IDEAS home Printed from https://ideas.repec.org/a/plo/pgph00/0003429.html
   My bibliography  Save this article

Uncertainty in tuberculosis clinical decision-making: An umbrella review with systematic methods and thematic analysis

Author

Listed:
  • Francesca Wanda Basile
  • Sedona Sweeney
  • Maninder Pal Singh
  • Else Margreet Bijker
  • Ted Cohen
  • Nicolas A Menzies
  • Anna Vassall
  • Pitchaya Indravudh

Abstract

Tuberculosis is a major infectious disease worldwide, but currently available diagnostics have suboptimal accuracy, particularly in patients unable to expectorate, and are often unavailable at the point-of-care in resource-limited settings. Test/treatment decision are, therefore, often made on clinical grounds. We hypothesized that contextual factors beyond disease probability may influence clinical decisions about when to test and when to treat for tuberculosis. This umbrella review aimed to identify such factors, and to develop a framework for uncertainty in tuberculosis clinical decision-making. Systematic reviews were searched in seven databases (MEDLINE, CINAHL Complete, Embase, Scopus, Cochrane, PROSPERO, Epistemonikos) using predetermined search criteria. Findings were classified as barriers and facilitators for testing or treatment decisions, and thematically analysed based on a multi-level model of uncertainty in health care. We included 27 reviews. Study designs and primary aims were heterogeneous, with seven meta-analyses and three qualitative evidence syntheses. Facilitators for decisions to test included providers’ advanced professional qualification and confidence in tests results, availability of automated diagnostics with quick turnaround times. Common barriers for requesting a diagnostic test included: poor provider tuberculosis knowledge, fear of acquiring tuberculosis through respiratory sampling, scarcity of healthcare resources, and complexity of specimen collection. Facilitators for empiric treatment included patients’ young age, severe sickness, and test inaccessibility. Main barriers to treatment included communication obstacles, providers’ high confidence in negative test results (irrespective of negative predictive value). Multiple sources of uncertainty were identified at the patient, provider, diagnostic test, and healthcare system levels. Complex determinants of uncertainty influenced decision-making. This could result in delayed or missed diagnosis and treatment opportunities. It is important to understand the variability associated with patient-provider clinical encounters and healthcare settings, clinicians’ attitudes, and experiences, as well as diagnostic test characteristics, to improve clinical practices, and allow an impactful introduction of novel diagnostics.

Suggested Citation

  • Francesca Wanda Basile & Sedona Sweeney & Maninder Pal Singh & Else Margreet Bijker & Ted Cohen & Nicolas A Menzies & Anna Vassall & Pitchaya Indravudh, 2024. "Uncertainty in tuberculosis clinical decision-making: An umbrella review with systematic methods and thematic analysis," PLOS Global Public Health, Public Library of Science, vol. 4(7), pages 1-23, July.
  • Handle: RePEc:plo:pgph00:0003429
    DOI: 10.1371/journal.pgph.0003429
    as

    Download full text from publisher

    File URL: https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0003429
    Download Restriction: no

    File URL: https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0003429&type=printable
    Download Restriction: no

