To what extent do patients and GPs have a shared understanding of blood testing in primary care?

Problem

Rates of blood testing are increasing in primary care, with significant implications for NHS costs and GPs workload. Increased testing rates are not mirrored by increased rates of disease, suggesting non-medical reasons such as patient or GP expectations may be important. There is increasing awareness about the importance of shared decision making in medicine, but most research focuses on treatment decisions rather than investigations. The aim of this research is to compare patients’ and GPs’ experience, expectation and understanding of testing, in order to improve communication and promote patient engagement.

Approach

Six general practices were recruited, reflecting a range of socioeconomic and demographic characteristics. Patients were recruited at the time of blood testing by phlebotomists or GPs. Qualitative interviews were undertaken with patients at two time points: (a) at or soon after their blood test and (b) after they had received their test results. We also undertook interviews with the patients’ GPs who requested the tests. This gave us paired data which enabled to us to examine areas of congruence and dissonance between GPs’ and patients’ expectations, experience and understanding of testing.

Findings

22 patient and 21 GP interviews have been either booked or completed, out of a target of 30 patients and 30 GPs. Early findings indicate a lack of shared understanding and a mismatch between patients’ and doctors’ expectations of testing. Patients are frequently unaware which tests have been done and why. Patients have high expectations of tests; expecting them to provide diagnostic certainty without mistakes, whereas doctors expectations are more modest. Whilst doctors tend to be reassured by normal results, patients with ongoing symptoms may find normal results unhelpful. Patients’ expectations that tests will provide answers can be frustrated by a lack of communication about test results.

Consequences

The results have implications, not just for shared decision making, but more fundamentally, informed consent. Misunderstanding and a lack of communication around testing and test results can lead to uncertainty, anxiety and frustration for patients. Promoting a shared understanding and shared decision making could help rationalise testing, potentially reducing unnecessary investigations and improving patient-centred care.