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PubMed1993

Dilemmas of disclosure to patients and colleagues when a therapist faces life-threatening illness.

This article highlights dilemmas imposed by disclosure and nondisclosure of a therapist's life-threatening illness to patients and colleagues. Literature is reviewed that illustrates a spectrum of circumstances and opinions, contrasting survivable with more complex or likely nonsurvivable conditions. In the case of a therapist's life-threatening illness, consultation regarding its effects on the treatment framework is appropriate and may include-while the therapist can still be a full participant in both processes-planning for both the continuity of patients' treatment and at times practice closure. This sensible, professional approach recognizes the patients' needs in the mourning process.

Female↗
PubMed2001

Disclosure of HIV status in the workplace: considerations and strategies.

Maintaining a role in the workplace despite significant health concerns can be important in meeting an individual's emotional and economic needs. This qualitative research study reviewed the workplace experiences and disclosure decisions of 18 HIV-positive individuals. The most frequently cited reasonsfor disclosing HIV status were to explain choices they were making as they interviewed for a job and concerns about their job performance and the needfor accommodations. For individuals who disclosed their HIV status to selective members of the workplace or disclosed to no one, the primary reasons given were preference for privacy, nature of the work environment, andfear of possible consequences. The practice, policy, and research implications for social workers are also discussed.

Adult↗
PubMed2001

Gamete donation and anonymity: disclosure to children conceived with donor gametes should not be optional.

The use of donor gametes in reproductive technology raises ethical, psychological and social questions that have been significant for the practice of adoption: that is, when, or if, to disclose biological origin to the child. The current wisdom is that adopted children should be told by their parents as early as possible that the family was created through adoption, and we argue that the same model should apply to the use of donor gametes. We argue that privacy concerns or other goals of parents who would prefer to avoid disclosure are outweighed by the negative consequences of holding such family secrets and by the child's right to, and medical need for, information about his/her origin. We believe fertility programmes and professional organizations ought to strongly encourage those using donor gametes to tell their child of their true origin as early as the child can understand reproduction in general.

Disclosure↗
PubMed2005

Barriers to disclosure to children with HIV.

Research suggests that it is healthy for children with chronic illness to discuss their illness, but clinical experience and research indicate that this seldom occurs. The purpose of this study was to identify barriers which prevent primary caregivers from discussing HIV/AIDS with children, and ways in which medical and community services could facilitate this process. Focus groups were performed with seventeen primary caregivers of children with HIV seen for care at Chris Hani Baragwanath Hospital in Soweto, South Africa in 2001. The study revealed that primary caregivers of children with HIV typically do not disclose HIV status to their children, despite the fact that these children often ask questions about their illness. For reasons including stigma, lack of knowledge and skills, and emotional unpreparedness, primary caregivers feel uncomfortable discussing HIV and illness with children. Health care and social service providers could facilitate disclosure of illness to children with HIV.

Adolescent↗
PubMed1998

Working through the public disclosure process mandated by use of 21 CFR 50.24 (exception to informed consent): guidelines for success.

New Food and Drug Administration guidelines allow research to be done under an "exception to informed consent." These guidelines mandate advance public disclosure (PD) but provide no specifics for how to accomplish this task. This report outlines the history of informed consent in emergency care situations, highlights the Food and Drug Administration regulations for an exception to informed consent, and describes a stepwise approach with specific details of a PD program for a study using a blood substitute. This descriptive report can serve as a guideline for subsequent emergency care investigators in the development of a strategic plan for PD.

Algorithms↗
PubMedDate not supplied

Improved hypertension control after disclosure of decades-old trauma.

This report presents the case of a 49-year-old woman who had been treated unsuccessfully for 6 years for longstanding severe and refractory essential hypertension. Although she reported no extraordinary stress or distress, her disclosure of a 3-decade-old rape and the experiencing of previously repressed and unconfided emotions related to it were followed by a dramatic and sustained improvement in her blood pressure. This case suggests that repressed emotions, which patients cannot report, may contribute substantially to the development of essential hypertension, even when they are related to decades-old events. More attention to repressed emotions, and better means of studying them, are needed before the mystery of the links between psychological factors and essential hypertension is unraveled.

Adult↗
PubMed2004

A meta-analysis of the effects of written emotional disclosure on the health outcomes of clinical populations.

