What Latina patients don't tell their doctors

The treatment patients receive is greatly affected by what they choose to disclose to their physicians. While culture can play an important role in what patients disclose and the manner in which they disclose it, few studies have focused on Latina patients' considerations about disclosure, and none have explored this in primary care. This qualitative study investigated factors associated with Latina patients' nondisclosure of medical information to their primary care doctors. Methods: Trained interviewers conducted in-depth one-on-one interviews in Spanish with a convenience sample of Latina women living in Brooklyn, most of whom were recent immigrants. A semi-structured interview guide was used based on that of Sankar and Jones, with many open-ended questions. Careful notes were taken during the interview and immediately transcribed. Data were analyzed using a grounded theory approach. Emerging themes were codified into a coherent list by all authors using a continuous iterative process. Transcripts were coded by at least 3 authors, and coding discrepancies resolved by discussion. Instances of themes in the transcripts were compared and contrasted to develop explanatory models. Results: Twenty-four Latinas consented to be interviewed. Six major themes emerged related to barriers to disclosure of important health information, deliberations about disclosure, or reasons for non-disclosure: language, physician gender and age, time constraints, the physician-patient relationship, cultural differences, and sensitive health issues. When the physician did not speak Spanish, problems could arise related to physician-patient interaction and the need for or presence of a translator. The physician being male or younger than the patient could impede disclosure, especially around issues of sexuality and the possibility of a genital examination. Regarding the patient-physician relationship, qualities of compassion, caring, human interest, and kindness were important to many Latinas, who would not share key information if these were not present. Time constraints could impair the development of trust. Cultural differences between patient and physician sometimes resulted in physicians' lack of awareness of issues that patients would not discuss outside their immediate families. Sensitive issues impeding disclosure included sexuality, family planning, domestic abuse, and use of recreational drugs. Discussion: This study identified several powerful factors that could impede Latina patients' disclosure of important medical information to their providers. Unique to this study were insights about physician manner, language issues, and cultural differences around the sharing of sensitive information. Physician awareness of such factors and focused training in communication could mitigate or eliminate their effect in many cases.