Do Interventions Designed to Support Shared Decision-Making Reduce Health Inequalities? : A Systematic Review and Meta-Analysis

Copyright: © 2014 Durand et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Background: Increasing patient engagement in healthcare has become a health policy priority. However, there has been concern that promoting supported shared decision-making could increase health inequalities. Objective: To evaluate the impact of SDM interventions on disadvantaged groups and health inequalities. Design: Systematic review and meta-analysis of randomised controlled trials and observational studies.Peer reviewe

Feasibility Pilot Outcomes of a Mammography Decision Support and Navigation Intervention for Women With Serious Mental Illness Living in Supportive Housing Settings.

Objective: People with serious mental illness (SMI) experience significant disparities in morbidity and mortality from preventable and treatable medical conditions. Women with SMI have low mammography screening rates. SMI, poverty, and poor access to care can have a significant effect on a woman’s opportunity to learn about and discuss breast cancer screening with health care providers. This study examines the feasibility pilot outcomes of mammography decision support and patient navigation intervention (DSNI) for women with SMI living in supportive housing settings. The primary research question was: Does the DSNI increase knowledge, promote favorable attitudes, and decrease decisional conflict relating to screening mammography? Methods: We developed the intervention with the community using participatory methods. Women (n = 21) with SMI who had not undergone screening mammography in the past year participated in an educational module and decision counseling session and received patient navigation over a 6-month period. We conducted surveys and interviews at baseline and follow-ups to assess mammography decisional conflict. Results: Among study participants, 67% received a mammogram. The mammogram DSNI was feasible and acceptable to women with SMI living in supportive housing settings. From baseline to 1-month follow-up, decisional conflict decreased significantly (P= .01). The patient navigation process resulted in 270 attempted contacts (M= 12.86, SD = 10.61) by study staff (phone calls and emails with patient and/or case manager) and 165 navigation conversations (M= 7.86, SD = 4.84). A barrier to navigation was phone communication, with in-person navigation being more successful. Participants reported they found the intervention helpful and made suggestions for further improvement. Conclusions: The process and outcomes evaluation support the feasibility and acceptability of the mammography DSNI. This project provides initial evidence that an intervention developed with participatory methods can improve cancer screening outcomes in supportive housing programs for people with SMI

People at Centre Stage: evaluation summary report

This report presents the results of an evaluation of consumer-directed community aged care. Consumer-Directed Care (CDC) is central to the aim of rendering community aged care more flexible and responsive. In Australia, it builds on experiences of consumer-directed community-based disability care and is intended to offer greater decisional authority to care recipients over the services they receive. Since the 1990s, there has been growing interest among Australian community care providers, service users, and policy makers to ‘modernise’ and reform community aged care. A suite of reports were commissioned that highlighted the facts that: fragmented programme arrangements in community care create planning and operational difficulties and inefficiencies; the service provision model is too complex, making it difficult for lay people to access the services they need or are entitled to; funding gaps exist throughout the care pathways; the system is inflexible and unresponsive to transitions in people’s lives and/or illness trajectories; the needs of a significant minority of care recipients are not sufficiently addressed, resulting in poor quality of care as well as resource wastage. The People at Centre Stage (PACS) project aimed to address some of these issues. The aim of the project was to—within the limitations of current legislation and guidelines—develop, implement and evaluate a community aged care model that gives care recipients with more complex needs the option to have as much control of their own care as they aspire to and feel comfortable with. The project intended to offer a continuum of care ranging from customary case management to CDC. This summary report provides a brief outline of the results of this evaluation. It is structured in two parts: following a brief overview of the PACS model, Part 1 outlines the key findings from the quantitative analysis, while Part 2 offers an overview of the qualitative findings. Part 2 deals exclusively with the experience of people participating in the intervention group

Comparing Rough Set Theory with Multiple Regression Analysis as Automated Valuation Methodologies

This paper focuses on the problem of applying rough set theory to mass appraisal. This methodology was first introduced by a Polish mathematician, and has been applied recently as an automated valuation methodology by the author. The method allows the appraiser to estimate a property without defining econometric modeling, although it does not give any quantitative estimation of marginal prices. In a previous paper by the author, data were organized into classes prior to the valuation process, allowing for the if-then, or right “rule” for each property class to be defined. In that work, the relationship between property and class of valued was said to be dichotomic.mass appraisal; property valuation; rough set theory; valued tolerance relation

Higher education decision making and decision support systems

The authors illustrate several issues in decision support and decision support systems (DSS), state of the art research in these fields, and also their own studies in designing a higher education DSS. The final section contains our contribution in outlining the modules of the DSS, involving the present systems and databases of FSEGA and UBB, results and activities belonging to FSEGA students, teaching and research staff, to assist decisions for all the actors implicated in the processes, in various specific situations.decision support, decision support systems (DSS), higher education institutions, Information and Communication Technologies (ICT)

An Empirical Analysis of the Medical Informed Consent Doctrine: Search for a Standard of Disclosure

Informed consent and its conceptual equivalents, e.g., right-to-know, are increasingly important. The author discusses the development of the informed consent doctrine in tort cases and attempts to evaluate the consistency of its application. He concludes that it is difficult to separate that which must be disclosed from that which need not be. He also argues that much remains to be done in achieving the objectives of the informed consent doctrine

Human elements and the pragmatic approach in the Australian, Scottish and Swedish standards for newly qualified teachers

Peer reviewedPublisher PD

E-Democracy and Knowledge. A Multicriteria Framework for the New Democratic Era

This paper analyses a new framework for decision-making in e-democracies that exploits the power of Internet based public knowledge, which is called briefly e-cognocracy. This is not a procedure to improve technical aspects using the Internet (e.g. e-voting); it is rather a procedure to add a new quality to the democratic system by using the network. This proposed system of e-cognocracy would allow those who are interested to solve highly complex problems by participatory decision-making. Furthermore, we suggest the multicriteria framework for the modelling and resolution of such complex problems. Similarly, using the analytic hierarchy process (AHP) approach, we propose decisional (analytic and informatic) tools for searching the knowledge - relevant for the decision-making process. This knowledge of patterns of behaviour, trends, opportunities, decisions and stylised facts will be the starting point of a consensus-reaching process, which is aimed to effectively solve problems of high complexity of the Internet society.E-democracy, Knowledge society, E-cognocracy, Multicriteria, AHP criterion, Consensus