Understanding physician-level barriers to the use of individualized risk estimates in percutaneous coronary intervention
| Autor: | Linda Garavalia, Carole Decker, Brian Garavalia, John A. Spertus, Adnan K. Chhatriwalla, Robert W. Yeh, Elizabeth Gialde |
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| Rok vydání: | 2015 |
| Předmět: |
Male
Attitude of Health Personnel medicine.medical_treatment media_common.quotation_subject Clinical Decision-Making MEDLINE 030204 cardiovascular system & hematology Risk Assessment 03 medical and health sciences 0302 clinical medicine Cardiologists Percutaneous Coronary Intervention Nursing Perception Physicians medicine Humans 030212 general & internal medicine Precision Medicine Qualitative Research media_common business.industry Percutaneous coronary intervention Foundation (evidence) Precision medicine Preference Female Cardiology and Cardiovascular Medicine business Risk assessment Qualitative research |
| Zdroj: | American heart journal. 178 |
| ISSN: | 1097-6744 |
| Popis: | Background The foundation of precision medicine is the ability to tailor therapy based upon the expected risks and benefits of treatment for each individual patient. In a prior study, we implemented a software platform, e PRISM, to execute validated risk-stratification models for patients undergoing percutaneous coronary intervention and found substantial variability in the use of the personalized estimates to tailor care. A better understanding of physicians' perspectives about the use of individualized risk-estimates is needed to overcome barriers to their adoption. Methods In a qualitative research study, we conducted interviews, in-person or by telephone, with 27 physicians at 8 centers that used e PRISM until thematic saturation occurred. Data were coded using descriptive content analyses. Results Three major themes emerged among physicians who did not use e PRISM to support decision making: (1) "Experience versus Evidence," physicians' preference to rely upon personal experience and subjective assessments rather than objective risk estimates; (2) "Omission of Therapy," the perception that the use of risk models leads to unacceptable omission of potentially beneficial therapy; and (3) "Unnecessary Information," the opinion that information derived from risk models is not needed because physicians' decision making is already sound and they already know the information. Conclusions Barriers to the use of risk models in clinical practice include physicians' perceptions that their experience is sufficient, that models may lead to omission of therapy in patients that may benefit from therapy, and that they already provide good care. Anticipating and overcoming these barriers may improve the adoption of precision medicine. |
| Databáze: | OpenAIRE |
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