Shared Decision-making on Medical Tests and Care Cascades

Mass General Brigham

Status: Completed

Conditions: Health Knowledge, Attitudes, Practice; Health Care Utilization

Treatments: Behavioral: General visit preparation materials; Behavioral: Patient education materials; Behavioral: Physician education materials; Behavioral: Physician peer-comparison email

Study type: Interventional

Funder types: Other

Identifiers

NCT04902664

2020P001080

Details and patient eligibility

About

The purpose of this randomized controlled trial is to evaluate the impact of patient and provider facing educational materials and peer comparison on medical testing conversations during annual physicals. The investigators hypothesize that education materials and peer comparison will improve conversation quality about medical testing decisions.

Full description

Medical tests may show unexpected findings leading to additional tests, treatments, and visits that cost money and take time but may not have benefits. This is a prevalent issue with major consequences for patients and clinicians. Making informed decisions about when to order medical tests may help avoid unnecessary costs and worry. However, doctors don't always have detailed conversations about medical testing and there are patient gaps in knowledge. The investigators hypothesize that education materials and peer comparison to promote conversations about medical tests will improve conversation quality about medical testing decisions. The investigators have developed patient and provider-facing interventions to educate on and promote conversations about the uses and consequences of medical tests, and the investigators will test the impact of this just-in-time educational and peer comparison intervention on the likelihood of patients having productive conversations about medical tests. The effects of the intervention will be assessed using surveys before and after the study. This work has the potential to help patients feel more supported by their healthcare system, empower patients to participate in shared decision-making, and build trust between patients and clinicians.

Enrollment: 329 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion criteria (Physicians):

• Primary care physicians at Brigham and Women's Hospital
• In active practice

Inclusion criteria (Patients):

• Adults age 18 years old or older
• English-speaking
• Access to email
• Did not opt out of receiving research invitations from health system
• Patients of participating physicians
• Scheduled annual physical during the study period

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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329 participants in 2 patient groups, including a placebo group

Intervention Arm

Experimental group

Description:

Intervention arm physicians will receive an email with feedback on how they compare to their peers in aggregate on test ordering during annual physicals, along with physician-facing education materials. This email will be sent before each patient study visit for all patients in the study. Participating patients of intervention arm physicians will receive patient education materials one to two days before their study visit.

Treatment:

Behavioral: Physician peer-comparison email

Behavioral: Physician education materials

Behavioral: Patient education materials

Control Arm

Placebo Comparator group

Description:

Control arm physicians receive an email with information on the general visit preparation tips that their patients will receive. Participating patients of control arm physicians will receive general visit preparation tips one to two days before their study visit.

Treatment:

Behavioral: General visit preparation materials