Use of Kiosks and Patient Understanding of Opt-out and Opt-in Consent for Routine Rapid Human Immunodeficiency Virus Screening in the Emergency Department
Use of Kiosks and Patient Understanding of Opt-out and Opt-in Consent for Routine Rapid Human Immunodeficiency Virus Screening in the Emergency Department
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DOI：
10.1111/j.1553-2712.2012.01290.x
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发表时间：
2012-03-01
影响因子：
4.4
通讯作者：
Bakes, Katherine
中科院分区：
文献类型：
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作者：
Haukoos, Jason S.;Hopkins, Emily;Bakes, Katherine
目的：目的是评估患者对急诊室（艾德）使用计算机自助服务终端进行非目标性选择退出和选择加入快速人类免疫缺陷病毒（HIV）筛查的接受程度和理解。方法：本研究是一项前瞻性准实验，在一家城市医院进行，每年有12万人次的艾德和紧急护理普查。在医疗筛查期间，13岁及以上的患者使用信息亭和选择退出同意书（2009年10月）或选择加入同意书（2009年12月）进行快速艾滋病毒筛查。使用随机时间段进行结构化调查，以评估患者对测试过程的理解。结果：在选择退出阶段，6,602人接受了检测，其中3,993人（61%）没有选择退出，886人（13%）完成了筛查。在选择入组阶段，为5，781例患者提供了检测，其中930例（16%）选择入组，389例（7%）完成了筛选（绝对差异= 6%，95%置信区间[CI] = 5%至8%）。在选择退出阶段，330名患者完成了调查。其中，201人（61%）没有选择退出，但108人（54%，95%CI = 47%至61%）回答说，他们没有被告知艾滋病毒检测。在已被告知的84名患者中，32名（38%，95%CI = 28%至49%）回答说他们不同意进行HIV检测。在选择加入阶段，416人完成了调查。其中，80人（19%）同意检测，2人（3%，95% CI = 0.3%至9%）回答说他们没有被告知艾滋病毒检测。在已被告知的74名患者中，只有2名（3%，95%CI = 0.3%至9%）回答说他们不同意进行HIV检测。结论：计算机化的信息亭可以成功地用于在ED中进行非靶向的快速HIV筛查。然而，当使用这种方法时，患者对选择性同意的理解明显优于选择性退出同意。
Objectives: The objective was to evaluate patient acceptance and understanding of nontargeted opt-out and opt-in rapid human immunodeficiency virus (HIV) screening using computerized kiosks in the emergency department (ED). Methods: This study was a prospective quasi-experiment in an urban hospital with an annual ED and urgent care census of 120,000 visits. During medical screening, patients 13 years and older were offered rapid HIV screening using kiosks and opt-out consent (October 2009) or opt-in consent (December 2009). Random time blocks were used to administer structured surveys to evaluate patient understanding of the testing process. Results: During the opt-out phase, 6,602 were offered testing, and of these 3,993 (61%) did not opt-out and 886 (13%) completed screening. During the opt-in phase, 5,781 were offered testing, and of these 930 (16%) opted-in and 389 (7%) completed screening (absolute difference = 6%, 95% confidence interval [CI] = 5% to 8%). During the opt-out phase, 330 patients completed the survey. Of these, 201 (61%) did not opt-out, but 108 (54%, 95% CI = 47% to 61%) responded that they had not been informed about an HIV test. Of the 84 patients who had been informed, 32 (38%, 95% CI = 28% to 49%) responded that they had not agreed to an HIV test. During the opt-in phase, 416 completed the survey. Of these, 80 (19%) agreed to testing and two (3%, 95% CI = 0.3% to 9%) responded that they had not been informed about an HIV test. Of the 74 patients who had been informed, only two (3%, 95% CI = 0.3% to 9%) responded that they had not agreed to an HIV test. Conclusions: Computerized kiosks can be successfully used to perform nontargeted rapid HIV screening in EDs. However, when using this approach, patient understanding of opt-in consent is significantly better than opt-out consent.