scholarly journals The empirical evidence underpinning the concept and practice of person-centred care for serious illness: a systematic review

2020 ◽  
Vol 5 (12) ◽  
pp. e003330
Author(s):  
Alessandra Giusti ◽  
Kennedy Nkhoma ◽  
Ruwayda Petrus ◽  
Inge Petersen ◽  
Liz Gwyther ◽  
...  
Keyword(s):  
Decision Making ◽  
Empirical Evidence ◽  
Complete Information ◽  
Primary Data ◽  
Free Text ◽  
High Quality ◽  
Joint Decision ◽  
Quality Healthcare ◽  
Serious Illness ◽  
Free Text Search

IntroductionPerson-centred care has become internationally recognised as a critical attribute of high-quality healthcare. However, the concept has been criticised for being poorly theorised and operationalised. Serious illness is especially aligned with the need for person-centredness, usually necessitating involvement of significant others, management of clinical uncertainty, high-quality communication and joint decision-making to deliver care concordant with patient preferences. This review aimed to identify and appraise the empirical evidence underpinning conceptualisations of ‘person-centredness’ for serious illness.MethodsSearch strategy conducted in May 2020. Databases: CINAHL, Embase, PubMed, Ovid Global Health, MEDLINE and PsycINFO. Free text search terms related to (1) person-centredness, (2) serious illness and (3) concept/practice. Tabulation, textual description and narrative synthesis were performed, and quality appraisal conducted using QualSyst tools. Santana et al’s person-centred care model (2018) was used to structure analysis.ResultsPRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow data: n=12,446 studies screened by title/abstract, n=144 full articles assessed for eligibility, n=18 studies retained. All studies (n=18) are from high-income countries, and are largely of high quality (median score 0.82). The findings suggest that person-centred care encompasses the patient and family being respected, given complete information, involved in decision-making and supported in their physical, psychological, social and existential needs. The studies highlight the importance of involving and supporting family/friends, promoting continuation of normality and self-identity, and structuring service organisation to enable care continuity.ConclusionPerson-centred healthcare must value the social network of patients, promote quality of life and reform structurally to improve patients’ experience interacting with the healthcare system. Staff must be supported to flexibly adapt skills, communication, routines or environments for individual patients. There remains a need for primary data investigating the meaning and practice of PCC in a greater diversity of diagnostic groups and settings, and a need to ground potential components of PCC within broader universal values and ethical theory.

scholarly journals What Explains Gender Gaps in Household Food Security? Evidence from Maize Farm Households in Southern Ethiopia

2021 ◽  
Author(s):  
Girma Gezimu Gebre ◽  
Hiroshi Isoda ◽  
Yuichiro Amekawa ◽  
Dil Bahadur Rahut ◽  
Hisako Nomura ◽  
...  
Keyword(s):  
Decision Making ◽  
Food Security ◽  
Farm Households ◽  
Primary Data ◽  
Household Food Security ◽  
Southern Ethiopia ◽  
Lower Probability ◽  
Gender Gaps ◽  
Joint Decision ◽  
Household Food

AbstractUsing primary data collected from 560 farm households in Dawuro zone, southern Ethiopia, this study analyzes the gender gaps in food security among male, female, and joint decision-making farm households. It examines the factors inducing gender gaps among the households of those three categories. The results show that female decision-making households have a lower probability of ensuring food-security and a higher probability of being transitionally and chronically food-insecure. Joint decision-making households showed a higher probability of falling into the chronically food-insecure category. The decomposition results show significant gender gaps between male and female decision-making households in terms of food-secure, transitory food-insecure, and chronically food-insecure categories. Overall, both the endowment and return effects account for the gaps; however, the magnitude of the effect from the return is higher than from the endowment on significant gaps in the food-secure, transitory, and chronically food-insecure categories. Hence, there is a need for policies that not only ensure equal levels of productive resources but also help households build their capacity in order to improve both transitory and chronically food insecure situations.

scholarly journals Intrahousehold Decision Making and Fertility

2017 ◽  
Author(s):  
Matthias Doepke ◽  
Fabian Kindermann
Keyword(s):  
Decision Making ◽  
Utility Function ◽  
Empirical Evidence ◽  
Important Determinant ◽  
Household Formation ◽  
Joint Decision ◽  
Considerable Heterogeneity ◽  
Unitary Model ◽  
Fertility Choices ◽  
Intrahousehold Decision Making

This chapter analyzes the implications of modeling fertility choices as outcomes of intrahousehold conflict and bargaining. It argues for a reformulation of fertility theories that are embedded in more realistic theories of household formation and joint decision making within the household. Empirical evidence suggests that disagreement regarding fertility choices is commonplace. In addition to a level difference in the desired fertility of women and men, there is evidence of considerable heterogeneity across households. The data on fertility preferences suggests at least the possibility that within-household disagreement on fertility is an important determinant of fertility outcomes. The chapter also shows how the vast majority of economic models of fertility have been based on a unitary model of the household, where the household is conceived as a single entity with a single utility function.

