Wegwarth Odette, Wagner Gert G, Gigerenzer Gerd
Max Planck Institute for Human Development, Harding Center for Risk Literacy, Berlin, Germany.
German Institute for Economic Research and Max Planck Institute for Human Development, Berlin, Germany.
PLoS One. 2017 Aug 23;12(8):e0183024. doi: 10.1371/journal.pone.0183024. eCollection 2017.
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.
医学中的知情决策，被定义为基于当前最佳医学证据做出决策，这需要有见识的医生和有见识的患者。然而，在癌症筛查方面，研究表明这些先决条件尚未得到满足。许多医生不了解或不理解筛查测试背后的医学证据，没有对（无症状）人群进行充分的筛查咨询，并且做出的建议与关于知情选择的现有指南相冲突。与此情况一致的是，全国性研究表明，普通公众误解了癌症筛查的作用，但当提供基于证据的信息时，这种理解会有很大改善。然而，基于证据的癌症筛查患者信息能否也使人们不太可能仅仅听从医生基于非证据的建议呢？对897名德国公民进行的全国性抽样调查，通过面对面的计算机辅助个人访谈进行，这些受访者收到了关于癌症筛查测试的基于证据的（例如，益处和危害的绝对风险；n = 451）或非基于证据的（例如，仅益处的相对风险；n = 446）患者信息，然后被要求做出他们的初始癌症筛查选择。此后，参与者收到了一个假设的医生建议，就现有的知情决策指南而言，该建议是基于非证据的（即只报告益处或危害中的一个；不提供数字）。当提供非基于证据的患者信息时（n = 446），在235名初始筛查选择与假设医生基于非证据的建议相矛盾的参与者中，平均有33.1%的人（95%置信区间：27.4%至39.4%）听从该建议调整了他们的选择，而在提供基于证据的患者信息时（n = 451），只有一半的人，即22,5人中平均有16.0%（95%置信区间：11.8%至21.4%）改变了他们的选择。因此，基于证据的患者信息使人们不太可能仅仅听从医生基于非证据的建议，并且即使在没有得到关于癌症筛查的充分咨询时，也能支持人们做出基于证据的决策。
