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PubMed1993

Self-disclosure and coping styles in men with cardiovascular reactivity.

The purpose of this study was to investigate self-disclosure, emotion-focused, and problem-focused coping styles among men with borderline hypertension and two groups of normotensive men differentiated by parental hypertension. Because blood pressure reactivity may discriminate between hypertensive and normotensive men, subjects in these three groups were categorized as high or low cardiovascular reactors based on their blood pressure response to a mental arithmetic task. Self-disclosure and coping styles were investigated in relation to status effects within the doctor-patient relationship. Men with exaggerated blood pressure reactivity were less self-disclosive and used fewer emotion-focused coping strategies than men with no blood pressure reactivity. Normotensives with a history of parental hypertension were less self-disclosive than normotensives without a history of parental hypertension.

Adaptation, Psychological↗

PubMed2004

The role of disclosure patterns and unsupportive social interactions in the well-being of breast cancer patients.

The purpose of this study was to examine the nature and potential effects of disclosure patterns and unsupportive social interactions in breast cancer patients. Disclosure, the thoughts and feelings people communicate to others, and unsupportive social interactions, the upsetting or unsupportive responses people receive from others, have been infrequently studied in breast cancer patients. Sixty-six early stage breast cancer patients diagnosed less than one year completed a written questionnaire. Results indicated that the women reported confiding in family and friends more than in mental health workers. Fears of recurrence and worries about the effects of the illness on family members were the most important concerns, whereas concerns about body image were the least troublesome. Failure to disclose concerns was associated with low social support, high unsupportive social interactions, and low emotional well-being. Most of the unsupportive responses received from other people were either behaviors of minimizing or distancing. Unsupportive reactions were significantly associated with greater role limitations due to emotional problems and decreased social functioning. Implications for interventions and future research are discussed.

Adult↗

PubMed2005

Relationships among perceived diagnostic disclosure, health locus of control, and levels of hope in Taiwanese cancer patients.

OBJECTIVES: To explore relationships among perceived diagnostic disclosure, health locus of control, and levels of hope in Taiwanese cancer patients. RESEARCH DESIGN: A cross-sectional, descriptive correlational design was used in this study. One hundred and twenty-four (N=124) patients were recruited. The Background Information Form, the Multidimensional Health Locus of Control (MHLC) Scales, the Herth Hope Index (HHI), and patients' medical records were used. Data were analyzed using descriptive statistics, t-test, ANOVA, Chi-square, Pearson's correlation, and multiple regression. RESULTS: The major findings of this study are as follows: (1) overall, cancer patients had medium levels of hope; (2) patients who were aware of their own diagnosis reported significantly higher levels of hope than those who were not informed of their own diagnosis; (3) patients who were aware of their diagnosis tended to have higher levels of the internal locus of control than those who were not informed; (4) the internal health locus of control was significantly positively related to levels of hope; (5) the chance health locus of control was significantly negatively related to levels of hope. CONCLUSIONS: The results of this study provide important implications for Taiwanese clinicians concerning the practice of diagnostic disclosure of cancer to patients.

Adult↗

PubMed2005

Family centred decision making and non-disclosure of diagnosis in a South East Asian oncology practice.

