Decision Aids for Generating Analytical Review Alternatives: The Impact of Goal Framing and Audit-Risk Level

2002 ◽  
Vol 14 (1) ◽  
pp. 157-177 ◽  
Author(s):  
Jennifer M. Mueller ◽  
John C. Anderson
Keyword(s):  
High Risk ◽  
Cognitive Load ◽  
Information Search ◽  
Decision Aid ◽  
Decision Aids ◽  
Risk Level ◽  
Audit Risk ◽  
Goal Framing ◽  
Analytical Review ◽  
The Impact

An auditor generating potential explanations for an unusual variance in analytical review may utilize a decision aid, which provides many explanations. However, circumstances of budgetary constraints and limited cognitive load deter an auditor from using a lengthy list of explanations in an information search. A two-way between-subjects design was created to investigate the effects of two complementary approaches to trimming down the lengthy list on the number of remaining explanations carried forward into an information search. These two approaches, which represent the same goal (reducing the list) but framed differently, are found to result in a significantly different number of remaining explanations, in both low- and high-risk audit environments. The results of the study suggest that the extent to which an auditor narrows the lengthy list of explanations is important to the implementation of decision aids in analytical review.

The Effect of Client vs. Decision Aid as a Source of Explanations upon Auditors' Sufficiency Judgments: A Research Note

2003 ◽  
Vol 15 (1) ◽  
pp. 1-11 ◽  
Author(s):  
John C. Anderson ◽  
Kimberly K. Moreno ◽  
Jennifer M. Mueller
Keyword(s):  
Decision Aid ◽  
Decision Aids ◽  
Information Source ◽  
Research Note ◽  
Analytical Review ◽  
Client Management ◽  
Source Reliability ◽  
The Impact

This study examines whether auditors will rate explanations for an unusual fluctuation provided by a decision aid as more sufficient than the same explanations provided by a client, when the explanations are insufficient to account for the fluctuation. While prior research has addressed auditors' sensitivity to the source reliability of various parties (e.g., client management, outside parties), little is known about auditors' perceptions of decision aids as an information source. Since a decision aid may be viewed as a highly objective source, auditors may tend to over-rate the sufficiency of explanations provided by a decision aid vs. those provided by a client. Our results show that auditors rated explanations provided by a decision aid as more sufficient than the same explanations provided by the client, when in fact the explanations were insufficient. These results suggest that more consideration be given to the impact of decision aids utilized in analytical review.

The Impact of Transparency and Decision Risk on Human–Automation Teaming Outcomes

2021 ◽  
pp. 001872082110334
Author(s):  
Shayne Loft ◽  
Adella Bhaskara ◽  
Brittany A. Lock ◽  
Michael Skinner ◽  
James Brooks ◽  
...  
Keyword(s):  
Decision Aid ◽  
Financial Incentive ◽  
Decision Aids ◽  
Rejection Rate ◽  
Decision Time ◽  
Correct Rejection ◽  
Incentive Scheme ◽  
Operator Behavior ◽  
The Impact ◽  
Financial Penalty

Objective Examine the effects of decision risk and automation transparency on the accuracy and timeliness of operator decisions, automation verification rates, and subjective workload. Background Decision aids typically benefit performance, but can provide incorrect advice due to contextual factors, creating the potential for automation disuse or misuse. Decision aids can reduce an operator’s manual problem evaluation, and it can also be strategic for operators to minimize verifying automated advice in order to manage workload. Method Participants assigned the optimal unmanned vehicle to complete missions. A decision aid provided advice but was not always reliable. Two levels of decision aid transparency were manipulated between participants. The risk associated with each decision was manipulated using a financial incentive scheme. Participants could use a calculator to verify automated advice; however, this resulted in a financial penalty. Results For high- compared with low-risk decisions, participants were more likely to reject incorrect automated advice and were more likely to verify automation and reported higher workload. Increased transparency did not lead to more accurate decisions and did not impact workload but decreased automation verification and eliminated the increased decision time associated with high decision risk. Conclusion Increased automation transparency was beneficial in that it decreased automation verification and decreased decision time. The increased workload and automation verification for high-risk missions is not necessarily problematic given the improved automation correct rejection rate. Application The findings have potential application to the design of interfaces to improve human–automation teaming, and for anticipating the impact of decision risk on operator behavior.

