UNIVERSITY OF UTAH HEALTH 14-AUG-2019
Facing the threat of
domestic violence, being a survivor of sexual assault, struggling with
depression or thoughts of suicide are four topics that are difficult to broach
with anyone. Including those who can help you.
A new study reveals up to
47.5 percent of patients who feel they face one or more of these four threats
do not disclose this critical information to care providers out of
embarrassment, fear of judgement or the possible long-term implications of
sharing such information.
Scientists at University
of Utah Health, Middlesex Community College, University of Michigan
and University of Iowa collaborated on the study, which was published online
in JAMA Network Open on August 14.
Understanding how to make
patients feel more comfortable with clinicians is key to helping patients
address such life-threatening risks, says the study's senior author Angela Fagerlin, Ph.D.
"For primary care
providers to help patients to achieve their best health, they need to know what
the patient is struggling with," says Fagerlin. Patients who withhold they
have been sexually assaulted are potentially at risk for post-traumatic stress
disorder and sexually-transmitted diseases, she explains. "These are
numerous ways providers can help patients with such as getting resources,
therapy and treatment." She is chair of the department of Population
Health Sciences at U of U Health and an investigator with the VA Salt Lake City
Health System's Informatics Decision-Enhancement and Analytic Sciences (IDEAS)
Center for innovation.
The study reflects
responses from over 4,500 people in two national online surveys from 2015.
Participants in one survey averaged 36 years old, while participants from the
second had a median age of 61. They reviewed a list of types of medically
relevant information and asked to indicate whether they had ever withheld this
information from a clinician. They were also asked to recall why.
The surveys show that 40
to 47.5 percent of participants chose not to tell their provider that they had
experienced at least one of the four threats. Over 70 percent said the reason
why was embarrassment or fear of being judged or lectured.
If the patient was female
or younger then the odds were higher they would keep this information to
themselves. What compounds this issue is that multiple studies in recent years
have highlighted how health care providers downplay or fail to take seriously
women's medical complaints.
One limitation noted by
the study's first author Andrea Gurmankin Levy, Ph.D., MBe, a professor in
social sciences at Middlesex Community College in Middletown, Connecticut, is
that study participants may have not shared in their survey responses all the
information they withheld, meaning that this phenomenon may be even more
prevalent than the study reveals.
Levy says the survey
reinforces the point that there is discomfort and a lack of trust between
patients and providers. If patients filled out a questionnaire about sensitive
information when they arrive at the provider's office, might that improve the
information flow? She wonders, "Is it easier to tell a piece of paper
something sensitive than to look into your clinician's eyes and say it?"
The next step in Fagerlin
and Levy's research may be contacting patients as they leave an appointment
with their provider. Person-to-person interviews would permit the research team
to get patients to respond while their memories are still clear.
"If we are there, we
can ask them right in the moment so they can more easily put their finger on
exactly what was at issue - why they didn't share such crucial
information," Levy says.
This is the second
article by this team to draw upon the 2015 surveys. The first, published in
November 2018 revealed that 60 to 80 percent of those surveyed did not share
pertinent information with their provider regarding daily issues like diet and
exercise. One third did not speak up when they disagreed with their provider's
recommendations.
Both surveys raise
concerns about communication and trust between patients and their care givers.
Improving rapport falls both on providers' and patients' shoulders, the authors
say. Providers need to establish an atmosphere where the patient feels neither
judged nor rushed but rather are able to share concerns fundamental to their
well-being. In addition, patients will benefit by sharing sensitive information
with their providers.
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