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3Objective: 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.
ARTIKEL
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.
ARTIKEL
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..
CONFERENTIEBIJDRAGE
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.
ARTIKEL
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
CONFERENTIEBIJDRAGE
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.
ARTIKEL
The central research question in this study is: Which meaning is given to sustainability within a Dutch housing association and does making sense of the concept of sustainability lead to sustainable strategic choices? The chosen research strategy is a longitudinal case study in the Dutch housing association Welbions. Data was collected in three periods between 2009 and 2018. Welbions associates sustainability mainly with the financial position, costs and affordability, and interprets the concept as investment measures in energy savings, reducing the usage of gas and CO2-emissions which are aimed at in covenants. From the listed factors influencing strategic decision-making, the economic, technical and personal frames appeared to be used mostly. The organizational and ethical frame were used only once, and the aesthetic frame was not used at all. Noteworthy is that ecological developments were not mentioned. Frames derived from the decision criteria showed a dominating economic frame. Making sense of sustainability does not result in sustainability-based actions, or choice. This indicates that sustainable values have not gained a position in strategic decision-making, compared to traditional values such as cost-efficiency and affordability.
PROEFSCHRIFT
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.
ARTIKEL
Purpose: This study assesses the perceived quality of the outcomes in decision-making phases by using the conversational ai approach. Design/Method: The research adopts an experimental design to explore the impact of conversational artificial intelligence (AI) in the separate phases of a decision-making making process. This investigation is conducted through a team-level “Shark Tank” game, which serves as a dynamic platform. Findings: The data indicated a discernible pattern across all five steps of the decision-making process. The integration of AI, particularly Conversational AI, consistently improves the perceived quality of decisions, with varying degrees of impact at various stages. Originality/Value: This study contributes by particularly focusing on the conversational AI approach, to discern its efficacy in enhancing decision making processes. It is critical in contributing to the rapidly growing field of AI in decision making, providing a deeper understanding of AI's role in improving decision making quality.
CONFERENTIEBIJDRAGE
Analyzing historical decision-related data can help support actual operational decision-making processes. Decision mining can be employed for such analysis. This paper proposes the Decision Discovery Framework (DDF) designed to develop, adapt, or select a decision discovery algorithm by outlining specific guidelines for input data usage, classifier handling, and decision model representation. This framework incorporates the use of Decision Model and Notation (DMN) for enhanced comprehensibility and normalization to simplify decision tables. The framework’s efficacy was tested by adapting the C4.5 algorithm to the DM45 algorithm. The proposed adaptations include (1) the utilization of a decision log, (2) ensure an unpruned decision tree, (3) the generation DMN, and (4) normalize decision table. Future research can focus on supporting on practitioners in modeling decisions, ensuring their decision-making is compliant, and suggesting improvements to the modeled decisions. Another future research direction is to explore the ability to process unstructured data as input for the discovery of decisions.
ARTIKEL
