Exploring older adults' tolerance of uncertainty in colorectal cancer screening decisions

Authors

• Hoda Fakhari, Department of Communication Studies, School of Communication, Northwestern University, Evanston, IL, USA. Electronic address: hoda@u.northwestern.edu.
• K D. Valentine, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
• Karen Sepucha, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
• Steven J. Atlas, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
• Lauren Leavitt, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
• Leigh H. Simmons, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
• Kathleen M. Fairfield, Department of Medicine, MaineHealth, Portland, ME, USA

Document Type

Article

Publication Date

4-1-2026

Institution/Department

Internal Medicine

Journal Title

Patient education and counseling

Abstract

OBJECTIVES: Uncertainty tolerance is an important characteristic thought to influence medical judgments and decisions. However, patients' tolerance of different types of uncertainty may vary and have different effects. The current study explored how tolerance of different types of uncertainty relates to decision-related outcomes among older adults considering colorectal cancer (CRC) screening. METHODS: A secondary analysis of data from a cluster randomized clinical trial of an intervention to improve shared decision making (SDM) for older adults considering CRC screening was conducted. Patients completed a questionnaire following clinic visits, including measures of tolerance of uncertainty due to ambiguity (Ambiguity Aversion in Medicine) and complexity (Geller Tolerance of Ambiguity), as well as key decision-related cognitive, affective, and behavioral variables: perceived benefit of screening, concern about harms of screening, and CRC screening intention. Multilevel regression analyses were used to evaluate the associations between tolerance of uncertainty and decision-related variables as well as various patient characteristics. RESULTS: The sample (N = 448) ranged in age from 76 to 85 (M=80, SD=3), and 53.7% were female, 94% were white, and 72% had at least a 4-year college degree. Higher tolerance of ambiguity, but not complexity, was associated with higher perceived benefit of screening (b=-0.077, p <  0.001). Higher tolerance of ambiguity (b=0.08, p <  0.01) and complexity (b=0.06, p <  0.05) were associated with lower concern about harms of screening, although neither were associated with CRC screening intentions. CONCLUSIONS: Tolerance of uncertainty due to ambiguity and complexity have different associations with key cognitive and affective variables related to older adults' CRC screening decisions, but not screening intentions. Patients' tolerance of different types of uncertainty may influence their responses to medical decisions involving uncertainty. PRACTICE IMPLICATIONS: By assessing different types of uncertainty tolerance, clinicians may be able to better tailor their approach to patient communication and SDM to improve decision quality.

First Page

109626

Recommended Citation

Fakhari, Hoda; Valentine, K D.; Sepucha, Karen; Atlas, Steven J.; Leavitt, Lauren; Simmons, Leigh H.; and Fairfield, Kathleen M., "Exploring older adults' tolerance of uncertainty in colorectal cancer screening decisions" (2026). MaineHealth Maine Medical Center. 4464.
https://knowledgeconnection.mainehealth.org/mmc/4464