Vulnerability to COVID-19 in Pernambuco, Brazil: A geospatial evaluation supported by multiple-criteria decision aid methodology

The paper presents an innovative application to identify areas vulnerable to coronavirus disease 2019 (COVID-19) considering a combination of spatial analysis and a multi-criteria learning approach. We applied this methodology in the state of Pernambuco, Brazil identifying vulnerable areas by considering a set of determinants and risk factors for COVID-19, including demographic, economic and spatial characteristics and the number of human COVID-19 infections. Examining possible patterns over a set number of days taking the number of cases recorded, we arrived at a set of compatible decision rules to explain the relation between risk factors and COVID-19 cases. The results reveal why certain municipalities are critically vulnerable to COVID-19 highlighting locations for which knowledge can be gained about environmental factors.

Digital decision aid for prenatal counseling in imminent extreme premature labor: development and pilot testing

Background In case of extreme premature delivery at 24 weeks of gestation, both early intensive care and palliative comfort care for the neonate are considered treatment options. Prenatal counseling, preferably using shared decision making, is needed to agree on the treatment option in case labor progresses. This article described the development of a digital decision aid (DA) to support pregnant women, partners and clinicians in prenatal counseling for imminent extreme premature labor. Methods This DA is developed following the International Patient Decision Aid Standards. The Dutch treatment guideline and the Dutch recommendations for prenatal counseling in extreme prematurity were used as basis. Development of the first prototype was done by expert clinicians and patients, further improvements were done after alpha testing with involved clinicians, patients and other experts (n = 12), and beta testing with non-involved clinicians and patients (n = 15). Results The final version includes information, probabilities and figures depending on users’ preferences. Furthermore, it elicits patient values and provides guidance to aid parents and professionals in making a decision for either early intensive care or palliative comfort care in threatening extreme premature delivery. Conclusion A decision aid was developed to support prenatal counseling regarding the decision on early intensive care versus palliative comfort care in case of extreme premature delivery at 24 weeks gestation. It was well accepted by parents and healthcare professionals. Our multimedia, digital DA is openly available online to support prenatal counseling and personalized, shared decision-making in imminent extreme premature labor.

An algorithmic-based multi-attribute decision making model under intuitionistic fuzzy environment

An outranking procedure for Multi-Attribute Decision-Making (MADM) problems is introduced in our work that acts as a decision-aid in recommending the products to the buyers. The buyer’s product assessment is taken as Interval-Valued Intuitionistic Fuzzy Sets (IVIFS) in each attribute. The confidence level that is implicit in the buyer’s product rating is explicated in the proposed work using fuzzy entropy. As the confidence level of the buyer on the product assessment is for both satisfaction and reluctance, it is suitably distributed in membership and non-membership parts of IVIFS. Our work generates a dominance matrix that represents partial or full dominance of one product over another after scoring the products that are unified with buyer’s confidence. The proposed work suggests the product ranking after ascertaining the buyer’s flexibility. An algorithm is written in our work to validate the procedure developed. We have compared our work with other similar works to highlight the benefits of the proposed work. A numerical example is illustrated to highlight the procedure developed.

Study protocols for the development and randomized controlled pilot trial of a patient decision aid to facilitate women's choice between oral and LAI ART for HIV (Preprint)

BACKGROUND Many women with HIV (WWH) have suboptimal adherence to oral antiretroviral therapy (ART) due to multilevel barriers to HIV care access and retention. A long-acting injectable (LAI) version of ART was approved by the Food and Drug Administration in January 2021 and has the potential to overcome many of these barriers by eliminating the need for daily pill-taking. However, it may not be optimal for all WWH. It is critical to develop tools that facilitate patient-provider shared decision making about oral versus LAI ART modalities to promote women’s adherence and long-term HIV outcomes. OBJECTIVE This study will develop and pilot test a web-based patient decision aid, called i.ART+support (iARTs). This decision aid aims to support shared decision-making between WWH and their providers, and help women choose between oral and LAI HIV treatment. METHODS The study will occur in three phases. In Phase 1, we will utilize a mixed-methods approach to collect data from WWH and medical and social service providers to inform i.ARTs content. During Phase 2, we will conduct focus groups with WWH and providers to refine i.ARTs content and develop the web-based decision aid. In Phase 3, i.ARTs will be tested in a randomized controlled trial (RCT) with n=180 women in Miami, FL and assessed for feasibility, usability and acceptability, as well as to evaluate the associations between receiving i.ARTs and viral suppression, ART refills, and clinic attendance. RESULTS Phase 1 participant recruitment began in September 2021. CONCLUSIONS This study is the first to develop a web-based patient decision aid to support WWH choices between oral and LAI ART. Its strengths include the incorporation of both patient and provider perspectives, a mixed-methods design, and implementation in a real-world clinical setting. CLINICALTRIAL We will apply for Clinicaltrials.gov registration prior to Phase 3 when we enroll our first participant in the RCT. This is anticipated to occur in April 2023.

Feasibility and Acceptability of a Culturally Sensitive Intervention To Promote Genetic Counseling

Background Despite the benefits of genetic counseling (GC) and testing, uptake of cancer genetic services is generally low and African American (AA) women are substantially less likely to receive genetic services than non-Hispanic White women. Our team developed a culturally sensitive, narrative decision aid video to promote uptake of GC among AA women at risk for a hereditary breast cancer syndrome. We report here a pilot study to demonstrate feasibility and acceptability of incorporating this intervention in conjunction with population-based cancer risk assessment in a clinical setting with medically underserved AA women. Methods AA women recommended for GC based on cancer genetic risk assessment performed in a mammography center were recruited at the time of the mammogram. A prospective, pre-post survey study design, guided by theoretical constructs, was used to evaluate baseline and immediate post-intervention psychosocial factors, including intention to participate in GC and intervention satisfaction. Results Pilot recruitment goals were met (n=30). Pre-intervention, 50% of participants indicated that they were extremely likely to make a GC appointment, compared with 70% post-intervention (p=0.0001). After watching the intervention, 50% of participants indicated that the video changed their mind regarding GC. Conclusions This study demonstrated cultural acceptability of a decision aid intervention designed to motivate AA women with hereditary breast cancer risk to attend a GC appointment. Our study showed that intention may be a specific and key construct to target in interventions designed to support decision-making about genetic services. Study results informed the design of a subsequent large scale, randomized implementation study.