How and why do doctors communicate about diagnostic uncertainty: an experimental vignette study: Presenter(s): Caitriona Cox, University of Cambridge, United Kingdom. (April 2023)

• Record Type: Journal Article
• Authors: Hatfield, Thea; Fritz, Zoe
• Is Part Of: Patient education and counseling. Volume 109(2023)Supplement
• Page Start: 122
• Publication Date: 2023-04
• Subjects: Patient education -- Periodicals; Health counseling -- Periodicals; Health education -- Periodicals; Counseling -- Periodicals; Patient Education -- Periodicals; Éducation des patients -- Périodiques; Counseling -- Périodiques; Éducation sanitaire -- Périodiques; 615.5071
• DOI: 10.1016/j.pec.2022.10.279
• Languages: English
• ISSNs: 0738-3991

Abstract

Abstract : Background: Diagnostic uncertainty (DU) is common in medicine, but little is known about if, how, and why, doctors communicate it to patients. This study aimed to characterise variation in doctors' communication of DU and why any such variation occurred. Methods: Participants (n=36) were general internal medicine doctors from five English hospitals. They were given four vignettes to read, each depicting a clinical scenario with significant DU. After each one they explained the diagnosis and to a 'patient' and were interviewed about reasons for their communication and prior training in communicating DU. Interviews were recorded, transcribed and then coded. Quantitative and thematic analysis was undertaken. Findings: Participants commonly explained investigation results and the most likely diagnosis, but less frequently acknowledged any uncertainty around this diagnosis: e.g. 50% mentioned their level of certainty in offering a diagnosis of IBS and 53% discussed other differentials they had considered. When differentials were discussed, participants were more likely to name benign diagnoses than malignancy. There was variation in explaining uncertainties in investigations: e.g. only 25% acknowledged that CT did not exclude subarachnoid haemorrhage. A minority of participants explicitly acknowledged when they could not provide a definitive diagnosis. Safety-netting was frequent, but participants rarely did so with any reference to risk of diagnostic error. When explaining their communication, participants referenced patient anxiety, perception of (un)certainty, and complexity of information. Those who explicitly communicated DU often did so to encourage shared decision-making or limit diagnostic errors by empowering patients to reattend. Few participants recalled receiving training in communicating DU, but many supported the idea. Discussion: There was significant variability in how much diagnostic uncertainty doctors communicate in a controlled setting. Participants expressed conflicting ideas about approaches for managing patient anxiety and safety-netting. Further patient-focused research is needed to explore these conflicts and inform future best practice guidelines.