Bone Abstracts

Background: The Improving uNderstanding of bone DEnsity (dXa) scans (INDEX) study explored how patient and clinician understanding of DXA scans and results can be optimised.

Methods: Semi-structured interviews with (1) patients attending DXA scans across three NHS sites and (2) primary and secondary care clinicians who refer to or receive results from DXA services. Recommendations to improve understanding were agreed using a modified Nominal Group Technique (NGT) involving experts by profession and lived experience. Public contributor and stakeholder meetings codeveloped resources to address unmet information needs, guided by interview findings and NGT recommendations.

Results: Interviews were completed with 38 patients (84% female; aged 43-83 years; 89% high health literacy; 97% white British) and 22 clinicians (12 primary care; 10 secondary care). Three themes related to: (un)met information needs regarding DXA scans and results; barriers and enablers to meeting these needs; and their impact. Patients described uncertainty about the purpose and process of DXA scans. Patients and clinicians reported difficulty interpreting DXA reports due to their technical nature and format, affecting decision-making, impacting treatment adherence and leading to clinical risk. Unmet information needs were underpinned and perpetuated by the low priority of osteoporosis at individual (e.g. competing health priorities) and system-levels (e.g. opportunistic and inequitable osteoporosis care). Two NGT meetings, each followed by online rating, involved 21 participants (17 professionals; 4 persons with lived experience). Consensus (70% agreement) was reached on 30 recommendations. Recommendations emphasised that bone density is one component of broader fracture risk assessment and highlighted the need to enhance understanding by offering patients opportunities to discuss results and use lay language in reports.

Interview findings and recommendations guided codevelopment of a: 1. Patient leaflet describing the purpose and process of DXA scanning. 2. Royal Osteoporosis Society DXA webpage with integrated understanding your DXA result guidance and animation illustrating the DXA scan journey. 3. Standardised DXA report template.

Conclusion: The INDEX study identified opportunities to enhance osteoporosis care by addressing unmet DXA information needs with patient education and clinical tools to improve understandability and consistency. Codeveloped resources are available via the Royal Osteoporosis Societys DXA webpage and DXA provision guidelines.