A Qualitative Assessment of Emergency Department Patients' Knowledge, Beliefs, Attitudes, and Acceptance Toward Revised HIV Testing Strategies

Abstract

Objectives The objective of this study was to explore emergency department (EDs) patient’s knowledge, beliefs, attitudes, and acceptability towards revised human immunodeficiency virus (HIV) testing recommendations. Methods Participants were recruited in proportion to the racial, sex, and ethnic makeup of the study ED. Interviewers presented participants with a stimulus followed by questions about opt-out consent, elimination of separate written consent, and curtailed counseling. Three investigators coded all transcripts using an iterative coding strategy until thematic saturation was achieved. Results Thirty-four semi-structured, in-depth, individual interviews were conducted, including five with patients ages 13 to 17 years, and five with Spanish-speaking patients. Nineteen (56%) participants were women. The mean age was 31 years (SD ±12 years). Most were Hispanic (38%), or African American/black (44%). Only one (2.9%) participant knew about the revised testing recommendations. Participants believed opt-out consent would result in increased testing, but this was confounded by misunderstanding of the consent process: “so the opt-out is, you basically don’t have a choice.” Participants thought eliminating separate written consent was a positive change but that it could result in people being tested without their knowledge. Attitudes diverged over curtailed counseling, but participants felt patients “should have options” for counseling because “everybody isn’t the same.” Conclusions Emergency department patients were unaware of revised HIV testing recommendations. Most felt opt-out consent and elimination of separate written consent were positive changes but could result in a patient being tested without his or her knowledge. The response to curtailed counseling was polarized but participants agreed on the need to accommodate personal preferences. This information may be useful to when designing ED-based HIV testing programs.

Understanding HIV Screening in the Emergency Department: Is Perception Reality?

“…Also, similar to results from our research group, Cowan et al importantly confirmed fundamental misunderstanding of opt‐out consent, which supports an existing notion that patients may not understand what they are consenting to . While the CDC explicitly states that “[s]creening should be voluntary and undertaken only with the patient's knowledge and understanding that HIV testing is planned,” these results, unfortunately, suggest otherwise.…”

“…The article by Cowan et al used semistructured interviews to assess patients' perceptions related to consent and counseling as suggested by the CDC . These authors nicely demonstrate support of the CDC recommendations for streamlining consent (i.e., integrating HIV consent into the general consent and eliminating the need for separate written consent); they also highlight differences in patients' perceptions related to counseling—some believing counseling is important and others not.…”

“…In this issue of Academic Emergency Medicine , Schnall et al and Cowan et al publish articles using qualitative methodology to better understand clinician and patient understanding, respectively, of routine HIV screening in the ED. Although qualitative research is meant to be exploratory or “hypothesis‐generating,” it is the correct methodology for beginning to understand perception, and the work published by these two groups significantly advances the science of HIV screening.…”

Patient Understanding of HIV and Hepatitis C Testing in an Emergency Department with an Integrated Program

“…It is our belief, however, as well as others, that patients have a certain tolerance for testing and often don't expect explicit consent to have testing performed. 7 Additional study to support this assumption is warranted.…”

HIV, trauma and the emergency departments: The CDC opt-out approach should be adopted in South Africa

“…Of 34 patients, from varied backgrounds, polled at a public teaching hospital in New York about their understanding of, beliefs about and reaction to opt-out testing in the ED, [27] some lack of understanding of the option to opt out was found, but they were generally in favour, citing the potential health benefits as the main reason to support the opt-out process. The main confusion was that participants incorrectly assumed that they would face mandatory testing, rather than having the option to refuse, especially if not of decision-making capability.…”