Example (2). The policy-level identified objectives for
implementing genetic testing at premarital visits include lowering
disease burden, suffering, and death due to fewer congenital diseases,
and social and cultural acceptance of testing and their consequences.
Possible generated data use could be a secondary objective to inform
patient care and policy, such as in precision medicine development.
There are also important objectives protecting patients’ privacy,
avoiding exposure of genetic information, financial requirements
planning, and community acceptance.
Development
In the development step, alternatives are sought. Searching for an easy,
readymade decision idea imposition process or a search and discovery
process is required if no ready solution is available or not seen as
suitable by the decision-maker, which necessitates the design of
custom-made decisions or innovation.
Example (1). Statin is used for primary prevention,21 its use has been studied extensively, and
well-developed guidelines exist to support decision-making.
Nevertheless, there are reports of deficiencies in reporting harm .22 Therefore, the development of decision
options requires research and credible references. Differences in
patients’ risk profiles and contexts necessitates the development of
alternatives before making decisions. Possible decision alternatives
could include starting with lifestyle changes and low- or
moderate-intensity statins or the same first step and adding statin if
lipid therapeutic targets are not met. Another alternative is to start
with high-intensity statin or a combination of more than one
lipid-lowering medication. Based on data from the identification step,
decision options are altered. If the patient has additional risk such as
chronic kidney disease, the search will be expanded to adapt
alternatives for this additional risk.