From Access to Activation: A Systematic Review of Patient Experiences with Online Lab Test Presentations (Preprint)

This is the authors' abstract. We don't add key points for this paper.

BACKGROUND Immediate release policies have expanded patients’ access to laboratory test results via patient portals. These policies aim to increase transparency and engagement but they shift interpretive and emotional burdens onto patients and introduce new pressures for clinicians. Prior reviews have examined specific components such as interface design or result presentation but have not integrated findings across the continuum from access to interpretation to activation. This review addresses these gaps by integrating evidence from retrospective portal-use analyses and studies capturing patients’ self-reported responses to online lab results. OBJECTIVE This review examines how patients access, interpret, and act upon online laboratory results. It identifies factors – including release policies, contextual variables, and design features – facilitate or hinder comprehension, emotional processing, and patient activation, and evaluates approaches to support more confident and equitable engagement. METHODS We conducted a comprehensive search of Web of Science, Embase, Engineering Village (Compendex and Inspec), and LISTA for English-language, peer-reviewed studies published from January 2013 through October 2025. Additional studies were identified via hand searching and backward and forward citation tracking. Eligible studies investigated patient access to, interpretation of, or responses to online lab results. Two reviewers independently screened citations, appraised study quality using design-appropriate tools, and extracted data using a standardized template. Recurring patterns across eight conceptual domains were identified through iterative thematic analysis. RESULTS Thirty-seven studies met inclusion criteria, with the most recent published in April 2025. Following immediate-release policies, retrospective studies reported increases in result viewing, secure messaging, and follow-up visits, with provider encouragement and automated notifications associated with higher portal engagement. Many patients valued timely access and independent review but described frequent interpretation challenges, including difficulty distinguishing normal from abnormal results or identifying those requiring immediate action. Textual and visual cues – such as brief explanations, color flags, and threshold indicators – sometimes aided understanding but also contributed to confusion when not aligned with clinical guidance. Participants expressed interest in plain-language summaries, actionable next steps, tailored explanations, and confirmation that a clinician had reviewed their results, though added detail sometimes increased cognitive load or conveyed urgency unintentionally. Disparities in access, comprehension, and follow-up confidence were commonly reported among older adults, non-English speakers, and individuals with lower health or digital literacy. CONCLUSIONS Expanded online access improves transparency but does not guarantee accurate interpretation or confident use of laboratory results. Rather than replacing clinician communication, portal access initiates a broader sensemaking process in which patients continue to seek confirmation and guidance from clinicians. Effective result-delivery systems must combine tailored interpretive support with workflow integration to ensure that portals and clinical review processes operate in tandem. Future approaches should incorporate co-design and emotionally supportive design and prioritize strategies that can accommodate diverse user needs and support meaningful activation.