Subtle Differences in Physician Communication and Substantial Impacts on Patient Decision-Making About Low-Value Care: An Experimental Vignette Study

Abstract

Rational, Aims and Objectives

While low-value care may have multiple contributing factors, it ultimately arises within patient-physician interactions, often influenced by communication. This study examines whether and the extent to which physician communication factors influence patients' willingness to undergo low-value care using hypothetical vignettes in South Korea.

Methods

We utilised data from a total of 1229 South Korean adults that included hypothetical vignettes on low-value care. Participants were presented with vignettes involving minor head injury and the potential use of computed tomography (CT). We assessed changes in the proportion of individuals willing to undergo low-value CT based on three physician communication factors: explicit recommendation, communication regarding test benefits and risks, and expressions indicative of defensive medicine, such as warning about missed problems and stating no legal responsibility. We also examined participant characteristics associated with their willingness to use low-value CT.

Results

Decisions regarding low-value care were significantly influenced by physician communication factors. For instance, while 68.5% of participants were willing to use low-value CT without explicit recommendation, 76.6% were willing when an explicit recommendation was made. Among those initially willing to use low-value CT without an explicit recommendation, 54.6% changed their decision and chose not to undergo the CT when presented with information on the risks and benefits. However, 69% of these individuals reversed their decision and opted for the CT when the vignette included elements indicative of defensive medicine. The willingness to use low-value care was not associated with most participant characteristics, except for supplementary private health insurance and individual preferences for health care.

Conclusions

Physician communication plays a pivotal role in patient decision-making regarding low-value care. To reduce low-value care, improving physician communication should be prioritised and considered a crucial leverage point in quality improvement initiatives.