OBJECTIVES:To evaluate the effects of diagnostic labels and management benefit-to-harms information for low-risk prostate pathology. METHODS:Two factorial (3x2) online hypothetical experiments randomised participants 11:1 to three labels: "low-risk prostate cancer, Gleason Group 1", "low-risk prostate neoplasm", or "low-risk prostate lesion", with second randomisation 1:1 to high or low information on management options. Participants were Australians aged ≥50 years with a prostate (males) or with a male partner aged ≥50 years (females). The primary outcome was preference for management with curative-intent (prostatectomy; radiation therapy) or conservative management (PSA monitoring; active surveillance). RESULTS:For 1340 males and 1435 females randomised April to June 2024, 50% vs 34% preferred PSA monitoring, 37% vs 46% active surveillance, 7% vs 11% prostatectomy, and 7% vs 8% radiotherapy. The "neoplasm" label reduced preference for curative-intent treatment in both males (low information Risk Difference (RD)-3.9%[95% CI:-10.5%,2.7%], high information RD: -5.2%[95% CI:-10.6%,0.2%]) and females (low information RD:-6.6% [95% CI:-14.3%,1.1%], high information RD: -2.3%[95%CI:-8.9%,4.3%]). The "lesion" label reduced preference for curative-intent treatment in females within low information groups (RD:-11.6%[95%CI:-18.9%,-4.3%]) but had minimal effect in males and in females within high information groups. High information reduced preference for curative-intent treatment within "cancer" label in both studies (males RD:-4.0%[95% CI:-10.5%,2.5%]; females RD:-10.3%[95%CI:-17.7%,-2.9%]). The combination of "neoplasm" and high information resulted in the largest effects (males RD:-9.2%[95%CI:-15.1%,-3.3%]; females RD:-12.6% [95% CI: -19.9%, -5.2%]). CONCLUSIONS:Clear communication about management benefit-to-harms, and using "neoplasm" to describe low-risk prostate pathology may support conservative management choices and mitigate overtreatment. TRIAL REGISTRATION:ANZCTR 386701;386889.

Communicating the harms associated with participation in national screening programmes is not a straightforward process. In a previous study, we interviewed Danish women in the age group 23-55 and found that they tended to reject or downplay the harms presented in an information pamphlet related to cervical cancer screening. This phenomenon we termed the 'Perception Gap'. In this article, we revisit the original data and draw on theoretical frameworks of governmentality and risk to elucidate the dynamics behind this perception gap. We found that the information material, itself, has minimal influence on how individuals understand and give meaning to the benefits and harms of screening. Instead, culturally and socially constructed logics of cancer and screening were essential to the women's meaning-making of cancer screening. We argue that the perception gap emerges from governmental power, as participants were not passively governed, but internalised prevailing norms and aligned their attitudes with socially constructed expectations that position screening participation as the only responsible way to manage health. This leaves little room for individuals to pursue individual preferences that conflict with this collectively constructed notion. We found that non-participation itself was constructed as implying that the individual bears responsibility for potential burdens such as later development of cancer. We argue that the collectively constructed concepts of cancer and screening identified in this article, as well as how they are used in governance, need to be addressed and critically challenged before harms of screening can be effectively communicated and meaningfully incorporated into decision-making.

