药物基因组学临床决策支持警报的设计原则和临床医生偏好
Design Principles and Clinician Preferences for Pharmacogenomic Clinical Decision Support Alerts
摘要：
目的：更好地了解临床医生对临床决策支持（CDS）工具中药物基因组学（PGx）信息显示的需求和偏好。材料和方法：我们开发了一种半结构化访谈，从具有现场PGx CDS工具经验的临床医生那里收集PGx CDS设计六个关键领域的反馈和偏好。来自西北医学（NM）普通内科诊所的八名临床医生参加了这项研究。研究结果：临床医生表示更喜欢在订单输入期间中断弹出警报，简要描述相关药物-基因相互作用，以及在药物禁忌时明确具体的推荐替代方案。他们不希望看到详细的遗传数据，更喜欢从基因型预测的表型信息。他们也不希望在基因检测结果不表明治疗计划改变时被打断。临床医生报告说，他们对临床药物遗传学实施联盟的处方建议不太熟悉，但报告说，他们信任他们的专业协会和UpToDate等资源的建议。对非结构化评论的分析与结构化结果一致，表明参与者对如何在实践中解释和应用PGx信息普遍存在不确定性。讨论内容：结果指出了几个基本原则，可以为未来的PGx CDS警报设计提供信息：具体和可行;简短;显示表型而不是基因型;依靠临床医生已经信任的来源;以及适应学习效果。结论：本研究是NM正在进行的PGx CDS设计的更广泛社会技术设计方法的一部分，并为未来PGx CDS开发提供了基线。基于这些结果的设计有可能提高临床医生的教育和依从性水平，并改善患者的预后。
英文摘要：
OBJECTIVE: To better understand clinician needs and preferences for the display of pharmacogenomic (PGx) information in clinical decision support (CDS) tools. MATERIALS AND METHODS: We developed a semi-structured interview to collect feedback and preferences in six key areas of PGx CDS design, from clinicians who had prior experience with live PGx CDS tools. Eight clinicians from Northwestern Medicine's (NM) General Internal Medicine clinic participated in the study. RESULTS: Clinicians expressed preference for interruptive pop-up alerts during order entry, brief descriptions of relevant drug-gene interactions, and a clear and specific recommended alternative course of action when a medication is contraindicated. They did not wish to see detailed genetic data, preferring phenotypic information predicted from the genotype. Nor did they wish to be interrupted when genetic test results do not indicate a change in treatment plan. Clinicians reported little familiarity with Clinical Pharmacogenetic Implementation Consortium prescribing recommendations but reported trusting recommendations of their professional societies and resources like UpToDate. Analysis of unstructured comments concurred with structured results, indicating a general uncertainty among participants around how to interpret and apply PGx information in practice. DISCUSSION: Results point to several underlying principles that can inform future PGx CDS alert designs: Be Specific and Actionable; Be Brief; Display Phenotypes not Genotypes; Rely on Sources Clinicians Already Trust; and, Be Adaptable to Learning Effects. CONCLUSION: This study is part of a broader socio-technical design approach to PGx CDS design underway at NM and provides a baseline for future PGx CDS development. Designs based on these results have the potential to improve clinician education and adherence levels, and to improve patient outcomes.
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