Tuesday, August 26, 2014

Is it all right to inform patients about unclear evidence?

What happens when patients are informed about the evidence, especially when the evidence is not totally conclusive?

Golly, perhaps it seems silly to ask, but let's give credit to Matthew Maurice and Robert Abouassaly for doing so in a rigorous way.  A current article in Urology 84 (2), 2014, is entitled "Patient Opinions on Prostate Screening are Swayed by the United States Preventative Task Force Recommendations."

The answer, simply, is that patients think about the evidence and draw their own conclusions.  Perhaps just like doctors do.  My take:  Working in partnership and sharing information, they'll both make better decisions.

The abstract:


To survey patient opinions on prostate cancer (PCa) screening in light of the United States Preventive Services Task Force recommendation against its use.


We conducted a survey of all-comers to urology and primary care clinics. Participants provided demographic information and responded to a 5-item questionnaire regarding their opinions on screening before and after reading opposing position statements.


The overall response rate was 48%. After excluding incomplete questionnaires, 54 surveys were available for analysis. Patients were predominantly white, middle-aged and older, college-educated men with middle-to-upper-middle-class incomes who were seen at urology clinics. Patients rated their “pre” level of understanding of screening recommendations as good or very good (52%), okay (30%), and poor (19%). After reading the information sheets, good or very good understanding of screening recommendations improved (65%; P = .05), and agreement with the importance of screening remained high (80%). However, nearly 20% of patients expressed a more neutral or less favorable attitude toward the risk-benefit ratio of screening (P = .09). Agreement that men should undergo screening, that screening helps detect cancer, and that screening saves lives remained high, regardless of the exposure.


Overall, patients favor PCa screening, but heightened awareness of the current controversy raises concerns about its potential harms. PCa screening is a complex issue, and insight into changing public opinion will be crucial to our future discussions with patients who are wrestling with the decision whether to undergo screening.


nonlocal MD said...

My concern is for the quality of the communication of the evidence, unclear or not. Imagining the practicalities of having PCP's try to inform patients accurately about some of these controversies can be mind-boggling. And the specialists are often known to be biased on one direction or the other.

As e-patient Dave says, you can no longer expect docs to be absolutely on top of all the latest on everything in medicine. It is a strong argument for opening medical literature to patients and letting them do their own research to at least augment the physician.

By the way, Google Scholar is invaluable for such research for the layman, and I find it seems to be a little-known resource.

JeffG said...

I'm (just) a patient. My own personal opinion is that I’d like to know evidence and its interpretation, even if inconclusive. I’d like to have the opportunity to discuss the issues with my doctor and/or a knowledgeable specialist.

I would think that not all patients share that view. So it’d probably be best if doctors have that discussion in general with their patients before an issue of specific tests or treatments arises.

“Nonlocal MD” responded with a post. His concern about “the quality of the communication of the evidence” is a valid concern. In general, patients have a relationship of trusting their doctors. Some of them may be misguided in that trust. (How would they know??) Doctors have an obligation to properly communicate the relevant “evidence” to their patients and to discuss its implications with them. I believe that most take that responsibility seriously, but some may be inadequately informed or unconsciously biased.

Nonlocal MD’s recommendation for patients to do their own research is, perhaps, only a good idea if used to “augment the physician.” I think opening medical literature to patients is a great idea. But I wouldn’t expect laymen to fully understand the literature they find, and there’s no way to know what they haven’t found. Patients would benefit from their doctors’ guidance in interpreting research and applying it to their individual circumstances, as well as in deciding what to research in the first place. Without guidance from their doctors, patients are relying on the news media to tell them what they should be researching.

As hard as it is for doctors to stay on top of medical developments, it’s even harder for patients, even if medical literature is available to them.

I’m not sure of the best way to address the problems of inadequate education and biases among doctors. But more knowledge about what doctors are doing, how they’re doing it, and how well they’re doing it in various areas of healthcare (including diagnosis) would help everyone involved.

Expecting patients to know more than their doctors about relevant medical developments is unrealistic. Allowing patients (and everyone) to know more about their doctors’ performance is imperative.