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Sample records for facilitate shared decision

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

    Science.gov (United States)

    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.

  2. The importance of communication in collaborative decision making: facilitating shared mind and the management of uncertainty.

    Science.gov (United States)

    Politi, Mary C; Street, Richard L

    2011-08-01

    Quality medical decision making requires that clinicians and patients incorporate the best available clinical evidence with the patients' values and preferences to develop a mutually agreed upon treatment plan. The interactive process involved in medical decision making is complex and requires patients and clinicians to use both cognitive and communicative skills to reach a shared understanding of the decision. The purpose of this paper is to present a communication model to help better understand quality medical decision making, and how patient-centered, collaborative communication enhances the decision-making process. We present research on shared mind and cognitive and communicative skills to highlight how they can facilitate the management of uncertainty during the interactive process involved in medical decision making. We provide simple examples about how to frame messages to achieve shared mind and foster uncertainty tolerance. Strategies such as providing clear explanations, checking for understanding, eliciting the patient's values, concerns, needs, finding common ground, reaching consensus on a treatment plan, and establishing a mutually acceptable follow-up plan can facilitate collaborative decision making. Future research should explore ways to implement collaborative decision-making processes in existing health care systems. © 2010 Blackwell Publishing Ltd.

  3. [Barriers and facilitators to implementing shared decision-making in oncology: Patient perceptions].

    Science.gov (United States)

    Ortega-Moreno, M; Padilla-Garrido, N; Huelva-López, L; Aguado-Correa, F; Bayo-Calero, J; Bayo-Lozano, E

    To determine, from the point of view of the oncological patient, who made the decision about their treatment, as well as the major barriers and facilitators that enabled Shared Decision Making to be implemented. A cross-sectional, descriptive, sand association study using a self-report questionnaire to selected cancer patients, with casual sampling in different oncology clinics and random time periods. A total of 108 patients provided analysable data. The information was collected on sociodemographic and clinical variables, who made the decision about treatment, and level of agreement or disagreement with various barriers and facilitators. More than one-third (38.1%) of patients claimed to have participated in shared decision making with their doctor. Barriers such as, time, the difficulty of understanding, the paternalism, lack of fluid communication, and having preliminary and often erroneous information influenced the involvement in decision-making. However, to have or not have sufficient tools to aid decision making or the patient's interest to participate had no effect. As regards facilitators, physician motivation, their perception of improvement, and the interest of the patient had a positive influence. The exception was the possibility of financial incentives to doctors. The little, or no participation perceived by cancer patients in decisions about their health makes it necessary to introduce improvements in the health care model to overcome barriers and promote a more participatory attitude in the patient. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Barriers and facilitators to implementing Decision Boxes in primary healthcare teams to facilitate shared decisionmaking: a study protocol

    Directory of Open Access Journals (Sweden)

    Giguere Anik

    2012-08-01

    Full Text Available Abstract Background Decision Boxes are summaries of the most important benefits and harms of health interventions provided to clinicians before they meet the patient, to prepare them to help patients make informed and value-based decisions. Our objective is to explore the barriers and facilitators to using Decision Boxes in clinical practice, more precisely factors stemming from (1 the Decision Boxes themselves, (2 the primary healthcare team (PHT, and (3 the primary care practice environment. Methods/design A two-phase mixed methods study will be conducted. Eight Decision Boxes relevant to primary care, and written in both English and in French, will be hosted on a website together with a tutorial to introduce the Decision Box. The Decision Boxes will be delivered as weekly emails over a span of eight weeks to clinicians of PHTs (family physicians, residents and nurses in five primary care clinics located across two Canadian provinces. Using a web-questionnaire, clinicians will rate each Decision Box with the Information Assessment Method (cognitive impacts, relevance, usefulness, expected benefits and with a questionnaire based on the Theory of Planned Behavior to study the determinants of clinicians’ intention to use what they learned from that Decision Box in their patient encounter (attitude, social norm, perceived behavioral control. Web-log data will be used to monitor clinicians’ access to the website. Following the 8-week intervention, we will conduct semi-structured group interviews with clinicians and individual interviews with clinic administrators to explore contextual factors influencing the use of the Decision Boxes. Data collected from questionnaires, focus groups and individual interviews will be combined to identify factors potentially influencing implementation of Decision Boxes in clinical practice by clinicians of PHTs. Conclusions This project will allow tailoring of Decision Boxes and their delivery to overcome the

  5. How can clinical practice guidelines be adapted to facilitate shared decision making? A qualitative key-informant study

    NARCIS (Netherlands)

    Weijden, T.T. van der; Pieterse, A.H.; Koelewijn-van Loon, M.S.; Knaapen, L.; Legare, F.; Boivin, A.; Burgers, J.S.; Stiggelbout, A.M.; Faber, M.J.; Elwyn, G.

    2013-01-01

    BACKGROUND: To explore how clinical practice guidelines can be adapted to facilitate shared decision making. METHODS: This was a qualitative key-informant study with group discussions and semi-structured interviews. First, 75 experts in guideline development or shared decision making participated in

  6. Developing and user-testing Decision boxes to facilitate shared decision making in primary care - a study protocol

    Directory of Open Access Journals (Sweden)

    Rousseau François

    2011-03-01

    Full Text Available Abstract Background Applying evidence is one of the most challenging steps of evidence-based clinical practice. Healthcare professionals have difficulty interpreting evidence and translating it to patients. Decision boxes are summaries of the most important benefits and harms of diagnostic, therapeutic, and preventive health interventions provided to healthcare professionals before they meet the patient. Our hypothesis is that Decision boxes will prepare clinicians to help patients make informed value-based decisions. By acting as primers, the boxes will enhance the application of evidence-based practices and increase shared decision making during the clinical encounter. The objectives of this study are to provide a framework for developing Decision boxes and testing their value to users. Methods/Design We will begin by developing Decision box prototypes for 10 clinical conditions or topics based on a review of the research on risk communication. We will present two prototypes to purposeful samples of 16 family physicians distributed in two focus groups, and 32 patients distributed in four focus groups. We will use the User Experience Model framework to explore users' perceptions of the content and format of each prototype. All discussions will be transcribed, and two researchers will independently perform a hybrid deductive/inductive thematic qualitative analysis of the data. The coding scheme will be developed a priori from the User Experience Model's seven themes (valuable, usable, credible, useful, desirable, accessible and findable, and will include new themes suggested by the data (inductive analysis. Key findings will be triangulated using additional publications on the design of tools to improve risk communication. All 10 Decision boxes will be modified in light of our findings. Discussion This study will produce a robust framework for developing and testing Decision boxes that will serve healthcare professionals and patients alike. It

  7. An Interactive Web Tool for Facilitating Shared Decision-Making in Dementia-Care Networks: A Field Study

    NARCIS (Netherlands)

    Span, M.; Smits, C.; Jukema, J.; Groen-van de Ven, L.M.; Janssen, R.; Vernooij-Dassen, M.; Eefsting, J.; Hettinga, M.

    2015-01-01

    BACKGROUND: An interactive web tool has been developed for facilitating shared decision-making in dementia-care networks. The DecideGuide provides a chat function for easier communication between network members, a deciding together function for step-by-step decision-making, and an individual opinio

  8. An Interactive Web Tool for Facilitating Shared Decision-Making in Dementia-Care Networks: A Field Study

    NARCIS (Netherlands)

    Span, M.; Smits, C.; Jukema, J.; Groen-van de Ven, L.M.; Janssen, R.; Vernooij-Dassen, M.; Eefsting, J.; Hettinga, M.

    2015-01-01

    BACKGROUND: An interactive web tool has been developed for facilitating shared decision-making in dementia-care networks. The DecideGuide provides a chat function for easier communication between network members, a deciding together function for step-by-step decision-making, and an individual

  9. Trial of an electronic decision support system to facilitate shared decision making in community mental health.

    Science.gov (United States)

    Woltmann, Emily M; Wilkniss, Sandra M; Teachout, Alexandra; McHugo, Gregory J; Drake, Robert E

    2011-01-01

    Involvement of community mental health consumers in mental health decision making has been consistently associated with improvements in health outcomes. Electronic decision support systems (EDSSs) that support both consumer and provider decision making may be a sustainable way to improve dyadic communication in a field with approximately 50% workforce turnover per year. This study examined the feasibility of such a system and investigated proximal outcomes of the system's performance. A cluster randomized design was used to evaluate an EDSS at three urban community mental health sites. Case managers (N=20) were randomly assigned to the EDSS-supported planning group or to the usual care planning group. Consumers (N=80) were assigned to the same group as their case managers. User satisfaction with the care planning process was assessed for consumers and case managers (possible scores range from 1 to 5, with higher summary scores indicating more satisfaction). Recall of the care plan was assessed for consumers. Linear regression with adjustment for grouping by worker was used to assess satisfaction scores. A Wilcoxon rank-sum test was used to examine knowledge of the care plan. Compared with case managers in the control group, those in the intervention group were significantly more satisfied with the care planning process (mean ± SD score=4.0 ± .5 versus 3.3 ± .5; adjusted p=.01). Compared with consumers in the control group, those in the intervention group had significantly greater recall of their care plans three days after the planning session (mean proportion of plan goals recalled=75% ± 28% versus 57% ± 32%; p=.02). There were no differences between the clients in the intervention and control groups regarding satisfaction. This study demonstrated that clients can build their own care plans and negotiate and revise them with their case managers using an EDSS.

  10. Facilitating Knowledge Sharing

    DEFF Research Database (Denmark)

    Holdt Christensen, Peter

    Abstract This paper argues that knowledge sharing can be conceptualized as different situations of exchange in which individuals relate to each other in different ways, involving different rules, norms and traditions of reciprocity regulating the exchange. The main challenge for facilitating...... and the intermediaries regulating the exchange, and facilitating knowledge sharing should therefore be viewed as a continuum of practices under the influence of opportunistic behaviour, obedience or organizational citizenship behaviour. Keywords: Knowledge sharing, motivation, organizational settings, situations...

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

    NARCIS (Netherlands)

    Mariani, E.; Vernooij-Dassen, M.; Koopmans, R.T.; Engels, Y.; Chattat, R.

    2017-01-01

    BACKGROUND: 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

  12. Facilitating Knowledge Sharing

    OpenAIRE

    Holdt Christensen, Peter

    2005-01-01

    Abstract This paper argues that knowledge sharing can be conceptualized as different situations of exchange in which individuals relate to each other in different ways, involving different rules, norms and traditions of reciprocity regulating the exchange. The main challenge for facilitating knowledge sharing is to ensure that the exchange is seen as equitable for the parties involved, and by viewing the problems of knowledge sharing as motivational problems situated in different organization...

  13. An interactive web tool for facilitating shared decision-making in dementia-care networks: a field study

    Directory of Open Access Journals (Sweden)

    Marijke eSpan

    2015-07-01

    Full Text Available BackgroundAn interactive web tool has been developed for facilitating shared decision-making in dementia-care networks. The DecideGuide provides a chat function for easier communication between network members, a deciding together function for step-by-step decision-making, and an individual opinion function for eight dementia-related life domains. The aim of this study was to gain insight in the user friendliness of the DecideGuide, user acceptance and satisfaction, and participants’ opinion of the DecideGuide for making decisions.Materials and methodsA 5-month field study included four dementia-care networks (19 participants in total. The data derived from structured interviews, observations, and information that participants logged in the DecideGuide. Structured interviews took place at the start, middle, and end of the field study with people with dementia, informal caregivers, and case managers. Results1. The user friendliness of the chat and individual opinion functions was adequate for case managers and most informal caregivers. Older participants, with or without dementia, had some difficulties using a tablet and the DecideGuide. The deciding together function does not yet provide adequate instructions for all. The user interface needs simplification. 2. User acceptance and satisfaction: everybody liked the chat’s easy communication, handling difficult issues for discussion, and the option of individual opinions. 3. The DecideGuide helped participants structure their thoughts. They felt more involved and shared more information about daily issues than before. ConclusionParticipants found the DecideGuide valuable in decision-making. The chat function seems powerful in helping members engage with one another constructively. Such engagement is a prerequisite for making shared decisions. Regardless of participants’ use of the tool, they saw the DecideGuide's added value.

  14. Knowledge sharing to facilitate regulatory decision-making in regard to alternatives to animal testing: Report of an EPAA workshop.

    Science.gov (United States)

    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.

  15. Shared decision making

    Science.gov (United States)

    ... the rest of your life Having major surgery Getting genetic or cancer screening tests Talking together about your options helps your provider know how you feel and what you value. How Shared Decision Making Works When facing a decision, your ...

  16. InformedTogether: Usability Evaluation of a Web-Based Decision Aid to Facilitate Shared Advance Care Planning for Severe Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Uhler, Lauren M; Pérez Figueroa, Rafael E; Dickson, Mark; McCullagh, Lauren; Kushniruk, Andre; Monkman, Helen; Witteman, Holly O; Hajizadeh, Negin

    2015-02-25

    Advance care planning may help patients receive treatments that better align with their goals for care. We developed a Web-based decision aid called InformedTogether to facilitate shared advance care planning between chronic obstructive pulmonary disease (COPD) patients and their doctors. Our objective was to assess the usability of the InformedTogether decision aid, including whether users could interact with the decision aid to engage in tasks required for shared decision making, whether users found the decision aid acceptable, and implications for redesign. We conducted an observational study with 15 patients and 8 doctors at two ethnically and socioeconomically diverse outpatient clinics. Data included quantitative and qualitative observations of patients and doctors using the decision aid on tablet or laptop computers and data from semistructured interviews. Patients were shown the decision aid by a researcher acting as the doctor. Pulmonary doctors were observed using the decision aid independently and asked to think aloud (ie, verbalize their thoughts). A thematic analysis was implemented to explore key issues related to decision aid usability. Although patients and doctors found InformedTogether acceptable and would recommend that doctors use the decision aid with COPD patients, many patients had difficulty understanding the icon arrays that were used to communicate estimated prognoses and could not articulate the definitions of the two treatment choices-Full Code and Do Not Resuscitate (DNR). Minor usability problems regarding content, links, layout, and consistency were also identified and corresponding recommendations were outlined. In particular, participants suggested including more information about potential changes in quality of life resulting from the alternative advance directives. Some doctor participants thought the decision aid was too long and some thought it may cause nervousness among patients due to the topic area. A decision aid for shared

  17. Shared clinical decision making

    Science.gov (United States)

    AlHaqwi, Ali I.; AlDrees, Turki M.; AlRumayyan, Ahmad; AlFarhan, Ali I.; Alotaibi, Sultan S.; AlKhashan, Hesham I.; Badri, Motasim

    2015-01-01

    Objectives: To determine preferences of patients regarding their involvement in the clinical decision making process and the related factors in Saudi Arabia. Methods: This cross-sectional study was conducted in a major family practice center in King Abdulaziz Medical City, Riyadh, Saudi Arabia, between March and May 2012. Multivariate multinomial regression models were fitted to identify factors associated with patients preferences. Results: The study included 236 participants. The most preferred decision-making style was shared decision-making (57%), followed by paternalistic (28%), and informed consumerism (14%). The preference for shared clinical decision making was significantly higher among male patients and those with higher level of education, whereas paternalism was significantly higher among older patients and those with chronic health conditions, and consumerism was significantly higher in younger age groups. In multivariate multinomial regression analysis, compared with the shared group, the consumerism group were more likely to be female [adjusted odds ratio (AOR) =2.87, 95% confidence interval [CI] 1.31-6.27, p=0.008] and non-dyslipidemic (AOR=2.90, 95% CI: 1.03-8.09, p=0.04), and the paternalism group were more likely to be older (AOR=1.03, 95% CI: 1.01-1.05, p=0.04), and female (AOR=2.47, 95% CI: 1.32-4.06, p=0.008). Conclusion: Preferences of patients for involvement in the clinical decision-making varied considerably. In our setting, underlying factors that influence these preferences identified in this study should be considered and tailored individually to achieve optimal treatment outcomes. PMID:26620990

  18. The Evaluation of Two Methods to Facilitate Shared Decision Making for Men Considering the Prostate-Specific Antigen Test

    Science.gov (United States)

    Frosch, Dominick L; Kaplan, Robert M; Felitti, Vincent

    2001-01-01

    OBJECTIVE California law (Grant H. Kenyon Prostate Cancer Detection Act) requires physicians to inform all patients older than aged 50 years who receive a prostate examination about the availability of the prostate-specific antigen (PSA) test. Physicians are not given guidance on how this information should be presented. We sought to evaluate the effects upon PSA screening rates of informing patients about PSA testing by 2 different techniques. DESIGN Factorial comparison of discussion versus video formats for presenting information about the PSA test. SETTING Patients were recruited through the Health Appraisal screening program in the Department for Preventive Medicine, Kaiser Permanente, San Diego, Calif. PARTICIPANTS Male patients undergoing health appraisal screening participated in 1 of 4 groups providing information about PSA screening: usual care ( n =43), discussion about risks and benefits of PSA ( n =45), shared decision-making video ( n =46), or video plus discussion ( n =42). Participants were sequentially assigned to 1 of the 4 groups. RESULTS No significant differences in demographics or family history was demonstrated between the groups at the time of group assignment. Participants in the intervention groups rated the information as clear, balanced, and fair. There were significant differences in the number of men requesting a PSA test, with the highest rate in the usual care group (97.7%), followed by discussion (82.2%), video (60.0%), and video plus discussion (50.0%). CONCLUSION Providing information about PSA screening in the form of video or discussion is feasible and significantly alters PSA screening rates. PMID:11422636

  19. Facilitating Decisions under Scarcity.

    Science.gov (United States)

    Bloomfield, Stefan D.

    1993-01-01

    This article proposes a conceptual decision-making framework for college and university offices of institutional research during times when budgetary retrenchment and reallocation of resources is necessary. Key issues the office should consider include understanding the institution's purpose, strategy selection, evaluation activities, student…

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

    NARCIS (Netherlands)

    Marrin, K.; Wood, F.; Firth, J.; Kinsey, K.; Edwards, A.; Brain, K.E.; Newcombe, R.G.; Nye, A.; Pickles, T.; Hawthorne, K.; Elwyn, G.

    2014-01-01

    BACKGROUND: 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 pr

  1. Greater than the Parts: Shared Decision Making.

    Science.gov (United States)

    Jensen, Anabel L.

    1986-01-01

    The article describes the goals, rationale, structure of the shared decision-making model in effect at the Nueva Learning Center, a private elementary school for gifted and talented in Hillsborough, California. An example applying the model to class scheduling and 10 steps for facilitating the process are given. (Author/DB)

  2. Enhancing shared decision making through assessment of patient-clinician concordance on decision quality

    DEFF Research Database (Denmark)

    Kaltoft, Mette Kjer; Selby, Warwick; Salkeld, Glenn

    Purpose: To explore the feasibility and potential of a prescriptive, web-based, decomposable measure of decision quality (MyDecisionQuality (MDQ)); to assess and enhance patient-clinician decision concordance, thereby facilitating more transparent shared decision making and documentation of bette...

  3. Shared decision-making in epilepsy management.

    Science.gov (United States)

    Pickrell, W O; Elwyn, G; Smith, P E M

    2015-06-01

    Policy makers, clinicians, and patients increasingly recognize the need for greater patient involvement in clinical decision-making. Shared decision-making helps address these concerns by providing a framework for clinicians and patients to make decisions together using the best evidence. Shared decision-making is applicable to situations where several acceptable options exist (clinical equipoise). Such situations occur commonly in epilepsy, for example, in decisions regarding the choice of medication, treatment in pregnancy, and medication withdrawal. A talk model is a way of implementing shared decision-making during consultations, and decision aids are useful tools to assist in the process. Although there is limited evidence available for shared decision-making in epilepsy, there are several benefits of shared decision-making in general including improved decision quality, more informed choices, and better treatment concordance. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. The potential for shared decision-making and decision aids in rehabilitation medicine

    OpenAIRE

    Til, van, J.A.; Drossaert, Constance H.C; Punter, R. Annemiek; IJzerman, Maarten J.

    2010-01-01

    Objective: Shared decision-making and the use of decision aids are increasingly promoted in various healthcare settings. The extent of their current use and potential in rehabilitation medicine is unknown. The aim of the present study was to explore the barriers to and facilitators of shared decision-making and use of decision aids in daily practice, and to explore the perceptions of physical and rehabilitation medicine (PRM) physicians toward them. Methods: A cross-sectional survey of 408 PR...

  5. The potential for shared decision-making and decision aids in rehabilitation medicine

    NARCIS (Netherlands)

    Til, van Janine; Drossaert, Constance H.C.; Punter, R. Annemiek; IJzerman, Maarten J.

    2010-01-01

    Objective: Shared decision-making and the use of decision aids are increasingly promoted in various healthcare settings. The extent of their current use and potential in rehabilitation medicine is unknown. The aim of the present study was to explore the barriers to and facilitators of shared decisio

  6. Sharing decisions on SDM skills teaching

    DEFF Research Database (Denmark)

    Nielsen, Annegrethe

    2015-01-01

    Abstract for teaching poster – EACH summer conference 2015 Author: Annegrethe Nielsen, MA & Ph.D., senior lecturer at University College Northern Denmark, ann@ucn.dk Title Sharing decisions on SDM skills teaching – a collaborative course development Background Patient involvement and shared...... for professionals involved in antenatal care and obstetrics was conducted. Aim The aim of the course was: • teaching a group of professionals the skills of SDM • enhancing the awareness of the complex task of SDM • developing competence within the group of professionals to secure an ongoing awareness and training...... of the skills Method As SDM is recognized by politicians and administrators as an important form of co-operation with patients, it is crucial to engage the professionals in this development. The course was planned in cooperation between a university college lecturer who acted as facilitator and two midwives who...

  7. Shared decision-making and patient autonomy.

    Science.gov (United States)

    Sandman, Lars; Munthe, Christian

    2009-01-01

    In patient-centred care, shared decision-making is advocated as the preferred form of medical decision-making. Shared decision-making is supported with reference to patient autonomy without abandoning the patient or giving up the possibility of influencing how the patient is benefited. It is, however, not transparent how shared decision-making is related to autonomy and, in effect, what support autonomy can give shared decision-making. In the article, different forms of shared decision-making are analysed in relation to five different aspects of autonomy: (1) self-realisation; (2) preference satisfaction; (3) self-direction; (4) binary autonomy of the person; (5) gradual autonomy of the person. It is argued that both individually and jointly these aspects will support the models called shared rational deliberative patient choice and joint decision as the preferred versions from an autonomy perspective. Acknowledging that both of these models may fail, the professionally driven best interest compromise model is held out as a satisfactory second-best choice.

  8. A Review of Shared Decision-Making and Patient Decision Aids in Radiation Oncology.

    Science.gov (United States)

    Woodhouse, Kristina Demas; Tremont, Katie; Vachani, Anil; Schapira, Marilyn M; Vapiwala, Neha; Simone, Charles B; Berman, Abigail T

    2017-01-30

    Cancer treatment decisions are complex and may be challenging for patients, as multiple treatment options can often be reasonably considered. As a result, decisional support tools have been developed to assist patients in the decision-making process. A commonly used intervention to facilitate shared decision-making is a decision aid, which provides evidence-based outcomes information and guides patients towards choosing the treatment option that best aligns with their preferences and values. To ensure high quality, systematic frameworks and standards have been proposed for the development of an optimal aid for decision making. Studies have examined the impact of these tools on facilitating treatment decisions and improving decision-related outcomes. In radiation oncology, randomized controlled trials have demonstrated that decision aids have the potential to improve patient outcomes, including increased knowledge about treatment options and decreased decisional conflict with decision-making. This article provides an overview of the shared-decision making process and summarizes the development, validation, and implementation of decision aids as patient educational tools in radiation oncology. Finally, this article reviews the findings from decision aid studies in radiation oncology and offers various strategies to effectively implement shared decision-making into clinical practice.

  9. Shared decision making, paternalism and patient choice.

    Science.gov (United States)

    Sandman, Lars; Munthe, Christian

    2010-03-01

    In patient centred care, shared decision making is a central feature and widely referred to as a norm for patient centred medical consultation. However, it is far from clear how to distinguish SDM from standard models and ideals for medical decision making, such as paternalism and patient choice, and e.g., whether paternalism and patient choice can involve a greater degree of the sort of sharing involved in SDM and still retain their essential features. In the article, different versions of SDM are explored, versions compatible with paternalism and patient choice as well as versions that go beyond these traditional decision making models. Whenever SDM is discussed or introduced it is of importance to be clear over which of these different versions are being pursued, since they connect to basic values and ideals of health care in different ways. It is further argued that we have reason to pursue versions of SDM involving, what is called, a high level dynamics in medical decision-making. This leaves four alternative models to choose between depending on how we balance between the values of patient best interest, patient autonomy, and an effective decision in terms of patient compliance or adherence: Shared Rational Deliberative Patient Choice, Shared Rational Deliberative Paternalism, Shared Rational Deliberative Joint Decision, and Professionally Driven Best Interest Compromise. In relation to these models it is argued that we ideally should use the Shared Rational Deliberative Joint Decision model. However, when the patient and professional fail to reach consensus we will have reason to pursue the Professionally Driven Best Interest Compromise model since this will best harmonise between the different values at stake: patient best interest, patient autonomy, patient adherence and a continued care relationship.

  10. Re-engineering shared decision-making.

    Science.gov (United States)

    Gillick, Muriel R

    2015-09-01

    Shared decision-making is widely accepted as the gold standard of clinical care. Numerous obstacles to achieving shared decision-making have been identified, including patient factors, physician factors and systemic factors. Until now, the paradigm is seldom successfully implemented in clinical practice, raising questions about the practicality of the process recommended for its use. A re-engineered model is proposed in which physicians elicit and prioritise patients' goals of care and then help translate those goals into treatment options, after clarifying the patient's underlying health status. Preliminary evidence suggests that each step of this revised process is feasible and that patients and physicians are comfortable with this strategy. Adoption of this model, after further testing, would allow the goal of shared decision-making to be realised. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  11. Shared decision making in endocrinology: present and future directions.

    Science.gov (United States)

    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

  12. Enhancing shared decision making through assessment of patient-clinician concordance on decision quality

    DEFF Research Database (Denmark)

    Kaltoft, Mette Kjer; Selby, Warwick; Salkeld, Glenn

    Purpose: To explore the feasibility and potential of a prescriptive, web-based, decomposable measure of decision quality (MyDecisionQuality (MDQ)); to assess and enhance patient-clinician decision concordance, thereby facilitating more transparent shared decision making and documentation of better......) of the 8 MDQ criteria (options, effects, importance, chances; trust, support, control, commitment) were elicited and fed back in decomposed formats, along with concordance measures (Mean Squared Difference (MSD), Mean Absolute Difference (MAD)). The Incremental Values of Perfect Ratings were calculated...... and clinician using the dually-personalised decomposable MyDecisionQuality (MDQ) instrument. This has the potential to guide future work on optimising dyad-specific patient-clinician communication for shared decision making and informed consent....

  13. Shared decision making and the internist.

    Science.gov (United States)

    Montori, Victor M; Kunneman, Marleen; Hargraves, Ian; Brito, Juan P

    2017-01-01

    In this narrative review, we locate within the tradition of great diagnosticians in internal medicine, a fundamental development in patient-centered care: shared decision making (SDM). In this way, we present SDM as a core component of the clinical method, one in which diagnosis of the situation and of the actions that resolve it is essential toward the practice of evidence-based medicine. Published by Elsevier B.V.

  14. Developing a framework to support shared decision making for youth mental health medication treatment.

    Science.gov (United States)

    Crickard, Elizabeth L; O'Brien, Megan S; Rapp, Charles A; Holmes, Cheryl L

    2010-10-01

    Medical shared decision making has demonstrated success in increasing collaboration between clients and practitioners for various health decisions. As the importance of a shared decision making approach becomes increasingly valued in the adult mental health arena, transfer of these ideals to youth and families of youth in the mental health system is a logical next step. A review of the literature and preliminary, formative feedback from families and staff at a Midwestern urban community mental health center guided the development of a framework for youth shared decision making. The framework includes three functional areas (1) setting the stage for youth shared decision making, (2) facilitating youth shared decision making, and (3) supporting youth shared decision making. While still in the formative stages, the value of a specific framework for a youth model in support of moving from a client-practitioner value system to a systematic, intentional process is evident.

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

    Science.gov (United States)

    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.

  16. Principles of shared decision-making within teams.

    Science.gov (United States)

    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

  17. Prior expectations facilitate metacognition for perceptual decision.

    Science.gov (United States)

    Sherman, M T; Seth, A K; Barrett, A B; Kanai, R

    2015-09-01

    The influential framework of 'predictive processing' suggests that prior probabilistic expectations influence, or even constitute, perceptual contents. This notion is evidenced by the facilitation of low-level perceptual processing by expectations. However, whether expectations can facilitate high-level components of perception remains unclear. We addressed this question by considering the influence of expectations on perceptual metacognition. To isolate the effects of expectation from those of attention we used a novel factorial design: expectation was manipulated by changing the probability that a Gabor target would be presented; attention was manipulated by instructing participants to perform or ignore a concurrent visual search task. We found that, independently of attention, metacognition improved when yes/no responses were congruent with expectations of target presence/absence. Results were modeled under a novel Bayesian signal detection theoretic framework which integrates bottom-up signal propagation with top-down influences, to provide a unified description of the mechanisms underlying perceptual decision and metacognition. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    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.

  19. Current concepts of shared decision making in orthopedic surgery.

    Science.gov (United States)

    Klifto, Kevin; Klifto, Christopher; Slover, James

    2017-06-01

    The Shared Decision Making (SDM) model, a collaborative decision making process between the physician and patient to make an informed clinical decision that enhances the chance of treatment success as defined by each patient's preferences and values, has become a new and promising tool in the healthcare process; however, minimal data exists on its application in the orthopedic surgical specialty. Increasing evidence has demonstrated that this once novel idea can be implemented successfully in the orthopedic setting to improve patient outcomes. SDM can be applied without significant increases in the office length. Patients report that a physician that takes the time to listen to them is among the most important factors in their care. When time was focused on the SDM process, there was a direct correlation between the time spent with a patient and patient satisfaction. Patients exposed to a decision aid prior to surgery gained a greater knowledge from baseline to make a higher quality decision that was consistent with their values. Involving family members preoperatively can help all patients adhere to postoperative regimens. Exposing patients to a decision aid can reduce expensive elective surgeries, in favor of non-operative management. Incorporating patient goals into the decision-making process has increased satisfaction, compliance, and outcomes. SDM is a two-way exchange of information that attempts to correct the inequality of power between the patient and physician. Decision-aids are helpful tools that facilitate the decision-making process. Treatment decisions are consistent with patient preferences and values when there may be no "best" therapy. A good patient-physician relationship is essential during the process to reduce decisional conflict and increase overall patient outcomes.

  20. Child-parent shared decision making about asthma management.

    Science.gov (United States)

    Garnett, Victoria; Smith, Joanna; Ormandy, Paula

    2016-05-09

    Aim To explore and describe child-parent shared decision making for the management of childhood asthma. Methods A qualitative, descriptive, interview-based study was undertaken. Eight children and nine parents participated. The framework approach underpinned data analysis. Findings A dynamic model of the way children and parents transfer, shift and share asthma management decisions was uncovered. Asthma management decisions between children and parents were non-linear, with responsibility transferring from parent to child under different conditions. Children made a range of decisions about their asthma, often sharing decisions with their parents. However, during acute illness episodes, children often relied on parents to make decisions about their asthma. Conclusion Neither the child nor parent has complete autonomy over asthma management decisions. Decision making is a dynamic, shifting and shared process, dependent on contextual factors and child and parent decision preferences.

  1. Facilitating Knowledge Sharing in Russian and Chinese Subsidiaries

    DEFF Research Database (Denmark)

    Hutchings, Kate; Michailova, Snejina

    2003-01-01

    operations hasbecome an issue of increasing importance. Where the cultural distance between homeand host nations is great, as it is between Western industrialised economies and thetransition economies of the (former) Communist nations, there is even greatersaliency for achieving effective knowledge sharing......The unprecedented escalation in the number of organisations that have decided tointernationalise their operations in the last two decades, and the internationalmovement of labour that has accompanied such expansion, has meant thatunderstanding the process of knowledge sharing within subsidiary...... if its potential value for gainingorganisational competitive advantage is to be harnessed. In examining knowledgesharing in Russia and China, this paper specifically addresses how group membershipand personal networking in these countries facilitate and impede knowledge sharing.Ultimately, the paper...

  2. Shared decision making interventions for people with mental health conditions.

    Science.gov (United States)

    Duncan, Edward; Best, Catherine; Hagen, Suzanne

    2010-01-20

    synthesis. We included two separate German studies involving a total of 518 participants. One study was undertaken in the inpatient treatment of schizophrenia and the other in the treatment of people newly diagnosed with depression in primary care. Regarding the primary outcomes, one study reported statistically significant increases in patient satisfaction, the other study did not. There was no evidence of effect on clinical outcomes or hospital readmission rates in either study. Regarding secondary outcomes, there was an indication that interventions to increase shared decision making increased doctor facilitation of patient involvement in decision making, and did not increase consultation times. Nor did the interventions increase patient compliance with treatment plans. Neither study reported any harms of the intervention. Definite conclusions cannot be drawn, however, on the basis of these two studies. No firm conclusions can be drawn at present about the effects of shared decision making interventions for people with mental health conditions. There is no evidence of harm, but there is an urgent need for further research in this area.

  3. When the business of sharing treatment decisions is not the same as shared decision making: A discourse analysis of decision sharing in general practice.

    Science.gov (United States)

    Robertson, Maggie; Moir, Jim; Skelton, John; Dowell, Jon; Cowan, Sue

    2011-01-01

    Although shared decision making (SDM) in general practice continues to be promoted as a highly desirable means of conducting consultations it is rarely observed in practice. The aim of this study is to identify the discursive features and conversational strategies particular to the negotiation and sharing of treatment decisions in order to understand why SDM is not yet embedded into routine practice. Consultations from Scottish general practices were examined using discourse analysis. Two themes were identified as key components for when the doctor and the patient were intent on sharing decisions: the generation of patient involvement using first-person pronouns, and successful and unsuccessful patient requesting practices. This article identifies a number of conversational activities found to be successful in supporting doctors' agendas and reducing their responsibility for decisions made. Doctor's use of 'partnership talk' was found to minimize resistance and worked to invite consensus rather than involvement. The information from this study provides new insight into the consultation process by identifying how treatment decisions are arrived at through highlighting the complexities involved. Notably, shared decision making does not happen with the ease implied by current models and appears to work to maintain a biomedical 'GP as expert' approach rather than one in which the patient is truly involved in partnership. We suggest that further research on the impact of conversational activities is likely to benefit our understanding of shared decision making and hence training in and the practice of SDM.

  4. Child-parent shared decision making about asthma management.

    OpenAIRE

    Garnett, V; Smith, J; Ormandy, P

    2016-01-01

    Aim To explore and describe child-parent shared decision making for the management of childhood asthma. Methods A qualitative, descriptive, interview-based study was undertaken. Eight children and nine parents participated. The framework approach underpinned data analysis. Findings A dynamic model of the way children and parents transfer, shift and share asthma management decisions was uncovered. Asthma management decisions between children and parents were non-linear, with responsibility tra...

  5. How contextual issues can distort shared decision making.

    Science.gov (United States)

    Gartlehner, Gerald; Matyas, Nina

    2016-12-01

    Shared decision making in medicine has become a widely promoted approach. The goal is for patients and physicians to reach a mutual, informed decision by taking into consideration scientific evidence, clinical experience, and the patient's personal values or preferences. Shared decision making, however, is not a straightforward process. In practice, it might fall short of what it promises and might even be misused to whitewash monetary motives. In this article, which summarizes a presentation given at the 17(th) Annual Conference of the German Network Evidence-based Medicine on March 4(th), 2016 in Cologne, Germany, we discuss three contextual factors that in our opinion can have a tremendous impact on any informed decision making: 1) opinions and convictions of physicians or other clinicians; 2) uncertainty of the evidence regarding benefits and harms; 3) uncertainty of patients about their own values and preferences. But despite barriers and shortcomings, modern medicine currently does not have an alternative to shared decision making. Shared decision making has become a central theme in good quality health care because it has a strong ethical component. Advocates of shared decision making, however, must realize that not all patients prefer to participate in decision making. For those who do, however, we must ensure that shared decisions can be made in a neutral environment as free of biases and conflicts of interest as possible. Copyright © 2016. Published by Elsevier GmbH.

  6. A Decision Model for Data Sharing

    NARCIS (Netherlands)

    Eckartz, S.; Hofman, W.J.; Veenstra, A.F. van

    2014-01-01

    Data-driven innovation has great potential for the development of innovative services that not only have economic value, but that help to address societal challenges. Many of these challenges can only be addressed by data sharing of public and privately owned data. These public-private data sharing

  7. A Decision Model for Data Sharing

    NARCIS (Netherlands)

    Eckartz, S.; Hofman, W.J.; Veenstra, A.F. van

    2014-01-01

    Data-driven innovation has great potential for the development of innovative services that not only have economic value, but that help to address societal challenges. Many of these challenges can only be addressed by data sharing of public and privately owned data. These public-private data sharing

  8. Shared decision making in public mental health care: perspectives from consumers living with severe mental illness.

    Science.gov (United States)

    Woltmann, Emily M; Whitley, Rob

    2010-01-01

    Most theoretical and empirical work regarding decision making in mental health suggests that mental health consumers have better outcomes when their preferences are integrated into quality of life decisions. A wealth of research, however, indicates that providers have difficulty predicting what their clients' priorities are. This study investigates consumer decision-making preferences and understanding of construction of decisions in community mental health. People living with severe mental illness being treated in the public mental health care system (N=16) participated in qualitative interviews regarding case management decision making as a part of a larger study investigating a decision support system to facilitate shared decision making. Interviews were transcribed, coded, and cross-case thematic analyses were conducted. Mental health consumers generally endorse a "shared" style of decision making. When asked what "shared" means, however, consumers describe a two-step process which first prioritizes autonomy, and if that is not possible, defers to case managers' judgment. Consumers also primarily focused on the relationship and affective components of decision making, rather than information-gathering or deliberating on options. Finally, when disagreements arose, consumers primarily indicated they handled them. Mental health consumers may have a different view of decision making than the literature on shared decision making suggests. Mental health consumers may consciously decide to at least verbally defer to their case managers, and remain silent about their preferences or wishes.

  9. Implementing shared decision making in Denmark

    DEFF Research Database (Denmark)

    Dahl Steffensen, Karina; Hjelholt Baker, Vibe; Vinter, Mette Marianne

    2017-01-01

    national plan for cancer treatment. What about tools for patient decision support? Development of evidence-based patient decision aids (PDAs) are still at an early stage in Denmark, but recent national and private funding has helped push the field forward. Furthermore, a few stakeholders have started...

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

    Science.gov (United States)

    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.

  11. Sharing Research Models: Using Software Engineering Practices for Facilitation.

    Science.gov (United States)

    Bryant, Stephanie P; Solano, Eric; Cantor, Susanna; Cooley, Philip C; Wagener, Diane K

    2011-03-01

    Increasingly, researchers are turning to computational models to understand the interplay of important variables on systems' behaviors. Although researchers may develop models that meet the needs of their investigation, application limitations-such as nonintuitive user interface features and data input specifications-may limit the sharing of these tools with other research groups. By removing these barriers, other research groups that perform related work can leverage these work products to expedite their own investigations. The use of software engineering practices can enable managed application production and shared research artifacts among multiple research groups by promoting consistent models, reducing redundant effort, encouraging rigorous peer review, and facilitating research collaborations that are supported by a common toolset. This report discusses three established software engineering practices- the iterative software development process, object-oriented methodology, and Unified Modeling Language-and the applicability of these practices to computational model development. Our efforts to modify the MIDAS TranStat application to make it more user-friendly are presented as an example of how computational models that are based on research and developed using software engineering practices can benefit a broader audience of researchers.

  12. Binary decision diagrams by shared rewriting

    NARCIS (Netherlands)

    Pol, J. van de; Zantema, H.

    2000-01-01

    BDDs provide an established technique for propositional formula manipulation. In this paper we re-develope the basic BDD theory using standard rewriting techniques. Since a BDD is a DAG instead of a tree we need a notion of shared rewriting and develope appropriate theory. A rewriting system is

  13. Overcoming Barriers to Shared Decision Making

    Science.gov (United States)

    ... State SELECT YOUR LANGUAGE Español (Spanish) 简体中文 (Traditional Chinese) 繁体中文 (Simplified Chinese) Tiếng Việt (Vietnamese) Healthy Living for Heart.org ... healthcare decisions . Barrier: Cultural and religious differences Solution: Culture and religion can influence what care you choose ...

  14. Implementing shared decision making in the UK

    NARCIS (Netherlands)

    Coulter, A.; Edwards, A.; Elwyn, G.; Thomson, R.

    2011-01-01

    WHAT ABOUT POLICY REGARDING SDM? SDM is on the national policy agenda and has been prioritised as part of the health reform bill currently going through the Houses of Parliament. The NHS Constitution emphasises patients' right to be involved in decisions and this is reinforced in standards set by

  15. Decision Facilitator for Launch Operations using Intelligent Agents

    Science.gov (United States)

    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.

  16. Interventions to support shared decision-making for women with heavy menstrual bleeding: A systematic review.

    Science.gov (United States)

    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

  17. Shared decision making in patients with stable coronary artery disease: PCI choice.

    Directory of Open Access Journals (Sweden)

    Megan Coylewright

    Full Text Available BACKGROUND: Percutaneous coronary intervention (PCI and optimal medical therapy (OMT are comparable, alternative therapies for many patients with stable angina; however, patients may have misconceptions regarding the impact of PCI on risk of death and myocardial infarction (MI in stable coronary artery disease (CAD. METHODS AND RESULTS: We designed and developed a patient-centered decision aid (PCI Choice to promote shared decision making for patients with stable CAD. The estimated benefits and risks of PCI+OMT as compared to OMT were displayed in a decision aid using pictographs with natural frequencies and text. We engaged patients, clinicians, health service researchers, and designers with over 20 successive iterations of the decision aid, which were field tested during real-world clinical encounters involving clinicians and patients. The decision aid is intended to facilitate knowledge transfer, deliberation based on patient values and preferences, and shared decision making. CONCLUSIONS: We describe the methods and outcomes of the design and development of a decision aid (PCI Choice to promote shared decision making between clinicians and patients regarding the choice of PCI+OMT vs. OMT for treatment of stable CAD. We will evaluate the impact of PCI Choice on patient knowledge, decisional conflict, participation in decision-making, and treatment choice in an upcoming randomized trial.

  18. Implementing shared decision-making: consider all the consequences.

    Science.gov (United States)

    Elwyn, Glyn; Frosch, Dominick L; Kobrin, Sarah

    2016-08-08

    The ethical argument that shared decision-making is "the right" thing to do, however laudable, is unlikely to change how healthcare is organized, just as evidence alone will be an insufficient factor: practice change is governed by factors such as cost, profit margin, quality, and efficiency. It is helpful, therefore, when evaluating new approaches such as shared decision-making to conceptualize potential consequences in a way that is broad, long-term, and as relevant as possible to multiple stakeholders. Yet, so far, evaluation metrics for shared decision-making have been mostly focused on short-term outcomes, such as cognitive or affective consequences in patients. The goal of this article is to hypothesize a wider set of consequences, that apply over an extended time horizon, and include outcomes at interactional, team, organizational and system levels, and to call for future research to study these possible consequences. To date, many more studies have evaluated patient decision aids rather than other approaches to shared decision-making, and the outcomes measured have typically been focused on short-term cognitive and affective outcomes, for example knowledge and decisional conflict. From a clinicians perspective, the shared decision-making process could be viewed as either intrinsically rewarding and protective, or burdensome and impractical, yet studies have not focused on the impact on professionals, either positive or negative. At interactional levels, group, team, and microsystem, the potential long-term consequences could include the development of a culture where deliberation and collaboration are regarded as guiding principles, where patients are coached to assess the value of interventions, to trade-off benefits versus harms, and assess their burdens-in short, to new social norms in the clinical workplace. At organizational levels, consistent shared decision-making might boost patient experience evaluations and lead to fewer complaints and legal

  19. Improving shared decision-making in adolescents through antibiotic education.

    Science.gov (United States)

    Ngadimon, I W; Islahudin, F; Mohamed Shah, N; Md Hatah, E; Makmor-Bakry, M

    2017-02-01

    Background Shared decision-making is vital in achieving desired drug therapy goals, especially with antibiotics, in view of the potential long-term reduction in drug resistance. However, shared decision-making is rarely practiced with adolescent patients. Objectives The aim of the study was to identify the effect antibiotic education has on willingness to engage in shared decision-making among adolescents in Malaysia. Setting Participants from secondary schools in Malaysia were enrolled with ethical approval. Method The adolescents answered a validated questionnaire, which included demographics, antibiotic knowledge, attitude towards antibiotic use, and the Control Preference Scale, which measures willingness to engage in shared decision-making. Afterwards, antibiotic education was delivered to participating students. Main outcome measure Knowledge about and attitude toward antibiotics were investigated. Results A total of 510 adolescents participated in the study. Knowledge of antibiotics significantly increased post education (pre 3.2 ± 1.8 vs. post 6.8 ± 2.1, p education (χ = 36.9, df = 2, p education improves knowledge, attitude, and willingness to engage in shared decision-making among adolescents. Antibiotic education can therefore be introduced as a strategy to reduce inappropriate antibiotic use.

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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

  2. The shared leadership process in decision-making teams.

    Science.gov (United States)

    Bergman, Jacqueline Z; Rentsch, Joan R; Small, Erika E; Davenport, Shaun W; Bergman, Shawn M

    2012-01-01

    The present study examined the process of shared leadership in 45 ad hoc decision-making teams. Each team member's leadership behavior (n = 180) was assessed by behaviorally coding videotapes of the teams' discussions. The within-team patterns of leadership behavior were examined using cluster analysis. Results indicated that the likelihood of a team experiencing a full range of leadership behavior increased to the extent that multiple team members shared leadership, and that teams with shared leadership experienced less conflict, greater consensus, and higher intragroup trust and cohesion than teams without shared leadership. This study supports previous findings that shared leadership contributes to overall team functioning, and begins to delineate the extent to which team members may naturally share leadership.

  3. Shared decision making in Spain: current state and future perspectives.

    Science.gov (United States)

    Perestelo-Perez, Lilisbeth; Rivero-Santana, Amado; Perez-Ramos, Jeanette; Gonzalez-Lorenzo, Marien; Roman, Javier Gracia-San; Serrano-Aguilar, Pedro

    2011-01-01

    In the last two decades there has been a growing recognition in the Spanish National Health System (NHS) of the importance of considering patients' values and preferences in clinical decisions. Patient participation in shared decision making (SDM) is gaining importance as a suitable approach to patient-health professional communication and decision making in Spain. In addition, the NHS is funding the development of patients' decision aids (PtDAs) for shared decision making (SDM) by Health Technology Assessment Agencies. However, the NHS has still not incorporated reforms in law that includes SDM and PtDAs as a key component of health care services and professional curricula, nor is there a standardised implementation of interventions to support decisions in routine care. Most patients are not very familiar with their rights to be kept informed and participate in their own health care decisions. Most professionals are not familiar with or educated about patients' rights to be kept informed and participate in health care decisions either. The future of SDM in Spain is promising. The next course of action should be to maintain the production and adaptation of high-quality PtDAs while at the same time reinforcing effective dissemination strategies among patients and training programmes for professionals focused on SDM.

  4. Understanding behavioral intent to participate in shared decision-making in medically uncertain situations.

    Science.gov (United States)

    Maffei, Roxana M; Dunn, K; Zhang, J; Hsu, C E; Holmes, J H

    2012-01-01

    This article describes the process undertaken to identify and validate behavioral and normative beliefs and behavioral intent based on the Theory of Reasoned Action (TRA) and applied to men between the ages of 45 and 70 in the context of their participation in shared decision-making (SDM) in medically uncertain situations. This article also discusses the preliminary results of the aforementioned processes and explores potential future uses of this information that may facilitate greater understanding, efficiency and effectiveness of clinician-patient consultations. Twenty-five male subjects from the Philadelphia community participated in this study. Individual semi-structure patient interviews were conducted until data saturation was reached. Based on their review of the patient interview transcripts, researchers conducted a qualitative content analysis to identify prevalent themes and, subsequently, create a category framework. Qualitative indicators were used to evaluate respondents' experiences, beliefs, and behavioral intent relative to participation in shared decision-making during medical uncertainty. Based on the themes uncovered through the content analysis, a category framework was developed to facilitate understanding and increase the accuracy of predictions related to an individual's behavioral intent to participate in shared decision-making in medical uncertainty. The emerged themes included past experience with medical uncertainty, individual personality, and the relationship between the patient and his physician. The resulting three main framework categories include 1) an individual's Foundation for the concept of medical uncertainty, 2) how the individual Copes with medical uncertainty, and 3) the individual's Behavioral Intent to seek information and participate in shared decision-making during times of medically uncertain situations. The theme of Coping (with uncertainty) emerged as a particularly critical behavior/characteristic amongst the

  5. Implementing shared decision-making: consider all the consequences

    NARCIS (Netherlands)

    Elwyn, G.; Frosch, D.L.; Kobrin, S.

    2016-01-01

    BACKGROUND: The ethical argument that shared decision-making is "the right" thing to do, however laudable, is unlikely to change how healthcare is organized, just as evidence alone will be an insufficient factor: practice change is governed by factors such as cost, profit margin, quality, and

  6. Shared decision making: a model for clinical practice

    NARCIS (Netherlands)

    Elwyn, G.; Frosch, D.; Thomson, R.; Joseph-Williams, N.; Lloyd, A.; Kinnersley, P.; Cording, E.; Tomson, D.; Dodd, C.; Rollnick, S.; Edwards, A.; Barry, M.

    2012-01-01

    The principles of shared decision making are well documented but there is a lack of guidance about how to accomplish the approach in routine clinical practice. Our aim here is to translate existing conceptual descriptions into a three-step model that is practical, easy to remember, and can act as a

  7. Shared decision making: a model for clinical practice

    NARCIS (Netherlands)

    Elwyn, G.; Frosch, D.; Thomson, R.; Joseph-Williams, N.; Lloyd, A.; Kinnersley, P.; Cording, E.; Tomson, D.; Dodd, C.; Rollnick, S.; Edwards, A.; Barry, M.

    2012-01-01

    The principles of shared decision making are well documented but there is a lack of guidance about how to accomplish the approach in routine clinical practice. Our aim here is to translate existing conceptual descriptions into a three-step model that is practical, easy to remember, and can act as a

  8. Shared Decision Making in Education Governance Using Business Portals

    Science.gov (United States)

    Peoples, Adrian L.

    2009-01-01

    The purpose of this study was to address a high-volume problem for the Delaware Department of Education Office of Professional Accountability (OPA). This problem was addressed by sharing the certification decision with qualified personnel located at each of the four teacher preparation programs located in Delaware at Delaware State University…

  9. Adherence, shared decision-making and patient autonomy.

    Science.gov (United States)

    Sandman, Lars; Granger, Bradi B; Ekman, Inger; Munthe, Christian

    2012-05-01

    In recent years the formerly quite strong interest in patient compliance has been questioned for being too paternalistic and oriented towards overly narrow biomedical goals as the basis for treatment recommendations. In line with this there has been a shift towards using the notion of adherence to signal an increased weight for patients' preferences and autonomy in decision making around treatments. This 'adherence-paradigm' thus encompasses shared decision-making as an ideal and patient perspective and autonomy as guiding goals of care. What this implies in terms of the importance that we have reason to attach to (non-)adherence and how has, however, not been explained. In this article, we explore the relationship between different forms of shared decision-making, patient autonomy and adherence. Distinguishing between dynamically and statically framed adherence we show how the version of shared decision-making advocated will have consequences for whether one should be interested in a dynamically or statically framed adherence and in what way patient adherence should be assessed. In contrast to the former compliance paradigm (where non-compliance was necessarily seen as a problem), using observations about (non-)adherence to assess the success of health care decision making and professional-patient interaction turns out to be a much less straightforward matter.

  10. Navigating the Decision Space: Shared Medical Decision Making as Distributed Cognition.

    Science.gov (United States)

    Lippa, Katherine D; Feufel, Markus A; Robinson, F Eric; Shalin, Valerie L

    2016-08-23

    Despite increasing prominence, little is known about the cognitive processes underlying shared decision making. To investigate these processes, we conceptualize shared decision making as a form of distributed cognition. We introduce a Decision Space Model to identify physical and social influences on decision making. Using field observations and interviews, we demonstrate that patients and physicians in both acute and chronic care consider these influences when identifying the need for a decision, searching for decision parameters, making actionable decisions Based on the distribution of access to information and actions, we then identify four related patterns: physician dominated; physician-defined, patient-made; patient-defined, physician-made; and patient-dominated decisions. Results suggests that (a) decision making is necessarily distributed between physicians and patients, (b) differential access to information and action over time requires participants to transform a distributed task into a shared decision, and (c) adverse outcomes may result from failures to integrate physician and patient reasoning. Our analysis unifies disparate findings in the medical decision-making literature and has implications for improving care and medical training.

  11. Temporal characteristics of decisions in hospital encounters: a threshold for shared decision making? A qualitative study.

    Science.gov (United States)

    Ofstad, Eirik H; Frich, Jan C; Schei, Edvin; Frankel, Richard M; Gulbrandsen, Pål

    2014-11-01

    To identify and characterize physicians' statements that contained evidence of clinically relevant decisions in encounters with patients in different hospital settings. Qualitative analysis of 50 videotaped encounters from wards, the emergency room (ER) and outpatient clinics in a department of internal medicine at a Norwegian university hospital. Clinical decisions could be grouped in a temporal order: decisions which had already been made, and were brought into the encounter by the physician (preformed decisions), decisions made in the present (here-and-now decisions), and decisions prescribing future actions given a certain course of events (conditional decisions). Preformed decisions were a hallmark in the ward and conditional decisions a main feature of ER encounters. Clinical decisions related to a patient-physician encounter spanned a time frame exceeding the duration of the encounter. While a distribution of decisions over time and space fosters sharing and dilution of responsibility between providers, it makes the decision making process hard to access for patients. In order to plan when and how to involve patients in decisions, physicians need increased awareness of when clinical decisions are made, who usually makes them, and who should make them. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  12. Facilitating Secure Sharing of Personal Health Data in the Cloud

    Science.gov (United States)

    Nepal, Surya; Glozier, Nick

    2016-01-01

    Background Internet-based applications are providing new ways of promoting health and reducing the cost of care. Although data can be kept encrypted in servers, the user does not have the ability to decide whom the data are shared with. Technically this is linked to the problem of who owns the data encryption keys required to decrypt the data. Currently, cloud service providers, rather than users, have full rights to the key. In practical terms this makes the users lose full control over their data. Trust and uptake of these applications can be increased by allowing patients to feel in control of their data, generally stored in cloud-based services. Objective This paper addresses this security challenge by providing the user a way of controlling encryption keys independently of the cloud service provider. We provide a secure and usable system that enables a patient to share health information with doctors and specialists. Methods We contribute a secure protocol for patients to share their data with doctors and others on the cloud while keeping complete ownership. We developed a simple, stereotypical health application and carried out security tests, performance tests, and usability tests with both students and doctors (N=15). Results We developed the health application as an app for Android mobile phones. We carried out the usability tests on potential participants and medical professionals. Of 20 participants, 14 (70%) either agreed or strongly agreed that they felt safer using our system. Using mixed methods, we show that participants agreed that privacy and security of health data are important and that our system addresses these issues. Conclusions We presented a security protocol that enables patients to securely share their eHealth data with doctors and nurses and developed a secure and usable system that enables patients to share mental health information with doctors. PMID:27234691

  13. Facilitating Group Decision-Making: Facilitator's Subjective Theories on Group Coordination

    Directory of Open Access Journals (Sweden)

    Michaela Kolbe

    2008-10-01

    Full Text Available A key feature of group facilitation is motivating and coordinating people to perform their joint work. This paper focuses on group coordination which is a prerequisite to group effectiveness, especially in complex tasks. Decision-making in groups is a complex task that consequently needs to be coordinated by explicit rather than implicit coordination mechanisms. Based on the embedded definition that explicit coordination does not just happen but is purposely executed by individuals, we argue that individual coordination intentions and mechanisms should be taken into account. Thus far, the subjective perspective of coordination has been neglected in coordination theory, which is understandable given the difficulties in defining and measuring subjective aspects of group facilitation. We therefore conducted focused interviews with eight experts who either worked as senior managers or as experienced group facilitators and analysed their approaches to group coordination using methods of content analysis. Results show that these experts possess sophisticated mental representations of their coordination behaviour. These subjective coordination theories can be organised in terms of coordination schemes in which coordination-releasing situations are facilitated by special coordination mechanisms that, in turn, lead to the perception of specific consequences. We discuss the importance of these subjective coordination theories for effectively facilitating group decision-making and minimising process losses. URN: urn:nbn:de:0114-fqs0901287

  14. Ten Years, Forty Decision Aids, And Thousands Of Patient Uses: Shared Decision Making At Massachusetts General Hospital.

    Science.gov (United States)

    Sepucha, Karen R; Simmons, Leigh H; Barry, Michael J; Edgman-Levitan, Susan; Licurse, Adam M; Chaguturu, Sreekanth K

    2016-04-01

    Shared decision making is a core component of population health strategies aimed at improving patient engagement. Massachusetts General Hospital's integration of shared decision making into practice has focused on the following three elements: developing a culture receptive to, and health care providers skilled in, shared decision making conversations; using patient decision aids to help inform and engage patients; and providing infrastructure and resources to support the implementation of shared decision making in practice. In the period 2005-15, more than 900 clinicians and other staff members were trained in shared decision making, and more than 28,000 orders for one of about forty patient decision aids were placed to support informed patient-centered decisions. We profile two different implementation initiatives that increased the use of patient decision aids at the hospital's eighteen adult primary care practices, and we summarize key elements of the shared decision making program.

  15. The concept of negotiation in shared decision making.

    Science.gov (United States)

    Sandman, Lars

    2009-09-01

    In central definitions of shared decision-making within medical consultations we find the concept of negotiation used to describe the interaction between patient and professional in case of conflict. It has been noted that the concept of negotiation is far from clear in this context and in other contexts it is used both in terms of rational deliberation and bargaining. The articles explores whether rational deliberation or bargaining accurately describes the negotiation in shared decision-making and finds that it fails to do so on both descriptive and normative grounds. At the end some notes on further analysis is given and it is suggested that the interaction is more accurately described in terms of an internal balancing of values like patient best interest, patient autonomy and patient adherence by the professional that is accepted by the patient.

  16. Sharing and Communicating Intuition in Organizational Decision Making

    DEFF Research Database (Denmark)

    Constantiou, Ioanna; Shollo, Arisa; Vendelø, Morten Thanning

    Research on intuition as part of decision making is well established in the fields of management and organization studies. There has been a large number of important theoretical works as well as empirical studies focusing on senior managers’ or executives’ intuition. While such studies are evidence...... built from a longitudinal, qualitative study of the prioritization of information technology projects in a large financial institution. Our findings indicate that during project prioritization meetings, managers use four tactics when they share and communicate intuition....

  17. [Cancer screening in clinical practice: the value of shared decision-making].

    Science.gov (United States)

    Cornuz, Jacques; Junod, Noëlle; Pasche, Olivier; Guessous, Idris

    2010-07-14

    Shared decision-making approach to uncertain clinical situations such as cancer screening seems more appropriate than ever. Shared decision making can be defined as an interactive process where physician and patient share all the stages of the decision making process. For patients who wish to be implicated in the management of their health conditions, physicians might express difficulty to do so. Use of patient decision aids appears to improve such process of shared decision making.

