Decision Aid Tool Research Articles

Determining the Distribution of Coast Guard Vessels

A typical coast guard has complex responsibilities, subject to its multiple missions in maritime jurisdiction regions. These maritime jurisdiction regions can be partitioned into responsibility areas, and each type of coast guard vessel has a set of attributes for each responsibility area. The distribution of coast guard assets deployed in their respective areas of responsibility should be linked to the types of events occurring in these areas. The objective of this study is to determine the appropriate distribution of coast guard assets in various maritime zones; we do this by evaluating models that assign coast guard surface vessel types to missions in these maritime zones. We use the analytic network process model to compare various vessel types and determine the task-type weights for each vessel type. Weighted goal programming allows us to combine data, including the weights we derive from the use of other decision-aid tools. Our objective is to determine the best compromise solution for distributing coast guard assets into four main responsibility zones. The Turkish Coast Guard implemented the model in 2014, and decided to use it once a year prior to executing the main process in which it allocates coast guard assets.

Breast Conservation Therapy Versus Mastectomy: Shared Decision-Making Strategies and Overcoming Decisional Conflicts in Your Patients.

Although breast-conserving therapy is considered the preferred treatment for the majority of women with early-stage breast cancer, mastectomy rates in this group remain high. The patient, physician, and systems factors contributing to a decision for mastectomy are complicated. Understanding the individual patient's values and goals when making this decision is paramount to providing a shared decision-making process that will yield the desired outcome. The cornerstones of this discussion include education of the patient, access to decision-aid tools, and time to make an informed decision. However, it is also paramount for the physician to understand that a significant majority of women with an informed and complete understanding of their surgical choices will still prefer mastectomy. The rates of breast conservation versus mastectomy should not be considered a quality measure alone. Rather, the extent by which patients are informed, involved in decision-making, and undergoing treatments that reflect their goals is the true test of quality. Here we explore some of the factors that impact the patient preference for breast conservation versus mastectomy and how shared decision-making can be maximized for patient satisfaction.

Explaining robust additive utility models by sequences of preference swaps

As decision-aiding tools become more popular everyday—but at the same time more sophisticated—it is of utmost importance to develop their explanatory capabilities. Some decisions require careful explanations, which can be challenging to provide when the underlying mathematical model is complex. This is the case when recommendations are based on incomplete expression of preferences, as the decision-aiding tool has to infer despite this scarcity of information. This step is key in the process but hardly intelligible for the user. The robust additive utility model is a necessary preference relation which makes minimal assumptions, at the price of handling a collection of compatible utility functions, virtually impossible to exhibit to the user. This strength for the model is a challenge for the explanation. In this paper, we come up with an explanation engine based on sequences of preference swaps, that is, pairwise comparison of alternatives. The intuition is to confront the decision maker with “elementary” comparisons, thus building incremental explanations. Elementary here means that alternatives compared may only differ on two criteria. Technically, our explanation engine exploits some properties of the necessary preference relation that we unveil in the paper. Equipped with this, we explore the issues of the existence and length of the resulting sequences. We show in particular that in the general case, no bound can be given on the length of explanations, but that in binary domains, the sequences remain short.

Lipoprotein(a) As A Clinical Decision-Aid Tool*

Lipoprotein(a) As A Clinical Decision-Aid Tool*

SP-0509: Validation of a prostate cancer decision aid tool for shared decision making

SP-0509: Validation of a prostate cancer decision aid tool for shared decision making

EP-1351: Developing a prostate decision aid tool considering patients and clinicians decisional needs

EP-1351: Developing a prostate decision aid tool considering patients and clinicians decisional needs

Invited Review: Designing a grazing experiment that can reliably detect meaningful differences

Grazing trials are critical to advance the understanding and management of complex systems involving land, plants, and animals. Experiments provide data that are directly useful to managers and that are required for parameterizing and ground-truthing models. However, grazing trials are expensive to conduct. Because of their resource-consuming nature, many facilities and studies are often lacking in adequate replication. In light of this, grazing researchers should focus on designing experiments that have adequate statistical power to detect the differences among treatments that they suspect actually exist or that are meaningful to managers or other researchers. Power in grazing trials could potentially be improved by increased tolerance of type I or II errors; increasing the df in the denominator of F-tests; and reducing experimental, sampling, and measurement errors. These could be accomplished in multiple ways through experimental design choices, selection of variables to measure, and how carefully measurements are made. Suggestions for these approaches and decision aid tools to evaluate their effectiveness are provided. A final approach to increasing power of grazing experiments is to plan for and use meta-analysis to its full potential. Ultimately, grazing researchers must continually seek and apply new techniques to achieve adequate power for the specific resources they have and the specific questions they seek to answer.

