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How do patients and the public understand overtesting and overdiagnosis? A protocol for a thematic meta-synthesis of qualitative research
  1. Tomas Rozbroj1,2,
  2. Romi Haas1,2,
  3. Denise A O’Connor1,2,
  4. Rae Thomas3,
  5. Kirsten McCaffery4,
  6. Stacy Carter5,
  7. Rachelle Buchbinder1,2
  1. 1Monash Department of Clinical Epidemiology, Cabrini Institute, Monash University, Clayton, Victoria, Australia
  2. 2Cabrini Institute, Cabrini Health, Malvern, Victoria, Australia
  3. 3Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
  4. 4Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
  5. 5Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, New South Wales, Australia
  1. Correspondence to Dr Tomas Rozbroj; tomas.rozbroj{at}


Introduction Examining patient and public understanding of overtesting and overdiagnosis (OverTD) is vital for reducing the burden of OverTD. Studies from disparate contexts, disciplines and focusing on disparate healthcare issues have examined patient and public understanding of OverTD. A synthesis is needed to bring this literature together, examine common themes, strengthen conclusions and identify gaps. This will help steer further research, policy and practice to improve patient and public understanding of OverTD. The objective of this study is to synthesise qualitative research data about patient and public understanding of OverTD.

Methods and analysis A thematic meta-synthesis will be used to synthesise primary qualitative research and qualitative components of primary mixed-methods research about patient and public understanding of OverTD. Studies published in English will be included. These will be identified using systematic searches from inception to March 2020 in the Scopus, CINAHL, PsycINFO and MEDLINE databases. Studies that satisfy eligibility criteria will be assessed for methodological quality using the Critical Appraisal Skills Programme (CASP) checklist. Thematic meta-synthesis will comprise three stages: (1) line-by-line coding; (2) generation of descriptive themes and (3) generation of analytic themes. Confidence in the synthesis findings will be assessed using the Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence (GRADE CERQual) approach. A summary of GRADE CERQual results will be presented alongside the key themes. Study eligibility screening, data extraction, analysis and the CASP and GRADE CERQual assessments will be undertaken independently by two review authors.

Ethics and dissemination Ethics approval is not required for this secondary analysis of published data. The results will be disseminated in peer-reviewed journals and may be presented in conference papers and elsewhere.

PROSPERO registration number CRD42020156838

  • protocols & guidelines
  • quality in health care
  • risk management
  • public health
  • qualitative research

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Twitter @drromihaas, @rthomasEBP, @kirstenmccaffer?lang=en, @stacymcarter, @rachellebuchbin?lang=en

  • Contributors TR, DAO and RB conceived the study and wrote the first draft of the protocol. RH, RT, KM and SC contributed to refining the protocol design and preparing subsequent protocol drafts. All authors approved the submitted protocol and are accountable for its content.

  • Funding This work is supported by an Australian National Health and Medical Research Council (NHMRC) Programme grant (Using Healthcare Wisely: reducing inappropriate use of tests and treatments, (APP1113532). DAO is supported by an NHMRC Translating Research into Practice (TRIP) Fellowship (APP1168749). RT is supported by an NHMRC Programme grant (#1106452). KM is supported by an NHMRC Principle Research Fellowship (1121110). SC is supported by an NHMRC Centres for Research Excellence grant (APP1104136). RB is supported by an NHMRC Senior Principal Research Fellowship (APP1082138).

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

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