The immediate release of test results without counseling from a clinician is controversial.
The vast majority of patients want to receive test results online even if their healthcare provider has not reviewed the test results, according to a new research article.
In April 2021, a federal rule went into effect requiring immediate electronic availability of medical test results upon request by patients and care partners. Providing patients access to their medical records has been proposed as a way to strengthen patient-clinician relationships. However, the immediate release of test results without counseling from a clinician is controversial.
The new research article, which was published by JAMA Network Open, features survey data collected from more than 8,000 adult patients and care partners who had gotten test results through an online patient portal from April 5, 2021, to April 4, 2022.
The survey was conducted at four academic medical centers: University of California, Davis Health; University of Colorado Anschutz Medical Center; University of Texas Southwestern Medical Center; and Vanderbilt University Medical Center.
The study features several key data points:
- 95.7% of all survey respondents wanted to receive test results immediately through the online patient portal, even if the results had not been reviewed by a healthcare provider
- 95.3% of survey respondents who received abnormal test results reported that they wanted to continue to receive test results immediately through the online patient portal
- Most survey respondents (57.3%) reported their test results were normal
- 7.5% of survey respondents reported that receiving test results before they were contacted by a healthcare provider increased worry
- Increased worry was more common among survey respondents who received an abnormal test result (16.5%) than among survey respondents who received a normal test result (5.0%)
"In this multisite survey study of patient attitudes and preferences toward receiving immediately released test results via a patient portal, most respondents preferred to receive test results via the patient portal despite viewing results prior to discussion with a health care professional. This preference persisted among patients with nonnormal results," the study's co-authors wrote.
Interpreting the data
Balancing patient worry with immediate access to test results is a key issue, study co-author Liz Salmi, communications and patient initiatives director of OpenNotes at Beth Israel Deaconess Medical Center, said in a prepared statement. "As healthcare systems continue to navigate this new era of health information transparency, balancing patients' expectation of immediate access to their information with the need to manage increased worry is important. Additional research is necessary to better understand the nuance of worry from receiving abnormal test results, especially as it relates to revealing information about a newly diagnosed condition such as Huntington's disease or cancer."
There are apparently positive factors to receiving test results immediately even when the results are abnormal, the study's co-authors wrote. "We found that 95.3% of participants who received abnormal test results would like to continue to receive immediately released results through the portal. This finding suggests that there may be benefits to receiving abnormal results online, such as allowing patients to choose where and with whom to view such results."
Most survey respondents (92.3%) reported receiving precounseling about their test results, but there was no association found between precounseling and lower levels of worry. The study's co-authors wrote that there can be several approaches to precounseling.
"Precounseling strategies might encompass both technical and social-technical approaches, including in-person anticipatory guidance, improved asynchronous communication, and portal-based educational materials. Other strategies include optimizing existing patient portal interfaces to give users control over their notification preferences related to sensitive or abnormal results or timing the release of test results during working hours. Additional research is necessary to further investigate the efficacy of strategies to mitigate emotional distress."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
95.7% of all survey respondents wanted to receive test results immediately through their online patient portal, even if the results had not been reviewed by a healthcare provider
95.3% of survey respondents who received abnormal test results reported that they wanted to continue to receive test results immediately through the online patient portal
7.5% of survey respondents reported that receiving test results before they were contacted by a healthcare provider increased worry