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

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Hunt, C; Lewin, S

2000-01-01

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

Women’s Health Decision-Making Autonomy and Skilled Birth Attendance in Ghana

Directory of Open Access Journals (Sweden)

Edward Kwabena Ameyaw

2016-01-01

Full Text Available Delivering in health facility under the supervision of skilled birth attendant is an important way of mitigating impacts of delivery complications. Empirical evidence suggests that decision-making autonomy is aligned with holistic wellbeing especially in the aspect of maternal and child health. The objective of this paper was to examine the relationship between women’s health decision-making autonomy and place of delivery in Ghana. We extracted data from the 2014 Ghana Demographic and Health Survey. Descriptive and logistic regression techniques were applied. The results indicated that women with health decision-making autonomy have higher tendency of health facility delivery as compared to those who are not autonomous [OR = 1.27, CI = 1.09–1.48]. However, those who have final say on household large purchases [OR = 0.71, CI = 0.59–0.84] and those having final say on visits [OR = 0.86, CI = 0.73–1.01] were less probable to deliver in health facility than those without such decision-making autonomy. Consistent with existing evidence, wealthier, urban, and highly educated women had higher inclination of health facility delivery. This study has stressed the need for interventions aimed at enhancing health facility delivery to target women without health decision-making autonomy and women with low education and wealth status, as this can play essential role in enhancing health facility delivery.

[Transparency in public health decision-making].

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García-Altés, Anna; Argimon, Josep M

2016-11-01

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

Supporting decision-making processes for evidence-based mental health promotion.

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Jané-Llopis, Eva; Katschnig, Heinz; McDaid, David; Wahlbeck, Kristian

2011-12-01

The use of evidence is critical in guiding decision-making, but evidence from effect studies will be only one of a number of factors that will need to be taken into account in the decision-making processes. Equally important for policymakers will be the use of different types of evidence including implementation essentials and other decision-making principles such as social justice, political, ethical, equity issues, reflecting public attitudes and the level of resources available, rather than be based on health outcomes alone. This paper, aimed to support decision-makers, highlights the importance of commissioning high-quality evaluations, the key aspects to assess levels of evidence, the importance of supporting evidence-based implementation and what to look out for before, during and after implementation of mental health promotion and mental disorder prevention programmes.

Rationality versus reality: the challenges of evidence-based decision making for health policy makers.

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McCaughey, Deirdre; Bruning, Nealia S

2010-05-26

Current healthcare systems have extended the evidence-based medicine (EBM) approach to health policy and delivery decisions, such as access-to-care, healthcare funding and health program continuance, through attempts to integrate valid and reliable evidence into the decision making process. These policy decisions have major impacts on society and have high personal and financial costs associated with those decisions. Decision models such as these function under a shared assumption of rational choice and utility maximization in the decision-making process. We contend that health policy decision makers are generally unable to attain the basic goals of evidence-based decision making (EBDM) and evidence-based policy making (EBPM) because humans make decisions with their naturally limited, faulty, and biased decision-making processes. A cognitive information processing framework is presented to support this argument, and subtle cognitive processing mechanisms are introduced to support the focal thesis: health policy makers' decisions are influenced by the subjective manner in which they individually process decision-relevant information rather than on the objective merits of the evidence alone. As such, subsequent health policy decisions do not necessarily achieve the goals of evidence-based policy making, such as maximizing health outcomes for society based on valid and reliable research evidence. In this era of increasing adoption of evidence-based healthcare models, the rational choice, utility maximizing assumptions in EBDM and EBPM, must be critically evaluated to ensure effective and high-quality health policy decisions. The cognitive information processing framework presented here will aid health policy decision makers by identifying how their decisions might be subtly influenced by non-rational factors. In this paper, we identify some of the biases and potential intervention points and provide some initial suggestions about how the EBDM/EBPM process can be

Rationality versus reality: the challenges of evidence-based decision making for health policy makers

Directory of Open Access Journals (Sweden)

Bruning Nealia S

2010-05-01

Full Text Available Abstract Background Current healthcare systems have extended the evidence-based medicine (EBM approach to health policy and delivery decisions, such as access-to-care, healthcare funding and health program continuance, through attempts to integrate valid and reliable evidence into the decision making process. These policy decisions have major impacts on society and have high personal and financial costs associated with those decisions. Decision models such as these function under a shared assumption of rational choice and utility maximization in the decision-making process. Discussion We contend that health policy decision makers are generally unable to attain the basic goals of evidence-based decision making (EBDM and evidence-based policy making (EBPM because humans make decisions with their naturally limited, faulty, and biased decision-making processes. A cognitive information processing framework is presented to support this argument, and subtle cognitive processing mechanisms are introduced to support the focal thesis: health policy makers' decisions are influenced by the subjective manner in which they individually process decision-relevant information rather than on the objective merits of the evidence alone. As such, subsequent health policy decisions do not necessarily achieve the goals of evidence-based policy making, such as maximizing health outcomes for society based on valid and reliable research evidence. Summary In this era of increasing adoption of evidence-based healthcare models, the rational choice, utility maximizing assumptions in EBDM and EBPM, must be critically evaluated to ensure effective and high-quality health policy decisions. The cognitive information processing framework presented here will aid health policy decision makers by identifying how their decisions might be subtly influenced by non-rational factors. In this paper, we identify some of the biases and potential intervention points and provide some initial

Rationality versus reality: the challenges of evidence-based decision making for health policy makers

Science.gov (United States)

2010-01-01

Background Current healthcare systems have extended the evidence-based medicine (EBM) approach to health policy and delivery decisions, such as access-to-care, healthcare funding and health program continuance, through attempts to integrate valid and reliable evidence into the decision making process. These policy decisions have major impacts on society and have high personal and financial costs associated with those decisions. Decision models such as these function under a shared assumption of rational choice and utility maximization in the decision-making process. Discussion We contend that health policy decision makers are generally unable to attain the basic goals of evidence-based decision making (EBDM) and evidence-based policy making (EBPM) because humans make decisions with their naturally limited, faulty, and biased decision-making processes. A cognitive information processing framework is presented to support this argument, and subtle cognitive processing mechanisms are introduced to support the focal thesis: health policy makers' decisions are influenced by the subjective manner in which they individually process decision-relevant information rather than on the objective merits of the evidence alone. As such, subsequent health policy decisions do not necessarily achieve the goals of evidence-based policy making, such as maximizing health outcomes for society based on valid and reliable research evidence. Summary In this era of increasing adoption of evidence-based healthcare models, the rational choice, utility maximizing assumptions in EBDM and EBPM, must be critically evaluated to ensure effective and high-quality health policy decisions. The cognitive information processing framework presented here will aid health policy decision makers by identifying how their decisions might be subtly influenced by non-rational factors. In this paper, we identify some of the biases and potential intervention points and provide some initial suggestions about how the

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

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

2015-11-01

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

Criteria for Drug Reimbursement Decision-Making: An Emerging Public Health Challenge in Bulgaria

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Georgi Iskrov

2016-02-01

Full Text Available Background: During times of fiscal austerity, means of reimbursement decision-making are of particular interest for public health theory and practice. Introduction of advanced health technologies, growing health expenditures and increased public scrutiny over drug reimbursement decisions have pushed governments to consider mechanisms that promote the use of effective health technologies, while constraining costs. Aims: The study’s aim was to explore the current rationale of the drug reimbursement decision-making framework in Bulgaria. Our pilot research focused on one particular component of this process – the criteria used – because of the critical role that criteria are known to have in setting budgets and priorities in the field of public health. The analysis pursued two objectives: to identify important criteria relevant to drug reimbursement decision-making and to unveil relationships between theory and practice. Study Design: Cross-sectional study. Methods: The study was realized through a closed-ended survey on reimbursement criteria among four major public health stakeholders – medical professionals, patients, health authorities, and industry. Empirical outcomes were then cross-compared with the theoretical framework, as defined by current Bulgarian public health legislation. Analysis outlined what is done and what needs to be done in the field of public health reimbursement decision-making. Results: Bulgarian public health stakeholders agreed on 15 criteria to form a tentative optimal framework for drug reimbursement decision-making. The most apparent gap between the empirically found preferences and the official legislation is the lack of consideration for the strength of evidence in reimbursement decisions. Conclusion: Bulgarian policy makers need to address specific gaps, such as formal consideration for strength of evidence, explicit role of efficiency criteria, and means to effectively empower patient and citizen

Cognitive level and health decision-making in children: A preliminary study.

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Okwumabua, J O; Okwumabua, T M; Hayes, A; Stovall, K

1994-06-01

The study examines children's stage of cognitive development in relation to their patterns of health decision-making, including their cognitive capabilities in integrating the sequential stages of the decision-making process. A sample of 81 male (N=33) and female (N=48) students were drawn from two urban public schools in West Tennessee. All participants in the study were of African-American descent. The Centers for Disease Control Decision-Making Instrument was used to assess students' decision-making as well as their understanding of the decision-making process. The children's cognitive level was determined by their performance on three Piagetian conservation tasks. Findings revealed that both the preoperational and concrete operational children performed significantly below the formal operational children in terms of total correct responses to the decision-making scenarios. Error type analyses indicated that the preoperational children made more errors involving "skipped step" than did either the concrete or formal operational children. There were no significant differences between children's level of cognitive development and any other error type. Implications for health promotion and disease prevention programs among prevention practitioners who work regularly with children are discussed.

Multi-criteria decision making--an approach to setting priorities in health care.

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Nobre, F F; Trotta, L T; Gomes, L F

1999-12-15

The objective of this paper is to present a multi-criteria decision making (MCDM) approach to support public health decision making that takes into consideration the fuzziness of the decision goals and the behavioural aspect of the decision maker. The approach is used to analyse the process of health technology procurement in a University Hospital in Rio de Janeiro, Brazil. The method, known as TODIM, relies on evaluating alternatives with a set of decision criteria assessed using an ordinal scale. Fuzziness in generating criteria scores and weights or conflicts caused by dealing with different viewpoints of a group of decision makers (DMs) are solved using fuzzy set aggregation rules. The results suggested that MCDM models, incorporating fuzzy set approaches, should form a set of tools for public health decision making analysis, particularly when there are polarized opinions and conflicting objectives from the DM group. Copyright 1999 John Wiley & Sons, Ltd.

Shared decision making interventions for people with mental health conditions.

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Duncan, Edward; Best, Catherine; Hagen, Suzanne

2010-01-20

One person in every four will suffer from a diagnosable mental health condition during their life course. Such conditions can have a devastating impact on the lives of the individual, their family and society. Increasingly partnership models of mental health care have been advocated and enshrined in international healthcare policy. Shared decision making is one such partnership approach. Shared decision making is a form of patient-provider communication where both parties are acknowledged to bring expertise to the process and work in partnership to make a decision. This is advocated on the basis that patients have a right to self-determination and also in the expectation that it will increase treatment adherence. To assess the effects of provider-, consumer- or carer-directed shared decision making interventions for people of all ages with mental health conditions, on a range of outcomes including: patient satisfaction, clinical outcomes, and health service outcomes. We searched: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2008, Issue 4), MEDLINE (1950 to November 2008), EMBASE (1980 to November 2008), PsycINFO (1967 to November 2008), CINAHL (1982 to November 2008), British Nursing Index and Archive (1985 to November 2008) and SIGLE (1890 to September 2005 (database end date)). We also searched online trial registers and the bibliographies of relevant papers, and contacted authors of included studies. Randomised controlled trials (RCTs), quasi-randomised controlled trials (q-RCTs), controlled before-and-after studies (CBAs); and interrupted time series (ITS) studies of interventions to increase shared decision making in people with mental health conditions (by DSM or ICD-10 criteria). Data on recruitment methods, eligibility criteria, sample characteristics, interventions, outcome measures, participant flow and outcome data from each study were extracted by one author and checked by another. Data are presented in a narrative

Decision Making and Cancer

OpenAIRE

Reyna, Valerie F.; Nelson, Wendy L.; Han, Paul K.; Pignone, Michael P.

2015-01-01

We review decision-making along the cancer continuum in the contemporary context of informed and shared decision making, in which patients are encouraged to take a more active role in their health care. We discuss challenges to achieving informed and shared decision making, including cognitive limitations and emotional factors, but argue that understanding the mechanisms of decision making offers hope for improving decision support. Theoretical approaches to decision making that explain cogni...

Personality and Health Care Decision-Making Style

OpenAIRE

Kathryn E. Flynn; Maureen A. Smith

2007-01-01

Using the Wisconsin Longitudinal Study Graduate Survey (N = 5,830), a population-based cohort of older adults (most aged 63–66 years), we explored relationships between five factors of personality and four preference types that account for multiple components of the health care decision-making process (information exchange, deliberation, and selection of treatment choice). After adjustment for personal, health, social, and economic factors, we found that increased conscientiousness and openne...

Implementing shared decision making in routine mental health care.

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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.

The impact of health and financial literacy on decision making in community-based older adults.

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James, Bryan D; Boyle, Patricia A; Bennett, Jarred S; Bennett, David A

2012-01-01

Health and financial literacy have been linked to the health and well-being of older adults, yet there are few data on how health and financial literacy actually impact decision making regarding healthcare and economic choices in advanced age. To examine the association of health and financial literacy with decision making in older adults. Data came from 525 community-dwelling older persons without dementia from the Rush Memory and Aging Project, an ongoing longitudinal study of aging. Health and financial literacy were assessed via a series of questions designed to measure comprehension of health and financial information and concepts. The two scores were averaged to yield a total literacy score. A modified, 12-item version of the Decision-Making Competence Assessment Tool was used to measure financial and healthcare decision making (6 items each), using materials designed to approximate those used in real world settings. All 12 items were summed to yield a total decision-making score. Associations were tested via linear regression models adjusted for age, sex and education. Secondary models adjusted for global cognitive function, income, depression and chronic medical conditions. On average, participants correctly answered 67% of the literacy questions (health literacy = 61.6%, SD = 18.8% and financial literacy = 72.5%, SD = 16.0%). After adjustment for cognitive function, the total literacy score was positively associated with the decision-making total score (estimate = 0.64, SE = 0.08, p financial decision making (estimate = 0.28, SE = 0.05, p literacy, health and financial literacy all were independently associated with decision making in models adjusted for covariates including income, depression, and chronic medical conditions (all p values literacy and healthcare decision making was stronger among older persons, poorer persons and persons at the lower ranges of cognitive ability. Among community based older persons without dementia, higher levels of health

An exploration of clinical decision making in mental health triage.

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Sands, Natisha

2009-08-01

Mental health (MH) triage is a specialist area of clinical nursing practice that involves complex decision making. The discussion in this article draws on the findings of a Ph.D. study that involved a statewide investigation of the scope of MH triage nursing practice in Victoria, Australia. Although the original Ph.D. study investigated a number of core practices in MH triage, the focus of the discussion in this article is specifically on the findings related to clinical decision making in MH triage, which have not previously been published. The study employed an exploratory descriptive research design that used mixed data collection methods including a survey questionnaire (n = 139) and semistructured interviews (n = 21). The study findings related to decision making revealed a lack of empirically tested evidence-based decision-making frameworks currently in use to support MH triage nursing practice. MH triage clinicians in Australia rely heavily on clinical experience to underpin decision making and have little of knowledge of theoretical models for practice, such as methodologies for rating urgency. A key recommendation arising from the study is the need to develop evidence-based decision-making frameworks such as clinical guidelines to inform and support MH triage clinical decision making.

Health technology assessment, value-based decision making, and innovation.

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Henshall, Chris; Schuller, Tara

2013-10-01

Identifying treatments that offer value and value for money is becoming increasingly important, with interest in how health technology assessment (HTA) and decision makers can take appropriate account of what is of value to patients and to society, and in the relationship between innovation and assessments of value. This study summarizes points from an Health Technology Assessment International (HTAi) Policy Forum discussion, drawing on presentations, discussions among attendees, and background papers. Various perspectives on value were considered; most place patient health at the core of value. Wider elements of value comprise other benefits for: patients; caregivers; the health and social care systems; and society. Most decision-making systems seek to take account of similar elements of value, although they are assessed and combined in different ways. Judgment in decisions remains important and cannot be replaced by mathematical approaches. There was discussion of the value of innovation and of the effects of value assessments on innovation. Discussion also included moving toward "progressive health system decision making," an ongoing process whereby evidence-based decisions on use would be made at various stages in the technology lifecycle. Five actions are identified: (i) development of a general framework for the definition and assessment of value; development by HTA/coverage bodies and regulators of (ii) disease-specific guidance and (iii) further joint scientific advice for industry on demonstrating value; (iv) development of a framework for progressive licensing, usage, and reimbursement; and (v) promoting work to better adapt HTA, coverage, and procurement approaches to medical devices.

The effect of women's decision-making power on maternal health services uptake: evidence from Pakistan.

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Hou, Xiaohui; Ma, Ning

2013-03-01

A large body of research has explored the links between women's decision making and their uptake of maternal health services, but the evidence so far is inconclusive. This study uses the Pakistan Social and Living Standards Measurement Survey to examine the influence of household decision making on women's uptake of maternal health services. We find that women's decision-making power has a significant positive correlation with maternal health services uptake and that influential males' decision-making power has the opposite effect, after controlling for socio-economic indicators and supply-side conditions. Our findings suggest that empowering women and increasing their ability to make decisions may increase their uptake of maternal health services. They also suggest that policies directed toward improving women's utilization of maternal health services in Pakistan must target men as well as women.

Reproductive health decision-making in perinatally HIV-infected adolescents and young adults.

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Fair, Cynthia; Wiener, Lori; Zadeh, Sima; Albright, Jamie; Mellins, Claude Ann; Mancilla, Michael; Tepper, Vicki; Trexler, Connie; Purdy, Julia; Osherow, Janet; Lovelace, Susan; Kapetanovic, Suad

2013-07-01

With widespread access to antiretroviral therapy in the United States, many perinatally HIV-infected (PHIV+) children are surviving into adolescence and adulthood, becoming sexually active and making decisions about their reproductive health. The literature focusing on the reproductive decisions of individuals behaviorally infected with HIV can serve as a springboard for understanding the decision-making process of PHIV+ youth. Yet, there are many differences that critically distinguish reproductive health and related decision-making of PHIV+ youth. Given the potential public health implications of their reproductive decisions, better understanding of factors influencing the decision-making process is needed to help inform the development of salient treatment and prevention interventions. To begin addressing this understudied area, a "think tank" session, comprised of clinicians, medical providers, and researchers with expertise in the area of adolescent HIV, was held in Bethesda, MD, on September 21, 2011. The focus was to explore what is known about factors that influence the reproductive decision-making of PHIV+ adolescents and young adults, determine what important data are needed in order to develop appropriate intervention for PHIV+ youth having children, and to recommend future directions for the field in terms of designing and carrying out collaborative studies. In this report, we summarize the findings from this meeting. The paper is organized around the key themes that emerged, including utilizing a developmental perspective to create an operational definition of reproductive decision-making, integration of psychosocial services with medical management, and how to design future research studies. Case examples are presented and model program components proposed.

ED Triage Decision-Making With Mental Health Presentations: A "Think Aloud" Study.

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Clarke, Diana E; Boyce-Gaudreau, Krystal; Sanderson, Ana; Baker, John A

2015-11-01

Triage is the process whereby persons presenting to the emergency department are quickly assessed by a nurse and their need for care and service is prioritized. Research examining the care of persons presenting to emergency departments with psychiatric and mental health problems has shown that triage has often been cited as the most problematic aspect of the encounter. Three questions guided this investigation: Where do the decisions that triage nurses make fall on the intuitive versus analytic dimensions of decision making for mental health presentations in the emergency department, and does this differ according to comfort or familiarity with the type of mental health/illness presentation? How do "decision aids" (i.e., structured triage scales) help in the decision-making process? To what extent do other factors, such as attitudes, influence triage nurses' decision making? Eleven triage nurses participating in this study were asked to talk out loud about the reasoning process they would engage in while triaging patients in 5 scenarios based on mental health presentations to the emergency department. Themes emerging from the data were tweaking the results (including the use of intuition and early judgments) to arrive at the desired triage score; consideration of the current ED environment; managing uncertainty and risk (including the consideration of physical reasons for presentation); and confidence in communicating with patients in distress and managing their own emotive reactions to the scenario. Findings support the preference for using the intuitive mode of decision making with only tacit reliance on the decision aid. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Cognitive-emotional decision making (CEDM): a framework of patient medical decision making.

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Power, Tara E; Swartzman, Leora C; Robinson, John W

2011-05-01

Assistance for patients faced with medical decisions has largely focussed on the clarification of information and personal values. Our aim is to draw on the decision research describing the role of emotion in combination with health behaviour models to provide a framework for conceptualizing patient decisions. A review of the psychological and medical decision making literature concerned with the role of emotion/affect in decision making and health behaviours. Emotion plays an influential role in decision making. Both current and anticipated emotions play a motivational role in choice. Amalgamating these findings with that of Leventhal's (1970) SRM provide a framework for thinking about the influence of emotion on a patient medical decision. Our framework suggests that a patient must cope with four sets of elements. The first two relate to the need to manage the cognitive and emotional aspects of the health threat. The second set relate to the management of the cognitive and emotional elements of the decision, itself. The framework provides a way for practitioners and researchers to frame thinking about a patient medical decision in order to assist the patient in clarifying decisional priorities. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

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

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Janknegt, R

2001-01-01

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

Understanding health decisions using critical realism: home-dialysis decision-making during chronic kidney disease.

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Harwood, Lori; Clark, Alexander M

2012-03-01

Understanding health decisions using critical realism: home-dialysis decision-making during chronic kidney disease This paper examines home-dialysis decision making in people with Chronic Kidney Disease (CKD) from the perspective of critical realism. CKD programmes focus on patient education for self-management to delay the progression of kidney disease and the preparation and support for renal replacement therapy e.g.) dialysis and transplantation. Home-dialysis has clear health, societal and economic benefits yet service usage is low despite efforts to realign resources and educate individuals. Current research on the determinants of modality selection is superficial and insufficient to capture the complexities embedded in the process of dialysis modality selection. Predictors of home-dialysis selection and the effect of chronic kidney disease educational programmes provide a limited explanation of this experience. A re-conceptualization of the problem is required in order to fully understand this process. The epistemology and ontology of critical realism guides our knowledge and methodology particularly suited for examination of these complexities. This approach examines the deeper mechanisms and wider determinants associated with modality decision making, specifically who chooses home dialysis and under what circumstances. Until more is known regarding dialysis modality decision making service usage of home dialysis will remain low as interventions will be based on inadequate epistemology. © 2011 Blackwell Publishing Ltd.

Multiple Criteria Decision Analysis for Health Care Decision Making--An Introduction: Report 1 of the ISPOR MCDA Emerging Good Practices Task Force.

Science.gov (United States)

Thokala, Praveen; Devlin, Nancy; Marsh, Kevin; Baltussen, Rob; Boysen, Meindert; Kalo, Zoltan; Longrenn, Thomas; Mussen, Filip; Peacock, Stuart; Watkins, John; Ijzerman, Maarten

2016-01-01

Health care decisions are complex and involve confronting trade-offs between multiple, often conflicting, objectives. Using structured, explicit approaches to decisions involving multiple criteria can improve the quality of decision making and a set of techniques, known under the collective heading multiple criteria decision analysis (MCDA), are useful for this purpose. MCDA methods are widely used in other sectors, and recently there has been an increase in health care applications. In 2014, ISPOR established an MCDA Emerging Good Practices Task Force. It was charged with establishing a common definition for MCDA in health care decision making and developing good practice guidelines for conducting MCDA to aid health care decision making. This initial ISPOR MCDA task force report provides an introduction to MCDA - it defines MCDA; provides examples of its use in different kinds of decision making in health care (including benefit risk analysis, health technology assessment, resource allocation, portfolio decision analysis, shared patient clinician decision making and prioritizing patients' access to services); provides an overview of the principal methods of MCDA; and describes the key steps involved. Upon reviewing this report, readers should have a solid overview of MCDA methods and their potential for supporting health care decision making. Copyright © 2016. Published by Elsevier Inc.

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

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

2015-01-01

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

Women's autonomy in health care decision-making in developing countries: a synthesis of the literature

Directory of Open Access Journals (Sweden)

Osamor PE

2016-06-01

Full Text Available Pauline E Osamor, Christine Grady Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD, USA Abstract: Autonomy is considered essential for decision-making in a range of health care situations, from health care seeking and utilization to choosing among treatment options. Evidence suggests that women in developing or low-income countries often have limited autonomy and control over their health decisions. A review of the published empirical literature to identify definitions and methods used to measure women’s autonomy in developing countries describe the relationship between women’s autonomy and their health care decision-making, and identify sociodemographic factors that influence women’s autonomy and decision-making regarding health care was carried out. An integrated literature review using two databases (PubMed and Scopus was performed. Inclusion criteria were 1 publication in English; 2 original articles; 3 investigations on women’s decision-making autonomy for health and health care utilization; and 4 developing country context. Seventeen articles met inclusion criteria, including eleven from South Asia, five from Africa, and one from Central Asia. Most studies used a definition of autonomy that included independence for women to make their own choices and decisions. Study methods differed in that many used study-specific measures, while others used a set of standardized questions from their countries’ national health surveys. Most studies examined women’s autonomy in the context of reproductive health, while neglecting other types of health care utilized by women. Several studies found that factors, including age, education, and income, affect women’s health care decision-making autonomy. Gaps in existing literature regarding women’s autonomy and health care utilization include gaps in the areas of health care that have been measured, the influence of sex roles and social support, and the

Women's autonomy in health care decision-making in developing countries: a synthesis of the literature.

Science.gov (United States)

Osamor, Pauline E; Grady, Christine

2016-01-01

Autonomy is considered essential for decision-making in a range of health care situations, from health care seeking and utilization to choosing among treatment options. Evidence suggests that women in developing or low-income countries often have limited autonomy and control over their health decisions. A review of the published empirical literature to identify definitions and methods used to measure women's autonomy in developing countries describe the relationship between women's autonomy and their health care decision-making, and identify sociodemographic factors that influence women's autonomy and decision-making regarding health care was carried out. An integrated literature review using two databases (PubMed and Scopus) was performed. Inclusion criteria were 1) publication in English; 2) original articles; 3) investigations on women's decision-making autonomy for health and health care utilization; and 4) developing country context. Seventeen articles met inclusion criteria, including eleven from South Asia, five from Africa, and one from Central Asia. Most studies used a definition of autonomy that included independence for women to make their own choices and decisions. Study methods differed in that many used study-specific measures, while others used a set of standardized questions from their countries' national health surveys. Most studies examined women's autonomy in the context of reproductive health, while neglecting other types of health care utilized by women. Several studies found that factors, including age, education, and income, affect women's health care decision-making autonomy. Gaps in existing literature regarding women's autonomy and health care utilization include gaps in the areas of health care that have been measured, the influence of sex roles and social support, and the use of qualitative studies to provide context and nuance.

The impact of health technology assessment reports on decision making in Austria.

Science.gov (United States)

Zechmeister, Ingrid; Schumacher, Ines

2012-01-01

Health technology assessment (HTA) was established in Austria in the 1990s and, since then, it has gained considerable importance. In this study, we aim to analyze whether the HTA reports that have been produced at the Institute for Technology Assessment (ITA) and at the Ludwig Boltzmann Institute for HTA (LBI-HTA) have had an impact on decision making within the Austrian health care system. We selected all reports that were intended for supporting (i) reimbursement/investment or (ii) disinvestment decisions. Eleven full HTA reports and fifty-eight rapid assessments fulfilled the inclusion criteria. We used interview data and administrative data on volumes, tariffs and expenditure of products/services to analyze whether and how reports were in reality used in decision making and what the consequences for health care expenditure and resource distribution have been. Five full HTA reports and fifty-six rapid technology assessments were used for reimbursement decisions. Four full HTA reports and two rapid assessments were used for disinvestment decisions and resulted in reduced volumes and expenditure. Two full HTA reports showed no impact on decision making. Impact was most evident for hospital technologies. HTA has played some role in reducing volumes of over-supplied hospital technologies, resulting in reduced expenditure for several hospital providers. Additionally, it has been increasingly included in prospective planning and reimbursement decisions of late, indicating re-distribution of resources toward evidence-based technologies. However, further factors may have influenced the decisions, and the impact could be considerably increased by systematically incorporating HTA into the decision-making process in Austria.

Decision-Oriented Health Technology Assessment: One Step Forward in Supporting the Decision-Making Process in Hospitals.

Science.gov (United States)

Ritrovato, Matteo; Faggiano, Francesco C; Tedesco, Giorgia; Derrico, Pietro

2015-06-01

This article outlines the Decision-Oriented Health Technology Assessment: a new implementation of the European network for Health Technology Assessment Core Model, integrating the multicriteria decision-making analysis by using the analytic hierarchy process to introduce a standardized methodological approach as a valued and shared tool to support health care decision making within a hospital. Following the Core Model as guidance (European network for Health Technology Assessment. HTA core model for medical and surgical interventions. Available from: http://www.eunethta.eu/outputs/hta-core-model-medical-and-surgical-interventions-10r. [Accessed May 27, 2014]), it is possible to apply the analytic hierarchy process to break down a problem into its constituent parts and identify priorities (i.e., assigning a weight to each part) in a hierarchical structure. Thus, it quantitatively compares the importance of multiple criteria in assessing health technologies and how the alternative technologies perform in satisfying these criteria. The verbal ratings are translated into a quantitative form by using the Saaty scale (Saaty TL. Decision making with the analytic hierarchy process. Int J Serv Sci 2008;1:83-98). An eigenvectors analysis is used for deriving the weights' systems (i.e., local and global weights' system) that reflect the importance assigned to the criteria and the priorities related to the performance of the alternative technologies. Compared with the Core Model, this methodological approach supplies a more timely as well as contextualized evidence for a specific technology, making it possible to obtain data that are more relevant and easier to interpret, and therefore more useful for decision makers to make investment choices with greater awareness. We reached the conclusion that although there may be scope for improvement, this implementation is a step forward toward the goal of building a "solid bridge" between the scientific evidence and the final decision

mHealth for Clinical Decision-Making in Sub-Saharan Africa : A Scoping Review

NARCIS (Netherlands)

Adepoju, Ibukun-Oluwa Omolade; Albersen, Bregje Joanna Antonia; De Brouwere, Vincent; van Roosmalen, Jos; Zweekhorst, M.B.M.

2017-01-01

BACKGROUND: In a bid to deliver quality health services in resource-poor settings, mobile health (mHealth) is increasingly being adopted. The role of mHealth in facilitating evidence-based clinical decision-making through data collection, decision algorithms, and evidence-based guidelines, for

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

Science.gov (United States)

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

2011-06-01

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

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, G.D.E.M. 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

Asian and Pacific Islander Cultural Values: Considerations for Health Care Decision Making.

Science.gov (United States)

McLaughlin, Linda A.; Braun, Kathryn L.

1998-01-01

Some history on health-care decision making is reviewed. The current "individualist" model in the United States is contrasted with "collectivist" models of Asian and Pacific Islander cultures. Decision making styles are discussed in relationship to Western medicine. Six groups' cultural norms are presented. Conflicts with U.S.…

Decision-making in job attendance within health care--a qualitative study.

Science.gov (United States)

Tveten, K M; Morken, T

2016-04-01

Musculoskeletal complaints are considered a major cause of sickness absence, particularly in areas such as the health sector. However, little is known about the personal decision-making process for self-certified sickness absence. To explore female health care workers' thoughts and experiences about work attendance when experiencing musculoskeletal symptoms. A qualitative study using individual, semi-structured, in-depth interviews with eight female health care workers was performed. Questions were related to factors influencing the decision to attend work and decision-making when facing the dilemma of attending work when experiencing musculoskeletal symptoms. The data were analysed according to the systematic text condensation. Subjects reported a high threshold before calling in sick. Self-certified sickness absence was not a strategy for coping with musculoskeletal symptoms as participants chose to be physically active and work part-time rather than taking sickness absence. Making decisions about attending work fostered conflicting norms, as women faced a dilemma between feeling guilt towards colleagues and patients and taking care of their own health. The findings highlight the complexity of managing work when experiencing musculoskeletal symptoms, and the dilemmas faced by those affected. The importance of work environment factors and the fact that some women feel compelled to work part-time in order to prioritize their own health require further consideration. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Shared decision making in mental health: the importance for current clinical practice.

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Alguera-Lara, Victoria; Dowsey, Michelle M; Ride, Jemimah; Kinder, Skye; Castle, David

2017-12-01

We reviewed the literature on shared decision making (regarding treatments in psychiatry), with a view to informing our understanding of the decision making process and the barriers that exist in clinical practice. Narrative review of published English-language articles. After culling, 18 relevant articles were included. Themes identified included models of psychiatric care, benefits for patients, and barriers. There is a paucity of published studies specifically related to antipsychotic medications. Shared decision making is a central part of the recovery paradigm and is of increasing importance in mental health service delivery. The field needs to better understand the basis on which decisions are reached regarding psychiatric treatments. Discrete choice experiments might be useful to inform the development of tools to assist shared decision making in psychiatry.

Comparing Chinese and European American mental health decision making.

Science.gov (United States)

Gao, Shanshan; Corrigan, Patrick W; Qin, Sang; Nieweglowski, Katherine

2017-12-20

Shared decision making (SDM) tends to reflect more Western values of individualism and empowerment, values that may be foreign to East Asian healthcare preferences for collectivism and family involvement: family centered decision making (FCDM). To show that Chinese will be more likely to believe FCDM would be more pleasing for them if they were the patient. Conversely, European Americans will respond more favorably to SDM. To examine effects of Western acculturation on FCDM compared to SDM. In this study, preferences for FCDM versus SDM and doctor-led decision making (DrDM) were examined in a vignette study completed online by European Americans (n = 298) and Chinese (n = 327). Research participants read a vignette about Lily (a depression patient) presenting with symptoms of depression. After reading the vignette, participants completed items representing two sets of outcomes: three perceptions of impact on Lily and how participants might respond for themselves in a similar decision making situation. Chinese rated FCDM greater than European and Chinese Americans. Chinese Americans mostly responded similar to European Americans and not Chinese. European Americans prefer SDM more for mental health services. Chinese value FCDM more than European Americans. Preferences of Chinese living in America seem to parallel European Americans.

Psychopharmacology decision-making among pregnant and postpartum women and health providers: informing compassionate and collaborative care women's health.

Science.gov (United States)

Price, Sarah Kye; Bentley, Kia J

2013-01-01

Psychopharmaceutical use by pregnant and postpartum women is complicated by the complexity of prescribing as well as the sociocultural context in which medication-related decisions are made. This study sought to advance understanding of decision-making processes and communication experiences regarding use of psychopharmaceuticals during pregnancy by considering both provider and consumer perspectives. An electronic survey was conducted with health care providers (N = 88) and women consumers (N = 83) from July 2010 through October 2011 regarding the perceived costs and benefits of taking mental health medication during and around the time of pregnancy. Descriptive analysis compared and contrasted experiences between the two groups regarding consumer-provider communication, critical incidents and triggers in decision-making, and response to case scenarios crafted around hypothetical client experiences. Both similarities and differences were evident among health care provider and women consumer responses regarding costs, benefits, communication experiences, and case scenario responses. Both quantitative and qualitative survey results indicated the need for more accurate, unbiased, and complete information exchange around mental health and medication. Study results suggested the centrality of the client-provider milieu to guide decision-making and emphasized the expressed need within both groups to create a shared decision-making practice environment characterized by authenticity, non-judgmental decision-making, compassion, humaneness, and reciprocity.

Self-Stigma and Consumer Participation in Shared Decision Making in Mental Health Services.

Science.gov (United States)

Hamann, Johannes; Bühner, Markus; Rüsch, Nicolas

2017-08-01

People with mental illness struggle with symptoms and with public stigma. Some accept common prejudices and lose self-esteem, resulting in shame and self-stigma, which may affect their interactions with mental health professionals. This study explored whether self-stigma and shame are associated with consumers' preferences for participation in medical decision making and their behavior in psychiatric consultations. In a cross-sectional study conducted in Germany, 329 individuals with a diagnosis of a schizophrenia spectrum disorder or an affective disorder and their psychiatrists provided sociodemographic and illness-related information. Self-stigma, shame, locus of control, and views about clinical decision making were assessed by self-report. Psychiatrists rated their impression of the decision-making behavior of consumers. Regression analyses and structural equation modeling were used to determine the association of self-stigma and shame with clinical decision making. Self-stigma was not related to consumers' participation preferences, but it was associated with some aspects of communicative behavior. Active and critical behavior (for example, expressing views, daring to challenge the doctor's opinion, and openly speaking out about disagreements with the doctor) was associated with less shame, less self-stigma, more self-responsibility, less attribution of external control to powerful others, and more years of education. Self-stigma and shame were associated with less participative and critical behavior, which probably leads to clinical encounters that involve less shared decision making and more paternalistic decision making. Paternalistic decision making may reinforce self-stigma and lead to poorer health outcomes. Therefore, interventions that reduce self-stigma and increase consumers' critical and participative communication may improve health outcomes.

