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Doctors and Patients’ Susceptibility to Framing Bias: A Randomized Trial

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ABSTRACT

BACKGROUND

Framing of risk influences the perceptions of treatment benefit.

OBJECTIVE

To determine which risk framing format corresponds best to comprehensive multi-faceted information, and to compare framing bias in doctors and in patients.

DESIGN

Randomized mail surveys.

PARTICIPANTS

One thousand four hundred and thirty-one doctors (56% response rate) and 1121 recently hospitalized patients (65% response rate).

INTERVENTION

Respondents were asked to interpret the results of a hypothetical clinical trial comparing an old and a new drug. They were randomly assigned to the following framing formats: absolute survival (new drug: 96% versus old drug: 94%), absolute mortality (4% versus 6%), relative mortality reduction (reduction by a third) or all three (fully informed condition). The new drug was reported to cause more side-effects.

MAIN MEASURE

Rating of the new drug as more effective than the old drug.

RESULTS

The proportions of doctors who rated the new drug as more effective varied by risk presentation format (abolute survival 51.8%, absolute mortality 68.3%, relative mortality reduction 93.8%, and fully informed condition 69.8%, p < 0.001). In patients these proportions were similar (abolute survival 51.7%, absolute mortality 66.8%, relative mortality reduction 89.3%, and fully informed condition 71.2%, p < 0.001). In both doctors (p = 0.72) and patients (p = 0.23) the fully informed condition was similar to the absolute risk format, but it differed significantly from the other conditions (all p < 0.01). None of the differences between doctors and patients were significant (all p > 0.1). In comparison to the fully informed condition, the odds ratio of greater perceived effectiveness was 0.45 for absolute survival (p < 0.001), 0.89 for absolute mortality (p = 0.29), and 4.40 for relative mortality reduction (p < 0.001).

CONCLUSIONS

Framing bias affects doctors and patients similarly. Describing clinical trial results as absolute risks is the least biased format, for both doctors and patients. Presenting several risk formats (on both absolute and relative scales) should be encouraged.

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Acknowledgment

The doctor survey was funded by an internal Research & Development grant, University Hospitals of Geneva; the patient survey was funded by the hospital’s Quality of Care Program. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Conflict of Interests

None disclosed.

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Authors and Affiliations

  1. Division of clinical epidemiology, University Hospitals of Geneva, 4 rue Gabrielle-Perret-Gentil, CH-1211, Geneva, Switzerland

    Thomas V. Perneger MD, PhD & Thomas Agoritsas MD

  2. Division of general internal medicine, University Hospitals of Geneva, Geneva, Switzerland

    Thomas Agoritsas MD

  3. Faculty of medicine, University of Geneva, Geneva, Switzerland

    Thomas V. Perneger MD, PhD & Thomas Agoritsas MD

Authors
  1. Thomas V. Perneger MD, PhD
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  2. Thomas Agoritsas MD
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Correspondence to Thomas V. Perneger MD, PhD.

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Perneger, T.V., Agoritsas, T. Doctors and Patients’ Susceptibility to Framing Bias: A Randomized Trial. J GEN INTERN MED 26, 1411–1417 (2011). https://doi.org/10.1007/s11606-011-1810-x

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  • DOI: https://doi.org/10.1007/s11606-011-1810-x

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