Richardson Safiya, Dauber-Decker Katherine L, McGinn Thomas, Barnaby Douglas P, Cattamanchi Adithya, Pekmezaris Renee
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States.
Division of Pulmonary and Critical Care Medicine and Partnerships for Research in Implementation Science for Equity (PRISE) Center, University of California San Francisco, San Francisco, CA, United States.
JMIR Hum Factors. 2021 Aug 4;8(3):e25046. doi: 10.2196/25046.
Clinicians often disregard potentially beneficial clinical decision support (CDS).
In this study, we sought to explore the psychological and behavioral barriers to the use of a CDS tool.
We conducted a qualitative study involving emergency medicine physicians and physician assistants. A semistructured interview guide was created based on the Capability, Opportunity, and Motivation-Behavior model. Interviews focused on the barriers to the use of a CDS tool built based on Wells' criteria for pulmonary embolism to assist clinicians in establishing pretest probability of pulmonary embolism before imaging.
Interviews were conducted with 12 clinicians. Six barriers were identified, including (1) Bayesian reasoning, (2) fear of missing a pulmonary embolism, (3) time pressure or cognitive load, (4) gestalt includes Wells' criteria, (5) missed risk factors, and (6) social pressure.
Clinicians highlighted several important psychological and behavioral barriers to CDS use. Addressing these barriers will be paramount in developing CDS that can meet its potential to transform clinical care.
临床医生常常忽视潜在有益的临床决策支持（CDS）。
在本研究中，我们试图探究使用CDS工具的心理和行为障碍。
我们开展了一项涉及急诊医学医生和医师助理的定性研究。基于能力、机会和动机-行为模型创建了一份半结构化访谈指南。访谈聚焦于使用一种基于韦尔斯肺栓塞标准构建的CDS工具的障碍，该工具旨在协助临床医生在进行影像学检查前确定肺栓塞的预测试概率。
对12名临床医生进行了访谈。确定了六个障碍，包括（1）贝叶斯推理，（2）担心漏诊肺栓塞，（3）时间压力或认知负荷，（4）格式塔包括韦尔斯标准，（5）遗漏风险因素，以及（6）社会压力。
临床医生强调了使用CDS的几个重要心理和行为障碍。在开发能够发挥其改变临床护理潜力的CDS时，解决这些障碍至关重要。
