1. In this randomized controlled trial, providing patients with single-page, evidence-based decision support sheets for low value or potentially low value-screening tests did not change their intention to receive these tests.
2. The investigators used four types of single-page decision support sheets, using words, numbers, numbers plus narratives, or numbers plus a framed presentation. None of the four types were significantly more effective than the others.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Inappropriate use of healthcare resources, especially in the form of low-value diagnostic testing, has been increasingly identified as a problem. In addition to the significant cost incurred by these services, many screening tests have been found to deliver net harm on a population-based level. Patient education is one potential site of intervention to decrease the prevalence of inappropriate testing. This study aimed to identify if a brief, evidence-based decision support sheet would alter patient intention to receive low-value testing.
The study investigators used four types of single-page evidence-based decision support sheets (based on United States Preventative Service Task Force data) for low value or potentially low value-screening tests, which did not change patient intention to receive these tests. None of the four types were significantly more effective than the others. Strengths of the study include the randomized design. However, convenience sampling was used, which may over or under-represent certain patient populations, which may limit the generalizability of this study. Moreover, no control arm was included in the study, and the intervention arms were only compared against each other and their own pre-intervention survey results.
Relevant Reading: The Harms of Screening
In-Depth [randomized controlled trial]: This randomized trial collected data a total of 775 patients across 32 clinicians associated with the Duke Primary Care Research Consortium. Patients aged 50-85 years received information about 1 of 3 screening services that were of net harm (prostate cancer screening in men 50-69), or low benefit (osteoporosis screening in women 50-64, or colorectal screening age 76-85). Patients were randomized to 1 of 4 intervention arms: single-page decision support sheets using words, umbers, numbers plus narratives, or numbers plus a framed presentation. The primary outcome was measured by survey, asking intention to accept screening on a scale of 1 (strongly disagree) to 5 (strongly agree).
At baseline, all intervention arms had high intention to accept screening (ranging from 3.53 to 3.71 out of 5). The intervention arms did not significantly differ in change in intention (p=0.57). Only the narrative format group had lower intention to accept screening after intervention (-0.12, 95% CI -0.22 – -0.02). There was improvement in a few secondary outcomes (disease specific knowledge, perceived disease severity, disease-specific screening attitudes, and self-efficacy for screening).
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