Patient response to physician expressions of uncertainty: a systematic review

The consequences of uncertainty are extensive with the potential to influence a multitude of issues such as patient expectations, diagnosis, treatment decisions, patient confidence and satisfaction and ultimately patient compliance. To review the relevant literature pertaining to physician expressions of uncertainty and its effects on patients. A search was conducted in July 2016 of electronic databases; PsycINFO, PsycARTICLES, MEDLINE and Embase. Key search terms included uncertainty, physician uncertainty, patient attitude, patient confidence and patient satisfaction. Other sources were obtained from reference lists. The eligibility of studies and data extracted were cross-checked with inclusion and exclusion criteria. The search yielded 14 studies and 4 were included for review. These studies yielded mixed results. In some studies patients preferred disclosure of uncertainty while in others such disclosure was negatively associated with patient confidence and satisfaction. This is at odds with the belief of theorists that uncertainty disclosure to patients is the crux of a successful doctor-patient relationship. The studies were, however, united in so far as the way in which the uncertainty was communicated to the patient was pivotal to patient responses to uncertainty. Uncertainty is a ubiquitous feature of medicine and more research should examine how physician's expressions of uncertainty affect patients.