Summary

There is a significant lack of investigation into style (text layout) on readability and comprehension of pathology reports in general and anatomical pathology reports specifically. This may be a result of a perception that style is not an important factor in communication of this type of information. Medical documents including pathology reports have developed over a long period of time and are more focussed on content, aesthetics and branding that on readability and comprehension.

In recent studies there is recognition that style( text layout) impacts on readability, speed of assimilation of information and in reference to consistency in layout, impacts on patient safety. Some of the key features noted are:

• Consistency in positioning
• Headings and subheadings to create visual landmarks
• Information grouping/chunking
• Topographical considerations – font, line spacing, white space

What is clearly lacking in the literature is any detailed study into a style of report for pathological information which supports quick and easy assimilation of often complex data. Of all the eye tracking and readability studies and tools, standardisation of format, investigations into effects of topography on reading and comprehension most are based on either non-health related documents or documents designed to be read by patients rather than complex documents design primarily to be read by medical personnel.

Wyatt⁷⁷ suggested we tap into the design skills of psychology, graphical design, perception, and typography and as with the design of railway timetables to electricity bills use this type of information to create the ideal vehicle for communicating pathological information. We must ensure that the formats designed are based on empirical study, not merely by asking clinicians to indicate a preference, since preferences can mislead⁴⁴. The formats preferred by doctors are not necessarily the formats which lead to optimal comprehension⁷⁷. Good design usually goes unnoticed. In a study by Nygren³⁵, participants had no recall of the layout of a well-formatted document they had just read but good recall of one with text attributes that slowed reading or were likely to induce errors. So any proposed formatting must be confirmed by detailed analysis into its affect on speed to assimilate and comprehension of content, as visual analysis into what “looks better” may in fact lead to the propagation of a poor design.

Eye tracking has proven a useful tool in evaluating usability of interfaces most pre-dominantly on screen interfaces in recent years. It may be an important tool to provide empirical data to support and fine tune any proposed report design.