Level Of Involvement In Decision-making Research Articles

Between Appeasement and Accommodation: Kōmeitō's Policy Influence under Second Abe Administration

Abstract This study examines the Kōmeitō's strategies for policy influence within the coalition framework with its coalition partner, the Liberal Democratic Party (LDP) during the period of Second Abe Administration (2012–2020). As a junior coalition partner, Kōmeitō faces unity–distinctiveness dilemma, where it must accommodate policy demands of the senior partner while appeasing its core support base, Sōka Gakkai. This article argues that the junior partner's strategies for policy influence are determined by two factors: overlap/distinctiveness of policy inclinations and the positive/negative issue associations measured by the level of involvement in decision-making, i.e. portfolio allocation. Three cases are analyzed to elucidate the diversity of Kōmeitō's policy influence, the strategies of which range from corrective moderation, to nudging, to threats, all utilized to maintain a balance between reinforcing “distinctiveness” from the senior partner and consolidating coalition coherence to sustain competence within the coalition framework.

Varying (preferred) levels of involvement in treatment decision-making in the intensive care unit before and during the COVID-19 pandemic: a mixed-methods study among relatives

BackgroundIn the intensive care unit (ICU) relatives play a crucial role as surrogate decision-makers, since most patients cannot communicate due to their illness and treatment. Their level of involvement in decision-making can affect their psychological well-being. During the COVID-19 pandemic, relatives’ involvement probably changed. We aim to investigate relatives’ involvement in decision-making in the ICU before and during the pandemic and their experiences and preferences in this regard.MethodsA mixed-methods study among relatives of ICU patients admitted to an ICU before or during the COVID-19 pandemic. Relatives in six ICUs completed a questionnaire (n = 329), including two items on decision-making. These were analysed using descriptive statistics and logistic regression analyses. Subsequently, relatives (n = 24) were interviewed about their experiences and preferences regarding decision-making. Thematic analysis was used for analysing the qualitative data.ResultsNearly 55% of the relatives indicated they were at least occasionally asked to be involved in important treatment decisions and of these relatives 97.1% reported to have had enough time to discuss questions and concerns when important decisions were to be made. During the first COVID-19 wave relatives were significantly less likely to be involved in decision-making compared to relatives from pre-COVID-19. The interviews showed that involvement varied from being informed about an already made decision to deliberation about the best treatment option. Preferences for involvement also varied, with some relatives preferring no involvement due to a perceived lack of expertise and others preferring an active role as the patient’s advocate. Discussing a patient’s quality of life was appreciated by relatives, and according to relatives healthcare professionals also found this valuable. In some cases the preferred and actual involvement was in discordance, preferring either a larger or a smaller role.ConclusionsAs treatment alignment with a patient’s values and preferences and accordance between preferred and actual involvement in decision-making is very important, we suggest that the treatment decision-making process should start with discussions about a patient’s quality of life, followed by tailoring the process to relatives’ preferences as much as possible. Healthcare professionals should be aware of relatives’ heterogeneous and possibly changing preferences regarding the decision-making process.

Effectiveness and implementation of SHared decision-making supported by OUTcome information among patients with breast cancer, stroke and advanced kidney disease: SHOUT study protocol of multiple interrupted time series

IntroductionWithin the value-based healthcare framework, outcome data can be used to inform patients about (treatment) options, and empower them to make shared decisions with their health care professional. To facilitate...

