Doctors' versus patients' global assessments of treatment effectiveness: empirical survey of diverse treatments in clinical trials

doi:10.1136/bmj.39560.759572.BE

BMJ 2008;336:1287-1290 (7 June), doi:10.1136/bmj.39560.759572.BE (published 21 May 2008)

Research

Doctors’ versus patients’ global assessments of treatment effectiveness: empirical survey of diverse treatments in clinical trials

Evangelos Evangelou, research associate¹, Georgios Tsianos, research associate¹, John P A Ioannidis, professor¹

¹ Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina 45110, Greece

Correspondence to: J P A Ioannidis jioannid{at}cc.uoi.gr

Objective To examine whether doctors’ global assessmentsof treatment effects agree with patients’ global assessments.

Design Survey of trials included in systematic reviews of treatmentsfor diverse conditions.

Data sources Cochrane database of systematic reviews.

Data extracted Data on patients’ global assessments andon doctors’ global assessment for the same treatment againstthe same comparator.

Main outcome measures Relative odds ratio (ratio of odds ratiosof global improvement with the experimental intervention versuscontrol according to doctors compared with patients), and improvementrates according to doctors and patients.

Results Doctors’ global assessments were compared withpatients’ global assessments for 63 different treatmentcomparisons (240 trials) in 18 conditions. The summary relativeodds ratio across the comparisons was not significant (0.98,95% confidence interval 0.88 to 1.08; I²=0%, 95% confidenceinterval 0% to 30%). In 62 of the 63 comparisons the effectsof treatment rated by patients and by doctors did not differbeyond chance, but for single comparisons the confidence intervalswere large. Rates of improvement on average did not differ betweendoctors’ assessments and patients’ assessments (summaryrelative odds ratio 0.98, 0.88 to 1.06; I²=0%, 0% to 24%).

Conclusion Doctors’ global assessments of the effectsof treatments are on average similar to those of patients.

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