Introducing Goal Structuring Notation to Explain Decisions in Clinical Practice

Clinical reasoning is a key contributor to the quality of healthcare. Clinical decisions at the policy level are made within a stochastic domain; decisions for individuals are usually more qualitative. In both cases, poor reasoning could result in an undesirable outcome. Clinical decisions are most typically communicated in a document through free text. Text has significant limitations (particularly ambiguity and poor structuring) whether used for analysis, or to explain the decisionmaking process. In safety engineering, similar problems are faced in conveying safety arguments to support certification. As a result, approaches have been developed to conveying arguments in ways which improve communication and which are more amenable to analysis. Goal Structuring Notation (GSN) [12] -a graphical argumentation notation for safety -was developed for those reasons. It has evolved to be one of the most widely used techniques for representing safety arguments. The purpose of this paper is to investigate the feasibility of representing and communication clinical reasoning with GSN. Based on an example, we discuss the benefits and problems of adopting GSN and similar safety-inspired argumentation approaches in clinical decision-making.