Factors Influencing Employee Retention in the Nepalese Hotel Industry: The Pathways to Future Research

Background: Staff retention has always been a significant concern as well as a challenge for all sectors of organizations. This work aims to identify the major factors that serve as determinants of staff retention, specifically in the hotel industry. The work has been solely guided to establish a conceptual framework that could be used for the systematic and objective investigations to be initiated in the future in this particular sector of the specialized economy.
 Methodology: Since this study is entirely thematic desk research-based, the present scribe has used exploratory research by comprehending different influencing factors of staff retention that were assessed through the review of various lead articles, policy guidelines, related published research reports, conceptual perspectives available in other sources, and institutional best practices in the global arena. 
 Results: The overall findings of the study reveal that the factors including the prevalence of two-way communication, style and quality of leadership, autonomy at the job, motivation level, involvement at work, organizational support, performance management, work-life balance, level of involvement in decision-making, career growth opportunity, availability of training and development opportunities, organizational culture, valuable inputs and constructive feedbacks, trade union and employer agreements, staff recruited from employment agencies and compensation package serve instrumental in the retention of staff. Additionally, this work has established the staff perceived level of glamour and lifestyle, job prestige, social recognition, and opportunity for learning and growth as the industry matched valences.
 Conclusions: The study concludes that in addition to several conventional factors affecting staff retention in different sectors, the tradition of scientific inquiry in the hotel industry should also focus on exploration of the shared impact of more innovative constructs, including state of glamour and lifestyle, social recognition, personal branding, opportunities for cross-cultural learning.
 Implications: The present work would serve as instrumental for the new generation of researchers to craft more innovative and suitable research areas with a balance of constructs to be observed. Similarly, this work establishes a stock of resources to be used in the academic discourses aimed at exploring determinants of staff retention with a specific focus on the hospitality industry, particularly the hotel sector. Also, the management in the respective industry may find suitable ways forward to adjust their organizational process climate and culture to retain the valuable staff.

Health Literacy and Patient Participation in Shared Decision-Making in Orthopedic Surgery.

The influence of health literacy on involvement in decision-making in orthopedic surgery has not been analyzed and could inform processes to engage patients. The goal of this study was to determine the relationship between health literacy and the patient's preferred involvement in decision-making. We conducted a cross-sectional observational study of patients presenting to a multispecialty orthopedic clinic. Patients completed the Literacy in Musculoskeletal Problems (LiMP) survey to evaluate their health literacy and the Control Preferences Scale (CPS) survey to evaluate their preferred level of involvement in decision-making. Statistical analysis was performed with Pearson's correlation and multivariable logistic regression. Thirty-seven percent of patients had limited health literacy (LiMP score <6). Forty-eight percent of patients preferred to share decision-making with their physician equally (CPS score=3), whereas 38% preferred to have a more active role in decision-making (CPS score≤2). There was no statistically significant correlation between health literacy and patient preference for involvement in decision-making (r=0.130; P=.150). Among patients with orthopedic conditions, there is no significant relationship between health literacy and preferred involvement in decision-making. Results from studies in other specialties that suggest that limited health literacy is associated with a preference for less involvement in decision-making are not generalizable to orthopedic surgery. Efforts to engage patients to be informed and participatory in decision-making through the use of decision aids and preference elicitation tools should be directed toward variation in preference for involvement in decision-making, but not toward patient health literacy. [Orthopedics. 2022;45(4):227-232.].

Patient and Surgeon Ratings of Patient Involvement in Decision-Making Are Not Aligned.

Specialists want to guide patients toward making informed treatment choices consistent with what matters most to them (their values). One measure of this goal is alignment between patient and surgeon-perceived involvement in decision-making. We performed a cross-sectional survey of patients presenting for musculoskeletal specialty care to determine agreement between patients and surgeons regarding patient involvement in shared decision-making. We also tested (1) factors associated with specialist-perceived involvement, accounting for the patient's perceived involvement in decision-making, and (2) factors associated with patient perception of involvement in decision-making, accounting for ratings of preferred involvement. In this cross-sectional survey, 136 patients seeking musculoskeletal care for conditions involving the upper or lower extremities rated their preferred level of involvement in decision-making (Control Preferences Scale) before the visit and their perceived level of involvement (Modified Control Preferences Scale) after the visit. Participants also completed measures of symptoms of depression and pain self-efficacy. After the visit, the surgeons rated their perception of the patient's involvement in decision-making (Modified Control Preferences Scale). There was poor agreement between patients and surgeons regarding the extent of patient participation in decision-making (ICC = 0.11). The median difference was 1 point on a 5-point Likert scale (interquartile range: 0 to 1). Accounting for demographic characteristics and personal factors in multivariable analysis, specialists rated patients who did not have a high school diploma as having less involvement in decision-making. Specialist-perceived patient involvement in decision-making was not related to patient-perceived involvement. The only factor associated with higher patient-rated involvement was higher patient-preferred involvement (OR = 3.9; 95% CI = 2.6 to 5.8; p < 0.001). The observation that surgeons misperceive patient participation in decision-making emphasizes the need for strategies to ensure patient participation, such as methods to help patients gain awareness of what matters most to them (their values), clinician checklists for identification and reorientation of common misinterpretations of symptoms, and decision aids or motivational interviewing tools that can help to ensure that patient choices are consistent with their values and are unhindered by misconceptions.

