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Aim: To develop and psychometrically test the triage decision‐making instrument, a tool to measure Emergency Department Registered Nurses decision‐making. Design: Five phases: (1) defining the concept, (2) item generation, (3) face validity, (4) content validity and (5) pilot testing. Methods: Concept definition informed by a grounded theory study from which four domains emerged. Items relevant to the four domains were generated and revised. Face validity was established using three focus groups. The target population upon which the reliability and validity of the triage decision‐making instrument was explored were triage registered nurses in emergency departments. Three expert judges assessed 89 items for content and domain designation using a 4‐point scale. Psychometric properties were assessed by exploratory factor analysis, following which the names of the four domains were modified. Results: The triage decision‐making instrument is a 22‐item tool with four factors: clinical judgement, managing acuity, professional collaboration and creating space. Focus group data indicated support for the domains. Expert review resulted in 46 items with 100% agreement and 13 with 66% agreement. Fifty‐nine items were distributed to a convenience sample of 204 triage nurses from six hospitals in 2019. The Kaiser–Meyer–Olkin measures indicated that the data were sufficient for exploratory factor analysis. Bartlett's test indicated patterned relationships among the items (X2 (231) = 1156.69). An eigenvalue of >1.0 was used and four factors explained 48.64% of the variance. All factor loadings were ≥0.40. Internal consistency was demonstrated by Cronbach's alphas of.596 factor 1,.690 factor 2,.749 factor 3 and.822 for factor 4. Conclusion: The triage decision‐making instrument meets the criteria for face validity, content validity and internal consistency. It is suitable for further testing and refinement. Impact: The instrument is a first step in quantifying triage decision‐making in real‐world clinical environments. The triage decision‐making instrument can be used for targeted triage interventions aimed at improving throughput and staff education. Statistical Support: Dr. Tak Fung who is a member of the research team is a statistician. Statistical Methods: Development, validation and assessment of instruments/scales. Descriptive statistics. Reporting Method: STROBE cross‐sectional checklist. Implications for the Profession and/or Patient Care: The TDI makes the complexity of triage decision‐making visible. Identifying the influence of decision‐making factors in addition to acuity that affect triage decisions will enable nurse managers and educators to develop targeted interventions and staff development initiatives. By extension, this will enhance patient care and safety. [ABSTRACT FROM AUTHOR]

Introduction: Total joint arthroplasty (TJA) for osteoarthritis is one of several treatment options with benefits and harms that patients value differently. However, the process for determining TJA appropriateness does not sufficiently acknowledge patient perspectives. The aim of this paper is to propose an evidence‐informed patient‐centred conceptual model for elective TJA appropriateness for hip and knee osteoarthritis. Methods: Our interprofessional team developed a conceptual model for determining the appropriateness of adults considering elective TJA. The model was informed by a review of the evidence, a qualitative study we conducted with adults who underwent TJA for osteoarthritis to determine barriers and facilitators to the use of appropriateness criteria, and the research and clinical experience of team members. Results: Appropriateness is providing health services (e.g., TJA) with net benefits to the right patient at the right time. The proposed Patient‐centred Elective TJA Appropriateness Conceptual Model involves three key steps. First, assess adults with osteoarthritis to determine eligibility for TJA. Second, acknowledge the patient's informed preferences including their expectations and goals. Third, explore and support their mental and physical readiness for TJA. Given that osteoarthritis is a chronic condition, these steps can be revisited over time with patients. Discussion and Conclusion: Our proposed conceptual model reconceptualises the appropriateness of TJA to be more patient‐centred. Hence, this approach has the potential to be a more inclusive approach and ensure patients undergoing TJA are eligible, ready to proceed, and achieve what matters most to them. Future research is needed to test and validate the model. [ABSTRACT FROM AUTHOR]

Physicians, patients, and families alike perceive a need to improve how goals of care (GOC) decisions occur in chronic critical illness (CCI), but little is currently known about this decision-making process. How do intensivists from various health systems facilitate decision-making about GOC for patients with CCI? What are barriers to, and facilitators of, this decision-making process? We conducted semistructured interviews with a purposeful sample of intensivists from the United States and Canada using a mental models approach adapted from decision science. We analyzed transcripts inductively using qualitative description. We interviewed 29 intensivists from six institutions. Participants across all sites described GOC decision-making in CCI as a complex, longitudinal, and iterative process that involved substantial preparatory work, numerous stakeholders, and multiple family meetings. Intensivists required considerable time to collect information on prior events and conversations, and to arrive at a prognostic consensus with other involved physicians prior to meeting with families. Many intensivists stressed the importance of scheduling multiple family meetings to build trust and relationships prior to explicitly discussing GOC. Physician-identified barriers to GOC decision-making included 1-week staffing models, limited time and cognitive bandwidth, difficulty eliciting patient values, and interpersonal challenges with care team members or families. Potential facilitators included scheduled family meetings at regular intervals, greater interprofessional involvement in decisions, and consistent messaging from care team members. Intensivists described a complex time- and labor-intensive group process to achieve GOC decision-making in CCI. System-level interventions that improve how information is shared between physicians and decrease logistical and relational barriers to timely and consistent communication are key to improving GOC decision-making in CCI. [ABSTRACT FROM AUTHOR]

Background: Different guideline panels, and individuals, may make different decisions based in part on their preferences. Preferences for or against an intervention are viewed as a consequence of the relative importance people place on the expected or experienced health outcomes it incurs. These findings can then be considered as patient input when balancing effect estimates on benefits and harms reported by empirical evidence on the clinical effectiveness of screening programs. This systematic review update examined the relative importance placed by patients on the potential benefits and harms of mammography-based breast cancer screening to inform an update to the 2018 Canadian Task Force on Preventive Health Care's guideline on screening. Methods: We screened all articles from our previous review (search December 2017) and updated our searches to June 19, 2023 in MEDLINE, PsycINFO, and CINAHL. We also screened grey literature, submissions by stakeholders, and reference lists. The target population was cisgender women and other adults assigned female at birth (including transgender men and nonbinary persons) aged ≥ 35 years and at average or moderately increased risk for breast cancer. Studies of patients with breast cancer were eligible for health-state utility data for relevant outcomes. We sought three types of data, directly through (i) disutilities of screening and curative treatment health states (measuring the impact of the outcome on one's health-related quality of life; utilities measured on a scale of 0 [death] to 1 [perfect health]), and (ii) other preference-based data, such as outcome trade-offs, and indirectly through (iii) the relative importance of benefits versus harms inferred from attitudes, intentions, and behaviors towards screening among patients provided with estimates of the magnitudes of benefit(s) and harms(s). For screening, we used machine learning as one of the reviewers after at least 50% of studies had been reviewed in duplicate by humans; full-text selection used independent review by two humans. Data extraction and risk of bias assessments used a single reviewer with verification. Our main analysis for utilities used data from utility-based health-related quality of life tools (e.g., EQ-5D) in patients; a disutility value of about 0.04 can be considered a minimally important value for the Canadian public. When suitable, we pooled utilities and explored heterogeneity. Disutilities were calculated for screening health states and between different treatment states. Non-utility data were grouped into categories, based on outcomes compared (e.g. for trade-off data), participant age, and our judgements of the net benefit of screening portrayed by the studies. Thereafter, we compared and contrasted findings while considering sample sizes, risk of bias, subgroup findings and data on knowledge scores, and created summary statements for each data set. Certainty assessments followed GRADE guidance for patient preferences and used consensus among at least two reviewers. Findings: Eighty-two studies (38 on utilities) were included. The estimated disutilities were 0.07 for a positive screening result (moderate certainty), 0.03–0.04 for a false positive (FP; "additional testing" resolved as negative for cancer) (low certainty), and 0.08 for untreated screen-detected cancer (moderate certainty) or (low certainty) an interval cancer. At ≤12 months, disutilities of mastectomy (vs. breast-conserving therapy), chemotherapy (vs. none) (low certainty), and radiation therapy (vs. none) (moderate certainty) were 0.02–0.03, 0.02–0.04, and little-to-none, respectively, though in each case findings were somewhat limited in their applicability. Over the longer term, there was moderate certainty for little-to-no disutility from mastectomy versus breast-conserving surgery/lumpectomy with radiation and from radiation. There was moderate certainty that a majority (>50%) and possibly a large majority (>75%) of women probably accept up to six cases of overdiagnosis to prevent one breast-cancer death; there was some uncertainty because of an indication that overdiagnosis was not fully understood by participants in some cases. Low certainty evidence suggested that a large majority may accept that screening may reduce breast-cancer but not all-cause mortality, at least when presented with relatively high rates of breast-cancer mortality reductions (n = 2; 2 and 5 fewer per 1000 screened), and at least a majority accept that to prevent one breast-cancer death at least a few hundred patients will receive a FP result and 10–15 will have a FP resolved through biopsy. An upper limit for an acceptable number of FPs was not evaluated. When using data from studies assessing attitudes, intentions, and screening behaviors, across all age groups but most evident for women in their 40s, preferences reduced as the net benefit presented by study authors decreased in magnitude. In a relatively low net-benefit scenario, a majority of patients in their 40s may not weigh the benefits as greater than the harms from screening whereas for women in their 50s a large majority may prefer screening (low certainty evidence for both ages). There was moderate certainty that a large majority of women 50 years of age and 50 to 69 years of age, who have usually experienced screening, weigh the benefits as greater than the harms from screening in a high net-benefit scenario. A large majority of patients aged 70–71 years who have recently screened probably think the benefits outweigh the harms of continuing to screen. A majority of women in their mid-70s to early 80s may prefer to continue screening. Conclusions: Evidence across a range of data sources on how informed patients value the potential outcomes from breast-cancer screening will be useful during decision-making for recommendations. The evidence suggests that all of the outcomes examined have importance to women of any age, that there is at least some and possibly substantial (among those in their 40s) variability across and within age groups about the acceptable magnitude of effects across outcomes, and that provision of easily understandable information on the likelihood of the outcomes may be necessary to enable informed decision making. Although studies came from a wide range of countries, there were limited data from Canada and about whether findings applied well across an ethnographically and socioeconomically diverse population. Systematic review registration: Protocol available at Open Science Framework https://osf.io/xngsu/. [ABSTRACT FROM AUTHOR]

