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Results for “Truth Disclosure”

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PubMed1996

Outcome-based practice: disclosure rates of child sexual abuse comparing allegation blind and allegation informed structured interviews.

The way in which children are interviewed can make the difference between prosecution, or continued abuse. There is a clear need for the development of an interview style that is acceptable in the legal system without compromising disclosure rate. This study was conducted to compare the disclosure rate of alleged child sexual abuse victims interviewed in a formal forensic setting with a structured "allegation informed" technique versus a structured "allegation blind" technique. The only difference between techniques was that the interviewer did not know the allegation for condition "allegation blind." Of the 1,535 interviews, 1,330 or 86.64% were conducted "allegation blind," 196 or 12.76% were conducted "allegation informed" and for 9 or .6% the interview type was unknown. The "allegation blind" interview technique yielded a statistically higher disclosure rate (chi 2 p = 0.378). Further research is warranted.

Adolescent↗
PubMedDate not supplied

Disclosure of HIV diagnosis to children: when, where, why, and how.

Despite recent recommendations by the American Academy of Pediatrics that strongly encourage disclosure of human immunodeficiency virus (HIV) infection to school-age children, health care providers vary widely in their actual disclosure practices. Concrete guidelines for accomplishing disclosure are not currently available. Nondisclosure can result in a variety of problems, including anxiety, depression, phobias, and exclusion from peer support groups and medical camps. This article reviews the available literature on disclosure of HIV infection to children and describes the disclosure process used in a large, urban pediatric HIV clinic.

Adaptation, Psychological↗
PubMed2004

Disclosure of a diagnosis of borderline personality disorder.

OBJECTIVE: Borderline personality disorder (BPD) is a common psychiatric disorder with a prevalence of 1%-2% in the general population. BPD also has the potential to cause significant distress in the lives of patients with BPD and their families. The diagnosis of BPD, however, is often withheld from patients. The purpose of this article is to explore the history of diagnostic disclosure in medicine and psychiatry and then discuss reasons why clinicians may or may not disclose the diagnosis of BPD. METHODS: The authors review medical literature about diagnostic disclosure and other issues that may affect the decision to disclose a diagnosis of BPD. RESULTS: The authors discuss the historical precedents for diagnostic disclosure and reasons a clinician may not disclose the diagnosis of BPD to a patient: questions regarding the validity of BPD as a diagnosis, worries about the stigma of the diagnosis being harmful to the patient, and transference/countertransference issues common in the treatment of patients with BPD. The authors cite factors promoting disclosure, such as the ideal of patient autonomy, possibilities for psychoeducation and collaboration with the patient toward more specific and effective therapies, and the increasing availability of diagnostic information available to patients from sources other than their clinicians. CONCLUSIONS: There are compelling reasons to make the diagnosis the subject of open examination and discussion between clinician and patient, and reasons to believe that disclosure would serve to advance the patient in his or her recovery.

Borderline Personality Disorder↗
PubMed1995

Unwanted sexual experiences in adolescents. Patterns of disclosure.

More than 300 patients who presented consecutively to a sexual abuse clinic, a family planning clinic, and a family practice clinic filled out an anonymous survey regarding unwanted sexual experiences. In the family planning and family practice clinics, 40% of females and 16% of males reported having at least one unwanted sexual experience prior to their 18th birthday. Although 85% had disclosed their unwanted sexual experience, time to disclosure was prolonged (mean 2.3 years, median 5 to 6 months). Fear and embarrassment were the most common reasons for delay or lack of disclosure. The most common reasons for disclosure reflected internal rather than external or environmental influences. Increased awareness of unwanted sexual experiences and pattern of disclosure may enhance detection and treatment in children and adolescents.

Adolescent↗
PubMed1996

Factors associated with disclosure of diagnosis to children with HIV/AIDS.

Disclosure of the diagnosis of human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) to a child is a controversial and emotionally laden issue. To understand the factors that affect the process of disclosure and its consequences, we studied 99 parent-child dyads recruited from patients being treated at the National Cancer Institute (NCI). Parents and HIV-infected children were interviewed and administered several standardized measures. Parental depression, family environment, social support satisfaction, socioeconomic status, child and parent gender, child's age, parental HIV serostatus, and disease severity were used to predict disclosure status. Results indicate that the majority of caregivers do disclose the diagnosis to the child, usually with no ill effects, and that age is the most significant predictor of whether or not a child has been told. The Centers for Disease Control and Prevention currently estimate that there are over 6611 children with AIDS (under age 13), and 2184 adolescents with AIDS (ages 13-19) in America. As an increasing number of children who are born infected with HIV live to older ages, the question of when and how to talk with them about their illness becomes more crucial. In addition to the growing number of children infected with HIV, there are many thousands of children profoundly affected by the impact of this disease on a close family member--a mother, father, sibling, or other relative in the kinship network. Yet, the initial reaction most adults have upon learning of their own, or of a family member's, HIV diagnosis is that the diagnosis must be kept a closely guarded secret. One reason frequently cited by parents and family members is their fear that the stigma of AIDS will have a negative impact on their children and their families. Disclosure of an HIV diagnosis to a child is a controversial and emotionally laden issue in the pediatric health-care community as well. However, no systematic research has studied the issues that surround disclosure of an HIV diagnosis to the patient and the factors that predict disclosure.

