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Barriers to the Use of Clinical Decision Support for the Evaluation of Pulmonary Embolism: Qualitative Interview
Safiya Richardson1, Katherine L Dauber-Decker1, Thomas McGinn1
1Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States.
Background:
Clinicians often disregard potentially beneficial clinical decision support (CDS).
Objective:
In this study, we sought to explore the psychological and behavioral barriers to the use of a CDS tool.
Methods:
We conducted a qualitative study involving emergency medicine physicians and physician assistants. A semistructured interview guide was created based on the Capability, Opportunity, and Motivation-Behavior model. Interviews focused on the barriers to the use of a CDS tool built based on Wells' criteria for pulmonary embolism to assist clinicians in establishing pretest probability of pulmonary embolism before imaging.
Results:
Interviews were conducted with 12 clinicians. Six barriers were identified, including (1) Bayesian reasoning, (2) fear of missing a pulmonary embolism, (3) time pressure or cognitive load, (4) gestalt includes Wells' criteria, (5) missed risk factors, and (6) social pressure.
Conclusions:
Clinicians 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.
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