Survey and analysis of the indicators of intellectual capital in MiPymes of León, Guanajuato under the Intellectus Model approach

This paper presents the result of a correlational study derived from the exploratory analysis of a previous work in 2019 on the behavior of key indicators of intellectual capital management under the approach of socio-evolutionary models such as the Intellectus Model from which a 27-question-survey was designed and applied to a sample of 69 companies of different sizes and lines of work in the city of León. The results of the study show that in the companies subjects of the research are found significant positive correlations in the behavior of key indicators such as levels of integration and motivation of staff, promotion mechanisms, level of involvement in decision-making, levels of education, propensity to change or improvement in products and processes, transfer of knowledge in the form of intangible assets as trademarks and patents which allow companies to increase their chances of permanence and growth in the long term. The above gathered from the statistical analysis applied to the database constructed from the results of the field research among the companies that agreed to answer the initial survey.

Job stress and employee outcomes: employment practices in a charity

PurposeThe study intends to examine employee relations with a changing workforce resulting from the business-like transformation in the charity sector. The authors investigated sector-specific employment practices that can alleviate job stress (as a given and which has been made worse by the transformation). Developed from the intrinsic and extrinsic motivation framework, the findings can inform human resource management practices in its new efficiency-seeking business model.Design/methodology/approachThe authors collected both quantitative (through a staff survey and administrative records of sick leave in the previous 12 months) and qualitative data (through interviews and focus groups) from one branch of an internationally well-established and UK-based religious charity between 2017 and 2018.FindingsThe quantitative results support a strong mediating effect of job satisfaction between job stress and staff sick leave. The negative correlation shown between job stress and job satisfaction is subject to paid staff perception of meaningful work and their level of involvement in decision-making, with the latter having a stronger moderating effect. The qualitative data provides further contextualized evidence on the findings.Practical implicationsIt is important for charities to uphold and reflect their charitable mission towards beneficiaries and paid staff during the shift to an efficiency-seeking business model. Charities should involve their new professional workforce in strategic decision-making to better shape a context-based operational model.Originality/valueThe study examined employee relations in the non-profit charity sector with a changing workforce during the transition to a more business-oriented model. In particular, the authors revealed sector-specific factors that can moderate the association between job stress and absenteeism, and thereby contribute to the understanding of human resource management practices in the sector.

P39.07 Evaluating the Success of the First Global Lung Cancer Coalition Patient Experience Survey

