Exploring provider roles, continuity, and mental models in cirrhosis care: A qualitative study

Area of Science:

• Healthcare delivery
• Medical education
• Patient care coordination

Background:

• Advanced cirrhosis leads to frequent healthcare utilization and mortality.
• Previous work identified differences in mental models of cirrhosis care among providers.
• This study explores how care continuity challenges influence provider mental models.

Purpose of the Study:

• To explore how challenges to continuity and coordination of care influence health care providers' approaches to and development of mental models of cirrhosis care.

Main Methods:

• Cross-sectional formal elicitation of mental models using Cognitive Task Analysis.
• 19 participants (family physicians, specialists, nurse practitioners) recruited over 6 months in Alberta.
• Purposive and chain-referral sampling strategies were employed.

Main Results:

• Lack of continuity (informational, management) hinders development of rich mental models for cirrhosis care.
• Continuity challenges influence whether providers adopt patient-centered or task-based mental models.
• Poor continuity impedes the development of shared mental models among healthcare providers.

Conclusions:

• Systemic barriers in cirrhosis care create a cycle where provider mental models perpetuate care coordination issues.
• Understanding provider adaptation to challenges offers insights into breaking the cycle.
• Improving continuity and coordination is essential for effective cirrhosis care management.