Development and content validation of a Chronic Cough Decision Support Tool (CC-DST) for Primary Care Doctors

Introduction: Chronic cough is a challenging complaint in primary healthcare, often leading to diagnostic uncertainties and delays in diagnosis and early referral. This research focuses on the development and content validation of a chronic cough decision support tool (CC-DST) to guide primary care doctors in the management of chronic cough. Methodology: CC-DST that consists of a clerking sheet, investigation, diagnosis and treatment (IDT) guide, referral and feedback forms were developed based on existing guidelines and literature reviews. Feedback from expert panels (eleven respiratory physicians, five gastroenterologists, five ear-nose-throat specialists, and twelve primary care physicians) was sought through a questionnaire via email focusing on the content and useability of the CC-DST. Next, a series of online meetings were held with the expert panels discussing content, readability, useability, and potential challenges of implementation. Iterative changes were made to the CC-DST based on the feedback from the questionnaire and meetings. Results: The finalized CC-DST comprises three components. The first component is a clerking sheet with guidance on history taking and examinations. Chest radiography (CXR) is a necessary primary investigation. The IDT guide (figure 1) provides a simplified algorithm to aid doctors in reaching possible diagnoses based on normal or abnormal CXR results. Doctors may refer to a probability chart and treatment guide to come to a possible diagnosis and treatment. Thirdly, a chronic cough referral form was created to be used when needed. Challenges such as the limited availability of spirometry and interpretation of lateral CXR influenced the development of the IDT guide component of CC-DST. Conclusion: The CC-DST has been developed and validated by experts. Its feasibility in clinical practice is needed to guide primary care doctors in managing chronic cough comprehensively. Declaration of Interest: This research is supported by IPCRG research prioritization and small grant awards.