Visual Decision Aid Research Articles

PREDICT-GTN 2: Two-factor streamlined models match FIGO performance in gestational trophoblastic neoplasia

ObjectiveThe International Federation of Gynecology and Obstetrics (FIGO) scoring system uses the sum of eight risk-factors to predict single-agent chemotherapy resistance in Gestational Trophoblastic Neoplasia (GTN). To improve ease of use, this study aimed to generate: (i) streamlined models that match FIGO performance and; (ii) visual-decision aids (nomograms) for guiding management. MethodsUsing training (n = 4191) and validation datasets (n = 144) of GTN patients from two UK specialist centres, logistic regression analysis generated two-factor models for cross-validation and exploration. Performance was assessed using true and false positive rate, positive and negative predictive values, Bland-Altman calibration plots, receiver operating characteristic (ROC) curves, decision-curve analysis (DCA) and contingency tables. Nomograms were developed from estimated model parameters and performance cross-checked upon the training and validation dataset. ResultsThree streamlined, two-factor models were selected for analysis: (i) M1, pre-treatment hCG + history of failed chemotherapy; (ii) M2, pre-treatment hCG + site of metastases and; (iii) M3, pre-treatment hCG + number of metastases. Using both training and validation datasets, these models showed no evidence of significant discordance from FIGO (McNemar's test p > 0.78) or across a range of performance parameters. This behaviour was maintained when applying algorithms simulating the logic of the nomograms. ConclusionsOur streamlined models could be used to assess GTN patients and replace FIGO, statistically matching performance. Given the importance of imaging parameters in guiding treatment, M2 and M3 are favoured for ongoing validation. In resource-poor countries, where access to specialist centres is problematic, M1 could be pragmatically implemented. Further prospective validation on a larger cohort is recommended.

Visual decision aids: Improving laypeople’s understanding of forensic science evidence.

Visual decision aids: Improving laypeople’s understanding of forensic science evidence.

Improving Shared Decision Making in Latino Men With Prostate Cancer: A Thematic Analysis.

Background. Multiple studies have shown that digitally mediated decision aids help prepare patients for medical decision making with their providers. However, few studies have investigated whether decision-support preferences differ between non-English-speaking and English-speaking Latino men with limited literacy. Objective. To identify and compare health information seeking patterns, preferences for information presentation, and interest in digital decision aids in a sample of Southern Californian underserved Latino men with newly diagnosed prostate cancer at a county hospital. Methods. We conducted semistructured, in-depth telephone interviews with 12 Spanish-speaking and 8 English-speaking Latino men using a purposive sampling technique. Following transcription of taped interviews, Spanish interviews were translated. Using a coding protocol developed by the team, two bilingual members jointly analyzed the transcripts for emerging themes. Coder agreement exceeded 80%. Differences were resolved through discussion. Results. Thematic differences between groups with different preferred languages emerged. Most respondents engaged in online health information seeking using cellphones, perceived a paternalistic patient-provider relationship, and expressed willingness to use hypothetical digital decision aids if recommended by their provider. English speakers reported higher digital technology proficiency for health-related searches. They also more frequently indicated family involvement in digital search related to their condition and preferred self-guided, web-based decision aids. In comparison, Spanish speakers reported lower digital technology proficiency and preferred family-involved, coach-guided, paper and visual decision aids. English speakers reported substantially higher levels of formal education. Conclusion. Preferences regarding the use of digital technology to inform prostate cancer treatment decision making among underserved Latino men varied depending on preferred primary language. Effective preparation of underserved Latino men for shared decision making requires consideration of alternative approaches depending on level of education attainment and preferred primary language.

Transfer of Training: Effectiveness of Context-Based Visual Decision Aids to Enhance the Situation Awareness of Windstorm Risk Engineers

Transfer of Training: Effectiveness of Context-Based Visual Decision Aids to Enhance the Situation Awareness of Windstorm Risk Engineers

Decision-Making Visual Aids for Late, Imaging-Guided Endovascular Thrombectomy for Acute Ischemic Stroke.