The Global Lung Cancer Coalition (GLCC) is a partnership of 40 patient organisations across 29 nations, dedicated to improving outcomes for lung cancer patients. The GLCC wanted to understand the experiences of lung cancer patients in different countries, identifying common themes and differences. However, little comparative data on patient experience exists. The GLCC therefore set out to run a global online survey of patients using its members’ networks. This was the first time the GLCC had attempted such a survey. The GLCC convened a steering group with representatives from the UK, Ireland, Netherlands and USA, including patients, clinicians and advocates. The group devised 10 questions which were translated into multiple languages, checking terminology was applicable. In addition to demographic questions, the survey asked what treatment types people had received, and considered how people felt about their care, as well as how they describe themselves. The survey was distributed by GLCC members via supporter emails, newsletters and social media. One organisation distributed hard copies in hospitals. The survey was open throughout January 2020. The results were collated and analysed by the steering group. The GLCC produced a global report with findings for all participating countries. Each member received a bespoke briefing with information on how patients in their country answered the survey compared to global respondents, for use in national campaigning. The survey was distributed in 17 of the 40 countries where the GLCC has members. 907 patients responded. There was variation in the number of responses, ranging from 157 in the UK (most responses) to one in Turkey (least responses). More women than men responded (74% were women). Most patients (66%) had been diagnosed in the past three years. The number of responses indicates the willingness of patients to contribute their time and insights to a global endeavour. The responses showed considerable variation in patients’ experience of their care, including their level of involvement in decision-making and whether they felt treated with dignity and respect by their care team. These initial findings merit further exploration at a national level, to test whether they are representative of the wider lung cancer patient population’s experience (particularly for countries with fewer responses). For future research, the GLCC would consider: How to increase the number of countries participating and overall volume of responses How to achieve a balance of women and men (for example, using other distribution channels) How to reach more patients who have survived for longer Other topics such as where patients look for information and who they trust to provide it Supplementing the survey with qualitative interviews The first GLCC survey is proof of principle: it is feasible to undertake a multi-nation patient experience survey and patients are willing to participate. We are grateful to all patients who responded. The GLCC’s members are using the global and national findings to support their advocacy work and would consider a similar initiative in the future.

Patient-clinician communication in a dental setting: a pilot study.

To undertake a pilot study and examine whether the communication assessment tool (CAT) is useful in assessing patient perceptions of dentists' interpersonal skills. Cross-sectional questionnaire study. Three speciality dental clinics in a University teaching hospital in the United Kingdom. PARTICIPANTS, MATERIALS AND MEASURES: One hundred patients, seen by 20 dentists, were recruited to the study. Patients completed the CAT after their consultation. Patient ratings of excellent interpersonal skills within a dental consultation according to dentists' experience, gender and speciality. Complete data was received from 95 patients. On average, dentists' communication skills were rated as excellent 73% of the time. Patients were least satisfied with opportunities to ask questions within their consultation and with their level of involvement in decision-making. There were suggested differences in patients' perceived satisfaction with communication according to dentists' experience and gender. Overall, patients are satisfied with the quality of communication with their dentist. Our findings are comparable to those from larger studies suggesting that the CAT is an effective tool to use in a dental context. The CAT would be useful in documenting the development of dentists' and students' interpersonal skills.

Identification of patient-derived outcomes after aortic aneurysm repair

Relatively few outcomes have been examined in randomized comparisons of endovascular and open aortic aneurysm repair, and no patient input was obtained in the selection of these outcomes. The aim of this study was to identify patient-derived, potentially novel outcomes that may be used to guide future clinical trials in aneurysm surgery. Focus group interviews were conducted with patients who had undergone endovascular or open aortic aneurysm repair. The discussions were transcribed and the transcript was analyzed by two indexers using constant-comparison analysis and grounded theory to identify potentially novel, patient-derived outcomes. Other potential themes relating to the patients' experience and their decision-making were also sought. Six focus groups were conducted (three with endovascular aneurysm repair patients and three with open aortic aneurysm repair patients), with a median of six participants, 2 to 12 months from surgery. Functional outcomes were most commonly mentioned and emphasized by patients. Recovery time and energy level were most frequently verbalized as important in the decision-making process between endovascular and open aneurysm repair. Other potential outcomes identified as important to patients included postoperative pain, time to walking normally, loss of appetite, extent and location of incisions, impact on cognition, being able to go home after surgery, and impact on caregivers. In addition to these outcomes, we identified three themes relating to the patient's experience: undervaluing or underappreciating the risk of death during surgery, differing informational needs and level of involvement in decision-making, and unrealistic patient expectations about the risks of and recovery after the procedure. Functional outcomes emerged as most important during qualitative analysis of patients' experiences with aneurysm repair. Perceived differences in recovery time were identified as an important consideration for aneurysm patients in deciding between open and endovascular repair. More work needs to be done clarifying the concept of recovery and other related functional outcomes for the development of methods to assess and to evaluate these in prospective clinical trials.

