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Managing Uncertainty in Cancer Communication

Uncertainty is ever present in communication surrounding cancer prevention, screening, and treatment.

News media continuously disseminate information and research findings regarding cancer causes and prevention. This constant cycle of new and sometimes conflicting information can be confusing and contribute to a chronic state of uncertainty about cancer prevention recommendations. In fact, the National Cancer Institute's 2007 Health Information National Trends Survey found that almost 75% of respondents were confused and uncertain about which cancer prevention recommendations to follow and 50% were uncertain about the causes of cancer.

Additionally, the U.S. Preventive Services Task Force (USPSTF) recently changed its screening recommendations for breast and prostate cancer, likely confusing many people in the process and leaving many uncertain about how to proceed. For example, the recent breast cancer screening recommendations were not universally adopted across all cancer organizations, which likely contributed to confusion and uncertainty in the public. An earlier post by Minal Patel on October 14 also discussed the importance of communication to address rapidly changing health behavior recommendations.

In the context of cancer care, patients and their family members frequently face uncertainties related to prognosis and treatment effectiveness.

How can health communication and health care professionals best address public and patient uncertainties? I sat in on a course this past fall that discussed theoretical approaches to understanding uncertainty in a variety of contexts, including health and illness, which provided some guidance.

The literature provides various definitions of uncertainty. According to Brashers (2001), "uncertainty exists when details of situations are ambiguous, complex, unpredictable, or probabilistic; when information is unavailable or inconsistent; and when people feel insecure in their own state of knowledge or the state of knowledge in general." Theoretical discussions of uncertainty have historically suggested that people typically attempt to reduce uncertainty because uncertainty leads to negative emotions, such as anxiety, and that in order to reduce uncertainty people seek information. However, the current state of research on uncertainty has shifted from an emphasis on uncertainty reduction to uncertainty management. In addition, people can feel uncertain even when they have a lot of information about a topic. In fact, when people have too much information, they may end up feeling overwhelmed and helpless rather than empowered.

It is also likely that as some uncertainties are reduced, others will surface. Therefore, addressing uncertainty is not always a matter of reducing it, but is frequently a matter of managing it. It can also involve managing resulting negative emotions, such as anxiety and fear, as well as allowing the opportunity for hope and preventing fatalism.

Managing uncertainty in patients and the public

Managing uncertainty is clearly important in each phase of the cancer continuum, including prevention, screening, diagnosis, treatment, survivorship, and end of life.

A monograph produced by Epstein and Street in 2007 for the National Cancer Institute (NCI) emphasized the important role of patient-centered communication between clinicians and cancer patients in helping to manage the many uncertainties faced by cancer patients and their families. Patient-centered communication considers patients' needs, perspectives, and individual experiences; provides opportunities to patients to participate in their care; allows clinicians and patients to come to a shared understanding of the problem; and enhances the patient-clinician relationship.

To successfully manage uncertainty, communication between clinicians and patients should acknowledge uncertainty while maintaining hope, recognize that uncertainty often cannot be eliminated, and help the patient effectively cope with uncertainty by providing information, emotional support, and cognitive strategies for dealing with the anxiety associated with uncertainty. Epstein and Street suggest that patient outcomes may be best when clinicians directly address uncertainties with patients rather than acting as if they do not exist.

Many of the same strategies suggested for managing uncertainty in patient-clinician interactions would likely benefit others communicating cancer information, such as community health educators and health journalists. A frequent criticism of news coverage of health is that it tends not to discuss research findings in the context of previous relevant studies, so that people can make informed decisions based on the information available. A commonly suggested way to improve news media coverage of cancer is to increase the degree of uncertainty it conveys. If the degree of uncertainty is increased in individual news stories, then the variation in messages across time will appear to be reduced. In other words, greater uncertainty within stories about research findings will soften the "yo-yo" approach to cancer coverage and prevent the confusing reversals that play out in media coverage of cancer causes and prevention behaviors. Contrary to what one might suspect, including expressions of uncertainty such as hedging in cancer news stories has been found to have a positive effect on perceptions of the credibility of journalists and scientists.

Finally, it is important to remember that education level and health literacy level also play important roles in the process of understanding, making decisions, and acting on health information.

References:
Brashers, B. E. (2001). Communication and uncertainty management. Journal of Communication, 51, 477-497.

Susana Peinado
2011 CCRC Doctoral Fellow
University of California, Santa Barbara

Written by CCRC at 12:48

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