scholarly journals Participatory Bullseye Toolkit Interview: Identifying Physicians’ Relative Prioritization of Decision Factors When Ordering Radiologic Imaging in a Hospital Setting

2018 ◽  
Vol 7 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Michael F. Rayo ◽  
Chandni Pawar ◽  
Elizabeth B.-N. Sanders ◽  
Beth W. Liston ◽  
Emily S. Patterson
Keyword(s):  
Decision Making ◽  
Participatory Design ◽  
Cognitive Task ◽  
Hospital Setting ◽  
Patient Comfort ◽  
Diagnostic Efficacy ◽  
Decision Factors ◽  
Resident Physicians ◽  
Radiologic Imaging ◽  
Decision Making Factors

Critical Decision Method (CDM), a popular cognitive task analysis (CTA) method, is an in-depth retrospective interview that uses a historical non-routine incident to identify experts’ decision-making factors in complex socio-technical settings with high consequences for failure. However, it is challenging to use CDM to make comparisons, including those between experts and trainees. We describe an alternative CTA method used to study physicians’ decision making for ordering diagnostic imaging. After being primed with 11 simulated patient scenarios, nine attending and 11 resident physicians were asked to map out and present their decision-making process with a bullseye participatory design toolkit. Interviews were analyzed qualitatively, revealing four common decision factors: diagnostic efficacy, patient safety, organizational constraints, and patient comfort. The bullseye maps were used to quantitatively measure priority differences between these decision factors. Attending and resident physicians both prioritized diagnostic efficacy over the other factors (2.38 vs. 3.71, p <.01, and 2.59 vs. 3.52, p<.01, respectively), but attending physicians’ decisions had a higher proportion of non-diagnostic items (65% vs. 50%, p = .008). Our results demonstrate the usefulness of this method in eliciting decision factors for a complex, face-valid task and for identifying differences due to levels of expertise and training.

scholarly journals Hybrid Analysis of the Decision-Making Factors for Software Upgrade Based on the Integration of AHP and DEMATEL

Symmetry ◽  
2022 ◽  
Vol 14 (1) ◽  
pp. 172
Author(s):  
Dosung Kim ◽  
Mi Kim
Keyword(s):  
Decision Making ◽  
Information Systems ◽  
Industrial Revolution ◽  
Organizational Level ◽  
It Professionals ◽  
Decision Factors ◽  
Related Information ◽  
Decision Making Factors ◽  
Software Upgrade ◽  
Relationship Of

Software is a very important part to implement advanced information systems, such as AI and IoT based on the latest hardware equipment of the fourth Industrial Revolution. In particular, decision making for software upgrade is one of the essential processes that can solve problems for upgrading the information systems. However, most of the decision-making studies for this purpose have been conducted only from the perspective of the IT professional and management position. Moreover, software upgrade can be influenced by various layers of decision makers, so further research is needed. Therefore, it is necessary to conduct research on what factors are required and affect the decision making of software upgrade at various layers of organization. For this purpose, decision factors of software upgrade are identified by literature review in this study. Additionally, the priority, degree of influence and relationship between the factors are analyzed by using the AHP and DEMATEL techniques at the organizational level of users, managers and IT professionals. The results show that the priority, weight value, causal relationship of decision factors of users, managers and IT professionals who constitute the organizational level were very different. The managers first considered the benefits, such as ROI, for organization as a leader. The users tended to consider their work efficiency and changes due to the software upgrade first. Finally, the IT professionals considered ROI, budget and compatibility for the aspect of the managers and users. Therefore, the related information of each organizational level can be presented more clearly for the systematic and symmetrical decision making of software upgrade based on the results of this study.

