This study aims to build on Moore and O’Doherty’s (
An often under-appreciated practical problem in the instantiation of deliberative forums is how to recognise endpoints of collective decisions. The challenge here is not only to ascertain the degree of support that is present for a particular position among a group, but also which reasons to attach to the collective decision. Deliberation, as envisaged by most theorists and practitioners in the field, involves detailed and iterative conversations among diverse participants. Participants are expected to listen carefully to each other and be willing to change their positions in light of new information or hearing the perspectives of others (
Moore and O’Doherty (
The purpose of this study is to build on the proposal by Moore and O’Doherty (
During deliberation, participants are encouraged to identify personal values, interests and opinions, highlight potential trade-offs, and test competing moral claims (
If the goal of deliberation is for participants to cultivate a mutually shared position on the issue at hand (
At the public deliberation, 24 participants collectively developed 16 recommendation statements with the help of a trained facilitator. The full list of recommendation statements developed in this public deliberation is provided in Appendix A. After each recommendation statement was produced, the facilitator called a vote during which participants were given three choices; they could choose to support the recommendation, reject the recommendation, or abstain. This vote was made publicly using iClicker devices (Figure
The iClicker device used for deliberative voting.
O’Doherty (
The process of voting and the associated practice of having dissenters and abstainers explain their reasons allows those who disagree with the majority position to have their views heard by the group and officially documented. The recommendation statements and the associated votes and reasons make up the official results of this public deliberation event. O’Doherty (
There are contingencies in deliberative processes that play a role in how conversations unfold and the ultimate outcomes of the deliberation. Arguably, the most notable are the framing of the topic of the deliberation and the actions of the facilitator(s).
The way a deliberation is framed by those who design and facilitate the event will impact both the process and outcomes. Thus, organizers have the ‘communicative power to structure the context of a given deliberation’ (
How issues are framed for a deliberation will also influence policymakers’ ability to take up recommendations made during the event. Therefore, involving decision-makers in the framing of issues and the formulation of questions for deliberation may be both warranted and effective in translating the outcomes of deliberation into policy. At the same time, deliberative practitioners and policy experts should recognize that their understanding of the issue may differ from the participants (
The facilitator is an active participant in the deliberative conversation while simultaneously being an integral part of the event’s structure (
In the analysis below, we examine the discursive dynamics of deliberative voting to further develop our theoretical understanding of the function of embedding voting procedures in deliberative processes. We explore how participants use deliberative voting as a communication tool to signal disagreement. We pay particular attention to the role of the facilitator in the deliberative voting process, and the role of the voting process in shaping the conclusions of the deliberants (i.e., the deliberative outputs).
The data examined in the current study comes from a more extensive project relating to cancer drug funding in Canada (
Cancer is the leading cause of death in Canada (
Bentley and colleagues’ (
The deliberation took place over a two-day weekend in May 2016. Prior to the event, each participant was sent a Citizen Brief (
Throughout the event, participants moved between small-group discussions and large- group deliberations. In small groups, deliberants explored a broad range of perspectives and positions. The purpose of the small groups was to get participants comfortable with the topic and talking to each other. At this point, there was no aim to work towards consensus but rather to explore the topic, hear the views of different participants, and get comfortable expressing perspectives. Participants engaged in a variety of small-group activities including listing their hopes and concerns about how new cancer drugs will be funded, and exploring their personal values by making difficult financial trade-offs for cancer drug funding. Small-group facilitators were instructed to encourage open dialogue, and avoid having the participants draw conclusions (
In the large-group, the purpose shifted to developing recommendation statements for policymakers with the help of a facilitator. The facilitator followed the form of deliberative voting described above. Directly following each vote, the facilitator asked the participants who disagreed with the recommendation to provide reasons for their position. The results of the vote and the reasons given by those who voted against or abstained from voting were officially documented in the deliberative outputs that were distributed to policymakers following the deliberation event (see
Participants were recruited using an online market research company. Twenty-four Nova Scotia residents participated in the two-day deliberation. Participants were selected to represent demographic diversity of the province. More details can be found in
Participant characteristics.
