Uncertainty tolerance among primary care physicians: Relationship to shared decision making-related perceptions, practices, and physician characteristics.

Autor: Valentine KD; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA., Leavitt L; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA., Sepucha KR; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA., Atlas SJ; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA., Simmons L; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA., Siegel L; Harvard Medical School, Boston, MA, USA; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA., Richter JM; Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA., Han PKJ; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA. Electronic address: paul.han@nih.gov.
Jazyk: angličtina
Zdroj: Patient education and counseling [Patient Educ Couns] 2024 Jun; Vol. 123, pp. 108232. Date of Electronic Publication: 2024 Mar 02.
DOI: 10.1016/j.pec.2024.108232
Abstrakt: Objective: Understand how physicians' uncertainty tolerance (UT) in clinical care relates to their personal characteristics, perceptions and practices regarding shared decision making (SDM).
Methods: As part of a trial of SDM training about colorectal cancer screening, primary care physicians (n = 67) completed measures of their uncertainty tolerance in medical practice (Anxiety subscale of the Physician's Reactions to Uncertainty Scale, PRUS-A), and their SDM self-efficacy (confidence in SDM skills). Patients (N = 466) completed measures of SDM (SDM Process scale) after a clinical visit. Bivariate regression analyses and multilevel regression analyses examined relationships.
Results: Higher UT was associated with greater physician age (p = .01) and years in practice (p = 0.015), but not sex or race. Higher UT was associated with greater SDM self-efficacy (p < 0.001), but not patient-reported SDM.
Conclusion: Greater age and practice experience predict greater physician UT, suggesting that UT might be improved through training, while UT is associated with greater confidence in SDM, suggesting that improving UT might improve SDM. However, UT was unassociated with patient-reported SDM, raising the need for further studies of these relationships.
Practice Implications: Developing and implementing training interventions aimed at increasing physician UT may be a promising way to promote SDM in clinical care.
Competing Interests: Declaration of Competing Interest The study was funded through a Patient-Centered Outcomes Research Institute® (PCORI) Award (CDR-2017C3–9270). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. With regards to potential conflicts of interest for this study, all authors report grant support from PCORI (CDR-2017C3–9270) for the study activities. Dr. Sepucha reports grant funding from Agency for Healthcare Research and Quality and a contract with Blue Cross Blue Shield of Massachusetts. Dr. Atlas reports grant funding from the National Cancer Institute and the Risk Management Foundation of Harvard. Dr. Simmons reports paid expert testimony from the US Department of Justice for testimony on cancer screening in primary care malpractice cases. Dr. Richter reports support from Exact Sciences and CRICO.
(Published by Elsevier B.V.)
Databáze: MEDLINE
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