The usefulness of a novel patient management decision aid to improve clinical decision-making skills in final year chiropractic students

Abstract Background The process of developing patient management plans requires a series of clinical decision-making skills that can take years in practice to develop. For the inexperienced practitioner, providing a logical, systematic patient management framework may assist in clinical scenarios and accelerate their decision-making skill development. The purpose of this study was to assess whether a novel clinical management decision aid would improve the management decision-making of chiropractic students. Methods A prospective before and after study tracked chiropractic master degree students in their final year of study across a 10-week period from February–May, 2017. Case-based assessments were performed at baseline, after initial exposure to the decision aid, and after repeated exposure over the course of the semester. Outcome measures included the results from the 3 assessments, scored out of 20 by two markers using a standardised marking rubric, then averaged and converted to percentages; and 2 feedback questionnaires, given after initial exposure and at 10 weeks. Results A total of 75 students (44 males; 31 females) participated in the study. The mean score at baseline was 8.34/20 (41.7%) (95% CI: 7.98, 8.70; SD: 1.56) and after initial exposure was 9.52/20 (47.6%) (95% CI: 9.06, 9.98; SD: 2.02). The mean score after repeated exposure was 15.04/20 (75.2%) (95% CI: 14.46, 15.62; SD: 2.54). From baseline to initial exposure, there was a statistically significant absolute increase in mean score of 1.18/20 (5.9%) (95% CI: 0.6, 1.76; p < 0.0001), or a 2.82/20 (14.1%) relative improvement. From baseline to repeated exposure, there was a statistically significant absolute increase in mean score of 6.7/20 (33.5%) (95% CI: 6.02, 7.38; p < 0.0001), or a 16.06/20 (80.3%) relative improvement. The questionnaire results were also favourable. 56/75 (75%) participants agreed that the decision aid was easy to use and 46/75 (61%) of participants agreed that the decision aid improved their ability to integrate various management techniques. Conclusion Implementing a clinical management decision aid into the teaching curriculum helped to facilitate the ability of chiropractic students to develop patient management plans.

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The use of multiple-criteria decision-making theory to measure students’ perceptions of high-fidelity simulation

BMJ Simulation and Technology Enhanced Learning ◽

10.1136/bmjstel-2016-000167 ◽

2017 ◽

Vol 3 (3) ◽

pp. 88-93 ◽

Cited By ~ 1

Author(s):

Maureen Anne Jersby ◽

Paul Van-Schaik ◽

Stephen Green ◽

Lili Nacheva-Skopalik

Keyword(s):

Decision Making ◽

Clinical Practice ◽

Repeated Measures ◽

Clinical Decision Making ◽

Learning Experience ◽

Clinical Decision ◽

High Fidelity ◽

High Fidelity Simulation ◽

Initial Exposure ◽

Repeated Measures Design

BackgroundHigh-Fidelity Simulation (HFS) has great potential to improve decision-making in clinical practice. Previous studies have found HFS promotes self-confidence, but its effectiveness in clinical practice has not been established. The aim of this research is to establish if HFS facilitates learning that informs decision-making skills in clinical practice using MultipleCriteria DecisionMaking Theory (MCDMT).MethodsThe sample was 2nd year undergraduate pre-registration adult nursing students.MCDMT was used to measure the students’ experience of HFS and how it developed their clinical decision-making skills. MCDMT requires characteristic measurements which for the learning experience were based on five factors that underpin successful learning, and for clinical decision-making, an analytical framework was used. The study used a repeated-measures design to take two measurements: the first one after the first simulation experience and the second one after clinical placement. Baseline measurements were obtained from academics. Data were analysed using the MCDMT tool.ResultsAfter their initial exposure to simulation learning, students reported that HFS provides a high-quality learning experience (87%) and supports all aspects of clinical decision-making (85%). Following clinical practice, the level of support for clinical decision-making remained at 85%, suggesting that students believe HFS promotes transferability of knowledge to the practice setting.ConclusionOverall, students report a high level of support for learning and developing clinical decision-making skills from HFS. However, there are no comparative data available from classroom teaching of similar content so it cannot be established if these results are due to HFS alone.

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Quality specifications: self pleasure for clinical laboratories or added value for patient management?

