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PubMedDate not supplied

Small numbers, disclosure risk, security, and reliability issues in Web-based data query systems.

This article describes the process for developing consensus guidelines and tools for releasing public health data via the Web and highlights approaches leading agencies have taken to balance disclosure risk with public dissemination of reliable health statistics. An agency's choice of statistical methods for improving the reliability of released data for Web-based query systems is based upon a number of factors, including query system design (dynamic analysis vs preaggregated data and tables), population size, cell size, data use, and how data will be supplied to users. The article also describes those efforts that are necessary to reduce the risk of disclosure of an individual's protected health information.

Adolescent↗

PubMed2005

Effects of a peer-led behavioral intervention to reduce HIV transmission and promote serostatus disclosure among HIV-seropositive gay and bisexual men.

OBJECTIVES: To evaluate the effects of an enhanced peer-led intervention on transmission risk behavior and serostatus disclosure of HIV-seropositive gay and bisexual men. DESIGN: A randomized intervention trial. METHODS: HIV-seropositive gay and bisexual men were recruited from New York City and San Francisco and were randomly assigned to either a standard or an enhanced intervention. The standard intervention consisted of one session that provided safer sex information. The enhanced intervention consisted of six sessions and included safer sex information, interactive learning activities, and discussion groups that were facilitated by HIV-seropositive peers. Participants completed audio computer-assisted self interview (A-CASI) assessments at baseline and 3 and 6-month follow-ups. Optional testing for sexually transmitted infections was offered at baseline and the 6-month follow-up. RESULTS: A total of 811 participants met the inclusion criteria for outcome analyses. Of these, 85 and 90% were retained for the 3 and 6-month follow-ups, respectively. Compared with the standard intervention, fewer men assigned to the enhanced intervention reported unprotected receptive anal intercourse with a negative or unknown-serostatus partner at 3 months (21 versus 26%, P < 0.05). However, there were no other significant differences in transmission risk or serostatus disclosure at 3 or 6 months. CONCLUSION: The enhanced intervention was associated with only a limited reduction in transmission risk at 3 months relative to the standard intervention. The characteristics of the intervention that may have reduced its efficacy are identified and directions for future research are suggested.

Adult↗

PubMed2005

Disclosure of diagnostic errors: the death knell of retrospective pathology reviews?

Full disclosure of medical errors to patients is now widely seen as an essential component of error management, although its update into daily clinical practice is variable. Laboratory diagnostic errors are discovered in retrospective reviews of previous surgical and cytopathology cases. This quality assurance practice is a valuable tool of practice audit and change for both cytotechnologists and pathologists. Presently, these diagnostic errors are only reported to the clinician and patient if the new finding affects current patient management. Mandatory full disclosure of all diagnostic errors discovered in the retrospective review process would have a significant adverse impact on cytotechnologists, pathologists, the laboratory, the clinic, the institution, and insurers. Retrospective pathology review would become so burdensome that its survival would be in jeopardy-unless measures are undertaken to ameliorate the anticipated adverse consequences.

Diagnostic Errors↗

PubMedDate not supplied

Effects of naltrexone on repressive coping and disclosure of emotional material: a test of the opioid-peptide hypothesis of repression and hypertension.

OBJECTIVE: The present study was designed to assess the role of endogenous opioids in the relationship of hypertension to repressive coping. METHODS: Ten hypertensive and 8 normotensive males were given either the opioid antagonist naltrexone or placebo in a randomized, double-blind fashion over the course of four laboratory sessions. Measures of repression and disclosure were completed and blood pressure was assessed during a laboratory stressor protocol. RESULTS: Opioid antagonism reduced repression and increased disclosure only in the hypertensive group. Also, opioid antagonism increased stress-related systolic blood pressure only in the hypertensive group. CONCLUSION: The results support the hypothesis that endogenous opioid dysregulation underlies both hypertension and repressive phenomena.

Adaptation, Psychological↗

PubMed2004

Maternal distress, child behaviour, and disclosure of psychosocial concerns to a paediatrician.

