Decision Points Research Articles

A Causal Network-Based Markov Decision Process Model for Intervention Planning

Patients suffering from chronic diseases often receive interventions after they are discharged from hospitals for their health management. The intervention decisions can be made sequentially during the course of disease progression and treatment process, and timely and proper interventions can lead to better health condition and quality of life and reduce the rate of re-hospitalization. Moreover, to determine effective intervention plans, personalized care should be considered. However, in many cases, intervention plans are not tailored to patients’ health conditions or dynamically adjusted based on their status changes due to the lack of adequate analytical methods. To address this issue, we introduce a causal Bayesian network-based Markov decision process (CNMDP) model to dynamically evaluate the health status and effectiveness of interventions for each patient and update the corresponding intervention strategy. In such a model, a causal Bayesian network is integrated in order to predict the effect of interventions in each patient’s health status. The resulting risk at each decision point is considered in a Markov decision process model by examining diverse factors of a patient to make a personalized optimal decision on intervention planning to minimize the risk of health deterioration or readmission. To illustrate the applicability of the model and develop a specific formulation, an intervention decision model for chronic obstructive pulmonary disease (COPD) patients is presented using the proposed method. Such a model can be applied to other diseases as well to design personalized, prompt, and effective intervention plans. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Note to Practitioners</i> —Substantial efforts have been devoted to treatment and care management of chronic diseases. Particularly, there has been an initiative to design appropriate follow-up plans and interventions for postdischarge care to reduce hospital readmissions. However, many intervention plans are not patient specific and do not change with patient conditions. To mitigate such an limitation, based on identified risk factors and causal relationships, a causal Bayesian network model is introduced to predict readmission risk and evaluate intervention effectiveness. The results are then embedded into a Markov decision process to derive optimal intervention plan to minimize readmission risk. Such a process is repeated dynamically to evaluate health status and update intervention strategies. Using chronic obstructive pulmonary disease (COPD) as an example of chronic disease, a case study at a community hospital is presented to illustrate the applicability of the model.

Модернизация китайского типа: эволюция концепции

The concept of “Chinese-style modernization” formulated in the end of the 1970s has been at the center of attention of the Chinese leadership and researchers since the beginning of this decade. The notion of primacy of national characteristics was transformed from a former reference to China’s weakness and backwardness to current focus on development success. Explanations of plans for China’s “basic socialist modernization” by 2035 formed the channel of influence of official policy on the academic discussions. The article analyzes contemporary Chinese comparisons of Chinese and Western paths of modernization along with theoretical reflections on the patterns of “Chinese-style modernization”. The determination to make China’s experience a reference point for policy decisions in developing countries is connected with studies in modernization theory. The question of the correlation between the general patterns of modernization and the specifics of the Chinese path of development has come to the fore. The emphasis on the differences between Chinese-style modernization and Western and Soviet models substantiates the theoretical possibility of a new development perspective for other countries, and encourages them to develop independent modernization strategies based on their own national specifics. Chinese researchers consider attempts by backward countries to copy the advanced institutions of developed nations as useless and even dangerous. China’s modernization is not complete, in the field of economic development there are mounting difficulties related to lagging behind in science and technology, deteriorating external environment, slowing growth, ageing population. While examining Chinese studies of Chinese-style modernization, it is appropriate to focus on the development of academic concepts, quantitative evaluation system and discursive system. Explorations in theory will be determined by practical achievements, first of all, by China’s ability to maintain sustainable balanced growth of the economy. The preliminary outcome can be assessed in the middle of the next decade, when China plans to build the foundations of modernization. The final judgement on the effectiveness of Chinese-style modernization will be made only after the results of China’s plans to become a world leader are known in the middle of this century.

Ethical considerations in using sensors to remotely assess pediatric health behaviors.

