Understanding Attitudes Towards Pathology Explanation Clinics

To the average patient, diagnostic pathology information can be confusing, and worrying. Even the most educated person may feel stressed when confronted with terms and measures that reference their own health. To address this concern a group of clinicians conceptualized Pathology Explanation Clinics (PECs) in 2018.¹    

A recent study, published in the American Journal of Clinical Pathology, examined the attitudes and opinions of clinicians about PECs, and the role of pathologists in patient communication. To learn more about this new study’s results, and the value of Pathology Explanation Clinics, we turned to study authors, Cathryn J. Lapedis, MD, MPH, Clinical Assistant Professor in Pathology at the VA Ann Arbor Health System, and Sophia R. Kurnot, BS, of the University of Michigan Undergraduate Research Opportunity Program.  

What are Pathology Explanation Clinics? 

Pathology Explanation Clinics (PECs) are a type of care model that provides an opportunity for rich dialogue between pathologists and patients. PECs also help streamline communication between non-pathology clinicians and their patients.  

“PECs provide an opportunity for patients to meet with pathologists face to face. During a PEC, the patient is given the opportunity to learn about the process of diagnosis, and to look at their tissue slides under a microscope,” explains Ms. Kurnot. As with any consultation, family members are encouraged to attend PECs as needed, to provide an extra pair of ears, and moral support, when necessary.  

PECs make the field of pathology visible to the public in a new way. They also enable patients to benefit from full transparency about the diagnostic process. This can be comforting to both patients and their families.  

“When asked, patients say they want the diagnostic process to be demystified. If patients aren’t fully informed about their diagnosis, my overall thought is that they can’t make a fully informed medical decision about their care plan. PECs improve patient understanding and contribute to patients' ability to make a high-quality medical decision,” adds Dr. Lapedis.  

Study results: how do clinicians feel about Pathology Explanation Clinics? 

The 2023 study, “A Mixed-Methods Study of Clinicians' Attitudes Toward Pathology Explanation Clinics,” was the third of a three-part series about Pathology Explanation Clinics. Part 1 focused on patients. Part 2 focused on pathologists. Part 3 zeroed in on non-pathologist clinicians practicing in a tertiary care academic medical center.  

Thirty-five clinicians participated in the study. Each was asked to rank their interest in having patients meet with a pathologist to discuss their pathology report and to view their tissue. The clinicians were also given the opportunity to voice their concerns about PECs and expand on the benefits they thought PECs might provide. A “snowball” recruitment strategy (ie, putting out the request for study participants in a random way to see who would respond) was used to access study participants. Represented specialties included surgery, hematology/oncology, and internal medicine.   

Of the clinicians interviewed, 83 percent reported some level of interest in PECs. Most ranked their level of interest as “definitely interested” or “interested.” A small percentage ranked their interest as “definitely not interested.”  

Many clinicians felt that PECs would have the most benefit for patients who were highly educated and motivated, although a review of relevant literature provided in the discussion suggests that PECs likely will provide benefit to all groups of people and special attention should be paid to making sure the PEC resource is offered equitably and without bias. Clinicians noted that PECs would provide value for improving understanding and emotional processing of patients about their diagnosis. They cautioned that emotional distress and cognitive overload were possible, especially if the diagnosis was not communicated in a balanced and thoughtful way. 

Some clinicians voiced concerns about the communication skills of the pathologists who would be participating in PECs and meeting face-to-face with patients to discuss their concerns. They also worried about care fragmentation, for example, which member of the care team would address or follow up on treatment plans, and the potential for increased clinician workload. However, most felt that PECs would increase clinician efficacy, and improve the level of quality of care. The study authors note that these perspectives are supported by pilot study work which showed that, “Following a PEC, patients were more prepared emotionally and cognitively for their visit with the treating clinician. This preparation allowed the treating clinician to spend more time answering nuanced questions about treatment and prognosis to support the patient in making an informed and values-based action plan,” says Ms. Kurnot.     

Best practices for starting a Pathology Explanation Clinic  

To date, there are functioning PECs in several pathology facilities; the largest PEC program is at Lowell General Hospital, run by Dr. Lija Joseph, and other facilities such as Duke Health and the University of Pennsylvania have clinics available for some subspecialties. Clinics have recently started at Massachusetts General Hospital and the VA Ann Arbor Healthcare System.   

To start, if you’re interested in pursuing the establishment of a PEC in your facility, Dr. Lapedis stresses the need for tight partnering and buy-in from your clinical colleagues. “The standard system of medicine doesn’t include patients as the target audience for pathology reports. Patient outreach will be needed to equitably recruit and schedule PECs for patients. Collaboration between colleagues is essential here,” she says. 

Establishing a clean logistical flow is also key. “Setting up a PEC requires a scheduler, the creation of an electronic medical records note, and billing procedures. If the PEC is done in person instead of virtually, a dedicated space needs to be created for this purpose,” she adds. Dr. Lapedis also recommends establishing systems that enable continuous improvement of the processes you create. This fluidity will help eliminate barriers down the road.    

To preserve professional relationships and maintain high standards of communication, a clear delineation of the pathologists’ role must also be established and adhered to. “The pathologist and non-pathology clinician should have a full understanding of who will discuss what. During a PEC the pathologist’s role is to discuss diagnosis. Conversations about prognosis and treatment should be left to the treating clinician,” says Ms. Kurnot. Protocols for communicating the results of the PEC should also be established between the pathologist and treating clinician, so everyone is on the same page. Writing a note in the EMR and checking in frequently via phone and/or video conference are effective ways to keep the lines of communication open and to make real-time adjustments to procedures as programs start.  

Obstacles to avoid 

As with any innovation, roadblocks may present themselves immediately, or occur down the road. These include a lack of buy-in from key decision-makers in either clinical departments or pathology departments. “There may be some who want to uphold the status quo of pathologists acting as the traditional ‘doctor’s-doctor,’” warns Dr. Lapedis. Concerns about funding, reimbursement, and added time constraints on pathologists may be issues that require addressing. 

Another potential obstacle is the overall shortage of pathologists currently working in the field. “Many pathologists are incredibly busy at baseline and may not have additional time to devote to learning about and completing Pathology Explanation Clinics,” adds Dr. Lapedis. Without enough hands on deck, PECs may not be properly staffed.