Decision-making Experiences Research Articles

We Have to Really Decide: The Childbearing Decisions of Women With Congenital Heart Disease.

Medical management and surgical improvement techniques permit persons with congenital heart conditions to live longer. Adults with congenital heart disease (CHD) have more childbearing options than previously available to them. However, there is an increased childbearing risk associated with certain types of CHD. Minimal investigation has been given to the childbearing decision-making experiences and adaptation of women with CHD. The aim of this study was to gain insight into the childbearing decision-making and adaptation experiences of women with CHD. Using a narrative inquiry approach, 17 adult women with CHD of any severity, of childbearing age, who had, within the last 5 years, made a decision regarding childbearing, were interviewed. In this study, we applied the key components of the Roy Adaptation Model to understand childbearing decision-making experiences and their adaptation. Data were analyzed using thematic analysis. Data analysis revealed 5 stages of childbearing decision making: (1) prologue: stimulus to consider childbearing; (2) exploring childbearing options; (3) considering childbearing options; (4) choosing to bear or not to bear a child; and (5) epilogue: adapting to the childbearing decision. Adaptation occurred in the areas of self-concept (ie, emotional adaptation), role function (ie, relational adaptation), and interdependence (ie, interactional adaptation). Childbearing decision making is a complex personal decision that is carefully and deliberately made. Women with CHD long for children and seek childbearing information from various resources and may experience grief regarding the inability to bear children. A greater understanding of childbearing decision making can be useful in addressing women's childbearing emotions and assist with adaptation to childbearing needs.

'Eating is like experiencing a gamble': A qualitative study exploring the dietary decision-making process in adults with inflammatory bowel disease.

For adults with inflammatory bowel disease (IBD), they experience many challenges in dietary decision-making. Thus, this study examined the perspective and experiences of adults with IBD in dietary decision-making. This study aimed to explore the perception and consideration of people with IBD in their daily dietary decisions through monitoring, interpretation and action during the decision-making process. A qualitative study of individuals affected by IBD was conducted through semistructured interviews. Twenty patients were recruited from four tertiary hospitals in Nanjing, China, and each participant completed a semistructured interview. The majority of participants reported on the process and experience of dietary decision-making. Key themes were categorised into three stages: (1) assessing needs, preferences and food cues (monitor); (2) moving from experience to expertise (interpret) and (3) balancing expectations amidst limitations (act). The majority of participants reported that their decisions were shaped by assessing current disease status and food cues. Those interviewed with IBD were willing to make tradeoffs for bowel stability, but their decisions were also influenced by past dietary experiences and traditional Chinese beliefs. The lack of awareness of dietary guidelines was a significant barrier to healthy eating decisions. Positive or negative feelings accompanied dietary decisions. Although most people with IBD change their diet after diagnosis, the changes made are often inconsistent with existing dietary recommendations. Several factors can influence the dietary decision-making process. This study will help assess the experiences of people with IBD in dietary decision-making to encourage the formation of targeted dietary health and well-being interventions. Knowledge of nutrition and diet should be provided in education and training programmes for IBD management. The first three authors of this paper were the lead researchers in this study's design. These authors were mentored by patient researchers who also contributed to the manuscript, and the research process was co-lead and directed by other patient participants and consultants. The results of this paper were directly obtained from patient participants.

Genetic testing decision-making experiences within families of colorectal cancer patients: A qualitative study

PurposeGenetic testing is the gold standard for the diagnosis of hereditary colorectal cancer syndromes but is currently inadequate and nonideal. The decision-making processes regarding genetic testing are even less well known. The present study aims to explore the decision-making experience of genetic testing for colorectal cancer patients and their family members. MethodA descriptive qualitative study was employed. Data were collected using individual semi-structured interviews with 5 colorectal cancer patients and 20 family members from November 2020 to April 2021. Interviews were transcribed and analysed using inductive content analysis. ResultsFour categories were identified: 1) the source of information for genetic testing, 2) the differentiated attitudes towards genetic testing, 3) genetic testing decisional needs, and 4) the factors influencing genetic testing decision-making. Colorectal cancer patients and their families engaged in two distinct pathways to genetic testing decisions: direct decision-making and indirect decision-making. Throughout these processes, due to the limited source of information, they had information needs that were met and facilitated genetic testing decision-making. ConclusionsColorectal cancer patients and family members need knowledge related to genetic testing, but they have limited access to information, which prevents them from making informed decisions. Providing decision aid interventions and informational support are significant steps towards addressing the support needs of this population.

