Abstract
The aim of this thesis was to analyze possibilities and restraints, from a cognitive perspective, of a CDSS for diagnostics in Psychiatry. To benefit from a CDSS for diagnostics, individual variations in cognitive functioning has to be considered. These individual variations in use are analysed in this thesis with the concepts of learning styles, learning skills and adaptive styles. Four studies were performed in this thesis.
Study I investigated the acceptance of the system from a learning style perspective. Study II assessed necessary skills for a successful use of the system. Study III tried to identify adaptability measures to the system by various ways of reasoning connected to diagnostic aspects and situations from an evidence-based medicine perspective. Study IV evaluated the computerized decision support system by a comparison with manual diagnosis. To get a complementary perspective on diagnostics, which might generate knowledge for system development, a narrative analysis of the two cases were also performed.
The results supported a number of conclusions: 1) those with preferences for abstract conceptualization mode in information management perceived future use of the system positively; 2) computer skill was low for most psychiatrists under study; 3) a high skill in initiative and sense making seemed to be important for successful use of the system; 4) preferences for concrete adaptive learning mode was connected to faster procedures in the system and that this might indicate low support from the system; 5) flexibility for abstract adaptive learning mode was connected to longer time system use; 6) pattern recognition was applied in the deciding situation where hypothetico-deductive reasoning was expected from an evidence-based medicine perspective; 7) no major difference in terms of correctness of the proposed diagnosis was found between the computerized method and the manual method for diagnosis and where a difference was noted it was in favour of the manual method; and 8) the use of decision support systems for diagnosis in Psychiatry has to be developed before they can be used on a routine basis.
The narrative analysis show the need/importance of physician-patient-interaction in the making/creation of diagnosis and using prognosis as positive future scenarios in the patients´ life.
