Assessing Problematic Substance Use in HIV Care: Which Questions Elicit Accurate Patient Disclosures?

Wynne Callon, Mary Catherine Beach, Somnath Saha, Geetanjali Chander, Ira B. Wilson, Michael Barton Laws, Victoria Sharp, Jonathan Cohn, Richard D Moore, P. Todd Korthuis

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Substance use is associated with higher rates of antiretroviral non-adherence and poor HIV outcomes. This study examined how HIV care providers assess substance use, and which questions elicit accurate patient disclosures. METHODS: We conducted a conversation analysis of audio-recorded encounters between 56 providers and 162 patients living with HIV (PLWH) reporting active substance use in post-encounter interviews (cocaine or heroin use in the past 30 days, > 4 days intoxicated in past 30 days, or AUDIT score ≥ 8). We assessed the frequency of substance use discussion, characterized the types of questions used by providers, and determined the frequency of accurate patient disclosure by question type. RESULTS: In 55 reports of active substance use, providers already knew about the use (n = 16) or patients disclosed unpromptednn = 39). Among the remaining 155 instances of substance use in which providers had the opportunity to elicit disclosure, 78 reports (50 %) of substance use were not discussed. Of the remaining 77 reports in which the provider asked about substance use, 55 (71 %) patients disclosed and 22 (29 %) did not disclose. Questions were classified as: open-ended (n = 18, “How’s the drinking going?”); normalizing (n = 14, “When was the last time you used?”); closed-ended (n = 36, “Have you used any cocaine?”); leading towards non-use (n = 9, “Have you been clean?”). Accurate disclosure followed 100 % of open-ended and normalizing questions, 58 % of closed-ended questions, and 22 % of leading questions. After adjusting for drug type, closed-ended questions were 41 % less likely (p <0.001), and ‘leading’ questions 78 % less likely (p = 0.016) than broad and normalizing questions to elicit disclosures. CONCLUSION: Providers in this sample missed almost half of the opportunities to identify and discuss substance use with PLWH. Providers can increase the probability of patient disclosure by using open-ended or normalizing questions that ask about the “last time” that the patient used drugs or alcohol.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalJournal of General Internal Medicine
DOIs
StateAccepted/In press - May 19 2016

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Disclosure
HIV
Cocaine
Heroin
Pharmaceutical Preparations
Drinking
Alcohols
Interviews

ASJC Scopus subject areas

  • Internal Medicine

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Assessing Problematic Substance Use in HIV Care : Which Questions Elicit Accurate Patient Disclosures? / Callon, Wynne; Beach, Mary Catherine; Saha, Somnath; Chander, Geetanjali; Wilson, Ira B.; Laws, Michael Barton; Sharp, Victoria; Cohn, Jonathan; Moore, Richard D; Korthuis, P. Todd.

In: Journal of General Internal Medicine, 19.05.2016, p. 1-7.

