Patients read test results first, often without context

Clinical takeaway: Good communication habits with your patients appear to help even when they are navigating complex results without professional assistance. 

Most patients now read their own test results before anyone has explained them. That follows the 2021 implementation of the federal information-blocking regulations in the 21st Century Cures Act. This means the explanation typically lands after results have already been viewed, on top of whatever the patient already concluded from a value and a reference range in a portal or an app. 

Immediate release of results is now the default experience, not an edge case. Nearly 70% of US adults with online record access and a recent test read the result before hearing from a clinician. Whether they understood what they read is an open question. A new survey analysis unpacked both patient viewing and self-rated comprehension. 

Among those who viewed early, 6.6% rated their understanding as poor and another 26.8% as only fair. Established patient-centered communication patterns were most strongly associated with understanding. Each one-point increase on the communication scale, which asks how often clinicians explain things understandably and involve patients in decisions, was associated with half the prevalence of poor understanding. Higher digital literacy also tracked with better comprehension. Neither education nor income showed a clear association after adjustment, and race and ethnicity did not either. 

Poor comprehension was roughly three times as common among patients in the Midwest, and about 2.5 times as common in the South, compared with the Northeast. Patients who reported experiencing discrimination in medical care were also more likely to rate their understanding as poor, even after accounting for digital literacy and communication scores. 

Viewing results before being contacted was associated with older age, female sex, household income of $50,000 or more, more chronic conditions, higher digital literacy, and more health-related social media use. All of those associations were modest, with digital literacy being the largest. 

Researchers analyzed the 2024 Health Information National Trends Survey, restricted to 4,982 US adults who had been offered online record access and reported a test in the past year, weighted to represent roughly 175 million adults. Respondents reported whether they viewed results before hearing from a health care practitioner and, among those who did, how well they understood what the results showed and meant for their care. 

Portals can add plain-language summaries and structured follow-up prompts, and vendors are moving that way, including with AI-generated explanations. Whether those tools will reach the patients who struggle most to understand their test results remains to be seen. In the meantime, cultivating strong communication habits—such as explaining findings in plain terms, involving patients in decision-making, and creating room for their questions—can be helpful. 

"While the Cures Act's goal of expanded patient access is being realized, a subset of patients who view their results before being contacted by their health care provider is having difficulty understanding what they see. Improving patient-centered communication may help in closing this comprehension gap," said Jemar Bather, assistant professor of biostatistics at NYU School of Global Public Health and the study's lead author. 

Source: Bather JR, et al. (2026 Aug 18) JAMA Netw Open. Patient Viewing and Comprehension of Immediately Released Test Results