Watchful waiting strategy may reduce low-value diagnostic testing

Background: pcps need effective communication strategies to address patient requests for low-value testing while sustaining patient-provider partnerships. watchful waiting - allowing a negotiated period of time to pass before making a firm testing decision - shows promise as a tool for addressing patient requests for low-value testing. methods: observational analysis of data from a randomized controlled trial of a communication intervention designed to boost patient-centeredness and reduce low-value test ordering among 61 resident primary care physicians. intervention effectiveness was assessed during follow-up encounters of unannounced standardized patients (sps) who requested low-value tests. we examined associations between five physician counseling behaviors and overall patient-centeredness (measure of patient-centered communication) and requested test ordering. results: during 155 sp encounters,residents most commonly used reassurance (96% of encounters),evidence-based recommendations (97%),and watchful waiting (68 %). resident advice to pursue watchful waiting was associated with 39% lower likelihood of test ordering (adjusted marginal effect of -38.6% [95% ci -43.6 to -33.6]). when all communication behaviors were examined together,only watchful waiting was significantly associated with test ordering (marginal effect of -38% [95% ci -44.3% to -31.7%]). overall patient-centeredness was not associated with lowvalue testing. conclusion: resident physician counseling to pursue watchful waiting was associated with less ordering of requested low-value diagnostic tests,while overall patient-centeredness was not.