  18. How can continuing professional development better promote shared decision-making? Perspectives from an international collaboration

    Science.gov (United States)

    2011-01-01

    Background Shared decision-making is not widely implemented in healthcare. We aimed to set a research agenda about promoting shared decision-making through continuing professional development. Methods Thirty-six participants met for two days. Results Participants suggested ways to improve an environmental scan that had inventoried 53 shared decision-making training programs from 14 countries. Their proposed research agenda included reaching an international consensus on shared decision-making competencies and creating a framework for accrediting continuing professional development initiatives in shared decision-making. Conclusions Variability in shared decision-making training programs showcases the need for quality assurance frameworks. PMID:21729310

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

    Science.gov (United States)

    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

  20. Shared Decision-Making in the Management of Congenital Vascular Malformations.

    Science.gov (United States)

    Horbach, Sophie E R; Ubbink, Dirk T; Stubenrouch, Fabienne E; Koelemay, Mark J W; van der Vleuten, Carine J M; Verhoeven, Bas H; Reekers, Jim A; Schultze Kool, Leo J; van der Horst, Chantal M A M

    2017-03-01

    In shared decision-making, clinicians and patients arrive at a joint treatment decision, by incorporating best available evidence and the patients' personal values and preferences. Little is known about the role of shared decision-making in managing patients with congenital vascular malformations, for which preference-sensitive decision-making seems obvious. The authors investigated preferences regarding decision-making and current shared decision-making behavior during physician-patient encounters. In two Dutch university hospitals, adults and children with congenital vascular malformations facing a treatment-related decision were enrolled. Before the consultation, patients (or parents of children) expressed their preference regarding decision-making (Control Preferences Scale). Afterward, participants completed shared decision-making-specific questionnaires (nine-item Shared Decision-Making Questionnaire, CollaboRATE, and satisfaction), and physicians completed the Shared Decision-Making Questionnaire-Physician questionnaire. Consultations were audiotaped and patient involvement was scored by two independent researchers using the five-item Observing Patient Involvement instrument. All questionnaire results were expressed on a scale of 0 to 100 (optimum shared decision-making). Fifty-five participants (24 parents and 31 adult patients) were included. Two-thirds preferred the shared decision-making approach (Control Preferences Scale). Objective five-item Observing Patient Involvement scores were low (mean ± SD, 31 ± 15), whereas patient and physician Shared Decision-Making Questionnaire scores were high, with means of 68 ± 18 and 68 ± 19, respectively. The median CollaboRATE score was 93. There was no clear relationship between shared decision-making and satisfaction scores. Although adults and parents of children with vascular malformations express a strong desire for shared decision-making, objective shared decision-making behavior is still lacking, most

  1. Shared decision making: skill acquisition for year III medical students.

    Science.gov (United States)

    Morrow, Cathleen E; Reed, Virginia A; Eliassen, M Scottie; Imset, Inger

    2011-01-01

    A foundation of care within a Patient-centered Medical Home (PCMH) is respect for patients' values and preferences. Shared decision making (SDM) involves a set of principles and approaches to working with patients that integrates medical information and data with the preferences, values, and support systems of individual patients facing medical decisions. The value of SDM is increasingly evidenced by the incorporation of principles of SDM into the definitions of patient-centered care and PCMHs, accountable care organizations, and the language of the Health Reform Act of 2010. We developed and integrated a curriculum on SDM in the third-year Family Medicine Clerkship at Dartmouth Medical School. The curriculum consisted of a mix of experiential, classroom, and online experiences designed to provide students with opportunities to learn content, practice skills, and share observations from their preceptorships. Student feedback was an important component of evaluating the SDM curriculum. Themes identified from students' reflections on their own behavior in a Simulated Patient Encounter included an increase in confidence and competence in their ability to use SDM, while noting the disconnect that may exist between what is taught in the clerkship and what they experience in their preceptorships. As this curriculum has developed, we have acquired a deep appreciation of the benefits and challenges of attempting to teach sophisticated communication and decision-making precepts to medical students who are working to master fundamentals of clinical work and who may or may not see such precepts reinforced in practice.

  2. Transforming work place relationships through shared decision making.

    Science.gov (United States)

    MacPhee, Maura; Wardrop, Andrea; Campbell, Cheryl

    2010-11-01

    Using Donabedian's Structure-Process-Outcomes (SPO) paradigm, this study explored the SPO linkages related to nurse-nurse leader shared decision making around workload issues, such as safe staffing assignments. Shared decision making represents nurses' control over practice, which is associated with positive nurse outcomes, such as job satisfaction. This study is based upon four project sites where nurse-led project teams addressed workload issues. Participatory action research was used, with the authors acting as participant observers. Four sites were case ordered and analysed: least successful to most successful outcomes. Cross-case matrices were constructed to identify SPO linkages. Data included observation field notes, interviews and focus groups. Operations leaders with formal access to empowerment structures, such as information and resources, were the critical link to successful outcomes. Sites with conflict that blocked team-operations leader relationships were unable to engage in effective, sustainable decision making. Effective work relationships among teams consisting of staff and front-line leaders contributed to successful outcomes, but team-operations leader relationships made the biggest difference. Formal access to power through leadership is critical for building and sustaining processes that promote and sustain nurses' control over practice. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

  3. A qualitative systematic review of internal and external influences on shared decision-making in all health care settings.

    Science.gov (United States)

    Truglio-Londrigan, Marie; Slyer, Jason T; Singleton, Joanne K; Worral, Priscilla

    2012-01-01

    . 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

  4. Oncology Nursing and Shared Decision Making for Cancer Treatment.

    Science.gov (United States)

    Tariman, Joseph D; Mehmeti, Enisa; Spawn, Nadia; McCarter, Sarah P; Bishop-Royse, Jessica; Garcia, Ima; Hartle, Lisa; Szubski, Katharine

    2016-10-01

    This study aimed to describe the contemporary role of the oncology nurse throughout the entire cancer shared decision-making (SDM) process. Study participants consisted of 30 nurses and nurse practitioners who are actively involved in direct care of patients with cancer in the inpatient or outpatient setting. The major themes that emerged from the content analysis are: oncology nurses have various roles at different time points and settings of cancer SDM processes; patient education, advocacy, and treatment side effects management are among the top nursing roles; oncology nurses value their participation in the cancer SDM process; oncology nurses believe they have a voice, but with various degrees of influence in actual treatment decisions; nurses' level of disease knowledge influences the degree of participation in cancer SDM; and the nursing role during cancer SDM can be complicated and requires flexibility.
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  5. Implementing shared decision making in routine mental health care.

    Science.gov (United States)

    Slade, Mike

    2017-06-01

    Shared decision making (SDM) in mental health care involves clinicians and patients working together to make decisions. The key elements of SDM have been identified, decision support tools have been developed, and SDM has been recommended in mental health at policy level. Yet implementation remains limited. Two justifications are typically advanced in support of SDM. The clinical justification is that SDM leads to improved outcome, yet the available empirical evidence base is inconclusive. The ethical justification is that SDM is a right, but clinicians need to balance the biomedical ethical principles of autonomy and justice with beneficence and non-maleficence. It is argued that SDM is "polyvalent", a sociological concept which describes an idea commanding superficial but not deep agreement between disparate stakeholders. Implementing SDM in routine mental health services is as much a cultural as a technical problem. Three challenges are identified: creating widespread access to high-quality decision support tools; integrating SDM with other recovery-supporting interventions; and responding to cultural changes as patients develop the normal expectations of citizenship. Two approaches which may inform responses in the mental health system to these cultural changes - social marketing and the hospitality industry - are identified. © 2017 World Psychiatric Association.

  6. Decision boxes for clinicians to support evidence-based practice and shared decision making: the user experience

    Directory of Open Access Journals (Sweden)

    Giguere Anik

    2012-08-01

    Full Text Available Abstract Background This project engages patients and physicians in the development of Decision Boxes, short clinical topic summaries covering medical questions that have no single best answer. Decision Boxes aim to prepare the clinician to communicate the risks and benefits of the available options to the patient so they can make an informed decision together. Methods Seven researchers (including four practicing family physicians selected 10 clinical topics relevant to primary care practice through a Delphi survey. We then developed two one-page prototypes on two of these topics: prostate cancer screening with the prostate-specific antigen test, and prenatal screening for trisomy 21 with the serum integrated test. We presented the prototypes to purposeful samples of family physicians distributed in two focus groups, and patients distributed in four focus groups. We used the User Experience Honeycomb to explore barriers and facilitators to the communication design used in Decision Boxes. All discussions were transcribed, and three researchers proceeded to thematic content analysis of the transcriptions. The coding scheme was first developed from the Honeycomb’s seven themes (valuable, usable, credible, useful, desirable, accessible, and findable, and included new themes suggested by the data. Prototypes were modified in light of our findings. Results Three rounds were necessary for a majority of researchers to select 10 clinical topics. Fifteen physicians and 33 patients participated in the focus groups. Following analyses, three sections were added to the Decision Boxes: introduction, patient counseling, and references. The information was spread to two pages to try to make the Decision Boxes less busy and improve users’ first impression. To try to improve credibility, we gave more visibility to the research institutions involved in development. A statement on the boxes’ purpose and a flow chart representing the shared decision

  7. Decision boxes for clinicians to support evidence-based practice and shared decision making: the user experience.

    Science.gov (United States)

    Giguere, Anik; Légaré, France; Grad, Roland; Pluye, Pierre; Haynes, R Brian; Cauchon, Michel; Rousseau, François; Alvarez Argote, Juliana; Labrecque, Michel

    2012-08-03

    This project engages patients and physicians in the development of Decision Boxes, short clinical topic summaries covering medical questions that have no single best answer. Decision Boxes aim to prepare the clinician to communicate the risks and benefits of the available options to the patient so they can make an informed decision together. Seven researchers (including four practicing family physicians) selected 10 clinical topics relevant to primary care practice through a Delphi survey. We then developed two one-page prototypes on two of these topics: prostate cancer screening with the prostate-specific antigen test, and prenatal screening for trisomy 21 with the serum integrated test. We presented the prototypes to purposeful samples of family physicians distributed in two focus groups, and patients distributed in four focus groups. We used the User Experience Honeycomb to explore barriers and facilitators to the communication design used in Decision Boxes. All discussions were transcribed, and three researchers proceeded to thematic content analysis of the transcriptions. The coding scheme was first developed from the Honeycomb's seven themes (valuable, usable, credible, useful, desirable, accessible, and findable), and included new themes suggested by the data. Prototypes were modified in light of our findings. Three rounds were necessary for a majority of researchers to select 10 clinical topics. Fifteen physicians and 33 patients participated in the focus groups. Following analyses, three sections were added to the Decision Boxes: introduction, patient counseling, and references. The information was spread to two pages to try to make the Decision Boxes less busy and improve users' first impression. To try to improve credibility, we gave more visibility to the research institutions involved in development. A statement on the boxes' purpose and a flow chart representing the shared decision-making process were added with the intent of clarifying the tool

  8. Environment Climate Data Sweden - Facilitating a wider sharing of environment and climate data

    Science.gov (United States)

    Klein, T.; Langner, J.; Broman, B.; Svensson, J.; Frankenberg, B.; Langborg, T.; Bennet, C.

    2012-04-01

    The global society is facing significant challenges. Earth is a complex system of systems, where humankind's activities have become a critical parameter, as is demonstrated by global environmental and climate change. Full and open sharing of environment and climate data is a critical prerequisite to advance the scientific understanding of environment and climate and the connections to humankind's socioeconomic activities. In addition, data sharing is vital for the design, implementation, monitoring and evaluation of environmental policies, informed decision making and, eventually, sustainable development. Full and open data access facilitates new ways to analyze, integrate and combine data from many different sources. This is in particular evident in the geosciences, where the complexity and level of integration of Earth system models is advancing rapidly. At the same time, many research communities are lacking resources, knowledge and in some cases motivation to allow for a professional stewardship of data. Insufficient coordination and a low priority of tasks such as data collection, storage and documentation put many important research data at risk of being lost. A recent hearing of Swedish environment and climate researchers found that researchers often have difficulties to get a good overview of relevant data within and beyond their field of study. Furthermore, it can be difficult to access and integrate relevant data. As a consequence, Sweden is establishing a new research infrastructure for environment and climate data called ECDS (Environment Climate Data Sweden, www.ecds.se). ECDS is a joint undertaking of the Swedish Research Council and the Swedish Meteorological and Hydrological Institute, in collaboration with the National Supercomputer Centre of Linköping University, Sweden. ECDS aims to facilitate the search, publication and long-term accessibility of data for research. The ECDS-infrastructure consists of a clearinghouse mechanism, allowing for the

  9. Barriers and facilitators to the dissemination of DECISION+, a continuing medical education program for optimizing decisions about antibiotics for acute respiratory infections in primary care: A study protocol

    Directory of Open Access Journals (Sweden)

    Gagnon Marie-Pierre

    2011-01-01

    Full Text Available Abstract Background In North America, acute respiratory infections are the main reason for doctors' visits in primary care. Family physicians and their patients overuse antibiotics for treating acute respiratory infections. In a pilot clustered randomized trial, we showed that DECISION+, a continuing medical education program in shared decision making, has the potential to reduce the overuse of antibiotics for treating acute respiratory infections. DECISION+ learning activities consisted of three interactive sessions of three hours each, reminders at the point of care, and feedback to doctors on their agreement with patients about comfort with the decision whether to use antibiotics. The objective of this study is to identify the barriers and facilitators to physicians' participation in DECISION+ with the goal of disseminating DECISION+ on a larger scale. Methods/design This descriptive study will use mixed methods and retrospective and prospective components. All analyses will be based on an adapted version of the Ottawa Model of Research Use. First, we will use qualitative methods to analyze the following retrospective data from the pilot study: the logbooks of eight research assistants, the transcriptions of 15 training sessions, and 27 participant evaluations of the DECISION+ training sessions. Second, we will collect prospective data in semi-structured focus groups composed of family physicians to identify barriers and facilitators to the dissemination of a future training program similar to DECISION+. All 39 family physicians exposed to DECISION+ during the pilot project will be eligible to participate. We will use a self-administered questionnaire based on Azjen's Theory of Planned Behaviour to assess participants' intention to take part in future training programs similar to DECISION+. Discussion Barriers and facilitators identified in this project will guide modifications to DECISION+, a continuing medical education program in shared

  10. Addressing Barriers to Shared Decision Making Among Latino LGBTQ Patients and Healthcare Providers in Clinical Settings.

    Science.gov (United States)

    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.

  11. Information and shared decision-making are top patients' priorities

    Directory of Open Access Journals (Sweden)

    Bronstein Alexander

    2006-02-01

    Full Text Available Abstract Background The profound changes in medical care and the recent stress on a patient-centered approach mandate evaluation of current patient priorities. Methods Hospitalized and ambulatory patients at an academic medical center in central Israel were investigated. Consecutive patients (n = 274 indicated their first and second priority for a change or improvement in their medical care out of a mixed shortlist of 6 issues, 3 related to patient-physician relationship (being better informed and taking part in decisions; being seen by the same doctor each time; a longer consultation time and 3 issues related to the organizational aspect of care (easier access to specialists/hospital; shorter queue for tests; less charges for drugs. Results Getting more information from the physician and taking part in decisions was the most desirable patient choice, selected by 27.4% as their first priority. The next choices – access and queue – also relate to more patient autonomy and control over that of managed care regulations. Patients studied were least interested in continuity of care, consultation time or cost of drugs. Demographic or clinical variables were not significantly related to patients' choices. Conclusion Beyond its many benefits, being informed by their doctor and shared decision making is a top patient priority.

  12. Communicating statin evidence to support shared decision-making.

    Science.gov (United States)

    Barrett, Bruce; Ricco, Jason; Wallace, Margaret; Kiefer, David; Rakel, Dave

    2016-04-06

    The practice of clinical medicine rests on a foundation of ethical principles as well as scientific knowledge. Clinicians must artfully balance the principle of beneficence, doing what is best for patients, with autonomy, allowing patients to make their own well-informed health care decisions. The clinical communication process is complicated by varying degrees of confidence in scientific evidence regarding patient-oriented benefits, and by the fact that most medical options are associated with possible harms as well as potential benefits. Evidence-based clinical guidelines often neglect patient-oriented issues involved with the thoughtful practice of shared decision-making, where individual values, goals, and preferences should be prioritized. Guidelines on the use of statin medications for preventing cardiovascular events are a case in point. Current guidelines endorse the use of statins for people whose 10-year risk of cardiovascular events is as low as 7.5%. Previous guidelines set the 10-year risk benchmark at 20%. Meta-analysis of randomized trials suggests that statins can reduce cardiovascular event rates by about 25%, bringing 10-year risk from 7.5 to 5.6%, for example, or from 20 to 15%. Whether or not these benefits should justify the use of statins for individual patients depends on how those advantages are valued in comparison with disadvantages, such as side effect risks, and with inconveniences associated with taking a pill each day and visiting clinicians and laboratories regularly. Whether or not the overall benefit-harm balance justifies the use of a medication for an individual patient cannot be determined by a guidelines committee, a health care system, or even the attending physician. Instead, it is the individual patient who has a fundamental right to decide whether or not taking a drug is worthwhile. Researchers and professional organizations should endeavor to develop shared decision-making tools that provide up-to-date best evidence in

  13. Shared decision-making in the context of unruptured intracranial aneurysms management

    Directory of Open Access Journals (Sweden)

    Luís Henrique de Castro-Afonso

    2015-09-01

    Full Text Available Shared decision-making practice has been encouraged in several clinical settings. In this model, clinical decisions are defined by doctors and patients based on the principle of patient autonomy. Shared decisions have been argued as an ethical clinical practice during complex and uncertain clinical situations. The best management of unruptured intracranial aneurysms (UIA remains controversial. Despite the fact that shared decisions has probably been practiced, as far as we are aware it has not yet been evaluated, nor has it been standardized for patients presenting UIA. We aim to discuss possible roles, pros and cons of shared decision-making on the management of UIA.

  14. Shared decision making in patients with low risk chest pain: prospective randomized pragmatic trial

    Science.gov (United States)

    Hollander, Judd E; Schaffer, Jason T; Kline, Jeffrey A; Torres, Carlos A; Diercks, Deborah B; Jones, Russell; Owen, Kelly P; Meisel, Zachary F; Demers, Michel; Leblanc, Annie; Shah, Nilay D; Inselman, Jonathan; Herrin, Jeph; Castaneda-Guarderas, Ana; Montori, Victor M

    2016-01-01

    Objective To compare the effectiveness of shared decision making with usual care in choice of admission for observation and further cardiac testing or for referral for outpatient evaluation in patients with possible acute coronary syndrome. Design Multicenter pragmatic parallel randomized controlled trial. Setting Six emergency departments in the United States. Participants 898 adults (aged >17 years) with a primary complaint of chest pain who were being considered for admission to an observation unit for cardiac testing (451 were allocated to the decision aid and 447 to usual care), and 361 emergency clinicians (emergency physicians, nurse practitioners, and physician assistants) caring for patients with chest pain. Interventions Patients were randomly assigned (1:1) by an electronic, web based system to shared decision making facilitated by a decision aid or to usual care. The primary outcome, selected by patient and caregiver advisers, was patient knowledge of their risk for acute coronary syndrome and options for care; secondary outcomes were involvement in the decision to be admitted, proportion of patients admitted for cardiac testing, and the 30 day rate of major adverse cardiac events. Results Compared with the usual care arm, patients in the decision aid arm had greater knowledge of their risk for acute coronary syndrome and options for care (questions correct: decision aid, 4.2 v usual care, 3.6; mean difference 0.66, 95% confidence interval 0.46 to 0.86), were more involved in the decision (observing patient involvement scores: decision aid, 18.3 v usual care, 7.9; 10.3, 9.1 to 11.5), and less frequently decided with their clinician to be admitted for cardiac testing (decision aid, 37% v usual care, 52%; absolute difference 15%; P<0.001). There were no major adverse cardiac events due to the intervention. Conclusions Use of a decision aid in patients at low risk for acute coronary syndrome increased patient knowledge about their risk, increased

  15. Incentivizing shared decision making in the USA--where are we now?

    NARCIS (Netherlands)

    Durand, M.A.; Barr, P.J.; Walsh, T.; Elwyn, G.

    2015-01-01

    BACKGROUND: The Affordable Care Act raised significant interest in the process of shared decision making, the role of patient decision aids, and incentivizing their utilization. However, it has not been clear how best to put incentives into practice, and how the implementation of shared decision mak

  16. Shared Decision-Making in the Management of Congenital Vascular Malformations

    NARCIS (Netherlands)

    Horbach, S.E.; Ubbink, D.T.; Stubenrouch, F.E.; Koelemay, M.J.; Vleuten, C.J.M. van der; Verhoeven, B.H.; Reekers, J.A.; Schultze Kool, L.J.; Horst, C.M. van der

    2017-01-01

    BACKGROUND: In shared decision-making, clinicians and patients arrive at a joint treatment decision, by incorporating best available evidence and the patients' personal values and preferences. Little is known about the role of shared decision-making in managing patients with congenital vascular malf

  17. Inside the black box of shared decision making: distinguishing between the process of involvement and who makes the decision.

    NARCIS (Netherlands)

    Edwards, A.; Elwyn, G.

    2006-01-01

    BACKGROUND: Shared decision making has practical implications for everyday health care. However, it stems from largely theoretical frameworks and is not widely implemented in routine practice. AIMS: We undertook an empirical study to inform understanding of shared decision making and how it can be o

  18. Shared decision-making in medication management: development of a training intervention.

    Science.gov (United States)

    Stead, Ute; Morant, Nicola; Ramon, Shulamit

    2017-08-01

    Shared decision-making is a collaborative process in which clinicians and patients make treatment decisions together. Although it is considered essential to patient-centred care, the adoption of shared decision-making into routine clinical practice has been slow, and there is a need to increase implementation. This paper describes the development and delivery of a training intervention to promote shared decision-making in medication management in mental health as part of the Shared Involvement in Medication Management Education (ShIMME) project. Three stakeholder groups (service users, care coordinators and psychiatrists) received training in shared decision-making, and their feedback was evaluated. The programme was mostly well received, with all groups rating interaction with peers as the best aspect of the training. This small-scale pilot shows that it is feasible to deliver training in shared decision-making to several key stakeholders. Larger studies will be required to assess the effectiveness of such training.

  19. Shared decision-making using personal health record technology: a scoping review at the crossroads.

    Science.gov (United States)

    Davis, Selena; Roudsari, Abdul; Raworth, Rebecca; Courtney, Karen L; MacKay, Lee

    2017-07-01

    This scoping review aims to determine the size and scope of the published literature on shared decision-making (SDM) using personal health record (PHR) technology and to map the literature in terms of system design and outcomes. Literature from Medline, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, Engineering Village, and Web of Science (2005-2015) using the search terms "personal health records," "shared decision making," "patient-provider communication," "decision aid," and "decision support" was included. Articles ( n  = 38) addressed the efficacy or effectiveness of PHRs for SDM in engaging patients in self-care and decision-making or ways patients can be supported in SDM via PHR. Analysis resulted in an integrated SDM-PHR conceptual framework. An increased interest in SDM via PHR is apparent, with 55% of articles published within last 3 years. Sixty percent of the literature originates from the United States. Twenty-six articles address a particular clinical condition, with 10 focused on diabetes, and one-third offer empirical evidence of patient outcomes. The tethered and standalone PHR architectural types were most studied, while the interconnected PHR type was the focus of more recently published methodological approaches and discussion articles. The study reveals a scarcity of rigorous research on SDM via PHR. Research has focused on one or a few of the SDM elements and not on the intended complete process. Just as PHR technology designed on an interconnected architecture has the potential to facilitate SDM, integrating the SDM process into PHR technology has the potential to drive PHR value.

  20. Exploring the experiences of client involvement in medication decisions using a shared decision making model: results of a qualitative study.

    Science.gov (United States)

    Goscha, Richard; Rapp, Charles

    2015-04-01

    This qualitative study explored a newly introduced model of shared decision making (CommonGround) and how psychiatric medications were experienced by clients, prescribers, case managers and peer support staff. Of the twelve client subjects, six were highly engaged in shared decision-making and six were not. Five notable differences were found between the two groups including the presence of a goal, use of personal medicine, and the behavior of case managers and prescribers. Implications for a shared decision making model in psychiatry are discussed.

  1. MAPPIN'SDM--the multifocal approach to sharing in shared decision making.

    Directory of Open Access Journals (Sweden)

    Jürgen Kasper

    Full Text Available BACKGROUND: The wide scale permeation of health care by the shared decision making concept (SDM reflects its relevance and advanced stage of development. An increasing number of studies evaluating the efficacy of SDM use instruments based on various sub-constructs administered from different viewpoints. However, as the concept has never been captured in operable core definition it is quite difficult to link these parts of evidence. This study aims at investigating interrelations of SDM indicators administered from different perspectives. METHOD: A comprehensive inventory was developed mapping judgements from different perspectives (observer, doctor, patient and constructs (behavior, perception referring to three units (doctor, patient, doctor-patient-dyad and an identical set of SDM-indicators. The inventory adopted the existing approaches, but added additional observer foci (patient and doctor-patient-dyad and relevant indicators hitherto neglected by existing instruments. The complete inventory comprising a doctor-patient-questionnaire and an observer-instrument was applied to 40 decision consultations from 10 physicians from different medical fields. Convergent validities were calculated on the basis of Pearson correlation coefficients. RESULTS: Reliabilities for all scales were high to excellent. No correlations were found between observer and patients or physicians neither for means nor for single items. Judgements of doctors and patients were moderately related. Correlations between the observer scales and within the subjective perspectives were high. Inter-perspective agreement was not related to SDM performance or patient activity. CONCLUSION: The study demonstrates the contribution to involvement made by each of the relevant perspectives and emphasizes the need for an inter-subjective approach regarding SDM measurement.

  2. Manufactured but not imported: new directions for research in shared decision making support and skills.

    NARCIS (Netherlands)

    Edwards, A.; Evans, R.W.; Elwyn, G.

    2003-01-01

    Significant conceptual work on shared decision making has taken place but there are still significant challenges in achieving it in routine clinical practice. This paper outlines what research has identified to date that may promote shared decision making, and the further research that is required t

  3. Translating shared decision-making into health care clinical practices: Proof of concepts.

    NARCIS (Netherlands)

    Legare, F.; Elwyn, G.; Fishbein, M.; Fremont, P.; Frosch, D.; Gagnon, M.P.; Kenny, D.A.; Labrecque, M.; Stacey, D.; St-Jacques, S.; Weijden, T.T. van der

    2008-01-01

    ABSTRACT: BACKGROUND: There is considerable interest today in shared decision-making (SDM), defined as a decision-making process jointly shared by patients and their health care provider. However, the data show that SDM has not been broadly adopted yet. Consequently, the main goal of this proposal i

  4. Shared decision making and risk communication in practice: a qualitative study of GPs' experiences.

    NARCIS (Netherlands)

    Edwards, A.; Elwyn, G.; Wood, F.; Atwell, C.; Prior, L.; Houston, H.

    2005-01-01

    BACKGROUND: Important barriers to the wider implementation of shared decision making remain. The experiences of professionals who are skilled in this approach may identify how to overcome these barriers. AIMS: To identify the experiences and views of professionals skilled in shared decision making

  5. Why shared decision making is not good enough: lessons from patients

    NARCIS (Netherlands)

    Olthuis, G.J.; Leget, C.J.W.; Grypdonck, M.H.F.

    2014-01-01

    A closer look at the lived illness experiences of medical professionals themselves shows that shared decision making is in need of a logic of care. This paper underlines that medical decision making inevitably takes place in a messy and uncertain context in which sharing responsibilities may impose

  6. Shared decision-making in pediatric otolaryngology: Parent, physician and observational perspectives.

    Science.gov (United States)

    Hong, Paul; Maguire, Erin; Gorodzinsky, Ayala Y; Curran, Janet A; Ritchie, Krista; Chorney, Jill

    2016-08-01

    To describe physician and parent behavior during pediatric otolaryngology surgical consultations, and to assess whether perceptions of shared decision-making and observed behavior are related. Parents of 126 children less than 6-years of age who underwent consultation for adeontonsillectomy or tympanostomy tube insertion were prospectively enrolled. Parents completed the Shared Decision-Making Questionnaire-Patient version (SDM-Q-9), while surgeons completed the Shared Decision-Making Questionnaire-Physician version (SDM-Q-Doc) after the consultation. Visits were video-recorded and analyzed using the Roter Interaction Analysis System to quantify physician and parent involvement during the consultation. Perceptions of shared decision-making between parents (SDM-Q-9) and physicians (SDM-Q-Doc) were significantly positively correlated (p = 0.03). However, there was no correlation between parents' perceptions of shared decision-making and observations of physician and parent behavior/involvement (proportion of physician socioemotional talk, task-focused talk, or proportion of parent talk). Surgeons' perceptions of shared decision-making were correlated with physician task-focused talk and proportion of parent talk. Parents and physicians had similar perceptions of the degree of shared decision-making to be taking place during pediatric otolaryngology consultations. However, there was variability in the degree to which parents participated, and parent perceptions of shared decision-making were not correlated with actual observed involvement. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  7. Core competencies for shared decision making training programs: insights from an international, interdisciplinary working group.

    Science.gov (United States)

    Légaré, France; Moumjid-Ferdjaoui, Nora; Drolet, Renée; Stacey, Dawn; Härter, Martin; Bastian, Hilda; Beaulieu, Marie-Dominique; Borduas, Francine; Charles, Cathy; Coulter, Angela; Desroches, Sophie; Friedrich, Gwendolyn; Gafni, Amiram; Graham, Ian D; Labrecque, Michel; LeBlanc, Annie; Légaré, Jean; Politi, Mary; Sargeant, Joan; Thomson, Richard

    2013-01-01

    Shared decision making is now making inroads in health care professionals' continuing education curriculum, but there is no consensus on what core competencies are required by clinicians for effectively involving patients in health-related decisions. Ready-made programs for training clinicians in shared decision making are in high demand, but existing programs vary widely in their theoretical foundations, length, and content. An international, interdisciplinary group of 25 individuals met in 2012 to discuss theoretical approaches to making health-related decisions, compare notes on existing programs, take stock of stakeholders concerns, and deliberate on core competencies. This article summarizes the results of those discussions. Some participants believed that existing models already provide a sufficient conceptual basis for developing and implementing shared decision making competency-based training programs on a wide scale. Others argued that this would be premature as there is still no consensus on the definition of shared decision making or sufficient evidence to recommend specific competencies for implementing shared decision making. However, all participants agreed that there were 2 broad types of competencies that clinicians need for implementing shared decision making: relational competencies and risk communication competencies. Further multidisciplinary research could broaden and deepen our understanding of core competencies for shared decision making training.

  8. Shared Decision Aids: Increasing Patient Acceptance of Long-Acting Reversible Contraception

    Directory of Open Access Journals (Sweden)

    Tracy P. George

    2015-04-01

    Full Text Available Unintended pregnancies are an important public health issue. Long-acting reversible contraceptive methods (LARCs are reliable, safe, highly effective methods for most women; however they are underutilized in the United States. Shared decision aids were added to usual care in five public health family planning clinics in the Southeastern United States, staffed by advance practice nurses and registered nurses. All five sites showed an increase in the use of LARCs during the time period that shared decision aids were used (results statistically significant to p < 0.001. It is important for women to make informed choices about contraception, and shared decision aids can be utilized to support this decision making. This resource has been adopted for statewide use in all public health clinics, and implications for practice suggest that the use of shared decision aids is an effective method to support informed patient decision making and acceptance of LARC methods of contraception.

  9. Creating and sharing clinical decision support content with Web 2.0: Issues and examples.

    Science.gov (United States)

    Wright, Adam; Bates, David W; Middleton, Blackford; Hongsermeier, Tonya; Kashyap, Vipul; Thomas, Sean M; Sittig, Dean F

    2009-04-01

    Clinical decision support is a powerful tool for improving healthcare quality and patient safety. However, developing a comprehensive package of decision support interventions is costly and difficult. If used well, Web 2.0 methods may make it easier and less costly to develop decision support. Web 2.0 is characterized by online communities, open sharing, interactivity and collaboration. Although most previous attempts at sharing clinical decision support content have worked outside of the Web 2.0 framework, several initiatives are beginning to use Web 2.0 to share and collaborate on decision support content. We present case studies of three efforts: the Clinfowiki, a world-accessible wiki for developing decision support content; Partners Healthcare eRooms, web-based tools for developing decision support within a single organization; and Epic Systems Corporation's Community Library, a repository for sharing decision support content for customers of a single clinical system vendor. We evaluate the potential of Web 2.0 technologies to enable collaborative development and sharing of clinical decision support systems through the lens of three case studies; analyzing technical, legal and organizational issues for developers, consumers and organizers of clinical decision support content in Web 2.0. We believe the case for Web 2.0 as a tool for collaborating on clinical decision support content appears strong, particularly for collaborative content development within an organization.

  10. Polyamine sharing between tubulin dimers favours microtubule nucleation and elongation via facilitated diffusion.

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    Alain Mechulam

    2009-01-01

    Full Text Available We suggest for the first time that the action of multivalent cations on microtubule dynamics can result from facilitated diffusion of GTP-tubulin to the microtubule ends. Facilitated diffusion can promote microtubule assembly, because, upon encountering a growing nucleus or the microtubule wall, random GTP-tubulin sliding on their surfaces will increase the probability of association to the target sites (nucleation sites or MT ends. This is an original explanation for understanding the apparent discrepancy between the high rate of microtubule elongation and the low rate of tubulin association at the microtubule ends in the viscous cytoplasm. The mechanism of facilitated diffusion requires an attraction force between two tubulins, which can result from the sharing of multivalent counterions. Natural polyamines (putrescine, spermidine, and spermine are present in all living cells and are potent agents to trigger tubulin self-attraction. By using an analytical model, we analyze the implication of facilitated diffusion mediated by polyamines on nucleation and elongation of microtubules. In vitro experiments using pure tubulin indicate that the promotion of microtubule assembly by polyamines is typical of facilitated diffusion. The results presented here show that polyamines can be of particular importance for the regulation of the microtubule network in vivo and provide the basis for further investigations into the effects of facilitated diffusion on cytoskeleton dynamics.

  11. Health Care Professional Factors Influencing Shared Medical Decision Making in Korea

    Directory of Open Access Journals (Sweden)

    Kae-Hwa Jo

    2015-11-01

    Full Text Available Till date, the medical decision-making process in Korea has followed the paternalist model, relying on the instructions of physicians. However, in recent years, shared decision making at the end-of-life between physicians and nurses is now emphasized in Korea. The purpose of this study was conducted to explore how health care professionals’ characteristics, attitude toward dignified dying, and moral sensitivity affect their shared medical decision making. The design was descriptive survey. This study was undertaken in two university hospitals in two metropolitan cities, South Korea. The participants were 344 nurses and 80 physicians who work at university hospitals selected by convenience sampling method. Data were collected from January 10 through March 20, 2014 using the Dignified Dying Scale, Moral Sensitivity Scale, and Shared Medical Decision-Making Scale. Shared medical decision making, attitude toward dignified dying, moral sensitivity, age, and working experience had a significant correlation with each other. The factors affecting shared medical decision making of Korean health care professionals were moral sensitivity and attitude toward dignified dying. These variables explained 22.4% of the shared medical decision making. Moral sensitivity and a positive attitude toward dignified dying should be promoted among health care professionals as a part of an educational program for shared medical decision making.

  12. Implementation of shared decision making in anaesthesia and its influence on patient satisfaction.

    Science.gov (United States)

    Flierler, W J; Nübling, M; Kasper, J; Heidegger, T

    2013-07-01

    There is a lack of data about the implementation of shared decision making in anaesthesia. To assess patients' preference to be involved in medical decision making and its influence on patient satisfaction, we studied 197 matched pairs (patients and anaesthetists) using two previously validated questionnaires. Before surgery, patients had to decide between general vs regional anaesthesia and, where appropriate, between conventional postoperative pain therapy vs catheter techniques. One hundred and eighty-six patients (94%) wished to be involved in shared decision making. One hundred and twenty-two patients (62%) experienced the exact amount of shared decision making that they wanted; 44 (22%) were slightly more involved and 20 (10%) slightly less involved in shared decision making than they desired. Preferences regarding involvement in shared decision making were similar between patients and anaesthetists with mean (SD) points of 54.1 (16.2) vs 56.4 (27.6) (p=0.244), respectively on a 0-100 scale; however, patients were found to have a stronger preference for a totally balanced shared decision-making process (65% vs 32%). Overall patient satisfaction was high: 88% were very satisfied and 12% satisfied with a mean (SD) value of 96.1 (10.6) on a 0-100 scale. Shared decision making is important for providing high levels of patient satisfaction.

  13. What motivates family physicians to participate in training programs in shared decision making?

    Science.gov (United States)

    Allaire, Anne-Sophie; Labrecque, Michel; Giguere, Anik; Gagnon, Marie-Pierre; Légaré, France

    2012-01-01

    Little is known about the factors that influence family physician (FP) participation in continuing professional development (CPD) programs in shared decision making (SDM). We sought to identify the factors that motivate FPs to participate in DECISION+, a CPD program in SDM. In 2007-2008, we collected data from 39 FPs who participated in a pilot randomized trial of DECISION+. In 2010, we collected data again from 11 of those participants and from 12 new subjects. Based on the theory of planned behavior, our questionnaire assessed FPs' intentions to participate in a CPD program in SDM and evaluated FPs' attitudes, subjective norms and perceived behavioral control. We also conducted 4 focus groups to explore FPs' salient beliefs. In 2010, FPs' mean intention to participate in a CPD program in SDM was relatively strong (2.6 ± 0.5 on a scale from -3 = "strongly disagree" to +3 = "strongly agree"). Affective attitude was the only factor significantly associated with intention (r = .51, p = .04). FPs identified the attractions of participating in a CPD program in SDM as (1) its interest, (2) the pleasure of learning, and (3) professional stimulation. Facilitators of their participation were (1) a relevant clinical topic, (2) an interactive program, (3) an accessible program, and (4) decision support tools. To attract FPs to a CPD program in SDM, CPD developers should make the program interesting, enjoyable, and professionally stimulating. They should choose a clinically relevant topic, ensure that the program is interactive and accessible, and include decision support tools. Copyright © 2012 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

  14. Shared decision making for psychiatric medication management: beyond the micro-social.

    Science.gov (United States)

    Morant, Nicola; Kaminskiy, Emma; Ramon, Shulamit

    2016-10-01

    Mental health care has lagged behind other health-care domains in developing and applying shared decision making (SDM) for treatment decisions. This is despite compatibilities with ideals of modern mental health care such as self-management and recovery-oriented practice, and growing policy-level interest. Psychiatric medication is a mainstay of mental health treatment, but there are known problems with prescribing practices, and service users report feeling uninvolved in medication decisions and concerned about adverse effects. SDM has potential to produce better tailoring of psychiatric medication to individuals' needs. This conceptual review argues that several aspects of mental health care that differ from other health-care contexts (e.g. forms of coercion, questions about service users' insight and disempowerment) may impact on processes and possibilities for SDM. It is therefore problematic to uncritically import models of SDM developed in other health-care contexts. We argue that decision making for psychiatric medication is better understood in a broader way that moves beyond the micro-social focus of a medical consultation. Contextualizing specific medication-related consultations within longer term relationships, and broader service systems enables recognition of the multiple processes, actors and agendas that shape how psychiatric medication is prescribed, managed and used, and which may facilitate or impede SDM. A broad conceptualization of decision making for psychiatric medication that moves beyond the micro-social can account for why SDM in this domain remains a rarity. It has both conceptual and practical utility for evaluating research evidence, identifying future research priorities and highlighting fruitful ways of developing and implementing SDM in mental health care. © 2015 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  15. GROUP DECISIONS. Shared decision-making drives collective movement in wild baboons.

    Science.gov (United States)

    Strandburg-Peshkin, Ariana; Farine, Damien R; Couzin, Iain D; Crofoot, Margaret C

    2015-06-19

    Conflicts of interest about where to go and what to do are a primary challenge of group living. However, it remains unclear how consensus is achieved in stable groups with stratified social relationships. Tracking wild baboons with a high-resolution global positioning system and analyzing their movements relative to one another reveals that a process of shared decision-making governs baboon movement. Rather than preferentially following dominant individuals, baboons are more likely to follow when multiple initiators agree. When conflicts arise over the direction of movement, baboons choose one direction over the other when the angle between them is large, but they compromise if it is not. These results are consistent with models of collective motion, suggesting that democratic collective action emerging from simple rules is widespread, even in complex, socially stratified societies.

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

    Science.gov (United States)

    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 (Ppractice.

  17. A preliminary evaluation of trust and shared decision making among intensive care patients' family members.

    Science.gov (United States)

    Epstein, Elizabeth G; Wolfe, Katherine

    2016-11-01

    The purpose of this study was to preliminarily evaluate ICU family members' trust and shared decision making using modified versions of the Wake Forest Trust Survey and the Shared Decision Making-9 Survey. Using a descriptive approach, the perceptions of family members of ICU patients (n=69) of trust and shared decision making were measured using the Wake Forest Trust Survey and the 9-item Shared Decision Making (SDM-9) Questionnaire. Both surveys were modified slightly to apply to family members of ICU patients and to include perceptions of nurses as well as physicians. Overall, family members reported high levels of trust and inclusion in decision making. Family members who lived with the patient had higher levels of trust than those who did not. Family members who reported strong agreement among other family about treatment decisions had higher levels of trust and higher SDM-9 scores than those who reported less family agreement. The modified surveys may be useful in evaluating family members' trust and shared decision making in ICU settings. Future studies should include development of a comprehensive patient-centered care framework that focuses on its central goal of maintaining provider-patient/family partnerships as an avenue toward effective shared decision making. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Externalising the autobiographical self: sharing personal memories online facilitated memory retention.

    Science.gov (United States)

    Wang, Qi; Lee, Dasom; Hou, Yubo

    2017-07-01

    Internet technology provides a new means of recalling and sharing personal memories in the digital age. What is the mnemonic consequence of posting personal memories online? Theories of transactive memory and autobiographical memory would make contrasting predictions. In the present study, college students completed a daily diary for a week, listing at the end of each day all the events that happened to them on that day. They also reported whether they posted any of the events online. Participants received a surprise memory test after the completion of the diary recording and then another test a week later. At both tests, events posted online were significantly more likely than those not posted online to be recalled. It appears that sharing memories online may provide unique opportunities for rehearsal and meaning-making that facilitate memory retention.

  19. I feel your fear: shared touch between faces facilitates recognition of fearful facial expressions.

    Science.gov (United States)

    Maister, Lara; Tsiakkas, Eleni; Tsakiris, Manos

    2013-02-01

    Embodied simulation accounts of emotion recognition claim that we vicariously activate somatosensory representations to simulate, and eventually understand, how others feel. Interestingly, mirror-touch synesthetes, who experience touch when observing others being touched, show both enhanced somatosensory simulation and superior recognition of emotional facial expressions. We employed synchronous visuotactile stimulation to experimentally induce a similar experience of "mirror touch" in nonsynesthetic participants. Seeing someone else's face being touched at the same time as one's own face results in the "enfacement illusion," which has been previously shown to blur self-other boundaries. We demonstrate that the enfacement illusion also facilitates emotion recognition, and, importantly, this facilitatory effect is specific to fearful facial expressions. Shared synchronous multisensory experiences may experimentally facilitate somatosensory simulation mechanisms involved in the recognition of fearful emotional expressions.

  20. 'OnePoint'--combining OneNote and SharePoint to facilitate knowledge transfer.

    Science.gov (United States)

    Barber, Christopher G; Haque, Nuzrul; Gardner, Ben

    2009-09-01

    The identification and development of novel drugs requires a multidisciplinary team of individuals whose membership changes during the lifecycle of a project. Incomplete knowledge transfer across this team can be a barrier to effective decision-making and efficient drug discovery. We have deployed a new infrastructure supporting information storage and distribution within small teams using Microsoft's SharePoint server technology in conjunction with the desktop application OneNote. This delivers a user-friendly collaborative workspace that is fast, flexible and carries a low training burden. Demand from drug project teams for this 'solution' has now resulted in site-wide deployment to over 500 people across research.

  1. Finding shared decisions in stakeholder networks: An agent-based approach

    Science.gov (United States)

    Le Pira, Michela; Inturri, Giuseppe; Ignaccolo, Matteo; Pluchino, Alessandro; Rapisarda, Andrea

    2017-01-01

    We address the problem of a participatory decision-making process where a shared priority list of alternatives has to be obtained while avoiding inconsistent decisions. An agent-based model (ABM) is proposed to mimic this process in different social networks of stakeholders who interact according to an opinion dynamics model. Simulations' results show the efficacy of interaction in finding a transitive and, above all, shared decision. These findings are in agreement with real participation experiences regarding transport planning decisions and can give useful suggestions on how to plan an effective participation process for sustainable policy-making based on opinion consensus.

  2. Individual responsibility as ground for priority setting in shared decision-making.

    Science.gov (United States)

    Sandman, Lars; Gustavsson, Erik; Munthe, Christian

    2016-10-01

    Given healthcare resource constraints, voices are being raised to hold patients responsible for their health choices. In parallel, there is a growing trend towards shared decision-making, aiming to empower patients and give them more control over healthcare decisions. More power and control over decisions is usually taken to mean more responsibility for them. The trend of shared decision-making would therefore seem to strengthen the case for invoking individual responsibility in the healthcare priority setting. To analyse whether the implementation of shared decision-making would strengthen the argument for invoking individual responsibility in the healthcare priority setting using normative analysis. Shared decision-making does not constitute an independent argument in favour of employing individual responsibility since these notions rest on different underlying values. However, if a health system employs shared decision-making, individual responsibility may be used to limit resource implications of accommodating patient preferences outside professional standards and goals. If a healthcare system employs individual responsibility, high level dynamic shared decision-making implying a joint deliberation resulting in a decision where both parties are willing to revise initial standpoints may disarm common objections to the applicability of individual responsibility by virtue of making patients more likely to exercise adequate control of their own actions. However, if communication strategies applied in the shared decision-making are misaligned to the patient's initial capacities, arguments against individual responsibility might, on the other hand, gain strength. 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/

  3. A Shared Decision-Making Approach to Telemedicine: Engaging Rural Patients in Glycemic Management.

    Science.gov (United States)

    Griffith, Michelle L; Siminerio, Linda; Payne, Tammie; Krall, Jodi

    2016-11-17

    Telemedicine can connect specialist health care providers with patients in remote and underserved areas. It is especially relevant in diabetes care, where a proliferation of treatment options has added further complexity to the care of an already complex, highly prevalent disease. Recent developments in health reform encourage delivery systems to use team-based models and engage patients in shared decision-making (SDM), where patients and providers together make health care decisions that are tailored to the specific characteristics and values of the patient. The goal of this project was to design, integrate, and evaluate a team-based, SDM approach delivered to patients with diabetes in a rural community, building upon the previously established telemedicine for reach, education, access, and treatment (TREAT) model. Patients in this feasibility study demonstrated improvement in hemoglobin A1c values, and reported better understanding of diabetes. Providers reported the SDM aids increased cohesion among team members (including patients) and facilitated patient education and behavioral goal setting. This project demonstrated that SDM could be integrated into the workflow of a telemedicine team visit with good provider and patient satisfaction.

  4. A Shared Decision-Making Approach to Telemedicine: Engaging Rural Patients in Glycemic Management

    Directory of Open Access Journals (Sweden)

    Michelle L. Griffith

    2016-11-01

    Full Text Available Telemedicine can connect specialist health care providers with patients in remote and underserved areas. It is especially relevant in diabetes care, where a proliferation of treatment options has added further complexity to the care of an already complex, highly prevalent disease. Recent developments in health reform encourage delivery systems to use team-based models and engage patients in shared decision-making (SDM, where patients and providers together make health care decisions that are tailored to the specific characteristics and values of the patient. The goal of this project was to design, integrate, and evaluate a team-based, SDM approach delivered to patients with diabetes in a rural community, building upon the previously established telemedicine for reach, education, access, and treatment (TREAT model. Patients in this feasibility study demonstrated improvement in hemoglobin A1c values, and reported better understanding of diabetes. Providers reported the SDM aids increased cohesion among team members (including patients and facilitated patient education and behavioral goal setting. This project demonstrated that SDM could be integrated into the workflow of a telemedicine team visit with good provider and patient satisfaction.

  5. Towards automatic decision support for bike-sharing system design

    OpenAIRE

    ter Beek, Maurice H.; Gnesi, Stefania; Latella, Diego; Massink, Mieke

    2015-01-01

    Public bike-sharing systems are a popular means of sustainable urban mobility, but their successful introduction in a city stands or falls with their specific designs. What kind of bikes and docking stations are needed, how many and where to install them? How to avoid as much as possible that stations are completely empty or full for some period? Hence, a bike-sharing system can be seen both as a highly (re)configurable system and as a collective adaptive system. In this paper, we present two...

  6. Instruments for evaluating shared medical decision making: a structured literature review.

    Science.gov (United States)

    Dy, Sydney Morss

    2007-12-01

    The author conducted a structured literature review of instruments for evaluating shared medical decision making. She included relevant instruments that were generalizable beyond specific situations and had been formally evaluated and organized them by domains of values or preferences, information and communication in decision making, and other aspects of decision making. For values or preferences, the author identified 11 instruments, mostly on preferences for roles and information. For information and communication, she found a systematic review of instruments for observational assessment of decision making, 3 additional observational instruments, and 3 questionnaires. For other aspects of decision making, the author identified 3 instruments in domains such as decision self-efficacy and 4 multidimensional instruments. Although instrument development tended to cluster in several areas and there were clear gaps in the literature, the diversity of instruments demonstrates the broad range of constructs involved in assessing shared decision making.

  7. School-Based Management/Shared Decision Making in Dade County (Miami).

    Science.gov (United States)

    Cistone, Peter J.; And Others

    1989-01-01

    Summarizes the historical background, planning, and implementation of a School-Based Management/Shared Decision Making (SBM/SDM) program in Dade County (Florida). Highlights interim evaluation findings and recommendations. (FMW)

  8. Confronting evidence: individualised care and the case for shared decision-making.

    Science.gov (United States)

    Ryan, P; Vaughan, D

    2014-01-01

    In many clinical scenarios there exists more than one clinically appropriate intervention strategy. When these involve subjective trade-offs between potential benefits and harms, patients' preferences should inform decision-making. Shared decision-making is a collaborative process, where clinician and patient reconcile the best available evidence with respect for patients' individualized care preferences. In practice, clinicians may be poorly equipped to participate in this process. Shared decision-making is applicable to many conditions including stable coronary artery disease, end-of-life care, and numerous small decisions in chronic disease management. There is evidence of more clinically appropriate care patterns, improved patient understanding and sense of empowerment. Many trials reported a 20% reduction in major surgery in favour of conservative treatment, although demand tends to increase for some interventions. The generalizability of international evidence to Ireland is unclear. Considering the potential benefits, there is a case for implementing and evaluating shared decision-making pilot projects in Ireland.

  9. Development of a Draft Core Set of Domains for Measuring Shared Decision Making in Osteoarthritis

    DEFF Research Database (Denmark)

    Toupin-April, Karine; Barton, Jennifer; Fraenkel, Liana;

    2015-01-01

    the decision into practice, and (7) assessing the effect of the decision. Contextual factors were also suggested. CONCLUSION: We proposed a draft core set of shared decision-making domains for OA intervention research studies. Next steps include a workshop at OMERACT 13 to reach consensus on these proposed......OBJECTIVE: Despite the importance of shared decision making for delivering patient-centered care in rheumatology, there is no consensus on how to measure its process and outcomes. The aim of this Outcome Measures in Rheumatology (OMERACT) working group is to determine the core set of domains...... for measuring shared decision making in intervention studies in adults with osteoarthritis (OA), from the perspectives of patients, health professionals, and researchers. METHODS: We followed the OMERACT Filter 2.0 method to develop a draft core domain set by (1) forming an OMERACT working group; (2) conducting...

  10. Confronting evidence: individualised care and the case for shared decision-making.

    LENUS (Irish Health Repository)

    Ryan, P

    2014-11-01

    In many clinical scenarios there exists more than one clinically appropriate intervention strategy. When these involve subjective trade-offs between potential benefits and harms, patients\\' preferences should inform decision-making. Shared decision-making is a collaborative process, where clinician and patient reconcile the best available evidence with respect for patients\\' individualized care preferences. In practice, clinicians may be poorly equipped to participate in this process. Shared decision-making is applicable to many conditions including stable coronary artery disease, end-of-life care, and numerous small decisions in chronic disease management. There is evidence of more clinically appropriate care patterns, improved patient understanding and sense of empowerment. Many trials reported a 20% reduction in major surgery in favour of conservative treatment, although demand tends to increase for some interventions. The generalizability of international evidence to Ireland is unclear. Considering the potential benefits, there is a case for implementing and evaluating shared decision-making pilot projects in Ireland.

  11. Attitudes towards poverty, organizations, ethics and morals: Israeli social workers' shared decision making.

    Science.gov (United States)

    Levin, Lia; Schwartz-Tayri, Talia

    2017-06-01

    Partnerships between service users and social workers are complex in nature and can be driven by both personal and contextual circumstances. This study sought to explore the relationship between social workers' involvement in shared decision making with service users, their attitudes towards service users in poverty, moral standards and health and social care organizations' policies towards shared decision making. Based on the responses of 225 licensed social workers from health and social care agencies in the public, private and third sectors in Israel, path analysis was used to test a hypothesized model. Structural attributions for poverty contributed to attitudes towards people who live in poverty, which led to shared decision making. Also, organizational support in shared decision making, and professional moral identity, contributed to ethical behaviour which led to shared decision making. The results of this analysis revealed that shared decision making may be a scion of branched roots planted in the relationship between ethics, organizations and Stigma. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

  12. 36 CFR 223.118 - Appeal process for small business timber sale set-aside program share recomputation decisions.

    Science.gov (United States)

    2010-07-01

    ... business timber sale set-aside program share recomputation decisions. 223.118 Section 223.118 Parks... business timber sale set-aside program share recomputation decisions. (a) Decisions subject to appeal. The... of the comment period, the Responsible Official shall make a decision on the small business...

  13. A demonstration of shared decision making in primary care highlights barriers to adoption and potential remedies

    NARCIS (Netherlands)

    Friedberg, M.W.; Busum, K. Van; Wexler, R.; Bowen, M.; Schneider, E.C.

    2013-01-01

    Recent developments in health reform related to the passage of the Affordable Care Act and ensuing regulations encourage delivery systems to engage in shared decision making, in which patients and providers together make health care decisions that are informed by medical evidence and tailored to the

  14. The problematic of decision-sharing: deconstructing 'cholesterol' in a clinical encounter.

    NARCIS (Netherlands)

    Gwyn, R.; Elwyn, G.; Edwards, A.; Mooney, A.

    2003-01-01

    Shared decision-making is increasingly advocated as a means of interacting with patients but there is also a widely accepted view that many factors will militate against this ideal. While some patients may not wish to take on the responsibility of decision-making, it is also evident that many find i

  15. A demonstration of shared decision making in primary care highlights barriers to adoption and potential remedies

    NARCIS (Netherlands)

    Friedberg, M.W.; Busum, K. Van; Wexler, R.; Bowen, M.; Schneider, E.C.

    2013-01-01

    Recent developments in health reform related to the passage of the Affordable Care Act and ensuing regulations encourage delivery systems to engage in shared decision making, in which patients and providers together make health care decisions that are informed by medical evidence and tailored to the

  16. Shared decision-making for cancer care among racial and ethnic minorities: a systematic review.

    Science.gov (United States)

    Mead, Erin L; Doorenbos, Ardith Z; Javid, Sara H; Haozous, Emily A; Alvord, Lori Arviso; Flum, David R; Morris, Arden M

    2013-12-01

    To assess decision-making for cancer treatment among racial/ethnic minority patients, we systematically reviewed and synthesized evidence from studies of "shared decision-making," "cancer," and "minority groups," using PubMed, PsycInfo, CINAHL, and EMBASE. We identified significant themes that we compared across studies, refined, and organized into a conceptual model. Five major themes emerged: treatment decision-making, patient factors, family and important others, community, and provider factors. Thematic data overlapped categories, indicating that individuals' preferences for medical decision-making cannot be authentically examined outside the context of family and community. The shared decision-making model should be expanded beyond the traditional patient-physician dyad to include other important stakeholders in the cancer treatment decision process, such as family or community leaders.

  17. Practicing shared decision making in the outpatient psychiatric care of adults with severe mental illnesses: redesigning care for the future.

    Science.gov (United States)

    Torrey, William C; Drake, Robert E

    2010-10-01

    Psychiatrist outpatient office visits have the potential to support the recovery of adults with severe mental illnesses by engaging them in a collaborative process of evaluating, selecting, and trying individually-tailored therapeutic options. Evidence-informed shared decision making is difficult for psychiatrists to offer within the framework of care as it is delivered today: it requires time, easy access to relevant scientific information, and extensive communication between patients and psychiatrists. In this paper, we describe the current structural obstacles to collaborative psychiatric care and envision a redesigned office visit process that facilitates active informed patient involvement.

  18. Shared decision-making in medical encounters regarding breast cancer treatment: the contribution of methodological triangulation.

    Science.gov (United States)

    Durif-Bruckert, C; Roux, P; Morelle, M; Mignotte, H; Faure, C; Moumjid-Ferdjaoui, N

    2015-07-01

    The aim of this study on shared decision-making in the doctor-patient encounter about surgical treatment for early-stage breast cancer, conducted in a regional cancer centre in France, was to further the understanding of patient perceptions on shared decision-making. The study used methodological triangulation to collect data (both quantitative and qualitative) about patient preferences in the context of a clinical consultation in which surgeons followed a shared decision-making protocol. Data were analysed from a multi-disciplinary research perspective (social psychology and health economics). The triangulated data collection methods were questionnaires (n = 132), longitudinal interviews (n = 47) and observations of consultations (n = 26). Methodological triangulation revealed levels of divergence and complementarity between qualitative and quantitative results that suggest new perspectives on the three inter-related notions of decision-making, participation and information. Patients' responses revealed important differences between shared decision-making and participation per se. The authors note that subjecting patients to a normative behavioural model of shared decision-making in an era when paradigms of medical authority are shifting may undermine the patient's quest for what he or she believes is a more important right: a guarantee of the best care available.

  19. Acceptance of shared decision making with reference to an electronic library of decision aids (arriba-lib) and its association to decision making in patients: an evaluation study.

    Science.gov (United States)

    Hirsch, Oliver; Keller, Heidemarie; Krones, Tanja; Donner-Banzhoff, Norbert

    2011-07-07

    Decision aids based on the philosophy of shared decision making are designed to help patients make informed choices among diagnostic or treatment options by delivering evidence-based information on options and outcomes. A patient decision aid can be regarded as a complex intervention because it consists of several presumably relevant components. Decision aids have rarely been field tested to assess patients' and physicians' attitudes towards them. It is also unclear what effect decision aids have on the adherence to chosen options. The electronic library of decision aids (arriba-lib) to be used within the clinical encounter has a modular structure and contains evidence-based decision aids for the following topics: cardiovascular prevention, atrial fibrillation, coronary heart disease, oral antidiabetics, conventional and intensified insulin therapy, and unipolar depression. We conducted an evaluation study in which 29 primary care physicians included 192 patients. After the consultation, patients filled in questionnaires and were interviewed via telephone two months later. We used generalised estimation equations to measure associations within patient variables and traditional crosstab analyses. Patients were highly satisfied with arriba-lib and the process of shared decision making. Two-thirds of patients reached in the telephone interview wanted to be counselled again with arriba-lib. There was a high congruence between preferred and perceived decision making. Of those patients reached in the telephone interview, 80.7% said that they implemented the decision, independent of gender and education. Elderly patients were more likely to say that they implemented the decision. Shared decision making with our multi-modular electronic library of decision aids (arriba-lib) was accepted by a high number of patients. It has positive associations to general aspects of decision making in patients. It can be used for patient groups with a wide range of individual

  20. Acceptance of shared decision making with reference to an electronic library of decision aids (arriba-lib and its association to decision making in patients: an evaluation study

    Directory of Open Access Journals (Sweden)

    Krones Tanja

    2011-07-01

    Full Text Available Abstract Background Decision aids based on the philosophy of shared decision making are designed to help patients make informed choices among diagnostic or treatment options by delivering evidence-based information on options and outcomes. A patient decision aid can be regarded as a complex intervention because it consists of several presumably relevant components. Decision aids have rarely been field tested to assess patients' and physicians' attitudes towards them. It is also unclear what effect decision aids have on the adherence to chosen options. Methods The electronic library of decision aids (arriba-lib to be used within the clinical encounter has a modular structure and contains evidence-based decision aids for the following topics: cardiovascular prevention, atrial fibrillation, coronary heart disease, oral antidiabetics, conventional and intensified insulin therapy, and unipolar depression. We conducted an evaluation study in which 29 primary care physicians included 192 patients. After the consultation, patients filled in questionnaires and were interviewed via telephone two months later. We used generalised estimation equations to measure associations within patient variables and traditional crosstab analyses. Results Patients were highly satisfied with arriba-lib and the process of shared decision making. Two-thirds of patients reached in the telephone interview wanted to be counselled again with arriba-lib. There was a high congruence between preferred and perceived decision making. Of those patients reached in the telephone interview, 80.7% said that they implemented the decision, independent of gender and education. Elderly patients were more likely to say that they implemented the decision. Conclusions Shared decision making with our multi-modular electronic library of decision aids (arriba-lib was accepted by a high number of patients. It has positive associations to general aspects of decision making in patients. It can be

  1. Predictors of shared decision making and level of agreement between consumers and providers in psychiatric care.

    Science.gov (United States)

    Fukui, Sadaaki; Salyers, Michelle P; Matthias, Marianne S; Collins, Linda; Thompson, John; Coffman, Melinda; Torrey, William C

    2014-05-01

    The purpose of this study was to quantitatively examine elements of shared decision making (SDM), and to establish empirical evidence for factors correlated with SDM and the level of agreement between consumer and provider in psychiatric care. Transcripts containing 128 audio-recorded medication check-up visits with eight providers at three community mental health centers were rated using the Shared Decision Making scale, adapted from Braddock's Informed Decision Making Scale (Braddock et al. 1997, 1999, 2008). Multilevel regression analyses revealed that greater consumer activity in the session and greater decision complexity significantly predicted the SDM score. The best predictor of agreement between consumer and provider was "exploration of consumer preference," with a four-fold increase in full agreement when consumer preferences were discussed more completely. Enhancing active consumer participation, particularly by incorporating consumer preferences in the decision making process appears to be an important factor in SDM.

