title: Uncovering healthcare practitioners' information processing using the think-aloud method: From paper-based guideline to clinical decision support system.
abstract: OBJECTIVE
  To investigate whether the use of the think-aloud method with propositional analysis could be helpful in the design of a Clinical Decision Support System (CDSS) providing guideline recommendations about long-term follow-up of childhood cancer survivors.
  
  
  METHODS
  The think-aloud method was used to gain insight into healthcare professionals' information processing while reviewing a paper-based guideline. A total of 13 healthcare professionals (6 physicians and 7 physician assistants) prepared 2 fictitious patient consults using the paper-based guideline. Propositional analysis was used to analyze verbal protocols of the think-aloud sessions. A prototype CDSS was developed and a usability study was performed, again with the think-aloud method.
  
  
  RESULTS
  The analysis revealed that the paper-based guideline did not support healthcare practitioners in finding patient-specific recommendations. An information processing model for retrieving recommendations was developed and used as input for the design of a CDSS prototype user interface. Usability analysis of the prototype CDSS showed that the navigational structure of the system fitted well with healthcare practitioners' daily practices.
  
  
  CONCLUSIONS
  The think-aloud method combined with propositional analysis of healthcare practitioners' verbal utterances while they processed a paper-based guideline was useful in the design of a usable CDSS providing patient-specific guideline recommendations.
authors.affiliation: Centre for Human Factors Engineering of interactive Health Information Technology (HIT-lab), Department of Medical Informatics, Academic Medical Center, University of Amsterdam, The Netherlands. Electronic address: e.kilsdonk@amc.uva.nl.
authors.forename: E
authors.initials: E
authors.lastname: Kilsdonk
authors.affiliation: Centre for Human Factors Engineering of interactive Health Information Technology (HIT-lab), Department of Medical Informatics, Academic Medical Center, University of Amsterdam, The Netherlands. Electronic address: l.w.peute@amc.uva.nl.
authors.forename: L W
authors.initials: LW
authors.lastname: Peute
authors.affiliation: Centre for Human Factors Engineering of interactive Health Information Technology (HIT-lab), Department of Medical Informatics, Academic Medical Center, University of Amsterdam, The Netherlands. Electronic address: rinkeriezebos@gmail.com.
authors.forename: R J
authors.initials: RJ
authors.lastname: Riezebos
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, University of Amsterdam, The Netherlands. Electronic address: l.c.kremer@amc.uva.nl.
authors.forename: L C
authors.initials: LC
authors.lastname: Kremer
authors.affiliation: Centre for Human Factors Engineering of interactive Health Information Technology (HIT-lab), Department of Medical Informatics, Academic Medical Center, University of Amsterdam, The Netherlands. Electronic address: m.w.jaspers@amc.uva.nl.
authors.forename: M W M
authors.initials: MW
authors.lastname: Jaspers
mesh_terms: D000328:Adult; D020000:Decision Support Systems, Clinical / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized / Q000592:standards*; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D009426:Netherlands; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014584:User-Computer Interface
keywords: Childhood cancer survivors; Clinical Decision Support System; Clinical guidelines; Human factors engineering; Think-aloud method