Background and PurposeSpeedy decision-making is important for optimal outcomes from endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). Figural decision aids facilitate rapid review of treatment benefits and harms, but have not yet been developed for late-presenting patients selected for EVT based on multimodal computed tomography or magnetic resonance imaging. MethodsFor combined pooled study-level randomized trial (DAWN and DEFUSE 3) data, as well as each trial singly, 100 person-icon arrays (Kuiper-Marshall personographs) were generated showing beneficial and adverse effects of EVT for patients with AIS and large vessel occlusion using automated (algorithmic) and expert-guided joint outcome table specification. ResultsAmong imaging-selected patients 6 to 24 hours from last known well, for the full 7-category modified Rankin Scale (mRS), EVT had number needed to treat to benefit 1.9 (interquartile range [IQR], 1.9 to 2.1) and number needed to harm 40.0 (IQR, 29.2 to 58.3). Visual displays of treatment effects among 100 patients showed that, with EVT: 52 patients have better disability outcome, including 32 more achieving functional independence (mRS 0 to 2); three patients have worse disability outcome, including one more experiencing severe disability or death (mRS 5 to 6), mediated by symptomatic intracranial hemorrhage and infarct in new territory. Similar features were present in person-icon figures based on a 6-level mRS (levels 5 and 6 combined) rather than 7-level mRS, and based on the DAWN trial alone and DEFUSE 3 trial alone. ConclusionsPersonograph visual decision aids are now available to rapidly educate patients, family, and healthcare providers regarding benefits and risks of EVT for late-presenting, imaging-selected AIS patients.

The Precision-Bias Distinction for Evaluating Visual Decision Aids for Risk Perception.

Risk communication is critically important, for both patients and providers. However, people struggle to understand risks because there are inherent biases and limitations to reasoning under uncertainty. A common strategy to enhance risk communication is the use of decision aids, such as charts or graphs, that depict the risk visually. A problem with prior research on visual decision aids is that it used a metric of performance that confounds 2 underlying constructs: precision and bias. Precision refers to a person's sensitivity to the information, whereas bias refers to a general tendency to overestimate (or underestimate) the level of risk. A visual aid is effective for communicating risk only if it enhances precision or, once precision is suitably high, reduces bias. This article proposes a methodology for evaluating the effectiveness of visual decision aids. Empirical data further illustrate how the new methodology is a significant advancement over more traditional research designs.

Abstract TP54: Visual Aids for Patient, Family, and Physician Decision Making About Late Imaging-Guided Endovascular Thrombectomy for Acute Ischemic Stroke

Background: Speedy decision-making is helpful for optimal outcomes from endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). Visual displays may facilitate rapid review of relevant outcomes with different courses of action, but have not yet been developed for late-presenting patients selected for EVT based on multimodal CT or MR imaging. Methods: From pooled, study-level randomized trial (DAWN and DEFUSE 3) data, 100 person-icon arrays (Kuiper-Marshall personographs) were generated showing beneficial and adverse effects of endovascular thrombectomy for patients with acute cerebral ischemia and large vessel occlusion using (1) automated (algorithmic) and (2) expert-guided joint outcome table specification. Results: Among imaging-selected patients 6-24 hours from last known well, for the full 7-category modified Rankin Scale (mRS), endovascular thrombectomy had number needed to treat to benefit 1.9 (IQR 1.9-2.1) and number needed to harm 40.0 (29.2-58.3). Visual displays of treatment effects among 100 patients showed that, with EVT: 52 patients have better disability outcome, including 32 more achieving functional independence (mRS 0-2); 3 patients have worse disability outcome, including 1 more experiencing severe disability or death (mRS 5-6), mediated by symptomatic intracranial hemorrhage and infarct in new territory. The person-icon figure integrated these outcomes, and early side-effects, in a single display (Figure). Similar features were present in person-icon figures based on a 6-level mRS (levels 5 and 6 combined) rather than 7-level mRS, and giving special emphasis to normal or near-normal outcome (mRS 0-1) rather than functional independence (mR 0-2). Conclusion: Personograph visual decision aids are now available to rapidly educate patients, family, and healthcare providers on the benefits and risks of late, imaging-guided endovascular thrombectomy therapies for acute ischemic stroke.

Effects of Shared Decision Making on Opioid Prescribing After Hysterectomy.

To evaluate the effects of shared decision making using a simple decision aid for opioid prescribing after hysterectomy. We conducted a prospective quality initiative study including all patients undergoing hysterectomy for benign, nonobstetric indications between March 1, 2018, and July 31, 2018, at our academic institution. Using a visual decision aid, patients received uniform education regarding postoperative pain management. They were then educated on the department's guidelines regarding the maximum number of tablets recommended per prescription and the mean number of opioid tablets used by a similar cohort of patients in a previously published study at our institution. Patients were then asked to choose their desired number of tablets to receive on discharge. Structured telephone interviews were conducted 14 days after surgery. The primary outcome was total opioids prescribed before compared with after implementation of the decision aid. Secondary outcomes included opioid consumption, patient satisfaction, and refill requests after intervention implementation. Of 170 eligible patients, 159 (93.5%) used the decision aid (one patient who used the decision aid was subsequently excluded from the analysis owing to significant perioperative complications), including 110 (69.6%) laparoscopic, 40 (25.3%) vaginal, and eight (5.3%) abdominal hysterectomies. Telephone surveys were completed for 89.2% (n=141) of participants. Student's t-test showed that patients who participated in the decision aid (post-decision aid cohort) were discharged with significantly fewer oral morphine equivalents than patients who underwent hysterectomy before implementation of the decision aid (pre-decision aid cohort) (92±35 vs 160±81, P<.01), with no significant change in the number of requested refills (9.5% [n=15] vs 5.7% [n=14], P=.15). In the post-decision aid cohort, 76.6% of patients (n=121) chose fewer tablets than the guideline-allotted maximum. Approximately 76% of patients (n=102) reported having leftover tablets. This quality improvement initiative illustrates that a simple decision aid can result in a significant decrease in opioid prescribing without compromising patient satisfaction or postoperative pain management.

