Challenging history taking encounters: a systematic review, meta-analysis and phenomenological framework.

Hossain, S; Murray, K; Zhang, L; Jassem, AM; Clarke, J; Somers, J; Dias, R; Uridge, A; Sharma, S; Teodorczuk, A; Keijzers, G; McConnell, H; Sun, J; Amey, L; Broadley, SA

Challenging history taking encounters: a systematic review, meta-analysis and phenomenological framework.

Hossain, S Murray, K Zhang, L Jassem, AM Clarke, J Somers, J Dias, R Uridge, A Sharma, S Teodorczuk, A Keijzers, G McConnell, H Sun, J

Amey, L Broadley, SA

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Publisher:: BMJ
Publication Type:: Journal Article
Citation:: BMJ Open, 2026, 16, (4), pp. e115891
Issue Date:: 2026-04-13

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Field	Value	Language
dc.contributor.author	Hossain, S
dc.contributor.author	Murray, K
dc.contributor.author	Zhang, L
dc.contributor.author	Jassem, AM
dc.contributor.author	Clarke, J
dc.contributor.author	Somers, J
dc.contributor.author	Dias, R
dc.contributor.author	Uridge, A
dc.contributor.author	Sharma, S
dc.contributor.author	Teodorczuk, A
dc.contributor.author	Keijzers, G
dc.contributor.author	McConnell, H
dc.contributor.author	Sun, J https://orcid.org/0000-0002-0097-2438
dc.contributor.author	Amey, L
dc.contributor.author	Broadley, SA
dc.date.accessioned	2026-04-20T03:03:13Z
dc.date.available	2026-03-02
dc.date.available	2026-04-20T03:03:13Z
dc.date.issued	2026-04-13
dc.identifier.citation	BMJ Open, 2026, 16, (4), pp. e115891
dc.identifier.issn	2044-6055
dc.identifier.issn	2044-6055
dc.identifier.uri	http://hdl.handle.net/10453/194766
dc.description.abstract	OBJECTIVES: All physicians will experience challenging history taking encounters, where communication is impaired and negatively impacts the diagnostic process. The aims of this systematic review were to (1) undertake a meta-analysis of the frequency of challenging encounters; (2) collate adverse outcomes of challenging encounters; (3) identify underlying causes of challenging encounters; (4) identify strategies to deal with different challenges; and (5) align these strategies with our published phenomenological framework of history taking challenges. DESIGN: This was a systematic review and meta-analysis of prevalence data adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses and the Meta-analyses of Observational Studies in Epidemiology guidelines. DATA SOURCES: A literature search in MEDLINE, Embase and Cochrane databases was performed on 12 July 2020, and updated on 4 August 2025, focusing on challenging history taking encounters in any clinical setting. ELIGIBILITY CRITERIA: Articles reporting on the frequency, adverse outcomes, causative factors or strategies used to address challenges in the history taking process in any clinical area of medicine. DATA EXTRACTION AND SYNTHESIS: Factors associated with challenging history encounters (causative or consequential) were categorised using inductive coding and referenced to a phenomenological framework. Meta-analysis was used to estimate the prevalence of history taking encounters using a restricted maximum likelihood model with τ 2 and I 2 as tests for heterogeneity and funnel plot with Egger's test for publication bias. RESULTS: 73 articles were included in the analysis. The overall prevalence of challenging history taking encounters was 19.5% (95% CI 14.2% to 24.7%). Adverse outcomes of patient dissatisfaction (level 1 evidence) and diagnostic uncertainty (level 3 evidence) were identified. Factors associated with (n=22) and strategies to mitigate challenging encounters (n=13) were categorised. Correlation of factors and strategies with a phenomenological approach created a framework to assist novice history takers in approaching such circumstances. CONCLUSIONS: Challenging history taking encounters are common. Little is known of the relative importance of factors associated with challenging history taking encounters or the impact of suggested strategies. Many of the suggested strategies to facilitate meaningful communication in these situations involve a departure from standard history taking. More research is required to better define the nature of challenges encountered in history taking with a view to develop better educational models for trainee physicians.
dc.language	eng
dc.publisher	BMJ
dc.relation.ispartof	BMJ Open
dc.relation.isbasedon	10.1136/bmjopen-2025-115891
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1103 Clinical Sciences, 1117 Public Health and Health Services, 1199 Other Medical and Health Sciences
dc.subject.classification	32 Biomedical and clinical sciences
dc.subject.classification	42 Health sciences
dc.subject.classification	52 Psychology
dc.subject.mesh	Humans
dc.subject.mesh	Medical History Taking
dc.subject.mesh	Physician-Patient Relations
dc.subject.mesh	Communication
dc.subject.mesh	Humans
dc.subject.mesh	Medical History Taking
dc.subject.mesh	Physician-Patient Relations
dc.subject.mesh	Communication
dc.title	Challenging history taking encounters: a systematic review, meta-analysis and phenomenological framework.
dc.type	Journal Article
utslib.citation.volume	16
utslib.location.activity	England
utslib.for	1103 Clinical Sciences
utslib.for	1117 Public Health and Health Services
utslib.for	1199 Other Medical and Health Sciences
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Engineering and Information Technology
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0/
dc.date.updated	2026-04-20T03:03:12Z
pubs.issue	4
pubs.publication-status	Published online
pubs.volume	16
utslib.citation.issue	4

Abstract:

OBJECTIVES: All physicians will experience challenging history taking encounters, where communication is impaired and negatively impacts the diagnostic process. The aims of this systematic review were to (1) undertake a meta-analysis of the frequency of challenging encounters; (2) collate adverse outcomes of challenging encounters; (3) identify underlying causes of challenging encounters; (4) identify strategies to deal with different challenges; and (5) align these strategies with our published phenomenological framework of history taking challenges. DESIGN: This was a systematic review and meta-analysis of prevalence data adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses and the Meta-analyses of Observational Studies in Epidemiology guidelines. DATA SOURCES: A literature search in MEDLINE, Embase and Cochrane databases was performed on 12 July 2020, and updated on 4 August 2025, focusing on challenging history taking encounters in any clinical setting. ELIGIBILITY CRITERIA: Articles reporting on the frequency, adverse outcomes, causative factors or strategies used to address challenges in the history taking process in any clinical area of medicine. DATA EXTRACTION AND SYNTHESIS: Factors associated with challenging history encounters (causative or consequential) were categorised using inductive coding and referenced to a phenomenological framework. Meta-analysis was used to estimate the prevalence of history taking encounters using a restricted maximum likelihood model with τ 2 and I 2 as tests for heterogeneity and funnel plot with Egger's test for publication bias. RESULTS: 73 articles were included in the analysis. The overall prevalence of challenging history taking encounters was 19.5% (95% CI 14.2% to 24.7%). Adverse outcomes of patient dissatisfaction (level 1 evidence) and diagnostic uncertainty (level 3 evidence) were identified. Factors associated with (n=22) and strategies to mitigate challenging encounters (n=13) were categorised. Correlation of factors and strategies with a phenomenological approach created a framework to assist novice history takers in approaching such circumstances. CONCLUSIONS: Challenging history taking encounters are common. Little is known of the relative importance of factors associated with challenging history taking encounters or the impact of suggested strategies. Many of the suggested strategies to facilitate meaningful communication in these situations involve a departure from standard history taking. More research is required to better define the nature of challenges encountered in history taking with a view to develop better educational models for trainee physicians.

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http://hdl.handle.net/10453/194766