Accepted for/Published in: JMIR Human Factors
Date Submitted: Mar 22, 2021
Date Accepted: Dec 19, 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Warning: This is an author submission that is not peer-reviewed or edited.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 and Facilitators for Acceptance of Comprehensive Clinical Decision Support System Driven Care Maps for Patients with Thoracic Trauma: A Qualitative Research Study
ABSTRACT
Background:
Background:
Comprehensive clinical decision support (CDS) care maps (CM) can improve the delivery of care and clinical outcomes however are frequently plagued by usability problems and poor user acceptance.
Objective:
Objective:
There is a need to characterize factors influencing successful design and utilization of comprehensive CDS-CM. The objective of this study was to identify themes associated with end-user acceptance of a thoracic trauma CDS-CM guided by the Unified Theory of Acceptance and Use of Technology (UTAUT) earlier in the process than has traditionally been done. This was a planned adaptive redesign stage of a User Acceptance and System Adaptation Model (UASAD) CDS-CM development and implementation strategy.
Methods:
Methods:
Twenty-two multidisciplinary end-users were identified and recruited using snowball sampling. Qualitative interviews were conducted, audio recorded, and transcribed verbatim. Generation of pre-specified codes and the interview guide were informed by UTAUT constructs and investigative team experience. Interviews were blinded and double coded. Thematic analysis yielded descriptive themes about factors influencing the construction and potential utilization of an acceptable CDS-CM.
Results:
Results:
Eight dominant themes were identified. Themes included factors directly affecting end-users (alert fatigue, redundancy, automation, and minimalistic design) or patient outcomes (evidence-based, prevent errors, comprehensive across spectrum of disease, and malleable to achieve a tailored fit). More experienced providers prioritized a system that is “easy to use”. Nurses prioritized a system which incorporates evidence into decision-support. All participants agreed that the amount of extra work generated should be minimal and that the system should help them administer optimal care efficiently.
Conclusions:
Conclusions:
End-user feedback reinforces attention toward factors to improve acceptance and use of a CDS-CM for patients with thoracic trauma. Common themes focused on system complexity, the ability of the system to fit different populations and settings, and providing optimal care. Identifying these factors early in the development and implementation process may facilitate a user-centered design and improve adoption. Clinical Trial: N/A
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