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- Title
Development and Piloting of a Patient-Centered Report Design for Stress Myocardial Perfusion Imaging Results.
- Authors
Patel, Krishna K.; Decker, Carole; Pacheco, Christina M.; Fuss, Christine; Boda, Illham; Gosch, Kensey L.; McGhie, Arthur I.; Thompson, Randall C.; Sperry, Brett W.; Bateman, Timothy M.; Spertus, John A.
- Abstract
Key Points: Question: What information do patients want after undergoing a cardiac stress test? Findings: In this qualitative study of 36 patients in focus groups and 123 patients in a pilot test, 5 broad themes that could be incorporated into myocardial perfusion imaging reporting to better meet patients' needs emerged: (1) providing written information, (2) discussing report with medical personnel, (3) presenting results in simple language with graphics, (4) providing comparisons with normal results, and (5) providing personalized risk estimates, especially in the context of posttest management. Incorporating these themes into a sample patient-centered report was associated with a greater proportion of patients reading the reports and understanding their future cardiac risk. Meaning: Reports incorporating key elements identified in this study could lead to improved patient satisfaction and, potentially, better care and outcomes by increasing patients' understanding of and engagement with treatment. This qualitative study designs and tests a patient-centered report for stress myocardial perfusion imaging test results. Importance: The management of coronary disease epitomizes the call to better engage patients in shared medical decision-making. Myocardial perfusion imaging (MPI) is the foundation of diagnosis, risk stratification, and subsequent therapy; however, MPI reports are currently interpretable by specialists but not patients. Objective: To design and test a patient-centered report for stress MPI test results. Design, Setting, and Participants: This qualitative study of outpatients who underwent an MPI stress test and clinicians used a mixed methods approach. Phase 1 (December 2018 to July 2019) used qualitative methods to design a patient-centered reporting tool, with 5 focus groups with 36 patients and 2 focus groups with 27 clinicians. Phase 2 (June to September 2019) consisted of pilot testing the reporting tool with feedback from a structured survey given to patients who received MPI reports before and after implementing the tool. Main Outcomes and Measures: Key themes around patient experiences with the current MPI reporting and their desire for a more useful report were identified, which led to a sample reporting tool after serial iterations with feedback. Differences in patient knowledge and engagement were assessed between patients before and after implementation of the new reporting tool using χ2 tests. Results: From patient focus groups (26 patients; mean [SD] age, 66.3 [9.6] years, 9 [35%] women), 3 themes on the inadequacies of current MPI reporting were identified: (1) inconsistent delivery of results, (2) use of medical jargon, and (3) unclear posttest course. We identified 5 themes for a more patient-centered MPI report: desire for written information, discussion of the report with medical personnel, presentation of results in simple language with use of visual graphics, comparisons with normal results, and personalized risk estimates. In a pilot survey with 123 patients split into a pre-implementation group (69 patients; mean [SD] age, 68.2 [8.5] years; 27 [51%] women) and a postimplementation group (54 patients; mean [SD] age, 66.4 [8.7] years; 30 [56%] women), the patient-centered report led to more patients reading the entire report (45 [83%] vs 46 [67%]; P =.04) and improved knowledge of future risk of cardiac events (41 [76%] vs 20 [29%]; P <.001). There was also a numerically higher percentage of patients who found the report easy to read (45 [83%] vs 44 [68%]; P =.05) and understand (42 [78%] vs 43 [66%]; P =.16), although these results were not statistically significant. Conclusions and Relevance: This study identified key elements of a patient-centered report design for stress MPI test results, which improved patient engagement and knowledge. These preliminary data support further implementation and study of a more patient-centered MPI report.
- Subjects
PILOT projects; FOCUS groups; PATIENT participation; RESEARCH methodology; PSYCHOLOGY of cardiac patients; CARDIOLOGISTS; PATIENT-centered care; FISHER exact test; RADIONUCLIDE imaging; HEALTH literacy; T-test (Statistics); DECISION making; CHI-squared test; DESCRIPTIVE statistics; RESEARCH funding; THEMATIC analysis; DATA analysis software; PERFUSION
- Publication
JAMA Network Open, 2021, Vol 4, Issue 8, pe2121011
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2021.21011