Attitudes and Perceptions on Advance Care Planning Among Chinese-Speaking Older Australians.

Current literature indicates low uptake of advance care planning (ACP) among the Chinese-speaking community in Australia. To increase the uptake of ACP among the Chinese-speaking community, a better understanding of their attitudes and perceptions on end-of-life (EOL) matters, and ACP is required. This study aimed to identify significant events and social and cultural factors that influence participants' values and characterize the attitudes and perceptions towards ACP among older Chinese-speaking Australians. A qualitative study explored participants' experiences through semi-structured one-to-one interviews. The interviews were conducted in Mandarin, Cantonese or English, then translated and transcribed into English. The transcripts were coded and analysed thematically. Twenty participants were recruited (14 female, six male). Participants typically reported a preference to make health-related decisions autonomously. Their perspectives were grounded in past experiences of illnesses and EOL decision-making of loved ones, personal values, and perceived needs. Family dynamics and intimacy of relationships appeared to influence the role and responsibility of family members in EOL decision-making and ACP. Most participants perceived the need to engage in ACP only when encountering significant health changes or higher care needs. Healthcare professionals should initiate ACP discussion using culturally appropriate communication with consideration of personal values, past experiences and family dynamics. Efforts should be invested in raising public awareness of ACP within the Chinese-Australian community.

Investigating tensions experienced by decision-makers during a business rescue event

Background: Practice has shown that decision-makers experience various tensions during a business rescue event, which adds to the complexity of their decision-making. Even though business rescue has been operational for more than a decade, decision-makers require training and development beyond the scope of the legal and finance realms to cope with the related tensions.Aim: This study endeavoured to report on the tensions experienced by decision-makers, classify them into puzzles, dilemmas, trade-offs and/or paradoxes, and to identify practical responses to the most commonly experienced tensions.Setting: The study was conducted in South Africa and made use of decision-makers in the field of business rescue.Methods: An interpretative phenomenological analysis was completed using 12 exceptionally experienced decision-makers. A multi-method approach was employed using in-depth interviews and follow-up questionnaires, validated with the literature after the completion of a pre-test.Results: Findings reported 16 major tensions, consisting of one puzzle, two dilemmas, four trade-offs and nine paradoxes with appropriate responses used in practice by participants.Conclusion: Significant findings include the differentiation in response to tensions based on the level of sophistication of stakeholders involved, the implementation of a team approach to decision-making and the use of empathy to decrease tension.Contribution: An insider’s perspective is provided into tensions experienced during a business rescue event, which may assist in the training of novice decision-makers. Participants used anecdotal evidence to verbalise their approaches and/or strategies to managing tension, which can be dissected and used to collate shared practice among decision-makers.

The role of nurses in shared decision-making about caring for older adults with chronic disease: A qualitative descriptive study

Purpose: The objective of this study is to explore nurses’ perception of their roles in shared decision-making about caring for older adults with chronic disease. Methods: This study was a qualitative descriptive study. Ten nurses participated in the focus group interviews. The collected data were analyzed using qualitative content analysis to explore nurses’ roles in shared decision-making about care for older adults with chronic disease. Results: The shared decision-making experiences about caring for older adults with chronic disease of nurses yielded four main themes and ten categories including ‘facilitating involvement in decision-making’, ‘providing information for decision-making’, ‘respecting patient values and preferences’, ‘evaluating the outcome of decision-making’. Conclusion: This study explored the roles of nurses in shared decision-making about caring of older adults with chronic disease. Nurses can enhance the shared decision-making process by identifying the decision needs and by facilitating decision-making.

Can the courts be viewed as an appropriate vehicle to settle clinical unease?

This paper is an exploration of the state of ‘clinical unease’ experienced by clinicians in contexts where professional judgement—grounded in clinical knowledge, critical reflection and a sound grasp of the...

