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Patients prefer expediency of telephone communication to receive skin biopsy results
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Individuals awaiting skin biopsy results to rule out melanoma preferred telephone and electronic notifications to face-to-face discussions, according to study results.
“Patients value timeliness of receiving results because delays can lead to increased anxiety,” Maria L. Wei, MD, PhD, of the department of dermatology at the University of California, San Francisco, and colleagues wrote. “Current guidelines on how to break bad news to patients with cancer are surprisingly not based on any systematic studies.”
Advances in online portals have allowed patients to access test results electronically, in lieu of a face-to-face clinician visit. However, regulatory guidelines for online communication of biopsy results vary across states, according to study background.
Wei and colleagues evaluated data from 298 individuals from three melanoma clinics at the University of California, San Francisco (UCSF); University of Pennsylvania and Duke University. The mean age of the population was 54 years (range, 19-90) and 53% (n = 159) were female. A majority of the participants were white (96.3%) and had a previous history of melanoma (88.6%).
Participants ranked their preferred method of notification for biopsy results. Options included telephone discussion, online face-to-face clinician visit, online portal access, e-mail, voice message and direct-message tweet. Participants also were asked to explain their reasons for selecting specific notification modalities and to signify whether they preferred a different communication method for receiving abnormal biopsy results.
Researchers also conducted a survey of 47 physicians at the three participating centers to ascertain physician communication preferences.
A majority of the study cohort (67.1%) preferred to receive biopsy results from their physician over the telephone, whereas 19.5% preferred a clinic visit. A small percentage selected either voice message or online portal access (5.1%), e-mail (2.7%) or text message (0.3%). No participants selected direct-message tweet.
Half of the participants (51.7%) signified rapidity as the most important factor in receiving biopsy results, whereas 7.8% preferred a method that was both expedient and afforded the opportunity to ask questions.
More than half of the participants (59.5%) indicated that they would choose the same method of communication regardless of biopsy results, although 40.5% indicated they would prefer a different mode of notification in the case of abnormal results.
Researchers noted that online notification systems were more popular among participants who were younger (aged 18 to 35 years) and highly educated (college degree or higher). Participants at Duke University displayed a markedly higher (14.1%) preference for online portal notification than participants from the University of Pennsylvania (2.8%) and UCSF (1.8%).
A majority of physicians (56.5%) preferred to inform patients with positive biopsy results over the telephone. Telephone notification also was the most cited method of communication for conveying negative biopsy results (31.2%); however, in the case of benign biopsy results, participants cited voicemail as the preferred communication method.
A majority of the physicians reported they were unaware of departmental (89.4%) or university (97.9%) policies for biopsy result notification.
The researchers acknowledged the small sample size and focus on academic treatment centers may limit these data. Ethnic minorities were also underrepresented in the study sample, as nearly 100% of the participants were white and all patients were English-speaking.
“The results of our study are likely relevant to biopsies performed by other specialists,” Wei and colleagues concluded. “Patients are not often asked about their preference for test result notification. We recommend asking about patients’ notification preference by including this question on the biopsy consent form.”
Patient notification preferences have followed a general trend toward electronic communication and the option should be presented accordingly, Reshmi Madankumar, BS; Marie C. Leger, MD, PhD; and Jennifer A. Stein, MD, PhD, all of The Ronald O. Perelman department of dermatology at the New York University School of Medicine, wrote in an accompanying editorial.
“It may be time to harness these changes and evolve the physician–patient interaction to match both patient preference and technological advances,” Madankumar, Leger and Stein wrote. “The future will likely continue to trend toward online portals. …[The researchers] suggest including a question on the biopsy consent form about how patients want notification of their results, which allows communication to be tailored to the individual patient. Creating a professional standard within the field of dermatology for sharing both normal and abnormal biopsy results would help to close this gap.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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