Chinese mothers use idioms in shared book reading: A predictor for children's Chinese vocabulary growth?

Idioms play an important role in language; however, little research has examined idioms in children's natural language settings. This study explored idioms usage in maternal talk during mother-child shared book reading and its relation to children's vocabulary development. Thirty-three Chinese children in Norway (aged 3;0-5;5) and their mothers participated. We observed shared reading at the onset of the study and assessed children's receptive and expressive vocabulary in Chinese three times across one year. Results demonstrated that mothers used an average of 1.8 idioms and explained one-third of the idioms. Maternal idiom usage was correlated with their talk amount and lexical diversity. Individual growth modeling revealed that the number of idioms mothers used predicted the growth of children's receptive vocabulary in Chinese. We speculate that idiom usage could be an effective and understudied marker of parental linguistic sophistication. This study underscores the importance of idiom exposure in children's language environment.

Bridging Gaps in Shared Decision-Making for Anxiety Disorders: A Commentary on Villena et al.

This commentary reflects on the recent study by Villena et al., which addresses the need for enhanced shared decision-making (SDM) for individuals with anxiety disorders. As a psychiatrist with expertise in anxiety management, I commend the study's emphasis on patient involvement and its alignment with real-world clinical challenges. The findings, particularly regarding patients' preferences for psychological interventions and the current trend towards pharmacological treatments, highlight the need to better align treatment approaches with evidence-based guidelines. Additionally, the study underscores the importance of psychoeducation and active coping strategies like exposure techniques. These insights offer valuable contributions towards improving patient-centred care and SDM in anxiety disorder treatment.

Projecting urban flood risk through hydrodynamic modeling under shared socioeconomic pathways.

Under future climate change, accurate risk assessment of urban flooding disasters is paramount for effective adaptation and mitigation strategies. However, conventional indicator-based assessment methods often fall short of accurately capturing the complexity of flooding dynamics. Current research predominantly focuses on predicting future hazard shifts while overlooking changes in other critical indicators. In this study, we establish a comprehensive index system for risk assessment, and quantified future changes in most indicators, utilizing the InfoWorks ICM model for hazard simulation and the CLUMondo model for land use predictions. Based on risk assessment results and regional characteristics, we further analyze the key factors driving future risk and discuss corresponding measures. The results indicate an exacerbation of future urban flood risk, with an 18% increase in high risk areas, primarily concentrated in the center of the study area. The dominant indicators are inundation depth and land use over the whole study area. However microtopography significantly affects risk in low-lying areas. Overall, under higher emission scenarios, the influence of GDP and population rises. These findings offer methodological insights for future urban flood risk assessment research and provide policymakers with valuable guidance to develop targeted adaptation measures in response to climate change.

"Will ICER's 'shared savings' approach decrease value-based prices most for the most severe diseases?"

OBJECTIVES: To identify the types of disease most likely to be impacted by the Institute for Clinical and Economic Review's (ICER) shared savings assumptions. METHODS: For diseases with treatments that were FDA-approved between 2019 and 2023, annual direct and indirect economic burden and characteristics of each disease were extracted from peer-reviewed literature. ICER's shared savings methodology was applied two ways: 50/50 shared savings and $150,000 cost-offset cap. The primary outcome was the difference in eligible cost savings provided by a hypothetical disease cure under ICER's 2 shared savings methods. Characteristics of diseases most impacted by these 2 methods were evaluated descriptively. RESULTS: FDA approved 260 therapies for 89 unique diseases between 2019 and 2023. Shared savings reduced value of a hypothetical cure for hemophilia A most (50/50 method: -$367,670 per year; cap method: -$585,340 per year), followed by acute hepatic porphyria (50/50 method: -$333,948; cap method: -$517,896) and paroxysmal nocturnal hemoglobinuria (50/50 method: -$291,997; cap method: -$433,993). Compared to diseases with annual burdens <$150,000, those ≥$150,000 had earlier disease onset by 22.0 years (age 12.3 vs. 34.3), lower life expectancy by 10.6 years (55.8 vs. 66.4 years), and lower disease prevalence (4.7 vs. 1981.5 per 100,000). Shared savings' impact on health benefit price benchmarks was projected to be larger for diseases with shorter life expectancy (ρ=-0.319; p=0.005), worse quality-of-life (ρ=-0.263; p=0.020), and lower prevalence (ρ=-0.418; p<0.001). CONCLUSIONS: ICER's shared savings assumptions would most likely have the largest negative impact on health benefit price benchmarks for rare, severe, and pediatric diseases.

