Uncertainty tolerance (UT) is an important, well-studied phenomenon in health care and many other important domains of life, yet its conceptualization and measurement by researchers in various ...disciplines have varied substantially and its essential nature remains unclear.
The objectives of this study were to: 1) analyze the meaning and logical coherence of UT as conceptualized by developers of UT measures, and 2) develop an integrative conceptual model to guide future empirical research regarding the nature, causes, and effects of UT.
A narrative review and conceptual analysis of 18 existing measures of Uncertainty and Ambiguity Tolerance was conducted, focusing on how measure developers in various fields have defined both the “uncertainty” and “tolerance” components of UT—both explicitly through their writings and implicitly through the items constituting their measures.
Both explicit and implicit conceptual definitions of uncertainty and tolerance vary substantially and are often poorly and inconsistently specified. A logically coherent, unified understanding or theoretical model of UT is lacking. To address these gaps, we propose a new integrative definition and multidimensional conceptual model that construes UT as the set of negative and positive psychological responses—cognitive, emotional, and behavioral—provoked by the conscious awareness of ignorance about particular aspects of the world. This model synthesizes insights from various disciplines and provides an organizing framework for future research. We discuss how this model can facilitate further empirical and theoretical research to better measure and understand the nature, determinants, and outcomes of UT in health care and other domains of life.
Uncertainty tolerance is an important and complex phenomenon requiring more precise and consistent definition. An integrative definition and conceptual model, intended as a tentative and flexible point of departure for future research, adds needed breadth, specificity, and precision to efforts to conceptualize and measure UT.
•Uncertainty tolerance (UT) is important, though its essential nature remains unclear.•A conceptual analysis of UT and ambiguity tolerance focused on past measures.•Definitions of UT vary; a unified, coherent conceptualization of UT is lacking.•We propose a multidimensional conceptual model that can guide future research on UT.
•Uncertainty in health care is an important phenomenon that is incompletely understood.•Much is both known and not known about the nature, effects, and communication of uncertainty in health ...care.•Addressing existing knowledge gaps requires a more systematic program of research on medical uncertainty.•A more systematic program of research requires integrative conceptual models and collaborative engagement of the broader research community.
To promote a more systematic approach to research on uncertainty in health care, and to explore promising starting points and future directions for this research.
We examine three fundamental aspects of medical uncertainty that a systematic research program should ideally address: its nature, effects, and communication. We summarize key insights from past empirical research and explore existing conceptual models that can help guide future research.
A diverse body of past research on medical uncertainty has produced valuable empirical insights and conceptual models that provide useful starting points for future empirical and theoretical work. However, these insights need to be more fully developed and integrated to answer remaining questions about what uncertainty is, how it affects people, and how and why it should be communicated.
Uncertainty in health care is an extremely important but incompletely understood phenomenon. Improving our understanding of the many important aspects of uncertainty in health care will require a more systematic program of research based upon shared, integrative conceptual models and active, collaborative engagement of the broader research community.
A more systematic approach to investigating uncertainty in health care can help elucidate how the clinical communication of uncertainty might be improved.
Background
Although patient‐driven second opinions are increasingly sought in oncology, the desirability of this trend remains unknown. Therefore, this systematic review assesses evidence on the ...motivation for and frequency of requests for second opinions and examines how they evolve and their consequences for oncological practice.
Materials and Methods
Relevant databases were sought using the terms “cancer,” “second opinion,” and “self‐initiated.” Included were peer‐reviewed articles that reported on patient‐initiated second opinions within oncology. Selection, data extraction, and quality assessment were performed and discussed by two researchers.
Results
Of the 25 included studies, the methodological designs were qualitative (n = 4), mixed (n = 1), or quantitative (n = 20). Study quality was rated high for 10 studies, moderate for eight, and low for seven studies. Reported rates of second opinion seeking ranged from 1%–88%. Higher education was most consistently related to seeking a second opinion. Patients’ primary motivations were a perceived need for certainty or confirmation, a lack of trust, dissatisfaction with communication, and/or a need for more (personalized) information. Reported rates of diagnostic or therapeutic discrepancies between the first and second opinions ranged from 2%–51%.
