Pediatric clinician perspectives on communicating diagnostic uncertainty

Abstract

Objective Diagnosis often evolves over time, involves uncertainty, and is vulnerable to errors. We examined pediatric clinicians’ perspectives on communicating diagnostic uncertainty to patients’ parents and how this occurs. Design We conducted semi-structured interviews, which were audiotaped, transcribed, and analyzed using content analysis. Two researchers independently coded transcripts and then discussed discrepancies to reach consensus. Setting A purposive sample of pediatric clinicians at two large academic medical institutions in Texas. Participants Twenty pediatric clinicians participated: 18 physicians, 2 nurse practitioners; 7 males, 13 females; 7 inpatient, 11 outpatient, and 2 practicing in mixed settings; with 0–16 years’ experience post-residency. Intervention(s) None. Main outcome measure(s) Pediatric clinician perspectives on communication of diagnostic uncertainty. Results Pediatric clinicians commonly experienced diagnostic uncertainty and most were comfortable seeking help and discussing with colleagues. However, when communicating uncertainty to parents, clinicians used multiple considerations to adjust the degree to which they communicated. Considerations included parent characteristics (education, socioeconomic status, emotional response, and culture) and strength of parent–clinician relationships. Communication content included setting expectations, explaining the diagnostic process, discussing most relevant differentials, and providing reassurance. Responses to certain parent characteristics, however, were variable. For example, some clinicians were more open to discussing diagnostic uncertainty with more educated parents- others were less. Conclusions While pediatric clinicians are comfortable discussing diagnostic uncertainty with colleagues, how they communicate uncertainty to parents appears variable. Parent characteristics and parent–clinician relationships affect extent of communication and content discussed. Development and implementation of optimal strategies for managing and communicating diagnostic uncertainty can improve the diagnostic process.

Something Else Going On? Diagnostic Uncertainty in Children with Chronic Pain and Their Parents

“…Poor trust in clinicians may be a barrier to treatment adherence, as high parent-reported patient satisfaction and positive expectations of treatment results have been associated with better treatment adherence in pediatric chronic pain [ 29 ]. From the perspective of health care providers, one thematic analysis found that pediatric providers also experience diagnostic uncertainty, but how much they communicate their own diagnostic uncertainty likely depends on parent characteristics and the strength of the parent-provider relationship [ 30 ]. In addition, some qualitative diagnostic uncertainty responses in the present study indicated an intent to see additional providers.…”

Communication of Diagnostic Uncertainty in Primary Care and Its Impact on Patient Experience: an Integrative Systematic Review

“…Study designs included quantitative, 23,[36][37][38][39][40] mixed methods, 25,41,42 and qualitative. [43][44][45][46][47][48][49][50][51][52] Studies were published between 1991 and 2019 and conducted predominantly in the USA (n=10) and UK (n=4).…”

“…38 The predominant race (between 68% and 87%) of participants was white 36,38,42 and most had completed high school education or higher. 25,36,41,42 Of the 19 articles, less than half (n=8) included definitions for expressions of uncertainty 25,38,40,41,46 or diagnostic uncertainty 39,48,52 (frequently adopting or adapting Bhise et al's definition 53 ). Expressions of uncertainty were defined generally (e.g.…”

“…fever), in 37% (n=7) of studies. 39,43,45,[49][50][51][52] Other common symptoms included chest pain (n=4), 37,40,42,48 abdominal pain (n=3), 36,37,52 neurological (n=3, e.g. dizziness or headache) 39,42,52 and respiratory symptoms (n=3, e.g.…”

Family-Centered Care for Children and Families Impacted by Neonatal Seizures: Advice From Parents

“…15,25 Prognostic uncertainty is a common feature of care for children with neurological conditions, and clinician approaches are variable; parents appreciated when clinicians were honest about this uncertainty. 25,26 Interventions to improve communication skills have been effective in many disciplines and should be adapted to this context. [27][28][29][30][31][32][33] Most parents emphasized the need for clinicians to understand and validate their experiences.…”