AIMS:To critically synthesize the evidence of lung cancer screening on lung cancer mortality, adverse effects, cost-effectiveness, and practical implementation, with a focus on the rationale and implications of introducing lung cancer screening in the Nordic countries. METHODS:We reviewed existing literature on lung cancer screening, primarily drawing on Cochrane reviews, to examine mortality outcomes, adverse effects, cost-effectiveness, and implementation challenges of lung cancer screening. RESULTS:Chest X-ray lung cancer screening has not been shown to reduce lung cancer mortality, whereas low-dose computed tomography (LDCT) screening has demonstrated a statistically significant reduction in lung cancer mortality in a high-risk population. For all-cause mortality, meta-analyses have shown mixed results depending on which trials are included and the methods used, albeit none of the European trials have revealed a reduction in all-cause mortality. Limited high-quality evidence on the unintended harms of LDCT screening exists but suggests that LDCT screening might cause considerable unintended harm, especially via false positives, incidentalomas, and overdiagnosis. Cost-effectiveness analyses on LDCT screening frequently fail to account for indirect costs, which might lead to an underestimation of the true economic burden of screening. Implementation of LDCT screening presents practical challenges, including reaching the target population and the limited capacity in the healthcare system. CONCLUSIONS:There is evidence of reduction in lung cancer mortality in a high-risk population screened with LDCT. However, further evaluation is needed to assess the potential unintended harms, the practical implementation within the Nordic healthcare systems, and the environmental impact, including increased CO2 emissions.

PURPOSE:Severe mental illness (SMI) accounts for over a third of all mental disorders globally, significantly reducing life expectancy and quality of life. Trends in SMI vary, with recent Danish studies reporting both stable and rising rates in the 2000s. This study examines the prevalence (1996-2018) and incidence (2000-2018) of SMI in Denmark, analyzing age- and sex-specific trends using nationwide health registry data. MATERIAL AND METHODS:The study included individuals aged ≥18 years with a psychiatric hospital diagnosis of SMI, recorded in the Danish National Patient Registry (1995-2018). SMI was defined as moderate to severe depression, bipolar disorder, or psychotic disorder based on ICD-10 classifications. We estimated five-year prevalence (2000-2018) and one-year incidence (1996-2018), stratified by age and sex. RESULTS:Between 2000 and 2018, the crude prevalence of depression more than doubled, while bipolar and psychotic disorders increased by 89.6% and 35.0%, respectively. All SMIs increased among individuals aged 18-29. From 1996 to 2018, depression and bipolar disorder incidence rose by 137.5% and 45.1%, respectively, while psychotic disorder incidence declined by 9.5%. The largest incidence increase occurred in the 18-29 age group. Bipolar and psychotic disorder prevalence declined in those ≥70 years. Depression was the most prevalent disorder among individuals ≥90 years. CONCLUSION:SMI prevalence and incidence in Denmark have risen over the past two decades, particularly among younger adults. However, professional, cultural, administrative, and societal factors must be considered before concluding an actual increase in SMI cases.

Background Living with severe mental illness (SMI) adversely affects quality of life (QoL). The SOFIA program, a coordinated general practice care initiative in Denmark, aimed to improve QoL and reduce mortality through extended general practitioner (GP) consultations, training for GPs and staff, and support in connecting patients with relevant health and social services.Objective To evaluate the impact of the SOFIA intervention on needs-based QoL, self-perceived inequity, and health-related QoL in people with SMI.Design and Setting Cluster-randomised, non-blinded controlled pilot trial conducted in nine Danish general practices between November 2020 and March 2021. Practices were allocated to a coordinated care program (CCP; n = 27), CCP plus a needs-based QoL tool (CCP+; n = 37), or usual care (control; n = 23).Subjects Adults with psychotic disorders, bipolar disorder, or severe depressive disorder.Main Outcome Measures Outcomes were assessed using the Multi-Morbidity Questionnaire (MMQ) and the EQ-5D-5L.Results No statistically significant differences were observed between intervention and control groups in changes in needs-based QoL. Compared with the control group, the CCP+ group showed statistically significant improvements in two self-perceived inequity domains: not being seen and heard and powerlessness. No significant differences were found for the remaining inequity domains or health-related QoL.Conclusion The findings suggest that comprehensive, coordinated GP consultations may help reduce feelings of inequity among people with SMI. Larger pragmatic randomised controlled trials with adequate power and longer follow-up are needed to determine the intervention’s effectiveness on patient-reported outcomes and long-term health.Trial registration The pilot trial protocol registration was dated 05/11/2020, and the registration number is NCT04618250.

