<p><strong>Introduction. </strong>Treatment decisions for locally recurrent prostate cancer are difficult due to the number of available treatment options, varied evidence about their effectiveness and differences in side effects. It has been shown that decision aids improve information delivery and patient confidence in treatment decision-making.</p> <p><strong>Purpose.</strong> The purpose of this study was to identify and describe the decisional support needs of men with locally recurrent prostate cancer.</p> <p><strong>Methods.</strong> A two-phase descriptive needs assessment study employing both quantitative and qualitative methods was conducted to identify and describe the treatment decision-making needs of men with recurrent prostate cancer. Through a two-round Delphi process in Phase 1, physician consensus on treatment options for the decision aid was established. Phase 2 involved patient interviews to determine treatment decision-making needs.</p> <p><strong>Results.</strong> Oncologists and patients agreed that the treatment decision-making process took time, and may take several months. Some patients described feelings of regret and/or uncertainty about their treatment decision. Individualized patient needs for information and support were recognized. Key barriers to effective treatment decision-making included information overload and lack of access to unbiased information sources. Establishing a centralized information resource such as nurse-led information sessions was recommended by patients.</p> <p><strong>Conclusions.</strong> Treatment decision-making is time consuming for oncologists and patients. Despite these efforts, patients report unmet information needs and are not always confident in their treatment decision. Time efficient and effective ways of improving patient confidence in treatment decision-making, as well as implications for nursing practice and future research are discussed.</p> / Master of Science in Nursing (MSN)

Le travail de thèse présenté dans ce mémoire porte sur des méthodes d'optimisation pour la conception conjointe des nomenclatures d'une famille de produits et de sa chaîne logistique. Dans les milieux industriels comme dans les services, le contexte commercial très concurrentiel oblige les entreprises à diversifier leurs offres pour mieux répondre aux demandes de leurs clients. La gestion de cette diversité est alors une problématique centrale : comment proposer une large variété de produits pour satisfaire les besoins des clients tout en maîtrisant les coûts de production, d'inventaire et de logistique ? Les réponses à ce problème relèvent des disciplines habituellement séparées : la conception des produits, la production et la logistique. Si une majorité des approches existantes traitent ces problématiques de façon séquentielle, l'interdisciplinarité apparaît cependant comme un élément essentiel dans la gestion de la diversité. L'objectif de cette thèse est de chercher comment améliorer les interactions entre la conception de familles de produits et l'optimisation des réseaux logistiques en proposant une étape de conception intermédiaire et en développant des outils mathématiques, avec un intérêt particulier porté aux problématiques de développement durable. / This PhD thesis addresses the problem of joint bills-of-materials and supply chain design for a product family. In industry as well as in services, the highly competitive business environment obliges companies to diversify their offers to meet the demands of their customers. Then, managing diversity is a central issue: how to offer a wide variety of products to meet customer needs while controlling costs of production, inventory and logistics? Answers to theses problems are usually in separate disciplines: product design, production and logistics. If most of existing approaches tackle these problems sequentially, interdisciplinarity, however, appears as a key aspect of diversity management. The objective of this thesis is to investigate how to improve the interaction between product families design and supply chain optimization and to develop mathematical tools, with a focus on sustainable development.

