The Use of Hedge Phrases in Histopathology Reports by Filipino Pathologists and Clinicians’ Interpretation of Them

Abstract

Introduction. When communicating uncertainty in histopathology reports, pathologists often use hedge phrases (HPs) to qualify their diagnoses, assuming that clinicians understand their meaning. However, Western studies have shown that these phrases have remarkable variations in intended and perceived certainty, which may impact the next steps of patient care.

Objectives. For seven commonly used HPs, we aimed to determine: how frequently these are used and encountered in histopathology reports in the Philippine setting; if there are differences in certainty among the phrases as well as between the intended and perceived certainty by pathologists and clinicians, respectively; the frequency of seeking clarification for each phrase, the preferred mode of communication, and the frequency that the next steps of patient management are taken for each phrase.

Methodology. Through snowball sampling, 57 pathologists and 111 clinicians from different geographic regions in the Philippines were recruited for an online survey. For each HP, participants reported the frequency of use of or encounter, rated percentage certainty, and answered questions regarding frequency of clarification, next step of management, and preferred mode of communication. Differences between intended and perceived certainty were determined by the Mann-Whitney U test. Differences in certainty among HPs were determined by the Kruskal-Wallis H test with the post-hoc Dunn test.

Results. The phrases “consistent with” and “diagnostic of” were the most and least frequent HPs, respectively. Certainty was perceived to be lower than intended for the phrase “cannot rule out” and for when no HP is used. Differences in certainty were found among most of the HPs. “Diagnostic of” and “consistent with” showed high certainty, “compatible with” and “favor” showed moderate certainty, “suggestive of” and “suspicious for” showed fair certainty, and “cannot rule out” had low certainty.

Conclusion. The variability of intended and perceived certainty for different HPs may warrant standardization of usage in reporting to prevent potential miscommunication and misinterpretation.