Since the first publication describing the identification of prostate-specific antigen （PSA） in the 1960s, much progress has been made. The PSA test changed from being initially a monitoring tool to being also used ...Since the first publication describing the identification of prostate-specific antigen （PSA） in the 1960s, much progress has been made. The PSA test changed from being initially a monitoring tool to being also used as a diagnostic tool. Over time, the test has been heavily debated due to its lack of sensitivity and specificity. However, up to now the PSA test is still the only biomarker for the detection and monitoring of prostate cancer. PSA-based screening for prostate cancer is associated with a high proportion of unnecessary testing and overdiagnosis with subsequent overtreatment. In the early years of screening for prostate cancer, high rates of uptake were very important. However, over time the opinion on PSA-based screening has shifted towards the notion of informed choice. Nowadays, it is thought to be unethical to screen men without them being aware of the pros and cons of PSA testing, as well as the fact that an informed choice is related to better patient outcomes. Now, as the results of three major screening studies have been presented and the downsides of screening are becoming better understood, informed choice is becoming more relevant.展开更多
Gastroesophageal reflux disease(GERD)is a common upper esophageal condition and typical symptoms can include heartburn and sensation of regurgitation while atypical symptoms include chronic cough,asthma,hoarseness,dys...Gastroesophageal reflux disease(GERD)is a common upper esophageal condition and typical symptoms can include heartburn and sensation of regurgitation while atypical symptoms include chronic cough,asthma,hoarseness,dyspepsia and nausea.Typically,diag-nosis is presumptive given the presence of typical and atypical symptoms and is an indication for empiric therapy.Treatment management can include lifestyle modifications and/or medication therapy with proton pump inhibitor(PPI)class being the preferred and most effective.Complete symptom resolution is not always achieved and long-term PPI therapy can put patients at risk for serious side effects and needless expense.The brain-gut connection and hypervigilance plays an important role in symptom resolution and treatment success,especially in the case of non-PPI responders.Hypervigilance is a combination of increased esophageal sensory sensitivity in combination with exaggerated threat perception surrounding esophageal symptoms.Hypervigilance requires a different approach to GERD managements,where continued PPI therapy and surgery are usually not recommended.Rather,helping physicians and patients understand the brain-gut connection can guide and improve care.Education and reassurance should be the main pillars or treatment.However,it is important not to suggest the symptoms are due to anxiety alone,this often leads to patient dissatisfaction.Patient dissatisfaction with treatment reveals the need for a more patient-centered approach to GERD management and better communication between patients and providers.Shared decision making(SDM)with the incorporation of patient-reported outcomes(PRO)promotes patient adherence and satisfaction.SDM is a joint discussion between clinician and patient in which a mutually shared solution is explored for GERD symptoms.For SDM to work the physician needs to capture patients'perceptions which may not be obtained in the standard interview.This can be done through the use of PROs which promote a dialogue with patients about their symptoms and treatment priorities in the context of the SDM patient encounter.SDM could potentially help in the management of patient expectations for GERD treatment,ultimately positively impacting their health-related quality of life.展开更多
Objective: To assess preferences for participation in shared decision making in a representative sample of psychiatric outpatients with affective disorders and to understand how clinical and socio-demographic variable...Objective: To assess preferences for participation in shared decision making in a representative sample of psychiatric outpatients with affective disorders and to understand how clinical and socio-demographic variables influence patients’ preferences for participation. Method: A cross-sectional survey of 172 consecutive psychiatric outpatients with affective disorders attending at Community Mental Health Care setting was carried out. Patients expressed preferences on each of 3 aspects of decision making (seeking information, discussing options, making the final decision). The “CGI Severity and Improvement Scales” and the “Beck Depression Inventory” scale were used for severity assessment. Additionally the “Drug Attitude Inventory”, the “Beliefs about Medicine Questionnaire” and the “Leeds Attitude toward Concordance Scale” were applied to all participants. Effects of variables considered on preferences were assessed using proportional odds regression models. Results: We registered a high response rate of 85%. Nearly all patients (91%) preferred to leave final decisions to their treating psychiatrists and 87% preferred to rely on psychiatrists for medical knowledge rather than seeking their own information. In contrast, 81% of patients preferred to be offered options and to be asked their opinion by their doctors. Gender, age, educational level, number of psychotropics used and belief about psychiatric medication overuse were significant predictors in decision making dimensions considered. Conclusion: Shared decision making approach of patients with affective disorder must take into consideration a more doctor-directed approach preferred by the patients in which the desire to be offered options is not automatically linked with the willingness of taking decisions or getting more knowledge.展开更多
