Is zero a good score? A qualitative study of patients' perceptions of radiology reports

This study aimed to examine the experience of patients who often attempt to understand the results of a radiologic exam without physician assistance. This experience is a common scenario that occurs when patients access radiology reports through an electronic medical record (EMR). We conducted twenty qualitative interviews with participants aged 20 to 79. Each participant was provided with an electronic copy of a coronary calcium CT scan report and asked to read it, as if it were their own. They were then asked to reflect on that experience as if they were the patient receiving the report. Additionally, they were asked to provide suggestions for improving the reporting process. The notable sample report findings included a coronary calcium score of zero with an incidental finding of pulmonary nodule. Interview transcripts were independently coded by two MD-MPH students. Directed content analysis was used to identify themes in participant responses. When presented with the sample report, eighty-five percent of the participants shared that if it were their report, they would be concerned or overwhelmed by the information. Many participants were unable to explain the findings and about half shared that if the report was theirs, they would feel "fear". Scoring systems and medical jargon were a major cause of confusion. Commonly suggested solutions included: adding a lay summary statement, including visual explanations and removing citations. The overwhelming majority of participants felt confused or distressed after receiving the sample report. Many participants felt unsure of the next steps and wanted guidance from a provider regarding follow-up. Noting that in a real-world scenario receiving emotionally charged results in this manner would cause distress. These study findings underscore the need for patient centered reporting in radiology and provide suggestions to improve report clarity.