Active Participation In Decision Research Articles

Rabbi 'Ovadia Yosef, the Shas Party, and the Arab-Israeli Peace Process

One of the prominent religious parties in Israel, intimately involved in political decision-making, has been the Shas party, led by the late Rabbi 'Ovadia Yosef. This article examines four components of Rabbi Yosef 's political stance: (1) his view of Jewish religious law as a factor that moderates the force of changes of seemingly historical and revolutionary significance; (2) his opposition to radical messianism; (3) his desire to adopt independent positions; and (4) his role in the development of a Mizrahi, ultra-Orthodox stream of Zionism.A bird's-eye view of the contemporary Middle East reveals the central role of religious parties in shaping the political agenda of the region. Israel is no different in this respect. While it is true that Israel is a nation-state founded by secular forces and that its secular elite is still strong, one cannot ignore two facts. First, religious parties play a leading role in Israeli governments. Second, religious parties' political positions have added weight in light of the fact that Israel is located on land to which deep religious significance is ascribed, both by the Muslim majority in the Middle East and by the Jewish majority in Israel. This fact, in and of itself, is enough to turn religious movements and their leaders into active participants in decisions of national significance. One of the prominent religious parties in Israel, intimately involved in political decision-making, has been the Worldwide Sephardic Association of Torah Guardians, an ethnic-based ultra-Orthodox (Haredi) party. It is better known to the Israeli public by its acronym, Shas.1Shas was founded in 1984 as an ethnic political home for Haredi yeshiva students and alumni of Mizrahi (Middle Eastern or North African) descent who felt discriminated by Ashkenazic (of Central or Eastern European origin) Haredi society. Since its inception in 1984, Shas has become a significant political-religious force in Israeli society. Its main electoral growth came in the 1990s. At its peak, Shas was the third-largest and third-most influential party in Israeli society. In recent years - due to changes in the Israeli electoral system, internal difficulties within the party, and the secular reaction to its influence - its electoral strength has declined. Nevertheless, Shas remains a significant political player in the Knesset and the government.Shas operates under the authority of its spiritual leadership, which directs the party and decides its path. From its inception, Shas's dominant spiritual leader was Rabbi 'Ovadia Yosef (1920-2013), one of the leading authorities on halacha (Jewish religious law) in contemporary Orthodox Judaism. Thanks to Rabbi Yosef's charisma, vast Torah knowledge, and reputation as a halachic authority, no one within Shas circles disputed his word. It would not be an exaggeration to say that Shas has developed from a party formed to represent Mizrahi yeshiva students into a party whose agenda, ideology, and goals were directed by one man. This is evident in the dominance of his halachic approach in Shas educational institutions.The fact that Shas has an ultra-Orthodox outlook and depends on a hawkish constituency places it in the rightist camp of Israeli politics. However, at least one thing differentiated Shas from the other right-wing religious parties in Israel. Its spiritual leader, Rabbi 'Ovadia Yosef, maintained an independent political stance and was prepared to make territorial compromises with Arab states in return for full peace. The fact that he offered a detailed justification for this position and did not rule out political cooperation with leftist parties, distinguished Shas from the veteran Ashkenazi Haredi parties as well. Whereas most Haredi leaders have tended to remain silent about regional political issues, speaking out only on rare occasion, Rabbi 'Ovadia Yosef was in the habit of reiterating his dovish views time and time again.This paper examines four components of Rabbi Yosef 's political stance: (1) his view of halacha as a factor that moderates the force of changes of seemingly historical and revolutionary significance; (2) his opposition to radical messianism; (3) his desire to adopt independent positions, and (4) his development of a Mizrahi, ultra-Orthodox stream of Zionism. …

Patient perspectives and preferences for communication of medical imaging risks in a cancer care setting.

