Sepember 25, 2013

Boston, Massachusetts - Medical tests with greater morbidity are less likely to be completed by patients, and this lack of health maintenance adherence has implications for future health outcomes. Knowing how medical tests may differ in their temporary changes to a patient’s quality of life can help doctors, clinicians and institutions better understand the patient experience and improve upon it. Such knowledge also gives patients actual data about medical testing rather than hearsay. Researchers at Massachusetts General Hospital have been working on making such information available.

In the article, “Responsiveness of the Testing Morbidities Index in Colonoscopy,” published in Value in Health, a new survey instrument called the Testing Morbidities Index (TMI) was used in patients undergoing screening colonoscopy. The study focused on responsiveness - thus the sensitivity of the TMI to detect change in quality of life caused by the testing experience. The authors found that the TMI, a brief 7 question survey, was much more responsive to change than two standard instruments, the EQ-5D-5L and the SF-6D; they showed no responsiveness or minimal responsiveness, respectively. The TMI survey asks patients about emotional and physical discomforts that occur before, during and after a testing procedure. The results showed that essentially all of the morbidity of colonoscopy occurs before the actual procedure. Patients can have substantial anxiety before colonoscopy and the bowel preparation is very uncomfortable for some. Morbidity during and after the procedure, however, is relatively minimal.

"Our results are not a surprise to clinicians and experienced patients, but they would likely be of interest to inexperienced patients who are scared to have the test," said the lead author on the study, Dr. J. Shannon Swan, MD, an Associate Professor at Harvard Medical School and a Senior Scientist at the MGH Institute for Technology Assessment. He adds, "More importantly, the TMI allows us to compare tests to one another. When we developed the TMI, we first tested it in breast biopsy, which we find has a different morbidity profile than colonoscopy." Lastly, Dr. Swan notes that for the future, the TMI results can be presented in various ways: "We can look at the morbidity in individual survey items, and can also combine the items so they can be used for various purposes. We are now implementing a TMI version that can provide results applicable to cost-effectiveness analysis."


Read this article online.

Evan Godt - Health Imaging

Jun 06, 2013

Radiologists who have access to patient exposure histories will make recommendations for future imaging that take into account previously incurred imaging risks, even though models of radiation exposure and cancer risk indicate previous imaging should not affect decision making, according to a study published in the June issue of the American Journal of Roentgenology .

"Our findings raise concern that many radiologists have a limited understanding of how to address patient exposure histories when making prospective imaging decisions and underscore the need for related educational interventions," wrote Pari V. Pandharipande, MD, MPH, of Massachusetts General Hospital in Boston, and colleagues.

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Study suggests low-risk patients can forego immediate treatment

June 17, 2013
Julia Hayes, MD

Many men with low-risk, localized prostate cancers can safely choose active surveillance or “watchful waiting” instead of undergoing immediate treatment and have better quality of life while reducing health care costs, according to a study by researchers at Dana-Farber Cancer Institute and Massachusetts General Hospital.

Writing in the June 18 issue of the Annals of Internal Medicine, the authors said their statistical models showed that “observation is a reasonable and, in some situations, cost-saving alternative to initial treatment” for the estimated 70 percent of men whose cancer is classified as low-risk at diagnosis.

The researchers, led by Julia Hayes, MD, a medical oncologist in the Lank Center for Genitourinary Oncology at Dana-Farber, said their findings support observation - active surveillance and watchful waiting - as a reasonable and underused option for men with low-risk disease.

Scott Gazelle was recently one of six MGH radiologists inducted as a fellow in the American College of Radiology (ACR). Only 10% of the College's 34,000 members achieve this distinction.