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Clinicians' tolerance for uncertainty and communication about uncertainty with older adults -a standardized patient assessment study.

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Τίτλος: Clinicians' tolerance for uncertainty and communication about uncertainty with older adults -a standardized patient assessment study.
Συγγραφείς: Hillen M; Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, P.O. Box 22660, Amsterdam, 1100DD, The Netherlands. m.a.hillen@amsterdamumc.nl.; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands. m.a.hillen@amsterdamumc.nl., Nijskens C; Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Wezeman S; Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, P.O. Box 22660, Amsterdam, 1100DD, The Netherlands., Franssen R; Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Smets E; Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, P.O. Box 22660, Amsterdam, 1100DD, The Netherlands.; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands.
Πηγή: BMC geriatrics [BMC Geriatr] 2025 Dec 08; Vol. 26 (1), pp. 46. Date of Electronic Publication: 2025 Dec 08.
Τύπος έκδοσης: Journal Article; Observational Study
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: BioMed Central Country of Publication: England NLM ID: 100968548 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2318 (Electronic) Linking ISSN: 14712318 NLM ISO Abbreviation: BMC Geriatr Subsets: MEDLINE
Imprint Name(s): Original Publication: London : BioMed Central, [2001]-
Ιατρικοί όροι (MeSH): Geriatric Assessment*/methods , Internship and Residency*/standards , Internship and Residency*/methods , Communication* , Physician-Patient Relations* , Uncertainty*, Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged
Περίληψη: BACKGROUND: Uncertainty is omnipresent in care for older adults. Resident-physicians may be challenged to manage and communicate about such uncertainty. We aimed to 1) describe how resident-physicians discussed uncertainty with an older adult patient and involved them in decisions; and 2) assess how resident-physicians’ tolerance for uncertainty predicted communication about uncertainty and efforts towards patient involvement. METHODS: A video-recorded, standardized patient assessment study was conducted involving resident-physicians in internal medicine. Participants conducted online consultations with a standardized geriatric patient. Self-report questionnaires assessed participants’ tolerance for uncertainty, feelings of ambivalence, and satisfaction with communication. Systematic observational coding assessed how residents communicated about uncertainty and involved the patient in decision-making. Descriptive statistics and correlations between observed communication and self-report measures were tested. RESULTS: Residents (N = 37) expressed uncertainty on average 14 times per consultation (range 7–24), most often implicitly (67%). They primarily used information focused approaches (72%, e.g., explaining uncertainty). Emotion-focused approaches were scarcer (21%, e.g., facilitating patients’ coping with uncertainty). Tolerance for uncertainty was relatively high, and unrelated to residents’ uncertainty communication. Residents involved the patient in decision making to an acceptable degree. Patient involvement was not associated with residents’ uncertainty tolerance. Consultations with higher patient involvement included more frequent uncertainty expressions by residents (rp=0.38, p = .02). CONCLUSIONS: More solid evidence is needed on the relation between residents’ uncertainty tolerance and communication within care for older adult patients. Research evidence could guide reflective education to support residents in managing uncertainty, as well as skills training to enhance uncertainty communication.
Competing Interests: Declarations. Ethics approval and consent to participate: The work described in this manuscript was carried out in accordance with the Declaration of Helsinki. The study was exempted from the Medical Research Regulations Involving Human Subjects Act by the Medical Ethics Committee of Amsterdam University Medical Centers, location AMC (W20_425 # 20.472). All participants provided e-informed consent and anonymity of their data was guaranteed. Consent for publication: All authors agree with the final manuscript version and agree to be accountable for all aspects of the work. Competing interests: The authors declare no competing interests. Clinical trial number: not applicable.