PURPOSE:Wearable technologies are increasingly used to screen for atrial fibrillation (AF), often outside formal clinical pathways. While this holds promise for early detection, the impact on patient outcomes remains unclear. We aimed to examine the hypothesis whether intermittent and continuous AF screening using wearable-like technologies leads to overdiagnosis in asymptomatic, high-risk individuals. METHODS:This hypothesis-generating analysis draws on available RCTs screening asymptomatic, high-risk individuals for AF using wearable-like ECG technologies. It is not a systematic review, as the field remains too early-stage for formal evidence synthesis. Eligible studies included either intermittent (≥10 recordings) or continuous monitoring for ≥1 week, reflecting typical smartwatch use. Primary outcomes included AF diagnoses, anticoagulant use, and adverse events. Overdiagnosis was inferred when excess AF detection did not translate into improved clinical outcomes. Analyses used Mantel-Haenszel random-effects models. RESULTS:Continuous screening nearly tripled AF diagnoses (OR 2.84; 95% CI, 1.61-5.02) and doubled anticoagulant use compared to controls. Intermittent screening showed a non-significant 1.8-fold increase. Neither method significantly reduced adverse outcomes. A pooled analysis revealed a marginal reduction in negative events (OR 0.94, 95% CI 0.90-0.99). Overdiagnosis estimates varied by method, ranging from 8-29% based on persistent differences in cumulative incidence after the screening period has ended and 47-65% based on increased diagnoses and treatment during the screening phase that are not followed by improved patient-relevant outcomes. CONCLUSION:Wearable-enabled screening for AF in high-risk patients increases diagnosis and treatment without clear benefit in clinical outcomes. These findings support the hypothesis of overdiagnosis and findings highlight the need for cautious integration of consumer technologies into primary care. Further trials with extended follow-up in low-risk populations are needed to clarify when AF detection improves outcomes versus when it leads to unnecessary medicalisation and harm.

Overdiagnosis is a major challenge in screening, leading to healthy individuals being diagnosed and treated for conditions that would never have caused harm. While evidence on overdiagnosis is growing, little is known about how health professionals (HPs) understand and engage with this phenomenon in practice. This study examines health professionals’ awareness, understanding and approaches to overdiagnosis in breast, lung, and prostate cancer screening. This is a qualitative study with semi-structured interviews, using Positioning Theory as an analytical lens, among HPs involved in breast, prostate, or lung cancer screening in Flanders, Belgium, both in public health settings and in individual clinical care. 34 HPs, of whom 21 were purposively invited, because of their professional role, research background or public advocacy related to screening. In addition, 13 clinicians were randomly recruited from a list of registered physicians (GPs, gynaecologists, urologists and pneumologists). Few participants spontaneously mentioned overdiagnosis as a harm of screening, although most recognised it, primarily in relation to prostate cancer screening. Some HPs demonstrated a thorough understanding of overdiagnosis, but did not necessarily perceive it as a relevant harm. HPs’ perceptions and corresponding approaches depended primarily on their overall position regarding screening. The participating HPs articulated three different storylines to motivate their positions: (1) routine screening, where HPs accept screening as self-evident and are largely unaware of overdiagnosis, (2) determined screening, where HPs emphasise the evidence-based benefits of screening and acknowledge overdiagnosis, which they try to mitigate, but also de-problematise, and (3) cautious screening, where HPs question the evidence base and benefits of screening and consider overdiagnosis one of the reasons for adopting a reluctant position towards screening. Participants rarely identify overdiagnosis as a harm of screening, despite being (passively) aware of it. HPs’ broader position on screening shapes how they understand, interpret, and respond to overdiagnosis and is primarily based on their knowledge of screening benefits, and influenced by professional contexts and personal characteristics. Regardless of their level of enthusiasm for screening, HPs with a more comprehensive understanding of its benefits and harms tend to adopt more deliberate and carefully considered - albeit divergent- approaches to overdiagnosis. Not applicable.