  2. Shared decision making within goal setting in rehabilitation settings: A systematic review.

    Science.gov (United States)

    Rose, Alice; Rosewilliam, Sheeba; Soundy, Andrew

    2017-01-01

    To map out and synthesise literature that considers the extent of shared decision-making (SDM) within goal-setting in rehabilitation settings and explore participants' views of this approach within goal-setting. Four databases were systematically searched between January 2005-September 2015. All articles addressing SDM within goal-setting involving adult rehabilitation patients were included. The literature was critically appraised followed by a thematic synthesis. The search output identified 3129 studies and 15 articles met the inclusion criteria. Themes that emerged related to methods of SDM within goal-setting, participants' views on SDM, perceived benefits of SDM, barriers and facilitators to using SDM and suggestions to improve involvement of patients resulting in a better process of goal-setting. The literature showed various levels of patient involvement existing within goal-setting however few teams adopted an entirely patient-centred approach. However, since the review has identified clear value to consider SDM within goal-setting for rehabilitation, further research is required and practice should consider educating both clinicians and patients about this approach. To enhance the use of SDM within goal-setting in rehabilitation it is likely clinicians and patients will require further education on this approach. For clinicians this could commence during their training at undergraduate level. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Better decision making in complex, dynamic tasks training with human-facilitated interactive learning environments

    CERN Document Server

    Qudrat-Ullah, Hassan

    2015-01-01

    This book describes interactive learning environments (ILEs) and their underlying concepts. It explains how ILEs can be used to improve the decision-making process and how these improvements can be empirically verified. The objective of this book is to enhance our understanding of and to gain insights into the process by which human facilitated ILEs are effectively designed and used in improving users’ decision making in complex, dynamic tasks. This book is divided into four major parts. Part I serves as an introduction to the importance and complexity of decision making in dynamic tasks. Part II provides background material, drawing upon relevant literature, for the development of an integrated process model on the effectiveness of human facilitated ILEs in improving decision making in dynamic tasks. Part III focuses on the design, development, and application of FishBankILE in laboratory experiments to gather empirical evidence for the validity of the process model. Finally, part IV presents a comprehensi...

  4. Community facilitation of problem structuring and decision making processes: Experiences from the EU LEADER+ programme

    DEFF Research Database (Denmark)

    Vidal, Rene Victor Valqui

    2009-01-01

    making processes related to the agreement on action plans. Learning to design, plan, manage and facilitate conferences and workshops have also being another central activity. The main purpose of these conferences and workshops was not only problem structuring and decision making in connection...... contribute to long-term and sustainable development in these regions. The main tasks have been the organisation and facilitation of conferences and workshops to structure the problematic situation of identifying and designing innovative projects for the development of the community and to support decision...

  5. Shared decision-making in dementia: A review of patient and family carer involvement.

    Science.gov (United States)

    Miller, Lyndsey M; Whitlatch, Carol J; Lyons, Karen S

    2016-09-01

    This paper reviews empirical findings concerning the decision-making process of persons with dementia and their family carers, with a particular focus on the extent and determinants of involvement of persons with dementia in the decision-making process. To be included in this review, studies needed to be published in peer-reviewed journals between 1999 and 2014, report empirical data from participants with dementia and/or their family carers, and pertain to the involvement of persons with dementia and their family carers in decisions about everyday care, medical care and treatment, or long-term care. A total of 36 studies were included. Results indicated that not all persons with dementia are excluded from participating in the decision-making process, but there is a broad spectrum of what constitutes shared decision-making in dementia. Studies concerning the determinants of shared decision-making mostly focused on non-modifiable factors. Future research is needed to better promote shared decision-making among persons with dementia and their family carers. © The Author(s) 2014.

  6. Shared decision-making in the care of individuals with diabetes.

    Science.gov (United States)

    Serrano, V; Rodriguez-Gutierrez, R; Hargraves, I; Gionfriddo, M R; Tamhane, S; Montori, V M

    2016-06-01

    People with diabetes often live with other chronic conditions and lead complicated lives. Determining what is the best management decision for a patient requires consideration of each individual's personal, social and biomedical context, what he or she values, the reasons he or she has to value the available options, and the relative contribution of each option in terms of benefits, harms, costs and inconveniences. Empathic conversations between patients and clinicians to diagnose the patient situation that necessitates action and the range of evidence-based actions that best address the situation, so-called shared decision-making, are essential to the personalized care of people with diabetes. The aim of the present review was to present key elements of shared decision-making and propose three different approaches for its application. The first approach focuses on transferring information to patients so that they can make decisions. The second approach, choice, focuses on cultivating the individual's ability to give voice to which choice is best for them. The third approach, conversation, establishes an empathic conversational environment through which the individual with diabetes and their clinician think and talk through how to address the problems of living with diabetes and related illnesses. These approaches are manifest in the design of evidence-based decision aids created to support shared decision-making. In randomized trials, decision aids can efficiently improve patient's knowledge, satisfaction, risk awareness, decisional conflict and involvement. Further research, however, is needed to better understand when and how to promote the empathic conversations, patient, clinician and service and policy contexts necessary to routinely implement shared decision-making in different at scale healthcare systems. In the interim, sufficient evidence and tools exist for persons with diabetes and their clinicians to gain expertise in making decisions together.

  7. Consumer and Provider Perspectives on Shared Decision Making: A Systematic Review of the Peer-Reviewed Literature

    OpenAIRE

    Nyna Williams; Chris Fleming

    2011-01-01

    This brief reports on findings from a systematic review of the peer-reviewed literature on consumer and provider perspectives on shared decision making, the process by which consumers join providers in the clinical decision-making process. The use of comparative effectiveness research rests on greater engagement in shared decision making by providers and consumers.

  8. Interventions for promoting participation in shared decision-making for children with cancer.

    LENUS (Irish Health Repository)

    Coyne, Imelda

    2013-01-01

    Children\\'s rights to have their views heard in matters that affect their lives are now well established since the publication of the UN Convention treaty (1989). Children with cancer generally prefer to be involved in decision-making and consider it important that they have the opportunity to take part in decision-making concerning their health care, even in end-of-life decisions. There is considerable support for involving children in healthcare decision-making at a level commensurate with their experience, age and abilities. Thus healthcare professionals and parents need to know how they should involve children in decision-making and what interventions are most effective in promoting shared decision-making (SDM) for children with cancer.

  9. BCG-vaccination of newborns – a descriptive study about shared decision making and decisional conflicts

    DEFF Research Database (Denmark)

    Thybo Pihl, Gitte

    mothers, 662 (67 %) had a score single parent status. To investigate the extent to which the decisional conflicts reflected inadequate knowledge......BCG-vaccination of newborns – a descriptive study about shared decision making and decisional conflicts Objective: To evaluate the use of shared decision making to support the parent in a low-evidence decision about a vaccine when using telephone consultations. The present study was conducted.......9 % of the mothers felt that they had inadequate support. Almost half of the mothers (43.7 %) were uncertain about the best choice, indicating that they were not confident that they had made the right decision. Discussion: Because all parents received both written information and were offered personal counselling...

  10. Shared decision making in ante- & postnatal care – focus on communication skills training

    DEFF Research Database (Denmark)

    Nielsen, Annegrethe; Yding, Annika; Skovsted, Katrine Brander

    2016-01-01

    . A project where a group of midwives and nurses worked together in a serial of workshops training communication skills suitable for involving women in decisions in ante- and postnatal care was conducted in 2015. Communication skills training involved group analysis of videos of real consultations...... and a variety of roleplays and rehearsals of communication situations. Besides training communication skills the project aimed at documenting institutional practices obstructive to the purpose of sharing decisions.......In recent years political focus has increasingly been on patient involvement in decisions in healthcare. One challenge in implementing the principles of shared decision making is to develop suitable communication practice in the clinical encounters between patients and healthcare providers...

  11. Effective follow-up consultations: the importance of patient-centered communication and shared decision making.

    Science.gov (United States)

    Brand, Paul L P; Stiggelbout, Anne M

    2013-12-01

    Paediatricians spend a considerable proportion of their time performing follow-up visits for children with chronic conditions, but they rarely receive specific training on how best to perform such consultations. The traditional method of running a follow-up consultation is based on the doctor's agenda, and is problem-oriented. Patients and parents, however, prefer a patient-centered, and solution-focused approach. Although many physicians now recognize the importance of addressing the patient's perspective in a follow-up consultation, a number of barriers hamper its implementation in practice, including time constraints, lack of appropriate training, and a strong tradition of the biomedical, doctor-centered approach. Addressing the patient's perspective successfully can be achieved through shared decision making, clinicians and patients making decisions together based on the best clinical evidence. Research shows that shared decision making not only increases patient, parent, and physician satisfaction with the consultation, but also may improve health outcomes. Shared decision making involves building a physician-patient-parent partnership, agreeing on the problem at hand, laying out the available options with their benefits and risks, eliciting the patient's views and preferences on these options, and agreeing on a course of action. Shared decision making requires specific communication skills, which can be learned, and should be mastered through deliberate practice.

  12. What Factors are Associated with Consumer Initiation of Shared Decision Making in Mental Health Visits?

    OpenAIRE

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

    2017-01-01

    Understanding consumer initiation of shared decision making (SDM) is critical to improving SDM in mental health consultations, particularly because providers do not always invite consumer participation in treatment decisions. This study examined the association between consumer initiation of nine elements of SDM as measured by the SDM scale, and measures of consumer illness self-management and the consumer-provider relationship. In 63 mental health visits, three SDM elements were associated w...

  13. Assessing Practitioners’ and Patients’ Needs Regarding Shared Decision-Making and Decision Aids

    Directory of Open Access Journals (Sweden)

    Michiel Hageman

    2016-04-01

    Full Text Available Background: As part of the process of developing a decision aid for carpal tunnel syndrome (CTS according to the Ottawa Decision Support Framework, we were interested in the level of ‘decisional conflict’ of hand surgeons and patients with CTS. This study addresses the null hypothesis that there is no difference between surgeon and patient decisional conflict with respect to test and treatment options for CTS. Secondary analyses assess the impact of patient and physician demographics and the strength of the patient-physician relationship on decisional conflict.   Methods: One-hundred-twenty-three observers of the Science of Variation Group (SOVG and 84 patients with carpal tunnel syndrome completed a survey regarding the Decisional Conflict Scale. Patients also filled out the Pain Self-efficacy Questionnaire (PSEQ and the Patient Doctor Relationship Questionnaire (PDRQ-9.   Results: On average, patients had significantly greater decision conflict and scored higher on most subscales of the decisional conflict scale than hand surgeons.Factors associated with greater decision conflict were specific hand surgeon, less self-efficacy (confidence that one can achieve one’s goals in spite of pain, and higher PDRQ (relationship between patient and doctor. Surgeons from Europe have--on average--significantly more decision conflict than surgeons in the United States of America.   Conclusions: Patients with CTS have more decision conflict than hand surgeons. Decision aids might help narrow this gap in decisional conflict.

  14. Using Sand Trays and Miniature Figures to Facilitate Career Decision Making

    Science.gov (United States)

    Sangganjanavanich, Varunee Faii; Magnuson, Sandy

    2011-01-01

    Sand tray therapy has earned status as a respected, often powerful, therapeutic modality. Counselors have used sand trays and figures for a variety of purposes with children, adolescents, adults, families, and groups. This modality can also be used to facilitate career decision making and related issues as clients create visual representations of…

  15. Using Sand Trays and Miniature Figures to Facilitate Career Decision Making

    Science.gov (United States)

    Sangganjanavanich, Varunee Faii; Magnuson, Sandy

    2011-01-01

    Sand tray therapy has earned status as a respected, often powerful, therapeutic modality. Counselors have used sand trays and figures for a variety of purposes with children, adolescents, adults, families, and groups. This modality can also be used to facilitate career decision making and related issues as clients create visual representations of…

  16. Perspectives on Cybersecurity Information Sharing among Multiple Stakeholders Using a Decision-Theoretic Approach.

    Science.gov (United States)

    He, Meilin; Devine, Laura; Zhuang, Jun

    2017-08-11

    The government, private sectors, and others users of the Internet are increasingly faced with the risk of cyber incidents. Damage to computer systems and theft of sensitive data caused by cyber attacks have the potential to result in lasting harm to entities under attack, or to society as a whole. The effects of cyber attacks are not always obvious, and detecting them is not a simple proposition. As the U.S. federal government believes that information sharing on cybersecurity issues among organizations is essential to safety, security, and resilience, the importance of trusted information exchange has been emphasized to support public and private decision making by encouraging the creation of the Information Sharing and Analysis Center (ISAC). Through a decision-theoretic approach, this article provides new perspectives on ISAC, and the advent of the new Information Sharing and Analysis Organizations (ISAOs), which are intended to provide similar benefits to organizations that cannot fit easily into the ISAC structure. To help understand the processes of information sharing against cyber threats, this article illustrates 15 representative information sharing structures between ISAC, government, and other participating entities, and provide discussions on the strategic interactions between different stakeholders. This article also identifies the costs of information sharing and information security borne by different parties in this public-private partnership both before and after cyber attacks, as well as the two main benefits. This article provides perspectives on the mechanism of information sharing and some detailed cost-benefit analysis. © 2017 Society for Risk Analysis.

  17. What Factors are Associated with Consumer Initiation of Shared Decision Making in Mental Health Visits?

    Science.gov (United States)

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

    2017-01-01

    Understanding consumer initiation of shared decision making (SDM) is critical to improving SDM in mental health consultations, particularly because providers do not always invite consumer participation in treatment decisions. This study examined the association between consumer initiation of nine elements of SDM as measured by the SDM scale, and measures of consumer illness self-management and the consumer-provider relationship. In 63 mental health visits, three SDM elements were associated with self-management or relationship factors: discussion of consumer goals, treatment alternatives, and pros and cons of a decision. Limitations, implications, and future directions are discussed.

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

    NARCIS (Netherlands)

    Lloyd, A.; Joseph-Williams, N.; Edwards, A.; Rix, A.; Elwyn, G.

    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

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

    NARCIS (Netherlands)

    Lloyd, A.; Joseph-Williams, N.; Edwards, A.; Rix, A.; Elwyn, G.

    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 s

  20. Improving access to shared decision-making for Hispanics/Latinos with inadequately controlled type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Davidson JA

    2015-04-01

    -quality, well-developed tools to facilitate shared decision-making in populations with limited access to culturally sensitive information can narrow gaps and align care with individual patient preferences. A newly developed PDA is available for shared decision-making that provides culturally appropriate treatment information for inadequately controlled Hispanics/Latinos with T2DM. The impact on the overall health of patients and care management of T2DM requires further study.Keywords: patient decision aid, language adaptation, Hispanic, decision making, type 2 diabetes

  1. A Principal's View: Giving Up My Traditional Ship. Personal Reflections of Shared Decision-Making.

    Science.gov (United States)

    Daniels, Cecil T.

    1990-01-01

    Describes one Florida principal's pursuit of school-based management and shared decision making for the wrong reason--to escape from central office domination. Although chosen as the lesser of two evils, the new committee structure has worked well for Myrtle Grove School. Since giving up veto power to gain staff trust and commitment, teacher…

  2. Interventions for improving the adoption of shared decision making by healthcare professionals

    NARCIS (Netherlands)

    Legare, F.; Stacey, D.; Turcotte, S.; Cossi, M.J.; Kryworuchko, J.; Graham, I.D.; Lyddiatt, A.; Politi, M.C.; Thomson, R.; Elwyn, G.; Donner-Banzhoff, N.

    2014-01-01

    BACKGROUND: Shared decision making (SDM) can reduce overuse of options not associated with benefits for all and respects patient rights, but has not yet been widely adopted in practice. OBJECTIVES: To determine the effectiveness of interventions to improve healthcare professionals' adoption of SDM.

  3. Some but not all dyadic measures in shared decision making research have satisfactory psychometric properties

    NARCIS (Netherlands)

    Legare, F.; Turcotte, S.; Robitaille, H.; Stewart, M.; Frosch, D.; Grimshaw, J.; Labrecque, M.; Ouimet, M.; Rousseau, M.; Stacey, D.; Weijden, T. van der; Elwyn, G.

    2012-01-01

    OBJECTIVE: To assess the psychometric properties of dyadic measures for shared decision making (SDM) research. STUDY DESIGN AND SETTING: We conducted an observational cross-sectional study in 17 primary care clinics with physician-patient dyads. We used seven subscales to measure six elements of SDM

  4. Los limites de las decisiones compartidas (The Limits of Shared Decision-Making). ERIC Digest.

    Science.gov (United States)

    Lashway, Larry

    Since the 1980s, shared decision making (SDM) has become a significant part of school-reform efforts. Advocates say that SDM will improve student learning, create teacher satisfaction, and develop new forms of leadership. This digest in Spanish presents an overview of research that investigated whether SDM delivers on these promises. Studies…

  5. Does training general practitioners result in more shared decision making during consultations?

    NARCIS (Netherlands)

    Sanders, A.R.J.; Bensing, J.M.; Essed, M.A.L.U.; Magnée, T.; Wit, N.J. de; Verhaak, P.F.M.

    2016-01-01

    Objective: We conducted a clustered randomised controlled trial to study the effects of shared decision making (SDM) on patient recovery. This study aims to determine whether GPs trained in SDM and reinforcing patients’ treatment expectations showed more trained behaviour during their consultations

  6. Sex differences in behavioral decision-making and the modulation of shared neural circuits

    Directory of Open Access Journals (Sweden)

    Mowrey William R

    2012-03-01

    Full Text Available Abstract Animals prioritize behaviors according to their physiological needs and reproductive goals, selecting a single behavioral strategy from a repertoire of possible responses to any given stimulus. Biological sex influences this decision-making process in significant ways, differentiating the responses animals choose when faced with stimuli ranging from food to conspecifics. We review here recent work in invertebrate models, including C. elegans, Drosophila, and a variety of insects, mollusks and crustaceans, that has begun to offer intriguing insights into the neural mechanisms underlying the sexual modulation of behavioral decision-making. These findings show that an animal's sex can modulate neural function in surprisingly diverse ways, much like internal physiological variables such as hunger or thirst. In the context of homeostatic behaviors such as feeding, an animal's sex and nutritional status may converge on a common physiological mechanism, the functional modulation of shared sensory circuitry, to influence decision-making. Similarly, considerable evidence suggests that decisions on whether to mate or fight with conspecifics are also mediated through sex-specific neuromodulatory control of nominally shared neural circuits. This work offers a new perspective on how sex differences in behavior emerge, in which the regulated function of shared neural circuitry plays a crucial role. Emerging evidence from vertebrates indicates that this paradigm is likely to extend to more complex nervous systems as well. As men and women differ in their susceptibility to a variety of neuropsychiatric disorders affecting shared behaviors, these findings may ultimately have important implications for human health.

  7. Promoting the value and practice of shared decision-making in mental health care.

    Science.gov (United States)

    Schauer, Carole; Everett, Anita; del Vecchio, Paolo; Anderson, Leigh

    2007-01-01

    Active consumer participation is critical in contemporary mental health care and treatment planning and has been a staple of the field of psychiatric rehabilitation for the last three decades. Providing the opportunity for consumers to chose interventions that fit personal preferences and recovery increase the likelihood that these interventions will enhance personal meaning, satisfaction and quality of life (Improving the Quality of Health Care for Mental and Substance Use Conditions, 2006). Similarly, self-determination and shared decision-making are critical components of recovery. As stated in the President's New Freedom Commission on Mental Health Final Report, recovery from mental illnesses should be the expectation in mental health care with services and treatments that are consumer and family-driven. Mental health care should be planned and delivered to ensure that consumers and families with children with mental health problems receive real and meaningful choices about treatment options and providers. The purpose of this paper is to explore the value and use of shared decision-making in health and mental health care, briefly examine the advantages and disadvantages of shared decision making and propose next steps in advancing use of shared decision-making in mental health care.

  8. Clinical trial or standard treatment? Shared decision making at the department of oncology

    DEFF Research Database (Denmark)

    Gregersen, Trine Ammentorp; Birkelund, Regner; Ammentorp, Jette

    2016-01-01

    Title: Clinical trial or standard treatment? Shared decision making at the department of oncology. Authors: Ph.d. student, Trine A. Gregersen. Trine.gregersen@rsyd.dk. Department of Oncology. Health Services Research Unit Lillebaelt Hospital / IRS University of Southern Denmark. Professor, Regner...... are involved in difficult treatment decisions including participation in clinical trials. The literature indicates that the decision is very often based on little knowledge about the treatment and that many patients who have consented to participate in a clinical trial are not always aware...... that they are participating in a trial. This place great demand on the healthcare providers’ ability to involve and advise patients in the decisions. The aim of this study is to investigate the characteristics of the communication when decisions about participation in clinical oncology trial are made and the patients...

  9. A legal framework to enable sharing of Clinical Decision Support knowledge and services across institutional boundaries.

    Science.gov (United States)

    Hongsermeier, Tonya; Maviglia, Saverio; Tsurikova, Lana; Bogaty, Dan; Rocha, Roberto A; Goldberg, Howard; Meltzer, Seth; Middleton, Blackford

    2011-01-01

    The goal of the CDS Consortium (CDSC) is to assess, define, demonstrate, and evaluate best practices for knowledge management and clinical decision support in healthcare information technology at scale - across multiple ambulatory care settings and Electronic Health Record technology platforms. In the course of the CDSC research effort, it became evident that a sound legal foundation was required for knowledge sharing and clinical decision support services in order to address data sharing, intellectual property, accountability, and liability concerns. This paper outlines the framework utilized for developing agreements in support of sharing, accessing, and publishing content via the CDSC Knowledge Management Portal as well as an agreement in support of deployment and consumption of CDSC developed web services in the context of a research project under IRB oversight.

  10. Beyond shared decision-making: Collaboration in the age of recovery from serious mental illness.

    Science.gov (United States)

    Treichler, Emily B H; Spaulding, William D

    2017-01-01

    The role that people with serious mental illness (SMI) play in making decisions about their own treatment and rehabilitation is attracting increasing attention and scrutiny. This attention is embedded in a broader social/consumer movement, the recovery movement, whose agenda includes extensive reform of the mental health system and advancing respect for the dignity and autonomy of people with SMI. Shared decision-making (SDM) is an approach for enhancing consumer participation in health-care decision-making. SDM translates straightforwardly to specific clinical procedures that systematically identify domains of decision-making and guide the practitioner and consumer through making the decisions. In addition, Collaborative decision-making (CDM) is a set of guiding principles that avoids the connotations and limitations of SDM. CDM looks broadly at the range of decisions to be made in mental health care, and assigns consumers and providers equal responsibility and power in the decision-making process. It recognizes the diverse history, knowledge base, and values of each consumer by assuming patients can lead and contribute to decision-making, contributing both value-based information and technical information. This article further discusses the importance of CDM for people with SMI. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  11. Shared Decision Making in the Care of Children with Developmental and Behavioral Disorders

    Science.gov (United States)

    Lipstein, Ellen A.; Lindly, Olivia J.; Anixt, Julia S.; Britto, Maria T.; Zuckerman, Katharine E.

    2015-01-01

    Objective Shared decision making (SDM) is most needed when there are multiple treatment options and no “right” choice. As with quality and experience of care, frequency of SDM may vary by health condition. The objectives of this study were (1) to compare parent report of SDM between a physical and a behavioral health condition and; (2) to compare parent report of SDM between two different behavioral health conditions. Methods Data on children age 3–17 years with asthma, attention deficit/ hyperactivity disorder (ADHD), and /or autism spectrum disorder (ASD) were drawn from the 2009/10 National Survey of Children with Special Health Care Needs. Weighted logistic regression was used to compare a parent-reported, composite measure of SDM. Analyses controlled for sociodemographic factors that may influence experience of SDM. Results Compared to parents of children with asthma, parents of children with ADHD were significantly less likely to report experiencing consistent SDM (aOR 0.73). Compared to parents of children with ADHD, those of children with ASD had significantly lower odds of experiencing consistent SDM (aOR 0.59). Those with both ADHD and ASD had the same odds as those with ASD alone of experiencing consistent SDM. Conclusion Use of SDM is particularly limited in developmental and behavioral conditions, such as ADHD and ASD. These data suggest that challenges to implementing SDM may include disease type, complexity, and use of specialty care. Research to identify specific barriers and facilitators of SDM is needed to inform interventions that will promote SDM in developmental and behavioral conditions. PMID:26518006

  12. Positive Student Affairs through Shared Decision Making in Elementary School?? You Bet!!!

    Science.gov (United States)

    Wilmore, Elaine L.

    This paper describes how an elementary school included parents in participative decision making to develop successful student-affairs programming. Including parents in the development of school activities mollifies complainers, creates opportunities for parent input, and facilitates innovation. Student-affairs programming offers an excellent…

  13. Real life clinic visits do not match the ideals of shared decision making.

    Science.gov (United States)

    Lipstein, Ellen A; Dodds, Cassandra M; Britto, Maria T

    2014-07-01

    To use observation to understand how decisions about higher-risk treatments, such as biologics, are made in pediatric chronic conditions. Gastroenterology and rheumatology providers who prescribe biologics were recruited. Families were recruited when they had an outpatient appointment in which treatment with biologics was likely to be discussed. Consent/assent was obtained to video the visit. Audio of the visits in which a discussion of biologics took place were transcribed and analyzed. Our coding structure was based on prior research, shared decision making (SDM) concepts, and the initial recorded visits. Coded data were analyzed using content analysis and comparison with an existing model of SDM. We recorded 21 visits that included discussions of biologics. In most visits, providers initiated the decision-making discussion. Detailed information was typically given about the provider's preferred option with less information about other options. There was minimal elicitation of preferences, treatment goals, or prior knowledge. Few parents or patients spontaneously stated their preferences or concerns. An implicit or explicit treatment recommendation was given in nearly all visits, although rarely requested. In approximately one-third of the visits, the treatment decision was never made explicit, yet steps were taken to implement the provider's preferred treatment. We observed limited use of SDM, despite previous research indicating that parents wish to collaborate in decision making. To better achieve SDM in chronic conditions, providers and families need to strive for bidirectional sharing of information and an explicit family role in decision making. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Optimal global value of information trials: better aligning manufacturer and decision maker interests and enabling feasible risk sharing.

    Science.gov (United States)

    Eckermann, Simon; Willan, Andrew R

    2013-05-01

    Risk sharing arrangements relate to adjusting payments for new health technologies given evidence of their performance over time. Such arrangements rely on prospective information regarding the incremental net benefit of the new technology, and its use in practice. However, once the new technology has been adopted in a particular jurisdiction, randomized clinical trials within that jurisdiction are likely to be infeasible and unethical in the cases where they would be most helpful, i.e. with current evidence of positive while uncertain incremental health and net monetary benefit. Informed patients in these cases would likely be reluctant to participate in a trial, preferring instead to receive the new technology with certainty. Consequently, informing risk sharing arrangements within a jurisdiction is problematic given the infeasibility of collecting prospective trial data. To overcome such problems, we demonstrate that global trials facilitate trialling post adoption, leading to more complete and robust risk sharing arrangements that mitigate the impact of costs of reversal on expected value of information in jurisdictions who adopt while a global trial is undertaken. More generally, optimally designed global trials offer distinct advantages over locally optimal solutions for decision makers and manufacturers alike: avoiding opportunity costs of delay in jurisdictions that adopt; overcoming barriers to evidence collection; and improving levels of expected implementation. Further, the greater strength and translatability of evidence across jurisdictions inherent in optimal global trial design reduces barriers to translation across jurisdictions characteristic of local trials. Consequently, efficiently designed global trials better align the interests of decision makers and manufacturers, increasing the feasibility of risk sharing and the expected strength of evidence over local trials, up until the point that current evidence is globally sufficient.

  15. A conceptual framework for interprofessional shared decision making in home care: Protocol for a feasibility study

    Directory of Open Access Journals (Sweden)

    Murray Mary-Anne

    2011-01-01

    Full Text Available Abstract Background Shared decision making (SDM is fundamental to informed consent and client-centered care. So far, SDM frameworks have been limited to the client-physician dyad, even though care is increasingly delivered by interprofessional (IP teams. IP collaboration is especially essential in home care, one of health care's most rapidly growing areas. This study will assess whether it is possible to practice SDM in IP home care. Methods/Design We will use a qualitative case study and a quantitative survey to capture the macro, meso and micro levels of stakeholders in home care. The case study will follow the knowledge-to-action process framework to evaluate the work of an IP home care team at a Quebec City health center. Sources of data will include one-on-one interviews with patients, family caregivers or surrogates and significant others, and administrators; a focus group of home care health professionals; organizational documents; and government policies and standards. The interview guide for the interviews and the focus group will explore current practices and clinical problems addressed in home care; factors that could influence the implementation of the proposed IP approach to SDM; the face and content validity of the approach; and interventions to facilitate the implementation and evaluation of the approach. The survey will ask 300 health professionals working in home care at the health center to complete a questionnaire based on the Theory of Planned Behaviour that measures their intentions to engage in an IP approach to SDM. We will use our analysis of the individual interviews, the focus group and the survey to elaborate a toolkit for implementing an IP approach to SDM in home care. Finally, we will conduct a pilot study in Alberta to assess the transferability of our findings. Discussion We believe that developing tools to implement IP SDM in home care is essential to strengthening Canada's healthcare system and furthering

  16. Design and development of a decision aid to enhance shared decision making by patients with an asymptomatic abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Dirk T Ubbink

    2008-11-01

    Full Text Available Dirk T Ubbink1,2, Anouk M Knops1, Sjaak Molenaar1, Astrid Goossens11Department of Quality Assurance and Process Innovation and 2Department of Surgery, Academic Medical Center, Amsterdam, The NetherlandsObjective: To design, develop, and evaluate an evidence-based decision aid (DA for patients with an asymptomatic abdominal aortic aneurysm (AAA to inform them about the pros and cons of their treatment options (ie, surgery or watchful observation and to help them make a shared decision.Methods: A multidisciplinary team defined criteria for the desired DA as to design, medical content and functionality, particularly for elderly users. Development was according to the international standard (IPDAS. Fifteen patients with an AAA, who were either treated or not yet treated, evaluated the tool.Results: A DA was developed to offer information about the disease, the risks and benefits of surgical treatment and watchful observation, and the individual possibilities and threats based on the patient’s aneurysm diameter and risk profile. The DA was improved and judged favorably by physicians and patients.Conclusion: This evidence-based DA for AAA patients, developed according to IPDAS criteria, is likely to be a simple, user-friendly tool to offer patients evidence-based information about the pros and cons of treatment options for AAA, to improve patients’ understanding of the disease and treatment options, and may support decision making based on individual values.Keywords: decision support techniques, research design, program development, abdominal aortic aneurysm, decision making

  17. Shared decision making in transplantation: how patients see their role in the decision process of accepting a donor liver.

    Science.gov (United States)

    Op den Dries, Sanna; Annema, Coby; Berg, Aad P van den; Ranchor, Adelita V; Porte, Robert J

    2014-09-01

    At the time of the organ offer for transplantation, donor-related risks such as disease transmission and graft failure are weighed against the patient's risk of remaining on the waiting list. The patient's commonly inactive role in decision making and the timing and extent of donor-specific risk information have been discussed in the medical literature. This is the first study revealing the opinions of liver patients on these issues. Forty patients listed for liver transplantation and 179 liver transplant patients participated in an anonymous questionnaire-based survey. The majority of the patients wanted to be informed about donor-related risks (59.8%-74.8%). The preferred timing for being informed about donor-related risks was the time of the organ offer for 53.3% of the patients. Among these patients, 79.8% wished to be involved in making the decision to accept or not accept a liver for transplantation, 10.6% wished to make the final decision alone, and only 9.6% did not want to be involved in the decision-making process. Implementing this knowledge through the standardization of the content, the manner of transfer, and the amount of information that we provide to our patients will improve opportunities for shared decision making at different time points during the transplant allocation process. This will enable us to provide the same opportunities and care to every patient on the waiting list.

  18. Dialysis or conservative care for frail older patients: ethics of shared decision-making.

    Science.gov (United States)

    Muthalagappan, Seetha; Johansson, Lina; Kong, Wing May; Brown, Edwina A

    2013-11-01

    Increasing numbers of frail elderly with end-stage renal disease (ESRD) and multiple comorbidities are undertaking dialysis treatment. This has been accompanied by increasing dialysis withdrawal, thus warranting investigation into why this is occurring and whether a different approach to choosing treatment should be implemented. Despite being a potentially life-saving treatment, the physical and psychosocial burdens associated with dialysis in the frail elderly usually outweigh the benefits of correcting uraemia. Conservative management is less invasive and avoids the adverse effects associated with dialysis, but unfortunately it is often not properly considered until patients withdraw from dialysis. Shared decision-making has been proposed to allow patients active participation in healthcare decisions. Through this approach, patients will focus on their personal values to receive appropriate treatment, and perhaps opt for conservative management. This may help address the issue of dialysis withdrawal. Moreover, shared decision-making attempts to resolve the conflict between autonomy and other ethical principles, including physician paternalism. Here, we explore the ethical background behind shared decision-making, and whether it is genuinely in the patient's best interests or whether it is a cynical solution to encourage more patients to consider conservative care, thus saving limited resources.

  19. Adjuncts or adversaries to shared decision-making? Applying the Integrative Model of behavior to the role and design of decision support interventions in healthcare interactions.

    NARCIS (Netherlands)

    Frosch, D.; Legare, F.; Fishbein, M.; Elwyn, G.

    2009-01-01

    ABSTRACT: BACKGROUND: A growing body of literature documents the efficacy of decision support interventions (DESI) in helping patients make informed clinical decisions. DESIs are frequently described as an adjunct to shared decision-making between a patient and healthcare provider, however little is

  20. Adjuncts or adversaries to shared decision-making? Applying the Integrative Model of behavior to the role and design of decision support interventions in healthcare interactions.

    NARCIS (Netherlands)

    Frosch, D.; Legare, F.; Fishbein, M.; Elwyn, G.

    2009-01-01

    ABSTRACT: BACKGROUND: A growing body of literature documents the efficacy of decision support interventions (DESI) in helping patients make informed clinical decisions. DESIs are frequently described as an adjunct to shared decision-making between a patient and healthcare provider, however little is

  1. Independence Giving or Autonomy Taking? Childhood Predictors of Decision-Sharing Patterns Between Young Adolescents and Parents

    OpenAIRE

    Romich, Jennifer L.; Lundberg, Shelly; Tsang, Kwok Ping

    2009-01-01

    This article reports on a study of whether young adolescents make decisions autonomously, share decisions with their parents, or have decisions made for them by parents. Using a sample of 2,632 12-and 13-year-olds from the National Longitudinal Survey of Youth 1979 Child Survey we examine how childhood behavior and competence influence decision patterns in young adolescence. Individual models are used to test whether traits predict decision patterns, and sibling fixed-effects models allow us ...

  2. DST, decision support tool to facilitate energy-efficient renovation of buildings

    Energy Technology Data Exchange (ETDEWEB)

    Kondratenko, I.; Koene, F.G.H.; Kaan, H.F. [ECN Energy in the Built Environment, Petten (Netherlands)

    2008-04-15

    The aim of the DEMOHOUSE project is to develop minimum standards and recommendations for energy-efficient and sustainable renovation of social housing estates. Within this, the Decision Support Tool is one of the final results and uses knowledge gathered throughout the DEMOHOUSE project. In many European countries, social housing is owned by housing associations, municipalities or housing co-operations. To facilitate the decision makers in these organisations a simple instrument which helps to select relevant information for making decisions is developed within the DEMOHOUSE project. There are several phases in the process of renovation of dwellings. Main decisions in relation to ambitions of the renovation in energy-efficiency, sustainability, economic feasibility and occupants participation take place in the first so called initiative phase. It is this phase that the DST is focusing on to guide the decision makers, hosing managers and home owners associations alike, through decision making process towards achieving energy-efficient and sustainable renovation of dwellings. As any building renovation is a complex process with many stages, the tool also contains practical information and offers guidance and links to further more in-depth information of relevance to other stakeholders for example: architects, energy experts, building contractors, and building users.

  3. Facilitating Oil Industry Access to Federal Lands through Interagency Data Sharing

    Energy Technology Data Exchange (ETDEWEB)

    Paul Jehn; Ben Grunewald

    2007-05-31

    -commerce. The next step beyond mere data sharing for facilitating the permitting process is to make it possible for industry to file those permit applications electronically. This process will involve the use of common XML schemas.

  4. Current Efforts in European Projects to Facilitate the Sharing of Scientific Observation Data

    Science.gov (United States)

    Bredel, Henning; Rieke, Matthes; Maso, Joan; Jirka, Simon; Stasch, Christoph

    2017-04-01

    This presentation is intended to provide an overview of currently ongoing efforts in European projects to facilitate and promote the interoperable sharing of scientific observation data. This will be illustrated through two examples: a prototypical portal developed in the ConnectinGEO project for matching available (in-situ) data sources to the needs of users and a joint activity of several research projects to harmonise the usage of the OGC Sensor Web Enablement standards for providing access to marine observation data. ENEON is an activity initiated by the European ConnectinGEO project to coordinate in-situ Earth observation networks with the aim to harmonise the access to observations, improve discoverability, and identify/close gaps in European earth observation data resources. In this context, ENEON commons has been developed as a supporting Web portal for facilitating discovery, access, re-use and creation of knowledge about observations, networks, and related activities (e.g. projects). The portal is based on developments resulting from the European WaterInnEU project and has been extended to cover the requirements for handling knowledge about in-situ earth observation networks. A first prototype of the portal was completed in January 2017 which offers functionality for interactive discussion, information exchange and querying information about data delivered by different observation networks. Within this presentation, we will introduce the presented prototype and initiate a discussion about potential future work directions. The second example concerns the harmonisation of data exchange in the marine domain. There are many organisation who operate ocean observatories or data archives. In recent years, the application of the OGC Sensor Web Enablement (SWE) technology has become more and more popular to increase the interoperability between marine observation networks. However, as the SWE standards were intentionally designed in a domain independent manner

  5. Facilitated workshop method to involve stakeholders and public in decision making process in radiological emergencies

    Energy Technology Data Exchange (ETDEWEB)

    Mustonen, Raimo; Sinkko, Kari [STUK-Radiation and Nuclear Safety Authority, Helsinki (Finland). Research and Environmental Surveillance; Haemaelaeinen, Raimo P. [Helsinki Univ. of Technology, Helsinki (Finland). System Analysis Laboratory

    2006-09-15

    International organisations in radiation protection have for many years recommended that key players, e.g. authorities, expert organisations, industry, producers of foodstuffs and even the public, should be involved in the planning of protective actions in case of a nuclear accident. In this work, we have developed and tested a facilitated workshop method where representatives from various fields of the society aim to identify and evaluate systematically protective actions. Decision analysis techniques have been applied in workshops in order to find out the most feasible countermeasure strategies and to make the decision making-process transparent and auditable. The work builds on case studies where it was assumed that a hypothetical accident had led to a release of considerable amounts of radionuclides and therefore various types of countermeasures should be considered. This paper provides experiences gained in several European countries on how to facilitate this kind of workshops and how modern decision analysis techniques can be applied in the decision-making process.

  6. The impact of the distance-dependent promotional effect on the promotion cost sharing decision

    Science.gov (United States)

    Sheen, Gwo-Ji; Wang, Shih-Yen; Yeh, Yingchieh

    2016-02-01

    This paper considers the promotion cost sharing decision between a supplier and a retailer. The customer demand is affected by both national and local promotional effects while the local promotional effect on a customer is dependent on the distance between the retailer and this customer. We propose a continuous approximation approach to modelling the sum of the customer demand in the whole market area served by the retailer. A model is provided to help managers decide on the retail price, the local advertising expenditure, the national advertising expenditure, and the supplier participation rate, with consideration of the influence of distance on the promotional effect. We also find that the supplier's promotion cost sharing rate increases as the market size increases or the influence of distance on the promotional effect decreases. A numerical example is given to show that the nature of distance-dependent promotional effect has a significant impact on the decisions and profits.

  7. Shared decision making in dermato-oncology: preference for involvement of melanoma patients.

    Science.gov (United States)

    Albrecht, Karoline J; Nashan, Dorothée; Meiss, Frank; Bengel, Jürgen; Reuter, Katrin

    2014-02-01

    Increasing importance is being conferred to the implementation of shared decision making (SDM) in clinical practice for medical, ethical, and sociological reasons. In Germany, SDM has recently been adopted as an explicit goal in the S3-melanoma treatment guideline. The aim of this study is to present data on how melanoma patients want to be involved in treatment decisions and second on the dynamic of these preferences for involvement. This was investigated in consecutively recruited melanoma patients (stages I-III) in two German Skin Cancer Centers as part of a longitudinal questionnaire study. The Control Preference Scale assessed patients' preferences at baseline (n=405) and was readministered 1 year later (n=314) to detect potential changes. In addition, the perceived realization of SDM in the adjuvant interferon-α treatment decision was investigated in a subgroup of patients (n=108) using the nine-item Shared Decision Making Questionnaire (SDM-Q-9). More than 80% of the patients want to play an active role (autonomous or collaborative) in treatment decisions and only 17% want to delegate their decision to the doctor. We found a significant preference shift within a year in 43% of the patients, predominantly toward more active involvement. The results of the SDM-Q-9 indicate a moderate degree of perceived participation, with differing perceived implementation of the individual the SDM process steps. With the majority of melanoma patients preferring an active role in treatment decisions and improvable implementation of the SDM process steps in clinical practice, our findings support the relevance of SDM in dermato-oncology.

  8. Information-sharing ethical dilemmas and decision-making for public health nurses in Japan.

    Science.gov (United States)

    Suzuki, Chisato; Ota, Katsumasa; Matsuda, Masami

    2015-08-01

    Information sharing is one of the most important means of public health nurses collaborating with other healthcare professionals and community members. There are complicated ethical issues in the process. To describe the ethical dilemmas associated with client information sharing that Japanese public health nurses experience in daily practice and to clarify their decision-making process to resolve these dilemmas. Data were collected using a three-phase consensus method consisting of semi-structured interviews, self-administered questionnaires and a group interview. We surveyed administrative public health nurses in Shizuoka Prefecture, Japan. The semi-structured interviews were carried out with 12 administrative public health nurses, and the self-administered questionnaires were sent to all 899 administrative public health nurses. The group interview was carried out with eight administrative public health nurses. Ethical approval was granted by the ethics committee of the School of Health Sciences, Nagoya University, Japan (8-158, 9-130). Information-sharing ethical dilemmas occurred most often when clients' decisions did not coincide with the nurses' own professional assessments, particularly when they faced clinical issues that were inherently ambiguous. In their decision-making processes, nurses prioritised 'protection of health and life'. These findings suggest that, above all, they sought to address urgent risks to clients' lives while upholding the principle of client autonomy as much as possible. In such cases, the nurses made decisions regarding whether to share information about the client depending on the individual situation. Public health nurses should protect the client's health while taking into consideration their relationship with the client. © The Author(s) 2014.

  9. Independence and shared decision making: the role of smart home technology in empowering older adults.

    Science.gov (United States)

    Demiris, George

    2009-01-01

    This study aims to explore the concepts of independence and shared decision making in the context of smart home technologies for older adults. We conducted a Delphi study with three rounds involving smart home designers, and researchers as well as community dwelling older adults. While there were differences in the way different stakeholders define these concepts, the study findings provide clear implications for the design, implementation and evaluation of smart home applications.

  10. Does training general practitioners result in more shared decision making during consultations?

    OpenAIRE

    Sanders, A.R.J.; Bensing, J.M.; Essed, M.A.L.U.; Magnée, T.; de Wit, N.J.; Verhaak, P.F.M.

    2016-01-01

    Objective: We conducted a clustered randomised controlled trial to study the effects of shared decision making (SDM) on patient recovery. This study aims to determine whether GPs trained in SDM and reinforcing patients’ treatment expectations showed more trained behaviour during their consultations than untrained GPs. Methods: We compared 86 consultations conducted by 23 trained GPs with 89 consultations completed by 19 untrained GPs. The primary outcomes were SDM, as measured by the OPTION s...

  11. Advice, authority and autonomy in shared decision-making in antenatal screening: the importance of context.

    Science.gov (United States)

    Pilnick, Alison; Zayts, Olga

    2016-03-01

    Shared decision-making (SDM) has been widely advocated across many branches of healthcare, yet there is considerable debate over both its practical application and how it should be examined or assessed. More recent discussions of SDM have highlighted the important of context, both internal and external to the consultation, with a recognition that decisions cannot be understood in isolation. This paper uses conversation analysis (CA) to examine how decision-making is enacted in the context of antenatal screening consultations in Hong Kong. Building on previous CA work (Collins et al. , Toerien et al. 2013), we show that, whilst previously identified formats are used here to present the need for a decision, the overriding basis professionals suggest for actually making a decision in this context is the level of worry or concern a pregnant woman holds about potential foetal abnormality. Professionals take an unknowing 'epistemic stance' (Heritage ) towards this worry, and hence step back from involvement in decision-making. We argue that this is linked to the non-directive ethos that prevails in antenatal screening services, and suggest that more research is needed to understand how the enactment of SDM is affected by wider professional contexts and parameters.

  12. On speaking terms: a Delphi study on shared decision-making in maternity care.

    Science.gov (United States)

    Nieuwenhuijze, Marianne J; Korstjens, Irene; de Jonge, Ank; de Vries, Raymond; Lagro-Janssen, Antoine

    2014-07-09

    For most women, participation in decision-making during maternity care has a positive impact on their childbirth experiences. Shared decision-making (SDM) is widely advocated as a way to support people in their healthcare choices. The aim of this study was to identify quality criteria and professional competencies for applying shared decision-making in maternity care. We focused on decision-making in everyday maternity care practice for healthy women. An international three-round web-based Delphi study was conducted. The Delphi panel included international experts in SDM and in maternity care: mostly midwives, and additionally obstetricians, educators, researchers, policy makers and representatives of care users. Round 1 contained open-ended questions to explore relevant ingredients for SDM in maternity care and to identify the competencies needed for this. In rounds 2 and 3, experts rated statements on quality criteria and competencies on a 1 to 7 Likert-scale. A priori, positive consensus was defined as 70% or more of the experts scoring ≥6 (70% panel agreement). Consensus was reached on 45 quality criteria statements and 4 competency statements. SDM in maternity care is a dynamic process that starts in antenatal care and ends after birth. Experts agreed that the regular visits during pregnancy offer opportunities to build a relationship, anticipate situations and revisit complex decisions. Professionals need to prepare women antenatally for unexpected, urgent decisions in birth and revisit these decisions postnatally. Open and respectful communication between women and care professionals is essential; information needs to be accurate, evidence-based and understandable to women. Experts were divided about the contribution of professional advice in shared decision-making and about the partner's role. SDM in maternity care is a dynamic process that takes into consideration women's individual needs and the context of the pregnancy or birth. The identified

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

    Science.gov (United States)

    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

  14. Understanding patients' and doctors' attitudes about shared decision making for advance care planning.

    Science.gov (United States)

    Hajizadeh, Negin; Uhler, Lauren M; Pérez Figueroa, Rafael E

    2015-12-01

    Although shared decision making (SDM) is the preferred model of making complex treatment decisions with patients, patients' and doctors' attitudes towards SDM for advance care planning are unknown. We sought to: (i) gain general insights into the current practice of SDM and attitudes about patient involvement, and (ii) gain specific insights into experience with, and attitudes about, SDM for advance care planning. Qualitative analysis of face-to-face semi-structured interviews. Patients with chronic lung disease and their doctors at a New York City public hospital. Although patients described participation in decision making, many deferred the final decision to their doctors. Doctors indicated a preference for SDM but expressed barriers including perceived lack of patient understanding and lack of patient empowerment. With regard to end-of-life discussions, patients were generally open to having these discussions with their doctors, although their openness sometimes depended on the circumstance (i.e. end-of-life discussions may be more acceptable to patients for whom the chance of dying is high). Doctors reported engaging in end-of-life treatment decisions with their patients, although expressed the need for conversations to take place earlier, in advance of acute illness, and identified a lack of prognostic estimates as one barrier to engaging in this discussion. Doctors should explore their patients' attitudes regarding end-of-life discussions and preferences for decision-making styles. There is a need for tools such as decision aids which can empower patients to participate in decision making and can support doctors with prognostic estimates pertinent to individual patients. © 2014 The Authors Health Expectations Published by John Wiley & Sons Ltd.

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

    Science.gov (United States)

    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.

  16. Supportive Care: Communication Strategies to Improve Cultural Competence in Shared Decision Making.

    Science.gov (United States)

    Brown, Edwina A; Bekker, Hilary L; Davison, Sara N; Koffman, Jonathan; Schell, Jane O

    2016-08-10

    Historic migration and the ever-increasing current migration into Western countries have greatly changed the ethnic and cultural patterns of patient populations. Because health care beliefs of minority groups may follow their religion and country of origin, inevitable conflict can arise with decision making at the end of life. The principles of truth telling and patient autonomy are embedded in the framework of Anglo-American medical ethics. In contrast, in many parts of the world, the cultural norm is protection of the patient from the truth, decision making by the family, and a tradition of familial piety, where it is dishonorable not to do as much as possible for parents. The challenge for health care professionals is to understand how culture has enormous potential to influence patients' responses to medical issues, such as healing and suffering, as well as the physician-patient relationship. Our paper provides a framework of communication strategies that enhance crosscultural competency within nephrology teams. Shared decision making also enables clinicians to be culturally competent communicators by providing a model where clinicians and patients jointly consider best clinical evidence in light of a patient's specific health characteristics and values when choosing health care. The development of decision aids to include cultural awareness could avoid conflict proactively, more productively address it when it occurs, and enable decision making within the framework of the patient and family cultural beliefs.

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

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    Amorin-Woods Lyndon G

    2012-03-01

    Full Text Available Abstract Background 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. Discussion 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'; Summary 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.

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

    Science.gov (United States)

    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.

  20. Facilitating Collaboration in Lecture-Based Learning through Shared Notes Using Wireless Technologies

    Science.gov (United States)

    Valtonen, T.; Havu-Nuutinen, S.; Dillon, P.; Vesisenaho, M.

    2011-01-01

    This paper reports a case study for developing lecture teaching in higher education by connecting simultaneously the benefits of face-to-face teaching and social software for capturing and sharing students' lecture notes. The study was conducted with 12 university students taking a degree course on pre-primary education. Data were collected on (1)…

  1. Enhancing Preschool Educators' Ability to Facilitate Conversations during Shared Book Reading

    Science.gov (United States)

    Milburn, Trelani F.; Girolametto, Luigi; Weitzman, Elaine; Greenberg, Janice

    2014-01-01

    The purpose of this study was to investigate whether professional development enhanced educators' use of conversational strategies during shared book reading with small groups of preschoolers. Twenty preschool educators and small groups of children from each of their classrooms were randomly assigned to the experimental or control group. The…

  2. Shared decision-making in neonatology: an utopia or an attainable goal?

    Science.gov (United States)

    D'Aloja, Ernesto; Floris, Laura; Muller, Mima; Birocchi, Francesca; Fanos, Vassilios; Paribello, Francesco; Demontis, Roberto

    2010-10-01

    Medical decision making is sometimes considered as a relatively simple process in which a decision may be made by the physician, by the patient, or by both patient and physician working together. There are three main models of decision making--paternalism, patient informed choice, and shared decision-making (SDM), having each one of these drawbacks and limitations. Historically, the most adopted one was the paternalism (strongly 'Doctor knows best'), where the professional made the decision based on what he/she considered to be as the patient's best interest, not necessarily contemplating patient's will and wishes. Currently, at the antipodes, the patient informed choice, where the patient makes his/her decision based on information received from the physician with no possible interference of professional's own preferences, seems to be the preferred relationship standard. SDM represents an intermediate approach between the two above-mentioned opposite models, being a medical process that involves actively the doctor and the patient who both bring their own facts and preferences to reach an agreement on the decision on if, when and how to treat a disease. This model, being characterized by elements pertaining to both the others, is gaining popularity in several medical and surgical scenarios whenever a competent patient is able to actively participate into the decisional process. On this basis can this model be implemented also in a Neonatology Intensive Care Unit where little patients are--by nature--incompetent, being the diagnostic/therapeutic choices taken by parents? We focused on this complex item considering four possible different scenarios and it seems to us that it could be possible to introduce such an approach, providing that parents' empowerment, a good physician's communication skill and consideration of all cultural, religious, economic, and ethic values of every single actor have been fairly taken into account.

  3. The opportunities and challenges for shared decision-making in the rural United States.

    Science.gov (United States)

    Nelson, William A; Barr, Paul J; Castaldo, Mary G

    2015-06-01

    The ethical standard for informed consent is fostered within a shared decision-making (SDM) process. SDM has become a recognized and needed approach in health care decision-making. Based on an ethical foundation, the approach fosters the active engagement of patients, where the clinician presents evidence-based treatment information and options and openly elicits the patient's values and preferences. The SDM process is affected by the context in which the information exchange occurs. Rural settings are one context that impacts the delivery of health care and SDM. Rural health care is significantly influenced by economic, geographical and social characteristics. Several specific distinctive features influence rural health care decision-making-poverty, access to health care, isolation, over-lapping relationships, and a shared culture. The rural context creates challenges as well as fosters opportunities for the application of SDM as a natural dynamic within the rural provider-patient relationship. To fulfill the ethical requirements of informed consent through SDM, it is necessary to understand its inherent challenges and opportunities. Therefore, rural clinicians and ethicists need to be cognizant of the impact of the rural setting on SDM and use the insights as an opportunity to achieve SDM.

  4. Shared Decision Making and Effective Physician-Patient Communication: The Quintessence of Patient-Centered Care

    Directory of Open Access Journals (Sweden)

    Huy Ming Lim

    2015-03-01

    Full Text Available The Institute of Medicine’s (IOM 2001 landmark report, Crossing the Quality Chasm: A New Health System for the 21st Century, identified patient-centeredness as one of the fundamental attributes of quality health care, alongside safety, effectiveness, timeliness, efficiency, and equity. The IOM defined patient-centeredness as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” This concept of patient-centered care represents a paradigm shift from the traditional disease-oriented and physician-centered care, grounding health care in the subjective experience of illness and the needs and preferences of individual patients rather than the evaluation and treatment of diseases which emphasizes on leveraging clinical expertise and evidence derived from population-based studies. Regrettably, despite the ubiquitous talk about patient-centered care in modern health care, shared decision-making and effective physician-patient communication—the two cruxes of patient-centered care—are yet to become the norms. Strategies to promote and enhance shared decision-making and effective communication between clinicians and patients should be rigorously implemented to establish a health care system that truly values patients as individuals and turn the rhetoric of patient-centered care into reality.

  5. Use of implicit persuasion in decision making about adjuvant cancer treatment: A potential barrier to shared decision making.

    Science.gov (United States)

    Engelhardt, Ellen G; Pieterse, Arwen H; van der Hout, Anja; de Haes, Hanneke J C J M; Kroep, Judith R; Quarles van Ufford-Mannesse, Patricia; Portielje, Johanneke E A; Smets, Ellen M A; Stiggelbout, Anne M

    2016-10-01

    Shared decision making (SDM) is widely advocated, especially for preference-sensitive decisions like those on adjuvant treatment for early-stage cancer. Here, decision making involves a subjective trade-off between benefits and side-effects, and therefore, patients' informed preferences should be taken into account. If clinicians consciously or unconsciously steer patients towards the option they think is in their patients' best interest (i.e. implicit persuasion), they may be unwittingly subverting their own efforts to implement SDM. We assessed the frequency of use of implicit persuasion during consultations and whether the use of implicit persuasion was associated with expected treatment benefit and/or decision making. Observational study design in which consecutive consultations about adjuvant systemic therapy with stage I-II breast cancer patients treated at oncology outpatient clinics of general teaching hospitals and university medical centres were audiotaped, transcribed and coded by two researchers independently. In total, 105 patients (median age = 59; range: 35-87 years) were included. A median of five (range: 2-10) implicitly persuasive behaviours were employed per consultation. The number of behaviours used did not differ by disease stage (P = 0.07), but did differ by treatment option presented (P = 0.002) and nodal status (P = 0.01). About 50% of patients with stage I or node-negative disease were steered towards undergoing chemotherapy, whereas 96% of patients were steered towards undergoing endocrine therapy, irrespective of expected treatment benefit. Decisions were less often postponed if more implicit persuasion was used (P = 0.03). Oncologists frequently use implicit persuasion, steering patients towards the treatment option that they think is in their patients' best interest. Expected treatment benefit does not always seem to be the driving force behind implicit persuasion. Awareness of one's use of these steering behaviours

  6. Can adults with low literacy understand shared decision making questions? A qualitative investigation.

    Science.gov (United States)

    Muscat, Danielle M; Shepherd, Heather L; Morony, Suzanne; Smith, Sian K; Dhillon, Haryana M; Trevena, Lyndal; Hayen, Andrew; Luxford, Karen; Nutbeam, Don; McCaffery, Kirsten

    2016-11-01

    Participation in shared decision-making (SDM) may be difficult for adults with lower literacy. Tools to support consumers to engage in SDM are rarely designed for or evaluated with adults with lower literacy and/or poor English language. Qualitative interviews were conducted with 26 adults with lower literacy and/or poor English language skills to investigate (a) whether participants where able to read and understand two generic SDM consumer support tools (Smart Health Choices and AskShareKnow question-sets), (b) which question-set was easier for participants and, (c) perceived usefulness of the question-sets and barriers to use. Interviews were analysed using Framework Analysis. Participants had difficulties understanding terms embedded within both the AskShareKnow and Smart Health Choices questions. Our findings suggest that the AskShareKnow question-set was easier for our participants than the Smart Health Choices questions, and clarification using a structured response was reasonably effective. While participants appreciated the usefulness of the questions, they identified important barriers to use. Generic question-sets alone are not sufficient to support SDM for adults with lower literacy and/or poor English-language skills. To ensure that SDM is accessible to all, we must consider how best to support adults with low literacy and/or poor English-language skills to participate in this process. Copyright © 2016. Published by Elsevier Ireland Ltd.

  7. Involvement as inclusion? Shared decision-making in social work practice in Israel: a qualitative account.

    Science.gov (United States)

    Levin, Lia

    2015-03-01

    Shared decision-making (SDM), a representation of shared knowledge and power between social workers and their clients, is gaining popularity and prevalence in social services around the world. In many senses, SDM reflects values traditionally associated with social work and service provision, such as equality and anti-discrimination. In the complex context of social problem-solving, however, the relationship between SDM, social workers and their clients is multi-faceted and deserves particular attention. The current study examined SDM and the dilemmas it entails through interviews conducted in 2012 with 77 Israeli social workers and policy makers whose responses were analysed according to the guiding principles of descriptive phenomenological content analysis and dialogical commonality. Participants' responses represent notions of hope, change, identity and choice. Findings are discussed in correspondence with current and recent trends in Israeli social services, and the social work profession in Israel.

  8. Translating shared decision-making into health care clinical practices: Proof of concepts

    Directory of Open Access Journals (Sweden)

    St-Jacques Sylvie

    2008-01-01

    Full Text Available Abstract Background There is considerable interest today in shared decision-making (SDM, defined as a decision-making process jointly shared by patients and their health care provider. However, the data show that SDM has not been broadly adopted yet. Consequently, the main goal of this proposal is to bring together the resources and the expertise needed to develop an interdisciplinary and international research team on the implementation of SDM in clinical practice using a theory-based dyadic perspective. Methods Participants include researchers from Canada, US, UK, and Netherlands, representing medicine, nursing, psychology, community health and epidemiology. In order to develop a collaborative research network that takes advantage of the expertise of the team members, the following research activities are planned: 1 establish networking and on-going communication through internet-based forum, conference calls, and a bi-weekly e-bulletin; 2 hold a two-day workshop with two key experts (one in theoretical underpinnings of behavioral change, and a second in dyadic data analysis, and invite all investigators to present their views on the challenges related to the implementation of SDM in clinical practices; 3 conduct a secondary analyses of existing dyadic datasets to ensure that discussion among team members is grounded in empirical data; 4 build capacity with involvement of graduate students in the workshop and online forum; and 5 elaborate a position paper and an international multi-site study protocol. Discussion This study protocol aims to inform researchers, educators, and clinicians interested in improving their understanding of effective strategies to implement shared decision-making in clinical practice using a theory-based dyadic perspective.

