument as well as to investigate the degree of PA participation in health policy decision-making in Cyprus. A convenient sample of 114 patients-members of patients associations took part in the study. Participants were recruited from an umbrella organization, the Pancyprian Federation of Patient Associations and Friends (PFPA). PA participation in health policy decision-making was assessed with the Health Democracy Index (HDI), an original 8-item tool. To explore its psychometric properties, Cronbach α was computed as regards to its internal consistency, while its convergent validity was tested against a self-rated question enquiring about the degree of PA participation in health policy decision-making. The findings revealed that the HDI has good internal consistency and convergent validity. Furthermore, PAs were found to participate more in consultations in health-related organizations and the Ministry of Health (MoH) as well as in reforms or crucial decisions in health policy. Lower levels were documented with regard to participation in hospital boards, ethics committees in clinical trials and health technology assessment (HTA) procedures. Overall, PA participation levels were found to be lower than the mid-point of the scale. Targeted interventions aiming to facilitate patients’ involvement in health policy decision-making processes and to increase its impact are greatly needed in Cyprus. PMID:27694659

Decision PBL: A 4-year retrospective case study of the use of virtual patients in problem-based learning.

PubMed

Ellaway, Rachel H; Poulton, Terry; Jivram, Trupti

2015-01-01

In 2009, St George's University of London (SGUL) replaced their paper-based problem-based learning (PBL) cases with virtual patients for intermediate-level undergraduate students. This involved the development of Decision-Problem-Based Learning (D-PBL), a variation on progressive-release PBL that uses virtual patients instead of paper cases, and focuses on patient management decisions and their consequences. Using a case study method, this paper describes four years of developing and running D-PBL at SGUL from individual activities up to the ways in which D-PBL functioned as an educational system. A number of broad issues were identified: the importance of debates and decision-making in making D-PBL activities engaging and rewarding; the complexities of managing small group dynamics; the time taken to complete D-PBL activities; the changing role of the facilitator; and the erosion of the D-PBL process over time. A key point in understanding this work is the construction and execution of the D-PBL activity, as much of the value of this approach arises from the actions and interactions of students, their facilitators and the virtual patients rather than from the design of the virtual patients alone. At a systems level D-PBL needs to be periodically refreshed to retain its effectiveness.

Interventions to support shared decision-making for women with heavy menstrual bleeding: A systematic review.

PubMed

Zandstra, D; Busser, J A S; Aarts, J W M; Nieboer, T E

2017-04-01

This review studies women's preferences for shared decision-making about heavy menstrual bleeding treatment and evaluates interventions that support shared decision-making and their effectiveness. PubMed, Cochrane, Embase, Medline and ClinicalTrials.gov were searched. Three research questions were predefined: 1) What is the range of perspectives gathered in studies that examine women facing a decision related to heavy menstrual bleeding management?; 2) What types of interventions have been developed to support shared decision-making for women experiencing heavy menstrual bleeding?; and 3) In what way might women benefit from interventions that support shared decision-making? All original studies were included if the study population consisted of women experiencing heavy menstrual bleeding. We used the TIDieR (Template for Intervention: Description and Replication) checklist to assess the quality of description and the reproducibility of interventions. Interventions were categorized using Grande et al. guidelines and collated and summarized outcomes measures into three categories: 1) patient-reported outcomes; 2) observer-reported outcomes; and 3) doctor-reported outcomes. Fifteen studies were included. Overall, patients preferred to decide together with their doctor (74%). Women's previsit preference was the strongest predictor for treatment choice in two studies. Information packages did not have a statistically significant effect on treatment choice or satisfaction. However, adding a structured interview or decision aid to increase patient involvement did show a positive effect on treatment choice and results, patient satisfaction and shared decision-making related outcomes. In conclusion shared decision-making is becoming more important in the care of women with heavy menstrual bleeding. Structured interviews or well-designed (computerized) tools such as decision aids seem to facilitate this process, but there is room for improvement. A shared treatment choice is only possible after careful provision of information, elicitation of patients' preferences and integrating those preferences. Interventions should be designed accordingly. Copyright © 2017 Elsevier B.V. All rights reserved.

SEA - Enhancing communication for better environmental decisions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vicente, Gustavo; Partidario, Maria R.

Over the years SEA has been subjected to several interpretations, often resulting from different views on democratic processes and social considerations in decision-making. More than strictly a technical tool, as in its original form, SEA has the potential to act as a mediating instrument, bridging problem perceptions with technical solutions, steering the assessment to facilitate the integration of environmental values into decision-making processes, influencing decision-makers' capacity of acceptance. This paper explores the potential of SEA to enhance communication between different stakeholders, enabling discussion and agreement independently of different beliefs, convictions, social roles, values, accumulated experiences, individual needs, or any othermore » factors, that express different world visions and determine the context within which decisions are taken. To face up to this challenge the authors suggest the establishment of communication strategies that enhance the role of SEA in the construction of social expectations and platforms of discussion, in the multiple negotiation processes that take place between stakeholders and decision-makers.« less

Communication and Decision Making in Cancer Care: Setting Research Priorities for Decision Support/Patients’ Decision Aids

PubMed Central

Barnato, Amber E.; Llewellyn-Thomas, Hilary A.; Peters, Ellen M.; Siminoff, Laura; Collins, E. Dale; Barry, Michael J.

2013-01-01

The following is a summary report from a special symposium, entitled “Translating Research into Practice: Setting a Research Agenda for Clinical Decision Tools in Cancer Prevention, Early Detection, and Treatment”, that was held on October 23, 2005 in San Francisco at the Annual Meeting of the Society for Medical Decision Making (SMDM). The symposium was designed to answer the question: “What are the top two research priorities in the field of patients’ cancer-related decision aids?” After introductory remarks by Dr. Barry, each of four panelists–Drs. Hilary Llewellyn-Thomas, Ellen Peters, Laura Siminoff, and Dale Collins–addressed the question and provided their rationale during prepared remarks. The moderator, Dr. Michael Barry, then facilitated a discussion between the panelists, with input from the audience, to further explore and add to the various proposed research questions. Finally, Dr. Amber Barnato conducted a simple vote count (see Table 1) to prioritize the panelists’ and the audience’s recommendations. PMID:17873249

The Interface of Clinical Decision-Making With Study Protocols for Knowledge Translation From a Walking Recovery Trial.

PubMed

Hershberg, Julie A; Rose, Dorian K; Tilson, Julie K; Brutsch, Bettina; Correa, Anita; Gallichio, Joann; McLeod, Molly; Moore, Craig; Wu, Sam; Duncan, Pamela W; Behrman, Andrea L

2017-01-01

Despite efforts to translate knowledge into clinical practice, barriers often arise in adapting the strict protocols of a randomized, controlled trial (RCT) to the individual patient. The Locomotor Experience Applied Post-Stroke (LEAPS) RCT demonstrated equal effectiveness of 2 intervention protocols for walking recovery poststroke; both protocols were more effective than usual care physical therapy. The purpose of this article was to provide knowledge-translation tools to facilitate implementation of the LEAPS RCT protocols into clinical practice. Participants from 2 of the trial's intervention arms: (1) early Locomotor Training Program (LTP) and (2) Home Exercise Program (HEP) were chosen for case presentation. The two cases illustrate how the protocols are used in synergy with individual patient presentations and clinical expertise. Decision algorithms and guidelines for progression represent the interface between implementation of an RCT standardized intervention protocol and clinical decision-making. In each case, the participant presents with a distinct clinical challenge that the therapist addresses by integrating the participant's unique presentation with the therapist's expertise while maintaining fidelity to the LEAPS protocol. Both participants progressed through an increasingly challenging intervention despite their own unique presentation. Decision algorithms and exercise progression for the LTP and HEP protocols facilitate translation of the RCT protocol to the real world of clinical practice. The two case examples to facilitate translation of the LEAPS RCT into clinical practice by enhancing understanding of the protocols, their progression, and their application to individual participants.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A147).

Facilitating informed choice in prenatal testing: how well are we doing?

PubMed

Marteau, T M; Dormandy, E

2001-01-01

There is a consensus that prenatal testing services need to provide the information and support necessary for women to make informed choices about prenatal testing. Informed choices are those based on relevant information that reflect the decision-maker's values. To date, most research has focused on the information provided to women deciding whether to undergo tests. This has highlighted the poor quality of information provided to many women. There is agreement on the need to provide information on three key aspects of any test: the condition for which testing is being offered, characteristics of the test, and the implications of testing. Very little research has been conducted on decisions after the diagnosis of a fetal abnormality and how information and emotional and decisional support are and should be provided. Research is now needed in four key areas: first, on the optimal ways of organizing services to facilitate choices that are not only based on relevant information, but also reflect the decision-maker's values; second, on the most effective ways of framing information needed for the different decisions involved in prenatal testing; third, on the most effective media in which to deliver information; and, fourth, to identify aspects of counseling that facilitate informed choices following diagnoses of fetal abnormality. If we value women's ability to make informed choices about prenatal tests as highly as we value reliable laboratory tests, evidence-based quality standards need to be developed for the information and support women are given at all stages of the process of prenatal testing.

Discussing Animal Rights and Animal Research in the Classroom.

ERIC Educational Resources Information Center

Herzog, Harold A.

1990-01-01

Reviews two prominent philosophical justifications for animal liberation and describes a simulation that facilitates class discussion of animal research issues. Students reported that the exercise increased their awareness of the issues and of the complexity of making ethical decisions. (DB)

Lay Consultations in Heart Failure Symptom Evaluation

PubMed Central

Reeder, Katherine M.; Sims, Jessica L.; Ercole, Patrick M.; Shetty, Shivan S.; Wallendorf, Michael

2017-01-01

Purpose Lay consultations can facilitate or impede healthcare. However, little is known about how lay consultations for symptom evaluation affect treatment decision-making. The purpose of this study was to explore the role of lay consultations in symptom evaluation prior to hospitalization among patients with heart failure. Methods Semi-structured interviews were conducted with 60 patients hospitalized for acute decompensated heart failure. Chi-square and Fisher’s exact tests, along with logistic regression were used to characterize lay consultations in this sample. Results A large proportion of patients engaged in lay consultations for symptom evaluation and decision-making before hospitalization. Lay consultants provided attributions and advice and helped make the decision to seek medical care. Men consulted more often with their spouse than women, while women more often consulted with adult children. Conclusions Findings have implications for optimizing heart failure self-management interventions, improving outcomes, and reducing hospital readmissions. PMID:29399657

Case-based ethics instruction: the influence of contextual and individual factors in case content on ethical decision-making.

PubMed

Bagdasarov, Zhanna; Thiel, Chase E; Johnson, James F; Connelly, Shane; Harkrider, Lauren N; Devenport, Lynn D; Mumford, Michael D

2013-09-01

Cases have been employed across multiple disciplines, including ethics education, as effective pedagogical tools. However, the benefit of case-based learning in the ethics domain varies across cases, suggesting that not all cases are equal in terms of pedagogical value. Indeed, case content appears to influence the extent to which cases promote learning and transfer. Consistent with this argument, the current study explored the influences of contextual and personal factors embedded in case content on ethical decision-making. Cases were manipulated to include a clear description of the social context and the goals of the characters involved. Results indicated that social context, specifically the description of an autonomy-supportive environment, facilitated execution of sense making processes and resulted in greater decision ethicality. Implications for designing optimal cases and case-based training programs are discussed.

An organizational intervention to influence evidence-informed decision making in home health nursing.

PubMed

Gifford, Wendy; Lefebre, Nancy; Davies, Barbara

2014-01-01

The aims of this study were to field test and evaluate a series of organizational strategies to promote evidence-informed decision making (EIDM) by nurse managers and clinical leaders in home healthcare. EIDM is central to delivering high-quality and effective healthcare. Barriers exist and organizational strategies are needed to support EIDM. Management and clinical leaders from 4 units participated in a 20-week organization-focused intervention. Preintervention (n = 32) and postintervention (n = 17) surveys and semistructured interviews (n = 15) were completed. Statistically significant increases were found on 4 of 31 survey items reflecting an increased organizational capacity for participants to acquire and apply research evidence in decision making. Support from designated facilitators with advanced skills in finding, appraising, and applying research was the highest rated intervention strategy. Results are useful to inform the development of organizational infrastructures to increase EIDM capacity in community-based healthcare organizations.