Background:Early detection efforts in melanoma by dermatologists have led to a rising incidence of localized melanoma without a corresponding decrease in late-stage disease or mortality, raising concerns about overdiagnosis. However, little is known about dermatologists' perspectives on melanoma screening and overdiagnosis. Objectives:To explore US dermatologists' views on melanoma screening and overdiagnosis and whether information about overdiagnosis should be communicated to patients and the public. Methods:Data were collected from semistructured qualitative interviews (n = 15) of US board-certified dermatologists recruited via two email listservs (local and national). Interviews were conducted from January to April 2024. We performed a thematic analysis from qualitative interviews. Results:Dermatologists [8 woman (53%) and 7 (47%) men, all of whom were non-Hispanic (n = 15) and 10 (67%) of whom were White; mean (SD) age 43.7 (7.6) years] described the benefits of melanoma screening, including early detection, patient education and reassurance. They also reported potential psychological, physical and economic harms of melanoma screening. Many dermatologists felt that the harms of screening did not outweigh the potential benefit. They acknowledged melanoma overdiagnosis as a phenomenon but thought that it mostly happened in other clinician practices due to excessive biopsies, and that a main source of the phenomenon was pathologists who overinterpret histological slides. Dermatologists expressed uncertainty and hesitation about discussing overdiagnosis with patients and the public. Conclusions:US dermatologists recognized the benefits and harms of melanoma screening, with many believing that the potential benefits outweighed the harms. While overdiagnosis was acknowledged as a concern at the population level, most dermatologists did not perceive it as a significant issue in their own practices or view themselves as contributors to the problem. Instead, they attributed overdiagnosis primarily to pathologists' diagnostic decision-making. Furthermore, dermatologists were reluctant to discuss the potential harms of melanoma screening, including overdiagnosis, with patients or the public, especially without the backing of a professional organization. This reluctance has important implications for shared decision-making, informed consent in melanoma screening and efforts to address melanoma overdiagnosis.

MMQ1 is a Danish-language patient-reported outcome measure (PROM) for quality of life (QOL) in people with multiple long-term conditions (MLTC). It measures needs-based QOL across six scales: Physical ability, Concerns and worries, Limitations in daily life, Social life, Personal finances and Self-image. There is currently no such measure available in English. This study aimed to translate and validate MMQ1 for use in the United Kingdom. Translation used a two-panel method (expert panel: n = 5; and lay panel: n = 6). Content validity was assessed via cognitive interviews (n = 6). A postal survey of 2,753 patients with MLTC recruited through eight GP practices in Scotland included EQ-5D-5L and ICE-CAP as comparator measures alongside MMQ1. Classical test theory psychometric analysis of survey responses followed the International Society for Quality of Life Research minimum reporting standards. Translation resulted in an English-language MMQ1 with good face validity. Cognitive interviews established good content validity. 597 survey responses were received (response rate 22

Objective To explore how trainee doctors in general practice navigate patient expectations and requests for non-indicated procedures or tests, and what factors may pressure them into practising defensively.Design and setting A qualitative interview study with 13 GP trainees from the Capital Region and Region Zealand in Denmark. An interview guide was developed based on existing literature and a pilot interview with an experienced GP. Data were coded in NVivo (version 15) and analysed using thematic analysis.Results The trainees described several challenges when facing patient requests for unnecessary procedures or tests. These challenges were linked to their own uncertainty, patient expectations and behavior, as well as external factors. The trainees described experiencing self-doubt and uncertainty, particularly when their clinical judgement was questioned by patients. Managing patient expectations, especially when patients were worried, sought tangible evidence, or had private health insurance, was described as challenging. Additionally, clinical values and a stressful environment was said to further influence decision-making processes. Together, these factors sometimes pressured the trainees into adopting a more defensive approach. With more experience, many developed greater confidence and argumentation, making it easier to refuse patient requests while maintaining a good relationship.Conclusion Our study indicates that uncertainty, patient expectations, and external circumstances may, in certain situations, pressure Danish GP trainees into practising defensively. Managing and navigating both their own and the patient’s uncertainty emerges as a key challenge. Future research is needed to explore how trainees can be better supported and educated in managing uncertainty and patient expectations in general practice.

