Family Decision-making Processes Research Articles

Delivering the diagnosis of multiple system atrophy: a multicenter survey on Japanese neurologists’ perspectives

BackgroundMultiple system atrophy (MSA) is a progressive, incurable, life-threatening neurodegenerative disease uniquely characterized by the risk of sudden death, which makes diagnosis delivery challenging for neurologists. Empirical studies on breaking a diagnosis of MSA are scarce, with no guidelines currently established. This study aimed to investigate neurologists’ current practices and experiences in delivering the diagnosis of MSA.MethodsWe conducted a multicenter online survey and employed a mixed-methods (quantitative and qualitative) study design in which responses to open-ended questions were analyzed qualitatively using critical incident technique.ResultsAmong the 194 neurologists surveyed, 166 opened the survey (response rate = 85.6%), of whom 144 respondents across various Japanese regions completed the survey. Accordingly, 92.3% and 82.8% of the participating neurologists perceived delivering the diagnosis of MSA and explaining the risk of sudden death as difficult, respectively. Factors independently associated with difficulties in diagnosis delivery included explaining the importance of the family decision making process in life-prolonging treatment, perceived difficulties in delivering information regarding the risk of sudden death, and perceived difficulties in differential diagnosis of MSA.ConclusionsOur findings showed that the majority of neurologists perceived delivering the diagnosis of MSA and explaining the risk of sudden death as difficult, which could have been associated with the difficulty of breaking the diagnosis of MSA. Difficulty in conveying bad news in MSA are caused by various factors, such as empathic burden on neurologists caused by the progressive and incurable nature of MSA, the need to explain complex and important details, including the importance of the family decision-making process in life-prolonging treatment, difficulty of MSA diagnosis, and communication barriers posed by mental status and cognitive impairment in patients or their family members. Neurologists consider various factors in explaining the risk of sudden death (e.g., patient’s personality, mental state, and degree of acceptance and understanding) and adjust their manner of communication, such as limiting their communication on such matters or avoiding the use of the term “sudden death” in the early stages of the disease. Although neurologists endeavor to meet the basic standards of good practice, there is room for the multiple aspects for improvement.

A Pilot Study of a Family Management Program for Parents of Children with Acute Lymphoblastic Leukemia

ObjectivesThe aim of this completed pilot study was to evaluate the feasibility of implementing a family management program (FMP) for parents of children with acute lymphoblastic leukemia (ALL). Data SourcesA convenience sample of 11 parents of preschool-aged children with ALL were recruited from an ambulatory chemotherapy-care clinic at a tertiary hospital in Thailand. Participants received three FMP sessions over 3 weeks. The FMP is based on two established family programs (ie, FMP-style framework and building on family strengths) and reviewed literature. The following measures were used to evaluate parents’ responses at baseline, postintervention, and follow-up: Family Management Measure, Beach-Center Family Quality-of-Life Scale, and Pediatric Quality of Life Inventory. Data were analyzed using one-way repeated-measures analysis of variance. ConclusionThe study results provide promising evidence that the FMP is feasible and improves family management and quality of life for parents of enrolled children with ALL. Implications for Nursing PracticeEducating pediatric oncology nurses and other healthcare professionals to replicate the FMP may help to provide better family management, and child quality of life support to future parents and other family members of young children diagnosed with ALL. This support should focus on educating parents about the potential effects of caring for a child with ALL on the family and fostering positive relationships within the family and offering guidance on effective family communications and decision-making processes.

Family Decision-Making Path for the Referral of Terminal Patients in Tertiary Hospitals

Objective To gain an in-depth understanding of the motivations,patterns,and related factors in family decision-making regarding the referral of terminal patients in tertiary hospitals. Methods Using purposive sampling,terminal patients and their family members from three tertiary hospitals in Beijing were selected as subjects.Semi-structured interviews were conducted,and the interview data were subjected to thematic analysis. Results Following the saturation principle,a total of 11 patients and 15 family members were included.The interview data were organized and analyzed,yielding six major themes:decision premises,decision patterns,family support,support from the referring hospital's medical team,referral channel conditions,and involvement of volunteer teams and social support.Based on these findings,a flowchart illustrating the family decision-making process for the referral of terminal patients was constructed. Conclusions The study provides a comprehensive analysis of various factors influencing family decision-making in the referral of terminal patients in tertiary hospitals.The results underscore the significance of internal and external factors,emphasizing the integrated impact of decision patterns,family support,medical team support,referral channel conditions,and the involvement of volunteer teams and social support.The research offers profound insights into improving the referral process for terminal patients and enhancing the quality of family decision-making.It provides valuable recommendations for future improvements in medical services and decision support.

