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Grounded in part the previous literature on household decision making and in part in the literature on tourism decision making, this paper tries to add to the literature by surveying Turkish academics with respect to spousal purch...
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Grounded in part the previous literature on household decision making and in part in the literature on tourism decision making, this paper tries to add to the literature by surveying Turkish academics with respect to spousal purchase decisions. In particular, the study assesses the decision tactics used for several consumer goods including vacation and travel and the link between decision tactics and consumer satisfaction/likelihood to produce positive word of mouth. The study findings confirm that spousal opinions matter and that compromise is a commonly used tactic, regardless of their features of durability (e.g. car, furniture) or non-durability (e.g. vacation, eating out), followed by the introduction of persuasion as the next most powerful tactic. Compromise is also positively associated with the level of consumer/tourist satisfaction with the product and the intention to recommend.
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Introduction. Little is known about how physicians present diagnosis and treatment planning in routine practice in preference-sensitive treatment decisions. We evaluated completeness and quality of informed decision making in loca...
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Introduction. Little is known about how physicians present diagnosis and treatment planning in routine practice in preference-sensitive treatment decisions. We evaluated completeness and quality of informed decision making in localized prostate cancer post biopsy encounters. Methods. We analyzed audio-recorded office visits of 252 men with presumed localized prostate cancer (Gleason 6 and Gleason 7 scores) who were seeing 45 physicians at 4 Veterans Affairs Medical Centers. Data were collected between September 2008 and May 2012 in a trial of 2 decision aids (DAs). Braddock's previously validated Informed Decision Making (IDM) system was used to measure quality. Latent variable models for ordinal data examined the relationship of IDM score to treatment received. Results. Mean IDM score showed modest quality (7.61 +/- 2.45 out of 18) and high variability. Treatment choice and risks and benefits were discussed in approximately 95% of encounters. However, in more than one-third of encounters, physicians provided a partial set of treatment options and omitted surveillance as a choice. Informing quality was greater in patients treated with surveillance ( = 1.1, p = .04). Gleason score (7 vs 6) and lower age were often cited as reasons to exclude surveillance. Patient preferences were elicited in the majority of cases, but not used to guide treatment planning. Encounter time was modestly correlated with IDM score (r = 0.237, p = .01). DA type was not associated with IDM score. Discussion. Physicians informed patients of options and risks and benefits, but infrequently engaged patients in core shared decision-making processes. Despite patients having received DAs, physicians rarely provided an opportunity for preference-driven decision making. More attention to the underused patient decision-making and engagement elements could result in improved shared decision making.
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Based on the object function of combining multi-attributes, the pattern of multiple attribute and multiple dimension grey decision making has been presented in this paper: The model can be used not only to order the decision makin...
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Based on the object function of combining multi-attributes, the pattern of multiple attribute and multiple dimension grey decision making has been presented in this paper: The model can be used not only to order the decision makings with multiple attributes, but also to recognize cluster of the decision makings, and to determine the weights of attributes. The example of investment decision making shows that the model is valid.
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BackgroundWhen patients are not adequately engaged in decision making, they may be at risk of decision regret. Our objective was to explore patients' perceptions of their decision-making experiences related to implantable cardiove...
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BackgroundWhen patients are not adequately engaged in decision making, they may be at risk of decision regret. Our objective was to explore patients' perceptions of their decision-making experiences related to implantable cardioverter defibrillators (ICDs).
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We present in this paper a new approach for building distributed decision support systems. Multiple decision makers support systems are devoted to assist setting a consensus while taking into account all aspects related to the dis...
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We present in this paper a new approach for building distributed decision support systems. Multiple decision makers support systems are devoted to assist setting a consensus while taking into account all aspects related to the distributed nature of the processes. This approach is based on the integration of the individual cognitive models of the decision makers of the team and on the modeling of the dynamics of individual decisions when being interleaved. Our model allows to detect and prevent extremal group behaviors and to identify the right information transfers to be set among decision makers. This model has been tested in a realistic application framework concerning decision making in Maritime Surveillance where several operators have to converge towards a unique decision in limited time. We conclude with proposing the main elements of a design methodology for decision makers support systems based on the proposed approach.
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The aim was to assess the financial and operational impact of our new gastroenterology referral pathway model on our services.An electronic ‘Clinical Assessment Service’ (CAS) proforma and an information platform were developed,...
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The aim was to assess the financial and operational impact of our new gastroenterology referral pathway model on our services.An electronic ‘Clinical Assessment Service’ (CAS) proforma and an information platform were developed, and all data were analysed retrospectively.Royal Wolverhampton NHS Trust.14 245 general practitioner (GP) referrals were received during January 2014–December 2016 with 9773 of them being triaged via our CAS.We looked into patients’ clinical outcome along with departmental performance and finances.A new outpatient appointment was offered to 60.1% (n=5873) of the CAS referred patients. Endoscopic or radiological investigations were requested for 29.2% (n=2854) of patients prior to deciding on further management plan. Out of those, 27% (n=765) went on to receive another gastroenterology (GI) clinic appointment. The remaining 21.3% (n=2089) of the CAS patients were discharged back to their GP following initial investigations. 5.5% (n=538) were discharged back to primary care with a letter of advice, whereas 5.2% (n=509) were deemed inappropriate for GI clinic and were redirected to other specialists. Overall, 32% (n=3127) of patients were managed without a face to face consultation in the GI clinic. This corresponds to 3136 less outpatient appointments with estimated reduced expenditure by the Clinical Commissioning Group (CCG) of ￡481K. The 18-week performance and waiting times remained stable despite the increasing referral population. The DNA rate dropped from 14% pre to 8.5%.Our clinical assessment model has, in addition to the clinical benefits, a considerable positive financial impact to the health economy.
