Patient attitudes towards the arteriovenous fistula: a qualitative study on vascular access decision making

ObjectivesPartial gland ablation (PGA) therapy is an emerging treatment modality that targets specific areas of biopsy-proven prostate cancer (PCa) to minimize treatment-related morbidity by sparing benign prostate. This qualitative study aims to explore and characterize perceptions and attitudes toward PGA in men with very-low-risk, low-risk, and favorable intermediate-risk PCa on active surveillance (AS).Design92 men diagnosed with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS were invited to participate in semistructured telephone interviews on PGA.SettingSingle tertiary care center located in New York City.Participants20 men with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS participated in the interviews.Main outcome measuresEmerging themes on perceptions and attitudes toward PGA were developed from transcripts inductively coded and analyzed under standardized methodology.ResultsFour themes were derived from 20 interviews that represent the primary considerations in treatment decision-making: (1) the feeling of psychological safety associated with low-risk disease; (2) preference for minimally invasive treatments; (3) the central role of the physician; (4) and the pursuit of treatment options that align with disease severity. Eleven men (55%) expressed interest in pursuing PGA only if their cancer were to progress, while nine men (45%) expressed interest at the current moment.ConclusionsAlthough an emerging treatment modality, patients were broadly accepting of PGA for PCa, with men primarily debating the risks versus benefits of proactively treating low-risk disease. Additional research on men’s preferences and attitudes toward PGA will further guide counseling and shared decision-making for PGA.

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Evidence use as sociomaterial practice? A qualitative study of decision-making on introducing service innovations in health care

Public Management Review ◽

10.1080/14719037.2021.1883098 ◽

2021 ◽

pp. 1-25

Author(s):

Simon Turner ◽

Danielle D´Lima ◽

Jessica Sheringham ◽

Nick Swart ◽

Emma Hudson ◽

...

Keyword(s):

Health Care ◽

Decision Making ◽

Qualitative Study ◽

Evidence Use

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Supported decision‐making and mental capacity assessment in care homes: A qualitative study

Health & Social Care in the Community ◽

10.1111/hsc.13512 ◽

2021 ◽

Author(s):

Mark Jayes ◽

Lynn Austin ◽

Laura J. E. Brown

Keyword(s):

Decision Making ◽

Qualitative Study ◽

Mental Capacity ◽

Care Homes ◽

Capacity Assessment

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A Qualitative Study on the US Forest Service’s Risk Management Assistance Efforts to Improve Wildfire Decision-Making

Forests ◽

10.3390/f12030344 ◽

2021 ◽

Vol 12 (3) ◽

pp. 344

Author(s):

Courtney A. Schultz ◽

Lauren F. Miller ◽

Sarah Michelle Greiner ◽

Chad Kooistra

Keyword(s):

Decision Making ◽

Risk Management ◽

Decision Support ◽

Qualitative Study ◽

Fire Management ◽

Perceived Value ◽

Forest Service ◽

The Us ◽

Decision Biases ◽

Line Officers

To support improved wildfire incident decision-making, in 2017 the US Forest Service (Forest Service) implemented risk-informed tools and processes, together known as Risk Management Assistance (RMA). The Forest Service is developing tools such as RMA to improve wildfire decision-making and implements these tools in complex organizational environments. We assessed the perceived value of RMA and factors that affected its use to inform the literature on decision support for fire management. We sought to answer two questions: (1) What was the perceived value of RMA for line officers who received it?; and (2) What factors affected how RMA was received and used during wildland fire events? We conducted a qualitative study involving semi-structured interviews with decision-makers to understand the contextualized and interrelated factors that affect wildfire decision-making and the uptake of a decision-support intervention such as RMA. We used a thematic coding process to analyze our data according to our questions. RMA increased line officers’ ability to communicate the rationale underlying their decisions more clearly and transparently to their colleagues and partners. Our interviewees generally said that RMA data analytics were valuable but did not lead to changes in their decisions. Line officer personality, pre-season exposure to RMA, local political dynamics and conditions, and decision biases affected the use of RMA. Our findings reveal the complexities of embracing risk management, not only in the context of US federal fire management, but also in other similar emergency management contexts. Attention will need to be paid to existing decision biases, integration of risk management approaches in the interagency context, and the importance of knowledge brokers to connect across internal organizational groups. Our findings contribute to the literature on managing change in public organizations, specifically in emergency decision-making contexts such as fire management.

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Age is just a number: Is frailty being ignored in vascular access planning for dialysis?

The Journal of Vascular Access ◽

10.1177/1129729821989902 ◽

2021 ◽

pp. 112972982198990

Author(s):

Kulli Kuningas ◽

Nicholas Inston

Keyword(s):

Decision Making ◽

Kidney Disease ◽

Vascular Access ◽

Clinical Condition ◽

The Elderly ◽

Dialysis Access ◽

Adverse Health Outcomes ◽

Risk Of Mortality ◽

Increased Risk ◽

First Choice

Current international guidelines advocate fistula creation as first choice for vascular access in haemodialysis patients, however, there have been suggestions that in certain groups of patients, in particular the elderly, a more tailored approach is needed. The prevalence of more senior individuals receiving renal replacement therapy has increased in recent years and therefore including patient age in decision making regarding choice of vascular access for dialysis has gained more relevance. However, it seems that age is being used as a surrogate for overall clinical condition and it can be proposed that frailty may be a better basis to considering when advising and counselling patients with regard to vascular access for dialysis. Frailty is a clinical condition in which the person is in a vulnerable state with reduced functional capacity and has a higher risk of adverse health outcomes when exposed to stress inducing events. Prevalence of frailty increases with age and has been associated with an increased risk of mortality, hospitalisation, disability and falls. Chronic kidney disease is associated with premature ageing and therefore patients with kidney disease are prone to be frailer irrespective of age and the risk increases further with declining kidney function. Limited data exists on the relationship between frailty and vascular access, but it appears that frailty may have an association with poorer outcomes from vascular access. However, further research is warranted. Due to complexity in decision making in dialysis access, frailty assessment could be a key element in providing patient-centred approach in planning and maintaining vascular access for dialysis.

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