Abstract 27: Patients' Perspectives on a Decision Aid to Facilitate Cost-sensitive Decisions for Sacubitril-Valsartan

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Andrea R Mitchell ◽  
Grace Venechuk ◽  
Larry A Allen ◽  
Dan D Matlock ◽  
Miranda Moore ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Decision Aids ◽  
Descriptive Analysis ◽  
Patient Specific ◽  
Shared Decision ◽  
Cost Information ◽  
Reduced Ejection Fraction ◽  
The Impact

Background: Decision aids frequently focus on decisions that are preference-sensitive due to an absence of superior medical option or qualitative differences in treatments. Out of pocket cost can also make decisions preference-sensitive. However, cost is infrequently discussed with patients, and cost has not typically been considered in developing approaches to shared decision-making or decision aids. Determining a therapy’s value to a patient requires an individualized assessment of both benefits and cost. A decision aid addressing cost for sacubitril-valsartan in heart failure with reduced ejection fraction (HFrEF) was developed because this medication has clear medical benefits but can entail appreciable out-of-pocket cost. Objective: To explore patients’ perspectives on a decision aid for sacubitril-valsartan in HFrEF. Methods: Twenty adults, ages 32-73, with HFrEF who met general eligibility for sacubitril-valsartan were recruited from outpatient HF clinics and inpatient services at 2 geographically-distinct academic health systems. In-depth interviews were conducted by trained interviewers using a semi-structured guide after patients reviewed the decision aid. Interviews were audio-recorded and transcribed; qualitative descriptive analysis was conducted using a template analytic method. Results: Participants confirmed that cost was relevant to this decision and that cost discussions with clinicians are infrequent but welcomed. Participants cited multiple ways that this decision aid could be helpful beyond informing a choice; these included serving as a conversation starter, helping inform questions, and serving as a reference later. The decision aid seemed balanced; several participants felt that it was promotional, while others wanted a more “positive” presentation. Participants valued the display of benefits of sacubitril-valsartan but had variable views about how to apply data to themselves and heterogenous interpretations of a 3% absolute reduction in mortality over 2 years. None felt this benefit was overwhelming; about half felt it was very small. The decision aid incorporated a novel “gist statement” to contextualize benefits and counter tendencies to dismiss this mortality reduction as trivial. Several participants liked this statement; few had strong impressions. Conclusion: Out of pocket cost should be part of shared decision-making. These data suggest patients are receptive to inclusion of cost in decision aids and that a “middle ground” between being promotional and negative may exist. The data, however, raise concerns regarding potential dismissal of clinically meaningful benefits and illustrate challenges identifying appropriate contextualizing language. The impact of various framings warrants further study, as does integration of decision aids with patient-specific out-of-pocket cost information during clinical encounters.

scholarly journals Web-Based Training for Nurses on Shared Decision Making and Prenatal Screening for Down Syndrome: Protocol for a Randomized Controlled Trial

10.2196/17878 ◽  
2020 ◽  
Vol 9 (10) ◽  
pp. e17878
Author(s):  
Alex Poulin Herron ◽  
Titilayo Tatiana Agbadje ◽  
Melissa Cote ◽  
Codjo Djignefa Djade ◽  
Geneviève Roch ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Training Program ◽  
Decision Aid ◽  
Prenatal Screening ◽  
Decision Aids ◽  
Control Group ◽  
Intention To Use ◽  
Shared Decision ◽  
Web Based ◽  
The Impact

