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Keywords:

  • ambiguity aversion;
  • patient–provider communication;
  • shared decision making

Abstract

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Conclusion
  7. Conflicts of interest
  8. Source of funding
  9. References

Background  Medical interventions are often characterized by substantial scientific uncertainty regarding their benefits and harms. Physicians must communicate to their patients as part of the process of shared decision making, yet they may not always communicate scientific uncertainty for several reasons. One suggested by past research is individual differences in physicians’ tolerance of uncertainty. Relatedly, an unexplored explanation is physicians’ beliefs about their patients’ tolerance of uncertainty.

Design  To test this possibility, we surveyed a sample of primary care physicians (= 1500) and examined the association between their attitudes about communicating and managing scientific uncertainty and their perceptions of negative reactions to uncertainty by their patients. Physician perceptions were measured by their propensity towards pessimistic appraisals of risk information and avoidance of decision making when risk information is ambiguous – of uncertain reliability, credibility or adequacy, known as ‘ambiguity aversion’.

Results  Confirming past studies, physician demographics (e.g. medical specialty) predicted attitudes toward communicating scientific uncertainty. Additionally, physicians’ beliefs about their patients’ ambiguity aversion significantly predicted these preferences. Physicians who thought that more of their patients would have negative reactions to ambiguous information were more likely to think that they should decide what is best for their patients (β = 0.065, = 0.013), and to withhold an intervention that had uncertainty associated with it (β = 0.170, < 0.001).

Discussion  When faced with the task of communicating scientific uncertainty about medical tests and treatments, physicians’ perce-ptions of their patients’ ambiguity aversion may be related to their attitudes towards communicating uncertainty.

Scientific uncertainty is ubiquitous in health care and information about the benefits and harms of many medical interventions are thus rarely as definitive as most people would prefer. This presents a challenge for patients and physicians who must make decisions in the face of incomplete evidence and conflicting expert opinion. Ethically physicians are obligated to inform patients about uncertainty and alternative options and to encourage participation in the decision-making process at a level they desire. These obligations represent core elements of shared decision making (SDM), an accepted normative standard of health care.1–4

Despite the acknowledged importance of communicating scientific uncertainty in health care, there are significant barriers to this practice. Patients may not always prefer information and participation in decision making.5–8 Deficits in numeracy and health literacy reduce patients’ capacity to understand information and to participate effectively in decision making.9,10 Physician barriers are also important. Most physicians endorse open models of communication; however, 14% endorse limited communication of information and a paternalistic decision-making process.7 There is wide variation in the degree to which physicians actually engage in SDM under conditions of scientific uncertainty.11 Less than half of physicians’ decision-making styles appear to be concordant with patient preferences.12–14

This discrepancy between physicians’ attitudes and practices has only begun to be explained. Structural factors such as a lack of time and reimbursement have been identified as important barriers. Higher patient volume is associated with less participatory decision making.8,11,15

Individual physician characteristics also play a role. Older age has been shown to predict a lower likelihood of SDM and greater endorsement of paternalistic decision making and communication styles.16,17 Physician gender and specialty are also associated with SDM.11

Emerging evidence also suggests the influence of psychological factors. Physician attitudes regarding the value, usefulness and scientific justification of SDM vary.8,15 Physicians also differ in their capacity to tolerate or deal with uncertainty. These differences may be related to physicians’ medical training and choice of subspecialty, which is reinforced by the training and socialisation process in medical school.11,18,19 Differences in physicians’ tolerance of uncertainty are important to understand, because they may influence the extent to which physicians disclose scientific uncertainty and involve patients in decision making. Lower tolerance of uncertainty has been associated with a lower likelihood of offering a hypothetical new predictive genetic test and disclosing ambiguous test results to patients.18 This suggests that physicians’ tolerance of uncertainty may influence the extent to which they adopt strategies such as non-directiveness and information disclosure, which are more likely to respect patient autonomy.

It is not clear, however, how much these communication strategies are driven by physicians’ own tolerance of uncertainty, as opposed to perceptions of their patients’ tolerance. The perception that patients are intolerant of uncertainty might disincline physicians to fully inform patients about medical decisions marked by uncertainty.

