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PubMed2001

Diagnosis disclosure in a Portuguese oncological centre.

The disclosure of a diagnosis of cancer to patients is a controversial matter. There have been major differences in practice concerning this issue through time and between cultures. A questionnaire was sent to the doctors of the Oporto Centre of the Portuguese Institute of Oncology in order to assess their attitudes. We received 45 responses (40%) from the 113 questionnaires sent. Of these, 32 (71%) said that they disclose the diagnosis as a general policy or at the patients' request, and 13 (29%) disclose it rarely or not at all. The most frequent reason indicated by these 13 physicians was that the disclosure might damage the patients psychologically. Forty-four (98%) doctors inform the family of the diagnosis. Thirty-nine (87%) think that patients are satisfied with the information provided. This study was carried out in one oncological centre only, so it is inappropriate to conclude that this is what happens throughout Portugal. As far as we know, this is the first study in Portugal addressing this area of practice. This subject is a very important topic of research both in Portugal and in other countries, as many published recommendations are not research based.

Attitude of Health Personnel↗

PubMed2004

The attitudes of cancer patients and their families toward the disclosure of terminal illness.

PURPOSE: To ascertain the attitude of cancer patients and their families toward disclosure of terminal illness to the patient. PATIENTS AND METHODS: We constructed a questionnaire that included demographic and clinical information and delivered it to 758 consecutive individuals (433 cancer patients and 325 families that have a relative with cancer) at seven university hospitals and one national cancer center in Korea. RESULTS: 380 cancer patients and one member from each of 281 families that have a relative with cancer completed the questionnaire. Cancer patients were more likely than family members to believe that patients should be informed of the terminal illness (96.1% v 76.9%; P <.001). Fifty percent of the family members and 78.3% of the patients thought that the doctor in charge should be the one who informs the patient. Additionally, 71.7% of the patients and 43.6% of the family members thought that patients should be informed immediately after the diagnosis. Stepwise multiple logistic regression indicated that the patient group was more likely than the family group to want the patient to be informed of the terminal illness (odds ratio [OR], 9.76; 95% CI, 4.31 to 22.14), by the doctor (OR, 4.00; 95% CI, 2.61 to 6.11), and immediately after the diagnosis (OR, 3.64; 95% CI, 2.45 to 5.41). CONCLUSION: Our findings indicated that most cancer patients want to be informed if their illness is terminal, and physicians should realize that the patient and the family unit may differ in their attitude toward such a disclosure. Our results also reflect the importance of how information is given to the patient.

Adult↗

PubMed2006

Native Hawaiian preferences for informed consent and disclosure of results from genetic research.

BACKGROUND: Informed consent is generally waived when using anonymous stored specimens in research because individual harm is minimal; however, group harm may arise if specimens contain ethnic identifiers. METHODS: We assessed preferences for informed consent and disclosure of results from genetic research through a survey (N = 429, 83.2% Native Hawaiian). RESULTS: Native Hawaiians were more likely than non-Hawaiians to require informed consent for genetic research using personally identified (81% vs 77.8%), anonymous (40.9% vs 34.7%), and ethnically identified specimens (51.3% vs 33.3%). Most respondents wanted results reported to them (87.6%) and to their physicians (79.0%). CONCLUSIONS: Recognizing community preferences for informed consent and disclosure of research results may alleviate concerns about group harms inherent in genetic research.

Adolescent↗

PubMedDate not supplied

Therapist self-disclosure in behavioural psychotherapy.

Therapist self-disclosure has been poorly defined until recently. This article presents a model of verbal self-disclosure and relates it to both client-centred therapy and counselling as social influence. The implications for behavioural psychotherapy are then reviewed.

Behavior Therapy↗

PubMed2001

Incest and women of color: a study of experiences and disclosure.

Clinical literature on incest trauma assumes a homogeneity of experience of all incest survivors including women of color. Experiences relating to community, culture, and family need to be acknowledged as salient aspects of the experiences of women of color who are also incest survivors. Twelve participants were interviewed regarding their experiences related to disclosure and coping. Participants described value systems, community mindedness, social attitudes, negative consequences amongst other social and cultural issues as factors affecting incest disclosure. Participants described cognitive reframing, determination and separation from the perpetrator as ways of coping with incest.

Adult↗

PubMed2004

To tell or not to tell? Professional and lay perspectives on the disclosure of personal health information in community-based dementia care.

