Watchful waiting strategy may reduce low-value diagnostic testing

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4 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)710-717
Number of pages8
JournalJournal of the American Board of Family Medicine
Volume29
Issue number6
DOIs
StatePublished - Nov 1 2016

Fingerprint

Watchful Waiting
Communication
Counseling
Physicians
Primary Care Physicians
Routine Diagnostic Tests
Randomized Controlled Trials

Keywords

  • Communication
  • Counseling
  • Diagnostic tests
  • Follow-up studies
  • Physical examination
  • Physicians
  • Primary care
  • Probability
  • Risk
  • Routine
  • Watchful waiting

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice

Cite this

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title = "Watchful waiting strategy may reduce low-value diagnostic testing",
abstract = "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.",
keywords = "Communication, Counseling, Diagnostic tests, Follow-up studies, Physical examination, Physicians, Primary care, Probability, Risk, Routine, Watchful waiting",
author = "May, {Larissa S} and Peter Franks and Jerant, {Anthony F} and Fenton, {Joshua J}",
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AU - May, Larissa S

AU - Franks, Peter

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AU - Fenton, Joshua J

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N2 - 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.

AB - 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.

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