Diagnostic investigations: harmless tests or booby traps?

Area of Science:

• Medical Ethics
• Health Decision-Making
• Diagnostic Test Evaluation

Background:

• Diagnostic tests are often perceived as harmless tools for medical problem-solving.
• However, diagnostic tests can entail significant psychological, moral, and existential harms alongside benefits.
• This necessitates exploring strategies like intentional unknowing to manage diagnostic knowledge acquisition.

Purpose of the Study:

• To demonstrate that diagnostic tests involve potential harms and benefits.
• To introduce and justify the strategy of intentional unknowing.
• To propose a conceptual model for categorizing diagnostic tests based on knowledge benefit and harm.

Main Methods:

• Development of a conceptual model categorizing diagnostic tests by knowledge benefit (high/low) and harm (high/low).
• Analysis of the relationship between test characteristics and the need for shared decision-making.
• Identification of conditions under which patients might prefer not to know diagnostic information.

Main Results:

• The need for shared decision-making is inversely related to knowledge benefit and directly related to knowledge harm.
• High benefit/high harm scenarios require the highest degree of shared decision-making.
• Low benefit/high harm scenarios indicate the lowest need for shared decision-making, supporting intentional unknowing.

Conclusions:

• Expanding diagnostic and prognostic capabilities increase uncertainty, impacting the utility of diagnostic knowledge.
• Informed patient preferences regarding the balance of harms and benefits are crucial.
• The strategy of intentional unknowing is appropriate in specific clinical contexts.