This study examined how physicians’ perceptions of their patients’ tolerance of uncertainty, in addition to physician and practice characteristics, are related to attitudes toward disclosing information and involving patients in decisions about medical interventions characterized by scientific uncertainty. We operationalized tolerance of uncertainty in terms of ambiguity aversion (AA). ‘Ambiguity’ refers to a specific type of uncertainty pertaining to the reliability, credibility or adequacy of risk information.20,21 Ambiguity is high when information is incomplete or conflicting and leads to pessimistic appraisals of risks and choice outcomes, and avoidance of decision making.22 This response, known as ‘ambiguity aversion’, has been demonstrated in decision-making domains both in and outside of health care.23,24

We were interested in attitudes about the willingness of physicians to communicate about scientific uncertainty and to adopt a shared versus paternalistic approach towards treatment decisions under conditions of uncertainty. We predicted that physicians who perceived greater AA on the part of their patients would report less favourable attitudes towards informing patients about scientific uncertainty and involving them in decision making. We predicted a similar pattern of results related to practice experience and patient volume, such that, those with more experience would have similar attitudes to those who perceived high patient AA.11,25 We also explored the influence of other factors such as physicians’ academic affiliation and medical specialty and patients’ financial status.8,15,18,19,26,27

Methods

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Conclusion
  7. Conflicts of interest
  8. Source of funding
  9. References

Procedure and participants

Data were gathered through the web-based DocStyles survey conducted by the public relations firm Porter Novelli, which administers the DocStyles survey annually. The overall DocStyles survey included 69 questions, focused on physicians’ attitudes and counselling behaviours regarding a variety of health issues including use and trust of health information; preferences, attitudes and usual practice for various medical and genetic tests; and issues related to patient–provider communication.

Physicians were sampled from the Epocrates Honors Panel, an opt-in panel of over 100 000 physicians who use Epocrates products and were verified against the American Medical Association’s master file.28 Recruitment quotas for the survey were 1000 primary care physicians (family practitioners or internists), 250 paediatricians and 250 OB/GYNs. Of the primary care physicians, 485 self-identified as internists, with the remainder in family or general practice.

The sample of physicians was designed to match the American Medical Association’s master file for the proportion of gender, age and geographic region. Physicians within the various combinations of these categories were randomly selected to receive an invitation to complete the survey. Inclusion criteria were that the physician practiced in the United States; actively saw patients; worked in an individual, group or hospital practice; and had been practising for at least 3 years. Physicians who met the inclusion criteria and completed the survey were compensated $45–55.a The overall response rate was 48%.

Measures

The authors licensed data from the 2006 DocStyles from Porter Novelli. The main dependent variables for this study were four items focusing on physicians’ attitudes towards communicating and managing scientific uncertainty. Because scales measuring physicians’ communication and management of scientific uncertainty do not exist, the dependent variables were created for this study. These variables were developed to assess attitudes about four conceptually distinct approaches to informing patients about scientific uncertainty and involving them in decision making about ambiguous interventions. Two of these approaches (Full disclosure and Patient autonomy) are consistent with SDM’s focus on giving patients necessary information and opportunity to participate in decision making. The other two approaches (Paternalism and Withholding intervention) represent lack of communication and patient autonomy, which can be construed as ways to avoid communicating about scientific uncertainty.

Physicians indicated their agreement with the following statements on a five-point Likert-type scale ranging from Strongly disagree to Strongly agree with 3 = Neutral: (i) Whenever experts have conflicting opinions about a medical test or treatment, doctors should give patients as much information as possible about it (Full disclosure), (ii) If experts have conflicting opinions about a medical test or treatment, doctors should decide what is best for each patient (Paternalism), (iii) Doctors should not offer a new medical test or treatment to people until it has been tested in many large studies (Withholding intervention) and (iv) Patients should have the freedom to try a new medical test or treatment, even if experts have conflicting opinions about it (Patient autonomy). Preliminary analyses confirmed that these items did, as planned, represent separate constructs; correlations among the items were weak (rs = 0.02–0.23).

Perceptions of patients’ AA were assessed using a version of the Ambiguity Aversion in Medicine scale.21 Physicians were asked to estimate the percentage of their patients, in 10% increments from 0 to 100%, who would have one of several potential negative reactions to a discussion about the scientific uncertainties and disagreements surrounding a controversial medical test or treatment. Those reactions included: becoming unwilling to have the test or treatment, finding the information upsetting, becoming less trustful of medical experts, being afraid of trying the test or treatment, avoiding making a decision about the test or treatment and losing confidence in the test or treatment. The scale had good internal consistency (α = 0.88), and each of the six items in this scale was significantly inter-correlated, rs = 0.37–0.66, Ps < 0.01; thus a composite measure was created representing the perceived average percentage of patients expected to demonstrate ambiguity aversion. This measure was designed to assess the physician’s beliefs about patients’ AA as a potential factor in the physicians’ communication and management of uncertainty.

