The Spectrum of Care
As outlined in the previous sections, various factors can influence the decisions made and actions taken by you and your healthcare practitioners regarding testing. No decision can be viewed as entirely clear-cut, and the elements influencing decision-making can be seen as existing along a continuum of possibilities. Balancing these influences according to a given situation can be central to improving healthcare. The scenarios in the following table illustrate some of these factors and address just a few examples of ways that testing decisions may be considered. They are listed according to three general categories along the spectrum of care.
To read a more detailed discussion of the examples provided, click on each Scenario.
|Scenario 1: When Strong Evidence Agrees With Patient Preferences
Sometimes the scientific evidence is abundant and the answers are relatively clear as to whether a test is or is not useful and the testing protocol recommended by the medical community is consistent with a patient's needs and wishes.
|Example 1: A1c for monitoring diabetes|
|Example 2: Colon cancer screening|
|Example 3: Pap smears in women younger than 21|
|Scenario 2: When Patient Choice Outweighs Proven Advantages of Testing
These are testing situations along the spectrum of care in which patient-centered considerations may be the priority if the patient chooses, regardless of the evidence.
|Example 1: First or second trimester screening for fetal abnormalities|
|Example 2: BRCA1 and BRCA2 testing|
|Example 3: Screening for hepatitis C in baby boomers|
|Scenario 3: When Lack of Evidence or Consensus Warrants More Informed Decision-making
These are the areas along the continuum of care where the available evidence for use of a test is not clear-cut or the significance of its use is disputed or questioned. In this situation, the patient-centered view may take precedence.
|Example 1: Prostate cancer screening with PSA test|
|Example 2: Breast cancer screening with mammography|
|Example 3: High-sensitivity CRP for cardiovascular risk|