[Fertility preservation in patients with hematopoietic diseases].

The prognosis of hematopoietic diseases has been improving over the past several decades, and measures to fulfill patients' wishes to have children are needed to improve survivors' quality of life. In Japan, the Japan Society for Fertility Preservation has taken the lead in developing guidelines, a national registry, and a nationwide uniform subsidy system. When considering fertility preservation in patients with hematopoietic diseases, interdisciplinary collaboration between oncology and onco-fertility is necessary to solve problems specific to hematopoietic diseases, such as the short time window between the onset of disease and the start of treatment, complications associated with fertility preservation treatment such as bleeding or ovarian hyperstimulation syndrome, and contamination of collected tissue with hematopoietic tumor cells. This article outlines the basic concept of fertility preservation in patients with hematopoietic diseases and recently established strategies for women with chronic myelogenous leukemia. It will also share some treatment innovations that can be considered in cases when fertility preservation treatment may be challenging.

[Evidence-based medicine and clinical ethics: toward shared decision making].

Evidence-based medicine (EBM) is "decision-making for better patient care that integrates current evidence, and clinical expertise with patients' preferences, values and circumstances." It is important to distinguish research evidence from EBM, which is comprehensive decision-making that takes into account the diversity and individuality of clinical situations while respecting evidence as a general theory. Clinical practice guidelines are "a document that evaluates the total body of evidence through systematic review and presents recommendations that are considered optimal, taking into account the balance of benefits and harms, in order to support decision-making on important health-related issues by healthcare users and providers," and is useful in the practice of EBM. Shared decision making (SDM), which has been attracting attention in recent years, is "a process in which the patient and the health care provider, through dialogue, decide on a treatment plan that is acceptable to the patient, based on the patient's own preferences and values, research evidence, and clinical expertise" and must be understood in relation to the above definition of EBM and from the perspective of clinical ethics.

The Barriers and Facilitators of Shared Decision Making in Pediatric Otolaryngology: A Qualitative Study.

OBJECTIVE: To identify barriers and facilitators to implementing shared decision making (SDM) in pediatric otolaryngology. STUDY DESIGN: A qualitative study. SETTING: Semistructured interviews of pediatric otolaryngologists. METHODS: The Theoretical Domains Framework (TDF) was used as a guide for data collection and analysis to consider capability, opportunity, and motivation (COM-B) factors. The focal surgical procedures were tonsillectomy, adenoidectomy, and tympanostomy tube placement. Deductive and inductive coding of interview transcripts according to TDF/COM-B domains were performed by 2 separate reviewers. RESULTS: A total of 11 interviews were conducted to achieve data saturation. The 4 dominant themes were: (1) inconsistent inclusion of SDM elements in practice, (2) social influences from parents, (3) environmental context, and (4) applicability of SDM in otolaryngology. Theme 1 identified that surgeons perceived SDM as a feature of their practice. However, the discussion of parents' values was seen as less explicit and structured interview formats were not commonly employed. Theme 2 demonstrated that surgeons saw parents' preconsult "agenda" as influencing their openness to consider multiple treatment options. Theme 3 pointed to the barriers of short appointment times, challenges in the use of support staff and lack of decision aids. Theme 4 emphasized surgeons' belief in the value of SDM and that parents' involvement in decision making reduced likelihood of decisional regret. CONCLUSION: Pediatric otolaryngologists strongly support the value of SDM during clinical encounters, particularly to allow parent ownership of decisions regarding treatment. The major barriers were lack of clinical translation of SDM knowledge, social influences, and environmental factors.

Teamwork in Clinical Medicine.

Clinical teams are at the heart of healthcare value. Teamwork requires an appreciation of the unique geniuses of each team member as well as an understanding of team dynamics and larger organizational challenges. Effective teams leverage each member's unique talents within a culture of shared humility, service, and dedication. While interpersonal communication is paramount, organizations which promote a culture of psychological safety to allow productive and necessary conflict are most effective at the fostering shared commitment that allows real accountability and result-oriented, responsive systems. Healthy teams can serve to energize clinicians to provide outstanding service and high value care.

