Decision Satisfaction Research Articles

Breast Cancer Survivors' Perceptions of Mastectomy Reconstruction: A Comparative Analysis of Medical Tattooing Impact on Aesthetics.

Studies indicate that physical appearance changes affect a significant proportion of breast cancer survivors, often leading to post-surgical distress. Both reconstructive surgery and medical tattoos are associated with patient-reported satisfaction, yet further research is necessary to understand their combined impact on aesthetic outcomes from the patient perspective. This study examined how breast cancer survivors evaluated the cosmetic and decision satisfaction of other patients who made various cosmetic intervention choices post-mastectomy. Breast cancer survivor support networks (n = 180) across 20 states agreed to share information about the online survey to their members. Participants (n = 251) rated the cosmetic outcome and decision satisfaction of images depicting other patients who had received mastectomy with three types of intervention: reconstruction alone, medical tattooing alone (flat closure), and reconstruction and medical tattooing combined. A factorial MANOVA produced significant within-subjects effects indicating participants consistently rated images of patients with a combination of reconstruction and medical tattooing highest in cosmetic quality, lowest in scar visibility, and highest in treatment decision satisfaction. The findings suggest that medical tattooing serves as a valuable complementary cosmetic intervention, with many survivors expressing interest and recognizing potential benefits once informed about the option. However, the study's limitations, such as the need for a more diverse range of patient images for evaluation, should be acknowledged. Future research should address these gaps by incorporating photographs of patients across varying demographics, including age, body weight, disease severity, and surgical procedures, to minimize bias. Despite these limitations, this study highlights the significant role that medical tattooing can play in enhancing aesthetic outcomes after surgery, particularly from a patient-centered perspective. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://link.springer.com/journal/00266 .

Decision regret and satisfaction with shared decision-making in pancreatic surgery

BackgroundPancreatic surgery often does not provide long-term survival in patients with cancer or consistently improve symptoms in benign disease. This study aimed to assess decision regret and satisfaction with the decision-making process among patients who underwent pancreatectomy. MethodsThis study administered the Brehaut Decision Regret Scale (DRS), 9-Item Shared Decision-Making Questionnaire (SDM-Q-9), and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) to all patients who underwent elective pancreatectomies from 2021 to 2023. Decision regret was defined as a DRS of >25. In addition, this study evaluated SDM-Q-9 responses in patients with and without regret. ResultsA total of 143 patients were included in this study, of whom 71 patients (49.6%) completed the distributed surveys. Demographics, pathology, and major complication rates were similar between responders and nonresponders. The indications for surgery were malignancy (67.6%) and benign disease (32.4%). Decision regret after pancreatic surgery was reported in 18.3% of patients. Patients who experienced regret were younger (50.8 ± 18.7 years [younger group] vs 62.0 ± 14.9 years [older group]; P = .03), more likely to have benign disease (39.1% [benign disease] vs 8.3% [malignant disease]; P < .01), underwent a distal pancreatectomy (34.5% [distal pancreatectomy] vs 7.7% [pancreaticoduodenectomy]; P = .02), or experienced a major complication (36.8% [major complication] vs 11.5% [no major complication]; P = .03). Patients with regret had lower global health (57.1 ± 20.1 [patients with regret] vs 76.2 ± 22.2 [patients without regret]; P < .01) and social function scores (61.5 ± 31.5 [patients with regret] vs 77.6 ± 22.0 [patients without regret]; P = .03) on the EORTC QLQ-C30. Patients with regret were less satisfied with the shared decision-making process. ConclusionStrong decision regret was reported in 18% of patients who underwent pancreatectomy. Younger age, distal pancreatectomy, benign indications, and major postoperative complications were associated with regret. Data from the SDM-9 highlight areas for potential improvement to help patients make decisions aligned with their goals of care.

Construction and application of a decision support tool for determining venous access in breast cancer chemotherapy patients.

