Differential diagnosis in the acute care setting
Research type
Research Study
Full title
The CANDID study: Understanding how to improve making, communicating and recording a medical (differential) diagnosis in the acute care setting through institutional, legal and ethical drivers.
IRAS ID
265331
Contact name
Zoe Fritz
Contact email
Sponsor organisation
Cambridge University Hospitals NHS Foundation Trust and the University Of Cambridge
Clinicaltrials.gov Identifier
19/EE/0244, REC; 265331, IRAS
Duration of Study in the UK
5 years, 1 months, 13 days
Research summary
Diagnosis is at the heart of the medical encounter, but many features of the making, communicating and recording of diagnoses remain poorly understood and little researched. Without greater understanding, we cannot provide adequate guidance to clinicians about what information to share with patients, or advise patients about what questions to ask their carers.
Key goals:
1. To examine the process of making, communicating and recording a medical (differential) diagnosis in the acute care setting;
2. To examine institutional and legal influences on the diagnostic process;
3. To examine ethical and philosophical influences on making and communicating diagnoses;
4. To establish an empirically based, ethically grounded framework for making, communicating and recording a diagnosis to improve patient outcomes on both individual and societal levels;
5. To understand the practical steps which result in phenotyping patients with diagnostic labelsMethodology:
Multi-disciplinary project articulated into five interwoven Workstreams:
Workstream 1: Ethics- and philosophy-informed literature review and analysis of how the interplay between responsibility, uncertainty and trust affects the making and communicating of a medical diagnosis.;
Workstream 2: Qualitative study of differential diagnosis, including: 1) observations of the diagnostic process in three acute care settings; 2) interviews with patients, relatives and healthcare providers participating in the observed diagnostic activities, and 3) interviews with policy makers, managers and lawyers involved in shaping the broader diagnostic process.
Workstream 3: Legal analysis combining traditional methods (analysis of UK case law, legal literature, professional guidelines, and the related law of foreign jurisdictions) and analysis of interviews from phase 2; Ethical analysis combining traditional methods and analysis of interviews from work stream 2.
Workstream 4: Medical Record Review Feasibility Study: Quantitative note review to examine the reach and permanence of diagnostic labels assigned in the acute care setting
Workstream 5:Development of an ethically and legally grounded, empirically evidenced framework for the making, communicating and recording of diagnosis.REC name
East of England - Essex Research Ethics Committee
REC reference
19/EE/0244
Date of REC Opinion
18 Dec 2019
REC opinion
Further Information Favourable Opinion