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Background Conversation aids can facilitate shared decision-making and improve patient-centered outcomes. However, few examples exist of sustained use of conversation aids in routine care due to numerous barriers at clinical and organizational levels. We explored factors that will promote the sustained use of two early-stage breast cancer conversation aids. We examined differences in opinions between the two conversation aids and across socioeconomic strata. Methods We nested this study within a randomized controlled trial that demonstrated the effectiveness of two early-stage breast cancer surgery conversation aids, one text-based and one picture-based. These conversation aids facilitated more shared decision-making and improved the decision process, among other outcomes, across four health systems with socioeconomically diverse patient populations. We conducted semi-structured interviews with a purposive sample of patient participants across conversation aid assignment and socioeconomic status (SES) and collected observations and field notes. We interviewed trial surgeons and other stakeholders. Two independent coders conducted framework analysis using the NOrmalization MeAsure Development through Normalization Process Theory. We also conducted an inductive analysis. We conducted additional sub-analyses based on conversation aid assignment and patient SES. Results We conducted 73 semi-structured interviews with 43 patients, 16 surgeons, and 14 stakeholders like nurses, cancer center directors, and electronic health record (EHR) experts. Patients and surgeons felt the conversation aids should be used in breast cancer care in the future and were open to various methods of giving and receiving the conversation aid (EHR, email, patient portal, before consultation). Patients of higher SES were more likely to note the conversation aids influenced their treatment discussion, while patients of lower SES noted more influence on their decision-making. Intervention surgeons reported using the conversation aids did not lengthen their typical consultation time. Most intervention surgeons felt using the conversation aids enhanced their usual care after using it a few times, and most patients felt it appeared part of their normal routine. Conclusions Key factors that will guide the future sustained implementation of the conversation aids include adapting to existing clinical workflows, flexibility of use, patient characteristics, and communication preferences. Trial registration ClinicalTrials.gov Identifier: NCT03136367 , registered on May 2, 2017

The purpose of this research is to illustrate, through a case study, a multilevel decision-making process able to support the decision maker in optimizing investment choices for the efficient allocation of public resources, with specific reference to recovery and adaptation to the reuse of unused historical public heritage. During the evaluation process, two methods in particular were combined according to a multiphase design: (i) a multi-criteria analysis to identify the Highest and Best Use among alternative reuse scenarios and (ii) a Discounted Cash Flow Analysis to support verification of the financial feasibility of the investment, in the hypothesis of an enhancement concession in a public–private partnership. Each method was applied in parallel to the evolution of the different design scenarios. The results of the study show that hybrid approaches are a promising line of research in the field of evaluation and urban design, applied to cultural heritage.

Clinical practice guidelines (CPGs) are designed to assist health care professionals in medical decision-making, but they often lack effective integration of shared decision-making (SDM) principles to reflect patient values and preferences, particularly in the context of preference-sensitive CPG recommendations. To address this shortcoming and foster SDM through CPGs, the integration of patient decision aids (PDAs) into CPGs has been proposed as an important strategy. However, methods for systematically identifying and prioritizing CPG recommendations relevant to SDM and related decision support tools are currently lacking. The aim of the project is to develop (1) a tool for systematically identifying and prioritizing CPG recommendations for which SDM is considered particularly relevant and (2) a platform for PDAs to support practical SDM implementation. The project consists of 6 work packages (WPs). It is embedded in the German health care context but has an international focus. In WP 1, we will conduct a scoping review in bibliographic databases and gray literature sources to identify methods used to foster SDM via PDAs in the context of CPGs. In WP 2, we will conduct semistructured interviews with CPG experts to better understand the concepts of preference sensitivity and identify strategies for fostering SDM through CPGs. WP 3, a modified Delphi study including surveys and focus groups with SDM experts, aims to define and operationalize preference sensitivity. Based on the results of the Delphi study, we will develop a methodology for prioritizing key questions in CPGs. In WP 4, the tool will be developed. A list of relevant items to identify CPG recommendations for which SDM is most relevant will be created, tested, and iteratively refined, accompanied by the development of a user manual. In WP 5, a platform for creating and digitizing German-language PDAs will be developed to support the practical application of SDM during clinical encounters. WP 6 will conclude the project by testing the tool with newly developed and revised CPGs. The Brandenburg Medical School Ethics Committee approved the project (165122023-ANF). An international multidisciplinary advisory board is involved to guide the tool development on CPGs and SDM. Patient partners are involved throughout the project, considering the essential role of the patient perspective in SDM. As of February 20, 2024, we are currently assessing literature references to determine eligibility for inclusion in the scoping review (WP 1). We expect the project to be completed by December 31, 2026. The tool will enable CPG developers to systematically incorporate aspects of SDM into CPG development, thereby providing guideline-based support for the patient-practitioner interaction. Together, the tool for CPGs and the platform for PDAs will create a systematic link between CPGs, SDM, and PDAs, which may facilitate SDM in clinical practice. DERR1-10.2196/57611.

