Share Decision Research Articles

Demand Shaping Through Bundling and Product Configuration: A Dynamic Multiproduct Inventory-Pricing Model

In today’s digital age, with the aid of the internet and data mining, many firms use vertically differentiated product bundling to influence demand to match up with inventory status, especially in industries with short product life cycles. Despite this practice, there is little understanding on how exactly the inventory dynamics impact the bundling strategy, and, in turn, how the bundling strategy affects the firm's inventory decisions. To fill this gap, we present a dynamic model to analyze the optimal joint replenishment, pricing, and bundling decisions over time. A key enabler of our analysis is a novel demand model that transfers the discrete bundling decision and the corresponding pricing decision into a continuous market share decision. We show that the optimal policy is dictated by a no-order set in each period. For items in this set, we do not place replenishment orders, because these items are overstocked. The rest of the policy parameters -- the order-up-to-levels for the items that we do order, the bundling and pricing decisions, and the bundle assembly quantity -- all depend on the overstock levels. We also characterize how the optimal bundling decision depends on item complementarity, cost structure, inventory levels, demand uncertainty, and supply responsiveness.

Desire for Information and Preference for Participation in Treatment Decisions in Patients With Cancer Presenting to the Department of General Surgery in a Tertiary Care Hospital in India.

PurposeProviding appropriate information to patients about their illness helps them to cope with the diagnosis. Shared decision making is a key concept in managing patients with cancer. There are no data available about the desire for information and preference for participation in treatment decisions among Indian patients with cancer. The objective of this study was to estimate the proportion of patients who have information needs and to study the patient preference for participation in treatment decisions and the factors associated with them.MethodsA cross-sectional survey was conducted among patients with cancer older than 18 years. They were interviewed with a questionnaire after signing an informed consent. The association of sex, educational level, residence, diagnosis (type of cancer), Eastern Cooperative Oncology Group performance status, and treatment status with information needs and decision-making preference was analyzed using χ2 testResultsApproximately 81% of patients said that they had an absolute need to know if the illness was cancer, and > 70% of patients either had an absolute need to know or would like to know about the prognosis, treatment options, and adverse effects. Regarding the decision-making preferences, 97% wanted their treating physicians to make the decision regarding their treatment, and 66% preferred to share decision making with their family.ConclusionThe majority of the patients with cancer expressed a need for knowing whether they had cancer. When it comes to treatment decisions, most of them preferred a passive role, and the majority wanted to involve their families in the decision-making process. We recommend that the treating physician should elicit the patient’s preference in participating in treatment decisions and their preference about involving their family in making treatment decisions

PO48 - Share Decision Making for Better Patient Participation in Advanced Breast Cancer Care

PO48 - Share Decision Making for Better Patient Participation in Advanced Breast Cancer Care

Who Decides IPO Withdrawal and When?

This paper explores the relationship between the sources of initial public offering (IPO) shares and withdrawal decision. Findings reveal that the amount of primary share does not have a direct relationship to the withdrawal decision. Furthermore, we analyze the relationship of the sources of secondary share and withdrawal decision making. The secondary share by the venture capitals positively relates to the withdrawal decision in any market condition. This is natural because the venture capitals usually cut off the relationship with the issuer firms. Moreover, the amount of secondary share by CEOs positively links with the withdrawal decision only during the IPO bubble period. These results imply that the preference for the IPO withdrawal decision differs by the secondary share seller, and that characteristics of the CEOs changes by the market timing.

Using Encounter Decision Aids to Share Decisions With Women Presenting With Heavy Menstrual Bleeding or Fibroids [20H

