Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1045 — Risk Communication in VA Healthcare: Minimizing Risks Leads to Poor Veteran Reported Outcomes

Lead/Presenter: A. Rani Elwy, COIN - Bedford/Boston
All Authors: Elwy AR (VA Boston Healthcare System) Maguire EM (Edith Nourse Rogers Memorial Veterans Hospital) Bokhour BG (Edith Nourse Rogers Memorial Veterans Hospital) Wagner TH (Health Economics Resource Center, VA Palo Alto) Asch SM (VA Palo Alto Healthcare System) Gifford AL (VA Boston Healthcare System) Gallagher TH (University of Washington School of Medicine) Durfee JM (Patient Care Services, Department of Veterans Affairs) Martinello RA (Yale University School of Medicine) Taylor TJ (VA Palo Alto Healthcare System)

Objectives:
VA Handbook 1004.08, Disclosure of Adverse Events to Patients, calls for transparent, timely communication to patients when harm either has or may have occurred as a result of potentially unsafe clinical practices (e.g. large-scale adverse events) that may have affected their care. Working with VA operational leaders, we sought evidence for how VA should frame risk communication about these large-scale adverse events in order to minimize harm to patients and maintain their trust, allowing patients to seek appropriate follow-up care.

Methods:
Veteran patients were randomized to receive one of six vignette surveys, using an online research panel that, after weighting, was representative of the US Veteran population. Each vignette described the same adverse event involving potential exposure to bloodborne pathogens, but vignettes varied by level of risk communicated by VA (high vs. low) and the disclosure process (beginning with a VA provider phone call, letter, or through social media). We used linear and logistic models to assess Veterans' perceived risk of HIV or viral hepatitis infection, likelihood of seeking follow-up testing, trust in VA, and views about whether VA helped them with subsequent healthcare decision-making.

Results:
1,013 Veterans (73.9% response rate) who reported using VA healthcare in the past three years (71% in last 6 months) completed the survey. Receiving a low-risk vignette was associated with lower perceived risk of HIV or viral hepatitis infection and less likelihood of seeking testing for these viruses. When information was framed as low-risk, Veterans reported that VA put forth less effort in helping them 1) understand their health issues and 2) choosing what to do next (all p < 0.05). Perceived trust in VA did not vary by risk information. There were no differences in how Veterans' perceived risk information resulting from different disclosure processes.

Implications:
Minimizing risk information by communicating low-risk information to patients when disclosing adverse events that may have affected their care resulted in poorer patient reported outcomes in this vignette study.

Impacts:
VA leaders should be assured that being transparent about potential risks is the correct patient-centered policy to adopt for future communication with Veterans about large-scale adverse events.