“My body, my choice”: A qualitative study of women’s mastectomy with flat closure experiences

This qualitative study aimed to describe and explore the pre and post-mastectomy experiences of women choosing flat closure after a breast cancer diagnosis. Aesthetic flat closure creates a flat contoured chest wall after a mastectomy. There is limited research on women’s flat closure experiences. To fill this gap, we interviewed 19 women (Mage = 53, range 31–72) with breast cancer who underwent a bilateral mastectomy with flat closure, examining decision-making, mirror-viewing, and flat closure experiences. Using a hermeneutic phenomenological design, we generated seven themes. Broadly, women choosing flat closure experienced pressure from their clinicians to undergo breast reconstruction. We found flat closure information to be consistently lacking. Mirror-viewing experiences of women obtaining suboptimal flat closure outcomes led to shattered expectations, mirror avoidance, psychological distress, and body image disturbances. Women negotiated their new reality by discovering ways to feel comfortable with their flat bodies. Regardless of surgical outcome, decision satisfaction was high. These findings illustrate the importance of bodily autonomy and supportive healthcare environments for women making flat closure decisions. Providing comprehensive information on all surgical options and addressing post-operative expectations can improve women’s decision-making and mirror-viewing experiences and assist women in adapting to their new body image.

Parents' Decision-making Experience in Choosing the MMR Vaccine in Banten, Indonesia

Research has extensively studied parental vaccination decision-making drivers and barriers. The most powerful predictors of vaccination actions include the understanding of the risks posed by the disease; and the side effects of vaccination; vaccine beliefs and attitudes; and their effectiveness and safety concerns. Thus, this study aimed to explore the parents decision-making experience in choosing MMR vaccine in Banten, Indonesia. In qualitative study, a purposeful sampling process was used to identify parents with a variety of expected MMR decisions: (1) accept MMR on time, (2) accept MMR late, (3) receive one or more individuals, (4) obtain no MMR or individuals. A qualitative quality analysis was used to interpret the transcribed text. A total of 25 participants from 5 different FGDs were included in this study. This qualitative interview resulted in 4 themes, namely: healthy life, own health perceptions, disease history, perceived severity, and susceptibility of vaccine-preventable illnesses. Research on the MMR vaccination should move a step forward and include studies looking at similarities and differences in the factors predicting parents’ intention to follow MMR vaccination recommendations by comparing parents of very young children, being the primary target group of MMR vaccination campaigns and interventions, with parents of adolescent children.
 Keywords: decision process, MMR vaccine, qualitative study

Experiences of Oncofertility Decision-Making and Care in a National Sample of Adolescent and Young Adult Cancer Patients and Parents.

Purpose: Cancer and its treatments are known to compromise fertility in adolescents and young adults (AYAs). The emotional burden of possible infertility is reduced in those who receive supportive oncofertility care. In legal minors, provision of health care must consider the legal context and desire that AYAs have for autonomous decision-making, together with their competence to make health decisions. This has important implications for how oncofertility discussions may, or may not, involve parents. The aim of this study was to explore oncofertility decision-making and care experiences in a national Australian sample of AYA cancer patients and their parents. Methods: AYAs aged 15-25 years and parents were recruited from 17 cancer care sites and CanTeen Australia as part of a national AYA cancer care study. The cross-sectional survey included open-ended questions regarding oncofertility care experiences. We used reflexive thematic analysis to identify themes. Results: Data were available for 99 AYAs and 111 parents. Four themes were identified: emotional care needs; parent-AYA dynamics including AYA autonomy and agency; decision-making considerations including values and practicalities; and reflections on oncofertility care and follow-up. Both AYAs and parents placed importance on AYA autonomy in fertility decision-making, but many AYAs appreciated the role of parents in providing support and guidance throughout the process. Conclusion: Health care professionals are encouraged to autonomously engage AYAs around fertility decision-making, while concurrently offering opportunities that promote parental support. Better psychological support and follow-up oncofertility care are also needed.

