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“Clinical decision support tools are designed to assist clinicians in making informed and accurate diagnostic and prognostic decisions using available characteristics of the patient and the larger context,” Anna Jones, MD, MPH, and her colleagues wrote in JAMA Network Open.
Jones is in the Department of Pediatrics at the University of Utah School of Medicine in Salt Lake City.
Jones and her coauthors concluded such a tool had the potential to improve evidence-based testing in pediatric diarrhea and help clinicians communicate clearly to parents the etiology of their child’s illness. Parents in the study, however, expressed skepticism over the tool, voicing concerns that physicians might over-rely on its algorithms.
The authors said that thanks to the development of multiplex polymerase chain reaction (PCR) panels for gastroenteritis, it is now possible to quickly identify up to 22 different pathogens from stool samples. What is lacking, they suggested, are protocols for knowing when to test for these pathogens.
“Although the Infectious Diseases Society of America 2017 clinical practice guidelines for the diagnosis and management of infectious diarrhea provide broad recommendations for when diarrhea-related diagnostics should be used, clear guidelines specific to the use of multiplex PCR panels do not exist,” Jones and her coauthors wrote, adding that misusing the diagnostics, however, “can lead to inappropriate antibiotic use and excess financial burdens.”
Meanwhile, communication breakdowns in the patient-doctor relationship are a leading contributor to diagnostic errors, according to the Agency for Healthcare Research and Quality. Subsequently, the National Academy of Medicine has recommended that healthcare professionals seek to engage patients and their families in the diagnostic process.
With these factors in mind, Jones and her colleagues recruited parents who had sought care for their child’s diarrhea and clinicians who routinely treat children with diarrhea. The recruits came from five urgent care sites and one emergency department (ED), all in Utah. Participants were interviewed between June 15, 2023, and January 24, 2025.
In all, the authors interviewed 44 parents (40 women; median age, 34 years). One parent (2%) identified as Asian, two (5%) as Black or African American, 15 (34%) as Hispanic or Latin, and 22 (50%) as White individuals. The remaining four participants (9%) were of unknown race and ethnicity. Most parents spoke English as their primary language (40 [91%]).
Among the 16 clinicians, 10 were physicians and six were nurse practitioners or physician associates. Eleven of the 16 were women and the group had a median age of 42 years. Fourteen clinicians (88%) self-identified as White individuals and two (13%) had unknown race and ethnicity.
All were interviewed on their management of pediatric diarrhea and about their expectations for diagnostic testing and treatment of the condition, as well as the perceived utility of a clinical decision support tool.
Jones and colleagues identified three motivations among parents who sought clinical care for a child with diarrhea. The first was reassurance, which the authors said included validation for what the parents were already doing to care for their child.
The second motivation was to obtain insight into the etiology of their child’s symptoms. “Many believed that diagnostic testing to identify the specific etiology of the illness would be useful. Parents indicated that knowing the etiology would offer desired reassurance and potentially inform treatment decisions,” Jones and her coauthors wrote.
Lastly, parents sought appropriate treatment and symptom relief.
Many clinicians acknowledged the benefits of a clinical decision support tool for help with evidence-based decision-making during diagnosis and to facilitate communication with families. However, they expressed skepticism over the use of diagnostics for etiology, noting that disease management was not dependent upon knowing it.
Some clinicians said many families expected a test. “Even if I don’t think that a GI [gastrointestinal] stool study is necessary, there are situations where…a family is not going to leave the [ED] happy without one. And so I probably order them sometimes when they’re not truly indicated,” a physician reported in the interview.
“That said,” Jones and her coauthors wrote, “clinicians thought that diagnostic testing for pediatric diarrhea was generally not warranted, except in unique cases [such as] bloody stools, prolonged duration of diarrhea, or travel history.”
Many clinicians thought a decision-making tool might help build trust and rapport with the patient’s family, reassuring them their child is getting evidence-based care.
“It just adds to that shared decision-making model. I think it adds trust…I think it does kind of back up our ability to defend why we’re doing what we’re doing,” reported one surveyed ED physician.
Parents were mostly wary of the potential use of a clinical decision-making tool. Jones and colleagues reported that in addition to some clinicians, “several parents expressed concerns that a tool does not account for nuances and would lead to ‘generalizing every kid’ (said the father of a child aged 1-3 years), as opposed to providing patient-centered care.”
Parents also said they worried a clinician would not reply upon their own clinical judgement if they had a diagnostic tool.
Jones and her colleagues concluded that before implementing a clinical decision support tool in pediatric diarrhea, strategies are necessary to, “resolve tension in care expectations, facilitate diagnostic stewardship, and optimize care.”
