scholarly journals Family Caregivers’ Decision-Support Needs Beyond the Decision Aid

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 67-67
Author(s):  
Katherine Britt ◽  
Karen Schlag
Keyword(s):  
Decision Support ◽  
Family Caregivers ◽  
Decision Aids ◽  
Decision Quality ◽  
Support Needs ◽  
Support Tool ◽  
Situational Contexts ◽  
Surrogate Decision ◽  
Eol Care ◽  
The Impact

Abstract Of the estimated 16 million U.S. family members currently providing essential yet unpaid caregiving for persons with dementia (PWD), many will also make end-of-life (EOL) care decisions as surrogates, a process that can be fraught with uncertainty. Even with dementia death rates rising, many families delay advanced care planning (ACP) discussions, and surrogate decision makers often lack crucial information and support, implicating the need to further study this topic in aging. While decision aids (DA) serve as a support tool for caregivers, they can be less effective when failing to address unresolved decisional needs. Utilizing the Ottawa Decision Support Framework (ODSF), which asserts caregiver decision needs affect decision quality, this study sought to identify surrogate decision-support needs extending beyond general ACP. This mixed study used cognitive interviews and focus groups with family caregivers (N=13) and healthcare professionals (n=14) to assess their knowledge and understanding of hospice and artificial hydration and nutrition. Data were audio-recorded, transcribed verbatim, and analyzed with thematic content analysis. Three main themes were identified: DAs alone aren’t enough to foster quality decision making for surrogates; individualized communication is necessary to clarify PWD and caregiver value priorities and disease trajectories; and clarification of the impact of care choices within situational contexts is quintessential. Further development is needed to create a practice protocol from these themes to inform professionals assisting surrogates in ACP at EOL. Practical implications from this study include highlighting the importance of individualized communication between PWD, providers, and caregivers in addressing EOL care decisional needs.

scholarly journals END-OF-LIFE DECISION SUPPORT NEEDS OF DEMENTIA FAMILY CAREGIVERS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S593-S593
Author(s):  
Jung Kwak ◽  
Lisa Geshell
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Family Caregivers ◽  
Advance Care Planning ◽  
Healthcare Professionals ◽  
Support Needs ◽  
Care Planning ◽  
Dementia Caregivers ◽  
Advance Care ◽  
Surrogate Decision

Abstract One third of older adults die with dementia. At the end of life (EOL), persons with dementia require surrogate decision-makers, often their family caregivers, to make important EOL decisions. However, only a handful of evidence-based interventions exist to guide dementia caregivers in surrogate-decision making. In order to examine the acceptability and appropriateness of a decision coaching intervention developed for dementia caregivers, we conducted cognitive interviews (n=4), and one focus group (n=9) with dementia caregivers, and two focus groups with healthcare professionals (n=14) from a large healthcare system and a managed long-term care organization. Guiding questions for interviews and focus groups included: (1) types of decisions (what), and circumstances or triggers (when and how) that call for decision-making support by healthcare professionals, (2) barriers to families receiving decision-making support, and (3) decision support needs of family caregivers. All face-to-face interviews were audio-recorded, transcribed verbatim, and verified for accuracy. Content analysis was conducted to identify and organize themes and patterns emerging from the interview transcripts. Two main themes and subthemes emerged: (1) decision-making challenges and barriers: lack of advance care planning, caregivers’ acquiescence with dementia progression and caregiving role, discontinuing life sustaining therapies, and lack of communication between providers; and (2) decision support for families: advance care planning at different stages of dementia, preparing caregivers for life after the patient’s death, and providing adequate information about benefits and harms of treatment options specific to the practical concerns of patient and family caregivers. These findings provide implications for practice and future research.

scholarly journals Assessment of alternative land management practices using hydrological simulation and a decision support tool: Arborea agricultural region, Sardinia

2007 ◽  
Vol 11 (6) ◽  
pp. 1811-1823 ◽  
Author(s):  
P. Cau ◽  
C. Paniconi
Keyword(s):  
Decision Support ◽  
Land Management ◽  
Quantitative Methods ◽  
Management Practices ◽  
Water Movement ◽  
Agricultural Practices ◽  
Treated Wastewater ◽  
Hydrological Simulation ◽  
Support Tool ◽  
The Impact

Abstract. Quantifying the impact of land use on water supply and quality is a primary focus of environmental management. In this work we apply a semidistributed hydrological model (SWAT) to predict the impact of different land management practices on water and agricultural chemical yield over a long period of time for a study site situated in the Arborea region of central Sardinia, Italy. The physical processes associated with water movement, crop growth, and nutrient cycling are directly modeled by SWAT. The model simulations are used to identify indicators that reflect critical processes related to the integrity and sustainability of the ecosystem. Specifically we focus on stream quality and quantity indicators associated with anthropogenic and natural sources of pollution. A multicriteria decision support system is then used to develop the analysis matrix where water quality and quantity indicators for the rivers, lagoons, and soil are combined with socio-economic variables. The DSS is used to assess four options involving alternative watersheds designated for intensive agriculture and dairy farming and the use or not of treated wastewater for irrigation. Our analysis suggests that of the four options, the most widely acceptable consists in the transfer of intensive agricultural practices to the larger watershed, which is less vulnerable, in tandem with wastewater reuse, which rates highly due to water scarcity in this region of the Mediterranean. More generally, the work demonstrates how both qualitative and quantitative methods and information can assist decision making in complex settings.