Characteristic | % |
---|---|
25–35 | 25% |
35–49 | 21% |
50–64 | 25% |
65 and over | 29% |
Female | 46% |
Male | 54% |
Less than $20,000 | 4% |
$20,000–$49,999 | 50% |
$50,000–$79,999 | 25% |
$80,000 or above | 4% |
No response | 17% |
High School | 13% |
College or Apprenticeship | 17% |
Some University | 21% |
University or above | 50% |
Aboriginal | 4% |
Black | 13% |
Chinese | 13% |
Filipino | 4% |
Latin American | 4% |
South Asian | 8% |
White | 50% |
Other | 4% |
Experience with chronic disease (personal or as a caregiver) | 54% |
Each participant received an honorarium of $125 per day (to a maximum of $250). Additionally, all expenses, including travel, accommodation and meals were remunerated. All participants consented to participate. Following the ethics protocol, all of the information presented here has been anonymized to protect participants’ confidentiality. All participants are referred to by pseudonyms.
This deliberation event received ethics approval from BC Cancer Agency Research Ethics Board, the University of British Columbia and Simon Fraser University Research Ethics Boards. The Research Ethics Boards at the University of Guelph and the University of British Columbia granted ethics approval for the current study.
During the deliberation, participants are responsible for weighing the validity of the arguments that are presented by their fellow deliberants (
In adopting this position, we are guided by the principles of discursive psychology. Discursive psychology is both a theoretical and a methodological framework for social psychological inquiry (
Deliberative voting is a mechanism that allows for disagreement and refusal to become publicly visible and therefore to be part of the ongoing deliberative dynamics. Voting is helpful because it enables us to conceptualize the act of disagreement through an explicit social action and analyze the consequences for the deliberative process. By conceptualizing the ‘no’ votes and abstentions as social actions, we can use a discursive psychological approach to examine the transcript and identify how disagreement and refusal happen and the social consequences of deliberative voting.
We examined the transcripts from the two-day event to document every instance when a participant voted against a recommendation statement or abstained from voting. We then used a discursive psychological approach and Moore and O’Doherty’s (
First, actual disagreements are based on fundamental value differences that were not overcome, despite the participants’ and the facilitator’s efforts to find common ground. Second, nuanced disagreement occurs when participants seek clarification of particular details to increase the precision of the wording used in the statement. Finally, marginal disagreements occur when ‘the dissent takes the form of a qualification that cannot easily be incorporated into the statement, but also does not constitute actual disagreement with the proposed collective statement’ (p. 316). In the following analysis, we use these three categories as a framework to examine how participants in this deliberation use the process of deliberative voting as a communication tool.
We now demonstrate how the three types of disagreement play out in the deliberation. When viewed as a social action, it becomes evident that participants use the vote to disagree or abstain in rhetorically diverse ways. These rhetorical functions can be roughly fit into the typology of actual, nuanced and marginal disagreements. Additionally, when viewed as a social action, we can analyze the discursive consequences of the unfolding deliberation that have been made visible by the vote.
Throughout the public deliberation event, when participants were asked to share the reason why they voted against a recommendation most constituted actual disagreements. The following excerpts illustrate examples of this form of disagreement. In excerpt one, Lillian articulates her disagreement with recommendation 10, which states: ‘Processes used to make drug funding decisions should be transparent, so the public understands how decisions are made and who is making them.’ Lillian is asked to explain why she voted against the recommendation.
LILLIAN: Myself as part of the public, I would not understand how the decision is made. I wouldn’t understand.
FACILITATOR: Okay.
LILLIAN: It’s just that I’m not qualified. That’s why I have the hope that the committee themselves, who are qualified medical professional, whatever, makes up the whole committee, they’re going to make the decision in my best interest.
FACILITATOR: Okay. So, in other words, just to make sure I’m understanding what you’re saying: Look, you can make this transparent, but I’m not necessarily going to be able to understand.
LILLIAN: I’m just a layman, I don’t understand what you’re making, as long as whatever decision you’re making is going to be in my best interest.
FACILITATOR: Right.
LILLIAN: I leave it up to you.
Lillian describes herself as unqualified to understand how drug funding decisions are made. Lillian refers to herself as ‘part of the public’ (line 1) and as a ‘layman’ (line 10). These descriptions work to position Lillian as passive and unqualified; she says, ‘I would not understand how the decision is made’ (lines 1–2). Lillian contrasts her position of being an unqualified layman with a depiction of committee members as ‘qualified medical professional[s]’ (line 5). Committee members are described as being responsible for making decisions for the public; she says: ‘I leave it up to you’ (line 11).