References: J Med Educ. 1977 Jul;52(7):548-54. (PMID: 874987)
Fam Pract. 2021 Sep 25;38(5):654-668. (PMID: 33907806)
BMC Fam Pract. 2017 Aug 7;18(1):79. (PMID: 28784088)
J Clin Oncol. 2013 Sep 10;31(26):3242-9. (PMID: 23940230)
Front Psychol. 2021 May 31;12:635422. (PMID: 34135806)
Acad Med. 2021 Jul 1;96(7):1036-1042. (PMID: 33149092)
Med Educ. 2022 Dec;56(12):1150-1152. (PMID: 36124815)
Clin Teach. 2020 Oct;17(5):497-502. (PMID: 31903672)
Med Decis Making. 2011 Nov-Dec;31(6):828-38. (PMID: 22067431)
Health Expect. 2021 Aug;24(4):1025-1043. (PMID: 34101951)
BMJ. 2001 Sep 15;323(7313):625-8. (PMID: 11557716)
J Gen Intern Med. 2025 Jan;40(1):226-233. (PMID: 38485878)
Health Expect. 2005 Mar;8(1):34-42. (PMID: 15713169)
N Engl J Med. 2004 Dec 30;351(27):2870-4. (PMID: 15625341)
J Am Geriatr Soc. 2003 Oct;51(10):1398-403. (PMID: 14511159)
Soc Sci Med. 1990;31(5):619-24. (PMID: 2218644)
BMC Med Educ. 2015 Nov 04;15:198. (PMID: 26537260)
BMC Geriatr. 2021 Feb 6;21(1):112. (PMID: 33549059)
Anat Sci Educ. 2023 Jan;16(1):128-147. (PMID: 35114066)
J Gen Intern Med. 2021 Aug;36(8):2408-2413. (PMID: 33532966)
Psychooncology. 2000 Jul-Aug;9(4):293-302. (PMID: 10960927)
Pediatrics. 2022 Jun 1;149(6):. (PMID: 35603505)
Patient Educ Couns. 2018 Sep;101(9):1518-1537. (PMID: 29655876)
JAMA. 2005 Aug 10;294(6):716-24. (PMID: 16091574)
J Gen Intern Med. 2004 Nov;19(11):1088-95. (PMID: 15566437)
Patient Educ Couns. 2002 Oct -Nov;48(2):171-6. (PMID: 12401420)
J Am Geriatr Soc. 2013 Feb;61(2):264-9. (PMID: 23320808)
Patient Educ Couns. 2020 Nov;103(11):2328-2334. (PMID: 32475710)
J Pers Soc Psychol. 1996 Sep;71(3):431-49. (PMID: 8831157)
Med Educ. 2023 Sep;57(9):787-789. (PMID: 37157928)
Eur Geriatr Med. 2019 Jun;10(3):517-522. (PMID: 34652805)
J Anxiety Disord. 2007;21(1):105-17. (PMID: 16647833)
Acute Med. 2021;20(3):204-218. (PMID: 34679138)
Theor Med Bioeth. 2016 Feb;37(1):71-83. (PMID: 26906556)
Patient Educ Couns. 2009 Sep;76(3):300-6. (PMID: 19604663)
Patient Educ Couns. 2019 Dec;102(12):2349-2352. (PMID: 31288956)
Health Expect. 2015 Aug;18(4):542-61. (PMID: 23451939)
Med Educ. 2022 Dec;56(12):1163-1173. (PMID: 35797009)
Med Care. 1990 Aug;28(8):724-36. (PMID: 2385142)
Med Educ Online. 2021 Dec;26(1):1972762. (PMID: 34459363)
Med Decis Making. 2015 May;35(4):458-66. (PMID: 25712448)
Med Educ. 1994 Jul;28(4):316-22. (PMID: 7862004)
BMJ. 2011 Mar 22;342:d1745. (PMID: 21427038)
Qual Saf Health Care. 2008 Apr;17(2):122-6. (PMID: 18385406)
Soc Sci Med. 2017 May;180:62-75. (PMID: 28324792)
Med Educ. 2024 Jul;58(7):869-879. (PMID: 37963570)
J Gen Intern Med. 1988 Mar-Apr;3(2):144-9. (PMID: 3357071)
Med Educ. 2020 Feb;54(2):125-137. (PMID: 31867801)
Biometrics. 1977 Mar;33(1):159-74. (PMID: 843571)
Fam Cancer. 2020 Jan;19(1):65-76. (PMID: 31773425)
Med Decis Making. 2021 Apr;41(3):275-291. (PMID: 33588616)
Grant Information: 016.veni.198.017 Nederlandse Organisatie voor Wetenschappelijk Onderzoek
Contributed Indexing: Keywords: Communication; Geriatrics; Observational coding; Patient-provider interaction; Physician-patient relation; Uncertainty
Entry Date(s): Date Created: 20251209 Date Completed: 20260626 Latest Revision: 20260724
Update Code: 20260725
PubMed Central ID: PMC12797895
DOI: 10.1186/s12877-025-06705-y
PMID: 41361772
Βάση Δεδομένων: MEDLINE
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  Data: Clinicians' tolerance for uncertainty and communication about uncertainty with older adults -a standardized patient assessment study.
