Values Clarity Research Articles

Short Graphic Values History Tool for decision making during serious illness

ObjectivesTo develop and validate a values clarification tool, the Short Graphic Values History Tool (GVHT), designed to support person-centred decision making during serious illness.MethodsThe development phase included input from experts...

Korean Students’ Responses to Non-Cognitive Variables Compared to Japanese and Singaporean Students Based on TIMSS Data

Abstract This study analyzed the responses of Korean students to interest, confidence, value, and instructional clarity in science and mathematics. To achieve this, the raw data of the recent student survey of TIMSS were analyzed. A one-way ANOVA was performed, and a post hoc test was performed. Additionally, a cohort analysis was performed to determine the changes when the fourth-grade students reached the eighth grade. The study results are as follows. First, interest and confidence were higher in the fourth grade than in the eighth grade. Second, in most cases, the average response of Singaporean students was the most positive, but in terms of interest and confidence in science in the fourth grade, the Japanese response average was generally the highest. Third, the average scores of Korean students on wanting to have a job related to their subject and knowing what teachers expect from them were low in both science and mathematics.

PD48-11 DECISIONAL CONFLICT IN PARENTS REGARDING NEWBORN CIRCUMCISION

You have accessJournal of UrologyCME1 May 2022PD48-11 DECISIONAL CONFLICT IN PARENTS REGARDING NEWBORN CIRCUMCISION Hannah Botkin, Denise Juhr, Douglas Storm, Christopher Cooper, and Gina Lockwood Hannah BotkinHannah Botkin More articles by this author , Denise JuhrDenise Juhr More articles by this author , Douglas StormDouglas Storm More articles by this author , Christopher CooperChristopher Cooper More articles by this author , and Gina LockwoodGina Lockwood More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002616.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Informed consent is obtained prior to circumcision of newborn males, but little is known about the degree of uncertainty parents experience surrounding the choice of whether or not to circumcise. We evaluated the degree of decisional conflict (DC) in parents of male children and children of unknown sex during the prenatal period. METHODS: We administered a validated questionnaire, the Decisional Conflict Scale (DCS), to pregnant mothers carrying a male child or child of unknown sex during prenatal care visits as well as to expecting parents via an institution-wide survey. DCS total score was calculated on a scale of 0 to 100, with 0 representing no DC, and 100 representing extremely high DC. Total score, as well as uncertainty, informed, values clarity, support, and effective decision subscores were calculated. Decisional conflict was considered to be low with a score of less than 25, intermediate with scores between 25 and 37.5 and high with scores greater than 37.5. Unpaired t-test was used to compare results between groups. RESULTS: 153 DCS were completed and analyzed. All mothers approached for survey completion during prenatal visits completed the survey. 57.9% (n=88) of respondents reported they would choose circumcision for their male child, with 33% (n=51) choosing not to circumcise, and the remaining 8.6% (n=13) unsure about the choice. Mean total DCS score was higher (mean = 44.4, SD 11.9) for parents reporting they were unsure, than those who selected circumcision (mean = 12.9, SD 14.2; p <0.0001) or no circumcision (mean = 5.5, SD 8.7; p <0.0001). Mean scores were not significantly different from trimester to trimester, and the number of those unsure about the decision were spread evenly between the first, second and third trimesters. Subscale scores were all low for conflict in those who had decided on circumcision or against it. All subscale scores in the unsure group were high, with the highest being the uncertainty subscale (mean = 62.8, SD 15.8) and the values clarity subscale (mean = 48.1, SD 14.9). CONCLUSIONS: Our survey data showed that a small proportion of parents-to-be do experience high levels of DC regarding the decision of whether or not to circumcise. Importantly, some parents report not understanding the risks, benefits, and side effects of this procedure, as reflected in the informed subscore or understanding the relative importance of their own values in this decision, as reflected in the values clarity subscore. Better understanding of the modifiable factors contributing to this hesitancy could help providers alleviate conflict and regret regarding this decision. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e803 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hannah Botkin More articles by this author Denise Juhr More articles by this author Douglas Storm More articles by this author Christopher Cooper More articles by this author Gina Lockwood More articles by this author Expand All Advertisement PDF DownloadLoading ...

