Browsing by Subject "Decision making"
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Item Ask the parents: Testing the acceptability and usability of a hypospadias decision aid(Elsevier, 2022) Binion, Kelsey; Miller, Andrew; Misseri, Rosalia; Kaefer, Martin; Longtin, Krista; Carroll, Aaron; Wiehe, Sarah E.; Chan, Katherine H.; Communication Studies, School of Liberal ArtsIntroduction: In previous work, we engaged key stakeholders to create a web-based decision aid (DA) prototype to facilitate shared decision making about hypospadias. Objective: The study's objective was to use a human-centered design approach to assess the DA's acceptability and usability and revise it prior to pilot testing. Methods: We recruited English-speaking parents (≥18 years old) of sons with hypospadias (≤5 years) for a two-phase process of semi-structured phone/video interviews to obtain feedback about our DA prototype. DA webpages included: "Hypospadias," "Surgery Basics," "No Surgery," "Family Stories," "Help Me Decide," and "FAQs." In both phases, participants viewed the DA using the "think aloud" technique and completed several validated scales to evaluate its acceptability and usability. In phase 1, we collected feedback about the "Homepage" organization, values clarification methods (VCM), and webpage content. In phase 2, participants searched the DA for answers to hypospadias-related questions, provided feedback on testimonial videos and VCM, and shared their preferences about data visualizations. All interviews were audio recorded. After each phase, transcripts were qualitatively analyzed to identify key areas for revision. Revisions were made between phase 1 and 2 to improve the DA's acceptability and usability. Results: We interviewed 20 participants (10/phase): median age 33.7 years, 60% female, 80% White. Mean score on the Preparation for Decision Making Scale: 86.8 (out of 100). We revised: 1) VCM, focusing on pros/cons of surgery and question prompts, 2) "Homepage," adding webpage descriptions (Extended Summary Figure), 3) menu organization, 4) "Surgery Day" webpage, adding general anesthesia risk information, and 5) "Hypospadias" webpage, adding an icon bar graph to help participants visualize statistics. Participants thought the testimonial videos were relatable and the VCMs would prepare them for their visit with their child's urologist. Discussion: Ours is the first parent-centered DA developed and pre-tested for hypospadias. Using validated usability and acceptability scales, participants highly rated the DA in helping them arrive at a decision about surgery. Study limitations include the sample's lack of diversity (i.e., educated, health literate) and participants already decided about their son's hypospadias management before enrolling. To learn more about the DA's usability and acceptability, we plan to pilot test it in a clinical setting. Conclusions: Participants found our DA informative in understanding hypospadias. There was a high perceived level of preparation for hypospadias decision making. Participatory research methods, such as "think aloud," may be helpful when testing DAs as they privilege the patient's experience.Item Association of Amyloid-β Pathology with Decision Making and Scam Susceptibility(IOS Press, 2021) Kapasi, Alifiya; Yu, Lei; Stewart, Christopher; Schneider, Julie A.; Bennett, David A.; Boyle, Patricia A.; Neurology, School of MedicineBackground: Recent findings suggest that poor decision making and increased scam susceptibility are harbingers of Alzheimer's disease (AD) dementia and may be among the earliest behavioral manifestations of pathologic cognitive aging. However, the degree to which poor decision making and scam susceptibility reflect accumulating Alzheimer's disease (AD) pathology remains unclear. Objective: To investigate the associations of AD pathology with decision making and scam susceptibility in older adults without dementia. Methods: Data came from 198 deceased participants without clinical dementia (mean age at death = 90 years; 69%women) from two ongoing studies of aging. All underwent annual clinical evaluations, completed assessments of healthcare and financial decision making and scam susceptibility, and brain donation. Neuropathologic evaluations quantified pathologic hallmarks of AD, amyloid-β and tau-tangles, Lewy body pathology, and TDP-43 proteinopathy. Results: In linear regression models adjusted for demographics, amyloid-β pathology was associated with lower decision making (estimate = -0.35; SE = 0.16, p = 0.03), particularly healthcare decision making (estimate = -0.20; SE = 0.09, p = 0.03), as well as greater scam susceptibility (estimate = 0.12; SE = 0.04, p = 0.003); tau-tangle pathology was not related. Further, TDP-43 pathology was associated with greater