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Decision Aid (decision + aid)
Kinds of Decision Aid Selected AbstractsPatient decision aids in general practice: availability and usagePRESCRIBER, Issue 5 2009Article first published online: 16 MAR 200 This article is based on the MeReC Extra Using Patient Decision Aids. The article describes patient decision aids and considers their availability and use in practice. Copyright © 2009 Wiley Interface Ltd [source] Decision aids in routine practice: lessons from the breast cancer initiativeHEALTH EXPECTATIONS, Issue 3 2006Kerry A. Silvia BA Abstract Background, Many decision aids have been developed to help patients make treatment and screening decisions; however, little is known about implementing them into routine clinical practice. Objective, To assess the feasibility of implementing a patient decision aid (PtDA) for the early stage breast cancer surgical decision into routine clinical care. Design, Structured individual interviews. Setting and participants, A convenience sample of providers from nine sites, including two community resource centres, a community hospital and six academic centres. Main outcome measures, Usage data, barriers to and resources for implementing the PtDAs. Results, Six of the nine sites were using the PtDAs with patients. Two sites were primarily using a scheduling system and four sites relied on a lending system. For the academic centres, the keys to successful implementation included integrating the PtDA into the flow of patients through the centre and having physicians who recommended it to patients. At the community centres, the keys to successful implementation included an informed staff and the flexibility to get the PtDAs to patients in different ways. Barriers that limited or prevented sites from using the PtDA included a lack of clinical support, a lack of system support, competing priorities and scheduling problems. Conclusions, It is feasible to implement a breast cancer PtDA into routine clinical care at academic centres and community resource centres. Future research should assess the effectiveness of PtDAs in routine clinical care as well as resources and barriers to their implementation in community hospitals. [source] Evaluating decision aids , where next?HEALTH EXPECTATIONS, Issue 2 2004Alicia O'Cathain BSc MSc MA Abstract Decision aids have been developed to help patients become involved in decision-making about their individual health care. During the evaluation of a particular decision aid in maternity care , a set of 10 ,Informed Choice' leaflets , we considered the lessons learnt for evaluation of decision aids in the future. Decision aids have been tested mainly in explanatory trials and have been found to be effective. We argue that existing decision aids should be subjected to more pragmatic trials to test their effectiveness in the real world. The small amount of evidence on their use in the real world shows that they face challenges, resulting in poor implementation. Therefore, we propose that implementation strategies are developed which take heed of the findings of research on getting evidence into practice, and in particular address structural barriers such as the lack of time available to health professionals. We recommend that these ,decision aid implementation packages' are developed in conjunction with both health professionals and patients, and identify and address potential barriers to both the delivery of patient involvement in decision-making, and the use of decision aids, in the real world. These ,packages' can then be submitted to pragmatic evaluation. [source] Using framing parameters to improve handling of uncertainties in water management practiceENVIRONMENTAL POLICY AND GOVERNANCE, Issue 2 2010Nicola Isendahl Abstract Management of water resources is afflicted with uncertainties. Nowadays it is facing more and new uncertainties since the pace and dimension of changes (e.g. climatic, demographic) are accelerating and are likely to increase even more in the future. Hence it is crucial to find pragmatic ways to deal with these uncertainties in water management. We argue for an analytical yet pragmatic approach to enable decision-makers to deal with uncertainties in a more explicit and systematic way and allow for better informed decisions. Our approach is based on the concept of framing, referring to the different ways in which people make sense of the world and of the uncertainties. We apply recently developed parameters of the framing of uncertainty in two sub-basins of the Rhine, the Dutch Kromme Rijn and the German Wupper. We present and discuss the results of a series of stakeholder interactions in the two basins aimed at developing strategies for improving dealing with uncertainties. The strategies are amended and synthesized in a check-list based on the uncertainty framing parameters as a hands-on tool for systematically identifying improvement options when dealing with uncertainty in water management practice. We conclude with suggestions for testing the developed check-list as a tool for decision aid in water management practice. Copyright © 2010 John Wiley & Sons, Ltd and ERP Environment. [source] Helping smokers to decide on the use of efficacious smoking cessation methods: a randomized controlled trial of a decision aidADDICTION, Issue 3 2006Marc C. Willemsen ABSTRACT Aims Most smokers attempt to stop smoking without using help. We evaluated the efficacy of a decision aid to motivate quitters to use efficacious treatment. Setting and participants A total of 1014 were recruited from a convenience sample of 3391 smokers who intended to quit smoking within 6 months. Design and intervention Smokers were assigned randomly to either receive the decision aid or no intervention. The decision aid was expected to motivate quitters to use efficacious cessation methods and contained neutral information on treatment methods, distinguishing between efficacious and non-efficacious treatments. Measurements Baseline questionnaire and follow-ups