Are there similarities and differences in the content and process of clinical decision making by Biomedical Engineers, Occupational Therapists and Speech and Language Therapists when assessing for electronic assistive technology for adults with an acquired brain injury?

• Main Author: Taylor-Goh, Sylvia Margaret Eileen Josephine
• Other Authors: Noble, Wendy Jane ; Hanger, Diane Pamela
• Published: King's College London (University of London) 2015
• Subjects: 615.8
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.684412

Electronic assistive technology (EAT) is prescribed by different professionals. Little is known regarding how these professionals make prescription decisions or their perceptions of their specialist knowledge and role in the assessment process. Study Aims: • to explore the participants’ perceptions of their specialist knowledge and role (Study 1); • to investigate the similarities and differences in the content and process of clinical decision making (CDM) during assessment and prescription of EAT for adults with an acquired brain injury (Study 2). Design: A cross-sectional design employing concurrent think-aloud method and semi-structured interviews. Methods: Two standardised case scenarios were presented to participants asked to think aloud their assessment of the patient (Study 2). A semi-structured interview followed (Study 1). Verbal data underwent thematic and analytic coding. The analytic coding underwent statistical analysis to explore the usage differences of the decision making processes between the professions. Decision process graphs (DPG) were drawn to explore whether there were patterns of use of the CDM processes according to level of expertise. Subjects: A purposive sample of 60 participants (BE, n=20; OT, n=20; SLT n=20) from assistive technology centres and brain injury units across England. Results: The CDM content was similar across the professions. The hypothetico-deductive model of decision making was used and two further stages, “cue implication” and “hypothesis implementation” emerged from the data. Patterns were observed in the DPG, which may be associated with differences in the CDM process according to levels of expertise. Participants’ reported profession-specific differences in their specialist knowledge and role, which were not clearly evident from the Study 2 results. Conclusions: The content and process of clinical decision making was similar across the three professions, though profession-specific specialist knowledge and role differences were reported by the participants. Level of expertise may affect the CDM process but did not affect the final prescription.