Abstract:
Decision making in the health care system – specifically with
regard to diagnostic imaging investigations – occurs at multiple levels.
Professional role players from various backgrounds are involved in making
these decisions, from the point of referral to the outcomes of the imaging
investigation. The aim of this study was to map the decision-making processes
and pathways involved when patients are referred for diagnostic imaging
investigations and to explore distributed decision-making events at the points
of contact with patients within a health care system. Method: A two-phased
qualitative study was conducted in an academic public health complex with the
district hospital as entry point. The first phase included case studies of 24
conveniently selected patients, and the second phase involved 12 focus group
interviews with health care providers. Data analysis was based on Rapley’s
interpretation of decision making as being distributed across time, situations
and actions, and including different role players and technologies. Results:
Clinical decisions incorporating imaging investigations are distributed across
the three vital points of contact or decision-making events, namely the initial
patient consultation, the diagnostic imaging investigation and the postinvestigation
consultation. Each of these decision-making events is made up of
a sequence of discrete decision-making moments based on the transfer of
retrospective, current and prospective information and its transformation into
knowledge. Conclusion: This paper contributes to the understanding of the
microstructural processes (the ‘when’ and ‘where’) involved in the distribution
of decisions related to imaging investigations. It also highlights the
interdependency in decision-making events of medical and non-medical
providers within a single medical encounter.
