Clinicians’ tolerance for uncertainty and communication about uncertainty with older adults –a standardized patient assessment study

TL;DR

This study examines how resident physicians handle and communicate uncertainty when caring for older adults, finding that they often express uncertainty implicitly and focus on information rather than emotions.

Contribution

The study introduces a standardized patient assessment to explore how resident physicians' tolerance for uncertainty influences communication and patient involvement in decision-making.

Findings

Residents expressed uncertainty an average of 14 times per consultation, mostly implicitly.

Residents primarily used information-focused approaches to communicate uncertainty.

Higher patient involvement in decision-making was linked to more frequent uncertainty expressions by residents.

Abstract

Uncertainty is omnipresent in care for older adults. Resident-physicians may be challenged to manage and communicate about such uncertainty. We aimed to 1) describe how resident-physicians discussed uncertainty with an older adult patient and involved them in decisions; and 2) assess how resident-physicians’ tolerance for uncertainty predicted communication about uncertainty and efforts towards patient involvement.

A video-recorded, standardized patient assessment study was conducted involving resident-physicians in internal medicine. Participants conducted online consultations with a standardized geriatric patient. Self-report questionnaires assessed participants’ tolerance for uncertainty, feelings of ambivalence, and satisfaction with communication. Systematic observational coding assessed how residents communicated about uncertainty and involved the patient in decision-making. Descriptive statistics and correlations between observed communication and self-report measures were tested.

Residents (N = 37) expressed uncertainty on average 14 times per consultation (range 7–24), most often implicitly (67%). They primarily used information focused approaches (72%, e.g., explaining uncertainty). Emotion-focused approaches were scarcer (21%, e.g., facilitating patients’ coping with uncertainty). Tolerance for uncertainty was relatively high, and unrelated to residents’ uncertainty communication. Residents involved the patient in decision making to an acceptable degree. Patient involvement was not associated with residents’ uncertainty tolerance. Consultations with higher patient involvement included more frequent uncertainty expressions by residents (rp=0.38, p = .02).

More solid evidence is needed on the relation between residents’ uncertainty tolerance and communication within care for older adult patients. Research evidence could guide reflective education to support residents in managing uncertainty, as well as skills training to enhance uncertainty communication.

The online version contains supplementary material available at 10.1186/s12877-025-06705-y.

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