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PubMed1997

The psychological impact of withholding disclosure of child sexual abuse.

Researchers have found equivocal results with respect to whether the disclosure of child sexual abuse is helpful or not. The threat of harm as well as the possibility of being humiliated, not believed, or blamed, render the disclosure of child sexual abuse difficult for some victims. Suppressing of traumatic events has been linked to negative health effects. The current study investigated the relationship between the inability to fully disclose the abuse and subsequent traumatic symptomatology. Questionnaires including the Trauma Symptom Checklist 40, the Child Sexual Experiences Questionnaire, and the Parental Support Scale were completed by 204 victims of child sexual abuse. Multiple regression analyses were performed using traumatic symptomatology as the dependent variable. The extent to which a victim wanted to tell about the abuse but held back from doing so and the severity of the abuse were related to adult symptomatology. Findings suggest that victims enduring more severe abuse are more likely to hold back from fully disclosing the abuse which is associated with more trauma-related symptoms.

Adolescent↗

PubMed1998

[Diagnosis disclosure: the place of beneficence, autonomy and veracity in medical ethics].

OBJECTIVE: The moral doctrine of diagnosis disclosure is derived from a respect for the patient's autonomy as well as the patient's beneficence. These two goals are not necessarily incompatible, but they often lead to different decisions about what information needs to be shared with patients. The ethics of veracity does not prescribe duties, either old or new, but implies a new way of thinking about ethics. METHOD: Theories of the three general sorts just mentioned are identified and explained here. RESULTS: The ethics of veracity as such is limited to unmasking the falsifications of desire that inhabit the moral life. This would meet the moral goals of shared decision-making, because patients could make sense of such data. CONCLUSIONS: Certainly other moral doctrines may turn out to be relevant to the problems discussed in this paper. Nonetheless, they are sufficiently comprehensive to provide an analytical framework by means of which moral problems of diagnosis disclosure can be evaluated. We cannot expect anything else from the enterprise of the ethics of veracity but a critique of authenticity. Its force is that of suspicion, not justification or legitimation, and still less that of prescription.

Diagnosis↗

PubMed1998

Self-disclosure or self presence?

The issue of self-disclosure reflects an interest in allowing the analyst to be present in the analytic situation in a way previously prohibited, as a fully participating subject. The authors develop the concept of the full-fledged communicational context as a way of allowing for, or even requiring, some form of voluntary self-disclosure. Anonymity is examined in the light of its claim to foster patient self-revelation. The authors maintain that such a claim is seriously flawed. Their examination of the concept of analytic objectivity located its foundation in the intersubjective field; therefore, the claim that objectivity is fostered by interpersonal distancing and anonymity is suspect. Further, they assert that asymmetry in the analytic dyad, although unavoidable in many respects, could be significantly reduced, with beneficial effects for both analyst and patient.

Female↗

PubMed2004

Authorship criteria and disclosure of contributions: comparison of 3 general medical journals with different author contribution forms.

CONTEXT: A number of general medical journals and the International Committee of Medical Journal Editors (ICMJE) request authors to disclose their contributions. Little is known about the effect of journal policies on authors' disclosure of their contributions. OBJECTIVE: To determine the number of named authors who do not meet ICMJE criteria for authorship, according to their published contributions, in 3 medical journals with different contribution disclosure practices. DESIGN: Observational study of authors' contributions in research articles published in 2002 in Annals of Internal Medicine (n = 72), BMJ (n = 107), and JAMA (n = 81). BMJ asks authors to describe research contributions in their own words; Annals asks authors to choose from a list of coded contributions; and JAMA uses a structured checklist with instructions on contributions that qualify for ICMJE authorship criteria. Honorary authorship was defined as the lack of contribution from the first ICMJE criterion (study conception and design, or acquisition of data, or analysis and interpretation of data) and/or second (drafting the article or critical revision for important intellectual content) ICMJE criterion. RESULTS: According to authors' published contributions, the number of honorary authors was highest in Annals (121/562 authors, 21.5%), followed by BMJ (46/482, 9.5%), and JAMA (3/641, 0.5%) (chi2(2) = 146.67, P<.001). The number of articles with honorary authors was 60% in Annals, 21% in BMJ, and 4% in JAMA. Honorary authors had fewer published contributions than authors who met ICMJE criteria and were positioned more toward the end of the byline. Honorary authors either lacked contributions for both ICMJE criteria (10% in Annals and 22% in BMJ) or contributions to the second ICMJE criterion (75% in Annals, 67% in BMJ, and 2 out of 3 in JAMA). CONCLUSIONS: General medical journals differed in prevalence of honorary authors according to published research contributions of named authors. Different authorship/contributorship policies and procedures should be explored as a possible explanation for the differences in contributions disclosed by authors among these journals.