Background Pregnant women often find it difficult to choose from among the wide variety of available prenatal screening options. To help pregnant women and their partners make informed decisions based on their values, needs, and preferences, a decision aid and a web-based shared decision making (SDM) training program for health professionals have been developed. In Canada, nurses provide maternity care and thus can train as decision coaches for prenatal screening. However, there is a knowledge gap about the effectiveness of SDM interventions in maternity care in nursing practice. Objective This study aims to assess the impact of an SDM training program on nurses’ intentions to use a decision aid for prenatal screening and on their knowledge and to assess their overall impressions of the training. Methods This is a 2-arm parallel randomized trial. French-speaking nurses working with pregnant women in the province of Quebec were recruited online by a private survey firm. They were randomly allocated (1:1 ratio) to either an experimental group, which completed a web-based SDM training program that included prenatal screening, or a control group, which completed a web-based training program focusing on prenatal screening alone. The experimental intervention consisted of a 3-hour web-based training hosted on the Université Laval platform with 4 modules: (1) SDM; (2) Down syndrome prenatal screening; (3) decision aids; and (4) communication between health care professionals and the patient. For the control group, the topic of SDM in Module 1 was replaced with “Context and history of prenatal screening,” and the topic of decision aids in Module 3 was replaced with “Consent in prenatal screening.” Participants completed a self-administered sociodemographic questionnaire with close-ended questions. We also assessed the participants' (1) intention to use a decision aid in prenatal screening clinical practice, (2) knowledge, (3) satisfaction with the training, (4) acceptability, and (5) perceived usefulness of the training. The randomization was done using a predetermined sequence and included 40 nurses. Participants and researchers were blinded. Intention to use a decision aid will be assessed by a t test. Bivariate and multivariate analysis will be performed to assess knowledge and overall impressions of the training. Results This study was funded in 2017 and approved by Genome Canada. Data were collected from September 2019 to late January 2020. This paper was initially submitted before data analysis began. Results are expected to be published in winter 2020. Conclusions Study results will inform us on the impact of an SDM training program on nurses’ intention to use and knowledge of decision aids for prenatal screening and their overall impressions of the training. Participant feedback will also inform an upgrade of the program, if needed. Trial Registration ClinicalTrials.gov NCT04162288; https://clinicaltrials.gov/ct2/show/NCT04162288 International Registered Report Identifier (IRRID) DERR1-10.2196/17878

scholarly journals Web-Based Training for Nurses on Shared Decision Making and Prenatal Screening for Down Syndrome: Protocol for a Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Alex Poulin Herron ◽  
Titilayo Tatiana Agbadje ◽  
Melissa Cote ◽  
Codjo Djignefa Djade ◽  
Geneviève Roch ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Training Program ◽  
Decision Aid ◽  
Prenatal Screening ◽  
Decision Aids ◽  
Control Group ◽  
Intention To Use ◽  
Shared Decision ◽  
Web Based ◽  
The Impact

BACKGROUND Pregnant women often find it difficult to choose from among the wide variety of available prenatal screening options. To help pregnant women and their partners make informed decisions based on their values, needs, and preferences, a decision aid and a web-based shared decision making (SDM) training program for health professionals have been developed. In Canada, nurses provide maternity care and thus can train as decision coaches for prenatal screening. However, there is a knowledge gap about the effectiveness of SDM interventions in maternity care in nursing practice. OBJECTIVE This study aims to assess the impact of an SDM training program on nurses’ intentions to use a decision aid for prenatal screening and on their knowledge and to assess their overall impressions of the training. METHODS This is a 2-arm parallel randomized trial. French-speaking nurses working with pregnant women in the province of Quebec were recruited online by a private survey firm. They were randomly allocated (1:1 ratio) to either an experimental group, which completed a web-based SDM training program that included prenatal screening, or a control group, which completed a web-based training program focusing on prenatal screening alone. The experimental intervention consisted of a 3-hour web-based training hosted on the Université Laval platform with 4 modules: (1) SDM; (2) Down syndrome prenatal screening; (3) decision aids; and (4) communication between health care professionals and the patient. For the control group, the topic of SDM in Module 1 was replaced with “Context and history of prenatal screening,” and the topic of decision aids in Module 3 was replaced with “Consent in prenatal screening.” Participants completed a self-administered sociodemographic questionnaire with close-ended questions. We also assessed the participants' (1) intention to use a decision aid in prenatal screening clinical practice, (2) knowledge, (3) satisfaction with the training, (4) acceptability, and (5) perceived usefulness of the training. The randomization was done using a predetermined sequence and included 40 nurses. Participants and researchers were blinded. Intention to use a decision aid will be assessed by a t test. Bivariate and multivariate analysis will be performed to assess knowledge and overall impressions of the training. RESULTS This study was funded in 2017 and approved by Genome Canada. Data were collected from September 2019 to late January 2020. This paper was initially submitted before data analysis began. Results are expected to be published in winter 2020. CONCLUSIONS Study results will inform us on the impact of an SDM training program on nurses’ intention to use and knowledge of decision aids for prenatal screening and their overall impressions of the training. Participant feedback will also inform an upgrade of the program, if needed. CLINICALTRIAL ClinicalTrials.gov NCT04162288; https://clinicaltrials.gov/ct2/show/NCT04162288 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17878

