Outpatient letters in renal care: preferences, barriers, and recommendations from a diverse patient population

ObjectivesOutpatient clinic letters are a key component of continuity and quality in patient care. National guidance from the Academy of Medical Royal Colleges recommends that these letters be addressed directly to patients, yet most remain clinician-directed and contain complex, inaccessible language. Evidence on patient perspectives, particularly within underserved groups and renal medicine, is limited. MethodsWe conducted a cross-sectional survey of 150 adult renal patients across two tertiary hospitals in [city], UK. A structured questionnaire was administered via face-to-face interviews, enabling inclusion of participants with diverse literacy, language, and accessibility needs. Quantitative and qualitative data were collected on experiences, comprehension, content preferences, and barriers to engagement. Associations with demographic, socioeconomic, and clinical factors were explored using chi-squared, Kruskal–Wallis, and Fisher’s exact tests. ResultsA total of 135 patients (90.0%) preferred letters addressed directly to themselves, with a copy sent to their GP. While 133 (88.7%) reported understanding their letters, notable disparities emerged: non-English speakers, Asian patients, and those with conditions affecting reading (e.g. visual impairment, dyslexia) reported lower comprehension and engagement. Patients on dialysis or with diabetes-related kidney disease experienced greater difficulties, whereas transplant recipients reported the most positive experiences. Common recommendations for improvement included a concise summary at the start of the letter, personalised advice, and web links for further information. ConclusionsPatient-directed letters are greatly preferred by patients. Although most patients reported good overall understanding, inequities in communication persist, influenced by language, ethnicity, and clinical status. Each group presented specific barriers and preferences for letter improvement. Clinical implications Routine adoption of these recommendations and patient-directed letters may enhance understanding, equity, and patient experience.