Experiences of randomization: interviews with patients and clinicians in the SPCG-IV trial.

PubMed

Bill-Axelson, Anna; Christensson, Anna; Carlsson, Marianne; Norlén, Bo Johan; Holmberg, Lars

2008-01-01

Recruitment of both patients and clinicians to randomized trials is difficult. Low participation carries the risk of terminating studies early and making them invalid owing to insufficient statistical power. This study investigated patients' and clinicians' experiences of randomization with the aim of facilitating trial participation in the future. This was a qualitative study using content analysis. Patients offered to participate in a randomized trial and randomizing clinicians were interviewed. Five participants, four non-participants and five randomizing clinicians were interviewed, 2-8 years from randomization. Clinicians used strategies in interaction with the patients to facilitate decision making. Patients' attitudes differed and experiences of relatives or friends were often stated as reasons for treatment preferences. Patients described that letting chance decide treatment was a difficult barrier to overcome for randomization. The clinicians used a number of different strategies perceived to make randomization more acceptable to their patients. The clinicians' own motivation for randomizing patients for trials depended on the medical relevance of the study question and the clinicians' major obstacle was to maintain equipoise over time. Regular meetings with the study group helped to maintain equipoise and motivation. To establish a good platform for randomization the clinician needs to know about the patient's treatment preferences and the patient's attitude concerning the role of the clinician to facilitate decision making. The strategies used by the clinicians were perceived as helpful and could be tested in an intervention study.

Is fear perception special? Evidence at the level of decision-making and subjective confidence.

PubMed

Koizumi, Ai; Mobbs, Dean; Lau, Hakwan

2016-11-01

Fearful faces are believed to be prioritized in visual perception. However, it is unclear whether the processing of low-level facial features alone can facilitate such prioritization or whether higher-level mechanisms also contribute. We examined potential biases for fearful face perception at the levels of perceptual decision-making and perceptual confidence. We controlled for lower-level visual processing capacity by titrating luminance contrasts of backward masks, and the emotional intensity of fearful, angry and happy faces. Under these conditions, participants showed liberal biases in perceiving a fearful face, in both detection and discrimination tasks. This effect was stronger among individuals with reduced density in dorsolateral prefrontal cortex, a region linked to perceptual decision-making. Moreover, participants reported higher confidence when they accurately perceived a fearful face, suggesting that fearful faces may have privileged access to consciousness. Together, the results suggest that mechanisms in the prefrontal cortex contribute to making fearful face perception special. © The Author (2016). Published by Oxford University Press.

DRUG EVALUATION AND DECISION MAKING IN CATALONIA: DEVELOPMENT AND VALIDATION OF A METHODOLOGICAL FRAMEWORK BASED ON MULTI-CRITERIA DECISION ANALYSIS (MCDA) FOR ORPHAN DRUGS.

PubMed

Gilabert-Perramon, Antoni; Torrent-Farnell, Josep; Catalan, Arancha; Prat, Alba; Fontanet, Manel; Puig-Peiró, Ruth; Merino-Montero, Sandra; Khoury, Hanane; Goetghebeur, Mireille M; Badia, Xavier

2017-01-01

The aim of this study was to adapt and assess the value of a Multi-Criteria Decision Analysis (MCDA) framework (EVIDEM) for the evaluation of Orphan drugs in Catalonia (Catalan Health Service). The standard evaluation and decision-making procedures of CatSalut were compared with the EVIDEM methodology and contents. The EVIDEM framework was adapted to the Catalan context, focusing on the evaluation of Orphan drugs (PASFTAC program), during a Workshop with sixteen PASFTAC members. The criteria weighting was done using two different techniques (nonhierarchical and hierarchical). Reliability was assessed by re-test. The EVIDEM framework and methodology was found useful and feasible for Orphan drugs evaluation and decision making in Catalonia. All the criteria considered for the development of the CatSalut Technical Reports and decision making were considered in the framework. Nevertheless, the framework could improve the reporting of some of these criteria (i.e., "unmet needs" or "nonmedical costs"). Some Contextual criteria were removed (i.e., "Mandate and scope of healthcare system", "Environmental impact") or adapted ("population priorities and access") for CatSalut purposes. Independently of the weighting technique considered, the most important evaluation criteria identified for orphan drugs were: "disease severity", "unmet needs" and "comparative effectiveness", while the "size of the population" had the lowest relevance for decision making. Test-retest analysis showed weight consistency among techniques, supporting reliability overtime. MCDA (EVIDEM framework) could be a useful tool to complement the current evaluation methods of CatSalut, contributing to standardization and pragmatism, providing a method to tackle ethical dilemmas and facilitating discussions related to decision making.

Participation in communication and decision-making: children and young people's experiences in a hospital setting.

PubMed

Coyne, Imelda; Gallagher, Pamela

2011-08-01

To explore hospitalised children and young people's experiences of participation in communication and decision-making. There is a growing recognition internationally that children and young people have a right to participate in matters that affect their lives. Although this has led to more support for children's participation in communication exchanges and decision-making in health care, there remains a lack of studies in this area. Qualitative. Data were obtained through a combination of focus groups and single interviews with participants aged 7-18 (n = 55), from three hospitals in Ireland. Children wanted to be included in communication exchanges but appeared to occupy a marginal role with discussions largely carried out between parents and health professionals. They wanted to participate in 'small' everyday decisions about their care and treatment but were constrained mainly by adults' actions. Although children want to be included in the decision-making process, some prefer to leave the more 'serious' decisions to parents and health professionals, whilst others prefer to share the decision. Children's preferences can vary; therefore, decision-making should be seen as being on a continuum rather than an 'all or nothing' basis. Health care professionals and parents appear to play a significant role on whether children's efforts to participate are facilitated and supported in the hospital setting. Clearly, some may have reservations/concerns about children's participation, which suggests the need for clear guidelines/policies that reflect all stakeholder views. Children should be supported in having their voices heard in matters that directly affect their lives. © 2011 Blackwell Publishing Ltd.

"Paying the price to get there": Motherhood and the dynamics of pregnancy deliberations among women with disabilities.

PubMed

LaPierre, Tracey A; Zimmerman, Mary K; Hall, Jean P

2017-07-01

Women with disabilities report fewer pregnancies than those without disabilities. To explore the range of factors involved in pregnancy decision-making among women with disabilities, and give insight into the decision making process. Data were obtained from 4 focus groups conducted with 22 women of child-bearing age, who had a chronic physical or mental health condition or disability that influenced their pregnancy decisions. Group transcripts were analyzed using conventional content analysis to identify the types of factors that influence pregnancy decisions and themes related to pregnancy decision-making. Most had a strong desire for motherhood, although there were varied decisions and some ambivalence over whether or not to attempt pregnancy. Decisions were influenced by an interplay of biomedical, social and personal factors that shaped assessments of three key areas of consideration: importance, feasibility, and costs of pregnancy/motherhood. It is not just the 'biomedical facts' of health conditions that are relevant, but rather the meaning attributed to these facts and how they are weighed in relation to other significant non-medical factors. By moving beyond the medical model of disability to recognize the importance of social and personal factors, and engaging in patient-centered communication, healthcare providers can facilitate pregnancy decision-making that is consistent with the values and preferences of women with disabilities and improve quality of care and support. In order to make motherhood a more viable option for women with disabilities, societal attitudes and a lack of role models for these women also need to be addressed. Copyright © 2017 Elsevier Inc. All rights reserved.

Caregivers’ perspectives on decision making about lung transplantation in cystic fibrosis

PubMed Central

Dellon, Elisabeth P.; Shores, Mitchell D.; Nelson, Katherine I.; Wolfe, Joanne; Noah, Terry L.; Hanson, Laura C.

2013-01-01

Context Lung transplantation extends survival for some patients with advanced cystic fibrosis, but it is complicated, has many potential risks, and its outcomes are difficult to predict. No standards exist for informed decision making about transplantation. Objective To assess decision making from the perspective of caregivers of patients who faced the transplant decision before dying of cystic fibrosis or transplant complications. Design Semistructured interviews with descriptive and qualitative content analysis. Participants Twenty-eight caregivers of patients with cystic fibrosis who received care at our center and died between 1996 and 2006. Results Of 28 patients who considered lung transplantation, 19 (68%) received transplants, 6 (21%) died while waiting for transplant, and 3 (11%) declined transplant. Three caregivers (11%) thought that the patient did not fully understand the reason for transplant referral. Five (18%) thought that the patient did not fully understand potential risks. Ten (36%) thought that alternatives were not fully understood. The only alternatives to transplant identified, progressive illness and the possibility of earlier death without transplant, were unacceptable to most. Thirteen caregivers (46%) reported that the patient thought that declining transplant was not an option. Caregivers described the decision as “easy” for 19 (68%), often expressing a sentiment of “do or die.” Those who described the decision as “easy” recalled fewer elements of informed decision making. Conclusions From caregivers’ reports, patients with cystic fibrosis may not fully understand risks of and alternatives to lung transplantation. Because a strong desire to prolong life necessitates honest communication about potential outcomes, interventions are needed to facilitate high-quality decision making. PMID:20050454

The Association of Patient Chronic Disease Burden and Self-Management Requirements With Shared Decision Making in Primary Care Visits

PubMed Central

Drum, Melinda; Cooper, Lisa A.

2014-01-01

Background: Shared decision making (SDM) is associated with positive health outcomes and may be particularly relevant for patients with chronic disease. Objectives: To investigate whether (1) patients with chronic diseases, particularly those requiring self-management, are more likely to engage in SDM behaviors than patients without chronic diseases and (2) patients with chronic diseases are more likely to have their physicians engage them in SDM. Design: A cross-sectional study of patients who were enrolled in a randomized controlled trial to improve patient–physician communication. Participants: Adult patients with hypertension at community health clinics in Baltimore, Maryland. Approach: We used multivariable regression models to examine the associations of the following predictor variables: (1) chronic disease burden and (2) diseases requiring self-management with the following outcome variables measuring SDM components: (1) patient information sharing, (2) patient decision making, and (3) physician SDM facilitation. Key Results: Patients with greater chronic disease burden and more diseases requiring self-management reported more information sharing (β = .07, P = .03 and β = .12, P = .046, respectively) and decision making (β = .06, P = .02 and β = .21, P < .001) as did patients who reported poor general health. Physician facilitation of SDM was not associated with chronic disease burden or with diseases requiring self-management but was associated with higher patient income. Conclusions: Patients with chronic diseases, particularly those requiring self-management, may be more likely to engage in SDM behaviors, but physicians may not be more likely to engage such patients in SDM. Targeting patients with chronic disease for SDM may improve health outcomes among the chronically ill, particularly among vulnerable patients (eg, minorities, low-income patients) who suffer disproportionately from such conditions. PMID:26640812

A Typology of Interprofessional Teamwork in Acute Geriatric Care: A Study in 55 units in Belgium.

PubMed

Piers, Ruth D; Versluys, Karen J J; Devoghel, Johan; Lambrecht, Sophie; Vyt, André; Van Den Noortgate, Nele J

2017-09-01

To explore the quality of interprofessional teamwork in acute geriatric care and to build a model of team types. Cross-sectional multicenter study. Acute geriatric units in Belgium. Team members of different professional backgrounds. Perceptions of interprofessional teamwork among team members of 55 acute geriatric units in Belgium were measured using a survey covering collaborative practice and experience, managerial coaching and open team culture, shared reflection and decision-making, patient files facilitating teamwork, members' belief in the power of teamwork, and members' comfort in reporting incidents. Cluster analysis was used to determine types of interprofessional teamwork. Professions and clusters were compared using analysis of variance. The overall response rate was 60%. Of the 890 respondents, 71% were nursing professionals, 20% other allied health professionals, 5% physicians, and 4% logistic and administrative staff. More than 70% of respondents scored highly on interprofessional teamwork competencies, consultation, experiences, meetings, management, and results. Fewer than 55% scored highly on items about shared reflection and decision-making, reporting incidents from a colleague, and patient files facilitating interprofessional teamwork. Nurses in this study rated shared reflection and decision-making lower than physicians on the same acute geriatric units (P < .001). Using the mean score on each of the six areas, four clusters that differed significantly in all areas were identified using hierarchical cluster analysis and scree plot analysis (P < .001). Interprofessional teamwork in acute geriatric units is satisfactory, but shared reflection and decision-making needs improvement. Four types of interprofessional teamwork are identified and can be used to benchmark the teamwork of individual teams. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Increasing public awareness and facilitating behavior change: Two guiding heuristics

NASA Astrophysics Data System (ADS)

Maibach, E.

