Decision-making In Canada Research Articles

Pharyngeal Electrical Stimulation for the Treatment of Dysphagia Associated With Neurologic Conditions


 Horizon Scan reports provide brief summaries of information regarding new and emerging health technologies.
 These technologies are identified through the CADTH Horizon Scanning Service as topics of potential interest to health care decision-makers in Canada.
 This Horizon Scan summarizes the available information regarding an emerging technology, Phagenyx, a pharyngeal electrical stimulation device for the treatment of difficulty swallowing associated with neurologic conditions.

Barricaid Spinal Implant Device

Horizon Scan reports provide brief summaries of information regarding new and emerging health technologies. These technologies are identified through the CADTH Horizon Scanning Service as topics of potential interest to health care decision-makers in Canada. This Horizon Scan summarizes the available information regarding an emerging technology, Barricaid — a spinal implant device for those at risk of recurrent spinal disc herniation.

The Portable Neuromodulation Stimulator: Targeting Neuroplasticity for Balance or Gait Deficit


 CADTH’s Horizon Scanning Service identifies new and emerging technologies that may be of interest to health care decision-makers in Canada
 Health Technology Update articles generally focus on a single technology or intervention.
 This Horizon Scan presents a brief summary of information relevant to the Portable Neuromodulation Stimulator, designed to be used in conjunction with physical therapy to improve balance or gait impairments associated with mild-to-moderate symptoms of multiple sclerosis or mild-to-moderate traumatic brain injury.

Qualitative Examination of Shared Decision-Making in Canada's Largest Health System: More Work to be Done : Shared Decision-Making-More Work to be Done.

Background: Shared Decision-Making (SDM) is an inclusive approach where patients and providers work in partnership to make health care decisions that are grounded in clinical best practice and align with patient preferences and values. Despite a growing recognition that SDM can lead to improved outcomes and reductions in unnecessary health investigations, tensions exist between patient agency and a historically paternalistic model of health care. As an evolving ideology, the Research Team sought to better understand the current state, challenges, and implementation opportunities of SDM practices across the health system. Methods: This study used a cross-sectional quality improvement design utilizing semistructured interviews to gather information from focus group participants. Five open-ended, qualitative questions were used to generate discussion on the perceptions of SDM and its role in clinical appropriateness in a variety of clinical contexts in our health system. A total of 12 focus groups (n = 95 participants) representative of patients and families, leaders, physicians, and frontline clinicians were engaged in the study. Results: Through a consensus-based approach, study results identified 4 recommendations based on 4 themes: Time, Communication, System Design, and Clinical Appropriateness. Conclusion: There are no easy solutions to the challenges of enabling SDM; however, success will be dependent upon recognizing the importance of patient agency, while maintaining an inclusive and continuous stakeholder engagement with both patients and providers. Implementation of the 4 recommendations at the organizational level highlighted in this study can serve as a road map for other health care institutions and will require a gradual approach to transform the general principles of SDM into tangible solutions to meet the emerging needs at both the local and system level.

Free Fallin’? The decline in evidence-based decision-making by Canada’s protected areas managers

The conservation of biodiversity requires various forms of evidence to ensure effective outcomes. In this study, we provide an updated assessment of the state of evidence-based decision-making in Canada’s protected areas organizations by examining practitioner perceptions of: ( i) the value and use of various forms of evidence, ( ii) the availability of evidence to support decisions, and ( iii) the extent to which various institutional and behavioural barriers influence the use of evidence. Our results compare national surveys conducted in 2019 and 2013, revealing a significant and concerning decline in the use of all forms of evidence. We found significant declines in the use of peer-reviewed literature, local knowledge, and Indigenous knowledge. Our results correspondingly demonstrate a host of systemic barriers to the effective use of evidence, including a lack of trust, how to deal with uncertainty, and limited training. These challenges persist at a time when the quantity of information is greater than ever, and recognition of the value of Indigenous knowledge is relatively high (and increasing). Leadership is required to cultivate more relevant evidence, to embed scientists and Indigenous Knowledge-Holders in conservation organizations, to (re)establishing knowledge sharing forums, and to establish accountability and reporting measures to support efforts aimed at effectively achieving Canada’s biodiversity conservation goals.

