Communication of incidental findings in the ED: Patient perspectives

Incidental findings are commonly identified on emergency department (ED) imaging, often unrelated to the reason for encounter. While system-level interventions have aimed to improve notification and follow-up, less is known about patients' experiences of receiving these unexpected results. We sought to explore ED patients' perspectives on incidental finding notification.

A qualitative analysis was conducted of semi-structured interviews of 16 adult ED patients undergoing abdominal CT or ultrasound imaging at a large academic ED. Interviews were originally collected for a larger implementation trial of an electronic health record-based incidental finding notification system. Interviews explored patient preferences for communication of incidental findings including preferred communicator and desired information. The analytic team employed inductive thematic analysis, using iterative coding and team reconciliation to ultimately develop themes. Descriptive statistics were used to characterize the sample.

Forty-four percent of the 16 participants were aged 35-44 (25% were aged 45-54 years; 31% were 55 years or older); 62.5% female (Table 1). Only 25% of participants reported awareness of the concept of incidental findings prior to the interview. Four themes emerged: (1) Empathetic expert communication is preferred; (2) Incidental findings trigger diverse health, emotional, and financial concerns; (3) Details of both the finding and cause are valued; and (4) Information and support are desired for next steps.

Patients view incidental findings as unexpected and often stressful information requiring clear, empathetic, and actionable communication. Incorporating these preferences into ED notification processes may improve understanding, reduce distress, and support timely follow-up.

Standardizing incidental finding disclosure to include plain language explanations of the finding, its cause, and detailed next steps may support ED patients as they navigate future care and the myriad concerns that arise from an unexpected result. Achieving such standardization will likely require both communication training and electronic health record integration. In ED practice, this should include a brief verbal disclosure paired with EHR-supported written instructions that identify the finding, explain urgency, name the appropriate follow-up clinician, and specify patient and clinician next steps.