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PubMed1996

[The relationship between self-esteem and self-disclosure of negative information].

Although self-disclosure after a negative experience may be good for our adjustment, we also feel hesitant to do so. This study investigated the relationship between self-esteem and hesitancy to disclose negative information about one's self. One hundred and fifty-five undergraduates imagined self-disclosure to a friend of high or low intimacy. They then answered a questionnaire concerning hesitancy to self-disclose negative information to friends, as well as expected negative consequences of such self-disclosure. Main results were: (1) Low intimacy strongly affected the hesitancy. (2) Factor analysis of the negative consequences found three factors: interpersonal and intra-personal negative-effect, and no positive expectation. (3) Hesitancy of high self-esteem students was most affected by the interpersonal factor. Impression management may be the reason. (4) On the other hand, low students tended to feel hurt after negative self-disclosure. Theirs was affected by the intra-personal and no positive expectation factors. Defensiveness may be the reason. The results were discussed from the viewpoint of adjustment when people have had a negative experience.

Adult↗

PubMed2001

Prognostic disclosure to patients with cancer near the end of life.

BACKGROUND: Patients' understanding of their prognosis informs numerous medical and nonmedical decisions, but patients with cancer and their physicians often have disparate prognostic expectations. OBJECTIVE: To determine whether physician behavior might contribute to the disparity between patients' and physicians' prognostic expectations. DESIGN: Prospective cohort study. SETTING: Five hospices in Chicago, Illinois. PATIENTS: 326 patients with cancer. INTERVENTION: Physicians formulated survival estimates and also indicated the survival estimates that they would communicate to their patients if the patients insisted. MEASUREMENTS: Comparison of the formulated and communicated prognoses. RESULTS: For 300 of 311 evaluable patients (96.5%), physicians were able to formulate prognoses. Physicians reported that they would not communicate any survival estimate 22.7% (95% CI, 17.9% to 27.4%) of the time, would communicate the same survival estimate they formulated 37% (CI, 31.5% to 42.5%) of the time, and would communicate a survival estimate different from the one they formulated 40.3% (CI, 34.8% to 45.9%) of the time. Of the discrepant survival estimates, most (70.2%) were optimistically discrepant. Multivariate analysis revealed that older patients were more likely to receive frank survival estimates, that the most experienced physicians and the physicians who were least confident about their prognoses were more likely to favor no disclosure over frank disclosure, and that female physicians were less likely to favor frank disclosure over pessimistically discrepant disclosure. CONCLUSIONS: Physicians reported that even if patients with cancer requested survival estimates, they would provide a frank estimate only 37% of the time and would provide no estimate, a conscious overestimate, or a conscious underestimate most of the time (63%). This pattern may contribute to the observed disparities between physicians' and patients' estimates of survival.

Humans↗

PubMedDate not supplied

Secrets and safety in the age of AIDS: does HIV disclosure lead to safer sex?

To fuel the HIV/AIDS epidemic, HIV-seropositive individuals must interact unsafely with HIV-seronegative individuals. Research indicates that up to one third of individuals diagnosed with HIV continue to have unprotected sex, at times without informing partners, who may be of negative or unknown serostatus. Some research and public health interventions have focused on encouraging HIV-positive individuals to reveal their serostatus to their sexual partners, predicated upon the assumption that disclosure will increase the safety of subsequent sexual activity with informed partners. This review examines the empirical literature on disclosure of HIV status and subsequent sexual risk behaviors of HIV-positive individuals. Only 15 of the 23 studies reviewed provided data that allowed us to examine the association between disclosure and safer sex. Fewer still provided a methodologically sound analysis, and those that did provided conflicting results, often with significant effects limited to only 1 subgroup of participants. However, this failure to demonstrate a consistent association does not necessarily mean that disclosure is irrelevant to the practice of safer sex. We discuss limitations of the research to date and implications for policy and practice.

Acquired Immunodeficiency Syndrome↗

PubMed2003

[European survey on current practice and disclosure of the diagnosis of Alzheimer's disease. A study based on caregiver's report].

