Decision Aid Research Articles

Comparative Effects of Neurodynamic Slider and Tensioner Mobilization Techniques on Sympathetic Nervous System Function: A Randomized Controlled Trial.

Objective: To investigate the effect of slider and tensioner neurodynamic techniques (NDTs) on the sympathetic nervous system (SNS) activity, aiming to identify which technique more effectively modulates autonomic responses in asymptomatic individuals. Materials and Methods: In this double-blind controlled trial, a total of 90 healthy participants were randomly allocated into three groups: slider, tensioner, and control. Skin conductance (SC) was continuously monitored throughout the entire 20 min experiment, while body temperature and blood pressure were measured pre- and post-intervention. Results: The SC levels significantly increased in both the slider and tensioner groups compared to the control group during the intervention and end rest period on the left leg (slider vs. control: p < 0.001, d = 1.20; tensioner vs. control: p < 0.001, d = 1.64) and on the right leg (slider vs. control: p < 0.001, d = 1.47; tensioner vs. control: p < 0.001, d = 0.73). There were no significant differences between the two NDTs on the left (p < 0.13, d = 0.89) and right legs (p < 1.00, d = 0.36). The body temperature of the slider group showed a significant increase compared to both the control group (p < 0.001, d = 0.95) and the tensioner group (p < 0.001, d = 1.48). There were no significant differences between the groups in systolic (p = 0.95) or diastolic blood pressure (p = 0.06). There were no side-specific effects on SNS activity between the left and right legs (p < 0.019) during all intervention phases. Conclusions: Significant sympathoexcitatory responses were elicited by both slider and tensioner NDTs in asymptomatic participants, demonstrating their efficacy in modulating the SNS. The differences between the two techniques were not statistically significant; however, the tensioner NDT showed a slightly more pronounced effect, suggesting that the tensioner NDT can be considered superior in terms of overall SNS effect. These findings indicate that both techniques may have the potential to enhance autonomic regulation in clinical practice; however, the tensioner NDT may be more effective. The consistent responses across participants highlight the systemic benefits of NDTs, providing a foundation for further research into their application in symptomatic populations. This study contributes to evidence-based practice by providing baseline data that support the development of theoretical frameworks and aid in clinical decision-making.

Anecdotes impact medical decisions even when presented with statistical information or decision aids

People are inundated with popular press reports about medical research concerning what is healthy, get advice from doctors, and hear personal anecdotes. How do people integrate conflicting anecdotal and statistical information when making medical decisions? In four experiments (N = 4126), we tested how people use conflicting information to judge the efficacy of artificial and real medical treatments. Participants read an anecdote from someone in a clinical trial, or who had undergone a medical treatment previously, for whom the medical treatment was ineffective. We found that reading anecdotes for either artificial or real medical treatments shifted participants’ beliefs about the efficacy of a medical treatment. We observed this result even when the anecdote was uninformative, was paired with an icon array, or when participants were provided with thorough medical decision aids about reproductive health procedures. Our findings highlight the pervasive effect of anecdotes on medical decision making.

Informing creation of the FEEDS Toolkit to support parent-delivered interventions for eating, drinking and swallowing difficulties in young children with neurodisability: intervention use by neurodevelopmental diagnosis and healthcare professional role

BackgroundThe FEEDS (Focus on Early Eating, Drinking and Swallowing) study focused on interventions used to improve feeding for children with neurodisability and eating, drinking and swallowing difficulties (EDSD), and the...

Risks and Legal Governance of Generative Artificial Intelligence

Generative Artificial Intelligence (AI) represents a significant advancement in the field of artificial intelligence, characterized by its ability to autonomously generate original content by learning from existing data. Unlike traditional decision-based AI, which primarily aids in decision-making by analyzing data, generative AI can create new texts, images, music, and more, showcasing its immense potential across various domains. However, this technology also presents substantial risks, including data security threats, privacy violations, algorithmic biases, and the dissemination of false information. Addressing these challenges requires a multi-faceted approach involving technical measures, ethical considerations, and robust legal frameworks. This paper explores the evolution and capabilities of generative AI, outlines the associated risks, and discusses the regulatory and legal mechanisms needed to mitigate these risks. By emphasizing transparency, accountability, and ethical responsibility, we aim to ensure that generative AI contributes positively to society while safeguarding against its potential harms.