Ethics and Bias in Clinical Trial Enrollment in Stroke.

To familiarize the reader with ethical concerns and potential scientific bias in management and conduction of clinical stroke trials. The goal of clinical trials in stroke is to find effective interventions for stroke prevention, acute treatment, and rehabilitation and recovery. Acute trials must be designed in the context of the time-sensitivity of revascularization therapies. Standard ethical constraints apply. However, informed consent is hindered by tight time windows for reperfusion therapy and frequent cognitive impairment in patients. These might be mitigated by using visual decision aids. Non-traditional methods of consent such as utilization of surrogates, telemedicine, and exception from informed consent are critical for successful and unbiased conduction of stroke trials. Stroke centers must have an a priori plan for deciding which trial to offer multiple-trial eligible patients. Historic non-generalizability of stroke trials due to under-enrollment of women, racial minorities, and age extremes is improving, but adequate representative recruitment and retention require up-front planning and training. Stroke trials have become less biased and more representative in the last decades, but there is still research to be done to improve ethical and unbiased recruitment and retention.

Analysis of Cotton Fibre Properties: A Data Mining Approach

The quality of cotton fibre is often characterized by its various physical properties, like bundle strength, elongation at break, fineness, mean length, maturity ratio, short fibre content, neps etc. As cotton is a natural fibre, all of its properties are always subjected to variation, thereby, influencing the characteristics of the final yarn. In this paper, these cotton fibre properties are analyzed in details using various tools of data mining. Decision tree is at first developed so as to identify the most predominant property affecting the spinnability of cotton fibres. It is also adopted to study the effects of different cotton fibre properties on yarn tenacity and unevenness. The developed dendograms help in identifying pairs or groups of cotton fibres having almost similar properties. On the other hand, cluster analysis acts as a visual decision aid in segregating the considered cotton fibres into different groups having maximum intraclass similarity and minimum interclass similarity to determine the constituent fibres in the final blend. These data mining techniques can also be implemented to study the physical characteristics of other natural fibres.

Use of Visual Decision Aids in Physician-Patient Communication: A Pilot Investigation.

Introduction:A risk calculator paired with a personalized decision aid (RC&DA) may foster shared decision-making in primary care. We assessed the feasibility of using an RC&DA with patients in a primary care outpatient clinic and patients’ experiences regarding communication and decision-making.Methods:This pilot study was conducted with 15 patients of 3 primary care physicians at a clinic within a tertiary medical center. An atherosclerotic cardiovascular disease (ASCVD) risk calculator was used to generate a personalized RC&DA that displayed absolute 10-year risk information as an icon array graphic. Patient perceptions of utility of the RC&DA, preferences for decision-making, and uncertainty with risk reduction decisions were measured with a semi-structured interview.Results:Patients reported that the RC&DA was easy to understand and knowledge gained was useful to modify their ASCVD risk. Patients used the RC&DA to make decisions and reported low uncertainty with those decisions.Conclusions:Our findings demonstrate the feasibility of, and positive patient experiences related to using, an RC&DA to facilitate shared decision-making between physicians and patients in an outpatient primary care setting.

Constructing a relevant decision aid for parents of children with bronchopulmonary dysplasia.

To develop and test a decision aid for counseling parents of children with bronchopulmonary dysplasia (BPD).Local problem:Parental education about complex conditions is not standardized and communication and understanding may not be adequate. Semi-structured interviews were conducted with 33 neonatal clinicians and 12 parents of children with BPD using a qualitative research design. The interviews were used to identify education topics that were felt to be important in BPD education. These topics were then used to create a visual decision aid to be used in counseling sessions with parents. The decision aid was then used in mock counseling sessions with 15 'experienced' participants and 7 'naïve' participants to assess its efficacy. The participants completed a pre and post test to assess change in knowledge as well as an 11-question Likert style acceptability survey. Implementation of a decision aid while educating parents about BPD. Topics identified during the interviews were used to create eight educational cards which included pictures, pictographs and statistics. Overall, participants thought the decision aid contained an appropriate amount of information, were easy to understand and improved their knowledge about BPD. Testing demonstrated a significant increase in knowledge in both the 'experienced' (P<0.0001) and 'naïve' group (P=0.0064). A decision aid for parents of children with BPD may improve understanding of the condition and help facilitate communication between parents and doctors.

