[2096] Communicating Diagnostic Uncertainty in Surgical Pathology Reports: Disparities between Sender and Receiver

Sarah W Lindley, Lewis A Hassell, Elizabeth M Gillies. University of Oklahoma, Health Sciences Center, Oklahoma City, OK

Background: Conveying diagnostic uncertainty in surgical pathology is a daily practice however there is no standardized wording for communication of uncertainty to clinicians.
Design: Attendees at multi-disciplinary tumor boards completed an anonymous survey that asked them to estimate the degree of certainty associated with eight diagnoses. One diagnosis contained no expression of uncertainty while the other seven contained the following phrases: cannot rule out; consistent with; highly suspicious; favor; indefinite for; suggestive of; and worrisome for. A total of 57 responses were received.
Results: For analysis the respondents were divided into the following groups: medical students, residents, fellows, attendings, medicine/medical subspecialties, pathologists/radiologists, and surgeons. The variations in the level of perceived certainty is quantified by the standard deviations from the means (table 1) and shown graphically (Figure 1).

Table 1: Standard deviations for the degree of certainty associated with phrases.

	Medical Students	Residents	Fellows	Attendings	Medicine	Pathologists/Radiologists	Surgeons
Cannot rule out	18	25	25	27	31	21	30
Consistent with	16	21	8.9	24	16	25	13
No uncertainty terms	8.3	8.1	30	15	30	6	13
Highly suspicious	27	23	27	18	26	19	27
Favor	10	23	23	24	24	25	23
Indefinite for	29	19	25	28	21	24	31
Suggestive of	22	26	23	25	26	23	29
Worrisome for	22	24	19	23	22	23	22

Conclusions: We found that all groups show marked variability between respondents in the degree of certainty they associated with the phrases. The high standard deviations for all phrases indicate that there is substantial ambiguity in these terms, even amongst pathologists who routinely use these phrases in their own reports. These preliminary findings highlight the need for more explicit communication of uncertainty between pathologists and clinicians. Clearly, we are not adequately communicating our intended level of diagnostic uncertainty with the phrases studied here. This communication gap opens the door for medical errors. While a more extensive study is necessary, we see the need to foster dialogue and actions to insure more accurate communication.
Category: Quality Assurance

Monday, March 19, 2012 1:15 PM

Platform Session: Section G, Monday Afternoon