Medical Decision Making
Physicians’ reactions to uncertainty in the context of shared decision making

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Abstract

Objective

Physicians’ reactions towards uncertainty may influence their willingness to engage in shared decision making (SDM). This study aimed to identify variables associated with physician's anxiety from uncertainty and reluctance to disclose uncertainty to patients.

Methods

We conducted a cross-sectional secondary analysis of longitudinal data of an implementation study of SDM among primary care professionals (n = 122). Outcomes were anxiety from uncertainty and reluctance to disclose uncertainty to patients. Hypothesized factors that would be associated with outcomes included attitude, social norm, perceived behavioral control, intention to implement SDM in practice, and socio-demographics. Stepwise linear regression was used to identify predictors of anxiety from uncertainty and reluctance to disclose uncertainty to patients.

Results

In multivariate analyses, anxiety from uncertainty was influenced by female gender (β = 0.483; p = 0.0039), residency status (1st year: β = 0.600; p = 0.001; 2nd year: β = 0.972; p < 0.001), and number of hours worked per week (β = −0.012; p = 0.048). Reluctance to disclose uncertainty to patients was influenced by having more years in formal education (β = −1.996; p = 0.012).

Conclusion

Variables associated with anxiety from uncertainty differ from those associated with reluctance to disclose uncertainty to patients.

Practice implications

Given the importance of communicating uncertainty during SDM, measuring physicians’ reactions to uncertainty is essential in SDM implementation studies.

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.

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