"First was to sit down and bring our minds together". A qualitative study on safer conception decision-making among HIV sero-different couples in Zimbabwe.

Decision-making on childbearing and safer conception use in HIV sero-different couples involves an intricate balance of individual desires and perceived HIV acquisition risk. This paper addresses an important knowledge gap regarding HIV sero-different couples' considerations and the relationship and power dynamics involved when deciding to use a safer conception method. Between February and June 2019, we conducted semi-structured in-depth interviews among 14 men and 17 women, representing 17 couples, who exited the SAFER study - a pilot study assessing the feasibility, acceptability and cost-effectiveness of a safer conception programme for HIV sero-different couples in Zimbabwe. All couples in SAFER were provided with a choice of safer conception methods and were followed for up to 12 months of pregnancy attempts and 3 months following pregnancy. While couples generally perceived their safer conception discussions to be easy and consensus-driven, the decision-making process also involved complex gender dynamics and trade-offs in relationship power, which resulted in differing interpretations of what constituted a joint or shared couple decision. Participants regarded effective couple communication as an essential component of and precursor to good safer conception conversations and requested additional training in couple communication. Couples relied on information from healthcare providers to kickstart their safer conception discussions. Safer conception programmes should address relationship power imbalances, promote effective couple communication and offer healthcare provider support to enable HIV sero-different couples to make informed choices about conception in a manner that upholds their safety and reproductive autonomy.

Our study explored how HIV sero-different couples in Zimbabwe made decisions on the use of safer conception methods. We interviewed 14 men and 17 women who participated in the SAFER study ­ a pilot study looking at how feasible, acceptable and cost-effective a safer conception programme for HIV sero-different couples is in Zimbabwe. We sought to understand the relationship dynamics, considerations and power trade-offs involved in choosing a safer conception method. Couples reported that their conversations about safer conception were easy and agreeable. At the same time, we found that both gender norms and HIV status shaped the couples' decision-making process, with male gender and partners with an HIV-negative status often having more influence in the final decision of which method to use. Effective couple communication was deemed crucial to support safer conception conversations, with participants requesting additional training in this area. The findings emphasise the importance of providing safer conception methods in a context that addresses power disparities, fosters good communication and includes healthcare providers' support to uphold HIV sero-different couples' reproductive rights and help them achieve their reproductive goals.

Factors influencing the fasting decisions of day-case surgery patients.

BACKGROUND: Patients admitted on the day of surgery are asked to arrive fasted, and they often fast for longer than necessary. Although pre-assessment supports patients to prepare for surgery, little is known about how they make fasting decisions. AIMS: To explore factors influencing the fasting decisions of day-case patients and how to provide information pre-operatively. METHODS: A qualitative descriptive study design was used. Semi-structured telephone interviews were carried out with 10 patients recruited from a single day-case unit. Data were analysed using thematic analysis. FINDINGS: Three themes provided context for fasting decisions: the operation as a serious event; the patient as an active partner; and the patient as a rule follower. Length of fast is determined by fasting decisions and practicalities. CONCLUSION: Patients approach fasting decisions according to their knowledge and experience and their individual preferences for information. Pre-assessment nurses should tailor information to the patient and explain the rationale for fasting.

[Home support for vulnerable older people: from shared decision-making to negotiation : A qualitative pilot study]. / L'accompagnement à domicile de personnes âgées vulnérables : de la prise de décision partagée à la négociation : Une étude qualitative pilote.

Shared decision-making allows older people to discuss and change their care with informal caregivers and healthcare professionals. When opinions differ, an older person's decision-making ability can be compromised by many factors. The objective of this qualitative pilot study was to study the dynamics of shared decision-making in home care support for vulnerable older people. Observations were carried out at the older people's homes during appointments with the network's healthcare professionals. Semi structured interviews were then conducted with older people, caregivers and healthcare professionals observed. When opinions differ, negotiation dynamics then develop between older people, caregivers and healthcare professionals. Using a dedicated negotiation framework, we identified four types of negotiation between the stakeholders in home care decision-making, influenced by various articulations of individual, collective and environmental factors.

