Key Themes and Quotes From Patient and Physician Interviews
low back pain, prostate cancer
SAID, PROSTATE CANCER
Parenthetical numbers are unique participant identifiers.When asked their views on testing, most patients expressed willingness to get tests that were routine, recommended by their physicians, or perceived as not burdensome. Some disagreed with study material content about testing downsides but most expressed prior understanding of these downsides, influenced by their own or their family’s or friends’ experiences with tests, health care training or, in 1 case, news about false positives triggering care cascades.Most patients described receiving test(s) during their study visit. Many patients said their physicians made the decision with little or no discussion; all patients said they would have felt comfortable asking questions if they had any. Many stated they trusted their physicians to recommend necessary tests. Most also said their physicians had discussed these tests with them previously, they had prior knowledge of tests, or they expected some routine tests during annual examinations.When physician participants were asked about reactions to the peer comparison email and materials, all physicians recalled having ordered unnecessary tests by patient request. Two noted a habit of overtesting that they wanted to break; the third shared a fear of missing something. When asked about impact of the materials, all described being at least somewhat more likely to discuss possible downsides of testing with patients after the study. However, they noted barriers to convincing patients to avoid certain tests (eg, “I give in because I just don’t have the time”). Given these constraints, 2 focused on discouraging low-value tests with more cascade potential, such as imaging for uncomplicated low back pain and prostate cancer screening. One physician suggested formal training to develop elevator pitches about test downsides.In our analysis of 68 open-ended patient survey responses, many justified a lack of discussion, most commonly by stating their tests were routine (eTable 9 in 