Design Of Decision Support Interventions Research Articles

What older adults and their caregivers need for making better health-related decisions at home: a participatory mixed methods protocol

IntroductionShared decision making is an interpersonal process whereby healthcare providers collaborate with and support patients in decision-making. Older adults receiving home care need support with decision-making. We will explore what...

Postmenopausal women with abdominal obesity choosing a nutritional approach for weight loss: A decisional needs assessment

ObjectivesTo identify the decisional needs of postmenopausal women with abdominal obesity choosing between two nutritional approaches for weight loss: a low-fat diet or a diet rich in fruit and vegetables. Study designOur descriptive qualitative study was based on the Ottawa Decision Support Framework. Main outcome measuresFour focus groups were conducted with postmenopausal women. A thematic content analysis was performed to determine the decisional needs influencing the choice of a low-fat diet or a diet rich in fruit and vegetables. ResultsSeventeen postmenopausal women participated in the study (median age 59 years). Most frequently reported decisional needs for each nutritional approach were sufficient levels of nutritional skills and knowledge, consideration of the physiological impacts and the sensory aspect of approaches, food availability, social support, finances and motivation. Partners, friends and daughters were considered as the most important individuals involved in the decision. ConclusionsWe identified several decisional needs influencing postmenopausal women when choosing between a low-fat diet and a diet rich in fruit and vegetables. These findings could inform the design of decision support interventions that address the decisional needs of women for making and implementing informed decisions about a nutritional approach for weight loss.

A Synthesis of Theoretical Models to Guide Decision Support Interventions for Surrogate Decision-Making at Adult End-of-Life (S720)

1.Describe what a theoretical model in general entails that purports to serve as the basis for decision support interventions.2.Be familiar with what theoretical models of surrogate decision-making related to adult end-of-life currently exist and what the major limitations of these models are in relation to intervention development.3.Understand what is needed in future theoretical models of surrogate decision-making in order to advance development of decision support interventions. Surrogate decision-makers (SDMs) take part in 1.5 million end-of-life (EOL) decisions per year. Many if not a majority of SDMs find the role inordinately burdensome, suffer negative after effects months to years afterwards, and often do make decisions concordant with patients’ wishes. To review the literature and synthesize theoretical models of surrogate decision-making at adult EOL to assess for potential use as explanatory foundations for decision support interventions. Data Sources: Literature published up to 2011 was reviewed using PubMed, MEDLINE, CINAHL, and EMBASE using the search terms “surrogate,” “proxy,” “end-of-life,” “life support withdrawal/withholding,” and “decision-making”. Selection criteria included: (a) studies or integrative reports of the empirical and theoretical research relevant to EOL surrogate decision-making; (b) articles aiming to produce a model of how SDMs make decisions for decisionally-incapacitated patients with relevance to the context of EOL; and (c) authors depicting diagrammatically their model of surrogate decision-making specifying key concepts and theoretical relationships. Articles focusing upon decision-making for decisionally-incapacitated children were excluded. A total of eight theoretical models meeting the selection criteria were identified. Five key insights were that: 1) diagrammatic maps of surrogate decision-making lacked consistency with model descriptions; 2) most models focused on description of concepts with a lesser focus on relational linkages and propositions; 3) ethical concepts and relationships have been insufficiently depicted in conceptual maps; 4) little emphasis was placed on how theoretical frameworks might guide intervention development; and 5) minimal attempts have been made to situate surrogate decision-making within a grander conceptual framework of decision-making. Several theories of surrogate decision-making at adult EOL have been proposed but further theory development is needed for design of decision support interventions.

The design of patient decision support interventions: addressing the theory–practice gap

Although an increasing number of decision support interventions for patients (including decision aids) are produced, few make explicit use of theory. We argue the importance of using theory to guide design. The aim of this work was to address this theory-practice gap and to examine how a range of selected decision-making theories could inform the design and evaluation of decision support interventions. We reviewed the decision-making literature and selected relevant theories. We assessed their key principles, theoretical pathways and predictions in order to determine how they could inform the design of two core components of decision support interventions, namely, information and deliberation components and to specify theory-based outcome measures. Eight theories were selected: (1) the expected utility theory; (2) the conflict model of decision making; (3) prospect theory; (4) fuzzy-trace theory; (5) the differentiation and consolidation theory; (6) the ecological rationality theory; (7) the rational-emotional model of decision avoidance; and finally, (8) the Attend, React, Explain, Adapt model of affective forecasting. Some theories have strong relevance to the information design (e.g. prospect theory); some are more relevant to deliberation processes (conflict theory, differentiation theory and ecological validity). None of the theories in isolation was sufficient to inform the design of all the necessary components of decision support interventions. It was also clear that most work in theory-building has focused on explaining or describing how humans think rather than on how tools could be designed to help humans make good decisions. It is not surprising therefore that a large theory-practice gap exists as we consider decision support for patients. There was no relevant theory that integrated all the necessary contributions to the task of making good decisions in collaborative interactions. Initiatives such as the International Patient Decision Aids Standards Collaboration influence standards for the design of decision support interventions. However, this analysis points to the need to undertake more work in providing theoretical foundations for these interventions.

Adjuncts or adversaries to shared decision-making? Applying the Integrative Model of behavior to the role and design of decision support interventions in healthcare interactions

BackgroundA growing body of literature documents the efficacy of decision support interventions (DESI) in helping patients make informed clinical decisions. DESIs are frequently described as an adjunct to shared decision-making between a patient and healthcare provider, however little is known about the effects of DESIs on patients' interactional behaviors-whether or not they promote the involvement of patients in decisions.DiscussionShared decision-making requires not only a cognitive understanding of the medical problem and deliberation about the potential options to address it, but also a number of communicative behaviors that the patient and physician need to engage in to reach the goal of making a shared decision. Theoretical models of behavior can guide both the identification of constructs that will predict the performance or non-performance of specific behaviors relevant to shared decision-making, as well as inform the development of interventions to promote these specific behaviors. We describe how Fishbein's Integrative Model (IM) of behavior can be applied to the development and evaluation of DESIs. There are several ways in which the IM could be used in research on the behavioral effects of DESIs. An investigator could measure the effects of an intervention on the central constructs of the IM - attitudes, normative pressure, self-efficacy, and intentions related to communication behaviors relevant to shared decision-making. However, if one were interested in the determinants of these domains, formative qualitative research would be necessary to elicit the salient beliefs underlying each of the central constructs. Formative research can help identify potential targets for a theory-based intervention to maximize the likelihood that it will influence the behavior of interest or to develop a more fine-grained understanding of intervention effects.SummaryBehavioral theory can guide the development and evaluation of DESIs to increase the likelihood that these will prepare patients to play a more active role in the decision-making process. Self-reported behavioral measures can reduce the measurement burden for investigators and create a standardized method for examining and reporting the determinants of communication behaviors necessary for shared decision-making.