INTRODUCTION: Heavy menstrual bleeding impacts women’s quality of life and can be treated in a variety of ways. Shared decision-making (SDM) requires providing tailored information to the patient about options and eliciting and integrating patient preferences as treatments are selected. decision aids used during the clinical encounter may facilitate SDM. We evaluated the impact of introducing decision aids for women presenting with heavy menstrual bleeding or fibroids on the level of SDM. METHODS: A before-after study was conducted in general OB-GYN practice in an academic medical center and two community practices between December 2014 and May 2015. Consultations were compared before (T1) and after (T2) introduction of two encounter decision aids on treatment options for heavy menstrual bleeding or uterine fibroids. Immediately after their appointments, patients filled out a brief validated survey (CollaboRATE) about the perceived level of SDM. Additionally, observers rated audio recordings of consultations for SDM using the OPTION5 instrument. RESULTS: Altogether, 16 providers participated, 25 patients were enrolled in T1, and 28 patients were enrolled in T2. The groups did not differ on demographic characteristics. The proportion of women reporting SDM increased significantly from T1 (50%) to T2 (75%; p < 0.05). The mean observer-rated level of SDM also increased significantly from T1 to T2 (mean difference = 12.50 on a scale of 0-100, where threshold for clinical relevance is 11.9). CONCLUSION: Implementation of encounter decision aids for women presenting with heavy menstrual bleeding or fibroids was associated with a higher level of SDM between women and gynecologists.

Caregivers’ Heart Failure Knowledge Is Necessary but Not Sufficient to Ensure Engagement With Patients in Self-care Maintenance

The chronic illness literature suggests that patient–informal caregiver dyads who are relationally oriented (share decisions and activities) are more efficient and effective than those who are not. But this is currently unknown in heart failure (HF). Our aim was to examine differences between individually and relationally oriented HF dyads relative to patient symptom management scores. This was a cross-sectional study of 55 dyads (spousal/adult child/relative) analyzed using Actor-Partner Interdependence Model techniques. Dyad orientation was measured by the Dyadic Symptom Management Type scale, and symptom management by Self-care of HF Index. On average, patients were older, white males with younger, female caregivers. Whether the dyads were individually oriented or relationally oriented did not make a difference. However, dyads’ agreement on that orientation and the caregivers’ HF-related knowledge impacted caregiver engagement in self-care maintenance or adherence and monitoring behaviors. It is assumed that caregivers will engage in HF care. Our study suggests that caregivers will engage if they agree with the patient on who is providing that care and are knowledgeable. The Dyadic Symptom Management Type scale is a 1-item question that can be administered in the clinical setting by a palliative care nurse in less than 2 minutes to assess agreement and target teaching.

The Unique Speech Needs of Children in Poverty

The Unique Speech Needs of Children in Poverty

Active Patient Programme: a local approach of integrated care in the Basque Country

Introduction : The management of chronic diseases represents a challenge for healthcare services. It is necessary to provide more efficient and coordinated care to patients with chronic conditions. As in other developed countries, the Spanish Health System is outdated, and a new organisational model is needed to provide a better care to chronic patients. A key role is given to self-management and educational programmes, implying a more active role of the patient In 2010 the Health Department of the Basque Country Government promoted a new strategy for chronic patient care based on the Chronic Care Model. Two of the cornerstones of this model are self-care promotion and community education. In this context, the “Active Patient” programme, based on the Chronic Disease Self-Management Program, has been proposed as a useful instrument. Description : The Active Patient programme is aimed at patients with a chronic condition or/and at their caregivers. It consists of 2.5 hours group sessions (8 to 15 people) once a week for 7 or 8 weeks. These sessions enable participants to acquire knowledge and skills related to the disease and its management, placing a strong emphasis on proactive tools (how to set realistic achievable targets, cope with problems related to their disease, effectively communication, share decision making…) to achieve healthier lifestyles (in terms of diet, physical exercise, management of emotions, and correct use of medication, among others). Each session is conducted by two leaders. At least one of them should be a chronic patient him/herself or caregiver. Lay leaders who are themselves chronic patients, or have close personal experience of a chronic condition, show greater empathy and tend to suggest more appropriate and realistic options than health professionals. They are volunteers. In this programme there are involved a lot of different stakeholders, among others, the public health system, citizens, patient associations, city halls, culture houses… Key findings : This programme was implanted in 2010 in 4 Osakidetza health care organisations. From 2012 has been expanded to all of them. Since November 2010 we have trained 3030 patients in two different courses. The effectiveness of the programme was evaluated by a randomized controlled clinical trial and a cualitative research. Participants satisfaction is very high 4.5/5. Nowadays we have 219 leaders, 80 are lay leaders and 139 professional leaders. During the past years the programme has been spread inside as well as outside the organisation. Focusing on the responsibility of the citizens towards their own health. Highlights : This innovative approach implies care from a holistic perspective and empowers patients through : - A better relationship between clinicians and patients - And extended knowledge of the illness and the habits recommended - Taking the drama out of the illness - Facilitating strategies to face the chronic condition and to strengthen self-esteem - Achieving a better quality of live and family relationships. - Supporting them to self-care, self-manage, engage in share decision making and co-develop and implement personalised care plans Self-efficacy significantly improved in diet, physical activity and control of the disease but no statistically significant differencies have been found in cardiovascular variables. . On the other side bringing this new approach has also found resistances among many clinicians, some agents and even some patients. We come from a traditional paternalist model and we are trying to change to a more cooperative model and so this needs some measures in order to readjust The main resistance we want to focus on is the fear and insecurity that comes up in some clinicians regarding their ability to work with and empowered patients. We must support clinicians to better support the health needs and goals of people This kind of change is progressive and need time Conclusion : It´s necessary to empower, activate and engage citizens, patients, families, carers and communities to coproduce health care service. At the same time we put in action a programme like this, we must train clinicians to encourage patients to be proactive.We must also help communication between patients and clinicians in order to make this change of philosophy possible. To involve clinicians is crucial to succeed. Even senior managers of healthcare organisations should have no doubts about the benefits of this new paradigm and should be aligned with it. The success of this innovative program will be possible when all the implicated parts are able to see the advantages that empowerment brings to all of them.