To identify opportunities for improving patient-centered communication about diagnostic imaging tests that involve the use of radiation in a cancer care setting. Institutional review board approval and informed consent were obtained for this HIPAA-compliant study. Patient knowledge, information sources, and communication preferences were assessed in six focus groups during 2012. The groups consisted of patients undergoing treatment for metastatic colorectal carcinoma, women treated within the past 6 months for early-stage breast carcinoma, men undergoing surveillance after testicular cancer treatment, parents of patients treated for stage I-III neuroblastoma, patients in a thoracic oncology survivorship program, and participants in a lung cancer screening program. A multidisciplinary research team performed thematic content analysis of focus group transcripts. High-level findings were summarized during consensus conferences. Although they were aware of the long-term risk of cancer from exposure to ionizing radiation, most participants reported that their health care provider did not initiate discussion about benefits and risks of radiation from imaging tests. Most patients obtained information by means of self-directed internet searches. Participants expressed gratitude for tests ("That CT saved my daughter's life," "I'd rather have the radiation dosage than being opened up"), yet they expressed concern about having to initiate discussions ("If you don't ask, nobody is going to tell you anything") and the desire to be offered information concerning the rationale for ordering specific imaging examinations, intervals for follow-up imaging, and testing alternatives. Participants believed that such information should be available routinely and that conversation with their personal physician or endorsed, readily available reference materials were ideal methods for information exchange. Understanding imaging radiation risks and active participation in decision making about imaging were especially important to cancer survivors. A substantial gap exists between patient expectations and current practices for providing information about medical imaging tests that involve the use of radiation.

Treatment preferences and involvement in treatment decision making of patients with endometrial cancer and clinicians.

Background:Vaginal brachytherapy (VBT) in high–intermediate-risk endometrial cancer (EC) provides a significant reduction in the risk of local cancer recurrence, but without survival benefit and with increased mucosal atrophy. Five-year local control is estimated to be similar for VBT and a watchful waiting policy (WWP), in which patients receive VBT combined with external radiation in case of a recurrence. Our aim was to assess treatment preferences of EC patients and clinicians regarding VBT and WWP, and to evaluate their preferred and perceived involvement in treatment decision making.Methods:Interviews were held with 95 treated EC patients. The treatment trade-off method was used to assess the minimally desired benefit from VBT in local control. Patients' preferred and perceived involvement in decision making were assessed using a questionnaire. Seventy-seven clinicians completed a questionnaire assessing their minimally desired benefit and preferred involvement in decision making.Results:Minimally desired benefit of VBT was significantly lower for patients than for clinicians (median=0 vs 8%, P<0.001), for irradiated than for non-irradiated patients (median=0 vs 6.5%, P<0.001), and for radiation oncologists than for gynaecologists (median=4 vs 13%, P<0.001). Substantial variation existed within the groups of patients and clinicians. Participants preferred the patient and clinician to share in the decision about VBT. However, irradiated patients indicated low perceived involvement in actual treatment decision making.Conclusions:We found variations between and within patients and clinicians in minimally desired benefit from VBT. However, the recurrence risk at which patients preferred VBT was low. Our results showed that patients consider active participation in decision making essential.

The eCHAT Program to Facilitate Healthy Changes in New Zealand Primary Care

This article describes eCHAT (electronic case-finding and help assessment tool), designed to improve health and well-being through systematic screening and intervention for modifiable lifestyle and mental health issues in primary care populations and monitoring to inform continuous quality improvement. eCHAT allows patients to identify unhealthy behaviors (risky substance use, gambling, being subject to abuse, physical inactivity) and negative mood states (depression, anxiety, anger) with which they would like help before a visit using an iPad in the waiting room or via the Internet in the community. Family physicians access summarized results, including scores and interpretations of screening tests at the point of care. eCHAT stimulates conversations between patients and clinicians about life changes they might make, encouraging active participation in decision making and engagement in self-management. Stepped-care clinical decision support tools offer interventions through self-management options to primary care interventions through to secondary care referral. As well as systematically screening and intervening in individual practice populations, anonymous collated and encrypted data also can be used to measure the mental health and lifestyle risk factors and interventions provided at practice network, regional, and national levels to monitor system and organizational performance improvements, identify regional and national variations, benchmark service delivery, and support quality improvement.

