scholarly journals Weight of Evidence: Participatory Methods and Bayesian Updating to Contextualize Evidence Synthesis in Stakeholders’ Knowledge

2021 ◽  
pp. 155868982110374
Author(s):  
Anna Dion ◽  
Alessandro Carini-Gutierrez ◽  
Vania Jimenez ◽  
Amal Ben Ameur ◽  
Emilie Robert ◽  
...  
Keyword(s):  
Decision Making ◽  
Mixed Methods Research ◽  
Cognitive Mapping ◽  
Evidence Synthesis ◽  
Perinatal Care ◽  
Family Physicians ◽  
Weight Of Evidence ◽  
Participatory Methods ◽  
Valid Knowledge ◽  
Context Specific

Mixed methods research is well-suited to grapple with questions of what counts as valid knowledge across different contexts and perspectives. This article introduces Weight of Evidence as a transformative procedure for stakeholders to interpret, expand on and prioritize evidence from evidence syntheses, with a focus on engaging populations historically excluded from planning and decision making. This article presents the procedure’s five steps using pilot data on perinatal care of immigrant women in Canada, engaging family physicians and birth companions. Fuzzy cognitive mapping offers an accessible and systematic way to generate priors to update published literature with stakeholder priorities. Weight of Evidence is a transparent procedure to broaden what counts as expertise, contributing to a more comprehensive, context-specific, and actionable understanding.

scholarly journals Cognitive mapping as an approach to facilitate organ donation among African Americans

2021 ◽  
Vol 104 (3) ◽  
pp. 003685042110294
Author(s):  
Jayme E Locke ◽  
Rhiannon D Reed ◽  
Richard M Shewchuk ◽  
Katherine L Stegner ◽  
Haiyan Qu
Keyword(s):  
Decision Making ◽  
African Americans ◽  
Organ Donation ◽  
Cognitive Mapping ◽  
The United States ◽  
Two Dimensions ◽  
Nominal Group ◽  
Solid Organ ◽  
Related Information ◽  
Empirical Framework

Making up 13.4% of the United States population, African Americans (AAs) account for 28.7% of candidates who are currently waiting for an organ donation. AAs are disproportionately affected by end-organ disease, particularly kidney disease, therefore, the need for transplantation among this population is high, and the high need is also observed for other solid organ transplantation. To this end, we worked with the AA community to derive an empirical framework of organ donation strategies that may facilitate AA decision-making. We used a cognitive mapping approach involving two distinct phases of primary data collection and a sequence of data analytic procedures to elicit and systematically organize strategies for facilitating organ donation. AA adults ( n = 89) sorted 27 strategies identified from nominal group technique meetings in phase 1 based on their perceived similarities. Sorting data were aggregated and analyzed using Multidimensional scaling and hierarchical cluster analyses. Among 89 AA participants, 68.2% were female, 65.5% obtained > high school education, 69.5% reported annual household income ≤ $50,000. The average age was 47.4 years (SD = 14.5). Derived empirical framework consisted of five distinct clusters: fundamental knowledge, psychosocial support, community awareness, community engagement, and system accountability; and two dimensions: Approach, Donor-related Information. The derived empirical framework reflects an organization scheme that may facilitate AA decision-making about organ donation and suggests that targeted dissemination of donor-related information at both the individual-donor and community levels may be critical for increasing donation rates among AAs.

scholarly journals Developing a model Fracture Liaison Service consultation with patients, carers and clinicians: a Delphi survey to inform content of the iFraP complex consultation intervention

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Laurna Bullock ◽  
Fay Crawford-Manning ◽  
Elizabeth Cottrell ◽  
Jane Fleming ◽  
Sarah Leyland ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Evidence Synthesis ◽  
Fracture Prevention ◽  
Fracture Liaison Service ◽  
Delphi Survey ◽  
Shared Decision ◽  
Secondary Fracture ◽  
Drug Treatments ◽  
Fracture Liaison

Abstract Summary Fracture Liaison Services are recommended to deliver best practice in secondary fracture prevention. This modified Delphi survey, as part of the iFraP (Improving uptake of Fracture Prevention drug Treatments) study, provides consensus regarding tasks for clinicians in a model Fracture Liaison Service consultation. Purpose The clinical consultation is of pivotal importance in addressing barriers to treatment adherence. The aim of this study was to agree to the content of the ‘model Fracture Liaison Service (FLS) consultation’ within the iFraP (Improving uptake of Fracture Prevention drug Treatments) study. Methods A Delphi survey was co-designed with patients and clinical stakeholders using an evidence synthesis of current guidelines and content from frameworks and theories of shared decision-making, communication and medicine adherence. Patients with osteoporosis and/or fragility fractures, their carers, FLS clinicians and osteoporosis specialists were sent three rounds of the Delphi survey. Participants were presented with potential consultation content and asked to rate their perception of the importance of each statement on a 5-point Likert scale and to suggest new statements (Round 1). Lowest rated statements were removed or amended after Rounds 1 and 2. In Round 3, participants were asked whether each statement was ‘essential’ and percentage agreement calculated; the study team subsequently determined the threshold for essential content. Results Seventy-two, 49 and 52 patients, carers and clinicians responded to Rounds 1, 2 and 3 respectively. One hundred twenty-two statements were considered. By Round 3, consensus was reached, with 81 statements deemed essential within FLS consultations, relating to greeting/introductions; gathering information; considering therapeutic options; eliciting patient perceptions; establishing shared decision-making preferences; sharing information about osteoporosis and treatments; checking understanding/summarising; and signposting next steps. Conclusions This Delphi consensus exercise has summarised for the first time patient/carer and clinician consensus regarding clearly defined tasks for clinicians in a model FLS consultation.