Bayesian updating and decision making using correlated structural health monitoring observations

DEFF Research Database (Denmark)

Nielsen, Jannie Sønderkær

2018-01-01

A Bayesian approach is often applied when updating a deterioration model using observations from expected structural health monitoring or condition monitoring. Usually, observations are assumed to be independent conditioned on the damage size, but this assumption does not always hold, especially ...... is properly modeled. In case of correlated observations, an advanced decision model using all past observations for decision making is needed to make monitoring feasible compared to only using inspections....

Shared decision-making and health for First Nations, Métis and Inuit women: a study protocol

Directory of Open Access Journals (Sweden)

Jull Janet

2012-12-01

Full Text Available Abstract Background Little is known about shared decision-making (SDM with Métis, First Nations and Inuit women (“Aboriginal women”. SDM is a collaborative process that engages health care professional(s and the client in making health decisions and is fundamental for informed consent and patient-centred care. The objective of this study is to explore Aboriginal women’s health and social decision-making needs and to engage Aboriginal women in culturally adapting an SDM approach. Methods Using participatory research principles and guided by a postcolonial theoretical lens, the proposed mixed methods research will involve three phases. Phase I is an international systematic review of the effectiveness of interventions for Aboriginal peoples’ health decision-making. Developed following dialogue with key stakeholders, proposed methods are guided by the Cochrane handbook and include a comprehensive search, screening by two independent researchers, and synthesis of findings. Phases II and III will be conducted in collaboration with Minwaashin Lodge and engage an urban Aboriginal community of women in an interpretive descriptive qualitative study. In Phase II, 10 to 13 Aboriginal women will be interviewed to explore their health/social decision-making experiences. The interview guide is based on the Ottawa Decision Support Framework and previous decisional needs assessments, and as appropriate may be adapted to findings from the systematic review. Digitally-recorded interviews will be transcribed verbatim and analyzed inductively to identify participant decision-making approaches and needs when making health/social decisions. In Phase III, there will be cultural adaptation of an SDM facilitation tool, the Ottawa Personal Decision Guide, by two focus groups consisting of five to seven Aboriginal women. The culturally adapted guide will undergo usability testing through individual interviews with five to six women who are about to make a health

Decision making and cancer.

Science.gov (United States)

Reyna, Valerie F; Nelson, Wendy L; Han, Paul K; Pignone, Michael P

2015-01-01

We review decision making along the cancer continuum in the contemporary context of informed and shared decision making in which patients are encouraged to take a more active role in their health care. We discuss challenges to achieving informed and shared decision making, including cognitive limitations and emotional factors, but argue that understanding the mechanisms of decision making offers hope for improving decision support. Theoretical approaches to decision making that explain cognition, emotion, and their interaction are described, including classical psychophysical approaches, dual-process approaches that focus on conflicts between emotion versus cognition (or reason), and modern integrative approaches such as fuzzy-trace theory. In contrast to the earlier emphasis on rote use of numerical detail, modern approaches emphasize understanding the bottom-line gist of options (which encompasses emotion and other influences on meaning) and retrieving relevant social and moral values to apply to those gist representations. Finally, research on interventions to support better decision making in clinical settings is reviewed, drawing out implications for future research on decision making and cancer. PsycINFO Database Record (c) 2015 APA, all rights reserved.

Introduction to health economics and decision-making: Is economics relevant for the frontline clinician?

Science.gov (United States)

Goeree, Ron; Diaby, Vakaramoko

2013-12-01

In a climate of escalating demands for new health care services and significant constraints on new resources, the disciplines of health economics and health technology assessment (HTA) have increasingly been turned to as explicit evidence-based frameworks to help make tough health care access and reimbursement decisions. Health economics is the discipline of economics concerned with the efficient allocation of health care resources, essentially trying to maximize health benefits to society contingent upon available resources. HTA is a broader field drawing upon several disciplines, but which relies heavily upon the tools of health economics and economic evaluation. Traditionally, health economics and economic evaluation have been widely used at the political (macro) and local (meso) decision-making levels, and have progressively had an important role even at informing individual clinical decisions (micro level). The aim of this paper is to introduce readers to health economics and discuss its relevance to frontline clinicians. Particularly, the content of the paper will facilitate clinicians' understanding of the link between economics and their medical practice, and how clinical decision-making reflects on health care resource allocation. Copyright © 2013 Elsevier Ltd. All rights reserved.

A critical narrative analysis of shared decision-making in acute inpatient mental health care.

Science.gov (United States)

Stacey, Gemma; Felton, Anne; Morgan, Alastair; Stickley, Theo; Willis, Martin; Diamond, Bob; Houghton, Philip; Johnson, Beverley; Dumenya, John

2016-01-01

Shared decision-making (SDM) is a high priority in healthcare policy and is complementary to the recovery philosophy in mental health care. This agenda has been operationalised within the Values-Based Practice (VBP) framework, which offers a theoretical and practical model to promote democratic interprofessional approaches to decision-making. However, these are limited by a lack of recognition of the implications of power implicit within the mental health system. This study considers issues of power within the context of decision-making and examines to what extent decisions about patients' care on acute in-patient wards are perceived to be shared. Focus groups were conducted with 46 mental health professionals, service users, and carers. The data were analysed using the framework of critical narrative analysis (CNA). The findings of the study suggested each group constructed different identity positions, which placed them as inside or outside of the decision-making process. This reflected their view of themselves as best placed to influence a decision on behalf of the service user. In conclusion, the discourse of VBP and SDM needs to take account of how differentials of power and the positioning of speakers affect the context in which decisions take place.

Health technology assessment and primary data collection for reducing uncertainty in decision making.

Science.gov (United States)

Goeree, Ron; Levin, Les; Chandra, Kiran; Bowen, James M; Blackhouse, Gord; Tarride, Jean-Eric; Burke, Natasha; Bischof, Matthias; Xie, Feng; O'Reilly, Daria

2009-05-01

Health care expenditures continue to escalate, and pressures for increased spending will continue. Health care decision makers from publicly financed systems, private insurance companies, or even from individual health care institutions, will continue to be faced with making difficult purchasing, access, and reimbursement decisions. As a result, decision makers are increasingly turning to evidence-based platforms to help control costs and make the most efficient use of existing resources. Most tools used to assist with evidence-based decision making focus on clinical outcomes. Health technology assessment (HTA) is increasing in popularity because it also considers other factors important for decision making, such as cost, social and ethical values, legal issues, and factors such as the feasibility of implementation. In some jurisdictions, HTAs have also been supplemented with primary data collection to help address uncertainty that may still exist after conducting a traditional HTA. The HTA process adopted in Ontario, Canada, is unique in that assessments are also made to determine what primary data research should be conducted and what should be collected in these studies. In this article, concerns with the traditional HTA process are discussed, followed by a description of the HTA process that has been established in Ontario, with a particular focus on the data collection program followed by the Programs for Assessment of Technology in Health Research Institute. An illustrative example is used to show how the Ontario HTA process works and the role value of information analyses plays in addressing decision uncertainty, determining research feasibility, and determining study data collection needs.

HMIS and decision-making in Zambia: re-thinking information solutions for district health management in decentralized health systems.

Science.gov (United States)

Mutemwa, Richard I

2006-01-01

At the onset of health system decentralization as a primary health care strategy, which constituted a key feature of health sector reforms across the developing world, efficient and effective health management information systems (HMIS) were widely acknowledged and adopted as a critical element of district health management strengthening programmes. The focal concern was about the performance and long-term sustainability of decentralized district health systems. The underlying logic was that effective and efficient HMIS would provide district health managers with the information required to make effective strategic decisions that are the vehicle for district performance and sustainability in these decentralized health systems. However, this argument is rooted in normative management and decision theory without significant unequivocal empirical corroboration. Indeed, extensive empirical evidence continues to indicate that managers' decision-making behaviour and the existence of other forms of information outside the HMIS, within the organizational environment, suggest a far more tenuous relationship between the presence of organizational management information systems (such as HMIS) and effective strategic decision-making. This qualitative comparative case-study conducted in two districts of Zambia focused on investigating the presence and behaviour of five formally identified, different information forms, including that from HMIS, in the strategic decision-making process. The aim was to determine the validity of current arguments for HMIS, and establish implications for current HMIS policies. Evidence from the eight strategic decision-making processes traced in the study confirmed the existence of different forms of information in the organizational environment, including that provided by the conventional HMIS. These information forms attach themselves to various organizational management processes and key aspects of organizational routine. The study results point

Consumer and relationship factors associated with shared decision making in mental health consultations.

Science.gov (United States)

Matthias, Marianne S; Fukui, Sadaaki; Kukla, Marina; Eliacin, Johanne; Bonfils, Kelsey A; Firmin, Ruth L; Oles, Sylwia K; Adams, Erin L; Collins, Linda A; Salyers, Michelle P

2014-12-01

This study explored the association between shared decision making and consumers' illness management skills and consumer-provider relationships. Medication management appointments for 79 consumers were audio recorded. Independent coders rated overall shared decision making, minimum level of shared decision making, and consumer-provider agreement for 63 clients whose visit included a treatment decision. Mental health diagnoses, medication adherence, patient activation, illness management, working alliance, and length of consumer-provider relationships were also assessed. Correlation analyses were used to determine relationships among measures. Overall shared decision making was not associated with any variables. Minimum levels of shared decision making were associated with higher scores on the bond subscale of the Working Alliance Inventory, indicating a higher degree of liking and trust, and with better medication adherence. Agreement was associated with shorter consumer-provider relationships. Consumer-provider relationships and shared decision making might have a more nuanced association than originally thought.

Parent participation in decision-making in health-care services for children: an integrative review.

Science.gov (United States)

Aarthun, Antje; Akerjordet, Kristin

2014-03-01

To describe and synthesize previous research on parents' perceptions of their participation in decision making in child health-care services. Health policy in the area of user involvement emphasizes parent participation in decision-making (DM), thus ensuring that services are provided in accordance with their child's needs and enhancing parents' control over their child's health-care services. A systematic literature search, covering the period January 2000 to February 2011, found 18 studies that met the inclusion criteria. The analysis process involved data extraction, reduction, comparison and synthesizing. Three themes emerged: (1) relational factors and interdependence, (2) personal factors and attitudes and (3) organisational factors. Parents highlighted the importance of the parent-health professional relationship, professionals' competence and the possibility of varying the degree of participation in decision making. Challenges involved asymmetry in authority and power, professionals' attitudes and competence and organisational shortcomings in health-care services. Health professionals need to become more aware of their critical role and responsibility in involving parents in DM. Health professionals' attitudes and competence can be improved by knowledge of user involvement and research and facilitating the inclusion of parents in decision making by influencing the culture, routines and resources in the health service. © 2012 John Wiley & Sons Ltd.

Challenges to fair decision-making processes in the context of health care services

DEFF Research Database (Denmark)

Shayo, Elizabeth H.; Norheim, Ole F.; Mboera, Leonard E. G.

2012-01-01

challenges to fair decision-making processes in health care services with a special focus on the potential influence of gender, wealth, ethnicity and education. We draw on the principle of fairness as outlined in the deliberative democratic theory. METHODS: The study was carried out in the Mbarali District......ABSTRACT: BACKGROUND: Fair processes in decision making need the involvement of stakeholders who can discuss issues and reach an agreement based on reasons that are justifiable and appropriate in meeting people's needs. In Tanzania, the policy of decentralization and the health sector reform place......: The study findings indicate a substantial influence of gender, wealth, ethnicity and education on health care decision-making processes. Men, wealthy individuals, members of strong ethnic groups and highly educated individuals had greater influence. Opinions varied among the study informants as to whether...

An Integrated Model of Decision-Making in Health Contexts: The Role of Science Education in Health Education

Science.gov (United States)

Arnold, Julia C.

2018-01-01

Health education is to foster health literacy, informed decision-making and to promote health behaviour. To date, there are several models that seek to explain health behaviour (e.g. the Theory of Planned Behaviour or the Health Belief Model). These models include motivational factors (expectancies and values) that play a role in decision-making…

Health economics and outcomes methods in risk-based decision-making for blood safety

NARCIS (Netherlands)

Custer, Brian; Janssen, Mart P.

2015-01-01

Analytical methods appropriate for health economic assessments of transfusion safety interventions have not previously been described in ways that facilitate their use. Within the context of risk-based decision-making (RBDM), health economics can be important for optimizing decisions among competing

Women’s autonomy in health care decision-making in developing countries: a synthesis of the literature

Science.gov (United States)

Osamor, Pauline E; Grady, Christine

2016-01-01

Autonomy is considered essential for decision-making in a range of health care situations, from health care seeking and utilization to choosing among treatment options. Evidence suggests that women in developing or low-income countries often have limited autonomy and control over their health decisions. A review of the published empirical literature to identify definitions and methods used to measure women’s autonomy in developing countries describe the relationship between women’s autonomy and their health care decision-making, and identify sociodemographic factors that influence women’s autonomy and decision-making regarding health care was carried out. An integrated literature review using two databases (PubMed and Scopus) was performed. Inclusion criteria were 1) publication in English; 2) original articles; 3) investigations on women’s decision-making autonomy for health and health care utilization; and 4) developing country context. Seventeen articles met inclusion criteria, including eleven from South Asia, five from Africa, and one from Central Asia. Most studies used a definition of autonomy that included independence for women to make their own choices and decisions. Study methods differed in that many used study-specific measures, while others used a set of standardized questions from their countries’ national health surveys. Most studies examined women’s autonomy in the context of reproductive health, while neglecting other types of health care utilized by women. Several studies found that factors, including age, education, and income, affect women’s health care decision-making autonomy. Gaps in existing literature regarding women’s autonomy and health care utilization include gaps in the areas of health care that have been measured, the influence of sex roles and social support, and the use of qualitative studies to provide context and nuance. PMID:27354830

A mixed methods thematic review: Health-related decision-making by the older person.

Science.gov (United States)

King, Lindy; Harrington, Ann; Linedale, Ecushla; Tanner, Elizabeth

2018-04-01

To undertake a mixed methods thematic literature review that explored how elderly adults approached decision-making in regard to their health care following discharge. A critical time for appropriate health decisions occurs during hospital discharge planning with nursing staff. However, little is known how the 89% of elderly living at home make decisions regarding their health care. Research into older adults' management of chronic conditions emerges as an important step to potentially encourage symptom monitoring, prevent missed care and detect deterioration. All should reduce the risk of hospital re-admission. A mixed methods thematic literature review was undertaken. The structure followed the PRISMA reporting guidelines for systematic reviews recommended by the EQUATOR network. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus online databases were searched using keywords, inclusion and exclusion criteria. References drawn from relevant publications, identified by experts and published between 1995 and 2017 were also considered. Twenty-five qualitative, quantitative and mixed methods studies and reviews were critically appraised (CASP 2013) before inclusion in the review. Analysis of each study's findings was undertaken using Braun and Clarke's (2006) steps to identify major themes and sub-themes. Four main themes associated with health-related decision-making in the elderly were identified: "the importance of maintaining independence," "decision making style," "management of conditions at home" and "discharge planning." Health care decision preferences in the elderly emerged as highly complex and influenced by multiple factors. Development of a tool to assess these components has been recommended. Nurses play a vital role in exploring and understanding the influence that maintaining independence has with each patient. This understanding provides an initial step toward development of a tool to assist collaboration between

Planning ahead in public health? A qualitative study of the time horizons used in public health decision-making.

Science.gov (United States)

Taylor-Robinson, David C; Milton, Beth; Lloyd-Williams, Ffion; O'Flaherty, Martin; Capewell, Simon

2008-12-18

In order to better understand factors that influence decisions for public health, we undertook a qualitative study to explore issues relating to the time horizons used in decision-making. Qualitative study using semi-structured interviews. 33 individuals involved in the decision making process around coronary heart disease were purposively sampled from the UK National Health Service (national, regional and local levels), academia and voluntary organizations. Analysis was based on the framework method using N-VIVO software. Interviews were transcribed, coded and emergent themes identified. Many participants suggested that the timescales for public health decision-making are too short. Commissioners and some practitioners working at the national level particularly felt constrained in terms of planning for the long-term. Furthermore respondents felt that longer term planning was needed to address the wider determinants of health and to achieve societal level changes. Three prominent 'systems' issues were identified as important drivers of short term thinking: the need to demonstrate impact within the 4 year political cycle; the requirement to 'balance the books' within the annual commissioning cycle and the disruption caused by frequent re-organisations within the health service. In addition respondents suggested that the tools and evidence base for longer term planning were not well established. Many public health decision and policy makers feel that the timescales for decision-making are too short. Substantial systemic barriers to longer-term planning exist. Policy makers need to look beyond short-term targets and budget cycles to secure investment for long-term improvement in public health.

Questioning context: a set of interdisciplinary questions for investigating contextual factors affecting health decision making

Science.gov (United States)

Charise, Andrea; Witteman, Holly; Whyte, Sarah; Sutton, Erica J.; Bender, Jacqueline L.; Massimi, Michael; Stephens, Lindsay; Evans, Joshua; Logie, Carmen; Mirza, Raza M.; Elf, Marie

2011-01-01

Abstract Objective  To combine insights from multiple disciplines into a set of questions that can be used to investigate contextual factors affecting health decision making. Background  Decision‐making processes and outcomes may be shaped by a range of non‐medical or ‘contextual’ factors particular to an individual including social, economic, political, geographical and institutional conditions. Research concerning contextual factors occurs across many disciplines and theoretical domains, but few conceptual tools have attempted to integrate and translate this wide‐ranging research for health decision‐making purposes. Methods  To formulate this tool we employed an iterative, collaborative process of scenario development and question generation. Five hypothetical health decision‐making scenarios (preventative, screening, curative, supportive and palliative) were developed and used to generate a set of exploratory questions that aim to highlight potential contextual factors across a range of health decisions. Findings  We present an exploratory tool consisting of questions organized into four thematic domains – Bodies, Technologies, Place and Work (BTPW) – articulating wide‐ranging contextual factors relevant to health decision making. The BTPW tool encompasses health‐related scholarship and research from a range of disciplines pertinent to health decision making, and identifies concrete points of intersection between its four thematic domains. Examples of the practical application of the questions are also provided. Conclusions  These exploratory questions provide an interdisciplinary toolkit for identifying the complex contextual factors affecting decision making. The set of questions comprised by the BTPW tool may be applied wholly or partially in the context of clinical practice, policy development and health‐related research. PMID:21029277

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

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

2017-08-01

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

Distributed Cognition in Cancer Treatment Decision Making: An Application of the DECIDE Decision-Making Styles Typology.

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Krieger, Janice L; Krok-Schoen, Jessica L; Dailey, Phokeng M; Palmer-Wackerly, Angela L; Schoenberg, Nancy; Paskett, Electra D; Dignan, Mark

2017-07-01

Distributed cognition occurs when cognitive and affective schemas are shared between two or more people during interpersonal discussion. Although extant research focuses on distributed cognition in decision making between health care providers and patients, studies show that caregivers are also highly influential in the treatment decisions of patients. However, there are little empirical data describing how and when families exert influence. The current article addresses this gap by examining decisional support in the context of cancer randomized clinical trial (RCT) decision making. Data are drawn from in-depth interviews with rural, Appalachian cancer patients ( N = 46). Analysis of transcript data yielded empirical support for four distinct models of health decision making. The implications of these findings for developing interventions to improve the quality of treatment decision making and overall well-being are discussed.

Allocating health care: cost-utility analysis, informed democratic decision making, or the veil of ignorance?

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Goold, S D

1996-01-01

Assuming that rationing health care is unavoidable, and that it requires moral reasoning, how should we allocate limited health care resources? This question is difficult because our pluralistic, liberal society has no consensus on a conception of distributive justice. In this article I focus on an alternative: Who shall decide how to ration health care, and how shall this be done to respect autonomy, pluralism, liberalism, and fairness? I explore three processes for making rationing decisions: cost-utility analysis, informed democratic decision making, and applications of the veil of ignorance. I evaluate these processes as examples of procedural justice, assuming that there is no outcome considered the most just. I use consent as a criterion to judge competing processes so that rationing decisions are, to some extent, self-imposed. I also examine the processes' feasibility in our current health care system. Cost-utility analysis does not meet criteria for actual or presumed consent, even if costs and health-related utility could be measured perfectly. Existing structures of government cannot creditably assimilate the information required for sound rationing decisions, and grassroots efforts are not representative. Applications of the veil of ignorance are more useful for identifying principles relevant to health care rationing than for making concrete rationing decisions. I outline a process of decision making, specifically for health care, that relies on substantive, selected representation, respects pluralism, liberalism, and deliberative democracy, and could be implemented at the community or organizational level.

[Patient expectations about decision-making for various health problems].

Science.gov (United States)

Delgado, Ana; López-Fernández, Luis Andrés; de Dios Luna, Juan; Saletti Cuesta, Lorena; Gil Garrido, Natalia; Puga González, Almudena

2010-01-01

To identify patient expectations of clinical decision-making at consultations with their general practitioners for distinct health problems and to determine the patient and general practitioner characteristics related to these expectations, with special focus on gender. We performed a multicenter cross-sectional study in 360 patients who were interviewed at home. Data on patients' sociodemographic, clinical characteristics and satisfaction were gathered. General practitioners supplied information on their gender and postgraduate training in family medicine. A questionnaire was used to collect data on patients' expectations that their general practitioner account of their opinion and on expectations of clinical decision making> at consultations with their general practitioner for five problems or hypothetical clinical scenarios (strong chest pain/cold with fever/abnormal discharge/depression or sadness/severe family problem). Patients were asked to indicate their preference that decisions on diagnosis and treatment be taken by: a) the general practitioner alone; b) the general practitioner, taking account of the patient's opinion; c) the patient, taking account of the general practitioner's opinion and d) the patient alone. A logistic regression was performed for clinical decision-making. The response rate was 90%. The mean age was 47.3 + or - 16.5 years and 51% were female. Patients' expectations that their general practitioner listen, explain and take account of their opinions were higher than their expectations of participating in decision-making, depending on the problem in question: 32% wished to participate in chest pain and 49% in family problems. Women had lower expectations of participating in depression and family problems. Patients with female general practitioners had higher expectations of participating in family problems and colds. Most patients wished to be listened to, informed and taken into account by their general practitioners and, to a lesser

Improving accountability in vaccine decision-making.

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Timmis, James Kenneth; Black, Steven; Rappuoli, Rino

2017-11-01

Healthcare decisions, in particular those affecting entire populations, should be evidence-based and taken by decision-makers sharing broad alignment with affected stakeholders. However, criteria, priorities and procedures for decision-making are sometimes non-transparent, frequently vary considerably across equivalent decision-bodies, do not always consider the broader benefits of new health-measures, and therefore do not necessarily adequately represent the relevant stakeholder-spectrum. Areas covered: To address these issues in the context of the evaluation of new vaccines, we have proposed a first baseline set of core evaluation criteria, primarily selected by members of the vaccine research community, and suggested their implementation in vaccine evaluation procedures. In this communication, we review the consequences and utility of stakeholder-centered core considerations to increase transparency in and accountability of decision-making procedures, in general, and of the benefits gained by their inclusion in Multi-Criteria-Decision-Analysis tools, exemplified by SMART Vaccines, specifically. Expert commentary: To increase effectiveness and comparability of health decision outcomes, decision procedures should be properly standardized across equivalent (national) decision bodies. To this end, including stakeholder-centered criteria in decision procedures would significantly increase their transparency and accountability, support international capacity building to improve health, and reduce societal costs and inequity resulting from suboptimal health decision-making.

Health Care Decisions at the End of Life: Theological and Ethical Foundations for Decision Making.

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Allegretti, Joseph G.

This paper provides a framework for making sense of perplexing problems surrounding issues of death and dying by exploring the theological and ethical background to health care decision making at the end of life. The paper first examines several of the basic principles that theologians and secular ethicists employ when analyzing such questions.…

The application of system dynamics modelling to environmental health decision-making and policy - a scoping review.

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Currie, Danielle J; Smith, Carl; Jagals, Paul

2018-03-27

Policy and decision-making processes are routinely challenged by the complex and dynamic nature of environmental health problems. System dynamics modelling has demonstrated considerable value across a number of different fields to help decision-makers understand and predict the dynamic behaviour of complex systems in support the development of effective policy actions. In this scoping review we investigate if, and in what contexts, system dynamics modelling is being used to inform policy or decision-making processes related to environmental health. Four electronic databases and the grey literature were systematically searched to identify studies that intersect the areas environmental health, system dynamics modelling, and decision-making. Studies identified in the initial screening were further screened for their contextual, methodological and application-related relevancy. Studies deemed 'relevant' or 'highly relevant' according to all three criteria were included in this review. Key themes related to the rationale, impact and limitation of using system dynamics in the context of environmental health decision-making and policy were analysed. We identified a limited number of relevant studies (n = 15), two-thirds of which were conducted between 2011 and 2016. The majority of applications occurred in non-health related sectors (n = 9) including transportation, public utilities, water, housing, food, agriculture, and urban and regional planning. Applications were primarily targeted at micro-level (local, community or grassroots) decision-making processes (n = 9), with macro-level (national or international) decision-making to a lesser degree. There was significant heterogeneity in the stated rationales for using system dynamics and the intended impact of the system dynamics model on decision-making processes. A series of user-related, technical and application-related limitations and challenges were identified. None of the reported limitations or challenges

[Correlation of resistance to peer pressure and risky decision-making with adolescent health risk behaviors].

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An, Jing; Sun, Ying; Wang, Xi; Zu, Ping; Mai, Jin-cheng; Liang, Jian-ping; Xu, Zhi-yong; Man, Xue-jun; Mao, Yan; Tao, Fang-biao

2013-03-01

To explore possible interrelationships among resistance to peer pressure, risky decision-making and health risk behaviors among young adolescents. Based on the cluster sampling method, the participants who were recruited from 5 junior middle schools in Guangzhou and 3 junior middle schools in Shenyang city on October, 2010, were administered to complete the questionnaire concerned with their experiences with drinking and smoking during the past 30 days preceding the survey, and the hours using computer daily both in weekdays and in weekend. The level of resistance to peer influence and risky decision-making were assessed by Resistance to peer influence scale (RPIS) and Youth decision-making questionnaire (YDMQ). Logistic regression was used to explore possible interrelationships among resistance to peer influence, risky decision-making and health risk behaviors among young adolescents. A total of 1985 questionnaires were valid, including 1001(50.4%) boys and 984 (49.6%) girls. About 27.1% (537/1985) junior middle school students reported having health risk behaviors, boys' (30.7%, 307/1001) was higher than girls' (23.4%, 230/984) with significant gender difference (P peer influence (low and middle level vs high level, had odds ratios of 2.97 (1.96 - 4.50) and 1.51 (1.05 - 2.16)), and also the middle and high level of risky decision-making (middle and high level vs low level, had odds ratios of 1.62 (1.19 - 2.22) and 3.43 (2.39 - 4.90)) were all the risk factors of adolescent health risk behaviors. Adolescents with poor ability of resistance to peer pressure and high risky decision-making were both the risk factors of adolescent health risk behaviors.

Evidence for the credibility of health economic models for health policy decision-making

DEFF Research Database (Denmark)

Søgaard, Rikke; Lindholt, Jes S.

2012-01-01

OBJECTIVE: To investigate whether the credibility of health economic models of screening for abdominal aortic aneurysms for health policy decision-making has improved since 2005 when a systematic review by Campbell et al. concluded that reporting standards were poor and there was divergence between...... benefited from general advances in health economic modelling and some improvements in reporting were noted. However, the low level of agreement between studies in model structures and assumptions, and difficulty in justifying these (convergent validity), remain a threat to the credibility of health economic...... models. Decision-makers should not accept the results of a modelling study if the methods are not fully transparent and justified. Modellers should, whenever relevant, supplement a primary report of results with a technical report detailing and discussing the methodological choices made....

The impact of mass media health communication on health decision-making and medical advice-seeking behavior of u.s. Hispanic population.

Science.gov (United States)

De Jesus, Maria

2013-01-01

Mass media health communication has enormous potential to drastically alter how health-related information is disseminated and obtained by different populations. However, there is little evidence regarding the influence of media channels on health decision-making and medical advice-seeking behaviors among the Hispanic population. The Pew 2007 Hispanic Healthcare Survey was used to test the hypothesis that the amount of mass media health communication (i.e., quantity of media-based health information received) is more likely to influence Hispanic adults' health decision-making and medical advice-seeking behavior compared to health literacy and language proficiency variables. Results indicated that quantity of media-based health information is positively associated with health decision-making and medical advice-seeking behavior above and beyond the influence of health literacy and English and Spanish language proficiency. In a context where physician-patient dynamics are increasingly shifting from a passive patient role model to a more active patient role model, media-based health information can serve as an influential cue to action, prompting Hispanic individuals to make certain health-related decisions and to seek more health advice and information from a health provider. Study implications are discussed.

The role of affect and cognition in health decision making.

Science.gov (United States)

Keer, Mario; van den Putte, Bas; Neijens, Peter

2010-03-01

Both affective and cognitive evaluations of behaviours have been allocated various positions in theoretical models of decision making. Most often, they have been studied as direct determinants of either intention or overall evaluation, but these two possible positions have never been compared. The aim of this study was to determine whether affective and cognitive evaluations influence intention directly, or whether their influence is mediated by overall evaluation. A sample of 300 university students filled in questionnaires on their affective, cognitive, and overall evaluations in respect of 20 health behaviours. The data were interpreted using mediation analyses with the application of path modelling. Both affective and cognitive evaluations were found to have significantly predicted intention. The influence of affective evaluation was largely direct for each of the behaviours studied, whereas that of cognitive evaluation was partially direct and partially mediated by overall evaluation. These results indicate that decisions regarding the content of persuasive communication (affective vs. cognitive) are highly dependent on the theoretical model chosen. It is suggested that affective evaluation should be included as a direct determinant of intention in theories of decision making when predicting health behaviours.

The Role of Health Care Provider and Partner Decisional Support in Patients' Cancer Treatment Decision-Making Satisfaction.

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Palmer-Wackerly, Angela L; Krieger, Janice L; Rhodes, Nancy D

2017-01-01

Cancer patients rely on multiple sources of support when making treatment decisions; however, most research studies examine the influence of health care provider support while the influence of family member support is understudied. The current study fills this gap by examining the influence of health care providers and partners on decision-making satisfaction. In a cross-sectional study via an online Qualtrics panel, we surveyed cancer patients who reported that they had a spouse or romantic partner when making cancer treatment decisions (n = 479). Decisional support was measured using 5-point, single-item scales for emotional support, informational support, informational-advice support, and appraisal support. Decision-making satisfaction was measured using Holmes-Rovner and colleagues' (1996) Satisfaction With Decision Scale. We conducted a mediated regression analysis to examine treatment decision-making satisfaction for all participants and a moderated mediation analysis to examine treatment satisfaction among those patients offered a clinical trial. Results indicated that partner support significantly and partially mediated the relationship between health care provider support and patients' decision-making satisfaction but that results did not vary by enrollment in a clinical trial. This study shows how and why decisional support from partners affects communication between health care providers and cancer patients.

Health literacy, numeracy, and other characteristics associated with hospitalized patients' preferences for involvement in decision making.

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Goggins, Kathryn M; Wallston, Kenneth A; Nwosu, Samuel; Schildcrout, Jonathan S; Castel, Liana; Kripalani, Sunil

2014-01-01

Little research has examined the association of health literacy and numeracy with patients' preferred involvement in the problem-solving and decision-making process in the hospital. Using a sample of 1,249 patients hospitalized with cardiovascular disease from the Vanderbilt Inpatient Cohort Study (VICS), we assessed patients' preferred level of involvement using responses to two scenarios of differing symptom severity from the Problem-Solving Decision-Making Scale. Using multivariable modeling, we determined the relationship of health literacy, subjective numeracy, and other patient characteristics with preferences for involvement in decisions, and how this differed by scenario. The authors found that patients with higher levels of health literacy desired more participation in the problem-solving and decision-making process, as did patients with higher subjective numeracy skills, greater educational attainment, female gender, less perceived social support, or greater health care system distrust (pparticipate more in the decision-making process when the hypothetical symptom they were experiencing was less severe (i.e., they deferred more to their physician when the hypothetical symptom was more severe). These findings underscore the role that patient characteristics, especially health literacy and numeracy, play in decisional preferences among hospitalized patients.

A Review of Contemporary Ethical Decision-Making Models for Mental Health Professionals

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Francis, Perry C.

2015-01-01

Mental health professionals are faced with increasingly complex ethical decisions that are impacted by culture, personal and professional values, and the contexts in which they and their clients inhabit. This article presents the reasons for developing and implementing multiple ethical decision making models and reviews four models that address…

Consumer decision making in the individual health insurance market.

Science.gov (United States)

Marquis, M Susan; Buntin, Melinda Beeuwkes; Escarce, José J; Kapur, Kanika; Louis, Thomas A; Yegian, Jill M

2006-01-01

This paper summarizes the results from a study of consumer decision making in California's individual health insurance market. We conclude that price subsidies will have only modest effects on participation and that efforts to reduce nonprice barriers might be just as effective. We also find that there is substantial pooling in the individual market and that it increases over time because people who become sick can continue coverage without new underwriting. Finally, we show that people prefer more-generous benefits and that it is difficult to induce people in poor health to enroll in high-deductible health plans.

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

Science.gov (United States)

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

2013-08-08

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

Patients With Limited Health Literacy Have Similar Preferences but Different Perceptions in Surgical Decision-making for Carpal Tunnel Release.

Science.gov (United States)

Roh, Young Hak; Koh, Young Do; Kim, Jong Oh; Noh, Jung Ho; Gong, Hyun Sik; Baek, Goo Hyun

2018-04-01

Health literacy is the ability to obtain, process, and understand health information needed to make appropriate health decisions. The proper comprehension by patients regarding a given disease, its treatment, and the physician's instructions plays an important role in shared decision-making. Studies have disagreed over the degree to which differences in health literacy affect patients' preferences for shared decision-making; we therefore sought to evaluate this in the context of shared decision-making about carpal tunnel release. (1) Do patients with limited health literacy have different preferences of shared decision-making for carpal tunnel release than those with greater levels of health literacy? (2) How do patients with limited health literacy retrospectively perceive their role in shared decision-making after carpal tunnel release? Over a 32-month period, one surgeon surgically treated 149 patients for carpal tunnel syndrome. Patients were eligible if they had cognitive and language function to provide informed consent and complete a self-reported questionnaire and were not eligible if they had nerve entrapment other than carpal tunnel release or had workers compensation issues; based on those, 140 (94%) were approached for study. Of those, seven (5%) were lost to followup before 6 months, leaving 133 for analysis here. Their mean age was 55 years (range, 31-76 years), and 83% (111 of 133) were women. Thirty-three percent (44 of 133) of patients had less than a high school education. Health literacy was measured according to the Newest Vital Sign during the initial visit, and a score of ≤ 3 was considered limited health literacy. Forty-four percent of patients had limited health literacy. The Control Preferences Scale was used for patients to indicate their preferred role in surgical decision-making preoperatively and to assess their perceived level of involvement postoperatively. Bivariate and multivariable analyses were performed to determine whether

Health technology assessment in India: the potential for improved healthcare decision-making.

Science.gov (United States)

Kumar, Mrityunjai; Ebrahim, Shah; Taylor, Fiona C; Chokshi, Maulik; Gabbay, John

2014-01-01

Health technology assessment (HTA) is a multidisciplinary approach that uses clinical effectiveness, cost-effectiveness, policy and ethical perspectives to provide evidence upon which rational decisions on the use of health technologies can be made. It can be used for a single stand-alone technology (e.g. a drug, a device), complex interventions (e.g. a rehabilitation service) and can also be applied to individual patient care and to public health. It is a tool for enabling the assessment and comparison of health technologies using the same metric of cost-effectiveness. This process benefits the patient, the health service, the healthcare payer and the technology producer as only technologies that are considered cost-effective are promoted for widespread use. This leads to greater use of effective technologies and greater health gain. The decision-making process in healthcare in India is complex owing to multiplicity of organizations with overlapping mandates. Often the decision-making is not evidence-based and there is no mechanism of bridging the gap between evidence and policy. Elsewhere, HTA is a frequently used tool in informing policy decisions in both resource-rich and resource-poor countries. Despite national organizations producing large volumes of research and clinical guidelines, India has not yet introduced a formal HTA programme. The incremental growth in healthcare products, services, innovation in affordable medical devices and a move towards universal healthcare, needs to be underpinned with an evidencebase which focuses on effectiveness, safety, affordability and acceptability to maximize the benefits that can be gained with a limited healthcare budget. Establishing HTA as a formal process in India, independent of healthcare providers, funders and technology producers, together with a framework for linking HTA to policy-making, would help ensure that the population gets better access to appropriate healthcare in the future. Copyright 2014, NMJI.