Background:Shared decision-making(SDM)implementation is a priority for Australian health systems,including general practices but it remains complex for specific groups like older rural Australians.We initiated a quali...Background:Shared decision-making(SDM)implementation is a priority for Australian health systems,including general practices but it remains complex for specific groups like older rural Australians.We initiated a qualitative study with older rural Australians to explore barriers to and facilitators of SDM in local general practices.Methods:We conducted a patient-oriented research,partnering with older rural Australians,families,and health service providers in research design.Participants who visited general practices were purposively sampled from five small rural towns in South Australia.A semi-structured interview guide was used for interviews and reflexive thematic coding was conducted.Results:Telephone interviews were held with 27 participants.Four themes were identified around older rural adults’involvement in SDM:(1)Understanding of"patient involvement";(2)Positive and negative outcomes;(3)Barriers to SDM;and(4)Facilitators to SDM.Understanding of patient involvement in SDM considerably varied among participants,with some reporting their involvement was contingent on the“opportunity to ask questions”and the“treatment choices”offered to them.Alongside the opportunity for involvement,barriers such as avoidance of cultural care and a lack of continuity of care are new findings.Challenges encountered in SDM implementation also included resource constraints and time limitations in general practices.Rural knowledge of general practitioners and technology integration in consultations were viewed as potential enablers..Conclusion:Adequate resources and well-defined guidelines about the process should accompany the implementation of SDM in rural general practices of South Australia.Innovative strategies by general practitioners promoting health literacy and culturally-tailored communication approaches could increase older rural Australians'involvement in general.展开更多
Background: Shared Decision Making (SDM) is primarily intended to enhance patient autonomy. To date, the relationship between patients’ perceived levels of involvement and autonomy support has never been investigated...Background: Shared Decision Making (SDM) is primarily intended to enhance patient autonomy. To date, the relationship between patients’ perceived levels of involvement and autonomy support has never been investigated in the field of physical therapy. Based on the recently reported extremely low level of observed SDM in physical therapy, similarly poor patient perceptions are expected. Objective: The main objectives of this study were to examine patients’ perceptions of SDM and autonomy support in physical therapy and to explore the relationship between both. Design: Patient survey after real consultations in physical therapy. Methods: Patients completed the Dyadic Observing Patient Involvement (Dyadic OPTION) instrument and the Health Care Climate Questionnaire (HCCQ) to examine patients’ perceived levels of SDM and autonomy support, respectively. Multilevel analyses were applied to determine the relationship between both perceptions. Results: Two hundred and twenty-nine patients, who were recruited by 13 physical therapists, agreed to participate. The median Dyadic OPTION score was 72.9 out of a total possible score of 100. The median HCCQ score was 94.3 out of a total possible score of 100. Patients’ experienced level of SDM (b = 0.14;p < 0.001) and patients’ age (b = 0.12;p = 0.001) contributed to patients’ perceived autonomy support. None of the physical therapist characteristics were related to patients’ perceived autonomy support. Limitations: Only 13 out of 125 therapists who were personally contacted agreed to participate. Conclusion: Using patients’ perceptions, we found that a relationship between SDM and autonomy support existed. In contrast to observational studies, our study also demonstrated that the participating physical therapists individually tailored patient support by adapting their implementation of SDM to each patient.展开更多
Very little is known about shared decision making (SDM) in residential aged care, despite world-wide policy and imperatives that encourage resident choice and autonomy. This paper provides a framework synthesis of SDM...Very little is known about shared decision making (SDM) in residential aged care, despite world-wide policy and imperatives that encourage resident choice and autonomy. This paper provides a framework synthesis of SDM in residential aged care (RAC) and potential barriers and enablers to implement SDM utilising a theoretical framework of implementation. A review of the literature on SDM in RAC from 2005 to 2016 was undertaken, using MEDLINE (Ovid), CINAHL, PsychINFO and Scopus. The articles were synthesised by utilising an implementation theory framework to better understand what may facilitate or hinder the introduction of SDM. Eighteen studies were identified and analysed to determine barriers and enablers to SDM in RAC from the perspectives of staff, residents and relatives. A workplace culture of person-centred care and judicious use of research evidence are enablers of SDM. There is a potential need for additional resources, such as education for staff and families to enable implementation of SDM. Implementation of any health care intervention, including SDM, relies on many complex factors but these are predominantly related to capacity. Determining current uptake and readiness of RAC organisations, residents and their families to adopt SDM is an essential starting point.展开更多
The rapid progress of research into inflammatory bowel disease(IBD)has resulted in increasingly more treatment options.Different options have different advantages and disadvantages,and the preferences of patients may ...The rapid progress of research into inflammatory bowel disease(IBD)has resulted in increasingly more treatment options.Different options have different advantages and disadvantages,and the preferences of patients may also differ.If patients can be invited to the formulation of medical decision-making,their compliance and satisfaction would be improved,thus possibly achieving better therapeutic results.The present review aims to summarize the current literature on shared decision-making(SDM)in the management of IBD,with the goal of promoting the application of SDM.展开更多
Across four studies,we explore the impact of solitude on consumers’reliance on feelings versus reasons in decision making,along with the underlying mechanism and boundary conditions.The results indicate that solitude...Across four studies,we explore the impact of solitude on consumers’reliance on feelings versus reasons in decision making,along with the underlying mechanism and boundary conditions.The results indicate that solitude individuals(vs.non-solitude)would prefer feeling-based strategy in decision-making,resulting in a higher intention of choosing the affectively superior option over the cognitively superior option(Study 1).Self-focus plays the underlying mechanism in the solitude effect(Study 2).Moreover,we also examine two boundary conditions:motivation(Study 3)and temporal orientation(Study 4),which indicates that involuntary motivation and future orientation can mitigate the solitude effect on affective processing.These findings provide insights into consumers’judgments of product attributes and selection of decision-making strategies according to their situations.展开更多
