• Teus H Kappen, Kim van Loon, Martinus A M Kappen, Leo van Wolfswinkel, Yvonne Vergouwe, Wilton A van Klei, Karel G M Moons, and Cor J Kalkman.
• Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, P.O. Box 85500, Mail Stop F.06.149, Utrecht 3508 GA, The Netherlands. Electronic address: teus_kappen@yahoo.com.
• J Clin Epidemiol. 2016 Feb 1; 70: 136-45.

ObjectivesPrediction models may facilitate risk-based management of health care conditions. In a large cluster-randomized trial, presenting calculated risks of postoperative nausea and vomiting (PONV) to physicians (assistive approach) increased risk-based management of PONV. This increase did not improve patient outcome-that is, PONV incidence. This prompted us to explore how prediction tools guide the decision-making process of physicians.Study Design And SettingUsing mixed methods, we interviewed eight physicians to understand how predicted risks were perceived by the physicians and how they influenced decision making. Subsequently, all 57 physicians of the trial were surveyed for how the presented risks influenced their perceptions.ResultsAlthough the prediction tool made physicians more aware of PONV prevention, the physicians reported three barriers to use predicted risks in their decision making. PONV was not considered an outcome of utmost importance; decision making on PONV prophylaxis was mostly intuitive rather than risk based; prediction models do not weigh benefits and risks of prophylactic drugs.ConclusionCombining probabilistic output of the model with their clinical experience may be difficult for physicians, especially when their decision-making process is mostly intuitive. Adding recommendations to predicted risks (directive approach) was considered an important step to facilitate the uptake of a prediction tool.Copyright © 2016 Elsevier Inc. All rights reserved.

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