Patient-Centered Outcomes Related to Imaging Testing in US Primary Care

Abstract

Background: Imaging tests are one of the most sophisticated types of diagnostic tools used in health care, yet there are concerns that imaging is overused. Currently, tests are typically evaluated and implemented based on their accuracy, and there is limited knowledge about the range of patient-centered outcomes (PCOs) that imaging tests may lead to. This study explores patients' experiences and subsequent outcomes of imaging tests most notable to patients. Methods: Adult patients from four primary care clinics who had an x-ray, CT, MRI, or ultrasound in the 12 months before recruitment participated in a single semistructured interview to recount their imaging experience. Interview transcripts were analyzed thematically. Results: Four themes related to PCOs were identified from 45 interviews. Participants' mean age was 53 years (25-83 years), 30 had undergone a diagnostic imaging test, and 15 underwent imaging for screening or monitoring. Themes included knowledge gained from the imaging test, its contribution to their overall health care journey, physical experiences during the test procedure, and impacts of the testing process on emotions. Conclusions: Patients identified various imaging test outcomes that were important to them. Measurement and reporting these outcomes should be considered more often in diagnostic research. Tools for providers and patients to discuss and utilize these outcomes may help promote shared decision making around the use and impact of imaging tests.

Provider Perspectives of Patient Experiences in Primary Care Imaging

“…[11][12][13][14][15] Studies that have explored patient perspective are consistent with our study, identifying PCOs such as emotions (eg, anxiety and relief), physical risks, knowledge gains, and ability to manage disease. 6,16 In our study, PCPs cited varying comfort with uncertainty. Previous research suggests clinicians use imaging as a tool to reduce return visits or to make a correct and definitive diagnosis.…”

“…Interview guides were informed by existing PCO literature related to diagnostic testing, PCOs identified from patient interviews and the PROD study stakeholder advisory board (consisting of patient advocates, caregivers, clinicians, methodologists, and nonprofit and industry representatives). 5,6 Site champions reviewed the guides to confirm clinical and cultural relevancy of the questions.…”

“…Through immersion, 3 transcripts were open coded by 2 coders (MZS, VH) to identify initial codes. 6 These were discussed and differences reconciled by a third researcher (MJT). Remaining transcripts were double-coded with revised codes (MZS, VH) and reconciled in the same manner.…”

Imaging-based patient-reported outcomes (PROs) database: How we do it

“…While significant, these barriers to PROs utilization in radiology can be overcome with formal education and the sharing of experiences (both good and bad) by those experienced in outcomes work. Fortunately, there are many educational resources, including dedicated outcomes seminars, courses, journal articles, and consensus panel recommendations, which can provide information and guidance to radiologists interested in patient outcomes [6][7][8][9][10][11][12].…”

Qualitative study to explore radiologist and radiologic technologist perceptions of outcomes patients experience during imaging in the USA

“… 11 12 Although evidence to support these domains and outcomes specific to imaging testing has been limited, research from patients to date has identified PCOs related to impacts on emotions, the value of the information gained, as well as physical side effects from the testing process. 13 14 However, there has been little research exploring what radiologists and their care teams, specifically radiologic technologists, perceive as most important to patients. With growing calls for the radiology profession to embrace a more patient-centred approach, understanding the insights of the entire care team may provide key enlightenment into PCOs.…”