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PubMedDate not supplied

How children tell: the process of disclosure in child sexual abuse.

In an analysis of the disclosure by a large number of children from three to 17 years of age of having been sexually abused, and who were eventually confirmed as credible victims, the large majority at first denied the abuse. The authors describe disclosure as a process with definable phases and characteristics--seldom the single entity that typical investigations consider disclosure to be, thereby setting the stage for ensuring injustices and harm to the children.

Adolescent↗

PubMed1995

Self-disclosure of HIV-1 antibody test results: the San Francisco General Hospital Cohort.

We followed 93 subjects from the San Francisco General Hospital Cohort for one year after notifying them of their HIV-1 antibody test results in order to examine self-disclosure, reactions, and concerns regarding disclosure. By one year post-notification, 92% of gay friends, 82% of primary sexual partners, 56% of new sexual partners, 46% of co-workers, 71% of physicians, 37% of dentists, 57% of psychotherapists, and 37% of family members had been told. Subjects were twice as likely to tell primary sexual partners, and more likely to self-disclose to all categories of persons (except physicians and dentists) than anticipated prior to notification. Least favorable reactions to seropositivity were from male family members and primary sexual partners, while seronegative subjects experienced unfavorable reactions only from some family members. Subjects were most concerned about health insurance (71%) and stigmatization (61%), but the latter declined (to 36%) at 12 months. Although encouraging, these findings suggest that self-disclosure should be discussed in both pre- and post-test counseling sessions.

AIDS Serodiagnosis↗

PubMed1996

[Truth disclosure to patients diagnosed with cancer].

OBJECTIVE: To find the sort of information given to cancer patients in PC and the factors which affect the disclosure of the diagnosis. DESIGN: A descriptive crossover study, carried out through a personal interview. SETTING: A county hospital with no oncology service. PATIENTS: All those patients with cancer (histologically confirmed) admitted to the hospital during April and May 1993. MEASUREMENTS AND MAIN RESULTS: Each patient was asked what illness he/she had, who told him/her and where, along with his/her sociodemographic details. Later the date of diagnosis and the site and spread of the tumour were taken from the medical records. Out of 108 patients under study, 8 knew they had cancer, 1 said he/she had a tumour and 11 believed they had "something bad". 7 patients had no information about their illness and 81 gave alternative diagnoses (inflammation, cyst...). Disclosure was more common in the cases of breast cancer, haematological cancer and those diagnosed over 6 months previously. No significant differences regarding the spread of the tumour or the sociodemographic variables were found. CONCLUSIONS: The disclosure of a diagnosis of cancer is the exception, not the rule. Concealment is only abandoned in the case of potentially curable tumours and those which offer a longer life expectancy.

Aged↗

PubMedDate not supplied

HIV risk assessment: a video doctor seeks patient disclosure.

We assessed the influence of a "video doctor's" affective communication style (warm vs. neutral) and of a preamble to questions about sexual activity on patients' disclosure of risky sexual behavior and injectable drug use. To isolate the effects of the independent variables, we created an interactive multimedia program for HIV risk assessment using a video doctor portrayed by an actor. Participants were assigned to one of four conditions: no preamble and a neutral physician, no preamble and a warm physician, a preamble and a neutral physician, or a preamble and a warm physician. Almost 60% of a convenience sample of 393 subjects reported engaging in two or more risky behaviors. Disclosure of risky behaviors was not significantly affected by the preamble. A warm communication style elicited more disclosure than a neutral style, suggesting that physicians' communication style is important in determining how much sensitive information patients are willing to reveal.

Adult↗

PubMed1997

When the analyst is ill: dimensions of self-disclosure.

This article examines questions related to the "inescapable," the "inadvertent," and the "deliberate" personal disclosures by an analyst. Technical and personal considerations that influence the analyst's decision to disclose, as well as the inherent responsibilities and potential clinical consequences involved in self-disclosure, are explored, with particular attention to transference-countertransference dynamics, therapeutic goals, and the negotiation of resistance. The author describes her clinical work during a period of prolonged illness, with case vignettes that illustrate how-self-disclosure may be regarded as both an occasional authentic requirement and a regular intrinsic component of clinical technique.

Breast Neoplasms↗

PubMed1995

Disclosure of donor insemination: parental attitudes.

