Patient decision aids enable patients to be better informed about the potential benefits and harms of their healthcare options. Certification of patient decision aids at the national level in the United States is a critical step towards responsible governance—primarily as a quality measure that increases patients’ safety, as mandated in the U.S. Patient Protection and Affordable Care Act (PPACA). Certification would provide a verification process to identify conflicts of interest that may otherwise bias the scientific evidence presented in (...) decision aids. Certification also benefits clinicians who may otherwise face malpractice claims based on harm to patients caused by possible reliance on patient decision aids that are inaccurate, incomplete, or presented in a manner that biases the patient’s decision. Existing work by the International Patient Decision Aid Standards Collaboration could guide the establishment of a certification process within the U.S. This article argues for national certification of patient decision aids and discusses how that may be achieved. (shrink)

Abstract In light of the complexity of unfolding disasters, the diversity of rapidly evolving events, the enormous amount of generated information, and the huge pool of casualties, emergency responders (ERs) may be overwhelmed and in consequence poor decisions may be made. In fact, the possibility of transporting the wounded victims to one of several hospitals and the dynamic changes in healthcare resource availability make the decision process more complex. To tackle this problem, we propose a multicriteria decision (...) support service, based on the Analytic Hierarchy Process (AHP) method, that aims to avoid overcrowding and outpacing the capacity of a hospital to effectively provide the best care to victims by finding out the most appropriate hospital that meets the victims’ needs. The proposed approach searches for the most appropriate healthcare institution that can effectively deal with the victims’ needs by considering the availability of the needed resources in the hospital, the victim’s wait time to receive the healthcare, and the transfer time that represents the hospital proximity to the disaster site. The evaluation and validation results showed that the assignment of hospitals was done successfully considering the needs of each victim and without overwhelming any single hospital. (shrink)

This paper proposes several concepts of efficient solutions for multicriteria decision problems under uncertainty. We show how alternative notions of efficiency may be grounded on different decision ‘contexts’, depending on what is known about the Decision Maker's (DM) preference structure and probabilistic anticipations. We define efficient sets arising naturally from polar decision contexts. We investigate these sets from the points of view of their relative inclusions and point out some particular subsets which may be especially (...) relevant to some decision situations. (shrink)

The objective of this study is to evaluate if use of a patient decision aid, when choosing between a repeat cesarean or a trial of labor after a cesarean, reduces medical liability exposure. The authors conclude that use of a PDA conferred liability protection when potential jurors were presented with a hypothetical malpractice claim against an obstetrician following a TOLAC.

The legal doctrine of informed consent has overwhelmingly failed to assure that the medical treatment patients get is the treatment patients want. This Article describes and defends an ongoing shift toward shared decision making processes incorporating the use of certified patient decision aids.

We focus on a class of multicriteria methods that are commonly used in environmental decision making--those that employ the weighted linear average algorithm (and this includes the popular analytic hierarchy process (AHP)). While we do not doubt the potential benefits of using formal decision methods of this type, we draw attention to the consequences of not using them well. In particular, we highlight a property of these methods that should not be overlooked when they are applied in (...) environmental and wider decision-making contexts: the final decision or ranking of options is dependent on the choice of performance scoring scales for the criteria when the criteria weights are held constant. We compare this "sensitivity" to a well-known criticism of the AHP, and we go on to describe the more general lesson when it comes to using weighted linear average methods--a lesson concerning the relationship between criteria weights and performance scoring scales. (shrink)

Incorporation of the behavioral issues of the decision maker (DM) is among the aspects that each Multicriteria Decision Making (MCDM) method implicitly or explicitly takes into account. As postulated by regret theory, the feelings of regret and rejoice are among the behavioral issues associated with the entire decision making process. Within the context of MCDM, the DM may feel regret, when the chosen alternative is compared with another one having at least one better criterion value. PROMETHEE (...) II is a widely known MCDM method that makes no explicit incorporation of regret attitude of the DM. In this paper, we elaborate on the applicability of regret theory to MCDM context. In particular, we investigate the findings of regret theory and explore the parallel between regret theory and PROMETHEE II method. Relying on the concepts of regret theory, we demonstrate how a decision that is made using a PROMETHEE II based outranking method conforms to the regret attitude of the DM. (shrink)

