Mark D. Mangano

Creating a Patient-Centered Radiology Practice Through the Establishment of a Diagnostic Radiology Consultation Clinic

OBJECTIVE The purposes of this study were to assess the feasibility of and to create a referral mechanism for a diagnostic radiology consultation clinic. SUBJECTS AND METHODS A pilot program was instituted with patients from a single primary care clinic over a 3-week period. Patients with findings of common problems at routine imaging, such as atherosclerosis, emphysema, and hepatic steatosis, were eligible to participate. As the patients arrived for their routine primary care visits, office staff informed them of the opportunity to formally meet with a radiologist to review their most recent imaging findings. The office staff of the primary care clinic then contacted the radiologist covering the diagnostic radiology consultation clinic to schedule a consultation. A survey was administered before and after the session. RESULTS Twenty-two patients participated (88% participation rate). Participants rated the consultation as very helpful (mean, 4.8 on 1-5 scale), and all participants would take the opportunity to review studies with the radiologist again. Significantly more patients preferred the involvement of the radiologist in communicating the results of an imaging examination after the consultation compared with before the consultation (p = 0.001). After the consultation session, patients had significantly improved understanding of a radiologists role (p = 0.004), and all participants were able to correctly identify the radiologist as a physician who interprets medical images. CONCLUSION A referral mechanism for a diagnostic radiology consultation clinic can be effectively integrated into the everyday workflow of both the referring physician and the radiologist. The consultations are useful to patients and help to increase their awareness of the role of the radiologist.

Radiologists' role in the communication of imaging examination results to patients: perceptions and preferences of patients.

OBJECTIVE It has been suggested that radiology reporting practices would be improved if radiologists were to discuss the results of an examination directly with the patient. The attitudes and preferences of patients with regard to direct communication with the radiologist are not well-defined. The purpose of this study was to survey patients about their preferred method of receiving radiologic results. MATERIALS AND METHODS An anonymous survey was distributed to adult patients undergoing contrast-enhanced CT or MRI over a 2-week period in June 2013. RESULTS The response rate was 58.4% (642 responses). For normal examination results, the preferred mode of communication was a telephone call from the ordering physician (34.1%); only 12% of respondents opted for a telephone call from the radiologist, and 2.6% chose a face-to-face meeting with the radiologist. For abnormal test results, the preferred mode of communication was also a telephone call from the ordering physician (49.8%); 14.4% of respondents selected a telephone call from the radiologist, and 8.3% chose a face-to-face meeting with the radiologist. Patients preferred receiving very detailed versions of radiology reports for both normal (46.4%) and abnormal (81.8%) test results. Patients also expressed a desire to have access to at least key images from their examinations. CONCLUSION Patients prefer receiving both normal and abnormal examination results from the physicians who ordered the examination rather than the radiologist. They also prefer to receive very detailed examination results rather than a brief summary in lay terms.

Screening Mammography: Patient Perceptions and Preferences Regarding Communication of Estimated Breast Cancer Risk

OBJECTIVE Many models exist to estimate a womans risk of development of breast cancer. At screening mammography, many imaging centers collect data required for these models to identify women who may benefit from supplemental screening and referral for cancer risk assessment. The purpose of this study was to discern perceptions and preferences of screening mammography patients regarding communication of estimated breast cancer risk. SUBJECTS AND METHODS An anonymous survey was distributed to screening and surveillance mammography patients between April and June 2015. Survey questions were designed to assess patient preferences regarding the receipt and complexity of risk estimate communication, including hypothetical scenarios with and without > 20% estimated risk of breast cancer. The McNemar test and the Wilcoxon signed rank test were used with p ≤ 0.05 considered statistically significant. RESULTS The survey was distributed to 1061 screening and surveillance mammography patients, and 503 patients responded (response rate, 47%). Although 86% (431/503) of patients expressed interest in learning their estimated risk, only 8% (38/503) had undergone formal risk assessment. The preferred method (241 respondents [26%]) of communication of risk < 20% was a mailed letter accompanying annual mammogram results. For risk > 20%, patients preferred oral communication and were 10-fold as likely to choose only oral communication (p < 0.000001). For risk < 20% and > 20%, patients preferred to learn their estimated risk in great detail (69% and 85%), although women were significantly more likely to choose greater detail for risk > 20% (p < 0.00001). CONCLUSION Screening mammography patients expressed interest in learning their estimated risk of breast cancer regardless of their level of hypothetical risk.

Radiology Reporting: Current Practices and an Introduction to Patient-Centered Opportunities for Improvement

OBJECTIVE As health care evolves, the radiology report must also change to satisfy referring physician and patient expectations. Knowledge of the issues and controversies regarding a patient-centered approach to reporting practices is important. This article will aid the radiologist in this endeavor by summarizing key facets of radiology reporting, including current reporting standards and emerging patient-centered concepts in report language, formatting, and delivery. CONCLUSION Future efforts to improve radiology reporting practices need to account for the needs of an increasingly heterogeneous audience that includes patients. Radiologists must exploit information technologies to craft and deliver meaningful patient-centered reports. A modern radiology report will be a powerful, flexible document that strengthens the connection between the radiologist and the patient.

Re: “Patients Prefer Results From the Ordering Provider and Access to Their Radiology Reports”

We read with great interest the recent article by Cabarrus et al [1], in which they sought to explore patient preferences with regard to receiving radiologic examination results. We applaud the authors for attempting to tackle a difficult topic that has far-reaching implications for the practice of radiology. Asmentioned in this interesting article, the direct communication of examination results to patients from radiologists has been proposed in recent years as ameans to increase both value and visibility, although patient and referring physician attitudes about this practice are not yet well defined. As such, the article by Cabarrus et al is a welcome addition to the literature. We were, however, disappointed that the authors asserted their results to be “the only patient-preferences survey indicating a patient preference for the status quo” while making no reference to our larger, previously published survey of 642 patients, which also demonstrated that patients prefer to receive both hypothetically “normal” and “abnormal” results from the ordering physician rather than the radiologist [2]. Certainly, much more researchneeds to be done this area to further elucidate the optimal role for radiologists in result delivery. To this end, our group has been actively working toward a mutually agreeable solution to this problem by surveying both patients and referring physicians. Some of these efforts, including the establishment of a diagnostic radiology consultation clinic (where patients have the opportunity tomeet face to face with radiologists), have been