Background: International retirement migration, which is the seasonal or permanent relocation of older people to another country, has grown in popularity in recent years. These retirees are motivated by the promise of warmer winter climates that are conducive to participating in health-promoting recreational and social activities. Ease of cross-border travel facilitates this transnational practice when undertaken seasonally. However, border closures and other travel-related measures put in place to manage the spread of COVID-19, disrupted travel, including for older Canadians who typically winter in the United States (US). During the 2020-21 winter season, for example, Canadians were advised not to engage in non-essential international travel and the land border between Canada and the US was closed to all but essential travellers. Nonetheless, retirement migration remained a significant draw for many Canadian retirees. Here, we qualitatively explore the factors that Canadian international retirement migrants considered when deciding whether or not to travel to the US for the 2020-21 winter during the COVID-19 pandemic. Methods: Guided by case study methodology, semi-structured interviews were conducted with 31 Canadian international retirement migrants who had wintered in the US prior to the COVID-19 pandemic and were in the US at the outset of the pandemic in late winter 2020. Interviews were transcribed verbatim and thematically analyzed to decipher what factors were most important to their travel-related decision-making during the pandemic. We structure the thematic results around four factors previously identified to motivate older people to become international retirement migrants and thus inform decision-making: the destination, the people, the cost, and the movement. Results: The previously identified factors that motivate older people to participate in international retirement migration include: the destination (e.g., climate and amenities), the people (e.g., social networks), the cost (e.g., health insurance and living costs), and the movement (e.g., ease of travel). These factors informed how international retirement migrants made decisions to travel abroad or not in the 2020-21 winter season. For example, destination-based factors included a lack of public health measures and high case counts, people-based factors comprised of less opportunities to engage in social activities, cost-based factors involved maintaining property investments and the lack of COVID-19 treatment coverage in available travel health insurance plans, and movement-based factors included challenges in ease of access when travel was viewed as essential or non-essential. These factors disincentivized or motivated international retirement migrants to travel abroad in the 2020-21 winter season during the COVID-19 pandemic. Conclusions: The results of this study support the need to create tailored decision-support tools for international retirement migrants to make informed travel-related decisions during crisis events so as to protect their health and wellbeing. More research is needed to explore perceptions of risk, especially health risks, among international retirement migrants and how they differently affect their travel-related decisions. [ABSTRACT FROM AUTHOR]

Paroling authorities should have a clear understanding of the empirical support for factors considered in suitability determinations. We presented a survey to paroling authorities across the United States and Canada to examine their purview and information considered in decision-making. We situated the findings among existing empirical research suggesting best practices for consideration of specific factors in parole decision-making. Paroling authorities claim to give equal consideration to all information available, regardless of its empirical relation to suitability for release. Probed further, they display a good understanding of the empirical support for and the weight to be applied to each factor. [ABSTRACT FROM AUTHOR]

The coronavirus 2019 (COVID-19) pandemic allowed for exceptional decision-making power to be placed in the hands of public health departments. Data and information were widely disseminated in the media and on websites. While the improvement of pandemic management is still a learning curve, the ecosystem perspective – that is, the interconnection of academic health research systems and decision-making spaces – has received little attention. In this commentary, we look at the mechanisms in place, or not, in Canada for ensuring decision-making spheres can "speak" to academic research systems. We look at the thick walls that are still in place between health research systems and decision-making spaces. More precisely, we discuss three organizational flaws that we identified in the evidence-informed decision-making ecosystem of Québec and, more broadly, Canada. We introduce some inspiring measures that other countries have implemented to better link evidence and public health decision-making during health crises. The observed flaws and options are related to the vitality of early information sharing relays, the cross-sectional capacity to issue opinions, and the collection and integration of hard and soft data. [ABSTRACT FROM AUTHOR]

Background: Responses to COVID-19 in Canadian postsecondary education have overhauled usual norms and practices, with policies of unclear rationale implemented under the pressure of a reported public health emergency. Objective: To critically appraise the decision-making process informing COVID-19 policy in the postsecondary education sector. Methods: Our scoping review will draw from macro and micro theories of public policy, specifically the critical tradition exemplified by Carol Bacchi’s approach “What is the problem represented to be” and will be guided by Arksey and O’Malley’s framework for scoping reviews and the team-based approach of Levan and colleagues. Data will include diverse and publicly available documents to capture multiple stakeholders’ perspectives on the phenomenon of interest and will be retrieved from university newsletters and legal websites using combinations of search terms adapted to specific data types. Two reviewers will independently screen, chart, analyze and synthesize the data. Disagreements will be resolved through full team discussion. Discussion: Despite the unprecedented nature of the mass medical mandates implemented in the postsecondary sector and their dramatic impact on millions of lives-students, faculty, staff and their families, friends and communities-the decision-making process leading to them has not been documented or appraised. By identifying, summarizing and appraising the evidence, our review should inform practices that can contribute to effective and equitable public health policies in postsecondary institutions moving forward. [ABSTRACT FROM AUTHOR]

Rational: The Hawker appropriateness criteria for total knee arthroplasty (TKA) are: osteoarthritis symptoms impacting quality of life, evidence of osteoarthritis, trial of conservative treatments, patient's realistic expectations, patient/surgeon agree benefits outweigh risks, and readiness for surgery. Little is known about the barriers and facilitators of using the Hawker et al. appropriateness criteria for TKA in clinical practice. Aims and Objectives: Explore the barriers and facilitators to using appropriateness criteria for TKA in making decisions for adults with knee osteoarthritis. Methods: Interpretive descriptive qualitative study at an academic hospital. Purposive sampling aimed to recruit: (1) healthcare team members at all levels influencing care delivery, and (2) adults with TKA assessed at the hospital clinic. Semi‐structured interviews asked about the barriers/facilitators to using the Hawker appropriateness criteria. Data analysis consisted of inductive thematic analysis with themes mapped to the Consolidated Framework for Implementation Research domains. Results: Nine healthcare professionals and 14 adults with TKA participated and identified common barriers to using the Hawker appropriateness criteria: (a) intervention characteristics domain: difficulty to assess criteria, patients expecting healthcare professionals to decide, limited accessibility to conservative treatments; (b) individuals characteristics domain: no need to change current TKA process, clinical judgement limited to OA severity/age, implicit assessment of subjective criteria; (c) inner setting domain: TKA information received after decision made; and (d) outer setting domain: no timely access to TKA. A facilitator of use was evidence/buy‐in fosters programme changes. Conclusion: Barriers to using the criteria relevant to clinical practice and the healthcare system were identified while only one facilitator was revealed. Interventions tailored to these barriers are needed to support the use of the Hawker appropriateness criteria in TKA decision‐making. [ABSTRACT FROM AUTHOR]