Priority Setting in Indigenous Health: Why We Need an Explicit Decision Making Approach

Directory of Open Access Journals (Sweden)

Michael E. Otim

2015-06-01

Full Text Available Indigenous Australians have significantly poorer health outcomes than the non-Indigenous population worldwide. The Australian government has increased its investment in Indigenous health through the "Closing the Health Gap" initiative. Deciding where to invest scarce resources so as to maximize health outcomes for Indigenous peoples may require improved priority setting processes. Current government practice involves a mix of implicit and explicit processes to varying degrees at the macro and meso decision making levels. In this article, we argue that explicit priority setting should be emphasized in Indigenous health, as it can ensure that the decision making process is accountable, systematic, and transparent. Following a review of the literature, we outline four key issues that need to be considered for explicit priority setting: developing an Indigenous health "constitution," strengthening the evidence base, selecting mechanisms for priority setting, and establishing appropriate incentives and institutional structure. We then summarize our findings into a checklist that can help a decision makers ensure that explicit priority setting is undertaken in Indigenous health. By addressing these key issues, the benefits of an explicit approach, which include increased efficiency, equity, and use of evidence, can be realized, thereby maximizing Indigenous health outcomes.

Rural and remote young people's health career decision making within a health workforce development program: a qualitative exploration.

Science.gov (United States)

Kumar, Koshila; Jones, Debra; Naden, Kathryn; Roberts, Chris

2015-01-01

One strategy aimed at resolving ongoing health workforce shortages in rural and remote settings has been to implement workforce development initiatives involving the early activation and development of health career aspirations and intentions among young people in these settings. This strategy aligns with the considerable evidence showing that rural background is a strong predictor of rural practice intentions and preferences. The Broken Hill Regional Health Career Academy Program (BHRHCAP) is an initiative aimed at addressing local health workforce challenges by helping young people in the region develop and further their health career aspirations and goals. This article reports the factors impacting on rural and remote youths' health career decision-making within the context of a health workforce development program. Data were collected using interviews and focus groups with a range of stakeholders involved in the BHRHCAP including local secondary school students, secondary school teachers, career advisors, school principals, parents, and pre-graduate health students undertaking a clinical placement in Broken Hill, and local clinicians. Data interpretation was informed by the theoretical constructs articulated within socio cognitive career theory. Young people's career decision-making in the context of a local health workforce development program was influenced by a range of personal, contextual and experiential factors. These included personal factors related to young people's career goals and motivations and their confidence to engage in career decision-making, contextual factors related to BHRHCAP program design and structure as well as the visibility and accessibility of health career pathways in a rural setting, and experiential factors related to the interaction and engagement between young people and role models or influential others in the health and education sectors. This study provided theoretical insight into the broader range of interrelating and

The EVOTION Decision Support System: Utilizing It for Public Health Policy-Making in Hearing Loss.

Science.gov (United States)

Katrakazas, Panagiotis; Trenkova, Lyubov; Milas, Josip; Brdaric, Dario; Koutsouris, Dimitris

2017-01-01

As Decision Support Systems start to play a significant role in decision making, especially in the field of public-health policy making, we present an initial attempt to formulate such a system in the concept of public health policy making for hearing loss related problems. Justification for the system's conceptual architecture and its key functionalities are presented. The introduction of the EVOTION DSS sets a key innovation and a basis for paradigm shift in policymaking, by incorporating relevant models, big data analytics and generic demographic data. Expected outcomes for this joint effort are discussed from a public-health point of view.

Heuristic decision making in medicine

Science.gov (United States)

Marewski, Julian N.; Gigerenzer, Gerd

2012-01-01

Can less information be more helpful when it comes to making medical decisions? Contrary to the common intuition that more information is always better, the use of heuristics can help both physicians and patients to make sound decisions. Heuristics are simple decision strategies that ignore part of the available information, basing decisions on only a few relevant predictors. We discuss: (i) how doctors and patients use heuristics; and (ii) when heuristics outperform information-greedy methods, such as regressions in medical diagnosis. Furthermore, we outline those features of heuristics that make them useful in health care settings. These features include their surprising accuracy, transparency, and wide accessibility, as well as the low costs and little time required to employ them. We close by explaining one of the statistical reasons why heuristics are accurate, and by pointing to psychiatry as one area for future research on heuristics in health care. PMID:22577307

Heuristic decision making in medicine.

Science.gov (United States)

Marewski, Julian N; Gigerenzer, Gerd

2012-03-01

Can less information be more helpful when it comes to making medical decisions? Contrary to the common intuition that more information is always better, the use of heuristics can help both physicians and patients to make sound decisions. Heuristics are simple decision strategies that ignore part of the available information, basing decisions on only a few relevant predictors. We discuss: (i) how doctors and patients use heuristics; and (ii) when heuristics outperform information-greedy methods, such as regressions in medical diagnosis. Furthermore, we outline those features of heuristics that make them useful in health care settings. These features include their surprising accuracy, transparency, and wide accessibility, as well as the low costs and little time required to employ them. We close by explaining one of the statistical reasons why heuristics are accurate, and by pointing to psychiatry as one area for future research on heuristics in health care.

Effect of shared decision-making on therapeutic alliance in addiction health care

Directory of Open Access Journals (Sweden)

EAG Joosten

2008-10-01

Full Text Available EAG Joosten1,2, GH de Weert3, T Sensky4, CPF van der Staak5, CAJ de Jong1,21Novadic-Kentron, Network for Addiction Treatment Services, Vught, the Netherlands; 2Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA, Nijmegen, the Netherlands; 3Julius Center for Health Sciences and Primary Health Care, UMC Utrecht, Utrecht, the Netherlands; 4Department of Psychological Medicine, Imperial College London, London, United Kingdom; 5Academic Centre for Social Sciences, Radboud University Nijmegen, Nijmegen, the NetherlandsBackground: In recent decades, shared decision-making (SDM models have been developed to increase patient involvement in treatment decisions. The purpose of this study was to examine the effect of a shared decision-making intervention (SDMI for substance-dependent patients on patients’ and clinicians’ perceptions of therapeutic alliance.Methods: Clinicians were randomly assigned to SDMI or usual procedures to reach a treatment agreement. SDMI is a structured, manualized, 5-session procedure to facilitate treatment agreement and consists of five standardized sessions.Results: Patients’ perceptions of the therapeutic alliance were very favorable at start of treatment, and no differences were found between intervention groups. Clinicians’ scores on perceived helpfulness and on the overall therapeutic alliance were higher in the SDMI group than in the controls, after 8 weeks of treatment and at the end of treatment.Conclusion: The present study has shown that a specific intervention to enhance shared decision-making results in favorable changes in clinicians’ perceptions of the therapeutic alliance.Keywords: therapeutic alliance, helping alliance, shared decision-making, addiction, substance-dependence

Exploring older and younger adults' preferences for health information and participation in decision making using the Health Information Wants Questionnaire (HIWQ).

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Xie, Bo; Wang, Mo; Feldman, Robert; Zhou, Le

2014-12-01

Existing measurements of patient preferences cover only a limited range of health information and participation in decision making. A broader approach is necessary to understand the breadth and variations in patient preferences. To explore the breadth and variances in patient preferences for health information and participation in decision making and to understand the relationship between age and each type of preference. The Health Information Wants Questionnaire (HIWQ) was administered during May-December 2010 to gather data about the information and corresponding decision-making autonomy participants would want in seven areas: diagnosis, treatment, laboratory tests, self-care, complementary and alternative medicine (CAM), psychosocial factors and health-care providers. A large state university, public libraries and senior centres in Maryland, USA. A convenience sample of 438 individuals, including 226 undergraduates (mean age = 20; SD = 2.15) and 212 community-dwelling older adults (mean age = 72; SD = 9.00). Ratings on the information and decision-making items of the HIWQ. Participants expressed higher levels of preference for information than for participation in decision making on six of seven subscales. On the psychosocial subscale, they expressed stronger desire for participation in decision making than for information. Age had no predictive effect on the overall preferences or specific preferences for information and participation in decision making about standard treatments and CAM. The predictive effect of age on the other types of preferences varied significantly. Physicians should take into account the breadth and variations in patient preferences. The predictive effect of age on patient preferences varied depending on the specific area of preferences. © 2012 John Wiley & Sons Ltd.

Mothers' process of decision making for gastrostomy placement.

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Brotherton, Ailsa; Abbott, Janice

2012-05-01

In this article we present the findings of an exploration of mothers' discourses on decision making for gastrostomy placement for their child. Exploring in-depth interviews of a purposive sample, we analyzed the mothers' discourses of the decision-making process to understand how their experiences of the process influenced their subsequent constructions of decision making. Mothers negotiated decision making by reflecting on their personal experiences of feeding their child, either orally or via a tube, and interwove their background experiences with the communications from members of the health care team until a decision was reached. Decision making was often fraught with difficulty, resulting in anxiety and guilt. Experiences of decision making ranged from perceived coercion to true choice, which encompasses a truly child-centered decision. The resulting impact of the decision-making process on the mothers was profound. We conclude with an exploration of the implications for clinical practice and describe how health care professionals can support mothers to ensure that decision-making processes for gastrostomy placement in children are significantly improved.

Health behaviour, decision making and perceived parenting: are ...

African Journals Online (AJOL)

The findings, therefore, suggest that authoritative parenting, vigilant decision making and frequent engagement in healthy lifestyle behaviours were the most prevalent behaviours amongst male and female learners. Keywords: Adolescence, decision making, gender, healthy lifestyle behaviours, learners, parenting ...

Neuroanatomical basis for recognition primed decision making.

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Hudson, Darren

2013-01-01

Effective decision making under time constraints is often overlooked in medical decision making. The recognition primed decision making (RPDM) model was developed by Gary Klein based on previous recognized situations to develop a satisfactory solution to the current problem. Bayes Theorem is the most popular decision making model in medicine but is limited by the need for adequate time to consider all probabilities. Unlike other decision making models, there is a potential neurobiological basis for RPDM. This model has significant implication for health informatics and medical education.

Adapting Scott and Bruce's General Decision-Making Style Inventory to Patient Decision Making in Provider Choice.

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Fischer, Sophia; Soyez, Katja; Gurtner, Sebastian

2015-05-01

Research testing the concept of decision-making styles in specific contexts such as health care-related choices is missing. Therefore, we examine the contextuality of Scott and Bruce's (1995) General Decision-Making Style Inventory with respect to patient choice situations. Scott and Bruce's scale was adapted for use as a patient decision-making style inventory. In total, 388 German patients who underwent elective joint surgery responded to a questionnaire about their provider choice. Confirmatory factor analyses within 2 independent samples assessed factorial structure, reliability, and validity of the scale. The final 4-dimensional, 13-item patient decision-making style inventory showed satisfactory psychometric properties. Data analyses supported reliability and construct validity. Besides the intuitive, dependent, and avoidant style, a new subdimension, called "comparative" decision-making style, emerged that originated from the rational dimension of the general model. This research provides evidence for the contextuality of decision-making style to specific choice situations. Using a limited set of indicators, this report proposes the patient decision-making style inventory as valid and feasible tool to assess patients' decision propensities. © The Author(s) 2015.

Prioritising public health: a qualitative study of decision making to reduce health inequalities

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O'Flaherty Martin

2011-10-01

Full Text Available Abstract Background The public health system in England is currently facing dramatic change. Renewed attention has recently been paid to the best approaches for tackling the health inequalities which remain entrenched within British society and across the globe. In order to consider the opportunities and challenges facing the new public health system in England, we explored the current experiences of those involved in decision making to reduce health inequalities, taking cardiovascular disease (CVD as a case study. Methods We conducted an in-depth qualitative study employing 40 semi-structured interviews and three focus group discussions. Participants were public health policy makers and planners in CVD in the UK, including: Primary Care Trust and Local Authority staff (in various roles; General Practice commissioners; public health academics; consultant cardiologists; national guideline managers; members of guideline development groups, civil servants; and CVD third sector staff. Results The short term target- and outcome-led culture of the NHS and the drive to achieve "more for less", combined with the need to address public demand for acute services often lead to investment in "downstream" public health intervention, rather than the "upstream" approaches that are most effective at reducing inequalities. Despite most public health decision makers wishing to redress this imbalance, they felt constrained due to difficulties in partnership working and the over-riding influence of other stakeholders in decision making processes. The proposed public health reforms in England present an opportunity for public health to move away from the medical paradigm of the NHS. However, they also reveal a reluctance of central government to contribute to shifting social norms. Conclusions It is vital that the effectiveness and cost effectiveness of all new and existing policies and services affecting public health are measured in terms of their impact on the

Prioritising public health: a qualitative study of decision making to reduce health inequalities.

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Orton, Lois C; Lloyd-Williams, Ffion; Taylor-Robinson, David C; Moonan, May; O'Flaherty, Martin; Capewell, Simon

2011-10-20

The public health system in England is currently facing dramatic change. Renewed attention has recently been paid to the best approaches for tackling the health inequalities which remain entrenched within British society and across the globe. In order to consider the opportunities and challenges facing the new public health system in England, we explored the current experiences of those involved in decision making to reduce health inequalities, taking cardiovascular disease (CVD) as a case study. We conducted an in-depth qualitative study employing 40 semi-structured interviews and three focus group discussions. Participants were public health policy makers and planners in CVD in the UK, including: Primary Care Trust and Local Authority staff (in various roles); General Practice commissioners; public health academics; consultant cardiologists; national guideline managers; members of guideline development groups, civil servants; and CVD third sector staff. The short term target- and outcome-led culture of the NHS and the drive to achieve "more for less", combined with the need to address public demand for acute services often lead to investment in "downstream" public health intervention, rather than the "upstream" approaches that are most effective at reducing inequalities. Despite most public health decision makers wishing to redress this imbalance, they felt constrained due to difficulties in partnership working and the over-riding influence of other stakeholders in decision making processes. The proposed public health reforms in England present an opportunity for public health to move away from the medical paradigm of the NHS. However, they also reveal a reluctance of central government to contribute to shifting social norms. It is vital that the effectiveness and cost effectiveness of all new and existing policies and services affecting public health are measured in terms of their impact on the social determinants of health and health inequalities. Researchers

Information search in health care decision-making: a study of word-of-mouth and internet information users.

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Snipes, Robin L; Ingram, Rhea; Jiang, Pingjun

2005-01-01

This paper investigates how individual consumers may differ in their information search behavior in health care decision-making. Results indicate that most consumers still use word-of-mouth as a primary information source for health care decisions. However, usage of the Internet is increasing. The results of this study indicate that consumers who are most likely to use the Internet for health care information are single, younger, and less educated, whereas consumers who are most likely to use word-of-mouth are middle-aged, married, with higher income and higher education. Surprisingly, no significant gender difference was found in information search behavior for health care decision-making. The results also suggest that consumers with the highest tendency to use word-of-mouth are also the lowest users of the Internet in health care decision-making. Implications of these findings are discussed.

[Ethical and philosophical dimensions of decision-making in public health].

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Grémy, F

2008-01-01

Decisions in public health, or in individual health care, are taken by people (individuals or collective) for other people (individuals or collective). Human values, that is to say what is connected to Ethics, should be to the fore, de jure. Too often, under the pretext that they refer to subjectivity, they appear only after very many technical considerations. The latter, in a scientist society, are supposed to deserve a claim to objectivity, this being of course illusory. The author, placing himself in the line of Levinas, Ricoeur, and also of Kant, for whom the "What must I do?" is the most fundamental question any human being has to face, develops four reasons which plead for the pre-eminence of ethics as the foundation of decisions in a policy for public health. 1) He reminds us the intangible values, which are on one side uniqueness and universality of mankind, and on the other side the singularity of the human person. 2) He insists on the ethical wreck which threatens the whole health- and healthcare systems. 3) He sets out some results of modern neurophysiological research (AR Damasio's work), joining an intuition of Aristoteles: the decision making process implies two phases: deliberation the aim of which is to list the different possible actions to undertake, then the choice between those actions. Damasio shows that the lack of emotions inhibits the choice, especially when decision implies human values. 4) Finally, he insists, after E. Morin, on the practical and theoretical difficulties in taking a "good" decision, and on what Morin calls "ecology of action". The results of a decision may completely escape from the decision-makers aims, very often for unexpected social and psychological reasons.

An international comparison of legal frameworks for supported and substitute decision-making in mental health services.

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Davidson, Gavin; Brophy, Lisa; Campbell, Jim; Farrell, Susan J; Gooding, Piers; O'Brien, Ann-Marie

2016-01-01

There have been important recent developments in law, research, policy and practice relating to supporting people with decision-making impairments, in particular when a person's wishes and preferences are unclear or inaccessible. A driver in this respect is the United Nations Convention on the Rights of Persons with Disabilities (CRPD); the implications of the CRPD for policy and professional practices are currently debated. This article reviews and compares four legal frameworks for supported and substitute decision-making for people whose decision-making ability is impaired. In particular, it explores how these frameworks may apply to people with mental health problems. The four jurisdictions are: Ontario, Canada; Victoria, Australia; England and Wales, United Kingdom (UK); and Northern Ireland, UK. Comparisons and contrasts are made in the key areas of: the legal framework for supported and substitute decision-making; the criteria for intervention; the assessment process; the safeguards; and issues in practice. Thus Ontario has developed a relatively comprehensive, progressive and influential legal framework over the past 30 years but there remain concerns about the standardisation of decision-making ability assessments and how the laws work together. In Australia, the Victorian Law Reform Commission (2012) has recommended that the six different types of substitute decision-making under the three laws in that jurisdiction, need to be simplified, and integrated into a spectrum that includes supported decision-making. In England and Wales the Mental Capacity Act 2005 has a complex interface with mental health law. In Northern Ireland it is proposed to introduce a new Mental Capacity (Health, Welfare and Finance) Bill that will provide a unified structure for all substitute decision-making. The discussion will consider the key strengths and limitations of the approaches in each jurisdiction and identify possible ways that further progress can be made in law, policy

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

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Land, Victoria; Parry, Ruth; Seymour, Jane

2017-12-01

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.

Application of HTA research on policy decision-making.

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Youngkong, Sitaporn

2014-05-01

This article provides an overview of the potential uses of health technology assessment (HTA) in health technology or health intervention-related policy decision-making. It summarises the role of HTA in policy planning, health system investment, price negotiation, development of clinical practice guidelines, and communication with health professionals. While the multifaceted nature of HTA means that some aspects of the data can result in conflicting conclusions, the comprehensive approach of HTA is still recommended. To help minimise the potential conflicts within HTA data, a multicriteria decision analysis (MCDA) approach is recommended as a way to assess a number of decision criteria simultaneously. A combination of HTA with MCDA allows policy decision-making to be undertaken in an empirically rigorous and rational way. This combination can be used to support policy decision-makers in Thailand and help them prioritise topics for assessment and make informed health benefit package coverage decisions. This approach enhances the legitimacy of policy decisions by increasing the transparency, systematic nature, and inclusiveness of the process.

Group Health's participation in a shared decision-making demonstration yielded lessons, such as role of culture change.

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King, Jaime; Moulton, Benjamin

2013-02-01

In 2007 Washington State became the first state to enact legislation encouraging the use of shared decision making and decision aids to address deficiencies in the informed-consent process. Group Health volunteered to fulfill a legislated mandate to study the costs and benefits of integrating these shared decision-making processes into clinical practice across a range of conditions for which multiple treatment options are available. The Group Health Demonstration Project, conducted during 2009-11, yielded five key lessons for successful implementation, including the synergy between efforts to reduce practice variation and increase shared decision making; the need to support modifications in practice with changes in physician training and culture; and the value of identifying best implementation methods through constant evaluation and iterative improvement. These lessons, and the legislated provisions that supported successful implementation, can guide other states and health care institutions moving toward informed patient choice as the standard of care for medical decision making.

Involved, inputting or informing: "Shared" decision making in adult mental health care.

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Bradley, Eleanor; Green, Debra

2018-02-01

A diagnosis of serious mental illness can impact on the whole family. Families informally provide significant amounts of care but are disproportionately at risk of carer burden when compared to those supporting people with other long-term conditions. Shared decision making (SDM) is an ethical model of health communication associated with positive health outcomes; however, there has been little research to evaluate how routinely family is invited to participate in SDM, or what this looks like in practice. This UK study aimed to better understand how the family caregivers of those diagnosed with SMI are currently involved in decision making, particularly decisions about treatment options including prescribed medication. Objectives were to Explore the extent to which family members wish to be involved in decisions about prescribed medication Determine how and when professionals engage family in these decisions Identify barriers and facilitators associated with the engagement of family in decisions about treatment. Open-ended questions were sent to professionals and family members to elicit written responses. Qualitative responses were analysed thematically. Themes included the definition of involvement and "rules of engagement." Staff members are gatekeepers for family involvement, and the process is not democratic. Family and staff ascribe practical, rather than recovery-oriented roles to family, with pre-occupation around notions of adherence. Staff members need support, training and education to apply SDM. Time to exchange information is vital but practically difficult. Negotiated teams, comprising of staff, service users, family, peers as applicable, with ascribed roles and responsibilities could support SDM. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Medical Decision-Making for Adults Who Lack Decision-Making Capacity and a Surrogate: State of the Science.

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Kim, Hyejin; Song, Mi-Kyung

2018-01-01

Adults who lack decision-making capacity and a surrogate ("unbefriended" adults) are a vulnerable, voiceless population in health care. But little is known about this population, including how medical decisions are made for these individuals. This integrative review was to examine what is known about unbefriended adults and identify gaps in the literature. Six electronic databases were searched using 4 keywords: "unbefriended," "unrepresented patients," "adult orphans," and "incapacitated patients without surrogates." After screening, the final sample included 10 data-based articles for synthesis. Main findings include the following: (1) various terms were used to refer to adults who lack decision-making capacity and a surrogate; (2) the number of unbefriended adults was sizable and likely to grow; (3) approaches to medical decision-making for this population in health-care settings varied; and (4) professional guidelines and laws to address the issues related to this population were inconsistent. There have been no studies regarding the quality of medical decision-making and its outcomes for this population or societal impact. Extremely limited empirical data exist on unbefriended adults to develop strategies to improve how medical decisions are made for this population. There is an urgent need for research to examine the quality of medical decision-making and its outcomes for this vulnerable population.

Health social workers sources of knowledge for decision making in practice.

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McDermott, Fiona; Henderson, Annabel; Quayle, Carol

2017-10-01

This article presents findings from research examining knowledge social workers in a health network in Victoria, Australia identified as informing their decision-making. Data for 13 patients, and in-depth interviews with six social workers who worked with these patients, were studied. A thematic analysis of interviews revealed that participants identified reliance on past experience and contextual/situational information as underpinning their decisions, demonstrating their commitment to person-in-environment perspectives. However, despite the availability of a repository of empirical evidence, no respondent made use of this. This study provided insight into health practitioners' sources of knowledge, highlighting gaps and areas for further exploration.

The Choice Project: Peer Workers Promoting Shared Decision Making at a Youth Mental Health Service.

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Simmons, Magenta Bender; Batchelor, Samantha; Dimopoulos-Bick, Tara; Howe, Deb

2017-08-01

In youth mental health services, consumer participation is essential, but few implementation strategies exist to engage young consumers. This project evaluated an intervention implemented in an Australian youth mental health service that utilized peer workers to promote shared decision making via an online tool. All new clients ages 16-25 were invited to participate in this nonrandomized comparative study, which used a historical comparison group (N=80). Intervention participants (N=149) engaged with a peer worker and used the online tool before and during their intake assessment. Pre- and postintake data were collected for both groups; measures included decisional conflict, perceived shared decision making, and satisfaction. A series of paired t tests, analyses of variance, and multiple regressions were conducted to assess differences in scores across intervention and comparison groups and pre- and postintake assessments. Ratings of perceived shared decision making with intake workers were higher in the intervention group than in the comparison group (p=.015). In both groups, decisional conflict scores were significantly lower after the intake assessment (pdecision making and lower decisional conflict were associated with satisfaction (pdecision making reported feeling more involved in their assessment. Feeling involved and having lower decisional conflict after seeing an intake worker were important for client satisfaction. These findings demonstrate the importance of both peer work and shared decision making for promoting optimal outcomes in youth mental health services.

What Factors Do Allied Health Take Into Account When Making Resource Allocation Decisions?

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Lane, Haylee; Sturgess, Tamica; Philip, Kathleen; Markham, Donna; Martin, Jennifer; Walsh, Jill; Hubbard, Wendy; Haines, Terry

2017-09-12

Allied health comprises multiple professional groups including dietetics, medical radiation practitioners, occupational therapists, optometrists and psychologists. Different to medical and nursing, Allied health are often organized in discipline specific departments and allocate budgets within these to provide services to a range of clinical areas. Little is known of how managers of allied health go about allocating these resources, the factors they consider when making these decisions, and the sources of information they rely upon. The purpose of this study was to identify the key factors that allied health consider when making resource allocation decisions and the sources of information they are based upon. Four forums were conducted each consisting of case studies, a large group discussion and two hypothetical scenarios to elicit data. A thematic content analysis commenced during post-forum discussions of key factors by forum facilitators. These factors were then presented to an expert working party for further discussion and refinement. Transcripts were generated of all data recordings and a detailed thematic analysis was undertaken by one author to ensure coded data matched the initial thematic analysis. Twelve factors affecting the decision-making of allied health managers and clinicians were identified. One of these factors was disendorsed by the expert working party. The 11 remaining factors can be considered to be key decision-making principles that should be consistently applied to resource allocation. These principles were clustered into three overarching themes of readiness, impact and appropriateness. Understanding these principles now means further research can be completed to more effectively integrate research evidence into health policy and service delivery, create partnerships among policy-makers, managers, service providers and researchers, and to provide support to answer difficult questions that policy-makers, managers and service providers

What role does health literacy play in patients' involvement in medical decision-making?

NARCIS (Netherlands)

Brabers, A.E.M.; Rademakers, J.J.D.J.M.; Groenewegen, P.P.; Dijk, L. van; Jong, J.D. de

2017-01-01

Patients vary in their preferences towards involvement in medical decision-making. Previous research, however, gives no clear explanation for this observed variation in their involvement. One possible explanation might be health literacy. Health literacy refers to personal characteristics and social

Written and spoken narratives about health and cancer decision making: a novel application of photovoice.

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Thomas, Tracey L; Owens, Otis L; Friedman, Daniela B; Torres, Myriam E; Hébert, James R

2013-11-01

Photovoice is a community-based participatory research method that researchers have used to identify and address individual and community health needs. We developed an abbreviated photovoice project to serve as a supplement to a National Cancer Institute-funded pilot study focusing on prostate cancer (PrCA) that was set in a faith-based African American community in South Carolina. We used photovoice for three reasons: (a) to enhance communication between study participants and researchers, (b) to empower African American men and women to examine their health decisions through photographs, and (c) to better understand how participants from this community make health-related decisions. The 15 individuals participating in the photovoice project were asked to photograph aspects of their community that informed their health-related decisions. Participants provided written and oral narratives to describe the images in a small sample of photographs. Four primary themes emerged in participants' photographs and narratives: (a) food choices, (b) physical activity practices, (c) community environment and access to care, and (d) influences of spirituality and nature on health. Although written and audio-recorded narratives were similar in content, the audio-recorded responses were more descriptive and emotional. Results suggest that incorporating audio-recorded narratives in community photovoice presentations may have a greater impact than written narratives on health promotion, decision making, and policy makers because of an increased level of detail and personalization. In conclusion, photovoice strengthened the parent study and empowered participants by making them more aware of factors influencing their health decisions.

A conceptual framework for automating the operational and strategic decision-making process in the health care delivery system.

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Ruohonen, Toni; Ennejmy, Mohammed

2013-01-01

Making reliable and justified operational and strategic decisions is a really challenging task in the health care domain. So far, the decisions have been made based on the experience of managers and staff, or they are evaluated with traditional methods, using inadequate data. As a result of this kind of decision-making process, attempts to improve operations usually have failed or led to only local improvements. Health care organizations have a lot of operational data, in addition to clinical data, which is the key element for making reliable and justified decisions. However, it is progressively problematic to access it and make usage of it. In this paper we discuss about the possibilities how to exploit operational data in the most efficient way in the decision-making process. We'll share our future visions and propose a conceptual framework for automating the decision-making process.

eHealth Literacy and Partner Involvement in Treatment Decision Making for Men With Newly Diagnosed Localized Prostate Cancer.

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Song, Lixin; Tatum, Kimberly; Greene, Giselle; Chen, Ronald C

2017-03-01

To examine how the eHealth literacy of partners of patients with newly diagnosed prostate cancer affects their involvement in decision making, and to identify the factors that influence their eHealth literacy.
. Cross-sectional exploratory study.
. North Carolina.
. 142 partners of men with newly diagnosed localized prostate cancer. 
. A telephone survey and descriptive and multiple linear regression analyses were used.
. The partners' eHealth literacy, involvement in treatment decision making, and demographics, and the health statuses of the patients and their partners. 
. Higher levels of eHealth literacy among partners were significantly associated with their involvement in getting a second opinion, their awareness of treatment options, and the size of the social network they relied on for additional information and support for treatment decision making for prostate cancer. The factor influencing eHealth literacy was the partners' access to the Internet for personal use, which explained some of the variance in eHealth literacy.
. This study described how partners' eHealth literacy influenced their involvement in treatment decision making for prostate cancer and highlighted the influencing factors (i.e., partners' access to the Internet for personal use).
. When helping men with prostate cancer and their partners with treatment decision making, nurses need to assess eHealth literacy levels to determine whether nonelectronically based education materials are needed and to provide clear instructions on how to use eHealth resources.

Lone ranger decision making versus consensus decision making: Descriptive analysis

OpenAIRE

Maite Sara Mashego

2015-01-01

Consensus decision making, concerns group members make decisions together with the requirement of reaching a consensus that is all members abiding by the decision outcome. Lone ranging worked for sometime in a autocratic environment. Researchers are now pointing to consensus decision-making in organizations bringing dividend to many organizations. This article used a descriptive analysis to compare the goodness of consensus decision making and making lone ranging decision management. This art...

Title: A study of the relationship between managers\\' decision making styles and organizational health in Isfahan University of Medical Sciences

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S Bahrami

2012-12-01

Full Text Available   Background and Aims: Managers decision making style can function effectively correct departments in universities and its positive impact on organizational health group will increase efficiency. The present study aims to examine the relationship between the decision-making styles and organizational health departments in Isfahan University of Medical Sciences.   Methods: A descriptive and survey research method was utilized. The statistical population included all 594 members of Isfahan Medical Science University Colleges from which a sample of 201 was selected though a classified random sampling   The data gathering instruments included, a researcher – made decision making questionnaire and the Ho & Feldmn (1990, organizational health questionnaire. The reliability of the instruments was estimated 0.86 and 0.92 respectively, though Cronbach Alpha coefficient. Utilizing SPSS (15 statistical software, both descriptive and inferential statistics were applied to analyze the data.   Results: Consultative decision making scored the highest average among the chairpersons, while the authoritative style scored the lowest average. The departments' organizational health was more than mean level in all dimensions except chairperson's influence. Moreover, a significant relationship was observed between decision making style and organizational health indices. Also a direct relationship was not observed between authoritarian decision makings and institutional integration, chairperson influence, consideration, initiating structure, and academic emphasis. A direct relationship was observed between Consultative decision making and chairperson influence, consideration, initiating structure, resource support, morale, and academic emphasis. A direct relationship was observed between Participative decision making and chairperson Influence, consideration, initiating structure.   Conclusion: Consultative and participative decision making can lead to enhancement

Health-care decision-making processes in Latin America: problems and prospects for the use of economic evaluation.

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Iglesias, Cynthia P; Drummond, Michael F; Rovira, Joan

2005-01-01

The use of economic evaluation studies (EE) in the decision-making process within the health-care system of nine Latin American (LA) and three European countries was investigated. The aim was to identify the opportunities, obstacles, and changes needed to facilitate the introduction of EE as a formal tool in health-care decision-making processes in LA. A comparative study was conducted based on existing literature and information provided through a questionnaire applied to decision makers in Argentina, Brazil, Colombia, Cuba, Mexico, Nicaragua, Peru, Portugal Spain, United Kingdom, Uruguay, and Venezuela. Systematic electronic searches of HEED, NHS EED, and LILACS were conducted to identify published economic evaluation studies in LA from 1982 onward. There is relatively little evidence of the conduct and use of EE within the health care systems in LA. Electronic searches retrieved 554 records; however, only 93 were EE. In the nine LA participating countries, broad allocation of health-care resources is primarily based on political criteria, historical records, geographical areas, and specific groups of patients and diseases. Public-health provision and inclusion of services in health-insurance package are responsibilities of the Ministry of Health. Decisions regarding the purchase of medicines are primarily made through public tenders, and mainly based on differences in clinical efficacy and the price of health technologies of interest. To expedite the process of incorporating EE as a formal tool to inform decision-making processes within the health-care systems in LA countries, two main conditions need to be fulfilled. First, adequate resources and skills need to be available to conduct EE of good quality. Second, decision-making procedures need to be modified to accommodate "evidence-based" approaches such as EE.

Health care decision making autonomy of women from rural districts of Southern Ethiopia: a community based cross-sectional study

OpenAIRE

Alemayehu M; Meskele M

2017-01-01

Mihiretu Alemayehu, Mengistu Meskele School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia Introduction: Millions of women have little health care decision making autonomy in many cultures and tribes. African women are often perceived to have little participation in health care decisions. However, little has been investigated to identify factors contributing to decision making autonomy. Hence, it is important to obtain inf...

Data for decision making in networked health

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Christian Bourret

2006-06-01

Full Text Available In developed countries, nowadays we live in a networked society: a society of information, knowledge and services (Castells, 1996, with strong specificities in the Health field (Bourret, 2003, Silber, 2003. The World Health Organization (WHO has outlined the importance of information for improving health for all. However, financial resources remain limited. Health costs represent 11% of GNP in France, Germany, Switzerland and Canada, 14% in the USA, and 7.5% in Spain and the United Kingdom. Governments, local powers, health or insurance organizations therefore face difficult choices in terms of opportunities and priorities, and for that they need specific and valuable data. Firstly, this paper provide a comprehensive overview of our networked society and the appointment of ICT (Information and Communication Technologies and Health (in other words e-Health in a perspective of needs and uses at the micro, meso, and macro levels. We point out the main challenges of development of Nationwide Health Information Network both in the US, UK and France. Then we analyze the main issues about data for Decision Making in Networked Health: coordination and evaluation. In the last sections, we use an Information System perspective to investigate the three interoperability layers (micro, meso and macro. We analyze the requirements and challenges to design an interoperability global architecture which supports different kinds of interactions; then we focus on the harmonization efforts provided at several levels. Finally, we identify common methodological and engineering issues.

Bibliometrics as a Tool for Supporting Prospective R&D Decision-Making in the Health Sciences

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Ismail, Sharif; Nason, Edward; Marjanovic, Sonja; Grant, Jonathan

2012-01-01

Abstract Bibliometric analysis is an increasingly important part of a broader “toolbox” of evaluation methods available to research and development (R&D) policymakers to support decision-making. In the US, UK and Australia, for example, there is evidence of gradual convergence over the past ten years towards a model of university research assessment and ranking incorporating the use of bibliometric measures. In Britain, the Department of Health (England) has shown growing interest in using bibliometric analysis to support prospective R&D decision-making, and has engaged RAND Europe's expertise in this area through a number of exercises since 2005. These range from the macro-level selection of potentially high impact institutions, to micro-level selection of high impact individuals for the National Institute for Health Research's faculty of researchers. The aim of this study is to create an accessible, “beginner's guide” to bibliometric theory and application in the area of health R&D decision-making. The study also aims to identify future directions and possible next steps in this area, based on RAND Europe's work with the Department of Health to date. It is targeted at a range of audiences, and will be of interest to health and biomedical researchers, as well as R&D decision-makers in the UK and elsewhere. The study was completed with funding support from RAND Europe's Health R&D Policy Research Unit with the Department of Health. PMID:28083218

Health care decision making autonomy of women from rural districts of Southern Ethiopia: a community based cross-sectional study.

