Deceiving Numbers : Survival Rates and Their Impact on Doctor' Risk Communication

Wegwarth, Odette; Gaissmaier, Wolfgang; Gigerenzer, Gerd

Deceiving Numbers : Survival Rates and Their Impact on Doctor' Risk Communication

Dateien

Wegwarth_280506.pdfGröße: 277.69 KBDownloads: 426

Datum

2011

URI (zitierfähiger Link)

http://nbn-resolving.de/urn:nbn:de:bsz:352-280506

DOI (zitierfähiger Link)

https://doi.org/10.1177/0272989X10391469

Open Access-Veröffentlichung

Open Access Green

Publikationstyp

Zeitschriftenartikel

Publikationsstatus

Published

Erschienen in

Medical Decision Making. 2011, 31(3), pp. 386-394. ISSN 0272-989X. eISSN 1552-681X. Available under: doi: 10.1177/0272989X10391469

Zusammenfassung

Background

Increased 5-y survival for screened patients is often inferred to mean that fewer patients die of cancer. However, due to several biases, the 5-y survival rate is a misleading metric for evaluating a screening’s effectiveness. If physicians are not aware of these issues, informed screening counseling cannot take place.

Methods
Two questionnaire versions ("Group" and "time") presented 4 conditions: 5-y survival (5Y), 5-y survival and annual disease-specific mortality (5YM), annual disease-specific mortality (M), and 5-y survival, annual disease-specific mortality, and incidence (5YMI). Questionnaire version "time" presented data as a comparison between 2 time points and version "group" as a comparison between a screened and an unscreened group. All data were based on statistics for the same cancer site (prostate). Outcome variables were the recommendation of screening, reason- ing behind recommendation, judgment of the screening's effectiveness, and, if judged effective, a numerical esti- mate of how many fewer people out of 1000 would die if screened regularly. After randomized allocation, 65 Ger- man physicians in internal medicine and its subspecial- ities completed either of the 2 questionnaire versions.

Results
Across both versions, 66% of the physicians recommended screening when presented with 5Y, but only 8% of the same physicians made the recommenda- tion when presented with M (5YM: 31%; 5YMI: 55%). Also, 5Y made considerably more physicians (78%) judge the screening to be effective than any other condition (5YM: 31%; M: 5%; 5YMI: 49%) and led to the highest overestimations of benefit. Conclusion. A large number of physicians erroneously based their screening recommendation and judgment of screening's effectiveness on the 5-y survival rate. Results show that reporting disease-specific mortality rates can offer a simple solution to phy- sicians' confusion about the real effect of screening.

Fachgebiet (DDC)

150 Psychologie

Schlagwörter

decision rules, risk communication or risk perception, shared decision making, health literacy, numeracy

Zitieren

ISO 690

WEGWARTH, Odette, Wolfgang GAISSMAIER, Gerd GIGERENZER, 2011. Deceiving Numbers : Survival Rates and Their Impact on Doctor' Risk Communication. In: Medical Decision Making. 2011, 31(3), pp. 386-394. ISSN 0272-989X. eISSN 1552-681X. Available under: doi: 10.1177/0272989X10391469

BibTex

@article{Wegwarth2011-05Decei-28050,
  year={2011},
  doi={10.1177/0272989X10391469},
  title={Deceiving Numbers : Survival Rates and Their Impact on Doctor' Risk Communication},
  number={3},
  volume={31},
  issn={0272-989X},
  journal={Medical Decision Making},
  pages={386--394},
  author={Wegwarth, Odette and Gaissmaier, Wolfgang and Gigerenzer, Gerd}
}

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    <dcterms:abstract xml:lang="eng">Background&lt;br /&gt;&lt;br /&gt;Increased 5-y survival for screened patients is often inferred to mean that fewer patients die of cancer. However, due to several biases, the 5-y survival rate is a misleading metric for evaluating a screening’s effectiveness. If physicians are not aware of these issues, informed screening counseling cannot take place.&lt;br /&gt;&lt;br /&gt;Methods&lt;br /&gt;Two questionnaire versions ("Group" and "time") presented 4 conditions: 5-y survival (5Y), 5-y survival and annual disease-specific mortality (5YM), annual disease-specific mortality (M), and 5-y survival, annual disease-specific mortality, and incidence (5YMI). Questionnaire version "time" presented data as a comparison between 2 time points and version "group" as a comparison between a screened and an unscreened group. All data were based on statistics for the same cancer site (prostate). Outcome variables were the recommendation of screening, reason- ing behind recommendation, judgment of the screening's effectiveness, and, if judged effective, a numerical esti- mate of how many fewer people out of 1000 would die if screened regularly. After randomized allocation, 65 Ger- man physicians in internal medicine and its subspecial- ities completed either of the 2 questionnaire versions.&lt;br /&gt;&lt;br /&gt;Results&lt;br /&gt;Across both versions, 66% of the physicians recommended screening when presented with 5Y, but only 8% of the same physicians made the recommenda- tion when presented with M (5YM: 31%; 5YMI: 55%). Also, 5Y made considerably more physicians (78%) judge the screening to be effective than any other condition (5YM: 31%; M: 5%; 5YMI: 49%) and led to the highest overestimations of benefit. Conclusion. A large number of physicians erroneously based their screening recommendation and judgment of screening's effectiveness on the 5-y survival rate. Results show that reporting disease-specific mortality rates can offer a simple solution to phy- sicians' confusion about the real effect of screening.</dcterms:abstract>
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