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Project

De rol van een keuzehulp in de ondersteuning van shared decision making in de eerste lijn

More than a decade ago, the Institute of Medicine (IOM) envisioned that by now, the vast majority of healthcare related decisions and choices would be supported by accurate, up-to-date and timely information. This goal was part of a larger aim to promote evidence-based healthcare across the country. To enable this vision, learning health systems were suggested as a substrate to disseminate and implement this information or evidence. Clinical decision support (CDS) systems play an important role in confronting healthcare providers with new evidence and providing them with this information in a format in which it can used to influence healthcare decisions. Across the globe, many healthcare systems have introduced policy to advance similar goals and aims. Research evidence, however, represents only one aspect of evidence-based healthcare. Just as important in making individual healthcare decisions are the clinical expertise of the healthcare provider and the values and preferences of the patient. The process in which these three facets of evidence-based healthcare interact and where healthcare providers and their patients come to well-informed decisions is what we call shared decision-making (SDM). In some situations, however, evidence-based guideline panels base their judgments on presumptions on patient values and preferences, which may or may not be correct. In these cases, recommendations may recommend or suggest actions that do not reflect the true discussions during patient encounters. There are currently no systems that capture or document which aspects regarding a condition (or its treatment) truly drive healthcare decisions. Hence there is no confirmation whether the assumptions made by guideline panels reflect the true values and preferences of patients. CDS systems are designed to use individual patient information (often directly from the electronic health record) and generate patient-specific recommendations or actions aimed to improve healthcare. The CDS interfaces are often developed targeting one actor in the SDM process (either the patient or the healthcare profession). Research has been conducted to better understand how research evidence can be presented to healthcare providers and patients (such as infographics and decision aids) to improve knowledge and understanding. However, it is unclear how the information presented in CDS systems is used in patient encounters to influence SDM and whether specific presentations or interfaces influence its use. In this PhD we aim to investigate the way CDS effects SDM and which factors can improve their use and uptake during the patient encounter. In addition, we aim to investigate how CDS can be used to document the SDM process during the patient encounter and how this information could be used to inform guideline panels when making judgements on patient values and preferences.

Datum:10 jan 2022 →  Heden
Trefwoorden:decision support, evidence-based medicine, shared decision making
Disciplines:Gezondheidswetenschappen niet elders geclassificeerd
Project type:PhD project