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Studies: Sensitive topics get short shrift during doctor visits :

January 16, 2019

Many teens and young adults aren’t having private discussions about sensitive topics with their doctors, two new studies found.

Foregoing these talks may impact their likelihood of receiving counseling or care regarding contraception, tobacco or drug use, sexual orientation, abuse and more, researchers said.

Medical societies recommend adolescent and young adult patients have opportunities for private discussions and confidential services. To find out how many were following these recommendations, researchers from Columbia University surveyed a nationally representative group of 1,918 adolescents and young adults ages 13-26.

The research, detailed in two reports, was sponsored by the Adolescent Health Consortium — the American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetricians and Gynecologists and the Society for Adolescent Health and Medicine.

Private time

Researchers found about 55% of young women and 49% of young men had ever had private time with their health care provider, and rates were similar for having discussed confidentiality, according to the report “Confidentiality Discussions and Private Time With a Health-Care Provider for Youth, United States, 2016” (Grilo SA, et al. J Adolesc Health. Jan. 9, 2019, https://www.jahonline.org/article/S1054-139X(18)30783-3/fulltext).

Rates of private time were lower for teenagers compared to young adults. Among 13- to 14-year-olds, about 22% of females and 14% of males reported private time with a health care provider compared to 69% of females and 62% of males ages 19-22.

Patients were more likely to report private time with a provider if they were older, had higher income or participated in risky behaviors. For women, having a female provider also was linked to increased likelihood of private time.

“We know that discussing confidentiality and having private time with a provider are critical for comprehensive clinical preventive services for young people, however about half of young people report never having had these with their provider,” lead author Stephanie A. Grilo, M.A., M.Phil., said in a news release. “… The gap between clinical recommendations and practice means there is a need for education of parents, providers and adolescents on the importance of private time and confidentiality for adolescent and young adult care.”

Sensitive topics

Researchers also analyzed specific sensitive topics adolescents and young adults have discussed with their providers using responses from 1,509 participants who had been to their regular provider in the past two years.

Only one of the 11 topics had been discussed by more than half of the respondents at their last visit, according to “Discussion of Potentially Sensitive Topics with Young People” (Santelli JS, et al. Pediatrics. Jan. 16, 2019, https://doi.org/10.1542/peds.2018-1403).

Mental health was most likely to be discussed (55%) followed by drug/alcohol use (46%) and tobacco use (44%). Gun safety was least likely to be broached (14%) followed by sexual orientation (20%) and sexual/physical abuse (21%).

On average, women discussed 3.7 of the topics at their last visit, virtually the same as men. They differed on discussions about birth control, which were significantly higher among females and increased with age. Overall, the number of topics discussed was highest for 15- to 18-year-olds and lowest for 23- to 26-year-olds.

When teens and young adults had discussed confidentiality with their provider, used a health screening questionnaire or were given significant time at a visit, they were more likely to discuss sensitive topics.

Authors suggested providers use these strategies in their practices to encourage engagement.

“Talking about confidentiality can create safe spaces for discussion,” lead author John S. Santelli, M.D., M.P.H., FAAP, said in a news release. “Health questionnaires can signal to young people that a healthcare provider is interested (in) discussing sensitive issues.”

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