UNLABELLED: The disclosure of a diagnosis of Alzheimer's disease is a complex and critical event. The aim of this study initiated by the Association Alzheimer-Europe was to explore 1) the context of the establishment of the diagnosis and the circumstances of its disclosure 2) the impact of the disclosure of the diagnosis on the patients and the caregivers 3) the amount and the adequacy of information provided by the physicians to the patients and the caregivers compared to their needs. Subjects. 323 caregivers were recruited through family associations in 11 European countries. METHODS: Data were collected using a structured questionnaire filled in by the caregivers. RESULTS: The caregivers' profile broadly was similar to that found in the published literature. The initial symptoms noted by the family members were memory disorders and behavioral manifestations, both in 50% of cases and isolated each in approximately 25%. Half of the carers reported a delay of one year or more between the initial symptoms and the first medical examination. The diagnosis was made mostly by neurologists, but also by psychiatrists, geriatricians, general practioners or neuropsychologists in various proportions according to the different countries. The diagnosis was disclosed in front of the patients only in approximately half of the cases. When the diagnosis was disclosed to the family alone, 56% of the carers did not want the diagnosis to be disclosed to the patients. Negative reactions of the carers to the disclosure of the diagnosis were clearly linked with the physician's attitude and time dedicated to information on the disease and its consequences. 43% of the carers were not satisfied by the information provided by the physicians and there was a discrepancy between the nature of the information provided by the physicians and the needs of the carers. Nearly one third of the patients had no regular follow-up after the diagnosis and 27% did not receive any treatment. CONCLUSION: This study shows important inadequacy in the management and counselling of patients with Alzheimer's disease and their relatives. Consideration should be given to developing a new philosophy of care based on a better understanding between health professionals, patients and families.

Aged↗

PubMed2005

The limits of competing interest disclosures.

OBJECTIVE: To assess the effectiveness of conflict of interest disclosure policies by comparing a competing interests disclosure statement that met the requirements established by the journal in a 2003 article on health effects of secondhand smoke based on the American Cancer Society CPS-I dataset with internal tobacco industry documents describing financial ties between the tobacco industry and authors of the study. DESIGN: Descriptive analysis of internal tobacco industry documents retrieved from the Legacy Tobacco Documents Library, University of California, San Francisco. RESULTS: Meeting the requirements for financial disclosure established by the journal did not provide the reader with a full picture of the tobacco industry's involvement with the study authors. The tobacco industry documents reveal that the authors had long standing financial and other working relationships with the tobacco industry. CONCLUSION: These findings are another example of how simply requiring authors to disclose financial ties with the tobacco industry may not be adequate to give readers (and reviewers) a full picture of the author's relationship with the tobacco industry. The documents also reveal that the industry funds research to enhance its credibility and endeavours to work with respected scientists to advance its goals. These findings question the adequacy of current journal policies regarding competing interest disclosures and the acceptability of tobacco industry funding for academic research.

Biomedical Research↗

PubMed2005

Does emotional disclosure have any effects? A systematic review of the literature with meta-analyses.

OBJECTIVES: Emotional disclosure has been widely publicized as having beneficial effects on physical and psychological health. A full systematic review was undertaken, with standard health technology appraisal methods, with the aim to assess the effects of emotional disclosure on healthy participants and those with pre-existing morbidity, particularly on longer-term physical health, performance, and psychological outcomes. METHODS: Randomized controlled trials of emotional disclosure were obtained from database searches (Medline (1966-2003), Embase (1980-2003), Cochrane Library (2002, issue 4), Web of Science (1981-2003), Cinahl (1982-2003), and Theses (March 2003), Internet sites (including Professor J.W. Pennebaker's home pages), and personal contacts. Quality was assessed qualitatively and by Jadad score. Meta-analysis was conducted, using Revman 4.1 software, where more than two trials reported the same outcome. RESULTS: Sixty-one trials were found meeting the inclusion criteria. Most had less than 100 participants and the median Jadad score was 0. A wide variety of physical, physiological, immunological, performance, and psychological outcomes were measured, but fewer were reported. There was no clear improvement for emotional disclosure compared with controls in objectively measured physical health and most other outcomes assessed. CONCLUSIONS: The opinion that this intervention is beneficial needs to be reassessed in light of the totality of evidence available.

