Fonseca, R and Jose, K and Marwick, TH, Understanding decision-making in cardiac imaging: determinants of appropriate use, European Heart Journal - Cardiovascular Imaging pp. 1-7. ISSN 2047-2404 (2017) [Refereed Article]
Copyright 2017 the Authors
Methods and results: Semi-structured face-to-face interviews with cardiologists and non-cardiologists who had requested echocardiograms were conducted at an Australian tertiary hospital. The interview guide included hypothetical clinical scenarios to better understand decision-making in ordering echocardiograms and the actions they could take when receiving test reports. Interviews underwent thematic analysis. Seventeen clinicians were interviewed, ten of whom were cardiologists. All participants ordered echocardiograms to support their clinical decision-making. Awareness of the AUC was low. The categorization of tests as 'appropriate' or 'inappropriate' was considered ineffective as it failed to reflect the decision-making process. The decision to request echocardiograms was influenced by a number of personal and systemic factors as well as guidelines and protocols. Training and experience, patients' expectations, and management of uncertainty were key personal factors. Systemic factors involved the accessibility of services and health insurance status of the patient.
Conclusion: Factors that influenced the ordering of echocardiograms by clinicians at a tertiary care hospital did not appear to be amenable to control with AUC. Alternative approaches may be more effective than the AUC in addressing the overuse of echocardiography.
|Item Type:||Refereed Article|
|Keywords:||appropriate use, echocardiography, thematic analysis|
|Research Division:||Medical and Health Sciences|
|Research Group:||Cardiorespiratory Medicine and Haematology|
|Research Field:||Cardiology (incl. Cardiovascular Diseases)|
|Objective Group:||Clinical Health (Organs, Diseases and Abnormal Conditions)|
|Objective Field:||Cardiovascular System and Diseases|
|Author:||Fonseca, R (Mr Ricardo Fonseca Diaz)|
|Author:||Jose, K (Dr Kim Jose)|
|Web of Science® Times Cited:||1|
|Deposited By:||Menzies Institute for Medical Research|
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