Conceptualizations of clinical decision-making: a scoping review in geriatric emergency medicine
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(2020) 20:73
RESEARCH ARTICLE
Open Access
Conceptualizations of clinical decisionmaking: a scoping review in geriatric emergency medicine Maria Louise Gamborg1,2* , Mimi Mehlsen3, Charlotte Paltved2, Gitte Tramm3 and Peter Musaeus1
Abstract Background: Clinical decision-making (CDM) is an important competency for young doctors especially under complex and uncertain conditions in geriatric emergency medicine (GEM). However, research in this field is characterized by vague conceptualizations of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is important to identify different definitions and their operationalizations in studies on GEM. Objective: A scoping review of empirical articles was conducted to provide an overview of the documented evidence of findings and conceptualizations of CDM in GEM. Methods: A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed, ProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a data extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized. Results: Four themes of operationalization of CDM emerged: CDM as dispositional decisions, CDM as cognition, CDM as a model, and CDM as clinical judgement. Study results and conclusions naturally differed according to how CDM was conceptualized. Thus, frailty-heuristics lead to biases in treatment of geriatric patients and the complexity of this patient group was seen as a challenge for young physicians engaging in CDM. Conclusions: This scoping review summarizes how different studies in GEM use the term CDM. It provides an analysis of findings in GEM and call for more stringent definitions of CDM in future research, so that it might lead to better clinical practice. Keywords: Decision making, Geriatric patients, Clinical judgement, Scoping review, Biases and heuristics, Cognition, Young physicians
Background Clinical Decision-Making (CDM) is an important part of medical education. Given young doctors’ limited experience, their CDM is more likely to be influenced by uncertainty [1, 2] and associated with errors [3]. However, a
* Correspondence: [email protected] 1 Centre for Health Sciences Education, Faculty of Health, Aarhus University, Aarhus, Denmark 2 Corporate HR MidtSim, Central Region of Denmark & Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark Full list of author information is available at the end of the article
variety of definitions and operationalizations are seen across medical domains [1, 4], Literature on CDM takes its point of departure from a variety of perspectives and approaches [5, 6], but CDM is commonly described as the formulation of hypotheses, diagnoses, and management plans in a systematic and structured process [4, 7–9]. Heuristics and biases [10], contextual factors [11], and bias-reduction [12] are emphasized in the literature. Taking a cognitive approach to understanding the processes underlying decisions [3, 10, 13], it focus
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