scam susceptibility (estimate = 0.10; SE = 0.04; p = 0.02). Conclusion: Accumulating AD pathology, particularly amyloid-β, is associated with poor decision making and increased scam susceptibility among older persons without overt cognitive impairment. These findings provide compelling evidence that decision making and scam susceptibility are sensitive to the earliest pathological changes of AD.Item The Association of Late Life Cognitive Activity with Healthcare and Financial Decision Making in Community-Dwelling, Non-Demented Older Adults(Elsevier, 2021) Glover, Crystal M.; Yu, Lei; Stewart, Christopher C.; Wilson, Robert S.; Bennett, David A.; Boyle, Patricia A.; Neurology, School of MedicineObjective: The purpose of this study was to test the hypothesis that late life cognitive activity is associated with decision-making in older adults and to examine whether this association varies by level of cognitive function. Design: This study employed a cross-sectional design. Setting: All data were collected in participants' community-based residences. Participants: Participants were 1,084 older adults (mean age = 81.05 years, standard deviation = 7.53) without dementia (median Mini-Mental State Examination score = 29, interquartile range = 27.86-30.00). Measurements: Participants completed assessments of late life cognitive activity, cognitive function, and decision-making. We used linear regression models to examine the associations of late life cognitive activity and cognitive function with decision-making. Results: In a regression model adjusted for age, gender, and education, more frequent late life cognitive activity was associated with better decision-making, as was higher cognitive function. Furthermore, in an additional model that included the interaction of late life cognitive activity and cognitive function, the interaction was significant, such that late life cognitive activity was most strongly associated with decision-making among participants with lower levels of cognitive function. Conclusion: Frequent engagement in late life cognitive activity may help maintain decision-making among older persons, particularly among those with lower levels of cognitive function.Item The Association of Surrogate Decision Makers’ Religious and Spiritual Beliefs with End of Life Decisions(Elsevier, 2020-02) Torke, Alexia M.; Fitchett, George; Maiko, Saneta; Burke, Emily S.; Slaven, James E.; Newton Watson, Beth; Ivy, Steven; Monahan, Patrick O.; Biostatistics, School of Public HealthContext: Although religion and spirituality are important to surrogate decision makers, little is known about the role of religion in decision making regarding life-sustaining treatments. Objectives: To determine the relationships between dimensions of religion and spirituality and medical treatment decisions made by surrogates. Methods: This prospective observational study enrolled patient/surrogate dyads from three hospitals in one metropolitan area. Eligible patients were 65 years or older and admitted to the medicine or medical intensive care services. Baseline surveys between hospital days 2 and 10 assessed seven dimensions of religion and spirituality. Chart reviews of the electronic medical record and regional health information exchange six months after enrollment identified the use of life-sustaining treatments and hospice for patients who died. Results: There were 291 patient/surrogate dyads. When adjusting for other religious dimensions, demographic, and illness factors, only surrogates' belief in miracles was significantly associated with a lower surrogate preference for do-not-resuscitate status (adjusted odds ratio [aOR] 0.39; 95% CI 0.19, 0.78). Among patients who died, higher surrogate intrinsic religiosity was associated with lower patient receipt of life-sustaining treatments within the last 30 days (aOR 0.66; 95% CI 0.45, 0.97). Belief in miracles (aOR 0.30; 95% CI 0.10, 0.96) and higher intrinsic religiosity (aOR 0.70; 95% CI 0.53, 0.93) were associated with lower hospice utilization. Conclusion: Few religious variables are associated with end-of-life preferences or treatment. Belief in miracles and intrinsic religiosity may affect treatment and should be identified and explored with surrogates by trained chaplains or other clinicians with appropriate training.Item Brain responses during delay discounting in youth at high-risk for substance use disorders(Elsevier, 2021) Butcher, Tarah J.; Dzemidzic, Mario; Harezlak, Jaroslaw; Hulvershorn, Leslie A.; Oberlin, Brandon G.; Psychiatry, School of MedicineOffspring of parents with substance use disorders (SUD) discount future rewards at a steeper rate on the monetary delay discounting task (DD) than typically developing youth. However, brain activation during DD has yet to be studied