Impact of uncertainty intolerance on clinical reasoning: A scoping review of the 21st‐century literature

• Published in: Journal of evaluation in clinical practice Vol. 29; no. 3; pp. 539 - 553
• Main Authors: Brun, Clémence, Zerhouni, Oulmann, Akinyemi, Alexis, Houtin, Laurène, Monvoisin, Richard, Pinsault, Nicolas
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-04-2023; Wiley
• Subjects: Anti-Bacterial Agents; Antibiotics; Clinical decision making; Clinical Reasoning; Critical thinking; decision making; diagnosis; Humanities and Social Sciences; Humans; intolerance of uncertainty; Medical diagnosis; Physicians; Prescriptions; Problem Solving; Psychology; Uncertainty; diagnosis; critical thinking; intolerance of uncertainty; clinical reasoning; decision making
• ISSN: 1356-1294; 1365-2753
• DOI: 10.1111/jep.13756

Rationale, Aims and Objectives
Clinical reasoning is currently extensively studied to find out how to make proper diagnoses. Literature indicates that intolerance of uncertainty (IU) may have a strong negative impact on clinical reasoning. We summarize the various consequences of IU on clinical reasoning.
Methods
A scoping review was conducted using relevant keywords to scientific databases (i.e., Google Scholar, Medline, PsycINFO and PBSC) from September to November 2021. Complementary research included relevant articles and articles retrieved through Google Scholar's alert system. We included articles about healthcare professionals as defined by the French Public Health Code (As defined here: https://www.vie-publique.fr/fiches/37855-categories-de-professionnels-de-sante-code-se-la-sante-publique), and articles reporting on the impact of IU or uncertainty management on clinical reasoning.
Results
We retrieved 1853 articles, of which 8 were kept for final analysis considering our inclusion criteria. Two behaviour categories were affected by uncertainty intolerance: investigative and prescriptive behaviours. Regarding the investigation process, mismanagement of uncertainty appeared to lead to reasoning bias, potentially resulting in diagnostic errors. IU was associated with withholding information, more referrals to peers and less use of new medical interventions. Regarding prescription behaviours, IU among health professionals could lead to overprescribing unnecessary or dangerous tests. IU was also associated with more antibiotic prescriptions for conditions where antibiotics are to be used carefully.
Conclusion
Few studies have yet addressed the impact of IU on clinical reasoning. IU's influence is primarily observed on investigative and prescribing behaviours. More studies are needed to fully understand the impact of IU on clinical reasoning itself, and not only on practical consequences.