Comprehensive Campaigns Needed to Dissuade Use of Low-Value Services

Presenting patients with a one-page handout of information on additional interventions and data on the low value of a service did little to dissuade patients choosing to use a low-value service.

A new study finds that simply presenting brief data on a traditional single paper handout is not enough to influence a patient’s decision to opt out of low-value services. The study, published in JAMA Internal Medicine, provides valuable insight on the need for additional interventions and supporting data to dissuade the use of low-value services.

Low-value services are those that are costly but have very low value, and where the results of such services do not justify the enormous cost contributed to healthcare overuse. This includes screening services for certain diseases provided to age groups that are not even prone to the disease.

For example, prostate cancer screening in men between ages 50 and 69 is a low-value screening, as is osteoporosis screening in low-risk women between ages 50 and 64, and colorectal cancer screening in men and women between ages 76 and 85.

Roughly $192 billion is spent annually on such services and, hence, it is critical to address this problem.

Study Process

Stacey L. Sheridan was the chief researcher for the study. With the help from fellow researchers, the study was conducted on 775 randomly selected eligible individuals between the ages 50 and 85. Information about any 1 of the 3 screening services and their visit to the clinician was collected.

The intervention arms were divided into four categories: words, numbers, numbers plus narrative, and numbers plus framed presentation. The participants were randomly assigned to each intervention format. However, the final analysis (intervention) was presented in one-page brief and provided evidence for the screening service.

The trial duration was from September 2012 to June 2014 at 2 family medicine and 2 internal medicine practices affiliated with the Duke Primary Care Research Consortium. The data was analyzed between May and September 2015.


The research was designed to primarily track the change in intention to accept screening process based on the intervention. The responses were recorded on a scale of 1 to 5. The secondary purpose of the research included understanding of general and disease-specific knowledge, perceived risk and consequences of disease, screening attitudes and perceived net benefit of screening.

From the 775 allocated interventions, 195 were words, 192 were numbers, 196 were narrative, and 192 were framed formats. Before the intervention was provided to the patients, they recorded a high level of intention to accept screening. After handing over the intervention, there was no significant change in their decision to accept screening. This means that the 1-page analysis, regardless of the format, was incapable of influencing the patient to opt out of a low-value screening.

Additional Intervention is a Necessity

Spending overly on low-value services results in physical, psychological, and financial harms, hassles and opportunity costs. Additionally, even after spending massive amounts, there is no potential benefit for the patient at the end of the medical process.

The burning question then is: How to reduce low value costs?

“Rather than simply intensifying current clinical interventions, effective approaches to reducing overuse of low-value services may need to take a comprehensive approach,” the authors wrote. “The most successful campaigns have targeted multiple levels of the public health pyramid.”

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