For the explosive development of emerging diagnostic and therapeutic technologies brought by the advancement of precision medicine strategy, shared decision-making could improve the quality of clinical decision-making...For the explosive development of emerging diagnostic and therapeutic technologies brought by the advancement of precision medicine strategy, shared decision-making could improve the quality of clinical decision-making and promote the transformation of clinical research evidence in TCM. Paying attention to patients＇ narrative needs and strengthening medical humanistic concerns could improve clinical outcome and patient satisfaction. We described the origins and development of evidence-based medicine, narrative medicine and shared decision-making, and analyzed the existing problems in TCM clinical decision-making. Further, we put forward the model of shared decision-making between clinicians and patients under the guidance of narrative evidence-based medicine concepts and methods.展开更多
Shared decision-making has been described as allowing patients to gain more control over their life situation and feel less helpless. The aim of this systematic review was to describe the involvement of older patients...Shared decision-making has been described as allowing patients to gain more control over their life situation and feel less helpless. The aim of this systematic review was to describe the involvement of older patients in shared decision-making in community settings. In accordance with the systematic review method, a total of 2468 abstracts were read, after which nine quantitative studies were included. A qualitative thematic analysis was performed and two themes emerged;increased understanding of self-management and a desire to strengthen one’s position in relationship with professionals, both of which were essential for empowering older patients to participate in shared decision-making. Older patients’ shared decision-making was seen as a struggle to maintain their autonomy in different areas of everyday life. Emotional and psychological problems made their position more difficult. In order to empower them in relationships with healthcare professionals, older patients require more knowledge (self-efficacy) and information about their illness, which could strengthen their position in the decision-making process. They also need a greater awareness of decisional conflicts that may arise. Age, gender and health status influence older patients’ chance of being respected and taken seriously in relationship with professionals.展开更多
We examined the relationship between social support and career adaptability,as well as the mediating roles of proactive personality and career decision-making self-efficacy in this process.A total of 1354 Chinese coll...We examined the relationship between social support and career adaptability,as well as the mediating roles of proactive personality and career decision-making self-efficacy in this process.A total of 1354 Chinese college students(female=964;mean age=19.53 years,SD=1.33 years)completed an online questionnaire.Path analysis indicated that social support was positively associated with higher levels of career adaptability.Both proactive personality and career decision-making self-efficacy served as parallel mediators,strengthening the relationship between social support and career adaptability.The complete chain mediation analysis revealed that social support influences career adaptability primarily through proactive personality,which in turn enhances career decision-making self-efficacy,further contributing to increased career adaptability.These findings extend career capital theory by demonstrating that social and psychological resources jointly facilitate career adaptability.展开更多
This study introduces a novel distance measure(DM)for(p,q,r)-spherical fuzzy sets((p,q,to improve decision-making in complex and uncertain environments.Many existing distance measures eitherr)-SFSs)fail to satisfy ess...This study introduces a novel distance measure(DM)for(p,q,r)-spherical fuzzy sets((p,q,to improve decision-making in complex and uncertain environments.Many existing distance measures eitherr)-SFSs)fail to satisfy essential axiomatic properties or produce unintuitive outcomes.To address these limitations,we propose a new three-dimensional divergence-based DM that ensures mathematical consistency,enhances the discrimination of information,and adheres to the axiomatic framework of distance theory.Building on this foundation,we construct a multi-criteria decision-making(MCDM)model that utilizes the proposed DM to evaluate and rank alternatives effectively.The applicability and robustness of the model are validated through a practical case study,demonstrating that it leads to more rational,consistent,and reliable decision outcomes compared to existing approaches.展开更多
In this manuscript,the notion of a hesitant fuzzy soft fixed point is introduced.Using this notion and the concept of Suzuki-type(μ,ν)-weak contraction for hesitant fuzzy soft set valued-mapping,some fixed point res...In this manuscript,the notion of a hesitant fuzzy soft fixed point is introduced.Using this notion and the concept of Suzuki-type(μ,ν)-weak contraction for hesitant fuzzy soft set valued-mapping,some fixed point results are established in the framework of metric spaces.Based on the presented work,some examples reflecting decision-making problems related to real life are also solved.The suggested method’s flexibility and efficacy compared to conventional techniques are demonstrated in decision-making situations involving uncertainty,such as choosing the best options in multi-criteria settings.We noted that the presented work combines and generalizes two major concepts,the idea of soft sets and hesitant fuzzy set-valued mapping from the existing literature.展开更多