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Alemayehu, Mihiretu; Meskele, Mengistu

2017-01-01

Millions of women have little health care decision making autonomy in many cultures and tribes. African women are often perceived to have little participation in health care decisions. However, little has been investigated to identify factors contributing to decision making autonomy. Hence, it is important to obtain information on the contributing factors of decision making autonomy and disparities across different socio-cultural contexts. A cross-sectional study was conducted in Wolaita and Dawro zones, Southern Ethiopia from February to March 2015. A total of 967 women were selected through multistage sampling. A survey was administered face-to-face through an interview format. EpiData v1.4.4.0 and SPSS version 20 were used to enter and analyze data, respectively. Proportions and means were used to describe the study population. Variables with P -value autonomy, while 40.9% of study participants' health care decisions were made by their husbands. The husband's education (adjusted odds ratio [AOR] =1.91 [1.10, 3.32]), wealth index (AOR =0.62 [0.42, 0.92]), age (AOR =2.42 [1.35, 4.32] and AOR =7 [3.45, 14.22]), family size (AOR =0.53 [0.33, 0.85] and AOR =0.42 [0.23, 0.75]), and occupation (AOR =1.66 [1.14, 2.41]), were predictors of health care decision making autonomy. Even though every woman has the right to participate in her own health care decision making, more than two fifths of them have no role in making health care decisions about their own health. Husbands play a major role in making health care decisions about their wives. A comprehensive strategy needs to be implemented in order to empower women, as well as to challenge the traditional male dominance. Special attention has to be given to women living in rural areas in order to reduce their dependency through education and income generating activities.

Rational decision-making in mental health: the role of systematic reviews.

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Gilbody, Simon M.; Petticrew, Mark

1999-09-01

BACKGROUND: "Systematic reviews" have come to be recognized as the most rigorous method of summarizing confusing and often contradictory primary research in a transparent and reproducible manner. Their greatest impact has been in the summarization of epidemiological literature - particularly that relating to clinical effectiveness. Systematic reviews also have a potential to inform rational decision-making in healthcare policy and to form a component of economic evaluation. AIMS OF THE STUDY: This article aims to introduce the rationale behind systematic reviews and, using examples from mental health, to introduce the strengths and limitations of systematic reviews, particularly in informing mental health policy and economic evaluation. METHODS: Examples are selected from recent controversies surrounding the introduction of new psychiatric drugs (anti-depressants and anti-schizophrenia drugs) and methods of delivering psychiatric care in the community (case management and assertive community treatment). The potential for systematic reviews to (i) produce best estimates of clinical efficacy and effectiveness, (ii) aid economic evaluation and policy decision-making and (iii) highlight gaps in the primary research knowledge base are discussed. Lastly examples are selected from outside mental health to show how systematic reviews have a potential to be explicitly used in economic and health policy evaluation. RESULTS: Systematic reviews produce the best estimates of clinical efficacy, which can form an important component of economic evaluation. Importantly, serious methodological flaws and areas of uncertainty in the primary research literature are identified within an explicit framework. Summary indices of clinical effectiveness can be produced, but it is difficult to produce such summary indices of cost effectiveness by pooling economic data from primary studies. Modelling is commonly used in economic and policy evaluation. Here, systematic reviews can provide the

[Patients' preferences for information in health care decision-making].

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Borracci, Raúl A; Manente, Diego; Giorgi, Mariano A; Calderón, Gustavo; Ciancio, Alejandro; Doval, Hernán C

2012-01-01

A survey was carried out among patients who concurred to cardiologic services to know how patients preferred to be informed about their health status, and the demographic characteristics associated to these preferences, considering the following items: knowledge about the disease, information about different therapeutic options and decision-making. From 770 people surveyed, 738 (95.8%) answered the form completely. A trend to trust only in the doctor's knowledge to obtain information (81.7%), in wanting to know the options of treatment and express one's point of view (85.9%), and to involve the family in the decisions (63.2%) was observed. 9.6% preferred to receive the minimum necessary information or "to know nothing" about an alleged serious disease. Males tended less to request options and give opinion on the subject (or: 0.64), giving less freedom to family involvement (or: 1.31). people with a lower social and economical level claim fewer options (or: 0.48) and gave less family participation (or = 1.79). Natives from other South American countries had a minor tendency to demand for options and express their thoughts (or: 0.60); and the ones with lower education level trusted less in the doctor's knowledge (or: 1.81), demanded fewer options (or: 0.45) and chose not to know the severity of the disease (or: 0.56). the analysis of the demographical variables allowed to define preferences associated to age, sex, origin, education, religion and health status. In conclusion, although it is imperative to promote the patient's autonomy, individual preferences must be taken into account before informing and compromising the patient in decision-making about his disease.

Health care decision making autonomy of women from rural districts of Southern Ethiopia: a community based cross-sectional study

Directory of Open Access Journals (Sweden)

Alemayehu M

2017-04-01

Full Text Available Mihiretu Alemayehu, Mengistu Meskele School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia Introduction: Millions of women have little health care decision making autonomy in many cultures and tribes. African women are often perceived to have little participation in health care decisions. However, little has been investigated to identify factors contributing to decision making autonomy. Hence, it is important to obtain information on the contributing factors of decision making autonomy and disparities across different socio-cultural contexts. Methodology: A cross-sectional study was conducted in Wolaita and Dawro zones, Southern Ethiopia from February to March 2015. A total of 967 women were selected through multi-stage sampling. A survey was administered face-to-face through an interview format. EpiData v1.4.4.0 and SPSS version 20 were used to enter and analyze data, respectively. Proportions and means were used to describe the study population. Variables with P-value <0.2 in bivariate analysis were selected for multivariable regression. Finally, variables with P-value <0.05 in multivariable logistic regressions were identified as independent predictors. Odds ratios along with confidence intervals were used to determine the presence of association. Result: It was determined that 58.4% of women have autonomy, while 40.9% of study participants’ health care decisions were made by their husbands. The husband’s education (adjusted odds ratio [AOR] =1.91 [1.10, 3.32], wealth index (AOR =0.62 [0.42, 0.92], age (AOR =2.42 [1.35, 4.32] and AOR =7 [3.45, 14.22], family size (AOR =0.53 [0.33, 0.85] and AOR =0.42 [0.23, 0.75], and occupation (AOR =1.66 [1.14, 2.41], were predictors of health care decision making autonomy. Conclusion: Even though every woman has the right to participate in her own health care decision making, more than two fifths of them have no role in making health care

Challenges to fair decision-making processes in the context of health care services: a qualitative assessment from Tanzania.

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Shayo, Elizabeth H; Norheim, Ole F; Mboera, Leonard E G; Byskov, Jens; Maluka, Stephen; Kamuzora, Peter; Blystad, Astrid

2012-06-07

Fair processes in decision making need the involvement of stakeholders who can discuss issues and reach an agreement based on reasons that are justifiable and appropriate in meeting people's needs. In Tanzania, the policy of decentralization and the health sector reform place an emphasis on community participation in making decisions in health care. However, aspects that can influence an individual's opportunity to be listened to and to contribute to discussion have been researched to a very limited extent in low-income settings. The objective of this study was to explore challenges to fair decision-making processes in health care services with a special focus on the potential influence of gender, wealth, ethnicity and education. We draw on the principle of fairness as outlined in the deliberative democratic theory. The study was carried out in the Mbarali District of Tanzania. A qualitative study design was used. In-depth interviews and focus group discussion were conducted among members of the district health team, local government officials, health care providers and community members. Informal discussion on the topics was also of substantial value. The study findings indicate a substantial influence of gender, wealth, ethnicity and education on health care decision-making processes. Men, wealthy individuals, members of strong ethnic groups and highly educated individuals had greater influence. Opinions varied among the study informants as to whether such differences should be considered fair. The differences in levels of influence emerged most clearly at the community level, and were largely perceived as legitimate. Existing challenges related to individuals' influence of decision making processes in health care need to be addressed if greater participation is desired. There is a need for increased advocacy and a strengthening of responsive practices with an emphasis on the right of all individuals to participate in decision-making processes. This

Challenges to fair decision-making processes in the context of health care services: a qualitative assessment from Tanzania

Directory of Open Access Journals (Sweden)

Shayo Elizabeth H

2012-06-01

Full Text Available Abstract Background Fair processes in decision making need the involvement of stakeholders who can discuss issues and reach an agreement based on reasons that are justifiable and appropriate in meeting people’s needs. In Tanzania, the policy of decentralization and the health sector reform place an emphasis on community participation in making decisions in health care. However, aspects that can influence an individual’s opportunity to be listened to and to contribute to discussion have been researched to a very limited extent in low-income settings. The objective of this study was to explore challenges to fair decision-making processes in health care services with a special focus on the potential influence of gender, wealth, ethnicity and education. We draw on the principle of fairness as outlined in the deliberative democratic theory. Methods The study was carried out in the Mbarali District of Tanzania. A qualitative study design was used. In-depth interviews and focus group discussion were conducted among members of the district health team, local government officials, health care providers and community members. Informal discussion on the topics was also of substantial value. Results The study findings indicate a substantial influence of gender, wealth, ethnicity and education on health care decision-making processes. Men, wealthy individuals, members of strong ethnic groups and highly educated individuals had greater influence. Opinions varied among the study informants as to whether such differences should be considered fair. The differences in levels of influence emerged most clearly at the community level, and were largely perceived as legitimate. Conclusions Existing challenges related to individuals’ influence of decision making processes in health care need to be addressed if greater participation is desired. There is a need for increased advocacy and a strengthening of responsive practices with an emphasis on the right of all

Decision making by patients: An application of naturalistic decision making theory to cervical screening and chronic renal failure, Working Paper 2006/5

OpenAIRE

Marion Haas

2006-01-01

Over their lifetime, individuals typically make many decisions about health and health care. Theoretical approaches to decision making have been dominated by a rational, analytic approach which assumes that problems are relatively fixed and well-defined and which have foreseeable and measurable endpoints. Naturalistic decision making (NDM) approaches attempt to mimic ?real world? situations where problems vary, may be defined differently by individuals with diverse perspectives and where endp...

Using NASA Environmental Data to Enhance Public Health Decision Making

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Al-Hamdan, Mohammad; Crosson, William; Economou, Sigrid; Estes, Maurice, Jr.; Estes, Sue; Hemmings, Sarah; Kent, Shia; Puckett, Mark; Quattrochi, Dale; Wade, Gina;

Does Positivity Operate When the Stakes are High?: Health Status and Decision-Making Among Older Adults

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English, Tammy; Carstensen, Laura L.

2015-01-01

Research and theory suggest that emotional goals are increasingly prioritized with age. Related empirical work has shown that, compared to younger adults, older adults attend to and remember positive information more than negative information. This age-related positivity effect has been eliminated in experiments that have explicitly demanded processing of both positive and negative information. In the present study, we explored whether a reduction of the preference for positive information over negative information appears when the material being reviewed holds personal relevance for the individual. Older participants whose health varied from poor to very good reviewed written material prior to making decisions about health related and non-health related issues. As predicted, older adults in relatively poor health (compared with those in relatively good health) showed less positivity in review of information while making health-related decisions. In contrast, positivity emerged regardless of health status for decisions that were unrelated to health. Across decision contexts, those individuals who focused more on positive information than negative information reported better post-decisional mood and greater decision satisfaction. Results are consistent with the theoretical argument that the age-related positivity effect reflects goal-directed cognitive processing and, furthermore, suggests that personal relevance and contextual factors determine whether or not positivity emerges. PMID:25894484

Understanding evidence: a statewide survey to explore evidence-informed public health decision-making in a local government setting.

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Armstrong, Rebecca; Waters, Elizabeth; Moore, Laurence; Dobbins, Maureen; Pettman, Tahna; Burns, Cate; Swinburn, Boyd; Anderson, Laurie; Petticrew, Mark

2014-12-14

The value placed on types of evidence within decision-making contexts is highly dependent on individuals, the organizations in which the work and the systems and sectors they operate in. Decision-making processes too are highly contextual. Understanding the values placed on evidence and processes guiding decision-making is crucial to designing strategies to support evidence-informed decision-making (EIDM). This paper describes how evidence is used to inform local government (LG) public health decisions. The study used mixed methods including a cross-sectional survey and interviews. The Evidence-Informed Decision-Making Tool (EvIDenT) survey was designed to assess three key domains likely to impact on EIDM: access, confidence, and organizational culture. Other elements included the usefulness and influence of sources of evidence (people/groups and resources), skills and barriers, and facilitators to EIDM. Forty-five LGs from Victoria, Australia agreed to participate in the survey and up to four people from each organization were invited to complete the survey (n = 175). To further explore definitions of evidence and generate experiential data on EIDM practice, key informant interviews were conducted with a range of LG employees working in areas relevant to public health. In total, 135 responses were received (75% response rate) and 13 interviews were conducted. Analysis revealed varying levels of access, confidence and organizational culture to support EIDM. Significant relationships were found between domains: confidence, culture and access to research evidence. Some forms of evidence (e.g. community views) appeared to be used more commonly and at the expense of others (e.g. research evidence). Overall, a mixture of evidence (but more internal than external evidence) was influential in public health decision-making in councils. By comparison, a mixture of evidence (but more external than internal evidence) was deemed to be useful in public health decision-making

Public preferences for engagement in Health Technology Assessment decision-making: protocol of a mixed methods study.

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Wortley, Sally; Tong, Allison; Lancsar, Emily; Salkeld, Glenn; Howard, Kirsten

2015-07-14

Much attention in recent years has been given to the topic of public engagement in health technology assessment (HTA) decision-making. HTA organizations spend substantial resources and time on undertaking public engagement, and numerous studies have examined challenges and barriers to engagement in the decision-making process however uncertainty remains as to optimal methods to incorporate the views of the public in HTA decision-making. Little research has been done to ascertain whether current engagement processes align with public preferences and to what extent their desire for engagement is dependent on the question being asked by decision-makers or the characteristics of the decision. This study will examine public preferences for engagement in Australian HTA decision-making using an exploratory mixed methods design. The aims of this study are to: 1) identify characteristics about HTA decisions that are important to the public in determining whether public engagement should be undertaken on a particular topic, 2) determine which decision characteristics influence public preferences for the extent, or type of public engagement, and 3) describe reasons underpinning these preferences. Focus group participants from the general community, aged 18-70 years, will be purposively sampled from the Australian population to ensure a wide range of demographic groups. Each focus group will include a general discussion on public engagement as well as a ranking exercise using a modified nominal group technique (NGT). The NGT will inform the design of a discrete choice study to quantitatively assess public preferences for engagement in HTA decision-making. The proposed research seeks to investigate under what circumstances and how the public would like their views and preferences to be considered in health technology assessments. HTA organizations regularly make decisions about when and how public engagement should occur but without consideration of the public's preferences on

Clinical Decision Making and Mental Health Service Use Among Persons With Severe Mental Illness Across Europe.

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Cosh, Suzanne; Zenter, Nadja; Ay, Esra-Sultan; Loos, Sabine; Slade, Mike; De Rosa, Corrado; Luciano, Mario; Berecz, Roland; Glaub, Theodora; Munk-Jørgensen, Povl; Krogsgaard Bording, Malene; Rössler, Wulf; Kawohl, Wolfram; Puschner, Bernd

2017-09-01

The study explored relationships between preferences for and experiences of clinical decision making (CDM) with service use among persons with severe mental illness. Data from a prospective observational study in six European countries were examined. Associations of baseline staff-rated (N=213) and patient-rated (N=588) preferred and experienced decision making with service use were examined at baseline by using binomial regressions and at 12-month follow-up by using multilevel models. A preference by patients and staff for active patient involvement in decision making, rather than shared or passive decision making, was associated with longer hospital admissions and higher costs at baseline and with increases in admissions over 12 months (p=.043). Low patient-rated satisfaction with an experienced clinical decision was also related to increased costs over the study period (p=.005). A preference for shared decision making may reduce health care costs by reducing inpatient admissions. Patient satisfaction with decisions was a predictor of costs, and clinicians should maximize patient satisfaction with CDM.

Autonomy and couples' joint decision-making in healthcare.

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Osamor, Pauline E; Grady, Christine

2018-01-11

Respect for autonomy is a key principle in bioethics. However, respecting autonomy in practice is complex because most people define themselves and make decisions influenced by a complex network of social relationships. The extent to which individual autonomy operates for each partner within the context of decision-making within marital or similar relationships is largely unexplored. This paper explores issues related to decision-making by couples (couples' joint decision-making) for health care and the circumstances under which such a practice should be respected as compatible with autonomous decision-making. We discuss the concept of autonomy as it applies to persons and to actions, human interdependency and gender roles in decision-making, the dynamics and outcomes of couples' joint decision-making, and the ethics of couples' joint decision-making. We believe that the extent to which couples' joint decision-making might be deemed ethically acceptable will vary depending on the context. Given that in many traditional marriages the woman is the less dominant partner, we consider a spectrum of scenarios of couples' joint decision-making about a woman's own health care that move from those that are acceptably autonomous to those that are not consistent with respecting the woman's autonomous decision-making. To the extent that there is evidence that both members of a couple understand a decision, intend it, and that neither completely controls the other, couples' joint decision-making should be viewed as consistent with the principle of respect for the woman's autonomy. At the other end of the spectrum are decisions made by the man without the woman's input, representing domination of one partner by the other. We recommend viewing the dynamics of couples' joint decision-making as existing on a continuum of degrees of autonomy. This continuum-based perspective implies that couples' joint decision-making should not be taken at face value but should be assessed against

[Boundaries of the autonomy of local health administration: innovation, creativity and evidence-based decision-making].

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Silva, Silvio Fernandes da; Souza, Nathan Mendes; Barreto, Jorge Otávio Maia

2014-11-01

The scope of this article was to identify the boundaries of the autonomy of local administration in the context of the federal pact in the Brazilian Unified Health System and the importance and potential for promoting innovation, creativity and evidence-based decision-making by local governments. The methodology used was to ask questions that favored dialogue with the specific literature to identify the influence of centrally-formulated policies in spaces of local autonomy and then to identify strategies to foster innovation, creativity and the systematic use of evidence-based research in health policy implementation. A gradual reduction in municipal decision-making autonomy was detected due to increased financial commitment of the municipalities resulting from responsibilities assumed, albeit with the possibility of reverting this trend in the more recent context. Some determinants and challenges for the dissemination of innovative practices were analyzed and some relevant national and international experiences in this respect were presented. The conclusion drawn is that it is possible to make local decision-making more effective provided that initiatives are consolidated to promote this culture and the formulation and implementation of evidence-based health policies.

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

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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.

Environmental Public Health Indicators Impact Report: Data and methods that support environmental public health decision-making by communities

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This report presents the results of twenty competitively funded Science-To-Achieve-Results (STAR) grants in EPA's Environmental Public Health Indicators (EPHI) research program. The grantsdirectly supported health interventions, informed policy and decision-making, and improved t...

Decision Making

Directory of Open Access Journals (Sweden)

Pier Luigi Baldi

2006-06-01

Full Text Available This article points out some conditions which significantly exert an influence upon decision and compares decision making and problem solving as interconnected processes. Some strategies of decision making are also examined.

Does young adults' preferred role in decision making about health, money, and career depend on their advisors' leadership skills?

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Garcia-Retamero, Rocio; Galesic, Mirta

2013-01-01

Few empirical data exist on how decision making about health differs from that in other crucial life domains with less threatening consequences. To shed light on this issue we conducted a study with 175 young adults (average age 19 years). We presented the participants with scenarios involving advisors who provided assistance in making decisions about health, money, and career. For each scenario, participants were asked to what extent they wanted the advisor to exhibit several leadership styles and competencies and what role (active, collaborative, or passive) they preferred to play when making decisions. Results show that decision making about health is distinct from that in the other domains in three ways. First, most of the participants preferred to delegate decision making about their health to their physician, whereas they were willing to collaborate or play an active role in decision making about their career or money. Second, the competencies and leadership style preferred for the physician differed substantially from those desired for advisors in the other two domains: Participants expected physicians to show more transformational leadership--the style that is most effective in a wide range of environments--than those who provide advice about financial investments or career. Finally, participants' willingness to share medical decision making with their physician was tied to how strongly they preferred that the physician shows an effective leadership style. In contrast, motivation to participate in decision making in the other domains was not related to preferences regarding advisors' leadership style or competencies. Our results have implications for medical practice as they suggest that physicians are expected to have superior leadership skills compared to those who provide assistance in other important areas of life.

Cognitive processes in anesthesiology decision making.

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Stiegler, Marjorie Podraza; Tung, Avery

2014-01-01

The quality and safety of health care are under increasing scrutiny. Recent studies suggest that medical errors, practice variability, and guideline noncompliance are common, and that cognitive error contributes significantly to delayed or incorrect diagnoses. These observations have increased interest in understanding decision-making psychology.Many nonrational (i.e., not purely based in statistics) cognitive factors influence medical decisions and may lead to error. The most well-studied include heuristics, preferences for certainty, overconfidence, affective (emotional) influences, memory distortions, bias, and social forces such as fairness or blame.Although the extent to which such cognitive processes play a role in anesthesia practice is unknown, anesthesia care frequently requires rapid, complex decisions that are most susceptible to decision errors. This review will examine current theories of human decision behavior, identify effects of nonrational cognitive processes on decision making, describe characteristic anesthesia decisions in this context, and suggest strategies to improve decision making.

Decision making regarding multifetal reduction.

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Maifeld, Michelle; Hahn, Sandra; Titler, Marita G; Mullen, Meredithe

2003-01-01

To identify salient variables that influence decision making regarding multifetal reduction (MFR) and describe their effect on individuals over time. Prospective, exploratory, descriptive design, using qualitative and quantitative methods. Midwestern tertiary care center. A convenience sample of 11 consecutive consenting couples with triplet or higher-order pregnancies who elected to undergo MFR. Semistructured audiotaped telephone interviews at three points: (a) 2 weeks postreduction, (b) 6 weeks postpartum, and (c) 6 months postpartum; a demographic and marital adjustment questionnaire. Themes identified by content analysis and compared via matrix analysis between males and females and at three points in time; trends in marital adjustment. Dominant variables influencing MFR decision making were risks associated with higher-order pregnancies and preservation of infants' and mothers' health. Most participants identified emotional issues, including moral and ethical dilemmas, as the most difficult aspect of reduction. Over time, participants reported feeling more positive about their decision; nonetheless, negative feelings emerged progressively. Risk aversion favored MFR decision making. Yet, both making and living with the decision were emotionally difficult for this sample. Interventions are needed to assist couples with this decision and its consequences.

Clinical reasoning and population health: decision making for an emerging paradigm of health care.

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Edwards, Ian; Richardson, Barbara

2008-01-01

Chronic conditions now provide the major disease and disability burden facing humanity. This development has necessitated a reorientation in the practice skills of health care professions away from hospital-based inpatient and outpatient care toward community-based management of patients with chronic conditions. Part of this reorientation toward community-based management of chronic conditions involves practitioners' understanding and adoption of a concept of population health management based on appropriate theoretical models of health care. Drawing on recent studies of expertise in physiotherapy, this article proposes a clinical reasoning and decision-making framework to meet these challenges. The challenge of population and community-based management of chronic conditions also provides an opportunity for physiotherapists to further clarify a professional epistemology of practice that embraces the kinds of knowledge and clinical reasoning processes used in physiotherapy practice. Three case studies related to the management of chronic musculoskeletal pain in different populations are used to exemplify the range of epistemological perspectives that underpin community-based practice. They illustrate the link between conceptualizations of practice problems and knowledge sources that are used as a basis for clinical reasoning and decision making as practitioners are increasingly required to move between the clinic and the community.

A Web-based graphical user interface for evidence-based decision making for health care allocations in rural areas

Science.gov (United States)

Schuurman, Nadine; Leight, Margo; Berube, Myriam

2008-01-01

Background The creation of successful health policy and location of resources increasingly relies on evidence-based decision-making. The development of intuitive, accessible tools to analyse, display and disseminate spatial data potentially provides the basis for sound policy and resource allocation decisions. As health services are rationalized, the development of tools such graphical user interfaces (GUIs) is especially valuable at they assist decision makers in allocating resources such that the maximum number of people are served. GIS can used to develop GUIs that enable spatial decision making. Results We have created a Web-based GUI (wGUI) to assist health policy makers and administrators in the Canadian province of British Columbia make well-informed decisions about the location and allocation of time-sensitive service capacities in rural regions of the province. This tool integrates datasets for existing hospitals and services, regional populations and road networks to allow users to ascertain the percentage of population in any given service catchment who are served by a specific health service, or baskets of linked services. The wGUI allows policy makers to map trauma and obstetric services against rural populations within pre-specified travel distances, illustrating service capacity by region. Conclusion The wGUI can be used by health policy makers and administrators with little or no formal GIS training to visualize multiple health resource allocation scenarios. The GUI is poised to become a critical decision-making tool especially as evidence is increasingly required for distribution of health services. PMID:18793428

Defining decision making strategies in software ecosystem governance

DEFF Research Database (Denmark)

Manikas, Konstantinos; Wnuk, Krzysztof; Shollo, Arisa

Making the right decisions is an essential part of software ecosystem governance. Decisions related to the governance of a software ecosystem can influence the health of the ecosystem and can result in fostering the success or greatly contributing to the failure of the ecosystem. However, very few...... studies touch upon the decision making of software ecosystem governance. In this paper, we propose decomposing software ecosystem governance into three activities: input or data collection, decision making, and applying actions. We focus on the decision making activity of software ecosystem governance...... and review related literature consisted of software ecosystem governance, organizational decision making, and IT governance. Based on the identified studies, we propose a framework for defining the decision making strategies in the governance of software ecosystems. We identify five decision areas...

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

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

2013-08-06

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

Political decision-making in health care: the Dutch case.

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Elsinga, E

1989-01-01

In many western countries health care is a subject of increasing importance on the political agenda. Issues such as aging, development of medical technologies, equity and efficiency of care, increasing costs, market elements, etc. are leading to a review of existing health care systems. In The Netherlands the government has proposed fundamental changes in the structure and financing of care, based on a report by the so-called Dekker Committee. The final result of a step-wise process of change should be the introduction of a new insurance scheme and the strengthening of market elements. After a short description of the government proposals, this article gives an analysis of the process of decision-making for a restructuring of health care in the Netherlands. The analysis is based on a bureaupolitical model, as originally described by Allison.

Modernization and development: impact on health care decision-making in Uganda.

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Singh, Debra Anne Kaur; Earnest, Jaya; Lample, May

2015-01-01

Uganda has faced numerous challenges over the past 50 years from overcoming political conflict and civil unrest, to rapid population growth, to combating the HIV epidemic and ever-growing health needs. Women in Uganda have had a major role to play in the health of families and communities. The researchers' purpose in this study, undertaken in rural Uganda, was to a) identify a people-centered definition of development, b) compare it to the process of modernization, and c) investigate how these processes have changed the role women play in decision-making, in areas directly and indirectly related to their health and that of their families. Twenty-two men and women participated in focus group discussion and completed questionnaires. Based on our analysis of discussions it appears that both modernization and development have impacted health positively and negatively. Key themes distilled from interviews included that modernization has led to the breakdown of families; increased maternal responsibility for children; diminished land and economic resources; and an erosion of cultural values and practices that had previously provided stability for the society. In terms of development, women play an increasing role in decision-making processes in the household and are gaining increasing respect for their expertise in a number of areas, notably health care. We propose a movement of grassroots discourse on modernization. Development, and its effect on health, is necessary if the positive aspects of Ugandan culture and those of similar emerging societies are not to be lost (International Covenant on Economic, Social and Cultural Rights, 1966).

Shared decision-making.

Science.gov (United States)

Godolphin, William

2009-01-01

Shared decision-making has been called the crux of patient-centred care and identified as a key part of change for improved quality and safety in healthcare. However, it rarely happens, is hard to do and is not taught - for many reasons. Talking with patients about options is not embedded in the attitudes or communication skills training of most healthcare professionals. Information tools such as patient decision aids, personal health records and the Internet will help to shift this state, as will policy that drives patient and public involvement in healthcare delivery and training.

Business making decisions

Directory of Open Access Journals (Sweden)

Enrique Benjamín Franklin Fincowsky

2011-06-01

Full Text Available People and organizations make better or get wrong as consequence of making decisions. Sometimes making decisions is just a trial and error process. Some others, decisions are good and the results profitable with a few of mistakes, most of the time because it’s considered the experience and the control of a specific field or the good intention of who makes them. Actually, all kinds of decisions bring learning. What is important is the intention, the attitude and the values considered in this process. People from different scenes face many facts and circumstances—almost always out of control—that affect the making decisions process. There is not a unique way to make decisions for all companies in many settings. The person who makes a decision should identify the problem, to solve it later using alternatives and solutions. Even though, follow all the steps it’s not easy as it seems. Looking back the conditions related to the decisions, we can mention the followings: uncertainty, risk and certainty. When people identify circumstances and facts, as well as its effects in a possible situation, they will make decisions with certainty. As long as the information decreases and it becomes ambiguous the risk becomes an important factor in the making decisions process because they are connected to probable objectives (clear or subjective (opinion judgment or intuition. To finish, uncertainty, involves people that make a decision with no or little information about circumstances or criteria with basis

Women's autonomy in household decision-making: a demographic study in Nepal.

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Acharya, Dev R; Bell, Jacqueline S; Simkhada, Padam; van Teijlingen, Edwin R; Regmi, Pramod R

2010-07-15

How socio-demographic factors influence women's autonomy in decision making on health care including purchasing goods and visiting family and relatives are very poorly studied in Nepal. This study aims to explore the links between women's household position and their autonomy in decision making. We used Nepal Demographic Health Survey (NDHS) 2006, which provided data on ever married women aged 15-49 years (n = 8257). The data consists of women's four types of household decision making; own health care, making major household purchases, making purchase for daily household needs and visits to her family or relatives. A number of socio-demographic variables were used in multivariable logistic regression to examine the relationship of these variables to all four types of decision making. Women's autonomy in decision making is positively associated with their age, employment and number of living children. Women from rural area and Terai region have less autonomy in decision making in all four types of outcome measure. There is a mixed variation in women's autonomy in the development region across all outcome measures. Western women are more likely to make decision in own health care (1.2-1.6), while they are less likely to purchase daily household needs (0.6-0.9). Women's increased education is positively associated with autonomy in own health care decision making (p make decision in own healthcare. Women from rural area and Terai region needs specific empowerment programme to enable them to be more autonomous in the household decision making. Women's autonomy by education, wealth quintile and development region needs a further social science investigation to observe the variations within each stratum. A more comprehensive strategy can enable women to access community resources, to challenge traditional norms and to access economic resources. This will lead the women to be more autonomous in decision making in the due course.

[Evaluation of the capacity of elderly patients to make decisions about their health].

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Atienza-Martín, F J; Garrido-Lozano, M; Losada-Ruiz, C; Rodríguez-Fernández, L M; Revuelta-Pérez, F; Marín-Andrés, G

2013-09-01

To assess the decision-making capacity and variables related to this, in elderly patients in a home care program. A cross-sectional study was conducted on 130 patients assigned to home care program or in social welfare residences of an urban health centre. Demographic variables, as well as comorbidities, social support, institutionalisation, number of drugs used, degree of dependence (Barthel Index), cognitive function (Pfeiffer) were collected. The primary endpoint was the capacity for decision-making about their health assessed using the Aid to Capacity Evaluation (ACE) tool. There was a prevalence of 58.5% capacity. There was an association between ability and independence for activities of daily living (odds ratio (OR): 12.214; Confidence interval 95% (95% CI): 3.90 to 32.29, P de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

Making sense of perceptions of risk of diseases and vaccinations: a qualitative study combining models of health beliefs, decision-making and risk perception

OpenAIRE

Bond Lyndal; Nolan Terry

2011-01-01

Abstract Background Maintaining high levels of childhood vaccinations is important for public health. Success requires better understanding of parents' perceptions of diseases and consequent decisions about vaccinations, however few studies have considered this from the theoretical perspectives of risk perception and decision-making under uncertainty. The aim of this study was to examine the utility of subjective risk perception and decision-making theories to provide a better understanding o...

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

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Notarianni, Maryann; Sundar, Purnima; Carter, Charles

2016-01-01

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

Decision making.

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Chambers, David W

2011-01-01

A decision is a commitment of resources under conditions of risk in expectation of the best future outcome. The smart decision is always the strategy with the best overall expected value-the best combination of facts and values. Some of the special circumstances involved in decision making are discussed, including decisions where there are multiple goals, those where more than one person is involved in making the decision, using trigger points, framing decisions correctly, commitments to lost causes, and expert decision makers. A complex example of deciding about removal of asymptomatic third molars, with and without an EBD search, is discussed.

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...

Challenges Associated With Applying Physiologically Based Pharmacokinetic Modeling for Public Health Decision-Making

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The development and application of physiologically based pharmacokinetic (PBPK) models in chemical toxicology have grown steadily since their emergence in the 1980s. However, critical evaluation of PBPK models to support public health decision-making across federal agencies has t...

Managed care and clinical decision-making in child and adolescent behavioral health: provider perceptions.

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Yanos, Philip T; Garcia, Christine I; Hansell, Stephen; Rosato, Mark G; Minsky, Shula

2003-03-01

This study investigated how managed care affects clinical decision-making in a behavioral health care system. Providers serving children and adolescents under both managed and unmanaged care (n = 28) were interviewed about their awareness of differences between the benefit arrangements, how benefits affect clinical decision-making, outcomes and quality of care; and satisfaction with care. Quantitative and qualitative findings indicated that providers saw both advantages and disadvantages to managed care. Although most providers recognized the advantages of managed care in increasing efficiency, many were concerned that administrative pressures associated with managed care compromise service quality.

Toward an operational model of decision making, emotional regulation, and mental health impact.

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Collura, Thomas Francis; Zalaquett, Ronald P; Bonnstetter, Carlos Joyce; Chatters, Seria J

2014-01-01

Current brain research increasingly reveals the underlying mechanisms and processes of human behavior, cognition, and emotion. In addition to being of interest to a wide range of scientists, educators, and professionals, as well as laypeople, brain-based models are of particular value in a clinical setting. Psychiatrists, psychologists, counselors, and other mental health professionals are in need of operational models that integrate recent findings in the physical, cognitive, and emotional domains, and offer a common language for interdisciplinary understanding and communication. Based on individual traits, predispositions, and responses to stimuli, we can begin to identify emotional and behavioral pathways and mental processing patterns. The purpose of this article is to present a brain-path activation model to understand individual differences in decision making and psychopathology. The first section discusses the role of frontal lobe electroencephalography (EEG) asymmetry, summarizes state- and trait-based models of decision making, and provides a more complex analysis that supplements the traditional simple left-right brain model. Key components of the new model are the introduction of right hemisphere parallel and left hemisphere serial scanning in rendering decisions, and the proposition of pathways that incorporate both past experiences as well as future implications into the decision process. Main attributes of each decision-making mechanism are provided. The second section applies the model within the realm of clinical mental health as a tool to understand specific human behavior and pathology. Applications include general and chronic anxiety, depression, paranoia, risk taking, and the pathways employed when well-functioning operational integration is observed. Finally, specific applications such as meditation and mindfulness are offered to facilitate positive functioning.

Knowledge translation is the use of knowledge in health care decision making.

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Straus, Sharon E; Tetroe, Jacqueline M; Graham, Ian D

2011-01-01

To provide an overview of the science and practice of knowledge translation. Narrative review outlining what knowledge translation is and a framework for its use. Knowledge translation is defined as the use of knowledge in practice and decision making by the public, patients, health care professionals, managers, and policy makers. Failures to use research evidence to inform decision making are apparent across all these key decision maker groups. There are several proposed theories and frameworks for achieving knowledge translation. A conceptual framework developed by Graham et al., termed the knowledge-to-action cycle, provides an approach that builds on the commonalities found in an assessment of planned action theories. Review of the evidence base for the science and practice of knowledge translation has identified several gaps including the need to develop valid strategies for assessing the determinants of knowledge use and for evaluating sustainability of knowledge translation interventions. Copyright © 2011 Elsevier Inc. All rights reserved.

Shared decision making

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... page: //medlineplus.gov/ency/patientinstructions/000877.htm Shared decision making To use the sharing features on this page, ... treatment you both support. When to use Shared Decision Making Shared decision making is often used when you ...

Big Data: transforming drug development and health policy decision making.

Science.gov (United States)

Alemayehu, Demissie; Berger, Marc L

The explosion of data sources, accompanied by the evolution of technology and analytical techniques, has created considerable challenges and opportunities for drug development and healthcare resource utilization. We present a systematic overview these phenomena, and suggest measures to be taken for effective integration of the new developments in the traditional medical research paradigm and health policy decision making. Special attention is paid to pertinent issues in emerging areas, including rare disease drug development, personalized medicine, Comparative Effectiveness Research, and privacy and confidentiality concerns.