In an accompanying editorial, KC Coffey, MD, MPH, concluded that the study by Jones and colleagues suggests that adapting such tools to incorporate parental expectations, “could facilitate patient engagement in the diagnostic process and increase acceptance of [using these tools for] decisions. Such discussions might also raise awareness of the potential harms of over testing.” Coffey is an epidemiologist and infectious disease physician at the University of Maryland in Baltimore.
Elizabeth Dobler, MD, who was not involved in the study, told GI & Hepatology News that “as the number of available tests continues to grow, stewardship is becoming more relevant than ever. Families may not always realize the downsides of unnecessary testing — such as false positives, avoidable procedures, or added risks — and part of our responsibility is to help them understand both the potential benefits and the potential harms of these tests.”
Dobler is the medical director for clinical decision support in the Department of Clinical Informatics at Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago.
Clinical decision support tools are helpful in the clinical setting, Dobler said because “they give providers quick access to the most relevant information needed for decision-making. This includes patient-specific details — symptoms, history, labs, and vitals” as well as the characteristics and downsides of the tests. In an ideal world, she said, clinicians would consider these data for every patient.
Dobler cautioned however, that, “it’s important to stress that these tools don’t replace clinical judgment — the provider still evaluates the patient, considers the clinical context, and incorporates the family’s preferences. But as a complement to that process, I believe these tools are very valuable.”
Lastly, Dobler said that transparency is key to helping parents overcome their hesitancy regarding these tools.
Jones, Coffey, and Dobler reported no relevant financial disclosures.
A version of this article appeared on Medscape.com.
“Clinical decision support tools are designed to assist clinicians in making informed and accurate diagnostic and prognostic decisions using available characteristics of the patient and the larger context,” Anna Jones, MD, MPH, and her colleagues wrote in JAMA Network Open.
Jones is in the Department of Pediatrics at the University of Utah School of Medicine in Salt Lake City.
Jones and her coauthors concluded such a tool had the potential to improve evidence-based testing in pediatric diarrhea and help clinicians communicate clearly to parents the etiology of their child’s illness. Parents in the study, however, expressed skepticism over the tool, voicing concerns that physicians might over-rely on its algorithms.
The authors said that thanks to the development of multiplex polymerase chain reaction (PCR) panels for gastroenteritis, it is now possible to quickly identify up to 22 different pathogens from stool samples. What is lacking, they suggested, are protocols for knowing when to test for these pathogens.
“Although the Infectious Diseases Society of America 2017 clinical practice guidelines for the diagnosis and management of infectious diarrhea provide broad recommendations for when diarrhea-related diagnostics should be used, clear guidelines specific to the use of multiplex PCR panels do not exist,” Jones and her coauthors wrote, adding that misusing the diagnostics, however, “can lead to inappropriate antibiotic use and excess financial burdens.”
Meanwhile, communication breakdowns in the patient-doctor relationship are a leading contributor to diagnostic errors, according to the Agency for Healthcare Research and Quality. Subsequently, the National Academy of Medicine has recommended that healthcare professionals seek to engage patients and their families in the diagnostic process.
With these factors in mind, Jones and her colleagues recruited parents who had sought care for their child’s diarrhea and clinicians who routinely treat children with diarrhea. The recruits came from five urgent care sites and one emergency department (ED), all in Utah. Participants were interviewed between June 15, 2023, and January 24, 2025.
In all, the authors interviewed 44 parents (40 women; median age, 34 years). One parent (2%) identified as Asian, two (5%) as Black or African American, 15 (34%) as Hispanic or Latin, and 22 (50%) as White individuals. The remaining four participants (9%) were of unknown race and ethnicity. Most parents spoke English as their primary language (40 [91%]).
Among the 16 clinicians, 10 were physicians and six were nurse practitioners or physician associates. Eleven of the 16 were women and the group had a median age of 42 years. Fourteen clinicians (88%) self-identified as White individuals and two (13%) had unknown race and ethnicity.
All were interviewed on their management of pediatric diarrhea and about their expectations for diagnostic testing and treatment of the condition, as well as the perceived utility of a clinical decision support tool.
Jones and colleagues identified three motivations among parents who sought clinical care for a child with diarrhea. The first was reassurance, which the authors said included validation for what the parents were already doing to care for their child.
The second motivation was to obtain insight into the etiology of their child’s symptoms. “Many believed that diagnostic testing to identify the specific etiology of the illness would be useful. Parents indicated that knowing the etiology would offer desired reassurance and potentially inform treatment decisions,” Jones and her coauthors wrote.
Lastly, parents sought appropriate treatment and symptom relief.
