6/3/18

1

ANXIETAL UNCERTAINTY: INCREASING THE PUBLIC FILTER

UNCERTAINTY IN HEALTHCARE

• Uncertainty is a pervasive and important problem that has attracted increasing attention in health care, given • the growing emphasis on evidence-based medicine

• Which requires research funding…so another underlying factor for increased in cost.

• shared decision making

• patient-centered care

• However, our understanding of this problem is limited, due in part to the absence of a unified, coherent concept of uncertainty.

UNCERTAINTY IN HEALTHCARE

• There are multiple meanings and varieties of uncertainty in health care, which are not often distinguished or acknowledged although each may have unique effects or warrant different courses of action.

6/3/18

2

“STRESS IS BAD FOR YOUR HEALTH. TODAY'S POLITICAL UNCERTAINTY MAKES IT WORSE”

• Americans are exposed to one of the most damaging sources of stress: uncertainty. • The assault on a fundamental

sense of security can make one sick.

HPA AXIS

• Sadly, relative to the political conditions we face now, we risk being an unwitting experiment in learned helplessness: • our sense of powerlessness in the face of uncaring leadership is continually reinforced in debates like the one

over our healthcare system.

• Through huge majorities oppose repeal – including many stakeholders in the healthcare industry, including doctors, patients and insurer groups

• This is another of the vicious cycles produced by today’s inequality: • it increases political polarization,

• the unchecked power of elites and

• overall helplessness.

6/3/18

3

• Uncertainty is a powerful force in medicine.

• Wennberg divides clinical uncertainty into several categories-• uncertainty about the nature of the patient's disease condition or health status• uncertainty about the effectiveness of a treatment even under ideal conditions and • uncertainty about patient preferences and values.

• Uncertainty also pervades the legal and regulatory governance of the health sphere, undermining efforts to pursue fairness

and efficiency through public policy.

UNCERTAINTY IN HEALTHCARE

• The literature on uncertainty in health care is fragmented, and existing insights have been incompletely translated to clinical practice.

• This will only be accomplished by synthesizing diverse theoretical and empirical literature from the fields of communication, decision science, engineering, health services research, and psychology, and developing a new integrative conceptual taxonomy of uncertainty.

• Uncertainty pervades and motivates every activity related to health care.

• At the most fundamental level, it is uncertainty of one form or another that fuels medical research, prompts patients to seek care, and stimulates medical intervention.

• The inability to abolish uncertainty, furthermore, promotes the perpetuation of these activities and creates difficult challenges for clinicians and patients.

6/3/18

4

• Despite the growing visibility and importance of uncertainty in health care, we have a limited understanding of how to address the many problems it poses for laypersons, patients, clinicians, and health policymakers.

• Consequently, little is still known about the optimal means and outcomes of communicating uncertainty to patients and the public,• and even less about how to help

clinicians, and patients cope with uncertainty.

• Implicit in the definition of uncertainty as a “state” is a conceptualization of uncertainty as a subjective, cognitive experience of people—• a state of mind rather than a feature of the objective world.

• The defining feature of this state, furthermore, appears to be lack of knowledge about some aspect of reality. • Importantly, however, the concept of uncertainty also implies a subjective consciousness or awareness of one’s lack of

knowledge, without which one could not feel uncertain

MULTIFACTORIAL

• A number of U.S. agencies play important public health roles that involve weighing evidence and taking into account uncertainties in the making of a policy or regulatory decision that affects public health.

• These different public health agencies and organizations to evaluate the human health risks and benefits and other factors influencing the decisions, along with their inherent uncertainties.

• Many organizations have no formal guidance materials related to their decision-making processes, and many do not conduct formal uncertainty analyses.

6/3/18

5

https://www.youtube.com/channel/UC_y4JDEYEWsgQDpxGiXEqmg

6/3/18

6

CLIMATE CHANGE PATH EXAMPLE

ENHANCED SELF-CARE

6/3/18

7

THE MOVE TOWARD E-HEALTH

• The United States health care system is an outdated model in need of fundamental change.

• As part of this change, the system must explore and take advantage of the potential benefits of the "e-revolution," a phenomenon that includes everyday use of the Internet by the general public.

• During 2002, an estimated 100 million Americans obtained information — including health information — from the Web as a basis for making decisions.

• The Internet has continued to become an exponentially influential force; and, as such, this medium could have a revolutionary role in retooling the trillion-dollar United States health care industry to improve patient self-management, patient satisfaction, and health outcomes.

• New e-technology formats introduced to the growing consumer movement will drive the next generation of self-care by allowing patients to manage their own health conveniently and proficiently.

6/3/18

8

• With an aging population, the greater burden of chronic disease and the development of new technologies, demand for healthcare is increasing, whilst healthcare budgets are limited.

• How much of a societies resources should be used in healthcare is a value based judgment.

• Ensuring that available resources are used for interventions that provide outcomes that patients most value, rather than a focus just on effectiveness and cost-effectiveness, may help to ensure that resources are used optimally.