Understanding the factors that influence clinical decision-making - a sequential explanatory mixed methods study protocol

2018 ◽  
Vol 6 (2) ◽  
pp. 329 ◽  
Author(s):  
Veena Manja ◽  
Sandra Monterio ◽  
Gordon Guyatt ◽  
John You ◽  
Satyan Lakshminrusimha ◽  
...  
Keyword(s):  
Decision Making ◽  
Mixed Methods ◽  
Patient Outcomes ◽  
Healthcare Costs ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Mixed Methods Study ◽  
Explanatory Mixed Methods ◽  
Survey Results ◽  
Case Based

Background: Despite soaring healthcare costs, patient outcomes are suboptimal in the USA. Efforts to limit healthcare costs and improve quality of care have had limited success. An improved understanding of factors that influence clinical decision-making may provide insight into optimizing the quality and costs of care. The process of healthcare decision-making is contextual, complex and poorly understood. This study aims to explore the factors that influence clinical decision-making in the setting of limited evidence of effectiveness, limited or conflicting guidance, significant resource burden and variation in values and preferences.Rationale for study design: This sequential explanatory mixed methods study includes a case-based survey (quantitative phase). The results of the survey will guide the sampling and questions for the semi-structured interviews (qualitative phase). The interviews will provide an in-depth explanation of the survey results. Combining the two methods provides complementary information and deeper understanding of the phenomenon of clinical decision-making.Methods: The quantitative strand will consist of case-based surveys in the fields of neonatology and cardiology. Participants are asked to pick the best management choice for each question followed by a rating of the influence of different factors on a 7-point Likert scale. Follow-up questions explore knowledge and influence of evidence, guideline recommendations and costs on decision-making. Analysis of the survey results will inform sampling and the focus of qualitative interviews. The interviews will be analyzed using qualitative description.Discussion: To our knowledge, this is the first study using a mixed methods approach including a case-based survey of physicians practicing in diverse settings to explore the factors that influence clinical decision-making. The results of this study may assist with strategies to implement high value care resulting in improved patient outcomes and limiting costs.

scholarly journals Clinical decision-making at the end of life: a mixed-methods study

2018 ◽  
Vol 10 (3) ◽  
pp. e26-e26 ◽  
Author(s):  
Paul Taylor ◽  
Miriam J Johnson ◽  
Dawn Wendy Dowding
Keyword(s):  
Heart Failure ◽  
Decision Making ◽  
Mixed Methods ◽  
End Of Life ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Study Groups ◽  
Mixed Methods Study ◽  
Semistructured Interview ◽  
The North

ObjectivesTo improve the ability of clinical staff to recognise end of life in hospital inpatients dying as a result of cancer and heart failure, and to generate new hypotheses for further research.MethodsThis mixed-methods study used decision theory as a theoretical basis. It involved a parallel databases-convergent design, incorporating findings from previously published research, with equal priority to study groups and synthesis by triangulation. The individual arms were (1) a retrospective cohort study of 102 patients with cancer and 81 patients with heart failure in an acute trust in the North of England, and(2) a semistructured interview study of 19 healthcare professionals caring for the same patient groups.ResultsThe synthesis of findings demonstrated areas of agreement, partial agreement, silence and dissonance when comparing the cohort findings with the interview findings. Trajectories of change are identified as associated with poor prognosis in both approaches, but based on different parameters. Management of patients has a significant impact on decision-making. The decision process requires repeated, iterative assessments and may benefit from a multidisciplinary approach. Uncertainty is a defining characteristic of the overall process, and objective parameters only have a limited role in predicting end of life.ConclusionsThe role of uncertainty is important as a trigger for discussions and a defined stage in a patient’s illness journey. This is consistent with current approaches to recognising irreversible deterioration in those with serious illness. This study contributes ongoing evidence that these concepts are vital for decision-making.

scholarly journals “Closing the loop”: a mixed-methods study about resident learning from outcome feedback after patient handoffs

Diagnosis ◽  
2018 ◽  
Vol 5 (4) ◽  
pp. 235-242 ◽  
Author(s):  
Edna C. Shenvi ◽  
Stephanie Feudjio Feupe ◽  
Hai Yang ◽  
Robert El-Kareh
Keyword(s):  
Mixed Methods ◽  
Learning Outcomes ◽  
Patient Outcomes ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Mixed Methods Study ◽  
Barriers To Learning ◽  
Outcome Feedback ◽  
Closing The Loop ◽  
Access Logs

Abstract Background Learning patient outcomes is recognized as crucial for ongoing refinement of clinical decision-making, but is often difficult in fragmented care with frequent handoffs. Data on resident habits of seeking outcome feedback after handoffs are lacking. Methods We performed a mixed-methods study including (1) an analysis of chart re-access rates after handoffs performed using access logs of the electronic health record (EHR); and (2) a web-based survey sent to internal medicine (IM) and emergency medicine (EM) residents about their habits of and barriers to learning the outcomes of patients after they have handed them off to other teams. Results Residents on ward rotations were often able to re-access charts of patients after handoffs, but those on EM or night admitting rotations did so <5% of the time. Among residents surveyed, only a minority stated that they frequently find out the outcomes of patients they have handed off, although learning outcomes was important to both their education and job satisfaction. Most were not satisfied with current systems of learning outcomes of patients after handoffs, citing too little time and lack of reliable patient tracking systems as the main barriers. Conclusions Despite perceived importance of learning outcomes after handoffs, residents cite difficulty with obtaining such information. Systematically providing feedback on patient outcomes would meet a recognized need among physicians in training.