Handbook on Decision Making Vol 2 Risk Management in Decision Making

CERN Document Server

Lu, Jie; Zhang, Guangquan

2012-01-01

This book presents innovative theories, methodologies, and techniques in the field of risk management and decision making. It introduces new research developments and provides a comprehensive image of their potential applications to readers interested in the area. The collection includes: computational intelligence applications in decision making, multi-criteria decision making under risk, risk modelling,forecasting and evaluation, public security and community safety, risk management in supply chain and other business decision making, political risk management and disaster response systems. The book is directed to academic and applied researchers working on risk management, decision making, and management information systems.

A randomized comparison between league tables and funnel plots to inform health care decision-making.

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Anell, Anders; Hagberg, Oskar; Liedberg, Fredrik; Ryden, Stefan

2016-12-01

Comparison of provider performance is commonly used to inform health care decision-making. Little attention has been paid to how data presentations influence decisions. This study analyzes differences in suggested actions by decision-makers informed by league tables or funnel plots. Decision-makers were invited to a survey and randomized to compare hospital performance using either league tables or funnel plots for four different measures within the area of cancer care. For each measure, decision-makers were asked to suggest actions towards 12-16 hospitals (no action, ask for more information, intervene) and provide feedback related to whether the information provided had been useful. Swedish health care. Two hundred and twenty-one decision-makers at administrative and clinical levels. Data presentations in the form of league tables or funnel plots. Number of actions suggested by participants. Proportion of appropriate actions. For all four measures, decision-makers tended to suggest more actions based on the information provided in league tables compared to funnel plots (44% vs. 21%, P decision-makers more often missed to react even when appropriate. The form of data presentation had an influence on decision-making. With league tables, decision-makers tended to suggest more actions compared to funnel plots. A difference in sensitivity and specificity conditioned by the form of presentation could also be identified, with different implications depending on the purpose of comparisons. Explanations and visualization aids are needed to support appropriate actions. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Trait mindfulness helps shield decision-making from translating into health-risk behavior.

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Black, David S; Sussman, Steve; Johnson, C Anderson; Milam, Joel

2012-12-01

The cognitive tendency toward mindfulness may influence the enactment of health and risk behaviors by its bringing increased attention to and awareness of decision-making processes underlying behavior. The present study examined the moderating effect of trait mindfulness on associations between intentions to smoke (ITS)/smoking refusal self-efficacy (SRSE) and smoking frequency. Self-reports from Chinese adolescents (N = 5,287; mean age = 16.2 years, standard deviation = .7; 48.8% female) were collected in 24 schools. Smoking frequency was regressed on latent factor interactions Mindful Attention Awareness Scale*ITS and Mindful Attention Awareness Scale*SRSE, adjusting for school clustering effects and covariates. Both interaction terms were significant in cross-sectional analyses and showed that high ITS predicted higher smoking frequency among those low, relative to high, in trait mindfulness, whereas low SRSE predicted higher smoking frequency among those low, relative to high, in trait mindfulness. Findings suggest trait mindfulness possibly shields against decision-making processes that place adolescents at risk for smoking. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

TESTING MULTI-CRITERIA DECISION ANALYSIS FOR MORE TRANSPARENT RESOURCE-ALLOCATION DECISION MAKING IN COLOMBIA.

Science.gov (United States)

Castro Jaramillo, Hector Eduardo; Goetghebeur, Mireille; Moreno-Mattar, Ornella

2016-01-01

In 2012, Colombia experienced an important institutional transformation after the establishment of the Health Technology Assessment Institute (IETS), the disbandment of the Regulatory Commission for Health and the reassignment of reimbursement decision-making powers to the Ministry of Health and Social Protection (MoHSP). These dynamic changes provided the opportunity to test Multi-Criteria Decision Analysis (MCDA) for systematic and more transparent resource-allocation decision-making. During 2012 and 2013, the MCDA framework Evidence and Value: Impact on Decision Making (EVIDEM) was tested in Colombia. This consisted of a preparatory stage in which the investigators conducted literature searches and produced HTA reports for four interventions of interest, followed by a panel session with decision makers. This method was contrasted with a current approach used in Colombia for updating the publicly financed benefits package (POS), where narrative health technology assessment (HTA) reports are presented alongside comprehensive budget impact analyses (BIAs). Disease severity, size of population, and efficacy ranked at the top among fifteen preselected relevant criteria. MCDA estimates of technologies of interest ranged between 71 to 90 percent of maximum value. The ranking of technologies was sensitive to the methods used. Participants considered that a two-step approach including an MCDA template, complemented by a detailed BIA would be the best approach to assist decision-making in this context. Participants agreed that systematic priority setting should take place in Colombia. This work may serve as the basis to the MoHSP on its interest of setting up a systematic and more transparent process for resource-allocation decision-making.

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. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Health economics and outcomes methods in risk-based decision-making for blood safety.

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Custer, Brian; Janssen, Mart P

2015-08-01

Analytical methods appropriate for health economic assessments of transfusion safety interventions have not previously been described in ways that facilitate their use. Within the context of risk-based decision-making (RBDM), health economics can be important for optimizing decisions among competing interventions. The objective of this review is to address key considerations and limitations of current methods as they apply to blood safety. Because a voluntary blood supply is an example of a public good, analyses should be conducted from the societal perspective when possible. Two primary study designs are recommended for most blood safety intervention assessments: budget impact analysis (BIA), which measures the cost to implement an intervention both to the blood operator but also in a broader context, and cost-utility analysis (CUA), which measures the ratio between costs and health gain achieved, in terms of reduced morbidity and mortality, by use of an intervention. These analyses often have important limitations because data that reflect specific aspects, for example, blood recipient population characteristics or complication rates, are not available. Sensitivity analyses play an important role. The impact of various uncertain factors can be studied conjointly in probabilistic sensitivity analyses. The use of BIA and CUA together provides a comprehensive assessment of the costs and benefits from implementing (or not) specific interventions. RBDM is multifaceted and impacts a broad spectrum of stakeholders. Gathering and analyzing health economic evidence as part of the RBDM process enhances the quality, completeness, and transparency of decision-making. © 2015 AABB.

Gender relations and reproductive decision making in Honduras.

Science.gov (United States)

Speizer, Ilene S; Whittle, Lisa; Carter, Marion

2005-09-01

Gender differences influence decision making about reproductive health. Most information on reproductive health decision making in Latin America has come from women's reports of men's involvement. Data were collected in Honduras in 2001 through two national surveys that used independent samples of men aged 15-59 years and women aged 15-49. Bivariate and multivariate analyses were used to identify factors associated with male-centered decision-making attitudes and behaviors regarding family size and family planning use. Overall, 25% of women and 28% of men said that men alone should be responsible for at least one of these reproductive decisions, and 27% of women and 21% of men said that the man in their household made one or both decisions. For women, having no children and being in a consensual union were each associated with holding male-centered decision-making attitudes; having less than a secondary education, being of medium or low socioeconomic status and living in a rural area were each associated with male-centered decision making. Among men, having less than secondary education and being in a consensual union were each associated with male-centered decision-making attitudes and behavior. Women who had ever used or were currently using modern methods were significantly less likely to hold attitudes supporting male-centered decision-making than were those who relied on traditional methods and those who had never used a modern method. Programs should recognize power imbalances between genders that affect women's ability to meet their stated fertility desires. In rural areas, programs should target men, encouraging them to communicate with their wives on reproductive decisions.

Decision Making with Imperfect Decision Makers

CERN Document Server

Guy, Tatiana Valentine; Wolpert, David H

2012-01-01

Prescriptive Bayesian decision making has reached a high level of maturity and is well-supported algorithmically. However, experimental data shows that real decision makers choose such Bayes-optimal decisions surprisingly infrequently, often making decisions that are badly sub-optimal. So prevalent is such imperfect decision-making that it should be accepted as an inherent feature of real decision makers living within interacting societies. To date such societies have been investigated from an economic and gametheoretic perspective, and even to a degree from a physics perspective. However, lit

Payer Perspectives on Patient-Reported Outcomes in Health Care Decision Making: Oncology Examples.

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Brogan, Andrew P; DeMuro, Carla; Barrett, Amy M; D'Alessio, Denise; Bal, Vasudha; Hogue, Susan L

2017-02-01

Health authorities and payers increasingly recognize the importance of patient perspectives and patient-reported outcomes (PROs) in health care decision making. However, given the broad variety of PRO endpoints included in clinical programs and variations in the timing of PRO data collection and country-specific needs, the role of PRO data in reimbursement decisions requires characterization. To (a) determine the effect of PRO data on market access and reimbursement decisions for oncology products in multiple markets and (b) assess the effect of PRO data collected after clinical progression on payer decision making. A 3-part assessment (targeted literature review, qualitative one-on-one interviews, and online survey) was undertaken. Published literature was identified through searches in PubMed/MEDLINE and Embase. In addition, a targeted search was conducted of health technology assessment (HTA) agency websites in the United States, the United Kingdom, France, and Germany. Qualitative one-on-one interviews were conducted with 16 payers from the RTI Health Solutions global advisory panel in 14 markets (Australia, Brazil, France, Germany, Italy, South Korea, Netherlands, Poland, Spain, Sweden, Taiwan, Turkey, the United Kingdom, and the United States [n = 3]). Of the 200 payers and payer advisors from the global advisory panel invited to participate in the online survey, 20 respondents (China, France, Germany, Spain [n = 2], Taiwan, the United Kingdom, and the United States [n = 13]) completed the survey, and 6 respondents (Australia, South Korea, and the United States [n = 4]) partially completed the survey. Reviews of the literature and publicly available HTAs and reimbursement decisions suggested that HTA bodies and payers have varying experience with and confidence in PRO data. Payers participating in the survey indicated that PRO data may be especially influential in oncology compared with other therapeutic areas. Payers surveyed offered little differentiation

Building capacity for evidence informed decision making in public health: a case study of organizational change.

Science.gov (United States)

Peirson, Leslea; Ciliska, Donna; Dobbins, Maureen; Mowat, David

2012-02-20

Core competencies for public health in Canada require proficiency in evidence informed decision making (EIDM). However, decision makers often lack access to information, many workers lack knowledge and skills to conduct systematic literature reviews, and public health settings typically lack infrastructure to support EIDM activities. This research was conducted to explore and describe critical factors and dynamics in the early implementation of one public health unit's strategic initiative to develop capacity to make EIDM standard practice. This qualitative case study was conducted in one public health unit in Ontario, Canada between 2008 and 2010. In-depth information was gathered from two sets of semi-structured interviews and focus groups (n = 27) with 70 members of the health unit, and through a review of 137 documents. Thematic analysis was used to code the key informant and document data. The critical factors and dynamics for building EIDM capacity at an organizational level included: clear vision and strong leadership, workforce and skills development, ability to access research (library services), fiscal investments, acquisition and development of technological resources, a knowledge management strategy, effective communication, a receptive organizational culture, and a focus on change management. With leadership, planning, commitment and substantial investments, a public health department has made significant progress, within the first two years of a 10-year initiative, towards achieving its goal of becoming an evidence informed decision making organization.

Race, ethnicity, and shared decision making for hyperlipidemia and hypertension treatment: the DECISIONS survey.

Science.gov (United States)

Ratanawongsa, Neda; Zikmund-Fisher, Brian J; Couper, Mick P; Van Hoewyk, John; Powe, Neil R

2010-01-01

Racial/ethnic differences in shared decision making about cardiovascular risk-reduction therapy could affect health disparities. To investigate whether patient race/ethnicity is associated with experiences discussing cardiovascular risk-reduction therapy with health care providers. National sample of US adults identified by random-digit dialing. Cross-sectional survey conducted in November 2006 to May 2007. Among participants in the National Survey of Medical Decisions (DECISIONS), a nationally representative sample of English-speaking US adults aged 40 and older, the authors analyzed respondents who reported discussing hyperlipidemia or hypertension medications with a health care provider in the previous 2 years. In multivariate linear and logistic regressions adjusting for age, gender, income, insurance status, perceived health, and current therapy, they assessed the relation between race/ethnicity (black/Hispanic v. white) and decision making: knowledge, discussion of pros and cons of therapy, discussion of patient preference, who made the final decision, preferred involvement, and confidence in the decision. Of respondents who discussed high cholesterol (N = 738) or hypertension (N = 745) medications, 88% were white, 9% black, and 4% Hispanic. Minorities had lower knowledge scores than whites for hyperlipidemia (42% v. 52%, difference -10% [95% confidence interval (CI): 15, -5], P decision-making process.

Supporting Informed Decision Making in Prevention of Prostate Cancer

Directory of Open Access Journals (Sweden)

Constantino MARTINS

2015-05-01

Full Text Available Identifying and making the correct decision on the best health treatment or screening test option can become a difficult task. Therefore is important that the patients get all types of information appropriate to manage their health. Decision aids can be very useful when there is more than one reasonable option about a treatment or uncertain associated with screening tests. The decision aids tools help people to understand their clinical condition, through the description of the different options available. The purpose of this paper is to present the project “Supporting Informed Decision Making In Prevention of Prostate Cancer” (SIDEMP. This project is focused on the creation of a Web-based decision platform specifically directed to screening prostate cancer, that will support the patient in the process of making an informed decision

Older Adults' Use of Online and Offline Sources of Health Information and Constructs of Reliance and Self-Efficacy for Medical Decision Making.

Science.gov (United States)

Hall, Amanda K; Bernhardt, Jay M; Dodd, Virginia

2015-01-01

We know little about older adults' use of online and offline health information sources for medical decision making despite increasing numbers of older adults who report using the Internet for health information to aid in patient-provider communication and medical decision making. Therefore we investigated older adult users and nonusers of online and offline sources of health information and factors related to medical decision making. Survey research was conducted using random digit dialing of Florida residents' landline telephones. The Decision Self-Efficacy Scale and the Reliance Scale were used to measure relationships between users and nonusers of online health information. Study respondents were 225 older adults (age range = 50-92 years, M = 68.9, SD = 10.4), which included users (n = 105) and nonusers (n = 119) of online health information. Users and nonusers differed in frequency and types of health sources sought. Users of online health information preferred a self-reliant approach and nonusers of online health information preferred a physician-reliant approach to involvement in medical decisions on the Reliance Scale. This study found significant differences between older adult users and nonusers of online and offline sources of health information and examined factors related to online health information engagement for medical decision making.

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.

Risky Decision Making in a Laboratory Driving Task Is Associated with Health Risk Behaviors during Late Adolescence but Not Adulthood

Science.gov (United States)

Kim-Spoon, Jungmeen; Kahn, Rachel; Deater-Deckard, Kirby; Chiu, Pearl; Steinberg, Laurence; King-Casas, Brooks

2016-01-01

Adolescence is characterized by increasing incidence of health risk behaviors, including experimentation with drugs and alcohol. To fill the gap in our understanding of the associations between risky decision-making and health risk behaviors, we investigated associations between laboratory-based risky decision-making using the Stoplight task and…

The emergency patient's participation in medical decision-making.

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Wang, Li-Hsiang; Goopy, Suzanne; Lin, Chun-Chih; Barnard, Alan; Han, Chin-Yen; Liu, Hsueh-Erh

2016-09-01

The purpose of this research was to explore the medical decision-making processes of patients in emergency departments. Studies indicate that patients should be given enough time to acquire relevant information and receive adequate support when they need to make medical decisions. It is difficult to satisfy these requirements in emergency situations. Limited research has addressed the topic of decision-making among emergency patients. This qualitative study used a broadly defined grounded theory approach to explore decision-making in an emergency department in Taiwan. Thirty emergency patients were recruited between June and December 2011 for semi-structured interviews that were audio-taped and transcribed verbatim. The study identified three stages in medical decision-making by emergency patients: predecision (interpreting the problem); decision (a balancing act) and postdecision (reclaiming the self). Transference was identified as the core category and pattern of behaviour through which patients resolved their main concerns. This transference around decision-making represents a type of bricolage. The findings fill a gap in knowledge about the decision-making process among emergency patients. The results inform emergency professionals seeking to support patients faced with complex medical decision-making and suggest an emphasis on informed patient decision-making, advocacy, patient-centred care and in-service education of health staff. © 2016 John Wiley & Sons Ltd.

Biotechnology and Consumer Decision-Making.

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Sax, Joanna K

Society is facing major challenges in climate change, health care and overall quality of life. Scientific advances to address these areas continue to grow, with overwhelming evidence that the application of highly tested forms of biotechnology is safe and effective. Despite scientific consensus in these areas, consumers appear reluctant to support their use. Research that helps to understand consumer decision-making and the public’s resistance to biotechnologies such as vaccines, fluoridated water programs and genetically engineered food, will provide great social value. This article is forward-thinking in that it suggests that important research in behavioral decision-making, specifically affect and ambiguity, can be used to help consumers make informed choices about major applications of biotechnology. This article highlights some of the most controversial examples: vaccinations, genetically engineered food, rbST treated dairy cows, fluoridated water, and embryonic stem cell research. In many of these areas, consumers perceive the risks as high, but the experts calculate the risks as low. Four major thematic approaches are proposed to create a roadmap for policymakers to consider for policy design and implementation in controversial areas of biotechnology. This article articulates future directions for studies that implement decision-making research to allow consumers to appropriately assign risk to their options and make informed decisions.

Health literacy, numeracy, and other characteristics associated with hospitalized patients' preferences for involvement in decision-making

OpenAIRE

Goggins, KM; Wallston, KA; Nwosu, S; Schildcrout, JS; Castel, L; Kripalani, S

2014-01-01

Little research has examined the association of health literacy and numeracy with patients' preferred involvement in the problem-solving and decision-making process in the hospital. Using a sample of 1,249 patients hospitalized with cardiovascular disease from the Vanderbilt Inpatient Cohort Study (VICS), we assessed patients' preferred level of involvement using responses to two scenarios of differing symptom severity from the Problem-Solving Decision-Making (PSDM) Scale. Using multivariable...

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

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

The objective of this review is to identify and synthesize the best available evidence related to the meaningfulness of internal and external influences on shared-decision making for adult patients and health care providers in all health care settings.The specific questions to be answered are: BACKGROUND: Patient-centered care is emphasized in today's healthcare arena. This emphasis is seen in the works of the International Alliance of Patients' Organizations (IAOP) who describe patient-centered healthcare as care that is aimed at addressing the needs and preferences of patients. The IAOP presents five principles which are foundational to the achievement of patient-centered healthcare: respect, choice, policy, access and support, as well as information. These five principles are further described as:Within the description of these five principles the idea of shared decision-making is clearly evident.The concept of shared decision-making began to appear in the literature in the 1990s. It is defined as a "process jointly shared by patients and their health care provider. It aims at helping patients play an active role in decisions concerning their health, which is the ultimate goal of patient-centered care." The details of the shared decision-making process are complex and consist of a series of steps including:Three overall representative decision-making models are noted in contemporary literature. These three models include: paternalistic, informed decision-making, and shared decision-making. The paternalistic model is an autocratic style of decision-making where the healthcare provider carries out the care from the perspective of knowing what is best for the patient and therefore makes all decisions. The informed decision-making model takes place as the information needed to make decisions is conveyed to the patient and the patient makes the decisions without the healthcare provider involvement. Finally, the shared decision-making model is representative of a

Post-marketing access to orphan drugs: a critical analysis of health technology assessment and reimbursement decision-making considerations

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Iskrov G

2014-01-01

Full Text Available Georgi Iskrov, Rumen Stefanov Department of Social Medicine and Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria Abstract: This study aims to explore the current rationale of post-marketing access to orphan drugs. As access to orphan medicinal products depends on assessment and appraisal by health authorities, this article is focused on health technology assessment (HTA and reimbursement decision-making considerations for orphan drugs. A critical analysis may identify important factors that could predetermine the combined outcomes of these two processes. Following this objective, an analytical framework was developed, comprising three overlaying issues: to outline what is currently done and what needs to be done in the field of HTA of orphan drugs, to synthesize important variables relevant to the reimbursement decision-making about orphan drugs, and to unveil relationships between theory and practice. Methods for economic evaluation, cost-effectiveness threshold, budget impact, uncertainty of evidence, criteria in reimbursement decision-making, and HTA research agenda are all explored and discussed from an orphan drug perspective. Reimbursement decision-making for orphan drugs is a debate of policy priorities, health system specifics, and societal attitudes. Health authorities need to pursue a multidisciplinary analysis on a range of criteria, ensuring an explicit understanding of the trade-offs for decisions related to eligibility for reimbursement. The only reasonable way to accept a higher valuation of orphan drug benefits is if these are demonstrated empirically. Rarity means that the quality of orphan drug evidence is not the same as for conventional therapies. Closing this gap is another crucial point for the timely access to these products. The generation of evidence goes far beyond pre-market authorization trials and requires transnational cooperation and coordination. Early constructive dialogue among orphan drug

Age Effects and Heuristics in Decision Making.

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Besedeš, Tibor; Deck, Cary; Sarangi, Sudipta; Shor, Mikhael

2012-05-01

Using controlled experiments, we examine how individuals make choices when faced with multiple options. Choice tasks are designed to mimic the selection of health insurance, prescription drug, or retirement savings plans. In our experiment, available options can be objectively ranked allowing us to examine optimal decision making. First, the probability of a person selecting the optimal option declines as the number of options increases, with the decline being more pronounced for older subjects. Second, heuristics differ by age with older subjects relying more on suboptimal decision rules. In a heuristics validation experiment, older subjects make worse decisions than younger subjects.

Correlates of healthcare and financial decision making among older adults without dementia.

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Stewart, Christopher C; Yu, Lei; Wilson, Robert S; Bennett, David A; Boyle, Patricia A

2018-03-22

Healthcare and financial decision making among older persons has been previously associated with cognition, health and financial literacy, and risk aversion; however, the manner by which these resources support decision making remains unclear, as past studies have not systematically investigated the pathways linking these resources with decision making. In the current study, we use path analysis to examine the direct and indirect pathways linking age, education, cognition, literacy, and risk aversion with decision making. We also decomposed literacy into its subcomponents, conceptual knowledge and numeracy, in order to examine their associations with decision making. Participants were 937 community-based older adults without dementia from the Rush Memory and Aging Project who completed a battery of cognitive tests and assessments of healthcare and financial decision making, health and financial literacy, and risk aversion. Age and education exerted effects on decision making, but nearly two thirds of their effects were indirect, working mostly through cognition and literacy. Cognition exerted a strong direct effect on decision making and a robust indirect effect working primarily through literacy. Literacy also exerted a powerful direct effect on decision making, as did its subcomponents, conceptual knowledge and numeracy. The direct effect of risk aversion was comparatively weak. In addition to cognition, health and financial literacy emerged as independent and primary correlates of healthcare and financial decision making. These findings suggest specific actions that might be taken to optimize healthcare and financial decision making and, by extension, improve health and well-being in advanced age. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Ethical analysis to improve decision-making on health technologies

DEFF Research Database (Denmark)

Saarni, Samuli I; Hofmann, Bjørn; Lampe, Kristian

2008-01-01

Health technology assessment (HTA) is the multidisciplinary study of the implications of the development, diffusion and use of health technologies. It supports health-policy decisions by providing a joint knowledge base for decision-makers. To increase its policy relevance, HTA tries to extend...... beyond effectiveness and costs to also considering the social, organizational and ethical implications of technologies. However, a commonly accepted method for analysing the ethical aspects of health technologies is lacking. This paper describes a model for ethical analysis of health technology...... to only analyse the ethical consequences of a technology, but also the ethical issues of the whole HTA process must be considered. Selection of assessment topics, methods and outcomes is essentially a value-laden decision. Health technologies may challenge moral or cultural values and beliefs...

External factors affecting decision-making and use of evidence in an Australian public health policy environment.

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Zardo, Pauline; Collie, Alex; Livingstone, Charles

2014-05-01

This study examined external factors affecting policy and program decision-making in a specific public health policy context: injury prevention and rehabilitation compensation in the Australian state of Victoria. The aim was twofold: identify external factors that affect policy and program decision-making in this specific context; use this evidence to inform targeting of interventions aimed at increasing research use in this context. Qualitative interviews were undertaken from June 2011 to January 2012 with 33 employees from two state government agencies. Key factors identified were stakeholder feedback and action, government and ministerial input, legal feedback and action, injured persons and the media. The identified external factors were able to significantly influence policy and program decision-making processes: acting as both barriers and facilitators, depending on the particular issue at hand. The factors with the most influence were the Minister and government, lawyers, and agency stakeholders, particularly health providers, trade unions and employer groups. This research revealed that interventions aimed at increasing use of research in this context must target and harness the influence of these groups. This research provides critical insights for researchers seeking to design interventions to increase use of research in policy environments and influence decision-making in Victorian injury prevention and rehabilitation compensation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Decision Making and Priority Setting: The Evolving Path Towards Universal Health Coverage.

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Paolucci, Francesco; Redekop, Ken; Fouda, Ayman; Fiorentini, Gianluca

2017-12-01

Health technology assessment (HTA) is widely viewed as an essential component in good universal health coverage (UHC) decision-making in any country. Various HTA tools and metrics have been developed and refined over the years, including systematic literature reviews (Cochrane), economic modelling, and cost-effectiveness ratios and acceptability curves. However, while the cost-effectiveness ratio is faithfully reported in most full economic evaluations, it is viewed by many as an insufficient basis for reimbursement decisions. Emotional debates about the reimbursement of cancer drugs, orphan drugs, and end-of-life treatments have revealed fundamental disagreements about what should and should not be considered in reimbursement decisions. Part of this disagreement seems related to the equity-efficiency tradeoff, which reflects fundamental differences in priorities. All in all, it is clear that countries aiming to improve UHC policies will have to go beyond the capacity building needed to utilize the available HTA toolbox. Multi-criteria decision analysis (MCDA) offers a more comprehensive tool for reimbursement decisions where different weights of different factors/attributes can give policymakers important insights to consider. Sooner or later, every country will have to develop their own way to carefully combine the results of those tools with their own priorities. In the end, all policymaking is based on a mix of facts and values.

The Re-contextualization of the Patient: What Home Health Care Can Teach Us About Medical Decision-Making.

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Salter, Erica K

2015-06-01

This article examines the role of context in the development and deployment of standards of medical decision-making. First, it demonstrates that bioethics, and our dominant standards of medical decision-making, developed out of a specific historical and philosophical environment that prioritized technology over the person, standardization over particularity, individuality over relationship and rationality over other forms of knowing. These forces de-contextualize the patient and encourage decision-making that conforms to the unnatural and contrived environment of the hospital. The article then explores several important differences between the home health care and acute care settings. Finally, it argues that the personalized, embedded, relational and idiosyncratic nature of the home is actually a much more accurate reflection of the context in which real people make real decisions. Thus, we should work to "re-contextualize" patients, in order that they might be better equipped to make decisions that harmonize with their real lives.

Improving Medical Decision Making and Health Promotion through Culture-Sensitive Health Communication : an Agenda for Science and Practice

OpenAIRE

Betsch, Cornelia; Böhm, Robert; Airhihenbuwa, Collins O.; Butler, Robb; Chapman, Gretchen B.; Haase, Niels; Herrmann, Benedikt; Igarashi, Tasuku; Kitayama, Shinobu; Korn, Lars; Nurm, Ülla-Karin; Rohrmann, Bernd; Rothman, Alexander J.; Shavitt, Sharon; Updegraff, John A.

2016-01-01

This review introduces the concept of culture-sensitive health communication. The basic premise is that congruency between the recipient's cultural characteristics and the respective message will increase the communication's effectiveness. Culture-sensitive health communication is therefore defined as the deliberate and evidence-informed adaptation of health communication to the recipients' cultural background in order to increase knowledge and improve preparation for medical decision making ...

The involvement of the striatum in decision making

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Goulet-Kennedy, Julie; Labbe, Sara; Fecteau, Shirley

2016-01-01

Decision making has been extensively studied in the context of economics and from a group perspective, but still little is known on individual decision making. Here we discuss the different cognitive processes involved in decision making and its associated neural substrates. The putative conductors in decision making appear to be the prefrontal cortex and the striatum. Impaired decision-making skills in various clinical populations have been associated with activity in the prefrontal cortex and in the striatum. We highlight the importance of strengthening the degree of integration of both cognitive and neural substrates in order to further our understanding of decision-making skills. In terms of cognitive paradigms, there is a need to improve the ecological value of experimental tasks that assess decision making in various contexts and with rewards; this would help translate laboratory learnings into real-life benefits. In terms of neural substrates, the use of neuroimaging techniques helps characterize the neural networks associated with decision making; more recently, ways to modulate brain activity, such as in the prefrontal cortex and connected regions (eg, striatum), with noninvasive brain stimulation have also shed light on the neural and cognitive substrates of decision making. Together, these cognitive and neural approaches might be useful for patients with impaired decision-making skills. The drive behind this line of work is that decision-making abilities underlie important aspects of wellness, health, security, and financial and social choices in our daily lives. PMID:27069380

Engaging patients in health care decisions in the emergency department through shared decision-making: a systematic review.

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Flynn, Darren; Knoedler, Meghan A; Hess, Erik P; Murad, M Hassan; Erwin, Patricia J; Montori, Victor M; Thomson, Richard G

2012-08-01

children with small lacerations; 2) options for rehydrating children presenting with vomiting or diarrhea or both; 3) risk of bacteremia (and associated complications), tests, and treatment options for febrile children; and 4) short-term risk of acute coronary syndrome (ACS) in adults with low-risk nontraumatic chest pain. Three studies had poor IPDASi probabilities and development process scores and lacked development informed by theory or involvement of clinicians and patients in development and usability testing. Overall, DSIs were associated with improvements in patients' knowledge and satisfaction with the explanation of their care, preferences for involvement, and engagement in decision-making and demonstrated utility for eliciting patients' preferences and values about management and treatment options. Two computerized DSIs (designed to predict risk of ACS in adults presenting to the ED with chest pain) were shown to reduce health care use without evidence of harm. None of the studies reported lack of feasibility of SDM in the ED. Early investigation of SDM in the ED suggests that patients may benefit from involvement in decision-making and offers no empirical evidence to suggest that SDM is not feasible. Future work is needed to develop and test additional SDM interventions in the ED and to identify contextual barriers and facilitators to implementation in practice. © 2012 by the Society for Academic Emergency Medicine.

Clinical decision-making: physicians' preferences and experiences

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White Martha

2007-03-01

Full Text Available Abstract Background Shared decision-making has been advocated; however there are relatively few studies on physician preferences for, and experiences of, different styles of clinical decision-making as most research has focused on patient preferences and experiences. The objectives of this study were to determine 1 physician preferences for different styles of clinical decision-making; 2 styles of clinical decision-making physicians perceive themselves as practicing; and 3 the congruence between preferred and perceived style. In addition we sought to determine physician perceptions of the availability of time in visits, and their role in encouraging patients to look for health information. Methods Cross-sectional survey of a nationally representative sample of U.S. physicians. Results 1,050 (53% response rate physicians responded to the survey. Of these, 780 (75% preferred to share decision-making with their patients, 142 (14% preferred paternalism, and 118 (11% preferred consumerism. 87% of physicians perceived themselves as practicing their preferred style. Physicians who preferred their patients to play an active role in decision-making were more likely to report encouraging patients to look for information, and to report having enough time in visits. Conclusion Physicians tend to perceive themselves as practicing their preferred role in clinical decision-making. The direction of the association cannot be inferred from these data; however, we suggest that interventions aimed at promoting shared decision-making need to target physicians as well as patients.

Seclusion, decision-making power, and gender disparities in adult health: Examining hypertension in India.

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Stroope, Samuel

2015-09-01

Research on the social determinants of health in developing countries is increasingly focusing on the importance of gender. Cardiovascular conditions such as hypertension are a growing concern in developing countries, where they are now the leading cause of death. Researchers have documented differences in hypertension between men and women, but the importance of gendered practices in shaping these differences has been left unexamined. Using national data from the India Human Development Survey 2005 (N=101,593), this study assesses the moderating role of two salient and widespread gendered practices-women's seclusion and decision-making power-on hypertension disparities between women and men. Both seclusion and low decision-making power are associated with increased odds of hypertension for women, but in the case of seclusion reduced hypertension for men. Results also show the gender gap in hypertension is exacerbated with women's seclusion and low decision-making power. Copyright © 2015 Elsevier Inc. All rights reserved.

Couple decision making and use of cultural scripts in Malawi.

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Mbweza, Ellen; Norr, Kathleen F; McElmurry, Beverly

2008-01-01

To examine the decision-making processes of husband and wife dyads in matrilineal and patrilineal marriage traditions of Malawi in the areas of money, food, pregnancy, contraception, and sexual relations. Qualitative grounded theory using simultaneous interviews of 60 husbands and wives (30 couples). Data were analyzed according to the guidelines of simultaneous data collection and analysis. The analysis resulted in development of core categories and categories of decision-making process. Data matrixes were used to identify similarities and differences within couples and across cases. Most couples reported using a mix of final decision-making approaches: husband-dominated, wife-dominated, and shared. Gender based and nongender based cultural scripts provided rationales for their approaches to decision making. Gender based cultural scripts (husband-dominant and wife-dominant) were used to justify decision-making approaches. Non-gender based cultural scripts (communicating openly, maintaining harmony, and children's welfare) supported shared decision making. Gender based cultural scripts were used in decision making more often among couples from the district with a patrilineal marriage tradition and where the husband had less than secondary school education and was not formally employed. Nongender based cultural scripts to encourage shared decision making can be used in designing culturally tailored reproductive health interventions for couples. Nurses who work with women and families should be aware of the variations that occur in actual couple decision-making approaches. Shared decision making can be used to encourage the involvement of men in reproductive health programs.

Categorization = Decision Making + Generalization

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Seger, Carol A; Peterson, Erik J.

2013-01-01

We rarely, if ever, repeatedly encounter exactly the same situation. This makes generalization crucial for real world decision making. We argue that categorization, the study of generalizable representations, is a type of decision making, and that categorization learning research would benefit from approaches developed to study the neuroscience of decision making. Similarly, methods developed to examine generalization and learning within the field of categorization may enhance decision making research. We first discuss perceptual information processing and integration, with an emphasis on accumulator models. We then examine learning the value of different decision making choices via experience, emphasizing reinforcement learning modeling approaches. Next we discuss how value is combined with other factors in decision making, emphasizing the effects of uncertainty. Finally, we describe how a final decision is selected via thresholding processes implemented by the basal ganglia and related regions. We also consider how memory related functions in the hippocampus may be integrated with decision making mechanisms and contribute to categorization. PMID:23548891

Building capacity for evidence informed decision making in public health: a case study of organizational change

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Peirson Leslea

2012-02-01

Full Text Available Abstract Background Core competencies for public health in Canada require proficiency in evidence informed decision making (EIDM. However, decision makers often lack access to information, many workers lack knowledge and skills to conduct systematic literature reviews, and public health settings typically lack infrastructure to support EIDM activities. This research was conducted to explore and describe critical factors and dynamics in the early implementation of one public health unit's strategic initiative to develop capacity to make EIDM standard practice. Methods This qualitative case study was conducted in one public health unit in Ontario, Canada between 2008 and 2010. In-depth information was gathered from two sets of semi-structured interviews and focus groups (n = 27 with 70 members of the health unit, and through a review of 137 documents. Thematic analysis was used to code the key informant and document data. Results The critical factors and dynamics for building EIDM capacity at an organizational level included: clear vision and strong leadership, workforce and skills development, ability to access research (library services, fiscal investments, acquisition and development of technological resources, a knowledge management strategy, effective communication, a receptive organizational culture, and a focus on change management. Conclusion With leadership, planning, commitment and substantial investments, a public health department has made significant progress, within the first two years of a 10-year initiative, towards achieving its goal of becoming an evidence informed decision making organization.

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

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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.

Collaborative decision-making and promoting treatment adherence in pediatric chronic illness

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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

What is known about parents' treatment decisions? A narrative review of pediatric decision making.

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Lipstein, Ellen A; Brinkman, William B; Britto, Maria T

2012-01-01

With the increasing complexity of decisions in pediatric medicine, there is a growing need to understand the pediatric decision-making process. To conduct a narrative review of the current research on parent decision making about pediatric treatments and identify areas in need of further investigation. Articles presenting original research on parent decision making were identified from MEDLINE (1966-6/2011), using the terms "decision making," "parent," and "child." We included papers focused on treatment decisions but excluded those focused on information disclosure to children, vaccination, and research participation decisions. We found 55 papers describing 52 distinct studies, the majority being descriptive, qualitative studies of the decision-making process, with very limited assessment of decision outcomes. Although parents' preferences for degree of participation in pediatric decision making vary, most are interested in sharing the decision with the provider. In addition to the provider, parents are influenced in their decision making by changes in their child's health status, other community members, prior knowledge, and personal factors, such as emotions and faith. Parents struggle to balance these influences as well as to know when to include their child in decision making. Current research demonstrates a diversity of influences on parent decision making and parent decision preferences; however, little is known about decision outcomes or interventions to improve outcomes. Further investigation, using prospective methods, is needed in order to understand how to support parents through the difficult treatment decisions.