Expressed Emotion↗

PubMed1995

Informed consent and disclosure in the physician-patient relationship: expanding obligations for physicians in the United States.

In recent years, the doctrine of informed consent has been one of the primary vehicles by which American courts and legislatures have evaluated the nature and scope of information that physicians must disclose to patients in a variety of treatment situations. Historically, physicians have had the primary responsibility to disclose to patients the nature of a proposed course of treatment, material risks and benefits, as well as reasonably available alternatives, in obtaining consent to treatment. Statutory and common-law developments in the United States appear to suggest that disclosure obligations of physicians in this context are continuing to evolve. This article examines recent judicial and legislative developments in the United States, which appear to underlie expanding disclosure obligations in a variety of situations that arise within the context of the physician-patient relationship. Emphasis is placed on disclosure obligations with respect to the physician's physical condition and its impact on the provision of medical care, information regarding the physician's general ability to perform certain surgeries or other medical procedures, as well as disclosure of research interests, financial interests, and other incentives that may bear upon clinical decision making. This article concludes that physicians should be aware of recent statutory and common-law developments in the United States that may give rise to heightened potential for legal accountability arising out of failure to disclose an increasingly diverse array of information to patients in the physician-patient relationship.

Conflict of Interest↗

PubMed2005

Error reporting and disclosure systems: views from hospital leaders.

CONTEXT: The Institute of Medicine has recommended establishing mandatory error reporting systems for hospitals and other health settings. OBJECTIVE: To examine the opinions and experiences of hospital leaders with state reporting systems. DESIGN AND SETTING: Survey of chief executive and chief operating officers (CEOs/COOs) from randomly selected hospitals in 2 states with mandatory reporting and public disclosure, 2 states with mandatory reporting without public disclosure, and 2 states without mandatory systems in 2002-2003. MAIN OUTCOME MEASURES: Perceptions of the effects of mandatory systems on error reporting, likelihood of lawsuits, and overall patient safety; attitudes regarding release of incident reports to the public; and likelihood of reporting incidents to the state or to the affected patient based on hypothetical clinical vignettes that varied the type and severity of patient injury. RESULTS: Responses were received from 203 of 320 hospitals (response rate = 63%). Most CEOs/COOs thought that a mandatory, nonconfidential system would discourage reporting of patient safety incidents to their hospital's own internal reporting system (69%) and encourage lawsuits (79%) while having no effect or a negative effect on patient safety (73%). More than 80% felt that the names of both the hospital and the involved professionals should be kept confidential, although respondents from states with mandatory public disclosure systems were more willing than respondents from the other states to release the hospital name (22% vs 4%-6%, P = .005). Based on the vignettes, more than 90% of hospital leaders said their hospital would report incidents involving serious injury to the state, but far fewer would report moderate or minor injuries, even when the incident was of sufficient consequence that they would tell the affected patient or family. CONCLUSIONS: Most hospital leaders expressed substantial concerns about the impact of mandatory, nonconfidential reporting systems on hospital internal reporting, lawsuits, and overall patient safety. While hospital leaders generally favor disclosure of patient safety incidents to involved patients, fewer would disclose incidents involving moderate or minor injury to state reporting systems.

Attitude of Health Personnel↗

PubMed2004

Psychologic distress after disclosure of genetic test results regarding hereditary nonpolyposis colorectal carcinoma.