Lillian suggests that medical professional committee members are responsible for working in the best interest of the public. Lillian repeats this phrase twice in her description: ‘in my best interest’ (lines 6 & 11). Lillian creates a dichotomy between herself as a passive and unqualified layman and expert committee members. Her articulation suggests that drug funding decisions should be within experts’ jurisdiction not the general public.
In Excerpt 1, the facilitator works to clarify Lillian’s argument by rephrasing the argument and presenting it back to Lillian for verification. The facilitator says: ‘So, in other words, just to make sure I’m understanding what you’re saying: Look, you can make this transparent, but I’m not necessarily going to be able to understand’ (Lines 7–9). According to Landwehr (
Excerpt 2 shows how Sam uses the reason giving period to articulate his disagreement with recommendation seven: ‘Evidence of effectiveness must be based on full disclosure to the regulator of clinical trial sample characteristics, full datasets, and it should be peer reviewed.’
FACILITATOR: Okay, yeah. Why no?
SAM: I wouldn’t want this recommendation to stand in the way of a pharmaceutical company potentially bringing a promising drug to market.
FACILITATOR: Okay. I think that’s a really good—that’s a really important to put in here. That we understand that there’s a tradeoff and that some of us are like no, I’m not going to make that tradeoff. Okay.
Sam’s description of the potential for regulation and mandatory reporting to impede pharmaceutical companies bringing drugs to market portrays the process of full disclosure as an impediment to medical progress. This articulation works to construct a dichotomy between regulation and progress. Sam’s ‘no’ vote signals his preference for getting drugs to market over full disclosure to a regulator. The facilitator supports Sam’s position in her reply, ‘we understand that there’s a tradeoff and that some of us are like no, I’m not going to make that tradeoff’ (lines 5–6).
Similar to Excerpt 1, the facilitator validates Sam’s dissenting view and supports the documentation of this perspective as an addendum to the recommendation statement. She says: ‘that’s a really important to put in here’ (line 4). The facilitator calls Sam’s disagreement ‘good’ and ‘important’, and verifies that it will be ‘put in’ to the outputs alongside the recommendation. These statements encourage participants to express views that may be counter to the majority perspective. This works to support a balanced and inclusive environment that allows for equal participation (
To sum up, many of the participants who voted against recommendations, or abstained from voting, expressed actual disagreements in the post-vote reason giving discussions. In almost all instances, the expression of actual disagreement did not lead to a revision of the recommendation statement. Nevertheless, these discussions allowed participants an opportunity to articulate their disagreements to the group of deliberants and to have them documented. Expressing actual disagreements gave participants with minority views an opportunity to have these views represented in the deliberative outputs. In these excerpts, the facilitator provided supportive statements that worked to validate the participants’ dissenting views as valuable and worth including in the deliberative outputs. However, as we will show in the following examples, this is not always the case.
In this section, we examine participants’ use of deliberative voting to signal nuanced disagreement with particular details of the recommendation statements. As described above, in these instances participants advocate for increased specificity of the wording and particular details to be included in the statements.
The following excerpt shows how Hua used the ‘no’ vote to signal disagreement about the scope of recommendation statement 15 (‘Priority should be given to cancer drugs that improve access to treatments where access is poor.’). Hua does not fundamentally disagree with the direction of the statement; rather, she uses her vote to indicate that the wording of the statement should be broadened to include a greater population.
HUA: I kinda, like, already stressed my point. Basically I think as long as it’s improve—well, assuming the two drugs are—all the other factors are the same, then I think as long as it is improved the access to treatment for any patient, I think we should take priority for it, not just only consider when the access is currently poor.
Hua explains that she voted against this recommendation because she disagreed with the phrase at the end of the statement: ‘where access is currently poor.’ She argues that if the drug ‘improved the access to treatment for any patient, I think we should take priority for it’ (line 3). Hua’s description works to construct the recommendation statement as too narrow, and she says that access should be improved broadly, ‘not just only consider when the access is currently poor’ (line 4). Hua voted against the statement because the wording was too restrictive, and she argues that the recommendation should be broadened to include improvement for ‘any patient’ (line 3).
If one were only to look at the results of the vote, and not the reason-giving that follows, it would appear that Hua disagrees that access should be improved. However, when we read Hua’s explanation we see precisely the contrary. Hua voted against the statement because the description of
In the next excerpt, Janet describes why she abstained from voting on recommendation 11: ‘Trustworthy drug funding decisions should not require patient members on their committees.’