To support primary care physicians (PCPs) and their patients with knee osteoarthritis (OA), we created a series of evidence-based whiteboard educational videos for patients with knee OA. In a previous study we piloted these videos with patients to understand their acceptability and impact. The purpose of this study was to explore PCPs' perspectives to understand the utility of novel patient education videos to support management. We conducted a qualitative descriptive study using semi-structured interviews of newly practicing and resident PCPs after watching a series of patient education videos. A thematic analysis approach was used combining both inductive and research question driven coding, category formation, and theme identification. Ten participants were included. Barriers to optimal management were identified including the challenge of patient adherence and access to non-operative treatments. PCPs indicated that the videos would support their management of patients with knee OA by (1) supporting credibility and building trust with their patient, (2) reinforcing patient understanding, and (3) enhancing their own management of patients. Future implementation of these resources with attention to barriers that may limit uptake is necessary and may optimize management of knee OA in primary care. The provision of patient educational materials may support patient buy-in regarding appropriate management, enhance patient understanding, and improve physicians' future practice. Viewing these videos could potentially improve physicians' future resource use, recommendation of non-operative treatments, and the quality of their total knee replacement referrals, which has benefits to both the patient and the healthcare system. Perceived barriers to implementing evidence-based recommendations may pose a challenge for patients and clinicians and should be considered to help facilitate the uptake of educational interventions. [ABSTRACT FROM AUTHOR]

Background the mySupport advance care planning intervention was originally developed and evaluated in Northern Ireland (UK). Family caregivers of nursing home residents with dementia received an educational booklet and a family care conference with a trained facilitator to discuss their relative's future care. Objectives to investigate whether upscaling the intervention adapted to local context and complemented by a question prompt list impacts family caregivers' uncertainty in decision-making and their satisfaction with care across six countries. Second, to investigate whether mySupport affects residents' hospitalisations and documented advance decisions. Design a pretest–posttest design. Setting in Canada, the Czech Republic, Ireland, Italy, the Netherlands and the UK, two nursing homes participated. Participants in total, 88 family caregivers completed baseline, intervention and follow-up assessments. Methods family caregivers' scores on the Decisional Conflict Scale and Family Perceptions of Care Scale before and after the intervention were compared with linear mixed models. The number of documented advance decisions and residents' hospitalisations was obtained via chart review or reported by nursing home staff and compared between baseline and follow-up with McNemar tests. Results family caregivers reported less decision-making uncertainty (−9.6, 95% confidence interval: −13.3, −6.0, P  < 0.001) and more positive perceptions of care (+11.4, 95% confidence interval: 7.8, 15.0; P  < 0.001) after the intervention. The number of advance decisions to refuse treatment was significantly higher after the intervention (21 vs 16); the number of other advance decisions or hospitalisations was unchanged. Conclusions the mySupport intervention may be impactful in countries beyond the original setting. [ABSTRACT FROM AUTHOR]

The decision to substantiate a report of child maltreatment represents a key decision point in the child welfare service decision-making continuum. This decision has various potential implications for children and their families, which may include more intensive child welfare involvement or the cessation of services. The substantiation decision is determined by whether there is enough evidence to suggest that maltreatment or the risk of maltreatment has occurred. To date, there has been minimal exploration of whether child welfare worker characteristics might influence this critical decision point. The Decision-Making Ecology would suggest that indeed, worker characteristics play a role in how they carry out their role. Given the importance of this decision point, this study uses secondary data to examine whether worker characteristics, such as education level and type, ethnoracial identity, caseload, and experience, predict substantiation in the Canadian child welfare context. Furthermore, this study utilizes multilevel modeling, a theoretically important and unique method of analyzing organizational data that considers differences in decisions among child welfare workers. The final model included 4,327 children and 567 workers from across Canada. Several case level factors (e.g., child age and functioning, caregiver risk factors) predicted the substantiation decision. Furthermore, and most importantly for this study, worker characteristics significantly predicted their substantiation decision. Workers with fewer years of experience, those in an Ongoing Services role, and with a lower caseload substantiated significantly more often than those with more work experience, in another role, and with higher caseloads. Lastly, caseload and years of experience, and training and caseload both interacted to predict the substantiation decision. Implications for policy and practice and future research areas are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Treatment decisions in older adults with acute myeloid leukemia (AML) are challenging, particularly for those who are not candidates for intensive chemotherapy (IC), and the trade-offs patients, their families and physicians consider when choosing a treatment option are not well understood. This qualitative research explored the value of extending survival and the treatment decision-making process from a multi-stakeholder perspective. Methods: Overall, 28 patients with AML (≥ 65 years old, unsuitable for IC), 25 of their relatives and 10 independent physicians from the US, UK and Canada took part in one-on-one, 60-minute qualitative interviews. Results: Across all stakeholders, improved health-related quality of life (HRQoL), extended survival and relief of AML symptoms were recognized as most important in AML treatment decision-making. However, extending survival in 'good health' was more important than extending survival alone, particularly because of the extra time it gives patients and their relatives together, and allows patients to achieve important goals. Patients' limited understanding of available treatment options, paired with incorrect perceptions of treatment side effects, impacted their involvement in the treatment decision-making process. Patients and physicians perceived physicians to have the most influence in the decision-making process despite their priorities not always aligning. Conclusion: These findings illustrate the importance of having structured discussions which explicitly assess patients' goals and their understanding and expectations of treatments and also the need for patient friendly resources about the lived experience of AML and available treatment options. These measures will help to ensure that patients are fully involved in the shared decision-making process. [ABSTRACT FROM AUTHOR]

Background: Involvement of young partners by experience in research is on the rise and becoming expected practice. However, literature on how to promote equitable and meaningful involvement of young people is scarce. The purpose of this paper is to describe and reflect on different approaches between researchers and young partners by experience based on six research projects conducted in Canada, Netherlands, and United Kingdom. Methods: From six exemplar research projects, at least one researcher and one young partner by experience were asked to collaboratively (1) describe the project; (2) summarise the values and practicalities of the project; and (3) reflect on their partnership. Thematic analysis was applied to the findings from these reflective exercises, which included meeting summaries, recordings, and notes. Results: All projects shared similar values, including mutual respect between all team members. Young partners were offered a variety of opportunities and approaches to being involved, for example in recruiting participants, co-analysing or (co-)presenting results. Supports were provided to the teams in a variety of ways, including organizing accessible meetings and having dedicated facilitators. Regular and proactive communication was encouraged by using asynchronous modes of communication, establishing reference documents, and a personal approach by facilitators. Facilitators aimed to tailor the needs of all team members by continuously discussing their preferred roles in the project. While most projects did not offer formal research training, various learning and skill development opportunities were provided throughout, including presenting skills or advocacy training. Conclusion: With this paper, we demonstrated the value of reflection, and we invite others to reflect on their partnerships and share their lessons learned. Our recommendations for involvement of young people in research are: (1) Remember that it is okay to not know what the partnership might look like and there is no single recipe of how to partner; (2) Take the time to invest in partnerships; (3) Provide ongoing opportunities to reflect on partnerships; (4) Consider how to balance the power dynamics; and (5) Consider how to incorporate diversity in the background of young partners in research. Plain English summary: In more and more projects, researchers and young people are working together in partnership; but there is little guidance about how to organize this partnership. In this paper, we share what partnerships in six projects from Canada, Netherlands, and United Kingdom looked like, so that others can be inspired. To do so, a researcher and a young partner from each project were asked to together: (1) describe their project, (2) summarize the practical details about the collaboration and (3) think about things that went well or could be improved. We found that all projects had the same beliefs important to partnerships, like having respect for each other. Young people could work on parts of the project they liked in a way that worked for them. They were supported by staff, could join meetings and were appreciated for their work. Clear communication during and in-between meetings was helpful. Youth were often asked about the role they wanted in the project. While there was often no formal training on how to do research, there were many opportunities to learn. We offer six recommendations to researchers and young people who want to partner together: (1) It is okay to not know what the partnership will look like and there is no single recipe of how to partner; (2) Take your time; (3) Discuss how the partnership is going; (4) Think about who is doing what and why; (5) Consider the diversity of young partners. We hope others will share their experiences. [ABSTRACT FROM AUTHOR]

