Technology-mediated macrocognition: Investigating how physicians, nurses, and respiratory therapists make critical decisions

J Crit Care. 2019 Oct;53:132-141. doi: 10.1016/j.jcrc.2019.06.002. Epub 2019 Jun 4.


Purpose: Although intensive care clinicians are expected to make data-driven critical decisions using the technologies available to them, the effect of those technologies on decision-making are not well understood. Using the macrocognitive framework, we studied critical decision-making and technology use to understand how different specialists within teams make decisions and guide the development of decision-making support technologies.

Materials and methods: The Critical Decision Method was used to understand the macrocognitive processes used during critical decision-making of twelve critical care clinicians. Deductive (based on the macrocognition framework) and inductive coding were used to analyze the macrocognitive processes, their interrelationships, and their relation to technologies.

Results: Over 60% of critical decision-making macrocognition was devoted to Sensemaking, Anticipation, and Communication. The most technology-mediated process was Sensemaking. Of particular note, physicians and respiratory therapists extracted information for their own use, while nurses extracted information to communicate to others. Physicians switched between ten macrocognitive processes, whereas nurses and respiratory therapists switched between five processes.

Conclusions: This exploratory study provides much needed details about the different ways in which specialists use technologies to support decision-making tasks, particularly those involving sensemaking, which are essential to the design and development of decision-support technologies.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Allied Health Personnel* / psychology
  • Clinical Decision-Making*
  • Cooperative Behavior
  • Critical Care*
  • Humans
  • Nurses* / psychology
  • Physicians* / psychology
  • Problem Solving