Research Department of Behavioural Science and Health, University College London, London, UK.
BMJ Open. 2018 Jun 27;8(6):e021260. doi: 10.1136/bmjopen-2017-021260.
Communicating the concept of 'overdiagnosis' to lay individuals is challenging, partly because the term itself is confusing. This study tested whether alternative descriptive labels may be more appropriate.
Questionnaire preceded by a description of overdiagnosis.
Home-based, computer-assisted face-to-face survey.
2111 adults aged 18-70 years in England recruited using random location sampling by a survey company. Data from 1888 participants were analysed after exclusions due to missing data.
Participants were given one of two pieces of text describing overdiagnosis, allocated at random, adapted from National Health Service breast and prostate cancer screening leaflets.
Main outcomes were which of several available terms (eg, 'overdetection') participants had previously encountered and which they endorsed as applicable labels for the concept described. Demographics and previous exposure to screening information were also measured. Main outcomes were summarised with descriptive statistics. Predictors of previously encountering at least one term, or endorsing at least one as making sense, were assessed using binary logistic regression.
58.0% of participants had not encountered any suggested term; 44.0% did not endorse any as applicable labels. No term was notably familiar; the proportion of participants who had previously encountered each term ranged from 15.9% to 28.3%. Each term was only endorsed as applicable by a minority (range: 27.6% to 40.4%). Notable predictors of familiarity included education, age and ethnicity; participants were less likely to have encountered terms if they were older, not white British or had less education. Findings were similar for both pieces of information.
Familiarity with suggested terms for overdiagnosis and levels of endorsement were low, and no clear alternative labels for the concept were identified, suggesting that changing terminology alone would do little to improve understanding, particularly for some population groups. Explicit descriptions may be more effective.
向非医学专业人士传达“过度诊断”的概念具有挑战性，部分原因是该术语本身令人困惑。本研究旨在检验替代描述性标签是否更合适。
在描述过度诊断之前，先进行问卷调查。
基于家庭的、计算机辅助的面对面调查。
通过调查公司采用随机位置抽样，在英格兰招募了 2111 名年龄在 18-70 岁之间的成年人。排除因数据缺失而导致的参与者后，对 1888 名参与者的数据进行了分析。
参与者随机分配阅读两种描述过度诊断的文本之一，改编自国民保健制度的乳腺癌和前列腺癌筛查传单。
主要结果是参与者之前遇到过的几种可用术语（例如，“过度检测”），以及他们认为哪些术语适用于所描述的概念。还测量了人口统计学特征和之前接触过的筛查信息。主要结果用描述性统计进行总结。使用二项逻辑回归评估以前至少遇到过一个术语或至少有一个术语有意义的预测因素。
58.0%的参与者没有遇到过任何建议的术语；44.0%的参与者不认为任何术语是适用的标签。没有一个术语特别常见；参与者以前遇到过的每个术语的比例范围从 15.9%到 28.3%。每个术语都只有少数人（范围：27.6%至 40.4%）认为适用。熟悉术语的显著预测因素包括教育程度、年龄和种族；年龄较大、不是白种英国人或教育程度较低的参与者不太可能遇到术语。这两种信息的结果相似。
对过度诊断的建议术语的熟悉程度和认可程度都很低，也没有确定该概念的明确替代标签，这表明仅改变术语并不能显著提高理解程度，尤其是对某些人群而言。明确的描述可能更有效。