Collaborative fisheries research: the Canadian Fisheries Research Network experience

The Canadian Fisheries Research Network (CFRN) was a collaboration among fish harvesters, academic researchers, and government scientists that undertook research between 2010 and 2016 on questions about fisheries that were identified by fish harvesters and pertinent to management objectives. This paper provides a synthesis of the scope and results of the CFRN. It explores the link between the increasing challenges to fisheries sustainability and the need for increased research capacity and for a collaborative approach. It documents the creation of the collaboration, the research it accomplished, and its benefits and explores the need for ongoing collaboration. The papers in this special issue on the CFRN demonstrate the benefits of collaborative fisheries research that are of relevance internationally and support the need for a permanent collaborative platform to conduct research to support fisheries management capacity and decision-making in Canada.

The value and consequences of using public health technology assessments for private payer decision-making in Canada: one size does not fit all

Background: Both public and private insurers provide drug coverage in Canada. All payers are under pressure to contain costs. It has recently been proposed that private plans leverage the public health technology assessment (HTA) evaluation process in their decision-making.Objectives: The objectives of the current study were to examine use of public health technology assessments (HTAs) for private payer decision-making in the literature, to gather the perspectives of experts from both public and private insurers on this practice, and to summarize which value parameters of public evaluations can be used for private payer decision-making.Methods: A targeted literature review was conducted to identify publications on the use of public HTA or cost-effectiveness data for private payer decision-making on pharmaceutical reimbursement. Concurrently, a roundtable meeting was organized with invited panelists, including private payer representatives and health economic consultants (total n = 9). The findings from both were synthesized and expressed in qualitative terms using the PICO framework.Results: The targeted review identified 20 studies meeting the inclusion criteria, primarily originating from the US and Canada. The panelists felt that, despite some similarities, there were substantial differences between both systems. The PICO framework highlighted the issues with transferability between the two systems. Most of the value parameters were either not applicable, needed to be added, needed to be adjusted, or their applicability to private payer systems needed to be confirmed.Conclusion: Some components of public HTA may be relevant for private payers, however there are reservations that still exist on whether the HTA process in Canada, designed for a public system, can address the informational needs of private payers. Private insurers need to use caution in assessing which value parameters from public HTAs can be used and which need to be confirmed, ignored, enhanced, or adjusted. One size HTA does not fit all applications.

Factors underlying treatment decision-making for localized prostate cancer in the U.S. and Canada: A scoping review using principal component analysis.

The purpose of this research is to gather, collate, and identify key factors commonly studied in localized prostate cancer (LPC) treatment decision-making in Canada and the U.S. This scoping review uses five databases (Medline, EMBASE, CINAHL, AMED, and PsycInfo) to identify relevant articles using a list of inclusion and exclusion criteria applied by two reviewers. A list of topics describing the themes of the articles was extracted and key factors were identified using principal component analysis (PCA). A word cloud of titles and abstracts of the relevant articles was created to identify complementary results to the PCA. This review identified 77 relevant articles describing 32 topics related to LPC treatment decision-making. The PCA grouped these 32 topics into five key factors commonly studied in LPC treatment decision-making: 1) treatment type; 2) socioeconomic/demographic characteristics; 3) personal reasons for treatment choice; 4) psychology of treatment decision experience; and 5) level of involvement in the decision-making process. The word cloud identified common phrases that were complementary to the factors identified through the PCA. This research identifies several possible factors impacting LPC treatment decision-making. Further research needs to be completed to determine the impact that these factors have in the LPC treatment decision-making experience.

Evidence-based decision-making in Canada’s protected areas organizations: Implications for management effectiveness

Aichi Biodiversity Target 19 calls on Parties to the United Nations Convention on Biological Diversity (CBD) to improve, share, transfer, and apply knowledge. In this study, we provide an initial assessment of the state of evidence-based decision-making in Canada’s protected areas organizations by examining (1) the value and use of various forms of evidence by managers and (2) the extent to which institutional conditions enable or inhibit the use of evidence in decision-making. Results revealed that although managers value and use many forms of evidence in their decision-making, information produced by staff and their organizations are given priority. Other forms of evidence, such as Indigenous knowledge and peer-reviewed information, are valued and used less. The most significant barriers to evidence-based decision-making were limited financial resources, lack of staff, inadequate timeframes for decision-making, a lack of monitoring programs, and a disconnect between researchers and decision-makers. Overall, our results suggest that the potential benefits of evidence-based approaches are not being maximized in Canada’s protected areas organizations. We propose several recommendations to introduce or improve the use of diverse forms of evidence to enhance management effectiveness of Canada’s protected areas and by extension conservation outcomes.