  9. Exploring emotions and the shared decision-making process in pediatric primary care

    Directory of Open Access Journals (Sweden)

    Francesca Dicé

    2016-12-01

    Full Text Available This paper aims to identify conversational interaction patterns in pediatrics with a focus on the shared decision-making process and dialogue about emotions in doctor–patient relationships. We documented conversations in 163 visits by 168 children in pediatric primary care; we observed, audiorecordered, transcribed and analyzed them with specific instruments of analysis of doctor patient relationship. Our survey was conducted in four pediatric primary care practices and 15 health providers were involved. The data collection period lasted three months and was undertaken twice a week on days. We analyzed visits with Verona Coding Definitions of Emotional Sequences (VR-CoDES and Observing Patient Involvement in Shared Decision Making (OPTION instruments. Frequencies of emotions’ signals (cues/concerns obtained using VR-CoDES were analyzed and compared with the OPTION ratings. We documented 318 cues/concerns for parents and 167 for children. The relationship between cues/concerns and Healthcare Providers responses was strongest in dialogues between parents and pediatricians. The conversational patterns focused on the procedures of the care, with little opportunities of dialogue about emerging emotions. We also observed limited possibilities for participant involvement, especially by children, due to several difficulties integrating dialogue about emotions and concordance processes. The conversations seemed to be characterized by rarity of shared decision making or attention to the informational value of children’s emotions. It could be useful to implement psychological interventions to achieve an enrichment of the dialogue between participants, helping them to incorporate emotions into conversations and to recognize decisional competences, necessary to concordance processes.

  10. Interventions for promoting participation in shared decision-making for children with cancer.

    Science.gov (United States)

    Coyne, Imelda; O'Mathúna, Dónal P; Gibson, Faith; Shields, Linda; Leclercq, Edith; Sheaf, Greg

    2016-11-29

    This is an update of the Cochrane systematic review of shared decision-making (SMD) making published in 2013. Children's rights to have their views heard in matters that affect their lives are now well established since the publication of the UN Convention treaty (1989). Children with cancer generally prefer to be involved in decision-making and consider it important that they have the opportunity to take part in decision-making concerning their health care, even in end-of-life decisions. There is considerable support for involving children in healthcare decision-making at a level commensurate with their experience, age and abilities. Thus, healthcare professionals and parents need to know how they should involve children in decision-making and what interventions are most effective in promoting SDM for children with cancer. To examine the effects of SDM interventions on the process of SDM for children with cancer who are aged four to 18 years. We searched the following sources for the review: Cochrane Central Register of Controlled Studies (CENTRAL) (the Cochrane Library 2016, Issue 1); PubMed (NLM) (1946 to February 2016); Embase (Ovid) (1974 to February 2016); CINAHL (EBSCO) (1982 to February 2016); ERIC (ProQuest) (1966 to February 2016); PsycINFO (EBSCO) (1806 to February 2016); BIOSIS (Thomson Reuters) (1980 to December 2009 - subscription ceased at that date); ProQuest Dissertations and Theses (1637 to February 2016); and Sociological Abstracts (ProQuest) (1952 to February 2016). In addition we searched the reference lists of relevant articles and review articles and the following conference proceedings (2005 up to and including 2015): American Academy on Communication in Healthcare (AACH), European Society for Medical Oncology (ESMO), European CanCer Organisation (ECCO), European Association for Communication in Healthcare (EACH), International Conference on Communication in Healthcare (ICCH), International Shared Decision Making Conference (ISDM), Annual

  11. Decisional equipoise is not decisional conflict: avoiding the false clarity bias in the evaluation of decision aids and Shared Decision Making processes

    DEFF Research Database (Denmark)

    Kaltoft, Mette Kjer; Salkeld, Glenn; Cunich, Michelle

    2014-01-01

    Purposes: To question the use of criteria related to decisional ‘sureness’ in evaluating decision aids and Shared Decision Making processes,- as occurs in the Decisional Conflict Scale (items 10-12) and its reduced form SURE (item 1) - on the ground that decisional equipoise is a legitimate outco...

  12. The Nanomaterial Registry: facilitating the sharing and analysis of data in the diverse nanomaterial community

    OpenAIRE

    Ostraat ML; Mills KC; Guzan KA; Murry D

    2013-01-01

    Michele L Ostraat, Karmann C Mills, Kimberly A Guzan, Damaris MurryRTI International, Durham, NC, USAAbstract: The amount of data being generated in the nanotechnology research space is significant, and the coordination, sharing, and downstream analysis of the data is complex and consistently deliberated. The complexities of the data are due in large part to the inherently complicated characteristics of nanomaterials. Also, testing protocols and assays used for nanomaterials are diverse and l...

  13. Psychometric evaluation of the Shared Decision-Making Instrument--Revised.

    Science.gov (United States)

    Bartlett, Jacqueline A; Peterson, Jane A

    2013-02-01

    The purpose of this study was to evaluate the psychometric properties of the Shared Decision-Making Inventory-Revised (SDMI-R) to measure four constructs (knowledge, attitudes, self-efficacy, and intent) theoretically defined as vital in discussing the human papillomavirus (HPV) disease and vaccine with clients. The SDMI-R was distributed to a sample (N = 1,525) of school nurses. Correlational matrixes denoted moderate to strong correlations, indicating adequate internal reliability. Reliability for the total instrument was satisfactory (α = .874) along with Attitude, Self-Efficacy and Intent subscales .828, .917, .891, respectively. Exploratory factor analysis revealed five components that explained 75.96% of the variance.

  14. Anorexia, bulimia, and obesity: shared decision making deficits on the Iowa Gambling Task (IGT).

    Science.gov (United States)

    Brogan, Amy; Hevey, David; Pignatti, Riccardo

    2010-07-01

    The pathological eating behaviors in Anorexia Nervosa (AN), Bulimia Nervosa (BN), and obesity are characterized by a preference for high immediate reward, despite higher future losses in terms of both physical and psychological outcomes. The present study compared the decision making profile of females with a diagnosis of AN (n = 22), BN (n = 17), obesity (n = 18), and a healthy weight comparison group (n = 20) using a standardized neuropsychological test, the Iowa Gambling Task (IGT). The three clinical groups (AN, BN, obesity) were significantly impaired on the IGT compared with the comparison group on both overall task performance and task learning; however, the three clinical groups were not significantly different from each other. Sixty-one percent to 77% of the clinical groups reached the threshold for impairment on the IGT, compared with 15% of the comparison group. The potential basis for this shared decision making profile is discussed.

  15. Momentum: A smartphone application to support shared decision making for people using mental health services.

    Science.gov (United States)

    Korsbek, Lisa; Tønder, Esben Sandvik

    2016-06-01

    The aim of the pilot study was to examine the use of a smartphone application as a modern decision aid to support shared decision making in mental health. 78 people using mental health services and 116 of their providers participated in a 4-month pilot study. At the end of the intervention, we conducted 3 focus group interviews with 12 multidisciplinary staff members, 1 focus group interview with doctors, and 7 individual interviews with consumers. Each interview was recorded and systematically reviewed to identify common themes and both similar and different traits between respondents through a process of induction. Consumers and providers found the application a useful tool to support people in recovery in providing an overview and setting an agenda. However, the pilot study found more technological obstacles to its use. Some results indicate an obstacle perhaps relating to the power asymmetry between people using mental health services and staff. Contrary to our hypothesis that peer support would be crucial, the use of the application was most widespread when it was presented to consumers by providers who found it was a useful tool. The results indicate the relevance of using modern technology to support shared decision making (SDM) and the recovery model, though raise the question of how the actual use in the study is to be understood. The study thereby points to a need of further research into the understanding of the central consumer-provider relationship in SDM and in how decision aids are presented. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  16. Development of a program theory for shared decision-making: a realist review protocol.

    Science.gov (United States)

    Groot, Gary; Waldron, Tamara; Carr, Tracey; McMullen, Linda; Bandura, Lori-Ann; Neufeld, Shelley-May; Duncan, Vicky

    2017-06-17

    The practicality of applying evidence to healthcare systems with the aim of implementing change is an ongoing challenge for practitioners, policy makers, and academics. Shared decision- making (SDM), a method of medical decision-making that allows a balanced relationship between patients, physicians, and other key players in the medical decision process, is purported to improve patient and system outcomes. Despite the oft-mentioned benefits, there are gaps in the current literature between theory and implementation that would benefit from a realist approach given the value of this methodology to analyze complex interventions. In this protocol, we outline a study that will explore: "In which situations, how, why, and for whom does SDM between patients and health care providers contribute to improved decision making?" A seven step iterative process will be described including preliminary theory development, establishment of a search strategy, selection and appraisal of literature, data extraction, analysis and synthesis of extracted results from literature, and formation of a revised program theory with the input of patients, physicians, nurse navigators, and policy makers from a stakeholder session. The goal of the realist review will be to identify and refine a program theory for SDM through the identification of mechanisms which shape the characteristics of when, how, and why SDM will, and will not, work. PROSPERO CRD42017062609.

  17. The status of shared decision making and citizen participation in Israeli medicine.

    Science.gov (United States)

    Miron-Shatz, Talya; Golan, Ofra; Brezis, Mayer; Siegal, Gil; Doniger, Glen M

    2011-01-01

    WHAT ABOUT POLICY REGARDING SDM? Though informed consent and patients' right to information are regulated by Israeli law, there is a low level of formal activities focused on shared decision making (SDM) in Israel. Further, there are few organized programs to promote SDM among medical professionals or the public, and governmental support of SDM-related research is minimal. WHAT ABOUT TOOLS - DECISION SUPPORT FOR PATIENTS? The Israeli government does not have a program on development of patient decision aids. WHAT ABOUT PROFESSIONAL INTEREST AND IMPLEMENTATION? Nonetheless, patients have begun to influence litigation in both formal and informal capacities, medical schools have begun to incorporate courses for improving physician-patient communication into their curricula, and the largest national health plan has initiated a plan to increase pubic awareness. Funding for researching and promoting SDM is not centrally allocated, and studies show that despite the positive effects of SDM, such an approach is infrequently applied in actual clinical practice, and initiatives to promote SDM (e.g., decision aids) are in their infancy. WHAT DOES THE FUTURE LOOK LIKE? In conclusion, though not actively promoting SDM at present, Israel, with its governmentally regulated universal coverage with good access to high-level services possesses all the requisite elements for rapid, widespread advances in SDM in future years.

  18. Best practices: a program to support shared decision making in an outpatient psychiatric medication clinic.

    Science.gov (United States)

    Deegan, Patricia E; Rapp, Charles; Holter, Mark; Riefer, Melody

    2008-06-01

    This column presents preliminary findings of an intervention to support shared decision making in psychopharmacology consultation. The waiting area in an urban psychiatric medication clinic was transformed into a peer-run Decision Support Center featuring a user-friendly, Internet-based software program with which clients could create a one-page computer-generated report for use in the medication consultation. The Decision Support Center was used 662 times by 189 unique users from a young-adult and general adult case management team from October 2006 to September 2007. All clients had severe mental disorders. Only ten clients refused to use the intervention at some point during the pilot study. Focus groups with medical staff (N=4), clients (N=16), case managers (N=14), and peer-specialist staff (N=3) reported that the intervention helped to create efficiencies in the consultation and empower clients to become more involved in treatment-related decision making. A randomized controlled trial is currently in process.

  19. Consumer Outcomes After Implementing CommonGround as an Approach to Shared Decision Making.

    Science.gov (United States)

    Salyers, Michelle P; Fukui, Sadaaki; Bonfils, Kelsey A; Firmin, Ruth L; Luther, Lauren; Goscha, Rick; Rapp, Charles A; Holter, Mark C

    2017-03-01

    The authors examined consumer outcomes before and after implementing CommonGround, a computer-based shared decision-making program. Consumers with severe mental illness (N=167) were interviewed prior to implementation and 12 and 18 months later to assess changes in active treatment involvement, symptoms, and recovery-related attitudes. Providers also rated consumers on level of treatment involvement. Most consumers used CommonGround at least once (67%), but few used the program regularly. Mixed-effects regression analyses showed improvement in self-reported symptoms and recovery attitudes. Self-reported treatment involvement did not change; however, for a subset of consumers with the same providers over time (N=83), the providers rated consumers as more active in treatment. This study adds to the growing literature on tools to support shared decision making, showing the potential benefits of CommonGround for improving recovery outcomes. More work is needed to better engage consumers in CommonGround and to test the approach with more rigorous methods.

  20. Shared decision making in health care settings: a role for social work.

    Science.gov (United States)

    Peterson, K Jean

    2012-01-01

    Shared decision making (SDM) is a process integral to social work practice, one where the provider/professional and the consumer/patient discuss treatment alternatives based on patient values and life circumstances and make a shared decision about whether and how to proceed with treatment. Evidence-based medicine suggests that for many health conditions, having the choice of several effective treatment options is not uncommon. In these cases treatment should be based on what is best for the individual, since many factors influence an individual's treatment preference, including the psychological, social, cultural, and spiritual history she/he brings to the medical encounter; a history that has long been ignored in somatic health care. This article develops the argument that medical social workers possess the professional knowledge and skill base to provide decisional coaching, and implementing SDM in primary care settings. Of particular importance are the values that guide professional social work practice, including client self-determination, which is the basis of SDM, and the ability to maintain neutrality.

  1. Shared decision making in Swedish community mental health services - an evaluation of three self-reporting instruments.

    Science.gov (United States)

    Rosenberg, David; Schön, Ulla-Karin; Nyholm, Maria; Grim, Katarina; Svedberg, Petra

    2017-04-01

    Despite the potential impact of shared decision making on users satisfaction with care and quality in health care decisions, there is a lack of knowledge and skills regarding how to work with shared decision making among health care providers. The aim of this study was to evaluate the psychometric properties of three instruments that measure varied dimensions of shared decision making, based on self-reports by clients, in a Swedish community mental health context. The study sample consisted of 121 clients with experience of community mental health care, and involved in a wide range of decisions regarding both social support and treatment. The questionnaires were examined for face and content validity, internal consistency, test-retest reliability and construct validity. The instruments displayed good face and content validity, satisfactory internal consistency and a moderate to good level of stability in test-retest reliability with fair to moderate construct correlations, in a sample of clients with serious mental illness and experience of community mental health services in Sweden. The questionnaires are considered to be relevant to the decision making process, user-friendly and appropriate in a Swedish community mental health care context. They functioned well in settings where non-medical decisions, regarding social and support services, are the primary focus. The use of instruments that measure various dimensions of the self-reported experience of clients, can be a key factor in developing knowledge of how best to implement shared decision making in mental health services.

  2. Facilitating the development of a shared purpose in a university department: the first stage towards developing a culture of shared governance

    Directory of Open Access Journals (Sweden)

    Brian McGowan

    2016-11-01

    Full Text Available Background and context: The structure of higher education departments tends to be hierarchical or, at the other extreme, characterised as ‘a galaxy of individual stars’ (Handy, 1993 p 190. Ours was no exception. However, changes in the way nursing education was provided, internal growth and development followed by a period of austerity, presented our school with an unprecedented opportunity. We found ourselves in a position where we had the possibility to change. Aims: The aim of the paper is to share our reflections on the process and outcomes to date of a culture change project in a university department. The purpose of this opening part of the project was to enable creative and collegial opportunities to work together. Conclusions: An inclusive culture can make a difference to peoples’ lives and reflect the underpinning principles of person-centred practice. This project has enabled us to define our shared purpose, clarify our values, make commitments and set standards. Overall, though it has allowed us to see each other as people who have emerged from behind a faceless organisational structure. Implications for practice: The values of inclusiveness, integrity and professionalism are important for a shared understanding and effective collaborative functioning within university departments internationally, especially those that espouse person-centredness Staff teams can be structured around professional and personal development needs but these also provide a direct link to both departmental and organisational purposes aligned to education Managerial support, staff participation and an experienced facilitator are vital for successful cultural change. Our project has been UK based but we believe these experiences to be transferable and of interest to university departments elsewhere that aspire to create cultures that enable staff, and therefore students and the wider community, to flourish

  3. Shared treatment decision-making and empowerment-related outcomes in psychosis: systematic review and meta-analysis.

    Science.gov (United States)

    Stovell, Diana; Morrison, Anthony P; Panayiotou, Margarita; Hutton, Paul

    2016-07-01

    In the UK almost 60% of people with a diagnosis of schizophrenia who use mental health services say they are not involved in decisions about their treatment. Guidelines and policy documents recommend that shared decision-making should be implemented, yet whether it leads to greater treatment-related empowerment for this group has not been systematically assessed. To examine the effects of shared decision-making on indices of treatment-related empowerment of people with psychosis. We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of shared decision-making concerning current or future treatment for psychosis (PROSPERO registration CRD42013006161). Primary outcomes were indices of treatment-related empowerment and objective coercion (compulsory treatment). Secondary outcomes were treatment decision-making ability and the quality of the therapeutic relationship. We identified 11 RCTs. Small beneficial effects of increased shared decision-making were found on indices of treatment-related empowerment (6 RCTs; g = 0.30, 95% CI 0.09-0.51), although the effect was smaller if trials with >25% missing data were excluded. There was a trend towards shared decision-making for future care leading to reduced use of compulsory treatment over 15-18 months (3 RCTs; RR = 0.59, 95% CI 0.35-1.02), with a number needed to treat of approximately 10 (95% CI 5-∞). No clear effect on treatment decision-making ability (3 RCTs) or the quality of the therapeutic relationship (8 RCTs) was found, but data were heterogeneous. For people with psychosis the implementation of shared treatment decision-making appears to have small beneficial effects on indices of treatment-related empowerment, but more direct evidence is required. © The Royal College of Psychiatrists 2016.

  4. The Nanomaterial Registry: facilitating the sharing and analysis of data in the diverse nanomaterial community.

    Science.gov (United States)

    Ostraat, Michele L; Mills, Karmann C; Guzan, Kimberly A; Murry, Damaris

    2013-01-01

    The amount of data being generated in the nanotechnology research space is significant, and the coordination, sharing, and downstream analysis of the data is complex and consistently deliberated. The complexities of the data are due in large part to the inherently complicated characteristics of nanomaterials. Also, testing protocols and assays used for nanomaterials are diverse and lacking standardization. The Nanomaterial Registry has been developed to address such challenges as the need for standard methods, data formatting, and controlled vocabularies for data sharing. The Registry is an authoritative, web-based tool whose purpose is to simplify the community's level of effort in assessing nanomaterial data from environmental and biological interaction studies. Because the Registry is meant to be an authoritative resource, all data-driven content is systematically archived and reviewed by subject-matter experts. To support and advance nanomaterial research, a set of minimal information about nanomaterials (MIAN) has been developed and is foundational to the Registry data model. The MIAN has been used to create evaluation and similarity criteria for nanomaterials that are curated into the Registry. The Registry is a publicly available resource that is being built through collaborations with many stakeholder groups in the nanotechnology community, including industry, regulatory, government, and academia. Features of the Registry website (http://www.nanomaterialregistry.org) currently include search, browse, side-by-side comparison of nanomaterials, compliance ratings based on the quality and quantity of data, and the ability to search for similar nanomaterials within the Registry. This paper is a modification and extension of a proceedings paper for the Institute of Electrical and Electronics Engineers.

  5. The Nanomaterial Registry: facilitating the sharing and analysis of data in the diverse nanomaterial community

    Directory of Open Access Journals (Sweden)

    Ostraat ML

    2013-09-01

    Full Text Available Michele L Ostraat, Karmann C Mills, Kimberly A Guzan, Damaris MurryRTI International, Durham, NC, USAAbstract: The amount of data being generated in the nanotechnology research space is significant, and the coordination, sharing, and downstream analysis of the data is complex and consistently deliberated. The complexities of the data are due in large part to the inherently complicated characteristics of nanomaterials. Also, testing protocols and assays used for nanomaterials are diverse and lacking standardization. The Nanomaterial Registry has been developed to address such challenges as the need for standard methods, data formatting, and controlled vocabularies for data sharing. The Registry is an authoritative, web-based tool whose purpose is to simplify the community's level of effort in assessing nanomaterial data from environmental and biological interaction studies. Because the registry is meant to be an authoritative resource, all data-driven content is systematically archived and reviewed by subject-matter experts. To support and advance nanomaterial research, a set of minimal information about nanomaterials (MIAN has been developed and is foundational to the Registry data model. The MIAN has been used to create evaluation and similarity criteria for nanomaterials that are curated into the Registry. The Registry is a publicly available resource that is being built through collaborations with many stakeholder groups in the nanotechnology community, including industry, regulatory, government, and academia. Features of the Registry website (https://www.nanomaterialregistry.org/ currently include search, browse, side-by-side comparison of nanomaterials, compliance ratings based on the quality and quantity of data, and the ability to search for similar nanomaterials within the Registry. This paper is a modification and extension of a proceedings paper for the Institute of Electrical and Electronics Engineers.Keywords: nanoinformatics

  6. Feasibility of preference-driven radiotherapy dose treatment planning to support shared decision making in anal cancer

    DEFF Research Database (Denmark)

    Rønde, Heidi S; Wee, Leonard; Pløen, John

    2017-01-01

    dose plans must be simultaneously explored. We quantified the degree to which different toxicity priorities might be incorporated into treatment plan selection, to elucidate the feasible decision space for shared decision making in anal cancer radiotherapy. MATERIAL AND METHODS: Retrospective plans...... that preference-informed dose planning is feasible for clinical studies utilizing shared decision making.......PURPOSE/OBJECTIVE: Chemo-radiotherapy is an established primary curative treatment for anal cancer, but clinically equal rationale for different target doses exists. If joint preferences (physician and patient) are used to determine acceptable tradeoffs in radiotherapy treatment planning, multiple...

  7. Shared decision making in preventive care in Switzerland: From theory to action.

    Science.gov (United States)

    Selby, Kevin; Auer, Reto; Cornuz, Jacques

    2017-06-01

    Switzerland with its decentralized, liberal health system and its tradition of direct democracy may be an ideal place for shared decision making (SDM) to take root organically, rather than using top-down regulations seen in other countries. There are now multiple directives and programmes in place to encourage SDM, with the creation of several decision aids and specific training programs in the five Swiss medical schools. There has been an emphasis on preventive care, with the integration of patient preference into an organized colorectal cancer screening program, clear recommendations for prostate cancer screening, and inroads into the primary prevention of cardiovascular disease. Focusing on the experience of the University of Lausanne, we describe multiple approaches being taken to teaching SDM and the local development of decision aids, drawing on international experience but tailored to local needs. Efforts are being made to further involve patients in not only SDM, but also associated research and quality improvement projects. Copyright © 2017. Published by Elsevier GmbH.

  8. Shared Decision-Making Models Acknowledging an Interprofessional Approach: A Theory Analysis to Inform Nursing Practice.

    Science.gov (United States)

    Lewis, Krystina B; Stacey, Dawn; Squires, Janet E; Carroll, Sandra

    2016-01-01

    Patient engagement in collaboration with health professionals is essential to deliver quality health care. A shared decision-making (SDM) approach requires that patients are involved in decisions regarding their health. SDM is expanding from the patient-physician dyad to incorporate an interprofessional perspective. Conceptual models can be used to better understand theoretical underpinnings for application in clinical practice. The aim of this article was to conduct a theory analysis of conceptual models using an interprofessional approach to SDM and discuss each model's relevance to nursing practice. Walker and Avant's theory analysis approach was used. Three conceptual models were eligible. For all models, the decision-making process was considered iterative. The development process was described for 1 model. All models were logical, parsimonious, and generalizable. One was supported by empirical testing. No model described how partnerships are enacted to achieve interprofessional SDM. Also, there was limited articulation as to how nurses' roles and contributions differ from other team members. This theory analysis highlights the need for a model that explains how partnerships among interprofessional team members are enacted to better understand the operationalization of interprofessional SDM. Implications for nursing practice at all system levels are offered and supported by the 3 models.

  9. Shared and selective neural correlates of inhibition, facilitation, and shifting processes during executive control.

    Science.gov (United States)

    Hedden, Trey; Gabrieli, John D E

    2010-05-15

    A network of prefrontal and parietal regions has been implicated in executive control processes. However, the extent to which individual regions within this network are engaged in component control processes, such as inhibition of task-irrelevant stimulus attributes or shifting (switching) between attentional foci, remains controversial. Participants (N=17) underwent functional magnetic resonance imaging while performing a global-local task in which the global and local levels could facilitate or interfere with one another. Stimuli were presented in blocks in which participants either constantly shifted between the global and local levels, or consistently responded to one level only. Activations related to inhibition and shifting processes were observed in a large network of bilateral prefrontal, parietal, and basal ganglia regions. Region of interest analyses were used to classify each region within this network as being common to inhibition and shifting, or preferential to one component process. Several regions were classified as being preferential to inhibition, including regions within the dorsolateral and ventrolateral prefrontal cortex, the parietal lobes, and the temporal-parietal junction. A limited set of regions in the parietal lobes and left dorsolateral prefrontal cortex were classified as preferential to shifting. There was a very large set of regions displaying activation common to both inhibition and shifting processes, including regions within the dorsolateral prefrontal cortex, anterior cingulate, and basal ganglia. Several of these common regions were also involved during facilitation, suggesting that they are responsive to the number of task-salient channels of information, rather than purely to demands on control processes. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  10. Facilitating values awareness through the education of health professionals: Can web based decision making technology help?

    Science.gov (United States)

    Godbold, Rosemary; Lees, Amanda

    2016-03-01

    Recent events in the health care landscape have focused nursing's collective mind on the role of values in health care delivery. For example, in England, the government has issued a mandate to health educators that places primacy on developing a workforce who prioritise and implement the core values of the National Health Service. In the current environment in which 'values' have become common currency, this paper begins by asking what values are, arguing for greater understanding and recognition of their intrinsic role in driving decisions. It then reports on research carried out in New Zealand exploring the potential of the Values Exchange web based educational technology to promote and facilitate a values aware health workforce. Qualitative thematic analysis from a cohort of pre-registration health professionals revealed new understandings about values through the facilitation of deeper, multi-layered thinking. The unique online space provided a safe pre-registration environment for deliberating complex cases, with students readily identifying advantages for future practice and patients. For lasting and meaningful change to occur, a fundamental shift is required in our understanding of values and how they ultimately impact on the way we individually and collectively deliver care to our patients. The Values Exchange may offer a contemporary and timely vehicle for achieving these goals.

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

    Directory of Open Access Journals (Sweden)

    Constanze Pfeiffer

    2008-11-01

    Full Text Available 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 decisionmaking, 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.

  12. The enemy of my enemy is my friend: intraguild predation between invaders and natives facilitates coexistence with shared invasive prey

    Science.gov (United States)

    MacNeil, Calum; Dick, Jaimie T. A.

    2014-01-01

    Understanding and predicting the outcomes of biological invasions is challenging where multiple invader and native species interact. We hypothesize that antagonistic interactions between invaders and natives could divert their impact on subsequent invasive species, thus facilitating coexistence. From field data, we found that, when existing together in freshwater sites, the native amphipod Gammarus duebeni celticus and a previous invader G. pulex appear to facilitate the establishment of a second invader, their shared prey Crangonyx pseudogracilis. Indeed, the latter species was rarely found at sites where each Gammarus species was present on its own. Experiments indicated that this may be the result of G. d. celticus and G. pulex engaging in more intraguild predation (IGP) than cannibalism; when the ‘enemy’ of either Gammarus species was present, that is, the other Gammarus species, C. pseudogracilis significantly more often escaped predation. Thus, the presence of mutual enemies and the stronger inter- than intraspecific interactions they engage in can facilitate other invaders. With some invasive species such as C. pseudogracilis having no known detrimental effects on native species, and indeed having some positive ecological effects, we also conclude that some invasions could promote biodiversity and ecosystem functioning. PMID:25122739

  13. The Evolution of an Interprofessional Shared Decision-Making Research Program: Reflective Case Study of an Emerging Paradigm

    Directory of Open Access Journals (Sweden)

    Maman Joyce Dogba

    2016-07-01

    Full Text Available Introduction: Healthcare research increasingly focuses on interprofessional collaboration and on shared decision making, but knowledge gaps remain about effective strategies for implementing interprofessional collaboration and shared decision-making together in clinical practice. We used Kuhn’s theory of scientific revolutions to reflect on how an integrated interprofessional shared decision-making approach was developed and implemented over time. Methods: In 2007, an interdisciplinary team initiated a new research program to promote the implementation of an interprofessional shared decision-making approach in clinical settings. For this reflective case study, two new team members analyzed the team’s four projects, six research publications, one unpublished and two published protocols and organized them into recognizable phases according to Kuhn’s theory. Results: The merging of two young disciplines led to challenges characteristic of emerging paradigms. Implementation of interprofessional shared-decision making was hindered by a lack of conceptual clarity, a dearth of theories and models, little methodological guidance, and insufficient evaluation instruments. The team developed a new model, identified new tools, and engaged knowledge users in a theory-based approach to implementation. However, several unresolved challenges remain. Discussion: This reflective case study sheds light on the evolution of interdisciplinary team science. It offers new approaches to implementing emerging knowledge in the clinical context.

  14. The Evolution of an Interprofessional Shared Decision-Making Research Program: Reflective Case Study of an Emerging Paradigm.

    Science.gov (United States)

    Dogba, Maman Joyce; Menear, Matthew; Stacey, Dawn; Brière, Nathalie; Légaré, France

    2016-07-19

    Healthcare research increasingly focuses on interprofessional collaboration and on shared decision making, but knowledge gaps remain about effective strategies for implementing interprofessional collaboration and shared decision-making together in clinical practice. We used Kuhn's theory of scientific revolutions to reflect on how an integrated interprofessional shared decision-making approach was developed and implemented over time. In 2007, an interdisciplinary team initiated a new research program to promote the implementation of an interprofessional shared decision-making approach in clinical settings. For this reflective case study, two new team members analyzed the team's four projects, six research publications, one unpublished and two published protocols and organized them into recognizable phases according to Kuhn's theory. The merging of two young disciplines led to challenges characteristic of emerging paradigms. Implementation of interprofessional shared-decision making was hindered by a lack of conceptual clarity, a dearth of theories and models, little methodological guidance, and insufficient evaluation instruments. The team developed a new model, identified new tools, and engaged knowledge users in a theory-based approach to implementation. However, several unresolved challenges remain. This reflective case study sheds light on the evolution of interdisciplinary team science. It offers new approaches to implementing emerging knowledge in the clinical context.

  15. Health-care needs and shared decision-making in priority-setting.

    Science.gov (United States)

    Gustavsson, Erik; Sandman, Lars

    2015-02-01

    In this paper we explore the relation between health-care needs and patients' desires within shared decision-making (SDM) in a context of priority setting in health care. We begin by outlining some general characteristics of the concept of health-care need as well as the notions of SDM and desire. Secondly we will discuss how to distinguish between needs and desires for health care. Thirdly we present three cases which all aim to bring out and discuss a number of queries which seem to arise due to the double focus on a patient's need and what that patient desires. These queries regard the following themes: the objectivity and moral force of needs, the prediction about what kind of patients which will appear on a micro level, implications for ranking in priority setting, difficulties regarding assessing and comparing benefits, and implications for evidence-based medicine.

  16. Is Shared Decision Making a Utopian Dream or an Achievable Goal?

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    Blair, Louisa; Légaré, France

    2015-12-01

    The idea of shared decision making (SDM) between patient and physician grew out of a generalized challenge to traditional social hierarchies that occurred in the middle of the last century. Governments have espoused SDM, thousands of articles about it have been published, and evidence has shown that it improves some of the healthcare processes as well as patient outcomes. Yet it has not been widely adopted. From their cross-disciplinary perspective (practical theology and clinical medicine), the authors locate this reluctance in the unfolding of scientific paradigm shifts, summarize the perceived risks and benefits of SDM and the evidence for each, and suggest practical, achievable approaches for clinicians. Finally, they explore some important emerging territories for SDM.

  17. Informed shared decision-making in planning for the end of life.

    Science.gov (United States)

    Price, Jane

    In recent years, a number of shortcomings in the NHS have been identified in end-of-life care delivered in hospital for people with long-term conditions other than terminal cancer. This article gives an overview of the findings of a Dignity in Care travel scholarship, which was undertaken to establish whether an American shared informed decision aid, specifically designed to initiate therapeutic conversations for this patient group, might reasonably be adopted in an NHS setting. One tool specifically for this purpose was in use in the USA at the time, and its efficacy formed part of a broader research study being carried out at Dartmouth Hitchcock Medical Center (DHMC) in New England. Concurrently in the UK, The Health Foundation supported a 3-year study that focused exclusively on the development of a range of 'option grids' for clinical interventions and did not include an end-of-life model.

  18. Designing an implementation strategy to improve interprofessional shared decision making in sciatica: study protocol of the DISC study

    Directory of Open Access Journals (Sweden)

    Hofstede Stefanie N

    2012-06-01

    Full Text Available Abstract Background Sciatica is a common condition worldwide that is characterized by radiating leg pain and regularly caused by a herniated disc with nerve root compression. Sciatica patients with persisting leg pain after six to eight weeks were found to have similar clinical outcomes and associated costs after prolonged conservative treatment or surgery at one year follow-up. Guidelines recommend that the team of professionals involved in sciatica care and patients jointly decide about treatment options, so-called interprofessional shared decision making (SDM. However, there are strong indications that SDM for sciatica patients is not integrated in daily practice. We designed a study aiming to explore the barriers and facilitators associated with the everyday embedding of SDM for sciatica patients. All related relevant professionals and patients are involved to develop a tailored strategy to implement SDM for sciatica patients. Methods The study consists of two phases: identification of barriers and facilitators and development of an implementation strategy. First, barriers and facilitators are explored using semi-structured interviews among eight professionals of each (paramedical discipline involved in sciatica care (general practitioners, physical therapists, neurologists, neurosurgeons, and orthopedic surgeons. In addition, three focus groups will be conducted among patients. Second, the identified barriers and facilitators will be ranked using a questionnaire among a representative Dutch sample of 200 GPs, 200 physical therapists, 200 neurologists, all 124 neurosurgeons, 200 orthopedic surgeons, and 100 patients. A tailored team-based implementation strategy will be developed based on the results of the first phase using the principles of intervention mapping and an expert panel. Discussion Little is known about effective strategies to increase the uptake of SDM. Most implementation strategies only target a single discipline, whereas

  19. [Medical decision making in hospital--results of an exploratory study on the value of shared decision making from the physicians point of view].

    Science.gov (United States)

    Ernst, J; Holze, S; Sonnefeld, C; Götze, H; Schwarz, R

    2007-04-01

    The changes in the relationship between doctors and patients and the transfer of shared decision making into medical treatment has often been discussed. The role and the perspective of the patients are primarily described. The aim of our study is to examine the attitudes of physicians regarding the shared decision making concept, based on 15 interviews with clinical doctors. Our findings show that most doctors know the content of the concept and mostly agree with it. Practical barriers for the realisation of shared decision making are often stressed. The meaning of the concept of shared decision making for the physicians is in some respects different from the meaning of this concept for the patients. It is important to examine this concept more particularly with standardised instruments. It will be necessary to explore not only the role of patients and physicians in the medical decision making process but also the position of other relevant persons like the relatives of the patients or the nursing staff.

  20. Adjuncts or adversaries to shared decision-making? Applying the Integrative Model of behavior to the role and design of decision support interventions in healthcare interactions

    Directory of Open Access Journals (Sweden)

    Fishbein Martin

    2009-11-01

    Full Text Available Abstract Background A growing body of literature documents the efficacy of decision support interventions (DESI in helping patients make informed clinical decisions. DESIs are frequently described as an adjunct to shared decision-making between a patient and healthcare provider, however little is known about the effects of DESIs on patients' interactional behaviors-whether or not they promote the involvement of patients in decisions. Discussion Shared decision-making requires not only a cognitive understanding of the medical problem and deliberation about the potential options to address it, but also a number of communicative behaviors that the patient and physician need to engage in to reach the goal of making a shared decision. Theoretical models of behavior can guide both the identification of constructs that will predict the performance or non-performance of specific behaviors relevant to shared decision-making, as well as inform the development of interventions to promote these specific behaviors. We describe how Fishbein's Integrative Model (IM of behavior can be applied to the development and evaluation of DESIs. There are several ways in which the IM could be used in research on the behavioral effects of DESIs. An investigator could measure the effects of an intervention on the central constructs of the IM - attitudes, normative pressure, self-efficacy, and intentions related to communication behaviors relevant to shared decision-making. However, if one were interested in the determinants of these domains, formative qualitative research would be necessary to elicit the salient beliefs underlying each of the central constructs. Formative research can help identify potential targets for a theory-based intervention to maximize the likelihood that it will influence the behavior of interest or to develop a more fine-grained understanding of intervention effects. Summary Behavioral theory can guide the development and evaluation of DESIs to

  1. Interspecific shared collective decision-making in two forensically important species.

    Science.gov (United States)

    Boulay, Julien; Deneubourg, Jean-Louis; Hédouin, Valéry; Charabidzé, Damien

    2016-02-10

    To date, the study of collective behaviour has mainly focused on intraspecific situations: the collective decision-making of mixed-species groups involving interspecific aggregation-segregation has received little attention. Here, we show that, in both conspecific and heterospecific groups, the larvae of two species (Lucilia sericata and Calliphora vomitoria, calliphorid carrion-feeding flies) were able to make a collective choice. In all groups, the choice was made within a few minutes and persisted throughout the period of the experiment. The monitoring of a focal individual within a group showed that these aggregations were governed by attractive and retentive effects of the group. Furthermore, the similarity observed between the conspecific and heterospecific groups suggested the existence of shared aggregation signals. The group size was found to have a stronger influence than the species of necrophagous larvae. These results should be viewed in relation to the well-known correlation between group size and heat generation. This study provides the first experimental examination of the dynamics of collective decision-making in mixed-species groups of invertebrates, contributing to our understanding of the cooperation-competition phenomenon in animal social groups.

  2. Shared Decision Making in Intensive Care Units: An American College of Critical Care Medicine and American Thoracic Society Policy Statement

    Science.gov (United States)

    Kon, Alexander A.; Davidson, Judy E.; Morrison, Wynne; Danis, Marion; White, Douglas B.

    2015-01-01

    Objectives Shared decision-making (SDM) is endorsed by critical care organizations, however there remains confusion about what SDM is, when it should be used, and approaches to promote partnerships in treatment decisions. The purpose of this statement is to define SDM, recommend when SDM should be used, identify the range of ethically acceptable decision-making models, and present important communication skills. Methods The American College of Critical Care Medicine (ACCM) and American Thoracic Society (ATS) Ethics Committees reviewed empirical research and normative analyses published in peer-reviewed journals to generate recommendations. Recommendations approved by consensus of the full Ethics Committees of ACCM and ATS were included in the statement. Main Results Six recommendations were endorsed: 1) Definition: Shared decision-making is a collaborative process that allows patients, or their surrogates, and clinicians to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values, goals, and preferences. 2) Clinicians should engage in a SDM process to define overall goals of care (including decisions regarding limiting or withdrawing life-prolonging interventions) and when making major treatment decisions that may be affected by personal values, goals, and preferences. 3) Clinicians should use as their “default” approach a SDM process that includes three main elements: information exchange, deliberation, and making a treatment decision. 4) A wide range of decision-making approaches are ethically supportable including patient- or surrogate-directed and clinician-directed models. Clinicians should tailor the decision-making process based on the preferences of the patient or surrogate. 5) Clinicians should be trained in communication skills. 6) Research is needed to evaluate decision-making strategies. Conclusions Patient and surrogate preferences for decision-making roles regarding value

  3. Graphics Processing Unit-Based Bioheat Simulation to Facilitate Rapid Decision Making Associated with Cryosurgery Training.

    Science.gov (United States)

    Keelan, Robert; Zhang, Hong; Shimada, Kenji; Rabin, Yoed

    2016-04-01

    This study focuses on the implementation of an efficient numerical technique for cryosurgery simulations on a graphics processing unit as an alternative means to accelerate runtime. This study is part of an ongoing effort to develop computerized training tools for cryosurgery, with prostate cryosurgery as a developmental model. The ability to perform rapid simulations of various test cases is critical to facilitate sound decision making associated with medical training. Consistent with clinical practice, the training tool aims at correlating the frozen region contour and the corresponding temperature field with the target region shape. The current study focuses on the feasibility of graphics processing unit-based computation using C++ accelerated massive parallelism, as one possible implementation. Benchmark results on a variety of computation platforms display between 3-fold acceleration (laptop) and 13-fold acceleration (gaming computer) of cryosurgery simulation, in comparison with the more common implementation on a multicore central processing unit. While the general concept of graphics processing unit-based simulations is not new, its application to phase-change problems, combined with the unique requirements for cryosurgery optimization, represents the core contribution of the current study.

  4. The Need for Accurate Risk Prediction Models for Road Mapping, Shared Decision Making and Care Planning for the Elderly with Advanced Chronic Kidney Disease.

    Science.gov (United States)

    Stryckers, Marijke; Nagler, Evi V; Van Biesen, Wim

    2016-11-01

    As people age, chronic kidney disease becomes more common, but it rarely leads to end-stage kidney disease. When it does, the choice between dialysis and conservative care can be daunting, as much depends on life expectancy and personal expectations of medical care. Shared decision making implies adequately informing patients about their options, and facilitating deliberation of the available information, such that decisions are tailored to the individual's values and preferences. Accurate estimations of one's risk of progression to end-stage kidney disease and death with or without dialysis are essential for shared decision making to be effective. Formal risk prediction models can help, provided they are externally validated, well-calibrated and discriminative; include unambiguous and measureable variables; and come with readily applicable equations or scores. Reliable, externally validated risk prediction models for progression of chronic kidney disease to end-stage kidney disease or mortality in frail elderly with or without chronic kidney disease are scant. Within this paper, we discuss a number of promising models, highlighting both the strengths and limitations physicians should understand for using them judiciously, and emphasize the need for external validation over new development for further advancing the field.

  5. The impact of decision aids to enhance shared decision making for diabetes (the DAD study: protocol of a cluster randomized trial

    Directory of Open Access Journals (Sweden)

    LeBlanc Annie

    2012-05-01

    Full Text Available Abstract Background Shared decision making contributes to high quality healthcare by promoting a patient-centered approach. Patient involvement in selecting the components of a diabetes medication program that best match the patient’s values and preferences may also enhance medication adherence and improve outcomes. Decision aids are tools designed to involve patients in shared decision making, but their adoption in practice has been limited. In this study, we propose to obtain a preliminary estimate of the impact of patient decision aids vs. usual care on measures of patient involvement in decision making, diabetes care processes, medication adherence, glycemic and cardiovascular risk factor control, and resource utilization. In addition, we propose to identify, describe, and explain factors that promote or inhibit the routine embedding of decision aids in practice. Methods/Design We will be conducting a mixed-methods study comprised of a cluster-randomized, practical, multicentered trial enrolling clinicians and their patients (n = 240 with type 2 diabetes from rural and suburban primary care practices (n = 8, with an embedded qualitative study to examine factors that influence the incorporation of decision aids into routine practice. The intervention will consist of the use of a decision aid (Statin Choice and Aspirin Choice, or Diabetes Medication Choice during the clinical encounter. The qualitative study will include analysis of video recordings of clinical encounters and in-depth, semi-structured interviews with participating patients, clinicians, and clinic support staff, in both trial arms. Discussion Upon completion of this trial, we will have new knowledge about the effectiveness of diabetes decision aids in these practices. We will also better understand the factors that promote or inhibit the successful implementation and normalization of medication choice decision aids in the care of chronic patients in primary care

  6. The Shared Decision Making Frontier: a Feasibility and Usability Study for Managing Non-Critical Chronic Illness by Combining Behavioural & Decision Theory with Online Technology.

    Science.gov (United States)

    Russell, Amina; Van Woensel, William; Abidi, Samina Raza

    2015-01-01

    The objective of this study is to determine if shared decisions for managing non-critical chronic illness, made through an online biomedical technology intervention, us feasible and usable. The technology intervention incorporates behavioural and decision theories to increase patient engagement, and ultimately long term adherence to health behaviour change. We devised the iheart web intervention as a "proof of concept" in five phases. The implementation incorporates the Vaadin web application framework, Drools, EclipseLink and a MySQL database. Two-thirds of the study participants favoured the technology intervention, based on Likert-scale questions from a post-study questionnaire. Qualitative analysis of think aloud feedback, video screen captures and open-ended questions from the post-study questionnaire uncovered six main areas or themes for improvement. We conclude that online shared decisions for managing a non-critical chronic illness are feasible and usable through the iheart web intervention.

  7. Communication practices that encourage and constrain shared decision making in health-care encounters: Systematic review of conversation analytic research.

    Science.gov (United States)

    Land, Victoria; Parry, Ruth; Seymour, Jane

    2017-05-18

    Shared decision making (SDM) is generally treated as good practice in health-care interactions. Conversation analytic research has yielded detailed findings about decision making in health-care encounters. To map decision making communication practices relevant to health-care outcomes in face-to-face interactions yielded by prior conversation analyses, and to examine their function in relation to SDM. We searched nine electronic databases (last search November 2016) and our own and other academics' collections. Published conversation analyses (no restriction on publication dates) using recordings of health-care encounters in English where the patient (and/or companion) was present and where the data and analysis focused on health/illness-related decision making. We extracted study characteristics, aims, findings relating to communication practices, how these functioned in relation to SDM, and internal/external validity issues. We synthesised findings aggregatively. Twenty-eight publications met the inclusion criteria. We sorted findings into 13 types of communication practices and organized these in relation to four elements of decision-making sequences: (i) broaching decision making; (ii) putting forward a course of action; (iii) committing or not (to the action put forward); and (iv) HCPs' responses to patients' resistance or withholding of commitment. Patients have limited opportunities to influence decision making. HCPs' practices may constrain or encourage this participation. Patients, companions and HCPs together treat and undertake decision making as shared, though to varying degrees. Even for non-negotiable treatment trajectories, the spirit of SDM can be invoked through practices that encourage participation (eg by bringing the patient towards shared understanding of the decision's rationale). © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  8. Resource effects of training general practitioners in risk communication skills and shared decision making competences.

    Science.gov (United States)

    Cohen, David; Longo, M F; Hood, Kerenza; Edwards, Adrian; Elwyn, Glyn

    2004-08-01

    Involving patients more in decisions about their own care requires doctors to be trained in effective ways of communicating information and in developing competences to negotiate levels of patient involvement which are most appropriate for each case. The aim of this study was to determine the cost of such training and identify which service resource variables are subsequently affected. An explanatory cluster randomized crossover trial was carried out which involved training general practitioners (GPs) in the use of risk communication (RC) tools, shared decision making (SDM) competences or both. Continuing care by GPs of patients with one of four chronic conditions (menopausal symptoms, menorrhagia, atrial fibrillation, prostatism) was reviewed before and after training. Cost of training was assessed by prospective monitoring of resources used. Data on prescribing, referrals and investigations were collected via questionnaires to participating practitioners. Data on follow-up GP consultations were extracted from medical records. Three two-level logistic models were performed to investigate the probability of training having an effect on prescribing, referrals and investigations ordered at the review consultation. Training cost pound 1218 per practitioner which increased the cost of a consultation by pound 2.89. Training in SDM or combined with RC significantly affected the probability of a prescription being issued to women with menopausal symptoms and menorrhagia (although RC on its own had no effect) but did not significantly affect prescribing for patients with prostatism or atrial fibrillation. It did not significantly affect the probability of investigations, referrals or follow-up GP visits for any of the conditions. Unless training has a major influence on consultation length, it is unlikely to have any major impacts on cost.

  9. Effective continuing professional development for translating shared decision making in primary care: A study protocol

    Science.gov (United States)

    2010-01-01

    Background Shared decision making (SDM) is a process by which a healthcare choice is made jointly by the healthcare professional and the patient. SDM is the essential element of patient-centered care, a core concept of primary care. However, SDM is seldom translated into primary practice. Continuing professional development (CPD) is the principal means by which healthcare professionals continue to gain, improve, and broaden the knowledge and skills required for patient-centered care. Our international collaboration seeks to improve the knowledge base of CPD that targets translating SDM into the clinical practice of primary care in diverse healthcare systems. Methods Funded by the Canadian Institutes of Health Research (CIHR), our project is to form an international, interdisciplinary research team composed of health services researchers, physicians, nurses, psychologists, dietitians, CPD decision makers and others who will study how CPD causes SDM to be practiced in primary care. We will perform an environmental scan to create an inventory of CPD programs and related activities for translating SDM into clinical practice. These programs will be critically assessed and compared according to their strengths and limitations. We will use the empirical data that results from the environmental scan and the critical appraisal to identify knowledge gaps and generate a research agenda during a two-day workshop to be held in Quebec City. We will ask CPD stakeholders to validate these knowledge gaps and the research agenda. Discussion This project will analyse existing CPD programs and related activities for translating SDM into the practice of primary care. Because this international collaboration will develop and identify various factors influencing SDM, the project could shed new light on how SDM is implemented in primary care. PMID:20977774

  10. Getting (Along) With the Guidelines: Reconciling Patient Autonomy and Quality Improvement Through Shared Decision Making.

    Science.gov (United States)

    Xu, Yan; Wells, Philip S

    2016-07-01

    In past decades, stark differences in practice pattern, cost, and outcomes of care across regions with similar health demographics have prompted calls for reform. As health systems answer the growing call for accountability in the form of quality indices, while responding to increased scrutiny on practice variation in the form of pay for performance (P4P), a rift is widening between the system and individual patients. Currently, three areas are inadequately considered by P4P structures based largely on physician adherence to guidelines: diversity of patient values and preferences; time and financial burden of therapy in the context of multimorbidity; and narrow focus on quantitative measures that distract clinicians from providing optimal care. As health care reform efforts place greater emphasis on value-for-money of care delivered, they provide an opportunity to consider the other "value"-the values of each patient and care delivery that aligns with them.The inherent balance of risks and benefits in every treatment, especially those involving chronic conditions, calls for engagement of patients in decision-making processes, recognizing the diversity of preferences at the individual level. Shared decision making (SDM) is an attractive option and should be an essential component of quality health care rather than its adjunct. Four interwoven steps toward the meaningful implementation of SDM in clinical practice-embedding SDM as a health care quality measure, "real-world" evaluation of SDM effectiveness, pursuit of an SDM-favorable health system, and patient-centered medical education-are proposed to bring focus back to the beneficiary of health care accountability, the patient.

  11. Facilitating clinical decision-making about the use of virtual reality within paediatric motor rehabilitation: application of a classification framework.

    Science.gov (United States)

    Levac, Danielle E; Galvin, Jane

    2011-01-01

    Multiple virtual reality (VR) systems are used to improve motor function in children and youth with neurological impairments. Galvin and Levac developed a classification framework to facilitate clinical decision-making about VR system use. This paper applies the classification framework to identify its strengths and limitations. The classification framework is applied to three case studies where therapists may consider using VR with children involved in paediatric rehabilitation programmes. The classification framework identified VR systems that met each child's individual needs. The relevance of each category to clinical decision-making varied depending on each child's goals. Categories requiring further development and suggestions for additional categories are discussed. The classification framework facilitates child-centred decision-making about the use of VR as a therapeutic intervention. It has shown initial utility but requires further validation with clinicians working in a variety of clinical settings and with a range of client populations.

  12. Most important factors for the implementation of shared decision making in sciatica care : ranking among professionals and patients

    NARCIS (Netherlands)

    Hofstede, Stefanie N; van Bodegom-Vos, Leti; Wentink, Manon M; Vleggeert-Lankamp, Carmen L A; Vliet Vlieland, Thea P M; Marang-van de Mheen, Perla J; Vroomen, P.C.

    2014-01-01

    INTRODUCTION: Due to the increasing specialization of medical professionals, patients are treated by multiple disciplines. To ensure that delivered care is patient-centered, it is crucial that professionals and the patient together decide on treatment (shared decision making (SDM)). However, it is n

  13. Shared decision-making in an intercultural context - Barriers in the interaction between physicians and immigrant patients

    NARCIS (Netherlands)

    J. Suurmond; C. Seeleman

    2006-01-01

    Objective: The objective of this exploratory paper is to describe several barriers in shared decision-making in an intercultural context. Methods: Based on the prevailing literature on intercultural communication in medical settings, four conceptual barriers were described. When the conceptual barri

  14. College Students, Shared Decision Making, and the Appropriate Use of Antibiotics for Respiratory Tract Infections: A Systematic Literature Review

    Science.gov (United States)

    Blyer, Kristina; Hulton, Linda

    2016-01-01

    Objective: This systematic review examines shared decision making to promote the appropriate use of antibiotics for college students with respiratory tract infections. Participants/Methods: CINAL, Cochrane, PubMed, EBSCO, and PsycNET were searched in October 2014 using the following criteria: English language, human subjects, peer-reviewed, shared…

  15. Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis

    NARCIS (Netherlands)

    Durand, M.A.; Carpenter, L.; Dolan, H.; Bravo, P.; Mann, M.; Bunn, F.; Elwyn, G.

    2014-01-01

    BACKGROUND: Increasing patient engagement in healthcare has become a health policy priority. However, there has been concern that promoting supported shared decision-making could increase health inequalities. OBJECTIVE: To evaluate the impact of SDM interventions on disadvantaged groups and health i

  16. Turning signals into meaning--'shared decision making' meets communication theory.

    Science.gov (United States)

    Kasper, Jürgen; Légaré, France; Scheibler, Fülöp; Geiger, Friedemann

    2012-03-01

    Shared decision making (SDM) is being increasingly challenged for promoting an innovative role model while adhering to an archaic approach to patient-clinician communication, both in clinical practice and the research field. Too often, SDM has been studied at the individual level, which ignores the interpersonal system between patients and physicians. We aimed to encourage debate by reflecting on the essentials of SDM in terms of epistemology. We operationalized the SDM core concept of information exchange in terms of social systems theory. An epistemological analysis of the term information refers to its inherent process character. Exchange of information thereby becomes synonymous with social sense construction, indicating that, rather than just being a vehicle, the act of communication itself is the information. We plead for the adoption of existing dyadic analytical methods such as those offered by the interpersonal paradigm. Implications of an updated concept of information for the use of SDM-evaluation methods, for SDM-goal setting, and for clinical practice of SDM are described. © 2011 Blackwell Publishing Ltd.

  17. Sharing NASA Science with Decision Makers: A Perspective from NASA's Applied Remote Sensing Training (ARSET) Program

    Science.gov (United States)

    Prados, A. I.; Blevins, B.; Hook, E.

    2015-12-01

    NASA ARSET http://arset.gsfc.nasa.gov has been providing applied remote sensing training since 2008. The goals of the program are to develop the technical and analytical skills necessary to utilize NASA resources for decision-support. The program has reached over 3500 participants, with 1600 stakeholders from 100 countries in 2015 alone. The target audience for the program are professionals engaged in environmental management in the public and private sectors, such as air quality forecasters, public utilities, water managers and non-governmental organizations engaged in conservation. Many program participants have little or no expertise in NASA remote sensing, and it's frequently their very first exposure to NASA's vast resources. One the key challenges for the program has been the evolution and refinement of its approach to communicating NASA data access, research, and ultimately its value to stakeholders. We discuss ARSET's best practices for sharing NASA science, which include 1) training ARSET staff and other NASA scientists on methods for science communication, 2) communicating the proper amount of scientific information at a level that is commensurate with the technical skills of program participants, 3) communicating the benefit of NASA resources to stakeholders, and 4) getting to know the audience and tailoring the message so that science information is conveyed within the context of agencies' unique environmental challenges.

  18. Patient perspectives on engagement in shared decision-making for asthma care.

    Science.gov (United States)

    Tapp, Hazel; Derkowski, Diane; Calvert, Melissa; Welch, Madelyn; Spencer, Sara

    2017-06-01

    Engagement of patient and advocacy group stakeholders is increasingly considered essential to meaningful outcomes research. Patient-centred research benefits from partnership formation between patients, clinicians and research team members. Here, we describe the rationale for engaging patients on a research team and a case study of patient engagement on an asthma shared decision-making study. Here, we describe a case study of patient engagement in outcomes research and examine the variety of roles patients are engaged in and the associated impact on the study. Patients assisted the project at various levels and were integrated into the research team by (i) advising on study development; (ii) assisting with design and usability of study materials, including the toolkit, patient surveys and dissemination strategies; and (iii) advocacy via membership in external disease-specific organizations and participating in outcomes research conferences. Patients were engaged both individually and as members of a patient advisory board. Primary lessons learned were the importance of building a trusting partnership with patients through understanding perspectives, being aware of clearly explaining patients' roles, research methods and jargon, providing training, listening to patients' needs and understanding what the partnership means from a patient perspective. For the case study described, patient engagement directly influenced multiple aspects of the study, including study design, implementation, data analysis and dissemination through incorporation of the patients' and caregivers' input and concerns.

  19. Cultural targeting and tailoring of shared decision making technology: a theoretical framework for improving the effectiveness of patient decision aids in culturally diverse groups.

    Science.gov (United States)

    Alden, Dana L; Friend, John; Schapira, Marilyn; Stiggelbout, Anne

    2014-03-01

    Patient decision aids are known to positively impact outcomes critical to shared decision making (SDM), such as gist knowledge and decision preparedness. However, research on the potential improvement of these and other important outcomes through cultural targeting and tailoring of decision aids is very limited. This is the case despite extensive evidence supporting use of cultural targeting and tailoring to improve the effectiveness of health communications. Building on prominent psychological theory, we propose a two-stage framework incorporating cultural concepts into the design process for screening and treatment decision aids. The first phase recommends use of cultural constructs, such as collectivism and individualism, to differentially target patients whose cultures are known to vary on these dimensions. Decision aid targeting is operationalized through use of symbols and values that appeal to members of the given culture. Content dimensions within decision aids that appear particularly appropriate for targeting include surface level visual characteristics, language, beliefs, attitudes and values. The second phase of the framework is based on evidence that individuals vary in terms of how strongly cultural norms influence their approach to problem solving and decision making. In particular, the framework hypothesizes that differences in terms of access to cultural mindsets (e.g., access to interdependent versus independent self) can be measured up front and used to tailor decision aids. Thus, the second phase in the framework emphasizes the importance of not only targeting decision aid content, but also tailoring the information to the individual based on measurement of how strongly he/she is connected to dominant cultural mindsets. Overall, the framework provides a theory-based guide for researchers and practitioners who are interested in using cultural targeting and tailoring to develop and test decision aids that move beyond a "one-size fits all" approach

  20. 5As Team obesity intervention in primary care: development and evaluation of shared decision-making weight management tools.

    Science.gov (United States)

    Osunlana, A M; Asselin, J; Anderson, R; Ogunleye, A A; Cave, A; Sharma, A M; Campbell-Scherer, D L

    2015-08-01

    Despite several clinical practice guidelines, there remains a considerable gap in prevention and management of obesity in primary care. To address the need for changing provider behaviour, a randomized controlled trial with convergent mixed method evaluation, the 5As Team (5AsT) study, was conducted. As part of the 5AsT intervention, the 5AsT tool kit was developed. This paper describes the development process and evaluation of these tools. Tools were co-developed by the multidisciplinary research team and the 5AsT, which included registered nurses/nurse practitioners (n = 15), mental health workers (n = 7) and registered dieticians (n = 7), who were previously randomized to the 5AsT intervention group at a primary care network in Edmonton, Alberta, Canada. The 5AsT tool development occurred through a practice/implementation-oriented, need-based, iterative process during learning collaborative sessions of the 5AsT intervention. Feedback during tool development was received through field notes and final provider evaluation was carried out through anonymous questionnaires. Twelve tools were co-developed with 5AsT. All tools were evaluated as either 'most useful' or 'moderately useful' in primary care practice by the 5AsT. Four key findings during 5AsT tool development were the need for: tools that were adaptive, tools to facilitate interdisciplinary practice, tools to help patients understand realistic expectations for weight loss and shared decision-making tools for goal setting and relapse prevention. The 5AsT tools are primary care tools which extend the utility of the 5As of obesity management framework in clinical practice.

