Decision Complexity Affects the Extent and Type of Decision Support Use

The increasing complexity of decision-making has emerged as a risk factor in clinical medicine. The impact that decision task complexity has on the uptake and use of clinical decision support systems (DSS) is also not well understood. Antibiotic prescribing in critical care is a complex, cognitively demanding task, made under time pressure. A web-based experiment was conducted to explore the impact of decision complexity on DSS utilization, comparing utilization of antibiotic guidelines and an interactive probability calculator for ventilator associated pneumonia (VAP) plus laboratory data. Decision support was found to be used more often for less complex decisions. Prescribing decisions of higher complexity were associated with a lower frequency of DSS use, but required the use of the more cognitively demanding situation assessment tool for infection risk along with pathology data. Decision complexity thus seems to impact on the extent and type of information support used by individuals when decision-making.

[1]  Kalervo Järvelin,et al.  Task complexity affects information seeking and use , 1995 .

[2]  J L Bootman,et al.  Physician prescribing decisions: the effects of situational involvement and task complexity on information acquisition and decision making. , 1993, Social science & medicine.

[3]  Constantin F. Aliferis,et al.  Studies in Health Technology and Informatics , 2007 .

[4]  V L Yu,et al.  Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription. , 2000, American journal of respiratory and critical care medicine.

[5]  Kathleen Foley Curley,et al.  The impact of knowledge and technology complexity on information systems development , 1995 .

[6]  Pai-Cheng Chu,et al.  The Joint Effects of Effort and Quality on Decision Strategy Choice with Computerized Decision Aids , 2000, Decis. Sci..

[7]  Vimla L. Patel,et al.  A framework for analyzing the cognitive complexity of computer-assisted clinical ordering , 2003, J. Biomed. Informatics.

[8]  Vimla L. Patel,et al.  Cognitive psychological studies of representation and use of clinical practice guidelines , 2001, Int. J. Medical Informatics.

[9]  Vimla L. Patel,et al.  Review: Medical Informatics and the Science of Cognition , 1998, J. Am. Medical Informatics Assoc..

[10]  Proposal for clinical algorithm standards. Society for Medical Decision Making Committee on Standardization of Clinical Algorithms. , 1992, Medical decision making : an international journal of the Society for Medical Decision Making.

[11]  C. S. Wallace,et al.  Coding Decision Trees , 1993, Machine Learning.

[12]  Vitali Sintchenko,et al.  Which clinical decisions benefit from automation? A task complexity approach , 2003, Int. J. Medical Informatics.

[13]  Charles G. Martin,et al.  Influence of data display formats on physician investigators' decisions to stop clinical trials: prospective trial with repeated measures , 1999, BMJ.

[14]  Pertti Vakkari,et al.  Task complexity, problem structure and information actions - Integrating studies on information seeking and retrieval , 1999, Inf. Process. Manag..

[15]  Enrico W. Coiera,et al.  Research Paper: Comparative Impact of Guidelines, Clinical Data, and Decision Support on Prescribing Decisions: An Interactive Web Experiment with Simulated Cases , 2004, J. Am. Medical Informatics Assoc..

[16]  R. Wood.  Task complexity: Definition of the construct , 1986 .