scholarly journals Digital health interventions in palliative care: a systematic meta-review

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Anne M. Finucane ◽  
Hannah O’Donnell ◽  
Jean Lugton ◽  
Tilly Gibson-Watt ◽  
Connie Swenson ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Systematic Reviews ◽  
Psychological Symptoms ◽  
Digital Health ◽  
Evidence Synthesis ◽  
Information Provision ◽  
Health Interventions ◽  
Meta Review

AbstractDigital health interventions (DHIs) have the potential to improve the accessibility and effectiveness of palliative care but heterogeneity amongst existing systematic reviews presents a challenge for evidence synthesis. This meta-review applied a structured search of ten databases from 2006 to 2020, revealing 21 relevant systematic reviews, encompassing 332 publications. Interventions delivered via videoconferencing (17%), electronic healthcare records (16%) and phone (13%) were most frequently described in studies within reviews. DHIs were typically used in palliative care for education (20%), symptom management (15%), decision-making (13%), information provision or management (13%) and communication (9%). Across all reviews, mostly positive impacts were reported on education, information sharing, decision-making, communication and costs. Impacts on quality of life and physical and psychological symptoms were inconclusive. Applying AMSTAR 2 criteria, most reviews were judged as low quality as they lacked a protocol or did not consider risk of bias, so findings need to be interpreted with caution.

OP179 Quantitative Evidence Synthesis Methods For Assessing The Effectiveness Of Treatment Sequences For Clinical And Economic Decision-Making: Methodology Review

2021 ◽  
Vol 37 (S1) ◽  
pp. 4-4
Author(s):  
Ruth Lewis ◽  
Dyfrig Hughes ◽  
Alex Sutton ◽  
Clare Wilkinson
Keyword(s):  
Decision Making ◽  
Chronic Conditions ◽  
Evidence Synthesis ◽  
Policy Decision ◽  
Clinical Effectiveness ◽  
Synthesis Methods ◽  
Economic Decision Making ◽  
Treatment Sequencing ◽  
Policy Decision Making ◽  
Treatment Sequences

IntroductionThe sequential use of alternative treatments for chronic conditions represents a complex, dynamic intervention pathway; previous treatment and patient characteristics affect both choice and effectiveness of subsequent treatments. Evidence synthesis methods that produce the least biased estimates of treatment-sequencing effects are required to inform reliable clinical and policy decision-making. A comprehensive review was conducted to establish what existing methods are available, outline the assumptions they make, and identify their shortcomings.MethodsThe review encompassed both meta-analytic techniques and decision-analytic modelling, any disease condition, and any type of treatment sequence, but not diagnostic tests, screening, or treatment monitoring. It focused on the estimation of clinical effectiveness and did not consider the impact of treatment sequencing on the estimation of costs or utility values.ResultsThe review included ninety-one studies. Treatment-sequencing is usually dealt with at the decision-modelling stage and is rarely addressed using evidence synthesis methodology for clinical effectiveness. Most meta-analyses are of discrete treatments, sometimes stratified by line of therapy. Prospective sequencing trials are scarce. In their absence, there is no single best way to evaluate treatment sequences, rather there is a range of approaches, each of which has advantages and disadvantages and is influenced by the evidence available and the decision problem. Due to the scarcity of data on sequential treatments, modelling studies generally apply simplifying assumptions to data on discrete treatments. A taxonomy for all possible assumptions was developed, providing a unique resource to aid the critique of decision-analytic models.ConclusionsThe evolution of network meta-analysis in HTA demonstrates that clinical and policy decision-making should account for the multiple treatments available for many chronic conditions. However, treatment-sequencing has yet to be accounted for within clinical evaluations. Economic modelling is often based on the simplifying assumption of treatment independence. This can lead to misrepresentation of the true level of uncertainty, potential bias in estimating the effectiveness and cost effectiveness of treatments and, eventually, the wrong decision.