Building bridges: evaluating policymakers' research capacities, engagement, and utilization in health policymaking within the Kuwaiti context: a cross-sectional study.

BACKGROUND: Health policymaking is a critical aspect of governmental decision-making that shapes the well-being of populations. In the Middle East and North Africa, particularly in Kuwait, limited attention has been given to exploring the research capacities, engagement, and utilization among health policymakers. This study aims to bridge this gap by investigating how Kuwaiti health policymakers incorporate evidence-based research into the formulation of health-related policies. METHODS: This cross-sectional study targeted health policymakers in leadership positions within the Kuwait Ministry of Health (MOH). Using the Seeking, Engaging with and Evaluating Research (SEER) questionnaire, participants' capacities, engagement, and use of research were assessed. The targeted sample was all health policymakers in leadership positions, starting from the head of departments and above. The questionnaire comprises four domains, 14 sections, and 50 questions and utilizes Likert and binary scales, with aggregate scores predicting engagement actions and research use. The data were collected between March and July 2023. All the statistical analyses were performed using SPSS v27, and the numerical and categorical variables were analyzed using appropriate statistical tests, including t-tests, ANOVA, and Pearson's correlation. RESULTS: Out of 205 policymakers, 88 participated (42.9% response rate): predominantly male (51.1%) and married (78.4%). The mean age was 49.84 ± 7.28 years, with a mean MOH tenure of 24.39 ± 6.80 years. Participants demonstrated high value for research (mean score 4.29 ± 0.55) and expressed confidence in the research utilization. Organizational emphasis on research use exhibited nuanced perceptions, identifying areas where MOH support may be lacking. Access to research resources and processes for policy development guidance were highlighted as challenges. CONCLUSIONS: This study provides crucial insights into the research capacities and engagement of Kuwaiti health policymakers. It emphasizes the need for targeted interventions to align individual perceptions with organizational expectations, address confidence disparities, and enhance collaborative efforts. Organizational investments are crucial for fostering a dynamic research ecosystem to improve evidence-based policy development in Kuwait's healthcare landscape.

A Proposed Decision-Making Framework for the Translation of In-Person Clinical Care to Digital Care: Tutorial.

Unlabelled: The continued demand for digital health requires that providers adapt thought processes to enable sound clinical decision-making in digital settings. Providers report that lack of training is a barrier to providing digital health care. Physical examination techniques and hands-on interventions must be adjusted in safe, reliable, and feasible ways to provide digital care, and decision-making may be impacted by modifications made to these techniques. We have proposed a framework to determine whether a procedure can be modified to obtain a comparable result in a digital environment or whether a referral to in-person care is required. The decision-making framework was developed using program outcomes of a digital physical therapy platform and aims to alleviate barriers to delivering digital care that providers may experience. This paper describes the unique considerations a provider must make when collecting background information, selecting and executing procedures, assessing results, and determining whether they can proceed with clinical care in digital settings.

Decision-making drivers for pandemic response for Institutions of Higher Education.

The purpose of this research is to identify how decision-makers within anchor institutions, using the context of higher education, determine the course of action in response to an improbable disaster event, such as the recent coronavirus disease 2019 (COVID-19) pandemic. A survey was conducted among higher education decision-makers during spring 2020 at the moment they were adapting to COVID-19. The survey aimed to identify policies and planning measures that may help Institutions of Higher Education learn from this experience to maintain continuity of operations should similar or unanticipated events occur in the future. With this knowledge, both assets and detriments contributing to community vulnerability can be better balanced to inform decision-making. The outcomes of the analysis and shared reflections inform the development of future policy and strengthen existing processes for preparedness and mitigation planning for unexpected events.

Experiences of patient organizations' involvement in medicine appraisal and reimbursement processes in Finland - a qualitative study.

