Patient Communications: Accessing, Delivering, and Explaining Test Results

By Nancy Wurtzel

Patients say one of the most difficult aspects of receiving treatment is waiting for test results.  Until 2014, health care providers were firmly in control of when and how to deliver lab and other testing outcomes.  Patients were forced to wait for their provider, and this period of days or weeks could be filled with anxiety and even fear.

Clamoring for change, patient advocates pushed for new federal HIPPA regulations, which were enacted three years ago.

The change meant patients could obtain testing results via phone, electronic medical record or by mail.  However, access has proved to be complicated.  Results are readily available, but they are often presented without the benefit of explanation or context, sometimes resulting in misunderstanding or only partial comprehension.

“Without context, the testing (labs, imaging) are no longer accurately aimed like a bullet, but becomes instead a shotgun blast, a scattered approach,” wrote general surgeon Kathryn A. Hughes, MD, in an article published on KevinMD.com. “The patient needs the time and space, and our interest and attention, to understand this context,” she added.

Dr. Jason Poston, an associate fellow at the Bucksbaum Institute for Clinical Excellence at the University of Chicago Medical Center, also has mixed feelings about direct access.

“It’s empowering for patients,” Dr. Poston said in an article written by Jan Hoffman for the Well section of The New York Times. “But anything abnormal shows up red and bold. Some of those results may be due to chance. Some of them are not suggestive that you have a disease. So you run the risk of anxiety either with too little or delayed information, or with free access to all the information, because it can overwhelm you.”

Even so most view the regulation change as necessary transparency, and a win for the patient’s ability to take charge of their health.

A 2016 survey published in PLOS ONE revealed that up to 80% of patient who used electronic portals, viewed their personal test results during previous year.

The study authors wrote:

“Of survey respondents, 82.7% noted test results to be a very useful feature and 70% agreed that patient portal has made their provider more accessible to them. Interviewed patients reported feeling they should have direct access to test results and identified the ability to monitor results over time and prepare prior to communicating with a provider as benefits. In interviews, both patients and physicians reported instances of test results leading to unnecessary patient anxiety.”

Common ground and common sense is that patient access to test results doesn’t have to be all or nothing.  Health care professionals can and should give options on which outcomes patients want to access directly, and which they prefer to receive from a professional.

Preferences will vary from patient-to-patient and also with the type of testing.  For instance, many patients will opt to learn their results of routine screenings directly from a lab.  However, when it comes to complex or sensitive results, they are more likely to want to have them delivered by their physician or another care provider.

According to an article published in the BMJ, an international peer-reviewed journal, “Although patients may discuss test results with family and friends or seek information on the internet, the responsibility for explaining test results lies with clinicians.”

With this in mind, providers are encouraged to deliver results in a timely manner and as the patient desires.  The one-size-fits-all approach never was never practical, and patients will push back if providers attempt to lump everyone together.

Here are seven suggestions for providers:  

1. Prior to testing, inform the patient how long it will take to have the results analyzed. Remember, patients say waiting is difficult.
2. Ask the patient to bring a family member or friend and encourage someone to take notes.
3. Briefly review why you had ordered the test and what the test can reveal.
4. Summarize the findings. The patient is searching for clarity,
5. Speak in layperson’s language, rather than medical terminology.
6. Don’t assume the patient understands. What sounds clear to you may not be to someone who has no healthcare training.  An example is ‘positive’ and ‘negative’ which can have different meanings depending upon what is being analyzed.
7. Before you move on, ask the patient, ‘Can you tell me your understanding of the test results?’ Depending on the answer, you may need to clarify further.