Cohen's d and Physicians’ Opinion on Effect Size: A Questionnaire on Anemia Treatment

Abstract

A well-known effect size (ES) indicator is Cohen's d. Cohen defined d measures of small, medium, and large ES as 0.2, 0.5, and 0.8, respectively. This approach has been criticized because practical and clinical importance depends on the context of research. The aim of the study was to examine physicians’ perception of ES using iron deficiency anemia treatment as an example and observing the effects of pretreatment level and duration of treatment on the magnitude of ES. We prepared a questionnaire describing four different clinical studies: (1) 1 month of treatment of anemia in a group of patients with a mean hemoglobin (Hb) of 10 g/dL; (2) 3 months of treatment at an Hb level of 10 g/dL; (3) 1 month of treatment at an Hb level of 8 g/dL; and (4) 3 months of treatment at an Hb level of 8 g/dL. In each scenario, respondents were required to evaluate six various levels of Hb improvement as being very small, small, medium, large, or very large effect: 0.1 g/dL, 0.3 g/dL, 0.7 g/dL, 1.1 g/dL, 1.7 g/dL, and 2.8 g/dL. The responses of 35 physicians were evaluated. For 10 mg/dL, the Cohen's d for small, medium, and large ES was 0.5, 0.8, and 1.2 respectively, for 1 month of treatment. In terms of 3 months of treatment, the Cohen's d was 0.8, 1.2, and 2, respectively. Two separate pretreatment Hb levels (8 g/dL and 10 g/dL) demonstrated a minor difference. Determination of ES during the planning phase of studies requires thorough evaluation of specific clinical cases. Our results are divergent from the classic Cohen's d values. Additionally, duration of treatment affects ES perception.