Non-clinical influences on clinical decision-making: a major challenge to                evidence-based practice

Hajjaj, F. M.; Salek, Mir-saeed; Basra, M. K. A.; Finlay, A.Y.

doi:10.1258/jrsm.2010.100104

Cited by 279 publications

(268 citation statements)

References 93 publications

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“…Domains with relatively low mean importance ratings appear to cover the nonclinical patient indicators, such as, treatment‐interfering maladaptive coping (domain 7) and social factors maintaining the depression (domain 9), whereas domains of relatively higher importance seem to describe the clinical patient indicators such as depression severity (domain 1), psychiatric and somatic comorbidity (domains 2, 6 and 3), and childhood trauma (domain 8). Although the high mean importance ratings of domains covering clinical patient indicators is consistent with findings indicating that most clinical decisions are largely based on ‘traditional’ clinical patient factors (Hajjaj, Salek, Basra, & Finlay, 2010), the impact of each domain on referral decisions in patients with MDD remains to be validated in an observational study. Future research should examine the relative importance and possible synergy of action between the domains.…”

Section: Discussionsupporting

confidence: 63%

Indicators to facilitate the early identification of patients with major depressive disorder in need of highly specialized care: A concept mapping study

et al. 2018

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BackgroundEarly identification of the subgroup of patients with major depressive disorder (MDD) in need of highly specialized care could enhance personalized intervention. This, in turn, may reduce the number of treatment steps needed to achieve and sustain an adequate treatment response. The aim of this study was to identify patient‐related indicators that could facilitate the early identification of the subgroup of patients with MDD in need of highly specialized care.MethodsInitial patient indicators were derived from a systematic review. Subsequently, a structured conceptualization methodology known as concept mapping was employed to complement the initial list of indicators by clinical expertise and develop a consensus‐based conceptual framework. Subject‐matter experts were invited to participate in the subsequent steps (brainstorming, sorting, and rating) of the concept mapping process. A final concept map solution was generated using nonmetric multidimensional scaling and agglomerative hierarchical cluster analyses.ResultsIn total, 67 subject‐matter experts participated in the concept mapping process. The final concept map revealed the following 10 major clusters of indicators: 1‐depression severity, 2‐onset and (treatment) course, 3‐comorbid personality disorder, 4‐comorbid substance use disorder, 5‐other psychiatric comorbidity, 6‐somatic comorbidity, 7‐maladaptive coping, 8‐childhood trauma, 9‐social factors, and 10‐psychosocial dysfunction.ConclusionsThe study findings highlight the need for a comprehensive assessment of patient indicators in determining the need for highly specialized care, and suggest that the treatment allocation of patients with MDD to highly specialized mental healthcare settings should be guided by the assessment of clinical and nonclinical patient factors.

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Section: Discussionsupporting

confidence: 63%

Indicators to facilitate the early identification of patients with major depressive disorder in need of highly specialized care: A concept mapping study

et al. 2018

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“…However, the wider 'social networks' of each of these key stakeholders may also be involved in the DM process and influential over the final decision, including other patients, family members, health professionals, friends, and neighbours [17,40]. In addition, a growing body of evidence is recognising that clinicians also exist within interprofessional networks, and other clinicians, allied health team members, and healthcare administrators may inform the clinician's position within the DM process [41][42][43]. Indeed, the involvement of other health professionals is well documented in situations where complex medical decisions are discussed at multidisciplinary team meetings [e.g.…”

Section: Concept 4: Dm Is Not Only Amongst Threementioning

confidence: 99%

The TRIO Framework: Conceptual insights into family caregiver involvement and influence throughout cancer treatment decision-making