The M.I.L.K Survey Study: Evaluation of a Breast Milk Hand Expression Toolkit

Breastmilk hand expression (BMHE) is recommended to promote lactation, relieve breast engorgement, and collect milk for future infant feedings. Resources to teach this skill are limited and infrequently developed in partnership with the obstetrical population. In collaboration with an expert working group, a one-page toolkit that illustrates step-by-step the process of BMHE was developed. The objective of this study was to evaluate the readability, clarity of content, layout, and informational value of this BMHE toolkit.

Decisional Satisfaction, Regret, and Conflict Among Parents of Infants with Neurologic Conditions

To characterize decisional satisfaction, regret, and conflict among parents of critically ill infants with neurologic conditions. In this prospective cohort study, we enrolled parents of infants with neurologic conditions in the intensive care unit (ICU). Hospital discharge surveys included the validated Family Satisfaction with the ICU (FS-ICU) decision making subscale, Decision Regret Scale (DRS), and Decisional Conflict Scale (DCS). We defined high satisfaction with decision making as an FS-ICU score ≥75, high decisional regret/conflict as DRS/DCS score >25, and within-couple disagreement as a difference of at least 25 points between scores. We enrolled 61 parents of 40 infants (n=40 mothers, n=21 fathers); 35 mothers and 15 fathers completed surveys. Most mothers reported high satisfaction with decision making (27 of 35; 77%) and low decision regret (28 of 35; 80%); 40% (14 of 35) reported high decisional conflict. Mothers and fathers reported higher decisional conflict in the domains of uncertainty and values clarity compared with the domain of effective decision making (Bonferroni-corrected P<.05). There were no differences in decision outcomes between paired mothers and fathers; however, within any given couple, there were numerous instances of disagreement (7 of 15 for decision regret and 5 of 15 for decisional conflict). Many parents experience decisional conflict even if they ultimately have high satisfaction and low regret, underscoring the need for decision aids targeting uncertainty and values clarity. Couples frequently experience different levels of decisional regret and conflict.

Evaluation of a breastmilk hand expression toolkit: the M.I.L.K survey study

BackgroundBreastmilk hand expression (BMHE) is recommended to promote lactation, relieve breast engorgement, and collect milk for future infant feedings. Resources to teach this skill are limited and infrequently developed in partnership with the obstetrical population. In collaboration with maternity care experts and individuals with recent breastfeeding experience, we designed a one-page toolkit that describes the process of BMHE and includes step-by-step instructions and images to illustrate the technique. This study aimed to evaluate the readability, clarity of content, layout, and informational value of this BMHE toolkit.MethodsIndividuals who intended to breastfeed, were currently breastfeeding, or had recently breastfed were electronically surveyed and completed a two-part survey that consisted of radio, multi-select, Likert scale, and open-ended questions. Part one captured sociodemographic factors, obstetrical history, and breastfeeding practices. Part two collected feedback on the BMHE toolkit. Participants were recruited electronically through social media and posters were circulated in antenatal and postnatal care settings in Ottawa, Canada between November 2020 and February 2021.ResultsOf the 123 participants, 117 (95.1%) had heard of hand expression prior to reviewing the toolkit and 99 (80.5%) had hand expressed before. Among the 48 participants who were no longer exclusively breastfeeding at the time of the survey, 22 (45.8%) had exclusively breastfed their infant for at least six months and 7 (14.6%) had discontinued exclusive breastfeeding within the first month. When asked about the BMHE toolkit, 118 (95.9%) participants said it was informative, 115 (93.5%) said it was easy to understand, and 114 (92.7%) said it was well laid-out. When asked about information seeking behaviours, participants indicated a preference for online resources (58.5%) and video resources (22.0%).ConclusionsThe BMHE toolkit was well received by participants and the feedback was favourable overall. The survey feedback will be used to create a revised version of the toolkit that has been validated by the obstetrical patient population. Future research should focus on identifying implementation strategies to optimize the use of the toolkit and increase its effectiveness as an educational resource to teach participants correctly BMHE.