BACKGROUND: This study investigated how patient representatives have experienced their involvement in medicines appraisal and reimbursement processes with the Council for Choices in Health Care in Finland (COHERE) and the Pharmaceuticals Pricing Board (PPB) and how authorities perceive the role of patient organizations' input. METHODS: Semi-structured thematic individual and pair interviews were conducted in 2021 with representatives (n = 14) of patient organizations and government officials (n = 7) of the Ministry of Social Affairs and Health. The interview data were analyzed using qualitative content analysis. RESULTS: Patient representatives expressed their appreciation for the PPB and the COHERE in creating consultation processes and systematic models that support involvement. However, there were many challenges: patient representatives were uncertain about how their submissions were utilized in official processes and whether their opinions had any significance in decision-making. Patients or patient organizations lack representation in appraisal and decision-making bodies, and patient representatives felt that decision-making lacked transparency. The importance of patient involvement was highlighted by the authorities, but they also emphasized that the patient organizations' contributions were complementary to the other materials. Submissions regarding the medications used to treat rare diseases and those with limited research evidence were considered particularly valuable. However, the submissions may not necessarily have a direct impact on decisions. CONCLUSIONS: The interviews provided relevant input for the development of involvement processes at the PPB and COHERE. The interviews confirmed the need for increased transparency in the medicines assessment, appraisal, and decision-making procedures in Finland.

Application of multi-criteria group decision-making for water quality management.

As waste discharge into numerous river systems escalates, the pollution of water bodies typically rises. Given the limited capacity of rivers to withstand pollution and their constrained self-cleaning capabilities, treated pollutants from waste discharge must be released into the river. Despite numerous models and algorithms proposed for managing river water quality to meet standards, literature, to our awareness, lacks the utilization of a comprehensive multi-criteria group decision-making approach for water quality management, particularly in river systems. Therefore, this research introduces a new, comprehensive multi-criteria group decision-making for the management of water quality in the Haraz River basin, located in Iran. To do so, the water quality of the basin, a one-dimensional water quality model, QUAL2Kw, was employed to simulate and calibrate the water quality along the river. The simulation results revealed that the downstream water quality violates the water quality standards. To mitigate this issue, various scenarios for waste load allocation (WLA) were evaluated, including no wastewater treatment, primary wastewater treatment, advanced secondary wastewater treatment utilizing the activated sludge (AS) method, and advanced wastewater treatment via the membrane bioreactor (MBR) method. Utilizing the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) and Fuzzy TOPSIS group decision-making model, it was determined that the optimal solution was the implementation of secondary wastewater treatment utilizing the activated sludge method for the 11 PS of pollution, while still adhering to Iranian water quality standard. In addition, the findings of the present study indicate that the implementation of primary wastewater treatment, advanced secondary wastewater treatment utilizing AS, and advanced wastewater treatment through MBR within the study area led to a significant enhancement in water quality. This enhancement ranged from 35 to 105% across various scenarios when compared to conditions where no actions were taken to the treatment of water.

The ethics of clinically assisted nutrition and hydration in adults and the role of the advanced clinical practitioner.

Clinically assisted nutrition and hydration (CANH) decision-making in adult patients presents complex ethical dilemmas that require careful consideration and navigation. This clinical review addresses the multifaceted aspects of CANH, emphasising the importance of ethical frameworks and the role of advanced clinical practitioners (ACPs) in guiding decision-making processes. The pivotal role of ACPs is highlighted, from their responsibilities and challenges in decision-making to the collaborative approach they facilitate involving patients, families and multidisciplinary teams. The article also explores ethical principles such as autonomy, beneficence, non-maleficence, and justice, elucidating their application in CANH decision-making. Legal and ethical frameworks covering CANH are examined, alongside case studies illustrating ethical dilemmas and resolutions. Patient-centred approaches to CANH decision-making are discussed, emphasising effective communication and consideration of cultural and religious beliefs. End-of-life considerations and palliative care in CANH are also examined, including the transition to palliative care and ethical considerations in withdrawal or withholding of CANH. Future directions for research and implications for clinical practice are outlined, highlighting the need for ongoing ethical reflection and the integration of ACPs in CANH decision-making.

Age, but not education, affects social decision-making in the ultimatum game paradigm.

