Understanding the Cognition and Decision Making of Community Anesthesiologists

Understanding the Cognition and Decision Making of Community Anesthesiologists in Their Management of End-of-case Neuromuscular Blockade: A Mixed Methods Study

The investigators are interested in studying why experienced clinicians make specific decisions regarding the monitoring of patients' physiological states and why clinicians might make decisions that are contrary to current best practices or known evidence. More generally, the program objective is to refine and validate a novel methodology to delineate clinicians' decision-making strategies. More specifically, the investigators will study the decision to reverse neuromuscular blockade at the end of an anesthetic. This clinical decision will be studied in this project because: 1) it has been well documented that a substantial percentage of practitioners do not follow best practices; 2) the variables are relatively circumscribed and well described; and 3) it can be framed as a binary decision.

The investigators propose to conduct an observational mixed-methods study developing and using clinical vignettes and cognitive interviews to better understand the decision-making approaches and preferences of clinically active anesthesia providers with regard to their decision-making during clinical anesthesia cases. After developing clinical vignettes and related questions, the investigators will first obtain detailed demographic and clinical practice variables from the participants via a survey. Participants will then review multiple vignettes that present different clinical situations that focus on decisions to reverse neuromuscular blockade and/or extubate the patient. Each participant will provide their decisions for each vignette. The investigators will then conduct an audiotaped interview, using cognitive task analysis methods, to ascertain the factors that played a role in these decisions.

Study Overview

• Status: Recruiting
• Conditions: Neuromuscular Blockade

Detailed Description

The investigators propose to conduct a 3-site prospective observational mixed-methods study using clinical vignettes and cognitive interviews to better understand the decision making approaches and preferences of practicing community anesthesiologists with regard to the management of non-depolarizing neuromuscular blockade (NMB) at the end of general endotracheal anesthesia cases.

The objectives of this initial study is to begin to understand:

1. When and why do community anesthesiologists choose to reverse NMB?
2. What are the decision preferences of community anesthesiologists with regard to their decisions to reverse NMB, and what are the clinician and clinical case factors that influence those decisions?
3. What are the operational knowledge gaps of anesthesia professionals with regard to their ability to follow best-practice evidence for the reversal of NMB? More generally, the program objective is to refine and validate a novel methodology to delineate clinicians' decision making strategies and triggers.

2.1.2. Study Hypotheses

For this initial study, the investigators hypothesize that:

1. There will be a significant distribution of clinical variables across community anesthesiologists' decision to reverse NMB.
2. There will be measurable differences in participant demographics and practice attributes between those who closely follow evidence-based expectations for reversal of NMB and those who do not. The investigators expect community practitioners who do not reverse NMB in accordance with current best evidence to be older, to not be fellowship trained or subspecialty certified, and to practice in lower acuity settings.

This will be a remotely conducted national prospective observational simulation study of 36 experienced community anesthesiologists using a clinical vignette and cognitive interviews to better understand the decision making approaches and preferences of practicing community anesthesiologists with regard to the management of neuromuscular blockade (NMB) at the end of general endotracheal anesthesia cases.

Cognitive interview transcript coders and analysts will be blinded to the identity and attributes of the participants.

• Study Type: Observational
• Enrollment (Estimated): 36

Contacts and Locations

• Study Contact: Name: Matt Weinger, MD; Phone Number: 615-936-6598; Email: matt.weinger@vumc.org

Study Locations

• United States
  • Tennessee
    • Nashville, Tennessee, United States, 37203
      • Recruiting
      • Vanderbilt University Medical Center
      • Contact: Jason Slagle, PhD; Phone Number: 615-936-5519; Email: jason.slagle@vumc.org

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 19 years to 78 years (Adult, Older Adult)
• Accepts Healthy Volunteers: N/A

• Sampling Method: Probability Sample

Study Population

Clinically active anesthesia providers

Description

Inclusion Criteria:

• Clinically active experienced anesthesia providers

Exclusion Criteria:

• Anesthesia providers who are no longer practicing or clinically active

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Other

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Anesthesia Providers; Clinically active anesthesia providers

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Average Decision Thresholds: Pharmacological measure of neuromuscular blocking drug effect	The average decision threshold is the average across all participant's decision threshold for this measure. The decision threshold is calculated by sequentially varying values of the pharmacological variables (i.e., doses and timing) within the context of a clinical scenario. Each participant's decision threshold is the equivalent of an ED50 or a MAC value (i.e., the equipoise point for their clinical decision based on that variable).	10 minutes
Average Decision Thresholds: Muscle strength	The average decision threshold is the average across all participant's decision threshold for this measure. The decision threshold is calculated by sequentially varying values of muscle strength within the context of a clinical scenario. Each participant's decision threshold is the equivalent of an ED50 or a MAC value (i.e., the equipoise point for their clinical decision based on that variable).	10 minutes
Average Decision Thresholds: Respiratory parameters	The average decision threshold is the average across all participant's decision threshold for this measure. The decision threshold is calculated by sequentially varying values of the respiratory parameters (i.e., variables contributing to minute ventilation) within the context of a clinical scenario. Each participant's decision threshold is the equivalent of an ED50 or a MAC value (i.e., the equipoise point for their clinical decision based on that variable).	10 minutes

Collaborators and Investigators

• Sponsor: Vanderbilt University Medical Center
• Collaborators: University of Pittsburgh; The Cooper Health System

Study record dates

Study Major Dates

• Study Start (Actual): August 3, 2023
• Primary Completion (Estimated): December 1, 2024
• Study Completion (Estimated): June 1, 2025

Study Registration Dates

• First Submitted: November 30, 2019
• First Submitted That Met QC Criteria: December 9, 2019
• First Posted (Actual): December 11, 2019

Study Record Updates

• Last Update Posted (Estimated): February 6, 2024
• Last Update Submitted That Met QC Criteria: February 3, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Other Study ID Numbers: 181711

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No