The present work reviews different decision making tools(material comparing and choosing tools)used for selecting the best material considering different parameters.In this review work,the authors have tried to addres...The present work reviews different decision making tools(material comparing and choosing tools)used for selecting the best material considering different parameters.In this review work,the authors have tried to address the following important enquiries:1)the engineering applications addressed by the different material choosing and ranking methods;2)the predominantly used decision making tools addressing the optimal material selection for the engineering applications;3)merits and demerits of decision making tools used;4)the dominantly used criteria or objectives considered while selecting a suitable alternative material;5)overview of DEA on material selection field.The authors have surveyed literatures from different regions of the globe and considered literatures since 1988.The present review not only stresses the importance of material selection in the early design stage of the product development but also aids the design and material engineers to apply different decision making tools systematically.展开更多
A semantics-based model is proposed to enable weakened hedges, such as ＂more or less＂ and ＂roughly＂ in the context of linguistic multi-criteria decision making. First, the resemblance relations are defined based o...A semantics-based model is proposed to enable weakened hedges, such as ＂more or less＂ and ＂roughly＂ in the context of linguistic multi-criteria decision making. First, the resemblance relations are defined based on the semantics of terms on the domain. Then, the hedges can be represented after the upper and loose upper approximations of a linguistic term are derived. Accordingly, some compact formulae can be derived for the semantics of linguistic expressions with hedges. Parameters in these formulae are objectively determined according to the semantics of original terms. The proposed model presents a more natural way to express the decision information under uncertainties and its semantics is clear. The proposed model is clarified by solving the problem of evaluation and selection of sustainable innovative energy technologies. Computational results demonstrate that the model can deal with various uncertainties of the problem. Finally, the model is compared with existing techniques and extended to the case when the semantics of terms are represented by trapezoidal fuzzy numbers.展开更多
A grey multi-stage decision making method is proposed for a type of grey multi-index decision problems with weighted values completely unknown and attributes as interval grey numbers. Firstly, a method for compar- ing...A grey multi-stage decision making method is proposed for a type of grey multi-index decision problems with weighted values completely unknown and attributes as interval grey numbers. Firstly, a method for compar- ing two grey numbers based on probability is developed to calculate weighted values of the attributes. Secondly, the experts＇ evaluation scores for attribute values are presented in terms of internal grey numbers. Finally, a weight solving method for multiple-stages evaluation is proposed. An example analysis verifies the availability of the proposed method. The method provides a new way of thinking for solving grey decision problem.展开更多
By combining the advantages of the additive weighted mean (AWM) operator and the ordered weighted averaging (OWA) operator, this paper first presents a hybrid operator for aggregating data information, and then propos...By combining the advantages of the additive weighted mean (AWM) operator and the ordered weighted averaging (OWA) operator, this paper first presents a hybrid operator for aggregating data information, and then proposes a hybrid aggregation (HA) operator-based method for multiple attribute decision making (MADM) problems. The theoretical analyses and the numerical results show that the HA operator generalizes both the AWM and OWA operators, and reflects the importance of both the given argument and the ordered position of the argument. Thus, the HA operator can reflect better real situations in practical applications. Finally, an illustrative example is given.展开更多
The problem of multiple attribute decision making under fuzzy linguistic environments, in which decision makers can only provide their preferences （attribute values）in the form of trapezoid fuzzy linguistic variable...The problem of multiple attribute decision making under fuzzy linguistic environments, in which decision makers can only provide their preferences （attribute values）in the form of trapezoid fuzzy linguistic variables（TFLV）, is studied. The formula of the degree of possibility between two TFLVs is defined, and some of its characteristics are studied. Based on the degree of possibility of fuzzy linguistic variables, an approach to ranking the decision alternatives in multiple attribute decision making with TFLV is developed. The trapezoid fuzzy linguistic weighted averaging （TFLWA） operator method is utilized to aggregate the decision information, and then all the alternatives are ranked by comparing the degree of possibility of TFLV. The method can carry out linguistic computation processes easily without loss of linguistic information, and thus makes the decision results reasonable and effective. Finally, the implementation process of the proposed method is illustrated and analyzed by a practical example.展开更多
Distance measures between exact linguistic variables and between uncertain linguistic variables are introduced respectively. Based on exact linguistic variables and uncertain linguistic variables, the concepts of posi...Distance measures between exact linguistic variables and between uncertain linguistic variables are introduced respectively. Based on exact linguistic variables and uncertain linguistic variables, the concepts of positive linguistic ideal solution and negative linguistic ideal solution of attribute values are defined. To rank and select alternatives, based on the distance measures of two types of linguistic variables and the linguistic ideal solutions, a method for multiple attribute decision making with different types of linguistic information is proposed, by which all alternatives can be ranked. The method can carry out linguistic computation processes easily without loss of linguistic information, and thus makes the decision result reasonable and effective. Finally, the implementation process of the proposed method is illustrated and analyzed by a numerical example.展开更多
