PATIENT-PROVIDER COMMUNICATION OF SCIENTIFIC UNCERTAINTY AND SURGICAL DECISION MAKING

Background and Purpose of the Study.  Decision making research has often overlooked the influence of patient-provider communication on patients’ clinical decisions. This study examined patient-provider communication of scientific uncertainty (the quality of risk information) during discussions about preference-sensitive surgical decisions.

 Method: To date, forty-nine women facing surgical decisions involving uncertainty have been recruited from the surgical clinic at a dedicated Breast Health Center. Forty-five (92%) consented and agreed to participate. The PI observed the surgical consult of consenting patients and rated the quality of patient-provider communication using a modified OPTION scale, an observational measure of patient-provider interactions. Patients’ reactions to uncertainty, numeracy level, understanding of treatment options, and demographic information were assessed immediately after the visit. Information-seeking behaviors and decision satisfaction were assessed one week later by telephone.

 Results. Participants were 51 years of age on average (range 27-71) and were seen by one of 5 breast surgeons (3 males, 2 females). Overall, women were satisfied with the information they received and their decision making process (mean = 5, possible range 1-6), although many women (86%) sought additional information from sources such as other health care providers (41%) or the Internet (64%). Most reported a strong ability to understand numeric information (68%), but only half (51%) said that they prefer to hear statistical information presented numerically. Surgeons communicated general uncertainty to patients most (91%) of the time, uncertainty about risk and probability occasionally (15% of the time), and uncertainty about evidence rarely (9% of the time). However, they often expressed uncertainty only when prompted by patients. 

 Conclusions: These preliminary results suggest that women may rely on sources beyond their surgeon for a satisfactory decision-making process. Findings also suggest that providers need to be informed about whether women want to hear information about scientific uncertainty. Moreover, it is important to determine how to present this information to patients to improve clinical decision making. More research is needed to determine how the quality of the patient-provider relationship influences patients’ reactions to scientific uncertainty and subsequent decisions.