Communicating uncertainty in cancer prognosis: A review of web-based prognostic tools.
Mark Harrison, Paul K J Han, Borsika Rabin and 5 others
PMID 30579771WHAT IT FOUND
Most cancer prognostic tools give a single risk number. 86% of tools did not show uncertainty around that estimate, and only 4% added plain language about its limits.
Key findings
01Most tools gave a quantitative risk estimate, but 86% did not represent uncertainty around the estimate.
02Only 14% of tools represented uncertainty around the estimate, and 78% of those used qualitative language or implied ranges.
03Only 4% of tools added plain language saying the estimate could be higher or lower because models are imperfect.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The search was not exhaustive and may over-represent prostate and head and neck cancers because it included an earlier focused search for those cancers. The review excluded tools that were not free, not interactive, not in English, not available online, or focused on prevention, so it may not describe all tools patients or clinicians encounter. Mobile applications were not included, even though clinicians increasingly use them. Classification required judgment, and phrases such as 'about X%' could mean uncertainty or simple rounding; inter-rater reliability was not calculated. The review did not test whether patients or clinicians understood the tools or whether the tools improved decisions. It did not evaluate the quality of the evidence behind the estimates or whether tools linked users to support.
The easy way to misread this
Do not read this as proof that prognostic tools help patients understand risk. The review described how tools present uncertainty; it did not test patient understanding or decisions.