Relative importance and interactions of factors influencing low-value care provision: a factorial survey experiment among Swedish primary care physicians

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cris.lastimport.scopus2025-12-16T04:19:39Z
dc.abstract.enBackground: Low-value care (LVC) describes practices that persist in healthcare, despite being ineffective, inefficient or causing harm. Several determinants for the provision of LVC have been identified, but understanding how these factors influence professionals’ decisions, individually and jointly, is a necessary next step to guide deimplementation. Methods: A factorial survey experiment was employed using vignettes that presented hypothetical medical scenarios among 593 Swedish primary care physicians. Each vignette varied systematically by factors such as patient age, patient request for the LVC, physician’s perception of this practice, practice cost to the primary care centre and time taken to deliver it. For each scenario, we measured the reported likelihood of providing the LVC. We collected information on the physician’s worry about missing a serious illness. Results: Patient requests and physicians’ positive perceptions of the practice were the factors that increased the reported likelihood of providing LVC the most (by 14 and 13 percentage points (pp), respectively). When the LVC was low in cost or not time-consuming, patient requests further boosted the likelihood of provision by 29 and 18 pp. In contrast, credible evidence against the LVC reduced the role of patient requests by 11 pp. Physicians’ fear of missing a serious illness was linked with higher reported probability of providing LVC, and the credibility of the evidence against the LVC reduced the role of this concern. Conclusions: The findings highlight that patient requests enhance the role of many determinants, while the credibility of evidence diminishes the impact of others. Overall, these findings point to the relevance of increased clinician knowledge about LVC, tools for patient communication and the use of decision support tools to reduce the uncertainty in decision-making.
dc.affiliationInstytut Psychologii
dc.contributor.authorRoczniewska, Marta
dc.contributor.authorAugustsson, Hanna
dc.contributor.authorIngvarsson, Sara
dc.contributor.authorHedberg Rundgren, Emma
dc.contributor.authorSzymański, Kamil
dc.contributor.authorvon Thiele Schwarz, Ulrica
dc.contributor.authorNilsen, Per
dc.contributor.authorHasson, Henna
dc.date.access2025-08-18
dc.date.accessioned2025-09-08T09:18:40Z
dc.date.available2025-09-08T09:18:40Z
dc.date.created2025-01-16
dc.date.issued2025-08-18
dc.description.abstract<jats:sec> <jats:title>Background</jats:title> <jats:p>Low-value care (LVC) describes practices that persist in healthcare, despite being ineffective, inefficient or causing harm. Several determinants for the provision of LVC have been identified, but understanding how these factors influence professionals’ decisions, individually and jointly, is a necessary next step to guide deimplementation.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A factorial survey experiment was employed using vignettes that presented hypothetical medical scenarios among 593 Swedish primary care physicians. Each vignette varied systematically by factors such as patient age, patient request for the LVC, physician’s perception of this practice, practice cost to the primary care centre and time taken to deliver it. For each scenario, we measured the reported likelihood of providing the LVC. We collected information on the physician’s worry about missing a serious illness.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Patient requests and physicians’ positive perceptions of the practice were the factors that increased the reported likelihood of providing LVC the most (by 14 and 13 percentage points (pp), respectively). When the LVC was low in cost or not time-consuming, patient requests further boosted the likelihood of provision by 29 and 18 pp. In contrast, credible evidence against the LVC reduced the role of patient requests by 11 pp. Physicians’ fear of missing a serious illness was linked with higher reported probability of providing LVC, and the credibility of the evidence against the LVC reduced the role of this concern.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The findings highlight that patient requests enhance the role of many determinants, while the credibility of evidence diminishes the impact of others. Overall, these findings point to the relevance of increased clinician knowledge about LVC, tools for patient communication and the use of decision support tools to reduce the uncertainty in decision-making.</jats:p> </jats:sec>
dc.description.accesstimeat_publication
dc.description.issue9
dc.description.physical570-579
dc.description.versionfinal_published
dc.description.volume34
dc.identifier.doi10.1136/bmjqs-2024-018045
dc.identifier.eissn2044-5423
dc.identifier.issn2044-5415
dc.identifier.urihttps://share.swps.edu.pl/handle/swps/1764
dc.identifier.weblinkhttps://qualitysafety.bmj.com/content/34/9/570?rss=1
dc.languageen
dc.pbn.affiliationpsychologia
dc.rightsCC-BY
dc.rights.questionYes_rights
dc.share.articleOTHER
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dc.titleRelative importance and interactions of factors influencing low-value care provision: a factorial survey experiment among Swedish primary care physicians
dc.title.journalBMJ Quality & Safety
dc.typeJournalArticle
dspace.entity.typeArticle