College of Medicine and Health, University of Exeter, Exeter, Devon, UK
PenARC, Exeter, Devon, UK.
BMJ Open. 2022 Jun 29;12(6):e060101. doi: 10.1136/bmjopen-2021-060101.
To conduct a systematic review and synthesise qualitative research of electronic risk assessment tools (eRATs) in primary care, examining how they affect the communication and understanding of diagnostic risk and uncertainty. eRATs are computer-based algorithms designed to help clinicians avoid missing important diagnoses, pick up possible symptoms early and facilitate shared decision-making.
Systematic search, using predefined criteria of the published literature and synthesis of the qualitative data, using Thematic Synthesis. Database searches on 27 November 2019 were of MEDLINE, Embase, CINAHL and Web of Science, and a secondary search of the references of included articles. Included studies were those involving electronic risk assessment or decision support, pertaining to diagnosis in primary care, where qualitative data were presented. Non-empirical studies and non-English language studies were excluded. 5971 unique studies were identified of which 441 underwent full-text review. 26 studies were included for data extraction. A further two were found from citation searches. Quality appraisal was via the CASP (Critical Appraisal Skills Program) tool. Data extraction was via line by line coding. A thematic synthesis was performed.
Primary care.
eRATs included differential diagnosis suggestion tools, tools which produce a future risk of disease development or recurrence or calculate a risk of current undiagnosed disease. Analytical themes were developed to describe separate aspects of the clinical consultation where risk and uncertainty are both central and altered via the use of an eRAT: 'Novel risk', 'Risk refinement', 'Autonomy', 'Communication', 'Fear' and 'Mistrust'.
eRATs may improve the understanding and communication of risk in the primary care consultation. The themes of 'Fear' and 'Mistrust' could represent potential challenges with eRATs.
CRD219446.
系统综述和综合定性研究电子风险评估工具（eRATs）在初级保健中的应用，考察它们如何影响诊断风险和不确定性的沟通和理解。eRATs 是一种基于计算机的算法，旨在帮助临床医生避免遗漏重要诊断，及早发现可能的症状，并促进共同决策。
使用已发表文献的预设标准进行系统搜索，并使用主题综合法对定性数据进行综合。于 2019 年 11 月 27 日在 MEDLINE、Embase、CINAHL 和 Web of Science 上进行数据库搜索，并对纳入文章的参考文献进行二次搜索。纳入的研究包括涉及电子风险评估或决策支持、与初级保健中的诊断相关、呈现定性数据的研究。排除非实证研究和非英语语言研究。共确定了 5971 项独特的研究，其中 441 项进行了全文审查。纳入了 26 项研究进行数据提取。通过引文搜索又发现了另外两项研究。质量评估通过 CASP（批判性评估技能计划）工具进行。数据提取通过逐行编码进行。进行了主题综合。
初级保健。
eRATs 包括鉴别诊断建议工具、预测疾病发展或复发未来风险的工具或计算当前未诊断疾病风险的工具。开发了分析性主题来描述临床咨询中风险和不确定性都是核心且通过使用 eRAT 改变的不同方面：“新风险”、“风险细化”、“自主性”、“沟通”、“恐惧”和“不信任”。
eRATs 可能会提高初级保健咨询中对风险的理解和沟通。“恐惧”和“不信任”这两个主题可能代表 eRATs 的潜在挑战。
CRD219446。
