Formatting Pathology Reports

There are two publications which discuss the impact of formatting of anatomical pathology reports. The first is a paper Formatting Pathology Reports: Applying Four Design Principles to Improve Communication and Patient Safety, by Valenstein² in which he describes four design principles for pathology reports.

1. Using headlines to emphasise key findings
2. Maintain layout continuity
3. Optimise information density
4. Reduce extraneous data or clutter

A structured report lends itself to all of these principles however the study makes no other specific recommendations on style.

The second investigation into surgical pathology report formats is by Powsner et al ³ in 2000. They found that there is a significant difference in clinicians understanding of the content of a pathological report based on the physical presentation of the information in the report. The participants compared existing formatted reports with a new streamlined report format with changes including spacing, highlighting, positioning of information, and font selection. They found that these items, did not in and of themselves, contribute to the content of the report; however, they did appear to contribute substantially to the comprehension of that report, despite nearly identical wording.

Powsner et al also found that changing the style (text layout) actually increased the error-rate which they postulate as “a negative short-term effect on .. readers (ie report disorientation).” In effect this finding demonstrating the impact of style (text layout) on the comprehension of documents. However the ‘streamlined’ format used in this study was based largely on aesthetic qualities preferred by the authors rather than any validated recommendations as “essentially no empirical literature exists on pathology report comprehension to provide a guide for improvement”³
The format in which pathology data is presented eg layout, font, tables, is often constructed solely for aesthetic and marketing (branding) purposes. Reports formats are generally perceived as simply a vehicle for information, inherently conveying a message as to the quality of work performed but with little regard to its impact on readability and comprehension by the clinician.

Ruby⁴ states that “reports are our product and effective communication is our connection with our clinical colleagues”. Have we missed a vital component in our communication?