The Premise and Development of CHECK IN—Check-In for Exchange of Clinical and Key Information to Enhance Palliative Care Discussions for Patients With Limited English Proficiency

2020 ◽  
pp. 104990912097998
Author(s):  
Amelia Barwise ◽  
Mei-Ean Yeow ◽  
Daniel K. Partain
Keyword(s):  
Decision Making ◽  
Limited English Proficiency ◽  
English Proficiency ◽  
Quality Care ◽  
Clinical Information ◽  
Clinical Encounter ◽  
High Quality ◽  
Serious Illness ◽  
Patient Goals ◽  
Medical Interpreter

Communication regarding serious illness is challenging in most circumstances. Patients with Limited English Proficiency (LEP) have unique language and cultural needs that often require collaboration with a trained medical interpreter, especially when the clinical encounter involves serious illness decision making or elucidation of patient goals, preferences, and values. Although there is mounting evidence to support interpreter/clinician huddles before a serious illness communication encounter, no current initiatives exist to operationalize this evidence. We are currently in the process of developing, evaluating, and implementing a formal interpreter/clinician huddle process to promote high quality care for patients with LEP. Our huddle guide, called the Check-In for Exchange of Clinical and Key Information (CHECK-IN), is designed to facilitate collaboration between an interpreter and clinician during a serious illness encounter by prompting exchange of relevant sociocultural and clinical information between clinicians and interpreters.

Behavioral integration in the boardroom

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Aspasia Pastra ◽  
Dimitrios N. Koufopoulos ◽  
Nikola Samac ◽  
Tafsir Johansson
Keyword(s):  
Decision Making ◽  
Information Exchange ◽  
Longitudinal Design ◽  
Primary Data ◽  
Strategic Leadership ◽  
Future Research ◽  
Joint Decision ◽  
Content Type ◽  
Behavioral Integration ◽  
Board Performance

Purpose This study aims to understand the relationship between behavioral integration in the boardroom and board performance. Design/methodology/approach The authors performed a series of multiple hierarchical regression analyses to explore research questions. Primary data were collected via questionnaires from 184 Nordic members to identify perceptions of behavioral integration and board performance in their boardroom. Findings The authors found that different dimensions of behavioral integration have a different effect on board performance. The collaborative behavior of the board did not predict any dimension of board performance, whereas information exchange predicted one dimension of board performance, that of providing strategic leadership. The paramount role of joint decision-making is underlined in this study as this positively predicted all of the dimensions of board performance (strategic leadership, networking and readiness of the board). Research limitations/implications Future research should investigate behavioral integration among board members using a longitudinal design and expand the sample cross-culturally. Practical implications For forming high-performing teams, emphasis should be given on the joint decision-making. Understanding the joint problems, transparency in actions and discussion about the problem under consideration are of paramount importance for the effectiveness of the team. Social implications Team’s conversational environment has crucial impact on team outcomes. Originality/value This is one of the rare studies that examine perceptions of executives about the level of behavioral integration in their board.

Mini-Publics and Deliberative Democracy

2018 ◽  
pp. 299-314
Author(s):  
Graham Smith ◽  
Maija Setälä
Keyword(s):  
Decision Making ◽  
Empirical Evidence ◽  
Deliberative Democracy ◽  
Political Process ◽  
Decisive Role ◽  
The Political ◽  
Public Concern ◽  
Political Decision ◽  
High Quality ◽  
Political Decision Making

Deliberative mini-publics are institutions in which a diverse body of citizens is selected randomly to reason together about an issue of public concern. Despite the intense scholarly interest in mini-publics, to date their role has been fairly marginal in democratic polities. The chapter opens with an introduction to the variations in the design of mini-publics. We then review empirical evidence on the internal practice of mini-publics and argue that their capacity to support high quality deliberation explains the growing interest in these institutions. Finally, we analyze the possible roles of mini-publics within the political process. In both practical and normative terms, mini-publics tend to be perceived as consultative bodies. We examine arguments against the use of mini-publics in political decision making, evidence from their integration with direct and representative decision-making, and finally arguments for giving mini-publics a more decisive role in the political process.

