scholarly journals Supporting surgeons in patient-centred complex decision-making: a qualitative analysis of the impact of a perioperative physician clinic

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e033277
Author(s):  
Clarabelle T Pham ◽  
Catherine L Gibb ◽  
Robert A Fitridge ◽  
Jon Karnon ◽  
Elizabeth Hoon
Keyword(s):  
Decision Making ◽  
High Risk ◽  
Elective Surgery ◽  
Structured Interviews ◽  
Complex Patients ◽  
Complex Decision Making ◽  
Complex Decision ◽  
Additional Value ◽  
The Impact ◽  
High Risk Clinic

ObjectivePatients with comorbidities can be referred to a physician-led high-risk clinic for medical optimisation prior to elective surgery at the discretion of the surgical consultant, but the factors that influence this referral are not well understood. The aims of this study were to understand the factors that influence a surgeon’s decision to refer a patient to the clinic, and how the clinic impacts on the management of complex patients.DesignQualitative study using theoretical thematic analysis to analyse transcribed semi-structured interviews.SettingInterviews were held in either the surgical consultant’s private office or a quiet office/room in the hospital ward.ParticipantsSeven surgical consultants who were eligible to refer patients to the clinic.ResultsWhen discussing the factors that influence a referral to the clinic, all participants initially described the optimisation of comorbidities and would then discuss with examples the challenges with managing complex patients and communicating the risks involved with having surgery. When discussing the role of the clinic, two related subthemes were dominant and focused on the management of risk in complex patients. The participants valued the involvement of the clinic in the decision-making and communication of risks to the patient.ConclusionsThe integration of the high-risk clinic in this study appears to offer additional value in supporting the decision-making process for the surgical team and patient beyond the clinical outcomes. The factors that influence a surgeon’s decision to refer a patient to the clinic appear to be driven by the aim to manage the uncertainty and risk to the patient regarding surgery and it was seen as a strategy for managing difficult and complex cases.

Abstract TP310: Effect of an Extended Treatment Window on Transfer Times in Patients With Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Dawn K Beland ◽  
Ilene Staff ◽  
Jenna Beckwith ◽  
Amre Nouh
Keyword(s):  
Decision Making ◽  
Process Of Care ◽  
Patient Demographics ◽  
Complex Decision Making ◽  
Complex Decision ◽  
Stroke Type ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
The Impact ◽  
Transfer Times

STK-OP-1 examines transfer times for patients going to a higher level of care. Known as door in, door out or DIDO, certified stroke centers are required to report times for both ischemic and hemorrhagic stroke patients transferred to a Primary or Comprehensive Stroke Center (CSC). Purpose: Barriers to time-sensitive transfer and complex decision making are common. As a result, Hartford Healthcare (HHC) began a QI initiative to measure DIDO times while introducing advanced CTP imaging and treatment in the extended window, April 2018. This project evaluates the impact on DIDO. Methods: This multi-center QI project evaluated data pre and post implementation for stroke transfers to the CSC. Pre-implementation was May 2017 to April 2018, post-implementation May 2018 to March 2019. Patient and process of care data abstracted from Epic was entered into Excel. The main analysis compared median DIDO times using Wilcoxon Ranked Sum. Results: Data were collected on hospital, stroke type/severity and treatments administered; patient demographics, and key timing variables of door in/door out, EMS and CT. While there is no universal criterion for DIDO, 60 minutes is often the ultimate goal with 90 or 120 minutes as intermediate goals. Pre and post implementation median DIDO times for all hospitals were 117 and 139 minutes (p = 0.02), for HHC hospitals 115 and 137 minutes (p = 0.027) and for non-HHC hospitals 118 and 140.5 minutes (p = 0.423). Of the pre-implementation group, 7.8% had CTP imaging prior to transfer compared with 9.3% post. Extended times post-implementation include factors such as complex decision making, patient eligibility or hospital capacity issues. A new transfer algorithm was implemented April 2019. Future analyses will correlate DIDO with patient, stroke and treatment categories to better define delays and barriers. Relevance: A JC directive to CSCs are to develop supportive relationships with referring hospitals to facilitate efficient care. As decision making becomes more complex, the process for transfer needs to improve. DIDO goals need to be realistic to prevent secondary imaging at the CSC, i.e. the tradeoff for an extra 15 or 20 minutes should translate into shorter door to puncture times. Reducing the time to treatment may help improve patient outcomes.

scholarly journals GPs’ insights about discontinuing long-term antidepressant use: a qualitative study

2021 ◽  
pp. BJGP.2020.0913
Author(s):  
Maria Donald ◽  
Riitta Partanen ◽  
Leah Sharman ◽  
Johanna Lynch ◽  
Genevieve A Dingle ◽  
...  
Keyword(s):  
Decision Making ◽  
Prescribing Practices ◽  
Structured Interviews ◽  
Relational Context ◽  
Qualitative Interview Study ◽  
Complex Decision Making ◽  
Complex Decision ◽  
Antidepressant Use ◽  
Set Up

