Assessing patient preferences for methods of disclosing skin biopsy results.
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Akhiyat S, Eleryan MG, Durrani S, Mitchell CB. Effectively Disclosing Skin Biopsy Results. JAMA Dermatol. 2017;153(2):229–231. doi:10.1001/jamadermatol.2016.4349
Optimizing physician-patient communication includes effective disclosure of skin biopsy results. It is critical to avoid poor patient rapport, increased patient anxiety, safety issues, and malpractice litigation.1,2 Patients may learn of skin biopsy results via follow-up appointments, telephone calls, voicemail messages, paper mail, or electronic medical record online portals. One study3 demonstrated a shift in the method by which patients prefer to be notified of skin biopsy results from follow-up appointments to disclosure via online portals. Our study builds upon this study by broadening participant inclusion criteria to better understand general patient preferences. We also attempt to determine whether specific factors, such as a previous history of skin biopsy tests or skin cancer, play a role in patient notification preferences.
We conducted a survey study through the general dermatology clinic at the George Washington University (GWU) Medical Faculty Associates. Every patient 18 years or older scheduled for a total body skin examination or “mole check” was consecutively recruited as they presented to clinic from January 2016 through June 2016. All participants provided verbal consent for study participation. The Figure shows the questionnaire used. Analysis was conducted by Stata advanced statistical analysis software (StataCorp LP), including odds ratios and 95% CIs for each predictor, analysis of variance tests, and χ2 tests for demographic group comparison. The GWU School of Medicine & Health Sciences institutional review board approved this study, waiving the requirement for written informed consent.
The survey yielded an estimated 85% response rate, with 204 patients out of an estimated 240 patients agreeing to participate. The population was 56.37% male and 43.63% female with no statistically significant difference, and 62.25% of participants had a college degree or higher level of education.
The highest ranked notification preferences were the online portal (59.40%) and telephone call (48.95%). About 54% of patients reported their preference would change depending on whether biopsy results were normal or abnormal (P < .001). For a normal skin biopsy result, most patients (n = 143) reported a preference for an online portal (55.20%). For abnormal results, most patients (n = 145) indicated a preference for a telephone call (69.2%).
Among participants with previous online portal experience, 52.05% indicated a preference for online portals. Of the participants who did not have experience using online portals, 61.11% indicated a preference for a telephone call; χ2 tests suggested a correlation between age and online portal experience, as well as age and online portal notification preference (P = .05).
Most participants ranked depth of information received (44.78%) and amount of time to discuss results (35.82%) as their most important factors for selecting a notification modality when receiving abnormal results. Other demographic data did not significantly influence ranking of preferred factors for being notified of abnormal results.
Patients who indicated that they preferred a quicker method of skin biopsy result notification did not differ based on history of skin biopsies or skin cancers. However, the odds of patients with online portal experience preferring a quicker method was statistically significant (Table).
Our findings support that online portals are the most preferred method of skin biopsy result disclosure among patients, particularly when results are normal. Patients reported that amount of information and time to discuss results were their most important factors for choosing a modality for receiving abnormal results. In addition, the odds of patients with online portal experience preferring a quicker notification method was significant.
There were study limitations that warrant discussion. We had a small sample size. Our location in a metropolitan area and large percentage of participants with college degrees or higher education may not be representative of other communities in the United States. We also did not collect demographic information regarding participant racial/ethnic group.
Corresponding Author: Sophia Akhiyat, BS, The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC 20052 (firstname.lastname@example.org).
Accepted for Publication: September 22, 2016.
Published Online: December 7, 2016. doi:10.1001/jamadermatol.2016.4349
Author Contributions: Dr Mitchell and Ms Akhiyat had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Akhiyat, Mitchell.
Acquisition, analysis, or interpretation of data: All Authors.
Drafting of the manuscript: Akhiyat, Eleryan, Mitchell.
Critical revision of the manuscript for important intellectual content: All Authors.
Statistical analysis: Eleryan, Durrani.
Administrative, technical, or material support: Eleryan, Mitchell.
Supervision: Akhiyat, Mitchell.
Conflict of Interest Disclosures: None reported.