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Thesis (M.S. in Computer Science) Naval Postgraduate School, June 1997. / Thesis advisors, LuQi, Valdis Berzins. Includes bibliographical references (p. 79-80). Also available online.

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Aims: This thesis had three aims: to review evidence evaluating the effectiveness of decision aids at increasing cancer patients’ treatment-related knowledge and reducing decisional conflict; to explore the decision-making processes of ovarian cancer patients who had opted for or against CA-125 testing during post-treatment surveillance; and to elicit patients’ and health professionals’ views on the proposed development of a decision aid aimed at helping women decide for or against CA-125 testing during post-treatment surveillance for ovarian cancer. Methods: A systematic review was conducted of evidence relating to the effectiveness of cancer treatment-related decision aids at increasing treatment-related knowledge and reducing decisional conflict. In the qualitative study, semi-structured interviews were conducted with ovarian cancer patients (n = 18) and health professionals (n = 6) in an outpatient gynecological oncology clinic. Framework analysis was used to identify themes in the qualitative data. Results: Overall, results from the systematic review supported previous research where decision aids were found to improve patient knowledge and reduce decisional conflict across a range of cancer treatment-related decisions. However, the lack of psychometric support for the treatment-related knowledge measures used in the majority of the studies compromised their ability to address the review question. In the qualitative study, accurate knowledge about CA-125 testing in post-treatment surveillance was found to greatly influence participants’ decision-making processes. Most women with less knowledge about the test chose to have testing based on the false belief that earlier detection of recurrence would lead to earlier treatment and prolonged survival. There was strong enthusiasm from patients and health professionals for the development of the proposed decision aid to assist women facing this treatment decision. Conclusions: The systematic review findings add to previous research supporting the use of decision aids in cancer-related treatment decisions and advocate for their continued development, evaluation and implementation into the healthcare system. The need for a decision aid to ensure accurate knowledge about CA-125 and to aid decision-making for women with ovarian cancer was supported. As well as assisting women with this decision, the proposed decision aid may ultimately support health professionals in practicing shared decision-making regarding CA-125 testing with ovarian cancer patients.

Medical Assistance in Dying (MAID) was legalized in Canada in 2016. In 2021, an update in legislation included changes to MAID eligibility and procedural safeguards. Guided by the Ottawa Decision Support Framework (ODSF), the overall aim was to describe how Canadian patients considering MAID are being supported in making the decision about end-of-life care. Eleven articles were included in the literature review. ODSF themes are evident in MAID literature. Nurses play key roles in end-of-life decision-making. Environmental scan of publicly available MAID resources identified 58 eligible resources. Sixty-nine percent of MAID resources were updated with 2021 legislation. None met the International Patient Decision Aid Standards criteria. Thirty met Patient Education Materials Assessment standard for adequate understandability and 11 for actionability. Although patient decision aids are effective for supporting health care decisions, none exist for MAID and current resources are inadequate for supporting people of lower health literacy.

An auditor performing analytical review must typically diagnose material variances of observed client data from his/her own expectations. The auditor may utilize a decision aid to help in generating potential explanations for a variance; it has, however, the capacity to provide many more explanations than are possible using other means. Under the circumstances of budgetary constraints and limited cognitive load for beginning an information search with these explanations, the auditor may consider the lengthy list and arrive at a more manageable sub-list of the most probable explanations. In doing so, the auditor either eliminates those explanations that are less likely or includes those that are more likely into a reduced list for further consideration. While the goal under either approach is the same-to reduce the list-studies in psychology have shown that those including will reduce the list to a much greater extent than those eliminating. If the auditor begins an information search with this reduced list of explanations, then whether the auditor uses inclusion or elimination may have effectiveness and efficiency implications for the remainder of the analytical review process. The auditor must also contend with risk in the audit environment, which also may influence the manner in which the auditor reduces the lengthy list of explanations. A risky audit environment is generally related to heightened auditor skepticism and increased audit effort, as predicted by the audit risk model (SAS 47, AICPA 1983). Each of these translates into the desire to pursue a greater number of plausible explanations in a high risk environment than in a low risk environment. Therefore, an auditor would be expected to reduce a decision-aid-provided list of explanations to a lesser degree in a high risk environment than a low risk environment. The purpose of this dissertation was to investigate the occurrence of a goal framing effect at varied levels of client risk. Using a two-way between subjects design, auditors in this study either eliminated or included explanations from a decision-aid-provided list in a low risk or high risk analytical review setting. As suggested by the goal framing theory, auditors who eliminated concluded with significantly more explanations than those who included. Furthermore, as suggested by the audit risk model, auditors in a high risk environment concluded with significantly more explanations than auditors in a low risk environment. Because previous auditing literature provides that auditor conservatism, which is heightened in periods of high risk, often mitigates biases and heuristics found in the general decision making or psychology literature, it was also predicted that in the high risk scenario, the influence of high risk in enlarging the set of explanations would overcome the influence of the inclusion goal framing in reducing the set of explanations. No support was found for this interaction. The results of this study have implications for the implementation of decision aids in practice. This study advises that in various client risk settings, auditors evaluating a lengthy decision-aid-provided list of explanations by inclusion may arrive at a significantly smaller number of explanations than by elimination. Given that the subsequent step of analytical review-information search-is planned according to what the auditor believes are the plausible hypotheses, goal framing may have an impact on the overall efficiency and effectiveness of analytical review, in both high and low risk client scenarios. / Ph. D.

