Facilitators and Barriers to Implementing a Digital Informed Decision Making Tool in Primary Care: A Qualitative Study

Background Informed decision aids provide information in the context of the patient's values and improve informed decision making (IDM). To overcome barriers that interfere with IDM, our team developed an innovative iPad-based application (aka “app”) to help patients make informed decisions about colorectal cancer screening. The app assesses patients' eligibility for screening, educates them about their options, and empowers them to request a test via the interactive decision aid. Objective The aim of the study is to explore how informed decision aids can be implemented successfully in primary care clinics, including the facilitators and barriers to implementation; strategies for minimizing barriers; adequacy of draft training materials; and any additional support or training desired by clinics. Design This work deals with a multicenter qualitative study in rural and urban settings. Participants A total of 48 individuals participated including primary care practice managers, clinicians, nurses, and front desk staff. Approach Focus groups and semi-structured interviews, with data analysis were guided by thematic analysis. Key Results Salient emergent themes were time, workflow, patient age, literacy, and electronic health record (EHR) integration. Saving time was important to most participants. Patient flow was a concern for all clinic staff, and they expressed that any slowdown due to patients using the iPad module or perceived additional work to clinic staff would make staff less motivated to use the program. Participants voiced concern about older patients being unwilling or unable to utilize the iPad and patients with low literacy ability being able to read or comprehend the information. Conclusion Integrating new IDM apps into the current clinic workflow with minimal disruptions would increase the probability of long-term adoption and ultimate sustainability. NIH trial registry number R01CA218416-A1.

The End of Monogamy? An Exploration of Non-monogamous Relationship Dynamics

Although monogamy is the dominant relationship style in the Western world, there are alternative options for non-monogamous relationship dynamics. This paper works to explore how the roots of how monogamy became the dominant structure, the hidden drawbacks of monogamy, how those who assert monogamy to be compulsory hold a stigma against those who partake in other dynamics, and how this stigma can work to oppress. It also explores what those dynamics are, who participates in them, and a myriad of benefits that non-monogamous relationships can have. Overall coming to the conclusion that everyone should be able to make an informed decision, free of societal judgment, to partake in whatever dynamic they may choose.

Bell v Tavistock: Rethinking informed decision-making as the practical device of consent for medical treatment

The decision of the High Court in Bell v Tavistock has excited considerable discussion about lawful consent for puberty-blocking drug treatment for children with gender dysphoria. The present paper draws attention to a wider question that surfaces through this case: is informed decision-making an adequate practical tool for seeking and obtaining patients’ consent for medical treatment? Informed decision-making engages the premises of the rational choice theory: that people will have well-crystallised health goals; and, if they are provided with sufficient information about medical treatments, then they will be able to choose the treatment that satisfies their goals. Whilst appealing, the informed decision-making paradigm is assailed by various fallacies, which apply not only to children but also to adults. In Bell v Tavistock, the High Court seems to have recognised such fallacies, and it rejected informed decision-making as an adequate tool for consent from children with gender dysphoria. Similar considerations apply to adults in various situations. Thus, Bell v Tavistock can be seen as an attempt to refine the views on the consent that were expressed by the Supreme Court in Montgomery. It can be inferred that the Supreme Court did recognise the limitations of informed decision-making, but it did not develop this point. Further work is required to formulate an adequate model of decision-making, and Bell v Tavistock serves as a useful reminder to rethink informed decision-making as the device for consent.

Mobile Audio Recording Technology to Promote Informed Decision Making in Advanced Prostate Cancer

PURPOSE Men with metastatic castration-resistant prostate cancer increasingly encounter complex treatment decisions. Consultation audio recordings and summaries promote patient informed decision making but are underutilized. Mobile recording software applications may increase access. Little is known regarding the feasibility of implementation in clinical encounters. METHODS We conducted a mixed-methods pilot study in men with progressive metastatic castration-resistant prostate cancer. We instructed patients to use a mobile software application to record an oncology visit. Patients could share the recording with our patient scribing program to receive a written summary. We assessed feasibility and acceptability with postvisit surveys. We measured patient-reported helpfulness of the intervention in decision making and change in Decisional Conflict Scale–informed subscale. We conducted semistructured interviews to explore implementation and analyzed transcripts using thematic analysis. RESULTS Across 20 patients, 18 (90%) recorded their visits. Thirteen of 18 (72%) listened to the recording, and 14 of 18 (78%) received a summary. Eighteen of 20 (90%) visits were telehealth. Fourteen patients (70% of all 20; 78% of 18 question respondents) found the application easy to use. Nine patients (50% of 18 recording patients; 90% of 10 question respondents) reported that the recording helped treatment decision making. Decisional conflict decreased from baseline to 1-week postvisit (47.4-28.5, P < .001). Interviews revealed benefits, facilitators, contextual factors, and technology and patient-related barriers to recordings and summaries. CONCLUSION In this single-institution academic setting, a mobile application for patients to record consultations was a feasible, acceptable, and potentially valued intervention that improved decision making in the telehealth setting. Studies in larger, diverse populations are needed.

Comparison between Will and Trust: A Conceptual Review

The growth of unclaimed inheritance in Malaysia is an issue since the independence of Malaysia. Inheritance planning or Estate planning can be defined as the process of determining how one’s property should be distributed to meet the deceased’ wish. There are two popular estate planning instruments namely will and trust. This study aims to explore the differences of will and trust as part of estate planning instruments. The concept of will and trust, as well as the comparison and barriers of estate planning have been discussed in depth. This study will provide more insights to people for better-informed decision in their estate-planning arrangements by understanding the key differences between these two estate planning instruments.

Dairy Farmers Perception on Cooperatives in East Java, Indonesia

Although past studies have shown that cooperatives can improve the welfare of rural communities. However, many farmers did not aware about the cooperative advantages. This begs a question as to whether cooperatives really contribute to the rural incomes and economies. This study aims to assess farmers’ perception on cooperative membership and how members have adopted innovative technologies. Data were obtained from a survey with 300 dairy farmers in Malang and Batu, East Java. The data were examined using a descriptive analysis. The results showed that farmers who do not join any cooperatives perceive that the institution is not able to determine the quality of their milk produce. Meanwhile, farmers who are members of a cooperative perceive that the institution can maintain stability of milk produce’s sales prices. This implies that education about cooperatives among farmers needs to be improved so that they can objectively view the benefits of cooperative membership and make informed decision in their economic activities.

Rapid reviews as an emerging approach to evidence synthesis in education

Rapid reviews using abbreviated systematic review methods are of increasing importance for evidence-informed decision-making in education, although there is little guidance about the most suitable approach. Three recently completed rapid review reports are compared to inform discussions on the utility of this type of review in education and to highlight appropriate methods for producing evidence syntheses in a limited time frame. Rapid review methods need to be chosen to fit the needs of the review, which involves: thinking broadly about different kinds of team experience and expertise; estimating the size and nature of the literature to be reviewed; considering the review purpose and nature of the topic; choosing an appropriate synthesis method for the review purpose, evidence base and reviewers’ expertise; fully describing the review approach, and discussing the potential limitations of chosen methods; and understanding the anticipated audiences and tailoring outputs accordingly. Rapid reviews to address urgent and high-priority questions provide the benefits of timeliness and reduced resource requirements. However, it is crucial to understand caveats and limitations to the rapid conduct of evidence syntheses for decision-making purposes. This article offers guidance to support researchers, postgraduate students and commissioners who wish to conduct rapid reviews in a transparent and systematic way, addressing complex questions of relevance to evidence-informed decision-making in education.