PurposeAdvance directives have been criticized for failing to help physicians make decisions consistent with patients’ wishes. This pilot study sought to determine if an interactive, computer-based decision aid that generates an advance directive can help physicians accurately translate patients’ wishes into treatment decisions.MethodsWe recruited 19 patient-participants who had each previously created an advance directive using a computer-based decision aid, and 14 physicians who had no prior knowledge of the patient-participants. For each advance directive, three physicians were randomly assigned (...) to review the advance directive and make five to six treatment decisions for each of six (potentially) end-of-life clinical scenarios.From the three individual physicians’ responses, a “consensus physician response” was generated for each treatment decision (total decisions = 32). This consensus response was shared with the patient whose advance directive had been reviewed, and she/he was then asked to indicate how well the physician translated his/her wishes into clinical decisions.ResultsPatient-participants agreed with the consensus physician responses 84 percent (508/608) of the time, including 82 percent agreement on whether to provide mechanical ventilation, and 75 percent on decisions about cardiopulmonary resuscitation (CPR).Across the six vignettes, patient-participants’ rating of how well physicians translated their advance directive into medical decisions was 8.4 (range = 6.5-10, where 1 = extremely poorly, and 10 = extremely well). Physicians’ overall rating of their confidence at accurately translating patients’ wishes into clinical decisions was 7.8 (range = 6.1-9.3, 1 = not at all confident, 10 = extremely confident).ConclusionFor simulated cases, a computer-based decision aid for advance care planning can help physicians more confidently make end-of-life decisions that patients will endorse. (shrink)

This paper introduces a refined single-valued neutrosophic set (RSVNS) and presents a similarity measure of RSVNSs. Then a multicriteria decision-making method with RSVNS information is developed based on the similarity measure of RSVNSs. By the similarity measure between each alternative and the ideal solution (ideal alternative), all the alternatives can be ranked and the best one can be selected as well. Finally, an actual example on the selecting problems of construction projects demonstrates the application and effectiveness of the (...) proposed method. (shrink)

This chapter addresses the problem of ranking available drugs in guideline development to support clinicians in their work. Based on a pragmatic approach to the notion of evidence and a hierarchical view on different kinds of evidence this chapter introduces a decision aid, HiDAD, which draws on the multi criteria decision making literature. This decision aid implements the wide-spread intuition that there are different kinds of evidence with varying degrees of importance by relying on a strict ordinal (...) ordering of kinds of evidence. In order to construct a ranking every pair of drugs is first compared separately on all kinds of evidence. Next, these quantitative comparisons are then aggregated into an overall comparison between drugs based on all the available evidence in a way which avoids that evidence of less importance is trumped by evidence of the higher levels. Finally, these overall comparisons are used to determine the final ranking of drugs which then informs the process of guideline writing. Properties, modifications and applicability of the decision aid HiDAD are discussed and assessed. (shrink)

This contribution discusses the development of the Data Ethics Decision Aid (DEDA), a framework for reviewing government data projects that considers their social impact, the embedded values and the government’s responsibilities in times of data-driven public management. Drawing from distinct qualitative research approaches, the DEDA framework was developed in an iterative process (2016–2018) and has since then been applied by various Dutch municipalities, the Association of Dutch Municipalities, and the Ministry of General Affairs (NL). We present the DEDA framework (...) as an effective process to moderate case-deliberation and advance the development of responsible data practices. In addition, by thoroughly documenting the deliberation process, the DEDA framework establishes accountability. First, this paper sheds light on the necessity for data ethical case deliberation. Second, it describes the prototypes, the final design of the framework, and its evaluation. After a comparison with other frameworks, and a discussion of the findings, the paper concludes by arguing that the DEDA framework is a useful process for ethical evaluation of data projects for public management and an effective tool for creating awareness of ethical issues in data practices. (shrink)

Syltern and colleagues argue that we should give parents more time to make difficult decisions about life-sustaining treatment at the margins of viability (Syltern et al. 2022). This thesis is appe...

