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Results for “Truth Disclosure”

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PubMed2002

Disclosure to therapists: what is and is not discussed in psychotherapy.

This study used the 80-item Disclosure to Therapist Inventory-R to investigate the nature of patient disclosure within therapy. Participants (45 men, 102 women) were all currently in therapy. A Principal Components Analyses with varimax rotation yielded nine meaningful factors; mean disclosure scores were lowest for the factors of Sexuality and Procreation and highest for the factors of Negative Affect and Intimacy. Specific items most extensively discussed included characteristics of parents that are disliked, and aspects of one's personality that are disliked or worrisome. No significant differences were found in overall degree of disclosure as a function of patient gender or shame-proneness; disclosure was, however, found to be positively correlated with strength of the therapeutic alliance.

Adolescent↗
PubMed2006

Attitudes toward disclosing the diagnosis of dementia in Japan.

BACKGROUND: The rapid increase in the elderly population in Japan has triggered a debate on whether or not patients with dementia should be informed of their diagnosis. The purpose of the present study was to investigate the attitudes of people in a large city in Japan toward the disclosure of a diagnosis of dementia. METHODS: In Study 1, 2000 residents aged 40-64 and 5000 residents aged 65 and over were sampled randomly, and a structured questionnaire was sent to them by mail. In Study 2, we administered a structured interview-based questionnaire to 3949 randomly enrolled residents of Nagoya City aged 45 and over whose family member had been certified as needing long-term care. RESULTS: In Study 1, 79.8% of the younger respondents (n = 710) stated that they would prefer the disclosure of a hypothetical diagnosis of dementia, as did 75.5% of the older respondents (n = 2162). Furthermore, 85.1% (n = 749) of the younger respondents and 82.5% (n = 2181) of the older respondents stated that they would prefer that the patient be told his or her hypothetical diagnosis of dementia. In Study 2, in the case of care recipients without dementia, 68.3% (n = 650) of their family members preferred disclosure of a hypothetical diagnosis of dementia. Among the families of care recipients who had dementia, 58.4% (n = 301) of family members preferred disclosure. CONCLUSIONS: The present survey of caregivers and non-caregivers in an urban city of Japan demonstrated that the desire for disclosure of a diagnosis of dementia is relatively high.

Adult↗
PubMed2003

Sharing a diagnosis of dementia--learning from the patient perspective.

Sharing a diagnosis of dementia is a key focus of debate and research in the field of dementia care. The pivotal role of the GP in the early identification and subsequent management of dementia has long been recognized and whilst diagnostic practice is improving, the knowledge gained from research exploring the patient perspective is insufficiently absorbed. This paper presents the evidence from the two perspectives of the diagnostic relationship: the views of GPs around giving a diagnosis and the views of patients on receiving one. The authors draw upon their own projects-as well as wider research-in suggesting ways that diagnostic practice can be improved by taking account of the patient perspective. The learning can be distilled around the dimensions of the process, approach and nature of disclosure with evidence particularly challenging the 'myths' held by many GPs around the value of early diagnosis. Whilst much work still needs to be done to incorporate the patient perspective in dementia care, there is clear evidence that patient oriented research has much to offer the development of disclosure practice in primary care to the benefit of patients, their families and GPs.

Aged↗
PubMed1999

Issues for women with heterosexually transmitted HIV disease.

The encouraging outcome of new antiretroviral therapies has not been accompanied by a decrease in the incidence of HIV disease. There are reports of increases in AIDS in select geographical areas, minorities, and women. In 1997, 39% of cases in women were from heterosexual contact, whereas in men 7% of cases were from heterosexual contact. It is the most common mode of transmission in women globally and the only category of transmission in which the incidence of opportunistic infection has increased in the United States. Female anatomy, physiology, and sexual practices contribute to increasing risk of transmission, although there are no major biomedical differences in development of the disease related to gender. Two case examples illustrate the vulnerabilities, life-settings, pressures, and methods of coping for this population. Extensive discussion and review of the literature on the epidemiology, testing, disclosure, health care services, and prevention of transmission in women bring into focus strategies for improved education, diagnosis, care, and treatment.

Adult↗
PubMed2004

Disclosing a dementia diagnosis: a review of opinion and practice, and a proposed research agenda.

PURPOSE: The ethical and practical issues in disclosing a dementia diagnosis remain subjects of some debate. In this review of the literature we document previous opinion and practice in the area of diagnostic disclosure. DESIGN AND METHODS: We identified sources for this review with a MEDLINE and PsycINFO database search, followed by collection of additional articles from reference lists. RESULTS: Across sources we were able to identify a broad list of arguments both for and against diagnostic disclosure. We briefly discuss some of the ethical principles that undergird those reasons. IMPLICATIONS: Practice guidelines and professional opinion regarding disclosure appear to depart from the actual experience reported by clinicians, patients, and family members. At a more detailed level, process issues in disclosure, such as who is told, how and what they are told, and the impact of disclosure, are poorly understood. Sensitivity to individual differences may promote an optimal approach to disclosure. Research in this area is sparse and often contradictory, and throughout the review we propose research questions that, when answered, could clarify issues in disclosure that are essential to sound dementia care.

Attitude of Health Personnel↗
PubMed1999

Disclosure of HIV status to sexual partners: predictors and temporal patterns.

BACKGROUND AND OBJECTIVES: Failure to disclose human immunodeficiency virus (HIV) infection to sexual partners interferes with risk reduction. GOAL OF THIS STUDY: The purpose of this study was to identify factors associated with disclosure and failure to disclose HIV infection to sexual partners and to describe condom use with nondisclosure. STUDY DESIGN: A longitudinal survey study of HIV seropositive persons recruited at a public STD clinic. RESULTS: Approximately 76% of the study population (n = 147) reported disclosing their HIV status to their last sex partner at baseline. Predictors of disclosure included consistent condom use and being in a monogamous relationship. Twenty-two percent of those who disclosed at baseline reported nondisclosure during follow-up. Approximately 23% reported not using a condom with a person to whom their status was not disclosed. CONCLUSIONS: These results suggest that ongoing partner notification may be necessary to increase disclosure of HIV status to sex partners over time.

Adult↗
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↗
PubMedDate not supplied

Hospital disclosure practices: results of a national survey.

New patient safety standards from JCAHO that require hospitals to disclose to patients all unexpected outcomes of care took effect 1 July 2001. In an early 2002 survey of risk managers at a nationally representative sample of hospitals, the vast majority reported that their hospital's practice was to disclose harm at least some of the time, although only one-third of hospitals actually had board-approved policies in place. More than half of respondents reported that they would always disclose a death or serious injury, but when presented with actual clinical scenarios, respondents were much less likely to disclose preventable harms than to disclose nonpreventable harms of comparable severity. Reluctance to disclose preventable harms was twice as likely to occur at hospitals having major concerns about the malpractice implications of disclosure.

Health Care Surveys↗
PubMed2001

Bioethics for clinicians: 23. Disclosure of medical error.

Adverse events and medical errors are not uncommon. In this article we review the literature on such events and discuss the ethical, legal and practical aspects of whether and how they should be disclosed to patients. Ethics, professional policy and the law, as well as the relevant empirical literature, suggest that timely and candid disclosure should be standard practice. Candour about error may lessen, rather than increase, the medicolegal liability of the health care professionals and may help to alleviate the patient's concerns. Guidelines for disclosure to patients, and their families if necessary, are proposed.

Attitude to Health↗
PubMed1999

An update on legal aspects of plan communications.

Plan communications can be a real challenge for trustees, unions and management, but effective communications are essential because they provide the link between plan sponsors' efforts to provide benefits and the actual receipt of those benefits by participants. Communication-related issues that must be considered by those responsible for keeping plan participants informed include ERISA provisions, the need for accurate information, disclosures concerning possible benefit plan changes, COBRA rights and HIPAA provisions.

Communication↗
PubMed1994

Preparations for AIDS vaccine trials. Developing brief valid screening instruments for HIV-related sexual risk behavior among gay and bisexual men.

Enrolling and tracking cohorts for HIV vaccine efficacy trials requires that participants disclose behaviors that place them at risk for exposure to HIV. Brief screening procedures have been suggested for this purpose. In a previous study gay and bisexual men in three U.S. cities reported unprotected anal intercourse on a brief screening instrument. Screen reports were compared to subsequent in-depth, face-to-face interview data; 29% of the men who reported unprotected anal intercourse during the interview failed to disclose this behavior during screening. For recruitment into an HIV vaccine feasibility study at the same study sites, screening procedures were modified to encourage accurate reporting: to lessen stigma, low risk as well as high risk sexual behaviors were assessed, and screens were administered by trained study staff who presented it as a tool for understanding the gay community. Failures to disclose risk decreased to 18%, a rate that, while lower than in the previous study, remains high. Men less likely to disclose unprotected sex during the screen engaged in fewer high risk sexual behaviors, had more stringent norms regarding sexual safety, and were less identified with the gay community than were men who disclosed unprotected sex. Failure to disclose risk may have significant implications for participant selection and behavior tracking during vaccine trials. More systematic assessments that are sensitive to target communities may facilitate disclosure.

AIDS Vaccines↗
PubMedDate not supplied

Health care fraud and abuse.

In recent years, health care fraud and abuse have become major issues, in part because of the rising cost of health care, industry consolidation, the emergence of private "whistle-blowers," and a change in the concept of fraud to include an emerging concern about quality of care. The 3 types of conduct that are generally prohibited by health care fraud laws are false claims, kickbacks, and self-referrals. False claims are subject to several criminal, civil, and administrative prohibitions, notably the federal civil False Claims Act. Kickbacks, or inducements with the intent to influence the purchase or sale of health care-related goods or services, are prohibited under the federal Anti-Kickback statute as well as by state laws. Finally, self-referrals-the referral of patients to an entity with which the referring physician has a financial relationship-are outlawed by the Ethics in Patient Referral Act as well as numerous state statutes. Consequences of violations of these laws can include, in addition to imprisonment and fines, civil monetary penalties, loss of licensure, loss of staff privileges, and exclusion from participation in federal health care programs. Federal criminal and civil statutes are enforced by the US Department of Justice; administrative actions are pursued by the Department of Health and Human Services' Office of Inspector General; and all state actions are pursued by the individual states. In addition, private whistle-blowers may, acting in the name of the United States, file suit against an entity under the False Claims Act. Enforcement of health care fraud and abuse laws has become increasingly commonplace and now affects many mainstream providers. This trend is likely to continue.

Disclosure↗
PubMed1991

Duty to disclose in medical genetics: a legal perspective.

As technical knowledge and public information in medical genetics continue to expand, the geneticist may expect to be held responsible for informing patients and clients about new developments in research and diagnosis. The long legal evolution of the physician's duty to disclose, and more recent findings of a physician's duty to recall former patients to inform them about newly discovered risks of treatment, indicate that medical geneticists may have a duty to disclose both current and future information about conditions that are or could be inherited. Recent case law supports findings of professional liability for both present and future disclosure, even in the absence of an active physician-patient relationship. The requirement of candid and complete disclosure will affect the counseling approach in testing for deleterious genes and in providing medical treatment for minors with hereditary diseases. Finding a duty to recall may impose further professional burdens on the geneticist to reach beyond the immediate counseling arena and to recontact patients, perhaps years after their initial visit to genetics clinic.

Beneficence↗