  1. Shared decision making PLUS - a cluster-randomized trial with inpatients suffering from schizophrenia (SDM-PLUS).

    Science.gov (United States)

    Hamann, Johannes; Holzhüter, Fabian; Stecher, Lynne; Heres, Stephan

    2017-02-23

    Shared decision making (SDM) is a model of how doctors and patients interact with each other. It aims at changing the traditional power asymmetry between doctors and patients by strengthening the exchange of information and the decisional position of the patient. Although SDM is generally welcomed by mental health patients as well as by mental health professionals its implementation in routine care, especially in the more acute settings, is still lacking. SDM-PLUS has been developed as an approach that addresses both patients and mental health professionals and aims at implementing SDM even for the very acutely ill patients. The SDM-PLUS study will be performed as a matched-pair cluster-randomized trial in acute psychiatric wards. On wards allocated to the intervention group personnel will receive communication training (addressing how to implement SDM for various scenarios) and patients will receive a group intervention addressing patient skills for SDM. Wards allocated to the control condition will continue treatment as usual. A total sample size of 276 patients suffering from schizophrenia or schizoaffective disorder on 12 wards is planned. The main outcome parameter will be patients' perceived involvement in decision making during the inpatient stay measured with the SDM-Q-9 questionnaire. Secondary objectives include the therapeutic relationship and long term outcomes such as medication adherence and rehospitalization rates. In addition, process measures and qualitative data will be obtained to allow for the analysis of potential barriers and facilitators of SDM-PLUS. The primary analysis will be a comparison of SDM-Q-9 sum scores 3 weeks after study inclusion (or discharge, if earlier) between the intervention and control groups. To assess the effect of the intervention on this continuous primary outcome, a random effects linear regression model will be fitted with ward (cluster) as a random effect term and intervention group as a fixed effect. This will be

  2. Psychosocial factors of dietitians' intentions to adopt shared decision making behaviours: a cross-sectional survey.

    Directory of Open Access Journals (Sweden)

    Sarah-Maude Deschênes

    Full Text Available OBJECTIVES: While shared decision making (SDM promotes health-related decisions that are informed, value-based and adhered to, few studies report on theory-based approaches to SDM adoption by healthcare professionals. We aimed to identify the factors influencing dietitians' intentions to adopt two SDM behaviours: 1 present dietary treatment options to patients and 2 help patients clarify their values and preferences. METHODS: We conducted a cross-sectional postal survey based on the Theory of Planned Behaviour among 428 randomly selected dietitians working in clinical practice across the Province of Quebec, Canada. We performed descriptive analyses and multiple regression analyses to determine the variables that explained the variance in intention to perform the behaviours. RESULTS: A total of 203 dietitians completed the questionnaire. Their ages were from 23 to 66 and they had been practising dietetics for 15.4±11.1 years (mean ± SD. On a scale from 1 to 7 (from strongly disagree to strongly agree, dietitians' intentions to present dietary treatment options and to clarify their patients' values and preferences were 5.00±1.14 and 5.68±0.74, respectively. Perceived behavioural control (β = 0.56, ρ<0.0001, subjective norm (β = 0.16, ρ<0.05, and moral norm (β = 0.22, ρ<0.0001, were the factors significantly predicting the intention to present dietary treatment options, while perceived behavioural control (β = 0.60, ρ<0.0001, attitude (β = 0.20, ρ<0.05, and professional norm (β = 0.22, ρ<0.001, significantly predicted the intention to help patients' clarify their values and preferences. CONCLUSION: Our results showed that dietitians intend to adopt the two SDM behaviours studied. Factors influencing intention were different for each behaviour, except for perceived behavioural control which was common to both behaviours. Thus, perceived behavioural control could be a key factor in interventions aiming to

  3. Shared decision-making: the perspectives of young adults with type 1 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Wiley J

    2014-04-01

    Full Text Available Janice Wiley,1 Mary Westbrook,1 Jerry R Greenfield,2,3 Richard O Day,4 Jeffrey Braithwaite11Centre for Clinical Governance Research in Health, Australian Institute of Health Innovation, University of New South Wales, 2Diabetes and Obesity Program, Garvan Institute of Medical Research, 3Department of Endocrinology, St Vincent's Hospital, University of New South Wales, Sydney, NSW, Australia; 4Department of Clinical Pharmacology, St Vincent's Hospital, University of New South Wales, Sydney, NSW, AustraliaBackground: Shared decision-making (SDM is at the core of patient-centered care. We examined whether young adults with type 1 diabetes perceived the clinician groups they consulted as practicing SDM.Methods: In a web-based survey, 150 Australians aged 18–35 years and with type 1 diabetes rated seven aspects of SDM in their interactions with endocrinologists, diabetes educators, dieticians, and general practitioners. Additionally, 33 participants in seven focus groups discussed these aspects of SDM.Results: Of the 150 respondents, 90% consulted endocrinologists, 60% diabetes educators, 33% dieticians, and 37% general practitioners. The majority of participants rated all professions as oriented toward all aspects of SDM, but there were professional differences. These ranged from 94.4% to 82.2% for "My clinician enquires about how I manage my diabetes"; 93.4% to 82.2% for "My clinician listens to my opinion about my diabetes management"; 89.9% to 74.1% for "My clinician is supportive of my diabetes management"; 93.2% to 66.1% for "My clinician suggests ways in which I can improve my self-management”; 96.6% to 85.7% for “The advice of my clinician can be understood”; 98.9% to 82.2% for “The advice of my clinician can be trusted”; and 86.5% to 67.9% for “The advice of my clinician is consistent with other members of the diabetes team". Diabetes educators received the highest ratings on all aspects of SDM. The mean weighted average of

  4. Transition from paternalism to shared decision making – a review of the educational environment in Bosnia and Herzegovina and Croatia

    Directory of Open Access Journals (Sweden)

    Marta Vučemilović

    2016-05-01

    Full Text Available In this article we will review the benefits of a system built on partnership of physicians and their patients, highlight some of the factors which impede this transition, and propose ways to address these factors. Also, we are going to analyze the educational environment in Bosnia and Herzegovina and Croatia concerning ethics and communication skills. Personal responsibility of patients for their health should be reflected in their joint involvement in health decisions with their physicians. Patients, insecure about their individual competence surrounding their health decisions, tend to shy away from responsibility, whereas physicians, pressured by the responsibilities of the profession, do not always show sensitivity to all of the patient’s concerns. They often treat illnesses instead of patients. A more open and collaborative relationship between the patient and the physician through shared decision making would be a better alternative. In the end, the patient ultimately decides whether a health intervention was satisfactory in fulfilling his or her specific needs. Transition from a paternalistic to a mutual relationship between doctors and patients has already begun. In an era of intense information sharing, shared decision making is a sensitive, ethical, legal, and political concept which needs empathic doctors with well-developed communication skills to integrate their clinical knowledge with patient-centered care. Conclusion. Transition from paternalistic to partner relation between physicians and patients is moving slowly ahead in Croatia and Bosnia and Herzegovina. Educational environment is improving but needs intense efforts to develop further.

  5. Delegation of Authority Under the Community Environmental Response Facilitation Act (CERFA) - Decision Memorandum

    Science.gov (United States)

    This memorandum concerns how the Office of Enforcement (OE) proposed that two new authorities under the Community Environmental Response Facilitation Act (CERFA) be delegated to the Regional Administrators.

  6. Sharing the burden of deciding: How physicians and parents make end-of-life decisions

    NARCIS (Netherlands)

    de Vos-Broerse, M.A.

    2015-01-01

    End-of-life decisions are among the most difficult decisions to make. They confront us with the limits of our medical knowledge, with moral dilemmas without best answers, and with feelings of powerlessness, injustice and grief. Making end-of-life decisions on behalf of a child is an even more burden

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

    Science.gov (United States)

    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...

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

    Science.gov (United States)

    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

  9. Shared decision making in the recovery of people with schizophrenia: the role of metacognitive capacities in insight and pragmatic language use.

    Science.gov (United States)

    Chan, Kevin K S; Mak, Winnie W S

    2012-08-01

    In the development of consumer-centered care for mental health consumers with schizophrenia, one key ingredient is consumer participation in health care decisions together with their healthcare providers, termed "shared decision making" (SDM). SDM requires consumers to form a number of complex ideas about themselves and their providers then use that knowledge to make sense of the illness and reach medical and psychosocial decisions. However, metacognitive deficits widely observed in schizophrenia might lead to poor insight and pragmatic language deficits in some consumers, disrupting the whole process by which a personal and consensually valid narrative account of psychiatric challenges is synthesized and flexibly evolved. Given the current understanding that it is possible to improve metacognition, in this article we summarize how Metacognitive Training (MCT) and individual psychotherapy could potentially be tailored, or modified, to help consumers to develop metacognitive capacities with an end goal of facilitating the SDM process. Consistent with the principles of consumer-defined recovery, we also suggest a strategy for engaging consumers in SDM dialogue based on "where the consumers are at". Providers are advised to be cognizant of their medically driven perspective and attempt to work with the consumers in the perspective of the consumers' own recovery goals.

  10. Investigating a training supporting shared decision making (IT'S SDM 2011: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Geiger Friedemann

    2011-10-01

    Full Text Available Background Shared Decision Making (SDM is regarded as the best practice model for the communicative challenge of decision making about treatment or diagnostic options. However, randomized controlled trials focusing the effectiveness of SDM trainings are rare and existing measures of SDM are increasingly challenged by the latest research findings. This study will 1 evaluate a new physicians' communication training regarding patient involvement in terms of SDM, 2 validate SDMMASS, a new compound measure of SDM, and 3 evaluate the effects of SDM on the perceived quality of the decision process and on the elaboration of the decision. Methods In a multi-center randomized controlled trial with a waiting control group, 40 physicians from 7 medical fields are enrolled. Each physician contributes a sequence of four medical consultations including a diagnostic or treatment decision. The intervention consists of two condensed video-based individual coaching sessions (15min. supported by a manual and a DVD. The interventions alternate with three measurement points plus follow up (6 months. Realized patient involvement is measured using the coefficient SDMMASS drawn from the Multifocal Approach to the Sharing in SDM (MAPPIN'SDM which includes objective involvement, involvement as perceived by the patient, and the doctor-patient concordance regarding their judges of the involvement. For validation purposes, all three components of SDMMASS are supplemented by similar measures, the OPTION observer scale, the Shared Decision Making Questionnaire (SDM-Q and the dyadic application of the Decisional Conflict Scale (DCS. Training effects are analyzed using t-tests. Spearman correlation coefficients are used to determine convergent validities, the influence of involvement (SDMMASS on the perceived decision quality (DCS and on the elaboration of the decision. The latter is operationalised by the ELAB coefficient from the UP24 (Uncertainty Profile, 24 items version

  11. Practices of US health insurance companies concerning MS therapies interfere with shared decision-making and harm patients

    OpenAIRE

    Bourdette, Dennis N.; Hartung, Daniel M.; Whitham, Ruth H.

    2016-01-01

    Abstract The US Food and Drug Administration has registered 13 multiple sclerosis (MS) disease-modifying therapies (DMTs). The medications are not interchangeable as they vary in route of administration, efficacy, and safety profile. Selecting the appropriate MS DMT for individual patients requires shared decision-making between patients and neurologists. To reduce costs, insurance companies acting through pharmacy benefit companies restrict access to MS DMTs through tiered coverage and other...

  12. Decision support for hospital bed management using adaptable individual length of stay estimations and shared resources

    Science.gov (United States)

    2013-01-01

    Background Elective patient admission and assignment planning is an important task of the strategic and operational management of a hospital and early on became a central topic of clinical operations research. The management of hospital beds is an important subtask. Various approaches have been proposed, involving the computation of efficient assignments with regard to the patients’ condition, the necessity of the treatment, and the patients’ preferences. However, these approaches are mostly based on static, unadaptable estimates of the length of stay and, thus, do not take into account the uncertainty of the patient’s recovery. Furthermore, the effect of aggregated bed capacities have not been investigated in this context. Computer supported bed management, combining an adaptable length of stay estimation with the treatment of shared resources (aggregated bed capacities) has not yet been sufficiently investigated. The aim of our work is: 1) to define a cost function for patient admission taking into account adaptable length of stay estimations and aggregated resources, 2) to define a mathematical program formally modeling the assignment problem and an architecture for decision support, 3) to investigate four algorithmic methodologies addressing the assignment problem and one base-line approach, and 4) to evaluate these methodologies w.r.t. cost outcome, performance, and dismissal ratio. Methods The expected free ward capacity is calculated based on individual length of stay estimates, introducing Bernoulli distributed random variables for the ward occupation states and approximating the probability densities. The assignment problem is represented as a binary integer program. Four strategies for solving the problem are applied and compared: an exact approach, using the mixed integer programming solver SCIP; and three heuristic strategies, namely the longest expected processing time, the shortest expected processing time, and random choice. A baseline approach

  13. Shared decision making does not influence physicians against clinical practice guidelines.

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    Mireille Guerrier

    Full Text Available While shared decision making (SDM and adherence to clinical practice guidelines (CPGs are important, some believe they are incompatible. This study explored the mutual influence between physicians' intention to engage in SDM and their intention to follow CPGs.Embedded within a clustered randomized trial to assess the impact of training physicians in SDM about using antibiotics to treat acute respiratory tract infections, this study evaluated physicians' intentions to both engage in SDM and follow CPGs. A self-administered questionnaire based on the theory of planned behavior evaluated both behavioral intentions and their respective determinants (attitude, subjective norm and perceived behavioral control at study entry and exit. We used path analysis to explore the relationships between the intentions. We conducted statistical analyses using the maximum likelihood method and the variance-covariance matrix. Goodness of fit indices encompassed the chi-square statistic, the comparative fit index and the root mean square error of approximation.We analyzed 244 responses at entry and 236 at exit. In the control group, at entry we observed that physicians' intention to engage in SDM (r = 0, t = 0.03 did not affect their intention to follow CPGs; however, their intention to follow CPGs (r = -0.31 t = -2.82 did negatively influence their intention to engage in SDM. At exit, neither behavioral intention influenced the other. In the experimental group, at entry neither behavioral intention influenced the other; at exit, the intention to engage in SDM still did not influence the intention to use CPGs, although the intention to follow CPGs (r = -0.15 t = -2.02 slightly negatively influenced the intention to engage in SDM, but this was not clinically significant.Physicians' intention to engage in SDM does not affect their intention to adopt CPGs even after SDM training. Physicians' intention to adopt CPGs had no clinically significant

  14. [Improving shared decision-making for hospital patients: Description and evaluation of a treatment intensity assessment tool].

    Science.gov (United States)

    Amblàs-Novellas, Jordi; Casas, Sílvia; Catalán, Rosa María; Oriol-Ruscalleda, Margarita; Lucchetti, Gianni Enrico; Quer-Vall, Francesc Xavier

    2016-01-01

    Shared decision-making between patients and healthcare professionals is crucial to guarantee adequate coherence between patient values and preferences, caring aims and treatment intensity, which is key for the provision of patient-centred healthcare. The assessment of such interventions are essential for caring continuity purposes. To do this, reliable and easy-to-use assessment systems are required. This study describes the results of the implementation of a hospital treatment intensity assessment tool. The pre-implementation and post-implementation results were compared between two cohorts of patients assessed for one month. Some record of care was registered in 6.1% of patients in the pre-implementation group (n=673) compared to 31.6% of patients in the post-implementation group (n=832) (P<.01), with differences between services. Hospital mortality in both cohorts is 1.9%; in the pre-implementation group, 93.75% of deceased patients had treatment intensity assessment. In hospital settings, the availability of a specific tool seems to encourage very significantly shared decision-making processes between patients and healthcare professionals -multiplying by more than 5 times the treatment intensity assessment. Moreover, such tools help in the caring continuity processes between different teams and the personalisation of caring interventions to be monitored. More research is needed to continue improving shared decision-making for hospital patients. Copyright © 2015 SEGG. Published by Elsevier Espana. All rights reserved.

  15. Sharing the burden of deciding: How physicians and parents make end-of-life decisions

    OpenAIRE

    de Vos-Broerse, M.A.

    2015-01-01

    End-of-life decisions are among the most difficult decisions to make. They confront us with the limits of our medical knowledge, with moral dilemmas without best answers, and with feelings of powerlessness, injustice and grief. Making end-of-life decisions on behalf of a child is an even more burdensome process. There is growing consensus that physicians should tailor their decision-making approach to the preferences and needs of the child’s parents. But how can physicians best do this? Shoul...

  16. From Perceived Values to Shared Values: A Multi-Stakeholder Spatial Decision Analysis (M-SSDA for Resilient Landscapes

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    Maria Cerreta

    2017-06-01

    Full Text Available This paper puts forth a Multi-Stakeholder Spatial Decision Analysis (M-SSDA which combines Multi-Stakeholders Decision Analysis (M-SDA and GIS processing based on a collaborative, hybrid and adaptive evaluative approach to support the elaboration of enhancement strategies designed for resilient landscapes. This methodology has been tested in the research project “Cilento Labscape: An integrated model for the activation of a Living Lab in the National Park of Cilento, Vallo di Diano and Alburni”, which was conducted in the Cilento National Park (Southern Italy. The aim of the methodology is to find alternative touristic routes for the promotion of the Park. The different steps in the process will be described, as will the employment of multiple tools/techniques (interviews, GIS tools, Semantic Analysis, and Geo-Statistical Analysis to improve the reliability of the decision-making process. The most relevant results of the methodology will also be outlined in terms of the transition from the identification of the perceived landscape’s values to the acknowledgement of the shared values, and their consequent employment for the outlining of new thematic itineraries for the Park. To realise sustainable territorial strategies and preserve the landscape through bottom-up decision-making processes, the different local communities need to gain a new awareness of their identity shared values and make an active contribution towards promoting and managing their site-specific resources.

  17. Development of a Conceptual Framework for Understanding Shared Decision making Among African-American LGBT Patients and their Clinicians.

    Science.gov (United States)

    Peek, Monica E; Lopez, Fanny Y; Williams, H Sharif; Xu, Lucy J; McNulty, Moira C; Acree, M Ellen; Schneider, John A

    2016-06-01

    Enhancing patient-centered care and shared decision making (SDM) has become a national priority as a means of engaging patients in their care, improving treatment adherence, and enhancing health outcomes. Relatively little is known about the healthcare experiences or shared decision making among racial/ethnic minorities who also identify as being LGBT. The purpose of this paper is to understand how race, sexual orientation and gender identity can simultaneously influence SDM among African-American LGBT persons, and to propose a model of SDM between such patients and their healthcare providers. We reviewed key constructs necessary for understanding SDM among African-American LGBT persons, which guided our systematic literature review. Eligible studies for the review included English-language studies of adults (≥ 19 y/o) in North America, with a focus on LGBT persons who were African-American/black (i.e., > 50 % of the study population) or included sub-analyses by sexual orientation/gender identity and race. We searched PubMed, CINAHL, ProQuest Dissertations & Theses, PsycINFO, and Scopus databases using MESH terms and keywords related to shared decision making, communication quality (e.g., trust, bias), African-Americans, and LGBT persons. Additional references were identified by manual reviews of peer-reviewed journals' tables of contents and key papers' references. We identified 2298 abstracts, three of which met the inclusion criteria. Of the included studies, one was cross-sectional and two were qualitative; one study involved transgender women (91 % minorities, 65 % of whom were African-Americans), and two involved African-American men who have sex with men (MSM). All of the studies focused on HIV infection. Sexual orientation and gender identity were patient-reported factors that negatively impacted patient/provider relationships and SDM. Engaging in SDM helped some patients overcome normative beliefs about clinical encounters. In this paper, we present a

  18. Sharing decisions during diagnostic consultations; an observational study in pediatric oncology

    NARCIS (Netherlands)

    Wiering, Bianca M.; Noordman, Janneke; Tates, Kiek; Zwaanswijk, Marieke; Elwyn, Glyn; De Bont, Eveline S. J. M.; Beishuizen, Auke; Hoogerbrugge, Peter M.; Van Dulmen, Sandra

    2016-01-01

    Objective: Children and parents need to make important decisions in the period of being informed about the diagnosis of childhood cancer. Although parents' and children's involvement is legally required, it is unclear whether oncologists involve them. This study explored which decisions families fac

  19. Sharing decisions during diagnostic consultations: an observational study in pediatric oncology.

    NARCIS (Netherlands)

    Wiering, B.M.; Noordman, J.; Tates, K.; Zwaanswijk, M.; Elwyn, G.; Bont, E.S.J.M. de; Beishuizen, A.; Hoogerbrugge, P.M.; Dulmen, A.M. van

    2016-01-01

    Objective: Children and parents need to make important decisions in the period of being informed about the diagnosis of childhood cancer. Although parents’ and children’s involvement is legally required, it is unclear whether oncologists involve them. This study explored which decisions families fac

  20. Can consumers learn to ask three questions to improve shared decision making? A feasibility study of the ASK (AskShareKnow) Patient-Clinician Communication Model(®) intervention in a primary health-care setting.

    Science.gov (United States)

    Shepherd, Heather L; Barratt, Alexandra; Jones, Anna; Bateson, Deborah; Carey, Karen; Trevena, Lyndal J; McGeechan, Kevin; Del Mar, Chris B; Butow, Phyllis N; Epstein, Ronald M; Entwistle, Vikki; Weisberg, Edith

    2016-10-01

    To test the feasibility and assess the uptake and acceptability of implementing a consumer questions programme, AskShareKnow, to encourage consumers to use the questions '1. What are my options; 2. What are the possible benefits and harms of those options; 3. How likely are each of those benefits and harms to happen to me?' These three questions have previously shown important effects in improving the quality of information provided during consultations and in facilitating patient involvement. This single-arm intervention study invited participants attending a reproductive and sexual health-care clinic to view a 4-min video-clip in the waiting room. Participants completed three questionnaires: (T1) prior to viewing the intervention; (T2) immediately after their consultation; and (T3) two weeks later. A total of 121 (78%) participants viewed the video-clip before their consultation. Eighty-four (69%) participants asked one or more questions, and 35 (29%) participants asked all three questions. For those making a decision, 55 (87%) participants asked one or more questions, while 27 (43%) participants asked all three questions. Eighty-seven (72%) participants recommended the questions. After two weeks, 47 (49%) of the participants recalled the questions. Enabling patients to view a short video-clip before an appointment to improve information and involvement in health-care consultations is feasible and led to a high uptake of question asking in consultations. This AskShareKnow programme is a simple and feasible method of training patients to use a brief consumer-targeted intervention that has previously shown important effects in improving the quality of information provided during consultations and in facilitating patient involvement and use of evidence-based questions. ©2015 The Authors. Health Expectations published by John Wiley & Sons Ltd.

  1. Knowledge Sharing among University Students Facilitated with a Creative Commons Licensing Mechanism: A Case Study in a Programming Course

    Science.gov (United States)

    Liu, Chen-Chung; Lin, Chia-Ching; Chang, Chun-Yi; Chao, Po-Yao

    2014-01-01

    Creative Commons (CC) mechanism has been suggested as a potential means to foster a reliable environment for online knowledge sharing activity. This study investigates the role of the CC mechanism in supporting knowledge sharing among a group of university students studying programming from the perspectives of social cognitive and social capital…

  2. A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients.

    Science.gov (United States)

    DeMeester, Rachel H; Lopez, Fanny Y; Moore, Jennifer E; Cook, Scott C; Chin, Marshall H

    2016-06-01

    Shared decision making (SDM) occurs when patients and clinicians work together to reach care decisions that are both medically sound and responsive to patients' preferences and values. SDM is an important tenet of patient-centered care that can improve patient outcomes. Patients with multiple minority identities, such as sexual orientation and race/ethnicity, are at particular risk for poor SDM. Among these dual-minority patients, added challenges to clear and open communication include cultural barriers, distrust, and a health care provider's lack of awareness of the patient's minority sexual orientation or gender identity. However, organizational factors like a culture of inclusion and private space throughout the visit can improve SDM with lesbian, gay, bisexual, and transgender ("LGBT") racial/ethnic minority patients who have faced stigma and discrimination. Most models of shared decision making focus on the patient-provider interaction, but the health care organization's context is also critical. Context-an organization's structure and operations-can strongly influence the ability and willingness of patients and clinicians to engage in shared decision making. SDM is most likely to be optimal if organizations transform their contexts and patients and providers improve their communication. Thus, we propose a conceptual model that suggests ways in which organizations can shape their contextual structure and operations to support SDM. The model contains six drivers: workflows, health information technology, organizational structure and culture, resources and clinic environment, training and education, and incentives and disincentives. These drivers work through four mechanisms to impact care: continuity and coordination, the ease of SDM, knowledge and skills, and attitudes and beliefs. These mechanisms can activate clinicians and patients to engage in high-quality SDM. We provide examples of how specific contextual changes could make SDM more effective for LGBT

  3. The Neuropeptide Oxytocin Enhances Information Sharing and Group Decision Making Quality.

    Science.gov (United States)

    De Wilde, Tim R W; Ten Velden, Femke S; De Dreu, Carsten K W

    2017-01-11

    Groups can make better decisions than individuals when members cooperatively exchange and integrate their uniquely held information and insights. However, under conformity pressures group members are biased towards exchanging commonly known information, and away from exchanging unique information, thus undermining group decision-making quality. At the neurobiological level, conformity associates with the neuropeptide oxytocin. A double-blind placebo controlled study found no evidence for oxytocin induced conformity. Compared to placebo groups, three-person groups whose members received intranasal oxytocin, focused more on unique information (i) and repeated this information more often (ii). These findings reveal oxytocin as a neurobiological driver of group decision-making processes.

  4. The Neuropeptide Oxytocin Enhances Information Sharing and Group Decision Making Quality

    Science.gov (United States)

    De Wilde, Tim R. W.; Ten Velden, Femke S.; De Dreu, Carsten K. W.

    2017-01-01

    Groups can make better decisions than individuals when members cooperatively exchange and integrate their uniquely held information and insights. However, under conformity pressures group members are biased towards exchanging commonly known information, and away from exchanging unique information, thus undermining group decision-making quality. At the neurobiological level, conformity associates with the neuropeptide oxytocin. A double-blind placebo controlled study found no evidence for oxytocin induced conformity. Compared to placebo groups, three-person groups whose members received intranasal oxytocin, focused more on unique information (i) and repeated this information more often (ii). These findings reveal oxytocin as a neurobiological driver of group decision-making processes. PMID:28074896

  5. Oncologist, patient, and companion questions during pretreatment consultations about adjuvant cancer treatment: a shared decision-making perspective.

    Science.gov (United States)

    Pieterse, A H; Kunneman, M; Engelhardt, E G; Brouwer, N J; Kroep, J R; Marijnen, C A M; Stiggelbout, A M; Smets, E M A

    2017-07-01

    To assess the occurrence of questions that foster shared decision making, in particular cancer patients' understanding of treatment decisions and oncologists' understanding of patients' priorities, during consultations in which preference-sensitive decisions are discussed. Specifically, (a) regarding patient understanding, do oncologists ask about patients' preexisting knowledge, information preferences, and understanding and do patients and companions ask about the disease and treatment, and (b) regarding patient priorities, do oncologists ask about patients' treatment- and decision-related preferences and do patients and companions ask about the decision? Audiotaped pretreatment consultations of 100 cancer patients with 32 oncologists about (neo)adjuvant treatment were coded and analyzed to document question type, topic, and initiative. The oncologists ascertained prior knowledge in 50 patients, asked 24 patients about preferred (probability) information, and invited questions from 56 patients. The oncologists asked 32 patients about treatment preferences and/or for consent. Respectively, one-third and one-fifth of patients and companions asked about treatment benefits compared with three-quarters of them who asked about treatment harms and/or procedures. It would be helpful to patients if oncologists more often assessed patients' existing knowledge to tailor their information provision. Also, patients could receive treatment recommendations that better fit their personal situation if oncologists collected information on patients' views about treatments. Moreover, by educating patients to ask about treatment alternatives, benefits, and harms, patients may gain a better understanding of the choice they have. Copyright © 2016 John Wiley & Sons, Ltd.

  6. [Shared decision making from the perspective of the cancer patient: participatory roles and evaluation of the process].

    Science.gov (United States)

    Padilla Garrido, N; Aguado Correa, F; Ortega Moreno, M; Bayo Calero, J; Bayo Lozano, E

    2017-04-30

    In Spain there is no clear knowledge about the degree to which Shared Decision Making (SDM) is carried out in the normal practice of oncology. Our article analyses the preferred role and the perceived role of oncological patients and measures the SDM process from their perspective. Descriptive transversal study using a self-conducted questionnaire with patients with different types of cancer. To evaluate the role preferred and perceived by the patient we used The Control Preference Scales (CPS) and to measure SDM we used The nine-item Shared Decision Making Questionnaire (SDM-Q-9). Out of the 132 patients surveyed, only 118 provided analysable data. No evidence was found that sex, age, educational level or type of tumour affected the preferred role or the perceived role. Only 59.3% was in agreement with the role exercised. All of those who preferred a passive role achieved this (21.2%), while out of those who wanted a shared role (78.8%), this was achieved by only 48.39% while the remaining 51.61% played a passive role. None preferred or played an active role. The set of patients evaluated the SDM process with a score of 41.07±5.94, on a scale of 0 to 100, with the highest score of 61.39 ± 13.24 reached by urological patients. Our study found no evidence that, from the point of view of the oncological patient, the SDM model is being implemented in practice.

  7. The Counseling, Self-Care, Adherence Approach to Person-Centered Care and Shared Decision Making: Moral Psychology, Executive Autonomy, and Ethics in Multi-Dimensional Care Decisions.

    Science.gov (United States)

    Herlitz, Anders; Munthe, Christian; Törner, Marianne; Forsander, Gun

    2016-08-01

    This article argues that standard models of person-centred care (PCC) and shared decision making (SDM) rely on simplistic, often unrealistic assumptions of patient capacities that entail that PCC/SDM might have detrimental effects in many applications. We suggest a complementary PCC/SDM approach to ensure that patients are able to execute rational decisions taken jointly with care professionals when performing self-care. Illustrated by concrete examples from a study of adolescent diabetes care, we suggest a combination of moral and psychological considerations to support the claim that standard PCC/SDM threatens to systematically undermine its own goals. This threat is due to a tension between the ethical requirements of SDM in ideal circumstances and more long-term needs actualized by the context of self-care handled by patients with limited capacities for taking responsibility and adhere to their own rational decisions. To improve this situation, we suggest a counseling, self-care, adherence approach to PCC/SDM, where more attention is given to how treatment goals are internalized by patients, how patients perceive choice situations, and what emotional feedback patients are given. This focus may involve less of a concentration on autonomous and rational clinical decision making otherwise stressed in standard PCC/SDM advocacy.

  8. An exploratory study of knowledge brokering in hospital settings: facilitating knowledge sharing and learning for patient safety?

    Science.gov (United States)

    Waring, Justin; Currie, Graeme; Crompton, Amanda; Bishop, Simon

    2013-12-01

    This paper reports on an exploratory study of intra-organisational knowledge brokers working within three large acute hospitals in the English National Health Services. Knowledge brokering is promoted as a strategy for supporting knowledge sharing and learning in healthcare, especially in the diffusion of research evidence into practice. Less attention has been given to brokers who support knowledge sharing and learning within healthcare organisations. With specific reference to the need for learning around patient safety, this paper focuses on the structural position and role of four types of intra-organisational brokers. Through ethnographic research it examines how variations in formal role, location and relationships shape how they share and support the use of knowledge across organisational and occupational boundaries. It suggests those occupying hybrid organisational roles, such as clinical-managers, are often best positioned to support knowledge sharing and learning because of their 'ambassadorial' type position and legitimacy to participate in multiple communities through dual-directed relationships.

  9. [Choice and disclosure of preferences, towards sharing the therapeutic decision in cancerology: from economic theory to medical practice].

    Science.gov (United States)

    Protière, C; Moatti, J P; Maraninchi, D; Viens, P

    1998-02-01

    Today, as it is often difficult to demonstrate the superiority of a new molecule or a therapeutic strategy in term of plain efficacy on disease, the incitement is strong to provide some complementary argument of assessment, we are assisting to the emergence of a new concept: shared therapeutic decision making. Is the application of this concept--with make the paternalistic model questionnable--adapted to all cases? What are the different levels of participation that could be envisaged? Are there favourable methods for this participations? This shared decision making--direct (patients' choice between treatment options) or indirect (integration of elicited preferences in the decision process)--if it has to be efficient, must surround with care: to define its application limitation, to protect itself of manipulation. It shall require to consider information transmission difficulties, to establish some elicitation preference method. Some technical, such as time trade off, standard gamble or willingness to pay, supported by economic theory of expected utility, permit to help eliciting patients' preferences and to structure the therapeutic choice. Some empirical study of preference elicitation shall permit to get clear the complexity of trade off between the different choice element that could enter in the acceptability of the treatment for patients.

  10. Shared decision-making on a 'life-and-care plan' in long-term care facilities: research protocol.

    Science.gov (United States)

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

    2016-07-01

    To determine whether the number of residents' preferences and needs together with the actions taken to satisfy them recorded into their 'life-and-care plans' will increase and the process of shared decision-making will improve the residents' psychosocial well-being. Shared decision-making is defined as a process where healthcare professionals and patients make decisions together, using the best available evidence. The aims of the present study were to assess the feasibility and acceptability of an SDM framework for care planning in long-term care facilities and its potential effectiveness on the proportion of dementia residents whose own preferences and needs and the related actions, are known, satisfied and documented in their 'life-and-care plans'. The current project is a feasibility trial and it was approved in November 2013. Research subjects are triads composed of the resident with dementia, a family caregiver and the professional usually taking care for the resident. Professional caregivers of two nursing homes, one located in Italy and one in the Netherlands, will receive a specific training in SDM principles and will guide the SDM interview in the triad. The primary outcome will be the proportion of residents whose preferences and needs, together with the related actions to meet them, are known, documented and satisfied in their 'life-and-care plans'. NCT02118701.

  11. An Environmental Decision Support System to Facilitate Stakeholder Interaction with Water Quality Models

    OpenAIRE

    Kumar, Saurav

    2012-01-01

    Environmental management has increasingly become a participatory process. In recent times, emphasis has been placed on watershed-based solutions to remediate the problems of diffuse source pollution and to engage stakeholders in designing solutions. Water quality models are an integral part of this process; such models are often inaccessible to lay stakeholders. A review of the literature suggests that properly applied partnerships have several benefits that go beyond decision-making. Stakeho...

  12. Development and pilot testing of an online case-based approach to shared decision making skills training for clinicians.

    Science.gov (United States)

    Volk, Robert J; Shokar, Navkiran K; Leal, Viola B; Bulik, Robert J; Linder, Suzanne K; Mullen, Patricia Dolan; Wexler, Richard M; Shokar, Gurjeet S

    2014-11-01

    Although research suggests that patients prefer a shared decision making (SDM) experience when making healthcare decisions, clinicians do not routinely implement SDM into their practice and training programs are needed. Using a novel case-based strategy, we developed and pilot tested an online educational program to promote shared decision making (SDM) by primary care clinicians. A three-phased approach was used: 1) development of a conceptual model of the SDM process; 2) development of an online teaching case utilizing the Design A Case (DAC) authoring template, a well-tested process used to create peer-reviewed web-based clinical cases across all levels of healthcare training; and 3) pilot testing of the case. Participants were clinician members affiliated with several primary care research networks across the United States who answered an invitation email. The case used prostate cancer screening as the clinical context and was delivered online. Post-intervention ratings of clinicians' general knowledge of SDM, knowledge of specific SDM steps, confidence in and intention to perform SDM steps were also collected online. Seventy-nine clinicians initially volunteered to participate in the study, of which 49 completed the case and provided evaluations. Forty-three clinicians (87.8%) reported the case met all the learning objectives, and 47 (95.9%) indicated the case was relevant for other equipoise decisions. Thirty-one clinicians (63.3%) accessed supplementary information via links provided in the case. After viewing the case, knowledge of SDM was high (over 90% correctly identified the steps in a SDM process). Determining a patient's preferred role in making the decision (62.5% very confident) and exploring a patient's values (65.3% very confident) about the decisions were areas where clinician confidence was lowest. More than 70% of the clinicians intended to perform SDM in the future. A comprehensive model of the SDM process was used to design a case

  13. The RISAP-study: a complex intervention in risk communication and shared decision-making in general practice

    DEFF Research Database (Denmark)

    Kirkegaard, Pia; Edwards, Adrian GK; Hansen, Bo

    2010-01-01

    General practitioners (GPs) and patients find it difficult to talk about risk of future disease, especially when patients have asymptomatic conditions, and treatment options are unlikely to cause immediate perceptible improvements in well-being. Further studies in risk communication training...... are needed. Aim:1) to systematically develop, describe and evaluate a complex intervention comprising a training programme for GPs in risk communication and shared decision-making, 2) to evaluate the effect of the training programme on real-life consultations between GPs and patients with high cholesterol...

  14. The Autonomy-Authority Duality of Shared Decision-Making in Youth Environmental Action

    Science.gov (United States)

    Schusler, Tania M.; Krasny, Marianne E.; Decker, Daniel J.

    2017-01-01

    While environmental action is recognized as an effective approach for developing young people's capabilities as citizens and contributing to environmental improvements, little research has addressed how adults facilitate youth action projects. Environmental action involves a partnership among youth and adults characterized by shared…

  15. Health care ontologies: knowledge models for record sharing and decision support.

    Science.gov (United States)

    Madsen, Maria

    2010-01-01

    This chapter gives an educational overview of: * The difference between informal and formal ontologies * The primary objectives of ontology design, re-use, extensibility, and interoperability * How formal ontologies can be used to map terminologies and classification systems * How formal ontologies improve semantic interoperability * The relationship between a well-formed ontology and the development of intelligent decision support.

  16. Decision Making Impairment: A Shared Vulnerability in Obesity, Gambling Disorder and Substance Use Disorders?

    Science.gov (United States)

    Mallorquí-Bagué, Nuria; Fagundo, Ana B.; Jimenez-Murcia, Susana; de la Torre, Rafael; Baños, Rosa M.; Botella, Cristina; Casanueva, Felipe F.; Crujeiras, Ana B.; Fernández-García, Jose C.; Fernández-Real, Jose M.; Frühbeck, Gema; Granero, Roser; Rodríguez, Amaia; Tolosa-Sola, Iris; Ortega, Francisco J.; Tinahones, Francisco J.; Alvarez-Moya, Eva; Ochoa, Cristian; Menchón, Jose M.

    2016-01-01

    Introduction Addictions are associated with decision making impairments. The present study explores decision making in Substance use disorder (SUD), Gambling disorder (GD) and Obesity (OB) when assessed by Iowa Gambling Task (IGT) and compares them with healthy controls (HC). Methods For the aims of this study, 591 participants (194 HC, 178 GD, 113 OB, 106 SUD) were assessed according to DSM criteria, completed a sociodemographic interview and conducted the IGT. Results SUD, GD and OB present impaired decision making when compared to the HC in the overall task and task learning, however no differences are found for the overall performance in the IGT among the clinical groups. Results also reveal some specific learning across the task patterns within the clinical groups: OB maintains negative scores until the third set where learning starts but with a less extend to HC, SUD presents an early learning followed by a progressive although slow improvement and GD presents more random choices with no learning. Conclusions Decision making impairments are present in the studied clinical samples and they display individual differences in the task learning. Results can help understanding the underlying mechanisms of OB and addiction behaviors as well as improve current clinical treatments. PMID:27690367

  17. Resource effects of training general practitioners in risk communication skills and shared decision making competences.

    NARCIS (Netherlands)

    Cohen, D.; Longo, M.F.; Hood, K.; Edwards, A.; Elwyn, G.

    2004-01-01

    RATIONALE, AIMS AND OBJECTIVES: Involving patients more in decisions about their own care requires doctors to be trained in effective ways of communicating information and in developing competences to negotiate levels of patient involvement which are most appropriate for each case. The aim of this

  18. Decision Making Impairment: A Shared Vulnerability in Obesity, Gambling Disorder and Substance Use Disorders?

    Science.gov (United States)

    Mallorquí-Bagué, Nuria; Fagundo, Ana B; Jimenez-Murcia, Susana; de la Torre, Rafael; Baños, Rosa M; Botella, Cristina; Casanueva, Felipe F; Crujeiras, Ana B; Fernández-García, Jose C; Fernández-Real, Jose M; Frühbeck, Gema; Granero, Roser; Rodríguez, Amaia; Tolosa-Sola, Iris; Ortega, Francisco J; Tinahones, Francisco J; Alvarez-Moya, Eva; Ochoa, Cristian; Menchón, Jose M; Fernández-Aranda, Fernando

    Addictions are associated with decision making impairments. The present study explores decision making in Substance use disorder (SUD), Gambling disorder (GD) and Obesity (OB) when assessed by Iowa Gambling Task (IGT) and compares them with healthy controls (HC). For the aims of this study, 591 participants (194 HC, 178 GD, 113 OB, 106 SUD) were assessed according to DSM criteria, completed a sociodemographic interview and conducted the IGT. SUD, GD and OB present impaired decision making when compared to the HC in the overall task and task learning, however no differences are found for the overall performance in the IGT among the clinical groups. Results also reveal some specific learning across the task patterns within the clinical groups: OB maintains negative scores until the third set where learning starts but with a less extend to HC, SUD presents an early learning followed by a progressive although slow improvement and GD presents more random choices with no learning. Decision making impairments are present in the studied clinical samples and they display individual differences in the task learning. Results can help understanding the underlying mechanisms of OB and addiction behaviors as well as improve current clinical treatments.

  19. Share Market Analysis Using Various Economical Determinants to Predict Decision of Investors

    Science.gov (United States)

    Ghosh, Arijit; Roy, Samrat; Bandyopadhyay, Gautam; Choudhuri, Kripasindhu

    2010-10-01

    The following paper tries to develop six major hypotheses in Bombay Stock Exchange (BSE) in India. The paper tries to proof the hypothesis by collecting data from the fields on six sectors: oil prices, gold price, Cash Reserve Ratio, food price inflation, call money rate and Dollar price. The research uses these data as indicators to identify relationship and level of influence on Share prices of Bombay Stock Exchange by rejecting and accepting the null hypothesis.

  20. Randomized Trial of Population-Based Clinical Decision Support to Facilitate Care Transitions.

    Science.gov (United States)

    Eisenstein, Eric L; Willis, Janese M; Edwards, Rex; Anstrom, Kevin J; Kawamoto, Kensaku; Fiol, Guilherme Del; Johnson, Fred S; Lobach, David F

    2017-01-01

    Medicaid beneficiaries in 6 North Carolina counties were randomly assigned to 1 of 3 clinical decision support (CDS) care transition strategies: (1) usual care (Control), (2) CDS messaging to patients and their medical homes (Reports), or (3) CDS messaging to patients, their medical homes, and their care managers (Reports+). We included 7146 Medicaid patients and evaluated transitions from specialist visit, ER and hospital encounters back to the patient's medical home. Patients enrolled in Medicare and Medicaid were not eligible. The number of care manager contacts was greater for patients in the Reports+ Group than in the Control Group. However, there were no treatment-related differences in emergency department (ED) encounter rates, or in the secondary outcomes of outpatient and hospital encounter rates and medical costs. Study monitors found study intervention documentation in approximately 60% of patient charts. These results highlight the importance of effectively integrating information interventions into healthcare delivery workflow systems.

  1. The role of advance euthanasia directives as an aid to communication and shared decision-making in dementia.

    Science.gov (United States)

    Hertogh, C M P M

    2009-02-01

    Recent evaluation of the practice of euthanasia and related medical decisions at the end of life in the Netherlands has shown a slight decrease in the frequency of physician-assisted death since the enactment of the Euthanasia Law in 2002. This paper focuses on the absence of euthanasia cases concerning patients with dementia and a written advance euthanasia directive, despite the fact that the only real innovation of the Euthanasia Law consisted precisely in allowing physicians to act upon such directives. The author discusses two principal reasons for this absence. One relates to the uncertainty about whether patients with advanced dementia truly experience the suffering they formerly feared. There is reason to assume that they don't, as a consequence of psychological adaptation and progressive unawareness (anosognosia). The second, more fundamental reason touches upon the ethical relevance of shared understanding and reciprocity. The author argues that, next to autonomy and mercifulness, "reciprocity" is a condition sine qua non for euthanasia. The absence thereof in advanced dementia renders euthanasia morally inconceivable, even if there are signs of suffering and notwithstanding the presence of an advance euthanasia directive. This does not mean, however, that advance euthanasia directives of patients with dementia are worthless. They might very well have a role in the earlier stages of certain subtypes of the disease. To illustrate this point the author presents a case in which the advance directive helped to create a window of opportunity for reciprocity and shared decision-making.

  2. Preferences and experiences of chronically ill and disabled patients regarding shared decision-making: does the type of care to be decided upon matter?

    NARCIS (Netherlands)

    Brink-Muinen, A. van den; Spreeuwenberg, P.; Rijken, M.

    2011-01-01

    OBJECTIVE: (1) To describe the importance chronically ill and disabled patients attach to involvement in decision-making when various care types are considered, and (2) to analyse the degree to which these patients are involved in shared decision-making (SDM) regarding these care types, and whether

  3. Decision Support System Knowledge Capture and Sharing for Telecom Network Management

    OpenAIRE

    Lorenzo Espinar, Berta

    2014-01-01

    This thesis work presents analysis and processing of the data from a European Distribution System Operator (DSO) in order to develop a decision support system which could help field technicians during the maintenance and operation of the electricity network. The proposed system is based on an artificial intelligence method called Case-Based Reasoning (CBR) which uses previous experiences to solve a new problem case. The four steps in this algorithm are: retrieval, reuse, revise and retain. ...

  4. From social network (centralized vs. decentralized) to collective decision-making (unshared vs. shared consensus).

    Science.gov (United States)

    Sueur, Cédric; Deneubourg, Jean-Louis; Petit, Odile

    2012-01-01

    Relationships we have with our friends, family, or colleagues influence our personal decisions, as well as decisions we make together with others. As in human beings, despotism and egalitarian societies seem to also exist in animals. While studies have shown that social networks constrain many phenomena from amoebae to primates, we still do not know how consensus emerges from the properties of social networks in many biological systems. We created artificial social networks that represent the continuum from centralized to decentralized organization and used an agent-based model to make predictions about the patterns of consensus and collective movements we observed according to the social network. These theoretical results showed that different social networks and especially contrasted ones--star network vs. equal network--led to totally different patterns. Our model showed that, by moving from a centralized network to a decentralized one, the central individual seemed to lose its leadership in the collective movement's decisions. We, therefore, showed a link between the type of social network and the resulting consensus. By comparing our theoretical data with data on five groups of primates, we confirmed that this relationship between social network and consensus also appears to exist in animal societies.

  5. Shared decision-making in mental health care—A user perspective on decisional needs in community-based services

    Directory of Open Access Journals (Sweden)

    Katarina Grim

    2016-05-01

    Full Text Available Background: Shared decision-making (SDM is an emergent research topic in the field of mental health care and is considered to be a central component of a recovery-oriented system. Despite the evidence suggesting the benefits of this change in the power relationship between users and practitioners, the method has not been widely implemented in clinical practice. Objective: The objective of this study was to investigate decisional and information needs among users with mental illness as a prerequisite for the development of a decision support tool aimed at supporting SDM in community-based mental health services in Sweden. Methods: Three semi-structured focus group interviews were conducted with 22 adult users with mental illness. The transcribed interviews were analyzed using a directed content analysis. This method was used to develop an in-depth understanding of the decisional process as well as to validate and conceptually extend Elwyn et al.'s model of SDM. Results: The model Elwyn et al. have created for SDM in somatic care fits well for mental health services, both in terms of process and content. However, the results also suggest an extension of the model because decisions related to mental illness are often complex and involve a number of life domains. Issues related to social context and individual recovery point to the need for a preparation phase focused on establishing cooperation and mutual understanding as well as a clear follow-up phase that allows for feedback and adjustments to the decision-making process. Conclusions and Implications for Practice: The current study contributes to a deeper understanding of decisional and information needs among users of community-based mental health services that may reduce barriers to participation in decision-making. The results also shed light on attitudinal, relationship-based, and cognitive factors that are important to consider in adapting SDM in the mental health system.

  6. Comparing the nine-item Shared Decision-Making Questionnaire to the OPTION Scale - an attempt to establish convergent validity.

    Science.gov (United States)

    Scholl, Isabelle; Kriston, Levente; Dirmaier, Jörg; Härter, Martin

    2015-02-01

    While there has been a clear move towards shared decision-making (SDM) in the last few years, the measurement of SDM-related constructs remains challenging. There has been a call for further psychometric testing of known scales, especially regarding validity aspects. To test convergent validity of the nine-item Shared Decision-Making Questionnaire (SDM-Q-9) by comparing it to the OPTION Scale. Cross-sectional study. Data were collected in outpatient care practices. Patients suffering from chronic diseases and facing a medical decision were included in the study. Consultations were evaluated using the OPTION Scale. Patients completed the SDM-Q-9 after the consultation. First, the internal consistency of both scales and the inter-rater reliability of the OPTION Scale were calculated. To analyse the convergent validity of the SDM-Q-9, correlation between the patient (SDM-Q-9) and expert ratings (OPTION Scale) was calculated. A total of 21 physicians provided analysable data of consultations with 63 patients. Analyses revealed good internal consistency of the SDM-Q-9 and limited internal consistency of the OPTION Scale. Inter-rater reliability of the latter was less than optimal. Association between the total scores of both instruments was weak with a Spearman correlation of r = 0.19 and did not reach statistical significance. By the use of the OPTION Scale convergent validity of the SDM-Q-9 could not be established. Several possible explanations for this result are discussed. This study shows that the measurement of SDM remains challenging. © 2012 John Wiley & Sons Ltd.

  7. Looking for Ms. Right: Allocating Attention to Facilitate Mate Choice Decisions

    Directory of Open Access Journals (Sweden)

    Kelly D. Suschinsky

    2007-04-01

    Full Text Available Through various signals, the human body provides information that may be used by receivers to make decisions about mate value. Here, we investigate whether there exists a complementary psychological system designed to selectively attend to these signals in order to choose, and direct effort toward the acquisition of, a potential mate. We presented young men with three images of the same woman (six women in total simultaneously, varying the waist-to-hip ratio (WHR of each image while holding other traits constant. While participants chose their preferred image, we monitored visual attention using an infrared eye-tracker. We found that participants focused their attention selectively on body regions known to provide reproductive information in a manner consistent with the research hypothesis: Reproductively relevant body regions, especially the head and breasts, received the most visual attention. Likewise, images with lower WHRs and reproductively relevant regions in images with lower WHRs received the most visual attention and were chosen as most attractive. Finally, irrespective of WHR size, participants fixated more often and for longer durations on the images that they selected as most attractive.

  8. Classification of Ovarian Cancer Surgery Facilitates Treatment Decisions in a Gynecological Multidisciplinary Team

    DEFF Research Database (Denmark)

    Bjørn, Signe Frahm; Schnack, Tine Henrichsen; Lajer, Henrik

    2017-01-01

    multidisciplinary team (MDT) decisions. MATERIALS AND METHODS: Four hundred eighteen women diagnosed with ovarian cancers (n = 351) or borderline tumors (n = 66) were selected for primary debulking surgery from January 2008 to July 2013. At an MDT meeting, women were allocated into 3 groups named "pre-COVA" 1 to 3...... classifying the expected extent of the primary surgery and need for postoperative care. On the basis of the operative procedures performed, women were allocated into 1 of the 3 corresponding COVA 1 to 3 groups. The outcome measure was the predictive value of the pre-COVA score compared with the actual COVA...... performed. RESULTS: The MDT meeting allocated 213 women (51%) to pre-COVA 1, 136 (33%) to pre-COVA 2, and 52 (12%) to pre-COVA 3. At the end of surgery, 168 (40%) were classified as COVA 1, 158 (38%) were classified as COVA 2, and 28 (7%) were classified as COVA 3. Traced individually, 212 (51%) patients...

  9. Developing a Cloud-Based Online Geospatial Information Sharing and Geoprocessing Platform to Facilitate Collaborative Education and Research

    Science.gov (United States)

    Yang, Z. L.; Cao, J.; Hu, K.; Gui, Z. P.; Wu, H. Y.; You, L.

    2016-06-01

    Efficient online discovering and applying geospatial information resources (GIRs) is critical in Earth Science domain as while for cross-disciplinary applications. However, to achieve it is challenging due to the heterogeneity, complexity and privacy of online GIRs. In this article, GeoSquare, a collaborative online geospatial information sharing and geoprocessing platform, was developed to tackle this problem. Specifically, (1) GIRs registration and multi-view query functions allow users to publish and discover GIRs more effectively. (2) Online geoprocessing and real-time execution status checking help users process data and conduct analysis without pre-installation of cumbersome professional tools on their own machines. (3) A service chain orchestration function enables domain experts to contribute and share their domain knowledge with community members through workflow modeling. (4) User inventory management allows registered users to collect and manage their own GIRs, monitor their execution status, and track their own geoprocessing histories. Besides, to enhance the flexibility and capacity of GeoSquare, distributed storage and cloud computing technologies are employed. To support interactive teaching and training, GeoSquare adopts the rich internet application (RIA) technology to create user-friendly graphical user interface (GUI). Results show that GeoSquare can integrate and foster collaboration between dispersed GIRs, computing resources and people. Subsequently, educators and researchers can share and exchange resources in an efficient and harmonious way.

  10. Decisional conflict in patients and their physicians: a dyadic approach to shared decision making.

    Science.gov (United States)

    LeBlanc, Annie; Kenny, David A; O'Connor, Annette M; Légaré, France

    2009-01-01

    Decisional conflict is defined as personal uncertainty about which course of action to take when choice among competing options involves risk, regret, or challenge to personal life values. It is influenced by inadequate knowledge, unclear values, inadequate support, and the perception that an ineffective decision has been made. Until recently, it has been studied at the individual level, which ignores the interpersonal system between patients and physicians. To explore the effect of feeling uninformed, unclear values, inadequate support, and the perception that an ineffective decision has been made on one own's outcome (actor effect) and on the other person's outcome (partner effect). After a clinical encounter, modifiable deficits and personal uncertainty were measured in physicians and patients using the Decisional Conflict Scale. Structural equation modeling was used to measure the parameters of the Actor-Partner Interdependence Model. A total of 112 dyads of physicians and patients were included in the analysis. For both patients and physicians, 2 actor effects, unclear values (P decision has been made (P personal uncertainty. One partner effect, feeling uninformed (P=0:03), was found to be negatively correlated with personal uncertainty. Personal uncertainty of patients and physicians is influenced not only by their respective deficits but also by the deficits of the other member of the dyad. Our results indicate that the more unclear the expression of their own values and the more they perceive that an ineffective choice had been made, the more both physicians and patients experience personal uncertainty. They also indicate that the less uninformed they feel, the more both physicians and patients experience personal uncertainty.

  11. An interprofessional approach to shared decision making: an exploratory case study with family caregivers of one IP home care team.

    Science.gov (United States)

    Légaré, France; Stacey, Dawn; Brière, Nathalie; Robitaille, Hubert; Lord, Marie-Claude; Desroches, Sophie; Drolet, Renée

    2014-07-02

    Within the context of an exploratory case study, the authors assessed the perceptions of family caregivers about the decision-making process regarding relocating their relative and about the applicability of an interprofessional approach to shared decision making (IP-SDM). They also assessed perceptions of health professionals and health managers about IP-SDM. From November 2010 to October 2011, we worked with one IP home care team dedicated to older adults (the case) from a large primary health care organization in Quebec City, Canada. We identified six of their clients who had faced a decision about whether to stay at home or move to a long-term care facility in the past year and interviewed their family caregivers. We explored the decision-making process they had experienced regarding relocating their relative and their perceptions about the applicability of IP-SDM in this context. Attitudes towards IP-SDM and potential barriers to this approach were explored using a focus group with the participating IP home care team, individual interviews with 8 managers and a survey of 272 health professionals from the primary care organization. A hybrid process of inductive and deductive thematic analysis was used and data were triangulated across all sources. Family caregivers reported lack of agreement on the nature of the decision to be made, a disconnection between home care services and relatives' needs, and high cost of long-term care alternatives. Factors influencing their decision included their ability to provide care for their relative. While they felt somewhat supported by the IP home care team, they also felt pressured in the decision. Overall, they did not perceive they had been exposed to IP-SDM but agreed that it was applicable in this context. Results from the survey, focus group and interviews with health professionals and managers indicated they all had a favourable attitude towards IP-SDM but many barriers hampered its implementation in their practice

  12. Use of video to facilitate sideline concussion diagnosis and management decision-making.

    Science.gov (United States)

    Davis, Gavin; Makdissi, Michael

    2016-11-01

    Video analysis can provide critical information to improve diagnostic accuracy and speed of clinical decision-making in potential cases of concussion. The objective of this study was to validate a hierarchical flowchart for the assessment of video signs of concussion, and to determine whether its implementation could improve the process of game day video assessment. Prospective cohort study. All impacts and collisions potentially resulting in a concussion were identified during 2012 and 2013 Australian Football League (AFL) seasons. Consensus definitions were developed for clinical signs associated with concussion. A hierarchical flowchart was developed based on the reliability and validity of the video signs of concussion. Ninety videos were assessed, with 45 incidents of clinically confirmed concussion, and 45 cases where no concussion was sustained. Each video was examined using the hierarchical flowchart, and a single response was given for each video based on the highest-ranking element in the flowchart. No protective action, impact seizure, motor incoordination or blank/vacant look were the highest ranked video signs in almost half of the clinically confirmed concussions, but in only 8.8% of non-concussed individuals. The presence of facial injury, clutching at the head and slow to get up were the highest ranked sign in 77.7% of non-concussed individuals. This study suggests that the implementation of a flowchart model could improve timely assessment of concussion, and it identifies the video signs that should trigger automatic removal from play. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  13. SU-E-P-26: Oncospace: A Shared Radiation Oncology Database System Designed for Personalized Medicine, Decision Support, and Research

    Energy Technology Data Exchange (ETDEWEB)

    Bowers, M; Robertson, S; Moore, J; Wong, J; DeWeese, T; McNutt, T [Johns Hopkins University, Baltimore, MD (United States); Phillips, M [Univ Washington, Seattle, WA (United States); Hendrickson, K [University of Washington, Seattle, WA (United States); Song, W; Kwok, P [Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, U of T, Toronto, Ontario (Canada)

    2015-06-15

    Purpose: Advancement in Radiation Oncology (RO) practice develops through evidence based medicine and clinical trial. Knowledge usable for treatment planning, decision support and research is contained in our clinical data, stored in an Oncospace database. This data store and the tools for populating and analyzing it are compatible with standard RO practice and are shared with collaborating institutions. The question is - what protocol for system development and data sharing within an Oncospace Consortium? We focus our example on the technology and data meaning necessary to share across the Consortium. Methods: Oncospace consists of a database schema, planning and outcome data import and web based analysis tools.1) Database: The Consortium implements a federated data store; each member collects and maintains its own data within an Oncospace schema. For privacy, PHI is contained within a single table, accessible to the database owner.2) Import: Spatial dose data from treatment plans (Pinnacle or DICOM) is imported via Oncolink. Treatment outcomes are imported from an OIS (MOSAIQ).3) Analysis: JHU has built a number of webpages to answer analysis questions. Oncospace data can also be analyzed via MATLAB or SAS queries.These materials are available to Consortium members, who contribute enhancements and improvements. Results: 1) The Oncospace Consortium now consists of RO centers at JHU, UVA, UW and the University of Toronto. These members have successfully installed and populated Oncospace databases with over 1000 patients collectively.2) Members contributing code and getting updates via SVN repository. Errors are reported and tracked via Redmine. Teleconferences include strategizing design and code reviews.3) Successfully remotely queried federated databases to combine multiple institutions’ DVH data for dose-toxicity analysis (see below – data combined from JHU and UW Oncospace). Conclusion: RO data sharing can and has been effected according to the Oncospace

  14. Collectible toys and decisions to share: I will gift you one to expand my set.

    Science.gov (United States)

    McAlister, Anna R; Cornwell, T Bettina; Cornain, Emilita Krisanti

    2011-03-01

    Two studies were used to examine the collecting behaviour of preschool children. Prior studies of collecting have defined the behaviour as exhibited by older children and adults. To understand childhood collecting, existing theoretical perspectives were discussed in terms of how they might apply to children's behaviour as collectors. Results showed that some preschool children are motivated to engage in collecting and possess the developmental capacities required for successful collecting. Individual differences in executive functioning (Study 1, N= 57) and theory of mind (Study 2, N= 46) explained why some preschoolers were more oriented towards collecting than others. Study 2 showed that the motivational pull of collectible toys can be very strong, with some children agreeing to pay the 'cost' of sharing with a confederate child in order to obtain a collectible toy. This research highlights similarities and differences between adult and child collecting. Suggestions are provided for parents and for policy considerations regarding the appropriateness of marketing collectible toys to preschoolers.

