Towards a framework for untangling complexity: The interprofessional decision‐making model for the complex patient

Abstract

Decision making for the complex patient is challenging for doctors because of increased complexity, such as multiple co-morbidities and interprofessionality for which evidence-based literature and guidelines are currently lacking. The consequent uncertainty causes vagueness, threatening patient safety and the quality of care. This article is motivated by the design science paradigm and describes the interprofessional decisionmaking model for the complex patient, namely, INDECO along with an example instantiation. Drawing on our experience in an intensive care unit of a tertiary hospital in Israel, the bi-dimensional view of this model includes the medical-and the interprofessional perspective. Retrospective assessment of 3 case studies of complex patients is used for assessing the usefulness of INDECO in decision making. The study reported here draws support from relevant literature, including the information science, information systems, and the medical domains. The findings resonate with emerging research developments focusing on healthcare decision making.

The Evolution of an Interprofessional Shared Decision-Making Research Program: Reflective Case Study of an Emerging Paradigm

“…In addition, using reverse citation, we identified more than 150 unique citations and dozens of teams that have been applied this team’s approach in their own areas of work (see Table 2 ). Our reverse citation searches suggest an important expansion of knowledge about IP-SDM that is reaching a variety of fields, including rehabilitation [ 44 45 ], mental health [ 46 47 ], care for complex patients [ 48 49 50 ], and educational research [ 38 51 ].…”

A framework for complexity in palliative care: A qualitative study with patients, family carers and professionals

“…22 Studies considering complexity have largely been in decisionmaking, multiple chronic conditions, paediatric care or general healthcare and have described complexity more broadly (beyond the individual). [23][24][25][26][27][28][29][30][31] Fernández-López et al 20 defined four levels of complexity for people nearing end-of-life (no complexity, low, medium and high), which establish intervention criteria for resource allocation, but without further validation. A recent study has also explored a predictive model of complexity (also adopting tiered levels) in palliative care, but only explores intervention and patient-level complexity in advanced cancer patients.…”

What is complexity of hospital-based physiotherapy from the perspective of physiotherapists themselves? A grounded theory study

“… 27 This study shows that complexity is a puzzle of considering different interactive perspectives which is also described in ‘the framework for untangling complexity’. 28 This indicates that, although this distinction is not specifically made by the participants, the HBPs addressed complex issues rather than complicated issues. 8 …”