Prognostic prediction tools and clinician communication: a qualitative study of the effect of the STUMBL tool on clinical practice

Claire O’Neill,Hayley A Hutchings,Zoe Abbott,Ceri Battle

doi:10.1186/s12873-020-00331-0

Abstract

BackgroundIn recent years, researchers and clinicians have been developing prognostic prediction tools (PPTs) as a way of identifying patients at risk of deterioration. The use of PPTs in the clinical environment not only impacts the risk of adverse outcomes for patients, but the use of these tools also effect clinical practice. Much attention has been paid to the clinical performance of PPTs. But more insight is needed on how the use of PPTs impacts clinical practice. The objective of this study was to map some of the ways in which PPTs effect clinical practice.The STUMBL (STUdy evaluating the impact of a prognostic model for Management of BLunt chest wall trauma patients) feasibility trial evaluated the use of a new prognostic prediction tool (PPT) to guide the management blunt chest wall trauma patients in the emergency departments (ED). The trial was undertaken between October 2016 and September 2018 and conducted at four sites in England and Wales. Nested within the feasibility trial was a qualitative study aimed at understanding how ED clinicians experienced and used the PPT. The qualitative methods included a focus group and telephone interviews with 9 ED clinicians. This study focused on participant perceptions of the feasibility and use of the STUMBL tool on clinical practice in the ED.ResultsClinical practice is reshaped as a result of the introduction of the STUMBL PPT into the clinical environment. The PPT enhanced reflexive awareness of prognostic practice; facilitated communication between patients and professionals; helps to guide patient outcomes; and provides a common ground for clinician discussion on prognostication.ConclusionsThe qualitative data collected offered useful insights into the ways in which the tool changes clinical practice. This was a small study of the effect of one kind of PPT on clinical practice. Nevertheless, this study maps areas in which clinical practice is affected by the introduction of a PPT into the clinical environment. More research is needed to better understand these effects, and to understand how these tools become embedded in clinical practice over the longer term.

Highlights

In recent years, researchers and clinicians have been developing prognostic prediction tools (PPTs) as a way of identifying patients at risk of deterioration
While a number of studies have focused on the effectiveness and usefulness of PPTs [9] and on the impact of these tools on clinician confidence [3], less attention has been paid to the usefulness of such interventions in clinical practice [10]
The STUMBL (STUdy evaluating the impact of a prognostic model for Management of BLunt chest wall trauma patients) study was a multi-site feasibility trial set up to understand the feasibility of using a PPT in an emergency department (ED) setting with patients presenting with blunt chest wall trauma [11]

Summary

Introduction

Researchers and clinicians have been developing prognostic prediction tools (PPTs) as a way of identifying patients at risk of deterioration. A number of concerns may deter clinicians from prognosticating These may include a fear that a prognosis becomes a self-fulfilling prophesy [5]; that it may jeopardise the clinician patient relationship [6]; or clinicians may lack confidence in the prognosis provided [7]. To address these challenges, researchers have been turning attention to the potential of prognostic prediction tools (PPTs) that “may provide the evidence-based input for shared decision-making, by providing estimates of the individual probabilities of risks and benefits” [8]. While a number of studies have focused on the effectiveness and usefulness of PPTs [9] and on the impact of these tools on clinician confidence [3], less attention has been paid to the usefulness of such interventions in clinical practice [10]. The integration of PPTs into medical care will rely on the provision of tools that clinicians find accurate, and useful

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