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  Data: <searchLink fieldCode="AU" term="%22Hillen+M%22">Hillen M</searchLink>; Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, P.O. Box 22660, Amsterdam, 1100DD, The Netherlands. m.a.hillen@amsterdamumc.nl.; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands. m.a.hillen@amsterdamumc.nl.<br /><searchLink fieldCode="AU" term="%22Nijskens+C%22">Nijskens C</searchLink>; Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.<br /><searchLink fieldCode="AU" term="%22Wezeman+S%22">Wezeman S</searchLink>; Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, P.O. Box 22660, Amsterdam, 1100DD, The Netherlands.<br /><searchLink fieldCode="AU" term="%22Franssen+R%22">Franssen R</searchLink>; Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.<br /><searchLink fieldCode="AU" term="%22Smets+E%22">Smets E</searchLink>; Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, P.O. Box 22660, Amsterdam, 1100DD, The Netherlands.; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands.
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  Data: <searchLink fieldCode="JN" term="%22100968548%22">BMC geriatrics</searchLink> [BMC Geriatr] 2025 Dec 08; Vol. 26 (1), pp. 46. <i>Date of Electronic Publication: </i>2025 Dec 08.
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– Name: Abstract
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  Data: BACKGROUND: Uncertainty is omnipresent in care for older adults. Resident-physicians may be challenged to manage and communicate about such uncertainty. We aimed to 1) describe how resident-physicians discussed uncertainty with an older adult patient and involved them in decisions; and 2) assess how resident-physicians’ tolerance for uncertainty predicted communication about uncertainty and efforts towards patient involvement. METHODS: A video-recorded, standardized patient assessment study was conducted involving resident-physicians in internal medicine. Participants conducted online consultations with a standardized geriatric patient. Self-report questionnaires assessed participants’ tolerance for uncertainty, feelings of ambivalence, and satisfaction with communication. Systematic observational coding assessed how residents communicated about uncertainty and involved the patient in decision-making. Descriptive statistics and correlations between observed communication and self-report measures were tested. RESULTS: Residents (N = 37) expressed uncertainty on average 14 times per consultation (range 7–24), most often implicitly (67%). They primarily used information focused approaches (72%, e.g., explaining uncertainty). Emotion-focused approaches were scarcer (21%, e.g., facilitating patients’ coping with uncertainty). Tolerance for uncertainty was relatively high, and unrelated to residents’ uncertainty communication. Residents involved the patient in decision making to an acceptable degree. Patient involvement was not associated with residents’ uncertainty tolerance. Consultations with higher patient involvement included more frequent uncertainty expressions by residents (rp=0.38, p = .02). CONCLUSIONS: More solid evidence is needed on the relation between residents’ uncertainty tolerance and communication within care for older adult patients. Research evidence could guide reflective education to support residents in managing uncertainty, as well as skills training to enhance uncertainty communication.
– Name: Abstract
  Label: Competing Interests
  Group: Ab
  Data: Declarations. Ethics approval and consent to participate: The work described in this manuscript was carried out in accordance with the Declaration of Helsinki. The study was exempted from the Medical Research Regulations Involving Human Subjects Act by the Medical Ethics Committee of Amsterdam University Medical Centers, location AMC (W20_425 # 20.472). All participants provided e-informed consent and anonymity of their data was guaranteed. Consent for publication: All authors agree with the final manuscript version and agree to be accountable for all aspects of the work. Competing interests: The authors declare no competing interests. Clinical trial number: not applicable.