Structural empirical model of personal positive youth development, parenting, and school climate

AbstractThis study tested an empirical model of the relationship between Personal Positive Youth Development (PPYD) and two contextual factors: Positive Parenting (PP), and Perception of the Climate and Functioning of the School (PcfS). The hypothesis tested was that a positive relationship with parents and a positive perception of the school will contribute to the prediction of PPYD. The sample was composed of 1507 adolescents recruited in 10 Spanish schools who were aged between 12 and 18 years and 52% were female. PPYD was evaluated through Dispositional optimism, Self‐competence, and Sense of coherence. PP was evaluated through Affect and communication, Autonomy granting, Humor, and Self‐disclosure. PcfS was evaluated through School climate, School bonds, Clarity of rules and values, and Empowerment. Previous reliability and validity analyses of the constructs were carried out, and correlational analyses and structural predictions were made. The results show that both PP and PcfS were associated with better scores in PPYD. Also, a positive correlation between those two contextual factors was found. Implications for applied research are discussed.

Real-time fluctuations in mindful awareness, willingness, and values clarity, and their associations with craving and dietary lapse among those seeking weight loss

BackgroundMindful awareness, willingness and values clarity have been examined as protective factors across a wide range of problems, including overweight/obesity. However, these variables have almost exclusively been examined at the trait-level. It is possible that these variables also fluctuate within individuals in daily life, and that these intraindividual fluctuations may in turn be related to food craving and dietary lapse. The current study used ecological momentary assessment (EMA) to examine the extent to which momentary mindful awareness, willingness, and values clarity varied within-person, and were associated with craving and likelihood of dietary lapse among weight-loss seeking individuals with overweight/obesity prior to starting a weight loss program. We also examined the extent to which craving was associated with dietary lapse. MethodsAdults with overweight/obesity (N = 126) completed one week of EMA prior to enrolling in a randomized controlled trial of behavioral weight loss treatments. They responded to EMA questions assessing dietary lapses, craving, mindful awareness, willingness, and values clarity six-times per day. ResultsMindful awareness, willingness, and values clarity demonstrated substantial within-person variability, and higher within-person mindful awareness, willingness, and values clarity were concurrently (but not prospectively) associated with lower craving and likelihood of dietary lapse. Higher craving was concurrently (but not prospectively) associated with higher likelihood of dietary lapse. Between-person, higher mindful awareness, willingness, and values clarity were associated with lower craving and likelihood of dietary lapse, and higher craving was associated with greater frequency of dietary lapses. ConclusionMindful awareness, willingness, and values clarity vary substantially at the daily level, and may be important mechanisms to target to reduce craving and dietary lapses in the daily lives of individuals with overweight/obesity.

Clinical Impact of the Predict Prostate Risk Communication Tool in Men Newly Diagnosed with Nonmetastatic Prostate Cancer: A Multicentre Randomised Controlled Trial

