Academic Journal
Exploring older adults' tolerance of uncertainty in colorectal cancer screening decisions.
| Τίτλος: | Exploring older adults' tolerance of uncertainty in colorectal cancer screening decisions. |
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| Συγγραφείς: | Fakhari H; Department of Communication Studies, School of Communication, Northwestern University, Evanston, IL, USA. Electronic address: hoda@u.northwestern.edu., Valentine KD; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA., Sepucha K; 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., Leavitt L; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA., Simmons LH; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA., Siegel LC; Harvard Medical School, Boston, MA, USA; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts., Richter JM; Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA., Fairfield KM; Department of Medicine, MaineHealth, Portland, ME, USA., Han PKJ; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA. |
| Πηγή: | Patient education and counseling [Patient Educ Couns] 2026 Aug; Vol. 149, pp. 109626. Date of Electronic Publication: 2026 Apr 01. |
| Τύπος έκδοσης: | Journal Article; Randomized Controlled Trial |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Country of Publication: Ireland NLM ID: 8406280 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-5134 (Electronic) Linking ISSN: 07383991 NLM ISO Abbreviation: Patient Educ Couns Subsets: MEDLINE |
| Imprint Name(s): | Publication: Limerick : Elsevier Original Publication: Princeton, N.J. : Excerpta Medica, c1983- |
| Ιατρικοί όροι (MeSH): | Colorectal Neoplasms*/diagnosis , Colorectal Neoplasms*/psychology , Early Detection of Cancer*/psychology , Mass Screening*/psychology , Decision Making* , Decision Making, Shared* , Patient Participation*, Humans ; Female ; Uncertainty ; Aged ; Male ; Aged, 80 and over ; Surveys and Questionnaires |
| Περίληψη: | Objectives: Uncertainty tolerance is an important characteristic thought to influence medical judgments and decisions. However, patients' tolerance of different types of uncertainty may vary and have different effects. The current study explored how tolerance of different types of uncertainty relates to decision-related outcomes among older adults considering colorectal cancer (CRC) screening. Methods: A secondary analysis of data from a cluster randomized clinical trial of an intervention to improve shared decision making (SDM) for older adults considering CRC screening was conducted. Patients completed a questionnaire following clinic visits, including measures of tolerance of uncertainty due to ambiguity (Ambiguity Aversion in Medicine) and complexity (Geller Tolerance of Ambiguity), as well as key decision-related cognitive, affective, and behavioral variables: perceived benefit of screening, concern about harms of screening, and CRC screening intention. Multilevel regression analyses were used to evaluate the associations between tolerance of uncertainty and decision-related variables as well as various patient characteristics. Results: The sample (N = 448) ranged in age from 76 to 85 (M=80, SD=3), and 53.7% were female, 94% were white, and 72% had at least a 4-year college degree. Higher tolerance of ambiguity, but not complexity, was associated with higher perceived benefit of screening (b=-0.077, p < 0.001). Higher tolerance of ambiguity (b=0.08, p < 0.01) and complexity (b=0.06, p < 0.05) were associated with lower concern about harms of screening, although neither were associated with CRC screening intentions. Conclusions: Tolerance of uncertainty due to ambiguity and complexity have different associations with key cognitive and affective variables related to older adults' CRC screening decisions, but not screening intentions. Patients' tolerance of different types of uncertainty may influence their responses to medical decisions involving uncertainty. Practice Implications: By assessing different types of uncertainty tolerance, clinicians may be able to better tailor their approach to patient communication and SDM to improve decision quality. (Copyright © 2026 Elsevier B.V. All rights reserved.) |
| Competing Interests: | Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Atlas receives consulting fees from the National Committee for Quality Assurance related to colorectal cancer screening. Dr. Simmons has received expert witness consultation fees from the United States Department of Justice for her consultation on cases involving cancer screening in primary care. |
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| Grant Information: | CDR-2017C3-9270 United States PCORI Patient-Centered Outcomes Research Institute; Z99 CA999999 United States ImNIH Intramural NIH HHS |
| Contributed Indexing: | Keywords: Colorectal cancer screening; Shared decision making; Uncertainty; Uncertainty tolerance |
| Entry Date(s): | Date Created: 20260407 Date Completed: 20260607 Latest Revision: 20260921 |
| Update Code: | 20260921 |
| PubMed Central ID: | PMC13162534 |
| DOI: | 10.1016/j.pec.2026.109626 |
| PMID: | 41945984 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1873-5134 |
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| DOI: | 10.1016/j.pec.2026.109626 |