A meta-analysis was conducted to examine the effects of the written emotional disclosure paradigm on health outcomes of people with physical or psychiatric disorders. After nine studies were meta-analyzed, it was determined that expressive writing significantly improved health (d = .19; p < .05). However, this positive relationship (r = .10) was not moderated by any systemic variables because of the nonsignificant test of homogeneity (Qw = 5.27; p = .73). Nonetheless, a planned contrast illustrated that expressive writing is more effective on physical (d = .21; p = .01) than on psychological (d = .07; p = .17) health outcomes (Qb > 10.83; p < .001). One explanation for the small effect size (ES) results and the nonsignificant test of homogeneity may be the small and heterogeneous samples used in some of the studies within this research synthesis. Future research with expressive writing should be tested with randomized controlled trials to increase the likelihood of detecting a larger treatment effect.

Adaptation, Psychological↗
PubMed2006

Impact of domestic violence posters on female caregivers' opinions about domestic violence screening and disclosure in a pediatric emergency department.

OBJECTIVES: The objectives of this study were to examine female caregivers' attitudes about the display of domestic violence (DV) resources in a pediatric emergency department (ED) and to explore whether these resources engendered positive feelings about DV screening and encouraged disclosure. METHODS: We conducted a cross-sectional survey in a pediatric ED during 2 distinct periods, comparing responses of female caregivers before (pre) and after (post) displaying DV posters and cards. Women were surveyed about (1) personal experience with DV, (2) the appropriateness of DV posters and screening in a pediatric ED, and (3) willingness to divulge DV, if abused. RESULTS: The 2 groups (pre, n = 133; post, n = 136) did not significantly differ with respect to age, race, education, or personal DV history. The majority endorsed that "it is appropriate to have DV posters," with the post group responding in this manner more often than the pre group (pre, 85%; post, 95%; odds ratio [OR], 3.3; 95% confidence interval [CI], 1.3-8.5). The post group was less likely to prefer pediatric ED DV screening (pre, 76%; post, 63%; OR, 0.5; 95% CI, 0.3-0.9) and tended to be less likely to say that they would divulge (pre, 85%; post, 75%; OR, 0.6; 95% CI, 0.3-1.1). In both groups, women with a DV history were less likely than women without this history to say that they would disclose DV to their pediatric ED provider (P < 0.001). CONCLUSIONS: These results suggest the need for further exploration of how to most effectively help and provide resources for abused women in this setting.

Adolescent↗
PubMed2006

Disclosure of HIV status on informed consent forms presents an ethical dilemma for protection of human subjects.

The privacy of copies of consent forms provided to research participants cannot be guaranteed. Therefore, consent forms that disclose a subject's HIV status may result in breach of confidentiality and cause social harms. Under the ethical principle of beneficence defined in the Belmont Report, we recommend that disclosure of HIV status be through voluntary counseling and testing; however, whenever possible, copies of consent form should not specify HIV status.

Consent Forms↗
PubMed2006

Management of stigma and disclosure of HIV/AIDS status in healthcare settings.

PURPOSE: This paper aims to examine the management strategies adopted by older people living with HIV/AIDS (PHAs) to conceal their positive status in healthcare settings, and their responses taken and means used to cope with the stigmatizing and exclusionary effects as a result of the disclosure of their status by/to healthcare workers. DESIGN/METHODOLOGY/APPROACH: Under the auspices of a local NGO in Hong Kong, a total of seven male older PHAs aged 55 or above from pre-existing HIV/AIDS self-help groups were recruited for two separate focus groups. A thematic approach was adopted for data analysis and specific themes identification. FINDINGS: An analysis of the data revealed that older PHAs did exercise their own agency in preventing against and managing stigma in their access to and use of health care services. Two more specific themes around "sign of disapproval" and "discriminatory practice" as barriers to access were also identified. RESEARCH LIMITATIONS/IMPLICATIONS: Because of the small sample size, the pattern of stigmatization experiences and coping strategies cannot claim to be representative of the complete picture of the stigma associated with HIV/AIDS. ORIGINALITY/VALUE: This is the first exploratory study of the stigmatization and devaluation suffered by older PHAs in healthcare settings in the context of Hong Kong. It also explored in details the pros and cons of the stigma management strategies employed by this vulnerable group of patients. The implications for practice both on the side of healthcare workers and policy makers and that of PHAs were discussed.

Adaptation, Psychological↗
PubMed2005

Public disclosure of surgeon-specific report cards: current status of the debate.

Clinical report cards are at the centre of an escalating debate on ways in which the performance of hospitals and individual doctors can be monitored. Report cards are a method of publishing outcome data that can be focused on a particular hospital, clinical unit, or an individual doctor. Following the public disclosure of results of individual cardiac surgeons in New York State, USA, and the recent Inquiry into paediatric cardiac surgical deaths at the Bristol Royal Infirmary, UK, there is increasing focus on the possibility of the introduction of report cards in Australia. At present, the increasing momentum and implementation of report cards is focused squarely on surgeons, and particularly on cardiac surgeons. This review outlines the events in the USA and UK and looks into the possible impact of the introduction of report cards in Australia.

