The aim of this project was to use patient scenarios (clinical/case vignettes) to explore three aspects of General Practitioners' (GPs') clinical decision-making: how difficult decisions are perceived to be, the time taken to make decisions, and the appropriateness of decisions relative to evidence-based clinical guideline recommendations. A systematic review synthesised the results of published scenario studies. A secondary analysis of scenario studies which investigated antibiotic prescribing for upper respiratory tract infection (URTI) and x-ray referral for low back pain was performed. Relationships between the three aspects of decision-making were investigated, and scenario and GP characteristics associated with these aspects were identified. An online scenario study further refined these relationships for two specific URTI types: sore throat and otitis media. Cognitive processes involved in clinical decision-making were investigated in a Think-Aloud interview study, where GPs verbalised their thoughts while making prescribing decisions for URTI scenarios. There was some evidence that inappropriate antibiotic prescribing for URTI was associated with greater decision difficulty and longer decision time. Decisions made using a more effortful cognitive process may therefore be less likely to be appropriate. Illness durations of four or more days and, in otitis media, unilateral ear examination findings were related to inappropriate prescribing. Based on these results, suggestions have been made for informing the design of interventions to support GPs in making appropriate decisions. A secondary aim was to provide an overview of the methodology and reporting of scenario studies. The systematic review indicated a lack of consistency in methodologies, while reporting is often inadequate. Formats less similar to real consultations (e.g. written scenarios) are commonly used: the results of studies using these formats may be less likely to reflect real practice decision-making than studies using more realistic formats (e.g. videos). Based on these findings, methodological recommendations for scenario studies have been developed.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:680995 |
| Date | January 2015 |
| Creators | McCleary, Nicola |
| Publisher | University of Aberdeen |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=229003 |
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