To construct a decision support tool for determining venous access in chemotherapy of breast cancer. A decision support tool for determining venous access was developed through semi-structured interviews, literature analysis, expert inquiry, and user adaptation. The subjects of the study were breast cancer patients with chemotherapy who planned to have deep vein catheterization in a Grade IIIA hospital in Nanjing from August to December 2023. The enrolled patients were then divided into the control group and the intervention group, with 44 cases in each group. The control group received routine pre-catheterization interviews, while the intervention group used the decision support tool on this basis. Further comparison was conducted on the willingness of and actual participation in decision-making, decisional conflict, decision-making satisfaction, and decision regret between the two groups using t-test and chi-square test. This study constructed a decision support tool for determining venous access in chemotherapy of breast cancer, including 8 primary indicators and 40 secondary indicators. The intervention group actually participated in treatment decisions more than the control group, and the intervention group was more willing to participate in treatment decisions (p < 0.05). Furthermore, the intervention group had significantly higher degrees of actual participation in decision-making and satisfaction with decision-making compared to the control group (p < 0.05); while the former group had significantly lower decisional conflict, decision regret at 1 month and 3 months after discharge than those in the latter group (p < 0.05). The decision support tool for determining venous access in chemotherapy of breast cancer is scientific and practical to promote patient participation in decision-making, reduce decisional conflicts, improve decision-making quality, and achieve joint decision-making between doctors and patients.

PENGARUH KUALITAS PRODUK DAN KUALITAS PELAYANAN TERHADAP KEPUTUSAN PEMBELIAN DENGAN KEPUASAN KONSUMEN SEBAGAI VARIABEL INTERVENING (STUDI KASUS DI PT. MANDALA MULTI FINANCE, TBK CABANG LUBUKLINGGAU

The problem in this research is product quality, where there is still a lack of product innovation, product attractiveness, there is still a lack of information on the characteristic features and the impression of the quality of the products being marketed. Then the quality of service, there is still a lack of reliability and responsiveness in serving the wishes of consumers. Purchasing decisions, there is still a lack of conveying information about prices, there is still a lack of strategy in marketing and consumer doubts regarding the accuracy of purchasing decisions. Furthermore, consumer satisfaction, service to consumers has not been maximized, there is still a lack of consumer comments on products, and there is still a lack of attention to products in promoting sales. This research was conducted to determine the effect of product quality and service quality on purchasing decisions with consumer satisfaction as an intervening variable (Case Study at PT. Mandala Multi Finance, Tbk Lubuklinggau Branch). In this study, a four-item variable questionnaire method was used, namely Product Quality (X1), Service Quality (X2), Purchase Decision (Y) and Consumer Satisfaction (I). The data analysis technique used is Multiple Linear Regression Analysis, Coefficient of Determination (R2), and FTest. From the results of the Multiple Regression Analysis, the equation Ŷ = 4.754+0.101 X1+0.823 X2 is obtained. Furthermore, from the analysis, the value of Rsquare (R2) is 0.918 or 91.8%. This value gives the understanding that Product Quality (X1) and Service Quality (X2) contribute 91.8% to the Purchase Decision (Y). While the remaining 8.2% is influenced by other variables that are not included in this study. Based on the results of the Anova calculation (Ftest), it can be seen that the Fcount value is 219.193 with a significant level of 0.000 while Ftable with α = 5% and (n-k-1) or (42-2-1) = 39. And the numerator (k-2 ) is 3.238. Fcount (219.193) &gt; Ftable (3.238), meaning that Ho is rejected and Ha is accepted. This shows that there is a significant influence between Product Quality and Service Quality on Purchasing Decisions.

Longitudinal Assessment of Communication With Patient-Reported Outcomes During Lung Cancer Screening

