Abstract
BackgroundClinical decision aids are used in various medical fields to support patients and clinicians when making healthcare decisions. Few attempts have been made to implement such tools in psychiatry. We developed Treatment E-Assist (TREAT); a routine outcome monitoring based computerized clinical decision aid, which generates personalized treatment recommendations in the care of people with psychotic disorders. The aim of this study is to investigate how TREAT is used and evaluated by clinicians and how this tool can be improved.MethodsClinicians working with TREAT during a clinical trial were asked to participate in semi-structured interviews. The Unified Theory of Acceptance and Use of Technology (UTAUT) was used as a sensitizing theory to structure a part of the interview questions. The transcripts were analyzed using inductive thematic analysis to uncover the main themes.ResultsThirteen clinicians (mean age: 49) of which eight psychiatrists and five nurse practitioners, participated in this study. Eight clinicians experienced TREAT as beneficial, whereas five experienced no additional benefits. Thematic analysis revealed five themes surrounding usage and evaluation of TREAT, views on TREAT’s graphic representation of routine outcome monitoring results, guideline based treatment recommendations, contextual factors, effects on patients and effects on shared decision-making. Performance and effort expectancy were perceived as high by clinicians. The facilitating conditions were optimal and perceived social influence was low.ConclusionThis article presents a qualitative evaluation by clinicians of a computerized clinical decision aid in psychosis care. TREAT was viewed by most clinicians as beneficial during their consultations. The graphic representation of routine outcome monitoring results was well-appreciated and provided input to discuss treatment planning with patients. The treatment recommendations did not change most treatment decisions but supported clinical reasoning. However, some clinicians were unconvinced about TREAT’s benefits. The delivery, applicability and the availability of resources require improvement to increase TREAT’s efficacy. Not all patients responded well to TREAT but the observed facilitation of shared decision-making is promising. All four predictors of the Unified Theory of Acceptance and Use of Technology were positively evaluated by the majority of clinicians.
Highlights
Clinical decision aids are used in various medical fields to support patients and clinicians when making healthcare decisions
Aligning Clinical decision aids (CDAs) with guidelines, care standards, clinical policies, existing infrastructure and workflows can augment their uptake within organizations [5]
Clinicians remain unconvinced of the benefits of CDAs [6], arguing that they do not agree with their content and use or lack time to implement them in their daily clinical practice [4]
Summary
Clinical decision aids are used in various medical fields to support patients and clinicians when making healthcare decisions. Clinical decision aids (CDAs) aim to facilitate and improve therapeutic decision-making. They help professionals and patients agree on important treatment options [1]. Less than half of all CDAs are still used after the experimental evaluation period [4] This is due to a lack of funding or endorsement by organizations, because the tools are out of date or do not fit the existing care processes [4]. Clinicians remain unconvinced of the benefits of CDAs [6], arguing that they do not agree with their content and use or lack time to implement them in their daily clinical practice [4]. It is important to involve clinicians in different stages of development of new CDAs and critically evaluate their functionality
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