Authorship↗

PubMed1998

Non-disclosure preimplantation genetic diagnosis for Huntington's disease: practical and ethical dilemmas.

Prenatal diagnosis of Huntington's Disease (HD) is controversial. Selective abortion is considered unacceptable by some, since, being a late-onset disorder, any child born carrying the HD mutation might still expect many years of disease-free life. The test result itself has implications for the parents and other members of the family who may have decided not to be tested but who know that they may be at risk because a family member is affected. For this reason some potential carriers do not want to know their carrier status and may prefer prenatal exclusion testing. However, since half the fetuses carrying the affected grandparental allele may be normal, aborting these fetuses is also controversial. Preimplantation genetic diagnosis (PGD) has been suggested as an alternative by which asymptomatic individuals who are at high risk of carrying HD can avail themselves of antenatal genetic testing without incurring the emotional, social and financial burdens that might result from the presymptomatic disclosure of their own carrier status. However, non-disclosure testing of embryos in vitro presents specific practical difficulties. Assurance of absolute secrecy is difficult in the large team required for in vitro fertilization biopsy and diagnosis, and changes in practice which may be required to maintain the deception may be unethical.

Confidentiality↗

PubMed1997

Extending the Benefits of Recategorization: Evaluations, Self-Disclosure, and Helping

The Common Ingroup Identity Model proposes that if members of different groups conceive of themselves more as a single group rather than as two separate groups, intergroup bias will be reduced through processes involving pro-ingroup favoritism. The present research extended work on this model by investigating the effects of recategorization on intergroup behavior, specifically helping and self-disclosure, as well as evaluations. Participants first worked as members of two three-person groups, and then the two groups interacted under conditions designed to enhance a two-group representation or recategorization with an inclusive one-group representation. As expected, the manipulation of the intergroup contact situation that created stronger impressions of one group reduced intergroup bias in evaluations, self-disclosure, and helping. Furthermore, ratings of the extent to which the six participants felt like one group mediated the reduction in bias, particularly for evaluative bias. Conditions facilitating the generalization of the benefits of recategorization to group members not present and to other groups are considered.

Journal Article↗

PubMed1979

Symptom disclosure to male and female physicians: effects of sex, physical attractiveness, and symptom type.

Seventy-five subjects (50 male and 25 female) rated their willingness to disclose symptoms of a personal nature, general nature, and mental illness nature to male and female physicians whose photographs had been pretested as being either physically attractive or physically unattractive. Increased willingness to disclose was related to (1) the more physically attractive physicians, (2) general as compared to personal and mental symptoms, (3) same-sex match-ups between patient and physician, especially when (4) disclosing personal or mental illness symptoms or concerns. The sex of the physician per se had no influence on patient's willingness to disclose symptoms. Implications are drawn concerning the patient's assignment to or choice of physician based on sex. Patient education and training in symptom disclosure as well as physician's skill building in facilitating symptom disclosure are also indicated.

Attitude to Health↗

PubMed1986

[Medical responsibility for disclosure in legal cases of the German federal court].

The principles herein discussed show yet again that in determining the physician's duty of disclosure, courts rely on general standards and statutory provisions which they then apply more particularly to the facts of the individual case. Physicians, however, are apprehensive of such flexibel criteria, and perhaps even prejudiced against "the lawyers" who, rather than directing their attention to the needs of the individual doctor-patient relationship, tend to think in terms of the principles involved. To quote a distinguished English judge, "It is always easy to be wise after the event". This, of course, is one thing the physician cannot afford to be. Although courts may have the benefit of hindsight, a physician must assess the patient's informational needs at the outset: a problem he has to learn to live with and for which the lawyer must develop a greater understanding. But in so doing, the lawyer must not lose sight of the patient, who is at the mercy of the physician and can easily fall victim to his lack of diligence. In summary, in defining the extent of the physician's duty to inform, particularly in respect of possible or as yet unknown side effects, the general standards referred to above must be applied, bearing in mind the facts of the individual case, such as the urgency of the proposed treatment, its severity and inherent risks, possible side effects, and the patient's educational background, as well as the possible effect of disclosure on his mental and emotional well-being.

Germany, West↗

PubMed2005

Cystic fibrosis disclosure may minimize risk of negative peer evaluations.

