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A Grounded Theory Study to Explore Clinicians' Point-of-care Decision-making Process and Behavior Following a Pharmacogenomics Alert

Carolyn R. Rohrer Vitek

出版	Saint Mary's University of Minnesota, 2018
URL	http://books.google.com.hk/books?id=Q7a9wgEACAAJ&hl=&source=gbs_api

註釋

Pharmacogenomics is an emerging field that uses how genes influence response to medications to improve medication safety and efficacy; however, many clinicians lack knowledge of how to use this information. Computer clinical decision support (CDS) systems have been developed for electronic prescribing that provide pharmacogenomics information and recommendations to guide clinician decision-making at the time of prescribing. Yet, the process of decision-making following a pharmacogenomics alert is incompletely understood. Understanding this process is critical to understanding decision making and future CDS development. This exploratory grounded theory study interviewed 15 healthcare professionals to understand the factors and processes that influence a clinician's decision-making following a pharmacogenomics alert. A three-stage model incorporating factors, processes, and consequences emerged. A complex combination of situational factors, including the patient presentation, clinician knowledge and perspective, and patient-clinician relationship provide a contextual basis and influence a prescriber's decision-making. Following the pharmacogenomics alert, clinicians use a series of processes prior to making a prescription decision: situating, assessing, and obtaining information. The resulting actual and anticipated consequences create a feedback loop, thus serving as inputs for future decision-making. The decision-making that occurs when a pharmacogenomics alert is presented creates a unique series of events that influences future decision-making. The resulting preliminary theoretical model of a clinician's pharmacogenomics decision-making following an alert deserves further investigation to enhance generalizability and may be used to better implement CDS and inform future education efforts.