Age-Related Differences in Motivational Integration and Cognitive Control

2019 ◽  
Author(s):  
Debbie Marianne Yee ◽  
Sarah L Adams ◽  
Asad Beck ◽  
Todd Samuel Braver
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Cognitive Control ◽  
Task Performance ◽  
Cognitive Task ◽  
Monetary Reward ◽  
Potential Candidate ◽  
Younger Adults ◽  
Age Related ◽  
Cognitive Task Performance

Motivational incentives play an influential role in value-based decision-making and cognitive control. A compelling hypothesis in the literature suggests that the brain integrates the motivational value of diverse incentives (e.g., motivational integration) into a common currency value signal that influences decision-making and behavior. To investigate whether motivational integration processes change during healthy aging, we tested older (N=44) and younger (N=54) adults in an innovative incentive integration task paradigm that establishes dissociable and additive effects of liquid (e.g., juice, neutral, saltwater) and monetary incentives on cognitive task performance. The results reveal that motivational incentives improve cognitive task performance in both older and younger adults, providing novel evidence demonstrating that age-related cognitive control deficits can be ameliorated with sufficient incentive motivation. Additional analyses revealed clear age-related differences in motivational integration. Younger adult task performance was modulated by both monetary and liquid incentives, whereas monetary reward effects were more gradual in older adults and more strongly impacted by trial-by-trial performance feedback. A surprising discovery was that older adults shifted attention from liquid valence toward monetary reward throughout task performance, but younger adults shifted attention from monetary reward toward integrating both monetary reward and liquid valence by the end of the task, suggesting differential strategic utilization of incentives. Together these data suggest that older adults may have impairments in incentive integration, and employ different motivational strategies to improve cognitive task performance. The findings suggest potential candidate neural mechanisms that may serve as the locus of age-related change, providing targets for future cognitive neuroscience investigations.

scholarly journals Embodied Ethical Decision-Making: A Clinical Case Study of Respect for Culturally Based Meaning Making in Mental Healthcare

2021 ◽  
Author(s):  
Megz Roberts
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Health Treatment ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Meaning Making ◽  
Hospital Setting ◽  
Mental Healthcare ◽  
Clinical Case Study ◽  
Culturally Based

AbstractHow does embodied ethical decision-making influence treatment in a clinical setting when cultural differences conflict? Ethical decision-making is usually a disembodied and rationalized procedure based on ethical codes (American Counseling Association, 2014; American Dance Therapy Association, 2015; American Mental Health Counseling Association, 2015) and a collective understanding of right and wrong. However, these codes and collective styles of meaning making were shaped mostly by White theorists and clinicians. These mono-cultural lenses lead to ineffective mental health treatment for persons of color. Hervey’s (2007) EEDM steps encourage therapists to return to their bodies when navigating ethical dilemmas as it is an impetus for bridging cultural differences in healthcare. Hervey’s (2007) nonverbal approach to Welfel’s (2001) ethical decision steps was explored in a unique case that involved the ethical decision-making process of an African-American dance/movement therapy intern, while providing treatment in a westernized hospital setting to a spiritual Mexican–American patient diagnosed with PTSD and generalized anxiety disorder. This patient had formed a relationship with a spirit attached to his body that he could see, feel, and talk to, but refused to share this experience with his White identifying psychiatric nurse due to different cultural beliefs. Information gathered throughout the clinical case study by way of chronological loose and semi-structured journaling, uncovered an ethical dilemma of respect for culturally based meanings in treatment and how we identify pathology in hospital settings. The application of the EEDM steps in this article is focused on race/ethnicity and spiritual associations during mental health treatment at an outpatient hospital setting. Readers are encouraged to explore ways in which this article can influence them to apply EEDM in other forms of cultural considerations (i.e. age) and mental health facilities. The discussion section of this thesis includes a proposed model for progressing towards active multicultural diversity in mental healthcare settings by way of the three M’s from the relational-cultural theory: movement towards mutuality, mutual empathy, and mutual empowerment (Hartling & Miller, 2004).

