Research Department of Behavioural Science and Health, University College London, London, UK.
BMJ Open. 2017 Aug 21;7(8):e015955. doi: 10.1136/bmjopen-2017-015955.
'Overdiagnosis', detection of disease that would never have caused symptoms or death, is a public health concern due to possible psychological and physical harm but little is known about how best to explain it. This study evaluated public perceptions of widely used information on the concept to identify scope for improving communication methods.
Experimental survey carried out by a market research company via face-to-face computer-assisted interviews.
Interviews took place in participants' homes.
2111 members of the general public in England aged 18-70 years began the survey; 1616 were eligible for analysis. National representativeness was sought via demographic quota sampling.
Participants were allocated at random to receive a brief description of overdiagnosis derived from written information used by either the NHS Breast Screening Programme or the prostate cancer screening equivalent.
The primary outcome was how clear the information was perceived to be (extremely/very clear vs less clear). Other measures included previous exposure to screening information, decision-making styles and demographic characteristics (eg, education). Binary logistic regression was used to assess predictors of perceived clarity.
Overdiagnosis information from the BSP was more likely to be rated as more clear compared with the prostate screening equivalent (adjusted OR: 1.43, 95% CI 1.17 to 1.75; p=0.001). Participants were more likely to perceive the information as more clear if they had previously encountered similar information (OR: 1.77, 1.40 to 2.23; p<0.0005) or a screening leaflet (OR: 1.35, 1.04 to 1.74; p=0.024) or had a more 'rational' decision-making style (OR: 1.06, 1.02 to 1.11; p=0.009).
Overdiagnosis information from breast screening may be a useful template for communicating the concept more generally (eg, via organised campaigns). However, this information may be less well-suited to individuals who are less inclined to consider risks and benefits during decision-making.
“过度诊断”是指检测出原本不会引起症状或死亡的疾病，这是一个公共卫生关注的问题，因为它可能会带来心理和身体上的伤害，但人们对如何最好地解释这一概念知之甚少。本研究评估了公众对广泛使用的该概念信息的看法，以确定改进沟通方法的范围。
通过市场研究公司进行的实验性调查，采用面对面的计算机辅助访谈。
访谈在参与者的家中进行。
2111 名年龄在 18-70 岁的英格兰普通公众开始参与调查；其中 1616 人符合分析条件。通过人口统计学配额抽样寻求全国代表性。
参与者被随机分配，阅读来自国民保健署（NHS）乳房筛查计划或前列腺癌筛查等效计划的书面信息中得出的关于过度诊断的简短描述。
主要结果是信息的清晰度（非常/非常清晰与不太清晰）。其他措施包括之前接触过的筛查信息、决策风格和人口统计学特征（如教育程度）。使用二元逻辑回归评估清晰度的预测因素。
与前列腺癌筛查等效信息相比，来自 BSP 的过度诊断信息更有可能被评为更清晰（调整后的比值比：1.43，95%置信区间 1.17 至 1.75；p=0.001）。如果参与者之前遇到过类似的信息（比值比：1.77，1.40 至 2.23；p<0.0005）或筛查传单（比值比：1.35，1.04 至 1.74；p=0.024），或者具有更“理性”的决策风格（比值比：1.06，1.02 至 1.11；p=0.009），他们更有可能认为信息更清晰。
乳房筛查的过度诊断信息可能是更广泛地传播这一概念的有用模板（例如，通过有组织的宣传活动）。然而，对于那些在决策过程中不太倾向于考虑风险和收益的人来说，这种信息可能不太适合。
