SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The level of maternal support to incest victims following disclosure was found to be more closely related to perpetrator than to child characteristics. Lack of maternal support was significantly associated with foster placement and higher psychopathology scores in a clinical interview. Evidence is presented challenging the validity of maternal behavioral reports in assessments of incest victims.
This article proposes that knowledge of cultural expectations concerning ethical responses to unintentional harm can help students and physicians better to understand patients' distress when physicians fail to disclose, apologize for, and make amends for harmful medical errors. While not universal, the Judeo-Christian traditions of confession, repentance, and forgiveness inform the cultural expectations of many individuals within secular western societies. Physicians' professional obligations concerning truth telling reflect these expectations and are inclusive of the disclosure of medical error, while physicians may express a need for self-forgiveness after making errors and should be aware that patients may also rely upon forgiveness as a means of dealing with harm. The article recommends that learning how to disclose errors, apologize to injured patients, ensure that these patients' needs are met, and confront the emotional dimensions of one's own mistakes should be part of medical education and reinforced by the conduct of senior physicians.
OBJECTIVE: The authors describe obstacles to children's disclosure of their sexual abuse experiences. METHOD: Ten children's descriptions of 102 incidents of sexual abuse and the process of disclosing these incidents during police interviews were studied. Children's self-reports of the abuse were compared to videotapes of the incidents made by the lone perpetrator. RESULTS: There was a significant tendency among the children to deny or belittle their experiences. Some children simply did not want to disclose their experiences, some had difficulties remembering them, and one child lacked adequate concepts to understand and describe them. CONCLUSIONS: Failure by children to disclose their experiences of sexual abuse might have diverse explanations. Professionals will most likely never be able to identify all cases of sexual abuse on the basis of children's narratives.
Experienced clinicians were interviewed to explore the criteria utilized in intentional therapist self-disclosure. Three themes emerged: the psychotherapy relationship, therapist self-awareness, and most significant, theoretical orientation. Five categories of criteria were identified: modeling, fostering the therapeutic alliance, validating reality, encouraging the patient's autonomy, and the therapist's satisfaction.
The intersection of psychodynamic psychotherapy and religious beliefs may present technical challenges for the psychotherapists; particularly if patients request to know more about the therapist's religious beliefs. Contrary to a recent technical recommendation for therapists to self-disclose personal religious beliefs when asked to do so, I suggest that such a request is complex and requires a thoughtful grounding in psychotherapeutic theory. Disclosing personal beliefs to patients runs the risk of being off-task as well as holding oneself out as an exemplar for the patient. Rather than adopt a formulaic response to requests for information, to deepen the understanding of the patient and the work of therapy, the therapist needs a complex understanding based on a careful diagnostic assessment of the patient, as well as an assessment of the current status of the psychotherapeutic venture. The workings of patients' particular transferences are often evident in requests for personal information and require careful evaluation and consideration. Likewise, countertransference elements may influence the type of response offered by the therapist. Using ethical principles as a guide is different from using them as a rule. The nexus of religious belief, psychosocial context, psychotherapy, and self-disclosure provides a potentially rich source of understanding when explored in the psychotherapeutic situation.
One hundred thirty-two graduates with learning disabilities (LD) of a large, public, competitive postsecondary institution were surveyed to determine if they had self-disclosed their LD to their current employer and to provide the reasons for choosing to self-disclose or not to self-disclose. Based on a response rate of 67.4% (n = 89), the results indicated that 86.5% of the respondents were employed full time. Although nearly 90% of the respondents stated that their LD affected their work in some way, only 30.3% self-disclosed to their employer. Of those who had not self-disclosed, the majority reported that there was no reason or need to self-disclose. However, 46.1% reported not self-disclosing due to fear of a potentially negative impact in the workplace or due to a concern for job security. Specific rationales for disclosure and information related to the use of self-reported accommodations and strategies are presented.
The requirement that the state disclose to an accused person all evidence in its possession which is not clearly irrelevant is a tenet fundamental to contemporary criminal law in Canada. In essence, the right to full answer and defence implies that the individual be allowed to completely understand the case which has been brought against him or her. This paper examines the concept of reciprocal disclosure, whereby the defence is obligated to provide evidence to the state. The confines of the ensuing discussion are limited to expert evidence and, more particularly, to psychiatric and psychological testimony. By arguing that early production of an expert's opinion advances rather than retards the interests of justice, the author attempts to debunk some of the myths which are used in Canadian legal circles to justify the suppression of opinion evidence by the defence until the last possible moment.