This “Legal Briefing” column covers recent legal developments involving patient decision aids. This topic has been the subject of recent articles in JCE. It is included in the 2010 Patient Protection and Affordable Care Act. And it has received significant attention in the biomedical literature, including a new book, a thematic issue of Health Affairs, and a recent article in the New England Journal of Medicine. Moreover, physicians and health systems across the United States are increasingly integrating decision (...) aids into their clinical practice. Both federal and state laws play a significant role in promoting this expanded use. On the other hand, concerns about liability could stymie development and implementation. We categorize legal developments concerning patient decision aids into the following five sections:1. Development of decision aids2. Effectiveness of decision aids3. Federal regulation of decision aids4. State regulation of decision aids5. Legal concerns regarding decision aids. (shrink)

Patients should not always receive hard data about the risks and benefits of a medical intervention. That information should always be available to patients who expressly ask for it, but it should be part of standard disclosure only sometimes, and only for some patients. And even then, we need to think about how to offer it.

Gaining informed consent among marginalized groups that include decisionally incapacitated individuals and those outside of the researcher's own geo-social and ethnic background still challenges many researchers. We suggest that there is a need for consideration of a different approach to research ethics in international settings. Based on extensive field work in West Africa on medical knowledge transfers and patient–healer relationships, this paper will discuss the challenges posed in obtaining informed individual consent in international settings. It is argued that while being (...) on the whole convincing, the top-down approach of the proposed solutions, which clearly dominates the participative approach, fails in building sustainable capacity, decision-making competency, and empowerment in the communities in which the research is conducted. Using appropriate decision aids can help resolve these issues. (shrink)

Within the ethical debate on Machine Learning-driven decision support systems (ML_CDSS), notions such as “human in the loop” or “meaningful human control” are often cited as being necessary for ethical legitimacy. In addition, ethical principles usually serve as the major point of reference in ethical guidance documents, stating that conflicts between principles need to be weighed and balanced against each other. Starting from a neo-Kantian viewpoint inspired by Onora O'Neill, this article makes a concrete suggestion of how to interpret (...) the role of the “human in the loop” and to overcome the perspective of rivaling ethical principles in the evaluation of AI in health care. We argue that patients should be perceived as “fellow workers” and epistemic partners in the interpretation of ML_CDSS outputs. We further highlight that a meaningful process of integrating (rather than weighing and balancing) ethical principles is most appropriate in the evaluation of medical AI. (shrink)

When individuals cannot make up their mind, they sometimes use a random decision-making aid such as a coin to make a decision. This aid may also elicit affective reactions: A person flipping a coin may (dis)like the outcome, and thus decide according to this feeling. We refer to this process as catalysing decisions and to the aid as catalyst. We investigate whether using a catalyst may not only elicit affect but also result in more affect-based decision making. (...) We used different online studies that examine affect-driven decisions by investigating scope insensitivity (indirect behavioural measure) and self-reported weight given to feelings versus reasons in hypothetical donation decisions. Study 1a showed that a catalyst (a lottery wheel) lead to more scope insensitive (i.e. affect-driven) donations. Study 1b included several changes and did not replicate these results. Study 2 (preregistered) examined scope insensitivity but did not replicate previous results; Study 3 (preregistered) looked at the weight given to feelings versus reason. Although catalyst (compared to control) participants descriptively reported relying more on feelings, this difference did not reach significance. In contrast to lay beliefs, results do not indicate support for the hypothesis that using a catalyst results in more affect-based hypothetical donation decisions. (shrink)

