Nonclinical influences, beyond diagnosis and severity, on clinical decision making in dermatology: understanding the gap between guidelines and practice

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

doi:10.1111/j.1365-2133.2010.09868.x

Cited by 33 publications

(59 citation statements)

References 56 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This gap has been highlighted for fields, such as dermatology [15], psychology [16], urology [17], etc. In [18], the authors investigate the reasons why clinicians do not always implement the best evidence.…”

Section: Motivation and Related Workmentioning

confidence: 99%

“…Chart abstractions, observational studies, chart audits, results of clinical trials, structured interviews have proven to be useful instruments to investigate this gap in various clinical fields [15,13,26,16,3]. Furthermore, in [27], the authors highlight how the frequency and consequences of errors in medical care can be reduced by monitoring the activities through Hospital Information Systems.…”

Section: Motivation and Related Workmentioning

confidence: 99%

See 1 more Smart Citation

Declarative process mining in healthcare

Rovani

Maggi

Leoni

et al. 2015

Expert Systems with Applications

124

View full text Add to dashboard Cite

Clinical guidelines aim at improving the quality of care processes based on evidence-based insights. However, there may be good reasons to deviate from such guidelines or the guidelines may provide insufficient support as they are not tailored towards a particular setting (e.g., hospital policy or patient group characteristics). Therefore, we propose an approach to mediate between event data reflecting the clinical reality and clinical guidelines describing best-practices in medicine. Concretely, we repair and enrich declarative process models based on event logs. Initial models based on clinical guidelines are improved by observing the real process.Declarative models are used as they allow for more flexibility. Process mining techniques are used to check conformance, analyze deviations, and enrich models with conformance-related diagnostics. The approach has been applied in the urology department of the Isala hospital in the Netherlands. The results demonstrate that the approach is feasible and that our toolset based on ProM and Declare is indeed able to provide valuable insights related to process conformance.

show abstract

Section: Motivation and Related Workmentioning

confidence: 99%

Section: Motivation and Related Workmentioning

confidence: 99%

Declarative process mining in healthcare

Rovani

Maggi

Leoni

et al. 2015

Expert Systems with Applications

124

View full text Add to dashboard Cite

show abstract

“…Our previous work has shown that dermatologists admit to a wide range of influences beyond diagnosis and severity on their clinical decision making [8]. For example, a patient’s rude behaviour or being a complainer could influence the decision made by dermatologists.…”

Section: Introductionmentioning

confidence: 99%

“…Our previous work [8] gave an insight into clinicians’ perspectives on the wide range of influences, beyond diagnosis and severity, which can impact on decision making. However, there is no information from the perspective of patients concerning the role of these influences.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Decision Making in Dermatology: Observation of Consultations and the Patients’ Perspectives

Hajjaj

Salek²,

Basra³

et al. 2010

Dermatology

Self Cite

View full text Add to dashboard Cite

Background: Clinical decision making is a complex process and might be influenced by a wide range of clinical and non-clinical factors. Little is known about this process in dermatology. Aims: The aim of this study was to explore the different types of management decisions made in dermatology and to identify factors influencing those decisions from observation of consultations and interviews with the patients. Methods: 61 patient consultations were observed by a physician with experience in dermatology. The patients were interviewed immediately after each consultation. Consultations and interviews were audio recorded, transcribed and their content analysed using thematic content analysis. Results: The most commonmanagement decisions made during the consultations included: follow-up, carrying out laboratory investigation, starting new topical treatment, renewal of systemic treatment, renewal of topical treatment, discharging patients and starting new systemic treatment. Common influences on those decisions included: clinical factors such as ineffectiveness of previous therapy, adherence to prescribing guidelines, side-effects of medications, previous experience with the treatment, deterioration or improvement in the skin condition, and chronicity of skin condition. Non-clinical factors included: patient’s quality of life, patient’s friends or relatives, patient’s time commitment, travel or transportation difficulties, treatment-related costs, availability of consultant, and availability of treatment. Conclusion: The study has shown that patients are aware that management decisions in dermatology are influenced by a wide range of clinical and non-clinical factors. Education programmes should be developed to improve the quality of decision making.

show abstract

Publication Trends of Qualitative Research in Dermatology

2023

View full text Add to dashboard Cite

ImportanceQualitative studies serve as a tool for dermatologists and researchers in dermatology to engage with and understand perspectives of populations with different cultures and backgrounds.ObjectiveTo assess (1) current approaches to qualitative dermatologic research and (2) the publication trends of these studies with the aim to inform researchers regarding qualitative research and its significance and applicability in the field of dermatology.Evidence ReviewA scoping review was conducted in which PubMed and CINAHL Plus were searched using dermatology AND qualitative, dermatology, and 7 qualitative methods terms. Studies were selected for inclusion using 3 levels of screening. Level 1 excluded articles published in a language other than English. Level 2 excluded articles of studies involving mixed methods, quantitative methods, systematic review, and meta-analysis. Level 3 excluded articles that were not specific to general dermatology, medical dermatology, pediatric dermatology, dermatologic surgery, dermatopathology, or education and training associated with dermatology. Finally, all duplicates were removed. The searches were conducted from July 23 to 28, 2022. All articles obtained from PubMed and CINAHL Plus searches were recorded in REDCap.FindingsA total of 1398 articles were reviewed, and of these, 249 (17.8%) were qualitative dermatology studies. Common qualitative methods included content analysis (58 [23.3%]) and grounded theory/constant comparison (35 [14.1%]). Individual interviews were the most common data collection method (198 [79.5%]), and patients (174 [69.9%]) were the most common participant type. Patient experience (137 [55.0%]) was the most common investigated topic. Overall, 131 qualitative studies (52.6%) in dermatology were published in dermatology journals, and 120 qualitative studies (48.2%) in dermatology were published between 2020 and 2022.Conclusions and RelevanceQualitative research in dermatology is becoming more prevalent. There is value in qualitative research, and we encourage researchers in dermatology to incorporate qualitative methods in their studies.

show abstract

Nonclinical influences, beyond diagnosis and severity, on clinical decision making in dermatology: understanding the gap between guidelines and practice

Abstract: This study has described one aspect of the reality of medical decision making beyond the conventional evidence-based guidelines approach. Proper understanding of nonclinical influences on decision making is of paramount importance for the best patient-centred treatment outcomes.

Cited by 33 publications

References 56 publications

Declarative process mining in healthcare

Declarative process mining in healthcare

Clinical Decision Making in Dermatology: Observation of Consultations and the Patients’ Perspectives

Publication Trends of Qualitative Research in Dermatology

Contact Info

Product

Resources

About