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Clinicians' perspectives on incidentally discovered silent brain infarcts - A qualitative study
Lester Y Leung1, Paul K J Han2, Christine Lundquist3
1Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, Massachusetts, United States of America.
Plos One
|March 30, 2018
Summary
Incidental silent brain infarcts (id-SBIs) create clinical uncertainty, leading to varied practices. Addressing diagnostic and prognostic unknowns is crucial for implementing effective stroke prevention strategies.
Area of Science:
- Neurology
- Clinical Medicine
- Radiology
Background:
- Silent brain infarcts (SBIs) detected incidentally (id-SBIs) have unknown clinical significance.
- id-SBIs may represent an opportunity for stroke prevention, but clinician uncertainty hinders action.
- Uncertainty surrounding id-SBIs complicates research and clinical management.
Purpose of the Study:
- To explore clinicians' perspectives on incidentally discovered silent brain infarcts (id-SBIs).
- To understand the impact of uncertainty on clinical decision-making regarding id-SBIs.
- To identify evidence needs for managing id-SBIs.
Main Methods:
- Semi-structured interviews with 15 practicing clinicians.
- Grounded theory and constant comparative analysis of interview transcripts.
- Purposeful sampling to ensure participant diversity across specialties.
Main Results:
- Clinicians expressed significant diagnostic, prognostic, and therapeutic uncertainty regarding id-SBIs.
- Uncertainty led to practice variations and reluctance to disclose findings to patients.
- Vascular neurologists considered id-SBIs prognostically similar to symptomatic stroke, while therapeutic uncertainty persisted.
Conclusions:
- Incidental silent brain infarcts (id-SBIs) are a significant source of clinical uncertainty, resulting in practice variation.
- Addressing diagnostic and prognostic uncertainties is essential for implementing preventative strategies for id-SBIs.
- Future research should focus on resolving these uncertainties to improve patient care and stroke prevention.