AIM: To audit the extent of non-disclosure of cancer diagnosis (NDD) in South-East Asian patients referred to a Western trained oncologist, and determine the factors associated with this pattern of decision-making. METHODS: Over a 12-month period, all new patients referred to a single radiation oncologist's practice were prospectively audited at time of the initial consultation. Data obtained included patient demographic features, tumour details, proposed treatment and decision-making process. A shared decision-making consultation was attempted but if there was a persistent request by family to avoid disclosure, then a family-centred model was adopted. Patient autonomy was maintained by formally asking desire to participate in decision-making process, and subsequent permission then sought to involve family members as surrogates. Treatment aim, predicted median survival and NDD was recorded at end of consultation. Endpoints of patient NDD and non-discussion of prognosis were audited over a 12-month period, and factors potentially associated with these endpoints were assessed. RESULTS: Over a 12-month period 369 new patients were referred to the oncologist's practice. Forty per cent were >65 years, 84% Chinese race, and 66% non-English speaking. Lung (33%) and breast (32%) primaries were prominent. Forty-seven per cent were managed with palliative intent and 24% had expected median survivals of <6 months. NDD was recorded in 66 patients or 17% of the patient group. Quantitative discussion of prognosis was avoided in 36.8% of patients. On univariate analysis advanced patient age (p<0.001, OR=9.6, 95% CI 4.9-18.9), female sex (p=0.035, OR=1.8, 95% CI 1.04-3.1), non-English speaking (p<0.001, OR=21.4, 95% CI 5.1-89.1), palliative treatment aim (p<0.001, OR=5.9, 95% CI 3.1-11.2) and short expected median survival (p<0.001, OR=4.0, 95% CI 2.3-7.1) were associated with NDD. Advanced patient age (p<0.001, OR=7.9, 95% CI 3.6-17.5), female sex (p<0.001, OR=6.4, 95% CI 2.8-14.7), non-English speaking (p=0.010, OR=7.4, 95% CI 1.6-33.3) and palliative treatment aim (p=0.010, OR=3.3, 95% CI 1.3-8.0) remained significantly associated with NDD on multivariate logistic regression analysis. CONCLUSIONS: A high rate of desired NDD is evident in this Asian oncology population when a family-centred model to medical decision making is used. This data confirms that NDD and the model of decision making remains a significant ethical issue.

Age Distribution↗

PubMed1999

To know you is to trust you: parents' trust is rooted in child disclosure of information.

As adolescents spend increasing amounts of time away from home, parental trust should become important. Little is known about how trust develops, however. We propose that parental trust is primarily based on knowledge. In this study, we pitted three types of knowledge of the child against each other in the prediction of parental trust: knowledge of feelings and concerns; of past delinquency; and of daily activities. Results showed that knowledge of daily activities was more important than knowledge of past delinquency. In further analyses, knowledge of daily activities that came from the child's spontaneous disclosure was most closely linked to parental trust. These findings add support to a recent re-interpretation of parental "monitoring" as parental knowledge that mainly comes from spontaneous child disclosure. Additionally, the role of parental trust for dysfunctional family relations was examined and it was found that the relations between the child's delinquency and family dysfunction were mediated by parental trust. Finally, even though there was substantial agreement between parents and children about parental trust in the child, the individual's unique perspectives were important. Family dysfunction from the child's perspective was based on whether they believed that their parents trusted them, and parental perceptions of family dysfunction were based on their own trust in the child.

Adolescent↗

PubMed1991

Hypothetical contractarianism and the disclosure requirement problem in informed consent.

Two of the more deeply problematic issues surrounding the doctrine of informed consent are providing a justification for the practice of informed consent and providing an account of the nature and amount of information that must be disclosed in order for informed consent to take place. This paper is concerned with the latter problem, the problem of disclosure requirements, but it deals with this problem in a novel way; it approaches the problem by asking what fully informed and fully rational agents would agree to under certain hypothetical conditions. In general terms I juxtapose the hypothetical contractarianism found in Rawls' A Theory of Justice with that found in Gauthier's Morals By Agreement and ask what their respective hypothetical contractors would agree to with respect to choosing a particular standard of disclosure to govern the practice of informed consent. In more specific terms a contrast is made between what a Rawlsian agent behind a veil of ignorance would choose as compared to what, in Gauthier's terms, an ideal actor making an Archimedean choice would choose. The idea of an Archimedean point, and the subsequent choice made from that point, although technically identified by Rawls, originated with Archimedes of Syracuse.

Altruism↗

PubMed1998

Direct disclosure of bone density results to patients: effect on knowledge of osteoporosis risk and anxiety level.

If bone mineral density (BMD) screening is to achieve the aim of preventing the complications of osteoporosis, women with low BMD measurements must learn that they are at risk, and women at risk must know about and be willing to adopt and persist with measures that can prevent osteoporosis. In this paper we present the results of a randomized controlled trial designed to examine whether disclosing the results of a BMD scan directly to women, as well as through their general practitioners (GPs), improves their knowledge of their bone density results without adverse psychological sequelae. Direct disclosure resulted in 19% (59% vs 40%; 95% CI for difference in proportions: 9.8% to 27.8%) more women being aware of their BMD status at the spine and 22% (58% vs 36%; 95% CI for difference: 12.2% to 29.8%) at the hip. These differences were observed irrespective of risk status. There was no significant difference in anxiety levels between the randomized groups. We conclude, therefore, that direct disclosure of BMD results to women, as well as to their GPs, leads to increased knowledge of BMD status without increasing anxiety, and that BMD measurement services should consider informing women routinely of their results directly as well as through their GPs.

