Clinician Conceptualization of the Benefits of Treatments for Individual Patients, 2021, Morgan, Pineles et al

JohnTheJack · Aug 12, 2021

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2782140

Key Points

Question How do clinicians conceptualize the benefits of treatments for common diseases?

Findings In this survey study of 542 clinicians, most respondents significantly overestimated the benefits of common therapies. Clinicians who conceptualized a greater chance of benefits of therapy were more likely to treat similar patients in their practice.

Meaning In this study, most clinicians were not well prepared to estimate individual patient chance of benefit, suggesting that an improved understanding of the effects of treatments could lead to more precise use of therapies and better patient outcomes.

Abstract
Importance Knowing the expected effect of treatment on an individual patient is essential for patient care.

Objective To explore clinicians’ conceptualizations of the chance that treatments will decrease the risk of disease outcomes.

Design, Setting, and Participants This survey study of attending and resident physicians, nurse practitioners, and physician assistants was conducted in outpatient clinical settings in 8 US states from June 2018 to November 2019. The survey was an in-person, paper, 26-item survey in which clinicians were asked to estimate the probability of adverse disease outcomes and expected effects of therapies for diseases common in primary care.

Main Outcomes and Measures Estimated chance that treatments would benefit an individual patient.

Results Of 723 clinicians, 585 (81%) responded, and 542 completed all the questions necessary for analysis, with a median (interquartile range [IQR]) age of 32 (29-44) years, 287 (53%) women, and 294 (54%) White participants. Clinicians consistently overestimated the chance that treatments would benefit an individual patient. The median (IQR) estimated chance that warfarin would prevent a stroke in the next year was 50% (5%-80%) compared with scientific evidence, which indicates an absolute risk reduction (ARR) of 0.2% to 1.0% based on a relative risk reduction (RRR) of 39% to 50%. The median (IQR) estimated chance that antihypertensive therapy would prevent a cardiovascular event within 5 years was 30% (10%-70%) vs evidence of an ARR of 0% to 3% based on an RRR of 0% to 28%. The median (IQR) estimated chance that bisphosphonate therapy would prevent a hip fracture in the next 5 years was 40% (10%-60%) vs evidence of ARR of 0.1% to 0.4% based on an RRR of 20% to 40%. The median (IQR) estimated chance that moderate-intensity statin therapy would prevent a cardiovascular event in the next 5 years was 20% (IQR 5%-50%) vs evidence of an ARR of 0.3% to 2% based on an RRR of 19% to 33%. Estimates of the chance that a treatment would prevent an adverse outcome exceeded estimates of the absolute chance of that outcome for 60% to 70% of clinicians. Clinicians whose overestimations were greater were more likely to report using that treatment for patients in their practice (eg, use of warfarin: correlation coefficient, 0.46; 95% CI, 0.40-0.53; P < .001).

Conclusions and Relevance In this survey study, clinicians significantly overestimated the benefits of treatment to individual patients. Clinicians with greater overestimates were more likely to report using treatments in actual patients.
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alktipping · Aug 12, 2021

they could of asked a dozen people with chronic illnesses and got the same answers .doctors rarely know the long term results of what benefits their patients get from standard protocols . my doctors only show interest when it comes to ticking the right boxes.

rvallee · Aug 12, 2021

There's that placebo effect again, the real one, creeping up wherever you can't measure things. Nothing to do with patients, it's the natural imprecision that comes from not being able to measure an effect. Same principle with a fake thermostat and asking people whether the temperature changed. The comparison is just too imprecise to be useful in most cases.

Although the idea that more education would solve that problem is hilariously naïve considering the worst offenders of this are often the creators of a treatment, who massively overestimate to the point of turning null results into full cures in the worst cases that we are all too familiar with. It's just good old bias, an issue that was simply never resolved yet people just assumed it was. Somehow.

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Clinician Conceptualization of the Benefits of Treatments for Individual Patients, 2021, Morgan, Pineles et al

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Clinician Conceptualization of the Benefits of Treatments for Individual Patients, 2021, Morgan, Pineles et al

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rvallee Senior Member (Voting Rights)

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