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Doctors rarely (15 prcnt) talked about Vitamin D and with very little ambiguity (96 prcnt)– Aug 2016

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

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   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.

MAIN MEASURES:
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.

RESULTS:
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


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Created by admin. Last Modification: Thursday July 22, 2021 11:57:46 GMT-0000 by admin. (Version 9)

Attached files

ID Name Comment Uploaded Size Downloads
9156 Certainty F1.jpg admin 09 Jan, 2018 24.66 Kb 416
9155 Certainty T3.jpg admin 09 Jan, 2018 104.47 Kb 378
9154 Recommendations in the Face of Scientific Uncertainty.pdf admin 09 Jan, 2018 488.47 Kb 464