Education in shared decision making

This article was migrated. The article was not marked as recommended. Introduction Shared decision making in healthcare is important. Education in shared decision making is required to ensure that healthcare professionals are equipped so that they can effectively share decisions with patients. Online learning may be one method of doing this. Online learning resources allow large numbers of users to access clinical content at a time and place that is convenient for them. Methods BMJ Learning is the online learning website of BMJ. BMJ Learning recently published a module on shared decision making. We evaluated the module by looking at how popular the module was, by examining the feedback that we received on the module and by looking at what percentage of users who started the module completed it. We analysed the feedback from a qualitative perspective.Results A total of 748 users started the module and 586 completed it. This gives a completion rate of 78%. The mean completion rate of all modules on the site is 83%. Feedback to the resource was mixed. 47 users described the resource as useful, good or excellent. 10 described it as interesting and 3 said that the content related to their learning needs. 10 users left negative comments.Conclusions Shared decision making is clearly a learning need amongst healthcare professionals and many users feel that an online learning module in this format is an effective means of satisfying this need.

Doctor patient relationship: Changing scenario in India

God has chosen special persons to take care of the physical pains and sufferings of man and such persons are known as doctors. But recently countrywide dissatisfaction on the major pillar of the medical services raises number of questions. In this present article authors have tried to find out the related factors with the changing scenario of doctor- patients relationship from India’s prospective. In the ancient India, doctors were enjoying the highest level of respect in the society because of the attitude and activity towards the patient. In the last decade of the 20th century and beginning of 21st century, a chronic dissatisfaction began to settle over the relationships between doctors and patients. High level of corruption in the health care industry, inequity in health care delivery, technological development in medical science, growth of health insurance, patient’s desire in share decision making, information technology development are few factors behind changing doctor- patient relationship. If physicians take a little more time in reassuring patients in the old fashioned way, this will restore the deteriorating relationship.Asian Journal of Medical Sciences Vol.7(4) 2016 1-5

Quality coaching counts

Scholastic sport is a double-edged sword that can have positive or negative effects. Whether those effects are positive or negative depends on those who wield that sword — chiefly, the school’s sports coach. While it is clear that coaches make a difference in ensuring that educational athletics lead to beneficial outcomes for student-athletes, a key question is what does good coaching involve? Luckily, researchers have been studying coaching effectiveness for some time and have discovered a number of important principles. Effective coaches have well thought-out coaching philosophies that align with educational athletic and school goals; share decision making with their athletes and provide rationale for their coaching actions; build strong coach-athlete relationships; create caring and supportive emotional climates; and are knowledgeable and good teachers.

