Communication of risks in oncology

Abstract

Efficient healthcare requires well-informed doctors and patients, yet our current healthcare system falls short in both regards. To illustrate the problem: a nationwide study involving 412 US physicians revealed that the majority were unaware of the misleading nature of the 5‑year survival statistic when it comes to screening, and consequently based their screening recommendations on this flawed metric. Similarly concerning, not a single surveyed German gynecologist provided patients with comprehensive information on the benefits and risks associated with mammography screening, impeding patients’ ability to make informed decisions. In addition, in a national survey of 300 US citizens who underwent one or more screening tests, a staggering 91% had never been informed by their doctors about the most significant risks of screening—overdiagnosis and overtreatment. Why do we have this lack of risk literacy? Research has demonstrated that the problem lies less in stable cognitive deficits than in how information is presented to physicians and patients. This includes biased reporting in medical journals, brochures, and the media that uses relative risks and other misleading statistics. What can be done? Every medical school should teach its students how to understand evidence in general and health statistics in particular. To cultivate informed patients, elementary and high schools should start teaching the mathematics of uncertainty—statistical thinking. Guidelines about complete and transparent reporting in journals, brochures, and the media need to be better enforced to ensure the spread of evidence and not misleading information. A critical mass of informed citizens will not resolve all health care problems, but it can constitute a major triggering factor for better care.