Diagnostic Decision Making in Oncology: Creating Shared Knowledge and Managing Complexity

Abstract

Drawing upon the concept of practice, the article explores diagnostic decision making in oncology through the analysis of informal conversations between doctors in an Italian hospital. The analysis shows that doctors rely on three collaborative practices: (a) joint interpretation, (b) intersubjective generation and validation of hypotheses, and (c) postponing the diagnostic decision. Through such practices, doctors jointly handle tough issues such as managing complexity, dealing with cognitive difficulties and limits of knowledge, and avoiding diagnostic errors. The article addresses some lacunae in the literature by providing empirical access to how decision making is done in an understudied and specialized branch of medicine.

Notes

¹ Among the hospital’s departments were psychiatry, intensive care, urology, surgery, nephrology, cardiology, general medicine, orthopaedics, and others.

² Interviews with doctors confirmed that such conversations are very common during the hospital’s everyday activities.

³ Neoplastic means related to a tumor or neoplasia.

⁴ Streptococcus is a group of bacteria that may cause infections.

⁵ Cryptococcus is a fungus.

⁶ Metastasis is the spread of a cancer from one organ or part to another nonadjacent organ or part.

⁷ Studies on large samples of cases in various branches of medicine have found an incidence of serious diagnostic errors of about 15% to 20%, half of which have a probable impact on prognosis (Podbregar et al., 2001; Shojania, McDonald, Wachter, & Owens, 2004). In the United States, one fifth of lawsuits on medical issues concern diagnostic errors (Bartlett, 1998).

⁸ Adenocarcinoma is a cancer of epithelial tissue.

⁹ PSA is a screening test for prostate cancer.