A Prospective Evaluation of Shared Decision-making Regarding Analgesics Selection for Older Emergency Department Patients With Acute Musculoskeletal Pain.

Musculoskeletal pain is a common reason for emergency department (ED) visit by older adults. Outpatient pain management following ED visits in this population is challenging as a result of contraindications to, and side effects from, available therapies. Shared decision-making (SDM) between patients and emergency physicians may improve patient experiences and health outcomes. Among older ED patients with acute musculoskeletal pain, we sought to characterize their desire for involvement in the selection of outpatient analgesics. We also sought to assess the impact of SDM on change in pain at 1 week, patient satisfaction, and side effects. This was a prospective study of adults aged 60 years and older presenting to the ED with acute musculoskeletal pain. Participants' desire to contribute to outpatient analgesic selection was assessed by phone within 24 hours of ED discharge using the Control Preferences Scale and categorized as active, collaborative, or passive. The extent to which SDM occurred in the ED was also assessed within 24 hours of discharge using the 9-item Shared Decision Making Questionnaire, and scores were subsequently grouped into tertiles of low, middle, and high SDM. The primary outcome was change in pain severity between the ED visit and 1 week. Secondary outcomes included satisfaction regarding the decision about how to treat pain at home, satisfaction with the pain medication itself, and side effects. Desire of participants (N = 94) to contribute to the decision regarding selection of outpatient analgesics varied: 16% active (i.e., make the final decision themselves), 37% collaborative (i.e., share decision with provider), and 47% passive (i.e., let the doctor make the final decision). The percentage of patients who desired an active role in the decision was higher for patients who were college educated versus those who were not college educated (28% vs. 11%; difference 17%, 95% confidence interval [CI] = 0% to 35%), received care from a nurse practitioner versus a resident or an attending physician (32% vs. 9%; difference 23%, 95% CI = 4% to 42%), or received care from a female versus a male provider (24% vs. 5%; difference 19%, 95% = CI 5% to 32%). After potential confounders were adjusted for, the mean decrease in pain severity from the ED visit to 1-week follow-up was not significantly different across tertiles of SDM (p = 0.06). Higher SDM scores were associated with greater satisfaction with the discharge pain medications (p = 0.006). SDM was not associated with the class of analgesic received. In this sample of older adults with acute musculoskeletal pain, the reported desire of patients to contribute to decisions regarding analgesics varied based on both patient and provider characteristics. SDM was not significantly related to pain reduction in the first week or type of pain medication received, but was associated with greater patient satisfaction.

Decisions, choice and shared decision making in antenatal clinics: An observational study

ObjectiveThe UK Government has prioritised shared decision making (SDM) and choice in maternity services, but no studies have explored the breadth of antenatal decisions or the feasibility of this aspiration. This study aimed to describe the decisions made, investigate the factors associated with choice and explore SDM practice. MethodsCross-sectional audio-recording of consultations in a UK district general hospital. Multi-level regression models were used to investigate associations between choice and doctor, patient, consultation and decision variables. Results585 decisions were documented with a mean of 3.0 (SD 1.5) per consultation. No choice was offered in 75% of decisions. Choice was associated with the decision topic, consultation length, Royal College membership status and presence on the specialist register. ConclusionsWithout a choice, it will be challenging for a patient and their healthcare profession to truly share decisions. Practice ImplicationsIf universal SDM is the aim, then further work is required to understand the factors impacting choice availability and SDM, while engaging and supporting healthcare professionals to offer options and share decisions with patients.

Puesta al día en estatinas. Nuevas recomendaciones

In November 2013, the American College of Cardiology and the American Heart Association (ACC/AHA) released a new clinical practice guideline for the treatment of blood cholesterol in people at high risk for cardiovascular disease. The guideline identifies: 1) 4 major groups of patients for whom statins should be prescribed to reduce the chance of stroke and heart attacks, 2) elimination of routine assessments of LDL cholesterol levels in patients receiving statin therapy, because target levels are no longer emphasized, and 3) avoidance of non-statin LDL cholesterol-lowering agents in statin-tolerant patients.This update represents the first major guideline revision since the released of the Adult Treatment Panel III report in 2002, which has been a subject of controversy. The main concerns focused on problems with the risk calculation, ethics (conflicts of interest), and inferences (too many people offered treatment).The guideline also emphasizes the importance of adopting a heart-healthy lifestyle to control high blood cholesterol, and create an opportunity to advance patient-centered care and share decision making. The new guideline gives the clinicians the tool to engage in discussing with individual patients about the potential benefits and potential harms of statin use to prevent future cardiovascular events.

