Abstract: Communication Initiation Barriers and Strategies in Patient Doorknob Disclosures

◆ Heather J. Carmack, University of Alabama
◆ Sydney Ringold, University of Alabama
◆ Eva Curran, University of Alabama
◆ Christopher Fantin, University of Alabama
◆ Morgan Pfiffner, University of Alabama
◆ Alexandra Pannell, University of Alabama
◆ Carly Gross, University of Alabama
◆ Ny'Nika McFadden, University of Alabama

Rationale: Doorknob disclosures occur when patients wait until the end of an appointment, often when the provider has their hand on the doorknob ready to leave the room, to (1) disclose their real reason for the visit, (2) disclose important health information needed for their care, or (3) ask important questions relevant to their care. Previous research about doorknob disclosures is limited; what is known is that providers see the communication event as disruptive to their appointment agenda setting and believe patients engage in doorknob disclosures for attention. No research exists examining doorknob disclosures from the patient perspective or from a communication perspective.

Method: Twenty participants who experienced a doorknob disclosure were interviewed. Participants doorknob disclosed about a variety of health issues, including cysts, allergies, vaping, requesting an Adderall prescription, and birth control. The semi-structured interview protocol asked participants to explain their doorknob disclosure event and offer recommendations for how patients and providers can work to reduce doorknob disclosures. The transcribed interviews resulted in 113 pages of single-spaced data. The authors used an emergent thematic analysis to analyze the data.

Results: Patients identified a number of communication initiation barriers which could contribute to a doorknob disclosure, including (a) embarrassment about their health issue, (b) uncertainty of provider response, including fear of provider judgment, (c) the controlling nature of the provider agenda setting, and (d) an inability and fear to admit health and life struggles. Many of these barriers were related to fear about their future health and the unknown outcome of the doorknob disclosure.

Participants engaged in two communication strategies to initiate the doorknob disclosure: (a) “waiting for the right time” and (b) a passive approach. Providers’ agenda setting drove the appointment, so many participants often waited and looked for an appropriate time to interrupt the provider’s agenda and change the direction of the discussion. To do this, patients often relied on a passive communication approach, rushing to get the question out and presenting it as an apathetic “no big deal” if the provider blew off the doorknob disclosure. These doorknob disclosure initiations were bound by a temporal tension—they were driven by a sense of imperative (“I can’t let them leave”) but also tethered by a concern for if that appointment was the right time or place to bring up their concern (“Should I do this when I didn’t say this was the original reason for the appointment?”).

Implications: Although participants identified primarily internal barriers (e.g., embarrassment, uncertainty), their communication strategies are deeply connected to the external control of the provider’s appointment agenda. Patients believe they must learn to read the provider’s agenda setting strategy and find ways to insert themselves into to the conversation. Patients’ use of passive and apathetic communication also serve as a face-saving strategy. This raises concerns about patients’ ability to be active participants in the decision-making process and providers’ commitment to patient-centered care. More research is needed to identify active communication strategies to help patients and providers navigate doorknob disclosures.