The effects of information framing on the practices of physicians

Abstract

OBJECTIVE:The presentation format of clinical trial results, or the "frame," may influence perceptions about the worth of a treatment. The extent and consistency of that influence are unclear. We undertook a systematic review of the published literature on the effects of information framing on the practices of physicians. DESIGN:Relevant articles were retrieved using bibliographic and electronic searches. Information was extracted from each in relation to study design, frame type, parameter assessed, assessment scale, clinical setting, intervention, results, and factors modifying the frame effect. MAIN RESULTS:Twelve articles reported randomized trials investigating the effect of framing on doctors' opinions or intended practices. Methodological shortcomings were numerous. Seven papers investigated the effect of presenting clinical trial results in terms of relative risk reduction, or absolute risk reductions or the number needing to be treated; gain/loss (positive/negative) terms were used in four papers; verbal/numeric terms in one. In simple clinical scenarios, results expressed in relative risk reduction or gain terms were viewed most positively by doctors. Factors that reduced the impact of framing included the risk of causing harm, preexisting prejudices about treatments, the type of decision, the therapeutic yield, clinical experience, and costs. No study investigated the effect of framing on actual clinical practice. CONCLUSIONS:While a framing effect may exist, particularly when results are presented in terms of proportional or absolute measures of gain or loss, it appears highly susceptible to modification, and even neutralization, by other factors that influence doctors' decision making. Its effects on actual clinical practice are unknown.KEY WORDS: information framing; systematic review; presentation format; absolute risk; relative risk; number needed to treat. J GEN INTERN MED 1999;14:633-642. In this era of evidence-based medicine, medical decisions are frequently based on data that estimate, in numeric terms, the expected benefits and harms of certain clinical interventions. Psychological analyses of decision making, however, have found that the interpretation of numeric data may vary depending on the presentation format or the "frame." 1,2 Similarly, in the medical literature, it has been found that under certain circumstances, the frame used to present the results of clinical trials may influence perceptions about the worth of treatments. [3][4][5] It appears that when the benefits of therapy, estimated from the results of large-scale clinical trials, are presented as relative risk reductions (RRR), enthusiasm for an intervention is higher than when the same data are presented as absolute risk reductions (ARR), or as the number needing to be treated in order to prevent a single event (NNT). For example, in a study that has been widely quoted to illustrate the framing effect, Forrow et al. found that physicians' judgments about treating patients with hypertension and hyperlipidemia differed depen...

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