were used 2 weeks and 6 months after the start of the intervention., Findings The decision aid increased knowledge of cessation methods and induced a more positive attitude towards these methods. Furthermore, 45% reported increased confidence about being able to quit and 43% said it helped them to choose between treatments. However, no clear effect on usage of treatment aids was found, but the intervention group had more quit attempts (OR = 1.52, 95% CI 1.14,2.02) and higher point prevalence abstinence at 6-month follow-up (20.2% versus 13.6%; OR = 1.51, 95% CI = 1.07,2.11). Conclusions An aid to help smokers decide to use efficacious treatment when attempting to quit smoking had a positive effect on smoking cessation, while failing to increase the usage of efficacious treatment. This finding lends support to the notion that the mere promotion of efficacious treatments for tobacco addiction might increase the number of quit attempts, irrespective of the actual usage of treatment. [source] Patient decision aid regarding natural health products for menopausal symptoms: a randomised controlled trialFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 2006S Dodin [source] Decision aids in routine practice: lessons from the breast cancer initiativeHEALTH EXPECTATIONS, Issue 3 2006Kerry A. Silvia BA Abstract Background, Many decision aids have been developed to help patients make treatment and screening decisions; however, little is known about implementing them into routine clinical practice. Objective, To assess the feasibility of implementing a patient decision aid (PtDA) for the early stage breast cancer surgical decision into routine clinical care. Design, Structured individual interviews. Setting and participants, A convenience sample of providers from nine sites, including two community resource centres, a community hospital and six academic centres. Main outcome measures, Usage data, barriers to and resources for implementing the PtDAs. Results, Six of the nine sites were using the PtDAs with patients. Two sites were primarily using a scheduling system and four sites relied on a lending system. For the academic centres, the keys to successful implementation included integrating the PtDA into the flow of patients through the centre and having physicians who recommended it to patients. At the community centres, the keys to successful implementation included an informed staff and the flexibility to get the PtDAs to patients in different ways. Barriers that limited or prevented sites from using the PtDA included a lack of clinical support, a lack of system support, competing priorities and scheduling problems. Conclusions, It is feasible to implement a breast cancer PtDA into routine clinical care at academic centres and community resource centres. Future research should assess the effectiveness of PtDAs in routine clinical care as well as resources and barriers to their implementation in community hospitals. [source] Evaluating decision aids , where next?HEALTH EXPECTATIONS, Issue 2 2004Alicia O'Cathain BSc MSc MA Abstract Decision aids have been developed to help patients become involved in decision-making about their individual health care. During the evaluation of a particular decision aid in maternity care , a set of 10 ,Informed Choice' leaflets , we considered the lessons learnt for evaluation of decision aids in the future. Decision aids have been tested mainly in explanatory trials and have been found to be effective. We argue that existing decision aids should be subjected to more pragmatic trials to test their effectiveness in the real world. The small amount of evidence on their use in the real world shows that they face challenges, resulting in poor implementation. Therefore, we propose that implementation strategies are developed which take heed of the findings of research on getting evidence into practice, and in particular address structural barriers such as the lack of time available to health professionals. We recommend that these ,decision aid implementation packages' are developed in conjunction with both health professionals and patients, and identify and address potential barriers to both the delivery of patient involvement in decision-making, and the use of decision aids, in the real world. These ,packages' can then be submitted to pragmatic evaluation. [source] Development and evaluation of a breast cancer prevention decision aid for higher-risk womenHEALTH EXPECTATIONS, Issue 1 2003CON(C), Dawn Stacey RN Abstract Objective, To develop and evaluate the effectiveness of a breast cancer prevention decision aid for women aged 50 and older at higher risk of breast cancer. Design, Pre-test,post-test study using decision aid alone and in combination with counselling. Setting, Breast Cancer Risk Assessment Clinic. Participants, Twenty-seven women aged 50,69 with 1.66% or higher 5-year risk of breast cancer. Intervention, Self-administered breast cancer prevention decision aid. Main outcome measures, Acceptability; decisional conflict; knowledge; realistic expectations; choice predisposition; intention to improve life-style practices; psychological distress; and satisfaction with preparation for consultation. Results, The decision aid alone, or in combination with counselling, decreased some dimensions of decisional conflict, increased knowledge (P < 0.01), and created more realistic expectations (P < 0.01). The aid in combination with counselling, significantly reduced decisional conflict (P < 0.01) and psychological distress (P < 0.02), helped the uncertain become certain (P < 0.02), and increased intentions to adopt healthier life-style practices (P < 0.03). Women rated the aid as acceptable, and both women and practitioners were satisfied with the effect it had on the counselling session. Conclusion, The decision aid shows promise as a useful decision support tool. Further research should compare the effect of the decision aid in combination with counselling to counselling alone. [source] Stubborn Reliance on Intuition and