Evaluation of a Digital Decision Aid for Knee Replacement Surgery.

We studied whether an individualized digital decision aid can improve decision-making quality for or against knee arthroplasty. An app-based decision aid (EKIT tool) was developed and studied in a stepped-wedge, cluster-randomized trial. Consecutive patients with knee osteoarthritis who were candidates for knee replacement were included in 10 centers in Germany. All subjects were asked via app on a tablet about their symptoms, prior treatments, and preferences and goals for treatment. For the subjects in the intervention group, the EKIT tool was used in the doctor-patient discussion to visualize the individual disease burden and degree of fulfillment of the indication criteria, and structured information on knee arthroplasty was provided. In the control group, the discussion was conducted without the EKIT tool in accordance with the local standard in each participating center. The primary endpoint was the quality of the patient's decision on the basis of the discussion of indications, as measured with the Hip and Knee Quality Decision Instrument (HK-DQI). (Registration number: ClinicalTrials.gov:NCT04837053). 1092 patients were included, and data from 1055 patients were analyzed (616 in the intervention group and 439 in the control group). Good decision quality, as rated by the HKDQI, was achieved by 86.0% of patients in the intervention group and 67.4% of patients in the control group (relative risk, 1.24; 95 % confidence interval, [1.15; 1.33]). A digital decision aid significantly improved the quality of decision-making for or against knee replacement surgery. The widespread use of this instrument may have an even larger effect, as this trial was conducted mainly in hospitals with high case numbers.

Accurate diagnosis of acute appendicitis in the emergency department: an artificial intelligence-based approach.

The diagnosis of abdominal pain in emergency departments is challenging, and appendicitis is a common concern. Atypical symptoms often delay diagnosis. Although the Alvarado score aids in decision-making, its low specificity can lead to unnecessary surgeries. By leveraging machine learning, we aim to enhance diagnostic accuracy by predicting appendicitis and distinguishing it from other causes of abdominal pain in the emergency department. Data were collected from 534 patients who presented with acute abdominal pain. Patient characteristics, laboratory results, and causes of pain were recorded. Machine learning algorithms (support vector classifier, random forest classifier, gradient boosting classifier, and Gaussian naive Bayes) were used to predict the cause of pain. Model calibration was assessed using the Brier score. The mean age was 46.89 (20.3) years, with an almost equal sex distribution (49% male, 51% female). Cholecystitis was the most prevalent outcome (37.07%), followed by appendicitis (25.84%). The Gaussian naive Bayes model exhibited superior performance in terms of accuracy (95.03% 95% CI 90.44-97.83%), sensitivity (87.18% 95% CI 72.57-95.70%), and specificity (97.54% 95% CI 92.98-99.49%), while the random forest model showed a sensitivity of 79.49%, specificity of 96.72%, and accuracy of 92.55%. The gradient boosting algorithm achieved a sensitivity, specificity, and accuracy of 89.74%, 95.90%, and 94.41%, respectively. The support vector classifier demonstrated a sensitivity of 89.74%, specificity of 92.62%, and accuracy of 91.93%. The use of modern machine learning methods aids in the accurate diagnosis of appendicitis.

Shared decision-making in adolescent healthcare: a literature review of ethical considerations.

