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PubMed2006

Conflicting messages: how criminal HIV disclosure laws undermine public health efforts to control the spread of HIV.

Twenty-three U.S. states currently have laws that make it a crime for persons who have HIV to engage in various sexual behaviors without, in most cases, disclosing their HIV-positive status to prospective sex partners. As structural interventions aimed at reducing new HIV infections, the laws ideally should complement the HIV prevention efforts of public health professionals. Unfortunately, they do not. This article demonstrates how HIV disclosure laws disregard or discount the effectiveness of universal precautions and safer sex, criminalize activities that are central to harm reduction efforts, and offer, as an implicit alternative to risk reduction and safer sex, a disclosure-based HIV transmission prevention strategy that undermines public health efforts. The article also describes how criminal HIV disclosure laws may work against the efforts of public health leaders to reduce stigmatizing attitudes toward persons living with HIV.

Criminal Law↗

PubMed2003

Determinants of disclosure of genital herpes to partners.

OBJECTIVE: To identify factors which determine whether and when patients will disclose infection with genital herpes to sexual partners. METHODS: The sample was 26 women and 24 men attending a herpes clinic in a sexually transmitted disease clinic. Semistructured interviews yielded quantitative data and also qualitative data which were subjected to content analysis. RESULTS: Characteristics of partners were very important in determining whether disclosure occurred. Respondents were less likely to tell partners regarded as casual. Perception of the likely reaction of partners was important in deciding whether to tell. Many respondents assumed that they were not infectious if they were not currently having an attack or if they were taking antiviral medication. The decision whether to tell tended to be based on considerations of likely discovery and of honesty towards the partner rather than control of transmission. Of patient characteristics only self rated depressed mood was related to disclosure to the most recent partner. CONCLUSIONS: Perception of the partner and anticipated partner response is crucially important in determining whether and when disclosure of genital herpes infection occurs.

Adult↗

PubMed2000

Self-disclosure of HPV infection to sexual partners.

Disclosure decisions of persons with genital HPV infection were examined. The research questions focused on relationships among knowledge of transmission, beliefs about the obligation to disclose knowledge of HPV infection to sexual partners, factors that influence the disclosure decision, and evaluations of the decision. Participants were 92 persons diagnosed with HPV 6 months prior to data collection. Sixty-three women and 29 men whose average age was 23.1 years constituted the sample. A subset of 48 persons provided detailed information about their reasons for disclosing or not disclosing knowledge of HPV and subsequent evaluation of their behavior. Knowledge of HPV transmission was adequate; however, there was no relationship between transmission knowledge and disclosure beliefs. Participants tended to disclose the presence of HPV to partners at point of diagnosis, but not to new partners 6 months later. Both disclosers and non-+disclosers felt positively about their decision. Possible changes in clinical interventions for persons with HPV infection are discussed.

Adult↗

PubMed2005

Adult female victims of child sexual abuse: multitype maltreatment and disclosure characteristics related to subjective health.

This study examined the impact of child sexual abuse and disclosure characteristics on adult psychological and psychosomatic symptoms. Data on abuse characteristics, disclosure-related events, and subjective health were collected through semistructured interviews and questionnaires from 123 adult women reporting having been sexually abused in childhood by someone close. The results indicate that disclosure-related events have a stronger relation than abuse characteristics to long-term consequences of childhood sexual abuse. In particular, a positive reaction from a partner was related to fewer symptoms. Of the abuse characteristics, exposure also to physical abuse was strongly associated to psychological sequelae.

Adult↗

PubMed1981

Disclosure standards and informed consent.

There is currently substantial disagreement about the kind of information that must be disclosed in obtaining an informed consent. This study examined physicians' interpretations of the demands of two alternative legal standards for disclosure, as well as a third standard intended to capture their normative sense of what should be disclosed to patients. Other factors which might affect disclosure practices of physicians were also studied. The findings raise questions about the extent to which a legal standard for disclosure can have an impact on medical practice; the data suggest that doctors currently disclose what they think patients want to be told. However, it appears that physicians substantially underestimate the amount of information patients wish to receive.

Disclosure↗

PubMed1993

Self-disclosure of HIV infection to dentists and physicians.

We prospectively examined self-disclosure of HIV infection by 129 men and women to dentists and physicians. After an average of 2.3 years since initial HIV-positive notification and repeated individual counseling, only 53 percent of subjects had told their dentists of HIV infection compared to 89 percent who had told their physicians. This high rate of non-disclosure despite extensive counseling raises concern about effectiveness of education alone in promoting voluntary self-disclosure. Our findings further support recommended universal precautions.

Adolescent↗

PubMed1996

Bioethics for clinicians: 2. Disclosure.

