Sinnott Carol, Kelly Martina A, Bradley Colin P
Department of General Practice, University College Cork, Cork, Ireland.
Cambridge Centre for Health Services Research, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK.
BMC Health Serv Res. 2017 Aug 22;17(1):583. doi: 10.1186/s12913-017-2539-y.
Chart-stimulated recall (CSR) is a case-based interviewing technique, which is used in the assessment of clinical decision-making in medical education and professional certification. Increasingly, clinical decision-making is a concern for clinical research in primary care. In this study, we review the prior application and utility of CSR as a technique for research interviews in primary care.
Following Arksey & O'Malley's method for scoping reviews, we searched seven databases, grey literature, reference lists, and contacted experts in the field. We excluded studies on medical education or competence assessment. Retrieved citations were screened by one reviewer and full texts were ordered for all potentially relevant abstracts. Two researchers independently reviewed full texts and performed data extraction and quality appraisal if inclusion criteria were met. Data were collated and summarised using a published framework on the reporting of qualitative interview techniques, which was chosen a priori. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines informed the review report.
From an initial list of 789 citations, eight studies using CSR in research interviews were included in the review: six from North America, one from the Netherlands, and one from Ireland. The most common purpose of included studies was to examine the influence of guidelines on physicians' decisions. The number of interviewees ranged from seven to twenty nine, while the number of charts discussed per interview ranged from one to twelve. CSR gave insights into physicians' reasoning for actions taken or not taken; the unrecorded social and clinical influences on decisions; and discrepancies between physicians' real and perceived practice. Ethical concerns and the training and influence of the researcher were poorly discussed in most of the studies. Potential pitfalls included the risk of recall, selection and observation biases.
Despite the proven validity, reliability and acceptability of CSR in assessment interviews in medical education, its use in clinical research is limited. Application of CSR in qualitative research brings interview data closer to the reality of practice. Although further development of the approach is required, we recommend a role for CSR in research interviews on decision-making in clinical practice.
图表激发式回忆（CSR）是一种基于案例的访谈技术，用于医学教育和专业认证中的临床决策评估。临床决策日益成为初级保健临床研究关注的问题。在本研究中，我们回顾了CSR作为初级保健研究访谈技术的先前应用及效用。
遵循阿克斯利和奥马利的范围综述方法，我们检索了七个数据库、灰色文献、参考文献列表，并联系了该领域的专家。我们排除了关于医学教育或能力评估的研究。由一名评审员筛选检索到的文献，为所有潜在相关摘要订购全文。两名研究人员独立审查全文，若符合纳入标准则进行数据提取和质量评估。使用预先选定的关于定性访谈技术报告的已发表框架对数据进行整理和总结。系统评价和荟萃分析的首选报告项目（PRISMA）指南为综述报告提供了指导。
从最初的789条文献列表中，八项在研究访谈中使用CSR的研究被纳入综述：六项来自北美，一项来自荷兰，一项来自爱尔兰。纳入研究最常见的目的是检验指南对医生决策的影响。受访者人数从7人到29人不等，每次访谈讨论的图表数量从1张到12张不等。CSR揭示了医生对已采取或未采取行动的推理；对决策的未记录的社会和临床影响；以及医生实际做法与认知做法之间的差异。大多数研究对伦理问题以及研究人员的培训和影响讨论不足。潜在的陷阱包括回忆、选择和观察偏倚的风险。
尽管CSR在医学教育评估访谈中已被证明具有有效性、可靠性和可接受性，但其在临床研究中的应用有限。CSR在定性研究中的应用使访谈数据更接近实际做法。尽管该方法需要进一步发展，但我们建议CSR在临床实践决策研究访谈中发挥作用。