    File URL: https://libkey.io/10.1371/journal.pgph.0003429?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Poshan Thapa & Rohan Jayasuriya & John J Hall & Kristen Beek & Parthasarathi Mukherjee & Nachiket Gudi & Padmanesan Narasimhan, 2021. "Role of informal healthcare providers in tuberculosis care in low- and middle-income countries: A systematic scoping review," PLOS ONE, Public Library of Science, vol. 16(9), pages 1-17, September.
    2. Desalegne Amare & Fentie Ambaw Getahun & Endalkachew Worku Mengesha & Getenet Dessie & Melashu Balew Shiferaw & Tegenaw Asemamaw Dires & Kefyalew Addis Alene, 2023. "Effectiveness of healthcare workers and volunteers training on improving tuberculosis case detection: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 18(3), pages 1-13, March.
    3. Jing Cai & Xianhua Wang & Aiguo Ma & Qiuzhen Wang & Xiuxia Han & Yong Li, 2015. "Factors Associated with Patient and Provider Delays for Tuberculosis Diagnosis and Treatment in Asia: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-22, March.
    4. repec:plo:pone00:0241039 is not listed on IDEAS
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Farman Ullah Khan & Faiz Ullah Khan & Khezar Hayat & Jie Chang & Muhammad Kamran & Asad Khan & Usman Rashid Malik & Asif Khan & Yu Fang, 2021. "Impact of Protracted Displacement on Delay in the Diagnosis Associated with Treatment Outcomes: A Cross-Sectional Study in Internally Displaced Tuberculosis Patients of Pakistan," IJERPH, MDPI, vol. 18(22), pages 1-14, November.
    2. Vanita Singh, 2022. "To Rx or Not: Mainstreaming Informal Providers," Vikalpa: The Journal for Decision Makers, , vol. 47(4), pages 314-316, December.
    3. Capuno, Joseph J. & Kraft, Aleli D. & Poco, Louisa Camille & Quimbo, Stella A. & Tan, Carlos Antonio R., 2019. "Health conditions, payments, proximity, and opportunity costs: Examining delays in seeking inpatient and outpatient care in the Philippines," Social Science & Medicine, Elsevier, vol. 238(C), pages 1-1.
    4. JJ Capuno & AD Kraft & LC Poco & SA Quimbo & CAR Tan, Jr., 2017. "Factors associated with the delay in seeking inpatient and outpatient care services in the Philippines," UP School of Economics Discussion Papers 201703, University of the Philippines School of Economics.
    5. Patrick D.M.C. Katoto & Aime Murhula & Tony Kayembe-Kitenge & Herve Lawin & Bertin C. Bisimwa & Jean Paul Cirhambiza & Eric Musafiri & Freddy Birembano & Zacharie Kashongwe & Bruce Kirenga & Sayoki Mf, 2018. "Household Air Pollution Is Associated with Chronic Cough but Not Hemoptysis after Completion of Pulmonary Tuberculosis Treatment in Adults, Rural Eastern Democratic Republic of Congo," IJERPH, MDPI, vol. 15(11), pages 1-13, November.
    6. Kee Chee Cheong & Sumarni Mohd Ghazali & Ahmed Syahmi Syafiq Md Zamri & Yoon Ling Cheong & Nuur Hafizah Md. Iderus & Tharmarajah Nagalingam & Qistina Ruslan & Mohd Azahadi Omar & Ahmad Faudzi Yusoff, 2022. "Gender Differences in Factors Associated with the Total Delay in Treatment of Pulmonary Tuberculosis Patients: A Cross-Sectional Study in Selangor, Malaysia," IJERPH, MDPI, vol. 19(10), pages 1-15, May.
    7. Sujan Babu Marahatta & Rajesh Kumar Yadav & Deena Giri & Sarina Lama & Komal Raj Rijal & Shiva Raj Mishra & Ashish Shrestha & Pramod Raj Bhattrai & Roshan Kumar Mahato & Bipin Adhikari, 2020. "Barriers in the access, diagnosis and treatment completion for tuberculosis patients in central and western Nepal: A qualitative study among patients, community members and health care workers," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-18, January.
    8. Long Viet Bui & Zohar Mor & Daniel Chemtob & Son Thai Ha & Hagai Levine, 2018. "Use of Geographically Weighted Poisson Regression to examine the effect of distance on Tuberculosis incidence: A case study in Nam Dinh, Vietnam," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-12, November.
    9. Rao, Krishna D. & Mehta, Akriti & Noonan, Caitlin & Peters, Michael A. & Perry, Henry, 2024. "Voting with their feet: Primary care provider choice and its implications for public sector primary care services in India," Social Science & Medicine, Elsevier, vol. 340(C).

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pgph00:0003429. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: globalpubhealth (email available below). General contact details of provider: https://journals.plos.org/globalpublichealth .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.