Initial Preference Research Articles

Patients' and Providers' Needs and Preferences When Considering Fertility Preservation Before Cancer Treatment: Decision-Making Needs Assessment.

BackgroundAs cancer treatments continue to improve, it is increasingly important that women of reproductive age have an opportunity to decide whether they want to undergo fertility preservation treatments to try to protect their ability to have a child after cancer. Clinical practice guidelines recommend that providers offer fertility counseling to all young women with cancer; however, as few as 12% of women recall discussing fertility preservation. The long-term goal of this program is to develop an interactive web-based patient decision aid to improve awareness, access, knowledge, and decision making for all young women with cancer. The International Patient Decision Aid Standards collaboration recommends a formal decision-making needs assessment to inform and guide the design of understandable, meaningful, and usable patient decision aid interventions.ObjectiveThis study aims to assess providers’ and survivors’ fertility preservation decision-making experiences, unmet needs, and initial design preferences to inform the development of a web-based patient decision aid.MethodsSemistructured interviews and an ad hoc focus group assessed current decision-making experiences, unmet needs, and recommendations for a patient decision aid. Two researchers coded and analyzed the transcripts using NVivo (QSR International). A stakeholder advisory panel guided the study and interpretation of results.ResultsA total of 51 participants participated in 46 interviews (18 providers and 28 survivors) and 1 ad hoc focus group (7 survivors). The primary themes included the importance of fertility decisions for survivorship, the existence of significant but potentially modifiable barriers to optimal decision making, and a strong support for developing a carefully designed patient decision aid website. Providers reported needing an intervention that could quickly raise awareness and facilitate timely referrals. Survivors reported needing understandable information and help with managing uncertainty, costs, and pressures. Design recommendations included providing tailored information (eg, by age and cancer type), optional interactive features, and multimedia delivery at multiple time points, preferably outside the consultation.ConclusionsDecision making about fertility preservation is an important step in providing high-quality comprehensive cancer care and a priority for many survivors’ optimal quality of life. Decision support interventions are needed to address gaps in care and help women quickly navigate toward an informed, values-congruent decision. Survivors and providers support developing a patient decision aid website to make information directly available to women outside of the consultation and to provide self-tailored content according to women’s clinical characteristics and their information-seeking and deliberative styles.

Applicant initial preferences: The relationship with job choices

AbstractAlthough the various factors that predict applicant attitudes and decisions during recruitment have been explored, far less is known about the decision‐making process applicants go through to develop attitudes to facilitate job choice decisions. In a field sample (Study 1), applicant initial preferences across four firms predicted the trajectory of subsequent organizational attraction toward the firms over the 5‐month recruiting cycle. Further, these initial preferences significantly predicted job choice decisions at the end of the recruiting cycle. Applicants’ organizational attraction trajectories that developed during the entire recruiting process mediated this relationship. Findings in a laboratory sample (Study 2) were consistent with research on predecisional information distortion (PID). Applicants evaluated the information presented about two hypothetical recruiting companies and overly favored the company that was installed as applicants’ initial preference. Initial preferences had a significant indirect effect on job choice through total PID when the information about the two companies was equivalent and when the initially preferred company was moderately worse. However, the indirect effect was not significant when the initially preferred company was presented as severely worse. Applicants arriving at job choice decisions using biased information evaluations driven by initial preferences can adversely affect both organizations and applicants’ careers.

Individual risk prediction of urinary incontinence after prostatectomy and impact on treatment choice in patients with localized prostate cancer.

Individualized information about the risk of incontinence after prostatectomy could help patients in shared decision-making. We compared a historical control cohort (n = 254; between June 2016 and 2017) that received standardized information about the risk of incontinence after robot-assisted radical prostatectomy (RARP) with a prospective patient cohort (n = 254; between June 2017 and May 2018) that received individualized information of the chance of recovery of incontinence within 6 months postoperatively based on the continence prediction tool (CPRED). We measured switch in treatment choice, health-related quality of life (QoL) in both cohorts and the accuracy of the CPRED tool. Patients in the individualized information group with RARP as initial preference switched more often to another treatment than patients who received standardized information (16% vs. 5%; p = 0.001). Patients in the individualized information group with a high risk of incontinence and with RARP as initial preference switched more often to other treatments than patients in intermediate/low risk of incontinence (35% vs. 9.8%; p = 0.001). Patients with a low risk of incontinence choosing RARP after individualized information were less likely to use more than one diaper a day at any time postoperative (p = 0.001) compared to men with an intermediate/high incontinence risk. Overall QoL was worse in patients with incontinence than patients with continence 6 and 12 months after RARP (respectively;p < 0.0001 and p = 0.007). Personalized information about the risk of incontinence after RARP makes more patients reconsidering their initial treatment preference. The CPRED correlated strongly with continence outcome after RARP and is a useful tool for shared decision-making.

