The shift toward patient-centered care has, in recent years, increased the pressure on radiologists to talk through imaging-exam results with as many patients as possible. This is all well and good, but what about educating patients before they step into the exam room? After all, the more informed a patient feels heading into any medical test, the more satisfied he or she is likely to be with the entire episode of care.
And satisfaction with the patient experience tends to correlate with amenability to subsequent treatment plans, potentially improving outcomes.
Unfortunately, informing patients pre-imaging may be the exception rather than the norm. In one study involving more than 1,400 patients surveyed at three pediatric hospitals and three adult hospitals, 78 percent said they had received information about their imaging exam.
“This may look like a good number at first glance, but it isn’t,” says the study’s lead author, Jay Pahade, MD, vice chair of quality and safety for radiology and biomedical imaging at Yale-New Haven Health. “It means that 22 percent of patients walked into a procedure having gotten little or no information about it ahead of time.”
The study, “What Patients Want to Know about Imaging Examinations: A Multiinstitutional U.S. Survey in Adult and Pediatric Teaching Hospitals on Patient Preferences for Receiving Information before Radiologic Examinations,” ran in the May 2018 edition of Radiology.
“A lack of patient education shouldn’t be happening at a time when care is supposed to be evolving more and more into patient-centered mode,” Pahade tells RBJ, “and when radiology as a specialty is aiming for more patient engagement and involvement.”
What’s more, previous research has shown that radiologists who have the opportunity to participate in patient education at any point in the episode of care derive considerable work satisfaction from the activity. To this Pahade adds that informing patients is as critical a part of providing care as interpreting images. As such, it can be equally if not even more personally gratifying.
How best to participate in the pre-exam patient education process? RBJ spoke with several radiologists who take a proactive stance on the matter, all of whom have experience with initiatives aimed at bridging what Pahade calls the “knowledge gap.” Here are their top tips.
1. Lend referrers a hand.
Referring clinicians are the ones who order imaging exams, so it makes sense that they are in the best position to discuss the particulars with patients. On top of that, the Pahade study showed that patients prefer to learn about their upcoming imaging from the doctor ordering the exam. However, there’s plenty radiologists can and should do to help these care collaborators step up their patient-engagement game.
Stamatia Destounis, MD, and her colleagues at six Elizabeth Wende Breast Care Center locations in upstate New York leverage a variety of methods to support referring clinicians’ educational efforts. The practice publishes a quarterly newsletter geared toward gynecologists and other specialists in women’s health. Distributed via email as well as snail mail, the newsletter covers new developments in breast imaging technology, research findings and similar topics referring clinicians can discuss with patients in the context of ordering tests. E-blasts with related content are sent to physicians as well.
“We frequently hold ‘lunch and learn’ events at local physicians’ offices,” DeStounis says, “so that referrers can learn about individual imaging procedures and obtain insight into how to explain them to patients.”
Similarly, many of the 900-plus rads of Radiology Partners, the mega practice that serves around 600 provider organizations in 16 states, make themselves available for one-on-one consultations not only to help referring clinicians determine which procedures are best suited to the needs of individual patients but also to advise them about how to answer patients’ questions pertaining to different imaging procedures.
“Patient education and radiologist availability have become part of our culture, and working with referrers to ensure that patients are ordered the right test is a cornerstone of that,” says Syed Zaidi, MD, Radiology Partners’ vice president of operations and growth.
Meanwhile, Jason Itri, MD, PhD, vice chair of quality for radiology at Wake Forest Baptist Medical Center in Winston-Salem, N.C., suggests that radiologists steer referring clinicians who can use a little—or a lot—of assistance on the patient education front to the RadiologyInfo.org, a collaborative effort of RSNA and the ACR.
Itri points out that the website’s “Physician Resources” section offers PDFs of printable handouts referring clinicians can distribute to their patients. Available in English and Spanish, each handout includes a detailed explanation of one of 150 imaging procedures and treatments spanning the gamut of general radiology and radiological subspecialties.
Another effective way for rads to help referrers is encouraging them to direct their patients to the main component of RadiologyInfo.org. That would be its comprehensive patient information section, which is updated frequently and currently contains more than 230 descriptions of procedures, exams and diseases. Some practices promote the availability of RadiologyInfo.org in their offices, with posters found on the website, as well as by including a link to the resource on their own websites.
“It’s really incumbent on us as radiologists to direct referrers to resources like RadiologyInfo.org, so they in turn can ensure that their patients get consistent information—information that has been vetted by the radiology community,” says Geoff Rubin, MD, MBA, of Duke Health. “Unfortunately, there are still so many patients who are unaware that this type of information is available to them.”
2. Bypass the middleman.
Increasingly, there have been moves among academic radiology and private practice constituents to augment referrers’ educational efforts by reaching out directly to patients at the pre-imaging stage.
“Obviously it is difficult, if not impossible, for radiologists themselves to actually sit with patients to discuss what’s going to happen with procedures, but that doesn’t mean we cannot reach out to them in one way or another,” Zaidi says.