Sensors, including accelerometer-based and electronic adherence monitoring devices, have transformed health data collection. Sensors allow for unobtrusive, real-time sampling of health behaviors that relate to psychological health, including sleep, physical activity, and medication-taking. These technical strengths have captured scholarly attention, with far less discussion about the level of human touch involved in implementing sensors. Researchers face several subjective decision points when collecting health data via sensors, with these decisions posing ethical concerns for users and the public at large. Using examples from pediatric sleep, physical activity, and medication adherence research, we pose critical ethical questions, practical dilemmas, and guidance for implementing health-based sensors. We focus on youth given that they are often deemed the ideal population for digital health approaches but have unique technology-related vulnerabilities and preferences. Ethical considerations are organized according to Belmont principles of respect for persons (e.g., when sensor-based data are valued above the subjective lived experiences of youth and their families), beneficence (e.g., with sensor data management and sharing), and justice (e.g., with sensor access and acceptability among minoritized pediatric populations). Recommendations include the need to increase transparency about the extent of subjective decision making with sensor data management. Without greater attention to the human factors involved in sensor research, ethical risks could outweigh the scientific promise of sensors, thereby negating their potential role in improving child health and care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Public procurement and labour market inequality: Conceptualising a multi-faceted relationship

Over the past few decades, policymakers have become increasingly intrigued by public procurement's potential to serve as a policy tool. In line with an increased prevalence of attempts to leverage public procurement for promoting employment-related goals, a growing body of research explores the linkages between public procurement and employment. Yet, while different aspects of the procurement process influence labour market outcomes and the linkages are multiple, current research focuses on individual aspects only. As a result, current understandings of the linkage between public procurement and its labour market effects remain fragmented. Considering choices between the initial identification of an object of purchase and the award and delivery of the contract, this article conceptualises the multi-faceted linkages between public procurement and labour market inequalities understood as issues of access to and (in)equality in employment. It argues that three key aspects (the design of the object, requirements set in the process of buying, and the type of provider) make distinct contributions to the overall impact that procurement processes have on labour market inequality and outlines a framework for analysing the implications of choices at these three core decision points.

Treatment of uncertainty in determining the UK's path to Net Zero

The Climate Change Committee (CCC) recommended the UK's 2050 Net Zero target in 2019 and then the emissions pathway to this as part of its advice on the Sixth Carbon Budget at the end of 2020. As part of this, the CCC's analysis included development of five pathways to Net Zero, incorporating a number of judgements and framings regarding uncertainty and decision points, to highlight key choices for Government and wider society on the path to Net Zero. This paper explores how the analysis, and its presentation, framed these choices and uncertainties, in order to highlight where decisions are required and what the trade-offs and potential contingency options might be. It concludes with reflections on the effectiveness of this approach and on the future challenges on decision-making and uncertainty toward Net Zero.

The Predictors of Complete Pathologic Response in Rectal Cancer during the Total Neoadjuvant Therapy Era: A Systematic Review.

The modern rectal cancer treatment paradigm offers additional opportunities for organ preservation, most notably via total neoadjuvant therapy (TNT) and consideration for a watch-and-wait (WW) surveillance-only approach. A major barrier to widespread implementation of a WW approach to rectal cancer is the potential discordance between a clinical complete response (cCR) and a pathologic complete response (pCR). In the pre-TNT era, the identification of predictors of pCR after neoadjuvant therapy had been previously studied. However, the last meta-analysis to assess the summative evidence on this important treatment decision point predates the acceptance and dissemination of TNT strategies. The purpose of this systematic review was to assess preoperative predictors of pCR after TNT to guide the ideal selection criteria for WW in the current era. An exhaustive literature review was performed and the electronic databases Embase, Ovid, MEDLINE, PubMed, and Cochrane were comprehensively searched up to 27 June 2023. Search terms and their combinations included "rectal neoplasms", "total neoadjuvant therapy", and "pathologic complete response". Only studies in English were included. Randomized clinical trials or prospective/retrospective cohort studies of patients with clinical stage 2 or 3 rectal adenocarcinoma who underwent at least 8 weeks of neoadjuvant chemotherapy in addition to chemoradiotherapy with pCR as a measured study outcome were included. In this systematic review, nine studies were reviewed for characteristics positively or negatively associated with pCR or tumor response after TNT. The results were qualitatively grouped into four categories: (1) biochemical factors; (2) clinical factors; (3) patient demographics; and (4) treatment sequence for TNT. The heterogeneity of studies precluded meta-analysis. The level of evidence was low to very low. There is minimal data to support any clinicopathologic factors that either have a negative or positive relationship to pCR and tumor response after TNT. Additional data from long-term trials using TNT is critical to better inform those considering WW approaches following a cCR.