How outside directors facilitate corporate R&D investment? Evidence from large Korean firms

This paper examines how outside directors facilitate corporate R&D investment in the face of family control and the discrepancy between share ownership and decision control. Our panel regression analysis of large Korean firms (1998 to 2005) shows that mere addition of a shareholder-oriented mechanism, namely outside directors, is not effective for promoting R&D intensity. However, the disciplining role of outside directors can become valid for R&D intensity by moderating the negative influence of the discrepancy when a firms' growth opportunity is high. In addition, family control is positively related to a firm's R&D investment when the firm's growth opportunity is low. Thus, we argue that the strategic management of organizational change in corporate governance should take into account the disciplining role of shareholder-oriented mechanisms in the context of ownership structure and a firm's strategic position.

The long road home: a discussion of the autonomy of schizophrenia patients after their discharge from the hospital

Every adult has the right to self-determination and to have his or her autonomy respected. While schizophrenia patients have the right to be discharged from the hospital, their needs subject their caregivers to high care loadings. This situation presents a dilemma for the medical team. The authors justify the patient's autonomy to request and to be granted a discharge. Then, present the decision-making process related to discharge for the reference of medical teams. Capacity is necessary to autonomy. There is currently no standard for assessing the capacity of patients that clearly defines their competence. A sliding scale approach to decision making distinguishes between decisions involving significant potential risk and, therefore, involving higher level of capacity requirements and decisions on minimal potential risk. In order to protect the interests of patients, the sliding scale approach takes into account different decisions. Cases in which schizophrenia patients choose to self-discharge involve a high-level of risk. Poor preparations for follow-up care lead to poor-quality patient care and may cause harm to the patients. In a share decision model, the medical team plays the role of negotiator between the patient and the family and respects the autonomy of the patient while supporting the family through the hospital discharge process. Medical team must have a discharge planning for the patient and family, follow-up care system, and support network. During hospitalization, the discharge plan aims to facilitate the life adaptation and disease recovery for patients with the goal of restoring their normal home life.

Medical futility in the era of evidence-based medicine.

One definition of futility is any treatment that merely preserves permanent unconsciousness or fails to end total dependence of a patient on intensive medical care[1]. However, no agreement has ever been reached on what the exact definition of futility is, as it is not only based on temporary values but also evolves into different subtypes, making it harder to define[2]. The difficulty in dealing with futility problem is how doctors evaluate the futile situation, which is further complicated by lack of standards for specific diseases and experience-based prognosis, leading to subjectivity in evaluation for futility. Since judgment and decision making by physicians play an overwhelmingly dominant role in the estimation of futility, evidence-based medicine (EBM) should be included as a general guideline, incorporating individual experience and the best current evidence[3]. EBM draws heavily from current research findings– especially from large randomized control trials (RCT)[4]. Furthermore, this concept is evolving with the deepening and development of research, being an evolution itself. However, it is worthwhile to point out that EBM only predicts the effectiveness of an intervention by adjusting the earlier conclusion according to the newest results of recent research, but it cannot work in every particular case even in an approximation formula[5]. Cardiopulmonary resuscitation (CPR) in the intensive care unit (ICU) is likely a futile exercise if indiscriminately practiced in patients, especially those who are unlikely to survive to hospital discharge. Despite the widespread use of do-not-resuscitate (DNR) orders, introduced nearly a half century ago, the outcome following CPR has not been substantially improved[6]. Therefore, evidence-based selection of patients who will benefit from CPR is of paramount importance in avoiding medical futility. CPR is predicated on the assumption that CPR will be successful in maintaining the sacred life of a patient; to guard against its indiscriminate and sometimes excessive use, we should garner clinical evidence through clinical trials and development of prediction models and scoring systems such as the Good Outcome Following Attempted Resuscitation (GO-FAR) score to guide physicians in making informed decision on the use of CPR[7]. On the other hand, the DNR order requires patient consent to prevent a medical procedure from being performed; many patients or surrogates may overestimate the effects of CPR[8] and may oppose a DNR order by the physician. Clinical studies are mainly classified into two categories: studies that confirm that treatment in a specific situation is futile, meaning that the result supports the futility diagnosis, and studies that show potential effectiveness of a treatment, meaning that the result refutes the futility diagnosis[9]. Futility usually focuses on two principles–improving the rate of survival and the quality of prolonged life[9]. Physicians may consider whether further intervention will abide by the two principles, and if not, futility ensues. However, sufficient and conclusive data from EBM, to some extent, is still lacking. Before conclusive data becomes available from EBM, physicians may have to rely on existing guidelines and professional judgment with consideration of patient autonomy to make an informed share decision in cases where medical futility may occur.