OBJECTIVE:To assess the comprehensiveness of the reporting of physical harms in colorectal cancer screening programmes (CRCSPs) in randomised controlled trials (RCTs) and systematic reviews (SRs). DESIGN:We conducted an overview of reviews, comparing the comprehensiveness of reporting of harms in SRs and RCTs with a recent SR conducted according to the PRISMA-harms extension, identifying 17 types of physical harm potentially resulting from CRCSPs. MAIN OUTCOME MEASURES:Proportion of the 17 types of physical harm reported per study (study coverage), across studies (outcome coverage) and the level of harm severity reported in RCTs and SRs. RESULTS:We identified 24 RCTs and 16 SRs investigating physical harms related to CRCSPs. The median study coverage was 4 and 3 out of the 17 types of harm, varying from 5.9-47.1% and 5.9-52.9% types of physical harm reported in RCTs and SRs, respectively. The median outcome coverage was 4 and 3 across RCTs and SRs, varying from 0-66.7% and 0-87.5% in RCTs and SRs, respectively. Of note, 4 types of harm were not reported in any of the identified SRs. Inconsistent definitions of harm in RCTs and SRs made it difficult to assess which levels of severity of harm that were reported in studies. DISCUSSION:Poor reporting of harms in RCTs was compounded in SRs. We found poor study and outcome coverage and considerable inconsistencies concerning how physical harms were defined in RCTs and SRs. The inconsistent reporting of harms may result in an underestimation of their magnitude in relation to CRCSPs, raising concerns about our current capacity to evaluate the safety of these programmes. Adequate use of existing guidelines for harm reporting in RCTs and SRs and international consensus on how best to define and measure harms in studies of CRCSPs is warranted.

Background The use of point-of-care ultrasound (POCUS) in general practice increases, but little is known about potential unintended findings and harms to patients. Information regarding such unwanted effects may be obtained by evaluating the medical records of patients who have been scanned by their general practitioner.Objective To identify and characterize re-consultations related to POCUS use in general practice, potential misdiagnosis, overdiagnosis, and incidental findings, and to compare potentially troublesome cases to GPs’ scanning competence and type of ultrasound device.Design and Setting Professors in general practice with extensive experience in both research and quality assurance in general practice did a blinded review of prospectively collected routine electronic medical record data combined with cross-sectional data collected in relation to POCUS examinations.Subjects Twenty general practitioners collected data on 564 patients examined with POCUS in primary care.Main Outcome Measures International standards for the classification of adverse events and incidental findings were used. First, research assistants identified all re-consultations described in the medical records that were related to the primary health complaint at the index consultation. Second, these re-consultations were classified by the medical experts in terms of seriousness and relation to the POCUS examination performed at the index consultation. In addition, the experts identified possible misdiagnosis, possible overdiagnosis, and incidental findings. Finally, identified cases were discussed in terms of appropriateness and described narratively.Results Medical records of 564 patients were reviewed. A low risk of possible misdiagnosis (5.3%), potential overdiagnosis (0.7%), and incidental findings (0.7%) were found. Eleven POCUS-related re-consultations were identified and described.Conclusion POCUS scanning performed by general practitioners was generally safe, but it can result in unnecessary examinations and potential harm in a few cases. Certain areas, e.g. pelvic scans that included the ovaries, may especially be prone to misdiagnosis.Trial Registration Number NCT03375333

Prevention is a fundamental aspect of the work of general practitioners (GPs) and family doctors (FDs); however, its implementation poses significant challenges due to conflicting guidelines, time constraints, competing demands, and equity concerns. This position paper proposes seven guiding principles to help GPs and FDs navigate preventive care effectively. It encourages GPs/FDs to recognise the intrinsic preventive value of high-quality general practice and adopt a critical approach to the evidence underpinning preventive recommendations. Prioritising a limited number of preventive services with a strong evidence base and targeting those patients most likely to benefit will contribute to sustainable, evidence-based, and equitable patient care.