BACKGROUND: Despite the availability of effective screening measures, primary care providers continue to fail to identify and manage many children with psychosocial problems. One of the best predictors of identification by a primary care physician is whether mothers disclose concerns about their child's psychosocial functioning to their child's physician. This study examined if maternal distress and child behaviour predicted whether mothers had and discussed concerns about their child's behaviour and emotions with paediatricians. METHODS: Participants were 138 mothers who accompanied their 4-12-year-old children to a health supervision visit at an urban teaching hospital. Mothers completed a demographic questionnaire, the Pediatric Symptom Checklist, the Beck Depression Inventory, and an exit questionnaire. Results Logistic regression correctly classified 97.3% of mothers who did not disclose child problems. Only 34.5% of mothers who did disclose were correctly classified. CONCLUSIONS: The results supported the hypothesis that mothers' psychosocial functioning is significantly related to concern about child behaviour and disclosure of concerns to the paediatrician. The inability of child behaviour and maternal functioning to predict which mothers were concerned and disclosed concerns supports the hypothesis that disclosure and identification of psychosocial problems in primary care is complex and requires a multifactor model.

Adult↗

PubMed2005

Patterns and barriers in information disclosure between health care professionals and relatives with cancer patients in Greek society.

The issue of whether, how and how much to tell cancer patients concerning diagnosis is still approached in various ways across different countries and cultures. The health care team-patient relationship is a triangle consisting of the health care professionals, the patient and the family. Each part supports the other two and is affected by the changes that happen in the triangle. The objective of the study was to investigate the communication context through which health care professionals and families with cancer patients interact. In Greece, physicians have the tendency to tell the truth more often today than in the past, although the majority still disclose the truth to the next of kin. Nurses in Greece are considered to be the most suitable health care professionals for the patients to share their thoughts and feelings with. Nevertheless, the decision on information disclosure lies with the treating physician. In Greek society the patient's family plays an important role in the provision of care and information disclosure. They often decide on the patient's behalf.

Attitude of Health Personnel↗

PubMed1998

Hospital consent for disclosure of medical records.

Disclosure of information clauses in general consent-to-treatment forms used by 202 large hospitals nationwide are described and mapped into a taxonomy to distinguish types of disclosures and to help structure consent documents.

Biomedical Research↗

PubMed1989

Self-disclosure in a clinical context by Asian and British psychiatric out-patients.

A study is described in which self-reported self-disclosure levels of Asian and British out-patients to psychiatrists are examined as a function of racial and gender match to psychiatrist. Analysis of self-disclosure scores for 77 subjects revealed no overall differences between Asian and British subjects, or between men and women. Asian subjects, however, reported being prepared to disclose significantly more to a psychiatrist of the same sex as themselves, regardless of race; no such effect was found for British subjects. British women reported being prepared to reveal significantly more to a psychiatrist of the same race as themselves; this effect was not observed in any of the other three subgroups. Implications of these findings for clinical practice are discussed.

Adult↗

PubMed1999

Family consent, communication, and advance directives for cancer disclosure: a Japanese case and discussion.

The dilemma of whether and how to disclose a diagnosis of cancer or of any other terminal illness continues to be a subject of worldwide interest. We present the case of a 62-year-old Japanese woman afflicted with advanced gall bladder cancer who had previously expressed a preference not to be told a diagnosis of cancer. The treating physician revealed the diagnosis to the family first, and then told the patient: "You don't have any cancer yet, but if we don't treat you, it will progress to a cancer". In our analysis, we examine the role of family consent, communication patterns (including ambiguous disclosure), and advance directives for cancer disclosure in Japan. Finally, we explore the implications for Edmund Pellegrino's proposal of "something close to autonomy" as a universal good.

Advance Directives↗

PubMed2006

Sexual behaviour, condom use, and disclosure of HIV status in HIV infected heterosexual individuals attending an inner London HIV clinic.

