Longitudinal assessment of residents' perceptions of shared decision-making, patient-centered communication, and reactions to uncertainty.

Abstract

Background: Managing uncertainty is an essential element of patient-centered communication (PCC) and shared decision making (SDM), yet we know little about how residents' reactions to uncertainty are related to their perceptions of their ability to engage in these important activities. This longitudinal study assesses whether residents' self-perceived PCC and SDM skills are associated with their reactions to uncertainty throughout residency.

Methods: Data were collected using a three-year, longitudinal survey of two cohorts of pediatric residents. Before each year of residency, residents self-reported PCC behaviors (information exchange and socioemotional communication), SDM skills, and general intolerance of uncertainty, and context-specific reactions to uncertainty in patient care. 100 residents completed Phase I (intern year), 61 residents completed Phase II (second year), and 53 residents completed Phase III (third year).

Results: Anxiety from uncertainty and reluctance to disclose uncertainty to parents were significant, negative predictors of SDM perceptions at each phase. Anxiety from uncertainty negatively predicted PCC information-related behaviors (seeking, giving, and verifying) at each phase, but not socioemotional communication. At each phase, concerns for bad outcomes only significantly predicted information giving. Tolerance of uncertainty was not a significant predictor of SDM perceptions or any of the four dimensions of PCC.

Conclusions: Residents with stronger negative reactions to uncertainty reported poorer self-perceptions of patient-centered communication and shared decision making over the course of residency. Thus, residency programs should implement training that normalizes conversations about uncertainty and identifies strategies for PCC and SDM in situations of clinical uncertainty.