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首页> 外文期刊>BMC Medical Informatics and Decision Making >Understanding complex clinical reasoning in infectious diseases for improving clinical decision support design
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Understanding complex clinical reasoning in infectious diseases for improving clinical decision support design

机译：了解传染病的复杂临床推理，以改善临床决策支持设计

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Clinical experts’ cognitive mechanisms for managing complexity have implications for the design of future innovative healthcare systems. The purpose of the study is to examine the constituents of decision complexity and explore the cognitive strategies clinicians use to control and adapt to their information environment. We used Cognitive Task Analysis (CTA) methods to interview 10 Infectious Disease (ID) experts at the University of Utah and Salt Lake City Veterans Administration Medical Center. Participants were asked to recall a complex, critical and vivid antibiotic-prescribing incident using the Critical Decision Method (CDM), a type of Cognitive Task Analysis (CTA). Using the four iterations of the Critical Decision Method, questions were posed to fully explore the incident, focusing in depth on the clinical components underlying the complexity. Probes were included to assess cognitive and decision strategies used by participants. The following three themes emerged as the constituents of decision complexity experienced by the Infectious Diseases experts: 1) the overall clinical picture does not match the pattern, 2) a lack of comprehension of the situation and 3) dealing with social and emotional pressures such as fear and anxiety. All these factors contribute to decision complexity. These factors almost always occurred together, creating unexpected events and uncertainty in clinical reasoning. Five themes emerged in the analyses of how experts deal with the complexity. Expert clinicians frequently used 1) watchful waiting instead of over- prescribing antibiotics, engaged in 2) theory of mind to project and simulate other practitioners’ perspectives, reduced very complex cases into simple 3) heuristics, employed 4) anticipatory thinking to plan and re-plan events and consulted with peers to share knowledge, solicit opinions and 5) seek help on patient cases. The cognitive strategies to deal with decision complexity found in this study have important implications for design future decision support systems for the management of complex patients.
机译：临床专家用于管理复杂性的认知机制对未来创新医疗系统的设计具有影响。该研究的目的是检查决策复杂性的组成部分，并探索临床医生用来控制和适应其信息环境的认知策略。我们使用认知任务分析（CTA）方法采访了犹他大学和盐湖城退伍军人管理局医疗中心的10位传染病（ID）专家。要求参与者使用关键决策方法（CDM）（一种认知任务分析（CTA））回忆起复杂，关键而生动的抗生素处方事件。使用“关键决策方法”的四次迭代，提出了一些问题以全面探究事件，并深入研究复杂性背后的临床组成部分。包括探针以评估参与者使用的认知和决策策略。以下三个主题成为传染病专家所经历的决策复杂性的组成部分：1）总体临床情况与模式不符; 2）对情况缺乏理解; 3）处理社会和情感压力，例如恐惧和焦虑。所有这些因素都会导致决策复杂性。这些因素几乎总是一起发生，从而在临床推理中产生了意料之外的事件和不确定性。分析专家如何处理复杂性时出现了五个主题。专业的临床医生经常使用1）警惕的等待而不是过度开抗生素，而是从事2）思维理论来投射和模拟其他从业者的观点，将非常复杂的案例简化为简单的方法3）启发式方法，采用4）预见性思维来计划和重新计划计划活动并与同行协商以共享知识，征求意见，并5）就患者病例寻求帮助。本研究中发现的应对决策复杂性的认知策略对设计未来的决策支持系统以管理复杂患者具有重要意义。

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