Subjectivity in Employee SelectionINDUSTRIAL AND ORGANIZATIONAL PSYCHOLOGY, Issue 3 2008SCOTT HIGHHOUSE The focus of this article is on implicit beliefs that inhibit adoption of selection decision aids (e.g., paper-and-pencil tests, structured interviews, mechanical combination of predictors). Understanding these beliefs is just as important as understanding organizational constraints to the adoption of selection technologies and may be more useful for informing the design of successful interventions. One of these is the implicit belief that it is theoretically possible to achieve near-perfect precision in predicting performance on the job. That is, people have an inherent resistance to analytical approaches to selection because they fail to view selection as probabilistic and subject to error. Another is the implicit belief that prediction of human behavior is improved through experience. This myth of expertise results in an overreliance on intuition and a reluctance to undermine one's own credibility by using a selection decision aid. [source] Growing decision trees in an ordinal settingINTERNATIONAL JOURNAL OF INTELLIGENT SYSTEMS, Issue 7 2003Kim Cao-Van Although ranking (ordinal classification/regression) based on criteria is related closely to classification based on attributes, the development of methods for learning a ranking on the basis of data is lagging far behind that for learning a classification. Most of the work being done focuses on maintaining monotonicity (sometimes even only on the training set). We argue that in doing so, an essential aspect is mostly disregarded, namely, the importance of the role of the decision maker who decides about the acceptability of the generated rule base. Certainly, in ranking problems, there are more factors besides accuracy that play an important role. In this article, we turn to the field of multicriteria decision aid (MCDA) in order to cope with the aforementioned problems. We show that by a proper definition of the notion of partial dominance, it is possible to avoid the counter-intuitive outcomes of classification algorithms when applied to ranking problems. We focus on tree-based approaches and explain how the tree expansion can be guided by the principle of partial dominance preservation, and how the resulting rule base can be graphically represented and further refined. © 2003 Wiley Periodicals, Inc. [source] Vulnerable Older People in the Community: Relationship Between the Vulnerable Elders Survey and Health Service UseJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2008Hannah M. McGee PhD OBJECTIVES: The Vulnerable Elders Survey (VES), a recently developed screening tool for at-risk older people in the community, has been validated in the United States. This study evaluated its profile in older Irish people. It assessed whether those categorized as vulnerable according to the VES were likely to use health services more frequently than others. DESIGN: Nationally representative cross-sectional interviews. SETTING: Private homes in the community. PARTICIPANTS: Randomly selected older people (aged ,65) (N=2,033; 68% response). MEASUREMENTS: Interviews included the 13-item VES and questions on health service use. RESULTS: The proportion scoring as vulnerable was identical to the U.S. sample (32.1% vs 32.3%). At the community healthcare level, participants categorized as vulnerable visited their primary care physician more frequently (mean visits 6.7 vs 4.0, P<.001), had more home-based public health nurse visits (29% vs 5%, P<.001), and were more likely to have had preventive influenza vaccinations (81% vs 72%, P<.001) in the previous year. More-vulnerable older adults did not differ on assessment of blood pressure (97% vs 96%), cholesterol (82% vs 85%), or receipt of smoking advice (66% vs 52%). Vulnerable participants were more likely to have used emergency department (17% vs 8%, P<.05), inpatient (21% vs 12%, P<.05), and outpatient (28% vs 21%, P<.05) hospital services. Fourteen percent of those categorized as vulnerable had zero or one visit to their family physician in the previous year. CONCLUSION: This study provides further evidence, from a different healthcare system, of the potential of the VES to differentiate more-vulnerable older people. Prospective studies are needed to assess use of the VES as a clinical decision aid for community professionals such as family physicians and public health nurses. [source] Inherent biases in decision support systems: the influence of optimistic and pessimistic DSS on choice, affect, and attitudesJOURNAL OF BEHAVIORAL DECISION MAKING, Issue 1 2008Pekka Korhonen Abstract This study investigates the influence of a decision aid on decision makers' model-based choices, emotions during the use of the model, and attitudes towards the model. A time allocation decision model was biased to purposefully provide optimistic or pessimistic criterion levels, on which subjects based their allocations. The results of our experiment indicate that the degree of "optimism" and "pessimism" inherent in the decision model had a significant impact on the decision maker's choices of criterion values, with optimism leading to higher criterion level choices and pessimism to lower levels. Furthermore, compared to pessimistic models, optimistic models significantly improved the decision makers' emotional states and, to some degree, their attitudes towards the decision aid. The implications of these conscious and sub-conscious influences on decision makers' choices, emotions, and attitudes are discussed and the need for model-builders and users to be aware of them is highlighted. Copyright © 2007 John Wiley & Sons, Ltd. [source] Decision Making by Low-Literacy Consumers in the Presence of Point-of-Purchase InformationJOURNAL OF CONSUMER AFFAIRS, Issue 2 2004HAERAN JAE Low-literacy consumers face disadvantages when making product choices. This article presents the results of two studies designed to explore differences in decision-making behavior across consumer literacy levels, focusing