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Protocol for a pre-implementation and post-implementation study on shared decision-making in the surgical treatment of women with early-stage breast cancer

Background: The majority of patients diagnosed with early-stage breast cancer are in a position to choose between having a mastectomy or lumpectomy with radiation therapy (breast-conserving therapy). Since the long-term survival rates for mastectomy and for lumpectomy with radiation therapy are comparable, patients’ informed preferences are important for decision-making. Although most clinicians believe that they do include patients in the decision-making process, the information that women with breast cancer receive regarding the surgical options is often rather subjective, and does not invite patients to express their preferences. Shared decision-making (SDM) is meant to help patients clarify their preferences, resulting in greater satisfaction with their final choice. Patient decision aids can be very supportive in SDM. We present the protocol of a study to β test a patient decision aid and optimise strategies for the implementation of SDM regarding the treatment of early-stage breast cancer in the actual clinical setting. Methods/design: This paper concerns a preimplementation and post-implementation study, lasting from October 2014 to June 2015. The intervention consists of implementing SDM using a patient decision aid. The intervention will be evaluated using qualitative and quantitative measures, acquired prior to, during and after the implementation of SDM. Outcome measures are knowledge about treatment, perceived SDM and decisional conflict. We will also conduct face-to-face interviews with a sample of these patients and their care providers, to assess their experiences with the implementation of SDM and the patient decision aid.

Distribution structure and distribution centre location decision-making – A review

Distribution structures and distribution centre (DC) locations are essential for logistics companies to optimise logistics costs and service levels. This paper reviews Supply Chain Management (SCM), Geography and Economic Geographic literature on distribution structure and DC locations decision-making. Two central decision-making elements are discussed: process steps and decision-making factors. Added value of our paper is 1) A literature review 2) Conclusions on the state of current scientific knowledge in three research streams 3) A research agenda. Reviewing literature shows decision-making factors are renowned, however, importance of factors in each process step is unknown. Results also show literature diverges on which process steps logistics companies take (descriptive) or should optimally take (prescriptive) in distribution structure and DC location decision-making. Thus, more research is needed. Developing a descriptive conceptual model and testing on several industry sectors will be valuable to understand differences on distribution structure and DC location decision-making.

Passende hulp bij multiproblematiek

What are the Relations Between the Characteristics and Context of the Board and its Effectivity in Decision-Making?

The decision-making process in boardrooms has a significant impact on organizational performance. In the last two decades, scientific research on the decision-making process in boardrooms has increased. This resulted in a substantial body of knowledge about boardroom factors and their relation to organizational performance. However, the effectiveness of the decision-making process in boardrooms is still mainly a black box. Amongst other things, scientific findings seem to contradict each other, which could mean additional insights are still missing. This research aims to contribute to a better understanding of this black box.

The impact of shared decision-making in perinatal care

Introduction: Shared decision-making is considered to be a key aspect of woman-centered care and a strategy to improve communication, respect, and satisfaction. This scoping review identified studies that used a shared decision-making support strategy as the primary intervention in the context of perinatal care. Methods: A literature search of PubMed, CINAHL, Cochrane Library, PsycINFO, and SCOPUS databases was completed for English-language studies conducted from January 2000 through November 2019 that examined the impact of a shared decision-making support strategy on a perinatal decision (such as choice of mode of birth after prior cesarean birth). Studies that only examined the use of a decision aid were excluded. Nine studies met inclusion criteria and were examined for the nature of the shared decision-making intervention as well as outcome measures such as decisional evaluation, including decisional conflict, decisional regret, and certainty. Results: The 9 included studies were heterogeneous with regard to shared decision-making interventions and measured outcomes and were performed in different countries and in a variety of perinatal situations, such as women facing the choice of mode of birth after prior cesarean birth. The impact of a shared decision-making intervention on women’s perception of shared decision-making and on their experiences of the decision-making process were mixed. There may be a decrease in decisional conflict and regret related to feeling informed, but no change in decisional certainty. Discussion: Despite the call to increase the use of shared decision-making in perinatal care, there are few studies that have examined the effects of a shared decision-making support strategy. Further studies that include antepartum and intrapartum settings, which include common perinatal decisions such as induction of labor, are needed. In addition, clear guidance and strategies for successfully integrating shared decision-making and practice recommendations would help women and health care providers navigate these complex decisions.

Applying AHP for supplier selection in aviation

The current systematic framework of aviation has developed complex air transport systems where reliability and performance are sensitive and instantly adaptive to the supply side due to the growing and elevated degree of demand in aviation market circumstances. The role of quality measurements has increased. Determining quality performance indicators is difficult because of the system's uniqueness, interdependency, and unsupportable characteristics. This is accomplished by using the 'analytical hierarchy process (AHP)' by developing a survey based on a three-level hierarchical model of the air transport supply-side quality dispersed among four groups of aviation professionals, namely 1) pilots 2) ATCOs 3) aircraft engineers, and 4) aviation managers. The scope of this study is to analyse the crucial components of the present air transportation system and draw a distinction between all the current system components.