Uncertainty Communication Toolkit

Uncertainty Communication Toolkit

Background

Why did we create this toolkit? At least 37% of patients treated in the emergency department (ED) are discharged without a definitive diagnosis, thus leaving the encounter with diagnostic uncertainty.1 A national survey of medical trainees found that 99% of trainees had experienced challenges discharging patients with diagnostic uncertainty, and 51% wanted formal communication training regarding uncertainty.2 In response to this need, we developed this toolkit to provide healthcare providers with a standardized approach to establish competency in communication of diagnostic uncertainty.  

How did we create this toolkit? The materials included in this toolkit were created through an AHRQ-funded study, “Promoting safe care transitions: Simulation-based mastery learning to improve communication in times of diagnostic uncertainty.” The toolkit components were developed with input from patients as well as an international panel of experts in in healthcare communication, diagnostic uncertainty, simulation and education. 

Funding information: This project was supported by grant R18HS025651 from the Agency for Healthcare Research and Quality (AHRQ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

1Wen L, Espinola J, Mosowsky J, Camargo C. Do Emergency Department Patients Receive a Pathological Diagnosis? A Nationally-Representative Sample. West J Emerg Med. 2015;16(1):50-54.

2Rising KL, Papanagnou D, McCarthy D, Gentsch A, Powell R. Emergency medicine resident perceptions about the need for increased training in communicating diagnostic uncertainty. Cureus. 2018;10(1).

Components of the toolkit were developed with input from researchers at Thomas Jefferson University (TJU) and Northwestern University (NU), as well as members of an expert panel composed of patients and experts in patient communication, education, health literacy, diagnostic uncertainty, and simulation. Roles at the time this work was conducted were as follows:

TJU TEAM:

Kristin Rising, MD MSHP (Principal Investigator, TJU): emergency medicine physician; clinical and health services researcher

Mandy Doty, MS (research coordinator, TJU): research coordinator

Dimitrios Papanagnou, MD MPH EdD (Co-I, TJU): emergency medicine physician; medical educator; Director of the Jefferson In Situ Simulation Training Program.

Rhea Powell, MD MPH (Co-I, TJU): primary care physician and researcher

NU TEAM:

Danielle McCarthy, MD MS (site-PI, NU): emergency medicine physician; health services researcher

Kenzie Cameron, PhD MPH (co-I, NU): research professor; health services researcher

William McGaghie, PhD (co-I, NU): medical education researcher

Kate Piserchia (research coordinator, NU): research coordinator

David Salzman, MD MEd (co-I, NU): emergency medicine physician; medical educator; Director of Simulation for Undergraduate Medical Studies at NU

EXPERT PANEL: Kirsten Engel, MD; Erik Hess, MD MS; Annemarie Jutel, RN BPhED(Hons) PhD; Juanita Lavalais; Larry Loebell, MA, MFA; Zachary Meisel, MD MPH MSHP; Erica Shelton, MD, MPH, MHS, FACEP; John Vozenliek, MD; Gail Weingarten; Michael Wolf, PhD MPH

ADDITIONAL COLLABORATORS: Jessica Diebold; Matt Klein, MD; Ben Leiby, PhD; Ayako Shimado, MS; Tony Zhang, MD

ACKNOWLEDGEMENTS: Thank you to the 2019-2020 Emergency Medicine residents and residency leadership of TJU and NU and Standardized Patients who participated in the trial associated with this work.

This toolkit was developed with funding from the Agency for Healthcare Research and Quality (AHRQ). There is no cost to use the materials included in this toolkit. However, if you are considering using any part of this curriculum, please provide your name and email. This information is helpful for us to be able to track the extent of use of this curriculum and its potential impact.

Toolkit Training Materials

Toolkit Curriculum Materials

For questions about using this curriculum, feedback, or any other thoughts, please contact Dr. Kristin Rising.

This toolkit was developed with funding from the Agency for Healthcare Research and Quality (AHRQ). There is no cost to use the materials included in this toolkit. However, if you are considering using any part of this curriculum, please provide your name and email. This information is helpful for us to be able to track the extent of use of this curriculum and its potential impact.

  1. Rising KL, Papanagnou D, McCarthy D, Gentsch A, Powell R. Emergency medicine resident perceptions about the need for increased training in communicating diagnostic uncertainty. Cureus. 2018 Jan;10(1): e2088. doi: 10.7759/cureus.2088 PMCID: PMC5858850; PMID: 29564193.
  2. Salzman DH, Rising KL, Cameron KA, Powell RE, Papanagnou D, Doty A, Piserchia K, Latimer L, McGaghie WC, McCarthy DM. Setting a Minimum Passing Standard for the Uncertainty Communication Checklist Through Patient and Physician Engagement. J Grad Med Educ. 2020 Feb;12(1):58-65. doi: 10.4300/JGME-D-19-00483.1. PMID: 32089795; PMCID: PMC7012525.
  3. McCarthy DM, Powell RE, Cameron KA, Salzman DH, Papanagnou D, Doty AM, Leiby BE, Piserchia K, Klein MR, Zhang XC, McGaghie WC, Rising KL. Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial. BMC Med Educ. 2020 Feb 19;20(1):49. doi: 10.1186/s12909-020-1926-y. PMID: 32070353; PMCID: PMC7029572.
  4. Rising KL, Powell RE, Cameron KA, Salzman DH, Papanagnou D, Doty AMB, Latimer L, Piserchia K, McGaghie WC, McCarthy DM. Development of the Uncertainty Communication Checklist: A Patient-Centered Approach to Patient Discharge From the Emergency Department. Acad Med. 2020 Jul;95(7):1026-1034. doi: 10.1097/ACM.0000000000003231. PMID: 32101919; PMCID: PMC7302334.
  5. Slovis BH, McCarthy DM, Nord G, Doty AM, Piserchia K, Rising KL. Identifying Emergency Department Symptom-Based Diagnoses with the Unified Medical Language System. West J Emerg Med. 2019 Oct 24;20(6):910-917. doi: 10.5811/westjem.2019.8.44230. PMID: 31738718; PMCID: PMC6860381.