Adolescence is a period of growing independence and maturity, within the period oflegal minority. As parents or guardians are socially and legally responsible for adolescents' medical decisions, shared decision-making in adolescent healthcare could be ethically challenging. This review aims to identify and map the ethical tensions in shared decision-making in adolescent healthcare. We systematically searched the literature following the PRISMA guidelines to identify relevant articles, which were analyzed using the review of reasons methodology Strech and Sofaer (J Med Ethics 38(2):121-6, 2012). We included 38 articles which involved adolescents, healthcare professionalsand parents as being the main stakeholders. Shared decision-making was influenced not only by individual stakeholders' characteristics, but by tensions between stakeholder dyads. Most studiessupported the involvement of the adolescent in decision-making, depending on their life experience, decision-making capacity and clinical condition. Shared decision-making in adolescent health is receiving increasing attention. However, questions remain on what this concept entails, the roles and involvement of stakeholders and its practical implementation. • Although adolescents wish to be involved in health decisions, shared decision-makingin adolescents is underexplored • Adolescentshared decision-making is different from pediatric and adult shared decision-making, and is ethically complex due to the adolescent's growing autonomy What is new: • Adolescent SDM involves three-way interactions between the adolescent, healthcare professionaland parents • In adolescent shared decision-making, involving or excluding a stakeholder and sharing or withholding information are ethically value-laden steps • Research is needed to further understand the roles of adolescents' personal value systems, extended or reconstituted families and decision aids in shared decision-making.

Exploring Cultural Capital in the College and Financial Aid Decision Process for the GEAR UP Federal Grant Program

This qualitative study investigates the relationship between cultural capital and financial aid in college decision-making through use of an updated model based on Perna’s (2006) cultural capital model, focusing on decision-making influences within the habitus layer. Researchers conducted focus groups and interviews, yielding (N=15) GEAR UP scholarship recipient participants. Findings from this study evidence the importance of personal and social networks, individual intuition, and trust in college decision-making, with these components often cited more frequently than traditionally cited factors beyond the habitus layer. This study serves as a model for investigating student decision-making, highlighting the importance of uplifting student voice, and as an initial investigation into the ways in which college-going students’ decision-making practices are changing.

Development, Evaluation, and User Testing of a Decision-Making Toolkit to Promote Organizations to Implement Universal Tumor Screening for Lynch Syndrome

Introduction: The Implementing Universal Lynch Syndrome Screening (IMPULSS) study explained institutional variation in universal tumor screening (UTS) with the goal of identifying ways to aid organizational decision-makers in implementing and optimizing Lynch syndrome UTS programs. Methods: After applying the Consolidated Framework for Implementation Research (CFIR 1.0) to analyze interviews with 66 stakeholders across 9 healthcare systems to develop a toolkit for implementation, we adapted the International Patient Decision Aid Standards (IPDAS) to assess toolkit potential to aid decision-making consistent with organizational values. We then conducted user testing with two experienced and four non-experienced implementers of UTS to improve the content and functionality of the toolkit and assess its acceptability and appropriateness. Results: Toolkit components were organized to address findings related to CFIR 1.0 constructs of evidence strength and quality, relative advantage, cost, engaging, planning, executing, and reflecting and evaluating. A home page was added to direct users to different sections based on whether they are deciding to implement UTS, planning for implementation, improving an existing UTS program, or considering a different approach to identify patients with Lynch syndrome. Upon initial evaluation, 31 of 64 IPDAS criteria were met by the original toolkit. All users rated the toolkit as acceptable and appropriate for assisting organizational decision-making and identified multiple areas for improvement. Numerous iterative changes were made to the toolkit, resulting in meeting 17 of the previously unmet IPDAS criteria. Conclusion: We demonstrate the rigorous development of a toolkit guided by the CFIR and show how user testing helped improve the toolkit to ensure it is acceptable, appropriate, and meets most IPDAS criteria relevant to organizational values-based decision-making.

Implantable cardioverter defibrillator explantation upon patient request: Clinical and ethical considerations.

