Introduction to Clinical Decision Making Questions And Answers

Clinical Question and Decision - ANS clinical experience, patient values and preferences, best available evidence, clinical circumstances and setting Hierarchy of Decision Making - ANS from worst to best: tradition> authority> trial and error> deductive/inductive reasoning> scientific method Clinical Decision Making - ANS based on facts: diagnosis, symptoms, lab values Ethical Decision Making - ANS based on values; biomedical ethics Shared Decision Making - ANS based on patient-family centered care; clinician and patient integrative process by engaging the patient in decision making; involved decisional conflict, providing decision support, offering decision tools, patient preferences Clinical Reasoning - ANS cognitive process used in evaluation and management of a patient; multi-dimensional process involving a wide range of cognitive skills PTs use to process information, reach decisions, and determine actions Clinical Decisions - ANS outcomes of clinical reasoning; form basis of patient/client management Evidence Based Practice in Decision Making - ANS best available research evidence, client population characteristics, state, needs, values, preferences, resources and practitioner expertise; environmental and organizational context EBP Steps - ANS 1) clinical problem is identified and answerable question is formulated 2) systematic literature review and collection of evidence 3) critically analyze evidence 4) critical appraisal is synthesized with clinician's expertise and patient's unique status 5) effectiveness and efficiency of steps are evaluated Measurement Error - ANS can be because of examiner/tester-rater; measuring instrument;; variability of characteristic being measured Evidence Based Clinical Practical Guidelines (CPGs) - ANS systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances AMAP/ANAP - ANS as much as possible, as normally as possible CCDD - ANS control centrally, direct distally Biomechanics - ANS necessary to determine optimal means of assisting patient with a task Stability to Mobility - ANS capacity for mobility> stability> controlled mobility> skill Decision Tree - ANS diagrammatic representation of relationship of the decision made by therapist to the outcome of patient; outlines critical pathways of choice for therapists Choice Point - ANS point in decision tree where therapist must make a decision; several possible decisions; indicated by rectangle Chance Point - ANS point int he decision tree in which events occur; events are outside of control of therapist; indicated by a circle Outcomes - ANS end result related to patient's care; end result of the choice and chance points; indicated in tree by long rectangle Path - ANS sequence of actions and events from the initiation of patient care to the outcome; passes through several choice and chance points; in tree: line Strategy - ANS decisions made at choice points based on preceding results of chance points in the decision tree; if..then.. Probabilities - ANS how likely consequences and outcomes will occur in the tree; expressed as percentages; must add up to 100% at any given chance point Hypothesis-Oriented Algorithm for Clinicians (HOAC II) - ANS algorithm designed to graphically represent the decision making process for problem solving with several possible solutions; poses a series of questions (yes/no) to guide process and/or indicate need for reevaluation of the viability of hypothesis Realm-Individual Process-Situation (RIPS) Model - ANS includes realm, individual process, situation; used in ethical decision making Realm - ANS individual: good of patient; organizational: concerned with good of organization; societal: concerned with common good (most complex) Individual Process - ANS moral sensitivity, moral judgement, moral motivation, moral courage Situation - ANS issue or problem: dilemma (two courses of action), distress (know what to do but are unauthorized to do it), temptation (benefit from doing the wrong thing), silence (no one speaks up about ethical value challenges) Decisional Conflict - ANS there is more than one medically reasonable option for patient and patient is uncertain about which option to choose Clinical Judgment - ANS combination of clinical reasoning and clinical decision making Clinical Reasoning Components - ANS identifying problem (history, observations, physical exam), validity, reliability, reasoning (forward and backward), errors in reasoning, metacognition Metacognition - ANS awareness and monitoring of the thinking process Outcome of Clinical Judgement - ANS noticing, interpreting, responding, reflecting Forward Reasoning - ANS for experienced clinicians; reasoning from data to hypothesis, recognize patient cues and patterns, decisions based on higher order skills and reflective processes, used by experts to solve routine cases within their area of specialty Backward Reasoning - ANS hypothetico-deductive process; used by novice and intermediates, by experts outside their area of expertise; reasoning from hypothesis to data; setting up hypotheses and collecting clinical data to prove or disprove the hypothesis Developing Expertise - ANS continually seek to enhance knowledge, perform EBP, consider each patient's rights, needs, abilities, preferences; ongoing process: make sound decisions, reflect on outcomes, modify practice, share knowledge Appreciative Inquiry - ANS opposite of problem-focused approach, focuses on what is working well, questions strengthen a person's potential, discover, dream, design, present successes, past accomplishments, unexplored potential, strengths