Dec 17 2020
New research reports that one in four clinical decisions by physicians does not meet best practices, but when they reviewed a simple traffic light system before making a clinical decision, uncertainty was minimized by 70% and treatment decisions improved.
Prof. Dr Gustavo Saposnik, a neurologist at St. Michael’s Hospital, a scientist at the hospital’s Li Ka Shing Knowledge Institute and lead author of the study. Image Credit: Unity Health Toronto.
Published recently in JAMA Network Open, the study analyzes the role of autonomic arousal, the stimulation of bodily functions unknowingly regulated, like heart rate or pupil dilation, in therapeutic decision-making.
At St. Michael’s Hospital of Unity Health Toronto, researchers focused on the link between treatment inertia and pupil dilation. Treatment inertia implies a more sophisticated treatment regimen is not provided even if it is suggested by best practices, or evidence indicates that the disease has progressed. In clinical care, treatment inertia is a common phenomenon related to higher health care costs and poorer outcomes.
Treatment inertia is a common phenomenon in medicine that leads to suboptimal or erroneous decisions impacting patients’ well-being.
Dr Gustavo Saposnik, Professor and Neurologist, St. Michael’s Hospital
Dr. Gustavo Saposnik is also the lead author of the study and a scientist at the hospital’s Li Ka Shing Knowledge Institute.
The researchers quantified the certainty of physicians’ decision-making by studying 34 neurologists across Canada while they listened to 10 simulated case-scenarios and then made treatment decisions for patients suffering from multiple sclerosis (MS).
The neurologists’ pupil responses were measured by eye trackers, where pupil enlargement was found to be linked to greater uncertainty, suboptimal decisions and a lack of intensifying treatment when warranted.
The researchers then made the neurologists listen to 10 more simulated case-scenarios, while intervening by showing them the traffic light system, which is an image with a green, yellow and red light.
Each color respectively corresponds to low, medium and high risk prognoses as a means to enable clinicians to determine the risk level of a patient and to find whether treatment should continue, be re-evaluated or escalated.
When the traffic light system was used—a previously tested method that was proven effective—there was a reduction in pupil dilation and uncertainty, resulting in a 35% improvement in the treatment decisions of the physicians and a 70% decrease in treatment inertia in the neurologists.
By taking advantage of existing colour-coded brain system pathways that couples a warning sign, such as the red color of the traffic light, with an action, our education intervention help doctors handle uncertainty, thus significantly improve treatment decisions.
Dr Gustavo Saposnik, Professor and Neurologist, St. Michael’s Hospital
According to the researchers, the study results could find practical applications in medical education, patient outcomes and therapeutic decisions. They added that more research works using functional MRI are required to assess the particular areas of the brain involved in the decision process and that more resources are required to close the knowledge and knowledge-to-action gaps in medical education.