Romanian transnational families: insights from a qualitative study on care workers

PurposeAn increasing number of international immigrant workers enter the EU labour market to fill the gap in many key economic sectors. Labour migration often implies a process of family adaptation and, in some cases, a breakdown in the community structure and networks. This study aims to provide insights into the dynamics of transnational families, focusing on changes in the redefinition of roles within family members and children care arrangements.Design/methodology/approachThe study was based on the analysis of 12 biographical interviews conducted using semi-structured interviews between November 2018 and December 2019 among Romanian women who worked as caregivers in families in an Italian metropolitan city and the surrounding urban area.FindingsDespite the economic dimension being essential, psychological well-being increasingly burdens workers’ migratory experience and that of their family members. Findings suggest including employers and children among the actively involved actors of the family decision-making process; working and contractual conditions as factors that significantly impact the opportunities and capability of workers to provide and receive care, mainly if the latter are employed in the informal market.Originality/valueThe study makes it possible to highlight that the dynamics in decision-making processes in transnational families change in the different phases of the migration project and involve numerous actors. These processes are not always rational and are strongly influenced by the labour market structure in which migrants are employed.

응용현상학과 임상의료윤리

This paper explores the intersection of applied phenomenology and clinical medical ethics, focusing on the work of Richard M. Zaner. The paper discusses how philosophers often find themselves in a precarious position in the clinical environment, where their principles, concepts, and theories are not directly applicable to clinical practice. The core argument revolves around the concept of human dignity, autonomy, and the “situated subject” in the context of illness. Zaner's approach to clinical ethics counseling suggests a shift from traditional ethical decision-making processes to a more engaged and dialogical method. He emphasizes understanding the patient's experience and context, considering the complexities of human interaction and communication in medical settings. The paper elaborates on Zaner's life and major works, his commitment to phenomenology, and his significant contributions to medical ethics. Zaner's methodology in clinical encounters and ethical consultations is examined, showcasing his unique approach to addressing ethical dilemmas in healthcare. Two cases are presented to illustrate Zaner's method in practice. The first case discusses the ethical dilemmas surrounding a critically ill newborn and the parents' role in decision-making. The second case involves the ethical considerations in the treatment of a terminally ill patient, highlighting the complexities of family dynamics and decision-making processes. In conclusion, the paper asserts that Zaner's achievements demonstrate the potential benefits of a phenomenological approach to clinical ethics. It suggests that this approach can bridge the gap between theory and practice in medical ethics, providing a more holistic and empathetic way of addressing ethical issues in healthcare.

International Study Abroad Tourism: A case study of the influence of Chinese families in location decision making

This paper explores the decision making process of Chinese students when choosing to study abroad, focusing on an under-represented group in the literature: students’ families. The paper has three objectives: 1) To explore the relationship between Chinese parents and their children in the context of a decision to study abroad; 2) To discover the rationale offered by parents for influencing their child’s decision; and 3) To investigate the role of the macro environment on the family decisionmaking process in the context of international education. Primary qualitative evidence is presented, drawing on semi-structured data collected in China with families between 2022–2023. During this period of time strict control of China’s borders remained in the context of pandemic management. The findings of the study reveal that parents in China exhibit high levels of involvement and interest in their children’s international education decisions. Financial capability empowers parents to have a stronger voice than their children concerning the decision-making process. Social capital is one of the motivations for parents to support the study abroad for their children. Destination managers, university management, recruitment agents and policymakers need to pay deeper attention to the role of parents in international education decision-making. A deeper understanding of parental ambitions, concerns and wishes would facilitate more targeted marketing and an improved student experience.

Critical care nurses' role in the decision-making process of withdrawal of life-sustaining treatment: A qualitative systematic review.

