Disclosure of Specialty Bias May Backfire

Bridget M. Kuehn

July 01, 2016

Physicians who disclose their specialty bias may actually increase the likelihood their patients will take their recommendation, according to the results of a study.

Sunita Sah, PhD, MBA, MB ChB, assistant professor of management and organizations at Cornell University's Johnson Graduate School of Business, and colleagues published the results online June 20 in the Proceedings of the National Academy of Sciences. In their article, Dr Sah and colleagues note that conflict-of-interest disclosures have become common in medicine and many other fields.

"The logic for disclosure is compelling," write Dr Sah, who studies bias and ethical decision-making, and colleagues. "Disclosure decreases the information gap between advisors and advisees and, theoretically, allows advisees to make more informed decisions."

Some research, however, has suggested that such disclosures may actually complicate decision-making or cause individuals to lose trust in their advisors, the authors note. Those giving the advice may also give more biased recommendations when they disclose. But most of the research so far has focused on financial disclosures.

Therefore, Dr Sah and colleagues conducted a two-part study to assess how surgeons disclosing their professional bias affected patient or mock patient decision-making regarding prostate cancer treatment. Prostate cancer was chosen because the primary treatments (surgery, radiation, and active surveillance) result in similar outcomes.

"Some surgeons spontaneously disclose their specialty bias, most likely due to their awareness of alternative and similarly effective treatment options in an attempt to reduce the influence of their biased recommendations on the patient's choice," the authors explain.

In the first study, the researchers analyzed transcripts from 219 recorded surgeon–patient interactions in which a patient was diagnosed with localized prostate cancer. The patients, who were seen at four Veterans Affairs hospitals, filled out surveys before the consultation to indicate their treatment preferences.

Surgeons disclosed their professional bias toward recommending surgery to 35 of the 219 patients (16.0%). Both patients who ended up hearing disclosures and those who did not reported similar preferences regarding surgery before their consultation. However, those patients who heard a disclosure were significantly more likely to undergo surgery (71.4%) than those who did not (25.5%; relative risk, 2.81; 95% confidence interval, 2.06 - 3.83; P < .001).

To confirm that bias disclosures influence patient decision-making, and find out why, the authors conducted a second randomized experiment. In the experiment, 447 men aged 50 years or older were asked to view a video of an actor portraying a surgeon giving prostate cancer results and advising about surgical and radiation treatment options. The men were randomly assigned to either a video with a bias disclosure or one without. The bias disclosure was taken verbatim from one of the transcripts analyzed in the first study. After viewing the videos, the men were asked about what decision they would make in this hypothetical scenario.

Again, those who heard the disclosure were more likely to report they would choose surgery (74.0% vs 64.7%; P = .03).

Moreover, the men in the disclosure group reported greater trust in the surgeon's expertise, and this largely explained their greater likelihood of reporting they would choose surgery, according to the authors.

The study authors said they believe the surgeons who disclosed in the observational part of the study were making a good-faith effort to help their patients make an informed decision. However, the study results suggest specialty bias disclosures may strongly influence patient's choices toward their recommendation.

"Our study highlights that the current practice of surgeons spontaneously disclosing their specialty bias to patients is not only ineffective but is likely to backfire," the authors write.

The observational study was funded by the US Department of Veterans Affairs, and the randomized experiment was funded by Georgetown University. The authors have disclosed no relevant financial relationships.

Proc Natl Acad Sci USA. Published online June 20, 2016. Abstract

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