The banning of images: questions arising in the field of management

PurposeThe purpose of this paper is to study how representation is conceptualized in Jewish culture, and how this relates to management. More specifically, it seeks to discuss the banning of images and what can be learned from this in the field of management.Design/methodology/approachThe paper explores the meaning of the prohibition of images in the sacred texts. This serves as a starting point to discuss representation of the world and different forms of thought in the management field.FindingsA major element in the banning of images deals with the involvement of the manager in decision making. The authors argue that organisational images such as accounting numbers are oriented towards economising our attention and thereby allowing the relative absence of the decision maker. The authors suggest that the banning of images reminds us of the importance of the manager's presence and of active participation in decision making and organisational transformation.Research limitations/implicationsThe paper contributes to the literature on the roles of managerial representation, notably accounting figures, and supports the idea that accountability should not be limited to reporting (be it numbers or qualitative elements). This paper argues for developing the density of the account, for instance by using narratives. This research echoes recent practice turn in management, as the authors’ findings can inform management teaching by providing students with dense case‐studies of management as actually practised, analysed using sociological or psychological theories. Such dense case‐studies do not aim to give students parsimonious models for analysis, or expose them to best practices: rather they seek to help them develop practical wisdom through a better understanding of management. This paper calls then for an increased presence rather than representation in management teaching classes, which is the main limitation of e‐learning.Originality/valueRather than exploring the mechanism of accounting figures in the behaviour of organizational actors or taking a political perspective, this paper focuses on a deep representation of the organization often rooted in magical thought. Relying on the practical wisdom of the Hebraic biblical banning of images, this paper aims to deconstruct organizational thought so as to highlight its contradictions.

Increasing the engagement of Latinos in services through community-derived programs: The Right Question Project–Mental Health.

A growing body of literature indicates that ethnic differences exist in the rates of retention and engagement in mental health services, and that these disparities stem partly from the inability of services to fulfill the needs and expectations of ethnic minority populations, including Latinos. Increasing the involvement of Latinos in their own mental health treatment may be an important component for improving their care and increasing their participation in treatment. The Right Question Project (RQP) is an educational strategy that encourages active participation in decisions that are important to the individual by facilitating a person’s ability to formulate effective questions and to engage others in an instructive dialogue and shared decision making. The purpose of this article is to describe how this strategy, developed by a community group, was adapted and tailored for use in a mental health setting, with the intention of shifting the level of the client’s active involvement with their providers in order to improve attendance at scheduled appointments and retention in mental health care. The article highlights the advantages of using practical interventions that originate from the community to improve the quality of services available to Latinos. At the same time, it reveals challenges and limitations that shaped implementation decisions, especially in terms of cultural, socioeconomic, and systemic factors affecting Latino participants. Implications for mental health providers, trainees, and supervisors are discussed.

Decision making in clinical stage I (CSI) testicular cancer (TC).

e15034 Background: Optimal management of CSI seminomatous (S) and nonseminomatous (NS) TC is an open question. Quality of life and patient preferences are the principal end-points for the best treatment choice. Multidisciplinary approach is required for CSI TC patients to allow an individualized treatment with a patient-centered approach and an active participation in decisions. The “shared decision making” (SDM) is the prevailing approach because patients together with clinicians arrive at a mutually agreed-on choice. We have a project concerning the involvement of patients with CSI TC in the SDM. Methods: We used some key points of SDM: define the problem; treatment options; discuss pros/cons; clarify patient preferences; clarify the patient’s understanding. Educational material are offered to patients. From 2005 to 2012, 32 patients with CSI TC were evaluated. For each patient some clinical and socio-demographic features, type of treatment chosen and some sequel related to treatment were analyzed. Results: Patients characteristics are reported in the table. 4 S patients chose surveillance, 10 chemotherapy and 6 radiotherapy. 2 NS patients chose surveillance, 9 chemotherapy. 4 relapsed: 1 S patient after 13 months from chemotherapy and 1 during the surveillance after 24 months. 2 NS patients relapsed after 12 and 18 months both during the surveillance. All relapsed patients received chemotherapy. Metabolic alterations were analyzed. 1 S patient treated with chemotherapy had a cardiovascular accident. Conclusions: We observed an high gap between surveillance and the active treatments: there is no best choice for every one so we should improve decision-making process and decision aids into the management of CSI patients with TC. [Table: see text]

Patient empowerment as a component of health system reforms: rights, benefits and vested interests

Different strategies have been developed across countries to foster citizens' and patients' involvement, from health policies to patients' active participation in decisions regarding their health. The spectrum varies from systems where patients lead the reform of health care services, to others where a paternalistic approach still limits patients' autonomy in decision-making. This paper describes: (1) different interventions for involving patients; (2) experiences to promote consumer evidence-based advocacy; and (3) barriers to consumer involvement in health system reforms, including vested interests in patients' associations. Citizens' involvement in health systems can vary substantially, but is gaining increasing weight.