Based on previous research on the association between physician demographic characteristics and tolerance of uncertainty, we also included the following physician and practice variables in our analyses: gender,b race (coded as white/non-white), specialty, number of years in practice, number of physicians in their practice, patient volume (operationalized as average number of patients seen per week,c and having privileges at a teaching hospital.8,11,15,18,19,25,26 In addition, as a characteristic of the practice in which the physician reported working, which may influence their general level of comfort communicating and managing scientific uncertainty, physicians reported their perception of the financial status of the majority of their patients, using five categories (Very poor – poor, Poor – lower middle class, Lower middle class – middle class, Middle class – upper middle class, and Upper middle class – affluent), which was re-coded into three categories, Very poor, Middle class and Affluent because of concerns about the distinctiveness and consequent usefulness of the five categories. Physician specialty was included to account for the effect of each specialty’s distinct training, population served, procedures used and potential distinct attitudes towards patient communication. Those internists and family practice physicians who identified themselves as primary care physicians were kept as distinct groups in the analysis. These physicians may often serve similar functions from the point of view of the patient; however, their training, clinical focus and patient population differ enough to justify examining them as distinct groups. Furthermore, family practice physicians and internists appear to respond differently to ambiguity; one study showed that these groups differ in their responses to multiple conflicting clinical practice guidelines.29

Separate multivariate linear regression models, with all predictors entered simultaneously, were fitted to examine the associations between each of the four attitude items and physicians’ perceptions of patients’ AA as well as physician and practice characteristics.

Results

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Conclusion
  7. Conflicts of interest
  8. Source of funding
  9. References

Descriptive results of outcome variables and AA items

Physician and practice characteristics of the sample are presented in Table 1. Means for the four communication and management attitude items were greater than the scale midpoint (3, signifying neutral) on average, indicating general agreement with the statements. Strongest agreement was for Full disclosure (= 4.15, SD = 0.662), followed by Paternalism (= 3.61, SD = 0.876), Withholding intervention (= 3.21, SD = 0.926) and Patient autonomy (= 3.31, SD = 0.913). All means were significantly higher than the scale midpoint, ts (1499) = 8.86–67.59, Ps < 0.001, and significantly different from each other, ts (1462) = 4.00–54.70, Ps < 0.001.

Table 1. Demographic characteristics of the sample (= 1500)
Demographic characteristicNumber or MeanPercentage or (SD)
Number of men (%)96464.3
Mean age, years44.3(8.3)
Race
 White111074.0
 Black or African American503.3
 Asian26517.7
 Native Hawaiian or Other Pacific Islander70.5
 American Indian or Alaskan Native60.4
 Other624.1
Medical specialty
 Family / general practitioner51534.3
 Internist48532.3
 Paediatrician25016.7
 OB/Gyn25016.7
Mean number of year practising13.9(7.5)
Mean number of patients per week120.2(72.1)
Mean number of physicians in practice15.9(52.4)
Number with privileges at a teaching hospital77751.8
Primary work setting
 Individual practice28819.2
 Group practice102268.1
 Hospital or clinic19012.7

Physicians’ perceptions of their patients’ AA were relatively high overall. On average, physicians reported that a notable percentage of their patients would have negative reactions in response to the disclosure of scientific uncertainty (= 37.3%, SD = 18.0). The most common potential reactions reported were: becoming unwilling to have the test or treatment (= 43.9%, SD = 21.5), followed by being afraid of trying the test of treatment (= 39.2%, SD = 22.7), avoiding making a decision about the test or treatment (M =37.9%, SD = 22.5), losing confidence in the test or treatment (= 37.7%, SD = 23.3) and finding the information upsetting (= 36.6%, SD = 23.7).

Predictors of physicians’ attitudes towards communicating scientific uncertainty

Results of the four regression analyses, all of which were significant, are organized later by outcome and can also be found in Table 2.

