Unlike reduced mortality rates, improved survival rates and increased early detection do not prove that cancer screening tests save lives. Nevertheless, these 2 statistics are often used to promote ...screening.
To learn whether primary care physicians understand which statistics provide evidence about whether screening saves lives.
Parallel-group, randomized trial (randomization controlled for order effect only), conducted by Internet survey. (ClinicalTrials.gov registration number: NCT00981019)
National sample of U.S. primary care physicians from a research panel maintained by Harris Interactive (79% cooperation rate).
297 physicians who practiced both inpatient and outpatient medicine were surveyed in 2010, and 115 physicians who practiced exclusively outpatient medicine were surveyed in 2011.
Physicians received scenarios about the effect of 2 hypothetical screening tests: The effect was described as improved 5-year survival and increased early detection in one scenario and as decreased cancer mortality and increased incidence in the other.
Physicians' recommendation of screening and perception of its benefit in the scenarios and general knowledge of screening statistics.
Primary care physicians were more enthusiastic about the screening test supported by irrelevant evidence (5-year survival increased from 68% to 99%) than about the test supported by relevant evidence (cancer mortality reduced from 2 to 1.6 in 1000 persons). When presented with irrelevant evidence, 69% of physicians recommended the test, compared with 23% when presented with relevant evidence (P < 0.001). When asked general knowledge questions about screening statistics, many physicians did not distinguish between irrelevant and relevant screening evidence; 76% versus 81%, respectively, stated that each of these statistics proves that screening saves lives (P = 0.39). About one half (47%) of the physicians incorrectly said that finding more cases of cancer in screened as opposed to unscreened populations "proves that screening saves lives."
Physicians' recommendations for screening were based on hypothetical scenarios, not actual practice.
Most primary care physicians mistakenly interpreted improved survival and increased detection with screening as evidence that screening saves lives. Few correctly recognized that only reduced mortality in a randomized trial constitutes evidence of the benefit of screening.
Harding Center for Risk Literacy, Max Planck Institute for Human Development.
Background. Fact boxes employ evidence-based guidelines on risk communication to present benefits and harms of health interventions in a balanced and transparent format. However, little is known ...about their short- and long-term efficacy and whether designing fact boxes to present multiple outcomes with icon arrays would increase their efficacy. Method. In study 1, 120 men (30–75 y) completed a lab study. Participants were randomly assigned to 1 of 3 fact box formats on prostate cancer screening: a tabular fact box with numbers, a fact box with numbers and icon array, and a fact box with numbers, separate icon arrays, and text to describe each benefit and harm. Comprehension of information (while materials were present) and short-term knowledge recall were assessed. Study 2 recruited an online sample of 244 German men (40–75 y). Participants were randomly assigned to 1 of the 3 fact box formats or widely distributed health information, and knowledge was assessed at baseline, shortly after presentation, and at 6-mo follow-up, along with comprehension while materials were present. Results. In both studies, comprehension and knowledge-recall scores were similar when comparing tabular and icon fact boxes. In the 6-mo follow-up, this positive effect on knowledge recall disappeared. Fact boxes increased knowledge relative to baseline but did not affect decision intentions or perceptions of having complete information to make decisions. Conclusions. This study shows that fact boxes with and without icon arrays are equally effective at improving comprehension and knowledge recall over the short-term and are simple formats that can improve on current health information. Specifically, if fact boxes are used at the time or immediately before a decision is made, they promote informed decisions about prostate cancer screening.
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Informed decision making in medicine, defined as basing one's decision on the best current medical evidence, requires both informed physicians and informed patients. In cancer screening, however, ...studies document that these prerequisites are not yet met. Many physicians do not know or understand the medical evidence behind screening tests, do not adequately counsel (asymptomatic) people on screening, and make recommendations that conflict with existing guidelines on informed choice. Consistent with this situation, nation-wide studies showed that the general public misperceives the contribution of cancer screening but that understanding considerably improves when evidence-based information is provided. However, can evidence-based patient information about cancer screening make people also less likely to simply follow a physician's non-evidence-based advice? A national sample of 897 German citizens, surveyed in face-to-face computer-assisted personal interviews, received either evidence-based (e.g., absolute risks on benefits and harms; n = 451) or non-evidence-based (e.g., relative risks on benefits only; n = 446) patient information about a cancer screening test and were then asked to make their initial cancer screening choice. Thereafter, participants received a hypothetical physician's recommendation, which was non-evidence-based in terms of existing guidelines on informed decision making (i.e., reporting either benefits or harms but not both; no provision of numbers). When provided with non-evidence-based patient information (n = 446), a mean of 33.1% of 235 participants whose initial screening choice contradicted the hypothetical physician's non-evidence-based recommendation adjusted their choice in deference to that recommendation (95% CI: 27.4 to 39.4%), whereas with evidence-based patient information (n = 451), only half as many, a mean of 16.0% of 225 (95% CI: 11.8 to 21.4%), modified their choice. Thus, evidence-based patient information makes people less likely to simply follow non-evidence-based recommendations of physicians and supports people in making evidence-based decisions even when not adequately counseled on cancer screening.
