Department of Communication Studies, School of Communication, Northwestern University, Evanston, IL, USA.
Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Med Decis Making. 2024 Nov;44(8):900-913. doi: 10.1177/0272989X241285036. Epub 2024 Oct 8.
Risk score calculators are a widely developed tool to support clinicians in identifying and managing risk for certain diseases. However, little is known about physicians' applied experiences with risk score calculators and the role of risk score estimates in clinical decision making and patient communication.
Physicians providing care in outpatient community-based clinical settings ( = 20) were recruited to participate in semi-structured individual interviews to assess their use of risk score calculators in practice. Two study team members conducted an inductive thematic analysis using a consensus-based coding approach.
Participants referenced at least 20 risk score calculators, the most common being the Atherosclerotic Cardiovascular Disease Risk Calculator. Ecological factors related to the clinical system (e.g., time), patient (e.g., receptivity), and physician (e.g., experience) influenced conditions and patterns of risk score calculator use. For example, compared with attending physicians, residents tended to use a greater variety of risk score calculators and with higher frequency. Risk score estimates were generally used in clinical decision making to improve or validate clinical judgment and in patient communication to serve as a motivational tool.
The degree to which risk score estimates influenced physician decision making and whether and how these scores were communicated to patients varied, reflecting a nuanced role of risk score calculator use in clinical practice. The theory of planned behavior can help explain how attitudes, beliefs, and norms shape the use of risk score estimates in clinical decision making and patient communication. Additional research is needed to evaluate best practices in the use of risk score calculators and risk score estimates.
The risk score calculators and estimates that participants referenced in this study represented a range of conditions (e.g., heart disease, anxiety), levels of model complexity (e.g., probability calculations, scales of severity), and output formats (e.g., point estimates, risk intervals).Risk score calculators that are easily accessed, have simple inputs, and are trusted by physicians appear more likely to be used.Risk score estimates were generally used in clinical decision making to improve or validate clinical judgment and in patient communication to serve as a motivational tool.Risk score estimates helped participants manage the uncertainty and complexity of various clinical situations, yet consideration of the limitations of these estimates was relatively minimal.Developers of risk score calculators should consider the patient- (e.g., response to risk score estimates) and physician- (e.g., training status) related characteristics that influence risk score calculator use in addition to that of the clinical system.
风险评分计算器是一种广泛开发的工具，用于帮助临床医生识别和管理某些疾病的风险。然而，对于医生在临床实践中应用风险评分计算器的经验以及风险评分估计在临床决策和患者沟通中的作用知之甚少。
我们招募了在社区门诊临床环境中提供护理的医生（n=20）参与半结构化的个人访谈，以评估他们在实践中使用风险评分计算器的情况。两名研究团队成员使用基于共识的编码方法进行了归纳主题分析。
参与者至少提到了 20 个风险评分计算器，最常见的是动脉粥样硬化性心血管疾病风险计算器。与临床系统（如时间）、患者（如接受程度）和医生（如经验）相关的生态因素影响了风险评分计算器使用的条件和模式。例如，与主治医生相比，住院医生更倾向于使用更多种类的风险评分计算器，且使用频率更高。风险评分估计通常用于临床决策，以改善或验证临床判断，并用于患者沟通，作为一种激励工具。
风险评分估计对医生决策的影响程度以及这些评分是否以及如何传达给患者有所不同，这反映了风险评分计算器在临床实践中的作用是微妙的。计划行为理论可以帮助解释态度、信念和规范如何影响风险评分估计在临床决策和患者沟通中的使用。需要进一步研究以评估风险评分计算器和风险评分估计的最佳使用实践。
本研究中参与者提到的风险评分计算器和估计值代表了一系列情况（例如，心脏病、焦虑症）、模型复杂性水平（例如，概率计算、严重程度量表）和输出格式（例如，点估计值、风险区间）。易于访问、输入简单且医生信任的风险评分计算器更有可能被使用。风险评分估计值通常用于临床决策，以改善或验证临床判断，并用于患者沟通，作为激励工具。风险评分估计值帮助参与者处理各种临床情况的不确定性和复杂性，但对这些估计值的局限性考虑相对较少。风险评分计算器的开发者除了考虑临床系统外，还应考虑与患者（例如，对风险评分估计值的反应）和医生（例如，培训状况）相关的特征，这些特征会影响风险评分计算器的使用。
