Disclosing neuroimaging incidental findings: a qualitative thematic analysis of health literacy challenges (original) (raw)
Related papers
Ethics & Behavior, 2014
How far does a researcher's responsibility extend when an incidental finding is identified? Balancing pertinent ethical principles such as beneficence, respect for persons, and duty to rescue is not always straightforward, particularly in neuroimaging research where empirical data that might help guide decision-making is lacking. We conducted a systematic survey of perceptions and preferences of 396 investigators, research participants and IRB members at our institution. Using the partial entrustment model as described by Richardson, we argue that our data supports universal reading by a neuroradiologist of all research MRI scans for incidental findings and providing full disclosure to all participants.
Perception of radiology reporting efficacy by neurologists in general and university hospitals
Clinical Radiology, 2018
To investigate how neurologists perceive the value of the radiology report and to analyse the relation with the neurologists own expertise in radiology and the level of subspecialisation of radiologists. MATERIALS AND METHODS: A web-based survey was distributed to neurologists. The level of subspecialisation was assessed by the percentage of fellowship-trained radiologists and the percentage of radiologists that were members of the Dutch Society of Neuroradiology. RESULTS: Most neurologists interpret all computed tomography (CT) and magnetic resonance imaging (MRI) studies themselves, and their self-confidence in making correct interpretations is high. Residents gave higher scores than neurologists for "Radiologist report answers the question" (p¼0.039) and for "Radiologist reports give helpful advice" (p¼0.001). Neurologists from university hospitals stated more frequently that the report answered their questions than neurologists from general hospitals (p¼0.008). The general appreciation for radiology reports was higher for neurologists from university hospitals than from general hospitals (8.2 versus 7.2; p¼0.003). Radiologists at university hospitals have a higher level of subspecialisation than those at general hospitals. CONCLUSION: Subspecialisation of radiologists leads to higher quality of radiology reporting as perceived by neurologists. Because of their expertise in radiology, neurologists are valuable sources of feedback for radiologists. Paying attention to the clinical questions and giving advice tailored to the needs of the referring physicians are opportunities to improve radiology reporting.
BMC Medical Research Methodology
Background The application of advanced imaging in pediatric research trials introduces the challenge of how to effectively handle and communicate incidental and reportable findings. This challenge is amplified in underserved populations that experience disparities in access to healthcare as recommendations for follow-up care may be difficult to coordinate. Therefore, the purpose of the present report is to describe the process for identifying and communicating findings from a research MRI to low-income Latino children and families. Methods Latino adolescents (n = 86) aged 12–16 years old with obesity and prediabetes underwent a research MRI (3 Tesla Philips Ingenia®) as part of a randomized controlled diabetes prevention trial. The research MRIs were performed at baseline and 6 months to assess changes in whole-abdominal fat distribution and organ fat in response to the intervention. An institutional pathway was developed for identifying and reporting findings to participants and fa...
Brain and behavior, 2017
Brain imaging studies using magnetic resonance imaging (MRI) sometimes reveal incidental findings (IFs) that might be relevant to some of the health issues in research participants. Although professional communities have discussed how to manage these IFs, there is no global consensus on the concrete handling procedures including how to inform participants of IFs. First, this study reviewed previous studies for the number of IFs discovered in brain imaging studies using MEDLINE. Second, a multi-institutional study determined the number of IF discoveries and evaluated the method of informing participants at multiple institutions, which participated in a national brain science project in Japan. Both the review and multi-institutional study showed that IFs with a high urgency level were discovered in 0-2.0% of participants, including healthy volunteers, and that the rate of IF discovery in general was higher in studies conducted in elderly population. Moreover, multi-institutional study...
Communicating Findings: A Justification and Framework for Direct Radiologic Disclosure
American Journal of Roentgenology, 2013
harm there might be to the patients in radiologists communicating them. We claim that the argument for limiting disclosure only to good news is seriously flawed . The practice guidelines that we advocate employ a sliding scale based on the diagnostic confidence of imaging results, in which the higher the radiologist's confidence is in the results, the stronger the duty is to disclose them.