  15. Assessing the feasibility and quality of shared decision making in China: evaluating a clinical encounter intervention for Chinese patients

    Directory of Open Access Journals (Sweden)

    Huang RC

    2016-11-01

    Full Text Available Rongchong Huang,1,* Xiantao Song,2,* Jian Wu,1 Wei Huang,2 Aaron L Leppin,3 Michael R Gionfriddo,3,4 Yongxian Liu,1 Kasey R Boehmer,3 Henry H Ting,5 Victor M Montori3,6 1Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, 2Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, People’s Republic of China; 3Knowledge and Evaluation Research Unit, 4Mayo Graduate School, Mayo Clinic, Rochester, MN, 5Value Institute, New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell, New York, NY, 6Division of Endocrinology, Mayo Clinic, Rochester, MN, USA *These authors contributed equally to this work Background: The aim of this study was to evaluate the feasibility of using the Statin Choice decision aid to have discussions about starting a statin medication for cardiovascular risk reduction in Chinese patients with stable coronary artery diseases.Methods: A prospective, pilot study of the Statin Choice decision aid in two teaching hospitals in Northern China was conducted. A total of seven clinicians were enrolled and underwent a 12-hour, group-based, in-person training on shared decision making (SDM and the Statin Choice decision aid. Then, these clinicians used the Statin Choice decision aid in patients during a clinical encounter. A total of 86 patients aged 40-80 years, who had stable angina, were enrolled. All clinical encounters were video recorded. A team of three researchers viewed and scored all the encounter recordings to evaluate the SDM process and fidelity to the intervention using the OPTION scale and Fidelity scale, respectively. All the patients were followed up for 12 months to record adherence to statin and any major adverse cardiac events (MACEs.Results: The average scores on the OPTION normalized score and Fidelity scale were 21 (range, 3–32; out of a possible, 48 and 10 (range, 6–10; out of a possible, 10, respectively. This

  16. Usability of clinical decision support system as a facilitator for learning the assistive technology adaptation process.

    Science.gov (United States)

    Danial-Saad, Alexandra; Kuflik, Tsvi; Weiss, Patrice L Tamar; Schreuer, Naomi

    2016-01-01

    The aim of this study was to evaluate the usability of Ontology Supported Computerized Assistive Technology Recommender (OSCAR), a Clinical Decision Support System (CDSS) for the assistive technology adaptation process, its impact on learning the matching process, and to determine the relationship between its usability and learnability. Two groups of expert and novice clinicians (total, n = 26) took part in this study. Each group filled out system usability scale (SUS) to evaluate OSCAR's usability. The novice group completed a learning questionnaire to assess OSCAR's effect on their ability to learn the matching process. Both groups rated OSCAR's usability as "very good", (M [SUS] = 80.7, SD = 11.6, median = 83.7) by the novices, and (M [SUS] = 81.2, SD = 6.8, median = 81.2) by the experts. The Mann-Whitney results indicated that no significant differences were found between the expert and novice groups in terms of OSCAR's usability. A significant positive correlation existed between the usability of OSCAR and the ability to learn the adaptation process (rs = 0.46, p = 0.04). Usability is an important factor in the acceptance of a system. The successful application of user-centered design principles during the development of OSCAR may serve as a case study that models the significant elements to be considered, theoretically and practically in developing other systems. Implications for Rehabilitation Creating a CDSS with a focus on its usability is an important factor for its acceptance by its users. Successful usability outcomes can impact the learning process of the subject matter in general, and the AT prescription process in particular. The successful application of User-Centered Design principles during the development of OSCAR may serve as a case study that models the significant elements to be considered, theoretically and practically. The study emphasizes the importance of close collaboration between the developers and

  17. Five shared decision-making tools in 5 months: use of rapid reviews to develop decision boxes for seniors living with dementia and their caregivers.

    Science.gov (United States)

    Lawani, Moulikatou Adouni; Valéra, Béatriz; Fortier-Brochu, Émilie; Légaré, France; Carmichael, Pierre-Hugues; Côté, Luc; Voyer, Philippe; Kröger, Edeltraut; Witteman, Holly; Rodriguez, Charo; Giguere, Anik M C

    2017-03-15

    Decision support tools build upon comprehensive and timely syntheses of literature. Rapid reviews may allow supporting their development by omitting certain components of traditional systematic reviews. We thus aimed to describe a rapid review approach underlying the development of decision support tools, i.e., five decision boxes (DB) for shared decision-making between seniors living with dementia, their caregivers, and healthcare providers. We included studies based on PICO questions (Participant, Intervention, Comparison, Outcome) describing each of the five specific decision. We gave priority to higher quality evidence (e.g., systematic reviews). For each DB, we first identified secondary sources of literature, namely, clinical summaries, clinical practice guidelines, and systematic reviews. After an initial extraction, we searched for primary studies in academic databases and grey literature to fill gaps in evidence. We extracted study designs, sample sizes, populations, and probabilities of benefits/harms of the health options. A single reviewer conducted the literature search and study selection. The data extracted by one reviewer was verified by a second experienced reviewer. Two reviewers assessed the quality of the evidence. We converted all probabilities into absolute risks for ease of understanding. Two to five experts validated the content of each DB. We conducted descriptive statistical analyses on the review processes and resources required. The approach allowed screening of a limited number of references (range: 104 to 406/review). For each review, we included 15 to 26 studies, 2 to 10 health options, 11 to 62 health outcomes and we conducted 9 to 47 quality assessments. A team of ten reviewers with varying levels of expertise was supported at specific steps by an information specialist, a biostatistician, and a graphic designer. The time required to complete a rapid review varied from 7 to 31 weeks per review (mean ± SD, 19 ± 10

  18. How Effective Is a Virtual Consultation Process in Facilitating Multidisciplinary Decision-Making for Malignant Epidural Spinal Cord Compression?

    Energy Technology Data Exchange (ETDEWEB)

    Fitzpatrick, David [Palliative Radiation Oncology Program and Princess Margaret Hospital, University Health Network, University of Toronto (Canada); St Luke' s Hospital, Dublin (Ireland); Grabarz, Daniel [Palliative Radiation Oncology Program and Princess Margaret Hospital, University Health Network, University of Toronto (Canada); Centro Oncologia Mendel and Associados, Sao Paulo (Brazil); Wang, Lisa [Department of Biostatistics, Princess Margaret Hospital, University Health Network, University of Toronto (Canada); Bezjak, Andrea [Palliative Radiation Oncology Program and Princess Margaret Hospital, University Health Network, University of Toronto (Canada); Fehlings, Michael G. [Division of Neurosurgery, Krembil Neuroscience Center, Spinal Program, Toronto Western Hospital, University Health Network, University of Toronto (Canada); Fosker, Christopher [Palliative Radiation Oncology Program and Princess Margaret Hospital, University Health Network, University of Toronto (Canada); Rampersaud, Raja [Division of Orthopaedic Surgery, Krembil Neuroscience Center, Spinal Program, Toronto Western Hospital, University Health Network, University of Toronto (Canada); Wong, Rebecca K.S., E-mail: rebecca.wong@rmp.uhn.on.ca [Palliative Radiation Oncology Program and Princess Margaret Hospital, University Health Network, University of Toronto (Canada)

    2012-10-01

    Purpose: The purpose of this study was to assess the accuracy of a virtual consultation (VC) process in determining treatment strategy for patients with malignant epidural spinal cord compression (MESCC). Methods and Materials: A prospective clinical database was maintained for patients with MESCC. A virtual consultation process (involving exchange of key predetermined clinical information and diagnostic imaging) facilitated rapid decision-making between oncologists and spinal surgeons. Diagnostic imaging was reviewed retrospectively (by R.R.) for surgical opinions in all patients. The primary outcome was the accuracy of virtual consultation opinion in predicting the final treatment recommendation. Results: After excluding 20 patients who were referred directly to the spinal surgeon, 125 patients were eligible for virtual consultation. Of the 46 patients who had a VC, surgery was recommended in 28 patients and actually given to 23. A retrospective review revealed that 5/79 patients who did not have a VC would have been considered surgical candidates. The overall accuracy of the virtual consultation process was estimated at 92%. Conclusion: The VC process for MESCC patients provides a reliable means of arriving at a multidisciplinary opinion while minimizing patient transfer. This can potentially shorten treatment decision time and enhance clinical outcomes.

  19. How effective is a virtual consultation process in facilitating multidisciplinary decision-making for malignant epidural spinal cord compression?

    Science.gov (United States)

    Fitzpatrick, David; Grabarz, Daniel; Wang, Lisa; Bezjak, Andrea; Fehlings, Michael G; Fosker, Christopher; Rampersaud, Raja; Wong, Rebecca K S

    2012-10-01

    The purpose of this study was to assess the accuracy of a virtual consultation (VC) process in determining treatment strategy for patients with malignant epidural spinal cord compression (MESCC). A prospective clinical database was maintained for patients with MESCC. A virtual consultation process (involving exchange of key predetermined clinical information and diagnostic imaging) facilitated rapid decision-making between oncologists and spinal surgeons. Diagnostic imaging was reviewed retrospectively (by R.R.) for surgical opinions in all patients. The primary outcome was the accuracy of virtual consultation opinion in predicting the final treatment recommendation. After excluding 20 patients who were referred directly to the spinal surgeon, 125 patients were eligible for virtual consultation. Of the 46 patients who had a VC, surgery was recommended in 28 patients and actually given to 23. A retrospective review revealed that 5/79 patients who did not have a VC would have been considered surgical candidates. The overall accuracy of the virtual consultation process was estimated at 92%. The VC process for MESCC patients provides a reliable means of arriving at a multidisciplinary opinion while minimizing patient transfer. This can potentially shorten treatment decision time and enhance clinical outcomes. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. Defining reasonable patient standard and preference for shared decision making among patients undergoing anaesthesia in Singapore.

    Science.gov (United States)

    Yek, J L J; Lee, A K Y; Tan, J A D; Lin, G Y; Thamotharampillai, T; Abdullah, H R

    2017-02-02

    A cross-sectional study to ascertain what the Singapore population would regard as material risk in the anaesthesia consent-taking process and identify demographic factors that predict patient preferences in medical decision-making to tailor a more patient-centered informed consent. A survey was performed involving patients 21 years old and above who attended the pre-operative evaluation clinic over a 1-month period in Singapore General Hospital. Questionnaires were administered to assess patients' perception of material risks, by trained interviewers. Patients' demographics were obtained. Mann-Whitney U test and Kruskal-Wallis one-way analysis of variance was used. Statistical significance was taken at p audio-visual multimedia for pre-operative anaesthetic counselling. The local population appears to place greater importance on rare but serious complications compared to common complications. This illustrates the need to contextualize information provided during informed consent to strengthen the doctor-patient relationship.

  1. [Barriers and facilitators to the implementation of computerized decision support systems in Italian hospitals: a grounded theory study].

    Science.gov (United States)

    Liberati, Elisa Giulia; Galuppo, Laura; Gorli, Mara; Maraldi, Marco; Ruggiero, Francesca; Capobussi, Matteo; Banzi, Rita; Kwag, Koren; Scaratti, Giuseppe; Nanni, Oriana; Ruggieri, Pietro; Polo Friz, Hernan; Cimminiello, Claudio; Bosio, Marco; Mangia, Massimo; Moja, Lorenzo

    2015-04-01

    Computerized Decision Support Systems (CDSSs) connect health care professionals with high-quality, evidence-based information at the point-of-care to guide clinical decision-making. Current research shows the potential of CDSSs to improve the efficiency and quality of patient care. The mere provision of the technology, however, does not guarantee its uptake. This qualitative study aims to explore the barriers and facilitators to the use of CDSSs as identified by health providers. The study was performed in three Italian hospitals, each characterized by a different level of familiarity with the CDSS technology. We interviewed frontline physicians, nurses, information technology staff, and members of the hospital board of directors (n=24). A grounded theory approach informed our sampling criteria as well as the data collection and analysis. The adoption of CDSSs by health care professionals can be represented as a process that consists of six "positionings," each corresponding to an individual's use and perceived mastery of the technology. In conditions of low mastery, the CDSS is perceived as an object of threat, an unfamiliar tool that is difficult to control. On the other hand, individuals in conditions of high mastery view the CDSS as a helpful tool that can be locally adapted and integrated with clinicians' competences to fulfil their needs. In the first positionings, the uptake of CDSSs is hindered by representational obstacles. The last positionings, alternatively, featured technical obstacles to CDSS uptake. Our model of CDSS adoption can guide hospital administrators interested in the future integration of CDSSs to evaluate their organizational contexts, identify potential challenges to the implementation of the technology, and develop an effective strategy to address them. Our findings also allow reflections concerning the misalignment between most Italian hospitals and the current innovation trends toward the uptake of computerized decision support

  2. Data-driven deselection for monographs: a rules-based approach to weeding, storage, and shared print decisions

    Directory of Open Access Journals (Sweden)

    Rick Lugg

    2012-07-01

    Full Text Available The value of local print book collections is changing. Even as stacks fill and library traffic grows, circulation continues to decline. Across the ‘collective collection’, millions of unused books occupy prime central campus space. Meanwhile, users want more collaborative study space and online resources. Libraries want room for information commons, teaching and learning centers and cafes. Done properly, removing unused books can free space for these and other purposes, with little impact on users. Many low-use titles are securely archived, accessible digitally, and widely held in print. Surplus copies can be removed without endangering the scholarly record. But identifying candidates for deselection is time-consuming. Batch-oriented tools that incorporate both archival and service values are needed. This article describes the characteristics of a decision-support system that assembles deselection metadata and enables library-defined rules to generate lists of titles eligible for withdrawal, storage, or inclusion in shared print programs.

  3. Involving people with dementia in developing an interactive web tool for shared decision-making: experiences with a participatory design approach.

    Science.gov (United States)

    Span, Marijke; Hettinga, Marike; Groen-van de Ven, Leontine; Jukema, Jan; Janssen, Ruud; Vernooij-Dassen, Myrra; Eefsting, Jan; Smits, Carolien

    2017-03-12

    The aim of this study was at gaining insight into the participatory design approach of involving people with dementia in the development of the DecideGuide, an interactive web tool facilitating shared decision-making in their care networks. An explanatory case study design was used when developing the DecideGuide. A secondary analysis focused on the data gathered from the participating people with dementia during the development stages: semi-structured interviews (n = 23), four focus group interviews (n = 18), usability tests (n = 3), and a field study (n = 4). Content analysis was applied to the data. Four themes showed to be important regarding the participation experiences of involving people with dementia in research: valuable feedback on content and design of the DecideGuide, motivation to participate, perspectives of people with dementia and others about distress related to involvement, and time investment. People with dementia can give essential feedback and, therefore, their contribution is useful and valuable. Meaningful participation of people with dementia takes time that should be taken into account. It is important for people with dementia to be able to reciprocate the efforts others make and to feel of significance to others. Implications for Rehabilitation People with dementia can contribute meaningfully to the content and design and their perspective is essential for developing useful and user-friendly tools. Participating in research activities may contribute to social inclusion, empowerment, and quality of life of people with dementia.

  4. Insights into the concept and measurement of health literacy from a study of shared decision-making in a low literacy population.

    Science.gov (United States)

    Smith, Sian K; Nutbeam, Don; McCaffery, Kirsten J

    2013-08-01

    This article explores the concept and measurement of health literacy in the context of shared health decision-making. It draws upon a series of qualitative and quantitative studies undertaken in the development and evaluation of a bowel cancer screening decision aid for low literacy populations. The findings indicate that different types of health literacy (functional, interactive and critical) are required in decision-making and present a set of instruments to assess and discriminate between higher level health literacy skills required for engagement in decision-making. It concludes that greater sophistication in both the definition and measurement of health literacy in research is needed.

  5. Research Using In Vivo Simulation of Meta-Organizational Shared Decision-making (SDM). Task 4: Modeling of Communication and Decision Functions within a Shared Decision-making (SDM) Framework

    Science.gov (United States)

    2011-12-01

    à l’Institut de santé des populations, et Professeure à l’École de psychologie , Faculté des sciences sociales, Université d’Ottawa. DRDC CSS CR...and should not be shared, cognitive overload, misinterpretation of data, and problems with the quality, quantity and access to raw information...participating organizations in overcoming social and cognitive barriers to collaboration (Chouinard, 2009, p.2). Given the wide adoption of

  6. Advancing theories, models and measurement for an interprofessional approach to shared decision making in primary care: a study protocol

    Directory of Open Access Journals (Sweden)

    Frosch Dominick

    2008-01-01

    Full Text Available Abstract Background Shared decision-making (SDM is defined as a process by which a healthcare choice is made by practitioners together with the patient. Although many diagnostic and therapeutic processes in primary care integrate more than one type of health professional, most SDM conceptual models and theories appear to be limited to the patient-physician dyad. The objectives of this study are to develop a conceptual model and propose a set of measurement tools for enhancing an interprofessional approach to SDM in primary healthcare. Methods/Design An inventory of SDM conceptual models, theories and measurement tools will be created. Models will be critically assessed and compared according to their strengths, limitations, acknowledgement of interprofessional roles in the process of SDM and relevance to primary care. Based on the theory analysis, a conceptual model and a set of measurements tools that could be used to enhance an interprofessional approach to SDM in primary healthcare will be proposed and pilot-tested with key stakeholders and primary healthcare teams. Discussion This study protocol is informative for researchers and clinicians interested in designing and/or conducting future studies and educating health professionals to improve how primary healthcare teams foster active participation of patients in making health decisions using a more coordinated approach.

  7. Contributing to Sustainable Mountain Development by Facilitating Networking and Knowledge Sharing through ICT - Collaboration between Rocky Mountain States and Central Asia

    Directory of Open Access Journals (Sweden)

    Baktybek Abdrisaev

    2011-12-01

    Full Text Available This paper highlights new opportunities for sharing knowledge and networking through the use of information and communication technologies to better contribute to Sustainable Mountain Development and Millennium Development Goals. It analyzes current challenges in mountain countries in Central Asia where political instability and weak governance, in addition to their challenging natural conditions, constitute major constraints for peoples’ lives. The authors examine possible ways to tackle the major obstacles through IT-enabled knowledge sharing and networking. They discuss a number of collaborative initiatives between Rocky Mountain States in the United States and mountain nations in Central Asia aimed at promoting the values of a democratic society and good governance through networking between educators, legislators. Also, these initiatives are aimed at fostering critical thinking through independent e-media. Based on the analysis, they suggest further ways in facilitating networking and knowledge sharing for Sustainable Mountain Development through the use of information and communication technologies by joining the efforts of all active players and also eliciting more contribution from the mountainous communities of the United States.

  8. Is 'shared decision-making' feasible in consultations for upper respiratory tract infections? Assessing the influence of antibiotic expectations using discourse analysis.

    Science.gov (United States)

    Elwyn, Glyn; Gwyn, Richard; Edwards, Adrian; Grol, Richard

    1999-05-01

    OBJECTIVES: To examine the discourse of consultations in which conflict occurs between parents and clinicians about the necessity of antibiotics to treat an upper respiratory tract infection. To appraise the feasibility of shared decision-making in such consultations. DESIGN: A qualitative study using discourse analysis techniques. SETTING: A general practice with 12 500 patients in an urban area of Cardiff, Wales. PARTICIPANTS: Two consultations were purposively selected from a number of audiotaped sessions. The consultations took place during normal clinics in which appointments are booked at 7-minute intervals. The practitioner is known to be interested in involving patients in treatment decisions. METHOD: Discourse analysis was employed to examine the consultation transcripts. This analysis was then compared with the theoretical competencies proposed for 'shared decision-making'. RESULTS: The consultations exhibit less rational strategies than those suggested by the shared decision-making model. Strong parental views are expressed (overtly and covertly) which seem derived from prior experiences of similar illnesses and prescribing behaviours. The clinician responds by emphasizing the 'normality' of upper respiratory tract infections and their recurrence, accompanied by expressions that antibiotic treatment is ineffective in 'viral' illness - the suggested diagnosis. The competencies of 'shared decision-making' are not exhibited. CONCLUSIONS: The current understanding of shared decision-making needs to be developed for those situations where there are dis-agreements due to the strongly held views of the participants. Clinicians have limited strategies in situations where patient treatment preferences are opposed to professional views. Dispelling 'misconceptions' by sharing information and negotiating agreed management plans are recommended. But it seems that communication skills, information content and consultation length have to receive attention if such

  9. The RISAP-study: a complex intervention in risk communication and shared decision-making in general practice

    Directory of Open Access Journals (Sweden)

    Lauritzen Torsten

    2010-09-01

    Full Text Available Abstract Background General practitioners (GPs and patients find it difficult to talk about risk of future disease, especially when patients have asymptomatic conditions, and treatment options are unlikely to cause immediate perceptible improvements in well-being. Further studies in risk communication training are needed. Aim:1 to systematically develop, describe and evaluate a complex intervention comprising a training programme for GPs in risk communication and shared decision-making, 2 to evaluate the effect of the training programme on real-life consultations between GPs and patients with high cholesterol levels, and 3 to evaluate patients' reactions during and after the consultations. Methods/Design The effect of the complex intervention, based around a training programme, will be evaluated in a cluster-randomised controlled trial with an intervention group and an active control group with 40 GPs and 280 patients in each group. The GPs will receive a questionnaire at baseline and after 6 months about attitudes towards risk communication and cholesterol-reducing medication. After each consultation with a participating high cholesterol-patient, the GPs will complete a questionnaire about decision satisfaction (Provider Decision Process Assessment Instrument. The patients will receive a questionnaire at baseline and after 3 and 6 months. It includes questions about adherence to chosen treatment (Morisky Compliance Scale, self-rated health (SF-12, enablement (Patient Enablement Instrument, and risk communication and decision-making effectiveness (COMRADE Scale. Prescriptions, contacts to the health services, and cholesterol level will be drawn from the registers. In each group, 12 consultations will be observed and tape-recorded. The patients from these 24 consultations will be interviewed immediately after the consultation and re-interviewed after 6 months. Eight purposefully selected GPs from the intervention group will be interviewed in a

  10. Towards biomarker-based tests that can facilitate decisions about prevention and management of preeclampsia in low-resource settings.

    Science.gov (United States)

    Acestor, Nathalie; Goett, Jane; Lee, Arthur; Herrick, Tara M; Engelbrecht, Susheela M; Harner-Jay, Claudia M; Howell, Bonnie J; Weigl, Bernhard H

    2016-01-01

    In recent years, an increasing amount of literature is emerging on candidate urine and blood-based biomarkers associated with incidence and severity of preeclampsia (PE) in pregnant women. While enthusiasm on the usefulness of several of these markers in predicting PE is evolving, essentially all work so far has focused on the needs of high-resource settings and high-income countries, resulting primarily in multi-parameter laboratory assays based on proteomic and metabolomics analysis techniques. These highly complex methods, however, require laboratory capabilities that are rarely available or affordable in low-resource settings (LRS). The importance of quantifying maternal and perinatal risks and identifying which pregnancies can be safely prolonged is also much greater in LRS, where intensive care facilities that can rapidly respond to PE-related health threats for women and infants are limited. For these reasons, simple, low cost, sensitive, and specific point-of-care (POC) tests are needed that can be performed by antenatal health care providers in LRS and that can facilitate decisions about detection and management of PE. Our study aims to provide a comprehensive systematic review of current and emerging blood and urine biomarkers for PE, not only on the basis of their clinical performance, but also of their suitability to be used in LRS-compatible test formats, such as lateral flow and other variants of POC rapid assays.

  11. An integrated information system for the acquisition, management and sharing of environmental data aimed to decision making

    Science.gov (United States)

    La Loggia, Goffredo; Arnone, Elisa; Ciraolo, Giuseppe; Maltese, Antonino; Noto, Leonardo; Pernice, Umberto

    2012-09-01

    This paper reports the first results of the Project SESAMO - SistEma informativo integrato per l'acquisizione, geStione e condivisione di dati AMbientali per il supportO alle decisioni (Integrated Information System for the acquisition, management and sharing of environmental data aimed to decision making). The main aim of the project is to design and develop an integrated environmental information platform able to provide monitoring services for decision support, integrating data from different environmental monitoring systems (including WSN). This ICT platform, based on a service-oriented architecture (SOA), will be developed to coordinate a wide variety of data acquisition systems, based on heterogeneous technologies and communication protocols, providing different sort of environmental monitoring services. The implementation and validation of the SESAMO platform and its services will involve three specific environmental domains: 1) Urban water losses; 2) Early warning system for rainfall-induced landslides; 3) Precision irrigation planning. Services in the first domain are enabled by a low cost sensors network collecting and transmitting data, in order to allow the pipeline network managers to analyze pressure, velocity and discharge data for reducing water losses in an urban contest. This paper outlines the SESAMO functional and technological structure and then gives a concise description of the service design and development process for the second and third domain. Services in the second domain are enabled by a prototypal early warning system able to identify in near-real time high-risk zones of rainfall-induced landslides. Services in the third domain are aimed to optimize irrigation planning of vineyards depending on plant water stress.

  12. Physicians as part of the solution? Community-based participatory research as a way to get shared decision making into practice

    NARCIS (Netherlands)

    Grande, S.W.; Durand, M.A.; Fisher, E.S.; Elwyn, G.

    2014-01-01

    Although support among policy makers and academics for the wide scale adoption of shared decision making (SDM) is growing, actual implementation is slow, and faces many challenges. Extensive systemic barriers exist that prevent physicians from being able to champion SDM and lead practice change. In

  13. Achieving involvement: process outcomes from a cluster randomized trial of shared decision making skill development and use of risk communication aids in general practice.

    NARCIS (Netherlands)

    Elwyn, G.; Edwards, A.; Hood, K.; Robling, M.; Atwell, C.; Russell, I.; Wensing, M.J.P.; Grol, R.P.T.M.

    2004-01-01

    BACKGROUND: A consulting method known as 'shared decision making' (SDM) has been described and operationalized in terms of several 'competences'. One of these competences concerns the discussion of the risks and benefits of treatment or care options-'risk communication'. Few data exist on clinicians

  14. Randomized trial of a shared decision-making intervention consisting of trade-offs and individualized treatment information for BRCA1/2 mutation carriers

    NARCIS (Netherlands)

    van Roosmalen, MS; Stalmeier, PFM; Verhoef, LCG; Hoekstra-Weebers, JEHM; Oosterwijk, JC; Hoogerbrugge, N; Moog, U; van Daal, WAJ

    2004-01-01

    Purpose To evaluate a shared decision-making intervention (SDMI) for BRCA1/2 mutation carriers who have to make a choice between screening and prophylactic surgery for breasts and/or ovaries. Patients and Methods The SDMI consisted of two value assessment sessions, using the time trade-off method,

  15. [Using Shared Decision-Making on a Patient With Renal Cell Carcinoma and Subcutaneous Metastasis: A Care Experience].

    Science.gov (United States)

    Tsai, Ling-Yu; Lin, Chiu-Chu

    2015-06-01

    When a patient aggressively receives treatment and looks forward to returning home, the prolonging of meaningful life is difficult, even with medical treatment. It is typically very challenging at this juncture for the members of the medical team to fully disclose to the patient the true extent of his / her condition and to recommend the withdrawal of life-support medical treatment. This article describes a nursing care experience with a renal cell carcinoma patient with subcutaneous metastasis. Her pain was induced by an edema and subcutaneous tumor in her lower limbs, which diminished the effectiveness of hemodialysis. During hospitalization, the mood of the patient shifted from looking forward to recovery to facing a rapidly worsening health status. Achieving a balance between fighting the disease and sustaining patient quality of life became increasingly difficult, and the patient began experiencing anxiety about dying. We use the belief of shared decision-making to guide the case in a discussion of her expectations during which primary medical care options and her choice to withdraw from hemodial-ysis treatment were explained. Essential oils, selected for appropriateness with her current disease stage, were used to stabilize her mood and relieve pain. In the end, we helped the patient to complete her pre-death preparations and to say goodbye to her children, parents, and siblings. As a result, the patient experienced a good death.

  16. Pack-Year Cigarette Smoking History for Determination of Lung Cancer Screening Eligibility. Comparison of the Electronic Medical Record versus a Shared Decision-making Conversation.

    Science.gov (United States)

    Modin, Hannah E; Fathi, Joelle T; Gilbert, Christopher R; Wilshire, Candice L; Wilson, Andrew K; Aye, Ralph W; Farivar, Alexander S; Louie, Brian E; Vallières, Eric; Gorden, Jed A

    2017-08-01

    Implementation of lung cancer screening programs is occurring across the United States. Programs vary in approaches to patient identification and shared decision-making. The eligibility of persons referred to screening programs, the outcomes of eligibility determination during shared decision-making, and the potential for the electronic medical record (EMR) to identify eligible individuals have not been well described. Our objectives were to assess the eligibility of individuals referred for lung cancer screening and compare information extracted from the EMR to information derived from a shared decision-making conversation for the determination of eligibility for lung cancer screening. We performed a retrospective analysis of individuals referred to a centralized lung cancer screening program serving a five-hospital health services system in Seattle, Washington between October 2014 and January 2016. Demographics, referral, and outcomes data were collected. A pack-year smoking history derived from the EMR was compared with the pack-year history obtained during a shared decision-making conversation performed by a licensed nurse professional representing the lung cancer screening program. A total of 423 individuals were referred to the program, of whom 59.6% (252 of 423) were eligible. Of those, 88.9% (224 of 252) elected screening. There was 96.2% (230 of 239) discordance in pack-year smoking history between the EMR and the shared decision-making conversation. The EMR underreported pack-years of smoking for 85.2% (196 of 230) of the participants, with a median difference of 29.2 pack-years. If identification of eligible individuals relied solely on the accuracy of the pack-year smoking history recorded in the EMR, 53.6% (128 of 239) would have failed to meet the 30-pack-year threshold for screening. Many individuals referred for lung cancer screening may be ineligible. Overreliance on the EMR for identification of individuals at risk may lead to missed opportunities

  17. Validation of a nomogram for predicting regression from impaired fasting glucose to normoglycaemia to facilitate clinical decision making.

    Science.gov (United States)

    Guo, Vivian Yw; Yu, Esther Yt; Wong, Carlos Kh; Sit, Regina Ws; Wang, Jenny Hl; Ho, S Y; Lam, Cindy Lk

    2016-08-01

    In Hong Kong, fasting plasma glucose (FPG) is the most popular screening test for diabetes mellitus (DM) in primary care. Individuals with impaired fasting glucose (IFG) are commonly encountered. To explore the determinants of regression to normoglycaemia among primary care patients with IFG based on non-invasive variables and to establish a nomogram for the prediction of regression from IFG. This cohort study consisted of 1197 primary care patients with IFG. These subjects were invited to repeat a FPG test and 75-g 2-hour oral glucose tolerance test (2h-OGTT) to determine the glycaemia change. Normoglycaemia was defined as FPG <5.6 mmol/L and 2h-OGTT <7.8 mmol/L. Stepwise logistic regression model was developed to predict the regression to normoglycaemia with non-invasive variables, using a randomly selected training dataset (810 subjects). The model was validated on the remaining testing dataset (387 subjects). Area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow test were used to evaluate discrimination and calibration of the model. A nomogram was constructed based on the model. After a mean follow-up period of 6.1 months, 180 subjects (15.0%) had normoglycaemia based on the repeated FPG and 2h-OGTT results at follow-up. Subjects without central obesity or hypertension, with moderate-to-high-level physical activity and a lower baseline FPG level, were more likely to regress to normoglycaemia. The prediction model had acceptable discrimination (AUC = 0.705) and calibration (P = 0.840). The simple-to-use nomogram could facilitate identification of subjects with low risk of progression to DM and thus aid in clinical decision making and resource prioritization in the primary care setting. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Detection of impaired IgG antibody formation facilitates the decision on early immunoglobulin replacement in hypogammaglobulinemic patients

    Directory of Open Access Journals (Sweden)

    Hermann Maximilian Wolf

    2015-02-01

    Full Text Available Hypogammaglobulinemia (serum IgG lower than 2SD below the age-matched mean and clinical symptoms such as increased susceptibility to infection, autoimmune manifestations, granulomatous disease, unexplained polyclonal lymphoproliferation are considered to be diagnostic hallmarks in patients with common variable immunodeficiency (CVID, the most frequent clinically severe primary immunodeficiency syndrome. In the present study we investigated patients with hypogammaglobulinemia and no clinical or immunological signs of defective cell-mediated immunity and differentiated two groups on the basis of their IgG antibody formation capacity against a variety of different antigens (bacterial toxins, polysaccharide antigens, viral antigens. Patients with hypogammaglobulinemia and intact antibody production (HIAP displayed no or only mild susceptibility to infections, while CVID patients showed marked susceptibility to bacterial infections that normalized following initiation of IVIG or SCIG replacement therapy. There was a substantial overlap in IgG serum levels between the asymptomatic HIAP group and the CVID patients examined before immunoglobulin treatment. HIAP patients showed normal levels of switched B memory cells (CD19+CD27+IgD-, while both decreased and normal levels of switched B memory cells could be found in CVID patients. IgG antibody response to a primary antigen, tick borne encephalitis virus (TBEV, was defective in CVID patients, thus confirming their substantial defect in IgG antibody production. Defective IgG antibody production against multiple antigens could also be demonstrated in an adult patient with recurrent infections but normal IgG levels. To facilitate early treatment before recurrent infections may lead to organ damage the antibody formation capacity should be examined in hypogammaglobulinemic patients and the decision to treat should be based on the finding of impaired IgG antibody production.

  19. Supporting shared decision-making for older people with multiple health and social care needs: a protocol for a realist synthesis to inform integrated care models.

    Science.gov (United States)

    Bunn, Frances; Goodman, Claire; Manthorpe, Jill; Durand, Marie-Anne; Hodkinson, Isabel; Rait, Greta; Millac, Paul; Davies, Sue L; Russell, Bridget; Wilson, Patricia

    2017-02-07

    Including the patient or user perspective is a central organising principle of integrated care. Moreover, there is increasing recognition of the importance of strengthening relationships among patients, carers and practitioners, particularly for individuals receiving substantial health and care support, such as those with long-term or multiple conditions. The overall aims of this synthesis are to provide a context-relevant understanding of how models to facilitate shared decision-making (SDM) might work for older people with multiple health and care needs, and how they might be applied to integrated care models. The synthesis draws on the principles of realist inquiry, to explain how, in what contexts and for whom, interventions that aim to strengthen SDM among older patients, carers and practitioners are effective. We will use an iterative, stakeholder-driven, three-phase approach. Phase 1: development of programme theory/theories that will be tested through a first scoping of the literature and consultation with key stakeholder groups; phase 2: systematic searches of the evidence to test and develop the theories identified in phase 1; phase 3: validation of programme theory/theories with a purposive sample of participants from phase 1. The synthesis will draw on prevailing theories such as candidacy, self-efficacy, personalisation and coproduction. Ethics approval for the stakeholder interviews was obtained from the University of Hertfordshire ECDA (Ethics Committee with Delegated Authority), reference number HSK/SF/UH/02387. The propositions arising from this review will be used to develop recommendations about how to tailor SDM interventions to older people with complex health and social care needs in an integrated care setting. 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/.

  20. Supporting shared decision-making for older people with multiple health and social care needs: a protocol for a realist synthesis to inform integrated care models

    Science.gov (United States)

    Bunn, Frances; Goodman, Claire; Manthorpe, Jill; Durand, Marie-Anne; Hodkinson, Isabel; Rait, Greta; Millac, Paul; Davies, Sue L; Russell, Bridget; Wilson, Patricia

    2017-01-01

    Introduction Including the patient or user perspective is a central organising principle of integrated care. Moreover, there is increasing recognition of the importance of strengthening relationships among patients, carers and practitioners, particularly for individuals receiving substantial health and care support, such as those with long-term or multiple conditions. The overall aims of this synthesis are to provide a context-relevant understanding of how models to facilitate shared decision-making (SDM) might work for older people with multiple health and care needs, and how they might be applied to integrated care models. Methods and analysis The synthesis draws on the principles of realist inquiry, to explain how, in what contexts and for whom, interventions that aim to strengthen SDM among older patients, carers and practitioners are effective. We will use an iterative, stakeholder-driven, three-phase approach. Phase 1: development of programme theory/theories that will be tested through a first scoping of the literature and consultation with key stakeholder groups; phase 2: systematic searches of the evidence to test and develop the theories identified in phase 1; phase 3: validation of programme theory/theories with a purposive sample of participants from phase 1. The synthesis will draw on prevailing theories such as candidacy, self-efficacy, personalisation and coproduction. Ethics and dissemination Ethics approval for the stakeholder interviews was obtained from the University of Hertfordshire ECDA (Ethics Committee with Delegated Authority), reference number HSK/SF/UH/02387. The propositions arising from this review will be used to develop recommendations about how to tailor SDM interventions to older people with complex health and social care needs in an integrated care setting. PMID:28174225

  1. Self-management and Shared Decision-Making in Alcohol Dependence via a Mobile App: a Pilot Study.

    Science.gov (United States)

    Barrio, Pablo; Ortega, Lluisa; López, Hugo; Gual, Antoni

    2017-02-24

    Mobile applications (apps) have created new opportunities in the field of alcohol dependence (AD) within new paradigms of shared decision-making and self-management. The aim of this study is to report the results of a pilot study testing the usability of and satisfaction with a mobile app (called SIDEAL) in AD patients. Adult AD outpatients were included. SIDEAL was installed on patients' personal phones. The Timeline Followback (TLFB) method for the preceding 6 weeks was administered both at baseline and after 6 weeks (end of the study). Self-reports from the app were also assessed at the end of the study and compared to data provided by the TLFB. An online questionnaire about usability and satisfaction was administered to participants after completion of the study. Exploratory efficacy analyses were conducted. Twenty-four patients were included (mean age 48 years (SD 11.3), women 50%). Most patients (22/24) selected a goal to reduce their consumption. Patients used the self-register module of the app for an average of 80% of the study days. The consumption and medication self-register modules were the most valued, as along with the weekly feedback provided by the app about participants' weekly rate of usage. Participants' satisfaction with the app was high. Significant reductions were observed in alcohol consumption (binge drinking days in the last 6 weeks declined from 25 (SD 18.6) to 5.8 (SD 8), p app by AD patients that could improve their efficacy in managing their AD. Further larger, randomized studies are warranted.

  2. Shared decision-making behaviours in health professionals: a systematic review of studies based on the Theory of Planned Behaviour.

    Science.gov (United States)

    Thompson-Leduc, Philippe; Clayman, Marla L; Turcotte, Stéphane; Légaré, France

    2015-10-01

    Shared decision making (SDM) requires health professionals to change their practice. Socio-cognitive theories, such as the Theory of Planned Behaviour (TPB), provide the needed theoretical underpinnings for designing behaviour change interventions. We systematically reviewed studies that used the TPB to assess SDM behaviours in health professionals to explore how theory is being used to explain influences on SDM intentions and/or behaviours, and which construct is identified as most influential. We searched PsycINFO, MEDLINE, EMBASE, CINAHL, Index to theses, Proquest dissertations and Current Contents for all years up to April 2012. We included all studies in French or English that used the TPB and related socio-cognitive theories to assess SDM behavioural intentions or behaviours in health professionals. We used Makoul & Clayman's integrative SDM model to identify SDM behaviours. We extracted study characteristics, nature of the socio-cognitive theory, SDM behaviour, and theory-based determinants of the SDM behavioural intention or behaviour. We computed simple frequency counts. Of 12,388 titles, we assessed 136 full-text articles for eligibility. We kept 20 eligible studies, all published in English between 1996 and 2012. Studies were conducted in Canada (n = 8), the USA (n = 6), the Netherlands (n = 3), the United Kingdom (n = 2) and Australia (n = 1). The determinant most frequently and significantly associated with intention was the subjective norm (n = 15/21 analyses). There was great variance in the way socio-cognitive theories predicted SDM intention and/or behaviour, but frequency of significance indicated that subjective norm was most influential. © 2014 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  3. The potential use of decision analysis to support shared decision making in the face of uncertainty: the example of atrial fibrillation and warfarin anticoagulation.

    Science.gov (United States)

    Robinson, A; Thomson, R G

    2000-12-01

    The quality of patient care is dependent upon the quality of the multitude of decisions that are made daily in clinical practice. Increasingly, modern health care is seeking to pursue better decisions (including an emphasis on evidence-based practice) and to engage patients more in decisions on their care. However, many treatment decisions are made in the face of clinical uncertainty and may be critically dependent upon patient preferences. This has led to attempts to develop decision support tools that enable patients and clinicians to make better decisions. One approach that may be of value is decision analysis, which seeks to create a rational framework for evaluating complex medical decisions and to provide a systematic way of integrating potential outcomes with probabilistic information such as that generated by randomised controlled trials of interventions. This paper describes decision analysis and discusses the potential of this approach with reference to the clinical decision as to whether to treat patients in atrial fibrillation with warfarin to reduce their risk of stroke.

  4. An evaluation of two interventions to enhance patient-physician communication using the observer OPTION(5) measure of shared decision making.

    Science.gov (United States)

    Dillon, Ellis C; Stults, Cheryl D; Wilson, Caroline; Chuang, Judith; Meehan, Amy; Li, Martina; Elwyn, Glyn; Frosch, Dominick L; Yu, Edward; Tai-Seale, Ming

    2017-10-01

    Evaluate interventions to enhance patient-physician communication and shared decision making (SDM). We used Observer OPTION(5) to evaluate primary care visits within a cluster randomized controlled trial in a California delivery organization. Trial interventions included Open Communication (OpenComm), combining patient activation and physician coaching, and AskShareKnow, a patient activation tool, and were compared to a usual care arm. Scores were analyzed with descriptive statistics and generalized estimating equation analysis for 40 visits containing 200 decision topics. The mean overall OPTION(5) score was 26.5 out of 100 (s.d.=15.2). Compared to visits in the usual care arm, OpenComm visits had higher mean item scores (0-4 scale) for eliciting (mean=1.0 vs 0.8) and integrating patient preferences (mean=1.0 vs 0.8). OpenComm and AskShareKnow visits had higher scores for presenting options (mean=1.5, 1.5 vs 1.3). AskShareKnow visits had higher scores for discussing pros/cons (mean=1.5 vs 1.1). Lower patient education attainment was associated with lower scores. OpenComm and AskShareKnow were associated with improved SDM relative to usual care. Results suggest targeting patient and physician behaviors promotes SDM better than patient activation only. Improving SDM for less educated patients is crucial. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. An Open Computing Infrastructure that Facilitates Integrated Product and Process Development from a Decision-Based Perspective

    Science.gov (United States)

    Hale, Mark A.

    1996-01-01

    Computer applications for design have evolved rapidly over the past several decades, and significant payoffs are being achieved by organizations through reductions in design cycle times. These applications are overwhelmed by the requirements imposed during complex, open engineering systems design. Organizations are faced with a number of different methodologies, numerous legacy disciplinary tools, and a very large amount of data. Yet they are also faced with few interdisciplinary tools for design collaboration or methods for achieving the revolutionary product designs required to maintain a competitive advantage in the future. These organizations are looking for a software infrastructure that integrates current corporate design practices with newer simulation and solution techniques. Such an infrastructure must be robust to changes in both corporate needs and enabling technologies. In addition, this infrastructure must be user-friendly, modular and scalable. This need is the motivation for the research described in this dissertation. The research is focused on the development of an open computing infrastructure that facilitates product and process design. In addition, this research explicitly deals with human interactions during design through a model that focuses on the role of a designer as that of decision-maker. The research perspective here is taken from that of design as a discipline with a focus on Decision-Based Design, Theory of Languages, Information Science, and Integration Technology. Given this background, a Model of IPPD is developed and implemented along the lines of a traditional experimental procedure: with the steps of establishing context, formalizing a theory, building an apparatus, conducting an experiment, reviewing results, and providing recommendations. Based on this Model, Design Processes and Specification can be explored in a structured and implementable architecture. An architecture for exploring design called DREAMS (Developing Robust

  6. Uncovering Barriers to Teaching Assistants (TAs) Implementing Inquiry Teaching: Inconsistent Facilitation Techniques, Student Resistance, and Reluctance to Share Control over Learning with Students †

    Science.gov (United States)

    Gormally, Cara; Sullivan, Carol Subiño; Szeinbaum, Nadia

    2016-01-01

    Inquiry-based teaching approaches are increasingly being adopted in biology laboratories. Yet teaching assistants (TAs), often novice teachers, teach the majority of laboratory courses in US research universities. This study analyzed the perspectives of TAs and their students and used classroom observations to uncover challenges faced by TAs during their first year of inquiry-based teaching. Our study revealed three insights about barriers to effective inquiry teaching practices: 1) TAs lack sufficient facilitation skills; 2) TAs struggle to share control over learning with students as they reconcile long-standing teaching beliefs with newly learned approaches, consequently undermining their fledgling ability to use inquiry approaches; and 3) student evaluations reinforce teacher-centered behaviors as TAs receive positive feedback conflicting with inquiry approaches. We make recommendations, including changing instructional feedback to focus on learner-centered teaching practices. We urge TA mentors to engage TAs in discussions to uncover teaching beliefs underlying teaching choices and support TAs through targeted feedback and practice. PMID:27158302

  7. Uncovering Barriers to Teaching Assistants (TAs Implementing Inquiry Teaching: Inconsistent Facilitation Techniques, Student Resistance, and Reluctance to Share Control over Learning with Students

    Directory of Open Access Journals (Sweden)

    Cara Gormally

    2016-05-01

    Full Text Available Inquiry-based teaching approaches are increasingly being adopted in biology laboratories. Yet teaching assistants (TAs, often novice teachers, teach the majority of laboratory courses in US research universities. This study analyzed the perspectives of TAs and their students and used classroom observations to uncover challenges faced by TAs during their first year of inquiry-based teaching. Our study revealed three insights about barriers to effective inquiry teaching practices: 1 TAs lack sufficient facilitation skills; 2 TAs struggle to share control over learning with students as they reconcile long-standing teaching beliefs with newly learned approaches, consequently undermining their fledgling ability to use inquiry approaches; and 3 student evaluations reinforce teacher-centered behaviors as TAs receive positive feedback conflicting with inquiry approaches. We make recommendations, including changing instructional feedback to focus on learner-centered teaching practices. We urge TA mentors to engage TAs in discussions to uncover teaching beliefs underlying teaching choices and support TAs through targeted feedback and practice.

  8. Uncovering Barriers to Teaching Assistants (TAs) Implementing Inquiry Teaching: Inconsistent Facilitation Techniques, Student Resistance, and Reluctance to Share Control over Learning with Students.

    Science.gov (United States)

    Gormally, Cara; Sullivan, Carol Subiño; Szeinbaum, Nadia

    2016-05-01

    Inquiry-based teaching approaches are increasingly being adopted in biology laboratories. Yet teaching assistants (TAs), often novice teachers, teach the majority of laboratory courses in US research universities. This study analyzed the perspectives of TAs and their students and used classroom observations to uncover challenges faced by TAs during their first year of inquiry-based teaching. Our study revealed three insights about barriers to effective inquiry teaching practices: 1) TAs lack sufficient facilitation skills; 2) TAs struggle to share control over learning with students as they reconcile long-standing teaching beliefs with newly learned approaches, consequently undermining their fledgling ability to use inquiry approaches; and 3) student evaluations reinforce teacher-centered behaviors as TAs receive positive feedback conflicting with inquiry approaches. We make recommendations, including changing instructional feedback to focus on learner-centered teaching practices. We urge TA mentors to engage TAs in discussions to uncover teaching beliefs underlying teaching choices and support TAs through targeted feedback and practice.

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

    Science.gov (United States)

    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

  10. Service innovation in glaucoma management: using a Web-based electronic patient record to facilitate virtual specialist supervision of a shared care glaucoma programme.

    Science.gov (United States)

    Wright, Heathcote R; Diamond, Jeremy P

    2015-03-01

    To assess the importance of specialist supervision in a new model of glaucoma service delivery. An optometrist supported by three technicians managed each glaucoma clinic. Patients underwent testing and clinical examination before the optometrist triaged them into one of five groups: 'normal', 'stable', 'low risk', 'unstable' and 'high risk'. Patient data were uploaded to an electronic medical record to facilitate virtual review by a glaucoma specialist. 24 257 glaucoma reviews at three glaucoma clinics during a 31-month period were analysed. The clinic optometrists and glaucoma specialists had substantial agreement (κ 0.69). 13 patients were identified to be high risk by the glaucoma specialist that had not been identified as such by the optometrist. Glaucoma specialists amended 13% of the optometrists' interim decisions resulting in an overall reduction in review appointments by 2.4%. Employing technicians and optometrists to triage glaucoma patients into groups defined by risk of blindness allows higher risk patients to be directed to a glaucoma specialist. Virtual review allows the glaucoma specialist to remain in overall control while reducing the risk that patients are treated or followed-up unnecessarily. Demand for glaucoma appointments can be reduced allowing scarce medical resources to be directed to patients most in need. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  11. Do not attempt cardiopulmonary resuscitation (DNACPR) orders: a systematic review of the barriers and facilitators of decision-making and implementation.

    Science.gov (United States)

    Mockford, Carole; Fritz, Zoë; George, Rob; Court, Rachel; Grove, Amy; Clarke, Ben; Field, Richard; Perkins, Gavin D

    2015-03-01

    Most people who die in hospital do so with a DNACPR order in place, these orders are the focus of considerable debate. To identify factors, facilitators and barriers involved in DNACPR decision-making and implementation. All study designs and interventions were eligible for inclusion. Studies were appraised guided by CASP tools. A qualitative analysis was undertaken. Included electronic databases: Medline, Embase, ASSIA, Cochrane library, CINAHL, PsycINFO, Web of Science, the King's Fund Library and scanning reference lists of included studies. Four key themes were identified: Considering the decision - by senior physicians, nursing staff, patients and relatives. Key triggers included older age, co-morbidities, adverse prognostic factors, quality of life and the likelihood of success of CPR. Discussing the decision - levels, and combinations, of physician and nursing skills, patient understanding and family involvement produced various outcomes. Implementing the decision - the lack of clear documentation resulted in a breakdown in communications within health teams. Staff knowledge and support of guidelines and local policies varied. Consequences of a DNACPR decision - inadequate understanding by staff resulted in suboptimal care, and incorrect withdrawal of treatment. Significant variability was identified in DNACPR decision-making and implementation. The evidence base is weak but the absence of evidence does not indicate an absence of good practice. Issues are complex, and dependent on a number of factors. Misunderstandings and poor discussions can be overcome such as with an overall care plan to facilitate discussions and reduce negative impact of DNACPR orders on aspects of patient care. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  12. Promoting Shared Decision Making to strengthen outcome of young children with Autism Spectrum Disorders: the role of staff competence.

    Science.gov (United States)

    Strauss, Kristin; Benvenuto, Arianna; Battan, Barbara; Siracusano, Martina; Terribili, Monica; Curatolo, Paolo; Fava, Leonardo

    2015-03-01

    Little is known on how the conceptual description of Shared Decision Making (SDM) accomplishes clinical practice in the context of lifetime disabilities as in particular Autism Spectrum Disorders (ASD), when intervention is long-lasting and requires constant family involvement. This study aimed mainly to investigate to what extent the staff's competence in SDM contributes to positive child and parent improvement when involving parents in Early Intensive Behavior Interventions (EIBI). It was also geared to verify whether SDM staff competence contributes to a child's treatment responsiveness. A total of 25 young children with ASD (23 male, 3 female, age range 34-92 months, mean age 51.4±13.6) were included in the study. Of these, nine children were allocated to a Parent Involvement condition accompanied by SDM Staff Training (PI-SDM), and eight children to a Parent Inclusion in Treatment Delivery Only condition without SDM Staff Training (PI-DO). Nine months treatment outcomes of severity, developmental and adaptive measures were compared to Treatment As Usual (n=8). PI-SDM was associated with improvement of autistic symptoms (p≤.05), adaptive functioning (p≤.01) and developmental outcome (p≤.01), as well as parent (p≤.05) and staff competence (p≤.001). The magnitude of outcome was inferior in the PI-PO and TAU group. A Reliable Change was identified in more than 40% of children included in PI-SDM, while PI-PO (>20%) and TAU (>12%) let to little Reliable Change and partially skill deterioration. Staff's SDM skill competence predicts reduced parental stress (β=-.500, p≤.05) and contributes significantly to a positive treatment responder trajectory (p≤.01), besides lower severity (p≤.05), higher adaptive (p≤.01) and communication skills (p≤.05). The study indicates that parent inclusion should be conceptualized as a collaborative partnership model rather than as adherence in treatment provision, based on a target SDM staff training that may

  13. Shared decision making for prostate cancer screening: the results of a combined analysis of two practice-based randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Sheridan Stacey L

    2012-11-01

    Full Text Available Abstract Background Professional societies recommend shared decision making (SDM for prostate cancer screening, however, most efforts have promoted informed rather than shared decision making. The objective of this study is to 1 examine the effects of a prostate cancer screening intervention to promote SDM and 2 determine whether framing prostate information in the context of other clearly beneficial men’s health services affects decisions. Methods We conducted two separate randomized controlled trials of the same prostate cancer intervention (with or without additional information on more clearly beneficial men’s health services. For each trial, we enrolled a convenience sample of 2 internal medicine practices, and their interested physicians and male patients with no prior history of prostate cancer (for a total of 4 practices, 28 physicians, and 128 men across trials. Within each practice site, we randomized men to either 1 a video-based decision aid and researcher-led coaching session or 2 a highway safety video. Physicians at each site received a 1-hour educational session on prostate cancer and SDM. To assess intervention effects, we measured key components of SDM, intent to be screened, and actual screening. After finding that results did not vary by trial, we combined data across sites, adjusting for the random effects of both practice and physician. Results Compared to an attention control, our prostate cancer screening intervention increased men’s perceptions that screening is a decision (absolute difference +41%; 95% CI 25 to 57% and men’s knowledge about prostate cancer screening (absolute difference +34%; 95% CI 19% to 50%, but had no effect on men’s self-reported participation in shared decisions or their participation at their preferred level. Overall, the intervention decreased screening intent (absolute difference −34%; 95% CI −50% to −18% and actual screening rates (absolute difference −22%; 95% CI −38 to

  14. How Does a Shared Decision-Making (SDM) Intervention for Oncologists Affect Participation Style and Preference Matching in Patients with Breast and Colon Cancer?

    Science.gov (United States)

    Bieber, Christiane; Nicolai, Jennifer; Gschwendtner, Kathrin; Müller, Nicole; Reuter, Katrin; Buchholz, Angela; Kallinowski, Birgit; Härter, Martin; Eich, Wolfgang

    2016-12-13

    The aims of this study are to assess patients' preferred and perceived decision-making roles and preference matching in a sample of German breast and colon cancer patients and to investigate how a shared decision-making (SDM) intervention for oncologists influences patients' preferred and perceived decision-making roles and the attainment of preference matches. This study is a post hoc analysis of a randomised controlled trial (RCT) on the effects of an SDM intervention. The SDM intervention was a 12-h SDM training program for physicians in combination with decision board use. For this study, we analysed a subgroup of 107 breast and colon cancer patients faced with serious treatment decisions who provided data on specific questionnaires with regard to their preferred and perceived decision-making roles (passive, SDM or active). Patients filled in questionnaires immediately following a decision-relevant consultation (t1) with their oncologist. Eleven of these patients' 27 treating oncologists had received the SDM intervention within the RCT. A majority of cancer patients (60%) preferred SDM. A match between preferred and perceived decision-making roles was reached for 72% of patients. The patients treated by SDM-trained physicians perceived greater autonomy in their decision making (p < 0.05) with more patients perceiving SDM or an active role, but their preference matching was not influenced. A SDM intervention for oncologists boosted patient autonomy but did not improve preference matching. This highlights the already well-known reluctance of physicians to engage in explicit role clarification.

  15. Using GTO-Velo to Facilitate Communication and Sharing of Simulation Results in Support of the Geothermal Technologies Office Code Comparison Study

    Energy Technology Data Exchange (ETDEWEB)

    White, Signe K.; Purohit, Sumit; Boyd, Lauren W.

    2015-01-26

    defined, the problem creator can provide a description using a template on the metadata page corresponding to the benchmark problem folder. Project documents, references and videos of the weekly online meetings are shared via GTO-Velo. A results comparison tool allows users to plot their uploaded simulation results on the fly, along with those of other teams, to facilitate weekly discussions of the benchmark problem results being generated by the teams. GTO-Velo is an invaluable tool providing the project coordinators and team members with a framework for collaboration among geographically dispersed organizations.

  16. User-Centered Design, Experience, and Usability of an Electronic Consent User Interface to Facilitate Informed Decision-Making in a HIV Clinic.

    Science.gov (United States)

    Ramos, S Raquel

    2017-05-05

    Health information exchange is the electronic accessibility and transferability of patient medical records across various healthcare settings and providers. In some states, patients have to formally give consent to allow their medical records to be electronically shared. The purpose of this study was to apply a novel user-centered, multistep, multiframework approach to design and test an electronic consent user interface, so patients with HIV can make more informed decisions about electronically sharing their health information. This study consisted of two steps. Step 1 was a cross-sectional, descriptive, qualitative study that used user-centric design interviews to create the user interface. This informed Step 2. Step 2 consisted of a one group posttest to examine perceptions of usefulness, ease of use, preference, and comprehension of a health information exchange electronic consent user interface. More than half of the study population had college experience, but challenges remained with overall comprehension regarding consent. The user interface was not independently successful, suggesting that in addition to an electronic consent user interface, human interaction may also be necessary to address the complexities associated with consenting to electronically share medical records. Comprehension is key factor in the ability to make informed decisions.

  17. Psychometric properties of the SDM-Q-9 questionnaire for shared decision-making in multiple sclerosis: item response theory modelling and confirmatory factor analysis.

    Science.gov (United States)

    Ballesteros, Javier; Moral, Ester; Brieva, Luis; Ruiz-Beato, Elena; Prefasi, Daniel; Maurino, Jorge

    2017-04-22

    Shared decision-making is a cornerstone of patient-centred care. The 9-item Shared Decision-Making Questionnaire (SDM-Q-9) is a brief self-assessment tool for measuring patients' perceived level of involvement in decision-making related to their own treatment and care. Information related to the psychometric properties of the SDM-Q-9 for multiple sclerosis (MS) patients is limited. The objective of this study was to assess the performance of the items composing the SDM-Q-9 and its dimensional structure in patients with relapsing-remitting MS. A non-interventional, cross-sectional study in adult patients with relapsing-remitting MS was conducted in 17 MS units throughout Spain. A nonparametric item response theory (IRT) analysis was used to assess the latent construct and dimensional structure underlying the observed responses. A parametric IRT model, General Partial Credit Model, was fitted to obtain estimates of the relationship between the latent construct and item characteristics. The unidimensionality of the SDM-Q-9 instrument was assessed by confirmatory factor analysis. A total of 221 patients were studied (mean age = 42.1 ± 9.9 years, 68.3% female). Median Expanded Disability Status Scale score was 2.5 ± 1.5. Most patients reported taking part in each step of the decision-making process. Internal reliability of the instrument was high (Cronbach's α = 0.91) and the overall scale scalability score was 0.57, indicative of a strong scale. All items, except for the item 1, showed scalability indices higher than 0.30. Four items (items 6 through to 9) conveyed more than half of the SDM-Q-9 overall information (67.3%). The SDM-Q-9 was a good fit for a unidimensional latent structure (comparative fit index = 0.98, root-mean-square error of approximation = 0.07). All freely estimated parameters were statistically significant (P 0.40) with the exception of item 1 which presented the lowest loading (0.26). Items 6 through to 8 were the

  18. Memory accessibility and medical decision-making for significant others: the role of socially shared retrieval-induced forgetting.

    Science.gov (United States)

    Coman, Dora; Coman, Alin; Hirst, William

    2013-01-01

    Medical decisions will often entail a broad search for relevant information. No sources alone may offer a complete picture, and many may be selective in their presentation. This selectivity may induce forgetting for previously learned material, thereby adversely affecting medical decision-making. In the study phase of two experiments, participants learned information about a fictitious disease and advantages and disadvantages of four treatment options. In the subsequent practice phase, they read a pamphlet selectively presenting either relevant (Experiment 1) or irrelevant (Experiment 2) advantages or disadvantages. A final cued recall followed and, in Experiment 2, a decision as to the best treatment for a patient. Not only did reading the pamphlet induce forgetting for related and unmentioned information, the induced forgetting adversely affected decision-making. The research provides a cautionary note about the risks of searching through selectively presented information when making a medical decision.

  19. Memory accessibility and medical decision-making for significant others: The role of socially-shared retrieval induced forgetting

    Directory of Open Access Journals (Sweden)

    Dora M Coman

    2013-06-01

    Full Text Available Medical decisions will often entail a broad search for relevant information. No sources alone may offer a complete picture, and many may be selective in their presentation. This selectivity may induce forgetting for previously learned material, thereby adversely affecting medical decision-making. In the study phase of two experiments, participants learned information about a fictitious disease and advantages and disadvantages of four treatment options. In the subsequent practice phase, they read a pamphlet selectively presenting either relevant (Experiment 1 or irrelevant (Experiment 2 advantages or disadvantages. A final cued recall followed and, in Experiment 2, a decision as to the best treatment for a patient. Not only did reading the pamphlet induce forgetting for related and unmentioned information, the induced forgetting adversely affected decision-making. The research provides a cautionary note about the risks of searching through selectively presented information when making a medical decision.

