Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison.
Department of Surgery, University of Michigan, Ann Arbor.
JAMA Netw Open. 2024 Jun 3;7(6):e2417098. doi: 10.1001/jamanetworkopen.2024.17098.
Medical overutilization contributes to significant health care expenditures and exposes patients to questionably beneficial surgery and unnecessary risk.
To understand public attitudes toward medical utilization and the association of these attitudes with beliefs about cancer.
DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional survey study conducted from August 26 to October 28, 2020, US-based, English-speaking adults were recruited from the general public using Prolific Academic, a research participant platform. Quota-filling was used to obtain a sample demographically representative of the US population. Adults with a personal history of cancer other than nonmelanoma skin cancer were excluded. Statistical analysis was completed in July 2022.
Medical utilization preferences were characterized with the validated, single-item Maximizer-Minimizer Elicitation Question. Participants preferring to take action in medically ambiguous situations (hereafter referred to as "maximizers") were compared with those who leaned toward waiting and seeing (hereafter referred to as "nonmaximizers"). Beliefs and emotions about cancer incidence, survivability, and preventability were assessed using validated measures. Logistic regression modeled factors associated with preferring to maximize medical utilization.
Of 1131 participants (mean [SD] age, 45 [16] years; 568 women [50.2%]), 287 (25.4%) were classified as maximizers, and 844 (74.6%) were classified as nonmaximizers. Logistic regression revealed that self-reporting very good or excellent health status (compared with good, fair, or poor; odds ratio [OR], 2.01 [95% CI, 1.52-2.65]), Black race (compared with White race; OR, 1.88 [95% CI, 1.22-2.89]), high levels of cancer worry (compared with low levels; OR, 1.62 [95% CI, 1.09-2.42]), and overestimating cancer incidence (compared with accurate estimation or underestimating; OR, 1.58 [95% CI, 1.09-2.28]) were significantly associated with maximizing preferences. Those who believed that they personally had a higher-than-average risk of developing cancer were more likely to be maximizers (23.6% [59 of 250] vs 17.4% [131 of 751]; P = .03); this factor was not significant in regression analyses.
In this survey study of US adults, those with medical maximizing tendencies more often overestimated the incidence of cancer and had higher levels of cancer-related worry. Targeted and personalized education about cancer and its risk factors may help reduce overutilization of oncologic care.
医疗过度利用导致了大量的医疗支出，并使患者面临有疑问的有益手术和不必要的风险。
了解公众对医疗利用的态度，以及这些态度与对癌症的信念之间的关联。
设计、设置和参与者：在这项 2020 年 8 月 26 日至 10 月 28 日进行的横断面调查研究中，从 Prolific Academic（一个研究参与者平台）招募了美国的英语为母语的成年人。使用配额填充法获得了在人口统计学上代表美国人口的样本。排除了患有非黑色素瘤皮肤癌以外的个人癌症史的成年人。统计分析于 2022 年 7 月完成。
使用经过验证的单一项目最大化-最小化启发问题来描述医疗利用偏好。与倾向于等待和观望的人（以下简称“非最大化者”）相比，在医学上模棱两可的情况下采取行动的人（以下简称“最大化者”）被进行了比较。使用经过验证的测量方法评估对癌症发病率、生存率和可预防性的信念和情绪。使用逻辑回归模型分析与偏好最大化医疗利用相关的因素。
在 1131 名参与者（平均[标准差]年龄 45[16]岁；568 名女性[50.2%]）中，287 名（25.4%）被归类为最大化者，844 名（74.6%）被归类为非最大化者。逻辑回归显示，自我报告的健康状况非常好或极好（与好、一般或差相比；比值比[OR]，2.01[95%置信区间，1.52-2.65]）、黑人（与白人相比；OR，1.88[95%CI，1.22-2.89]）、高水平的癌症担忧（与低水平相比；OR，1.62[95%CI，1.09-2.42]）和对癌症发病率的高估（与准确估计或低估相比；OR，1.58[95%CI，1.09-2.28]）与最大化偏好显著相关。那些认为自己患癌症的风险高于平均水平的人更有可能成为最大化者（23.6%[250 人中有 59 人]与 17.4%[751 人中有 131 人]；P = .03）；在回归分析中，这一因素并不显著。
在这项对美国成年人的调查研究中，那些有医疗最大化倾向的人更经常高估癌症的发病率，并且癌症相关的担忧水平更高。针对癌症及其危险因素的有针对性和个性化的教育可能有助于减少肿瘤治疗的过度利用。
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