Recently, technology has impacted upon sports umpiring and refereeing. One effect is that the means to make sound judgments has becoe ?distributed? to new groups of people such as TV viewers and commentators. The result is that justice on the sports field is often seen not to be done and the readiness to question umpires' decisions that once pertained only to the players and, in some sports, to the crowd, has spread to anyone who has a television. What is more, (...) the questioning can now be done on good grounds. This change is explained and a way of thinking about it is put forward. The aim is to develop a theory of the relationship between human match officials and technology. Toward this end I offer a new terminology for the kinds of justice that are involved in match officiating. I argue that the introduction of new technology should be done in such a way as to maintain the justice of decisions and that justice is not the same as accuracy. Justice is best served with a restrained use of new technology. (shrink)

Background Recent publications reveal shortcomings in evidence review and summarization methods for patient decision aids. In the large-scale "Share to Care (S2C)" Shared Decision Making (SDM) project at the University Hospital Kiel, Germany, one of 4 SDM interventions was to develop up to 80 decision aids for patients. Best available evidence on the treatments' impact on patient-relevant outcomes was systematically appraised to feed this information into the decision aids. Aims of this paper were to (1) describe (...) how PtDAs are developed and how S2C evidence reviews for each PtDA are conducted, (2) appraise the quality of the best available evidence identified and (3) identify challenges associated with identified evidence. Methods The quality of the identified evidence was assessed based on GRADE quality criteria and categorized into high-, moderate-, low-, very low-quality evidence. Evidence appraisal was conducted across all outcomes assessed in an evidence review and for specific groups of outcomes, namely mortality, morbidity, quality of life, and treatment harms. Challenges in evidence interpretation and summarization resulting from the characteristics of decision aids and the type and quality of evidence are identified and discussed. Conclusions Evidence reviews in this project were carefully conducted and summarized. However, the evidence identified for our decision aids was indeed a "scattered landscape" and often poor quality. Facing a high prevalence of low-quality, non-directly comparative evidence for treatment alternatives doesn't mean it is not necessary to choose an evidence-based approach to inform patients. While there is an urgent need for high quality comparative trials, best available evidence nevertheless has to be appraised and transparently communicated to patients. (shrink)

Norton has argued for the salience of deliberative strategies for making environmental decisions which is supposed to be preferable to formal decision analysis. This paper argues that formal multicriteria decision analysis, when deployed with care, has the flexibility to absorb the advantages of deliberative decision making. It can also be used for decision support during a deliberative process. This feature of decision analysis is illustrated using a case study from Merauke in Papua province of (...) Indonesian New Guinea. (shrink)

According to Sutton et al. a “clinical decision support system (CDSS) is intended to improve healthcare delivery by enhancing medical decisions with targeted clinical knowledge, patient information...

The rapid progress and expanding development of machine learning-driven clinical decision support systems (ML_CDSS) have led to calls for involving “humans in the loop” in the design, development,...

There is significant potential for machine learning (ML) models and systems to enhance prognostic, diagnostic, and therapeutic decision-making in the healthcare context. When used in clinical setti...

Recently, technology has impacted upon sports umpiring and refereeing. One effect is that the means to make sound judgments has becoe ‘distributed’ to new groups of people such as TV viewers and commentators. The result is that justice on the sports field is often seen not to be done and the readiness to question umpires' decisions that once pertained only to the players and, in some sports, to the crowd, has spread to anyone who has a television. What is more, (...) the questioning can now be done on good grounds. This change is explained and a way of thinking about it is put forward. The aim is to develop a theory of the relationship between human match officials and technology. Toward this end I offer a new terminology for the kinds of justice that are involved in match officiating. I argue that the introduction of new technology should be done in such a way as to maintain the justice of decisions and that justice is not the same as accuracy. Justice is best served with a restrained use of new technology. (shrink)

Asylum legal aid lawyers are under continuous public scrutiny. On the one hand, these lawyers are portrayed as being solely motivated by profit. On the other hand, they are depicted as leftist activists frustrating the legal system. When assisting their asylum seeking clients under the state's legal aid scheme, lawyers need to balance the client's interest, the public interest in the administration of justice and their own interest in profit or survival. The current book examines this balancing act and explores (...) the role of the institutional context. It does so by studying the decision making of asylum legal aid lawyers in the Netherlands and England in respect of two ethical issues: 'time vs. money' and 'hopeless cases'. This empirical research into lawyers' professional ethics in practice will appeal to scholars engaged in lawyers' ethics, policy makers and those involved in the regulation of the legal profession. Dissertation. [Subject: Politics, Human Rights Law, International Law]. (shrink)