2016-12-01

If there is a single aspiration that unifies the professionals who work on the challenges associated with global change, it is likely their desire to see policy makers, business managers and members of the public make decisions that are better informed by the realities of what we know about how to stabilize the climate and prevent needless harm to people and eco-systems. This calls an obvious question: What can we - as scientists and science organizations - to do more effectively promote evidence-based decision-making and actions by important decision-makers? In this talk I will distinguish between two related challenges: more effectively sharing what we know (i.e., improving our communication); and more effectively helping decision-makers take helpful actions (i.e., improving our efforts to facilitate behavior change). Drawing on both theory and empirical evidence in communication science, behavioral science and other related social sciences, I suggest two guiding heurstics - one for each of the two challenges - that will help scientists and science organizations improve the impact of their outreach efforts. To more effectively share what we know, we need "simple clear messages, repeated often, by a variety of trusted sources." To help people convert their good intentions into effective actions, we need to do more to "make the behaviors we are promoting easy, fun and popular." I refer to each of these as "heuristics" in the sense that they organize a relatively large amount of prescriptive information into a relatively easy to use method or process. In this talk, I will unpack each of these heurtistics with the aim of making them practical for all in attendance.

Policy analysis for deciding on a malaria vaccine RTS,S in Tanzania.

PubMed

Romore, Idda; Njau, Ritha J A; Semali, Innocent; Mwisongo, Aziza; Ba Nguz, Antoinette; Mshinda, Hassan; Tanner, Marcel; Abdulla, Salim

2016-03-08

Traditionally, it has taken decades to introduce new interventions in low-income countries. Several factors account for these delays, one of which is the absence of a framework to facilitate comprehensive understanding of policy process to inform policy makers and stimulate the decision-making process. In the case of the proposed introduction of malaria vaccines in Tanzania, a specific framework for decision-making will speed up the administrative process and shorten the time until the vaccine is made available to the target population. Qualitative research was used as a basis for developing the Policy Framework. Interviews were conducted with government officials, bilateral and multilateral partners and other stakeholders in Tanzania to assess malaria treatment policy changes and to draw lessons for malaria vaccine adoption. The decision-making process for adopting malaria interventions and new vaccines in general takes years, involving several processes: meetings and presentations of scientific data from different studies with consistent results, packaging and disseminating evidence and getting approval for use by the Ministry of Health and Social Welfare (MOHSW). It is influenced by contextual factors; Promoting factors include; epidemiological and intervention characteristics, country experiences of malaria treatment policy change, presentation and dissemination of evidence, coordination and harmonization of the process, use of international scientific evidence. Barriers factors includes; financial sustainability, competing health and other priorities, political will and bureaucratic procedures, costs related to the adoption and implementations of interventions, supply and distribution and professional compliance with anti-malarial drugs. The framework facilitates the synthesis of information in a coherent way, enabling a clearer understanding of the policy process, thereby speeding up the policy decision-making process and shortening the time for a malaria vaccine to become available.

The GRADE Evidence to Decision (EtD) framework for health system and public health decisions.

PubMed

Moberg, Jenny; Oxman, Andrew D; Rosenbaum, Sarah; Schünemann, Holger J; Guyatt, Gordon; Flottorp, Signe; Glenton, Claire; Lewin, Simon; Morelli, Angela; Rada, Gabriel; Alonso-Coello, Pablo

2018-05-29

To describe a framework for people making and using evidence-informed health system and public health recommendations and decisions. We developed the GRADE Evidence to Decision (EtD) framework for health system and public health decisions as part of the DECIDE project, in which we simultaneously developed frameworks for these and other types of healthcare decisions, including clinical recommendations, coverage decisions and decisions about diagnostic tests. Building on GRADE EtD tables, we used an iterative approach, including brainstorming, consultation of the literature and with stakeholders, and an international survey of policy-makers. We applied the framework to diverse examples, conducted workshops and user testing with health system and public health guideline developers and policy-makers, and observed and tested its use in real-life guideline panels. All the GRADE EtD frameworks share the same basic structure, including sections for formulating the question, making an assessment and drawing conclusions. Criteria listed in the assessment section of the health system and public health framework cover the important factors for making these types of decisions; in addition to the effects and economic impact of an option, the priority of the problem, the impact of the option on equity, and its acceptability and feasibility are important considerations that can inform both whether and how to implement an option. Because health system and public health interventions are often complex, detailed implementation considerations should be made when making a decision. The certainty of the evidence is often low or very low, but decision-makers must still act. Monitoring and evaluation are therefore often important considerations for these types of decisions. We illustrate the different components of the EtD framework for health system and public health decisions by presenting their application in a framework adapted from a real-life guideline. This framework provides a structured and transparent approach to support policy-making informed by the best available research evidence, while making the basis for decisions accessible to those whom they will affect. The health system and public health EtD framework can also be used to facilitate dissemination of recommendations and enable decision-makers to adopt, and adapt, recommendations or decisions.

An evidence-based shared decision making programme on the prevention of myocardial infarction in type 2 diabetes: protocol of a randomised-controlled trial.

PubMed

Buhse, Susanne; Heller, Tabitha; Kasper, Jürgen; Mühlhauser, Ingrid; Müller, Ulrich Alfons; Lehmann, Thomas; Lenz, Matthias

2013-10-19

Lack of patient involvement in decision making has been suggested as one reason for limited treatment success. Concepts such as shared decision making may contribute to high quality healthcare by supporting patients to make informed decisions together with their physicians.A multi-component shared decision making programme on the prevention of heart attack in type 2 diabetes has been developed. It aims at improving the quality of decision-making by providing evidence-based patient information, enhancing patients' knowledge, and supporting them to actively participate in decision-making. In this study the efficacy of the programme is evaluated in the setting of a diabetes clinic. A single blinded randomised-controlled trial is conducted to compare the shared decision making programme with a control-intervention. The intervention consists of an evidence-based patient decision aid on the prevention of myocardial infarction and a corresponding counselling module provided by diabetes educators. Similar in duration and structure, the control-intervention targets nutrition, sports, and stress coping. A total of 154 patients between 40 and 69 years of age with type 2 diabetes and no previous diagnosis of ischaemic heart disease or stroke are enrolled and allocated either to the intervention or the control-intervention. Primary outcome measure is the patients' knowledge on benefits and harms of heart attack prevention captured by a standardised knowledge test. Key secondary outcome measure is the achievement of treatment goals prioritised by the individual patient. Treatment goals refer to statin taking, HbA1c-, blood pressure levels and smoking status. Outcomes are assessed directly after the counselling and at 6 months follow-up. Analyses will be carried out on intention-to-treat basis. Concurrent qualitative methods are used to explore intervention fidelity and to gain insight into implementation processes. Interventions to facilitate evidence-based shared decision making represent an innovative approach in diabetes care. The results of this study will provide information on the efficacy of such a concept in the setting of a diabetes clinic in Germany. ISRCTN84636255.

Operating room managerial decision-making on the day of surgery with and without computer recommendations and status displays.

PubMed

Dexter, Franklin; Willemsen-Dunlap, Ann; Lee, John D

2007-08-01

There are three basic types of decision aids to facilitate operating room (OR) management decision-making on the day of surgery. Decision makers can rely on passive status displays (e.g., big screens or whiteboards), active status displays (e.g., text pager notification), and/or command displays (e.g., text recommendations about what to do). Anesthesiologists, OR nurses, and housekeepers were given nine simulated scenarios (vignettes) involving multiple ORs to study their decision-making. Participants were randomized to one of four groups, all with an updated paper OR schedule: with/without command display and with/without passive status display. Participants making decisions without command displays performed no better than random chance in terms of increasing the predictability of work hours, reducing over-utilized OR time, and increasing OR efficiency. Status displays had no effect on these end-points, whereas command displays improved the quality of decisions. In the scenarios for which the command displays provided recommendations that adversely affected safety, participants appropriately ignored advice. Anesthesia providers and nursing staff made decisions that increased clinical work per unit time in each OR, even when doing so resulted in an increase in over-utilized OR time, higher staffing costs, unpredictable work hours, and/or mandatory overtime. Organizational culture and socialization during clinical training may be a cause. Command displays showed promise in mitigating this tendency. Additional investigations are in our companion paper.

Situation awareness: when nurses decide to admit or not admit a person with mental illness as an involuntary patient.

PubMed

Patterson, Christopher; Procter, Nicholas; Toffoli, Luisa

2016-09-01

This paper will explore the application of situation awareness in nursing to determine its suitability as a framework to study how the decision to admit or not admit a person as an involuntary patient is made. The decision by a specially qualified nurse to admit or not admit a person to a mental health facility against their will remains a central component of contemporary mental health legislation. The decision has an impact on a person's autonomy and human rights. Conversely, the decision to admit may facilitate urgent assessment and treatment and ensure the safety of the individual and others. Research highlights that decision-making in this context is challenging due to the multiple information sources and often incomplete information available to the clinician. Situation awareness is a concept used to explain how practitioners identify, use and make meaning of a multitude of factors and elements relevant to their practice. Discussion paper. A search of terms related to situation awareness and mental health nursing was conducted in the period 2000 - present. Exploring nurses decision-making using a situation awareness framework provides for a more nuanced understanding of nurses knowledge and skill when deciding to admit or not a person as an involuntary patient. The concept of situation awareness provides a framework to better understand the decision-making process associated with the involuntary admission decision. © 2016 John Wiley & Sons Ltd.

The Voice of the Patient Methodology: A Novel Mixed-Methods Approach to Identifying Treatment Goals for Men with Prostate Cancer.

PubMed

Saigal, Christopher S; Lambrechts, Sylvia I; Seenu Srinivasan, V; Dahan, Ely

2017-06-01

Many guidelines advocate the use of shared decision making for men with newly diagnosed prostate cancer. Decision aids can facilitate the process of shared decision making. Implicit in this approach is the idea that physicians understand which elements of treatment matter to patients. Little formal work exists to guide physicians or developers of decision aids in identifying these attributes. We use a mixed-methods technique adapted from marketing science, the 'Voice of the Patient', to describe and identify treatment elements of value for men with localized prostate cancer. We conducted semi-structured interviews with 30 men treated for prostate cancer in the urology clinic of the West Los Angeles Veteran Affairs Medical Center. We used a qualitative analysis to generate themes in patient narratives, and a quantitative approach, agglomerative hierarchical clustering, to identify attributes of treatment that were most relevant to patients making decisions about prostate cancer. We identified five 'traditional' prostate cancer treatment attributes: sexual dysfunction, bowel problems, urinary problems, lifespan, and others' opinions. We further identified two novel treatment attributes: a treatment's ability to validate a sense of proactivity and the need for an incision (separate from risks of surgery). Application of a successful marketing technique, the 'Voice of the Customer', in a clinical setting elicits non-obvious attributes that highlight unique patient decision-making concerns. Use of this method in the development of decision aids may result in more effective decision support.

A functional MRI study on how oxytocin affects decision making in social dilemmas: Cooperate as long as it pays off, aggress only when you think you can win.

PubMed

Lambert, Bruno; Declerck, Carolyn H; Boone, Christophe; Parizel, Paul M

2017-08-01

We investigate if the neuropeptide oxytocin (OT), known to moderate social behaviour, influences strategic decision making in social dilemmas by facilitating the integration of incentives and social cues. Participants (N=29) played two economic games with different incentive structures in the fMRI scanner after receiving OT or placebo (following a double blind, within-subject design). Pictures of angry or neutral faces (the social cues) were displayed alongside the game matrices. Consistent with a priori hypotheses based on the modulatory role of OT in mesolimbic dopaminergic brain regions, the results indicate that, compared to placebo, OT significantly increases the activation of the nucleus accumbens during an assurance (coordination) game that rewards mutual cooperation. This increases appetitive motivation so that cooperative behaviour is facilitated for risk averse individuals. OT also significantly attenuates the amygdala, thereby reducing the orienting response to social cues. The corresponding change in behaviour is only apparent in the chicken (or anti-coordination) game, where aggression is incentivized but fatal if the partner also aggresses. Because of this ambiguity, decision making can be improved by additional information, and OT steers decisions in the chicken game in accordance with the valence of the facial cue: aggress when face is neutral; retreat when it is angry. Through its combined influence on amygdala and nucleus accumbens, OT improves the selection of a cooperative or aggressive strategy in function of the best match between the incentives of the game and the social cues present in the decision environment. Copyright © 2017 Elsevier Inc. All rights reserved.

