Walking the tightrope: communicating overdiagnosis in modern healthcare
BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i348 (Published 05 February 2016) Cite this as: BMJ 2016;352:i348
- Kirsten J McCaffery, health psychologist 1,
- Jesse Jansen, cognitive psychologist1,
- Laura D Scherer, social psychologist2,
- Hazel Thornton, independent citizen advocate3,
- Jolyn Hersch, health psychologist1,
- Stacy M Carter, public health ethicist4,
- Alexandra Barratt, epidemiologist1,
- Stacey Sheridan, primary care provider5,
- Ray Moynihan, research fellow6,
- Jo Waller, health psychologist 7,
- John Brodersen, professor89,
- Kristen Pickles, PhD student4,
- Adrian Edwards, general practitioner10
- 1School of Public Health, University of Sydney, New South Wales 2006, Australia
- 2Department of Psychological Sciences, University of Missouri, Columbia, USA
- 3Department of Health Sciences, University of Leicester, Leicester, UK
- 4Centre for Values, Ethics and the Law in Medicine, University of Sydney
- 5Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina, Chapel Hill, USA
- 6Bond University, Queensland, Australia
- 7Epidemiology and Public Health, University College London, UK
- 8Research Unit and Section of General Practice, Department of Public Health University of Copenhagen, Denmark
- 9Primary Health Care Research Unit, Zealand Region, Denmark
- 10Division of Population Medicine, School of Medicine, Cardiff University, UK
- Correspondence to: K J McCaffery kirsten.mccaffery{at}sydney.edu.au
Overdiagnosis and overtreatment have serious implications for individuals, healthcare systems, and society,1 2 and effective strategies are urgently needed to help the public, clinicians, and policy makers address this problem. Communication about overdiagnosis has been highlighted as essential for moving forward but presents several challenges, such as the potential to confuse the public, undermine trust, and adversely affect people who already have a diagnosis. Various communication based strategies offer real promise; we describe what is known and what we need to know to communicate effectively and safely about overdiagnosis and overtreatment.
What are the key messages to be communicated?
Understanding of overdiagnosis among the general public and health professionals is limited, so it is essential to communicate what it means for individuals, the health system, and society (box 1). By definition, overdiagnosis will not improve prognosis and will probably harm individuals (for example, by unnecessary intervention) or society (opportunity costs). For individuals, it is important to communicate the nature (physical or psychological), likelihood, and duration of the harms. For societies with free public healthcare, the financial strain and opportunity cost are usually at system level—resources wasted on unnecessary tests and treatments are unavailable for people in greater need. But in private healthcare systems, overdiagnosis can be a huge personal financial burden, even for those with insurance.
Box 1: Overdiagnosis and its consequences12
Overdiagnosis occurs when a diagnosis is “correct” according to current professional standards but when the diagnosis or associated treatment has a low probability of benefiting the person diagnosed.2 It is caused by a range of factors such as:
Use of increasingly sensitive tests that identify abnormalities that are indolent, non-progressive, or regressive (overdetection)
Expanded definitions of disease—for example, attention-deficit/hyperactivity disorder …
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