Decision fatigue in low-value prostate cancer screening

Area of Science:

• Urology
• Health Services Research
• Decision Science

Background:

• Low-value prostate-specific antigen (PSA) testing is a significant contributor to healthcare waste and potential patient harm.
• Decision fatigue, a phenomenon where decision-making ability declines with repeated choices, is proposed as a factor influencing low-value care.
• Understanding the role of decision fatigue in PSA testing patterns can inform strategies to improve urologic care efficiency.

Purpose of the Study:

• To investigate whether patterns of low-value PSA testing in outpatient settings are associated with decision fatigue among clinicians.
• To analyze the relationship between appointment timing and the likelihood of ordering PSA tests, considering test appropriateness.

Main Methods:

• Retrospective analysis of over 1.5 million outpatient appointments for adult men without a prostate cancer diagnosis from 2011-2018.
• Assessment of PSA testing rates based on appointment time, stratified by patient age and guideline appropriateness.
• Separate examination of testing patterns among urologists versus other outpatient clinicians.

Main Results:

• PSA testing, both appropriate and low-value, decreased significantly as the clinic day progressed.
• The decline in appropriate PSA testing was more pronounced than the decline in low-value testing throughout the day.
• Urologists exhibited distinct PSA testing patterns compared to other clinicians.

Conclusions:

• Outpatient PSA testing behaviors among most clinicians align with the concept of decision fatigue.
• Decision fatigue presents a potentially actionable target for interventions aimed at reducing wasteful and low-value urologic care.
• Addressing decision fatigue could mitigate unnecessary testing and subsequent patient harm.