Fear Factor: New index focuses on patient experience during medical tests

A new index that scores short-term effects on patient quality of life from diagnostic testing may be useful in shared-decision making among practitioners and could enhance patient-centered outcomes.

Published online on Oct. 13 in the Journal of the American College of Radiology, the research was led by J. Shannon Swan, MD, of Massachusetts General Hospital in Boston.

As the healthcare industry attempts to focus on patient-centered healthcare, measuring utility (a preference for a state of health) and disutility (the toll on a health state) has been found to be a valuable tool when attempting to understand the effects that diagnostic tests have on patients.

“An aspect of interest in medical care process utility is the morbidity of the diagnostic testing or screening experience,” Swan and associates wrote.

Their study focused on 100 patients who had recently undergone recent breast core-needle biopsies as well as a separate group of 109 patients who underwent screening colonoscopies. It sought to apply the recently developed Testing Morbidities Index (TMI) to patient experiences after recent cancer screenings.

All evaluations were collected via telephone within a week of the procedure, and in the biopsy cases, evaluations were completed before results of the test were released to study participants.

The TMI scored quality of life factors, both physical and emotional, affected by test-specific aspects occurring before, during, or after any test.  Responses ranged from 1 (no pain or discomfort or not applicable) to 5 (extreme pain or discomfort).

The index contains 7 domains and survey items and index results ranged from 0 (dead) to 1 (full health).

In Swan et al’s study, index results for the breast biopsy scored worse (0.84) than the colonoscopy patients (0.88), a difference that was statistically significant.

For the breast biopsy, the morbidity profile is different from that of the colonoscopy—prior to the biopsy, there is no real preparation (unlike with the colonoscopy) so physical discomfort is not relevant.

Anxiety is expected before the biopsy at greater levels than the colonoscopy. Also, the results from the breast biopsy would not be immediately available to the patient as they would for the colonoscopy, so breast biopsy was nearly significant in being worse in terms of mental status afterward, which included higher levels of anxiety and worry.

“Because millions of people undergo testing and screening, the TMI was developed to assess process utility during the diagnostic process,” Swan and colleagues said.

This study is the first use of a process utility index to compare one cancer screening with another and the subsequent data generated can assist decision making in medical institutions as well as inform economic analyses of new and existing technologies.

Data from the index in general can be used in various ways across diagnostic tests. For example, in the case of colonoscopy exams, index results can be shared with patients nervous about the procedure to show that in the opinion of more experienced colonoscopy patients, discomfort and unease is relatively limited.