Developing a Family of Visual Decision Aids for Intravenous and Endovascular Reperfusion Therapies for Acute Ischemic Stroke (S25.006)

Developing a Family of Visual Decision Aids for Intravenous and Endovascular Reperfusion Therapies for Acute Ischemic Stroke (S25.006)

Decision-Making Support Using a Standardized Script and Visual Decision Aid to Reduce Door-to-Needle Time in Stroke.

Decision-Making Support Using a Standardized Script and Visual Decision Aid to Reduce Door-to-Needle Time in Stroke.

Performance evaluation of Indian states in tourism using an integrated PROMETHEE-GAIA approach

Tourism development has a unique responsibility in regional policy of almost all countries. It is a well known fact that tourism has a remarkable contribution in sustainable development, economic growth and social benefits for a country, if planned methodically. This is due to its unquestionable advantages and benefits for the local community with respect to economic, social and environmental aspects. Since few decades, it has become a driving area in Indian economic planning strategy to deal with tourism issues for effective utilization of its wide range of destination resources and also optimize the intensity of financial involvement for developing tourist infrastructure in a restraint economic province. This paper applies a simple methodology to quantify the tourism potential of Indian states using an integrated visual decision aid model of preference ranking organization method for enrichment evaluation (PROMETHEE) and geometrical analysis for interactive aid (GAIA). Several social and physical attributes are considered to evaluate and rank the Indian states with respect to their performance in tourism. The adoption of this integrated visual decision aid model identifies Jammu and Kashmir, and Jharkhand as the best and the worst performing states respectively. In GAIA plane, the position of Jammu and Kashmir is the farthest from origin, followed by Madhya Pradesh. A close comparison between these two top performing states reveals that Jammu and Kashmir mainly outperforms Madhya Pradesh with respect to budget allocation, population density, pollution index and cost of living index criteria. The performance of Jharkhand is not at all the best with respect to even a single criterion. In GAIA plane, it is also observed that the considered beneficial and non-beneficial criteria form two different clusters, as expected. This performance evaluation problem is identified to be not at all a hard problem to solve.

Abstract 272: Preliminary Data from RESOLVE (Rapid Evaluation for Stroke Outcomes using Lytics in Vascular Events) Study

Background: Communicating the risks and benefits of recombinant tissue plasminogen activator (rt-PA) for the treatment of acute ischemic stroke (AIS) is complex and often a hurried conversation in the emergency department (ED). Visual decision aids have been shown to be superior to standard treatment decision counseling and useful in emergency decision-making. Current rt-PA tools primarily focus on harmful risks while minimizing the positive benefits of treatment. Despite evidence to support enhancement of patient understanding of rt-PA treatment, use of these materials remains low. This study explored patient and family caregiver (CG) recall of rt-PA information provided, and comprehension of AIS and rt-PA education prior to piloting an enhanced individualized risk and benefit decision tool for rt-PA treatment in the ED. Methods: The goal is to interview 150 consecutive AIS rt-PA eligible patients and their CG to obtain feedback on the type of information (verbal or visual), comprehension and recall of risks and benefits provided in the ED. Currently 20 individuals (stroke patients = 8 and CG =12) at one large metropolitan medical center have completed the study. The participants were 35% (7/20) male; mean age 55.9 years, and 100% (20/20) of the survivors received rt-PA. Findings: All participants (20/20) received information on treatment options for AIS education in the ED. Ninety five percent (19/20) of patients did not recall receiving any visual material used in education of risks and benefits. Most patients (18/20) reported understanding that a stroke was caused by a clot in the brain, however only 30% (6/20) recalled having heard of rt-PA prior to coming to the hospital. Forty-five percent (9/20) of the subjects perceived the descriptions of rt-PA with its risks and benefits as being completely clear whereas 20% (4/20) reported they were not at all clear. Conclusions: Preliminary findings showed that less than half of the patients and CG felt the education was clear. However additional interviews are planned. Preliminary insights suggest an opportunity to use an individualized risk and benefit decision tool to inform and engage patients and CG regarding treatment decisions. We believe this can be accomplished without increasing the door to needle time in administration of rt-PA.

