Exploring physicians and patients’ perspectives for current interventions on thyroid nodules using a MCDA method

Abstract Background The detection of thyroid cancer has rapidly increased over last few decades without an increase in disease specific mortality. Several studies claim that the diagnose of thyroid nodules through routine ultrasound imaging is often the trigger for cascade effects leading to unnecessary follow-up over many years or to invasive treatment. The objective of this study was to explore physicians’ and patients’ insights and preferences regarding the current interventions on thyroid nodules. Methods An online survey was developed using a comprehensive multi-criteria decision analysis (MCDA) framework, the EVIdence based Decision-Making (EVIDEM). The EVIDEM core model used in this study encompassed 13 quantitative criteria and four qualitative criteria. Participants were asked to provide weights referring to what matters most important in general for each criterion, performance scores for appraising the interventions on thyroid nodules and their consideration of impact of contextual criteria. Normalized weights and standardized scores were combined to calculate a value contribution across all participants, additionally differences across physicians and patients’ group were explored. Results 48 patients and 31 physicians were included in the analysis. The value estimate of the interventions on thyroid nodules reached 0.549 for patients’ group and 0.5 was reported by the physicians’ group, compared to 0.543 for all participants. The highest value contributor was ‘Comparative effectiveness’ (0.073 ± 0.020). For the physicians’ group, ‘Comparative safety’ (0.050 ± 0.023) was given with higher value. And for the patients’ group, ‘Type of preventive benefits’ (0.059 ± 0.022) contributed more positively to the value estimation. 51% participants considered ‘Population priorities and access’ having a negative impact on the interventions of nodules.66% participants thought that the ‘system capacity’ had a negative impact. Conclusion Our study shows participants’ preferences on each criterion, i.e., physician indicated keeping the interventions safe and effective more important, patients indicated quality of life after receiving interventions more important. Through comparison among participants, differences have been highlighted, which can make better communication between physicians and patients. This study provides a supportive decision-making for healthcare providers when they explored the interventions on thyroid nodules.

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Exploring Perspectives and Preferences for Over-Diagnosis and Overtreatment of Thyroid Nodules using a MCDA Method

10.21203/rs.3.rs-89748/v1 ◽

2020 ◽

Author(s):

Linda Karrer ◽

Shixuan Zhang ◽

Thomas Kühlein ◽

Peter L Kolominsky-Rabas

Keyword(s):

Quality Of Life ◽

Decision Making ◽

Online Survey ◽

Thyroid Nodules ◽

Positive Impact ◽

Health Providers ◽

Invasive Treatment ◽

Health Care Intervention ◽

Cascade Effects

Abstract Background: The detection of thyroid cancer has rapidly increased over last few decades without an increase in disease specific mortality. Several studies claim that the diagnose of thyroid nodules through routine ultrasound imaging is often the trigger for cascade effects leading to unnecessary follow-up over many years or to invasive treatment. The objective of this study was to explore physicians’ and patients’ insights and preferences for diagnosis and treatment of thyroid nodules as well as awareness of over-diagnosis and overtreatment. Methods: An online survey was developed using a comprehensive multi criteria decision Analysis (MCDA) framework, the EVIdence based Decision-Making (EVIDEM). The EVIDEM core model used in this study encompassed 13 quantitative criteria and four qualitative criteria. Participants were asked to provide weights for each criterion, performance scores for appraising the thyroid nodules interventions and their consideration of impact of contextual criteria. Normalized weights and standardized scores were combined to calculate a value contribution across all participants, additionally differences across participants were explored. Results: Of all 105 participants, there are 48 patients, 31 physicians and 26 normal citizens. The highest value estimate of the intervention on thyroid nodules reached 0.401 for citizens’ group and lowest value of 0.287 was reported for physicians’ group, compared to 0.359 for all participants. The highest value contributors were efficacy and prevention. Compared to all participants, physicians gave less weight to quality of life and prevention benefits. In addition, physicians’ group gave less score on the treatment such like thyroid surgery compared to other two groups. 59% participants considered healthcare system had a positive impact on the diagnostic of thyroid nodules. Conclusion: Our study shows participants’ preferences on each criterion, i.e., physician indicated keeping the intervention safe and effective more important, patients indicated quality of life after receiving intervention more important. Through comparison among participants, differences have been highlighted, which can make better communication between physicians and patients. This study provided a supportive decision making for health providers when they conduct researches on thyroid nodules.Trial registration: This study did not report the results of a health care intervention on human participants.

