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Communicating Biopsy Results to Patients in a New Technological Era

Communicating Biopsy Results to Patients in a New Technological Era Although the landscape of communication in medicine is changing, there is no established standard for how dermatologists should communicate biopsy results to patients, a gap identified in the article by Choudhry et al.1 Uncertainty about the Health Insurance Portability and Accountability Act regulations governing what patient information can and cannot be shared through current technological modalities has further complicated this issue for dermatologists. Historically, the training of physicians has deemed face-to-face conversations as the criterion standard for breaking bad news to patients. These conversations provide an interactive forum for a physician to project empathy and to respond to the patient’s nonverbal cues. Choudhry et al report, however, that patients prioritize the rapidity of receiving test results, which has shifted their preference from face-to-face communication to telephone conversations for discussing biopsy results, even if the result is abnormal. Traditional face-to-face conversations may not always be practical because of scheduling follow-ups, length of wait time for appointments, loss of work time, and distance traveled. Telling a patient that their results are too serious to be discussed over the telephone and must be discussed in person can create a tremendous amount of fear about the potential diagnosis until the appointment. The change in patient preference parallels the change in technology as the medical world is adopting electronic health records and online patient portals. It may be time to harness these changes and evolve the physician-patient interaction to match both patient preference and technological advances. The future will likely continue the trend toward online portals. According to the article, both the younger population and patients who were more familiar with the use of online portals had an inclination toward electronic communication for normal results. Ultimately, different patients will have different communication preferences, and giving patients the choice of how to receive biopsy results is ideal. Choudhry et al 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. There are lessons we can learn from the field of mammography based on standards that they have established for communicating results. The Mammography Quality Standards Reauthorization Act formalized the standards for communicating mammography results to patients in a timely fashion,2 and it was found that patient satisfaction and timeliness of reporting results improved after implementation of this act.3 Barriers to closing this gap include inconsistent and poorly understood state and federal regulations about electronic patient-physician communication, which makes it difficult to create a universal standard for all dermatologists. The dogma of traditional teaching and the novelty of online patient portals may result in an initial resistance to adopting this method of communication on the part of physicians and patients. It may be time to adjust curriculums to include updated paradigms of breaking bad news that integrate current technology. Back to top Article Information Corresponding Author: Jennifer A. Stein, MD, PhD, The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 E 38th St, 11th Floor, New York, NY 10016 (Jennifer.Stein@nyumc.org). Published Online: April 1, 2015. doi:10.1001/jamadermatol.2015.38. Conflict of Interest Disclosures: None reported. References 1. Choudhry A, Hong J, Chong K, et al. Patients’ preferences for biopsy result notification in an era of electronic messaging methods [published online April 1, 2015]. JAMA Dermatol. doi:10.1001/jamadermatol.2014.5634.Google Scholar 2. Mammography Quality Standards Act Regulations. http://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/Regulations/ucm110906.htm. Accessed January 9, 2015. 3. Priyanath A, Feinglass J, Dolan NC, Haviley C, Venta LA. Patient satisfaction with the communication of mammographic results before and after the Mammography Quality Standards Reauthorization Act of 1998. AJR Am J Roentgenol. 2002;178(2):451-456.PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Dermatology American Medical Association

Communicating Biopsy Results to Patients in a New Technological Era

Communicating Biopsy Results to Patients in a New Technological Era

Abstract

Although the landscape of communication in medicine is changing, there is no established standard for how dermatologists should communicate biopsy results to patients, a gap identified in the article by Choudhry et al.1 Uncertainty about the Health Insurance Portability and Accountability Act regulations governing what patient information can and cannot be shared through current technological modalities has further complicated this issue for dermatologists. Historically, the training of...
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Publisher
American Medical Association
Copyright
Copyright © 2015 American Medical Association. All Rights Reserved.
ISSN
2168-6068
eISSN
2168-6084
DOI
10.1001/jamadermatol.2015.38
pmid
25831268
Publisher site
See Article on Publisher Site

Abstract

Although the landscape of communication in medicine is changing, there is no established standard for how dermatologists should communicate biopsy results to patients, a gap identified in the article by Choudhry et al.1 Uncertainty about the Health Insurance Portability and Accountability Act regulations governing what patient information can and cannot be shared through current technological modalities has further complicated this issue for dermatologists. Historically, the training of physicians has deemed face-to-face conversations as the criterion standard for breaking bad news to patients. These conversations provide an interactive forum for a physician to project empathy and to respond to the patient’s nonverbal cues. Choudhry et al report, however, that patients prioritize the rapidity of receiving test results, which has shifted their preference from face-to-face communication to telephone conversations for discussing biopsy results, even if the result is abnormal. Traditional face-to-face conversations may not always be practical because of scheduling follow-ups, length of wait time for appointments, loss of work time, and distance traveled. Telling a patient that their results are too serious to be discussed over the telephone and must be discussed in person can create a tremendous amount of fear about the potential diagnosis until the appointment. The change in patient preference parallels the change in technology as the medical world is adopting electronic health records and online patient portals. It may be time to harness these changes and evolve the physician-patient interaction to match both patient preference and technological advances. The future will likely continue the trend toward online portals. According to the article, both the younger population and patients who were more familiar with the use of online portals had an inclination toward electronic communication for normal results. Ultimately, different patients will have different communication preferences, and giving patients the choice of how to receive biopsy results is ideal. Choudhry et al 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. There are lessons we can learn from the field of mammography based on standards that they have established for communicating results. The Mammography Quality Standards Reauthorization Act formalized the standards for communicating mammography results to patients in a timely fashion,2 and it was found that patient satisfaction and timeliness of reporting results improved after implementation of this act.3 Barriers to closing this gap include inconsistent and poorly understood state and federal regulations about electronic patient-physician communication, which makes it difficult to create a universal standard for all dermatologists. The dogma of traditional teaching and the novelty of online patient portals may result in an initial resistance to adopting this method of communication on the part of physicians and patients. It may be time to adjust curriculums to include updated paradigms of breaking bad news that integrate current technology. Back to top Article Information Corresponding Author: Jennifer A. Stein, MD, PhD, The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 E 38th St, 11th Floor, New York, NY 10016 (Jennifer.Stein@nyumc.org). Published Online: April 1, 2015. doi:10.1001/jamadermatol.2015.38. Conflict of Interest Disclosures: None reported. References 1. Choudhry A, Hong J, Chong K, et al. Patients’ preferences for biopsy result notification in an era of electronic messaging methods [published online April 1, 2015]. JAMA Dermatol. doi:10.1001/jamadermatol.2014.5634.Google Scholar 2. Mammography Quality Standards Act Regulations. http://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/Regulations/ucm110906.htm. Accessed January 9, 2015. 3. Priyanath A, Feinglass J, Dolan NC, Haviley C, Venta LA. Patient satisfaction with the communication of mammographic results before and after the Mammography Quality Standards Reauthorization Act of 1998. AJR Am J Roentgenol. 2002;178(2):451-456.PubMedGoogle ScholarCrossref

Journal

JAMA DermatologyAmerican Medical Association

Published: May 1, 2015

References