Developments in information technology and the ongoing restructuring of health services to increase provision in community settings militate in favour of a streamlining of communications and the exchange of information about patients among health and social care providers. Yet the principles of confidentiality and privacy appear to inhibit this process. In order to explore the practical, ethical, and legal imperatives attendant upon personal health information exchange, we conducted a series of interviews with professional care providers, persons with early-stage dementia, and their family caregivers. The findings indicate some degree of discordance. Professionals reported valuing disclosure both to colleagues and family caregivers on the basis of its being in the patients' best interests. Patients also valued inter-professional exchange, but sought strong control over disclosure to family members. Family caregivers valued being kept informed of the patient's condition, even without the latter's consent. Implications for research and policy are discussed.

Aged↗

PubMedDate not supplied

Improving quality through public disclosure of performance information.

Despite a growing consensus that serious quality problems afflict U.S. health care, state and federal governments have done little to improve the quality of care. Proposed health insurance reforms, including a Medicare prescription drug benefit and the use of tax credits for insurance expansion, could create a mechanism for stimulating and then monitoring improvements in quality. We propose legislative requirements that any new expenditure of federal funds for health benefits be accompanied by public disclosure of performance information regarding quality, effectiveness, and safety. Such disclosure could yield diverse public and institutional benefits.

Attitude to Health↗

PubMed2002

The triadic intersubjective matrix in supervision: the use of disclosure to work through painful affects.

The use of the psychoanalyst's subjective reactions as a tool to better understand his/her patient has been a central feature of clinical thinking in recent decades. While there has been much discussion and debate about the analyst's use of countertransference in individual psychoanalysis, including possible disclosure of his/her feelings to the patient, the literature on supervision has been slower to consider such matters. The attention to parallel processes in supervision has been helpful in appreciating the impact of affects arising in either the analyst/patient or the supervisor/analyst dyads upon the analytic treatment and its supervision. This contribution addresses the ways in which overlapping aspects of the personalities of the supervisor, analyst and patient may intersect and create resistances in the treatment. That three-way intersection, described here as the triadic intersubjective matrix, is considered inevitable in all supervised treatments. A clinical example from the termination phase of a supervised analysis of an adolescent is offered to illustrate these points. Finally, the question of self-disclosure as an aspect of the supervisory alliance is also discussed.

Adolescent↗

PubMed2005

Serostatus disclosure, seroconcordance, partner relationship, and unprotected anal intercourse among HIV-positive Latino men who have sex with men.

This article examined, in a sample of 219 HIV-positive Latino men who have sex with men (MSM), a set of three variables that can shape the context of sexual encounters between men and influence sexual risk behaviors: disclosure of positive HIV serostatus, seroconcordance of partners, and relationship between partners. Participants from Boston, New York, and Washington completed a survey in English or Spanish using computer-assisted self-interview technology with audio enhancement. At the bivariate level, disclosure, seroconcordance, and partner relationship were all interrelated, as well as associated with the likelihood of unprotected intercourse. Unprotected anal intercourse with the most recent partner was more likely when the partner (a) knew that the participant was HIV-positive, (b) was the participant's main partner, and (c) was himself also HIV-positive. A logistic set regression revealed that the set of three variables added significantly to the prediction of unprotected anal intercourse, beyond demographic variables of income, education, and age. In the multivariate model, however, of the three, only seroconcordance achieved significance. The importance of a contextual approach to understanding sexual risk behavior was discussed.

Adult↗

PubMed1991

Self-disclosure of HIV infection to sexual partners.

Self-disclosure of HIV infection to current sexual partners was examined in 138 seropositive men, mostly lower income Hispanics, from Los Angeles. Forty-five percent had been sexually active since learning their serostatus. Of these, 52% had kept their infection secret from one or more partners. The likelihood of disclosure decreased in direct proportion to the number of partners. Nondisclosure occurred in conjunction with unprotected receptive and insertive anal intercourse. Potential factors promoting nondisclosure are discussed.

HIV Seropositivity↗

PubMed1977

Effects of physical and phenomenological distance on self-disclosure.

This study was designed to investigate the effects of physical and phenomenological distance on self-disclosure. Two physical distances, culturally appropriate and culturally inappropriate, and three degrees of phenomenological closeness were selected. Differences in physical and phenomenological distances had significant effects upon the subjects' (n = 60) durations of self-disclosure. Subjects' feelings toward the experimenter and experiment were affected by differences in physical distance. No significant interactions between physical and phenomenological distance were evident.

Humans↗

PubMed1988

Sex and age/grade differences in adolescents' self-disclosure.

Few significant differences in self-disclosure were noted for 202 adolescents in Grades 8 and 12. Reliability and validity were reasonable but varied over 6 categories of disclosure. Both boys and girls disclosed more to target females and less to fathers. Findings agree with prior literature.

