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Facing epistemic and complex uncertainty in serious illness: The role of mindfulness and shared mind.

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Title: Facing epistemic and complex uncertainty in serious illness: The role of mindfulness and shared mind.
Authors: Epstein, Ronald M.1 (AUTHOR) ronald_epstein@urmc.rochester.edu
Source: Patient Education & Counseling. Nov2021, Vol. 104 Issue 11, p2635-2642. 8p.
Subject Terms: *Ambiguity tolerance, *Communication, *Decision making, Epistemic uncertainty, Advance directives (Medical care), Terror management theory, Mindfulness, Physician-patient relations, Uncertainty, Probability theory
Abstract: Background: Epistemic uncertainty refers to situations in which available evidence is insufficient or unreliable, often accompanied by complexity due to novel contexts, multifactorial causation, and emerging options (the "unknowable unknown"). It stands in contrast to aleatory uncertainty where probabilities are known, and potential benefits and harms can be calculated and presented graphically (the "knowable unknown").Discussion: Epistemic uncertainty is common, and encompasses uncertainty about the nature of the illness, whom to entrust with one's care, and one's ability to adapt and cope. Communication about the "unknowable unknown" occurs infrequently and ineffectively, and there is little research on improving communication in the face of epistemic and complex uncertainty. Terror Management Theory (TMT) predicts that in encountering serious illness, people engage in "worldview defense" - suppressing death-related thoughts, affiliating with like-minded others, and developing cognitive rigidity and intolerance of information that challenges their worldview. Mindfulness is associated with diminished defensive worldview reactions and cognitive rigidity, and greater tolerance of ambiguity. Shared mind encompasses shared understanding and affective attunement.Conclusion: For clinicians and seriously ill patients facing epistemic uncertainty, psychologically-informed interventions that promote mindfulness and shared mind offer promise in promoting open discussions regarding prognostic uncertainty, advance care planning, and treatment decision-making. [ABSTRACT FROM AUTHOR]
Copyright of Patient Education & Counseling is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Education Research Complete
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  Data: Facing epistemic and complex uncertainty in serious illness: The role of mindfulness and shared mind.
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  Data: <searchLink fieldCode="AR" term="%22Epstein%2C+Ronald+M%2E%22">Epstein, Ronald M.</searchLink><relatesTo>1</relatesTo> (AUTHOR)<i> ronald_epstein@urmc.rochester.edu</i>
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  Data: <searchLink fieldCode="JN" term="%22Patient+Education+%26+Counseling%22">Patient Education & Counseling</searchLink>. Nov2021, Vol. 104 Issue 11, p2635-2642. 8p.
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  Data: *<searchLink fieldCode="DE" term="%22Ambiguity+tolerance%22">Ambiguity tolerance</searchLink><br />*<searchLink fieldCode="DE" term="%22Communication%22">Communication</searchLink><br />*<searchLink fieldCode="DE" term="%22Decision+making%22">Decision making</searchLink><br /><searchLink fieldCode="DE" term="%22Epistemic+uncertainty%22">Epistemic uncertainty</searchLink><br /><searchLink fieldCode="DE" term="%22Advance+directives+%28Medical+care%29%22">Advance directives (Medical care)</searchLink><br /><searchLink fieldCode="DE" term="%22Terror+management+theory%22">Terror management theory</searchLink><br /><searchLink fieldCode="DE" term="%22Mindfulness%22">Mindfulness</searchLink><br /><searchLink fieldCode="DE" term="%22Physician-patient+relations%22">Physician-patient relations</searchLink><br /><searchLink fieldCode="DE" term="%22Uncertainty%22">Uncertainty</searchLink><br /><searchLink fieldCode="DE" term="%22Probability+theory%22">Probability theory</searchLink>
– Name: Abstract
  Label: Abstract
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  Data: <bold>Background: </bold>Epistemic uncertainty refers to situations in which available evidence is insufficient or unreliable, often accompanied by complexity due to novel contexts, multifactorial causation, and emerging options (the "unknowable unknown"). It stands in contrast to aleatory uncertainty where probabilities are known, and potential benefits and harms can be calculated and presented graphically (the "knowable unknown").<bold>Discussion: </bold>Epistemic uncertainty is common, and encompasses uncertainty about the nature of the illness, whom to entrust with one's care, and one's ability to adapt and cope. Communication about the "unknowable unknown" occurs infrequently and ineffectively, and there is little research on improving communication in the face of epistemic and complex uncertainty. Terror Management Theory (TMT) predicts that in encountering serious illness, people engage in "worldview defense" - suppressing death-related thoughts, affiliating with like-minded others, and developing cognitive rigidity and intolerance of information that challenges their worldview. Mindfulness is associated with diminished defensive worldview reactions and cognitive rigidity, and greater tolerance of ambiguity. Shared mind encompasses shared understanding and affective attunement.<bold>Conclusion: </bold>For clinicians and seriously ill patients facing epistemic uncertainty, psychologically-informed interventions that promote mindfulness and shared mind offer promise in promoting open discussions regarding prognostic uncertainty, advance care planning, and treatment decision-making. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: <i>Copyright of Patient Education & Counseling is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=ehh&AN=153030181
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        Value: 10.1016/j.pec.2021.07.030
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        Text: English
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        Type: general
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      – SubjectFull: Decision making
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      – SubjectFull: Epistemic uncertainty
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      – SubjectFull: Uncertainty
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              Text: Nov2021
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