To synthesise the qualitative evidence regarding the role of critical care nurses in the decision-making process of withdrawing life-sustaining treatment in critically ill adults. Qualitative systematic review. This qualitative systematic review employed the guidelines of Bettany-Saltikov and McSherry. The review was reported according to the ENTREQ checklist. Pairs of authors independently assessed eligibility, appraised methodological quality and extracted data. Data were synthesised using thematic synthesis. CINAHL, MEDLINE and EMBASE were searched for studies published between January 2001 and November 2021. Twenty-three studies were included. Three analytical themes were synthesised: performing ethical decision-making to safeguard patients' needs rights, and wishes; tailoring a supporting role to guide the family's decision-making process; and taking on the role of the middleman by performing coordination. The role of the critical care nurses in the decision-making process in withdrawal of life-sustaining treatment requires experience and the development of the clinical perspective of critical care nurses. Enhanced knowledge of the decision-making process of withdrawing life-sustaining treatment can prepare critical care nurses to be more equipped to master this role and enhance their ability to handle the emotional and moral stress associated with this part of the critical care unit. The literature reveals the complex and challenging role of critical care nurses during the decision-making process of withdrawing life-sustaining treatment. Critical care nurses perform ethical decision-making to safeguard patients' concerns, guide the family's decision-making process and take on the role of the middleman. The findings have implications for critical nurses working in critical care units in hospitals and for educators and students in training in critical care nursing. No patient or public contribution was included.

The Association of Gender Based Violence (GBV) with Familial and Social Determinants and Mental Health Status of Bengali Married Working Women: A Cross-sectional Study

Background: Gender Based Violence (GBV) represents a severe violation of women's human rights beyond geographical, cultural, religious, social, and economic aspects. This study aimed to identify the prevalence of GBV, its association with mental health status, and familial and social determinants among the higher socio-economic married working women in Bangladesh. Methods: A cross-sectional study was conducted from June to November 2019 among the higher socio-economic married women working in Dhaka. To reach the targeted participants, five hundred sixty participants were recruited using multistage sampling. Women with a minimum graduate degree, monthly income >35000, and working outside were included in this study. A semi-structured questionnaire was used to collect data through a face-to-face interview. Mental health status was measured by 20 items on the CES-D scale. Descriptive statistics and bivariate (unadjusted) and multivariate (adjusted) logistic regression were used to explore the determinants and mental health status. Results: The mean age of participants was 35.7 ± 4.8 years. Around 13.6% of women faced GBV. The age, marriage duration, family type, monthly income, parental status, number of children, and education level showed a significant association with GBV. The binary logistic regression model found that the status of mental health was strongly significant in both unadjusted and adjusted models, OR (95% CI) =2.589 (1.577-4.252) and 4.542 (2.362-8.734). Participation in the family's decision-making process was strongly associated with GBV OR (95% CI) = 4.529 (2.332- 8.796). The attitude of the husband or in-laws was strongly significant in both unadjusted OR (95% CI) = 10.605 (4.988 - 22.548) and adjusted models 5.972 (1.836-19.421). Having a good understanding of the husband was strongly significant in two models, OR (95% CI) = 27.383 (13.568 -55.263) and 17.553 (6.160 -50.018). The odds of GBV, if any family members are suffering from chronic disease, were around six-fold higher among married working women in the unadjusted model OR (95% CI) =5.935 (2.791 - 12.623) and almost eight-fold higher in adjusted model 7.679 (2.293 -25.719). Time for attending social obligation was strongly significant in both unadjusted OR (95% CI)= 11.633 (5.239 -25.832) and adjusted model 24.402 (7.511 -79.277). Conclusion: The GBV prevalence was comparatively low, and it was found to be related to working women with higher socio-economic status. This issue should not be neglected as it impedes the empowerment of women, which is a global concern and developmental plan. Hence, there is a need to formulate better policies and programs to attain a gender-based, violence-free society.

Knowledge of Technical Nursing Professionals About the Subject of Brain Death and the Process of OrganDonation and Transplantation

Background: The low percentage of effective organ donations result from challenges encountered by the team in identifying and maintaining potential donors, the need for knowledge regarding the subject, and the health system’s structural adversities. It is the role of nursing to act actively throughout the family decision-making process, expanding the focus beyond the donation of organs and tissues, respecting the suffering of the family and providing integrated care to those involved. Objective: This study aims to verify the knowledge of technical nursing professionals working in an intensive care unit about brain death, organ donation, and transplantation. Method: A cross-sectional study in which the nursing technicians personnel from the General Adult Intensive Care Unit of a university hospital were interviewed and invited to answer a questionnaire containing demographic variables (age and gender), work (work shift, workload, another job, time in the position and if you have already witnessed the performance of a clinical test, and complementary examination of brain death), and the questions related to the process of organ donation and brain death, with descriptive and multiple choice questions. Result: A total of 137 nursing technicians were included in the study, predominantly female (80%). Of these, 97 (71%) did not consider themselves capable of answering questions about organ donation and transplants. When questioned about participation in events and training that addressed the subject of brain death, organ donation and transplants, 112 employees (82%) had never participated. When asked about “which professionals can diagnose brain death?,” 26% correctly answered the professional who is qualified to perform the diagnosis of brain death. Ninety percent of the study participants correctly stated that you must notify your family to be a donor. However, 50% of the technicians believe that it is necessary to register with an identification document valid in the country. Erroneously, 79% of the interviewees answered that it would not be required for the patient to be on mechanical ventilation to start the investigation of brain death. Conclusion: We concluded that there is a deficit in the knowledge of nursing technicians in intensive care units of the referred hospital regarding brain death and organ donation for transplantation.

