How common are “cascades” after incidental findings? In @JAMANetworkOpen we present our survey of US generalists (n=376 completed,RR 45%). Most had experienced cascades w/ no clinically impt outcomes yet caused harms to patients and themselves. THREAD(1/9) bit.ly/33BS7WM
99% of doctors experienced cascades, most frequently including phone calls with patients, repeated tests. Most had experienced a cascade leading to an invasive test, ED visit, or hospitalization. (2/9) w/ @greyscalespaces @TomSequist @AJMainor @CHColla @ClaireLupo @ACPinternists 
Most doctors reported patient harms (incl psych, $, physical) from cascades ≥several times/year. They reported frequent harms to themselves (wasted time/effort, frustration, anxiety), especially physicians in rural settings and those reporting discomfort with uncertainty. (3/9)
Cascades often followed from imaging tests and tests for diagnostic reasons. 1/3 stemmed from tests that may have been clinically unnecessary. Most cascades caused harms, even among those with clinically meaningful outcomes. (4/9)
To mitigate cascades, physicians favored point of care solutions like evidence-based recs on radiology / lab reports, accessible guidelines, and decision aids rather than payment solutions. (5/9)
Read the thoughtful accompanying editorial by @drjohnm and @dr_dmorgan (6/9) jamanetwork.com/journals/jaman…
These findings build on our previous work on physician predictors of pursuing cascades (7/9)
And follow from our efforts to quantify cascades in Medicare claims (8/9)
Thank you to @AHRQNews for supporting this work! Cc @eliowa @budr0s @UM_VBID @EveKerrMD @RogueRad @mwfriedberg @dkorenstein @NAChristakis @zakkohane @EricTopol @sacha_bhatia @sameerdsaini @jnmafi @tomradomskimd @costsofcare @shannonbrownlee @lowninstitute (9/9)
