Article Text

Original research
Patient and general practitioner views of tools to delay diagnostic imaging for low back pain: a qualitative study
  1. Adrian C Traeger1,2,
  2. Juliet Checketts3,
  3. Elise Tcharkhedian4,
  4. Denise A O’Connor5,6,
  5. Christiane Klinner1,
  6. Sweekriti Sharma1,2,
  7. Parima Vyas3,
  8. Loai Albarqouni7,
  9. Kirsten McCaffery2,8
  1. 1Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
  2. 2School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  3. 3Australian Government Department of Health, Canberra, Australian Capital Territory, Australia
  4. 4Department of Physiotherapy, Liverpool Hospital, Liverpool, New South Wales, Australia
  5. 5Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
  6. 6Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  7. 7Institute for Evidence-Based Healthcare, Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
  8. 8Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Adrian C Traeger; adrian.traeger{at}


Objective Delayed prescribing is a promising strategy to manage patient requests for unnecessary tests and treatments. The purpose of this study was to explore general practitioner (GP) and patient views of three communication tools (Overdiagnosis Leaflet, Dialogue Sheet and ‘Wait-and-see’ Note) to support delayed prescribing of diagnostic imaging.

Design Qualitative study.

Setting Primary and emergency care in Sydney, Australia.

Participants 16 GPs and 14 patients with recent episode of low back pain.

Outcome Views on the tools to delay diagnostic imaging for low back pain. Data were collected using a combination of focus groups and individual interviews.

Analysis Two researchers independently performed a thematic analysis, and the author team reviewed and refined the analysis.

Results GP participants responded positively to the Overdiagnosis Leaflet. The Dialogue Sheet and ‘Wait-and-see’ Note raised several concerns about patient pushback, adding to time pressure and being overwhelmed with hard-to-find paper resources. GPs preferred to communicate verbally the reasons to delay an imaging test. For patients, the reactions to the tools were more positive. Patients valued written information and a signed agreement to delay the test. However, patients expressed that a strong desire for diagnostic imaging would likely over-ride any effect of written advice to delay the test. The term ‘false alarm’ to describe overdiagnosis was poorly understood by patients.

Conclusions GPs and patients agreed that a leaflet about overdiagnosis could support a delayed prescribing approach to imaging for low back pain. The Dialogue Sheet and ‘Wait-and-see’ Note were acceptable to patients but not to GPs.

  • diagnostic radiology
  • quality in health care
  • rehabilitation medicine
  • back pain
  • internal medicine

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  • Twitter @adrian_traeger, @SweekritiSharma, @@LoaiAlbarqouni, @KirstenMcCaffer

  • Contributors Study concept and design: ACT, JC, ET, DAO, CK, SS, PV, LA, KM. Acquisition of data: ACT, JC, ET, DAO, CK, SS, PV. Analysis or interpretation of data: ACT, JC, ET, DAO, CK, SS, PV, LA, KM. Drafting of the manuscript: ACT. Critical revision of the manuscript for important intellectual content: ACT, JC, ET, DAO, CK, SS, PV, LA, KM. Analysis: ACT, JC, ET, DAO, CK, SS, PV, LA, KM. Obtained funding: KM, ACT. Study supervision: ACT.

  • Funding Financial support for this study was provided entirely by a grant from the Australian National Health and Medical Research Council (NHMRC Program Grant APP1113532) entitled 'Using healthcare wisely: reducing inappropriate use of tests and treatments'. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing and publishing the report. DAO is supported by an Australian National Health and Medical Research Council (NHMRC) Translating Research into Practice Fellowship (APP1168749).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Study procedures were approved by the University of Sydney HREC (ref: 2019/591), the Southwest Sydney Local Health District HREC (ref: 2019/ETH00281) and the Bond University HREC (ref: LA03323).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. No additional data are available.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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