TY - JOUR
T1 - Diagnostic testing in children
T2 - A qualitative study of pediatricians' considerations
AU - Ropers, Fabienne G.
AU - Rietveld, Sophie
AU - Rings, Edmond H. H. M.
AU - Bossuyt, Patrick M. M.
AU - van Bodegom- Vos, Leti
AU - Hillen, Marij A.
N1 - Funding Information: The authors are very grateful to all the paediatricians involved in this study for their participation and thank AM Oudesluys-Murphy for her English editing of the manuscript. Publisher Copyright: © 2023 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.
PY - 2023/12
Y1 - 2023/12
N2 - Aims and Objectives: Studies in adult medicine have shown that physicians base testing decisions on the patient's clinical condition but also consider other factors, including local practice or patient expectations. In pediatrics, physicians and parents jointly decide on behalf of a (young) child. This might demand more explicit and more complex deliberations, with sometimes conflicting interests. We explored pediatricians' considerations in diagnostic test ordering and the factors that influence their deliberation. Method: We performed in-depth, semistructured interviews with a purposively selected heterogeneous sample of 20 Dutch pediatricians. We analyzed transcribed interviews inductively using a constant comparative approach, and clustered data across interviews to derive common themes. Results: Pediatricians perceived test-related burden in children higher compared with adults, and reported that avoiding an unjustified burden causes them to be more restrictive and deliberate in test ordering. They felt conflicted when parents desired testing or when guidelines recommended diagnostic tests pediatricians perceived as unnecessary. When parents demanded testing, they would explore parental concern, educate parents about harms and alternative explanations of symptoms, and advocate watchful waiting. Yet they reported sometimes performing tests to appease parents or to comply with guidelines, because of feared personal consequences in the case of adverse outcomes. Conclusion: We obtained an overview of the considerations that are weighed in pediatric test decisions. The comparatively strong focus on prevention of harm motivates pediatricians to critically appraise the added value of testing and drivers of low-value testing. Pediatricians' relatively restrictive approach to testing could provide an example for other disciplines. Improved guidelines and physician and patient education could help to withstand the perceived pressure to test.
AB - Aims and Objectives: Studies in adult medicine have shown that physicians base testing decisions on the patient's clinical condition but also consider other factors, including local practice or patient expectations. In pediatrics, physicians and parents jointly decide on behalf of a (young) child. This might demand more explicit and more complex deliberations, with sometimes conflicting interests. We explored pediatricians' considerations in diagnostic test ordering and the factors that influence their deliberation. Method: We performed in-depth, semistructured interviews with a purposively selected heterogeneous sample of 20 Dutch pediatricians. We analyzed transcribed interviews inductively using a constant comparative approach, and clustered data across interviews to derive common themes. Results: Pediatricians perceived test-related burden in children higher compared with adults, and reported that avoiding an unjustified burden causes them to be more restrictive and deliberate in test ordering. They felt conflicted when parents desired testing or when guidelines recommended diagnostic tests pediatricians perceived as unnecessary. When parents demanded testing, they would explore parental concern, educate parents about harms and alternative explanations of symptoms, and advocate watchful waiting. Yet they reported sometimes performing tests to appease parents or to comply with guidelines, because of feared personal consequences in the case of adverse outcomes. Conclusion: We obtained an overview of the considerations that are weighed in pediatric test decisions. The comparatively strong focus on prevention of harm motivates pediatricians to critically appraise the added value of testing and drivers of low-value testing. Pediatricians' relatively restrictive approach to testing could provide an example for other disciplines. Improved guidelines and physician and patient education could help to withstand the perceived pressure to test.
KW - clinical decision making
KW - diagnostic tests
KW - guidelines
KW - low-value care
KW - pediatrics
UR - http://www.scopus.com/inward/record.url?scp=85160104240&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/jep.13867
DO - https://doi.org/10.1111/jep.13867
M3 - Article
C2 - 37221991
SN - 1356-1294
VL - 29
SP - 1326
EP - 1337
JO - Journal of evaluation in clinical practice
JF - Journal of evaluation in clinical practice
IS - 8
ER -