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When evidence says no: gynaecologists' reasons for (not) recommending ineffective ovarian cancer screening

Wegwarth, O; Pashayan, N; (2019) When evidence says no: gynaecologists' reasons for (not) recommending ineffective ovarian cancer screening. BMJ Quality & Safety 10.1136/bmjqs-2019-009854. (In press). Green open access

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Abstract

Introduction Most patients likely assume that physicians offer medical procedures backed by solid, scientific evidence that demonstrates their superiority—or at least non-inferiority—to alternative approaches.1 Doing otherwise would waste healthcare resources urgently needed elsewhere in the system and also would jeopardise patient health and safety as well as undermine patients’ trust in medicine2 and care. In some instances, however, physicians’ healthcare practices appear to act against scientific evidence.3–5 For example, evidence from two large randomised controlled trials6 7 on ovarian cancer screening’s effectiveness showed that the screening has no mortality benefits—neither cancer-specific nor overall—in average-risk women but considerable harms, including false-positive surgeries in women without ovarian cancer. Consequently, the US Preventive Services Task Force and medical associations worldwide recommend against ovarian cancer screening.8 Nevertheless, a considerable number of US gynaecologists persist in recommending the screening to average-risk women.9 To understand why physicians continue using a practice called into question by scientific evidence, we investigated gynaecologists’ reasons for or against recommending ovarian cancer screening, their assumptions about why other gynaecologists recommend it, and the association between their knowledge of basic concepts of cancer screening statistics10 and recommendation behaviour.

Type: Article
Title: When evidence says no: gynaecologists' reasons for (not) recommending ineffective ovarian cancer screening
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/bmjqs-2019-009854
Publisher version: https://doi.org/10.1136/bmjqs-2019-009854
Language: English
Additional information: This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Keywords: Continuing education, continuing professional development, decision making, evidence-based medicine, medical education, patient safety
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Applied Health Research
URI: https://discovery.ucl.ac.uk/id/eprint/10086318
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