Auditors use substantive analytical procedures to make assertions about the adequacy and appropriateness of client balances. The analytical procedure process consists of auditors creating independent account expectations and corroborating unusual fluctuations through obtaining and evaluating additional audit evidence. Prior analytical procedure research has found that knowledge of clients' unaudited account balances biases auditors' expectations towards the current year figures. However, this research has failed to examine the impact of biased expectations on the subsequent stages of analytical procedures. This dissertation assesses the full impact of biased account expectations on auditors' use of analytical procedures. I experimentally test the hypotheses of my dissertation through administering an experiment to senior level auditors. After inducing an account expectation bias that favors the client account balance in half the participants, I examine the auditors' cognitive investigation into an unusual account fluctuation. The results indicate that a biased account expectation negatively affects auditors' judgment quality. In particular, a biased expectation leads auditors to favor hypotheses and additional information that supports the proposition that the client's balance is reasonably stated. Alternatively, auditors with unbiased account expectations are more willing to consider all hypotheses and are able to identify the most pertinent additional information to the decision task. As a result of the different decision strategies employed, auditors who form unbiased account expectations are significantly more likely than auditors with biased account expectations to identify the correct relationship among the underlying data and the proposed hypotheses during a substantive analytical procedure.

Purpose. To systematically develop and conduct preliminary evaluation of a decision support intervention to engage patients and their families about whether to accept or decline implantable cardioverter-defibrillator (ICD) pulse generator replacement. Methods. A series of studies using multi-methods and guided by the Ottawa Decision Support Framework and the Normalization Process Theory: 1) an integrative review of patients’ perspectives on ICD decision-making; 2) a systematic review of the risks and benefits of ICD replacement; 3) an embedded mixed methods study to iteratively develop a patient decision aid (PDA) and simultaneously plan for its implementation; and 4) a feasibility pilot randomized controlled trial to evaluate ease of recruitment, decision support intervention delivery and data collection. Findings. The integrative review of 25 articles reported that ICD decision-making was difficult and the majority of patients misunderstood ICD therapy. The systematic review of 17 nonrandomized studies reported that complication rates are higher at replacement as compared to initial implant, mortality benefit post ICD replacement is unclear, and patients’ clinical profile can affect ICD’s effectiveness. Findings from both studies were used to draft a PDA. Interviews with 18 end-users (clinicians, patients, spouses) revealed that the current ICD replacement process is automated and needs to elicit patient preferences. The PDA was considered the optimal tool to initiate the discussion of options. In a feasibility trial, 30 patients were randomized to the decision support intervention (PDA + decision coaching) (n=15) or usual care (n=15). The intervention was used as intended, users found the PDA acceptable but acceptability of decision coaching was variable. Patients exposed to the intervention had better knowledge scores compared to controls. Conclusion. The Ottawa Decision Support Framework and Normalization Process Theory were complementary frameworks to ensure that the decision support intervention has the potential for implementation. To determine whether this approach was successful, future research is required to evaluate and implement the intervention in clinical practice. Findings from the feasibility study will be used to design an effectiveness trial.

Infrastructure management agencies are facing multiple challenges, including aging infrastructure, reduction in capacity of existing infrastructure, and availability of limited funds. Therefore, decision makers are required to think innovatively and develop inventive ways of using available funds. Maintenance investment decisions are generally made based on physical condition only. It is important to understand that spending money on public infrastructure is synonymous with spending money on people themselves. This also requires consideration of decision parameters, in addition to physical condition, such as strategic importance, socioeconomic contribution and infrastructure utilization. Consideration of multiple decision parameters for infrastructure maintenance investments can be beneficial in case of limited funding. Given this motivation, this dissertation presents a prototype decision support framework to evaluate trade-off, among competing infrastructures, that are candidates for infrastructure maintenance, repair and rehabilitation investments. Decision parameters’ performances measured through various factors are combined to determine the integrated state of an infrastructure using Multi-Attribute Utility Theory (MAUT). The integrated state, cost and benefit estimates of probable maintenance actions are utilized alongside expert opinion to develop transition probability and reward matrices for each probable maintenance action for a particular candidate infrastructure. These matrices are then used as an input to the Markov Decision Process (MDP) for the finite-stage dynamic programming model to perform project (candidate)-level analysis to determine optimized maintenance strategies based on reward maximization. The outcomes of project (candidate)-level analysis are then utilized to perform network-level analysis taking the portfolio management approach to determine a suitable portfolio under budgetary constraints. The major decision support outcomes of the prototype framework include performance trend curves, decision logic maps, and a network-level maintenance investment plan for the upcoming years. The framework has been implemented with a set of bridges considered as a network with the assistance of the Pima County DOT, AZ. It is expected that the concept of this prototype framework can help infrastructure management agencies better manage their available funds for maintenance.

