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Evans RP, Bryant LD, Russell G, Absolom K. Trust and acceptability of data-driven clinical recommendations in everyday practice: A scoping review. Int J Med Inform 2024; 183:105342. [PMID: 38266426 DOI: 10.1016/j.ijmedinf.2024.105342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/08/2023] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Increasing attention is being given to the analysis of large health datasets to derive new clinical decision support systems (CDSS). However, few data-driven CDSS are being adopted into clinical practice. Trust in these tools is believed to be fundamental for acceptance and uptake but to date little attention has been given to defining or evaluating trust in clinical settings. OBJECTIVES A scoping review was conducted to explore how and where acceptability and trustworthiness of data-driven CDSS have been assessed from the health professional's perspective. METHODS Medline, Embase, PsycInfo, Web of Science, Scopus, ACM Digital, IEEE Xplore and Google Scholar were searched in March 2022 using terms expanded from: "data-driven" AND "clinical decision support" AND "acceptability". Included studies focused on healthcare practitioner-facing data-driven CDSS, relating directly to clinical care. They included trust or a proxy as an outcome, or in the discussion. The preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) is followed in the reporting of this review. RESULTS 3291 papers were screened, with 85 primary research studies eligible for inclusion. Studies covered a diverse range of clinical specialisms and intended contexts, but hypothetical systems (24) outnumbered those in clinical use (18). Twenty-five studies measured trust, via a wide variety of quantitative, qualitative and mixed methods. A further 24 discussed themes of trust without it being explicitly evaluated, and from these, themes of transparency, explainability, and supporting evidence were identified as factors influencing healthcare practitioner trust in data-driven CDSS. CONCLUSION There is a growing body of research on data-driven CDSS, but few studies have explored stakeholder perceptions in depth, with limited focused research on trustworthiness. Further research on healthcare practitioner acceptance, including requirements for transparency and explainability, should inform clinical implementation.
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Affiliation(s)
- Ruth P Evans
- University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK.
| | | | - Gregor Russell
- Bradford District Care Trust, Bradford, New Mill, Victoria Rd, BD18 3LD, UK.
| | - Kate Absolom
- University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK.
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Mouchabac S, Adrien V, Diot T, Renaud MC, Carrié A, Bourla A, Ferreri F. Insights into medical students' perceptions of work culture during the COVID-19 pandemic: a mixed method study. BMC MEDICAL EDUCATION 2024; 24:21. [PMID: 38172850 PMCID: PMC10765811 DOI: 10.1186/s12909-023-04936-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The COVID-19 pandemic brought about profound social changes that affected students worldwide. These changes had both psychological and economic consequences, and also led to the adoption of new teaching methods. It can also have an impact on work culture, which is the collective set of values, norms, and practices within a specific profession, shaping how individuals in that field behave, communicate, and identify with their work. The aim of the study was to examine medical students' perception of professional culture during the COVID-19 crisis when they voluntarily participated in the healthcare network established, outside of university placements, for the management of COVID patients. METHODS A questionnaire study based on the vignette methodology was conducted among third-year medical students. Drawing from three scenarios in which students were variably engaged in crisis management, it included questions about their perceptions of the medical profession, their motivation, and their sense of belonging to the profession. RESULTS 352 students responded to the survey. The pandemic had both a positive and a negative impact on students' perceptions of the medical profession. Cluster analysis using a k-means algorithm and principal component analysis revealed three clusters of students with different perceptions of the medical profession. The first cluster, which represented the majority of students, corresponded to a relatively positive perception of the profession that was reinforced during the pandemic. In the second cluster, students' perceptions were reinforced still further, and particular importance was attached to field experience. Students in the third cluster had the most negative perceptions, having been shaken the most by the pandemic, and they attached little importance to field experience. CONCLUSIONS The analysis highlighted the importance of students being able to adapt and draw on a range of resources during the COVID-19 pandemic. This underscores the need for work cultures that support adaptability and coping. Further research is needed to understand its long-term effects on students' perceptions of the medical profession and to identify interventions that could support students in the aftermath of this difficult period.
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Affiliation(s)
- Stephane Mouchabac
- Department of Psychiatry, Saint-Antoine Hospital, Sorbonne University, AP-HP, Paris, F-75012, France.
