Tests do little to reassure patients who likely didn't need them

Patients who receive diagnostic tests for the purpose of reassurance don't feel less worried in either the short or long term, a meta-analysis found.

To study the effect of diagnostic tests on worry about illness, anxiety, symptom persistence, and subsequent use of health care resources in patients with a low pretest probability of serious illness, researchers conducted a systematic review and meta-analysis of 14 randomized, controlled trials that included 3,828 patients.

Results appeared online at JAMA Internal Medicine on Feb. 25.

Three trials showed no overall effect of diagnostic tests on illness worry (odds ratio [OR], 0.87; 95% CI, 0.55 to 1.39), and two showed no effect on nonspecific anxiety (standardized mean difference, 0.06; 95% CI, −0.16 to 0.28). Ten trials showed no overall long-term effect on continuation of symptoms (odds ratio, 0.99; 95% CI, 0.85 to 1.15). After excluding outliers, the authors found the suggestion of a reduction in visits after conducting tests (OR, 0.77; 95% CI, 0.62 to 0.96). Researchers noted that the number of patients needed to test to avoid one subsequent visit varied from 16 to 26, depending on the symptom.

They concluded, “In the context of widespread belief that diagnostic testing reassures patients, these findings suggest that physicians overestimate the value of testing when the probability of serious disease is low.” They added that the reassurance of a negative test offers comfort that can last as little as a few hours—”a fleeting sense of relief”—instead of long-term assurance.

An editorial noted that if it requires testing 16 to 26 patients to avoid one repeat visit, and the tests cost $250 to $500 per test, then the health care system is spending between $4,000 and $16,000 to prevent a $100 primary care visit.

The editorial offered five suggestions:

• Order diagnostic tests based on greater anxiety, symptom persistence or complexity;
• Don't assume patients want more testing;
• Offer reassurance through written or verbal information on the meaning of normal results;
• Develop evidence-based guidelines for diagnostic testing for common conditions; and
• Address reasonable physician concerns about malpractice.