Dermatopathologists’ Experience With and Perceptions of Patient Online Access to Pathologic Test Result Reports

Abstract

IMPORTANCE Many patients presently have access to their pathologic test result reports via online patient portals, yet little is known about pathologists' perspective on this topic. OBJECTIVE To examine dermatopathologists' experience and perceptions of patient online access to pathology reports. DESIGN, SETTING, AND PARTICIPANTS A survey of 160 dermatopathologists currently practicing in the United States who are board certified and/or fellowship trained in dermatopathology was conducted between July 15, 2018, and September 23, 2019. Those who reported interpreting skin biopsies of melanocytic lesions within the previous year and expected to continue interpreting them for the next 2 years were included. MAIN OUTCOMES AND MEASURES Dermatopathologists' demographic and clinical characteristics, experiences with patient online access to pathologic test result reports, potential behaviors and reactions to patient online access to those reports, and effects on patients who read their pathologic test result reports online. RESULTS Of the 160 participating dermatopathologists from the 226 eligible for participation (71% response rate), 107 were men (67%); mean (SD) age was 49 (9.7) years (range, 34-77 years). Ninety-one participants (57%) reported that patients have contacted them directly about pathologic test reports they had written. Some participants noted that they would decrease their use of abbreviations and/or specialized terminology (57 [36%]), change the way they describe lesions suspicious for cancer (29 [18%]), and need specialized training in communicating with patients (39 [24%]) if patients were reading their reports. Most respondents perceived that patient understanding would increase (97 [61%]) and the quality of patient-physician communication would increase (98 [61%]) owing to the availability of online reports. Slightly higher proportions perceived increased patient worry (114 [71%]) and confusion (116 [73%]). However, on balance, most participants (114 [71%]) agreed that making pathologic test result reports available to patients online is a good idea. CONCLUSIONS AND RELEVANCE Dermatopathologists in this survey study perceived both positive and negative consequences of patient online access to pathologic test result reports written by the respondents. Most participants believe that making pathologic test result reports available to patients online is a good idea; however, they also report concerns about patient worry and confusion increasing as a result. Further research regarding best practices and the effect on both patients and clinicians is warranted.

Does Patient Access to Clinical Notes Change Documentation?

“…As with all new technologies, changes in work practice can be more challenging to implement than the technology itself. In a recent survey, only a quarter of dermatopathologists reported that if their notes were accessible they would need specialized training in how to communicate with patients (14). Going further, we suggest that in the new era of open notes, it is imperative that all clinicians are trained in how to preserve the traditional functions of medical notes, and in maximizing the potential new benefits of this communication tool.…”

“…How do healthcare clinicians view the practice? While the majority of surveyed physicians consider open notes to be a good idea (5) there does appear to be some variation in attitudes both between medical specialties (2,(11)(12)(13)(14) and countries (14,15). Mental health clinicians, for example, including psychiatrists, in the U.S. and in Sweden appear to be more cautious [(11, 12), p. 2].…”

“…In a survey at a medical center in the U.S. Veterans Health Administration nearly one in two mental health clinicians (49% n = 98) reported that they would be "pleased" if the practice were discontinued. Some healthcare professionals report negative effects of note sharing including perceptions of heightened patient distress or worry from reading notes [(12), p. 2, (14,15)]. Finally, while around one third of surveyed clinicians report spending more time writing notes (6, 11) most do not perceive an increase in patient contact or visit times [ (5,11,12), p. 2, (14)] because of open notes.…”

Histopathologic synoptic reporting of invasive melanoma: How reliable are the data?

“…The eligibility criteria were as follows: they were currently practicing in the United States, were board‐certified and/or fellowship‐trained in dermatopathology, had interpreted melanocytic skin biopsies within the previous year, and were expected to continue interpreting melanocytic skin lesions for the next 2 years. Eligible dermatopathologists were invited to enroll and to complete an online survey of demographic and clinical practice characteristics 19 between July 2018 and September 2019; it included the question “How often do you provide a synoptic report for melanoma cases?” with possible responses of “always,” “sometimes,” and “never.”…”

Terminology for melanocytic skin lesions and the MPATH‐Dx classification schema: A survey of dermatopathologists

“…As a part of the study, participants completed an online survey as described previously. 18,19 The survey queried dermatopathologists about their demographics, training, experience, clinical practice, opinions on diverse terminology and adoption of the MPATH-Dx schema for reporting interpretations of melanocytic skin lesion cases. The survey questions pertaining to diverse terminology and adoption of the MPATH-Dx for classifying melanocytic skin lesions are available in Data S1.…”