Factors in Decisions to Make, Purchase, and Use On-board Safety Technologies

DOT National Transportation Integrated Search

2005-12-01

In support of its goal to reduce large truck-related fatalities and crashes, FMCSA plans to facilitate the deployment of Intelligent Vehicle Initiative (IVI) technologies that have shown a potential to improve the safety of commercial vehicle operati...

EPA'S REGIONAL VULNERABILITY ASSESSMENT PROGRAM: TOOLS TO FACILITATE REGIONAL TO LOCAL DECISION-MAKING

EPA Science Inventory

EPA's Regional Vulnerability Assessment (ReVA) program is developing and testing approaches to conducting comparative environmental risk assessments at the regional scale, considering impacts to ecological human, and fiscal health endpoints. It seeks an objective and quantifiable...

Health care decisionmaking by children. Is it in their best interest?

PubMed

Ross, L F

1997-01-01

The argument for children's rights in health care has been long in the making. The success of this position is reflected in the 1995 American Academy of Pediatrics recommendations for the role of children in health care decisionmaking, which suggest that children be given greater voice as they mature. But there are good moral and practical reasons for exercising caution in these health care situations, especially when the child and parents disagree. Parents need the moral and legal space within which to make decisions that will facilitate their child's long-term autonomy, not only her present-day autonomy. Moreover, third-party intrusion, by physicians or the state, should be resisted unless negligent and abusive decisions are in the making.

Use of cost-effectiveness data in priority setting decisions: experiences from the national guidelines for heart diseases in Sweden

PubMed Central

Eckard, Nathalie; Janzon, Magnus; Levin, Lars-Åke

2014-01-01

Background: The inclusion of cost-effectiveness data, as a basis for priority setting rankings, is a distinguishing feature in the formulation of the Swedish national guidelines. Guidelines are generated with the direct intent to influence health policy and support decisions about the efficient allocation of scarce healthcare resources. Certain medical conditions may be given higher priority rankings i.e. given more resources than others, depending on how serious the medical condition is. This study investigated how a decision-making group, the Priority Setting Group (PSG), used cost-effectiveness data in ranking priority setting decisions in the national guidelines for heart diseases. Methods: A qualitative case study methodology was used to explore the use of such data in ranking priority setting healthcare decisions. The study addressed availability of cost-effectiveness data, evidence understanding, interpretation difficulties, and the reliance on evidence. We were also interested in the explicit use of data in ranking decisions, especially in situations where economic arguments impacted the reasoning behind the decisions. Results: This study showed that cost-effectiveness data was an important and integrated part of the decision-making process. Involvement of a health economist and reliance on the data facilitated the use of cost-effectiveness data. Economic arguments were used both as a fine-tuning instrument and a counterweight for dichotomization. Cost-effectiveness data were used when the overall evidence base was weak and the decision-makers had trouble making decisions due to lack of clinical evidence and in times of uncertainty. Cost-effectiveness data were also used for decisions on the introduction of new expensive medical technologies. Conclusion: Cost-effectiveness data matters in decision-making processes and the results of this study could be applicable to other jurisdictions where health economics is implemented in decision-making. This study contributes to knowledge on how cost-effectiveness data is used in actual decision-making, to ensure that the decisions are offered on equal terms and that patients receive medical care according their needs in order achieve maximum benefit. PMID:25396208

A web-based multicriteria evaluation of spatial trade-offs between environmental and economic implications from hydraulic fracturing in a shale gas region in Ohio.

PubMed

Liu, X; Gorsevski, P V; Yacobucci, M M; Onasch, C M

2016-06-01

Planning of shale gas infrastructure and drilling sites for hydraulic fracturing has important spatial implications. The evaluation of conflicting and competing objectives requires an explicit consideration of multiple criteria as they have important environmental and economic implications. This study presents a web-based multicriteria spatial decision support system (SDSS) prototype with a flexible and user-friendly interface that could provide educational or decision-making capabilities with respect to hydraulic fracturing site selection in eastern Ohio. One of the main features of this SDSS is to emphasize potential trade-offs between important factors of environmental and economic ramifications from hydraulic fracturing activities using a weighted linear combination (WLC) method. In the prototype, the GIS-enabled analytical components allow spontaneous visualization of available alternatives on maps which provide value-added features for decision support processes and derivation of final decision maps. The SDSS prototype also facilitates nonexpert participation capabilities using a mapping module, decision-making tool, group decision module, and social media sharing tools. The logical flow of successively presented forms and standardized criteria maps is used to generate visualization of trade-off scenarios and alternative solutions tailored to individual user's preferences that are graphed for subsequent decision-making.

A dedicated software application for treatment verification with off-line PET/CT imaging at the Heidelberg Ion Beam Therapy Center

NASA Astrophysics Data System (ADS)

Chen, W.; Bauer, J.; Kurz, C.; Tessonnier, T.; Handrack, J.; Haberer, T.; Debus, J.; Parodi, K.

2017-01-01

We present the workflow of the offline-PET based range verification method used at the Heidelberg Ion Beam Therapy Center, detailing the functionalities of an in-house developed software application, SimInterface14, with which range analysis is performed. Moreover, we introduce the design of a decision support system assessing uncertainties and facilitating physicians in decisions making for plan adaptation.

Exchanging environmental information and decision making: developing the local Pilot Environmental Virtual Observatory with stakeholder communities

NASA Astrophysics Data System (ADS)

Mackay, E.; Beven, K.; Brewer, P.; M, Haygarth, P.; Macklin, M.; Marshall, K.; Quinn, P.; Stutter, M.; Thomas, N.; Wilkinson, M.

2012-04-01

Public participation in the development of flood risk management and river basin management plans are explicit components of both the Water Framework and Floods Directives. At the local level, involving communities in land and water management has been found to (i) aid better environmental decision making, (ii) enhance social, economic and environmental benefits, and (iii) increase a sense of ownership. Facilitating the access and exchange of information on the local environment is an important part of this new approach to the land and water management process, which also includes local community stakeholders in decisions about the design and content of the information provided. As part of the Natural Environment Research Council's pilot Environment Virtual Observatory (EVO), the Local Level group are engaging with local community stakeholders in three different catchments in the UK (the rivers Eden, Tarland and Dyfi) to start the process of developing prototype visualisation tools to address the specific land and water management issues identified in each area. Through this local collaboration, we will provide novel visualisation tools through which to communicate complex catchment science outcomes and bring together different sources of environmental data in ways that better meet end-user needs as well as facilitate a far broader participatory approach in environmental decision making. The Local Landscape Visualisation Tools are being evolved iteratively during the project to reflect the needs, interests and capabilities of a wide range of stakeholders. The tools will use the latest concepts and technologies to communicate with and provide opportunities for the provision and exchange of information between the public, government agencies and scientists. This local toolkit will reside within a wider EVO platform that will include national datasets, models and state of the art cloud computer systems. As such, local stakeholder groups are assisting the EVO's development and participating in local decision making alongside policy makers, government agencies and scientists.

The Elasticity of Preferences.

PubMed

Simon, Dan; Spiller, Stephen A

2016-12-01

We explore how preferences for attributes are constructed when people choose between multiattribute options. As found in prior research, we observed that while people make decisions, their preferences for the attributes in question shift to support the emerging choice, thus enabling confident decisions. The novelty of the studies reported here is that participants repeated the same task 6 to 8 weeks later. We found that between tasks, preferences returned to near their original levels, only to shift again to support the second choice, regardless of which choice participants made. Similar patterns were observed in a free-choice task (Study 1) and when the favorableness of options was manipulated (Study 2). It follows that preferences behave in an elastic manner: In the absence of situational pressures, they rest at baseline levels, but during the process of reaching a decision, they morph to support the chosen options. This elasticity appears to facilitate confident decision making in the face of decisional conflict.

The role of low-spatial frequencies in lexical decision and masked priming.

PubMed

Boden, C; Giaschi, D

2009-04-01

Spatial frequency filtering was used to test the hypotheses that low-spatial frequency information in printed text can: (1) lead to a rapid lexical decision or (2) facilitate word recognition. Adult proficient readers made lexical decisions in unprimed and masked repetition priming experiments with unfiltered, low-pass, high-pass and notch filtered letter strings. In the unprimed experiments, a filtered target was presented for 105 or 400 ms followed by a pattern mask. Sensitivity (d') was lowest for the low-pass filtered targets at both durations with a bias towards a 'non-word' response. Sensitivity was higher in the high-pass and notch filter conditions. In the priming experiments, a forward mask was followed by a filtered prime then an unfiltered target. Primed words, but not non-words, were identified faster than unprimed words in both the low-pass and high-pass filtered conditions. These results do not support a unique role for low-spatial frequency information in either facilitating or making rapid lexical decisions.

Implementation of a Nurse-Led Family Meeting in a Neuroscience Intensive Care Unit.

PubMed

Wu, Huixin; Ren, Dianxu; Zinsmeister, Glenn R; Zewe, Gretchen E; Tuite, Patricia K

2016-01-01

The aims of this study were to develop, implement, and evaluate the impact of early intensive care unit (ICU) nurse-led family meetings on nurse-family communication, family decision making, and satisfaction of family members. Intensive care unit nurses are in an ideal position to meet family needs, and family members may cope better with the crisis of an ICU admission if consistent honest information is provided by nurses; however, there are no early ICU family meetings led by bedside nurses. This quality improvement project was implemented in a 10-bed neuroscience ICU over a 3-month period. A convenience sample of 23 nurses participated in the project. Following development of a communication protocol to facilitate nurse-led meetings, the nurses received education and then implemented the protocol. Thirty-one family members participated in the project. Family members were surveyed before and after the meetings. Mean meeting time was 26 (SD, 14) minutes. Following implementation of the meetings, findings demonstrated that families felt that communication improved (P = .02 and P = .008), they had appropriate information for decision making allowing them to feel in control (P = .002), and there was an increase in family satisfaction (P = .001). Early ICU nurse-led family meetings were feasible, improved communication between ICU nurses and family members, facilitated decision making in ICU families, and increased satisfaction of family members.

Values and options in cancer care (VOICE): study design and rationale for a patient-centered communication and decision-making intervention for physicians, patients with advanced cancer, and their caregivers

PubMed Central

2013-01-01

Background Communication about prognosis and treatment choices is essential for informed decision making in advanced cancer. This article describes an investigation designed to facilitate communication and decision making among oncologists, patients with advanced cancer, and their caregivers. Methods/design The Values and Options in Cancer Care (VOICE) Study is a National Cancer Institute sponsored randomized controlled trial conducted in the Rochester/Buffalo, NY and Sacramento, CA regions. A total of 40 oncologists, approximately 400 patients with advanced cancer, and their family/friend caregivers (one per patient, when available) are expected to enroll in the study. Drawing upon ecological theory, the intervention uses a two-pronged approach: oncologists complete a multifaceted tailored educational intervention involving standardized patient instructors (SPIs), and patients and caregivers complete a coaching intervention to facilitate prioritizing and discussing questions and concerns. Follow-up data will be collected approximately quarterly for up to three years. Discussion The intervention is hypothesized to enhance patient-centered communication, quality of care, and patient outcomes. Analyses will examine the effects of the intervention on key elements of physician-patient-caregiver communication (primary outcomes), the physician-patient relationship, shared understanding of prognosis, patient well-being, and health service utilization (secondary outcomes). Trial registration Clinical Trials Identifier: NCT01485627 PMID:23570278

[Neural Mechanisms That Facilitate Adaptive Behavior Based on Acquired Stimulus-Outcome Information].

PubMed

Ogawa, Masaaki

2017-11-01

In response to changing internal and external situations, we always need to adapt our behavior based on previous experiences, particularly, acquired stimulus-outcome information. The orbitofrontal cortex (OFC), a prefrontal cortical region, is critical for this type of decision-making. The current understanding of the fundamental functions of the OFC has been reviewed by introducing, as an example, how the OFC contributes to the processing of uncertain rewards. Furthermore, the importance of revealing context and temporally specific causal roles of neural circuits including the OFC in decision-making, as well as the techniques to achieve the goal, have been discussed.