BACKGROUND: To the authors' knowledge, there have been few studies of the psychologic distress after disclosure of genetic test results for hereditary nonpolyposis colorectal carcinoma (HNPCC). The objectives of this study were to identify the prevalence rates and predictors of psychologic distress and to evaluate the feelings of guilt after disclosure of the test results in Japanese probands and unaffected relatives. METHODS: Probands and unaffected relatives were interviewed immediately after the first genetic counseling session for HNPCC and again 1 month after disclosure of the genetic test results. The prevalence of major and minor depression, acute stress disorder (ASD), posttraumatic stress disorder (PTSD), and posttraumatic stress symptoms (PTSS) were assessed using the Structured Clinical Interview based on the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition revised (DSM-III-R) or the DSM-IV; feelings of guilt were investigated using a numeric scale and a semistructured interview. RESULTS: Among 47 participants who completed the baseline interview, 42 participants (89%) completed the 1-month follow-up interview. Although none of the participants met the criteria for major depression, ASD, or PTSD at the follow-up interview, 3 of 42 participants (7%) met the criteria for minor depression and 2 participants (5%) had PTSS. The only predictor of psychologic distress found was the presence of a history of major or minor depression (odds ratio, 19.41; 95% confidence interval, 1.42-264.95; P < 0.05). Five of 42 participants (12%) had feelings of guilt. CONCLUSIONS: Disclosure of genetic test results for HNPCC may not cause significant psychologic distress in Japanese probands or relatives. However, healthcare providers should not neglect to assess these individuals for psychologic responses, such as minor depression and PTSS.

Adult↗

PubMedDate not supplied

Children's patterns of disclosures and recantations of sexual and ritualistic abuse allegations in psychotherapy.

Patterns of disclosures and recantations of abuse made in psychotherapy were examined in a sample of 63 children who reported sexual and ritualistic abuse in a preschool setting. Therapists completed a measure that instructed them to identify the time since the child began therapy when any disclosures or recantations were made, to specify the type of abuse disclosed or recanted, and to identify any events that might be related to the timing of a disclosure or recantation. The findings revealed that the majority of subjects (76.2%) disclosed abuse within the first month of therapy. Recantation occurred in 17 cases (27%) and all but two children who recanted redisclosed abuse after the initial recantation. There was some evidence that children's experiences within the legal system may have been associated with recantations. Subjects tended to make vague disclosures before revealing more specific acts, reveal less intrusive sexual abuse (e.g., kissing) before more intrusive types (e.g., intercourse), and to disclose ritualistic abuse after other types.

Adolescent↗

PubMed2001

Physician's attitudes towards disclosure of cancer diagnosis to elderly patients: a report from Tokyo, Japan.

Physicians' attitudes towards the disclosure of a cancer diagnosis to 114 consecutive patients (age range, 65-93 years; median 78 years) admitted to the Tokyo Metropolitan Tama Geriatric Hospital from April 1994 to May 1995 were analyzed utilizing a questionnaire administered to the attending physicians. Eighty-seven patients (76%) had been informed of their diagnosis before the initiation of cancer treatment, while 27 patients (24%) were not told. 'To carry out the treatment under patient's understanding' and 'consideration for patient's quality of life' were the major reasons for diagnosis disclosure, while 'lack of patient's ability to understand the information' and 'family's wish that the patient not be informed of the truth' were the major reasons for non-disclosure. Dementia, deteriorated performance status, and non-curability were major factors related to non-disclosure. Even with decisional ability, 15% of patients were not told their cancer diagnosis because wishes of their families were preferred. The current results suggest that telling cancer diagnosis to the elderly patients will not yield negative attitude of the patients and that there is no rationale for physicians to hesitate to disclose cancer diagnosis merely because of patient's high age.

Journal Article↗

PubMed1997

Patients' preferences for risk disclosure and role in decision making for invasive medical procedures.

OBJECTIVE: To assess the level of involvement patients want in decision making related to the acceptance or rejection of an invasive medical intervention and whether their preference for decision making is related to their preference for qualitative (verbal) or quantitative (numeric) information about the risks of the procedure. SETTING: A university-based Department of Veterans Affairs Medical Center. DESIGN: Cross-sectional study using structured interviews of consecutive patients seen for continuity care visits in a general medicine clinic. PATIENTS: Four hundred and sixty-seven consecutive patients with a mean age of 65.2 years (SD 10.70 years, range 31-88 years) and with a mean of 12.6 years (SD 2.96 years, range 0-24 years) of formal education. MEASUREMENTS AND MAIN RESULTS: In the context of an invasive diagnostic or therapeutic intervention, patients were asked whether they preferred patient-based, physician-based, or shared patient-physician decision making. Patients were asked to give the ratio of patient-to-physician decision making they preferred, and whether they preferred discussions using words, numbers, or both. Of 467 subjects, 318 (68%) preferred shared decision making; 100 (21.4%) preferred physician-based decision making; and 49 (10.5%) preferred patient-based decision making. In terms of risk disclosure, 436 (93.4%) preferred that their physician disclose risk information to them. Of these 436 patients, 42.7% preferred disclosure of information about the probability of adverse outcomes using qualitative (verbal) expressions of probability; 35.7% preferred disclosure in terms of quantitative (numeric) expressions of probability; and 9.8% preferred disclosure in both qualitative and quantitative terms. Younger patients (odds ratio [OR] 0.96; confidence interval [CI] 0.93, 0.99), patients who had at least one stroke (OR 3.03; CI 1.03, 8.90), and patients who preferred to discuss risk information with their physicians in terms of numbers (OR 2.39; CI 1.40, 4.06) tended to prefer patient-based or shared decision making. CONCLUSIONS: Male veterans consistently preferred shared patient-physician decision making in the context of invasive medical interventions.