Health literacy and decision making styles for complex antithrombotic therapy among older multimorbid adults

ObjectivesTo evaluate the effect of functional health literacy (FHL) on preferences for decision-making; and among those initially preferring a passive decision-making role, to explore how preferences change if their physician actively encourages their involvement. MethodsConsecutive older adults with cardiovascular disease receiving complex antithrombotic therapy completed a comprehensive assessment including measures of FHL and preferences for shared decision making. ResultsHalf of all participants had inadequate or marginal FHL. Those with inadequate FHL were more likely (P=0.01) to prefer passive rather than active decision making styles even after controlling for age, education, and numeracy. However, 40% of patients preferring passive styles had adequate FHL and these patients were significantly more likely to change their preference to more active styles (odds ratio=7.17, P<.01) if their physician “was more supportive or encouraged participation”. ConclusionsScreening FHL can provide insight into patients’ preferences for active participation in decision making. Clinicians’ encouragement of participation can increase engagement by patients with adequate FHL. Practice implicationsWe propose an algorithm for screening FHL and preferences for participating in decisions about complex medication regimens.

LEVEL OF EMPOWERMENT OF WOMEN

Objective: To Investigate the Level of Empowerment of Women in accordance with human rights. Design: A cross-sectional study. Setting: Residence Colony of Punjab Medical College, Faisalabad. Period: August - September 2007. Material &amp; Methods: There were 600 houses and 6 Blocks A, B, C, D, E &amp; F in the Colony. By Simple random sampling 10 houses were taken from each Block by drawing lots. Sixty married women’s between the age of 25 – 45 years (One from each house) were interviewed using a pre-tested structured questionnaire. Results: The mean age of the respondents was 37.2 years. Among the total 60 (100%) Women, 16 (26.6%) were illiterate, while 44 (73.3%) had primary education and above. Only 10(22.2%) out of 44 educated women had graduate and above degree. Thirty-Eight (63.3%) women had the opportunity to use the reproductive health services and family planning, while 22 (36.6%) could not utilize the family planning methods. A total of 40 (66.6%) women had good nutritional status, while 20 (33.3%) had imbalances in nutrition. Nineteen (31.6%) women were doing jobs in different public and private institutions, while 41(68.3%) had not got opportunity for jobs. Thirty-Three (55%) women had monthly income lessthan Rs.10,000/- per month and 27(45%) had Rs.10,000/- and above. Forty (66.6%) women were given importance and active participation in decision making, in children marriages. house-hold and in political process (vote casting) at all levels, while 20(33.3%) were not given importance in decision making of above matters. Forty -Three (71.6%) woman were given their right of inheritance / property. Fourteen (23.3%)women were forced to wear veil while going out of house. Forty (66.6%) woman admitted to have suffered from violence either psychological, physical or sexual in their life. Safe drinking water supply was available to 30 (50%) women, however sewage disposal, toilet facilities with in house were available to majority of the respondents. A total of 40 (66.6%) women were over all empowered. Conclusions: Women do havehuman rights as well. The results obtained from this study are encouraging but not up to the standards of International Human rights Principles, which are universal, inalienable; indivisible; interdependent and interrelated.

Clinician's Commentary

Clinician's Commentary

Treatment of lumbar disc herniation: Evidence-based practice

What is the best treatment for lumbar disc herniations? For patients failing six weeks of conservative care, the current literature supports surgical intervention or prolonged conservative management as appropriate treatment options for lumbar radiculopathy in the setting of disc herniation. Surgical intervention may result in more rapid relief of symptoms and restoration of function. While surgery appears to provide more rapid relief, many patients will gradually get better with continued nonoperative management; thus, patient education and active participation in decision-making is vital.