Cross-sectoral input for the potential role of science in Canada’s environmental assessment

Since being elected in 2015, Canada’s federal Liberal government has taken steps to overhaul major environment-related laws and policies, including federal environmental assessment (EA) and regulatory processes. During 2016–2017, a government-appointed panel toured Canada and received >1000 suggestions from diverse sectors of society regarding EA reform. Yet, different sectors of society may have different views concerning scientific components of EA. We analyzed written submissions during public consultation (categorized into five sectors) regarding five key scientific components of EA: (1) openly sharing information, (2) evaluating cumulative effects, (3) scientific rigour, (4) transparency in decision-making, and (5) independence between regulators and proponents. On the whole, submissions from Indigenous groups, non-governmental organizations, and individuals/academics supported strengthening all five components. In contrast, most contributions from industry/industry associations, and, to a lesser extent, government bodies or agencies, suggested that there was no need for increased scientific rigour or increased independence. These findings indicate that there is cross-sectoral support for strengthening some scientific aspects of EA. However, the degree to which the Government of Canada strengthens the scientific rigour and independence of EA will indicate whether environmental decision-making in Canada is aligned with preferences from industry or the rest of Canada.

Informing Canada’s commitment to biodiversity conservation: A science-based framework to help guide protected areas designation through Target 1 and beyond

Biodiversity is intrinsically linked to the health of our planet—and its people. Yet, increasingly, human activities are causing the extinction of species, degrading ecosystems, and reducing nature’s resilience to climate change and other threats. As a signatory to the Convention on Biological Diversity, Canada has a legal responsibility to protect 17% of land and freshwater by 2020. Currently, Canada has protected ∼10% of its terrestrial lands, requiring a marked increase in the pace and focus of protection over the next three years.Given the distribution, extent, and geography of Canada’s current protected areas, systematic conservation planning would provide decision-makers with a ranking of the potential for new protected area sites to stem biodiversity loss and preserve functioning ecosystems. Here, we identify five key principles for identifying lands that are likely to make the greatest contribution to reversing biodiversity declines and ensuring biodiversity persistence into the future. We identify current gaps and integrate principles of protecting ( i) species at risk, ( ii) representative ecosystems, ( iii) intact wilderness, ( iv) connectivity, and ( v) climate refugia. This spatially explicit assessment is intended as an ecological foundation that, when integrated with social, economic and governance considerations, would support evidence-based protected area decision-making in Canada.

Investigating Race Salience, Defendant Race, and Victim Race Effects on Mock Juror Decision-Making in Canada

The purpose of this study was to test whether defendant and victim race (White, Black, Aboriginal Canadian) would jointly influence mock juror decision-making, and to test the effectiveness of making race a salient issue in mitigating bias. Participants (N = 558) read a robbery trial transcript in which race salience was experimentally manipulated via the defense’s closing argument (with defendant and victim race manipulated via photographs), then provided verdicts and indicated whether they perceived race to be a salient issue in the trial. Results demonstrated differential victim and defendant race effects as a function of experimental race salience manipulation and mock juror race, as well as effects for participants’ self-reported perception that race was a relevant feature of the trial. Overall, these findings suggest important differences in the impact of the race salience technique as a function of victim race.

Investigating Canadian parents' HPV vaccine knowledge, attitudes and behaviour: a study protocol for a longitudinal national online survey

IntroductionHuman papillomavirus (HPV), a sexually transmitted infection, can cause anogenital warts and a number of cancers. To prevent morbidity and mortality, three vaccines have been licensed and are recommended by...

Supported decision-making in Canada: principles, policy, and practice

This article considers the experience of supported decision-making in Canada and the lessons for the implementation and practice of supported decision-making that can be drawn from the Canadian experience to date. Supported decision-making has a long history in Canada with both legal and practice initiatives dating back to the 1970s. In Canada, most social policy and legislation related to decision-making, legal capacity, and support falls within provincial jurisdiction, so much of this article deals with provincial rather than national developments with a particular focus on British Columbia, which has the most developed system of supported decision-making.

PC-FACS

PC-FACS

Patient-centered rapid reviews will drive local decision making: commentary on Hartling et al.

Rapid reviews have attained increasing recognition as a product sought after by decision makers, demonstrated by the February 2015 Rapid Review Summit (https://www. cadth.ca/cadth-summit-series) convened by the Canadian Association for Drugs and Technology for Health (CADTH), which celebrated 10 years of conducting rapid health technology assessments this year. As another example, a recent policy dialogue concluded that there is sufficient appetite in Canada to explore a sustainable rapid response service for decision makers in Canada [1]. Despite their popularity with decision makers and interest in rapid reviews, there is little known about their methods, risk of bias, or utility for decision making. In this issue of JCE, Hartling et al. provide a classification system of four rapid review products on the basis of the extent of synthesis used, providing an advance from previous descriptions of cohorts of rapid reviews [2e4], consisting of:

