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3 Big Revelations in Study on Synoptic Reporting for Cancer Pathology

When discussing synoptic medical reporting, people usually focus on the end-users (those filling out the forms) and the data that can be used downstream for important research. But one element that is often buried is the recipient of the reports. The audiences of these reports aren't just researchers sifting through data or other physicians generating the forms. The audiences are surgeons that sent the sample to the pathology lab, referring physicians that will want to know everything going on with their patients, and other doctors that will need to use the captured information to determine treatment decisions. How do the audiences of these reports feel about receiving and reviewing synoptic reports versus those created using dictation and transcription? A study was recently published in the Archives of Pathology titled Standardized Synoptic Cancer Pathology Reports: So What and Who Cares? A Population-Based Satisfaction Survey of 970 Pathologists, Surgeons, and Oncologists. The results of the study show the various ways that synoptic reporting positively impacts these physicians and the specific ways that it improves over the previous methods of reporting.

Here are the 3 biggest revelations from that study:

Easier to Find Important Information

Practice-related comments referred to the improvement of the information available (eg, "allows me to find the information I need quickly and efficiently;" "by having a common language, this improves the efficiency of patient management")

With synoptic reports, physicians no longer have to search through unstructured text transcribed from the dictation of pathologists, unsure when/where in the report the pathologists will refer to the part that especially interests the physician in that unique case. And, due to uniformity of language - the words used to describe the findings are all the same - these physicians can quickly find the section they want and just as efficiently understand the response given.

Physicians Think Synoptic Reports are 'More Complete' Than Reports Made with Dictation/Transcription

Multiple points in the study point to the same finding in the survey question: physicians reading/using these synoptic pathology reports think they are more complete. The sample of oncologists, surgeons, referring physicians, etc., all report that they believe that the standardized, structured synoptic report they receive is more comprehensive than the one that is produced through dictation/transcription without any structure or adherence to standards. It should be pointed out that some physicians stated in the survey that they worry that "completeness can mask accuracy." By which they seem to mean that all the fields are filled out, but that doesn't mean they are filled out correctly. Which is fair - but is also a criticism of any pathology reporting; it will only be as good or as accurate as the pathologist filling it out. However, with synoptic reporting, there's a greater likelihood that a more complete picture will be developed as the reporters are compelled to fill out all of the fields in concrete ways, instead of vague allusions allowed in dictation.

This has been backed up by many other studies in the past (here's one, for example) that show that when prompted (or reminded) of elements that could be in the report, pathologists will be more inclusive of information. This has been discussed in other realms of medicine - most famously in Gawande's The Checklist Manifesto - with studies showing that when physicians see elements listed out, it not only prompts them to recall about what's written, but can also lead to the inclusion of other information that is also pertinent to the treatment of the patient.

Overall, Physicians Feel Positively About Synoptic Reporting

Results showed a moderately strong positive relationship between respondents’ perceptions of overall satisfaction with the level of information provided in synoptic reports and respondents’ perceptions of the completeness of the reports for clinical decision making (r = 0.750, n = 313, P < .001), comparison with accepted content standards (r = 0.692, n = 313, P < .001), ease of finding information for clinical decision making (clinicians: r = 0.663, n = 314, P = .001; pathologists: r = 0.510, n = 171, P < .001), and the report’s ability to facilitate a consistent approach to diagnostic and prognostic factors (clinicians: r = 0.717, n = 312, P < .001; pathologists: r = 0.638, n = 168, P<.001)

Physicians receiving these synoptic reports are generally happier with them than those presented in unstructured formats. They know exactly where to look to find the information they need in consistent wording that empowers them to make important treatment decisions. They don't have to worry about vague descriptions or wade through paragraphs of unimportant dictation to find what they really need. In the unstructured way, too often the physicians have to follow-up with the pathologists to clarify these matters, which takes time out of their busy schedules and also impedes treatment. Furthermore, for many pathologists, these surgeons/physicians are their "customers" - physicians and facilities select these labs to receive their specimens. The happier the customer base, the more business that lab will receive - so there is a financial incentive to please the readers of the report. If the physicians dread receiving a report because it means they will have to take the time to call the lab to find out what a sentence meant or what the pathologist found, then they will be less likely to want to continue to use that particular lab for those services. But if that physician knows that s/he will receive standardized reports in a reliable structured format with consistent language, they can easily incorporate that into their workflow and will be happy to continue using that lab.


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