APPROACHES TO CLINICAL DECISION-MAKING IN ASSESSMENT FOR
ELECTRONIC ASSISTIVE TECHNOLOGY
Sylvia Taylor-Goh, Ruth Mayagoitia-Hill, Sheila Kitchen
Division of Applied Biomedical Research, 3.11 Shepherd’s House, King’s College London,
London, SE1 1UL, United Kingdom
Introduction
Prior to the prescription of electronic assistive technology, a multi-disciplinary team of professionals will usually be involved in the assessment process. Little is known about how these professionals reach decisions regarding what to prescribe and what informs their thinking. No research has been carried out which investigates clinical decision-making in the assessment for electronic assistive technology. The importance of this study is in its clinical application. Wrongful prescription is not only very costly but can be detrimental to the individual's health, quality of life and independence. Hoppestad, 2006 said “the assessment process is likely the most consequential phase in the provision of assistive technology services…. Without an effective assessment, failure of the technology to provide any demonstrable benefit is practically assured”
Aims
This study investigated if there are there differences and similarities in the process and content of clinical decision-making by Biomedical Engineers, Occupational Therapists and Speech and Language Therapists when assessing for electronic assistive technology. Two of the specific aims are:
1. To examine whether there are differences in clinical decision making:
§ between disciplines
§ between specialist assistive technology centres and non- specialist centres
§ between experts and novices
2. To explore the perceptions of each profession in relation to their specific role and expertise.
Method
A qualitative approach called Protocol Analysis was used to obtain access to the participant’s cognitive reasoning processes by asking them to "think−aloud" as they considered possible solutions to a given problem. The study employed two video and audio enhanced written case scenarios of adults who require electronic assistive technology post acquired brain injury. Each participant was seen individually and asked to think aloud as they assess and decide what type of equipment they would prescribe for each individual. This was followed up by a semi-structured interview which asked about their expertise and role within assessment for electronic assistive technology. A purposive sample of 60 professionals sourced from national assistive technology centres in addition to brain injury units were the study participants.
Analysis
The data gathered during each think−aloud session was transcribed verbatim from the audio recording and analysed according to the principles of verbal protocol analysis. This analysis involves identification of codes and themes from the data in relation to the process and content of their clinical decision-making. The semi-structured interview responses underwent thematic analysis. The presentation will outline the key results of the study.
References
Hoppestad, B. S. (2006). Essential elements for assessment of persons with severe neurological impairments for computer access utilizing assistive technology devices: A Delphi study. Disability and Rehabilitation: Assistive Technology, 1, 3-16.