In the study, researchers gathered responses from 579 physicians, nurse practitioners and physician assistants. Of the respondents, 69.5 percent were physicians, 6.6 percent were physician assistants and 27.8 were nurse practitioners.
Researchers posed a scenario for respondents in which a hypothetical 45-year-old woman with nonspecific lower back pain and no red-flag symptoms requested a computerized tomography or magnetic resonance imaging scan. Respondents explained what they would do in this scenario and what impacted their decision.
Here are seven key thoughts:
1. Merely 3.3 percent of those polled said the hypothetical patient would benefit from the imaging.
2. Moreover, 77.1 percent said they have concerns that the imaging could lead to more unnecessary tests or procedures.
3. More than half (57.8 percent) reported being worried a patient would be upset if they did not order the CT or MRI, and 25.8 percent believe they would not have ample time during the visit to delve into imaging’s risks and benefits with the patient.
4. Nearly 75.7 percent said they did not think they could refer the patient to a specialist unless they ordered the imaging first and 27.2 percent of clinicians were concerned failing to order the imaging may leave them vulnerable to a malpractice claim.
5. A large majority (94.2 percent) said the desire to satisfy a patient’s request would not drive them to order a CT or MRI, while 89.4 percent said they would have a “good strategy” to talk with patients about their reasoning for not ordering imaging.
6. More than half (61.8 percent) of respondents said decision support tools would be useful in assessing whether a patient would benefit from a CT or MRI and 92.7 percent would like patient education materials for talking with a patient about whether they should receive imaging.
7. Some respondents (14.8 percent) said they would have difficulty following the Choosing Wisely campaign recommendations, with many citing liability concerns. The campaign’s mission is to limit unnecessary procedures to improve patient care.
“Reduction in low-value diagnostic testing for [low back pain] will require efficient patient education interventions to address patient demands within the limited time constraints of clinicians,” the authors wrote. “Furthermore, greater attention to referral requirements is needed to assure that clinicians are able to follow evidence-based recommendations, while still being able to refer patients to specialty clinics.”
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