BACKGROUND: Social decision-making (SDM) is often studied through gaming paradigms, in which participants allocate resources among themselves and others based on predefined rules. In an adapted version of the ultimatum game (UG), SDM behavior was modulated in response to the degree of fairness of monetary offers and the social context of opponents, designed to generate either prosocial or punishing behaviors. OBJECTIVE: To investigate whether SDM evaluated by the UG is affected by age and schooling, as it is relevant to know whether sociodemographic variables may bias UG results. METHODS: A total of 131 healthy adults participated: 35 young university students and 96 participants in Universidade de São Paulo's USP 60+ program (formerly known as Universidade Aberta à Terceira Idade, a program for people aged ≥ 60 years to attend university). The sample was divided into 3 age groups (17-22, 60-69, and 70-79 years) and 3 schooling groups (4-8, 9-11, and ≥ 12 years of schooling). RESULTS: Age and schooling did not affect performance in fair monetary offers. Differences were observed in the unfair conditions. The oldest group (70-79 years) accepted less frequently the baseline unfair offers (without social context), when compared with the 17-22 and the 60-69 years groups (17-22 = 60-69 > 70-79). Regarding the prosocial unfair and punishing unfair conditions, older adults accepted such offers more frequently (17-22 < 60-69 = 70-79). Schooling effects were not observed. CONCLUSION: In the context of SDM, older adults may show prosocial behaviors more frequently than younger adults. The findings suggest performance in the UG is affected by age, but not by schooling.

ANTECEDENTES: A tomada de decisão social (TDS) é frequentemente estudada por meio de paradigmas de jogo, em que os participantes alocam recursos entre si e outros com base em regras predefinidas. Em uma versão adaptada do jogo do ultimato (JU), o comportamento de TDS foi modulado em resposta ao grau de justiça das ofertas monetárias e ao contexto social dos oponentes, projetado para produzir comportamentos pró-sociais ou punitivos. OBJETIVO: Investigar se a TDS avaliada pelo JU é afetada pela idade e escolaridade, pois é relevante saber se variáveis sociodemográficas podem influenciar os resultados do JU. MéTODOS: Participaram 131 adultos saudáveis, sendo 35 jovens universitários e 96 participantes do programa USP 60+ (antigo Universidade Aberta à Terceira Idade). A amostra foi dividida em 3 faixas etárias (17­22, 60­69 e 70­79 anos) e 3 faixas de escolaridade (4­8, 9­11 e ≥ 12 anos). RESULTADOS: Idade e escolaridade não afetaram o desempenho em ofertas monetárias justas. Diferenças foram observadas nas condições injustas. O grupo mais velho (70­79 anos) aceitou menos as ofertas injustas de referência (sem contexto social), quando comparado com o grupo de 17­22 e o de 60­69 anos (17­22 = 60­69 > 70­79). Em relação às condições pró-sociais injustas e punitivas injustas, os idosos aceitaram com maior frequência tais ofertas (17­22 < 60­69 = 70­79). Efeitos da escolaridade não foram observados. CONCLUSãO: No contexto da TDS, os idosos podem apresentar comportamentos pró-sociais com mais frequência do que os adultos mais jovens. Os resultados sugerem que o desempenho no JU é afetado pela idade, mas não pela escolaridade.

The effect of confession evidence on jurors' verdict decisions: A systematic review and meta-analysis.

OBJECTIVE: Over the past 4 decades, discrepant research findings have emerged in the juror-confession literature, prompting the need for a systematic review and meta-analysis that assesses the effect of confession evidence (coerced or noncoerced) on conviction rates and the efficacy of trial safeguards. HYPOTHESES: We did not predict any directional hypotheses. Some studies show increased convictions when a confession is present (vs. not), regardless of whether that confession was coerced; other studies demonstrate that jurors are able to discount coerced confessions. Studies have also demonstrated sensitivity effects (safeguards aided jurors in making appropriate decisions), skepticism effects (safeguards led jurors to indiscriminately disregard confession evidence), or null effects with regard to expert testimony and jury instructions. METHOD: We identified 83 independent samples (N = 24,860) that met our meta-analytic inclusion criteria. Using extracted Hedges' g effect sizes, we conducted both network meta-analysis and metaregression to address key research questions. RESULTS: Coerced and noncoerced confessions (vs. no confession) increased convictions (network gs = 0.34 and 0.70, respectively), yet coerced (vs. noncoerced) confessions reduced convictions (network g = -0.36). When jury instructions were employed (vs. not), convictions in coerced confession cases were reduced (this difference did not emerge for noncoerced confessions; a sensitivity effect). Expert testimony, however, reduced conviction likelihood regardless of whether a confession was coerced (a skepticism effect). CONCLUSION: Confession evidence is persuasive, and although jurors appear to recognize the detrimental effect of coercive interrogation methods on confession reliability, they do not fully discount unreliable confessions. Educational safeguards are therefore needed, but more research is encouraged to identify the most effective forms of jury instructions and expert testimony. One potential reform could be in the interrogation room itself, as science-based interviewing approaches could provide jurors with more reliable defendant statement evidence that assists them in reaching appropriate verdict decisions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Vaccine Politics.

