Health care systems are increasingly moving towards more integrated approaches. Shared decision making (SDM) is central to these models but may be complicated by the need to negotiate and communicate ...decisions between multiple providers, as well as patients and their family carers; particularly for older people with complex needs. The aim of this review was to provide a context relevant understanding of how interventions to facilitate SDM might work for older people with multiple health and care needs, and how they might be applied in integrated care models.
Iterative, stakeholder driven, realist synthesis following RAMESES publication standards. It involved: 1) scoping literature and stakeholder interviews (n = 13) to develop initial programme theory/ies, 2) systematic searches for evidence to test and develop the theories, and 3) validation of programme theory/ies with stakeholders (n = 11). We searched PubMed, The Cochrane Library, Scopus, Google, Google Scholar, and undertook lateral searches. All types of evidence were included.
We included 88 papers; 29 focused on older people or people with complex needs. We identified four context-mechanism-outcome configurations that together provide an account of what needs to be in place for SDM to work for older people with complex needs. This includes: understanding and assessing patient and carer values and capacity to access and use care, organising systems to support and prioritise SDM, supporting and preparing patients and family carers to engage in SDM and a person-centred culture of which SDM is a part. Programmes likely to be successful in promoting SDM are those that allow older people to feel that they are respected and understood, and that engender confidence to engage in SDM.
To embed SDM in practice requires a radical shift from a biomedical focus to a more person-centred ethos. Service providers will need support to change their professional behaviour and to better organise and deliver services. Face to face interactions, permission and space to discuss options, and continuity of patient-professional relationships are key in supporting older people with complex needs to engage in SDM. Future research needs to focus on inter-professional approaches to SDM and how families and carers are involved.
In our research we investigated the optimal utilization of land resources for agricultural production in Tabriz County, Iran. A GIS-based Multi Criteria Decision Making land suitability analysis was ...performed. Hereby, several suitability factors including soils, climatic conditions, and water availability were evaluated, based on expert knowledge from stakeholders at various levels. An Analytical Hierarchical Process was used to rank the various suitability factors and the resulting weights were used to construct the suitability map layers. In doing so, the derived weights were used, and subsequently land suitability maps for irrigated and dry-farm agriculture were created. Finally, a synthesized land suitability map was generated by combining these maps and by comparing the product with current land use SPOT 5 satellite images. The resulting suitability maps indicate the areas, in which the intensity of land use for agriculture should increase, decrease or remain unchanged. Our investigations have revealed that 65676 hectares may be suitable for irrigation and 120872 hectares may be suitable for dry-farm agriculture. This indicates a substantial potential to satisfy the significantly increasing regional demand for agricultural products. The results of our research have been provided to the regional authorities and will be used in strategic land use planning.
Pediatric shared decision-making (SDM) is a fundamental part of family-centered care. Pediatric palliative care (PPC) is one of the more difficult fields for healthcare providers when choosing to ...utilize SDM. However, to our knowledge, there are still few structured approaches of SDM in PPC. We aimed to build a model of SDM in PPC that achieves better care and outcomes for children and their family members.
This study is a descriptive phenomenology study. Participants included physicians, nurses, and social workers in the PPC team. Participants were individually interviewed face-to-face or via an online meeting software. Data were collected in semi-structured interviews and analyzed using a thematic framework analysis.
In total, 27 healthcare providers were interviewed. The model of SDM in PPC identified three themes, including the participants, the principle and the process of SDM. Decision participants involved the children, parents, the PPC team and others. The decision principle had three sub-themes including type, standard and precondition. The decision process describes the fundamental process of SDM and provides suggestions for mobilizing patients and parents to engage in decision-making and seeking conflict resolution.
This is the first study to develop a SDM model in PPC. This model can provide guidance to PPC teams on SDM practices. In addition, the model contributes to the existing body of knowledge by providing a conceptual model for SDM in the context of PPC.
Orthopair fuzzy sets are fuzzy sets in which every element is represented by a pair of values in the unit interval, one of which refers to membership and the other refers to non-membership. The ...different types of orthopair fuzzy sets given in the literature are distinguished according to the proposed constrain for membership and non-membership grades. The aim of writing this manuscript is to familiarize a new class of orthopair fuzzy sets called “(2,1)-Fuzzy sets” which are good enough to control some real-life situations. We compare (2,1)-Fuzzy sets with IFSs and some of their celebrated extensions. Then, we put forward the fundamental set of operations for (2,1)-Fuzzy sets and investigate main properties. Also, we define score and accuracy functions which we apply to rank (2,1)-Fuzzy sets. Moreover, we reformulate aggregation operators to be used with (2,1)-Fuzzy sets. Finally, we develop the successful technique “aggregation operators” to handle multi-criteria decision-making (MCDM) problems in the environment of (2,1)-Fuzzy sets. To show the effectiveness and usability of the proposed technique in MCDM problems, an illustrative example is provided.