This study attempted to assess the degree of knowledge of the diagnosis, and the attitude towards that information, in a group of terminally ill cancer patients. We also tried to determine the influence of the knowledge of the diagnosis on other patient psychosocial needs. We assessed 97 patients (64 in an oncology service, 33 in a palliative care unit) by means of a semistructured personal interview, and a psychosocial needs questionnaire. Data collected showed that 68% of patients had not been informed of their diagnosis; 60% of this group had a high degree of suspicion of their diagnosis, but 42% of noninformed patients did not want to receive more information. Information on diagnosis appears to be beneficial in establishing satisfactory relationships and communication between patients and relatives and staff. We have tried to answer the most relevant issues related to diagnosis disclosure in our clinical setting, questioning the feasibility of truth telling within our cultural boundaries.
AIMS AND BACKGROUND: In Turkey, it is a common belief that most family members of patients with cancer would not want them to be informed of a diagnosis of cancer. Our aim was to evaluate the attitudes and opinions of people accompanying cancer patients, regarding cancer diagnosis disclosure. METHODS: In a cross-sectional study 270 caregivers accompanying cancer patients during outpatient chemotherapy sessions were asked to fill in a questionnaire to determine their opinions regarding whether the diagnosis of cancer should be disclosed to the patients and their relatives or not. Timing of telling the diagnosis and from whom it should be learned were queried as well. Possible influential factors for the answers were analyzed with the chi-square test. RESULTS: Of the 270 accompanying persons, 130 (48.2%) said that the patients should be informed of the diagnosis, whereas a greater number (236, 87.4%) believed that the patient's relatives should be informed. Being younger than 40 years old (P = 0.0005), being unmarried (P = 0.002), having a higher educational status (P = 0.0001) and having passed less than four months since the diagnosis (P = 0.005) positively affected opinions regarding telling the truth to the patient. Higher education (P = 0.012) and high monthly income (P = 0.002) positively affected opinions regarding disclosing a diagnosis of cancer to the patient's relatives. CONCLUSION: As a result, in a survey of caregivers' points of view, more than half of the accompanying persons did not agree with disclosing a cancer diagnosis to patients, whereas the majority agreed with disclosing it to the relatives, and educational level seemed to be the major influential factor.
OBJECTIVE: To encourage mental health professionals concerned about the practice of psychotherapy to add their voices to the legal debate on disclosure. METHOD: Analysis of recent court decisions, in particular 2 Supreme Court of Canada judgements, R. v. O'Connor and R. v. Carosella, and 1 United States Supreme Court judgement, Jaffee v. Redmond. RESULTS: The lack of a common definition of psychotherapy may, in part, have made it awkward for mental health professionals to mount a concerted defence of psychotherapy dossiers. CONCLUSIONS: Unless mental health professionals develop a more robust justification and delimitation for privilege, in Canadian courts possible relevance of clinical material is likely to override concern for the patient's privacy interest. Future research might evaluate the impact of loss of privilege upon different types of psychotherapy.
This article explores Dietrich Bonhoeffer's writings on truth telling with reference to the problem of medical error in the US, the UK, and other developed nations, with particular attention to physicians' resistance to disclosing their own mistakes to injured patients and their families. The brief essay 'What is Meant by "Telling the Truth"?' and its historical context--Bonhoeffer's imprisonment and interrogation in 1943--is proposed as a text for medical ethicists and others seeking to overcome the barrier of the 'hidden curriculum' within the culture of medicine, which encourages medical students and physicians to conceal their errors and to fear disclosure.
This article examines the debate surrounding the challenging concept of informed consent. It argues whilst the English courts have effectively excluded the use of the tort of battery as an appropriate mechanism for protecting a patient's right to self-determination, they have left the law in a state of flux due to the uncertainties associated with categorising similar claims within negligence where the onus is on risk disclosure. This confusion may stem firstly from the fact that medical practitioners are unsure exactly which risks to disclose, and secondly, from the way in which both doctors and patients perceive the consent process. The paper suggests this disorder may be having a detrimental effect on medical practice as medical practitioners are taking it upon themselves to disclose excessive information, which patient's may not want or need. A suggestion is also made that in these situations, in order that the law truly respects self-determination, consideration must be given to the patient's desire to waive their right to informed consent.
The objective of this study was to assess the perceptions of Malaysian HIV-positive subjects towards the attitude of dental personnel in providing oral care to them. The study design was cross-sectional with the sampling frame comprising of 27 Government Drug Rehabilitation Centres throughout Malaysia. A convenience sample was then taken from 20 centres with the highest enrolment of HIV-positive subjects. A self-administered questionnaire was used to elicit information on the perception of HIV-positive subjects towards the attitude of dental personnel in providing oral care to the patient with HIV-positive. The study sample consisted of 509 HIV-positive individuals with a mean age of 31.3+/-12.9 years old. Of these, only 15.1% attended a dental clinic after confirmation of HIV-positive status. The study demonstrated that 67.5% of the HIV-positive subjects disclosed their status voluntarily to the dentists and majority of the dentists (76.9%) did not show any negative reaction on knowing their HIV positive status. There was also no difference in the attitude of auxiliary staff toward the above disclosure. In conclusion, the study showed that oral health care personnel are more receptive to the HIV-positive subjects receiving dental care and treatment.
