Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Director, Center for Translational Imaging Informatics, Perelmen School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
J Am Coll Radiol. 2021 Jul;18(7):951-961. doi: 10.1016/j.jacr.2021.02.012. Epub 2021 Mar 13.
The aim of this study was to evaluate the effect of Pennsylvania Act 112 notification reading level and presentation on patient understanding and anxiety.
Four notifications were developed by alternating 12th grade and 6th grade reading level Act 112 language with letters or infographics. Using Amazon Mechanical Turk, 909 US adult volunteers were randomly assigned to one notification followed by a survey. Participants who answered all 12 survey questions on understanding, anxiety, and sociodemographics were paid $0.10. Chi-square analysis and multivariate regression were used to determine the impact of notification type and sociodemographic data on understanding of communicated information and anxiety.
Sixty percent of participants (489 of 821) correctly understood all three questions directly answered within notifications regarding Act 112 subject, next steps, and process for obtaining reports. Approximately half of respondents understood that notifications indirectly conveyed "definitely" or "possibly" abnormal test results (344 of 821 [42%] and 99 of 821 [12%], respectively). Compared with the 12th grade letter, correct understanding of all directly communicated information was lower with the 12th grade infographic after adjustment (odds ratio, 0.61; 95% confidence interval, 0.39-0.95; P = .028) and equivalent with the 6th grade infographic and letter (P = .744 and P = .316). Correct indirect understanding of abnormal test results was not associated with notification type after adjustment but was associated with higher anxiety (odds ratio, 2.86; 95% confidence interval, 0.57-1.35; P < .001).
Layperson understanding of information directly and indirectly communicated in Pennsylvania Act 112 is suboptimal, regardless of reading level or presentation. New Act 112 language is needed to improve patient understanding, which would ideally be coproduced with Pennsylvania patients, policymakers, and other relevant stakeholders.
本研究旨在评估宾夕法尼亚州第 112 号法案通知的阅读水平和呈现方式对患者理解和焦虑的影响。
通过交替使用 12 年级和 6 年级阅读水平的宾夕法尼亚州第 112 号法案语言以及字母或信息图表，开发了 4 份通知。通过亚马逊 Mechanical Turk，909 名美国成年志愿者被随机分配到一份通知后进行调查。回答了通知中关于理解、焦虑和社会人口统计学的所有 12 个问题的参与者获得 0.10 美元的报酬。使用卡方分析和多元回归来确定通知类型和社会人口统计学数据对所传达信息的理解和焦虑的影响。
60%的参与者（489/821）正确理解了通知中直接回答的关于宾夕法尼亚州第 112 号法案主题、下一步行动以及获取报告的过程的三个问题。大约一半的受访者理解通知间接传达了“肯定”或“可能”异常的测试结果（344/821[42%]和 99/821[12%]）。与 12 年级的信件相比，调整后，12 年级信息图表对所有直接传达信息的正确理解较低（优势比，0.61；95%置信区间，0.39-0.95；P=0.028），与 6 年级的信息图表和信件相当（P=0.744 和 P=0.316）。调整后，异常测试结果的正确间接理解与通知类型无关，但与较高的焦虑相关（优势比，2.86；95%置信区间，0.57-1.35；P<0.001）。
无论阅读水平或呈现方式如何，宾夕法尼亚州第 112 号法案中传达的信息，患者的理解都不理想。需要新的第 112 号法案语言来提高患者的理解能力，这最好是与宾夕法尼亚州的患者、政策制定者和其他相关利益相关者共同制定。
