Objective: To construct the underlying value structure of shared decision making (SDM) models. Method: We included previously identified SDM models (n = 40) and 15 additional ones. Using a thematic analysis, we coded the data using Schwartz’s value theory to define values in SDM and to investigate value relations. Results: We identified and defined eight values and developed three themes based on their relations: shared control, a safe and supportive environment, and decisions tailored to patients. We constructed a value structure based on the value relations and themes: the interplay of healthcare professionals’ (HCPs) and patients’ skills [Achievement], support for a patient [Benevolence], and a good relationship between HCP and patient [Security] all facilitate patients’ autonomy [Self-Direction]. These values enable a more balanced relationship between HCP and patient and tailored decision making [Universalism]. Conclusion: SDM can be realized by an interplay of values. The values Benevolence and Security deserve more explicit attention, and may especially increase vulnerable patients’ Self-Direction. Practice implications: This value structure enables a comparison of values underlying SDM with those of specific populations, facilitating the incorporation of patients’ values into treatment decision making. It may also inform the development of SDM measures, interventions, education programs, and HCPs when practicing.
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During the past two decades the implementation and adoption of information technology has rapidly increased. As a consequence the way businesses operate has changed dramatically. For example, the amount of data has grown exponentially. Companies are looking for ways to use this data to add value to their business. This has implications for the manner in which (financial) governance needs to be organized. The main purpose of this study is to obtain insight in the changing role of controllers in order to add value to the business by means of data analytics. To answer the research question a literature study was performed to establish a theoretical foundation concerning data analytics and its potential use. Second, nineteen interviews were conducted with controllers, data scientists and academics in the financial domain. Thirdly, a focus group with experts was organized in which additional data were gathered. Based on the literature study and the participants responses it is clear that the challenge of the data explosion consist of converting data into information, knowledge and meaningful insights to support decision-making processes. Performing data analyses enables the controller to support rational decision making to complement the intuitive decision making by (senior) management. In this way, the controller has the opportunity to be in the lead of the information provision within an organization. However, controllers need to have more advanced data science and statistic competences to be able to provide management with effective analysis. Specifically, we found that an important skill regarding statistics is the visualization and communication of statistical analysis. This is needed for controllers in order to grow in their role as business partner..
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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.
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People with dementia are confronted with many decisions. However, they are often not involved in the process of the decision-making. Shared Decision-Making (SDM) enables involvement of persons with dementia in the decision-making process. In our study, we develop a supportive IT application aiming to facilitate the decision-making process in care networks of people with dementia. A key feature in the development of this SDM tool is the participation of all network members during the design and development process, including the person with dementia. In this paper, we give insight into the first phases of this design and development process in which we conducted extensive user studies and translated wishes and needs of network members into user requirements
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Background: Patient decision aids (PDAs) can support the treatment decision making process and empower patients to take a proactive role in their treatment pathway while using a shared decision-making (SDM) approach making participatory medicine possible. The aim of this study was to develop a PDA for prostate cancer that is accurate and user-friendly. Methods: We followed a user-centered design process consisting of five rounds of semi-structured interviews and usability surveys with topics such as informational/decisional needs of users and requirements for PDAs. Our userbase consisted of 8 urologists, 4 radiation oncologists, 2 oncology nurses, 8 general practitioners, 19 former prostate cancer patients, 4 usability experts and 11 healthy volunteers. Results: Informational needs for patients centered on three key factors: treatment experience, post-treatment quality of life, and the impact of side effects. Patients and clinicians valued a PDA that presents balanced information on these factors through simple understandable language and visual aids. Usability questionnaires revealed that patients were more satisfied overall with the PDA than clinicians; however, both groups had concerns that the PDA might lengthen consultation times (42 and 41%, respectively). The PDA is accessible on http://beslissamen.nl/. Conclusions: User-centered design provided valuable insights into PDA requirements but challenges in integrating diverse perspectives as clinicians focus on clinical outcomes while patients also consider quality of life. Nevertheless, it is crucial to involve a broad base of clinical users in order to better understand the decision-making process and to develop a PDA that is accurate, usable, and acceptable.
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Background: For most women, participation in decision-making during maternity care has a positive impact on their childbirth experiences. Shared decision-making (SDM) is widely advocated as a way to support people in their healthcare choices. The aim of this study was to identify quality criteria and professional competencies for applying shared decision-making in maternity care. We focused on decision-making in everyday maternity care practice for healthy women. Methods: An international three-round web-based Delphi study was conducted. The Delphi panel included international experts in SDM and in maternity care: mostly midwives, and additionally obstetricians, educators, researchers, policy makers and representatives of care users. Round 1 contained open-ended questions to explore relevant ingredients for SDM in maternity care and to identify the competencies needed for this. In rounds 2 and 3, experts rated statements on quality criteria and competencies on a 1 to 7 Likert-scale. A priori, positive consensus was defined as 70% or more of the experts scoring ≥6 (70% panel agreement). Results: Consensus was reached on 45 quality criteria statements and 4 competency statements. SDM in maternity care is a dynamic process that starts in antenatal care and ends after birth. Experts agreed that the regular visits during pregnancy offer opportunities to build a relationship, anticipate situations and revisit complex decisions. Professionals need to prepare women antenatally for unexpected, urgent decisions in birth and revisit these decisions postnatally. Open and respectful communication between women and care professionals is essential; information needs to be accurate, evidence-based and understandable to women. Experts were divided about the contribution of professional advice in shared decision-making and about the partner’s role. Conclusions: SDM in maternity care is a dynamic process that takes into consideration women’s individual needs and the context of the pregnancy or birth. The identified ingredients for good quality SDM will help practitioners to apply SDM in practice and educators to prepare (future) professionals for SDM, contributing to women’s positive birth experience and satisfaction with care.
