Clinical Decision Making for Interprofessional Collaborative Practice

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Boschen, Mark
Morrissey, Shirley
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Glendon, Aleck
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2019-08-28
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Abstract

Objective: Interprofessional collaborative practice skills and the ability to make effective clinical decisions are among the most important skills required for practising health professionals, and are an important focus of health discipline students’ training. Individual differences can affect decision making style (e.g., Appelt, Milch, Handgraaf & Weber, 2011; Hewes, 2009; Phillips, Fletcher, Marks, & Hine, 2016; Shaban, 2005), and cognitive processes that use decision making heuristics are prone to biases by both expert and novice clinicians (Bradley, 2005). Therefore, errors and biases could affect the successful interprofessional functioning of healthcare teams. Understanding individual health practitioners’ and students’ natural cognitive processing style, decision making style, and factors that influence these, could be key to researching methods of enhancing clinical decision making (CDM). Considerable evidence supports the positive benefits of healthcare practitioners engaging in interprofessional collaborative practices (IPCP) for patients, clients, and consumers (Morgan, Pullon, & McKinlay, 2015; Sexton, 2016). This includes interprofessional education (IPE) and interprofessional practice development (Barr, Freeth, Hammick, Koppel, & Reeves, 2006; Blue & Garr, 2007; Curran, Sharpe, Flynn, & Button, 2009, (McAllister, Morrissey, Davidson, McAuliffe, McConnell, & Reddy, 2011, Mickan, Hoffman, & Nasmith, 2010; Morgan, Pullon, & McKinlay, 2015, Sexton, 2016). Being able to make optimal clinical decisions and the ability to communicate and collaborate around clinical decisions with other team members, consumers and their families is paramount to successful healthcare. These core IPCP processes are also considered to be extremely important components of contemporary interprofessionalism. This thesis comprises a series of published and under review papers, that provide a critical analysis of cognitive continuum theory (CCT), and which examines a selective number of individual difference factors with clear theoretical relevance to explore natural processing and decision--making styles in student and health practitioner samples. The CCT theoretical framework is explored as a decision--making orientation strategy in IPE. To further examine CCT’s influence on health practitioner, student, and simulated healthcare teams’ clinical decision making, this thesis assesses the extent to which IPE training can optimally orientate such decision making. CCT requires a precise language to describe both the type of task under consideration, and decision--making methods employed. This research also examines the feasibility of IPE workshops and their potential for providing a platform for healthcare teams to communicate and collaborate around clinical decisions, specifically, CCT’s ability to control for individual differences in cognitive processing, and natural decision--making style. Method: One critical analysis and two research studies were conducted. The critical analysis explored CCT as a model of human judgment and decision making with the potential to orientate decision--making processes. The critical review specifically examined current applications of CCT and its potential use to a wider range of interprofessional healthcare team processes, including implications for future research, education, practice and policy. The two research studies assessed individual novice––expert health practitioner and interprofessional team decision--making, and components of interprofessional practice (IPP; communication and collaboration) through IPE. Study 1 explored key variables used to assess individual differences in cognitive processing and decision--making styles. Theoretically relevant factors that the literature indicated as having significant influences were examined. These include the amount of discipline education, clinical experience, IPE, IPP experience, age, personality, and interpersonal motivations, as well as natural decision--making and cognitive processing styles on intuitive, analytic, rational, and experiential continua. A convenience sample (N = 229) current Australian--based healthcare practitioners, and students enrolled in tertiary related health programs, completed an online survey. Respondents were classified as either novices (n = 73), intermediate (n = 85), or expert (n = 71) in their discipline (dental/oral health, dietetics/nutrition, exercise physiology, human service/social work, medicine, midwifery, nursing, occupational therapy, pharmacy, physiotherapy, podiatry, psychology, speech & language pathology). Study 2 explored the feasibility of using CCT as a decision--making orientation strategy within IPE workshops using a cross--sectional design and an independent convenience sample (N = 33) of health professionals. Using a randomized control method with student participants, this research compared collaborative practice in workshops with the decision--making orientation strategy (CCT workshop) with another already well--established IPE multi--disciplinary mental health (MDMH) workshop (Morrissey, Davidson, McAuliffe, McAllister, McConnell & Reddy, 2011). A convenience sample of 43 students was randomly assigned to either the MDMH or the CCT workshop. In addition, this research also examined the CCT model in a series of workshops with 33 practising health professionals. In summary workshop totals included professional workshops (n = 33), CCT student workshops (n = 23), and MDMH student workshops (n = 20). This format enabled the workshop content and processes in part 1 (CCT or MDMH) to be examined within student interprofessional groups while part 2 also compared CCT suitability for students and professional practitioner populations. Results: The analysis identified applying CCT as having the potential to improve both individual health practitioner, and interprofessional team understanding about, and communication of, CDM processes. It highlighted the need for further research using the CCT framework before extending its widespread deployment within healthcare sectors. The studies added to the literature with respect to critically appraising a CDM orientation strategy. Study 1 expanded understanding of the complexity of examining natural cognitive processing and decision--making styles, and factors influencing these. Study 2 examined IPP through IPE, and the feasibility of CCT’s application to improve and orientate CDM and interprofessional teams’ communication and collaboration. The critical review concluded that, by guiding decision--making, a CCT framework can potentially provide a useful application in interprofessional healthcare education around CDM. The findings from Study 1 highlighted that research into cognitive processing and decision--making styles yielded inconsistent and contradictory results, which were challenging to interpret, and that were inevitably sample specific. These findings were demonstrated even when research was conducted using a systematic theory--driven approach. Study 2 examined CCT as an IPE tool and usefully added to the literature with respect to the benefits of encouraging IPP through IPE and interprofessional learning in tertiary education and continuing professional development.

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Thesis (PhD Doctorate)
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Doctor of Philosophy in Clinical Psychology (PhD ClinPsych)
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School of Applied Psychology
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Collaborative practice
Clinical decision making
Healthcare
Cognitive continuum theory (CCT)
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