Objective: Carrier couples of recessive diseases face an important decision-making process regarding their familial planning that can become a significant source of discomfort and potential regrets. To date, no study has described the decisional needs of carrier couples of Leigh syndrome French-Canadian type, hereditary tyrosinemia type 1, hereditary motor and sensory neuropathy with or without agenesis of the corpus callosum and autosomal recessive spastic ataxia of Charlevoix-Saguenay undergoing family planning decision-making process. Our study aimed to describe the decisional needs of carrier couples according to the Ottawa Decision Support Framework.Methods: A qualitative descriptive study was conducted. Qualitative individual and joint couple interviews were performed among 39 carrier individuals and 11 health and social care professionals.Results: Carrier couples' decision-making process is complex, and their decisional needs include, among others, sufficient knowledge about the disease and the reproductive options, personal values and available support. Increased decisional conflict was observed among carriers of diseases associated with low morbidity and mortality.Conclusion: Family planning decision-making is an evolutive deliberative process that requires appropriate shared decision-making to insure decisional comfort.Practice Implications: Carrier couples family planning decision-making process needs to be better supported. [ABSTRACT FROM AUTHOR]

Background: Conversations about end of life rarely take place beyond healthcare spaces and in advance of imminent death. As the Canadian ageing population increases and new policies and options emerge for end‐of‐life choices, there will be an increasing need for supports for decision‐making on end of life. Time Moving was a participatory art exhibit created to engage participants in reflections on end‐of‐life experiences and the ways in which their perception of time fluctuated within these moments. Design: A participatory and constructivist approach informed decisions on exhibit design and analysis. The Time Moving exhibit was installed in a downtown university hall for 10 days during the 2019 annual DesignTO festival, open to all members of the public. The exhibit was used as the primary method of data collection. There were three prompts informed by concepts from prior work on time perception. Participants were invited to respond by drawing, writing or constructing. Outcome: There were over 120 contributions of participants over the duration of the Time Moving exhibit. These contributions revealed new insights related to temporal perception and end‐of‐life experiences. Participants shared their perception of time during end‐of‐life experiences in a variety of ways, revealing a diversity of perceptions of time beyond calendar and clock time, including time experienced as a spiral. Conclusions: The insights on time perception highlight opportunities for approaching dialogue on end of life and in grief support, and for exhibit as a mechanism for research and education. Patient or Public Contribution: As a public exhibit, over 120 people contributed ideas, personal stories, drawings and other creative outputs to the exhibit. An estimated 250 people visited the exhibit. [ABSTRACT FROM AUTHOR]

An online conference was organized to promote the Interprofessional Shared Decision‐Making model and maximize its dissemination among stakeholders (citizens, health care providers, administrative staffs, policy makers, academics) in Canada. The goal was to enhance knowledge of and engagement in shared decision‐making in a patient‐oriented research, since shared decision‐making has been hampered by reduced face‐to‐face contact, fear of infection, and overworked health professionals due to the COVID‐19 pandemic. Therefore, we share a summary of what has been done to engage citizens in shared decision‐making and to inform the interprofessional community about active citizen engagement in an online conference. [ABSTRACT FROM AUTHOR]

Objective: With the development of 75% of mental health disorders before age 25, it is alarming that service use among youth is so low. Little theoretically driven research has explored the decision-making process youth make when accessing services. This study utilized a decision-making framework, the Unified Theory of Behavior (UTB), to understand service use among youth attending Foundry, a network of integrated youth services centres designed to support the health and wellbeing of youth. Methods: Forty-one participants were recruited from one Foundry centre in an urban community in Canada. Semi-structured interviews with participants aged 15 -- 24 explored the relationship between UTB constructs and service use. Youth and parent advisory teams were engaged in the research process. Analysts used content analysis methodology to develop a taxonomy of the top categories for each construct. Results: Categories with the most salient and rich content were reported for each construct. The impact of emotions on service use was most commonly discussed in relation to the framework. The UTB constructs 'self-efficacy' and 'knowledge' were found to be interrelated. Differences in UTB categories emerged by symptom severity. Findings pointed towards a dynamic nature of service use, whereby service use experiences, may lead youth to consider future decisions surrounding service use within Foundry. Conclusions: This study contributes to a new understanding of integrated youth services utilization. The results can help shape the development of interventions to increase service access and retention, in addition to informing the design of systems of care that are accessible to all. [ABSTRACT FROM AUTHOR]

Introduction: Developing professionalism notably involves learning how to make professional judgements in ambiguous situations. The Concordance of Judgement Test (CJT) is a learning tool that was proposed to develop professionalism competencies, but it was never performed in dentistry or used with a synchronous methodology. The present study evaluated the feasibility of the use of CJT in the context of dental education, to foster professionalism and stimulate reflexivity and discussion., Materials and Methods: After different steps of optimization, a questionnaire presenting 12 vignettes was submitted to 33 Canadian students. Second, after an additional optimization, a questionnaire of 7 vignettes was submitted to 87 French students. An immediate educational feedback was proposed after each vignette to promote reflexivity and discussions during the experience., Results: The overall experience of the students was reported as good, thanks to the feedback of real-life situations. This promoted reflexivity and stimulated discussion between students and educators regarding professionalism issues. The students considered CJT as a relevant and well-adapted tool, and reported positive feelings regarding the inter-university aspect of the activity. The mean score of the panel members was close to 80/100 and the mean score of the students was 5 to 10 points lower, which is in agreement with docimological performance., Conclusion: The results suggested that the use of CJT in a synchronous way was a feasible and relevant tool to motivate the students to improve their professionalism, and to stimulate their reflexivity and discussion. The students reported positive experience with CJT, and we believe that this tool can be integrated in the dental curriculum., (© 2024 The Authors. European Journal of Dental Education published by John Wiley & Sons Ltd.)

Background: Primary care physicians are at the forefront of the clinical process that can lead to diagnosis, referral, and treatment. With electronic medical records (EMRs) being introduced and, over time, gaining acceptance by primary care users, they have now become a standard part of care. EMRs have the potential to be further optimized with the introduction of artificial intelligence (AI). There has yet to be a widespread exploration of the use of AI in primary health care and how clinicians envision AI use to encourage further uptake., Objective: The primary objective of this research is to understand if the user-centered design approach, rooted in contextual design, can lead to an increased likelihood of adoption of an AI-enabled encounter module embedded in a primary care EMR. In this study, we use human factor models and the technology acceptance model to understand the results., Methods: To accomplish this, a partnership has been established with an industry partner, TELUS Health, to use their EMR, the collaborative health record. The overall intention is to understand how to improve the user experience by using user-centered design to inform how AI should be embedded in an EMR encounter. Given this intention, a user-centered approach will be used to accomplish it. The approach of user-centered design requires qualitative interviewing to gain a clear understanding of users' approaches, intentions, and other key insights to inform the design process. A total of 5 phases have been designed for this study., Results: As of March 2024, a total of 14 primary care clinician participants have been recruited and interviewed. First-cycle coding of all qualitative data results is being conducted to inform redesign considerations., Conclusions: Some limitations need to be acknowledged related to the approach of this study. There is a lack of market maturity of AI-enabled EMR encounters in primary care, requiring research to take place through scenario-based interviews. However, this participant group will still help inform design considerations for this tool. This study is targeted for completion in the late fall of 2024., International Registered Report Identifier (irrid): DERR1-10.2196/54365., (©Krizia Mae Francisco, Catherine M Burns. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 18.07.2024.)

