Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
Center for Pediatric Clinical Effectiveness, PolicyLab, and The Possibilities Project, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.
Appl Clin Inform. 2022 Mar;13(2):504-515. doi: 10.1055/s-0042-1748148. Epub 2022 May 18.
Helping parents quit smoking is a public health priority. However, parents are rarely, if ever, offered tobacco use treatment through pediatric settings. Clinical decision support (CDS) systems developed for the workflows of pediatric primary care may support consistent screening, treatment, and referral.
This study aimed to develop a CDS system by using human-centered design (HCD) that identifies parents who smoke, provides motivational messages to quit smoking (informed by behavioral science), and supports delivery of evidence-based tobacco treatment.
Our multidisciplinary team applied a rigorous HCD process involving analysis of the work environment, user involvement in formative design, iterative improvements, and evaluation of the system's use in context with the following three cohorts: (1) parents who smoke, (2) pediatric clinicians, and (3) clinic staff. Participants from each cohort were presented with scenario-based, high-fidelity mockups of system components and then provided input related to their role in using the CDS system.
We engaged 70 representative participants including 30 parents, 30 clinicians, and 10 clinic staff. A key theme of the design review sessions across all cohorts was the need to automate functions of the system. Parents emphasized a system that presented information in a simple way, highlighted benefits of quitting smoking, and allowed direct connection to treatment. Pediatric clinicians emphasized automating tobacco treatment. Clinical staff emphasized screening for parent smoking via several modalities prior to the patient's visit. Once the system was developed, most parents (80%) reported that it was easy to use, and the majority of pediatricians reported that they would use the system (97%) and were satisfied with it (97%).
A CDS system to support parental tobacco cessation in pediatric primary care, developed through an HCD process, proved easy to use and acceptable to parents, clinicians, and office staff. This preliminary work justifies evaluating the impact of the system on helping parents quit smoking.
帮助父母戒烟是公共卫生的重点。然而，父母很少甚至从未通过儿科环境获得烟草使用治疗。为儿科初级保健工作流程开发的临床决策支持 (CDS) 系统可以支持一致的筛查、治疗和转诊。
本研究旨在通过使用以人为中心的设计 (HCD) 开发 CDS 系统，该系统可以识别吸烟的父母，提供戒烟的动机信息（基于行为科学），并支持提供基于证据的烟草治疗。
我们的多学科团队应用了严格的 HCD 流程，包括分析工作环境、用户参与形成性设计、迭代改进，以及在以下三个队列中评估系统的使用情况：（1）吸烟的父母，（2）儿科临床医生，和（3）诊所工作人员。每个队列的参与者都展示了系统组件的基于场景的高保真模拟，然后就他们在使用 CDS 系统方面的角色提供了相关意见。
我们共招募了 70 名具有代表性的参与者，包括 30 名父母、30 名临床医生和 10 名诊所工作人员。所有队列的设计审查会议的一个关键主题是需要使系统的功能自动化。父母强调系统以简单的方式呈现信息，突出戒烟的好处，并允许直接连接到治疗。儿科临床医生强调自动化烟草治疗。临床工作人员强调在患者就诊前通过多种方式对父母吸烟情况进行筛查。一旦开发了系统，大多数父母（80%）表示使用起来很容易，大多数儿科医生表示他们会使用该系统（97%）并对其满意（97%）。
通过以人为中心的设计过程开发的支持儿科初级保健中父母烟草戒断的 CDS 系统，被证明易于使用且被父母、临床医生和办公室工作人员接受。这项初步工作证明了评估该系统帮助父母戒烟的影响是合理的。
