Risk Communication After Health Care Exposures: An Experimental Vignette Survey With Patients

A Rani Elwy; Elizabeth M Maguire; Thomas H Gallagher; Steven M Asch; Janet M Durfee; Richard A Martinello; Barbara G Bokhour; Allen L Gifford; Thomas J Taylor; Todd H Wagner

doi:10.1177/23814683211045659

Risk Communication After Health Care Exposures: An Experimental Vignette Survey With Patients

MDM Policy Pract. 2021 Sep 17;6(2):23814683211045659. doi: 10.1177/23814683211045659. eCollection 2021 Jul-Dec.

Affiliations

¹ Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts.
² Division of General Internal Medicine, University of Washington, Seattle, Washington.
³ Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, California.
⁴ Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Washington, DC.
⁵ Yale-New Haven Hospital Departments of Medicine (Infectious Diseases) and Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
⁶ Center for Healthcare Organization and Implementation Research, VA Boston Health Care System, Jamaica Plain, Massachusetts.

Abstract

Purpose. We investigated how health care systems should communicate with patients about possible exposures to blood-borne pathogens that may have occurred during their care. Our goal was to determine how best to communicate uncertain risk information in a way that would minimize harm to patients, maintain their trust, and encourage patients to seek follow-up treatment. Methods. Participants (N = 1103) were randomized to receive one of six vignette surveys; 997 (98.4%) responded. All vignettes described the same event, but differed by risk level and recommendations (lower risk v. higher risk) and by communication mode (telephone, letter, social media). We measured participants' perceived risk of blood-borne infection, trust in the health care system, and shared decision making about next clinical steps. Open-ended questions were analyzed using grounded thematic analysis. Results. When the vignette requested patients to undergo testing and practice certain health behaviors (higher risk), participants' likelihood of seeking follow-up testing for blood-borne pathogens and their understanding of health issues increased. Perceived trust was unaffected by risk level or communication processes. Qualitative data indicated a desire for telephone communication from providers known to the patient. Limitations. It is not clear whether higher risk language or objective risk levels in vignettes motivated patients' behavioral intentions. Conclusion. Using higher risk language when disclosing large-scale adverse events increased participants' willingness to seek follow-up care. Implications. Health care organizations' disclosures should focus on the next steps to take after health care exposures. This communication should involve helping patients to understand their personal health issues better, make them feel that they know which steps to take following the receipt of this information, and encouraging them to seek follow-up infectious disease testing in order to better take care of themselves.

Keywords: experimental study; healthcare exposures; risk communication; veterans; vignettes.