Watchful Waiting Strategy May Reduce Low-Value Diagnostic Testing.

Area of Science:

• Primary Care Medicine
• Health Communication
• Clinical Decision-Making

Background:

• Primary care physicians (PCPs) require effective communication strategies to manage patient requests for low-value diagnostic tests.
• Maintaining patient-provider partnerships is crucial when addressing these requests.
• Watchful waiting, a strategy involving a negotiated delay in testing decisions, shows potential in managing low-value test requests.

Purpose of the Study:

• To assess the effectiveness of physician communication behaviors in reducing low-value test ordering.
• To determine the association between specific counseling behaviors and test ordering in primary care settings.
• To evaluate the impact of patient-centeredness on low-value test requests.

Main Methods:

• Observational analysis of data from a randomized controlled trial involving 61 resident primary care physicians.
• Intervention effectiveness was evaluated using unannounced standardized patients (SPs) requesting low-value tests.
• Examined associations between five physician counseling behaviors, patient-centeredness, and test ordering.

Main Results:

• Watchful waiting was employed in 68% of standardized patient encounters.
• Resident advice to pursue watchful waiting was linked to a 39% lower likelihood of test ordering.
• Only watchful waiting, not overall patient-centeredness, was significantly associated with reduced low-value test ordering.

Conclusions:

• Counseling by resident physicians to adopt watchful waiting is associated with decreased ordering of low-value diagnostic tests.
• Overall patient-centeredness did not demonstrate a significant association with the reduction of low-value test ordering.
• Watchful waiting emerges as a promising communication tool for PCPs to manage patient-driven low-value testing.