U.S. hospitals tout TAVR’s benefits, downplay risks

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Patients challenged by biased health care information

Patients often get information about their illness and possible treatments by searching on the Internet. The research letter by Dr. Neuman and his associates showed that hospital advertisements for TAVR are imbalanced. Their findings raise four significant concerns:

• Hospital websites often have the appearance of an education portal. Many of the websites for hospitals that perform TAVR bear the imprimatur of top medical centers and look like reputable health information. Patients who are referred to such pages to learn about a procedure may not be aware that they are consuming promotional materials rather than impartial educational resources.

• The regulatory environment for health care advertising in the United States is lax. Hospital advertisements may describe specific medical interventions that entail significant risks but there is no legal requirement that these risks be disclosed. Unbiased health information may be hard to find unless patients can read the medical literature.

• Patients lack a framework for evaluating what they need to know about many medical treatments and surgical procedures and, therefore, whether the information they have received is adequate. An advertisement for TAVR that fails to mention the potential for kidney injury or vascular complications is unlikely to prompt questions from patients. Poor-quality medical information is hard to recognize unless the person reading it is a clinician.

• An important shift away from medical paternalism in recent decades has meant that patient preferences are increasingly elicited and incorporated into health care decisions. Patient preferences for medical treatments are shaped by cognitive biases that may easily be exploited by online health care advertising.

An important first step toward ameliorating these concerns would be to clearly label hospital websites in a manner that allows patients to identify them as advertisements. More resources are needed to create, and direct patients to, balanced online informational tools. Clinicians should ask patients what they have learned from online medical searches and assist them in forming a complete picture of the risks and benefits of treatment options.

Finally, we must focus future attention not only on the content of health care advertising but on its impact. The risk that imbalanced information on U.S. hospital websites may negatively impact patient decision making should be an area of close scrutiny and may provide support for stricter advertising regulations.

Yael Schenker, M.D., is in the section of palliative care and medical ethics at the University of Pittsburgh. Alex John London, Ph.D., is in the department of philosophy at Carnegie Mellon University in Pittsburgh. They made these comments in an invited commentary that accompanied the report (JAMA Intern. Med. 2015 [doi:10.1001/jamainternmed.2014.7400]). They had no disclosures.




If patients seek out information online about transcatheter aortic valve replacement, they’ll read mostly about the procedure’s benefits and see much less about its risks, according to a survey of 317 U.S. hospital websites done in spring 2014.

Close examination of the information available for transcatheter aortic valve replacement (TAVR) on the websites of U.S. hospitals that perform the procedure revealed that 99% of the 262 hospitals with websites that described TAVR mentioned at least one benefit from the procedure, while 26% mentioned at least one risk, Dr. Mark D. Neuman and his associates reported in a research letter published online on Jan. 12 (JAMA Internal Medicine 2015; [doi:10.1001/jamainternmed.2014.7392]).

“Our findings suggest that web-based advertising of TAVR to the public by hospitals may understate the established risks of this procedure and provide little context for the magnitude of those risks to inform patient decision making. Hospitals may promote appropriate use of TAVR by presenting more balanced information regarding TAVR’s risks and benefits,” wrote Dr. Neuman, an anesthesiologist at the University of Pennsylvania in Philadelphia, and his coauthors.

During May-June 2014 they reviewed the websites for each of the 317 U.S. hospitals listed as sites that offer TAVR by the Society of Thoracic Surgeons and the American College of Cardiology. Fifty-five of the hospitals’ websites did not have their own English-language web page that mentioned TAVR. Of the 262 U.S. TAVR centers with a web page that described the procedure, 260 mentioned at least one benefit, most commonly the reduced degree of invasiveness of the procedure compared with open-surgery valve replacement, which appeared on 250 (95%) of the websites.

Of the 69 websites that mentioned at least one risk, they most commonly cited stroke, on 18% of the sites, followed by vascular complications, on 14%, and death, on 12%. In addition, the hospital sites supplied numerical quantification for benefits more frequently than for risks.

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