Minimizing Missed Opportunities: Modeling Relationships between the State and Business in Russia

2009 ◽  
pp. 42-61
Author(s):  
A. Oleynik
Keyword(s):  
Decision Making ◽  
Empirical Evidence ◽  
Common Good ◽  
The State ◽  
Power Relationships ◽  
Individual Decision ◽  
Missed Opportunities ◽  
Power Domination ◽  
Individual Decision Making ◽  
Optimal Outcomes

Power involves a number of models of choice: maximizing, satisficing, coercion, and minimizing missed opportunities. The latter is explored in detail and linked to a particular type of power, domination by virtue of a constellation of interests. It is shown that domination by virtue of a constellation of interests calls for justification through references to a common good, i.e. a rent to be shared between Principal and Agent. Two sources of sub-optimal outcomes are compared: individual decision-making and interactions. Interactions organized in the form of power relationships lead to sub-optimal outcomes for at least one side, Agent. Some empirical evidence from Russia is provided for illustrative purposes.

STRATEGI MAKSIMALISASI ANGGARAN BELANJA PADA BALAI PENELITIAN DAN PENGEMBANGAN LINGKUNGAN HIDUP DAN KEHUTANAN MANOKWARI

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Arif Hasan ◽  
Dedi Budiman Hakim ◽  
Irdika Mansur
Keyword(s):  
Decision Making ◽  
Descriptive Analysis ◽  
Secondary Data ◽  
Primary Data ◽  
Fiscal Year ◽  
The Third ◽  
Swot Matrix ◽  
Three Stages ◽  
Using Data

This study aims to analyze causes of the low uptake of the budget and formulate a strategy of maximizing the absorption of expenditure on Balai Penelitian dan Pengembangan Lingkungan Hidup dan Kehutanan Manokwari. Respondents involved are 20 people that consist of: treasury officials and holder output of activity. The data used were secondary data in the form of reports on budget realization (LRA) quarter I, II, III and IV of the fiscal year 2011 to 2015, and the primary data were in the form of interviews with the help of a questionnaire. While the analysis of the data used was descriptive analysis using data tabulation, and the analysis of the three stages strategy of the decision making used IFE and EFE matrix, SWOT matrix and QSPM matrix.The results showed that there are 19 factors causing low of budget absorption until the end of the third quarter, and there were 10 drafts of policy as a strategy for maximizing the absorption of the budget on Balai Penelitian dan Pengembangan Lingkungan Hidup dan Kehutanan Manokwari.ABSTRAKPenelitian ini bertujuan untuk menganalisis penyebab rendahnya penyerapan anggaran belanja dan merumuskan strategi maksimalisasi penyerapan anggaran belanja pada Balai Penelitian dan Pengembangan Lingkungan Hidup dan Kehutanan Manokwari. Responden yang terlibat adalah 20 orang yaitu pejabat perbendaharaan dan pemegang output kegiatan. Data yang digunakan adalah data sekunder berupa laporan realisasi anggaran (LRA) triwulan I, II, III dan IV tahun anggaran 2011 sampai 2015, dan data primer berupa wawancara dengan bantuan kuesioner. Sedangkan analisis data yang digunakan adalah analisis deskriptif menggunakan analisis tabulasi, dan analisis analisis strategi tiga tahap pengambilan keputusan menggunakan matriks IFE dan EFE, matriks SWOT dan matriks QSPM. Hasil penelitian menunjukkan bahwa terdapat 19 faktor penyebab rendahnya penyerapan anggaran belanja sampai akhir triwulan III, dan terdapat 10 rancangan kebijakan sebagai strategi maksimalisasi penyerapan anggaran belanja di Balai Penelitian dan Pengembangan Lingkungan Hidup dan Kehutanan Manokwari.

Is the Deductive Falsification Approach a Better Basis for Clinical Trial Appraisal?

