Are Clinical Decision Support Systems Compatible with Patient-Centred Care?
Few, if any, of the Clinical Decision Support Systems developed and reported within the informatics literature incorporate patient preferences in the formal and quantitatively analytic way adopted for evidence. Preferences are assumed to be 'taken into account' by the clinician in the asso...
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ftlshtm:oai:researchonline.lshtm.ac.uk:4657393 2023-05-15T16:50:58+02:00 Are Clinical Decision Support Systems Compatible with Patient-Centred Care? Rajput, Vije Kumar Dowie, Jack Kaltoft, Mette Kjer 2020-06 text https://researchonline.lshtm.ac.uk/id/eprint/4657393/ https://researchonline.lshtm.ac.uk/id/eprint/4657393/1/rajput%20dowie%20kaltoft%20%202020%20MIE%20CDSS.pdf en eng https://researchonline.lshtm.ac.uk/id/eprint/4657393/1/rajput%20dowie%20kaltoft%20%202020%20MIE%20CDSS.pdf Rajput, Vije Kumar; Dowie, Jack <https://researchonline.lshtm.ac.uk/view/creators/ppehjdow.html>; Kaltoft, Mette Kjer; (2020) Are Clinical Decision Support Systems Compatible with Patient-Centred Care? Studies in health technology and informatics, 270. pp. 532-536. ISSN 0926-9630 DOI: https://doi.org/10.3233/SHTI200217 <https://doi.org/10.3233/SHTI200217> cc_by_nc CC-BY-NC Article NonPeerReviewed 2020 ftlshtm 2022-03-03T07:30:38Z Few, if any, of the Clinical Decision Support Systems developed and reported within the informatics literature incorporate patient preferences in the formal and quantitatively analytic way adopted for evidence. Preferences are assumed to be 'taken into account' by the clinician in the associated clinical encounter. Many CDSS produce management recommendations on the basis of embedded algorithms or expert rules. These are often focused on a single criterion, and the preference trade-offs involved have no empirical basis outside an expert panel. After illustrating these points with the Osteoporosis Adviser CDSS from Iceland, we review an ambitious attempt to address both the monocriterial bias and lack of empirical preference-sensitivity, in the context of Early Rheumatoid Arthritis. It brings together the preference data from a Discrete Choice Experiment and the best available evidence data, to arrive at the percentage of patients who would prefer particular treatments from those in the listed options. It is suggested that these percentages could assist a GRADE panel determine whether to produce a strong or weak recommendation. However, any such group average preference-based recommendations are arguably in breach of both the reasonable patient legal standard for informed consent and simple ethical principles. The answer is not to localise, but personalise, decisions through the use of preference-sensitive multi-criteria decision support tools engaged with at the point of care. Article in Journal/Newspaper Iceland London School of Hygiene & Tropical Medicine: LSHTM Research Online |
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London School of Hygiene & Tropical Medicine: LSHTM Research Online |
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English |
description |
Few, if any, of the Clinical Decision Support Systems developed and reported within the informatics literature incorporate patient preferences in the formal and quantitatively analytic way adopted for evidence. Preferences are assumed to be 'taken into account' by the clinician in the associated clinical encounter. Many CDSS produce management recommendations on the basis of embedded algorithms or expert rules. These are often focused on a single criterion, and the preference trade-offs involved have no empirical basis outside an expert panel. After illustrating these points with the Osteoporosis Adviser CDSS from Iceland, we review an ambitious attempt to address both the monocriterial bias and lack of empirical preference-sensitivity, in the context of Early Rheumatoid Arthritis. It brings together the preference data from a Discrete Choice Experiment and the best available evidence data, to arrive at the percentage of patients who would prefer particular treatments from those in the listed options. It is suggested that these percentages could assist a GRADE panel determine whether to produce a strong or weak recommendation. However, any such group average preference-based recommendations are arguably in breach of both the reasonable patient legal standard for informed consent and simple ethical principles. The answer is not to localise, but personalise, decisions through the use of preference-sensitive multi-criteria decision support tools engaged with at the point of care. |
format |
Article in Journal/Newspaper |
author |
Rajput, Vije Kumar Dowie, Jack Kaltoft, Mette Kjer |
spellingShingle |
Rajput, Vije Kumar Dowie, Jack Kaltoft, Mette Kjer Are Clinical Decision Support Systems Compatible with Patient-Centred Care? |
author_facet |
Rajput, Vije Kumar Dowie, Jack Kaltoft, Mette Kjer |
author_sort |
Rajput, Vije Kumar |
title |
Are Clinical Decision Support Systems Compatible with Patient-Centred Care? |
title_short |
Are Clinical Decision Support Systems Compatible with Patient-Centred Care? |
title_full |
Are Clinical Decision Support Systems Compatible with Patient-Centred Care? |
title_fullStr |
Are Clinical Decision Support Systems Compatible with Patient-Centred Care? |
title_full_unstemmed |
Are Clinical Decision Support Systems Compatible with Patient-Centred Care? |
title_sort |
are clinical decision support systems compatible with patient-centred care? |
publishDate |
2020 |
url |
https://researchonline.lshtm.ac.uk/id/eprint/4657393/ https://researchonline.lshtm.ac.uk/id/eprint/4657393/1/rajput%20dowie%20kaltoft%20%202020%20MIE%20CDSS.pdf |
genre |
Iceland |
genre_facet |
Iceland |
op_relation |
https://researchonline.lshtm.ac.uk/id/eprint/4657393/1/rajput%20dowie%20kaltoft%20%202020%20MIE%20CDSS.pdf Rajput, Vije Kumar; Dowie, Jack <https://researchonline.lshtm.ac.uk/view/creators/ppehjdow.html>; Kaltoft, Mette Kjer; (2020) Are Clinical Decision Support Systems Compatible with Patient-Centred Care? Studies in health technology and informatics, 270. pp. 532-536. ISSN 0926-9630 DOI: https://doi.org/10.3233/SHTI200217 <https://doi.org/10.3233/SHTI200217> |
op_rights |
cc_by_nc |
op_rightsnorm |
CC-BY-NC |
_version_ |
1766041074482020352 |