Opening Pandora's box: the unpredictability of reassurance by a normal test result

McDonald, Ian G.; Daly, Jeanne; Jelinek, V. M.; Panetta, F; Gutman, Jack

doi:10.1136/bmj.313.7053.329

Cited by 173 publications

(120 citation statements)

References 12 publications

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“…Anxiety fell after consultation whatever forms of reassurance were observed, but only transiently. In cancer care as elsewhere in medicine, reassurances that the disease is not present may not result in enduring reductions in anxiety (McDonald et al, 1996). After 1 week of follow-up, and longer, different forms of reassurance did not have the same impact.…”

Section: Discussionmentioning

confidence: 89%

“…Oncologists may then seek to explain that the symptoms experienced are not due to worsening of the cancer. The process of explanation that symptoms are not due to serious disease is commonly referred to as 'reassurance', and has been widely studied within medical care outside oncology (McDonald et al, 1996;Howard and Wessely, 1996;Kathol, 1997;Lucock et al, 1997;Coia and Morley, 1998;Starcevic, 2001). Reassurance takes various forms, but frequently includes simple statements such as 'not to worry' about serious disease being present, explanation about the symptom, and radiological or other investigation (Howard and Wessely, 1996;Kathol, 1997;Coia and Morley, 1998;Price, 2000).…”

Section: Beliefsmentioning

confidence: 99%

“…'General anxiety' describes a broader problem, characterised by somatic symptoms of autonomic overactivity at the immediate time of measurement. 'Reassurance' refers to statements communicating to patients that the symptoms are not due to serious disease, in this case that cancer is not active (Howard and Wessely, 1996;McDonald et al, 1996;Kathol, 1997;Lucock et al, 1997;Coia and Morley, 1998;Starcevic, 2001). …”

Section: Definitionsmentioning

confidence: 99%

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Reassurance and the anxious cancer patient

et al. 2004

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Section: Discussionmentioning

confidence: 89%

Section: Beliefsmentioning

confidence: 99%

Section: Definitionsmentioning

confidence: 99%

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Reassurance and the anxious cancer patient

et al. 2004

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“…This is important for both the patient, who is exposed to risk and suffers the adverse effects of testing, 11,12 and for the healthcare system. The quanti- tative adequacy of test ordering in Pelotas is at odds with the long waiting time for the actual performance of tests within the public sector.…”

Section: Discussionmentioning

confidence: 99%

Epidemiologia da solicitação de exame complementar em consultas médicas

Capilheira

Santos

2006

Rev. Saúde Pública

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OBJECTIVE:To identify type of service, frequency, and individual patient determinants associated with diagnostic test ordering in medical appointments. METHODS:A population-based study included 3,100 adults aged 20 years or older, living in the city of Pelotas, Southern Brazil. Sampling was carried out in multiple stages. Information were collected by means of a questionnaire, administered between October and December 2003. Multivariate analyses were carried out using Poisson Regression, based on a conceptual model. A sub-study was also conducted based on the test requests received during one workday in all laboratories in the city processing requests from both the public and private sectors. RESULTS:Fifty-five percent of subjects reported having had medical appointments during the three-month period investigated. Of these, 60% reported more than one appointment, generating a total of 4,167 appointments, most of which were paid for by health plans (38%). Diagnostic test were requested in 55% of appointments. Women and diabetic patients were more likely to have tests ordered. The greater the age (p<0.001) the higher the socioeconomic level (p=0.04), and the number of medical appointments (p<0.001), the greater the proportion of appointments leading to test requests. Mean waiting time between test request and sample collection was six days for the private sector and 21 days for the public sector (p<0.001). The mean number of tests per request was 4.4. CONCLUSIONS:The proportion of appointments leading to the request for some type of diagnostic test was in accordance with Brazilian recommendations. The waiting time before sample collection indicates an excessive number of tests per request and/ or insufficient financial resources to fulfill the demand for tests.

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“…[1,14,28] It would be important to gain insight into whether clinical impact and changes in management eventually translate into improved health outcomes in primary healthcare. These effects could be assessed in a followup study.…”

Section: Study Limitationsmentioning

confidence: 99%

Impact of transthoracic echocardiography at district hospital level

et al. 2015

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Background. The use of and demand for echocardiography (ECHO) has increased worldwide. In developed countries, this has not translated into improved access outside tertiary centres. Previous studies have favoured the appropriate use of ECHO over its clinical impact, limiting generalisability to resourceconstrained settings. Objectives. To assess the impact of an ECHO service at district hospital level in Cape Town, South Africa. Methods. A prospective, crosssectional study was performed. A total of 210 consecutive patients, referred to the ECHO clinic over a 5month period, were recruited. Transthoracic ECHO was evaluated in terms of its indication, new information provided, correlation with the referring doctor's diagnosis and subsequent management plan. Impact included the escalation and deescalation of treatment, as well as usefulness without a change in management. Results. The results show that 83.8% of the patients' management was impacted on by echocardiography. Valvular lesions were the main indication. The most frequent contribution was information provided towards the diagnosis of heart failure and assessment after myocardial infarction. Of the echocardiograms, 56.2% confirmed the referring doctor's diagnosis, yet were still associated with a significant impact. The rational prescription of medication had the major impetus, followed by deescalation of therapy and screening patients to determine referral to a tertiary facility. Conclusion. ECHO has a positive impact on patient management outside tertiary settings, where the definition of impact appears to be different. The value of a normal study, screening prior to upstream referral and usefulness irrespective of change have been established. This should alert policy makers against restriction of access to ECHO and promote training of personnel in its use.

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Opening Pandora's box: the unpredictability of reassurance by a normal test result

Cited by 173 publications

References 12 publications

Reassurance and the anxious cancer patient

Reassurance and the anxious cancer patient

Epidemiologia da solicitação de exame complementar em consultas médicas

Impact of transthoracic echocardiography at district hospital level

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