• Whiting, Penny F.
• Salisbury, Chris
• Hamilton, William
• Banks, Jonathan
• Watson, Jessica

Abstract

Objective<br/>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. <br/><br/>Methods <br/>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. <br/><br/>Results<br/>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. <br/><br/>Conclusion<br/>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.<br/>

Topics

• impedance spectroscopy