Physicians' perceptions of two ways of algorithm presentation: graphic versus text-based approach

Abstract

Acute bleeding during surgery or after trauma harms patients, and challenges involved physicians. Protocols and cognitive aids can help in such situations. This dual-centre study investigated physicians' opinions regarding two ways to present cognitive aids, graphic ‘Haemostasis Traffic Light’ and text-based, using the example of a coagulation management algorithm to identify the strengths and limitations of both presentation modalities. Using qualitative research methods, we identified recurring answer patterns and derived major topics and subthemes through inductive coding. Eighty-four physicians participated. We assigned each half randomly to one of the cognitive aids (graphic/text-based) and determined 447 usable statements. We qualitatively deduced the importance of having a cognitive aid for physicians. Furthermore, it is noticeable that the graphic group made more positive comments (154 of 242 (64%) statements), while the text-based participants made more negative annotations (126 of 205 (61%) statements), suggesting a generally stronger approval of this cognitive aid.

Practitioner summary: This qualitative study provides an overview of physicians` positive and negative perceptions regarding two presentation ways for a coagulation management algorithm. Participants perceived the graphic method created according to user-centred design principles more positively. The analysis reveals components that an ideal algorithm should have to help streamline the decision-making process.

Keywords:

• Algorithms
• cognitive aid
• decision-making
• graphic presentation
• qualitative research
• user-centred design

Acknowledgements

The authors are thankful to the study participants for their time and effort. The authors thank biostatistician Dr. Julia Braun- Gruebel Ph.D. for her statistical advice regarding this manuscript. This study was carried out within the framework of a collaborative research and education agreement between USZ and HIBA.

Disclosure statement

EDK and FGM received honoraria for their participation in ROTEM frontier council from Werfen, Instrumentation Laboratory, Bedford, MA.

DRS's academic department is receiving grant support from the Swiss National Science Foundation, Berne, Switzerland, the Swiss Society of Anaesthesiology and Reanimation (SGAR), Berne, Switzerland, the Swiss Foundation for Anaesthesia Research, Zurich, Switzerland, Vifor SA, Villars-sur-Glâne, Switzerland and Vifor (International) AG, St. Gallen, Switzerland.

DRS is co-chair of the ABC-Trauma Faculty, sponsored by unrestricted educational grants from Novo Nordisk Health Care AG, Zurich, Switzerland, CSL Behring GmbH, Marburg, Germany, LFB Biomédicaments, Courtaboeuf Cedex, France and Octapharma AG, Lachen, Switzerland.

DRS received honoraria/travel support for consulting or lecturing from:

Danube University of Krems, Austria, US Department of Defense, Washington, USA, European Society of Anaesthesiology, Brussels, BE, Korean Society for Patient Blood Management, Seoul, Korea, Korean Society of Anaesthesiologists, Seoul, Korea, Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis, Paris, France, Baxalta Switzerland AG, Volketswil, Switzerland, Bayer AG, Zürich, Switzerland, B. Braun Melsungen AG, Melsungen, Germany, Boehringer Ingelheim GmbH, Basel, Switzerland, Bristol-Myers-Squibb, Rueil-Malmaison Cedex, France and Baar, Switzerland, CSL Behring GmbH, Hattersheim am Main, Germany and Berne, Switzerland, Celgene International II Sàrl, Couvet, Switzerland, Daiichi Sankyo AG, Thalwil, Switzerland, Haemonetics, Braintree, MA, USA, Instrumentation Laboratory (Werfen), Bedford, MA, USA, LFB Biomédicaments, Courtaboeuf Cedex, France, Merck Sharp & Dohme, Kenilworth, New Jersey, USA, Novo Nordisk Health Care AG, Zurich, Switzerland, PAION Deutschland GmbH, Aachen, Germany, Pharmacosmos A/S, Holbaek, Denmark, Pfizer AG, Zürich, Switzerland, Pierre Fabre Pharma, Alschwil, Switzerland, Portola Schweiz GmbH, Aarau, Switzerland, Roche Diagnostics International Ltd, Reinach, Switzerland, Sarstedt AG & Co., Sevelen, Switzerland and Nümbrecht, Germany, Shire Switzerland GmbH, Zug, Switzerland, Tem International GmbH, Munich, Germany, Vifor Pharma, Munich, Germany, Neuilly sur Seine, France and Villars-sur-Glâne, Switzerland, Vifor (International) AG, St. Gallen, Switzerland, Zuellig Pharma Holdings, Singapore, Singapore.

DWT is a designated inventor of Visual Patient technology, for which the University of Zurich holds various patents and trademarks. There are cooperation and licencing agreements with Philips Medizin Systeme Böblingen GmbH, Böblingen, Germany; Koninklijke Philips NV, Amsterdam, The Netherlands; and Philips Research/Philips Electronics Nederland BV, Eindhoven, The Netherlands. Under these agreements, DWT may receive royalties. DWT and DRS are designated inventors of Visual Clot technology, for which the University of Zurich holds various patents and trademarks. The University of Zurich signed a letter of intent for a cooperation and licencing agreement with Instrumentation Laboratory Company/Werfen Corporation, Bedford, MA, USA and Barcelona, Spain. Under this and future agreements, DWT and DRS may receive royalties. DWT and DRS received travel support for consulting Instrumentation Laboratory, Bedford, MA, USA.

The other authors do not have any competing interests.

Data availability statement

The datasets supporting the conclusions of this article are available in this article and its supplementary information files.