BackgroundPredict Prostate is a freely available online personalised risk communication tool for men with nonmetastatic prostate cancer. Its accuracy has been assessed in multiple validation studies, but its clinical impact among patients has not hitherto been assessed. ObjectiveTo assess the impact of the tool on patient decision-making and disease perception. Design, setting, and participantsA multicentre randomised controlled trial was performed across eight UK centres among newly diagnosed men considering either active surveillance or radical treatment. A total of 145 patients were included between 2018 and 2020, with median age 67 yr (interquartile range [IQR] 61–72) and prostate-specific antigen 6.8 ng/ml (IQR 5.1–8.8). InterventionParticipants were randomised to either standard of care (SOC) information or SOC and a structured presentation of the Predict Prostate tool. Outcome measurements and statistical analysisValidated questionnaires were completed by assessing the impact of the tool on decisional conflict, uncertainty, anxiety, and perception of survival. Results and limitationsMean Decisional Conflict Scale scores were 26% lower in the Predict Prostate group (mean = 16.1) than in the SOC group (mean = 21.7; p = 0.027). Scores on the “support”, “uncertainty”, and “value clarity” subscales all favoured Predict Prostate (all p < 0.05). There was no significant difference in anxiety scores or final treatment selection between the two groups. Patient perception of 15-yr prostate cancer–specific mortality (PCSM) and overall survival benefit from radical treatment were considerably lower and more accurate among men in the Predict Prostate group (p < 0.001). In total, 57% of men reported that the Predict Prostate estimates for PCSM were lower than expected, and 36% reported being less likely to select radical treatment. Over 90% of patients in the intervention group found it useful and 94% would recommend it to others. ConclusionsPredict Prostate reduces decisional conflict and uncertainty, and shifts patient perception around prognosis to be more realistic. This randomised trial demonstrates that Predict Prostate can directly inform the complex decision-making process in prostate cancer and is felt to be useful by patients. Future larger trials are warranted to test its impact upon final treatment decisions. Patient summaryIn this national study, we assessed the impact of an individualised risk communication tool, called Predict Prostate, on patient decision-making after a diagnosis of localised prostate cancer. Men were randomly assigned to two groups, which received either standard counselling and information, or this in addition to a structured presentation of the Predict Prostate tool. Men who saw the tool were less conflicted and uncertain in their decision-making, and recommended the tool highly. Those who saw the tool had more realistic perception about their long-term survival and the potential impact of treatment upon this. Take Home MessageThe use of an individualised risk communication tool, such as Predict Prostate, reduces patient decisional conflict and uncertainty when deciding about treatment for nonmetastatic prostate cancer. The tool leads to more realistic perceptions about survival outcomes and prognosis.

P–475 The mediator role of infertility-related psychological inflexibility in the relationship between infertility-stress domains and psychopathological symptoms

Abstract Study question Does infertility-related psychological inflexibility play a role in the relationship between infertility-related stress domains and psychopathological symptoms (depression, anxiety)? Summary answer Infertility-related psychological inflexibility mediated the relationship between infertility-related stress domains and depression. There were no effects between infertility-related stress domains and anxiety symptoms. What is known already The emotional impact of infertility may include anxiety and depressive symptoms and these seem to be related to stress. Beliefs about the importance of parenthood (need for parenthood) and rejection of a childfree lifestyle, as well as the impact of infertility in several life areas (social, sexual, and relationship) are conceptually considered two infertility-related stress domains. Although the relationship between infertility-related stress and psychopathological symptoms has been previously recognized, the mechanism underlying this relationship remains undetermined. Psychological inflexibility has been pointed as a core transdiagnostic process contributing to the development and maintenance of several psychological difficulties. Study design, size, duration Cross-sectional study. Participants were recruited through the Associação Portuguesa de Fertilidade (patients’ association). Inclusion criteria were age (18 years or older) and an infertility medical diagnosis. Data were collected online through self-report instruments between June and December 2019. Participants/materials, setting, methods: A sample comprising 287 women pursuing infertility medical treatment (at different stages) completed online a sociodemographic questionnaire, the depression and anxiety subscales of the Depression, Anxiety and Stress Scales (DASS – 21), the Psychological Inflexibility Scale - Infertility (PIS-I), and the Fertility Problem Inventory (FPI). Descriptive and correlational analyses were computed through SPSS v. 26, and path analyses were estimated in AMOS (v. 24) with bootstrap procedures (2000 samples). Main results and the role of chance Correlation analyses revealed that FPI domains (importance of parenthood and impact on life domains), depressive and anxiety symptoms were significantly and positively associated with PIS-I. A mediation analysis was conducted to examine whether PIS-I mediated the effect of FPI domains on depressive and anxiety symptoms. Paths showing not to be statistically significant were removed. This model showed a good fit to the empirical data: χ2(4) = 1.59, p = .810, CMIN/DF = .40; TLI = 1.00; CFI = 1.00; RMSEA = .00, 95% CI = .00 to .06. The effect of the importance of parenthood on depressive symptoms revealed to be both direct (b = .03; SEb = .01; Z = 2.46; p = .014; β= .15) and partially mediated by the PIS-I (b = .31, 95% CI = .24 to .37, p = .018). The effect of the impact of infertility in several life areason depressive symptoms was fully mediated by PIS-I (b = .15, 95% CI = .10 to .21, p = .008). This model explained 43% of the total variance of depressive symptoms. No significant effects were found for anxiety symptoms. Limitations, reasons for caution Participants were at different stages of their fertility treatment. Data collection was completed online and this tends to recruit participants with more access to online platforms. Results rely on cross-sectional and self-report data. Wider implications of the findings: Results suggest the relevance of targeting processes encompassing psychological inflexibility, such as cognitive fusion, experiential avoidance, conceptualized self, conceptualized past and future, lack of values clarity, and inability to commit with values-driven actions, in psychological interventions designed for women with infertility. Trial registration number N/A.

