Stakeholder consultations and the legitimacy of regulatory decision-making: A survey experiment in Belgium.
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SUBMITTER: Beyers J
PROVIDER: S-EPMC8359407 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectivesOur objective was to elicit clinicians' and parents' perspectives about decision-making related to hospitalization for children with bronchiolitis and the use of shared decision-making (SDM) to guide these decisions.MethodsWe conducted individual, semistructured interviews with purposively sampled clinicians (pediatric emergency medicine physicians and nurses) at 2 children's hospitals and parents of children age <2 years with bronchiolitis evaluated in the emergency department at 1 hospital. Interviews elicited clinicians' and parents' perspectives on decision-making and SDM for bronchiolitis. We conducted an inductive analysis following the principles of grounded theory until data saturation was reached for both groups.ResultsWe interviewed 24 clinicians (17 physicians, 7 nurses) and 20 parents. Clinicians identified factors in 3 domains that contribute to hospitalization decision-making for children with bronchiolitis: demographics, clinical factors, and social-emotional factors. Although many clinicians supported using SDM for hospitalization decisions, most reported using a clinician-guided decision-making process in practice. Clinicians also identified several barriers to SDM, including the unpredictable course of bronchiolitis, perceptions of parents' preferences for engaging in SDM, and parents' emotions, health literacy, preferred language, and comfort with discharge. Parents wanted the opportunity to express their opinions during decision-making about hospitalization, although they often felt comfortable with the clinician's decision when adequately informed.ConclusionsAlthough clinicians and parents of children with bronchiolitis are supportive of SDM, most hospitalization decision-making is clinician guided. Future investigation should evaluate how to address barriers and implement SDM in practice, including training clinicians in this SDM approach.
| S-EPMC9647631 | biostudies-literature
Project description:The Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services(IPBES) strengthens the science-policy interface by producing scientific assessments on biodiversity and ecosystem services to inform policy. IPBES fosters knowledge exchange across disciplines, between researchers and other knowledge holders, practitioners, societal actors and decision makers working at different geographic scales. A number of avenues for participation of stakeholders across the four functions if IPBES exist. Stakeholders come from diverse backgrounds, including Indigenous Peoples and local communities, businesses, and non-governmental organization. They represent multiple sources of information, data, knowledge, and perspectives on biodiversity. Stakeholder engagement in IPBES seeks to 1. communicate, disseminate, and implement the findings of IPBES products; 2. Develop guidelines for biodiversity conservation within member countries; and 3. create linkages between global policy and local actors - all key to the implementation of global agreements on biodiversity. This paper reflects on the role of stakeholders in the first work programme of IPBES (2014-2018). It provides an overview of IPBES processes and products relevant to stakeholders, examines the motivation of stakeholders to engage with IPBES, and explores reflections by the authors (all active participants on the platform) for improved stakeholder engagement and contributions to future work of the platform.
| S-EPMC7484931 | biostudies-literature
Project description:BackgroundVaccine hesitancy is a significant threat to global health. A key part of addressing hesitancy is to ensure that public health messaging prioritises information that is considered important to the public. This study aimed to examine how different vaccine characteristics affect public preferences for vaccines in New Zealand, what trade-offs they are willing to make between different vaccine characteristics, and how their preferences are affected by their vaccine-related conspiracy beliefs and COVID-19 vaccination status.MethodsAn online discrete choice experiment (DCE) was designed to elicit individual preferences about vaccines using the 1000minds platform. Members of the general population of New Zealand aged ≥ 18 years were invited to complete the DCE. Participants were asked to indicate their preference between two options showing different combinations of vaccine characteristics. Data on sociodemographic characteristics were collected. Beliefs were measured using the vaccine conspiracy beliefs scale (VCBS) with scores ≥ 19 indicating strong vaccine-related conspiracy beliefs. The DCE was analysed using the PAPRIKA method (Potentially All Pairwise RanKings of all possible Alternatives) and preferences compared between respondents with high versus low VCBS scores and vaccinated versus unvaccinated respondents for COVID-19.ResultsA total of 611 respondents from 15 regions completed the DCE. Mean (SD) age was 45.9 (14.7) years with most having had 2 or more doses of the coronavirus vaccine (86%). Mean (SD) VCBS score was 18.5 (12.4) indicating moderate vaccine-related conspiracy beliefs. Risk of severe adverse effects was the most highly valued vaccine characteristic, followed by vaccine effectiveness and duration of protection. Vaccine origin and route of administration were ranked least important. Respondents scoring high on the VCBS placed less value on the effectiveness of vaccines but greater value on development time and total number of doses (p < 0.001). COVID-19 unvaccinated respondents ranked development time and total number of doses more highly than those vaccinated respondents (p < 0.001).ConclusionsRisk of severe adverse effects, vaccine effectiveness and duration of protection were rated by the New Zealand public as the top three most important vaccine characteristics. This information is important for informing public health messaging to promote vaccine uptake and inform vaccine decision-making.
