GPs' perspectives on diagnostic testing in children with persistent non-specific symptoms: a qualitative study

Background Diagnostic testing is prevalent among children with persistent non- specific symptoms (PNS), and both undertesting and overtesting have negative consequences for child and society. Research in adults with PNS has shown that GPs use diagnostic testing for reasons other than diagnosis, but comparable research has not, to the best of our knowledge, been conducted in children. Understanding GPs' perspectives of testing decisions in children could provide insights into mechanisms of undertesting and overtesting. Aim To investigate GPs' perspectives of conducting or refraining from diagnostic testing in children with PNS and the differences compared with their motives when treating adults. Design and setting Qualitative study using semi-structured interviews with Dutch GPs. Method We purposively sampled GPs until data saturation. Reasons for conducting or refraining from diagnostic tests were explored using two real-life cases from daily practice. Online video interviews were transcribed verbatim. Data were collected and analysed concurrently by thematic content analysis. Results Twelve GPs participated. Their decision making involved a complex trade- off among four themes: medical considerations (for example, alarm symptoms), psychosocial factors (for example, doctor- patient relationship), consultation management (for example, 'quick fix'), and efficient resource utilisation (for example, sustainability). Compared with when treating adults, GPs were more hesitant to conduct diagnostic testing in children because of their higher vulnerability to fearing invasive procedures, lower probability of organic disease, and reduced autonomy. Conclusion As in adults, GPs' decisions to conduct diagnostic tests in children were motivated by reasons beyond diagnostic uncertainty. Educational programmes, interventions, and guidelines that aim to change the testing behaviours of GPs in children with PNS should target these reasons.