Decision aid for women with newly diagnosed breast cancer seeking breast reconstruction surgery: A prospective, randomized, controlled, single-blinded, pilot study

Women undergoing immediate breast reconstruction for breast cancer often experience anxiety when faced with reconstruction and the type of reconstruction to choose. The purpose of this study is to analyze the impact of a decision aid on decisional conflict in women with newly diagnosed breast cancer seeking breast reconstruction.Newly diagnosed breast cancer patients seeking breast reconstruction at a single center were prospectively randomized into two groups. Comparisons were made between two groups using the decisional conflict scale (DCS): women who reviewed the standard educational materials prior to initial consultation (control) and women who reviewed standard materials prior to initial consultation and then reviewed a decision aid brochure at initial consultation and two-week post-consultation (intervention). Pre-to-post-consultation DCS scores were compared within and between the control groups and intervention groups to assess which group had lower DCS scores.A total of 20 patients, mean age 53±9 years were included. Median differences between pre-to-post-consultation DCS total scores in the control and intervention groups lowered from 32 to 22 and 28 to 16, respectively. Significant differences in subscores were control group: uncertainty: 54-21 (p = 0.030), and intervention group: uncertainty: 46-29 (p = 0.036) and values clarity: 29-25(p = 0.042). Pre-to-post-consultation differences between DCS scores and subscores did not demonstrate any statistical significance.Decision aids did not significantly reduce pre-operative DCS total scores compared to current educational materials. More educational materials may not always be helpful for patients.

Factors Associated With Decision Regret Among Patients With Diverticulitis in the Elective Setting

BackgroundWe aimed to identify decision process measures associated with patient decisional regret regarding the decision to pursue elective colectomy or observation for diverticulitis. Materials and methodsThis was a single-center cross-sectional survey study. We included adult patients treated for diverticulitis between 2014 and 2019 and excluded patients who required urgent or emergent colectomy. The primary outcome was regret regarding the decision to pursue elective surgery or observation for diverticulitis, measured using the Decision Regret Scale. We used multivariable linear regression to examine hypothesized predictors of decision regret, including decisional conflict (Decision Conflict Scale and its subscales), shared decision-making, and decision role concordance. ResultsOf 923 eligible patients, 133 were included in the analysis. Patients had a median of five episodes of diverticulitis (interquartile range 3-8), occurring a median of 2 y (interquartile range 1-3) before survey administration. Thirty-eight patients (29%) underwent elective surgery for diverticulitis. Decision regret (Decision Regret Scale score ≥25) was present in 42 patients (32%). After controlling for surgery, gender, health status, and years since treatment, decision regret was associated with decisional conflict and inversely associated with values clarity, decision role concordance, shared decision-making, and feeling informed, supported, and effective in decision-making (all P < 0.001). ConclusionsNearly one-third of survey respondents experienced regret regarding the decision between elective surgery and observation for diverticulitis. Decision regret may be reduced through efforts to improve patient knowledge, values clarity, role concordance, and shared decision-making.

