红斑狼疮的误诊、漏诊和延迟诊断:对风湿免疫科医生的定性研究。

IF 3.7 2区 医学 Q1 RHEUMATOLOGY
Shalmali Bane, Titilola Falasinnu, Patricia Rodriguez Espinosa, Julia F. Simard
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引用次数: 0

摘要

目的:门诊中的诊断错误会导致严重后果,尤其是对系统性红斑狼疮(SLE)等罕见疾病。最近一项基于小故事的实验研究显示,人口统计学因素影响了风湿免疫科医生对系统性红斑狼疮的诊断,从而引发了对潜在诊断偏差的担忧。我们进行了一项定性研究,对这些结果进行了背景分析,以深入了解诊断方面的挑战和偏差,以及其根本原因:我们对美国风湿病学家进行了 41 次半结构式访谈。采用演绎-归纳混合法和主题分析法,由至少两名编码员对访谈记录进行独立编码。由四名研究人员组成的小组集体审查并确定主题,同时解决任何差异:结果:66%的参与者为女性,49%的参与者拥有超过 10 年的研究员职位经验。共产生了五大主题,包括从种族或性别的角度接受培训、系统性红斑狼疮流行病学文献的作用、模式识别和应试策略、病例小故事作为患者互动的不完全替代物,以及诊断偏见给患者带来的各种后果。与会者指出,诊断偏差的后果可能包括因延误诊断而导致病情恶化、因漏诊或误诊而导致不必要和不恰当的治疗,以及增加费用和伤害:这项研究强调了诊断系统性红斑狼疮的独特挑战,造成诊断偏差和延误的因素非常复杂。医学教育中的干预措施可以防止下游的诊断偏差。未来的研究应探索减轻诊断偏倚的干预措施,并改进小故事以更好地反映真实世界的临床场景。了解系统性红斑狼疮的诊断偏倚对于改善患者预后和改进医学培训实践至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Misdiagnosis, Missed Diagnosis, and Delayed Diagnosis of Lupus: A Qualitative Study of Rheumatologists

Misdiagnosis, Missed Diagnosis, and Delayed Diagnosis of Lupus: A Qualitative Study of Rheumatologists

Misdiagnosis, Missed Diagnosis, and Delayed Diagnosis of Lupus: A Qualitative Study of Rheumatologists

Objective

Diagnostic errors in outpatient settings lead to significant consequences, especially in rare diseases such as systemic lupus erythematosus (SLE). A recent vignette-based experimental study revealed that demographic factors influenced rheumatologists’ diagnoses of SLE, raising concerns about potential diagnostic biases. We conducted a qualitative study to contextualize these results to generate insights about diagnostic challenges and biases, and root causes.

Methods

We conducted 41 semistructured interviews among US rheumatologists. Transcripts were independently coded by at least two coders using a hybrid deductive–inductive approach and thematic analysis. A team of four researchers reviewed and defined themes collectively, and also resolved any discrepancies.

Results

Participants were 66% women, and 49% had more than10 years of postfellowship experience. Five major themes were generated, including receiving training through the lens of race or sex, the role of the documented epidemiology of SLE, pattern recognition and test-taking strategies, patient vignettes as an imperfect proxy for patient interactions, and varied consequences to patients from diagnostic bias. Participants noted that the consequences of diagnostic bias could include progressed disease from delayed diagnosis, unnecessary and inappropriate treatment due to missed diagnosis or misdiagnosis, and increased cost and harm.

Conclusion

This study underscores the unique challenges of diagnosing SLE, with complex factors contributing to diagnosis bias and delays. Interventions during medical education could prevent downstream diagnostic biases. Future research should explore interventions to mitigate diagnostic bias and refine vignettes to better mirror real-world clinical scenarios. Understanding diagnostic bias in SLE is crucial for improving patient outcomes and refining medical training practices.

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来源期刊
CiteScore
9.40
自引率
6.40%
发文量
368
审稿时长
3-6 weeks
期刊介绍: Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals (a division of the College), is a peer-reviewed publication that publishes original research, review articles, and editorials that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with rheumatic diseases, major topics are evidence-based practice studies, clinical problems, practice guidelines, educational, social, and public health issues, health economics, health care policy, and future trends in rheumatology practice.
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