Do Physicians Understand Cancer Screening Statistics? : A National Survey of Primary Care Physicians in the United States

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2012
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Wegwarth, Odette
Schwartz, Lisa M.
Woloshin, Steven
Gigerenzer, Gerd
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Annals of Internal Medicine. 2012, 156(5), pp. 340-349. ISSN 0003-4819. eISSN 1539-3704. Available under: doi: 10.7326/0003-4819-156-5-201203060-00005
Zusammenfassung

Background: Unlike reduced mortality rates, improved survival rates and increased early detection do not prove that cancer screen- ing tests save lives. Nevertheless, these 2 statistics are often used to promote screening.


Objective: To learn whether primary care physicians understand which statistics provide evidence about whether screening saves lives.


Design: Parallel-group, randomized trial (randomization controlled for order effect only), conducted by Internet survey. (ClinicalTrials. gov registration number: NCT00981019)


Setting: National sample of U.S. primary care physicians from a research panel maintained by Harris Interactive (79% cooperation rate).


Participants: 297 physicians who practiced both inpatient and out- patient medicine were surveyed in 2010, and 115 physicians who practiced exclusively outpatient medicine were surveyed in 2011.


Intervention: 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.


Measurements: Physicians’ recommendation of screening and per- ception of its benefit in the scenarios and general knowledge of screening statistics.


Results: 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 physi- cians recommended the test, compared with 23% when presented with relevant evidence (P < 0.001). When asked general knowl- edge 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.”


Limitation: Physicians’ recommendations for screening were based on hypothetical scenarios, not actual practice.


Conclusion: Most primary care physicians mistakenly interpreted improved survival and increased detection with screening as evi- dence that screening saves lives. Few correctly recognized that only reduced mortality in a randomized trial constitutes evidence of the benefit of screening.

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150 Psychologie
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primary care physicians, cancer, cancer screening, screening test, mortality
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ISO 690WEGWARTH, Odette, Lisa M. SCHWARTZ, Steven WOLOSHIN, Wolfgang GAISSMAIER, Gerd GIGERENZER, 2012. Do Physicians Understand Cancer Screening Statistics? : A National Survey of Primary Care Physicians in the United States. In: Annals of Internal Medicine. 2012, 156(5), pp. 340-349. ISSN 0003-4819. eISSN 1539-3704. Available under: doi: 10.7326/0003-4819-156-5-201203060-00005
BibTex
@article{Wegwarth2012-03-06Physi-28048,
  year={2012},
  doi={10.7326/0003-4819-156-5-201203060-00005},
  title={Do Physicians Understand Cancer Screening Statistics? : A National Survey of Primary Care Physicians in the United States},
  number={5},
  volume={156},
  issn={0003-4819},
  journal={Annals of Internal Medicine},
  pages={340--349},
  author={Wegwarth, Odette and Schwartz, Lisa M. and Woloshin, Steven and Gaissmaier, Wolfgang and Gigerenzer, Gerd}
}
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    <dcterms:abstract xml:lang="eng">Background: Unlike reduced mortality rates, improved survival rates and increased early detection do not prove that cancer screen- ing tests save lives. Nevertheless, these 2 statistics are often used to promote screening.&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;Objective: To learn whether primary care physicians understand which statistics provide evidence about whether screening saves lives.&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;Design: Parallel-group, randomized trial (randomization controlled for order effect only), conducted by Internet survey. (ClinicalTrials. gov registration number: NCT00981019)&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;Setting: National sample of U.S. primary care physicians from a research panel maintained by Harris Interactive (79% cooperation rate).&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;Participants: 297 physicians who practiced both inpatient and out- patient medicine were surveyed in 2010, and 115 physicians who practiced exclusively outpatient medicine were surveyed in 2011.&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;Intervention: 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.&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;Measurements: Physicians’ recommendation of screening and per- ception of its benefit in the scenarios and general knowledge of screening statistics.&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;Results: 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 physi- cians recommended the test, compared with 23% when presented with relevant evidence (P &lt; 0.001). When asked general knowl- edge 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.”&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;Limitation: Physicians’ recommendations for screening were based on hypothetical scenarios, not actual practice.&lt;br /&gt;&lt;br /&gt;&lt;br /&gt;Conclusion: Most primary care physicians mistakenly interpreted improved survival and increased detection with screening as evi- dence that screening saves lives. Few correctly recognized that only reduced mortality in a randomized trial constitutes evidence of the benefit of screening.</dcterms:abstract>
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