Matthew J Thompson1, Victoria Hardy2, Monica Zigman Suchsland3, Beth Devine4, David Kurth5, Roger Chou6, G Rebecca Haines5, Jeffrey G Jarvik7. 1. Department of Family Medicine, University of Washington, Seattle, Washington. Electronic address: mjt@uw.edu. 2. University of Cambridge, Cambridge, England. 3. Department of Family Medicine, University of Washington, Seattle, Washington. 4. The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Washington. 5. American College of Radiology, Reston, Virginia. 6. Oregon Health & Science University, Portland, Oregon. 7. Departments of Radiology, Neurological Surgery and Health Services, and the Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, Washington.
Abstract
CONTEXT: There is a growing body of literature indicating imaging testing can affect patients cognitively, socially, behaviorally, and emotionally. The extent to which these patient-centered outcomes (PCOs) are reported in the imaging literature is unclear. Identifying PCOs may facilitate shared decision making around imaging testing. OBJECTIVE: To identify PCOs across a spectrum of clinical topics included in the ACR's Appropriateness Criteria (AC). METHODS: We systematically reviewed AC evidence tables for eligible articles of studies conducted in any clinical setting in high-income countries. Included studies reported PCOs occurring as a direct or indirect result of an imaging test performed for any reason (eg, diagnosis, screening, surveillance, or staging). PCOs and the methods used to measure them were extracted through a secondary analysis and descriptive synthesis. RESULTS: Our search identified 89 articles that reported outcomes of radiation exposure (n = 37), downstream testing (n = 20), complications (n = 19), incidental findings (n = 10), quality of life (n = 7), physical discomfort (n = 5), patient values and experiences (n = 4), patient financial and time costs (n = 4), psychosocial outcomes (n = 4), and test duration (n = 2). These outcomes were rarely reported from the patient perspective and were measured using a range of standardized or validated and nonstandardized methods. CONCLUSIONS: We identified few PCOs incorporated in the AC. Our findings reflect the historical emphasis of diagnostic research on accuracy, clinical utility, and selected outcomes (eg, adverse events). As radiology moves to a more patient-centered approach, it will be important to measure PCOs reported directly from patients.
CONTEXT: There is a growing body of literature indicating imaging testing can affect patients cognitively, socially, behaviorally, and emotionally. The extent to which these patient-centered outcomes (PCOs) are reported in the imaging literature is unclear. Identifying PCOs may facilitate shared decision making around imaging testing. OBJECTIVE: To identify PCOs across a spectrum of clinical topics included in the ACR's Appropriateness Criteria (AC). METHODS: We systematically reviewed AC evidence tables for eligible articles of studies conducted in any clinical setting in high-income countries. Included studies reported PCOs occurring as a direct or indirect result of an imaging test performed for any reason (eg, diagnosis, screening, surveillance, or staging). PCOs and the methods used to measure them were extracted through a secondary analysis and descriptive synthesis. RESULTS: Our search identified 89 articles that reported outcomes of radiation exposure (n = 37), downstream testing (n = 20), complications (n = 19), incidental findings (n = 10), quality of life (n = 7), physical discomfort (n = 5), patient values and experiences (n = 4), patient financial and time costs (n = 4), psychosocial outcomes (n = 4), and test duration (n = 2). These outcomes were rarely reported from the patient perspective and were measured using a range of standardized or validated and nonstandardized methods. CONCLUSIONS: We identified few PCOs incorporated in the AC. Our findings reflect the historical emphasis of diagnostic research on accuracy, clinical utility, and selected outcomes (eg, adverse events). As radiology moves to a more patient-centered approach, it will be important to measure PCOs reported directly from patients.
Authors: Monica Zigman Suchsland; Maria Jessica Cruz; Victoria Hardy; Jeffrey Jarvik; Gianna McMillan; Anne Brittain; Matthew Thompson Journal: BMJ Open Date: 2020-07-20 Impact factor: 2.692