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- W2897049965 abstract "Increased knowledge and diagnostic developments enable earlier diagnosis of Alzheimer's disease and dementia. Patients and caregivers could benefit from an early diagnosis because it may reduce their uncertainty around the nature of their symptoms. However, diagnostic testing frequently yields uncertainty, instead of reducing it. How uncertainty is addressed in diagnostic consultations can affect treatment decisions and patients’ expectations and satisfaction. We investigated to which extent and how clinicians communicate uncertainty when disclosing test results. We audiotaped clinician-patient encounters in an unselected sample of 78 new patients from eight Dutch memory clinics. In the post-diagnostic testing consultations, all segments in which clinicians expressed uncertainty were identified and transcribed verbatim. Qualitative content analysis was used to double code these segments using MAXQDA software. For each segment, the source and the topic of the uncertainty were determined. Quantitatively, we tested for differences in the amount of uncertainty expressions based on diagnostic certainty (no dementia vs no clear diagnosis vs clear diagnosis). 78 post-diagnostic testing consultations were audiotaped, involving 46 male and 32 female patients (mean age=71 (SD=11); mean MMSE-score=25 (SD=4)) and 22 clinicians (15 neurologists and 7 geriatricians). Clinicians discussed uncertainty in 57 (73%) of these consultations. How often uncertainty was expressed (mean=1.6, range 0-7) did not depend on diagnostic certainty (p= .624). Two main sources of uncertainty were identified. Uncertainty caused by probability refers to an inability to predict the future, and mostly pertained to the risk of developing dementia, or the inability to predict the course the disease. Uncertainty caused by ambiguity refers to the incompleteness, inadequacy, or unreliability of information, and related mostly to clinicians’ inability to generate a definite diagnosis based on the current test results. Clinicians often express uncertainties when disclosing test results to patients and caregivers, remarkably, even when the (dementia) diagnosis is certain. Apparently, diagnostic testing within the context of dementia does not necessarily reduce uncertainty. Patients should be informed beforehand that diagnostic testing might not lead to certainty in order to manage their expectations. Moreover, future research should investigate if and how clinicians’ discussion about uncertainty affects patient/caregiver outcomes." @default.
- W2897049965 created "2018-10-26" @default.
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- W2897049965 date "2018-07-01" @default.
- W2897049965 modified "2023-09-26" @default.
- W2897049965 title "P2‐352: COMMUNICATING UNCERTAINTY WHEN DISCLOSING DIAGNOSTIC TEST RESULT: THE ABIDE‐CLINICAL ENCOUNTER STUDY" @default.
- W2897049965 doi "https://doi.org/10.1016/j.jalz.2018.06.1043" @default.
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