Using Web-Enabled Technology to Promote the Adoption of Practice Guidelines

The rapid expansion of scientific knowledge brings increased physician uncertainty in clinical decisionmaking. Clinical practice guidelines have been developed to reduce physician uncertainty. The broad movement to develop and disseminate clinical practice guidelines is rooted in evidence-based medicine. Although the development and dissemination of evidence-based guidelines has increased dramatically over the past decade, studies indicate serious deficiencies in the adoption of guidelines into practice. Developments such as client/server networks, the Internet, and the World Wide Web are rapidly expanding potential educational applications for information and communications technologies and the capacity for introducing strategies to promote guideline adoption. Web-enabled computer technology can enhance the capability of healthcare information systems to reduce variation in clinical decisionmaking.

Informational Needs of Parents of Sick Neonates

Sixty-one parents of 43 neonates in a neonatal intensive care unit were interviewed within 3 days of their first conference with the neonatologist to assess their needs for medical information. The conference with the physician and the interview with the investigator were audiotaped. Information given by the physician and information recalled by the parents was categorized and rated by the investigator. The physicians gave very detailed information about diagnosis in 77% of cases whereas 39% of the parents recalled diagnostic information in great detail. Respective percentages for prognosis were 16 and 33; for current management (eg, investigation, therapy), 28 and 66; and for cause of illness, 16 and 18. The statistical significance of the differences between the very detailed information in the physician-parent conferences and in the parent-investigator interviews was, by category,<.002,<.041,<.004, and not significant, respectively. Information in the respective categories was described as "most helpful" by 20%, 67%, 90%, and 8% of parents. All but one of the parents stated that they wanted the whole truth. Physician uncertainty in providing information was significantly associated with severity of illness. It is concluded that while parents wanted information in all categories, they paid most attention to that relating to management. Physician-parent discordances with respect to information about management, diagnosis, and prognosis suggest directions for future investigation of the optimal content of information for parents in this context.

Physician uncertainty, specialty ideology, and a second opinion prior to tonsillectomy

For half a century, the tonsil has been the target of a large-scale, uncontrolled surgical experiment-tonsillectomy. In the fourth and fifth decades of this century, well over 50% of children appear to have undergone the procedure; since World War II, opinion has swung away from mass use and by 1973 about 25% of children appear to have been affected. Pediatricians have been the weathermen in the change of clinical climate, pressing for reduction in use of tonsillectomy in their journal articles. Among a sample of California physicians, the offspring of pediatricians underwent fewer tonsillectomies than the children of other types of physicians.