Physicians’ cognitive approach to prognostication after cardiac arrest,Resuscitation

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Physicians’ cognitive approach to prognostication after cardiac arrest
Resuscitation ( IF 6.5 ) Pub Date : 2022-01-08 , DOI: 10.1016/j.resuscitation.2022.01.001
Alexis Steinberg ₁ , Emily Grayek ₂ , Robert M Arnold ₃ , Clifton Callaway ₄ , Baruch Fischhoff ₅ , Tamar Krishnamurti ₆ , Deepika Mohan ₇ , Douglas B White ₈ , Jonathan Elmer ₁

Affiliation

Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA.
Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA; Institute for Politics and Strategy, Carnegie Mellon University, Pittsburgh, PA, USA.
Department of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Objective

Elucidate how physicians formulate a neurological prognosis after cardiac arrest and compare differences between experts and general providers.

Methods

We performed semi-structured interviews with experts in post-arrest care and general physicians. We created an initial model and interview guide based on professional society guidelines. Two authors independently coded interviews based on this initial model, then identified new topics not included in it. To describe individual physicians’ cognitive approach to prognostication, we created a graphical representation. We summarized these individual “mental models” into a single overall model, as well as two models stratified by expertise.

Results

We performed 36 interviews (17 experts and 19 generalists), most of whom practice in Europe (23) or North America (12). Participants described their approach to prognosis formulation as complex and iterative, with sequential and repeated data acquisition, interpretation, and prognosis formulation. Eventually, this cycle results in a final prognosis and treatment recommendation. Commonly mentioned factors were diagnostic test performance, time from arrest, patient characteristics. Participants also discussed factors rarely discussed in prognostication research including physician and hospital characteristics. We found no substantial differences between experts and general physicians.

Conclusion

Physicians’ cognitive approach to neurologic prognostication is complex and influenced by many factors, including some rarely considered in current research. Understanding these processes better could inform interventions designed to aid physicians in prognostication.

中文翻译：

医生对心脏骤停后预后的认知方法

客观的

阐明医生如何制定心脏骤停后的神经预后，并比较专家和一般提供者之间的差异。

方法

我们对逮捕后护理专家和全科医生进行了半结构化访谈。我们根据专业协会指南创建了一个初始模型和访谈指南。两位作者根据这个初始模型独立编码访谈，然后确定未包含在其中的新主题。为了描述个体医生对预后的认知方法，我们创建了一个图形表示。我们将这些单独的“心理模型”总结为一个单一的整体模型，以及两个按专业知识分层的模型。

结果

我们进行了 36 次采访（17 位专家和 19 位通才），其中大多数人在欧洲 (23) 或北美 (12) 执业。参与者将他们的预后制定方法描述为复杂和迭代的，具有连续和重复的数据采集、解释和预后制定。最终，这个周期会产生最终的预后和治疗建议。经常提到的因素是诊断测试性能、逮捕时间、患者特征。与会者还讨论了预后研究中很少讨论的因素，包括医生和医院的特征。我们发现专家和全科医生之间没有实质性差异。