Disclosing the Uncertainty Associated with Prognostic Estimates in Breast Cancer.

Autor:	Engelhardt EG; Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS)., Pieterse AH; Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS)., Han PK; Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME (PKJH)., van Duijn-Bakker N; Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS)., Cluitmans F; Department of Oncology, Alrijne Hospital, Leiderdorp, the Netherlands (FC)., Maartense E; Department of Oncology, Reinier de Graaf Hospital, Delft, the Netherlands (ED, MMEMB)., Bos MM; Department of Oncology, Reinier de Graaf Hospital, Delft, the Netherlands (ED, MMEMB)., Weijl NI; Department of Internal Medicine and Oncology, MCH Bronovo Hospital, The Hague, the Netherlands (NIW)., Punt CJ; Department of Medical Oncology, Academic Medical Center, Amsterdam, the Netherlands (CJAP)., Quarles van Ufford-Mannesse P; Department of Oncology, HAGA Hospital, The Hague, the Netherlands (PQvU-M, HS, JEAP)., Sleeboom H; Department of Oncology, HAGA Hospital, The Hague, the Netherlands (PQvU-M, HS, JEAP)., Portielje JE; Department of Oncology, HAGA Hospital, The Hague, the Netherlands (PQvU-M, HS, JEAP)., van der Hoeven KJ; Department of Clinical Oncology, Leiden University Medical Center, Leiden, the Netherlands (KJMvdH, FJSW-A-J, JRK)., Woei-A-Jin FJ; Department of Clinical Oncology, Leiden University Medical Center, Leiden, the Netherlands (KJMvdH, FJSW-A-J, JRK)., Kroep JR; Department of Clinical Oncology, Leiden University Medical Center, Leiden, the Netherlands (KJMvdH, FJSW-A-J, JRK)., de Haes HC; Department of Medical Psychology, Academic Medical Center, Amsterdam, the Netherlands (HCJMdH, EMAS)., Smets EM; Department of Medical Psychology, Academic Medical Center, Amsterdam, the Netherlands (HCJMdH, EMAS)., Stiggelbout AM; Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands (EGE, AHP, NvD, AMS).
Jazyk:	angličtina
Zdroj:	Medical decision making : an international journal of the Society for Medical Decision Making [Med Decis Making] 2017 Apr; Vol. 37 (3), pp. 179-192. Date of Electronic Publication: 2016 Sep 29.
DOI:	10.1177/0272989X16670639
Abstrakt:	Background: Treatment decision making is often guided by evidence-based probabilities, which may be presented to patients during consultations. These probabilities are intrinsically imperfect and embody 2 types of uncertainties: aleatory uncertainty arising from the unpredictability of future events and epistemic uncertainty arising from limitations in the reliability and accuracy of probability estimates. Risk communication experts have recommended disclosing uncertainty. We examined whether uncertainty was discussed during cancer consultations and whether and how patients perceived uncertainty. Methods: Consecutive patient consultations with medical oncologists discussing adjuvant treatment in early-stage breast cancer were audiotaped, transcribed, and coded. Patients were interviewed after the consultation to gain insight into their perceptions of uncertainty. Results: In total, 198 patients were included by 27 oncologists. Uncertainty was disclosed in 49% (97/197) of consultations. In those 97 consultations, 23 allusions to epistemic uncertainty were made and 84 allusions to aleatory uncertainty. Overall, the allusions to the precision of the probabilities were somewhat ambiguous. Interviewed patients mainly referred to aleatory uncertainty if not prompted about epistemic uncertainty. Even when specifically asked about epistemic uncertainty, 1 in 4 utterances referred to aleatory uncertainty. When talking about epistemic uncertainty, many patients contradicted themselves. In addition, 1 in 10 patients seemed not to realize that the probabilities communicated during the consultation are imperfect. Conclusions: Uncertainty is conveyed in only half of patient consultations. When uncertainty is communicated, oncologists mainly refer to aleatory uncertainty. This is also the type of uncertainty that most patients perceive and seem comfortable discussing. Given that it is increasingly common for clinicians to discuss outcome probabilities with their patients, guidance on whether and how to best communicate uncertainty is urgently needed.
Databáze:	MEDLINE
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