Book Recommender System Using Matrix Factorization with Alternating Least Square Method

In this digital age, we are faced with countless choices of books. Finding books that match our interests and desires becomes a complex challenge. However, the existence of a book recommender system is useful to help provide the best decision-making experience that users can have. This research develops a book recommender system using Collaborative Filtering (CF) Matrix Factorization with Alternating Least Squares method which is compared with Singular Value Decomposition method to see an accurate recommender system. This research uses datasets from Goodreads in the form of book data and rating data. This research uses several evaluation metrics, namely RMSE and MAE for regression metrics and F1-Score and Precision for classification metrics. Based on the research that has been done, SVD gets a better accuracy value with an RMSE value of around 0.86822, for MAE values around 0.6903, for F1-Score values around 0.827923 and for Precision values around 0.568347. Meanwhile, the ALS algorithm gets an RMSE value of around 1.09320, for MAE value of around 0.86479, for F1-Score value of around 0.000304 and for Precision value of around 0.000596.

Adolescents' and Parents' Perspectives on a Novel Decision-Making Process for Return of Results in Genomic Research.

To understand whether they found a two-step decision process helpful and why, adolescent-parent dyads participating in a study investigating return of genomic testing results were asked about their decision-making experience. Responses were qualitatively coded and analyzed using thematic analysis. Adolescents and parents found both joint and independent decision-making stages helpful. Regarding independent decision-making, adolescents appreciated exercising independence, while parents valued both adolescent and parental independence. Joint decision-making allowed each to hear the other's viewpoints. Some found joint decision-making irrelevant but recognized it might help others. Overall, adolescents and parents had similar reasons for finding the two-step decision-making process helpful. Our findings support using such a process for engaging parents and adolescents in challenging research and clinical decisions.

Theory-based cognitive–narrative intervention versus didactic education for promoting prompt care-seeking for acute myocardial infarction: A multisite mixed-methods randomized controlled trial

BackgroundProlonged delays by patients in making care-seeking decisions remain a significant obstacle to the effective management of acute myocardial infarction. ObjectivesThis study aimed to compare the effects of a theory-based cognitive–narrative intervention with those of didactic education over a 24-month period on the participants' attitudes, beliefs, and knowledge regarding acute myocardial infarction, prehospital delay time, and the use of an ambulance. We also explored participants' engagement in the intervention. DesignThis study adopted a sequential mixed-methods design comprising a multisite randomized controlled trial and a qualitative study. MethodsCommunity-dwelling adult patients with a prior history of acute myocardial infarction in the past year were recruited from four hospitals in Hong Kong. They were randomly assigned to an 8-week theory-based cognitive–narrative intervention that involved a vivid experience of complex decision-making or didactic education. The Acute Coronary Syndrome Response Index questionnaire was administered at baseline (T0) and at 3- (T1), 12- (T2), and 24-month (T3) follow-up time points. Prehospital delay time and the use of an ambulance were evaluated for those participants who had recurrent acute myocardial infarction attacks during the study period. ResultsA total of 608 participants were randomly assigned to the theory-based cognitive–narrative intervention group (n = 304) or the didactic education group (n = 304). The intervention group reported greater improvements than the control group in their attitudes (β = −1.053, p = 0.002) and beliefs (β = −0.686, p = 0.041) regarding acute myocardial infarction and care-seeking at T1. These effects were sustained at T2 [attitudes (β = −0.797, p = 0.018); beliefs (β = −0.692, p = 0.047)] and T3 [attitudes (β = −0.717, p = 0.024); beliefs (β = −0.701, p = 0.032)]. Sixty-three participants experienced another acute myocardial infarction event by T2. The median delay times for the intervention and control groups were 3.13 h (interquartile range (IQR: 1.15–6.48)) and 4.82 h (IQR: 2.23–9.02), respectively. The prehospital delay time was significantly reduced in the intervention group compared with the control group (β = −0.07, p = 0.011). The qualitative findings echoed the quantitative findings, as participants indicated that the intervention helped them to understand the variable nature of the disease presentation, which enabled them to recognize the symptoms more readily. ConclusionThe novel cognitive–narrative intervention used in this study effectively improved the participants' attitudes and beliefs regarding acute myocardial infarction and reduced the prehospital delay time. Trial registrationThis study was registered with the International Clinical Trials Registry Platform of the World Health Organization (ChiCTR-IIC-17010576) on February 2, 2017; the first participant was recruited on January 11, 2018.

