A co-designed patient reported experience measure for understanding the patient's and public experience of receiving X-ray results

Introduction: The National Health Service England (NHSE) General Practitioner (GP) contract mandates the implementation of electronic health records (EHR) to improve patient access to medical results. However, access to complex X-ray reports can lead to patient anxiety and misunderstanding, necessitating the requirement for clear communication. This paper reports an example of a good practice approach to research co-design and co-production with Patient and Public Involvement (PPI) experts to develop a Patient Reported Experience Measure (PREM) to explore accessing X-ray reports through EHR.

Method: A participatory method of a modified e-Delphi (iterative process) utilising PPI focus groups followed by two rounds of reviewing online survey questions to gain consensus. The PREM used Likert scoring, data analysis of each subscale score, and distributions, including face, construct, and content validity, reliability coefficient, principal component and factor analysis, and dimension reduction.

Results: The phase one PPI focus groups (n=28 participants) co-produced n=16 themes related to the experience of receiving X-ray results. Key themes emphasised the need for patient-friendly language to reduce anxiety and misunderstanding of complex language and terminology. The PREM tool was refined through two rounds of iterative feedback. The phase two survey included n=57 questions, while the phase three survey pared down questions to n=27.

Conclusion: It is critical to involve patients in the co-design and co-production of PREM tools to ensure they appropriately capture patient and public lived experiences. Implementing clear, patient-friendly communication within EHR X-ray reports could reduce anxiety and empower patients’ decision-making.

Implications for Practice: National testing of the PREM involving a large sample of diverse participant demographics is recommended. Future PREM findings will assist in recommending and developing strategies to improve EHR communication of X-ray report wording, structure, and content.