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Results for “Truth Disclosure”

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PubMed1997

The relationship of homophobia to intimacy in heterosexual men.

Interpersonal intimacy is more difficult to achieve for American men than women. Research has shown that men disclose less, have fewer close friendships, and are viewed by their wives as low in intimacy. Among the barriers to intimacy among men, Tognoli (1980) suggested that homophobia is the most powerful. The present study tested this idea by asking men to disclose a personal secret to either a male confidant, a female confidante, or by writing the secret. It was expected that the presence of a male confidant would stimulate homophobic feelings and inhibit disclosure, while the other two conditions would result in more personal disclosure. A correlation between intimacy of disclosure and level of homophobia was also expected. Subjects were 75 heterosexual men, 31 to 50 years of age, randomly assigned to one of the three conditions. They also completed the Miller Social Intimacy Scale, the Jourard Self-Disclosure Questionnaire, the Index of Homophobia, and the Marlowe-Crowne Social Desirability Scale. Results showed that homophobia was inversely related to level of social intimacy. There was some indication that homophobia does relate to less intimate disclosure to other males. Thus this study found some support for the idea that homophobia is an obstacle to intimacy for men.

Adult↗
PubMed2004

Communicating with parents with full disclosure: a case of cloacal extrophy with genital ambiguity.

UNLABELLED: Full disclosure and complete involvement of parents in decisions concerning assignment of sex and genital surgery must be part of medical care for children presenting with findings consistent with disorders of intersex. Intersex most commonly involves disorders of steroidogenesis or gonadal function, but may include multiple cloacal anomalies, such as presented here. OBJECTIVE: To describe full disclosure of medical findings, by a multi-disciplinary medical team, as they became available over a period of weeks, in an infant originally assigned male, but eventually assigned female. PATIENT: An infant born at 24 weeks of gestation, after prenatal ultrasound showing distended bladder, ascites, and bilateral hydroureters, found to have an imperforate anus and a tubular structure appearing as a thin penis, without palpable corpora. DISCUSSION: Events concerning this case are discussed in relation to full disclosure of medical information to parents, guidelines for management of intersex, and the diagnosis (cloacal anomaly, cloacal extrophy, ano-rectal anomalies or uro-rectal septum malformation sequence). CONCLUSIONS: Full disclosure with involvement of parents with medical decisions is not only mandated currently, but also can be an effective approach in intersex care.

Cloaca↗
PubMed2004

Disclosure of Alzheimer's disease. Senior citizens' opinions.

OBJECTIVE: To determine the proportion of elderly people without dementia who would want disclosure of a diagnosis of Alzheimer's disease (AD), for themselves or for their spouses, and to verify whether the availability of medication would influence their decision. DESIGN: A cross-sectional survey with a semistructured questionnaire completed during face-to-face interviews. SETTING: Medical and surgical outpatient clinics in St Mary's Hospital Center. PARTICIPANTS: 204 subjects 65 years or older with at most mild cognitive impairment. MAIN OUTCOME MEASURES: Percentage of positive responses for disclosure of a diagnosis of AD to self or to spouse, with or without medication. RESULTS: Nearly all (98%) subjects wanted disclosure for themselves. Most (78%) wanted disclosure for their potentially afflicted spouses when medication was said to be unavailable. This proportion increased to 97%, however, if medication was available. CONCLUSION: Most participants requested honesty for themselves. Most wanted disclosure to a potentially affected spouse when medication is said to be available.

Aged↗
PubMed1998

[Diagnosis disclosure: the place of beneficence, autonomy and veracity in medical ethics].

OBJECTIVE: The moral doctrine of diagnosis disclosure is derived from a respect for the patient's autonomy as well as the patient's beneficence. These two goals are not necessarily incompatible, but they often lead to different decisions about what information needs to be shared with patients. The ethics of veracity does not prescribe duties, either old or new, but implies a new way of thinking about ethics. METHOD: Theories of the three general sorts just mentioned are identified and explained here. RESULTS: The ethics of veracity as such is limited to unmasking the falsifications of desire that inhabit the moral life. This would meet the moral goals of shared decision-making, because patients could make sense of such data. CONCLUSIONS: Certainly other moral doctrines may turn out to be relevant to the problems discussed in this paper. Nonetheless, they are sufficiently comprehensive to provide an analytical framework by means of which moral problems of diagnosis disclosure can be evaluated. We cannot expect anything else from the enterprise of the ethics of veracity but a critique of authenticity. Its force is that of suspicion, not justification or legitimation, and still less that of prescription.

Diagnosis↗
PubMed2004

Disclosure: what works now and what can work even better.

This three-part series on disclosure of unanticipated outcomes in health care is intended to provide an overview of the current thinking about disclosure and steps the organization can take to develop an approach to disclosure that is comprehensive and supportive of the needs of patients, families and providers. What should be apparent is that disclosure is not simply a requirement--it is a philosophy and part of a comprehensive approach to patient/family communication.

Cultural Diversity↗
PubMed2003

Relationship of psychological morbidity and quality of life to illness-related disclosure among HIV-infected persons.