Foundations of Playwork

By Fraser, Brown and Chris, Taylor ( eds ) Maidenhead : Open University Press , 2008 ISBN 9780335222919 , 344 pp, £19.99 (pb) Foundations of Playwork are for anyone interested in contemporary children’s play and open a window to the work of playwork professionals. It comes at a point when playwork appears to be at a crossroads, ‘fighting for survival’ while ‘children’s early play experiences at school … are being manipulated into a learning ethos with an emphasis on achievements’ (Stobart, p18). The good news, however, is that the play policy landscape is changing dramatically in the UK: various contributions demonstrate the dynamic if uneven commitment to play by the four nations’ governments. Foundations, therefore, arrives within a context offering tremendous scope for exploration, challenge – engagement both within the playwork sector, between theorists and practitioners, nationally and internationally and through interaction with the wider children’s workforce, parents and carers. Sporting no fewer than 56 bite-sized contributions in 10 Parts, this collection offers many pieces of a giant jigsaw puzzle. Piecing them together, we gain a fairly comprehensive snapshot about play and playwork in the UK in 2008. Plus a virtual Who’s Who? of UK play experts – heavyweights, ludocentrics and emerging. Proof of the mushrooming of interest in play in recent years comes in the form of almost 400 references cited – a useful reading list in itself. More than half of these have been published in the 21st century including announcements by the Health and Safety Executive and diverse government departments. The hugely influential role of earlier play theorists, practitioners and related professions, such as Lady Allen of Hurtwood, Freud, Piaget, Huizinga, Montessori, the Opies and Winnicott is well captured, while Sutton-Smith’s special feature describes his intellectual journey since 1978 based on a ‘bias that play was a kind of dialectical experience’ (p139). Foundations has a welcome focus on quality, ethics and inclusive practice, although many contributions might have benefited from interweaving gender, disability and ethnic minority issues throughout. Cole-Hamilton (pp234ff) helpfully outlines the relevance to playworkers of many children’s rights within the UN Convention on the Rights of the Child (UNCRC), in addition to Article 31. It would have been good to see an acknowledgement of the significant role of International Play Association: Promoting the Child’s Right to Play in the 1980s in ensuring that the right to play was included in this treaty. Many children’s workforce professionals struggle with giving expression to children’s right to participate. The implication of Article 12 UNCRC for playwork is that children ‘should be given the chance to be active participants in decisions about the play opportunities offered to them’ (Cole-Hamilton, p236). Yet, while several contributors touch on participation, this is an area that merits a fuller future exploration at both theoretical and practical levels. Be prepared to be taken out of your comfort zone. For example, try to locate and compare the different takes on adventure playgrounds. Or consider where you stand on Brown’s identification of gaps in and critique of No. 2 of the Playwork Principles and whether you agree on what is unique about playworkers that sets them apart from the rest of the children’s workforce (p 126). Or on the question of inclusion, which Wilson (p241) argues lies ‘at the core of our work’. She shatters some common sense (and therefore often wrong) assumptions about the play of disabled children, through an eye-opening story of a boy who ‘stops abruptly and begins rocking to-an-fro, eyes locked in the middle distance’. Staff and children notice this, mirror his poise and understand: ‘He has spotted a sunburst around a tree trunk –– broken shards of rainbow. Seeing this glory once was not enough. So he rocked back and forth to see it again and again. Now we could all see it too.’ And then there is the silent scream by Kapasi, whose challenging ‘If I was an anti-racist, I would notice that…’ poem (p238ff) must not fall on deaf ears. Curiously absent is a discussion of the global playground created by the internet, of how new technologies are beginning to transform some playgrounds and how children move between their online and offline play worlds. The editors take readers through a breathtaking landscape of perspectives on the foundations of playwork. Taylor (p47) ends appropriately with a story about Nicholson (1971), famous for his ‘theory of loose parts’. After sending his Open University students boxes of loose parts for their assignments, the last box in the course was empty, except for a note that said, ‘it’s up to you now’. This book invites you to reflect (see Palmer, p51). But above all, it is one that inspires action.