Effect of a discordant opinion offered by a second opinion physician on the patient’s decision for management of spinal disc disease

BackgroundFactors that influence a patient’s decision for spinal surgery and selection of the spine surgeon have not been studied in the context of a Second Opinion (SO). Providing insight into these factors will guide surgeons in their discussion of treatment options with patients. ObjectiveThis study aims to assess the impact of a discordant SO on the final decision of patients as compared to their initial preference regarding spinal disc disease treatment for chronic neck and low back pain. Patient involvementPatients in this study engage in clinical vignettes designed to induce decisional conflict. MethodsA cross-sectional study using clinical vignette-based questionnaires was presented to patients at the Family Medicine, Orthopedic, and Neurosurgery clinics at a university-based tertiary academic medical center. ResultsA total of 246 patients participated in the study (response rate, 66.8%). Irrespective of the initial offered treatment, most patients wanted to consult a SO (64.2%). Most patients preferred conservative treatment to surgery after getting the initial recommendation (78.5%) and after getting a discordant SO (56.5%). There was an association between the agreement of the patient with the initial recommendation and the effect of the SO on the final decision of patients (p < 0.001). Patients who disagreed with the initially offered treatment were more likely to abide by their initial decision after the SO (80.8%) as compared to those who were in agreement (17.7%), while those who agreed with the initially offered treatment were more likely to change their decision (39.5%) or to take a third opinion (42.9%). DiscussionA discordant SO may validate patients’ wishes when they disagree with the initially offered treatment and may lead to confusion when they agree with the initial physicians’ recommendations. Practical valueAs patients tend to abide by their initial preference, physicians should explicitly consider patients’ wishes when discussing options for management of spinal disc disease.

Protein Appetite Drives Macronutrient-Related Differences in Ventral Tegmental Area Neural Activity.

Control of protein intake is essential for numerous biological processes as several amino acids cannot be synthesized de novo, however, its neurobiological substrates are still poorly understood. In the present study, we combined in vivo fiber photometry with nutrient-conditioned flavor in a rat model of protein appetite to record neuronal activity in the VTA, a central brain region for the control of food-related processes. In adult male rats, protein restriction increased preference for casein (protein) over maltodextrin (carbohydrate). Moreover, protein consumption was associated with a greater VTA response, relative to carbohydrate. After initial nutrient preference, a switch from a normal balanced diet to protein restriction induced rapid development of protein preference but required extensive exposure to macronutrient solutions to induce elevated VTA responses to casein. Furthermore, prior protein restriction induced long-lasting food preference and VTA responses. This study reveals that VTA circuits are involved in protein appetite in times of need, a crucial process for animals to acquire an adequate amount of protein in their diet.SIGNIFICANCE STATEMENT Acquiring insufficient protein in one's diet has severe consequences for health and ultimately will lead to death. In addition, a low level of dietary protein has been proposed as a driver of obesity as it can leverage up intake of fat and carbohydrate. However, much remains unknown about the role of the brain in ensuring adequate intake of protein. Here, we show that in a state of protein restriction a key node in brain reward circuitry, the VTA, is activated more strongly during consumption of protein than carbohydrate. Moreover, although rats' behavior changed to reflect new protein status, patterns of neural activity were more persistent and only loosely linked to protein status.

