Psychometric re-evaluation of the German version of the Physicians’ Reaction to Uncertainty Scale

David Zybarth^1*Laura Inhestern¹Corinna Bergelt²

• ¹University Medical Center Hamburg-Eppendorf, Hamburg, Germany
• ²Greifswald University Hospital, Greifswald, Germany

Introduction: Uncertainties are integral to medicine and can lead to adverse effects if not addressed. However, assessing these uncertainties can be challenging. The Physicians’ Reaction to Uncertainty Scale is a widely used instrument to assess behavioral and emotional reactions to uncertainty. This study aims to examine the factorial structure and to re-evaluate the psychometric properties of the German version in a heterogeneous sample of physicians. Methods: We conducted an online survey targeting German physicians, irrespective of their medical specialties. We calculated means, standard deviations, as well as difficulty and discrimination indices for items. We computed Cronbach’s alpha for all subscales and used confirmatory factor analyses to assess factorial validity due to discrepancies in the assignment of item 5 between the original and the German versions. In the original version, item 5 was assigned to the subscale “anxiety due to uncertainty”, whereas in the German version, based on exploratory factor analysis, it was assigned to the subscale “concern about bad outcomes”. We tested three models: Model 1 (original), Model 2 (German version) and Model 3 (excludes item 5). Results: A total of 136 physicians (59% female) from 22 different medical specialties participated. The German version exhibited good psychometric properties. Most item difficulties were acceptable and all items demonstrated good item discrimination indices. The Cronbach’s alpha values were satisfactory for all subscales. Confirmatory factor analyses revealed a Heywood case for all models, which necessitated setting the variance of item 14 to zero. The fit indices for Models 1 and 2 were insufficient. Model 3 showed superior fit indices (robust root mean square error of approximation=0.064, robust Tucker‒Lewis index=0.952, robust comparative fit index=0.962). The Akaike’s information criterion and Bayesian information criterion statistics indicated a substantially better fit for Model 3 compared to Models 1 and 2. Discussion: The 14-item German version of the Physicians’ Reaction to Uncertainty Scale demonstrated good psychometric properties in a heterogeneous sample of physicians. It serves as a valuable tool for assessing uncertainty and for international comparison of uncertainty scores and training effects. However, the German version seems to need further adaptation, particularly concerning item 5.