Anxiety↗

PubMed2006

Social support, disclosure, and use of antiretroviral therapy.

This paper investigates the association between social support, disclosure of HIV/AIDS, and odds of initiating combination antiretroviral drug therapy in its first years on the market. Data are drawn from the first three rounds of the Community Health Advisory and Information Network (CHAIN) survey, collected between 1994 and 1997. CHAIN documents service needs and rates of service utilization among a representative sample of persons with HIV/AIDS in New York City. A two-step logistic regression estimated associations between (1) perceived social support and use of combination antiretroviral therapy, and (2) the interaction between concealing HIV/AIDS and perceived social support. Results offered evidence that the positive association between social support and use of highly active antiretroviral treatment (HAART) and other combination antiretroviral therapies is contingent upon disclosure of HIV status within the household or among friend and acquaintance networks. A positive association between social support and odds of using combination therapy was only observed among those who disclosed their HIV status.

Adult↗

PubMed2006

Disclosure of HIV status and adherence to daily drug regimens among HIV-infected children in Uganda.

Pediatric adherence to daily drug regimens has not been widely assessed in Africa where majority of HIV infected children live. Using in-depth interviews of 42 HIV-infected children taking ART and/or cotrimoxazole prophylaxis, and 42 primary caregivers, at a comprehensive HIV/AIDS clinic in Uganda, we evaluated their adherence experiences for purposes of program improvement. Daily drug regimens provided by the pediatric clinic included cotrimoxazole prophylaxis as well as ART and cotrimoxazole combined. Complete disclosure of HIV status by caregivers to children and strong parental relationships were related to good adherence. Structural factors including poverty and stigma were barriers to adherence even for children who had had complete disclosure and a supportive relationship with a parent. To ensure adherence to life-extending medications, our findings underscore the need for providers to support caregivers to disclose, provide on-going support and maintain open communication with HIV-infected children taking cotrimoxazole prophylaxis and ART.

AIDS-Related Opportunistic Infections↗

PubMed1991

Improving disclosure of smoking by pregnant women.

Smoking is a major modifiable risk factor in pregnancy, and low-cost interventions have been developed and tested in diverse populations of pregnant smokers. Successful intervention depends on identification, however, and nondisclosure can be a problem. This randomized study compared rates of disclosure with two response formats--multiple choice, in which the patient is able to describe herself as having "cut down," and the usual history question, "Do you smoke?," in which she is forced to answer simply "yes" or "no". Each format was tested in both oral and written channels with a multiethnic adult prenatal population (n = 1078) entering care in a multispecialty group. Study results indicate that the multiple choice question improved disclosure, regardless of channel (oral versus written), by 40%. This effect was observed across racial and ethnic groups. Biochemical tests of urine samples from reported nonsmokers indicated smoking in only 3%. Eleven percent of the "nonsmokers" in the experimental groups refused consent for the urine test, however, and many of these were probably smokers.

Adolescent↗

PubMedDate not supplied

Network therapy using videotape disclosures for adult sexual abuse survivors.

Treatment of childhood sexual abuse survivors may be enhanced by a technique designed to generate a therapeutic constituency for the survivor around the disclosure of childhood abuse experiences. The need for validating relationships is hypothesized as a condition for successful treatment. The videotaped disclosure process proceeds in five stages: (1) Deciding to make a tape, (2) making a videotape following a semistructured interview format, (3) the patient viewing the tape, (4) showing the tape to potential therapeutic team members, and (5) possibly using the tape for a confrontation with the abuser. The technique has been used on 27 cases. Case histories are given to illustrate the procedure. Discussion includes potential mechanisms of action and issues in treatment that arise with the use of the method described.

Adolescent↗

PubMed1996

Secondary traumatization in parents following the disclosure of extrafamilial child sexual abuse: initial effects.

