Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Wichita, KS, USA.
Clin Neuropsychol. 2021 Aug;35(6):1134-1153. doi: 10.1080/13854046.2020.1722243. Epub 2020 Feb 7.
Providing feedback to clinical patients who produce invalid neuropsychological test data presents with several potential challenges. Given the limited guidance available on the topic, neuropsychologists most likely utilize approaches that idiosyncratically incorporate professional values related to both assessment and patient care to address overarching feedback goals. The current article discusses professional values believed to inform feedback decisions and presents survey results regarding how neuropsychologists would approach feedback across various clinical scenarios where testing is invalid.
Participants were 209 adult-focused clinical neuropsychologists recruited via professional listservs, the majority of whom reported being board certified. Respondents were provided three case vignettes of clinical patients who produced invalid test data and were asked how they would provide feedback to each patient. Open-ended responses were coded to determine the relative frequency of feedback approaches, explicit statements, and implied goals.
Nearly all respondents (98%) indicated that feedback would include some description of the invalid findings, and most respondents indicated that they would provide explanations for the reasons of invalidity (67%) and statements regarding the impact of invalidity on test interpretation (75%). There was little agreement across respondents, however, regarding specific feedback approach. Feedback goals included to Inform, Investigate, Treat, Educate, and Correct, with the presence of these implied goals also varying across respondents.
The findings indicate that there is minimal consensus regarding feedback approaches provided to patients who produce invalid test data and underscore a need for further development and validation of specific feedback methods. The results are discussed within the context of the potentially competing professional values of evidence-based assessment, patient-doctor collaboration, and aspirational principles of beneficence and fidelity.
为产生无效神经心理学测试数据的临床患者提供反馈存在一些潜在挑战。鉴于该主题可用的指导有限，神经心理学家可能最倾向于使用独特的方法，将与评估和患者护理相关的专业价值观纳入其中，以实现总体反馈目标。本文讨论了据信能为反馈决策提供信息的专业价值观，并介绍了有关神经心理学家在各种测试无效的临床情况下如何进行反馈的调查结果。
通过专业名录，招募了 209 名专注于成人的临床神经心理学家作为参与者，他们中的大多数人报告说已经获得了委员会认证。向受访者提供了三个产生无效测试数据的临床患者的案例简述，并要求他们如何为每位患者提供反馈。对开放式回答进行编码，以确定反馈方法、明确陈述和隐含目标的相对频率。
几乎所有的受访者（98%）都表示反馈将包括对无效发现的一些描述，大多数受访者表示他们将为无效的原因提供解释（67%），并对无效对测试解释的影响做出说明（75%）。然而，受访者之间几乎没有达成关于具体反馈方法的共识。反馈目标包括告知、调查、治疗、教育和纠正，这些隐含目标的存在也因受访者而异。
研究结果表明，对于提供给产生无效测试数据的患者的反馈方法几乎没有共识，并强调需要进一步开发和验证特定的反馈方法。结果在基于证据的评估、医患合作以及有利和忠实的理想原则等潜在竞争的专业价值观背景下进行了讨论。