Validation of Alternative In Vitro Methods to Animal Testing: Concepts, Challenges, Processes and Tools.

This chapter explores the concepts, processes, tools and challenges relating to the validation of alternative methods for toxicity and safety testing. In general terms, validation is the process of assessing the appropriateness and usefulness of a tool for its intended purpose. Validation is routinely used in various contexts in science, technology, the manufacturing and services sectors. It serves to assess the fitness-for-purpose of devices, systems, software up to entire methodologies. In the area of toxicity testing, validation plays an indispensable role: "alternative approaches" are increasingly replacing animal models as predictive tools and it needs to be demonstrated that these novel methods are fit for purpose. Alternative approaches include in vitro test methods, non-testing approaches such as predictive computer models up to entire testing and assessment strategies composed of method suites, data sources and decision-aiding tools. Data generated with alternative approaches are ultimately used for decision-making on public health and the protection of the environment. It is therefore essential that the underlying methods and methodologies are thoroughly characterised, assessed and transparently documented through validation studies involving impartial actors. Importantly, validation serves as a filter to ensure that only test methods able to produce data that help to address legislative requirements (e.g. EU's REACH legislation) are accepted as official testing tools and, owing to the globalisation of markets, recognised on international level (e.g. through inclusion in OECD test guidelines). Since validation creates a credible and transparent evidence base on test methods, it provides a quality stamp, supporting companies developing and marketing alternative methods and creating considerable business opportunities. Validation of alternative methods is conducted through scientific studies assessing two key hypotheses, reliability and relevance of the test method for a given purpose. Relevance encapsulates the scientific basis of the test method, its capacity to predict adverse effects in the "target system" (i.e. human health or the environment) as well as its applicability for the intended purpose. In this chapter we focus on the validation of non-animal in vitro alternative testing methods and review the concepts, challenges, processes and tools fundamental to the validation of in vitro methods intended for hazard testing of chemicals. We explore major challenges and peculiarities of validation in this area. Based on the notion that validation per se is a scientific endeavour that needs to adhere to key scientific principles, namely objectivity and appropriate choice of methodology, we examine basic aspects of study design and management, and provide illustrations of statistical approaches to describe predictive performance of validated test methods as well as their reliability.

Comparison of Mixed-Integer Linear Models for Fuel-Optimal Air Conflict Resolution With Recovery

Any significant increase in current levels of air traffic will need the support of efficient decision-aid tools. One of the tasks of air traffic management is to modify trajectories when necessary to maintain a sufficient separation between pairs of aircraft. Several algorithms have been developed to solve this problem, but the diversity in the underlying assumptions makes it difficult to compare their performance. In this paper, separation is maintained through changes of heading and velocity while minimizing a combination of fuel consumption and delay. For realistic trajectories, the speed is continuous with respect to time, the acceleration and turning rate are bounded, and the planned trajectories are recovered after the maneuvers. After describing the major modifications to existing models that are necessary to satisfy this definition of the problem, we compare three mixed-integer linear programs. The first model is based on a discretization of the airspace and the second relies on a discretization of the time horizon. The third model implements a time decomposition of the problem; it allows only one initial maneuver and is periodically solved with a receding horizon to build a complete trajectory. The computational tests are conducted on a benchmark of artificial instances specifically built to include complex situations. Our analysis of the results highlights the strengths and limits of each model. The time decomposition proves to be an excellent compromise.

The Concordance between Patients' Renal Replacement Therapy Choice and Definitive Modality: Is It a Utopia?

