Obstacles to answering doctors' questions about patient care with evidence: qualitative study
Obstacles to answering doctors' questions about patient care with evidence: qualitative study
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DOI：
10.1136/bmj.324.7339.710
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发表时间：
2002-03-23
影响因子：
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通讯作者：
Pifer, EA
中科院分区：
文献类型：
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作者：
Ely, JW;Osheroff, JA;Pifer, EA
目的描述试图用证据回答医生问题时遇到的障碍。设计定性研究。在爱荷华州的一般做法。参与者9名全科医生，14名家庭医生，2名医学图书馆员。主要结果衡量在为医生的问题寻找基于证据的答案时遇到的障碍分类。结果共遇到59个障碍，并按照提问和回答问题的5个步骤进行整理：认识知识空白、提出问题、搜索相关信息、提出答案、利用答案指导患者护理。调查人员和执业医生认为有六个障碍特别突出：查找信息所需的时间过多；难以修改原来的问题，原来的问题往往含糊不清，可以解释；难以选择最优搜索策略；看似合适的资源未能覆盖死亡主题；不确定如何知道所有相关证据何时已经找到，以便停止搜查；以及将多种证据不充分地综合成临床有用的陈述。结论在询问和回答如何护理患者的问题时遇到了许多障碍。解决这些障碍可以通过改善临床导向的信息资源来改善患者护理。
Objective To describe the obstacles encountered when attempting to answer doctors' questions with evidence.Design Qualitative study.Setting General practices in Iowa.Participants 9 academic generalist doctors, 14 family doctors, and 2 medical librarians.Main outcome measure A taxonomy of obstacles encountered while searching for evidence based answers to doctors' questions.Results 59 obstacles were encountered and organised according to the five steps in asking and answering questions: recognise a gap in knowledge, formulate a question, search for relevant information, formulate an answer, and use the answer to direct patient care. Six obstacles were considered particularly salient by the investigators and practising doctors: the excessive time required to find information; difficulty modifying the original question, which was often vague and open to interpretation; difficulty selecting an optimal strategy to search for information; failure of a seemingly appropriate resource to cover die topic; uncertainty about how to know when all the relevant evidence has been found so that the search can stop; and inadequate synthesis of multiple bits of evidence into a clinically useful statement.Conclusions Many obstacles are encountered when asking and answering questions about how to care for patients. Addressing these obstacles could lead to better patient care by improving clinically oriented information resources.