Disclosures by parents with a child conceived by donor insemination were compared to those of parents with adopted children and parents with children conceived by in vitro fertilization. None of the donor-insemination parents had told their child. The factors found to create the greatest difficulties for disclosure were the father's infertility, the timing and method of telling, and the lack of genetic information for the child.

Adoption↗

PubMed2000

Physician disclosure of healthy personal behaviors improves credibility and ability to motivate.

CONTEXT: While some studies have shown that physicians with healthy personal habits are especially likely to discuss prevention with their patients, to our knowledge no one has published information testing whether physician credibility and patient motivation to adopt healthier habits are enhanced by physician's disclosures of their own healthy behaviors. DESIGN: Two brief health education videos about improving diet and exercise were produced and shown to subjects (n1 = 66, n2 = 65) in an Emory University general medical clinic waiting room in Atlanta, Ga. In one video, the physician revealed an additional half minute of information about her personal healthy dietary and exercise practices and had a bike helmet and an apple visible on her desk (physician-disclosure video). In the other video, discussion of personal practices and the apple and bike helmet were not included (control video). RESULTS: Viewers of the physician-disclosure video considered the physician to be generally healthier, some-what more believable, and more motivating than did viewers of the control video. They also rated this physician to be specifically more believable and motivating regarding exercise and diet (P < or = .001). CONCLUSION: Physicians' abilities to motivate patients to adopt healthy habits can be enhanced by conveying their own healthy habits. Educational institutions should consider encouraging health professionals-in-training to practice and demonstrate healthy personal lifestyles.

Adult↗

PubMed2003

Longitudinal care improves disclosure of psychosocial information.

BACKGROUND: While longitudinal primary care is thought to promote patient rapport and trust, it is not known if longitudinality helps overcome barriers to communication that may occur when the patient and physician are of different ethnicities and/or sexes. OBJECTIVE: To examine if longitudinal pediatric care ameliorates disparities in parent disclosure of psychosocial information associated with ethnic and gender discordance between parent and physician. DESIGN: Longitudinal, observational study of parent-physician interaction at early visits and over the course of 1 year. PARTICIPANTS: Parents (90% African American and 10% white mothers or female guardians) and their infant's assigned primary care physician (white first- and second-year pediatric residents). MAIN OUTCOME MEASURE: Parents' psychosocial information giving measured by the Roter Interaction Analysis System. RESULTS: Sex- and race-related barriers to disclosure of psychosocial information were evident early in the parent-physician relationship. At early visits, African American mothers made 26% fewer psychosocial statements than white mothers; this discrepancy was not affected by physician sex. At early visits, white mothers made twice as many psychosocial statements when seeing white female compared with white male physicians. CONCLUSIONS: Patient-centeredness is an important factor promoting psychosocial information giving for African American and white mothers, regardless of physician sex. Longitudinal relationships facilitate mothers' disclosure to physicians of a different ethnicity or sex, but only if physicians remain patient-centered.

Adolescent↗

PubMed2004

Impact of BRCA1/2 testing and disclosure of a positive test result on women affected and unaffected with breast or ovarian cancer.

To evaluate the impact of BRCA1/2 testing and disclosure of a positive test result on women affected and unaffected with cancer. Longitudinal cohort study including women affected and unaffected with breast or ovarian cancer testing for a BRCA1/2 mutation. Data on well-being (anxiety, depression, cancer related distress, general health), treatment choice, and decision making about cancer prevention were collected at baseline (1 week after blood sampling; affected n = 192, unaffected n = 176) and at follow-up (2 weeks after disclosure of a positive test result; affected n = 23, unaffected n = 66). Women affected and unaffected with breast or ovarian cancer were compared using univariate statistics. Change over time was examined using repeated measures analysis of variance. With respect to well-being, affected women scored worse at baseline. At follow-up, both affected and unaffected women experienced a decline in well-being, which tended to be stronger in affected women. Women diagnosed with cancer less than 1 year previously tended to report a worse well-being than those diagnosed longer ago. With respect to treatment choice, more affected women intended to obtain prophylactic surgery and valued it higher at both time points. With respect to decision making, affected women had a lower preference for participation in decision making at baseline; no differences were found at follow-up. At follow-up, both affected and unaffected women showed an increase in strength of treatment preference and a decrease in decision uncertainty. Disclosure of a positive test result had a negative impact on well-being. Affected women, especially those who have been recently diagnosed with cancer, experienced the worst well-being and could benefit from psychosocial support.

