Is it good to express uncertainty to a patient? Correlates and consequences for medical students in a standardized patient visit

Blanch, Danielle C.; Hall, Judith A.; Roter, Debra; Frankel, Richard M.

doi:10.1016/j.pec.2009.06.002

Cited by 50 publications

(50 citation statements)

References 42 publications

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“…28 Active participation would involve discussions of uncertainty and alternatives. Some existing studies suggest that when providers express uncertainty during medical encounters, patients are less satisfied and confident in their provider, [29][30][31] but these studies mostly examined scenarios in which providers indicated that they were unsure about proper treatments. Patient reactions to discussions of medical uncertainty require additional investigation.…”

Section: Discussionmentioning

confidence: 99%

Provider Recommendations in the Face of Scientific Uncertainty: An Analysis of Audio-Recorded Discussions about Vitamin D

2016

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BACKGROUND:Little is known about how providers communicate recommendations when scientific uncertainty exists. OBJECTIVES: To compare provider recommendations to those in the scientific literature, with a focus on whether uncertainty was communicated. DESIGN: Qualitative (inductive systematic content analysis) and quantitative analysis of previously collected audio-recorded provider-patient office visits. PARTICIPANTS: Sixty-one providers and a socioeconomically diverse convenience sample of 603 of their patients from outpatient community-and academicbased primary care, integrative medicine, and complementary and alternative medicine provider offices in Southern California. MAIN MEASURES:Comparison of provider informationgiving about vitamin D to professional guidelines and scientific information for which conflicting recommendations or insufficient scientific evidence exists; certainty with which information was conveyed. RESULTS: Ninety-two (15.3 %) of 603 visit discussions touched upon issues related to vitamin D testing, management and benefits. Vitamin D deficiency screening was discussed with 23 (25 %) patients, the definition of vitamin D deficiency with 21 (22.8 %), the optimal range for vitamin D levels with 26 (28.3 %), vitamin D supplementation dosing with 50 (54.3 %), and benefits of supplementation with 46 (50 %). For each of the professional guidelines/scientific information examined, providers conveyed information that deviated from professional guidelines and the existing scientific evidence. Of 166 statements made about vitamin D in this study, providers conveyed 160 (96.4 %) with certainty, without mention of any equivocal or contradictory evidence in the scientific literature. No uncertainty was mentioned when vitamin D dosing was discussed, even when recommended dosing was higher than guideline recommendations. CONCLUSIONS AND RELEVANCE: Providers convey the vast majority of information and recommendations about vitamin D with certainty, even though the scientific literature contains inconsistent recommendations and declarations of inadequate evidence. Not communicating uncertainty blurs the contrast between evidence-based recommendations and those without evidence. Providers should explore best practices for involving patients in decision-making by acknowledging the uncertainty behind their recommendations. INTRODUCTIONMedical care is full of uncertainty. Uncertainty is inherent in most diagnostic and treatment decisions.1,2 Decision-making is complicated by equivocal, insufficient or nonexistent scientific evidence, and by differences in provider or patient interpretations of the evidence. Medical communication guidelines suggest disclosing uncertainty to patients.3,4 Yet providers typically fail to convey uncertainty, 5 and the scientific literature contains little information about provider recommendations in the context of uncertainty.Vitamin D supplementation is a good topic for investigating provider-patient communication around scientific uncertainty, because 26-56 % of Americans tak...

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Section: Discussionmentioning

confidence: 99%

Provider Recommendations in the Face of Scientific Uncertainty: An Analysis of Audio-Recorded Discussions about Vitamin D

2016

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“…Indeed, medical students' expressions of uncertainty may increase patient anxiety [21]. One explanation for this strategy is that while trainees and providers confront the presence of uncertainty in medical knowledge, they do not engage with its wide-ranging implications [6].…”

Section: Physician Experience With Uncertaintymentioning

confidence: 99%

Conveying Uncertainty in Prognosis to Patients with ESRD

et al. 2015

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Background: Prognosis is a component of medical practice imbued with uncertainty. In nephrology, where mortality rates of elderly patients on dialysis are comparable to those of cancer patients, the implications of prognosis are unavoidable. Yet while most patients with end-stage renal disease (ESRD) desire to hear their prognosis, many nephrologists balk at this prospect in part owing to the uncertainty inherent in prognostic estimates. Summary: In this review, the concept of ‘uncertainty' in clinical practice is considered from physician and patient perspectives. From the training perspective, providers learn that uncertainty is inescapable in medicine and develop strategies to manage its presence, including the avoidance of communicating uncertainty to their patients. This presages infrequent discussions of prognosis, which in turn influence patient preferences for treatments that have little therapeutic benefits. A general approach to conveying prognostic uncertainty to ESRD patients includes confronting our own emotional reaction to uncertainty, learning how to effectively communicate uncertainty to our patients, and using an effective interdisciplinary team approach to demonstrate an ongoing commitment to our patients despite the presence of prognostic uncertainty. Key Messages: Uncertainty in prognosis is inevitable. Once providers learn to incorporate it into their discussions of prognosis and collaborate with their ESRD patients, such discussions can foster trust and reduce anxiety for both sides.

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“…Collaborative multidisciplinary teamwork environment has been associated with lower assessment of patient psychological status, unequal flow of information exchange -mainly from physicians to patients [28] -and poor physician-patient relationship building [9,15 && ,28]. It should be noted that reassurance strategies used intuitively -and often prematurely -by physicians during consultations have been shown to be counterproductive with anxious cancer patients in remission [30].…”

Section: Patient Characteristics and Skillsmentioning

confidence: 99%

“…Regarding communication strategies, studies have shown that disclosure of evidence-based information -and thus also the disclosure of a lack of medical knowledge or evidence -may have a negative impact on patients' confidence in their physician [27] or on patients' perception of physicians' communication abilities [28]. Such disclosures have been shown to negatively impact patient satisfaction about treatment decision [28], especially when patient preference about their involvement in decision-making is not explored [29 && ]. Moreover, this disclosure strategy…”

Section: Introductionmentioning

confidence: 99%