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Burns A, Donnelly B, Feyi-Waboso J, Shephard E, Calitri R, Tarrant M, Dean SG. How do electronic risk assessment tools affect the communication and understanding of diagnostic uncertainty in the primary care consultation? A systematic review and thematic synthesis. BMJ Open 2022; 12:e060101. [PMID: 35768084 PMCID: PMC9244669 DOI: 10.1136/bmjopen-2021-060101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To conduct a systematic review and synthesise qualitative research of electronic risk assessment tools (eRATs) in primary care, examining how they affect the communication and understanding of diagnostic risk and uncertainty. eRATs are computer-based algorithms designed to help clinicians avoid missing important diagnoses, pick up possible symptoms early and facilitate shared decision-making. DESIGN Systematic search, using predefined criteria of the published literature and synthesis of the qualitative data, using Thematic Synthesis. Database searches on 27 November 2019 were of MEDLINE, Embase, CINAHL and Web of Science, and a secondary search of the references of included articles. Included studies were those involving electronic risk assessment or decision support, pertaining to diagnosis in primary care, where qualitative data were presented. Non-empirical studies and non-English language studies were excluded. 5971 unique studies were identified of which 441 underwent full-text review. 26 studies were included for data extraction. A further two were found from citation searches. Quality appraisal was via the CASP (Critical Appraisal Skills Program) tool. Data extraction was via line by line coding. A thematic synthesis was performed. SETTING Primary care. RESULTS eRATs included differential diagnosis suggestion tools, tools which produce a future risk of disease development or recurrence or calculate a risk of current undiagnosed disease. Analytical themes were developed to describe separate aspects of the clinical consultation where risk and uncertainty are both central and altered via the use of an eRAT: 'Novel risk', 'Risk refinement', 'Autonomy', 'Communication', 'Fear' and 'Mistrust'. CONCLUSION eRATs may improve the understanding and communication of risk in the primary care consultation. The themes of 'Fear' and 'Mistrust' could represent potential challenges with eRATs. TRIAL REGISTRATION NUMBER CRD219446.
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Affiliation(s)
- Alex Burns
- College of Medicine and Health, University of Exeter, Exeter, Devon, UK
- PenARC, Exeter, Devon, UK
| | | | | | | | - Raff Calitri
- College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Mark Tarrant
- College of Medicine and Health, University of Exeter, Exeter, Devon, UK
- PenARC, Exeter, Devon, UK
| | - Sarah Gerard Dean
- College of Medicine and Health, University of Exeter, Exeter, Devon, UK
- PenARC, Exeter, Devon, UK
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Kondylakis H, Axenie C, Kiran Bastola D, Katehakis DG, Kouroubali A, Kurz D, Larburu N, Macía I, Maguire R, Maramis C, Marias K, Morrow P, Muro N, Núñez-Benjumea FJ, Rampun A, Rivera-Romero O, Scotney B, Signorelli G, Wang H, Tsiknakis M, Zwiggelaar R. Status and Recommendations of Technological and Data-Driven Innovations in Cancer Care: Focus Group Study. J Med Internet Res 2020; 22:e22034. [PMID: 33320099 PMCID: PMC7772066 DOI: 10.2196/22034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/02/2020] [Accepted: 10/26/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The status of the data-driven management of cancer care as well as the challenges, opportunities, and recommendations aimed at accelerating the rate of progress in this field are topics of great interest. Two international workshops, one conducted in June 2019 in Cordoba, Spain, and one in October 2019 in Athens, Greece, were organized by four Horizon 2020 (H2020) European Union (EU)-funded projects: BOUNCE, CATCH ITN, DESIREE, and MyPal. The issues covered included patient engagement, knowledge and data-driven decision support systems, patient journey, rehabilitation, personalized diagnosis, trust, assessment of guidelines, and interoperability of information and communication technology (ICT) platforms. A series of recommendations was provided as the complex landscape of data-driven technical innovation in cancer care was portrayed. OBJECTIVE This study aims to provide information on the current state of the art of technology and data-driven innovations for the management of cancer care through the work of four EU H2020-funded projects. METHODS Two international workshops on ICT in the management of cancer care were held, and several topics were identified through discussion among the participants. A focus group was formulated after the second workshop, in which the status of technological and data-driven cancer management as well as the challenges, opportunities, and recommendations in this area were collected and analyzed. RESULTS Technical and data-driven innovations provide promising tools for the management of cancer care. However, several challenges must be successfully addressed, such as patient engagement, interoperability of ICT-based systems, knowledge management, and trust. This paper analyzes these challenges, which can be opportunities for further research and practical implementation and can provide practical recommendations for future work. CONCLUSIONS Technology and data-driven innovations are becoming an integral part of cancer care management. In this process, specific challenges need to be addressed, such as increasing trust and engaging the whole stakeholder ecosystem, to fully benefit from these innovations.
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Affiliation(s)
| | - Cristian Axenie
- Audi Konfuzius-Institut Ingolstadt Lab, Technische Hochschule Ingolstadt, Ingolstadt, Germany
| | - Dhundy Kiran Bastola
- School of Interdisciplinary Informatics, University of Nebraska, Omaha, NE, United States
| | | | | | - Daria Kurz
- Interdisziplinäres Brustzentrum, Helios Klinikum München West, Munich, Germany
| | - Nekane Larburu
- Vicomtech, Health Research Institute, San Sebastian, Spain
| | - Iván Macía
- Vicomtech, Health Research Institute, San Sebastian, Spain
| | - Roma Maguire
- University of Strathclyde, Glasgow, United Kingdom
| | - Christos Maramis
- eHealth Lab, Institute of Applied Biosciences - Centre for Research & Technology Hellas, Thessaloniki, Greece
| | | | - Philip Morrow
- School of Computing, Ulster University, Newtownabbey, United Kingdom
| | - Naiara Muro
- Vicomtech, Health Research Institute, San Sebastian, Spain
| | | | - Andrik Rampun
- Academic Unit of Radiology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | | | - Bryan Scotney
- School of Computing, Ulster University, Newtownabbey, United Kingdom
| | | | - Hui Wang
- School of Computing and Engineering, University of West London, London, United Kingdom
| | | | - Reyer Zwiggelaar
- Department of Computer Science, Aberystwyth University, Aberystwyth, United Kingdom
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