Development of a computerised decision XXXX for thrombolysis in @entity64 .

@entity1 @entity64 @entity548 @entity3224 @entity204
BACKGROUND: Thrombolytic treatment for acute @entity64 improves prognosis, although there is a risk of @entity548 complications leading to early @entity204 /severe disability. Benefit from thrombolysis is time dependent and treatment must be administered within 4.5  hours from onset of symptoms, which presents unique challenges for development of tools to support decision making and @entity1 understanding about treatment. Our aim was to develop a decision @entity3224 to support @entity1 -specific clinical decision-making about thrombolysis for acute @entity64 , and clinical communication of personalised information on benefits/risks of thrombolysis by clinicians to @entity1 /relatives. METHODS: Using mixed methods we developed a COMPuterised decision @entity3224 for @entity64 thrombolysiS (COMPASS) in an iterative staged process (review of available tools; a decision analytic model; interactive group workshops with clinicians and @entity1 /relatives; and prototype usability testing). We then tested the tool in simulated situations with final testing in real life @entity64 thrombolysis decisions in hospitals. Clinicians used COMPASS pragmatically in managing acute @entity64 @entity1 potentially eligible for thrombolysis; their experience was assessed using self-completion forms and interviews. Computer logged data assessed time in use, and utilisation of graphical risk presentations and additional features. @entity1 '/relatives' experiences of discussions supported by COMPASS were explored using interviews. RESULTS: COMPASS expresses predicted outcomes ( @entity548 complications, @entity204 , and extent of disability) with and without thrombolysis, presented numerically (percentages and natural frequencies) and graphically (pictographs, bar graphs and flowcharts). COMPASS was used for 25 @entity1 and no adverse effects of use were reported. Median time in use was 2.8  minutes. Graphical risk presentations were shared with 14 @entity1 /relatives. Clinicians (n   =   10) valued the @entity1 -specific predictions of benefit from thrombolysis, and the support of better risk communication with @entity1 /relatives. @entity1 (n   =   2) and relatives (n   =   6) reported that graphical risk presentations facilitated understanding of benefits/risks of thrombolysis. Additional features (e.g. dosage calculator) were suggested and subsequently embedded within COMPASS to enhance usability. CONCLUSIONS: Our structured development process led to the development of a gamma prototype computerised decision @entity3224 . Initial evaluation has demonstrated reasonable acceptability of COMPASS amongst @entity1 , relatives and clinicians. The impact of COMPASS on clinical outcomes requires wider prospective evaluation in clinical settings.
