Awkward moments in patient-physician communication about HIV risk

Highland Hospital Primary Care Institute, University of Rochester School of Medicine and Dentistry, New York 14620, USA.
Annals of internal medicine (Impact Factor: 17.81). 03/1998; 128(6):435-42.
Source: PubMed


Physicians frequently encounter patients who are at risk for HIV infection, but they often evaluate risk behaviors ineffectively.
To describe the barriers to and facilitators of comprehensive HIV risk evaluation in primary care office visits.
Qualitative thematic and sequential analysis of videotaped patient-physician discussions about HIV risk. Tapes were reviewed independently by physician and patient and were coded by the research team.
Physicians' offices.
Convenience sample of 17 family physicians and general internists. Twenty-six consenting patients 18 to 45 years of age who indicated concern about or risks for HIV infection on a 10-item questionnaire administered before the physician visit were included.
A thematic coding scheme and a five-level description of the depth of HIV-related discussion.
In 73% of the encounters, physicians did not elicit enough information to characterize patients' HIV risk status. The outcome of HIV-related discussions was substantially influenced by the manner in which the physician introduced the topic, handled awkward moments, and dealt with problematic language and the extent to which the physician sought the patient's perspective. Feelings of ineffectiveness and strong emotions interfered with some physicians' ability to assess HIV risk. Physicians easily recognized problematic communication during reviews of their own videotapes.
Comprehensive HIV risk discussions included providing a rationale for discussion, effectively negotiating awkward moments, repairing problematic language, persevering with the topic, eliciting the patient's perspective, responding to fears and expectations, and being empathic. Educational programs should use videotape review and should concentrate on physicians' personal reactions to discussing emotionally charged topics.

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Available from: Howard B Beckman, May 15, 2014
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    • "Many of the studies were concerned with generic aspects of the consultation and as such have a relatively unselected sample. However, five studies were focused on specific consultation content: patients’ expressed psychological problems [13]; discussion of smoking cessation [14]; HIV risk [15]; self-management in long term conditions [16] and health promotion [17]. In justifying the choice of method, many sought simply to gain a fuller understanding of participants’ experiences. "
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    BMC Medical Research Methodology 08/2014; 14(1):101. DOI:10.1186/1471-2288-14-101 · 2.27 Impact Factor
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    • "At times, this can involve substantive costs to both the customers and companies (Huffington Post, 2012). Self-disclosure poses many threats that can be both financial and social, including frauds, thefts, and complicated doctorpatient relations (Epstein et al., 1998; Alter and Oppenheimer, 2009). Thus, it is important to understand what causes people to reveal their personal information, especially the incidental effects of common environmental cues. "
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    ABSTRACT: With continuous growth in information aggregation and dissemination, studies on privacy preferences are important to understand what makes people reveal information about them. Previous studies have demonstrated that short-term gains and possible monetary rewards make people risk disclosing information. Given the malleability of privacy preferences and the ubiquitous monetary cues in daily lives, we measured the contextual effect of reminding people about money on their privacy disclosure preferences. In experiment 1, we found that priming money increased willingness to disclose their personal information that could be shared with an online shopping website. Beyond stated willingness, experiment 2 tested whether priming money increases propensity for actually giving out personal information. Across both experiments, we found that priming money increases both the reported willingness and the actual disclosure of personal information. Our results imply that not only do short-term rewards make people trade-off personal security and privacy, but also mere exposure to money increases self-disclosure.
    Frontiers in Psychology 11/2013; 4:839. DOI:10.3389/fpsyg.2013.00839 · 2.80 Impact Factor
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    • "We found that generalists were less familiar with PrEP efficacy results than were HIV specialists, which is particularly relevant since most persons at risk for HIV are not likely to seek care from HIV specialists. Given that physicians are not often comfortable discussing sexual behavior with their patients (Bernstein et al., 2008; Epstein et al., 1998; Petroll & Mosack, 2011), innovative provider education programs are needed for PrEP to be effective in decreasing HIV spread. Moderate provider willingness to prescribe oral/topical PrEP to Table 1. "
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    ABSTRACT: In 2010, the centre for the AIDS Programme of Research in South Africa (CAPRISA)004 and iPrEx trials (microbicide gel containing tenofovir and oral pill containing tenofovir-emtricitabine, respectively) demonstrated that antiretroviral preexposure prophylaxis (PrEP) reduced the risk of HIV acquisition among high-risk individuals. To determine the facilitators and barriers to PrEP provision by health-care providers, we conducted an online, quantitative survey of Massachusetts-area physicians following the publication of the CAPRISA and iPrEx results. We assessed awareness and comprehension of efficacy data, prescribing experience, and anticipated provision of oral and topical PrEP among physicians, as well as demographic and behavioral factors associated with PrEP awareness and prescribing intentions. The majority of HIV specialists and generalist physicians were aware of data from these PrEP trials and able to correctly interpret the results, however, correct interpretation of findings tended to vary according to specialty (i.e., HIV specialists had greater awareness than generalists). In addition, provider concerns regarding PrEP efficacy and safety, as well its ability to divert funds from other HIV prevention resources, were associated with decreased intentions to prescribe both oral and topical PrEP. Findings suggest that a substantial proportion of physicians who may have contact with at-risk individuals may benefit from interventions that provide accurate data on the risks and benefits of PrEP in order to facilitate effective PrEP discussions with their patients. Future studies to develop and test interventions aimed at health-care providers should be prioritized to optimize implementation of PrEP in clinical settings.
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