Australia↗
PubMed2006

Assessing surgeons' disclosure of risk information before carotid endarterectomy.

BACKGROUND: To make an informed decision about treatment, patients need accurate information about the benefits and risks of treatment and 'non-treatment' options. A survey was conducted to determine patients' recall of the extent and effect of preoperative disclosure by surgeons to patients of risks about carotid endarterectomy (CEA). METHODS: A self-administered questionnaire was given to 133 patients undergoing elective CEA in New South Wales. The primary outcome measures were patient recall of preoperative discussion, self-assessed estimates of stroke risk with and without surgery and receipt of written information before CEA. RESULTS: A significantly higher proportion of patients recalled that their surgeon discussed the short-term stroke risk (i.e. within 30 days) if they decided to undergo CEA (86.2%) than if they decided not to have the procedure (76.9%) (P = 0.04). Of those patients who recalled the surgeon discussing their short-term stroke risk with CEA, only 24 (18.0%) were accurately able to quantify this risk. Patients were significantly more likely to recall their surgeon discussing their long-term stroke risk (i.e. within 2 years) if they decided not to have CEA (72.4%) than if they decided to have the CEA (31.5%) (P < 0.0001). CONCLUSIONS: Patients recalled discussions with their surgeon about short-term stroke risk. Only a minority, however, accurately quantified their postoperative stroke risk. In view of variable patient recall, decision aids could assist.

Aged↗
PubMed1988

"Telling bad news": physicians and the disclosure of undesirable information.

To address the issue of what physicians tell patients, and how they arrive at that decision, this report focuses on a single episode in breast cancer--the event of telling the patient for the first time that she has cancer. This is a participant-observation account of 118 events, framed from the physicians' perspective. It describes how the 17 surgeons at the Breast Cancer Clinic developed, organized and implemented their disclosure policies, and what strategies they utilized to routinize a task they defined as difficult and unpleasant.

Breast Neoplasms↗
PubMed1995

Forming a consortium: a design for interagency collaboration in the delivery of service following the disclosure of incest.

A central issue in the treatment of intrafamilial sexual abuse is the "secondary trauma" experienced by both the victimized child and her family when the wider system of regulatory and treatment agencies present redundant, incongruent, or conflicting perspectives and demands. This article describes an attempt to effect second-order change through formation of a consortium of regulatory and treatment agencies to develop a consistent and coordinated response to the disclosure of sexual abuse. Feminist, social constructionist, and organizational development ideas are used to develop principles of intersubjectivity, collaboration and a "both-and" stance, which have guided both the clinical and wider systems work.

Child↗
PubMedDate not supplied

Disclosure of sexual abuse. The secret is out--what now?

The sexual abuse of a child is a well-kept secret. Disclosure creates difficulties for the child, the family, and sometimes for the professionals working with them. A multidisciplinary, multiagency model is one method to facilitate care and recovery for the child victim. Each agency and service has a different purpose and goal. Cooperative coordination and communication are the keys to case management with reduced psychological trauma for the child and family. Child psychiatric nurses can be effective members of the child abuse health team model. Advocacy roles also can be developed by nurses who work with sexual victimization through the avenues of media, writing, committee membership and research.

Child↗
PubMed2006

The limits of disclosure: what research subjects want to know about investigator financial interests.

Research participants' views about investigator financial interests were explored. Reactions ranged from concern to acceptance, indifference, and even encouragement. Although most wanted such information, some said it did not matter, was private, or was burdensome, and other factors were more important to research decisions. Very few said it would affect their research decisions, and many assumed that institutions managed potential conflicts of interest. Although disclosure of investigator financial interest information to research participants is often recommended, its usefulness is limited, especially when participation is desired because of illness.

Attitude to Health↗
PubMed1998

Therapist physical attractiveness: an unexplored influence on client disclosure.

Existing research indicates that clients perceive facially attractive therapists as more competent, trustworthy, genuine, and effective than less attractive therapists. No studies exist to help explain how the therapist's attractiveness influences a client's self-disclosure. Participants (n = 241) were randomly assigned to one of eight experimental groups to test the interaction of the therapist's attractiveness, client's gender, the nature of presenting problem, and the client's comfort with disclosing in a hypothetical couple therapy scenario. Analysis of variance procedures established that most participants reported feeling more comfortable disclosing a benign (communication) problem than a potentially embarrassing (sexual) problem, and more comfortable disclosing problems to an attractive than to a less attractive female therapist. Therapists are encouraged to understand the power attractiveness may have in their own and their clients' lives.

Adolescent↗