Adolescent risk-taking and decision making: a qualitative investigation of a virtual reality experience of gangs and violence

Introduction: Gang involvement poses serious risks to young people, including antisocial and criminal behaviour, sexual and criminal exploitation, and mental health problems. There is a need for research-informed development of preventive interventions. To this end, we conducted a qualitative study of young people’s responses to an educational virtual reality (VR) experience of an encounter with a gang, to understand young people’s decisions, emotions and consequences.Methods: Young people (N = 24 aged 13-15, 11 female, 13 male) underwent the VR experience followed by semi-structured focus group discussions. Questions focused on virtual decision-making (motivations, thoughts, feelings, consequences) and user experiences of taking part. Data were analysed using Thematic Analysis.Results: Three themes were developed to represent how participants’ perceptions of the gang, themselves, and the context influenced virtual decisions. Social pressure from the gang competed with participants’ wish to stand by their morals and establish individual identity. The VR setting, through its escalating events and plausible characters, created an “illusion of reality” and sense of authentic decisions and emotions, yielding insights for real-life in a safe, virtual environment.Discussion: Findings shed light on processes influencing adolescent decision-making in a virtual context of risk-taking, peer pressure and contact with a gang. Particularly, they highlight the potential for using VR in interventions with young people, given its engaging and realistic nature.

Family experiences of engagement in inclusive childcare programs for toddlers

Previous research has explored family engagement experiences and practices in childcare programs. The purpose of this study was to explore family members’ experiences related to their engagement in decision-making processes across various inclusive, toddler childcare programs. Five early educators and eight parents participated in the study. Four parents had a child with a diagnosed disability or developmental delays, were at-risk for developmental delays, and/or received speech, occupational, or physical therapy. Eligible early educators participating in the study taught toddlers (18 to 30 months) in a private, faith-based, or university childcare program. A semi-structured interview style was used to collect family participant responses. The early educators’ inclusive practice indicator rubric scores previously collected from the larger grant funded project were used to triangulate data. Through a phenomenological qualitative design, this study gained a better understanding of families’ decision-making experiences, facilitators and barriers that may impact family engagement, and opportunities early educators have provided or not provided to encourage family engagement in inclusive, toddler childcare programs.

Comparison of methods to engage diverse stakeholder populations in prioritizing PrEP implementation strategies for testing in resource-limited settings: a cross-sectional study

BackgroundThere is a lack of consensus about how to prioritize potential implementation strategies for HIV pre-exposure prophylaxis (PrEP) delivery. We compared several prioritization methods for their agreement and pragmatism in practice in a resource-limited setting.MethodsWe engaged diverse stakeholders with clinical PrEP delivery and PrEP decision-making experience across 55 facilities in Kenya to prioritize 16 PrEP delivery strategies. We compared four strategy prioritization methods: (1) “past experience surveys” with experienced practitioners reflecting on implementation experience (N = 182); (2 and 3) “pre- and post-small-group ranking” surveys before and after group discussion (N = 44 and 40); (4) “go-zone” quadrant plots of perceived effectiveness vs feasibility. Kendall’s correlation analysis was used to compare strategy prioritization using the four methods. Additionally, participants were requested to group strategies into three bundles with up to four strategies/bundle by phone and online survey.ResultsThe strategy ranking correlation was strongest between the pre- and post-small-group rankings (Tau: 0.648; p < 0.001). There was moderate correlation between go-zone plots and post-small-group rankings (Tau: 0.363; p = 0.079) and between past-experience surveys and post-small-group rankings (Tau: 0.385; p = 0.062). For strategy bundling, participants primarily chose bundles of strategies in the order in which they were listed, reflecting option ordering bias. Neither the phone nor online approach was effective in selecting strategy bundles. Participants agreed that the strategy ranking activities conducted during the workshop were useful in prioritizing a final set of strategies.ConclusionsBoth experienced and inexperienced stakeholder participants’ strategy rankings tended to prioritize strategies perceived as feasible. Small group discussions focused on feasibility and effectiveness revealed moderately different priorities than individual rankings. The strategy bundling approach, though less time- and resource-intensive, was not effective. Future research should further compare the relative effectiveness and pragmatism of methodologies to prioritize implementation strategies.

