title: Adult Patients' Perspectives on the Benefits and Harms of Overused Screening Tests: a Qualitative Study.
abstract: BACKGROUND
  In recent years, there has been a growing interest in reducing the overuse of healthcare services. However, little is known about how patients conceptualize the benefits and harms of overused screening tests or how patients make decisions regarding these tests.
  
  
  OBJECTIVE
  To determine how patients think about the harms and benefits of overused screening tests and how they consider these and other factors when making decisions.
  
  
  METHODS
  Semi-structured, qualitative interviews.
  
  
  METHODS
  The study comprised 50 patients, ages 50-84, who had previously received or not received any of four overused screening services: 1) prostate cancer screening (men ages 50-69), 2) colon cancer screening (men and women ages 76-85), 3) osteoporosis screening (low-risk women ages 50-64), or 4) cardiovascular disease screening (low-risk men and women ages 50-85).
  
  
  METHODS
  We conducted a thematic analysis, using a hybrid inductive-deductive approach. Two independent coders analyzed interview transcriptions to identify themes and exemplifying quotes.
  
  
  RESULTS
  Many patients could not name a harm of screening. When they did name harms, patients often focused on only the harms of the screening test itself and rarely mentioned harms further along the screening cascade (e.g., from follow-up testing and treatment). In contrast, patients could easily name benefits of screening, although many seemed to misunderstand or overestimate the magnitude of the benefits. Furthermore, patients described many additional factors they considered when making screening decisions, including their clinicians' recommendations, their age, family or friends' experiences with disease, and insurance coverage.
  
  
  CONCLUSIONS
  This study highlights the need to help adults recognize and understand the benefits and harms of screening and make appropriate decisions about overused screening tests.
authors: Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, 27599, USA.
authors: Anne
authors: A
authors: Sutkowi-Hemstreet
authors: Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, 27599, USA.|Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, 27599, USA.
authors: Maihan
authors: M
authors: Vu
authors: Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, 27599, USA.|Division of General Medicine and Clinical Epidemiology, 5039 Old Clinic Bldg, CB 7110, Chapel Hill, NC, 27599, USA.|Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA.
authors: Russell
authors: R
authors: Harris
authors: Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA.|UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, 27514, USA.
authors: Noel T
authors: NT
authors: Brewer
authors: Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
authors: Rowena J
authors: RJ
authors: Dolor
authors: Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, 27599, USA. Stacey_sheridan@med.unc.edu.|Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, 27599, USA. Stacey_sheridan@med.unc.edu.|Division of General Medicine and Clinical Epidemiology, 5039 Old Clinic Bldg, CB 7110, Chapel Hill, NC, 27599, USA. Stacey_sheridan@med.unc.edu.|Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA. Stacey_sheridan@med.unc.edu.
authors: Stacey L
authors: SL
authors: Sheridan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D002318:Cardiovascular Diseases / Q000175:diagnosis; D003110:Colonic Neoplasms / Q000175:diagnosis; D003657:Decision Making; D055088:Early Detection of Cancer / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000523:psychology* / Q000706:statistics & numerical data; D008875:Middle Aged; D009657:North Carolina; D010024:Osteoporosis / Q000175:diagnosis; D010353:Patient Education as Topic / Q000379:methods; D011320:Primary Health Care / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000175:diagnosis; D036301:Qualitative Research; D019564:Unnecessary Procedures / Q000523:psychology / Q000706:statistics & numerical data
keywords: Medical decision-making; Patient education; Preventive care; Qualitative research; Screening