Patient access to preliminary imaging reports decreases anxiety

Patients want rapid access to the results of preliminary readings, which helps avoid frustration due to long response times and cryptic reports.

Eleven patients recently made their dissatisfaction with outpatient imaging services known during focus group sessions designed to measure their attitudes. The subjects, all of whom had received at least one MRI, were assigned to one of two groups based on whether their scan had been normal or they'd had at least one abnormal MR finding.

The distinction, however, made no difference in their responses. Patients in both groups told an experienced focus group facilitator they experienced high levels of stress while waiting for their results. Delays ranged from days to weeks. One patient never received the results.

Healthcare consumers typically never see or speak to a radiologist when they receive prescribed imaging, explained Dr. Annette Johnson, lead author of the study appearing in the November issue of the Journal of the American College of Radiology (2009;6[11]:786-794).

"Patients in our study aren't happy with that system," she said. "They want their results quickly, in writing, and they want detailed information about the test results in language they can understand."

A solution to the problem comes from Metro Imaging, which owns and operates five imaging centers in St. Louis. The firm developed OnSite Results cards in 2007 to make sure patient preferences were disclosed and addressed as they wished. Patients fill out the cards before their imaging session to specify if they want to receive a copy of preliminary results from their studies. It also informs them the final reading will go to their physician, who will be available for consultation.

The program has worked well, according to Metro Imaging CEO Dr. Harley Hammerman.

"In the satisfaction surveys they tell us they love it. Anecdotally they give us all kinds of reasons," he said.

Internet communications could also be used to quickly transmit results to patients, said Johnson, an associate professor of radiology at Wake Forest University in Winston Salem, NC. An online approach has several theoretical advantages. It could help prepare patients for their next physician visit. It could teach them about their disease or condition, minimize delays for the next steps in their care, and facilitate their success in seeking social support, she said.

An online system could be structured to enable the patient to disclose whether they want access to their imaging results, Johnson said.

"We wouldn't want someone to log into the system to schedule an appointment, for instance, and inadvertently find out—perhaps all alone at home—the MRI they went for a week ago came back showing a tumor," she said.

Legally, the patient has a right to his or her test results, but the question is how much detail should be given, Hammerman said.

"I want to give patients the whole kit and caboodle, in terms of the report, to the extent they can understand it," he said. "If the patient is given a report that's meant for the referring physician, they won't understand the terminology and I'm not sure that's necessarily doing them any good. It's not that I think anything should be hidden from them, but it needs to be given to them in terms they can understand."

It's tempting to offer a quick fix—online access for instance—but careful and thoughtful planning is needed, Johnson said.

Many caregivers and some of the patients in Johnson's study were concerned some patients either may not understand reports or may become very upset by reports they read on their own.

"Increased patient access to test results will probably be a good thing, but how best to achieve this type of access without worsening patient anxiety is something that I think requires further study," she said.