{
  "abstract": "Background People typically require a ‘metacognitive shift’ to start taking the risks of overdiagnosis seriously. Metacognition means ‘thinking about thinking’. The ‘metacognitive shift’ involves pausing and re-appraising some of the factors which tend to predispose doctors and patients to dismiss or minimise overdiagnosis even in the face of evidence. For example, specific beliefs, assumptions, accepted norms and emotional cognition. Research and anecdotal evidence details instances of metacognitive shifts that led individuals to start taking overdiagnosis seriously. Among patients, these have included bad treatment experiences, loss of trust in clinicians and ‘conversion experiences’ through long conversations with trusted others. Among clinicians, they included disenchantment with pharmaceutical company claims or particular treatment experiences. The metacognitive shifts have typically involved significant personal experiences; facts alone, such as risk-benefit statistics, rarely seem to trigger a metacognitive shift.There are already a range of interventions that have been used to promote metacognition in order to improve medical decision-making across various medical topics. Can these interventions be adapted to help prevent overdiagnosis? Answering this question requires several steps. The first step is to synthesise existing interventions. The second is to appraise their potential suitability for use in preventing overdiagnosis. Finally, promising strategies need to be adapted into novel interventions aimed specifically at preventing overdiagnosis and evaluated. The present study seeks to take the first two steps.Aims Systematically review interventions that explicitly seek to influence people’s metacognition to alter their decision-making about specific medical tests or treatments.Critically analyse interventions for potential use in preventing overdiagnosis.Methods PubMed, PsycINFO and Embase will be systematically searched. Primary research peer-reviewed studies will be included if they meet the description in Aim 1, regardless of population, context, language, or publication date. We will extract details including study design, intervention design, intervention effect and participant characteristics. A narrative synthesis will be undertaken. The study protocol will be published on OSF.All metacognition interventions synthesised in the systematic review will be critically analysed for suitability for use in preventing overdiagnosis. We will use evidence from overdiagnosis literature to iteratively develop an evaluation framework that will be used for this critical analysis. Evaluation domains may include: theoretical plausibility; magnitude and reliability of effects; relevance to overdiagnosed conditions; viability for use in different communications about overdiagnosis (e.g. in clinical settings, clinician training, patient education, decision aids); scalability. We will then critically analyse all interventions. Descriptive results will be reported.Results and Implications Data collection and analysis are ongoing but will be completed in time to be presented at the Preventing Overdiagnosis conference.The presentation will give conference attendees an understanding of potential metacognition interventions and their theoretical applicability for addressing overdiagnosis. This may spur the development of novel strategies to communicate about overdiagnosis to patients and doctors. Metacognition strategies could potentially overcome some important limitations of relying on fact-based communications alone to address overdiagnosis. The presentation could be considered a conference ‘hot topic’, because it presents a novel and clinically relevant idea that may contribute to solutions to overdiagnosis.",
  "authors": [
    {
      "affiliations": [
        "Monash University, Melbourne, Australia"
      ],
      "name": "Tomas Rozbroj"
    },
    {
      "affiliations": [
        "Monash University, Melbourne, Australia"
      ],
      "name": "Bayden McKenzie"
    },
    {
      "affiliations": [
        "Bond University, Gold Coast, Australia"
      ],
      "name": "Justin Clark"
    },
    {
      "affiliations": [
        "Monash University, Melbourne, Australia"
      ],
      "name": "Denise A O’Connor"
    },
    {
      "affiliations": [
        "Monash University, Melbourne, Australia"
      ],
      "name": "Rachelle Buchbinder"
    }
  ],
  "title": "110 Using metacognition to address overdiagnosis in medical decision-making: systematic review and critical analysis of potential strategies",
  "uid": "878991d6-8c51-5ad7-97a0-0a5733b238ab"
}