0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Review | Less Is More

Patients’ Expectations of the Benefits and Harms of Treatments, Screening, and Tests A Systematic Review

Tammy C. Hoffmann, PhD1,2; Chris Del Mar, MD, FRACGP1
[+] Author Affiliations
1Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
2School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
JAMA Intern Med. 2015;175(2):274-286. doi:10.1001/jamainternmed.2014.6016.
Text Size: A A A
Published online

Importance  Unrealistic patient expectations of the benefits and harms of interventions can influence decision making and may be contributing to increasing intervention uptake and health care costs.

Objective  To systematically review all studies that have quantitatively assessed patients’ expectations of the benefits and/or harms of any treatment, test, or screening test.

Evidence Review  A comprehensive search strategy was used in 4 databases (MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO) up to June 2013, with no language or study type restriction. We also ran cited reference searches of included studies and contacted experts and study authors. Two researchers independently evaluated methodological quality and extracted participants’ estimates of benefit and harms and authors’ contemporaneous estimates.

Findings  Of the 15 343 records screened, 36 articles (from 35 studies) involving a total of 27 323 patients were eligible. Fourteen studies focused on a screen, 15 on treatment, 3 a test, and 3 on treatment and screening. More studies assessed only benefit expectations (22 [63%]) than benefit and harm expectations (10 [29%]) or only harm (3 [8%]). Fifty-four outcomes (across 32 studies) assessed benefit expectations: of the 34 outcomes with overestimation data available, the majority of participants overestimated benefit for 22 (65%) of them. For 17 benefit expectation outcomes, we could not calculate the proportion of participants who overestimated or underestimated, although for 15 (88%) of these, study authors concluded that participants overestimated benefits. Expectations of harm were assessed by 27 outcomes (across 13 studies): underestimation data were available for 15 outcomes and the majority of participants underestimated harm for 10 (67%) of these. A correct estimation by at least 50% of participants only occurred for 2 outcomes about benefit expectations and 2 outcomes about harm expectations.

Conclusions and Relevance  The majority of participants overestimated intervention benefit and underestimated harm. Clinicians should discuss accurate and balanced information about intervention benefits and harms with patients, providing the opportunity to develop realistic expectations and make informed decisions.

Figures in this Article

Figures

Place holder to copy figure label and caption
Figure 1.
Flow of the Information Through the Phases of the Review
Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Proportion of Participants Providing a Correct Estimate, Underestimate, or Overestimate of Intervention Benefit

Ca indicates cancer; HT, hormone therapy; IBD, irritable bowel disease; PSA, prostate-specific antigen.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Proportion of Participants Providing a Correct Estimate, Underestimate, or Overestimate of Intervention Harm

Ca indicates cancer; CT, computed tomography; HT, hormone therapy.

Graphic Jump Location

Tables

References

Correspondence

CME


You need to register in order to view this quiz.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

7,522 Views
27 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();