Delivering difficult results
Tone, sequence and structure for the moment an app tells someone something they did not want to hear, with no clinician present and no question available.
What this means
Clinicians are trained, at length, in how to give someone difficult news. The training covers where to sit, what to say first, how much to say, when to stop talking, and how to check what the person actually heard. It exists because doing this badly causes lasting harm, and because doing it well is not intuitive.
An app has none of those instruments, and works instead with a card, a type size, and a moment it did not choose: 06:40, on a commute, opened from a notification. Four separate capabilities are missing at that moment. The interface cannot observe the reader's reaction and adapt what it says next. It cannot control the pace, because the reader sets that by scrolling. It cannot answer the question the result provokes, because nobody is present to be asked. And it does not know whether the reader is alone.
The design position that follows is control rather than delivery technique: the interface discloses as little as is necessary at each step, in plain language, and the reader decides when and how much more arrives. Every surface that carries such a result ends in a route to a person.
The rule
A result that may be distressing is disclosed deliberately: the reader knows what is coming before they see it, the language is plain and non-catastrophic, and the surface always ends in a route to a person.
Fourteen requirements follow, grouped by what each one governs: the sequence in which a result reaches the reader, the language it is written in, and the structure of the surface that carries it. The numbering runs across all three groups and is cited elsewhere on this page.
| # | Group | Requirement | What the reader must be able to do | Where it is specified in full |
|---|---|---|---|---|
| 1 | Sequence | A result the reader has not asked to see is announced before it is shown, and is opened only by a deliberate action. The announcement states its own weight: "Your results are ready. There is something here worth going through. You can look now or later." | Learn that a result is waiting, and roughly what kind of reading it will be, before any of it is on screen. | |
| 2 | Sequence | No notification opens directly into a full result, and no result appears on a dashboard the reader opened for something else. | Choose the moment of disclosure, and use the rest of the product without passing through the result. | |
| 3 | Sequence | The plain-language summary comes first, the numbers sit behind a deliberate step, and the clinical detail sits behind a further one. The order is never reversed. | Stop at any layer and still hold a complete and accurate account of what was found. | |
| 4 | Sequence | The surface states what happens next, who is arranging it, and how to reach someone. The last element on the screen is never the number. | Leave the screen knowing who to contact and by what means. | |
| 5 | Language | The finding is stated in the words that describe it. "Your result shows X" is used in preference to "your result requires further discussion". | Learn the finding itself, rather than inferring it from the fact that a discussion is being arranged. | |
| 6 | Language | Neither "this is very serious" nor "don't worry" appears, because both are claims the interface cannot support. | Read the result without a severity judgement that the system has no basis to make. | |
| 7 | Language | The constructions "you failed to", "your poor control" and "you should have" are not used. | Read the result without being assigned responsibility for it. | |
| 8 | Language | The interface reports a result and names the next step, and states nothing about what the result means for the reader's life. | Take the result to a clinician with no interpretation already attached to it. | |
| 9 | Language | Sentences are short, the words are ordinary, and each sentence carries one idea, because the reader's comprehension is reduced at this moment and the words are the last thing to be tested. | Read each sentence once and take its meaning. | Voice and tone |
| 10 | Language | The surface names what the result does not establish: "This result on its own does not tell us X". | Distinguish what has been found from what has not yet been ruled out. | |
| 11 | Structure | The next step carries the same visual prominence as the result: the same type scale, and no placement that requires scrolling to reach it. | See the plan and the finding in the same glance. | |
| 12 | Structure | No cross-sell, rating prompt, streak or unrelated alert appears on that screen, and the alarm-fatigue suppression rules apply to it. | Attend to one thing at a time on that screen. | Alarm fatigue |
| 13 | Structure | The result remains findable afterwards in the same words, and can be shared with someone the reader trusts. | Return to the result later, find it unchanged, and show it to another person. | Sharing with a clinician |
| 14 | Structure | A way to defer reading the result is offered where that is clinically appropriate, and is never offered where a delay could cause harm. | Postpone reading a result without losing access to it. | Emergency and escalation |
Why (evidence)
evidence: mixed.Applying it
Do
Announce the result before showing it: "Your results are ready. One of them is worth going through properly. You might want a few quiet minutes." Place a button labelled "Open results" beneath the announcement. The announcement names that one result needs attention and leaves the moment of opening to the reader.
Don’t
Send a push notification reading "Abnormal result. Tap to view" that opens straight onto a red card. The notification states a finding on a locked screen, and the direct open removes the reader's choice of moment.
Do
Give the finding, the route and the fallback together: "Your result is higher than your laboratory's usual range. Your GP has been sent this and will contact you within 5 working days. If you have not heard by then, call the surgery." The wording names what was found, who now holds it, when contact will come, and what to do if it does not.
Don’t
Write "Your result requires further discussion with your healthcare provider." The sentence states no finding, names no next step and gives no interval, so the reader supplies all three from their own assumptions.
Do
Name what the result does not establish: "This result on its own does not tell us why. That is what the next test is for." The two sentences state the boundary of the finding and the step that addresses the remainder.
Don’t
Write "Don't worry, this is usually nothing." The sentence makes a prognostic claim about how often this finding is benign, which nothing on the screen supports, and it makes that claim in the product's own voice rather than a clinician's.
Do
Keep the summary in one place, in the same words, permanently, with a way to save or share it. The stored copy is the one the reader returns to and the one they can hand to a clinician.
Don’t
Show it once in a dismissible banner. A dismissed banner leaves no copy to return to, and a reader who comes back for the exact wording finds whatever else the product happened to keep.
Components that implement this
ResultCard is specified with a required next-step slot, which is rule 4
expressed as an API constraint. A result rendered with nothing after it is the
failure this page exists to prevent, and an optional slot would sit empty on
precisely the surfaces where rule 4 binds.
What this does not cover
- What the result means. All clinical interpretation rests with the implementing organisation and its clinical governance.
- Whether a result should be released to the reader at all, and on what delay. That decision is clinical and often regulatory, and it is taken within the implementing organisation's health system rather than in the design layer.
- Emergency findings, which follow Emergency and escalation instead, because rule 1's announcement step does not apply where a delay causes harm.
- Disclosure of risk of harm inside a questionnaire, which is Crisis and self-harm.
- The wording itself in detail, which is Voice and tone and Writing status and alerts.
- Results concerning someone else fall outside this page, because consent and tone both change. Someone else might be a child, a relative, a person being cared for.
Updates to this page
Last read through against the system on 2026-09-02. Due for review every 6 months; expiry is reported by pnpm run check:freshness.
Crisis and self-harm
What an interface must do when someone discloses thoughts of suicide or self-harm, and how to signpost support without ambush, judgement or a dead end.
Consent and disclosure
Consent that is granular, revocable, recorded and re-asked, and the difference between a lawful basis for processing and a person's actual understanding.