Ambiguity under growing awareness

In this paper, we study choice under growing awareness in the wake of new discoveries. The decision maker's behavior is described by two preference relations, one before and one after new discoveries are made. The original preference admits a subjective expected utility representation. As awareness grows, the original decision problem expands and so does the state space. Therefore, the decision maker's original preference has to be extended to a larger domain, and consequently the new preference might exhibit ambiguity aversion. We propose two consistency notions that connect the original and new preferences. Unambiguity Consistency requires that the original states remain unambiguous while new states might be ambiguous. This provides a novel interpretation of ambiguity aversion as a systematic preference to bet on old states than on newly discovered states. Likelihood Consistency requires that the relative likelihoods of the original states are preserved. Our main results axiomatically characterize a maxmin expected utility (MEU) representation of the new preference that satisfies the two consistency notions. We also extend our model by allowing the initial preference to be MEU, and characterize reverse full-Bayesianism, which is an extension of the reverse Bayesianism of Karni and Vierø (2013) to MEU preferences.

Conservative or Aggressive? The Dynamic Adjustment of the Feed-in Tariff Policy for Photovoltaic Power Generation in China

With the technological progress of photovoltaic (PV) enterprises, the subsidy standard of PV power generation in China is declining. However, the conservative adjustment of feed-in tariff (FIT) policy is considered to increase the financial burden of the government, while the aggressive adjustment will have a serious impact on the PV enterprises and may reduce the research and development (R&amp;amp;D) investment of them. By constructing a game model between the government and PV enterprises, this article analyzes the relationship between the adjustment of government subsidy policy and R&amp;amp;D investment of PV enterprises. The evolution path and strategic stability of the system have been studied through evolutionary analysis and numerical simulation. Results show that three strategies may become the evolutionary stability strategy (ESS) of the system under certain conditions. Firstly, the investigation of these conditions reveals the strategy that the government chooses conservative adjustment and enterprises choose to increase R&amp;amp;D investment is more likely to be an ESS. Secondly, the initial preference of the government and enterprises cannot change the final result of system evolution, but only changes the speed of reaching it. Finally, the research on the interaction between government and enterprises illustrates that when the degree of influence is small, the ESS is that the government chooses aggressive adjustment and enterprises choose to increase R&amp;amp;D investment. But when the degree of influence is large enough, the government is more inclined to choose conservative adjustment and enterprises choose to increase R&amp;amp;D investment. The decision-making of the government should be focused on the interaction between the government and enterprises. The encouraging cooperation among PV enterprises, universities, and research institutions can promote the technological progress of the PV industry, so as to achieve the purpose of subsidy policies more effectively.

Intergroup Competition Mitigates Effects of Reward Structure on Preference-Consistency Bias and Group Decision Failure

Group discussion often becomes one-sided and confirmatory, with poor decisions as the unfortunate outcome. Here we examine whether intergroup competition amplifies or mitigates effects of individual versus team reward on information sharing biases and group decision quality. Individuals (N = 309) in 103 interacting groups were given private information on four decision alternatives and discussed a joint decision. Private information was distributed such that groups faced a “hidden profile” in which pushing for initial preferences and commonly held information prohibits the group from finding the best alternative. Group members were rewarded for team or individual performance, and groups faced intergroup competition or not. Whereas intergroup competition did not influence common-information bias, we find that when intergroup competition is absent, groups under individual (versus team) reward have stronger preference-consistency bias and make poorer decisions. When intergroup competition is present, however, groups under individual reward perform as good as groups under team reward. Results resonate with the possibility that intergroup competition overshadows within-group rivalry, and can promote even-handed discussions within small groups of decision-makers.