Background: In paternalistic models, healthcare providers’ responsibility is to decide what is best for patients. The main concern is that such models fail to respect patient autonomy and do not promote patient respo...Background: In paternalistic models, healthcare providers’ responsibility is to decide what is best for patients. The main concern is that such models fail to respect patient autonomy and do not promote patient responsibility. Aim: To evaluate mental healthcare team members’ perceptions of their own role in encouraging elderly persons to participate in shared decision-making after implementation of the CCM. The CCM is not an explanatory theory, but an evidence-based guideline and synthesis of best available evidence. Methods: Data were collected from two teams that took part in a focus group interview, and the transcript was analysed by means of qualitative thematic analysis. Results: One overall theme emerged—Preventing the violation of human dignity based on three themes, namely, Changing understanding and attitudes, Increasing depressed elderly persons’ autonomy and Clarifying the mental healthcare team coordinator’s role and responsibility. The results of this study reveal that until recently, paternalism has been the dominant decision-making model within healthcare, without any apparent consideration of the patient perspective. Community mental healthcare can be improved by shared decision-making in which team members initiate a dialogue focusing on patient participation to prevent the violation of human dignity. However, in order to determine how best to empower the patient, team members need expert knowledge and intuition.展开更多
文摘Since the first publication describing the identification of prostate-specific antigen （PSA） in the 1960s, much progress has been made. The PSA test changed from being initially a monitoring tool to being also used as a diagnostic tool. Over time, the test has been heavily debated due to its lack of sensitivity and specificity. However, up to now the PSA test is still the only biomarker for the detection and monitoring of prostate cancer. PSA-based screening for prostate cancer is associated with a high proportion of unnecessary testing and overdiagnosis with subsequent overtreatment. In the early years of screening for prostate cancer, high rates of uptake were very important. However, over time the opinion on PSA-based screening has shifted towards the notion of informed choice. Nowadays, it is thought to be unethical to screen men without them being aware of the pros and cons of PSA testing, as well as the fact that an informed choice is related to better patient outcomes. Now, as the results of three major screening studies have been presented and the downsides of screening are becoming better understood, informed choice is becoming more relevant.
文摘Gastroesophageal reflux disease(GERD)is a common upper esophageal condition and typical symptoms can include heartburn and sensation of regurgitation while atypical symptoms include chronic cough,asthma,hoarseness,dyspepsia and nausea.Typically,diag-nosis is presumptive given the presence of typical and atypical symptoms and is an indication for empiric therapy.Treatment management can include lifestyle modifications and/or medication therapy with proton pump inhibitor(PPI)class being the preferred and most effective.Complete symptom resolution is not always achieved and long-term PPI therapy can put patients at risk for serious side effects and needless expense.The brain-gut connection and hypervigilance plays an important role in symptom resolution and treatment success,especially in the case of non-PPI responders.Hypervigilance is a combination of increased esophageal sensory sensitivity in combination with exaggerated threat perception surrounding esophageal symptoms.Hypervigilance requires a different approach to GERD managements,where continued PPI therapy and surgery are usually not recommended.Rather,helping physicians and patients understand the brain-gut connection can guide and improve care.Education and reassurance should be the main pillars or treatment.However,it is important not to suggest the symptoms are due to anxiety alone,this often leads to patient dissatisfaction.Patient dissatisfaction with treatment reveals the need for a more patient-centered approach to GERD management and better communication between patients and providers.Shared decision making(SDM)with the incorporation of patient-reported outcomes(PRO)promotes patient adherence and satisfaction.SDM is a joint discussion between clinician and patient in which a mutually shared solution is explored for GERD symptoms.For SDM to work the physician needs to capture patients'perceptions which may not be obtained in the standard interview.This can be done through the use of PROs which promote a dialogue with patients about their symptoms and treatment priorities in the context of the SDM patient encounter.SDM could potentially help in the management of patient expectations for GERD treatment,ultimately positively impacting their health-related quality of life.
基金The Instituto de Salud Carlos III, FEDER Union Europea (Grant No. PI10/00955).
文摘Objective: To assess preferences for participation in shared decision making in a representative sample of psychiatric outpatients with affective disorders and to understand how clinical and socio-demographic variables influence patients’ preferences for participation. Method: A cross-sectional survey of 172 consecutive psychiatric outpatients with affective disorders attending at Community Mental Health Care setting was carried out. Patients expressed preferences on each of 3 aspects of decision making (seeking information, discussing options, making the final decision). The “CGI Severity and Improvement Scales” and the “Beck Depression Inventory” scale were used for severity assessment. Additionally the “Drug Attitude Inventory”, the “Beliefs about Medicine Questionnaire” and the “Leeds Attitude toward Concordance Scale” were applied to all participants. Effects of variables considered on preferences were assessed using proportional odds regression models. Results: We registered a high response rate of 85%. Nearly all patients (91%) preferred to leave final decisions to their treating psychiatrists and 87% preferred to rely on psychiatrists for medical knowledge rather than seeking their own information. In contrast, 81% of patients preferred to be offered options and to be asked their opinion by their doctors. Gender, age, educational level, number of psychotropics used and belief about psychiatric medication overuse were significant predictors in decision making dimensions considered. Conclusion: Shared decision making approach of patients with affective disorder must take into consideration a more doctor-directed approach preferred by the patients in which the desire to be offered options is not automatically linked with the willingness of taking decisions or getting more knowledge.
