Multicriteria Decision Support Would Avoid Overdiagnosis and Overtreatment.

Area of Science:

• Medical Decision Making
• Health Services Research
• Preventive Medicine

Background:

• Population-level studies reveal high rates of overdiagnosis and overtreatment, especially with routine screening of asymptomatic individuals.
• Informed consent processes must address the potential harms of overdiagnosis and overtreatment to encourage informed participation.
• Integrating population-level data on these phenomena into individual decision-making presents a significant challenge.

Purpose of the Study:

• To evaluate strategies for incorporating overdiagnosis and overtreatment rates into individual patient decision-making.
• To identify practical approaches for presenting complex health information during the screening consent process.
• To propose an improved method for decision support that accounts for diagnostic and treatment uncertainties.

Main Methods:

• Review of existing literature on overdiagnosis and overtreatment in screening programs.
• Analysis of current practices in informed consent for screening, particularly for cancer.
• Critique of strategies for presenting statistical risks to patients.
• Proposal and conceptualization of an outcome-focused multicriteria decision support tool.

Main Results:

• The dominant strategy of presenting discrete overdiagnosis/overtreatment rates alongside condition-specific mortality is impractical and difficult for patients to process.
• Existing cancer decision aids often present complex, isolated information, hindering effective patient understanding and decision-making.
• A multicriteria decision support tool offers a more integrated and practical approach to incorporating these harms.

Conclusions:

• Presenting isolated statistics on overdiagnosis and overtreatment is not an effective strategy for informed consent.
• An outcome-focused multicriteria decision support tool can effectively integrate the impacts of overdiagnosis, overtreatment, underdiagnosis, and undertreatment.
• This approach enhances shared decision-making by providing a more holistic view of screening outcomes.