Table 2.

Summary of convergent synthesis results

Review objective	Sub-categories	Included studies (n)			Summary of key findings
		Quantitative	Qualitative	Mixed methods
1. What interventions can be used to improve communication of blood test results to patients and carer in primary care?		3			No RCTs identified.
					No evidence of benefit for a question prompt list29 or for a standardised letter for test communication.27 Weak evidence of increased proportion of reduction in workload using enhanced automation to sort and flag critical abnormal results.26
2. Patients’ needs and preferences	Mode of communication preferences	14	5	3	Online portals were generally acceptable to patients,31–36 but preferences vary between patient populations31,37 and for sensitive or abnormal results.31,32,36,40–42 Text messages are generally acceptable, particularly for normal results.28,35,45–47 Some patients prefer telephone or face-to-face communication,50 particularly for sensitive or abnormal results.45
	Information needs and preferences Preferences for timing of test communication Preferences for level of access to results	5	4	4	Patients often needed and wanted to know more about the test results, particularly in terms of ‘what next’, including lifestyle changes and treatment options.34,40,52–54
		4	4	3	Patients preferred as little waiting time as possible; ‘delays’ were associated with frustration, anxiety, and avoidance.31,32,35,36,38,41,51,57
		4	3	2	Patients preferred to access test results easily, securely, at any time,34–36,51 with any level of ability,36,53 and to view as much or as little information as they wanted.53
3. Clinicians’ needs and preferences	Communicating result information to patients	3	2	1	US doctors were prepared to have normal test results released automatically to patients.61 There was a mix of opinions on whether providing further information about the tests would be beneficial.47
	Mode and timing of communication	3	4	2	Clinicians preferred interactive communication methods for more impactful results33,35,45,62,64 and passive methods where the results were normal.33,45,62 Clinicians were concerned that direct online release of results created patient anxiety and clinician workload.65
	Communication via healthcare staff	2			Unclear communication could have negative impact on staff, particularly receptionists,66 and training may help to improve this.47
4. Barriers and facilitators	Practical issues (that is, cost, travel, time spent)	5	7	2	Practical considerations (for example, cost, incorrect details, waiting) were reported as barriers to result communication.35,46,51,66–71 Literacy and numeracy may affect patient ability to interpret test results.23,54 Reference ranges and medical terminology confused patients.23,38,39,60
	Responsibility for test result communication	1	7	1	Lack of clarity around responsibility to follow-up test results had implications for patient safety.47,51,57,62,66 Clinicians often took responsibility for test communication where the patient was vulnerable, or results were likely abnormal and/or impactful.64,72
	Workarounds		2	3	Electronic or paper-based manual steps used in addition to standard process (for example, paper lists) can cause frustration, duplication, and increased workload.64,66,67,73,74 These were used to cope with poor organisation and communication of data,73 and to avoid safety issues.64
	Alerts and notifications	2	2		The number of electronic alert notifications was perceived as too high.27,74,75 Nevertheless, they were believed to reduce risks of failure to communicate abnormal results.68
	Physician clinician behaviour	0	2	3	Negative emotional reactions,66,76 providing unclear test result information,66 or ordering sensitive tests without informing the patient,69 were reported as barriers to communication.
	Display format and content of results	9	4	2	Presentation of test results in graphical or tabular format, use of goal or reference ranges,77 and additional information in video or verbal formats helped patients understand the results.21,22,25.35,40,53,63

RCT = randomised controlled trial.