The authors argue that the tendency of physicians and other health professionals to overestimate benefits and underestimate harms offers support for the notion of “therapeutic illusion,” which is when patients and physicians have unjustified enthusiasm for treatment, screening or testing. “Clinicians may seek evidence that supports interventions they believe to be effective and already use in a possible illustration of confirmation bias,” they wrote.
According to the authors, other factors potentially contributing to the problem are:
- A preoccupation with pathophysiological mechanisms of interventions rather than trial-derived effectiveness
- The difficulty of keeping up to date with the evidence for interventions, which is compounded by the exponential growth in trials and systematic reviews
- The dynamic nature of evidence for many interventions
- The difficulty of extrapolating accurately from trial evidence to individual patients
- The inherent uncertainty that accompanies benefit and harm estimates
“Solutions for redress are not easy,” they added. “Shared decision-making is a logical mechanism for bringing evidence into consultations, but this requires clinicians to know the best current evidence about the benefits and harms of the interventions being contemplated. To facilitate discussions, clinicians need ready access to up-to-date, concise and clear summaries of intervention benefits and harms.”
Decision-support tools can help. In particular, the authors—Chris Del Mar, MD, and Tammy C. Hoffman, PhD, of the Centre for Research in Evidence-Based Practice—highlighted the Sharing Evidence to Inform Treatment Decisions (SHARE-IT) tool made available by the MAGIC project. This tool can be used to create decision aids generated from evidence summaries in guidelines or systematic reviews.
AMA members can receive a free 18-month trial of DynaMed Plus, an evidence-based, physician-developed reference tool to help physicians get immediate answers to clinical questions in many specialties.
The AMA’s STEPS Forward™ collection of practice-improvement modules offers concrete advice on how to use clinical decision support as part of the image-ordering process and how to incorporate the Choosing Wisely® recommendations into your practice. These modules may also be completed for continuing medical education credit. There are seven new modules now available from the AMA’s STEPS Forward collection, bringing the total number of practice improvement strategies to 43; several thanks to a grant from, and collaboration with, the Transforming Clinical Practices Initiative.