Knowledge is power: Numbers help patients understand incidental finding risk

Incidental findings often take patients by surprise—causing anxiety, raising questions of severity and leading to uninformed decision-making. When it comes to incidental renal lesions, researchers found communicating risks with numerical graphics may provide patients with a better understanding of options.

20. study was published in the February edition of the American Journal of Roentenology.

Routine communication related to incidental findings with imaging is non-standardized and variable and often not communicated whatsoever. Decision-making can be negatively impacted by these differences.

A randomized survey study was given to adults undergoing outpatient imaging. Surveys were split into two groups: descriptive graphical risk information and a combination of descriptive and numeric graphical risk information about three hypothetical incidental renal findings at CT.

The hypothetical findings included: two-cm (low-risk), five-cm (high-risk) renal tumors and a two-cm (low-risk) renal artery aneurysm.

Surveys from 299 participants were then analyzed. The responses measured patient distress, perceived risk (qualitative and quantitative), treatment preference and valuation of lesion discovery.

Below are findings from the survey:

Perceived Risk

• For the two-cm renal mass group, perceived risk was 34.1 percent versus 16.3 percent for descriptive instead of numeric risk information.
• For the two-cm renal aneurysm group, perceived risk was 33.9 percent with descriptive information, compared to 14.1 percent with numeric.

Patient Distress

• Patients worried more when they received only descriptive risk information.
• In the two-cm renal mass group, mean score for worry was 4.12 with descriptive information, compared to 3.56 with numeric risk information.

Treatment preference

• In the two-cm renal mass group, patients who received only descriptive information preferred surgical consultation 46.9 percent of the time.
• When numeric risk information was added to the above outcome, 29.3 percent of patients preferred surgical consultation.
• In the five-cm renal mass group, patients preferred surgical consultation in both survey outcomes.

Valuation of lesion discovery

• In both surveys, the discovery of the five-cm renal mass was valued more than the other lesions. Overall, scores were high for patient satisfaction with knowing about the finding.

Given the fact that this study has demonstrated how important communication is when discussing incidental findings, the authors suggest further research may be needed to standardize risk communication.

“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,” wrote corresponding author Stella K. Kang with the Department of Radiology at NYU Langone Medical Center, et al.