Understanding non-disclosure of deferrable risk: a study of blood donors with a history of intravenous drug use

Abstract

Non-disclosure of deferrable risk has received little attention in the literature. We examined deferrable risk (history of intravenous drug use [IVDU]) and donor attitudes towards truthfulness, the screening process and interpretation of the screening question as well as risk profile. Donors negative for all markers with a self-reported history of IVDU (N = 30) and matched controls were identified from an anonymous mail-out survey. In a separate survey, hepatitis C virus (HCV)-positive donors participated in a telephone interview, from which all those with IVDU history (N = 29) were selected plus matched controls (combined total 59 IVDU, 236 controls). IVDU donors, when compared with matched controls, tended to believe that it is OK not to answer truthfully if one believes that her/his blood is safe (18.6% vs. 4.7%) and that some questions are a little too personal (35.6% vs. 21.7%). IVDU donors were more likely than controls to say they failed to acknowledge screening questions appropriately (23% vs. 2.2%) or to agree that IVDU questions are mainly about recent drug taking or sharing needles (29% vs. 11%) even though the screening question asked about IVDU ever without any such qualifiers. IVDU donors were also more likely to have other lifestyle/risk factors such as history of sex with IVDU (45.5% vs. 1.7%). Donors with deferrable IVDU history may rationalise that revealing their status is not necessary and may misinterpret the question. Failure to acknowledge risk behaviour is complex, and some degree of non-disclosure may be an inherent part of pre-donation screening.

Hepatitis C Virus Antibody Positivity and Predictors Among Previously Undiagnosed Adult Primary Care Outpatients: Cross-Sectional Analysis of a Multisite Retrospective Cohort Study

“…First, blood transfusion before 1992, an important determinant of anti-HCV positivity among older adults, was not included in this analysis due to a lack of consistent data collection across sites. Second, it is likely that risk factors such as IDU were underreported [31–35]; nondisclosure of relevant patient risk factors could lead to confounding of estimates [36]. Nonetheless, we determined that the proportions of patients identified as having history of IDU, hemophilia, HIV positivity, or elevated ALT were comparable to estimates reported in previous studies [12, 14, 16].…”

Characteristics of post donation information donors and comparison with appropriately deferred donors

“…This failure to disclose could be for several reasons. In a recent study, O'Brien and colleagues 16 noted that IV drug users tended to believe that it was appropriate not to answer correctly about this health history as long as they believed that their blood was safe when compared to matched controls. The unwillingness to disclose this kind of sensitive deferral may also be related to the mode of questioning as Katz and colleagues 17 reported increased admissions of high‐risk behaviors using computer‐assisted self‐interviewing when compared to paper‐and‐pencil self‐administered questionnaires.…”

Socioeconomic status in HCV infected patients – risk and prognosis

“…This hypothesis is supported by cause of death analyses among HCV infected patients 4,9,14. However, IDU is generally considered as unaccepted behavior leading to stigma, and therefore, IDU is often not disclosed in a patient–doctor relationship 15,16…”