Balancing benefit, harm, and uncertainty in diagnosis: determining the testing threshold in clinical practice

Area of Science:

• Clinical Medicine
• Medical Decision Making
• Diagnostic Testing

Background:

• Diagnostic testing is fundamental to clinical practice.
• Decisions regarding diagnostic tests range from simple to complex.
• Testing thresholds offer a structured approach to these decisions.

Purpose of the Study:

• To propose a novel framework for analyzing testing thresholds.
• To incorporate patient-specific and broader contextual variables into testing threshold analysis.
• To guide clinicians in optimizing diagnostic testing for high-value care.

Main Methods:

• Developed a framework analyzing testing thresholds.
• Included patient-related variables: symptom amplitude, clinical course, patient preferences.
• Incorporated systemic variables: medical context, costs, public health concerns, test characteristics.

Main Results:

• The proposed framework expands the traditional testing threshold concept.
• Identified patient and systemic factors influencing testing threshold dynamics.
• Highlighted the variability of testing thresholds based on test quality and cost.

Conclusions:

• Testing thresholds are crucial for guiding diagnostic test decisions.
• A comprehensive framework considering patient and systemic factors enhances clinical decision-making.
• Testing thresholds are dynamic and require continuous calibration in evolving clinical scenarios.