title: Watchful Waiting Strategy May Reduce Low-Value Diagnostic Testing.
abstract: PCPs need effective communication strategies to address patient requests for low-value testing while sustaining patient-provider partnerships. Watchful waiting - allowing a negotiated period of time to pass before making a firm testing decision - shows promise as a tool for addressing patient requests for low-value testing.
  
  
  
  Observational analysis of data from a randomized controlled trial of a communication intervention designed to boost patient-centeredness and reduce low-value test ordering among 61 resident primary care physicians. Intervention effectiveness was assessed during follow-up encounters of unannounced standardized patients (SPs) who requested low-value tests. We examined associations between five physician counseling behaviors and overall patient-centeredness (Measure of Patient-Centered Communication) and requested test ordering.
  
  
  
  During 155 SP encounters, residents most commonly used reassurance (96% of encounters), evidence-based recommendations (97%), and watchful waiting (68 %). Resident advice to pursue watchful waiting was associated with 39% lower likelihood of test ordering (adjusted marginal effect of -38.6% [95% CI -43.6 to -33.6]). When all communication behaviors were examined together, only watchful waiting was significantly associated with test ordering (marginal effect of -38% [95% CI -44.3% to -31.7%]). Overall patient-centeredness was not associated with low-value testing.
  
  
  
  Resident physician counseling to pursue watchful waiting was associated with less ordering of requested low-value diagnostic tests, while overall patient-centeredness was not.
authors.affiliation: From the Departments of Emergency Medicine (LM) and Family and Community Medicine (PF, AJ, JF), University of California-Davis, Sacramento, CA.
authors.forename: Larissa
authors.initials: L
authors.lastname: May
authors.affiliation: From the Departments of Emergency Medicine (LM) and Family and Community Medicine (PF, AJ, JF), University of California-Davis, Sacramento, CA.
authors.forename: Peter
authors.initials: P
authors.lastname: Franks
authors.affiliation: From the Departments of Emergency Medicine (LM) and Family and Community Medicine (PF, AJ, JF), University of California-Davis, Sacramento, CA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Jerant
authors.affiliation: From the Departments of Emergency Medicine (LM) and Family and Community Medicine (PF, AJ, JF), University of California-Davis, Sacramento, CA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Fenton
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D001416:Back Pain / Q000000981:diagnostic imaging; D003376:Counseling / Q000379:methods*; D019317:Evidence-Based Medicine; D005221:Fatigue / Q000000981:diagnostic imaging; D005260:Female; D006261:Headache / Q000000981:diagnostic imaging; D006801:Humans; D007396:Internship and Residency; D008279:Magnetic Resonance Imaging; D008297:Male; D009426:Netherlands; D059906:Neuroimaging; D018802:Patient-Centered Care / Q000379:methods*; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care / Q000523:psychology; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D019564:Unnecessary Procedures; D057832:Watchful Waiting
keywords: Communication; Counseling; Diagnostic Tests; Follow-up Studies; Physical Examination; Physicians; Primary Care; Probability; Risk; Routine; Watchful Waiting