– Name: Ref
  Label: References
  Group: RefInfo
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(PMID: <searchLink fieldCode="PM" term="%2231903672%22">31903672)</searchLink><br />Med Decis Making. 2011 Nov-Dec;31(6):828-38. (PMID: <searchLink fieldCode="PM" term="%2222067431%22">22067431)</searchLink><br />Health Expect. 2021 Aug;24(4):1025-1043. (PMID: <searchLink fieldCode="PM" term="%2234101951%22">34101951)</searchLink><br />BMJ. 2001 Sep 15;323(7313):625-8. (PMID: <searchLink fieldCode="PM" term="%2211557716%22">11557716)</searchLink><br />J Gen Intern Med. 2025 Jan;40(1):226-233. (PMID: <searchLink fieldCode="PM" term="%2238485878%22">38485878)</searchLink><br />Health Expect. 2005 Mar;8(1):34-42. (PMID: <searchLink fieldCode="PM" term="%2215713169%22">15713169)</searchLink><br />N Engl J Med. 2004 Dec 30;351(27):2870-4. (PMID: <searchLink fieldCode="PM" term="%2215625341%22">15625341)</searchLink><br />J Am Geriatr Soc. 2003 Oct;51(10):1398-403. (PMID: <searchLink fieldCode="PM" term="%2214511159%22">14511159)</searchLink><br />Soc Sci Med. 1990;31(5):619-24. (PMID: <searchLink fieldCode="PM" term="%222218644%22">2218644)</searchLink><br />BMC Med Educ. 2015 Nov 04;15:198. (PMID: <searchLink fieldCode="PM" term="%2226537260%22">26537260)</searchLink><br />BMC Geriatr. 2021 Feb 6;21(1):112. (PMID: <searchLink fieldCode="PM" term="%2233549059%22">33549059)</searchLink><br />Anat Sci Educ. 2023 Jan;16(1):128-147. (PMID: <searchLink fieldCode="PM" term="%2235114066%22">35114066)</searchLink><br />J Gen Intern Med. 2021 Aug;36(8):2408-2413. (PMID: <searchLink fieldCode="PM" term="%2233532966%22">33532966)</searchLink><br />Psychooncology. 2000 Jul-Aug;9(4):293-302. (PMID: <searchLink fieldCode="PM" term="%2210960927%22">10960927)</searchLink><br />Pediatrics. 2022 Jun 1;149(6):. (PMID: <searchLink fieldCode="PM" term="%2235603505%22">35603505)</searchLink><br />Patient Educ Couns. 2018 Sep;101(9):1518-1537. (PMID: <searchLink fieldCode="PM" term="%2229655876%22">29655876)</searchLink><br />JAMA. 2005 Aug 10;294(6):716-24. (PMID: <searchLink fieldCode="PM" term="%2216091574%22">16091574)</searchLink><br />J Gen Intern Med. 2004 Nov;19(11):1088-95. (PMID: <searchLink fieldCode="PM" term="%2215566437%22">15566437)</searchLink><br />Patient Educ Couns. 2002 Oct -Nov;48(2):171-6. (PMID: <searchLink fieldCode="PM" term="%2212401420%22">12401420)</searchLink><br />J Am Geriatr Soc. 2013 Feb;61(2):264-9. (PMID: <searchLink fieldCode="PM" term="%2223320808%22">23320808)</searchLink><br />Patient Educ Couns. 2020 Nov;103(11):2328-2334. (PMID: <searchLink fieldCode="PM" term="%2232475710%22">32475710)</searchLink><br />J Pers Soc Psychol. 1996 Sep;71(3):431-49. (PMID: <searchLink fieldCode="PM" term="%228831157%22">8831157)</searchLink><br />Med Educ. 2023 Sep;57(9):787-789. (PMID: <searchLink fieldCode="PM" term="%2237157928%22">37157928)</searchLink><br />Eur Geriatr Med. 2019 Jun;10(3):517-522. (PMID: <searchLink fieldCode="PM" term="%2234652805%22">34652805)</searchLink><br />J Anxiety Disord. 