基金financed by the Flinders University College of Business,Government and Law Large Project Grant(Grant number:100031.21).
文摘Background:Shared decision-making(SDM)implementation is a priority for Australian health systems,including general practices but it remains complex for specific groups like older rural Australians.We initiated a qualitative study with older rural Australians to explore barriers to and facilitators of SDM in local general practices.Methods:We conducted a patient-oriented research,partnering with older rural Australians,families,and health service providers in research design.Participants who visited general practices were purposively sampled from five small rural towns in South Australia.A semi-structured interview guide was used for interviews and reflexive thematic coding was conducted.Results:Telephone interviews were held with 27 participants.Four themes were identified around older rural adults’involvement in SDM:(1)Understanding of"patient involvement";(2)Positive and negative outcomes;(3)Barriers to SDM;and(4)Facilitators to SDM.Understanding of patient involvement in SDM considerably varied among participants,with some reporting their involvement was contingent on the“opportunity to ask questions”and the“treatment choices”offered to them.Alongside the opportunity for involvement,barriers such as avoidance of cultural care and a lack of continuity of care are new findings.Challenges encountered in SDM implementation also included resource constraints and time limitations in general practices.Rural knowledge of general practitioners and technology integration in consultations were viewed as potential enablers..Conclusion:Adequate resources and well-defined guidelines about the process should accompany the implementation of SDM in rural general practices of South Australia.Innovative strategies by general practitioners promoting health literacy and culturally-tailored communication approaches could increase older rural Australians'involvement in general.
文摘Background: Shared Decision Making (SDM) is primarily intended to enhance patient autonomy. To date, the relationship between patients’ perceived levels of involvement and autonomy support has never been investigated in the field of physical therapy. Based on the recently reported extremely low level of observed SDM in physical therapy, similarly poor patient perceptions are expected. Objective: The main objectives of this study were to examine patients’ perceptions of SDM and autonomy support in physical therapy and to explore the relationship between both. Design: Patient survey after real consultations in physical therapy. Methods: Patients completed the Dyadic Observing Patient Involvement (Dyadic OPTION) instrument and the Health Care Climate Questionnaire (HCCQ) to examine patients’ perceived levels of SDM and autonomy support, respectively. Multilevel analyses were applied to determine the relationship between both perceptions. Results: Two hundred and twenty-nine patients, who were recruited by 13 physical therapists, agreed to participate. The median Dyadic OPTION score was 72.9 out of a total possible score of 100. The median HCCQ score was 94.3 out of a total possible score of 100. Patients’ experienced level of SDM (b = 0.14;p < 0.001) and patients’ age (b = 0.12;p = 0.001) contributed to patients’ perceived autonomy support. None of the physical therapist characteristics were related to patients’ perceived autonomy support. Limitations: Only 13 out of 125 therapists who were personally contacted agreed to participate. Conclusion: Using patients’ perceptions, we found that a relationship between SDM and autonomy support existed. In contrast to observational studies, our study also demonstrated that the participating physical therapists individually tailored patient support by adapting their implementation of SDM to each patient.
文摘Very little is known about shared decision making (SDM) in residential aged care, despite world-wide policy and imperatives that encourage resident choice and autonomy. This paper provides a framework synthesis of SDM in residential aged care (RAC) and potential barriers and enablers to implement SDM utilising a theoretical framework of implementation. A review of the literature on SDM in RAC from 2005 to 2016 was undertaken, using MEDLINE (Ovid), CINAHL, PsychINFO and Scopus. The articles were synthesised by utilising an implementation theory framework to better understand what may facilitate or hinder the introduction of SDM. Eighteen studies were identified and analysed to determine barriers and enablers to SDM in RAC from the perspectives of staff, residents and relatives. A workplace culture of person-centred care and judicious use of research evidence are enablers of SDM. There is a potential need for additional resources, such as education for staff and families to enable implementation of SDM. Implementation of any health care intervention, including SDM, relies on many complex factors but these are predominantly related to capacity. Determining current uptake and readiness of RAC organisations, residents and their families to adopt SDM is an essential starting point.
基金Supported by Peking Union Medical College,No.2019zlgc0503.
文摘The rapid progress of research into inflammatory bowel disease(IBD)has resulted in increasingly more treatment options.Different options have different advantages and disadvantages,and the preferences of patients may also differ.If patients can be invited to the formulation of medical decision-making,their compliance and satisfaction would be improved,thus possibly achieving better therapeutic results.The present review aims to summarize the current literature on shared decision-making(SDM)in the management of IBD,with the goal of promoting the application of SDM.
文摘Across four studies,we explore the impact of solitude on consumers’reliance on feelings versus reasons in decision making,along with the underlying mechanism and boundary conditions.The results indicate that solitude individuals(vs.non-solitude)would prefer feeling-based strategy in decision-making,resulting in a higher intention of choosing the affectively superior option over the cognitively superior option(Study 1).Self-focus plays the underlying mechanism in the solitude effect(Study 2).Moreover,we also examine two boundary conditions:motivation(Study 3)and temporal orientation(Study 4),which indicates that involuntary motivation and future orientation can mitigate the solitude effect on affective processing.These findings provide insights into consumers’judgments of product attributes and selection of decision-making strategies according to their situations.