Abstract W P245: Process Improvement to Reduce Time Interval From Hospital Arrival to Intravenous Thrombolysis in Acute Stroke

Background: Rapid administration of intravenous recombinant tissue plasminogen (rt-PA) is an effective way to enhance thrombolytic efficacy in stroke patients. We had already shown that a stroke code program based on the computerized physician order entry system could reduce time interval from hospital arrival to IV thrombolysis. We investigated that process improvement, which is an activity to improve existing process by making changes, could further reduce in-hospital time delay in thrombolytic therapy. Methods: During the first period (Jan. 2007 - Dec. 2009), we set the target time from emergency department (ED) arrival to IV thrombolysis at 40 minutes, monitored time intervals to evaluations and treatment at weekly stroke conference and determined the possible factors that were associated with time delay in cases who did not receive IV thrombolysis within 40 minutes. During the second period (Jan. 2010 - Dec. 2012), after review of factors of time delay during the first period, we implemented a tool for explanation to patients and their families, which included a standardized script and a Visual Decision Aid for tPA treatment (developed by UCLA stroke center). Results: After setting the target time and continuous monitoring of the process, median time from ED arrival to IV thrombolysis was reduced from 63 min to 45 min (p&lt;0.001). During the first period, the most common cause of the time delay was delayed decision of family (15.9%). After implementation of the standardized patient explanation tool, the proportion of the time delay due to the delayed decision was significantly reduced from 15.9% to 3.3% (p=0.005), which resulted in further reduction of time interval from ED arrival to IV thrombolysis to 43 min (p=0.001). Conclusion: Continuous process improvement activity was effective in reduction of time intervals from ED arrival to IV thrombolysis in acute stroke patients. Setting target time with continuous monitoring of the performance and a standardized explanation for patients and their families using a script and a Visual Decision Aid were helpful to improve stroke team performance and reduction of time delays.

A decision-making model for non-traditional machining processes selection

Article history: Received March 14, 2014 Accepted July 25, 2014 Available online July 31 2014 Non-traditional machining (NTM) refers to a variety of thermal, chemical, electrical and mechanical material removal processes, developed to generate complex and intricate shapes in advanced engineering materials with high strength-to-weight ratio. Selection of the optimal NTM process for generating a desired feature on a given material requires the consideration of several factors among which the type of the work material and shape to be machined are the most significant ones. Presence of a large number of NTM processes along with their complex characteristics and capabilities, and lack of experts in NTM process selection domain compel for development of a structured approach for NTM process selection for a given machining application. Thus, the objective of this paper is set to develop a decision-making model in Visual BASIC 6.0 to automate the NTM process selection procedure with the help of graphical user interface and visual decision aids. It is also integrated with quality function deployment technique to correlate the customers’ requirements (product characteristics) with technical requirements (process characteristics). Four illustrative examples are also provided to demonstrate the potentiality of the developed model in solving NTM process selection problems. © 2014 Growing Science Ltd. All rights reserved.

Patient Empowerment with Shared Decision Spaces

Abstract Patients face significant challenges when trying to understand the relative advantages and disadvantages of the variety of treatment options for serious diseases. This paper presents a description and evaluation of a novel visual decision aid designed to support shared decision making between patients and physicians. The objective of this research is empower patients to understand the differences among treatments that people like them chose, in terms of their resulting health outcomes. The visual depiction of the available options and the distributions of their relative desirability is called a decision space visualization (DSV). Prior research on DSVs shows that they have the potential to help shared patient-physician decision-making processes in situations where choices are not obvious and individual differences play a significant role in the decision. The DSV described here was achieved through three phases: developing requirements for the healthcare data that is filtered and displayed by the DSV, designing and developing the DSV application, and assessing the usability of the application in the context of a cancer diagnosis. The DSV detailed in this paper was found to be easy to understand, helpful, and promoted confidence in making treatment decisions.

What Keeps Managers Away from a Losing Course of Action? Go/Stop Decisions in New Product Development

The purpose of this experimental study is to test whether specific approaches can reduce escalation of commitment—namely, decision‐makers' tendency to persist with an innovation project despite negative feedback that the initial investment has not reached its goals. This study focuses on the decision process for 137 research and development managers who must decide whether to abandon previously chosen courses of action or to continue in the face of probable and increasing losses in a stage‐gate system. The results show that visual decision aids and consultant advice reduce managers' decisions to continue funding a losing course of action. The results also show that using both approaches simultaneously has the strongest effect. Finally, the study reveals that the escalation of commitment issue can be reduced more effectively before an innovation project is commercialized while using both approaches.