Application of ExpressDecision2 in User-Centered and Shared-with-Expert Decisions Under Risk and Uncertainty

Abstract: ExpressDecision2 is a general-purpose web application designed to support the individual in making difficult decisions under uncertainty, which are emotionally driven and typically solved by using rational intuition. This web app is based on the self-regulation model of the thinking process developed within the framework of the systemic-structural activity theory. This paper demonstrates the application of two customized versions of ExpressDecision2: 1. ED2StatinChoice – for making a patient-centered and shared-with-clinician decision about taking statins for cholesterol reduction to prevent a heart attack or stroke. The two primary resources regarding taking statins for cholesterol reduction are The 2018 AHA/ACC Cholesterol Guideline and Mayo Clinic Statin Choice Decision-Aid tool. These and other guidelines and decision aids, as well as information derived from a health professional, provide the patient with essential information regarding the pros and cons of using statins, while also empowering the patient to make the ultimate decision regarding whether they should take statins. Overall, such a problem is both uncertain and difficult for the patient and so requires them to establish both short- and long-term goals, as well as relevant options for selection. ED2StatinChoice is designed specifically to help the patient make the best choice in such a difficult scenario. ED2StatinChoice complements existing decision-support tools, such as the Mayo Clinic Statin Choice Decision Aid. Its method of assistance involves clarifying the goal and various choices with subsequent aggregation of all pros and cons, thus helping make a motivated decision regarding which statin therapy is most preferable. 2. ED2InsuranceChoice – for making a client-centered and potentially shared-with-agent decision about buying an insurance policy in order to reduce financial uncertainty and make accidental loss more manageable. People buy health, car, life, home and other types of insurance to protect themselves from financial loss in the event of illness, car damage, house fire and other accidents, respectively. For example, they make decisions when choosing from among liability, comprehensive and collision insurance types. This decision-making process is guided by tangible statistical factors regarding people’s risks of accidental losses and by non-tangible factors, such as “peace of mind” due to being protected against financial loss in the event of an accident. It is important to note that peace of mind is an essential and decisive factor when selecting an insurance policy. It reflects subjective justification of rate adequacy for the premium: the premium should be reasonable and coverage must be sufficient. Unfortunately, such non-tangible factors as peace of mind from being protected against financial loss in an accident, as well as anxiety from losing money while paying an insurance premium for coverage that doesn’t get used unless you have an accident are not sufficiently reflected in existing models of insurance choice.

Keywords: Systemic-structural activity theory, decision making, web application

DOI: 10.54941/ahfe1001812

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