Brun Clémence, Zerhouni Oulmann, Akinyemi Alexis, Houtin Laurène, Monvoisin Richard, Pinsault Nicolas
Université Grenoble Alpes, TIMC-IMAG UMR CNRS 5525, ThEMAS Team, Domaine de la Merci, La Tronche, France.
Laboratoire Parisien de Psychologie Sociale, EA 4386 (équipe PS2C), Nanterre, France.
J Eval Clin Pract. 2023 Apr;29(3):539-553. doi: 10.1111/jep.13756. Epub 2022 Sep 7.
RATIONALE, AIMS AND OBJECTIVES: Clinical reasoning is currently extensively studied to find out how to make proper diagnoses. Literature indicates that intolerance of uncertainty (IU) may have a strong negative impact on clinical reasoning. We summarize the various consequences of IU on clinical reasoning.
A scoping review was conducted using relevant keywords to scientific databases (i.e., Google Scholar, Medline, PsycINFO and PBSC) from September to November 2021. Complementary research included relevant articles and articles retrieved through Google Scholar's alert system. We included articles about healthcare professionals as defined by the French Public Health Code (As defined here: https://www.vie-publique.fr/fiches/37855-categories-de-professionnels-de-sante-code-se-la-sante-publique), and articles reporting on the impact of IU or uncertainty management on clinical reasoning.
We retrieved 1853 articles, of which 8 were kept for final analysis considering our inclusion criteria. Two behaviour categories were affected by uncertainty intolerance: investigative and prescriptive behaviours. Regarding the investigation process, mismanagement of uncertainty appeared to lead to reasoning bias, potentially resulting in diagnostic errors. IU was associated with withholding information, more referrals to peers and less use of new medical interventions. Regarding prescription behaviours, IU among health professionals could lead to overprescribing unnecessary or dangerous tests. IU was also associated with more antibiotic prescriptions for conditions where antibiotics are to be used carefully.
Few studies have yet addressed the impact of IU on clinical reasoning. IU's influence is primarily observed on investigative and prescribing behaviours. More studies are needed to fully understand the impact of IU on clinical reasoning itself, and not only on practical consequences.
原理、目的和目标：目前对临床推理进行了广泛研究，以找出如何做出正确诊断。文献表明，对不确定性的不耐受（IU）可能对临床推理产生强烈的负面影响。我们总结了IU对临床推理的各种后果。
于2021年9月至11月使用相关关键词对科学数据库（即谷歌学术、医学期刊数据库、心理学文摘数据库和护理及相关健康文献累积索引数据库）进行了范围综述。补充研究包括相关文章以及通过谷歌学术警报系统检索到的文章。我们纳入了法国公共卫生法典所定义的医疗保健专业人员相关文章（此处定义：https://www.vie-publique.fr/fiches/37855-categories-de-professionnels-de-sante-code-se-la-sante-publique），以及报告IU或不确定性管理对临床推理影响的文章。
我们检索到1853篇文章，根据纳入标准，最终保留8篇进行分析。两类行为受到不确定性不耐受的影响：调查行为和处方行为。在调查过程中，对不确定性的管理不善似乎会导致推理偏差，可能导致诊断错误。IU与隐瞒信息、更多地向同行咨询以及较少使用新的医疗干预措施有关。在处方行为方面，医疗保健专业人员中的IU可能导致过度开具不必要或危险的检查。IU还与在应谨慎使用抗生素的情况下更多地开具抗生素处方有关。
很少有研究探讨IU对临床推理的影响。IU的影响主要体现在调查和处方行为上。需要更多研究来全面了解IU对临床推理本身的影响，而不仅仅是对实际后果的影响。
