Patients’ understanding of blood tests and attitudes to HIV screening in the emergency department of a Swiss teaching hospital: a cross-sectional observational study

Timothée Favre-Bulle; Dimitri Baudat; Katharine Darling; Rachel Mamin; Solange Peters; Matthias Cavassini; Olivier Hugli

doi:10.4414/smw.2015.14206

Original article

Vol. 145 No. 4950 (2015)

Patients’ understanding of blood tests and attitudes to HIV screening in the emergency department of a Swiss teaching hospital: a cross-sectional observational study

Timothée Favre-Bulle
Dimitri Baudat
Katharine Darling
Rachel Mamin
Solange Peters
Matthias Cavassini
Olivier Hugli

DOI: https://doi.org/10.4414/smw.2015.14206
Cite this as:: Swiss Med Wkly. 2015;145:w14206
Published: 29.11.2015

Summary

BACKGROUND: In Switzerland, patients may undergo “blood tests” without being informed what these are screening for. Inadequate doctor-patient communication may result in patient misunderstanding. We examined what patients in the emergency department (ED) believed they had been screened for and explored their attitudes to routine (non-targeted) human immunodeficiency virus (HIV) screening.

METHODS: Between 1st October 2012 and 28th February 2013, a questionnaire-based survey was conducted among patients aged 16–70 years old presenting to the ED of Lausanne University Hospital. Patients were asked: (1) if they believed they had been screened for HIV; (2) if they agreed in principle to routine HIV screening and (3) if they agreed to be HIV tested during their current ED visit.

RESULTS: Of 466 eligible patients, 411 (88%) agreed to participate. Mean age was 46 ± 16 years; 192 patients (47%) were women; 366 (89%) were Swiss or European; 113 (27%) believed they had been screened for HIV, the proportion increasing with age (p ≤0.01), 297 (72%) agreed in principle with routine HIV testing in the ED, and 138 patients (34%) agreed to be HIV tested during their current ED visit.

CONCLUSION: In this ED population, 27% believed incorrectly they had been screened for HIV. Over 70% agreed in principle with routine HIV testing and 34% agreed to be tested during their current visit. These results demonstrate willingness among patients concerning routine HIV testing in the ED and highlight a need for improved doctor-patient communication about what a blood test specifically screens for.

