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

Caitríona Cox1, Thea Hatfield1, Zoë Fritz1

  • 1The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK.

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|June 3, 2024
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Summary
This summary is machine-generated.

Doctors communicate diagnostic uncertainty differently, with implicit expressions more common than explicit. This variation in communication impacts patient safety and health inequalities, necessitating patient-focused research.

Keywords:
communicationdiagnostic uncertaintydoctor–patient relationshipethicssafety‐netting

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Area of Science:

  • Medical Communication
  • Clinical Decision-Making
  • Patient Safety

Background:

  • Communicating diagnostic uncertainty to patients is crucial but under-researched.
  • Understanding variations in how doctors convey uncertainty is essential for improving patient care.

Purpose of the Study:

  • To characterize the variation in doctors' communication of diagnostic uncertainty.
  • To explore the underlying reasons for observed communication variations.

Main Methods:

  • Utilized four clinical vignettes depicting diagnostic uncertainty scenarios.
  • Conducted semi-structured interviews with 36 doctors across five hospitals.
  • Employed quantitative and qualitative thematic analyses of interview transcripts.

Main Results:

  • Significant variation observed in discussing differential diagnoses, levels of uncertainty, and safety-netting.
  • Implicit communication of uncertainty was more prevalent than explicit.
  • Doctors cited diverse communication goals (e.g., reducing anxiety, building trust) and strategies, with a recognized need for training.

Conclusions:

  • Variations in diagnostic uncertainty communication persist, influenced by differing goals and ethical principles.
  • These communication disparities have implications for patient safety and health equity.
  • Further patient-centered research is recommended to inform clinical practice.