Improving communication of diagnostic uncertainty to families of hospitalized children

Eleanor E. Young; Joelle Kane; Kristen Timmons; Jodi Kelley; Philip A. Hagedorn; Patrick W. Brady; Trisha L. Marshall

doi:10.1515/dx-2023-0088

Article

Improving communication of diagnostic uncertainty to families of hospitalized children

Eleanor E. Young , Joelle Kane , Kristen Timmons , Jodi Kelley , Philip A. Hagedorn , Patrick W. Brady and Trisha L. Marshall

Published/Copyright: October 26, 2023

Published by

Become an author with De Gruyter Brill

Submit Manuscript Author Information Explore this Subject

From the journal Diagnosis Volume 11 Issue 2

Abstract

Objectives

Diagnostic uncertainty is not reliably communicated to patients and caregivers. This study aims to identify barriers and facilitators to effective communication of diagnostic uncertainty, including development of potential tools and strategies for improvement, as perceived by healthcare professionals and caregivers.

Methods

We completed structured interviews with providers and caregivers of hospitalized children with uncertain diagnoses (UD). The interview guides addressed barriers to communication, key components for communication of uncertainty, and qualities of effective communication. The interviews concluded with respondents prioritizing potential interventions to improve communication of uncertainty. Interviews were audio recorded, transcribed, and independently analyzed by two team members to identify common themes.

Results

Ten provider and five caregiver interviews were conducted. Common barriers to communication of uncertainty included time constraints, language barriers, and lack of clear definition of UD. Caregiver suggestions for improvement included sharing expectations of the diagnostic process and use of both written and visual communication tools. Interview respondents favored interventions of a sign summarizing the key components of diagnostic uncertainty for display in patient rooms and a structured diagnostic pause during daily rounds.

Conclusions

We identified several potential interventions that may enhance communication of diagnostic uncertainty and better engage patients and caregivers in the diagnostic process.

Keywords: diagnostic uncertainty; effective communication; diagnostic error; patient safety; pediatrics

Corresponding author: Eleanor E. Young, MD, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA, Phone: +(513) 344-7192, E-mail: eleanor.young@cchmc.org

Funding source: DxQI Seed Grant Program, Society to Improve Diagnosis in Medicine in conjunction with the Gordon and Betty Moore Foundation.

Acknowledgments

This work was funded by the Society to Improve Diagnosis in Medicine in conjunction with the Moore Foundation.

Research ethics: Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013), and has been approved by the authors’ Institutional Review Board (IRB00000231).
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: The authors state no conflict of interest.
Research funding: Funding was attained by receipt of the DxQI grant through the Society to Improve Diagnosis in Medicine.

References

1. Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: a new health system for the 21st century. Washington, DC: National Academy Press (US); 2001.Search in Google Scholar

2. Committee on Diagnostic Error in Health Care; Board on Health Care Services; Institute of Medicine; The National Academies of Sciences, Engineering, and Medicine. Improving diagnosis in health care. In: Balough, EP, Miller, BT, Ball, JR, editors. Improving diagnosis in health care. Washington (DC): National Academies Press (US); 2015.Search in Google Scholar

3. Ha, JF, Longnecker, N. Doctor-patient communication: a review. Ochsner J 2010;10:38–43.Search in Google Scholar

4. Dingley, C, Daugherty, K, Derieg, MK, Persing, R. Improving patient safety through provider communication strategy enhancements. In: Henriksen, K, Battles, JB, Keyes, MA, Grady, ML, editors. Advances in patient safety: new directions and alternative approaches (vol. 3: performance and tools). Rockville (MD): Agency for Healthcare Research and Quality (US); 2008.Search in Google Scholar

5. Bhise, V, Meyer, AND, Menon, S, Singhal, G, Street, RL, Giardina, TD, et al.. Patient perspectives on how physicians communicate diagnostic uncertainty: an experimental vignette study. Int J Qual Health Care 2018;30:2–8. https://doi.org/10.1093/intqhc/mzx170.Search in Google Scholar PubMed

6. Bhise, V, Rajan, SS, Sittig, DF, Morgan, RO, Chaudhary, P, Singh, H. Defining and measuring diagnostic uncertainty in medicine: a systematic review. J Gen Intern Med 2018;33:103–15. https://doi.org/10.1007/s11606-017-4164-1.Search in Google Scholar PubMed PubMed Central

7. Dahm, MR, Crock, C. Understanding and communicating uncertainty in achieving diagnostic excellence. JAMA 2022;327:1127–8. https://doi.org/10.1001/jama.2022.2141.Search in Google Scholar PubMed

8. Simpkin, A, Armstrong, K. Communicating uncertainty: a narrative review and framework for future research. J Gen Intern Med 2019;34:2586–259. https://doi.org/10.1007/s11606-019-04860-8.Search in Google Scholar PubMed PubMed Central

9. Meyer, AND, Giardina, TD, Khanna, A, Bhise, V, Singhal, GR, Street, RL, et al.. Pediatric clinician perspectives on communicating diagnostic uncertainty. Int J Qual Health Care 2019;31:G107–12. https://doi.org/10.1093/intqhc/mzz061.Search in Google Scholar PubMed

10. Meyer, AND, Giardina, TD, Khawaja, L, Singh, H. Patient and clinician experiences of uncertainty in the diagnostic process: current understanding and future directions. Patient Educ Counsel 2021;104:2606–15. https://doi.org/10.1016/j.pec.2021.07.028.Search in Google Scholar PubMed

11. Gheihman, G, Johnson, M, Simpkin, A. Twelve tips for thriving in the face of clinical uncertainty. Med Teach 2020;42:493–9. https://doi.org/10.1080/0142159x.2019.1579308.Search in Google Scholar

12. Ipsaro, A, Patel, S, Warner, D, Marshall, TL, Chan, ST, Rohrmeier, K, et al.. Declaring uncertainty: using quality improvement methods to change the conversation of diagnosis. Hosp Pediatr 2021;11:334–41. https://doi.org/10.1542/hpeds.2020-000174.Search in Google Scholar PubMed

13. Rising, K, Powell, R, Cameron, K, Salzman, DH, Papanagnou, D, Doty, AMB, et al.. Development of the uncertainty communication checklist: a patient-centered approach to patient discharge from the emergency department. Acad Med 2020;95:1026–34. https://doi.org/10.1097/acm.0000000000003231.Search in Google Scholar PubMed PubMed Central

14. Khazen, M, Mirica, M, Carlile, N, Groisser, A, Schiff, GD. Developing a framework and electronic tool for communicating diagnostic uncertainty in primary care: a qualitative study. JAMA Netw Open 2023;6:e232218. https://doi.org/10.1001/jamanetworkopen.2023.2218.Search in Google Scholar PubMed PubMed Central

Received: 2023-07-12

Accepted: 2023-10-03

Published Online: 2023-10-26

You are currently not able to access this content.

Articles in the same Issue

https://doi.org/10.1515/dx-2023-0088

Keywords for this article

diagnostic uncertainty; effective communication; diagnostic error; patient safety; pediatrics