When reporting incidental findings, providing detailed data helps patients worry less

Providing more context when communicating with patients about incidental findings can have a significant impact on how much they worry, according to a study published by the American Journal of Roentgenology.

The authors surveyed adult patients preparing to undergo outpatient imaging studies, showing them information about hypothetical incidental findings using either descriptive information or “a combination of descriptive and numeric graphical risk information.” Patients were then asked a variety of questions to see how the way information is presented to patients impacts their perception. Patient distress, perceived risk and treatment preference were all tracked, with patients using a five-point scale to provide their answers.

Overall, 299 patients were surveyed. Respondents said they were less worried about a 2-cm rental tumor when receiving numerical and graphical information (a mean score of 3.56 out of five) than when just receiving descriptive information (a mean score of 4.12 out of five). In addition, fewer patients favored surgical consultation when receiving numerical and graphical information instead of just receiving descriptive information (a mean score of 29.3 percent compared to 46.9 percent).

“Incidental findings are commonly discovered on diagnostic imaging tests and are associated with highly variable degrees of risk and nonuniform recommendations for additional tests and specialty consultations,” wrote Stella K. Kang, MD, NYU Langone Medical Center in New York City, and colleagues. “Because of a high degree of uncertainty around the natural history of some lesions or clinical equipoise related to the overall low risk associated with some lesions, management decisions around many incidental findings justifiably incorporate patient preferences for shared decision making.”

The authors added that’s patients showed they overestimate the “absolute risk of adverse events” no matter how the risk is communicated,” but they do worry much more when only descriptive information is provided.

Kang et al. did note their study had multiple limitations, including the fact that it took place at a single institution and the use of hypothetical findings.

“These findings may warrant prospective study of the effect of radiologists' risk communication and management recommendations on patient decision making, given how commonly incidental lesions are encountered,” the authors concluded.