Exploring Sentiment Extraction from Dota 2 Update 7.33 “The New Frontiers” Tweets Using STANZA and NLTK

Updates of a game can give a different experience while playing and sometimes it becomes the most awaited and decisive point for players who have left the game to return. Updates can come in the form of gameplay changes or character skin updates. Dota 2 game has complex game elements ranging from choosing heroes to choosing the right items to counter the opponent's hero. The big updates provided by the Dota 2 game are always awaited by casual to professional players and also enthusiasts of the game, some update may lead to negative impact in gameplay and otherwise. In this study, a classification will be carried out from the results of sentiment analysis given by people on the biggest Dota 2 ver 3.33 update from twitter. This update overhauls many elements in the game and to find out whether there are many people who like it or not, the test was conducted. From the results of the sentiment analysis, a comparison of the automatic targeting using the Stanza and NLTK libraries is also performed, which results in a different number of positive, neutral and negative statement values.

Hereditary Colorectal Cancer Diagnosis by Next-Generation Sequencing.

Pathogenic germline variants causally contribute to the etiology of colorectal cancer (CRC) and polyposis. The era of massively parallel sequencing, also known as next-generation sequencing (NGS), make it highly possible, effective, and efficient to offer rapid and cost-effective diagnosis for CRC. To aid clinical laboratories in testing the most clinically significant genes, along with the published ACMG CRC technical standard guidelines, this protocol aims to provide a step-by-step technical workflow for carrying out the NGS-panel based CRC molecular diagnosis focusing on the wet lab portion of library preparation and massively parallel sequencing. Using the most popular pull-down-based target enrichment, the chapter particularly encompasses genomic DNA (gDNA) fragmentation, adapter ligation, indexing, hybridization, and capture, which is the most variable and technically challenging part of NGS testing involving at least 3 quality control (QC) checkpoints plus the pre- and post-capture PCR. The gDNA extraction and sequencing is less covered because they are relatively standard technologies with little variations and choices. Although this protocol also introduces pertinent testing algorithms and a brief guideline for pre- and post-testing genetic counselling, the audiences are required to refer to National Comprehensive Cancer Network (NCCN) clinical practice guidelines to determine the most appropriate testing strategies. Since NGS panel-based testing is a highly complex and dynamic platform with multiple choices from different technology and commercial resources, this technical benchtop-based protocol also aims to cover some of the key ramification points for decision-making by each laboratory at the discretion of the directors. © 2023 Wiley Periodicals LLC. Basic Protocol: Hereditary colorectal cancer (CRC) diagnosis by next-generation sequencing.

A Systems Evaluation Model for the Development of Companion Diagnostics and Associated Molecularly Targeted Therapies

PurposeMonoclonal antibodies (mAbs) are important active ingredients of molecularly targeted drugs, which are only effective for specific patient groups. Early assessment of their effectiveness is important for more efficient use of time and resources. Companion diagnostics (CDx) are medical devices or tests to identify groups of promising patients based on specific biomarkers. This work offers a systems evaluation model and a comprehensive assessment from multiple stakeholder perspectives.MethodsThis work introduces a new systems model for assessing available treatment options. Process system diagrams, consisting of independently defined unit structures, are applied to represent the expected decision points and outcomes. A sensitivity analysis is conducted to identify the critical requirements for achieving cost-effectiveness. The model was applied to a case of terminal colorectal cancer treatment to compare mAb drugs to standard therapy.ResultsThe results showed that from the payers’ perspective, the cost and response rates of the mAb drug were critical parameters to improve for achieving the target cost-effectiveness. The results give quantitative guidance for the required improvement.ConclusionThis work represents an important step towards a fair and systematic assessment of treatment alternatives and serves as a guideline for future CDx and therapy technology development efforts.

