Participation Improves Collective Decisions (When It Involves Deliberation): Experimental Evidence From Kenya

Citizen participation in decision making has been widely lauded as a method for improving societal outcomes. Deliberative discussion, in particular, is believed to be more transformative than a mere aggregation of individual preferences, leading to more socially optimal decision making and behavior. I report the results from a laboratory experiment with 570 subjects in Nairobi, directly testing the effect of participation in deliberative group decision making on collective outcomes. Participants engage in a group task to earn compensation toward a shared group fund. Randomly assigned treatments vary according to whether decision making over the task to be completed involves: (1) external assignment; (2) non-deliberative majority voting; or (3) consensus through deliberative discussion. I find that deliberation improves collective decision making. Deliberation is also associated with changes in preferences, greater agreement with decision outcomes, and greater perceived fairness. Evidence for behavior change is weaker, but there is some support for further research into the relationship between preference change and behavior change.

Staging the development and implementation of a Coordinated Cancer Care Model using risk-based survivorship care: A deliberative discussion among multiple stakeholders.

e18027 Background: Risk-based survivorship care has become one of the best practices care recommended by the Institute of Medicine. It involves coordinated follow-up services based on the risk of long-term and late effects, cancer recurrence and an individualised care plan. Risk-based care requires specific knowledge about cancer histology, treatments, and potential consequences of cancer and its treatment to guide surveillance, screening and counseling. Diagnostic and treatment details and their associated health risks may not be known by survivors or their multiple care providers. Implementing risk-based survivorship care is often challenging for providers. This presentation report on a deliberative workshop on the development and planning of a risk-based survivorship care model. Methods: The deliberative workshop is part of a larger study in two regional cancer networks in Quebec, selected for there differences (geographic location, population size, academic mandate). A total of 25 key informants (researchers, managers, family physicians, oncologists, cancer survivors, nurses, social workers) participated into the workshop on October 2nd, 2018. Deliberative discussion between local stakeholders followed by videoconference, getting together stakeholders from both networks was drawn from Gupta et al 3 steps: 1) identify the problem; 2) develop the innovation; 3) design the pilot test. Results: Although the context of the network was different, main issues were similar: 1) there is no common understanding of the concept “risk-based survivorship care”, either for survivors, primary care providers and cancer specialist; 2) “silo functioning” within and between teams is a main barriers to ensure care coordination based on risk assessment; 3) organizational assets should be formalized to insure safe coordination of survivorship care based on cancer risk assessment. Conclusions: Given the recognized importance of risk-based survivorship care and implementation challenges, deliberative discussions may provide a useful lens to inform translation of this model into real practices and guide empirical studies.