Adult↗

PubMed1999

Social reactions of Swedish and Turkish adolescents to a close friend's suicidal disclosure.

BACKGROUND: The prevalence of nonfatal suicidal behavior has been shown to be equal in Swedish and Turkish adolescents, but more Swedish than Turkish adolescents kill themselves. Social attitudes towards self-killing are liberal/permissive in Sweden compared to condemnatory/prohibiting attitudes in Turkey. Against this background, this study investigated Swedish and Turkish adolescents' reactions to a close friend's suicidal disclosure. It also compared students' beliefs about whether or not the suicidal friend needed treatment, and their perceptions of mental illness in, and prognosis for, the suicidal friend. METHOD: A questionnaire was used to assess adolescents' attitudes towards a hypothetical close friend who discloses his/her suicidal plan. RESULTS: Swedish students were more accepting of a suicidal friend, but were also more disapproving of a suicidal disclosure by a close friend, than their Turkish peers. Turkish students, on the other hand, were more emotionally involved with, and took more responsibility for, a suicidal close friend than their Swedish counterparts. CONCLUSIONS: Due to disapproving social attitudes towards suicidal disclosures in Sweden compared to Turkey, persons undergoing suicidal crises in Sweden may choose not to communicate their suicidal intent, and hence can not make use of social support systems to combat personal crises of a suicidal nature.

Adolescent↗

PubMed1983

Professional disclosure in the counseling profession: a review of the literature.

Professional disclosure is a vehicle by which clients can become informed about the services they may receive in a professional setting, including those in the allied health fields. This paper reviews the literature on professional disclosure from the viewpoints of shaping client expectations, promoting counselor accountability, and being ethically responsible. A written professional disclosure statement can be provided that satisfies these requirements.

Community Participation↗

PubMed2000

Disclosure of diagnosis and planning for the future in HIV-affected families in Europe.

Information relating to disclosure of infection status in families affected by HIV and the existence of plans for the future social care of children with infected parents was collected as part of a larger survey on clinical and psychosocial service use of these families. Parents and alternative carers of HIV-affected children in follow-up in 10 paediatric centres from seven European countries were surveyed. A total of 182 questionnaires were returned: most (73%) were completed by parents, of whom 92% were HIV-infected. Of the 226 children cared for by the respondents, most (62%) were HIV-infected. Disclosure of both the child's and the parent's infection status was rare and found to be associated with child's age in both cases. Infected children living with their parents were less likely to know their diagnosis than those living in alternative care. Uninfected parents and carers were significantly more likely to want professional help with disclosing to an infected child than infected parents. Infected parents also face difficult decisions regarding the issue of who will care for their children when they are unable to. Half of the infected parents had made long-term plans for their children's future social care. European parents were more likely to have made such plans than those from elsewhere (mainly Africa) and parents with plans had known about their HIV infection for significantly longer than those without. Increasing numbers of vertically infected children are reaching adolescence as a result of improvements in the management of paediatric HIV infection. As both disclosure and planning for the future social care of HIV-affected children have been found to be strongly associated with child's age, the changing epidemiology of paediatric HIV highlights the need for more information on these issues in order to support families more effectively.

Adolescent↗

PubMed1990

On patients' disclosure of parents' and siblings' names during treatment.

The patient's spontaneous disclosure of a parent's name is frequently associated with appearance of core conflicts, especially genetic and transference themes of incest, other oedipal derivatives, and separation anxiety. Using a parent's first name has the unconscious implication of incest, since one is doing something which one's other parent but not oneself is allowed to do. In some primitive cultures, saying aloud the names of one's parents was strictly forbidden. Disclosing a parent's name to the analyst may parallel the developmental step during childhood when the patient learned the parent had a first name. The child's acquisition of language, including proper names, fosters object constancy and the internalization of the parents, from whom language is learned. For patients who do not usually refer to a sibling by name, disclosure of the sibling's name may also reflect the concurrent emergence of central conflicts. In particular, such disclosure may accompany associations about an earlier closeness with the sibling giving way to subsequent estrangement. Naming the sibling may also mark an intensification of a sibling transference to the analyst.

Adult↗

PubMed2006

Effects of insightful disclosure within computer mediated support groups on women with breast cancer.