Multi-objective optimization of gradient gas diffusion layer structures for enhancing proton exchange membrane fuel cell performance based on response surface methodology and non-dominated sorting genetic algorithm-III

The gas diffusion layer structure has a significant impact on water and gas transport in proton exchange membrane fuel cell (PEMFC). In this study, a multi-objective optimization (MOO) method is applied to optimize the PEMFC gas diffusion layer (GDL) structures for performance enhancement. Nine design parameters are studied to analyses the output performance of the fuel cell and the average water content of the membrane, oxygen concentration non-uniformity, power density and system efficiency are used as performance indexes. The MOO forms the response surface regression model based on the three-dimensional numerical model of PEMFC, and the response surface methodology after processing through the non-dominated sorting genetic algorithm-III (NSGA-III) to obtain the Pareto frontier, and prioritizes the best operating conditions and structures based on technique for order preference by similarity to an ideal solution (TOPSIS). Compared with the reference point, the performance indexes of the decision point obtained by the NSGA-III algorithm and TOPSIS algorithm is enhanced by 0.45 %, 42.06 %, 2.99 % and 0.25 %, respectively. This study presents a new multi-objective optimization method for optimizing operating conditions combine with GDL structures for building efficient PEMFC, which provides a solution for achieving higher performance. The optimal results in this paper can provide some guidance for fuel cell performance improvement and control optimization.

Memory effects of visual and olfactory landmark information in human wayfinding

Non-human animals are exceptionally good at using smell to find their way through the environment. However, the use of olfactory cues for human navigation is often underestimated. Although the sense of smell is well-known for its distinct connection to memory and emotion, memory effects in human navigation using olfactory landmarks have not been studied yet. Therefore, this article compares wayfinding and recognition performance for visual and olfactory landmarks learned by 52 participants in a virtual maze. Furthermore, it is one of the first empirical studies investigating differences in memory effects on human navigation by using two separate test situations 1 month apart. The experimental task was to find the way through a maze-like virtual environment with either olfactory or visual cues at the intersections that served as decision points. Our descriptive results show that performance was above chance level for both conditions (visual and olfactory landmarks). Wayfinding performance did not decrease 1 month later when using olfactory landmarks. In contrast, when using visual landmarks wayfinding performance decreased significantly, while visual landmarks overall lead to better recognition than olfactory landmarks at both times of testing. The results demonstrate the unique character of human odor memory and support the conclusion that olfactory cues may be used in human spatial orientation. Furthermore, the present study expands the research field of human wayfinding by providing a study that investigates memory for landmark knowledge and route decisions for the visual and olfactory modality. However, more studies are required to put this important research strand forward.

User-Centered Design of a Gamified Mental Health App for Adolescents in Sub-Saharan Africa: Multicycle Usability Testing Study.

There is an urgent need for scalable psychological treatments to address adolescent depression in low-resource settings. Digital mental health interventions have many potential advantages, but few have been specifically designed for or rigorously evaluated with adolescents in sub-Saharan Africa. This study had 2 main objectives. The first was to describe the user-centered development of a smartphone app that delivers behavioral activation (BA) to treat depression among adolescents in rural South Africa and Uganda. The second was to summarize the findings from multicycle usability testing. An iterative user-centered agile design approach was used to co-design the app to ensure that it was engaging, culturally relevant, and usable for the target populations. An array of qualitative methods, including focus group discussions, in-depth individual interviews, participatory workshops, usability testing, and extensive expert consultation, was used to iteratively refine the app throughout each phase of development. A total of 160 adolescents from rural South Africa and Uganda were involved in the development process. The app was built to be consistent with the principles of BA and supported by brief weekly phone calls from peer mentors who would help users overcome barriers to engagement. Drawing on the findings of the formative work, we applied a narrative game format to develop the Kuamsha app. This approach taught the principles of BA using storytelling techniques and game design elements. The stories were developed collaboratively with adolescents from the study sites and included decision points that allowed users to shape the narrative, character personalization, in-app points, and notifications. Each story consists of 6 modules ("episodes") played in sequential order, and each covers different BA skills. Between modules, users were encouraged to work on weekly activities and report on their progress and mood as they completed these activities. The results of the multicycle usability testing showed that the Kuamsha app was acceptable in terms of usability and engagement. The Kuamsha app uniquely delivered BA for adolescent depression via an interactive narrative game format tailored to the South African and Ugandan contexts. Further studies are currently underway to examine the intervention's feasibility, acceptability, and efficacy in reducing depressive symptoms.