Introduction: Les incertitudes des pronostics cliniques et les dilemmes moraux associés aux technologies des tests prénataux affectent les expériences et les processus décisionnels des femmes et des couples. D’une part, la validité des normes relatives au ‘consentement autonome’ et au conseil ‘non directif’ est remise en question. D’autre part, les aides à la décision sont prônées pour rehausser la prise de décision éclairée. L’objectif de ce mémoire est de construire un modèle de l’expérience des femmes et des couples qui font face aux tests prénataux afin d’identifier les facteurs qui amélioreraient les expériences, la prise de décision et le rôle des aides à la décision et informeraient le modèle de soin. Méthodologie: La modélisation et l’analyse des expériences des femmes et des couples qui affrontent les tests prénataux reposent sur une méta-ethnographie des études qualitatives et sur une analyse narrative thématique des études quantitatives. La critique d’un outil (PT) en matière de tests prénataux est également effectuée en ayant recours aux critères de qualité de l’International Patient Decision Aid Standards (IPDAS). Résultats: Un cadre conceptuel décrivant les expériences vécues est construit et l’analyse thématique le complète en soulignant que la prise de décision n’est que rarement éclairée. Les normes d’une ‘décision autonome’ et d’un ‘conseil non directif’ sont problématiques pour les femmes. Les aides à la décision amélioraient les scores de connaissances, sans pour autant modifier la perception du risque, ni les niveaux d'anxiété. L’outil PT favorise une prise de décision basée sur les préférences, mais les critères IPDAS sont difficilement applicables et leur rôle dans une décision de qualité est incertain. Discussion et conclusion: Les résultats éclairent les facteurs macro, méso et micro pouvant améliorer les expériences vécues des femmes et des couples et affecter la prise de décision et l’utilisation des aides à la décision. Un changement de paradigme préconisant le concept d’autonomie relationnelle dans le modèle de soins est suggéré. Dans le contexte des avancées en matière de test prénataux, une réévaluation des normes de pratique et de modèles de soin est requise. Le rôle des aides à la décision devra être élucidé. / Introduction: The clinical prognostic uncertainties and moral dilemmas associated with technological advances of prenatal testing impact the experiences and decision-making of women and couples. While the validity of the norms of ‘autonomous consent’ and ‘non-directive’ counseling is being questioned, decision aids are promoted to enhance informed decision-making. The goals of this thesis are to develop a model of the experiences of women and couples in prenatal testing so as to identify factors that may improve experiences, decision-making, the role of decision aids and inform the care model. Methods: A model of the experiences of prenatal testing is developed through a meta-ethnography of qualitative studies and a narrative synthesis of the themes explored in quantitative studies. A prenatal testing (PT) decision tool is critically assessed using the International Patient Decision Aids Standards (IPDAS) quality criteria for decision aids. Results: A conceptual framework of the experiences of women and couples in prenatal diagnosis is constructed and complemented by a narrative thematic analysis showing that decision-making is rarely informed and that the norms of an ‘autonomous decision’ and a ‘non-directive’ counselling are problematic for women. Decision aids improve knowledge scores, but do no modify risk perception or anxiety levels. A PT tool increases preference based informed decision-making, but quality criteria are not always applicable and their role in quality decision-making is unclear. Discussion and conclusion: The results highlight macro, meso and micro-level factors that may improve the experiences of women and couples and inform decision-making processes as well as the use of decision aids. A paradigm shift towards the concept of relational autonomy in the prenatal diagnosis model of care is suggested. Advances in prenatal testing require a re-evaluation of the norms of practice and care model. The role of decision aids requires further elucidation.

The literature suggests that informed consent documents (ICDs) are not well understood by research participants. The patient decision aid model may suggest improvements for the informed consent process, particularly in the critical care setting (ICU) because of patient capacity issues. Our goal was to evaluate the extent to which existing ICDs used in ICU research adhere to standards and recommendations for high quality informed consent. Eighteen items from recommendations specific to ICU trials were added to a previously developed ICD evaluation tool. A sample of ICU trials was identified from clinicaltrials.gov database and the investigators contacted for their trial ICD. Conformity to the recommendations was variable. Some information are found routinely in consent documents for critical care research and some are not. Efforts should aim to establish tools for measuring decision quality in the ICU with the goal of facilitating and helping patients and surrogates work through trial participation decisions.

