Johns Hopkins University School of Nursing, Baltimore, MD, USA.
Johns Hopkins Department of Emergency Medicine, Baltimore, MD, USA.
Diagnosis (Berl). 2023 Sep 26;11(1):97-101. doi: 10.1515/dx-2023-0085. eCollection 2024 Feb 1.
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.
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.
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.
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.
对于患者如何感知诊断不确定性，我们知之甚少。我们试图了解在急诊或紧急护理环境中，患者和护理伙伴如何感知不确定性，因为在这种情况下，通常无法做出最终诊断。
我们向一个全国代表性的关于急诊或紧急护理环境中患者报告的诊断卓越性的患者报告面板进行了一项调查。该调查包括与感知诊断卓越性、就诊特征和人口统计学相关的具体项目。我们分析了那些报告在他们得到的解释中存在不确定性的人的两个开放式问题的回答。使用归纳法确定主题，并根据他们是否同意他们得到的解释是真实的来比较主题。
在 1116 名受访者中，有 106 名（10%）报告说，护理团队对他们健康问题的解释不确定。在开放式回答中确定了五个主题：沟通不良（73%）、使不确定性透明（10%）、提供错误信息（9%）、测试设备不足（4%）和无法确定（4%）。在报告不确定性的受访者中，21%（n=22/106）报告他们的问题解释不真实。
这项分析的结果表明，大多数患者及其护理伙伴并不将不确定性等同于对其健康问题的错误解释，而沟通不良是感知不确定性的最常见原因。