A dynamical model of growth and maturation in Drosophila.

The decision to stop growing and mature into an adult is a critical point in development that determines adult body size, impacting multiple aspects of an adult's biology. In many animals, growth cessation is a consequence of hormone release that appears to be tied to the attainment of a particular body size or condition. Nevertheless, the size-sensing mechanism animals use to initiate hormone synthesis is poorly understood. Here, we develop a simple mathematical model of growth cessation in Drosophila melanogaster, which is ostensibly triggered by the attainment of a critical weight (CW) early in the last instar. Attainment of CW is correlated with the synthesis of the steroid hormone ecdysone, which causes a larva to stop growing, pupate, and metamorphose into the adult form. Our model suggests that, contrary to expectation, the size-sensing mechanism that initiates metamorphosis occurs before the larva reaches CW; that is, the critical-weight phenomenon is a downstream consequence of an earlier size-dependent developmental decision, not a decision point itself. Further, this size-sensing mechanism does not require a direct assessment of body size but emerges from the interactions between body size, ecdysone, and nutritional signaling. Because many aspects of our model are evolutionarily conserved among all animals, the model may provide a general framework for understanding how animals commit to maturing from their juvenile to adult form.

Excel – a new way to join the dots

Professional judgment is an essential and expected graduate skill. The ability to make considered judgments based on sound critical thinking must be developed progressively by students throughout their lifelong learning journey. To support Business School students critical thinking development, an innovative series of interactive and scaffolded tutorial tools were created in Excel. Based on real world business scenarios, students develop the necessary skills to justify and make robust professional judgments. Used as supportive tutorial activities with formative feedback opportunities, students learnt how to perform the necessary steps and argue related justifications. To go deeper, students further question the unresolved and unreasonable, determine the impacts of what if scenarios and make confident decisions that influence professional judgments. This innovative interactive approach provides students with several autonomy and self-efficacy experiences and brings students confidently into the realm of doing (Schwartz et al., 2012). It is adaptive to professional judgment based units of study across all disciplines. For adaptation in more technical and practice based domains, the Excel tutorial worksheet contained background information for the business world scenario. At each sub decision point, data validation and conditional formatting tools have been adopted to allow students to explore drop down possible choices. These are subsequently linked to possible justifications, further information required questions, what if diagrams, and descriptors of how these influence critical justifications. To highlight connection to logical thinking, a “Green to go” colour change code is used which allows students to confirm their understanding or seek further support. Working with students in tutorial time and using the MS Excel text colour function, teaching staff model critical thinking and professional business world expectations. The file’s interactive decision making process, supportive explanatory notes and tips are unveiled so the professional judgment is made in partnership between students and staff. This tool can also be used to develop critical thinking for extended written response decisions. This adaption is designed as a step by step supportive essay planner and response template. Within the Excel worksheet, the essay question is broken down into separate sectional row tasks (introduction, discussion of theories, related application, conclusion). Each sectional row contains an in tutorial discussion box (completed in the expansive social tutorial time), your own response box and, using the Excel data validation tool, a drop down marking rubric. Students are encouraged to complete a full essay response and, via the share function, forward their Excel response to the teaching team who provide formative feedback. The approach’s visual and supported critical thinking path assists students to form their own opinions from many perspectives, make judgments and, most importantly, by enhancing student engagement, experience, and self-efficacy, aids deeper student learning (Cahill &amp; Bloch-Schulman, 2012, Turner &amp; Baskerville, 2013). The presentation will showcase the initiative’s interactive and highly effective model of critical thinking and decision making.

