Patients Are Failing to Disclose Imminent Health Threats to Physicians

According to a study published in JAMA Network Open, many patients withhold information from their physicians about imminent health threats that they face.

The authors of this study wrote that “patient disclosure to their clinician about experiencing an imminent threat is a critical step toward receiving support or assistance.” Thus, the researchers sought to examine the frequency of patients not disclosing their experience of imminent threats to their clinician while discerning possible reasons for doing so.

In this survey study, researchers assessed the results of two national nonprobability samples that comprised 2,011 (60.3% female, 60.2% white, mean age, 36) US adults enrolled from Amazon’s Mechanical Turk (MTurk) from March 16-30, 2015 and 2,499 (51% female, 78.8% white participants recruited from Survey Sampling International (SSI) from November 6 to 18, 2015. The study’s key endpoints were self-reported nondisclosure to physicians of four imminent threats that included depression, suicidality, abuse, and sexual assault. The researchers aggregated and analyzed data from December 20 to 28, 2018.

A Better Physician Understanding ‘Is Critical’

According to the results of this study, among those participants who reported experiencing at least 1 of the 4 imminent threats, 613 of 1,292 MTurk participants (47.5%) and 581 of 1,453 SSI participants (40.0%) withheld information from their clinician. The researchers found that the most commonly used reasons for withholding imminent health information included being embarrassed (MTurk: 72.7%; SSI: 70.9%), not wanting to be judged or lectured (MTurk: 66.4%; SSI: 53.4%), and not wanting to engage in a difficult follow-up behavior (MTurk: 62.4%; SSI: 51.1%).

Moreover, the study found that survey respondents who experienced at least 1 of the 4 imminent threats had appreciably greater odds of nondisclosure in both samples if they were female (MTurk: odds ratio [OR], 1.66 [95% CI, 1.30 to 2.11]; and SSI: OR, 1.33 [95% CI, 1.07 to 1.67]) or younger (MTurk: OR, 0.99 [95% CI, 0.98 to 1.00]; and SSI: OR, 0.98 [95% CI, 0.97 to 1.00]). Worse self-rated health was also associated with nondisclosure, but only in the SSI sample (OR, 0.85 [95% CI, 0.74-0.96]).

“This study suggests that many people withhold information from their clinicians about imminent health threats that they face,” the study authors wrote. “A better understanding of how to increase patients’ comfort with reporting this information is critical to allowing clinicians to help patients mitigate these potentially life-threatening risks.”