Consensus in group decision making requires discussion and deliberation between the group members with the aim to reach a decision that reflects the opinions of every group member in order for it to ...be acceptable by everyone. Traditionally, the consensus reaching problem is theoretically modelled as a multi stage negotiation process, i.e. an iterative process with a number of negotiation rounds, which ends when the consensus level achieved reaches a minimum required threshold value. In real world decision situations, both the consensus process environment and specific parameters of the theoretical model can change during the negotiation period. Consequently, there is a need for developing dynamic consensus process models to represent effectively and realistically the dynamic nature of the group decision making problem. Indeed, over the past few years, static consensus models have given way to new dynamic approaches in order to manage parameter variability or to adapt to environment changes. This paper presents a systematic literature review on the recent evolution of consensus reaching models under dynamic environments and critically analyse their advantages and limitations.
As the global population ages, older decision makers will be required to take greater responsibility for their own physical, psychological and financial well-being. With this in mind, researchers ...have begun to examine the effects of ageing on decision making and associated neural circuits. A new 'affect-integration-motivation' (AIM) framework may help to clarify how affective and motivational circuits support decision making. Recent research has shed light on whether and how ageing influences these circuits, providing an interdisciplinary account of how ageing can alter decision making.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SBMB, UILJ, UKNU, UL, UM, UPUK
Shared decision making was first highlighted in a report by the Institute of Medicine in 2001. The primary aim of this initiative was to improve the quality of care provided to patients in the United ...States by creating a health care system that is safe, effective, efficient, and equitable. Currently, medical decision making is based on a patient-centered approach, with the individual's preferences, needs, and values guiding optimal care. Patients are frequently faced with various treatment choices with no absolute guarantee of any desired outcome and no clear indication of the "best or least worse" option. In fact, in healthcare, each of these options usually has potential trade-offs and outcomes. The process of how to choose a particular option becomes a discussion where the clinician and the patient have to jointly review the medical evidence, but also the patient's openness and preference for balancing particular attributes of the treatment (both positive and negative). Shared decision making is important for chronic diseases that require long-term management, such as most allergic conditions, including food allergies. The landscape of food allergies has changed considerably in recent years with multiple and significant scientific advances in both diagnostics and treatment, providing an ideal field for the use of shared decision making. For the purposes of this review, we will discuss different areas of food allergy management within a single complex case, focusing on the role of shared decision making.
This book presents a simple geometric model of voting as a tool to analyze parliamentary roll call data. Each legislator is represented by one point and each roll call is represented by two points ...that correspond to the policy consequences of voting Yea or Nay. On every roll call each legislator votes for the closer outcome point, at least probabilistically. These points form a spatial map that summarizes the roll calls. In this sense a spatial map is much like a road map because it visually depicts the political world of a legislature. The closeness of two legislators on the map shows how similar their voting records are, and the distribution of legislators shows what the dimensions are. These maps can be used to study a wide variety of topics including how political parties evolve over time, the existence of sophisticated voting and how an executive influences legislative outcomes.
Aims and objectives
To explore how excellent nurses in hospitals take into account patient preferences in nursing decision‐making in the evidence‐based practice towards personalised care.
Background
...In evidence‐based practice, nursing decision‐making is based on scientific evidence, evidence of best practice and individual patient preferences. Little is known about how nurses in hospitals take into account patient preferences in nursing decision‐making.
Design
Qualitative grounded theory.
Methods
Data collection entailed 27 semi‐structured interviews with nurses designated by their colleagues as excellent caregivers, followed by 57 hours of participant observation. Data analysis was conducted using three‐level coding with constant comparison and theoretical sampling. The COREQ checklist for qualitative research was followed.
Results
A main finding was that participants used three implicit tools to discover patient preferences: establishing a connection, using antennae and asking empathic questions, thus instantly reassuring patients from the very first contact. Their starting point in care was the patient's perception of quality of life wherein they shifted towards their patient's perspective: “Teach me to provide the best care for you in this situation.” During the observations, it was confirmed that the excellent nurses behaved as they had described before.
Conclusion
Excellent nurses actively turn towards patients’ expectations and experienced quality of life by carefully blending individual sensitive and situation specific patient preferences with scientific evidence and evidence of best practice. In doing so, they are able to balancing more equally patient preferences in to the equation called evidence‐based practice, thus leading to wise decision‐making in personalised nursing care.
Relevance to clinical practice
Patient preferences become a fully fledged part of nursing decision‐making in EBP when in education and practice, the implicit knowledge of excellent nurses about how to take into account patient preferences to provide personalised care is more valued and taught.
Recent work has emphasized the role that orbitofrontal cortex (OFC) has in value-based decision-making. However, it is also clear that a number of discrepancies have arisen when comparing the ...findings from animal models to those from humans. Here, we examine several possibilities that might explain these discrepancies, including anatomical difference between species, the behavioral tasks used to probe decision-making and the methodologies used to assess neural function. Understanding how these differences affect the interpretation of experimental results will help us to better integrate future results from animal models. This will enable us to fully realize the benefits of using multiple approaches to understand OFC function.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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