Decision support tools overlooked
medwireNews: Doctors are reluctant to direct patients to decision support tools, web-based or otherwise, with many sceptical about the value of such tools and uncertain about when to use them, shows a study published in BMJ Open.
Analysis of referral data and web logs revealed that fewer than expected patients were offered access to decision support tools.
For example, just 157 patients visiting antenatal clinics were directed to an amniocentesis decision tool, out of around 700 potentially eligible patients. Similarly, only 36 breast cancer patients were directed to a tool to support them in making a decision on surgery, again out of a potential pool of about 700 patients.
Authors Professor Glyn Elwyn and team, from the Cochrane Institute of Primary Care and Public Health at Cardiff University, say that where patients did overcome the initial access barrier, they showed considerable interest in the tools; 48% of those who gained access to the amniocentesis web tool viewed the site for 30 minutes or longer.
Semistructured interviews with 57 NHS clinicians revealed a strong perception that they were already involving patients in decisions anyway and that there was no need to alter existing pathways to change or adopt decision support.
Clinicians also expressed concern that patients may not be able to access the information, for example because of technical problems, as well as citing external barriers such as needing to meet efficiency targets and 'best practice' recommendations.
"Clinicians will not use these interventions simply because they are made available, despite good evidence of benefit to patients," Professor Elwyn and colleagues write.
"These attitudes are deep seated and will not be modified by solely developing web-based interventions: a broader strategy will be required to embed DESIs [decision support interventions] into routine practice."
medwireNews is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
By Caroline Price, Senior medwireNews Reporter