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Value-impregnated factual claims may undermine medical decision-making

Clinical Ethics ◽

10.1177/1477750918765283 ◽

2018 ◽

Vol 13 (3) ◽

pp. 151-158 ◽

Cited By ~ 2

Author(s):

Niels Lynøe ◽

Gert Helgesson ◽

Niklas Juth

Keyword(s):

Decision Making ◽

Medical Decision Making ◽

Clinical Decision Making ◽

Negative Impact ◽

Personal Values ◽

Healthcare Providers ◽

Clinical Decision ◽

Medical Decision ◽

Clinical Decisions ◽

Soft Laws

Clinical decisions are expected to be based on factual evidence and official values derived from healthcare law and soft laws such as regulations and guidelines. But sometimes personal values instead influence clinical decisions. One way in which personal values may influence medical decision-making is by their affecting factual claims or assumptions made by healthcare providers. Such influence, which we call ‘value-impregnation,’ may be concealed to all concerned stakeholders. We suggest as a hypothesis that healthcare providers’ decision making is sometimes affected by value-impregnated factual claims or assumptions. If such claims influence e.g. doctor–patient encounters, this will likely have a negative impact on the provision of correct information to patients and on patients’ influence on decision making regarding their own care. In this paper, we explore the idea that value-impregnated factual claims influence healthcare decisions through a series of medical examples. We suggest that more research is needed to further examine whether healthcare staff’s personal values influence clinical decision-making.

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Resource allocation and health technology assessment in Australia: Views from the local level

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462309090187 ◽

2009 ◽

Vol 25 (02) ◽

pp. 134-140 ◽

Cited By ~ 10

Author(s):

Gisselle Gallego ◽

Kees van Gool ◽

Dianne Kelleher

Keyword(s):

Decision Making ◽

Health Service ◽

Health Technology Assessment ◽

Technology Assessment ◽

Online Survey ◽

Local Level ◽

Healthcare Providers ◽

Health Technology ◽

Health Technologies ◽

Decision Making Processes

Objectives:Several studies have shown that a key determinant of successful health technology assessment (HTA) uptake is a clear, fair, and consistent decision-making process for the approval and introduction of health technologies. The aim of this study was to gauge healthcare providers' and managers' perceptions of local level decision making and determine whether these processes offer a conducive environment for HTA. An Area Health Service (AHS) aimed to use the results of this study to help design a new process of technology assessment and decision making.Methods:An online survey was sent to all health service managers and healthcare providers working in one AHS in Sydney, Australia. Questions related to perceptions of current health technology decisions in participants' own institution/facility and opinions on key criteria for successful decision-making processes.Results:Less than a third of participants agreed with the statements that local decision-making processes were appropriate, easy to understand, evidence-based, fair, or consistently applied. Decisions were reportedly largely influenced by total cost considerations as well as by the central state health departments and the Area executive.Conclusions:Although there are renewed initiatives in HTA in Australia, there is a risk that such investments will not be productive unless policy makers also examine the decision-making contexts within which HTA can successfully be implemented. The results of this survey show that this is especially true at the local level and that any HTA initiative should be accompanied by efforts to improve decision-making processes.

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COVID-19 Lockdown Disrupts Support Networks Integral to Maintaining Foot Health: A Mixed-methods Study

10.21203/rs.3.rs-169666/v1 ◽

2021 ◽

Author(s):

Lindsey Cherry ◽

Lucy Gates ◽

David Culliford ◽

Karen Walker-Bone ◽

Mari-Carmen Portillo

Keyword(s):