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Influential work on human thinking suggests that our judgment is often biased because we minimize cognitive effort and intuitively substitute hard questions by easier ones. A key question is whether or not people realize that they...
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Influential work on human thinking suggests that our judgment is often biased because we minimize cognitive effort and intuitively substitute hard questions by easier ones. A key question is whether or not people realize that they are doing this and notice their mistake. Here, we test this claim with one of the most publicized examples of the substitution bias, the bat-and-ball problem. We designed an isomorphic control version in which reasoners experience no intuitive pull to substitute. Results show that people are less confident in their substituted, erroneous bat-and-ball answer than in their answer on the control version that does not give rise to the substitution. Contrary to popular belief, this basic finding indicates that biased reasoners are not completely oblivious to the substitution and sense that their answer is questionable. This calls into question the characterization of the human reasoner as a happy fool who blindly answers erroneous questions without realizing it.
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Background: To evaluate the quality of the decision-making processes of pharmaceutical companies during medicines development for evidence generation to support reimbursement of new medicines and the appraisal recommendation decis...
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Background: To evaluate the quality of the decision-making processes of pharmaceutical companies during medicines development for evidence generation to support reimbursement of new medicines and the appraisal recommendation decision-making process by health technology assessment (HTA) agencies. Methods: Two questionnaires were developed and subsequently piloted for the purpose of content validation. These were sent to 24 pharmaceutical companies and 16 HTA agencies. Results: Responses were obtained from 11 companies and 11 HTA agencies. Some similarities were identified between the decision-making processes of companies and agencies, such as the use of committees, having a primarily mixed (qualitative/quantitative) internal decisionmaking system, as well as the lack of systematic assessments of quality decision making and the relatively infrequent use of formal decision-making frameworks. Nevertheless, the results indicate differences as companies and agencies use diverse processes to arrive at the final decision either through consensus, majority vote, or an individual making the decision. The majority of companies and agencies believe that the quality of decision making can and should be measured. Moreover, organizations considered the occurrence of biases within their organization as pertinent. Finally, almost all the participants felt that there was room for improvement for their organization's quality of decision making. Conclusion: These findings are consistent with a published study on regulatory processes and support the need for more consistent and predictable decision-making processes during the life cycle of medicines. This could be achieved through capacity building, systematically evaluating the quality of decision making, and encouraging utilization of formal decision-making frameworks within companies and agencies.
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Background. Multicriteria decision-making (MCDM) methods are well-suited to serve as the foundation for clinical decision support systems. To do so, however, they need to be appropriate for use in busy clinical settings. We compar...
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Background. Multicriteria decision-making (MCDM) methods are well-suited to serve as the foundation for clinical decision support systems. To do so, however, they need to be appropriate for use in busy clinical settings. We compared decision-making processes and outcomes of patient-level analyses done with a range of multicriteria methods that vary in ease of use and intensity of decision support, 2 factors that could affect their ease of implementation into practice. Methods. We conducted a series of Internet surveys to compare the effects of 5 multicriteria methods that differ in user interface and required user input format on decisions regarding selection of a preferred method for lowering the risk of cardiovascular disease. The study sample consisted of members of an online Internet panel maintained by Fluidsurveys, an Internet survey company. Study outcomes were changes in preferred option, decision confidence, preparation for decision making, the Values Clarification and Decisional Uncertainty subscales of the Decisional Conflict Scale, and method ease of use. Results. The frequency of changes in the preferred option ranged from 9% to 38%, P < 0.001, and rose progressively as the level of decision support provided by the MCDM method increased. The proportion of respondents who rated the method as easy ranged from 57% to 79% and differed significantly among MCDM methods, P = 0.003, but was not consistently related to intensity of decision support or ease of use. Conclusion. Decision support based on MCDM methods is not necessarily limited by decreases in ease of use. This result suggests that it is possible to develop decision support tools using sophisticated multicriteria techniques suitable for use in routine clinical care settings.
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Despite decades of research on organizational disasters, such events remain too common. Scholars across a wide range of disciplines agree that one of the most viable approaches to preventing such catastrophes is to observe near-mi...
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Despite decades of research on organizational disasters, such events remain too common. Scholars across a wide range of disciplines agree that one of the most viable approaches to preventing such catastrophes is to observe near-misses and use them to identify and eliminate problems before they produce large failures. Unfortunately, these important warning signals are too often ignored because they are perceived as successes rather than near-misses (or near-failures). In this article, we explore the effect of a climate for safety on improving near-miss recognition by observers, hypothesizing that safety climate increases the level of attention that observers pay to the underlying processes that generate an apparently successful outcome. Using a database of anomaly reports for unmanned NASA missions, we show that organizational safety climate and project stakes increase reporting rates of near-misses, both independently and interactively. In follow-up laboratory experiments, we confirm the independence of these effects to improve the likelihood that people differentiate near-miss outcomes from successes. Results suggest organizations can increase the recognition of near-misses with organizational messages that emphasize a positive safety climate.
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