Accepted for/Published in: JMIR Human Factors
Date Submitted: Oct 15, 2020
Date Accepted: Apr 5, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Barriers to Use of Clinical Decision Support for the Evaluation of Pulmonary Embolism: Results of a Qualitative Study
ABSTRACT
Background:
Providers often disregard potentially beneficial clinical decision support (CDS). Improvements in quality of care seen with CDS have been significantly limited by consistently low provider adoption, estimated at 10%.
Objective:
We sought to explore the psychological and behavioral barriers to use of a CDS tool.
Methods:
We conducted a qualitative study involving Emergency Medicine physicians and physician assistants. A semi-structured interview guide was created based on the Capability Opportunity Motivation Behavior (COM-B) model. Interviews focused on barriers to use of a CDS tool built based on Wells’ Criteria for Pulmonary Embolism to assist providers in establishing pre-test probability of pulmonary embolism (PE) before imaging.
Results:
Interviews were conducted with 12 providers. Six barriers were identified: 1. Bayesian Reasoning, 2. Fear of Missing PE, 3. Time Pressure / Cognitive Load, 4. Gestalt Includes Wells’, 5. Missed Risk Factors, and 6. Social Pressure.
Conclusions:
Providers highlighted several important psychological and behavioral barriers to CDS use. Addressing these barriers will be paramount in developing CDS that can meet its potential to transform clinical care. Clinical Trial: NA
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