Drivers of unnecessary diagnostic imaging for uncomplicated low back pain among family physicians: a theory-informed qualitative study.

BACKGROUND

Most major society guidelines recommend against diagnostic imaging for uncomplicated low back pain (LBP), referring to LBP that is not accompanied by symptoms that suggest a serious diagnosis, as it does not benefit patients. Despite this, diagnostic imaging for uncomplicated LBP remains common and contributes to overdiagnosis, overtreatment, and increased healthcare costs.

AIM: The purpose of this qualitative study was to use a framework to rigorously understand the factors influencing family physicians' decisions to order diagnostic imaging for uncomplicated LBP in our context.

DESIGN AND

SETTING

This qualitative study used the Theoretical Domains Framework (TDF) to design and analyze semi-structured interviews with family physicians in Alberta, Canada, to examine drivers of diagnostic imaging for uncomplicated LBP.

METHODS

Family physicians in Alberta were recruited to participate in semi-structured, one-on-one interviews through a provincial physician newsletter. After deductive coding, the study team generated belief statements for each section of coded text and inductive themes that described each group of belief statements were written. We identified the themes expected to be important barriers or facilitators to ordering imaging for uncomplicated LBP using predefined criteria.

RESULTS

Data saturation occurred after 13 interviews. There were five key themes related to unnecessary imaging for uncomplicated LBP: Beliefs about consequences, Skills, Environmental context and resources, Social influences, and Reinforcement. Participants used diagnostic imaging to reassure themselves that they had not missed an important diagnosis. Though participants considered the need to maintain the therapeutic relationship with their patients, most felt that this could be achieved without unnecessary diagnostic imaging.

CONCLUSIONS

Interventions to reduce unnecessary diagnostic imaging in uncomplicated LBP should address physicians' fears of missing serious diagnosis rather than only providing recommendations.