The Dominant Integral Affect Model of Unethical Employee Behavior

Unethical employee behavior (UEB), an important organizational phenomenon, is dynamic and multi-faceted. Recent renewed interest in the role of emotion in ethical decision-making (EDM) suggests that unethical behaviors are neither always rationally derived nor deliberately undertaken. This study explores how to integrate the conscious and nonconscious dimensions of unethical decision-making. By broadening the scope of inquiry, we explore how integral affect—the emotion tied to anticipated decision outcomes for the employee engaging in misconduct—can shed light on UEB. We review related literature on affect and EDM and propose a model in which we assert that at a decision point, an employee experiences multiple integral affects that are either persuasive or dissuasive toward UEB. We further posit that among these integral affects, a dominant integral affect (DIA) emerges, determining the nature and direction of unethical behavior. In addition, our model considers the role of affective residue and the influence of other factors, such as incidental affect, disposition, context, and retrospection, to derive propositions. Our DIA model can help managers gain a comprehensive understanding of how affect, characterized by its locus (self or other orientation) and valence (enhancing or harming), determines the characteristics of UEB.

Delivery of Care for Pediatric Patients Receiving Blinatumomab: A Children's Oncology Group Study.

Blinatumomab is an immunotherapy agent used in pediatric oncology for the treatment of B-lineage acute lymphoblastic leukemia. Administration of blinatumomab, via continuous 28-day infusion cycles, can present multiple decision points and challenges related to patient care. Nurses are at the forefront of coordinating and delivering care for patients receiving blinatumomab. To describe the current state of practice across Children's Oncology Group (COG) member institutions regarding blinatumomab administration in both inpatient and home/outpatient settings. Between August and December 2021, a cross-sectional survey was used to determine current institutional practices related to blinatumomab administration. A single targeted respondent who was actively engaged in coordinating blinatumomab administration completed the survey on behalf of each COG institution. Survey participation rate was 78% (150/192). During the first 28-day blinatumomab cycle, 71 institutions (53%) reported patient hospital stays between 73 hours and 7 days; 42 (31%) reported hospital stays ≤72 hours, and only 12 (9%) reported hospitalization for the full 28-day infusion. Small- to medium-size institutions were more likely to report longer hospitalizations ( P = .03). Most blinatumomab administration occurred in the outpatient setting, with low rates of unplanned clinic/emergency room visits. The majority of COG institutions have navigated the complex coordination of care required for children to receive blinatumomab at home. Wide variations in practice were noted across institutions. This study describes current institutional practices surrounding administration of 28-day blinatumomab infusions in children with leukemia and offers a starting point for institutional benchmarking and standardization of practice.

Improving disaster relief plans for hurricanes with social media

Decisions on humanitarian responses to natural disasters are subject to considerable epistemic uncertainty. This paper advocates for postponing the decision point of pre-positioning relief supplies as close to landfall as possible and searching social media right post-landfall so that the demands can be estimated more accurately. We use a realistic hurricane preparedness case to demonstrate the effectiveness of our models and parametric estimation using social media data. The optimal timing to deploy relief supplies before hurricane landfall is noted to be 12 h in advance, which reduces the total cost by 13% more than if relief supplies are deployed 18+ hours in advance. Meanwhile, utilizing social media information can reduce the total cost as well as all kinds of specific costs being considered, excluding the point of dispensing (POD) sites setup cost, by approximately 15%. As the attitude toward risk goes from optimistic, to neutral, and to pessimistic, the number of PODs increases from 3 to 7, and to 8. A similar pattern can be noted in the total costs incurred by these decision-makers. Further, as the aversion to risk increases, locations tend to be chosen farther from landfall with these farther locations serving the less severe patients.