scholarly journals Framing Benefits in Decision Aids: Effects of Varying Contextualizing Statements on Decisions About Sacubitril-Valsartan for Heart Failure

2021 ◽  
Vol 6 (2) ◽  
pp. 238146832110416
Author(s):  
Mary C. Thomson ◽  
Larry A. Allen ◽  
Scott D. Halpern ◽  
Yi-An Ko ◽  
Daniel D. Matlock ◽  
...  
Keyword(s):  
Heart Failure ◽  
Decision Aid ◽  
Absolute Risk ◽  
Decision Aids ◽  
Group Assignment ◽  
Hypothetical Scenario ◽  
Clinically Significant ◽  
Self Reported Health Status ◽  
Numeric Data ◽  
The Impact

Background. Presenting numeric data alone may result in patients underappreciating clinically significant benefits. Contextualizing statements to counter this may raise concern about absence of neutrality. These issues arose during construction of a decision aid for sacubitril-valsartan, a heart failure medication associated with a ∼3% absolute reduction in 2-year mortality that carries high out-of-pocket cost. A contextualizing statement framing this as a “pretty big benefit” was incorporated. The impact of statements like this within decision aids is unknown. Objective. This online Qualtrics survey sought to deepen understanding of benefit framing by testing the impact of varying contextualizing statements within a decision aid for sacubitril-valsartan. Design. Participants were randomly assigned to receive one of six abbreviated versions of a decision aid for sacubitril-valsartan that varied only by contextualizing statement (ranging from strongly neutral to strongly positive and using relative and absolute risk reductions). Participants were asked to answer questions regarding the likelihood of taking the medication at a cost of $50/month and their perception of the drug’s benefits. Results. A total of 1873 participants who were demographically similar to the heart failure population completed the survey. Fifty-four percent were willing to take sacubitril-valsartan at $50/month. Each of the five experimental contextualizing statements was compared with the baseline version; no significant differences were observed in reported likelihood of taking sacubitril-valsartan. After controlling for demographics and covariates, group assignment did not predict likelihood of taking the medication. Higher income, better self-reported health status, and younger age were associated with increased likelihood of taking sacubitril-valsartan. Limitations. This study used a hypothetical scenario and evaluated one method of delivering contextualizing statements. Conclusions. Contextualizing statements as tested within this decision aid did not affect decision making.

scholarly journals P563 Shared decision-making in pregnancy in inflammatory bowel disease: Design of a pregnancy in IBD decision aid (PIDA)

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S474-S475
Author(s):  
A J Williams ◽  
Y Leung ◽  
K O’Connor ◽  
V Huang
Keyword(s):  
Decision Making ◽  
Focus Groups ◽  
Disease Activity ◽  
Decision Aid ◽  
Negative Impact ◽  
Decision Aids ◽  
Mode Of Delivery ◽  
Surgical History ◽  
The Impact ◽  
In Pregnancy

