Educating Clinicians Reduces Unnecessary Tests for Prostate Patients

Consistent reminders about clinical guidelines for testing patients with low-risk prostate cancer deters unnecessary testing, according to a study published online in the Journal of the National Cancer Institute.

Curtailing unneeded medical tests is an important part of the Choosing Wisely Campaign, an initiative of the ABIM Foundation. Unnecessary medical tests contribute to the high cost of healthcare. The campaign’s goal is to reduce unnecessary tests and procedures, while supporting physicians to help patients make informed choices about their care.

Researchers from NYU Langone Medical Center sought to identify how to encourage fewer requests for unnecessary tests among patients with low-risk prostate cancer. “In the United States, we have guidelines about the overuse of imaging tests, but lack a roadmap for their implementation,” lead author Danil V. Makarov, MD, said in a release. Makarov is an assistant professor of urology and population health at the medical center.

Working with colleagues in Sweden, the researchers examined the records of approximately 100,000 Swedish men who had been diagnosed with prostate cancer from 1998 to 2009. Sweden’s National Prostate Cancer Registry (NPCR) introduced a campaign in 2000 aimed at clinicians to reduce the amount of inappropriate testing performed on men with low-risk prostate cancer. Local statistics on inappropriate imaging were presented at urology meetings, where the guidelines for imaging were repeatedly reviewed.

The results showed that this “public shaming” of sorts had a significant effect on the number of inappropriate tests performed after the campaign began, dropping from 45 percent to 3 percent among low-risk patients. However, Makarov pointed out that appropriate scanning among high-risk patients dropped as well, from 63 percent to 46 percent, unfortunately.

“The caveat here is that when guidelines are implemented to limit the inappropriate use of a healthcare resource, the appropriate use of that resource should be simultaneously encouraged - otherwise those patients who most need the resource may no longer have access to it,” Makarov said. “But the true lesson from this study is that inappropriate utilization of healthcare resources can be reduced by giving feedback to practitioners.”