OBJECTIVE: The aim of this study was to examine the relationship between HIV-related disclosure and quality of life, anxiety and depression among HIV-infected subjects in South India. METHODOLOGY: 68 subjects (35 men and 33 women) were assessed for quality of life and psychological morbidity using WHOQOL-BREF and the Hospital Anxiety and Depression Scale (HADS). Details of disclosure were collected using a semistructured interview. RESULTS: Certain disclosure-related variables appear to relate significantly with quality of life among HIV-infected persons. A positive outcome related to disclosure and extent to which a subject felt the need to disclose were significantly associated with higher scores on the total quality of life measure and in the social and environmental domains of the WHOQOL-BREF. No relationship was found between disclosure-related variables and psychological morbidity or other domains of quality of life. The type of disclosure (voluntary/without consent) did not appear to influence quality of life in this sample. CONCLUSION: Disclosure-related variables may have an important influence on QOL in the context of HIV infection in India.

Adolescent↗
PubMedDate not supplied

An analysis of allegations of sexual abuse in a multi-victim day-care center case.

Sexual abuse in day-care centers is a phenomenon of increasing concern, both in terms of its prevalence and its serious effects on child victims. Legal intervention in this area is problematic because criminal investigations are usually beset with difficulties: Characteristics of children and of the abuse situation affect disclosure rates and credibility. Research on children as witnesses is amassing; however, so far, little systematic analysis has been conducted on multi-victim child sexual abuse cases. The present study concerns a case of sexual abuse in a day-care center with over 100 alleged victims. Criteria derived from Statement Validity Analysis (SVA) protocols were applied to aggregate record review data to assess the veritability of the abuse allegations. Individual children's abuse disclosures were also analyzed, vis-à-vis characteristics of the children (age, gender, recency of attendance) and of the investigation (agency doing the interview, number of interviews, use of anatomically detailed dolls). The use of SVA criteria supported the veritability of allegations in this day-care abuse case. Even acknowledging the limitations of archival data collected for other purposes, the aggregate data analysis reflected consistency, logical structure, and spontaneity; however, little evidence of accommodation was found. Multivariate comparison of disclosing and nondisclosing children found an unexpected inverse relationship of disclosure with age, as well as positive associations with number of interviews and use of dolls. Alternative interpretations of these results are discussed.

Age Factors↗
PubMedDate not supplied

The disclosure of information to cancer patients and its relationship to their mental state in a consultation-liaison psychiatry setting in Japan.

In Japan, as in some other countries, not all cancer patients are informed of their diagnosis and expected prognosis. However, we do not know enough about the relationship between the kind of information given to cancer patients and their mental state. The following is a study that examines this relationship. The subjects were 81 adult cancer inpatients referred to psychiatrists. Those with mental disorders before admission or with delirium were excluded. The subjects were classified into three groups according to the kind of information given to them: 28 were not informed of a diagnosis of cancer, 36 were informed of a diagnosis of cancer, and 17 were informed of both a diagnosis of cancer and a poor prognosis. The distributions of DSM-IV Axis I diagnoses were nearly equal among the three groups of patients. In each group, more than 90% of patients were diagnosed as having either major depressive disorder or adjustment disorders. In the results of HAM-D, HAM-A, and a question about irritability, the mean total HAM-A scores and mean scores for the factors of Suicide, Behavior at Interview, and Irritability, differed significantly among the three groups. They were highest in patients who were not informed of a diagnosis of cancer. The authors discuss the nature of relationship between the disclosure of information and the mental state in cancer patients.

Adaptation, Psychological↗
PubMed1996

Disclosing misattributed paternity.

In 1994, the Committee on Assessing Genetic Risks of the Institute of Medicine published their recommendations regarding the ethical issues raised by advances in genetics. One of the Committee's recommendations was to inform women when test results revealed misattributed paternity, but not to disclose this information to the women's partners. The Committee's reason for withholding such information was that "genetic testing should not be used in ways that disrupt families". In this paper, I argue that the Committee's conclusion in favour of non-disclosure to the male partner is unethical. I argue that both parties ought to be informed.

Altruism↗
PubMed2005

Parental preferences for error disclosure, reporting, and legal action after medical error in the care of their children.

OBJECTIVE: No data exist on parental preferences for disclosure, reporting, and seeking legal action after errors in the care of their children are disclosed. This study examined parental preferences for error disclosure and reporting; responses to error disclosure; and preferences and responses by race/ethnicity, gender, age, and insurance. METHODS: A 4-scenario survey instrument portraying a range of medical error was provided to a convenience sample of parents who presented with children to an emergency department. Parents were asked to categorize the error, express preferences for disclosure and reporting, and then report how they expected to respond with and without disclosure. Basic demographics were collected also. Bivariate analyses of demographics were performed with Fisher's exact tests, analysis of scenario responses was performed with Somers' D, and the independent effects of the study variables were assessed with a generalized estimating equation. RESULTS: Research assistants approached 661 parents; 499 participated (75% response rate). Of all scenarios presented to the parents, they judged 54% of the scenarios as severe, 99% wanted disclosure, 39% wanted the error reported to a disciplinary body, and 36% were less likely to seek legal action if the error was disclosed by the physician. In multivariate modeling, severity was associated with desire for disclosure, reporting, and change in likelihood of legal action with disclosure. CONCLUSIONS: Regardless of severity, parents want to be informed of error. Educational interventions to improve error disclosure should emphasize the uniformity of parental preferences for disclosure, reporting, and the decreased likelihood of legal action when errors are disclosed than if discovered through other means.