BACKGROUND: The National Strategy for Sexual Health and HIV for England (2001) emphasised the role of HIV services in reducing secondary transmission of HIV through prevention work with HIV infected people. OBJECTIVE: To determine the sexual behaviour, condom use, and disclosure of HIV status of HIV infected heterosexuals attending an inner London HIV clinic. DESIGN: Cross sectional questionnaire study of heterosexual HIV infected individuals attending an HIV outpatient clinic. METHODS: We collected demographic data for all respondents and sexual behaviour data for those sexually active over the past year using a self administered questionnaire. Viral load and CD4 count for responders and age, sex, ethnicity, viral load, and CD4 count for non-responders were obtained from the clinic database. RESULTS: The response rate was 47.3% (n = 142). 100 participants reported being sexually active in the past year, of whom 73% used condoms when they last had vaginal sex. Knowledge of partner's HIV status was the only variable significantly associated with the participant disclosing their HIV status to their partner (p<0.001). In those who had disclosed their status, only knowledge of partner's HIV status was significantly associated with condom use (p = 0.03). CONCLUSIONS: Issues relating to non-disclosure and partner notification in HIV infected heterosexuals will need to be better understood to improve sexual health in this group and to reduce onward transmission of HIV.

Adolescent↗

PubMed2006

Disclosure of HIV status to sex partners and sexual risk behaviours among HIV-positive men and women, Cape Town, South Africa.

BACKGROUND: The HIV epidemic continues to amplify in southern Africa and there is a growing need for HIV prevention interventions among people who have tested HIV positive. METHODS: Anonymous surveys were completed by 413 HIV-positive men and 641 HIV-positive women sampled from HIV/AIDS services; 73% were <35 years old, 70% Black African, 70% unemployed, 75% unmarried, and 50% taking antiretroviral treatment. RESULTS: Among the 903 (85%) participants who were currently sexually active, 378 (42%) had sex with a person to whom they had not disclosed their HIV status in the previous 3 months. Participants who had not disclosed their HIV status to their sex partners were considerably more likely to have multiple partners, HIV-negative partners, partners of unknown HIV status and unprotected intercourse with non-concordant sex partners. Not disclosing their HIV status to partners was also associated with having lost a job or a place to stay because of being HIV positive and feeling less able to disclose to partners. CONCLUSIONS: HIV-related stigma and discrimination are associated with not disclosing HIV status to sex partners, and non-disclosure is closely associated with HIV transmission risk behaviours. Interventions are needed in South Africa to reduce the AIDS stigma and discrimination and to assist people with HIV to make effective decisions on disclosure.

Adult↗

PubMed1979

Self-disclosure in therapy: marriage of the therapist.

The author presents how his interest on the general subject of self-disclosures in therapy evolved. Literature on this subject is reviewed with particular attention to intercurrent events in the therapist's life that may affect ongoing psychotherapy. Six clinical vignettes of psychotherapy cases illustrate varying reactions. The effects that planned disclosure of an intercurrent event (his marriage) had on this process are discussed.

Adult↗

PubMed2005

Self-disclosure in psychotherapy.

This paper examines the ramifications of a psychotherapist's self-disclosure stimulated by the film Gloomy Sunday (Barkow, N., 1988, Universal Pictures, 1999). It describes the five-year psychoanalysis of a depressed surgeon who made serious medical errors while treating family members. Analysis provided considerable symptom relief, but decades later the patient again became depressed. His depression was precipitated by his having made a major medical error while treating a family member, his daughter, which had an almost fatal result. The surgeon then resumed psychotherapy two times a week for three years. Cultural and professional similarities between psychiatrist and patient cemented the therapeutic alliance, but the patient's medical errors when treating his family members persisted. The psychotherapist's self-disclosure stimulated by the viewing of the film became a fulcrum for renewed investigation of the patient's childhood unconscious contributions to his psychopathology. It also stimulated self-analysis regarding counter-transference issues in the therapist which was related to his own perceptions of Nazis. The resumed treatment ameliorated the patient's tendency to make medical errors. The description of both treatments is intended to deepen the understanding of a "boundary crossing" intervention that assisted psychotherapeutic progress, and to contribute to further consideration of its benefits and risks.

