Abstract
Efficient patient care requires the conscientious use of current best evidence. Such evidence on ovarian cancer screening showed that the screening has no survival benefit but considerable harms; currently no medical organization recommends it. In a cross-sectional online survey study with 401 US outpatient gynecologists we investigated whether they follow the recommendation of their medical organizations in daily practice and report estimates of ovarian cancer screening’s effectiveness that approximate current best evidence (within a ± 10 percent margin of error), and if not, whether a fact box intervention summarizing current best evidence improves judgments. Depending on question, 44.6% to 96.8% reported estimates and beliefs regarding screening’s effectiveness that diverged from evidence, and 57.6% reported regularly recommending the screening. Gynecologists who recommend screening overestimated the benefit and underestimated the harms more frequently. After seeing the fact box, 51.6% revised initial estimates and beliefs, and the proportion of responses approximating best evidence increased on all measures (e.g., mortality reduction: 32.9% [95% CI, 26.5 to 39.7] before intervention, 77.3% [71.0 to 82.8] after intervention). Overall, results highlight the need for intensified training programs on the interpretation of medical evidence. The provision of fact box summaries in medical journals may additionally improve the practice of evidence-based medicine.
Highlights
The practice of evidence-based medicine (EbM) requires physicians to conscientiously and judiciously use the currently best scientific evidence in making sound decisions about patients’ care
Sample American Medical Association (AMA) Masterfile asked three questions: First, do US outpatient gynecologists currently recommend ovarian cancer screening? Second, do gynecologists report estimates and beliefs regarding the benefit and harms of ovarian cancer screening by transvaginal ultrasound (TVU) and cancer antigen (CA-)125 testing that approximate the evidence from the PLCO trial? Third, when provided with an easy-to-understand fact box summarizing the findings from the PLCO trial[5], do gynecologists revise their initial estimates and beliefs of the benefit and harms of screening if these differed from the evidence?
To better reflect the general population of US gynecologists, we applied quotas matching the distribution of years in practice and gender of the American Medical Association (AMA) Masterfile at the point of survey completion. 401 gynecologists completed the survey for analysis
Summary
The practice of evidence-based medicine (EbM) requires physicians to conscientiously and judiciously use the currently best scientific evidence in making sound decisions about patients’ care. In 2011, the randomized controlled US Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial5—involving 78,216 average-risk women aged 55 to 74 years assigned to undergo either annual screening involving a combination of 6 years of cancer antigen (CA-)[125] testing and 4 subsequent years of transvaginal ultrasound (TVU) (screening group) or usual care (nonscreening group)—showed that about 3 women in 1,000 in both the screening and the nonscreening group died of ovarian cancer within that time frame, and about 85 in 1,000 in each group of other causes It further revealed substantial harms within the screening group: 96 women in every 1,000 screened had a false alarm, of whom 32 had their ovaries unnecessarily removed as part of further diagnostic work-up[5]. Asked three questions: First, do US outpatient gynecologists currently recommend ovarian cancer screening? Second, do gynecologists report estimates and beliefs regarding the benefit and harms of ovarian cancer screening by TVU and CA-125 testing that approximate the evidence from the PLCO trial? Third, when provided with an easy-to-understand fact box summarizing the findings from the PLCO trial[5], do gynecologists revise their initial estimates and beliefs of the benefit and harms of screening if these differed from the evidence?
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