Objectives To explore the experiences, acceptability and utility of a decision aid for family carers of people with dementia towards the end of life. Methods We conducted semi‐structured interviews with a sample of family carers enroled into a 6‐month feasibility study in England, sampling to gain a range of experiences and views, based on relationship to person they cared for (e.g., spouse, adult child), age, gender, and self‐reported use of the decision aid during the feasibility study. Interviews were conducted in March 2021–July 2021 and analysed using reflexive thematic analysis. We used COREQ checklist to report our methods and results. Results Family carers found the decision aid acceptable, describing it as comprehensive, accessible with relevant information and its presentation enabled good engagement. Experiences of the decision aid covered four main themes which demonstrated the perceived acceptability and utility: 1. A source of support and reassurance; 2. Empowering conversations and confidence; 3. Including the person living with dementia; and 4. Breaking down complexity. Conclusions An aid focussing on decisions about dementia end of life care supported family carers break down complex and emotive decisions, not only with making decisions in the moment but also in future planning. Patient or Public Contribution Our three Patient and Public Involvement (PPI) members (all former family carers) were crucial throughout the wider study. PPI supported development of the topic guides, supported trialling the topic guide and interview procedures and finally supported the development of themes as part of the analysis.

Background: We evaluated the effects of our postpartum Green Star family planning decision aid on the decisional conflict, knowledge, satisfaction, and uptake of long-acting reversible contraception among pregnant adolescents in Tanzania. Methods: We used a facility-based pre–post quasi-experimental design. The intervention arm received routine family planning counseling and the decision aid. The control received only routine family planning counseling. The primary outcome was the change in decisional conflict measured using the validated decision conflict scale (DCS). The secondary outcomes were knowledge, satisfaction, and contraception uptake. Results: We recruited 66 pregnant adolescents, and 62 completed this study. The intervention group had a lower mean score difference in the DCS than in the control (intervention: −24.7 vs. control: −11.6, p < 0.001). The mean score difference in knowledge was significantly higher in the intervention than in the control (intervention: 4.53 vs. control: 2.0, p < 0.001). The mean score of satisfaction was significantly higher in the intervention than in the control (intervention: 100 vs. control: 55.8, p < 0.001). Contraceptive uptake was significantly higher in the intervention [29 (45.3%)] than in the control [13 (20.3%)] (p < 0.001). Conclusion: The decision aid demonstrated positive applicability and affordability for pregnant adolescents in Tanzania.