What if the baby doesn't survive? Health-care decision making for ill newborns in Ethiopia.

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Onarheim, Kristine Husøy; Sisay, Mitike Molla; Gizaw, Muluken; Moland, Karen Marie; Miljeteig, Ingrid

2017-12-01

Despite efforts to improve access to and quality of care for newborns, the first month after birth remains the most dangerous period of life. Given high neonatal mortality in low-income countries, saving newborn lives is a key priority for global and national health policy agendas. However, little is known about how these policies resonate with local understandings, experiences and household priorities. In this qualitative study we examined families' decision making and health-care-seeking in Butajira, Ethiopia. Data were collected through observation in hospital, in-depth interviews (41), and focus group discussions (7) with family members, health-care workers, and community members (October-November 2015). Transcripts and field notes were analyzed inductively using qualitative content analysis. Findings indicate that newborn health was not always the family's priority. Local perceptions of newborns as not yet useful members of the household alongside costly health-care services delayed decision making and care-seeking. While sickness was recognized as dangerous for the ill newborn, seeking health-care could be harmful for the economic survival of the family. In a resource-constrained setting, families' focused on productive assets in order to minimize long-term risks, and waited before seeking newborn health-care services. Until the baby had survived the first vulnerable weeks and months of life, the unknown newborn was not yet seen as a social person by the community. Personhood evolved progressively as the baby became a part of the family. A newborn death was surrounded by silence, and families received minimal support from traditional financial associations, iddirs. Decisions regarding health-care were contingent upon families' understandings of newborns and their resource-constrained circumstances. Improving newborn health involves recognizing why families choose to (not) seek health-care, and their actual opportunities and constraints in making such

[Health technology assessment for decision-making in Latin America: good practice principles].

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Pichon-Riviere, Andrés; Soto, Natalie C; Augustovski, Federico Ariel; García Martí, Sebastián; Sampietro-Colom, Laura

2018-02-19

Identify the most relevant, applicable, and priority good practice principles in health technology assessment (HTA) in Latin America, and potential barriers to implementing them in the region. HTA good practice principles postulated worldwide were identified and then explored through a deliberative process in a forum of evaluators, funders, and technology producers. Forty-two representatives from ten Latin American countries participated in the forum. The good practice principles postulated at the international level were considered valid and potentially applicable in Latin America. Five principles were identified as priorities and as having greater potential to be expanded at this time: transparency in carrying out HTA; involvement of stakeholders in the HTA process; existence of mechanisms to appeal decisions; existence of clear mechanisms for HTA priority-setting; and existence of a clear link between assessment and decision-making. The main challenge identified was to find a balance between application of these principles and available resources, to prevent the planned improvements from jeopardizing report production times and failing to meet decision-makers' needs. The main recommendation was to gradually advance in improving HTA and its link to decision-making by developing appropriate processes for each country, without attempting to impose, in the short term, standards taken from examples at the international level without adequate adaptation to the local context.

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

Science.gov (United States)

Smebye, Kari Lislerud; Kirkevold, Marit; Engedal, Knut

2012-08-07

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

Decision-making strategies: ignored to the detriment of healthcare training and delivery?

Science.gov (United States)

Desmond, Chris; Brubaker, Kathryn A; Ellner, Andrew L

2013-01-01

Context : People do not always make health-related decisions which reflect their best interest - best interest being defined as the decision they would make if they carefully considered the options and fully understood the information available. A substantial literature has developed in behavioral economics and social psychology that seeks to elucidate the patterns in individual decision-making. While this is particularly relevant to healthcare, the insights from these fields have only been applied in a limited way. To address the health challenges of the twenty-first century, healthcare providers and healthcare systems designers need to more fully understand how individuals are making decisions. Methods : We provide an overview of the theories of behavioral economics and social psychology that relate to how individuals make health-related decisions. The concentration on health-related decisions leads to a focus on three topics: (1) mental shortcuts and motivated reasoning; (2) implications of time; and (3) implications of affect. The first topic is relevant because health-related decisions are often made in a hurry without a full appreciation of the implications and the deliberation they warrant. The second topic is included because the link between a decision and its health-related outcomes can involve a significant time lag. The final topic is included because health and affect are so often linked. Findings : The literature reviewed has implications for healthcare training and delivery. Selection for medical training must consider the skills necessary to understand and adapt to how patients make decisions. Training on the insights garnered from behavioral economics and social psychology would better prepare healthcare providers to effectively support their clients to lead healthy lives. Healthcare delivery should be structured to respond to the way in which decisions are made. Conclusions : These patterns in decision-making call into question basic assumptions

The effect of professional identity on comprehensiveness in strategic decision making: physician executives in the Canadian health care context.

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Karmali, Shazia

2012-01-01

This paper explores differences in decision-making approaches between physician executives and nonphysician executives in a managerial setting. Fredrickson and Mitchell's (1984) conceptualization of the construct of comprehensiveness in strategic decision making is the central construct of this paper. Theories of professional identity, socialization, and institutional/dominant logics are applied to illustrate their impact on strategic decision-making approaches of physician and nonphysician executives. This paper proposes that high-status professionals, specifically physicians, occupying senior management roles are likely to approach decision making in a way that is consistent with their professional identity, and by extension, that departments led by physician executives are less likely to exhibit comprehensiveness in strategic decision-making processes than departments led by nonphysician executives. This paper provides conceptual evidence that physicians and nonphysicians approach management differently, and introduces the utility of comprehensiveness as a construct for strategic decision making in the context of health care management.

IS THE LINK BETWEEN HEALTH AND WEALTH CONSIDERED IN DECISION MAKING? RESULTS FROM A QUALITATIVE STUDY.

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Garau, Martina; Shah, Koonal Kirit; Sharma, Priya; Towse, Adrian

2015-01-01

The aim of this study was to explore whether wealth effects of health interventions, including productivity gains and savings in other sectors, are considered in resource allocations by health technology assessment (HTA) agencies and government departments. To analyze reasons for including, or not including, wealth effects. Semi-structured interviews with decision makers and academic experts in eight countries (Australia, France, Germany, Italy, Poland, South Korea, Sweden, and the United Kingdom). There is evidence suggesting that health interventions can produce economic gains for patients and national economies. However, we found that the link between health and wealth does not influence decision making in any country with the exception of Sweden. This is due to a combination of factors, including system fragmentation, methodological issues, and the economic recession forcing national governments to focus on short-term measures. In countries with established HTA processes and methods allowing, in principle, the inclusion of wider effects in exceptional cases or secondary analyses, it might be possible to overcome the methodological and practical barriers and see a more systematic consideration of wealth effect in decision making. This would be consistent with principles of efficient priority setting. Barriers for the consideration of wealth effects in government decision making are more fundamental, due to an enduring separation of budgets within the public sector and current financial pressures. However, governments should consider all relevant effects from public investments, including healthcare, even when benefits can only be captured in the medium- and long-term. This will ensure that resources are allocated where they bring the best returns.

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

A system of system lenses for leadership decision-making.

Science.gov (United States)

Cady, Phil

2016-01-01

The sheer volume and dynamics among system agents in healthcare makes decision-making a daunting task at all levels. Being clear about what leaders mean by "healthcare system" is critical in aligning system strategy and leadership decision-making. This article presents an emerging set of lenses (ideology and beliefs, rational and irrational information processing, interpersonal social dynamics, process and value creation, and context) to help frame leadership decision-making in healthcare systems. © 2015 The Canadian College of Health Leaders.

What Is Known about Parents’ Treatment Decisions? A Narrative Review of Pediatric Decision Making

Science.gov (United States)

Lipstein, Ellen A.; Brinkman, William B.; Britto, Maria T.

2013-01-01

Background With the increasing complexity of decisions in pediatric medicine, there is a growing need to understand the pediatric decision-making process. Objective To conduct a narrative review of the current research on parent decision making about pediatric treatments and identify areas in need of further investigation. Methods Articles presenting original research on parent decision making were identified from MEDLINE (1966–6/2011), using the terms “decision making,” “parent,” and “child.” We included papers focused on treatment decisions but excluded those focused on information disclosure to children, vaccination, and research participation decisions. Results We found 55 papers describing 52 distinct studies, the majority being descriptive, qualitative studies of the decision-making process, with very limited assessment of decision outcomes. Although parents’ preferences for degree of participation in pediatric decision making vary, most are interested in sharing the decision with the provider. In addition to the provider, parents are influenced in their decision making by changes in their child’s health status, other community members, prior knowledge, and personal factors, such as emotions and faith. Parents struggle to balance these influences as well as to know when to include their child in decision making. Conclusions Current research demonstrates a diversity of influences on parent decision making and parent decision preferences; however, little is known about decision outcomes or interventions to improve outcomes. Further investigation, using prospective methods, is needed in order to understand how to support parents through the difficult treatment decisions. PMID:21969136

Making interactive decision support for patients a reality.

NARCIS (Netherlands)

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

2004-01-01

Interactive decision support applications might help patients to make difficult decisions about their health care. They lie in the context of traditional decision aids, which are known to have effects on a number of patient outcomes, including knowledge and decisional conflict. The problem of

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

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

2012-01-01

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

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

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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.

How to make the best decision. Philosophical aspects of clinical decision theory.

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Wulff, H R

1981-01-01

An attempt is made to discuss some of the philosophical implications of the use of decision-analytic techniques. The probabilities of a decision analysis are subjective measures of belief, and it is concluded that clinicians base their subjective beliefs on both recorded observations and theoretical knowledge. The clinical decision maker also evaluates the consequences of his actions, and therefore clinical decision theory transcends medical science. A number of different schools of normative ethics are mentioned to illustrate the complexity of everyday decision making. The philosophical terminology is useful for the analysis of clinical problems, and it is argued that clinical decision making has both a teleological and a deontological component. The results of decision-analytic studies depend on such factors as the wealth of the country, the organization of the health service, and cultural norms.

Risky decision making in adults with ADHD.

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Matthies, S; Philipsen, A; Svaldi, J

2012-09-01

Risky decision making and disadvantageous choices constitute core characteristics of patients with attention-deficit/hyperactivity disorder (ADHD). Consequences include negative psychosocial and health-related outcomes. However, risky decision making and its interrelations with emotional states in ADHD are poorly understood. Therefore, the authors investigated risky decision making without and after boredom induction in adults with and without ADHD. In study 1, ADHD patients (n = 15) and age/education matched controls (CG; n = 16) were compared on the Game of Dice Task (GDT), an established task measuring decision making in unambiguous situations. In study 2, ADHD patients (n = 14) and CG (n = 13) underwent boredom induction prior to the GDT. In study 1, ADHD patients selected the disadvantageous alternatives significantly more often than CG. In study 2, no significant group differences were found due to an increase in risky decision making in CG following the boredom induction. Even if severity of depression did not affect our results, it may be necessary to compare GDT responses in ADHD patients with and without current depression. Risk as a motor of disadvantageous decision making needs to be taken into account in therapeutic contexts as a maintenance factor of dysfunctional behaviour. The findings of study 2 are in line with postulated alterations of emotional state adjustment in ADHD. The link between decisions making and emotional regulation in ADHD needs further attention in research. Copyright © 2012 Elsevier Ltd. All rights reserved.

Maternal Household Decision-Making Autonomy and Adolescent Education in Honduras.

Science.gov (United States)

Hendrick, C Emily; Marteleto, Leticia

2017-06-01

Maternal decision-making autonomy has been linked to positive outcomes for children's health and well-being early in life in low- and middle-income countries throughout the world. However, there is a dearth of research examining if and how maternal autonomy continues to influence children's outcomes into adolescence and whether it impacts other domains of children's lives beyond health, such as their education. The goal of this study was to determine whether high maternal decision-making was associated with school enrollment for secondary school-aged youth in Honduras. Further, we aimed to assess whether the relationships between maternal autonomy and school enrollment varied by adolescents' environmental contexts and individual characteristics such as gender. Our analytical sample included 6,579 adolescents ages 12-16 living with their mothers from the Honduran Demographic and Health Survey (DHS) 2011-12. We used stepwise logistic regression models to investigate the association between maternal household decision-making autonomy and adolescents' school enrollment. Our findings suggest that adolescents, especially girls, benefit from their mothers' high decision-making autonomy. Findings suggest that maternal decision-making autonomy promotes adolescents' school enrollment above and beyond other maternal, household, and regional influences.

Decision Making for Healthcare Resource Allocation: Joint v. Separate Decisions on Interacting Interventions.

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Dakin, Helen; Gray, Alastair

2018-05-01

Standard guidance for allocating healthcare resources based on cost-effectiveness recommends using different decision rules for independent and mutually exclusive alternatives, although there is some confusion around the definition of "mutually exclusive." This paper reviews the definitions used in the literature and shows that interactions (i.e., non-additive effects, whereby the effect of giving 2 interventions simultaneously does not equal the sum of their individual effects) are the defining feature of mutually exclusive alternatives: treatments cannot be considered independent if the costs and/or benefits of one treatment are affected by the other treatment. The paper then identifies and categorizes the situations in which interventions are likely to have non-additive effects, including interventions targeting the same goal or clinical event, or life-saving interventions given to overlapping populations. We demonstrate that making separate decisions on interventions that have non-additive effects can prevent us from maximizing health gained from the healthcare budget. In contrast, treating combinations of independent options as though they were "mutually exclusive" makes the analysis more complicated but does not affect the conclusions. Although interactions are considered by the World Health Organization, other decision makers, such as the National Institute for Health and Care Excellence (NICE), currently make independent decisions on treatments likely to have non-additive effects. We propose a framework by which interactions could be considered when selecting, prioritizing, and appraising healthcare technologies to ensure efficient, evidence-based decision making.

Decision Making Under Uncertainty

Science.gov (United States)

2010-11-01

A sound approach to rational decision making requires a decision maker to establish decision objectives, identify alternatives, and evaluate those...often violate the axioms of rationality when making decisions under uncertainty. The systematic description of such observations may lead to the...which leads to “anchoring” on the initial value. The fact that individuals have been shown to deviate from rationality when making decisions

Decision Making in Action

Science.gov (United States)

Orasanu, Judith; Statler, Irving C. (Technical Monitor)

1994-01-01

The importance of decision-making to safety in complex, dynamic environments like mission control centers and offshore installations has been well established. NASA-ARC has a program of research dedicated to fostering safe and effective decision-making in the manned spaceflight environment. Because access to spaceflight is limited, environments with similar characteristics, including aviation and nuclear power plants, serve as analogs from which space-relevant data can be gathered and theories developed. Analyses of aviation accidents cite crew judgement and decision making as causes or contributing factors in over half of all accidents. A similar observation has been made in nuclear power plants. Yet laboratory research on decision making has not proven especially helpful in improving the quality of decisions in these kinds of environments. One reason is that the traditional, analytic decision models are inappropriate to multidimensional, high-risk environments, and do not accurately describe what expert human decision makers do when they make decisions that have consequences. A new model of dynamic, naturalistic decision making is offered that may prove useful for improving decision making in complex, isolated, confined and high-risk environments. Based on analyses of crew performance in full-mission simulators and accident reports, features that define effective decision strategies in abnormal or emergency situations have been identified. These include accurate situation assessment (including time and risk assessment), appreciation of the complexity of the problem, sensitivity to constraints on the decision, timeliness of the response, and use of adequate information. More effective crews also manage their workload to provide themselves with time and resources to make good decisions. In brief, good decisions are appropriate to the demands of the situation. Effective crew decision making and overall performance are mediated by crew communication. Communication

Institutionalizing telemedicine applications: the challenge of legitimizing decision-making.

Science.gov (United States)

Zanaboni, Paolo; Lettieri, Emanuele

2011-09-28

During the last decades a variety of telemedicine applications have been trialed worldwide. However, telemedicine is still an example of major potential benefits that have not been fully attained. Health care regulators are still debating why institutionalizing telemedicine applications on a large scale has been so difficult and why health care professionals are often averse or indifferent to telemedicine applications, thus preventing them from becoming part of everyday clinical routines. We believe that the lack of consolidated procedures for supporting decision making by health care regulators is a major weakness. We aim to further the current debate on how to legitimize decision making about the institutionalization of telemedicine applications on a large scale. We discuss (1) three main requirements--rationality, fairness, and efficiency--that should underpin decision making so that the relevant stakeholders perceive them as being legitimate, and (2) the domains and criteria for comparing and assessing telemedicine applications--benefits and sustainability. According to these requirements and criteria, we illustrate a possible reference process for legitimate decision making about which telemedicine applications to implement on a large scale. This process adopts the health care regulators' perspective and is made up of 2 subsequent stages, in which a preliminary proposal and then a full proposal are reviewed.

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

Science.gov (United States)

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

2016-01-01

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. 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. 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. 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. 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.

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.

Distributed decision making in action: diagnostic imaging investigations within the bigger picture.

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Makanjee, Chandra R; Bergh, Anne-Marie; Hoffmann, Willem A

2018-03-01

Decision making in the health care system - specifically with regard to diagnostic imaging investigations - occurs at multiple levels. Professional role players from various backgrounds are involved in making these decisions, from the point of referral to the outcomes of the imaging investigation. The aim of this study was to map the decision-making processes and pathways involved when patients are referred for diagnostic imaging investigations and to explore distributed decision-making events at the points of contact with patients within a health care system. A two-phased qualitative study was conducted in an academic public health complex with the district hospital as entry point. The first phase included case studies of 24 conveniently selected patients, and the second phase involved 12 focus group interviews with health care providers. Data analysis was based on Rapley's interpretation of decision making as being distributed across time, situations and actions, and including different role players and technologies. Clinical decisions incorporating imaging investigations are distributed across the three vital points of contact or decision-making events, namely the initial patient consultation, the diagnostic imaging investigation and the post-investigation consultation. Each of these decision-making events is made up of a sequence of discrete decision-making moments based on the transfer of retrospective, current and prospective information and its transformation into knowledge. This paper contributes to the understanding of the microstructural processes (the 'when' and 'where') involved in the distribution of decisions related to imaging investigations. It also highlights the interdependency in decision-making events of medical and non-medical providers within a single medical encounter. © 2017 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation

[The ethical reflection approach in decision-making processes in health institutes].

Science.gov (United States)

Gruat, Renaud

2015-12-01

Except in the specific case of end-of-life care, the law says nothing about the way in which health professionals must carry out ethical reflection regarding the treatment of their patients. A problem-solving methodology called the "ethical reflection approach" performed over several stages can be used. The decision-making process involves the whole team and draws on the ability of each caregiver to put forward a reasoned argument, in the interest of the patient. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Decision-making: Theory and practice

OpenAIRE

SM Turpin; MA Marais

2004-01-01

This paper compares a number of theoretical models of decision-making with the way in which senior managers make decisions in practice. Six prominent decision-makers were interviewed about their own decision-making style, as well as their use of decision support technology. Significant variation was found in personal decision-making styles. However, some central themes emerged, such as the importance of sensitivity to the decision-making context, attention to the presentation of information, ...

[Decision making in cariology

NARCIS (Netherlands)

Verdonschot, E.H.A.M.; Liem, S.L.; Palenstein Helderman, W.H. van

2003-01-01

By conducting an oral examination, during radiographic examination and in treatment planning procedures dentists make numerous decisions. A dentist will be required to make his decisions explicit. Decision trees and decision analyses may play an important role. In a decision analysis, the

HEALTH TECHNOLOGY ASSESSMENT FOR DECISION MAKING IN LATIN AMERICA: GOOD PRACTICE PRINCIPLES.

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Pichon-Riviere, Andrés; Soto, Natalie C; Augustovski, Federico Ariel; García Martí, Sebastián; Sampietro-Colom, Laura

2018-06-11

The aim of this study was to identify good practice principles for health technology assessment (HTA) that are the most relevant and of highest priority for application in Latin America and to identify potential barriers to their implementation in the region. HTA good practice principles proposed at the international level were identified and then explored during a deliberative process in a forum of assessors, funders, and product manufacturers. Forty-two representatives from ten Latin American countries participated. Good practice principles proposed at the international level were considered valid and potentially relevant to Latin America. Five principles were identified as priority and with the greatest potential to be strengthened at this time: transparency in the production of HTA, involvement of relevant stakeholders in the HTA process, mechanisms to appeal decisions, clear priority-setting processes in HTA, and a clear link between HTA and decision making. The main challenge identified was to find a balance between the application of these principles and the available resources in a way that would not detract from the production of reports and adaptation to the needs of decision makers. The main recommendation was to progress gradually in strengthening HTA and its link to decision making by developing appropriate processes for each country, without trying to impose, in the short-term, standards taken from examples at the international level without adequate adaptation of these to local contexts.

The Relations between Decision Making in Social Relationships and Decision Making Styles

Science.gov (United States)

Sari, Enver

2008-01-01

The research reported in this paper aimed to examine the relationships between decisiveness in social relationships, and the decision-making styles of a group of university students and to investigate the contributions of decision-making styles in predicting decisiveness in social relationship (conflict resolution, social relationship selection…

Research on self-esteem in decision-making and decision-making styles in orienteering athletes

Directory of Open Access Journals (Sweden)

Eroğlu Başak

2016-01-01

Full Text Available The aim of this study is to examine the self-esteem in decision making and decision-making styles of orienteering athletes in terms of different variables. 157 male and 43 female orienteering athletes, making a total of 200 athletes that joined the 3rd Level of Turkey Championship in 2015 have participated in this study which is in a survey model. The data collection tools were the Melbourne Decision-making. Quastionnaire I-II and the Personal Information Form which were adapted into Turkish by Deniz (2004. In the data analysis, descriptive statics, anova, t test and Tukey test have been utilized. There is a significant difference between athletes’ marital status, age groups, experiences in orienteering sports and self-esteem in decision making, decision making styles (p<0.05. According to the research results, it has been determined that married orienteering athletes prefer both self-esteem in decision making and vigilance decision-making style more often than the single athletes that mostly prefer procrastination decision-making style. Also, it has been found out that as the athletes’ age and experiences in sports increase, selfesteem and decision-making styles are affected more positively as well.

Evidence, values, guidelines and rational decision-making.

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Barrett, Bruce

2012-02-01

Medical decision-making involves choices, which can lead to benefits or to harms. Most benefits and harms may or may not occur, and can be minor or major when they do. Medical research, especially randomized controlled trials, provides estimates of chance of occurrence and magnitude of event. Because there is no universally accepted method for weighing harms against benefits, and because the ethical principle of autonomy mandates informed choice by patient, medical decision-making is inherently an individualized process. It follows that the practice of aiming for universal implementation of standardized guidelines is irrational and unethical. Irrational because the possibility of benefits is implicitly valued more than the possibility of comparable harms, and unethical because guidelines remove decision making from the patient and give it instead to a physician, committee or health care system. This essay considers the cases of cancer screening and diabetes management, where guidelines often advocate universal implementation, without regard to informed choice and individual decision-making.

StaySafe: A self-administered android tablet application for helping individuals on probation make better decisions pertaining to health risk behaviors

Directory of Open Access Journals (Sweden)

Wayne E.K. Lehman

2018-06-01

Full Text Available This paper describes the development and protocol for feasibility and efficacy testing of a risk reduction intervention designed to improve behavioral health outcomes among drug offenders on probation under community supervision or in residential substance abuse treatment centers. StaySafe is a self-administered tablet-based intervention for teaching better decision-making skills regarding health risk behaviors, especially those involving HIV risks. We are using pre/post, experimental/control group randomized clinical trial (RCT in both community and residential probation settings with goals to 1 assess the feasibility and acceptance of StaySafe by examining participation rates and satisfaction measures, and 2 examine the impact of StaySafe on decision-making skills, confidence and motivation to avoid sex and drug risks, willingness to discuss health risks and concerns with helpful others, and engagement in health risk behaviors.StaySafe consists of 12 brief sessions and utilizes an evidence-based decision-making schema, called WORKIT, which guides participants through steps for identifying the problem and options, evaluating the options and making a decision about which option to carry out. Multiple sessions of StaySafe provide a practice effect so that the WORKIT steps become easily accessible to participants when making decisions. Three of the sessions provide participants a choice of activities designed to provide additional information about HIV and reinforce lessons learned during the WORKIT sessions. Preliminary data demonstrate feasibility and high levels of satisfaction with StaySafe. Keywords: Clinical trial, HIV, Probation, Tablet-based intervention, Decision-making

Internet use and decision making in community-based older adults

Directory of Open Access Journals (Sweden)

Bryan David James

2013-09-01

Full Text Available Use of the internet may provide tools and resources for better decision making, yet little is known about the association of internet use with decision-making in older persons. We examined this relationship in 66190 community-dwelling older persons without dementia from the Rush Memory and Aging Project, an ongoing longitudinal study of aging. Participants were asked to report if they had access to the internet and how frequently they used the internet and email. A 12-item instrument was used to assess financial and healthcare decision making using materials designed to approximate those used in real world settings. Items were summed to yield a total decision-making score. Associations were tested via linear regression models adjusted for age, sex, race, education, and a measure of global cognitive function. Secondary models further adjusted for income, depression, loneliness, social networks, social support, chronic medical conditions, instrumental activities of daily living, life space size, and health and financial literacy. Interaction terms were used to test for effect modification. Almost 70% of participants had access to the internet, and of those with access, 55% used the internet at least several times a week. Higher frequency of internet use was associated with better financial and healthcare decision making (β=0.11, p=0.002. The association persisted in a fully adjusted model (β=0.08, p=0.024. Interaction models indicated that higher frequency of internet use attenuated the relationships of older age, poorer cognitive function, and lower levels of health and financial literacy with poorer healthcare and financial decision making. These findings indicate that internet use is associated with better health and financial decision making in older persons. Future research is required to understand whether promoting the use of the internet can produce improvements in healthcare and financial decision making.

Using the Situated Clinical Decision-Making framework to guide analysis of nurses' clinical decision-making.

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Gillespie, Mary

2010-11-01

Nurses' clinical decision-making is a complex process that holds potential to influence the quality of care provided and patient outcomes. The evolution of nurses' decision-making that occurs with experience has been well documented. In addition, literature includes numerous strategies and approaches purported to support development of nurses' clinical decision-making. There has been, however, significantly less attention given to the process of assessing nurses' clinical decision-making and novice clinical educators are often challenged with knowing how to best support nurses and nursing students in developing their clinical decision-making capacity. The Situated Clinical Decision-Making framework is presented for use by clinical educators: it provides a structured approach to analyzing nursing students' and novice nurses' decision-making in clinical nursing practice, assists educators in identifying specific issues within nurses' clinical decision-making, and guides selection of relevant strategies to support development of clinical decision-making. A series of questions is offered as a guide for clinical educators when assessing nurses' clinical decision-making. The discussion presents key considerations related to analysis of various decision-making components, including common sources of challenge and errors that may occur within nurses' clinical decision-making. An exemplar illustrates use of the framework and guiding questions. Implications of this approach for selection of strategies that support development of clinical decision-making are highlighted. Copyright © 2010 Elsevier Ltd. All rights reserved.

Altered Decision-Making under Risk in Obesity.

Directory of Open Access Journals (Sweden)

Juan F Navas

Full Text Available The negative consequences of energy dense foods are well known, yet people increasingly make unhealthy food choices leading to obesity (i.e., risky decisions. The aims of this study were: [1] to compare performance in decision-making tasks under risk and under ambiguity between individuals with obesity, overweight and normal weight; [2] to examine the associations between body mass index (BMI and decision-making, and the degree to which these associations are modulated by reward sensitivity.Seventy-nine adults were recruited and classified in three groups according to their BMI: obesity, overweight and normal-weight. Groups were similar in terms of age, education and socio-economic status, and were screened for comorbid medical and mental health conditions. Decision-making under risk was measured via the Wheel of Fortune Task (WoFT and decision-making under ambiguity via the Iowa Gambling Task (IGT. Reward sensitivity was indicated by the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ.Individuals with obesity made riskier choices in the WoFT, specifically in choices with an expected value close to zero and in the propensity to risk index. No differences were found in IGT performance or SPSRQ scores. BMI was associated with risk-taking (WoFT performance, independently of reward sensitivity.Obesity is linked to a propensity to make risky decisions in experimental conditions analogous to everyday food choices.

Shared decision-making in the paediatric field: a literature review and concept analysis.

Science.gov (United States)

Park, Eun Sook; Cho, In Young

2017-09-13

The concept of shared decision-making is poorly defined and often used interchangeably with related terms. The aim of this study was to delineate and clarify the concept of shared decision-making in the paediatric field. Rodgers and Knafl's evolutionary concept analysis was used to delineate and clarify the concept. Following a search of the CINAHL, PubMed and MEDLINE databases and online journals between 1995 and 2016, we included a total of 42 articles that referred to shared decision-making in the paediatric field. The attributes included active participation of the three: parents, children and health professionals; collaborative partnership; reaching a compromise; and common goal for child's health. Antecedents were existing several options with different possible outcomes; substantial decisional conflict; recognising child's health situations that decision-making is needed; and willingness to participate in decision-making. Finally, the consequences included decreased decisional conflict; mutual empowerment; improved child health status; and improved quality of paediatric health care. This study provides a theoretical understanding of the concept of shared decision-making in the paediatric field; furthermore, by integrating this concept into paediatric practice, it may help to reduce the gap between theory and practice. The analysis could also provide nursing researchers with insight into paediatric decision-making and establish a foundation to develop future interventions and situation-specific theory for promoting high-quality decision-making in the paediatric field. © 2017 Nordic College of Caring Science.

Social Networks and Decision Making for Clandestine Unsafe ...

African Journals Online (AJOL)

AJRH Managing Editor

networks play in decision making for and facilitation of clandestine abortions. It was a mixed ... Keywords: abortion decisions, social influence, health seeking behavior. Résumé ..... Special attention is given to young women who depend more ...

[Interoception and decision-making].

Science.gov (United States)

Ohira, Hideki

2015-02-01

We sometimes make decisions relying not necessarily on deliberative thoughts but on intuitive and emotional processes in uncertain situations. The somatic marker hypothesis proposed by Damasio argued that interoception, which means bodily responses such as sympathetic activity, can be represented in the insula and anterior cingulate cortex and can play critical roles in decision-making. Though this hypothesis has been criticized in its theoretical and empirical aspects, recent studies are expanding the hypothesis to elucidate multiple bodily responses including autonomic, endocrine, and immune activities that affect decision-making. In addition, cumulative findings suggest that the anterior insula where the inner model of interoception is represented can act as an interface between the brain and body in decision-making. This article aims to survey recent findings on the brain-body interplays underlying decision-making, and to propose hypotheses on the significance of the body in decision-making.

Improving Medical Decision Making and Health Promotion through Culture-Sensitive Health Communication: An Agenda for Science and Practice.

Science.gov (United States)

Betsch, Cornelia; Böhm, Robert; Airhihenbuwa, Collins O; Butler, Robb; Chapman, Gretchen B; Haase, Niels; Herrmann, Benedikt; Igarashi, Tasuku; Kitayama, Shinobu; Korn, Lars; Nurm, Ülla-Karin; Rohrmann, Bernd; Rothman, Alexander J; Shavitt, Sharon; Updegraff, John A; Uskul, Ayse K

2016-10-01

This review introduces the concept of culture-sensitive health communication. The basic premise is that congruency between the recipient's cultural characteristics and the respective message will increase the communication's effectiveness. Culture-sensitive health communication is therefore defined as the deliberate and evidence-informed adaptation of health communication to the recipients' cultural background in order to increase knowledge and improve preparation for medical decision making and to enhance the persuasiveness of messages in health promotion. To achieve effective health communication in varying cultural contexts, an empirically and theoretically based understanding of culture will be indispensable. We therefore define culture, discuss which evolutionary and structural factors contribute to the development of cultural diversity, and examine how differences are conceptualized as scientific constructs in current models of cultural differences. In addition, we will explicate the implications of cultural differences for psychological theorizing, because common constructs of health behavior theories and decision making, such as attitudes or risk perception, are subject to cultural variation. In terms of communication, we will review both communication strategies and channels that are used to disseminate health messages, and we will discuss the implications of cultural differences for their effectiveness. Finally, we propose an agenda both for science and for practice to advance and apply the evidence base for culture-sensitive health communication. This calls for more interdisciplinary research between science and practice but also between scientific disciplines and between basic and applied research. © The Author(s) 2015.

Electricity, health and the environment: Comparative assessment in support of decision making. Proceedings of a symposium

International Nuclear Information System (INIS)

1996-01-01

The main objective of the Symposium was to enhance and strengthen information sharing and co-operation between interested and affected parties in the field of electricity demand analysis and supply planning, aiming at implementing sustainable policies in the power sector, taking into account economic, social, health and environmental aspects. To meet this objective, the Symposium sessions addressed the following topics: key issues in the decision making process; assessment of health and environmental impacts; integrated framework for comparative assessment; implementation of comparative assessment; country case studies; and comparative assessment in decision making. A closing round table focused on challenges for international co-operation aiming at implementation of sustainable electricity policies. In addition to the main sessions, poster presentations illustrated results from comparative assessment studies carried out in different countries, and software demonstration provided opportunities for participants to gain information about state of the art computer tools, databases and analytical models that are available for use in decision support studies. Refs, figs, tabs

Decision Making Among Older Adults at the End of Life: A Theoretical Perspective.

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Romo, Rafael D; Dawson-Rose, Carol S; Mayo, Ann M; Wallhagen, Margaret I

Understanding changes in decision making among older adults across time is important for health care providers. We examined how older adults with a limited prognosis used their perception of prognosis and health in their decision-making processes and related these findings to prospect theory. The theme of decision making in the context of ambiguity emerged, reflecting how participants used both prognosis and health to value choices, a behavior not fully captured by prospect theory. We propose an extension of the theory that can be used to better visualize decision making at this unique time of life among older adults.

mHealth for Clinical Decision-Making in Sub-Saharan Africa: A Scoping Review.

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Adepoju, Ibukun-Oluwa Omolade; Albersen, Bregje Joanna Antonia; De Brouwere, Vincent; van Roosmalen, Jos; Zweekhorst, Marjolein

2017-03-23

In a bid to deliver quality health services in resource-poor settings, mobile health (mHealth) is increasingly being adopted. The role of mHealth in facilitating evidence-based clinical decision-making through data collection, decision algorithms, and evidence-based guidelines, for example, is established in resource-rich settings. However, the extent to which mobile clinical decision support systems (mCDSS) have been adopted specifically in resource-poor settings such as Africa and the lessons learned about their use in such settings are yet to be established. The aim of this study was to synthesize evidence on the use of mHealth for point-of-care decision support and improved quality of care by health care workers in Africa. A scoping review of 4 peer-reviewed and 1 grey literature databases was conducted. No date limits were applied, but only articles in English language were selected. Using pre-established criteria, 2 reviewers screened articles and extracted data. Articles were analyzed using Microsoft Excel and MAXQDA. We retained 22 articles representing 11 different studies in 7 sub-Saharan African countries. Interventions were mainly in the domain of maternal health and ranged from simple text messaging (short message service, SMS) to complex multicomponent interventions. Although health workers are generally supportive of mCDSS and perceive them as useful, concerns about increased workload and altered workflow hinder sustainability. Facilitators and barriers to use of mCDSS include technical and infrastructural support, ownership, health system challenges, and training. The use of mCDSS in sub-Saharan Africa is an indication of progress in mHealth, although their effect on quality of service delivery is yet to be fully explored. Lessons learned are useful for informing future research, policy, and practice for technologically supported health care delivery, especially in resource-poor settings. ©Ibukun-Oluwa Omolade Adepoju, Bregje Joanna Antonia

Family involvement in medical decision-making: Perceptions of nursing and psychology students.

