Large Language Models for Supporting Clear Writing and Detecting Spin in Randomized Controlled Trials in Oncology: Comparative Analysis of GPT Models and Prompts.

Abstract

Background Randomized controlled trials (RCTs) are the gold standard for evaluating interventions in oncology, but reporting can be subject to "spin"-presenting results in ways that mislead readers about true efficacy. Objective This study aimed to investigate whether large language models (LLMs) could provide a standardized approach to detect spin, particularly in the conclusions, where it most commonly occurs. Methods We randomly sampled 250 two-arm, single-primary end point oncology RCTs from 7 major medical journals published between 2005 and 2023. Two authors independently annotated trials as positive or negative based on whether they met their primary end point. Three commercial LLMs (GPT-3.5 Turbo, GPT-4o, and GPT-o1) were tasked with classifying trials as positive or negative when provided with (1) conclusions only; (2) methods and conclusions; (3) methods, results, and conclusions; or (4) title and full abstract. LLM performance was evaluated against human annotations. Afterward, trials incorrectly classified as positive when the model was provided only with the conclusions but correctly classified as negative when provided with the whole abstract were analyzed for patterns that may indicate the presence of spin. Model performance was assessed using accuracy, precision, recall, and F1-score calculated from confusion matrices. Results Of the 250 trials, 146 (58.4%) were positive, and 104 (41.6%) were negative. The GPT-o1 model demonstrated the highest performance across all conditions, with F1-scores of 0.932 (conclusions only; 95% CI 0.90-0.96), 0.96 (methods and conclusions; 95% CI 0.93-0.98), 0.98 (methods, results, and conclusions; 95% CI 0.96-0.99), and 0.97 (title and abstract; 95% CI 0.95-0.99). Analysis of trials incorrectly classified as positive when the model was provided only with the conclusions revealed shared patterns, including absence of primary end point results, emphasis on subgroup improvements, or unclear distinction between primary and secondary end points. These patterns were almost never found in trials correctly classified as negative. Conclusions LLMs can effectively detect potential spin in oncology RCT reporting by identifying discrepancies between how trials are presented in the conclusions vs the full abstracts. This approach could serve as a supplementary tool for improving transparency in scientific reporting, although further development is needed to address more complex trial designs beyond those examined in this feasibility study.

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