Implantable Cardioverter Defibrillator (ICD) implantation has significantly modified the natural history of patients at high risk of sudden cardiac death (SCD) in various types of heart diseases. However there is a high rate of psychological distress and reduced quality of life in patients with an ICD, more evident in younger individuals. The ICD removal upon patient request is a very rare event and causes many clinical and ethical issues. The article discusses the case of a young patient affected by hypertrophic obstructive cardiomyopathy, who underwent implantable cardioverter defibrillator (ICD) implantation as a primary prevention of sudden cardiac death (SCD). Two years after the implantation, the patient repeatedly requested removal of the ICD due to of a significant and untreatable psychological device intolerance. Intervention became possible only after extensive psychological evaluation, which excluded specific pathology, and the ratification of Italian law 219/2017 on informed consent and advance directives, which guarantees the patient's independent decisions on current and future medical treatment. The explantation was performed 7 years after the implant. The patient is alive and in good health. The paper debates the issues related to establishing a patient-physician relationship based on respect for the patient's autonomy and experience of illness, in reference to principles such as beneficence and non-maleficence, and the conflicts that sometimes arise between them. If a paternalistic approach in the patient-physician relationship evolves into a patient-centered model, it is more certain that the patient's choice is realistically known and shared, and that it is consistent with the patient's values and life goals. The shared decision making (SDM) process and the use of pathology-specific decision aids are able to transform the informed consent tool, usually related to medical-legal issues, into an aid for true partnership between the patient and the medical care team.

A shared decision-making intervention between health care professionals and individuals undergoing Pulmonary Rehabilitation: An iterative development process with qualitative methods.

Pulmonary Rehabilitation (PR) services typically offer programmes to support individuals living with COPD make rehabilitation choices that best meet their needs, however, uptake remains low. Shared Decision-Making (SDM; e.g., Patient Decision Aids (PtDA)) interventions increase informed and values-based decision-making between individuals and healthcare professionals (HCPs). We aimed to develop an intervention to facilitate PR SDM which was acceptable to individuals living with COPD and PR HCPs. An iterative development process involving qualitative methods was adopted. Broad overarching frameworks included: complex intervention development framework, the multiple stakeholder decision making support model, and the Ottawa Decision Support Framework. Development included: assembling a steering group, outlining the scope for the PtDA, collating data to inform the PtDA design, prototype development, alpha testing with individuals with COPD (n = 4) and PR HCPs (n = 8), PtDA finalisation, and design and development of supporting components. This took nine months. The PtDA was revised six times before providing an acceptable, comprehensible, and usable format for all stakeholders. Supporting components (decision coaching training and a consultation prompt) were necessary to upskill PR HCPs in SDM and implement the intervention into the PR pathway. We have developed a three-component SDM intervention (a PtDA, decision coaching training for PR healthcare professionals, and a consultation prompt) to support individuals living with COPD make informed and values-based decision about PR together with their PR healthcare professional. Clear implementation strategies are outlined which should support its integration into the PR pathway.

A post-abortion contraception text-and-call service to support patients to access effective contraception after telemedicine abortion

BackgroundMost abortions in Scotland are conducted at home before 12 weeks’ gestation using telemedicine. The volume of information given at a pre-abortion consultation may feel overwhelming and contraception may not...

A Formative Usability Study Evaluating a Decision Aid for Caregivers of Incapacitated Patients

A Formative Usability Study Evaluating a Decision Aid for Caregivers of Incapacitated Patients

Evaluating the Influence of Incorrect Reassurances on Trust in Imperfect Automated Decision Aid

Prior research on trust in automation has primarily focused on instances where decision aids form predictions based on the same raw input information as humans. This study extends the paradigms into the human-processed input framework, where machine predictions are based on human-processed data, instead of the raw input. The human-processed input framework introduces a unique error pattern, “incorrect reassurance,” where faulty automation prediction erroneously validates users’ initial errors. This study examined the impact of “incorrect reassurance” on human trust in automation in the human-processed input framework. Thirty-five participants completed a Mental Rotation Task (MRT), using an imperfect automated decision aid. Results show that incorrect reassurance patterns led to larger trust decrement, lower final performance, and quicker final reaction time compared to other performance patterns. The findings emphasize the importance of understanding trust in automation in the context of the human-processed input framework.

