Patients Prefer Phone Over Clinic for Biopsy Results

Marcia Frellick

April 02, 2015

Patient preference has shifted in terms of the way they want to hear skin biopsy results: most patients now say they would rather get the news faster by telephone than wait for a face-to-face clinic visit.

In a study by Aditi Choudhry, MD, from the Dermatology Service, Veterans Affairs Medical Center in San Francisco, California, and colleagues, most (67.1%) of the 301 patients who responded to a survey preferred to speak directly with their physician by telephone to get results. Another top preference was being notified in a clinic visit (19.5%); 5.1% of patients preferred either voice message or online patient portal.

Results of the study were published online April 1 in JAMA Dermatology.

A total of 59.5% of participants said they would stick with their preference regardless of the biopsy results, but 40.5% preferred a different form of notification if their results revealed a malignant tumor.

Physicians' preferences for delivering news were similar to patients', with 56.5% preferring speaking by telephone. For benign results, 31.2% of physicians chose to speak by telephone; 32.1% of patients preferred voicemail.

That may be related to physicians' uncertainty as to regulations and privacy concerns surrounding communication of test results, the authors write.

However, the study points out that methods of communicating bad news are all over the map and lack consistent guidelines.

When physicians were asked about how they would contact patients if the biopsy were positive for melanoma, 56.5% preferred a telephone call, 12.9% would forward a message to an assistant to contact the patient, 9.8% would write a letter, 8.2% would set up an appointment, 5.3% would use a secure online portal, 4.3% would leave a voice message, and 2.4% would send an email.

If the results were negative, 31.2% would call patients, 23.4% would forward a message to an assistant to contact the patient, 14.4% would leave a voice message, 12.9% would send a letter, 8.9% would use a secure portal, 6.0% would set up an appointment, and 2.0% would send an email. Most physicians said they were not aware of any departmental or university policy for biopsy result notification.

Because options for getting news have expanded and answers may differ depending on whether the news is positive, the authors recommend doctors ask patients what they prefer on their biopsy consent form.

"We also recommend developing notification guidelines for physicians for both normal and abnormal test results in concordance with state and federal regulations," they write.

Previously, In-Person News Preferred

Results show a switch from the past, the researchers note, when most patients preferred to hear news about a possible melanoma diagnosis face-to-face and those informed via telephone would have preferred to be told in person.

The authors studied English-speaking adults from melanoma clinics at three academic medical centers: University of California, San Francisco; University of Pennsylvania; and Duke University. Patients were surveyed from July 1, 2012, through July 31, 2013. A second survey included physicians at those institutions.

The researchers found no significant difference in participant preferences on the basis of age, sex, education, ethnicity, stage of melanoma, previous history of malignant melanoma, or distance from clinic.

In an invited commentary, Reshmi Madankumar, BS, and colleagues from the Ronald O. Perelman Department of Dermatology, New York University School of Medicine in New York City, note that historically, physicians have been trained to deliver bad news in person, but technology has given patients more options that may dictate a change in practice.

"It may be time to adjust curriculums to include updated paradigms of breaking bad news that integrate current technology," they write.

They said although this study looked at dermatology, the results would likely be applicable across specialties.

The authors and commentators have disclosed no relevant financial relationships.

JAMA Dermatol. Published online April 1, 2015. Article abstract, Commentary extract

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