心不全における適時緩和ケアを促進するための臨床意思決定支援ツールの設計

Palliative care improves quality of life and reduces healthcare utilization for people with heart failure, yet referrals remain inconsistent and delayed. Clinical decision support (CDS) offers a promising strategy to facilitate timely palliative care, but no CDS tool currently exists to specifically support palliative care decision-making in this population.

Guided by the User-Centered Framework for Implementation of Technology (UFIT), we conducted a qualitative descriptive study of focus groups and interviews with referring (i.e., hospitalists, cardiologists) and palliative care clinicians across two hospitals in an academic health system. Using rapid qualitative and content analysis, we identified needs, contextual factors, and design requirements to inform CDS tool development for timely palliative care.

Clinicians (n=25) identified pain points in the current workflow, clinicians' goals and expectations for earlier referral, and barriers to timely palliative care, such as timing uncertainty. Informational needs included prognostic and clinical data. Context reflected clinicians' prior experiences with CDS tools, where they reported few options specific to palliative care and disliked interruptive "pop-up" alerts not tailored to clinical contexts or workflow. CDS requirements included incorporation of objective markers of clinical deterioration, tailored recommendations and workflow integration based on clinical acuity and palliative needs, and a clear, visually appealing design.

Clinicians identified critical information for a CDS tool to promote timely palliative care for patients with heart failure. These findings directly inform the design, workflow, implementation strategies, and future pilot testing of our palliative care CDS tool and subsequent clinical trial.

What is new?: 1)This study is the first to apply the UFIT framework to guide the development of a CDS tool to promote timely palliative care among patients with heart failure.This work advances palliative care innovation by showing how a CDS tool can address barriers through integration of clinical and contextual insights.What are the clinical implications?: 2)This qualitative study informs the development of a clinical decision support tool to promote guideline-concordant palliative care in heart failure.Findings underscore that successful implementation of CDS tools depends on the tool's alignment with established clinical workflows to enhance usability, support clinician adoption, and minimize workflow disruption.