A decade of experience in high-stakes decision-making in competency-based education.

A decade of experience in high-stakes decision-making in competency-based education.

CAREER EXPLORATORY INTENTIONS AND DECIDEDNESS AMONG STUDENTS: A CAREER SELF-MANAGEMENT PERSPECTIVE

The present study aimed to expand the knowledge on the career exploratory intentions and decidedness in the career self-management model of Social Cognitive Career Theory (Lent &amp; Brown, 2013). To predict these career behaviours, we used hierarchical regression and analysed the predictors role of socioeconomic status, social support, career exploration, and decision-making learning experiences, self-efficacy, and outcome expectations. In addition to the career variables included in the Career Self-Management Model, this study also explored the role of work volition, a central variable from the Psychology of Working Theory. Data were collected using an online survey filled in by 235 college students. The results showed that positive emotions and outcome expectations were significant predictors of exploratory intentions, while self-efficacy was a constant significant predictor of career decidedness. Socioeconomic status and work volition were not significant predictors in any of the models.

Dynamics of Human Resource Management: Integrating Technology, Sustainability, and Adaptability in the Modern Organizational Landscape

This research explores the dynamics of Human Resource Management (HRM) in facing the challenges of the contemporary era characterized by technological integration, environmental sustainability, and organizational adaptability. Through a review of scholarly articles, this research explores the relationship between innovative HRM practices and their impact on organizational performance, employees, and response to change. Technology integration in HRM is a focus of attention. The integration of Artificial Intelligence (AI) and Advanced Analytics is changing the paradigm of HRM processes by improving efficiency, decision-making, and employee experience. The review showed that technology enables personalization of HRM and has a positive impact on organizational performance. The importance of environmental sustainability is also reflected in the practice of Green Human Resource Management (GHRM). The integration of environmentally sound transformational leadership components, environmentally sound social capital, and environmentally sound values in GHRM has a positive correlation with pro-environmental behavior in the workplace. These findings encourage a sustainable organizational culture and support employee performance. The era of the Fourth Industrial Revolution (Industry 4.0) presents new challenges for HRM. The integration of advanced technologies shapes organizational dynamics and employee behavior. This research highlights the importance of adaptability in HRM to deal with rapid contextual changes. Supply chain resilience is becoming an important aspect of HRM, especially in the face of unexpected disruptions. HRM practices that encourage employee participation in supply chain resilience development have a positive impact on organizational resilience and operational performance. The COVID-19 pandemic crisis demands adaptive and innovative HRM practices. This research shows that adaptable HRM practices contribute to organizational readiness in the face of challenges and sudden changes. The results of this review provide a foundation for further research in understanding the relationship between HRM practices and organizational and employee performance. In-depth quantitative research is expected to test the hypotheses formulated and provide guidance for effective HRM strategies in the face of modern organizational dynamics.

Circumstances affecting patients’ euthanasia or medically assisted suicide decisions from the perspectives of patients, relatives, and healthcare professionals: A qualitative systematic review

This study aims to explore circumstances affecting patients’ euthanasia and medically assisted suicide (MAS) decisions from the perspectives of patients, relatives, and healthcare professionals. A qualitative systematic review was performed following PRISMA recommendations. The review protocol is registered in PROSPERO (CRD42022303034). Literature searches were conducted in MEDLINE, EMBASE, CINAHL Complete, Eric, PsycInfo, and citation pearl search in Scopus from 2012 to 2022. In total, 6840 publications were initially retrieved. The analysis included a descriptive numerical summary analysis and a qualitative thematic analysis of 27 publications, resulting in two main themes—Contexts and factors influencing actions and interactions, and Finding support while dealing with resistance in euthanasia and MAS decisions—and related sub-themes. The results illuminated the dynamics in (inter)actions between patients and involved parties that might both impede and facilitate patients’ decisions related to euthanasia/MAS, potentially influencing patients’ decision-making experiences, and the roles and experiences of involved parties.