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Table 2 Selected responses to open-ended survey question and links to related themes from focus groups

From: Understanding clinical prediction models as ‘innovations’: a mixed methods study in UK family practice

Response to open-ended survey question Related themes from focus groups
Risk scores can be very useful in their place to guide treatment or investigation. The overall clinical picture can only be gained from a clinician, so they cannot replace all thought. Perceived threat to professionalism
Perceived effects on personalised care
Population risk doesn’t equal individual patient risk; these scoring systems should be used to aid discussion and communication, not as an end or decision-maker. Other scoring tools (e.g. Oxford ortho scores, IPSS, GAD-6 etc) don’t necessarily reflect ‘risk’ but are similar in their use in communication & negotiation with patients. Linking scoring tools to read codes can be useful (in the same way entering a Read code will bring up web mentor topics on EMIS for example) in assisting the clinician to utilise these tools - otherwise it’s a case of remembering the right tool and searching for it on the web. Perceived effects on personalised care
Perceived effects on communication
Ease of use
Risk scores are often suggested from small pieces of research. They don’t always help guide decisions, and there is a struggle between usability and being comprehensive that many scores don’t achieve. I hate stretched acronyms (like CHADS2-VASC) where you cannot remember the components. I often use MD Calc if I need a risk score Actionability
Ease of use
Knowledge of CPMs
Ultimately it is a computer generated score. It can’t replace clinical judgement however once you use it and document it, from a medico legal aspect, you have to be very confident and brave to ignore it and often this is the barrier to using it as opposed to clinical judgement in the first place. I probably use it more to add weight to my decisions. Fear of litigation
Have seen both sides - man with a healthy lifestyle in 70s score 50 % on QRISK making him feel there was little point to his lifestyle improvements and a very unhealthy man (obese, drinker) etc who scored lowly so then thought he had justification to continue with his unhealthy lifestyle - risk scores useful when used with clinical judgement Perceived effects on personalised care
Only useful if the basic statistical and trial data is understood by the doctor doesnt always apply to the patient/ population in front of you Perceived effects on personalised care
Risk scores are very important, especially in general practice, but clinical judgement always reigns supreme. I like showing patients their QRISK2 score and what would happen to their risk were they to stop smoking for example. But barely-existent integration of such scores undermines their use in day-to-day consultations. Most family physician clinical systems are very poorly designed, and this is something I am planning to take up as a challenge once I complete my training and get settled. Perceived effects on communication
Ease of use
I think younger Family physicians / trainees are more aware of risk scores eg CURBS, Wells (how to use Well’s properly which is drilled into us as foundation years but Family physicians often may not know how to use properly) Knowledge of CPMs
Clinical confidence and experience