Prior to their appointments, patients of Radiology Partners receive a telephone call from a staff member, who explains what they should do to get ready for whichever imaging procedure they are about to undergo. Zaidi would like to see the practice implement consultation clinics where patients could interact with radiologists regarding procedures. “Contact between radiologists and patients should be made a part of the care delivery model,” he says. “However, it’s a matter of securing the organizational resources, which is a big job.”
At Yale-New Haven Hospital, Pahade notes, a third-party software system generates pre-imaging emails that in many cases incorporate a link to RadiologyInfo.org along with way-finding details. Information pertaining to imaging procedures is currently being augmented.
“Our mission is to make this information accessible and relevant,” Pahade says. “It takes work and an incredible amount of time, but the end—it can create a more positive patient experience and more informed patients all around—justifies the means.”
Some practices are extending “direct-from-radiologist” education to personal contact with patients in the office or radiology department, albeit through staff rather than radiologists themselves. In the radiology department of Duke University Medical Center, caregivers who accompany children are given a handout with FAQs about pediatric imaging. The document delves into pediatric imaging guidelines set forth under the aegis of the Alliance for Radiation Safety in Pediatric Imaging’s Image Gently campaign. However, technologists also spend time interacting with parents to answer their questions and let them know what to anticipate during their child’s imaging procedure.
“It’s not enough to present information to patients in the office,” says Donald Frush, MD, a Duke pediatric radiologist who works closely with the Image Gently Alliance. “That information has to be customized depending on the individual patient, as the level of understanding varies. You have to account for that, or it’s not good education.”
Elizabeth Wende Breast Care employs a patient advocate whose responsibilities include discussing imaging procedures with patients and responding to any concerns they may have. Additionally, a section of its website geared toward first-time patients features a step-by-step run-down of what happens when a woman goes to the facility for a screening mammogram, from the moment of her arrival until she receives the results of the exam prior to her departure. The content is presented in a first-person, conversational format, with both a patient and Destounis addressing the “audience.”
3. See things from the patient’s point of view.
Giving patients a pre-exam rundown on what to expect and how to prepare can only improve their overall experience. And the connection is only logical, Pahade suggests. “Patients don’t like dealing with the unknown in a medical context,” he says. “The more information they have in hand and the fewer the pre-imaging surprises, the more comfortable they’ll feel.” Making mental preparations to consume contrast or have an IV inserted, for example, encourages feelings of maintaining control.
As for helping their own pursuit of optimal outcomes, if patients know an imaging procedure “isn’t going to be ‘bad,’ they are more likely to show up for the appointment instead of avoiding it,” Pahade says. “If there’s a finding that needs to be addressed, it can be addressed sooner.”
Geoffrey Rubin, MD, MBA, of Duke Health believes informing patients gives them the sense that they “own” their experience. “Going for an imaging procedure without context creates anxiety and a sense of inconvenience,” he says. “It disrupts their routine, takes up their time, costs money and requires that they subject themselves to an unfamiliar environment. The sense of understanding they gain once they have been educated helps to mitigate annoyance and fear.”
4. Oﬀer a taste of ‘risk talk’ before fully going there.
While some patients want to know everything there is to know about their upcoming imaging procedure, many are disinterested in details. And that includes some aspects of considerable consequence. For example, the Pahade study showed that patients care quite a lot about how to prepare for their imaging appointment—and very little about understanding how the risks of radiation exposure stack up against the rewards.
That said, should risk-related information be shared with patients regardless of whether or not they wish to hear it? It depends on the patient. “Not every patient needs to know about risks, which are outweighed by benefits anyway,” Itri says. “Talking about risks when patients don’t want to hear it only adds to anxiety and reluctance. The patients we need to be concerned about—the ones for whom it may be more of an issue—are the ‘frequent flyers’ whose condition necessitates undergoing the same imaging procedure at frequent intervals, like every three months.”
Pahade concurs. “It’s difficult to extrapolate true risks, as most radiation risk data is based on atomic bomb survivors,” he says. “In general, we have to remember that an indicated medical imaging test will usually have benefits that far outweigh any potential risks, even for tests on children.”
5. Request relevant resources.
Radiology administrators can do more to support radiologists who want to assume a more active role in the patient-educating process. While obtaining such support may prove difficult from a logistical and even a financial standpoint, it behooves radiologists to ask. Sources propose that radiologists push for workflow or staffing adjustments to free up rads to devote time to sharing information with referring physicians, whether through one-on-one conversations or organized meetings.
According to Itri, Wake Forest Baptist Medical Center is establishing a “reading room concierge” whose responsibilities will include fielding phone calls so radiologists have a little more time to focus on education.
Rubin is all for the idea. “It would be great, also, if radiologists could convince their healthcare organizations to dedicate resources to patient educators who could either reach out directly or be available at the patient’s convenience to inform and allay concerns rather than hoping that this will happen within a busy radiology department at the time of the imaging exam,” Rubin says. “All in all, many organizations are increasing focus on patient education—but there continue to be untapped opportunities available for greater engagement.”