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Introduction This paper presents the preliminary results of a decision-tree analysis of Patient Decision Aids (PDA). PDAs are online or offline tools used to structure health information, elicit relevant values and emphasize the decision as a process, in ways that help patients make more informed health decisions individually or with relevant others. Method Twenty PDAs are randomly selected from the International Patient Decision Aids Standards (IPDAS) ( https://decisionaid.ohri.ca/AZlist.html ) approved list. An evaluation tool is built bottom-up and top-down and results are described in terms of communicating uncertainty, completeness of the decision tree, ambiguous or misleading phrasing, overall strategies suggested within personal stories. Results Twelve of the analyzed PDAs had branches of the decision tree which were not discussed in the tool and 6 had logically ambiguous phrasing. Many tools included dichotomous options, when the option range was wider. Several options were clustered within the “Do not take/Do not do” option and thus the PDA failed to provide all comparisons necessary to make a decision. Some tools employ expressions that do not differentiate between lack of information and known negative effects. Other tools provide unequal amounts or non-comparable bits of information about the options. Conclusion These results indicate a very loose range of interpretations of what constitutes an option, a treatment, and a treatment option. It thus emphasizes a gap between theory and practice in the evaluation of PDAs. Future developments of PDA evaluation tools should keep track of missing decision tree branches, accurate communication of uncertainty, ambiguity, and lack of knowledge and consider using measures for evaluating the completeness of the option spectrum at an agreed period in time. Electronic supplementary material The online version of this article (10.1186/s12911-019-0840-x) contains supplementary material, which is available to authorized users.

This article is meant to describe and analyze some of the ethical difficulties encountered in a pilot research on treatment decisions of patients with chronic viral hepatitis C infection in Romania. It departs from an overview of the main ethics codes, and it shows that social health research on patients falls in between institutional codes of ethics. Furthermore, the article moves on to analyze so-called "important moments" of empirical research, such as the implementation of the ethical protocol, dealing with informal payments and with information on shady actions, as well as requests of information from interviewed patients and deciding when and if to breach confidentiality. In an attempt to evaluate the ad hoc solutions found in the field, the concluding remarks discuss these issues at the threshold of theory and practice.

In a previous paper, the evolution of certainty measured during a consensus-based smallgroup decision process was shown to oscillate to an equilibrium value for about twothirds of the participants in the experiment. Starting from the observation that experimental participants are split into two groups, those for whom the evolution of certainty oscillates and those for whom it does not, in this paper we perform an analysis of this bifurcation with a more accurate model and answer two main questions: what is the meaning of this bifurcation, and is this bifurcation amenable to the approximation method or numerical procedure? Firstly, we have to refine the mathematical model of the evolution of certainty to a function explicitly represented in terms of the model parameters and to verify its robustness to the variation of parameters, both analytically and by computer simulation. Then, using the previous group decision experimental data, and the model proposed in this paper, we run the curve-fitting software on the experimental data. We also review a series of interpretations of the bifurcated behaviour. We obtain a refined mathematical model and show that the empirical results are not skewed by the initial conditions, when the proposed model is used. Thus, we reveal the analytical and empirical existence of the observed bifurcation. We then propose that sensitivity to the absolute value of certainty and to its rate of change are considered as potential interpretations of this split in behaviour, along with certainty/uncertainty orientation, uncertainty interpretation, and uncertainty/certainty-related intuition and affect.