on consumers' ability to evaluate information in print ads and product packaging. The authors demonstrate that the presence of a visual decision aid at the point of purchase can improve choice for low-literacy consumers. [source] Clinician's use of the Statin Choice decision aid in patients with diabetes: a videographic study nested in a randomized trialJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2009Roberto Abadie PhD Abstract Objective, To describe how clinicians use decision aids. Background, A 98-patient factorial-design randomized trial of the Statin Choice decision vs. standard educational pamphlet; each participant had a 1:4 chance of receiving the decision aid during the encounter with the clinician resulting in 22 eligible encounters. Design, Two researchers working independently and in duplicate reviewed and coded the 22 encounter videos. Setting and participants, Twenty-two patients with diabetes (57% of them on statins) and six endocrinologists working in a referral diabetes clinic randomly assigned to use the decision aid during the consultation. Main outcome measures, Proportion and nature of unintended use of the Statin Choice decision aid. Results, We found eight encounters involving six clinicians who did not use the decision aid as intended either by not using it at all (n = 5; one clinician did use the decision aid in three encounters), offering inaccurate quantitative and probabilistic information about the risks and benefits of statins (n = 2), or using the decision aid to advance the agenda that all patients with diabetes should take statin (n = 1). Clinicians used the decision aid as intended in all other encounters. Conclusions, Unintended decision aid use in the context of videotaped encounters in a practical randomized trial was common. These instances offer insights to researchers seeking to design and implement effective decision aids for use during the clinical visit, particularly when clinicians may prefer to proceed in ways that the decision aid apparently contradicts. [source] Latest news and product developmentsPRESCRIBER, Issue 12 2007Article first published online: 4 OCT 200 NAO: GPs still not prescribing efficiently The National Audit Office (NAO) says NHS funds are being wasted through inefficient GP prescribing and patients not taking their medicines. The NAO's long-awaited report, Prescribing Costs in Primary Care (www.nao.org.uk), found large variations between PCTs in generic prescribing of statins, ACE inhibitors and angiotensin-II antagonists, and protonpump inhibitors; PCTs were also paying widely differing prices for these products. There was a five-fold variation in prescribing volume for clopidogrel between PCTs. These four drugs accounted for only 19 per cent of total spending but, if all practices matched the performance of the best 25 per cent, the NHS would save £200 million annually. PCTs should do more to rationalise prescribing and support their GPs, the NAO concludes. The NAO says that the cost of medicines dispensed for but not taken by patients lies somewhere in the range £100-£800 million annually. Strategies to reduce waste include public awareness campaigns and restricting supplies to four weeks (or two weeks for new medicines). Rosiglitazone may increase CV death risk A meta-analysis of 42 clinical trials has suggested that rosiglitazone is associated with increased risks of myocardial infarction (MI) and cardiovascular death (N Engl J Med 2007; published online 21 May: doi 10.1056/ NEJMoa072761). Like the COX-2 inhibitors, rosiglitazone was licensed without determining its possible effects on long-term cardiovascular outcomes, and interpretation of the latest findings is complicated by the multiple comparisons involved. For risk of MI, there was no significant difference between rosiglitazone and placebo (though this was of borderline statistical signifi-cance , p=0.07), metformin, sulphonylureas or insulin. Rosiglitazone was associated with a statistically significant 43 per cent increased risk compared with all comparators combined but the absolute increase in risk was very small (0.02 per cent). The trends were similar for risk of cardiovascular death, though rosiglitazone was associated with a 64 per cent increased risk compared with all comparators combined that was of borderline statistical significance (p=0.06). The authors acknowledge that their analysis pooled short-term studies that excluded patients at risk of heart disease and was not designed to determine cardiovascular outcomes, and they had no access to patientlevel data; as a result, there is uncertainty about their findings. Nevertheless, they say there is now an urgent need to clarify the risk associated with rosiglitazone. GlaxoSmithKline has rebutted the findings, stating that the cardiovascular risk profile of rosiglitazone is comparable with that of other oral antidiabetic drugs. The MHRA says warnings in the current SPCs for Avandia and Avandamet already reflect most of the data in the latest US review. The possible effects of rosiglitazone on cardiovascular events is currently being evaluated in the Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of glycaemia in Diabetes (RECORD) study. Good management tool The Department of Health has published a disease management tool to enable PCTs to model local interventions that could reduce emergency admissions. The web-based ,voluntary good practice tool' will demonstrate how interventions in primary care and social care settings can improve the management of long-term conditions including cardiovascular disease, asthma and COPD, and dementia and depression. Counterfeit medicines The MHRA has issued an unprecedented three alerts about fake medicines in the legitimate supply chain, recalling all affected lot numbers. Three batches of Zyprexa 10mg tablets (olanzapine) were withdrawn after a company printing labels became suspicious and alerted Eli Lilly. Two of the batches, which contained 60 per cent of the stated active ingredient, had reached patients but no