Clinician Conceptualization of the Benefits of Treatments for Individual Patients

Daniel J. Morgan, Lisa Pineles, Jill Owczarzak, Larry Magder, Laura Scherer, Jessica P. Brown, Chris Pfeiffer, Chris Terndrup, Luci Leykum, David Feldstein, Andrew Foy, Deborah Stevens, Christina Koch, Max Masnick, Scott Weisenberg, Deborah Korenstein

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Article number19747
JournalJAMA network open
Volume4
Issue number7
DOIs
StatePublished - Jul 21 2021

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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