Park Ji Sun, Lee Ji-Su, Do Young Kyung
Department of Health Policy and Management, Seoul National University College of Medicine, Jongno-gu, South Korea.
Graduate School of Data Science, Korea Advanced Institute of Science and Technology, Daejeon, South Korea.
J Eval Clin Pract. 2025 Aug;31(5):e70208. doi: 10.1111/jep.70208.
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.
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.
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.
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.
原理、目的和目标：虽然低价值医疗可能有多种促成因素，但它最终产生于医患互动中，且常常受到沟通的影响。本研究使用韩国的假设性情景案例，考察医生的沟通因素是否以及在多大程度上影响患者接受低价值医疗的意愿。
我们利用了总共1229名韩国成年人的数据，其中包括关于低价值医疗的假设性情景案例。向参与者展示了涉及轻度头部损伤以及计算机断层扫描（CT）潜在使用的情景案例。我们根据三个医生沟通因素评估愿意接受低价值CT检查的个体比例的变化：明确推荐、关于检查益处和风险的沟通，以及表明防御性医疗的表述，如警告漏诊问题和声明无法律责任。我们还研究了与他们愿意使用低价值CT相关的参与者特征。
关于低价值医疗的决策受到医生沟通因素的显著影响。例如，在没有明确推荐的情况下，68.5%的参与者愿意使用低价值CT，而在有明确推荐时，这一比例为76.6%。在那些最初愿意在没有明确推荐的情况下使用低价值CT的人中，当提供有关风险和益处的信息时，54.6%的人改变了决定，选择不进行CT检查。然而，当情景案例包含表明防御性医疗的要素时，这些人中69%的人又改变了决定，选择进行CT检查。除了补充性私人医疗保险和个人对医疗保健的偏好外，愿意接受低价值医疗与大多数参与者特征无关。
医生沟通在患者关于低价值医疗的决策中起着关键作用。为了减少低价值医疗，应优先改善医生沟通，并将其视为质量改进举措中的一个关键杠杆点。