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Itzhaki, Michal; Hildesheimer, Galya; Barnoy, Sivia; Katz, Michael

2016-05-01

Family members often rely on health care professionals to guide and support them through the decision-making process. Although family involvement in medical decisions should be included in the preservice curriculum for the health care professions, perceptions of students in caring professions on family involvement in medical decision-making have not yet been examined. To examine the perceptions of nursing and psychology students on family involvement in medical decision-making for seriously ill patients. A descriptive cross-sectional design was used. First year undergraduate nursing and psychology students studying for their Bachelor of Arts degree were recruited. Perceptions were assessed with a questionnaire constructed based on the Multi-Attribute Utility Theory (MAUT), which examines decision-maker preferences. The questionnaire consisted of two parts referring to the respondent once as the patient and then as the family caregiver. Questionnaires were completed by 116 nursing students and 156 psychology students. Most were of the opinion that family involvement in decision-making is appropriate, especially when the patient is incapable of making decisions. Nursing students were more inclined than psychology students to think that financial, emotional, and value-based considerations should be part of the family's involvement in decision-making. Both groups of students perceived the emotional consideration as most acceptable, whereas the financial consideration was considered the least acceptable. Nursing and psychology students perceive family involvement in medical decision-making as appropriate. In order to train students to support families in the process of decision-making, further research should examine Shared Decision-Making (SDM) programs, which involve patient and clinician collaboration in health care decisions. Copyright © 2016 Elsevier Ltd. All rights reserved.

Integrated Risk-Informed Decision-Making for an ALMR PRISM

Energy Technology Data Exchange (ETDEWEB)

Muhlheim, Michael David [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Belles, Randy [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Denning, Richard S. [Self Employed

2016-05-01

Decision-making is the process of identifying decision alternatives, assessing those alternatives based on predefined metrics, selecting an alternative (i.e., making a decision), and then implementing that alternative. The generation of decisions requires a structured, coherent process, or a decision-making process. The overall objective for this work is that the generalized framework is adopted into an autonomous decision-making framework and tailored to specific requirements for various applications. In this context, automation is the use of computing resources to make decisions and implement a structured decision-making process with limited or no human intervention. The overriding goal of automation is to replace or supplement human decision makers with reconfigurable decision-making modules that can perform a given set of tasks rationally, consistently, and reliably. Risk-informed decision-making requires a probabilistic assessment of the likelihood of success given the status of the plant/systems and component health, and a deterministic assessment between plant operating parameters and reactor protection parameters to prevent unnecessary trips and challenges to plant safety systems. The probabilistic portion of the decision-making engine of the supervisory control system is based on the control actions associated with an ALMR PRISM. Newly incorporated into the probabilistic models are the prognostic/diagnostic models developed by Pacific Northwest National Laboratory. These allow decisions to incorporate the health of components into the decision–making process. Once the control options are identified and ranked based on the likelihood of success, the supervisory control system transmits the options to the deterministic portion of the platform. The deterministic portion of the decision-making engine uses thermal-hydraulic modeling and components for an advanced liquid-metal reactor Power Reactor Inherently Safe Module. The deterministic multi

Making sense of perceptions of risk of diseases and vaccinations: a qualitative study combining models of health beliefs, decision-making and risk perception

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Bond Lyndal

2011-12-01

Full Text Available Abstract Background Maintaining high levels of childhood vaccinations is important for public health. Success requires better understanding of parents' perceptions of diseases and consequent decisions about vaccinations, however few studies have considered this from the theoretical perspectives of risk perception and decision-making under uncertainty. The aim of this study was to examine the utility of subjective risk perception and decision-making theories to provide a better understanding of the differences between immunisers' and non-immunisers' health beliefs and behaviours. Methods In a qualitative study we conducted semi-structured in-depth interviews with 45 Australian parents exploring their experiences and perceptions of disease severity and susceptibility. Using scenarios about 'a new strain of flu' we explored how risk information was interpreted. Results We found that concepts of dread, unfamiliarity, and uncontrollability from the subjective perception of risk and ambiguity, optimistic control and omission bias from explanatory theories of decision-making under uncertainty were useful in understanding why immunisers, incomplete immunisers and non-immunisers interpreted severity and susceptibility to diseases and vaccine risk differently. Immunisers dreaded unfamiliar diseases whilst non-immunisers dreaded unknown, long term side effects of vaccines. Participants believed that the risks of diseases and complications from diseases are not equally spread throughout the community, therefore, when listening to reports of epidemics, it is not the number of people who are affected but the familiarity or unfamiliarity of the disease and the characteristics of those who have had the disease that prompts them to take preventive action. Almost all believed they themselves would not be at serious risk of the 'new strain of flu' but were less willing to take risks with their children's health. Conclusion This study has found that health messages

Making sense of perceptions of risk of diseases and vaccinations: a qualitative study combining models of health beliefs, decision-making and risk perception.

Science.gov (United States)

Bond, Lyndal; Nolan, Terry

2011-12-20

Maintaining high levels of childhood vaccinations is important for public health. Success requires better understanding of parents' perceptions of diseases and consequent decisions about vaccinations, however few studies have considered this from the theoretical perspectives of risk perception and decision-making under uncertainty. The aim of this study was to examine the utility of subjective risk perception and decision-making theories to provide a better understanding of the differences between immunisers' and non-immunisers' health beliefs and behaviours. In a qualitative study we conducted semi-structured in-depth interviews with 45 Australian parents exploring their experiences and perceptions of disease severity and susceptibility. Using scenarios about 'a new strain of flu' we explored how risk information was interpreted. We found that concepts of dread, unfamiliarity, and uncontrollability from the subjective perception of risk and ambiguity, optimistic control and omission bias from explanatory theories of decision-making under uncertainty were useful in understanding why immunisers, incomplete immunisers and non-immunisers interpreted severity and susceptibility to diseases and vaccine risk differently. Immunisers dreaded unfamiliar diseases whilst non-immunisers dreaded unknown, long term side effects of vaccines. Participants believed that the risks of diseases and complications from diseases are not equally spread throughout the community, therefore, when listening to reports of epidemics, it is not the number of people who are affected but the familiarity or unfamiliarity of the disease and the characteristics of those who have had the disease that prompts them to take preventive action. Almost all believed they themselves would not be at serious risk of the 'new strain of flu' but were less willing to take risks with their children's health. This study has found that health messages about the risks of disease which are communicated as though there

Organizational decision making

OpenAIRE

Grandori, Anna

2015-01-01

Approved for public release; distribution is unlimited This thesis develops a heuristic approach to organizational decision-making by synthesizing the classical, neo-classical and contingency approaches to organization theory. The conceptual framework developed also integrates the rational and cybernetic approaches with cognitive processes underlying the decision-making process. The components of the approach address the role of environment in organizational decision-maki...

Teachers' Grading Decision Making

Science.gov (United States)

Isnawati, Ida; Saukah, Ali

2017-01-01

This study investigated teachers' grading decision making, focusing on their beliefs underlying their grading decision making, their grading practices and assessment types, and factors they considered in grading decision making. Two teachers from two junior high schools applying different curriculum policies in grade reporting in Indonesian…

Care decision making of frontline providers of maternal and newborn health services in the greater Accra region of Ghana.

Directory of Open Access Journals (Sweden)

Ebenezer Oduro-Mensah

Full Text Available To explore the "how" and "why" of care decision making by frontline providers of maternal and newborn services in the Greater Accra region of Ghana and determine appropriate interventions needed to support its quality and related maternal and neonatal outcomes.A cross sectional and descriptive mixed method study involving a desk review of maternal and newborn care protocols and guidelines availability, focus group discussions and administration of a structured questionnaire and observational checklist to frontline providers of maternal and newborn care.Tacit knowledge or 'mind lines' was an important primary approach to care decision making. When available, protocols and guidelines were used as decision making aids, especially when they were simple handy tools and in situations where providers were not sure what their next step in management had to be. Expert opinion and peer consultation were also used through face to face discussions, phone calls, text messages, and occasional emails depending on the urgency and communication medium access. Health system constraints such as availability of staff, essential medicines, supplies and equipment; management issues (including leadership and interpersonal relations among staff, and barriers to referral were important influences in decision making. Frontline health providers welcomed the idea of interventions to support clinical decision making and made several proposals towards the development of such an intervention. They felt such an intervention ought to be multi-faceted to impact the multiple influences simultaneously. Effective interventions would also need to address immediate challenges as well as more long-term challenges influencing decision-making.Supporting frontline worker clinical decision making for maternal and newborn services is an important but neglected aspect of improved quality of care towards attainment of MDG 4 & 5. A multi-faceted intervention is probably the best way to make a

The state of shared decision making in Malaysia.

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Lee, Yew Kong; Ng, Chirk Jenn

2017-06-01

Shared decision making (SDM) activities in Malaysia began around 2010. Although the concept is not widespread, there are opportunities to implement SDM in both the public and private healthcare sectors. Malaysia has a multicultural society and cultural components (such as language differences, medical paternalism, strong family involvement, religious beliefs and complementary medicine) influence medical decision making. In terms of policy, the Ministry of Health has increasingly mentioned patient-centered care as a component of healthcare delivery while the Malaysian Medical Council's guidelines on doctors' duties mentioned collaborative partnerships as a goal of doctor-patient relationships. Current research on SDM comprises baseline surveys of decisional role preferences, development and implementation of locally developed patient decision aids, and conducting of SDM training workshops. Most of this research is carried out by public research universities. In summary, the current state of SDM in Malaysia is still at its infancy. However, there are increasing recognition and efforts from the academic institutions and Ministry of Health to conduct research in SDM, develop patient decision support tools and initiate national discussion on patient involvement in decision making. Copyright © 2017. Published by Elsevier GmbH.

Capacity for Preferences: Respecting Patients with Compromised Decision-Making.

Science.gov (United States)

Wasserman, Jason Adam; Navin, Mark Christopher

2018-05-01

When a patient lacks decision-making capacity, then according to standard clinical ethics practice in the United States, the health care team should seek guidance from a surrogate decision-maker, either previously selected by the patient or appointed by the courts. If there are no surrogates willing or able to exercise substituted judgment, then the team is to choose interventions that promote a patient's best interests. We argue that, even when there is input from a surrogate, patient preferences should be an additional source of guidance for decisions about patients who lack decision-making capacity. Our proposal builds on other efforts to help patients who lack decision-making capacity provide input into decisions about their care. For example, "supported," "assisted," or "guided" decision-making models reflect a commitment to humanistic patient engagement and create a more supportive process for patients, families, and health care teams. But often, they are supportive processes for guiding a patient toward a decision that the surrogate or team believes to be in the patient's medical best interests. Another approach holds that taking seriously the preferences of such a patient can help surrogates develop a better account of what the patient's treatment choices would have been if the patient had retained decision-making capacity; the surrogate then must try to integrate features of the patient's formerly rational self with the preferences of the patient's currently compromised self. Patients who lack decision-making capacity are well served by these efforts to solicit and use their preferences to promote best interests or to craft would-be autonomous patient images for use by surrogates. However, we go further: the moral reasons for valuing the preferences of patients without decision-making capacity are not reducible to either best-interests or (surrogate) autonomy considerations but can be grounded in the values of liberty and respect for persons. This has

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

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

2017-08-01

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

Decision Making on the Labor and Delivery Unit: An Investigation of Influencing Factors.

Science.gov (United States)

Gregory, Megan E; Sonesh, Shirley C; Feitosa, Jennifer; Benishek, Lauren E; Hughes, Ashley M; Salas, Eduardo

2017-09-01

Objective The aim of this study was to describe the relationship between negative affect (NA), decision-making style, time stress, and decision quality in health care. Background Health care providers must often make swift, high-stakes decisions. Influencing factors of the decision-making process in this context have been understudied. Method Within a sample of labor and delivery nurses, physicians, and allied personnel, we used self-report measures to examine the impact of trait factors, including NA, decision-making style, and perceived time stress, on decision quality in a situational judgment test (Study 1). In Study 2, we observed the influence of state NA, state decision-making style, state time stress, and their relationship with decision quality on real clinical decisions. Results In Study 1, we found that trait NA significantly predicted avoidant decision-making style. Furthermore, those who were higher on trait time stress and trait avoidant decision-making style exhibited poorer decisions. In Study 2, we observed associations between state NA with state avoidant and analytical decision-making styles. We also observed that these decision-making styles, when considered in tandem with time stress, were influential in predicting clinical decision quality. Conclusion NA predicts some decision-making styles, and decision-making style can affect decision quality under time stress. This is particularly true for state factors. Application Individual differences, such as affect and decision-making style, should be considered during selection. Training to reduce time stress perceptions should be provided.

Hospice decision making: diagnosis makes a difference.

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Waldrop, Deborah P; Meeker, Mary Ann

2012-10-01

This study explored the process of decision making about hospice enrollment and identified factors that influence the timing of that decision. This study employed an exploratory, descriptive, cross-sectional design and was conducted using qualitative methods. In-depth in-person semistructured interviews were conducted with 36 hospice patients and 55 caregivers after 2 weeks of hospice care. The study was guided by Janis and Mann's conflict theory model (CTM) of decision making. Qualitative data analysis involved a directed content analysis using concepts from the CTM. A model of hospice enrollment decision making is presented. Concepts from the CTM (appraisal, surveying and weighing the alternatives, deliberations, adherence) were used as an organizing framework to illustrate the dynamics. Distinct differences were found by diagnosis (cancer vs. other chronic illness, e.g., heart and lung diseases) during the pre-encounter phase or before the hospice referral but no differences emerged during the post-encounter phase. Differences in decision making by diagnosis suggest the need for research about effective means for tailored communication in end-of-life decision making by type of illness. Recognition that decision making about hospice admission varies is important for clinicians who aim to provide person-centered and family-focused care.

Decision-making: Theory and practice

Directory of Open Access Journals (Sweden)

SM Turpin

2004-12-01

Full Text Available This paper compares a number of theoretical models of decision-making with the way in which senior managers make decisions in practice. Six prominent decision-makers were interviewed about their own decision-making style, as well as their use of decision support technology. Significant variation was found in personal decision-making styles. However, some central themes emerged, such as the importance of sensitivity to the decision-making context, attention to the presentation of information, and the use of intuition. In terms of the use of decision support technology, the use of self-help tools, such as office software, was clearly favoured.

Examining chronic care patient preferences for involvement in health-care decision making: the case of Parkinson's disease patients in a patient-centred clinic.

Science.gov (United States)

Zizzo, Natalie; Bell, Emily; Lafontaine, Anne-Louise; Racine, Eric

2017-08-01

Patient-centred care is a recommended model of care for Parkinson's disease (PD). It aims to provide care that is respectful and responsive to patient preferences, values and perspectives. Provision of patient-centred care should entail considering how patients want to be involved in their care. To understand the participation preferences of patients with PD from a patient-centred care clinic in health-care decision-making processes. Mixed-methods study with early-stage Parkinson's disease patients from a patient-centred care clinic. Study involved a modified Autonomy Preference Index survey (N=65) and qualitative, semi-structured in-depth interviews, analysed using thematic qualitative content analysis (N=20, purposefully selected from survey participants). Interviews examined (i) the patient preferences for involvement in health-care decision making; (ii) patient perspectives on the patient-physician relationship; and (iii) patient preferences for communication of information relevant to decision making. Preferences for participation in decision making varied between individuals and also within individuals depending on decision type, relational and contextual factors. Patients had high preferences for communication of information, but with acknowledged limits. The importance of communication in the patient-physician relationship was emphasized. Patient preferences for involvement in decision making are dynamic and support shared decision making. Relational autonomy corresponds to how patients envision their participation in decision making. Clinicians may need to assess patient preferences on an on-going basis. Our results highlight the complexities of decision-making processes. Improved understanding of individual preferences could enhance respect for persons and make for patient-centred care that is truly respectful of individual patients' wants, needs and values. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Strategic Decision-Making by Deans in Academic Health Centers: A Framework Analysis

Science.gov (United States)

Keeney, Brianne

2012-01-01

This study examines strategic decision-making at the college level in relation to seven theoretical frames. Strategic decisions are those made by top executives, have wide-ranging influence throughout the organization, affect the long-term future of the organization, and are connected to the external environment. The seven decision-making frames…

Decision Making in Nursing Practice: A Concept Analysis.

Science.gov (United States)

Johansen, Mary L; O'Brien, Janice L

2016-01-01

The study aims to gain an understanding of the concept of decision making as it relates to the nurse practice environment. Rodgers' evolutionary method on concept analysis was used as a framework for the study of the concept. Articles from 1952 to 2014 were reviewed from PsycINFO, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), JSTOR, PubMed, and Science Direct. Findings suggest that decision making in the nurse practice environment is a complex process, integral to the nursing profession. The definition of decision making, and the attributes, antecedents, and consequences, are discussed. Contextual factors that influence the process are also discussed. An exemplar is presented to illustrate the concept. Decision making in the nurse practice environment is a dynamic conceptual process that may affect patient outcomes. Nurses need to call upon ways of knowing to make sound decisions and should be self-reflective in order to develop the process further in the professional arena. The need for further research is discussed. © 2015 Wiley Periodicals, Inc.

Using social network analysis to evaluate health-related adaptation decision-making in Cambodia.

Science.gov (United States)

Bowen, Kathryn J; Alexander, Damon; Miller, Fiona; Dany, Va

2014-01-30

Climate change adaptation in the health sector requires decisions across sectors, levels of government, and organisations. The networks that link these different institutions, and the relationships among people within these networks, are therefore critical influences on the nature of adaptive responses to climate change in the health sector. This study uses social network research to identify key organisational players engaged in developing health-related adaptation activities in Cambodia. It finds that strong partnerships are reported as developing across sectors and different types of organisations in relation to the health risks from climate change. Government ministries are influential organisations, whereas donors, development banks and non-government organisations do not appear to be as influential in the development of adaptation policy in the health sector. Finally, the study highlights the importance of informal partnerships (or 'shadow networks') in the context of climate change adaptation policy and activities. The health governance 'map' in relation to health and climate change adaptation that is developed in this paper is a novel way of identifying organisations that are perceived as key agents in the decision-making process, and it holds substantial benefits for both understanding and intervening in a broad range of climate change-related policy problems where collaboration is paramount for successful outcomes.

Using Social Network Analysis to Evaluate Health-Related Adaptation Decision-Making in Cambodia

Directory of Open Access Journals (Sweden)

Kathryn J. Bowen

2014-01-01

Full Text Available Climate change adaptation in the health sector requires decisions across sectors, levels of government, and organisations. The networks that link these different institutions, and the relationships among people within these networks, are therefore critical influences on the nature of adaptive responses to climate change in the health sector. This study uses social network research to identify key organisational players engaged in developing health-related adaptation activities in Cambodia. It finds that strong partnerships are reported as developing across sectors and different types of organisations in relation to the health risks from climate change. Government ministries are influential organisations, whereas donors, development banks and non-government organisations do not appear to be as influential in the development of adaptation policy in the health sector. Finally, the study highlights the importance of informal partnerships (or ‘shadow networks’ in the context of climate change adaptation policy and activities. The health governance ‘map’ in relation to health and climate change adaptation that is developed in this paper is a novel way of identifying organisations that are perceived as key agents in the decision-making process, and it holds substantial benefits for both understanding and intervening in a broad range of climate change-related policy problems where collaboration is paramount for successful outcomes.

Ethical decision making within the bureaucratic context: a case study.

Science.gov (United States)

Desai, Kathryn

2003-01-01

Balancing the polarized notions of quality and quantity of service and care is a challenge for the 21st century health and social service system. The expectation of transparent decision making at both the policy and the practice level of case management has forced practitioners to seek guidance in ethical decision making. Case management, as a system, has potential to lead this new practice approach by incorporating the principles of ethical decision making in planning and coordinating care. A recent case study of ethical decision making within the bureaucratic context offers some insight and learning and may help inform future practice.

Human factors influencing decision making

OpenAIRE

Jacobs, Patricia A.

1998-01-01

This report supplies references and comments on literature that identifies human factors influencing decision making, particularly military decision making. The literature has been classified as follows (the classes are not mutually exclusive): features of human information processing; decision making models which are not mathematical models but rather are descriptive; non- personality factors influencing decision making; national characteristics influencing decision makin...

Developing eHealth technology for people with dementia : towards a supportive decision tool facilitating shared decision making in dementia

NARCIS (Netherlands)

Span, M.; Smits, C.; Groen-van der Ven, L.; Jukema, J.; Cremers, A.H.M.; Vernooij-Dassen, M.; Eefsting, J.; Hettinga, M.

2013-01-01

People with dementia are confronted with many decisions. However, they are often not involved in the process of the decision-making. Shared Decision-Making (SDM) enables involvement of persons with dementia in the decision-making process. In our study, we develop a supportive IT application aiming

The United Nations Convention on the Rights of Persons with Disabilities: a new approach to decision-making in mental health law.

Science.gov (United States)

Morrissey, Fiona

2012-12-01

The UN Convention on the Rights of Persons with Disabilities (CRPD) requires us to engage in new approaches to decision-making in mental health law. The reclassification of mental health rights to the realm of disability rights is an important step towards equal treatment for persons with psychosocial disabilities. Law reformers worldwide are beginning to consider the implications of the provisions. Legislators will be required to understand the underlying philosophy of the CRPD to realise the rights set out in it. The CRPD possesses a number of innovative provisions which can transform decision-making in the mental health context. Article 12 provides a new conceptualisation of persons with disabilities and their capacity to participate by requiring support to exercise legal capacity. While good practice exists, the provision has yet to be fully implemented by many State Parties. This article discusses the impact of the CRPD on mental health law, legal capacity law and describes examples of supported decision-making models for mental health care.

Daily decision-making about food during pregnancy: a New Zealand study.

Science.gov (United States)

Pullon, Susan; Ballantyne, Angela; Macdonald, Lindsay; Barthow, Christine; Wickens, Kristin; Crane, Julian

2018-01-12

Pregnancy has always been a life-changing event for women and their families, but societal concern about pregnancy and motherhood has become intense in the digital age. The role of health promotion agencies and others supplying health-related resources about lifestyle behaviours is both important and in need of scrutiny. Ever increasing advice for pregnant women, their families and health professionals, abounds. This study of decision making during pregnancy investigated how women made everyday decisions during pregnancy about food and drink, as well as dietary supplements and medications, alcohol and recreational drugs. This qualitative interview study was a side-arm to a double-blind randomized, placebo-controlled trial conducted with pregnant women in Wellington New Zealand, 2013-2016. Data from interviews with 20 women were analysed using inductive thematic analysis. In relation to decision-making about lifestyle behaviours, five themes emerged-Information about food; Wanted and unwanted advice; Worry, anxiety and indecision; Making daily decisions about food; Changes in decision making over time. Participating women talked more about food selection and restriction advice than any other lifestyle topic. Analysis demonstrated concern about information accuracy and overload from multiple, diverse sources. Women described learning how to assess resource credibility, how to develop decision-making skills, and who to trust. The study raises important questions about how the health information environment, despite best intentions, can be confusing or potentially harmful. The study underlines the continued importance of the role health professionals have in not only interpreting information to discuss individualized advice, but also in empowering pregnant women to develop lifestyle-related decision-making skills. © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The decision-making process in Brazil's ratification of the World Health Organization Framework Convention on Tobacco Control.

Science.gov (United States)

Rangel, Erica Cavalcanti; Pereira, Andre; Cavalcante, Tania Maria; Oliveira, Egléubia Andrade; Silva, Vera Luiza da Costa E

2017-09-21

Tobacco consumption is a leading cause of various types of cancer and other tobacco-related diseases. In 2003, the World Health Assembly adopted the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC), which aims to protect citizens from the health, social, environmental, and economic consequences of tobacco consumption and exposure to tobacco smoke. The Convention was to be ratified by the Member States of the WHO; in Brazil's case, ratification involved the National Congress, which held public hearings in the country's leading tobacco growing communities (municipalities). The current study analyzes this decision-making process according to the different interests, positions, and stakeholders. In methodological terms, this is a qualitative study based on document research, drawing primarily on the shorthand notes from the public hearings. We analyze the interests and arguments for and against ratification. The article shows that although preceded by intense debates, the final decision in favor of ratification was made by a limited group of government stakeholders, characterizing a decision-making process similar to a funnel.

Medical decision making and medical education: challenges and opportunities.

Science.gov (United States)

Schwartz, Alan

2011-01-01

The Flexner Report highlighted the importance of teaching medical students to reason about uncertainty. The science of medical decision making seeks to explain how medical judgments and decisions ought ideally to be made, how they are actually made in practice, and how they can be improved, given the constraints of medical practice. The field considers both clinical decisions by or for individual patients and societal decisions designed to benefit the public. Despite the relevance of decision making to medical practice, it currently receives little formal attention in the U.S. medical school curriculum. This article suggests three roles for medical decision making in medical education. First, basic decision science would be a valuable prerequisite to medical training. Second, several decision-related competencies would be important outcomes of medical education; these include the physician's own decision skills, the ability to guide patients in shared decisions, and knowledge of health policy decisions at the societal level. Finally, decision making could serve as a unifying principle in the design of the medical curriculum, integrating other curricular content around the need to create physicians who are competent and caring decision makers.

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

Science.gov (United States)

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

2009-05-01

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

Dementia, Decision Making, and Capacity.

Science.gov (United States)

Darby, R Ryan; Dickerson, Bradford C

After participating in this activity, learners should be better able to:• Assess the neuropsychological literature on decision making and the medical and legal assessment of capacity in patients with dementia• Identify the limitations of integrating findings from decision-making research into capacity assessments for patients with dementia ABSTRACT: Medical and legal professionals face the challenge of assessing capacity and competency to make medical, legal, and financial decisions in dementia patients with impaired decision making. While such assessments have classically focused on the capacity for complex reasoning and executive functions, research in decision making has revealed that motivational and metacognitive processes are also important. We first briefly review the neuropsychological literature on decision making and on the medical and legal assessment of capacity. Next, we discuss the limitations of integrating findings from decision-making research into capacity assessments, including the group-to-individual inference problem, the unclear role of neuroimaging in capacity assessments, and the lack of capacity measures that integrate important facets of decision making. Finally, we present several case examples where we attempt to demonstrate the potential benefits and important limitations of using decision-making research to aid in capacity determinations.

Culinary Decision Making.

Science.gov (United States)

Curtis, Rob

1987-01-01

Advises directors of ways to include day care workers in the decision-making process. Enumerates benefits of using staff to help focus and direct changes in the day care center and discusses possible pitfalls in implementation of a collective decision-making approach to management. (NH)

The roles of family members, health care workers, and others in decision-making processes about genetic testing among individuals at risk for Huntington disease.

Science.gov (United States)

Klitzman, Robert; Thorne, Deborah; Williamson, Jennifer; Marder, Karen

2007-06-01

To understand how individuals at risk for Huntington disease view the roles of others, e.g., family members and health care workers, in decision making about genetic testing. Twenty-one individuals (eight mutation-positive, four mutation-negative, and nine not tested) were interviewed for approximately 2 hours each. Interviewees illuminated several key aspects of the roles of family members and health care workers (in genetics and other fields) in decision making about testing that have been underexplored. Family members often felt strongly about whether an individual should get tested. Health care workers provided information and assistance with decision making and mental health referrals that were often helpful. Yet health care workers varied in knowledge and sensitivity regarding testing issues, and the quality of counseling and testing experiences can range widely. At times, health care workers without specialized knowledge of Huntington disease offered opinions of whether to test. Input from families and health care workers could also conflict with each other and with an individual's own preferences. Larger institutional and geographic contexts shaped decisions as well. Decision-making theories applied to Huntington disease testing have frequently drawn on psychological models, yet the current data highlight the importance of social contexts and relationships in testing decisions. This report, the first to our knowledge to explore individuals' perceptions of social factors (particularly family and health care worker involvement) in Huntington disease testing decisions, has critical implications for practice, education, research, and policy.

Defining decision making: a qualitative study of international experts' views on surgical trainee decision making.

Science.gov (United States)

Rennie, Sarah C; van Rij, Andre M; Jaye, Chrystal; Hall, Katherine H

2011-06-01

Decision making is a key competency of surgeons; however, how best to assess decisions and decision makers is not clearly established. The aim of the present study was to identify criteria that inform judgments about surgical trainees' decision-making skills. A qualitative free text web-based survey was distributed to recognized international experts in Surgery, Medical Education, and Cognitive Research. Half the participants were asked to identify features of good decisions, characteristics of good decision makers, and essential factors for developing good decision-making skills. The other half were asked to consider these areas in relation to poor decision making. Template analysis of free text responses was performed. Twenty-nine (52%) experts responded to the survey, identifying 13 categories for judging a decision and 14 for judging a decision maker. Twelve features/characteristics overlapped (considered, informed, well timed, aware of limitations, communicated, knowledgeable, collaborative, patient-focused, flexible, able to act on the decision, evidence-based, and coherent). Fifteen categories were generated for essential factors leading to development of decision-making skills that fall into three major themes (personal qualities, training, and culture). The categories compiled from the perspectives of good/poor were predominantly the inverse of each other; however, the weighting given to some categories varied. This study provides criteria described by experts when considering surgical decisions, decision makers, and development of decision-making skills. It proposes a working definition of a good decision maker. Understanding these criteria will enable clinical teachers to better recognize and encourage good decision-making skills and identify poor decision-making skills for remediation.

[Citizens' participation in health: education and shared decision-making. SESPAS Report 2012].

Science.gov (United States)

Ruiz-Azarola, Ainhoa; Perestelo-Pérez, Lilisbeth

2012-03-01

In recent decades, citizen's participation has become increasingly important in the field of public health, with the new role of the patient as an active agent, manager and producer of his or her own health, and the paradigm of patient-centered care. These changes have represented some of the most important milestones in the continuous improvement of healthcare. The involvement of patients is a new way of understanding the relationship between patients, health professionals and health systems, not only in terms of knowledge management and patients' control of their own health, individually or collectively, but also in terms of the influence that patients may have in health policy planning. Increased life expectancy and the consequent rise in the prevalence of chronic diseases, which already account for 80% of primary care consultations, is one of the key factors changing the role of patients. The place traditionally occupied by professional consultations given any symptoms or signs of alarm is beginning to be occupied by self-care and information and health education resources within the reach of patients and citizens. Internet access is an inexhaustible source of health information resources aimed at patients and provides participation tools. Social networks are places to exchange information and practical advice among patients, families and health professionals. Patients may be experts in their own illnesses and may thus take a more active role in decisions about their health, such as in shared decision making, as part of initiatives, and as part of evaluation of public health activities and health services. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

Pediatric provider processes for behavioral health screening, decision making, and referral in sites with colocated mental health services.

Science.gov (United States)

Hacker, Karen; Goldstein, Joel; Link, David; Sengupta, Nandini; Bowers, Rachael; Tendulkar, Shalini; Wissow, Larry

2013-01-01

Validated behavioral health (BH) screens are recommended for use at well-child visits. This study aimed to explore how pediatricians experience and use these screens for subsequent care decisions in primary care. The study took place at 4 safety net health centers. Fourteen interviews were conducted with pediatricians who were mandated to use validated BH screens at well-child visits. Interview questions focused on key domains, including clinic BH context, screening processes, assessment of screening scores, and decision making about referral to mental health services. Qualitative analysis used the Framework Approach. A variety of themes emerged: BH screens were well accepted and valued for the way they facilitated discussion of mental health issues. However, screening results were not always used in the way that instrument designers intended. Providers' beliefs about the face validity of the instruments, and their observations about performance of instruments, led to discounting scored results. As a result, clinical decisions were made based on a variety of evidence, including individual item responses, parent or patient concerns, and perceived readiness for treatment. Additionally, providers, although interested in expanding their mental health discussions, perceived a lack of time and of their own skills to be major obstacles in this pursuit. Screens act as important prompts to stimulate discussion of BH problems, but their actual scored results play a variable role in problem identification and treatment decisions. Modifications to scheduling policies, additional provider training, and enhanced collaboration with mental health professionals could support better BH integration in pediatric primary care.

Individual decision making, group decision making and deliberation

Directory of Open Access Journals (Sweden)

Radovanović Bojana

2012-01-01

Full Text Available Each of us makes a number of decisions, from the less important to those with far-reaching consequences. As members of different groups, we are also actors of group decision making. In order to make a rational decision, a choice-making procedure must satisfy a number of assumptions (conditions of rationality. In addition, when it comes to group decisions, those procedures should also be “fair.” However, it is not possible to define a procedure of choice-making that would transform individual orders of alternatives based on preferences of perfectly rational individuals into a single social order and still meet conditions of rationality and ethics. The theory of deliberative democracy appeared in response to the impossibility of Social Choice theory. The basic assumption of deliberative democracy is that individuals adjust their preferences taking into account interests of the community. They are open for discussion with other group members and are willing to change their attitudes in order to achieve common interests. Ideally, group members come to an agreement during public discussion (deliberation. Still, this concept cannot completely over­come all the difficulties posed by the theory of social choice. Specifically, there is no solution for strategic and manipulative behavior of individuals. Also, the concept of deliberative democracy faces certain problems particular to this approach, such as, to name but a few, problems with the establishment of equality of participants in the debate and their motivation, as well as problems with the organization of public hearings. [Projekat Ministarstva nauke Republike Srbije, br. 47009: Evropske integracije i društveno-ekonomske promene privrede Srbije na putu ka EU i br. 179015: Izazovi i perspektive strukturnih promena u Srbiji: Strateški pravci ekonomskog razvoja i usklađivanje sa zahtevima EU

Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals.

Science.gov (United States)

Peicius, Eimantas; Blazeviciene, Aurelija; Kaminskas, Raimondas

2017-06-05

This paper joins the debate over changes in the role of health professionals when applying advance directives to manage the decision-making process at the end of life care. Issues in relation to advance directives occur in clinical units in Lithuania; however, it remains one of the few countries in the European Union (EU) where the discussion on advance directives is not included in the health-care policy-making agenda. To encourage the discussion of advance directives, a study was designed to examine health professionals' understanding and preferences related to advance directives. In addition, the study sought to explore the views of health care professionals of the application of Advance Directives (AD) in clinical practice in Lithuania. A cross-sectional survey was conducted by interviewing 478 health professionals based at major health care centers in Kaunas district, Lithuania. The design of the study included the use of a questionnaire developed for this study and validated by a pilot study. The collected data were analyzed using standard descriptive statistical methods. The analysis of knowledge about AD revealed some statistically significant differences when comparing the respondents' profession and gender. The analysis also indicated key emerging themes among respondents including tranquility of mind, the longest possible life expectancy and freedom of choice. Further, the study findings revealed that more than half of the study participants preferred to express their will while alive by using advance directives. The study findings revealed a low level of knowledge on advance directives among health professionals. Most health professionals agreed that AD's improved end-of-life decision making while the majority of physicians appreciated AD as the best tool for sharing responsibilities in clinical practice in Lithuania. More physicians than nurses preferred the presence of advance directives to support their decision making in end-of-life situations.

How can health care organisations make and justify decisions about risk reduction? Lessons from a cross-industry review and a health care stakeholder consensus development process

International Nuclear Information System (INIS)

Sujan, Mark A.; Habli, Ibrahim; Kelly, Tim P.; Gühnemann, Astrid; Pozzi, Simone; Johnson, Christopher W.

2017-01-01

Interventions to reduce risk often have an associated cost. In UK industries decisions about risk reduction are made and justified within a shared regulatory framework that requires that risk be reduced as low as reasonably practicable. In health care no such regulatory framework exists, and the practice of making decisions about risk reduction is varied and lacks transparency. Can health care organisations learn from relevant industry experiences about making and justifying risk reduction decisions? This paper presents lessons from a qualitative study undertaken with 21 participants from five industries about how such decisions are made and justified in UK industry. Recommendations were developed based on a consensus development exercise undertaken with 20 health care stakeholders. The paper argues that there is a need in health care to develop a regulatory framework and an agreed process for managing explicitly the trade-off between risk reduction and cost. The framework should include guidance about a health care specific notion of acceptable levels of risk, guidance about standardised risk reduction interventions, it should include regulatory incentives for health care organisations to reduce risk, and it should encourage the adoption of an approach for documenting explicitly an organisation's risk position. - Highlights: • Empirical description of industry perceptions on making risk reduction decisions. • Health care consensus development identified five recommendations. • Risk concept should be better integrated into safety management. • Education and awareness about risk concept are required. • Health systems need to start a dialogue about acceptable levels of risk.

Communicative processes and decision-making in relation to prostate cancer patients

DEFF Research Database (Denmark)

Løwe Netsey-Afedo, Mette Margrethe; Birkelund, Regner

BACKGROUND: There are many benefits of involving patients in decision-making, including increased patient safety and improved health. Many patients with prostate cancer wish to be involved when making decisions in the course of their treatment. However, studies show that Patient Involvement and SDM...... of treatment, it is essential to involve patients' preferences, needs and desires when making decisions during the course of their disease. Furthermore, it is important that patients are adequately informed about treatment, side effects, and other specific issues important for the individual patient. The aim...... of this project is to examine the processes of communication between prostate cancer patients and health professionals related to decision-making in the course of the patient’s treatment. Organizational possibilities and constraints related to the involvement will also be examined. METHODS: Data will be collected...