Physical Activity ◽

Online Survey ◽

Negative Impact ◽

Healthcare Providers ◽

Self Care ◽

Support Networks ◽

Foot Pain ◽

Cross Sectional ◽

Foot Health ◽

Viral Spread

Abstract Background: In response to the COVID-19 pandemic, populations were advised to remain at home to control viral spread. Government-mandated restrictions on free movement affected individuals’ engagement with physical activity, with reported increases leading to biopsychosocial health benefits and conversely increased sedentary behaviour leading to poorer health. Good foot health is key to enabling physical activity and maximal participation in activities of occupation and daily living.Methods: A population-based cross-sectional study was performed, using a web-based platform. Quantitative and qualitative data were captured through responses to open survey questions. Anybody with a foot health condition was eligible to participate in the online survey. Links were sent through professional networks, support groups and charities, using a snowball strategy to maximise participation.Results: 255 respondents completed the survey. Most (n=193, 75.69%) reported an ongoing foot pain or problem that had been present for four weeks or longer, whilst 49 respondents (19.22%) noted a new pain or problem. Pain was the most frequently reported symptom (n=139, 54.51%), whilst change in appearance of the foot was also commonly reported (n=122, 47.84%), often alongside the observable presence of swelling. Musculoskeletal foot symptoms were frequently reported (n=123, 48%), and were significantly associated with reported reduced physical activity (X2=6.61, p=0.010). Following qualitative analysis five themes and 11 subthemes emerged, informed by 49 independent codes. A central theme of lockdown disrupting support networks, both formal (healthcare providers) and informal (friends or family members) emerged. The 5 sub-themes were: 1. foot pain is a constant companion, 2. self-care, 3. ‘cope or crumble’ scenarios, 4. future intent to access healthcare and 5. reduced ability to undertake physical activity.Conclusions: COVID-19 lockdown restrictions disrupted support networks integral to maintaining foot health. Foot pain was common and poor foot health impacted people’s ability to remain physically active during lockdown. Foot problems previously considered relatively ‘minor’ such as support for skin and nail care were exacerbated by the restricted support networks leading to greater negative impact. Lockdown highlighted a lack of support to self-care.

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COVID-19 lockdown disrupts support networks integral to maintaining foot health: a mixed-methods study

Journal of Foot and Ankle Research ◽

10.1186/s13047-021-00486-4 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Lindsey Cherry ◽

Lucy Gates ◽

David Culliford ◽

Karen Walker-Bone ◽

Mari Carmen Portillo

Keyword(s):

Physical Activity ◽

Support Groups ◽

Online Survey ◽

Negative Impact ◽

Healthcare Providers ◽

Support Networks ◽

Foot Pain ◽

Cross Sectional ◽

Foot Health ◽

Viral Spread

Abstract Background In response to the COVID-19 pandemic, populations were advised to remain at home to control viral spread. Government-mandated restrictions on free movement affected individuals’ engagement with physical activity, with reported increases leading to biopsychosocial health benefits and conversely increased sedentary behaviour leading to poorer health. Good foot health is key to enabling physical activity and maximal participation in activities of occupation and daily living. Methods A population-based cross-sectional study was performed, using a web-based platform. Quantitative and qualitative data were captured through responses to closed and open survey questions. Anybody with a foot health condition was eligible to participate in the online survey. Links were sent through professional networks, support groups and charities, using a snowball strategy to maximise participation. Results Two hundred fifty-five respondents completed the survey. Most (n = 193, 75.69%) reported an ongoing foot pain or problem that had been present for 4 weeks or longer, whilst 49 respondents (19.22%) noted a new pain or problem. Pain was the most frequently reported symptom (n = 139, 54.51%), whilst change in appearance of the foot was also commonly reported (n = 122, 47.84%), often alongside the observable presence of swelling. Musculoskeletal foot symptoms were frequently reported (n = 123, 48%), and were significantly associated with reported reduced physical activity (X2 = 6.61, p = 0.010). Following qualitative analysis five themes and 11 subthemes emerged, informed by 49 independent codes. A central theme of lockdown disrupting support networks, both formal (healthcare providers) and informal (friends or family members) emerged. The 5 sub-themes were: 1. foot pain is a constant companion, 2. self-care, 3. ‘cope or crumble’ scenarios, 4. future intent to access healthcare and 5. reduced ability to undertake physical activity. Conclusions Pain was the most frequently reported foot problem during COVID-19 lockdown restriction. Lockdown restrictions disrupted support networks integral to maintaining foot health. Poor foot health impacted people’s ability to remain physically active. Complaints previously considered relatively ‘minor’ such as support for skin and nail care, were found to be exacerbated by restricted support networks, leading to greater negative impact.

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Ready for SDM: evaluating a train-the-trainer program to facilitate implementation of SDM training in Norway

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-021-01494-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Simone Kienlin ◽

Marie-Eve Poitras ◽

Dawn Stacey ◽

Kari Nytrøen ◽

Jürgen Kasper

Keyword(s):