JANET: I abstained because I had the same problem in our group. I’m kind of on the fence of whether—I think definitely survivors should be included but I don’t know if a current patient is in the mental state to make the decisions. And I think that’s where I’m coming from. I definitely think survivors should be included. But I don’t know if a current patient would be in the right mental state to make that type of decision.
Janet abstained because she is ‘on the fence’ (line 1) about whether or not she agrees with the recommendation. Although Janet states that cancer ‘survivors should be included’ (line 2) on drug funding committees, she does not know if ‘a current patient would be in the right mental state to make that type of decision’ (lines 4–5). Janet’s reference to the ‘mental state’ (used twice) of current patients is used to justify claims about patients’ inability to make decisions about funding for cancer drugs. This description works to minimize the decision-making capacity of people who are currently experiencing cancer. Simultaneously, Janet works up a representation of former patients that maximizes their value and faculties. Former patients are referred to as ‘survivors’ who should ‘definitely’ be included in decision making.
Janet abstained from voting on this recommendation because the wording ‘patient members’ did not provide enough detail regarding what stage in their cancer journey these members would be. She did not disagree with the notion that people who have personal experience with cancer should be included in decision-making processes. Instead, the abstention signaled a lack of specificity in the recommendation between people who are survivors of cancer and people who are current patients.
In the next excerpt, Graham explains why he abstained from voting on recommendation 12: ‘Trustworthy drug funding decisions should not require members of the general public as participants.’
GRAHAM: I think it’s more the wording of the question than anything else. I think drug funding decisions shouldn’t require members of the public, but I think that it does. It think it makes the decision makers more accountable to have us there.
FACILITATOR: So you think that they should be a part?
GRAHAM: It’s more the wording of the question. Like I feel like it shouldn’t need people to be there to hold them accountable to make the decisions more—do you know what I mean?
FACILITATOR: Yeah.
GRAHAM: But I feel like it—that we do need it.
FACILITATOR: So really we shouldn’t need this in a perfect world but we do need it?
GRAHAM: Yeah.
Graham abstained in response to the ‘wording of the question’ (lines 1 & 5). He implies that decision-makers may be untrustworthy. Distrust is worked up through the suggestion that having members of the public present would increase accountability. The criticism of decision-makers is emphasised by normative claims by both Graham and the facilitator. Articulations are made about what ‘should’ and ‘shouldn’t’ be the case; ‘funding decisions shouldn’t require members of the public, but I think that it does’ (line 2). These statements work to construct decision-makers as failing to fulfill their obligations to members of the public, in instances where members of the public are not present to hold them accountable. Graham’s abstention gives him space to critique the statement’s wording and also the overall trustworthiness of decision-makers.
In summary, deliberants used deliberative voting to express nuanced disagreements relating to concerns about the wording, scope, and specificity of recommendation statements. Nuanced disagreements were more likely than actual disagreements to lead to a revision of the wording of the recommendation statement. This reflects the iterative nature of deliberative voting where the group discussion advances through a continual process of crafting, voting, and revising statements.
Finally, we identified instances in which participants in this deliberation used deliberative voting to articulate what Moore and O’Doherty (
Excerpt 6 shows Oscar explaining his position as the only participant to not vote ‘yes’ on recommendation nine: ‘Life extension is valuable, provided there is reasonable quality of life.’ He explains why he abstained:
OSCAR: All right, so I abstained because while I believe it’s important to provide that context that Marvin was mentioning, and I abstained from voting on the statement because I feel that that was already a common understanding from a previous recommendation.
Oscar provides two reasons for his abstention: ‘it’s important to provide that context that Marvin was mentioning’ (line 1–2), and ‘there was already a common understanding from a previous recommendation’ (line 3). Oscar refers to an additional context that was given about the topic by Marvin, one of the principal investigators (PIs), during the discussion that led to the formation of this recommendation. Oscar argues that because this context did not make it into the final wording of the statement, he abstained. Oscar criticizes the statement for not providing sufficient detail to convey the participants’ position to policymakers adequately. Oscar also discusses a ‘common understanding’ (line 3) from an unspecified previous statement. These descriptions work to construct the recommendation statement as redundant. This description also suggests that the recommendation statements are not free-standing entities, but rather hang together and perhaps build off of one another. Given a previous recommendation, this statement is redundant.
