Study Shows Patient Preferences for Receiving Imaging Results

Kelly Parent understands how it feels to anxiously anticipate an imaging report.  She went through the experience 15 years ago, when her daughter was diagnosed with brain cancer. “Waiting for results is awful. Getting results can be terribly frightening,” Parent said.


Her daughter, now a young adult, requires regular follow-up imaging. And although waiting for results continues to be agonizing, Parent said she does not like to access results earlier through an online patient portal, which is an option becoming more common in health care.

“I know my daughter’s MRIs will never look normal again. And for me to read that, it scares the heck out of me,” said Parent, who serves as vice president for the Patient and Family Experience at Beaumont Health System, Southfield, MI. 

Instead, Parent prefers that the referring physicians explain any changes revealed during imaging and discuss what they mean.

Parent is not alone. According to a recent Radiology study designed to gauge the effectiveness of online patient portals, most patients undergoing imaging tests for known or suspected cancer expressed similar preferences: They want the results as soon as possible, from their physician, and over the phone.

However, patients do prefer having access to immediate online results under certain circumstances. The study showed most patients would prefer immediate access to imaging results through an online portal if they otherwise were forced to wait more than 11 days to receive results over the telephone.

Although health systems might hope for a straightforward solution for releasing imaging results, the study reaffirms that the issue is complex and multi-layered. 

In fact, the Radiology study suggests the answer is, “It depends,” said Matthew S. Davenport, MD, associate professor of radiology at the University of Michigan and senior author of the study. Parent is a co-author on the study.

Questionnaire-Style Survey Effective

Using a process called “conjoint analysis,” a trained research coordinator surveyed 464 patients at four outpatient sites in the Midwest immediately after a CT, MRI or other imaging exams, and asked them to make a series of choices related to results for receiving a possible or known cancer diagnosis.

“Conjoint analysis allows us to derive implied preferences by analyzing how patients make choices,” Dr. Davenport said. “This is arguably a more accurate way of understanding someone’s point of view than simply asking, ‘How anxious would you be if we made you wait for three days?’”

Integrating the study into the clinical encounter encouraged participation, resulting in a 90.5 percent response rate and 99.5 percent completion rate.  The study showed that less than half of study participants had previous experience with an online patient portal; of those who did, 95 percent liked it. The majority of patients who have not used an online patient portal indicated an interest in future use.

Overall, patients preferred fast results over the phone, from their physician. However, for each additional day of delay, their preference decreased by 13 percent. If they had to wait more than six days to get results in the office and more than 11 days by phone, patients preferred instead to receive results immediately via an online patient portal.

When compared to receiving results in the office on day seven, patients preferred to receive the information immediately through the portal without their physician’s involvement as long as they also received a phone call within six days or an office visit within two days.

The results were somewhat surprising to Dr. Davenport, given the trend toward patient autonomy.

“My assumption was that immediate release of results would generally be favored by patients, but it turns out that is not the case,” he said. “When you release results to someone, that news may come with some degree of emotional harm.”

Mitigating that harm requires timely communication with a referring physician about what the results of their test means.

From the referring physician’s perspective, there are a number of potential downsides to releasing results to patients before a physician has reviewed them, said David Liebovitz, MD, associate professor and executive medical director for Informatics Education and Innovation at the University of Chicago.

“For one thing, the reports often are not written with a patient audience in mind,” said Dr. Liebovitz, who was not involved with the Radiology study but has published research related to online patient portals. “For most tests, there aren’t structured or standard formats that make it easy for patients to tell which parts of the report are truly relevant.”

Or, the radiologist might flag an incidental finding in the report that may concern the patient, when the referring physician would be able to explain that there was no cause for alarm. 

Another drawback: The radiologist may not have access to the patient’s history or previous test results, which could change the interpretation of the findings. Again, the referring physician could put the findings in context, said Dr. Liebovitz. For these reasons, he prefers a slight delay in the release of patient results.

Working Toward Solutions

While there is no easy solution, study authors suggest ways referring physicians, radiologists, and office staff can work together to best serve patients. To minimize emotional harm, health systems can evaluate their existing patterns, Dr. Davenport suggested. If there tends to be a considerable delay in communicating results, health systems may consider adding immediate release through a portal.
But if results are typically delivered quickly, removing any embargo might not help, and might even prove harmful. Physicians and administrators should also consider the makeup of their particular population. Unsurprisingly, the study results suggest that older patients or those with limited experience with technology were less likely to want to receive results online. Ideal procedures might vary between a practice with those types of patients and one in which younger, techsavvy patients predominate, Dr. Davenport said.
There are also hybrid approaches. Dr. Liebovitz said his office releases results automatically if the referring physician has not contacted patients within a set number of days.
“When I release results to patients, I always include an annotation on the results, explaining the implications of the findings,” he said. That addition might change a patient’s calculations and could be considered in future research.
Whatever a health care system decides, having a consistent policy — and one that is communicated clearly to patients so they can make informed decisions — is critical, Dr. Davenport said.
For instance, if an office releases results immediately, patients could turn portal alerts off until hearing from physicians.
“Then it becomes the choice of the patient,” Parent said. In his accompanying Radiology editorial, Ronald L. Arenson, MD, professor emeritus in the Department of Radiology, University of California, San Francisco, suggests another solution for releasing patient results.
“By using decision support rules or artificial intelligence techniques, cancer and perhaps a few other diagnoses or instances of findings suspicious for cancer could be embargoed while automatically releasing all other results,” Dr. Arenson wrote. “Selecting certain physicians such as oncologists for embargo could solve the problem.”
For more on communicating imaging results with patients and referring physicians, read the article, “Transparency, Communication, Key to the Radiology Report of the Future.”


For additional reading, access the Radiology study, “Optimizing Electronic Release of Imaging Results through an Online Patient Portal,” and the accompanying editorial, “Building a Better Online Portal for Patients to Obtain Radiologic Results,” by Ronald L. Arenson, MD.