Abstract
Amaç: Overdiagnosis, kelime anlamı aşırı teşhis olan ve teşhis edilmediği takdirde kişiye zarar vermeyecek bir hastalığın veya anormal bir durumun tespit edilmesi olarak tanımlanmaktadır. Çalışmadaki amacımız sosyal ve demografik açıdan bireylerinoverdiagnosis hakkındaki farkındalığını arttırmaktır. Böylelikle acil serviste gereksiz laboratuar tetkiklerinin, bilgisayarlı tomografi ve diğer görüntüleme testlerinin sayısının azalabileceğini düşünüyoruz.
Gereç ve Yöntem: Çalışma için acil servise başvuran hastalara yönelik demografik verileri ve aşırı teşhis hakkındaki 7 soruyu içeren anket formu hazırlandı. Anket formu hastadan sorumlu acil uzmanları ve kıdemli acil asistanları tarafından katılımcılarla karşılıklı soru cevap şeklinde dolduruldu.
Bulgular: Elde ettiğimiz birincil bulgular şunlardır: (1) Hastaların Overdiagnosis hakkındaki fikirleri ile cinsiyet, eğitim düzeyi, ikamet yeri, ekonomik durum, kronik hastalıklar ve kullandığı ilaç sayıları gibi değişkenler arasında istatistiksel olarak anlamlı düzeyde ilişki vardır; (2) Hastalara şikayete sebep olmayan ancak ciddi bir hastalığın teşhisi için tarama testi yaptırmak ister misiniz diye sorduğumuzda 406(%76,5) kişi tarama testi yaptırmak istediğini belirtti. Ancak aşırı teşhis hakkında bilgilendirme sonrasında bu sayının 261 (%49,2) kişiye düştüğü görüldü.
Sonuç: Çalışmamızda herhangi bir tarama testi yapmadan önce hastaları aşırı teşhis ve tedavi konusunda bilgilendirdiğimiz de hastaların büyük bir oranda gereksiz teşhis ve tedavileri istemediğini görmekteyiz. Dolayısıyla eğer hastalar yeterli bir şekilde bilgilendirilirse, sağlık sistemleri üzerinde büyük bir yük oluşturan aşırı teshis ve tedavinin azalabileceğini düşünüyoruz.
References
- Jenniskens K, De Groot JAH, Reitsma JB, Moons KGM, Hooft L, Naaktgeboren CA. Overdiagnosis across medical disciplines: a scoping review. BMJ Open 2017; 7(12): e018448.
- Pathirana T, Clark J, Moynihan R. Mapping the drivers of overdiagnosis to potential solutions. BMJ 2017; 358.
- Moynihan R, Doust J, Henry D. Preventing overdiagnosis: how to stop harming the healthy. BMJ 2012; 344: e3502.
- Coon ER, Quinonez RA, Moyer VA, Schroeder AR. Overdiagnosis: how our compulsion for diagnosis may be harming children. Pediatrics 2014; 358: 1013-23.
- Welch HG, Black WC. Overdiagnosis in cancer. Journal of the National Cancer Institute 2010; 102(9): 605-613.
- Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Dal Maso L. Worldwide thyroid-cancer epidemic? the increasing impact of overdiagnosis. New England journal of medicine 2016; 358: 614-617.
- Moynihan R, Nickel B, Hersch J, Beller E, Doust J, Compton S, et al. Public opinions about overdiagnosis: a national community survey. PLoS One 2015; 10(5): e0125165.
- Wiener Soylemez R, Schwartz LM, Woloshin S. Time trends in pulmonary embolism in the United States: evidence of overdiagnosis. Archives of internal medicine 2011; 171: 831–837.
- Anjum O, Bleeker H, Ohle R. Computed tomography for suspected pulmonary embolism results in a large number of non-significant incidental findings and follow-up investigations. Emergency radiology 2019: 26: 29–35.
- Brenner AT, Malo TL, Margolis M, Lafata JE, James S, Vu MB, et al. Evaluating shared decision making for lung cancer screening. JAMA internal medicine 2018; 178(10): 1311-1316.
- Barratt A, Jørgensen KJ, Autier, P. Reform of the national screening mammography program in France. JAMA internal medicine2018; 178(2): 177-178.
- Hersch J, Barratt A, Jansen J, Irwig L, McGeechan K, Jacklyn G, et al. Use of a decision aid including information on overdetection to support informed choice about breast cancer screening: a randomised controlledtrial. The Lancet 2015; 385(9978): 1642-1652.
- Welch HG, Skinner JS, Schroeck FR, Zhou W, Black WC. Regional variation of computed tomographic imaging in the United States and the risk of nephrectomy. JAMA internal medicine 2018; 178(2): 221-227.
- Abelson J, Tripp L, Brouwers MC, Pond G, Sussman J. Uncertain times: A survey of Canadian women's perspectives toward mammography screening. Preventive Medicine 2018;112: 209-215.
- Nekhlyudov L, Li R, Fletcher SW. Informed decision making before initiating screening mammography: does it occur and does it make a difference?.Health Expectations 2008; 11(4): 366-375.
- Solmi F, Von Wagner C, Kobayashi LC, Raine R, Wardle J, Morris S. Decomposing socio-economic inequality in colorectal cancer screening uptake in England. Sociel Science&Medicine 2015; 134: 76-86.
