Provider Recommendations in the Face of Scientific Uncertainty: An Analysis of Audio-Recorded Discussions about Vitamin D.
J Gen Intern Med. 2016 Aug;31(8):909-17. doi: 10.1007/s11606-016-3667-5. Epub 2016 Mar 23.
Tarn DM1, Paterniti DA2,3, Wenger NS4.
1 Department of Family Medicine, David Geffen School of Medicine at UCLA, University of California-Los Angeles, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA, 90024, USA. dtarn at mednet.ucla.edu.
2 Department of Sociology, Sonoma State University, Sacramento, CA, USA.
3 Departments of Internal Medicine and Sociology, University of California-Davis Medical Center, Sacramento, CA, USA.
4 Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, University of California-Los Angeles, Los Angeles, CA, USA.
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Note: these discussions only occured 15% of the time
so only 6% of CAM visits discussed vitamin D and the immune system ( 15% X 40%)
but NONE of the conventional doctors vitamin D and the immune system
BACKGROUND: Little is known about how providers communicate recommendations when scientific uncertainty exists.
OBJECTIVES: To compare provider recommendations to those in the scientific literature, with a focus on whether uncertainty was communicated.
DESIGN: Qualitative (inductive systematic content analysis) and quantitative analysis of previously collected audio-recorded provider-patient office visits.
PARTICIPANTS: Sixty-one providers and a socio-economically diverse convenience sample of 603 of their patients from outpatient community- and academic-based primary care, integrative medicine, and complementary and alternative medicine provider offices in Southern California.
Comparison of provider information-giving about vitamin D to professional guidelines and scientific information for which conflicting recommendations or insufficient scientific evidence exists; certainty with which information was conveyed.
Ninety-two (15.3 %) of 603 visit discussions touched upon issues related to vitamin D testing, management and benefits.
- Vitamin D deficiency screening was discussed with 23 (25 %) patients, the
- definition of vitamin D deficiency with 21 (22.8 %), the
- optimal range for vitamin D levels with 26 (28.3 %),
- vitamin D supplementation dosing with 50 (54.3 %), and
- benefits of supplementation with 46 (50 %).
For each of the professional guidelines/scientific information examined, providers conveyed information that deviated from professional guidelines and the existing scientific evidence. Of 166 statements made about vitamin D in this study, providers conveyed 160 (96.4 %) with certainty, without mention of any equivocal or contradictory evidence in the scientific literature. No uncertainty was mentioned when vitamin D dosing was discussed, even when recommended dosing was higher than guideline recommendations.
CONCLUSIONS AND RELEVANCE:
Providers convey the vast majority of information and recommendations about vitamin D with certainty, even though the scientific literature contains inconsistent recommendations and declarations of inadequate evidence. Not communicating uncertainty blurs the contrast between evidence-based recommendations and those without evidence. Providers should explore best practices for involving patients in decision-making by acknowledging the uncertainty behind their recommendations.
PMID: 27008650 PMCID: PMC4945557 DOI: 10.1007/s11606-016-3667-5