IntroductionIt is desirable for patients to play active roles in the choice of renal replacement therapy (RRT). Patient decision aid tools (PDAs) have been developed to allow the patients to choose the option best suited to their individual needs.Material and MethodsAn observational, prospective registry was conducted in 26 Spanish hospitals between September 2010 and May 2012. The results of the patients’ choice and the definitive RRT modality were registered through the progressive implementation of an Education Process (EP) with PDAs designed to help Chronic Kidney Disease (CKD) patients choose RRT.ResultsPatients included in this study: 1044. Of these, 569 patients used PDAs and had made a definitive choice by the end of registration. A total of 88.4% of patients chose dialysis [43% hemodialysis (HD) and 45% peritoneal dialysis (PD)] 3.2% preemptive living-donor transplant (TX), and 8.4% conservative treatment (CT). A total of 399 patients began RRT during this period. The distribution was 93.4% dialysis (53.6% HD; 40% PD), 1.3% preemptive TX and 5.3% CT. The patients who followed the EP changed their mind significantly less often [kappa value of 0.91 (95% CI, 0.86–0.95)] than those who did not follow it, despite starting unplanned treatment [kappa value of 0.85 (95% CI, 0.75–0.95]. A higher agreement between the final choice and a definitive treatment was achieved by the EP and planned patients [kappa value of 0.93 (95% CI, 0.89–0.98)]. Those who did not go through the EP had a much lower index of choosing PD and changed their decision more frequently when starting definitive treatment [kappa value of 0.73 (95% CI, 0.55–0.91)].ConclusionsFree choice, assisted by PDAs, leads to a 50/50 distribution of PD and HD choice and an increase in TX choice. The use of PDAs, even with an unplanned start, achieved a high level of concordance between the chosen and definitive modality.

Treatment preference and patient centered prostate cancer care: Design and rationale

Prostate cancer is a slow progressing cancer that affects millions of men in the US. Due to uncertainties in outcomes and treatment complications, it is important that patients engage in informed decision making to choose the "optimal treatment". Patient centered care that encompasses informed decision-making can improve treatment choice and quality of care. Thus, assessing patient treatment preferences is critical for developing an effective decision support system. The objective of this patient-centered randomized clinical trial was to study the comparative effectiveness of a conjoint analysis intervention compared to usual care in improving subjective and objective outcomes in prostate cancer patients. We identified preferred attributes of alternative prostate cancer treatments that will aid in evaluating attributes of treatment options. In this two-phase study, in Phase 1 we used mixed methods to develop an adaptive conjoint task instrument. The conjoint task required the patients to trade-off attributes associated with treatments by assessing their relative importance. Phase 2 consisted of a randomized controlled trial of men with localized prostate cancer. We analyzed the effect of conjoint task intervention on the association between preferences, treatment and objective and subjective outcomes. Our conjoint task instrument can lead to a values-based patient-centered decision aid tool and help tailor treatment decision making to the values of prostate cancer patients. This will ultimately improve clinical decision making, clinical policy process, enhance patient centered care and improve prostate cancer outcomes.

Review: Impact of underground structures on the flow of urban groundwater

Property economics favours the vertical development of cities but flow of groundwater can be affected by the use of underground space in them. This review article presents the state of the art regarding the impact of disturbances caused by underground structures (tunnels, basements of buildings, deep foundations, etc.) on the groundwater flow in urban aquifers. The structures built in the underground levels of urban areas are presented and organised in terms of their impact on flow: obstacle to the flow or disturbance of the groundwater budget of the flow system. These two types of disturbance are described in relation to the structure area and the urban area. The work reviewed shows, on one hand, the individual impacts of different urban underground structures, and on the other, their cumulative impacts on flow, using real case studies. Lastly, the works are placed in perspective regarding the integration of underground structures with the aim of operational management of an urban aquifer. The literature presents deterministic numerical modelling as a tool capable of contributing to this aim, in that it helps to quantify the effect of an underground infrastructure project on groundwater flow, which is crucial for decision-making processes. It can also be an operational decision-aid tool for choosing construction techniques or for formulating strategies to manage the water resource.

Contribution of rainfall vs. water management to Mediterranean wetland hydrology: Development of an interactive simulation tool to foster adaptation to climate variability

Mediterranean wetlands are increasingly managed to maintain their functions and services following modification in water allocation, embankment and climate change, calling for proactive and adaptive water management. In a first step, we used long-term monitoring of water levels in 37 adjacent embanked marshes in the Camargue as a repeated non-controlled experiment to build a hydrological model. Without information on water input/output by marsh users, we could nevertheless estimate evapotranspiration under flooding and dry conditions, and soil water coefficient. The model provided a high predictive accuracy (adjusted R2 = 0.73–0.83) of monthly water levels when applied to an independent sample of 12 marshes. In a second step we developed an interactive decision-aid tool that allows users to visualize the impact of their management strategy (desired water level at a specific month) on subsequent water levels, and their consequence on different components of the ecosystem over a 10-yr period.

