Facing epistemic and complex uncertainty in serious illness: The role of mindfulness and shared mind
Facing epistemic and complex uncertainty in serious illness: The role of mindfulness and shared mind
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DOI：
10.1016/j.pec.2021.07.030
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发表时间：
2021-10-16
影响因子：
3.5
通讯作者：
Epstein, Ronald M.
中科院分区：
文献类型：
--
作者：
Epstein, Ronald M.
背景：认知不确定性是指现有证据不足或不可靠的情况，通常伴随着由于新背景、多因素因果关系和新出现的选项（“不可知的未知”）而导致的复杂性。它与偶然不确定性形成鲜明对比，偶然不确定性的概率是已知的，潜在的好处和危害可以计算并以图形方式呈现（“已知的未知数”）。讨论：认知不确定性很常见，包括疾病性质、委托谁照顾以及适应和应对能力的不确定性。关于“不可知的未知”的沟通很少发生且无效，并且在面对认知和复杂的不确定性时改善沟通的研究很少。恐怖管理理论（TMT）预测，在遭遇严重疾病时，人们会进行“世界观防御”——压抑与死亡相关的想法，与志同道合的人交往，并对挑战其世界观的信息产生认知僵化和不容忍。正念与防御性世界观反应和认知僵化的减少以及对模糊性的更大容忍度相关。共同的思想包括共同的理解和情感协调。结论：对于面临认知不确定性的临床医生和重病患者来说，促进正念和共享思想的心理干预措施有望促进有关预后不确定性、预先护理计划和治疗决策的公开讨论。 (c) 2021 Elsevier B.V. 保留所有权利。
Background: Epistemic uncertainty refers to situations in which available evidence is insufficient or un-reliable, 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 "un-knowable unknown" occurs infrequently and ineffectively, and there is little research on improving com-munication 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 in-formation 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. (c) 2021 Elsevier B.V. All rights reserved.