Study shows that doctors with personal experience of cancer are more likely to act against established guidelines to recommend that low-risk women receive ovarian cancer screening.
What do shark attacks, the lottery and ovarian cancer screening having in common? It turns out our judgments about these things are all influenced by unconscious bias. Humans are prone to overestimating the likelihood of extreme events. Blame it on availability bias — the tendency to judge the frequency of an event by how easy it is to recall examples from memory.
Guidelines for Ovarian Cancer Screening
Now a study published in the Journal of Women's Health shows that availability bias may thumb the scale of a doctor's cancer screening recommendations, as well. Survey results from 497 primary care physicians show that doctors who have had cancer themselves, or experienced cancer with a family member, close friend, or coworker, are 17% more likely than doctors without personal cancer experience to act against established guidelines to recommend that low-risk women receive ovarian cancer screening.
"Most doctors are pretty comfortable with the idea that our personal experience can make a positive impact on our practice — we've known someone and so it gives us insight into how to take care of patients in similar circumstances. This study helps us realize that sometimes it can go beyond that. Personal experiences can impact our practice in a variety of ways," says Margaret Ragland.
Screening guidelines are designed to do the most good while causing the least harm. In the case of cancer, this means screening the patients who have the greatest chance of hiding a dangerous cancer at a treatable stage.
Screening routinely saves the lives of high-risk patients. But for low-risk patients, the cost and chance that false-positive results will lead to anxiety and even unnecessary treatments outweigh the minuscule chance of finding a dangerous, treatable cancer. In other words, for a population of low-risk patients, the harm outweighs the good.
The survey collected responses from 3,200 randomly sampled physicians who provide primary care to women, with the goal of discovering characteristics of providers that might be at the greatest risk of recommending care that conflicts with guidelines. Baldwin's goal is to identify and educate these potentially non-compliant doctors to help ensure that patients more uniformly receive the best possible care.
"The reasons that doctors with personal cancer experience may be more likely to not follow screening guidelines are complicated and we don't know all the answers," Ragland says. "But my hypothesis is that a doctor's personal experience may influence their assessment of risk. You see a patient in front of you and you may assess the risk to be higher than it actually is."
"We're physicians, but we also have life experiences," Ragland says. "What this study tells us is that in ways we may not be aware, for better and for worse, our personal experience may affect our practice."