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帮助医生和患者理解健康统计数据。

Helping Doctors and Patients Make Sense of Health Statistics.

机构信息

Max Planck Institute for Human Development, Berlin Harding Center for Risk Literacy, Berlin

Max Planck Institute for Human Development, Berlin Harding Center for Risk Literacy, Berlin.

出版信息

Psychol Sci Public Interest. 2007 Nov;8(2):53-96. doi: 10.1111/j.1539-6053.2008.00033.x. Epub 2007 Nov 1.

Abstract

Many doctors, patients, journalists, and politicians alike do not understand what health statistics mean or draw wrong conclusions without noticing. Collective statistical illiteracy refers to the widespread inability to understand the meaning of numbers. For instance, many citizens are unaware that higher survival rates with cancer screening do not imply longer life, or that the statement that mammography screening reduces the risk of dying from breast cancer by 25% in fact means that 1 less woman out of 1,000 will die of the disease. We provide evidence that statistical illiteracy (a) is common to patients, journalists, and physicians; (b) is created by nontransparent framing of information that is sometimes an unintentional result of lack of understanding but can also be a result of intentional efforts to manipulate or persuade people; and (c) can have serious consequences for health. The causes of statistical illiteracy should not be attributed to cognitive biases alone, but to the emotional nature of the doctor-patient relationship and conflicts of interest in the healthcare system. The classic doctor-patient relation is based on (the physician's) paternalism and (the patient's) trust in authority, which make statistical literacy seem unnecessary; so does the traditional combination of determinism (physicians who seek causes, not chances) and the illusion of certainty (patients who seek certainty when there is none). We show that information pamphlets, Web sites, leaflets distributed to doctors by the pharmaceutical industry, and even medical journals often report evidence in nontransparent forms that suggest big benefits of featured interventions and small harms. Without understanding the numbers involved, the public is susceptible to political and commercial manipulation of their anxieties and hopes, which undermines the goals of informed consent and shared decision making. What can be done? We discuss the importance of teaching statistical thinking and transparent representations in primary and secondary education as well as in medical school. Yet this requires familiarizing children early on with the concept of probability and teaching statistical literacy as the art of solving real-world problems rather than applying formulas to toy problems about coins and dice. A major precondition for statistical literacy is transparent risk communication. We recommend using frequency statements instead of single-event probabilities, absolute risks instead of relative risks, mortality rates instead of survival rates, and natural frequencies instead of conditional probabilities. Psychological research on transparent visual and numerical forms of risk communication, as well as training of physicians in their use, is called for. Statistical literacy is a necessary precondition for an educated citizenship in a technological democracy. Understanding risks and asking critical questions can also shape the emotional climate in a society so that hopes and anxieties are no longer as easily manipulated from outside and citizens can develop a better-informed and more relaxed attitude toward their health.

摘要

许多医生、患者、记者和政客都不理解健康统计数据的含义,或者在没有注意到的情况下得出错误的结论。集体性统计文盲是指广泛存在的无法理解数字含义的现象。例如,许多公民不知道癌症筛查的生存率提高并不意味着寿命延长,或者说乳房 X 光筛查实际上将死于乳腺癌的风险降低了 25%,这意味着每 1000 名女性中就会有 1 人不会死于这种疾病。我们提供的证据表明,统计文盲(a)普遍存在于患者、记者和医生中;(b)是由信息的非透明呈现造成的,这种信息呈现有时是由于缺乏理解而无意识产生的,但也可能是出于操纵或说服人们的有意努力;(c)会对健康造成严重后果。统计文盲的原因不应仅仅归因于认知偏见,还应归因于医患关系的情感本质和医疗保健系统中的利益冲突。传统的医患关系基于(医生的)家长式作风和(患者的)对权威的信任,这使得统计素养似乎变得不必要;因此,决定论(医生寻求原因,而不是机会)和确定性的幻觉(当没有确定性时,患者寻求确定性)的传统结合也是如此。我们表明,信息手册、网站、制药业分发给医生的传单,甚至医学期刊,经常以非透明的形式报告证据,暗示特色干预措施的巨大益处和较小的危害。如果不了解相关数字,公众就容易受到政治和商业对其焦虑和希望的操纵,从而破坏知情同意和共同决策的目标。可以采取哪些措施?我们讨论了在小学和中学以及医学院中教授统计思维和透明表示的重要性。然而,这需要让孩子们尽早熟悉概率的概念,并将统计素养作为解决现实世界问题的艺术来教授,而不是将公式应用于关于硬币和骰子的玩具问题。统计素养的一个主要前提是透明的风险沟通。我们建议使用频率陈述而不是单一事件概率、绝对风险而不是相对风险、死亡率而不是生存率以及自然频率而不是条件概率。需要对透明的风险视觉和数字表示形式进行心理研究,并对医生进行使用方面的培训。统计素养是科技民主中受教育公民的必要前提。理解风险并提出批判性问题也可以塑造社会的情感氛围,使希望和焦虑不再那么容易受到外界的操纵,使公民能够对自己的健康形成一种知情程度更高、更为放松的态度。

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