One-quarter of adults may seek unnecessary medical treatment
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Key takeaways:
- Roughly 25% of individuals tended to seek treatment in medically ambiguous situations.
- Certain subgroups more likely sought treatment when it may not be needed.
Compared with the rest of the general public, certain subpopulations in the U.S. tended to seek medical treatment in situations where interventions may be unnecessary, results from a survey study showed.
The findings, published in JAMA Network Open, found that, compared with White individuals, those who self-identify as Black have a higher likelihood of seeking medical care in ambiguous situations. This trend toward maximizing medical care also applied to those who reported being in very good or excellent health, those who worry more about developing cancer, and individuals who overestimate the incidence of cancer.
“These findings indicate that educational efforts to reduce patient-associated medical overutilization across the cancer continuum should account for racial differences, emotional concerns about cancer and beliefs about the risk [for] developing cancer,” Alexander Chiu, MD, MPH, assistant professor in the department of surgery at University of Wisconsin, and colleagues wrote.
Background and methodology
Roughly $200 billion is spent each year on medical tests, treatments and procedures that individuals did not need, according to background information researchers provided.
Numerous factors can lead to overtreatment, including concerns of malpractice, lack of care coordination, duplicate tests, reduced time with patients and patient preference.
“In a survey of more than 2,000 physicians, the second most commonly cited reason for overtreatment, after fear of malpractice, was pressure from patients to order tests and treatments,” researchers wrote. “Part of this push from patients comes from a common perception that more care means better care, combined with increased satisfaction when patients perceive something proactive is ‘being done’ for their health, regardless of utility.”
Chiu and colleagues conducted a cross-sectional survey study to investigate how individuals who preferred to act in uncertain situations (maximizers) compared with those who did not in their beliefs and attitudes regarding cancer care.
They recruited participants using Prolific Academic, “a research participant platform that maintains a panel of more than 130,000 people from around the world who voluntarily participate in behavioral research,” they wrote.
Individuals had to be aged at least 18 years, have no cancer history other than nonmelanoma skin cancer and speak English.
A total of 1,131 individuals participated (mean age 45 years; 50.2% women; 73.9% white).
Results and next steps
Maximizers made up 25.4% of the study cohort.
“The prevalence of medical maximizing preferences has previously been undefined at a scale such as this study, to our knowledge,” researchers wrote.
Maximizers had a higher likelihood of self-reporting very good or excellent health (53% vs. 38.3%; P < .001).
A significantly higher rate of maximizers overestimated incidence of cancer in the U.S. (19.2% vs. 13%; P = .01) and reported they, personally, had a higher risk for cancer (23.6% vs. 17.4%, P = .03).
Additionally, maximizers reported much more cancer-related worry (15.7% vs. 11.3%; P = .05).
Both groups underestimated 5-year OS rates, and both cohorts responded similarly to questions about the preventability and curability of cancer, and whether the thought of cancer provokes thoughts of death.
Subpopulations that had maximizing preferences based on multivariable logistic regression included self-reporting very good or excellent health (OR = 2.01; 95% CI, 1.52-2.65), Black race compared with white race (OR = 1.88; 95% CI, 1.22-2.89), elevated levels of cancer worry (OR = 1.62; 95% CI, 1.09-2.42) and overestimating cancer incidence (OR = 1.58; 95% CI, 1.09-2.28).
Chiu and colleagues cited previous research showing Black individuals preferred to take aggressive action rather than rely on hospice care during end-of-life situations due to mistrust of the medical system.
“This racial difference in medical maximizing preference may not translate into increased unnecessary treatment or overutilization,” researchers wrote.
“A systematic review of the racial and ethnic differences in overtreatment showed that white patients more often receive overtreatment,” they added. “These findings highlight existing health disparities and a discordance in the preferences of patients of racial and ethnic minority groups with respect to their preference of taking action in medically ambiguous situations and their actual lack of receipt of this treatment.”
Researchers noted multiple study limitations, including the overall demographic not fully representing the U.S. because of Prolific Academic being an opt-in service, as well as the survey not asking about comorbidities.
“Knowing the magnitude of potential patients with high medical maximizing preferences is significant, as maximizers have been shown to be more likely to pursue health care with questionable benefit, likely contributing to the significant amount of overtreatment seen in the U.S. health system,” they wrote.
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