Clinicians' perspectives on Integrating Pathologists into Patient Care Teams
By Lynn McCain | March 2 2023Researchers from the Department of Pathology recently published a fascinating study into clinician’s perspectives on integrating pathologists into the patient’s care team in the form of pathology explanation clinics (PECs) [1]. Clinicians were asked, “How interested would you be in having your patient meet with a pathologist to discuss their pathology report and see their tissue under the microscope?”
This study is the final arm in a stakeholder analysis characterizing the attitudes of key organizational members (namely patients, pathologists, and clinicians) towards patient-pathologist interactions. In the patient-centered arm, 85% of cancer patients expressed interest in engaging with pathologists to help them better understand their diagnoses and test results, citing an interest in improved understanding of diagnosis, demystification of the diagnostic process, and empowerment [2]. In the pathologist-centered arm, 86% of pathologists also expressed interest in engaging in PECs [3]. PECs may be of more interest to a broader community since the implementation of the 21st Century Cares Act which now requires immediate release of pathology reports to patients.
The research team including, co-first authors Sarah Bergholtz, MPH (top right) and Sophia Kurnot, BS (bottom) and their mentor, Cathryn Lapedis, MD, MPH, (top left) set out to better understand how well-run PECs would be received by clinicians. Of 35 clinicians surveyed and interviewed, 83% expressed some level of interest, assuming that patients are told their diagnosis by their treating physician, the pathologist would only discuss the diagnosis and would refer the patient back to their clinician for questions regarding prognosis and treatment, and the pathologist would send a follow-up note to the clinical team after the PEC.
This study uncovered nuanced attitudes of clinicians towards PECs that would need to be considered in any program incorporating the pathologists into the care team. Clinicians described that PECs could provide useful information to patients about their diagnosis, and the process of diagnosis. Clinicians note that the visual nature of PECs could be particularly valuable. Clinicians were concerned that pathology information would need to be carefully timed and titrated to each individual patient’s needs as information can be harmful to some patients, leading to information overload and emotional distress. Although literature does not support this attitude, clinicians in the study believed that only a subset of highly educated and motivated patients were most likely to benefit from or want to participate in a PEC.
Clinicians had concerns about pathologists’ ability to effectively communicate with patients but did feel that if pathologic information was communicated clearly integrating pathologists into clinical care had the potential to improve efficiency and quality of care. Clinicians were also concerned about integrating PECs into an already complex system of medical care.
In this final arm of the stakeholder analysis, significant concerns were raised, and many important nuances were identified by treating clinicians, but there was still a high level of interest in the potential for integrating the pathologist into the care team in the form of PECs. Key potential benefits identified included improved patient understanding and emotional processing, as well as improved clinician efficiency and quality of care.
In conclusion, Lapedis commented, "I especially want to thank Anatomic Pathology Division, Department of Pathology, Michigan Medicine and the Health Services Research Student Fellowship and Internship Program of the Institute for Healthcare Policy and Innovation at Michigan Medicine for their support of this project."
Citations:
- Bergholtz SE, Kurnot SR, DeJonckheere M, Hawley ST, Owens SR, Lapedis CJ. A Mixed-Methods Study of Clinicians' Attitudes Toward Pathology Explanation Clinics. Am J Clin Pathol. 2023 Feb 23:aqac175. doi: 10.1093/ajcp/aqac175. Epub ahead of print. PMID: 36821476.
- Lapedis CJ, Horowitz JK, Brown L, Tolle BE, Smith LB, Owens SR. The Patient-Pathologist Consultation Program: A Mixed-Methods Study of Interest and Motivations in Cancer Patients. Arch Pathol Lab Med. 2020 Apr;144(4):490-496. doi: 10.5858/arpa.2019-0105-OA. Epub 2019 Aug 20. PMID: 31429605.
- Lapedis CJ, Kroll-Wheeler L, DeJonckheere M, Johnston D, Owens SR. Broadening the Scope: A Qualitative Study of Pathologists' Attitudes Toward Patient-Pathologist Interactions. Am J Clin Pathol. 2021 Nov 8;156(6):969-979. doi: 10.1093/ajcp/aqab044. PMID: 33948623.
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