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The impact of physicians' reactions to uncertainty on patients' decision satisfaction

Authors

  • Mary C. Politi PhD,

    Corresponding author
    1. Assistant Professor, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
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  • Melissa A. Clark PhD,

    1. Associate Professor, Department of Community Health, Brown University, Providence, RI, USA
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  • Hernando Ombao PhD,

    1. Associate Professor, Department of Community Health, Center for Statistical Sciences, Alpert Medical School of Brown University, Providence, RI, USA
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  • France Légaré MD PhD

    1. Tier 2 Canada Research Chair in Implementation of Shared Decision Making in Primary Care, Research Centre of the Centre Hospitalier Universitaire de Québec, and Full Professor, Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada
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  • Conference presentation: An earlier version of this paper was presented in a poster presentation at the Society for Medical Decision Making, October 2009.

Dr Mary C. Politi, Department of Surgery, Washington University School of Medicine, 700 Rosedale Avenue, St. Louis, MO 63112, USA. E-mail: mpoliti@wustl.edu

Abstract

Rationale  Patients' and physicians' response to uncertainty may affect decision outcomes. The purpose of this study was to explore the impact of patients' and physicians' reactions to uncertainty on patients' satisfaction with breast health decisions.

Methods  Seventy-five women facing breast cancer prevention or treatment decisions and five surgeons were recruited from a breast health centre. Patients' and physicians' anxiety from uncertainty was assessed using the Physicians' Reactions to Uncertainty Scale; wording was slightly modified for patients to ensure the scale was applicable. Patients' decision satisfaction was assessed 1–2 weeks after their appointment. A mixed-effects logistic regression model was used to assess associations between patients' and providers' anxiety from uncertainty and patients' decision satisfaction. A provider-specific random effects term was included in the model to account for correlation among patients treated by the same provider.

Results  Patients' decision satisfaction was associated with physicians' anxiety from uncertainty (beta = 0.92, P < 0.01), but not with patients' anxiety from uncertainty (beta = −0.18, P > 0.27).

Conclusions  This study suggests that physicians' reactions to uncertainty may have an effect on decision satisfaction in patients. More research is needed to confirm this relationship and to determine how to help patient–provider dyads to manage the uncertainty that is inherent in most cancer decisions.

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