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Evidence Summary

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In people at low risk for serious illness, diagnostic testing does not reduce worry, anxiety, or presenting symptoms

Rolfe A, Burton C. Reassurance after diagnostic testing with a low pretest probability of serious disease: systematic review and meta-analysis. JAMA Intern Med. 2013;173:407-16.

Review question

When a serious illness is not likely, does diagnostic testing reassure patients?

Background

People often come to doctors with symptoms not caused by any apparent serious illness.

About 17% of visits to doctors are for symptoms not related to any apparent physical illness. More than 33% of referrals from doctors to specialists occur for similar reasons.

The problem for doctors is whether they should run diagnostic tests and, if so, how thoroughly.

The belief is that patients want these diagnostic tests and that the results would be reassuring.

Doctors may then recommend such tests more often than patients actually request them.

How the review was done

This summary is based on a systematic review of 14 randomized controlled trials. 9 took place in family doctors’ offices and 5 in specialists’ clinics.

The studies were published between 1981 and 2009 and included 3828 people (average age 32 to 62 years).

The review focused on the effects of diagnostic testing in comforting patients who are very unlikely to have a serious disease.

Outcomes were worry about illness, anxiety, symptom persistence, and later use of health care resources.

What the researchers found

Diagnostic testing did not reduce patients’ overall worries or anxiety about a possible illness.

Testing had no effect on the persistence of symptoms after 3 months.

Testing resulted in a small reduction in additional doctor visits after the initial assessment.

Conclusion

Diagnostic testing for symptoms with a low risk for serious illness does not reassure patients, decrease their anxiety, or resolve their symptoms.

Tests may reduce additional visits for the same condition.


Effects of diagnostic tests when serious illness is not likely

Outcomes

Effect of having diagnostic tests

Worry

Do not reduce worry

Anxiety

Do not reduce anxiety

Symptoms

Have no effect on symptom persistence

Doctor visits

Reduce additional doctor visits a little

 




Glossary

Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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