Screening guidelines often lack effective information for patients

Abstract

The majority of cancer prevention and screening guidelines in the United States do not quantify risks and benefits, and do not present enough balanced information to help patients make effective decisions, says a new study.1 The study authors suggest that that these recommendations be improved to give both clinicians and patients access to better information in an effort to help patients make educated decisions regarding their care. Tanner Caverly, MD, MPH, of the Ann Arbor Veterans Affairs Medical Center in Michigan, and his colleagues examined screening and prevention guidelines from the US Preventive Services Task Force, the ACS, the American College of Physicians, the National Comprehensive Cancer Network, and other US guide-lines within the National Guideline Clearinghouse between November 20, 2013, and January 1, 2014, with updates to the guidelines reviewed through July 1, 2015. Specifically, the researchers examined statements regarding improvements in clinically important outcomes to use as information concerning the benefits of the cancer screening and prevention services. Next, they analyzed descriptive statistics to evaluate the guideline data and how risk/benefit information was presented. The authors found 55 recommendations for using interventions to prevent or detect breast, prostate, colon, cervical, and lung cancer in 32 guidelines. Of those 55 recommendations, 39% received a comparable rating—meaning the recommendations presented absolute effects for both benefits and harms—whereas 14.5% received an incomplete rating and 54.5% received an asymmetric rating. The researchers note that better clarifying the benefits and harms would promote more accurate perceptions concerning cancer screening recommendations and help patients to make more informed decisions with regard to their specific circumstances. Although some effects of these interventions are difficult to determine precisely, firm recommendations should not be made without guideline developers and clinicians estimating how big the benefits and harms are likely to be, they emphasize. Michael Pignone, MD, MPH, of the division of general medicine at the University of North Carolina in Chapel Hill, notes in an accompanying editorial that these findings “could be an important root cause of inadequate patient-provider communication and low patient knowledge about cancer screening services.”2