How health professionals navigate diagnostic uncertainty in clinical practice: A rapid scoping review.

Abstract

Diagnostic uncertainty is a routine but challenging aspect of healthcare, shaping the experiences of both patients and health professionals. This rapid scoping review aimed to synthesize the strategies health professionals use to navigate diagnostic uncertainty in clinical practice. An electronic database search was conducted in PubMed and CINAHL with a publication date range of 2015-2025. Studies were eligible if they investigated strategies adopted by health professionals to navigate diagnostic uncertainty. Data were extracted independently by two reviewers and synthesised narratively using inductive codebook thematic analysis. Eighteen studies were included, representing a range of professional fields and clinical settings. Three overarching themes were identified. (1) Communication strategies; health professionals adopted nuanced and indirect language, balanced transparency with reassurance, and incorporated safety-netting to communicate diagnostic uncertainty and maintain trust and patient safety. (2) Clinical reasoning strategies; health professionals integrated diagnostic investigations and the "test of time" approach to reduce their discomfort with uncertainty, support decision-making and patient understanding. (3) Collaborative strategies; peer and interprofessional collaboration were described as helping to normalise uncertainty and share emotional and cognitive burdens associated with it. Health professionals use communication, clinical reasoning and collaborative strategies in an attempt to normalise uncertainty, maintain patient safety, reduce their discomfort with uncertainty and promote trust in the health professional. Strategies focused on communication, clinical reasoning and collaboration may assist health professionals to navigate diagnostic uncertainty in clinical practice. Education settings and workplaces could explore ways to normalise uncertainty, foster collaboration and tailor strategies to navigate uncertainty in specific healthcare contexts.