Cystic fibrosis has traditionally been conceptualized as a fatal childhood disease. In contrast, survival age has been increasing steadily such that adults now routinely seek to gain employment and form close relationships, situations that might require telling others about the disease. Here, the author examines three situations of disclosure based on interviews with 31 adults with the disease. First, in a low-risk situation, for example a short period of social contact, a low level of intimacy exists between the adult with cystic fibrosis and another. Here the disease may be concealed easily with little risk of discovery. Second, in a medium-risk situation, the perceived reaction of the other begins to influence the decision to disclose, as the level of intimacy becomes higher. Last, in high-risk situations, such as employment, the consequences of disclosing or concealing CF are most severe. However, a multiplicity of factors, including perceived social support and disease progression, are seen to influence adults' decisions to disclose their disease.
Intimate partner violence (IPV) is a major cause of health conditions among women presenting for health care. Many physicians and nurses miss potential opportunities to increase battered women's safety. The purpose of this study is to increase health care providers' understanding of abused women's preferences concerning provider response when they do disclose IPV in order to increase effectiveness of interventions. A total of 26 abused women from a larger study participated in five focus groups at three agencies on "how a hospital or doctor's office can be most helpful to a woman who is experiencing domestic violence." Women identified seven preferences for responses: (a) treat me with respect and concern, (b) protect me, (c) documentation, (d) give me control, (e) immediate response, (f) give me options, and (g) be there for me later. These findings indicate that women prefer an active role by health care providers when responding to disclosure.
Most practitioners find disclosing the diagnosis of Alzheimer s disease (AD) to an individual with dementia very difficult. Literature results show a wide variability in attitudes and clinicalpractice, and diagnosis seems to be more often disclosed to caregivers than to patients. The objective of this study was to examine whether and how diagnosis of AD is disclosed in French general practice and which issues are addressed with the patient. A questionnaire was sent via mail to 1,629 general practitioners (GPs), 1,105 belonging to the Sentinel's network and 524 specially recruited doctors practicing in the Rhône-Alpes region. A total of 631 questionnaires were returned (response rate, 39 percent), of which 616 were eligible for analysis. Twenty-eight percent of GPs reported having disclosed diagnosis to the patient (25 percent mentioned "Alzheimer's disease"), whereas 88 percent considered it their role to announce the diagnosis to the patient. Regarding the type of information provided to the patient, only 25 percent discussed the nature of the illness, 23 percent behavioral problems, and 47 percent depression, mainly for psychological reasons (63 percent). Stress was discussed with 79 percent of the caregivers. We concluded that GPs do not discuss the consquences of AD and symptoms (e.g., behavioral disorders) with patients, mainly for psychological reasons, whereas they have a less-reluctant attitude toward caregivers. As the GP has the weighty task of providing ropriate community care and psychological support to the patient, it is of utmost importance to reflect on how disclosure of diagnosis can be facilitated.
BACKGROUND: A writing and theatre workshop, conducted in northern New Hampshire with 8 posttreatment breast cancer survivors, utilized expressive disclosure in a nonscientific environment. METHOD: Through writing, the participants have explored both negative and positive feelings about cancer and its impact on their lives. Through theatre games and rehearsals, the participants have had the opportunity to learn new expressive skills. In performance, they have helped others by telling their own stories. RESULTS: Participants reported a feeling of transformation and a renewed sense of well-being as a result of the workshop, as well as an ongoing desire to positively affect others with their work. CONCLUSIONS: The facilitators and participants agreed that the results of this work have been transformative for all involved. The facilitators are encouraged by the idea of further practical exploration of these methods. This article is a blueprint for this type of work and an exploration of the scientific background that supports this method as a valid tool to aid in emotional recovery.
This is the second of two articles that consider the findings of a study exploring mental health nursing students' reasons for their use and non-use of self-disclosure in their relationships with patients. The first article (Vol 12(20): 1220-7) described the background to the deployment of this skill within therapeutic approaches, the paucity of literature discussing its use within nursing, the methods employed in this study and the findings for mental health nursing students' reasons for using the skill. This second article focuses on student's reasons for not deploying this skill, which are discussed in the following categories: 'crossing the line', 'unhelpful', 'name, rank and serial number' and 'students' vulnerability'. A discussion of the findings from both articles and their implications is offered.