Factors associated with patients' demand for low-value care: a scoping review

Area of Science:

• Health Services Research
• Healthcare Economics
• Patient Behavior Studies

Background:

• Low-value care, defined as unnecessary medical services, significantly contributes to global healthcare expenditures and inefficient resource allocation.
• Factors influencing patient demand for low-value care are often overlooked and scattered across scientific literature.

Purpose of the Study:

• To systematically review and synthesize factors associated with patients' demand for low-value care.
• To consolidate dispersed knowledge on patient-driven demand for unnecessary medical interventions.

Main Methods:

• A scoping review methodology was employed, searching Embase and Scopus databases.
• Articles were selected based on relevance to low-value care and demand-related factors, followed by thematic analysis of extracted text fragments.
• Thematic analysis identified core themes and subthemes related to patient demand for low-value care.

Main Results:

• Forty-seven articles were included, revealing eight core themes influencing patient demand for low-value care.
• Identified themes include cognitive biases, emotions, preferences, knowledge, socio-cultural aspects, biomedical factors, economic influences, and healthcare provider interactions.
• Thirty-three subthemes were further identified, such as risk aversion, anticipated regret, consumerism, and income effects.

Conclusions:

• This review provides a comprehensive overview of the multifaceted factors driving patient demand for low-value care.
• Patient demand for unnecessary care is influenced by a complex interplay of psychological, social, economic, and clinical factors.
• Future research should explore the interaction and relative importance of these factors across diverse healthcare settings to better understand patient perspectives.