Addressing Barriers to Shared Decision Making Among Latino LGBTQ Patients and Healthcare Providers in Clinical Settings.

PubMed

Baig, Arshiya A; Lopez, Fanny Y; DeMeester, Rachel H; Jia, Justin L; Peek, Monica E; Vela, Monica B

2016-10-01

Effective shared decision making (SDM) between patients and healthcare providers has been positively associated with health outcomes. However, little is known about the SDM process between Latino patients who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ), and their healthcare providers. Our review of the literature identified unique aspects of Latino LGBTQ persons' culture, health beliefs, and experiences that may affect their ability to engage in SDM with their healthcare providers. Further research needs to examine Latino LGBTQ patient-provider experiences with SDM and develop tools that can better facilitate SDM in this patient population.

Addressing Barriers to Shared Decision Making Among Latino LGBTQ Patients and Healthcare Providers in Clinical Settings

PubMed Central

Lopez, Fanny Y.; DeMeester, Rachel H.; Jia, Justin L.; Peek, Monica E.; Vela, Monica B.

2016-01-01

Abstract Effective shared decision making (SDM) between patients and healthcare providers has been positively associated with health outcomes. However, little is known about the SDM process between Latino patients who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ), and their healthcare providers. Our review of the literature identified unique aspects of Latino LGBTQ persons’ culture, health beliefs, and experiences that may affect their ability to engage in SDM with their healthcare providers. Further research needs to examine Latino LGBTQ patient–provider experiences with SDM and develop tools that can better facilitate SDM in this patient population. PMID:27617356

Implementing information technology to improve workplace health: a web-based information needs assessment of managers in Fraser Health, British Columbia.

PubMed

Sandhu, Jag S; Anderson, Keith; Keen, Dave; Yassi, Annalee

2005-01-01

A web-based questionnaire-survey was administered primarily to determine what information is useful to managers in Fraser Health, of British Columbia to support decision-making for workplace health and safety. The results indicated that managers prefer electronic quarterly reports, with targets, goals, and historical trends rated as "very important." Over 85.7% "agree" that if information was readily available in the "most beneficial" format, they would be able to improve workplace health. Recommendations include that managers be presented with clear and concise workplace health reports that facilitate analysis for decision-making.

Patients Should Define Value in Health Care: A Conceptual Framework.

PubMed

Kamal, Robin N; Lindsay, Sarah E; Eppler, Sara L

2018-05-10

The main tenet of value-based health care is delivering high-quality care that is centered on the patient, improving health, and minimizing cost. Collaborative decision-making frameworks have been developed to help facilitate delivering care based on patient preferences (patient-centered care). The current value-based health care model, however, focuses on improving population health and overlooks the individuality of patients and their preferences for care. We highlight the importance of eliciting patient preferences in collaborative decision making and describe a conceptual framework that incorporates individual patients' preferences when defining value. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Risk assessment as standard work in design.

PubMed

Morrill, Patricia W

2013-01-01

This case study article examines a formal risk assessment as part of the decision making process for design solutions in high risk areas. The overview of the Failure Modes and Effects Analysis (FMEA) tool with examples of its application in hospital building projects will demonstrate the benefit of those structured conversations. This article illustrates how two hospitals used FMEA when integrating operational processes with building projects: (1) adjacency decision for Intensive Care Unit (ICU); and (2) distance concern for handling of specimens from Surgery to Lab. Both case studies involved interviews that exposed facility solution concerns. Just-in-time studies using the FMEA followed the same risk assessment process with the same workshop facilitator involving structured conversations in analyzing risks. In both cases, participants uncovered key areas of risk enabling them to take the necessary next steps. While the focus of this article is not the actual design solution, it is apparent that the risk assessment brought clarity to the situations resulting in prompt decision making about facility solutions. Hospitals are inherently risky environments; therefore, use of the formal risk assessment process, FMEA, is an opportunity for design professionals to apply more rigor to design decision making when facility solutions impact operations in high risk areas. Case study, decision making, hospital, infection control, strategy, work environment.

Collaborative Visual Analytics: A Health Analytics Approach to Injury Prevention

PubMed Central

Fisher, Brian; Smith, Jennifer; Pike, Ian

2017-01-01

Background: Accurate understanding of complex health data is critical in order to deal with wicked health problems and make timely decisions. Wicked problems refer to ill-structured and dynamic problems that combine multidimensional elements, which often preclude the conventional problem solving approach. This pilot study introduces visual analytics (VA) methods to multi-stakeholder decision-making sessions about child injury prevention; Methods: Inspired by the Delphi method, we introduced a novel methodology—group analytics (GA). GA was pilot-tested to evaluate the impact of collaborative visual analytics on facilitating problem solving and supporting decision-making. We conducted two GA sessions. Collected data included stakeholders’ observations, audio and video recordings, questionnaires, and follow up interviews. The GA sessions were analyzed using the Joint Activity Theory protocol analysis methods; Results: The GA methodology triggered the emergence of ‘common ground’ among stakeholders. This common ground evolved throughout the sessions to enhance stakeholders’ verbal and non-verbal communication, as well as coordination of joint activities and ultimately collaboration on problem solving and decision-making; Conclusions: Understanding complex health data is necessary for informed decisions. Equally important, in this case, is the use of the group analytics methodology to achieve ‘common ground’ among diverse stakeholders about health data and their implications. PMID:28895928

Decentralised water systems: emotional influences on resource decision making.

PubMed

Mankad, Aditi

2012-09-01

The study of emotion has gathered momentum in the field of environmental science, specifically in the context of community resource decision-making. Of particular interest in this review is the potential influence of emotion, risk and threat perception on individuals' decisions to acceptance and adopt decentralised water systems, such as rainwater tanks and greywater systems. The role of message framing is also considered in detail, as well as the influences that different types of framing can have on decision making. These factors are considered as possible predictors for analysing community acceptance of decentralised water in urban environments. Concepts believed to be influenced by emotion, such as trust and framing, are also discussed as potentially meaningful contributors to an overall model of community acceptance of decentralised water. Recommendations are made for how emotion-based concepts, such as risk and threat, can be targeted to facilitate widespread adoption of decentralised systems and how researchers can explore different types of emotions that influence decision making in distinct ways. This review is an important theoretical step in advancing the psycho-social understanding of acceptance and adoption of on-site water sources. Avenues for future research are recommended, including the need for greater theoretical development to encourage future social science research on decentralised systems. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

Collaborative Visual Analytics: A Health Analytics Approach to Injury Prevention.

PubMed

Al-Hajj, Samar; Fisher, Brian; Smith, Jennifer; Pike, Ian

2017-09-12

Background : Accurate understanding of complex health data is critical in order to deal with wicked health problems and make timely decisions. Wicked problems refer to ill-structured and dynamic problems that combine multidimensional elements, which often preclude the conventional problem solving approach. This pilot study introduces visual analytics (VA) methods to multi-stakeholder decision-making sessions about child injury prevention; Methods : Inspired by the Delphi method, we introduced a novel methodology-group analytics (GA). GA was pilot-tested to evaluate the impact of collaborative visual analytics on facilitating problem solving and supporting decision-making. We conducted two GA sessions. Collected data included stakeholders' observations, audio and video recordings, questionnaires, and follow up interviews. The GA sessions were analyzed using the Joint Activity Theory protocol analysis methods; Results : The GA methodology triggered the emergence of ' common g round ' among stakeholders. This common ground evolved throughout the sessions to enhance stakeholders' verbal and non-verbal communication, as well as coordination of joint activities and ultimately collaboration on problem solving and decision-making; Conclusion s : Understanding complex health data is necessary for informed decisions. Equally important, in this case, is the use of the group analytics methodology to achieve ' common ground' among diverse stakeholders about health data and their implications.

A framework for considering externalities in urban water asset management.

PubMed

Marlow, David; Pearson, Leonie; Macdonald, Darla Hatton; Whitten, Stuart; Burn, Stewart

2011-01-01

Urban communities rely on a complex network of infrastructure assets to connect them to water resources. There is considerable capital investment required to maintain, upgrade and extend this infrastructure. As the remit of a water utility is broader than just financial considerations, infrastructure investment decisions must be made in light of environmental and societal issues. One way of facilitating this is to integrate consideration of externalities into decision making processes. This paper considers the concept of externalities from an asset management perspective. A case study is provided to show the practical implications to a water utility and asset managers. A framework for the inclusion of externalities in asset management decision making is also presented. The potential for application of the framework is highlighted through a brief consideration of its key elements.

Strategies for distributing cancer screening decision aids in primary care.

PubMed

Brackett, Charles; Kearing, Stephen; Cochran, Nan; Tosteson, Anna N A; Blair Brooks, W

2010-02-01

Decision aids (DAs) have been shown to facilitate shared decision making about cancer screening. However, little data exist on optimal strategies for dissemination. Our objective was to compare different decision aid distribution models. Eligible patients received video decision aids for prostate cancer (PSA) or colon cancer screening (CRC) through 4 distribution methods. Outcome measures included DA loans (N), % of eligible patients receiving DA, and patient and provider satisfaction. Automatically mailing DAs to all age/gender appropriate patients led to near universal receipt by screening-eligible patients, but also led to ineligible patients receiving DAs. Three different elective (non-automatic) strategies led to low rates of receipt. Clinician satisfaction was higher when patients viewed the DA before the visit, and this model facilitated implementation of the screening choice. Regardless of timing or distribution method, patient satisfaction was high. An automatic DA distribution method is more effective than relying on individual initiative. Enabling patients to view the DA before the visit is preferred. Systematically offering DAs to all eligible patients before their appointments is the ideal strategy, but may be challenging to implement. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

Cancer patient decision making related to clinical trial participation: an integrative review with implications for patients' relational autonomy.

PubMed

Bell, Jennifer A H; Balneaves, Lynda G

2015-04-01

Oncology clinical trials are necessary for the improvement of patient care as they have the ability to confirm the efficacy and safety of novel cancer treatments and in so doing, contribute to a solid evidence base on which practitioners and patients can make informed treatment decisions. However, only 3-5 % of adult cancer patients enroll in clinical trials. Lack of participation compromises the success of clinical trials and squanders an opportunity for improving patient outcomes. This literature review summarizes the factors and contexts that influence cancer patient decision making related to clinical trial participation. An integrative review was undertaken within PubMed, CINAHL, and EMBASE databases for articles written between 1995 and 2012 and archived under relevant keywords. Articles selected were data-based, written in English, and limited to adult cancer patients. In the 51 articles reviewed, three main types of factors were identified that influence cancer patients' decision making about participation in clinical trials: personal, social, and system factors. Subthemes included patients' trust in their physician and the research process, undue influence within the patient-physician relationship, and systemic social inequalities. How these factors interact and influence patients' decision-making process and relational autonomy, however, is insufficiently understood. Future research is needed to further elucidate the sociopolitical barriers and facilitators of clinical trial participation and to enhance ethical practice within clinical trial enrolment. This research will inform targeted education and support interventions to foster patients' relational autonomy in the decision-making process and potentially improve clinical trial participation rates.

Factors affecting vasectomy acceptability in Tanzania.

PubMed

Bunce, Arwen; Guest, Greg; Searing, Hannah; Frajzyngier, Veronica; Riwa, Peter; Kanama, Joseph; Achwal, Isaac

2007-03-01

Calls for increased inclusion of men in matters of reproductive health emphasize the need for research into vasectomy acceptability and decision making. Vasectomy is a safe, simple and effective method of contraception, but is underused worldwide. Focus group discussions and in-depth interviews were conducted with potential and actual sterilization clients and their partners in the Kigoma Region of Tanzania. Content analysis was used to search for emergent themes related to vasectomy decision making. Six themes emerged as overarching factors contributing to the vasectomy decision-making process: economics, spousal influence, religion, provider reputation and availability, uncertainty about the future, and poor vasectomy knowledge and understanding. There was substantial communication between partners regarding the vasectomy decision, and wives had a strong influence on the outcome; however, men and women agreed that husbands would resist vasectomy if wives initially raised the topic. Vasectomy acceptance is limited by the scarcity of skilled vasectomy providers and by the fact that men and women hold many of the same misunderstandings about vasectomy, including a fear of decreased sexual performance as a result of the procedure. Spousal discussions are important in the decision to get a vasectomy, but these discussions should be initiated by the male partner. Programs need to educate men about contraceptive options, including vasectomies. Detailed, culturally relevant knowledge of the barriers and facilitators individuals experience during their decision- making process will enable vasectomy promotion programs to more successfully target appropriate populations.

