Patients Overly Optimistic About the Benefits of Treatments, Tests, Screening

Patients have a naïve optimism about medical care. A new study in JAMA found that patients have an unrealistic expectation of the benefits and harms of common medical treatments, tests, and screens.

These expectations may be contributing the increased interventions and healthcare costs, according to authors Tammy C. Hoffmann, PhD, from the University of Queensland, Brisbane, Australia, and Bond University, Queensland, Australia; and Chris Del Mar, MD, FRACGP, from Bond University.

Among the 15,343 papers they screen, 35 involving 27,323 patients were eligible. Most screening studies were about cancer screening. Various treatments studied included surgery, medications, and other things like cardiopulmonary resuscitation.

Overall, most people overestimated the benefits of an intervention and underestimated the harms, the authors wrote on the University of Queensland website

“Across most studies, the proportion of people who correctly estimated intervention benefits and harms was generally low,” they wrote. “In other words, people appear to have set a halo around medical care, expecting it to deliver better outcomes than is reality.”

There was only one study (out of the 35 reviewed) where the majority of participants actually underestimated the benefit, and another study where the majority overestimated the harm.

Some of the likely factors for this phenomenon include the assumption that more healthcare is better and clinicians wanting to convey hope and encouragement. The authors believe overly optimistic expectations have contributed to the increasing use of health services.

The researchers named a number of groups responsible to counteract the unrealistic expectations of patients: researchers, journalists, health services and the pharmaceutical industry, and clinicians.

“In the process of negotiating the best clinical option, clinicians should elicit the patient’s expectations and preconceptions about what they are expecting from the intervention, discuss any misperceptions, and provide accurate information about the benefits and harms of each management option,” Drs Hoffman and Del Mar concluded in their paper.