Depression↗

PubMedDate not supplied

Impact of diabetes disclosure on perceptions of eating and self-care behaviors.

PURPOSE: This study investigated whether disclosure of diabetes and gender influenced perceptions of eating and self-care behaviors. METHODS: A vignette was developed in which a hypothetical friend engaged in diabetes self-care behaviors during a meal. Respondents (231 young adults) read vignettes that varied according to a 2 x 2 design (male vs female, preventative disclosure vs nondisclosure of diabetes). Participants answered 12 questions, which resulted in 2 factors: concern for friend and encourage professional help. RESULTS: Significantly higher scores resulted on the concern for friend and encourage professional help factors when diabetes was not disclosed. Female characters also received significantly higher scores on the concern for friend factor. CONCLUSIONS: Individuals with diabetes who choose to disclose their illness may prevent negative or incorrect perceptions related to self-care and eating behaviors, and may have a decreased likelihood that a true eating disorder would be identified by others.

Adolescent↗

PubMedDate not supplied

The dilemma of truth disclosure: Stoke-on-Trent, England.

Two case studies are used to demonstrate the continuing dilemma experienced by some doctors in the United Kingdom--whether or not to disclose to cancer patients their diagnosis. The two schools of thought concerning truth disclosure are discussed, together with the ethical implications and differences in views as a result of culture. Truth disclosure and associated communications skills are seen as an important area of medical education.

Adult↗

PubMed2004

Disclosure, reactions, and social support: findings from a sample of adult victims of child sexual abuse.

Information about abuse characteristics, disclosure, and current social support was collected through semistructured interviews and questionnaires from 122 adult women reporting exposure to child sexual abuse by someone close. Women who used an active disclosure strategy in childhood reported more physical and violent abuse. Moreover, women who reported more severe abuse had more often received negative reactions from the social network. Furthermore, a relation was found between current social support and positive-but not negative-reactions.

Adult↗

PubMed2005

Disclosure of child abuse in conflict areas.

Analyzing legal policies requires an in-depth understanding of the sociopolitical contexts within which sexual abuse is disclosed. Data presented in this study are based on a larger study of 628 Palestinian Israeli girls aged 14 to 16 years. Of these 628 girls, 28 victims of sexual abuse discussed their abuse with the research team. In addition, interviews were conducted with professional helpers. The contextual analyses of the interviews focused on the way young girls perceived disclosure, social support, and legal intervention to their abuse. Data revealed that the girls' attitudes not only conformed to general findings on disclosure of sexual abuse but also reflected sociopolitical fears and stressors. Helpers struggled between their beliefs that they should abide by the state's formal legal policies and their consideration of the victim's context. The study reveals how decontextualizing child protection laws and policies can keep sexually abused girls from seeking help.

Adolescent↗

PubMed2001

Hepatitis B virus infected physicians and disclosure of transmission risks to patients: a critical analysis.

BACKGROUND: The potential for transmission of blood-borne pathogens such as hepatitis B virus from infected healthcare workers to patients is an important and difficult issue facing healthcare policymakers internationally. Law and policy on the subject is still in its infancy, and subject to a great degree of uncertainty and controversy. Policymakers have made few recommendations regarding the specifics of practice restriction for health care workers who are hepatitis B seropositive. Generally, they have deferred this work to vaguely defined "expert panels" which will have the power to dictate the conditions under which infected health care workers may continue to practice. DISCUSSION: In this paper we use recent Canadian policy statements as a critical departure point to propose more specific recommendations regarding disclosure of transmission risks in a way that minimizes practice restriction of hepatitis B seropositive health care workers without compromising patient safety. The range of arguments proposed in the literature are critically examined from the perspective of ethical analysis. SUMMARY: A process for considering the ethical implications of the disclosure of the sero-status of health care workers is advanced that considers the varied perspectives of different stakeholders.

Canada↗