Schuler Katharina, Jung Ian-C, Zerlik Maria, Hahn Waldemar, Sedlmayr Martin, Sedlmayr Brita
Institute for Medical Informatics and Biometry, Faculty of Medicine, University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany.
Center for Scalable Data Analytics and Artificial Intelligence (ScaDS.AI), Dresden/Leipzig, Dresden, Germany.
BMC Med Inform Decis Mak. 2025 Mar 17;25(1):133. doi: 10.1186/s12911-025-02965-1.
Clinical decision support systems (CDSS) frequently exhibit insufficient contextual adaptation, diminishing user engagement. To enhance the sensitivity of CDSS to contextual conditions, it is crucial first to develop a comprehensive understanding of the context factors influencing the clinical decision-making process. Therefore, this study aims to systematically identify and provide an extensive overview of contextual factors affecting clinical decision-making from the literature, enabling their consideration in the future implementation of CDSS.
A scoping review was conducted following the PRISMA-ScR guidelines to identify context factors in the clinical decision-making process. Searches were performed across nine databases: PubMed, APA PsycInfo, APA PsyArticles, PSYINDEX, CINAHL, Scopus, Embase, Web of Science, and LIVIVO. The search strategy focused on combined terms related to contextual factors and clinical decision-making. Included articles were original research articles written in English or German that involved empirical investigations related to clinical decision-making. The identified context factors were categorized using the card sorting method to ensure accurate classification.
The data synthesis included 84 publications, from which 946 context factors were extracted. These factors were assigned to six primary entities through card sorting: patient, physician, patient's family, institution, colleagues, and disease treatment. The majority of the identified context factors pertained to individual characteristics of the patient, such as health status and demographic attributes, as well as individual characteristics of the physician, including demographic data, skills, and knowledge.
This study provides a comprehensive overview of context factors in clinical decision-making previously investigated in the literature, highlighting the complexity and diversity of contextual influences on the decision-making process. By offering a detailed foundation of identified context factors, this study paves the way for future research to develop more effective, context-sensitive CDSS, enhancing personalized medicine and optimizing clinical outcomes with implications for practice and policy.
临床决策支持系统（CDSS）常常表现出情境适应性不足，导致用户参与度降低。为提高CDSS对情境条件的敏感性，首先必须全面了解影响临床决策过程的情境因素。因此，本研究旨在系统地从文献中识别并全面概述影响临床决策的情境因素，以便在CDSS的未来实施中加以考虑。
按照PRISMA-ScR指南进行了一项范围综述，以识别临床决策过程中的情境因素。在九个数据库中进行了检索：PubMed、APA PsycInfo、APA PsyArticles、PSYINDEX、CINAHL、Scopus、Embase、Web of Science和LIVIVO。检索策略侧重于与情境因素和临床决策相关的组合术语。纳入的文章为用英语或德语撰写的原创研究文章，涉及与临床决策相关的实证研究。使用卡片分类法对识别出的情境因素进行分类，以确保准确分类。
数据综合包括84篇出版物，从中提取了946个情境因素。通过卡片分类将这些因素分配到六个主要类别：患者、医生、患者家属、机构、同事和疾病治疗。识别出的大多数情境因素与患者的个体特征有关，如健康状况和人口统计学属性，以及医生的个体特征，包括人口统计学数据、技能和知识。
本研究全面概述了文献中先前研究的临床决策情境因素，突出了情境对决策过程影响的复杂性和多样性。通过提供已识别情境因素的详细基础，本研究为未来开发更有效、情境敏感的CDSS的研究铺平了道路，加强了个性化医疗并优化了临床结果，对实践和政策具有启示意义。
