Patient and clinician experiences of uncertainty in the diagnostic process: Current understanding and future directions
Patient and clinician experiences of uncertainty in the diagnostic process: Current understanding and future directions
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DOI：
10.1016/j.pec.2021.07.028
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发表时间：
2021-10-16
影响因子：
3.5
通讯作者：
Singh, Hardeep
中科院分区：
文献类型：
--
作者：
Meyer, Ashley N. D.;Giardina, Traber D.;Singh, Hardeep
目的：不确定性发生在整个诊断过程中，必须加以管理，以促进准确和及时的诊断和治疗。更好地表征不确定性可以为临床实践中更有效地管理它的策略提供信息。我们提供了诊断相关的不确定性描述（1）患者和临床医生在诊断过程中的经验不确定性，（2）不确定性如何影响诊断过程，（3）与概率/风险，模糊性或复杂性相关的不确定性的根源，以及（4）管理不确定性的策略的当前文献的全面概述。讨论内容：每个诊断过程步骤都涉及不确定性，包括患者与医疗保健系统的互动;信息收集、解释和整合;制定工作诊断;以及向患者传达诊断。一般的管理策略包括承认不确定性，从患者那里获得更多的背景信息（例如，收集职业和家族史），创建诊断安全网（例如，告知患者要寻找哪些危险信号），参与最坏情况/最好情况方案规划，并将诊断不确定性传达给患者、家属和同事。还概述了针对诊断不确定性的各个方面的潜在策略。结论：关于诊断不确定性的科学知识，虽然以前难以捉摸，但现在正变得更加明确。下一步包括研究评估诊断不确定性的管理和沟通与改善患者预后之间的关系。由爱思唯尔公司出版
Objective: Uncertainty occurs throughout the diagnostic process and must be managed to facilitate accurate and timely diagnoses and treatments. Better characterization of uncertainty can inform strategies to manage it more effectively in clinical practice. We provide a comprehensive overview of current literature on diagnosis-related uncertainty describing (1) where patients and clinicians experience uncertainty within the diagnostic process, (2) how uncertainty affects the diagnostic process, (3) roots of uncertainty related to probability/risk, ambiguity, or complexity, and (4) strategies to manage uncertainty. Discussion: Each diagnostic process step involves uncertainty, including patient engagement with the healthcare system; information gathering, interpretation, and integration; formulating working diagnoses; and communicating diagnoses to patients. General management strategies include acknowledging un-certainty, obtaining more contextual information from patients (e.g., gathering occupations and family histories), creating diagnostic safety nets (e.g., informing patients what red flags to look for), engaging in worst case/best case scenario planning, and communicating diagnostic uncertainty to patients, families, and colleagues. Potential strategies tailored to various aspects of diagnostic uncertainty are also outlined. Conclusion: Scientific knowledge on diagnostic uncertainty, while previously elusive, is now becoming more clearly defined. Next steps include research to evaluate relationships between management and communication of diagnostic uncertainty and improved patient outcomes. Published by Elsevier B.V.