Abstract
Background
Diagnostic MRI reports can be distressing for patients with limited health literacy. Humans tend to prepare for the worst particularly when we are in pain, and words like “tear” can make us feel damaged and in need of repair. Research on words used in provider-patient interactions have shown an affect on response to treatment and co** strategies, but the literature on this remains relatively sparse.
Questions/purposes
The aim of this observational cross-sectional study is to determine whether rewording of MRI reports in understandable, more dispassionate language will result in better patient ratings of emotional response, satisfaction, usefulness, and understanding. Furthermore, we wanted to find out which type of report patients would choose to receive.
Methods
One hundred patients visiting an orthopaedic hand and upper extremity outpatient office for reasons unrelated to the presented MRI report were enrolled. Four MRI reports, concerning upper extremity conditions, were reworded to an eighth-grade reading level and with the use of neutral descriptive words and the most optimistic interpretations based on current best evidence. After reading each report, emotional response was measured using the Self Assessment Manikin (SAM). Subjects also completed questions about satisfaction, usefulness, and understanding of the report.
Results
According to the results of the SAM questionnaire, the reworded MRI reports resulted in significantly higher pleasure and dominance scores and lower arousal scores. The mean satisfaction, usefulness, and understanding scores of the reworded report were significantly higher compared with the original reports. Seventy percent of the patients preferred the reworded reports over the original reports.
Conclusions
Emotional response, satisfaction, usefulness, and understanding were all superior in MRI reports reworded for lower reading level and optimal emotional content and optimism. Given that patients increasingly have access to their medical records and diagnostic reports, attention to health literacy and psychologic aspects of the report may help optimize health and patient satisfaction.
Level of Evidence
Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Additional information
One or more of the authors (DR) received funding from Skeletal Dynamics (Miami, FL, USA) (USD $10,000–100,000); Wright Medical (Memphis, TN, USA) (< USD $10,000), Biomet (Warsaw, IN, USA) (< USD $10,000); AO North America (Philadelphia, PA, USA) (USD $10,000–$100,000) and AO International (Dubendorf, Switzerland) (< USD $10,000). One or more of the authors (JKJB) received a faculty grant for medicine students from Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. One or more of the authors (MGH) received general nonmedical grants from Marti kuning Eckhardt fonds and Spinoza fonds and a Dutch orthopaedic travel grant from AnnaFonds. One or more of the authors (JDK) received a research grant from USC Keck School of Medicine.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
This work was performed at the Orthopaedic Hand and Upper Extremity Service, Massachusetts
General Hospital, Boston, MA, USA.
Appendices
Appendix 1. Original and reworded reports for epicondylitis
Original Report
Findings:
There is a skin marker over the lateral humeral epicondyle. There is severe thickening of the common extensor tendon insertion consistent with tendinosis, and a superimposed partial tear measuring 5 mm. There is prominence of the adjacent joint capsule raising the question of concurrent partial tear of the radial collateral ligament.
The remaining ligaments and tendons are normal in configuration and signal intensity. The ulnar nerve is in the groove. Bones and bone marrow are unremarkable.
Impression:
Tendinosis and partial tear of the common extensor tendon at the insertion on the lateral humeral epicondyle.
Reworded Report
Findings:
Thickening and signal changes of the origins of the common extensor tendon and radial collateral ligament origin consistent with tendinopathy. The remaining ligaments, tendons, bones and nerves are normal.
Impression:
Findings consistent with lateral epicondylitis.
Appendix 2. Original and reworded reports for rotator cuff
Original Report
Findings:
Rotator cuff: There is subtotal articular sided tear of the distal supraspinatus tendon with delaminating component and proximal retraction of articular sided fibers up to 2 cm from the greater tuberosity. Full thickness tendon perforation may be present. The tear extends inferiorly into the infraspinatus, which remains mostly intact at the greater tuberosity attachment site. There is subscapularis tendinopathy without full thickness tear. The teres minor is intact. The rotator cuff muscle bulk is intact.
Glenoid labrum and biceps tendon: Just proximal to the biceps tendon groove, there is fusiform enlargement of the biceps tendon with signal increase suggesting longitudinal tear. The extracapsular biceps tendon remains within the groove. There is degenerative tearing of the superior and anterior labrum. There is a small joint effusion.
AC joint: There are hypertrophic degenerative changes of the acromioclavicular joint. There is trace fluid in the subacromial bursa.
Articular cartilage: The articular cartilage is of normal thickness. No focal defects are seen.
Bone: There is subchondral cyst formation in the humeral head.
Impression:
Subtotal articular surface tear of the distal supraspinatus tendon with delaminating component and proximal retraction of articular sided fibers up to 2 cm from the greater tuberosity. The tear extends posteriorly into the infraspinatus which remains mostly intact at the greater tuberosity attachment site.
Prominent bicipital tendinosis with longitudinal partial tear just proximal to the bicipital groove.
Hypertrophic degenerative changes of the acromioclavicular joint.
Reworded Report
Findings:
Rotator cuff: There is signal change consistent with tendinopathy involving the entire supraspinatus tendon and part of the infraspinatus and subscapularis tendons consistent with age. There is thinning of the supraspinatus. The muscles are healthy.
Glenoid labrum and biceps tendon: Enlargement and signal changes in the biceps tendon consistent with rotator cuff tendinopathy as expected at this age. There is a small amount of superior and anterior labral changes, a small subchondral cyst in the humeral head, and a small amount of fluid in the joint suggestive of very mild glenohumeral arthrosis consistent with age. The articular cartilage is of normal thickness and without defect.
AC joint: Arthritis consistent with age.
Impression:
Expected age-related changes including:
-
1.
Rotator cuff/biceps tendinopathy with some thinning in the supraspinatus, but no defect and healthy muscle.
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2.
Moderate arthritis of the acromioclavicular joint.
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3.
Very mild arthritis of the glenohumeral joint.
Appendix 3
Appendix 4
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Bossen, J.K.J., Hageman, M.G.J.S., King, J.D. et al. Does Rewording MRI Reports Improve Patient Understanding and Emotional Response to a Clinical Report?. Clin Orthop Relat Res 471, 3637–3644 (2013). https://doi.org/10.1007/s11999-013-3100-x
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DOI: https://doi.org/10.1007/s11999-013-3100-x