Table 2 Traits, strategies and skills influencing and impacting on managing uncertainty: Qualitative studies

Griffiths 2005

UK [13]

Qualitative study

Hormone replacement therapy, bone densitometry and breast screening/Practice nurses, general practitioners, consultants, specialist registrars, specialist nurse, radiographer

7 general practices, 3 secondary care clinics (n = 25)

Constant comparative analysis of audio recorded transcripts

Strategies health professionals use

Utilizing safety netting techniques (C)

Communicating uncertainty to patients (Eth)

Accepting uncertainty (E)

Three key strategies were identified: 1) Focus on certainty for now and this test; 2) providing a coherent account of the medical evidence for the risks and benefits (blurring the uncertainty); and 3) acknowledging inherent uncertainty of medical evidence and negotiating a provisional decision.

Hewson 1996

USA [32]

Process evaluation

Primary and secondary care/a range of clinical experiences (1st year residents to faculty physicians)

Primary and secondary care. 10 tapes of 9 physicians interacting with 4 standardized patient cases in phase one. 19 faculty physicians rating the strategies in phase two.

Clinicians reasoning and strategic medical management was rated using the “Medical checklist, Clinical Reasoning Skills Rating Scale, Interpersonal Skills Rating Scale & Strategic Medical Management Checklist”.

Identification and frequency of strategies used by clinicians when faced with uncertainty

Behaviour patterns when clinicians are faced with diagnostic uncertainty (C)

Patient communication and involvement with uncertainty (Eth).

Nine important strategies were identified: 1) defining the context of diagnosis and explaining symptoms; 2) eliminating alternative diagnoses; 3) describing the prognosis; 4) negotiating problems; 5) negotiating the plan of action; 6) keeping diagnostic options open; 7) cautious not to miss potential diagnoses; 8) appropriate time limited safety netting and 9) appropriate contingency planning.

Seaburn 2005

USA [33]

Observational study with 2 unannounced SP visits (thematic analysis)

Family practice / internists and family physicians

Community based primary care in a metropolitan area (n = 23); n = 46 interviews (the application of 7 codes from thematic analyses led to potentially >46 types of responses).

NA

NA

Greater knowledge about patient’s life circumstances (C) Physician responses to ambiguous symptom presentations by patients (Eth)

Primary care physicians respond to ambiguity by either ignoring the ambiguity and becoming more directive (UC) or, less often, by acknowledging the ambiguity and attempting to explore symptoms and patient concerns in more detail (HP).

Sommers 2007

USA [34]

Intervention evaluation-thematic and frequency analysis

Primary care physicians/NS

Primary care (n = 14 practice sites, 98 clinicians with 118 patient cases)

Practice-based learning in small groups

Intervention “Practice Inquiry”

Not knowing enough about the patient and managing clinician-patient boundaries, expectations and trust (C + Eth)

Using gut feelings (E)

Of the 30 sites approached between 2002 and 2005, 14 held introductory meetings and by summer 2006, 98 clinicians from 11 sites continued to hold regular Practice Inquiry group meetings suggesting the feasibility and acceptability of the intervention to clinicians.