Gonzalez Xiomara T, Steger-May Karen, Abraham Joanna
Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX 78712, United States.
Center for Biostatistics and Data Science, Washington University School of Medicine, St Louis, MO 63110, United States.
J Am Med Inform Assoc. 2025 Jan 1;32(1):150-162. doi: 10.1093/jamia/ocae257.
Successful implementation of machine learning-augmented clinical decision support systems (ML-CDSS) in perioperative care requires the prioritization of patient-centric approaches to ensure alignment with societal expectations. We assessed general public and surgical patient attitudes and perspectives on ML-CDSS use in perioperative care.
A sequential explanatory study was conducted. Stage 1 collected public opinions through a survey. Stage 2 ascertained surgical patients' experiences and attitudes via focus groups and interviews.
For Stage 1, a total of 281 respondents' (140 males [49.8%]) data were considered. Among participants without ML awareness, males were almost three times more likely than females to report more acceptance (OR = 2.97; 95% CI, 1.36-6.49) and embrace (OR = 2.74; 95% CI, 1.23-6.09) of ML-CDSS use by perioperative teams. Males were almost twice as likely as females to report more acceptance across all perioperative phases with ORs ranging from 1.71 to 2.07. In Stage 2, insights from 10 surgical patients revealed unanimous agreement that ML-CDSS should primarily serve a supportive function. The pre- and post-operative phases were identified explicitly as forums where ML-CDSS can enhance care delivery. Patients requested for education on ML-CDSS's role in their care to be disseminated by surgeons across multiple platforms.
The general public and surgical patients are receptive to ML-CDSS use throughout their perioperative care provided its role is auxiliary to perioperative teams. However, the integration of ML-CDSS into perioperative workflows presents unique challenges for healthcare settings. Insights from this study can inform strategies to support large-scale implementation and adoption of ML-CDSS by patients in all perioperative phases. Key strategies to promote the feasibility and acceptability of ML-CDSS include clinician-led discussions about ML-CDSS's role in perioperative care, established metrics to evaluate the clinical utility of ML-CDSS, and patient education.
在围手术期护理中成功实施机器学习增强型临床决策支持系统(ML-CDSS)需要优先考虑以患者为中心的方法,以确保符合社会期望。我们评估了公众和外科手术患者对围手术期护理中使用ML-CDSS的态度和观点。
进行了一项序贯解释性研究。第1阶段通过调查收集公众意见。第2阶段通过焦点小组和访谈确定手术患者的经历和态度。
对于第1阶段,共考虑了281名受访者(140名男性[49.8%])的数据。在没有机器学习意识的参与者中,男性报告对围手术期团队使用ML-CDSS的接受程度更高(OR = 2.97;95% CI,1.36 - 6.49)和更愿意接受(OR = 2.74;95% CI,1.23 - 6.09)的可能性几乎是女性的三倍。在所有围手术期阶段,男性报告接受程度更高的可能性几乎是女性的两倍,OR值范围为1.71至2.07。在第2阶段,10名手术患者的见解显示一致认为ML-CDSS应主要发挥支持作用。术前和术后阶段被明确确定为ML-CDSS可以改善护理提供的论坛。患者要求外科医生在多个平台上传播关于ML-CDSS在其护理中的作用的教育。
如果ML-CDSS在围手术期护理中的作用是辅助围手术期团队,公众和手术患者在整个围手术期护理中都接受使用ML-CDSS。然而,将ML-CDSS整合到围手术期工作流程中给医疗机构带来了独特的挑战。本研究的见解可为支持患者在所有围手术期阶段大规模实施和采用ML-CDSS的策略提供信息。促进ML-CDSS可行性和可接受性的关键策略包括临床医生主导的关于ML-CDSS在围手术期护理中的作用的讨论、评估ML-CDSS临床效用的既定指标以及患者教育。