Adult↗
PubMed1992

[Psychotherapy in child incest: the dangers of a psychic break].

There seems to be a consensus today by which a child, who is a victim of incest or sexually abused, must be directed to therapy in order that he or she provides a factual account of the traumatism and, by the same token, exorcises it. The authors deplore the widespread use of this destabilizing method. They emphasize that, for many children, recovery is achieved more successfully through "repression" (in the psychoanalytical sense of the term). After having obtained disclosure from the child, the authors argue that it is preferable for the intervenor to create the appropriate therapeutic conditions allowing the child to positively bury the event and move on with his or her life.

Child↗
PubMed1999

Helping children to the other side of silence: a study of the impact of the stay safe programme on Irish children's disclosures of sexual victimization.

OBJECTIVE: This study aimed to evaluate the effectiveness of a school based safety skills program--The Stay Safe Programme--in facilitating the disclosure of sexual abuse among sexually victimized children and adolescents in Dublin. METHOD: A Cohort of 145 children who had participated in the Stay Safe Programme prior to their referral to a sexual abuse assessment unit were compared with a cohort of 443 children who had not participated in the prevention program on a range of disclosure related variables abstracted from case notes. RESULTS: More Stay Safe participants, particularly female adolescents, made disclosures of suspected sexual abuse than non-participants. A higher rate of initial disclosure to teachers was made by Stay Safe participants and more teachers in schools participating in the Stay Safe Programme initiated referrals for evaluation of suspected child sexual abuse. Following assessment a higher rate of confirmed abuse occurred among Stay Safe participants and for these confirmed cases more Stay Safe participants made purposeful disclosures and in significantly more cases referral was due to the child telling someone about the abuse. These differences in disclosure between program participants and non-participants were unrelated to demographic factors or characteristics of the abuse. CONCLUSIONS: The Stay Safe Programme was an effective secondary prevention intervention deserving widespread implementation.

Adolescent↗
PubMed2005

Disclosure between patients with gastrointestinal cancer and their spouses.

This study examined patterns of disclosure about cancer-related concerns between patients with GI cancer and their spouses, and associations between patient and spouse disclosure and patient adjustment, spouse adjustment, and aspects of relationship functioning. A sample of 47 patients and 45 of their spouses completed a measure of disclosure which included ratings of their level of disclosure and level of holding back from disclosure of cancer-related concerns. Patients completed a measure of quality of life, spouses completed a measure of caregiver strain, and all participants completed measures of psychological distress and relationship functioning (intimacy, empathy, and partner avoidance and criticism). Data analyses revealed that patients and spouses reported moderately high levels of disclosure and low levels of holding back, with patients reporting higher levels of disclosure than spouses. Among patients and spouses, low levels of disclosure and high levels of holding back were associated with poorer relationship functioning. There were also some indications that high levels of holding back, and to a lesser extent low levels of disclosure, were associated with increased psychological distress for both patients and spouses. However, there were no indications that patient or spouse disclosure was harmful for the other person. Considered overall, the results of this study suggest that levels of disclosure between cancer patients and their spouses may be important in understanding how they adjust as a couple to the demands of the patient's illness.

Adaptation, Psychological↗
PubMed2005

How surgeons disclose medical errors to patients: a study using standardized patients.

BACKGROUND: Calls are increasing for physicians to disclose harmful medical errors to patients, but little is known about how physicians perform this challenging task. For surgeons, communication about errors is particularly important since surgical errors can have devastating consequences. Our objective was to explore how surgeons disclose medical errors using standardized patients. METHODS: Thirty academic surgeons participated in the study. Each surgeon discussed 2 of 3 error scenarios (wrong-side lumpectomy, retained surgical sponge, and hyperkalemia-induced arrhythmia) with standardized patients, yielding a total of 60 encounters. Each encounter was scored by using a scale developed to rate 5 communication elements of effective error disclosure. Half of the encounters took place face-to-face; the remainder occurred by videoconference. RESULTS: Surgeons were rated highest on their ability to explain the medical facts about the error (mean scores for the 3 scenarios ranged from 3.93 to 4.20; maximum possible score, 5). Surgeons used the word error or mistake in only 57% of disclosure conversations, took responsibility for the error in 65% of encounters, and offered a verbal apology in 47%. Surgeons acknowledged or validated patients' emotions in 55% of scenarios. Eight percent discussed how similar errors would be prevented, and 20% offered a second opinion or transfer of care to another surgeon. CONCLUSIONS: The patient safety movement calls for disclosure of medical errors, but significant gaps exist between how surgeons disclose errors and patient preferences. Programs should be developed to teach surgeons how to communicate more effectively with patients about errors.

Communication↗