文摘For the explosive development of emerging diagnostic and therapeutic technologies brought by the advancement of precision medicine strategy, shared decision-making could improve the quality of clinical decision-making and promote the transformation of clinical research evidence in TCM. Paying attention to patients＇ narrative needs and strengthening medical humanistic concerns could improve clinical outcome and patient satisfaction. We described the origins and development of evidence-based medicine, narrative medicine and shared decision-making, and analyzed the existing problems in TCM clinical decision-making. Further, we put forward the model of shared decision-making between clinicians and patients under the guidance of narrative evidence-based medicine concepts and methods.
文摘Shared decision-making has been described as allowing patients to gain more control over their life situation and feel less helpless. The aim of this systematic review was to describe the involvement of older patients in shared decision-making in community settings. In accordance with the systematic review method, a total of 2468 abstracts were read, after which nine quantitative studies were included. A qualitative thematic analysis was performed and two themes emerged;increased understanding of self-management and a desire to strengthen one’s position in relationship with professionals, both of which were essential for empowering older patients to participate in shared decision-making. Older patients’ shared decision-making was seen as a struggle to maintain their autonomy in different areas of everyday life. Emotional and psychological problems made their position more difficult. In order to empower them in relationships with healthcare professionals, older patients require more knowledge (self-efficacy) and information about their illness, which could strengthen their position in the decision-making process. They also need a greater awareness of decisional conflicts that may arise. Age, gender and health status influence older patients’ chance of being respected and taken seriously in relationship with professionals.
基金supported by“Planning Subject for the 14th Five Year Plan of National Education Sciences of China(DBA210296)”.
文摘We examined the relationship between social support and career adaptability,as well as the mediating roles of proactive personality and career decision-making self-efficacy in this process.A total of 1354 Chinese college students(female=964;mean age=19.53 years,SD=1.33 years)completed an online questionnaire.Path analysis indicated that social support was positively associated with higher levels of career adaptability.Both proactive personality and career decision-making self-efficacy served as parallel mediators,strengthening the relationship between social support and career adaptability.The complete chain mediation analysis revealed that social support influences career adaptability primarily through proactive personality,which in turn enhances career decision-making self-efficacy,further contributing to increased career adaptability.These findings extend career capital theory by demonstrating that social and psychological resources jointly facilitate career adaptability.
文摘This study introduces a novel distance measure(DM)for(p,q,r)-spherical fuzzy sets((p,q,to improve decision-making in complex and uncertain environments.Many existing distance measures eitherr)-SFSs)fail to satisfy essential axiomatic properties or produce unintuitive outcomes.To address these limitations,we propose a new three-dimensional divergence-based DM that ensures mathematical consistency,enhances the discrimination of information,and adheres to the axiomatic framework of distance theory.Building on this foundation,we construct a multi-criteria decision-making(MCDM)model that utilizes the proposed DM to evaluate and rank alternatives effectively.The applicability and robustness of the model are validated through a practical case study,demonstrating that it leads to more rational,consistent,and reliable decision outcomes compared to existing approaches.
基金funded by National Science,Research and Innovation Fund(NSRF)King Mongkut's University of Technology North Bangkok with Contract No.KMUTNB-FF-68-B-46.
文摘In this manuscript,the notion of a hesitant fuzzy soft fixed point is introduced.Using this notion and the concept of Suzuki-type(μ,ν)-weak contraction for hesitant fuzzy soft set valued-mapping,some fixed point results are established in the framework of metric spaces.Based on the presented work,some examples reflecting decision-making problems related to real life are also solved.The suggested method’s flexibility and efficacy compared to conventional techniques are demonstrated in decision-making situations involving uncertainty,such as choosing the best options in multi-criteria settings.We noted that the presented work combines and generalizes two major concepts,the idea of soft sets and hesitant fuzzy set-valued mapping from the existing literature.
基金the financial support received from MHRD, India during the course of research work.
文摘The present work reviews different decision making tools(material comparing and choosing tools)used for selecting the best material considering different parameters.In this review work,the authors have tried to address the following important enquiries:1)the engineering applications addressed by the different material choosing and ranking methods;2)the predominantly used decision making tools addressing the optimal material selection for the engineering applications;3)merits and demerits of decision making tools used;4)the dominantly used criteria or objectives considered while selecting a suitable alternative material;5)overview of DEA on material selection field.The authors have surveyed literatures from different regions of the globe and considered literatures since 1988.The present review not only stresses the importance of material selection in the early design stage of the product development but also aids the design and material engineers to apply different decision making tools systematically.
