Modelling elderly cardiac patients decision making using Cognitive Work Analysis: Identifying requirements for patient decision aids

• Patient's day-to-day decision making is a complex socio-technical system.
• Cognitive Work Analysis provides analysis of decision making from different perspectives.
• Decisions are not just rule based, it involves skills and knowledge based behaviour.
• Systems should support different approaches to patients’ decision making.
• CWA is helpful in modelling decision making and for identifying requirements.

BackgroundPatients make various healthcare decisions on a daily basis. Such day-to-day decision making can have significant consequences on their own health, treatment, care, and costs. While decision aids (DAs) provide effective support in enhancing patient's decision making, to date there have been few studies examining patient's decision making process or exploring how the understanding of such decision processes can aid in extracting requirements for the design of DAs.ObjectiveThis paper applies Cognitive Work Analysis (CWA) to analyse patient's decision making in order to inform requirements for supporting self-care decision making.MethodThis study uses focus groups to elicit information from elderly cardiovascular disease (CVD) patients concerning a range of decision situations they face on a daily basis. Specifically, the focus groups addressed issues related to the decision making of CVD in terms of medication compliance, pain, diet and exercise.ResultsThe results of these focus groups are used to develop high level views using CWA. CWA framework decomposes the complex decision making problem to inform three approaches to DA design: one design based on high level requirements; one based on a normative model of decision-making for patients; and the third based on a range of heuristics that patients seem to use.ConclusionCWA helps in extracting and synthesising decision making from different perspectives: decision processes, work organisation, patient competencies and strategies used in decision making. As decision making can be influenced by human behaviour like skills, rules and knowledge, it is argued that patients require support to different types of decision making. This paper also provides insights for designers in using CWA framework for the design of effective DAs to support patients in self-management.