Quantifying implicit uncertainty in primary care consultations: A systematic comparison of communication about medically explained versus unexplained symptoms

Stortenbeker, Inge; Houwen, Juul; Dulmen, Sandra van; Hartman, Tim olde; Das, Enny

doi:10.1016/j.pec.2019.07.005

Cited by 9 publications

(28 citation statements)

References 17 publications

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“…Three publications suggested that (4) providers should allow flexibility in the extent to which uncertainty is communicated, depending on the individual and circumstance. This strategy requires taking into account patient preferences and psychological capacity to tolerate uncertainty and adjusting one's communication accordingly, for example by using more implicit wording (eg, “it could be” rather than “I don't know”) 28,61,62 . All three publications provided empirical support for this recommendation.…”

Section: Resultsmentioning

confidence: 99%

“…For example, when sensing that patients react negatively to explicit statements of uncertainty such as “I don't know”, it may be better to resort to more implicit means that effectively reflect the complex reality. Examples are as follows: explaining the most likely diagnoses, 61 asking other doctors for advice 28 and using careful terms such as “maybe” 61 , 62 …”

Section: Resultsmentioning

confidence: 99%

“… 28 , 61 A third (observational) study reported that general practitioners’ implicit expressions of uncertainty did not affect patients’ anxiety. 62 …”

Section: Resultsmentioning

confidence: 99%

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A scoping review of practice recommendations for clinicians’ communication of uncertainty

Medendorp

Stiggelbout

Aalfs

et al. 2021

Health Expectations

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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 abstracts, 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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

A scoping review of practice recommendations for clinicians’ communication of uncertainty

Medendorp

Stiggelbout

Aalfs

et al. 2021

Health Expectations

View full text Add to dashboard Cite

show abstract

“…This experience of "shared uncertainty"-where uncertainty resides in the minds of both the physician and the patientmay reassure patients and enhance their trust (Hillen et al, 2017a). In contrast, oncologists may remain implicit and/or omit specific uncertain information in an attempt to protect patients from experiencing strong emotions by not overly emphasizing uncertainty and potentially worrying them (Stortenbeker et al, 2019). However, this could cause patients to be oblivious to the severity of their situation and unable to take well-informed decisions .…”

Section: Discussionmentioning

confidence: 99%

Oncologists' Communication About Uncertain Information in Second Opinion Consultations: A Focused Qualitative Analysis

et al. 2021

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Introduction: Uncertainty is omnipresent in cancer care, including the ambiguity of diagnostic tests, efficacy and side effects of treatments, and/or patients' long-term prognosis. During second opinion consultations, uncertainty may be particularly tangible: doubts and uncertainty may drive patients to seek more information and request a second opinion, whereas the second opinion in turn may also affect patients' level of uncertainty. Providers are tasked to clearly discuss all of these uncertainties with patients who may feel overwhelmed by it. The aim of this study was to explore how oncologists communicate about uncertainty during second opinion consultations in medical oncology.Methods: We performed a secondary qualitative analysis of audio-recorded consultations collected in a prospective study among cancer patients (N = 69) who sought a second opinion in medical oncology. We purposively selected 12 audio-recorded second opinion consultations. Any communication about uncertainty by the oncologist was double coded by two researchers and an inductive analytic approach was chosen to allow for novel insights to arise.Results: Seven approaches in which oncologists conveyed or addressed uncertainty were identified: (1) specifying the degree of uncertainty, (2) explaining reasons of uncertainty, (3) providing personalized estimates of uncertainty to patients, (4) downplaying or magnifying uncertainty, (5) reducing or counterbalancing uncertainty, and (6) providing support to facilitate patients in coping with uncertainty. Moreover, oncologists varied in their (7) choice of words/language to convey uncertainty (i.e., “I” vs. “we”; level of explicitness).Discussion: This study identified various approaches of how oncologists communicated uncertain issues during second opinion consultations. These different approaches could affect patients' perception of uncertainty, emotions provoked by it, and possibly even patients' behavior. For example, by minimizing uncertainty, oncologists may (un)consciously steer patients toward specific medical decisions). Future research is needed to examine how these different ways of communicating about uncertainty affect patients. This could also facilitate a discussion about the desirability of certain communication strategies. Eventually, practical and evidence-based guidance needs to be developed for clinicians to optimally inform patients about uncertain issues and support patients in dealing with these.

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“…6 A study of implicit uncertainty in primary care consultations showed an increased likelihood of expressing uncertainty when patients' symptoms were medically unexplained, particularly for diagnostic and treatment recommendations. 7 Interestingly, no relationship between implicit expression of uncertainty and patient anxiety was found. 7 The quality of medical student case presentations can also be improved by a clinical reasoning curriculum.…”

Section: Introductionmentioning

confidence: 99%

Frequency of medical students' language expressing implicit uncertainty in simulated handovers

et al. 2022

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Objectives:The aim of this study was to investigate the number and type of implicit expressions of uncertainty by medical students during simulated patient handovers. Methods: Eighty-seven volunteer medical students, a convenience sample collected on a first-come, first-served basis, participated in simulated handovers. They each worked with three simulated patients who presented with different chief complaints and personal conditions. The handovers were video recorded and transcribed. A framework of implicit expressions of uncertainty was used to identify and count modifiers that attenuate or strengthen medical information using MAXQDA lexical search. We analysed the findings with respect to the patients' contexts. Results: Implicit uncertainty expressions which attenuate or strengthen information occurred in almost equal frequency, 1879 (55%) versus 1505 (45%). Attenuators were found most frequently in the category 'Questionable', 1041 (55.4%), strengtheners in the category 'Focused', 1031 (68.5%). Most attenuators and strengtheners were found in the handover of two patients with challenging personal conditions ('angry man', 434 (23.1%) versus 323 (21.5%); 'unfocused woman', 354 (19.4%) versus 322 (21.4%)) and one patient with abnormal laboratory findings ('elevated creatinine', 379 (20.2%) versus 285 (18.9%)). Conclusions: Medical students use a variety of implicit expressions of uncertainty in simulated handovers. These findings provide an opportunity for medical educators to design communication courses that raise students' awareness for content-dependent implicit expressions of uncertainty and provide strategies to communicate uncertainty explicitly.

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Quantifying implicit uncertainty in primary care consultations: A systematic comparison of communication about medically explained versus unexplained symptoms

Cited by 9 publications

References 17 publications

A scoping review of practice recommendations for clinicians’ communication of uncertainty

A scoping review of practice recommendations for clinicians’ communication of uncertainty

Oncologists' Communication About Uncertain Information in Second Opinion Consultations: A Focused Qualitative Analysis

Frequency of medical students' language expressing implicit uncertainty in simulated handovers

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