“Unfortunately, I don’t have an answer for you”: How resident physicians communicate diagnostic uncertainty to patients during emergency department discharge

Doty, Amanda; Rising, Kristin L.; Hsiao, TingAnn; Amadio, Grace; Gentsch, Alexzandra T.; Salcedo, Venise J.; McElwee, Ian; Cameron, Kenzie A.; Salzman, David H.; Papanagnou, Dimitrios; McCarthy, Danielle M.

doi:10.1016/j.pec.2021.12.002

Cited by 7 publications

(7 citation statements)

References 20 publications

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“…A estratificação dos dados de acordo com cada pergunta realizada no teste de dependência da internet (TDI), como demonstrado na figura 2, nos permitiu avaliar mais a fundo, quais os problemas que afetam a maioria dos estudantes que responderam ao questionário. Foi levantado que as perguntas 1,5,7,10,12, 16 e 17 obtiveram as maiores médias aritméticas. Portanto, podemos concluir, de acordo com cada uma dessas perguntas, que:…”

Section: Resultsunclassified

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O Papel Do Profissional De Educação Física No Nível Motivacional Para a Prática De Atividades Físicas

Santos,

Tritany,

Filho

2023

Estratégias Metodológicas Na Área Da Saúde: Contribuições Para O Conhecimento

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Os autores desta obra assumem publicamente a responsabilidade pelo seu conteúdo, garantindo que o mesmo é de autoria própria, original e livre de plágio acadêmico. Os autores declaram, ainda, que o conteúdo não infringe nenhum direito de propriedade intelectual de terceiros e que não há nenhuma irregularidade que comprometa a integridade da obra. Os autores assumem integral responsabilidade diante de terceiros, quer de natureza moral ou patrimonial, em razão do conteúdo desta obra. Esta declaração tem por objetivo garantir a transparência e a ética na produção e divulgação do artigo. Cumpre esclarecer que o conteúdo do artigo é de responsabilidade exclusiva dos autores, não refletindo, necessariamente, a opinião da editora ou do conselho editorial.

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Section: Resultsunclassified

“…A implementação das estratégias gerou desgaste e adoecimento (5) Utilização de toda criatividade possível (1); As estratégias trouxeram desgaste e sofrimento (3); Positivas para os estudantes, mas não para os docentes (1).…”

Section: Núcleos De Sentidos Ideias Centraisunclassified

O Papel Do Profissional De Educação Física No Nível Motivacional Para a Prática De Atividades Físicas

Santos,

Tritany,

Filho

2023

Estratégias Metodológicas Na Área Da Saúde: Contribuições Para O Conhecimento

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“…This is further evidence that sharing of uncertainty of diagnosis with patients and care partners is an organic component of diagnostic co-production, especially sought in emergency care. 26,27 To encourage expanding our findings to broader contexts such as shared diagnostic decision making, we are coining a name for a diagnostic focal area-patient reasoning-to describe the cognitive processes by which patients and care partners perceive, assess, and act upon explanations of health problems they receive from health care providers. While analyses of patient complaints and patient narratives have been robust and extensive, with elaborate codifications, focusing on cognitive processes and patient reasoning behind patient perspectives within the diagnostic context is novel.…”

Section: Discussionmentioning

confidence: 99%

Patient Reasoning: Patients’ and Care Partners’ Perceptions of Diagnostic Accuracy in Emergency Care

