Ishani Ganguli|Arabella L Simpkin|Claire Lupo|Arlene Weissman|Alexander J Mainor|E. John Orav|Meredith B. Rosenthal|Carrie H. Colla|Thomas D. Sequist
Cascades of Care After Incidental Findings in a US National Survey of Physicians
Harvard University|Brigham and Women's Hospital|Harvard University|Massachusetts General Hospital|Brigham and Women's Hospital|American College of Physicians|Dartmouth Institute for Health Policy and Clinical Practice|Brigham and Women's Hospital|Harvard University|Harvard University|Dartmouth Institute for Health Policy and Clinical Practice|Harvard University|Brigham and Women's Hospital
incidental findings screening diagnostic tests common may prompt cascades testing treatment uncertain value study date examined physician perceptions experiences cascades nationallyto estimate national frequency consequences cascades care incidental findings using national survey us physicianspopulationbased survey study using data 44item crosssectional online survey among 991 practicing us internists research panel representative american college physicians national membership survey emailed panel members january 22 2019 analysis performed march 11 may 27 2019physician report prior experiences cascades features recently experienced cascade perception potential interventions limit negative consequences cascadesthis study achieved 447 response rate 376 completed surveys weighted responses nationally representative mean se age respondents 434 07 years 604 respondents male almost respondents 994 percentages weighted reported experiencing cascades including cascades clinically important intervenable outcomes 909 cascades outcome 944 physicians reported cascades caused patients psychological harm 684 physical harm 156 financial burden 575 personally caused physicians wasted time effort 691 frustration 525 anxiety 454 asked recent cascade 337 371 respondents reported test revealing incidental finding may clinically appropriate recent cascade physicians reported guidelines followup testing followed 81 exist knowledge 532 lessen negative consequences cascades 628 376 respondents chose accessible guidelines 446 chose decision aids potential solutionsthe survey findings indicate almost respondents experienced cascades incidental findings lead clinically meaningful outcomes yet caused harm patients policy makers health care leaders address cascades incidental findings part efforts improve health care value reduce physician burnout