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Decision support systems often neglect high-level cognitive performance. This study identified five key themes in complex cognitive processing during primary care visits, highlighting the need for integrated mental models.

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Area of Science:

  • Cognitive Science
  • Decision Support Systems
  • Healthcare Informatics

Background:

  • Current decision support systems often fail to adequately support high-level cognitive functions.
  • Development trends focus on minimizing attention and deep processing, potentially hindering complex decision-making.
  • A dual-process perspective suggests both automatic and deliberative cognitive processes require support.

Purpose of the Study:

  • To qualitatively explore complex cognitive processing in healthcare settings.
  • To identify key cognitive processes involved in high-level performance during patient care.
  • To inform the design of decision support tools that better accommodate human cognition.

Main Methods:

  • Qualitative analysis guided by the Contextual Control Model.
  • Analysis of transcripts from 33 primary care visits across 4 Veterans Affairs locations.
  • Iterative process of construct and thematic development to identify patterns.

Main Results:

  • Five major themes emerged: Joint Exchange and Patient Activation, Planning and Proactive Problem Solving, Script and heuristic processing, Time perspectives, and Uncertainty management.
  • These themes represent critical aspects of high-level cognitive processing in real-world clinical scenarios.
  • Findings underscore the complexity of cognitive demands in decision support.

Conclusions:

  • Decision support designs must evolve to support, not circumvent, complex cognitive processing.
  • Integrated views and mental models are crucial for effective decision support.
  • Future systems should be developed with a deeper understanding of dual-process cognitive models.