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Review
. 2023 Nov 8:15:100349.
doi: 10.1016/j.jpi.2023.100349. eCollection 2024 Dec.

Cognitive factors impacting patient understanding of laboratory test information

Edward C Klatt  1
Affiliations
Review

Cognitive factors impacting patient understanding of laboratory test information

Edward C Klatt. J Pathol Inform. .

Abstract

Laboratory testing can provide information useful to promote patient health literacy and ultimately patient well-being. The human state of mind involves not only cognition but also emotion and motivation factors when receiving, processing, and acting upon information. The cognitive load for patients acquiring and processing new information is high. Modes of distribution can affect both attention to and receipt of information. Implicit unconscious biases can affect whom and what patients believe. Positive wording and framing of information with salience for patients can evoke positive emotions. Providing patients with the gist, or essential meaning, of information can positively influence decision-making. What laboratorians provide as information helps to combat mis- and disinformation. Laboratorians can actively participate in measures to improve the patient experience in health care by developing and contributing to high-quality information to enable timely, meaningful communication and interpretation of test results.

Keywords: Bias; Cognition; Health literacy; Laboratory test; Patient experience; Trust.

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Conflict of interest statement

The author declares that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.Table A.1Cognitive load.Table A.1Intrinsic loadThe number of new information elements (pieces of data) to be processed simultaneouslyModified by element interactivity and conceptual difficulty: how many elements, how complex are the elements, and how closely are they are related to one another. Reduced by breaking down complex tasks into a series of simplified tasks.Extrinsic loadThe cognitive demand of information acquisition by the ways it is received.High when there is no long-term working memory and when searching for information; high with multitasking.Germane loadThe extent that information resonates with the motivation to expend mental effort in comprehending information.Modified by perceived level of importance. Reduced by implicit biases, lack of trust in information sources, mental fatigue, and distractions.Table A.2Modes of learning inform best practices to provide information.Table A.2Mode of learningAttributesBest practicesReading (printed report or electronic device screen display)An efficient way to distribute information. Requires literacy with language fluency for deciphering the meaning of informational content with the level of complexity presented.Appropriate size fonts without dense text; break large data into smaller chunks and use lists to organize data elements; clearly identify abnormal values. Use positive wording. Avoid technical jargon; avoid irrelevant information.Visual (graphical display of static images; or video recording)Seeing illustrations or watching a video can lessen cognitive demands on working memory to comprehend new information. Less dependent upon language skills.Judicious use of graphic illustrations in printed reports; format for visual clarity at appropriate magnification for the detail required; avoid overly complex imagery. Adapt for color blindness.Auditory (hearing a narration)Hearing while reading or watching a video aids information acquisition to lessen cognitive demand. Requires language fluency.Provide vocal clarity with even pace, tone, and volume; avoid distracting noise or accent; avoid “talking head” with video.Kinesthetic (performing a task)Put into practice what was read, heard, or seen first. Can be combined with coaching.Provide a private place without distractions; focus on the task, not the surroundings. Repeat as needed.Table A.3Cognitive biases influence information reception and processing.Table A.3Explicit biasAttitudes and assumptions we consciously acknowledge as part of our own personal belief systems.Implicit biasUnconscious associations, beliefs, or attitudes toward others (prejudice) that can affect our judgment, decisions, and behaviors directed at others as an adaptive means to quickly react to novel or uncertain situations. They are formed through a combination of early experiences, emotions, and learned cultural practices.Continued influence effectInformation initially presented as true, but later shown to be false, may continue influencing memory and reasoning, with reluctance to dismiss past information without a plausible alternative. If new information is presented to replace initial false information, repeating false information may serve to reinforce it, not replace it.Illusory truth effectThe more a statement is repeated and becomes familiar, the more likely it is believed, whether true or not, as in mass marketing strategies.Framing effectHow information is perceived may depend upon whether it is presented as a positive gain or a negative loss.Salience biasThe perceived value, relevance, and attainability of an outcome of importance can be connected to information being presented, along with the mental effort to comprehend it, emotional resonance with it, and motivation to seek reward using the information.Motivated reasoningSearching for facts to support what we want to be true, confirming our beliefs, rather than letting facts guide us to a rationale conclusion. Even scientists are subject to bias supporting positive, conclusive results in experiments and clinical trials when there is reward for positive results, not negative results.Table A.4Design elements for patient portal information.Table A.4Provide a takeaway message for a test resultThe patient wants to know if the test result is good or bad, if the variation up or down in serial results is meaningful, and if a result indicates some action may be needed.Make reference ranges clearProvide an explanation that reference ranges typically apply to healthy people, results within range may vary even when healthy, and small changes outside the range may not be serious, and that consultation with a medical professional may help resolve uncertainties.Promote patient accessibility and usageLaboratory information may be accessed on multiple devices, from desktop to laptop computers to mobile devices like a smartphone. Web Content Accessibility Guidelines may aid in developing enhanced access. Provide for download of results in standard file formats to retain formatting of graphics, reference ranges, and text.Provide for conversion of results to other units of measureTest results may originate from different sources reporting in different units or scales. Patients may get results from different health care providers or institutions. Patient may take results and try to apply them to online sources like risk calculators for result interpretation.Collaborate with others in developmentEmploy focus groups of patient end users, both new to and experienced with electronic information access. Collaborate with experts in interface design for diverse audiences, content experts in interpretation of test data, and experienced clinicians who interface in person with patients.Table A.5Sample takeaway messages for test result reporting to patients.Table A.5Test performedYour resultReference rangeInterpretationHemoglobin A1c (Hgb A1c)6.6%Less than 5.7% in healthy peopleYour result increased from the last test, and above 6.4% can mean that diabetes mellitus is present. Treatment of diabetes can lower Hgb A1c.Lead level in blood53.7 μg/dL3.5–19.9 μg/dLImmediate medical attention is needed.HER2 (ERBB2) for breast cancerPositive (3+)Negative or PositivePositive result enables breast cancer treatment with HER2 specific therapy.COVID-19 (SARS-CoV-2) by NAAPositiveNegativePositive result is a risk for serious illness and passing this virus to others. A positive result can occur if you are not ill, but medical attention is recommended.Prostate-specific antigen (PSA), total5.0 ng/mL0.0–4.0 ng/mLFor your elevated result, an additional free PSA test may be helpful in distinguishing benign conditions like hyperplasia (BPH) from prostate cancer, along with medical evaluation.Prothrombin time (PT) International Normalized Ratio (INR)1.5 INR2.0–3.0 INRWhen taking warfarin (coumadin), for an INR below 2 or above 3, medical attention is recommended to determine if the dose needs adjusting.Cholesterol, total176 mg/dL<200 mg/dL (<5.2 mmol/L in SI units)Your result is good.

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