  20. Social acceptability: Towards a definition and shared understanding of its significance and contribution to decision-making

    Energy Technology Data Exchange (ETDEWEB)

    Cote, Gilles; Perusse, Martin

    2010-09-15

    Social acceptability is increasingly described in the discourse of social players as a sine qua non condition for projects to be carried out. It is referred to as an approach (participation in the decision-making process) and as an outcome (citizens' concurrence with the decision). The application of this new concept generated considerable expectations. In our opinion, social acceptability must pass through three complementary stages: i) discussing material (downstream) and structural (upstream) issues; ii) establishing a transparent and equitable consultation process; and iii) ensuring that a legitimate decision-making process occurs.

  1. Life and Death Decisions: Using School-Based Health Education to Facilitate Family Discussion about Organ and Tissue Donation

    Science.gov (United States)

    Waldrop, Deborah P.; Tamburlin, Judith A.; Thompson, Sanna J.; Simon, Mark

    2004-01-01

    Public education that encourages family discussions about organ and tissue donation can enhance understanding, facilitate a donor's wishes and increase the numbers of donations. Action research methods were used to explore the impact of a student-initiated family discussion about donation. Most discussions were positive; only 7% middle school and…

  2. The Role of the European Commission in Co-decision A strategic facilitator operating in a situation of structural disadvantage

    Directory of Open Access Journals (Sweden)

    Anne Rasmussen

    2003-10-01

    Full Text Available The co-decision procedure has had significant implications for the interaction between the EU institutions and has attracted the attention of a series of formal, rational choice institutionalists. However, these have mostly dealt with the Commission in a relatively superficial way and their conclusions about its legislative role have been rather pessimistic. Instead this study examines the role of the Commission in more detail by looking closer at both the formal and informal ways in which the Commission has affected legislation in co-decision from Maastricht to one year after the entering into force of the Amsterdam Treaty. The study includes interview and quantitative data at a general level as well as from three Socrates procedures completed in 1995, 1998, and 2000. In line with the formal, rational choice theorists, the paper notes that the Commissions room for manoeuvre is significantly reduced in co-decision, but it argues that its relative loss of power with the introduction of the procedure should not blur the picture that in absolute terms it is still an important actor in the day-to-day decision-making of the EU.

  3. Facilitating Decision Making, Re-Use and Collaboration: A Knowledge Management Approach for System Self-Awareness

    Science.gov (United States)

    2009-10-01

    Information Systems Experimentation ( DISE ) Group Naval Postgraduate School, Monterey, CA 93943 Keywords: Program self-awareness, decision making...PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Naval Postgraduate School,Distributed Informaiton Systems Experimentation ( DISE ) Group,Monterey,CA,93943...3.1 Apply to Structured Data Each year, the Distributed Information Systems Experimentation ( DISE ) group at the Naval Postgraduate School (NPS

  4. Developing and pre-testing a decision board to facilitate informed choice about delivery approach in uncomplicated pregnancy

    Directory of Open Access Journals (Sweden)

    Wood Stephen

    2009-10-01

    Full Text Available Abstract Background The rate of caesarean sections is increasing worldwide, yet medical literature informing women with uncomplicated pregnancies about relative risks and benefits of elective caesarean section (CS compared with vaginal delivery (VD remains scarce. A decision board may address this gap, providing systematic evidence-based information so that patients can more fully understand their treatment options. The objective of our study was to design and pre-test a decision board to guide clinical discussions and enhance informed decision-making related to delivery approach (CS or VD in uncomplicated pregnancy. Methods Development of the decision board involved two preliminary studies to determine women's preferred mode of risk presentation and a systematic literature review for the most comprehensive presentation of medical risks at the time (VD and CS. Forty women were recruited to pre-test the tool. Eligible subjects were of childbearing age (18-40 years but were not pregnant in order to avoid raising the expectation among pregnant women that CS was a universally available birth option. Women selected their preferred delivery approach and completed the Decisional Conflict Scale to measure decisional uncertainty before and after reviewing the decision board. They also answered open-ended questions reflecting what they had learned, whether or not the information had helped them to choose between birth methods, and additional information that should be included. Descriptive statistics were used to analyse sample characteristics and women's choice of delivery approach pre/post decision board. Change in decisional conflict was measured using Wilcoxon's sign rank test for each of the three subscales. Results The majority of women reported that they had learned something new (n = 37, 92% and that the tool had helped them make a hypothetical choice between delivery approaches (n = 34, 85%. Women wanted more information about neonatal risks and

  5. Moving toward comprehensive acute heart failure risk assessment in the emergency department: the importance of self-care and shared decision making.

    Science.gov (United States)

    Collins, Sean P; Storrow, Alan B

    2013-08-01

    Nearly 700,000 emergency department (ED) visits were due to acute heart failure (AHF) in 2009. Most visits result in a hospital admission and account for the largest proportion of a projected $70 billion to be spent on heart failure care by 2030. ED-based risk prediction tools in AHF rarely impact disposition decision making. This is a major factor contributing to the 80% admission rate for ED patients with AHF, which has remained unchanged over the last several years. Self-care behaviors such as symptom monitoring, medication taking, dietary adherence, and exercise have been associated with decreased hospital readmissions, yet self-care remains largely unaddressed in ED patients with AHF and thus represents a significant lost opportunity to improve patient care and decrease ED visits and hospitalizations. Furthermore, shared decision making encourages collaborative interaction between patients, caregivers, and providers to drive a care path based on mutual agreement. The observation that “difficult decisions now will simplify difficult decisions later” has particular relevance to the ED, given this is the venue for many such issues. We hypothesize patients as complex and heterogeneous as ED patients with AHF may need both an objective evaluation of physiologic risk as well as an evaluation of barriers to ideal self-care, along with strategies to overcome these barriers. Combining physician gestalt, physiologic risk prediction instruments, an evaluation of self-care, and an information exchange between patient and provider using shared decision making may provide the critical inertia necessary to discharge patients home after a brief ED evaluation.

  6. Facilitating the use of evidence for decision-making – a review of 64 WHO Health Evidence Network synthesis reports and its impact

    DEFF Research Database (Denmark)

    Nguen, Tim; Takahashi, Ryoko; Kuchenmueller, Tanja;

    in selecting an appropriate literature search and synthesis method and writing specifically for policy-makers in mind. To facilitate the uptake of evidence in policy-making, HEN collaborates with decision-makers in identifying priority health policy areas, framing a synthesis question and disseminating......The stakes of producing evidence-informed policies are high when available evidence is abundant yet often not applicable and useful to policy-makers. The literature indicates that policy-makers need summaries of evidence with policy options and implications that are timely and relevant to health...

  7. Family Group Decision Making (FGDM) with Lakota families in two tribal communities: tools to facilitate FGDM implementation and evaluation.

    Science.gov (United States)

    Marcynyszyn, Lyscha A; Bear, Pete Small; Geary, Erin; Conti, Russ; Pecora, Peter J; Day, Priscilla A; Wilson, Stephen T

    2012-01-01

    This article describes an adapted Family Group Decision Making (FGDM) practice model for Native American communities, the FGDM family and community engagement process, and FGDM evaluation tools as one example for other native communities. Challenges and successes associated with the implementation and evaluation of these meetings are also described in the context of key historical and cultural factors, such as intergenerational grief and trauma, as well as past misuse of data in native communities.

  8. To Give or Not to Give: Children's and Adolescents' Sharing and Moral Negotiations in Economic Decision Situations

    Science.gov (United States)

    Gummerum, Michaela; Keller, Monika; Takezawa, Masanori; Mata, Jutta

    2008-01-01

    This study interconnects developmental psychology of fair and moral behavior with economic game theory. One hundred eighty-nine 9- to 17-year-old students shared a sum of money as individuals and groups with another anonymous group (dictator game). Individual allocations did not differ by age but did by gender and were predicted by participants'…

  9. [Value-based cancer care. From traditional evidence-based decision making to balanced decision making within frameworks of shared values].

    Science.gov (United States)

    Palazzo, Salvatore; Filice, Aldo; Mastroianni, Candida; Biamonte, Rosalbino; Conforti, Serafino; Liguori, Virginia; Turano, Salvatore; De Simone, Rosanna; Rovito, Antonio; Manfredi, Caterina; Minardi, Stefano; Vilardo, Emmanuelle; Loizzo, Monica; Oriolo, Carmela

    2016-04-01

    Clinical decision making in oncology is based so far on the evidence of efficacy from high-quality clinical research. Data collection and analysis from experimental studies provide valuable insight into response rates and progression-free or overall survival. Data processing generates valuable information for medical professionals involved in cancer patient care, enabling them to make objective and unbiased choices. The increased attention of many scientific associations toward a more rational resource consumption in clinical decision making is mirrored in the Choosing Wisely campaign against the overuse or misuse of exams and procedures of little or no benefit for the patient. This cultural movement has been actively promoting care solutions based on the concept of "value". As a result, the value-based decision-making process for cancer care should not be dissociated from economic sustainability and from ethics of the affordability, also given the growing average cost of the most recent cancer drugs. In support of this orientation, the National Comprehensive Cancer Network (NCCN) has developed innovative and "complex" guidelines based on values, defined as "evidence blocks", with the aim of assisting the medical community in making overall sustainable choices.

  10. What Patients With Severe Mental Illness Transitioning From Hospital to Community Have to Say About Care and Shared Decision-Making.

    Science.gov (United States)

    Velligan, Dawn I; Roberts, David L; Sierra, Cynthia; Fredrick, Megan M; Roach, Mary Jo

    2016-06-01

    Shared decision-making (SDM) has been slow to disseminate in mental health. We conducted focus groups with ten individuals with serious mental illness (SMI) treated in a 90 day, outpatient transitional care clinic. Parallel groups were held with family caregivers (n = 8). Individuals with SMI wanted longer visits, to have their stories heard, more information about options presented simply, to hear from peers about similar experiences, and a bigger say in treatment choices. Caregivers wanted to be invited to participate to a larger extent.  Results suggest that after a decade, SDM may not have the expected penetration in community mental health.

  11. European and U.S. Perspectives on the Sharing and Integration of Weather Information into ATM Decisions

    Science.gov (United States)

    2011-02-10

    is provide the mechanisms to nddress ullcertainty in decision making processes. It is accepted that a transat lan tic fli ght approaching the outer...standards, such as the spatial data standards supported by the International Standardization Organization USO ) or the Open Geospatial Consortium

  12. Shared Attention.

    Science.gov (United States)

    Shteynberg, Garriy

    2015-09-01

    Shared attention is extremely common. In stadiums, public squares, and private living rooms, people attend to the world with others. Humans do so across all sensory modalities-sharing the sights, sounds, tastes, smells, and textures of everyday life with one another. The potential for attending with others has grown considerably with the emergence of mass media technologies, which allow for the sharing of attention in the absence of physical co-presence. In the last several years, studies have begun to outline the conditions under which attending together is consequential for human memory, motivation, judgment, emotion, and behavior. Here, I advance a psychological theory of shared attention, defining its properties as a mental state and outlining its cognitive, affective, and behavioral consequences. I review empirical findings that are uniquely predicted by shared-attention theory and discuss the possibility of integrating shared-attention, social-facilitation, and social-loafing perspectives. Finally, I reflect on what shared-attention theory implies for living in the digital world.

  13. Use of a knowledge synthesis by decision makers and planners to facilitate system level integration in a large Canadian provincial health authority

    Directory of Open Access Journals (Sweden)

    Esther Suter

    2011-03-01

    Full Text Available Purpose: The study is an examination of how a knowledge synthesis, conducted to fill an information gap identified by decision makers and planners responsible for integrating health systems in a western Canadian health authority, is being used within that organisation. Methods: Purposive sampling and snowball technique were used to identify 13 participants who were interviewed about how they are using the knowledge synthesis for health services planning and decision-making. Results: The knowledge synthesis is used by those involved in the strategic direction of the provincial healthcare organisation and those tasked with the operationalization of integration at the provincial or local level. Both groups most frequently use the ten key principles for integration, followed by the sections on integration processes, strategies and models. The key principles facilitate discussion on priority areas to be considered and provide a reference point for a desired future state. Perceived information gaps relate to a lack of detail on "how to" strategies, tools and processes that would lead to successful integration. Discussion and conclusion: The current project demonstrates that decision makers and planners will effectively use a knowledge synthesis if it is timely, relevant and accessible. The information can be applied at strategic and operations levels. Attention needs to be paid to include more information on implementation strategies and processes. Including knowledge users in identifying research questions will increase information uptake.

  14. Use of a knowledge synthesis by decision makers and planners to facilitate system level integration in a large Canadian provincial health authority

    Directory of Open Access Journals (Sweden)

    Esther Suter

    2011-03-01

    Full Text Available Purpose: The study is an examination of how a knowledge synthesis, conducted to fill an information gap identified by decision makers and planners responsible for integrating health systems in a western Canadian health authority, is being used within that organisation.Methods: Purposive sampling and snowball technique were used to identify 13 participants who were interviewed about how they are using the knowledge synthesis for health services planning and decision-making.Results: The knowledge synthesis is used by those involved in the strategic direction of the provincial healthcare organisation and those tasked with the operationalization of integration at the provincial or local level. Both groups most frequently use the ten key principles for integration, followed by the sections on integration processes, strategies and models. The key principles facilitate discussion on priority areas to be considered and provide a reference point for a desired future state. Perceived information gaps relate to a lack of detail on "how to" strategies, tools and processes that would lead to successful integration.Discussion and conclusion: The current project demonstrates that decision makers and planners will effectively use a knowledge synthesis if it is timely, relevant and accessible. The information can be applied at strategic and operations levels. Attention needs to be paid to include more information on implementation strategies and processes. Including knowledge users in identifying research questions will increase information uptake.

  15. Perceived barriers to care and attitudes towards shared decision-making among low socioeconomic status parents: role of health literacy.

    Science.gov (United States)

    Yin, H Shonna; Dreyer, Benard P; Vivar, Karina L; MacFarland, Suzanne; van Schaick, Linda; Mendelsohn, Alan L

    2012-01-01

    Although low parent health literacy (HL) has been linked to poor child health outcomes, it is not known whether differences in perceptions related to access to care and provider-parent partnership in care are potential contributing factors. We sought to assess whether parent HL is associated with differences in perceived barriers to care and attitudes regarding participatory decision-making with the provider. This was a cross-sectional analysis of data collected from parents presenting with their child to an urban public hospital pediatric clinic in New York City. Dependent variables were caregiver-reported barriers to care (ability to reach provider at night/on weekends, difficult travel to clinic) and attitudes towards participatory decision-making (feeling like a partner, relying on doctor's knowledge, leaving decisions up to the doctor, being given choices/asked opinion). The primary independent variable was caregiver HL (Short Test of Functional Health Literacy in Adults [S-TOHFLA]). A total of 823 parents were assessed; 1 in 4 (27.0%) categorized as having low HL. Parents with low HL were more likely to report barriers to care than those with adequate HL: trouble reaching provider nights/weekends, 64.9% vs. 49.6%, (p parent HL may be helpful in ameliorating barriers to care and promoting provider-parent partnership in care. Copyright © 2012 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  16. Pre-consultation educational group intervention to improve shared decision-making in postmastectomy breast reconstruction: study protocol for a pilot randomized controlled trial

    Science.gov (United States)

    2013-01-01

    Background The Pre-Consultation Educational Group Intervention pilot study seeks to assess the feasibility and inform the optimal design for a definitive randomized controlled trial that aims to improve the quality of decision-making in postmastectomy breast reconstruction patients. Methods/design This is a mixed-methods pilot feasibility randomized controlled trial that will follow a single-center, 1:1 allocation, two-arm parallel group superiority design. Setting: The University Health Network, a tertiary care cancer center in Toronto, Canada. Participants: Adult women referred to one of three plastic and reconstructive surgeons for delayed breast reconstruction or prophylactic mastectomy with immediate breast reconstruction. Intervention: We designed a multi-disciplinary educational group workshop that incorporates the key components of shared decision-making, decision-support, and psychosocial support for cancer survivors prior to the initial surgical consult. The intervention consists of didactic lectures by a plastic surgeon and nurse specialist on breast reconstruction choices, pre- and postoperative care; a value-clarification exercise led by a social worker; and discussions with a breast reconstruction patient. Control: Usual care includes access to an informational booklet, website, and patient volunteer if desired. Outcomes: Expected pilot outcomes include feasibility, recruitment, and retention targets. Acceptability of intervention and full trial outcomes will be established through qualitative interviews. Trial outcomes will include decision-quality measures, patient-reported outcomes, and service outcomes, and the treatment effect estimate and variability will be used to inform the sample size calculation for a full trial. Discussion Our pilot study seeks to identify the (1) feasibility, acceptability, and design of a definitive RCT and (2) the optimal content and delivery of our proposed educational group intervention. Thirty patients have been

  17. Impact of a web-based treatment decision aid for early-stage prostate cancer on shared decision-making and health outcomes: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Cuypers, Maarten; Lamers, Romy E D; Kil, Paul J M; van de Poll-Franse, Lonneke V; de Vries, Marieke

    2015-05-27

    At an early stage, prostate cancer patients are often eligible for more than one treatment option, or may choose to defer curative treatment. Without a pre-existing superior option, a patient has to weigh his personal preferences against the risks and benefits of each alternative to select the most appropriate treatment. Given this context, in prostate cancer treatment decision-making, it is particularly suitable to follow the principles of shared decision-making (SDM), especially with the support of specific instruments like decision aids (DAs). Although several alternatives are available, present tools are not sufficiently compatible with routine clinical practice. To overcome existing barriers and to stimulate structural implementation of DAs and SDM in clinical practice, a web-based prostate cancer treatment DA was developed to fit clinical workflow. Following the structure of an existing DA, Dutch content was developed, and values clarification methods (VCMs) were added. The aim of this study is to investigate the effect of this DA on (shared) treatment choice and patient-reported outcomes. Nineteen Dutch hospitals are included in a pragmatic, cluster randomized controlled trial, with an intervention and a control arm. In the intervention group, the DA will be offered after diagnosis, and a summary of the patients' preferences, which were identified with the DA, can be discussed by the patient and his clinician during later consultation. Patients in the control group will receive information and decisional support as usual. Results from both groups on decisional conflict, treatment choice and the experience with involvement in the decision-making process are compared. Patients are requested to fill in questionnaires after treatment decision-making but before treatment is started, and 6 and 12 months later. This will allow the development of treatment satisfaction, decisional regret, and quality of life to be monitored. Clinicians from both groups will evaluate

  18. A web-based collaborative framework for facilitating decision making on a 3D design developing process

    Directory of Open Access Journals (Sweden)

    Purevdorj Nyamsuren

    2015-07-01

    Full Text Available Increased competitive challenges are forcing companies to find better ways to bring their applications to market faster. Distributed development environments can help companies improve their time-to-market by enabling parallel activities. Although, such environments still have their limitations in real-time communication and real-time collaboration during the product development process. This paper describes a web-based collaborative framework which has been developed to support the decision making on a 3D design developing process. The paper describes 3D design file for the discussion that contains all relevant annotations on its surface and their visualization on the user interface for design changing. The framework includes a native CAD data converting module, 3D data based real-time communication module, revision control module for 3D data and some sub-modules such as data storage and data management. We also discuss some raised issues in the project and the steps underway to address them.

  19. Facilitating clinical decision-making about the use of virtual reality within paediatric motor rehabilitation: describing and classifying virtual reality systems.

    Science.gov (United States)

    Galvin, Jane; Levac, Danielle

    2011-01-01

    The use of virtual reality (VR) as a therapeutic intervention to improve motor function is an emerging area of rehabilitation practice and research. This paper describes VR systems reported in research literature and proposes a classification framework that categorizes VR systems according to characteristics relevant to motor rehabilitation. A comprehensive database search was undertaken to explore VR systems used in motor rehabilitation for children. Description of these systems, motor learning literature and expert opinion informed development of a classification framework. Six VR systems are included. The descriptive analysis describes each system according to 12 user, system and context variables. The classification framework identifies three features common to all VR systems. Seven categories are proposed to differentiate between systems. This paper organizes available information to facilitate clinical decision-making about VR systems and identifies areas of research to support the use of VR as a therapeutic intervention.

  20. Health Care Decision Making by the Elderly: I Get by with a Little Help from My Family.

    Science.gov (United States)

    Kapp, Marshall B.

    1991-01-01

    Shared decision making about placement and medical interventions can be empowering to older persons, relieve burdens on older person and family, and facilitate better surrogate decision making later. Potential dangers of shared process include coercion, conflicts of interest, and disagreements between family members. New legal concepts could help…

  1. Comparing Traditional Journal Writing with Journal Writing Shared over E-mail List Serves as Tools for Facilitating Reflective Thinking: A Study of Preservice Teachers

    Science.gov (United States)

    Kaplan, Diane S.; Rupley, William H.; Sparks, Joanne; Holcomb, Angelia

    2007-01-01

    To determine the conditions that would best encourage reflection in journal writing of preservice teachers in field-based reading internships, the degree of reflective content found in self-contained traditional journals was compared to the reflective content found in journal entries shared over e-mail list serves. Participants were 56 preservice…

  2. Barriers and facilitators in the provision of post-abortion care at district level in central Uganda - a qualitative study focusing on task sharing between physicians and midwives.

    Science.gov (United States)

    Paul, Mandira; Gemzell-Danielsson, Kristina; Kiggundu, Charles; Namugenyi, Rebecka; Klingberg-Allvin, Marie

    2014-01-21

    Abortion is restricted in Uganda, and poor access to contraceptive methods result in unwanted pregnancies. This leaves women no other choice than unsafe abortion, thus placing a great burden on the Ugandan health system and making unsafe abortion one of the major contributors to maternal mortality and morbidity in Uganda. The existing sexual and reproductive health policy in Uganda supports the sharing of tasks in post-abortion care. This task sharing is taking place as a pragmatic response to the increased workload. This study aims to explore physicians' and midwives' perception of post-abortion care with regard to professional competences, methods, contraceptive counselling and task shifting/sharing in post-abortion care. In-depth interviews (n = 27) with health care providers of post-abortion care were conducted in seven health facilities in the Central Region of Uganda. The data were organized using thematic analysis with an inductive approach. Post-abortion care was perceived as necessary, albeit controversial and sometimes difficult to provide. Together with poor conditions post-abortion care provoked frustration especially among midwives. Task sharing was generally taking place and midwives were identified as the main providers, although they would rarely have the proper training in post-abortion care. Additionally, midwives were sometimes forced to provide services outside their defined task area, due to the absence of doctors. Different uterine evacuation skills were recognized although few providers knew of misoprostol as a method for post-abortion care. An overall need for further training in post-abortion care was identified. Task sharing is taking place, but providers lack the relevant skills for the provision of quality care. For post-abortion care to improve, task sharing needs to be scaled up and in-service training for both doctors and midwives needs to be provided. Post-abortion care should further be included in the educational curricula of

  3. 3D printing of an aortic aneurysm to facilitate decision making and device selection for endovascular aneurysm repair in complex neck anatomy.

    Science.gov (United States)

    Tam, Matthew D B S; Laycock, Stephen D; Brown, James R I; Jakeways, Matthew

    2013-12-01

    To describe rapid prototyping or 3-dimensional (3D) printing of aneurysms with complex neck anatomy to facilitate endovascular aneurysm repair (EVAR). A 75-year-old man had a 6.6-cm infrarenal aortic aneurysm that appeared on computed tomographic angiography to have a sharp neck angulation of ~90°. However, although the computed tomography (CT) data were analyzed using centerline of flow, the true neck length and relations of the ostial origins were difficult to determine. No multidisciplinary consensus could be reached as to which stent-graft to use owing to these borderline features of the neck anatomy. Based on past experience with rapid prototyping technology, a decision was taken to print a model of the aneurysm to aid in visualization of the neck anatomy. The CT data were segmented, processed, and converted into a stereolithographic format representing the lumen as a 3D volume, from which a full-sized replica was printed within 24 hours. The model demonstrated that the neck was adequate for stent-graft repair using the Aorfix device. Rapid prototyping of aortic aneurysms is feasible and can aid decision making and device delivery. Further work is required to test the value of 3D replicas in planning procedures and their impact on procedure time, radiation dose, and procedure cost.

  4. Stepping stones to significant market shares for renewables. The European forum for market players and decision makers in the renewable energy industry

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2007-07-01

    This invitation to a two-day European Forum for market players and decision makers in the renewable energy business lists the presentations made at the conference in 2007. The programme included contributions in the following areas: Policies and market deployment initiatives, market trends and experience - from support schemes to market experience, opportunities in a changing framework in Switzerland, instruments and infrastructure requirements - how to make the market work and supply and demand aspects of a growing market. The conference examined how renewable forms of energy can gain significant market shares and reach a quota of 50% renewables in 50 years. The first session examined policies and market deployment initiatives, the second market trends and experiences, the third opportunities for Switzerland in a changing framework. The second day featured sessions on instruments and infrastructure requirements as well as on supply and demand aspects in a growing market. The conference was complemented with four workshops.

  5. Fast decision tree-based method to index large DNA-protein sequence databases using hybrid distributed-shared memory programming model.

    Science.gov (United States)

    Jaber, Khalid Mohammad; Abdullah, Rosni; Rashid, Nur'Aini Abdul

    2014-01-01

    In recent times, the size of biological databases has increased significantly, with the continuous growth in the number of users and rate of queries; such that some databases have reached the terabyte size. There is therefore, the increasing need to access databases at the fastest rates possible. In this paper, the decision tree indexing model (PDTIM) was parallelised, using a hybrid of distributed and shared memory on resident database; with horizontal and vertical growth through Message Passing Interface (MPI) and POSIX Thread (PThread), to accelerate the index building time. The PDTIM was implemented using 1, 2, 4 and 5 processors on 1, 2, 3 and 4 threads respectively. The results show that the hybrid technique improved the speedup, compared to a sequential version. It could be concluded from results that the proposed PDTIM is appropriate for large data sets, in terms of index building time.

  6. [The territorial expression of health-service planning: scenarios for shared decision-making on the development and adaptation of services on a territorial level].

    Science.gov (United States)

    Fusté, Josep; Frigola, David; Olivet, Miquel

    2008-12-01

    To apply planning criteria on a territorial level, with a forward-looking approach and taking into account the specificities of each location, in the Health Map of Catalonia, scenarios have been constructed for the development and adaptation of services for the 2015 horizon. The territorial scale is that of the 37 areas into which Catalonia has been divided in order to promote a new form of decentralised, combined decision- making, through the Territorial Health Governments. The new territorial health organisation is the substrate which must enable the relationship between professionals and services that share the same reference population to be coordinated. This article deals with the methodology for constructing the scenarios, and a summary is given of the principal action proposals which arise from the map in the aforementioned 37 territories. Detailed content of the territorial scenarios is also given, based on two practical cases.

  7. Understanding Advanced Prostate Cancer Decision Making Utilizing an Interactive Decision Aid.

    Science.gov (United States)

    Jones, Randy A; Hollen, Patricia J; Wenzel, Jennifer; Weiss, Geoff; Song, Daniel; Sims, Terran; Petroni, Gina

    2016-11-01

    Prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer deaths among men in the United States. Patients with advanced prostate cancer are vulnerable to difficult treatment decisions because of the nature of their disease. The aims of this study were to describe and understand the lived experience of patients with advanced prostate cancer and their decision partners who utilized an interactive decision aid, DecisionKEYS, to make informed, shared treatment decisions. This qualitative study uses a phenomenological approach that included a sample of 35 pairs of patients and their decision partners (16 pairs reflected patients with 6 months since their diagnosis of metastatic castration-resistant prostate cancer). Qualitative analysis of semistructured interviews was conducted describing the lived experience of patients with advanced prostate cancer and their decision partners using an interactive decision aid. Three major themes emerged: (1) the decision aid facilitated understanding of treatment options; (2) quality of life was more important than quantity of life; and (3) contact with healthcare providers greatly influenced decisions. Participants believed the decision aid helped them become more aware of their personal values, assisted in their treatment decision making, and facilitated an interactive patient-healthcare provider relationship. Decision aids assist patients, decision partners, and healthcare providers make satisfying treatment decisions that affect quality/quantity of life. These findings are important for understanding the experiences of patients who have to make difficult decisions.

  8. Analysis of Swedish Forest Owners' Information and Knowledge-Sharing Networks for Decision-Making: Insights for Climate Change Communication and Adaptation.

    Science.gov (United States)

    André, Karin; Baird, Julia; Gerger Swartling, Åsa; Vulturius, Gregor; Plummer, Ryan

    2017-03-08

    To further the understanding of climate change adaptation processes, more attention needs to be paid to the various contextual factors that shape whether and how climate-related knowledge and information is received and acted upon by actors involved. This study sets out to examine the characteristics of forest owners' in Sweden, the information and knowledge-sharing networks they draw upon for decision-making, and their perceptions of climate risks, their forests' resilience, the need for adaptation, and perceived adaptive capacity. By applying the concept of ego-network analysis, the empirical data was generated by a quantitative survey distributed to 3000 private forest owners' in Sweden in 2014 with a response rate of 31%. The results show that there is a positive correlation, even though it is generally weak, between forest owner climate perceptions and (i) network features, i.e. network size and heterogeneity, and (ii) presence of certain alter groups (i.e. network members or actors). Results indicate that forest owners' social networks currently serve only a minimal function of sharing knowledge of climate change and adaptation. Moreover, considering the fairly infrequent contact between respondents and alter groups, the timing of knowledge sharing is important. In conclusion we suggest those actors that forest owners' most frequently communicate with, especially forestry experts providing advisory services (e.g. forest owner associations, companies, and authorities) have a clear role to communicate both the risks of climate change and opportunities for adaptation. Peers are valuable in connecting information about climate risks and adaptation to the actual forest property.

  9. Analysis of Swedish Forest Owners' Information and Knowledge-Sharing Networks for Decision-Making: Insights for Climate Change Communication and Adaptation

    Science.gov (United States)

    André, Karin; Baird, Julia; Gerger Swartling, Åsa; Vulturius, Gregor; Plummer, Ryan

    2017-06-01

    To further the understanding of climate change adaptation processes, more attention needs to be paid to the various contextual factors that shape whether and how climate-related knowledge and information is received and acted upon by actors involved. This study sets out to examine the characteristics of forest owners' in Sweden, the information and knowledge-sharing networks they draw upon for decision-making, and their perceptions of climate risks, their forests' resilience, the need for adaptation, and perceived adaptive capacity. By applying the concept of ego-network analysis, the empirical data was generated by a quantitative survey distributed to 3000 private forest owners' in Sweden in 2014 with a response rate of 31%. The results show that there is a positive correlation, even though it is generally weak, between forest owner climate perceptions and (i) network features, i.e. network size and heterogeneity, and (ii) presence of certain alter groups (i.e. network members or actors). Results indicate that forest owners' social networks currently serve only a minimal function of sharing knowledge of climate change and adaptation. Moreover, considering the fairly infrequent contact between respondents and alter groups, the timing of knowledge sharing is important. In conclusion we suggest those actors that forest owners' most frequently communicate with, especially forestry experts providing advisory services (e.g. forest owner associations, companies, and authorities) have a clear role to communicate both the risks of climate change and opportunities for adaptation. Peers are valuable in connecting information about climate risks and adaptation to the actual forest property.

  10. Shared governance in a clinic system.

    Science.gov (United States)

    Meyers, Michelle M; Costanzo, Cindy

    2015-01-01

    Shared governance in health care empowers nurses to share in the decision-making process, which results in decentralized management and collective accountability. Share governance practices have been present in hospitals since the late 1970s. However, shared governance in ambulatory care clinics has not been well established. The subjects of this quality project included staff and administrative nurses in a clinic system. The stakeholder committee chose what model of shared governance to implement and educated clinic staff. The Index of Professional Nursing Governance measured a shared governance score pre- and postimplementation of the Clinic Nursing Council. The Clinic Nursing Council met bimonthly for 3 months during this project to discuss issues and make decisions related to nursing staff. The Index of Professional Nursing Governance scores indicated traditional governance pre- and postimplementation of the Clinic Nursing Council, which is to be expected. The stakeholder committee was beneficial to the initial implementation process and facilitated staff nurse involvement. Shared governance is an evolutionary process that develops empowered nurses and nurse leaders.

  11. Getting Decision Makers to the Table: Digestible Facts, a Few Good Friends and Sharing Recipes for Solutions to Climate Change Impacts.

    Science.gov (United States)

    Boudrias, M. A.; Estrada, M.; Gershunov, A.; Silva-Send, N. J.; Young, E.

    2014-12-01

    leaders and an increased willingness to share their successes publicly. Climate Education Partners is finding that linking excellent local science with healthy community dialogue is resulting in San Diego leaders and their communities making more informed decisions on how to adapt to climate change now and for all future generations.

  12. Non-ETS emission targets for 2030. Indication of emission targets for the Netherlands and other EU Member States under the European Effort Sharing Decision

    Energy Technology Data Exchange (ETDEWEB)

    Verdonk, M.; Hof, A.

    2013-10-15

    As European Member States are making progress towards their 2020 targets in the Effort Sharing Decision, the attention of policymakers is shifting to a framework beyond 2020. The European Commission launched a discussion with its Green Paper on a possible policy framework for 2030. This PBL Note aims to contribute to that discussion by analysing the effects of various assumptions on Member States' non-ETS emission targets for 2030. The effort sharing of the current European target for 2020 has resulted in an emission target of +20% relative to 2005 levels for the least wealthy Member State and -20% for the three wealthiest Member States. The targets for all other Member States were determined based on per-capita income levels of 2005. For possible non-ETS targets for 2030, we assumed a Europe-wide emission reduction target of 40% for 2030, compared to 1990 levels. This target is considered by the European Commission as the most cost-efficient to achieve a low-carbon economy by 2050. The 2030 target was split into a target for emissions covered by the EU Emissions Trading System (ETS) and one for emissions that are not covered by the ETS (non-ETS). According to our estimations, European non-ETS emissions need to be reduced by around 30% by 2030, compared to 2005 levels. We distributed the non-ETS reduction target of 30% over the Member States by using similar effort sharing principles that are applied in the EU Effort Sharing Decision for 2020, but with different targets assumed for the least wealthy Member State. We also took recent per-capita income levels into account. However, we did not take into account the costs and effects of emission reductions on GDP. This PBL Note analyses two possible scenarios that differ in the target assumed for the least wealthy Member State, in order to assess the effects of differing assumptions on the 2030 non-ETS targets. These scenarios should be considered as 'what if' scenarios and not as political positions

  13. An approach to quantify sources, seasonal change, and biogeochemical processes affecting metal loading in streams: Facilitating decisions for remediation of mine drainage

    Science.gov (United States)

    Kimball, B.A.; Runkel, R.L.; Walton-Day, K.

    2010-01-01

    Historical mining has left complex problems in catchments throughout the world. Land managers are faced with making cost-effective plans to remediate mine influences. Remediation plans are facilitated by spatial mass-loading profiles that indicate the locations of metal mass-loading, seasonal changes, and the extent of biogeochemical processes. Field-scale experiments during both low- and high-flow conditions and time-series data over diel cycles illustrate how this can be accomplished. A low-flow experiment provided spatially detailed loading profiles to indicate where loading occurred. For example, SO42 - was principally derived from sources upstream from the study reach, but three principal locations also were important for SO42 - loading within the reach. During high-flow conditions, Lagrangian sampling provided data to interpret seasonal changes and indicated locations where snowmelt runoff flushed metals to the stream. Comparison of metal concentrations between the low- and high-flow experiments indicated substantial increases in metal loading at high flow, but little change in metal concentrations, showing that toxicity at the most downstream sampling site was not substantially greater during snowmelt runoff. During high-flow conditions, a detailed temporal sampling at fixed sites indicated that Zn concentration more than doubled during the diel cycle. Monitoring programs must account for diel variation to provide meaningful results. Mass-loading studies during different flow conditions and detailed time-series over diel cycles provide useful scientific support for stream management decisions.

  14. SharePoint 2010 User's Guide Learning Microsoft's Collaboration and Productivity Platform

    CERN Document Server

    Bates, Seth

    2010-01-01

    Microsoft SharePoint Foundation 2010 and SharePoint Server 2010 provide a collection of tools and services you can use to improve user and team productivity, make information sharing more effective, and facilitate business decision-making processes. In order to get the most out of SharePoint 2010, you need to understand how to best use the capabilities to support your information management, collaboration, and business process management needs. This book is designed to provide you with the information you need to effectively use these tools. Whether you are using SharePoint as an intranet or b

  15. Qualitative insights into the experience of teaching shared decision making within adult education health literacy programmes for lower-literacy learners.

    Science.gov (United States)

    Muscat, Danielle M; Morony, Suzanne; Smith, Sian K; Shepherd, Heather L; Dhillon, Haryana M; Hayen, Andrew; Trevena, Lyndal; Luxford, Karen; Nutbeam, Don; McCaffery, Kirsten J

    2017-07-05

    Enhancing health literacy can play a major role in improving healthcare and health across the globe. To build higher-order (communicative/critical) health literacy skills among socially disadvantaged Australians, we developed a novel shared decision making (SDM) training programme for adults with lower literacy. The programme was delivered by trained educators within an adult basic education health literacy course. To explore the experience of teaching SDM within a health literacy programme and investigate whether communicative/critical health literacy content meets learner needs and teaching and institutional objectives. Qualitative interview study with 11 educators who delivered the SDM programme. Transcripts were analysed using the Framework approach; a matrix-based method of thematic analysis. Teachers noted congruence in SDM content and the institutional commitment to learner empowerment in adult education. The SDM programme was seen to offer learners an alternative to their usual passive approach to healthcare decision making by raising awareness of the right to ask questions and consider alternative test/treatment options. Teachers valued a structured approach to training building on foundational skills, with language reinforcement and take-home resources, but many noted the need for additional time to develop learner understanding and cover all aspects of SDM. Challenges for adult learners included SDM terminology, computational numerical risk tasks and understanding probability concepts. SDM programmes can be designed in a way that both supports teachers to deliver novel health literacy content and empowers learners. Collaboration between adult education and healthcare sectors can build health literacy capacity of those most in need. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  16. Development and validation of a computer-based situational judgement test to assess medical students' communication skills in the field of shared decision making.

    Science.gov (United States)

    Kiessling, Claudia; Bauer, Johannes; Gartmeier, Martin; Iblher, Peter; Karsten, Gudrun; Kiesewetter, Jan; Moeller, Grit E; Wiesbeck, Anne; Zupanic, Michaela; Fischer, Martin R

    2016-11-01

    To develop a computer-based test (CBT) measuring medical students' communication skills in the field of shared decision making (SDM) and to evaluate its construct validity. The CBT was developed in the context of an experimental study comparing three different trainings for SDM (including e-learning and/or role-play) and a control group. Assessment included a CBT (Part A: seven context-poor questions, Part B: 15 context-rich questions) and interviews with two simulated patients (SP-assessment). Cronbach's α was used to test the internal consistency. Correlations between CBT and SP-assessment were used to further evaluate construct validity of the CBT. Seventy-two students took part in the study. Mean value for the CBT score was 72% of the total score. Cronbach's α was 0.582. After eliminating three items, Cronbach's α increased to 0.625. Correlations between the CBT and SP-assessment were low to moderate. The control group scored significantly lower than the training settings (pquestions would be needed. We encourage teachers who particularly work with large student numbers to consider CBT as a feasible assessment method for cognitive aspects of communication skills. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. Shared decision-making: is it time to obtain informed consent before radiologic examinations utilizing ionizing radiation? Legal and ethical implications.

    Science.gov (United States)

    Berlin, Leonard

    2014-03-01

    Concerns about the possibility of developing cancer due to diagnostic imaging examinations utilizing ionizing radiation exposure are increasing. Research studies of survivors of atomic bomb explosions, nuclear reactor accidents, and other unanticipated exposures to similar radiation have led to varying conclusions regarding the stochastic effects of radiation exposure. That high doses of ionizing radiation cause cancer in humans is generally accepted, but the question of whether diagnostic levels of radiation cause cancer continues to be hotly debated. It cannot be denied that overexposure to ionizing radiation beyond a certain threshold, which has not been exactly determined, does generate cancer. This causes a dilemma: what should patients be informed about the possibility that a CT or similar examination might cause cancer later in life? At present, there is no consensus in the radiology community as to whether informed consent must be obtained from a patient before the patient undergoes a CT or similar examination. The author analyzes whether there is a legal duty mandating radiologists to obtain such informed consent but also, irrespective of the law, whether there an ethical duty that compels radiologists to inform patients of potential adverse effects of ionizing radiation. Over the past decade, there has been a noticeable shift from a benevolent, paternalistic approach to medical care to an autonomy-based, shared-decision-making approach, whereby patient and physician work as partners in determining what is medically best for the patient. Radiologists should discuss the benefits and hazards of imaging with their patients.

  18. Knowledge grows when shared

    DEFF Research Database (Denmark)

    Elbæk, Mikael Karstensen

    2010-01-01

    Knowledge is one of the few commodities that don’t devalue when used. Actually knowledge grows when shared and the free online access to peer-reviewed scientific publications is a potent ingredient the process of sharing. The sharing of knowledge is facilitated by the Open Access Movement. However...... infrastructure for Open Access was launched in Ghent, Belgium. This project and initiative is facilitating the success of the Open Access Pilot in FP7 as presented earlier in this journal. In this brief article I will present some of the most interesting issues that were discussed during the first session...

  19. Perceived Barriers and Facilitators of Using a Web-Based Interactive Decision Aid for Colorectal Cancer Screening in Community Practice Settings: Findings From Focus Groups With Primary Care Clinicians and Medical Office Staff

    OpenAIRE

    2013-01-01

    Background Information is lacking about the capacity of those working in community practice settings to utilize health information technology for colorectal cancer screening. Objective To address this gap we asked those working in community practice settings to share their perspectives about how the implementation of a Web-based patient-led decision aid might affect patient-clinician conversations about colorectal cancer screening and the day-to-day clinical workflow. Methods Five focus group...

  20. Development and Testing of a Computerized Decision Support System to Facilitate Brief Tobacco Cessation Treatment in the Pediatric Emergency Department: Proposal and Protocol

    Science.gov (United States)

    Dexheimer, Judith W; Khoury, Jane C; Miller, Julie A; Gordon, Judith S

    2016-01-01

    Background Tobacco smoke exposure (TSE) is unequivocally harmful to children's health, yet up to 48% of children who visit the pediatric emergency department (PED) and urgent care setting are exposed to tobacco smoke. The incorporation of clinical decision support systems (CDSS) into the electronic health records (EHR) of PED patients may improve the rates of screening and brief TSE intervention of caregivers and result in decreased TSE in children. Objective We propose a study that will be the first to develop and evaluate the integration of a CDSS for Registered Nurses (RNs) into the EHR of pediatric patients to facilitate the identification of caregivers who smoke and the delivery of TSE interventions to caregivers in the urgent care setting. Methods We will conduct a two-phase project to develop, refine, and integrate an evidence-based CDSS into the pediatric urgent care setting. RNs will provide input on program content, function, and design. In Phase I, we will develop a CDSS with prompts to: (1) ASK about child TSE and caregiver smoking, (2) use a software program, Research Electronic Data Capture (REDCap), to ADVISE caregivers to reduce their child's TSE via total smoking home and car bans and quitting smoking, and (3) ASSESS their interest in quitting and ASSIST caregivers to quit by directly connecting them to their choice of free cessation resources (eg, Quitline, SmokefreeTXT, or SmokefreeGOV) during the urgent care visit. We will create reports to provide feedback to RNs on their TSE counseling behaviors. In Phase II, we will conduct a 3-month feasibility trial to test the results of implementing our CDSS on changes in RNs’ TSE-related behaviors, and child and caregiver outcomes. Results This trial is currently underway with funding support from the National Institutes of Health/National Cancer Institute. We have completed Phase I. The CDSS has been developed with input from our advisory panel and RNs, and pilot tested. We are nearing completion of

  1. Principles of data management facilitating information sharing

    CERN Document Server

    Gordon, Keith

    2013-01-01

    Data is a valuable corporate asset and its effective management can be vital to success. This professional guide covers all the key areas of data management, including database development and corporate data modelling. The new edition covers web technology and its relation to databases and includes material on the management of master data.

  2. A Data Sharing Story

    Directory of Open Access Journals (Sweden)

    Mercè Crosas

    2012-01-01

    Full Text Available From the early days of modern science through this century of Big Data, data sharing has enabled some of the greatest advances in science. In the digital age, technology can facilitate more effective and efficient data sharing and preservation practices, and provide incentives for making data easily accessible among researchers. At the Institute for Quantitative Social Science at Harvard University, we have developed an open-source software to share, cite, preserve, discover and analyze data, named the Dataverse Network. We share here the project’s motivation, its growth and successes, and likely evolution.

  3. Assessing medical student knowledge and attitudes about shared decision making across the curriculum: protocol for an international online survey and stakeholder analysis.

    Science.gov (United States)

    Durand, Marie-Anne; Yen, Renata; Barr, Paul J; Cochran, Nan; Aarts, Johanna; Légaré, France; Reed, Malcolm; James O'Malley, A; Scalia, Peter; Painchaud Guérard, Geneviève; Elwyn, Glyn

    2017-06-23

    Shared decision making (SDM) is a goal of modern medicine; however, it is not currently embedded in routine care. Barriers include clinicians’ attitudes, lack of knowledge and training and time constraints. Our goal is to support the development and delivery of a robust SDM curriculum in medical education. Our objective is to assess undergraduate medical students’ knowledge of and attitudes towards SDM in four countries. The first phase of the study involves a web-based cross-sectional survey of undergraduate medical students from all years in selected schools across the United States (US), Canada and undergraduate and graduate students in the Netherlands. In the United Kingdom (UK), the survey will be circulated to all medical schools through the UK Medical School Council. We will sample students equally in all years of training and assess attitudes towards SDM, knowledge of SDM and participation in related training. Medical students of ages 18 years and older in the four countries will be eligible. The second phase of the study will involve semistructured interviews with a subset of students from phase 1 and a convenience sample of medical school curriculum experts or stakeholders. Data will be analysed using multivariable analysis in phase 1 and thematic content analysis in phase 2. Method, data source and investigator triangulation will be performed. Online survey data will be reported according to the Checklist for Reporting the Results of Internet E-Surveys. We will use the COnsolidated criteria for REporting Qualitative research for all qualitative data. The study has been approved for dissemination in the US, the Netherlands, Canada and the UK. The study is voluntary with an informed consent process. The results will be published in a peer-reviewed journal and will help inform the inclusion of SDM-specific curriculum in medical education worldwide. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article

  4. Study on the Influence of Service Relationship on the Supply Chain Information Sharing and Trust Decision%服务关系对供应链信息分享和信任决策的影响研究

    Institute of Scientific and Technical Information of China (English)

    徐刚; 秦进

    2015-01-01

    Based on asymmetric information between supplier and manufacturer, information sharing and trust decision are the key to supplying chain coordination.To ensure adequate supply, the manufacturer shares private demand information with the supplier, but does so with a cheating motivation.In view of the manufacturer's infor-mation sharing, the supplier determines capacity investment and makes trust decision.Our study shows that low deceive cost will cause the untruthful manufacturer information sharing .On the establishment of the service value model, we analyze how the service relationship affects information sharing and trust decision.The results show that if service value is high enough, the value of services will enable manufacturers to share information truly, and the supplier can fully trust the manufacturer information sharing.If the service value is, the manufacturer will have an incentive to inflate private information in a costless communication.So the supplier should doubt manufacturers’ information sharing.%由于信息不对称,供应商和制造商之间的信息分享和信任决策是供应链协调的关键。为了获得充足供给,制造商分享其私有需求信息,但同时存在欺骗动机;鉴于制造商的信息分享,供应商进行信任决策和产能投资。本文通过构建服务价值模型,分析了供应商与制造商之间的服务关系对信息分享和信任决策的影响。研究结果表明如果供应商的服务价值足够高,制造商会选择真实分享信息,此时供应商可以充分信任制造商的信息;如果服务价值低,制造商会采取放大需求信息的欺骗行为,此时供应商应怀疑制造商所分享信息的真实性。

  5. Key role of social work in effective communication and conflict resolution process: Medical Orders for Life-Sustaining Treatment (MOLST) Program in New York and shared medical decision making at the end of life.

    Science.gov (United States)

    Bomba, Patricia A; Morrissey, Mary Beth; Leven, David C

    2011-01-01

    In this article, the authors review the development of the Medical Orders for Life-Sustaining Treatment (MOLST) Program and recent landmark legislation in New York State in the context of advance care planning and shared medical decision making at the end of life. Social workers are central health care professionals in working with patients, families, practitioners, health care agents, and surrogates in the health systems and in the communication and conflict resolution process that is integral to health care decision making. The critical importance of ethics and end-of-life training and education for social workers is also addressed. Data from a pilot study evaluating interdisciplinary ethics training on legal and ethical content in communication and conflict resolution skills in health care decision making are reported. Recommendations are made for research on education and training of social workers, and investigation of the role and influence of systems in shaping social work involvement in end-of-life and palliative care.

  6. Improving the communication of benefits and harms of treatment strategies: decision AIDS for localized prostate cancer treatment decisions.

    Science.gov (United States)

    Hoffman, Richard M

    2012-12-01

    Treatment decisions for localized prostate cancer are preference sensitive. The optimal treatment strategy is unknown, and active treatment is not always necessary. Choosing among the various options involves tradeoffs between cancer control and complications that affect quality of life. A shared decision-making process, particularly facilitated by a decision aid, can help a patient make an informed decision that is concordant with his values and preferences. Studies have shown that informed patients are more willing to forego aggressive treatment, but much work is needed to develop and evaluate high-quality decision aids that accurately portray active surveillance. The research agenda for decision aids includes evaluating content elements and format, timing and setting for delivery, the quality of the decision-making process, and the effects of decision support on treatment selection (which will occur repeatedly for men opting for active surveillance) and quality of life.

  7. District decision-making for health in low-income settings: a qualitative study in Uttar Pradesh, India, on engaging the private health sector in sharing health-related data.

    Science.gov (United States)

    Gautham, Meenakshi; Spicer, Neil; Subharwal, Manish; Gupta, Sanjay; Srivastava, Aradhana; Bhattacharyya, Sanghita; Avan, Bilal Iqbal; Schellenberg, Joanna

    2016-09-01

    Health information systems are an important planning and monitoring tool for public health services, but may lack information from the private health sector. In this fourth article in a series on district decision-making for health, we assessed the extent of maternal, newborn and child health (MNCH)-related data sharing between the private and public sectors in two districts of Uttar Pradesh, India; analysed barriers to data sharing; and identified key inputs required for data sharing. Between March 2013 and August 2014, we conducted 74 key informant interviews at national, state and district levels. Respondents were stakeholders from national, state and district health departments, professional associations, non-governmental programmes and private commercial health facilities with 3-200 beds. Qualitative data were analysed using a framework based on a priori and emerging themes. Private facilities registered for ultrasounds and abortions submitted standardized records on these services, which is compulsory under Indian laws. Data sharing for other services was weak, but most facilities maintained basic records related to institutional deliveries and newborns. Public health facilities in blocks collected these data from a few private facilities using different methods. The major barriers to data sharing included the public sector's non-standardized data collection and utilization systems for MNCH and lack of communication and follow up with private facilities. Private facilities feared information disclosure and the additional burden of reporting, but were willing to share data if asked officially, provided the process was simple and they were assured of confidentiality. Unregistered facilities, managed by providers without a biomedical qualification, also conducted institutional deliveries, but were outside any reporting loops. Our findings suggest that even without legislation, the public sector could set up an effective MNCH data sharing strategy with private

  8. Performing the sharing economy.

    OpenAIRE

    Richardson, L

    2015-01-01

    The sharing economy converges around activities facilitated through digital platforms that enable peer-to-peer access to goods and services. It constitutes an apparent paradox, framed as both part of the capitalist economy and as an alternative. This duplicity necessitates focusing on the performances of the sharing economy: how it simultaneously constructs diverse economic activities whilst also inviting the deconstruction of ongoing practices of dominance. Such performances hold open the qu...

  9. The role of the CSIR/WRC Sanitation Technology Demonstration Centre in creating awareness, sharing information and in decision-making regarding sanitation technologies

    CSIR Research Space (South Africa)

    Mema, V

    2010-09-01

    Full Text Available (DWA). Sanitation technology demonstration will play an important role in assisting stakeholders in decision- making processes with regards to sanitation options and general design issues related to sustainable human settlements. 1. Introduction... and decision making regarding sanitation technologies. The Centre will present sanitation technology providers and users an open process to understanding comparable and accessible sanitation technologies with assistance of the personnel on site. Visits...

  10. The Role of the European Commission in Co-decision – A strategic facilitator operating in a situation of structural disadvantage

    Directory of Open Access Journals (Sweden)

    Anne Rasmussen

    2003-10-01

    Full Text Available The co-decision procedure has had significant implications for the interaction between the EU institutions and has attracted the attention of a series of formal, rational choice institutionalists. However, these have mostly dealt with the Commission in a relatively superficial way and their conclusions about its legislative role have been rather pessimistic. Instead this study examines the role of the Commission in more detail by looking closer at both the formal and informal ways in which the Commission has affected legislation in co-decision from Maastricht to one year after the entering into force of the Amsterdam Treaty. The study includes interview and quantitative data at a general level as well as from three Socrates procedures completed in 1995, 1998, and 2000. In line with the formal, rational choice theorists, the paper notes that the Commission’s room for manoeuvre is significantly reduced in co-decision, but it argues that its relative loss of power with the introduction of the procedure should not blur the picture that in absolute terms it is still an important actor in the day-to-day decision-making of the EU.

  11. Shared lives, shared energy

    Energy Technology Data Exchange (ETDEWEB)

    Madsen, P.; Goss, K.

    1982-07-01

    A social experiment in Denmark is described in which 25 families combine private ownership (each family owns its own home) and collectivism (each family owns 1/25 of the grounds, large common house and other facilities). The superinsulated individual homes are small (< 1000 ft/sup 2/) but the common house (7800 ft/sup 2/) provides dining and meeting facilities for all 25 families as well as a central heating plant. Heat may be supplied from solar, wind and/or oil-fired boiler. Adequate hot water storage is provided using solar collectors and a 55 kW Vesta wind generator (surplus power is sold). All south facing roof surfaces are fitted with solar collectors (4455 ft/sup 2/ total). A total of 70% of the energy used is produced on site (solar and wind). The manner of living and sharing (child care, automobiles, cooking, etc.) is described as well as typical floor plans for the units. Other collective housing in Denmark is described and it is postulated that overdrevet may serve as a model. (MJJ)

  12. Too Much Information Sharing?

    DEFF Research Database (Denmark)

    Ganuza, Juan José; Jansen, Jos

    2013-01-01

    By using general information structures and precision criteria based on the dispersion of conditional expectations, we study how oligopolists’ information acquisition decisions may change the effects of information sharing on the consumer surplus. Sharing information about individual cost...... parameters gives the following trade-off in Cournot oligopoly. On the one hand, it decreases the expected consumer surplus for a given information precision, as the literature shows. On the other hand, information sharing increases the firms’ incentives to acquire information, and the consumer surplus...... increases in the precision of the firms’ information. Interestingly, the latter effect may dominate the former effect....

  13. Sharing Economy

    DEFF Research Database (Denmark)

    Marton, Attila; Constantiou, Ioanna; Thoma, Antonela

    De spite the hype the notion of the sharing economy is surrounded by, our understanding of sharing is surprisingly undertheorized. In this paper, we make a first step towards rem edying this state of affairs by analy sing sharing as a s ocial practice. Based on a multi ple - case study, we analyse...... the institutional assemblage of sharing on online platforms to counter the prevalent assumpti o n i n the literature that sharing derives primarily from the shareability of goods and resources. Sharing, we contend, is a fundament al human practice that, in our case study, takes the particular form of coord inated...

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

    Science.gov (United States)

    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.

  15. Key Decision Points in the Careers of Geoscientists: The Role of the YES Network in Facilitating Successful Career Transitions for Early Career Geoscientists (Invited)

    Science.gov (United States)

    Venus, J. H.; Gonzales, L. M.; Yes Network

    2010-12-01

    The external influences on the decisions that geoscientists make pertaining to their careers are often assumed but not quantified. The YES Network is conducting an international study to determine the Key Decision points in the career pathways of early career geoscientists. The study aims to identify factors contributing to individual career decisions and to monitor these over a ten year period. The Initial phase of the study is now underway enabling preliminary conclusions to be drawn and will identify a group of individuals that will be tracked over the 10 year programme. The Survey will highlight reoccurring areas where Early Career Geoscientists are experiencing progression difficulties and, importantly, provide respondents with an opportunity to suggest solutions whilst also allowing general resource needs to be identified from the results as a whole. Early results show an overwhelming majority expressing job satisfaction most or all of the time (only 2 candidates reporting none). Respondents rate job satisfaction and respect highly, returning more responses than good salaries. A general frustration with administration, paper work and bureaucracy is particularly evident in those employed by government organisations. Early Career geoscientists express a frustration concerning a lack of involvement in decision making processes; interestingly several later career respondents also acknowledge a need to properly train, nurture and encourage new recruits to retain good graduates who may otherwise become disillusioned and leave the profession. The role of family in career choices has been highlighted both in survey and general feedback responses particularly by female geoscientists and those working in jobs with high levels of fieldwork; we aim to determine, to some extent, to what point these decisions are controlled by family as opposed to normal career progression. Flexible working conditions and agreed time away from field duty have been independently suggested

  16. A prospective study comparing the predictions of doctors versus models for treatment outcome of lung cancer patients: A step toward individualized care and shared decision making

    NARCIS (Netherlands)

    C. Oberije (Cary); G.I. Nalbantov (Georgi); A.T. den Dekker (Alexander); L. Boersma (Liesbeth); J.H. Borger (Jacques); B. Reymen (Bart); A. van Baardwijk (Angela); R. Wanders (Rinus); D.K.M. de Ruysscher (Dirk); E.W. Steyerberg (Ewout); A.M.C. Dingemans (Anne-Marie); P. Lambin (Philippe)

    2014-01-01

    textabstractBackground: Decision Support Systems, based on statistical prediction models, have the potential to change the way medicine is being practiced, but their application is currently hampered by the astonishing lack of impact studies. Showing the theoretical benefit of using these models cou

  17. Sharing Economy

    DEFF Research Database (Denmark)

    Marton, Attila; Constantiou, Ioanna; Thoma, Antonela

    De spite the hype the notion of the sharing economy is surrounded by, our understanding of sharing is surprisingly undertheorized. In this paper, we make a first step towards rem edying this state of affairs by analy sing sharing as a s ocial practice. Based on a multi ple - case study, we analyse...

  18. Medicare Program; Medicare Shared Savings Program; Accountable Care Organizations--Revised Benchmark Rebasing Methodology, Facilitating Transition to Performance-Based Risk, and Administrative Finality of Financial Calculations. Final rule.

    Science.gov (United States)

    2016-06-10

    Under the Medicare Shared Savings Program (Shared Savings Program), providers of services and suppliers that participate in an Accountable Care Organization (ACO) continue to receive traditional Medicare fee-for-service (FFS) payments under Parts A and B, but the ACO may be eligible to receive a shared savings payment if it meets specified quality and savings requirements. This final rule addresses changes to the Shared Savings Program, including: Modifications to the program's benchmarking methodology, when resetting (rebasing) the ACO's benchmark for a second or subsequent agreement period, to encourage ACOs' continued investment in care coordination and quality improvement; an alternative participation option to encourage ACOs to enter performance-based risk arrangements earlier in their participation under the program; and policies for reopening of payment determinations to make corrections after financial calculations have been performed and ACO shared savings and shared losses for a performance year have been determined.

  19. Sharing City

    DEFF Research Database (Denmark)

    This magazine offers an insight into the growing commercial innovation, civic movements, and political narratives surrounding sharing economy services, solutions and organisational types. It presents a cross-section of the manifold sharing economy services and solutions that can be found in Denmark....... Solutions of sharing that seeks to improve our cities and local communities in both urban and rural environments. 24 sharing economy organisations and businesses addressing urban and rural issues are being portrayed and seven Danish municipalities that have explored the potentials of sharing economy....... Moreover, 15 thought leading experts - professionals and academic - have been invited to give their perspective on sharing economy for cities. This magazine touches upon aspects of the sharing economy as mobility, communities, sustainability, business development, mobility, and urban-rural relation....