References

Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006;55:1–17; quiz CE1-4.
Office fédéral de la santé publique: Dépistage du VIH effectué sur l’initiative des médecins en présence de certaines pathologies (maladies évocatrices d’une infection à VIH). Bull OFSP. 2013;47/13:1–5 http://www.bag.admin.ch/hiv_aids/05464/12752/index.html?lang=fr. Bulletin de l’OFSP. 2013;47/13:1–5.
Musso MW, Perret JN, Sanders T, Daray R, Anderson K, Lancaster M, et al. Patients’ comprehension of their emergency department encounter: a pilot study using physician observers. Ann Emerg Med. 2015;65:151–5 e4.
Lyons MS, Lindsell CJ, Haukoos JS, Almond G, Brown J, Calderon Y, et al. Nomenclature and definitions for emergency department human immunodeficiency virus (HIV) testing: report from the 2007 conference of the National Emergency Department HIV Testing Consortium. Acad Emerg Med. 2009;16:168–77.
Cowan E, Leider J, Velastegui L, Wexler J, Velloza J, Calderon Y. A qualitative assessment of emergency department patients’ knowledge, beliefs, attitudes, and acceptance toward revised HIV testing strategies. Acad Emerg Med. 2013;20:287–94.
Albrecht E, Frascarolo P, Meystre-Agustoni G, Farron A, Gilliard N, Darling K, et al. An analysis of patients’ understanding of “routine” preoperative blood tests and HIV screening. Is no news really good news? HIV Med. 2012;13:439–43.
Khakoo NM, Lindsell CJ, Hart KW, Ruffner AH, Wayne DB, Lyons MS. Patient Perception of Whether an HIV Test Was Provided during the Emergency Department Encounter. J Int Assoc Provid AIDS Care. 2014;13:506–10.
Darling KE, Gloor E, Ansermet-Pagot A, Vaucher P, Durieux-Paillard S, Bodenmann P, et al. Suboptimal access to primary healthcare among street-based sex workers in southwest Switzerland. Postgrad Med J. 2013;89:371–5.
Irvin CB, Flagel BT, Fox JM. The emergency department is not the ideal place for routine HIV testing. Ann Emerg Med. 2007;49:722.
Darling KE, Hugli O, Mamin R, Cellerai C, Martenet S, Berney A, et al. HIV testing practices by clinical service before and after revised testing guidelines in a Swiss university hospital. PLoS One. 2012;7:e39299.
Darling KE, de Allegri N, Fishman D, Kehtari R, Rutschmann OT, Cavassini M, et al. Awareness of HIV testing guidelines is low among Swiss emergency doctors: a survey of five teaching hospitals in French-speaking Switzerland. PLoS One. 2013;8:e72812.
Cantonal Act on Public Health, article 25ss (Public Health Law of the Canton of Vaud, RSV 800.01).
Cantonal Regulations of Biomedical Research, article 3 and 14 paragraph 2 (RRB, RSV 800.21.1).
Vilpert S, Ruedin HJ, Trueb L, Monod-Zorzi S, Yersin B, Bula C. Emergency department use by oldest-old patients from 2005 to 2010 in a Swiss university hospital. BMC Health Serv Res. 2013;13:344.
Joint United Nations Programme on HIV/AIDS. UNAIDS report on the global AIDS epidemic 2012. http://www.unaids.org/sites/default/files/media_asset/20121120_UNAIDS_Global_Report_2012_with_annexes_en_1.pdf [cited 2015 20 August].
Bogousslavsky J RW, Mattle H. Hirnschlag-Kampagne der Schweizerischen Herzstiftung (SHS) und Zerebrovaskularen Arbeitsgruppe der Schweiz (ZAS) (German). Schweiz Arzteztg. 2000;81:677–9.
Mancini M. Self Care Diabète: Campagne nationale de dépistage (French). Primary Care. 2002;2:205–9
Ohmann C, Kuchinke W, Canham S, Lauritsen J, Salas N, Schade-Brittinger C, et al. Standard requirements for GCP-compliant data management in multinational clinical trials. Trials. 2011;12:85.
LaPorte DM, Mont MA, Jones LC, Padden DA, Hungerford DS. Human immunodeficiency virus testing for elective orthopedic procedures: results in a community-based hospital. Orthopedics. 2001;24:52–5.
Marks G, Crepaz N, Janssen R. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS. 2006;20:1447–50.
Brenner BG, Roger M, Routy JP, Moisi D, Ntemgwa M, Matte C, et al. High rates of forward transmission events after acute/early HIV-1 infection. J Infect Dis. 2007;195:951–9.
Haukoos JS, Hopkins E, Byyny RL, Denver Emergency Department HIVTSG. Patient acceptance of rapid HIV testing practices in an urban emergency department: assessment of the 2006 CDC recommendations for HIV screening in health care settings. Ann Emerg Med. 2008;51:303–9, 9 e1.
White DA, Sadoun T, Tran T, Alter HJ. Increased acceptance rates of HIV screening using opt-out consent methods in an urban emergency department. J Acquir Immune Defic Syndr. 2011;58:277–82.
Brown J, Kuo I, Bellows J, Barry R, Bui P, Wohlgemuth J, et al. Patient perceptions and acceptance of routine emergency department HIV testing. Public Health Rep. 2008;123(Suppl 3):21–6.
Ubhayakar ND, Lindsell CJ, Raab DL, Ruffner AH, Trott AT, Fichtenbaum CJ, et al. Risk, reasons for refusal, and impact of counseling on consent among ED patients declining HIV screening. Am J Emerg Med. 2011;29:367–72.
Christopoulos KA, Weiser SD, Koester KA, Myers JJ, White DA, Kaplan B, et al. Understanding patient acceptance and refusal of HIV testing in the emergency department. BMC Public Health. 2012;12:3.
d’Almeida KW, Pateron D, Kierzek G, Renaud B, Semaille C, de Truchis P, et al. Understanding providers’ offering and patients’ acceptance of HIV screening in emergency departments: a multilevel analysis. ANRS 95008, Paris, France. PLoS One. 2013;8:e62686.
Rayment M, Rae C, Ghooloo F, Doku E, Hardie J, Finlay S, et al. Routine HIV testing in the emergency department: tough lessons in sustainability. HIV Med. 2013;14(Suppl 3):6–9.
Freeman AE, Sattin RW, Miller KM, Dias JK, Wilde JA. Acceptance of rapid HIV screening in a southeastern emergency department. Acad Emerg Med. 2009;16:1156–64.
Smith RD, Delpech VC, Brown AE, Rice BD. HIV transmission and high rates of late diagnoses among adults aged 50 years and over. AIDS. 2010;24:2109–15.
Sanchez B, Hirzel AH, Bingisser R, Ciurea A, Exadaktylos A, Lehmann B, et al. State of Emergency Medicine in Switzerland: a national profile of emergency departments in 2006. Int J Emerg Med. 2013;6:23.
Vilpert S. Consultations dans un service d’urgence en Suisse (French/German). Neuchâtel: Observatoire suisse de la santé, 2013 Report No. 3/2013.
Diserens L, Egli L, Fustinoni S, Santos-Eggimann B, Staeger P, Hugli O. Emergency department visits for non-life-threatening conditions: evolution over 13 years in a Swiss urban teaching hospital. Swiss Med Wkly. 2015;145:w14123.