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm.2007.094 ◽

2007 ◽

Vol 45 (4) ◽

Cited By ~ 16

Author(s):

Mario Plebani

Keyword(s):

Decision Making ◽

Patient Management ◽

Clinical Decision Making ◽

Laboratory Data ◽

Clinical Decision ◽

Added Value ◽

Internal Quality ◽

Laboratory Services ◽

Management Procedures ◽

Quality Specifications

AbstractAnalytical quality specifications play a key role in assuring and continuously improving high-quality laboratory services. However, I believe, that there are two “missing links” in the effective management of quality specifications in the delivery of laboratory services. The first is the evidence that pre-analytical variation and related problems are not taken into great consideration by laboratory professionals. The second missing link is the communication of quality specifications to clinicians and other possible stakeholders. If quality specifications represent “the level of performance required to facilitate clinical decision-making”, they cannot be used only for internal quality management procedures but must be communicated to facilitate clinical reasoning, decision-making and patient management. A consensus should be achieved in the scientific community on these issues to assure better utilization of laboratory data and, ultimately, improved clinical outcomes.Clin Chem Lab Med 2007;45:462–6.

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Analysing Breast Cancer Multidisciplinary Patient Management: A Prospective Observational Evaluation of Team Clinical Decision-Making

World Journal of Surgery ◽

10.1007/s00268-018-4815-3 ◽

2018 ◽

Vol 43 (2) ◽

pp. 559-566 ◽

Cited By ~ 3

Author(s):

T. A. K. Gandamihardja ◽

T. Soukup ◽

S. McInerney ◽

J. S. A. Green ◽

N. Sevdalis

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Patient Management ◽

Clinical Decision Making ◽

Clinical Decision

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P114: Barriers and facilitators affecting implementation of a decision aid for the diagnosis of acute aortic syndrome: a qualitative study

CJEM ◽

10.1017/cem.2020.320 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S106-S106

Author(s):

C. Dmitriew ◽

R. Ohle

Keyword(s):

Decision Making ◽

Clinical Practice ◽

Practice Guidelines ◽

Resource Use ◽

Decision Aid ◽

Clinical Decision Making ◽

Clinical Decision ◽

Barriers And Facilitators ◽

Acute Aortic Syndrome ◽

D Dimer

Introduction: Acute aortic syndrome (AAS) is an uncommon, life-threatening emergency that is frequently misdiagnosed. The Canadian clinical practice guidelines for the diagnosis of AAS were developed in order to reduce the frequency of misdiagnoses and number of diagnostic tests. As part of the guidelines, a clinical decision aid was developed in order to facilitate clinician decision-making based on practice recommendations. The objective of this study was to identify barriers and facilitators among physicians to implementation of the decision aid. Methods: We conducted semi-structured interviews with emergency room physicians working at 5 sites distributed between urban academic and rural settings. We used purposive sampling, contacting ED physicians until data saturation was reached. Interview questions were designed to understand potential barriers and facilitators affecting the probability of decision aid uptake and accurate application of the tool. Two independent raters coded interview transcripts using an integrative approach to theme identification, combining an inductive approach to identification of themes within an organizing framework (Theoretical Domains Framework), discrepancies in coding were resolved through discussion until consensus was reached. Results: A majority of interviewees anticipated that the decision aid would support clinical decision making and risk stratification while reducing resource use and missed diagnoses. Facilitators identified included validation and publication of the guidelines as well as adoption by peers. Barriers to implementation and application of the tool included the fact that the use of D-dimer and knowledge of the rationale for its use in the investigation of AAS were not widespread. Furthermore, scoring components were, at times, out of alignment with clinician practices and understanding of risk factors. The complexity of the decision aid was also identified as a potential barrier to accurate use. Conclusion: Physicians were amenable to using the AAS decision aid to support clinical decision-making and to reduce resource use, particularly within rural contexts. Key barriers identified included the complexity of scoring and inclusion criteria, and the variable acceptance of D-dimer among clinicians. These barriers should be addressed prior to implementation of the decision aid during validation studies of the clinical practice guidelines.

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P043 Effect of a Video Decision Aid on Clinical Decision-Making About Cardiopulmonary Resuscitation

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2016.10.153 ◽

2016 ◽

Vol 52 (6) ◽

pp. e77

Author(s):

John J. You ◽

Marilyn Swinton ◽

Carol Mantle ◽

Dev Jayaraman ◽

Daren K. Heyland

Keyword(s):

Decision Making ◽

Cardiopulmonary Resuscitation ◽

Decision Aid ◽

Clinical Decision Making ◽

Clinical Decision

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Distinct fracture characteristics influence decision making and patient management in fragility fractures of the pelvis – an alternative approach for fracture evaluation

British Journal of Surgery ◽

10.1093/bjs/znab202.048 ◽

2021 ◽

Vol 108 (Supplement_4) ◽

Author(s):

