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Exploring older adults' tolerance of uncertainty in colorectal cancer screening decisions.

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Τίτλος: Exploring older adults' tolerance of uncertainty in colorectal cancer screening decisions.
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.
References: Cancer Causes Control. 2008 Dec;19(10):1227-32. (PMID: 18592383)
BMC Public Health. 2006 Nov 06;6:272. (PMID: 17083746)
BMC Fam Pract. 2006 Mar 24;7:21. (PMID: 16563164)
J Health Commun. 2009 Sep;14(6):556-72. (PMID: 19731127)
Cancer Epidemiol Biomarkers Prev. 2007 Mar;16(3):458-66. (PMID: 17372241)
J Behav Med. 2023 Apr;46(1-2):40-53. (PMID: 35394240)
Soc Sci Med. 2017 May;180:62-75. (PMID: 28324792)
JAMA. 2021 May 18;325(19):1965-1977. (PMID: 34003218)
Br J Soc Psychol. 2001 Dec;40(Pt 4):471-99. (PMID: 11795063)
J Gen Intern Med. 1995 Oct;10(10):557-64. (PMID: 8576772)
Psychooncology. 2011 Oct;20(10):1023-33. (PMID: 21954045)
Soc Sci Med. 1990;31(5):619-24. (PMID: 2218644)
Med Decis Making. 2021 Feb;41(2):240-244. (PMID: 33435829)
J Clin Outcomes Manag. 2009 Jan 1;16(1):20-29. (PMID: 20046798)
J Health Commun. 2018;23(5):435-444. (PMID: 29648962)
Patient Educ Couns. 2018 Sep;101(9):1518-1537. (PMID: 29655876)
MDM Policy Pract. 2022 Dec 12;7(2):23814683221141377. (PMID: 36532296)
Cancer Epidemiol Biomarkers Prev. 2014 Dec;23(12):2916-23. (PMID: 25258015)
Psychooncology. 2005 Jul;14(7):517-34. (PMID: 15490428)
Med Educ Online. 2015 Sep 08;20:28285. (PMID: 26356230)
Epilepsy Res. 2014 Oct;108(8):1335-44. (PMID: 25138986)
Psychol Health Med. 2021 Aug;26(7):805-817. (PMID: 32426996)
Med Decis Making. 2011 Nov-Dec;31(6):828-38. (PMID: 22067431)
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
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– Name: Abstract
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  Data: Objectives: Uncertainty tolerance is an important characteristic thought to influence medical judgments and decisions. However, patients&#39; 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.&lt;br /&gt;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.&lt;br /&gt;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 &amp;lt; 0.001). Higher tolerance of ambiguity (b=0.08, p &amp;lt; 0.01) and complexity (b=0.06, p &amp;lt; 0.05) were associated with lower concern about harms of screening, although neither were associated with CRC screening intentions.&lt;br /&gt;Conclusions: Tolerance of uncertainty due to ambiguity and complexity have different associations with key cognitive and affective variables related to older adults&#39; CRC screening decisions, but not screening intentions. Patients&#39; tolerance of different types of uncertainty may influence their responses to medical decisions involving uncertainty.&lt;br /&gt;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.&lt;br /&gt; (Copyright &#169; 2026 Elsevier B.V. All rights reserved.)
– Name: Abstract
  Label: Competing Interests
  Group: Ab
  Data: 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.