A vaccine law and policy expert reflects on the dangers of the influence of politics on public health decision making.

A qualitative study on the effect of a decision aid on knowledge of cataract surgery in patients in developing countries.

BACKGROUND: Despite cataract surgery being a safe procedure with a low incidence of perioperative complications rates, poor knowledge, concerns about the effectiveness of treatment and cost-benefit analysis of the procedure significantly hinder cataract surgery uptake rates in Africa. This study describes the effect of a decision aid on knowledge and decision conflict on cataract patients in Africa. METHODS AND ANALYSIS: 120 patients with cataracts reporting to a tertiary hospital in Ghana were randomly assigned to receive a decision aid containing information on the possible outcomes of cataract surgery or a control booklet containing general knowledge about cataracts without information about cataract surgery. The primary outcome measured was the effect of the decision aid on their knowledge of cataract surgery. A score greater than 6/12 (50%) was deemed adequate knowledge. The secondary outcome was the decision conflict experienced by the participants assessed using the Decision Conflict Scale. RESULTS: Compared to the control group, the participants in the intervention group scored higher marks across all sections of the questionnaire (2.92 vs 2.7, p = 0.042 in section "Background"; 2.62 vs 1.77, p < 0.001 in section "Materials"; 1.87 vs 1.55, p = 0.03 in section "Results"). The average total score was higher in the intervention group than in the control (36.7% difference; p < 0.001). Participants in the intervention group also demonstrated lower decision conflict scores than those in the control group (13.00 vs 37.17; p < 0.001). CONCLUSION: The decision aid increased knowledge of cataract surgery and reduced decision conflict among patients in a developing country.

Hippocampus and striatum show distinct contributions to longitudinal changes in value-based learning in middle childhood.

The hippocampal-dependent memory system and striatal-dependent memory system modulate reinforcement learning depending on feedback timing in adults, but their contributions during development remain unclear. In a 2-year longitudinal study, 6-to-7-year-old children performed a reinforcement learning task in which they received feedback immediately or with a short delay following their response. Children's learning was found to be sensitive to feedback timing modulations in their reaction time and inverse temperature parameter, which quantifies value-guided decision-making. They showed longitudinal improvements towards more optimal value-based learning, and their hippocampal volume showed protracted maturation. Better delayed model-derived learning covaried with larger hippocampal volume longitudinally, in line with the adult literature. In contrast, a larger striatal volume in children was associated with both better immediate and delayed model-derived learning longitudinally. These findings show, for the first time, an early hippocampal contribution to the dynamic development of reinforcement learning in middle childhood, with neurally less differentiated and more cooperative memory systems than in adults.

Decision making for health-related research outcomes that alter diagnosis: A model from paediatric brain tumours.