Introduction This study aimed to either identify or develop and validate a patient-reported outcome measure (PROM) to assess treatment burden related to general practice for patients with multimorbidity, which can be used alongside the MultiMorbidity Questionnaire part 1 (MMQ1) without overwhelming the target population with redundant items.Methods We conducted a systematic literature review to identify all existing PROMs measuring treatment burden. If no suitable PROM was found, our plan was to: (1) develop a draft PROM using items from existing instruments, (2) carry out group and individual interviews with patients with multimorbidity to ensure the PROM’s understandability, clarity, completeness and relevance and (3) undertake psychometric validation with a diverse sample of primary care patients with chronic conditions.Results We did not identify an eligible PROM in the literature review. The draft PROM consisted of 30 items divided into six domains; Information about treatment, Challenges with medication, Medical appointments, Self-monitoring, Health behaviour and Challenges in the contact to the health system. In the psychometric validation, neither these domains nor any other theoretical constellation of items had adequate psychometric properties. Individual items had good criterion validity and sensitivity to change.Conclusions In this study, we developed a 30-item PROM with high content validity where various individual items showed adequate criterion validity and sensitivity to change, making these items useful as a supplemental measure to the MMQ1.Trial registration number NCT05676541 Registration Date: 16 December 2022.

BACKGROUND:The Danish Holm and Cordoba Urinary Tract Infection Score (HCUTI) assessing symptom severity, bothersomeness and impact of uncomplicated urinary tract infections (uUTIs) on daily activities in women is a promising patient-reported outcome measure (PROM) for use in future research. For potential application in Germany, the present study aimed (i) to perform translation and linguistic validation of the HCUTI, and (ii) to assess content validity of the German version of the HCUTI. METHODS:Translation and linguistic validation was performed using the dual-panel method. A bilingual panel of nonprofessional Danish-German speaking persons translated the HCUTI, and the translated version was evaluated regarding comprehensibility by a lay panel of native German-speaking women with past uUTI. Content validity of the German version of the HCUTI was assessed according to the criteria of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. In individual cognitive interviews, women with a history of uUTI and experts from different medical fields rated the instructions, items, response options and recall period of the HCUTI in terms of relevance, comprehensiveness and comprehensibility. RESULTS:Translation and linguistic validation resulted in a German version of the HCUTI which lay persons considered easy to understand. In content validity assessments, participants rated the questionnaire as generally relevant and comprehensive. One item was removed due to lack of relevance. The response options were linguistically modified, and a dichotomous scale was introduced for 10 items on symptoms. To enhance comprehensibility, eight items on symptoms and bothersomeness, and one item on daily activities were slightly reformulated. After modification, the German version of the HCUTI includes 18 items on symptoms, 18 items on bothersomeness, and six items on impact on daily activities. The study team reviewed and linguistically standardized the final version of the questionnaire to ensure consistency in wording and sentence structure across all items. CONCLUSIONS:The German version of the HCUTI is a suitable tool to assess symptoms, bothersomeness and impact of uUTIs in women. Data on psychometric properties of the instrument will be collected in a subsequent survey among women with uUTIs.