Continuous adaptation of conversation aids for uterine fibroids treatment options in a four-year multi-center implementation project.

BACKGROUND: Fibroids are non-cancerous uterine growths that can cause symptoms impacting quality of life. The breadth of treatment options allows for patient-centered preference. While conversation aids are known to facilitate shared decision making, the implementation of these aids for uterine fibroids treatments is limited. We aimed to develop two end-user-acceptable uterine fibroids conversation aids for an implementation project. Our second aim was to outline the adaptations that were made to the conversation aids as implementation occurred. METHODS: We used a multi-phase user-centered participatory approach to develop a text-based and picture-enhanced conversation aid for uterine fibroids. We conducted a focus group with project stakeholders and user-testing interviews with eligible individuals with symptomatic uterine fibroids. We analyzed the results of the user-testing interviews using Morville's Honeycomb framework. Spanish translations of the conversation aids occurred in parallel with the English iterations. We documented the continuous adaptations of the conversation aids that occurred during the project using an expanded framework for reporting adaptations and modifications to evidence-based interventions (FRAME). RESULTS: The first iteration of the conversation aids was developed in December 2018. Focus group participants (n = 6) appreciated the brevity of the tools and suggested changes to the bar graphs and illustrations used in the picture-enhanced version. User-testing with interview participants (n = 9) found that both conversation aids were satisfactory, with minor changes suggested. However, during implementation, significant changes were suggested by patients, other stakeholders, and participating clinicians when they reviewed the content. The most significant changes required the addition or deletion of information about treatment options as newer research was published or as novel interventions were introduced into clinical practice. CONCLUSIONS: This multi-year project revealed the necessity of continuously adapting the uterine fibroids conversation aids so they remain acceptable in an implementation and sustainability context. Therefore, it is important to seek regular user feedback and plan for the need to undertake updates and revisions to conversation aids if they are going to be acceptable for clinical use.

Simulating runoff changes and evaluating under climate change using CMIP6 data and the optimal SWAT model: a case study.

This study examines the influence of climate change on hydrological processes, particularly runoff, and how it affects managing water resources and ecosystem sustainability. It uses CMIP6 data to analyze changes in runoff patterns under different Shared Socioeconomic Pathways (SSP). This study also uses a Deep belief network (DBN) and a Modified Sparrow Search Optimizer (MSSO) to enhance the runoff forecasting capabilities of the SWAT model. DBN can learn complex patterns in the data and improve the accuracy of runoff forecasting. The meta-heuristic algorithm optimizes the models through iterative search processes and finds the optimal parameter configuration in the SWAT model. The Optimal SWAT Model accurately predicts runoff patterns, with high precision in capturing variability, a strong connection between projected and actual data, and minimal inaccuracy in its predictions, as indicated by an ENS score of 0.7152 and an R2 coefficient of determination of 0.8012. The outcomes of the forecasts illustrated that the runoff will decrease in the coming years, which could threaten the water source. Therefore, managers should manage water resources with awareness of these conditions.

A Joanna Briggs Institute Framework Approach to Shared Decision Making in End-of-Life.

AIM: To implement shared decision-making (SDM) through a patient decision aid (PtDA) for the initiation of palliative care (PC) in end-of-life (EOL) cancer patients. METHODOLOGY: A comprehensive Scoping Review was conducted on SDM in PubMed, CINAHL and PsycInfo. An evidence-based implementation of PtDAs was created using the Joanna Briggs Institute framework, which followed rigorous pillars: (1) context, (2) facilitation and (3) evaluation. RESULTS: Fifteen studies were identified and categorised into (1) Implementation characteristics and (2) Strategies for implementing SDM in terminally ill cancer patients. SDM should consider the decision-making location, optimal timing, participants and decision type. Strategies include professional training, PtDAs and implementation programmes. A PtDA implementation protocol in video format for deciding to initiate PC is proposed, following International Patient Decision Aid Standards (IPDAS) and Clinical Practice Guidelines (CPG). CONCLUSIONS: SDM implementation should be guided by evidence-based methodological models justifying and structuring its execution, especially in complex and interdisciplinary contexts. National or international frameworks facilitate the adoption of health innovations, such as PtDAs, benefiting patients and improving their usage. PRACTICE IMPLICATIONS: SDM is not just a concept but an important approach to the Care of cancer patients at EOL, enhancing patient satisfaction and improving care quality. The success and sustainability of SDM hinge on the fundamental aspects of staff training, interdisciplinary collaboration and ongoing evaluation. The lack of specific aid in Spanish underscores the immediate need for local development. Further research is needed in this area, as most reviewed studies did not measure SDM effectiveness in diverse hospital settings. PATIENT OR PUBLIC CONTRIBUTION: This proposal was developed based on the experience and input of the nursing staff from the healthcare service where it is intended to be implemented.

