Purpose: The way patients’ and providers’ influence each other in the context of decision making may impact decision outcomes. This study examined the impact of a measure of the difference in scores between patients’ and providers’ reactions to uncertainty on patients’ satisfaction with breast health decisions.
Method: Seventy-five women facing decisions involving uncertainty and five breast surgeons were recruited from a dedicated Breast Health Center. Patients’ and providers’ reactions to uncertainty were assessed using the Physicians’ Reactions to Uncertainty Scale (“stress from uncertainty” subscale); the wording was slightly modified for patients to ensure the scale was applicable to patients. Patients’ decision satisfaction was assessed one to two weeks later by telephone.
Result: Participants were 51 years of age on average (range 26-82) and were seen by one of 5 breast surgeons (3 males, 2 females). Forty-six (61%) were facing cancer treatment decisions, and 29 (39%) were facing cancer prevention decisions involving uncertainty. “Stress from uncertainty” subscale scores ranged from 7 to 25 for providers, and 8 to 36 for patients (possible range 6 – 36; 6 = low stress, 36 = high stress). We fit a logistic regression model with patient satisfaction as the binary dependent variable. Our independent variables included the mean (rather than the sum) of the subscale items because some patients had missing data on individual items. Patients with a higher level of anxiety from uncertainty than their providers had a significantly lower probability of being satisfied with their decision (beta = -0.34, p<0.03). There was no significant association between the difference score and patients’ actual decisions, or the consistence between their decisions and providers’ recommendations.
Conclusion: A mismatch between patients’ and providers’ anxiety from uncertainty could influence the decision discussion and patients’ comfort with their treatment choices. More research is needed to determine how to help patients to tolerate and manage the uncertainty that is inherent in most medical decisions.
Candidate for the Lee B. Lusted Student Prize Competition