Why Most Australians Consider It Valuable to Find Harmless Abnormalities with Diagnostic Tests: A Mixed-Methods Study

BackgroundIndividuals commonly want diagnostic testing even after being informed the test is clinically unbeneficial and has risks. These preferences are poorly understood but may relate to beliefs that any testing information is valuable. To explore this, we examined Australian adults' attitudes toward finding harmless abnormalities using diagnostic tests and the broader beliefs related to these attitudes.MethodsData collected via survey were analyzed using mixed methods. Free text explaining attitudes to finding harmless abnormalities were analyzed using comparative content and interpretative analyses. Associations between attitudes to finding harmless abnormalities and broader beliefs and demographics were analyzed using regression.ResultsAlmost three-fifths of 655 participants considered it valuable to identify harmless abnormalities using tests. Qualitative analyses showed this attitude was driven by beliefs that identification would provide psychological reassurance, valuable biodata, and enable monitoring and management of the harmless abnormalities. These beliefs were underpinned by a skepticism that abnormalities can ever be harmless and by a range of beliefs about the broader value of diagnostic testing. Participants with negative attitudes to identifying harmless abnormalities were concerned about resultant anxiety and unnecessary health interventions. Regression showed that positive attitudes to identifying harmless abnormalities were associated with greater confidence in doctors, lesser concerns about overtreatment, and a stronger desire to know as much about their bodies as possible as well as with several demographic variables.Conclusions and ImplicationsOur study explores why people seek diagnostic tests that they know lack obvious clinical benefits. It identifies broader beliefs and psychological factors that profoundly influence testing choices. This knowledge will help overcome the limitations of existing strategies to explain the risks of tests to patients and the public.HighlightsFindings help explain why facts showing that particular diagnostic tests are ineffective or harmful fail to dissuade many Australians from seeking those tests.Many Australians value diagnostic testing for perceived reassurance, understanding one's body, and use in medical decision making.Many are skeptical that identifying incidentalomas is harmful, and are confident they can avoid unnecessarily treating them.Messages about testing risks should focus on broader beliefs and respond to psychological factors that undermine the effect of risk/benefit information.