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Results for “Truth Disclosure”

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PubMed1997

Toward a hermeneutic model of ethical decision making in clinical practice.

Documented ethical violations and empirical research have demonstrated that, despite professional standards and formal training in ethical principles, some psychotherapists engage in unethical behaviors that compromise the welfare of clients. It appears that competing values and interests that emerge in the therapeutic endeavor can interfere with therapists' considerations of ethical standards and their willingness to act ethically. Expanding current models of ethical decision making, this article offers a hermeneutic model that recognizes that in addition to moral reasoning, the context of the therapeutic relationship and the therapist's subjective responses are fundamental considerations in the interpretation and application of ethical interventions. Implications for understanding and training of ethics in psychotherapy in this broader context are explored.

Altruism↗
PubMed2001

Conflict of interest policies in science and medical journals: editorial practices and author disclosures.

This study examines the extent to which scientific and biomedical journals have adopted conflict of interest (COI) policies for authors, and whether the adoption and content of such policies leads to the publishing of authors' financial interest disclosure statements by such journals. In particular, it reports the results of a survey of journal editors about their practices regarding COI disclosures. About 16 percent of 1396 highly ranked scientific and biomedical journals had COI policies in effect during 1997. Less than 1 percent of the articles published during that year in the journals with COI policies contained any disclosures of author personal financial interests while nearly 66 percent of the journals had zero disclosures of author personal financial interests. Nearly three fourths of journal editors surveyed usually publish author disclosure statements suggesting that low rates of personal financial disclosures are either a result of low rates of author financial interest in the subject matter of their publications or poor compliance by authors to the journals' COI policies.

Authorship↗
PubMed2005

Guidelines to the United Kingdom Disability Discrimination Act (DDA) 1995 and the Special Educational Needs and Disability Act (SENDA) 2001 with regard to nurse education and dyslexia.

This paper concerns the impact of disability legislation on nurse education, nurse educators and student nurses, in relation to academic work and clinical placement, with regard to dyslexia. The two United Kingdom acts considered are the Disability Discrimination Act (DDA), 1995 and the Special Educational Needs and Disability Act (SENDA), 2001, which is an amendment to the DDA. The paper examines and defines the main points of the acts, such as discrimination; less favourable treatment and its justification; reasonable adjustments; making adjustments in advance; disclosure and confidentiality requests; substantial disadvantage; current systems and regulations and concludes by raising issues which require clarification.

Certification↗
PubMed2002

Epilepsy--giving the diagnosis. A survey of British paediatric neurologists.

Adult-centred studies continue to show poor information provision and understanding in people with epilepsy. This study explores whether paediatric neurologists work within a consultation framework designed to meet information needs. A questionnaire on how to give the diagnosis was sent to 32 UK Paediatric Neurologists. Consultation content was largely determined intuitively rather than on a shared knowledge of the process involved. Little consensus was identified in relation to analogy and the usefulness or awareness of available unevaluated literature; but most acknowledged the value of a specialist epilepsy nurse. Most responses were based on a typical medical agenda but less than 20% addressed emotional responses and adaptation. Three approaches were identified-'pro-active' (running the risk of overload but recognising the right of parents to information), 'reactive' (more individually tailored, but assumes doctors can judge parental reactions) and 'drip-feed' (protective and pre-selecting topics to meet the situation). Our aim to establish a guideline proved impossible. Further study should develop more detailed models of the disclosure process, and identify epilepsy explanations that can be consumer-tested.

Adult↗
PubMed2000

Disclosure of developmental disability: a study of parent satisfaction and the determinants of satisfaction.

OBJECTIVE: To investigate the level of parent satisfaction with the first communication of a diagnosis of developmental disability in their child ('disclosure') and the determinants of this satisfaction. METHODOLOGY: Interviews with parents of children with developmental disabilities regarding their experiences at the time of disclosure and their level of satisfaction with the process were carried out. RESULTS: Parent satisfaction with disclosure overall was found to be high (82.6%). Parents were more likely to be satisfied if they received a large amount of information. Parent satisfaction was found to be higher when the disclosing professional communicates well with the parents, has an understanding of parental concerns, and is direct in manner. Having both parents, the child or support people present were not found to have any significant relationship to parent satisfaction. CONCLUSIONS: The high level of satisfaction with disclosure in this study supports the claim made by earlier researchers that parental dissatisfaction with the disclosure process is not inevitable. The major determinants of parental satisfaction with disclosure are directness, understanding of parental concerns and good communication on the part of the disclosing professional, and receiving a large amount of information.