Table 2. Predictors of physicians’ attitudes towards communicating and managing uncertainty
  1. Gender was coded as 1 = Male, 2 = Female; Race was coded as 0 = Non-White, 1 = White; Physician Specialty (Family Practice, Internist, Paediatrician, OB/GYN) were effect coded with family practice as the reference group. *< 0.05, **< 0.01, ***< 0.001

 Whenever experts have conflicting opinions about a medical test or treatment, doctors should give patients as much information as possible about it (full disclosure) F(11, 1462) = 2.01, = 0.024If experts have conflicting opinions about a medical test or treatment, doctors should decide what is best for each patient (paternalism) F(11, 1462) = 5.57, < 0.001Doctors should not offer a new medical test or treatment to people until it has been tested in many large studies (withholding intervention) F(11, 1462) = 7.53, < 0.001Patients should have the freedom to try a new medical test or treatment, even if experts have conflicting opinions about it (patient autonomy) F(10, 14 862) = 3.18, < 0.001
  β P β P β P β P
Constant0.0000.0000.0000.000
Gender0.0210.455−0.0870.002**0.0020.9520.0030.924
Race−0.0260.347−0.0720.008**−0.1210.000***0.0400.143
Years practising0.0400.1510.0450.1010.0750.006**−0.0750.007**
Teaching hospital−0.0130.6300.0350.1810.0040.8820.0170.522
Practice size0.0070.803−0.0360.1610.0200.439−0.0320.219
Patient volume−0.0030.9240.1090.000***−0.0300.2560.0750.005**
Internist vs. family practice−0.1220.001**0.0040.9080.0170.630−0.0610.090
Paediatrician vs. family practice0.0890.016*0.0670.0680.0550.128−0.0280.444
OB/GYN vs. family practice0.0440.242−0.0300.418−0.0210.5700.1370.000***
Financial situation0.0070.784−0.0150.5590.0510.049*−0.0370.159
Ambiguity aversion−0.0310.2440.0560.032*0.1720.000***−0.0270.313

For Full disclosure, the only significant predictor of giving patients as much information as possible was physician specialty. Family practice physicians reported more positive attitudes toward giving patients as much information as possible in the face of conflicting expert opinion than did Internists (β = −0.119, = 0.001). Paediatricians endorsed the item significantly more than family practice physicians (β = 0.088, = 0.016).

For paternalism, a number of significant predictors emerged. Non-white physicians were more paternalistic than white physicians (β = −0.072, = 0.008), and female physicians were more paternalistic than male physicians (β = −0.087, = 0.002). There was also an effect for patient volume (β = 0.109, < 0.001), such that physicians who reported seeing more patients per week were more paternalistic (A small number of physicians reported an extremely high number of patients per week. Data from 37 physicians reporting patient volume more than 3 SDs above the mean were excluded. Analysis of these 37 physicians revealed only that men disproportionately reported excessively high patient volume compared with women χ2 = 10.26, = 0.001. Analyses including these outliers did not change the interpretation of the results). Paediatricians were marginally significantly more paternalistic than family practice physicians (β = 0.067, = 0.068). Finally, physicians’ perception of patients’ ambiguity aversion was a significant predictor (β = 0.056, = 0.032). The greater percentage of patients that physicians thought would have a negative reaction to discussing scientific uncertainty, the more paternalistic they were.

For withholding intervention, similarly to paternalism, non-white physicians were more likely to endorse withholding intervention compared with white physicians (β = −0.121, < 0.001). Additionally, years practising medicine was a significant predictor; the longer the physicians had been practising medicine, the more they agreed with withholding intervention until it has been tested in many large studies (β = 0.075, = 0.006). In addition, the perceived financial situation of patient was a small, but statistically significant predictor (β = 0.051, = 0.049). Physicians who perceived their patients at higher financial standing were more likely to withhold intervention. Finally, physicians’ perception of patients’ ambiguity aversion was a significant predictor (β = 0.172, < 0.001); the more patients whom physicians thought would have a negative reaction to the disclosure of scientific uncertainty, the more likely they were to withhold intervention.

Finally, for patient autonomy, as in previous regressions, both years practising medicine (β = −0.075, = 0.007) and patient volume (β = 0.075, = 0.005) emerged as small, but significant predictors. Physicians who reported more experience, as measured by years practising medicine, reported a lesser belief in patient autonomy (patients should have the freedom to try a new medical test or treatment, even if experts have conflicting opinions about it), whereas those who reported more experience measured by average patient volume reported more belief in patient autonomy. In addition, there were effects for specialty, such that OB/GYNs reported higher endorsement of patient autonomy than did family practice physicians (β = 0.137, < 0.001).

Discussion

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Conclusion
  7. Conflicts of interest
  8. Source of funding
  9. References

This study examined factors associated with physicians’ attitudes towards the communication and management of scientific uncertainty in clinical practice. Physicians’ attitudes towards communicating scientific uncertainty were related not only to demographic factors, confirming past research, but also to physicians’ perceptions of their patients’ AA.

