504 - Did my Doctor Really Say That? Patient Confusion in Verbal, Written, and Online Portal Communication

Publication Number: 4495.504

Rheanne K. Maravelas, University of Minnesota Medical School, Roseville, MN, United States; Cris G. Ebby, UT Southwestern Medical Center, Dallas, TX, United States; Jenna Fleming, University of Minnesota Medical School, Minneapolis, MN, United States; Emily Hause, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States; Marissa Hendrickson, University of Minnesota Medical School, Minneapolis, MN, United States; Michelle M. Kelly, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Sydney N. Loy, University of Minnesota Masonic Children's Hospital, Eden Prairie, MN, United States; Scott Lunos, University of Minnesota, Minneapolis, MN, United States; Sage M. Marmet, University of Minnesota Masonic Children's Hospital, Ann Arbor, MI, United States; Joshua B. Morof, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States; Michael B. pitt, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States; Alexis Quade, University of Minnesota Medical School, Minneapolis, MN, United States; Aarabhi S. Rajagopal, Seattle Children's, Seattle, WA, United States; Maya M. Ryaboy, University of Minnesota Medical School, Eden Prairie, MN, United States; Aarohi Shah, University of Minnesota Medical School, Maple Grove, MN, United States; Arman A. Shahriar, Indian Health Service, Minneapolis, MN, United States; Jordan Marmet, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States

Background: Prior studies indicate that the public does not understand many medical terms, but little is known about how often they experience confusion when receiving information in healthcare settings.

Objective: To quantify public experience of confusion when receiving multi-modal clinical health information and to explore preferred strategies for improving communication.

Design/Methods: We developed a brief, mixed-methods survey that was conducted at the 2025 Minnesota State Fair. Adult English-speaking volunteers without prior medical or nursing training completed an electronic survey. The survey assessed their experiences of confusion across multiple healthcare communication formats, including in-person verbal encounters, written materials, and online patient portals. We also included an option to recount specific experiences of confusion.

Results: 321 individuals completed the survey via convenience sampling. Most respondents were female (60.9%) and 55% had a bachelor's degree or higher.
When asked about confusion following in-person verbal encounters, 14% reported feeling confused always or often, 36% sometimes, 50% rarely or never (Figure 1). After reading written materials provided during a healthcare visit, 19% reported feeling confused always or often, 35% sometimes, and 46% rarely or never. After reviewing online portal content, 15% reported feeling confused always or often, 39% sometimes, and 44% rarely or never. Most respondents (77%) used online portals at least every few months, and 64% reviewed information online before they were contacted by their provider. While most had neutral (42%) to positive (32%) emotions after portal use, 26% reported feeling confused, worried, or powerless (Figure 2). Through narrative accounts, respondents highlighted feelings of fear, abandonment, or frustration; some shared confusion about their treatment plans. Respondents identified several potential interventions to reduce confusion, including more time during appointments (61%), receiving a written summary of the care plan (54%), seeing pictures or diagrams (51%), and others (Figure 3).

Conclusion(s): Even among a well-educated population, confusion following healthcare communication was common. A substantial minority experienced strong negative emotions, highlighting that ineffective communication can undermine the patient-provider relationship and lead to gaps in care. The patient portal emerged as a double-edged tool, empowering some while leaving others anxious or confused. Respondent-endorsed interventions may help improve care, trust, and patient understanding.

Figure 1
Confusion after Receiving Medical Information

Figure 2
Emotions after Viewing Results Online

Figure 3
Interventions to Reduce Confusion