基金The National Natural Science Foundation of China(No.61273209)the Scientific Research Foundation of Graduate School of Southeast University(No.YBJJ1528)the Scientific Innovation Research of College Graduates in Jiangsu Province(No.KYLX15-0191)
文摘A semantics-based model is proposed to enable weakened hedges, such as ＂more or less＂ and ＂roughly＂ in the context of linguistic multi-criteria decision making. First, the resemblance relations are defined based on the semantics of terms on the domain. Then, the hedges can be represented after the upper and loose upper approximations of a linguistic term are derived. Accordingly, some compact formulae can be derived for the semantics of linguistic expressions with hedges. Parameters in these formulae are objectively determined according to the semantics of original terms. The proposed model presents a more natural way to express the decision information under uncertainties and its semantics is clear. The proposed model is clarified by solving the problem of evaluation and selection of sustainable innovative energy technologies. Computational results demonstrate that the model can deal with various uncertainties of the problem. Finally, the model is compared with existing techniques and extended to the case when the semantics of terms are represented by trapezoidal fuzzy numbers.
基金Supported by the National Natural Science Foundation of China(90924022,70901041,71071077,71171113,71171116)the China Postdoctoral Science Foundation Funded Project(20100481137)+5 种基金the Humanisticand Social Science Foundation of the Ministry of Education of China(11YJC630032,12YJA630122,11YJC630273,09YJC630129)the Social Science Foundation of the College of Jiangsu Province(2011SJB630004)the Research Project of National Bureau of Statistics(2011LY008)the Jiangsu Planned Projects for Postdoctoral Research Funds(1101094C)the Qing Lan Project of Jiangsu Province(2010)the Educational Science Planning Key Projects of Jiangsu Piovince(B-a/2011/01/008)~~
文摘A grey multi-stage decision making method is proposed for a type of grey multi-index decision problems with weighted values completely unknown and attributes as interval grey numbers. Firstly, a method for compar- ing two grey numbers based on probability is developed to calculate weighted values of the attributes. Secondly, the experts＇ evaluation scores for attribute values are presented in terms of internal grey numbers. Finally, a weight solving method for multiple-stages evaluation is proposed. An example analysis verifies the availability of the proposed method. The method provides a new way of thinking for solving grey decision problem.
文摘By combining the advantages of the additive weighted mean (AWM) operator and the ordered weighted averaging (OWA) operator, this paper first presents a hybrid operator for aggregating data information, and then proposes a hybrid aggregation (HA) operator-based method for multiple attribute decision making (MADM) problems. The theoretical analyses and the numerical results show that the HA operator generalizes both the AWM and OWA operators, and reflects the importance of both the given argument and the ordered position of the argument. Thus, the HA operator can reflect better real situations in practical applications. Finally, an illustrative example is given.
基金2008 Soft Science Program of Jiangsu Science and Technology Department (No.BR2008098)
文摘The problem of multiple attribute decision making under fuzzy linguistic environments, in which decision makers can only provide their preferences （attribute values）in the form of trapezoid fuzzy linguistic variables（TFLV）, is studied. The formula of the degree of possibility between two TFLVs is defined, and some of its characteristics are studied. Based on the degree of possibility of fuzzy linguistic variables, an approach to ranking the decision alternatives in multiple attribute decision making with TFLV is developed. The trapezoid fuzzy linguistic weighted averaging （TFLWA） operator method is utilized to aggregate the decision information, and then all the alternatives are ranked by comparing the degree of possibility of TFLV. The method can carry out linguistic computation processes easily without loss of linguistic information, and thus makes the decision results reasonable and effective. Finally, the implementation process of the proposed method is illustrated and analyzed by a practical example.
基金The National Natural Science Foundation of China(Nos.70571087,70472033).
文摘Distance measures between exact linguistic variables and between uncertain linguistic variables are introduced respectively. Based on exact linguistic variables and uncertain linguistic variables, the concepts of positive linguistic ideal solution and negative linguistic ideal solution of attribute values are defined. To rank and select alternatives, based on the distance measures of two types of linguistic variables and the linguistic ideal solutions, a method for multiple attribute decision making with different types of linguistic information is proposed, by which all alternatives can be ranked. The method can carry out linguistic computation processes easily without loss of linguistic information, and thus makes the decision result reasonable and effective. Finally, the implementation process of the proposed method is illustrated and analyzed by a numerical example.
文摘Background: In paternalistic models, healthcare providers’ responsibility is to decide what is best for patients. The main concern is that such models fail to respect patient autonomy and do not promote patient responsibility. Aim: To evaluate mental healthcare team members’ perceptions of their own role in encouraging elderly persons to participate in shared decision-making after implementation of the CCM. The CCM is not an explanatory theory, but an evidence-based guideline and synthesis of best available evidence. Methods: Data were collected from two teams that took part in a focus group interview, and the transcript was analysed by means of qualitative thematic analysis. Results: One overall theme emerged—Preventing the violation of human dignity based on three themes, namely, Changing understanding and attitudes, Increasing depressed elderly persons’ autonomy and Clarifying the mental healthcare team coordinator’s role and responsibility. The results of this study reveal that until recently, paternalism has been the dominant decision-making model within healthcare, without any apparent consideration of the patient perspective. Community mental healthcare can be improved by shared decision-making in which team members initiate a dialogue focusing on patient participation to prevent the violation of human dignity. However, in order to determine how best to empower the patient, team members need expert knowledge and intuition.