Adolescent↗
PubMedDate not supplied

Disclosing unexpected outcomes and medical error.

Health-care professionals have a responsibility to communicate honestly and empathetically with patients and families when there has been a disappointing outcome in care. They need to understand how all parties think about, feel, and react to the situation. It is too easy for health-care providers and patients and their families to feel that their interests are no longer aligned and to have expectations go unmet. Based on the authors' clinical experience, this article outlines a suggested educational approach for organizations interested in developing their clinicians' skills in the art of disclosure when an unexpected outcome or medical error occurs.

Hospital-Patient Relations↗
PubMed1997

Malpractice--the dentist's perspective.

A lawyer with more than twenty years of experience defending dentists in malpractice situations reflects on the attitudes he typically sees in dentist defendants. The "professional" orientation that patients should expect nothing more than that the dentist does his or her best, is often at odds with the patient plaintiff view that they will have their feelings recognized at almost any price. The lawyer's role is often one of education. As the facts and perspectives involved are revealed through disclosure, resolutions begin to emerge. The best approach is for dentists to learn to communicate with patients--from their perspectives.

Attitude of Health Personnel↗
PubMed1999

Disclosing physician financial incentives.

Federal and state regulatory initiatives as well as court decisions increasingly require managed care organizations to disclose physician financial incentives and have raised the issue of disclosure by physicians themselves. These mandates are based on ethical and legal principles arising from the patient-physician relationship and the relationship between health plan sponsors and enrollees. Disclosing incentives also serves important policy objectives: it can inform enrollees' choice of plan, reinforce enrollees' capacity to understand and exercise other rights under managed care, and discourage use of compensation methods that might compromise patients' access to treatment. However, significant conceptual and practical questions remain about implementing a disclosure mandate. Unresolved issues include the timing, content, and scope of disclosure, the relationship of disclosure to patients' substantive rights, and the impact of disclosure on trust between patients and physicians. These uncertainties exemplify the challenges facing policymakers, plans, and physicians as they determine how best to inform patients about managed care.

Conflict of Interest↗
PubMed1994

Informed consent and Huntington disease: a model for communication.

American and Canadian professional accreditation standards for medical genetics, and genetic counseling require certain abilities with regard to "communication." What remains unclear is how such standards are to be interpreted in terms of appropriate clinical protocols, objectives, and values. These issues have significant medical and legal implications, particularly with regard to medical malpractice. From the perspective of genetic testing for Huntington disease, this paper identifies those clinical objectives and practices which may be described as constituting the appropriate standard of care for "communication," and informed consent.

Age of Onset↗
PubMed2005

Predictors of serostatus disclosure to partners among young people living with HIV in the pre- and post-HAART eras.

Predictors of serostatus disclosure were identified among youth living with HIV pre- and post-introduction of highly active antiretroviral therapy (HAART). Two cohorts of HIV-positive youth, aged 13-24, in 1994-1996 (n = 351) and 1999-2000 (n = 253) in Los Angeles, New York, San Francisco, and Miami were sampled through medical providers and a variety of social service agencies. Data were collected on demographic, social, medical, and behavioral topics. Men who had sex with men were more likely to disclose serostatus to their partners. Moreover, a positive association with length of time since diagnosis and the likelihood of disclosure exists; across time, youth were less likely to disclose serostatus to casual partners or HIV-negative partners. Post-HAART, number of sex acts with a partner was associated with increased likelihood of disclosure. Interventions for HIV-positive youth must improve disclosure to casual and serodiscordant sexual partners.

Adolescent↗
PubMed2005

Disclosing adverse events to patients.

BACKGROUND: The rationale for, and recommended approaches to, disclosing adverse events to patients are examined on the basis of the experience of the Veterans Health Administration (VHA). The VHA's National Ethics Committee endorses a general policy requiring the routine disclosure of adverse events to patients and offers practical recommendations for implementation. PRACTICAL APPROACHES TO DISCLOSING ADVERSE EVENTS: Disclosure is required when the adverse event (1) has a perceptible effect on the patient that was not discussed in advance as a known risk; (2) necessitates a change in the patient's care; (3) potentially poses an important risk to the patient's future health, even if that risk is extremely small; (4) involves providing a treatment or procedure without the patient's consent. From an ethical perspective, disclosure is required and should not be limited to cases in which the injury is obvious or severe. Disclosure of near misses is also discretionary but is advisable at times. In general, disclosure by a clinician involved in the patient's care is appropriate. CONCLUSION: Although a variety of psychological and cultural factors may make clinicians and organizations reluctant to disclose adverse events to patients, the arguments favoring routine disclosure are compelling. Organizations should develop clear policies supporting disclosure and should create supportive environments that enable clinicians to meet their ethical obligations to disclose adverse events to patients and families.

Family↗