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Cited by 401Healthcare cost, quality, practicesClinical Reasoning and Diagnostic SkillsPatient-Provider Communication in Healthcare

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

Hoffmann, Tammy C., Del Mar, Chris·2017·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2016.8254
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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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Metadata

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)
DOI
10.1001/jamainternmed.2016.8254
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

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