The Role of Children in the Family Purchase Decision-Making Process About Healthy Versus Unhealthy Food

This study explores how children are involved in the family decision-making process when buying healthy vs unhealthy food, and whether this involvement is influenced by family emotional climate. Participants are 239 parents of 7 to 13 years old children. They completed a set of self-report questionnaire related to healthy and unhealthy foods perception; consumer purchase decision making process; children's influences strategies in food purchase; influence exerted by children in the food purchasing process; family cohesion, flexibility, and communication. The results highlight how the children used influence strategies and became more involved in consumer purchasing decisions when they come to unhealthy food than healthy food. The emotional family climate also modifies both the frequency of use and the level of participation in the consumer purchase decision making process. This study provides insight into the key predictors of the development of certain consumption skills in children and how they use them to influence the family purchase of healthy and unhealthy foods.

Unauthorized Love: Mixed-Citizenship Couples Negotiating Intimacy, Immigration, and the State by Jane Lilly López

Unauthorized Love centers relationships between U.S. citizens and U.S. noncitizens to document the reach of U.S. immigration law into the lives of mixed-citizenship families. Through an analysis of 56 ethnographic interviews with mixed-citizenship families, López examines interactions between families and the U.S. administrative state, family decision-making processes, and family reunification outcomes and consequences. Unauthorized Love demonstrates that governmental rejection and family separation is a central feature of U.S. immigration policy, with serious consequences for family-level integration in the United States. Chapter 1 introduces readers to mixed-citizenship couples by recounting their love stories and foreshadows the disparate paths families will navigate. While marriage is a mechanism available to U.S. citizens to extend citizenship rights to their spouses, immigrant applicants and their sponsors are not treated equally under the law. Chapter 2 provides a visual to demonstrate how the 1952 Immigration and Nationality Act (INA), the 1986 Immigration Marriage Fraud Amendments (IMFA), and the 1996 Illegal Immigration Reform and Immigrant Responsibility Act (IIRIRA) work collectively to systematically favor higher-class, more highly educated, and better-resourced immigrant applicants and citizen sponsors.

Determinants of Women’s Participation in Family Decision-Making Process in Bangladesh: Statistical Analysis

Determinants of Women’s Participation in Family Decision-Making Process in Bangladesh: Statistical Analysis

Analysis of death in children not submitted to cardiopulmonary resuscitation

ObjectiveDescribe the epidemiology of deaths in children not submitted to CPR, compare to a CPR group and evaluate patients’ medical records of those not submitted to CPR. MethodsObservational cross-sectional study assessing deaths between 2015 and 2018 in a pediatric tertiary hospital, divided into two groups: CPR and no- CPR. The source of data included the cardiorespiratory arrest register, based on Utstein style. Children's medical records in no-CPR group were researched by hand. Results241 deaths were included, 162 in CPR group and 79 in the no-CPR group. Preexisting diseases were observed in 98.3% of patients and prior advanced intervention in 78%. Of the 241 deaths, 212 (88%) occurred in the PICU, being 138/162 (85.2%) in CPR group and 74/79 (93.7%) in no-CPR group (p = 0.018). Bradycardia as the initial rhythm was five times more frequent in the CPR group (OR 5.06, 95% CI 1.94–13,19). There was no statistically significant difference regarding age, gender, preexisting diseases, and period of the day of the occurrence of death. Medical records revealed factors related to the family decision-making process or the suitability of therapeutic effort. Discrepancies between the practice of CPR and medical records were identified in 9/79 (11,4%) records allocated to the no-CPR group. ConclusionMost deaths with CPR and with the no-CPR occurred in the PICU. Bradycardia as the initial rhythm was five times more frequent in the CPR group. Medical records reflected the complexity of the decision not to perform CPR. Discrepancies were identified between practice and medical records in the no-CPR group.