M Ramser ◽

D Cadosch ◽

W Vach ◽

F Saxer ◽

H Eckardt

Keyword(s):

Decision Making ◽

Risk Factor ◽

Patient Management ◽

Independent Risk Factor ◽

Clinical Decision Making ◽

Pelvic Ring ◽

Fragility Fractures ◽

Clinical Decision ◽

Ring Fracture ◽

Fracture Characteristics

Abstract Objective Pelvic ring fractures in the elderly with osteoporotic bone are often caused by a minor trauma. A separate classification for these fragility fractures of the pelvis (FFP) has been proposed by Rommens. However, at our institution the management algorithm is rather based on patient profile, clinical course and the ability to mobilize than on the fracture category. We aimed to identify fracture characteristics that might better reflect clinical decision making and show an association with outcome. Methods Four fracture characteristics were investigated as potential variables: 1. Extent of the dorsal pelvic ring fracture (absent, unilateral, bilateral); 2. Extent of the ventral pelvic ring fracture (absent, unilateral, bilateral); 3. Ventral comminution/dislocation; 4. Presence of a horizontal sacral fracture. These four characteristics were assessed retrospectively in a series of 548 patients with a CT scan proven FFP. The association of the fracture morphology with the decision to perform surgery, failure of conservative treatment and the length of hospital stay (LOS) was determined. Results Three of the four evaluated characteristics showed an independent and significant association with clinical decision making and patient management. In particular the extent of the dorsal fractures was identified as an independent risk factor for the decision to perform surgery with a 7.3-fold increase per category (p < 0.001). The same was observed for the presence of ventral comminution/dislocation (OR = 2.4; p = 0.002). The extent of ventral fractures (OR = 1.5; p = 0.047) was an independent risk factor for a longer LOS in conservatively treated patients. Conclusion Three evaluated morphologic aspects of FFPs showed a clear and independent relation to current clinical decision making and patient management at our institution. Importantly, the ventral fracture component has been shown to have major impact on treatment decision and outcome, which has been underestimated in the current FFP classification system. These four easily distinguishable fracture characteristics have the potential to form the basis of an alternative classification system that matches clinical reality and captures prognostic aspects.

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Barriers and facilitators affecting implementation of the Canadian clinical practice guidelines for the diagnosis of acute aortic syndrome

Implementation Science Communications ◽

10.1186/s43058-021-00160-7 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Caitlin Dmitriew ◽

Robert Ohle

Keyword(s):

Decision Making ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Decision Aid ◽

Clinical Decision Making ◽

Clinical Decision ◽

Barriers And Facilitators ◽

Acute Aortic Syndrome ◽

Potential Barriers

Abstract Background Acute aortic syndrome (AAS) is an uncommon, life-threatening emergency that is frequently misdiagnosed. The 2020 Canadian clinical practice guidelines for the diagnosis of AAS incorporate all available evidence into four key recommendations. In order to facilitate the implementation of these recommendations, a clinical decision aid was created. The objective of this study was to identify barriers and facilitators among physicians prior to implementation of the guideline recommendations in a multicentre step wedge cluster randomized control trial. Methods We conducted semi-structured interviews with nine emergency room physicians working at five sites distributed between urban academic and rural settings. We used purposive sampling, contacting physicians until data saturation was reached. Interview questions were designed to understand potential barriers and facilitators to guideline recommendation uptake and use. Responses were analysed according to the Theoretical Domains Framework, and overarching themes describing these barriers and facilitators were identified. Results Two themes and six subthemes encompassing 13 theoretical domains were identified. These included clinical decision-making support, awareness of the evidence, social factors, expected consequences, ability of physicians to acquire the necessary data and ease of use. A majority of interviewees anticipated that the guideline recommendations would support clinical decision making and more effectively risk-stratify patients. Other facilitators included endorsement of the guidelines by professional organizations and peers. Barriers to implementation include the fact that laboratory testing and knowledge of the rationale for its use in the investigation of AAS were not widespread. The complexity of the clinical decision aid and concerns about test specificity were also identified as potential barriers to use. Conclusion Physicians were amenable to using the AAS guideline recommendations to support clinical decision-making and to reduce resource use. A structured intervention should be developed to address the identified barriers and leverage the facilitators in order to ensure successful implementation. Our findings may have implications for the implementation of other guidelines used in emergency departments.

