How do people understand overtesting and overdiagnosis? Systematic review and meta-synthesis of qualitative research

Rozbroj, Tomas; Haas, Romi; O’Connor, Denise; Carter, Stacy M; McCaffery, Kirsten; Thomas, Rae; Donovan, Jan; Buchbinder, Rachelle

doi:10.1016/j.socscimed.2021.114255

Cited by 23 publications

(20 citation statements)

References 69 publications

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“…Research in the context of screening for cancer and in other settings11 21 22 has shown it is challenging to communicate about overdiagnosis. Overcoming this challenge will be essential however, as screening policy evolves in the light of emerging evidence and new risk assessment tools.…”

Section: Discussionmentioning

confidence: 99%

Effects of awareness of breast cancer overdiagnosis among women with screen-detected or incidentally found breast cancer: a qualitative interview study

et al. 2022

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ObjectivesTo explore experiences of women who identified themselves as having a possible breast cancer overdiagnosis.DesignQualitative interview study using key components of a grounded theory analysis.SettingInternational interviews with women diagnosed with breast cancer and aware of the concept of overdiagnosis.ParticipantsTwelve women aged 48–77 years from the UK (6), USA (4), Canada (1) and Australia (1) who had breast cancer (ductal carcinoma in situ n=9, (invasive) breast cancer n=3) diagnosed between 2004 and 2019, and who were aware of the possibility of overdiagnosis. Participants were recruited via online blogs and professional clinical networks.ResultsMost women (10/12) became aware of overdiagnosis after their own diagnosis. All were concerned about the possibility of overdiagnosis or overtreatment or both. Finding out about overdiagnosis/overtreatment had negative psychosocial impacts on women’s sense of self, quality of interactions with medical professionals, and for some, had triggered deep remorse about past decisions and actions. Many were uncomfortable with being treated as a cancer patient when they did not feel ‘diseased’. For most, the recommended treatments seemed excessive compared with the diagnosis given. Most found that their initial clinical teams were not forthcoming about the possibility of overdiagnosis and overtreatment, and many found it difficult to deal with their set management protocols.ConclusionThe experiences of this small and unusual group of women provide rare insight into the profound negative impact of finding out about overdiagnosis after breast cancer diagnosis. Previous studies have found that women valued information about overdiagnosis before screening and this knowledge did not reduce subsequent screening uptake. Policymakers and clinicians should recognise the diversity of women’s perspectives and ensure that women are adequately informed of the possibility of overdiagnosis before screening.

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Section: Discussionmentioning

confidence: 99%

Effects of awareness of breast cancer overdiagnosis among women with screen-detected or incidentally found breast cancer: a qualitative interview study

et al. 2022

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“…For all GRADE CERQual components, appraisal began with the assumption that there were no concerns regarding the body of data contributing to each finding with the rating downgraded based on appraisal results. The GRADE CERQual approach was not applied to analytic themes due to the interpretative nature of these higher-order themes [ 37 ].…”

Section: Methodsmentioning

confidence: 99%

Perceived listening ability and hearing loss: Systematic review and qualitative meta-synthesis

