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
In the context of cancer care, patients and their family members
frequently face uncertainties related to prognosis and treatment
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
Managing uncertainty in patients and the
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
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
Brashers, B. E. (2001). Communication and uncertainty management.
Journal of Communication, 51, 477-497.
2011 CCRC Doctoral Fellow
University of California, Santa Barbara