adverse events were reported. Two lots of parallel-imported Plavix 75mg tablets (clopidogrel) have been withdrawn after counterfeit packs were identified. The lots were in French original packaging but will have been overlabelled for the UK market. The counterfeits were mixed with genuine packs from Sanofi-Aventis. Fake Casodex 50mg tablets (bicalutamide) have been identified in a parallel import from France. The Royal Pharmaceutical Society reports that the fake contains 75 per cent of the stated dose of bicalutamide. Alcohol-free mometasone Schering-plough has introduced an alcohol-free formulation of mometasone furoate nasal spray (Nasonex) for hay fever. The company says that an alcohol vehicle causes nasal irritation and leaves an unpleasant aftertaste, adding that over 40 per cent of patients cite this as the main reason for stopping treatment, and over 50 per cent state a preference for an alcohol-free product. Aid to improve statin adherence Adherence to statin therapy can be improved if patients use a decision aid when they are offered treatment,US investigators say (Arch Intern Med 2007;167:1076-82). The decision aid estimated the individual's 10-year cardiovascular risk and the risk reduction from treatment, and summarised the disadvantages of statins.Patients with diabetes who used the aid knew more about their risk and were less indecisive about treatment than those who did not. The odds of having missed a dose over three months were three times higher for patients who had not used the aid. Online tool calculates switch savings A new online tool can help GPs estimate the savings achievable from switching patients to cheaper medicines. The Switch Saving Calculator, developed by the Prescribing Analysis & Support Team at the NHS Regional Drug and Therapeutics Centre in Newcastle, calculates potential savings based on past, current or projected use of the target drug. It can be applied to individual prescribers or scaled up to practice, commissioning group, PCT, health authority or even national level. Separate calculators are available for primary and secondary care. The current version calculates potential savings by switching from atorvastatin to simvastatin. The Newcastle team says other drugs will be added and they will update prices regularly. The calculator is at www.nyrdtc.nhs.uk:80/Services/presc_supp/ switch_saving_calculator/switch_saving_calculator.html. No improvement in drug information for patients leaving hospital The information given to patients discharged from hospital is not improving, according to the Healthcare Commission's annual patient survey (www.healthcare commission.org.uk). The 2006 survey found that the commonest reason patients were kept waiting for at least four hours to leave hospital was the delay in providing discharge medicines. Provision of written information increased from 62 per cent of patients in 2005 to 65 per cent in 2006. However, only 76 per cent said they had been told about their medicines in a way they could ,completely' understand (79 per cent in 2002). The proportion of patients reporting complete information about sideeffects also fell (from 40 per cent in 2005 to 37 per cent). Aspirin in preeclampsia A new meta-analysis has found that primary prevention with low-dose aspirin modestly but consistently reduces the risk of preeclampsia (Lancet 2007; published online 18 May). The study of 31 trials involving 32 217 women at low to moderate risk found that antiplatelet agents (mostly aspirin) reduced the risk of pre-eclampsia and preterm birth by 10 per cent without an increased risk of bleeding. The benefit was similar across subgroups. There were also nonsignificant reductions in the risk of small for age, stillborn and death before discharge. New from NICE NICE approves varenicline for NHS NICE has endorsed the use of varenicline (Champix) as an aid to smoking cessation within the NHS for England and Wales; it has already been approved for use in Scotland by the Scottish Medicines Consortium. Varenicline is a partial agonist at the ,4,2 nicotinic receptor. It alleviates craving and withdrawal symptoms, and reduces the rewarding and reinforcing effects of smoking. The commonest adverse effect is mild to moderate nausea, which improves with time.1 Varenicline is licensed for smoking cessation in adults; NICE says it should be offered as an option for smokers who say they want to quit as part of a programme of behavioural support. However, treatment should not be withheld if counselling and support are not available. NICE was critical of manufacturer Pfizer's economic arguments in favour of varenicline, which inappropriately included US data, assumed a single quit attempt and may have overestimated its efficacy. It nonetheless concluded that varenicline is more effective than nicotine replacement therapy (NRT) or bupropion (Zyban) in achieving continuous abstinence. NICE estimated that, compared with NRT, the odds of abstinence at one year with varenicline were 54 per cent greater. A Cochrane review1 concluded that abstinence was 66 per cent more likely with varenicline than with bupropion, and three times more likely than with placebo. There was also a benefit from offering smokers a wider choice of treatments. A 12-week course of varenicline costs £163.80; it is also licensed for an additional 12-week course and dose tapering may be considered for those at high risk of relapse. The final appraisal determination does not state which is the treatment of first choice for smoking cessation. NICE is currently preparing guidance on smoking cessation in pri-mary care, pharmacies and workplaces. Copyright © 2007 Wiley Interface Ltd [source] A Note on the Interdependence between Hypothesis Generation and Information Search in Conducting Analytical Procedures,CONTEMPORARY ACCOUNTING RESEARCH, Issue 2 2003Stephen K. Asare Abstract This study examines the linkage among the initial hypothesis set, the information search, and decision performance in performing analytical procedures. We manipulated the quality