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Barriers and Facilitators Affecting Implementation of a Clinical Decision aid for the Diagnosis of Acute Aortic Syndrome: A Qualitative Study

10.21203/rs.3.rs-60191/v1 ◽

2020 ◽

Author(s):

Caitlin Dmitriew ◽

Robert Ohle

Keyword(s):

Decision Making ◽

Decision Aid ◽

Clinical Decision Making ◽

Theoretical Domains Framework ◽

Clinical Decision ◽

Barriers And Facilitators ◽

Acute Aortic Syndrome ◽

Structured Interviews ◽

Potential Barriers ◽

D Dimer

Abstract Background: Acute aortic syndrome (AAS) is an uncommon, life-threatening emergency that is frequently misdiagnosed. The Canadian clinical practice guidelines for the diagnosis of AAS were developed to improve patient outcomes and include a clinical decision aid designed to facilitate clinician decision-making. The objective of this study was to prospectively identify barriers and facilitators among physicians prior to implementation of the decision aid.Methods: We conducted semi-structured interviews with emergency room physicians working at five sites distributed between urban academic and rural settings. We used purposive sampling, contacting physicians until data saturation was reached. Interview questions were designed to understand potential barriers and facilitators to decision aid uptake and use. Responses were analysed according to the Theoretical Domains Framework, and overarching themes describing these barriers and facilitators were identified. Results: A majority of interviewees anticipated that the decision aid would support clinical decision making and risk stratification. Potential facilitators identified included guideline validation and publication and endorsement by peers. Barriers to implementation and application of the aid included the fact that the use of D-dimer and knowledge of the rationale for its use in the investigation of AAS were not widespread. The complexity of the decision aid and insufficient specificity of D-dimer were also identified as potential barriers to use. Conclusion: Physicians were amenable to using the AAS decision aid to support clinical decision-making and to reduce resource use. The barriers identified should be addressed prior to implementation in order to support decision aid uptake and use.

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Optimizing Patient Management in Crohn’s Disease in a Tertiary Referral Center: the Impact of Fast-Track MRI on Patient Management and Outcomes

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.274.ocm ◽

2018 ◽

Vol 27 (4) ◽

pp. 391-397 ◽

Cited By ~ 2

Author(s):

Akos Ilias ◽

Barbara D Lovasz ◽

Lorant Gonczi ◽

Zsuzsanna Kurti ◽

Zsuzsanna Vegh ◽

...

Keyword(s):

Decision Making ◽

Crohn’S Disease ◽

Disease Activity ◽

Patient Management ◽

Fast Track ◽

Clinical Decision Making ◽

Clinical Decision ◽

Clinical Disease ◽

Clinical Disease Activity ◽

The Impact

Background & Aims: Rapid optimization of treatment algorithms and disease outcomes requires an objective measurement of disease activity in patients with Crohn’s disease (CD). Our aim was to evaluate the impact of rapid-access to magnetic resonance imaging (MRI) on treatment optimization, clinical decision-making and outcomes for CD patients in a specialized tertiary care for inflammatory bowel disease (IBD) patients.Methods: A cohort of 75 referral CD patients (median age: 34, IQR: 25-43 years) who had underwent 90 fasttrack MR enterography (MRE) scans between January 2014 and June 2016 were retrospectively enrolled. The MRI results were compared to clinical activity scores and biomarkers (C-reactive protein). The immediate impact of fast-track MRI on clinical decision-making, including changes in medical therapy, the need of hospitalization and surgery were evaluated.Results: The location of CD was ileo-colonic in 61% of the patients with perianal fistulas in 56% and previous surgeries in 55%. The indication for fast-track MRI scans was active disease (clinical or biomarker activity) in 55.6%. The radiological activity (including mild radiological signs to severe lesions) was detected in 94% of cases. Significant/severe MRI activity was depicted in 68% of these patients. Correlation between MRI radiological activity and clinical disease activity or colonoscopy was moderate (kappa: 0.609 and 0.652). A change in therapeutic strategy was made in 94.1% of cases with severe MRI radiological activity vs. 50% of patients without severe MRI radiological activity (p=0.001). Significant/severe MRI activity was followed by higher surgery rates among patients with clinical disease activity (50% vs. 12.5%; p=0.013). MRI performed on patients with clinical and biomarker remission identified disease activity in a significantly smaller proportion.Conclusions: Fast-track MRI had a great impact on patient management in CD patients with clinical or biomarker activity, leading to better patient stratification and faster optimization of the therapy (medical or surgical), while MRI revealed previously undiagnosed disease activity only in a small proportion of patients in clinical remission.

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