Costa Nathalia, Olson Rebcca, Dillon Miriam, Mescouto Karime, Butler Prudence, Forbes Roma, Setchell Jenny
The University of Queensland's Clinical Trial Capability (ULTRA) Team, Faculty of Health, Medicine and Behavioural Sciences, Brisbane, QLD, Australia.
School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia.
Health (London). 2025 Sep;29(5):609-632. doi: 10.1177/13634593241310383. Epub 2025 Mar 13.
Theoretical and practical guidance on how to navigate uncertainties in healthcare are scarce. Here, we draw from Gibson's ethic of openness to explore clinicians' experiences navigating uncertainty with individuals who experience low back pain (LBP) and provide guidance on avenues for navigating uncertainty in LBP and healthcare more broadly. Our analysis suggests that clinicians practice within different philosophical commitments when providing care for individuals with LBP, with some of them aligning with a (post)positivist approach with pre-determined endpoints and others an ethic of openness, with no fixed endpoints and consideration of multiple options and perspectives. Based on our analysis, an ethic of openness may help to surface these philosophical commitments, creating space for possibilities other than denying uncertainty and oversimplifying (evidence-based) practice. We argue that an ethic of openness may assist clinicians to navigate uncertainty in fruitful ways - embracing uncertainty, engaging in reflexivity and creativity, moving clinicians to directions that are likely to best meet the needs of patients.
关于如何应对医疗保健中的不确定性的理论和实践指导非常匮乏。在此，我们借鉴吉布森的开放伦理，探讨临床医生与腰痛患者共同应对不确定性的经历，并更广泛地为腰痛及医疗保健领域应对不确定性的途径提供指导。我们的分析表明，临床医生在为腰痛患者提供护理时，秉持不同的哲学理念，其中一些人遵循（后）实证主义方法，有预先确定的终点，而另一些人则秉持开放伦理，没有固定终点，会考虑多种选择和观点。基于我们的分析，开放伦理可能有助于揭示这些哲学理念，为除了否认不确定性和过度简化（循证）实践之外的其他可能性创造空间。我们认为，开放伦理可能有助于临床医生以富有成效的方式应对不确定性——接受不确定性，进行反思和创新，引导临床医生朝着最有可能满足患者需求的方向发展。
