Table 6 Examples of review findings relating to professional identity threat and enhancement
Author | Professional group | Examples |
|---|---|---|
Threat to professional control and autonomy | ||
[154] | Physicians | CDSSs’ potential to substitute physician knowledge is viewed as a threat: “…So, the fact that it [CDSS] can’t take in the whole clinical picture but manually we can.” |
[91] | Physicians | “… it [CDSS recommendation] makes me feel useless.” |
[128] | Senior and junior physicians | Senior physicians perceive CDSSs as threat to their authority over junior physicians: “Junior physicians were inclined to accept [the CDSS’] recommendations most of the time, but had to override its recommendations when senior colleagues decided on a different antibiotic.” |
Threat to professional skills and expertise | ||
[74] | Nursing professionals and physicians | Physicians and nursing professionals become dependent on pharmacists’ knowledge and expertise when resolving complicated CDSS order checks. |
[24] | Physicians | CDSSs threaten physicians’ expertise and conscience: “… It’s humiliating to think that we can be substituted by a computer! … We need to have the courage to do what we think is right, not to merely comply with the guidelines dictated by a system. … The knowledge that I get from visiting 150 patients is more substantial than what [the CDSS] can give me.” |
[77] | Junior physicians | Even junior physicians acknowledge that if CDSSs are misused or used too much, they “forget to think” and “going to lose the ability to think by ourselves.” |
[154] | Physicians | This potential loss of skill was seen as particular problematic in situations in which decision support differs between institutions: “… when we use a lot more programs we don’t think as much, so if we do go to other hospitals where they don’t have these programs then you may not be as well versed in how to dose and adjust vancomycin.” |
[24] | Orthopedics | CDSSs are perceived as not being a useful tool for orthopedic specialties: “The actual evidences in [orthopedic surgery] are not very many, you know, I can’t really see how [the CDSS] would be useful for us. …. The actual tools of an orthopedic resemble those of a crafts worker. … We learn by reading books and articles, but also by … observing the experts at work, learning how they do things...” |
Loss of control over patient relationships | ||
[162] | Physicians | Physicians stated that they “… are responsible for the treatment of their patients and not a CDSS.” |
[81] | Physicians | Physicians stated that “the problem with all of this (digitization) is that it is so impersonal. It takes all the joy out of practicing medicine. I want to build a relationship with the patient. It isn’t all about the medication, they want to share their pain, anxiety, family issues. We can’t change the tide. We can’t do anything about this (the move to digital).” |
Enhancement of professional control and autonomy | ||
[34] | Nurse practitioners | Nurse practitioners perceived the CDSS as an empowerment: “… If a CDS tool is designed well, it could empower nurses to advocate for patients and contribute to treatment decision-making. As an objective assessment of a patient’s condition, the CDS tool has the potential to provide participants with a structured method by which nurses can garner support for their recommendations.” |
[8] | Nurse practitioners | The CDSS “empowered staff nurses to manage more complicated scenarios independently.” |
[155] | Physicians | The care professionals expressed that the CDSS could enhance their control and confidence in their work: “Off hand, I would say that I would get a better feeling of what I do – and an overview of the patients, especially when we take over each other’s patients.” |
Enhancement of professional skills and expertise | ||
[162] | Physicians, nurse practitioners | “… sixty-two percent of the respondents reported that advice of a CDSS on how to treat a (…) patient is a welcome supplement to their own expertise, …” |
[178] | Pharmacist | Pharmacists saw the CDSS as: “offering opportunities to demonstrate their skills and to further develop their role working within general practice settings.” |
[24] | Physicians | Physicians viewed the CDSS as a useful tool, but not to support their own work, but as a support tool for other specialists or residents with less clinical experience: “Maybe I could use it. I think it would be more useful for young physicians, those who have only just graduated, or those with little experience… You know, to avoid mistakes…” “It’s brilliant. Really, really useful. I think it’s more so for medics though, rather than [surgeons].” |
Enhancement of control over patient relationships | ||
[35] | Physicians | Physicians expressed the need for CDSS features which enhance patient communication, such as “informative yet brief patient summaries” as this would provide them with a “greater sense of control” over the digitalized information and knowledge exchange with patients, and engender greater trust between patients and physicians. |