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The United States Preventive Services Task Force (USPSTF) is a group of medical experts that helps decide if certain types of health care help prevent disease. This type of care is called preventive care. Many consumers are not familiar with how the USPSTF makes its recommendations. The USPSTF gives letter grades based on the evidence for both the benefits and harms of a screening test or treatment. For example, a screening test that reliably finds disease might get an A grade and be recommended for a large population. A test that is less reliable might get a C grade. By law, health insurance plans must pay the entire cost of preventive care if the USPSTF gives it an A or B grade. For care that receives a lower grade, insurance companies can choose to pay some or none of the cost.
Lack of patient understanding of USPSTF recommendations and how they were created can lead to under- and overuse of preventive care.
The study had two goals. The researchers wanted to
First, using an online survey, the researchers surveyed 2,529 adults in the United States on their understanding and feelings about preventive care, the USPSTF, and its recommendations.
Second, based on the findings from the survey, the researchers wrote messages explaining the USPSTF recommendations regarding prostate and cervical cancer screening. For each screening, the team developed three messages that focused on the following:
Then, the research team surveyed 2,321 people, randomly giving each person one of the messages and asking questions about their reactions to the message. The researchers sent messages about prostate cancer screening to men and messages about cervical cancer screening to women. The researchers sent the survey in English or Spanish to people from different backgrounds who were old enough to want or need the screenings. The researchers sent the survey to the same people eight weeks later, and 1,730 people completed the survey. The researchers looked at the responses from both surveys to see if people had a positive response to the messages and to see if the messages made them want to follow the USPSTF screening recommendations.
In the first part of the study, the team found that
In the second part of the study, the researchers found that
The survey only showed what people said they would do in the future about getting preventive care. The researchers don’t know if people will actually do what they said they would.
The researchers learned that most people don’t know very much about the USPSTF or their recommendations about preventive care. The researchers also learned that people want medical advice based on research evidence.
The researchers also learned that the focus of a message about a recommendation may make a difference in whether or not patients plan to look for more information about it and whether people discuss the recommendation with their doctors or with family or friends.
The researchers published articles about the study in academic journals and gave presentations on the findings to organizations.
The Patient Protection and Affordable Care Act includes key provisions that attempt to increase the use of clinical preventive services, including a provision that most health insurance plans must provide first dollar coverage for specified preventive services, including those that receive an A or B rating from the US Preventive Services Task Force (USPSTF). Uncertainty and confusion among patients regarding guideline recommendations and the process used to create them is related to both over- and underuse of clinical preventive services. Thus, patient-centered, informed preventive care requires an understanding of the purpose, process, and results of evidence-based guidelines and how to interpret and use them for personal care decisions.
With input and guidance from a patient-centric advisory board, the following were the primary aims of this research project:
Aim 1 employed a population-based online cross-sectional survey. Aim 2 was an experiment that involved random assignment to gender-specific communication messages/frames regarding a cancer screening test (PSA or Pap test), with an eight-week follow-up survey in a population-based online sample.
Primary data were collected through two separate surveys that were developed and implemented in nationally representative samples of adults through KnowledgePanel®, a probability-based survey panel of approximately 60,000 adults, statistically representative of the US noninstitutionalized population. African Americans, Hispanics, and adults with less than a high school education were oversampled in each survey. Surveys were offered in English and Spanish.
For both study aims, the survey data were weighted to take into account the sampling strategy. Statistical analyses were conducted using regression techniques.
All information is self-reported. Reports of future behavioral intentions may not be accurate.
This study contributes to evidence on how best to inform and engage consumers regarding guidelines that recommend reduced use of screening tests compared to previous guidelines.