Seen, heard and protected in their best interest: childhood construction within the worldview of the Fantse of Ghana

Children in Africa are generally construed to be marginalised due to their minimal involvement in family decision-making processes. This article, which provides a worldview of childhood construction among the Fantse of Ghana, draws on the PhD dissertation and other research studies by the author and uses the social constructivist theory by Vygotsky and Meyer Fortes� stages in the developmental cycle in domestic groups to explore children�s social standing. The expectation in the academy is that many of the worldviews in African societies should be waning. However, they prevail in some rural and urban communities in Ghana today. Significantly, the larger context of Fantse social systems promotes peer-learning and acculturation among children. Therefore, even though some children may be marginalised, the emphasis placed on children�s voices ensures their participation in decision-making in matters affecting them. This article recommends that Fantse social systems should be considered for ensuring compliance with child rights policies in Ghana.

Perceptions Toward the Use of Digital Technology for Enhancing Family Planning Services: Focus Group Discussion With Beneficiaries and Key Informative Interview With Midwives

BackgroundModern family planning (FP) methods allow married couples to discuss and determine the number of children and years of spacing between them. Despite many significant improvements in FP services in Jordan, there are still many issues related to the uptake of FP services for both host communities and Syrian refugees, due to limitations in the health care system based on public health facilities. Digital technologies can provide opportunities to address the challenges faced in the health system, thus offering the potential to improve both coverage and quality of FP services and practices.ObjectiveThe aim of this study was to explore the perceptions of Jordanian women, Syrian refugees, and midwives in Jordan toward the use of digital health technology to support and enhance access to FP services.MethodsWe employed a qualitative study based on semistructured, face-to face key informative interviews with 17 midwives (providers) and focus group discussions with 32 married women of reproductive age (clients). Both midwives and clients were recruited from 9 health centers in 2 major governorates in Jordan (Irbid and Mafraq), where 17 in-depth interviews were conducted with midwives and 4 focus groups were conducted with the women. Each focus group included 4 Syrian refugees and 4 Jordanian women. The transcribed narratives were analyzed using inductive thematic analysis.ResultsThree major themes were derived from the narratives analysis, which covered the pros of using digital technology, concerns about digital technology use, and the ideal app or website characteristics. Ten subthemes emerged from these 3 main themes. Overall, midwives and women (Syrian refugees and host communities) agreed that digital technology can be feasible, cost-effective, well accepted, and potentially beneficial in increasing woman’s awareness and knowledge regarding the FP methods and their side effect. Furthermore, digital technology can assist in enabling women’s empowerment, which will allow them to make better decisions regarding FP use. No harmful risks or consequences were perceived to be associated with using digital technology. However, several concerns regarding digital technology use were related to eHealth literacy and the accuracy of the information provided. Midwives were mainly concerned about the patients who would rely mostly on the technology and choose to avoid consulting a health care professional.ConclusionsAs perceived by midwives and women, incorporating digital technology in FP services can be feasible, cost-effective, well accepted, and potentially beneficial in increasing woman’s awareness regarding the FP methods and their side effect. It may also empower the women to play an active role in the shared (with their husband and family) decision-making process. Therefore, digital technologies are recommended to address the challenges faced in health system and to improve both the coverage and the quality of FP services and practices.

Societal and environmental impacts of seaweed farming in relation to rural development: The case of Kibuyuni village, south coast, Kenya

Seaweed cultivation has become a major alternative source of livelihood to a number of coastal inhabitants in developing countries. It has a high return on investment compared to activities like fishing. Farming was introduced to communities in the south coast of Kenya to improve the wellbeing and enhance development initially with one village (Kibuyuni) but has currently spread to five other villages and continue to interest more participants. The current study aimed to understand the societal and environmental impacts of seaweed farming at Kibuyuni village in the south coast of Kenya to inform management interventions in the coastal areas. A multidisciplinary research approach using different methods including observation, surveys, focus group discussion and field experiments were used to collect data. Secondary data was mined from grey literature on the project that included project reports, farm records and unpublished status reports. On growth of seaweeds, the study revealed that off bottom culture method provided better growth rates and was fully adopted by farmers. Seaweed farming is practised within specific times of the day and month thus offer flexibility in involvement of farmers and labourers to participate in other income generating activities for diversification and spreading of risks. Further, the farming has different production chains that create employment for casual labourers. The industry raised a total of $ 12,000 direct income to Kibuyuni village through sell of dry seaweeds in 2017 in addition to other indirect benefits accrued. Income gained from sell of dry seaweed revolutionised the village through construction of modern houses, paying of school fees, medical care, food security and nutrition among other investments. Women form the highest proportion of seaweed farmers (75.2%) while youth and men contribute 7.62% and 17.14% respectively. Income earned from the business has given women an opportunity to contribute in the family decision-making process. Prices for dry seaweeds have fluctuated over time though the local buyers have maintained the purchasing power. During the last years, farmers have been involved in fabrication of value added products from seaweeds like soaps, salad, shampoo and fish feed with an aim of increasing revenue from seaweed farming. Investments in seaweed farming enterprises at Kibuyuni have opened the village to development of road networks and electrical power supply. The study found out that seaweed farming has minimal environmental impacts to the marine (herbivores fish increased while carnivores fish decreased after establishment of farmers) and terrestrial ecosystem bordering the farms. Therefore seaweed-farming has a potential of impacting positively on the wellbeing of coastal communities if proper management interventions are put in place to mitigate the associated negative impacts that may arise in addition to broader effects of development like migrations that are currently minimal.

