Table 1.

Uncertainty Toolbox: Principles in the Approach to Uncertainty in the Clinical Encounter

Principle	Definition or Clarification	Example	Reference
Honesty	Intersects with other concepts such as integrity, truth-telling; empowers patients to decide on the course of therapy	“Whether statins should be used to prevent heart disease is a matter of dispute.”	10
Recognition of emotion	Explicit mention of the non-cognitive element of the decision that may be felt by patient or provider	“It seems like you are very nervous about the possibility of cancer. I understand that might play into your desire to have a mammogram at your age.”	11
Hope	The ability to envisage a positive outlook	“There is every reason to believe that regular activity and a healthy diet can favorably affect the progression of knee osteoarthritis.”	12
Support/coordination of care	Presenting possible options and following up on their execution	“While I do not think that the evidence for prostate biopsy is unequivocal, many people would see a urologist in this instance, and I could discuss with him the goals for a referral.”	13
Willingness to readdress	Actively presenting the possibility of future discussions in which other options might be chosen	“We can come back to this decision later. If things get worse you might want to make another choice.”	14
Respecting personal decisions	Explicitly stating that the decision can rely on the patient’s personal preference and that the provider will respect that	“While we are sharing the process of making this decision, you should feel free to make a decision which is right for you.”	3
A lack of decision is possible	Offering the status quo as an option	“You don’t have to make a decision right now.”	15,16