Abstract
Challenges facing the clinical adoption of a new prognostic biomarker: a case study
Background
Scientific and technological solutions to address the socio-economic challenges resulting from population aging in Western societies are increasing (Green and Hillersdal 2021). Technologies are therefore ubiquitous and inevitable, but what these technologies can do depends on how they are used and what they are used for. How they are used and for what depends on their possibilities for coming into existence in the practice they are set to function. Through the case of a particular biotechnology, suPAR, and a particular context, an emergency department in Denmark, this article shows how the existence and use of a technology is not given, delimited or stable but is an ongoing complex and relational becoming. Furthermore we discuss and reflect on what enables the becoming of suPAR as an object for clinical use in the emergency department.
Methods
We explore the contextual becoming of this biomarker, suPAR, through interviews with nurses and physicians and through relational ontology. Relational ontology means that we understand technologies as brought into being in relations with other human- and non-human elements why they are enacted in practice (Barad 2007; Mol 2002). When we study practice through interviews, we understand
speech as material-discursive practices, in other words they are constitutive of ‘becomings’. This is a performative approach to interviews in which we understand utterances as “specific material (re)configurings of the world” (Barad 2003,p. 829). We ask which enacting forces (Law 1992) link matter to other matter relationally, within complex systems or groupings in which elements connect and together structure a function as suPARs existence in the emergency department.
Results – The relational becomings and enacting forces
We describe the relational becomings as: suPAR in the knowledge relation of “pattern recognition”, suPAR in the relation of methods – “doing the right thing to find the cause”, suPAR in the relation of ethics, suPAR in the relation of financial aspects of healthcare. The enacting forces that link matter in these relational becomings we define as specificity and diagnostic practices versus non-specificity and prognostic practices.
From these analytical insights we discuss how suPARs existence can be stengthened in the emergency department through becommings of ‘ a secure clincal action’, ’a (reverse) triage strategy’, ’new diagnostic possibilities’ that better accommodate the complexity and ambiguity of the health problems presented in an emergency department than the existing ones do, and through special attention to becomings characterised as ‘liminal innovation practices’.
Conclusion
We find that as a prognostic biomarker suPAR is challenged in it’s becoming as an object for clinical practice in the emergency department by the power of diagnostic practices and the desire for experience-based scripts that quickly enable the clinician to reach the right diagnosis. Specific diagnostic criteria versus prognostic interpretation and non-specificity risk profiling challenges the way healthcare workers in an emergency department understand the tasks they are set to solve and how to solve them. suPAR is brought into being in a state between experimentation and care. When healthcare workers find themselves in this liminal state it causes ambiguous responses to the choices and uncertainties new technologies bring.
Background
Scientific and technological solutions to address the socio-economic challenges resulting from population aging in Western societies are increasing (Green and Hillersdal 2021). Technologies are therefore ubiquitous and inevitable, but what these technologies can do depends on how they are used and what they are used for. How they are used and for what depends on their possibilities for coming into existence in the practice they are set to function. Through the case of a particular biotechnology, suPAR, and a particular context, an emergency department in Denmark, this article shows how the existence and use of a technology is not given, delimited or stable but is an ongoing complex and relational becoming. Furthermore we discuss and reflect on what enables the becoming of suPAR as an object for clinical use in the emergency department.
Methods
We explore the contextual becoming of this biomarker, suPAR, through interviews with nurses and physicians and through relational ontology. Relational ontology means that we understand technologies as brought into being in relations with other human- and non-human elements why they are enacted in practice (Barad 2007; Mol 2002). When we study practice through interviews, we understand
speech as material-discursive practices, in other words they are constitutive of ‘becomings’. This is a performative approach to interviews in which we understand utterances as “specific material (re)configurings of the world” (Barad 2003,p. 829). We ask which enacting forces (Law 1992) link matter to other matter relationally, within complex systems or groupings in which elements connect and together structure a function as suPARs existence in the emergency department.
Results – The relational becomings and enacting forces
We describe the relational becomings as: suPAR in the knowledge relation of “pattern recognition”, suPAR in the relation of methods – “doing the right thing to find the cause”, suPAR in the relation of ethics, suPAR in the relation of financial aspects of healthcare. The enacting forces that link matter in these relational becomings we define as specificity and diagnostic practices versus non-specificity and prognostic practices.
From these analytical insights we discuss how suPARs existence can be stengthened in the emergency department through becommings of ‘ a secure clincal action’, ’a (reverse) triage strategy’, ’new diagnostic possibilities’ that better accommodate the complexity and ambiguity of the health problems presented in an emergency department than the existing ones do, and through special attention to becomings characterised as ‘liminal innovation practices’.
Conclusion
We find that as a prognostic biomarker suPAR is challenged in it’s becoming as an object for clinical practice in the emergency department by the power of diagnostic practices and the desire for experience-based scripts that quickly enable the clinician to reach the right diagnosis. Specific diagnostic criteria versus prognostic interpretation and non-specificity risk profiling challenges the way healthcare workers in an emergency department understand the tasks they are set to solve and how to solve them. suPAR is brought into being in a state between experimentation and care. When healthcare workers find themselves in this liminal state it causes ambiguous responses to the choices and uncertainties new technologies bring.
| Originalsprog | Engelsk |
|---|---|
| Publikationsdato | 2023 |
| Status | Udgivet - 2023 |
| Begivenhed | Forskningsdag Amager og Hvidovre Hospital - Amager og Hvidovre Hospital, Danmark Varighed: 27 apr. 2023 → … |
Konference
| Konference | Forskningsdag Amager og Hvidovre Hospital |
|---|---|
| Lokation | Amager og Hvidovre Hospital |
| Land/Område | Danmark |
| Periode | 27/04/2023 → … |