The first theme that emerged in our results related to physician demographic and practice characteristics. Professional experience was related to physicians’ attitudes towards communicating and managing scientific uncertainty. Physician’s practising longer showed less favourable attitudes towards practices consistent with open disclosure of scientific uncertainty to their patients, confirming previous findings.11 Patient volume was also related to these attitudes; physicians who saw more patients were more likely to respond that patients should have the freedom to try a new test or treatment, but also endorsed greater paternalism. This apparent contradiction might be explained pragmatically. Perhaps reflecting an important nuance in physicians’ responses to uncertainty, physicians with high patient volume may be willing to have their patients try a new intervention, but may prefer to retain final decisional authority, or to limit discussion of such topics. This is consistent with findings that that people often prefer ambiguous options if those options are perceived to be ability based, as may be the case with skilled physicians.27

Confirming past findings related to SDM practices, differences by physician specialty were also found.11,18,19 These results may reflect physicians’ experiences in treating particular patient populations and their medical training paediatricians, who in previous studies have also been found to have moderate levels of tolerance for ambiguity, showed higher endorsement of full disclosure, which may reflect their desire to divulge as much information to paediatric patients and their caregivers as possible, whereas internists showed the opposite pattern.19 Also replicating some previous findings, non-white physicians reported higher levels of paternalism and attitudes toward withholding intervention. However, other studies have found no racial differences for tolerance for ambiguity.11,19 The effect of race on the communication of uncertainty is clearly complex and must be understood in the context of its effects on physician–patient communication more broadly. For example, research on physician and patient race concordance suggests that medical interactions that are race concordant are more patient-centred.30 It is still unknown whether factors that influence the relationship between race and patient-centred communication also influence the extent of communication about scientific uncertainty.

With respect to other socio-demographic factors, an unexpected finding emerged: female physicians were more paternalistic than male physicians. Although there is a long literature indicating that men are more paternalistic in communication, a systematic review of the topic suggests that although this is usually the case, among OB/GYNs, women may actually be more paternalistic.31–34 In the present study, male physicians accounted for nearly half of the OB/GYN respondents, which may account for this seemingly contradictory finding. As many of the past studies have focused on general physician–patient communication, future research should explore gender differences in ambiguity aversion and the communication and management of scientific uncertainty.

A second theme that emerged concerned physicians’ perceptions of their patients’ responses to ambiguity. Although previous work on AA has focused on how AA can affect one’s own intentions and behaviours, ours is the first to show that perceptions of another’s AA might also have important effects. Physicians’ perceptions of their patients’ AA significantly predicted physician’s reluctance to engage in open communication about scientific uncertainty. Notably, these associations were significant over and above the effects of physician and practice characteristics. Physicians who thought more of their patients would have aversive reactions to dealing with ambiguity were less likely to communicate to their patients. This propensity is potentially important, because it would preclude giving patients the opportunity to react to uncertainty. Interestingly, physicians’ perceptions of patients’ AA were not significantly related to full disclosure of information about scientific uncertainty, although the effect was in the expected direction. However, the totality of our findings provide preliminary evidence that physicians’ perceptions of patients’ AA may influence physicians to adopt paternalistic practices and to forego communicating with patients about scientific uncertainty and involving them in decision making. This might paradoxically and counterproductively increase patients’ uncertainty and would be problematic to the extent that physicians overestimate patients’ level of ambiguity aversion.

Future research is needed to explore whether physicians’ perceptions represent accurate assessments of their patients’ attitudes, given that data are lacking on the prevalence of AA in patient populations.21 Physicians may simply project their own AA onto their patients, or rationalize their own preferences for managing scientific uncertainty. A long line of research suggests that when information about another person’s state, mood or attitude is unknown the perceiver’s perception is likely to drive behaviour.35 Other well-described psychological factors and motivations such as the power differential between physicians and patients might also contribute to physicians’ misperceptions of patients’ AA. For example, those high in power or status exhibit interpersonal perception biases; such biases could lead physicians to form inaccurate perceptions of patients’ reactions to uncertain information.36–38 However, evidence about the effect of power differentials on the accuracy of interpersonal perception is mixed.33,39 More research is necessary to determine whether cognitive biases resulting from physicians’ perceptions of their power moderate the effect of their perceptions of their patients’ AA on their attitudes.

