Patient preferences for diagnostic testing in the emergency department: a cross-sectional study

Abstract

Background

Diagnostic testing is common during emergency department visits. Little is understood about patient preferences for such testing. We hypothesized that a patient's willingness to undergo diagnostic testing is influenced by the potential benefit, risk, and personal cost.

Methods

We conducted a cross sectional survey among emergency department patients for diagnostic testing in 2 hypothetical scenarios: chest pain (CP) and mild traumatic brain injury (mTBI). Each scenario defined specific risks, benefits, and costs of testing. The odds of a participant desiring diagnostic testing were calculated using a series of nested multivariable logistic regression models.

Results

Participants opted for diagnostic testing 68.2% of the time, including 69.7% of CP and 66.7% of all mTBI scenarios. In the chest pain scenario, 81% of participants desired free testing versus 59% when it was associated with a $100 copay (difference: 22%; 95% CI 16 - 28%). Similarly, in the mTBI scenario, 73% of adult participants desired free testing versus 56% when charged a $100 copayment (difference 17%; 95% CI 11 - 24%). Benefit and risk had mixed effects across the scenarios. In fully adjusted models, the association between cost and desire for testing persisted in the CP (OR 0.33; 95% CI 0.23 - 0.47) and adult mTBI (OR 0.47; 95% 0.33 - 0.67) scenarios.

Conclusions

In this emergency department based study, patient preferences for diagnostic testing differed significantly across levels of risk, benefit, and cost of diagnostic testing. Cost was the strongest and most consistent factor associated with decreased desire for testing.

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