Background and Objectives: The inability of individuals in the advanced stage of dementia to communicate about preferences in care at the end-of-life poses a challenge for healthcare professionals and family carers. The proven effective Family Carer Decision Support intervention has been designed to inform family carers about end-of-life care options available to a person living with advanced dementia. The objectives of the mySupport study were to adapt the application of the intervention for use in different countries, assess impact on family satisfaction and decision-making, and identify costs and supportive conditions for the implementation of the intervention., Research Design and Methods: A multiple-case study design was chosen where the nursing home was the case. Nursing homes were enrolled from six countries: Canada, Czech Republic, Italy, Netherlands, Republic of Ireland, and United Kingdom., Results: Seventeen cases (nursing homes) participated, with a total of 296 interviews completed including family carers, nursing home staff, and health providers. Five themes relevant to the implementation of the intervention were identified: supportive relationships; committed staff; perceived value of the intervention; the influence of external factors on the nursing home; and resource impact of delivery., Discussion and Implications: There is a commonality of facilitators and barriers across countries when introducing practice innovation. A key learning point was the importance of implementation being accompanied by committed and supported nursing home leadership. The nursing home context is dynamic and multiple factors influence implementation at different points of time., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Background: Informed consent is an ethical and legal requirement that differs from informed decision-making-a collaborative process that fosters participation and provides information to help patients reach treatment decisions. The objective of this study was to measure informed consent and informed decision-making before major surgery.Study Design: We audio-recorded 90 preoperative patient-surgeon conversations before major cardiothoracic, vascular, oncologic, and neurosurgical procedures at 3 centers in the US and Canada. Transcripts were scored for 11 elements of informed consent based on the American College of Surgeons' definition and 9 elements of informed decision-making using Braddock's validated scale. Uni- and bivariate analyses tested associations between decision outcomes as well as patient, consultation, and surgeon characteristics.Results: Overall, surgeons discussed more elements of informed consent than informed decision-making. They most frequently described the nature of the illness, the operation, and potential complications, but were less likely to assess patient understanding. When a final treatment decision was deferred, surgeons were more likely to discuss elements of informed decision-making focusing on uncertainty (50% vs 15%, p = 0.006) and treatment alternatives (63% vs 27%, p = 0.02). Conversely, when surgery was scheduled, surgeons completed more elements of informed consent. These results were not associated with the presence of family, history of previous surgery, location, or surgeon specialty.Conclusions: Surgeons routinely discuss components of informed consent with patients before high-risk surgery. However, surgeons often fail to review elements unique to informed decision-making, such as the patients' role in the decision, their daily life, uncertainty, understanding, or patient preference. [ABSTRACT FROM AUTHOR]

Projects that undergo environmental impact assessment (EIA) are rarely rejected. Online registries and anecdotal evidence suggest that authorities approve almost all proposed and assessed projects, though often with mitigation requirements. The objective of this study was: 1) to identify the rules or criteria that reviewers and authorities must observe when considering the acceptance or rejection of projects; and 2) to understand how rare cases of rejection decisions are justified by reviewers. Data were collected through literature and regulatory reviews, and content analysis of review reports related to five Canadian and seven Brazilian rejected projects. Reviewers from Canada and Brazil adopted similar approaches to decision-making based on qualitative reasoning. Rejection recommendations were based on reasons, such as significance of biophysical impacts, sensitivity of locations and community values. The influence of reviewers' recommendations on final decisions remains unknown. The study highlights practical implications and calls for greater transparency and rigor in EIA decision-making. [ABSTRACT FROM AUTHOR]

This study reports findings from a series of focus groups with persons with dementia and family caregivers intended to explore: (1) perceptions of and experiences with advance care planning (ACP); (2) concerns related to future care including, but not limited to, end-of-life care; and (3) practices that may support positive engagement with ACP. A total of 18 participants including 10 persons with dementia and eight family caregivers participated in five focus groups held in two urban cities in Canada. All focus group deliberations were audio recorded, transcribed verbatim, and analyzed in five stages using a semantic thematic approach. All participants expressed some form of engagement in ACP, but understandings were limited and divergence was expressed regarding the timing of more expansive conversations about future care. Although some persons with dementia were ready to engage in future care discussions, most preferred focusing on the present and suggested their families did not require direction. This placed families in the complex dilemma of protecting their loved ones while compromising their own needs for dialogue. Although individually focused models of ACP engagement hold promise for those persons with dementia ready to engage in future planning, our findings suggest that early engagement of families in the reflective process may go a long way in supporting ACP activation. Our findings further suggest that persons with dementia who do not have close family/friends may require extensive ACP encouragement and support from service providers. [ABSTRACT FROM AUTHOR]

Summary: The early detection of anomalies associated with changes in the behavior of structures is important for ensuring their serviceability and safety. Identifying anomalies from monitoring data is prone to false and missed alarms due to the uncertain nature of the infrastructure responses' dependency on external factors such as temperature and loading. Existing anomaly detection strategies typically rely on univariate threshold values and disregard the planning horizon in the context of decision making. This paper proposes an anomaly detection framework that combines the interpretability of existing Bayesian dynamic linear models, a particular form of state‐space models, with the long‐term planning ability of reinforcement learning. The new framework provides (a) reinforcement learning formalism for anomaly detection in Bayesian dynamic linear models, (b) a method for simulating anomalies with respect to its height, duration, and time of occurrence, and (c) a method for quantifying anomaly detectability. The potential of the new framework is demonstrated on monitoring data collected on a bridge in Canada. The results show that the framework is able to detect real anomalies that were known to have occurred, as well as synthetic anomalies. [ABSTRACT FROM AUTHOR]

Young children are particularly susceptible to the deleterious consequences of maltreatment to their survival and well-being. Previous research suggests that there are age-specific differences with respect to how the child welfare system responds to children and their families. Caregivers of young children are among the most likely to receive child welfare services following an investigation; however, little is known about the child, family, household and case factors associated with service provision decisions. Data from the sixth cycle of the Ontario Incidence Study of Reported Child Abuse and Neglect (OIS) for 2018 was analyzed. Of the 158,476 estimated maltreatment-related investigations of children 0–17 years of age, approximately 5% involved infants (less than one year) and approximately 14% involved toddlers (1–3 years). The most influential factors associated with the decision to transfer a case to ongoing services were explored for both infants and toddlers through a multivariate tree-classification technique, Chi square automatic interaction detection (CHAID). For both models, worker assessment and determination that the child was at significant risk of future maltreatment and caregiver mental health were influential and significant predictors. Differences did emerge between groups. For infant investigations, caregiver risk factors interacted with the child's household running out of money for basic necessities; whereas, for toddler investigations, child characteristics interacted with caregiver risk factors. A better understanding of the child welfare system's response to young children is crucial to the development of innovative practice and policy strategies within the field of child welfare and across allied child- and family-service systems. [ABSTRACT FROM AUTHOR]

Studies have confirmed the benefits of using Third-party logistics (TPL) for efficient construction management, especially in large projects. Nevertheless, there is a dearth of decision-making models evaluating the exact role of TPL providers as drivers for supply chain (SC) integration and optimisation. This study aims to develop a decision-making model for construction supply chain (CSC) optimisation, with possible TPL integration. The proposed model considers two types of purchased materials (type-1 and type-2) and assists the main contractor in determining construction supply chain management (CSCM) strategies, including supplier selection, order quantity determination, and TPL use evaluation. Using the model, the main contractor can take advantage of the TPL provider's warehouse and order larger quantities, if necessary, to obtain lower prices offered by suppliers. Through case examples in Canada, we find that the proposed model performs better in optimising total SC cost, as compared to the model without TPL. Model validations also show that TPL can be conditionally used to improve construction logistics performance and to meet practical requirements targeting issues in the construction industry. [ABSTRACT FROM AUTHOR]

This article demonstrates to proponents that adopting good practices early in the impact assessment process can help to achieve positive project outcomes. Drawing from a case study of the Adaptive Phased Management Project proposed by Canada's Nuclear Waste Management Organization, we show ways in which impact assessment can be leveraged to achieve beneficial outcomes for interested parties through early planning that includes a commitment to transparency and participatory engagement. A considerable benefit of the approach we outline is the establishment of good relationships between stakeholders, rights-holders, and the proponent, which facilitate dialogue regarding the goals of each party and how implementing the project can help to achieve them. Examples of stakeholder, Indigenous community, and proponent collaboration during early planning for the regulatory approval process, including legislated impact assessment, of a multi-billion dollar infrastructure project with an extended timeline are provided. [ABSTRACT FROM AUTHOR]