– Name: Ref
  Label: References
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  Data: Cancer Causes Control. 2008 Dec;19(10):1227-32. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2218592383%22&quot;&gt;18592383)&lt;/searchLink&gt;&lt;br /&gt;BMC Public Health. 2006 Nov 06;6:272. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2217083746%22&quot;&gt;17083746)&lt;/searchLink&gt;&lt;br /&gt;BMC Fam Pract. 2006 Mar 24;7:21. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2216563164%22&quot;&gt;16563164)&lt;/searchLink&gt;&lt;br /&gt;J Health Commun. 2009 Sep;14(6):556-72. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2219731127%22&quot;&gt;19731127)&lt;/searchLink&gt;&lt;br /&gt;Cancer Epidemiol Biomarkers Prev. 2007 Mar;16(3):458-66. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2217372241%22&quot;&gt;17372241)&lt;/searchLink&gt;&lt;br /&gt;J Behav Med. 2023 Apr;46(1-2):40-53. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2235394240%22&quot;&gt;35394240)&lt;/searchLink&gt;&lt;br /&gt;Soc Sci Med. 2017 May;180:62-75. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2228324792%22&quot;&gt;28324792)&lt;/searchLink&gt;&lt;br /&gt;JAMA. 2021 May 18;325(19):1965-1977. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2234003218%22&quot;&gt;34003218)&lt;/searchLink&gt;&lt;br /&gt;Br J Soc Psychol. 2001 Dec;40(Pt 4):471-99. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2211795063%22&quot;&gt;11795063)&lt;/searchLink&gt;&lt;br /&gt;J Gen Intern Med. 1995 Oct;10(10):557-64. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%228576772%22&quot;&gt;8576772)&lt;/searchLink&gt;&lt;br /&gt;Psychooncology. 2011 Oct;20(10):1023-33. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2221954045%22&quot;&gt;21954045)&lt;/searchLink&gt;&lt;br /&gt;Soc Sci Med. 1990;31(5):619-24. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%222218644%22&quot;&gt;2218644)&lt;/searchLink&gt;&lt;br /&gt;Med Decis Making. 2021 Feb;41(2):240-244. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2233435829%22&quot;&gt;33435829)&lt;/searchLink&gt;&lt;br /&gt;J Clin Outcomes Manag. 2009 Jan 1;16(1):20-29. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2220046798%22&quot;&gt;20046798)&lt;/searchLink&gt;&lt;br /&gt;J Health Commun. 2018;23(5):435-444. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2229648962%22&quot;&gt;29648962)&lt;/searchLink&gt;&lt;br /&gt;Patient Educ Couns. 2018 Sep;101(9):1518-1537. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2229655876%22&quot;&gt;29655876)&lt;/searchLink&gt;&lt;br /&gt;MDM Policy Pract. 2022 Dec 12;7(2):23814683221141377. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2236532296%22&quot;&gt;36532296)&lt;/searchLink&gt;&lt;br /&gt;Cancer Epidemiol Biomarkers Prev. 2014 Dec;23(12):2916-23. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2225258015%22&quot;&gt;25258015)&lt;/searchLink&gt;&lt;br /&gt;Psychooncology. 2005 Jul;14(7):517-34. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2215490428%22&quot;&gt;15490428)&lt;/searchLink&gt;&lt;br /&gt;Med Educ Online. 2015 Sep 08;20:28285. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2226356230%22&quot;&gt;26356230)&lt;/searchLink&gt;&lt;br /&gt;Epilepsy Res. 2014 Oct;108(8):1335-44. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2225138986%22&quot;&gt;25138986)&lt;/searchLink&gt;&lt;br /&gt;Psychol Health Med. 2021 Aug;26(7):805-817. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2232426996%22&quot;&gt;32426996)&lt;/searchLink&gt;&lt;br /&gt;Med Decis Making. 2011 Nov-Dec;31(6):828-38. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2222067431%22&quot;&gt;22067431)&lt;/searchLink&gt;
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          Name:
            NameFull: Simmons LH
      – PersonEntity:
          Name:
            NameFull: Siegel LC
      – PersonEntity:
          Name:
            NameFull: Richter JM
      – PersonEntity:
          Name:
            NameFull: Fairfield KM
      – PersonEntity:
          Name:
            NameFull: Han PKJ
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 08
              Text: 2026 Aug
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-electronic
              Value: 1873-5134
          Numbering:
            – Type: volume
              Value: 149
          Titles:
            – TitleFull: Patient education and counseling
              Type: main
ResultId 1