A computer decision aid for medical prevention: a pilot qualitative study of the Personalized Estimate of Risks (EsPeR) system.
BACKGROUND
Many preventable diseases such as ischemic heart diseases and breast cancer prevail at a large scale in the general population. Computerized decision support systems are one of the solutions for improving the quality of prevention strategies.


METHODS
The system called EsPeR (Personalized Estimate of Risks) combines calculation of several risks with computerisation of guidelines (cardiovascular prevention, screening for breast cancer, colorectal cancer, uterine cervix cancer, and prostate cancer, diagnosis of depression and suicide risk). We present a qualitative evaluation of its ergonomics, as well as it's understanding and acceptance by a group of general practitioners. We organised four focus groups each including 6-11 general practitioners. Physicians worked on several structured clinical scenarios with the help of EsPeR, and three senior investigators leaded structured discussion sessions.


RESULTS
The initial sessions identified several ergonomic flaws of the system that were easily corrected. Both clinical scenarios and discussion sessions identified several problems related to the insufficient comprehension (expression of risks, definition of familial history of disease), and difficulty for the physicians to accept some of the recommendations.


CONCLUSIONS
Educational, socio-professional and organisational components (i.e. time constraints for training and use of the EsPeR system during consultation) as well as acceptance of evidence-based decision-making should be taken into account before launching computerised decision support systems, or their application in randomised trials.
Colombet
Isabelle
I
SPIM, Broussais Hotel Dieu University, ERM 202, INSERM, Paris, France. isabelle.colombet@spim.jussieu.fr
Dart
Thierry
T
Leneveut
Laurence
L
Zunino
Sylvain
S
Ménard
Joël
J
Chatellier
Gilles
G
D001292:Attitude to Computers; D003658:Decision Making, Computer-Assisted; D003863:Depression / Q000150:complications / Q000175:diagnosis; D006804:Ergonomics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000517:prevention & control; D009369:Neoplasms / Q000517:prevention & control; D010821:Physicians, Family; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011315:Preventive Medicine / Q000379:methods*; D036301:Qualitative Research; D018570:Risk Assessment; D000092864:Suicide Prevention