The Canadian Arctic is a complex and fragile region which is currently experiencing unprecedented environmental degradation due to climate change. The effects of climate change on the Canadian Arctic is just one example where we're seeing the decline of ecosystems and socio-culture-environmental traditions. Mineral development in this already fragile ecosystem is indeed a contentious and high-risk endeavour. However, mining is currently one of the few industries and economic development opportunities in the Canadian Arctic, which is one of the poorest regions in Canada. Unfortunately, mining struggles to achieve environmental sustainability due to mineral development's inherent trade-off of short-term economic gains for long-term environmental impacts. Local communities are usually left with trying to find this balance. This paper analyzes how we can apply decision-making techniques and environmental management tools for the Canadian Arctic's mining industry to promote better environmental sustainability, understanding of environmental-economic trade-offs, and community involvement. Specific decision-making methodologies and management tools are analyzed to develop, discuss, and explore their application for the Canadian Arctic. This paper concludes with a framework that brings together the analyzed methods and Arctic specificities; to prioritize environmental issues and to ensure long-term thriving communities in the Arctic. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to provide insight into the capital budgeting decision-making of Canadian and Mexican entrepreneurs in small businesses in the food sector. The objective is to understand the capital budgeting decisions through the lens of bounded rationality and how these decisions are affected by different (national) contexts. Design/methodology/approach: This is a comparative study in which the use of constructivist grounded theory allowed deep conversations about capital budgeting decisions. Data was collected from forty semi-structured interviews with entrepreneurs/managers in two regions, Mexico and Canada. Findings: Insights from this study suggest that entrepreneurs' capital budgeting decisions are not only taken under conditions of bounded rationality but also suggest a prominent role of context in how bounded rationality is applied differently towards investment decisions. Research limitations/implications: While the findings cannot simply be generalized, exploring how capital budgeting decisions are made differently across two regional contexts adds to the understanding of the nexus of context, bounded rationality and capital budgeting decision-making. Practical implications: Using a bounded rationality lens, this study contrasts and explains similarities and differences in the entrepreneur's capital budgeting decision-making within small businesses. The insights add to the body of knowledge and help entrepreneurs to reflect on their approach to decision-making. Originality/value: The paper uses a less commonly applied approach to understand two under-researched regional contexts. We use constructivist grounded theory to explore entrepreneurs' capital budgeting decision-making in small businesses in two regions, Canada and Mexico. The comparative approach and the findings add to the understanding of decision-making, highlight the prominent role of context and also challenge some insights from previous research. [ABSTRACT FROM AUTHOR]

BACKGROUND: People living with human immunodeficiency virus (HIV) often make highly personal decisions about whether or not to disclose their HIV status in the workplace. OBJECTIVE: We aimed to determine current practices that support people living with HIV to make workplace disclosure decisions and to understand factors that affect disclosure decision-making. METHODS: Ninety-four people who provide health, social and peer-based services responded to an on-line survey about their experiences supporting workplace disclosure decisions of employees living with HIV. RESULTS: Respondents identified a range of strategies to support workplace disclosure decision-making. One-third of respondents were only a little or not confident in their abilities to support people in making disclosure decisions and 32% expressed little or no confidence in the resources available. Respondents working at HIV-specific organizations, as compared to respondents not working at those organizations, were more confident supporting people with disclosure decisions and in available resources, p <.05. Perceived barriers to disclosure decisions included stigma, lack of knowledge, and personal factors. Supports for decision-making resided within personal, workplace and societal contexts. CONCLUSIONS: The study provides important understanding about the complexity of disclosure decision-making and strategies that people living with HIV can use to address this complex issue. [ABSTRACT FROM AUTHOR]

The National Collegiate Athletics Association (NCAA) Division I women's hockey programs that exist throughout the US are of interest to many Canadian women hockey players looking to continue participating at a high level of competition. There are currently 311 Canadian women players on NCAA Division I school rosters in women's collegiate hockey; this trend can be considered a talent drain from Canada's hockey system. Thus, the purpose of this study was to explore Canadian women hockey players' decisions for selecting an NCAA Division I hockey program in the US. Data were collected through 14 semi-structured interviews with former and current NCAA Division I Canadian women hockey players. The themes that emerged identified that the Canadian athletes found three features to be important when selecting NCAA institutions: Resources, Competitive Level, and Past Player Achievements. These themes would indicate the reputation is factor in the decision-making process for Canadian female players. [ABSTRACT FROM AUTHOR]

Aims: To examine how physical therapists (PTs) use evaluation measures to guide prescription and re-assessment of ankle-foot orthoses (AFOs) for children with CP. Methods: PTs in Canada who work with children with CP were invited to complete an online survey. Survey questions examined PT evaluation and interpretation of findings at initial AFO prescription and re-assessment. Closed-ended responses were analyzed using descriptive statistics, and a conventional content analysis examined responses to open-ended questions. Results: Sixty responses from ten provinces were analyzed. Three themes emerged from the open-ended responses, which were supported by closed-ended responses. (1) Focus on impairment-level measures. Although evaluation primarily involved observational, non-standardized measures of impairments and gait pattern, most respondents also considered participation-level constructs. (2) Lack of confidence/knowledge. Respondents reported a moderate level of confidence concerning decision-making about AFO type and characteristics. 3) Inconsistent practices between therapists, possibly reflecting the paucity of available evidence or individualization of the prescription. Conclusions: Non-standardized, observational assessment methods, and impairment-level constructs appear to guide AFO prescription decisions. Integrating current knowledge into practice, developing best practice guidelines, and developing standardized tools to assess the effects of AFOs on participation may promote confidence, consistency, and improved outcomes. [ABSTRACT FROM AUTHOR]

Background The rate of mastectomy is much higher in Newfoundland and Labrador than in any other province in Canada, even for women diagnosed at an early stage. In this paper, we present qualitative data from women who have made a decision for surgical treatment and from breast surgeons in an effort to better explicate factors influencing breast cancer (bca) surgical decision-making. Methods The study's descriptive, qualitative design involved holding interviews with breast surgeons and holding focus groups and interviews with women who were offered the choice of breast-conserving surgery (bcs) or mastectomy (mt). Results Participants included 35 women and 13 surgeons. High interest in mt and increasing requests for prophylactic contralateral mt were evident. A host of factors--clinical, demographic, psychosocial, education-related, and cultural--influenced the decisions. A key factor for women was fear of recurrence and a need to "just get rid of it," but the experiences of others also influenced the decisions. Life stage and family considerations also factored prominently into women's decisions. Conclusions Women with early-stage bca more often chose mt and often demanded prophylactic removal of the healthy breast. Findings highlight the importance of ensuring that women at average risk are appropriately counselled about the low likelihood of a subsequent contralateral bca and the lack of survival benefit associated with prophylactic contralateral mt. Findings also revealed other areas of presurgical discussion that might help women think through their personal circumstances and values so as to encourage informed surgical decisions. [ABSTRACT FROM AUTHOR]

Our aim is to develop a robust socio‐geographical transferable theory outlining the basic social process used by members of an interprofessional health care team when making decisions around wound care management. Using a qualitative multigrounded theory approach, three focus groups were held at the Royal Victoria Regional Health Centre in Barrie, Ontario, Canada, comprised of 13 clinicians who participate in wound care decision‐making. Data were analysed using an approach developed for multigrounded theory. A Critical Realist theoretical lens was applied to data analysis in the development of conclusions. Ten categories were identified before thematic saturation. Category interactions developed a perceived basic social process outlining how interprofessional clinicians determine how they approach wound care decisions: patient factors, scope of practice, equipment and supplies, internal clinician factors, knowledge and education, interprofessional team, assessment, wound care specialist consultation, and care plan, as well as documentation and communication. Understanding how wound care decision‐making is determined by interprofessional health care providers will assist clinical leaders and policy makers in creating a foundation for determining resource allocation, allowing clinicians to use evidence‐based practice to improve patient and clinician satisfaction, wound healing time, decrease costs, and prevent wound recurrence. [ABSTRACT FROM AUTHOR]

