Article

Preventing overdiagnosis: How to stop harming the healthy

Bond University, Robina, Queensland, Australia.
BMJ (online) (Impact Factor: 17.45). 05/2012; 344(may28 4):e3502. DOI: 10.1136/bmj.e3502
Source: PubMed
Download full-text

Full-text

Available from: David Henry, Aug 16, 2014
  • Source
    • "Clinical practice guidelines (CPGs) in Canada currently recommend BMD testing in specific at-risk populations, including testing to screen for osteoporosis in patients over 65 years of age or who experience a fragility fracture after the age of 40[1,2]. However, evidence of inappropriate testing has been identified in terms of overtesting in low risk women[3,4]translating into unnecessary costs to the health care system and harm to patients through overdiagnosis and overtreatment[5]. In contrast, our research team has previously reported undertesting among high-risk patients at a population level[4]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: . Evidence of inappropriate bone mineral density (BMD) testing has been identified in terms of overtesting in low risk women and undertesting among patients at high risk. In light of these phenomena, the objective of this study was to understand the referral patterns for BMD testing among Ontario’s family physicians (FPs). Methods . A qualitative descriptive approach was adopted. Twenty-two FPs took part in a semi-structured interview lasting approximately 30 minutes. An inductive thematic analysis was performed on the transcribed data in order to understand the referral patterns for BMD testing. Results . We identified a lack of clarity about screening for osteoporosis with a tendency for baseline BMD testing in healthy, postmenopausal women and a lack of clarity on the appropriate age for screening for men in particular. A lack of clarity on appropriate intervals for follow-up testing was also described. Conclusions . These findings lend support to what has been documented at the population level suggesting a tendency among FPs to refer menopausal women (at low risk). Emphasis on referral of high-risk groups as well as men and further clarification and education on the appropriate intervals for follow-up testing is warranted.
    Full-text · Article · Jan 2016 · Journal of Osteoporosis
  • Source
    • "[12] As such, inappropriate pathology testing could be considered low-value in that it does not benefit the ongoing management of the patient. [13] A number of influences have been described [14] [15] [16] [17] for the test ordering behaviors of clinicians, including doctor related factors such as experience, perceived medico-legal risk, patient related factors such as anxiety, hospital related factors such as business processes, systems related factors such as the development of new tests, health system incentives favoring more tests, and cultural beliefs that more is better. Inappropriate pathology testing can lead to over-diagnosis, which leads to unnecessary treatment, and adds to the risk of patient harm. "

    Preview · Article · Dec 2015
  • Source
    • "This is at odds with the implicit assumption of a unique, orderly and gradual progression of cancers on which screening is based [9]. Overdiagnosis can also result from the detection of precancerous lesions even with screening methods ofFig. 1 Overdiagnosis and lead time in screening (adapted from [2])Table 1 Causes of overdiagnosis [14, 27] @BULLET established success, such as cervical intraepithelial neoplasia or polyp for cervical and colorectal cancer. A more subtle form of overdiagnosis is due to the tendency to broaden the definition of conditions requiring treatment. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Overdiagnosis is the diagnosis of an abnormality that bears no substantial health hazard and no benefit for patients to be aware of. Resulting mainly from the use of increasingly sensitive screening and diagnostic tests, as well as broadened definitions of conditions requiring an intervention, overdiagnosis is a growing but still largely misunderstood public health issue. Fear of missing a diagnosis or of litigation, financial incentives or patient’s need of reassurance are further causes of overdiagnosis. The main consequence of overdiagnosis is overtreatment. Treating an overdiagnosed condition bears no benefit but can cause harms and generates costs. Overtreatment also diverts health professionals from caring for those most severely ill. Recognition of overdiagnosis due to screening is challenging since it is rarely identifiable at the individual level and difficult to quantify precisely at the population level. Overdiagnosis exists even for screening of proven efficacy and efficiency. Measures to reduce overdiagnosis due to screening include heightened sensitization of health professionals and patients, active surveillance and deferred treatment until early signs of disease progression and prognosis estimation through biomarkers (including molecular) profiling. Targeted screening and balanced information on its risk and benefits would also help limit overdiagnosis. Research is needed to assess the public health burden and implications of overdiagnosis due to screening activity.
    Preview · Article · Dec 2015
Show more