Adult↗

PubMed2002

Are HIV care providers talking with patients about safer sex and disclosure?: A multi-clinic assessment.

OBJECTIVES: To examine HIV-positive patients' reports of whether HIV care providers ever talked with them about practicing safer sex and disclosing seropositive status to sex partners. DESIGN: Cross-sectional survey (1998-1999) of HIV-positive men and women sampled randomly at six public HIV clinics in California. METHODS: Participants were interviewed and asked whether applicable clinic providers (physician, physician assistant, nurse practitioner, nurse, social worker, health educator, psychologist, psychiatrist) ever talked with them about safer sex or disclosure. Responses were analyzed by clinic site, HIV medical status (viral load), demographic, and behavioral variables (unprotected intercourse, non-disclosure). RESULTS: The sample (n = 839) included heterosexual men (n = 127), men who have sex with men (MSM; n = 607), and women (n = 105). Thirty-nine percent were white, 36% Hispanic, 17% black, and 8% other/mixed ethnicity. Overall, 71% reported that an applicable provider had talked with them at least once about safer sex (range across clinics, 52-94%); 50% reported discussion of disclosure (range across clinics, 31-78%). Discussion of safer sex was more prevalent with physicians than with other clinic staff. In multivariate analyses, in addition to significant clinic differences, MSM (versus heterosexual men) and whites (versus blacks or Hispanics) were less likely to receive prevention messages on these topics. Patients' behaviors (unsafe sex, non-disclosure) and HIV medical status were not independently associated with provider communication. CONCLUSIONS: HIV clinics differed substantially in the percentage of patients who reported that they received prevention messages from clinic staff. Care providers should assess and overcome barriers to providing prevention messages to patients.

Communication↗

PubMedDate not supplied

The disclosure decisions of parents who conceive children using donor eggs.

STUDY OBJECTIVE: To identify variables that influence the disclosure decisions of parents who conceive children using donor eggs and to compare such variables among disclosing, nondisclosing, and undecided families. DESIGN: Exploratory, comparative, descriptive. SETTING: A university hospital-assisted reproductive technology program in the Midwest. PARTICIPANTS: Thirty-one couples with children conceived with anonymously donated eggs. METHODS: Audiotaped telephone interviews, measures of social support and family environment, and a demographic survey. MAIN OUTCOME MEASURES: Content analysis of interview transcripts and comparison of recurring themes among groups. RESULTS: The majority of parents intended disclosure. Dominant themes among disclosing parents included the belief that a child has a right to know and concerns about the harmful effects of family secrets. Among nondisclosing parents, common themes were knowing of no compelling reason to tell and perceiving potential harm in telling. Undecided parents reported concerns about how and when to tell and the child's possible reaction. Parents in all groups expressed concern about their disclosure decisions. CONCLUSIONS: Dominant decisional influences were beliefs and values and concerns about possible harm. Longitudinal study is needed to determine the impact of disclosure decisions on children, families, and society.

Adult↗

PubMed2000

Anticipated versus actual emotional reactions to disclosure of results of genetic tests for cancer susceptibility: findings from p53 and BRCA1 testing programs.