BackgroundMany organizations recommend clinicians use structured communication processes, referred to as “shared decision making,” to improve patient-reported outcomes for patients considering lung cancer screening (LCS). Research QuestionWhich components of high-quality patient-centered communication are associated with decision regret and distress? Study Design and MethodsWe conducted a prospective, longitudinal, repeated measures, cohort study among patients undergoing lung cancer screening in three different healthcare systems. We surveyed participants using validated measures of decision regret, decision satisfaction, distress, and patient-clinician communication domains up to a year after the low-dose computed tomography (LDCT) for LCS. For longitudinal analyses, we applied a series of generalized estimating equations to measure the association of the “patient as person” communication domain, screening knowledge, and decision concordance with decision regret and distress. ResultsWhen assessed 2-4 weeks after the LDCT, 202 (58.9%) and 8 (2.3%) of 343 total respondents reported mild and moderate/severe decision regret, respectively, while 29 (9.2%) participants of 315 total reported mild distress and 19 (6.0%) moderate or greater distress. The mean ± SD decision satisfaction scores (0 to 10 scale) were 9.82 ± 0.89, 9.08 ± 1.54, and 6.13 ± 3.40 among those with no, mild, and moderate/severe regret respectively. Distress scores remained low after the LDCT, even among those with nodules. Patient-centered communication domains were not associated with decision regret or distress. InterpretationPatients undergoing LCS rarely experience moderate or greater decision regret and distress. Although many participants reported mild decision regret, most were very satisfied over the year after their LDCT for LCS. Communication processes were not associated with regret and distress, suggesting that it may be challenging for communication interventions to reduce the harms of LCS.

대학생의 전공선택 탐색 및 새로운 학사제도에 대한 인식

[Objective] This study aims to determine whether the motivation for choosing a major affects the satisfaction with major decisions after entering university. Additionally, it seeks to understand perceptions of new academic systems designed to increase satisfaction. [Contents] This study analyzed whether the motivation for selecting a major before enrollment influences the desired major decision. In addition, it is intended to analyze the factors affecting the satisfaction of major decision after admission, and to suggest the direction of education policy after understanding the recognition of the introduction of a new academic system to operate it effectively. [Conclusions] The conclusion of this study is as follows. First, the intrinsic factors (aptitude and interest, dream realization) of major selection before entering college were higher than the extrinsic factors (employment outlook, grades). Second, it was confirmed that the satisfaction with major decision after entering college affects the satisfaction with major decision in the order of the connection between college major and employment, the relationship between college major and career, high school career education, and university field. Finally, it was said that ‘support for opportunities to experience various studies’ is the most necessary for matters to be considered at the university level in relation to the operation of the new school system, and as a problem, there are concerns about ‘the phenomenon of concentration on popular departments’ and ‘difficulty in managing students related to major decision’. Based on these results, implications and suggestions for follow-up research were presented in relation to college student’s major decision and career education.

16 - Decision satisfaction and regret in patients undergoing ATOMS® adjustable sling implantation for urinary stress incontinence

16 - Decision satisfaction and regret in patients undergoing ATOMS® adjustable sling implantation for urinary stress incontinence

FACE-Q eye module for measuring patient-reported outcomes in blepharoplasty surgery: A validation study

This study aimed to conduct a linguistic validation of all FACE-Q eye module scales in German, and to evaluate the reliability and validity of the scales in patients with blepharoplasty.According to international recommendations, all FACE-Q scales and checklists were translated from English to German. Psychometric testing of blepharoplasty surgery-related scales of translated versions were administered to patients with blepharochalasis or dermatochalasis and a history of blepharoplasty surgery (n = 64; 11 scales) or no history of blepharoplasty surgery (n = 65; seven scales), and to a group of control subjects (n = 64; seven scales).Most of the subscales showed acceptable internal consistency, with Cronbach’s alphas ranging from 0.75 to 0.97. Intraclass correlation coefficients were high (0.70–0.92), indicating good reliability, with total values of 0.63 (95% CI 0.46–0.76) and 0.68 (95% CI 0.53–0.80) for the upper eyelid and social function scores, respectively. There was good discriminability between pre- and post-blepharoplasty patients and normal subjects (p < 0.05).The German-language version of the FACE-Q eye module is a successfully validated and helpful tool for assessing outcomes after blepharoplasty surgery, especially with respect to ‘satisfaction with overall facial appearance’, ‘psychological well-being, social function’, ‘decision satisfaction, outcome satisfaction’, and ‘early-life impact recovery’.

One size does not fit all: the personal nature of completed embryo donation.