Young chicks quickly lose their spontaneous preference to aggregate with females

It is not clear when and how animals start to discriminate between male and female conspecifics and how this distinction drives their social behaviour. A study on pheasants found that 1-week-old chicks (Phasianus colchicus) preferentially aggregated with same-sex peers and this trend became more pronounced through development, suggesting that sexual segregation increases during ontogeny. However, it remains unclear whether this ability depends on experience or develops spontaneously. Using a similar experimental protocol, we investigated whether sex discrimination is present at birth in domestic chickens (Gallus gallus) by testing the social preferences of young chicks with clutch mates. We measured the amount of time spent close to male and female conspecifics in visually inexperienced chicks. Soon after hatching, both males and females preferentially aggregated with females. To clarify whether the experience with conspecifics modifies the initial preference for females, we used an imprinting procedure. We exposed chicks to conspecifics of the same sex, different sex or both sexes for 3 days and then tested their preferences to aggregate with males or females. No sex preference was observed after 3 days of imprinting exposure. The disappearance of the initial sex preference shows that, although chicks can discriminate between conspecifics of different sex, sex segregation does not influence sex preferences in the first week of life. We suggest that the absence of sexual assortment in the first week of age can enhance the social cohesion of the flock. The ability to discriminate males from females affects a wide range of social behaviours, including the preferences for own sex conspecifics during sex segregation and the choice of a partner in the mating period. However, it remains unclear when and how males and females start to discriminate members of the same/different sex. We tested the domestic chicks to explore whether sex discrimination is present at birth or appears later on. Males and females discriminated between sexes at hatching and preferred to spend more time with female chicks. However, this preference disappeared after exposure to same-sex, different-sex or mixed-sex chicks. The lack of a preference for a specific sex may increase group cohesion postponing the appearance of sex segregation later in life, when chicks move further from their group.

No preference for prosocial helping behavior in rats with concurrent social interaction opportunities.

Helping behavior tasks are proposed to assess prosocial or "empathic" behavior in rodents. This paradigm characterizes the behavior of subject animals presented with the opportunity to release a conspecific from a distressing situation. Previous studies found a preference in rats for releasing restrained or distressed conspecifics over other controls (e.g., empty restrainers or inanimate objects). An empathy account was offered to explain the observed behaviors, claiming subjects were motivated to reduce the distress of others based on a rodent homologue of empathy. An opposing account attributes all previous results to subjects seeking social contact. To dissociate these two accounts for helping behavior, we presented subject rats with three simultaneous choice alternatives: releasing a restrained conspecific, engaging a nonrestrained conspecific, or not socializing. Subjects showed an initial preference for socializing with the nonrestrained conspecific, and no preference for helping. This result contradicts the empathy account, but is consistent with the social-contact account of helping behavior.

The Science of Effective Group Process: Lessons for Clinical Competency Committees.

The Science of Effective Group Process: Lessons for Clinical Competency Committees.

Quality of group decisions by board members: a hidden-profile experiment

PurposeReaching decisions in a deliberative manner is of utmost importance for boards, as their decision-making impacts entire organisations. The current study aims to investigate (1) the quality of group decisions made by board members, (2) their confidence in, satisfaction with, and reflection on the decision-making, and (3) the effect of two discussion procedures on objective decision quality and subjective evaluations of the decision-making.Design/methodology/approachBoard members of various Dutch non-profit organisations (N = 141) participated in a group decision-making task and a brief questionnaire. According to the hidden-profile paradigm, information was asymmetrically distributed among group members and should have been pooled to reach the objectively best decision. Half of the groups received one of two discussion procedures (i.e. advocacy decision or decisional balance sheet), while the other half received none.FindingsOnly a fifth of the groups successfully chose the best decision alternative. The initial majority preference strongly influenced the decision, which indicates that discussion was irrelevant to the outcome. Nevertheless, board members were satisfied with their decision-making. Using a discussion procedure enhanced participants' perception that they adequately weighed the pros and cons, but did not improve objective decision quality or other aspects of the subjective evaluation. These findings suggest that board members are unaware of their biased decision-making, which might hinder improvement.Originality/valueRather than using student samples, this study was the first to have board members participating in a hidden-profile task.

Culture and prevalence of sanctioning institutions

To investigate the impact of culture on the acceptance and prevalence of sanctioning institutions, we report the results of controlled lab experiments in two countries with substantial cultural differences: Germany and Turkey. We find, if a sanctioning institution is one of two alternatives that individuals can freely choose in an endogenous setting, then it is the clear winner against a non-sanctioning institution, both in Germany and Turkey. Though there are some differences in initial institutional preferences and contributions in both countries, the dynamics of institution choice, the evolution of contributions and sanctioning behavior are remarkably similar. Our results extend the findings of a previous study by Herrmann, Thöni, and Gächter (2008) that finds less cooperative behaviors in some countries (among them Turkey) if the sanctioning institutions are exogenous. We show that in one of those countries, Turkey, in an endogenous setting, sanctioning institutions beneficial to societies are adapted and prevail.

