In case of a major cyber incident, organizations usually rely on external providers of Cyber Incident Response (CIR) services. CIR consultants operate in a dynamic and constantly changing environment in which they must actively engage in information management and problem solving while adapting to complex circumstances. In this challenging environment CIR consultants need to make critical decisions about what to advise clients that are impacted by a major cyber incident. Despite its relevance, CIR decision making is an understudied topic. The objective of this preliminary investigation is therefore to understand what decision-making strategies experienced CIR consultants use during challenging incidents and to offer suggestions for training and decision-aiding. A general understanding of operational decision making under pressure, uncertainty, and high stakes was established by reviewing the body of knowledge known as Naturalistic Decision Making (NDM). The general conclusion of NDM research is that experts usually make adequate decisions based on (fast) recognition of the situation and applying the most obvious (default) response pattern that has worked in similar situations in the past. In exceptional situations, however, this way of recognition-primed decision-making results in suboptimal decisions as experts are likely to miss conflicting cues once the situation is quickly recognized under pressure. Understanding the default response pattern and the rare occasions in which this response pattern could be ineffective is therefore key for improving and aiding cyber incident response decision making. Therefore, we interviewed six experienced CIR consultants and used the critical decision method (CDM) to learn how they made decisions under challenging conditions. The main conclusion is that the default response pattern for CIR consultants during cyber breaches is to reduce uncertainty as much as possible by gathering and investigating data and thus delay decision making about eradication until the investigation is completed. According to the respondents, this strategy usually works well and provides the most assurance that the threat actor can be completely removed from the network. However, the majority of respondents could recall at least one case in which this strategy (in hindsight) resulted in unnecessary theft of data or damage. Interestingly, this finding is strikingly different from other operational decision-making domains such as the military, police and fire service in which there is a general tendency to act rapidly instead of searching for more information. The main advice is that training and decision aiding of (novice) cyber incident responders should be aimed at the following: (a) make cyber incident responders aware of how recognition-primed decision making works; (b) discuss the default response strategy that typically works well in several scenarios; (c) explain the exception and how the exception can be recognized; (d) provide alternative response strategies that work better in exceptional situations.
DOCUMENT
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.
DOCUMENT
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
DOCUMENT
In this thesis several studies are presented that have targeted decision making about case management plans in probation. In a case management plan probation officers describe the goals and interventions that should help offenders stop reoffending, and the specific measures necessary to reduce acute risks of recidivism and harm. Such a plan is embedded in a judicial framework, a sanction or advice about the sanction in which these interventions and measures should be executed. The topic of this thesis is the use of structured decision support, and the question is if this can improve decision making about case management plans in probation and subsequently improve the effectiveness of offender supervision. In this chapter we first sketch why structured decision making was introduced in the Dutch probation services. Next we describe the instrument for risk and needs assessment as well as the procedure to develop case management plans that are used by the Dutch probation services and that are investigated in this thesis. Then we describe the setting of the studies and the research questions, and we conclude with an overview of this thesis.
DOCUMENT
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.
DOCUMENT
Proper decision-making is one of the most important capabilities of an organization. Therefore, it is important to have a clear understanding and overview of the decisions an organization makes. A means to understanding and modeling decisions is the Decision Model and Notation (DMN) standard published by the Object Management Group in 2015. In this standard, it is possible to design and specify how a decision should be taken. However, DMN lacks elements to specify the actors that fulfil different roles in the decision-making process as well as not taking into account the autonomy of machines. In this paper, we re-address and-present our earlier work [1] that focuses on the construction of a framework that takes into account different roles in the decision-making process, and also includes the extent of the autonomy when machines are involved in the decision-making processes. Yet, we extended our previous research with more detailed discussion of the related literature, running cases, and results, which provides a grounded basis from which further research on the governance of (semi) automated decision-making can be conducted. The contributions of this paper are twofold; 1) a framework that combines both autonomy and separation of concerns aspects for decision-making in practice while 2) the proposed theory forms a grounded argument to enrich the current DMN standard.
DOCUMENT
Aim To provide insight into the basic characteristics of decision making in the treatment of symptomatic severe aortic stenosis (SSAS) in Dutch heart centres with specific emphasis on the evaluation of frailty, cognition, nutritional status and physical functioning/functionality in (instrumental) activities of daily living [(I)ADL]. Methods A questionnaire was used that is based on the European and American guidelines for SSAS treatment. The survey was administered to physicians and non-physicians in Dutch heart centres involved in the decision-making pathway for SSAS treatment. Results All 16 Dutch heart centres participated. Before a patient case is discussed by the heart team, heart centres rarely request data from the referring hospital regarding patients’ functionality (n = 5), frailty scores (n = 0) and geriatric consultation (n = 1) as a standard procedure. Most heart centres ‘often to always’ do their own screening for frailty (n = 10), cognition/mood (n = 9), nutritional status (n = 10) and physical functioning/functionality in (I)ADL (n = 10). During heart team meetings data are ‘sometimes to regularly’ available regarding frailty (n = 5), cognition/mood (n = 11), nutritional status (n = 8) and physical functioning/functionality in (I)ADL (n = 10). After assessment in the outpatient clinic patient cases are re-discussed ‘sometimes to regularly’ in heart team meetings (n = 10). Conclusions Dutch heart centres make an effort to evaluate frailty, cognition, nutritional status and physical functioning/functionality in (I)ADL for decision making regarding SSAS treatment. However, these patient data are not routinely requested from the referring hospital and are not always available for heart team meetings. Incorporation of these important data in a structured manner early in the decision-making process may provide additional useful information for decision making in the heart team meeting.
LINK
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.
DOCUMENT
AIM: To understand the steps in the decision-making process regarding pain assessment and management for people living with dementia from the perspectives and experiences of people with dementia, formal and informal carers.METHODS: A systematic review was conducted. Seven English databases were searched, including PubMed, Psychological Information Database, Cochrane Library, Scopus, Cumulative Index of Nursing and Allied Health Literature, Web of Science, and ProQuest, using synonyms and derivatives for "dementia", "cognitive impairment", "pain", "pain assessment", "pain management", "decision", "decision support", and "decision-making".RESULTS: Twenty-eight studies fulfilled the eligibility criteria. Pain assessment and management in dementia are complex, successive, and collaborative processes carried out by different individuals over a period based on one's understanding of the person with dementia but with high uncertainty. Pain assessment involves a certain degree of guesswork, while pain management is a trial-and-error process.CONCLUSION: More pragmatic approaches are needed to overcome challenges, including uncertainty and decisional conflicts.
DOCUMENT
Background: Shared decision-making is one key element of interprofessional collaboration. Communication is often considered to be the main reason for inefficient or ineffective collaboration. Little is known about group dynamics in the process of shared decision-making in a team with professionals, including the patient or their parent. This study aimed to evaluate just that. Methods: Simulation-based training was provided for groups of medical and allied health profession students from universities across the globe. In an overt ethnographic research design, passive observations were made to ensure careful observations and accurate reporting. The training offered the context to directly experience the behaviors and interactions of a group of people. Results: Overall, 39 different goals were defined in different orders of prioritizing and with different time frames or intervention ideas. Shared decision-making was lacking, and groups chose to convince the parents when a conflict arose. Group dynamics made parents verbally agree with professionals, although their non-verbal communication was not in congruence with that. Conclusions: The outcome and goalsetting of an interprofessional meeting are highly influenced by group dynamics. The vision, structure, process, and results of the meeting are affected by multiple inter- or intrapersonal factors.
DOCUMENT