The Mediating Effect of Perceived Social Support and Health Literacy on the Relationship Between Decisional Dilemma and Participation in Shared Decision-Making Among Chinese Parents of Premature Infants.

PURPOSE: This research was conducted to explore the mediating effect of perceived social support and health literacy on the relationship between decisional dilemmas and participation in shared decision-making among Chinese parents of premature infants. DESIGN AND METHODS: This cross-sectional study recruited 225 Chinese parents of premature infants in a neonatal ward of a Chinese hospital through convenience sampling. Data were collected from August 2022 to February 2023 using 5 self-administered instruments. Structural equation modeling and multiple mediation tests were applied to explore the interplay among perceived social support, health literacy, decisional dilemmas, and participation in shared decision-making. The study is reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. RESULTS: Decisional dilemmas were found to negatively impact participation in shared decision-making. Perceived social support and health literacy were identified as partial mediators in this relationship, collectively accounting for a mediation effect of -0.413, which represents 50.0% of the total effect. CONCLUSION: The findings elucidate a multifaceted model of factors influencing participation in shared decision-making among Chinese parents of premature infants. Prompt recognition of these variables can enable nursing professionals to incorporate tailored management strategies within patient-centered care frameworks, thereby enhancing decisional outcomes.

Impact of Shared Decision-Making on Family Satisfaction With Intensive Care Services: 'Share With Care' has a New Meaning in ICU.

Background: Physician's clinical inputs and informed bystander opinions are essential for successful intensive care unit (ICU) patient outcomes. There is insufficient data regarding the impact of shared decision-making on treatment outcomes and family satisfaction in Indian ICU settings. We aimed to determine the effect of shared decision-making factors on family satisfaction with ICU services. Patients and Methods: Family bystanders of 336 ICU patients with a stay >72 hours were conveniently surveyed across 13 months prospectively using Family Satisfaction in the Intensive Care Unit 24 Revised (FS-ICU 24R) questionnaire. We analyzed the responses to determine shared decision-making factors impacting family satisfaction. Results: Univariate analysis of ten variables of FS-ICU 24R questionnaire decision-making subscale revealed that consistency of information (OR 8.71, P < 0.001), honesty of information (OR 7.04, P < 0.001), and frequency of communication with doctors (OR 6.25, P < 0.001) were associated with highest odds of family involvement and satisfaction. Multivariable logistic regression showed that consistency of information (adjusted OR 3.85, P < 0.001) and frequent doctor communication (adjusted OR 2.22, P = 0.02) were independent predictors associated with family satisfaction. The number of decision-makers (P = 0.463) or family's prior ICU experience (P = 0.430) was not associated with family satisfaction. Conclusion: A consistent and honest effort to cater to the family's information needs and frequent physician-bystander interaction is essential for family's satisfaction with ICU services. This even outweighs other decision-making factors such as number of decision-makers and their prior ICU experience. Incorporating shared decision-making in counseling should be a continuing practice.Trial registry name: Clinical Trials Registry - India.Registration number: CTRI/2022/09/045571.

The effect of shared ecological value on buyer-supplier relationship within mountaineering tourism.

Shared values play an important role in attracting new tourists, retaining existing ones and gaining an important competitive advantage. Building upon the Commitment-Trust model, this study tested the role of shared ecological values in the creation of tourist trust and relationship commitment, and finally tourist behavioral intention. To test the hypotheses, a sample consisting of 480 mountaineering tourists of two representative travel agencies were surveyed, and a mixed-method approach based on a quantitative survey (n = 436) and qualitative interviews (n = 60) was also adopted to examine their relationships. Results revealed that shared ecological values between tourists and travel agencies were significantly negative predictors of credibility, while credibility and benevolence emerged as significantly positive predictors of relationship commitment. Moreover, credibility and relationship commitment were partially positively predictors of tourist's behavioral intentions. The findings enrich the extant knowledge on mountaineering tourist relationship marketing and human-nature relationships and provide implications for destination management and wildlife protection.

