Medical Decision MakingPhysicians’ reactions to uncertainty in the context of shared decision making
Introduction
Scientific uncertainty results from numerous sources and can complicate clinical decisions. Experts conceptualize scientific uncertainty in many ways, including but not limited to: stochastic uncertainty (risk or probability of a future event); ambiguity (uncertainty about the strength or quality of risk estimates, resulting from conflicting study results or differences in study design used to calculate risk); uncertainty from unknown data; and uncertainty resulting from translating population level findings to individuals [1], [2]. Communicating scientific uncertainty is essential for shared decision making (SDM) [3]. Nonetheless, discussions about uncertainty rarely occur in practice [4], [5].
Most SDM implementation studies have not examined physicians’ reactions to uncertainty, and do not provide information on physician characteristics that might foster SDM adoption [6]. Physicians who cope well with uncertainty may be more likely to support SDM [7]. Their responses to uncertainty may play a key role in uncertainty disclosure and willingness to engage in SDM [8]. Using data from a previous trial [9], we explored variables that were associated with physicians’ anxiety from uncertainty and reluctance to disclose uncertainty to patients to better understand the relationship between these distinct variables and SDM adoption.
Section snippets
Data source and participants
Data originated from an SDM implementation study conducted in primary care practices in Québec City, Canada between September 2003 and April 2004. Clinical teachers and residents in family medicine who enrolled were asked to recruit five patients with whom a decision had been made and to provide post-clinical encounter data. Clinicians then attended a training session on SDM. They were subsequently asked to recruit five additional patients and provide the same post-clinical encounter data.
Results
Sixty-seven clinical teachers (including one nurse practitioner and one dietician) and 53 residents enrolled (participation rate = 75%). Eligible non-participants were more likely to be male (p = 0.02). There was no difference in training or practice status between participants and non-participants. Table 1 presents socio-demographics of participants.
Overall, the mean anxiety about uncertainty score was 14.96 (SD 4.75, range 5–26) and the mean reluctance to disclose uncertainty score was 12.14 (SD
Discussion
This study described theory-based variables associated with physicians’ reactions to uncertainty in the context of SDM. Findings showed that different variables related to physicians’ reluctance to disclose uncertainty and their anxiety from uncertainty. The results can inform potential pathways for the successful implementation of SDM in clinical practice and reinforce the need to assess PRU in SDM implementation studies.
Holding one or more graduate degrees in addition to an MD (i.e., more
Conflict of interest
The authors have no conflicts of interest to declare.
References (18)
- et al.
Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions
Patient Educ Couns
(2008) The theory of planned behavior
Organ Behav Hum Decis
(1991)- et al.
Risk taking and tolerance of uncertainty: implications for surgeons
J Surg Res
(2006) - et al.
Eisenberg center 2006 white paper series: communicating the uncertainty of harms and benefits of medical interventions
Med Decis Making
(2007) Theorizing about causes at the individual level while estimating effects at the population level: implications for prevention
Epidemiol Soc
(2005)- et al.
Shared decision-making and the concept of equipoise: the competences of involving patients in healthcare choices
Brit J Gen Pract
(2000) - et al.
How doctors and patients discuss routine clinical decisions. Informed decision making in the outpatient setting
J Gen Intern Med
(1997) - et al.
Informed decision making in outpatient practice: time to get back to basics
JAMA
(1999)