The nature of medical evidence and its inherent uncertainty for the clinical consultation: qualitative study

As supplied by authors

Research process detail

The study

This paper reports on data collected as part of a study funded by the ESRC Innovative Health Technology Programme which aims to understand the interaction between health technology and society. This project focused on how individual women and health professionals interact with the health technologies.

Recruitment

Recruitment and consent was undertaken by researchers (MT and DT) in each clinic/surgery waiting room over 2-4 days. The health professional started the audio-recorder on receipt of the consent form from the woman.

Analysis

The transcripts were checked for accuracy by the researchers (MT and DT) and then analysed in stages. As part of the wider study, FG and EG initially read 20% of the consultations, identified major themes and discussed them, drawing on their different disciplinary backgrounds (medicine and sociology). The theme at the focus of this paper emerged as a key issue in the interaction of women and health professionals with technological health interventions. Six members of the research team (FG, EG, MT, DT, KMB and GB) then read three different consultations (plus interview transcripts from the wider study) and these were discussed. From this an initial categorisation was developed of how the uncertainty was dealt with in consultations. This categorisation was used for structuring further analysis on this issue. MT and DT read all the consultations, FG read 80% and PL read 20%. The content of the consultations with only a brief mention of the health interventions were summarised. Relevant part(s) of the other consultations were extracted (sometimes this was the whole consultation). The remaining 45 were categorised and the analytical categories were developed and refined through constant comparison of the extracts. All the consultation extracts were then reviewed by FG/PL to check their categorisation. The consultations were finally reviewed to categorise the health concerns discussed in the consultations (AL/FG). Further comparative analysis (AL/FG) explored links between the role of the health professional, the type of health care setting, the health concern discussed, and how uncertainty was dealt with.

Focus groups

The results of the analysis was presented by FG to three focus groups formed from existing groupings at the University of Warwick, one of GP Lecturers, one of GP registrars and one of patients. A limitation of this process was the lack of representation of clinical specialists and nurses. The groups were audio-recorded or detailed notes taken. All three groups recognised the dilemma of uncertainty and with minor refinements, affirmed the validity of the categories of consultations from their own experience. Their feedback was used in developing the discussion section of the paper.

Examples of consultations with only a brief mention of interventions

• A woman receiving Tamoxifen has vaginal dryness and hormone replacement therapy is mentioned by her doctor as treatment she cannot have.
• In an appointment for a cervical smear, taking the smear was not possible due to vaginal soreness. This was the main topic of discussion with the Practice Nurse: HRT mentioned as something tried in the past with no benefit.
• Brief discussion of how the mammography service is organised -in a GP consultation about other issues.
• Before a bone scan the Radiographer briefly explains to the woman why she is having the scan.
• In a consultation about diabetes, GP checks if woman is happy with her HRT while issuing a repeat prescription.