Neville Alexandra, Clemente Ignasi, Meldrum Marcia L, Zeltzer Lonnie, Jordan Abbie, Oberlander Tim F, Watson Katelyn, Daly-Cyr Jennifer, Noel Melanie
Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States.
Department of Anthropology, Hunter College, City University of New York, New York, NY, United States.
J Pain. 2025 Jul;32:105406. doi: 10.1016/j.jpain.2025.105406. Epub 2025 Apr 25.
Approximately one third of youth with chronic primary pain receiving care in a tertiary care pediatric pain setting, and their parents, report diagnostic uncertainty, which is associated with poorer child pain outcomes and is intricately tied to clinical communication along the pain care journey. This study utilized archived data (collected 2003-2006) to explore components of the clinical encounter that influence diagnostic uncertainty among youth with chronic pain and their parents. Twenty-three youth with chronic primary pain and at least one of their parents who presented for an initial visit at a tertiary pediatric pain clinic participated. Initial clinic intake visits were audio and video recorded, and youth and parents participated in semi-structured interviews prior to, and several months following, their intake appointment. Transcripts of clinical encounters and pre- and post-interviews were analyzed using interpretative phenomenological analysis. Analyses generated four themes: 1) Diagnostic uncertainty is a social phenomenon critically shaped in clinical encounters; 2) (In)validation of pain, the journey, and diagnostic uncertainty; 3) The (missing) link between origin story & pain explanation; and 4) The fragility of certainty. These themes illustrate that youth's and parents' experiences of diagnostic uncertainty are complex, dynamic, and shaped within clinical encounters. The actions taken and explanations provided by clinicians in the clinical encounter can heighten or lower diagnostic uncertainty. Clinician communication, including (in)validation, messages of (un)certainty, elicitation of youth's and parents' pain origin stories and their connection to a pain explanation, influence diagnostic uncertainty and could be targets for assessment, training, and intervention.
在三级儿科疼痛治疗机构接受治疗的患有慢性原发性疼痛的青少年及其父母中，约三分之一报告存在诊断不确定性，这与儿童较差的疼痛治疗结果相关，并且在疼痛治疗过程中与临床沟通密切相关。本研究利用存档数据（收集于2003年至2006年）来探究临床问诊中影响慢性疼痛青少年及其父母诊断不确定性的因素。23名患有慢性原发性疼痛的青少年及其至少一位父母参加了在一家三级儿科疼痛诊所的首次就诊。首次诊所接诊进行了音频和视频记录，青少年及其父母在接诊预约之前以及预约后的几个月参与了半结构化访谈。使用解释现象学分析方法对临床问诊记录以及访谈前后的内容进行了分析。分析得出了四个主题：1）诊断不确定性是一种在临床问诊中受到严重影响的社会现象；2）对疼痛、病程及诊断不确定性的（不）认可；3）病因故事与疼痛解释之间的（缺失）联系；4）确定性的脆弱性。这些主题表明，青少年及其父母对诊断不确定性的体验是复杂、动态的，且是在临床问诊中形成的。临床医生在临床问诊中采取的行动和给出的解释会增加或降低诊断不确定性。临床医生的沟通，包括（不）认可、（不）确定性信息、引出青少年及其父母的疼痛病因故事以及它们与疼痛解释之间的联系，会影响诊断不确定性，并且可能成为评估、培训及干预的目标。