ВЗАИМОСВЯЗЬ КАТЕГОРИЙ «ПОЛИТИЧЕСКАЯ КУЛЬТУРА» И «ЭЛЕКТОРАЛЬНОЕ ПОВЕДЕНИЕ» В ЕВРОПЕЙСКОЙ ПОЛИТИЧЕСКОЙ МЫСЛИ

This article is devoted to identifying the interrelationship and interdependence of political culture and electoral behavior in the concepts of European political researchers. The methodology of the study is based on the assumption that electoral behavior is a comprehensive political and legal indicator of the level and nature of political culture. The following methods of research are used: systemic analysis, chronological analysis of scientific concepts on the topic of research, analysis of factors that affect the dynamics of political consciousness and electoral behavior. As a result of the study of scientific approaches on the topic of the article, it was revealed that the methodology for studying the dynamics of political processes is now in the active development stage and is constantly replenished with new research hypotheses. It is shown that in chronologically early concepts, moral and ethical ideas, traditions, customs and religion come first in the structure of political consciousness. This circumstance is associated with the high role of traditional and religious factors in the consciousness and life of all societies until the beginning of the 20th century. It is argued that at the present stage of post-industrial development, the model of electoral behavior preferred for Western European researchers is the model of a targeted voter, which involves the sustainability and clarity of political values and preferences, normative oriented political behavior, as well as the "habit" of critically analyzing the programs and speeches of public leaders and parties for their usefulness for the voter. At the same time, this model still remains quite abstract and difficult to implement in electoral practices, since its implementation is hindered by irrational political archetypes, symbols, myths - components of the political consciousness of modern man.

Factors that Affect Government Accountability with Moderating Variable Accounting Control

This study aims to determine the effect of budget performance, budget objectives and value for money on government performance accountability with accounting control as a moderating variable. This research was conducted by purposive sampling as many as 50 respondents from 14 Regional Work Unit at the Makassar City Government using multiple linear regression analysis. The results showed that budget performance, clarity of budget objectives and value for money had a significant and positive effect on government performance accountability. Likewise, accounting control is able to strengthen the relationship between budget performance and value for money on government performance accountability, while accounting control does not strengthen the relationship between clarity of budget objectives and government performance accountability.

Decisional conflict scale in metastatic colorectal cancer patients using an Arabic decision aid versus usual care: a multicenter randomized controlled trial

Background: Shared decision-making is an essential part of patient care. Patients need more information to support their decision-making about treatment options. An Arabic language decision aid (DA) for metastatic colorectal cancer patients (mCRC) was developed, considering systemic therapy (chemotherapy with or without targeted therapy) as a choice of treatment to assess its role in patients' decision-making. Methods: A multicenter randomized controlled trial was conducted in four out patients in oncology clinics in Saudi Arabia to measure patient certainty when selecting their treatment options and the satisfaction and willingness of oncology physicians using the Arabic DA among mCRC patients. Results: Ninety-two patients with mCRC considering first-line systemic therapy were randomly allocated to the intervention arm (DA with usual care) or control arm (usual care alone). The outcome measured the patients' certainty regarding their decision: Decisional Conflict Scale (DCS). 51 (55%) were randomized to the DA arm. Both arms scored low in the DCS, with less than 40 (score range 1-100). However, the DA arm scored lower (range 15.1-24.3), on the overall DCS and the DCS sub-scores than the usual care arm (18.8 and 37.6). The values clarity subscale was significantly lower in the DA arm (p = 0.030). Conclusion: This trial found significant difference with the DA's use in mCRC patients' rate of decisional conflict in the domain of clarity lower than patients receiving usual care, which could enhance a patients' ability to make treatment-related decisions. Our recommendation is to include the DA with usual care for mCRC patients as a part of the initial consultation to support shared decision making.

User-Centered Design and Evaluation of a Web-Based Decision Aid for Older Adults Living With Mild Cognitive Impairment and Their Health Care Providers: Mixed Methods Study.

