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Factors Driving Resistance to Clinical Decision Support: Finding Inspiration in Radiology 3.0.

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Clinician resistance to clinical decision support (CDS) stems from a desire to reduce diagnostic uncertainty. Addressing this discomfort through education and radiologist consultation is key to improving CDS effectiveness.

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Area of Science:

  • Medical Informatics
  • Clinical Practice Guidelines
  • Healthcare Quality Improvement

Background:

  • Evidence-based guidelines (EBGs) and clinical decision support (CDS) are crucial for optimal patient care.
  • Clinician resistance significantly impedes the effective implementation of EBGs and CDS.

Purpose of the Study:

  • To investigate the underlying reasons for clinician resistance to clinical decision support (CDS).
  • To identify specific factors that drive clinicians to disregard EBGs and CDS recommendations.

Main Methods:

  • A mixed-methods approach combining web-based surveys, focus groups, and individual interviews.
  • Utilized the Amplifire electronic learning module to assess clinician knowledge gaps regarding EBGs and CDS.
  • Explored clinicians' rationales for ordering imaging studies not aligned with EBGs.

Main Results:

  • The primary driver of resistance to CDS was clinicians' desire to order imaging studies not supported by EBGs.
  • This ordering behavior was predominantly motivated by the need to alleviate diagnostic uncertainty.
  • Both quantitative and qualitative data highlighted diagnostic uncertainty as a core issue.

Conclusions:

  • Enhancing CDS effectiveness requires addressing clinician discomfort with diagnostic uncertainty.
  • Educational outreach and ongoing radiologist consultation are vital strategies.
  • Mitigating resistance involves supporting clinicians in managing uncertainty and understanding the role of imaging.