Background: There is considerable concern about increasing antidepressant use, with Australians among the highest users in the world. Evidence suggests this is driven by patients on long-term rather than new prescriptions. Most antidepressant prescriptions are generated in general practice and it is likely that attempts to discontinue are either not occurring or are proving unsuccessful. Aim: To explore GPs’ insights about long-term antidepressant prescribing. Design and Setting: A qualitative interview study with Australian GPs. Method: Semi-structured interviews explored GPs’ discontinuation experiences, decision-making, perceived risks and benefits, and support for patients. Data were analysed using reflexive thematic analysis. Results: Three overarching themes were identified from interviews with 22 GPs. The first, ‘Not a simple deprescribing decision’, speaks to the complex decision-making GPs undertake in determining whether a patient is ready to discontinue. The second, ‘A journey taken together’ captures a set of steps GPs take together with their patients to initiate and set-up adequate support before, during and after discontinuation. The third: ‘Supporting change in GPs’ prescribing practices’ describes what GPs would like to see change to better support them and their patients to discontinue antidepressants. Conclusions: GPs see discontinuation of long-term antidepressant use as more than a simple deprescribing decision. It begins with considering a patients’ social and relational context and is a journey involving careful preparation, tailored care and regular review. These insights suggest interventions to redress long-term use will need to take these considerations into account and be placed in a wider discussion about the use of antidepressants.

Examining the Impact of Training and Feedback on Visualization-Supported Decision Making under Uncertainty

2018 ◽  
Vol 62 (1) ◽  
pp. 1449-1453
Author(s):  
Jihye Song ◽  
Olivia B. Newton ◽  
Stephen M. Fiore ◽  
Jonathan Coad ◽  
Jared Clark ◽  
...  
Keyword(s):  
Decision Making ◽  
Ecological Validity ◽  
Critical Role ◽  
Decision Making Under Uncertainty ◽  
Cognitive Efficiency ◽  
Training Interventions ◽  
Complex Decision Making ◽  
Complex Decision ◽  
Task Training ◽  
The Impact

Empirical evaluations of uncertainty visualizations often employ complex experimental tasks to ensure ecological validity. However, if training for such tasks is not sufficient for naïve participants, differences in performance could be due to the visualizations or to differences in task comprehension, making interpretation of findings problematic. Research has begun to assess how training is related to performance on decision-making tasks using uncertainty visualizations. This study continues this line of research by investigating how training, in general, and feedback, in particular, affect performance on a simulated resource allocation task. Additionally, we examined how this alters metacognition and workload to produce differences in cognitive efficiency. Our results suggest that, on a complex decision-making task, training plays a critical role in performance with respect to accuracy, subjective workload, and cognitive efficiency. This study has implications for improving research on complex decision making, and for designing more efficacious training interventions to assess uncertainty visualizations.

scholarly journals How Does Part-Time Farming Affect Farmers’ Adoption of Conservation Agriculture in Jianghan Plain, China?

2020 ◽  
Vol 17 (16) ◽  
pp. 5983
Author(s):  
Xin Yang ◽  
Yiming Sang
Keyword(s):  
Decision Making ◽  
Conservation Agriculture ◽  
Positive Influence ◽  
Jianghan Plain ◽  
The Sustainable Development ◽  
Multivariate Logistic Model ◽  
Part Time ◽  
Complex Decision Making ◽  
Complex Decision ◽  
The Impact

Part-time farming has been suggested by scholars to play an important part in farmers’ decision making, but seldom empirical evidence has been done on the field of conservation agriculture (CA) technology adoption worldwide. Based on the field survey data of 433 farmers in Jianghan Plain, China, this paper estimate the impact of part-time farming on farmers’ adoption of CA technology by applying the multivariate logistic model. The results show that 91.92% of the farmers adopted CA technology. Part-time farming had a highly significant positive influence on the likelihood of adoption. Moreover, the impact degree increased along with the deepening of part-time farming. In addition, farmers’ adoption behaviors were affected by gender, contracted land area, economic welfare cognition and social welfare cognition. Our results help to understand farmers’ complex decision-making on farmland and to promote the sustainable development of agriculture in Jianghan Plain. A somewhat targeted approach to design policies to support technological, policy and institutional interventions to encourage farmers to engage in part-time farming are recommended, especially in areas that share similar edaphic and climatic characteristics with Jianghan Plain.

scholarly journals Longshot or Favorite: The Ending Effect in Investment Decisions

2021 ◽  
Vol 12 ◽  
Author(s):  
Qi Wang ◽  
JiaYuan Zhang ◽  
Cai Xing
Keyword(s):  
Decision Making ◽  
High Risk ◽  
Risk Taking ◽  
Past Research ◽  
Psychological Consequences ◽  
Risky Decision ◽  
Risk Levels ◽  
Safe Option ◽  
Complex Decision Making ◽  
Complex Decision