Many clinicians acknowledged the benefits of a clinical decision support tool for help with evidence-based decision-making during diagnosis and to facilitate communication with families. However, they expressed skepticism over the use of diagnostics for etiology, noting that disease management was not dependent upon knowing it.
Some clinicians said many families expected a test. “Even if I don’t think that a GI [gastrointestinal] stool study is necessary, there are situations where…a family is not going to leave the [ED] happy without one. And so I probably order them sometimes when they’re not truly indicated,” a physician reported in the interview.
“That said,” Jones and her coauthors wrote, “clinicians thought that diagnostic testing for pediatric diarrhea was generally not warranted, except in unique cases [such as] bloody stools, prolonged duration of diarrhea, or travel history.”
Many clinicians thought a decision-making tool might help build trust and rapport with the patient’s family, reassuring them their child is getting evidence-based care.
“It just adds to that shared decision-making model. I think it adds trust…I think it does kind of back up our ability to defend why we’re doing what we’re doing,” reported one surveyed ED physician.
Parents were mostly wary of the potential use of a clinical decision-making tool. Jones and colleagues reported that in addition to some clinicians, “several parents expressed concerns that a tool does not account for nuances and would lead to ‘generalizing every kid’ (said the father of a child aged 1-3 years), as opposed to providing patient-centered care.”
Parents also said they worried a clinician would not reply upon their own clinical judgement if they had a diagnostic tool.
Jones and her colleagues concluded that before implementing a clinical decision support tool in pediatric diarrhea, strategies are necessary to, “resolve tension in care expectations, facilitate diagnostic stewardship, and optimize care.”
In an accompanying editorial, KC Coffey, MD, MPH, concluded that the study by Jones and colleagues suggests that adapting such tools to incorporate parental expectations, “could facilitate patient engagement in the diagnostic process and increase acceptance of [using these tools for] decisions. Such discussions might also raise awareness of the potential harms of over testing.” Coffey is an epidemiologist and infectious disease physician at the University of Maryland in Baltimore.
Elizabeth Dobler, MD, who was not involved in the study, told GI & Hepatology News that “as the number of available tests continues to grow, stewardship is becoming more relevant than ever. Families may not always realize the downsides of unnecessary testing — such as false positives, avoidable procedures, or added risks — and part of our responsibility is to help them understand both the potential benefits and the potential harms of these tests.”
Dobler is the medical director for clinical decision support in the Department of Clinical Informatics at Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago.
Clinical decision support tools are helpful in the clinical setting, Dobler said because “they give providers quick access to the most relevant information needed for decision-making. This includes patient-specific details — symptoms, history, labs, and vitals” as well as the characteristics and downsides of the tests. In an ideal world, she said, clinicians would consider these data for every patient.
Dobler cautioned however, that, “it’s important to stress that these tools don’t replace clinical judgment — the provider still evaluates the patient, considers the clinical context, and incorporates the family’s preferences. But as a complement to that process, I believe these tools are very valuable.”
Lastly, Dobler said that transparency is key to helping parents overcome their hesitancy regarding these tools.
Jones, Coffey, and Dobler reported no relevant financial disclosures.
A version of this article appeared on Medscape.com.
“Clinical decision support tools are designed to assist clinicians in making informed and accurate diagnostic and prognostic decisions using available characteristics of the patient and the larger context,” Anna Jones, MD, MPH, and her colleagues wrote in JAMA Network Open.
Jones is in the Department of Pediatrics at the University of Utah School of Medicine in Salt Lake City.
Jones and her coauthors concluded such a tool had the potential to improve evidence-based testing in pediatric diarrhea and help clinicians communicate clearly to parents the etiology of their child’s illness. Parents in the study, however, expressed skepticism over the tool, voicing concerns that physicians might over-rely on its algorithms.
The authors said that thanks to the development of multiplex polymerase chain reaction (PCR) panels for gastroenteritis, it is now possible to quickly identify up to 22 different pathogens from stool samples. What is lacking, they suggested, are protocols for knowing when to test for these pathogens.
“Although the Infectious Diseases Society of America 2017 clinical practice guidelines for the diagnosis and management of infectious diarrhea provide broad recommendations for when diarrhea-related diagnostics should be used, clear guidelines specific to the use of multiplex PCR panels do not exist,” Jones and her coauthors wrote, adding that misusing the diagnostics, however, “can lead to inappropriate antibiotic use and excess financial burdens.”
Meanwhile, communication breakdowns in the patient-doctor relationship are a leading contributor to diagnostic errors, according to the Agency for Healthcare Research and Quality. Subsequently, the National Academy of Medicine has recommended that healthcare professionals seek to engage patients and their families in the diagnostic process.
