Considering the impact of sharing images with patients from a wider

with patients during a clinical consultation. These have been divided into practical and ethical considerations.

5.4.5.1.Practical considerations

Several practical considerations were raised by focus group participants. These were the resources required to produce and show 3D images to patients; patients receiving a copy of their own image to take away and the patients’ eyesight. They will each be discussed in turn.

The resources (namely time, equipment and costs) required to make and show 3D images to patients were considered by participants during five groups. These were raised briefly in two groups with participants asking what is the cost of producing the 3D image and whether “fancier equipment” is required? EP explained that 3D images are created using the digital data from 2D scans and so require no additional equipment. The other three groups discussed time. One group believed the additional time required to create and communicate the images was a potential barrier to their use because the additional time costs money. Another group argued that additional time would only amount to a matter of minutes per patient. In contrast, one participant in another focus group proposed that, in the long term, showing images to patients could save time and money if patients know and understand their conditions. This perspective was also raised by a clinician and a patient in study one who argued that consultation times could be shorter if patients can grasp information more quickly.

Participants discussed keeping a copy of their image, with four groups enthusiastic about patients being able to keep a copy of their image. Three groups asked if patients are able to ask for a copy of their images while one group stated that they would ask for a copy. Participants said that patients may benefit from keeping a copy of their image as it would

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allow them to show their images to their families and friends and study their images in their own time which may “jog their memory to ask a question” (FG6). Within one group, participants argued that if patients are to be given an image to take away they should also be given a written explanation to accompany it, as they had discussed that “the explanation is as important as the image” (FG3). Similarly, group four expressed concern about the amount of verbal information patients receive, emphasising the importance of giving patients written information, including hospital records (FG4). Two groups appeared less enthusiastic about patients keeping a copy of their image. However, they did state that if patients wanted a copy they should be allowed one. Further, one group was concerned that patients who have taken a copy of their image home may start to misinterpret their image if they forget the information that they were told alongside it.

One group also noted that the patient’s eyesight is a factor to consider, explaining that the helpfulness of the image can depend on how well they can “focus on the different colours” (FG6). This was raised during a discussion comparing a 2D image of liver metastases to a 3D image of liver metastases where the differences between normal tissue and metastatic tissue were subtle and could be hard for people with poor eyesight to distinguish.

5.4.5.2.Ethical considerations

Several ethical considerations were raised by focus group participants. These included patient consent, overuse of imaging and pressuring patients.

Three groups explained that patients should be asked if they wish to view their images before they are shown. For one group, this appeared to be an important issue that dominated their discussions. Within this group, one participant had been previously shown his imaging results without being asked beforehand, which he described as distressing. Participants explained that while some patients will want to view their images, others would not. One group stated that the wishes of patients who do not want to view their images should be respected. In

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contrast, participants in one group argued that it is perhaps more complex than that. If the doctor’s duty is to explain a medical condition to a patient in a way that they understand and are able to use to make an informed choice, then they may need to show them an image in order to do this (as demonstrated by the quote below).

So the mere fact that someone says ‘I don’t want to know’ isn’t necessarily the end of the consultation… and pictures might help (FG3)

Furthermore, one patient, who had previously asked to view her imaging results, commented that patients who do want to view their images might not have the courage to ask.

One group expressed concern about the potential for overuse of imaging. They were worried that clinicians may ask for more CT scans if showing 3D images to patients made them seem more patient-friendly. They were also worried that patients may ask for more imaging tests if they became aware that 3D images of the insides could be taken. The main reason for their concern was the high levels of ionising radiation in a CT scan and they were worried patients may ignore the radiation aspect if they wanted a 3D image.

A further consideration raised within one group was the use of images to pressure patients. As previously described, several participants discussed the use of medical images as a tool for shocking patients and promoting behaviour change and generally argued that the use of the image in this way was justified. However, one participant described feeling “nervous about it (the image) being used as a shock tactic” (FG4). He described this as “brow-beating the patient” (FG4) if the patient does not follow the recommended treatment.

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