Reassurance After Diagnostic Testing With a Low Pretest Probability of Serious Disease: Systematic Review and Meta-analysis
Abstract
IMPORTANCE: Diagnostic tests are often ordered by physicians in patients with a low pretest probability of disease to rule out conditions and reassure the patient. OBJECTIVE: 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. EVIDENCE ACQUISITION: Systematic review and meta-analysis. We searched MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, PsychINFO, CINAHL, and ProQuest Dissertations electronic databases through December 31, 2011, for eligible randomized controlled trials. We independently identified studies for inclusion and extracted the data. Disagreements were resolved by discussion. We performed meta-analysis if heterogeneity was low or moderate (I2 < 50%). RESULTS: Fourteen randomized controlled trials that included 3828 patients met the inclusion criteria and were analyzed with outcomes categorized as short term (≤3 months) or long term (>3 months). Three trials showed no overall effect of diagnostic tests on illness worry (odds ratio, 0.87 [95% CI, 0.55-1.39]), and 2 showed no effect on nonspecific anxiety (standardized mean difference, 0.06 [-0.16 to 0.28]). Ten trials showed no overall long-term effect on symptom persistence (odds ratio, 0.99 [95% CI, 0.85-1.15]). Eleven trials measured subsequent primary care visits. We observed a high level of heterogeneity among trials (I2 = 80%). Meta-analysis after exclusion of outliers suggested a small reduction in visits after investigation (odds ratio, 0.77 [95% CI, 0.62-0.96]). CONCLUSIONS AND RELEVANCE: Diagnostic tests for symptoms with a low risk of serious illness do little to reassure patients, decrease their anxiety, or resolve their symptoms, although the tests may reduce further primary care visits. Further research is needed to maximize reassurance from medically necessary tests and to develop safe strategies for managing patients without testing when an abnormal result is unlikely.
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Tests for symptoms with low risk of serious illness did not decrease illness anxiety or alleviate symptoms.
“Tests for symptoms with low risk of serious illness did not decrease illness anxiety or alleviate symptoms. (11)”
From Approach to the patient with multiple somatic symptoms (2021) · cites this paper as [11]
Physicians overestimate the value of diagnostic testing in reassuring patients.
“A meta-analysis by Rolfe and Burton found that physicians overestimate the value of diagnostic testing in reassuring patients.”
From Approach to the patient with multiple somatic symptoms (2021) · cites this paper as [11]
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References 42 · Cited by 172
- Authors
- Rolfe, A., & Burton, C.
- Affiliations
- University of Edinburgh (GB)
- Corresponding author
- Burton, Christopher
- ORCID
- Burton, Christopher
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2013-03-25
- Volume
- 173
- Issue
- 6
- Pages
- 407
- ISSN
- 2168-6106 (ISSN-L)
- OpenAlex
- W2085763831
- Cited by
- 172
- References
- 42
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 12 · 2023: 11 · 2022: 10 · 2021: 21 · 2020: 15 · 2019: 12 · 2018: 6 · 2017: 20 · 2016: 12 · 2015: 13 · 2014: 13 · 2013: 13
- FWCI
- 30.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- diagnostic testing, reassurance, anxiety, symptom persistence, health care utilization, primary care visits, unnecessary testing
- MeSH terms
- Anxiety, Attitude to Health, Diagnostic Tests, Routine, Disease, Humans, Probability, Severity of Illness Index, Randomized Controlled Trials as Topic, Outcome Assessment, Health Care, Sickness Impact Profile, Risk Assessment, Disease Management, Unnecessary Procedures
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