20th Anniversary Update of the Ottawa Decision Support Framework: Part 2 Subanalysis of a Systematic Review of Patient Decision Aids

2020 ◽  
Vol 40 (4) ◽  
pp. 522-539 ◽  
Author(s):  
Lauren Hoefel ◽  
Krystina B Lewis ◽  
Annette O’Connor ◽  
Dawn Stacey
Keyword(s):  
Decision Support ◽  
Usual Care ◽  
Risk Perceptions ◽  
Decision Aids ◽  
Cochrane Review ◽  
Decision Quality ◽  
Patient Decision Aids ◽  
Patient Decision ◽  
Decision Support Framework ◽  
Ottawa Decision Support Framework

Background. The Ottawa Decision Support Framework (ODSF) has guided the development of patient decision aids (PtDAs) for 20 years and needs updating across a range of decisions and hypothesized outcomes. Purpose. To determine the effectiveness of ODSF-developed PtDAs on hypothesized outcomes and to recommend framework changes. Data Source. A subanalysis of randomized controlled trials included in the 2017 Cochrane review of PtDAs comparing PtDAs to usual care in adults considering health treatment or screening decisions (searched to 2015). Study Selection. Trials in the original review that evaluated ODSF-developed PtDAs. Data Synthesis. Meta-analyses of ODSF outcomes with similar measurements and descriptions of other reported outcomes. Results. Of 105 trials, 24 evaluated ODSF-developed PtDAs. Compared with usual care, ODSF PtDAs improved knowledge (mean difference [MD] 13.85; 95% confidence interval [CI] 10.32−17.37; 14 trials), increased accurate risk perceptions (risk ratio [RR] 2.41; 95% CI 1.66−3.48; 7 trials), and increased congruence between informed values and chosen options (RR 1.32; 95% CI 1.09−1.59; 4 trials). They reduced perceived decisional needs as measured using the Decisional Conflict Scale (MD −5.92; 95% CI −8.58 to −3.26; 15 trials) and the proportion of undecided patients (RR 0.65; 95% CI 0.50−0.83; 13 trials). Non-ODSF PtDAs, designed with or without a specific framework, also outperformed usual care. Few ODSF trials measured secondary outcomes. Limitations. The included trials had heterogeneity. Conclusion. ODSF PtDAs address decisional needs and improve decision quality; the best indicator of addressing perceived uncertainty is “proportion undecided.” Secondary ODSF outcomes should be reduced to adherence to one’s chosen option and use/costs of health services, which warrant further research.

Using a decision support tool to screen for pro-poor policies: Application of Extrapolate to smallholder dairy systems in East Africa

2005 ◽  
Vol 2005 ◽  
pp. 28-28
Author(s):  
P. K. Thornton ◽  
P. J. Thorne ◽  
C. Quiros ◽  
D. Sheikh ◽  
R. L. Kruska ◽  
...  
Keyword(s):  
Decision Support ◽  
Poverty Reduction ◽  
Intervention Mapping ◽  
Decision Support Tool ◽  
Target Groups ◽  
Support Tool ◽  
Policy Alternatives ◽  
Ex Ante ◽  
Policy Measures ◽  
The Impact

Extrapolate (EX-ante Tool for RAnking POLicy AlTErnatives) is a decision support tool to assess the impact of policy measures on different target groups. It is designed to serve as a “filter” that, given the broad characteristics of the population, allows the user to sift through different policy measures to assess ex ante the broad potential impacts of these before deciding to look at particular policy options in more detail. Extrapolate models, in a very simple way, the impact of changes on constraints facing potential beneficiary groups, and how these may affect outcomes and their livelihood status. Extrapolate now makes use of mapping facilities from another decision-support tool, PRIMAS (Poverty Reduction Intervention Mapping in Agricultural Systems), that allows the user to match characteristics of particular technological options and constraints with the spatial characteristics of particular target groups in the landscape.