Swarm Intelligence: When Uncertainty Meets Conflict

Good decision making is important for the survival and fitness of stakeholders, but decisions usually involve uncertainty and conflict. We know surprisingly little about profitable decision-making strategies in conflict situations. On the one hand, sharing decisions with others can pool information and decrease uncertainty (swarm intelligence). On the other hand, sharing decisions can hand influence to individuals whose goals conflict. Thus, when should an animal share decisions with others? Using a theoretical model, we show that, contrary to intuition, decision sharing by animals with conflicting goals often increases individual gains as well as decision accuracy. Thus, conflict-far from hampering effective decision making-can improve decision outcomes for all stakeholders, as long as they share large-scale goals. In contrast, decisions shared by animals without conflict were often surprisingly poor. The underlying mechanism is that animals with conflicting goals are less correlated in individual choice errors. These results provide a strong argument in the interest of all stakeholders for not excluding other (e.g., minority) factions from collective decisions. The observed benefits of including diverse factions among the decision makers could also be relevant to human collective decision making.

Apports des thérapies comportementales et cognitives - Psychoéducation pour les patients douloureux chroniques

Chronic pain is frequent and many publications have shown that multidisciplinary approaches are active such as therapeutic patient education (TPE) or psychoeducation using cognitive behavioral tools (CBT). Indeed, they both use an initial exhaustive evaluation taking into account patients’ expectations and preferences. They also share the same goals; making the patient competent and active. Therefore, an appropriate treatment program, including pain coping strategies, may be proposed to each patient. Patients should be involved as earlier as possible in this share decision process.

Implementation of Shared Decision Making in Physical Therapy: Observed Level of Involvement and Patient Preference

Shared decision making (SDM) reduces the asymmetrical power between the therapist and the patient. Patient involvement improves patient satisfaction, adherence, and health outcomes and is a prerequisite for good clinical practice. The opportunities for using SDM in physical therapy have been previously considered. The objective of this study was to examine the status of SDM in physical therapy, patients' preferred levels of involvement, and the agreement between therapist perception and patient preferred level of involvement. This was an observational study of real consultations in physical therapy. In total, 237 consultations, undertaken by 13 physical therapists, were audiorecorded, and 210 records were analyzed using the Observing Patient Involvement (OPTION) instrument. Before the consultation, the patient and therapist completed the Control Preference Scale (CPS). Multilevel analysis was used to study the association between individual variables and the level of SDM. Agreement on preferences was calculated using kappa coefficients. The mean OPTION score was 5.2 (SD=6.8), out of a total score of 100. Female therapists achieved a higher OPTION score (b=-0.86, P=0.01). In total, 36.7% of the patients wanted to share decisions, and 36.2% preferred to give their opinion before delegating the decisions. In the majority of cases, therapists believed that they had to decide. The kappa coefficient for agreement was poor at .062 (95% confidence interval=-.018 to .144). Only 13 out of 125 therapists who were personally contacted agreed to participate. Shared decision making was not applied; although patients preferred to share decisions or at least provide their opinion about the treatment, physical therapists did not often recognize this factor. The participating physical therapists were more likely to make decisions in the best interest of their patients; that is, these therapists tended to apply a paternalistic approach rather than involving the patient.