Insights into imaging, 2012
To determine why, despite growing evidence that radiologists and referring physicians prefer structured reporting (SR) to free text (FT) reporting, SR has not been widely adopted in most radiology departments. A focus group was formed consisting of 11 radiology professionals from eight countries. Eight topics were submitted for discussion. The meeting was videotaped, transcribed, and analyzed according to the principles of qualitative healthcare research. Perceived advantages of SR were facilitation of research, easy comparison, discouragement of ambiguous reports, embedded links to images, highlighting important findings, not having to dictate text nobody will read, and automatic translation of teleradiology reports. Being compelled to report within a rigid frame was judged unacceptable. Personal convictions appeared to have high emotional value. It was felt that other healthcare stakeholders would impose SR without regard to what radiologists thought of it. If the industry were to...
An Epidemiological Study on Paediatric Brain MRIs with a Focus on Contextual Reporting
EMJ Radiology
Objectives: Paediatric neuroradiology is one of the most challenging areas in the wide gamut of disciplines that modern radiology encompasses. There is a paucity of literature on the epidemiology of paediatric neuroimaging and contextual reporting in this field. The objectives of this study were to study the epidemiology of the paediatric neurological disorders and to study the role of contextual reporting in this field. Materials and methods: This study was conducted at a tertiary care centre in Southwestern India over 1 year. It was a retrospective epidemiological study. The authors studied 112 patients referred as in- or outpatients for a brain MRI for a wide range of indications. The authors analysed the reports issued by their radiologists and reformatted them into a newly proposed contextual reporting template for the paediatric brain. Then, the authors conducted an epidemiological analysis of the compiled data. Results: The authors found that the most common indication for pa...
Evolution of universal review and disclosure of MRI reports to research participants
Brain and Behavior, 2016
Background: Although incidental findings (IF) are commonly encountered in neuroimaging research, there is no consensus regarding what to do with them. Whether researchers are obligated to review scans for IF, or if such findings should be disclosed to research participants at all, is controversial. Objective data are required to inform reasonable research policy; unfortunately, such data are lacking in the published literature. This manuscript summarizes the development of a radiology review and disclosure system in place at a neuroimaging research institute and its impact on key stakeholders. Methods: The evolution of a universal radiology review system is described, from inception to its current status. Financial information is reviewed, and stakeholder impact is characterized through surveys and interviews. Results: Consistent with prior reports, 34% of research participants had an incidental finding identified, of which 2.5% required urgent medical attention. A total of 87% of research participants wanted their magnetic resonance imaging (MRI) results regardless of clinical significance and 91% considered getting an MRI report a benefit of study participation. A total of 63% of participants who were encouraged to see a doctor about their incidental finding actually followed up with a physician. Reasons provided for not following-up included already knowing the finding existed (14%), not being able to afford seeing a physician (29%), or being reassured after speaking with the institute's Medical Director (43%). Of those participants who followed the recommendation to see a physician, nine (38%) required further diagnostic testing. No participants, including those who pursued further testing, regretted receiving their MRI report, although two participants expressed concern about the excessive personal cost. The current cost of the radiology review system is about $23 per scan. Conclusions: It is possible to provide universal radiology review of research scans through a system that is cost-effective, minimizes investigator burden, and does not overwhelm local healthcare resources.
A practical approach to incidental findings in neuroimaging research
Neurology, 2011
We describe the systematic approach to incidental findings (IFs) used at the Mind Research Network (MRN) where all MRI scans receive neuroradiologist interpretation and participants are provided results. From 2004From to 2011 MRI scans were acquired by 45 researchers. As mandated by MRNЈs external institutional review board, all structural sequences were evaluated by a clinical neuroradiologist who generated a report that included recommendations for referral if indicated. Investigators received a copy of their participants' reports, which were also mailed to participants unless they specifically declined. To better understand the impact of the radiology review process, a financial analysis was completed in addition to a follow-up phone survey to characterize participant perceptions regarding receiving their MRI scan results.