Dataset Information

Patient facing decision support system for interpretation of laboratory test results.

ABSTRACT:

Background

In some healthcare systems, it is common that patients address laboratory test centers directly without a physician's recommendation. This practice is widely spread in Russia with about 28% of patients who visiting laboratory test centers for diagnostics. This causes an issue when patients get no help from the physician in understanding the results. Computer decision support systems proved to efficiently solve a resource consuming task of interpretation of the test results. So, a decision support system can be implemented to rise motivation and empower the patients who visit a laboratory service without a doctor's referral.

Methods

We have developed a clinical decision support system for patients that solves a classification task and finds a set of diagnoses for the provided laboratory tests results. The Wilson and Lankton's assessment model was applied to measure patients' acceptance of the solution.

Results

A first order predicates-based decision support system has been implemented to analyze laboratory test results and deliver reports in natural language to patients. The evaluation of the system showed a high acceptance of the decision support system and of the reports that it generates.

Conclusions

Detailed notification of the laboratory service patients with elements of the decision support is significant for the laboratory data management, and for patients' empowerment and safety.

SUBMITTER: Kopanitsa G

PROVIDER: S-EPMC6053711 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Publications

Patient facing decision support system for interpretation of laboratory test results.

Kopanitsa Georgy G Semenov Ilia I

BMC medical informatics and decision making 20180720 1

<h4>Background</h4>In some healthcare systems, it is common that patients address laboratory test centers directly without a physician's recommendation. This practice is widely spread in Russia with about 28% of patients who visiting laboratory test centers for diagnostics. This causes an issue when patients get no help from the physician in understanding the results. Computer decision support systems proved to efficiently solve a resource consuming task of interpretation of the test results. So ...[more]

PMID: 30029644

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Project description:BACKGROUND:Patient portals are considered valuable instruments for self-management of long term conditions, however, there are concerns over how patients might interpret and act on the clinical information they access. We hypothesized that visual cues improve patients' abilities to correctly interpret laboratory test results presented through patient portals. We also assessed, by applying eye-tracking methods, the relationship between risk interpretation and visual search behaviour. METHODS:We conducted a controlled study with 20 kidney transplant patients. Participants viewed three different graphical presentations in each of low, medium, and high risk clinical scenarios composed of results for 28 laboratory tests. After viewing each clinical scenario, patients were asked how they would have acted in real life if the results were their own, as a proxy of their risk interpretation. They could choose between: 1) Calling their doctor immediately (high interpreted risk); 2) Trying to arrange an appointment within the next 4 weeks (medium interpreted risk); 3) Waiting for the next appointment in 3 months (low interpreted risk). For each presentation, we assessed accuracy of patients' risk interpretation, and employed eye tracking to assess and compare visual search behaviour. RESULTS:Misinterpretation of risk was common, with 65% of participants underestimating the need for action across all presentations at least once. Participants found it particularly difficult to interpret medium risk clinical scenarios. Participants who consistently understood when action was needed showed a higher visual search efficiency, suggesting a better strategy to cope with information overload that helped them to focus on the laboratory tests most relevant to their condition. CONCLUSIONS:This study confirms patients' difficulties in interpreting laboratories test results, with many patients underestimating the need for action, even when abnormal values were highlighted or grouped together. Our findings raise patient safety concerns and may limit the potential of patient portals to actively involve patients in their own healthcare.

Project description:BackgroundDirect access of patients to their web-based patient portal, including laboratory test results, has become increasingly common. Numeric laboratory results can be challenging to interpret for patients, which may lead to anxiety, confusion, and unnecessary doctor consultations. Laboratory results can be presented in different formats, but there is limited evidence regarding how these presentation formats impact patients' processing of the information.ObjectiveThis study aims to synthesize the evidence on effective formats for presenting numeric laboratory test results with a focus on outcomes related to patients' information processing, including affective perception, perceived magnitude, cognitive perception, perception of communication, decision, action, and memory.MethodsThe search was conducted in 3 databases (PubMed, Web of Science, and Embase) from inception until May 31, 2023. We included quantitative, qualitative, and mixed methods articles describing or comparing formats for presenting diagnostic laboratory test results to patients. Two reviewers independently extracted and synthesized the characteristics of the articles and presentation formats used. The quality of the included articles was assessed by 2 independent reviewers using the Mixed Methods Appraisal Tool.ResultsA total of 18 studies were included, which were heterogeneous in terms of study design and primary outcomes used. The quality of the articles ranged from poor to excellent. Most studies (n=16, 89%) used mock test results. The most frequently used presentation formats were numerical values with reference ranges (n=12), horizontal line bars with colored blocks (n=12), or a combination of horizontal line bars with numerical values (n=8). All studies examined perception as an outcome, while action and memory were studied in 1 and 3 articles, respectively. In general, participants' satisfaction and usability were the highest when test results were presented using horizontal line bars with colored blocks. Adding reference ranges or personalized information (eg, goal ranges) further increased participants' perception. Additionally, horizontal line bars significantly decreased participants' tendency to search for information or to contact their physician, compared with numerical values with reference ranges.ConclusionsIn this review, we synthesized available evidence on effective presentation formats for laboratory test results. The use of horizontal line bars with reference ranges or personalized goal ranges increased participants' cognitive perception and perception of communication while decreasing participants' tendency to contact their physicians. Action and memory were less frequently studied, so no conclusion could be drawn about a single preferred format regarding these outcomes. Therefore, the use of horizontal line bars with reference ranges or personalized goal ranges is recommended to enhance patients' information processing of laboratory test results. Further research should focus on real-life settings and diverse presentation formats in combination with outcomes related to patients' information processing.