The Encounter of Two Worlds: Divided Narratives of Decision-Making on Cancer Treatment Between Physicians and Patients.

INTRODUCTION: Divided narratives pose long-standing difficulties in physician and patient communication. In decision-making on cancer treatment, divided narratives between physicians and patients hinder mutual understanding and agreement over the illness and its treatment. For effective decision-making on treatments, it is necessary to investigate the similarities and differences in these divided narratives. METHODS: This study adopted a qualitative research design of narrative inquiry to examine the data, which included interviews with 32 cancer patients and 16 paired physicians in two hospitals in China. Data analysis was conducted using grounded theory to generate findings. RESULTS: Both physicians and patients were concerned about goals and obstacles to their decision-making on cancer treatment. Four common aspects of goal setting were identified from the divided narratives: decision pools, treatment goals, identity practice and preferred identity. Four common obstacles were identified: pains and trust, communication gap, financial issues and complex family. However, the meanings attached to these eight aspects differed between physicians and patients. CONCLUSION: Cancer treatment decision-making is an encounter of the scientific world and lifeworld. A divided narrative approach can identify the similarities and differences in the decision-making on cancer treatment between physicians and patients. Physicians generally adopt a rational decision-making approach, whereas patients generally adopt a relational decision-making approach. Despite the common concerns in their goals and obstacles, physicians and patients differed in their contextualized interpretations, which demonstrates the physicians' and the patients' pursuit of preferred identities in decision-making. The results of this study provide a new perspective to treatment decision-making, emphasizing the importance of narrative integration in reaching mutual agreement. PATIENT AND PUBLIC CONTRIBUTION: The findings were shared with 15 cancer patients and caregivers for feedback and advice in June 2024. This study was also presented at the international conferences of COMET (International and Interdisciplinary Conference on Communication, Medicine, and Ethics) and ICCH (International Conference on Communication in Healthcare) 2023 for continuous feedback and comments.

Clinician and patient experiences with shared decision-making to promote daily arm use for individuals with chronic stroke: an exploratory qualitative study.

Purpose: To explore the attitudes and experiences of clinicians and individuals with chronic stroke on the use of shared decision-making (SDM) during upper extremity rehabilitation to improve daily arm use in the home environment. Specifically, we aimed to describe clinician and client perspectives regarding the facilitators and barriers to using SDM within the context of a self-directed upper extremity intervention for individuals living in the community with chronic stroke. Methods: Data were collected within the context of an interventional study examining the feasibility of the Use My Arm-Remote intervention. Focus group interviews were conducted with the clinicians (n = 3) providing the intervention and individual semi-structured interviews with the participants (n = 15) of the study. All interview data were collected after the end of the intervention period. Data were analyzed using thematic analysis. Results: The following themes were identified: (1) Equal partnership; (2) Enhancing clinician confidence; and (3) This is different. Facilitators and barriers were identified within each theme. Key facilitators for clinicians were competence with SDM and patient characteristics; while facilitators for patients were open and trusting relationships with clinicians and personalized experience. Key barriers to SDM for clinicians were lack of expertise in SDM and participant buy in; while patients identified a lack of foundational knowledge of stroke rehabilitation as a potential barrier. Conclusions: Key barriers were analyzed using the consolidated framework for advancing implementation science to interpret results and identify strategies for enhancing the implementation of SDM in a virtual setting. The CFIR-ERIC tool highlighted the need for targeted educational meetings and materials to address the training and educational needs of both clinicians and patients for future iterations of this intervention.

Delusional Parasitosis in Comorbidity With Shared Paranoid Disorder in a Marriage.

Delusional parasitosis is a psychotic disorder where the patient has the delusion of being infested with some insect or parasite. In contrast, shared paranoid disorder or folie à deux is described when the same delusions affect two or more closely related people. It is common for these two situations to cause comorbidity in the family unit. This case report concerns a couple married for 37 years. The husband described that 2 years ago, he began with a tingling sensation throughout his body, related to the presence of parasites coming out from all his body orifices, with no evidence of self-harm. Likewise, the wife reported symptoms of formication and the feeling that there were invisible animals, as mentioned by her husband, and that she felt the parasites running throughout her body. The husband was diagnosed with endoparasitic delusional parasitosis, which caused folie à deux in his wife due to ectoparasitic parasitosis. The patient's treatment included sertraline and risperidone in oral dosage lasting 3 months reducing delirium, later biperidene was prescribed due to main treatment's side effects such as akathisia and sialorrhea, however the patient could not take the medication due to economic reasons. The wife was asked to sleep in a separate room, and she reported that the sensory hallucinations disappeared as soon as she slept in a different room. We conclude that the pharmacological approach, the intervention in the family life, and the gradual reintegration of marital habits once the patient improves are crucial in the therapy of delusional disorder.

