Abstract
Objective
Blood tests are commonly used in primary care as a tool to aid diagnosis, and to offer reassurance and validation for patients. If doctors and patients do not have a shared understanding of the reasons for testing and the meaning of results these aims may not be fulfilled. Shared decision-making is widely advocated, yet most research focuses on treatment decisions rather than diagnostic decisions. The aim of this study was to explore to explore communication and decision making around diagnostic blood tests in primary care.
Methods
Qualitative interviews with patients and clinicians in UK primary care were undertaken. Patients were interviewed at the time of blood testing, with a follow-up interview after they received test results. Interviews with clinicians who requested the tests provided paired data to compare clinicians’ and patients’ expectations, experiences and understandings of tests. Interviews were analysed thematically using inductive and deductive coding.
Results
80 interviews with 28 patients and 19 doctors were completed. We identified a mismatch in expectations and understanding of tests, which led to downstream consequences including frustration, anxiety and uncertainty for patients. There was no evidence of shared decision-making in consultations preceding the decision to test. Doctors adopted a paternalistic approach, believing they were protecting patients from anxiety.
Conclusion
Patients were not able to develop informed preferences and did not perceive that choice is possible in decisions about testing, because they did not sufficient information and a shared understanding of tests. A lack of shared understanding at the point of decision-making led to downstream consequences when test results did not fulfil patients’ expectations. Although shared decision-making is recommended as best practice, it does not reflect the reality of doctors’ and patients’ accounts of testing; a broader model of shared understanding seems to be more relevant to the complexity of primary care diagnosis.
Blood tests are commonly used in primary care as a tool to aid diagnosis, and to offer reassurance and validation for patients. If doctors and patients do not have a shared understanding of the reasons for testing and the meaning of results these aims may not be fulfilled. Shared decision-making is widely advocated, yet most research focuses on treatment decisions rather than diagnostic decisions. The aim of this study was to explore to explore communication and decision making around diagnostic blood tests in primary care.
Methods
Qualitative interviews with patients and clinicians in UK primary care were undertaken. Patients were interviewed at the time of blood testing, with a follow-up interview after they received test results. Interviews with clinicians who requested the tests provided paired data to compare clinicians’ and patients’ expectations, experiences and understandings of tests. Interviews were analysed thematically using inductive and deductive coding.
Results
80 interviews with 28 patients and 19 doctors were completed. We identified a mismatch in expectations and understanding of tests, which led to downstream consequences including frustration, anxiety and uncertainty for patients. There was no evidence of shared decision-making in consultations preceding the decision to test. Doctors adopted a paternalistic approach, believing they were protecting patients from anxiety.
Conclusion
Patients were not able to develop informed preferences and did not perceive that choice is possible in decisions about testing, because they did not sufficient information and a shared understanding of tests. A lack of shared understanding at the point of decision-making led to downstream consequences when test results did not fulfil patients’ expectations. Although shared decision-making is recommended as best practice, it does not reflect the reality of doctors’ and patients’ accounts of testing; a broader model of shared understanding seems to be more relevant to the complexity of primary care diagnosis.
| Original language | English |
|---|---|
| Pages (from-to) | 2453-2461 |
| Number of pages | 9 |
| Journal | Health Expectations |
| Volume | 25 |
| Issue number | 5 |
| Early online date | 19 Jul 2022 |
| DOIs | |
| Publication status | Published - 29 Oct 2022 |
Bibliographical note
Funding Information:The authors would like to thank all the patients and general practitioners who participated in this study and the patient and public participation group who contributed to the conceptualization, methodology and analysis of the study. This study was funded by JW's National Institute for Health Research (NIHR) Doctoral Research Fellowship (NIHR‐DRF‐2016‐09‐034). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Jonathan Banks and Chris Salisbury are supported by the National Institute for Health Research Applied Research Collaboration West (NIHR ARC West).
Publisher Copyright:
© 2022 The Authors. Health Expectations published by John Wiley & Sons Ltd.