Health Care Utilization, Health Knowledge, Attitudes, Practice
Conditions
Brief summary
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.
Detailed 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.
Interventions
BEHAVIORALPatient education materials
Patients receive a text-message and email with educational materials about medical testing.
BEHAVIORALPhysician peer-comparison email
Physicians receive an email with feedback on how they compare to their peers in aggregate on test ordering during annual physicals.
BEHAVIORALPhysician education materials
Physicians receive reference materials on medical test interpretation and incidental findings.
BEHAVIORALGeneral visit preparation materials
Patients receive a text-message and email with general visit preparation tips.
Sponsors
RAND
Robert Wood Johnson Foundation
Brigham and Women's Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
20 primary care physicians will be recruited and randomized to an intervention and a control arm. For each physician, we will recruit at least 10 of their patients with upcoming scheduled physicals. All included patients of intervention physicians will receive the intervention, and all included patients of control physicians will receive general patient visit prep materials.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Shared Decision-Making Process 4 Survey | Within two weeks after visit | Composite score of survey items completed by the patient after physician visit. Min 0, Max 4 (higher is better). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Presence of testing discussion | Within two weeks after visit | Binary measure from patient post-visit survey (present vs absent) |
| Satisfaction with testing discussion | Within two weeks after visit | Binary measure from patient post-visit survey (high vs low) |
| Discussion of next steps | Within two weeks after visit | Binary measure from patient post-visit survey (present vs absent) |
| Whether doctor explained tests in a way that was easy to understand | Within two weeks after visit | Binary measure from patient post-visit survey (yes completely vs yes a little or no) |
| Patient knowledge | Within two weeks after visit | Composite score of survey items from patient post-visit survey. Min 0, Max 4 (higher is better). |
Countries
United States
Outcome results
None listed