| S-EPMC10863187 | biostudies-literature
Project description:ObjectiveTo assess decision-making in multiple sclerosis (MS) from third observer and patient perspectives.MethodAudio recordings of first-ever consultations with a participating physician (88 outpatients, 10 physicians) at four tertiary MS care clinics in Italy, were rated by a third observer using the Observing Patient Involvement in Shared Decision Making (OPTION) and by patients using the Perceived Involvement in Care Scale (PICS).ResultsMean patient age was 37.5, 66% were women, 72% had MS, and 28% had possible MS or other disease. Mean PICS subscale scores (range 0 poor, 100 best possible) were 71.9 (SD 24.3) for "physician facilitation" (PICS-F); 74.6 (SD 22.9) for "patient information exchange" (PICS-I); and only 22.5 (SD 16.2) for "patient decision making" (PICS-DM). Mean OPTION total score (0 poor, 100 best possible) was 29.6 (SD 10.3). Poorest OPTION scores were found for items assessing "preferred patient approach to receiving information" and "preferred patient level of involvement." Highest scores were for "clinician drawing attention to identified problem", "indicating need for decision making," and "need to review the decision." Consultation time, woman physician, patient-physician gender concordance and PICS-F were associated with higher OPTION total score; older physician and second opinion consultation were associated with lower OPTION score.ConclusionsIn line with findings in other settings, our third observer findings indicated limited patient involvement abilities of MS physicians during first consultations. Patient perceptions of physician skills were better than third observers', although they correlated. Consultations with women physicians, and younger physicians, were associated with higher third observer and patient-based scores. Our findings reveal a need to empower Italian MS physicians with better communication and shared decision-making skills, and show in particular that attention to MS patient preferences for reception of information and involvement in health decisions, need to be improved.
| S-EPMC3614559 | biostudies-literature
Project description:Despite decades of declining crime rates, longstanding tensions between police and the public continue to frustrate the formation of cooperative relationships necessary for the function of the police and the provision of public safety. In response, policy makers continue to promote community-oriented policing (COP) and its emphasis on positive, nonenforcement contact with the public as an effective strategy for enhancing public trust and police legitimacy. Prior research designs, however, have not leveraged the random assignment of police-public contact to identify the causal effect of such interactions on individual-level attitudes toward the police. Therefore, the question remains: Do positive, nonenforcement interactions with uniformed patrol officers actually cause meaningful improvements in attitudes toward the police? Here, we report on a randomized field experiment conducted in New Haven, CT, that sheds light on this question and identifies the individual-level consequences of positive, nonenforcement contact between police and the public. Findings indicate that a single instance of positive contact with a uniformed police officer can substantially improve public attitudes toward police, including legitimacy and willingness to cooperate. These effects persisted for up to 21 d and were not limited to individuals inclined to trust and cooperate with the police prior to the intervention. This study demonstrates that positive nonenforcement contact can improve public attitudes toward police and suggests that police departments would benefit from an increased focus on strategies that promote positive police-public interactions.
| S-EPMC6778229 | biostudies-literature
Project description:IntroductionShared decision making (SDM) is a goal of modern medicine; however, it is not currently embedded in routine care. Barriers include clinicians’ attitudes, lack of knowledge and training and time constraints. Our goal is to support the development and delivery of a robust SDM curriculum in medical education. Our objective is to assess undergraduate medical students’ knowledge of and attitudes towards SDM in four countries.Methods and analysisThe first phase of the study involves a web-based cross-sectional survey of undergraduate medical students from all years in selected schools across the United States (US), Canada and undergraduate and graduate students in the Netherlands. In the United Kingdom (UK), the survey will be circulated to all medical schools through the UK Medical School Council. We will sample students equally in all years of training and assess attitudes towards SDM, knowledge of SDM and participation in related training. Medical students of ages 18 years and older in the four countries will be eligible. The second phase of the study will involve semistructured interviews with a subset of students from phase 1 and a convenience sample of medical school curriculum experts or stakeholders. Data will be analysed using multivariable analysis in phase 1 and thematic content analysis in phase 2. Method, data source and investigator triangulation will be performed. Online survey data will be reported according to the Checklist for Reporting the Results of Internet E-Surveys. We will use the COnsolidated criteria for REporting Qualitative research for all qualitative data.Ethics and disseminationThe study has been approved for dissemination in the US, the Netherlands, Canada and the UK. The study is voluntary with an informed consent process. The results will be published in a peer-reviewed journal and will help inform the inclusion of SDM-specific curriculum in medical education worldwide.
