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首页> 外文期刊>BMC Medical Informatics and Decision Making >Development of a computerised decision aid for thrombolysis in acute stroke care
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Development of a computerised decision aid for thrombolysis in acute stroke care

机译：急性卒中治疗中溶栓的计算机决策辅助工具的开发

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Background Thrombolytic treatment for acute ischaemic stroke improves prognosis, although there is a risk of bleeding complications leading to early death/severe disability. Benefit from thrombolysis is time dependent and treatment must be administered within 4.5?hours from onset of symptoms, which presents unique challenges for development of tools to support decision making and patient understanding about treatment. Our aim was to develop a decision aid to support patient-specific clinical decision-making about thrombolysis for acute ischaemic stroke, and clinical communication of personalised information on benefits/risks of thrombolysis by clinicians to patients/relatives. Methods Using mixed methods we developed a COMPuterised decision Aid for Stroke thrombolysiS (COMPASS) in an iterative staged process (review of available tools; a decision analytic model; interactive group workshops with clinicians and patients/relatives; and prototype usability testing). We then tested the tool in simulated situations with final testing in real life stroke thrombolysis decisions in hospitals. Clinicians used COMPASS pragmatically in managing acute stroke patients potentially eligible for thrombolysis; their experience was assessed using self-completion forms and interviews. Computer logged data assessed time in use, and utilisation of graphical risk presentations and additional features. Patients’/relatives’ experiences of discussions supported by COMPASS were explored using interviews. Results COMPASS expresses predicted outcomes (bleeding complications, death, and extent of disability) with and without thrombolysis, presented numerically (percentages and natural frequencies) and graphically (pictographs, bar graphs and flowcharts). COMPASS was used for 25 patients and no adverse effects of use were reported. Median time in use was 2.8?minutes. Graphical risk presentations were shared with 14 patients/relatives. Clinicians (n?=?10) valued the patient-specific predictions of benefit from thrombolysis, and the support of better risk communication with patients/relatives. Patients (n?=?2) and relatives (n?=?6) reported that graphical risk presentations facilitated understanding of benefits/risks of thrombolysis. Additional features (e.g. dosage calculator) were suggested and subsequently embedded within COMPASS to enhance usability. Conclusions Our structured development process led to the development of a gamma prototype computerised decision aid. Initial evaluation has demonstrated reasonable acceptability of COMPASS amongst patients, relatives and clinicians. The impact of COMPASS on clinical outcomes requires wider prospective evaluation in clinical settings.
机译：背景急性缺血性卒中的溶栓治疗可改善预后，尽管存在出血并发症导致早期死亡/严重残疾的风险。溶栓的益处是时间依赖性的，必须在症状发作后4.5小时内进行治疗，这对开发支持决策和患者对治疗的理解的工具提出了独特的挑战。我们的目的是开发一种决策辅助工具，以支持针对急性缺血性卒中的溶栓治疗的患者特定临床决策，以及有关临床医生对患者/亲属的溶栓益处/风险的个性化信息的临床交流。方法使用混合方法，我们在迭代的过程中开发了计算机化的卒中血栓形成决策辅助工具（COMPASS）（对可用工具进行了审查;决策分析模型;与临床医生和患者/亲属进行的交互式小组讨论会;以及原型可用性测试）。然后，我们在模拟情况下对该工具进行了测试，并在医院中对现实生活中的血栓溶解决策进行了最终测试。临床医生务实地使用COMPASS来管理可能符合溶栓作用的急性中风患者。他们的经验是通过自我完成表格和访谈来评估的。计算机记录的数据评估了使用时间以及图形化风险表示和其他功能的利用。通过访谈探讨了患者/亲属在COMPASS支持下的讨论经验。结果COMPASS表示有或没有溶栓的预测结果（出血并发症，死亡和残疾程度），以数字（百分比和自然频率）和图形（象形图，条形图和流程图）表示。 COMPASS用于25例患者，未报告使用不良反应。平均使用时间为2.8分钟。图形风险提示与14位患者/亲戚共享。临床医生（n？=？10）重视患者对溶栓治疗获益的特定预测，以及与患者/亲戚更好的风险沟通的支持。患者（n = 2）和亲戚（n = 6）报告说，图形化的风险提示有助于理解溶栓的益处/风险。建议使用其他功能（例如剂量计算器），然后将其嵌入COMPASS中以增强可用性。结论我们的结构化开发过程导致了伽马原型计算机决策辅助工具的开发。初步评估表明，COMPASS在患者，亲属和临床医生中均可接受。 COMPASS对临床结果的影响需要在临床环境中进行更广泛的前瞻性评估。

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