Primary Care Physicians’ Action Plans for Responding to Results of Screening Tests Based on the Concept of Quaternary Prevention

Abstract

Since noncommunicable diseases (NCDs) are generally controllable rather than curable, more emphasis is placed on prevention than on treatment. For the early detection of diseases, primary care physicians (PCPs), as well as general practitioners and family physicians, should interpret screening results accurately and provide screenees with appropriate information about prevention and treatment, including potential harms. The concept of quaternary prevention (QP), which was introduced by Jamoulle and Roland in 1995, has been applied to screening results. This article summarizes situations that PCPs encounter during screening tests according to the concept of QP, and suggests measures to face such situations. It is suggested that screening tests be customized to fit individual characteristics instead of being performed based on general guidelines. Since screening tests should not be carried out in some circumstances, further studies based on the concept of prevention levels proposed by Jamoulle and Roland are required for the development of strategies to prevent NCDs, including cancers. Thus, applying the concept of QP helps PCPs gain better insights into screening tests aimed at preventing NCDs and also helps improve the doctor-patient relationship by helping screenees understand medical uncertainties.

Shared decision making: relevant concepts and facilitating strategies

“…The higher the level of patient participation, the stronger is the patient self-monitoring and the higher the treatment safety [ 13 , 24 ]. Further, it is directly connected to quaternary prevention, the concept of protecting patient safety by preventing overmedicalization [ 28 ].…”

Quaternary prevention. Prediabetes: risk, disease or overdiagnosis? The diseases which are not of great danger should not be teased by medicines (Plato, 5th century BC)

“…P4 teži prevenciji ovih postupaka: [1][2][3][4][5] -suvišna dijagnoza (engl. Overdiagnosis) nepotreb no je dodjeljivanje dijagnoze predijagnozi (engl.…”

“…Međutim, rizik od suvišne dijagnoze viši je s brojem biomarkera (ovdje HbA 1c ), a biomedicinski parametri odvajaju se od pacijenta i ukupnoga kliničkog sta tusa. 2,3 Godine 2017. Međunarodna dijabetička federacija (engl.…”

Ethical, pedagogical, socio-political and anthropological implications of quaternary prevention

“…• First, the QP has preferentially highlighted the principle of non-maleficence (primum non nocere) 32 by avoiding over-medication. [33][34][35] Because clinicians have ethical obligation to protect patients from potential harm. 36 Especially general practitioners or family physicians (GP/FP) usually are in position to the starting point of clinical management so that they play the important role of preven-ting the cascade of unnecessary medical services.…”