Effect of information format on intentions and beliefs regarding diagnostic imaging for non-specific low back pain: A randomised controlled trial in members of the public. Issue 3 (March 2021)

• Record Type: Journal Article
• Authors: Sharma, Sweekriti; Traeger, Adrian C.; O'Keeffe, Mary; Copp, Tessa; Freeman, Alexandra; Hoffmann, Tammy; Maher, Chris G.
• Is Part Of: Patient education and counseling. Volume 104:Issue 3(2021)
• Page Start: 595
• Page End: 602
• Publication Date: 2021-03
• Subjects: Health communication -- Diagnostic imaging -- Medical overuse -- Low back pain; Patient education -- Periodicals; Health counseling -- Periodicals; Health education -- Periodicals; Counseling -- Periodicals; Patient Education -- Periodicals; Éducation des patients -- Périodiques; Counseling -- Périodiques; Éducation sanitaire -- Périodiques; 615.5071
• DOI: 10.1016/j.pec.2020.08.021
• Languages: English
• ISSNs: 0738-3991

Abstract

Highlights: The impact of consumer information materials on the use of low value care is unclear. Written materials that emphasised potential harms of diagnostic imaging reduced a consumer's intention to request the test. Balanced information about benefits and harms may be insufficient to manage consumer requests for diagnostic imaging. Drawing awareness to potential harms could reduce desire for unnecessary healthcare, but may promote public mistrust. Abstract: Objective: To evaluate the effects of information format on intentions to request diagnostic imaging for non-specific low back pain in members of the public. Methods: We performed a three arm, 1:1:1, superiority randomised trial on members of the public. Participants were randomised to one of the three groups: a Standard Care Leaflet group (standard information on low back pain), a Neutral Leaflet group (balanced information on the benefits and harms of imaging) and a Nudge Leaflet group (with behavioural cues to emphasise the harms of unnecessary imaging). Our primary outcome was intention to request imaging for low back pain. Results: 418 participants were randomised. After reading the leaflet, intention to request imaging (measured on an 11-point scale (0 = definitely would not request to 10 = definitely would request) was lower in the Nudge Leaflet group (mean = 4.6, SD = 3.4) compared with the Standard Care Leaflet group (mean = 5.3, SD = 3.3) and the Neutral Leaflet group (mean = 5.3, SD = 3.0) (adjusted mean difference between Nudge and Neutral, −1.0 points, 95%CI −1.6 to −0.4). Conclusion: Framing information to emphasise potential harms from overdiagnosis reduced intention to request diagnostic imaging for low back pain. Practice implications: Nudge leaflets could help clinicians manage patient pressure for unnecessary tests.