A new digital background calibration technique for pipeline analog to digital converters using decision points of the voltage transfer characteristics

A new digital background calibration technique for pipeline analog to digital converters using decision points of the voltage transfer characteristics

Analysis of design solutions for inpatient emergency departments using simulation modeling

Purpose. Conduct an analysis of projects of various inpatient emergency departments and identify optimal planning solutions. Methods. To analyze the projects of various inpatient emergency departments and search for optimal planning solutions, it is possible to use simulation modeling. This approach allows you to create a virtual model of the system and conduct many scenario tests in order to evaluate the efficiency and optimize the work of departments in various conditions. Using simulation modeling, three models of inpatient emergency departments of various sizes (1000, 1200 and 2500 m2) were created. The definition of functioning features was carried out with the same threshold value of the incoming flow of patients — 150 per day. In addition to the structural components of the departments, a “point of primary decision-making” was singled out. After the experiments, a comparison of the obtained statistical data was carried out. Results. As a result of the study, on the model of an inpatient emergency department with an area of 1200 m2 and 2500 m2, there were no queues in the process of work at the “point of primary decision making”. At the same time, on a model with a total area of 1000 m2 with the same flow of patients, a queue was formed at the established “primary decision point”, waiting for 10 minutes of model time, which was due to the initial small area in the waiting room. Conclusion. Based on the data obtained, it was concluded that the optimal design solution for the creation of an inpatient emergency department is the department area of 1200 m2.

Engagement of Older Adults Receiving Home Care Services and Their Caregivers in Health Decisions in Partnership With Clinical Teams: Protocol for a Multimethod Study to Prioritize and Culturally Adapt Decision Aids for Home Care.

Older adults (people aged 65 years and older) face many difficult decisions. Patient decision aids (PtDAs) can help them and their families make informed value-congruent decisions. Some PtDAs have been developed for the home care context, but little is known about scaling them for use with older adults in a different culture. This study aims to (1) assess the scalability of existing PtDAs for older adults in the home care context; (2) prioritize those that best match the decisional needs of older adults in home care; and (3) culturally adapt the prioritized PtDAs so they can be scaled successfully to the Quebec health care system. This multimethod study includes 3 phases. All phases will be overseen by a steering committee of older adults, caregivers, health professionals, decision makers, community organization representatives, and researchers with the needed expertise. In phase 1, we will use the Innovation Scalability Self-administered Questionnaire, a validated scalability self-assessment tool, to assess the scalability of 33 PtDAs previously identified in a systematic review. Based on their scalability, their quality (based on the International Patient Decision Aids Standards), and the importance of the decision point, we will retain approximately a third of these. In phase 2, we will conduct a 2-round web-based Delphi to prioritize the PtDAs selected in phase 1. Using a snowball recruitment strategy, we aim to recruit 60 Delphi participants in the province of Quebec, including older adults, caregivers, health professionals, decision makers involved in home care services, and PtDA experts. In the first round, we will ask participants to rate the importance of several PtDA decision points according to various criteria such as prevalence and difficulty on a 5-point Likert scale (1=not important to 5=very important). Approximately 6 of the highest-rated PtDAs will be retained for presentation in the second round, and we will select up to 3 PtDAs judged as having the highest priority for cultural adaptation. In phase 3, using the Chenel framework and user-centered design methods, we will update and adapt the PtDAs to the Quebec health care system and integrate these PtDAs into an interprofessional shared decision-making training program for home care teams. The adapted PtDAs will respect the International Patient Decision Aids Standards criteria. This study was funded in March 2022 by the Canadian Institutes of Health Research. Data collection for the web-based Delphi began in October 2023. Results are expected to be published in May 2024. This project will provide relevant and culturally appropriate decision support tools for older adults making difficult decisions and their home care teams that will be ready for scaling across the province of Quebec. PRR1-10.2196/53150.