Consumer understanding of terms used in diagnostic imaging reports requested for shoulder pain

Background: Shoulder problems are a significant cause of morbidity and disability in the general population. A systematic review of eighteen cross-sectional studies reported point prevalence figures for shoulder complaints ranging from 6.9 to 26%. Shoulder pain is a common reason for seeking medical care and is the third most common musculoskeletal presentation to general practice. The annual prevalence and incidence of adults consulting a general practitioner for shoulder pain is reported to be 2.4% and 1.5% respectively. Imaging requests for shoulder pain are common and increasing. In Australia, between 2009 and 2012, a total of 1173 imaging tests were ordered for shoulder problems at a rate of 44.5 imaging tests per 100 shoulder problems managed. This is estimated to be a 37% increase since the period between 2002 and 2005. During this time ultrasound of the shoulder increased significantly from 17.4 to 28.5 per 100 shoulder problems. However, best available evidence does not routinely recommend imaging for shoulder pain unless there is a suggestion of serious pathology, or in cases with an abnormal clinical course or that do not respond to treatment. Despite these recommendations, a survey of a random sample of Australian general practitioners and rheumatologists has demonstrated a high reliance on imaging for common shoulder problems. Inappropriate imaging can lead to poorer health outcomes and increased healthcare costs through radiation exposure and misinterpretation of results by clinicians and patients. Misinterpretation of imaging results can occur due to the high prevalence of imaging abnormalities that are poorly correlated with clinical symptoms. For example, asymptomatic individuals commonly have ultrasound evidence of rotator cuff tears and this increases with age. Misinterpretation may also occur as a result of information and labels that may not be well understood by the clinician or consumer. For example, communication of uncertainty using terms such as unsure, possible or likely has been identified as a potential source of misunderstanding in radiological reports. Likewise, the use of hedge words, tautological phrases are not recommended in radiological reports. The potential for misinterpretation has led to concerns that ultrasound findings might be misleading and result in over-diagnosis and/or overtreatment. Changing the language used and/or content of imaging reports may be a potential way to improve understanding of diagnostic imaging reports requested for shoulder pain. A cross-sectional study demonstrated that rewording MRI reports for upper extremity conditions in simplified and more dispassionate language was associated with better patient ratings of emotional response, satisfaction, usefulness and understanding. Another study that analysed the content of radiology reports for patients with chronic low back pain, found degenerative terms such as wear and tear were associated with a poor perceived prognosis by patients. However, to our knowledge, no previous studies have examined the understanding and perceived prognosis of terms used in shoulder imaging reports and whether or not there may be terms that are less worrisome. Aims: This project will have 2 aims; 1) to understand how well patients/consumers understand terminology used in shoulder ultrasound reports, their level of concern and perceived prognosis of common findings for shoulder pain 2) identify if there are less worrisome words that have the same meaning to consumers/patients Methods: A scoping review conducted by the department has identified the most commonly used words in ultrasound reports, those that are common findings in asymptomatic individuals, words which are the most/least preferred by consumers/patients, as well as words that have been associated with positive and negative emotions (pleasant, unpleasant), creating a sense of unease or reassurance and words that make patients/consumers feel in control or dominated. Consumers/patients with and without shoulder pain will be invited to participate in an online survey. The online questionnaire will provide a list of the terms identified in this scoping review and will ask them to rate a how strongly they agree or disagree with the statements: 1) I understand what this terms means 2) If my ultrasound included this label, would I be worried that I had something seriously wrong 3) If my ultrasound included this label it means that I’m going to have ongoing shoulder troubles 4) I will need surgery to fix this problem The survey will also include demographic questions and questions about their history of past/present shoulder pain and severity. It will also ask questions about who they think should see imaging reports, if they should be written in lay language and whether or not they think information about how common the findings are in people without shoulder pain. Skill acquisition: Quantitative and qualitative analysis