Patients expect too much of screening and prevention

Patients overestimate the benefit that can be expected from cancer screening and preventive medications, setting minimal acceptable benefits unrealistically high, the results of a New Zealand study indicate.

The team, led by Ben Hudson, from the University of Otago, in Christchurch, say: "Our findings suggest that doctors should be aware that many patients have overly optimistic expectations of the benefits of preventive interventions and screening.

"This misperception may impair informed decision making about the use of such interventions, and physicians should consider using decision aids with patients when discussing these interventions."

In all, 354 general practice patients aged 50-70 years completed a questionnaire that asked them to estimate the number of events prevented by screening for breast cancer and bowel cancer, and preventive medication for hip fracture and cardiovascular disease, in a group of 5000 patients receiving an intervention for 10 years.

The researchers note that they considered the correct range of number of deaths avoided as two to 15 for breast cancer screening, five to 10 for bowel cancer screening, and 75-85 for cardiovascular disease. The number of hip fractures that would be avoided by prevention medication was 54.

The results, published in the Annals of Family Medicine, reveal that 90% of participants overestimated the benefit of breast cancer screening, while 94% overestimated the benefits of bowel cancer screening, 82% of hip fracture prevention, and 69% of cardiovascular disease prevention.

Multivariate analysis showed that individuals with a higher educational level, defined as a postschool qualification, were significantly less likely than those with a primary or secondary school education only to overestimate the expected benefit of screening or prevention, by around 50% for both breast cancer and bowel cancer screening and for cardiovascular disease prevention.

While the estimates of minimal acceptable benefit from interventions were more conservative than the estimates of benefit, it was observed that 70% of participants indicated a minimal acceptable benefit that was greater than the achievable benefit for breast cancer screening, along with 71% of patients for bowel cancer screening, 64% for hip fracture prevention, and 46% for cardiovascular disease prevention.

A lower level of education was a significant predictor for indicating a higher minimum level of acceptable benefit across all interventions, while increasing age was a significant predictor for breast and bowel cancer screening, and cardiovascular disease prevention.

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