With these factors in mind, Jones and her colleagues recruited parents who had sought care for their child’s diarrhea and clinicians who routinely treat children with diarrhea. The recruits came from five urgent care sites and one emergency department (ED), all in Utah. Participants were interviewed between June 15, 2023, and January 24, 2025.
In all, the authors interviewed 44 parents (40 women; median age, 34 years). One parent (2%) identified as Asian, two (5%) as Black or African American, 15 (34%) as Hispanic or Latin, and 22 (50%) as White individuals. The remaining four participants (9%) were of unknown race and ethnicity. Most parents spoke English as their primary language (40 [91%]).
Among the 16 clinicians, 10 were physicians and six were nurse practitioners or physician associates. Eleven of the 16 were women and the group had a median age of 42 years. Fourteen clinicians (88%) self-identified as White individuals and two (13%) had unknown race and ethnicity.
All were interviewed on their management of pediatric diarrhea and about their expectations for diagnostic testing and treatment of the condition, as well as the perceived utility of a clinical decision support tool.
Jones and colleagues identified three motivations among parents who sought clinical care for a child with diarrhea. The first was reassurance, which the authors said included validation for what the parents were already doing to care for their child.
The second motivation was to obtain insight into the etiology of their child’s symptoms. “Many believed that diagnostic testing to identify the specific etiology of the illness would be useful. Parents indicated that knowing the etiology would offer desired reassurance and potentially inform treatment decisions,” Jones and her coauthors wrote.
Lastly, parents sought appropriate treatment and symptom relief.
Many clinicians acknowledged the benefits of a clinical decision support tool for help with evidence-based decision-making during diagnosis and to facilitate communication with families. However, they expressed skepticism over the use of diagnostics for etiology, noting that disease management was not dependent upon knowing it.
Some clinicians said many families expected a test. “Even if I don’t think that a GI [gastrointestinal] stool study is necessary, there are situations where…a family is not going to leave the [ED] happy without one. And so I probably order them sometimes when they’re not truly indicated,” a physician reported in the interview.
“That said,” Jones and her coauthors wrote, “clinicians thought that diagnostic testing for pediatric diarrhea was generally not warranted, except in unique cases [such as] bloody stools, prolonged duration of diarrhea, or travel history.”
Many clinicians thought a decision-making tool might help build trust and rapport with the patient’s family, reassuring them their child is getting evidence-based care.
“It just adds to that shared decision-making model. I think it adds trust…I think it does kind of back up our ability to defend why we’re doing what we’re doing,” reported one surveyed ED physician.
Parents were mostly wary of the potential use of a clinical decision-making tool. Jones and colleagues reported that in addition to some clinicians, “several parents expressed concerns that a tool does not account for nuances and would lead to ‘generalizing every kid’ (said the father of a child aged 1-3 years), as opposed to providing patient-centered care.”
Parents also said they worried a clinician would not reply upon their own clinical judgement if they had a diagnostic tool.
Jones and her colleagues concluded that before implementing a clinical decision support tool in pediatric diarrhea, strategies are necessary to, “resolve tension in care expectations, facilitate diagnostic stewardship, and optimize care.”
In an accompanying editorial, KC Coffey, MD, MPH, concluded that the study by Jones and colleagues suggests that adapting such tools to incorporate parental expectations, “could facilitate patient engagement in the diagnostic process and increase acceptance of [using these tools for] decisions. Such discussions might also raise awareness of the potential harms of over testing.” Coffey is an epidemiologist and infectious disease physician at the University of Maryland in Baltimore.
Elizabeth Dobler, MD, who was not involved in the study, told GI & Hepatology News that “as the number of available tests continues to grow, stewardship is becoming more relevant than ever. Families may not always realize the downsides of unnecessary testing — such as false positives, avoidable procedures, or added risks — and part of our responsibility is to help them understand both the potential benefits and the potential harms of these tests.”
Dobler is the medical director for clinical decision support in the Department of Clinical Informatics at Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago.
Clinical decision support tools are helpful in the clinical setting, Dobler said because “they give providers quick access to the most relevant information needed for decision-making. This includes patient-specific details — symptoms, history, labs, and vitals” as well as the characteristics and downsides of the tests. In an ideal world, she said, clinicians would consider these data for every patient.
Dobler cautioned however, that, “it’s important to stress that these tools don’t replace clinical judgment — the provider still evaluates the patient, considers the clinical context, and incorporates the family’s preferences. But as a complement to that process, I believe these tools are very valuable.”
Lastly, Dobler said that transparency is key to helping parents overcome their hesitancy regarding these tools.
Jones, Coffey, and Dobler reported no relevant financial disclosures.
A version of this article appeared on Medscape.com.