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Current German and EU package leaflets (PLs) do not distinguish to what extent listed side effects are indeed side effects caused by drug intake or instead symptoms that occur regardless of drug use. ...We recently showed that most health professionals misinterpret the frequencies of listed side effects as solely caused by the drug. The present study investigated whether (1) these misinterpretations also prevail among laypeople and (2) alternative PLs reduce these misinterpretations.
In March 2017, 397 out of 400 laypeople approached completed an online survey. They were randomized to one of four PL formats: three alternative PLs (drug facts box with/without reading instruction, narrative format with numbers) and one standard PL. Each PL listed four side effects for a fictitious drug: two were presented as occurring more often, one as equally often, and one as less often with drug intake. The alternative formats (interventions) included information on frequencies with and without drug intake and included a statement on the causal relation. The standard PL (control) only included information on frequency ranges with drug intake. Questions were asked on general occurrence and causality of side effects.
Participants randomized to the standard PL were unable to answer questions on causality. For side effects occurring more often (equally; less often) with drug intake, only 1.9% to 2.8% (equally: 1.9%; less often: 1.9%) provided correct responses about the causal nature of side effects, compared to 55.0% to 81.9% (equally: 23.8% to 70.5%; less often: 21.0% to 43.2%) of participants who received alternative PLs. It remains unclear whether one alternative format is superior to the others.
In conclusion, information on the frequency of side effects in current package leaflets is misleading. Comparative presentation of frequencies for side effects with and without drug intake including statements on the causal relation significantly improves understanding.
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Personal cancer risk assessments enable stratified care, for example, offering preventive surgical measures such as risk-reducing mastectomy (RRM) to women at high risk for breast cancer. In ...scenario-based experiments, we investigated whether different benefit-harm ratios of RRM influence women's consideration of this, whether this consideration is influenced by women's perception of and desire to know their personal cancer risk, or by their intention to take a novel cancer risk-predictive test, and whether consideration varies across different countries.
In January 2017, 1,675 women 40 to 75 years of age from five European countries-Czech Republic, Germany, UK, Italy, and Sweden-took part in an online scenario-based experiment. Six different scenarios of hypothetical benefit-harm ratios of RRM were presented in accessible fact box formats: Baseline risk/risk reduction pairings were 20/16, 20/4, 10/8, 10/2, 5/4, and 5/1 out of 1,000 women dying from breast cancer.
Varying the baseline risk of dying from breast cancer and the extent of risk reduction influenced the decision to consider RRM for 23% of women. Decisions varied by country, risk perception, and the intention to take a cancer risk-predictive test. Women who expressed a stronger intention to take such a test were more likely to consider having RRM. The desire to know one's risk of developing any female cancer in general moderated women's decisions, whereas the specific desire to know the risk of breast cancer did not.
In this hypothetical scenario-based study, only for a minority of women did the change in benefit-harm ratio inform their consideration of RRM. Because this consideration is influenced by risk perception and the intention to learn one's cancer risks via a cancer risk-predictive test, careful disclosure of different potential preventive measures and their benefit-harm ratios is necessary before testing for individual risk. Furthermore, information on risk testing should acknowledge country-specific sensitivities for benefit-harm ratios.
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Epigenetic markers might be used for risk-stratifying cancer screening and prevention programs in the future. Although the clinical utility of consequent epigenetic tests for risk stratification is ...yet to be proven, successful adoption into clinical practice also requires the public's acceptance of such tests. This cross-sectional online survey study sought to learn for the first time about European women's perceptions, attitudes, and intended behavior regarding a predictive epigenetic test for female cancer (breast, ovarian, cervical, and endometrial) risks.
1675 women (40-75 years) from five European countries (Czech Republic, Germany, United Kingdom, Italy, Sweden), drawn from online panels by the survey sampling company Harris Interactive (Germany), participated in an online survey where they first received online leaflet information on a predictive epigenetic test for female cancer risks and were subsequently queried by an online questionnaire on their desire to know their female cancer risks, their perception of the benefit-to-harm ratio of an epigenetic test predicting female cancer risks, reasons in favor and disfavor of taking such a test, and their intention to take a predictive epigenetic test for female cancer risks.
Most women desired information on each of their female cancer risks, 56.6% (95% CI: 54.2-59.0) thought the potential benefits outweighed potential harms, and 75% (72.0-77.8) intended to take a predictive epigenetic test for female cancer risks if freely available. Results varied considerably by country with women from Germany and the Czech Republic being more reserved about this new form of testing than women from the other three European countries. The main reason cited in favor of a predictive epigenetic test for female cancer risks was its potential to guide healthcare strategies and lifestyle changes in the future, and in its disfavor was that it may increase cancer worry and coerce unintended lifestyle changes and healthcare interventions.
A successful introduction of predictive epigenetic tests for cancer risks will require a balanced and transparent communication of the benefit-to-harm ratio of healthcare pathways resulting from such tests in order to curb unjustified expectations and at the same time to prevent unjustified concerns.