Purpose: To synthesize evidence on decisional needs assessments and patient decision aid (PtDA) trials based on the Ottawa Decision Support Framework (ODSF) in order to validate the concepts and test the main assertion in the ODSF. Decisional Needs: The systematic review studies (n=45) validated all of the decisional needs identified in the ODSF. Nine new manifestations of ODSF decisional needs emerged (e.g. information overload, unreceptive to information/deliberation, relationship barriers with practitioner). PtDAs: The sub-analysis identified 24 ODSF PtDA trials. Compared to usual care, ODSF PtDAs improved decision quality, addressed decisional needs and reduced decision delay. Further evaluation is needed on downstream impacts of these improvements on decision-making. Conclusions: Using Walker and Avant’s theory testing steps, the integrated findings from the systematic review and sub-analysis validated the ODSF decisional needs concepts and tested the main assertion in the ODSF (that PtDAs address decisional needs and improve decision quality).

In organizations with decision makers across multiple hierarchical levels, conflicting objectives are commonly observed. The decision maker, or agent, at the highest level usually makes decisions in the interest of the organization, while a subordinate agent may have a conflict of interest between taking a course of action that is best for the organization and the course of action that is best for itself. The Multiscale Decision-Making (MSDM) model was established by Wernz (2008). The model has been developed to capture interactions in multi-agent systems, by integrating both the hierarchical and temporal scale of decisions made in organizations. This thesis contributes towards expanding the results in the hierarchical interaction domain of MSDM by extending the model to incorporate N decision alternatives and outcomes instead of two, and studying its effect on the interaction between agents. We consider decisions with uncertain outcomes, where the outcomes of the decisions made by agents lower in hierarchy affect the transition probabilities of the decisions made by agents above them in hierarchy. This leads to a game theoretic situation, where the lower-level agents need to be sufficiently incentivized in order to shift their best response strategy to one in the interest of their superior and the organization. Mathematical expressions for the optimal incentives at each hierarchical level are developed. We analyze systems with agents interacting across two and three organizational levels. We then study the effect of introducing the cost of taking an action on the optimal incentives. We discuss a health care application of MSDM. / Master of Science

Recent studies find that mutual funds exhibit differential and persistent performance which is frequently attributed to superior managerial decision making. We extend the literature by examining the impact of the fund's management structure on performance outcomes. Specifically, we examine directly whether superior outcomes, in terms of risk-adjusted returns, may be explained by behavioral decision making theory that asserts that teams make better decisions than individuals. Empirical results are consistent with the classical decision making theory and the efficient market hypothesis.

Le domaine de la théorie de la decision a été très actif depuis von Neumann Morgenstern 1943. De nouveaux modèles de décision ont révolutionné la manière avec laquelle on peut analyser nos actions et nos décisions. Cependant, le paradoxe de Allais en 1953 a obligé les théoriciens à clarifier l’objectif de leurs modèles. Alors de nombreux auteurs ont mis en avant le but normatif du modèle utilité espérée (les choix tel que nous devrions les faire, potentiellement meilleurs) et ont délaissé l’objectif descriptif (les choix réels, potentiellement biaisés).Cette évolution a permis a la discipline de définir de claire et solides méthodes de validation empirique de son approche descriptive. Cependant à l’inverse, la théorie de la decision normatif peine toujours à déterminer une méthodologie objective et constructive afin de trancher ses débats internes au sujet de la rationalité des modèles de théorie de la décision. Fournir une telle méthodologie est l’objectif principal de cette thèse. / Decision Theory has been a very dynamic field since von Neumann and Morgenstern 1943. New decision models have opened new ways to think about our actions and every day decisions.Allais’ Paradox in 1953 forced decision theorists to be clearer about the intents their models and several authors claimed that expected utility solely has a normative intent (choices that we should make, potentially better) and not a descriptive one (choices as we make them, potentially flawed).It also allowed to define better methods of validation for a descriptive point of view. Best practices in descriptive decision theory have emerged and we have now clear-cut and vetted methods of justifying the use of a given model of decision theory for a descriptive aim.However for normative decision theory that intents to help us make better choices, we do not have a clear cut way to determine and "prove" that a given model is the right one. This thesis provides an empirical design that provides such a methodology.