Abstract Background A lack of IBD-specific reproductive knowledge has been associated with increased ‘voluntary childlessness’.Furthermore, a lack of patient and clinician knowledge may contribute to inappropriate medication changes during or after pregnancy that may lead to a flare of disease. Evidence exists for the benefit of decision aids to support decision-making in pregnancy in general, as well as in multiple other chronic disease; however, such a resource for pregnancy in IBD has not been identified. Methods Using International Patient Decision Aids Standards, we have commenced design of our Pregnancy in IBD Decision Aid (PIDA). A steering committee consisting of Canadian and Australian Healthcare professionals with an interest in IBD management in pregnancy, in addition to a patient representative was established. Initial patient and clinician focus groups were conducted. Themes prospectively chosen for discussion included inheritance, fertility, nutrition, medications, mode of delivery, breastfeeding, infant infections and vaccinations. We designed an electronic PIDA draft that incorporates individualised information (for example, type of IBD, pre-conception or pregnant, surgical history and current medications) in personalised decision-making. Further patient focus groups and interviews were conducted to obtain user opinion of the PIDA draft. Results In July 2017, patient and clinician focus groups were conducted at a Canadian site. Patient concerns regarding pregnancy included the impact of disease, previous surgical history on fertility, preterm delivery; the potential impact of current and past drug therapies on the fetus/ infant; and the negative impact of active disease on both maternal and fetal/infant health. Clinician concerns included the absence of pre-conception counselling and potential for lack of patient understanding about the impact of disease activity and IBD medication use in pregnancy. Patient feedback (n = 15) obtained through interviews at two Canadian and one Australian site regarding the current electronic PIDA draft was predominantly positive, with comments pertaining to the adequacy of content coverage, personalisation, readability and unbiased information presentation. Suggestions were made for inclusion of further content such as the impact of IBD on sexual function, expected laboratory changes and the timing of recommencement of medications post-partum. Conclusion The completion of pre and post-PIDA design focus groups and interviews affirmed the role for PIDA. Main decisions that were considered necessary to address included ideal timing of conception pending disease activity, management of medications and delivery methods. Ongoing user feedback is being obtained at Australian and Canadian sites currently.

Decision Aids and Experiential Learning

2005 ◽  
Vol 17 (1) ◽  
pp. 175-189 ◽  
Author(s):  
Jacob M. Rose
Keyword(s):  
Experiential Learning ◽  
Cognitive Load ◽  
Knowledge Acquisition ◽  
Decision Aid ◽  
Decision Aids ◽  
Accounting Students ◽  
Task Completion ◽  
Manual Task ◽  
Research Decision

Rose and Wolfe (2000) demonstrated that decision aid design is critical to learning from decision aids, and aids that produce less cognitive load result in superior learning by aid users compared to aids that produce more cognitive load. The current research investigates whether a tax decision aid has differential affects on the knowledge acquisition of accounting students with varying perceived aptitudes for tax and interest in tax as a career. Results indicate that participants with more interest in and perceived aptitude for tax acquire more tax-related knowledge during manual task completion than participants with less perceived aptitude and interest. Similar to prior research, decision aids generally decrease learning relative to unaided environments. When decision aids do not produce a heavy cognitive load, however, participants with less perceived aptitude for and interest in tax learn as much in aided environments as they learn in unaided environments.

scholarly journals Other Ways of Knowing

2017 ◽  
Vol 37 (3) ◽  
pp. 216-229 ◽  
Author(s):  
Negin Hajizadeh ◽  
Melissa J. Basile ◽  
Andrzej Kozikowski ◽  
Meredith Akerman ◽  
Tara Liberman ◽  
...  
Keyword(s):  
Lived Experiences ◽  
Decision Aid ◽  
Decision Aids ◽  
Ways Of Knowing ◽  
Emotional Reactions ◽  
Chronic Obstructive ◽  
Prognostic Information ◽  
Comfort Care ◽  
Starting Point ◽  
The Impact