Testicular Germ Cell Tumours - features and prospects of the novel tumour marker microRNA-371a-3p (M371 test): a narrative review

Testicular germ cell tumours (GCTs) represent a paradigm for the usefulness of serum tumour markers in clinical management of diseases. However, the tumour markers currently in use, beta human chorionic gonadotropin (bHCG), alpha fetoprotein (AFP) and lactate dehydrogenase (LDH) are expressed in less than 50% of GCT cases. In 2011, microRNA-371a-3p (currently named M371) was suggested as a novel marker for the first time. Chemically, microRNAS represent small RNA molecules consisting of 18-24 base pairs. Physiologically, these microRNAs play a prominent role in the epigenetic control of protein biosynthesis. M371 can be measured in serum with PCR-techniques.There is high level evidence for a 90% sensitivity and >90% specificity for GCTs of the marker M371. That high diagnostic accuracy is true for both seminoma and nonseminoma but not for the histologic subgroup of teratoma. Testicular tumours of non-germ cell origin and malignant neoplasms of other organs do not express the marker. M371 involves a very short half-life of <24 hours.The test does likely involve the prospects of providing substantial aid in clinical decision-making with respect to instances where improvement of GCT management is still required. In particular, the following clinical scenarios will probably benefit from the employment of the M371 test: (1) diagnostic work-up of incidentally detected small testicular masses with decision-making in regard to testis sparing surgery or full orchiectomy (2) simplifying the follow-up of GCT patients with sparing of imaging procedures in a number of cases; (3) diagnostic evaluation of retroperitoneal lymphadenopathy upon clinical staging; (4) diagnostic evaluation of false-positive elevations of classical tumour markers (AFP, bHCG); (5) rapid appraisal of therapeutic success or failure by means of the very short half-life of M371; (6) diagnostic evaluation of postchemotherapy residual masses particularly those in seminoma patients.The discovery and development of the novel tumour marker M371 probably represents a milestone progress in the history of the clinical management of testicular GCTs.

Journey through the Decades: The Evolution in Treatment and Shared Decision Making for Locally Advanced Rectal Cancer.

The management of locally advanced rectal cancer has undergone significant transformations over the decades and optimal treatment approaches continue to evolve. There have been numerous advances in surgery, chemotherapy, and radiation therapy from the first description of the abdominoperineal resection in 1908, timing of chemotherapy and radiation therapy in the late 20th and early 21st century, and most recently, the introduction of organ preservation or nonoperative management in 2004. Alongside these advancements, the concept of shared decision making in medicine has evolved, prompting a focus on patient-centered care. This evolution in practice has been fueled by a growing recognition of the importance of patient autonomy and the alignment of treatment options with patients' values and preferences. With the growing number of possible treatment options, variability in patient counseling exists, highlighting the need for a standardized approach to shared decision making in locally advanced rectal cancer. This narrative review will describe the evolution of treatment options of locally advanced rectal cancer as well as the concept of shared decision making and decision aids, and will introduce a decision aid for patients with locally advanced rectal cancer who have achieved a complete clinical response and are eligible for watch and wait.

Assessment, quantification and propagation of uncertainty in seismic life-cycle cost analysis

Seismic life-cycle cost analysis (SLCCA) is a comprehensive tool to estimate the expected lifetime economic losses due to seismic events in terms of present-day value and aids in lifetime investment planning and design decision-making. The state-of-the-art framework for SLCCA incorporates three essential components: seismic hazard analysis, seismic fragility curves and damage cost estimates. Due to different sources of uncertainty prevailing in each component, the SLCC estimates may vary substantially. However, most of the existing literature primarily focuses on the expected value of the SLCC, and uncertainties stemming from multiple sources are unaccounted for. To address this drawback, this study proposes a comprehensive approach to quantify and propagate multiple uncertainties and offers a visualization of the shape and nature of SLCC distribution. Furthermore, the application of the framework is demonstrated using a case study example of the reinforced concrete (RC) frame building. Results reveal that the SLCC distribution is multimodal due to multiple uncertainty sources and the expected SLCC values also shift significantly compared to the state-of-the-art approaches, highlighting the criticality of the uncertainty propagation. Lastly, a novel framework is proposed to rank uncertainty sources based on their relative influence that will aid stakeholders in informed decision-making under uncertainty.

