Jenna F Kruger1, Alice Hm Chen1, Alex Rybkin2, Kiren Leeds1, Dominick L Frosch3, L Elizabeth Goldman1. 1. Division of General Internal Medicine, Department of Medicine, UCSF, San Francisco, California, USA. 2. Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA. 3. UCLA Division of General Internal Medicine & HSR, Department of Medicine, Palo Alto Medical Foundation Research Institute; Gordon & Betty Moore Foundation, Palo Alto, California, USA.
Abstract
BACKGROUND AND OBJECTIVES: Increased computer tomography (CT) scan use has contributed to a rise in medically-associated radiation exposure. The extent to which clinicians consider radiation exposure when ordering imaging tests is unknown. We examined (1) outpatient clinician attitudes towards considering radiation exposure when ordering CT scans; and (2) clinician reactions to displaying radiation exposure information for CT scans at clinician electronic order entry. METHODS: We conducted nine focus groups with primary care clinicians and subspecialty physicians (nephrology, pulmonary and neurology) (n=50) who deliver outpatient care across 12 hospital-based clinics and community health centres in an urban safety-net health system, which use a common electronic order entry system. We analysed focus group transcripts using an inductive framework to identify emergent themes and illustrative quotations. FINDINGS: Clinicians felt they had limited knowledge of the clinical implications of radiation exposure. Many believed clinically relevant information such as the increased risk of malignancy from CT scans would be useful to inform decision-making and patient-clinician discussions. Clinicians noted that patient vulnerability and long wait times for tests with less radiation exposure (such as MRI or ultrasound) often acted as barriers to minimise patient radiation exposure from CT scans. Clinicians suggested providing patients' cumulative radiation exposure or formal decision aids to improve the usefulness of the radiation exposure information. CONCLUSIONS: Displaying clinically relevant radiation exposure information at order entry may improve clinician knowledge and inform patient-clinician discussions regarding risks and benefits of imaging. However, limited access to tests with lower radiation exposure in safety-net settings may trump efforts to minimise patient radiation exposure. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BACKGROUND AND OBJECTIVES: Increased computer tomography (CT) scan use has contributed to a rise in medically-associated radiation exposure. The extent to which clinicians consider radiation exposure when ordering imaging tests is unknown. We examined (1) outpatient clinician attitudes towards considering radiation exposure when ordering CT scans; and (2) clinician reactions to displaying radiation exposure information for CT scans at clinician electronic order entry. METHODS: We conducted nine focus groups with primary care clinicians and subspecialty physicians (nephrology, pulmonary and neurology) (n=50) who deliver outpatient care across 12 hospital-based clinics and community health centres in an urban safety-net health system, which use a common electronic order entry system. We analysed focus group transcripts using an inductive framework to identify emergent themes and illustrative quotations. FINDINGS: Clinicians felt they had limited knowledge of the clinical implications of radiation exposure. Many believed clinically relevant information such as the increased risk of malignancy from CT scans would be useful to inform decision-making and patient-clinician discussions. Clinicians noted that patient vulnerability and long wait times for tests with less radiation exposure (such as MRI or ultrasound) often acted as barriers to minimise patient radiation exposure from CT scans. Clinicians suggested providing patients' cumulative radiation exposure or formal decision aids to improve the usefulness of the radiation exposure information. CONCLUSIONS: Displaying clinically relevant radiation exposure information at order entry may improve clinician knowledge and inform patient-clinician discussions regarding risks and benefits of imaging. However, limited access to tests with lower radiation exposure in safety-net settings may trump efforts to minimise patient radiation exposure. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Entities:
Keywords:
Attitudes; Health services research; Qualitative research; Shared decision making
Authors: B Lumbreras; J Vilar; I González-Álvarez; M Guilabert; L A Parker; M Pastor-Valero; M L Domingo; M F Fernández-Lorente; I Hernández-Aguado Journal: BMJ Open Date: 2016-10-31 Impact factor: 2.692
Authors: Ayazullah Safi; Matthew Cole; Adam L Kelly; Mohammed Gulrez Zariwala; Natalie C Walker Journal: Int J Environ Res Public Health Date: 2022-08-01 Impact factor: 4.614
Authors: José Joaquín Mira; Irene Carrillo; Carmen Silvestre; Pastora Pérez-Pérez; Cristina Nebot; Guadalupe Olivera; Javier González de Dios; Jesús María Aranaz Andrés Journal: BMJ Open Date: 2018-06-15 Impact factor: 2.692
Authors: Ana S F Ribeiro; Olga Husson; Nicholas Drey; Iain Murray; Katherine May; Jim Thurston; Wim J G Oyen Journal: Nucl Med Commun Date: 2020-06 Impact factor: 1.698