Direct health-care costs attributed to hip fractures among seniors: a matched cohort study

SummaryUsing a matched cohort design, we estimated the mean direct attributable cost in the first year after hip fracture in Ontario to be $36,929 among women and $39,479 among men. These estimates translate into an annual $282 million in direct attributable health-care costs in Ontario and $1.1 billion in Canada.IntroductionOsteoporosis is a major public health concern that results in substantial fracture-related morbidity and mortality. It is well established that hip fractures are the most devastating consequence of osteoporosis, yet the health-care costs attributed to hip fractures in Canada have not been thoroughly evaluated.MethodsWe determined the 1- and 2-year direct attributable costs and cost drivers associated with hip fractures among seniors in comparison to a matched non-hip fracture cohort using health-care administrative data from Ontario (2004–2008). Entry into long-term care and deaths attributable to hip fracture were also determined.ResultsWe successfully matched 22,418 female (mean age = 83.3 years) and 7,611 male (mean age = 81.3 years) hip fracture patients. The mean attributable cost in the first year after fracture was $36,929 (95 % CI $36,380–37,466) among women and $39,479 (95 % CI $38,311–$40,677) among men. These estimates translate into an annual $282 million in direct attributable health-care costs in Ontario and $1.1 billion in Canada. Primary cost drivers were acute and post-acute institutional care. Approximately 24 % of women and 19 % of men living in the community at the time of fracture entered a long-term care facility, and 22 % of women and 33 % of men died within the first year following hip fracture. Attributable costs remained elevated into the second year ($9,017 among women, $10,347 among men) for patients who survived the first year.ConclusionsWe identified significant health-care costs, entry into long-term care, and mortality attributed to hip fractures. Results may inform health economic analyses and policy decision-making in Canada.

Information behaviour of Canadian pharmaceutical policy makers

Understanding the information behaviour of policy makers targeted by knowledge translation efforts is key to improving policy research impact. This study explores the reported information behaviour of pharmaceutical policy decision-makers in Canada, a country highly associated with evidence-based practice yet still facing substantial barriers to evidence-informed health policy. We conducted semi-structured telephone interviews with a purposive sample of 15 Canadian pharmaceutical policy decision-makers. Results of the descriptive, qualitative analysis were compared with the General Model of Information Seeking of Professionals (GMISP) proposed by Leckie, Pettigrew and Sylvain in 1996. Characteristics of information needs included topic, depth/breadth of questions and time sensitivity. Approaches to information seeking were variously scattershot, systematic and delegated, depending on the characteristics as well as respondent resources. Major source types were human experts, electronic sources and trusted organisations. Affective (emotion-related) outcomes were common, including frustration and desire for better information systems and sources. The GMISP model may be adapted to model information behaviour of Canadian pharmaceutical policy makers. In the absence of a dedicated, independent source for rapid-response policy research, these policy makers will likely continue to satisfice (make do) with available resources, and barriers to evidence-informed policy will persist.

End‐of‐Life Decision‐Making in Canada: The Report by the Royal Society of Canada Expert Panel on End‐of‐Life Decision‐Making

This report on end-of-life decision-making in Canada was produced by an international expert panel and commissioned by the Royal Society of Canada. It consists of five chapters.Chapter 1 reviews what is known about end-of-life care and opinions about assisted dying in Canada.Chapter 2 reviews the legal status quo in Canada with regard to various forms of assisted death.Chapter 3 reviews ethical issues pertaining to assisted death. The analysis is grounded in core values central to Canada's constitutional order.Chapter 4 reviews the experiences had in a number of jurisdictions that have decriminalized or recently reviewed assisted dying in some shape or form.Chapter 5 provides recommendations with regard to the provision of palliative care in Canada, as well as recommendations for reform with respect to the various forms of assisted death covered in this document.

Using health technology assessment to support evidence-based decision-making in Canada: an academic perspective

Health technology assessment (HTA) adopts a multidisciplinary approach to comprehensively assess safety, efficacy, effectiveness, economic and organizational impact, and any potential social and ethical implications associated with adoption and diffusion of a technology in a healthcare system. Canada was one of the first pioneers in using HTA as a research tool to support evidence-based decision-making. This article describes the current application of HTA in Canada, with a focus on some federal and Ontario initiatives in which the authors have extensive knowledge and experience to illustrate how academic researchers conduct HTA in collaboration with decision makers. Some issues and challenges are also highlighted that will hopefully stimulate a broader discussion among HTA stakeholders to move HTA forward.