Discussion
Additional studies are required to further examine the medical, practical, and psychological consequences of second opinions for patients and oncologists. Future studies could compare the potential advantages and disadvantages of second opinion seeking, and might offer guidance to patients and physicians to better facilitate the second opinion process. Some practical recommendations are provided for oncologists to optimally discuss and conduct second opinions with their patients. The Oncologist 2017;22:1197–1211
Implications for Practice
Although cancer patients increasingly seek a second opinion, the benefits of this process remain unclear. Results of this systematic review suggest that the available studies on this topic are highly variable in both methodology and quality. Moreover, reported rates for a second opinion (1%–88%) as well as for disagreement between the first and second opinion (2%–51%) range widely. The primary motivations of patients are a need for certainty, lack of trust, dissatisfaction with communication, and/or a need for more (personalized) information. Additional research should evaluate how unnecessary second opinions might be avoided. Practical suggestions are provided for oncologists to optimize second opinions.
An increasing number of cancer patients appears to seek a second opinion about diagnosis or treatment. This systematic review examines the available empirical evidence on patient‐initiated second opinions in oncology and provides recommendations to clinicians for optimal communication about second opinions.
Background
Health‐care providers increasingly have to discuss uncertainty with patients. Awareness of uncertainty can affect patients variably, depending on how it is communicated. To date, no ...overview existed for health‐care professionals on how to discuss uncertainty.
Objective
To generate an overview of available recommendations on how to communicate uncertainty with patients during clinical encounters.
Search strategy
A scoping review was conducted. Four databases were searched following the PRISMA‐ScR statement. Independent screening by two researchers was performed of titles and s, and subsequently full texts.
Inclusion criteria
Any (non‐)empirical papers were included describing recommendations for any health‐care provider on how to orally communicate uncertainty to patients.
Data extraction
Data on provided recommendations and their characteristics (eg, target group and strength of evidence base) were extracted. Recommendations were narratively synthesized into a comprehensible overview for clinical practice.
Results
Forty‐seven publications were included. Recommendations were based on empirical findings in 23 publications. After narrative synthesis, 13 recommendations emerged pertaining to three overarching goals: (a) preparing for the discussion of uncertainty, (b) informing patients about uncertainty and (c) helping patients deal with uncertainty.
Discussion and conclusions
A variety of recommendations on how to orally communicate uncertainty are available, but most lack an evidence base. More substantial research is needed to assess the effects of the suggested communicative approaches. Until then, health‐care providers may use our overview of communication strategies as a toolbox to optimize communication about uncertainty with patients.
Patient or public contribution
Results were presented to stakeholders (physicians) to check and improve their practical applicability.
Physician gaze towards patients is fundamental for medical consultations. Physicians’ use of Electronic Health Records (EHR) affects their gaze towards patients, and may negatively influence this ...interaction. We aimed to study conversation patterns during gaze shifts of physicians from the patient towards the EHR.
Outpatient consultations (N = 8) were eye-tracked. Interactions around physician gaze shifts towards the computer were transcribed.
We found that physician gaze shifts have different interactional functions, e.g., introducing a topic switch or entering data into the EHR. Furthermore, physicians differ in how they account for their gaze shifts, i.e., both implicitly and explicitly. Third, patients vary in treating the gaze shift as an indication to continue their turn or not.
Our results suggest that physician gaze shifts vary in function, in how physicians account for them, and in how they influence the conversation. Future research should take into account distinctions when relating gaze to patient outcomes.
Physicians may be aware of the interactional context of their gaze behaviour. Patients respond differently to various types of gaze shifts. How physicians handle gaze shifts can therefore have different consequences for the interaction.
•We studied physician gaze shifts from patient towards the computer.•We combined Conversation Analysis with mobile eye-tracking data.•Gaze shifts differ in interactional function and how they are accounted for.•Patient responses to physicians gaze shifts vary.•Research on physician gaze should take variations in gaze shifts into account.
•Physicians’ death anxiety does not seem to relate to avoidant communication and decision-making.•Death anxiety does seem to make end-of-life care more difficult for physicians.•Education focused on ...death competence may support physicians caring for patients at the end of life.
To examine the relationship between physicians’ death anxiety and medical communication and decision-making. It was hypothesized that physicians’ death anxiety may lead to the avoidance of end-of-life conversations and a preference for life-prolonging treatments.
PubMed and PsycInfo were systematically searched for empirical studies on the relation between physicians’ death anxiety and medical communication and decision-making.
This review included five quantitative and two qualitative studies (N = 7). Over 38 relations between death anxiety and communication were investigated, five were in line with and one contradicted our hypothesis. Physicians’ death anxiety seemes to make end-of-life communication more difficult. Over 40 relations between death anxiety and decision-making were investigated, three were in line with and two contradicted the hypothesis. Death anxiety seemes related to physicians’ guilt or doubt after a patient’s death.
There was insufficient evidence to confirm that death anxiety is related to more avoidant communication or decision-making. However, death anxiety does seem to make end-of-life communication and decision-making more difficult for physicians.
