Department of Surgery and Cancer, Imperial College London, London, UK.
J Am Med Inform Assoc. 2023 Apr 19;30(5):888-898. doi: 10.1093/jamia/ocad019.
Physicians' low adoption of diagnostic decision aids (DDAs) may be partially due to concerns about patient/public perceptions. We investigated how the UK public views DDA use and factors affecting perceptions.
In this online experiment, 730 UK adults were asked to imagine attending a medical appointment where the doctor used a computerized DDA. The DDA recommended a test to rule out serious disease. We varied the test's invasiveness, the doctor's adherence to DDA advice, and the severity of the patient's disease. Before disease severity was revealed, respondents indicated how worried they felt. Both before [t1] and after [t2] severity was revealed, we measured satisfaction with the consultation, likelihood of recommending the doctor, and suggested frequency of DDA use.
At both timepoints, satisfaction and likelihood of recommending the doctor increased when the doctor adhered to DDA advice (P ≤ .01), and when the DDA suggested an invasive versus noninvasive test (P ≤ .05). The effect of adherence to DDA advice was stronger when participants were worried (P ≤ .05), and the disease turned out to be serious (P ≤ .01). Most respondents felt that DDAs should be used by doctors "sparingly" (34%[t1]/29%[t2]), "frequently," (43%[t1]/43%[t2]) or "always" (17%[t1]/21%[t2]).
People are more satisfied when doctors adhere to DDA advice, especially when worried, and when it helps to spot serious disease. Having to undergo an invasive test does not appear to dampen satisfaction.
Positive attitudes regarding DDA use and satisfaction with doctors adhering to DDA advice could encourage greater use of DDAs in consultations.
医生对诊断决策辅助工具（DDA）的采用率较低，部分原因可能是他们对患者/公众看法的担忧。我们调查了英国公众对 DDA 使用的看法以及影响看法的因素。
在这项在线实验中，730 名英国成年人被要求想象在一次医疗预约中，医生使用了计算机化的 DDA。DDA 建议进行一项测试以排除严重疾病。我们改变了测试的侵入性、医生对 DDA 建议的遵守程度以及患者疾病的严重程度。在揭示疾病严重程度之前，受访者表示他们感到担忧的程度。在揭示严重程度之前[t1]和之后[t2]，我们测量了对咨询的满意度、推荐医生的可能性以及建议的 DDA 使用频率。
在两个时间点，当医生遵守 DDA 建议时（P≤.01），以及当 DDA 建议进行侵入性而非非侵入性测试时（P≤.05），满意度和推荐医生的可能性都增加了。当参与者感到担忧时（P≤.05），以及当疾病严重时（P≤.01），对 DDA 建议的遵守程度的影响更大。大多数受访者认为 DDA 应该“谨慎”使用（34%[t1]/29%[t2]）、“经常”（43%[t1]/43%[t2]）或“总是”（17%[t1]/21%[t2]）。
当医生遵守 DDA 建议时，尤其是当患者感到担忧且有助于发现严重疾病时，患者会更加满意。进行侵入性测试似乎不会降低满意度。
对 DDA 使用的积极态度以及对医生遵守 DDA 建议的满意度可能会鼓励在咨询中更多地使用 DDA。
