Assessment of Patient Nondisclosures to Clinicians of Experiencing Imminent Threats

Key Points Question How common is it for patients to withhold information from clinicians about imminent threats that they face (depression, suicidality, abuse, or sexual assault), and what are common reasons for nondisclosure? Findings This survey study, incorporating 2 national, nonprobability, online surveys of a total of 4510 US adults, found that at least one-quarter of participants who experienced each imminent threat reported withholding this information from their clinician. The most commonly endorsed reasons for nondisclosure included potential embarrassment, being judged, or difficult follow-up behavior. Meaning These findings suggest that concerns about potential negative repercussions may lead many patients who experience imminent threats to avoid disclosing this information to their clinician.


Introduction
Thank you for your time. This study is being conducted by the Center for Bioethics and Social Sciences in Medicine at the University of Michigan and the University of St. Joseph-Connecticut. By taking this survey, you can help researchers better understand how patients communicate with their physicians. Specifically, the information we learn will help physicians to better understand how to talk to their patients and help them feel comfortable. This survey will take about 10 minutes. Your name will not be recorded anywhere in this survey. All of your answers will be completely anonymous. If you choose to complete the survey, you can stop at any time. You may choose not to answer any questions you don't want to answer. If you want to stop and restart the survey at a later time, just click on the survey link in your email invitation again to continue where you left off. We will also collect some information about what operating system and browser you are using to view this survey and how long you spend on each page. This information is being collected for quality control. The Health Science and Behavioral Science Institutional Review Board (HSBS-IRB) has reviewed this study and has determined that it is exempt from IRB oversight. Your help means a lot to us. We thank you again for taking the time to complete this survey.
On the following pages, we will ask you about types of situations that many patients avoid telling their health care providers about. By health care provider we mean any medical care giver such as a doctor, physician's assistant, or nurse. For each situation, we will ask you whether you have ever avoided telling a health care provider about it and if so, the reasons why you might have avoided sharing this information, such as: I was embarrassed, I wanted the health care provider to like me, I didn't want the information documented in my medical record. Please remember that this survey does not ask for your name or any other identifying information. Thank you again for your help.
Have you ever avoided telling a health care provider that you did not understand their instructions to you?  Yes (1 You said that you have avoided telling a health care provider that you had an unhealthy diet or how unhealthy your diet was. What were your reasons for not telling the health care provider this information? (Please click yes or no for each of the items below).
No (1) Yes (2) I was embarrassed to admit that I had an unhealthy diet. You said that you have avoided telling a health care provider that you took a certain medication (prescription, over-the-counter, or alternative medicines). What were your reasons for not telling the health care provider this information? (Please click yes or no for each of the items below).
No (1) Yes (2) I was embarrassed to admit that I took this medication. (1 You said that you have avoided telling a health care provider that you did not take your prescription medication as instructed. What were your reasons for not telling the health care provider this information? (Please click yes or no for each of the items below).
No (1) Yes (2) I was embarrassed to admit that I did not take my perscription medication as instructed. (1 You said that you have avoided telling a health care provider that you drank alcohol when you shouldn't have or how much alcohol you drank. What were your reasons for not telling the health care provider this information? (Please click yes or no for each of the items below).
No (1) Yes (2) I was embarrassed to admit that I drank alcohol when I shouldn't have or how much alcohol I drank.
(1) You said that you have avoided telling a health care provider that you smoked or how much you smoked. What were your reasons for not telling the health care provider this information? (Please click yes or no for each of the items below).
No (1) Yes (2) I was embarrassed to admit that I smoked or how much I smoked.
(1) You said that you have avoided telling a health care provider that you were depressed or how depressed you were. What were your reasons for not telling the health care provider this information? (Please click yes or no for each of the items below).
No (1) Yes (2) I was embaressed to admit that I was depressed or how depressed I was.
(1) You said that you have avoided telling a health care provider that you had an embarrassing symptom or how severe the symptom was. What were your reasons for not telling the health care provider this information? (Please click yes or no for each of the items below).
No (1) Yes ( You said that you have avoided telling a health care provider that you used recreational drugs or how much you used recreational drugs. What were your reasons for not telling the health care provider this information? (Please click yes or no for each of the items below).
No (1) Yes (2) I was embarrassed to admit that I had used recreational drugs or how much I had used recreational drugs. (1