Laidsaar-Powell

Butow

Charles

et al. 2017

Patient Education and Counseling

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Dedication:This paper is dedicated to the memory of our colleague, the late Professor Cathy Charles, who made a major contribution to the TRIO conceptual framework.2 Highlights  Empirically-grounded conceptual Framework of DM with a corresponding graphical aid  Focuses on the form and extent of family caregiver involvement in/influence over DM  Presents six conceptual insights derived from empirical evidence and DM theory  May serve as a useful guide for future empirical, ethical and/or theoretical work AbstractObjective: Family caregivers are regularly involved in cancer consultations and treatment decisionmaking (DM). Yet there is limited conceptual description of caregiver influence/involvement in DM.To address this, an empirically-grounded conceptual framework of triadic DM (TRIO Framework) and corresponding graphical aid (TRIO Triangle) were developed.Methods: Jabareen's model for conceptual framework development informed multiple phases of development/validation, incorporation of empirical research and theory, and iterative revisions by an expert advisory group. Results:Findings coalesced into six empirically-grounded conceptual insights: i) Caregiver influence over a decision is variable amongst different groups; ii) Caregiver influence is variable within the one triad over time; iii) Caregivers are involved in various ways in the wider DM process; iv) DM is not only amongst three, but can occur among wider social networks; v) Many factors may affect the form and extent of caregiver involvement in DM; vi) Caregiver influence over, and involvement in, DM is linked to their everyday involvement in illness care/management. Conclusion:The TRIO Framework/Triangle may serve as a useful guide for future empirical, ethical and/or theoretical work.Practice Implications: This Framework can deepen clinicians's and researcher's understanding of the diverse and varying scope of caregiver involvement and influence in DM.

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“…[11][12][13] Patient characteristics can influence physician perceptions of the patient's clinical presentation, capacity to engage in shared decision making, likelihood to follow treatment recommendations, and ultimately the clinical decisions …”

Section: The Patientmentioning

confidence: 99%

Factors Contributing to Variations in Physicians’ Use of Evidence at The Point of Care: A Conceptual Model

2015

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There is ample evidence that many clinical decisions made by physicians are inconsistent with current and generally accepted evidence. This leads to the underuse of some efficacious diagnostic, preventive or therapeutic services, and the overuse of others of marginal or no value to the patient. Evolving new payment and delivery models place greater emphasis on the provision of evidence-based services at the point of care. However, changing physician clinical behaviors is likely to be difficult and slow. Policy makers therefore need to design interventions that are most effective in promoting greater evidence-based care. To help identify modifiable factors that can influence clinical decisions at the point of care, we present a conceptual model and literature review of physician decision making. We describe the multitude of factors-drawn from different disciplines-that have been shown to influence physician point-of-care decisions. We present a conceptual framework for organizing these factors, dividing them into patient, physician, practice site, physician organization, network, market, and public policy influences. In doing so, we review some of the literature that speak to these factors. We then identify areas where additional research is especially needed, and discuss the challenges and opportunities for health services and policy researchers to gain a better understanding of these factors, particularly those that are potentially modifiable by policymakers and organizational leaders. 5 Many studies have observed large variations in clinical practice, across geographic areas and within local areas or even specific physician organizations. 6 We are undergoing rapid change in healthcare organization and delivery. Physicians are increasingly practicing in larger organizations and systems of care, in part prompted by widespread initiatives by federal, state, and private payers to improve care quality and lower costs. These reform efforts, such as patient-centered medical homes and accountable care organizations, along with significant federal funding of comparative effectiveness research, incentives for adoption of health information technology that includes decision support, and feedback on clinical quality performance raise the hope and expectation that clinical decision making will improve, with greater adherence to accepted evidence.Within this context, research and requisite data collection on key factors affecting physician decision making is necessary to design interventions and refine current ones. In this article, we present a conceptual framework for understanding factors contributing to physician clinical decision making, specifically those related to physicians' use of evidence at the point of care. With this framework, we conclude with directions for future research and the data needs necessary to conduct this research.We frame our discussion in the context of physician decision making as part of a broader inquiry into collecting data on physicians and their practice organizations. Of course, evidence...

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Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice

Cited by 279 publications

References 93 publications

Indicators to facilitate the early identification of patients with major depressive disorder in need of highly specialized care: A concept mapping study

Indicators to facilitate the early identification of patients with major depressive disorder in need of highly specialized care: A concept mapping study

The TRIO Framework: Conceptual insights into family caregiver involvement and influence throughout cancer treatment decision-making

Factors Contributing to Variations in Physicians’ Use of Evidence at The Point of Care: A Conceptual Model

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