Introduction: Countries with large economies are observing a growing number of culturally and linguistically diverse (CALD) older adults, many of whom will be affected by cancer. Little is known about the experiences and factors that influence cancer treatment decision-making in this population. The purposes of this scoping review are: (1) to summarize the published literature on cancer treatment-related decision-making with this population; and (2) to identify potential differences in how cancer treatment decisions are made compared to non-CALD older adults with cancer., Materials and Methods: We conducted a scoping review following Arksey and O'Malley and Levac methods, Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review Guidelines. We conducted a comprehensive multidatabase search, screening 1,139 titles/abstracts. Following data abstraction, we analyzed the data using tabular and narrative summary., Results: We extracted data from six studies that met the inclusion criteria: four quantitative and two qualitative; five from the United States and one from Canada. Three themes were identified: (1) barriers to decision-making, (2) the influence of family and friends on decisionmaking, and (3) differences in uptake and types of treatment received between CALD and non-CALD older adults., Discussion: This comprehensive review of treatment decision-making among CALD older adults with cancer highlights the paucity of research in this area. The findings are limited to North American populations and may not represent experiences in other regions of the world. Future research should focus on studying their treatment-related decision-making experiences to improve the quality of care for this vulnerable population., Competing Interests: Declaration of Competing Interest BL has received honoraria from AstraZeneca outside of the submitted work. LAC has received payment for expert testimony, for travel to attend a meeting, and is an elected board of directors for the Advanced Practitioner Society for Hematology and Oncology (unpaid). LN and RJ are elected members of the board of directors for the Canadian Association of Nurses in Oncology (unpaid). CME, SP, KK, RJ, KK, PSB, JL, YZ, MP, CB, FK, JLK, TR, EB, CK, LK, and KRH have no disclosures., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

In assessing the benefits of using e-health systems, the main goal of this study is to evaluate the real use of the clinical decision support system (CDSS) between 2007 and 2014 in Canada's healthcare sector. The quantitative method was based on data collected by the National Physician Survey in Canada. Results indicate that 63.8% of healthcare providers were using a CDSS at work in 2014 to help them in the decision-making process, a six-fold improvement since 2007. As for usage rate by sex, we found a statistically significant difference between men and women, with women from the Canadian physicians' group reporting greater CDSS use than men. In all age groups, a higher percentage of younger physicians used a CDSS in their practice. A number of suggestions are put forth to improve technological infrastructure and reduce the gap among age groups, genders and specialties. [ABSTRACT FROM AUTHOR]

The first episode of psychosis often emerges during young adulthood, when individuals are pursuing important educational and career goals that can become derailed because of the development of major impairments. Past research has neglected the developmental nature of employment and education decisions that young adults with first episode psychosis make within the context of their lives. The purpose of this grounded theory study was to advance a model of the career decision-making processes of young adults with first-episode psychosis, and the influences that affect their career decision-making. The career decision-making of young adults with first-episode psychosis emerged as a multistaged, iterative process that unfolded over three phases of illness, and was affected by several internal and environmental influences. These findings suggest the phase of illness and career decision-making stage should be considered in future vocational programming for young adults with first-episode psychosis. [ABSTRACT FROM AUTHOR]

Despite the substantial body of literature on racial disparities in child welfare involvement in the Unites States, there is relatively little research on such differences for Canadian children and families. This study begins to address this gap by examining decision-making among workers investigating Black and White families investigated for child protection concerns in Ontario, Canada. Using provincially representative data, the study assessed whether Black children were more likely than White children to be investigated by child welfare, if there was disparate decision-making by race throughout the investigation, and how the characteristics of Black and White children contribute to the decision to transfer to ongoing services. The results indicate that Black children were more likely to be investigated than White children, but there was little evidence to suggest that workers in Ontario child welfare agencies made the decision to substantiate, transfer to ongoing services, or place the child in out-of-home care based on race alone. Black and White children differed significantly with respect to child characteristics, characteristics of the investigation, caregiver risk factors, and socioeconomic circumstances. When adjusting for these characteristics, Black families had 33% greater odds (OR = 1.33; 95% CI: 1.26, 1.40; p = <0.001) of being transferred to ongoing services compared to White families. Among Black families, the assessed quality of the parent-child relationship and severe economic hardship were the most significant and substantial contributors to the decision to provide child welfare services. Implications for practice, policy, and research are discussed. [ABSTRACT FROM AUTHOR]

Screening for oral cancer and other mucosal conditions is a knowledge-to-action objective that should be easy: there is supportive evidence, it is fast and non-invasive, and the oral cavity is easy to visualize. However, over 60% of oral cancers are diagnosed late, when treatment is complex and prognosis poor. Adjunctive screening devices (ASDs), e.g. toluidine blue (TB), fluorescence visualization (FV), chemiluminescence (CL) and brush biopsies, were designed to assess risk of oral lesions or aid in identification and localization of oral premalignant and malignant lesions. Little is known on how clinicians feel about using ASDs. Objectives To evaluate use and level of comfort in using ASDs for oral cancer screening among dental hygienists. Methods Online email survey of a stratified random sample of nearly 3000 dental hygienists from four Canadian provinces. Results A total of 369 hygienists responded about ASDs. Ninety-three (25%) had used an ASD. Use was associated with six or more continuing education ( CE) courses per year ( P = 0.030), having a CE course in oral pathology within the last 3 years ( P = 0.003) and having a screening protocol ( P = 0.008). The most commonly used ASD is FV, which was the tool hygienists felt most comfortable using. Few used brush biopsies. Older graduates were more comfortable using TB ( P = 0.014) and CL (0.033). Conclusion Current evidence and education through CE appears to bolster knowledge translation efforts for hygienists to become more comfortable in the use of ASDs. ASDs with minimal supporting evidence and not specifically targeted to hygienists, such as the brush biopsies, are not well utilized. [ABSTRACT FROM AUTHOR]

Case studies of the Canada Department of Fisheries and Oceans (DFO), Northwest Atlantic Fisheries Organization (NAFO), and the Food and Agriculture Organization of the United Nations (FAO) highlighted factors influencing scientific communication that are contingent on the characteristics of the many dynamic and iterative science-policy interfaces among decision-makers, scientists, and other stakeholders. Direct observations of 15 scientific and management meetings coupled with interviews with 78 scientists and managers revealed aspects of the information pathways, i.e., production, communication, and use of scientific information in these organizations. Unique features of decision-making and information use enable the production of credible, relevant, and legitimate information in each organization, including trade-offs in these attributes to support fisheries governance objectives. For instance, defined processes for producing scientific advice embedded in fisheries management authorities, such as DFO and NAFO, ensure uptake of information in decision-making. As a boundary organization, FAO bridges science and policy-making groups among its member countries. The demand for scientific advice, policy development, and trade aspects are primary drivers in the information pathways. However, organizational aspects such as dispersed units and inadequate communication persist as barriers to information flow. Across the geographic scales of the three organizations, stakeholders apart from government scientists and policy-makers, e.g., the fishing industry, non-governmental organizations (NGOs), and the public, are increasingly involved in the information pathways. Insights about the information pathways can equip the organizations to evaluate or modify practices to increase the uptake of information in decision-making as fisheries management issues and considerations become more complex. [ABSTRACT FROM AUTHOR]

New products usually offer advantages over existing products, but in health care, most new drugs are 'me-too', comparable in effectiveness and side effects to existing drugs, but with a more ambiguous evidence base around adverse effects. Despite this, new treatments drive increased health care spending, suggesting a preference for 'newness' in this setting. We explore (1) whether preferences for treatments labeled 'new' exist and (2) persist once the ambiguity in the evidence base reflecting newness is described. We use a Canadian general population sample (n = 2837) characterized by their innovativeness in adopting new products in normal markets. We found that innovators/early adopters (n = 173) had significant preferences for 'newer' treatments (B = 0.162, p = 0.038) irrespective of comparable benefits and side effects and all respondents had significant preferences for less ambiguity in benefit/side effect estimates. Notably, when 'newness' was combined with ambiguity, no significant preferences for new treatments were observed regardless of respondent innovativeness. We conclude that preferences for new products exist for some people in health care markets but disappear when the implication of ambiguity in the evidence base for new treatments is communicated. Physicians should avoid describing treatments as 'new' or be mindful to qualify the implications of 'new' treatments in terms of evidence ambiguity. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Using administrative child welfare data from the Ontario Child Abuse and Neglect Data System (OCANDS), this study compared the profiles of Asian-Canadian and White-Canadian children and families that experienced a case closure after an investigation instead of being transferred to ongoing child protection services (CPS). Child protection investigations involving Asian-Canadian and White-Canadian children and families that were transferred to ongoing CPS presented a different profile of case characteristics and caregiver and child clinical needs. Asian-Canadian children and families received ongoing CPS for over a month longer than White-Canadian children and families and were less likely (odds ratio [OR] = 0.39) to be reinvestigated for any form of maltreatment-related concerns within 1 year after case closure. It appears that child protection investigations involving Asian-Canadian children and families are less likely to be closed prematurely than White-Canadian children and families, and the child protection system may be meeting the needs of Asian-Canadian communities. Alternatively, it is possible there is unaccounted biases that may be reflective of systemic problem of discriminative practices in the child protection system. Further research is needed to explore this phenomenon. [ABSTRACT FROM AUTHOR]