To assess factors associated with embryo donation among individuals interested in donation in the United States. An invitation to complete the 123-item survey was emailed from June to September 2022 to patients at a private practice fertility clinic with interest in donation at the time of IVF. Survey questions included disposition decision, attitudes about embryo status and genetic relatedness, donation disclosure, ideal donation arrangement, and decision satisfaction. Three hundred thirty-seven completed the survey. Two hundred thirty donated to another person(s), 75 discarded embryos, 25 remained undecided, and disposition was unknown for 7 respondents. There were no demographic differences between groups based on final disposition or use of donor gametes. Few gamete recipients were interested in donation due to biological attachment to embryos. Final embryo disposition was associated with religious factors, not wanting to waste embryos, and storage fee concerns. Final disposition was also significantly associated with concern about donor-conceived children's (DCP) welfare, being denied the ability to complete donation, personal IVF outcomes, financial or legal issues, future contact with DCP, cognitive appraisal of disposition, beliefs about embryos, someone else raising their genetic child, anonymity, and beliefs about DCP not knowing genetic relationships (p < .001). Donation to others was associated with less regret and greater satisfaction with the emotional/medical aspects of donation and counseling compared to those who discarded embryos (p < .001). The decision to donate embryos to another person(s) is complex. Counseling that considers individual circumstances, values, and evolving dynamics may facilitate informed decision-making for those navigating infertility treatment, family building, and embryo disposition.

Co-design and usability of an interactive web-based fertility decision aid for transgender youth and young adults.

To develop a patient- and family-centered Aid For Fertility-Related Medical Decisions (AFFRMED) interactive website targeted for transgender and nonbinary (TNB) youth/young adults and their parents to facilitate shared decision-making about fertility preservation interventions through user-centered participatory design. TNB youth/young adults interested in or currently receiving pubertal suppression or gender-affirming hormone treatment and parents of eligible TNB youth/young adults were recruited to participate in a series of iterative human-centered co-design sessions to develop an initial AFFRMED prototype. Subsequently, TNB youth/young adults and parents of TNB youth/young adults were recruited for usability testing interviews, involving measures of usability (i.e., After Scenario Questionnaire, Net Promotor Score, System Usability Scale). Twenty-seven participants completed 18 iterative co-design sessions and provided feedback on 10 versions of AFFRMED (16 TNB youth/young adults and 11 parents). Nine TNB youth/young adults and six parents completed individual usability testing interviews. Overall, participants rated AFFRMED highly on measures of acceptability, appropriateness, usability, and satisfaction. However, scores varied by treatment cohort, with TNB youth interested in or currently receiving pubertal suppression treatment reporting the lowest usability scores. We co-created a youth- and family-centered fertility decision aid prototype that provides education and decision support in an online, interactive format. Future directions include testing the efficacy of the decision aid in improving fertility and fertility preservation knowledge, decisional self-efficacy, and decision satisfaction.

Abstract PO2-26-03: Patient decision making and preferences regarding neoadjuvant chemotherapy in Mexican women with early breast cancer

