| Overarching CMOCs | Illustrative examples of underpinning CMOCs |
|---|---|
| When laboratory tests are perceived to be relatively trivial (C1), and cognitive resources are limited (C2), clinicians prioritise efficiency over thoroughness for test-ordering decisions, directing their cognitive resources to other clinical decisions (M) so decisions about testing will be based on heuristics or routines (O). | When clinicians have incomplete technical knowledge about laboratory medicine and/or diagnostic reasoning (C), they rely on ‘gist’ understanding (M) to develop decision-making heuristics for test ordering (O) [CMOC 1b].In the presence of diagnostic uncertainty (C), clinicians may apply a heuristic of 'more testing is better' (O1) or 'rule out the worst case' (O2) as they seek to minimise the risk of missing a diagnosis (M) [CMOCs 2a–2b].When a test or condition is 'in fashion', and there is high awareness among clinicians and/or the public (C), the use of this test may be incorporated into testing heuristics (O) owing to increased awareness (‘salience’) (M) [CMOC 3g]. |
| When laboratory tests are perceived to be relatively trivial (C1), and cognitive resources are limited (C2), clinicians prioritise efficiency over thoroughness for test-ordering decisions, and direct their cognitive resources to other clinical decisions (M) and so tests may be used to fulfil social and strategic functions (O). | In the presence of diagnostic uncertainty (C), clinicians may demonstrate care (M1), attempt to reassure (M2), or exert control via ‘doing something’ for their patients (M3) by ordering tests (O) [CMOCs 5a–5c].When clinicians anticipate a 'difficult' interaction with a patient (C), they may use the offer of a laboratory test (O) as a strategy to help manage the consultation (M) [CMOC 6c].When clinicians anticipate disagreement with a patient about their proposed management plan (C), they may acquiesce to patient requests or expectations and order tests (O) to avoid having to explain why they are inappropriate (M1) or avoid conflict in the consultation (M2) [CMOCs 7b–7c]. |
| When laboratory tests are perceived to be relatively trivial (C1), and cognitive resources are limited (C2), clinicians will prioritise efficiency over thoroughness in test-ordering decisions, and direct their cognitive resources to other clinical decisions (M) so decisions about testing will be open to wider system influences (O). | When responsibility for patient care is shifted from secondary to primary care (C), clinicians in primary care settings comply with testing expectations and requests (M) received from secondary care and take on responsibility for associated testing (O) [CMOC 9c].In the absence of disincentives for inappropriate testing (C), clinicians and laboratory managers will not prioritise concerns about under/overtesting (M) and so will not take action to address these problems (O) [CMOC 10b].When tests are available to order as part of profiles or panels (C), clinicians may try to save time and cognitive energy (M) by ordering full panels instead of individual tests (O) [CMOC 11b]. |
C = context; M = mechanism; O = outcome