Background: the mySupport advance care planning intervention was originally developed and evaluated in Northern Ireland (UK). Family caregivers of nursing home residents with dementia received an educational booklet and a family care conference with a trained facilitator to discuss their relative's future care., Objectives: to investigate whether upscaling the intervention adapted to local context and complemented by a question prompt list impacts family caregivers' uncertainty in decision-making and their satisfaction with care across six countries. Second, to investigate whether mySupport affects residents' hospitalisations and documented advance decisions., Design: a pretest-posttest design., Setting: in Canada, the Czech Republic, Ireland, Italy, the Netherlands and the UK, two nursing homes participated., Participants: in total, 88 family caregivers completed baseline, intervention and follow-up assessments., Methods: family caregivers' scores on the Decisional Conflict Scale and Family Perceptions of Care Scale before and after the intervention were compared with linear mixed models. The number of documented advance decisions and residents' hospitalisations was obtained via chart review or reported by nursing home staff and compared between baseline and follow-up with McNemar tests., Results: family caregivers reported less decision-making uncertainty (-9.6, 95% confidence interval: -13.3, -6.0, P < 0.001) and more positive perceptions of care (+11.4, 95% confidence interval: 7.8, 15.0; P < 0.001) after the intervention. The number of advance decisions to refuse treatment was significantly higher after the intervention (21 vs 16); the number of other advance decisions or hospitalisations was unchanged., Conclusions: the mySupport intervention may be impactful in countries beyond the original setting., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background:Unlike other chronic injuries, acquired brain injuries (ABI's) affect physical, cognitive, social, and emotional functioning. Although collaborative decision-making, high patient engagement, and positive healthcare relationships are generally encouraged within the patient-centred care (PCC) framework, little is known about how ABI patients experience healthcare relationships and decision-making and whether their experiences align with PCC principles. Method:The purpose of this study was to obtain a better understanding of how mild to moderate ABI patients in the chronic phase of recovery (i.e. minimum 2 years post-injury) experience and navigate healthcare using narrative methods. Participants were 11 Canadian adults living in the community and recruited from their local brain injury association. Semi-structured interviews were conducted and analyzed for their thematic content, structural aspects, and performative aspects in order to get at the meaning-making underlying the narrated stories. Findings:These participants told one coherent narrative with two main storylines: one in which they positively portrayed their doctors and their healthcare relationships – reporting feeling lost and needing their doctor's help; and another in which they negatively portrayed their doctors and their healthcare relationships – reporting being capable and therefore not needing their doctor's help. Although seemingly contradictory, these two storylines speak to one coherent experience in which capability served as a counter-narrative to what they perceived as a global narrative of being devalued, dismissed and patronized. Discussion:The implication of how this counter-narrative affects their experience of healthcare is discussed, including implications for why doctors may want to focus on fostering a positive doctor–patient relationship by conveying that they care for and value their ABI patients, and why simple interactions may contribute to this positive relationship. [ABSTRACT FROM AUTHOR]

The article focuses on a study conducted on the judgment of chief executive officers' (CEOs) leadership ability from their facial appearance. Topics discussed include the role of the facial appearance of CEOs in predicting the financial success of their companies; the role of formal training in increasing a person's skills in various tasks; and leadership ability of Master of Business Administration (MBA) students.

Rationale Traditional perspectives on informed consent assume that when faced with decisions about whether to participate in research, individuals behave according to principles of classical rationality, taking into account all available information to weigh risks and benefits to come to a decision that is optimal for them. However, theoretical and empirical research in psychology suggests that people may not make decisions in this way. Less is known about decision-making processes as they pertain to participating in biomedical research, particularly when the participants are children. Objective We sought to better understand research decision processes especially in children who tend to participate extensively in research due to chronic illness. Methods To learn more about children’s decision-making in this context, we interviewed 19 young patients with cystic fibrosis (male n = 7; female n = 12) aged 8–18 years ( M = 13 years) at a children’s hospital in Canada between April and August 2013. Results We found that participants generally had a default approach to participation decisions, which they attributed to their parents’ attitudes to research, experiences of having grown up participating in research, trusting the researchers, and wanting to help. Most of our participants made the decision to participate in research based on a heuristic with a baseline to say “yes”, subject to change based on aspects of the research or particular preferences. In particular, concerns with the procedure, unwillingness to talk about cystic fibrosis, logistical challenges, and perceptions of risk all influenced the decision, as did the perceived importance or personal relevance of the research. Conclusion Our study illustrates that rather than conducting risk/benefit analyses, participants tended to adopt a heuristic-like approach, consistent with decision theories that view heuristic decision-making as ecologically rational. [ABSTRACT FROM AUTHOR]

Canada has strong institutional capacity for science-based decision-making related to natural resource conservation and environmental management. Yet, the concept of using systematic reviews (conducted in accordance with established guidelines) to support evidence-based conservation and environmental management in Canada is in its infancy. Here we discuss the Canadian context for implementing more rigorous evidence-based approaches using systematic reviews. Of particular relevance to Canada is its vast size, broad diversity of ecosystems and heavy economic reliance on natural resources that vary widely in the type and scale of their environmental effects. These factors result in a wide variety of environmental monitoring needs over an extensive area that pose challenges to the scientific community charged with overseeing wise use of the environment. In addition, there are diverse and engaged user groups (e.g., hunters, trappers, fishers, bird watchers, foresters) and indigenous peoples that have constitutional rights to their natural resources. Traditional environmental knowledge is a complementary source of evidence in the Canadian environmental impact assessment process and therefore must be a part of evidence synthesis. Systematic reviews are not intended to replace local field studies, but rather have the opportunity to draw upon a broader suite of evidence that can be interfaced with local perspectives. The existing institutional structures in Canada could easily incorporate systematic reviews into their science advice and decision-making frameworks but to date, there are few examples of where this has occurred. Drawing on the expertise of a growing global collaboration for environmental evidence synthesis, Canadian institutions (federal, provincial and NGO) are poised to more broadly incorporate systematic reviews once their benefits are fully realized and the capacity to undertake such systematic reviews is fully developed. Systematic reviews offer a consolidated view of the available scientific literature on a given question. The results may offer significant value when working with stakeholders and decision makers contributing other sources of information to the question. For example, mechanisms to capture and integrate scientific knowledge with stakeholder and traditional knowledge may benefit from the scientific sources being filtered, interpreted and summarized for discussion. In other cases, where timeframes for decision making preclude formal systematic reviews, opportunities for more rapid evidence synthesis methods will be needed before the concept will be fully embraced. [ABSTRACT FROM AUTHOR]

This article studies the different institutional factors that influence a strategic wind energy decision-making process through a comparative transnational study of Quebec (Canada) and France. Research confirms that political choices are dynamic and vary with a change in the wind energy context, the balance of power between pressure groups, supranational influences, energy evaluation approaches and social acceptance. Until the 90׳s, an initially unfavorable national energy context, combined with a neocorporatist culture, as defined by Szarka (2004) [1] , limited the place of wind energy in both jurisdictions. In the 2000׳s, a political window opened when the private sector penetrated the market with the deregulation of the electricity sector, exogenous pressure from the European Union in France, endogenous pressure from social actions in Quebec, and a more favorable energy context in both cases. However, this political window was short-lived due to social acceptance issues. In Quebec, political will was stronger until 2013. Now, the social controversy surrounding wind energy has shifted from the local to the national level. Projects are better accepted locally because of local financial involvement, but an anticipated electricity surplus questions the relevance of new energy projects. In France, political support depends on the government in power. Between 2005 and 2013, the reduction in annual wind power installations from 1246 MW to 621 MW was due to the major influence of the anti-wind lobby on a right-wing government. After 2013, the left-wing government׳s arrival coincided with a phasing out of several regulatory and financial uncertainties. Today, both jurisdictions are at a crossroads and the future energy mix will depend on the relative influence of the institutional components identified. In our opinion, key solutions to more sustainable political choices are conditioned by an improvement in the way projects and policies, plans and programs are assessed. [ABSTRACT FROM AUTHOR]