A new University of California San Francisco study has found that patients are willing to discuss risky behavior with their primary care physicians and that it matters little whether they do that face-to-face or with the help of technology.
The study, published in the January edition of Medical Care, found that patients are willing to disclose behavior that puts them at risk for conditions ranging from HIV to domestic violence regardless of whether they believe their doctors will receive the information. In addition, the study found that patients are as willing to disclose such information in oral or written interviews -- methods previously thought to hamper discussions -- as they are with the aid of technology, such as computers.
The findings are a key step in opening up dialogue about sensitive subjects, including risky sexual behavior, drug and alcohol use and domestic violence, between doctors and their patients, said UCSF psychologist Barbara Gerbert, PhD, professor and chair of UCSF's Behavioral Sciences Division in the School of Dentistry and the study's principal investigator.
Though such discussions can ultimately help reduce patients' health risks, they all too often don't take place because physicians don't know how to broach the issues and believe patients don't want to be asked about them, Gerbert said.
The study's findings, however, should help break down such barriers, as now there is proof that patients believe that it is within their doctors' domain to know about behavior that can put their health at risk -- and it doesn't much matter what method they use to find out, Gerbert said.
"Now we know that if asked patients will tell," Gerbert said. "So the asking on the part of physicians is the important part."
The study, conducted at four San Francisco Bay Area primary care medical facilities, involved 1,952 patients who were asked to complete a questionnaire about HIV risks, drug, alcohol and tobacco use, domestic violence, oral health and seat belt use. Half were told their doctors would see the results. The other half were told only researchers would see their responses.
There were no significant differences in the two groups' answers. For example, 68 percent of patients in the first group disclosed behavior that would put them at risk for HIV versus 67 percent in the second group. Twenty percent of patients in both groups disclosed misuse of alcohol and 20 percent of patients in the first group and 22 percent of patients in the second group disclosed drug use. The answers of 31 percent of patients in the first group showed they were at-risk of domestic violence versus 32 percent in the second group.
The study also found that patients' answers did not vary much when different methods were used to administer the questionnaire. Although previous studies found that patients were more likely to answer questions about sensitive subjects truthfully when questionnaires were administered through technology, such as computers, than more personal methods, the new UCSF study found that is not necessarily the case, Gerbert said.
The most significant difference surrounded the question of HIV risk-related behavior; 71 percent of patients disclosed risky behavior when asked through technology versus 63 percent in face-to-face or written interviews. And 22 percent of patients using technology disclosed alcohol misuse versus 17 percent questioned in traditional interviews.
Those differences, however, are small enough that doctors need not be concerned about which methods they use to screen patients for risks, Gerbert said. Rather, the study shows that big facilities with access to computers and small practices that may need to use more traditional interviewing techniques will likely get similar results, she said.
"Each setting can decide what works," Gerbert said. "This gives them lots of freedom."
Co-researchers on the study are: Amy Bronstone, PhD, UCSF Division of Behavioral Sciences research associate; Steven Pantilat, MD, UCSF assistant professor of medicine; Stephen McPhee, MD, UCSF professor of medicine; Michael Allerton, MS, HIV operations policy officer, Kaiser-Permanente; and James Moe, PhD, UCSF Division of Behavioral Sciences research associate.
The study was funded by the National Institute of Mental Health.