How Do Paediatricians Manage Comfort with Uncertainty in Clinical Decision-Making

Area of Science:

• Medical Education
• Pediatrics
• Healthcare Management

Background:

• Healthcare practice involves inherent uncertainty, yet postgraduate training lacks formal support for comfort with uncertainty (CWU).
• Medical training pedagogies may conflict with CWU by emphasizing problem-solving.
• Managing uncertainty impacts patient referral rates and healthcare resource utilization.

Purpose of the Study:

• To explore pediatricians' experiences and strategies for managing uncertainty in clinical practice.
• To understand the factors influencing clinicians' comfort with uncertainty (CWU).
• To investigate the link between clinician CWU and caregiver comfort with doctors' reassurance (CDR).

Main Methods:

• Qualitative study involving 34 Irish pediatricians.
• Face-to-face interviews conducted after participants viewed videos of clinician-patient interactions.
• Thematic analysis of interview data, with triangulation and member checking for validity.

Main Results:

• Five key themes emerged: information quality, clinical assessment confidence, managing anxiety, coping strategies for uncertainty, and parental expectations.
• Clinician CWU is significantly moderated by caregiver CDR.
• Clinical management may deviate from plans if caregiver CDR is not adequately addressed.

Conclusions:

• Clinician CWU in pediatrics is closely tied to caregiver CDR.
• Social context, including caregiver expectations, is crucial for understanding and supporting clinician CWU.
• Educational interventions should address both clinician CWU and caregiver CDR to optimize patient care and resource use.