Patients improve test compliance by considering health impact

When asked to contemplate the personal implications of tests, 50% of patients are more likely to follow through with screening, a new study says.

By — Posted Aug. 19, 2013

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It is impossible for physicians to diagnose and treat patients who are unwilling to get recommended screening tests because they are scared of what the results might mean. Yet such behavior, which experts dub health-information avoidance, is common. Previous research has found, for example, that as many as 55% of people tested for HIV never return to learn the results.

A combination of factors drives this self-defeating behavior, health psychology researchers say. This “defensive avoidance” comes about because patients fear that test results would threaten their sense of self, make them feel bad or require lifestyle changes. But new research shows that prompting patients to first think about the potential implications of learning their risk of disease can improve their willingness to follow through with testing by about 50%, according to a study posted online July 10 in the journal Psychological Science.

Researchers surveyed nearly 500 college undergraduates and Internet users about their willingness to learn their risk for different serious medical conditions. All the participants completed an online risk calculator, and some of the research subjects also answered a so-called contemplation questionnaire designed to make them think about how knowing their risk would affect them.

For example, the questionnaire for type 2 diabetes asked participants how strongly they agreed with statements such as:

  • I can control whether I develop diabetes.
  • It would be useful to know my risk for diabetes.
  • Learning that I am at high risk for diabetes would challenge my view of myself as healthy.
  • I personally have what it takes to deal with the news should I learn that I am at risk for diabetes.
  • It will be difficult for me to deal with the news should I learn that I am at risk for diabetes.

Long-term thinking encouraged

The questionnaire is not designed to screen for right or wrong answers, but to encourage more deliberative decision-making, said Jennifer L. Howell, the study's lead author. She is a health psychology researcher at the University of Florida in Gainesville.

“The whole idea behind this is that a lot of information avoidance, especially with regards to medical decision-making, is borne out of fear that this is going to mean something scary for me and negative for me in my life at this moment,” Howell said. “If we can get people to step back and focus on the long-term consequences, it will make them a little bit more likely to make a rational decision rather than an emotionally based decision.”

Although 44% of patients who did not take the contemplation questionnaire chose to avoid learning their risk for type 2 diabetes, only 25% of those who did the contemplative exercise opted out of learning their risk — a 43% drop in health-information avoidance. There was a 50% drop in avoidance in learning about personal risk for cardiovascular disease, the study found.

Howell and her colleagues have developed a scale to help identify patients who are at high risk for avoiding health information such as test results. Such avoidant attitudes are present in about one-third of the U.S. population, she said.

Physicians should anticipate noncompliance on testing and follow-up among some of their patients, and they ought to emphasize how knowledge can be empowering, Howell said.

“It's about getting patients to think through the process,” she said. “If you can, emphasize the controllable aspects of the condition.”

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Which patients avoid health information?

A quick survey has been shown to predict whether patients are willing to be screened for cancer of the mouth or breast cancer. On a one to seven scale, with seven being the highest, patients are asked how strongly they agree with statements such as:

  • Even if it will upset me, I want to know everything about my health.
  • I want to know everything about my health.
  • It is important to know everything about my health.
  • I would want to know everything about my health immediately.

Source: “Information Avoidance Scale,” provided by Jennifer Howell

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External links

“Reducing Health-Information Avoidance Through Contemplation,” Psychological Science, posted online July 10 (link)

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