Oncologist Perceptions of Algorithm-Based Nudges to Prompt Early Serious Illness Communication: A Qualitative Study.
Oncologist Perceptions of Algorithm-Based Nudges to Prompt Early Serious Illness Communication: A Qualitative Study.
复制标题
肿瘤学家对基于算法的推动促进早期严重疾病沟通的看法：一项定性研究。
DOI：
10.1089/jpm.2022.0095
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发表时间：
2022
影响因子：
2.8
通讯作者：
Shea,JudyA
中科院分区：
文献类型：
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作者：
Parikh,RaviB;Manz,ChristopherR;Nelson,MariaN;Ferrell,William;Belardo,Zoe;Temel,JenniferS;Patel,MiteshS;Shea,JudyA
背景：关于护理目标和预后的早期严重疾病对话（SICs）可以改善情绪，生活质量和临终护理质量。对肿瘤学家的基于算法的行为推动增加了此类对话的频率和及时性。然而，临床医生的观点，这样的nudges是unknown.Design：定性研究包括半结构化的采访中的肿瘤临床医生谁参加了一个阶梯楔群随机试验的会话连接，一个基于算法的干预，包括行为的nudges，以促进早期SICs在门诊肿瘤setting.Results：79个符合条件的肿瘤临床医生，56（71%）接近参加面试和25（45%）接受。基于算法的推动的关键促进因素包括促进对话记录，同行比较，绩效报告以及验证早期对话的规范。障碍包括算法性能的癌症特异性异质性以及短信的频率和语气。改进的领域包括利用不同的信息渠道，识别患者的疾病轨迹的早期，并纳入以患者为目标的消息，强调早期conversation.Conclusions的价值：肿瘤临床医生确定的关键促进者和障碍对话连接。这些见解为未来基于算法的肿瘤学支持性护理干预提供了信息。对照试验（NCT 03984773）。
Background:Early serious illness conversations (SICs) about goals of care and prognosis improve mood, quality of life, and end-of-life care quality. Algorithm-based behavioral nudges to oncologists increase the frequency and timeliness of such conversations. However, clinicians' perspectives on such nudges are unknown.Design:Qualitative study consisting of semistructured interviews among medical oncology clinicians who participated in a stepped-wedge cluster randomized trial of Conversation Connect, an algorithm-based intervention consisting of behavioral nudges to promote early SICs in the outpatient oncology setting.Results:Of 79 eligible oncology clinicians, 56 (71%) were approached to participate in interviews and 25 (45%) accepted. Key facilitators to algorithm-based nudges included prompting documentation of conversations, peer comparisons, performance reports, and validating norms around early conversations. Barriers included cancer-specific heterogeneity in algorithm performance and the frequency and tone of text messages. Areas of improvement included utilizing different information channels, identifying patients earlier in the disease trajectory, and incorporating patient-targeted messaging that emphasizes the value of early conversations.Conclusions:Oncology clinicians identified key facilitators and barriers to Conversation Connect. These insights inform future algorithm-based supportive care interventions in oncology. Controlled trial (NCT03984773).