Clinician-patient communication: a systematic review

The goal of this work was to identify methods of clinician-patient cancer-related communication that may impact patient outcomes associated with distress at critical points in the course of cancer care. A systematic review of practice guidelines, systematic reviews, or randomized trials on this topic was conducted. Guidelines for quality was evaluated using the Appraisal of Guidelines for Research and Evaluation Instrument, and the contributive value for recommendations was assessed. Systematic reviews and randomized trials were also evaluated for methodological rigor. Four existing guidelines, eight systematic reviews and nine randomized trials were identified. Two of the guidelines were of high quality, and all systematic reviews reported clear search criteria and support for their conclusions; the randomized trials were of modest or low quality. For all situations and disease stages, guidelines consistently identified open, honest, and timely communication as important; specifically, there was evidence for a reduction in anxiety when discussions of life expectancy and prognosis were included in consultations. Techniques to increase patient participation in decision-making were associated with greater satisfaction but did not necessarily decrease distress. Few studies took cultural and religious diversity into account. There is little definitive evidence supporting the superiority of one specific method for communicating information compared to another. Evidence regarding the benefit of decision aids or other strategies to facilitate better communication is inconsistent. Since patients vary in their communication preferences and desire for active participation in decision making, there is a need to individualize communication style.

Patients' perceptions of safety if interpersonal continuity of care were to be disrupted.

To determine if patients vary in perceptions of safety if interpersonal continuity were to be disrupted. If so, which characteristics are associated with feeling unsafe? The extent to which patients' preference for continuity with a personal physician is due to perceptions of safety is unclear. Observational study (Wisconsin Longitudinal Study Graduate and Sibling Survey). A total of 6827 respondents (most aged 63-66 years) who completed the 2003-06 survey round. Age, gender, marital status, education, health insurance type, illnesses, medications, length of relationship with provider and place, personality type, decision-making preference and trust in physician deliberation. Safety perception when visiting another doctor or clinic if own doctor were not available. Twelve percent of respondents felt unsafe. After adjustment, as compared to those who felt safe, those who felt unsafe were more likely to be women (Odds ratio=1.65, 95% confidence interval=1.35-2.01), have more chronic conditions (1.27, 1.08-1.50) and have a longer relationship with a usual provider: 5-9 years (1.53, 1.11-2.10) 10-14 years (1.41, 1.02-1.95) and 15 or more years (1.62, 1.20-2.17) compared to 0-4 years. Those who preferred active participation in decision making and had trust in their physician were less likely to feel safe (1.63, 1.10-2.41). Certain older adults perceive being unsafe if not seeing their usual physician. Further research should investigate reasons for perceptions of safety if continuity were disrupted and any implications for care.

Social Capital and Household Welfare in Kwara State, Nigeria

This study examined the effects of social capital on household welfare in Kwara State, Nigeria. The data for the study were collected from 315 households in six local government areas (LGAs) of the state using probability proportionate to size of the registered institutions in the LGAs. Data analysis was done using descriptive statistics, social capital indices and regression technique. Average age of household heads stood at 44.3 years with about 8 years of formal education. Household size was 7 members with monthly per capita income of N 4, 184.40. About 49.9% of the per capita expenditure of N3, 059.52 was spent on food. Household own production constituted 31.4% of the total food expenditure. Membership of households in local level institutions averaged 6 with urban households belonging to one less institutions. Households attended two out of every three meetings and had moderate level of active participation in decision making of 57.5%. The index of heterogeneity at 29.1 indicated low level of diversity of the associations. Monthly cash contribution was highest for members in religious associations amounting to N1,574.53 followed by cooperative associations at N 1, 015.03. A one unit increase in social capital would increase household per capita expenditure by 0.15%. Disaggregation of social capital into its components showed that its effect on welfare was traceable to membership and active participation in decision making of households in associations. Social capital was truly exogenous to household's welfare with no reverse causality. The study concluded that social capital positively affected household welfare.

