October 22, 2013
When doctors don’t discuss harms of screening tests with patients
Another important paper in the JAMA Internal Medicine “Less is More” series.
“Overdiagnosis and Overtreatment: Evaluation of What Physicians Tell Their Patients About Screening Harms,” is by one of my risk communication gurus, Gerd Gigerenzer and colleague Odette Wegwarth. They surveyed 317 US men and women aged 50-69 years, a population with the highest exposure to screening programs.
Their summary:
Most participants in our sample who underwent routine cancer screening reported that their physicians did not tell them about overdiagnosis and overtreatment. The few who received information about overtreatment had unrealistic beliefs about the extent of that risk. The large number of uninformed patients might be explained by a large number of physicians who themselves know little about screening harms. When a national sample of 412 US primary care physicians, part of a larger project on physicians’ understanding of cancer screening statistics,was asked about the extent of overdiagnosis for mammography screening and PSA testing; only 33.9% and 42.9%, respectively, were able to provide a correct estimate.
The results of the present study indicate that physicians’ counseling on screening does not meet patients’ standards. Most individuals desired information about screening harms, which was not given, and attested that this knowledge would matter to them: 69% of the sample indicated that they would not start screening if overdiagnosis was as high (ie, ?10 cases per 1 life saved) as it is in mammography and PSA testing.
Our results should prompt medical educators to improve the quality of teaching about screening and encourage medical journal editors to enforce clear reporting about overtreatment when publishing results on the effectiveness of cancer screening. These means may not be sufficient but would be a first step toward enhancing the number of physicians and patients who thoroughly understand the potential consequences of taking a cancer screening test.
Gigerenzer’s work consistently demonstrates the trickle-down effect of how we end up with a poor public dialogue about screening tests. Many physicians don’t get it right. They may turn to published papers in journals that overestimate the effectiveness of screening. And so communication with patients suffers.
And, as we consistently point out, many media messages – in journalism, advertising, marketing and public relations – lead to even worse public understanding. Here’s a Reuters Health story on the paper – one of the only mainstream news stories we saw on it.
Here are some things we’ve published in the past about Gigerenzer’s work:
———————
Follow us on Twitter:
https://twitter.com/garyschwitzer
https://twitter.com/healthnewsrevu
and on Facebook.
Comments (1)
Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.
Comments are closed.
Our Comments Policy
But before leaving a comment, please review these notes about our policy.
You are responsible for any comments you leave on this site.
This site is primarily a forum for discussion about the quality (or lack thereof) in journalism or other media messages (advertising, marketing, public relations, medical journals, etc.) It is not intended to be a forum for definitive discussions about medicine or science.
We will delete comments that include personal attacks, unfounded allegations, unverified claims, product pitches, profanity or any from anyone who does not list a full name and a functioning email address. We will also end any thread of repetitive comments. We don”t give medical advice so we won”t respond to questions asking for it.
We don”t have sufficient staffing to contact each commenter who left such a message. If you have a question about why your comment was edited or removed, you can email us at feedback@healthnewsreview.org.
There has been a recent burst of attention to troubles with many comments left on science and science news/communication websites. Read “Online science comments: trolls, trash and treasure.”
The authors of the Retraction Watch comments policy urge commenters:
We”re also concerned about anonymous comments. We ask that all commenters leave their full name and provide an actual email address in case we feel we need to contact them. We may delete any comment left by someone who does not leave their name and a legitimate email address.
And, as noted, product pitches of any sort – pushing treatments, tests, products, procedures, physicians, medical centers, books, websites – are likely to be deleted. We don”t accept advertising on this site and are not going to give it away free.
The ability to leave comments expires after a certain period of time. So you may find that you’re unable to leave a comment on an article that is more than a few months old.
You might also like