  20. 知识共享视角下生鲜农产品供应链决策行为研究%A Knowledge Sharing Perspective on Decision-making Behaviors within Fresh Farm Produce Supply Chains

    Institute of Scientific and Technical Information of China (English)

    邱洪全

    2016-01-01

    In this paper, on the basis of an exposition of the knowledge sharing in the fresh farm produce supply chain and the concept of supply chain relationship, and with the“one-to-many”two-echelon supply chain system composed by one wholesaler and multiple retailers in the fresh farm produce industry as example, we built its knowledge sharing system model with the Stackelberg game characteristics, and in view of the result of the quantitative analysis, discussed the decisions of the wholesaler and retailers toward knowledge sharing.%在阐述生鲜农产品供应链知识共享和分析供应链关系的基础上,以生鲜农产品供应链中一家批发商与多家零售商构成的“单对多”二级供应链系统为例,构建了其具备Stackelberg博弈特征的知识共享系统模型,并针对定量分析的结果探讨了批发商与零售商知识共享的决策行为。

  1. Sharing code

    OpenAIRE

    Kubilius, Jonas

    2014-01-01

    Sharing code is becoming increasingly important in the wake of Open Science. In this review I describe and compare two popular code-sharing utilities, GitHub and Open Science Framework (OSF). GitHub is a mature, industry-standard tool but lacks focus towards researchers. In comparison, OSF offers a one-stop solution for researchers but a lot of functionality is still under development. I conclude by listing alternative lesser-known tools for code and materials sharing.

  2. The Nominal Share Price Puzzle

    National Research Council Canada - National Science Library

    William C. Weld; Roni Michaely; Richard H. Thaler; Shlomo Benartzi

    2009-01-01

    ... investigate in this paper is whether vestigial norms and customs affect corporate decision making. Consider the following fact: The average nominal price for a share of stock on the New York Stock exchange has remained roughly constant (about $35) since the Great Depression. The mechanism that has allowed share prices to remain remarkably con...

  3. Power Sharing Courts

    Directory of Open Access Journals (Sweden)

    Stefan Graziadei

    2016-06-01

    Full Text Available In this paper, I introduce a novel concept, the one of power sharing courts. Scholars of judicial politics look at the reasons behind judicial selection and the patterns of decision making within courts through the lens of ideology (left-right. However, the resulting fertile scholarly analysis has not been extended to divided societies, where the main cleavages are not partisan but ethno-national. In these societies, the liberal model of selecting judges and taking decisions within an apex court is often corrected to specifically include politically salient ascriptive cleavages (such as ethnicity/nationality/language/religion. The main thrust of my argument is that there is a model of selecting judges, taking decisions and sharing posts of influence within apex courts in divided societies that has not yet been conceptually captured: power sharing courts. In analogy to consociationalism in the political system, power sharing in the judiciary aims to solve salient inter-community conflicts by including all relevant groups in these bodies on a basis of parity or proportionality. The paper is of equal interest to scholars of constitutional courts, consociationalists, comparatists, as well as country specialists.

  4. Modelling Facilitates Silvicultural Decision-Making for Improving the Mitigating Effect of Beech (Fagus Sylvatica L. Dominated Alpine Forest against Rockfall

    Directory of Open Access Journals (Sweden)

    Petra Kajdiž

    2015-06-01

    Full Text Available In southeast Europe, silvicultural measures for improving forest protective effects against rockfall are often based on unsystematic observation and experience. We compared formalised expert assessment of forest protective effects and silvicultural decision-making with an approach supported by modelling (Rockyfor3D, Rockfor.NET, shadow angle method. The case study was conducted in Fagus sylvatica dominated Alpine forests above the regional road leading to the Ljubelj pass, in Slovenia. We analysed rock sources, silent witnesses, forest structure and regeneration. Expert assessment indicated acceptable protection effects of the forest and their decline in the future. Modelling revealed several road sections endangered by rockfalls. It also indicated subtle differences between silvicultural alternatives: current forest, current forest with cable crane lines, selection forest and non-forested slope. This outcome may be due to short transition zones, small rock sizes, low rock source heights and low resolution of the digital elevation model. Modelling requires more initial input than formalised expert assessment but gives spatially explicit results that enable comparison of silvicultural alternatives, coordination of silviculture and forest operations, and delineation of protection forests. Modelling also supported prioritising of silvicultural measures, where the necessity of silvicultural measures increases with increasing rockfall susceptibility and decreasing long-term stability of stands.

  5. Attitudes to Sharing Personal Health Information in Living Kidney Donation

    Science.gov (United States)

    Hizo-Abes, Patricia; Young, Ann; Reese, Peter P.; McFarlane, Phil; Wright, Linda; Cuerden, Meaghan

    2010-01-01

    Background and objectives: In living kidney donation, transplant professionals consider the rights of a living kidney donor and recipient to keep their personal health information confidential and the need to disclose this information to the other for informed consent. In incompatible kidney exchange, personal health information from multiple living donors and recipients may affect decision making and outcomes. Design, setting, participants, & measurements: We conducted a survey to understand and compare the preferences of potential donors (n = 43), potential recipients (n = 73), and health professionals (n = 41) toward sharing personal health information (in total 157 individuals). Results: When considering traditional live-donor transplantation, donors and recipients generally agreed that a recipient's health information should be shared with the donor (86 and 80%, respectively) and that a donor's information should be shared with the recipient (97 and 89%, respectively). When considering incompatible kidney exchange, donors and recipients generally agreed that a recipient's information should be shared with all donors and recipients involved in the transplant (85 and 85%, respectively) and that a donor's information should also be shared with all involved (95 and 90%, respectively). These results were contrary to attitudes expressed by transplant professionals, who frequently disagreed about whether such information should be shared. Conclusions: Future policies and practice could facilitate greater sharing of personal health information in living kidney donation. This requires a consideration of which information is relevant, how to put it in context, and a plan to obtain consent from all concerned. PMID:20299371

  6. Advancing the Direction of Health Information Management in Greek Public Hospitals: Theoretical Directions and Methodological Implications for Sharing Information in order to Obtain Decision-Making

    Directory of Open Access Journals (Sweden)

    Evagelia Lappa

    2016-08-01

    Full Text Available Although consultants have long placed the use of research information at the centre of their activity, the extent that physicians use this information tends to vary widely. Despite this study and its recommendations, there is still a gap between the functions of a manager and the use of the associated information, while the decision-making procedures vary according to the organization in which they work. The cost of IT remains the largest barrier, while some current IT solutions are not user friendly and out-of-date, particularly for public hospitals in Greece. The knowledge management is concerned not only with the facts and figures of production, but also with the know-how of staff. The information needs protocol should not be referred only to those who comply with formal computer-based information systems, but also to those who take into account other informal information and its flow within the organization. In a field such as medicine, where out-of-date information may be positively dangerous, doctors make heavy use of journals and several texts from the web. The decision-making process is a complex approach, particularly in human diagnostic and therapeutic applications. Therefore, it is very important to set priorities in the sector of health information management and promote education and training on information and communication technology (ICT.

  7. Decision Models for Airline Alliance Network under Revenue Sharing Mechanism%收益共享机制下航空联盟网络的决策模型

    Institute of Scientific and Technical Information of China (English)

    丛晓妮; 李实萍; 崔毅

    2014-01-01

    A decision-making model in the airline alliance network made up of two airlines is proposed and the effect of revenue sharing mechanism on performance in airline alliance networks investigated .Firstly, an equilibrium model in the airline alliance network is analyzed under the centralized decision -making .It is found that lower transportation costs not only reduce ticket prices of airlines , increasing passenger traf-fic, but also enhance the overall effectiveness of airline alliances .Secondly, under the revenue sharing mechanism , the decentralized decision-making model in the airline alliance network is investigated .The results show that revenue sharing mechanism can not only maximize the effectiveness of the individual alli -ance members , but also maximize the overall effectiveness of airline alliances .The implementation of the revenue sharing mechanism can improve the performance of airline alliance members .The level of perform-ance is closely related to the revenue sharing coefficient , the substitution relationship between airlines and the ratio of operating costs in the domestic and international routes .In addition , the numerical results de-termine that the effects of different parameters on the performances of the airline alliance members are dif -ferent under the revenue sharing mechanism .%构建由两个航空公司组成的航空联盟网络的决策模型,研究了航空联盟网络的收益共享机制对其绩效的影响。首先,分析了航空联盟网络在集中决策下的均衡模型,研究发现降低运输成本不仅降低机票的价格、增加旅客运输量,还能提升联盟整体的收益。其次,研究了航空联盟网络在收益共享机制下的分散决策模型,结果表明收益共享机制不仅可以实现联盟成员个人的收益最大,同时可以达到联盟网络整体收益的最大化。研究还发现,实施收益共享机制可以提高联盟成员的绩效水平,绩效水平提升的

  8. File sharing

    NARCIS (Netherlands)

    van Eijk, N.

    2011-01-01

    ‘File sharing’ has become generally accepted on the Internet. Users share files for downloading music, films, games, software etc. In this note, we have a closer look at the definition of file sharing, the legal and policy-based context as well as enforcement issues. The economic and cultural impact

  9. 关于城市轨道交通信息共享智能决策系统建设的思考%Construction of Information Sharing and Intelligent Decision-making Platform for UMT

    Institute of Scientific and Technical Information of China (English)

    刘增祥; 夏益青

    2012-01-01

    The rapid development of urban rail transit system requires the support of information resources in rail transit network planning, daily operation, command and dispatch, disaster prevention and relief, major decisions and post-construction, etc. However, the current information system can't meet the high-level application and decision-making requirements in aspects of rail construction, operation, planning, security, disaster prevention and so on. other aspects. Based on comprehensive a-nalysis, deep exploration and integration of the sub-system information, the construction of an information sharing and intelligent decision platform will play an, active role in higher level resource utilization, management and decision-making.%城市轨道交通的迅速发展使得各支撑系统的信息资源在城市轨道交通路网规划、日常运营、指挥调度、防灾救灾、重大决策、后期建设等方面发挥了重要作用.但当前对信息的应用无法满足城市轨道交通在建设、运营、规划、安保、防灾等方面的高层应用与决策需求.进一步分析、挖掘与融合城市轨道交通线各专业信息并建设信息共享智能决策系统,可以为更高层次的使用、管理与决策提供服务.

  10. Shared leadership

    DEFF Research Database (Denmark)

    Ulhøi, John Parm; Müller, Sabine

    2012-01-01

    The aim of this paper is twofold. First, this paper comprehensively will review the conceptual and empirical literature to identify such critical underlying mechanisms which enable shared or collective leadership. Second, this article identifies the antecedents and outcomes of shared leadership...... according to the literature review to develop a re-conceptualised and synthesized framework for managing the organizational issues associated with shared leadership on various organizational levels. The paper rectifies this by identifying the critical factors and mechanisms which enable shared leadership...... and its antecedents and outcomes, and to develop a re-conceptualized and synthesized framework of shared leadership. The paper closes with a brief discussion of avenues for future research and implications for managers....

  11. Sharing Graphs

    CERN Document Server

    Sahasranand, K R

    2010-01-01

    Almost all known secret sharing schemes work on numbers. Such methods will have difficulty in sharing graphs since the number of graphs increases exponentially with the number of nodes. We propose a secret sharing scheme for graphs where we use graph intersection for reconstructing the secret which is hidden as a sub graph in the shares. Our method does not rely on heavy computational operations such as modular arithmetic or polynomial interpolation but makes use of very basic operations like assignment and checking for equality, and graph intersection can also be performed visually. In certain cases, the secret could be reconstructed using just pencil and paper by authorised parties but cannot be broken by an adversary even with unbounded computational power. The method achieves perfect secrecy for (2, n) scheme and requires far fewer operations compared to Shamir's algorithm. The proposed method could be used to share objects such as matrices, sets, plain text and even a heterogeneous collection of these. S...

  12. Shared leadership

    DEFF Research Database (Denmark)

    Ulhøi, John Parm; Müller, Sabine

    2012-01-01

    The aim of this paper is twofold. First, this paper comprehensively will review the conceptual and empirical literature to identify such critical underlying mechanisms which enable shared or collective leadership. Second, this article identifies the antecedents and outcomes of shared leadership...... according to the literature review to develop a re-conceptualised and synthesized framework for managing the organizational issues associated with shared leadership on various organizational levels. The paper rectifies this by identifying the critical factors and mechanisms which enable shared leadership...... and its antecedents and outcomes, and to develop a re-conceptualized and synthesized framework of shared leadership. The paper closes with a brief discussion of avenues for future research and implications for managers....

  13. Clinicians’ concerns about decision support interventions for patients facing breast cancer surgery options: understanding the challenge of implementing shared decision‐making

    Science.gov (United States)

    Caldon, Lisa J.M.; Collins, Karen A.; Reed, Malcolm W.; Sivell, Stephanie; Austoker, Joan; Clements, Alison M.; Patnick, Julietta; Elwyn, Glyn

    2011-01-01

    Abstract Background  There is interest in interventions that provide support for patients facing challenging decisions, such as the choice between mastectomy and breast conservation surgery for breast cancer. However, it is difficult to implement these interventions. One potential source of resistance is the attitudes of clinicians. Objective  To examine specialist breast clinicians’ opinions about the provision of decision support interventions (DesIs) for patients. Methods  As part of the development of a web‐based DesI (BresDex), semi‐structured interviews were conducted with specialist clinicians [breast surgeons, breast care nurses (BCNs) and oncologists] from four breast units in a UK region, and speciality national opinion leaders. Interviews were recorded, transcribed and analysed using the Framework approach. Results  A majority of the 24 clinicians interviewed did not have a working knowledge of DesIs and were ambivalent or sceptical. Many expressed conflicting opinions: they noted the potential benefits, but at the same time expressed reservations about information overlap, overload and about content that they considered inappropriate. Many wanted access to DesIs to be always under clinical supervision. In particular, they were uncertain as regards how DeSIs could be tailored to individual patients’ needs and also accommodate clinical practice variation. BCNs were particularly concerned that DesIs might induce patient anxiety and replace their role. Conclusions  The concept of providing interventions to support patients in decision‐making tasks generated concern, defensiveness and scepticism. These attitudes will be a significant barrier. Implementation efforts will need to recognize and address these issues if these interventions are to become embedded in clinical practice. PMID:21029281

  14. Application of decision analysis to intelligent transportation system societal issues. Final report, 15 March 1996-14 March 1997

    Energy Technology Data Exchange (ETDEWEB)

    Richardson, B.C.; Albers, W.A.; Kostyniuk, L.P.; Barnes, M.A.; Rodriguez, D.A.

    1997-03-14

    A demonstration of the use of decision analysis to address societal and institutional issues in an Intelligent Transportation System-based paratransit implementation was performed. A decision analysis technique called Multi-Organization Decision Analysis (MODA) was developed, and it is based on the Decision Risk Analysis process used widely in the private sector. Its objective is to facilitate consensus among the disparate public and private sector stakeholders in a decision process. The stakeholders are represented on a decision-making team, and they are supported by a team of analysts. MODA meetings are aided by facilitators. The process includes the development of a shared vision statement framing the problem, developing alternative solutions, analyzing the alternatives, and reaching a decision. Progression to the next step of the process does not occur until consensus is reached on the present step.

  15. Knowledge Sharing

    DEFF Research Database (Denmark)

    Holdt Christensen, Peter

    The concept of knowledge management has, indeed, become a buzzword that every single organization is expected to practice and live by. Knowledge management is about managing the organization's knowledge for the common good of the organization -but practicing knowledge management is not as simple...... as that. This article focuses on knowledge sharing as the process seeking to reduce the resources spent on reinventing the wheel.The article introduces the concept of time sensitiveness; i.e. that knowledge is either urgently needed, or not that urgently needed. Furthermore, knowledge sharing...... is considered as either a push or pull system. Four strategies for sharing knowledge - help, post-it, manuals and meeting, and advice are introduced. Each strategy requires different channels for sharing knowledge. An empirical analysis in a production facility highlights how the strategies can be practiced....

  16. 基于本体的轨道交通应急信息共享与辅助决策%Emergency Information Sharing and Decision Aid of Urban Rail Transit Based on Ontology

    Institute of Scientific and Technical Information of China (English)

    杨珂; 韩宝明

    2011-01-01

    In view of the characteristics of information in emergency management operation and the requirements of information share in urban rail transit, the ontology theory has been introduced in standardization of emergency information. Authors established a model of ontology description through dividing emergency process into several stages and related objects to construct an identical frame of expression for emergency information sharing, and set up rules to construct identification and mapping for information ontology and logic of operation. Semantic matching and relevancy expansion were applied to optimize the treatment scheme suitable for the layout of the scene, to realize decision-making based on information integration.%针对城市轨道交通应急管理业务的信息特征及信息共享需求,将本体论引入应急信息标准化;根据应急处置流程划分阶段及其业务对象,建立本体知识表达模型,构建共享所需的规范化框架,设立规则对信息本体、业务逻辑进行辨识和映射.应用语义匹配、关联扩展策略,制订和修正处置方案来用于现场布局,以实现信息集成对应急决策的支撑.

  17. Health Literacy and Health-Care Engagement as Predictors of Shared Decision-Making Among Adult Information Seekers in the USA: a Secondary Data Analysis of the Health Information National Trends Survey.

    Science.gov (United States)

    Wigfall, Lisa T; Tanner, Andrea H

    2016-06-02

    The objective of this study is to examine the relationship between health literacy, health-care engagement, and shared decision-making (SDM). We analyzed Health Information National Trends Survey 4 (cycle 3) data for 1604 information seekers who had one or more non-emergency room health-care visits in the previous year. SDM was more than two times higher among adults who "always" versus "usually/sometimes/never" take health information to doctor visits (OR = 2.54; 95 % CI 1.19-5.43). There was a twofold increase in SDM among adults who were "completely/very confident" versus "somewhat/a little/not confident" about finding health information (OR = 2.03; 95 % CI 1.37-3.02). Differences in SDM between adults who understood health information and those who had difficulty understanding health information were not statistically significant (OR = 1.39; 95 % CI 0.93-2.07). A Healthy People 2020 goal is to increase SDM. Previous research has suggested that SDM may improve health outcomes across the continuum of care. Only about half of adults report always being involved in health-care decisions. Even more alarming is the fact that SDM has not increased from 2003 to 2013. Our findings suggest that increasing health literacy has the potential to increase health-care engagement and subsequently increase SDM. Effective intervention strategies are needed to improve health literacy and promote health-care engagement.

  18. Evaluation of the Facilitated Communication Pilot

    Science.gov (United States)

    Cooper-Martin, Elizabeth

    2014-01-01

    The Office of Special Education and Student Services asked the Office of Shared Accountability to evaluate the "Facilitated Communication Pilot." In facilitated communication (FC), people with communication impairments express themselves by typing with the aid of a communication partner, called a facilitator, who provides physical (and…

  19. Decision support systems for robotic surgery and acute care

    Science.gov (United States)

    Kazanzides, Peter

    2012-06-01

    Doctors must frequently make decisions during medical treatment, whether in an acute care facility, such as an Intensive Care Unit (ICU), or in an operating room. These decisions rely on a various information sources, such as the patient's medical history, preoperative images, and general medical knowledge. Decision support systems can assist by facilitating access to this information when and where it is needed. This paper presents some research eorts that address the integration of information with clinical practice. The example systems include a clinical decision support system (CDSS) for pediatric traumatic brain injury, an augmented reality head- mounted display for neurosurgery, and an augmented reality telerobotic system for minimally-invasive surgery. While these are dierent systems and applications, they share the common theme of providing information to support clinical decisions and actions, whether the actions are performed with the surgeon's own hands or with robotic assistance.

  20. Electronic market models for decision support systems on the Web

    Institute of Scientific and Technical Information of China (English)

    谢勇; 王红卫; 费奇

    2004-01-01

    With the prevalence of the Web, most decision-makers are likely to use the Web to support their decision-making. Web-based technologies are leading a major stream of researching decision support systems (DSS). We propose a formal definition and a conceptual framework for Web-based open DSS (WODSS). The formal definition gives an overall view of WODSS, and the conceptual framework based on browser/broker/server computing mode employs the electronic market to mediate decision-makers and providers, and facilitate sharing and reusing of decision resources. We also develop an admitting model, a trading model and a competing model of electronic market in WODSS based on market theory in economics. These models reveal the key mechanisms that drive WODSS operate efficiently.

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

    Science.gov (United States)

    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.

  2. Outcomes of dysvascular partial foot amputation and how these compare to transtibial amputation: a systematic review for the development of shared decision-making resources.

    Science.gov (United States)

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

    2017-03-14

    Dysvascular partial foot amputation (PFA) is a common sequel to advanced peripheral vascular disease. Helping inform difficult discussions between patients and practitioners about the level of PFA, or the decision to have a transtibial amputation (TTA) as an alternative, requires an understanding of the current research evidence on a wide range of topics including wound healing, reamputation, quality of life, mobility, functional ability, participation, pain and psychosocial outcomes, and mortality. The aim of this review was to describe a comprehensive range of outcomes of dysvascular PFA and compare these between levels of PFA and TTA. The review protocol was registered in PROSPERO (CRD42015029186). A systematic search of the literature was conducted using MEDLINE, EMBASE, psychINFO, AMED, CINAHL, ProQuest Nursing and Allied Health, and Web of Science. These databases were searched using MeSH terms and keywords relating to different amputation levels and outcomes of interest. Peer reviewed studies of original research-irrespective of the study design-were included if published in English between 1 January 2000, and 31 December 2015, and included discrete cohort(s) with dysvascular PFA or PFA and TTA. Outcomes of interest were rate of wound healing and complications, rate of ipsilateral reamputation, quality of life, functional ability, mobility, pain (i.e., residual limb or phantom pain), psychosocial outcomes (i.e., depression, anxiety, body image and self-esteem), participation, and mortality rate. Included studies were independently appraised by two reviewers. The McMaster Critical Review Forms were used to assess methodological quality and identify sources of bias. Data were extracted based on the Cochrane Consumers and Communication Review Group's data extraction template by a primary reviewer and checked for accuracy and clarity by a second reviewer. Findings are reported as narrative summaries given the heterogeneity of the literature, except for mortality

  3. Health innovations in patient decision support: Bridging the gaps and challenges

    Directory of Open Access Journals (Sweden)

    Chirk Jenn Ng

    2013-02-01

    Full Text Available Patient decision aids (PDAs help to support patients in making an informed and value-based decision. Despite advancement in decision support technologies over the past 30 years, most PDAs are still inaccessible and few address individual needs. Health innovation may provide a solution to bridge these gaps. Information and computer technology provide a platform to incorporate individual profiles and needs into PDAs, making the decision support more personalised. Health innovation may enhance accessibility by using mobile, tablet and Internet technologies; make risk communication more interactive; and identify patient values more effectively. In addition, using databases to capture patient data and the usage of PDAs can help: developers to improve PDAs’ design; clinicians to facilitate the decisionmaking process more effectively; and policy makers to make shared decision making more feasible and cost-effective. Health innovation may hold the key to advancing PDAs by creating a more personalised and effective decision support tool for patients making healthcare decisions.

  4. Health innovations in patient decision support: Bridging the gaps and challenges.

    Science.gov (United States)

    Ng, Chirk Jenn; Lee, Yew Kong; Lee, Ping Yein; Abdullah, Khatijah Lim

    2013-01-01

    Patient decision aids (PDAs) help to support patients in making an informed and value-based decision. Despite advancement in decision support technologies over the past 30 years, most PDAs are still inaccessible and few address individual needs. Health innovation may provide a solution to bridge these gaps. Information and computer technology provide a platform to incorporate individual profiles and needs into PDAs, making the decision support more personalised. Health innovation may enhance accessibility by using mobile, tablet and Internet technologies; make risk communication more interactive; and identify patient values more effectively. In addition, using databases to capture patient data and the usage of PDAs can help: developers to improve PDAs' design; clinicians to facilitate the decisionmaking process more effectively; and policy makers to make shared decision making more feasible and cost-effective. Health innovation may hold the key to advancing PDAs by creating a more personalised and effective decision support tool for patients making healthcare decisions.

  5. 企业知识共享的促进、阻碍与管理举措——以江苏通灵公司“组织智慧”构建为例%The Research of Facilitating, Impeding and Managing Knowledge Sharing in Organizations: A Case Study of Jiangsu Tongling Company

    Institute of Scientific and Technical Information of China (English)

    龙静; 冯帆; 杨忠

    2012-01-01

    In knowledge economy times, human capital and knowledge management are keys to success. According to Barney ( 1991 ), the resources that can provide sustainable competitive advantage should be valuable, unique, not easily imitable, and not easily replaced. Human capital meets all standards of the above, because it is considered as the skills and abilities that employees have as well as enterprise' s reservoir of knowledge. Knowledge is vital for a company to get competitive advantage, and needs to be maximized by being shared in the organization. Therefore, the effective management of knowledge transfer becomes key point of enhancing the competitiveness and maintaining success. Knowledge sharing is an important way of knowledge transfer. In this paper, we first analyzed social psycho- logical factors of knowledge sharing behaviors theoretically, and made five propositions : ( 1 ) Positive attitude will promote knowledge sharing behavior. (2)Social network and sharing language help to create knowledge sharing atmosphere, and promote knowledge sharing attitude and behavior. (3)Trust will encourage positive knowledge sharing attitude, and promote knowledge sharing behavior. (4) Low cost perception or high output perception, self-efficacy, and group identity will encourage positive knowledge sharing attitude, and promote knowledge sharing behavior. (5)Mutual expectation will encourage positive knowledge sharing attitude, and promote knowledge sharing behavior. Then, we use Jiangsu Tongling Company as an example to understand the facilitating and impeding factors of knowledge sharing in this company. Jiangsu TongLing Company was established in 1997, with jewelry sales as its main business. The main products are emeralds and diamonds. Because jewelry sales industry is capital-intensive industry, in order to get the core competitive ability in the market, the company has to focus on effective management and rapid brand promotion. All of this

  6. 新医学模式下的医患合作式决策诊疗辨析%Analysis on Shared Decision Making of Diagnosis and Treatment under New Medical Model

    Institute of Scientific and Technical Information of China (English)

    张锦英

    2015-01-01

    In the medical service system of new medical model ,there are still some disputes on shared decision model by doctor and patient ,which focus on the question of who dominates the medical decision‐making authority .In fact ,this problem itself is a problem .Simply emphasizing on any one party is one‐sided thinking ,and is from one extreme to the other extreme .The result will be without any results .The key point involving shared mode is not a technical problem ,but human problems .Medical model determines the medical service form .The discussion on the cooperation mode is not the ownership of medical decision making ,but how to combining the two together .The key to the transformation is the change of ideas .Trust is the foundation of the cooperation of doctors and patients .Language is a bridge of doctor‐patient coordination and morality is the core of program running .%在新医学模式下的医疗服务领域中,对医患合作式决策模式仍存在着一定争议,其焦点在于医疗的决策权由谁来主导的问题。实际上,这个问题本身就是问题,单纯强调任何一方都是片面的,是从一个极端走向另一个极端,其结果是没有结果。医患合作模式涉及的重点不是技术问题,而是人文问题。医学模式决定着服务方式的形态,医患合作模式探讨的不是医疗决策权的归属问题,而是如何将两者有机结合在一起。其中,理念转变是转型的关键,信任是医患合作的基础,语言是医患协调的桥梁,道德是模式运行的核心。

  7. Learning to Facilitate (Online) Meetings

    DEFF Research Database (Denmark)

    Reimann, Peter; Bull, Susan; Vatrapu, Ravi

    2013-01-01

    We describe an approach to teaching collaboration skills directly by building on competences for meeting facilitation. (Online) meetings provide a rich arena to practice collaboration since they can serve multiple purposes: learning, problem solving, decision making, idea generation and advancement......, etc.. We argue that facilitating meetings is a competence worth developing in students and describe the main knowledge and skill components that pertain to this competence. We then describe some implemented software tools that can be used in schools and colleges to provide opportunities for practicing...... and developing group facilitation skills....

  8. Institutional shared resources and translational cancer research

    Directory of Open Access Journals (Sweden)

    De Paoli Paolo

    2009-06-01

    Full Text Available Abstract The development and maintenance of adequate shared infrastructures is considered a major goal for academic centers promoting translational research programs. Among infrastructures favoring translational research, centralized facilities characterized by shared, multidisciplinary use of expensive laboratory instrumentation, or by complex computer hardware and software and/or by high professional skills are necessary to maintain or improve institutional scientific competitiveness. The success or failure of a shared resource program also depends on the choice of appropriate institutional policies and requires an effective institutional governance regarding decisions on staffing, existence and composition of advisory committees, policies and of defined mechanisms of reporting, budgeting and financial support of each resource. Shared Resources represent a widely diffused model to sustain cancer research; in fact, web sites from an impressive number of research Institutes and Universities in the U.S. contain pages dedicated to the SR that have been established in each Center, making a complete view of the situation impossible. However, a nation-wide overview of how Cancer Centers develop SR programs is available on the web site for NCI-designated Cancer Centers in the U.S., while in Europe, information is available for individual Cancer centers. This article will briefly summarize the institutional policies, the organizational needs, the characteristics, scientific aims, and future developments of SRs necessary to develop effective translational research programs in oncology. In fact, the physical build-up of SRs per se is not sufficient for the successful translation of biomedical research. Appropriate policies to improve the academic culture in collaboration, the availability of educational programs for translational investigators, the existence of administrative facilitations for translational research and an efficient organization

  9. A systematic review of decision aids for patients making a decision about treatment for early breast cancer.

    Science.gov (United States)

    Nicholas Zdenkowski; Butow, Phyllis; Tesson, Stephanie; Boyle, Frances

    2016-04-01

    Several complex treatment decisions may be offered to women with early stage breast cancer, about a range of treatments from different modalities including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids can facilitate shared decision-making and improve decision-related outcomes. We aimed to systematically identify, describe and appraise the literature on treatment decision aids for women with early breast cancer, synthesise the data and identify breast cancer decisions that lack a decision aid. A prospectively developed search strategy was applied to MEDLINE, the Cochrane databases, EMBASE, PsycINFO, Web of Science and abstract databases from major conferences. Data were extracted into a pre-piloted form. Quality and risk of bias were measured using Qualsyst criteria. Results were synthesised into narrative format. Thirty-three eligible articles were identified, evaluating 23 individual treatment decision aids, comprising 13 randomised controlled trial reports, seven non-randomised comparative studies, eight single-arm pre-post studies and five cross-sectional studies. The decisions addressed by these decision aids were: breast conserving surgery versus mastectomy (+/- reconstruction); use of chemotherapy and/or endocrine therapy; radiotherapy; and fertility preservation. Outcome measures were heterogeneous, precluding meta-analysis. Decisional conflict decreased, and knowledge and satisfaction increased, without any change in anxiety or depression, in most studies. No studies were identified that evaluated decision aids for neoadjuvant systemic therapy, or contralateral prophylactic mastectomy. Decision aids are available and improved decision-related outcomes for many breast cancer treatment decisions including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids for neoadjuvant systemic therapy and contralateral prophylactic mastectomy could not be found, and may be warranted.

  10. Principal Leader Behaviour and Shared Decision Making.

    Science.gov (United States)

    Moyle, Colin R. J.

    1979-01-01

    The leadership of the principal is a crucial factor in the functioning of the Instructional Improvement Committees (IICs) in the multiunit schools studies. IICs are representative cabinet-type leadership committees. (Author/IRT)

  11. [Shared decision making: a scoping review].

    Science.gov (United States)

    Guarinoni, Milena Giovanna; Dignani, Lucia; Motta, Paolo Carlo

    2016-01-01

    Scopo. L’obiettivo primario dello studio è implementare e utilizzare uno strumento validato per misurare il fenomeno delle dimissioni difficili, che possa supportare il personale infer- mieristico nella programmazione della dimissione del paziente ricoverato nei reparti di Geria- tria e Medicina. Gli obiettivi secondari sono: - Sperimentare l’utilizzo dell’indice di BRASS - Studiare le caratteristiche della popolazione a rischio di dimissione difficile Metodo. studio osservazionale prospettico per misurare il fenomeno delle dimissioni difficili attraverso l’implementazione dell’indice di BRASS nei reparti di Geriatria e Medicina dell’Ospedale di Rovigo Ulss 18, al fine di studiare le caratteristiche della popolazione a rischio di dimissione difficile. Risultati. In un campione di 165 pazienti il 42,4% (70) era rispettivamente a rischio alto e medio di dimissione difficile, mentre il 15,2% (25) era a basso rischio. La media dei punteggi BRASS era di 18,76. Il 37,6% dei pazienti ad alto rischio erano ricoverati in Geriatria, mentre in Medicina i pazienti si concentrano maggiormente nella classe medio rischio. Conclusioni. Lo studio ha permesso di misurare il fenomeno delle dimissioni difficili classi- ficando i pazienti nei gruppi di rischio. L’analisi delle dimissioni protette ha fatto emergere la congruenza tra punteggio BRASS e caratteristiche del campione. Lo strumento non richiede tempi di compilazione lunghi, è di supporto al processo decisionale dell’infermiere perché rileva la necessità di creare un percorso strutturato sulla dimissione del paziente, in modo sistematico e programmato, evitando la dispersione di informazioni importanti al fin di garantire la continuità assistenziale.

  12. Development of a decision support tool to facilitate primary care management of patients with abnormal liver function tests without clinically apparent liver disease [HTA03/38/02]. Abnormal Liver Function Investigations Evaluation (ALFIE

    Directory of Open Access Journals (Sweden)

    Sullivan Frank M

    2007-04-01

    support tool. Discussion The results of this study will be widely disseminated to primary care, as well as G.I. hospital specialists through publications and presentations at local and national meetings and the project website. This will facilitate optimal decision-making both for the benefit of the patient and the National Health Service.

  13. A scientist's guide to engaging decision makers

    Science.gov (United States)

    Vano, J. A.

    2015-12-01

    Being trained as a scientist provides many valuable tools needed to address society's most pressing environmental issues. It does not, however, provide training on one of the most critical for translating science into action: the ability to engage decision makers. Engagement means different things to different people and what is appropriate for one project might not be for another. However, recent reports have emphasized that for research to be most useful to decision making, engagement should happen at the beginning and throughout the research process. There are an increasing number of boundary organizations (e.g., NOAA's Regional Integrated Sciences and Assessment program, U.S. Department of the Interior's Climate Science Centers) where engagement is encouraged and rewarded, and scientists are learning, often through trial and error, how to effectively include decision makers (a.k.a. stakeholders, practitioners, resource managers) in their research process. This presentation highlights best practices and practices to avoid when scientists engage decision makers, a list compiled through the personal experiences of both scientists and decision makers and a literature review, and how this collective knowledge could be shared, such as through a recent session and role-playing exercise given at the Northwest Climate Science Center's Climate Boot Camp. These ideas are presented in an effort to facilitate conversations about how the science community (e.g., AGU researchers) can become better prepared for effective collaborations with decision makers that will ultimately result in more actionable science.

  14. Facilitating Learning in Multidisciplinary Groups with Transactive CSCL Scripts

    NARCIS (Netherlands)

    Noroozi, O.; Teasley, S.D.; Biemans, H.J.A.; Weinberger, A.; Mulder, M.

    2013-01-01

    Knowledge sharing and transfer are essential for learning in groups, especially when group members have different disciplinary expertise and collaborate online. Computer-Supported Collaborative Learning (CSCL) environments have been designed to facilitate transactive knowledge sharing and transfer i

  15. FDA Facilitates Research on Earlier Stages of Alzheimer's Disease

    Science.gov (United States)

    ... Updates FDA Facilitates Research on Earlier Stages of Alzheimer's Disease Share Tweet Linkedin Pin it More sharing ... disease.” back to top New Paths for New Alzheimer’s Drugs FDA’s draft guidance aims to encourage research ...

  16. Knowledge Management Technology for Decision Support: an empirical examination

    Directory of Open Access Journals (Sweden)

    Meliha Handzic

    2001-11-01

    Full Text Available This paper reports the results of an empirical examination of the effectiveness of one type of knowledge management technology, namely 'contextual knowledge repository', for supporting individual decision makers in a predictive judgement task context. 31 volunteer subjects participated in the study. The results indicate that a given technology was fairly useful, but insufficient to maximally enhance individual decision making. On one hand, subjects were found to extract more knowledge and make significantly smaller decision errors than their notional naive counterparts. On the other hand, subjects tended to extract less knowledge and make significantly larger decision errors compared to notional optimal counterparts. These findings suggest that individuals could potentially benefit from those knowledge management technologies that would provide additional explicit analytical and procedural knowledge, or those that would facilitate sharing of tacit knowledge through interaction with others. Future research is necessary to address these issues.

  17. Collaborative decision-making and promoting treatment adherence in pediatric chronic illness

    Directory of Open Access Journals (Sweden)

    Dennis Drotar

    2010-03-01

    Full Text Available Dennis Drotar, Peggy Crawford, Margaret BonnerCincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USAAbstract: Collaborative or shared decision-making between health care providers and families can facilitate treatment adherence, health outcomes, and satisfaction with care in the management of pediatric chronic illness, but raises special challenges. Barriers such as authoritarian models of medical care as well as absence of time and opportunity for dialogue limit collaborative decision making and can disrupt treatment adherence. However, models of provider-family communication that emphasize communication and shared goal-setting inform an anticipatory guidance model of collaborative decision-making that can enhance treatment adherence. Salient challenges and strategies involved in implementing collaborative decision-making in pediatric chronic illness care are described. Research is needed to: 1 describe the communication and decision-making process in the management of pediatric chronic illness; and 2 evaluate the impact of interventions that enhance collaborative decision-making on provider-family communication, illness management, and treatment adherence.Keywords: collaborative decision-making, shared decision-making, treatment adherence, pediatric chronic illness

  18. Decision Making By Children

    OpenAIRE

    Lundberg, Shelly; Romich, Jennifer; Tsang, Kwok P.

    2007-01-01

    In this paper, we examine the determinants of decision-making power by children and young adolescents. Moving beyond previous economic models that treat children as goods consumed by adults rather than agents, we develop a noncooperative model of parental control of child behavior and child resistance. Using child reports of decision-making and psychological and cognitive measures from the NLSY79 Child Supplement, we examine the determinants of shared and sole decision-making in seven domains...

  19. Facilitating Value Co-Creation

    DEFF Research Database (Denmark)

    Veith, Anne; Assaf, Albert; Josiassen, Alexander

    2013-01-01

    ) introduced a new dominant logic in the marketing literature, the Service-Dominant Logic (S-D Logic), in which service, interactions, and enhanced experiences help create value, and this potential for value is what attracts consumers. Therefore organizations must be customer-centric in order to facilitate...... unique, positive experiences. As the name indicates, both organizations and consumers (should) obtain value when co-creating, which is why both parties are willing to increase their degree of involvement, e.g. spending more resources, sharing tacit knowledge, etc., because a high degree of involvement....... Through an exploratory qualitative study, 9 facilitators for B2C value co-creation were uncovered. The study was set in the creative industries. The 9 facilitators are a combination of the main facilitators found in the literature review and the ones found through the empirical research. The 9...

  20. An analysis from the Quality Outcomes Database, Part 1. Disability, quality of life, and pain outcomes following lumbar spine surgery: predicting likely individual patient outcomes for shared decision-making.

    Science.gov (United States)

    McGirt, Matthew J; Bydon, Mohamad; Archer, Kristin R; Devin, Clinton J; Chotai, Silky; Parker, Scott L; Nian, Hui; Harrell, Frank E; Speroff, Theodore; Dittus, Robert S; Philips, Sharon E; Shaffrey, Christopher I; Foley, Kevin T; Asher, Anthony L

    2017-10-01

    of the 4 separate novel predictive models was good, with a c-index of 0.69 for ODI, 0.69 for EQ-5D, 0.67 for NRS-BP, and 0.64 for NRS-LP (i.e., good concordance between predicted outcomes and observed outcomes). CONCLUSIONS This study found that preoperative patient-specific factors derived from a prospective national outcomes registry significantly influence PRO measures of treatment effectiveness at 12 months after lumbar surgery. Novel predictive models constructed with these data hold the potential to improve surgical effectiveness and the overall value of spine surgery by optimizing patient selection and identifying important modifiable factors before a surgery even takes place. Furthermore, these models can advance patient-focused care when used as shared decision-making tools during preoperative patient counseling.

  1. Shared Millennium use in a research and academic library

    CSIR Research Space (South Africa)

    Joubert, A

    2007-09-01

    Full Text Available This paper presents an overview of a shared integrated catalogue by two different institutions, using the Innovative Millennium system. Looks at the factors that lead to the decision to share the OPAC and highlights the main points...

  2. Sharing values, sharing a vision

    Energy Technology Data Exchange (ETDEWEB)

    1993-12-31

    Teamwork, partnership and shared values emerged as recurring themes at the Third Technology Transfer/Communications Conference. The program drew about 100 participants who sat through a packed two days to find ways for their laboratories and facilities to better help American business and the economy. Co-hosts were the Lawrence Livermore National Laboratory and the Lawrence Berkeley Laboratory, where most meetings took place. The conference followed traditions established at the First Technology Transfer/Communications Conference, conceived of and hosted by the Pacific Northwest Laboratory in May 1992 in Richmond, Washington, and the second conference, hosted by the National Renewable Energy Laboratory in January 1993 in Golden, Colorado. As at the other conferences, participants at the third session represented the fields of technology transfer, public affairs and communications. They came from Department of Energy headquarters and DOE offices, laboratories and production facilities. Continued in this report are keynote address; panel discussion; workshops; and presentations in technology transfer.

  3. LC Data QUEST: A Technical Architecture for Community Federated Clinical Data Sharing.

    Science.gov (United States)

    Stephens, Kari A; Lin, Ching-Ping; Baldwin, Laura-Mae; Echo-Hawk, Abigail; Keppel, Gina A; Buchwald, Dedra; Whitener, Ron J; Korngiebel, Diane M; Berg, Alfred O; Black, Robert A; Tarczy-Hornoch, Peter

    2012-01-01

    The University of Washington Institute of Translational Health Sciences is engaged in a project, LC Data QUEST, building data sharing capacity in primary care practices serving rural and tribal populations in the Washington, Wyoming, Alaska, Montana, Idaho region to build research infrastructure. We report on the iterative process of developing the technical architecture for semantically aligning electronic health data in primary care settings across our pilot sites and tools that will facilitate linkages between the research and practice communities. Our architecture emphasizes sustainable technical solutions for addressing data extraction, alignment, quality, and metadata management. The architecture provides immediate benefits to participating partners via a clinical decision support tool and data querying functionality to support local quality improvement efforts. The FInDiT tool catalogues type, quantity, and quality of the data that are available across the LC Data QUEST data sharing architecture. These tools facilitate the bi-directional process of translational research.

  4. Shared Memories?

    DEFF Research Database (Denmark)

    Wæhrens, Anne

    2011-01-01

    This paper analyses how the memory of the Holocaust has been addressed in the European Parliament from 1989 to 2009. I identify two major changes that occurred in the 1990s and after the 2004 enlargement of the European Union respectively. In the 1990s the war in Bosnia and the question of restit......This paper analyses how the memory of the Holocaust has been addressed in the European Parliament from 1989 to 2009. I identify two major changes that occurred in the 1990s and after the 2004 enlargement of the European Union respectively. In the 1990s the war in Bosnia and the question...... of restitution universalised the memory of the Holocaust and made it present. The 2004 enlargement brought the memory of Soviet Communism into the Union and made it a central task to construct a community of memory that includes both the memory of the Holocaust and of Soviet Communism. The analysis also...... identifies what seems to be a political memory split between Left and Right; and it shows that the time might not be ripe for a shared European memory....

  5. Information sharing promotes prosocial behaviour

    CERN Document Server

    Szolnoki, Attila

    2013-01-01

    More often than not, bad decisions are bad regardless of where and when they are made. Information sharing might thus be utilized to mitigate them. Here we show that sharing the information about strategy choice between players residing on two different networks reinforces the evolution of cooperation. In evolutionary games the strategy reflects the action of each individual that warrants the highest utility in a competitive setting. We therefore assume that identical strategies on the two networks reinforce themselves by lessening their propensity to change. Besides network reciprocity working in favour of cooperation on each individual network, we observe the spontaneous emerge of correlated behaviour between the two networks, which further deters defection. If information is shared not just between individuals but also between groups, the positive effect is even stronger, and this despite the fact that information sharing is implemented without any assumptions with regards to content.

  6. Information sharing promotes prosocial behaviour

    Science.gov (United States)

    Szolnoki, Attila; Perc, Matjaž

    2013-05-01

    More often than not, bad decisions are bad regardless of where and when they are made. Information sharing might thus be utilized to mitigate them. Here we show that sharing information about strategy choice between players residing on two different networks reinforces the evolution of cooperation. In evolutionary games, the strategy reflects the action of each individual that warrants the highest utility in a competitive setting. We therefore assume that identical strategies on the two networks reinforce themselves by lessening their propensity to change. Besides network reciprocity working in favour of cooperation on each individual network, we observe the spontaneous emergence of correlated behaviour between the two networks, which further deters defection. If information is shared not just between individuals but also between groups, the positive effect is even stronger, and this despite the fact that information sharing is implemented without any assumptions with regard to content.

  7. Modifiers for quality assurance in group facilitation

    NARCIS (Netherlands)

    Kolfschoten, G.L.; Grünbacher, P.; Briggs, R.O.

    2011-01-01

    A key task of a professional facilitator is to assure the quality of the knowledge products created through collaborative effort. To manage the quality of the knowledge a group generates, facilitators attend to, judge, and question the quality of the contributions a group makes, the decisions it mak

  8. Increasing public awareness and facilitating behavior change: Two guiding heuristics

    Science.gov (United States)

    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.

  9. Electronic Communication and Decision Making.

    Science.gov (United States)

    Feldman, M. S.; Sarbaugh-Thompson, M.

    1996-01-01

    Electronic communication can either facilitate or sabotage decision-making contexts. This article formulates recommendations about when and how to use electronic communication to enhance decision making and describes various decision contexts. Solutions to communication problems such as groupthink, social deadlock, bureaucratic isolation from…

  10. Shared governance in the endoscopy department.

    Science.gov (United States)

    Metcalf, R; Tate, R

    1995-01-01

    Studies have indicated that active participation by employees improves job satisfaction and performance. There is a sense of pride and accountability that is demonstrated in the work environment when staff are involved in the decision-making process. Recent emergence of a relatively new philosophy for management that promotes employee ownership is shared governance. This type of leadership allows individuals who are at the center of the work place to participate in the decisions that actively reflect their needs. In this article, the authors describe the process of implementing shared governance in an Endoscopy Department. The effectiveness of shared governance is evidenced by the renewed enthusiasm and energy demonstrated by the staff.

  11. Facilitering som styringsredskab

    OpenAIRE

    Jørgensen, Karen Overgaard

    2006-01-01

    #This thesis surveys facilitation as a new tool of steering within the public sector in Denmark. It is explored how facilitation is articulated and practiced among facilitators from the public, private and voluntary sector. Furthermore, the facilitator’s challenges by using facilitation are examined. The thesis is based on the presumption that facilitation is articulated by rationalities, which influence how facilitation is practiced and performed. Also, a facilitator is seen as a performer a...

  12. Capacity sharing of water reservoirs

    Science.gov (United States)

    Dudley, Norman J.; Musgrave, Warren F.

    1988-05-01

    The concept of a water use property right is developed which does not apply to water volumes as such but to a share of the capacity (not contents) of river storage reservoirs and their inflows. The shareholders can withdraw water from their share over time in accordance with their preferences for stability of water deliveries. The reservoir authority does not manage reservoir releases but keeps record of individual shareholder's withdrawals and net inflows to monitor the quantity of water in each shareholder's capacity share. A surplus of total reservoir contents over the sum of the contents of the individual shareholder's capacity shares will accrue over time. Two different criteria for its periodic distribution among shareholders are compared. A previous paper Dudley (this issue(b)) noted a loss of short-run economic efficiency as reservoir and farm management decision making become separated. This is largely overcome by capacity sharing which allows each user to integrate the management of their portion of the reservoir and their farming operations. The nonattenuated nature of the capacity sharing water rights also promotes long-run economic efficiency.

  13. Interim report on the scientific investigations in the Animas River watershed, Colorado to facilitate remediation decisions by the U.S. Bureau of Land Management and the U.S. Forest Service, March 29, 2000 meeting, Denver, Colorado

    Science.gov (United States)

    ,

    2000-01-01

    INTRODUCTION The joint U.S. Department of the Interior and U.S. Department of Agriculture Abandoned Mine Lands Initiative (AMLI) was developed as a collaborative effort between the Federal land management agencies (FLMA, that is the U.S. Bureau of Land Management and the U.S. Forest Service) and the U.S. Geological Survey (USGS) in 1996. The stated goal of the AML Initiative was to develop a strategy for gathering and communicating the scientific information needed to develop effective and cost-efficient remediation of abandoned mines within the framework of a watershed. Four primary objectives of the AMLI are to: 1. Provide the scientific information needed (in the short-term) by the FLMAs to make decisions related to the design and implementation of cleanup actions, 2. Develop a multi-disciplined, multi-division approach that integrates geologic, hydrologic, geochemical and ecological information into a knowledge base for sound decision making, 3. Transfer technologies developed within the scientific programs of the USGS to the field and demonstrate their suitability to solve real, practical problems, and 4. Establish working relationships among involved members of land management and regulatory agencies within the framework of a watershed approach to the cleanup of abandoned mines. Long-term process-based research, including development of analytical tools, is recognized as being critical to the long-term success in remediating watersheds impacted by historical mining activities (AML 5-year plan, http://amli.usgs.gov/amli). In a meeting of Federal agencies (U.S. Bureau of Land Management [BLM], U.S. Bureau of Reclamation [BOR], U.S. National Park Service [NPS], U.S. Forest Service [USFS], the U.S. Environmental Protection Agency [EPA], the U.S. Fish and Wildlife Service [F&WS]), and State agencies (Colorado Division of Public Health and Environment, Colorado Division of Mines and Geology), several watersheds were examined within the state whose water quality was

  14. The design decision trail

    OpenAIRE

    Attenburrow, Derek H

    2012-01-01

    This was a published paper presented at the International Conference on Engineering and Product Design Education on the 6th and 7th of September 2012 at the Artisis University College, Antwerp, Belgium. The Design Decision Trail is a student produced, visual narrative of a design project. It includes the signposting of key design decision points within the edited from the project. It is used to share information with student peers, tutors and potential employers. It is now being used in both ...

  15. Software Facilitates Sharing of Water Quality Data Worldwide

    Science.gov (United States)

    2015-01-01

    John Freighery was an environmental engineer at Johnson Space Center when a new, simplified version of the coliform bacteria test was developed for astronaut use on the International Space Station. Through his New York City-based mWater Foundation, Freighery is using the test to help rural communities monitor their water supplies for contamination. The organization has also developed a mobile phone app to make the information publicly available.

  16. Shared Cognition Facilitated by Teacher Use of Interactive Whiteboard Technologies

    Science.gov (United States)

    Redman, Christine; Vincent, John

    2014-01-01

    This paper reports on a study designed to examine the dialogic processes teachers used to sustain focused discussions, using questioning techniques and Interactive Whiteboards (IWBs). IWBs and their related technologies such as plasma touch screens and projected tablets have passed through several phases of implementation as classroom objects,…

  17. Shortcomings in Information Sharing Facilitates Transnational Organized Crime

    Science.gov (United States)

    2017-06-09

    Despite a long and successful history of dismantling criminal organizations and developing common international standards for cooperation against...affect national economic and security interests.184 The impacts of these powerful criminal organizations prevent the development of weak states...TOC organizationally differ? Both terrorist and TOC organizations are criminal organizations . These criminal organizations are only distinguishable

  18. Multicriteria decision analysis: Overview and implications for environmental decision making

    Science.gov (United States)

    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.

  19. Decision-making Mechanism for Knowledge Sharing in Reverse Supply Chain%逆向供应链企业间知识共享的决策机制研究

    Institute of Scientific and Technical Information of China (English)

    张旭梅; 黄陈宣

    2013-01-01

    针对由单一制造商和单一第三方回收商组成的两级逆向供应链,建立了逆向供应链企业间知识共享的博弈模型;通过该模型得出了逆向供应链知识共享的均衡策略,进一步探讨了逆向供应链知识共享的2个合作条件:①制造商在成本节约收益中的分享比例必须大于某个阈值,②制造商所获得的整体收益比例必须大于制造商的知识共享成本分担比例;最后分析了知识共享成本分担比例和总体回收量对知识共享量的影响,以及成本节约收益共享比例和边际收益对知识共享成本分担比例的影响.%Aiming at two-stage reverse supply chain which consists of one manufacturer and one third-party recycler, a game model of knowledge sharing among reverse supply chain enterprises is proposed. Then the equilibrium strategies of knowledge sharing in reverse supply chain are indicated with the model. Furthermore, two conditions for cooperation are also discussed in the paper, which are: i) manufacturers' share ratio of cost saving must be greater than a threshold value; ii) manufacturers' proportion of the overall benefits must be greater than manufacturers' cost-sharing ratio of knowledge sharing. Finally, the cost-sharing ratio of knowledge sharing and the amount of overall recycling which have effect on the amount of knowledge sharing and the cost-sharing ratio and marginal revenue which have effect on the cost-sharing ratio of knowledge sharing are both analyzed.

  20. Decision and decision makers

    Directory of Open Access Journals (Sweden)

    Anuta Porutiu

    2010-12-01

    Full Text Available In the current economic context, decision making requires complex and multiple actions on the part of the policy makers, who are more challenged than in previous situations, due to the crisis that we are facing. Decision problems cannot be solved by focusing on manager’s own experience or intuition, but require constant adaptation of the methods used effectively in the past to new challenges. Thus, a systemic analysis and modeling of arising issues is required, resulting in the stringent use of Decision Support Systems (DSS, as a necessity in a competitive environment. DSS optimize the situation by getting a timely decision because the decision making process must acquire, process and interpret an even larger amount of data in the shortest possible time. A solution for this purpose is the artificial intelligence systems, in this case Decision Support Systems (DSS, used in a wider area due to expansion of all the new information technologies in decisionmaking processes. These substantial cyber innovations have led to a radical shift in the relationship between enterprise success and quality of decisions made by managers.

  1. Communication from the Information Sharing Working Group: Agreement for Data Sharing Among Caribbean Foresters

    Science.gov (United States)

    Tamara Heartsill Scalley; Saara DeWalt; François Korysko; Guy Van Laere; Kasey Jacobs; Seth Panka; Joseph Torres

    2016-01-01

    We presented a new information-sharing platform at the 16th Caribbean Foresters Meeting in August 2013 to facilitate and promote collaboration among Caribbean foresters. The platform can be accessed through the Caribbean Foresters website where information and data on forest research sites can be shared. There is a special focus on identifying potential collaborations...

  2. The Cross-Cultural Knowledge Sharing Challenge

    DEFF Research Database (Denmark)

    Persson, John Stouby

    2013-01-01

    Cross-cultural offshoring in software development challenges effective knowledge sharing. While research has suggested temporarily co-locating participants to address this challenge, few studies are available on what knowledge sharing practices emerge over time when co-locating cross-cultural sof......Cross-cultural offshoring in software development challenges effective knowledge sharing. While research has suggested temporarily co-locating participants to address this challenge, few studies are available on what knowledge sharing practices emerge over time when co-locating cross......-cultural software developers. This paper presents a longitudinal case study of an offshoring project with co-location of Indian and Danish software developers for 10½ months. A community-of-practice (CoP) analysis is offered of what knowledge sharing practices emerge over time and how these where facilitated...... period of colocation four facilitators of cross-cultural knowledge sharing were shared office, shared responsibility for tasks and problems, shared prioritization of team spirit, and a champion of social integration....

  3. 基于后台分离与共享的自然资源型景区空间新结构及应用决策模型研究%The Decision-making Model on Adoption of the New Spatial Structure of Nature-based Scenic Spot Based on Decoupling and Sharing of Back Stage Functions

    Institute of Scientific and Technical Information of China (English)

    陈觉; CLERGEAUCécile; 王婧

    2014-01-01

    There are several common problems in planning and managing the scenic spots,namely the environment pollution, tight land-use,low resource utilization and poor service quality controlling,which are to great extent closely related to the unbal-ance of front and back stage structure of the scenic spot as a whole.The paper proposes a new spatial structure for scenic spot based on back stage decoupling and sharing to settle these problems by incorporating the experiences from financial industry and theory of service system structure.A decision-making model for whether adopting the new structure is also proposed.The envi-ronment quality costs and service provision costs are used to compare the possible benefits in costs efficiency,service quality and environment protection between the new and traditional structures.A concept of “standard operation unit”is defined to facilitate the calculation of the overall scale of the companies of scenic spot.Based on the costs analysis the minimum quantity of the stand-ard operation units could be determined and used for decision-making on the adoption of the new structure.%环境污染、用地紧张、资源利用效率低以及服务质量管理难度大等是自然资源型景区规划与管理中容易出现的几个问题,这些问题的原因很大程度上与景区的前后台总体结构失衡有关。借鉴金融业的经验,结合服务系统前后台结构理论,提出了以后台功能分离与服务共享中心、建立为主要内容的景区空间新结构,为解决景区这些问题提供新思路。在此基础上分析了新结构应用的条件并据此构建了应用决策模型。在决策模型中引入了基准经营单位的概念,用以表述和测算景区内各类旅游企业的经营规模及其总和,再采用环境质量成本和服务提供成本两个经济指标作为考量新旧结构各自效果的主要依据,而后通过这两种成本的比较分析确定有效实施新结构

  4. Building a data sharing model for global genomic research.

    Science.gov (United States)

    Kosseim, Patricia; Dove, Edward S; Baggaley, Carman; Meslin, Eric M; Cate, Fred H; Kaye, Jane; Harris, Jennifer R; Knoppers, Bartha M

    2014-08-11

    Data sharing models designed to facilitate global business provide insights for improving transborder genomic data sharing. We argue that a flexible, externally endorsed, multilateral arrangement, combined with an objective third-party assurance mechanism, can effectively balance privacy with the need to share genomic data globally.

  5. Sharing Knowledge: Contextualising Socio-Technical Thinking and Practice

    Science.gov (United States)

    Sondergaard, Susanne; Kerr, Micky; Clegg, Chris

    2007-01-01

    Purpose: The purpose of this research is to present the empirical findings from a case study in knowledge sharing with the aim of understanding knowledge sharing in a strategic context through a socio-technical approach. Design/methodology/approach: Knowledge sharing facilitators and barriers were examined in a UK owned multinational engineering…

  6. Knowledge Sharing Strategies for Large Complex Building Projects.

    Directory of Open Access Journals (Sweden)

    Esra Bektas

    2013-06-01

    Full Text Available The construction industry is a project-based sector with a myriad of actors such as architects, construction companies, consultants, producers of building materials (Anumba et al., 2005. The interaction between the project partners is often quite limited, which leads to insufficient knowledge sharing during the project and knowledge being unavailable for reuse (Fruchter et al. 2002. The result can be a considerable amount of extra work, delays and cost overruns. Design outcomes that are supposed to function as boundary objects across different disciplines can lead to misinterpretation of requirements, project content and objectives. In this research, knowledge is seen as resulting from social interactions; knowledge resides in communities and it is generated through social relationships (Wenger 1998, Olsson et al. 2008. Knowledge is often tacit, intangible and context-dependent and it is articulated in the changing responsibilities, roles, attitudes and values that are present in the work environment (Bresnen et al., 2003. In a project environment, knowledge enables individuals to solve problems, take decisions, and apply these decisions to actions. In order to achieve a shared understanding and minimize the misunderstanding and misinterpretations among project actors, it is necessary to share knowledge (Fong 2003.Sharing knowledge is particularly crucial in large complex building projects (LCBPs in order to accelerate the building process, improve architectural quality and prevent mistakes or undesirable results. However, knowledge sharing is often hampered through professional or organizational boundaries or contractual concerns. When knowledge is seen as an organizational asset, there is little willingness among project organizations to share their knowledge. Individual people may recognize the need to promote knowledge sharing throughout the project, but typically there is no deliberate strategy agreed by all project partners to address

  7. Right choice, right time: Evaluation of an online decision aid for youth depression.

    Science.gov (United States)

    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.

  8. Visual Storyboarding Provides a Conceptual Bridge from Research to Development: Students Can Imagine the Results of Their Decision Making, and Their Prioritization of the Many Facets of the Design Problem Will Facilitate the Development of a Strong Final Solution

    Science.gov (United States)

    Reeder, Kevin

    2005-01-01

    In order to facilitate the selection/prioritization process and bridge the gap of design research to design conceptualization, students need to visualize the big picture that describes how the research categories such as "user," "marketing," "functional/mechanical research" are related. This is achieved through the use of a visual storyboard. The…