Sladek Ruth M, Phillips Paddy A, Bond Malcolm J
Flinders University, Adelaide, South Australia.
Implement Sci. 2006 May 25;1:12. doi: 10.1186/1748-5908-1-12.
A better theoretical base for understanding professional behaviour change is needed to support evidence-based changes in medical practice. Traditionally strategies to encourage changes in clinical practices have been guided empirically, without explicit consideration of underlying theoretical rationales for such strategies. This paper considers a theoretical framework for reasoning from within psychology for identifying individual differences in cognitive processing between doctors that could moderate the decision to incorporate new evidence into their clinical decision-making.
Parallel dual processing models of reasoning posit two cognitive modes of information processing that are in constant operation as humans reason. One mode has been described as experiential, fast and heuristic; the other as rational, conscious and rule based. Within such models, the uptake of new research evidence can be represented by the latter mode; it is reflective, explicit and intentional. On the other hand, well practiced clinical judgments can be positioned in the experiential mode, being automatic, reflexive and swift. Research suggests that individual differences between people in both cognitive capacity (e.g., intelligence) and cognitive processing (e.g., thinking styles) influence how both reasoning modes interact. This being so, it is proposed that these same differences between doctors may moderate the uptake of new research evidence. Such dispositional characteristics have largely been ignored in research investigating effective strategies in implementing research evidence. Whilst medical decision-making occurs in a complex social environment with multiple influences and decision makers, it remains true that an individual doctor's judgment still retains a key position in terms of diagnostic and treatment decisions for individual patients. This paper argues therefore, that individual differences between doctors in terms of reasoning are important considerations in any discussion relating to changing clinical practice.
It is imperative that change strategies in healthcare consider relevant theoretical frameworks from other disciplines such as psychology. Generic dual processing models of reasoning are proposed as potentially useful in identifying factors within doctors that may moderate their individual uptake of evidence into clinical decision-making. Such factors can then inform strategies to change practice.
需要一个更好的理论基础来理解专业行为的改变，以支持基于证据的医学实践变革。传统上，鼓励临床实践改变的策略一直是凭经验指导的，没有明确考虑这些策略背后的理论依据。本文探讨了一个来自心理学的理论框架，用于识别医生之间认知加工的个体差异，这些差异可能会影响将新证据纳入临床决策的决定。
并行双加工推理模型假定，人类推理时两种认知信息加工模式在持续运作。一种模式被描述为经验性的、快速的和启发式的；另一种模式是理性的、有意识的和基于规则的。在这些模型中，新研究证据的采纳可以由后一种模式来代表；它是反思性的、明确的和有意的。另一方面，熟练的临床判断可以定位在经验模式中，是自动的、反射性的和迅速的。研究表明，人们在认知能力（如智力）和认知加工（如思维方式）方面的个体差异会影响两种推理模式的相互作用。既然如此，那么可以推测医生之间的这些相同差异可能会影响新研究证据的采纳。在研究实施研究证据的有效策略时，这些性格特征在很大程度上被忽视了。虽然医疗决策发生在一个具有多种影响因素和决策者的复杂社会环境中，但对于个体患者的诊断和治疗决策而言，个体医生的判断仍然占据关键地位。因此，本文认为，在任何有关改变临床实践的讨论中，医生在推理方面的个体差异都是重要的考虑因素。
医疗保健中的变革策略必须考虑来自其他学科（如心理学）的相关理论框架。通用的双加工推理模型被认为可能有助于识别医生内部可能影响其将证据个体性纳入临床决策的因素。这些因素随后可为改变实践的策略提供信息。
