One-page decision support tools didn't sway patients from low-value screening

Last Updated: 2015-12-29

By Anne Harding

NEW YORK (Reuters Health) - A one-page decision support tool is unlikely to change patients' intentions about whether to undergo low-value screening services, according to new findings.

"This is preliminary evidence that a one-page decision support sheet is not sufficient by itself to reduce intentions for screening for low-value or potentially low-value services," Dr. Stacey Sheridan of the University of North Carolina at Chapel Hill told Reuters Health in a telephone interview.

Overuse of health care costs the U.S. $192 billion annually, Dr. Sheridan and her team note in their report, published online December 28 in JAMA Internal Medicine. "This results in physical, psychological, and financial harms; hassle; and opportunity costs without potential benefit for patients," they add.

The researchers sought to investigate the effectiveness of a patient communication strategy for reducing use of three low-value or potentially low-value screening services: prostate cancer screening in men 50 to 69 years old; osteoporosis screening for low-risk women age 50 to 64; and colorectal screening for men and women 76 to 85 years old.

They investigated four different formats: words, numbers, numbers plus narrative, or numbers plus a framed presentation. A total of 775 patients were assigned to words (195), numbers (192), narrative (196) or framed (192).

At the study's outset, patients' intent to accept screening based on a scale of one to five ranged from 3.53 to 3.71, with no significant difference among the four groups. While researchers found a 0.12-point reduction in intention to accept screening for patients who received the narrative format, they found no differences from baseline to post-intervention in the three other groups, and no statistical difference existed across the four groups in intentions for screening.

"Basically what we found is that none of these formats differentially affected intentions for screening services," Dr. Sheridan said. While patients did show a small increase in outcomes such as knowledge after the intervention, she added, "it's probably not clinically significant."

The journal should be commended for publishing a study with null results, Dr. Judith Prochaska, of the Stanford Prevention Research Center at Stanford University in California, told Reuters Health in a telephone interview. Dr. Prochaska coauthored an editorial accompanying the new study. "I wouldn't say the findings necessarily give us a clear direction on what to do next in practice, but there are some good lessons that could be learned from the study design."

Only about a third of the patients recruited for the study decided to enroll, Dr. Prochaska noted, meaning that the study participants were likely fairly motivated to undergo screening; most had also undergone the screening tests in the past.

Patients were also highly educated, with more than 90% having college degrees, and all were receiving continuity care. "Unknown is how study findings generalize to younger, more socioeconomically disadvantaged groups, and those without interest and prior screening experience," she and Dr. Ashley Sanders-Jackson of Michigan State University in East Lansing note in their editorial.

"That most of the study sample had been screened prior, likely within the clinical practice through which the intervention was being tested, without ill-reported effects and with intention to screen again, suggests the appropriateness of a more personalized and multilevel systems approach," they conclude.

"It can be hard with just the patient information sheet because you don't know how much exposure the person's getting," Dr. Prochaska added. "There are novel creative approaches you can get to make sure that they're interacting with the content and understanding it."

This could include interactive videos, for example, or simply a five- to 10-minute discussion between doctor and patient about the pros and cons of a test, she said. While this takes time that doctors don't feel they have, she added, sending patients for tests also takes time and costs money. "If you can invest that additional five to 10 minutes to have that conversation it can pay off well for the system."

The Agency for Healthcare Research and Quality supported this research. The authors reported no disclosures.

SOURCE: http://bit.ly/1RPxddV and http://bit.ly/1ZznWbf

JAMA Intern Med 2015.