AIMS: The question of how to handle clinically actionable outcomes from retrospective research studies is poorly explored. In neuropathology, this problem is exacerbated by ongoing refinement in tumour classification. We sought to establish a disclosure threshold for potential revised diagnoses as determined by the neuro-oncology speciality. METHODS: As part of a previous research study, the diagnoses of 73 archival paediatric brain tumour samples were reclassified according to the WHO 2016 guidelines. To determine the disclosure threshold and clinical actionability of pathology-related findings, we conducted a result-evaluation approach within the ethical framework of BRAIN UK using a surrogate clinical multidisciplinary team (MDT) of neuro-oncology specialists. RESULTS: The MDT identified key determinants impacting decision-making, including anticipated changes to patient management, time elapsed since initial diagnosis, likelihood of the patient being alive and absence of additional samples since cohort inception. Ultimately, none of our research findings were considered clinically actionable, largely due to the cohort's historic archival and high-risk nature. From this experience, we developed a decision-making framework to determine if research findings indicating a change in diagnosis require reporting to the relevant clinical teams. CONCLUSIONS: Ethical issues relating to the use of archival tissue for research and the potential to identify actionable findings must be carefully considered. We have established a structured framework to assess the actionability of research data relating to patient diagnosis. While our specific findings are most applicable to the pathology of poor prognostic brain tumour groups in children, the model can be adapted to a range of disease settings, for example, other diseases where research is dependent on retrospective tissue cohorts, and research findings may have implications for patients and families, such as other tumour types, epilepsy-related pathology, genetic disorders and degenerative diseases.

Organ Offer Review Cards: Improving Transparency on the Kidney Transplant Waitlist.

INTRODUCTION: The 2022 National Academy of Sciences, Engineering, and Medicine report on equity in organ transplantation highlighted limited transparency and accountability for organ offer declines and recommended prioritizing patient engagement in decisions regarding organ offers. Yet, there is no guidance on how to incorporate patients in organ offers. We elected to study the experiences of patients on the waitlist and their perception of a novel Organ Offer Review Card (OORC). METHODS: A prototype OORC was created using Donornet refusal codes. Sixty randomly selected kidney waitlist patients at a single center were asked to participate in a web-based survey focusing on current medical decision-making preferences and perceptions of the prototype OORC. RESULTS: Among the 43 patients reached, 17 (39.5%) completed the survey. Most participants (88.2%) expressed it was important to be involved in the decision-making about organ offers, with 100.0% of respondents wanting to know why an organ was declined. Regarding the prototype OORC, 94.1% thought it helped them understand the factors and priorities considered when selecting an organ, and 88.2% said it increased their belief that their team was acting in their best interest. CONCLUSION: An OORC could increase transparency and communication during the waitlist process while enhancing trust in the transplant team.

Transferability of Effective Consultation Skills for Decision-Making Support in the Voluntary Surrender of Older Adult Drivers' Licences in Super-Aged Japan.

INTRODUCTION: Previously, we identified eight effective consultation skills to support decision-making in the voluntary surrender of older adult drivers' licences in super-aged Japan. This study aimed to clarify the transferability of these skills. METHODS: We collected text data by interviewing 11 safe-driving counsellors (four police officers, four clerical staff and three nurses) in the License Division of the National Police Agency from February to March 2022. Interviews were semi-structured and conducted by telephone or email. During the interview, participants were asked to recall their experiences as counsellors providing decision-making support to older drivers and to compare their experiences with the eight consultation skills. We analysed the content of the responses by quantitative text analysis with KH Coder 3 software. RESULTS: As a characteristic of the words and phrases used by counsellors in their narratives about consultation skills, the most frequently extracted words from among 3147 words were think, parties and family, and promote had the highest mediation centrality. The eight subgraphs were 'Respecting the will of relevant parties from their standpoint is natural', 'Listening attentively and empathetically to relevant parties is effective', 'Presenting objective data to guide decisions is successful', 'Showing cognitive functioning test results is often effective', 'Counselors with medical expertise can elicit positive counseling outcomes', 'Intervention by medical or police counselors facilitates the decision to surrender voluntarily', 'Counseling skills need to be improved' and 'A diagram of the 8 skills is helpful for inexperienced counselors'. CONCLUSION: The results suggest that the eight consultation skills have similarities and are transferable. This transferability might contribute to practical application or cohort follow-up study research. These skills can be incorporated into counsellor training, and counsellors can be expected to use these skills in the future. Regardless of the safe-driving counsellor's years of experience, the skills can help them provide uniform and accurate support in decision-making regarding the voluntary surrender of older adult drivers' licences. These skills are a promising approach to help older adults lead safe and secure lives as they age.