Browsing by Subject "DECISION"

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  • Malde, S.; Umbach, R.; Wheeler, J.R.; Lytvyn, L.; Cornu, J.-N.; Gacci, M.; Gratzke, C.; Herrmann, T.R.W.; Mamoulakis, C.; Rieken, M.; Speakman, M.J.; Gravas, S.; Drake, M.J.; Guyatt, G.H.; Tikkinen, K.A.O. (2021)
    Context: Understanding men's values and preferences in the context of personal, physical, emotional, relational, and social factors is important in optimising patient counselling, facilitating treatment decision-making, and improving guideline recommendations. Objective: To systematically review the available evidence regarding the values, preferences, and expectations of men towards the investigation and treatment (conservative, pharmacological, and surgical) of male lower urinary tract symptoms (LUTS). Evidence acquisition: We searched electronic databases until August 31, 2020 for quantitative and qualitative studies that reported values and preferences regarding the investigation and treatment of LUTS in men. We assessed the quality of evidence and risk of bias using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) and GRADE Confidence in the Evidence from Reviews of Qualitative Research (CERQual) approaches. Evidence synthesis: We included 25 quantitative studies, three qualitative studies, and one mixed-methods study recruiting 9235 patients. Most men reported urodynamic testing to be acceptable, despite discomfort or embarrassment, as it significantly informs treatment decisions (low certainty evidence). Men preferred conservative and less risky treatment options, but the preference varied depending on baseline symptom severity and the risk/benefit characteristics of the treatment (moderate certainty). Men preferred pharmacological treatments with a low risk of erectile dysfunction and those especially improving urgency incontinence (moderate certainty). Other important preference considerations included reducing the risk of acute urinary retention or surgery (moderate certainty). Conclusions: Men prefer lower-risk management options that have fewer sexual side effects and are primarily effective at improving urgency incontinence and nocturia. Overall, the evidence was rated to be of low to moderate certainty. This review can facilitate the treatment decision-making process and improve the trustworthiness of guideline recommendations. Patient summary: We thoroughly reviewed the evidence addressing men's values and preferences regarding the management of urinary symptoms and found that minimising adverse effects is particularly important. Further research to understand other factors that matter to men is required. (C) 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.
  • Chen, An; Tenhunen, Henni; Torkki, Paulus; Heinonen, Seppo; Lillrank, Paul; Stefanovic, Vedran (2017)
    Introduction Nowadays, an important decision for pregnant women is whether to undergo prenatal testing for aneuploidies and which tests to uptake. We investigate the factors influencing women's choices between non-invasive prenatal testing (NIPT) and invasive prenatal tests in pregnancies with elevated a priori risk of fetal aneuploidies. Methodology This is a mixed-method study. We used medical data (1st Jan 2015-31st Dec 2015) about women participating in further testing at Fetomaternal Medical Center at Helsinki University Hospital and employed Chi-square tests and ANOVA to compare the groups of women choosing different methods. Multinomial logistic regressions revealed the significant clinical factors influencing women's choice. We explored the underlying values, beliefs, attitudes and other psychosocial factors that affect women's choice by interviewing women with the Theory of Planned Behavior framework. The semi-structured interview data were processed by thematic analysis. Results Statistical data indicated that gestational age and counseling day were strong factors influencing women's choice. Interview data revealed that women's values and moral principles on pregnancy and childbirth chiefly determined the choices. Behavioral beliefs (e.g. safety and accuracy) and perceived choice control (e.g. easiness, rapidness and convenience) were also important and the major trade-offs happened between these constructs. Discussion Values are the determinants of women's choice. Service availability and convenience are strong factors. Medical risk status in this choice context is not highly influential. Choice aids can be developed by helping women to identify their leading values in prenatal testing and by providing lists of value-matching test options and attributes.
  • Favereau, Judith; Nagatsu, Michiru (2020)
    In this paper, we critically and constructively examine the methodology of evidence-based development economics, which deploys randomized field experiments (RFEs) as its main tool. We describe the context in which this movement started, and illustrate in detail how RFEs are designed and implemented in practice, drawing on a series of experiments by Pascaline Dupas and her colleagues on the use of bednets, saving and governance in Kenya. We show that this line of experiments have evolved to address the limitation of obtaining policy-relevant insights from RFEs alone, characterized as their lack of external validity in the literature. After examining the two prominent responses by leading figures of evidence-based development economics, namely machine learning and structured speculation, we propose an alternative methodological strategy that incorporates two sub-fields, namely experimental economics and behavioral economics, to complement RFEs in investigating the data-generating process underlying the treatment effects of RFEs. This strategy highlights promising methodological developments in RFEs neither captured by the two proposals nor recognized by methodologists, and also guides how to combine different sub-fields of economics.
  • Niska, Miira; Nikander, Pirjo (2021)
    Population ageing presents major challenges to the welfare system across the European Union. Consequently, emphasizing delayed retirement age and extended working lives abound in political discussions. Researchers have recognized numerous problems, which make the extended working life a challenging political task. One of these problems are citizens' negative attitudes toward delayed retirement and extended working life. In this paper, we approach this "attitude problem" from the perspective of discursive social psychology and analyze the variation in the way aspirations to extend working lives are evaluated by older workers. The data analyzed in the study consists of interviews where participants between 50 and 65 years of age comment on the political goal to extend working lives. The article sheds light on the "attitude problem" by turning the attention from underlying individual preferences to discursive resources used to undermine the political goal and the situational functions these evaluative practices have.
  • Annila, Arto (2022)
    Decision-making is described as a natural process, one among others, consuming free energy in the least time. The thermodynamic tenet explains why data associated with decisions display the same patterns as any other data: skewed distributions, sigmoidal cumulative curves, oscillations, and even chaos. Moreover, it is shown that decision-making is intrinsically an intractable process because everything depends on everything else. However, no decision is arbitrary but bounded by free energy, such as resources and propellants, and restricted by mechanisms like molecular, neural, and social networks. The least-time maximation of entropy, equivalent to the minimization of free energy, parallels the optimization of subjective expected utility. As the system attains a state of balance, all driving forces vanish. Then there is no need or use to make further decisions. In general, the thermodynamic theory regards those decisions well-motivated that take into account forces, i.e., causes comprehensively in projecting motions, i.e., consequences.