How do patients and care partners describe diagnostic uncertainty in an emergency department or urgent care setting?

Athena P. DeGennaro; Natalia Gonzalez; Susan Peterson; Kelly T. Gleason

doi:10.1515/dx-2023-0085

Article

How do patients and care partners describe diagnostic uncertainty in an emergency department or urgent care setting?

Athena P. DeGennaro , Natalia Gonzalez , Susan Peterson and Kelly T. Gleason

Published/Copyright: September 26, 2023

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From the journal Diagnosis Volume 11 Issue 1

Abstract

Objectives

Little is known about how patients perceive diagnostic uncertainty. We sought to understand how patients and care partners perceive uncertainty in an emergency or urgent care setting, where making a final diagnosis is often not possible.

Methods

We administered a survey to a nationally representative panel on patient-reported diagnostic excellence in an emergency department or urgent care setting. The survey included items specific to perceived diagnostic excellence, visit characteristics, and demographics. We analyzed responses to two open-ended questions among those who reported uncertainty in the explanation they were given. Themes were identified using an inductive approach, and compared by whether respondents agreed or disagreed the explanation they were given was true.

Results

Of the 1,116 respondents, 106 (10 %) reported that the care team was not certain in the explanation of their health problem. Five themes were identified in the open-ended responses: poor communication (73 %), uncertainty made transparent (10 %), incorrect information provided (9 %), inadequate testing equipment (4 %), and unable to determine (4 %). Of the respondents who reported uncertainty, 21 % (n=22/106) reported the explanation of their problem given was not true.

Conclusions

The findings of this analysis suggest that the majority of patients and their care partners do not equate uncertainty with a wrong explanation of their health problem, and that poor communication was the most commonly cited reason for perceived uncertainty.

Keywords: diagnostic quality; uncertainty; patient communication; emergency department

Corresponding author: Kelly T. Gleason, PhD, RN, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21225, USA, Phone: 708 334 4876, E-mail: kgleaso2@jhmi.edu

Funding source: Gordon and Betty Moore Foundation

Award Identifier / Grant number: 9904

Acknowledgments

The authorship team wishes to acknowledge Drs. Vadim Dukhanin and Kathryn M. McDonald for their role in PRIME-ED instrument development.

Research ethics: The research related to human subjects has complied with all the relevant national regulations, institutional policies, and in accordance with the tenets of the Helsinki Declaration, and has been approved by the Johns Hopkins Medicine IRB, IRB00228732.
Informed consent: Informed consent was obtained from all individuals included in this study.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Research funding: This work was supported by the Gordon and Betty Moore Foundation under grant #9904 (Development of a Patient-Reported Measure Set of Diagnostic Excellence). The funders did not have a role in the research design, implementation, interpretation, or writing or submitting the report.

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Received: 2023-07-11

Accepted: 2023-09-04

Published Online: 2023-09-26

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Articles in the same Issue

https://doi.org/10.1515/dx-2023-0085

Keywords for this article

diagnostic quality; uncertainty; patient communication; emergency department