Watchful waiting strategy may reduce low-value diagnostic testing

Background: PCPs need effective communication strategies to address patient requests for low-value testing while sustaining patient-provider partnerships. Watchful waiting - allowing a negotiated period of time to pass before making a firm testing decision - shows promise as a tool for addressing patient requests for low-value testing. Methods: Observational analysis of data from a randomized controlled trial of a communication intervention designed to boost patient-centeredness and reduce low-value test ordering among 61 resident primary care physicians. Intervention effectiveness was assessed during follow-up encounters of unannounced standardized patients (SPs) who requested low-value tests. We examined associations between five physician counseling behaviors and overall patient-centeredness (Measure of Patient-Centered Communication) and requested test ordering. Results: During 155 SP encounters, residents most commonly used reassurance (96% of encounters), evidence-based recommendations (97%), and watchful waiting (68 %). Resident advice to pursue watchful waiting was associated with 39% lower likelihood of test ordering (adjusted marginal effect of -38.6% [95% CI -43.6 to -33.6]). When all communication behaviors were examined together, only watchful waiting was significantly associated with test ordering (marginal effect of -38% [95% CI -44.3% to -31.7%]). Overall patient-centeredness was not associated with lowvalue testing. Conclusion: Resident physician counseling to pursue watchful waiting was associated with less ordering of requested low-value diagnostic tests, while overall patient-centeredness was not.