Understanding Patient and Family Perspectives on the Value and Timing of Routine Laboratory Testing

Background: Routine morning lab draws are a common practice in academic institutions, but may not change management and may negatively affect patient and family experience. It is important to understand patients’ and families’ perspectives on routine morning labs to encourage patient-centered care and better guide high-value decision-making.

Methods: This was a qualitative analysis of open-ended survey responses from a convenience sample of caregiver and patient members of a patient and family advisory council. A seven-question, free response survey was designed to solicit previous experiences and perceived values of laboratory draws from patients and families related to an ongoing quality improvement project (Table 1). The survey was reviewed by three clinicians including the clinician liaison for the patient and family advisory councils. This survey distributed as a paper form and no identifying information was collected. Responses were transcribed and analyzed using primary inductive coding. Codes were reviewed and categorized and subsequently, primary codes were collapsed into broader codes and a refined codebook was created, and themes developed. Descriptive counts of code and theme prevalence were created.

Results: The survey was answered by 32 participants. Six major themes were developed during coding revision (Table 2). Physician and nursing providers impacted the laboratory draw experience in several ways including valuing the family’s expertise, creating a calm environment, and willingness to change phlebotomy methods if not initially successful. Respondents identified several resources and processes that improved experience, especially highlighting the availability of the child life and vascular access teams. Regarding the timing of laboratory draws, late morning was the leading preference with 18 responses. Patients and families described both positive and negative implications to laboratory draws occurring later in the day. Negatives included a fear that results might change management and the opportunity to discuss results with the team on rounds. Positives included better sleep and parents having input on what tests were necessary. Most respondents saw value in drawing labs for reassurance while some described a preference for avoiding these types of laboratory draws. Many respondents described laboratory draws as a traumatic experience.

Conclusion: Patients and caregivers demonstrated a diverse set of perspectives around the factors that increase or decrease the value and experience of laboratory testing. Given this variety of perspectives, directly engaging families in discussions of how they value laboratory testing and results may be necessary to provide the best patient experience. Focusing on key themes around communication, timing, and support resources for patients and families in future improvement and research efforts may have the greatest potential impact on laboratory testing value.