Browsing by Subject "decision-making"

Now showing 1 - 10 of 27
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    Expanding the political market framework to explain executive decision-making during the COVID-19 crisis
    (ASPA, 2023-09) Curley, Cali; Federman, Peter Stanley; Shen, Ruowen; School of Public and Environmental Affairs
    The traditional political market framework (PMF) argues that elected officials respond to policy demands by adopting policy that furthers their goal of reelection. However, an emerging crisis can make this approach to decision-making challenging as the immediacy of response, the needs of the public, and technical expertise may conflict with reelection goals. This conflict can encourage elected officials to engage in blame avoidance by delegating policy-making powers to the bureaucracy. Utilizing a mixed methods approach to analyze state-level governor responses to COVID-19, this paper expands the PMF by capturing the influence of bureaucratic demands on elected official decisions to delegate or transfer power to the bureaucracy. We find evidence that bureaucratic expertise, under the right set of circumstances, influences policymaker decisions to delegate policymaking power. Lastly, we advocate for a renewed focus on democratic principles and the consequences of delegation for transparency, accountability, and social equity. In understanding the specific dynamics at play when bureaucrats and executives work to develop policy in crisis, practitioners may gain a better understanding of how to navigate difficult decisions. The specific executive orders across states are not particularly well-known, and providing evidence of the steps other states took to combat the crisis may prove useful to practitioners in the emergency management space. If practitioners have a more complete understanding of why policy is made and by what mechanisms, they may apply a focus on implementation strategies that are effective and relevant.
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    Family Communication About End-of-Life Decisions
    (2025-04) Myers, Anne Louise; Goering, Elizabeth M.; Bute, Jennifer J.; Parrish-Sprowl, John; Schwartz, Peter H.
    Purpose: For adults with serious illness nearing the end of life there are difficult decisions to be made about medical care and treatment. However, persons with life-threatening illness are commonly incapacitated, leaving the responsibility for making critical end-of-life decisions to family. To date, research on end-of-life decision-making and communication has framed proxy decision-making as a role for a “key” individual, despite growing evidence that multiple relatives often make decisions together. Also, although the literature examines communication between clinicians and patients or surrogates there is little research focused on family communication and how it relates to end-of-life decisions. The objective of the current study is to move towards bridging these gaps by examining within-family communication and decision-making from the perspectives of the family members themselves. Methods: This qualitative study explored family communication about end-of-life decisions through in-depth family interviews (n = 22). I applied Relational Dialectics Theory 2.0, a framework used for understanding relational communication within a particular context. To examine text derived from interviews, I used contrapuntal analysis, a type of discourse analysis that facilitates identification of competing discourses. Results: Three competing sets of discourses were predominant: 1) families providing care versus families relinquishing care, 2) independent versus interdependent decision-making, and 3) the certainty of knowing the patient’s wishes versus the uncertainty of knowing how to honor those wishes. Conclusions: The results highlight three key aspects of family decision-making. First, because families perceived caring for a loved one at home as normative, relinquishing end-of-life care to hospice or long-term care was a significant source of emotional burden. Second, families engaged in collaborative decision-making rather than having a primary decision-maker acting independently. Third, even when a patient’s wishes were known to the family, decision-makers still struggled with the uncertainty of understanding how to apply those preferences to medical decisions. Implications: This study provides insight into the communicative needs of family decision-makers that can be used to refine communication interventions and improve end-of-life experiences for families. These findings also suggest that more support is needed from clinicians to guide decision-makers with in-the-moment decision-making.
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    Family Members End of Life Decision Making Experiences
    (Office of the Vice Chancellor for Research, 2013-04-05) Garcia, Aiza; Carpenter, Janet S.
    Significance: The purpose of this study was to explore the experiences of individuals who accept the role of decision maker for a family member at the end of life, particularly focusing on their perspectives on their interactions with clinicians and the impact these interactions made on their decision-making process. With the completion of this study, the hopes are to develop a better understanding of the needs and of individuals making decisions for their family members at their end of life to ultimately improve the way clinicians interact with them. Objective: To understand family members’ experiences with end of life decision making including how clinicians interacted with them. Method: Individual interviews were conducted with 10 family members who contributed to making an end-of-life decision for a family member. All individuals who were 18 or older, English speaking, and willing to discuss their experiences were eligible for the study. The participants were privately interviewed over the phone. For analysis of the data, a coding scheme was constructed by selecting significant components of the family members’ experiences. The texts of the interviews were transcribed and coded allowing for the review of commonalities across the experiences. Measurements: Qualitative interviews were used to describe experiences using a semi-structured interview guide. The interview guide was developed using the Ottawa Decision Support Framework, a guide for clients to use in decision-making regarding the health or social aspects of their life. This framework allows the interview and data to focus on evaluating the needs of the individual. Main Results: Pending – data analysis is underway Conclusions: Results will be used to understand needs and improve interactions with families making end of life decisions.