in drug naïve youth with a family history (FH) of SUD. Here, we investigate brain activation differences in high-risk youth during DD. We recruited substance naïve youth, aged 11–12, into three groups to compare brain activation during DD: (1) High-risk youth (n = 35) with a FH of SUD and externalizing psychiatric disorders, (2) psychiatric controls (n = 25) who had no FH of SUD, but with equivalent externalizing psychiatric disorders as high-risk youth, and (3) a healthy control group (n = 24) with no FH of SUD and minimal psychopathology. A whole-brain voxel wise analysis of the [Delay > Baseline], [Immediate > Baseline], and [Control > Baseline] contrasts identified functional regions of interest, from which extracted parameter estimates were tested for significant group differences. Relative to control youth, high-risk youth showed stronger activation in the left posterior insula and thalamus when making delayed choices, and stronger activation of the parahippocampal gyrus when making both delayed and control choices (ps < 0.05). Activation in the left posterior insula negatively correlated with both subscales of the Emotion Regulation Checklist, and positively correlated with the Stroop interference effect (ps < 0.05). Our findings suggest possible heritable SUD risk neural markers that distinguish drug naïve high-risk youth from psychiatric and healthy controls.Item Building the Agenda for Institutional Research in Water Resource Management(JAWRA Journal of the American Water Resources Association, 2004) Blomquist, William; Heikkila, Tanya; Schlager, EdellaThis paper pursues more specifically the recommendations of a recent National Research Council report recommending greater attention to research on institutions in the field of water resource management. The important challenge for the future in institutional research lies in going beyond the observation that institutions are important and in explaining instead how institutions actually affect management options and outcomes. It is possible to illuminate the relationships between institutional features and water management through comparative institutional research. This paper offers recommendations for studying water institutions in a comparative context, including methodological recommendations concerning approaches to comparative institutional research, and topics for comparative institutional research that appear especially fruitful at this time. The example of conjunctive management is used to illustrate the importance of institutional factors in water management, drawing to some extent on the authors’ recent experience with a comparative study of conjunctive management institutions.Item Consulting “Dr. YouTube”: an objective evaluation of hypospadias videos on a popular video-sharing website(Elsevier, 2020-02-16) Salama, Amr; Panoch, Janet; Bandali, Elhaam; Carroll, Aaron; Wiehe, Sarah; Downs, Stephen; Cain, Mark P.; Frankel, Richard; Chan, Katherine H.; Urology, School of MedicineIntroduction: Parents who make decisions about hypospadias repair for their child may seek information from online platforms such as YouTube. Objective: The purpose of this study is to evaluate the health literacy demand of hypospadias videos on YouTube using the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V). Study design: We performed a YouTube search using the term "hypospadias," limiting results to the first 100 videos. We excluded videos that were <1 min or >20 min and videos that were not in English or did not include subtitles. Two evaluators independently examined videos and determined PEMAT-A/V scores for understandability and actionability (i.e., ability to identify actions the viewer can take). Videos with scores >70% are understandable or actionable. The inter-rater reliability (kappa) and intraclass correlation coefficient (ICC) of PEMAT scores were calculated. Bivariate and multivariable linear regression models assessed the association of video characteristics with respective scores. Results: Of the 100 videos that were identified on YouTube, 47 (47%) were excluded leaving 53 for analysis: 14 were >20 min, 14 were <1 min, 9 had no audio or subtitles, 7 were not in English, 1 was a duplicate, 1 was unrelated to hypospadias, and 1 was deleted at the time of data analysis. Three (5.6%) were understandable (mean score 54.5%, standard deviation (SD) 14.9) and eight (15.1%) were actionable (mean score 21.8%, SD 16.6) (Extended Summary Figure). Kappa values ranged from 0.4 to 1. The ICC's were 0.55 and 0.33 for understandability and actionability, respectively. In the bivariate analysis, mean understandability scores were significantly higher for English language videos (p = 0.04), videos with animation (p = 0.002), and those produced by industry (p = 0.02). In the