title: Disclosing neuroimaging incidental findings: a qualitative thematic analysis of health literacy challenges.
abstract: Returning neuroimaging incidental findings (IF) may create a challenge to research participants' health literacy skills as they must interpret and make appropriate healthcare decisions based on complex radiology jargon. Disclosing IF can therefore present difficulties for participants, research institutions and the healthcare system. The purpose of this study was to identify the extent of the health literacy challenges encountered when returning neuroimaging IF. We report on findings from a retrospective survey and focus group sessions with major stakeholders involved in disclosing IF.
  
  
  
  We surveyed participants who had received a radiology report from a research study and conducted focus groups with participants, parents of child participants, Institutional Review Board (IRB) members, investigators and physicians. Qualitative thematic analyses were conducted using standard group-coding procedures and descriptive summaries of health literacy scores and radiology report outcomes are examined.
  
  
  
  Although participants reported high health literacy skills (m = 87.3 on a scale of 1-100), 67 % did not seek medical care when recommended to do so; and many participants in the focus groups disclosed they could not understand the findings described in their report. Despite their lack of understanding, participants desire to have information about their radiology results, and the investigators feel ethically inclined to return findings.
  
  
  
  The language in clinically useful radiology reports can create a challenge for participants' health literacy skills and has the potential to negatively impact the healthcare system and investigators conducting imaging research. Radiology reports need accompanying resources that explain findings in lay language, which can help reduce the challenge caused by the need to communicate incidental findings.
authors.affiliation: The Mind Research Network, Albuquerque, NM, 87106, USA.
authors.forename: Caitlin E
authors.initials: CE
authors.lastname: Rancher
authors.affiliation: The Mind Research Network, Albuquerque, NM, 87106, USA.
authors.forename: Jody M
authors.initials: JM
authors.lastname: Shoemaker
authors.affiliation: The Mind Research Network, Albuquerque, NM, 87106, USA.
authors.forename: Linda E
authors.initials: LE
authors.lastname: Petree
authors.affiliation: College of Pharmacy, The University of New Mexico Health Science Center, Albuquerque, NM, 87106, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Holdsworth
authors.affiliation: Department of Neurology, The University of New Mexico, Albuquerque, NM, 87106, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Phillips
authors.affiliation: College of Population Health, MSC 09-5070 Health Sciences Center, University of New Mexico, Albuquerque, NM, 87131-0001, USA. helitzer@salud.unm.edu.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Helitzer
mesh_terms: D022126:Access to Information; D000328:Adult; D032882:Comprehension; D030881:Disclosure; D005260:Female; D017144:Focus Groups; D057220:Health Literacy; D006801:Humans; D033162:Incidental Findings; D008297:Male; D059906:Neuroimaging; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D012106:Research; D035842:Research Subjects; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
keywords: Health literacy; Incidental findings; Neuroimaging