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Immediate Release of Prostate Biopsy Test Results - Provider Experiences with the 21st Century Cures Act
Anna M. Ochsner, MD, Angelo Blancaflor, BS, Vikas Bhatt, MD MPH, Taylor Braunagel, MS, Liam Connolly, BS, Andrew Tompkins, MD, Elias Hyams, MD.
Brown University Health, Minimally Invasive Urology Institute, Providence, RI, USA.
BACKGROUND: The 21st Century Cures Act from 2016 mandates the immediate electronic release of clinical information to patients. While praised for promoting transparency and patient empowerment, there are concerns regarding patient anxiety and confusion with receipt of these results.
METHODS: We surveyed AUA members from New England to assess their experiences and preferences with this federal law. Residents and fellows were excluded. Providers were invited via email to complete a 13-question anonymous survey on Qualtrics. Descriptive statistics and Chi-square tests were performed using Prism 10 software.
RESULTS: Out of 549 providers contacted, 54 responses were received (10%). Of the respondents, 10 (19%) were trained in Urologic Oncology. Responses by state were: 5 ME (10%), 5 NH (10%), 4 VT (8%), 14 MA (27%), 13 RI (25%), and 7 CT (13%). Most providers (74%) were aware of the legal requirement to release biopsy results immediately. If given the choice, <10% (5) of providers would choose to keep the current policy. 39% (21) preferred manual release to the portal; 28% (15) release after the follow-up appointment; and 15% (8) preferred a delay. Regarding provider satisfaction, 37% were satisfied, 28% neutral, and 35% dissatisfied with the current policy. Satisfaction did not correlate with years of experience (X² = 7.67, p = 0.466) or biopsy monthly volume (X² = 3.0, p = 0.56). However, dissatisfaction was associated with more frequent patient messaging and calls regarding results (X² = 12.08, p = 0.002).
CONCLUSIONS: This study demonstrates discontent among urologic providers regarding the current electronic release rules. Differing opinions on how to best support patients facing a potential cancer diagnosis should encourage further investigation from a health policy standpoint. Certain states have passed laws that enable a delayed release; this should be considered in New England with a collaborative discussion between patients, providers, and policy-makers.
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