Dukhanin,

McDonald,

Gonzalez

et al. 2023

Med Decis Making

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Objectives In the context of validating a measure of patient report specific to diagnostic accuracy in emergency department or urgent care, this study investigates patients’ and care partners’ perceptions of diagnoses as accurate and explores variations in how they reason while they assess accuracy. Methods In February 2022, we surveyed a national panel of adults who had an emergency department or urgent care visit in the past month to test a patient-reported measure. As part of the survey validation, we asked for free-text responses about why the respondents indicated their (dis)agreement with 2 statements comprising patient-reported diagnostic accuracy: 1) the explanation they received of the health problem was true and 2) the explanation described what to expect of the health problem. Those paired free-text responses were qualitatively analyzed according to themes created inductively. Results A total of 1,116 patients and care partners provided 982 responses coded into 10 themes, which were further grouped into 3 reasoning types. Almost one-third (32%) of respondents used only corroborative reasoning in assessing the accuracy of the health problem explanation (alignment of the explanation with either test results, patients’ subsequent health trajectory, their medical knowledge, symptoms, or another doctor’s opinion), 26% used only perception-based reasoning (perceptions of diagnostic process, uncertainty around the explanation received, or clinical team’s attitudes), and 27% used both types of reasoning. The remaining 15% used general beliefs or nonexplicated logic (used only about accurate diagnoses) and combinations of general reasoning with perception-based and corroborative. Conclusions Patients and care partners used multifaceted reasoning in their assessment of diagnostic accuracy. Implications As health care shifts toward meaningful diagnostic co-production and shared decision making, in-depth understanding of variations in patient reasoning and mental models informs use in clinical practice. Highlights An analysis of 982 responses examined how patients and care partners reason about the accuracy of diagnoses they received in emergency or urgent care. In reasoning, people used their perception of the process and whether the diagnosis matched other factual information they have. We introduce “patient reasoning” in the diagnostic measurement context as an area of further research to inform diagnostic shared decision making and co-production of health.

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“…1,32,33 A 2022 study explored how US residents communicated with standardised patients in scenarios without a clear diagnosis: 28% did not discuss diagnostic uncertainty at all, and those who did varied in their use of explicit and implicit language. 34 Overall, although the communication of uncertainty has been Participants read four clinical vignettes (presented in random order to mitigate order effect), each involving significant diagnostic uncertainty.…”

Section: What Is Currently Known About Diagnostic Uncertainty Communi...mentioning

confidence: 99%

“…Some suggest that diagnostic uncertainty is infrequently communicated, 30,31 while others observed it more commonly 1,32,33 . A 2022 study explored how US residents communicated with standardised patients in scenarios without a clear diagnosis: 28% did not discuss diagnostic uncertainty at all, and those who did varied in their use of explicit and implicit language 34 …”

Section: Introductionmentioning

confidence: 99%

How and why do doctors communicate diagnostic uncertainty: An experimental vignette study

Cox,

Hatfield,

Fritz

2024

Health Expectations

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BackgroundDiagnostic uncertainty is common, but its communication to patients is under‐explored. This study aimed to (1) characterise variation in doctors' communication of diagnostic uncertainty and (2) explore why variation occurred.MethodsFour written vignettes of clinical scenarios involving diagnostic uncertainty were developed. Doctors were recruited from five hospitals until theoretical saturation was reached (n = 36). Participants read vignettes in a randomised order, and were asked to discuss the diagnosis/plan with an online interviewer, as they would with a ‘typical patient’. Semi‐structured interviews explored reasons for communication choices. Interview transcripts were coded; quantitative and qualitative (thematic) analyses were undertaken.ResultsThere was marked variation in doctors' communication: in their discussion about differential diagnoses, their reference to the level of uncertainty in diagnoses/investigations and their acknowledgement of diagnostic uncertainty when safety‐netting. Implicit expressions of uncertainty were more common than explicit. Participants expressed both different communication goals (including reducing patient anxiety, building trust, empowering patients and protecting against diagnostic errors) and different perspectives on how to achieve these goals. Training in diagnostic uncertainty communication is rare, but many felt it would be useful.ConclusionsSignificant variation in diagnostic uncertainty communication exists, even in a controlled setting. Differing communication goals—often grounded in conflicting ethical principles, for example, respect for autonomy versus nonmaleficence—and differing ideas on how to prioritise and achieve them may underlie this. The variation in communication behaviours observed has important implications for patient safety and health inequalities. Patient‐focused research is required to guide practice.Patient or Public ContributionIn the design stage of the study, two patient and public involvement groups (consisting of members of the public of a range of ages and backgrounds) were consulted to gain an understanding of patient perspectives on the concept of communicating diagnostic uncertainty. Their feedback informed the formulations of the research questions and the choice of vignettes used.

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“Unfortunately, I don’t have an answer for you”: How resident physicians communicate diagnostic uncertainty to patients during emergency department discharge

Cited by 7 publications

References 20 publications

O Papel Do Profissional De Educação Física No Nível Motivacional Para a Prática De Atividades Físicas

O Papel Do Profissional De Educação Física No Nível Motivacional Para a Prática De Atividades Físicas

Patient Reasoning: Patients’ and Care Partners’ Perceptions of Diagnostic Accuracy in Emergency Care

How and why do doctors communicate diagnostic uncertainty: An experimental vignette study

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