Numbers, graphs and words – do we really understand the lab test results accessible via the patient portals?

Abstract

Background The heavy reliance on remote patient care (RPC) during the COVID-19 health crisis may have expedited the emergence of digital health tools that can contribute to safely and effectively moving the locus of care from the hospital to the community. Understanding how laypersons interpret the personal health information accessible to them via electronic patient records (EPRs) is crucial to healthcare planning and the design of services. Yet we still know little about how the format in which personal medical information is presented in the EPR (numerically, verbally, or graphically) affects individuals’ understanding of the information, their assessment of its gravity, and the course of action they choose in response. Methods We employed an online questionnaire to assess respondents’ reactions to 10 medical decision-making scenarios, where the same information was presented using different formats. In each scenario, respondents were presented with real (anonymized) patient lab results using either numeric expressions, graphs, or verbal expressions. Participants were asked to assess the gravity of the hypothetical patient’s condition and the course of action they would follow if they were that patient. The questionnaire was distributed to more than 300 participants, of whom 225 submitted usable responses. Results Laypersons were more likely to overestimate the gravity of the information when it was presented either numerically or graphically compared to the narrative format. High perceived gravity was most likely to produce an inclination to actively seek medical attention, even when unwarranted. “Don’t know” responses were most likely to produce an inclination to either search the Internet or wait for the doctor to call. Policy recommendations We discuss the study’s implications for the effective design of lab results in the patient portals. We suggest (1) that graphs, tables, and charts would be easier to interpret if coupled with a brief verbal explanation; (2) that highlighting an overall level of urgency may be more helpful than indicating a diversion from the norm; and (3) that statements of results should include the type of follow-up required.

Patient and Health Care Provider Perspectives on Patient Access to Test Results via Web Portals: Scoping Review

“…(5) focused on software development and implementation as well as portals developed for research purposes (one example is the study by Fraccaro et al [24]); (6) used hypothetical scenarios on simulated patients (one example is the study by Bar-Lev and Beimel [25]); and (7) were situated outside of high-resource countries (this was seen as contextually unique). We also excluded review papers and gray literature.…”

Quality of Answers of Generative Large Language Models Versus Peer Users for Interpreting Laboratory Test Results for Lay Patients: Evaluation Study

“…Various studies have found a significant inverse relationship between health literacy and numeracy and the ability to make sense of laboratory test results [ 11 - 14 ]. Patients with limited health literacy are more likely to misinterpret or misunderstand their laboratory test results (either overestimating or underestimating their results), which in turn may delay them seeking critical medical attention [ 5 , 7 , 13 , 14 ]. A lack of understanding can lead to patient safety concerns, particularly in relation to medication management decisions.…”

“…Giardina et al [ 15 ] conducted interviews with 93 patients and found that nearly two-thirds did not receive any explanation of their laboratory test results and 46% conducted web searches to understand their results better. Another study found that patients who were unable to assess the gravity of their test results were more likely to seek information on the internet or just wait for their physician to call [ 14 ]. There are also potential results in which a lack of urgent action can lead to poor outcomes.…”

Patient-centered care: achieving higher quality by designing care through the patient’s eyes

“…In 2020, the Israel Journal of Health Policy Research published seven papers [ 10 – 16 ] that related to different aspects of patient-centered care: the rights, roles, experiences, and perspectives of patients about their interactions in different health care settings. These articles underscore the difference between what clinicians think patients’ value and what they care about, reinforcing the critical importance of partnering with patients to understand their experiences of illness and what they hope for in encounters with a provider or the health care system.…”

“…Although interpersonal interactions are extremely important in providing patient-centered care, the Picker Principles also focus on making health care institutions and systems patient-centered. Bar-Lev and Beimel address one aspect of the systems approach in a paper that discusses the nature of lab test result reports that are accessible to patients via electronic patient portals [ 16 ]. They analyzed 225 patient responses to an online questionnaire and concluded that patients tended to overestimate the seriousness of the information “when it was presented either numerically or graphically compared to the narrative format.” They recommended that “graphs, tables, and charts would be easier to interpret if coupled with a brief verbal explanation; highlighting an overall level of urgency may be more helpful than indicating a diversion from the norm; and statements of results should include the type of follow-up required.”…”