Results of a new study that used Amazon’s survey technology reveal that many patients may not be telling clinicians when they face imminent threats to their health. The findings, published in JAMA Network Open, suggest that more work is needed on the part of clinicians to build trust and communicate effectively with their patients.
For the research, the authors incorporated results from two national, nonprobability samples of US adults. One group was recruited between March 16 and 30, 2015, from Amazon’s Mechanical Turk (MTurk) marketplace, a population of Internet users who participate in surveys and other tasks in exchange for financial compensation. To balance the younger skew of that sample, the authors recruited a second group of adults aged ≥ 50 from Survey Sampling International (SSI) from November 6 to 17, 2015.
Of the 2011 participants in the MTurk sample, 60.3% were female and 60.2% were white, with a mean age of 35.7, compared with a population that was 51.0% female, 78.8% white, and mean age 61 in the SSI sample of 2499 participants. All were asked whether they had avoided telling a clinician about four imminent threats: depression, suicidal thoughts, abuse, and sexual assault. The definition of a clinician included any medical caregiver.
The majority of patients in both samples—64.3% in MTurk and 58.1% in SSI—reported having experienced at least one of the four imminent threats, yet of those subsets, 47.5% and 40.0%, respectively, had withheld from their clinician information about at least one of those threats. Abuse was the threat most likely not to be disclosed by the MTurk group (42.2%) followed by depression (38.1%), suicidality (37.8%), and sexual assault (28.8%). Abuse also was most likely not be disclosed by the SSI group (42.3%), followed by sexual assault (41.6%), suicidality (37.0%) and depression (29.0%).
In both groups, embarrassment was the most common reason that participants gave for nondisclosure (MTurk 72.7%; SSI 70.9%), followed by not wanting to be judged or lectured (MTurk 66.4%; SSI 53.4%), not wanting to have to engage in a difficult follow-up behavior (MTurk 62.4%; SSI 51.1%), and not wanting the information in their medical record (MTurk 57.1%; SSI 52.7%).
The authors noted that the odds of nondisclosure to a clinician were significantly higher, in both groups, among participants who were female (MTurk odds ratio [OR], 1.66 [95% CI 1.30 to 2.11]; SSI OR 1.33 [95% CI 1.07 to 1.67]) and younger (MTurk OR 0.99 [95% CI 0.98 to 1.00]; SSI OR 0.98 [95% CI 0.97 to 1.00]). In the SSI group but not the MTurk group, a self-report of poor health also was associated with significantly higher odds of nondisclosure (OR 0.85 [95% CI 0.74 to 0.96]). There was no significant association between either race/ethnicity or education and nondisclosure in either group.
The authors noted that their data point to an “important concern about clinician-patient communication” in that if clinicians do not know that their patients are facing imminent threats, they cannot help mitigate those threats. “These results,” the researchers said, “highlight the continued need to develop effective interventions that improve the trust and communication between patients and their clinicians, particularly for sensitive, potentially life-threatening topics.”