Background. Patients with advanced-stage chronic obstructive pulmonary disease (COPD) may suffer severe respiratory exacerbations and need to decide between accepting life-sustaining treatments versus foregoing these treatments (choosing comfort care only). We designed the InformedTogether decision aid to inform this decision and describe results of a pilot study to assess usability focusing on participants’ trust in the content of the decision aid, acceptability, recommendations for improvement, and emotional reactions to this emotionally laden decision. Methods. Study participants ( N = 26) comprising clinicians, patients, and surrogates viewed the decision aid, completed usability tasks, and participated in interviews and focus groups assessing comprehension, trust, perception of bias, and perceived acceptability of InformedTogether. Mixed methods were used to analyze results. Results. Almost all participants understood the gist (general meaning) of InformedTogether. However, many lower literacy participants had difficulty answering the more detailed questions related to comprehension, especially when interpreting icon arrays, and many were not aware that they had misunderstood the information. Qualitative analysis showed a range of emotional reactions to the information. Participants with low verbatim comprehension frequently referenced lived experiences when answering knowledge questions, which we termed “alternative knowledge.” Conclusions. We found a range of emotional reactions to the information and frequent use of alternative knowledge frameworks for deriving meaning from the data. These observations led to insights into the impact of lived experiences on the uptake of biomedical information presented in decision aids. Communicating prognostic information could potentially be improved by eliciting alternative knowledge as a starting point to build communication, in particular for low literacy patients. Decision aids designed to facilitate shared decision making should elicit this knowledge and help clinicians tailor information accordingly.

The impact of within-visit and pre-visit decision aids for localized prostate cancer on patient knowledge.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 151-151
Author(s):  
Jon Charles Tilburt ◽  
Joel E Pacyna ◽  
Kristin Cina ◽  
Daniel G. Petereit ◽  
Judith Salmon Kaur ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Linear Regression ◽  
Cancer Treatment ◽  
Usual Care ◽  
Decision Aid ◽  
Decision Aids ◽  
Specific Antigen ◽  
Patient Knowledge ◽  
Prostate Cancer Treatment ◽  
The Impact

151 Background: Decision aids (DAs) for prostate cancer treatment can improve knowledge and reduce decisional conflict, but the relative effect of pre-visit and within-visit DAs is not known, and effect sizes for minority populations has not been estimated. Methods: We conducted a 3-arm, patient-level-RCT in specialty urology and radiation oncology practices in Ohio, South Dakota, and Alaska, test the effect of pre-consultation and with-in consultation decision aids on patient knowledge immediately after specialty consultation compared to usual care. We used linear regression to estimate effects of each intervention arm, including the respective standard error, two-sided 95% confidence interval, and two-sided P value for testing the study’s hypotheses. Results: 103 patients were recruited and randomized to receive either the pre-visit decision aid, within-visit decision aid, or neither decision aids (usual care). In 2017 and 20018, we accrued similar numbers of men to pre-consultation aid (n = 37), during-consultation aid (n = 33) and usual care arms, respectively (n = 33). The median (range) age in years was 64 [49, 81]; 67.6% were White, 15.7% were Black or African American, 16.7% were American Indian or Alaska Native, and 1% were not reported. 47.6%, 45.6%, and 6.8% had a baseline clinical stage of T1, T2, and T3, respectively. The median [range] prostate specific antigen (PSA) was 8.0 [2.4, 53.7]. There were no clinically notable imbalances. We obtained usable data on 102 of the 103 patient-participants. The pre-visit decision aid arm showed a mean knowledge effect of 0.694 (0.636, 0.753). The within-visit decision arm showed a very similar mean knowledge effect of 0.686 (0.625, 0.748). The usual care arm showed a mean knowledge effect of 0.644 (0.582,0.705). The linear regression model showed, that, compared with usual care, neither intervention effect achieved statistical significance in the primary analysis (p = 0.24, 0.330, for pre-visit and within-visit, respectively). Conclusions: Modest knowledge gains of pre-visit and during-visit decision aids for prostate cancer treatment were not statistically significant. Clinical trial information: NCT03182998 .

Sign in / Sign up

Export Citation Format

Share Document