Lost in Translation: Patients Struggle to Decode Health Information
Exploring the communication gap between patients and radiology results
As an Emory University medical student participating in clinical rotations, Jada Hislop, MD, encountered a lot of patients who expressed confusion about the health information they received. The experience inspired her first R&E Foundation-funded research project.
“I wanted to figure out a way to bridge the gaps in patient knowledge with simple ways of communicating,” said Dr. Hislop, an intern at Wellstar Kennestone Hospital in Marietta, GA, who will begin a diagnostic radiology residency at Weill Cornell Medicine in New York this summer.
When she received her R&E Research Medical Student Grant in 2023, Dr. Hislop channeled her interest in radiology toward finding a simpler solution of communicating screening mammography results to patients.
“For patients with suboptimal imaging quality, indeterminate findings or dense breasts, it’s crucial that patients comply with follow-up imaging recommendations so that breast cancer isn’t missed,” Dr. Hislop said. “The language used to communicate with screening mammography patients is not only important for general education, it’s also vital to patients getting the appropriate follow-up care.”
Federal guidelines require radiologists to inform patients of their mammogram results in a written letter with language easily understood by a layperson. Several health agencies, including the U.S. National Institutes of Health recommend that patient-centered communication be written between the sixth- and eighth-grade level. However, Dr. Hislop said research has shown that the letters currently sent by many institutions use language that exceeds recommended reading levels.
“I think there’s been a lot of work to get us to where we are now, but there’s still more to be done,” she said.
Help Inform Your Patients
For more than two decades, RSNA and the American College of Radiology have worked together to create and maintain RadiologyInfo.org.
This patient-friendly resource helps reduce uncertainty and empower patients with information they need to better understand and make decisions about their health care.
Content for the site is reviewed regularly and updated to meet the changing health care reporting landscape.
In addition to explaining various imaging tests, treatments, screenings, diseases, conditions and safety details, articles and videos on the site include “How to” guidance for reading specific imaging reports. Health care providers are encouraged to take advantage of this free resource. Help your patients become better informed by referring them to RadiologyInfo.org.
Revised Letter Includes Illustrations and Graphic Elements
Dr. Hislop began her project by assessing the letters that the Emory University Department of Radiology sent to women whose results fall into the BIRADS 0 category and who have dense breasts.
Using the Flesch-Kincaid and Lexile framework, she determined the two letters were written at a reading level between 10th and 12th grade. She revised the written language of the letters using ChatGPT and made further revisions with input from breast imaging experts. She enhanced the visual design of the letters by adding graphics and incoprorating design elements into the layout. Additional revisions were made with feedback from breast care physicians across multiple departments and patients on the readability and understandability of the existing letter compared to the revised ones.
Unlike the traditional results letter, Dr. Hislop designed the letter to include illustrations and graphic elements such as capitalized letters, highlighted subheads and colored text boxes.
A subhead “About Mammograms” introduces a short paragraph defining mammography and the radiologist’s role. It defines the BIRADS-0 category in simple terms by stating that the study was incomplete and additional imaging is needed. Copy under the subhead “What’s Next” encourages the patient to use the provided phone number to schedule additional imaging as quickly as possible.
Dr. Hislop created her own simple illustrations of a woman and a mammography unit and others that depict dense breasts that can hide cancerous lesions. Emory’s marketing department then refined those illustrations to align with the hospital branding and style guidelines.
Even though tools that measure language reading level don’t take graphic elements into account, Dr. Hislop thinks they help make information more easily understood.
“Reading comprehension isn’t just about the words; it’s also the format, design, and visual look,” she said. “Looking at a picture can improve comprehension.”
For More Information
Learn more about available R&E Foundation grants at RSNA.org/Research/Funding-Opportunities.
Read previous RSNA News articles about R&E Foundation grants:
- Training Interventional Radiologists in East Africa
- Imaging-Based AI Platform Predicts Head and Neck Cancer Spread
- Research Identifies Imaging Measurements and Serum Biomarkers Associated With Cardiac Strain and Myocardial Injury