Abstract Background: Neoadjuvant therapy in breast cancer is considered standard treatment for the majority of patients with locally advanced breast cancer. Its use has been extended to early breast cancer aiming to downstage the extent of disease and surgery in the breast and/or axillary lymph nodes, to provide information regarding effectiveness of systemic therapy (which might guide adjuvant treatment recommendations), to provide prognostic information, as well as to extend time for appropriate genetic testing and planning breast reconstruction. However, little is known about patient decision making and preferences in this scenario. We aimed to describe patients’ preferences regarding neoadjuvant chemotherapy (NAC) for early breast cancer, patient decision-making patterns, and satisfaction with their decisions. Methods: Single arm prospective study at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City. We included patients aged ≥18 years with recent localized and operable breast cancer diagnosis. Electronic preferences and decision-making questionnaires were completed by each patient before NAC was started. A decision regret scale was completed within the first month after surgery was performed. Demographic and clinico-pathologic characteristics were extracted from the electronic medical records. Results: From March 2020 to April 2023, 29 women were enrolled. Mean age was 49.2 (SD 16.2), 55.5% (n=16) were married or had a partner, 79.3% (n= 23) had at least one child, 58.6% (n=17) had high school or higher education, and 48.2% (n=14) were housewives. 75.8% of women answered that they were proposed to be treated with NAC because of the tumor size, 55.1% due to positive lymph nodes, 72.4% to obtain a conserving surgery and 72.4% to obtain prognostic information. In 75.8% of the cases the oncologist made the decision of NAC and in 96.5% the chemotherapy schedule was explained to patients and their families. 82.7% of women answered that it was important for them to have a breast conserving surgery, 93.1% were worried about adverse events, 79.3% thought that there were possibilities to disappear the tumor with the chemotherapy and 31% thought that if the tumor disappear, they would not require surgery. After surgery was performed 96.1% answered that the decision of NAC was the right one, 7.6% would not make the same choice, and 23% felt that the decision to receive NAC caused them harm. Conclusion: Our study suggests that the reason to make a treatment decision related to NAC for early breast cancer was discussed and explained to the majority of the patients. However, physicians’ opinion was the most powerful to influence decision. A significant proportion of patients desire to have a conserving surgery and were worried about adverse events. Perspectives of patients’ preferences regarding NAC should be considered in treatment decision making to improve their decision satisfaction. Citation Format: Yanin Chavarri-Guerra, Haydee Cristina Verduzco-Aguirre, Roberto Gonzalez-Salazar, Ilana de la Puente Tawil, Paulina Quiroz-Friedman, Alejandro Alfaro-Goldaracena, Sofia Sanchez-Roman, Zuleyma Nieto-Garcia. Patient decision making and preferences regarding neoadjuvant chemotherapy in Mexican women with early breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-26-03.

Abstract PO3-28-02: BODY-IMAGE DISTRESS IN BREAST CANCER SURVIVORS AND THEIR EVALUATION OF MEDICAL TATTOOING FOLLOWING SURGERY

Abstract A review of the literature reveals a high incidence of body-image distress among breast cancer survivors who have undergone surgery, which is a natural response to the significant changes in their appearance. Reconstructive surgery, utilizing implants or flaps, may be employed to restore breast size and shape. Medical tattooing can recreate the nipple-areola complex and decorative appliques can conceal scars and skin color variations. Both reconstructive surgery and medical tattoos are associated with patient-reported satisfaction, yet further research is necessary to understand their combined impact on body-image distress. To investigate this, a survey was distributed among national breast cancer support groups and advocacy organizations, yielding 207 responses from individuals meeting the study's criteria. The participants were categorized into two groups: those who received post-surgical medical tattoos (n = 61) and those who did not (n = 146). The study also examined how participants evaluated the cosmetic and decision satisfaction of patients who made various surgical and cosmetic intervention choices. This was accomplished by having participants rate images of patients who had received three types of intervention: mastectomy and reconstruction only, mastectomy and medical tattooing only, and mastectomy, reconstruction, and medical tattooing. Using linear regression and multilevel modeling that controlled for demographic and clinical factors associated with body-image distress, the findings demonstrated that participants with medical tattoos reported significantly lower levels of body-image distress, depressive symptoms, and perceived stress compared to those without medical tattoos. Furthermore, participants rated images of patients who underwent both reconstruction and medical tattooing post-mastectomy as having significantly higher cosmetic and decision satisfaction ratings than images of patients who received reconstruction or medical tattooing alone. This research expands on our understanding of body-image distress in survivors as a multidimensional construct and may serve to indicate potential means for intervention. Enhancing our understanding of how breast cancer treatment and surgery affects survivors' body-image distress may aid healthcare professionals in offering additional psychoeducation and recommendations. Furthermore, presenting information about medical tattooing as a complementary cosmetic option early in the treatment process allows patients the opportunity to consider it within the context of their overall treatment plan. Table. Linear regression results using BIBCQ as the outcome variable and medical tattoo group as the predictor variable with covariates included. Note. PHQ9 = Patient Health Questionnaire-9. PSS = Perceived Stress Scale. Citation Format: Miranda Proctor, Jeffrey Cassisi. BODY-IMAGE DISTRESS IN BREAST CANCER SURVIVORS AND THEIR EVALUATION OF MEDICAL TATTOOING FOLLOWING SURGERY [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-28-02.