How to Cite

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Favre-Bulle T, Baudat D, Darling K, Mamin R, Peters S, Cavassini M, Hugli O. Patients’ understanding of blood tests and attitudes to HIV screening in the emergency department of a Swiss teaching hospital: a cross-sectional observational study. Swiss Med Wkly [Internet]. 2015 Nov. 29 [cited 2024 Apr. 19];145(4950):w14206. Available from: https://smw.ch/index.php/smw/article/view/2114

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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[1] Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006;55:1–17; quiz CE1-4.

[2] Office fédéral de la santé publique: Dépistage du VIH effectué sur l’initiative des médecins en présence de certaines pathologies (maladies évocatrices d’une infection à VIH). Bull OFSP. 2013;47/13:1–5 http://www.bag.admin.ch/hiv_aids/05464/12752/index.html?lang=fr. Bulletin de l’OFSP. 2013;47/13:1–5.

[3] Musso MW, Perret JN, Sanders T, Daray R, Anderson K, Lancaster M, et al. Patients’ comprehension of their emergency department encounter: a pilot study using physician observers. Ann Emerg Med. 2015;65:151–5 e4.

[4] Lyons MS, Lindsell CJ, Haukoos JS, Almond G, Brown J, Calderon Y, et al. Nomenclature and definitions for emergency department human immunodeficiency virus (HIV) testing: report from the 2007 conference of the National Emergency Department HIV Testing Consortium. Acad Emerg Med. 2009;16:168–77.

[5] Cowan E, Leider J, Velastegui L, Wexler J, Velloza J, Calderon Y. A qualitative assessment of emergency department patients’ knowledge, beliefs, attitudes, and acceptance toward revised HIV testing strategies. Acad Emerg Med. 2013;20:287–94.

[6] Albrecht E, Frascarolo P, Meystre-Agustoni G, Farron A, Gilliard N, Darling K, et al. An analysis of patients’ understanding of “routine” preoperative blood tests and HIV screening. Is no news really good news? HIV Med. 2012;13:439–43.

[7] Khakoo NM, Lindsell CJ, Hart KW, Ruffner AH, Wayne DB, Lyons MS. Patient Perception of Whether an HIV Test Was Provided during the Emergency Department Encounter. J Int Assoc Provid AIDS Care. 2014;13:506–10.

[8] Darling KE, Gloor E, Ansermet-Pagot A, Vaucher P, Durieux-Paillard S, Bodenmann P, et al. Suboptimal access to primary healthcare among street-based sex workers in southwest Switzerland. Postgrad Med J. 2013;89:371–5.

[9] Irvin CB, Flagel BT, Fox JM. The emergency department is not the ideal place for routine HIV testing. Ann Emerg Med. 2007;49:722.

[10] Darling KE, Hugli O, Mamin R, Cellerai C, Martenet S, Berney A, et al. HIV testing practices by clinical service before and after revised testing guidelines in a Swiss university hospital. PLoS One. 2012;7:e39299.

[11] Darling KE, de Allegri N, Fishman D, Kehtari R, Rutschmann OT, Cavassini M, et al. Awareness of HIV testing guidelines is low among Swiss emergency doctors: a survey of five teaching hospitals in French-speaking Switzerland. PLoS One. 2013;8:e72812.

[12] Cantonal Act on Public Health, article 25ss (Public Health Law of the Canton of Vaud, RSV 800.01).

[13] Cantonal Regulations of Biomedical Research, article 3 and 14 paragraph 2 (RRB, RSV 800.21.1).

[14] Vilpert S, Ruedin HJ, Trueb L, Monod-Zorzi S, Yersin B, Bula C. Emergency department use by oldest-old patients from 2005 to 2010 in a Swiss university hospital. BMC Health Serv Res. 2013;13:344.