- Hoffman RM, Elmore JG, Fairfield KM, Gerstein BS, Levin CA, Pignone MP. Lack of shared decision making in cancer screening discussions: results from a national survey. American journal of preventive medicine 2014; 47(3): 251-259.
Abstract
Background/Aims: Overdiagnosis is defined as detecting a disease or abnormal condition that, if left undiagnosed, would not harm the individual.
Our aim in the study is to increase the awareness of individuals about overdiagnosis in terms of social and demographic. Thus, we think that the number of unnecessary laboratory tests, computed tomography and other imaging tests in the emergency department can be reduced.
Methods: For the study, a questionnaire including demographic data and 7 questions about overdiagnosis was prepared for the patients who applied to the emergency department. The questionnaire was filled by the emergency specialists and senior emergency assistants in charge of the patient in the form of questions and answers with the participants.
Results: Our primary findings are: (1) There is a statistically significant relationship between patients' ideas about Overdiagnosis and variables such as gender, education level, place of residence, economic status, chronic diseases and the number of drugs used; (2) When we asked the patients if they would like to have a screening test for the diagnosis of a serious disease that does not cause complaints, 406 (76.5%) people stated that they wanted to have a screening test. However, after informing about overdiagnosis, this number decreased to 261 (49.2%) people.
Conclusion: In our study, we demonstrated that patients did not want unnecessary diagnosis and treatment when informed about overdiagnosis and overtreatment before performing any screening test. Therefore, we think that if patients are adequately informed, overdiagnosis and overtreatment rates, which greatly burden the health system, can be reduced.
References
- Jenniskens K, De Groot JAH, Reitsma JB, Moons KGM, Hooft L, Naaktgeboren CA. Overdiagnosis across medical disciplines: a scoping review. BMJ Open 2017; 7(12): e018448.
- Pathirana T, Clark J, Moynihan R. Mapping the drivers of overdiagnosis to potential solutions. BMJ 2017; 358.
- Moynihan R, Doust J, Henry D. Preventing overdiagnosis: how to stop harming the healthy. BMJ 2012; 344: e3502.
- Coon ER, Quinonez RA, Moyer VA, Schroeder AR. Overdiagnosis: how our compulsion for diagnosis may be harming children. Pediatrics 2014; 358: 1013-23.
- Welch HG, Black WC. Overdiagnosis in cancer. Journal of the National Cancer Institute 2010; 102(9): 605-613.
- Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Dal Maso L. Worldwide thyroid-cancer epidemic? the increasing impact of overdiagnosis. New England journal of medicine 2016; 358: 614-617.
- Moynihan R, Nickel B, Hersch J, Beller E, Doust J, Compton S, et al. Public opinions about overdiagnosis: a national community survey. PLoS One 2015; 10(5): e0125165.
- Wiener Soylemez R, Schwartz LM, Woloshin S. Time trends in pulmonary embolism in the United States: evidence of overdiagnosis. Archives of internal medicine 2011; 171: 831–837.
- Anjum O, Bleeker H, Ohle R. Computed tomography for suspected pulmonary embolism results in a large number of non-significant incidental findings and follow-up investigations. Emergency radiology 2019: 26: 29–35.
- Brenner AT, Malo TL, Margolis M, Lafata JE, James S, Vu MB, et al. Evaluating shared decision making for lung cancer screening. JAMA internal medicine 2018; 178(10): 1311-1316.
- Barratt A, Jørgensen KJ, Autier, P. Reform of the national screening mammography program in France. JAMA internal medicine2018; 178(2): 177-178.
- Hersch J, Barratt A, Jansen J, Irwig L, McGeechan K, Jacklyn G, et al. Use of a decision aid including information on overdetection to support informed choice about breast cancer screening: a randomised controlledtrial. The Lancet 2015; 385(9978): 1642-1652.
- Welch HG, Skinner JS, Schroeck FR, Zhou W, Black WC. Regional variation of computed tomographic imaging in the United States and the risk of nephrectomy. JAMA internal medicine 2018; 178(2): 221-227.
- Abelson J, Tripp L, Brouwers MC, Pond G, Sussman J. Uncertain times: A survey of Canadian women's perspectives toward mammography screening. Preventive Medicine 2018;112: 209-215.
- Nekhlyudov L, Li R, Fletcher SW. Informed decision making before initiating screening mammography: does it occur and does it make a difference?.Health Expectations 2008; 11(4): 366-375.
- Solmi F, Von Wagner C, Kobayashi LC, Raine R, Wardle J, Morris S. Decomposing socio-economic inequality in colorectal cancer screening uptake in England. Sociel Science&Medicine 2015; 134: 76-86.
- Hoffman RM, Elmore JG, Fairfield KM, Gerstein BS, Levin CA, Pignone MP. Lack of shared decision making in cancer screening discussions: results from a national survey. American journal of preventive medicine 2014; 47(3): 251-259.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Original Article |
| Authors | |
| Early Pub Date | December 29, 2023 |
| Publication Date | December 31, 2023 |
| Submission Date | March 30, 2023 |
| Published in Issue | Year 2023 Volume: 33 Issue: 6 |
Journal of General Medicine is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY NC).