Patients with a hematologic malignancy increasingly prefer to be actively involved in treatment decision-making. Shared decision-making (SDM), a process that supports decision-making in preference-sensitive decisions, fits well with this need. A decision is preference sensitive when well-informed patients considerably differ in their trade-offs between the pros and cons of one option, or if more equal treatment options are available, including no treatment. SDM involves several steps: the first is choice talk, where the professional informs the patient that a decision needs to be made between the various relevant options and that the patient's opinion is important. The second is option talk, where the professional explains the options and their pros and cons. In the third step, preference talk, the professional and the patient discuss the patient's preferences. The professional supports the patient in deliberation. The final step is decision talk, where the professional and patient discuss the patient's decisional role preference, make or defer the decision and discuss possible follow-up.
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.
In the decision-making environment of evidence-based practice, the following three sources of information must be integrated: research evidence of the intervention, clinical expertise, and the patient’s values. In reality, evidence-based practice usually focuses on research evidence (which may be translated into clinical practice guidelines) and clinical expertise without considering the individual patient’s values. The shared decision-making model seems to be helpful in the integration of the individual patient’s values in evidence-based practice. We aim to discuss the relevance of shared decision making in chronic care and to suggest how it can be integrated with evidence-based practice in nursing. We start by describing the following three possible approaches to guide the decision-making process: the paternalistic approach, the informed approach, and the shared decision-making approach. Implementation of shared decision making has gained considerable interest in cases lacking a strong best-treatment recommendation, and when the available treatment options are equivalent to some extent. We discuss that in chronic care it is important to always invite the patient to participate in the decision-making process. We delineate the following six attributes of health care interventions in chronic care that influence the degree of shared decision making: the level of research evidence, the number of available intervention options, the burden of side effects, the impact on lifestyle, the patient group values, and the impact on resources. Furthermore, the patient’s willingness to participate in shared decision making, the clinical expertise of the nurse, and the context in which the decision making takes place affect the shared decision-making process. A knowledgeable and skilled nurse with a positive attitude towards shared decision making – integrated with evidence-based practice – can facilitate the shared decision-making process. We conclude that nurses as well as other health care professionals in chronic care should integrate shared decision making with evidence- based practice to deliver patient-centred care.
The impacts of tourism on destinations and the perceptions of local communities have been a major concern both for the industry and research in the past decades. However, tourism planning has been mainly focused on traditions that promote the increase of tourism without taking under consideration the wellbeing of both residents and visitors. To develop a more sustainable tourism model, the inclusion of local residents in tourism decision-making is vital. However, this is not always possible due to structural, economic and socio-cultural restrictions that residents face resulting to their disempowerment. This study aims to explore and interpret the formal processes around tourism decision-making and community empowerment in urban settings. The research proposes a comparative study of three urban destinations in Europe (The Hague in the Netherlands, San Sebastian in Spain and, Ioannina in Greece) that experience similar degree of tourism growth. The proposed study will use a design-based approach in order to understand tourism decision-making and what empowers or disempowers community participation within the destinations. Based on the findings of primary and secondary data, a community empowerment model will be applied in one the destinations as a pilot for resident engagement in tourism planning. The evaluation of the pilot will allow for an optimized model to be created with implications for tourism planning at a local level that can contribute to sustainable destinations that safeguard the interests of local residents and tourists.
Hoogwaardig afvalhout van bewoners, bouwbedrijven en meubelmakers blijft momenteel ongebruikt omdat het te arbeidsintensief is om grote hoeveelheden ongelijke stukken hout van verschillende afmetingen en soorten te verwerken. Waardevol hout wordt waardeloos afval, tegen de principes van de circulaire economie in. In CW.Code werken Powerhouse Company, Bureau HUNC en Vrijpaleis samen met de HvA om te onderzoeken hoe een toegankelijke ontwerptool te ontwikkelen om upcycling en waardecreatie van afvalhout te faciliteren. In andere projecten hebben HvA en partners verschillende objecten gemaakt van afvalhout: een stoel, een receptiebalie, kleine meubels en objecten voor de openbare ruimte, vervaardigd met industriële robots. Deze objecten zijn 3D gemodelleerd met behulp van specifieke algoritmen, in de algemeen gebruikte ontwerpsoftware Rhino en Grasshopper. De projectpartners willen nu onderzoeken hoe deze algoritmen via een toegankelijke tool bruikbaar te maken voor creatieve praktijken. Deze tool integreert generatieve ontwerpalgoritmen en regelsets die rekening houden met beschikbaar afvalhout, en de ecologische, financiële en sociale impact van resulterende ontwerpen evalueren. De belangrijkste ontwerpparameters kunnen worden gemanipuleerd door ontwerpers en/of eindgebruikers, waardoor het een waardevol hulpmiddel wordt voor het co-creëren van circulaire toepassingen voor afvalhout. Dit onderzoek wordt uitgevoerd door HvA Digital Production Research Group, met bovengenoemde partners. HUNC heeft ervaring met stadsontwikkeling waarbij gebruik wordt gemaakt van lokaal gekapt afvalhout. Vrijpaleis biedt toegang tot een actieve, lokale community van makers met een sterke band met buurtbewoners. Powerhouse Company heeft ervaring in het ontwerpen met hout in de bouw. Alle drie kunnen profiteren van slimmere circulaire ontwerptools, waarbij beschikbaar materiaal, productiebeperkingen en impactevaluatie worden geïntegreerd. De tool wordt ontwikkeld en getest voor twee designcases: een binnenmeubelobject en een buitengevelelement. Bevindingen hiervan zullen leidend zijn bij de ontwikkeling van de tool. Na afronding van het project is een bètaversie gereed voor validatie door ontwerpers, bewonerscollectieven en onderzoek/onderwijs van de HvA.
Can provision of outdoor fitness and engaging communities in decision making process , encourage residents to use the facilities and be more physical active?ongoing project This a practical project that is part of the BIOR program in Groningen. We are aiming to explore the impact of implementing the fitness equipment as well as community involvements in four different areas in Groningen on physical activity level of residents and/or park utilisation. The project is drawing on qualitative data based on observation using SOPARC, interview with stakeholders and survey and focus group discussion with residents.