Stressed decision makers and use of decision aids: a literature review and conceptual model

2019 ◽  
Vol 33 (2) ◽  
pp. 710-754 ◽  
Author(s):  
Monica Adya ◽  
Gloria Phillips-Wren
Keyword(s):  
Decision Making ◽  
Conceptual Model ◽  
Perceived Stress ◽  
Decision Aids ◽  
Decision Makers ◽  
Decision Quality ◽  
Negative Effects ◽  
Managerial Decision ◽  
Content Type ◽  
The Impact

Purpose Decision making is inherently stressful since the decision maker must choose between potentially conflicting alternatives with unique hazards and uncertain outcomes. Whereas decision aids such as decision support systems (DSS) can be beneficial in stressful scenarios, decision makers sometimes misuse them during decision making, leading to suboptimal outcomes. The purpose of this paper is to investigate the relationship between stress, decision making and decision aid use. Design/methodology/approach The authors conduct an extensive multi-disciplinary review of decision making and DSS use through the lens of stress and examine how stress, as perceived by decision makers, impacts their use or misuse of DSS even when such aids can improve decision quality. Research questions examine underlying sources of stress in managerial decision making that influence decision quality, relationships between a decision maker’s perception of stress, DSS use/misuse, and decision quality, and implications for research and practice on DSS design and capabilities. Findings The study presents a conceptual model that provides an integrative behavioral view of the impact of a decision maker’s perceived stress on their use of a DSS and the quality of their decisions. The authors identify critical knowledge gaps and propose a research agenda to improve decision quality and use of DSS by considering a decision maker’s perceived stress. Originality/value This study provides a previously unexplored view of DSS use and misuse as shaped by the decision and job stress experienced by decision makers. Through the application of four theories, the review and its findings highlight key design principles that can mitigate the negative effects of stressors on DSS use.

scholarly journals Clinical implementation of pharmacogenomics via a health system-wide research biobank: the University of Colorado experience

2020 ◽  
Vol 21 (6) ◽  
pp. 375-386 ◽  
Author(s):  
Christina L Aquilante ◽  
David P Kao ◽  
Katy E Trinkley ◽  
Chen-Tan Lin ◽  
Kristy R Crooks ◽  
...  
Keyword(s):  
Decision Support ◽  
Health System ◽  
Clinical Decision Support ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Clinical Implementation ◽  
Support Tool ◽  
University Of Colorado ◽  
The University ◽  
The Impact

In recent years, the genomics community has witnessed the growth of large research biobanks, which collect DNA samples for research purposes. Depending on how and where the samples are genotyped, biobanks also offer the potential opportunity to return actionable genomic results to the clinical setting. We developed a preemptive clinical pharmacogenomic implementation initiative via a health system-wide research biobank at the University of Colorado. Here, we describe how preemptive return of clinical pharmacogenomic results via a research biobank is feasible, particularly when coupled with strong institutional support to maximize the impact and efficiency of biobank resources, a multidisciplinary implementation team, automated clinical decision support tools, and proactive strategies to engage stakeholders early in the clinical decision support tool development process.

scholarly journals BEETSOIL: a decision support tool for forecasting the impact of soil conditions on sugar beet harvest

2019 ◽  
Vol 191 ◽  
pp. 131-141
Author(s):  
Miguel A. Gabarron-Galeote ◽  
Jacqueline A. Hannam ◽  
Thomas Mayr ◽  
Patrick J. Jarvis
Keyword(s):  
Decision Support ◽  
Sugar Beet ◽  
Decision Support Tool ◽  
Soil Conditions ◽  
Support Tool ◽  
The Impact

scholarly journals Estimating the impact of deploying an electronic clinical decision support tool as part of a national practice improvement project

2019 ◽  
Vol 26 (7) ◽  
pp. 630-636 ◽  
Author(s):  
Ellen K Kerns ◽  
Vincent S Staggs ◽  
Sarah D Fouquet ◽  
Russell J McCulloh
Keyword(s):  
Clinical Practice ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Market Area ◽  
Improvement Project ◽  
Support Tool ◽  
Febrile Infant ◽  
The Impact ◽  
Electronic Clinical Decision Support

Abstract Objective Estimate the impact on clinical practice of using a mobile device–based electronic clinical decision support (mECDS) tool within a national standardization project. Materials and Methods An mECDS tool (app) was released as part of a change package to provide febrile infant management guidance to clinicians. App usage was analyzed using 2 measures: metric hits per case (metric-related screen view count divided by site-reported febrile infant cases in each designated market area [DMA] monthly) and cumulative prior metric hits per site (DMA metric hits summed from study month 1 until the month preceding the index, divided by sites in the DMA). For each metric, a mixed logistic regression model was fit to model site performance as a function of app usage. Results An increase of 200 cumulative prior metric hits per site was associated with increased odds of adherence to 3 metrics: appropriate admission (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.06-1.18), appropriate length of stay (OR, 1.20; 95% CI, 1.12-1.28), and inappropriate chest x-ray (OR, 0.82; 95% CI, 0.75-0.91). Ten additional metric hits per case were also associated: OR were 1.18 (95% CI, 1.02-1.36), 1.36 (95% CI, 1.14-1.62), and 0.74 (95% CI, 0.62-0.89). Discussion mECDS tools are increasingly being implemented, but their impact on clinical practice is poorly described. To our knowledge, although ecologic in nature, this report is the first to link clinical practice to mECDS use on a national scale and outside of an electronic health record. Conclusions mECDS use was associated with changes in adherence to targeted metrics. Future studies should seek to link mECDS usage more directly to clinical practice and assess other site-level factors.

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