Patient perspectives on how physicians communicate diagnostic uncertainty: An experimental vignette study

Area of Science:

• Medical Communication
• Patient-Provider Relationship
• Health Psychology

Background:

• Communicating diagnostic uncertainty is a critical aspect of patient care.
• Previous research has not fully elucidated optimal strategies for conveying uncertainty.
• Understanding patient perceptions is key to improving communication effectiveness.

Purpose of the Study:

• To evaluate the impact of three distinct communication strategies for diagnostic uncertainty on patient perceptions.
• To assess effects on physician competence, trust, confidence, visit satisfaction, and adherence.
• To inform the development of evidence-based communication guidelines.

Main Methods:

• Experimental vignette-based study with pediatric cases.
• Parents were randomly assigned to one of three communication scenarios: explicit uncertainty, implicit uncertainty (broad differential diagnoses), or implicit uncertainty (most likely diagnoses).
• Web-based questionnaires assessed patient perceptions of physician competence, trust, satisfaction, and adherence.

Main Results:

• Explicit communication of uncertainty led to lower perceived physician competence, trust, and patient adherence compared to implicit strategies.
• Implicit communication strategies (broad differential diagnoses or most likely diagnoses) yielded comparable positive outcomes.
• Participant groups were similar in demographics, parent activation measure (PAM), and intolerance to uncertainty.

Conclusions:

• Implicit communication of diagnostic uncertainty may foster more positive patient perceptions of physician competence and trust.
• Strategies involving broad differential diagnoses or most likely diagnoses appear more favorable than explicit statements of uncertainty.
• Further research is needed to develop and validate evidence-based methods for communicating diagnostic uncertainty effectively.