Project description:BackgroundPatients are increasingly able to access their laboratory test results via patient portals. However, merely providing access does not guarantee comprehension. Patients could experience confusion when reviewing their test results.ObjectiveThe aim of this study is to examine the challenges and needs of patients when comprehending laboratory test results.MethodsWe conducted a web-based survey with 203 participants and a set of semistructured interviews with 13 participants. We assessed patients' perceived challenges and needs (both informational and technological needs) when they attempted to comprehend test results, factors associated with patients' perceptions, and strategies for improving the design of patient portals to communicate laboratory test results more effectively. Descriptive and correlation analysis and thematic analysis were used to analyze the survey and interview data, respectively.ResultsPatients face a variety of challenges and confusion when reviewing laboratory test results. To better comprehend laboratory results, patients need different types of information, which are grouped into 2 categories-generic information (eg, reference range) and personalized or contextual information (eg, treatment options, prognosis, what to do or ask next). We also found that several intrinsic factors (eg, laboratory result normality, health literacy, and technology proficiency) significantly impact people's perceptions of using portals to view and interpret laboratory results. The desired enhancements of patient portals include providing timely explanations and educational resources (eg, a health encyclopedia), increasing usability and accessibility, and incorporating artificial intelligence-based technology to provide personalized recommendations.ConclusionsPatients face significant challenges in interpreting the meaning of laboratory test results. Designers and developers of patient portals should employ user-centered approaches to improve the design of patient portals to present information in a more meaningful way.

Project description:BackgroundOne of the current major factors of not following up on the abnormal test results is the lack of information about the test results and missing interpretations. Clinical decision support systems (CDSS) can become a solution to this problem. However, little is known how patients react to the automatically generated interpretations of the test results, and how this can affect a decision to follow up. In this research, we study how patients perceive the interpretations of the laboratory tests automatically generated by a clinical decision support system depending on how they receive these recommendations and how this affects the follow-up rate.MethodsA study of 3200 patients was done querying the regional patient registry. The patients were divided into 4 groups who received: 1. Recommendations automatically generated by a CDSS with a clear indication of their automatic nature. 2. Recommendations received personally from a doctor with a clear indication of their automatic nature. 3. Recommendations from a doctor with no indication of their automated generation. 4. No recommendations, only the test results. A follow-up rate was calculated as the proportion of patients referred to a laboratory service for a follow-up investigation after receiving a recommendation within two weeks after the first test with abnormal test results had been completed and the interpretation was delivered to the patient. The second phase of the study was a research of the patients' motivation. It was performed with a group of 789 patients.ResultsAll the patients who received interpretations on the abnormal test results demonstrated a significantly higher rate of follow-up (71%) in comparison to the patients who received only test results without interpretations (49%). Patients mention a time factor as a significant benefit of the automatically generated interpretations in comparison to the interpretations they can receive from a doctor.ConclusionThe results of the study show that delivering automatically generated interpretations of test results can support patients in making a decision to follow up. They are trusted by patients and raise their motivations and engagement.

Project description:There are several methods to read skin prick test results in type-I allergy testing. A commonly used method is to characterize the wheal size by its 'average diameter'. A more accurate method is to scan the area of the wheal to calculate the actual size. In both methods, skin prick test (SPT) results can be corrected for histamine-sensitivity of the skin by dividing the results of the allergic reaction by the histamine control. The objectives of this study are to compare different techniques of quantifying SPT results, to determine a cut-off value for a positive SPT for histamine equivalent prick -index (HEP) area, and to study the accuracy of predicting cashew nut reactions in double-blind placebo-controlled food challenge (DBPCFC) tests with the different SPT methods.Data of 172 children with cashew nut sensitisation were used for the analysis. All patients underwent a DBPCFC with cashew nut. Per patient, the average diameter and scanned area of the wheal size were recorded. In addition, the same data for the histamine-induced wheal were collected for each patient. The accuracy in predicting the outcome of the DBPCFC using four different SPT readings (i.e. average diameter, area, HEP-index diameter, HEP-index area) were compared in a Receiver-Operating Characteristic (ROC) plot.Characterizing the wheal size by the average diameter method is inaccurate compared to scanning method. A wheal average diameter of 3 mm is generally considered as a positive SPT cut-off value and an equivalent HEP-index area cut-off value of 0.4 was calculated. The four SPT methods yielded a comparable area under the curve (AUC) of 0.84, 0.85, 0.83 and 0.83, respectively. The four methods showed comparable accuracy in predicting cashew nut reactions in a DBPCFC.The 'scanned area method' is theoretically more accurate in determining the wheal area than the 'average diameter method' and is recommended in academic research. A HEP-index area of 0.4 is determined as cut-off value for a positive SPT. However, in clinical practice, the 'average diameter method' is also useful, because this method provides similar accuracy in predicting cashew nut allergic reactions in the DBPCFC.Trial number NTR3572.

Dataset Information

Patient facing decision support system for interpretation of laboratory test results.

Background

Methods

Results

Conclusions

Publications

Patient facing decision support system for interpretation of laboratory test results.

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