Guy's & St Thomas' Foundation Trust and Imperial College Healthcare Trust, London, England.
Warwick Business School, University of Warwick, Coventry, England.
BMC Health Serv Res. 2019 Nov 21;19(1):863. doi: 10.1186/s12913-019-4693-x.
Pregnancy represents a complex challenge to clinicians treating women with chronic inflammatory disease. Many clinicians face a situation of heightened sensitivity to the potential risks and uncertainties associated with the effect of pharmacological treatment on pregnancy outcomes. This may create an environment vulnerable to clinical inertia, whereby behavioural factors such as cognitive heuristics and biases, and other factors such as attitudes to risk and emotion can contribute. This systematic review was undertaken to assess if clinical inertia has been investigated/identified in this setting and took a behavioural science approach to identify and understand the potential determinants of clinical inertia in this treatment setting.
A systematic literature search was conducted to identify publications which investigated or described clinical inertia or its determinants (e.g. heuristics, biases etc.). Results were coded for thematic analysis using two inter-related behavioural models: the COM-B model and the Theoretical Domains Framework.
Whilst studies investigating or describing clinical inertia in this treatment setting were not identified, the behavioural analysis revealed a number of barriers to the pharmacological management of women of fertile age affected by chronic inflammatory disease. Factors which may be influencing clinician's behaviour were identified in all domains of the COM-B model. The primary factors identified were a lack of knowledge of treatment guidelines and fears concerning the safety of medications for mother and fetus. Lack of experience of treating pregnant patients was also identified as a contributing factor to undertreatment.
Using a behavioural approach, it was possible to identify potential factors which may be negatively influencing clinician's behaviour in this treatment setting, although specific research was limited.
妊娠对治疗慢性炎症性疾病女性的临床医生来说是一个复杂的挑战。许多临床医生对药物治疗对妊娠结局的潜在风险和不确定性高度敏感，这可能导致临床惯性，即认知启发式和偏见等行为因素，以及对风险和情绪的态度等其他因素会起作用。本系统评价旨在评估在这种情况下是否已经研究/确定了临床惯性，并采取行为科学方法来确定和理解这种治疗环境中临床惯性的潜在决定因素。
进行了系统文献检索，以确定研究或描述临床惯性或其决定因素（例如启发式、偏见等）的出版物。使用两个相互关联的行为模型（COM-B 模型和理论领域框架）对结果进行编码以进行主题分析。
虽然没有发现针对该治疗环境中临床惯性的研究，但行为分析揭示了在治疗受慢性炎症性疾病影响的育龄妇女时，药物治疗存在许多障碍。在 COM-B 模型的所有领域都确定了可能影响临床医生行为的因素。主要确定的因素是缺乏治疗指南的知识以及对药物对母亲和胎儿安全性的担忧。缺乏治疗孕妇的经验也被确定为治疗不足的一个促成因素。
使用行为方法，可以确定可能对这种治疗环境中临床医生行为产生负面影响的潜在因素，但具体研究有限。
