Patient and general practitioner views of tools to delay diagnostic imaging for low back pain: a qualitative study

ObjectiveDelayed prescribing is a promising strategy to manage patient requests for unnecessary tests and treatments. The purpose of this study was to explore general practitioner (GP) and patient views of three communication tools (Overdiagnosis Leaflet, Dialogue Sheet and ‘Wait-and-see’ Note) to support delayed prescribing of diagnostic imaging.DesignQualitative study.SettingPrimary and emergency care in Sydney, Australia.Participants16 GPs and 14 patients with recent episode of low back pain.OutcomeViews on the tools to delay diagnostic imaging for low back pain. Data were collected using a combination of focus groups and individual interviews.AnalysisTwo researchers independently performed a thematic analysis, and the author team reviewed and refined the analysis.ResultsGP participants responded positively to the Overdiagnosis Leaflet. The Dialogue Sheet and ‘Wait-and-see’ Note raised several concerns about patient pushback, adding to time pressure and being overwhelmed with hard-to-find paper resources. GPs preferred to communicate verbally the reasons to delay an imaging test. For patients, the reactions to the tools were more positive. Patients valued written information and a signed agreement to delay the test. However, patients expressed that a strong desire for diagnostic imaging would likely over-ride any effect of written advice to delay the test. The term ‘false alarm’ to describe overdiagnosis was poorly understood by patients.ConclusionsGPs and patients agreed that a leaflet about overdiagnosis could support a delayed prescribing approach to imaging for low back pain. The Dialogue Sheet and ‘Wait-and-see’ Note were acceptable to patients but not to GPs.