Language of Uncertainty: the Expression of Decisional Conflict Related to Skin Cancer Prevention Recommendations


User-generated information on the Internet provides opportunities for the monitoring of health information consumer attitudes. For example, information about cancer prevention may cause decisional conflict. Yet posts and conversations shared by health information consumers online are often not readily actionable for interpretation and decision-making due to their unstandardized format. This study extends prior research on the use of natural language as a predictor of consumer attitudes and provides a link to decision-making by evaluating the predictive role of uncertainty indicators expressed in natural language. Analyzed data included free-text comments and structured scale responses related to information about skin cancer prevention options. The study identified natural language indicators of uncertainty and showed that it can serve as a predictor of decisional conflict. The natural indicators of uncertainty reported here can facilitate the monitoring of health consumer perceptions about cancer prevention recommendations and inform education and communication campaign planning and evaluation.

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  1. 1.

    Ancker JS, Carpenter KM, Paul G, Randi H, Rita K, Laura AVM, Prigerson HG, Quillin JM (2009) Peer-to-peer communication, cancer prevention, and the internet. J Health Commun 14:38–46. doi:10.1080/10810730902806760

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Sanchez MA, Rabin BA, Gaglio B, Michelle H, Khair Elzarrad M, Purcell P, Glasgow RE (2013) A systematic review of eHealth cancer prevention and control interventions: new technology, same methods and designs? Translat Behav Med 3:392–401. doi:10.1007/s13142-013-0224-1

    Article  Google Scholar 

  3. 3.

    Han PKJ, Richard PM, William MPK (2007) Perceived ambiguity about cancer prevention recommendations: associations with cancer-related perceptions and behaviours in a US population survey. Health Expect 10:321–336. doi:10.1111/j.1369-7625.2007.00456.x

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Brashers DE (2001) Communication and uncertainty management. J Commun 51:477–497. doi:10.1111/j.1460-2466.2001.tb02892.x

    Article  Google Scholar 

  5. 5.

    Han PKJ, William MP K, Lehman T, Bill K, Holly M, Andrew NF (2011) Communication of uncertainty regarding individualized cancer risk estimates effects and influential factors. Med Decis Mak 31:354–366

    CAS  Article  Google Scholar 

  6. 6.

    Becker MH, Maiman LA (1975) Sociobehavioral determinants of compliance with health and medical care recommendations. Med Care 13:10–24

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Rosenstock IM (1966) Why people use health services. Milbank Mem Fund Q 44(Suppl):94–127

    Article  Google Scholar 

  8. 8.

    Politi MC, Clark MA, Ombao H, Dizon D, Elwyn G (2011) Communicating uncertainty can lead to less decision satisfaction: a necessary cost of involving patients in shared decision making? Health Expect 14:84–91. doi:10.1111/j.1369-7625.2010.00626.x

    Article  PubMed  Google Scholar 

  9. 9.

    Einhorn HJ, and Robin MH (1988) Decision making under ambiguity: A note. Springer

  10. 10.

    Briss P, Rimer B, Reilley B, Coates RC, Lee NC, Mullen P, Corso P et al (2004) Promoting informed decisions about cancer screening in communities and healthcare systems. Am J Prev Med 26:67–80

    Article  PubMed  Google Scholar 

  11. 11.

    O’Connor AM (1995) Validation of a decisional conflict scale. Med Decis Mak 15:25–30. doi:10.1177/0272989X9501500105

    Article  Google Scholar 

  12. 12.

    Sherblom J, Van Rheenen DD (1984) Spoken language indices of uncertainty. Hum Commun Res 11:221–230. doi:10.1111/j.1468-2958.1984.tb00046.x

    Google Scholar 

  13. 13.

    Lakoff G (1988). Cognitive Semantics. In Meaning and Mental Representations, ed. Umberto Eco, Marco Santambrogio, and Patrizia Violi. Indiana University Press.

  14. 14.

    Jensen JD (2008) Scientific uncertainty in news coverage of cancer research: effects of hedging on scientists’ and journalists’ credibility. Hum Commun Res 34:347–369. doi:10.1111/j.1468-2958.2008.00324.x

    Article  Google Scholar 

  15. 15.

    Reyna VF (1981) The language of possibility and probability: effects of negation on meaning. Mem Cogn 9:642–650. doi:10.3758/BF03202359

    CAS  Article  Google Scholar 

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Yulia A. Strekalova is a PhD candidate in the College of Journalism and Communications. Vaughan James is an MA student in the College of Journalism and Communications.

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Correspondence to Yulia A. Strekalova.

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This work supported in part by the Graham Professional Development Health and Science Communication Research Fund. The authors declared that they have no competing interests.

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Strekalova, Y.A., James, V.S. Language of Uncertainty: the Expression of Decisional Conflict Related to Skin Cancer Prevention Recommendations. J Canc Educ 32, 532–536 (2017).

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  • Natural language processing
  • Uncertainty
  • Semantics
  • Cancer prevention