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    How to intervene in the caries process in adults: proximal and secondary caries? An EFCD-ORCA-DGZ expert Delphi consensus statement
    (Springer, 2020) Schwendicke, Falk; Splieth, Christian H.; Bottenberg, Peter; Breschi, Lorenzo; Campus, Guglielmo; Doméjean, Sophie; Ekstrand, Kim; Giacaman, Rodrigo A.; Haak, Rainer; Hannig, Matthias; Hickel, Reinhard; Juric, Hrvoje; Lussi, Adrian; Machiulskiene, Vita; Manton, David; Jablonski-Momeni, Anahita; Opdam, Niek; Paris, Sebastian; Santamaria, Ruth; Tassery, Hervé; Zandona, Andrea; Zero, Domenick; Zimmer, Stefan; Banerjee, Avijit; Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
    Objectives To provide consensus recommendations on how to intervene in the caries process in adults, specifically proximal and secondary carious lesions. Methods Based on two systematic reviews, a consensus conference and followed by an e-Delphi consensus process were held with EFCD/ORCA/DGZ delegates. Results Managing an individual’s caries risk using non-invasive means (oral hygiene measures including flossing/interdental brushes, fluoride application) is recommended, as both proximal and secondary carious lesions may be prevented or their activity reduced. For proximal lesions, only cavitated lesions (confirmed by visual-tactile, or radiographically extending into the middle/inner dentine third) should be treated invasively/restoratively. Non-cavitated lesions may be successfully arrested using non-invasive measures in low-risk individuals or if radiographically confined to the enamel. In high-risk individuals or if radiographically extended into dentine, for these lesions, additional micro-invasive (lesion sealing and infiltration) treatment should be considered. For restoring proximal lesions, adhesive direct restorations allow minimally invasive, tooth-preserving preparations. Amalgams come with a lower risk of secondary lesions and may be preferable in more clinically complex scenarios, dependent on specific national guidelines. In structurally compromised (especially endodontically treated) teeth, indirect cuspal coverage restorations may be indicated. Detection methods for secondary lesions should be tailored according to the individual’s caries risk. Avoiding false positive detection and over-treatment is a priority. Bitewing radiographs should be combined with visual-tactile assessment to confirm secondary caries detections. Review/refurbishing/resealing/repairing instead of replacing partially defective restorations should be considered for managing secondary caries, if possible. Conclusions An individualized and lesion-specific approach is recommended for intervening in the caries process in adults.
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    Informed Consent
    (Wiley, 2023) Brann, Maria; Communication Studies, School of Liberal Arts
    This entry provides an overview of informed consent in healthcare interactions. By addressing what constitutes informed consent, taking a brief look at the historical significance of informed consent, and highlighting research that focuses on the informed consent process in health communication, readers gain a better understanding of this necessary communicative act for patient-centered healthcare. The Western value of patient autonomy is noted as necessary for informed decision making, and the problems when respect for persons is overlooked by not engaging in informed consent are discussed. The act, and end result, of informed consent is a recognized right for patients during healthcare interactions.
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    Investigating Canadian parents' HPV vaccine knowledge, attitudes and behaviour: a study protocol for a longitudinal national online survey
    (BMJ Journals, 2017-09-11) Shapiro, Gilla K; Perez, Samara; Naz, Anila; Tatar, Ovidiu; Guichon, Juliet R; Amsel, Rhonda; Zimet, Gregory D; Rosberger, Zeev; Pediatrics, School of Medicine
    Introduction Human papillomavirus (HPV), a sexually transmitted infection, can cause anogenital warts and a number of cancers. To prevent morbidity and mortality, three vaccines have been licensed and are recommended by Canada’s National Advisory Committee on Immunisation (for girls since 2007 and boys since 2012). Nevertheless, HPV vaccine coverage in Canada remains suboptimal in many regions. This study will be the first to concurrently examine the correlates of HPV vaccine decision-making in parents of school-aged girls and boys and evaluate changes in parental knowledge, attitudes and behaviours over time. Methods and analysis Using a national, online survey utilising theoretically driven constructs and validated measures, this study will identify HPV vaccine coverage rates and correlates of vaccine decision-making in Canada at two time points (August–September 2016 and June–July 2017). 4606 participants will be recruited to participate in an online survey through a market research and polling firm using email invitations. Data cleaning methods will identify inattentive or unmotivated participants. Ethics and dissemination The study received research ethics board approval from the Research Review Office, Integrated Health and Social Services University Network for West-Central Montreal (CODIM-FLP-16–219). The study will adopt a multimodal approach to disseminate the study’s findings to researchers, clinicians, cancer and immunisation organisations and the public in Canada and internationally.
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    Making health care decisions. [Chapter 1]
    (1982-10) United States. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research
    Studies the issues of informed consent regarding health care choices.
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    Making health care decisions. [Chapter 2]
    (1982-10) United States. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research
    Studies the issues of informed consent regarding health care choices.
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    Making health care decisions. [Chapter 3]
    (1982-10) United States. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research
    Studies the issues of informed consent regarding health care choices.
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    Making health care decisions. [Chapter 4(a)]
    (1982-10) United States. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research
    Studies the issues of informed consent regarding health care choices.