Young patients', parents', and survivors' communication preferences in paediatric oncology: Results of online focus groups

BackgroundGuidelines in paediatric oncology encourage health care providers to share relevant information with young patients and parents to enable their active participation in decision making. It is not clear to what extent this mirrors patients' and parents' preferences. This study investigated communication preferences of childhood cancer patients, parents, and survivors of childhood cancer.MethodsCommunication preferences were examined by means of online focus groups. Seven patients (aged 8–17), 11 parents, and 18 survivors (aged 8–17 at diagnosis) participated. Recruitment took place by consecutive inclusion in two Dutch university oncological wards. Questions concerned preferences regarding interpersonal relationships, information exchange and participation in decision making.ResultsParticipants expressed detailed and multi-faceted views regarding their needs and preferences in communication in paediatric oncology. They agreed on the importance of several interpersonal and informational aspects of communication, such as honesty, support, and the need to be fully informed. Participants generally preferred a collaborative role in medical decision making. Differences in views were found regarding the desirability of the patient's presence during consultations. Patients differed in their satisfaction with their parents' role as managers of the communication.ConclusionYoung patients' preferences mainly concur with current guidelines of providing them with medical information and enabling their participation in medical decision making. Still, some variation in preferences was found, which faces health care providers with the task of balancing between the sometimes conflicting preferences of young cancer patients and their parents.

Is Internet Information Adequate to Facilitate Surgical Decision-Making in Familial Adenomatous Polyposis?

Prophylactic surgery decisions are difficult. Supplemental information improves patients' knowledge, promoting active participation in decision-making. Our objective was to examine internet information regarding prophylactic surgery for familial adenomatous polyposis to determine its adequacy in facilitating patient participation in surgical decision-making. We searched the internet for information on surgery for familial adenomatous polyposis, using an intentionally simple strategy to represent patients' searches. We examined the first 50 sites from each search, assessing each for content by using predefined criteria. Every site was evaluated by two investigators (kappa 0.71) by using the DISCERN criteria, a tool for evaluating quality of health information. Search-efficiency was calculated. Searches revealed 307,138 "hits"; 20 sites met inclusion criteria. GOOGLE demonstrated the highest search-efficiency (28 percent). Sites were maintained by general health pages (35 percent), hospitals (30 percent), professional organizations (15 percent), familial adenomatous polyposis registries (10 percent), and government (10 percent). Only 40 percent had been developed and/or updated within two years. Most included basic information regarding risk, symptoms, diagnosis, as well as discussion of familial adenomatous polyposis-associated diseases and surveillance (80-100 percent). Although 90 percent of sites presented surgical treatment options, only 60 percent provided details. Few provided information regarding postoperative bowel function (40 percent), sexual function (20 percent), or fertility (5 percent). Seven (35 percent) were identified as being of "good/excellent" quality. Only four were patient-oriented; variable information was provided. Internet information regarding surgical treatment of familial adenomatous polyposis is sparse, and insufficient to support active patient participation in decision-making. Despite the time and financial commitment required, development of high-quality internet resources may be justified given the lack of adequate patient-oriented information currently available.

Inclusive design: planning public urban spaces for children

This paper critically examines questions of inclusive design and planning to encourage children's spatial mobility in public spaces. This perspective is based on three interrelated premises: first, public space must be inclusive for children and youth, and their spatial mobility in civic events, activities and gatherings must be encouraged via planning and design. Second, an intergenerational perspective is indispensable to the task of rejuvenating lost public space for the young. Third, a participatory approach to the planning and design of the public realm is central to the creation of an inclusive environment. The paper identifies design attributes of public spaces that encourage children's mobility and emphasises the need for children's active participation in decision making.

Older people's preferences for involvement in their own care: A qualitative study in primary health care in 11 European countries

Objective The aim of the study was to explore the views of people aged over 70 years on involvement in their primary health care in 11 different European countries. Methods Older patients were asked about their views on patient involvement in a face-to-face interview. All interviews were audio-recorded, transcribed and analysed in accordance with the principles of ‘qualitative content analysis’. An international code list was used. Results Four hundred and six primary care patients aged between 70 and 96 years were interviewed. Their views could be categorized into four major groups: doctor–patient interaction, GP related topics, patient related issues and contextual factors. Conclusion People over 70 do want to be involved in their care but their definition of involvement is more focussed on the ‘caring relationship’, ‘person-centred approach’ and ‘receiving information’ than on ‘active participation in decision making’. Practice implications The desire for involvement in decision making is highly heterogeneous so an individual approach for each patient in the ageing population is needed. Future research and medical education should focus on methods and training to elicit older patients’ preferences. The similar views in 11 countries suggest that methods for enhancing patient involvement in older people could be internationally developed and exchanged.