RSNA: A substantial gap exists between patient expectations and current
practices for providing information about medical imaging tests that use
radiation, according to a new study published online in the journal Radiology. Researchers said the findings highlight a need for better communication as medicine enters an era of patient-centered care.
In recent years, there have been numerous reports in the media about
potential risks of tests that use ionizing radiation. However,
benefit-risk discussions about ionizing radiation from medical imaging
are rare and seldom initiated by clinicians.
For the new study, researchers from Memorial Sloan Kettering Cancer
Center (MSKCC) in New York City analyzed over nine hours of transcribed
conversations with 30 people who had undergone medical imaging exams to
determine their understanding of the benefits and risks associated with
various medical imaging procedures and their expectations regarding
communication of those benefits and risks.
The study group was divided into six focus groups, including five
groups of cancer patients and one group of participants in a lung cancer
screening program. The study found that participants perceived clear
benefits from imaging tests like x-rays, computed tomography (CT) scans,
and nuclear medicine examinations, but that patient knowledge regarding
which imaging tests use ionizing radiation was variable and generally
poor.
Most participants were highly aware of risks associated with ionizing
radiation exposure, including the potential risk of future cancer, but
expressed a desire to receive this information from their own doctor.
In addition to information about risk, the patients expressed a
desire to be offered information concerning the rationale for specific
test orders and testing intervals, as well as testing alternatives. Most
met their needs for more information through self-directed Internet
searches.
"This may not be what we in the medical field want to hear, but I
think it's important that we hear it," said senior author Jennifer Hay,
Ph.D., a behavioral scientist at MSKCC. "Patients want this information,
and they prefer to receive it from doctors they know and trust."
Knowledge about imaging tests was highly variable among the study
participants, even though many of them had undergone frequent
examinations. For instance, some patients were unsure if ionizing
radiation was used in mammography, bone scans and stress tests. Many
participants were uncertain if magnetic resonance imaging (MRI) used
ionizing radiation. Ionizing radiation from diagnostic medical imaging
was occasionally confused with radiation therapy, and some participants
were unable to distinguish between the two.
Participants desired a wide range of information about medical
imaging tests. Most wanted basic education about which imaging tests
used ionizing radiation and how doses compared among them. Nearly all
the patients wanted to understand how tests differ, what governs
selection of one over another, and why multiple tests are sometimes
ordered. Most agreed that learning about possible future risks was
important but that having this information would probably not alter
their decision to proceed with a recommended test.
The desire for information on the risks associated with ionizing
radiation from medical imaging was strongest among patients who had made
the transition from treatment to survivorship. These patients wanted to
know how risk accumulates from multiple exams over time, whether
additional ionizing radiation exposure could be avoided by substituting
MRI for CT, and if longer intervals between follow-up examinations could
be negotiated.
"Interest in having more information and participating in decision
making about medical imaging clearly increased as patients transitioned
from active cancer treatment to survivorship," said the study's lead
author Raymond H. Thornton, M.D., an interventional radiologist at
MSKCC. "Cancer survivors typically focus on healthful living and
risk-factor reduction, so they were particularly eager to participate in
discussions about potential long-term risks of radiation."
The different levels of desire for information among patients lend
support to a tiered approach for patient-centered communication,
according to Dr. Hay.
"A tiered approach would provide all patients with information and
offer additional options to those who want to dig deeper and find out
more," she said.
Despite concerns about future risks, the study participants expressed
appreciation for the imaging tests, with many emphasizing that imaging
reports were a patient's most important evidence of treatment efficacy.