From detente to containment: the emergence of Iran's new Saudi strategy

2021 ◽  
Author(s):  
Hassan Ahmadian ◽  
Payam Mohseni
Keyword(s):  
Decision Making ◽  
Saudi Arabia ◽  
Middle East ◽  
Strategic Decision ◽  
Key Factors ◽  
Peace And Conflict ◽  
Key Factor ◽  
Decision Making Factors ◽  
Containment Strategy ◽  
The Persian Gulf

Abstract Iran's strategy with respect to Saudi Arabia is a key factor in the complex balance of power of the Middle East as the Iranian–Saudi rivalry impacts the dynamics of peace and conflict across the region from Yemen to Syria, Lebanon, Iraq and Bahrain. What is Iranian strategic thinking on Saudi Arabia? And what have been the key factors driving the evolution of Iranian strategy towards the Kingdom? In what marks a substantive shift from its previous detente policy, we argue that Tehran has developed a new containment strategy in response to the perceived threat posed by an increasingly prox-active Saudi Arabia in the post-Arab Spring period. Incorporating rich fieldwork and interviews in the Middle East, this article delineates the theoretical contours of Iranian containment and contextualizes it within the framework of the Persian Gulf security architecture, demonstrating how rational geopolitical decision-making factors based on a containment strategy, rather than the primacy of sectarianism or domestic political orientations, shape Iran's Saudi strategy. Accordingly, the article traces Iranian strategic decision-making towards the Kingdom since the Islamic Revolution of 1979 and examines three cases of Iran's current use of containment against Saudi Arabia in Syria, Yemen and Qatar.

scholarly journals Determinants of Managed Entry Agreements in the context of Health Technology Assessment: a comparative analysis of oncology therapies in four countries

2021 ◽  
Vol 37 ◽  
Author(s):  
Olina Efthymiadou ◽  
Panos Kanavos
Keyword(s):  
Decision Making ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Best Practice ◽  
Health Technology ◽  
Future Research ◽  
Best Practice Guidelines ◽  
Chi Squared ◽  
Decision Making Factors ◽  
Managed Entry Agreements

Abstract Background Managed Entry Agreements (MEAs) are increasingly used to address uncertainties arising in the Health Technology Assessment (HTA) process due to immature evidence of new, high-cost medicines on their real-world performance and cost-effectiveness. The literature remains inconclusive on the HTA decision-making factors that influence the utilization of MEAs. We aimed to assess if the uptake of MEAs differs between countries and if so, to understand which HTA decision-making criteria play a role in determining such differences. Methods All oncology medicines approved since 2009 in Australia, England, Scotland, and Sweden were studied. Four categories of variables were collected from publicly available HTA reports of the above drugs: (i) Social Value Judgments (SVJs), (ii) Clinical/Economic evidence submitted, (iii) Interpretation of this evidence, and (iv) Funding decision. Conditional/restricted decisions were coded as Listed With Conditions (LWC) other than an MEA or LWC including an MEA (LWCMEA). Cohen's κ-scores measured the inter-rater agreement of countries on their LWCMEA outcomes and Pearson's chi-squared tests explored the association between HTA variables and LWCMEA outcomes. Results A total of 74 drug-indication pairs were found resulting in n = 296 observations; 8 percent (n = 23) were LWC and 55 percent (n = 163) were LWCMEA. A poor-to-moderate agreement existed between countries (−.29 < κ < .33) on LWCMEA decisions. Cross-country differences within the LWCMEA sample were partly driven by economic uncertainties and largely driven by SVJs considered across agencies. Conclusions A set of HTA-related variables driving the uptake of MEAs across countries was identified. These findings can be useful in future research aimed at informing country-specific, “best-practice” guidelines for successful MEA implementation.

scholarly journals Process Mapping to Examine How Goals of Care Discussions and Decisions about Life-Sustaining Treatments Occur On Medical Wards: A Multi-Center Observational Study

2020 ◽  
Vol 15 (1) ◽  
pp. 12-25
Author(s):  
Dev Jayaraman ◽  
Nishan Sharma ◽  
Alannah Smrke ◽  
Jessica Simon ◽  
Peter Dodek ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Nous Avons ◽  
Healthcare Workers ◽  
Hospital Setting ◽  
Hospitalized Patients ◽  
Communication Process ◽  
Prise De Décision ◽  
Goals Of Care ◽  
Travailleurs De La Santé