MOSAICA: A multi-scale bioeconomic model for the design and ex ante assessment of cropping system mosaics

To understand the effects of policy changes on organisations and compositions of cropping systems at regional scale and their contribution to the sustainable development of regions, we built a regional, spatially explicit, multi-scale, bioeconomic model called MOSAICA. This model explicitly incorporates information at field, farm, sub-regional and regional scales to provide cropping system mosaics by way of regional optimisation of the sum of individual farmer's utilities under field, farm and territory biophysical and socio-economic constraints. Its generic structure means it can be used in different regions with geographic information on the location of the field and farm, data on cropping system performance, on location factors and on policy schemes. We used the model in Guadeloupe to test the impact of three scenarios of change on the agricultural subsidy regimes. The model produced three cropping system mosaics which reduced the area under banana and sugarcane, turned specialised banana and sugarcane farming systems into breeding systems while improving the overall contribution of agriculture to sustainable development. The spatially explicit results of changes in ecosystem services, and in farming systems with MOSAICA make it an appropriate decision-aid tool for regional planning.

Hydroxyurea therapy for children with sickle cell disease: describing how caregivers make this decision.

BackgroundHydroxyurea (HU) is underutilized in children with sickle cell disease (SCD) because caregivers frequently decline HU when it is offered. This study explores what impacts this decision.ResultsCaregivers of children with clinically severe SCD whose children were offered HU previously were interviewed. We used a qualitative analytical approach to analyze their telephone interview transcripts. Caregivers who chose HU (n = 9) reported their children had severe SCD, sought detailed information about HU, and accepted HU as a preventative therapy. In contrast, caregivers who did not choose HU (n = 10) did not perceive their children as having severe SCD and did not question their child’s provider about HU.ConclusionsThis study identifies specific areas that providers should address to when they discuss HU with families so that they can make informed decisions. Our study also uncovered factors that are important to consider when designing future interventions to improve hydroxyurea acceptance and when developing decision-aid tools to assist caregivers of children with SCD who are considering disease modifying therapies.

Accuracy of physician assessment of treatment preferences and health status in elderly patients with higher-risk myelodysplastic syndromes

Higher-risk myelodysplastic syndromes (MDS) are rarely curable and have a poor prognosis. We investigated the accuracy of physicians’ perception of patients’ health status and the patients’ preferences for involvement in treatment decisions.We examined 280 newly diagnosed higher-risk elderly MDS patients paired with their physicians. Survey tools included the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and the Control Preference Scale.Overall concordance was 49% for physician perception of patient preferences for involvement in treatment decisions. In 36.4% of comparisons there were minor differences and in 14.6% there were major differences. In 44.7% of the patients preferring a passive role, physicians perceived them as preferring an active or collaborative role. Absence of the patient's request for prognostic information (P=0.001) and judging the patient as having a poor health status (P=0.036) were factors independently associated with the physicians’ attitude toward a lower degree of patient involvement in clinical decisions. Agreement on health status was found in 27.5% of cases. Physicians most frequently tended to overestimate health status of patients who reported low-level health status.The value of decision aid-tools in the challenging setting of higher-risk MDS should be investigated to further promote patient-centered care.

Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research: Implementing the patient-driven research paradigm to aid decision making in stroke care

Stroke is common and costly, annually depriving the lives and well-being of 800,000 Americans. Despite demonstrated efficacy in clinical trials, questions remain about the safety and clinical effectiveness of various treatment options given patient characteristics, conditions, preferences, and their desired outcomes. The Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) is a Patient-Centered Outcomes Research Institute-sponsored project designed to help patients, physicians, and other stakeholders make informed decisions regarding stroke care and improve outcomes through patient-centered comparative effectiveness research. The primary outcomes identified and prioritized by stroke patients are "home time" (time spent alive and outside a hospital) and major adverse cardiovascular events. With inputs from stroke patients themselves, a series of comparative safety and effectiveness analyses will be performed across 3 prioritized therapeutic areas identified as important by stroke survivors: oral anticoagulants, statin therapy, and antidepressants. We obtained data from Get With the Guidelines-Stroke linked with Medicare claims and follow-up telephone interviews. Our combined retrospective and prospective research strategy allows the evaluation of the safety and effectiveness of various treatment options and patient-centered longitudinal outcomes. To ensure the rapid translation of findings into clinical practice, results will be disseminated to stroke survivors, caregivers, and health care providers through traditional and social media, including an online decision aid tool. PROSPER is a patient-centered outcome research study guided by patients, caregivers, and the broader health care community. By addressing knowledge gaps in treatment uncertainties through comparative effectiveness research, PROSPER has the potential to improve decision making in stroke care and patient outcomes reflecting individual patient preferences, needs, and values.