of the initial hypothesis set and the quality of the information search to investigate the extent to which deficiencies (or benefits) in either process can be remedied (or negated) by the other phase. The hypothesis set manipulation entailed inheriting a correct hypothesis set, inheriting an incorrect hypothesis set, or generating a hypothesis set. The information search was manipulated by providing a balanced evidence set to auditors (i.e., evidence on a range of likely causes including the actual cause - analogous to a standard audit program) or asking them to conduct their own search. One hundred and two auditors participated in the study. The results show that auditors who inherit a correct hypothesis set and receive balanced evidence performed better than those who inherit a correct hypothesis set and did their own search, as well as those who inherited an incorrect hypothesis set and were provided a balanced evidence set. The former performance difference arose because auditors who conducted their own search were found to do repeated testing of non-errors and truncated their search. This suggests that having a correct hypothesis set does not ensure that a balanced testing strategy is employed, which, in turn, diminishes part of the presumed benefits of a correct hypothesis set. The latter performance difference was attributable to auditors' failure to generate new hypotheses when they received evidence about a hypothesis that was not in the current hypothesis set. This demonstrates that balanced evidence does not fully compensate for having an initial incorrect hypothesis set. These findings suggest the need for firm training and/or decision aids to facilitate both a balanced information search and an iterative hypothesis generation process. [source] The Difficult Client-Acceptance Decision in Canadian Audit Firms: A Field Investigation,CONTEMPORARY ACCOUNTING RESEARCH, Issue 2 2001Yves Gendron Abstract Auditing is often depicted in scientific and professional literature as being subject to conflicting forces, such as mechanization versus flexibility, and professionalism versus commercialism. This paper examines how auditors actually make the client-acceptance decision in the midst of these forces. The investigation was conducted via a field study at three Big 6 firms located in Canada. The results show that in all firms the client-acceptance decision process in action is largely flexible, being characterized by a high degree of informal communication and the adaptation of the client-acceptance written policies and decision aids to circumstances. Furthermore, while commercialism in one firm (A) has a significant influence on the decision process, in the two other firms (B and C) the decision process is mostly consistent with professionalism. This result conflicts with the concerns that North American regulators have recently expressed about auditors' professionalism. [source] Review of dyspnoea quantification in the emergency department: Is a rating scale for breathlessness suitable for use as an admission prediction tool?EMERGENCY MEDICINE AUSTRALASIA, Issue 5 2007Amanda Saracino Abstract Acute shortness of breath is a potential marker of serious cardiopulmonary disease and requires rapid assessment. In our current health-care system, increasing pressure on the ED to limit costs and waiting times has resulted in the development of many clinical decision aids and admission prediction tools designed to assist ED physicians in meeting these demands. However, most of these tools are disease specific, and none are currently available for application to patients presenting to the ED with shortness of breath. Although somewhat limited, current evidence supports the utilization of a simple dyspnoea rating scale, to assist in the streamlining of clinical severity assessments and urgency evaluations, and to potentially provide useful information to facilitate rapid and accurate site-of-care decisions in this setting. [source] Cue usage in financial statement fraud risk assessments: effects of technical knowledge and decision aid useACCOUNTING & FINANCE, Issue 1 2009Jean-Lin Seow M41; M49 Abstract This paper investigates the effects of technical knowledge and decision aid use on financial statement fraud risk assessments made by directors and students. More extreme fraud risk assessments are made when participants identify and process larger (smaller) numbers of diagnostic (non-diagnostic) factors, with technical knowledge driving diagnostic factor identification. Significant decision aid-technical knowledge effects are also found; decision aid use has a detrimental effect on high-knowledge directors while improving performance in inexperienced, low-knowledge students. These results suggest that although decision aids can afford gains in performance in inexperienced users, they can have unintended and/or paradoxical behavioural effects on experienced users. [source] Decision aids in routine practice: lessons from the breast cancer initiativeHEALTH EXPECTATIONS, Issue 3 2006Kerry A. Silvia BA Abstract Background, Many decision aids have been developed to help patients make treatment and screening decisions; however, little is known about implementing them into routine clinical practice. Objective, To assess the feasibility of implementing a patient decision aid (PtDA) for the early stage breast cancer surgical decision into routine clinical care. Design, Structured individual interviews. Setting and participants, A convenience sample of providers from nine sites, including two community resource centres, a community hospital and six academic centres. Main outcome measures, Usage data, barriers to and resources for implementing the PtDAs. Results, Six of the nine sites were using the PtDAs with patients. Two sites were primarily using a scheduling system and four sites relied on a lending system. For the academic centres, the keys to successful implementation included integrating the PtDA into the flow of patients through the centre and having physicians who