User Experience of Self-Reported Computerized Medical History Taking for Acute Chest Pain in the Clinical Expert Operating System - Chest Pain Danderyd Study (CLEOS-CPDS): Interview Study Among Patients (Preprint)

BACKGROUND Chest pain is one of the most common complaints in emergency departments (EDs). The effectiveness of care for patients with chest pain requires that individual circumstances and the complexity of the patient's clinical issues are determined by medical history taking. The knowledge base for history taking and for interpreting the clinical significance of the information collected can be formalized by software to enable computerized history taking (CHT) directly from patients and subsequently reporting the findings promptly to physicians. The adoption of CHT in clinical practice depends, among other issues, on reactions and attitudes to the technology from patients and their belief that the technology will have benefits for their medical care. OBJECTIVE The objective of this study was to explore the user experience of the self-reported CHT program CLEOS (Clinical Expert Operating System) in the setting of patients attending an ED for acute chest pain. METHODS This qualitative interview study is part of the ongoing CLEOS-Chest Pain Danderyd Study (CLEOS-CPDS), at a cardiology ED. A subset (n=84) of the larger sample who had taken part in self-reported history taking by the CLEOS program during waiting times at the ED were contacted by telephone and n=54 (64%) accepted participation. An interview guide with open-ended questions developed for this study was used. The text was analyzed using conventional content analysis in a deductive way by using the headings in the interview guide. RESULTS Six categories emerged: Clinical context, Individual context, Time aspect, Acceptability of the program, Usability of the program, and Perceptions of usefulness in a clinical context. A majority of the patients thought CLEOS had worked well. Patients also appreciated the opportunities, of interacting with the program and contributing to information about their own health while waiting for care. The program was generally perceived as easy to use and that the questions were mostly seen as relevant and straight forward. Many patients were of the opinion, however, that too many questions were asked and sometimes they mentioned there was insufficient time for responding to them. Some had found it difficult to find the strength to answer all the questions due to their condition. CONCLUSIONS The patients’ experience of the CLEOS program at a cardiology ED reflects an overall positive attitude. The CLEOS program was by some perceived as extensive, although most found the program user-friendly. Despite the busy ED environment, patients were highly motivated and felt that the program would be helpful in leading to a correct diagnosis. These findings suggest an important role for patient-entered CHT programs such as CLEOS in the setting of an ED from the perspective of the patients. CLINICALTRIAL ClinicalTrials.gov NCT03439449