title: Provider Recommendations in the Face of Scientific Uncertainty: An Analysis of Audio-Recorded Discussions about Vitamin D.
abstract: Little is known about how providers communicate recommendations when scientific uncertainty exists.
  
  
  
  To compare provider recommendations to those in the scientific literature, with a focus on whether uncertainty was communicated.
  
  
  
  Qualitative (inductive systematic content analysis) and quantitative analysis of previously collected audio-recorded provider-patient office visits.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: 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@mednet.ucla.edu.
authors.forename: Derjung M
authors.initials: DM
authors.lastname: Tarn
authors.affiliation: Department of Sociology, Sonoma State University, Sacramento, CA, USA.|Departments of Internal Medicine and Sociology, University of California-Davis Medical Center, Sacramento, CA, USA.
authors.forename: Debora A
authors.initials: DA
authors.lastname: Paterniti
authors.affiliation: 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.
authors.forename: Neil S
authors.initials: NS
authors.lastname: Wenger
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D019587:Dietary Supplements; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods* / Q000592:standards; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care / Q000592:standards; D013637:Tape Recording / Q000379:methods*; D035501:Uncertainty; D014807:Vitamin D / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000175:diagnosis / Q000178:diet therapy
chemical_list: D014807:Vitamin D
keywords: complementary and alternative medicine; dietary supplements; provider–patient relations; qualitative research methods; scientific uncertainty; vitamin D