PURPOSE: We examined the ability of individuals undergoing genetic testing for cancer susceptibility in two structured research protocols to accurately anticipate emotional reactions to disclosure of their test result. We explored whether accuracy of emotional anticipation was associated with postdisclosure psychologic adjustment. METHODS: Data from 65 individuals were analyzed; 24 members of Li-Fraumeni cancer syndrome families were tested for p53 mutations (all 24 were unaffected), and 41 subjects with hereditary breast-ovarian cancer susceptibility were tested for BRCA1 mutations (34 were unaffected and seven were affected). Subjects were from families in which a germline mutation had been previously identified. At the pretest session, subjects rated the extent to which they anticipated feeling each of six emotional states (relief, happiness, sadness, guilt, anger, and worry) after disclosure that they did or did not carry the familial mutation. After receiving their test result, they rated their feelings on the same scale of emotions for the appropriate condition. Extent of accuracy and association with psychologic distress at 6 months, as assessed with standardized measures, were evaluated. RESULTS: Overall, mean levels of emotional reactions after receiving test results were not different from those anticipated before result disclosure. However, affected BRCA1 carriers experienced higher levels of anger and worry than they had anticipated. Underestimation of subsequent distress emotions related to test result was associated with a significant increase in general psychologic distress at 6 months. CONCLUSION: Unaffected individuals in cancer-predisposition testing programs are generally accurate in anticipating emotional reactions to test results. However, cancer patients may underestimate their distress after disclosure of positive results and could benefit from intervention strategies.

Adult↗

PubMed1991

Resisting disclosure of mental health records during Medicaid investigations and audits.

In a previous article, the author discussed the legal foundation for resisting the disclosure of medical and mental health records, the nature of the right to confidentiality of medical and mental health records, the privileges against disclosure, how those privileges are lost, and the health care provider's liability for improper disclosure. In this article, the author offers a "nuts and bolts" approach to resisting the disclosure of mental health records for counsel representing health care practitioners and institutions involved in Medicaid audits and investigations.

Confidentiality↗

PubMed2001

Shame and non-disclosure: A study of the emotional isolation of people referred for psychotherapy.

Thirty-four people referred to an NHS psychotherapy department were given a modified form of Oatley and Duncan's (1992) emotion diary which included questions about whether each recorded emotion had been subsequently disclosed to anyone (for example a partner, friend or professional). One week later the diaries were collected and participants interviewed. Interviews focused, among other things, on reasons for non-disclosure of recorded emotional experiences and the relationship between shame and non-disclosure. The results indicated that a majority of the emotional incidents recorded in the diaries were not disclosed (68%). This result contrasts with studies on non-clinical samples in which only approximately 10% of everyday emotions are kept secret. Qualitative analysis of the interview data revealed that participants appeared to be habitual non-disclosers of emotional and personal experiences and that non-disclosure was related to the anticipation of negative interpersonal responses to disclosure (in particular labelling and judging responses) in addition to more self-critical factors including shame. It is suggested that these results add to the existing literature on shame by illustrating the interpersonal effects of shame in a clinical sample.

Journal Article↗

PubMed1982

Subjecting hospitals to truth in lending disclosure requirements: Bright V. Ball Memorial Hospital.

The federal Truth in Lending Act requires creditors to comply with complex disclosure requirements whenever they engage in consumer credit transactions. In light of procedures adopted by hospitals and health care professionals which permit payment for services over time, there is some question as to whether these groups may be considered creditors within the meaning of the Act and therefore subject to the Act's disclosure requirements. In Bright v. Ball Memorial Hospital, the Court of Appeals for the Seventh Circuit concluded that a hospital can be a creditor with respect to certain hospital-patient transactions. However, the court found that the defendant had not consummated consumer credit transactions with the plaintiffs and consequently had not violated the Act by failing to make disclosures. This Case Comment contends that although the court correctly determined that a hospital, in certain circumstances, may be subject to the Act, it incorrectly held that Ball Memorial failed to consummate consumer credit transactions with the plaintiffs. This Case Comment also discusses the circumstances under which a hospital should be considered a creditor for purposes of the Truth in Lending Act and recommends that hospitals offering installment payment plans routinely comply with disclosure requirements of the Act.

Accounting↗