The ending effect describes the phenomenon that at the end of a series of repeated risky decision-making tasks, participants become more likely to engage in risk-taking behavior. Past research has suggested that the ending effect might be caused by a motivational shift induced by changes in time perception. Previous studies mainly tested this phenomenon in a binary decision-making setting (e.g., a decision-making task usually includes two alternatives). However, none of these prior studies included safe options and risky options that differed in risk levels. To address this knowledge gap, the present study replicated the ending effect in a repeated decision-making task that included both a safe option and risky options that differed in risk levels (N = 104). We found that at the end of the decision-making task, participants became more likely to engage in risk-taking and to favor the option with the highest risk. Further, we found that the investment likelihood and investment amount of high-risk options both increased significantly at the ending. In addition, a shift in favoring the safe option emerged in the noninformed condition at the end. We also found that the emotional motivation in the last round could predict the increased preference for high-risk at the ending. This study extended previous findings on the ending effect by adopting a more complex decision-making scenario and, more broadly, helped further our understanding of the psychological consequences of perceived endings.

Exploring Complex Decision Making Units: A New Approach

1982 ◽  
Vol 19 (2) ◽  
pp. 182-191 ◽  
Author(s):  
Rowland T. Moriarty ◽  
John E. G. Bateson
Keyword(s):  
Decision Making ◽  
Large Scale ◽  
Empirical Studies ◽  
Single Stage ◽  
New Approach ◽  
Second Stage ◽  
Decision Making Unit ◽  
Complex Decision Making ◽  
Complex Decision ◽  
The Impact

Though the concept of a multiperson decision making unit (DMU) has been widely accepted in principle, very few empirical studies have surveyed all members of the DMU. In those few studies which have surveyed multiple decision participants, data were collected via “snowball” personal interviews. In a single-stage snowball a known member of the DMU is asked to provide a list of other persons involved in the decision making process. That list is used for a subsequent study. Multiple-stage snowballing involves asking all of the respondents in the first stage who else was in the DMU, then those in the second stage, and so on. Exhaustive snowballing involves continuing the process until no new DMU members are generated. As snowball personal interveiws are an extremely expensive method of collecting data, large-scale DMU research has been financially impractical for most empirical studies. A study of 319 DMUs was designed to assess the feasibility of snowballing by telephone and to ascertain the impact of exhaustive versus single-stage snowballing on the nature of the resultant DMU.

Think, blink or sleep on it? The impact of modes of thought on complex decision making

2009 ◽  
Vol 62 (4) ◽  
pp. 707-732 ◽  
Author(s):  
Ben R. Newell ◽  
Kwan Yao Wong ◽  
Jeremy C. H. Cheung ◽  
Tim Rakow
Keyword(s):  
Decision Making ◽  
Thought Processes ◽  
Unconscious Thought ◽  
Attribute Weighting ◽  
Final Experiment ◽  
Complex Decision Making ◽  
Complex Decision ◽  
Modes Of Thought ◽  
The Impact

This paper examines controversial claims about the merit of “unconscious thought” for making complex decisions. In four experiments, participants were presented with complex decisions and were asked to choose the best option immediately, after a period of conscious deliberation, or after a period of distraction (said to encourage “unconscious thought processes”). In all experiments the majority of participants chose the option predicted by their own subjective attribute weighting scores, regardless of the mode of thought employed. There was little evidence for the superiority of choices made “unconsciously”, but some evidence that conscious deliberation can lead to better choices. The final experiment suggested that the task is best conceptualized as one involving “online judgement” rather than one in which decisions are made after periods of deliberation or distraction. The results suggest that we should be cautious in accepting the advice to “stop thinking” about complex decisions.

Applying design thinking to the decision-making process: a field study in Swedish local authorities

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Jane Elisabeth Frisk ◽  
Frank Bannister
Keyword(s):  
Decision Making ◽  
Local Government ◽  
Design Thinking ◽  
Structured Interviews ◽  
Local Authorities ◽  
Content Type ◽  
Decision Making Processes ◽  
Complex Decision Making ◽  
Complex Decision

PurposeThis study aims to examine the application of design thinking to complex decision-making processes in local government and to link the design thinking to the theoretical work of leading thinkers in decision-making.Design/methodology/approachThis study uses multiple case studies, including non-participant observation, group discussions, semi-structured interviews, presentations and questionnaires.FindingsFor complex decisions, design thinking can contribute to more effective decision-making by expanding the range of solutions considered, people consulted and involved, sources of data/information and decision tools as well as in achieving buy-in to the eventual decision.Research limitations/implicationsThe principal limitations include that this is one study in one country and in the public sector. There were some practical problems with external factors disrupting two of the cases, but these do not affect the findings. The principal implication is that by adopting a design thinking approach to complex decision-making, the quality of decision-making and decisions can be significantly improved.Practical implicationsWhen it comes to complex decisions, organisations can improve the quality of both their decision-making processes and their decisions by adopting and implementing ideas and insights from design thinking.Social implicationsFor local authorities, a design approach can enhance the quality of the services provided by local authorities to citizens in particular in better meeting the needs of users and other stakeholders and in opening up better lines of communications between officials and citizens.Originality/valueThis research was based on an initiative in Swedish local government and its first implementation in practice. The authors are not aware of any similar study done elsewhere.

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