Another question raised by our findings is the extent to which physicians’ perceptions of patients’ AA, if inaccurate, can be made either more accurate or less influential in physicians’ propensity to communicate about uncertainty. It seems desirable to improve the accuracy of physicians’ assessments of their patients’ responses to ambiguity, to promote communication strategies that are acceptable to patients and consistent with their preferences. However, a deeper question is whether patients’ AA should matter to physicians’ communication preferences. Open communication of scientific uncertainty is justified ethically by the principle of respect for patient autonomy.40 Even if disclosing information and involving patients in decision making leads to heightened risk perceptions or decisional conflict this may not be sufficient cause to forego such discussions. If, as our data suggest, physicians are truly disinclined towards such communication because they perceive their patients to be ambiguity averse, then the appropriate task at hand may not be to increase the accuracy of physicians’ perceptions. Instead, the task should be to uncouple these perceptions from physicians’ communication practices and to develop ways of improving patients’ tolerance of ambiguity. This suggests the need for meta-communication about uncertainty. That is, physicians and patients need to talk about how they talk about uncertainty. This might involve eliciting preferences for discussing such information or discussing the physician’s own tolerance for uncertainty. Such meta-communication may be a critical preliminary step towards reducing the barriers that impede SDM under the increasingly common circumstance of scientific uncertainty in health care.

Limitations

Although drawn from a large nationally representative sample of physicians, conclusions are limited by the cross-sectional nature of the data, which restricts causal inferences about the relationship between physicians’ perceptions of patients’ AA and their attitudes towards SDM practices. Because the study outcomes were limited to attitudes and not actual behaviour, we do not know how our findings would translate into actual physician practice, especially given the small, although statistically significant, size of many of the effects. Although studies examining AA in patients have found consistent effects on actual behaviours, further research is needed to confirm the effects of physicians’ perceptions of patients’ AA on physician behaviours. More work is also needed to compare these effects to those of physicians’ own AA to disentangle physicians’ perceptions of their patients’ AA from their own AA.

A second limitation of this study is a potential social desirability bias of the respondents in their endorsement of the items assessing methods of communicating and managing scientific uncertainty. However, this does not appear to be a major limitation of our study, given attitudes with low social desirability, such as paternalism, received a moderate level of endorsement in the sample.

In addition, paediatricians’ mental models underlying their responses are unclear. We do not know whether paediatricians were thinking about their patients or those patients’ caregivers, who may be responsible for clinical decision making when responding to the items. The measure of ambiguity aversion also assessed physicians’ estimates of the overall proportion of their patients who were ambiguity averse; it did not ascertain physicians’ ability to discriminate between individual patients who would and would not have negative reactions to uncertainty. Nevertheless, it supports the potential influence of the physicians’ perceptions of patients’ AA on SDM practices and endorses the value of further research to elucidate this relationship.

Finally, the four main outcome variables were developed for use in the study, given the lack of validated scales to measure the extent and nature of physicians’ communication of scientific uncertainty. As designed, they exhibited low correlations with each other; however, they need to be validated in further studies. Importantly, these measures represent a novel method for assessing this process and have face validity as indicators of goals and practices fundamental to the communication of scientific uncertainty and SDM.

Conclusion

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Conclusion
  7. Conflicts of interest
  8. Source of funding
  9. References

The communication of scientific uncertainty is a challenging task and an essential element of shared decision making. Our study suggests that physicians’ attitudes towards the communication of uncertainty may be influenced not only by socio-demographic characteristics but also by perceptions of their patients’ aversion to ambiguity. These findings have important implications for clinical practice and future research.

Footnotes
  • a

    Variation in the honorarium provided was because of the differential response burden for certain respondents for the overall DocStyles survey (e.g. physicians who do not see children did not answer certain questions whereas paediatricians did), and to help with recruitment of certain physician specialties to meet the quota.

  • b

    Women accounted for nearly 60% of OB/GYN respondents, but only 30–33% of the other specialties inline image = 70.13, < 0.001. However, gender was retained in the regression models due to its known independent association with patient–provider communication style. In addition, collinearity diagnostics indicated that the variance inflation because of the inclusion of both gender and physician specialty was minimal (<2.1)

  • c

    A small number of physicians reported an extremely high number of patients per week. Data from 37 physicians reporting patient volume more than 3 SDs above the mean were excluded. Analysis of these 37 physicians revealed only that men disproportionately reported excessively high patient volume compared with women χ2 = 10.26, = 0.001. Analyses including these outliers did not change the interpretation of the results.

References

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Conclusion
  7. Conflicts of interest
  8. Source of funding
  9. References
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