Clinicians’ Expectations of the Benefits and Harms of Treatments, Screening, and Tests: A Systematic Review
Abstract
Importance Inaccurate clinician expectations of the benefits and harms of interventions can profoundly influence decision making and may be contributing to increasing intervention overuse. Objective To systematically review all studies that have quantitatively assessed clinicians’ expectations of the benefits and/or harms of any treatment, test, or screening test. Evidence Review A comprehensive search strategy of 4 databases (MEDLINE, EMBASE, Cumulative Index of Nursing and Allied Health Literature, and PsycINFO) from the start years to March 17-20, 2015, with no language or study type restriction, was performed. Searches were also conducted on cited references of the included studies, and experts and study authors were contacted. Two researchers independently evaluated methodologic quality and extracted participants’ estimates of benefit and harms and authors’ contemporaneous estimates. Findings Of the 8166 records screened, 48 articles (13 011 clinicians) were eligible. Twenty studies focused on treatment, 20 on medical imaging, and 8 on screening. Of the 48 studies, 30 (67%) assessed only harm expectations, 9 (20%) evaluated only benefit expectations, and 6 (13%) assessed both benefit and harm expectations. Among the studies comparing benefit expectations with a correct answer (total of 28 outcomes), most participants provided correct estimation for only 3 outcomes (11%). Of the studies comparing expectations of harm with a correct answer (total of 69 outcomes), a majority of participants correctly estimated harm for 9 outcomes (13%). Where overestimation or underestimation data were provided, most participants overestimated benefit for 7 (32%) and underestimated benefit for 2 (9%) of the 22 outcomes, and underestimated harm for 20 (34%) and overestimated harm for 3 (5%) of the 58 outcomes. Conclusions and Relevance Clinicians rarely had accurate expectations of benefits or harms, with inaccuracies in both directions. However, clinicians more often underestimated rather than overestimated harms and overestimated rather than underestimated benefits. Inaccurate perceptions about the benefits and harms of interventions are likely to result in suboptimal clinical management choices.
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For either medication or diet, weighing benefits against risks is vital: treatment benefits are often overestimated but harms underestimated.
“For either medication or diet, weighing benefits against risks is vital: treatment benefits are often overestimated but harms underestimated [71].”
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Taylor‐Phillips, S., Stinton, C., di Ruffano, L. F., Seedat, F., Clarke, A., & Deeks, J. J. (2018) · BMJ · doi:10.1136/bmj.k1612 · Cited by 22 · see citing works
Braschi, É., Stacey, D., Légaré, F., Grad, R. M., & Archibald, D. (2020) · Perspectives on Medical Education · doi:10.1007/s40037-020-00578-0 · Cited by 21 · see citing works
To Expand the Evidence Base About Harms from Tests and Treatments
Korenstein, D. R., Harris, R., Elshaug, A. G., Ross, J. S., Morgan, D. J., Cooper, R. J., Cho, H. J., & Segal, J. B. (2021) · Journal of General Internal Medicine · doi:10.1007/s11606-021-06597-9 · Cited by 21 · see citing works
Hoffmann, T., Gibson, E. M., Barnett, C., & Maher, C. G. (2021) · PLoS ONE · doi:10.1371/journal.pone.0251347 · Cited by 21 · see citing works
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Clinician Perspectives on Overscreening for Cancer in Older Adults With Limited Life Expectancy
Schoenborn, N. L., Massare, J., Park, R., Pollack, C. E., Choi, Y., & Boyd, C. M. (2020) · Journal of the American Geriatrics Society · doi:10.1111/jgs.16415 · Cited by 21 · see citing works
Breast cancer mortality and associated factors in São Paulo State, Brazil: an ecological analysis
Diniz, C. S. G., Pellini, A. C. G., Ribeiro, A. G., Tedardi, M. V., de Miranda, M. J., Touso, M. M., Baquero, O. S., dos Santos, P. C., & Neto, F. C. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-016395 · Cited by 20 · see citing works
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- Authors
- Hoffmann, T. C., & Del Mar, C.
- Affiliations
- Bond University (AU)
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- ORCID
- Hoffmann, Tammy C.
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2017-03-01
- Volume
- 177
- Issue
- 3
- Pages
- 407
- ISSN
- 2168-6106 (ISSN-L)
- OpenAlex
- W4253624900
- Cited by
- 401
- References
- 0
- Citations by year
- 2026: 22 · 2025: 36 · 2024: 37 · 2023: 36 · 2022: 51 · 2021: 46 · 2020: 51 · 2019: 50 · 2018: 47 · 2017: 25
- FWCI
- 76.70
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA Internal Medicine (publishedVersion)
- Bond University Research Portal (Bond University) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- clinician expectations, overuse of medical interventions, screening test, diagnostic imaging, risk perception, clinical decision-making
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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