. 2020 Nov 8;10(11):e039936.

doi: 10.1136/bmjopen-2020-039936.

Patient and general practitioner views of tools to delay diagnostic imaging for low back pain: a qualitative study

Adrian C Traeger^{1

2}, Juliet Checketts³, Elise Tcharkhedian⁴, Denise A O'Connor^{5

6}, Christiane Klinner⁷, Sweekriti Sharma^{7

2}, Parima Vyas³, Loai Albarqouni⁸, Kirsten McCaffery^{2

9}

Affiliations

¹ Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia adrian.traeger@sydney.edu.au.
² School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
³ Australian Government Department of Health, Canberra, Australian Capital Territory, Australia.
⁴ Department of Physiotherapy, Liverpool Hospital, Liverpool, New South Wales, Australia.
⁵ Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia.
⁶ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁷ Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia.
⁸ Institute for Evidence-Based Healthcare, Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia.
⁹ Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.

PMID: 33162393
PMCID: PMC7651716
DOI: 10.1136/bmjopen-2020-039936

Patient and general practitioner views of tools to delay diagnostic imaging for low back pain: a qualitative study

Adrian C Traeger et al. BMJ Open. 2020.

. 2020 Nov 8;10(11):e039936.

doi: 10.1136/bmjopen-2020-039936.

Authors

Affiliations

¹ Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia adrian.traeger@sydney.edu.au.
² School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
³ Australian Government Department of Health, Canberra, Australian Capital Territory, Australia.
⁴ Department of Physiotherapy, Liverpool Hospital, Liverpool, New South Wales, Australia.
⁵ Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia.
⁶ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁷ Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia.
⁸ Institute for Evidence-Based Healthcare, Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia.
⁹ Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.

PMID: 33162393
PMCID: PMC7651716
DOI: 10.1136/bmjopen-2020-039936

Abstract

Objective: Delayed prescribing is a promising strategy to manage patient requests for unnecessary tests and treatments. The purpose of this study was to explore general practitioner (GP) and patient views of three communication tools (Overdiagnosis Leaflet, Dialogue Sheet and 'Wait-and-see' Note) to support delayed prescribing of diagnostic imaging.

Design: Qualitative study.

Setting: Primary and emergency care in Sydney, Australia.

Participants: 16 GPs and 14 patients with recent episode of low back pain.

Outcome: Views on the tools to delay diagnostic imaging for low back pain. Data were collected using a combination of focus groups and individual interviews.

Analysis: Two researchers independently performed a thematic analysis, and the author team reviewed and refined the analysis.

Results: GP participants responded positively to the Overdiagnosis Leaflet. The Dialogue Sheet and 'Wait-and-see' Note raised several concerns about patient pushback, adding to time pressure and being overwhelmed with hard-to-find paper resources. GPs preferred to communicate verbally the reasons to delay an imaging test. For patients, the reactions to the tools were more positive. Patients valued written information and a signed agreement to delay the test. However, patients expressed that a strong desire for diagnostic imaging would likely over-ride any effect of written advice to delay the test. The term 'false alarm' to describe overdiagnosis was poorly understood by patients.

Conclusions: GPs and patients agreed that a leaflet about overdiagnosis could support a delayed prescribing approach to imaging for low back pain. The Dialogue Sheet and 'Wait-and-see' Note were acceptable to patients but not to GPs.

Keywords: back pain; diagnostic radiology; internal medicine; quality in health care; rehabilitation medicine.

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Conflict of interest statement

Competing interests: None declared.

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Patient and general practitioner views of tools to delay diagnostic imaging for low back pain: a qualitative study

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Patient and general practitioner views of tools to delay diagnostic imaging for low back pain: a qualitative study

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