scholarly journals Quantifying the Impact of Patient-Specific Factors and Disease Severity on Clinical Decision Making in Cuff Tear Arthropathy: A Case-Based Survey

2019 ◽  
Vol 15 (3) ◽  
pp. 276-285
Author(s):  
Adam P. Schumaier ◽  
Yehia H. Bedeir ◽  
Joshua S. Dines ◽  
Keith Kenter ◽  
Lawrence V. Gulotta ◽  
...  
Keyword(s):  
Decision Making ◽  
Disease Severity ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Patient Specific ◽  
Cuff Tear Arthropathy ◽  
Cuff Tear ◽  
Specific Factors ◽  
The Impact ◽  
Case Based

scholarly journals Teaching Cognitive Biases in Clinical Decision Making: A Case-Based Discussion

MedEdPORTAL ◽  
2015 ◽  
Vol 11 (1) ◽  
Author(s):  
Keng Sheng Chew ◽  
Jeroen van Merrienboer ◽  
Steven Durning
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Cognitive Biases ◽  
Clinical Decision ◽  
Case Based

A decision theory overview and case-based discussion

2021 ◽  
Vol 13 (8) ◽  
pp. 320-324
Author(s):  
David Thom
Keyword(s):  
Decision Making ◽  
Decision Theory ◽  
Reliability Analysis ◽  
Clinical Case ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Human Reliability ◽  
Human Reliability Analysis ◽  
Use Of Technology ◽  
Case Based

Paramedics make decisions as part of their everyday role but often, the theory behind clinical decision-making is not discussed in depth. This article explores the theories of decision-making as they apply to a clinical case. With the increasing use of technology in healthcare, the introduction of human reliability analysis is becoming more pertinent.

Diagnostic conversations: Clinical Decision Making in surgery – Part 1

Diagnosis ◽  
2014 ◽  
Vol 1 (1) ◽  
pp. 99-102 ◽  
Author(s):  
David Allan Watters ◽  
Spencer Wynyard Beasley ◽  
Wendy Crebbin
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Learning Opportunities ◽  
Clinical Scenario ◽  
Decision Making Processes ◽  
Expert Surgeon ◽  
Thinking Processes ◽  
Royal Australasian College ◽  
Case Based

AbstractSound and efficient decision making are hallmarks of an expert surgeon. Unfortunately, those experts are often unable to explain their thinking processes, or to teach their trainees and colleagues how they do it. Surgeons and staff of the Royal Australasian College of Surgeons worked together to develop a model to explain the processes around clinical decision making and used this understanding and knowledge to devise a Clinical Decision Making (CDM) training course. The surgical faculty ensure the model is applicable to specific surgical cases, as well as presenting a framework of how clinical decisions are made. Wendy targets the specific decision making processes that are occurring with each clinical scenario, and highlights some of the learning opportunities that they provide. The conversation in this paper models the kinds of case-based interactions which occur in the development and teaching of the CDM course.

scholarly journals Observational Study of the Multisciplinaryteam role (MDT) on Healthcare Management of Cancer Patients: Benefits and Barriers, AbuDhabi 2017

2019 ◽  
Vol 61 (1) ◽  
pp. 18-24
Author(s):  
Ibtisam Hussein Al Obaidi
Keyword(s):  
Decision Making ◽  
Cancer Patients ◽  
Patient Outcomes ◽  
Health Care Professionals ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Healthcare Management ◽  
Survey Study ◽  
Multidisciplinary Teams ◽  
The Impact

Background: Multidisciplinary team meetings (MDTs) are designed to optimize patient outcomes. It appears intuitive that MDTs are essential to clinical decision - making and patient management; however, it is unclear whether that belief is supported by evidence. With regard to cancer patients, studies demonstrated that  treatment plans made by interacting health care professionals are more effective than those made by individual practitioners. Objectives: To assess the impact of multidisciplinary teams (MDTs) on clinical decision - making and  patient outcomes. Methods: We follow a descriptive questionnaire survey study design and created a (10) sections  surveymonkey that was distributed via email to (150) experts in surgical oncology, general surgery, oncology, radiation oncology, pathologists, and administrative staff. Fourty (40) completed responses were collected to ensure a statistical basis on which to draw sound conclusions. The remaining 110 staff have submitted incomplete answers. Answers were discussed in a separate MDT meeting with most of the  participants.The survey was followed by an interpretation of the respondents’ results and comparison with literatures.  Results: 75% of the participants chose” Agree and strongly agree”, supporting the hypothesis that MDT  meetings ensure an effective and up-to- date management guidelines. This means that the risk of not  discussing a cancer patient cannot be neglected any longer. So the hypothesis statement (H0) is rejected and the alternative statement (Ha) is accepted. Conclusions: The majority of participants saw the value in the MDT process and expressed support for its implementation locally and nationally; however, feedback about the most appropriate format is yet to be established. The clinicians identified the need for agreed standards in MDT performance

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