Disclosure or discovery of extrafamilial sexual abuse (ESA) has the potential to traumatize the entire family system. Little controlled research has examined the initial reactions of parents to this type of trauma. The present study evaluated the adjustment of 93 parents (63 mothers and 30 fathers) within 3 months of the disclosure of ESA. Parents' functioning was compared to that of a nonclinical comparison group of 136 parents (74 mothers, 62 fathers). Parent adjustment was assessed using self-report measures of psychological distress, parent competence, family functioning, marital functioning, life stressors, and environmental support. Results revealed that mothers of sexually abused children, in comparison to mothers of nonabused children, experienced greater overall emotional distress, poorer family functioning, and lower satisfaction in their parenting role. Fathers of sexually abused children also experienced greater overall emotional distress relative to comparison fathers but their level of distress remained below that of mothers. Standard and hierarchical multiple regressions on maternal self-reports revealed that mothers' satisfaction with their parenting role and their perceived level of environmental support predicted their emotional functioning. Abuse-related variables did not contribute to the prediction of emotional functioning. These results emphasize the need to expand our focus beyond the child victims to the traumatized families and to normalize the potential for all close family members to be vulnerable to experience adjustment difficulties following ESA.

Adaptation, Psychological↗

PubMedDate not supplied

The effects of alcohol, expectancy, and alcohol beliefs on anxiety and self-disclosure in women: do beliefs moderate alcohol effects?

This study investigates the effects of alcohol, expectancy, and alcohol-related beliefs on self-reported anxiety and self-disclosure behavior in a social interaction situation. Seventy-two female social drinkers were assigned to eight conditions in a 2 x 2 x 2 factorial balanced-placebo design, controlling for drink content, expectancy, and beliefs. Results show that alcohol expectancy resulted in an anxiety reduction in subjects who believed that alcohol has a positive influence on social behavior, whereas expectancy had no effect in subjects with negative alcohol beliefs. Furthermore, subjects who expected alcohol were less anxious when they had positive alcohol beliefs than when they had negative beliefs, whereas beliefs made no difference in subjects who expected tonic. Our results suggest that the effect of alcohol expectancy on social anxiety in women is moderated by differences in the content of their alcohol-related beliefs. We conclude that the inconsistency in previous results about the effect of alcohol expectancy on social behavior might be explained by differences in subjects' alcohol beliefs. Finally, as neither of the three factors had any effect on self-disclosure behavior, we suggest that this behavioral measure is unrelated to self-reported anxiety.

Adult↗

PubMed2007

Implementing emergency research requiring exception from informed consent, community consultation, and public disclosure.

Conducting emergency research in the out-of-hospital and emergency department setting is a challenge because of the inability of patients to provide informed consent in many situations. Federal guidelines allowing research under an exception from informed consent for emergency research have been established (21 CRF 50.24). Community consultation and public disclosure, 2 required components of obtaining this exception, are seen by many as a barrier to resuscitation research. This article will provide a brief overview of the history of the exception from informed consent for emergency research and summarize our methods recently used to successfully complete community consultation and public disclosure for a trial evaluating 2 devices used during cardiopulmonary resuscitation in a large metropolitan area.

Attitude to Health↗

PubMed2004

Adolescents who experienced sexual abuse: fears, needs and impediments to disclosure.

OBJECTIVE: Understanding the impediments that prevented sexually abused adolescents from disclosure to their family or to professionals, and analyzing the responses they received when they did disclose. METHODS: In depth anonymous interviews were conducted in Italy through a toll-free telephone line with 36 young people who experienced sexual abuse in adolescence. A qualitative analysis was carried out of the adolescents' feelings, fears and needs, and of the help received, if any. RESULTS: The main impediments to disclose to a family member were fear of not being believed, shame, and fear of causing trouble to the family. The main impediments for not seeking services were ignorance of the existence/functioning of protective agencies, wish to keep the secret, lack of awareness of being abused, mistrust of adults and professionals, and fear of the consequences of disclosure. When they did disclose to professionals, the teens received very limited support. CONCLUSION: Adolescents need to receive proper information about the risk of being sexually abused and about the help they can receive from their social network and protective agencies. There is a crucial need for appropriate training of professionals.