Education focused on death and dying and physicians’ emotions in medical practice may improve the perceived ease with which physicians care for patients at the end of life.
As tantalizing as the idea that background music beneficially affects foreign vocabulary learning may seem, there is-partly due to a lack of theory-driven research-no consistent evidence to support ...this notion. We investigated inter-individual differences in the effects of background music on foreign vocabulary learning. Based on Eysenck's theory of personality we predicted that individuals with a high level of cortical arousal should perform worse when learning with background music compared to silence, whereas individuals with a low level of cortical arousal should be unaffected by background music or benefit from it. Participants were tested in a paired-associate learning paradigm consisting of three immediate word recall tasks, as well as a delayed recall task one week later. Baseline cortical arousal assessed with spontaneous EEG measurement in silence prior to the learning rounds was used for the analyses. Results revealed no interaction between cortical arousal and the learning condition (background music vs. silence). Instead, we found an unexpected main effect of cortical arousal in the beta band on recall, indicating that individuals with high beta power learned more vocabulary than those with low beta power. To substantiate this finding we conducted an exact replication of the experiment. Whereas the main effect of cortical arousal was only present in a subsample of participants, a beneficial main effect of background music appeared. A combined analysis of both experiments suggests that beta power predicts the performance in the word recall task, but that there is no effect of background music on foreign vocabulary learning. In light of these findings, we discuss whether searching for effects of background music on foreign vocabulary learning, independent of factors such as inter-individual differences and task complexity, might be a red herring. Importantly, our findings emphasize the need for sufficiently powered research designs and exact replications of theory-driven experiments when investigating effects of background music and inter-individual variation on task performance.
Non-normative uncertainty (uncertainty about empirical facts) and normative uncertainty (uncertainty about moral values or beliefs) regarding unsolicited findings (UFs) might play an important role ...in clinical genetics. Identifying normative uncertainty is of special interest since it might guide towards novel directions for counseling practice. This study aims to gain insight into the role of non-normative and normative uncertainty regarding UFs, as expressed by counselees and counselors.
We performed a secondary qualitative analysis of interviews with counselees (n = 20) and counselors (n = 20) who had been confronted with UFs. Following a deductive approach, we used Han et al.’s existing theoretical framework of uncertainty, in which we additionally incorporated normative uncertainty.
Major issues of non-normative uncertainty were practical and personal for counselees, whilst counselors’ uncertainty pertained mainly to scientific issues. Normative uncertainty was a major theme throughout the interviews. We encountered the moral conflicts of autonomy vs. beneficence and non-maleficence and of autonomy vs. truthfulness.
Non-normative uncertainty regarding UFs highlights the need to gain more insight in their penetrance and clinical utility. This study suggests moral conflicts are a major source of feelings of uncertainty in clinical genetics.
Exploring counselees’ non-normative uncertainties and normative conflicts seems a prerequisite to optimize genetic counseling.
•Counselees and counselors confronted with UFs experience normative and non-normative uncertainty.•Moral conflicts might play a major role in clinical genetics in general.•The focus of informed consent should be on the quality of dialogue during pre-test counseling.•Multidisciplinary team meetings could provide counselors with guidance on UF disclosure.
Purpose
The original 18-item, four-dimensional Trust in Oncologist Scale assesses cancer patients’ trust in their oncologist. The current aim was to develop and validate a short form version of the ...scale to enable more efficient assessment of cancer patients’ trust.
Methods
Existing validation data of the full-length Trust in Oncologist Scale were used to create a short form of the Trust in Oncologist Scale. The resulting short form was validated in a new sample of cancer patients (
n
= 92). Socio-demographics, medical characteristics, trust in the oncologist, satisfaction with communication, trust in healthcare, willingness to recommend the oncologist to others and to contact the oncologist in case of questions were assessed. Internal consistency, reliability, convergent and structural validity were tested.
Results
The five-item Trust in Oncologist Scale Short Form was created by selecting the statistically best performing item from each dimension of the original scale, to ensure content validity. Mean trust in the oncologist was high in the validation sample (response rate 86%,
M
= 4.30,
SD
= 0.98). Exploratory factor analyses supported one-dimensionality of the short form. Internal consistency was high, and temporal stability was moderate. Initial convergent validity was suggested by moderate correlations between trust scores with associated constructs.
Conclusions
The Trust in Oncologist Scale Short Form appears to efficiently, reliably and validly measures cancer patients’ trust in their oncologist. It may be used in research and as a quality indicator in clinical practice. More thorough validation of the scale is recommended to confirm this initial evidence of its validity.
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