Identifying health outcomes that matter to patients getting imaging tests
BACKGROUND: Diagnostic tests inform most health care decisions, yet methods and standards used to evaluate tests focus on their accuracy and overlook additional outcomes that may be important to patients. This makes it challenging for patients and their providers to compare the full range of benefic...
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| Format: | eBook |
| Language: | English |
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Washington, DC
Patient-Centered Outcomes Research Institute
2021, 2021
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| Series: | Final research report
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | BACKGROUND: Diagnostic tests inform most health care decisions, yet methods and standards used to evaluate tests focus on their accuracy and overlook additional outcomes that may be important to patients. This makes it challenging for patients and their providers to compare the full range of beneficial and harmful effects of tests. Imaging tests are one of the most frequently used kinds of tests in health care, yet there are also indications that they are overused. PCORI highlighted the lack of standards for comparative effectiveness research (CER) of diagnostic tests and the need for methods to measure the effects of diagnostic tests on patient-centered outcomes (PCOs). OBJECTIVES: The overall goal was to identify which PCOs are important in evaluations of imaging tests and to propose a more comprehensive and patient-centered assessment of the benefits and harms of imaging tests. We achieved this by (1) exploring patient and health care stakeholder experiences and outcomes with different types of imaging tests to identify PCOs; (2) assessing the types and frequencies of PCOs used in existing studies of imaging tests; and (3) developing consensus recommendations by which PCOs should be measured and reported in comparative effectiveness studies of imaging tests. METHODS: A large stakeholder group including patients, caregivers, clinicians, imaging industry representatives, and methods experts was directly engaged in the research.1. Aim 1. Perform semistructured interviews with patients in primary care as well as primary care providers, radiology technologists, and radiologists to identify PCOs.2. Aim 2. Conduct a secondary analysis of systematic reviews from the American College of Radiology (ACR) Appropriateness Criteria to identify the frequency and methods used to measure PCOs.3. Aim 3. PCOs included monetary costs and opportunity costs (ie, the loss or benefit from other alternatives when one alternative is chosen). CONCLUSIONS: Our study defined PCOs of imaging tests, and it directly addresses a current methodological gap in CER of diagnostic tests. The PCOs of diagnostic tests fall into 4 domains. Patients should have information on the PCOs that occur within each domain to inform choices about the use and selection of imaging testing. CER of imaging tests needs to measure and report PCOs within these domains, and this could be implemented as part of shared decision-making with patients. LIMITATIONS: The patients and providers selected may not be representative of all clinical settings. Our sample did not achieve a balance of sex, racial, and ethnic diversity. The secondary analysis yielded only limited data on PCOs, yet it reflects the paucity of data currently used to inform decision-making. Our findings may not be generalizable to all types of diagnostic testing Hold a consensus meeting with stakeholders using NIH consensus methods to produce guidance defining the domains of PCOs, their placement within the testing pathway, and the factors that influence them. RESULTS: We conducted 77 interviews with patients and providers, which identified several domains of PCOs important to patients and the factors that moderate them. The secondary analysis of ACR data identified 89 articles, which reported outcomes in only 10 categories. We agreed on 4 key domains of PCOs at the consensus meeting:1. Knowledge gained from the imaging test. PCOs included finding the cause of symptoms or concerns, ruling in/out a condition, inconclusive tests, false-negative/false-positive results, and incidental findings.2. Physical effects of the imaging test. PCOs included the physical impact of the test.3. Emotional effects of the imaging test. PCOs included reassurance or relief, and worry or anxiety.4. Burden of the test on the patient. |
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| Physical Description: | 1 PDF file (84 pages) illustrations |