Patients largely unaware of potential CT harms

A majority of patients believe the final decision to have a CT scan mainly belonged to a physician, while less than half said they discussed the risk of the test with their healthcare professional, according to the results of a survey revealed in a research letter published March 4 in JAMA Internal Medicine.

Patients who discussed risks and benefits of CT with their provider, though, were shown to be no more likely to know that CT was associated with more radiation than chest radiography compared with respondents who did not have a risk-benefit discussion, according to Tanner J. Caverly, MD, of the University of Colorado Anschutz Medical Campus, Aurora, and colleagues.

“We believe it is problematic when the potential harms of CT are not adequately conveyed,” they wrote. “Ignoring downsides can lead to imbalanced decision making in favor of overuse…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.”

A total of 271 patients undergoing outpatient CT at the Denver Veterans Affairs Medical Center completed the survey, 92 percent of whom had undergone a previous scan.

Results showed 62 percent thought the final decision to have a CT was mainly the physician’s, and 35 percent discussed the potential risks beforehand. Thirty-seven percent knew that CT was associated with more radiation than chest x-ray. No respondents mentioned downstream consequences of incidental findings as a potential risk.

Only 17 percent reported having a shared final decision and a discussion of both benefits and risks of CT with their provider, according to Caverly and colleagues.

“Efforts to improve the risk communication skills of clinicians are a strategy to reduce imaging overuse (imaging that is inappropriate or discretionary),” wrote the authors. “When patients are fully informed, they often opt for fewer tests and less aggressive care.”