RATIONALE:Implementing palliative care for patients with cancer in the healthcare sector is a complex task. Some patients with cancer do not receive timely and comprehensive palliative care tailored to their needs, potentially reducing their quality of life. AIMS AND OBJECTIVES:The goal is to develop an Implementation Program to improve the implementation of the national guidelines for general palliative cancer care. Moreover, the study aims to evaluate the acceptability and feasibility of the implementation strategies among healthcare professionals. DESIGN:We used a participatory action research approach and the Quality Implementation Framework to guide the program. Additionally, we evaluated the acceptability and feasibility of the implementation strategies through a qualitative descriptive design. METHODS:Thirty-one healthcare professionals from oncology, municipalities, and general practice took part in developing the Implementation Program with guidance from a facilitator. We utilized data triangulation, including qualitative interviews (n = 17), observation data from in-person meetings (n = 5), virtual meetings (n = 50), and process data gathered from November 2021 to March 2023. We analyzed the data using Content Analysis methods. RESULTS:A program comprising 14 critical steps was developed. The implementation strategies were found acceptable and feasible, particularly for cross-sectoral networking and a facilitator supporting collaboration. However, Plan-Do-Study-Act cycles were considered problematic. The value of learning from experiences was recognized, and healthcare professionals appreciated the advantages of cross-sector collaboration. CONCLUSION:This study involved cross-sectoral healthcare professionals in developing the Implementation Program for general palliative cancer care. Networking is vital in this context and should be considered a stand-alone implementation strategy.

Validated patient-reported outcome measures (PROMs) are crucial for assessing patients’ experiences in the healthcare system. Both clinically and theoretically, patient-centered consultations are essential in patient-care, and are often suggested as the optimal strategy in caring for patients with multimorbidity. To either identify or develop and validate a patient-reported outcome measure (PROM) to assess patient-centredness in consultations for patients with multimorbidity in general practice. We attempted to identify an existing PROM through a systematic literature review. If a suitable PROM was not identified, we planned to (1) construct a draft PROM based on items from existing PROMs, (2) conduct group and individual interviews among members of the target population to ensure comprehensibility, comprehensiveness and relevance, and (3) perform a psychometric validation in a broad sample of patients from primary care. We did not identify an eligible PROM in the literature review. The item extraction and face validity meetings resulted in a new PROM consisting of 47 items divided into five domains: biopsychosocial perspective; `patient-as-person’; sharing power and responsibility; therapeutic alliance; and coordinated care. The interviews resulted in a number of changes to the layout and phrasing as well as the deletion of items. The PROM used in the psychometric validation consisted of 28 items. Psychometric validation showed high internal consistency, overall high reliability, and moderate fit indices in the confirmatory factor analysis for all five domains. Few items demonstrated differential item functioning concerning variables such as age, sex, and education. This study successfully developed and validated a PROM to measure patient-centredness in consultations for patients with multimorbidity. The five domains demonstrated high reliability and validity, making it a valuable tool for measuring patient-centredness of consultations in general practice. Trial registration number (data for psychometric validation): https://clinicaltrials.gov : NCT05676541 Registration Date: 2022-12-16.

Drawing on phenomenological concepts of embodiment and the theory of clinical judgment, we examine how radiologists navigate the inherent risk of overtesting and overdiagnosis in breast cancer screening. Based on 12 weeks of fieldwork at a breast radiology department, we explore how radiologists navigate clinical ambiguity when women are recalled for further diagnostics following an abnormal screening mammogram. Radiologists expressed a strong sense of ethical obligation and responsibility, shaped by the structural and moral expectations of the screening programme, which fostered a precautionary mindset. We show how radiologists draw on a combination of knowledge, experience, sensory input, and emotional reasoning to navigate these ethical responsibilities. This interplay of emotions, ethics, and diagnostic skill constitutes a form of embodied expertise, which we term the "expert eye". The expert eye enables radiologists to critically engage with guideline-based diagnostics and perform less defensive, context-sensitive practices in a high-stakes setting. Ultimately, we argue that this form of expertise plays a crucial role in bridging the epistemic gap of overdiagnosis and the fundamental inability to know about or predict the progression of ambiguous findings. Our analysis also highlights the complexity of managing overtesting and overtreatment in clinical practice and suggests that supporting subjectivity in medicine, through the use of the expert eye, may in fact allow clinicians to perform higher-value care.