Public Opinions about Overdiagnosis: A National Community Survey

PLoS One. 2015 May 20;10(5):e0125165. doi: 10.1371/journal.pone.0125165. eCollection 2015.

Abstract

Background: Despite evidence about the "modern epidemic" of overdiagnosis, and expanding disease definitions that medicalize more people, data are lacking on public views about these issues. Our objective was to measure public perceptions about overdiagnosis and views about financial ties of panels setting disease definitions.

Methods: We conducted a 15 minute Computer Assisted Telephone Interview with a randomly selected community sample of 500 Australians in January 2014. We iteratively developed and piloted a questionnaire, with a convenience sample (n=20), then with participants recruited by a research company (n=20). Questions included whether respondents had been informed about overdiagnosis; opinions on informing people; and views about financial ties among panels writing disease definitions.

Findings: Our sample was generally representative, but included a higher proportion of females and seniors, typical of similar surveys. American Association for Public Opinion Research response rate was 20% and cooperation rate was 44%. Only 10% (95% CI 8%-13%) of people reported ever being told about overdiagnosis by a doctor. 18% (95% CI 11%-28%) of men who reported having prostate cancer screening, and 10% (95% CI 6%-15%) of women who reported having mammography said they were told about overdiagnosis. 93% (95% CI 90%-95%) agreed along with screening benefits, people should be informed about overdiagnosis. On panels setting disease definitions, 78% (95% CI 74%-82%) felt ties to pharmaceutical companies inappropriate, and 91% (95% CI 82%-100%) believed panels should have a minority or no members with ties. Limitations included questionnaire novelty and complexity.

Conclusions: A small minority of Australians surveyed, including those reporting being screened for prostate or breast cancer, reported being informed of overdiagnosis; most believed people should be informed; and a majority felt it inappropriate that doctors with ties to pharmaceutical companies write disease definitions. Results suggest strategies to better inform people about overdiagnosis, and review disease definition processes, have significant public sympathy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude to Health*
  • Australia
  • Conflict of Interest*
  • Drug Industry / standards
  • Female
  • Humans
  • Interviews as Topic
  • Male
  • Medical Overuse / statistics & numerical data*
  • Medical Overuse / trends*
  • Physician's Role*
  • Public Opinion*
  • Surveys and Questionnaires

Grant support

RM and JD's positions receive funding from Screening and Test Evaluation Program (STEP) grant from the National Health and Medical Research Council (www.nhmrc.gov.au) (NHMRC) #633003; EB’s position receives funding from Australia Fellowship grant: Glasziou NHMRC #527500; the survey received part funding from a Bond University Vice-Chancellors Research Grant (www.bond.edu.au) and part funding from NHRMC (STEP) grant #633003. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.