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Yanovsky RL, Mostaghimi A, Buzney E, Watson A. Patient Ability to Interpret Dermatopathology Reports in an Academic Dermatology Practice. JAMA Dermatol. 2020;156(3):341–342. doi:10.1001/jamadermatol.2019.4195
The health care transparency movement has demonstrated that direct access to physician notes can increase patient engagement and understanding of their medical conditions, but, to our knowledge, its association with dermatology practice has not been examined.1-3 Potential concerns include patients’ ability to understand specialized vocabulary and the association with administrative burden.4
Brigham and Women’s Hospital in Boston, Massachusetts, has a patient portal that allows secure messaging between patients and physicians, as well as the sharing of laboratory, radiology, and pathology results. Finalized pathology reports are automatically made available to the physician and 3 days later to the patient via an online portal. In this study, we tested patients’ ability to interpret a dermatopathology report.
An anonymous survey (eFigure in the Supplement) was offered to all patients presenting to 4 physicians at a dermatology clinic at Brigham and Women’s Hospital over 6 days in April 2019. Patients were asked demographics, attitudes about technology, and to interpret a deidentified pathology report with a clinical concern for nodular melanoma but a pathologic diagnosis of ulcerated capillary hemangioma.
Data were collected and analyzed in Microsoft Excel. This study was granted institutional review board exemption from Partner Healthcare and consent was waived for being a quality improvement initiative.
A total of 225 patients (65.2%) of a maximum 345 seen over the 6 April days completed the survey. Most participants were highly educated (189 [84%] had gone to college or above) and 158 (70%) used the patient portal on an at least monthly basis. Participants generally rated themselves as confident in their technology and health literacy and did not think that looking at their health information online would be confusing (Table 1).
Twenty-seven of 225 patients (12%) circled the correct diagnosis, 79 (35.1%) circled the incorrect diagnosis, and 92 (47.6%) did not circle any diagnosis. Despite these errors, 125 of 203 (61.6%) felt that the report was somewhat easy or very easy to understand. Although the pathologic diagnosis was benign, 170 of 184 (92.4%) were somewhat or very worried after reading the pathology report. Only 14 of 184 respondents (7.6%) felt somewhat or very reassured by the result, including false reassurance for 4 individuals who incorrectly interpreted the result as malignant nodular melanoma (Table 2).
In this study of a highly educated, technologically literate population, few patients (12%) were able to correctly identify the diagnosis from a dermatopathology report. The perception of whether the report was easy or difficult to understand was not associated with the ability to identify the correct diagnosis. Those answering correctly were largely unclear as to the implications of the diagnosis.
Our study has several limitations. Many patients did not circle a presumptive diagnosis; we do not know if this is because they misinterpreted the question or simply did not know which answer to circle. We showed all respondents a single pathology form but believed that the scenario of clinical concern for malignancy with benign pathology finding was a common one that had previously caused patient misunderstanding in our clinic. Other institutions may use different form layouts that may be easier to interpret. Finally, the pathology form was interpreted by respondents without the context of a connected clinical visit.
While transparency is a worthy goal, it cannot be realized by simply sharing health information without offering context. Efforts should be made to redesign pathology reports to be easier for patients to interpret; for example, they could include autogenerated definitions, bold titles, and clearer lay language. Without such changes, providing patients access to interprofessional communications may lead to confusion, heightened anxiety, and an increased administrative burden. We hope this study inspires conversation regarding thoughtful ways to provide transparency to patients desiring accessibility to their health data while avoiding unintended consequences.
Corresponding Author: Alice Watson, MD, MPH, Department of Dermatology, Brigham and Women’s Hospital, 221 Longwood Ave, Boston, MA 02115 (email@example.com).
Published Online: January 29, 2020. doi:10.1001/jamadermatol.2019.4195
Author Contributions: Dr Watson had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: All authors.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Yanovsky, Buzney, Watson.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Yanovsky.
Administrative, technical, or material support: Mostaghimi.
Supervision: Mostaghimi, Buzney, Watson.
Conflict of Interest Disclosures: Dr Mostaghimi reported personal fees from Pfizer, hims, and 3derm outside the submitted work. No other disclosures were reported.
Disclaimer: Dr Mostaghimi is Associate Editor of JAMA Dermatology but was not involved in any of the decisions regarding review of the manuscript or its acceptance.