recommended it to patients. At the community centres, the keys to successful implementation included an informed staff and the flexibility to get the PtDAs to patients in different ways. Barriers that limited or prevented sites from using the PtDA included a lack of clinical support, a lack of system support, competing priorities and scheduling problems. Conclusions, It is feasible to implement a breast cancer PtDA into routine clinical care at academic centres and community resource centres. Future research should assess the effectiveness of PtDAs in routine clinical care as well as resources and barriers to their implementation in community hospitals. [source] Evaluating decision aids , where next?HEALTH EXPECTATIONS, Issue 2 2004Alicia O'Cathain BSc MSc MA Abstract Decision aids have been developed to help patients become involved in decision-making about their individual health care. During the evaluation of a particular decision aid in maternity care , a set of 10 ,Informed Choice' leaflets , we considered the lessons learnt for evaluation of decision aids in the future. Decision aids have been tested mainly in explanatory trials and have been found to be effective. We argue that existing decision aids should be subjected to more pragmatic trials to test their effectiveness in the real world. The small amount of evidence on their use in the real world shows that they face challenges, resulting in poor implementation. Therefore, we propose that implementation strategies are developed which take heed of the findings of research on getting evidence into practice, and in particular address structural barriers such as the lack of time available to health professionals. We recommend that these ,decision aid implementation packages' are developed in conjunction with both health professionals and patients, and identify and address potential barriers to both the delivery of patient involvement in decision-making, and the use of decision aids, in the real world. These ,packages' can then be submitted to pragmatic evaluation. [source] Stubborn Reliance on Intuition and Subjectivity in Employee SelectionINDUSTRIAL AND ORGANIZATIONAL PSYCHOLOGY, Issue 3 2008SCOTT HIGHHOUSE The focus of this article is on implicit beliefs that inhibit adoption of selection decision aids (e.g., paper-and-pencil tests, structured interviews, mechanical combination of predictors). Understanding these beliefs is just as important as understanding organizational constraints to the adoption of selection technologies and may be more useful for informing the design of successful interventions. One of these is the implicit belief that it is theoretically possible to achieve near-perfect precision in predicting performance on the job. That is, people have an inherent resistance to analytical approaches to selection because they fail to view selection as probabilistic and subject to error. Another is the implicit belief that prediction of human behavior is improved through experience. This myth of expertise results in an overreliance on intuition and a reluctance to undermine one's own credibility by using a selection decision aid. [source] End-of-Life Decision-Making, Decisional Conflict, and Enhanced Information: Race EffectsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2008Rebecca S. Allen PhD OBJECTIVES: To examine the effect of enhanced information regarding the risks, benefits, and life-sustaining treatment alternatives on hypothetical medical decisions and decisional conflict in older, community-dwelling Caucasian and African-American adults. DESIGN: Two-group (enhanced information; no information) between-subjects design. SETTING: Community-based dwellings, two assisted living facilities, and one senior citizen center. PARTICIPANTS: Seventy-eight adults (aged 74.5±7.18) with a mean Telephone Interview for Cognitive Status,Modified (TICS-m) score of 31.5±4.7 were recruited through personal contacts and informational talks held at the recruitment sites. MEASUREMENTS: Measures included the Life Support Preferences/Predictions Questionnaire,modified (LSPQ-m); the Decisional Conflict Scale; and enhanced information, including detailed descriptions of life-sustaining treatment options for each LSPQ-m illness scenario, risks of the treatment, benefits of the treatment, and alternatives for each treatment (called medical information stimuli). RESULTS: Enhanced information (e.g., medical information stimuli) reduced decisional conflict (P=.049, d=0.47) for hypothetical life-sustaining treatment decisions. A mixed analysis of variance with group and race as between-subjects variables and illness and treatment as within-subjects variables revealed significant main effects of race, illness, and treatment, as well as a significant race-by-illness-by-group interaction (Wilk's lambda=0.923, F(2, 73)=3.05, P=.05, partial ,2=0.08). Enhanced information produced different patterns of desire for life-sustaining treatments in African Americans and Caucasians. CONCLUSION: Physicians and other healthcare professionals can reduce decisional conflict in patients by providing enhanced information regarding treatment risks, benefits, and alternatives. Such decision aids may provide new information or knowledge and thus reduce desire for treatment in African Americans. [source] Clinician's use of the Statin Choice decision aid in patients with diabetes: a videographic study nested in a randomized trialJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2009Roberto Abadie PhD Abstract Objective, To describe how clinicians use decision aids. Background, A 98-patient factorial-design randomized trial of the Statin Choice decision vs. standard educational pamphlet; each participant had a 1:4 chance of receiving the decision aid during the encounter with the clinician resulting in 22 eligible encounters. Design, Two researchers working independently and in duplicate reviewed and coded the 22 encounter videos. Setting and participants, Twenty-two patients with diabetes (57% of them on statins) and six