Research output: Contribution to journalArticle

Callon, Wynne ; Beach, Mary Catherine ; Saha, Somnath ; Chander, Geetanjali ; Wilson, Ira B. ; Laws, Michael Barton ; Sharp, Victoria ; Cohn, Jonathan ; Moore, Richard D ; Korthuis, P. Todd. / Assessing Problematic Substance Use in HIV Care : Which Questions Elicit Accurate Patient Disclosures?. In: Journal of General Internal Medicine. 2016 ; pp. 1-7.
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abstract = "BACKGROUND: Substance use is associated with higher rates of antiretroviral non-adherence and poor HIV outcomes. This study examined how HIV care providers assess substance use, and which questions elicit accurate patient disclosures. METHODS: We conducted a conversation analysis of audio-recorded encounters between 56 providers and 162 patients living with HIV (PLWH) reporting active substance use in post-encounter interviews (cocaine or heroin use in the past 30 days, > 4 days intoxicated in past 30 days, or AUDIT score ≥ 8). We assessed the frequency of substance use discussion, characterized the types of questions used by providers, and determined the frequency of accurate patient disclosure by question type. RESULTS: In 55 reports of active substance use, providers already knew about the use (n = 16) or patients disclosed unpromptednn = 39). Among the remaining 155 instances of substance use in which providers had the opportunity to elicit disclosure, 78 reports (50 {\%}) of substance use were not discussed. Of the remaining 77 reports in which the provider asked about substance use, 55 (71 {\%}) patients disclosed and 22 (29 {\%}) did not disclose. Questions were classified as: open-ended (n = 18, “How’s the drinking going?”); normalizing (n = 14, “When was the last time you used?”); closed-ended (n = 36, “Have you used any cocaine?”); leading towards non-use (n = 9, “Have you been clean?”). Accurate disclosure followed 100 {\%} of open-ended and normalizing questions, 58 {\%} of closed-ended questions, and 22 {\%} of leading questions. After adjusting for drug type, closed-ended questions were 41 {\%} less likely (p <0.001), and ‘leading’ questions 78 {\%} less likely (p = 0.016) than broad and normalizing questions to elicit disclosures. CONCLUSION: Providers in this sample missed almost half of the opportunities to identify and discuss substance use with PLWH. Providers can increase the probability of patient disclosure by using open-ended or normalizing questions that ask about the “last time” that the patient used drugs or alcohol.",
author = "Wynne Callon and Beach, {Mary Catherine} and Somnath Saha and Geetanjali Chander and Wilson, {Ira B.} and Laws, {Michael Barton} and Victoria Sharp and Jonathan Cohn and Moore, {Richard D} and Korthuis, {P. Todd}",
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T2 - Which Questions Elicit Accurate Patient Disclosures?

AU - Callon, Wynne

AU - Beach, Mary Catherine

AU - Saha, Somnath

AU - Chander, Geetanjali

AU - Wilson, Ira B.

AU - Laws, Michael Barton

AU - Sharp, Victoria

AU - Cohn, Jonathan

AU - Moore, Richard D

AU - Korthuis, P. Todd

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N2 - BACKGROUND: Substance use is associated with higher rates of antiretroviral non-adherence and poor HIV outcomes. This study examined how HIV care providers assess substance use, and which questions elicit accurate patient disclosures. METHODS: We conducted a conversation analysis of audio-recorded encounters between 56 providers and 162 patients living with HIV (PLWH) reporting active substance use in post-encounter interviews (cocaine or heroin use in the past 30 days, > 4 days intoxicated in past 30 days, or AUDIT score ≥ 8). We assessed the frequency of substance use discussion, characterized the types of questions used by providers, and determined the frequency of accurate patient disclosure by question type. RESULTS: In 55 reports of active substance use, providers already knew about the use (n = 16) or patients disclosed unpromptednn = 39). Among the remaining 155 instances of substance use in which providers had the opportunity to elicit disclosure, 78 reports (50 %) of substance use were not discussed. Of the remaining 77 reports in which the provider asked about substance use, 55 (71 %) patients disclosed and 22 (29 %) did not disclose. Questions were classified as: open-ended (n = 18, “How’s the drinking going?”); normalizing (n = 14, “When was the last time you used?”); closed-ended (n = 36, “Have you used any cocaine?”); leading towards non-use (n = 9, “Have you been clean?”). Accurate disclosure followed 100 % of open-ended and normalizing questions, 58 % of closed-ended questions, and 22 % of leading questions. After adjusting for drug type, closed-ended questions were 41 % less likely (p <0.001), and ‘leading’ questions 78 % less likely (p = 0.016) than broad and normalizing questions to elicit disclosures. CONCLUSION: Providers in this sample missed almost half of the opportunities to identify and discuss substance use with PLWH. Providers can increase the probability of patient disclosure by using open-ended or normalizing questions that ask about the “last time” that the patient used drugs or alcohol.

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