Adult↗
PubMed2004

Families affected by HIV: parents' and children's characteristics and disclosure to the children.

The reduced risk of mother-to-child transmission due to improved HIV treatment has resulted in an increasing number of healthy children born to mothers living with HIV. The study's objective was to identify the number of parents or caregivers in a sample of persons living with HIV in Flanders, the number of HIV-affected children as well as specific family-related characteristics. Using a structured survey quantitative data were assessed on a total of 628 patients at three Flemish Aids reference centres. Qualitative data were collected in a small sub-sample of African caregivers living in Flanders. Twenty-seven per cent of the overall sample had children younger than 18 years, totalling 165 HIV-affected families with 279 children. Parents from developing countries had significantly more children than European parents. One hundred and eighty-two (68%) of all children were HIV-negative, while the HIV status of 75 (28%) was unknown. Disclosure rate was low: 26 (10%) children were aware of the parental HIV disease. The study shows that HIV-affected families have to deal with complex psychosocial issues such as migration, family illness, family secrecy around HIV and disclosure. Service implications are discussed.

Adaptation, Psychological↗
PubMed2006

Disclosure of HIV serostatus to sex partners: a new approach to measurement.

OBJECTIVE: The objective of this study was to assess measurement of full HIV serostatus disclosure (before sex), delayed disclosure (after sex), and no disclosure to both current and recent past (in the last year) sex partners. GOAL: The goal of this study was to propose a refined measure of HIV disclosure. STUDY DESIGN: This study consisted of a cross-sectional study using audio computer-assisted survey interviews with 63 persons with HIV/AIDS who reported on 145 sex partnerships. RESULTS: Considering all sex partners in the past year, full disclosure occurred in 54%, delayed disclosure in 22%, and no disclosure occurred in 24%. Delayed/no disclosure among all partners in the past year was substantially higher than standard measures of no disclosure among current partners only, 46% (95% confidence interval [CI], 38-54%) versus 12% (95% CI, 5-19%). No disclosure was more common in past partnerships than current partnerships (40% vs. 12%, P < 0.01). Predictors of disclosure included partnership characteristics of having an HIV-positive partner and being in a primary, heterosexual relationship. CONCLUSIONS: Standard measures may underestimate nondisclosure. Counseling and interventions that promote disclosure should include strategies for disclosure in ongoing relationships, assistance in notifying past partners, and a focus on partnership characteristics and dynamics.

Computer-Aided Design↗
PubMed1992

Paediatricians' practice in disclosure and follow-up of severe physical disability in young children.

Twenty-four paediatricians were asked about their policy and practice regarding disclosure and follow-up of the diagnosis of disability, and for suggestions to improve current practice. Doctors with less clinical experience were more likely to mention the presence of the child as an element of the disclosure interview, and scored higher than those with more experience on an index score of the format of the disclosure interview. Paediatricians' reported constraints on their preferred practice and findings from interviews with mothers in the same study confirmed continuing shortcomings in disclosure practice. Changes in medical training, the adoption of a written policy of good practice and the nomination of a 'key worker' for each family are suggested.

Child↗
PubMed2006

Uncertainty, responsibility, and the evolution of the physician/patient relationship.

The practice of evidence based medicine has changed the role of the physician from information dispenser to gatherer and analyser. Studies and controlled trials that may contain unknown errors, or uncertainties, are the primary sources for evidence based decisions in medicine. These sources may be corrupted by a number of means, such as inaccurate statistical analysis, statistical manipulation, population bias, or relevance to the patient in question. Regardless of whether any of these inaccuracies are apparent, the uncertainty of their presence in physician information should be disclosed to the patient. These uncertainties are not, however, shared by physicians with patients, and have caused a direct increase in patient responsibilities and mistrust. Only when disclosure of uncertainty becomes commonplace in medical practice will the physician/patient relationship evolve to a level of greater understanding and satisfaction for both the physician and patient.

