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Table 5 Results of Usability Testing for the SAMI-Self-Care CDS Program: Clinician Perspectives

From: Algorithm-based decision support for symptom self-management among adults with Cancer: results of usability testing

Usability Testing Themes CDS Tool Context* CDS Tool Component** Examples
Visual appeal General comment related to the look and feel of the system Format “Use larger fonts and colors as a way to distinguish instructions from question.”
Nausea and vomiting Format “Give a visual description of what a 16-oz container might look like, e.g., a Poland spring water bottle.”
Understanding of terminology Pain severity question Written content and preference for terminology Disapproval of wording, “bearable pain.”
Nausea and vomiting question Written content “Clearly indicate what issue is being evaluated, e.g., [for] position change, are we asking about getting up quickly or vertigo?”
Pain question Written content “Add timeframes, e.g., did taking the pain mediation offer you relief after 30 min?”
Nausea and vomiting Format “Add graphics such as [a picture of] fire in the esophagus, which doesn’t need a definition.”
All symptoms Written content and format “Medication lists might be overwhelming for some patients.”
Pain Written content “Offer educational explanation such as risk factors regarding why the patients shouldn’t take certain medication, e.g., for ibuprofen explain why stomach protection is needed for those 65 or older.”
Format and navigation Comment about introduction and orientation to the program Format “Select a symptom that is bothering the patients the most, and then come back to evaluate other symptoms.”
Nausea and vomiting question Written content and algorithms.
This related to the issue that chemotherapy induced nausea may be more common than position-induced nausea
“Prioritize question order based on frequency of issues experienced by the patients to reduce number of questions patients have to answer and to avoid patients having to answer questions to symptoms majority might not experience.”
Comment to improve the look and feel of the program Format and navigation “Try to reduce the number of clicks needed to move the system forward, e.g., they shouldn’t have to select the symptom and press next to move forward.”
Provide an introduction to questions so patients will know what to expect and why Format and navigation “Tell patients upfront the different symptoms or medications the program will ask about.”
General comment related to sequencing of questions Format and navigation “Add skip patterns for those who might have used the system before.”
General comment about sequence of questions Written content “Work on lessening redundancy of the questions.”
Wording of self-management suggestions Symptom reports Written content “Be clear with instructions regarding communication w/ clinicians.”
Symptom reports for red flag questions. Written content “Clearly indicate to the patient to call now, so they do not mistakenly think the report has been automatically sent to their clinician and that someone will follow up.”
Symptom reports Written content “Educate the patient on how to use the paging service.”
Symptom reports Written content “Don’t put ‘during normal business hours’ because it sounds like we’re telling patients to stop bothering us.”
Symptom reports Written content “List phone number of clinician on the report or a paging service for after hours.”
Other    
 Patient safety All symptoms red flag questions developed for safety Algorithm content Identify all red flag/emergency issues.
Pain red flag safety questions Algorithm content “Ask about new or severe pain not just one [or the other] and, [a] ‘yes’ [response] should mean call your doctor right away.”
General comment about reports that are generated for self-management Written content Clinicians worried that they may not be informed about patient problems.
All symptoms red flag questions added Algorithm content Clinicians concerned they may miss or overlook critical situations.
General comment about the report Written content “Include notification to patient that they should always call provider with questions.”
General comment Written content “Wouldn’t want the patient to use the program instead of getting care.”
 Resources General concern about use of iPad Format Concern that some patients will not have access to computers.
 Best care practices Pain self-management for severe pain Written content about when to call their clinicians Lack of consensus among clinicians regarding clinical best practices.
Nausea and vomiting acid reflux Algorithm content Some providers recommend medication like TUMS, but GI doctors may avoid it because it creates acid.
Pain and nausea and vomiting Written content wanted more comprehensive lists for medications Recommended some medications be added on to lists [of medications already included].
Pain medication question Written content “Change dosing criteria for long acting to 8–12 h.”
Pain medication lists Written content “Certain medications on the list not used across the board causing worry, e.g., fentanyl or tapentadol.”
  1. * CDS tool content refers to what aspect of the CDS tool that the comment sought to improve (i.e. medication vs. pain severity question)
  2. ** CDS tool component refers to what aspect of the CDS tool that the component that the comment sought to improve (i.e. written content vs. visual appeal)