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PubMed2004

Ambivalence of nonoffending guardians after child sexual abuse disclosure.

A concern in the intervention with sexually abused children is the support of their nonoffending guardians after disclosure of the abuse. Approximately a third of nonoffending guardians respond with vacillation in support, and these nonoffending guardians are at greater risk for having their children removed. This article reconceptualizes vacillation in support as an ambivalent response. Drawing on the interdisciplinary literature, this article suggests that ambivalence in support reflects the confluence between the nonoffending guardian's valence toward the child and perpetrator. This article further proposes that ambivalence is normative when the costs of disclosure are high and when the nonoffending guardian is ambivalent/preoccupied in attachment. Ambivalence may also be both a precursor to and an effect of the traumatic experience of the disclosure on the nonoffending guardian. In a study of 30 nonoffending mothers whose partners sexually abused their children, these relationships were supported.

Child↗

PubMed2005

Giving the reasonable patient a voice: information disclosure and the relevance of empirical evidence.

In England the standard of risk disclosure required of doctors to avoid liability in negligence is governed by the Bolam test. The test is determined by what would be accepted as reasonable by the responsible doctor. Although able to lay down an independent standard, the courts have usually been guided by the medical expert's evidence. The judge's duty to scrutinise expert evidence was reaffirmed by the recent House of Lords ruling in Bolitho v City and Hackney HA. In Pearce v United Bristol Healthcare NHS Trust, Lord Woolf MR confirmed that this also applied to risk disclosure. Brazier & Miola argue that Pearce effectively introduces the prudent patient standard into English law. This paper examines that claim and considers whether it is justified by the Pearce judgment. The implications of Pearce are explored and, given the appeal to the concept of a material risk, I discuss the relevance of empirical research to determining the standard of disclosure. Finally, a small piece of empirical work is presented as an illustration of the pros and cons of such an approach and as a possible springboard for future research.

Anesthesia, General↗

PubMed2003

The disclosure of a diagnosis of an autistic spectrum disorder: determinants of satisfaction in a sample of Scottish parents.

Satisfaction with disclosure of the diagnosis of an autistic spectrum disorder was investigated using a self-report questionnaire completed by 126 parents. On a rating of satisfaction, 55 percent indicated that they were satisfied or very satisfied with the disclosure. Parents were more likely to be satisfied if they gave positive ratings to the manner of the professional and the quality of the information provided; if they had been given written information and the opportunity to ask questions; and if their early suspicions had been accepted by professionals. These factors were combined into a global index of satisfaction; those gaining higher scores were more likely to have been given the diagnosis of Asperger syndrome (as opposed to autism), to have had a definite diagnosis, and to have children who were not currently in an educational placement. These results underline the importance of the interaction between parent and professional during the disclosure interview.

Adult↗

PubMed2004

Disclosure of cancer diagnosis and prognosis: a survey of the general public's attitudes toward doctors and family holding discretionary powers.

BACKGROUND: This study aimed to ask a sample of the general population about their preferences regarding doctors holding discretionary powers in relation to disclosing cancer diagnosis and prognosis. METHODS: The researchers mailed 443 questionnaires to registered voters in a ward of Tokyo which had a socio-demographic profile similar to greater Tokyo's average and received 246 responses (response rate 55.5%). We describe and analysed respondents' attitudes toward doctors and family members holding discretionary powers in relation to cancer diagnoses disclose. RESULTS: Amongst respondents who wanted full disclosure about the diagnosis without delay, 117 (69.6 %) respondents agreed to follow the doctor's discretion, whilst 111 (66.1 %) respondents agreed to follow the family member's decision. For respondents who preferred to have the diagnosis and prognosis withheld, 59 (26.5 %) agreed to follow the doctor's decision, and 79 (35.3 %) of respondents agreed with following family member's wishes. CONCLUSIONS: The greater proportion of respondents wants or permits disclosure of cancer diagnosis and prognosis. In patients who reveal negative attitudes toward being given a cancer disclosure directly, alternative options exist such as telling the family ahead of the patient or having a discussion of the cancer diagnosis with the patient together with the family. It is recommended that health professionals become more aware about the need to provide patients with their cancer diagnosis and prognosis in a variety of ways.