Generating Options and Choosing Between Them Depend on Distinct Forms of Value Representation

2021 ◽  
pp. 095679762110057
Author(s):  
Adam Morris ◽  
Jonathan Phillips ◽  
Karen Huang ◽  
Fiery Cushman
Keyword(s):  
Decision Making ◽  
Real World ◽  
Hybrid Architecture ◽  
Important Challenge ◽  
Current Context ◽  
Context Specific ◽  
Enormous Number ◽  
Value Representation

Humans have a remarkable capacity for flexible decision-making, deliberating among actions by modeling their likely outcomes. This capacity allows us to adapt to the specific features of diverse circumstances. In real-world decision-making, however, people face an important challenge: There are often an enormous number of possibilities to choose among, far too many for exhaustive consideration. There is a crucial, understudied prechoice step in which, among myriad possibilities, a few good candidates come quickly to mind. How do people accomplish this? We show across nine experiments ( N = 3,972 U.S. residents) that people use computationally frugal cached value estimates to propose a few candidate actions on the basis of their success in past contexts (even when irrelevant for the current context). Deliberative planning is then deployed just within this set, allowing people to compute more accurate values on the basis of context-specific criteria. This hybrid architecture illuminates how typically valuable thoughts come quickly to mind during decision-making.

Living class in a ‘meritocratic’ Australia: The burdens of class and choice on young people’s end-of-school transitions

2017 ◽  
Vol 54 (3) ◽  
pp. 396-411 ◽  
Author(s):  
Felix Donovan
Keyword(s):  
High School ◽  
Decision Making ◽  
High School Students ◽  
Young People ◽  
Educational Outcomes ◽  
Mixed Methods Research ◽  
School Transitions ◽  
School Students ◽  
Australian Education

In the Australian education system, there are substantial class inequalities in educational outcomes and transitions. These inequalities persist despite increased choice and individual opportunity for young people. This article explores high school students’ experiences of class in a social context they largely believe to be a meritocracy. Specifically, it asks: how does class shape young people’s thinking and decision-making about their post-school futures? I use Bourdieu’s ‘habitus’ as a frame to understand the role of class in young people’s lives, stressing its generative and heterogeneous aspects. Drawing on qualitative-led mixed methods research, this article argues that young people have internalised the ‘doxa’ of meritocracy, agency and ambition, conceiving of themselves as individual agents in this context. However, risk and security, opportunities and constraints, are not distributed equally in a class-stratified society. Young people from working-class backgrounds more commonly imagine insecure, uncertain futures.

scholarly journals Social work in municipalities

2013 ◽  
Vol 8 (1) ◽  
pp. 71-94
Author(s):  
Rolv Lyngstad
Keyword(s):  
Decision Making ◽  
Social Work ◽  
Wide Sense ◽  
Professional Discretion ◽  
Local Decision ◽  
Local Discretion ◽  
Specific Meaning ◽  
Local Decision Making ◽  
Context Specific ◽  
The Relationship

The point of departure of this article is contemporary changes in the relationship between national and local decision making in the Norwegian political system. The last decades’ centralization tendencies seem to be challenged by a “new” emphasis on local discretion, and the article discusses how this will affect social work in municipalities. The changes are contested and controversial and allude to questions such as how much discretion should be given to local decision makers in the name of local democracy, and how much difference should be accepted in the name of diversity? The article argues that professional social work must be context-specific, meaning that in a wide sense local knowledge is a prerequisite for good social work. Devolution and local political and professional discretion are necessary in many cases, but not sufficient in themselves as conditions for success. Professional social workers will encounter a lot of difficult dilemmas arousing from issues related to the equality/liberty debate and the diversity/difference/equality debate in social work discourses. In order to approach these dilemmas, more of a focus on local deliberation and place shaping, in combination with a social work focus on democratic professionalism, is necessary. If this is done successfully, devolution and a recapturing of local discretion and decision-making power will empower clients as well as professionals. Thus, current changes in the relationship between different levels of decision making will enlarge the possibilities for professional social work in the municipalities.

Target Detection by Opponent Coding in Monkey Prefrontal Cortex

2010 ◽  
Vol 22 (4) ◽  
pp. 751-760 ◽  
Author(s):  
Makoto Kusunoki ◽  
Natasha Sigala ◽  
Hamed Nili ◽  
David Gaffan ◽  
John Duncan
Keyword(s):  
Decision Making ◽  
Target Detection ◽  
Neural Model ◽  
Stimulus Onset ◽  
Stimulus Category ◽  
Flexible Control ◽  
Cell Groups ◽  
Show Evidence ◽  
Context Specific ◽  
Monkey Prefrontal Cortex

The pFC plays a key role in flexible, context-specific decision making. One proposal [Machens, C. K., Romo, R., & Brody, C. D. Flexible control of mutual inhibition: A neural model of two-interval discrimination. Science, 307, 1121–1124, 2005] is that prefrontal cells may be dynamically organized into opponent coding circuits, with competitive groups of cells coding opposite behavioral decisions. Here, we show evidence for extensive, temporally evolving opponent organization in the monkey pFC during a cued target detection task. More than a half of all randomly selected cells discriminated stimulus category in this task. The largest set showed target-positive activity, with the strongest responses to the current target, intermediate activity for a nontarget that was a target on other trials, and lowest activity for nontargets never associated with the target category. Second most frequent was a reverse, antitarget pattern. In the ventrolateral frontal cortex, opponent organization was strongly established in phasic responses at stimulus onset; later, such activity was widely spread across dorsolateral and ventrolateral sites. Task-specific organization into opponent cell groups may be a general feature of prefrontal decision making.

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