Understanding diagnostic conversations in clinical practice: A systematic review.

Area of Science:

• Medical Communication
• Diagnostic Processes
• Healthcare Quality Improvement

Background:

• Diagnostic conversations are central to clinical practice.
• Effective communication is key for accurate diagnosis and patient outcomes.
• Existing frameworks for diagnostic conversations are limited.

Purpose of the Study:

• To systematically review and summarize frameworks for understanding diagnostic conversations.
• To identify components of diagnostic conversations and methods for their assessment.
• To explore the role of communication in the diagnostic process.

Main Methods:

• Systematic literature search of multiple databases (MEDLINE, Scopus, Cochrane) up to July 2022.
• Independent review of studies for eligibility and quality assessment using the Mixed Methods Appraisal Tool.
• Extraction of data on study characteristics, diagnostic conversation frameworks, and assessment components.

Main Results:

• Eight studies were included in the review.
• Only one empirical framework for diagnostic conversations was identified, detailing problem identification, information gathering, and diagnosis delivery.
• Thematic analysis emphasized patient-clinician communication's role in symptom presentation, significance negotiation, and uncertainty management.

Conclusions:

• There is a significant gap in empirical frameworks describing diagnostic conversations.
• Patients play a vital role in diagnosis beyond merely providing information.
• Diagnostic conversations require further research to develop comprehensive frameworks and assessment tools.