A study on examining interrelationships among customer satisfaction, loyalty, and switching intent in industrial food suppliers

Article history: Received January 2, 2014 Accepted 8 May 2014 Available online June 1 2014 Brand loyalty is one of the most important concepts in brand literature. Customer’s loyalty toward brand can increase firm’s share price. In addition, firms’ market share maintains close relationship with net profit and capital used return. Company efforts to motivate customers to switch from competitive brands to their own or to induce them to repurchase their own brands are very important in their marketing activities. Therefore, investigating customer varietyseeking orientation and level of involvement in decision-making plays essential role in explaining customers’ product selection activities. This study intends to examine interrelationships among customer satisfaction, loyalty, and switching intent in industrial food suppliers and verifies the moderating effect of customer variety-seeking orientation and purchase decision involvement. The findings indicate that, the impact of purchase involvement was lower than variety seeking and the satisfaction had the highest negative impact on switching intent of customers.

Role of religiosity in medical decision making among patients with colorectal cancer.

9579 Background: Physician-based medical decision making (DM) has declined in favor of more patient-centered approaches. Most studies indicate that patients want to be involved; however, the level of desired involvement varies between patients wanting to make their own decisions and those preferring to leave decisions to physicians. Little is known of the factors associated with DM preferences. Given data demonstrating the influence of religion among cancer patients, we explored religiosity and decision making preferences in colorectal cancer (CRC) patients. Methods: We surveyed a population-based cohort of Stage III CRC patients from the Detroit and Georgia SEER registries. Patients were queried about desired level of involvement in DM, trust in physicians, religiosity, receipt of adjuvant chemotherapy, and demographics. Religiosity was assessed using the Holland System of Belief Inventory. Physician trust was assessed using the Wake Forest Physician Trust scale. Responses were collected along a Likert scale and results were dichotomized. Surveys were analyzed using univariate and bivariate methods. Results: Thus far, 430 CRC patients have responded (56% response rate). The median participant age is 61 years, 45% are female, and 19% are black. 54% indicated a preference for shared DM, 35% prefer “doctors to make [their] decisions”, and 11% prefer to “make [their] own decisions”. The distribution did not differ by age, gender, race, income, or level of education. Higher religiosity was associated with higher trust in the surgeon (p=0.007) but not the oncologist (p=0.3). Patients with higher religiosity scores and higher physician trust were more likely to prefer that their doctors make the decisions (p= 0.023, p&lt;0.001). Preference for physician DM was associated with higher receipt of adjuvant chemotherapy (p=0.002). Conclusions: Patients who were more religious preferred to leave medical DM to physicians. Those who relied on physician DM were more likely to receive chemotherapy. This association may be mediated through higher trust. Understanding the influence of religiosity may be a tool to help providers get their patients appropriate cancer care.

Content of Hematologic Malignancies Consultations: Good and Bad News From the HEMA-COMM Study.

