Table 1.
Traits, strategies and skills influencing and impacting on managing uncertainty: Quantitative cross-sectional studies
| Author Year Country |
Study type | Specialty or condition/clinician grade or experience | Setting/ recruitment/ Sample size (n) and response rate (RR %) | Uncertainty assessment | Uncertainty Resource | Uncertainty type Cognitive (C) Emotional (E) Ethical (ETH) |
Results |
|---|---|---|---|---|---|---|---|
| Cooke 2013 Australia [30] | Cross-sectional survey | General practice / Registrar | Survey participants recruited from advertisements and through training events; (n = 128) (RR: 90%) |
Intolerance of uncertainty scale −12 (IUS-12) Physicians reactions to uncertainty Scale −8 (PRUS) |
Resilience | General intolerance of uncertainty Anxiety due to uncertainty (E) Reluctance to disclose uncertainty to patients (Eth) |
Lower resilience was associated with lower tolerance of uncertainty. |
| Evans 2009 USA [4] |
Cross sectional survey | Pediatrics, family medicine and internal medicine/ Board certified and resident physicians in primary care with a mixture of experience levels | Primary care / Survey participants recruited from an academic medical centre (n = 78) (RR: 76%) | Physicians Belief Scale −32 (PBS), Physician reactions to uncertainty Scale – 8 (PRUS) | Cognitive beliefs | Conceptual uncertainty – difficulties applying abstract criteria to concrete situations (C) Stress reactions to uncertainty (E) |
Physicians adopting a biopsychosocial epistemology model were associated with less stress reactions to uncertainty while a biomedical model was associated with more stress reactions to uncertainty. Clinician gender, specialty area and experience were correlated with stress reactions to uncertainty. |
| Nevalainen 2014 Finland [29] |
Questionnaire-based survey (self-assessment) | Primary Care/Recently qualified GPs (<5 years, mean age 31.2 years) and experienced GPs (>5 years, mean age 48.4 years) | Convenience sample of GPs recruited via email. N = 165/244 (RR: 68%) | Custom made questionnaire | Experience | Access to information sources (C) Tolerance of uncertainty (E) |
Experienced GPs better tolerate uncertainty (53.8% (95% CI; 42.2–65.0) in medical decision-making than their younger colleagues (25.9% (95% CI; 17.0–36.5) (p < 0.001). |
| Portnoy, 2011 USA [6] |
Cross-sectional survey-representative sample | Mixed –Family practice, internists, pediatrics, obstetrics and gynecology / Mixed 13.9 years practicing (SD ± 7.5) | Primary care; n = 1500 total; (GPs n = 515 34.3%) (RR: 48%) | Ambiguity aversion (AA) in medicine scale. | Factors influencing physicians’ attitudes towards the communication and management of scientific uncertainty in clinical practice | Physicians’ attitudes about communicating and managing uncertainty and their perceptions of negative reactions to uncertainty by their patients (Eth) | Physician demographics (including medical specialty, ethnicity and gender) predicted attitudes towards communicating and managing scientific uncertainty. Physicians’ perceptions of their patients’ responses to ambiguity also influenced decisions to share ambiguity where physicians who thought more of their patients would have negative reactions to ambiguous information were more likely to decide what’s best for the patient (p = 0.013) and to withhold an intervention that had uncertainty associated with it (p = <0.001). |
| Schneider 2010 Germany [10] |
Survey – questionnaire (development consisting of focus groups) | General Practice / Overall experience as a doctor –mean years =22.7, experience as a GP, 15.4 years | University hospital conference & 23 “quality circles” (GP groups). Responders n = 93 (conference) & n = 232 (quality circles) (Overall RR: 68%) |
Developing the Dealing with uncertainty questionnaire (DUQ); GP diagnostic action scale and GP diagnostic reasoning scale. | Cognitive heuristics | Dealing with diagnostic uncertainty and heuristics in diagnostic thinking (C) Tolerance of uncertainty (E) | The use of test of time, knowledge of family situation and occupational situation as a simple heuristic. Emotional intolerance against uncertainty correlates with an increase in diagnostic activity. Emotional responses to uncertainty might influence gender-specific reactions to uncertainty in different ways. |
| Schneider 2014 Germany [31] |
Mixed methods study (focus groups and cross sectional survey) | Primary care, generic conditions/ clinical experience 23.9 years (SD ± 23.9 years) | Development - 10 experienced GPs and survey - n = 228 (RR: 97%) | Communicating and dealing with uncertainty questionnaire (CoDU), Physician reaction to Uncertainty (PRU), and Big Five Inventory (BFI-K) | Personality traits of GPs in relation to decision making concerning uncertainty management | Diagnostic action (C) Intuition (E) Extended social anamnesis (Eth) Anxiety due to uncertainty (E) Communicating uncertainty (Eth) |
GPs scoring high in neuroticism demonstrated more anxiety due to uncertainty and higher reluctance to communicate with patients. Extraversion, conscientiousness and openness correlated negatively with anxiety due to uncertainty and positively with patient communication. |
RR Response rate, SP Standardized patients NA not applicable, NS not stated, C Cognitive, E emotional, Eth ethical