BACKGROUND: Given the relatively lower body weight associated with cystic fibrosis (CF) and the visible regimen associated with eating, there is a risk that individuals with CF may be mistakenly perceived to have an eating disorder or otherwise be negatively evaluated. Based upon a theoretical model, this study explored whether disclosing CF would curtail negative peer perceptions. METHODS: Young adult respondents (N = 391) read vignettes that varied in a 2 (male vs. female character) x 2 (preventative disclosure of disorder vs. nondisclosure) design and answered 28 questions, which resulted in three subscales that were validated using confirmatory factor analysis: Abnormal Behavior, Hiding an Eating Disorder, and Worry. Vignettes depicted a lunchtime interaction including concerns about gaining weight and taking enzymes before eating. RESULTS: Disclosure of CF significantly reduced perceptions of abnormal behavior, ameliorated perceptions of an eating disorder, and alleviated respondents' worries. Manipulations of vignette character gender did not result in any significant differences; however, female respondents reported significantly more worry for the character than males. CONCLUSIONS: Individuals who disclose their CF may potentially curtail negative peer perceptions. Those who choose not to disclose may risk having their thinness and appropriate self-care misperceived as signs of an eating disorder.

Adolescent↗

PubMed2000

Disclosure of tests and raw test data to the courts: a need for reform.

Psychologists' current practices with respect to the disclosure of tests and raw test data to courts are damaging their reputations as scientists, undermining their credibility as honest professionals acting in good faith, and contrary to the best interests of consumers. The profession is conducting itself in a contradictory fashion that deserves reform. There is need for an interdisciplinary panel drawn from the American Psychological Association and American Bar Association to develop reasonable procedures for disclosure of tests and test data in legal proceedings. These procedures should be developed with input from experienced psychological expert witnesses, attorneys, and judges from a variety of state and federal jurisdictions, diverse geographical areas, and different types of legal proceedings. This expert panel should also address the issue of attorney coaching of clients in preparation for assessment by psychologists.

Confidentiality↗

PubMed2004

Hastening death by selective disclosure of treatment options--beneficence or "euthanasia by deception"?

In this paper I make a radical claim regarding selective non-disclosure of treatment options that have some hope of prolonging a patient's life. I suggest that selective non-disclosure under such circumstances is tantamount to what might be called "euthanasia by deception." I offer a case to test the validity of my claim and to demonstrate how the failure to offer or, at least, to discuss renal dialysis in this case (and, by inference, any other form of treatment which has some hope of prolonging a patient's life) qualifies as paternalism in its most egregious form. I discuss the actions of the health care team and try to find some plausible reasons why they acted as they did. I conclude that there must be greater emphasis placed on teaching clinicians how better to incorporate frank, open and on-going discussion about the central elements of the therapeutic relationship with patients long before they lose decisional capacity.

Aged↗

PubMed2004

Emotional disclosure in homeless people: a pilot study.

Symptoms of stress are prevalent among the homeless. Growing evidence suggests that disclosure of traumatic experiences is beneficial to health. This pilot study examined the effects of an emotional disclosure protocol on a group of 8 homeless people, using a single-group design. Clinical effectiveness was evaluated using the Impact of Event Scale, the Beck Depression Inventory, the Beck Anxiety Inventory, the Perceived Stress Scale, the Reading Span Task, and the Digit Span Test. Participant satisfaction was also measured. Results showed significant improvements in functioning at 1- and 6-week follow-up, and good satisfaction levels. The discussion remarks on the limitations (lack of a control group, small sample size, and other biases) and the need for more research in this topic.

Adult↗

PubMed1999

Public disclosure of health care performance reports: a response from the UK.

In the UK, the experience with public disclosure of health care performance data related to provider organizations is limited to a small set of administrative data known as the 'Patient's Charter' which has concentrated mainly on aspects of efficiency and which is currently being reviewed, and, most recently, to a set of reference costs by case type (known as Healthcare Resource Groups). Clinically oriented performance data has been published in Scotland since 1994 and will be published in England and Wales early in 1999. Knowledge about the impact and effect of such publication is limited, even in the USA, but there is some evidence that consumers and purchasers become gradually familiar with them and confident in their use. However, even with this scant knowledge, it would appear that the publication of data across the public services will continue to be a policy of the current UK Government for the foreseeable future. It would seem likely that this policy will have the tacit approval of the general population who have been educated to be somewhat wary of professional self-regulation. The greater public accountability that public disclosure of information brings, needs to be evaluated against the overall costs of the exercise, particularly within a publicly financed system, and against the disadvantages in public confidence and impact on the patient-doctor relationship that might occur if not managed appropriately.

Consumer Advocacy↗

PubMed1989

A randomized prospective study on anxiety reduction by preparatory disclosure with and without video film show about a planned heart catheterization.