Some Reflections on Educated Mothering

On the basis of interviews of a total of 75 mothers belonging to varied socio-economic backgrounds in a village in Odisha, this article argues that educated mothers play an active role in family decision-making processes that relate to daughters’ education and future career paths. From the early school years of their children, educated mothers use their informed experiences to sketch future career paths. The views of mothers on children’s present schooling and their ideas about further education and occupation plans are discussed. The present exploratory empirical village study finds that irrespective of their caste origins, the educational attainment of mothers brings a change in their outlook, gives them confidence to guide children’s schooling and participate in the family decision-making processes on education and career goals.

Factors affecting adolescents' risk-taking in single-child families

Introduction: Given the current concerns about population decline and the prevalence of single-child families, as well as risky behaviors which are increasing in the community, there is a need to provide backgrounds for more information regarding the characteristics of single child and factors affecting the risk-taking of adolescents in these families to modify the risk factors of these in adolescents. Methods: This is a descriptive, analytical study. The sample was single-child adolescents and their parents conducted in the census method. The data collection tools were demographics questionnaires, Iranian adolescents risk-taking, and Baumrind parenting style inventory completed by the participants in health centers of Qazvin, Iran, in 2017–2018. The SPSS software version 24 as well as step-wise multiple linear regression model were used to analyze the data. Results: One hundred and seventeen adolescents aged 12–19 years participated in this study. About 79% of mothers and 69.3% of fathers had high education. Most of the mothers were homemakers (62.9%) and fathers were employees (76.9%). The regression model demonstrated that emotional and social supports reduce risk-taking. If a decision-maker or supervisor for a teenager is someone other than parents, moreover, when the number of meals served by parents is less than twice a day and lack of leisure-time increase the risky behaviors (adjusted R2 = 0.66, P = 0.003). Conclusion: Although many factors affect the risk-taking of adolescents in single-child families, parents can reduce their adolescents' risk-taking by increasing their social and emotional supports, planning for spending more time, and allowing them to participate in family decision-making process.

Children's influence in museum visits: antecedents and consequences

ABSTRACTFamilies are an important target group for museums. To attract them, museum managers use diverse marketing measures when addressing parents. However, children often influence family decision-making processes significantly. This study investigates the determinants and consequences of children's influence on museum visit decisions. Research questions focus on the decision process variations among family groups. Literature on family decision making and family consumption serves as a basis for the conceptual framework. A sample of families visiting a museum (n = 167) is used to conduct a survey. By applying factor and cluster analyses, several profiles are distinguished on the joint basis of children's interaction modes, their expertize, what families are interested in and individual preferences for museum visits. The revealed profiles enable museum managers to segment and target different types of family audiences. Conceptually, the study deepens the focus on family dynamics and widens the perspective on decision-making processes concerning museum visits.

Decision making in pediatric hematopoietic cell transplantation: Influential factors vary among diseases.

Hematopoietic cell transplantation (HCT) is not a trivial treatment decision in pediatrics. We sought to understand what influences this decision-making process from the perspectives of the pediatric patients, their family, and physicians. Using integrative review methods, we identified 19 relevant studies: six qualitative, ten quantitative, and three mixed methods. Synthesis of the results revealed six themes describing patient, family, and provider decision-making processes with distinct subthemes contrasting influential factors among malignant and nonmalignant diseases. Identification of what influences HCT decision making will aid in development of decision support, education, and communication strategies. The child/adolescent voice and provider perspective warrant more attention.