Hughes

Boisvert²,

McMahon³

et al. 2022

PLoS ONE

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Background Hearing loss (HL) can affect communication in complex ways. Understanding how adults with HL reflect on and conceptualise the way they listen (metacognition) is required if interventions, and the outcome measures used to evaluate them, are to address barriers to functional communication arising from HL. Objectives This study describes how adults with HL experience and report the processes, behaviours, and components of listening, as presented in published studies. Design Systematic review and meta-synthesis of qualitative studies. Methods Systematic searches identified English-language, peer-reviewed journal articles reporting the results of qualitative or mixed-methods studies of adults’ with HL perceived listening abilities. Medline, PsychInfo, Web of Science, Embase, and Google Scholar were searched from inception to November 2021. Handsearching reference lists of included studies identified additional studies for inclusion. The Critical Appraisal Skills Programme (CASP) qualitative checklist was used to appraise studies’ methodological quality. Data from included studies were analysed using thematic meta-synthesis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Confidence in the Evidence from Reviews of QUALitative (CERQual) approach assessed confidence in the review findings. Two reviewers independently completed all screening and quality appraisal. Thematic meta-synthesis and GRADE CERQual assessment was completed by one reviewer and confirmed by a second reviewer. Discrepancies were resolved through discussion. Results Data from 46 studies were included in the review. Thematic meta-synthesis identified six descriptive themes: 1) perceived listening ability; 2) external modifiers; 3) psychosocial impacts of hearing loss; 4) communication partner perspectives; 5) self-efficacy for listening; and 6) cognitive load. GRADE CERQual ratings for descriptive themes ranged from low to moderate confidence. Descriptive themes were related by analytic themes of liminality and reciprocity. Conclusions Adults with HL provide in-depth accounts of components and processes of listening, with studies reporting both cognitive and affective experiences consistent with theoretical models of metacognition. The findings will inform content generation for a hearing-specific patient-reported outcome measure of perceived listening ability in everyday communication.

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“…[8][9][10][11] A recent systematic review synthesised all qualitative research on lay people's understanding of overtesting and overdiagnosis. 12 Only a minority of patients seems familiar with the phenomenon, and most people cannot remember receiving information about the risk of overdiagnosis before getting screened. Participants find the concept difficult to understand, are often baffled that it exists and generally prefer to be informed about it.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…Since then, multiple studies have tried to assess to what extent this information has reached the general public, especially those who already participated or are about to participate in a screening programme 8–11. A recent systematic review synthesised all qualitative research on lay people’s understanding of overtesting and overdiagnosis 12. Only a minority of patients seems familiar with the phenomenon, and most people cannot remember receiving information about the risk of overdiagnosis before getting screened.…”

Section: Introductionmentioning

confidence: 99%

Do doctors and other healthcare professionals know overdiagnosis in screening and how are they dealing with it? A protocol for a mixed methods systematic review

et al. 2022

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IntroductionOverdiagnosis is the diagnosis of a disease that would never have caused any symptom or problem. It is a harmful side effect of screening and may lead to unnecessary treatment, costs and emotional drawbacks. Doctors and other healthcare professionals (HCPs) have the opportunity to mitigate these consequences, not only by informing their patients or the public but also by adjusting screening methods or even by refraining from screening. However, it is unclear to what extent HCPs are fully aware of overdiagnosis and whether it affects their screening decisions. With this systematic review, we aim to synthesise all available research about what HCPs know and think about overdiagnosis, how it affects their position on screening policy and whether they think patients and the public should be informed about it.Methods and analysisWe will systematically search several databases (MEDLINE, Embase, Web of Science, Scopus, CINAHL and PsycArticles) for studies that directly examine HCPs' knowledge and subjective perceptions of overdiagnosis due to health screening, both qualitatively and quantitatively. We will optimise our search by scanning reference and citation lists, contacting experts in the field and hand searching abstracts from the annual conference on 'Preventing Overdiagnosis'. After selection and quality appraisal, we will analyse qualitative and quantitative findings separately in a segregated design for mixed-method reviews. The data will be examined and presented descriptively. If the retrieved studies allow it, we will review them from a constructivist perspective through a critical interpretive synthesis.Ethics and disseminationFor this type of research, no ethical approval is required. Findings from this systematic review will be published in a peer-reviewed journal and presented at the annual congress of 'Preventing Overdiagnosis'. In addition, the results will serve as guidance for further research on this topic.PROSPERO registration numberCRD42021244513.

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How do people understand overtesting and overdiagnosis? Systematic review and meta-synthesis of qualitative research

Cited by 23 publications

References 69 publications

Effects of awareness of breast cancer overdiagnosis among women with screen-detected or incidentally found breast cancer: a qualitative interview study

Effects of awareness of breast cancer overdiagnosis among women with screen-detected or incidentally found breast cancer: a qualitative interview study

Perceived listening ability and hearing loss: Systematic review and qualitative meta-synthesis

Do doctors and other healthcare professionals know overdiagnosis in screening and how are they dealing with it? A protocol for a mixed methods systematic review

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