Physical mechanism of mind changes and tradeoffs among speed, accuracy, and energy cost in brain decision making: Landscape, flux, and path perspectives

NASA Astrophysics Data System (ADS)

Han, Yan; Kun, Zhang; Jin, Wang

2016-07-01

Cognitive behaviors are determined by underlying neural networks. Many brain functions, such as learning and memory, have been successfully described by attractor dynamics. For decision making in the brain, a quantitative description of global attractor landscapes has not yet been completely given. Here, we developed a theoretical framework to quantify the landscape associated with the steady state probability distributions and associated steady state curl flux, measuring the degree of non-equilibrium through the degree of detailed balance breaking for decision making. We quantified the decision-making processes with optimal paths from the undecided attractor states to the decided attractor states, which are identified as basins of attractions, on the landscape. Both landscape and flux determine the kinetic paths and speed. The kinetics and global stability of decision making are explored by quantifying the landscape topography through the barrier heights and the mean first passage time. Our theoretical predictions are in agreement with experimental observations: more errors occur under time pressure. We quantitatively explored two mechanisms of the speed-accuracy tradeoff with speed emphasis and further uncovered the tradeoffs among speed, accuracy, and energy cost. Our results imply that there is an optimal balance among speed, accuracy, and the energy cost in decision making. We uncovered the possible mechanisms of changes of mind and how mind changes improve performance in decision processes. Our landscape approach can help facilitate an understanding of the underlying physical mechanisms of cognitive processes and identify the key factors in the corresponding neural networks. Project supported by the National Natural Science Foundation of China (Grant Nos. 21190040, 91430217, and 11305176).

Fostering Synergies Among Organizations to put Climate in Context for Use in Decision Making

NASA Astrophysics Data System (ADS)

Garfin, G. M.; Parris, A.; Dow, K.; Meyer, R.; Close, S.

2016-12-01

Making science usable for decision making requires a knowledge of the social and institutional contexts of decision making, an ability to develop or tap into networks for sharing information and developing knowledge, a capacity for innovating or providing services, and a program for social learning to inform decisions and improve the processes of engagement and collaboration (i.e., mechanisms for feedback, evaluation, and changes in policy or practices). Active participation by and partnerships between researchers, practitioners, and decision-makers provides a foundation for making progress in each of the aforementioned areas of endeavor. In twenty years of incubating experimental climate services, the NOAA Regional Integrated Sciences and Assessments program offers not a few ideas and examples of practices to foster synergies among organizations, that result in tangible benefits to decision-makers. Strategies include (a) designing explicit mutual learning through temporary institutions, such as workshop series, in order to develop social capital and knowledge networks (e.g., to co-develop and disseminate experimental forecasts); (b) articulating ground rules, roles, and responsibilities in managing the boundary between scientists and practitioners (e.g., in multi-partner climate adaptation planning processes); and (c) cross-training between scientists and practitioners, by embedding team members in other organizations or recruiting members from those organizations (e.g., Cooperative Extension). A promising strategy is boundary chaining, pioneered by the Great Lakes Integrated Sciences and Assessments, in which science information and service providers partner with other boundary organizations, to leverage networks, expertise, resources, and to reduce transaction costs. Partners with complementary strengths and roles can then, work iteratively and synergize to mediate the co-production of a combination of services for decision making, such as data and information, facilitation, and evaluation.

Smart strategies for doctors and doctors-in-training: heuristics in medicine.

PubMed

Wegwarth, Odette; Gaissmaier, Wolfgang; Gigerenzer, Gerd

2009-08-01

How do doctors make sound decisions when confronted with probabilistic data, time pressures and a heavy workload? One theory that has been embraced by many researchers is based on optimisation, which emphasises the need to integrate all information in order to arrive at sound decisions. This notion makes heuristics, which use less than complete information, appear as second-best strategies. In this article, we challenge this pessimistic view of heuristics. We introduce two medical problems that involve decision making to the reader: one concerns coronary care issues and the other macrolide prescriptions. In both settings, decision-making tools grounded in the principles of optimisation and heuristics, respectively, have been developed to assist doctors in making decisions. We explain the structure of each of these tools and compare their performance in terms of their facilitation of correct predictions. For decisions concerning both the coronary care unit and the prescribing of macrolides, we demonstrate that sacrificing information does not necessarily imply a forfeiting of predictive accuracy, but can sometimes even lead to better decisions. Subsequently, we discuss common misconceptions about heuristics and explain when and why ignoring parts of the available information can lead to the making of more robust predictions. Heuristics are neither good nor bad per se, but, if applied in situations to which they have been adapted, can be helpful companions for doctors and doctors-in-training. This, however, requires that heuristics in medicine be openly discussed, criticised, refined and then taught to doctors-in-training rather than being simply dismissed as harmful or irrelevant. A more uniform use of explicit and accepted heuristics has the potential to reduce variations in diagnoses and to improve medical care for patients.

Assessing Patient Participation in Health Policy Decision-Making in Cyprus.

PubMed

Souliotis, Kyriakos; Agapidaki, Eirini; Peppou, Lily Evangelia; Tzavara, Chara; Samoutis, George; Theodorou, Mamas

2016-06-20

Although the importance of patient participation in the design and evaluation of health programs and services is well-documented, there is scarcity of research with regard to patient association (PA) participation in health policy decision-making processes. To this end, the present study aimed to validate further a previously developed instrument as well as to investigate the degree of PA participation in health policy decision-making in Cyprus. A convenient sample of 114 patients-members of patients associations took part in the study. Participants were recruited from an umbrella organization, the Pancyprian Federation of Patient Associations and Friends (PFPA). PA participation in health policy decision-making was assessed with the Health Democracy Index (HDI), an original 8-item tool. To explore its psychometric properties, Cronbach α was computed as regards to its internal consistency, while its convergent validity was tested against a self-rated question enquiring about the degree of PA participation in health policy decision-making. The findings revealed that the HDI has good internal consistency and convergent validity. Furthermore, PAs were found to participate more in consultations in health-related organizations and the Ministry of Health (MoH) as well as in reforms or crucial decisions in health policy. Lower levels were documented with regard to participation in hospital boards, ethics committees in clinical trials and health technology assessment (HTA) procedures. Overall, PA participation levels were found to be lower than the mid-point of the scale. Targeted interventions aiming to facilitate patients' involvement in health policy decision-making processes and to increase its impact are greatly needed in Cyprus. © 2016 by Kerman University of Medical Sciences.

The missing link: Creating science policies that facilitate the use of research in environmental and water-related decision-making

NASA Astrophysics Data System (ADS)

Dilling, L.; Pielke, R.; Sarewitz, D.

2005-12-01

Despite all good intentions, it is clear that science intended to serve decision making needs often fails to achieve that purpose. The aftermath of Hurricane Katrina provides a recent, tragic example. The reasons for failures of science to support decision making are varied. Researchers studying forecasts of climate variability have found, for example, cases where information provided is not needed; information is needed but not provided; information lacks regional specificity; information is provided in an inaccessible form; poor communication exists between potential users and providers; there is a lack of trust in information or deliverers; institutional constraints prevent use of new information; and so on. Traditional science policies have institutionalized the separation of the conduct of science from its application and use. It is clear that as long as such a separation, reinforced by tradition, institution and culture, is the dominant paradigm of science policies, the efficient and effective use of science in environmental and water-related decision making will be hampered. We introduce here a research methodology for examining the decision making involved in setting science policies for research aimed at being useful. Based on the economic concept, the notion of "reconciling supply and demand" for information offers a framework for identifying missed opportunities where science policies can be adjusted to improve the usefulness of a given research portfolio. We present results from a case study focused on internal science policies and decision making within the Regional Integrated Sciences and Assessments (RISA) projects. The RISA program aims to "expand the range of choices available to private and public communities in a region, by...enabling practical decisions...using research-based knowledge" and so provides an excellent opportunity for harvesting lessons for creating usable science.

Cognitive Structures in Vocational Information Processing and Decision Making.

ERIC Educational Resources Information Center

Nevill, Dorothy D.; And Others

1986-01-01

Tested the assumptions that the structural features of vocational schemas affect vocational information processing and career self-efficacy. Results indicated that effective vocational information processing was facilitated by well-integrated systems that processed information along fewer dimensions. The importance of schematic organization on the…

Aboveboard

ERIC Educational Resources Information Center

Pisch, Frank S.

2013-01-01

Being a good board member is a tough responsibility these days. Boards are under increased scrutiny in the wake of recent events regarding inappropriate oversight. Organizations send board members an ever expanding volume of material to facilitate informed decision-making. There's mounting pressure for governing boards to be strong and effective.…

75 FR 9475 - Notice and Request for Comments

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-02

... designations change. The Board uses this information to facilitate reasoned decision making. In addition, this... Regulatory Affairs, Attention: Chandana Achanta, Surface Transportation Board Desk Officer, by fax at (202... Proceedings. OMB Control Number: 2140-0008. Form Number: None. Type of Review: Extension without change...

WWW.LCACCESS -- GLOBAL DIRECTORY OF LCI RESOURCES

EPA Science Inventory

LCAccess is a USEPA sponsored web-site intended to promote the use of Life Cycle Assessments in business decision-making by facilitating access to data sources useful in developing a life cycle inventory (LCI). While LCAccess will not itself contain data, it will be a searchable...

An Exploratory Study of Marketing International Education Online.

ERIC Educational Resources Information Center

Gomes, Liza; Murphy, Jamie

2003-01-01

Investigated from two perspectives the Internet's role in communicating educational opportunities: students' Internet use to facilitate information search and decision making, and educational institutions' e-business adoption and implementation. Two surveys of international students and face-to-face interviews with marketing executives from nine…

Creating Business Intelligence from Course Management Systems

ERIC Educational Resources Information Center

van Dyk, Liezl; Conradie, Pieter

2007-01-01

Purpose: This article seeks to address the interface between individual learning facilitators that use course management systems (CMS) data to support decision-making and course design and institutional infrastructure providers that are responsible for institutional business intelligence. Design/methodology/approach: The design of a data warehouse…

A qualitative systematic review of internal and external influences on shared decision-making in all health care settings.

