Patients with a hematologic malignancy increasingly prefer to be actively involved in treatment decision-making.1,2 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.3,4
Purpose: This study aimed to develop and pretest a systematic conversation approach for nurses to tailor aftercare to oncology patient's goals, unmet needs and wishes. Methods: We used an iterative developmental process for complex interventions: 1. Identifying problems 2. Identifying overall objectives 3. Designing the intervention 4. Pretesting and adapting the intervention. Results: The main results of the problem identification were: non-systematic and incomplete screening of potential issues, caveats in providing information, and shared decision-making. The overall objective formulated was: To develop a model for aftercare conversations based on shared goal-setting and decision-making. The conversation approach consists of four phases: 1. Preparation of the consultation including a questionnaire, 2. Shared goal-setting by means of a tool visualizing domains of life, and 3. Shared care planning by means of an overview of possible choices in aftercare, a database with health care professionals and a cancer survivorship care plan. 4. Evaluation. The results of the pretest revealed that the conversation approach needs to be flexible and tailored to the patient and practice setting, and embedded in the care processes. The conversation approach was perceived as enhancing patient-centeredness and leading to more in-depth consultations. Conclusion: The conversation approach was developed in co-creation with stakeholders. The results of the pretest revealed important implications and suggestions for implementation in routine care. The aftercare conversation approach can be used by nurses to provide tailored patient-centered evidence-based aftercare. Tailored aftercare should support oncology patient's goals, unmet needs and wishes. Further tailoring is needed.
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.
MULTIFILE
The energy transition is a highly complex technical and societal challenge, coping with e.g. existing ownership situations, intrusive retrofit measures, slow decision-making processes and uneven value distribution. Large scale retrofitting activities insulating multiple buildings at once is urgently needed to reach the climate targets but the decision-making of retrofitting in buildings with shared ownership is challenging. Each owner is accountable for his own energy bill (and footprint), giving a limited action scope. This has led to a fragmented response to the energy retrofitting challenge with negligible levels of building energy efficiency improvements conducted by multiple actors. Aggregating the energy design process on a building level would allow more systemic decisions to happen and offer the access to alternative types of funding for owners. “Collect Your Retrofits” intends to design a generic and collective retrofit approach in the challenging context of monumental areas. As there are no standardised approaches to conduct historical building energy retrofits, solutions are tailor-made, making the process expensive and unattractive for owners. The project will develop this approach under real conditions of two communities: a self-organised “woongroep” and a “VvE” in the historic centre of Amsterdam. Retrofit designs will be identified based on energy performance, carbon emissions, comfort and costs so that a prioritisation strategy can be drawn. Instead of each owner investing into their own energy retrofitting, the neighbourhood will invest into the most impactful measures and ensure that the generated economic value is retained locally in order to make further sustainable investments and thus accelerating the transition of the area to a CO2-neutral environment.
The IMPULS-2020 project DIGIREAL (BUas, 2021) aims to significantly strengthen BUAS’ Research and Development (R&D) on Digital Realities for the benefit of innovation in our sectoral industries. The project will furthermore help BUas to position itself in the emerging innovation ecosystems on Human Interaction, AI and Interactive Technologies. The pandemic has had a tremendous negative impact on BUas industrial sectors of research: Tourism, Leisure and Events, Hospitality and Facility, Built Environment and Logistics. Our partner industries are in great need of innovative responses to the crises. Data, AI combined with Interactive and Immersive Technologies (Games, VR/AR) can provide a partial solution, in line with the key-enabling technologies of the Smart Industry agenda. DIGIREAL builds upon our well-established expertise and capacity in entertainment and serious games and digital media (VR/AR). It furthermore strengthens our initial plans to venture into Data and Applied AI. Digital Realities offer great opportunities for sectoral industry research and innovation, such as experience measurement in Leisure and Hospitality, data-driven decision-making for (sustainable) tourism, geo-data simulations for Logistics and Digital Twins for Spatial Planning. Although BUas already has successful R&D projects in these areas, the synergy can and should significantly be improved. We propose a coherent one-year Impuls funded package to develop (in 2021): 1. A multi-year R&D program on Digital Realities, that leads to, 2. Strategic R&D proposals, in particular a SPRONG/sleuteltechnologie proposal; 3. Partnerships in the regional and national innovation ecosystem, in particular Mind Labs and Data Development Lab (DDL); 4. A shared Digital Realities Lab infrastructure, in particular hardware/software/peopleware for Augmented and Mixed Reality; 5. Leadership, support and operational capacity to achieve and support the above. The proposal presents a work program and management structure, with external partners in an advisory role.
The purpose of this project was to create a roadmap with selected mechanisms to assist destination management organisations to optimize the benefits generated by tourism for their destination communities and ensure that it is shared equitably. By providing tools to identify and address inequality in terms of access to the benefits and value tourism generates, it is envisaged that a more equitable tourism model can be implemented leading to the fair distribution of benefits in destination communities, potentially increasing the value for previously excluded or underserved groups. To produce the roadmap, the study team will explore the range of challenges that hinder the equitable distribution of tourism-induced benefits in destinations as well as the enabling factors that influence the extent to which this is achieved. The central question the research team has set out to answer is the following: What does an equitable tourism model look like for destination communities?Societal issueHowever, while those directly involved in tourism will gain the most, the burden of hosting visitors is widely felt by local communities. This imbalance has, unsurprisingly, sparked civil mobilisations and protests in destinations around the world. It’s clear that placemaking and benefit-sharing must be part of the future of destination management to maintain public support. This project addressed issues around equity (environmental, economic, spatial, cultural and tourism experience). In line with the intentions set out in the CELTH Agenda Conscious Destinations.Benefit to societyBased on 25 case studies around 40 mechanisms were identified that can grow or better distribute the value from tourism, so that more people in destination communities benefit. These mechanisms are real-world practices already in use. DMOs and NTOs can consider introducing the mechanisms that best fit their destination context, pulling levers such as: taxes and revenue sharing, business incubation and training, licencing and zoning, community enterprises and volunteering, and product development..This report also outlines a pathway to an Equity-Driven Management (EDM) approach, which is grounded in participatory decision-making principles and aims to create a more equitable tourism system by strengthening the hand of destination governance and retaining control of local resources.Collaborative partnersNBTC, the Travel Foundation, Destination Think, CELTH, ETFI, HZ.