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Abstract
Background
Long-term prescriptions of strong opioids for chronic noncancer pain—which are not supported by scientific evidence—suggest miscalibrated risk perceptions among those who ...prescribe, dispense, and take opioids. Because risk perceptions and behaviors can differ depending on whether people learn about risks through description or experience, we investigated the effects of descriptive versus simulated-experience educative formats on physicians’ risk perceptions of strong opioids and their prescription behavior for managing chronic noncancer pain.
Methods
Three hundred general practitioners and 300 pain specialists in Germany—enrolled separately in two independent exploratory randomized controlled online trials—were randomly assigned to either a descriptive format (fact box) or a simulated-experience format (interactive simulation).
Primary endpoints
Objective risk perception (numerical estimates of opioids’ benefits and harms), actual prescriptions of seven therapy options for managing chronic pain.
Secondary endpoint
Implementation of intended prescriptions of seven therapy options for managing chronic pain.
Results
Both formats improved the proportion of correct numerical estimates of strong opioids’ benefits and harms immediately after intervention, with no notable differences between formats. Compared to description, simulated experience led to significantly lower reported actual prescription rates for strong and/or weak opioids, and was more effective at increasing prescription rates for non-drug-based therapies (e.g., means of opioid reduction) from baseline to follow-up for both general practitioners and pain specialists. Simulated experience also resulted in a higher implementation of intended behavior for some drug-based and non-drug-based therapies.
Conclusions
The two formats, which recruit different cognitive processes, may serve different risk-communication goals: If the goal is to improve exact risk perception, descriptive and simulated-experience formats are likely to be equally suitable. If, however, the goal is to boost less risky prescription habits, simulated experience may be the better choice.
Trial registration
DRKS00020358 (German Clinical Trials Register, first registration: 07/01/2020).
Although transparency is crucial for building public trust, public health communication during the COVID-19 pandemic was often nontransparent.
In a cross-sectional online study with COVID-19 ...vaccine-hesitant German residents (
= 763), we explored the impact of COVID-19 public health communication on the attitudes of vaccine-hesitant individuals toward vaccines as well as their perceptions of incomprehensible and incomplete information. We also investigated whether specific formats of public health messaging were perceived as more trustworthy.
Of the 763 participants, 90 (11.8%) said they had become more open-minded toward vaccines in general, 408 (53.5%) reported no change, and 265 (34.7%) said they had become more skeptical as a result of public health communication on COVID-19 vaccines. These subgroups differed in how incomprehensible they found public health communication and whether they thought information had been missing. Participants' ranking of trustworthy public health messaging did not provide clear-cut results: the
message, which reported the benefit and harms in terms of absolute risk, and the
message, which reported only the benefit in terms of relative risk were both considered equally trustworthy (
= 0.848).
Increased skepticism about vaccines during the COVID-19 pandemic may have partly been fueled by subpar public health communication. Given the importance of public trust for coping with future health crises, public health communicators should ensure that their messaging is clear and transparent.
Zusammenfassung
Eine effiziente Gesundheitsversorgung braucht gut informierte ÄrztInnen
und
PatientInnen. In unserem gegenwärtigen Gesundheitssystem gibt es beide nicht. Um das Problem zu ...illustrieren: In einer nationalen Studie mit 412 US-amerikanischen ÄrztInnen wusste die Mehrzahl nicht, dass die Fünf-Jahres-Überlebensstatistik eine irreführende Metrik im Kontext von Screenings ist und basierten fälschlicherweise ihre Screeningempfehlung darauf. Unter deutschen GynäkologInnen gab es nicht eine einzige, die alle Informationen zu Nutzen und Schaden des Mammographiescreenings bereitstellte, deren es für eine informierte Entscheidung bedürfte. Und in einer nationalen Stichprobe von 300 US-BürgerInnen, die an einer oder mehreren Früherkennungsuntersuchungen teilgenommen hatten, waren 91 % von ihren ÄrztInnen nie über die größten Schäden von Früherkennungsuntersuchungen – Überdiagnosen und Überbehandlungen – informiert worden. Warum haben wir diesen Mangel an Risikokompetenz? Die Forschung dokumentiert, dass es weniger kognitive oder emotionale Defizite sind, die Menschen davon abhalten, Evidenz richtig zu verstehen, sondern vielmehr die Art und Weise, wie statistische Informationen präsentiert werden. Was kann gegen den Mangel getan werden? Medizinische Fakultäten sollten damit beginnen, StudentInnen die simplen Techniken der Risikokommunikation beizubringen, um sie dabei zu unterstützen, medizinische Statistiken richtig zu verstehen. Leitlinien zur vollständigen und transparenten Berichterstattung in Fachzeitschriften, Broschüren und den Medien müssen besser durchgesetzt werden, um die Vermittlung tatsächlicher Fakten zu fördern. Eine kritische Masse informierter Menschen wird nicht alle Probleme unseres Gesundheitssystems lösen, aber sie kann der auslösende Faktor für eine bessere Versorgung sein.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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