PubMed

Truglio-Londrigan, Marie; Slyer, Jason T; Singleton, Joanne K; Worral, Priscilla

The objective of this review is to identify and synthesize the best available evidence related to the meaningfulness of internal and external influences on shared-decision making for adult patients and health care providers in all health care settings.The specific questions to be answered are: BACKGROUND: Patient-centered care is emphasized in today's healthcare arena. This emphasis is seen in the works of the International Alliance of Patients' Organizations (IAOP) who describe patient-centered healthcare as care that is aimed at addressing the needs and preferences of patients. The IAOP presents five principles which are foundational to the achievement of patient-centered healthcare: respect, choice, policy, access and support, as well as information. These five principles are further described as:Within the description of these five principles the idea of shared decision-making is clearly evident.The concept of shared decision-making began to appear in the literature in the 1990s. It is defined as a "process jointly shared by patients and their health care provider. It aims at helping patients play an active role in decisions concerning their health, which is the ultimate goal of patient-centered care." The details of the shared decision-making process are complex and consist of a series of steps including:Three overall representative decision-making models are noted in contemporary literature. These three models include: paternalistic, informed decision-making, and shared decision-making. The paternalistic model is an autocratic style of decision-making where the healthcare provider carries out the care from the perspective of knowing what is best for the patient and therefore makes all decisions. The informed decision-making model takes place as the information needed to make decisions is conveyed to the patient and the patient makes the decisions without the healthcare provider involvement. Finally, the shared decision-making model is representative of a sharing and a negotiation towards treatment decisions. Thus, these models represent a range with patient non-participation at one end of the continuum to informed decision making or a high level of patient power at the other end. Several shared decision-making models focus on the process of shared decision-making previously noted. A discussion of several process models follows below.Charles et al. depicts a process model of shared decision-making that identifies key characteristics that must be in evidence. The patient shares in the responsibility with the healthcare provider in this model. The key characteristics included:This model illustrates that there must be at least two individuals participating, however, family and friends may be involved in a variety of roles such as the collector of information, the interpreter of this information, coach, advisor, negotiator, and caretaker. This model also depicts the need to take steps to participate in the shared decision-making process. To take steps means that there is an agreement between and among all involved that shared decision-making is necessary and preferred. Research about patient preferences, however, offers divergent views. The link between patient preferences for shared decision-making and the actuality of shared decision-making in practice is not strong. Research concerning patients and patient preferences on shared decision-making points to variations depending on age, education, socio-economic status, culture, and diagnosis. Healthcare providers may also hold preferences for shared decision-making; however, research in this area is not as comprehensive as is patient focused research. Elwyn et al. explored the views of general practice providers on involving patients in decisions. Both positive and negative views were identified ranging from receptive, noting potential benefits, to concern for the unrealistic nature of participation and sharing in the decision-making process. An example of this potential difficulty, from a healthcare provider perspective, is identifying the potential conflict that may develop when a patient's preference is different from clinical practice guidelines. This is further exemplified in healthcare encounters when a situation may not yield itself to a clear answer but rather lies in a grey area. These situations are challenging for healthcare providers.The notion of information sharing as a prerequisite to shared decision-making offers insight into another process. The healthcare provider must provide the patient the information that they need to know and understand in order to even consider and participate in the shared decision-making process. This information may include the disease, potential treatments, consequences of those treatments, and any alternatives, which may include the decision to do nothing. Without knowing this information the patient will not be able to participate in the shared decision-making process. The complexity of this step is realized if one considers what the healthcare provider needs to know in order to first assess what the patient knows and does not know, the readiness of the patient to participate in this educational process and learn the information, as well as, the individual learning styles of the patient taking into consideration the patient's ideas, values, beliefs, education, culture, literacy, and age. Depending on the results of this assessment the health care provider then must communicate the information to the patient. This is also a complex process that must take into consideration the relationship, comfort level, and trust between the healthcare provider and the patient.Finally, the treatment decision is reached between both the healthcare provider and the patient. Charles et al. portrays shared decision-making as a process with the end product, the shared decision, as the outcome. This outcome may be a decision as to the agreement of a treatment decision, no agreement reached as to a treatment decision, and disagreement as to a treatment decision. Negotiation is a part of the process as the "test of a shared decision (as distinct from the decision-making process) is if both parties agree on the treatment option."Towle and Godolphin developed a process model that further exemplifies the role of the healthcare provider and the patient in the shared decision-making process as mutual partners with mutual responsibilities. The capacity to engage in this shared decision-making rests, therefore, on competencies including knowledge, skills, and abilities for both the healthcare provider and the patient. This mutual partnership and the corresponding competencies are presented for both the healthcare provider and the patient in this model. The competencies noted for the healthcare provider for shared decision making include:Patient competencies include:This model illustrates the shared decision-making process with emphasis on the role of the healthcare provider and the patient very similar to the prior model. This model, however, gives greater emphasis to the process of the co-participation of the healthcare provider and the patient. The co-participation depicts a mutual partnership with mutual responsibilities that can be seen as "reciprocal relationships of dialogue." For this to take place the relationship between and among the participants of the shared decision-making process is important along with other internal and external influences such as communication, trust, mutual respect, honesty, time, continuity, and commitment. Cultural, social, and age group differences; evidence; and team and family are considered within this model.Elwyn et al. presents yet another model that depicts the shared decision-making process; however, this model offers a view where the healthcare provider holds greater responsibility in this process. In this particular model the process focuses on the healthcare provider and the essential skills needed to engage the patient in shard decisions. The competencies outlined in this model include:The healthcare provider must demonstrate knowledge, competencies, and skills as a communicator. The skills for communication competency require the healthcare provider to be able to elicit the patient's thoughts and input regarding treatment management throughout the consultation. The healthcare provider must also demonstrate competencies in assessment skills beyond physical assessment that includes the ability to assess the patient's perceptions and readiness to participate. In addition, the healthcare provider must be able to assess the patient's readiness to learn the information that the patient needs to know in order to fully engage in the shared decision-making process, assess what the patient already knows, what the patient does not know, and whether or not the information that the patient knows is accurate. Once this assessment is completed the healthcare provider then must draw on his/her knowledge, competencies, and skills necessary to teach the patient what the patient needs to know to be informed. This facilitates the notion of the tailor-made information noted previously. The healthcare provider also requires competencies in how to check and evaluate the entire process to ensure that the patient does understand and accept with comfort not only the plan being negotiated but the entire process of sharing in decision-making. In addition to the above, there are further competencies such as competence in working with groups and teams, competencies in terms of cultural knowledge, competencies with regard to negotiation skills, as well as, competencies when faced with ethical challenges.Shared decision-making has been associated with autonomy, empowerment, and effectiveness and efficiency. Both patients and health care providers have noted improvement in relationships and improved interactions when shared decision-making is in evidence. Along with this improved relationship and interaction enhanced compliance is noted. Additional research points to patient satisfaction and enhanced quality of life. There is some evidence to suggest that shared decision-making does facilitate positive health outcomes.In today's healthcare environment there is greater emphasis on patient-centered care that exemplifies patient engagement, participation, partnership, and shared decision-making. Given the shift from the more autocratic delivery of care to the shared approach there is a need to more fully understand the what of shared decision-making as well as how shared decision-making takes place along with what internal and external influences may encourage, support, and facilitate the shared decision-making process. These influences are intervening variables that may be of significance for the successful development of practice-based strategies that may foster shared decision-making in practice. The purpose of this qualitative systematic review is to identify internal and external influences on shared decision-making in all health care settings.A preliminary search of the Joanna Briggs Library of Systematic Reviews, MEDLINE, CINAHL, and PROSPERO did not identify any previously conducted qualitative systematic reviews on the meaningfulness of internal and external influences on shared decision-making.

Electronic Risk Assessment System as an Appropriate Tool for the Prevention of Cancer: a Qualitative Study.

PubMed

Javan Amoli, Amir Hossein; Maserat, Elham; Safdari, Reza; Zali, Mohammad Reza

2015-01-01

Decision making modalities for screening for many cancer conditions and different stages have become increasingly complex. Computer-based risk assessment systems facilitate scheduling and decision making and support the delivery of cancer screening services. The aim of this article was to survey electronic risk assessment system as an appropriate tool for the prevention of cancer. A qualitative design was used involving 21 face-to-face interviews. Interviewing involved asking questions and getting answers from exclusive managers of cancer screening. Of the participants 6 were female and 15 were male, and ages ranged from 32 to 78 years. The study was based on a grounded theory approach and the tool was a semi- structured interview. Researchers studied 5 dimensions, comprising electronic guideline standards of colorectal cancer screening, work flow of clinical and genetic activities, pathways of colorectal cancer screening and functionality of computer based guidelines and barriers. Electronic guideline standards of colorectal cancer screening were described in the s3 categories of content standard, telecommunications and technical standards and nomenclature and classification standards. According to the participations' views, workflow and genetic pathways of colorectal cancer screening were identified. The study demonstrated an effective role of computer-guided consultation for screening management. Electronic based systems facilitate real-time decision making during a clinical interaction. Electronic pathways have been applied for clinical and genetic decision support, workflow management, update recommendation and resource estimates. A suitable technical and clinical infrastructure is an integral part of clinical practice guidline of screening. As a conclusion, it is recommended to consider the necessity of architecture assessment and also integration standards.

Attitudes toward shared decision-making and risk communication practices in residents and their teachers.

PubMed

van der Horst, Klazine; Giger, Max; Siegrist, Michael

2011-01-01

Health professionals' attitudes toward shared decision-making (SDM) are an important facilitator of SDM, but information on these attitudes is limited. The purpose of this study is to examine attitudes, education and practices around SDM and risk communication in residents and their teachers. A questionnaire was mailed to residents in Swiss hospitals in postgraduate medical training programs assessing risk communication education and SDM. In an Internet survey, teachers of the medical training programs answered questions on SDM and risk communication practices. Data were analyzed with ANOVAs and paired samples t-tests. Significant differences in residents' and teachers' opinions regarding SDM were found between specialties and number of residents in a residency (1-3, 4-10, ≥11 residents). Teachers showed a high use of verbal risk communication. Neither residents nor teachers expressed a strong feeling that they lacked the time for decision-making. Residents were significantly more negative about the ability of patients to participate in decision-making compared to their teachers. As residents are more negative about SDM compared to teachers and teachers do not always use the preferred and best methods for risk communication, more education for teachers and residents is needed to improve communication practices in the future.

A Peer-Led Decision Support Intervention Improves Decision Outcomes in Black Women with Breast Cancer

PubMed Central

Wallington, Sherrie F.; Willey, Shawna C.; Hampton, Regina M.; Lucas, W.; Jennings, Y.; Horton, S.; Muzeck, N.; Cocilovo, C.; Isaacs, C.

2013-01-01

Previous reports suggest that Black breast cancer patients receive less patient-centered cancer care than their White counterparts. Interventions to improve patient-centered care (PCC) in Black breast cancer patients are lacking. Seventy-six women with histologically confirmed breast cancer were recruited from the Washington, DC area. After a baseline telephone interview, women received an in-person decision support educational session led by a trained survivor coach. The coach used a culturally appropriate guidebook and decision-making model—TALK Back!© A follow-up assessment assessed participants’ acceptability of the intervention and intermediate outcomes. After the intervention, participants reported increased: self-efficacy in communicating with providers (70 %) and self-efficacy in making treatment decisions (70 %). Compared to baseline scores, post-intervention communication with providers significantly increased (p=.000). This is the first outcome report of an intervention to facilitate PCC in Black breast cancer patients. Testing this intervention using RCTs or similar designs will be important next steps. PMID:23576067

Making cognitive decision support work: Facilitating adoption, knowledge and behavior change through QI.

PubMed

Weir, Charlene; Brunker, Cherie; Butler, Jorie; Supiano, Mark A

2017-07-01

This paper evaluates the role of facilitation in the successful implementation of Computerized Decision Support (CDS). Facilitation processes include education, specialized computerized decision support, and work process reengineering. These techniques, as well as modeling and feedback enhance self-efficacy, which we propose is one of the factors that mediate the effectiveness of any CDS. In this study, outpatient clinics implemented quality improvement (QI) projects focused on improving geriatric care. Quality Improvement is the systematic process of improving quality through continuous measurement and targeted actions. The program, entitled "Advancing Geriatric Education through Quality Improvement" (AGE QI), consisted of a 6-month, QI based, intervention: (1) 2h didactic session, (2) 1h QI planning session, (3) computerized decision support design and implementation, (4) QI facilitation activities, (5) outcome feedback, and (6) 20h of CME. Specifically, we examined the impact of the QI based program on clinician's perceived self-efficacy in caring for older adults and the relationship of implementation support and facilitation on perceived success. The intervention was implemented at 3 institutions, 27 community healthcare system clinics, and 134 providers. This study reports the results of pre/post surveys for the forty-nine clinicians who completed the full CME program. Self-efficacy ratings for specific clinical behaviors related to care of older adults were assessed using a Likert based instrument. Self-ratings of efficacy improved across the following domains (depression, falls, end-of-life, functional status and medication management) and specifically in QI targeted domains and were associated with overall clinic improvements. Published by Elsevier Inc.

From Data to Improved Decisions: Operations Research in Healthcare Delivery.

PubMed

Capan, Muge; Khojandi, Anahita; Denton, Brian T; Williams, Kimberly D; Ayer, Turgay; Chhatwal, Jagpreet; Kurt, Murat; Lobo, Jennifer Mason; Roberts, Mark S; Zaric, Greg; Zhang, Shengfan; Schwartz, J Sanford

2017-11-01

The Operations Research Interest Group (ORIG) within the Society of Medical Decision Making (SMDM) is a multidisciplinary interest group of professionals that specializes in taking an analytical approach to medical decision making and healthcare delivery. ORIG is interested in leveraging mathematical methods associated with the field of Operations Research (OR) to obtain data-driven solutions to complex healthcare problems and encourage collaborations across disciplines. This paper introduces OR for the non-expert and draws attention to opportunities where OR can be utilized to facilitate solutions to healthcare problems. Decision making is the process of choosing between possible solutions to a problem with respect to certain metrics. OR concepts can help systematically improve decision making through efficient modeling techniques while accounting for relevant constraints. Depending on the problem, methods that are part of OR (e.g., linear programming, Markov Decision Processes) or methods that are derived from related fields (e.g., regression from statistics) can be incorporated into the solution approach. This paper highlights the characteristics of different OR methods that have been applied to healthcare decision making and provides examples of emerging research opportunities. We illustrate OR applications in healthcare using previous studies, including diagnosis and treatment of diseases, organ transplants, and patient flow decisions. Further, we provide a selection of emerging areas for utilizing OR. There is a timely need to inform practitioners and policy makers of the benefits of using OR techniques in solving healthcare problems. OR methods can support the development of sustainable long-term solutions across disease management, service delivery, and health policies by optimizing the performance of system elements and analyzing their interaction while considering relevant constraints.

