Enhancing patient understanding of laboratory test results: a systematic review of presentation formats and their impact on perception, decision, action, and memory (Preprint)

Abstract

Direct access of patients to their electronic health records, including laboratory test results, has become increasingly common. Laboratory results can be challenging to interpret by patients, which may lead to anxiety, confusion, and unnecessary doctor consultations. Laboratory results can be presented in different formats, but there is limited evidence about the effect of presentation formats on patient outcomes.

To synthesize the evidence on effective formats for presenting laboratory test results with a focus on patient outcomes, including affective perception, perceived magnitude, cognitive perception, perception of communication, decision, action, and memory.

The search was conducted in three databases (PubMed, Web of Science, and EMBASE), until May 31st, 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 characteristics of the articles and presentation formats used. Quality of the included articles was assessed by two independent reviewers by using the Mixed Methods Appraisal Tool.

Eighteen studies were included, which were heterogeneous in terms of study design and primary outcomes used. Quality of the articles ranged from poor to excellent. Most studies (n = 16/18) used mock test results. The most frequently used presentation formats were numerical values with reference ranges (n = 12/18), horizontal line bars with colored blocks (n = 12/18), or a combination of horizontal line bars with numerical values (n = 8/18). All studies examined perception as a patient outcome, while action and memory were studied in one and three articles, respectively. In general, participants’ satisfaction and usability were highest when test results were presented using horizontal line bars with colored blocks. Adding reference ranges or personalized information (e.g. goal ranges) further increased participants’ perception. Additionally, horizontal line bars significantly decreased participants’ tendency to search for information or to contact their physician, compared to numerical values with reference ranges.

In 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 physician. Action and memory were less frequently studied, so no conclusion could be drawn about a single preferred format regarding these outcomes. Further research should focus on real-life settings, diverse presentation formats and patient outcomes. Eventually, the overarching objective is to facilitate the development of tools to effectively communicate laboratory test results to patients in clinical practice.