Background Screening for prostate cancer is debated, there is conflicting data on the net benefit of screening. Men who consider screening need to be informed on the pros and cons. Rehospitalization after surgery can be used as an indicator of general quality of care. For radical prostatectomy, little is known on the readmission rate after surgery. Men diagnosed with low- and intermediate-risk prostate cancer have low prostate-cancer specific mortality. However, adverse effects after curative treatment can be severe and decrease quality of life. Curative treatments for prostate cancer differ mainly in the pattern of adverse effects but detailed analysis of long-term adverse effects is lacking. The aim of this thesis was to assess the perioperative quality of radical prostatectomy and the risk of adverse effects after curative treatment for prostate cancer. Material and Methods In this thesis, data from the National Prostate Cancer Register (NPCR) and other nationwide Swedish registers were used. By use of the Swedish personal identity number, NPCR was cross-linked to other registers creating Prostate Cancer data Base Sweden (PCBaSe), a large dataset for research. Results The proportion of men who had received information on the pros and cons of screening for prostate cancer with PSA testing was low (14%) indicating that the majority of men who were screened did not make an informed decision. The risk of rehospitalization within 90 days after radical prostatectomy was approximately 10% and similar after retropubic and robot-assisted radical prostatectomy. Compared to controls, there was an increased risk of adverse effects after both radiotherapy and radical prostatectomy up to twelve years after treatment and the overall risk was quite similar after retropubic and robot-assisted radical prostatectomy. Conclusion Improved information to men on the pros and cons of PSA screening is warranted. The risk of adverse effects was elevated up to 12 years after curative treatment for prostate cancer. The pattern of adverse effects was different after radiotherapy and radical prostatectomy but quite similar after retropubic and robot-assisted radical prostatectomy.

Purposes/Aims: The aim of this study was to create a web-based brokerage of patient decision-making aids, titled Split Decision™, and to evaluate student nurse and student nurse practitioners' intent to use and recommend the prototype website based on their perceived usability, usefulness and satisfaction. Rationale/Background: Adult patients frequently report confusion about treatment options, hindering their ability to fully participate in healthcare decision-making. Over 500 patient decision-aids exist on the internet, but are scattered across dozens of websites. Creation of a web-based decision-aid platform would utilize the existing information-seeking habits of patients, but provide them with evidence-based information when evaluating treatment options. Methods: Exemplar decision-aids were chosen from the 563 decision-aids published in the Ottawa Research Institute database and posted on a decision-aid brokerage website. Online access to the website was offered to study participants (n=29) from May to June 2016. Demographic information, quantitative and qualitative responses were collected from each website user and analyzed to evaluate perceived usability, satisfaction, and intention to use the pilot website. Results: Usability of the Split Decision™ website was found to be above average on Systems Usability Scale ratings. Participants rated the website highest on visual appeal and clear terminology on quantitative measures. Qualitative responses cited confusion with the navigation of pages and hyperlinks as areas of future improvement. Conclusion: Study participants expressed a hope for future expansion of the website to other topics and patient populations. Further study of the Split Decision™ website will be planned to test revisions suggested during by participants during this doctoral project.

The fair-value hierarchy used in financial accounting has been criticized because of its complexity being the reason for several accounting issues. This study examines the underlying factors affecting decision makers in the process of fair-value accounting of financial instruments within the fair-value hierarchy. Research has been conducted through in-depth interviews with representatives of five Swedish banks. The findings have been analysed with a frame of reference built on prior judgment and decision making research. The results of the study show that the extent of the affecting factors vary between different banks depending on the banks' individual prerequisites.

Consumer decision behavior has been an interesting research topic for researchers and marketing people. While E-Commerce websites and online self-service are becoming more and more popular, it is important to understand how to support consumer in their online shopping decision process. The purpose of this research is to understand how consumer¡¦s decision behavior would be influenced in online shopping environment, when facing different product price and complexity, and discover the personal factors that might influence it¡¦s decision behavior. The result of our research showed that product complexity has significant influence on consumer¡¦s decision behavior. When product complexity become higher, the effort and time for a consumer to complete a purchase decision will also become higher. When consumer is more familiar with the product, more involve with the product, or have higher computer self-efficacy, consumer will use much harder decision tools then usual. But our result also showed that product price has no influence on consumer¡¦s decision behavior, this might be that in our experiment, consumers don¡¦t really have to pay for the product, so the influence of product price has no effect on consumer. From our result we can know that for different product complexity and consumer will result in different decision behavior. In the future, online shopping store can provide different decision tools for different consumer when facing different products, to help consumer make better decision.