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首页> 外文期刊>BMC Medical Informatics and Decision Making >Analysis of clinical uncertainties by health professionals and patients: an example from mental health
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Analysis of clinical uncertainties by health professionals and patients: an example from mental health

机译：卫生专业人员和患者的临床不确定性分析：来自心理健康的例子

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Background The first step in practising Evidence Based Medicine (EBM) has been described as translating clinical uncertainty into a structured and focused clinical question that can be used to search the literature to ascertain or refute that uncertainty. In this study we focus on questions about treatments for schizophrenia posed by mental health professionals and patients to gain a deeper understanding about types of questions asked naturally, and whether they can be reformulated into structured and focused clinical questions. Methods From a survey of uncertainties about the treatment of schizophrenia we describe, categorise and analyse the type of questions asked by mental health professionals and patients about treatment uncertainties for schizophrenia. We explore the value of mapping from an unstructured to a structured framework, test inter-rater reliability for this task, develop a linguistic taxonomy, and cross tabulate that taxonomy with elements of a well structured clinical question. Results Few of the 78 Patients and 161 clinicians spontaneously asked well structured queries about treatment uncertainties for schizophrenia. Uncertainties were most commonly about drug treatments (45.3% of clinicians and 41% of patients), psychological therapies (19.9% of clinicians and 9% of patients) or were unclassifiable.(11.8% of clinicians and 16.7% of patients). Few naturally asked questions could be classified using the well structured and focused clinical question format (i.e. PICO format). A simple linguistic taxonomy better described the types of questions people naturally ask. Conclusion People do not spontaneously ask well structured clinical questions. Other taxonomies may better capture the nature of questions. However, access to EBM resources is greatly facilitated by framing enquiries in the language of EBM, such as posing queries in PICO format. People do not naturally do this. It may be preferable to identify a way of searching the literature that more closely matches the way people naturally ask questions if access to information about treatments are to be made more broadly available.
机译：背景技术实践循证医学（EBM）的第一步已被描述为将临床不确定性转化为结构化且重点突出的临床问题，可用于搜索文献以确定或反驳该不确定性。在本研究中，我们重点研究心理健康专业人员和患者提出的有关精神分裂症治疗的问题，以便对自然提出的问题类型有更深入的了解，以及是否可以将其重新构造为结构化和重点突出的临床问题。方法从对精神分裂症治疗不确定性的调查中，我们描述，分类和分析了精神卫生专业人员和患者对精神分裂症治疗不确定性所提出的问题类型。我们探索了从非结构化框架到结构化框架的映射的价值，测试此任务的评估者之间的可靠性，开发了语言分类法，并将该分类法与结构良好的临床问题的要素进行交叉制表。结果78名患者和161名临床医生中很少有人自发地询问有关精神分裂症治疗不确定性的结构合理的问题。不确定性最常见的是药物治疗（45.3％的临床医生和41％的患者），心理疗法（19.9％的临床医生和9％的患者）或无法分类的不确定性（11.8％的临床医生和16.7％的患者）。使用结构良好且重点突出的临床问题格式（即PICO格式），很少有自然问​​题可以分类。简单的语言分类法可以更好地描述人们自然会问的问题类型。结论人们不会自发地提出结构合理的临床问题。其他分类法可能会更好地反映问题的性质。但是，通过以EBM语言编写查询框架（例如以PICO格式提出查询），极大地方便了对EBM资源的访问。人们自然不会这样做。如果要更广泛地获得有关治疗的信息的访问，则最好是找到一种与人们自然提出问题的方式更匹配的文献搜索方式。

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