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PurposeIn order to better understand how heuristics are used in practice, the authors explore what type of heuristics is used in the managerial domain of financial advisors to small and medium-sized enterprises (SMEs) and what influences the shaping of these heuristics. In doing so, the authors detect possible fast-and-frugal heuristics in day-to-day decision-making of independent financial advisers who help owners of SMEs to acquire capital (e.g. loans, factoring, leasing and equity).Design/methodology/approachThe authors inductively assessed the work of financial advisers of SMEs. Based on group discussions, the authors drew up a semi-structured interview-protocol with descriptive questions about how financial advisers come to a deal for their clients. The interviews of 19 professionals were analysed by relating them to the theory of fast-and-frugal heuristics.FindingsWithin their decision-making, advisers estimate the likelihood of acceptance by a few financial providers they know well in their personal network with a strong bias towards traditional banking products, although there are a large number of alternatives on the Dutch market. “Less is more” seems to be a relevant principle when defined as satisficing. Heuristics help advisers to deal with behavioural and economic limitations. Also, the authors have found that client interaction, previous working experience and the company the adviser is working for influences the shaping of the simple rules the adviser is using.Research limitations/implicationsThe study shows how difficult it is to understand the ecological rationality of a certain group of professionals and to understand the “less is more” principle. Financial advisers to SMEs use cognitive shortcuts and simple rules to advise SME-owners, based on previous experiences, but it is difficult to determine whether that leads to the same or even better solutions for them and their clients than using probability theory and financial optimisation models. Within heuristics, satisficing seems to be a dominant mechanism. Here, heuristics help advisers in recognising possibilities by searching for similarities between a current financing case and previous experiences. The data suggests that if “less is more” is defined as satisficing for one or more stakeholders involved, the principle dominates the decision making of financial advisers of SME's.Practical implicationsThe authors suggest the relevance of a behavioural approach to finance by assessing the day-to-day decisions of financial advisers of SMEs. Also, the authors suggest that financial advisers are guided by previous experiences, and they do not fully assess a wide range of options in their work but need shortcuts to fulfil the needs of their clients.Originality/valueThe study comes close to day-to-day decision-making in finance by assessing how professionals make decisions. The authors try to understand types of heuristics in relation with “ecological rationality” and the less is more principle. The authors assess financial advisers of SME-companies, a group that has gotten little research attention until now. The influence of client interaction and of the company the adviser is working for is remarkable in the shaping of the advisers' simple rules.
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Clinical Decision Support Systems (CDSS) are increasingly developed for hospital nursing practice, yet their impact on decision-making, workflow efficiency, and patient outcomes remains complex. This rapid review synthesizes findings from 21 studies, highlighting both the benefits and challenges of CDSS implementation focused on three key areas. CDSS can enhance nursing decision-making by reducing variability and improving standardization, but there are concerns about system usability and the tendency to override recommendations. While CDSS improve workflow efficiency by prioritizing tasks, issues such as alert fatigue and poor interoperability with hospital systems hinder their potential. Patient outcomes benefit from CDSS-driven medication safety and risk prevention, yet adherence to recommendations varies among nurses. These findings underscore the need for user-centered CDSS that align with nursing values. Future research should explore long-term effectiveness, implementation strategies and best practices for integrating CDSS into nursing workflows.
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This paper is about the political imbalance in the EU when it comes to attracting European agencies. Over the years, mainly due to the Brexit negotiations and for cost-efficiency reasons, many EU agencies moved from the UK to elsewhere, finding a new sea for headquarters functions or other departments. Whenever such a move is announced, EU countries and their candidate host cities jump into the breach to make a beneficial offer. The way these processes take place is a vector of the politicization of European integration. Nevertheless, these new locations of the EU agencies have won the bidding contest, is a process that usually takes place under the radar. The decision-making of these kinds of processes rests with the member states of the agency. Instead of choosing the most strategic place and ensuring an equal distribution among EU countries, which is the deal, often the highest bidder or the state contributing the most wins the agency. Interestingly, these processes have hardly been studied in the light of the increased politicization. This paper is an attempt to fill this research gap, by focusing on three cases and the processes of decision-making. The cases are the Collège européen de police (European Police College, CEPOL) which moved from the UK to Budapest in 2014, the European Medicine Agency (EMA) moving from London to Amsterdam in 2019, and the European Centre for Medium-Range Weather Forecasts (ECMWF) which moved its EU-funded program to Bonn and Helsinki mid-2021. The research strategy is as follows: the cases and the lobbying processes are described, then the main political actors are described, and the outcomes are described. The main research question is: How do these processes of political decision-making work out in practice? By answering this question, this study contributes to the discussion on globalized decision-making across the EU and the politicized imbalance which is the result of this.
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The shift towards a more sustainable circular economy will require innovations. While SMEs can contribute to this development, financing innovations within SMEs is difficult. Various authors have not ed moreover that the concept of the circular economy has further increased the complexity of investment decisions concerning sustainable innovations, due to the multiple value creation and new business models involved . On the other hand
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