Adult↗

PubMed2003

Ethical issues after the disclosure of a terminal illness: Danish and Norwegian hospice nurses' reflections.

This research explored the ethical issues that nurses reported in the process of elaboration and further disclosure after an initial diagnosis of a terminal illness had been given. One hundred and six hospice nurses in Norway and Denmark completed a questionnaire containing 45 items of forced-choice and open-ended questions. This questionnaire was tested and used in three countries prior to this study; for this research it was tested on Danish and Norwegian nurses. All respondents supported the ethics of ongoing disclosure to terminally ill patients based on ethical principles embedded in their country's Patients' Rights Acts. Truth, as an intrinsic value, proved foundational to patient autonomy, the most frequent ethical principle these nurses reported to justify their ethical position on information disclosure to terminally ill people. Telling the truth about a diagnosis was not the end of ethics in hospice care, but rather the beginning because what occurs ethically in dealing with prognosis issues became central to these hospice nurses, the patients and their families. Coupled with truth-telling, compassionate interaction and care become extensions of patients' rights.

Adult↗

PubMed1984

Disclosure of information to adult cancer patients: issues and update.

Clinicians are regularly faced with decisions regarding disclosure of information to cancer patients. Many of these decisions constitute a dilemma between the physician's paternalistic concern for the patient and the patient's right to know as much as possible. This paper reviews changes in the attitudes of physicians over the last several decades, elaborates on the problems that confront the clinician in the process of disclosure, and reviews the available data concerning the documented impact on the patient from receiving or not receiving information. The arguments both supporting and challenging the paternalistic view are discussed, and the necessity for viewing the disclosure of clinical information as a clinical process is offered.

Attitude of Health Personnel↗

PubMed2003

Finding positive meaning and its association with natural killer cell cytotoxicity among participants in a bereavement-related disclosure intervention.

This study tested the hypothesis that cognitive processing about a past bereavement would produce increases in goals and priorities indicative of finding positive meaning from the loss. It was further hypothesized that increases in meaning-related goals would be associated with changes in immune function, specifically increased natural killer cell cytotoxicity (NKCC). Cognitive processing was manipulated using written emotional disclosure. Forty-three women who had lost a close relative to breast cancer wrote about the death (cognitive processing/disclosure group) or about nonemotional topics weekly for 4 weeks. Contrary to predictions, written disclosure did not induce changes in meaning-related goals or NK cell parameters. However, women in both experimental groups who reported positive changes in meaning-related goals over the study period also showed increases in NKCC. Results suggest that prioritizing goals emphasizing relationships, personal growth, and striving for meaning in life may have positive biological correlates but that solitary written disclosure may not be sufficient to induce changes in these goals in response to a past bereavement.

Adaptation, Psychological↗

PubMed2005

Hope, disclosure, and control in the neonatal intensive care unit.

The parents of critically ill newborns who have been admitted to a neonatal intensive care unit (NICU) generally face several challenges. Included in these challenges is the possibility of having access to information and a certain level of disclosure about the diagnosis, treatment options, and prognosis for their newborn. A related challenge is the ability to have some control over the care of their newborn. In this article, I (first author) share my own experiences of having a child admitted to an NICU, and I discuss how a lack of disclosure affected the decision making and involvement I had in my child's care and hindered my ability to find hope. A loss of hope can both contribute to a sense of powerlessness and exacerbate the negative aspects of these NICU experiences. I argue that when health care providers offer parents the disclosure they want and need, as well as a certain amount of control over the care of their child while in the NICU, the ability of parents to find hope will be increased, and they will be better able to cope successfully in the NICU environment.

Health Personnel↗

PubMed2006

Written disclosure of experiences with racial discrimination and antibody response to an influenza vaccine.

