Introduction

This literature review was undertaken for the Structured Reporting of Cancer project. These are the main points relevant to the collaborative Effective Communication of Pathology Results project that I drew from this literature review:

• There has not been much research done on style / format / readability of medical reports
• There is increasing recognition that readability has a direct impact on processing of information and understanding
• The design of an ideal vehicle to communicate information should use skills of psychology, graphical design, perception and typography.
• Eye tracking is a useful tool – especially for the design of screen based formats
• Formats on paper and on screen need to be comprehensively analysed as there appears to be differences in how information via these two mediums are processed
• Empirical evidence is a better guide than preferences in the design process

Cancer is a growth industry. The incidence rate for all cancers combined has increased by 27% since 1982¹ with the number of people being diagnosed with cancer projected to increase by over 3,000 extra cases per year as a result of the ageing population.

The pathology report is the foundation of a patient’s cancer journey. Most significant treatment decisions are based on the pathology report which:

• provides the definitive diagnosis
• includes information necessary for staging,
• evaluates the adequacy of the surgical excision,
• gives a determination of appropriate chemotherapy and/or radiation therapy
• and identifies important prognostic indicators.

The magnitude of the surgical intervention and the extent and type of treatment is all based on the pathology report details. It is the pathology report that dictates management and prognosis by detailing the disease process. In addition, the pathology report is the most significant source of information for cancer registries providing information for cancer care planning and resource distribution at a national level.

A pathologist’s role is to provide information. The pathology report is the one forum in which they are able to document and communicate that information. The challenge faced by pathologists, is to create a document that is simple to read, streamlined, comprehensive, useful, and that contains sufficient documentation to meet all requirements. However, the style in which this data is presented eg layout, font, tables, is often constructed solely for aesthetic and marketing (branding) purposes with little regard to its impact on readability and comprehension.

The aim of this literature review is to identify the evidence relating to the style (text layout) of pathology reports and the impact that this has on enhancing communication, understanding and readability. While the focus is cancer reports, by necessity this evaluates the form/layout of pathology reports in general and in a wider context, other healthcare documentation.