Understanding and Discouraging Overuse of Potentially Harmful Screening Tests
Condition: Preventive Screening; Prostate Cancer; Osteoporosis; Colorectal Cancer
MeSH terms: Osteoporosis
Study type: Interventional

Summary: 
      Most prevention efforts focus on promoting services (e.g. vaccination, screening tests).
      While some of these services have clear net benefit, many instead have possible or clear net
      harm. Currently, three quarters of services graded by the U.S. Preventive Services Task Force
      (USPSTF) have possible or clear net harm (C, I, and D services). Many of these services are
      delivered in healthcare settings at higher rates than what might be expected based on their
      potential for harm. This leads to adverse outcomes, excess costs, and missed opportunities to
      deliver more quality care. An important issue in delivering prevention messages is how to
      shift toward a focus on the appropriateness of prevention: encouraging services with clear
      net benefit and either discouraging or reducing demand for services with possible or clear
      net harm. Unfortunately, little is known about what drives overuse of potentially harmful
      screening services or how to make harms relevant to patients.

      This randomized controlled trial (RCT) of 775 patients at 4 primary care practices aims to 1)
      assess factors associated with intent to receive possibly or clearly harmful screening
      services and 2) determine whether and how patients' plans to get screened change with various
      presentations of information about harms (e.g. qualitative, quantitative, narrative, framed).
      The investigators will focus on three types of screening services: osteoporosis screening
      (previous C recommendation and now no recommendation for women < 65 years old with no
      fracture risk factors), prostate-specific antigen (PSA) screening (D recommendation for all
      men, regardless of age), and colorectal cancer (CRC) screening (C for ages 76-85).
    


Intervention name(s): Quantitative Information Sheet; Qualitative Information Sheet; Narrative Information Sheet; Framed Information Sheet
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral
Intervention description(s): Patients will read an information sheet about one of the three exemplar services in one of four presentations: quantitative, qualitative, narrative, or framed. In the quantitative information sheet, harms will be communicated in absolute risks with accompanying fact box (i.e. box containing key facts and rates). In addition to information about harms, the information sheet will include the following information: a description of the disease to be detected and the screening test, a description of the possible benefits of the service, and a statement encouraging decision. As an adjunct to numerical information in paragraph form, fact boxes engage individuals to process information and improve understanding.; Patients will read an information sheet about one of the three exemplar services in one of four presentations: quantitative, qualitative, narrative, or framed. In the qualitative information sheet, harms will be communicated using verbal descriptors. In addition to information about harms, the information sheet will include the following information: a description of the disease to be detected and screening test, a description of the possible benefits of the service, and a statement encouraging decision.; Patients will read an information sheet about one of the three exemplar services in one of four presentations: quantitative, qualitative, narrative, or framed. In the narrative information sheet, harms will be communicated using patient narratives with accompanying fact box. In addition to information about harms, the information sheet will include the following information: a description of the disease to be detected and screening test, a description of the possible benefits of the service, and a statement encouraging decision.; Patients will read an information sheet about one of the three exemplar services in one of four presentations: quantitative, qualitative, narrative, or framed. In the framed information sheet, harms will be communicated using a gain frame (as described in the arm section above) with accompanying fact box. In addition to information about harms, the information sheet will include the following information: a description of the disease to be detected and screening test, a description of the possible benefits of the service, and a statement encouraging decision.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention