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PubMed2002

Diagnosis disclosure in cancer patients--when the family says "no!".

It is not uncommon for family members to thwart a doctor's attempt at disclosure of cancer diagnosis to the patient. This stems from concern and love as well as fear of the negative psychological impact of such revelation. Indeed, collusion of this nature was the norm in medical practice till the not too distant past. In this era of patient autonomy and the right to information, we must be careful not to allow attitudes of medical staff or patients' families, language difficulties and organisational issues become barriers to patient's access to information and their psychological coping of the illness. At the same time, we also need to be acutely aware of the unique cultural environment we work in and the families' emotional needs even as we aim to match the patient's desire for information.

Family↗
PubMed2003

[Disclosure of incest as an emancipatory act--once again: "The Feast" by Thomas Vinterberg].

The author examines the Danish film "The Feast" referring to the dynamics of a typical incest family. The disclosure of the incest is the central point of the scenario of the film. It is understood as an expression of emancipatory strivings of the victim, the need to separate from denying collaboration and from identification with the role of the victim (identification with the aggressor). Closely connected with this emancipatory process is the development of the siblings out of their mutual relationships and those to their parents towards a self defined life.

Adult↗
PubMed1992

The doctor's duty of disclosure and excessive information liability.

This article critically examines the recent phenomenon of legal liability for so-called excessive disclosure within the context of the informed consent doctrine. An attempt is made to formulate a set of workable principles to cater for both the doctor's dilemma and the patient's protection in over-information cases against the backdrop of the general principles of the doctor's duty to disclose.

Beneficence↗
PubMed2003

Public disclosure of healthcare performance information and its application to the Singapore context.

The increasing worldwide trend towards publicly and actively disclosing healthcare provider performance information requires that healthcare professionals in Singapore understand the relevant issues and implications. The current evidence suggests that there needs to be caution in any related move here in Singapore, since the benefits have not been entirely established and the associated problems not inconsequential. This article identifies public accountability and the commercial need to demonstrate value as possibly the main drivers for local public disclosure. It concludes that a proper needs analysis and true stakeholder involvement are necessary in contemplating such an initiative locally.

Benchmarking↗
PubMed2001

Fear of disclosure and popular stigmas contribute to bad outcomes. CDC finds that 1 in 5 people stigmatize HIV.

Two decades into the HIV epidemic, many Americans still are misinformed about how HIV is transmitted, and they continue to blame the disease on those who are infected, according to a new survey conducted by the Centers for Disease Control and Prevention in Atlanta. This widespread stigmatization of the disease and those who have it has led some HIV-infected people to delay testing and treatment, according to experts. And it affects th way some deal with workplace issues. Many HIV-infected workers are afraid to disclose their HIV status, even if the disclosure would enable them to seek reasonable accommodations for their health issues and treatment.

Adolescent↗
PubMed2003

Lethal sex: conditions of disclosure in counseling sexually active clients with HIV.

Confidentiality in psychological counseling is necessary if clients are to feel comfortable in revealing their darkest secrets. But this bond of trust has its moral limits. These limits are crossed in some cases in which HIV positive clients are sexually active with unsuspecting third parties. Distinguishing between Type 1 and Type 2 cases, the author shows how he has used applied ethics in drafting and defending a model rule for the American Counseling Association's Code of Ethics that permits, and sometimes morally requires disclosure in the former cases, but not in the latter.

Confidentiality↗
PubMed2004

[On the disclosure of the diagnosis of Alzheimer's disease].

In contrast to the legal or professional instructions, many French or European physicians remain reluctant for disclosing the diagnosis of Alzheimer's disease to their patients. The reasons put forward for not telling the truth appear to be no more justified. The wish to protect the patient from negative reactions as well as the argument that the patient is not able to understand the significance of the diagnosis are not clinically grounded. Moreover, the situation is presently modified by new circumstances: the early diagnosis of the illness in most cases and the availability of active drugs and support measures. Therefore, it appears necessary to more deeply understand the difficulties met by the patient, the family but also by the physician in the process of disclosure of the diagnosis of Alzheimer's disease. In this purpose, some practical suggestions are presented to facilitate the dynamic of the communication between physician, patient and family.

Alzheimer Disease↗
PubMed2005

Fiduciary disclosure of medical mistakes: the duty to promptly notify patients of adverse health care events.

Fiduciary obligations are imposed by the common law to ensure that a person occupying a societal role with a high potential for the manipulation of vulnerable persons exercises utmost good faith. Australian law has recognised that the doctor-patient relationship, while not wholly fiduciary, has fiduciary aspects. Amongst such duties are those prohibiting sexual or financial abuse of patients or disclosure without express authority of confidential information. One important consequence of attaching such fiduciary duties to the doctor-patient relationship is that the onus of proof falls not upon the vulnerable party (the patient), but upon the doctor (to disprove the allegation). Another is that consent cannot be pleaded as an absolute defence. In this article the authors advocate that the law should now accept that the fiduciary obligations of the doctor-patient relationship extend to creating a legal duty that any adverse health care event be promptly reported to the patient involved. The reasons for creating such a presumption, as well as its elements and exceptions, are explained.

Australia↗
PubMed2005

Disclosure of medical errors to patients.

The literature review presented here explores the feelings of patients and health care providers regarding the disclosure of medical errors. Findings from these studies illuminate patients' desires for information about medical errors and what they are likely to do with the information once they are informed.

Age Factors↗
PubMed2005

Canadian developments. Recommendations published concerning non-disclosure of HIV status.

The conclusions from an expert working group on persons who fail to disclose their HIV status were published in the 1 March 2005 edition of the Public Health Agency of Canada's Communicable Disease Report. The recommendations recognize that legal and ethical considerations must inform and guide both policy and practice as they relate to non-disclosure of HIV/AIDS. The expert working group favoured a graduated response model based on a public health approached to the issue rather than a criminal law approach.

Canada↗
PubMed2005

Hope and the ethics of disclosure for terminally ill cancer patients.

Cancer diagnosis presents a disclosure dilemma for physicians, holding in tension the physician's obligation to provide diagnosis and its impact on the patient. To address this dilemma the traditional approach of physicians, typified as the psychological-empirical approach to hope, needs to be complemented by a patient-oriented approach, described as the phenomenological hermeneutics of hope.

Emotions↗
PubMed2006

Lesbian disclosure: disrupting the taken for granted.

The purpose of this interpretive inquiry was to generate understandings about the experience of lesbian disclosure. The inquiry relied on Gadamerian hermeneutic and feminist philosophical thought and was situated in women's health. In a feminist understanding of women's health, experiences of health are inseparable from the everyday experiences of an embodied life and are constituted within each woman's social, material, and discursive realities. The study was informed by conversations with 15 women who self-identified as lesbian for the purpose of the inquiry, accounts of women in the media, and the researcher's reflective journals. The findings move us towards new understandings about the multiple meanings of "lesbian." They challenge nurses to consider the binary categories of homosexual and heterosexual as inadequate signifiers for the reality of women's lives, to consider the particular arrangements of each woman's life, and to disrupt assumptions of heterosexism in order to reduce the negative impact of social exclusion, isolation, discrimination, and stigmatization as social determinants of health.

Adult↗
PubMed2006

Family physicians' views on disclosure of a diagnosis of cancer and care of terminally ill patients in Croatia.

INTRODUCTION: Family physicians have a crucial role in communication and palliative care for terminally ill patients. AIMS: To examine family physicians' views about the disclosure of the diagnosis and information about cancer to their patients and to their families; to establish the most appropriate person to deliver the diagnosis of cancer to the patient; to examine whether family physicians cooperate with palliative care associations, and to assess their opinions about euthanasia and emotional support to dying patients. SUBJECTS AND METHODS: One hundred and thirty four family physicians participated in the study. The data was collected by questionnaire designed for this survey about cancer care. RESULTS: The majority of respondents 96 (71.64%) delivered the cancer diagnosis to their patients sometimes, and 69 (51.5%) told the truth about the cancer diagnosis to the family without the patient's permission. The respondents 90 (70.3%) considered that the family physician was the most appropriate person to disclose the cancer diagnosis and 107 (80.5%) considered that the patients' home was the most appropriate place for terminal care. The majority of physicians 61 (45.5%) thought that they did not cooperate enough with palliative care associations. In working with terminal patients, 42 (32.1%) respondents considered communication with the patients to be particularly difficult and 122 (93.8%) thought that emotional support of family and friends was most important. CONCLUSION: The majority of physicians deliver a diagnosis of cancer to their patients occasionally, and they also tell it to the patient's family. They considered family physician to be the most appropriate person to disclose a diagnosis of cancer and the patient's home was considered the most appropriate place for terminal care. In caring for terminally ill patients communication is considered particularly difficult, and the emotional support of family and friends is considered most important.

Adult↗
PubMed2006

Computing latent taxonomies from patients' spontaneous self-disclosure to form compatible support groups.

A growing number of Internet sites provide patients with an opportunity to share experiences about their illness. Unfortunately, it depends on the luck of the draw whether patients find compatible others for mutual support. To improve this situation, this paper demonstrates how tools from Information Retrieval can be deployed to discover patients with compatible stories more systematically. We show how finding compatible support is like finding relevant documents on the Internet, and also in what way it is different. We designed an algorithm to produce a 'latent' taxonomy over patients' self-disclosures to aid them in forming support groups. At the end we briefly consider the result of this taxonomy based on only the patients' stories, with one based on explicit questionnaires.

Humans↗
PubMed2006

Patient confidentiality vs disclosure of inheritable risk: a survey-based study.

BACKGROUND: As the field of genetic medicine advances and more tests for genetic diseases become available, a dilemma of legal and ethical importance will be increasingly encountered by family physicians. Protecting the confidentiality of a patient with a genetic disease when the patient's family is at risk for inheriting the disease is a conflict that more and more physicians will be forced to address. METHODS: In March 2003, osteopathic family physicians in New Jersey were given a vignette in which a patient reveals that he has a genetic disease and demands that the information be kept confidential. The physicians were then given a 33-item questionnaire asking their opinions about disclosing an untreatable and a treatable disease to each of the patient's children and their mother, a former spouse. Also, physicians' opinions on larger issues were gathered, such as potential legal consequences of their actions and state laws in this area. Correlations between physicians' opinions and their demographic characteristics were also explored. Data were analyzed using Pearson product moment correlations and repeated-measures analyses of variance. RESULTS: Physicians tended to agree that adult children should be told if the disease were treatable, and these physicians were willing to accept responsibility for deciding whom to tell. With regard to the characters in the vignette, physicians felt comfortable telling the 22-year-old daughter, were unsure about telling the 17-year-old son, and would not tell either a former spouse or the 12-year-old son. The respondents agreed that state laws should permit disclosure rather than require it, and they did not think state laws should forbid it. CONCLUSION: The authors recommend that states draft a definitive public policy about when, how, and whether to disclose pertinent medical information to those at risk for inheriting a genetic disease.

Adult↗
PubMed1987

"Informed consent" and disclosure of risks in medical treatment: some recent developments.

This paper discusses the implications for the doctor/patient relationship of the House of Lords' decision in Sidaway v Royal Bethlem Hospital (1985). In this decision the House of Lords rejected the "informed consent" doctrine developed in the United States in relation to the doctor's duty to disclose risks involved in medical procedures, favouring an approach in which the matter of disclosure is treated as an aspect of the doctor's duty of care towards the patient. The paper seeks to criticize this approach on the basis that it does not give sufficient protection to the patient's right to decide whether to consent to medical procedures.

England↗
PubMed1994

End-of-life family decision-making from disclosure of HIV through bereavement.

End-of-life decision-making is conceptualized as the foreground against the background of a family, transitional model of illness with the human immunodeficiency virus (HIV). Both foreground and background represent new knowledge and theory development emerging from six research studies over a 7-year period. The research was phenomenological, longitudinal, ethnographic, descriptive survey, narrative, and grounded using the constant comparative method. In all, 100 families were studied in their home settings in the District of Columbia and 29 states across the United States. Throughout the transitional process from disclosure of HIV through bereavement, families engaged in end-of-life decision-making. Their decision-making style was primarily cognitive or primarily emotional or somewhere in between. Families using a cognitive style of decision-making were less disrupted and more able to surmount hurdles and move toward goals. Exemplars from 23 families illustrated family decision-making and components of the transitional, family model.

Adaptation, Psychological↗