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HOW DIFFICULT ARE DIAGNOSTIC AND SCREENING TESTS FOR PATIENTS?


Posted: Wednesday, September 25, 2013

Boston, Massachusetts - Medical tests with greater morbidity are less likely to be completed by patients, and this lack of health maintenance adherence has implications for future health outcomes. Knowing how medical tests may differ in their temporary changes to a patient’s quality of life can help doctors, clinicians and institutions better understand the patient experience and improve upon it. Such knowledge also gives patients actual data about medical testing rather than hearsay. Researchers at Massachusetts General Hospital have been working on making such information available.

In the article, “Responsiveness of the Testing Morbidities Index in Colonoscopy,” published in Value in Health, a new survey instrument called the Testing Morbidities Index (TMI) was used in patients undergoing screening colonoscopy. The study focused on responsiveness - thus the sensitivity of the TMI to detect change in quality of life caused by the testing experience.  The authors found that the TMI, a brief 7 question survey, was much more responsive to change than two standard instruments, the EQ-5D-5L and the SF-6D; they showed no responsiveness or minimal responsiveness, respectively. The TMI survey asks patients about emotional and physical discomforts that occur before, during and after a testing procedure. The results showed that essentially all of the morbidity of colonoscopy occurs before the actual procedure. Patients can have substantial anxiety before colonoscopy and the bowel preparation is very uncomfortable for some. Morbidity during and after the procedure, however, is relatively minimal.

"Our results are not a surprise to clinicians and experienced patients, but they would likely be of interest to inexperienced patients who are scared to have the test," said the lead author on the study, Dr. J. Shannon Swan, MD, an Associate Professor at Harvard Medical School and a Senior Scientist at the MGH Institute for Technology Assessment. He adds, "More importantly, the TMI allows us to compare tests to one another. When we developed the TMI, we first tested it in breast biopsy, which we find has a different morbidity profile than colonoscopy." Lastly, Dr. Swan notes that for the future, the TMI results can be presented in various ways: "We can look at the morbidity in individual survey items, and can also combine the items so they can be used for various purposes. We are now implementing a TMI version that can provide results applicable to cost-effectiveness analysis." 


Value in Health (ISSN 1098-3015) publishes papers, concepts, and ideas that advance the field of pharmacoeconomics and outcomes research as well as policy papers to help health care leaders make evidence-based decisions. The journal is published bi-monthly and has over 8,000 subscribers (clinicians, decision-makers, and researchers worldwide).

International Society for Pharmacoeconomics and Outcomes Research (ISPOR) is a nonprofit, international, educational and scientific organization that strives to increase the efficiency, effectiveness, and fairness of health care resource use to improve health. 

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