How can patient and primary care professional understanding of bone density (DXA) scans be optimised? Qualitative findings from the INDEX study

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

3F.6

Presenter:

Chelsea Kettle

Co-authors:

Chelsea Kettle, Jo Butterworth, Jill Griffin, Beverly Henderson, Clare Jinks, Karen Knapp, Fay Manning, Laurna Bullock, Zoe Paskins

Author institutions:

Centre for Musculoskeletal Health Research at Keele University, Midlands Partnership University NHS Foundation Trust, Exeter Collaboration for Academic Primary Care (APEx), University Hospitals Plymouth NHS Trust, Royal Osteoporosis Society, Keele University Research User Group, Faculty of Health and Life Sciences at Exeter University

Problem

Primary care is crucial to identifying, investigating, and managing people with, or, at risk of osteoporosis. Patient and primary care professionals (PCPs) report difficulty understanding dual-energy X-ray absorptiometry (DXA) scans and results, impacting decision-making about osteoporosis medicines. The Improving uNderstanding of bone DEnsity (dXa) scans (INDEX) study aims to explore patient and PCP understanding of DXA scans and results to identify opportunities to optimise DXA understanding.

Approach

Semi-structured think-aloud interviews with (1) patients attending DXA scans across 3 NHS sites and (2) PCPs that refer to, and receive results from, DXA services. Two Public Involvement meetings with people with osteoporosis shaped the study design, data collection materials, and early data interpretations. Interviews were transcribed verbatim and framework analysis is ongoing, sensitised by the common-sense model of illness self-regulation to explore how patients perceive, interpret, and respond to their condition.

Findings

28 patient (89.3% female; mean age of 67 years; 92.9% high health literacy) and 11 PCP (10 General Practitioners, 1 First Contact Practitioner) interviews have been completed. Recruitment is ongoing. Early analysis generated four themes relating to (1) the significance of bone health screening, (2) unmet information needs and the (3) consequences and (4) barriers and facilitators to addressing information needs. Patients had varying attitudes towards having a DXA scan. Some patients expressed apprehension about receiving DXA results whilst others described low concerns, often because ‘higher priority’ comorbidities were present that were perceived to be more ‘important’ or requiring more PCP attention.Unmet information needs were common; for patients these included (1) what DXA results meant, (2) treatment options and instructions and (3) ongoing osteoporosis management. PCPs also described unmet information needs regarding (1) who to target for osteoporosis screening, (2) medicine options and management, and (3) clinical report content. In result, patients reported consequences, with some describing anxiety from misinterpreting DXA results, causing them to look elsewhere for explanations. Also, PCPs reported reduced confidence communicating results and difficulties with clinical decision-making because of unmet information needs. Barriers to meeting information needs included DXA result content and delivery. Many patients with osteoporosis or osteopenia felt that written results (e.g. texts, clinical reports) were insufficient without further explanation and opportunities for questions. Likewise, PCPs described verbally communicating DXA results involving new diagnoses and/or medicine initiation. Often, patients wanted but were unable to visualise their risk of osteoporosis due to the information provided. To address this, PCPs suggested inclusion of graphs within clinical reports to support DXA result communication.

Consequences

The INDEX study highlights uncertainties about DXA among patients and PCPs and reveals opportunities to optimise understanding. Findings will inform coproduced resources to enhance DXA understanding, with the aim of supporting clinical and shared decision-making and osteoporosis medicine uptake.

Submitted by:

CHELSEA KETTLE

Funding acknowledgement:

This study is funded by the Royal Osteoporosis Society (ROS) Research Grant 2021 (REF:478). ZP is funded by the National Institute for Health and Care Research (NIHR) [Clinician Scientist Award (CS-2018-18-ST2-010)/NIHR Academy] and has received consultancy fees and grant funding from UCB Pharma. CJ is part funded by NIHR Applied Research Collaboration (ARC) West Midlands. FM is funded by the NIHR Applied Research Collaboration South West Peninsula. JB is funded by a NIHR Doctoral Fellowship award (2017-10-005). The views expressed are those of the author(s) and not necessarily those of the National Health Service, the ROS, or the Department of Health and Social Care.