Decision Making ◽

Large Scale ◽

Online Survey ◽

Descriptive Analysis ◽

Healthcare Providers ◽

Expert Assessment ◽

Quantitative Descriptive Analysis ◽

Train The Trainer ◽

Interprofessional Healthcare ◽

Basic Course

Abstract Background Healthcare providers need training to implement shared decision making (SDM). In Norway, we developed “Ready for SDM”, a comprehensive SDM curriculum tailored to various healthcare providers, settings, and competence levels, including a course targeting interprofessional healthcare teams. The overall aim was to evaluate a train-the-trainer (TTT) program for healthcare providers wanting to offer this course within their hospital trust. Methods Our observational descriptive design was informed by Kirkpatrick´s Model of Educational Outcomes. The South-Eastern Regional Health Authority invited healthcare providers from all health trusts in its jurisdiction to attend. The TTT consisted of a one-day basic course with lectures on SDM, exercises and group reflections followed by a two-day advanced course including an SDM observer training. Immediately after each of the two courses, reaction and learning (Kirkpatrick levels 1 and 2) were assessed using a self-administered questionnaire. After the advanced course, observer skills were operationalized as accuracy of the participants’ assessment of a consultation compared to an expert assessment. Within three months post-training, we measured number of trainings conducted and number of healthcare providers trained (Kirkpatrick level 3) using an online survey. Qualitative and quantitative descriptive analysis were performed. Results Twenty-one out of 24 (basic) and 19 out of 22 (advanced) healthcare providers in 9 health trusts consented to participate. The basic course was evaluated as highly acceptable, the advanced course as complex and challenging. Participants identified a need for more training in pedagogical skills and support for planning implementation of SDM-training. Participants achieved high knowledge scores and were positive about being an SDM trainer. Observer skills regarding patient involvement in decision-making were excellent (mean of weighted t = .80). After three months, 67% of TTT participants had conducted more than two trainings each and trained a total of 458 healthcare providers. Conclusion Findings suggest that the TTT is a feasible approach for supporting large-scale training in SDM. Our study informed us about how to improve the advanced course. Further research shall investigate the efficacy of the training in the context of a comprehensive multifaceted strategy for implementing SDM in clinical practice. Trial registration: Retrospectively registered at ISRCTN (99432465) March 25, 2020.

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Would you Make the Right Decision? – Decision Making Biases in Economy - Related Dilemmas

Valahian Journal of Economic Studies ◽

10.2478/vjes-2018-0006 ◽

2018 ◽

Vol 9 (1) ◽

pp. 59-66

Author(s):

Zsuzsanna Gödör ◽

Georgina Szabó

Keyword(s):

Decision Making ◽

Online Survey ◽

Framing Effect ◽

Economic Knowledge ◽

Bank Account ◽

Financial Decisions ◽

Hungarian Population ◽

The Moment ◽

The Right ◽

Decision Making Biases

Abstract As they say, money can’t buy happiness. However, the lack of it can make people’s lives much harder. From the moment we open our first bank account, we have to make lots of financial decisions in our life. Should I save some money or should I spend it? Is it a good idea to ask for a loan? How to invest my money? When we make such decisions, unfortunately we sometimes make mistakes, too. In this study, we selected seven common decision making biases - anchoring and adjustment, overconfidence, high optimism, the law of small numbers, framing effect, disposition effect and gambler’s fallacy – and tested them on the Hungarian population via an online survey. In the focus of our study was the question whether the presence of economic knowledge helps people make better decisions? The decision making biases found in literature mostly appeared in the sample as well. It proves that people do apply them when making decisions and in certain cases this could result in serious and costly errors. That’s why it would be absolutely important for people to learn about them, thus increasing their awareness and attention when making decisions. Furthermore, in our research we did find some connection between decisions and the knowledge of economics, people with some knowledge of economics opted for the better solution in bigger proportion

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Experiences and impact of international medical volunteering: a multi-country mixed methods study

BMJ Open ◽

10.1136/bmjopen-2020-041599 ◽

2021 ◽

Vol 11 (3) ◽

pp. e041599 ◽

Cited By ~ 1

Author(s):

Mary McCauley ◽

Joanna Raven ◽

Nynke van den Broek

Keyword(s):

