Patient-centered Precision Medicine Lab Result Communication for Older Adults

At UCLA Health over 80% of all patients >65 years view their lab results through the patient portal within one day of their availability, making this a potentially very powerful way to communicate with patients (in contrast to patient portal messaging which generally has much lower rates of viewing/uptake). Currently, lab results displayed to patients and providers via the EHR include a reference range; results outside this range are printed in red and marked by a red arrow indicator ("flagged"). Though there is a disclaimer in small text at the bottom of the report explaining that "[a] test result listed as 'abnormal' may be normal for you," the header of the report prominently features a large yellow box with the text "Abnormal."

In 2023, the investigators conducted a formal community engagement studio (CES) using well-tested methods to learn more about older adults' lived experiences with communication of lab results. The CES included 11 community stakeholders representing aging and health services organizations including but not limited to the LA County Aging and Disabilities Department, the local Area Agency on Aging (AAA), AARP California, and Watts Labor Community Action Center. Results from that CES include consensus around two key conclusions: 1) older adults want more "useful information" to accompany their lab results; 2) there is tremendous enthusiasm around the idea of individualizing communication of the results of diagnostic lab tests.

For this study, the primary analysis is to compare self-report attitudes in response to behavioral-science grounded new template reports versus each other. Four arm Randomized Controlled Trial (RCT) between unique participants. The primary analyses will assess differences between each new template report and the control communication. Secondary analyses include testing the acceptability/preference of the new template reports combined versus control across participants and also a within participant analysis for the 3 arms who receive one of the new communications first followed by the control.

The revised survey improves wording and participant understanding. The current study uses the amended version for confirmatory analyses.

Patient Inclusion Criteria:

• Older adults (aged ≥65 years);
• Currently have a UCLA primary care provider (PCP);
• Enrolled in the patient portal;
• English-speaking (as the language of the tool is currently only in English, and it would be impractical to have validated translations created for all of the potential variations and derivatives of the tool template reports); and
• Without dementia or other neurocognitive disease.
• Does not have End-Stage Kidney Disease (ESKD)

Provider Inclusion Criteria:

• UCLA Health providers who care for large numbers of older adults in outpatient settings.

Patient Exclusion Criteria:

• Are under the age of 65
• Do not have a UCLA PCP;
• Are not enrolled in the patient portal;
• Are not English speaking (as the tool prototypes are only in English until final verbiage is determined);
• Are diagnosed with dementia or other neurocognitive disease.
• Have ESKD

Provider Exclusion:

• Do not care for large numbers of older adults in outpatient settings