Institute for Ethics and History of Medicine, Eberhard Karls University Tuebingen, Tuebingen, Germany.
Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany.
J Med Internet Res. 2024 Aug 23;26:e55717. doi: 10.2196/55717.
Clinical decision support systems (CDSSs) are increasingly being introduced into various domains of health care. Little is known so far about the impact of such systems on the health care professional-patient relationship, and there is a lack of agreement about whether and how patients should be informed about the use of CDSSs.
This study aims to explore, in an empirically informed manner, the potential implications for the health care professional-patient relationship and to underline the importance of this relationship when using CDSSs for both patients and future professionals.
Using a methodological triangulation, 15 medical students and 12 trainee nurses were interviewed in semistructured interviews and 18 patients were involved in focus groups between April 2021 and April 2022. All participants came from Germany. Three examples of CDSSs covering different areas of health care (ie, surgery, nephrology, and intensive home care) were used as stimuli in the study to identify similarities and differences regarding the use of CDSSs in different fields of application. The interview and focus group transcripts were analyzed using a structured qualitative content analysis.
From the interviews and focus groups analyzed, three topics were identified that interdependently address the interactions between patients and health care professionals: (1) CDSSs and their impact on the roles of and requirements for health care professionals, (2) CDSSs and their impact on the relationship between health care professionals and patients (including communication requirements for shared decision-making), and (3) stakeholders' expectations for patient education and information about CDSSs and their use.
The results indicate that using CDSSs could restructure established power and decision-making relationships between (future) health care professionals and patients. In addition, respondents expected that the use of CDSSs would involve more communication, so they anticipated an increased time commitment. The results shed new light on the existing discourse by demonstrating that the anticipated impact of CDSSs on the health care professional-patient relationship appears to stem less from the function of a CDSS and more from its integration in the relationship. Therefore, the anticipated effects on the relationship between health care professionals and patients could be specifically addressed in patient information about the use of CDSSs.
临床决策支持系统（CDSS）越来越多地被引入医疗保健的各个领域。到目前为止，人们对这些系统对医患关系的影响知之甚少，也没有就患者是否应该以及如何被告知使用 CDSS 达成共识。
本研究旨在以实证为依据，探讨 CDSS 使用对医患关系的潜在影响，并强调患者和未来专业人员使用 CDSS 时这一关系的重要性。
采用方法三角学，2021 年 4 月至 2022 年 4 月，在半结构化访谈中对 15 名医学生和 12 名实习护士进行了访谈，并对 18 名患者进行了焦点小组访谈。所有参与者均来自德国。研究中使用了三种不同领域的 CDSS 示例（即手术、肾病学和强化家庭护理）作为刺激物，以确定不同应用领域使用 CDSS 的异同。对访谈和焦点小组的记录进行了结构化的定性内容分析。
从分析的访谈和焦点小组中确定了三个主题，这些主题相互关联，涉及患者和医疗保健专业人员之间的互动：（1）CDSS 及其对医疗保健专业人员角色和要求的影响，（2）CDSS 及其对医疗保健专业人员与患者关系的影响（包括共同决策的沟通要求），以及（3）利益相关者对患者教育和有关 CDSS 及其使用的信息的期望。
研究结果表明，使用 CDSS 可能会重构未来医疗保健专业人员和患者之间既定的权力和决策关系。此外，受访者期望使用 CDSS 将涉及更多的沟通，因此他们预计时间投入会增加。结果通过表明 CDSS 对医患关系的预期影响似乎不是源于 CDSS 的功能，而是源于其在关系中的整合，为现有论述提供了新的视角。因此，可在有关 CDSS 使用的患者信息中具体解决对医疗保健专业人员和患者关系的预期影响。