Decision support improves information integration and criterion placement in a multi-cue signal-identification task

Identifying contacts in a military context can require operators to integrate multiple cues and to adjust response criteria to event base rates. The current experiment tested whether support from a decision aid would improve these processes. Participants performed a signal identification task that required them to integrate cues displayed as visual scale readings. In a static condition, participants saw a single set of readings each trial. In dynamic conditions, readings were updated over time. Base rates of signal categories were unequal, requiring participants to adopt biased response criteria to maximise response accuracy. Participants worked with or without an aid that combined cues and base rate information in an ideal manner. Support from the aid pushed participants’ response criteria towards optimal and improved integration of dynamic cues. Decision aids may be especially useful when task demands require biased response criteria and when cues are sampled over time.

On extension of 2-copulas for information fusion

Copulas are very applicable tools from a statistical point of view. Their capability to model joint distribution makes them a useful tool for statisticians. Yet, they have been applied rarely in multi-criteria decision aiding (MCDA). This paper introduces a novel family of aggregation functions based on 2-copulas for MCDA. More specifically, the proposed copula-based method is applied to construct the popular Choquet integral (CI) and attitudinal Choquet integral (ACI). The forms obtained are utilized to develop a machine learning model to explain choices in the human decision-making situations. Exemplary pairwise preferences are provided as training information for the proposed model. Our approach effectively represents the dependencies between criteria under uncertainty. Experimental results on multiple real-world datasets demonstrate that our approach significantly outperforms popular MCDA methods, such as RBF-kernel, Tchebycheff, etc.

Feasibility and acceptability of the ShareD dEciSIon making for patients with kidney failuRE to improve end-of-life care intervention: A pilot multicentre randomised controlled trial

BackgroundKidney failure is associated with a high disease burden and high mortality rates. National and international guidelines recommend health professionals involve patients with kidney failure in making decisions about end-of-life care, but implementation of these conversations within kidney services varies. We developed the DESIRE (ShareD dEciSIon-making for patients with kidney failuRE to improve end-of-life care) intervention from our studies investigating multiple decision maker needs and experiences of end-of-life care in kidney services. The DESIRE intervention's three components are a training programme for health professionals, a patient decision aid, and a kidney service consultation held to facilitate shared decision-making conversations about planning end-of-life care. ObjectivesTo assess the feasibility and acceptability of integrating the DESIRE intervention within kidney services. DesignA pilot study using a multicentre randomised controlled design. SettingFour Danish nephrology departments. ParticipantsPatients with kidney failure who were 75 years of age or above, their relatives, and health professionals. MethodsPatients were randomised to either the intervention or usual care. Feasibility data regarding delivering the intervention, the trial design, and outcome measures were collected through questionnaires and audio recordings at four points in time: before, during, post, and 3 months after the intervention. Acceptability data were collected through semi-structured interviews with patients and relatives, as well as a focus group with health professionals post the intervention. ResultsTwenty-seven patients out of the 32 planned were randomised either to the intervention (n= 14) or usual care (n= 13). In addition, four relatives and 12 health professionals participated. Follow-up was completed by 81 % (n= 22) of patient participants. We found that both feasibility and acceptability data suggested health professionals improved their decision support and shared decision-making skills via the training. Patient and relative participants experienced the intervention as supporting a shared decision-making process; from audio recordings, we showed health professionals were able to support proactively decision-making about end-of-life care within these consultations. All stakeholders perceived the intervention to be effective in promoting shared decision-making and relevant for supporting end-of-life care planning. ConclusionsParticipant feedback indicated that the DESIRE intervention can be integrated into practice to support patients, relatives, and health professionals in planning end-of-life care alongside the management of worsening kidney failure. Minimising exhaustion and enhancing engagement with the intervention should be a focus for subsequent refinement of the intervention. RegistrationThe study has been registered at ClinicalTrials.gov with the identifier: NCT05842772. Date of first recruitment: March 20, 2023.