December 2022 Communication Tip

December 2022 Communication Tip

Discussing Portal-delivered Results

 

The 21st Century Cures Act makes sharing electronic health information with patients the expected norm in U.S. health care.  It requires the release of medical information directly to patients, typically immediately once the report is available.  While some details, built-in delays, and exceptions are being debated and hammered out, “portal-delivered news” is clearly here for us all to deal with as best we can.  As hard as communicating about test results may be, it can be even more difficult when information is delivered initially to a patient’s inbox by MyChart, even before a clinician is able to discuss the findings and put them in the proper context.

There is little research about how to communicate most effectively in these situations.  However, Jessica Hahne and her colleagues have just published a paper in the Journal of Oncology Practice with some helpful suggestions (Hahne J, Carpenter BD, Epstein AS, Prigerson HG, Derry-Vick HM. Communication Skills Training for Oncology Clinicians After the 21st Century Cures Act: The Need to Contextualize Patient Portal-Delivered Test Results. JCO Oncol Pract. 2022 Nov 10:OP2200567).

Below are 5 recommendations for framing (preparing for news delivery) and clarifying (processing the meaning of the delivered news) for oncology clinicians discussing portal-delivered test results.  Below are the first 2 columns from the paper’s Table 1

Communication Skill Table

It’s a great table and I would like to highlight 2 things:

  1. Framing is important.  As with many things, some time spent beforehand “framing” in preparation for the portal-delivery of news may be very well-spent (potentially saving time overall and preventing unnecessary patient distress).  As has often been said, “the delivery of serious news starts when you order the test.”
  2. Clarification begins with understanding what patients know and do not know.  For patients who have seen test results first on the portal, uninterpreted by you, you might start by asking “What were your takeaways and concerns?”  It’s our patients’ data, but they are still our patients and almost always need our guidance, expert communication skills, and compassion.

All My Best,

Mike

PS You can find an archive of my past communication tips on the MERI website: https://meri.ucsf.edu/meri-center-communication-tips