基于网络的患者填写式临床决策辅助工具对短暂性意识丧失进行鉴别诊断的可接受性和实用性:定性访谈研究

Acceptability and Utility of a Web-Based Patient-Completed Clinical Decision Aid for the Differential Diagnosis of Transient Loss of Consciousness: Qualitative Interview Study.

作者信息

Wardrope Alistair, Blank Lindsay, Ferrar Melloney, Goodacre Steve, Habershon Daniel, Reuber Markus

机构信息

Division of Neuroscience, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, United Kingdom, 44 01142434343 ext 12118.

Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.

出版信息

JMIR Form Res. 2025 Jul 24;9:e67608. doi: 10.2196/67608.

Abstract

BACKGROUND

Web-based patient-completed clinical decision aids (CDAs) have the potential to reduce inefficient resource use and patient risk in acute and emergency settings while minimizing additional clinician time burdens. However, such interventions must be acceptable for use by their target audience-patients.

OBJECTIVE

The objective of this study is to assess acceptability and utility to patients of a novel online patient-completed CDA for the differential diagnosis of transient loss of consciousness (TLoC).

METHODS

Within a larger validation study of a patient-completed CDA, we conducted nested qualitative semistructured interviews with a purposive sample of 20 patients who used the CDA in the study and performed thematic analysis of interview transcripts.

RESULTS

We identified 11 themes within the data: 3 addressing the content of the CDA, 3 addressing the online implementation, and 4 addressing usability and acceptability of the CDA. Respondents generally felt an online CDA was easy to complete and acceptable, though they felt that increased options to personalize descriptions of their experience would be helpful and offered guidance on how to make it a more useful resource for patients as well as clinicians. We present good practice points for the design of patient-completed online CDAs on the basis of our thematic analysis.

CONCLUSIONS

Findings suggest that patient-completed CDAs may be accessible and feasible in acute and emergency settings, though further research is needed to explore their real-world usability. In designing such tools, clinicians should endeavor to maintain their accessibility for all relevant patient groups and to use them to provide direct patient benefit, as well as to support clinical decision-making, for example, through simultaneous patient-directed outputs.

摘要

背景

基于网络的患者完成的临床决策辅助工具(CDA)有潜力减少急性和紧急情况下资源的低效使用以及患者风险,同时将额外的临床医生时间负担降至最低。然而,此类干预措施必须为其目标受众——患者所接受。

目的

本研究的目的是评估一种用于短暂意识丧失(TLoC)鉴别诊断的新型在线患者完成的CDA对患者的可接受性和实用性。

方法

在一项对患者完成的CDA进行的更大规模验证研究中,我们对20名在研究中使用该CDA的患者进行了有目的抽样的嵌套定性半结构化访谈,并对访谈记录进行了主题分析。

结果

我们在数据中确定了11个主题:3个涉及CDA的内容,3个涉及在线实施,4个涉及CDA的可用性和可接受性。受访者普遍认为在线CDA易于完成且可以接受,不过他们觉得增加个性化描述自身经历的选项会有所帮助,并就如何使其成为对患者和临床医生都更有用的资源提供了指导。基于我们的主题分析,我们提出了患者完成的在线CDA设计的良好实践要点。

结论

研究结果表明,患者完成的CDA在急性和紧急情况下可能是可获取且可行的,不过还需要进一步研究来探索其在现实世界中的可用性。在设计此类工具时,临床医生应努力使其对所有相关患者群体都易于使用,并利用它们为患者直接带来益处,以及支持临床决策,例如通过同时向患者提供有针对性的输出。

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