| S-EPMC5541622 | biostudies-literature
Project description:BACKGROUND: Few researchers have examined the perceptions of physicians referring cases for angiography regarding the degree to which collaboration occurs during percutaneous coronary intervention (PCI) decision-making. We sought to determine perceptions of physicians concerning their involvement in PCI decisions in cases they had referred to the cardiac catheterization laboratory at a major academic medical center. METHODS: An anonymous survey was mailed to internal medicine faculty members at a major academic medical center. The survey elicited whether responders perceived that they were included in decision-making regarding PCI, and whether they considered such collaboration to be the best process of decision-making. RESULTS: Of the 378 surveys mailed, 35% (133) were returned. Among responding non-cardiologists, 89% indicated that in most cases, PCI decisions were made solely by the interventionalist at the time of the angiogram. Among cardiologists, 92% indicated that they discussed the findings with the interventionalist prior to any PCI decisions. When asked what they considered the best process by which PCI decisions are made, 66% of non-cardiologists answered that they would prefer collaboration between either themselves or a non-interventional cardiologist and the interventionalist. Among cardiologists, 95% agreed that a collaborative approach is best. CONCLUSION: Both non-cardiologists and cardiologists felt that involving another decision-maker, either the referring physician or a non-interventional cardiologist, would be the best way to make PCI decisions. Among cardiologists, there was more concordance between what they believed was the best process for making decisions regarding PCI and what they perceived to be the actual process.
| S-EPMC2443120 | biostudies-literature
Project description:Climate change, population growth, and declining federal budgets are threatening the health of ecosystems, and the services they provide. Under these changing conditions, managing landscapes and resources assumes new and unprecedented challenges. Adaptive management has been identified as a natural resource management approach that allows practitioners to incorporate change and uncertainty into decision-making through an iterative process that involves long-term monitoring and continued review and adjustment of management actions. However, the success of these efforts in watershed health relies on the collective and sustained monitoring of indicators, which is seldom studied. The purpose of this analysis is to examine (1) the practical challenge of choosing a list of indicators for long-term monitoring, (2) the negotiation process among stakeholders around the selection and interpretation of indicators, and (3) the communication tools that can be used to convey the assessment's results and findings. To do this, we analyze our ongoing work in the Cienega Watershed in southern Arizona. Our analysis shows that the selective use of indicators, regular assessment and review, and establishment of partnerships among stakeholders are all important elements in establishing effective adaptive management efforts. The selection of indicators and data sources is a moving target that requires regular consensus and review among stakeholders. The assessment itself is also a powerful engagement tool with the public at large, providing legitimacy and support to land management decision-making. Here, we outline some lessons learned that can be transferred to other cases and identify potential barriers for engagement, decision-making, and project success.
| S-EPMC8821513 | biostudies-literature
Project description:The increasing prevalence and burden of nonalcoholic steatohepatitis (NASH) has spurred the development of new treatments and a need to consider outcomes used for NASH treatment decision making. Development of a NASH core outcome set (COS) can help prioritize outcomes of highest importance by incorporating the perspectives from a variety of decision makers. coreNASH was an initiative to develop a COS for NASH using a modified Delphi consensus process with a multi-stakeholder voting panel. A candidate outcome list was created based on a literature review and key informant interviews. The candidate outcome list was then condensed and prioritized through three rounds of online voting and through discussion at an in-person meeting. Outcomes were retained or eliminated based on predetermined consensus criteria, which included special weighting of patients' opinions in the first two voting rounds. The coreNASH Delphi panel included 53 participants (7 patients, 10 clinicians and researchers, 7 health technology assessors, 22 industry representatives, 2 regulators, and 5 payers) who considered outcomes for two NASH-related COS: one for NASH without cirrhosis (F2-F3) and one for NASH with cirrhosis (F4). The initial candidate outcome list for both disease stages included 86 outcomes. The panel agreed on including two core outcomes for NASH without cirrhosis and nine core outcomes for NASH with cirrhosis in the COS. Conclusion: A consensus-based COS has been developed that can be used across the life cycle of NASH treatments. Outcomes included can contribute to decision making for regulatory, market access, and on-market decision making. Including the coreNASH COS in clinical development programs will facilitate improved comparisons and help decision makers assess the value of new products.
| S-EPMC8122373 | biostudies-literature
Project description:The current study, using a multi-factorial survey experiment with a sample of the general public (N = 800), investigates if and how types of risk information on crime and public safety, such as maps, graphs, or tables, commonly used and communicated by law enforcement elicit dual-process (affective and cognitive) risk information processing in risk-based decision-making, and if such processing or decision-making differs depending on the risk level, context, or the type or format of risk information communicated. Participants responded to a vignette in which they were asked to choose a ride-share pick-up point within a certain geographic area with varying risk levels of being involved in a pedestrian-automobile crash. Results showed that risk information related to crime and public safety elicits dual-process risk information processing, and that both affective and cognitive processing significantly predicted risk-based decision-making, regardless of the risk level or type of risk information examined. Interestingly, risk information was used to create an almost “black and white” distinction for participants, in which their lowest-risk choice was treated as their comparison point, relative to all other higher levels of risk, in risk processing and decision-making. Further, the risk level or type of risk information examined did affect the nature and level of affective and cognitive processing elicited, suggesting that different types or characteristics of risk information can change modes of processing and their effects on risk-based decisions. Our findings provide first-of-its-kind data that show members of the general public, as consumers of risk information in relation to crime and public safety, process and make decisions surrounding such information using the dual-process approach. Implications for communicating risk information in relation to crime and public safety to both the general public and police, as well as how to extend the current inquiry to future areas of research on police, are discussed.
| S-EPMC7500154 | biostudies-literature