Au vu de la prévalence significative des événements indésirables liés aux médicaments, ainsi que du risque croissant de résistance aux antibiotiques (causée principalement par les prescriptions inappropriées et une utilisation excessive), nous proposons une architecture générale pour des systèmes de recommandation adaptés à ce type de contexte et nous en développons un pour la prescription d’antibiotiques (PARS). Le type de contexte pour lequel l’approche est proposée est caractérisé par des décisions à haut risque et/ou à enjeux importants. Le système ne peut être basé sur l’apprentissage car une base de données de cas n’est pas disponible. Toutefois, des connaissances et des règles de bonnes pratiques existent et de ce fait il convient de développer un système capable de les modéliser et de les mettre en oeuvre. Le système est destiné à un utilisateur qui est le décideur qui doit adapter sa décision à chaque sujet dont les besoins et les caractéristiques sont spécifiques. Le modèle doit pouvoir s’adapter à différents types d’évolutions. L’approche est basée sur la combinaison des technologies web sémantique avec un modèle d’aide multicritère à la décision. Le système comporte deux étapes. Compte tenu de la spécificité du domaine d’application, l’approche évalue d’abord la pertinence d’une alternative (action) pour un sujet et un besoin donnés dans un contexte spécifique. Le premier niveau du modèle d’aide à la décision est de sélectionner selon le besoin l’ensemble des alternatives qui ont le potentiel d’être appropriées. Le deuxième niveau consiste à évaluer et à trier les alternatives dans des catégories en fonction de leur adéquation. Nous proposons une approche qui exploite les schémas de connaissances du web sémantiques (ontologies) et qui structure les règles de recommandation en une méthode de tri adaptée : MR-Sort avec Veto. Cette approche permet de lier et de mettre en correspondance des sources de connaissances hétérogènes exprimées par des experts. En collaboration avec le Centre hospitalier EpiCURA, nous avons appliqué cette approche dans le domaine médical et plus précisément, pour la prescription des antibiotiques. Les performances de l’approche ont été comparées aux recommandations données par EpiCURA. Les résultats ont montré que le système proposé est plus détaillé dans ses recommandations par comparaison aux guidelines en usage au Centre EpiCURA. En prenant éventuellement en compte des caractéristiques supplémentaires des sujets, le modèle est capable de s’adapter à des changements dans le contexte (nouveaux antibiotiques, effets secondaires, développement de germes résistants). / Motivated by the well documented worldwide spread of adverse drug events that are associated to antibiotics usage, as well as the increased danger of antibiotic resistance (caused mainly by inappropriate prescribing and overuse), we propose a general architecture for recommendation systems adapted for this kind of context and we develop a specific system for antibiotic prescription (PARS). The type of context that our architecture covers is characterised by highly risky decisions or decisions with high stakes. Such a system cannot be based on machine learning, since there are no available training data sets or case bases. However, rules of good practice and expert knowledge are available, therefore our system should be able to model and implement them. The proposed solution is intended to be used by a decision maker who must adapt his/her decision both to each subject’s specific needs and characteristics, as well as to different types of evolution. Our approach is based on the combination of semantic technologies with MCDA (Multi-Criteria Decision Aids). The decision support process involves two steps. First, by taking into account the specific application domain, the approach evaluates the relevance of each alternative (action) in order to satisfy the needs of a given subject. The first level of the decision support model aims to select all the alternatives that have the potential to fulfill the subject’s needs. Subsequently, the second level consists of evaluating and sorting the selected alternatives in categories according to their adequacy to the characteristics of the subject. We propose an approach that exploits the knowledge schemes of semantic web technologies (ontologies) and that structures the recommendation rules into a suitable sorting method: the MR-Sort with Veto. By doing so, our solution is able to link and match heterogeneous knowledge sources expressed by experts. In collaboration with the EpiCURA Hospital Center, we have applied this approach in the medical domain and more specifically in the prescription of antibiotics. The system’s recommendations were compared with those expressed in the guidelines currently in use at EpiCURA. The results showed us that PARS allows for a better consideration of the sensitivity of the patients to the adverse effects of antibiotics. Moreover, by taking into account the additional characteristics of the patients, the model is able to adapt to contextual changes (such as new antibiotics, side effects and development of resistant micro-organisms).

In recent years, AI has received increased attention in the field of marketing and is believed to grow even more in the future. It seems that the use of AI in marketing has a significant impact on consumer value creation. The purpose of this thesis is to explore how consumers experience the role of AI-marketing within the scope of the online customer journey, including how both positive and negative aspects of AI-based decision aids influence their value co-creation. Based on previous research, a conceptual model was created to determine whether consumers co-create or co-destroy value in the interactions with AI-based decision aids, as well as which types of values that are the outcomes. Three focus groups were used as a qualitative method to collect empirical data. Findings resulted in two main insights. Firstly, consumers experience the role of AI-based decision aids positively and can co-create values regarding economic and efficiency benefits, facilitation of information search, and more inspiring, personal and relevant experiences. Secondly, AI-based decision aids are also perceived negatively and contribute to co-destruction of value as well. Consumers experienced negative aspects regarding manipulation, limitations and loss of integrity and autonomy, as well as risks of overspending, being misled and distracted, and having irrelevant experiences. This thesis contributes with new insights into the consumer perspective of AI-marketing. Marketers can use these results to understand consumers’ value creation and avoid the negative aspects to achieve the best possible AI-marketing strategies.