In the context of patient consent, "disclosure" refers to the provision of relevant information by the clinician and its comprehension by the patient. Both elements are necessary for valid consent. Disclosure should inform the patient adequately about the treatment and its expected effects, relevant alternative options and their benefits and risks, and the consequences of declining or delaying treatment. The clinician's goal is to disclose information that a reasonable person in the patient's position would need in order to make an informed decision. Therefore, clinicians may need to consider how the proposed treatment (and other options) might affect the patient's employment, finances, family life and other personal concerns. Clinicians may also need to be sensitive to cultural and religious beliefs that can affect disclosure.

Adult↗

PubMed2006

Financial conflict of interest disclosure and voting patterns at Food and Drug Administration Drug Advisory Committee meetings.

CONTEXT: In January 2002, the US Food and Drug Administration (FDA) issued a draft guidance requiring more detailed financial conflict of interest disclosure at advisory committee meetings. OBJECTIVES: To characterize financial conflict disclosures at drug-related meetings, and to assess the relationship between conflicts and voting behavior at meetings that considered specific products. DESIGN AND SETTING: Cross-sectional study using agendas and transcripts from all FDA Drug Advisory Committee meetings (2001-2004) listed on the FDA Web site. MAIN OUTCOME MEASURES: Conflict rates, type, and size. The relationship between having a conflict and voting in favor of the index drug was described for each voter using Mantel-Haenszel relative risks and Monte Carlo simulations; Spearman rho was used for a meeting-level analysis comparing rates of conflict with voting patterns. The impact of the removal of persons with conflicts of interest on the vote margins was also evaluated. RESULTS: A total of 221 meetings held by 16 advisory committees were included in the study. In 73% of the meetings, at least 1 advisory committee member or voting consultant disclosed a conflict; only 1% of advisory committee members were recused. For advisory committee members (n = 1957) and voting consultants combined (n = 990), 28% (n = 825) disclosed a conflict. The most commonly specified conflicts were consulting arrangements, contracts/grants, and investments. Nineteen percent of consulting arrangements involved over 10,000 dollars, 23% of contracts/grants exceeded 100,000 dollars, and 30% of investments were over 25,000 dollars. The meeting-level analysis did not show a statistically significant relationship between conflict rates ("index conflict," "competitor conflict," or "any conflict") and voting patterns, but a weak, statistically significant positive relationship was apparent for competitor conflict and any conflict in the Mantel-Haenszel analyses. The Monte Carlo analyses produced similar findings in the competitor conflict analysis only. In all 3 conflict categories, the exclusion of advisory committee members and voting consultants with conflicts would have produced margins less favorable to the index drug in the majority of meetings, but this would not have changed whether the majority favored or opposed the drug. CONCLUSIONS: Disclosures of conflicts of interest at drug advisory committee meetings are common, often of considerable monetary value, and rarely result in recusal of advisory committee members. A weak relationship between certain types of conflicts and voting behaviors was detected, but excluding advisory committee members and voting consultants with conflicts would not have altered the overall vote outcome at any meeting studied.

Advisory Committees↗

PubMed1995

The effects of cognitive pretraining on cohesion and self-disclosure in small groups: an analog study.

This study examined the effects of written, cognitive pretraining on the development of cohesion and self-disclosure in interpersonal learning groups. Subjects in the experimental condition received a written introduction to the group experience, and subjects in the control condition received written information on the history of group psychotherapy. Results demonstrated that the experimental groups had a higher level of group cohesion than the control groups, p < .0001, but were not different on self-disclosure. The correlation between cohesion and self-disclosure was not statistically significant. The results were discussed as an extension of the empirical support for cognitive pretraining.

Adolescent↗

PubMedDate not supplied

To tell or not to tell: patterns of disclosure among men with prostate cancer.

This paper draws on the results of a longitudinal, qualitative study of men with prostate cancer (treated with prostatectomy) and their spouses. Interviews were conducted separately and simultaneously with men and their spouses, at three points in time (pre-surgery, 8-10 weeks post-surgery and 11-13 months post-surgery). The primary focus in the paper is on men's responses to questions about their decisions to share information (or not) with others about their diagnosis and ongoing medical situation. Most men with prostate cancer avoided disclosure about their illness where possible, and placed great importance on sustaining a normal life. Factors related to limiting disclosure included men's low perceived need for support, fear of stigmatization, the need to minimize the threat of illness to aid coping, practical necessities in the workplace, and the desire to avoid burdening others. This study contributes to an understanding of disclosure issues related to prostate cancer, and raises issues about how best to be helpful to men, given their tendency to minimize the impact of illness, and the need for support.

Adaptation, Psychological↗

PubMed2004

Medical privacy and the disclosure of personal medical information: the beliefs and experiences of those with genetic and other clinical conditions.