In the next excerpt, we examine the reasons that Emerson and Wyatt report for abstaining from recommendation two: ‘We should discontinue funding a cancer drug when there is another drug available of comparable effectiveness and less cost.’ When asked why they abstained, the participants explained:
EMERSON: Basically the way it’s phrased (inaudible) basically redundant.
WYATT: My point exactly. If basically you’re looking for your best bang for your buck and you do this in all areas, I would think that the government would already be doing this, I would assume.
[Inaudible/overlapping speakers]
WYATT: I was looking at like a way to save money, so I don’t see how this isn’t already being practiced in the system already. I think we’re just saying something that’s being done.
FACILITATOR: Is this a helpful recommendation, Marvin, to our policy friends? Is this something that is so, of course they’re doing this.
MARVIN (PI): I’d like to say it was redundant, but it’s not. This is a very helpful recommendation for the policymakers.
FACILITATOR: Does that change your vote at all? It doesn’t have to, it doesn’t have to. Do we want to make one more about the ‘better than’ one or are we still getting pooped out or—
GEORGIA: We’re tired.
Emerson describes the recommendation as ‘basically redundant’ (line 1), and Wyatt agrees: ‘My point exactly’ (line 2). The practice of discontinuing funding is described as an obvious procedure that the government would ‘already’ (used three times) be doing to save money. The obviousness of this procedure is worked up through the descriptions that Wyatt provides, such as ‘I would assume’ (lines 3–4) and ‘you do this in all areas’ (line 3). These phrases work to normalize the practice under question and present it as something that is obviously already being done by policymakers. Together, these descriptions work to present the recommendation as redundant.
When the facilitator asks the PI, Marvin, if this is a useful recommendation, he responds by telling the group that it is. Marvin says: ‘I’d like to say it was redundant, but it’s not. This is a very helpful recommendation for the policymakers’ (lines 10–11). Following this statement, the facilitator asks the participants if they would like to change their votes in light of this new information. This invitation for participants to change their votes works to encourage an open and uncoercive speech environment (
Abstaining from voting on this recommendation opened a conversation with the PI, Marvin, about whether this statement would be helpful to policymakers. As for previous examples, this action also gave participants an opportunity to have their concerns officially documented in the deliberative outputs.
Recent years have seen a growing interest in methods aimed to engage ordinary citizens in deliberative decision making (
This analysis illustrates how deliberative voting can effectively work as a communication tool in public deliberation, as suggested by O’Doherty (
The process of documenting minority views provides policymakers with more context and details than the statements and vote tallies would on their own. When the facilitator called on those who had voted against a recommendation or abstained, most participants expressed actual disagreements with the statement. These disagreements may reflect fundamental value differences that persisted despite the participants’ and facilitator’s efforts to find common ground. Documenting actual disagreements alongside the deliberative outputs ensures the preservation of minority views and thus allows policymakers to consider these diverse perspectives in their decision-making. In contrast, nuanced disagreements led to changes in the wording of recommendation statements more often. In these instances, participants articulated issues with the specific wording, scope, or specificity of the statements. Finally, participants infrequently expressed marginal disagreements and did not appear to influence the wording of statements.
In processes that use deliberative voting, the facilitator decides when the process of deliberative voting will begin, and when it ends; thus, ‘[t]he facilitator is both part of the structure within which deliberation is supposed to emerge, and self-evidently a participant in the actual discourse itself’ (
To produce a voting process that is both deliberative and iterative, facilitators should take time to encourage dissent, and explore participants’ reasons for disagreement. In the examples discussed here, we showed how the facilitator does this through asking questions, clarifying, validating, seeking more information from PIs and giving deliberants opportunities to change their votes in light of new information. In the final extract we saw how the facilitator invited a PI into the conversation to provide additional context to participants who argued a recommendation was redundant. Once presented with the information that this recommendation was not, in fact, redundant for policymakers, she invited the deliberants to revise their votes. Thus, the facilitator ensures that voting is an iterative process, in which the deliberants are presented with opportunities to change their individual votes, or revise the recommendation statement, in light of new information. This process may provide those participants whose style of communication deviates from the norms of deliberation an explicit opportunity to have their minority positions heard by the group and represented in the deliberative outputs.
