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J Gen Intern Med. 2019 Jun 13. doi: 10.1007/s11606-019-04860-8. [Epub ahead of print]

Communicating Uncertainty: a Narrative Review and Framework for Future Research.

Author information

1
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. asimpkin@mgh.harvard.edu.
2
Harvard Medical School, Boston, MA, USA. asimpkin@mgh.harvard.edu.
3
Department of Pharmacology, University of Oxford, Oxford, UK. asimpkin@mgh.harvard.edu.
4
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
5
Harvard Medical School, Boston, MA, USA.

Abstract

Discussing the uncertainty associated with a clinical decision is thought to be a critical element of shared decision-making. Yet, empirical evidence suggests that clinicians rarely communicate clinical uncertainty to patients, and indeed the culture within healthcare environments is often to equate uncertainty with ignorance or failure. Understanding the rationale for discussion of uncertainty along with the current evidence about approaches to communicating and managing uncertainty can advance shared decision-making as well as highlight gaps in evidence. With an increasing focus on personalized healthcare, and advances in genomics and new disease biomarkers, a more sophisticated understanding of how to communicate the limitations and errors that come from applying population-based, epidemiologic findings to predict individuals' futures is going to be essential. This article provides a narrative review of studies relating to the communication of uncertainty, highlighting current strategies together with challenges and barriers, and outlining a framework for future research.

KEYWORDS:

communication; decision-making; doctor-patient relationships; medical education; patient-centered care

PMID:
31197729
DOI:
10.1007/s11606-019-04860-8

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