- Infrastructure for Clinical Research in Neurosciences (iCRIN), Paris Brain Institute, Paris, France.
| | - Vladimir Adrien
- Department of Psychiatry, Saint-Antoine Hospital, Sorbonne University, AP-HP, Paris, F-75012, France
- Infrastructure for Clinical Research in Neurosciences (iCRIN), Paris Brain Institute, Paris, France
| | - Thomas Diot
- Department of Psychiatry, Saint-Antoine Hospital, Sorbonne University, AP-HP, Paris, F-75012, France
| | | | - Alain Carrié
- Faculty of Medicine, Sorbonne University, Paris, France
| | - Alexis Bourla
- Department of Psychiatry, Saint-Antoine Hospital, Sorbonne University, AP-HP, Paris, F-75012, France
- Infrastructure for Clinical Research in Neurosciences (iCRIN), Paris Brain Institute, Paris, France
| | - Florian Ferreri
- Department of Psychiatry, Saint-Antoine Hospital, Sorbonne University, AP-HP, Paris, F-75012, France
- Infrastructure for Clinical Research in Neurosciences (iCRIN), Paris Brain Institute, Paris, France
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Tulk Jesso S, Kelliher A, Sanghavi H, Martin T, Henrickson Parker S. Inclusion of Clinicians in the Development and Evaluation of Clinical Artificial Intelligence Tools: A Systematic Literature Review. Front Psychol 2022; 13:830345. [PMID: 35465567 PMCID: PMC9022040 DOI: 10.3389/fpsyg.2022.830345] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/09/2022] [Indexed: 12/11/2022] Open
Abstract
The application of machine learning (ML) and artificial intelligence (AI) in healthcare domains has received much attention in recent years, yet significant questions remain about how these new tools integrate into frontline user workflow, and how their design will impact implementation. Lack of acceptance among clinicians is a major barrier to the translation of healthcare innovations into clinical practice. In this systematic review, we examine when and how clinicians are consulted about their needs and desires for clinical AI tools. Forty-five articles met criteria for inclusion, of which 24 were considered design studies. The design studies used a variety of methods to solicit and gather user feedback, with interviews, surveys, and user evaluations. Our findings show that tool designers consult clinicians at various but inconsistent points during the design process, and most typically at later stages in the design cycle (82%, 19/24 design studies). We also observed a smaller amount of studies adopting a human-centered approach and where clinician input was solicited throughout the design process (22%, 5/24). A third (15/45) of all studies reported on clinician trust in clinical AI algorithms and tools. The surveyed articles did not universally report validation against the “gold standard” of clinical expertise or provide detailed descriptions of the algorithms or computational methods used in their work. To realize the full potential of AI tools within healthcare settings, our review suggests there are opportunities to more thoroughly integrate frontline users’ needs and feedback in the design process.
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Affiliation(s)
- Stephanie Tulk Jesso
- Fralin Biomedical Research Institute, Virginia Tech, Roanoke, VA, United States.,Institute for Creativity, Arts, and Technology, Blacksburg, VA, United States
| | - Aisling Kelliher
- Department of Computer Science, College of Engineering, Virginia Tech, Blacksburg, VA, United States
| | | | - Thomas Martin
- Institute for Creativity, Arts, and Technology, Blacksburg, VA, United States.,Department of Electrical and Computer Engineering, College of Engineering, Virginia Tech, Blacksburg, VA, United States
| | - Sarah Henrickson Parker
- Fralin Biomedical Research Institute, Virginia Tech, Roanoke, VA, United States.,Department of Health Systems and Implementation Science, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
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Telepsychiatry to Provide Mental Health Support to Healthcare Professionals during the COVID-19 Crisis: A Cross-Sectional Survey among 321 Healthcare Professionals in France. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910146. [PMID: 34639447 PMCID: PMC8508285 DOI: 10.3390/ijerph181910146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/25/2021] [Accepted: 09/26/2021] [Indexed: 12/28/2022]
Abstract
Pandemics are difficult times for the mental health of healthcare professionals, who are more likely to present with PTSD-like symptoms. In the context of a highly contagious communicable disease, telemedicine is a useful alternative to usual care, and should be considered as a means to support healthcare professionals’ mental health. This is a multicenter (n = 19), cross-sectional study, based on a 27-item questionnaire, aiming to investigate the acceptability to healthcare workers of a telepsychiatry service as a means of providing mental health support during the COVID-19 pandemic. Between October and December 2020, 321 responses were received, showing that women, caregiving staff, and those directly involved in the care of COVID-19 patients are less favorable to the idea of receiving remote support. In our population, barriers were related to the clinical setting or ethics, and most of the respondents would not accept a drug prescription by telepsychiatry. Although telepsychiatry should be a part of the armamentarium of mental health management, it is not suitable as a stand-alone approach, and should be combined with conventional face-to-face consultations.