BackgroundMild cognitive impairment (MCI) is often considered a transitional state between normal and pathologic (eg, dementia) cognitive aging. Although its prognosis varies largely, the diagnosis carries the risk of causing uncertainty and overtreatment of older adults with MCI who may never progress to dementia. Decision aids help people become better informed and more involved in decision making by providing evidence-based information about options and possible outcomes and by assisting them in clarifying their personal values in relation to the decision to be made.ObjectiveThis study aimed to incorporate features that best support values clarification and adjust the level of detail of a web-based decision aid for individuals with MCI.MethodsWe conducted a rapid review to identify options to maintain or improve cognitive functions in individuals with MCI. The evidence was structured into a novel web-based decision aid designed in collaboration with digital specialists and graphic designers. Qualitative and user-centered evaluations were used to draw on users’ knowledge, clarify values, and inform potential adoption in routine clinical practice. We invited clinicians, older adults with MCI, and their caregivers to evaluate the decision aid in 6 consecutive rounds, with new participants in each round. Quantitative data were collected using the Values Clarity and Informed subscales of the Decisional Conflict Scale, the System Usability Scale, the Ottawa Acceptability questionnaire, and a 5-point satisfaction rating scale. We verified their comprehension using a teach-back method and recorded usability issues. We recorded the audio and computer screen during the session. An inductive thematic qualitative analysis approach was used to identify and describe the issues that arose. After each round, an expert panel met to prioritize and find solutions to mitigate the issues. An integrated analysis was conducted to confirm our choices.ResultsA total of 7 clinicians (social workers, nurses, family physicians, psychologists) and 12 older (≥60 years) community-dwelling individuals with MCI, half of them women, with education levels going from none to university diploma, were recruited and completed testing. The thematic analysis revealed 3 major issues. First, the user should be guided through the decision-making process by tailoring the presentation of options to users’ priorities using the values clarification exercise. Second, its content should be simple, but not simplistic, notably by using information layering, plain language, and pictograms. Third, the interface should be intuitive and user friendly, utilize pop-up windows and information tips, avoid drop-down menus, and limit the need to scroll down. The quantitative assessments corroborated the qualitative findings.ConclusionsThis project resulted in a promising web-based decision aid that can support decision making for MCI intervention, based on the personal values and preferences of the users. Further ongoing research will allow its implementation to be tested in clinical settings.

Examining and expanding the friction ridge value decision

The first step of a friction ridge examination involves determining the suitability—or value—of an impression. Often, this is interpreted as whether the impression is suitable for comparison. However, examiners tend to be variable in their suitability determinations, and suitability itself can be a multi-faceted decision, comprising suitability for comparison, suitability for exclusion, suitability for identification, suitability for AFIS entry, complexity, and others. We undertook a white box study to explore the different facets of suitability determinations and to measure the specific categories of information upon which examiners most heavily rely when reaching these decisions. Although minutiae count was the best indicator of a value determination, clarity and distortion were better predictors of complexity determinations. Examiners were found to be highly variable in their determinations, as well as in their annotations of what information they relied upon. Some unanimous decisions were reached for only high-quality impressions; there was never unanimity on “no value” determinations. Examiners tended to use high-confidence minutiae markers, even when there was connective ambiguity or low clarity. Several new suitability categorizations were introduced and had good usage from study participants, indicating that they might have some value for inclusion in routine casework.

Comparison of explicit values clarification method (VCM), implicit VCM and no VCM decision aids for men considering prostate cancer screening: protocol of a randomized trial