2007;21(1):105-17. (PMID: <searchLink fieldCode="PM" term="%2216647833%22">16647833)</searchLink><br />Acute Med. 2021;20(3):204-218. (PMID: <searchLink fieldCode="PM" term="%2234679138%22">34679138)</searchLink><br />Theor Med Bioeth. 2016 Feb;37(1):71-83. (PMID: <searchLink fieldCode="PM" term="%2226906556%22">26906556)</searchLink><br />Patient Educ Couns. 2009 Sep;76(3):300-6. (PMID: <searchLink fieldCode="PM" term="%2219604663%22">19604663)</searchLink><br />Patient Educ Couns. 2019 Dec;102(12):2349-2352. (PMID: <searchLink fieldCode="PM" term="%2231288956%22">31288956)</searchLink><br />Health Expect. 2015 Aug;18(4):542-61. (PMID: <searchLink fieldCode="PM" term="%2223451939%22">23451939)</searchLink><br />Med Educ. 2022 Dec;56(12):1163-1173. (PMID: <searchLink fieldCode="PM" term="%2235797009%22">35797009)</searchLink><br />Med Care. 1990 Aug;28(8):724-36. (PMID: <searchLink fieldCode="PM" term="%222385142%22">2385142)</searchLink><br />Med Educ Online. 2021 Dec;26(1):1972762. (PMID: <searchLink fieldCode="PM" term="%2234459363%22">34459363)</searchLink><br />Med Decis Making. 2015 May;35(4):458-66. (PMID: <searchLink fieldCode="PM" term="%2225712448%22">25712448)</searchLink><br />Med Educ. 1994 Jul;28(4):316-22. (PMID: <searchLink fieldCode="PM" term="%227862004%22">7862004)</searchLink><br />BMJ. 2011 Mar 22;342:d1745. (PMID: <searchLink fieldCode="PM" term="%2221427038%22">21427038)</searchLink><br />Qual Saf Health Care. 2008 Apr;17(2):122-6. (PMID: <searchLink fieldCode="PM" term="%2218385406%22">18385406)</searchLink><br />Soc Sci Med. 2017 May;180:62-75. (PMID: <searchLink fieldCode="PM" term="%2228324792%22">28324792)</searchLink><br />Med Educ. 2024 Jul;58(7):869-879. (PMID: <searchLink fieldCode="PM" term="%2237963570%22">37963570)</searchLink><br />J Gen Intern Med. 1988 Mar-Apr;3(2):144-9. (PMID: <searchLink fieldCode="PM" term="%223357071%22">3357071)</searchLink><br />Med Educ. 2020 Feb;54(2):125-137. (PMID: <searchLink fieldCode="PM" term="%2231867801%22">31867801)</searchLink><br />Biometrics. 1977 Mar;33(1):159-74. (PMID: <searchLink fieldCode="PM" term="%22843571%22">843571)</searchLink><br />Fam Cancer. 2020 Jan;19(1):65-76. (PMID: <searchLink fieldCode="PM" term="%2231773425%22">31773425)</searchLink><br />Med Decis Making. 2021 Apr;41(3):275-291. (PMID: <searchLink fieldCode="PM" term="%2233588616%22">33588616)</searchLink>
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            NameFull: Hillen M
      – PersonEntity:
          Name:
            NameFull: Nijskens C
      – PersonEntity:
          Name:
            NameFull: Wezeman S
      – PersonEntity:
          Name:
            NameFull: Franssen R
      – PersonEntity:
          Name:
            NameFull: Smets E
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 08
              M: 12
              Text: 2025 Dec 08
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-electronic
              Value: 1471-2318
          Numbering:
            – Type: volume
              Value: 26
            – Type: issue
              Value: 1
          Titles:
            – TitleFull: BMC geriatrics
              Type: main
ResultId 1