Unfortunately, giving preparatory information to the patient is generally regarded as legally mandatory for obtaining his written consent to an invasive procedure. Disclosure, however, could be used to reduce his anxiety as well; we hypothesized that showing a preparatory video film might be helpful in this respect. Patients who were admitted for elective coronary angiography were eligible for the study. 65 were randomized to two groups: both groups received the same leaflet and personal interview with the doctor, but only one group (Group 2) additionally watched a 14 min preparatory video. Anxiety was assessed with the State-Trait Anxiety Inventory (STAI). The two groups did not differ with respect to initial anxiety levels and other important parameters. Group 1 patients, who did not watch the video had no significant reduction in anxiety score; group 2 patients showed a significant benefit. We conclude that disclosure with the additional aid of a video film may be an easy, yet effective way to reduce patients' anxiety.

Adult↗

PubMed1994

Psychiatric status of sexually abused children 12 months after disclosure of abuse.

OBJECTIVE: The assessment of psychiatric status of sexually abused children 12 months after the disclosure of recent sexual abuse. METHOD: Ninety-five children, aged from 4 through 16 years, were recruited to the study from a variety of agencies other than psychiatric units. Sixty-six (69.5%) were assessed for psychiatric diagnosis on DSM-III-R using data from parents, teachers, and children 12 months after disclosure of abuse. Abuse was extra- and intrafamilial. RESULTS: Overall 63.5% of the children warranted a diagnosis on Axis I. There was a wide range of diagnoses, with particularly high rates of oppositional defiant disorder (19.6%), post-traumatic stress disorder (18.2%), anxiety disorders (30.3%), depressive disorders (12.1%), and attention-deficit hyperactivity disorder (13.6%). Boys had a higher rate of diagnosis than girls. Abuse and social variables did not predict diagnoses but mothers' mental status rated on the General Health Questionnaire did. Subjects not located at follow-up were more often male and more likely to be socioeconomically disadvantaged. Thus the estimates of psychopathology here are likely to be conservative. CONCLUSIONS: This study highlights the need of sexually abused children for skilled long-term therapy tailored to individual presentation.

Adolescent↗

PubMed1994

Reactions to disclosure of childhood sexual abuse. The effect on adult symptoms.

This study examines the effect disclosing childhood sexual abuse had on adult psychological functioning as measured on symptom checklists. One hundred eighty-eight adults filled out questionnaires regarding childhood trauma experiences and the reaction they received from the first person they told of their sexual abuse, and symptom checklists measuring depression, trauma symptoms, posttraumatic stress disorder symptoms, and dissociation. Data were analyzed using multiple regression analysis and path modeling. Those who told in childhood (N = 66) reported a significantly worse reaction to disclosing abuse than individuals who waited until adulthood (N = 112). For those who told in childhood, primarily to close family members, reaction to disclosure had a mediating effect between childhood abuse and adult symptoms, with those experiencing a bad reaction from the first person told having worse scores on general trauma symptoms, posttraumatic stress disorder symptoms, and dissociation. These results support other studies showing childhood sexual abuse to be associated with adult psychological symptoms. It also suggests the importance of the reaction received from family members responding to disclosure of abuse as a contributor to adult psychopathology.

Adult↗

PubMed1998

Involuntary disclosure of private medical records to the defence in criminal proceedings.

This article concerns the law and procedure governing the production and disclosure to an accused of medical and therapeutic records in the hands of third parties, not part of the Crown's case against the accused. Following a brief analysis of the medico-legal issues involved, this article examines recent statutory changes regarding involuntary disclosure to an accused by third parties of private records in their possession.

Confidentiality↗

PubMed2002

The families evaluation on management, care and disclosure for terminal stage cancer patients.

BACKGROUND: Quality of life is an important concept which is subjective and personal; what is an acceptable quality of life to one may be 'worse than death' to another. The objective of this study was to develop and validate a questionnaire to assess relatives' perceptions and attitudes towards their terminal stage cancer patients' management (information disclosure, treatment choice, hospitalization and support-communication and care) including aspects regarding end-of-life and quality-of-life decisions. METHODS: The final study consisted of 146 relatives of advanced terminal stage cancer patients receiving palliation, attending a Pain Relief and Palliative Care Unit. The questionnaire incorporated 6 multi-item and 7 single-item scales, and was developed following a systematic review of measures appropriate for use in palliative care settings. RESULTS: Following analysis of the 25-item scale, the questionnaire has been validated as a shortened 21-item scale consisting of 5 multi-item and 5 single-item scales. Factor analysis was based upon information disclosure, hospitalization, and support-communication demonstrating Cronbach's alpha coefficients of 0.66, 0.5 and 0.70 respectively. Average item totals and inter-item scale correlations were between 0.62-0.70, with convergent validity correlations between 0.60-0.86. The questionnaire was well accepted by all subjects with an 8-10 minute completion time. CONCLUSION: The shortened 21-item self-assessment questionnaire may provide acceptable and valid assessment of caregiver(s)/Greek cancer patients' relatives perceptions on palliative care.

Journal Article↗