TY - JOUR T1 - Clinical decision support system to optimise symptom management in palliative medicine: focus group study JF - BMJ Supportive & Palliative Care JO - BMJ Support Palliat Care DO - 10.1136/bmjspcare-2021-002940 SP - bmjspcare-2021-002940 AU - Lotte van der Stap AU - Albert H de Heij AU - Agnes van der Heide AU - Anna KL Reyners AU - Yvette M van der Linden Y1 - 2021/07/16 UR - http://spcare.bmj.com/content/early/2021/07/16/bmjspcare-2021-002940.abstract N2 - Objectives Suboptimal symptom control in patients with life-limiting illnesses is a major issue. A clinical decision support system (CDSS) that combines a patient-reported symptom assessment scale (SAS) and guideline-based individualised recommendations has the potential to improve symptom management. However, lacking end-user acceptance often prevents CDSS use in daily practice.We aimed to evaluate the acceptability and feasibility of a palliative care CDSS according to its targeted end-users.Methods Six focus groups with different groups of stakeholders were conducted: (1) patient representatives; (2) community nurses; (3) hospital nurses; (4) general practitioners; (5) hospital physicians and (6) palliative care specialists. Audiotapes were transcribed verbatim and thematically analysed.Results Fifty-one stakeholders (6–12 per focus group) participated. Six themes were discussed: effect, validity, continuity, practical usability, implementation and additional features. All participants expected a CDSS to improve symptom management, for example, by reminding clinicians of blind spots and prompting patient participation. They feared interference with professional autonomy of physicians, doubted the validity of using a patient-reported SAS as CDSS input and thought lacking care continuity would complicate CDSS use. Clinicians needed clear criteria for when to use the CDSS (eg, life-limiting illness, timing in illness trajectory). Participants preferred a patient-coordinated system but were simultaneously concerned patients may be unwilling or unable to fill out an SAS.Conclusions A palliative care CDSS was considered useful for improving symptom management. To develop a feasible system, barriers for successful implementation must be addressed including concerns about using a patient-reported SAS, lacking care continuity and unclear indications for use.The data that support the findings of this study are available from the corresponding author on reasonable request. ER -