endocrinologists working in a referral diabetes clinic randomly assigned to use the decision aid during the consultation. Main outcome measures, Proportion and nature of unintended use of the Statin Choice decision aid. Results, We found eight encounters involving six clinicians who did not use the decision aid as intended either by not using it at all (n = 5; one clinician did use the decision aid in three encounters), offering inaccurate quantitative and probabilistic information about the risks and benefits of statins (n = 2), or using the decision aid to advance the agenda that all patients with diabetes should take statin (n = 1). Clinicians used the decision aid as intended in all other encounters. Conclusions, Unintended decision aid use in the context of videotaped encounters in a practical randomized trial was common. These instances offer insights to researchers seeking to design and implement effective decision aids for use during the clinical visit, particularly when clinicians may prefer to proceed in ways that the decision aid apparently contradicts. [source] Women's Decision Making About the Use of Hormonal and Nonhormonal Remedies for the Menopausal TransitionJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 6 2003Rosemary Theroux Objective: To critically review qualitative research on women's decision making about the use of hormonal and nonhormonal remedies for the menopausal transition. Data Sources: Computerized searches in CINAHL, MEDLINE, Medscape, and PsychINFO databases, using the keywords decision making, hormone therapy, herbal remedies, attitude toward hormone therapy, and qualitative research; and ancestral bibliographies. Study Selection: Articles from indexed journals from 1982 to 2001 in the English language relevant to the keywords were evaluated. Sixteen studies met inclusion criteria and were included in the analysis. Data Extraction: Study findings were organized into several categories and compared and contrasted across publications and categories. Data Synthesis: Half of the researchers described decision making as a weighing of benefits and risks. Women's considerations, beliefs, and values, as well as interaction with the environment, were primary influences on the process. Conclusions: Major gaps in care for midlife women were identified. Women need information about the process of menopause and the range of available options for menopause management. Nurses can play a major role in providing information, counseling, and developing decision aids. Women's values and beliefs, cultures, life contexts, and desire for involvement in the decision should guide interventions. [source] Patient decision aids in general practice: availability and usagePRESCRIBER, Issue 5 2009Article first published online: 16 MAR 200 This article is based on the MeReC Extra Using Patient Decision Aids. The article describes patient decision aids and considers their availability and use in practice. Copyright © 2009 Wiley Interface Ltd [source] Healthcare professionals' views on two computer-based decision aids for women choosing mode of delivery after previous caesarean section: a qualitative studyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 7 2009KM Rees Objective, To explore healthcare professionals' views about decision aids, developed by the DiAMOND study group, for women choosing mode of delivery after a previous caesarean section. Design/Methods, A qualitative focus group study. Data were analysed thematically. Setting, Two city maternity units, surrounding community midwife units and general practitioner (GP) practices in southwest England. Sample, Twenty-eight healthcare professionals, comprising obstetricians, hospital and community midwives and GPs, who participated in six focus groups. Results, Participants were generally positive about the decision aids. Most thought they should be implemented during early pregnancy in the community, but should be accessible throughout pregnancy, with any arising questions discussed with an obstetrician nearer to term. Perceived barriers to implementation included service issues (e.g. time pressure, cost and access), computer issues (e.g. computer literacy) and people issues (e.g. women's prior delivery preferences and clinician preference). Facilitators to implementation included access to more standardised and reliable information and empowerment of the user. Self-accessing the aids, increased awareness of decision aids among healthcare professionals and incorporation of aids into usual care were suggested as possible ways to improve implementation success. Conclusions, This study gives insight into healthcare professionals' views on the role of decision aids for women choosing a mode of delivery after a prior caesarean section. It highlights potential obstacles to their implementation and ways to address these. Such aids could be a useful adjunct to current antenatal care. [source] Integrating Decision Making and Mental Health Interventions Research: Research DirectionsCLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 1 2006Celia E. Wills The importance of incorporating patient and provider decision-making processes is in the forefront of the National Institute of Mental Health (NIMH) agenda for improving mental health interventions and services. Key concepts in patient decision making are highlighted within a simplified model of patient decision making that links patient-level/"micro" variables to services-level/"macro" variables via the decision-making process that is a target for interventions. The prospective agenda for incorporating decision-making concepts in mental health research includes (a) improved measures for characterizing decision-making processes that are matched to study populations, complexity, and types of decision making; (b) testing decision aids in effectiveness research for diverse populations and clinical settings; and (c) improving the understanding and incorporation of preference concepts in enhanced intervention designs. [source] | |||||||||||||||||||