This study examined whether Blacks who wrote about their experiences with racial discrimination in a laboratory-based disclosure intervention would show greater levels of antibody production in response to an influenza vaccine compared with Blacks who wrote about a neutral topic. Forty-seven participants were randomized to write about their thoughts and feelings around their experiences with racism, or to write about their schedule for the week. Participants wrote on the same topic during each of three 20-min sessions. Blood was drawn prior to the intervention and at 1 and 3 months postvaccination to assess antibody production. Participants in the racism disclosure group produced significantly less antibodies to 2 of 3 viral strains. Post hoc analysis suggests that participants who were unsure about whether their events were due to racism or due to other factors had reduced levels of antibody to 1 viral strain. The attributional ambiguity sometimes associated with racism may inhibit the benefits of disclosure interventions for these types of stressors.

Antibody Formation↗

PubMed2003

Prevalence, disclosure and interpretations of sexual activities in a sample of Canadian college-aged blood donors.

This study assessed the prevalence, level of disclosure, and interpretations of sexual activities in a sample of 123 college-aged blood donors in Montreal, Quebec. Within six months of their donation, participants completed an anonymous questionnaire designed to assess sexual definitions, levels of disclosure to sexual partners, as well as prevalence of various blood safety behavioural risks. Responses indicated that (1) there was a lack of consensus regarding what constitutes 'sex', (2) levels of sexual disclosure varied widely, and (3) participants engaged in numerous blood safety behavioural risk activities. These results are discussed with respect to their implications for how people think about sex, particularly in the blood donation context. Suggestions to improve specific blood donor screening questions are also presented.

Adolescent↗

PubMed2000

Family secrets: disclosure of HIV status among gay men with HIV/AIDS to the family of origin.

A mail survey obtained a sample of 117 gay men with HIV/AIDS to examine levels of disclosure of HIV status to the family of origin and the association between disclosure and levels of support and barriers to support from the family. Among men with HIV there was a significant difference in knowledge of HIV status between family members such that mothers and siblings were more likely to be knowledgeable than fathers. For the total sample disclosure of HIV status was associated with higher levels of support from all family members and with a lower level of barrier to support from mothers and fathers. Implications for practice are discussed.

Acquired Immunodeficiency Syndrome↗

PubMed2000

Trust and disclosure of sexual orientation in gay males' mother-son relationships.

This study explored the possibility that changes in feelings of trust for mother are associated with gay males' decisions to disclose (or withhold) their sexual orientation in their mother-son relationships. Fifty gay and bisexual males completed a questionnaire about their coming out experiences in the context of their relationships with their mothers. As part of this questionnaire, they completed a retrospective graphical trust history task that involved plotting the degree of trust they felt for their mothers over time and across important events (such as disclosure). Results are discussed in terms of gay men's expectations about their mothers' responses to disclosure, the evidence for stability versus change in their memories regarding the nature of their feelings of maternal trust over time, the complexity of the trust histories participants drew, similarity between disclosers and non-disclosers in the shape of their trust curves, and the types of events and experiences that constituted the timeline or "plot" in the stories participants told about their mother-son relationships. This study offers the first empirical evidence to support speculations linking disclosure of sexual orientation to the climate of trust that exists in the relationship between discloser and target (e.g., Holtzen, Kenny & Mahalik, 1995).

Adolescent↗

PubMedDate not supplied

Disclosure of medical injury to patients: an improbable risk management strategy.

Pressure mounts on physicians and hospitals to disclose adverse outcomes of care to patients. Although such transparency diverges from traditional risk management strategy, recent commentary has suggested that disclosure will actually reduce providers' liability exposure. We tested this theory by modeling the litigation consequences of disclosure. We found that forecasts of reduced litigation volume or cost do not withstand close scrutiny. A policy question more pressing than whether moving toward routine disclosure will expand litigation is the question of how large such an expansion might be.

Compensation and Redress↗

PubMed2005

Advance directives for truth disclosure.

