Abstract
BackgroundIncidentally discovered silent brain infarcts (id-SBIs) are an understudied condition with probable clinical significance, but it is not known how patients respond to or prioritize this condition. We sought to assess reporting of id-SBIs and how patients approach their diagnosis.MethodsPatients with id-SBIs were identified from sequential scans between 12/2015–5/2016, were referred by treating clinicians, or self-referred for the study. This study used qualitative semi-structured interviews. Purposeful sampling was used to achieve diversity in acuity, setting, and recruitment strategy. Interviews were audio-recorded and transcribed. A constant comparative method was used to develop a coding schema, find consensus, and iteratively explore emergent themes until thematic saturation was achieved.ResultsOnly 10 of 102 patients prospectively identified by neuroimaging were informed of the imaging findings. Twelve participants in total were interviewed. Among the study participants, the primary themes were cognitive, emotional, and behavioral responses to diagnostic, prognostic, and therapeutic uncertainty regarding id-SBIs. Clinicians described id-SBIs to participants as an ambiguous condition. Participants feared potential consequences of id-SBIs, including symptomatic stroke, dementia, and disability. Participants attempted to reduce uncertainty with strategies including equating id-SBIs with symptomatic stroke, self-education about stroke, and seeking second opinions.ConclusionParticipants considered id-SBIs to be a serious medical condition. Ambiguous counseling by clinicians on id-SBIs provoked or failed to attenuate fear, leading to participants adopting strategies aimed at reducing uncertainty.
Highlights
Discovered silent brain infarcts are an understudied condition with probable clinical significance, but it is not known how patients respond to or prioritize this condition
Considering that Silent brain infarcts (SBIs) are asymptomatic and lack an overt, immediate functional impact for patients, clinicians may be uncertain about the diagnostic significance of SBIs, potentially leading to inconsistent reporting to patients and counseling of patients with this condition. [7]. Adding to this uncertainty is that patients with incidentally discovered SBIs are a completely unstudied population facing an emerging clinical decision making scenario: prior studies of natural history and outcomes have only assessed patients with SBIs undergoing protocol-driven neuroimaging
We interviewed a diverse group of clinicians from various specialties who had experience providing care for patients with Incidentally discovered silent brain infarcts (id-SBIs), and we found that they endorsed considerable diagnostic and prognostic uncertainty that they viewed as barriers to addressing this condition [7]
Summary
Discovered silent brain infarcts (id-SBIs) are an understudied condition with probable clinical significance, but it is not known how patients respond to or prioritize this condition. Diagnostic uncertainty often complicates medical decision making, as well as the counseling of patients by clinicians [1, 2]. In the absence of standardized screening, SBIs are by definition discovered incidentally in routine clinical. Adding to this uncertainty is that patients with incidentally discovered SBIs (id-SBIs) are a completely unstudied population facing an emerging clinical decision making scenario: prior studies of natural history and outcomes have only assessed patients with SBIs undergoing protocol-driven neuroimaging. We explored the perspectives of patients on these issues, focusing on how patients with id-SBIs interpret and respond to the diagnosis of id-SBIs and how they manage uncertainties surrounding this diagnosis
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