Politi Mary C, Han Paul K J, Col Nananda F
Brown Medical School/Rhode Island Hospital, Providence, Rhode Island, USA.
Med Decis Making. 2007 Sep-Oct;27(5):681-95. doi: 10.1177/0272989X07307270. Epub 2007 Sep 14.
There is growing interest in shared medical decision making among patients, physicians, and policy makers. This requires patients to interpret increasing amounts of medical information, much of which is uncertain. Little is known about the optimal approaches to or outcomes of communicating uncertainty about the risks and benefits of treatments.
The authors reviewed the literature on various issues related to uncertainty in decision making: conceptualizing uncertainty, identifying its potential sources, assessing uncertainty, potential methods of communicating uncertainty, potential outcomes of communicating uncertainty, and current practices and recommendations by expert groups on communicating uncertainty.
There are multiple sources of uncertainty in most medical decisions. There are conceptual differences in how researchers define uncertainty and its sources, as well as in its measurement. The few studies that have assessed alternate means of communicating uncertainty dealt mostly with presenting uncertainty about probabilities. Both patients' and physicians' interpretation of and responses to uncertainty may depend on their personal characteristics and values and may be affected by the manner in which uncertainty is communicated.
Research has not yet identified best practices for communicating uncertainty to patients about harms and benefits of treatment. More conceptual, qualitative, and quantitative studies are needed to explore fundamental questions about how people process, interpret, and respond to various types of uncertainty inherent in clinical decisions.
患者、医生和政策制定者对共同医疗决策的兴趣日益浓厚。这要求患者解读越来越多的医疗信息，其中许多信息具有不确定性。对于传达治疗风险和益处不确定性的最佳方法或结果，人们知之甚少。
作者回顾了关于决策中不确定性相关各种问题的文献：不确定性的概念化、识别其潜在来源、评估不确定性、传达不确定性的潜在方法、传达不确定性的潜在结果，以及专家小组关于传达不确定性的当前实践和建议。
大多数医疗决策中存在多种不确定性来源。研究人员在如何定义不确定性及其来源以及如何衡量不确定性方面存在概念差异。少数评估传达不确定性替代方法的研究主要涉及呈现概率方面的不确定性。患者和医生对不确定性的解读和反应可能取决于他们的个人特征和价值观，并且可能受到传达不确定性方式的影响。
研究尚未确定向患者传达治疗危害和益处不确定性的最佳做法。需要更多的概念性、定性和定量研究来探索关于人们如何处理、解读和应对临床决策中固有各种不确定性的基本问题。