INTRODUCTION: Although most patients wish to be fully informed about bad news such as a diagnosis of cancer, a significant minority prefer no or minimal information. We examined the value of asking patients about their disclosure preferences at the outset of hospitalization. METHODS: Consecutive patients admitted to a respiratory and a geriatric unit were asked whether and how they would wish to be told of cancer or Alzheimer disease. RESULTS: Of the 207 patients interviewed, 174 (84%) wanted to be told about cancer or dementia; the proportion who would wish to be told did not differ between older patients (89 of 108 patients; 82%) and younger patients (85 of 99 patients; 86%; p = 0.34). Thirty patients (15%) sought reassurance during or after the interview, and 13 patients (6%) reported that they had been bothered by the questions. Of the 207 patients, cancer or dementia was diagnosed in 23 patients (11%). Preferences for disclosure or nondisclosure were honored for 20 patients (87%). CONCLUSIONS: Seeking preferences regarding truth disclosure at the outset of hospitalization is helpful and feasible in everyday practice, and the results can be used by clinicians to improve communication with patients and families in accordance with patients' own wishes.

Advance Directives↗

PubMed2003

Reasons for HIV disclosure or nondisclosure to casual sexual partners.

The purpose of this study was to investigate reasons HIV-positive gay men give for disclosing or not disclosing their serostatus to their casual sexual partners. Participants were 78 HIV-positive gay men who were part of a larger HIV and disclosure project. A clear factor structure for disclosure emerged which suggests that issues of responsibility dominated men's decisions to disclose. No clear factor structure for nondisclosure emerged. Reasons for disclosure or nondisclosure to casual sexual partners were varied and this data could provide new insights for secondary prevention efforts. More research needs to be conducted to better understand salient issues in considering whether to disclose.

Adolescent↗

PubMed2006

Gay men's report of regret of HIV disclosure to family, friends, and sex partners.

The purpose of this study was to examine whether HIV-positive MSM experience regret as a consequence of disclosing their HIV serostatus. Participants for this study were 76 HIV-positive MSM involved in a longitudinal study of HIV disclosure (N = 139). Men with at least one network member that was aware of his HIV infection were included in the analyses. Results revealed that overall, HIV-positive men do not regret family or friends knowing about their serostatus (63%). The observed proportion of regret events was practically negligible (4.2%). Compared with friends, the odds of experiencing regret were greater in the immediate family, with coworkers, and casual sex partners but was not significantly different in the extended family or committed sex partners. Despite disclosure being regarded as an anxiety provoking activity and negative reactions are typically anticipated, HIV disclosure appears to elicit very little regret to a wide variety of social network members. Furthermore, there were no differences in the occurrence of regret whether the HIV-positive person disclosed personally or if someone else disclosed for them. In both instances regret was remarkably low.

Adult↗

PubMed2003

Self-disclosure with all-male groups.

Given the relational deficits men bring to a group, therapist self-disclosure is particularly pertinent with all-male groups. The use of this intervention reflects the author's long experience with such groups. The author writes from an interpersonal, collaborative model of group therapy, and discusses types of self-disclosure and the guiding principles in their use. Drawing primarily from his own practice, the author presents and discusses clinical vignettes that illustrate both helpful and nonhelpful uses of self-disclosure.

Adult↗

PubMedDate not supplied

[The cancer diagnosis disclosure for the patient and healthcare professionals].

The disclosure of the cancer diagnosis is considered a crucial moment and the way healthcare professionals communicate it interferes directly in patient's relationship with his/her diagnosis. The study aims to discuss about the importance of the disclosure of the cancer diagnosis for the patient and for the health professionals. The methodology is an essay. The discussion begins with works perspectives which involves health professionals' interaction with the patient and cancer diagnosis disclosure presenting the difficulties lived by both as well as nursing performance in this process. The difficult task of revealing the diagnosis can diverge in each one's experience field and health professionals should be prepared to act in an effective way by taking into account patient's cultural, social and psychological background related to the way the information is communicated to them.

Humans↗