title: Relationship between Physicians' Uncertainty about Clinical Assessments and Patient-Centered Recommendations for Colorectal Cancer Screening in the Elderly.
abstract: The goal of this study was to examine associations between physicians' clinical assessments, their certainty in these assessments, and the likelihood of a patient-centered recommendation about colorectal cancer (CRC) screening in the elderly.
  
  
  
  Two hundred seventy-six primary care physicians in the United States read 3 vignettes about an 80-year-old female patient and answered questions about her life expectancy, their confidence in their life expectancy estimate, the balance of benefits/downsides of CRC screening, their certainty in their benefit/downside assessment, and the best course of action regarding CRC screening. We used logistic regression to determine the relationship between these variables and patient-centered recommendations about CRC screening.
  
  
  
  In bivariate analyses, physicians had higher odds of making a patient-centered recommendation about CRC screening when their clinical assessments did not lead to a clear screening recommendation or when they experienced uncertainty in their clinical assessments. However, in a multivariate regression model, only benefit/downside assessment and best course of action remained statistically significant predictors of a patient-centered recommendation.
  
  
  
  Our findings demonstrate that when the results of clinical assessments do not lead to obvious screening decisions or when physicians feel uncertain about their clinical assessments, they are more likely to make patient-centered recommendations. Existing uncertainty frameworks do not adequately describe the uncertainty associated with patient-centered recommendations found in this study. Adapting or modifying these frameworks to better reflect the constructs associated with uncertainty and the interactions between uncertainty and the complexity inherent in clinical decisions will facilitate a more complete understanding of how and when physicians choose to include patients in clinical decisions.
authors.affiliation: Department of Medicine, Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (AFD, CLL)
authors.forename: Alexandra F
authors.initials: AF
authors.lastname: Dalton
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC (CG)|Department of Health Behavior and Health Education, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC (CG)
authors.forename: Carol E
authors.initials: CE
authors.lastname: Golin
authors.affiliation: Department of Biostatistics, Yale University School of Public Health, New Haven, CT (DE)
authors.forename: Denise
authors.initials: D
authors.lastname: Esserman
authors.affiliation: Department of Medicine, Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (MPP, DEP)
authors.forename: Michael P
authors.initials: MP
authors.lastname: Pignone
authors.affiliation: Department of Medicine, Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (MPP, DEP)|Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC (DEP).
authors.forename: Donald E
authors.initials: DE
authors.lastname: Pathman
authors.affiliation: Department of Medicine, Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (AFD, CLL)
authors.forename: Carmen L
authors.initials: CL
authors.lastname: Lewis
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002755:Choice Behavior; D002983:Clinical Competence; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006304:Health Status; D006801:Humans; D008017:Life Expectancy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care; D010820:Physicians / Q000523:psychology*; D011795:Surveys and Questionnaires; D035501:Uncertainty; D014481:United States
keywords: colorectal cancer screening; decision making; patient-centered recommendations; uncertainty