BackgroundPoor quality communication about goals of care with seriously ill, hospitalized patients is associated with substantial discordance between prescribed medical orders for life-sustaining treatment and patients’ stated preferences. Designing tailored solutions to this discordance requires a better understanding of this communication process. ObjectiveTo acquire a detailed understanding of the process of communication about goals of care and decision making about life-sustaining treatments for hospitalized patients, and to seek opportunities for improvement. SettingMedical wards of three university-affiliated teaching hospitals in Canada. MethodAt each site, we used drop-in sessions and one-on-one interviews to consult with health care workers on eligible wards to create cross-functional (swim lane) maps of the process of communication about goals of care and decision making about life-sustaining treatments. Healthcare workers were also asked about barriers to this process to enable the identification of opportunities for improvement. ResultsA total of 112 healthcare workers provided input into the creation of process maps across the three sites. Common elements across sites were that: (1) physicians play a central role, (2) the full process for a given patient involves several interactions amongst members of the inter-professional team, and (3) the process is iterative. We also noted between-site variations in the location of GoC discussions and the extent to which trainees and multi-disciplinary team members were involved. Finally, we identified several key barriers that may serve as targets for future quality improvement efforts: suboptimal location of conversations, insufficient support of physician learners in goals-of-care conversations, and incomplete engagement of the inter-professional team. ConclusionEfforts to improve the quality of goals-of-care discussions and decision making about life-sustaining treatments in the hospital setting need to account for the central role played by physicians in the process but can be enhanced if they can more fully engage the inter-professional health care team.Resume Contexte Une communication de mauvaise qualité sur les objectifs des soins aux patients gravementmalades et hospitalisés est associée à une discordance importante entre les ordonnances médicales prescrites pour un traitement de survie et les préférences déclarées des patients. La conception de solutions adaptées à cette discordance nécessite une meilleure compréhension de ce processus de communication. ObjectifAcquérir une compréhension détaillée du processus de communication sur les objectifs des soins et la prise de décision sur les traitements de maintien de la vie pour les patients hospitalisés, et rechercher des possibilités d’amélioration. ParamètresLes services médicaux de trois hôpitaux universitaires canadiens affiliés à l’université. MéthodeSur chaque site, nous avons eu recours à des séances d’information et à des entretiens individuels pour consulter les travailleurs de la santé dans les services éligibles afin de créer des cartes interfonctionnelles (couloir de nage) du processus de communication sur les objectifs des soins et la prise de décision sur les traitements de maintien des fonctions vitales. Les travailleurs de la santé ont également été interrogés sur les obstacles à ce processus afin de permettre l’identification des possibilités d’amélioration. RésultatsAu total, 112 travailleurs de la santé ont participé à la création de cartes de processus sur les trois sites. Les éléments communs à tous les sites étaient les suivants : (1) les médecins jouent un rôle central, (2) le processus complet pour un patient donné implique plusieurs interactions entre les membres de l’équipe interprofessionnelle, et (3) le processus est itératif. Nous avons également noté des variations entre les sites en ce qui concerne le lieu des discussions du gouvernement et le degré d’implication des stagiaires et des membres de l’équipe pluridisciplinaire. Enfin, nous avons identifié plusieurs obstacles clés qui pourraient servir de cibles aux futurs efforts d’amélioration de la qualité : le lieu sous-optimal des conversations, le soutien insuffisant des apprenants médecins dans les conversations sur les objectifs de soins et l’engagement incomplet de l’équipe interprofessionnelle. ConclusionLes efforts visant à améliorer la qualité des discussions sur les objectifs des soins et la prise de décision concernant les traitements vitaux en milieu hospitalier doivent tenir compte du rôle central joué par les médecins dans le processus, mais peuvent être renforcés s’ils peuvent faire participer davantage l’équipe interprofessionnelle de soins de santé.

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