Med Decis Making - Deceiving numbers: survival rates and their impact on doctors' risk communication.


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CKGROUND: Increased 5-y survival for screened patients is often inferred to mean that fewer patients die of cancer. However, due to several biases, the 5-y survival rate is a misleading metric for evaluating a screening's effectiveness. If physicians are not aware of these issues, informed screening counseling cannot take place.METHODS: Two questionnaire versions ("group" and "time") presented 4 conditions: 5-y survival (5Y), 5-y survival and annual disease-specific mortality (5YM), annual disease-specific mortality (M), and 5-y survival, annual disease-specific mortality, and incidence (5YMI). Questionnaire version "time" presented data as a comparison between 2 time points and version "group" as a comparison between a screened and an unscreened group. All data were based on statistics for the same cancer site (prostate). Outcome variables were the recommendation of screening, reasoning behind recommendation, judgment of the screening's effectiveness, and, if judged effective, a numerical estimate of how many fewer people out of 1000 would die if screened regularly. After randomized allocation, 65 German physicians in internal medicine and its subspecialities completed either of the 2 questionnaire versions.RESULTS: Across both versions, 66% of the physicians recommended screening when presented with 5Y, but only 8% of the same physicians made the recommendation when presented with M (5YM: 31%; 5YMI: 55%). Also, 5Y made considerably more physicians (78%) judge the screening to be effective than any other condition (5YM: 31%; M: 5%; 5YMI: 49%) and led to the highest overestimations of benefit.CONCLUSION: A large number of physicians erroneously based their screening recommendation and judgment of screening's effectiveness on the 5-y survival rate. Results show that reporting disease-specificmortality rates can offer a simple solution to physicians' confusion about the real effect of screening.

Resumo Limpo

ckground increas y surviv screen patient often infer mean fewer patient die cancer howev due sever bias y surviv rate mislead metric evalu screen effect physician awar issu inform screen counsel take placemethod two questionnair version group time present condit y surviv y y surviv annual diseasespecif mortal ym annual diseasespecif mortal m y surviv annual diseasespecif mortal incid ymi questionnair version time present data comparison time point version group comparison screen unscreen group data base statist cancer site prostat outcom variabl recommend screen reason behind recommend judgment screen effect judg effect numer estim mani fewer peopl die screen regular random alloc german physician intern medicin subspeci complet either questionnair versionsresult across version physician recommend screen present y physician made recommend present m ym ymi also y made consider physician judg screen effect condit ym m ymi led highest overestim benefitconclus larg number physician erron base screen recommend judgment screen effect y surviv rate result show report diseasespecificmort rate can offer simpl solut physician confus real effect screen

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