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Higher tolerance of ambiguity correlates with higher perceived benefit in colorectal cancer screeningHow your comfort with uncertainty affects colorectal cancer screening

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Key Takeaway
Note that higher tolerance of ambiguity correlates with better perceived benefit but does not impact screening intention.

This secondary analysis of a cluster randomized clinical trial evaluated the relationship between tolerance of uncertainty and decision-making outcomes in 448 older adults considering colorectal cancer (CRC) screening. The study specifically measured two types of uncertainty: ambiguity (Ambiguity Aversion in Medicine) and complexity (Geller Tolerance of Ambiguity).

Regarding primary outcomes, higher tolerance of ambiguity was associated with a higher perceived benefit of screening (b=-0.077, p < 0.001). Additionally, both higher tolerance of ambiguity (b=0.08, p < 0.01) and complexity (b=0.06, p < 0.05) were associated with a lower concern about the harms of screening. However, neither tolerance of ambiguity nor complexity showed a statistically significant association with CRC screening intentions.

Safety data and tolerability were not reported. The study is limited by its design as a secondary analysis of a cluster randomized trial. While these findings suggest that clinicians may tailor communication to improve decision quality in shared decision making, the results do not establish a causal link between uncertainty tolerance and patient intention to undergo screening.

How this fits prior evidence

How this fits prior evidence: This finding addresses a gap in understanding how patient perceptions of risk and benefit influence colorectal cancer screening decisions. While previous coverage established that FIT positivity and neoplasia detection rates peak in the first round of screening programs, this study explores the psychological factors influencing a patient's perception of those risks. It does not relate to surgical techniques or chemotherapy timing previously reported.

Deciding on a medical test can be stressful, especially when there is uncertainty about what the results might mean. For older adults facing colorectal cancer screening, this feeling of uncertainty can change how they view the benefits and risks of getting tested.

A study of 448 older adults looked at how people handle two types of uncertainty: ambiguity (not knowing what will happen) and complexity (dealing with many moving parts). The researchers found that people who were more comfortable with these types of uncertainty felt more confident in the benefits of screening. They also had fewer concerns about potential harms from the procedure.

While being comfortable with uncertainty helped patients feel better about the benefits and risks, it did not actually change their final intention to get screened. Because this was a secondary analysis of an existing trial, we know these results show a link rather than a direct cause. Doctors can use these findings to help tailor how they talk to patients about the complexities of cancer screening.

What this means for you:
Patients who are more comfortable with medical uncertainty feel more confident in the benefits of colon cancer screenings.

Common questions

Does being comfortable with uncertainty change if someone decides to get screened?

The study found that while people who were more comfortable with ambiguity and complexity felt more confident in the benefits of screening, it did not actually change their final intention to get a colorectal cancer screening.

How does uncertainty affect how patients view the risks of screening?

People who had a higher tolerance for both ambiguity and complexity reported lower concerns about the potential harms of undergoing a colorectal cancer screening procedure.

What is 'ambiguity' in this medical context?

In this study, ambiguity refers to the uncertainty caused by not knowing exactly what will happen. Patients who were more comfortable with this type of uncertainty felt more confident in the benefits of their cancer screenings.

Study Details

Study typeRct
EvidenceLevel 2
Follow-up48.0 mo
PublishedAug 2026
View Original 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.
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