Impact of Sensory Marketing on Consumer Satisfaction

Sensory marketing, engaging various senses such as sight, taste, touch, smell, and hearing, enhances consumer satisfaction, influences purchase behavior, and increases the likelihood of customers revisiting and recommending businesses. The purpose of this study was to analyse the impact of factors of sensory marketing on consumer satisfaction and to examine whether exist any significant difference between demographic and sensory marketing. Used questionnaire method to collect data. The study reveals sensory marketing plays a vital role in purchase decision and consumer satisfaction.

Effectiveness of computerised decision aids for patients with chronic diseases in shared decision-making: A systematic review and meta-analysis.

To synthesise the composition and effectiveness of computer-based patient decision aid (PDAs) in interventions for patients with chronic diseases. A systematic review with meta-analysis. Five databases were searched, and only randomised controlled trials (RCTs)were included. This review was conducted with the PRISMA guidelines. The JBI Appraisal Tools for randomised trials were used to assess the risk of bias. We used the random-effects model to conduct meta-analyses. Evidence from RCTs was synthesised using standardised mean differences or mean differences. The GRADE system was employed to assess the certainty of evidence and recommendations. This study was registered on PROSPERO (number: CRD42022369340). PubMed, Embase, Web of Science, CINAHL and Cochrane Library were searched for studies published before October 2022. The review included 22 studies, and most computer-based PDAs reported information on the disease, treatment options, pros and cons and risk comparison and value clarification. The use of computer-based PDAs showed a significant effect on decision conflict and knowledge, but not on decision regret, satisfaction, self-efficacy, anxiety and quality of life. The overall GRADE certainty of evidence was low. Although the quality of evidence was low, however, using computer-based PDAs could reduce decision conflict and enhance knowledge when making medical decisions. More research is needed to support the contention above. Computer-based PDAs could assist health-care providers and patients in the shared decision-making process and improving the quality of decision-making. This study adhered to PRISMA guidelines. NO PATIENT OR PUBLIC CONTRIBUTION.

Decision made, good feelings fade? How noise and multitasking affect decision confidence and well-being

Objectives. This study aimed to examine the influence of office noise and multitasking on decision confidence, overconfidence, satisfaction, calibration and affective well-being. Detrimental effects of noise and multitasking on perceived annoyance and concentration are well documented. Little is known about whether decision confidence and well-being during decisions are also affected. Methods. The study was a between-subjects laboratory experiment (n = 109) involving a noise condition with office noise presented through headphones (A-weighted equivalent sound pressure level of LA eq = 60 dB), a multitasking condition with an email-sorting task as the primary task and a control condition. Results. Compared to the control condition, subjects in the noise and multitasking conditions exhibited overestimation of confidence. There was also a significant decrease in well-being for people in the noise condition. Calibration was not affected. Conclusion. In the case of noise, well-being is affected even before the thresholds of workplace legislation are reached. Undue overconfidence can have detrimental effects upon subsequent decisions and risk-taking. Findings suggest that there should be greater consideration of environmental influences during decision-making in work environments.

Decision-making in women considering planned oocyte cryopreservation: decision satisfaction or regret?

Research question: Among women considering planned oocyte cryopreservation (OC), does decision regret differ among those that pursued planned OC vs. those that did not? Design: A survey was emailed to all women seen in consult for planned OC from January 2016–December 2021 using a secure REDCap platform. The survey comprised of questions on demographics, reproductive planning, and a validated decision regret scale (DRS). Univariable and multivariable models were fitted to examine decision regret in the group that pursued vs the group that did not pursue planned OC. A sentiment analysis was employed to characterize respondents’ emotional tone. Results: A total of 338 respondents met eligibility criteria, of which 178 (52.7%) underwent and 160 (47.3%) did not undergo planned OC. The groups were similar in age, race/ethnicity, and education. Respondents who underwent planned OC were more likely to be single, anticipate starting a family ≥39yo, and consider donor sperm acceptable. Those that did not undergo planned OC more frequently reported starting attempts at conception. A higher proportion of respondents that did not undergo planned OC experienced moderate-to-severe regret in their decision compared to those that underwent ≥1 cycle (50% vs. 13%, p<0.001). There was a correlation between decreasing number of cryopreserved oocytes and increasing DRS score (P<0.001). Conclusions: There is substantial decision regret among women considering planned OC who did not proceed with it. DRS score was highest among those that did not proceed with planned OC and those that underwent ≥1 cycle resulting in a low number of oocytes.