Seventeen television journalistsfrom Indianapolis and Terre Haute, Indiana encountered a computer simulation of newsgathering, based on Potter's Box. The situation involved showing identijable faces in a story about AIDS testing. Additional information was the most accessed resource. Organizational codes of ethics were accessed the least. Journalism organization members sought more advice from all resources than others. More experienced respondents accessed more advicefrom professional peers. Females were less interested in peer advice than their male counterparts.

Volume 19, Issue 10, October 2019, Page 61-63.

Visual aids can improve comprehension of risks associated with medical treatments, screenings, and lifestyles. Do visual aids also help decision makers accurately assess their risk comprehension? That is, do visual aids help them become well calibrated? To address these questions, we investigated the benefits of visual aids displaying numerical information and measured accuracy of self-assessment of diagnostic inferences (i.e., metacognitive judgment calibration) controlling for individual differences in numeracy. Participants included 108 patients who made diagnostic inferences about three medical tests (...) on the basis of information about the sensitivity and false-positive rate of the tests and disease prevalence. Half of the patients received the information in numbers without a visual aid, while the other half received numbers along with a grid representing the numerical information. In the numerical condition, many patients --especially those with low numeracy-- misinterpreted the predictive value of the tests and profoundly overestimated the accuracy of their inferences. Metacognitive judgment calibration mediated the relationship between numeracy and accuracy of diagnostic inferences. In contrast, in the visual aid condition, patients at all levels of numeracy showed high-levels of inferential accuracy and metacognitive judgment calibration. Results indicate that accurate metacognitive assessment may explain the beneficial effects of visual aids and numeracy --a result that accords with theory suggesting that metacognition is an essential part of risk literacy. We conclude that well-designed risk communications can inform patients about health-relevant numerical information while helping them assess the quality of their own risk comprehension. (shrink)

I identify an undertheorized problem with decisions we make with the aid of algorithms: the problem of inauthenticity. When we make decisions with the aid of algorithms, we can make ones that go against our commitments and values in a normatively important way. In this paper, I present a framework for algorithm-aided decision-making that can lead to inauthenticity. I then construct a taxonomy of the features of the decision environment that make such outcomes likely, and I discuss three (...) possible solutions to the problem. (shrink)

In this study, we propose a new approach based on fuzzy TODIM (Portuguese acronym for interactive and multicriteria decision-making) for decision-making problems in uncertain environments. Our method incorporates group utility and individual regret, which are often ignored in traditional multicriteria decision-making (MCDM) methods. To enhance the analysis and application of fuzzy sets in decision-making processes, we introduce novel entropy and distance measures for q-rung picture fuzzy sets. These measures include an entropy measure based on (...) the sine function and a distance measure derived from the Jensen-Shannon divergence. In our methodology, incorporating the sine function into the entropy measure stands out as a distinctive decision, grounded in a profound understanding of the inherent characteristics of fuzzy sets. Utilizing the sine function proves especially advantageous when handling fuzzy sets that exhibit cyclical variations or fluctuations in their membership degrees. We effectively weight the criteria for an improved evaluation by using this new entropy measure. The introduced distance measure finds application in the TODIM approach, allowing the execution of TODIM method steps within a fuzzy environment until the determination of one alternative’s dominance over another—an advancement beyond traditional approaches. We apply our enhanced fuzzy TODIM method to a real-life construction project management problem from the literature and compare the results with those in the literature and obtained from other MCDM methods. Our proposed measures are robust, as demonstrated by the sensitivity analysis that varied the weights of group utility and individual regret, with the results visualized in a 3D sensitivity plot. The findings demonstrate the superiority of our method in providing a more comprehensive evaluation of alternatives, making it a useful tool for decision-makers facing complex and uncertain decision-making problems. (shrink)