multivariable analysis, mean understandability scores were significantly higher for "expert testimonial" or "other" video types after adjusting for graphics type and overall tone (p = 0.04). Mean understandability scores were also significantly higher for videos with animation after adjusting for video type and overall tone (p = 0.01). Mean actionability scores were significantly higher for videos with a negative tone (p = 0.01). Discussion: The vast majority of hypospadias-related YouTube content is not appropriate for users with low health literacy although certain types of videos, such those with animation and expert testimonials, scored higher on understandability than other types. Conclusion: Due to the lack of sufficient online informational content regarding hypospadias, we plan to engage parents of sons with hypospadias in the development of high-quality patient educational materials about hypospadias.Item Coping with organizational change: a multidimensional perspective(2011-03-10) Bussell, Stephen L.; Goering, Elizabeth M.; Parrish-Sprowl, John; Sandwina, Ronald M.This paper introduces a unified model for organizational change that is designed to help change analysts think through the decision-making process. Most organizational leaders do not manage change effectively because they fail to acquire the minimum amount of information necessary to make a sound decision. In large part, this deficiency is a result of considering only a small part of the organization’s total change reality, which can be expressed in terms of the following four categories: 1) Environment creates change, 2) Organization responds to environmental change, 3) Organization initiates new changes, and 4) Organization changes environment. Through the principle of diagnostic communication, leaders can adjust to the incoming changes [categories 1 and 2]. Through the principle of rhetorical communication, they can create effective outgoing changes [categories 3 and 4]. Through the principle of dialogical communication, they can achieve a strategic balance between too much conformity, which results from diagnostic communication in isolation, and too much non-conformity, which results from communication in isolation. By understanding and communicating about change from this multi-dimensional perspective, organizational leaders, both designated and non-designated, can learn to appreciate the extent to which they influence and are influenced by the larger cultural environment of which they are a part.Item COVID-19 Pandemic: The response of the American academy of neurology(Elsevier, 2021-10) Stevens, James; Neurology, School of MedicineThe Covid-19 pandemic is the most disruptive force the world has experienced in over 100 years. This presentation will discuss the process the American Academy of Neurology employed in making decisions during the unprecedented changes and uncertainties which arose from the pandemic, the programs which were initiated, and the resulting successes experienced by the organization, the membership, and patients suffering from neurologic disease.Item Decentralization of River Basin Management: A Global Analysis(World Bank Group, 2005) Dinar, Ariel; Kemper, Karin; Blomquist, William; Diez, Michele; Sine, Gisele; Fru, WilliamDecentralization and increased stakeholder involvement have been major elements of water sector reform as ways to promote sustainable and integrated resource management particularly of river basins. Based on an analytical framework for relating decentralization and stakeholder involvement to improved river basin management, this paper infers several hypotheses about factors associated with greater or lesser likelihood of success of the decentralization process using data from 83 river basins worldwide. The results suggest that physical, political, economic, financial, and institutional characteristics of the basin do affect the process and the level of performance of the decentralization. In particular, the presence of water scarcity may be a stimulus to reform, uniting the stakeholders in the basin and leading to better performance; organized user groups push for the initiation of decentralization reforms but may be associated with costs to the process and difficulty of achieving decentralization; the existence of dispute resolution mechanisms supports stakeholder involvement and improves decentralization performance; where stakeholders accepted greater financial responsibility, complying with tariffs and contributing to the budget for basin management, the decentralization process and performance measures increased; basins with higher percentages of their budgets from external governmental sources benefited from better stability and support and it shows in the performance of the decentralization process.