科提供者的观点和在透析患者中使用死亡预后工具
Jennifer Bergeron1,2, Christina Marchese3,4, Colton Jensen3
1Division of Nephrology, Department of Medicine, West Virginia University School of Medicine, 1 Medical Center Drive, PO Box 9165, Morgantown, WV, 26506, USA. jennifer.bergeron@hsc.wvu.edu.
BMC nephrology
|November 26, 2024
概括
科提供者由于对概括性和对临床判断的信任的担忧,未充分利用死亡率预测工具. 即使在审查了患者的工具性能之后,医疗服务提供者也更喜欢临床gestalt而不是预后工具进行决策.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 医疗信息学 医疗信息学
- 临床决策支持 临床决策支持
背景情况:
- 死亡率预测工具可以帮助功能衰竭患者共享决策.
- 这些有价值的工具目前在临床实践中未得到充分利用.
- 了解提供者的观点对于改善工具采用至关重要.
研究的目的:
- 调查科提供者关于死亡预测工具的现行做法.
- 识别阻碍在日常护理中使用这些工具的障碍.
- 评估提供者在审查其患者群体中工具性能之前和之后的态度.
主要方法:
- 半结构面试与10名脏病提供者 (8名医生,2名执业护士) 进行.
- 基于理论被用来识别提供者响应中的共同主题.
- 在279名透析患者中,使用后勤回归和ROC分析评估了三个六个月死亡预测工具.
主要成果:
- 提供者报告了工具使用的重大障碍,包括对通用性,对临床判断的信任,时间限制和缺乏数据知识的担忧.
- 尽管了解这些工具在患者群体中的表现,但提供者并不打算将其纳入实践.
- 医疗服务提供者更喜欢临床gestalt而不是预后工具,认为它们更适合人群而不是个体患者.
结论:
- 科提供者不经常使用可用的死亡率预测工具,即使是在教育干预后.
- 与感知可用性和提供者自主性相关的障碍阻碍了工具集成.
- 需要采取替代策略,有效地将预后纳入透析患者的共享决策.
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