2019 ◽  
Vol 14 (3) ◽  
pp. 224-228
Author(s):  
Steffen Mickenautsch
Keyword(s):  
Clinical Trial ◽  
Decision Making ◽  
Empirical Evidence ◽  
Clinical Decision Making ◽  
Inductive Reasoning ◽  
Clinical Decision ◽  
Future Trial ◽  
Grading Systems ◽  
Component Scores ◽  
Current Clinical Trial

Background: Inductive reasoning relies on an infinite regress without sufficient factual basis and verification is at any time vulnerable to single contrary observation. Thus, appraisal based on inductive verification, as applied in current clinical trial appraisal scales, checklists or grading systems, cannot prove or justify trial validity. Discussion: Trial appraisal based on deductive falsification can identify invalid trials and give evidence for the recommendation to exclude these from clinical decision-making. Such appraisal remains agnostic towards corroborated trials that pass all appraisal criteria. The results of corroborated trials cannot be considered more robust than falsified trials since nothing within a particular set of complied trial criteria can give certainty for trial compliance with any other appraisal criterion in future. A corroborated trial may or may not reflect therapeutic truth and may thus be the basis for clinical guidance, pending results of any future trial re-appraisal. Conclusion: Trial grading following appraisal based on deductive falsification should be binary (0 = Invalid or 1 = Unclear) and single component scores should be multiplied. Appraisal criteria for the judgment of trial characteristics require a clear rationale, quantification of such rationale and empirical evidence concerning the effect of trial characteristics on trial results.

The use of a Domain Ontology for the Management of Essential Hypertension (Preprint)

2020 ◽  
Author(s):  
Emma Chavez ◽  
Vanessa Perez ◽  
Angélica Urrutia
Keyword(s):  
Decision Making ◽  
Essential Hypertension ◽  
Medical History ◽  
Medical Records ◽  
Medical Training ◽  
Relevant Information ◽  
Domain Ontology ◽  
Free Text ◽  
Snomed Ct ◽  
History Of

BACKGROUND : Currently, hypertension is one of the diseases with greater risk of mortality in the world. Particularly in Chile, 90% of the population with this disease has idiopathic or essential hypertension. Essential hypertension is characterized by high blood pressure rates and it´s cause is unknown, which means that every patient might requires a different treatment, depending on their history and symptoms. Different data, such as history, symptoms, exams, etc., are generated for each patient suffering from the disease. This data is presented in the patient’s medical record, in no order, making it difficult to search for relevant information. Therefore, there is a need for a common, unified vocabulary of the terms that adequately represent the diseased, making searching within the domain more effective. OBJECTIVE The objective of this study is to develop a domain ontology for essential hypertension , therefore arranging the more significant data within the domain as tool for medical training or to support physicians’ decision making will be provided. METHODS The terms used for the ontology were extracted from the medical history of de-identified medical records, of patients with essential hypertension. The Snomed-CT’ collection of medical terms, and clinical guidelines to control the disease were also used. Methontology was used for the design, classes definition and their hierarchy, as well as relationships between concepts and instances. Three criteria were used to validate the ontology, which also helped to measure its quality. Tests were run with a dataset to verify that the tool was created according to the requirements. RESULTS An ontology of 310 instances classified into 37 classes was developed. From these, 4 super classes and 30 relationships were obtained. In the dataset tests, 100% correct and coherent answers were obtained for quality tests (3). CONCLUSIONS The development of this ontology provides a tool for physicians, specialists, and students, among others, that can be incorporated into clinical systems to support decision making regarding essential hypertension. Nevertheless, more instances should be incorporated into the ontology by carrying out further searched in the medical history or free text sections of the medical records of patients with this disease.

A Comparative Analysis of Investor and Auditor Materiality Judgments

2018 ◽  
Vol 38 (3) ◽  
pp. 149-166 ◽  
Author(s):  
F. Todd DeZoort ◽  
Travis P. Holt ◽  
Jonathan D. Stanley
Keyword(s):  
Decision Making ◽  
Comparative Analysis ◽  
Empirical Evidence ◽  
Professional Standards ◽  
Policy Capturing ◽  
Cue Utilization ◽  
Critical Domain ◽  
Extant Literature

SUMMARY Materiality remains a challenging concept for auditors to implement in practice. The challenges underlying auditor materiality assessments are compounded by the fact that courts, regulation, and professional standards emphasize that materiality should be based on a “reasonable investor” perspective. Despite the investor orientation and ambiguous nature of the “reasonable investor” criterion, the extant literature lacks empirical evidence about investor materiality judgments and decision-making. To address this problem, we model sophisticated and unsophisticated investors' materiality judgments in a policy-capturing study and compare them to experienced auditors charged with assessing materiality from an investor perspective. The results indicate significant differences in materiality judgments, judgment consensus, and cue utilization among the three participant groups. We conclude the paper with discussion of the study's implications, highlighting that the overall results suggest the need for further consideration of ways to help auditors meet standards and expectations in this critical domain.

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