Patient/Physician Communication

The best way to communicate uncertainty to patients about the harms and benefits of treatments remains unidentified

For patients to truly share in medical decisions with their doctors, they must understand their medical condition, know what treatments are available, and understand the expected outcomes of treatment. In the process, patients must interpret a great deal of medical information about the benefits and harms of certain procedures, much of which is uncertain.

Research studies suggest many recommendations for and examples of communicating uncertainty, but few are supported by evidence, concludes a review of studies on the topic. The studies also revealed the multiple sources of uncertainty in most medical decisions. These include uncertainty about future outcomes, the validity of evidence about risks, the personal significance of particular risks (for example, their severity or timing), and the uncertainty arising from the complexity of risk information (for example, multiplicity of risks and benefits and their changes over time). Also, researchers differ in how they define uncertainty and its sources, as well as its measurement.

There are multiple types of uncertainty that clinicians may want and need to communicate to patients, and the assessment of these uncertainties is often not straightforward. Also, both patients' and physicians' interpretation of and responses to uncertainty may depend on their personal characteristics, such as tolerance for risk, education, culture, and values. Patients' responses may be affected by the way in which uncertainty is communicated.

The authors conclude that the best way to present uncertainty depends on the decision the patient must make and the type of uncertainty presented. They call for more studies on the topic.

The study was supported by the Agency for Healthcare Research and Quality (Contract No. 290-05-0013).

More details are in "Communicating the uncertainty of harms and benefits of medical interventions," by Mary C. Politi, Ph.D., Paul K. Han, M.D., M.A., M.P.H., and Nananda F. Col, M.D., M.P.P., M.P.H., F.A.C.P., in the September-October 2007 Medical Decision Making 27, pp. 681-695.

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