Decision-Making under Uncertain Conditions: The Internist, as a Director of the Diagnostic/Therapeutic Pathway in Grey Zones

Tirotta, Daniela; Durante, Vittorio

doi:10.31021/ijcmc.20181101

Cited by 2 publications

(2 citation statements)

References 12 publications

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“…Similarly, Tirotta and Durante pointed to the extensive literatures as a cause of diagnostic uncertainty. [ 28 ] Therefore, the need for reliable studies, and accurate and calculated information is essential to increase medical knowledge and improve the provision of health services. However, there are limitations to the information available in terms of quality, reliability, and usability that lead to uncertainty.…”

Section: Discussionmentioning

confidence: 99%

A qualitative approach to identify clinical uncertainty in practicing physicians and clinical residents

Arabshahi

Bigdeli

Baradaran

et al. 2022

Journal of Education and Health Promotion

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BACKGROUND: Clinical decision-making is not only stressful to physicians, but also to patients and even their companions. Thus, managing uncertainty in clinical decision-making is essential which requires knowing its origins. Therefore, this study aimed to understand determinants of uncertainty in clinical decision-making from the perspective of clinical physicians. MATERIALS AND METHODS: This is a qualitative study which is done during October to November 2020. An in-depth interview is performed with 24 specialists of clinical groups including obstetrics, surgery, internal medicine, and pediatrics, working in teaching hospitals affiliated to Iran University of Medical Sciences. All the interviews were recorded, transcribed and analyzed according to the steps suggested by Graneheim and Lundman. The interviews were analyzed through comparative method. Then, the interviewer created initial codes, categories, and key concepts and sent them to fourteen physicians for member check. RESULTS: According to the participants’ view, determinants of uncertainty in clinical decision-making consisted of three themes: individual determinants, dynamics of medical sciences, and diagnostic and instrumental constraint. Individual determinants can be related to the physician or patient. The dynamics of medical sciences could be explained in two categories: variation of medical science and complexity. Diagnostic and instrumental constraint category could be also explained in subcategories such as lack of efficient diagnostic tests and unknown etiology. CONCLUSION: To curb uncertainty, the more accessible way is considering interventional programs with a focus on individual determinants related to physicians, such as strengthening doctor–patient relationships, and considering related mandatory retraining courses to reduce insufficient knowledge of physicians.

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Section: Discussionmentioning

confidence: 99%

A qualitative approach to identify clinical uncertainty in practicing physicians and clinical residents

Arabshahi

Bigdeli

Baradaran

et al. 2022

Journal of Education and Health Promotion

View full text Add to dashboard Cite

show abstract

“…At first, the literature was reviewed based on to derive raw items [ 5 , 6 , 12 , 18 , 19 ]. A systematized review of research papers relating to the reliability and validity of uncertainty in clinical decision-making questionnaires and its dimensions was conducted throughout 2019 to 2020.…”

Section: Methodsmentioning

confidence: 99%

Developing and validating of the Clinical Uncertainty Measurement Questionnaire (CUMQ) among practicing physicians and clinical residents in Iran

et al. 2022

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Background Despite the fact that clinicians face uncertainty in their decisions, there is no comprehensive framework to measure it in medical practices which is the knowledge gap especially for Iran. Therefore, this study aimed to evaluate the reliability and validity of a Persian questionnaire which is designed to measure different determining aspects of uncertainty from clinical physicians’ perspectives in Iran. Methods Clinical Uncertainty Measurement Questionnaire (CUMQ) has been derived from a mixed method study since March 2019 to January 2021. To exclude raw items of the questionnaire, the literature was reviewed and in-depthinterviews were implemented with 24 residents,specialists and sub-specialists in all major clinical fields which resulted in the first theoretical uncertainty in clinical decision making framework. CUMQ content validity has been evaluated using content validity index (CVI) and content validity ratio (CVR). The structural validity of the questionnaire was assessed using confirmatory factor analysis and factor loading and t-value for each indicator of uncertainty is reported. Moreover, to analyze the research model we used the Partial Least Squares (PLS) technique using the SmartPLS software. Convergent (using Average Variance Extracted (AVEs) for each latent variable) and discriminant validity (using the criteria of Fornell and Larckerand cross loading) of the model was also evaluated. After that, the quality of the model was evaluated adjustment through predictive validity (Q2) and effect size (f2). In addition, the reliability was also assessed using Cronbach’s alpha and composite reliability. Results The CVR and CVI ranged from 0. 80 to 1. 00 which illustrates high content validity. Out of 30 items, 24 items had acceptable factor loading and remained in the questionnaire which have been categorized as five main clinical uncertainty dimensions; general determinants, individual determinants of the physician, individual determinants of patient, dynamics of medical sciences, diagnostic and instrumental limitations. The value of composite reliability and Cronbach’s alpha for all dimensions were above the threshold value of 0. 7 and the reliability has been confirmed. As AVE values were greater than 0. 5, convergent validity is confirmed. The result of Fornell-Larcker and cross-loadings also indicated that discriminant validity is well established. Conclusion This CUMQ is as avalid and reliable instrument and a suitable tool to measure clinical uncertainty in the Iranian Medical community. However, the reliability of this questionnaire can be studied in other languages and in other countries.

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Decision-Making under Uncertain Conditions: The Internist, as a Director of the Diagnostic/Therapeutic Pathway in Grey Zones

Cited by 2 publications

References 12 publications

A qualitative approach to identify clinical uncertainty in practicing physicians and clinical residents

A qualitative approach to identify clinical uncertainty in practicing physicians and clinical residents

Developing and validating of the Clinical Uncertainty Measurement Questionnaire (CUMQ) among practicing physicians and clinical residents in Iran

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