How is diagnostic uncertainty communicated and managed in real world primary care settings?

IF 3.2 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Jessica Russell, Laura Boswell, Athena Ip, Jenny Harris, Hardeep Singh, Ashley N. D. Meyer, Traber D. Giardina, Afsana Bhuiya, Katriina L. Whitaker, Georgia B. Black
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引用次数: 0

Abstract

Managing diagnostic uncertainty is a major challenge in primary care due to factors such as the absence of definitive tests, variable symptom presentations and disease evolution. Maintaining patient trust during a period of investigative uncertainty, whilst minimising scope for diagnostic error is a challenge. Mismanagement can lead to diagnostic errors, treatment delays, and suboptimal patient outcomes. Our aim was to explore how UK primary care physicians (GPs) address and communicate diagnostic uncertainty in practice. This qualitative study used video and audio-recordings. Verbatim transcripts were coded with a modified, validated tool to capture GPs’ actions and communication in primary care consultations that included diagnostic uncertainty. The tool includes items relating to advice regarding new symptoms or symptom deterioration (sometimes called ‘safety netting’). Video data was analysed to identify GP and patient body postures during and after the delivery of the management plan. All patient participants had a consultation with a GP, were over the age of 50 and had (1) at least one new presenting problem or (2) one persistent problem that was undiagnosed. Data collection occurred in GP-patient consultations during 2017–2018 across 7 practices in UK during 2017–2018. GPs used various management strategies to address diagnostic uncertainty, including (1) symptom monitoring without treatment, (2) prescribed treatment with symptom monitoring, and (3) addressing risks that could arise from administrative tasks. GPs did not make management plans for potential treatment side effects. Specificity of uncertainty management plans varied among GPs, with only some offering detailed actions and timescales. The transfer of responsibility for the management plan to patients was usually delivered rather than negotiated, with most patients confirming acceptance before concluding the discussion. We offer guidance to healthcare professionals, improving awareness of using and communicating management plans for diagnostic uncertainty.
在现实的初级医疗机构中,如何交流和管理诊断的不确定性?
由于缺乏确定性检查、症状表现多变和疾病演变等因素,处理诊断的不确定性是初级医疗的一大挑战。在检查不确定期间,如何保持患者的信任,同时最大限度地缩小诊断错误的范围是一项挑战。管理不当会导致诊断错误、治疗延误和患者预后不佳。我们的目的是探索英国全科医生(GPs)在实践中如何处理和交流诊断的不确定性。这项定性研究使用了视频和音频记录。逐字记录誊本采用经过修改和验证的工具进行编码,以捕捉全科医生在诊断不确定性的初级保健咨询中的行为和交流。该工具包括与新症状或症状恶化相关的建议项目(有时称为 "安全网")。对视频数据进行了分析,以确定全科医生和患者在实施管理计划期间和之后的身体姿势。所有患者均接受过全科医生的咨询,年龄在 50 岁以上,并且(1)至少有一个新出现的问题或(2)有一个未被诊断的持续性问题。数据收集发生在 2017-2018 年期间英国 7 家诊所的全科医生与患者的会诊中。全科医生采用了各种管理策略来应对诊断的不确定性,包括(1)不进行治疗的症状监测,(2)进行症状监测的处方治疗,以及(3)应对行政任务可能带来的风险。全科医生没有针对潜在的治疗副作用制定管理计划。不确定性管理计划的具体内容因全科医生而异,只有部分全科医生提供了详细的行动和时间表。将管理计划的责任移交给患者的过程通常是交付而非协商,大多数患者会在讨论结束前确认接受。我们为医护人员提供指导,提高他们对使用和交流诊断不确定性管理计划的认识。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Family Practice
BMC Family Practice 医学-医学:内科
CiteScore
3.20
自引率
0.00%
发文量
0
审稿时长
4-8 weeks
期刊介绍: BMC Family Practice is an open access, peer-reviewed journal that considers articles on all aspects of primary health care research. The journal has a special focus on clinical decision making and management, continuing professional education, service utilization, needs and demand, and the organization and delivery of primary care and care in the community.
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