Medical Record Access

Medical Record Access

PEP Topic 
Anxiety
Description 

Medical record access involves provision of test results and other medical record content to the patient. Provision of medical record information to the patient proactively, without the patient requesting this information, has been examined in patients with cancer for its effect on anxiety.

Effectiveness Not Established

Research Evidence Summaries

Gravis, G., Protiere, C., Eisinger, F., Boher, J.M., Tarpin, C., Coso, D., . . . Viens, P. (2011). Full access to medical records does not modify anxiety in cancer patients: Results of a randomized study. Cancer, 117, 4796–4804.

doi: 10.1002/cncr.26083
Print

Study Purpose:

To assess the effect of providing systematic full access to the medical record on patients’ anxiety, quality of life, and satisfaction

Intervention Characteristics/Basic Study Process:

Participants were randomly assigned to either requested access to the medical record or systematic full access groups. In the requested access group, information and the medical record were delivered to the patient at the physician’s or patient’s request. In the systematic access group, patients were given a briefcase that they were to bring to each visit. The briefcase was filled with administrative data as well as reports of surgery, pathology, laboratory, radiology, and hospitalizations and nursing narrative notes. Documents were provided to the patient as well as on CDs, including radiology images. Documents were updated at each visit, and in between visits materials were mailed to the patient. A coordinator provided updated information for the patient to put in the briefcase and explained the material to the patient in a standardized way. Medical and nursing staff also provided information and answered patient questions. Patients completed questionnaires for the study data collection at the beginning of the study and at the end of their first chemotherapy cycle.

Sample Characteristics:

  • The study reported on a sample of 295 patients.
  • Mean patient age was 54.6 ± 12.1.
  • The sample was 86.8% female and 31.2% male.
  • Newly diagnosed breast cancer, colon cancer, and Hodgkin and non-Hodgkin lymphoma were the most common diagnoses.
  • All patients were beginning adjuvant chemotherapy.
  • Of the sample, 70.6% were married or cohabiting, 50.2% had secondary or higher level education, and 61.7% were currently employed.

Setting:

  • Multisite
  • Outpatient setting
  • Cancer center in France

Phase of Care and Clinical Applications:

Patients were undergoing the active treatment phase of care.

Study Design:

The study was a randomized controlled trial with repeated measures.

Measurement Instruments/Methods:

  • Spielberger State-Trait Anxiety Inventory
  • European Organization for Research and Treatment of Cancer Quality of Life Questionnaire
  • Four-point Likert-type scale for satisfaction

Results:

Mean anxiety score at baseline was 40.7 in all patients (scores of 20–80 generally indicate a higher level of anxiety). There were no differences at baseline between groups and no change over time in the systematic full access group. There was a significant reduction in anxiety at the end of treatment in the requested access group (p = 0.009), but no differences between study groups. There were no differences between groups in quality-of-life findings. A higher percentage of patients in the full access group were completely satisfied with treatment explanations than in the requested access group; however, the difference between groups was not significant. Full access was not a source of anxiety for 68.8% of patients, and 82.2% said they understood the information.

Conclusions:

Provision of full information in an organized medical record provided to patients did not increase patient anxiety, was practical to implement, and may have a positive effect on patient satisfaction with information.

Limitations:

  • There was no subgroup analysis of state anxiety findings by anxiety trait findings. 
  • The satisfaction measure was a single measure with no established validity or reliability.

Nursing Implications:

This study outlines a practical way to provide full medical record information to patients in a way that was acceptable to them. Findings show that provision of full information did not increase patient anxiety and was associated with a tendency for patients to have more satisfaction with information provision. This may be a useful approach to engage patients in their care. Most of these patients were fairly well-educated, so it is not clear whether these results can be generalized to less educated patients.


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