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Diagnostic investigations: harmless tests or booby traps?

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  • 13728 The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College , Lebanon, NH, USA.

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Summary

Diagnostic tests offer benefits but also carry potential harms. Patients may choose "intentional unknowing" to decline diagnostic knowledge when harms outweigh benefits, influencing shared decision-making.

Keywords:
deliberate ignorancediagnostic testingintentional unknowing

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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.