Piessens Veerle, Van den Bruel Ann, Piessens An, Van Hecke Ann, Brodersen John Brandt, Lauwerier Emelien, Stul Florian, De Sutter An, Heytens Stefan
Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Centre for Family Medicine, Ghent University, Ghent, Belgium.
Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium.
PLoS One. 2025 Feb 3;20(2):e0315247. doi: 10.1371/journal.pone.0315247. eCollection 2025.
Medical screening is a major driver of overdiagnosis, which should be considered when making an informed screening decision. Health professionals (HPs) often initiate screening and are therefore responsible for informing eligible screening participants about the benefits and harms of screening. However, little is known about HPs' knowledge of overdiagnosis and whether they are prepared to inform screening candidates about this risk and enable people to make an informed screening decision.
This is a systematic review of studies examining HPs' knowledge and perception of overdiagnosis, whether it affects their position on offering screening, and their willingness to inform screening candidates about overdiagnosis. We conducted systematic searches in MEDLINE, Embase, Web of Science, Scopus, CINAHL, and PsycArticles without language restrictions. Two authors analysed the qualitative and quantitative data separately. Confidence in the findings of the qualitative data was assessed using the GRADE-CERQual approach.
We included 23 publications after screening 9786 records. No studies directly examined HPs' knowledge of overdiagnosis. HPs' perceptions of overdiagnosis varied widely, from considering it a significant harm to seeing it as negligible. This seems linked to their overall beliefs about the benefits and harms of screening and to their position on offering screening, which varies from discouraging to actively promoting it. HPs also hold diverging approaches to informing screening candidates about overdiagnosis, from providing detailed explanations to limited or no information.
There is a lack of research on HPs' knowledge of overdiagnosis, however, HPs who do know about overdiagnosis attribute substantially different levels of harm to it. This seems intertwined with their overall beliefs about the benefits of screening, their position towards offering screening, and their willingness to inform screening candidates about overdiagnosis. This has important implications for the public's right to evidence-based information and compromises an individual's right to make an informed screening decision.
医学筛查是过度诊断的主要驱动因素，在做出明智的筛查决策时应予以考虑。卫生专业人员（HPs）通常发起筛查，因此有责任告知符合条件的筛查参与者筛查的益处和危害。然而，对于卫生专业人员对过度诊断的了解以及他们是否准备好告知筛查对象这种风险并使人们能够做出明智的筛查决策，我们知之甚少。
这是一项对研究卫生专业人员对过度诊断的了解和认知、其是否影响他们对提供筛查的立场以及他们向筛查对象告知过度诊断情况的意愿的研究进行的系统评价。我们在MEDLINE、Embase、科学网、Scopus、护理学与健康领域数据库（CINAHL）和心理学文摘数据库（PsycArticles）中进行了无语言限制的系统检索。两位作者分别分析定性和定量数据。使用GRADE-CERQual方法评估对定性数据结果的信心。
在筛查9786条记录后，我们纳入了23篇出版物。没有研究直接考察卫生专业人员对过度诊断的了解。卫生专业人员对过度诊断的认知差异很大，从认为这是一种重大危害到认为其微不足道。这似乎与他们对筛查益处和危害的总体信念以及他们对提供筛查的立场有关，他们的立场从不鼓励到积极推广各不相同。卫生专业人员在向筛查对象告知过度诊断情况时也有不同的做法，从提供详细解释到提供有限或不提供信息。
关于卫生专业人员对过度诊断的了解缺乏研究，然而，了解过度诊断的卫生专业人员对其危害程度的认定存在很大差异。这似乎与他们对筛查益处的总体信念、他们提供筛查工作的立场以及他们向筛查对象告知过度诊断情况的意愿交织在一起。这对公众获取循证信息的权利具有重要影响，并损害了个人做出明智筛查决策的权利。