Background Parkinson’s disease (PD) is a neurodegenerative disease characterized by motor and nonmotor symptoms that worsen over time. In some cases, an advanced treatment may be needed. The use of levodopa-carbidopa intestinal gel (LCIG) is one of these options. However, deciding whether to receive it can be difficult. A patient decision aid (PDA), a tool designed to inform about treatment options, can help and promote patients’ participation in decision making. Objectives This study was conducted to develop a PDA on LCIG and assess its acceptability. Methods The International Patient Decision Aid Standards framework was used to develop the PDA. An advisory committee (n = 5) gave feedback on the PDA prototype. Acceptability was evaluated using a cross-sectional descriptive design. A convenience sample of 36 participants (including persons with PD receiving and not receiving LCIG, caregivers, and health care professionals) was used. Acceptability data, sociodemographics, and health literacy were collected using questionnaires and a focus group. Results Sample characteristics were a mean age of 64.4 y (s = 14 y), university level of education (46.7%), and duration of illness of less than 10 y (80%). The health literacy score was judged as very good ( x ¯ = 55.2/70, s = 7.3). Qualitative data analysis allowed for final adjustments to the published PDA version. Conclusions. This study is the first to report the development of a PDA on LCIG and its acceptability testing. Participants found the PDA to be useful and would recommend it. All health care professionals indicated they intended to use it in their practice. More research will be needed to evaluate the PDA’s implementation and its effects on users. Highlights Deciding whether to opt for an advanced Parkinson’s disease treatment such as levodopa-carbidopa intestinal gel can be challenging for many patients. A patient decision aid on levodopa-carbidopa intestinal gel for Parkinson’s disease persons, caregivers, and health care professionals was developed to support a decision-making process. This article summarizes the steps used for its development and its acceptability testing.

Background Encounter decision aids (EDAs) are tools that can support shared decision making (SDM), up to the clinical encounter. However, adoption of these tools has been limited, as they are hard to produce, to keep up-to-date, and are not available for many decisions. The MAGIC Evidence Ecosystem Foundation has created a new generation of decision aids that are generically produced along digitally structured guidelines and evidence summaries, in an electronic authoring and publication platform (MAGICapp). We explored general practitioners’ (GPs) and patients' experiences with five selected decision aids linked to BMJ Rapid Recommendations in primary care. Methods We applied a qualitative user testing design to evaluate user experiences for both GPs and patients. We translated five EDAs relevant to primary care, and observed the clinical encounters of 11 GPs when they used the EDA with their patients. We conducted a semi-structured interview with each patient after the consultation and a think-aloud interview with each GPs after multiple consultations. We used the Qualitative Analysis Guide (QUAGOL) for data analysis. Results Direct observations and user testing analysis of 31 clinical encounters showed an overall positive experience. The EDAs created better involvement in decision making and resulted in meaningful insights for patients and clinicians. The design and its interactive, multilayered structure made the tool enjoyable and well-organized. Difficult terminology, scales and numbers hindered understanding of certain information, which was sometimes perceived as too specialized or even intimidating. GPs thought the EDA was not suitable for every patient. They perceived a learning curve was required and the need for time investment was a concern. The EDAs were considered trustworthy as they were provided by a credible source. Conclusions This study showed that EDAs can be useful tools in primary care by supporting actual shared decision making and enhancing patient involvement. The graphical approach and clear representation help patients better understand their options. To overcome barriers such as health literacy and GPs attitudes, effort is still needed to make the EDAs as accessible, intuitive and inclusive as possible through use of plain language, uniform design, rapid access and training. Trial registration The study protocol was approved by the The Research Ethics Committee UZ/KU Leuven (Belgium) on 31–10-2019 with reference number MP011977.

Operational research (OR) offers efficient tools to support managers in strategic decision-making processes. Data envelopment analysis (DEA) and multiple criteria decision aid (MCDA) are two important research areas in OR. These two domains are both based on the evaluation of “objects” according to multiple “points of views”. Within the MCDA framework, choosing appropriate weights for the different criteria often arises as a problem itself for decision makers. As a consequence, researchers have developed original methodologies to help them during this elicitation phase. In this work, we aim to investigate how DEA can be used to propose weights in the context of the PROMETHEE II method. More precisely, we suggest an extension of the so-called “decision maker brain” used in the GAIA plane (also known as PROMETHEE VI) based on DEA. The underlying idea is based on the computation of weights in PROMETHEE (GAIA brain) which are compatible with the DEA analysis. We end this paper with a numerical example.

