Analysis of questions asked by family physicians regarding patient care

Ely, John; Osheroff, Jerome A.; Ebell, Mark H.; Bergus, George; Levy, Barcey T.; Chambliss, M. Lee; Evans, Eric R

doi:10.1136/ewjm.172.5.315

Cited by 21 publications

(12 citation statements)

References 12 publications

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“…The success of such search engines to answer clinical questions is therefore limited. Indeed, Ely et al [8] concluded that clinicians usually do not spend more than two minutes to search for an answer to a clinical question before giving up.…”

Section: Introductionmentioning

confidence: 99%

Assisted Knowledge Discovery for the Maintenance of Clinical Guidelines

et al. 2013

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BackgroundImproving antibiotic prescribing practices is an important public-health priority given the widespread antimicrobial resistance. Establishing clinical practice guidelines is crucial to this effort, but their development is a complex task and their quality is directly related to the methodology and source of knowledge used.ObjectiveWe present the design and the evaluation of a tool (KART) that aims to facilitate the creation and maintenance of clinical practice guidelines based on information retrieval techniques.MethodsKART consists of three main modules 1) a literature-based medical knowledge extraction module, which is built upon a specialized question-answering engine; 2) a module to normalize clinical recommendations based on automatic text categorizers; and 3) a module to manage clinical knowledge, which formalizes and stores clinical recommendations for further use. The evaluation of the usability and utility of KART followed the methodology of the cognitive walkthrough.ResultsKART was designed and implemented as a standalone web application. The quantitative evaluation of the medical knowledge extraction module showed that 53% of the clinical recommendations generated by KART are consistent with existing clinical guidelines. The user-based evaluation confirmed this result by showing that KART was able to find a relevant antibiotic for half of the clinical scenarios tested. The automatic normalization of the recommendation produced mixed results among end-users.ConclusionsWe have developed an innovative approach for the process of clinical guidelines development and maintenance in a context where available knowledge is increasing at a rate that cannot be sustained by humans. In contrast to existing knowledge authoring tools, KART not only provides assistance to normalize, formalize and store clinical recommendations, but also aims to facilitate knowledge building.

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Section: Introductionmentioning

confidence: 99%

Assisted Knowledge Discovery for the Maintenance of Clinical Guidelines

et al. 2013

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“…Clinical questions have been categorized as to the kind of knowledge they sought and the kind of answers they needed, with taxonomic and other organizing structures proposed for them [ 24 , 27 , 35 , 37 ]. The questions of family-medicine, elder-care, and rural-health physicians have been explored [ 25 , 29 , 30 , 32 , 34 , 44 ]. Experiments have been done on different ways of capturing clinical questions through voice and other input media [ 28 , 39 – 43 ].…”

Section: Discussionmentioning

confidence: 99%

Exploring patient information needs in type 2 diabetes: A cross sectional study of questions

et al. 2018

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This study set out to analyze questions about type 2 diabetes mellitus (T2DM) from patients and the public. The aim was to better understand people’s information needs by starting with what they do not know, discovered through their own questions, rather than starting with what we know about T2DM and subsequently finding ways to communicate that information to people affected by or at risk of the disease. One hundred and sixty-four questions were collected from 120 patients attending outpatient diabetes clinics and 300 questions from 100 members of the public through the Amazon Mechanical Turk crowdsourcing platform. Twenty-three general and diabetes-specific topics and five phases of disease progression were identified; these were used to manually categorize the questions. Analyses were performed to determine which topics, if any, were significant predictors of a question’s being asked by a patient or the public, and similarly for questions from a woman or a man. Further analysis identified the individual topics that were assigned significantly more often to the crowdsourced or clinic questions. These were Causes (CI: [-0.07, -0.03], p < .001), Risk Factors ([-0.08, -0.03], p < .001), Prevention ([-0.06, -0.02], p < .001), Diagnosis ([-0.05, -0.02], p < .001), and Distribution of a Disease in a Population ([-0.05,-0.01], p = .0016) for the crowdsourced questions and Treatment ([0.03, 0.01], p = .0019), Disease Complications ([0.02, 0.07], p < .001), and Psychosocial ([0.05, 0.1], p < .001) for the clinic questions. No highly significant gender-specific topics emerged in our study, but questions about Weight were more likely to come from women and Psychosocial questions from men. There were significantly more crowdsourced questions about the time Prior to any Diagnosis ([(-0.11, -0.04], p = .0013) and significantly more clinic questions about Health Maintenance and Prevention after diagnosis ([0.07. 0.17], p < .001). A descriptive analysis pointed to the value provided by the specificity of questions, their potential to disclose emotions behind questions, and the as-yet unrecognized information needs they can reveal. Large-scale collection of questions from patients across the spectrum of T2DM progression and from the public–a significant percentage of whom are likely to be as yet undiagnosed–is expected to yield further valuable insights.

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“…Other taxonomies may better capture the nature of questions people naturally ask, for example a linguistic taxonomy of the type described here. Access to EBM resources is greatly facilitated by framing enquiries in the language of EBM [ 9 , 10 ]. People do not naturally do this.…”

Section: Discussionmentioning

confidence: 99%

Analysis of clinical uncertainties by health professionals and patients: an example from mental health

Lloyd

Cella

Tanenblatt

et al. 2009

BMC Med Inform Decis Mak

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BackgroundThe 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.MethodsFrom 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.ResultsFew 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.ConclusionPeople 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.

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Analysis of questions asked by family physicians regarding patient care

Cited by 21 publications

References 12 publications

Assisted Knowledge Discovery for the Maintenance of Clinical Guidelines

Assisted Knowledge Discovery for the Maintenance of Clinical Guidelines

Exploring patient information needs in type 2 diabetes: A cross sectional study of questions

Analysis of clinical uncertainties by health professionals and patients: an example from mental health

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