BackgroundScreening with prostate-specific antigen (PSA) test for prostate cancer is considered a preference sensitive decision; meaning it does not only depend on what is best from a medical point of view, but also from a patient value standpoint. Decision aids are evidence-based tools which are shown to help people feel clearer about their values; therefore it has been advocated that decision aids should contain a specific values clarification method (VCM). VCMs may be either implicit or explicit, but the evidence concerning the best method is scarce. We aim to compare the perceived clarity of personal values in men considering PSA screening using decision aids with no VCM versus an implicit VCM versus an explicit VCM.MethodsMale factory employees from an industrial facility in the Northern region of Portugal aged 50 to 69 years old will be randomly assigned to one of three decision aid groups used to support prostate cancer screening decisions: (i) decision aid with information only (control), (ii) decision aid with information plus an implicit VCM, (iii) decision aid with information plus an explicit VCM.Men will be allowed release time from work to attend a session at their workplace. After a brief oral presentation, those willing to participate in the study will fill the baseline questionnaire, plus a 5 point-Likert scale question about intentions to undergo screening, and will then receive the intervention materials to complete.We estimated a total sample size of 276 participants; with 92 in each group.The primary outcome will be the perceived clarity of personal values assessed by the Portuguese validated translation of the three subscales of the Decisional Conflict Scale. Secondary outcomes will be intention to be screened (before and after the intervention), the total score from the Decisional Conflict Scale and the self-report of having or not undergone screening at 6 months.DiscussionThis study will add to the body of evidence on the role of decision aids to support health preference-sensitive choices and provide further insight on the impact of different methods for eliciting people’s values embedded within a decision aid.Trial registrationNCT03988673 - clinicalTrials.gov (2019/06/17).

Women's decisional conflict in the pathway of prenatal screening and testing: an explorative study within Finnish public maternity care.

Objectives To explore women's decisional conflict in the pathway of prenatal screening and testing (PreST) in Finland and to evaluate a counseling service. Methods Self-completion surveys were conducted at two medical settings (screening and further testing) of PreST. Decisional Conflict Scale (DCS) was the main measure. Different types of statistical tests were used to compare women's decisional conflict at different medical settings of PreST, and before-after pre-test counseling. Multivariable linear regressions analyzed the influences of the medical settings and other factors on women's decisional conflict. Results Compared to women in population-based screening, women in further testing (before pre-test counseling) were more likely to feel well informed (P < 0.001), had increased values clarity (P < 0.001), but more likely experienced uncertainty (P = 0.040). Besides medical settings, maternal age, gravidity and previous experience of fetal aneuploidy significantly influenced decisional conflict. After counseling, screen-positive women felt better informed (P < 0.001), had increased values clarity (P < 0.001), perceived more support (P < 0.001), and had better decision certainty (P < 0.001) than before counseling. Conclusions Medical settings influence women's decisional conflict during PreST. Individual counseling is effective in improving screen-positive women's decisional conflict. This research adds knowledge and experience on developing decision-making supports across the pathway of PreST.

Abstract 14: Decision Aid For Women With Newly Diagnosed Breast Cancer Seeking Breast Reconstruction Surgery: A Prospective, Randomized, Controlled, Single-blinded, Pilot Study

Purpose: Women undergoing immediate mastectomy for breast cancer often experience anxiety when faced with breast reconstruction and the type of reconstruction to choose. The purpose of this study is to analyze the impact of a decision aid on decisional conflict in women with newly diagnosed breast cancer seeking breast reconstruction. Methods: Thirty-three newly diagnosed breast cancer patients seeking breast reconstruction at a single-center were prospectively randomized into two groups. Comparisons were made between two groups using the Decisional Conflict Scale (DCS): women who reviewed the standard educational materials prior to initial consultation (control) and women who reviewed standard materials prior to initial consultation and then reviewed a decision aid brochure at initial consultation and two weeks post-consultation (intervention). Differences between pre-to-post-consultation DCS scores, and DCS scores two weeks post-consultation in the control groups and intervention groups were compared to assess which group had lower DCS scores. Results: A total of 20 patients, mean age 53±9 years were included. Median differences between pre-to-post-consultation DCS Total scores in the control and intervention groups lowered from 32 to 22 and 28 to 16, respectively. Significant differences in subscores were control group: Uncertainty: 54 to 21 (p=0.030), and intervention group: Uncertainty: 46 to 29(p=0.036) and Values clarity: 29 to 25 (p=0.042). Differences between DCS scores and subscores two weeks post-consultation did not demonstrate statistical significance. Conclusions: Decision aids did not significantly reduce pre-operative DCS scores compared to current educational materials. Patients receiving the decision aid felt they clearly understood what reconstruction option meant most to them prior to surgery.