The hierarchical sensitivity to social misalignment during decision-making under uncertainty

Social misalignment occurs when a person’s attitudes and opinions deviate from those of others. We investigated how individuals react to social misalignment in risky (outcome probabilities are known) or ambiguous (outcome probabilities are unknown) decision contexts. During each trial, participants played a forced-choice gamble, and they observed the decisions of four other players after they made a tentative decision, followed by an opportunity to keep or change their initial decision. Behavioral and event-related potential data were collected. Behaviorally, the stronger the participants’ initial preference, the less likely they were to switch their decisions, whereas the more their decisions were misaligned with the majority, the more likely they were to switch. Electrophysiological results showed a hierarchical processing pattern of social misalignment. Misalignment was first detected binarily (i.e. match/mismatch) at an early stage, as indexed by the N1 component. During the second stage, participants became sensitive to low levels of misalignment, which were indexed by the feedback-related negativity. The degree of social misalignment was processed in greater detail, as indexed by the P3 component. Moreover, such hierarchical neural sensitivity is generalizable across different decision contexts (i.e. risky and ambiguous). These findings demonstrate a fine-grained neural sensitivity to social misalignment during decision-making under uncertainty.

Selective exposure in action: Do visitors of product evaluation portals select reviews in a biased manner?

Most people in industrialized countries regularly purchase products online. Consumers often rely on previous customers’ reviews to make purchasing decisions. The current research investigates whether potential online customers select these reviews in a biased way and whether typical interface properties of product evaluation portals foster biased selection. Based on selective exposure research, potential online customers should have a bias towards selecting positive reviews when they have an initial preference for a product. We tested this prediction across five studies (total N = 1376) while manipulating several typical properties of the review selection interface that should – according to earlier findings – facilitate biased selection. Across all studies, we found some evidence for a bias in favor of selecting positive reviews, but the aggregated effect was non-significant in an internal meta-analysis. Contrary to our hypothesis and not replicating previous research, none of the interface properties that were assumed to increase biased selection led to the predicted effects. Overall, the current research suggests that biased information selection, which has regularly been found in many other contexts, only plays a minor role in online review selection. Thus, there is no need to fear that product evaluation portals elicit biased impressions about products among consumers due to selective exposure.

Selective exposure in action: Do visitors of product evaluation portals select reviews in a biased manner?

Most people in industrialized countries regularly purchase products online. Consumers often rely on previous customers’ reviews to make purchasing decisions. The current research investigates whether potential online customers select these reviews in a biased way and whether typical interface properties of product evaluation portals foster biased selection. Based on selective exposure research, potential online customers should have a bias towards selecting positive reviews when they have an initial preference for a product. We tested this prediction across five studies (total N = 1376) while manipulating several typical properties of the review selection interface that should – according to earlier findings – facilitate biased selection. Across all studies, we found some evidence for a bias in favor of selecting positive reviews, but the aggregated effect was non-significant in an internal meta-analysis. Contrary to our hypothesis and not replicating previous research, none of the interface properties that were assumed to increase biased selection led to the predicted effects. Overall, the current research suggests that biased information selection, which has regularly been found in many other contexts, only plays a minor role in online review selection. Thus, there is no need to fear that product evaluation portals elicit biased impressions about products among consumers due to selective exposure.

Comprehensive minimum cost models for large scale group decision making with consistent fuzzy preference relations

Nowadays, society demands group decision making (GDM) problems that require the participation of a large number of experts, so-called large scale group decision making (LS-GDM) problems. Logically, the more experts are involved in the decision making process, the more common is the emergence of disagreements in the group. For this reason, consensus reaching processes (CRPs) are key in the resolution of these problems in order to smooth such disagreements in the group and reach consensual solutions. A CRP requires that experts are receptive to change their initial preferences, but demanding excessive changes could lead to deadlocks. The well-known minimum cost consensus (MCC) model allows to obtain an agreed solution by preserving experts’ preferences as much as possible. However, this MCC model only considers the distance among experts and collective opinion, which is not enough to guarantee a desired degree of consensus. To overcome this limitation, it was proposed comprehensive MCC models (CMCC) in which both consensus degree and distance are considered, and CMCC models deal with fuzzy preference relations (FPRs) for modeling experts’ opinions. However, these models are not efficient to deal with LS-GDM problems and the FPRs consistency is ignored in them. Therefore, this paper aims to propose new CMCC models focused on LS-GDM problems in which experts use FPRs whose consistency is taken into account in order to obtain reliable results. A case study is introduced to show the effectiveness of the proposed models.

