Uncertainty in Decision Making in Medicine: A Scoping Review and Thematic Analysis of Conceptual Models

Abstract

Purpose The practice of medicine is rarely straightforward. Data used to facilitate medical decision making may be conflicting, ambiguous, or scarce, and providing optimal care requires balancing clinicians’ expertise and available evidence with patients’ preferences. To explore uncertainty in decision making across disciplines, the authors performed a scoping review and thematic analysis of the literature to formulate a model describing the decision-making process in medicine under uncertain conditions. Method In 2016, the authors performed a comprehensive search of key databases using a combination of keywords and controlled vocabulary. They identified and reviewed 3,398 records. After applying their inclusion and exclusion criteria to the titles and abstracts and then full texts, 19 articles were selected. The authors applied a qualitative thematic analysis to these articles, using codes to extract themes related to uncertainty in decision making. Results The 19 articles spanned 6 fields of study and 5 disciplines within the health sciences. The thematic analysis revealed 6 main themes: recognition of uncertainty, classification of uncertainty, stakeholder perspectives, knowledge acquisition, decision-making approach, and evaluation of the decision-making process. Conclusions Based on the themes that emerged from their thematic analysis of the literature characterizing the effects of uncertainty and ambiguity on the decision-making process, the authors developed a framework depicting the interplay between these themes with a visual representation of the decision-making process under uncertain conditions. Future research includes further development and validation of this framework to inform medical school curricula.

Managing Uncertainty During the Communication of Diagnostic Test Information Between Patients and Clinicians in Australian Emergency Care

“…Relying on limited and imperfect data (Simpkin & Schwartzstein, 2016) and uncertain diagnostic interpretations in laboratory pathology reports (Bracamonte et al, 2016), clinicians reach a sufficient rather than absolute level of diagnostic certainty (The National Academies of Sciences, Engineering and Medicine, 2015) for clinical decision-making. "All medical encounters revolve around things we don't know" (Morgan, 2019), and during the clinical encounter between patient and clinician, diagnostic uncertainty is entwined with medical uncertainty (Simpkin & Schwartzstein, 2016), illness uncertainty (Kuang, 2018), prognostic uncertainty (Rasmussen et al, 2019), uncertainty in clinical decision-making (Helou et al, 2019), patient uncertainty (Rising et al, 2019), and numerous other uncertainties in complex health care settings (Pomare et al, 2019). Uncertainty is thus a multifaceted and deeply pervasive construct with far-reaching implications for patient safety, satisfaction, and care.…”

Tolerance for Uncertainty and Professional Development: a Normative Analysis

“…Over the past 30 years, scholars from a range of disciplines including medicine, 1 – 4 sociology, 5 , 6 psychology, 7 – 11 and philosophy 12 , 13 have addressed the concepts of ambiguity and uncertainty in medical practice and training, including several notable reviews. 6 , 7 , 9 , 10 , 14 , 15 Interest in uncertainty has reemerged in response to recent advances in medicine 16 and the impact of uncertainty on physicians’ well-being. 17 , 18 In light of the current COVID-19 pandemic, the subject of uncertainty has taken on new significance as healthcare providers face unprecedented uncertainty both inside and outside of the hospital.…”

Managing Uncertainty: Physicians' Decision Making for Stroke Prevention for Patients with Atrial Fibrillation and Intracerebral Hemorrhage

“…16 In this study, joint decision making with the stroke team or within the MDT was seen as an important part of the critical thinking process that ensured a more satisfactory decision. Acknowledging different individuals' views during decision making is part of information gathering, a way of facilitating the decision-making process 20 and may be a way of overcoming the limitations of knowledge. 16 Furthermore, communal decision-making minimizes the psychological burden experienced by individuals by reducing feelings of stress and regret associated with the risk of making a “wrong” decision.…”