Low Income ◽

Online Survey ◽

Positive Impact ◽

Healthcare Providers ◽

International Medical ◽

Middle Income ◽

Use Of Resources ◽

The Uk ◽

Medical Volunteers ◽

The Impact

ObjectiveTo assess the experience and impact of medical volunteers who facilitated training workshops for healthcare providers in maternal and newborn emergency care in 13 countries.SettingsBangladesh, Ghana, India, Kenya, Malawi, Namibia, Nigeria, Pakistan, Sierra Leone, South Africa, Tanzania, UK and Zimbabwe.ParticipantsMedical volunteers from the UK (n=162) and from low-income and middle-income countries (LMIC) (n=138).Outcome measuresExpectations, experience, views, personal and professional impact of the experience of volunteering on medical volunteers based in the UK and in LMIC.ResultsUK-based medical volunteers (n=38) were interviewed using focus group discussions (n=12) and key informant interviews (n=26). 262 volunteers (UK-based n=124 (47.3%), and LMIC-based n=138 (52.7%)) responded to the online survey (62% response rate), covering 506 volunteering episodes. UK-based medical volunteers were motivated by altruism, and perceived volunteering as a valuable opportunity to develop their skills in leadership, teaching and communication, skills reported to be transferable to their home workplace. Medical volunteers based in the UK and in LMIC (n=244) reported increased confidence (98%, n=239); improved teamwork (95%, n=232); strengthened leadership skills (90%, n=220); and reported that volunteering had a positive impact for the host country (96%, n=234) and healthcare providers trained (99%, n=241); formed sustainable partnerships (97%, n=237); promoted multidisciplinary team working (98%, n=239); and was a good use of resources (98%, n=239). Medical volunteers based in LMIC reported higher satisfaction scores than those from the UK with regards to impact on personal and professional development.ConclusionHealthcare providers from the UK and LMIC are highly motivated to volunteer to increase local healthcare providers’ knowledge and skills in low-resource settings. Further research is necessary to understand the experiences of local partners and communities regarding how the impact of international medical volunteering can be mutually beneficial and sustainable with measurable outcomes.

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The Impact of the COVID-19 Pandemic on the Working Conditions, Employment, Career Development and Well-Being of Refugee Researchers

Societies ◽

10.3390/soc11030071 ◽

2021 ◽

Vol 11 (3) ◽

pp. 71

Author(s):

Ourania Tzoraki ◽

Svetlana Dimitrova ◽

Marin Barzakov ◽

Saad Yaseen ◽

Vasilis Gavalas ◽

...

Keyword(s):

Online Survey ◽

Negative Impact ◽

Well Being ◽

Appropriate Technology ◽

Public Authorities ◽

Policy Makers ◽

Home Setting ◽

The Public ◽

Work From Home ◽

The Impact

The ongoing ‘refugee crisis’ of the past years has led to the migration of refugee researchers (RRs) to European countries. Due to the COVID-19 pandemic, RRs often had to work from home and/or to continue their social, cultural and economic integration process under new conditions. An online survey carried out to explore the impact of the pandemic on the refugee researchers showed that RRs found it difficult to adapt their everyday working life to the ‘home’ setting. The majority have had neither a suitable work environment at home nor the appropriate technology. Although they stated that they are rather pleased with the measures taken by the public authorities, they expressed concern about their vulnerability due to their precarious contracts and the bureaucratic asylum procedures, as the pandemic has had a negative impact on these major issues. The majority of RRs working in academia seem not to have been affected at all as far as their income is concerned, while the majority of those employed in other sectors became unemployed during the pandemic (58%). Recommendations are provided to the public authorities and policy makers to assist RRs to mitigate the consequences of the pandemic on their life.

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307 A systems approach to understanding biosecurity decision-making

Journal of Animal Science ◽

10.1093/jas/skaa278.078 ◽

2020 ◽

Vol 98 (Supplement_4) ◽

pp. 43-43

Author(s):

Scott C Merrill ◽

Christopher Koliba ◽

Gabriela Bucini ◽

Eric Clark ◽

Luke Trinity ◽

...

Keyword(s):

Decision Making ◽

Negative Impact ◽

Risk Mitigation ◽

African Swine Fever Virus ◽

The United States ◽

Mitigation Strategies ◽

Communication Strategy ◽

Livestock Industry ◽

Diarrhea Virus ◽

Operational Level

Abstract Disease and its consequences result in social and economic impacts to the US animal livestock industry, ranging from losses in human capital to economic costs in excess of a billion dollars annually. Impacts would dramatically escalate if a devastating disease like Foot and Mouth Disease or African Swine Fever virus were to emerge in the United States. Investing in preventative biosecurity can reduce the likelihood of disease incursions and their negative impact on our livestock industry, yet uncertainty persists with regards to developing an effective biosecurity structure and culture. Here we show the implications of human behavior and decision making for biosecurity effectiveness, from the operational level to the owner/managerial level and finally to the systems level. For example, adjustments to risk messaging strategies could double worker compliance with biosecurity practices at the operational level. The improvement of our risk communication strategy may increase willingness to invest in biosecurity. Furthermore, the adaptation of policies could nudge behavior so that we observe a short disease outbreak followed by a quick eradication instead of a pandemic. Our research shows how the emergence of now-endemic diseases, such as Porcine Epidemic Diarrhea virus, cannot be adequately modeled without the use of a human behavioral component. Focusing solely on any one sector or level of the livestock system is not sufficient to predict emergent disease patterns and their social and economic impact on livestock industries. These results provide insight toward developing more effective risk mitigation strategies and ways to nudge behavior toward more disease resilient systems.

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