Article Text

Patient-centred outcomes of imaging tests: recommendations for patients, clinicians and researchers
  1. Matthew J Thompson1,
  2. Monica Zigman Suchsland1,
  3. Victoria Hardy2,
  4. Danielle C Lavallee3,
  5. Sally Lord4,
  6. Emily Beth Devine5,
  7. Jeffrey G Jarvik6,
  8. Steven Findlay7,
  9. Thomas A Trikalinos8,
  10. Fiona M Walter9,
  11. Roger Chou10,
  12. Beverly B Green11,
  13. Karen J Wernli11,
  14. Annette L Fitzpatrick12,
  15. Patrick M Bossuyt13
  1. 1 Department of Family Medicine, University of Washington, Seattle, Washington, USA
  2. 2 Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  3. 3 Department of Health Systems and Population Research, University of Washington, Seattle, Washington, USA
  4. 4 The University of Sydney, Sydney, New South Wales, Australia
  5. 5 The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, School of Pharmacy, University of Washington School of Pharmacy, Seattle, Washington, USA
  6. 6 Departments of Radiology and Neurological Surgery, University of Washington, Seattle, Washington, USA
  7. 7 Barnesville, Maryland, USA
  8. 8 Departments of Health Services, Policy & Practice, and Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA
  9. 9 Wolfson Institute of Population Health Science, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  10. 10 Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
  11. 11 Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
  12. 12 Departments of Family Medicine, Epidemiology, and Global Health, University of Washington, Seattle, Washington, USA
  13. 13 Epidemiology & Data Science, Amsterdam Public Health, Amsterdam University Medical Centres, Amsterdam, The Netherlands
  1. Correspondence to Professor Matthew J Thompson, Department of Family Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA; mjt{at}uw.edu

Abstract

Background Imaging tests are one of the most frequently used diagnostic modalities in healthcare, but the benefits of their direct impacts on clinical decision-making have been countered by concerns that they can be overused. Assessing the relative value of imaging tests has largely focused on measures of test accuracy, which overlooks more comprehensive benefits and risks of imaging tests, particularly their impact on patient-centred outcomes (PCOs). We present the findings of the Patient Reported Outcomes of Diagnostics (PROD) research study in response to a methodological gap in the area of diagnostic test comparative effectiveness research.

Methods Over a 3-year period, the PROD Study engaged with multiple stakeholders to identify existing conceptual models related to PCOs for imaging testing, conducted primary research and evidence synthesis, and developed consensus recommendations to describe and categorise PCOs related to imaging testing.

Results The PROD framework categorises PCOs from imaging studies within four main domains: information or knowledge yielded, physical impact, emotional outcomes and test burden. PCOs interact with each other and influence effects across domains, and can be modified by factors related to the patient, clinical situation, healthcare team and the testing environment.

Conclusions Using PCOs to inform healthcare decision-making will require ways of collating and presenting information on PCOs in ways that can inform patient–provider decision-making, and developing methods to determine the relative importance of outcomes (including test accuracy) to one another.

  • comparative effectiveness research
  • decision support
  • clinical
  • evaluation methodology
  • patient-centred care
  • quality improvement methodologies

Data availability statement

No data are available. We do not have data to share for this manuscript.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Data availability statement

No data are available. We do not have data to share for this manuscript.

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Footnotes

  • Contributors MJT conceived the study, obtained funding and supervised the research programme, drafted the manuscript and is the guarantor of the submitted manuscript. MZS, VH, EBD, DL, SL, SF, TAT, FMW, RC, BBG, KJW, AF and PMB assisted in drafting and editing the manuscript. All authors reviewed and approved the final version of the manuscript prior to submission.

  • Funding This study was funded by Patient Centered Outcomes Research Institute (PCORI) (ME-1503-29245).

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of PCORI

  • Competing interests JGJ reports grants from NIH/NIAMS, during the conduct of the study, in particular he was supported by the UW Clinical Learning, Evidence And Research (CLEAR) Center for Musculoskeletal Disorders, NIH/NIAMS P30AR072572 and the content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. JGJ also resports grants from Springer Publishing: royalties as a book co-editor; GE-Association of University Radiologists Radiology Research Academic Fellowship (GERRAF): travel reimbursement for Faculty Board of Review; Wolters Kluwer/UpToDate: royalties as a chapter author.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.