[15] Joint United Nations Programme on HIV/AIDS. UNAIDS report on the global AIDS epidemic 2012. http://www.unaids.org/sites/default/files/media_asset/20121120_UNAIDS_Global_Report_2012_with_annexes_en_1.pdf [cited 2015 20 August].

[16] Bogousslavsky J RW, Mattle H. Hirnschlag-Kampagne der Schweizerischen Herzstiftung (SHS) und Zerebrovaskularen Arbeitsgruppe der Schweiz (ZAS) (German). Schweiz Arzteztg. 2000;81:677–9.

[17] Mancini M. Self Care Diabète: Campagne nationale de dépistage (French). Primary Care. 2002;2:205–9

[18] Ohmann C, Kuchinke W, Canham S, Lauritsen J, Salas N, Schade-Brittinger C, et al. Standard requirements for GCP-compliant data management in multinational clinical trials. Trials. 2011;12:85.

[19] LaPorte DM, Mont MA, Jones LC, Padden DA, Hungerford DS. Human immunodeficiency virus testing for elective orthopedic procedures: results in a community-based hospital. Orthopedics. 2001;24:52–5.

[20] Marks G, Crepaz N, Janssen R. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS. 2006;20:1447–50.

[21] Brenner BG, Roger M, Routy JP, Moisi D, Ntemgwa M, Matte C, et al. High rates of forward transmission events after acute/early HIV-1 infection. J Infect Dis. 2007;195:951–9.

[22] Haukoos JS, Hopkins E, Byyny RL, Denver Emergency Department HIVTSG. Patient acceptance of rapid HIV testing practices in an urban emergency department: assessment of the 2006 CDC recommendations for HIV screening in health care settings. Ann Emerg Med. 2008;51:303–9, 9 e1.

[23] White DA, Sadoun T, Tran T, Alter HJ. Increased acceptance rates of HIV screening using opt-out consent methods in an urban emergency department. J Acquir Immune Defic Syndr. 2011;58:277–82.

[24] Brown J, Kuo I, Bellows J, Barry R, Bui P, Wohlgemuth J, et al. Patient perceptions and acceptance of routine emergency department HIV testing. Public Health Rep. 2008;123(Suppl 3):21–6.

[25] Ubhayakar ND, Lindsell CJ, Raab DL, Ruffner AH, Trott AT, Fichtenbaum CJ, et al. Risk, reasons for refusal, and impact of counseling on consent among ED patients declining HIV screening. Am J Emerg Med. 2011;29:367–72.

[26] Christopoulos KA, Weiser SD, Koester KA, Myers JJ, White DA, Kaplan B, et al. Understanding patient acceptance and refusal of HIV testing in the emergency department. BMC Public Health. 2012;12:3.

[27] d’Almeida KW, Pateron D, Kierzek G, Renaud B, Semaille C, de Truchis P, et al. Understanding providers’ offering and patients’ acceptance of HIV screening in emergency departments: a multilevel analysis. ANRS 95008, Paris, France. PLoS One. 2013;8:e62686.

[28] Rayment M, Rae C, Ghooloo F, Doku E, Hardie J, Finlay S, et al. Routine HIV testing in the emergency department: tough lessons in sustainability. HIV Med. 2013;14(Suppl 3):6–9.

[29] Freeman AE, Sattin RW, Miller KM, Dias JK, Wilde JA. Acceptance of rapid HIV screening in a southeastern emergency department. Acad Emerg Med. 2009;16:1156–64.

[30] Smith RD, Delpech VC, Brown AE, Rice BD. HIV transmission and high rates of late diagnoses among adults aged 50 years and over. AIDS. 2010;24:2109–15.

[31] Sanchez B, Hirzel AH, Bingisser R, Ciurea A, Exadaktylos A, Lehmann B, et al. State of Emergency Medicine in Switzerland: a national profile of emergency departments in 2006. Int J Emerg Med. 2013;6:23.

[32] Vilpert S. Consultations dans un service d’urgence en Suisse (French/German). Neuchâtel: Observatoire suisse de la santé, 2013 Report No. 3/2013.

[33] Diserens L, Egli L, Fustinoni S, Santos-Eggimann B, Staeger P, Hugli O. Emergency department visits for non-life-threatening conditions: evolution over 13 years in a Swiss urban teaching hospital. Swiss Med Wkly. 2015;145:w14123.