Adolescent↗

PubMed1989

Effects of therapist's self-disclosure and a physical barrier on subjects' perceptions of the therapist: an analogue study.

This analogue study was designed to assess the effects of a therapist's self-disclosure and a physical barrier between therapist and client on subjects' perceptions of the therapist. College students viewed one of four videotaped therapy interactions during which an actor, playing the role of a therapist, did or did not disclose, and where a barrier was or was not present. Students rated the mock therapist on expertness, trustworthiness, and attractiveness. Analysis showed that students rated him higher on trustworthiness and attractiveness when he disclosed than when he did not disclose. Moreover, the mock therapist's disclosure had more effect on students' ratings when a barrier was present than when no barrier was present.

Adult↗

PubMed1990

Interpersonal trust, self-disclosure and control in adult children of alcoholics.

Personality differences between 39 adult children of alcoholics and 28 control subjects were evaluated using measures of self-disclosure, trust, and control. The former group had higher need for interpersonal control, but no differences between groups were found on trust or self-disclosure. Sex of the alcoholic parent was related to personality functioning. Subjects with alcoholic fathers had higher scores on the control measure, while subjects with alcoholic mothers had lower trust scores. For adult children of alcoholics small but significant correlations were found between distress associated with parental alcoholism and trust (lower) and reported involvement with alcohol (higher). These results provide some support for the hypothesis that the effects of parental alcoholism persist into early adulthood. The differences documented were modest and did not suggest dysfunction in the sample of adult children of alcoholics.

Adult↗

PubMed1991

Effects of self-awareness on self-disclosure.

This study assessed the effects of self-awareness enhanced by a mirror on self-disclosure when another person was present. Subjects disclosed more intimately when looking into a mirror than when no mirror was present. Moreover, 40 men disclosed longer than 40 women, women had a higher rate of self-referenced thought units than men, and questions of medium intimacy elicited more intimate disclosures than questions of low intimacy.

Adult↗

PubMed2003

Perspectives of people with psychiatric disabilities on employment disclosure.

The Americans with Disabilities Act (ADA) of 1990 protects people with disabilities from employment discrimination. Under the ADA, employers must accommodate the known disabilities of a qualified employee or applicant. For persons with psychiatric disabilities, which are often invisible, the individual is required to make a conscious decision regarding disclosing their disability to an employer. The decision to disclose is very complex because the person needs to consider the possibility of confronting stigma and negative stereotypes. A qualitative study including a focus group and individual interviews was conducted to gather data from people with psychiatric disabilities/labels regarding employment disclosure. Major findings include the significant impact of disability identity (does the participant think they have a disability), and the importance of appropriate job matching as a disclosure strategy.

Adult↗

PubMed2005

Disclosure of natural product use to primary care physicians: a cross-sectional survey of naturopathic clinic attendees.

OBJECTIVE: To determine factors that predict disclosure of natural product use by patients to their primary care physicians. METHODS: An 18-item survey about health care use and communication was distributed to patients who presented to the Canadian College of Naturopathic Medicine in March 2003. We examined correlations between responses and created a multivariable logistic regression model to explore which factors were associated with patients' discussion of natural product use with their primary care physicians. RESULTS: The survey was given to 198 patients, 174 of whom responded (response rate, 87.9%). Most respondents (161 [92.5%] of 174) made use of natural products, and many (61 [41.5%] of 147) reported that they did not discuss natural product use with their primary care physician. The most significant factor predictive of patients having discussed natural product use with their primary care physician was having their primary care physician ask about natural product use (odds ratio, 18.77; 95% confidence interval, 5.06-69.62). Most respondents (107 [69.9%] of 153) indicated that their primary care physician did not ask about natural product use. CONCLUSIONS: An important number of patients who visit a naturopathic clinic do not disclose natural product use to their primary care physicians. Our findings suggest that disclosure rates could be improved by physicians taking a more active role in asking their patients about natural product use.

Adolescent↗

PubMed1989

[The relation of person's motives for self-disclosure and the congruency of personality judgment by discloser and recipient].

This study examined the relationship of a person's motives for self-disclosure and degree of self-disclosure to the congruency of personality judgment by the discloser and recipient. The subjects used were 76 pairs of close friends, members in each pair being of the same sex. Personality judgments of disclosers were executed by the disclosers themselves as well as the recipients; and disclosers were also asked to fill out (SMI) and (JSDQ). Results demonstrated that (JSDQ) had no relation to the congruency of personality judgments, but the motives had. In particular, persons who were apt to disclose based on mostly the emotional motive had the minimum congruencies on their personality judgment by disclosers and recipients.

Adult↗