PT  - JOURNAL ARTICLE
AU  - Myura Nagendran
AU  - Yang Chen
AU  - Anthony C Gordon
TI  - Real time self-rating of decision certainty by clinicians: a systematic review
AID  - 10.7861/clinmed.2019-0169
DP  - 2019 Sep 01
TA  - Clinical Medicine
PG  - 369--374
VI  - 19
IP  - 5
4099  - http://www.rcpjournals.org/content/19/5/369.short
4100  - http://www.rcpjournals.org/content/19/5/369.full
SO  - Clin Med2019 Sep 01; 19
AB  - BackgroundWe sought to establish to what extent decision certainty has been measured in real time and whether high or low levels of certainty correlate with clinical outcomes.MethodsOur pre-specified study protocol is published on PROSPERO, CRD42019128112. We identified prospective studies from Medline, Embase and PsycINFO up to February 2019 that measured real time self-rating of the certainty of a medical decision by a clinician.FindingsNine studies were included and all were generally at high risk of bias. Only one study assessed long-term clinical outcomes: patients rated with high diagnostic uncertainty for heart failure had longer length of stay, increased mortality and higher readmission rates at 1 year than those rated with diagnostic certainty. One other study demonstrated the danger of extreme diagnostic confidence – 7% of cases (24/341) labelled as having either 0% or 100% diagnostic likelihood of heart failure were made in error.ConclusionsThe literature on real time self-rated certainty of clinician decisions is sparse and only relates to diagnostic decisions. Further prospective research with a view to generating hypotheses for testable interventions that can better calibrate clinician certainty with accuracy of decision making could be valuable in reducing diagnostic error and improving outcomes.