Roles of pediatric surgeons in palliative pediatric oncology.

Pediatric surgeons engaged in oncology will inevitably treat patients receiving palliative care, but their role in this context is poorly described. This article identifies some of the challenges and opportunities of surgical involvement in pediatric oncology palliative care, underscoring how the surgeon's expertise can be exploited to significantly benefit children with cancer. Specific examples of skills (procedural, communication, and coordination) that surgeons can provide to the multidisciplinary palliative care teams are described and the importance of collaboration is highlighted.

Assessing the Burden of Atopic Dermatitis in Portugal through Patient-Centered Experiences.

INTRODUCTION: Adult patients and caregivers of children with atopic dermatitis experience high physical, mental, and financial burden in Portugal. We outline the experience of atopic dermatitis management and how the current medical care model impacts patient-centered concerns such as financial burden, quality of life, disease burden, and treatment satisfaction. METHODS: We conducted a survey of 419 Portuguese adults and caregivers of children to capture the experience of managing atopic dermatitis in Portugal. RESULTS: Respondents reported average satisfaction with treatment, with a mean satisfaction rating of 3.15/5.00 (SD = 0.77). Adults reported slightly better control of atopic dermatitis symptoms (mean = 56.6) than pediatric patients (mean = 55.9, caregiver reported). Nearly 34% of adults and 39% of caregivers of children and adolescents indicated that their healthcare providers asked about their priorities at the last medical visit. Additionally, only 40% of adult patients and 32% of caregivers reported that patient training was offered to them. Respondents seeing dermatologists reported higher satisfaction than those seeing other healthcare providers (p = 0.01) but there were no differences in long-term control of symptoms by provider type (p = 0.85) when controlling for severity. Portuguese adult patients scored 0.86/1.00 on the EQ-5D (where 0 = death and 1 = perfect health). Financial concern was high as nearly 80% of patients and caregivers reported using savings, borrowing money, and/or reducing spending to cover atopic dermatitis-related costs. CONCLUSION: Portuguese patients with atopic dermatitis and caregivers experience financial burden, lower health-related quality of life, higher disease burden, and treatment satisfaction issues with their current medical care. These factors often deteriorate as the disease's severity increases. Providers, researchers and policymakers should focus on better addressing patient-centered concerns for individuals suffering from atopic dermatitis to improve care and health outcomes.

Development of the World Federation of Hemophilia Shared Decision-Making Tool.

INTRODUCTION: The use of shared decision-making (SDM) in clinical settings is becoming more prevalent. The evolving and increasingly complex treatment landscape of haemophilia management has augmented the need and desire for SDM between patients and their healthcare team. SDM tools have been used in other chronic conditions and can be an effective form of education for patients and clinicians. AIM: The World Federation of Hemophilia (WFH) partnered with people with haemophilia (PWH), patient advocacy groups, and healthcare practitioners to form an expert working group to develop an educational tool for PWH and their caregivers. The primary objectives included educating PWH on the available prophylactic treatments and facilitating discussion between PWH and their healthcare team. METHODS: The tool was proposed and developed by the expert working group, workshopped at conference round tables, and evaluated in two focus groups. RESULTS: The interactive WFH SDM Tool guides users through the SDM treatment journey and provides an opportunity for reflection on current disease impact and treatment preferences, educational fact sheets and videos, and a comparison between treatment classes. Two forms of the SDM Tool are available: an online platform with a summary page that may be printed and shared and a printable workbook. All evidence in the tool is based on the prescribing information or phase III clinical trial publications. The Tool will be updated twice each year. CONCLUSION: The WFH SDM Tool is the first available resource that translates published guidance on SDM in haemophilia into a practical, user-friendly tool aimed at facilitating patient-centred treatment decisions.