There has been heightened legislative attention to medical privacy and to protections from genetic discrimination, without large-scale studies to document privacy concerns or analysis of whether experiences differ by whether the condition is genetic (defined here as a single-gene disorder) or non-genetic. To determine whether experiences regarding privacy, disclosure, and consequences of disclosure differ by whether one's medical condition is genetic, we conducted a descriptive study with one-time, structured quantitative and qualitative interviews. We interviewed approximately 100 adults or parents of children with each of the following medical conditions: sickle cell disease, cystic fibrosis, diabetes, and HIV, and 200 adults with or at risk for breast cancer or colon cancer. The percentages of the total 597 respondents experiencing positive or negative consequences of disclosure and the degree to which experiences differed by whether the condition was genetic were the outcomes of interest. Seventy-four percent were glad and 13% regretted others knew about their condition; these findings did not differ significantly by genetic vs. non-genetic condition. Reports of job and health insurance discrimination were not uncommon for the overall study population (19 and 27%, respectively) but were more likely among those with genetic conditions (30 and 37%, respectively). Legislation and other policy-making should target the needs of persons with all conditions and not focus exclusively on genetic discrimination, given that experiences and concerns generally do not differ based on the genetic etiology of the condition.

Adolescent↗

PubMed2005

Disclosure patterns of eating and weight concerns to clinicians, educational professionals, family, and peers.

OBJECTIVE: The current study investigated disclosure of eating and weight concerns to professionals, peers, and family. METHOD: Responses to a telephone questionnaire probing disclosure patterns were analyzed in a sample of 216 adult subjects with eating or weight symptoms, concerns, or problems. RESULTS: Nearly all of the sample (97.7%) had disclosed information about eating or weight symptoms or concerns to someone. Only 57% of the sample had disclosed this information to a health care professional. However, among subjects who had not otherwise volunteered information about their concerns, those who were queried were more likely than not to disclose them to health care professionals, counselors, and coaches. Disclosure to a health care professional or school counselor was associated with a higher likelihood of subsequent treatment seeking. DISCUSSION: These data suggest that individuals with disordered eating may be quite amenable to disclosing symptoms in clinical settings. Asking about an eating disorder may enhance detection and facilitate treatment in clinical settings.

Adolescent↗

PubMed1999

On the question of self-disclosure by the analyst: error or advance in technique?

The question of self-disclosure by the analyst and its uses in treatment is an issue widely debated today. In this paper, the author reviews this controversial technique from historical and contemporary points of view, delineates several forms of self-disclosure, and, by means of several clinical examples, discusses the effects on the patient and the analytic process of utilizing one or another kind of self-disclosure in these particular situations.

Adult↗

PubMed1999

Playing one's cards face up in analysis: an approach to the problem of self-disclosure.

A policy of consistent willingness on the analyst's part to make his or her own views explicitly available to the patient is discussed and illustrated by clinical vignettes. Playing one's cards face up is contrasted with contemporary conceptions of selective self-disclosure by the analyst, especially with respect to the way ground rules for the analytic treatment relationship get established. The objective of the analyst playing his or her cards face up is to create a candid dialogue, thus facilitating maximally effective collaboration between analyst and patient. Concerns about the analyst's self-disclosure foreclosing exploration of the patient's unconscious fantasies and transferences, or intruding upon the patient's autonomy, are addressed, as is the relation between self-disclosure and an individual analyst's personal style.

Female↗

PubMed2003

Self-disclosure in psychotherapy practice and supervision: an introduction.

Disclosure in psychotherapy may be considered from multiple perspectives: therapist to patient, patient to therapist, trainee to supervisor, and supervisor to trainee. Individuals in each of these roles must decide if, when, and how they should articulate certain thoughts or feelings to their therapeutic counterpart. Multicultural considerations may well influence these decisions. The articles in this issue, including two that are research reviews, question the value and parameters of self-disclosure in each of these contexts; they speak to the inevitable tension within psychotherapeutic dyads between the demands of open and honest disclosures and the equally potent countervailing forces of shame, tact, and appropriateness.

Cultural Diversity↗

PubMed2003

Self-disclosure in psychoanalytic-existential therapy.

This article is an effort to integrate contemporary psychoanalytic and existential perspectives on intentional therapist self-disclosure. It offers a two-stage decision-making model that considers self-disclosure from the vantage points of style and internalization. Clinical and research findings are presented to support the notion that the meanings a patient attributes to a particular self-disclosure, and its power to move him or her towards greater health, is the product of a fluctuating matrix of interpersonal and intrapsychic variables. Special consideration is given to the challenges that arise during the early and termination stages of treatment and to the psychotherapy of therapists.

Decision Making↗

PubMed2003

Cross-cultural considerations of therapist self-disclosure.

Much of the existing literature on psychotherapist self-disclosure has been with White or European American individuals. This article discusses cross-cultural considerations related to therapist self-disclosure. We present a clinical example of how therapist self-disclosure might play an important role with regard to working with people of color.

Adult↗

PubMed2003

Supervisor self-disclosure: balancing the uncontrollable narcissist with the indomitable altruist.

The purpose of this article is to provide supervisors with a framework to determine the effectiveness of self-disclosure in supervision. We posit how self-disclosures can be both memorable to the trainee and facilitative of supervision process and outcome, specifically the supervisory working alliance, trainee disclosure, and trainee edification. Case examples based on the literature and our own personal experiences are offered to illustrate the models' applicability.

Adult↗