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Background Diagnostic uncertainty (DU) in primary care is ubiquitous, yet no review has specifically examined its communication, or the associated ethical issues. Objectives To identify what is known about the communication of DU in primary care and the associated ethical issues. Methods Systematic review, critical interpretive synthesis and ethical analysis of primary research published worldwide. Medline, Embase, Web of Science and SCOPUS were searched for papers from 1988 to 2020 relating to primary care AND diagnostic uncertainty AND [ethics OR behaviours OR communication]. Critical interpretive synthesis and ethical analysis were applied to data extracted. Results Sixteen papers met inclusion criteria. Although DU is inherent in primary care, its communication is often limited. Evidence on the effects of communicating DU to patients is mixed; research on patient perspectives of DU is lacking. The empirical literature is significantly limited by inconsistencies in how DU is defined and measured. No primary ethical analysis was identified; secondary analysis of the included papers identified ethical issues relating to maintaining patient autonomy in the face of clinical uncertainty, a gap in considering the direct effects of (not) communicating DU on patients, and considerations regarding over-investigation and justice. Conclusions This review highlights significant gaps in the literature: there is a need for explicit ethical and patient-centred empirical analyses on the effects of communicating DU, and research directly examining patient preferences for this communication. Consensus on how DU should be defined, and greater research into tools for its measurement, would help to strengthen the empirical evidence base.

Limited Print and Electronic Distribution RightsThis document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions.The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest.RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.Support RAND Make a tax-deductible charitable contribution at www.rand.org/giving/contribute www.rand.org For more information on this publication, visit www.rand.org/t/RR2256Published by the RAND Corporation, Santa Monica, Calif. © Copyright 2017 RAND CorporationR® is a registered trademark.iii Preface This report presents and illustrates an approach for estimating economic benefit of research and services at the National Institute for Occupational Safety and Health (NIOSH), using three case studies. Although no set of three case studies can be regarded as fully representative, we selected the cases to represent important variations in NIOSH activities and intended audiences. The report might be of interest to anyone seeking to understand the impacts of research, services, and practice related to worker safety and health. RAND Corporation researchers have published the following related reports:• Eric Landree, Hirokazu Miyake, and Victoria Greenfield, Nanomaterial Safety in RAND Infrastructure Resilience and Environmental PolicyThe research reported here was conducted in the RAND Infrastructure Resilience and Environmental Policy program, which performs analyses on urbanization and other stresses. This includes research on infrastructure development; infrastructure financing; energy policy; urban planning and the role of public-private partnerships; transportation policy; climate response, mitigation, and adaptation; environmental sustainability; and water resource management and coastal protection. Program research is supported by government agencies, foundations, and the private sector.RAND Justice, Infrastructure, and Environment (JIE) conducts research and analysis in civil and criminal justice, infrastructure development and financing, environmental policy, transportation planning and technology, immigration and border protection, public and occupational safety, energy policy, science and innovation policy, space, telecommunications, and trends and implications of artificial intelligence and other computational technologies.Questions or comments about this r...

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The literature on tax salience finds taxpayers are less responsive to the financial implications of a low-salience tax change than to an otherwise equivalent price change. This paper adds to this literature by showing that taxpayers are more responsive to the more salient features of a given complex tax change. Data from the Consumer Expenditure Survey are used to show that taxpayers responded to the direct implications of the 2003 expansion of the Child and Dependent Care Credit, but did not respond to the expansion's less salient interactions with other elements of the tax code.

This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions.The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.Support RAND Make a tax-deductible charitable contribution at www.rand.org/giving/contribute www.rand.org For more information on this publication, visit www.rand.org/t/RR3038

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This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions.The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest.RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.Support RAND Make a tax-deductible charitable contribution at www.rand.org/giving/contribute www.rand.org For more information on this publication, visit www.rand.org/t/RR1739Library of Congress Cataloging-in-Publication Data is available for this publication.ISBN: 978-0-8330-9971-6 Published by the RAND Corporation, Santa Monica, Calif. © Copyright 2017 RAND CorporationR® is a registered trademark. Cover: The cover image, taken by U.S. Army Corps of Engineers photographer Mark Rankin, is of Chickamauga Lock and Dam, which is located seven miles North East of Chattanooga, Tenn., and was completed in 1940. The lock is owned by the Tennessee Valley Authority and operated by the U.S. Army Corps of Engineers. A project to replace the now-deteriorating lock began in 2003and is scheduled for completion in 2023.iii PrefaceFederal investment in infrastructure has been receiving more attention than usual since the Trump Administration and new Congress took office in January 2017. Not surprisingly, the debate is largely about money: how to finance repairs, new roads, and other projects without adding to the deficit, either by direct public spending or tax credits. Less discussed but no less important are issues concerning the policies that support the mature and urban-centered economy that the United States has now-rather than the economy it had decades ago, when most of the current terms of federal engagement were set. These issues are the focus of this report. We frame the infrastructure debate around the case for modernizing federal policies related to funding, finance, and project selection; recognizing the centrality of regional initiatives that transcend local government and state boundaries; and understanding different types of financing-public, private, and public-private partnerships. The premise is that if compelling public benefits can be articulated and financial incentives properly aligned on both the public and private sides, appropriate investment and maintenance will follow. Poorly targeted investment comes from poorly designed policy. Inadequate maintenance often is a symptom of management and governan...