Direct statement of uncertainty harms patient-provider relationship

Explaining diagnostic uncertainty directly to patients results in lower perceived trust and adherence to physician advice, according to a study published in the International Journal for Quality in Health Care.

How to communicate with patients when a diagnosis is uncertain is often explained in clinical guidelines, but exactly how that uncertainty is communicated affects patients is up for debate. In this study, researchers examined three types of communicating diagnostic uncertainty to provide insight into how physicians can improve satisfaction, adherence and trust.

"Misdiagnosis is common in medical practice and to enable improvements, uncertainty of diagnosis is something both doctors and patients will need to embrace" said Hardeep Singh, MD, MPH, senior author and researcher at the Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety and Baylor College of Medicine. "Our study provides a foundation for future development of evidence-based guidance on how doctors can best communicate diagnostic uncertainty to patients to improve diagnosis and care outcomes."

In all, 71 parents of pediatric patients were split into groups who were hypothetically received a uncertain diagnosis. Participants received their messages in three ways: with a direct expression of uncertainty, an implicit expression of uncertainty or an implicit expression with a broad explanation of possible diagnoses. Data was collected with the completion of a 37-question survey.

Results showed direct expressions of uncertainty lead to a lower perception of physician’s technical skill, trust and patient adherence when compared to implicit communication.

“Parents may react less negatively in terms of perceived competence, physician confidence and trust, and intention to adhere when diagnostic uncertainty is communicated using implicit strategies, such as using broad differential diagnoses or most likely diagnoses,” wrote Singh and colleagues. “Evidence-based strategies to communicate diagnostic uncertainty to patients need further development.”