Abstract
BackgroundCognitive aids are increasingly recommended in clinical practice, yet little is known about the attitudes of physicians towards these tools.MethodsWe employed a qualitative, descriptive design to explore physician attitudes towards cognitive aids in pediatric intensive care units (PICUs). Semi-structured interviews elicited the opinions of a convenience sample of practicing PICU physicians towards the use of cognitive aids. We analyzed interview data for thematic content to examine the three factors of intention to use cognitive aids as defined by the Theory of Planned Behavior (TPB), attitudes, social norms, and perceived control.ResultsAnalysis of 14 interviews suggested that in the PICU setting, cognitive aids are widely used. Discovered themes related to their use touched on all three TPB factors of intention and included: aids are perceived to improve team communication; aids may improve patient safety; aids may hinder clinician judgment; physicians may resist implementation if it occurs prior to demonstration of benefit; effective adoption requires cognitive aids to be integrated into local workplace culture; and implementation should take physician concerns into account.ConclusionsOur sample of PICU physicians were open to cognitive aids in their practice, as long as such aids preserve the primacy of clinical judgment, focus on team communication, demonstrate effectiveness through preliminary testing, and are designed and implemented with the local culture and work environment in mind. Future knowledge translation efforts to implement cognitive aids would benefit from consideration of these issues.
Highlights
Cognitive aids are increasingly recommended in clinical practice, yet little is known about the attitudes of physicians towards these tools
Our findings suggest that implementation would likely benefit from an iterative process, where feedback from the end users is incorporated in a way that allows for modification within the local culture and workflow
Our sample of Pediatric Intensive Care Unit (PICU) physicians were open to welldesigned cognitive aids in their practice
Summary
Cognitive aids are increasingly recommended in clinical practice, yet little is known about the attitudes of physicians towards these tools. The term cognitive aid includes a wide range of tools designed to reduce mental burden on memory and complex decision making. Weiss et al BMC Medical Informatics and Decision Making (2016) 16:53 promising tool, but one that required further study [11] This growing body of experimental evidence suggests a role for cognitive aids, but, as discussed below, there is limited published research about physician attitudes towards these tools. Implementation of the same WHO surgical checklist has shown variable effectiveness outside of the initial project, as documented in Guatemala City [13] and across the UK [14] These examples suggest that understanding of local factors and attitudes towards cognitive aid use might play an important role in their effectiveness
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