Understanding and Discouraging Overuse of Potentially Harmful Screening Tests

Most prevention efforts focus on promoting services (e.g. vaccination, screening tests).
While some of these services have clear net benefit, many instead have possible or clear net
harm. Currently, three quarters of services graded by the U.S. Preventive Services Task
Force (USPSTF) have possible or clear net harm (C, I, and D services). Many of these
services are delivered in healthcare settings at higher rates than what might be expected
based on their potential for harm. This leads to adverse outcomes, excess costs, and missed
opportunities to deliver more quality care. An important issue in delivering prevention
messages is how to shift toward a focus on the appropriateness of prevention: encouraging
services with clear net benefit and either discouraging or reducing demand for services with
possible or clear net harm. Unfortunately, little is known about what drives overuse of
potentially harmful screening services or how to make harms relevant to patients.

This randomized controlled trial (RCT) of 775 patients at 4 primary care practices aims to
1) assess factors associated with intent to receive possibly or clearly harmful screening
services and 2) determine whether and how patients' plans to get screened change with
various presentations of information about harms (e.g. qualitative, quantitative, narrative,
framed). The investigators will focus on three types of screening services: osteoporosis
screening (previous C recommendation and now no recommendation for women < 65 years old with
no fracture risk factors), prostate-specific antigen (PSA) screening (D recommendation for
all men, regardless of age), and colorectal cancer (CRC) screening (C for ages 76-85).