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Mouchabac S, Conejero I, Lakhlifi C, Msellek I, Malandain L, Adrien V, Ferreri F, Millet B, Bonnot O, Bourla A, Maatoug R. Improving clinical decision-making in psychiatry: implementation of digital phenotyping could mitigate the influence of patient’s and practitioner’s individual cognitive biases. DIALOGUES IN CLINICAL NEUROSCIENCE 2021; 23:52-61. [PMID: 35860175 PMCID: PMC9286737 DOI: 10.1080/19585969.2022.2042165] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
High stake clinical choices in psychiatry can be impacted by external irrelevant factors. A strong understanding of the cognitive and behavioural mechanisms involved in clinical reasoning and decision-making is fundamental in improving healthcare quality. Indeed, the decision in clinical practice can be influenced by errors or approximations which can affect the diagnosis and, by extension, the prognosis: human factors are responsible for a significant proportion of medical errors, often of cognitive origin. Both patient’s and clinician’s cognitive biases can affect decision-making procedures at different time points. From the patient’s point of view, the quality of explicit symptoms and data reported to the psychiatrist might be affected by cognitive biases affecting attention, perception or memory. From the clinician’s point of view, a variety of reasoning and decision-making pitfalls might affect the interpretation of information provided by the patient. As personal technology becomes increasingly embedded in human lives, a new concept called digital phenotyping is based on the idea of collecting real-time markers of human behaviour in order to determine the ‘digital signature of a pathology’. Indeed, this strategy relies on the assumption that behaviours are ‘quantifiable’ from data extracted and analysed through connected tools (smartphone, digital sensors and wearable devices) to deduce an ‘e-semiology’. In this article, we postulate that implementing digital phenotyping could improve clinical reasoning and decision-making outcomes by mitigating the influence of patient’s and practitioner’s individual cognitive biases.
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Affiliation(s)
- Stéphane Mouchabac
- Department of Psychiatry, Hôpital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Sorbonne Université, Hôpital de la Pitié Salpêtrière, iCRIN (Infrastructure for Clinical Research In Neurosciences), Brain Institute (ICM), INSERM, CNRS, Paris, France
| | - Ismael Conejero
- Department of Psychiatry, CHU Nîmes, University of Montpellier, Nîmes, France
- Inserm, Unit 1061 “Neuropsychiatry: Epidemiological and Clinical Research”, Montpellier, France
| | - Camille Lakhlifi
- PICNIC lab (Physiological investigation of clinically normal and impaired cognition), Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Université de Paris, Sorbonne Université, Paris, France
| | - Ilyass Msellek
- Sorbonne Université, Hôpital de la Pitié Salpêtrière, iCRIN (Infrastructure for Clinical Research In Neurosciences), Brain Institute (ICM), INSERM, CNRS, Paris, France
| | - Leo Malandain
- University Hospital Cochin (site Tarnier), Paris, France
| | - Vladimir Adrien
- Department of Psychiatry, Hôpital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Sorbonne Université, Hôpital de la Pitié Salpêtrière, iCRIN (Infrastructure for Clinical Research In Neurosciences), Brain Institute (ICM), INSERM, CNRS, Paris, France
| | - Florian Ferreri
- Department of Psychiatry, Hôpital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Sorbonne Université, Hôpital de la Pitié Salpêtrière, iCRIN (Infrastructure for Clinical Research In Neurosciences), Brain Institute (ICM), INSERM, CNRS, Paris, France
| | - Bruno Millet
- Sorbonne Université, Hôpital de la Pitié Salpêtrière, iCRIN (Infrastructure for Clinical Research In Neurosciences), Brain Institute (ICM), INSERM, CNRS, Paris, France
| | - Olivier Bonnot
- Department of Child and Adolescent Psychiatry, CHU de Nantes, Nantes, France
- Pays de la Loire Psychology Laboratory, Nantes, France
| | - Alexis Bourla
- Department of Psychiatry, Hôpital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Sorbonne Université, Hôpital de la Pitié Salpêtrière, iCRIN (Infrastructure for Clinical Research In Neurosciences), Brain Institute (ICM), INSERM, CNRS, Paris, France
- Jeanne d'Arc Hospital, INICEA Korian, Saint-Mandé, France
| | - Redwan Maatoug
- Sorbonne Université, Hôpital de la Pitié Salpêtrière, iCRIN (Infrastructure for Clinical Research In Neurosciences), Brain Institute (ICM), INSERM, CNRS, Paris, France
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