We conducted an anonymous, self-administered, cross-sectional survey of outpatients at five clinics at Harborview Medical Center, a public urban hospital and regional trauma center in Seattle, WA, to define the importance that patients place on testing for HCV, compared to HIV and diabetes mellitus. We included HIV as testing requires special consent procedures, thus universal screening for HIV might raise additional concerns relative to HCV. We included diabetes because a manner of universal screening is already de facto present in every chemistry panel with a glucose result, but consent is not consistently obtained and normal results may be inconsistently discussed with patients (even abnormal results are only discussed with patients 66-88% of the time[15
]). This study was approved by the Human Subjects Division of the University of Washington.
The instrument was piloted with five patients, met a Flesh-Kincaid fifth-grade reading level, and was in English, a language accessible to 90% of this hospital's patients (personal communication, Harborview Interpreter Services, 2 July 2010). We collected patient demographics and expectations as to physician communication regarding laboratory testing.
The remaining sections addressed HCV, HIV, and diabetes. Each section was preceded by a brief description of the disease and a statement that some people do not learn about their condition until they are sick. Initial questions in each section asked subjects' disease status and risk factors, followed by a series of questions about aspects of universal screening detailed in the accompanying tables. All questions were asked of HCV, but to ensure brevity only a subset of questions were included in sections on HIV and diabetes. The primary outcome variable, asked of HCV and HIV, allowed respondents to select one of three screening options: (1) universal screening of all blood samples without patient knowledge of the test and without receiving negative results, (2) universal screening without receiving negative results but with a chance to refuse testing, or (3) screening based on clinician judgment. Comments were solicited at the end of the survey.
Forty surveys were collected from each of five clinics (General Medicine, Family Medicine, Womens', General Surgery, and Orthopedics), selected to represent the diverse nature of outpatient care, including primary care serving a largely inner-city population and surgical care serving five northwest states. Researchers sequentially approached all patients in the waiting room after they had checked into the clinic and completed registration paperwork. Eligible subjects were more than 15 years of age, able to communicate in English, and had not previously completed the survey. Interested subjects were provided an "information sheet" in lieu of signed consent and, if they still wanted to participate, a survey and pencil. Subjects completed the survey in the waiting area or a clinic room and received $5 compensation when they returned the completed survey to the researcher. All data collection activities were completed in August 2010.
Data were analyzed with STATA 11.1, utilizing descriptive statistics, Pearson's Chi-square, and McNemar's test of matched pairs. To evaluate for any associations with the primary outcome of preferred screening method, we collapsed the two options for universal screening and compared those respondents to those who preferred screening by clinician judgment. Missing values were excluded. We coded optional comments based on identified themes.