Joshua Fenton, a UC Davis professor of family and community medicine, has received a $1.4 million, four-year grant from the U.S. Department of Health and Human Services (HHS) to test an approach to helping low-back pain patients understand when they do not need imaging tests that increase radiation exposure and provide no clinical benefit.

Joshua Fenton Joshua Fenton

Spinal imaging is commonly ordered during doctors’ office visits for acute low-back pain, even though it is only recommended for patients with symptoms of neurologic deficits or other conditions requiring prompt evaluation. Otherwise, watchful waiting is advised. Given the high costs of low-back pain care ― which exceed $100 billion per year in the U.S. ― assuring that all diagnostics are necessary and useful in patient care has become a national priority.

Imaging requests often come directly from patients, with doctors giving in to maintain patient trust, according to Fenton.

“We want to give physicians strategies for communicating with patients about their symptoms and then doing what is needed ― no more, no less ― to diagnose and treat them safely and effectively,” Fenton said.

The strategies will first be tested with focus groups of primary care providers, and then in a randomized trial with primary care providers and actors portraying patients with low-back pain. The goals are to see if they build skills in encouraging acceptance of a watchful waiting approach for low-back pain and reduce imaging rates among real patients.

“The long-term goal is to give primary care physicians skills they can use to avoid costly and potentially harmful testing while preserving the doctor-patient relationship,” Fenton said.

The study is funded by HHS’s Agency for Healthcare Research and Quality (grant 1R18HS026415-01) and coordinated by the UC Davis Center for Healthcare Policy and Research.

More information about UC Davis Health, including its Department of Family and Community Medicine and Center for Healthcare Policy and Research, is at health.ucdavis.edu.

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Study to test a new way of talking with patients about low-back pain imaging

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