E055 Exploring patient and clinician understanding of bone density (DXA) scan results: qualitative findings from the INDEX study

Kettle, Chelsea; Manning, Fay; Henderson, Beverly; Griffin, Jill; Knapp, Karen; Butterworth, Jo; Jinks, Clare; Bullock, Laurna; Paskins, Zoe

Abstract

Background/Aims Dual-energy X-ray absorptiometry (DXA) scans are routinely performed to assess bone mineral density (BMD), diagnose osteoporosis, refine fracture risk assessment and inform osteoporosis medicine decisions. The INDEX (understandINg bone DEnsity [dXa] scans) study aimed to explore patient and clinician understanding of DXA scans and results to identify opportunities to optimise DXA understanding. Methods Semi-structured think-aloud interviews with patients attending DXA scans across 3 NHS sites and primary and secondary care clinicians who refer to, and receive results from, DXA services. Interviews were transcribed verbatim and analysed using framework analysis, sensitised by the common-sense model of illness self-regulation, to explore how patients and clinicians perceive, interpret, and respond to DXA scan results. Results Interviews were completed with 38 patients (84% female; mean age of 66 years; 89% high health literacy), 12 primary care clinicians (11 General Practitioners, 1 First Contact Practitioner), and 10 secondary care clinicians. Four overarching themes related to (1) the importance of DXA scans; (2) (un)met information needs and (3) the impact of these; and (4) barriers and facilitators to addressing information needs. Perceived importance of DXA scans was influenced by individual and system-level factors. Patient and clinician attitudes towards osteoporosis and DXA scans varied, with some describing it as a low priority condition, particularly if ‘higher priority’ comorbidities were present. The reported opportunistic model of osteoporosis care coupled with the disconnect between primary and secondary care means that some patients may not receive adequate care. Patients had unmet information needs about the (1) purpose of a DXA scan, their DXA scan result, and what it means for their bone health and (2) the need for osteoporosis medicines and future scans. These unmet information needs impacted whether patients felt prepared for their DXA scan and anxiety caused by (mis)interpreting their DXA result. Unmet information needs impacted patient decisions about taking osteoporosis medicines. Clinicians also described unmet information needs regarding (1) who to refer for a DXA scan, (2) interpretation of DXA reports, and (3) drug treatment options and management. Barriers to meeting information needs included in DXA result format and content, including technical information. Patients and clinicians reflected that written results (e.g. texts, clinical reports) were insufficient to meet their information needs, particularly in absence of clinical interpretation. Some clinicians described potential clinical risk associated with misreading DXA reports. Opportunities for clinicians to explain DXA results and for patients to ask questions facilitated patient understanding, however time and resource constraints limited this. Conclusion The INDEX study highlights unmet information needs about DXA among patients and clinicians, revealing opportunities to optimise understanding. Findings will inform the coproduction of recommendations and resources to enhance DXA understanding, with the aim of supporting clinical and shared decision-making, osteoporosis care, and medicine uptake. Disclosure C. Kettle: None. F. Manning: Grants/research support; funded by the NIHR Applied Research Collaboration South West Peninsula. B. Henderson: None. J. Griffin: None. K. Knapp: None. J. Butterworth: Grants/research support; funded by a NIHR Doctoral Fellowship award (2017-10-005). C. Jinks: Grants/research support; part funded by NIHR Applied Research Collaboration (ARC) West Midlands. L. Bullock: None. Z. Paskins: Consultancies; received consultancy fees from UCB Pharma. Grants/research support; funded by the National Institute for Health and Care Research (NIHR) [Clinician Scientist Award (CS-2018-18-ST2-010)/NIHR Academy].

Citation

Kettle, C., Manning, F., Henderson, B., Griffin, J., Knapp, K., Butterworth, J., Jinks, C., Bullock, L., & Paskins, Z. (2025, April). E055 Exploring patient and clinician understanding of bone density (DXA) scan results: qualitative findings from the INDEX study. Poster presented at British Society for Rheumatology Annual Conference 2025, Manchester Central Convention Complex, Manchester, England, UK

• Presentation Conference Type: Poster
• Conference Name: British Society for Rheumatology Annual Conference 2025
• Start Date: Apr 28, 2025
• End Date: Apr 30, 2025
• Acceptance Date: Apr 28, 2025
• Online Publication Date: Apr 28, 2025
• Publication Date: Apr 28, 2025
• Deposit Date: Jun 6, 2025
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Electronic ISSN: 1462-0332
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 64
• Issue: Supplement_3
• DOI: https://doi.org/10.1093/rheumatology/keaf142.291
• Public URL: https://keele-repository.worktribe.com/output/1242711
• Publisher URL: https://academic.oup.com/rheumatology/article/64/Supplement_3/keaf142.291/8114949