In 2005, researchers at the University of California in San Francisco surveyed 970 mammography screening patients to determine the extent to which they understood the written reports they received following the tests. The researchers found that 70 percent of patients reported that they fully understood the reports, while 30 percent admitted they did not have full understanding. Among the 970 subjects were 304 whose tests included suspicious abnormalities. The researchers found that only 51 percent of those patients understood their results to be abnormal.
Many patients find mammography reports confusing. Even those who report no confusion often misunderstand their results.
The ACR’s Sample Letters
Studies like this have motivated the American College of Radiology to revise the language used in reporting mammography results to patients. The ACR’s recommended “lay letters” are revised on an ongoing basis to promote clarity and communication.
These efforts have not yet achieved their goals. An April 2011 study by researchers at the University of Miami’s Miller School of Medicine found that the ACR letters available at that time were written at a 10th grade reading level, which requires significantly more effort to read than the sixth-grade level recommended by communication researchers. Studies show that nearly 20 percent of American adults read at the fifth-grade level or below. It’s no wonder that they find mammogram results difficult to interpret. “Common deficiencies,” the researchers noted, “included use of the passive voice, vague wording, and technical jargon.” These factors have led to serious gaps in mammography patients’ understanding of their reports.
Are My Mammography Results Normal?
Despite the presence of words like “abnormality” in their results, many interviewed patients report that their findings were normal.
The ACR’s sample letters use “abnormality” in its medical sense, as a noun, a usage that is foreign to patients who lack medical training. Critics say letters should include a clear statement of whether mammography results are normal or abnormal.
Is More Medical Imaging Required?
The ACR’s sample letters recommend this language for patients whose results indicate a need for more tests: “Your recent [mammogram or breast ultrasound or breast MRI] showed a finding that requires additional imaging studies, such as additional mammographic views or ultrasound, for a complete evaluation.”
Critics say that this jargon-filled sentence is unclear and that it understates the urgency of the physician’s recommendation. They’d prefer to see a sentence like this: “You need more tests.”
Even then, the 2011 study shows that patients don’t understand whether many or few patients are called in for further tests, nor to what extent they should be concerned about the need for further testing. They don’t understand why they are being called in for further tests. In fact, many don’t understand that “your mammogram illustrates the need for further evaluation” means “come in for more tests.”
Patients would surely benefit from knowing that of 1,000 women in their 50s who receive screening mammograms, about 91 are called in for further tests, and of those three will find an invasive cancer as a result of the mammogram and one will find a ductal carinoma. These figures, which are rarely communicated to patients, could help them get a clearer understanding of their status.
Do I Have Breast Cancer?
Naturally, a yes-or-no answer to the cancer question is at the forefront of patients’ minds. Physicians understand that each patient’s results must be interpreted individually, and that the term “cancer” includes a wide spectrum of benign and malignant structures. This medical understanding is necessary for effective treatment but it stands in the way of communication.
Many patients interpret a recommendation for more tests as confirmation of their worst fears about breast cancer.
Critics say the ACR’s letters could be improved by ditching jargon in favor of clearer language.
Why Should I Care About Breast Density?
Many agencies follow guidelines requiring them to report breast density to patients. Tissue density is an important factor in assessing how effective scans are, and it is therefore of great importance to radiologists, oncologists, and other medical personnel. However, many patients do not understand how to add breast-density ratings to their understanding of mammography results.
Most often, a finding of dense breast tissue leads to a recommendation for more frequent testing. Critics say mammography reports should say that, just that clearly. Breast density is not a sign of disease, but it is a factor that can complicate other diagnostic efforts, and certain patients should therefore submit to more testing more often.
Addressing the Communication Problem
Studies show that women who receive briefings from their doctors on test results — either in person or over the telephone — achieve a greater understanding of the results and their implications. They are also more likely to comply with doctors’ recommendations. The logical conclusion is that personal briefings save lives.
Consulting with patients regarding test results is time-consuming and it takes physicians away from what many see as their primary responsibilities. However, increasing clarity regarding tests can result in improved outcomes. In addition to ensuring that the written reports they deliver to patients are more clear and accessible, physicians should schedule time to speak with patients individually about their test results.
If you are looking for an experienced radiology practice in Fort Lauderdale, West Palm Beach, or Miami with a better patient experience, you can count on SteleRAD. Call us at 954-358-5250 or contact us online for a consultation.