Results Summary

PCORI funded the Pilot Projects to explore how to conduct and use patient-centered outcomes research in ways that can better serve patients and the healthcare community. Learn more.

Background

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.

Project Purpose

The study had two goals. The researchers wanted to

  • Learn what adults in the United States knew about the USPSTF and how they felt about the changes USPSTF made to grades for certain cancer screenings
  • Develop and test new ways of explaining USPSTF recommendations for two different cancer screening tests

Methods

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:

  • Harms resulting from patients not following the recommendation
  • Benefits resulting from patients following the recommendation
  • Both benefits and harms resulting from following or not following the recommendation

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.

Findings

In the first part of the study, the team found that

  • A little more than a third  of adults knew that health insurance plans were required by law to pay the whole cost for care rated with an A or B grade.
  • Fewer than 1 in 10 people had heard of the USPSTF.
  • One third of people said that they trusted a task force like the USPSTF to make fair recommendations.
  • Almost 4 in 10 people thought that the government used recommendations about preventive care to limit health care.
  • Most people thought that recommendations should be based on research evidence and that doctors should follow those recommendations.
  • Less than 1 in 10 people thought that the recommendation alone was enough for a patient to decide whether to get care.

In the second part of the study, the researchers found that

  • People who liked the message they saw about cancer screening were more likely to say they would look for more information about cancer or talk to their doctor about the screening than people who did not think the messages were important.
  • People who saw messages that talked about harms resulting from not following a recommendation were more likely to say they would talk to friends and family about cancer screening tests or look for more information.

Limitations

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.

Conclusions

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.

Sharing the Results

The researchers published articles about the study in academic journals and gave presentations on the findings to organizations.

Project Information

Paula Lantz, PhD, MS, MA
The George Washington University
$568,153
Strategies for Assisting Patient Decisions Regarding Controversial Evidence-Based Guidelines for Clinical Preventive Services

Key Dates

June 2012
December 2014
2012
2014

Study Registration Information

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Has Results
Award Type
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State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: March 4, 2022