How Important is e-WOM for an Agrotourism in Batu City? Second-order PLS-SEM Approach

Objectives: The objective of this research is to compare the influence of each dimension (first-order e-WOM) with its second-order e-WOM. This research also examined how e-WOM can influence tourists' decision behavior and satisfaction in Batu City agrotourism. Methodology: This research was conducted using primary data in 2023. The population in this study consists of 119 respondents who have visited agrotourism in Batu City and obtained information about agrotourism from e-WOM on Social Networking Services. The data was processed using Warp-Partial Least Square (WarpPLS) 8.0.Finding: E-WOM has proven itself as a valuable source of information for tourists visiting agrotourism in the city of Batu. With the help of e-WOM, tourists can obtain more up-to-date insights into the conditions of agrotourism. Agrotourism operators also benefit since they receive free marketing from their tourists.Conclusion: Overall, this research results indicate a contrasting comparison between the first-order e-WOM model and the second-order e-WOM. Only two dimensions of e-WOM, namely the valence of opinion and content, have a direct influence on visitation decisions and tourist satisfaction. Additionally, this study demonstrates that all three dimensions of e-WOM collectively have a significant impact on tourist behavior. Second-order e-WOM has a more substantial impact on tourists in influencing their decisions and satisfaction levels.

A Pilot Survey of Indian Stakeholders: Parents, Doctors, and Grown-Up Patients of Disorders of Sexual Differentiation on Management Decisions and Associated Gender Dysphoria.

Of late, there are many legal representations from select quarters to halt all medical interventions in children with differences of sex development (DSD). In this survey on management decisions in DSD, we distil the views of Indian stakeholders: parents, physicians, and grown-up patients with DSD on their management decisions to identify decisional satisfaction or gender dysphoria. The survey domains included the patient demographics, final diagnosis, decision on the sex of rearing, surgical interventions, opinion of the stakeholders on the preferred age of sex assignment, final sex of rearing, and agreement/disagreement about sex assignment (gender dysphoria). A total of 106 responses were recorded (66% parents, 34% grown-up patients aged 12-50 years). Among parents, 65/70 (95%) preferred the sex to be assigned soon after birth. All grown-up patients preferred sex to be assigned soon after birth. Regarding decisions on surgery, 74% of physicians and 75% of the grown-up patients felt parents should be allowed to decide interventions. Among Indian parents, 90% felt they should have the right to decide surgery in the best interest of their child for a safe social upbringing. Overall, gender dysphoria among Indian DSD patients was <1% (1/103, 0.97%). The predominant preference and opinion of major Indian stakeholders (physicians, parents, and grown-up DSD patients) support the existing approach toward DSD management, including early sex assignment and necessary medical intervention.

Investigating the Influence of Indecision on Customer’s Decision Satisfaction

Investigating the Influence of Indecision on Customer’s Decision Satisfaction

Implementation of the ORESTE Method in Determining the Selection of Service Ambassador Events

The selection of candidates to become Service Ambassadors is an important and complex process. Assessors need to consider many factors and the relative weight of each factor to ensure the best candidate is selected for the position. One method that can be used in candidate selection is the ORESTE method. The ORESTE method is a multi-criteria decision-making method developed by J.P. Brans and B. Mareschal in 1994. This method allows assessors to aggregate multiple criteria and consider the relative weight of each criterion to compare alternatives and produce a ranking of candidates based on the highest relative value. In the context of Service Ambassador selection, the ORESTE method can assist assessors in solving complex decision-making problems and ensuring the best candidate is selected for the position. The method allows raters to consider multiple criteria and consider the relative weight of each criterion, resulting in a ranking of candidates based on the highest relative value. Thus, the use of the ORESTE method in determining the selection of Tourism Ambassadors can simplify and speed up the candidate selection process, as well as increase accuracy and satisfaction in decision making. By using the ORESTE method, the results of the decision to select the winner of the Service Ambassador event are obtained with a preference value of 4.42