Abstract
Background : Uncertainty is inherent in general practice. General practitioners may feel helpless, indecisive, anxious towards patients’ complaints. They have to find a way to include that uncertainty in their decision making. This process has been studied through many qualitative studies.This study aims to develop a comprehensive analysis of the way uncertainty is included into primary care decision making, from a qualitative meta synthesis.MethodSynthesis method of qualitative studies.- Systematic review and selection of relevant qualitative studies, according to inclusion and quality criteria.- Key themes identification and reciprocal translation so as to bring a higher order interpretation, leading to a global synthesis.- Data triangulation performed by two researchers.- Redaction using ENTREQ reporting guidelines and eMERge reporting guidance.ResultsWe included 57 studies. The five tertiary themes consider medical decision making within uncertainty context as :-a decision relying on the patient-centred approach, by building a relationship of trust and matching the whole patient attributes.-a decision leading to a specific visceral sensation called « gut-feeling », that helps avoiding danger.-a decision that has to be shared, so as uncertainty.-a decision depending on the context and is subjected to a pressure notion.-a situation that shapes the GPs’ perceptions of work experiences (lack of confidence, anxiety, stress)DiscussionThis original synthesis explores the way medical decison - shared with the patient, with his relatives and with other healthcareers - and patient-centred approach enable GPs to develop tolerance for uncertainty. Uncertainty may not clear out with experience but it could be managed with a reflexive approach, relying on GPs’ values. Uncertainty is an inherent and intricated skill of general practice.