Patient and Health Care Provider Perspectives on Patient Access to Test Results via Web Portals: Scoping Review.

BACKGROUND: A frequently used feature of electronic patient portals is the viewing of test results. Research on patient portals is abundant and offers evidence to help portal implementers make policy and practice decisions. In contrast, no comparable comprehensive summary of research addresses the direct release of and patient access to test results. OBJECTIVE: This scoping review aims to analyze and synthesize published research focused on patient and health care provider perspectives on the direct release of laboratory, imaging, and radiology results to patients via web portals. METHODS: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Searches were conducted in CINAHL, MEDLINE, and other databases. Citations were screened in Covidence using the inclusion and exclusion criteria. Primary studies that focused on patient and health care provider perspectives on patient access to laboratory and imaging results via web portals were included. An updated search was conducted up to August 2023. Our review included 27 articles-20 examining patient views, 3 examining provider views, and 4 examining both patient and provider views. Data extraction and inductive data analysis were informed by sensitizing concepts from sociomaterial perspectives, and 15 themes were generated. RESULTS: Patient perspectives (24 papers) were synthesized using nine themes: (1) patterns of use and patient characteristics; (2) emotional response when viewing the results and uncertainty about their implications; (3) understanding test results; (4) preferences for mode and timing of result release; (5). information seeking and patients' actions motivated by viewing results via a portal; (6) contemplating changes in behavior and managing own health; (7) benefits of accessing test results via a portal; (8) limitations of accessing test results via a portal; and (9) suggestions for portal improvement. Health care provider perspectives (7 papers) were synthetized into six themes: (1) providers' view of benefits of patient access to results via the portal; (2) effects on health care provider workload; (3) concerns about patient anxiety; (4) timing of result release into the patient portal; (5) the method of result release into the patient portal: manual versus automatic release; and (6) the effects of hospital health information technology system on patient quality outcomes. CONCLUSIONS: The timing of the release of test results emerged as a particularly important topic. In some countries, the policy context may motivate immediate release of most tests directly into patient portals. However, our findings aim to make policy makers, health administrators, and other stakeholders aware of factors to consider when making decisions about the timing of result release. This review is sensitive to the characteristics of patient populations and portal technology and can inform result release framework policies. The findings are timely, as patient portals have become more common internationally.

Fake kindness, caring and symbolic violence.

The article starts by offering a definition of fake kindness focused on the dissociation between the behavioural components of kindness and the intent to sincerely pay some heed to the needs of others. Using the sociological theory of Pierre Bourdieu, this definition is then used to articulate how fake kindness can be conceptualized as a specific form of symbolic violence. Such a view allows explanations as to how and why the prevalence and effectiveness of fake kindness vary according to microsociological norms and values. The generic definition and conceptualization of fake kindness as a form of symbolic violence are then used to discuss how nursing's enthrallment with the concept of caring and its operationalization as a moral compass likely fosters the growth of fake kindness within the profession. In this view, the institutional enforcement of propriety and well-behaved professionalism is more likely to lead to toxic environments than to healthy workplaces. We hope that being able to understand how professional norms and institutional rules are sometimes turned into social tools to enforce obedience and existing hierarchies can empower victims of those phenomena to resist them more effectively. It might also contribute to increasing the awareness of well-meaning nurses or people in position of authority who have been socialized in environments where fake kindness is normalized.