Adolescent↗

PubMed2005

Child peer sexual abuse: preliminary data on outcomes and disclosure experiences.

OBJECTIVE: This study compared experiences of children sexually abused by peers to those of children abused by adolescents/adults. Variables examined included perceived negativity of the abuse, self-reported outcomes, overall psychological functioning, and disclosure. METHOD: An archival data set containing retrospective reports of childhood sexual experiences was culled for instances of sexual abuse by child peers and adolescents/adults. An equivalent nonabused comparison group was identified. The Self-Report Outcome Checklist (SROC; Gilbert, 1994b), the MMPI-Hugo Short Form (Hugo, 1971) and a disclosure survey were also retrieved from these data. RESULTS: Compared to abuse by peers, abuse perpetrated by adolescents/adults was more intrusive and intrafamilial. Both groups rated their experiences as equally negative, and reported equally pervasive outcomes. Those abused by adolescents/adults reported significantly higher scores on the Psychopathic Deviate, Psychasthenia, and Schizophrenia scales compared to nonabused controls; similar findings did not emerge for those abused by child peers. Less than a fourth in either abuse group reported disclosing their experience to a parent. Among those who did not disclose, participants abused by child peers anticipated less support from both parents and more anger from their mothers. CONCLUSIONS: The findings suggest that child peer sexual abuse may be associated with adverse outcomes.

Adolescent↗

PubMedDate not supplied

Disclosure of CAM use to medical practitioners: a review of qualitative and quantitative studies.

BACKGROUND: Many people use complementary or alternative medicine (CAM). It is estimated that over 50% of patients that require health care use CAM either in conjunction with, or separate from, conventional health care. Despite the popular use of CAM, patients do not always inform their conventional medicine health carers of their CAM use. The medical practitioner is in most cases the first health care professional a person contacts concerning a health care matter, and needs to have a full history of a health problem to understand and provide optimum care. This literature review aims to provide an understanding of the degree to which patients disclose their use of CAM to their medical practitioners, and their reasons for not doing so. METHOD: A comprehensive literature search identified 12 studies published between 1993 and 2002 that examined what percentage of consumers did not disclose to their medical practitioners their use of CAM, and their reasons for not doing so. RESULTS: The rate of non-disclosure of those using CAM is as high as 77% in some studies. The main reasons patients provided for not disclosing their use of CAM to their medical practitioners were concerns about a negative response by the practitioners, the belief that the practitioner did not need to know about their CAM use, and the fact that the practitioner did not ask. DISCUSSION: The pre-conceptions patients have that influence their non-disclosure may be based on three issues. First, beliefs and concerns that influence their decision-making, second personal experiences in their consultations with medical practitioners, and third, the desire for more control over their health care. Medical practitioners need to acknowledge the concerns and beliefs of patients in making their health care decisions, and work with patients so that the use of CAM is acknowledged and the patients' needs, beliefs and concerns respected.

Attitude of Health Personnel↗

PubMed2004

Disclosure decisions among known and anonymous oocyte donation recipients.

OBJECTIVE: The purpose of this study was to compare anonymous and known donor mothers' demographics, knowledge about the donor, and disclosure attitudes. DESIGN: Cross-sectional survey of oocyte donation parents. SETTING: Academic medical centers. PATIENT(S): Women having a child through oocyte donation in the past 12 years. INTERVENTION(S): Subjects completed a survey regarding their oocyte donation experience. MAIN OUTCOME MEASURE(S): Donor characteristics and disclosure behavior. RESULT(S): Questionnaires were sent to 524 individuals (262 couples); 157 (92 women and 65 men) were returned yielding a response rate of 31.4% (157/500). The average age of the women was 44.7 years and the average age of the child was 2.89 years. Seventy women used anonymous donors and 20 women used known donors. Significantly more known recipients knew their donors' religion, number of children, hobbies, profession, and photograph. Eighty percent of both groups told others about using a donor to conceive. Regarding telling the child, there were also no significant differences with approximately 10% who have told, 49% plan to tell, 31% are not telling, and 10% are unsure. CONCLUSION(S): Contrary to conventional wisdom we found no differences in plans to inform the child based on the use of a known or an anonymous donor.

Adult↗