Written expression about emotionally traumatic events is associated with physical and mental health benefits, and this study examines how insightful disclosure within a computer-mediated support group for women with breast cancer affects breast cancer-related concerns, emotional well-being, and self-reported physical well-being. Using a word counting program that notes the percentage of words related to various linguistic dimensions, this research specifically examined the effects of insightful disclosure written within these groups. Surveys were administered just before group access and then 2 months and 5 months later. Insightful disclosure improved emotional well-being and reduced negative mood but did not influence breast cancer-related concerns or self-reported physical well-being. Despite the common and frequent use of computer-mediated social support (CMSS) groups for people coping with health concerns, very little research to date has quantitatively tested the effects of participating in CMSS groups, and this is among the first published studies to quantitatively link any specific activity within a CMSS group to any specific outcomes. Implications for improving psychosocial interventions for people with health concerns are discussed, and future research objectives are suggested.

Adult↗

PubMed1983

Privacy Act of 1974; proposed new routine uses--PHS. Notification of new routine uses permitting disclosure of information from four Privacy Act systems of records.

In accordance with the requirements of the Privacy Act, the Public Health Service (PHS) is publishing notice of a proposal to establish new routine uses permitting disclosure of information from four Privacy Act systems of records maintained by the National Institutes of Health (NIH): 09-25-0008, "Administration: Radiation Workers Monitoring, HHS/NIH/ORS"; 09-25-0010, "Research Resources: Registry of Individuals Potentially Exposed to Microbial Agents, HHS/NIH/NCI"; 09-25-0077, "Clinical Research: Biological Carcinogenesis Branch Human Specimen Program, HHS/NIH/NCI"; and 09-25-0099, "Clinical Research: Patient Medical Records, HHS/NIH/CC." The NIH Office of Research Services (ORS) is responsible for the first of these systems. The National Cancer Institute (NCI), a component of NIH, maintains the second and third systems of records. The NIH Clinical Center (CC) maintains the fourth system. The new routine uses will allow disclosure to contractors for routine records keeping and processing activities. These disclosures will be wholly compatible with the purposes of these systems, as discussed below.

Confidentiality↗

PubMed1984

Medicare program; acquisition, protection and disclosure of utilization and quality control peer review organization (PRO) information--HCFA. Proposed rule.

This proposal would govern the acquisition, protection and disclosure of information obtained or generated by Utilization and Quality Control Peer Review Organizations (PROs). The Peer Review Improvement Act of 1982 authorizes PROs to acquire information necessary to fulfill their duties and functions, places limits on the disclosure of PRO information, and establishes penalties for unauthorized disclosure. These regulations would implement the PROs' statutory right of access to necessary information and set forth their responsibilities to assure that information once acquired is adequately safeguarded, and used only for proper purposes.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1985

Medicare program; acquisition, protection, and disclosure of utilization and quality control peer review organization (PRO) information--HCFA. Final rule.

These regulations govern the acquisition, protection, and disclosure of information obtained or generated by Utilization and Quality Control Peer Review Organization (PROs). The Peer Review Improvement Act of 1982 authorizes PROs to acquire information necessary to fulfill their duties and functions, places limits on disclosure of PRO information, and establishes penalties for unauthorized disclosure. These regulations implement the PROs' statutory right of access to necessary information and set forth their responsibilities to assure that information once acquired is adequately safeguarded and disclosed only for proper purposes.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1999

[Disclosure of medical information after a patient's death: principles and recent developments in jurisprudence].

After a patient's death, the obligation of medical secrecy remains in force; the physician is still bound to confidentiality and when necessary should invoke his right to remain silent. However, it is generally accepted that circumstances can occur in which a doctor may disclose confidential information to third parties like the relatives Inspection of the medical file after the patient's death is subject to the following principles. Disclosure of medical data after a patient's death is--apart from the general exceptions on medical secrecy--justified when the wish of the deceased can be reconstructed, or (if this is impossible) if there are such important interests of third parties involved that the obligation to maintain confidentiality may be put aside. The relatives have no personal right of access to medical data of the deceased, and they cannot authorize disclosure of data to other parties (e.g. the attorney of the hospital). With regard to the ex-mentor it seems as if the traditional opinion on medical secrecy after a patient's death has been abandoned. In principle, the physician should inform this person, unless it can be proven that disclosure is in conflict with the wish of the deceased.

Confidentiality↗