Abstract 68 Introduction:Communications literature suggests that optimal doctor-patient communication in medical encounters should include several specific behaviors to enhance successful communication. Very little is known about how often hematologic malignancy subspecialists engage in these behaviors, but several studies have documented that patients are more optimistic about their prognoses than their physicians. We anticipated that a first consultation with a hematology-oncology subspecialist would provide an opportunity to study doctor-patient communication in a particularly intense situation, since the patient and physician are meeting for the first time, discussing a life-threatening disease, and usually confirming or deciding on a treatment plan. Methods and Subjects: We studied 236 patients having first consultations with 40 physicians at two academic institutions in the HEMA-COMM study. The HEMA-COMM study is an observational study designed to evaluate doctor-patient communication with data collected through patient and physician surveys, patient interviews, and audiotaping and coding of the consultations. Results: Median patient age was 55 years and 53% were men, 89% White, 78% married and 60% had at least a college education. Diagnoses included lymphoma (31%), acute leukemia (19%), myelodysplastic syndrome (17%), multiple myeloma (16%) and chronic leukemia (16%). Median age of physicians was 47 years and 85% were men. The median year of fellowship completion was 1992. Physicians estimated they saw a median of 8 new patients a month, 80% of whom were direct referrals. Results: Median duration of the consultations was 80 minutes. Coding of recorded consultations showed the frequency at which recommended communication behaviors occurred: discussion about purpose of the visit (78%), patient prior knowledge about disease (89%), patient preference for decision-making role (37%), patient understanding of presented information (31%), and patient preference for information (5%). Consultations addressed treatment recommendations (97%) and treatment impact on quality of life (52%), but rarely patient participation in recovery (1%). Qualitative prognostic information was provided in 97% of consultations and quantitative information in 90%, but “hedging” (suggestions that prognostic estimates do not apply to the individual) occurred in 23%. Overall, 64% of consultations included clear discussion of mortality risk without hedging and 49% included clear discussions of cure risk without hedging. The median number of patient questions was 23 (range 0-122). The percentage of patients with a treatment plan increased from 31% before the consultation to 79% after the consultation and 98% of patients were happy with their level of involvement in decision-making. Patients were satisfied with their consultations and 80% were very likely to recommend the consulting physician to other patients. Conclusion: Physicians could improve their verbal communication by assessing patients' preferences for information and decision-making roles, and checking for patient understanding during consultations. Approximately half of consultations in our study clearly addressed prognostic topics such as mortality and cure. These data form the basis for investigating factors which contribute to optimal doctor-patient communication about life-threatening disorders. Disclosures:No relevant conflicts of interest to declare.

Perceptions of young people about decision making in the acute healthcare environment

This study explored young people's perceptions of their involvement in healthcare decisions affecting their management of care. A phenomenological approach was used to allow in-depth examination of the young people's personal accounts of their experiences. Data were obtained from 10 hospitalised young people between the ages of 12-16 years from both genders and from different medical and surgical specialities using focused interviews. Transcribing, reading and listening to the data enabled data analysis through reflection and analysis. Three themes were identified: level of involvement in decision-making; psychological impact of involvement in decision making; and communication. Professional practice in the care of young people should include effective communication, a policy of inclusion and active assessment of competence.

Trade Unions—Enterprise Bargaining and Control at Work Evidence From The First Wave of Enterprise Agreements

ABSTRACT Since the articulation of the Enterprise Bargaining principle by the Australian Industrial Relations Commission in 1991, and the reforms to the Industrial Relations Act passed in 1994, the pace of industrial relations deregulation in Australia has quickened considerably. This paper explores some of the characteristics of the first wave of enterprise bargains with particular reference to the role of trade unions in mediating the enterprise bargaining process and the results of workplace change. Following the claims of many in the federal government, the trade union movement and employer groups, we consider the extent to which enterprise bargaining has facilitated greater labour flexibility and employee participation in workplace decision-making using original data drawn from a survey of the first wave of federally and state registered enterprise agreements. In particular, we examine whether level of unionisation in specific workplaces appears to malre a dilference to the negotiatim of several key aspects of control and discretion at work. We consider whether unions appear to make a difference to the ways in which employment conditions are determined at the workplace, the way in which changes to work organisation are negotiated, the means by which employees are consulted through the change process, the level of employee involvement in decision-making and the methods by which pay is determined. On the basis of the survey evidence, we conclude that union presence and density appears to affect the results of enterprise bargaining especially with respect to matters of workplace control and the exercise of managerial prerogative at work.