Given the important role that organizers and facilitators of deliberative events have in shaping the official conclusions of a deliberative forum, their practice could be enhanced by engaging in reflexive investigation into the ways in which power operates within the structure and practice of deliberation. Blue and Dale (
Through consistent inquiry into how issues are framed and given meaning in particular institutional settings, deliberative practitioners are better positioned to ask neglected questions about how knowledge and power are wielded in practical settings and how existing power relations might be negotiated so that marginalized perspectives and values are given a fair hearing (
The following suggestions may provide guidance for practitioners and facilitators who are interested in engaging in reflexive investigation into how aspects of their practice may influence the process and outcomes of deliberation. First, facilitators should recognize that whom they call on in the reason-giving period will reflect which of the minority views get documented alongside the voting results. Second, practitioners and facilitators alike should be aware of their role in co-producing the outputs of the deliberation. Third, when participants express a disagreement that does not include a direct suggestion for how the wording of the recommendation should be changed, facilitators may find it useful to ask the participant to make an explicit wording suggestion. Finally, facilitators should consider the power and position of event organisers (such as, for example, principal investigators) when they call on them to participate in the conversation. Future research may investigate how facilitators’ social locations, style of communication, and framing of the issues influences the process of deliberative voting and the ultimate outputs of deliberation.
One potential limitation of our study is that the social processes and facilitation described in this analysis are context-specific and cannot be directly transposed onto other deliberating groups. Although the conclusions drawn here may not be directly generalizable to other deliberation events, they may provide helpful information for deliberative practitioners who utilize deliberative voting techniques.
Deliberative voting provides an effective method of identifying collective endpoints of deliberation. We suggest that deliberation facilitators and practitioners should continue to investigate their roles in influencing the collective decisions generated in public engagement forums. In this article, we have used a discursive psychological approach to examine how participants use deliberative voting as a tool to communicate disagreement in a public deliberation event on funding for cancer drugs in Canada. This analysis builds on a small but growing area of research in social psychology on public deliberation. Future research should continue to investigate the social processes taking place within deliberation events.
Recommendation Statement | Yes | No | Abstain |
---|---|---|---|
1) When we are making recommendations, we take into account some factors. For example, we all agree that prevention is of the utmost importance. | 24 | 0 | 0 |
2) We should discontinue funding a cancer drug when there is another drug available of comparable effectiveness and less cost. | 21 | 1 | 2 |
3) There should be baseline criteria for funding any drug. | 24 | 0 | 0 |
4) Baseline criteria for funding any cancer drug should include moderate improvements to at least one of the following: quality of life, length of life, cost-effectiveness. | 20 | 2 | 2 |
5) Approved drugs should be re-reviewed based on post-approval data. | 24 | 0 | 0 |
6) The most important criteria to consider when funding cancer drugs is… |
– | – | 4 |
7) Evidence of effectiveness must be based on full disclosure to the regulator of clinical trial sample characteristics, full datasets, and it should be peer reviewed. | 23 | 1 | 0 |
8) When considering new drugs, we need to consider the costs and benefits of existing drugs. And if needed, to delist the existing ones and with grandfathering allowed for those people who are still on it. | 24 | 0 | 0 |
9) Life extension is valuable, provided there is reasonable quality of life. | 23 | 0 | 1 |
10) Processes used to make drug funding decisions should be transparent, so the public understands how decisions are made and who is making them. | 23 | 1 | 0 |
11) Trustworthy drug funding decisions should not require patient members on their committees. | 9 | 14 | 1 |
12) Trustworthy drug funding decisions should not require members of the general public as participants. | 5 | 18 | 1 |
13) The public and public values should play a role in cancer drug funding decisions and this should happen in different ways and at different times. So maybe the public sitting on funding committees, or on citizen panels, for example. | 21 | 1 | 2 |
14) How cancer drugs are administered should not restrict whether funding is provided for them, whether that be in the hospital or in the community. | 22 | 2 | 0 |
15) Priority should be given to cancer drugs that improve access to treatments where access is poor. | 18 | 6 | 0 |
16) There should be a pan-Canadian approach to cancer drug funding decisions, not just funding recommendations. | 24 | 0 | 0 |
We thank Dr. Colene Bentley for her administrative support, and Drs. Michael Burgess, Stuart Peacock, and Julia Abelson for inviting us to contribute to this research project. We also thank two anonymous reviewers for insightful and constructive feedback that helped us strengthen the article.
This research was supported by funding from the Ontario Ministry of Research and Innovation (ER14-10-056).
The authors have no competing interests to declare.
K.S. led the writing of the manuscript with the support and supervision of K.O. Both authors contributed to all sections of the final manuscript.