Involvement of people with dementia in making decisions about their lives: a qualitative study that appraises shared decision-making concerning daycare

PubMed Central

Groen-van de Ven, Leontine; Smits, Carolien; de Graaff, Fuusje; Span, Marijke; Eefsting, Jan; Jukema, Jan; Vernooij-Dassen, Myrra

2017-01-01

Objective To explore how people with dementia, their informal caregivers and their professionals participate in decision making about daycare and to develop a typology of participation trajectories. Design A qualitative study with a prospective, multiperspective design, based on 244 semistructured interviews, conducted during three interview rounds over the course of a year. Analysis was by means of content analysis and typology construction. Setting Community settings and nursing homes in the Netherlands. Participants 19 people with dementia, 36 of their informal caregivers and 38 of their professionals (including nurses, daycare employees and case managers). Results The participants’ responses related to three critical points in the decision-making trajectory about daycare: (1) the initial positive or negative expectations of daycare; (2) negotiation about trying out daycare by promoting, resisting or attuning to others; and (3) trying daycare, which resulted in positive or negative reactions from people with dementia and led to a decision. The ways in which care networks proceeded through these three critical points resulted in a typology of participation trajectories, including (1) working together positively toward daycare, (2) bringing conflicting perspectives together toward trying daycare and (3) not reaching commitment to try daycare. Conclusion Shared decision making with people with dementia is possible and requires and adapted process of decision making. Our results show that initial preferences based on information alone may change when people with dementia experience daycare. It is important to have a try-out period so that people with dementia can experience daycare without having to decide whether to continue it. Whereas shared decision making in general aims at moving from initial preferences to informed preferences, professionals should focus more on moving from initial preferences to experienced preferences for people with dementia. Professionals can play a crucial role in facilitating the possibilities for a try-out period. PMID:29133329

Advancing research collaborations among agencies through the Interagency Arctic Research Policy Committee: A necessary step for linking science to policy.

NASA Astrophysics Data System (ADS)

LaValley, M.; Starkweather, S.; Bowden, S.

2017-12-01

The Arctic is changing rapidly as average temperatures rise. As an Arctic nation, the United States is directly affected by these changes. It is imperative that these changes be understood to make effective policy decisions. Since the research needs of the Arctic are large and wide-ranging, most Federal agencies fund some aspect of Arctic research. As a result, the U.S. government regularly works to coordinate Federal Arctic research in order to reduce duplication of effort and costs, and to enhance the research's system perspective. The government's Interagency Arctic Research Policy Committee (IARPC) accomplishes this coordination through its policy-driven five-year Arctic Research Plans and collaboration teams (CTs), which are research topic-oriented teams tasked with implementing the plans. The policies put forth by IARPC thus inform science, however IARPC has been less successful of making these science outcomes part of an iterative decision making process. IARPC's mandate to facilitate coordinated research through information sharing communities can be viewed a prerequisite step in the science-to- decision making process. Research collaborations and the communities of practice facilitated by IARPC allow scientists to connect with a wider community of scientists and stakeholders and, in turn, the larger issues in need of policy solutions. These connections help to create a pathway through which research may increasingly reflect policy goals and inform decisions. IARPC has been growing into a more useful model for the science-to-decision making interface since the publication of its Arctic Research Plan FY2017-2021, and it is useful to evaluate how and why IARPC is progressing in this realm. To understand the challenges facing interagency research collaboration and the progress IARPC has made, the Chukchi Beaufort and Communities CTs, were evaluated as case studies. From the case studies, several recommendations for enhancing collaborations across Federal agencies emerge, including establishing appropriate agency leadership; determining focused and achievable scope of team goals; providing room for bottom-up, community-driven determination of goals; and finally, building relationships and creating an inclusive team environment.

The values underlying team decision-making in work rehabilitation for musculoskeletal disorders.

PubMed

Loisel, Patrick; Falardeau, Marlène; Baril, Raymond; José-Durand, Marie; Langley, Ann; Sauvé, Sandrine; Gervais, Julie

2005-05-20

This paper presents the results of a qualitative study on the values underlying the decision-making process of an interdisciplinary team working in a work rehabilitation facility of a Québec teaching hospital. In order to document the values underlying the decision-making process, a single case observational study was conducted. Interdisciplinary team weekly discussions on ongoing cases of 22 workers absent from work due to musculoskeletal disorders were videotaped. All discourses were transcribed and analyzed following an inductive and iterative approach. The values identified were validated by feedback from team members. Ten common decision values emerged from the data: (1) team unity and credibility, (2) collaboration with stakeholders, (3) worker's internal motivation, (4) worker's adherence to the program, (5) worker's reactivation, (6) single message, (7) reassurance, (8) graded intervention, (9) pain management and (10) return to work as a therapy. The analysis of these values led to the design of a model describing interrelations between them. This study throws light on some mechanisms underlying the decisions made by the team and determining its action. This improves understanding of the actions taken by an interdisciplinary team in work rehabilitation and may facilitate knowledge transfer in the training of other teams.

Understanding and applying principles of social cognition and decision making in adaptive environmental governance.

PubMed

DeCaro, Daniel A; Arnol, Craig Anthony Tony; Boama, Emmanuel Frimpong; Garmestani, Ahjond S

2017-03-01

Environmental governance systems are under greater pressure to adapt and to cope with increased social and ecological uncertainty from stressors like climate change. We review principles of social cognition and decision making that shape and constrain how environmental governance systems adapt. We focus primarily on the interplay between key decision makers in society and legal systems. We argue that adaptive governance must overcome three cooperative dilemmas to facilitate adaptation: (1) encouraging collaborative problem solving, (2) garnering social acceptance and commitment, and (3) cultivating a culture of trust and tolerance for change and uncertainty. However, to do so governance systems must cope with biases in people's decision making that cloud their judgment and create conflict. These systems must also satisfy people's fundamental needs for self-determination, fairness, and security, ensuring that changes to environmental governance are perceived as legitimate, trustworthy, and acceptable. We discuss the implications of these principles for common governance solutions (e.g., public participation, enforcement) and conclude with methodological recommendations. We outline how scholars can investigate the social cognitive principles involved in cases of adaptive governance.

Understanding and applying principles of social cognition and decision making in adaptive environmental governance

PubMed Central

DeCaro, Daniel A.; Arnol, Craig Anthony (Tony); Boama, Emmanuel Frimpong; Garmestani, Ahjond S.

2018-01-01

Environmental governance systems are under greater pressure to adapt and to cope with increased social and ecological uncertainty from stressors like climate change. We review principles of social cognition and decision making that shape and constrain how environmental governance systems adapt. We focus primarily on the interplay between key decision makers in society and legal systems. We argue that adaptive governance must overcome three cooperative dilemmas to facilitate adaptation: (1) encouraging collaborative problem solving, (2) garnering social acceptance and commitment, and (3) cultivating a culture of trust and tolerance for change and uncertainty. However, to do so governance systems must cope with biases in people’s decision making that cloud their judgment and create conflict. These systems must also satisfy people’s fundamental needs for self-determination, fairness, and security, ensuring that changes to environmental governance are perceived as legitimate, trustworthy, and acceptable. We discuss the implications of these principles for common governance solutions (e.g., public participation, enforcement) and conclude with methodological recommendations. We outline how scholars can investigate the social cognitive principles involved in cases of adaptive governance. PMID:29780425

Next generation data systems and knowledge products to support agricultural producers and science-based policy decision making.

PubMed

Capalbo, Susan M; Antle, John M; Seavert, Clark

2017-07-01

Research on next generation agricultural systems models shows that the most important current limitation is data, both for on-farm decision support and for research investment and policy decision making. One of the greatest data challenges is to obtain reliable data on farm management decision making, both for current conditions and under scenarios of changed bio-physical and socio-economic conditions. This paper presents a framework for the use of farm-level and landscape-scale models and data to provide analysis that could be used in NextGen knowledge products, such as mobile applications or personal computer data analysis and visualization software. We describe two analytical tools - AgBiz Logic and TOA-MD - that demonstrate the current capability of farmlevel and landscape-scale models. The use of these tools is explored with a case study of an oilseed crop, Camelina sativa , which could be used to produce jet aviation fuel. We conclude with a discussion of innovations needed to facilitate the use of farm and policy-level models to generate data and analysis for improved knowledge products.

'She's usually quicker than the calculator': financial management and decision-making in couples living with dementia.

PubMed

Boyle, Geraldine

2013-09-01

This article explores how married couples managed their finances and made financial decisions when one spouse had dementia, drawing comparisons with the approaches used prior to the illness. More specifically, the article examines the role of social factors in influencing the involvement of people with dementia in financial management and decision-making, particularly whether a gender dynamic adopted earlier in a marriage similarly influenced a gendered approach following dementia. The research formed part of a larger study of everyday decision-making by couples living with dementia which explored the role of non-cognitive factors in influencing whether people with dementia were involved in decision-making processes. Twenty-one married couples living at home took part; the recently-diagnosed were excluded. Qualitative methods -including participant observation and interviews - were used to examine the couples' fiscal management and decision-making-processes, the perceptions of people with dementia and their spouses about their current financial abilities and whether any support provided by spouse-carers influenced their partners' financial capacity. The fieldwork was undertaken in the North of England between June 2010 and May 2011. Thematic analysis of the data showed that social factors influenced the perceived capacity of people with dementia and the financial practices adopted by the couples. In particular, gender influenced whether people with dementia were involved in financial decisions. The research demonstrated that non-cognitive factors need to be taken into account when assessing and facilitating the capacity of people with dementia. In addition, as people with dementia were somewhat marginalised in decisions about designating financial authority (Lasting Power of Attorney), spouse-carers may need guidance on how to undertake advance care planning and how to support their relatives with dementia in major decision-making, particularly when there are communication difficulties. © 2013 John Wiley & Sons Ltd.

Environmental impact assessment of transportation projects: An analysis using an integrated GIS, remote sensing, and spatial modeling approach

NASA Astrophysics Data System (ADS)

El-Gafy, Mohamed Anwar

Transportation projects will have impact on the environment. The general environmental pollution and damage caused by roads is closely associated with the level of economic activity. Although Environmental Impact Assessments (EIAs) are dependent on geo-spatial information in order to make an assessment, there are no rules per se how to conduct an environmental assessment. Also, the particular objective of each assessment is dictated case-by-case, based on what information and analyses are required. The conventional way of Environmental Impact Assessment (EIA) study is a time consuming process because it has large number of dependent and independent variables which have to be taken into account, which also have different consequences. With the emergence of satellite remote sensing technology and Geographic Information Systems (GIS), this research presents a new framework for the analysis phase of the Environmental Impact Assessment (EIA) for transportation projects based on the integration between remote sensing technology, geographic information systems, and spatial modeling. By integrating the merits of the map overlay method and the matrix method, the framework analyzes comprehensively the environmental vulnerability around the road and its impact on the environment. This framework is expected to: (1) improve the quality of the decision making process, (2) be applied both to urban and inter-urban projects, regardless of transport mode, and (3) present the data and make the appropriate analysis to support the decision of the decision-makers and allow them to present these data to the public hearings in a simple manner. Case studies, transportation projects in the State of Florida, were analyzed to illustrate the use of the decision support framework and demonstrate its capabilities. This cohesive and integrated system will facilitate rational decisions through cost effective coordination of environmental information and data management that can be tailored to specific projects. The framework would facilitate collecting, organizing, analyzing, archiving, and coordinating the information and data necessary to support technical and policy transportation decisions.