ATES: a geo-informatics decision aid tool for the integration of groundwater into land planning

Groundwater is the primary source of drinking water for small municipalities and individuals. However, groundwater can be polluted by almost any land use. Consequently, many governments have acquired groundwater information in the aim of protecting the resource. Nevertheless, the resulting data are often ill-fitted to planning needs. In a previous study, a method was developed to help planners interpret hydrogeological data. It combines land planning and hydrogeological data through multicriteria analysis, in order to obtain groundwater contamination risk maps. The method proved efficient and useful. However, it could not be easily implemented by land planners, who do not always have training with these types of data and geographical information system (GIS). This paper presents how the method was integrated into a web-based interface called Aménagement du Territoire et Eau Souterraine (ATES). ATES allows planners to view groundwater basic maps, evaluate the present contamination risk for groundwater, and analyse new planning scenarios. ATES also suggests mitigation measures and offers tools to discuss the possible solutions. The tool has been developed, tested and validated with land planners. To our knowledge, it is the first geo-informatics tool developed especially for planners that aims at facilitating the incorporation of groundwater into planning. Moreover, an innovative approach called MACBETH was used for data aggregation, a novelty in groundwater management and spatial data integration.

A fuzzy MCDM algorithm and practical decision aid tool to determine the best ROV design alternative

Purpose – Proposing a fuzzy multi-criteria decision making (MCDM) algorithm that is able to incorporate the heterogeneousness effect of DM group into the decision process, in order to determine the best remotely operated vehicle (ROV) design alternative to manufacture and developing a practical decision aid tool based on this algorithm. The paper aims to discuss these issues. Design/methodology/approach – An algorithm utilizes fuzzy AHP Buckley’s approach for modeling heterogeneousness of the DM group, fuzzy AHP Chang’s extent analysis to calculate the priority values of criteria and Chen’s fuzzy TOPSIS for ranking the alternatives and finally group working technique for initiation issues is developed. MATLAB is used to implement the algorithm and generate a decision aid tool. Real life application and sensitivity analysis is performed by the help of generated tool. Literature and background explanations are also provided. Findings – A MCDM algorithm that incorporates the heterogeneousness effect of the DM group into the decision process is introduced. Sensitivity analysis suggested the independence of the final result from DM group and criteria set. A practical decision aid tool is generated for ROV manufacturing companies. Practical implications – A computerized MCDM aid tool that incorporates heterogeneousness of the DM group into the decision process is generated. Tool let ROV manufacturing companies to evaluate ROV design alternatives with respect to qualitative and quantitative criteria and determine proper choice. Originality/value – Determination of the proper ROV design alternative to manufacture gap within the literature filled with an algorithm that provides more reliable results due to its incorporation the heterogeneousness of the DM group into the decision process characteristic. A practical decision aid tool is generated.

Transitioning to routine breast cancer risk assessment and management in primary care: what can we learn from cardiovascular disease?

To capitalise on advances in breast cancer prevention, all women would need to have their breast cancer risk formally assessed. With ~85% of Australians attending primary care clinics at least once a year, primary care is an opportune location for formal breast cancer risk assessment and management. This study assessed the current practice and needs of primary care clinicians regarding assessment and management of breast cancer risk. Two facilitated focus group discussions were held with 17 primary care clinicians (12 GPs and 5 practice nurses (PNs)) as part of a larger needs assessment. Primary care clinicians viewed assessment and management of cardiovascular risk as an intrinsic, expected part of their role, often triggered by practice software prompts and facilitated by use of an online tool. Conversely, assessment of breast cancer risk was not routine and was generally patient- (not clinician-) initiated, and risk management (apart from routine screening) was considered outside the primary care domain. Clinicians suggested that routine assessment and management of breast cancer risk might be achieved if it were widely endorsed as within the remit of primary care and supported by an online risk-assessment and decision aid tool that was integrated into primary care software. This study identified several key issues that would need to be addressed to facilitate the transition to routine assessment and management of breast cancer risk in primary care, based largely on the model used for cardiovascular disease.