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11-03-2013 | Legal medicine | Article

CT imaging risk communication deficits exposed

Abstract

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medwireNews: Survey results highlight the inadequacy of risk communication to patients undergoing computed tomography (CT) imaging, with most patients receiving no or poor quality information from their physician.

Responses from 271 patients undergoing outpatient CT imaging at Denver Veterans Affairs Medical Center in 2011 showed that only 35% of patients discussed the potential risks of imaging with their physician, with 17% discussing both risks and benefits of CT.

Just 37% of patients understood that chest CT was associated with a higher radiation dose than chest radiography, regardless of age, education, gender, receipt of previous scans, or ordering clinician. And only a minority of patients were able to list the potential harms of CT, such as radiation (24%), cancer (5%), or a reaction to contrast solution (3%).

Of concern, there was no significant difference in the understanding of CT radiation risks between patients who had discussed the pros and benefits of CT with their physician and those who had not, say Tanner Caverly (University of Colorado, Denver, USA) and co-authors.

The majority (62%) of patients believed the final decision to undergo CT was mostly the responsibility of their doctor.

The researchers admit as the majority of their participants were veterans aged over 50 years (86%) and male (92%), the results may not be applicable to other populations, but say their findings reflect other surveys.

"We believe it is problematic when the potential harms of CT are not adequately conveyed," Caverly et al write in JAMA Internal Medicine. "Ignoring downsides can lead to imbalanced decision making in favor of overuse."

Acknowledging calls for mandatory informed consent before CT imaging, due to the risk from radiation-induced cancer, the team concludes: "Correcting the lack of knowledge and the lack of communication about the potential harms of imaging tests-thereby enhancing shared decision making-should be part of any attempt to curb imaging overuse.

"It is time to begin empirically testing risk communication methods and translate these methods into routine clinical practice."

By Lynda Williams, Senior medwireNews Reporter

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