Attitude of Health Personnel↗
PubMed2004

Therapeutic engagement styles of child sexual offenders in a group treatment program: a grounded theory study.

It is widely observed that child sexual offenders typically exhibit considerable reluctance to self-disclose at a level that reflects the full reality of their offending. Their successful engagement in relapse prevention-based programs is therefore problematic. This paper describes a study involving men undertaking a prototypical group treatment program, facing the challenge of revealing to others the details of their offense process. A procedure was developed to access their covert responses at the time of this encounter. From a grounded theory analysis, participants were found to employ various strategies to manage situations where self-disclosure was required. Four distinct disclosure management styles emerged: exploratory, oppositional, evasive, and placatory; the latter three of which appear unfavorable to effective engagement in treatment. As well as suggesting ways of influencing disclosure management style, analysis indicated that it might be possible to predict these different orientations during routine assessment.

Adult↗
PubMed1995

On being informed you are HIV positive: experiences of Navy service members.

This study addressed the experience of being told that one has become infected with the human immunodeficiency virus (HIV) while serving in the United States Navy. Responses to a questionnaire, administered to 150 HIV-positive service members, indicated that feelings of fear, shock, disbelief, and embarrassment were experienced by study participants upon learning of their HIV-positive status. The manner in which their HIV diagnosis was disclosed was generally viewed in favorable terms and more so in recent years relative to the earliest days of the Navy's HIV program. Having a medical officer as a disclosing official was associated with more negative experiences than was the case for other categories of disclosing officials. Lastly, post-disclosure events were often excessively stressful, and no improvement in this regard over 6 years of the Navy's HIV program was evident.

Adult↗
PubMed2005

Disclosure of HIV status and psychological well-being among Latino gay and bisexual men.

This study examined disclosure of HIV-positive serostatus by 301 Latino gay and bisexual men to members of their social networks and the mental health consequences of such disclosure. The sample was recruited from clinics, hospitals, and community agencies in New York City, Washington, DC, and Boston. Proportions disclosing differed depending on the target, with 85% having disclosed to closest friend, 78% to male main partner, 37% to mother, and 23% to father. Although there were differences depending on the target, disclosure was related to greater quality of social support, greater self-esteem, and lower levels of depression. Moreover, findings indicated that social support mediated the relationship between disclosure of serostatus and both self-esteem and depression. Thus, disclosure resulted in greater social support, which in turn had positive effects on psychological well-being. Findings demonstrate that generally Latino gay men are selective in choosing people to whom they disclose their serostatus and that disclosure tends to be associated with positive outcomes.

Adaptation, Psychological↗
PubMed2002

Voluntary disclosure of BRCA1 mutation test results.

This study assessed the probability that individuals tested for a BRCA1 gene mutation share their test results with family members, co-workers, and insurers. Members of a large kindred known to be at-risk for carrying a BRCA1 gene mutation were tested and they learned their results from a genetic counselor. During a follow-up interview, 4 months later, subjects were asked with whom they had shared their results. Respondents were most likely to have communicated results to family members, followed by co-workers, and insurers. Carrier status affected their willingness to disclose results to insurers. High rates of disclosure to family members should promote awareness of hereditary cancer risk. Selective disclosure to co-workers and insurers may promote information asymmetries that could affect employment and insurance markets.

Adult↗
PubMed1989

Warning third parties at risk of AIDS: APA's policy is a reasonable approach.

The author argues that the American Psychiatric Association's AIDS policy on confidentiality and disclosure provides reasonable guidelines for psychiatrists struggling to balance their obligation to maintain the confidentiality of individual patients infected with human immunodeficiency virus (HIV) with their obligation to protect the community's health. The policy states that notification of third parties who may be exposed to infection through the behavior of an HIV-positive patient is ethically permissible if the psychiatrist has exhausted efforts to work with the patient to terminate behavior that places others at risk and if the patient understands the limits of confidentiality. The author points out that judicious notification is within the medical tradition that includes disclosure of a patient's dangerousness in situations involving infectious diseases such as tuberculosis and is supported by the duty-to-warn precedent set by the Tarasoff decision.

Acquired Immunodeficiency Syndrome↗