Implementing and evaluating shared decision making in oncology practice.

Science.gov (United States)

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

2014-01-01

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

Treatment decision-making among breast cancer patients in Malaysia

Directory of Open Access Journals (Sweden)

Nies YH

2017-10-01

Full Text Available Yong Hui Nies,1 Farida Islahudin,1 Wei Wen Chong,1 Norlia Abdullah,2 Fuad Ismail,3 Ros Suzanna Ahmad Bustamam,4 Yoke Fui Wong,5 JJ Saladina,2 Noraida Mohamed Shah1 1Faculty of Pharmacy, 2Department of Surgery, 3Department of Radiotherapy and Oncology, Universiti Kebangsaan Malaysia Medical Centre, 4Department of Radiotherapy and Oncology, Hospital Kuala Lumpur, Kuala Lumpur, 5Department of Radiotherapy and Oncology, National Cancer Institute, Putrajaya, Malaysia Purpose: This study investigated breast cancer patients’ involvement level in the treatment decision-making process and the concordance between patients’ and physician’s perspectives in decision-making. Participants and methods: A cross-sectional study was conducted involving physicians and newly diagnosed breast cancer patients from three public/teaching hospitals in Malaysia. The Control Preference Scale (CPS was administered to patients and physicians, and the Krantz Health Opinion Survey (KHOS was completed by the patients alone. Binary logistic regression was used to determine the association between sociodemographic characteristics, the patients’ involvement in treatment decision-making, and patients’ preference for behavioral involvement and information related to their disease. Results: The majority of patients preferred to share decision-making with their physicians (47.5%, while the second largest group preferred being passive (42.6% and a small number preferred being active (9.8%. However, the physicians perceived that the majority of patients preferred active decision-making (56.9%, followed by those who desired shared decision-making (32.8%, and those who preferred passive decision-making (10.3%. The overall concordance was 26.5% (54 of 204 patient–physician dyads. The median of preference for information score and behavioral involvement score was 4 (interquartile range [IQR] =3–5 and 2 (IQR =2–3, respectively. In univariate analysis, the ethnicity and

Decision Making in the Airplane

Science.gov (United States)

Orasanu, Judith; Shafto, Michael G. (Technical Monitor)

1995-01-01

The Importance of decision-making to safety in complex, dynamic environments like mission control centers, aviation, and offshore installations has been well established. NASA-ARC has a program of research dedicated to fostering safe and effective decision-making in the manned spaceflight environment. Because access to spaceflight is limited, environments with similar characteristics, including aviation and nuclear power plants, serve as analogs from which space-relevant data can be gathered and theories developed. Analyses of aviation accidents cite crew judgement and decision making as causes or contributing factors in over half of all accidents. Yet laboratory research on decision making has not proven especially helpful In improving the quality of decisions in these kinds of environments. One reason is that the traditional, analytic decision models are inappropriate to multi-dimensional, high-risk environments, and do not accurately describe what expert human decision makers do when they make decisions that have consequences. A new model of dynamic, naturalistic decision making is offered that may prove useful for improving decision making in complex, isolated, confined and high-risk environments. Based on analyses of crew performance in full-mission simulators and accident reports, features that define effective decision strategies in abnormal or emergency situations have been identified. These include accurate situation assessment (including time and risk assessment), appreciation of the complexity of the problem, sensitivity to constraints on the decision, timeliness of the response, and use of adequate information. More effective crews also manage their workload to provide themselves with time and resources to make good decisions. In brief, good decisions are appropriate to the demands of the situation. Effective crew decision making and overall performance are mediated by crew communication. Communication contributes to performance because it assures that

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.

Parental decision making involvement and decisional conflict: a descriptive study.

Science.gov (United States)

Boland, Laura; Kryworuchko, Jennifer; Saarimaki, Anton; Lawson, Margaret L

2017-06-13

Decisional conflict is a state of uncertainty about the best treatment option among competing alternatives and is common among adult patients who are inadequately involved in the health decision making process. In pediatrics, research shows that many parents are insufficiently involved in decisions about their child's health. However, little is known about parents' experience of decisional conflict. We explored parents' perceived decision making involvement and its association with parents' decisional conflict. We conducted a descriptive survey study in a pediatric tertiary care hospital. Our survey was guided by validated decisional conflict screening items (i.e., the SURE test). We administered the survey to eligible parents after an ambulatory care or emergency department consultation for their child. Four hundred twenty-nine respondents were included in the analysis. Forty-eight percent of parents reported not being offered treatment options and 23% screened positive for decisional conflict. Parents who reported being offered options experienced less decisional conflict than parents who reported not being offered options (5% vs. 42%, p conflict after their clinical consultation. Involving parents in the decision making process might reduce their risk of decisional conflict. Evidence based interventions that support parent decision making involvement, such as shared decision making, should be evaluated and implemented in pediatrics as a strategy to reduce parents' decisional conflict.

Modelling elderly cardiac patients decision making using Cognitive Work Analysis: identifying requirements for patient decision aids.

Science.gov (United States)

Dhukaram, Anandhi Vivekanandan; Baber, Chris

2015-06-01

Patients make various healthcare decisions on a daily basis. Such day-to-day decision making can have significant consequences on their own health, treatment, care, and costs. While decision aids (DAs) provide effective support in enhancing patient's decision making, to date there have been few studies examining patient's decision making process or exploring how the understanding of such decision processes can aid in extracting requirements for the design of DAs. This paper applies Cognitive Work Analysis (CWA) to analyse patient's decision making in order to inform requirements for supporting self-care decision making. This study uses focus groups to elicit information from elderly cardiovascular disease (CVD) patients concerning a range of decision situations they face on a daily basis. Specifically, the focus groups addressed issues related to the decision making of CVD in terms of medication compliance, pain, diet and exercise. The results of these focus groups are used to develop high level views using CWA. CWA framework decomposes the complex decision making problem to inform three approaches to DA design: one design based on high level requirements; one based on a normative model of decision-making for patients; and the third based on a range of heuristics that patients seem to use. CWA helps in extracting and synthesising decision making from different perspectives: decision processes, work organisation, patient competencies and strategies used in decision making. As decision making can be influenced by human behaviour like skills, rules and knowledge, it is argued that patients require support to different types of decision making. This paper also provides insights for designers in using CWA framework for the design of effective DAs to support patients in self-management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Bridging the gap between evidence and policy for infectious diseases: How models can aid public health decision-making

Directory of Open Access Journals (Sweden)

Gwenan M. Knight

2016-01-01

Full Text Available The dominant approach to decision-making in public health policy for infectious diseases relies heavily on expert opinion, which often applies empirical evidence to policy questions in a manner that is neither systematic nor transparent. Although systematic reviews are frequently commissioned to inform specific components of policy (such as efficacy, the same process is rarely applied to the full decision-making process. Mathematical models provide a mechanism through which empirical evidence can be methodically and transparently integrated to address such questions. However, such models are often considered difficult to interpret. In addition, models provide estimates that need to be iteratively re-evaluated as new data or considerations arise. Using the case study of a novel diagnostic for tuberculosis, a framework for improved collaboration between public health decision-makers and mathematical modellers that could lead to more transparent and evidence-driven policy decisions for infectious diseases in the future is proposed. The framework proposes that policymakers should establish long-term collaborations with modellers to address key questions, and that modellers should strive to provide clear explanations of the uncertainty of model structure and outputs. Doing so will improve the applicability of models and clarify their limitations when used to inform real-world public health policy decisions.

Nurse manager cognitive decision-making amidst stress and work complexity.

Science.gov (United States)

Shirey, Maria R; Ebright, Patricia R; McDaniel, Anna M

2013-01-01

  The present study provides insight into nurse manager cognitive decision-making amidst stress and work complexity.   Little is known about nurse manager decision-making amidst stress and work complexity. Because nurse manager decisions have the potential to impact patient care quality and safety, understanding their decision-making processes is useful for designing supportive interventions.   This qualitative descriptive study interviewed 21 nurse managers from three hospitals to answer the research question: What decision-making processes do nurse managers utilize to address stressful situations in their nurse manager role? Face-to-face interviews incorporating components of the Critical Decision Method illuminated expert-novice practice differences. Content analysis identified one major theme and three sub-themes.   The present study produced a cognitive model that guides nurse manager decision-making related to stressful situations. Experience in the role, organizational context and situation factors influenced nurse manager cognitive decision-making processes.   Study findings suggest that chronic exposure to stress and work complexity negatively affects nurse manager health and their decision-making processes potentially threatening individual, patient and organizational outcomes.   Cognitive decision-making varies based on nurse manager experience and these differences have coaching and mentoring implications. This present study contributes a current understanding of nurse manager decision-making amidst stress and work complexity. © 2012 Blackwell Publishing Ltd.

Ethical analysis to improve decision-making on health technologies.

Science.gov (United States)

Saarni, Samuli I; Hofmann, Bjørn; Lampe, Kristian; Lühmann, Dagmar; Mäkelä, Marjukka; Velasco-Garrido, Marcial; Autti-Rämö, Ilona

2008-08-01

Health technology assessment (HTA) is the multidisciplinary study of the implications of the development, diffusion and use of health technologies. It supports health-policy decisions by providing a joint knowledge base for decision-makers. To increase its policy relevance, HTA tries to extend beyond effectiveness and costs to also considering the social, organizational and ethical implications of technologies. However, a commonly accepted method for analysing the ethical aspects of health technologies is lacking. This paper describes a model for ethical analysis of health technology that is easy and flexible to use in different organizational settings and cultures. The model is part of the EUnetHTA project, which focuses on the transferability of HTAs between countries. The EUnetHTA ethics model is based on the insight that the whole HTA process is value laden. It is not sufficient to only analyse the ethical consequences of a technology, but also the ethical issues of the whole HTA process must be considered. Selection of assessment topics, methods and outcomes is essentially a value-laden decision. Health technologies may challenge moral or cultural values and beliefs, and their implementation may also have significant impact on people other than the patient. These are essential considerations for health policy. The ethics model is structured around key ethical questions rather than philosophical theories, to be applicable to different cultures and usable by non-philosophers. Integrating ethical considerations into HTA can improve the relevance of technology assessments for health care and health policy in both developed and developing countries.

Rational decision-making in medicine: implications for overuse and underuse

OpenAIRE

Djulbegovic, B.; Elqayam, Shira; Dale, W.

2017-01-01

open access article In spite of substantial spending and resource utilization, today's health care remains characterized by poor outcomes, largely due to overuse (over-testing/treatment) or underuse (under-testing/treatment) of services. To a significant extent, this is a consequence of low-quality decision-making that appears to violate various rationality criteria. Such sub-optimal decision-making is considered a leading cause of death and is responsible for more than 80% of health expen...

Decision Making Styles and Progress in Occupational Decision Making.

Science.gov (United States)

Phillips, Susan D.; And Others

1984-01-01

Examined the role of rational, intuitive, and dependent decisional strategies in facilitating decisions about postcollege occupation among college students (N=71). Results indicated that the use of a dependent decision-making style was the single most powerful predictor of progress. (LLL)

Shared decision making and patient choice for growth hormone therapy: current perspectives

Directory of Open Access Journals (Sweden)

George B

2016-06-01

Full Text Available Belinda George, Vageesh Ayyar Department of Endocrinology, St. John’s Medical College Hospital, Bangalore, Karnataka, India Abstract: Growth hormone has now been available in medical practice for close to 50 years. Its use has provided dramatic results in patients with growth hormone deficiency and it is associated with an overall favorable safety profile. Over the years, the utility of growth hormone has expanded to include treatment for short stature associated with conditions other than growth hormone deficiency, and this situation warrants greater involvement of the child and parents in the shared decision-making process. Shared decision making is in good conformance to the principle of informed consent, and it also improves the compliance and adherence to therapy as the patient fully understands the benefit and safety of the treatment. In the pediatric-care setting, the decision-making interactions usually occur between the health care provider, patient, and parents. The process may range from an autonomous decision-making pattern, where the patient or parents are fully responsible for the decision taken, to the paternalistic decision-making pattern, where the health care provider assumes full responsibility for the decision taken. However, the ideal situation is one where a truly shared decision-making process happens, in which the doctor and patient/parents work together to choose an evidence-based option, in line with the patient’s preferences and wishes. The limited data available on shared decision making with regard to growth hormone replacement, however, is not very encouraging and suggests that the actual involvement of the parents as perceived by them is less than optimal. Introduction of a simple structured model for a shared decision-making process that can be easily incorporated into clinical practice and familiarization of health care providers with the same is essential to improve our shared decision-making practices

Clinical Decision-Making in Community Children's Mental Health: Using Innovative Methods to Compare Clinicians With and Without Training in Evidence-Based Treatment.

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Baker-Ericzén, Mary J; Jenkins, Melissa M; Park, Soojin; Garland, Ann F

2015-02-01

Mental health professionals' decision-making practice is an area of increasing interest and importance, especially in the pediatric research and clinical communities. The present study explored the role of prior training in evidence-based treatments on clinicians' assessment and treatment formulations using case vignettes. Specifically, study aims included using the Naturalistic Decision Making (NDM) cognitive theory to 1) examine potential associations between EBT training and decision-making processes (novice versus expert type), and 2) explore how client and family contextual information affects clinical decision-making. Forty-eight clinicians across two groups (EBT trained=14, Not EBT trained=34) participated. Clinicians were comparable on professional experience, demographics, and discipline. The quasi-experimental design used an analog "think aloud" method where clinicians read case vignettes about a child with disruptive behavior problems and verbalized case conceptualization and treatment planning out-loud. Responses were coded according to NDM theory. MANOVA results were significant for EBT training status such that EBT trained clinicians' displayed cognitive processes more closely aligned with "expert" decision-makers and non-EBT trained clinicians' decision processes were more similar to "novice" decision-makers, following NDM theory. Non-EBT trained clinicians assigned significantly more diagnoses, provided less detailed treatment plans and discussed fewer EBTs. Parent/family contextual information also appeared to influence decision-making. This study offers a preliminary investigation of the possible broader impacts of EBT training and potential associations with development of expert decision-making skills. Targeting clinicians' decision-making may be an important avenue to pursue within dissemination-implementation efforts in mental health practice.

THE MAKING OF DECISION MAKING

Directory of Open Access Journals (Sweden)

Leonardo Yuji Tamura

2016-04-01

Full Text Available Quantum Electronics was a Brazilian startup in the 1990's that was acquired by an American equity fund in 2012. They are currently the largest manufacturer of vehicle tracking and infotainment systems. The company was founded by three college friends, who are currently executives at the company: Camilo Santos, Pedro Barbosa and Luana Correa. Edward Hutter was sent by the equity fund to take over the company’s finances, but is having trouble making organizational decisions with his colleagues. As a consultant, I was called to help them improve their decision making process and project prioritization. I adapted and deployed our firm's methodology, but, in the end, its adequacy is shown to be very much in question. The author of this case study intends to explore how actual organizational decisions rely on different decision models and their assumptions, .as well as demonstrate that a decision model is neither absolutely good nor bad as its quality is context dependent.

Rule-based decision making model

International Nuclear Information System (INIS)

Sirola, Miki

1998-01-01

A rule-based decision making model is designed in G2 environment. A theoretical and methodological frame for the model is composed and motivated. The rule-based decision making model is based on object-oriented modelling, knowledge engineering and decision theory. The idea of safety objective tree is utilized. Advanced rule-based methodologies are applied. A general decision making model 'decision element' is constructed. The strategy planning of the decision element is based on e.g. value theory and utility theory. A hypothetical process model is built to give input data for the decision element. The basic principle of the object model in decision making is division in tasks. Probability models are used in characterizing component availabilities. Bayes' theorem is used to recalculate the probability figures when new information is got. The model includes simple learning features to save the solution path. A decision analytic interpretation is given to the decision making process. (author)

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

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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.

Putting children forward for epilepsy surgery: A qualitative study of UK parents' and health professionals' decision-making experiences.

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Heath, Gemma; Abdin, Shanara; Begum, Rahima; Kearney, Shauna

2016-08-01

Against a backdrop of recommendations for increasing access to and uptake of early surgical intervention for children with medically intractable epilepsy, it is important to understand how parents and professionals decide to put children forward for epilepsy surgery and what their decisional support needs are. The aim of this study was to explore how parents and health professionals make decisions regarding putting children forward for pediatric epilepsy surgery. Individual interviews were conducted with nine parents of children who had undergone pediatric epilepsy surgery at a specialist children's hospital and ten healthcare professionals who made up the children's epilepsy surgery service multidisciplinary healthcare team (MDT). Three MDT meetings were also observed. Data were analyzed thematically. Four themes were generated from analysis of interviews with parents: presentation of surgery as a treatment option, decision-making, looking back, and interventions. Three themes were generated from analysis of interviews/observations with health professionals: triangulating information, team working, and patient and family perspectives. Parents wanted more information and support in deciding to put their child forward for epilepsy surgery. They attempted to balance the potential benefits of surgery against any risks of harm. For health professionals, a multidisciplinary approach was seen as crucial to the decision-making process. Advocating for the family was perceived to be the responsibility of nonmedical professionals. Decision-making can be supported by incorporating families into discussions regarding epilepsy surgery as a potential treatment option earlier in the process and by providing families with additional information and access to other parents with similar experiences. Copyright © 2016 Elsevier Inc. All rights reserved.

Ethical Decision Making

DEFF Research Database (Denmark)

Lauesen, Linne Marie

2012-01-01

of the interaction between a corporation and its stakeholders. Methodology/approach: This paper offers a theoretical 'Organic Stakeholder Model' based on decision making theory, risk assessment and adaption to a rapidly changing world combined with appropriate stakeholder theory for ethical purposes in decision...... applicable): The Model is based on case studies, but the limited scope of the length of the paper did not leave room to show the empirical evidence, but only the theoretical study. Originality / value of a paper: The model offers a new way of combining risk management with ethical decision-making processes...... by the inclusion of multiple stakeholders. The conceptualization of the model enhances business ethics in decision making by managing and balancing stakeholder concerns with the same concerns as the traditional risk management models does – for the sake of the wider social responsibilities of the businesses...

Registered nurses' decision-making regarding documentation in patients' progress notes.

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Tower, Marion; Chaboyer, Wendy; Green, Quentine; Dyer, Kirsten; Wallis, Marianne

2012-10-01

To examine registered nurses' decision-making when documenting care in patients' progress notes. What constitutes effective nursing documentation is supported by available guidelines. However, ineffective documentation continues to be cited as a major cause of adverse events for patients. Decision-making in clinical practice is a complex process. To make an effective decision, the decision-maker must be situationally aware. The concept of situation awareness and its implications for making safe decisions has been examined extensively in air safety and more recently is being applied to health. The study was situated in a naturalistic paradigm. Purposive sampling was used to recruit 17 registered nurses who used think-aloud research methods when making decisions about documenting information in patients' progress notes. Follow-up interviews were conducted to validate interpretations. Data were analysed systematically for evidence of cues that demonstrated situation awareness as nurses made decisions about documentation. Three distinct decision-making scenarios were illuminated from the analysis: the newly admitted patient, the patient whose condition was as expected and the discharging patient. Nurses used mental models for decision-making in documenting in progress notes, and the cues nurses used to direct their assessment of patients' needs demonstrated situation awareness at different levels. Nurses demonstrate situation awareness at different levels in their decision-making processes. While situation awareness is important, it is also important to use an appropriate decision-making framework. Cognitive continuum theory is suggested as a decision-making model that could support situation awareness when nurses made decisions about documenting patient care. Because nurses are key decision-makers, it is imperative that effective decisions are made that translate into safe clinical care. Including situation awareness training, combined with employing cognitive

Introduction of new technologies and decision making processes: a framework to adapt a Local Health Technology Decision Support Program for other local settings

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Poulin P

2013-11-01

Full Text Available Paule Poulin,1 Lea Austen,1 Catherine M Scott,2 Michelle Poulin,1 Nadine Gall,2 Judy Seidel,3 René Lafrenière1 1Department of Surgery, 2Knowledge Management, 3Public Health Innovation and Decision Support, Alberta Health Services, Calgary, AB, Canada Purpose: Introducing new health technologies, including medical devices, into a local setting in a safe, effective, and transparent manner is a complex process, involving many disciplines and players within an organization. Decision making should be systematic, consistent, and transparent. It should involve translating and integrating scientific evidence, such as health technology assessment (HTA reports, with context-sensitive evidence to develop recommendations on whether and under what conditions a new technology will be introduced. However, the development of a program to support such decision making can require considerable time and resources. An alternative is to adapt a preexisting program to the new setting. Materials and methods: We describe a framework for adapting the Local HTA Decision Support Program, originally developed by the Department of Surgery and Surgical Services (Calgary, AB, Canada, for use by other departments. The framework consists of six steps: 1 development of a program review and adaptation manual, 2 education and readiness assessment of interested departments, 3 evaluation of the program by individual departments, 4 joint evaluation via retreats, 5 synthesis of feedback and program revision, and 6 evaluation of the adaptation process. Results: Nine departments revised the Local HTA Decision Support Program and expressed strong satisfaction with the adaptation process. Key elements for success were identified. Conclusion: Adaptation of a preexisting program may reduce duplication of effort, save resources, raise the health care providers' awareness of HTA, and foster constructive stakeholder engagement, which enhances the legitimacy of evidence

Coping with Inflammatory Bowel Disease: Engaging with Information to Inform Health-Related Decision Making in Daily Life.

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Restall, Gayle J; Simms, Alexandria M; Walker, John R; Haviva, Clove; Graff, Lesley A; Sexton, Kathryn A; Miller, Norine; Targownik, Laura E; Bernstein, Charles N

2017-08-01

People with inflammatory bowel disease (IBD) require disease and lifestyle information to make health-related decisions in their daily lives. Derived from a larger qualitative study of the lived experiences of people with IBD, we report on findings that explored how people with IBD engage with health-related information in their daily lives. Participants were recruited primarily from the Manitoba IBD Cohort Study. We used purposive sampling to select people with a breadth of characteristics and experiences. Individual interviews were audio-recorded and transcribed verbatim. Data were analyzed using inductive qualitative methods consistent with a phenomenological approach. Forty-five people with IBD participated; 51% were women. Findings highlighted the temporal and contextual influences on engagement with health-related information. Temporal influences were described as the changing need for health-related information over time. Participants identified 6 contextual factors influencing engagement with information to make health decisions: (1) emotional and attitudinal responses, (2) perceived benefits and risks, (3) trust in the source of the information, (4) knowledge and skills to access and use information, (5) availability of evidence to support decisions, and (6) social and economic environments. Findings illustrate the changing needs for health-related information over the course of IBD, and with evolving health and life circumstances. Practitioners can be responsive to information needs of people with IBD by having high-quality information available at the right time in a variety of formats and by supporting the incorporation of information in daily life.

Decision-Making under Criteria Uncertainty

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Kureychik, V. M.; Safronenkova, I. B.

2018-05-01

Uncertainty is an essential part of a decision-making procedure. The paper deals with the problem of decision-making under criteria uncertainty. In this context, decision-making under uncertainty, types and conditions of uncertainty were examined. The decision-making problem under uncertainty was formalized. A modification of the mathematical decision support method under uncertainty via ontologies was proposed. A critical distinction of the developed method is ontology usage as its base elements. The goal of this work is a development of a decision-making method under criteria uncertainty with the use of ontologies in the area of multilayer board designing. This method is oriented to improvement of technical-economic values of the examined domain.

Patients' perceptions of sharing in decisions: a systematic review of interventions to enhance shared decision making in routine clinical practice.

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Légaré, France; Turcotte, Stéphane; Stacey, Dawn; Ratté, Stéphane; Kryworuchko, Jennifer; Graham, Ian D

2012-01-01

Shared decision making is the process in which a healthcare choice is made jointly by the health professional and the patient. Little is known about what patients view as effective or ineffective strategies to implement shared decision making in routine clinical practice. This systematic review evaluates the effectiveness of interventions to improve health professionals' adoption of shared decision making in routine clinical practice, as seen by patients. We searched electronic databases (PubMed, the Cochrane Library, EMBASE, CINAHL, and PsycINFO) from their inception to mid-March 2009. We found additional material by reviewing the reference lists of the studies found in the databases; systematic reviews of studies on shared decision making; the proceedings of various editions of the International Shared Decision Making Conference; and the transcripts of the Society for Medical Decision Making's meetings. In our study selection, we included randomized controlled trials, controlled clinical trials, controlled before-and-after studies, and interrupted time series analyses in which patients evaluated interventions to improve health professionals' adoption of shared decision making. The interventions in question consisted of the distribution of printed educational material; educational meetings; audit and feedback; reminders; and patient-mediated initiatives (e.g. patient decision aids). Two reviewers independently screened the studies and extracted data. Statistical analyses considered categorical and continuous process measures. We computed the standardized effect size for each outcome at the 95% confidence interval. The primary outcome of interest was health professionals' adoption of shared decision making as reported by patients in a self-administered questionnaire. Of the 6764 search results, 21 studies reported 35 relevant comparisons. Overall, the quality of the studies ranged from 0% to 83%. Only three of the 21 studies reported a clinically significant effect

The Drug Reimbursement Decision-Making System in Iran.

Science.gov (United States)

Ansaripour, Amir; Uyl-de Groot, Carin A; Steenhoek, Adri; Redekop, William K

2014-05-01

Previous studies of health policies in Iran have not focused exclusively on the drug reimbursement process. The aim of this study was to describe the entire drug reimbursement process and the stakeholders, and discuss issues faced by policymakers. Review of documents describing the administrative rules and directives of stakeholders, supplemented by published statistics and interviews with experts and policymakers. Iran has a systematic process for the assessment, appraisal, and judgment of drug reimbursements. The two most important organizations in this process are the Food and Drug Organization, which considers clinical effectiveness, safety, and economic issues, and the Supreme Council of Health Insurance, which considers various criteria, including budget impact and cost-effectiveness. Ultimately, the Iranian Cabinet approves a drug and recommends its use to all health insurance organizations. Reimbursed drugs account for about 53.5% of all available drugs and 77.3% of drug expenditures. Despite its strengths, the system faces various issues, including conflicting stakeholder aims, lengthy decision-making duration, limited access to decision-making details, and rigidity in the assessment process. The Iranian drug reimbursement system uses decision-making criteria and a structured approach similar to those in other countries. Important shortcomings in the system include out-of-pocket contributions due to lengthy decision making, lack of transparency, and conflicting interests among stakeholders. Iranian policymakers should consider a number of ways to remedy these problems, such as case studies of individual drugs and closer examination of experiences in other countries. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Collective Decision Making as the Actualization of Decision Potential

Directory of Open Access Journals (Sweden)

Andrej Ule

2009-12-01

Full Text Available This paper presents some characteristics and dilemmas of collective decision making. Collective decision making could be presented as the process of successive crystallization of dominant alternatives under the influence of different decision contexts from primary given decision potentials. This process is presented as the many-phased process of the acting of contextually dependent “energizing factors” of the collective decision making on the “attractiveness matrix” of outcomes of collective decisions. The attractiveness matrix determines the attractiveness for each alternative of decision, and the most attractive alternative in the given situation presents the rational decision in the given situation. In the final phase of decision making holds a context which gets a simplified attractiveness matrix. It corresponds to the common decision for one of the alternatives.

Assessing an Adolescent's Capacity for Autonomous Decision-Making in Clinical Care.

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Michaud, Pierre-André; Blum, Robert Wm; Benaroyo, Lazare; Zermatten, Jean; Baltag, Valentina

2015-10-01

The purpose of this article is to provide policy guidance on how to assess the capacity of minor adolescents for autonomous decision-making without a third party authorization, in the field of clinical care. In June 2014, a two-day meeting gathered 20 professionals from all continents, working in the field of adolescent medicine, neurosciences, developmental and clinical psychology, sociology, ethics, and law. Formal presentations and discussions were based on a literature search and the participants' experience. The assessment of adolescent decision-making capacity includes the following: (1) a review of the legal context consistent with the principles of the Convention on the Rights of the Child; (2) an empathetic relationship between the adolescent and the health care professional/team; (3) the respect of the adolescent's developmental stage and capacities; (4) the inclusion, if relevant, of relatives, peers, teachers, or social and mental health providers with the adolescent's consent; (5) the control of coercion and other social forces that influence decision-making; and (6) a deliberative stepwise appraisal of the adolescent's decision-making process. This stepwise approach, already used among adults with psychiatric disorders, includes understanding the different facets of the given situation, reasoning on the involved issues, appreciating the outcomes linked with the decision(s), and expressing a choice. Contextual and psychosocial factors play pivotal roles in the assessment of adolescents' decision-making capacity. The evaluation must be guided by a well-established procedure, and health professionals should be trained accordingly. These proposals are the first to have been developed by a multicultural, multidisciplinary expert panel. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Tools for collaborative decision-making

CERN Document Server

Zaraté, Pascale

2013-01-01

Decision-making has evolved recently thanks to the introduction of information and communication technologies in many organizations, which has led to new kinds of decision-making processes, called "collaborative decision-making", at the organizational and cognitive levels. This book looks at the development of the decision-making process in organizations. Decision-aiding and its paradigm of problem solving are defined, showing how decision-makers now need to work in a cooperative way. Definitions of cooperation and associated concepts such as collaboration and coordination are given and a framework of cooperative decision support systems is presented, including intelligent DSS, cooperative knowledge-based systems, workflow, group support systems, collaborative engineering, integrating with a collaborative decision-making model in part or being part of global projects. Several models and experimental studies are also included showing that these new processes have to be supported by new types of tools, several ...

Advance directives and outcomes of surrogate decision making before death.

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Silveira, Maria J; Kim, Scott Y H; Langa, Kenneth M

2010-04-01

Recent discussions about health care reform have raised questions regarding the value of advance directives. We used data from survey proxies in the Health and Retirement Study involving adults 60 years of age or older who had died between 2000 and 2006 to determine the prevalence of the need for decision making and lost decision-making capacity and to test the association between preferences documented in advance directives and outcomes of surrogate decision making. Of 3746 subjects, 42.5% required decision making, of whom 70.3% lacked decision-making capacity and 67.6% of those subjects, in turn, had advance directives. Subjects who had living wills were more likely to want limited care (92.7%) or comfort care (96.2%) than all care possible (1.9%); 83.2% of subjects who requested limited care and 97.1% of subjects who requested comfort care received care consistent with their preferences. Among the 10 subjects who requested all care possible, only 5 received it; however, subjects who requested all care possible were far more likely to receive aggressive care as compared with those who did not request it (adjusted odds ratio, 22.62; 95% confidence interval [CI], 4.45 to 115.00). Subjects with living wills were less likely to receive all care possible (adjusted odds ratio, 0.33; 95% CI, 0.19 to 0.56) than were subjects without living wills. Subjects who had assigned a durable power of attorney for health care were less likely to die in a hospital (adjusted odds ratio, 0.72; 95% CI, 0.55 to 0.93) or receive all care possible (adjusted odds ratio, 0.54; 95% CI, 0.34 to 0.86) than were subjects who had not assigned a durable power of attorney for health care. Between 2000 and 2006, many elderly Americans needed decision making near the end of life at a time when most lacked the capacity to make decisions. Patients who had prepared advance directives received care that was strongly associated with their preferences. These findings support the continued use of advance

Viewpoint: Decision-making in committees

OpenAIRE

Li Hao; Wing Suen

2009-01-01

This article reviews recent developments in the theory of committee decision-making. A committee consists of self-interested members who make a public decision by aggregating imperfect information dispersed among them according to a pre-specified decision rule. We focus on costly information acquisition, strategic information aggregation, and rules and processes that enhance the quality of the committee decision. Seeming inefficiencies of the committee decision-making process such as over-cau...

Rational decision making in medicine: Implications for overuse and underuse.

Science.gov (United States)

Djulbegovic, Benjamin; Elqayam, Shira; Dale, William

2018-06-01

In spite of substantial spending and resource utilization, today's health care remains characterized by poor outcomes, largely due to overuse (overtesting/overtreatment) or underuse (undertesting/undertreatment) of health services. To a significant extent, this is a consequence of low-quality decision making that appears to violate various rationality criteria. Such suboptimal decision making is considered a leading cause of death and is responsible for more than 80% of health expenses. In this paper, we address the issue of overuse or underuse of health care interventions from the perspective of rational choice theory. We show that what is considered rational under one decision theory may not be considered rational under a different theory. We posit that the questions and concerns regarding both underuse and overuse have to be addressed within a specific theoretical framework. The applicable rationality criterion, and thus the "appropriateness" of health care delivery choices, depends on theory selection that is appropriate to specific clinical situations. We provide a number of illustrations showing how the choice of theoretical framework influences both our policy and individual decision making. We also highlight the practical implications of our analysis for the current efforts to measure the quality of care and link such measurements to the financing of health care services. © 2017 The Authors. Journal of Evaluation in Clinical Practice Published by John Wiley & Sons Ltd.

Decision-making in Swiss home-like childbirth: A grounded theory study.

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Meyer, Yvonne; Frank, Franziska; Schläppy Muntwyler, Franziska; Fleming, Valerie; Pehlke-Milde, Jessica

2017-12-01

Decision-making in midwifery, including a claim for shared decision-making between midwives and women, is of major significance for the health of mother and child. Midwives have little information about how to share decision-making responsibilities with women, especially when complications arise during birth. To increase understanding of decision-making in complex home-like birth settings by exploring midwives' and women's perspectives and to develop a dynamic model integrating participatory processes for making shared decisions. The study, based on grounded theory methodology, analysed 20 interviews of midwives and 20 women who had experienced complications in home-like births. The central phenomenon that arose from the data was "defining/redefining decision as a joint commitment to healthy childbirth". The sub-indicators that make up this phenomenon were safety, responsibility, mutual and personal commitments. These sub-indicators were also identified to influence temporal conditions of decision-making and to apply different strategies for shared decision-making. Women adopted strategies such as delegating a decision, making the midwife's decision her own, challenging a decision or taking a decision driven by the dynamics of childbirth. Midwives employed strategies such as remaining indecisive, approving a woman's decision, making an informed decision or taking the necessary decision. To respond to recommendations for shared responsibility for care, midwives need to strengthen their shared decision-making skills. The visual model of decision-making in childbirth derived from the data provides a framework for transferring clinical reasoning into practice. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Institutional change and political decision-making in the creation of the Brazilian National Health Surveillance Agency.

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Piovesan, Márcia Franke; Labra, Maria Eliana

2007-06-01

This article examines the decision-making process that led to the creation of the Brazilian National Health Surveillance Agency (ANVISA) in 1999. The authors begin by discussing the history of the Agency's predecessor, the Health Surveillance Secretariat, and the need for its modernization to adjust the quality of the products under its control to domestic and international demands. From the theoretical perspective of neo-institutionalism, the article goes on to analyze the social and political context surrounding the debate on the proposed alternatives to adjust Health Surveillance to new rules in line with such requirements, focusing especially on the formulation of the new policy, the decision-making arena, and the actors with specific interests in the sector. The research drew on extensive documentary and media material, plus interviews with key actors. The article concludes that a determinant factor for the creation of ANVISA was the favorable domestic political context, fostering a positive correlation of forces that (in an extremely short timeframe, 1998-1999) allowed the creation of the first regulatory agency in the social policies area in Brazil.

Tactical decision making under stress (TADMUS) decision support system

OpenAIRE

Morrison, Jeffrey G.; Kelly, Richard T.; Moore, Ronald A.; Hutchins, Susan G.

1996-01-01

A prototype decision support system (DSS) was developed to enhance Navy tactical decision making based on naturalistic decision processes. Displays were developed to support critical decision making tasks through recognition-primed and explanation-based reasoning processes and cognitive analysis of the decision making problems faced by Navy tactical officers in a shipboard Combat Information Center. Baseline testing in high intensity, peace keeping, littoral scenarios indicated...

Risk perception and clinical decision making in primary care

DEFF Research Database (Denmark)

Barfoed, Benedicte Marie Lind

2015-01-01

Objectives We aim to present new knowledge about different perspectives of health care professionals’ risk perceptions and clinical decision making. Furthermore, we intend to discuss differences between professional and personal risk perceptions and the impact on decisions in terms of both short...... and long-term outcomes. Background Insight into healthcare professionals’ perception of risk is a cornerstone for understanding their strategies for practising preventive care. The way people perceive risk can be seen as part of a general personality trait influenced by a mixture of individual...... considerations and the specific context. Most research has been focused on understanding of the concepts of risk. However healthcare professionals’ risk perception and personal attitudes also affect their clinical decision-making and risk communication. The differences between health care professionals’ personal...

A decision technology system for health care electronic commerce.

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

1999-08-01

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

Patient preferences versus physicians' judgement: does it make a difference in healthcare decision making?

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