ObjectiveTo identify factors that might facilitate or impede the implementation of a shared decision-making in lupus electronic tool (SMILE) in clinics by assessing perspectives of clinicians, clinic champions, and patient advocacy organization leaders.MethodsWe conducted a series of semi-structured telephone interviews (25–45 minutes) about facilitators and barriers of implementing the SMILE decision-aid tool with 23 lupus care providers (18 physicians, 5 champions), and leaders of two patient advocacy organizations. Interviews were audio recorded, transcribed, coded, and analyzed.ResultsPhysicians and clinic champions were from 18 geographically diverse US clinics. The patient advocacy leaders were from the Lupus Foundation of America and the Arthritis Foundation. Most of the clinics were rheumatology specialty (94%), at university-based academic centers (72%), located in urban areas (72%), had a specialized lupus clinic (72%), were very interested (72%) in the SMILE tool and were ready to implement it (89%). Several specific factors, composed as four themes, were identified that could either facilitate or impede the implementation of the SMILE tool: (1) patient-related theme: patient recruitment and education, and the clinic visit time; (2) clinic-related theme: staff work-load and time, and physical space to view and use the SMILE tool; (3) technology-related theme: Wi-Fi connection and iPad navigation; and (4) management-related theme: influence on the clinics’ daily workflow, the need of a study champion and coordination, and leadership support.ConclusionPhysicians, staff, and patient advocacy leaders perceived the SMILE as a promising tool to facilitate patient-provider communication and quality improvement in lupus. Identification of the patient-, clinic-, technology-, and management-related barriers to the SMILE implementation will allow its integration into busy clinical practice workflow.Key Points• Physicians, staff and patient advocacy leaders perceived computerized lupus decision aid to be a promising tool to facilitate shared decision-making for lupus treatment.• Stakeholder identified patient-related, clinic-resource-related, technology-related and clinic-management related themes as barriers or facilitators to viewing computerized lupus decision aid during regular clinic visits.

Introduction Decision aids (DAs) are helpful instruments used to support shared decision making (SDM). Patients with atrial fibrillation (AF) face complex decisions regarding stroke prevention strategies. While a few DAs have been made for AF stroke prevention, an encounter DA (EDA) and patient DA (PDA) have not been created to be used in conjunction with each other before. Design Using iterative user-centered design, we developed 2 DAs for anticoagulation choice and stroke prevention in AF. Prototypes were created, and we elicited feedback from patients and experts via observations of encounters, usability testing, and semistructured interviews. Results User testing was done with 33 experts (in AF and SDM) and 51 patients from 6 institutions. The EDA and PDA underwent 1 and 4 major iterations, respectively. Major differences between the DAs included AF pathophysiology and a preparation to meet with the clinician in the PDA as well as different language throughout. Content areas included personalized stroke risk, differences between anticoagulants, and risks of bleeding. Based on user feedback, developers 1) addressed feelings of isolation with AF, 2) improved navigation options, 3) modified content and flow for users new to AF and those experienced with AF, 4) updated stroke risk pictographs, and 5) added structure to the preparation for decision making in the PDA. Limitations These DAs focus only on anticoagulation for stroke prevention and are online, which may limit participation for those less comfortable with technology. Conclusions Designing complementary DAs for use in tandem or separately is a new method to support SDM between patients and clinicians. Extensive user testing is essential to creating high-quality tools that best meet the needs of those using them. Highlights First-time complementary encounter and patient decision aids have been designed to work together or separately. User feedback led to greater structure and different experiences for patients naïve or experienced with anticoagulants in patient decision aids. Online tools allow for easier dissemination, use in telehealth visits, and updating as new evidence comes out.