Exploring and reconciling discordance between documented and preferred resuscitation preferences for hospitalized patients: a quality improvement study.

A discordance, predominantly towards overtreatment, exists between patients' expressed preferences for life-sustaining interventions and those documented at hospital admission. This quality improvement study sought to assess this discordance at our institution. Secondary objectives were to explore if internal medicine (IM) teams could identify patients who might benefit from further conversations and if the discordance can be reconciled in real-time. Two registered nurses were incorporated into IM teams at a tertiary hospital to conduct resuscitation preference conversations with inpatients either specifically referred to them (group I, n = 165) or randomly selected (group II, n = 164) from 1 August 2016 to 31 August 2018. Resuscitation preferences were documented and communicated to teams prompting revised resuscitation orders where appropriate. Multivariable logistic regression was used to determine potential risk factors for discordance. Three hundred and twenty-nine patients were evaluated with a mean (standard deviation) age of 80 (12) and Charlson Comorbidity Index Score of 6.8 (2.6). Discordance was identified in 63/165 (38%) and 27/164 (16%) patients in groups I and II respectively. 42/194 patients (21%) did not want cardiopulmonary resuscitation (CPR) and 15/36 (41%) did not prefer intensive care unit (ICU) admission, despite these having been indicated in their initial preferences. 93% (84/90) of patients with discordance preferred de-escalation of care. Discordance was reconciled in 77% (69/90) of patients. Hospitalized patients may have preferences documented for CPR and ICU interventions contrary to their preferences. Trained nurses can identify inpatients who would benefit from further in-depth resuscitation preference conversations. Once identified, discordance can be reconciled during the index admission.

Dimension reduction of preference profile for aggregation of energy audit data

The paper aims to improve a technique based on preference aggregation, which allows to process a big amount of data from instrumental examinations of energy losses by substations of electrical energy distribution networks. An approach to transformation of the initial preference profile into the hierarchical one is considered. The absence of the influence of such a transformation on the correctness of processing results is shown. The workability of the proposed method is demonstrated on the basis of real energy surveys using the example of the Khakass enterprise of the Backbone Electric Grids (BEGs), being a part of Siberian BEG of the Unified National Electric Network of Russia. The method makes it possible to identify sources of economically inefficient expenditure of energy resources and unjustified energy losses, and also to provide compression of large volumes of energy survey data without diminution of essential information. The proposed method allows obtaining and representing a great amount of data of instrumental survey of substation energy losses in a form of a compact integral estimate in the ordinal scale. It can be an appropriate and promising tool for organizations engaged in energy consulting.

Expandable Preference Lists: A Mechanism for College Admissions in a Large Market

Although Gale-Shapley’s student optimal stable matching mechanism (SOSM) has desirable properties, it is infeasible for college admissions in a large market because it is impossible to ask every student to provide a complete ranking of thousands of colleges. Regarding college admissions problems in large-scale contexts, this paper introduces a new matching mechanism that allows students to provide incomplete but expandable preference lists (EPLs). In contrast to the standard one-shot (direct-revelation) or multirun (sequential-like) designs, the EPL mechanism matches students and colleges in a continuous period. Before the matching period begins, every college provides an algorithm to give a complete strict preference list over all students to the clearinghouse, whereas every student only needs to provide an incomplete initial preference list. During the matching period, (1) every student can expand her own preference list but cannot withdraw or change the order of colleges in her already submitted preference list; (2) the clearinghouse produces and updates the virtual (not final) matching results according to SOSM; and (3) a student can confirm (finalize) her own “best match” without the need to wait until the matching period ends. Theoretical analysis suggests that the EPL mechanism not only inherits much of the desirable stability and incentive properties of the SOSM but is also partially obviously strategy-proof. This paper proposes that by allowing interaction among participants, we can design matching mechanisms with more desirable properties.