Indiana University-Purdue University Indianapolis (IUPUI) / Purpose The experience of surgical patient decision-making for amputation, rotationplasty, or limb salvage surgery for the lower extremity was explored with osteosarcoma survivors and parents. Issues and patient concerns were examined prospectively in Facebook posts and retrospectively in personal interviews. Recommendations were sought for the development of a decision aid. Methods A qualitative inquiry was conducted in two studies: 1) a content analysis of 15 Facebook posts on the Osteosarcoma and Ewing’s Sarcoma Support Group about the surgical decision, and 2) a narrative analysis of 20 interviews with survivors and parents about their lived experience. The interview guide was informed by a knowledge translation theoretical model. In-person or video interviews included 29 parents or adolescent-young adults between the ages of 14-71 across 15 states. Results Participants were concerned about making the best decision for themselves or their child. Having little time to make the decision contributes to feeling overwhelmed and uninformed. The lack of information about options, potential limitations, prosthetic needs, and long-term functional outcomes impacts the decision-making process. Resources for finding information are limited. Shared decision-making approaches were preferred though many decisions were made by the surgeon. Patients felt unprepared for complications encountered after limb salvage. Conclusions Limb salvage surgery remains the gold standard for most providers; participants felt there was a bias on the surgeon’s part for salvage. Potential complications and uncertainties of each option were largely omitted in consultations; information about living with a prosthesis is an unmet need for decision-making. The decision affected their quality of life in ways they did not anticipate, resulting in additional decisions. Implications The findings of this study can be used in medical education for orthopedic surgeons to understand the long-term outcomes of limb salvage surgery. Patient preferences matter in the decision and patients who are involved in the decision are more satisfied if they are prepared for the unknown and potential complications. Recommendations for a decision aid include an online format, content that includes a discussion of uncertainties as well as complications of each option, patient stories for long-term outcomes, and resources for psychosocial support.

No description available.

Thesis submitted to the Faculty of Commerce, Law and Management, University of the Witwatersrand, in partial fulfilment of the requirements for the Degree of Master of Management in the Field of Public Policy April 2017 / The study examined the legal framework establishing Kampala Capital City Authority (KCCA) as well as actor interactions within the agency policy process, with an ultimate aim of ascertaining the extent of public decision-making. The study was structured around three main components: an in-depth investigation of the literature on agencification; an application of the institutionalism theoretical framework; and an applied case study approach to examine the extent and context of policy decision making within KCCA. The major finding and indeed central argument is that despite the creation of a central policy-making role enshrined in the law establishing KCCA, the policy outcomes are not influenced by the elected leaders but rather by the central government and as such, there is limited public decision-making. This study has empirically shown that the creation of a matrix agency structure with multiple reporting and accountability centres was a symbolic move intended to dupe elected leaders with superficial status and authority, but in essence, without any real powers to demand policy changes, let alone, be able to sanction bureaucrats for their actions or inaction. The study further affirms that bureaucrats managing KCCA affairs, to a great extent, not only play a policy implementation function, but also disproportionately influence the shape of policy as a consequence of the discretionary powers bestowed upon them by the KCC Act (2010). The paper concludes by highlighting that agencification as one of the new public management (NPM) approaches has increased institutional and policy complexities that alienate citizens and citizen groups from the decision-making process. This reality challenges the existing literature on agencification and New Public Management which claims that once we structurally disaggregate and create semi-independent agencies, then we see bureaucrats who are more accountable to citizens. / MT 2017