Alarming Rates of Life-Threatening Patient Nondisclosures

A patient’s full disclosure of medically relevant information to their clinician is essential to ensuring all-encompassing health support, developing successful treatment strategies and guaranteeing optimal outcomes. This is especially true in cases of imminent threat, which range from drug and substance abuse habits to domestic violence incidents. Previous research has revealed that patients often choose not to share details about certain behaviors, such as lack of exercise or poor diet, in fear of being judged or reprimanded. However, relatively little knowledge was available thus far about the disclosure rates for life-threatening factors.

While it is essential for primary care providers to be aware of all details affecting patient health, a recent study indicates that nearly half of patients withhold potentially life-threatening information from their physicians. Aiming to determine the prevalence of patient nondisclosure about imminent threats and identify the common underlying reasons, researchers evaluated data from 4,510 Amazon’s Mechanical Turk (MTurk) and Survey Sampling International (SSI) survey respondents.

Patient Nondisclosures to Clinicians of Imminent Threats 

Published in August in JAMA Network Open, the findings reveal alarmingly high rates of nondisclosure of life-threatening information. Dr. Andrea Gurmankin Levy from Middlesex Community College, and colleagues evaluated data from over 4.500 respondents from two national online surveys and found that up to 47.5% of patients do not share critical information with their primary care providers in one or more of four life-threatening categories. Data revealed that nearly half of respondents did not disclose information concerning: potential for domestic violence, survival of sexual assault, struggles with depression, or suicidal thoughts.    

For their investigation, Dr. Levy and her team examined 2015 survey data from two larger national questionnaires in which participants shared whether or not they had ever kept medically relevant information from a clinician and if so, why. Researchers found that in both surveys, domestic abuse was the factor most often not disclosed with a rate of approximately 42%. The next highest factor was depression within the MTurk sample (38.1%) and sexual assault in the SSI cohort (41.6%). In the MTurk group, suicidal thoughts were not reported by 37.8% of participants and sexual assault by 28.8%. Similarly, in the SSI sample 37% of respondents did not report suicidal thoughts to their clinicians and 29% did not disclose struggling with depression.

Why Do Patients Withhold Life-Threatening Information?

Dr. Levy and colleagues discovered that the primary reason behind nondisclosures was patient embarrassment. Over 70% of respondents admitted they were embarrassed to share even such potentially life-threatening information. Over 50% withheld information because they did not want to be judged or lectured and because they did not want to engage in the difficult follow-up conversation. Furthermore, over half of participants reported not wanting the information to appear in their medical record, despite its clinical relevance. The study results suggest that the potential difficult or negative repercussions of disclosing life-threatening information deter many patients from sharing imminent threats with their clinician, putting them in even greater physical and mental danger.

These recent findings not only underscore the need for building trust and honest relationships between clinicians and patients, but they also emphasize the need for improved communication between both parties. Moreover, the issue may be worse than data suggest as survey respondents may not have disclosed all of the information they have withheld from clinicians, notes Dr. Levy. Further research is necessary to determine the actual scale of the nondisclosure phenomenon and to gather more recent and relevant data upon which to base recommendations for next steps.